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Why science in medicine needs all the friends it can get…

The Friends of Science in Medicine is a loose collaboration of doctors and other scientists and concerned citizens who have chosen to speak out on the topic of where science belongs in medicine, and where pseudoscience belongs in society. Much of that discussion has taken place on this very website.

It seems odd that the role of scientific understanding in medicine should even need to be defended, given the extraordinary progress that has been made in the last century with medical technology. The scientific approach to the study of medicine has given more benefit to humanity in the last two centuries than any other form of health knowledge in the last two millenia. Perhaps scientific medicine is a victim of its own success at some level.

Galileo remarked in the 1600s that the goal of science is not to open the door to ultimate wisdom but rather to set limits upon infinite error.There are a million and one ways to be wrong about the human body and the ways that it functions. There are only a few ways to be right. The precise demands of human physiology are remarkably invariable from one human to another, because there are only a handful of ways to defy the improbable odds of being able to maintain existence in this hostile universe. Let alone be self-aware and morally good on top of that! The more detailed the knowledge that science gives us about biology, the more it constrains the possibilities of other proposed states of being in the universe. Homeopathy, Qi life energy, biofield energies, chiropractic subluxations, phrenological bumps and the four humours are just a handful of examples of ways to be wrong about the body that have not been compatible with the rapidly evolving body of scientific biology.

Accumulating facts is not good enough to be scientific, however. As the French mathematician Henri Poincare pointed out

Science is facts; just as houses are made of stones, so is science made of facts; but a pile of stones is not a house and a collection of facts is not necessarily science.

A scientific approach generates facts into hypotheses, which are then tested rigorously and discarded if they fail. A pleasing ideological worldview is no substitute for being able to very closely approximate objective reality. For the science-based health practitioner, a cherished therapy will be ruthlessly jettisoned no matter how painfully if the evidence demands the sacrifice. For most doctors this happens every couple of years throughout their career. I can think of several treatments within my own speciality of Pain Medicine which I have stopped using in the last couple of years, and I expect that in five years I will be treating chronic pain patients differently to the way I do now. I can quote at length the strengths and weaknesses of the evidence supporting all the therapies I currently ask my patients to agree to, and I wouldn’t expect them to settle for less than that. I’m not sure yet which parts of what I currently accept as fairly true will have to be junked in the face of better research, but I can’t wait to find out.

Having an organisation like FSM to kick-start a public debate about the value of science in healthcare is invaluable. The science-based health care community has not done very well in the last couple of decades at sharing with the public at large the excitement, frustration and genuine hope of doing real science. We have not explained as well as we perhaps could have why the scientific approach is not perfect, but better than every other system we’ve tried to date. One of the greatest strengths of science is its unselfishness, and its honesty. Self-examination and self-correction is built into the system. We know that the things we have discovered by a disciplined adherence to scientific principles will always be right until something better comes along. The ideas of clinical trials for medications and quarantine for infectious diseases have been around since the great medieval Arab physician Ibn Rushd and are no less correct now than they have always been. In science-based medicine, once you’re right, you stay right. That doesn’t mean we can’t learn something by trying to prove you wrong.

Pseudoscience is fundamentally sterile and unproductive, based more on charismatic personalities, unchanging eternal ‘truths’ and unreliable anecdotes. I have a patient whose back pain was fixed by falling down some stairs while dropping her grand-daughter off at playgroup. That doesn’t mean I have started shoving my other patients down the steps to fix them. It’s just an interesting yarn. DD Palmer started chiropractic based on a similarly improbable cure. Ignaz von Pelczy did the same in starting iridology. No useful research breakthroughs have changed the fate of humanity from either field since.

So to the extent that FSM can get the media and the general public thinking about how much they might value science as opposed to pseudoscience in their healthcare it can only be a good thing. That’s why I stopped sitting on the sidelines of the debate and signed up when I found out about them.

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27 Comments sorted by

  1. Dale Bloom

    Analyst

    The country cannot afford the present health system, or if the finances of the country decline, the money going to the health system will have to be reduced. All points towards preventative medicine as the most cost effective way to manage the country’s health.

    So, how does anyone know what is scientific preventative health, and what is pseudoscience in the preventative health area?

    For example, how does someone know if it is better to walk for exercise, or use an aerobics machine they bought on sale from a shop?

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    1. Citizen SG

      Citizen

      In reply to Dale Bloom

      I'm not a health researcher,but...
      you could establish a trial between each cohort and a control and compare all four results, you could compare the two cohorts against a a control and compare results, or you could extrapolate a reasonable position from available evidence. I imagine a trial would take some time to establish an accurate answer to your question. My opinion is that it's probably not a function of the exercise equipment that would lead to better health outcomes but more a consequence…

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    2. Dale Bloom

      Analyst

      In reply to Citizen SG

      I don’t know about that. I have heard from a physiotherapist that many pieces of aerobic equipment commonly sold in shops can be harmful as they cause repetitive strain injury. Common exercises such as sit ups also don’t support the back and can cause back injury.

      There are also a plethora of “healthy diets” in magazines, but these diets appear next to “chocolate cake pudding” type recipes, or appear next to advertisements for the latest facial creams and cleansers. It does seem preventative medicine is the answer in the longer term, but it has to be the correct preventative medicine, and a lot of things that are advertised as being healthy may not actually be healthy.

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    3. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Dale Bloom

      That's a fair comment about preventive medicine Dale. It has been a policy of successive Federal governments of both sides of politics to try to increase spending on preventive health given that it must certainly be a good long term investment. This has led to a burgeoning fitness industry with examples of both sound and unsound science. There are excellent discussion of food-related misinformation elsewhere on this very site, especially the series about the obesity epidemic.

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  2. Citizen SG

    Citizen

    Michael,
    Great article. Getting this reasoned message into the mainstream appears to be difficult. I wonder how many journalists view this site...

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Citizen SG

      Agreed, Sean. But perhaps "what we have been doing is mainly pretty much right, and nearly everyone agrees" doesn't make great headlines...

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    2. Citizen SG

      Citizen

      In reply to Sue Ieraci

      True... Medical disasters and wonder cures sells newspapers I suppose.

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  3. steve jenkin

    logged in via LinkedIn

    Michael,
    A well written piece.

    This is your entry in the FoSiM Members list of 3-March-2012.

    Dr Michael Vagg MBBS(Hons) FAFRM(RACP) FFPMANZCA, Consultant in Rehabilitation and Pain Medicine, Barwon Health. Clinical Senior Lecturer, Deakin University School of Medicine. Fellow, Institute for Science in Medicine

    I note as well you've written about Chiropractic for the sponsoring group of FoSiM, Australian Skeptics.

    I' have to agree with you "Science is Facts', so I wonder what's going on here that authors and commenters leave out facts central to this discussion.

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    1. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to steve jenkin

      Steve

      I'm aware of my entry on the FSM members list, I sent it in. My other biographical details are also on my bio here at The Conversation. My article for The Skeptic magazine was an analysis of the split within the chiropractic profession between progressive, science-based chiros and old-school subluxation believers. It is entirely consistent with my reasoning above, in that I support and welcome moves from within chiropractic to put the discipline on a more scientific footing. Unfortunately the science-based chiropractors are not in the political ascendancy at the moment, which to me is disappointing. I'm not sure exactly how that invalidates any of the piece above.

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    2. steve jenkin

      logged in via LinkedIn

      In reply to Michael Vagg

      Michael,

      You're right, acknowledging that you are a member of the organisation you're discussing does not invalidate anything you've written. I wasn't aware of the content of the Chiro article, only its title. Thanks for that.

      I'm disturbed in this on-going debate that people write articles and comments without acknowledging their biases and sometimes interests. As a reader, it influences what importance I give to the material. I've become very sensitive (in this debate) to what for me is rampant abuse of this (no ack. of interest).

      It's an important debate and one that wouldn't be happening without people like you being prepared to both contribute and to "speak your truth" [hippy phrase :-(]. Vibrant democracies need lively debate without fear.

      Thanks for your prompt and tolerant response. Less Heat and more Light is most welcome.
      And thanks very much for your contributions on this site - as I said first off: a well written piece.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to steve jenkin

      I agree with Steve here. Yes, the bios are more detailed, but they are not presented adjacent to the essays.

      Just like those people who write in favour of alternative therapies should declare openly that they are practising naturopaths (or whatever) someone writing specifically in favour of an organisation should declare their membership. I don't see that it detracts from the message at all - with which I strongly agree.

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  4. Alan Shiell

    CEO Centre of Excellence in Intervention and Prevention Science

    Whole-heartedly support the argument in favour of science. CEIPS has a role in elevating the science underpinning prevention. Thus, while I agree with the central point, I can't let the assertion that "The scientific approach to the study of medicine has given more benefit to humanity in the last two centuries than any other form of health knowledge in the last two millenia." ... unless of course by 'study of medicine' you mean all health and social sciences. Big impacts on health and well-being…

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    1. Marcello Costa

      Professor of Neurophysiology, Department of Physiology at Flinders University

      In reply to Alan Shiell

      Good point Alan, but all what you still happened under the umbrella of 'scientific' (read rational) attitude to life. Medical science is embedded and mutually dependent on all other sciences.

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    2. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Alan Shiell

      How did we know that stopping smoking would reduce disease if not for medical science demonstrating the health effects of smoking and medical scientists pushing (along with others once the health effects were clear) for legislation.

      Clean water is a direct effect of basic medical science (the germ theory of disease on epidemiology ala John Snow and basic science understanding understanding of how to treat water supplies). Improvements in air quality are a direct effect of basic science research…

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    3. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Alan Shiell

      Agree with both Alan and Marcello. Public health and health promotion have always been dependent on the political and social milieu. But it's no help having effective delivery of useless initiatives, and being scientific about what to deliver relies on good basic and clinical research.

      I do generally use the term 'medicine' to include all science-based health activities, because knowledge about health and disease is by no means the exclusive preserve of doctors.

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  5. Sui Generis

    logged in via Facebook

    Why is it that psychiatry is not listed among pseudo-science?

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    1. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Sui Generis

      This is an interesting point of view which deserves a fuller exploration. I will expand in a future column, particularly as DSM V approaches release.

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  6. Alan Schmukler

    Homeopath

    There are two misrepresentations here. The first is that conventional medicine is scientific and based on scientific research. Virtually all drug research is carried out by Pharmaceutical companies which have a vested interest and have lied about their results repeatedly. They control the variables, the method, what gets published and who reviews it. If objective research conflicts with profits, it is ignored or buried. Witness the study by Irving Kirsch some years ago, clearly demonstrating that…

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    1. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Alan Schmukler

      The Swiss study was a rigged review by homeopathy proponents using out of date data. See http://www.randi.org/site/index.php/swift-blog/1628-the-swiss-endorse-homeopathy.html
      2005 Review "This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects."
      http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=16125589
      2010 Review "The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo."
      http://www.ncbi.nlm.nih.gov/pubmed/20402610

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    2. Laurie Willberg

      Journalist

      In reply to Ian Musgrave

      It's very telling that you'd quote the website of the leading American pseudoskeptic James Randi, a retired stage magician with no academic credentials, as being an authority on Homeopathy... That you'd parrot a complete fabrication that a legitimate meta-analysis was "rigged by homeopathy proponents" from a disreputable rumour mill is dismissable nonsense.
      The Swiss study discredits the 2005 review you're referring to as being completely unreliable.
      As far as placebo effects are concerned, this…

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    3. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Laurie Willberg

      I always find that the 'appeal to thalidomide' is the last desperate canard of those who haven't followed the rest of the argument. Laurie, you accuse myself and others of being an astro-turf for the pharma industry, but I submit that this only seems logical to those who think that money is the only motivation for anybody to do anything. If you want to look for that sort of thing you should look at how the pharma companies really spend their astro-turfing dollars, ie on some patient-support groups…

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    4. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Alan Schmukler

      Alan

      I actually don't care if the Swiss government wants to waste its health budget on implausible therapies.

      I think your use of the term 'misrepresentation' must surely be ironic, given what follows.

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    5. jerry sprom

      logged in via email @gmail.com

      In reply to Michael Vagg

      Michael,

      If FSM is concerned with the quality of health care in Australia, why are they campaigning to have chiropractic removed from universities? also, how will decreasing the quality and educational standards of CAM courses, chiropractic in particular, by removing them from universities help to reduce the real and potential harm or CAM?

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    6. Laurie Willberg

      Journalist

      In reply to Michael Vagg

      This recent article from the Journal of Orthomolecular Medicine says it all:
      http://orthomolecular.org/resources/omns/v08n11.shtml
      What FSM is campaigning for is based on "Selective" EBM, which just holds up the old addage that there are
      Lies, Damn Lies and Statistics.
      The fact that FSM is getting funding from "skeptic" organizations with a well-worn antipathy towards CAM shows that it is just part and parcel of an orchestrated PR campaign that ultimately benefits the pharmaceutical industry.

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    7. jerry sprom

      logged in via email @gmail.com

      In reply to Ian Musgrave

      Ian,
      Perhaps you could encourage FSM to clarify this on their website. As it just simply states 'chiropractic'. No distinction between what they think is the 'pseudo-scientific' parts and the 'scientific' parts.

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