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Fighting CAM – In Australia

by Steven Novella, Dec 12 2011

One thing that I notice when the issue of so-called complementary and alternative medicine (CAM, although some of my colleagues add the “s” from “so-called” to make is SCAM) is brought up in the media is that many misconceptions will be cited as fact, often by both sides, although far more by the pro-CAM side. CAM advocates seem to rely almost entirely on misconceptions and factual errors.

In Australia recently an ABC program aired that was highly critical of CAM, and now CAM advocates are firing back. The latest exchange was initiated by a group of 34 Australian physicians who are campaigning against pseudoscience in medicine. This is something that should not be controversial, but amazingly there is a large number of practitioners (although a minority) that stand  up to defend pseudoscience in medicine. They report:

Emeritus Professor of Medicine at the University of New South Wales John Dwyer says some courses previously offered at Southern Cross were more “magic” than science.
“We were off to a bad start with Southern Cross University when their founding Professor of Health and Nursing was teaching for years Healing Touch therapy; quite extraordinary nonsense.”

Good for him and his colleagues – we need more professionals who are not afraid to point out that the CAM emperor has no clothes.

Defending nonsense we have:

Professor Iain Graham from Southern Cross University’s School of Health yesterday defended his university, saying the use of alternative therapies, such as homeopathy, can be traced as far back as ancient Greece.

The Argument from Antiquity

I have to give the standard caveat that professor Graham may have been misquoted or misrepresented, but he was quoted making the same argument in a different piece as well. Taken at face value, we have a misstatement of fact combined with a logical fallacy. He probably (if I am being generous) did not mean to state that homeopathy can be traced back to ancient Greece, just that some CAM therapies can. Homeopathy was invented by Samuel Hahnemann about 200 years ago.

But I wonder what CAM modalities he had in mind. Chiropractic? About 100 years. Therapeutic touch? A few decades. Acupuncture is a complex question, but what passes for acupuncture today is less than 100 years old. Perhaps he was thinking about blood letting or trepanation.

It is true, however, that some basic concepts, like the notion of a life energy, can trace it roots to ancient Greece, and other ancient cultures. However, such notions are pre-scientific nonsense. Scientists abandoned the notion of life energy over a century ago because there is no evidence that such a force exists (and there still isn’t) and after figuring out all the basic processes of life there was essentially nothing left for the alleged life force to do.

For some reason, however, professor Graham believes that antiquity in science is a virtue – the “argument from antiquity” logical fallacy. The unstated assumption is that if an idea has survived for hundreds or thousands of years it must be legitimate. This is demonstrably false. Galenic medicine (blood letting, purging, etc. based on the notion of the four humours) survived for thousands of years, and yet it was based on complete an utter primitive nonsense. In fact its tendrils still exists – there is still blood letting, cupping (which is just another form of blood letting) and similar practices going on in the world. It was replaced in the West because of the advent of science in medicine – a trend that Graham apparently wants to reverse.

The Argument from Popularity

Graham’s second swing and a miss is this:

“Eighty per cent of Australians seek alternative therapies,” Prof Graham said.

“Obviously orthodox medicine is not working for everyone,” he said.

I highly doubt that the 80% figure is correct. Most such figures are highly inflated by including all sorts of practices in the CAM category, like exercise, eating organic food, and sometimes prayer is included. US surveys show the percentage of CAM use is around 1/3, but this is mostly things like massage and chiropractic manipulations. Homeopathy is around 3-4%, and acupuncture 6-7%. In fact, only manipulation and massage were in the double digits.

This is all marketing deception – create a false category (CAM), pad it out with commonly used methods, and then claim that the extreme fringes are therefore getting more popular. I don’t know how Graham got to 80% (I doubt such methods are that much more popular in Australia) but it is close to one survey from 2007 that found that 69% of Australians used one of the 17 most popular forms of CAM in the last year. However, they included in their list: martial arts, yoga, massage, meditation, and taking multivitamins. I am not sure what taking multivitamins says about the popularity of homeopathy, but apparently professor Graham thinks that is significant.

In any case – I will grant that CAM as a marketing concept has been somewhat successful, and even that it has gained popularity recently (although not as much as advocates would have you think). That is entirely irrelevant, however, to the question of whether or not any particular CAM modality is science-based and appropriate for a university curriculum (the question at hand).

Universities are supposed to be thought-leaders, to have intellectual standards that rise above the mere notion of popularity. They are supposed to uphold academic standards of scholarship, and in scientific disciplines of high standards in science. It is therefore very odd and disturbing to defend a university policy based upon popularity. Should we allow surveys of public opinion to determine whether or not we teach creationism or astrology in our universities?

Conclusion

These same two arguments keep coming up in the defense of CAM, despite the fact that they are factually dubious and logically fallacious. That, however, is the nature of CAM – it is an intellectually dubious enterprise. We need more professionals like John Dwyer who are not afraid to say so.

In the comments to the above article another very common CAM canard was presented. Commenter “shotinfo” wrote:

According to articles published in both the British Medical Journal and the New England Journal of Medicine, between 85% and 90% of all mainstream medical drugs and procedures have never been scientifically proven to either work or be effective.

I love the fake references – of course no such articles in BMJ or NEJM exist, and no references were offered, but it certainly makes the fake factoid sound legitimate. I have already discussed this issue in detail. The bottom line is that surveys of medical practice find that about 78% of them are reasonably evidence-based. Yet again we have a factual misstatement used to support a logical fallacy (tu quoque). All medical practice should strive to be more science and evidence-based. Pointing out the deficiencies in one discipline does not justify deficiencies in another.

The commenter, however, also misses the real point of criticism of CAM. Mainstream medicine is based upon a culture and institution of science, and a science-based standard of care. The execution of this standard is flawed, but the principle is clear. CAM is not based on a science-based standard. It, in fact, seeks to subvert and even remove the science-based standard of care. And CAM proponents live in a culture of pseudoscience, not legitimate science.

We need to keep pointing this out – and the defenders of CAM will keep making our point for us by quoting the same factual errors and logical fallacies over and over again.

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29 Responses to “Fighting CAM – In Australia”

  1. Old Rockin' Dave says:

    It takes no big stretch to make the new acronym. Just keep calling it “So-Called Alternative Medicine (SCAM)”. If a few people in the right places start doing it, it will catch on.

  2. Janet Camp says:

    Mark Crislip, MD, calls it S(Supplements), CAM.

    I would only note that the argument that science has found no evidence of a “life force”, does little to convince true believing SCAMmers. They simply reply that that will come in time as science “advances” and that “quantum theory has already begun to do so”.

    I realize that you are trying to reach “shruggies” more so than the religiously devout practitioners, but sadly, I keep running into the latter.

    • Wrong says:

      There’s a problem with the supplement being included, since some supplements are actually necessary, evidentiary, and prescribed as actual medicine by doctors. If someone has say, an iron deficiency, such as anaemia, they need supplementary iron. That’s not to say that all supplements are good, but it’s disingenuous to state that they are all bad.

  3. tmac57 says:

    Some more ‘justifications’ for CAM:

    1.Science doesn’t know everything,therefore CAM works!

    B.My aunt had a neighbor who’s daughter’s mother had a very serious thing that her doctor said would kill her in 2 days,but she was completely cured by her homeopathic rekei master.

    III. We know that X treatment is implausible,and probably has no clinical effect,but if it makes people ‘feel’ better,what’s the harm?

  4. Phea says:

    They could also bump up that inflated percentage by including everyone who says, “bless you”, after someone sneezes.

  5. CountryGirl says:

    SCAM is the poison pill that will destroy public health care and open market health care insurance. There is no upper limit on how much fake care is required to make a person better. There is a second factor in this that will complete the perfect storm and that is health problems that are either not real or might be real and cannot realistically be treated. Once science based medicine tells you that your problem is psychosomatic and they cannot/will not treat it I can assure you that SCAM will treat it no matter how much it costs. The end result will be runaway costs and a general degradation in science based health care as a result of less money to spend on real illnesses.

  6. Renegade Saint says:

    So, I assume Professor Iain Graham believes creationism should be taught at the university level too? It’s really old and popular!

  7. Other Paul says:

    Appealing to logic to those who call it “your science” and “your logic” strikes me as a complete waste of time and effort.

  8. AUSTRALIA, 6th DECEMBER 2011:

    “DOZENS of senior primary healthcare figures have written to Central Queensland University (CQU) accusing it of “legitimising anti-science” and giving “unacceptable practices an undeserved imprimatur” by starting a chiropractic course next year…”

    Source:
    http://webcache.googleusercontent.com/search?q=cache:9_-4-pKRpQAJ:www.medicalobserver.com.au/news/uni-censured-on-antiscience

  9. John K. says:

    I am glad there are people who have the patience to wade through such <a href="http://rationalwiki.org/wiki/Fractal_wrongness&quot; fractal wrongness. Even if all the premises were true they don’t support the conclusion and most of the premises are incorrect anyway. Good grief.

  10. John K. says:

    Doh, HTML fail. My apologies.

  11. Richard says:

    I have always been impressed with David Coquhon’s (sorry if misspelled) technique of sending sillibuses of CAM courses to college deans, showing these skeptical academics how magical and ridiculous these systems are. I think many Americans are skeptical enough to listen to similar exposures of CAM’s magic.

  12. Max says:

    I prefer the term “Appeal to Tradition” or “Argument from Longevity” over “Argument from Antiquity”, because it doesn’t say, “X was done 2000 years ago,” but rather, “X has been done for the last 2000 years.” See the difference?

    Is the percentage of true ideas that survived thousands of years greater than the percentage of false ideas that survived that long? I don’t know, but if so, then longevity shifts the odds in favor of the idea being true.

    • tmac57 says:

      The usefulness of an idea to separate a person from their money,may likely survive through the ages as well.

    • Max says:

      It’s reasonable to assume that a true idea is more likely to survive thousands of years than a false one, but I don’t think that’s equivalent to comparing what percent of all ideas, past and present, had survived thousands of years. It depends on the birth and death rates of true and false ideas.

      • Max says:

        Sorry, I should’ve said, “I don’t think that’s equivalent to comparing what percent of current true and false ideas had survived thousands of years.”

    • Phea says:

      To just discuss ideas, out of context, as being true or false, or good or bad, can be tricky. Take the idea of slavery. We, for the most part view it as a bad idea nowadays, when in the past it might very well have been a good, humane alternative to genocide. It might be wiser to consider why an idea has lasted for a long time along with it’s current, and past validity.

      • Max says:

        My point here is that informal logical fallacies might not be fallacies if you think in terms of probabilities.

      • Wrong says:

        For deductive reasoning they are. For inferential logic and inductive claims, they may be valid claims to establish a likelihood, but that doesn’t give them certainty. And if we were to look at the concept of false ideas dying out, we still live in a largely religious world, do we not?

  13. Kenn says:

    Anyone have a reference (link) regarding the validity of dietary supplements?

  14. James says:

    Q: What do you call alternative medicine that works?
    A: Medicine.

    :)

  15. Kenn says:

    thanks. very helpful.

  16. Ed Brown says:

    “In the comments to the above article another very common CAM canard was presented. Commenter “shotinfo” wrote”

    I do believe that ‘shotinfo’ is the username Meryl Dorey (from the anti-vax Australian Vaccination Network) often uses online. Doesn’t surprise me to see her butting in with her usual nonsense.

  17. Guy McCardle says:

    As long as organizations like NCCAM are funded by the US government I feel our international credibility as skeptics takes somewhat of a hit. Our own government is funding sheer nonsense. The very existence of the NCCAM can be seen as legitimizing the entire concept of CAM.

    –Guy
    The Inconvenient Truth

    • Max says:

      What’s wrong with NCCAM? Its very mission to define the usefulness and safety of CAM, or the way it executes its mission?

  18. Rod Ferguson says:

    No life-force, is that why there seems to be so many zombies out there?

    Qi or Chi = life-force / energy – a concept thousands of years old and still achieving results

    Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems.

    http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/May/The-health-benefits-of-tai-chi

    Its not magic there is an investment and practice required to gain benefits – its not a panacea – follow the advice of your professional medical advisor

    We teach Tai Chi focusing on healthy aging, relaxation therapy and appropriate intensity of exercise for the individual

    Exercise as medicine is gaining momentum check physiotherapists, check BJSM’s Karim Khan and many more you find the references

    Regards

    https://twitter.com/#!/TaiChiVideos

    • Syd Foster says:

      If you talked about the benefits of exercise and meditation, fine… why bring in the mystical idea of qi? That panders to people’s desire for magic, when there is simply no evidence for it… you degrade your practice by bringing in magic.

      I wasn’t impressed by the article on the Harvard website. The results were all improvement in balance and mobility etc, just as you would expect from practicing a physical skill such as tai chi movements. Ascribing these results (in such small samples as well!) to some mysterious action of qi is disingenuous, and premature. Harvard is obviously not very rigorous in evaluating faddy health benefits before promulgating them as if they were proven. The mere fact they explain all the qi and yin yang concepts in such a wishy washy fashion (“qi is thought to circulate”) shows they know it’s hogwash, but they reckon it’s harmless, and they want toilet their readers feel good about it. That kind of pandering to feel good nonsense legitimises more extreme inroads into science-based understanding. Experts should be strong in their speech, they should set a firm and clear-headed example, so that laypeople don’t get confused, and become vulnerable at some point to exploitation by “mystery” pedlars.

  19. Heath says:

    A big issue with reports on CAM in Australian media is the false balance a lot of stories receive. I’m still seeing a current affair stories all the time with a doctor given equal time to some looney waving their hands about and the lazy “you decide” conclusion at the end.

    An Aussie prime time program did an “expose” on dodgy psychics last week, which looked promising, but to my bafflement still gave air time to a “real psychic” who muddled through a guide to “spot the difference between reals and fakes” – to which a friend of mine followed up with “I don’t believe in clairvoyants but mediums are real, right?” *massive facepalm*

    I just don’t understand why many in the media seem so reluctant to just call these people on the evidence and conclude that consumers should avoid them. I mean they seem perfectly happy to come to that conclusion when they do a story about dodgy butchers or credit card scams – what’s the difference?!