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Debating Homeopathy Part I

by Steven Novella, Mar 25 2013

Six years ago I was asked to participate in a group debate over the legitimacy of homeopathy at the University of CT (there were six speakers, three on each side). This year I was asked to participate in another homeopathy debate at UCONN, but this time one-on-one with Andre Saine ND from the Canadian Academy of Homeopathy taking the pro-homeopathy side. (I will provide a link when the video is posted online.)

While the basic facts of homeopathy have not changed in the past six years, the details and some of the specific arguments of the homeopaths have evolved, so it was good to get updated on what they are saying today. In this post I will discuss some overall patterns in the logic used to defend homeopathy and then discuss the debate over plausibility. In tomorrow’s post I will then discuss the clinical evidence, with some final overall analysis.

Believers and Skeptics

As with the last debate, the audience this time was packed with homeopaths and homeopathy proponents. When I was introduced as the president of the New England Skeptical Society, in fact, laughter erupted from the audience. But that’s alright – I like a challenge. It did not surprise me that the audience, and my opponent, were unfamiliar with basic skeptical principles. Andre, in fact, used the word “skeptic” as a pejorative throughout his presentation.

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The Marshmallow Test

by Steven Novella, Mar 18 2013

The human brain is perhaps the most complex machine that we have investigated, especially the higher cognitive functions. Psychologists have been working for decades to untangle the complex set of genetic, neurological, environmental, and situational factors that ultimately result in human behavior, with a great deal of success.

There are a few standouts – seminal experiments that not only demonstrate something interesting about human nature, but also create an entire paradigm of psychological studies that other researcher replicate with various modifications. One such such is the marshmallow test, first conducted by a team lead by Walter Mischel then at Stanford University.

The first series of such studies Mischel published in 1972 took a group of preschoolers and offered them their choice of three rewards: a cookie, a pretzel, or a marshmallow. The researcher then told the children that they could eat their treat whenever they want, but if they hold off the researcher would return with an additional treat. The study was a test of self-control and the ability to delay gratification.

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Revenge of the Woo

by Steven Novella, Mar 11 2013

Sometimes the targets of our skeptical analysis notice, and they usually are not pleased with the attention.

Last year the Acupuncture Trialists Collaboration published a meta-analysis of acupuncture trials in which they claim, “The results favoured acupuncture.” The report was widely criticized among those of use who pay attention to such things. In my analysis I focused on the conclusions that the authors drew, rather than their methods, while others also had concerns about the methods used.

The authors did not appreciate the criticism and went as far as to publish a response, in which they grossly mischaracterize their critics and manage to completely avoid the substance of our criticism.

To review, the original meta-analysis concluded:

Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

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CAM Practitioners as Primary Care Doctors

by Steven Novella, Mar 04 2013

Chiropractors and naturopaths would like to be your primary care physician. They are tirelessly lobbying to expand their scope of practice, with the goal of achieving full parity with actual physicians. This would be an unmitigated disaster, for reasons I will detail below.

Oregon is setting up coordinated care organizations to help promote improved care at reduced cost. The idea sounds plausible and is a good experiment in how to reduce health care costs. The idea is to set up local groups of health practitioners who work in a coordinated way to take care of the local population, including physical and mental health, with dental health on the way. These CCOs would focus on preventive care with the goal of reducing illness and ER visits.

With any new health care initiative (including Obamacare, and this CCO initiative) so-called complementary and alternative medicine (CAM) practitioners see them as an opportunity to expand their power, reach, and scope. Unfortunately they have been largely successful – they know how to talk to both ends of the political spectrum, and the relevant science seems to get lost or distorted in all the propaganda.

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Moving Forward

by Steven Novella, Feb 25 2013

As movements grow, internal conflict becomes inevitable. A movement dedicated to reason, thoughtful introspection, and putting logic above emotion, one would think, should be able to deal with such conflict in a constructive way. If the events of the last couple of years have taught us anything, however, it is that we are all still biased and flawed humans, despite our striving for reason.

There is, perhaps, some sign of a light at the end of the tunnel, if you bear with me for a bit more preamble.

I have not been a direct participant in the recent drama over sexism in the movement, but I have had a front row seat. It has struck me throughout that many of the people involved, steeped in critical thinking, firmly believe they are correct and are being reasonable and yet are in such heated conflict with other critical thinkers who also believe they are correct and being reasonable.

There are, it seems to me, three general sources of this conflict. One is sincere and real ideological differences. If you read the recent exchange between Harriet Hall on SBM and Will on Skepchick, and a sample of the comments to each, these differences become apparent. Where exactly to draw the line between free speech and the avoidance of offense is one recurrent theme. Still, this by itself should not be enough to cause such a rift, for our common ground dwarfs these differences.

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GM Crops Overregulated?

by Steven Novella, Feb 18 2013

Genetically modified (GM) crops are the target of significant worldwide controversy, to the greatest extent in Europe but also in the US and elsewhere. Are the concerns over GM crops justified by the science? What is the proper balance between the precautionary principle and making potentially improved crops available to a hungry world?

GM “golden rice” – rice genetically modified to produce beta carotene, a form of Vitamin A, is set to be introduced in the Philippines, creating another round of debate on this issue.

Crops have been genetically modified to resist pests or herbicide, to thrive in adverse environmental conditions (cold, drought), and to enhance nutrition. At present GM crops are highly regulated, with proponents arguing that the regulation is too strict while GM opponents argue that they are too lax. Still others argue for a case-by-case assessment of each GM product, which seems to me to be the most sensible approach.

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The Evolution of Feathers

by Steven Novella, Feb 11 2013

As a follow up to my post last week on feathered dinosaurs, I received this question over e-mail:

How would a creature get feathers in the first place? I figure there would be some intermediary stages between no feathers and fully feathered, but what would these stages possibly be? No other family of species seems to have anything remotely like feathers. Also, what would be the evolutionary advantage of having feathers be specially since the dinosaurs discovered in China were flightless and (to the best of my knowledge) flying dinosaurs like the pterodactyl were already featherless. Any light you could shed would be appreciated.

The e-mail comes from someone who accepts evolution (not a denier), but is genuinely confused about the above questions. This is an excellent question, one that Darwin himself confronted. This also remains one of the common denialist tactics of the creationists, despite the fact that Darwin gave a very cogent answer in Origin of the Species.

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DSM-V – Mental Illness vs Normal Behavior

by Steven Novella, Feb 04 2013

The coming fifth edition of the Diagnostic and Statistical Manual (DSM-V) has rekindled debate over the legitimacy of the very concept of “mental illness.” A recent article by Peter Kinderman, a professor of clinical psychology, takes a strong position against the “mental illness” approach, writing:

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

This is a healthy debate to have, as the concepts involved are tricky and there are real implications for societal perception, insurance coverage, and treatment strategies. I do not, however, share Dr. Kinderman’s position, which in my experience is fairly typical for a clinical psychologist. He is essentially saying that his profession’s approach to the question of mental illness is superior to the psychiatric profession. While the debate is legitimate and important, I can’t help feeling that there is a major component of a turf battle here also.

The question is essentially how we should think about symptoms of mood, thought, and behavior. At one extreme we night consider all aspects of human mentality as being part of the normal spectrum, with differences being just that – differences. Those who follow the position of Thomas Szasz consider labels on mental differences to be largely politically and culturally motivated forms of repression.

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Up-Goer Five and Science Communication

by Steven Novella, Jan 28 2013

Do you think you could communicate a scientific concept to a general audience using only the 1,000 most commonly used words? A thousand words sounds like a lot, but is it? Clearly this would not allow for the use of specialized scientific jargon, which is the point. A good science communicator should be able to translate complex science into everyday language, and use accessible analogies to make those concepts understandable.

This is something I do everyday, and not just on my blog and other social media. As a physician I have to communicate sometimes complex medical information to patients and their families. To make things more challenging my patients vary from being other physicians, health care workers, scientists or academics, to lacking a high school education or even not being a native English speaker.

Communicating to the public effectively means targeting a broad range of background knowledge. An effective science communicator should be interesting to experts while being understandable to a novice. Another challenge is to make scientific concepts simple without being oversimplified.

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Lead and Crime

by Steven Novella, Jan 14 2013

A recent article in Mother Jones discusses the potential role of lead in the increase in crime from the 1960s to the early 1990s, and the subsequent steady decline in crime rates since then. I have received numerous questions about this article and this possible connection between lead and crime. It is a well-written article, and an interesting question. Could one toxin really be responsible, among all the other possible causes, of the rise and fall in crime rates in the US?

Before we get to that, it’s interesting that this is not the first time in history this question has come up. There is a theory that the fall of Rome was due, in part, to chronic lead toxicity. The Romans used lead to make their water pipes (the origin of the word “plumber” as the root “plumb” refers to lead). But this was probably not the most significant source of lead for the Roman aristocracy, who also sweetened their wine and some of their food deliberately with lead. Analysis of lead levels in bones of burials from the time do show variable but often elevated lead levels, but the data is too scant to draw any firm conclusions.

They apparently knew of the toxic effects of lead, but thought that this was limited to acute lead toxicity – something that slave lead miners had to worry about, but not citizens. They did not think that low level chronic exposure was a risk, and apparently they were wrong.

However – there are problems with this nice story. Some scholars doubt that lead poisoning was as endemic in Rome as others claim. The evidence is complex. Lead was probably not added deliberately to wine, but wine was occasionally heated in lead containers. Terra cotta pipes were often used instead of lead for carrying water specifically because the risk of too many lead pipes was understood. And contemporary references in medical and veterinary writing make scant mention of lead poisoning, even though the syndrome was well recognized.

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