Complementary and alternative medicine Medicine

The writer of the U.S. News & World Report study on the infiltration of CAM into academia argues from ignorance

I’m a little late on this, but Avery Comarow, the reporter who wrote the big story three weeks ago in U.S. News & World Report about the infiltration of woo into academic medicine, has responded to criticisms of his column in his blog.

His response, I’m afraid, is underwhelming.

First, he starts out with the claim that he is an “evidence” guy:

A few words about that story and how it evolved. Regular readers (scratch “regular”–anybody who’s read a single post) can tell I’m an evidence kind of guy. Claims without backup data give me the urge to turn the page, click on another link, get off the phone. Call it a bias if you want, but every medical reporter knows it’s a crucial filter, considering some of the stuff we get from researchers (from their PR agencies much of the time) and publishers.

I suggested an article on alternative medicine because academic medical centers all over the country–venerable altars of clinical research and practice like Mayo and Duke, top-ranked cancer centers, and even children’s hospitals–are scrambling to roll out therapies that five or 10 years ago most regarded as dubious at best, crackpot at worst. Acupuncture, homeopathy, herbs, traditional Chinese medicine. It’s a fascinating development. And I vowed to report it with an open mind.

The problem is, Mr. Comarow’s mind appears to have been so open that his brains fell out for this story. He freely admits that the one thing he discovered at every academic medical center that he contacted or visited was “that not a single researcher or clinician bothered arguing that the evidence for any of the alternative therapies they were testing and using on patients was persuasive. To the contrary, all agreed that almost none of the studies that show positive results have been designed or run very well.”

Sadly, none of that stopped Comarow from writing something that is deeply disturbing to see coming from a reporter:

If I wanted an evidence base, I was out of luck. But absence of evidence, as the late astronomer Carl Sagan said, is not evidence of absence. And if we lack an understanding of or explanation for how something works (as was the case for decades for how an airplane could stay airborne), that doesn’t give us the ammunition to state that it doesn’t work. In philosophy, that kind of reasoning is called argument by ignorance. Heaven forbid I should be guilty of a sin with “ignorance” in its name.

Yet, arguing from ignorance is exactly what Camarow has just done! He has in essence stated that, just because we don’t know how these therapies work (never mind that we don’t even “know” that they do anything) doesn’t mean that they aren’t necessarily effective. In other words, just because we don’t know how ghosts pass through walls mean that they don’t. He’s basically arguing that, because science can never prove a negative 100% we should take dubious, physically and scientifically highly implausible CAM therapies seriously as scientists. This sort of argument totally belies Camarow’s claim of being an “evidence guy,” as does his utterly risible analogy to the airplane. We know the airplane worked because it flew! There was repeatable, unequivocal evidence that airplanes could fly. All that remained was to figure out the physical laws that allowed that to happen, some of the physics of which was understood years before the Wright brothers hit Kitty Hawk with their contraption. There is no such unequivocal, repeatable evidence of efficacy greater than that of a placebo for the vast majority of CAM therapies. Moreover, just because he “wrestled” with the story for weeks before publishing it does not make it any more valid to have written a mostly credulous and approving account of the infiltration of unscientific medicine into the bastions of academia than if he had had no doubts and published it immediately upon completing his research. Worse, Camarow lacks any understanding of how anecdotes are not scientific evidence and how they are inherently misleading:

Some of these therapies, maybe most, do indeed work. The patients I spoke with told me how acupuncture had made their allergies go away, how they were able to avoid painkillers after major surgery because of hypnosis or visualization or other mind-body techniques, how a homeopathic remedy that science would regard simply as water reduced swelling and pain within hours after an injury. I heard many such anecdotes, along with candid appraisals of treatments that seemed to be effective only for a short time or not at all. These people were not all true believers.

Yes, well we also used to think that bloodletting “worked” based on anecdotes. We used to think that purging with toxic metals “worked’ based on anecdotes and tradition. Based on anecdotes and the all-too-human tendency to confuse correlation with causation, there are large segments of the population that believe that vaccines cause autism, despite several large, well-designed studies that have found no correlation and no evidence of causation, and that quackery such as chelation therapy “cures” autism, despite no good evidence that it does. Finally, he should be aware that, because of the vagaries of scientific studies of hypotheses with a low prior probability of being true, there is a high rate of false positive results, producing apparently positive studies when there really is no effect. That’s why the totality of the literature has to be considered. Surely a reporter such as Camarow should know that, but apparently he doesn’t. Worse, he demonstrates it even more pointedly in the comments, where some of his responses to skeptics, including the Amazing Randi himself, are weak at best and pathetic at worst. In a followup post, he backtracks a bit, but still seems unrepentant

Camarow calls his blog Camarow on Quality. Sadly, as far as his story and beliefs about alternative medicine and its infiltration into academia, his blog title appears incongruous in the extreme.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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