Complementary and alternative medicine Medicine Pseudoscience Quackery Skepticism/critical thinking

How does a scientist or doctor become a crank?

As a physician and scientists who’s dedicated his life to the application of science to the development of better medical treatments, I’ve often wondered how formerly admired scientists and physicians degenerate into out-and-out cranks. I’m talking about people like Peter Duesberg, who was once an admired scientist thought to be on track for a Nobel Prize; that is, until he became fixated on the idea that HIV does not cause AIDS. True, lately he’s been trying to resurrect his scientific reputation with his chromosomal aneuploidy hypothesis of cancer, but, alas, true to form he’s been doing it by acting like a crank. I’m talking about people like Dr. Lorraine Day, who was a respected academic orthopedic surgeon and then after being diagnosed with breast cancer degenerated into a purveyor of woo, as well as a New World Order conspiracy theorist, religious loon, and Holocaust denier. There’s also Linus Pauling, another Nobel Laureate, who later in life became convinced that high dose vitamin C would cure cancer. And let’s not forget Mark Geier, who, although not a distinguished scientist, did, before his conversion to antivaccinationism, apparently do a real fellowship at the NIH and appeared to be on track to a respectable, maybe even impressive, career as an academic physician. Now he’s doing “research” in his basement, injecting autistic children with a powerful anti-sex hormone drug, and abusing epidemiology. There are innumerable other examples.

ERV has posted a good start in analyzing why this happens. Because her interest is HIV research, she’s particularly interested in how a brilliant man like Peter Duesberg could have fallen so far into pseudoscience. However, because she is a basic scientist, her view lacks a bit when it comes to why physicians become cranks or quacks. Consequently, I thought I’d expand a bit on this topic and bring a medical perspective to the question. Because I am both a surgeon and a scientist, I routinely straddle both worlds (sometimes not being taken seriously in either). I’m not sure that this gives me any special insight, but it does give me a different perspective than ERV.

First, ERV shows great insight in pointing out that scientists are wrong all the time. Indeed, science can almost be defined as a system or a method of self-correction that brings us closer to models of how nature works. An absolutely essential part of science, therefore, is that we scientists must test our hypotheses and try to falsify them. When we attempt to do so, there are generally one of three results:

  1. The hypothesis is not falsified.
  2. The hypothesis is falsified.
  3. The results are not sufficiently clear to falsify or support the hypothesis.

When a hypothesis is not falsified, generally scientists will either try to find new ways of falsifying it until they are satisfied that it takes all reasonable challenges. Alternatively, they will build on it and refine it based on their experiments, after which they try to falsify the new versions of the hypothesis until they succeed. If the initial hypothesis is falsified, scientists generally will move on to a new hypothesis. True, they may not do so quickly or easily; after all, scientists are human too and just as prone to becoming emotionally attached to their favorite ideas and hypotheses, but move on they generally do–eventually. Of course, result #3 is the most common result; the answer is not always immediately clear. Indeed, this uncertainty may persist for years, if not decades, before some scientific questions are resolved. That’s what true scientific controversies, and, once again because scientists are human, they can be quite rancorous, on rare occasions even escalating to the point of scientists yelling “bullshit!” at each other at seminars and scientific meetings. (Such meetings can actually be kind of fun.) Over time, however, evidence will accumulate, and experimental results will start pointing towards an answer. Sometimes a dramatic result, a stroke of genius, like Eintstein’s Theory of Relativity or Charles Darwin’s Theory of Evolution by Natural Selection, will appear like a bolt out of the blue and change everything. However it happens, once a hypothesis is roundly falsified, though, scientists will indeed, even if reluctantly, admit that the hypothesis was incorrect, form a consensus, and then move on to test other hypotheses. Or, as ERV put it:

Now here is where we get to the kook part– Say we finally determine that MMTV does not cause any kind of breast cancer in humans. All the normal scientists on the ‘MMTV causes cancer’ side will say ‘Aw. Man. Oh well, my bad.’ and keep doing science. Admitting youre wrong in science is not a big deal because scientists are wrong all the time!

Perhaps the best illustration of this attitude among scientists was a tale told by Richard Dawkins in The Root of All Evil? about an elderly and esteemed scientist who had held to a certain hypothesis for many years. One day a visiting professor from America came to give a talk and presented evidence that conclusively refuted this professor’s favorite hypothesis. Afterwards, according to Dawkins, the old man strode to the podium, shook the speakers hand, and thanked him profusely, and said, “I have been wrong these fifteen years.” In response, the audience applauded uproariously. Whether this story is apocryphal or not or whether it’s grown with retelling over time, it is nonetheless the ideal towards which science strives. Scientists are supposed to be willing to give up cherished hypotheses if that’s what evidence and experimental results show. Of course, the difficulty in doing so tends to be proportional to both the length of time the hypothesis has been cherished and the intensity of attachment. Now, here’s where “scientist” transitions to “kook”:

Where one transitions from ‘scientist’ to ‘kook’ is the inability to say ‘I was wrong’ and move forward. In the 1980s, Peter Duesberg could have been right! No one knew what was causing this scary-ass world-wide epidemic. Yeah, it might have been HIV-1, but in the US it could have been a side-effect of some recreational drug, only surfacing when use was wide-spread and intense enough. Duesberg could have been right!

But as time went on, evidence stacked up on the side of the ‘HIV-1–>AIDS’ people, and nothing supported the ‘drugs–>AIDS’ people. If Duesberg were a scientist, he could say ‘Ek. Im wrong. Good on you all.’ and continued his career.

Indeed, assuming that Duesberg had done this before he had burned too many bridges by so harshly criticizing and insulting colleagues who were part of the “orthodoxy,” it probably would indeed have been “no harm no foul,” and Duesberg would be a happily well-funded scientists doing important research, rather than a tenured crank working in crappy basement laboratory on a shoestring budget. Heck, even after he had burned a lot of those bridges, he probably could have rebuilt them with just a little diplomacy. But he didn’t, because, like all cranks, he had become so enamored of his hypothesis that he was unable to let go of it even when the contradictory evidence became overwhelming. He had become convinced that he was right and the world of HIV scientists were (and are) wrong.

The other point that ERV makes that’s worth pointing out is that being a contrarian is not in and of itself particularly impressive because scientists are wrong so often while studying various questions. Indeed, I find “contrarian” scientists who won’t support their doubts of the established consensus with good science (and sometimes not even good logical arguments) of their own to be particularly annoying, like a two-year old who says “No!” to everything. Being “contrarian” is only productive if the contrarian scientist can produce actual evidence using sound experimental methodology suggesting that the consensus is not correct. That’s one reason why “intelligent design” creationists are not taken seriously. They point out what they see as “defects” in evolutionary theory but do no research–and don’t even try to do any research–that might suggest alternatives. The same is true of cranks of all stripes, including “alt-med” cranks, HIV/AIDS denialists, and many other varieties.

So basically the key ingredients of a scientific crank are an inordinate attraction to an idea or hypothesis to the point that he won’t abandon it in the face of overwhelming evidence coupled with the arrogance necessary to believe that he is correct and the rest of the scientific community is not. This is probably true no matter what sort of science is being abused. However, when it’s medical science that leads to outright quackery, there are other issues that come into play.

The first thing that one needs to take into account when considering the evolution of a medical crank is that most physicians are not scientists. As much as it pains me to admit it, sadly it’s true. Indeed, I have lamented time and time again how little training in the scientific method most medical students and residents receive in the scientific method. This makes all too many physicians very susceptible to pseudoscience because they don’t have a good grasp of what good scientific methodology is, and I’ve provided ample examples of this in this blog, particularly when it comes to physicians endorsing “intelligent design” creationism and and quackery. The second thing that needs to be considered is that there is a component of being a physician that doesn’t exist for basic scientists that provides added impetus to the transition from scientist/physician to kook, and that component is direct interactions with patients. This component is a powerful contributor to physicians becoming what Prometheus likes to call them, “brave maverick doctors.”

Consider this: Despite what many who do not like “conventional” physicians say, the vast majority of physicians go into medicine because they want to help people. They honestly want to help their patients, and not being able to help their patients causes them intense feelings of inadequacy and disappointment. In other words, there is a strong incentive, both positive (to get that fantastic feeling we get when we realize that we’ve really helped a patient) and negative (to avoid that feeling of inadequacy and frustration that we get when we cannot help a patient), to find treatments that the physician perceives to help patients. There’s also the ego gratification that comes from patients telling one that he’s great and has helped him enormously. The problem with this desire, however noble, is that it makes physicians uniquely susceptible to pseudoscience in the form of quackery. Here’s why. “From the ground,” a single physician looking at a group of his or her own patients being treated with a therapeutic modality will almost always “see” that the therapy “works.” The reason, of course, is the placebo effect. Without a controlled clinical trial, the placebo effect will almost always bestow upon almost any therapeutic modality at least the illusion of therapeutic efficacy, particularly at the single practitioner level. Thus, it is not surprising that homeopathy, reiki, acupuncture, and all manner of modalities that clinical trials show to be no more effective than placebo can easily appear to be effective when a single practitioner does what is in essence an uncontrolled, single-arm observational trial by treating patients with these modalities. Add to these human tendencies a significant financial incentive, and one can see how the slide into quackery can start out as an exercise in idealism, with “start out” being the operative phrase.

For example, for all the venom I’ve dripped on Dr. Mark Geier (venom he richly deserves), I have little doubt that he probably honest believes that he is helping autistic children with his “Lupron protocol,” as autism is a condition of developmental delay, not stasis. Many autistic children improve simply with growth and development, and without a control group and controlled, blinded randomization it’s impossible to tell whether a given intervention leads to an improvement in symptoms over and above what would have occurred anyway. Unfortunately, this belief has led them into some incredibly unethical activities in the service of their belief that they are somehow “helping” autistic children and with the claim that they “know” it works. Indeed, it is rather interesting to read Dr. Geier’s statement in defense of Clifford Shoemaker, in which he complains of Kathleen Seidel’s activities against his pseudoscience as though he’s a poor, persecuted crusader for good. Of course, poor crusaders for good rarely charge the exorbitant fees that Dr. Geier charges or skirt human subjects research ethics the way he does, but in his world-view he is a lone iconoclast.

This is where physician cranks (i.e., quacks) then become just like cranks of all scientific stripes, the sole exception being that their crankery endangers patients. They no longer try to falsify hypotheses or do trials to figure out if their remedies work. Why should they? They know they work! Instead, they cherry pick studies that support their idea and, if they do any clinical studies or science at all, it is almost universally bad science. Over time, they come to believe that they are right “because I see the evidence in my patients,” as quacks like to say, forgetting utterly how easy it is to be fooled by a combination of the placebo effect, expectation, confirmation bias, and observation effect when one is a single physician treating all patients. Whether it’s preexisting arrogance or a developed arrogance, these physicians will then often dismiss the “sheeple” physicians who practice evidence-based medicine as lacking the vision that they have, all the while making excuses for not doing clinical studies that would confirm or disprove the efficacy of their remedies over and above a placebo. Some, like Dr. Rashid Buttar, will charge enormous fees for their services and think it justified to the point that when they are questioned about the evidence supporting their therapies they will dance around the question and when they are finally brought in front of medical boards for their activities they will behave as an aggrieved, persecuted party, sometimes even going so far as Dr. Buttar as referring to the medical board as a “rabid dog.”

I tend to consider physician-cranks to be almost a special case of scientific cranks in general. In no other field of which I’m aware can the combination of an attraction to a hypothesis and arrogance combine with an honest desire to help patients in such an incredibly toxic manner. For most scientists, the forces that seduce them into pseudoscience are largely a combination of intellect and arrogance. For physicians, care for patients and the placebo effect enter into the equation to form a perfect storm that can tempt them into even the most indefensible pseudoscience.

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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