Skeptics, like Rodney Dangerfield, “don’t get no respect, no respect at all,” at least not from academics. This lack of respect for what we do (and for science communication in general) has historically ranged from indifference to outright disdain and contempt and is nothing new. For example, Carl Sagan’s fame and science communication negatively impacted his career. Arguably, nowhere has this been more true than in the branch of skepticism dealing with medical claims and quackery; in other words, the very branch with which I’m most associated. Basically, there remains a prevalent attitude out there among all too many physicians, particularly academics, that countering quacks and antivaxxers is just so damned easy that it’s not worth our precious time and mental effort as physicians. To some extent, that attitude is changing, a process that, from my perspective, began with the growing prominence of the antivaccine movement several years ago, whose growing influence resulted in measles outbreaks, and accelerated with the arrival of the COVID-19 pandemic in the US earlier this year and the tsunami of medical misinformation, quackery, and conspiracy theories that followed. Even so, the more things change, the more they stay the same, at least in some ways, which brings us to the case of someone whom I like to refer to as the very eminent rising star in oncology (VERSO), Dr. Vinay Prasad.
Late last year, Dr. Prasad made a bit of a splash (and suffered a bit of well-earned blowback) on social media. As I discussed, a few months before COVID-19 hit the US Dr. Prasad Tweeted disdainfully and contemptuously about how criticizing Goop’s selling of jade eggs and other pseudoscience was like “dunking on a 7′ hoop” and how skeptics should put the hoop back up to 10′ by—of course!—joining him in taking on clinical trial shenanigans by big pharma. During our exchange, he even went so far as to suggest that I give up my usual topics for six months and spend those six months doing what he does (because—don’t you know?—what he does is so much more difficult and worthwhile). Interestingly, as I was writing that particular post about the exchange, I noticed that Dr. Prasad had deleted the most obnoxious of his Tweets, in which he had made fun of skeptics who deconstruct quackery and pseudoscience and communicate science-based medicine to the public, implying that such activity is so painful easy (you know, “dunking on a 7′ hoop”) as to be unworthy of our efforts and that what he does, analyze clinical trials and question commonly used medical interventions, is so much more difficult.
It never occurred to the eminent Dr. Prasad there’s considerable overlap in skillsets, given that skeptics frequently have to go deep into the weeds of the design and methodology of clinical trials of, say, acupuncture or homeopathy to demonstrate why these studies do not show what advocates claim. When this was pointed out to him, even more obnoxiously (and disingenuously), he portrayed that rebuttal as tacit confirmation that we skeptics secretly really do think that what he does is of so much more value than what we do and that that’s why we were arguing that we in fact do do the same sorts of analyses of clinical trials that he does. I’m not going to rehash that particular incident any more than I already have, except than to refer you to the last section of this post, other than as a prelude to say that this week Dr. Prasad was up to his old antics again.
What you care about = Waste of time. What I care about = So very, very important.
A year went by, and during that time Dr. Prasad did occasionally say the same sorts of things on Twitter, as I discovered from third parties (by then we had blocked each other). I only occasionally took notice, given that the COVID-19 pandemic and its accompanying torrent of bad science, pseudoscience, misinformation, and disinformation had more or less consumed my blogging efforts, with little time left for any other topic. Then, a couple of days ago, I saw that he had published an article on MedPage Today entitled, Applying Skepticism to Medical Skepticism, with the subtitle, “Debunking should focus on areas most in need — which might not be homeopathy.” Dr. Prasad, for whatever reason, has apparently decided to double down on his analogy. Worse, his article demonstrates that, not only has he learned nothing, but he still doesn’t even understand what he is criticizing as a waste of time. Basically, he’s learned nothing.
After expressing surprise that he got blowback on Twitter for having posted a Tweet with an image of a man literally dunking on what looks like to me a 4′ (not 7′ hoop) and writing, “Dunking on alternative medicine is like dunking on a 7-foot hoop; let’s raise it back up to 10 feet,” Dr. Prasad launches into condescension:
To my surprise, my tweet struck a nerve. My impression is that it was irritating to folks who, for the most part, spend time debating and debunking alternative and complementary claims or self-identify as doing so. Their objections to my tweet were twofold — first, some felt that they also spent time criticizing conventional medicine, and second, alternative medicine topics — like cupping and acupuncture — are important ways people waste their own time and money and are worthy of debunking. I hope that my thinking through this topic has the potential to inspire the next generation of skeptics to pursue the topics we need more activism on.
There’s no better way to win over people who normally would be natural allies than to dismissively inform them that you view what they do as so much less important, so much less difficult, and so much less worthwhile than what you do, right? Why on earth would they ever get their hackles up over that? And the very eminent Dr. Prasad was surprised that the reaction to his statement was so negative? No doubt he’ll be equally surprised at the negative reaction his MedPage Today article will likely engender. (Or maybe not. I suspect this time he is intentionally trolling skeptics, for whatever reason.)
Whatever the case, though, as before, Dr. Prasad is not only attacking a straw man version of medical skepticism, but he’s also misrepresenting some of our objections to his characterization of what we do. In this, he reminds me a lot of Scientific American journalist John Horgan, who in 2016 was invited to give a talk to the Northeast Conference on Science and Skepticism (NECSS), an opportunity he decided to use to take the skeptics in attendance to task for spending time analyzing and debunking what he called “soft topics” (e.g., Bigfoot and homeopathy) instead of his preferred “hard topics” (e.g., cancer screening and, yes, war). At the time, my response was very similar to what my reaction to Dr. Prasad’s latest was, because Dr. Prasad’s entire argument is basically the same, just limited to medicine. Just as John Horgan argued, in essence, “Why are you wasting time on Bigfoot and homeopathy when you should be devoting your efforts to conventional medical issues like cancer screening or to world peace?” Dr. Prasad is arguing, “Why are you wasting your time on homeopathy when you should be doing what I do?” Along the way, he makes some hilariously off-base claims. Or they would be hilarious if he weren’t so influential.
I once referred to Horgan’s shtick as “’Soft targets’ = What you care about. ‘Hard targets’ = what I care about.” Dr. Prasad’s shtick is a variant on the same theme, in essence, “What you care about = A waste of time and way too easy to be worth wasting brainpower on. What I care about = So very, very important and so very satisfyingly intellectually challenging.” (Oh, so very, very, very important. And difficult. While what you do is pathetically easy and unimportant. Why don’t you realize that, you ignorant boobs?)
I also like Dan Loxton’s response to this sort of dismissive, contemptuous argument:
I’ve spent much of my career confronting the common argument that skeptics should not perform the service skeptics do best, but instead tackle other subjects we may not be qualified to address. It’s a head scratcher, honestly. “You have specialized expertise in X, but I think X is trivial. Why don’t you specialize in Y, because I think Y is important?” Nobody ever says this to Shakespeare scholars or doctors or plumbers. (“Dear ‘fire fighters,’ fight fires less and solve more murders”?) Seemingly everyone says it to skeptics.
As I put it at the time, if someone came up to me and said, “Why don’t you stop writing about alternative medicine, antivaccine pseudoscience, and homeopathy and look at Bigfoot instead?” I’d laugh dismissively. Admittedly, it also grates when someone like Dr. Prasad says something like, “Why don’t you stop writing about alternative medicine, antivaccine pseudoscience,, and homeopathy and focus on cancer screening instead, medical devices, and useless surgical procedures instead?” Why? Because I’ve been writing about mammography and cancer screening, including over diagnosis and the shortcomings of screening for well over a decade! I even have a publication in the New England Journal of Medicine expressing skepticism over whether mammography and prostate-specific antigen screening has had as large an impact on deaths from breast cancer and prostate cancer as claimed. It’s even with H. Gilbert Welch, someone whom Dr. Prasad expresses great admiration for. Heck, I’ve repeatedly likened vertebroplasty to acupuncture—starting eleven years ago! Basically, skeptics can walk and chew gum at the same time—unlike Dr. Prasad apparently.
I’ll stop with this line of rebuttal (at least for the moment) because no doubt the ever-so-eminent Dr. Prasad will once again disingenuously interpret it as an admission that secretly I really do think that what he does is more important than what skeptics do. I will mention, though, that Dr. Prasad, as before, makes a number of rookie mistakes. One thing that’s particularly annoying is how he seems to think that his criticisms, which are really very unoriginal, haven’t been a topic of discussion and debate among those of us who’ve been at this a while. Basically, Dr. Prasad, like John Horgan before him, seems to think that he’s the first one to have made brilliant observations about medical skepticism that none of us have ever thought of before! In this, he reminds me of a couple of physicists I’ve discussed before who seem to think they’ve identified major shortcomings in our understanding of cancer that cancer biologists, surgeons, and physicians haven’t considered and already rejected or computer scientists who think that artificial intelligence will “solve” cancer in a decade.
Let’s dig in point by point.
A self-refuting argument
Dr. Prasad makes a simple point before he launches into his list of criteria that he believes medical skeptics should use as a framework to prioritize their efforts:
Let me start by acknowledging a truth of the cosmos: time is a fixed commodity. If one spends most of one’s time critiquing acupuncture or homeopathy — those are hours not spent critiquing robotic surgery, prostate-specific antigen screening, or a new prescription drug. Of course, any single person may have written on a variety of topics, but every hour spent on one activity is time taken from another. If you wrote 5,000 words on homeopathy, there is some other topic you did not write 5,000 words on. And, the truth is, there is waste — i.e., things that don’t work — in all domains: alternative and complementary medicine, but also conventional medicine. In other words, skepticism has an opportunity cost.
I was a bit amused reading this passage, because that “5,000 words” dig is almost certainly aimed at me, given my reputation for verbosity.
The contention that there is only limited time and that time spent doing one thing is time taken away from doing something else is what I like to refer to as a “Well, duh!” observation, a statement whose truth is so obvious that the most appropriate response is, “Well, duh!” But Dr. Prasad is clever. Note the false equivalence. He notes that there is waste in “all domains: alternative and complementary medicine but also conventional medicine,” as though the two were even on the same planet or in the same order of magnitude when it comes to waste. Let’s just put it this way. Complementary and alternative medicine (CAM) is nearly all waste because very little of it actually works! (And what does work tends to include science-based modalities, like nutrition and lifestyle, co-opted by CAM advocates.) Very little of it is supported by scientific evidence, and a whole lot of it is actually disproven rather than unproven. (There’s homeopathy again!) Yet Dr. Prasad seems to want you to think that conventional medicine, which, one must admit, does have a significant number of practices that are not as well-supported by evidence as they should be, is just as bad. It’s not. Not by a long shot! However, this false equivalence serves Dr. Prasad’s deceptive purpose in that it implies that time spent debunking quackery is “wasting time” that could be oh-so-much better applied to what Dr. Prasad considers important.
This is basically a self-refuting argument, and I can’t think of a better way of saying it than this:
Yes, Dr. Prasad’s “opportunity cost” argument is a self-refuting argument. (After, all, even if it took Dr. Prasad, say, only a half hour to write his MedPage Today article, that’s a half hour that could have gone into critiquing the menace of big pharma. Why is he wasting his time criticizing skeptics for debunking homeopathy when he could be criticizing big pharma?) This is particularly true in that the vast majority of those of us who refute quack claims and debunk alternative medicine do it as a hobby. Unlike the case for Dr. Prasad, our activities promoting science-based medicine are not our careers. Dr. Prasad spends his work time doing what he does and garners copious funding for it, resulting in professional advancement and rewards. Nothing could be further from the truth when it comes to medical skepticism aimed at alternative medicine; indeed, few have managed to forge anything resembling a successful academic career applying skepticism to alternative medicine (although I do see more opportunities emerging in studying science denial, like the antivaccine movement). Dr. Prasad doesn’t seem to realize that his suggestion is yet another false equivalence and that, in reality, what he is suggesting is that we skeptics should spend all our free time that we normally devote to what he refers to dunking on a low hoop to doing what he does.
Cost and harm
The first four items in Dr. Prasad’s “framework” of how to think about prioritizing skeptical activities all boil down to three things: Cost, harm, and whether it affects other people; so I will treat them as a single block. First, Dr. Prasad makes this observation:
1. Cost. All things being equal, we should focus our energies on interventions that cost more (per unit), and have greater budgetary impact (total cost for all units). Some medical devices and pills cost in the tens and thousands of dollars per use or month, and conventional healthcare is a nontrivial portion of the U.S. gross domestic product. Conventional medicine is like alternative medicine in terms of budget impact, but add one or two more zeros.
Using the same argument, perhaps we should disparage doctors who focus their time on rare diseases because, well, you know, they affect so few people and cost so little money compared to the big diseases like heart disease, cancer, diabetes, and asthma. Actually, that is rather how our current system works. Given that there is only a limited amount of resources and time, of course people tend to devote their time and resources to the more common, big problems, but we generally don’t disparage people who decide to devote their time to less common problems that cost less money, do we?
Also, Dr. Prasad’s is a very US-centric view. In the US, alternative medicine is big business, but not as big as big pharma and big medical device, but the same is not necessarily true elsewhere in the world, as I will discuss in a moment in the context of Dr. Prasad’s other arguments.
Let’s move on to #2:
2. Harm and invasiveness. All things being equal, we should focus our time on interventions that have greater harms — death, perforation, cardiac arrest — than those that offer minor harms — cutaneous bruising. We should focus more on things that are invasive — placed inside or within — that those that are merely superficial.
It’s here that I’m going to throw Dr. Prasad’s opportunity cost argument right back at him. Sure, many, if not most, alternative medicine treatments are harmless. However, it is also true that there are quite a few alternative medicine treatments that are potentially very harmful, such as subjecting autistic children to bleach by mouth and enema to treat their autism, black salve to treat cancer, chiropractic (vertebral dissections, anyone), and even acupuncture. In other words, the “harms” of alternative medicine are not just “cutaneous bruising” (as from cupping). Those examples aside, much of the harm of alternative medicine is the opportunity cost; in other words, patients who pursue ineffective treatments for their disease end up letting their disease progress to the point where it causes more harm (or even kills them) or at least becomes a lot more difficult and expensive to treat. It’s funny how selective Dr. Prasad is in applying his “opportunity cost” argument. Or maybe it isn’t, as he appears to be mainly trolling with extremely disingenuous arguments.
I’ll treat #3 and #4 together:
- Does it affect other people? This is an important factor. Topics that affect others — the spread of contagious infections — are fundamentally different than topics that affect only ourselves — e.g., cupping for pain. We should give extra attention, all things equal, to practices that have implications for others — like infectious diseases.
- Who pays? I think it matters who pays for a therapy. Individuals are free to use their own money as they see fit. An individual might spend money on a lavish car or golf clubs, or even furniture, wallpaper, or décor. Wearing a copper bracelet for arthritis or wearing a silver one for beauty are both things we do because they make us feel better. Ultimately it is impossible to tell someone how they ought to spend their own money. At the same time, practices covered by health insurance are all of our concern. Through tax subsidies, government funded healthcare, these are things we all pay for; thus, we have a special responsibility to think critically about them.
Of course, the main reason skeptics spend so much effort on refuting antivaccine pseudoscience is that, by scaring parents out of vaccinating their children, antivaxxers endanger other children. In the age of COVID-19, antivaccine disinformation could result in the unnecessary deaths of untold thousands who will refuse to be vaccinated against SARS-CoV-2. I’m glad to see that Dr. Prasad agrees with us that combatting such disinformation is important!
As for the question of who pays for woo, Dr. Prasad demonstrates shocking ignorance. He seems to labor under the delusion that alternative medicine is solely the province of Goop-loving, jade egg-buying, homeopathy-loving people with, as British comedians David Mitchell and Robert Webb once put it, more money than sense and that none of “our” money goes to purchase this quackery.
He’s quite wrong, and, once again, also demonstrates a very US-centric view of the world—and an ignorant view at that. For example, let’s go back to Dr. Prasad’s favorite hobby horse whose debunking he loves to keep contemptuously referring to as “dunking on a 7′ hoop.” Did Dr. Prasad ever hear of the United States Pharmacopeia-National Formulary (USP-NF) or the Homeopathic Pharmacopeia of the United States (HPUS)? Yes, the FDA determines what homeopathic remedies are permissible, something mandated by law since 1938! Does Dr. Prasad even know that some states (e.g., Arizona) license homeopathic physicians? Does he know that many states license naturopaths and that all naturopaths are trained in homeopathy? (As I put it, you can’t have naturopathy without homeopathy.) Homeopathy is part and parcel of naturopathy, with the naturopathic licensing examination (NPLEX) featuring clinical vignettes and questions involving homeopathy, and, while some naturopaths don’t practice homeopathy, most do. Also, did I mention that naturopathy is infiltrating academic medical centers and that the Veterans Administration is increasingly paying to have naturopaths and all manner of other alternative medicine practitioners treat veterans in its medical centers? Indeed, the VA even hired a true believer to bring quackery to veterans.
That’s just the US. In France, the government reimbursed its citizens for homeopathy for many years until it was finally decided to phase this funding out as a result of—you guessed it!—skeptical activism. These skeptics also paid a price, with attacks and one of them even seeing his license suspended for signing an anti-homeopathy statement. Meanwhile, traditional Chinese medicine (TCM) is big business in China, with China working actively to export it to the world and to codify it through its influence over the World Health Organization into the ICD-11, all while criminalizing criticism of TCM. China has even reportedly forced people to undergo TCM treatment for COVID-19. Meanwhile, in Germany and other parts of Europe, quack cancer clinics preying on desperate patients are big business spreading to other parts of the world.
I could go on and on and on about cost (NCCIH, anyone?), but you get the idea. Dr. Prasad is not only clueless about what medical skeptics do, but he’s utterly oblivious to the cost and potential harms of what he views as “harmless” alternative medicine, at least “harmless” in comparison to the harms he considers important.
Vinay Prasad on “unmet need” and power of persuasion?
I’m going to treat #5 and 7 as a unit, because it strikes me as appropriate. First, Dr. Prasad is so very, very, very concerned about our ability to persuade. This is a not unreasonable concern, but, again, he treats his utterly unoriginal observation as though it were some startling new revelation that we clueless skeptics had never considered before. Noting that whether or not a new drug or device is the best treatment for a given disease is a question that tends to have “swing voters,” or a “massive number of healthcare providers who simply have not taken a stand” and are therefore presumably open to persuasion, he goes on to write:
Issues that are deeply challenging are those that wed politics, identity, and tribalism. Topics like herbal medicine, chiropractic, and (sadly) even masks during COVID-19 may have become so deeply polarized and tied to identity that argument can no longer persuade. In these cases, if the cause is sufficiently important — such as MMR vaccination — I think we should move towards randomized trials of different persuasion strategies to find what actually works. If, however, a topic fails by several aforementioned metrics, I think we might just have to let it go.
Wait, what? Here, Dr. Prasad seems to be suggesting that because issues such as the use of masks to slow the spread of COVID-19 and vaccination against measles, for example, have become so polarizing and wedded to political or ideological “tribal” identity, we desperately need randomized clinical trials of of different persuasion strategies to tell us which ones work. In and of itself, that’s not a horrible idea, but it’s almost as though Dr. Prasad is either utterly ignorant of the entire discipline of communications known as science communication. (If only we had people who have studied these questions and tried to figure out the answer to the question of which science communication strategies work the best!) I find Dr. Prasad’s attitude particularly odd in the middle of a pandemic, in which countering misinformation that keeps people from cooperating with public health interventions or, now, being vaccinated against COVID-19, could literally save thousands upon thousands of lives. Do you see the inconsistency at the heart of his arguments?
It’s also as though Dr. Prasad thinks that skeptics don’t think of these things routinely pretty much every day and that we spend our time trying to persuade the hard-core, those who are nearly unpersuadable. We actually agree that these people are so unlikely to change their minds and then only at the cost of incredible effort that our efforts are better spent elsewhere. Indeed, one reason why I now emphasize the central role of conspiracy theories in medical denialism, antivaccine views, and quackery is not just because conspiracy theories are central to these problems (they are), but because recognizing this centrality allows the crafting of “pre-bunking” messages that empower those susceptible to messages by the hard core science deniers by recognizing the characteristics of conspiracy theories and bad arguments before they encounter them.
Dr. Prasad’s arguments get worse, though:
7. Unmet need. You as a skeptic should take stock of which fields have unmet needs. My research team is doing some ongoing work to identify places in medicine where no one is a critical third party. These places desperately need you. Just like investigative journalism, sometimes the best stories emerge from domains where no one is looking (e.g., local politics). I worry that some topics have oversized interests — acupuncture — while others are neglected entirely — base of skull surgery.
Acupuncture is an oversized interest? What planet is Dr. Prasad on? Does he realize how few in number and influence critics of acupuncture are in comparison to the number of academics who have uncritically embraced this unscientific practice based on a prescientific understanding of how the body works? Does he even know that, for example, Harvard has offered a yearly course in acupuncture for well over a decade now and actively defends it against criticism? Does he realize how many academic cancer centers offer acupuncture or that acupuncture has now infiltrated the American Society of Clinical Oncology (ASCO) conference, the cancer conference that, I’m sure, he attends every year? (ASCO has even endorsed a set of quack guidelines for treating cancer.) Contrary to Dr. Prasad’s Twitter-warped perception of the issue, skeptics taking on alternative and “integrative” medicine are far more akin to how Dr. Prasad sees himself with respect to big pharma and big device: Outgunned, outmanned, and outspent by the opposition. Skeptics are addressing a largely unmet need!
His is, again, that most offensive of dismissive arguments, namely, “Why aren’t you interested in what I’m interested in, because what I’m interested in is so much more important than what you’re interested in?”
While I’m on this, Dr. Prasad apparently thinks that the reason we do what we do is because we love them clicks:
Above all else, the goal of skepticism is to encourage better healthcare choices. In the world of Facebook and Twitter it is easy to be misled. Absolute and blanket condemnation may be popular amongst people already inclined to oppose complementary and alternative medicine, but perhaps unlikely to persuade anyone who sees value in the practices. The modern information ecosystem encourages preaching to our choirs, rather than broadening our base. We must be careful to avoid this temptation.
Again, Dr. Prasad seems to think that we’ve never even considered the problems of “preaching to the choir,” while ignoring the observation that preaching to the choir is not always a bad thing; for instance, it can be a very good thing indeed when it motivates skeptics and gives them the tools to join the fray. He also seems to think that we are incapable of nuance, but maybe that’s just projection. Come to think of it, maybe Dr. Prasad’s accusation of being controversial for the clicks is projection too. (I suspect that there is no “maybe” about it.)
One area where Vinay Prasad and I agree
In the name of looking for common ground, I’m going to conclude with one point that Dr. Prasad makes that I actually agree with, but my agreement with him on this point actually makes what he does with his observation even more puzzling to me:
6. Your unique skill set. In deciding what you should spend your time on, it is important to think about what you are uniquely qualified and able to comment on. If you are a practicing orthopedic surgeon or allergist-immunologist, you are part of a tiny guild of people who have the knowledge to even identify the excesses in your field. Sure, you can talk about vitamin C, but so can many others. Why not focus on what few can do?
No skeptic I know of would disagree with the contention that people should do what their unique skillsets make them uniquely qualified to do. The problem is, as Steve Novella has pointed out, that Dr. Prasad seems not to view skepticism, science-based (as opposed to evidence-based) medicine, and science communication as a skillsets. Similarly, his perspective seems to be warped by the very social media tendencies he decries. He seems to think that, because he’s riled up a lot of skeptics on Twitter resulting in their taking him to task, there must be a lot of us compared to doctors like him.
What I mean is this: There are lots of physicians who are critical of big pharma and big device, who analyze “conventional” clinical trials and find fault with them and their conclusions. There might not be a lot of physicians who’ve made an academic career of such criticism, as Dr. Prasad has (an achievement for which he deserves plaudits), but there are plenty of physicians who do this sort of thing. In contrast, in the grand scheme of things the number of physicians who engage in skeptical activism about alternative medicine is tiny indeed. Certainly, the increasing influence of the antivaccine movement and, now, the rise of COVID-19 science denialists have led to an increasing overlap between the groups of physicians and medical scientists who both analyze and critique the science behind conventional medicine and also combat medical misinformation and quackery, and I view that as a good thing. Indeed, I hope that overlap only grows and doesn’t recede once the pandemic finally abates. That being said, though, I’m going to turn Dr. Prasad’s argument right back at him: Medical skeptics are focusing on what the “few” can do better than the vast majority of doctors. We are doing what so few else are willing to do, and some of us are paying a price for it professionally and personally (aside from having to deal with the arrogant scorn of academics like Dr. Prasad).
I would add that physicians—and people in general—should also pursue what they are passionate about. If you’re passionate about critiquing clinical trials and thereby (hopefully) improving them, as Dr. Prasad is, then have at it! I won’t criticize you if what you’re doing has value to science and society. What is perpetually frustrating, though, is Dr. Prasad’s seeming inability to give skeptics the same consideration coupled with his highly annoying penchant for lecturing skeptics about how we should not concentrate on what we are passionate about even though our activities have value for science and society, simply because he doesn’t think it’s sufficiently “important’ or “challenging.” Indeed, Dr. Prasad’s concluding paragraph is profoundly offensive, as he returns to his “dunking on a 7′ hoop” analogy:
Social media algorithms encourage us to chase the popular, faddish and, dare I say, 7-foot topics — like homeopathy — and perhaps not the topics where we are desperately needed. Topics that cost a lot, impact budgets, are paid for by insurers, have serious harms, are invasive, affect others, where there are lots of undecided people, where there is unmet need, and where we, with our unique skillset can help. Those are the 10-foot issues. I think it’s time we raise the hoop.
Homeopathy is a “popular” and “faddish” topic? Again, what planet is Dr. Prasad living on? It’s a perpetual topic in skepticism because, no matter how ridiculous its precepts are, homeopathy just won’t die. Moreover, what skeptics do addresses almost exactly what Dr. Prasad claims it does not, “topics that cost a lot, impact budgets, are paid for by insurers, have serious harms, are invasive, affect others, where there are lots of undecided people, where there is unmet need, and where we, with our unique skillset can help.” Dr. Prasad seems to think that all we are battling as medical skeptics are jade eggs, magnetic bracelets, and chanting reiki masters. He is dismissing the pseudoscience and quackery that we battle with, in essence, a hearty “What’s the harm?” Meanwhile, although it is impossible to quantify exactly how many people are dying of COVID-19 due to conspiracy theories, pseudoscience, and science denial, there is no doubt that the toll is real and that the number affected is a very large one.
I conclude with a message for Dr. Prasad: No one expects him to join our efforts if he doesn’t consider what we do to be important or sufficiently “challenging” for his apparently stupendously awesome medical intellect. We could certainly use someone with his skillset, but such is life, and he’s generally doing good work in a subdiscipline of skepticism. I only wish that Dr. Prasad could bring himself to recognize or accept that we are also doing good and necessary work in skepticism, even if it’s not his cup of tea, so to speak. At the very least, he could do us the favor of not regularly shitting on what we do with his criticisms based in ignorance, arrogance, straw men, and false equivalence, because, given his ignorance of the pervasiveness and harm of medical misinformation and disinformation, coupled with his refusal to address what we actually do, refuting Dr. Prasad’s criticisms is, to borrow his own analogy, “dunking on a 7′ hoop.”
I have a suggestion. Dr. Prasad should either learn what we actually do by—well, duh!—actually talking to us instead of lecturing us or, being too lazy or uninterested to do that, at least do us the favor of staying out of our way. That would be one way he could raise the hoop back to 10′, because, as all skeptics recognize, attacking straw men is dunking on a 4′ hoop. Sadly, when not dealing with clinical trials and big pharma, Dr. Prasad sure does seem to love dunking on ridiculously low hoops.
Thus endeth my 5,000+ word treatise on Dr. Prasad’s bad arguments. You know, now that I’ve finished it, I have to admit: He might had a point. Dunking on a 7′ foot hoop like his criticisms of skepticism might have been a waste of my time. It’s a good thing for me that taking on pseudoscience in the age of a pandemic is more akin to my trying to dunk on a 12′ hoop as a person with mediocre (at best) skill playing basketball, and I now return to that task, which is never-ending.