Evidenced-Based Practice and Pseudoscience

  1. evidenced-based practice and pseudoscience - is evidenced-based practice compatible with cam and holistic nursing practices? or, are the philosophies so far apart (as far as east is from west) that never the twain shall meet?
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    About VickyRN

    Joined: Mar '01; Posts: 12,040; Likes: 6,492
    Nurse Educator; from US
    Specialty: 16 year(s) of experience in Gerontological, cardiac, med-surg, peds


  3. by   Josh L.Ac.
    I really do not see how most CAM / integrative therapies cannot be tested in some form to determine efficacy or mechanism. The biomedical research of acupuncture has been very interesting and has resulted in many refinements in the research itself - and is also well chronicled in "Clinical Acupuncture: Scientific Basis" (Amazon.com: Clinical Acupuncture: Scientific Basis: Books: B.M. Berman,S. Birch,C.M. Cassidy,Z.H. Cho,J. Ezzo,R. Hammerschlag,J.S. Han,L. Lao,T. Oleson,B. Pomeranz,C. Shang,G. Stux,C. Takeshige,Gabriel Stux,Richard Hammerschlag.

    The article did bring up some good points but I did percieve a certain bias that reminds me of an article along the lines of "who watches the watchers"? I have noticed, in my debates with doctors, nurses, and laypeople, that many that claim to be skeptical are just as biased as those they rail against.

    I would go into detail but a poster on SDF did a wonderful job of summarizing "pseudoskepticism":

    Below are some excerpts, links, and highlights that support my assertion. I know, if you spend time to read/explore the links, you will no longer accept any of these sources with a blind eye as being even remotely credible. and will consider their diatribes for the deceptive and dishonest rantings they truly are.

    Why the so-called "skeptics"(you referred to) are not "skeptics" at all-
    Scooped! Sciency debunkery and other pseudoskeptical topics


    Some notes on Skepticism
    Some notes on Skepticism

    Many who loudly advertise themselves as skeptics are actually disbelievers. Properly, a skeptic is a nonbeliever, a person who refuses to jump to conclusions based on inconclusive evidence. A disbeliever, on the other hand, is characterized by an a priori belief that a certain idea is wrong and will not be swayed by any amount of empirical evidence to the contrary. Since disbelievers usually fancy themselves skeptics, I will follow Truzzi and call them pseudoskeptics, and their opinions pseudoskepticism.

    The remainder of this text is devoted to a detailed discussion of pseudoskeptical arguments and their pseudohonest debating tactics.
    -If it was true, there is no way that science could have missed it!
    This is a variation of the end of science argument

    -Confusing Assumptions with Findings
    Pseudoskeptics like to claim that the assumptions underlying modern science are empirical facts that science has proved

    -"Debate Closed" Mentality
    Since Pseudoskeptics have by their nature made up their minds on any question long before the evidence is in, they are not interested in participating in what could become an involved, drawn-out debate. On the contrary, their concern is with preserving their own understanding of how nature works, so discordant evidence has to be disposed of as quickly as possible. When sound evidence to that end is unavailable, anything that sufficiently resembles it will suffice. Pseudoskeptics like to jump to conclusions quickly - when the conclusion is their own, preconceived one.

    -Overreaching and Armchair Quarterbacking
    Faced with contradictory or inconclusive evidence, the skeptic will only say that the claim has not been proved at this time, and give the claimant the benefit of the doubt. The pseudoskeptic will make the (incorrect) counter-claim that the original claim has been disproved by the evidence (and usually follow up with generous amounts of name-calling and other extra-scientific arguments discussed below).

    -Assuming False Scientific Authority
    Many high-profile pseudoskeptics pass judgement based on scientific expertise they don't have. James Randi, for example, shares the following tirade in a July 13, 2001 commentary on his web site:

    -Double Standards of Acceptable Proof and Ad-Hoc Hypotheses(this is a BIG one and needs to be read thoroughly)

    The true skeptic will apply her skepticism equally to conventional and unconventional claims, and even to skepticism itself. In particular, the true skeptic recognizes an ad-hoc hypothesis regardless of the source. The pseudoskeptic, on the other hand, reserves her critical facilities for unconventional claims only.

    -Responding to Claims that were not made aka Demolishing Straw Men.
    Benveniste (who showed that ultradilutions, i.e. homeopathic preparations not containing a single molecule of the original substance can still have a biological effect) was attacked by Nature editor John Maddox with the argument that dilutions of the kind used by Benveniste can simply not exist because they would require "1074 world oceans" (that is more water than contained in the entire universe) to manufacture. That is correct, if the definition of "dilution" requires that at least one molecule remain, but Benveniste (and generations of homeopaths) have readily conceded that very point! Everyone agrees that high homeopathic dilutions do not contain a single active molecule, so Maddox's argument is nothing but the ritual dissection of a straw man. He is not alone - "skeptical" discussions of homeopathy invariably spend a lot of time making this completely uncontested point.

    -Technically Correct Pseudo-Refutation (credit for the term goes to Daniel Drasin):
    Pseudoskeptics are fond of arguing that hundreds of respectable scientists believe that a certain idea is bunk, and therefore, it must be. When one points out to them that many scientific breakthroughs were ridiculed and dismissed by the scientific establishment of the time, they retort that not every idea that has been ridiculed or dismissed turned out to be correct. Correct, but completely irrelevant, because it responds to an argument that was not made. The argument was not that ridicule or dismissal by scientific experts is sufficient grounds for accepting an unorthodox claim, simply that it is insufficient grounds for rejecting it.

    -Making criticisms that apply equally to conventional and unconventional research.
    It should be obvious that a criticism is invalid if it applies just as well to established science as it applies to an unconventional claim (such a criticism is called uncontrolled). But pseudoskeptics get away with using this technique anyway. What follows are some common examples of uncontrolled and therefore invalid criticisms.
    --Demanding an Unreasonable Degree of Reproducibility:......
    --Profit Motive........
    --Statistics can prove Anything!.........
    --Fraud cannot be ruled out!........
    --In Medicine: It's Unsafe!.......
    --Accusations of Selective Reporting (the "File Drawer Effect").......
    --Trying to End the Race when Their Side is Ahead:.........As an example, consider Randi's never-ending tirades against homeopathy. If you study his website, you will see that all he ever quotes is disconfirming medical studies, while the ones that confirm homeopathy are conveniently ignored.........
    --Theory overrides Evidence:
    --Misapplying Occam's Razor:...... in science, the simplest explanation tends to be the best. Pseudoskeptics usually insist that this heuristic rule of thumb is an immutable law of nature! In addition, they usually confuse simplicity with familiarity, and explanation with rationalization.
    --Dislike of the consequences:
    --Refusal to see the totality of the evidence:
    --Setting Arbitrary Standards of Proof and Moving the goalposts: (changing previously agreed upon standards of evidence when those standards have been met.)
    --Debunkery by association: If paranormal phenomena are real, then we might just as well believe in werewolves, fairies and unicorns! (one of my personal faves!!)

    --Dismissing claims because of their philosophical pedigree
    Where debunkery by association seeks to discredit claims by linking them with similar, but unrelated, claims, this technique seeks to discredit ideas by discounting their empirical merits in favor of their philosophical origins. The Skeptic's Dictionary gives us once again a prime example. Under the heading "alternative health practices", we find the following definition:

    Health or medical practices are called "alternative" if they are based on untested, untraditional or unscientific principles, methods, treatments or knowledge. "Alternative" medicine is often based upon metaphysical beliefs and is frequently anti-scientific.

    But doctors of alternative medicine are frequently more scientific than their conventional colleagues. While the former employ modalities whose safety and efficacy has been demonstrated by decades (nutrition), centuries (homeopathy) or millennia (acupuncture) of clinical practice, the latter frequently derive their "scientific" knowledge from biased information and rigged drug studies communicated by pharma lobbyists. Death from alternative medicine is unheard of, but side-effects of conventional treatments are estimated to kill 100,000 people in the United States every year. It is therefore hard to dismiss alternative medicine on empirical grounds.

    Yet for the pseudoskeptics, alternative medicine remains "unscientific", even "anti-scientific", because much of it is inspired by ancient beliefs and metaphysical ideas, such as the notion of a vital energy that animates the body, or the idea that thoughts create physical reality, not the other way. Pseudoskeptics find the notion that ancient civilizations could have known things that are still beyond the understanding of our current civilization deeply offensive. As rationalists, they believe that our ancestors were without exception superstitious, ignorant savages, and that our current understanding of nature represents the highest level of scientific knowledge that has ever existed on this planet. They are therefore categorically unwilling to entertain the notion that there could be any truth or validity to medical practices that were not developed by mechanistic, reductionist Western medicine. Whether or not alternative medicine has any merit is not at all a scientific question for them- it's personal.

    --Slurs and Ridicule:......the true skeptic refrains from ad hominem attacks and name calling while the pseudoskeptic elevates them to an art form. Examples abound in pseudoskeptical books and periodicals. .......

    Dr. Stephen Barrett of Quackwatch Exposed In Court Cases
    At trial, under a heated cross-examination by Negrete, Barrett conceded that he was not a Medical Board Certified psychiatrist because he had failed the certification exam.

    This was a major revelation since Barrett had provided supposed expert testimony as a psychiatrist and had testified in numerous court cases. Barrett also had said that he was a legal expert even though he had no formal legal training.

    The most damning testimony before the jury, under the intense cross-examination by Negrete, was that Barrett had filed similar defamation lawsuits against almost 40 people across the country within the past few years and had not won one single one at trial.

    During the course of his examination, Barrett also had to concede his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA).
    Dr. Stephen Barrett of Quackwatch Exposed In Court Cases, critic of lyme disease doctors and diagnosis

    Some other very important reading here:

    Data please: holding quackbusters to their own standards, Part I

    Data please: holding quackbusters to their own standards, Part II

    Credibility of Barrett/Quackwatchers etc.
    Topix.net: News Front Page
    ** Judge Fromholtz(not fooled by the fraudelent shift of "burden of proof" and in recognition of financial rewards-) ruled:
    ***Furthermore, the Court finds that both Dr. Sampson and Dr. Barrett are biased heavily in favor of the Plaintiff and thus the weight to be accorded their testimony is slight in any event. Both are long-time board members of the Plaintiff; Dr. Barrett has served as its Chairman. Both participated in an application to the U.S. FDA during the early 1990s designed to restrict the sale of most homeopathic drugs. Dr. Sampson’s university course presents what is effectively a one-sided, critical view of alternative medicine. Dr. Barrett’s heavy activities in lecturing and writing about alternative medicine similarly are focused on the eradication of the practices about which he opines. Both witnesses’ fees, as Dr. Barrett testified, are paid from a fund established by Plaintiff NCAHF from the proceeds of suits such as the case at bar. Based on this fact alone, the Court may infer that Dr. Barrett and Sampson are more likely to receive fees for testifying on behalf of NCAHF in future cases if the Plaintiff prevails in the instant action and thereby wins funds to enrich the litigation fund described by Dr. Barrett. It is apparent, therefore, that both men have a direct, personal financial interest in the outcome of this litigation. Based on all of these factors, Dr. Sampson and Dr. Barrett can be described as zealous advocates of the Plaintiff’s position, and therefore not neutral or dispassionate witnesses or experts. In light of these affiliations and their orientation, it can fairly be said that Drs. Barrett and Sampson are themselves the client, and therefore their testimony should be accorded little, if any, credibility on that basis as well.

    *****Stephen Barrett, is the operator of 19 different Web sites, and to the uninformed, it would look like(which is exactly his intent) there is a large/huge following, when in essence, it only a handful of heavily networked/linked/computer savvy posters/contributors.-------------------

    Edit: now that all being said, I strongly feel that CAM providers should spend time and effort cleaning up their own backyard...before somebody else comes and does it for us.
    Last edit by Josh L.Ac. on Dec 29, '06