The harms of medical pseudoscience and why it is on the rise
Updated: 15 hours ago
(This email is in a series of emails on pseudoscience in medicine, and a continuation of my last email.)
In this email, I plan to demonstrate that pseudoscience in medicine is a problem. First, it is a problem because it can cause harm; either directly, or by undermining science. Second, despite these harms, pseudoscience is on the rise and thriving in our current environment of expanded societal freedoms. Let's explore these claims...
The harms of medical pseudoscience
I have been writing about medical pseudoscience for over twenty years now. The typical response I get is, “What's the harm Dr Woolf? So what if pseudoscience produces medical treatments that probably don't work. At worst, it can provide a comforting placebo. Don't you want your patients to feel better?”
Actually, there are several harms of medical pseudoscience. First, the placebo effect is only psychologic, not physiologic. Therefore, sick people can "feel" better, when in reality they are still sick, and should be seeking proper care. Second, there are opportunity costs to pseudoscience; time wasted that could have been applied to the correct diagnosis and treatment. Third, pseudoscience-based medical treatments (like all treatments) have direct side effects. These include treatments without any proven benefit (colonics, home IV vitamin infusions, detox cleanses), or treatments used outside of their proven benefit (hydroxychloroquine for COVID; antifungals for Candida syndrome, antibotics for chronic Lyme disease, chiropractic neck adjustments for ear infection.)
Forth, and most important, pseudoscience promotes anti-science thinking. This is because pseudoscience, by definition, lacks strong evidence and is threatened by peer review. It’s only recourse when challenged is to discredit science or try to fool us with logical fallacy. Typical strategies include: appealing to false authority, denying the scientific hierarchy of evidence to make weak evidence look strong, attacking the scientific method to avoid disconfirming evidence, applying magical thinking to explain the implausible, and when all else fails, invoking ad hominem attacks and conspiracy theories against science.
Because pseudoscience lacks strong evidence and is threatened by peer review it’s only recourse to challenge is to discredit science or to try fool us with logical fallacy.
Anti-science thinking is often insidious in nature. With time, a person with good intentions can be slowly indoctrinated with conspiracy thinking. Indeed, this has become quite problematic and prevalent. A survey published in JAMA in 2014 found that 37% of the US population believed “Big Pharma” was conspiring with the government to suppress the cure for cancer. Beliefs like these can be quite hazardous to your health. Anti-scinece thinking makes pseudoscience, not just a superior choice, but your only choice. Observational studies have shown that patients who use alternative medicine exclusively to treat their cancer, are at a 250% increased risk of death compared to patients that use conventional therapies. (Observational studies are not strong evidence, but a large effect size like this is hard to explain away).
Anti-scinece thinking makes pseudoscience, not just a superior choice, but your only choice.
Without getting into details, the recent COVID pandemic has perfectly manifested all of the above dangers of pseudoscience - especially the last one. In a tragic turn of events, it has provided me with the ultimate anecdotal evidence for the harms of pseudoscience I wish I never had.
Medical pseudoscience on the rise
Despite the incredible fruits of scientific reasoning in the field of medicine, and the obvious harms of medical pseudoscience, it appears that medical pseudoscience is actually on the rise. The reasons for this are complex and multifactorial. However, an expansion of our freedoms over the past several decades appears to be the one overarching factor. These freedoms include: social freedom, freedom of industry, freedom of information, and patient freedom. All of these freedoms are generally good, but every freedom comes with a price and a responsibility.
Every freedom comes with a price and with a responsibility.
Let’s review each of these freedoms, and how it has created an environment for medical pseudoscience to thrive in:
Social freedom is the result of globalization and the accompanying enlightenment of moral relativism. Over the centuries we have become more open-minded and more tolerant to differences in people's political, cultural, and ethical beliefs. Unfortunately, this ideology has spread in the past several decades to areas it does not belong, such as the medical sciences and other fact-based disciplines. Here, it is called, “factual relativism". Factual relativism holds that there is no absolute truth. Everything is relative. All beliefs are equally good, and all beliefs must be respected and given equal weight. This means, that in science, we must be tolerant and non-judgmental of different beliefs.
As an example of this factual relativism in medicine, we once called medical pseudoscience, “Quackery”. However, over the recent decades this name was slowly, but forcefully, amended to reflect the ideology of tolerance. “Quackery” was criticized for making pseudoscience sound too corrupt. So we began to call it, "Alternative medicine". But this was criticized for making pseudoscience sound too fringe. So we began to call it, "Complementary medicine". But this was criticized for making pseudoscience sound too subservient. So now we call it, "Integrative medicine"; to make science and pseudoscience sound equal, and completely avoid any accusations of bigotry or intolerance.
The term “integrative medicine“ is, of course, absurd. We are only fooling ourselves that science and pseudoscience are equals; to be "integrated" and live in perfect harmony. Science is not just different from pseudoscience, it is the antithesis of pseudoscience. In fact, one undermines the other. Science must be critical of beliefs. It works by disconfirming and discarding beliefs. An environment that prohibits critical thought will mark the death of science, and the ideal environment for pseudoscience to thrive.
Science is not just different from pseudoscience, it is the antithesis of pseudoscience.
Despite this, both academic medical institutions, and government, have bowed down to factual relativism. A particularly problematic development as it gives a false sense of legitimacy to medical pseudoscience. All of the major academic medical institutions now have substantial departments of Integrative medicine; many of which are partially government funded. You can go to Cleveland Clinic and have your heart fixed by the hands of a surgeon, or you can have your heart metaphorically fixed by the hands of an Energy healer. The NIH grants billions of your taxpayer dollars for research to its pseudoscience division, NCCIM (National Center for Complementary and Integrative Medicine). Money well spent on trials like this one, testing whether multiple daily enemas of coffee can cure pancreatic cancer. State governments are now legislating, licensing, and credentialing pseudoscience-based practices, such as: Naturopathy, Chiropractic, and Acupuncture. These practitioners have even attained the legal status of "primary care physicians" in certain states. All of this giving medical pseudoscience a false sense of legitimacy, in the name of tolerance and freedom.
(What‘s interesting is that factual relativism has not yet penetrated to other areas of the hard sciences. We don’t yet have a department of Astrology “integrated" into the Astrophysics department, or a department of Alchemy in the Chemistry Department, or an Alternative Aeronautical Engineering department that is pursuing magic carpets for flight. No, this ideology seems to be most penetrant in the field of medicine.)
Freedom of industry
Medical pseudoscience thrives in a free market. It has all the earnings potential of science without all the red tape and expense of clinical trials to prove safety and effectiveness. This makes medical pseudoscience a far more attractive business model than science. In addition, industry has recently found many loopholes around regulation, or successfully lobbied to have it removed, so health products without evidence can now be sold. It is easy to market and sell them directly to patients, and get away with all sorts of dubious health claims and promises. For example: laboratories are allowed to sell unvalidated tests (genetic tests, food sensitivity tests, etc) as long as they provide a disclaimer, supplements have grown to over 80,000 products since they became unregulated in 1994 (with the DSHEA act), foods with health claims (gluten-free, kale, GMO-free, pesticide-free) have become a multibillion dollar industry, stem cell clinics have opened up in the thousands, and IV infusions with all sorts of dubious claims can be ordered to your home like Instacart.
A free market also responds to demand, and from this perspective, pseudoscience, once again, has science beat. Without the requirements of strong evidence, pseudoscience can create demand by offering far more enticing and broad-scoping promises, such as: boost your immunity, recover from exercise faster, lose weight, improve your memory, a cure for hangovers, and a cure for cancer. Did I mention that all of this is "natural" and completely side effect free? You can't compete with that. The big academic institutions selling Integrative medicine, and the thousands of independent pseudoscience practitioners selling supplements and other services, are simply responding to market forces and demand.
Freedom of information
Medical pseudoscience thrives with freedom of information. Where industry draws a line with the claims it is willing to make, the internet, social media, and TV shows like Dr Oz, have no bounds. They give pseudoscience a platform to connect directly with patients. and make claims and promises that even a marketing executive would balk at.
In the current environment, pseudoscience will always win over science. It looks like science, it is legitimized by academia and government, and it can creates far better clickbait. This leads to more views, more likes, more subscribers, and more ad revenue. In fact, medical pseudoscience can be used as the perfect model of exponential growth in our new information age. Case in point, the science-based medical blogs, videos, and podcasts I admire have hundreds of subscribers. The ones with pseudoscience have tens of millions. To make things worse, the conspiracy thinking and anti-science message embedded within pseudoscience comes along for the ride, leaving pseudoscience as, not only the superior choice, but the only choice. All of this is reinforced and radicalized by echo-chambers created by algorithms designed for more views. To claim that medical pseudoscience and conspiracy thinking have thrived with freedom of information, is an understatement. It's been viral.
Pseudoscience thrives with patient freedom. Over the last century, patients have been extended many legal rights to ensure their freedoms: the right to make decisions for themselves (autonomy), the right to a second opinion, the right to privacy (HIPAA), the right to access their health records, etc. These freedoms are then enabled by the above freedoms of industry and information. Patients now have direct and convenient access to medicine outside of their doctor's office. Direct access to educate themselves, diagnose themselves, connect with specialists, and purchase treatments. The age of medical paternalism, in which the doctor knows best and completely entrusted to diagnose and treat the patient, is over. This is a good thing.
But, there is a dark side. Patients are vulnerable. They are suffering, and just want to get some answers. However, they are unable to tell science from pseudoscience and pseudoscience will always win. It looks like science, it is legitizmed by academia and government, and it offers simple solutions to complex problems. With the added anti-science message, it becomes, not just the superior choice, but the only choice for the vulnerable.
The problem of medical pseudoscience
In summary, pseudoscience can cause harm. It can cause harm directly, or by undermining science. Despite these harms, it is on the rise and thriving in environments with expanded freedoms. Environments where all beliefs are respected, legitimized, and left unchallenged. Environments where industry and information are left unregulated. And environments where the vulnerable are left to their own devices to figure things out. In these environments pseudoscience will always win over science.
To solve the above problem, I certainly will not recommend the curtailment of anyone's freedoms, nor will I speculate any other long term sociopolitical solutions. It is far from my area of expertise. Furthermore, long term solutions won't help you for the immediate future. A more immediate fix is to learn how to tell science from pseudoscience. As I mentioned earlier, freedom comes with a price and a responsibility. Your responsibility is to learn this skill. My responsibility is to teach it to you. Stay tuned, this will be your next email, "22 red flags of medical pseudoscience".