It can be very instructive when proponents of alternative medicine respond to comments or criticism from skeptics. Sometimes, they respond with reasoned, even evidence-based defense of a specific practice. This is a good sign and can lead to productive discussion. More often, they respond with passionate but empty rhetoric simply asserting that they are right and their critics are ignorant, greedy, or simply terrible people. This is not a good sign, but it is still instructive because it often reveals, in their own words, underlying beliefs or attitudes that inform their practices and give the lie to any impression they may try to create that they are offering evience-based therapies.
Such is the response of Dr. Will Falconer to “skeptics,” which I suspect may mean me given his blog post comes a few months after several of mine mentioning him and his dangerous rejection of science-based medicine in favor of homeopathy (here and here). Dr. Falconer’s posts are regularly recommended on the Facebook page of the Academy of Veterinary Homeopathy, so I think it fair to say he is not a lone extremist but a representative of a perspective widely accepted among veterinary homeopaths, and I suspect the larger holistc veterinary medical community.
The core of his response to skeptics is a straightforward rejection of science in favor of personal experience, which is one of the key philosophical underpinnings I have previously identified as a characteristic feature of alternative medicine. He calls this “Common sense vs The Age of Science,” and makes it clear that when science is in conflict with belief and intuition, science is to be rejected. He uses one of the classic examples of quackery to suggest that what science says is untrue is patently obvious to anyone with common sense–the disproven but still widely feared link between vaccines and autism:
The “science” drum is beaten loudly when skeptics enter a conversation. Instead of being open minded and inquiring, these minds have snapped shut like a steel trap, rebuking anyone who doesn’t toe the line they’ve drawn on what’s real.
“Where’s the research, the double blind studies?!” “There’s no scientific proof that homeopathy is anything more than water. Anyone who gets well from it is making it all up! It’s a placebo response!!” “Vaccinations do not cause autism.” Etc. etc.
Meanwhile, mothers are seeing their perfectly normal, well adjusted toddlers lose all vestiges of normal life shortly after getting vaccinated. The rising autism incidence parallels closely the rise in vaccine requirements for children over the last 20-30 years. Any careful medical research could uncover this.
The evidence is overwhelming that vaccines do not cause autism and that the irrational fear of vaccines has sickened and killed many children, but Dr. Falconer believes we are all so infallible that simple, everyday experience outweighs the evidence of hundreds of studies involving millions of children. Except, of course, for the everyday experience of those of us whose common sense tells us vaccines have nothing to do with autism.
Dr. Falconer then goes on to try and show that scientific research is worthless, and that even leading figures in science and evidence-based medicine don’t believe in it. His failure to understand what he reads, and his ability to twist it to fit his ideology despite the fact that the people he discusses are in direct and active opposition to his view, is truly amazing.
He begins by citing John Ioannidis’ work showing that false positive findings and exaggerated effect sizes are common in publishes scientific research. Quacks love to cite this study because they believe it means science is worthless and they are free to ignore it. As others have discussed in detail, this is not at all what this research means or what Dr. Ioannidis believes. Science, unlike “common sense,” intuition, and personal faith is an ongoing, self-correcting process. We are constantly identifying each other’s mistakes and working as a community towards better understanding. Identifying and correcting the sources of error in the conduct and reporting of research is part of this processes. Dr. Ioannidis is not suggesting we give up on science. In fact in his latest paper, which I wrote about last week, he lays out a strategy for using scientific research to do precisely what faith-based practitioners like Dr. Falconer are so unwilling to do: to identify and abandon ineffective therapies using scientific research.
Dr. Falconer also cites one of the founding figures of the evidence-based medicine (EBM) movement, Dr. David Sackett, stating that he has given up on evidence-based practice. However, even the quote Falconer uses shows that the reason Dr. Sackett has quit teaching EBM is precisely because he’s afraid his status as an expert might inappropriately lead others to value his opinion and experience as an individual over objective data.
Sackett is not doing this because he has ceased to believe in evidence based clinical practice but, as the BMJ comments, because he is worried about the power of experts in stifling new ideas…
Dr. Sackett has twice announced he is quitting a specialty in which he has been recognized as an expert, and in a recent interview he explains why. He feels that recognition of expertise too easily leads to the fallacy of appeal to authority, in which the personal experience and opinion of the expert is given too much credence and contrary arguments or evidence is ignored.
Yet this is exactly what Dr. Falconer is arguing for, the rejection of scientific evidence in favor of the opinion and experience of supposed experts. He lauds Andrew Wakefield and Samuel Hahneman for the wisdom of their experience and ignores the fact that extensive scientific research has proven them both to be wrong. Rather than a brave, independent thinker challenging dogma and orthodoxy, Falconer is advocating uncritically accepting and following the word of supposed experts based on their individual experience. And rather than humbly accepting human fallibility and accepting the need for mechanisms to guard against our own errors and misjudgments, he, like Dr. Fallek and so many other alternative practitioners, believes his own experiences and perceptions to be so reliable that no amount of data or evidence to the contrary can cause him to question his beliefs.
And then, without a trace of self-consciousness or irony, he concludes his response to skeptics by asserting his proud refusal to listen to anything that challenges his beliefs and his adherence to two of the most definitively false beliefs of alternative medicine, and he bizarrely tries to turn the world on its head and call this attitude “evidence-based medicine.” Bizarre but instructive:
Just as you’ll never convince mothers of autistic children that vaccinations are harmless, you’ll never convince veterinary homeopaths that animals are getting well by delusion. We’ve got volumes of patients that speak otherwise. Animals don’t live in delusion.
We don’t have time for the skeptic’s blathering. We’ve got work to do. Medical research marches on, pet by pet, horse by horse, tot by tot: real patients, real results.
Homeopathy: Evidence based medicine at its finest.