Monday, May 12, 2014

Needles, Facebook, & being a Skeptic

When is it proper for a skeptic to opine on a topic job in everyday life?  I recently had a situation that made me think through why I actually think on a topic and do I reach a particular conclusion.   

Require better evidence before
I would needle this dog.
Acupuncture.  As someone who listens and/or reads Science Based Medicine, the SGU, Doubtful News, Respectful Insolence, and Quackcast, among others, the evidence is pretty clear that acupuncture at best is no better than placebo.  With this in mind when an article crossed my path on veterinarians use of acupuncture as not supported by evidence, I posted the story on Facebook.  I don't care much for people, but man do I love my critters (pets).  Next thing I know a Veterinarian who is a Facebook friend took offense as he uses acupuncture in his treatment of critters. He sent me an outtake from a peer reviewed study that acupuncture is indeed indicated and efficacious in animal treatment.   It kinda went downhill from there.  I have had similar discussion with physicians on the efficacy of chiropractic, on vaccines implicated in causing autism, and the use of acupuncture to treat patients over the years.  Be it a treater of critters or people, the provider always falls back on ‘but there are studies’ for whatever dubious claims or treatment modality they are supporting. 

When I get into these types of discussion with a legitimately trained expert in a field, it always gives me pause to ponder if I am on thin ice.  Who the hell am I, an attorney by trade, a historian in my dreams and educated in undergrad, and a mere science enthusiast to tell a licensed health care provider that what they are basing their knowledge upon for treatment practices is suspect?  I am a mere cheerleader for good scientific practice or a conduit for the unfortunate many holes and errors that exist in scientific studies. As a skeptic, it is fairly clear in realm of science, medicine, and discovery in general that there are studies that are large, robust, and repeatable that give an insight to how things work, and there are studies that might give an interesting result but are not of large enough scale, robust, or may not be repeated that give little or the wrong insight on how things work.  
Stick a needle in this innocent
faced critter for no good reason? I think not.

I can read an abstract and get the gist of it most of the time.  I can even at times make some heads or tails of the actual body of the study.  When it comes to whether the study itself is a good one, I rely upon experts to explain why one study is good and another is dubious.  Dr. Harriet Hall, Dr. Steven Novella, Dr. Mark Crislip, Dr. Gorski etc are wonderful at breaking down medical studies and why one study is good and another is not so hot.  The issue is that medical providers for men or beasts for the most part just rely on the fact that a study was done, and don’t dig down deeper.  I do not criticize providers for such practices they should be able to rely on studies more but there are a lot of crummy studies that are under-vetted.  Enough studies give the patina of widespread and deep support. 

Despite the above, sharing with an undoubtedly smart and trained professional that the information they are relying upon is crummy rarely goes over well.   When it comes down to it, I am not telling them they are wrong in their treatment practices. is not easy to get across I am not saying medical treatment X has weak support, I am just relaying what other experts who are learned in the field at hand are saying, but it does not engender much respect.  I am not exactly sure how to get around this problem of being a cheerleader, but not an actual player.  The best analogy I can think of is that if someone asked me to do some legal task (no, let's use the editor as the example as she is a superb attorney) to do a legal brief on a topic, but some of the law texts are unknowingly incorrect, the final product is bound to be flawed.  The skills of the attorney might be excellent, but if the basis for the brief is wrong all those practiced skills are for naught.  When it comes down to it, I am not telling them they are dumb and I cannot say what is good practice.  I can point out practices that appear to be based on poor evidence when they are brought to the curious person's attention.  

I will say I was frustrated that one of the researchers being criticized in the article I shared on Facebook for the efficacy of animal acupuncture was one of the researchers being repeated back to me as evidence that acupuncture works in animal treatment.  I wished to laugh, but instead I just want to cry.   I am not an expert.  I rely upon the expertise of others who also explain their reasoning.  Unfortunately, science and academia are imperfect and at times let their practitioners down.  

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