Science Based Medicine, and Hard Conversations

Before I disappear for the holiday weekend, I wanted to put out one last post.

Firstly, go check out Science Based Medicine - a blog about the battle against pseudoscience. Go check it out! I’ll wait right here. I promise it’s relevant to the rest of this post.

Secondly, through the short lifetime of this blog my goal has been to educate people about science and evidence based medicine. This has proved more difficult than I initially hoped.

In my initial posts I at least try to keep the language understandable to the generic educated lay person. Sadly by about comment 3, a pseudoscience advocate cites 3-10 articles that they don’t understand, or that are thoroughly out of date. Then by comment 10, multiple scientists have appropriately responded, but the thread is no  longer in reach for the very people I was hoping to reach with this blog.

Unfortunately, journal articles are just as easy to manipulate into pseudoscience as any other resource. Google-fu now makes it easy to put multiple citations and some 10 dollar words between a loving family and the appropriate evidence.

I’m going to try to make some changes going forward to make this blog still more accessible, and hopefully keep the discussion more relevant and understandable. Unfortunately, to do so I’m having to make some hard decisions. I banned my first poster last night, which greatly disappointed me. I was hoping by keeping a respectful tone I’d be able to have an open engaging discussion with both sides of the aisle.

I was warned before I started that affording respect to those who will abuse it would burn me. Some sites don’t have this problem – without the courteous tone I’ve encouraged, it’s very easy to burn the pseudo-scientific offenders out. Sadly, until now it’s been very easy for someone to just keep citing random articles and throw out a few “I don’t understand”‘s to sound reasonable enough, yet derail any progress.

Now after the holiday weekend – I’ll be swearing off the Internet from when this post comes up on line until Monday – I will post updated guidelines for the Hard Conversations series, and for this posting on this blog in general. I’ll continue to be soft on patients, but I will be much Harder on Woo. I apologize if that makes this blog feel less open, less free of speech, but I now think it’s necessary to ensure we are not hijacked by the unscrupulous minions of ignorance.  

So how does this connect to the Science Based Medicine blog? The post series in particular is by the wonderful Kimball Atwood, “Harvard Medical School: Veritas for Sale” . I have linked to the first post in that series. It may not be entirely appropriate reading for one segment of my audience – the parents/patients  among you will find it dry. The scientists and doctors may find it an entertaining, and disturbing look at the big business of medicine. I find this relevant because if Harvard can’t get it’s business in order on science based medicine, how in the world can you?!

The reality is that, it’s a complicated task to keep up with what is science and what is pseudoscience. I will endeavour to cover and explain science based medicine to the best of my ability. Please continue to let me know where I can improve guys, I really appreciate your input.

For now, enjoy!

-Whitecoat Tales

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31 Comments on “Science Based Medicine, and Hard Conversations”

  1. Michael Says:

    I’ll continue to be soft on patients, but I will be much Harder on Woo. I apologize if that makes this blog feel less open, less free of speech, but I now think it’s necessary to ensure we are not hijacked by the unscrupulous minions of ignorance.

    You’re going to be a physician, and whatever your future specialty or whether you go into research, we’re going to rely upon you to be strong in knowledge, conviction, and science. Being hard on Woo is what you should do. We’ll all try to be civil to the trolls. :)

    And, if I could make a special plea, go edit a couple of medical articles on Wikipedia. You’ll see woo in its glory, where editors use a few articles out of context to prove their point.

  2. Chuck Says:

    There are many problems that evidence based sciences cannot currently address and may never be able to address. Not all sciences are evidenced based due to subjectivity. Evidence based sciences may never be able to answer many problems because reality is often very unethical.

    The subjectivity of reality handicaps a great many possibilities for evidence based sciences.


    • Disappointing…
      You either haven’t read much of this blog, or you didn’t understand it.

      But congrats! You’ve made a statement so horrendously incorrect, that you’ve earned yourself a post dedicated to you!

    • John H. Says:

      What are the problems to which you refer? Please explain. I don’t understand what “reality is often very unethical” means. “Subjectivity of reality”? What we perceive does depend on our ability to perceive, and we affect what we observe, but otherwise I don’t quite understand what you’re saying.

      • Chuck Says:

        Evidence based science relies on ethical analysis of objectively defined criteria that is repeatable by different entities. [Whitecoattales please feel free to chime in if this is not a good simple summation]

        Many things that happen in the real world will never be studied in the evidence based test tube because it would be unethical to do so even though it is observable.

        Doctors will often tout an evidence based study that relies on a subjectively define population or narrowly defined set of objectively defined criteria that makes the study nothing more then a lie of omission.

      • Michael Says:

        Chuck, I don’t mean to be snarky, but I have no clue what you’re saying. Everything in the “real world” has a scientific explanation.

    • trrll Says:

      There are many problems that evidence based sciences cannot currently address and may never be able to address. Not all sciences are evidenced based due to subjectivity.

      If it is not evidence-based, it is not science, so a more accurate way to express this is, “Not everything is science.” There are certainly many questions that science will never be able to answer, such as, “How much would could a woodchuck chuck if a woodchuck could chuck wood?” But any question that relates to the real world is subject to an evidence-based approach.

      Evidence based sciences may never be able to answer many problems because reality is often very unethical.

      Is a rock ethical? That is another questions that falls into the “woodchuck” category, because the word “ethical” as normally understood applies only to the choices made by thinking beings, so reality is neither ethical nor unethical. It has no choices to make; it just is. It is certainly true that there are many cases in which we cannot ask a question in the most convenient way, because it would require us to do something that we would consider unethical–take a large number of children, randomly vaccinate half of them, while leaving the other half unvaccinated and vulnerable to the risk of illness, brain damage, disability, and death from vaccine-preventable diseases, for example. But in science, there are almost always other approaches to a question that do not violate the bounds of ethics.

  3. John H. Says:

    Chuck, I was hoping for an example, because your statements are very opaque. Non-scientist here. Layman’s terms are called for.

    Your statements sound ominous, but unless we have an example that illustrates your point, they are just so many words. And it also goes beyond that: please explain how this is relevant and on-topic.

    • Michael Says:

      I agree. It almost sounds like Chuck is using complex verbiage and sentence structure to sound like he knows something, but it reads like a bunch of random words. Again, I’m willing to read anything that anyone writes, but I want to at least partially understand it.

    • Chuck Says:

      One example:

      Evidence based science will never be able to objectively prove the effectiveness of some vaccines. To objectively prove a vaccine’s reported effectiveness, you would have to expose individuals to the virus/sickness/malady. That would be unethical.

      • John H. Says:

        I suppose if the “natural” infection rate among a population is some known percentage, then the subsequent measurement of a much lower–or non-existent–infection rate, post-vaccination, doesn’t count as adequate “proof”? How is that not objective measurement? What’s missing from that assessment? Furthermore, what’s your point in all this? I still don’t see how what you’ve said is relevant.


      • The great thing about science is that we understand the underlying physiology before applying medicine. Before vaccines were “invented”, we had to understand immunology. In fact, a vaccine works by establishing a solid immune response to an infectious disease. Then, we publish a clinical trial that establishes that the vaccine actually does that.

        Then we publish epidemiological studies that show how the disease rate nearly disappears.

        Chuck, you fail to understand how these studies are performed and how the results are conclusive, without a subjective interpretation.

      • Chuck Says:

        Other than exposing an individual, how do you objectively prove that an individual has received immunity from the vaccine?


      • If you don’t understand how to prove immunity without exposure, I suggest you read an immunology text book.

        Argument from your own ignorance isn’t just a bad argument, it’s insulting to the community.

        It’s not my job to teach you basic science that you should have learned before entering the debate.

        One wouldn’t discuss gravity without knowing the math behind gravity. One should not enter the discussion on vaccination without studying basic immunology.

        Do your own due diligence!

        If a parent or patient asks a question out of ignorance, its a teaching moment.

        If an advocate persistantly asks questions while holding strong opinions, they are willfully ignorant.

        Shame on you, for letting my readers think you know at all what you are talking about.

      • Chuck Says:

        Proof of titers is not proof of immunity. Maybe you could provide some pointers that I could research on PUBMED abstracts.


      • Perhaps you could cite some evidence that titers do not correlate with immunity.

        Perhaps you could give a basic science explanation on why titers would not correlate with immunity.

        Perhaps you could read before wasting my time.

        Your questions are basic, you need to go to the library and find a textbook, as far as I can tell your understanding doesn’t justify a pubmed reference.

      • Chuck Says:

        Testing of titers is time sensitive to when the test was performed. Diabetes, kidney dysfunction, AIDS can have adverse effects on titers. If the individual was exposed to the actual malady, they have a better chance of regaining that immunity versus an individual that was immunized. I cannot list all of the possible agents that may adversely effect vaccinated immunity.


      • Diabetes, kidney dysfunction, AIDS can have adverse effects on titers.

        Extraordinary claims.
        AIDS will have an adverse effect on immunity period. No if’s ands or buts involving vaccination vs catching the disease.
        As for diabetes and kidney dysfunction, no citation, no truth.
        Furthermore, you’re claiming titers don’t work IN GENERAL, not that they might possibly have less value in some situations.

        If the individual was exposed to the actual malady, they have a better chance of regaining that immunity versus an individual that was immunized.

        No citation, no truth. No basic science explanation, no proof of concept, merely a grandiose claim from a diseased mind.

        I cannot list all of the possible agents that may adversely effect vaccinated immunity.

        You cannot list them because you don’t know them. You have broken all of the cardinal rules I have set forth for this blog, multiple times. This is your warning. Further ignorance of the rules will result in banning.

  4. Chuck Says:

    “What’s missing from that assessment? ”

    Was the probability of being exposed pre and post vaccination held constant and known as certainty for both populations and can it be objectively measured and determined that the vaccine is the only reason for the change in the exposure rate?


    • A small amount of google-fu reveals that Chuck has his own blog of this nonsense. He’s started out here as he has elsewhere with seemingly innocent comment about subjectivity. I’ll just shortcut out the next few posts and let you know how this conversation goes.

      Chuck your comments here have really been a word salad rather than a coherant relevant discussion.
      My patience for these conversations has waned greatly since starting this blog.

      What’s missing from that assessment? ”

      Was the probability of being exposed pre and post vaccination held constant and known as certainty for both populations and can it be objectively measured and determined that the vaccine is the only reason for the change in the exposure rate?

      As it happens you need none of these things to show the probability that vaccination was the cause of improvement to an acceptable P value. Knowing all of that might improve our accuracy – but they aren’t necessary.

      Why not? Because diseases like polio, measles, mumps and rubella were once rampant. I promise you it’s not better nutrition that has vanquished them, its vaccination.

      Now, knowing Chuck, he’ll bring in his favorite topic – the flu vaccine and how it doesn’t help anyone. He’ll probably bring in an anecdote of his having a bad reaction to a vaccine, thus NOONE should get vaccines.
      Then we’d have to explain the more subtle science used to prove these one way or another. Or we’d have to explain that a small percentage of people may have reactions to vaccines, but it does not ‘prove’ anything about vaccines.
      The reality is that Chuck’s understanding is limited to the very basics of science. He can ask one million questions about what he perceives as flaws of science. But he doesn’t understand the statistics that allow us to design good experiments.
      Furthermore, if we let him continue to froth at the mouth he’ll probably go off on a diatribe about how the CDC can’t be trusted, and we should only look for “independantly verifiable data” – which means “there is no data that I will truth, and any data presented to me will be unsatisfactory”

      I find you disappointing Chuck. Your posts elsewhere read like Jake Crosby’s – almost word for word in places. I will not tolerate more of this drivel here.

      • Chuck Says:

        I do not deny there are vaccines that I do not trust and will not use. I also do not deny that I do not trust government entities that report information without supplying objective support for that information.

        Whitecoattales, do you believe everything the government tells you?

        Vaccination should be just like every other medical procedure, voluntary and proven to be useful to the individual that is receiving it.


      • Chuck, please don’t use the appeal to the secret conspiracy as an ad hominem argument. I trust the CDC, NIH and FDA implicitly, even if they are government agencies, mainly because they are made of individuals who are ethical to the core.

        The reality is that Chuck’s understanding is limited to the very basics of science. He can ask one million questions about what he perceives as flaws of science. But he doesn’t understand the statistics that allow us to design good experiments.

        Sorry Whitecoat, but I’m not even giving him this much. If he understood basic biology, he would find these arguments trite and tendentious. But he doesn’t.

      • Chuck Says:

        “I trust the CDC, NIH and FDA implicitly, even if they are government agencies, mainly because they are made of individuals who are ethical to the core.”

        I implicitly trust people, but I do not implicitly trust organizations or government bureaucracies because they may have individuals who are ethical to the core, but they may not be in a position to dictate decisions or be in a position to direct their organization in the ethical direction that they believe to be correct. Politics makes ugly bedfellows.

        I do not deny that the CDC, NIH and FDA have made some good decisions and have made some bad decisions. The people I know that work in these organizations can tell you the good and the bad just like any other office environment.


      • Ad hominem arguments again. Hard to debate.

      • Chuck Says:

        I do not know what the proper response for the Argument from Authority fallacy should be. I will work on it.

  5. Chuck Says:

    Simpler explanation:

    “I suppose if the “natural” infection rate among a population is some known percentage, then the subsequent measurement of a much lower–or non-existent–infection rate, post-vaccination, doesn’t count as adequate “proof”? ”

    That is correlation. That is not proof.


    • Wow, you are getting tendentious. It’s hard to discuss anything with you when you fail to understand basic scientific reasoning. This correlation would be added to other data to support the hypothesis that vaccinations lower the incidence of disease.

      • Chuck Says:

        In an evidence based study, I would hope that other data would be added. Is the example as it was given, proof? No. I do not assume things that might be presented. Should any evidence based study assume things that are not presented? No.


  6. You’re writing in circles. Sorry, but I have no clue what you’re saying, and I’m pretty smart.

  7. trrll Says:

    Chuck says:

    Other than exposing an individual, how do you objectively prove that an individual has received immunity from the vaccine?

    You can ask this question at the population level. If you take a large enough number of people and randomly divide them into two groups, then then statistically a similar number of each group will be exposed to disease. If you vaccinate one group and do not vaccinate the other, and then compare the number of people who get sick in each group, you can tell whether the vaccine produced immunity in individuals within the vaccinated group.

    This is, as a matter of fact, how vaccines are actually tested.


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