Science-Based Medicine ? CAM and Creationism: Separated at Birth?

Over the past weekend, I had the opportunity to attend CSICon in Nashville, Tennessee. The Committee for Skeptical Inquiry (?CSI?) combats all sorts of pseudoscience, including creationism/creation science/intelligent design and alternative/complementary/integrative medicine. Our own Team SBM was ably represented by Harriet Hall, David Gorski and Kimball Atwood, whose presentation highlighted the credulous acceptance of CAM in some medical schools, and by Steve Novella, who gave a talk on the placebo effect and its exploitation by CAM proponents. Among many other presentations were those on the Mayan calendar and the end of the world,?unmasking of (supposedly) paranormal events, and the neurobiology of memory. Pseudoscience was given a well-deserved thrashing by rational minds.

On Saturday, I once again had the pleasure of hearing Eugenie Scott ,Ph.D., the virtually one-woman anti-creationism campaign who founded and heads the National Center for Science Education (NCSE). As I listened to her talk I couldn?t help but being struck by a number of similarities in the weaknesses apparent in arguments for creationism/ creation science/intelligent design (or ?ID?)and those for alternative/complementary/integrative medicine (or ?CAM?). I doubt the two groups like to think of themselves as ideological twins, but gosh, they sure do look alike.

CAM and creationism

Of course, CAM is not monolithic. I imagine some of those who promote CAM diagnostic methods and treatments would be perfectly happy being associated with Intelligent Design or any of its previous iterations, such as creationism. After all, if you think all interpretations of how the world works are equally valid you are not likely to quibble with the idea that God created the earth in 6 days any more than you would argue with acupuncture?s meridians and qi. And some CAM providers are so deficient in scientific training we can well imagine they might view the creation of man from clay as a plausible explanation of human evolution. On the other hand, if you are in, say, academic medicine, you would likely bristle at the idea that you have anything in common with an ID proponent. Even some of those in the Health Care Freedom movement, who endorse the concept that all treatments, no matter how implausible or ineffective, should be available to anyone who wants them, would probably draw the line at the notion that their arguments are no better than those which supposedly support ID.

ID, on the other hand, is exclusively a fundamentalist Christian concept, although with variations within that single ideology. (Mainstream Christianity does not reject evolution as an explanation for the origins of life.) As explained on the NCSE website, which I highly recommend, there are several types of anti-evolution creationists with differing points of view. (Below is but a rough summary and may somewhat conflate the various subtypes in the interest of brevity.)

Originally, anti-evolution creationists argued that the Bible is the inerrant word of God. Thus, if the Bible says that God created the sun, moon and stars on day four of creation, then that is exactly what happened. That was fine as long as those views were confined to religious settings. But the creationists wanted to go further by banning the teaching of evolution and teaching creationism in public schools. Here they ran into trouble in the form of the First Amendment and courts consistently held that creationism is religion, not science, and could not be taught in science classes. The creationists regrouped and invented ?creation science,? which argued that the creation story is actually supported by good science. That didn?t fly as an end-run around the Constitution so they came up with Intelligent Design, which attempts to expurgate creationism of all religious language. ID argues, as the name suggests, that science supports the existence of an Intelligent Designer (code for God) and that Darwinian evolution (which is, after all, ?just a theory?) is full of holes so, by default, ID correctly explains the origin of life.

It is my impression that CAM concepts such as vitalism will pass muster with IDers as long as the ?life force? underlying it is understood as God. I know anecdotally of Christian chiropractors who claim that what was originally known in chiropractic as ?Innate Intelligence? is actually God at work. However, to the extent that any CAM is inconsistent with Christian theology it cannot be accepted because of the exclusivity of Christian principles. Thus one cannot accept both that qi and meridians exist if one is loyal to Christianity. Although not an example from fundamentalist Christianity, this inconsistency with Christian doctrine is why reiki was condemned as a belief in the supernatural by the U.S.?Conference of Catholic Bishops in 2009.

I find there are remarkable parallels between the logical fallacies and sub-par?thinking?committed in typical?arguments made in favor of CAM and those in favor of ID. So if you are offended by the lack of good science behind one it is hard to be logically consistent in supporting the other. Let?s look at my list, which I set out with brief comments. Perhaps you can think of others.

Argument from antiquity

One of the well-worn arguments in favor of acupuncture is that it has been used for 2000 years (or 5000 years or ?thousands of years?) so there ?must be something to it.? (Actually, the acupuncture of today dates from the middle of the last century.) A similar argument is made for Ayurveda, Traditional Chinese Medicine (which incorporates acupuncture) and herbal medicine. As David Gorski pointed out in his talk at CSICon, this argument from antiquity could be made for humoural medicine, the concept that bodily function is governed by the four humours and the source of the ?science? behind bloodletting. Fortunately, it?s one ancient therapy that didn?t survive.

The Christian fundamentalist theology behind creationism also relies on the Bible?s antiquity as support for its inerrancy. When they sing ?that ole time religion . . . is good enough for me,? they really mean ?ole.? This is no more persuasive than the antiquity (real or invented) behind CAM diagnostic methods and treatments. There is nothing wrong, of course, with ancient peoples attempting to interpret their world as best they could with the tools at hand, but their views of biology and physiology should no longer hold sway when surpassed by scientific discovery.

Argument from ignorance

As Irish comedian and CAM critic Dara O?Briain famously said:

Science knows it doesn?t know everything; otherwise, it?d stop. But just because science doesn?t know everything doesn?t mean you can fill in the gaps with whatever fairy tale most appeals to you.

NCSE echoes this thought in discussing ID:

ID has been called an argument from ignorance, as it relies upon a lack of knowledge for its conclusion: Lacking a natural explanation, we assume intelligent cause. Most scientists would reply that unexplained is not unexplainable, and that ?we don?t know yet? is a more appropriate response than invoking a cause outside of science.

Bad science

What we might collectively (and colloquially) refer to as ?bad science? is the sine qua non of CAM. Without bad science CAM cannot exist and thus we find it across the full spectrum of CAM promotion. Whether cherry-picking the evidence,?tooth fairy?science, lack of plausibility, making inappropriate conclusions from studies, or other insufficiently rigorous methodology, bad science can be found at all levels of CAM. At the lower reaches, go to any CAM organization or practitioner website and I defy you to find a complete explication of the scientific evidence for or against a CAM treatment (that is, real CAM, not treatments rebranded as CAM.) At the higher levels of CAM apologists and promoters, such as NCCAM, hospitals, medical organizations and otherwise respectable medical schools, you?ll find plenty of examples of bad science harnessed in the service of CAM.

While I do not understand evolutionary biology (or any kind of biology for that matter) well enough to list the many examples of bad science in ID, fortunately Eugenie Scott does. An article she and Nicholas J. Matzke authored and published in the Proceedings of the National Academy of Sciences (2007) gives a brief explanation and supplies references to scholarly critiques of ID and its predecessors. Those criticisms were brought to bear on ID in the landmark case Kitzmiller v. Dover, in which?a federal?district court judge found that?ID was simply a form of creationism and its teaching in public schools a violation of the First Amendment.

(As an aside, I have often wished for a similar opportunity to put CAM, or any of its iterations, on trial. Unfortunately, there is no constitutional prohibition against bad science. Perhaps there should be.)

Keeping an open mind

Although years of research have failed to uncover a single CAM treatment that is better than placebo, proponents claim that we should ?keep an open mind.? As David Gorski pointed out in his CSICon presentation on CAM in medical schools, it?s not a good idea to keep one?s mind open to the extent that one?s brains fall out.

Likewise, ID proponents attempt to dress up teaching the pseudoscience of ID in the classroom as ?teaching the controversy? and an issue of ?academic freedom:?

Although in the 1990s IDC [Intelligent Design/Creationism] advocates had encouraged the teaching of ID in public school science classes as an alternative to evolution, in the early 2000s they shifted their strategy. IDCs currently concentrate their efforts on attacking evolution. Under innocuous-sounding guises such as ?academic freedom,? ?critical analysis of evolution,? or ?teaching the strengths and weaknesses of evolution,? IDCs attempt to encourage teachers to teach students wrongly that there is a ?controversy? among scientists over whether evolution has occurred. So-called ?evidence against evolution? or ?weaknesses of evolution? consist of the same sorts of long-discredited arguments against evolution which have been a staple of creationism since the 1920s and earlier.

Moving the goalposts

Steve Novella?s CSICon presentation on the placebo effect noted that originally CAM proponents claimed they would show that CAM treatments had real physiological effects. But after a billion or so dollars of taxpayer funded research that didn?t pan out so they switched claims. Now they are ?harnessing the power of the placebo? and physiological effects have been exchanged for ?healing? (whatever that means).

Likewise, creationists originally sought to ban the teaching of evolution in public schools. They succeeded early in the last century, hence the Scopes trial in the 1920s, in which a teacher was convicted of defying the Tennessee ban on teaching evolution. However, when a series of federal court cases decided that creationism was pure religion, not science, tactics shifted to teaching creationism, later rebranded as ID, along with the science of evolution. When ID was exposed as creationism, the tactics shifted again to the ?academic freedom? argument mentioned above.

Legislative alchemy

If science doesn?t support you, make sure the state legislature does. In a process I call ?legislative alchemy? implausible and unproven treatments such as subluxation-based chiropractic, homeopathy and acupuncture are transformed into licensed health care practices.

IDers use the same approach. As mentioned, early on they were able to simply ban the teaching of evolution. Now, they take a different tack in the form of so-called academic freedom laws.

There are two main strains of ?academic freedom? bills. The first mandates that teachers be able to discuss ?the full range of scientific views regarding biological and chemical evolution,? and offers students ?protection for subscribing to a particular position on views regarding biological or chemical evolution.? Bills of this strain typically also include unsubstantiated claims of widespread persecution of teachers and students who criticize evolution. The Discovery Institute?s ?Model Academic Freedom Statute on Evolution? is of this form.

The second strain does not purport to be concerned with student rights, and cites the need to help students develop ?critical thinking skills? on ?controversial issues.? To this end, it permits teachers to discuss ?the scientific strengths and scientific weaknesses of existing scientific theories.? The listed ?theories? often cover several topics of concern to the religious right: primarily evolution and abiogenesis, but also global warming, human cloning and stem cell research. One example of this strain is 2008?s Louisiana Science Education Act.

From 2004 to spring 2011, at least forty such bills have been filed in 13 states.

To date, these bills have become law in Louisiana and Tennessee.

Conclusion

So where does all of this get us? I do not argue that if one believes that CAM should be a part of medicine in particular or health care in general then one necessarily believes in ID, or vice versa. But I do believe that the arguments for CAM are based on the same logical fallacies and fuzzy thinking that the ID movement uses. And if the thought that their arguments are cut from the same cloth as creationists makes CAM proponents queasy then perhaps it is time they reexamine their beliefs.

Source: http://www.sciencebasedmedicine.org/index.php/cam-and-creationism-separated-at-birth/

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