Sunday, March 17, 2013

The most recent "Anonymous" comment to my kefir post raised some interesting points that I felt required a more formal response.  Here is the text of the comment, without edit:

Anonymous said...
It is condescending attitudes like this that are driving patients away from mainstream medicine and toward charlatans. Just because medical labs have not adequately tested a treatment methodology does not mean there is no evidence for its efficacy.

What difference does it make whether the anecdotal self-reports are being published in medical journals or on amateur hobby websites? In either case you still have to take the patients' word when they say they feel better. And who cares if it's a placebo? Do they feel better or not?

By all means, critique foodsellers making untested medical claims. But don't mock the self-reports of patients who are proving more successful at treating their own illnesses than you are--especially when the treatment they have found has centuries of traditional use.

If they are saying that it works, then get in your lab and start testing.

I have been experimenting with kefir for the last two weeks. Despite the fact that I am a natural skeptic AND I hate plain yogurt, there is no question that my Crohn's, my ADHD, my chronic anxiety, and my restless limb symptoms are significantly improving, with a marked improvement in my bowel regularity. And the stuff tastes and smells absolutely delicious

I am indeed contemptuous and condescending regarding of the expounders of nonsense.  Nothing else seems to work as well when my goal requires drawing attention to quackery.  Besides that, its fun!

One of the important points raised in the Anonymous comment relates to "lack of evidence is not evidence of lack."  This appears to constitute the main point of Anonymous's first paragraph.  Great.  I get that.  But, understand that simply being ignorant is not an argument in favor of anything!  The fact that I don't know, simply means that I don't know!  It doesn't mean that I have to err in favor of this week's favorite quackery.  That would be an argument from ignorance--something that a skeptic, like Anonymous claims to be in his last paragraph, would understand.  The burden of proof regarding the efficacy of a treatment modality lies  with the purveyor.  Just because some crackpot claims he has a cure form an illness does not mean I need to break out the lab equipment.  The research dollars wasted by Anonymous's approach would be astounding.

Anonymous's second paragraph addresses, first, anecdotal evidence.  He implies that anecdotal evidence is an accepted, and even trustworthy, part of scientific research.  Medical and, more generally, science researchers, understand exactly the opposite to be true.  They understand that human beings are excellent at pattern recognition, but phenomenally terrible at statistics.  Anecdotal evidence is astoundingly error-prone.  That means that anecdotal evidence is considered untrustworthy.  In fact, one of the principle goals of a researcher in science is to bias-proof the research as much as possible.  In other words, the researchers work hard to eliminate sources of personal opinion and belief from their studies.

The second point in the same paragraph, regarding placebos, is more complicated.  I believe Anonymous means, essentially, that the "end justifies the means."  Hey, if a placebo works, what's the harm, right?  I believe this is a particularly paternalistic and dangerous approach to healthcare.  How would you feel if your physician recommended a treatment for you that he or she absolutely knew, worked no better than fake treatment, in other words, was just a placebo.  Worse yet, how would you feel if your physician, billed you, and your insurance, $130 for something he or she knew worked no better than that fake treatment?  In other economic areas like retail and auto repair, obtaining money by lying to customers is called fraud.

Patients have a right to expect that their physicians will tell them the truth about risks and benefits for tests and treatments, and that their physicians will not bill for services or treatments that the physicians know provide no benefit beyond that obtained by fake therapy.

Anonymous's last paragraph is just more anecdotal evidence.  "The plural of anecdote is anecdotes, not data."