I am highly intellectually attracted to skeptics and their writing. Their books are intelligent and entertaining, and they write about subject matters which I find fascinating. If I drew a Venn diagram with skeptics on the one side and alternative therapists on the other, I would be in that segment in the middle. I used to find it odd that Carl Sagan, atheistic scientist, was involved in the search for extraterrestrial intelligence (aka SETI) and openly pondered the existence of God. I took a course with a skeptical medical acupuncturist who was totally dismissive of cranial (“it’s entirely placebo”), yet was quite happy with the concept of something which sounded like “deh chi”, a term seeming to mean ‘when you can’t quite say exactly what is happening, but you know something is happening.’ Richard Dawkins, instead of simply leaving religion to the nutters, insists on thinking about it so much he is compelled to write a huge book about it. Simon Singh has done considerably more research than I have into a wide array of alternative medical practices, and it’s my industry! Edzard Ernst claims to have wished he could have been left to pursue his drumming and rheology research in peace, but dragged into the arena he has now engaged fully and adversarially with the alternative medicine world.
Read my account of his talk on chiropractic here.
Yes they think I’m on the “lunatic fringe”. I think their books are a great read and I’d recommend them.
Try not to use the following arguments with these people
Acquainted as I am with how they think, I know just how weary and frustrated they are by our un-thought-through arguments. Here are just a few of the things we say that make them consider us to be idiots and loonies. This is a plea not to use these without thinking them through. If you think them through, you probably won’t use these arguments because you’ll realise they don’t hold water. If you are using one of these arguments, and can justify it, please do let me know, as I have a huge interest in putting our case to the skeptics.
- People wouldn’t keep coming back if it didn’t work.
Really? They might. Ever heard of co-dependency? Let’s face it, people come back to abusive relationships which are demonstrably doing them great harm. Your patients might come back to you because they like you, because this relationship with you is the one time in their week when someone touches them, or listens to them, or puts them first. I know someone who found a reason to go to his local newsagent six times a day becuase he fancied the woman working there. Patients might even feel a sense of obligation to you, or be scared to tell you the treatment isn’t helping.
A skeptic would say: They might indeed come back, because they mistakenly believe it is working, or because it is an unhealthy, unethical or dependent relationship.
2. I see patients getting better every day
Well, I know that we do see patients getting better every day, and let’s be clear, I do believe osteopathy does makes people better every day, but that’s only acceptable scientific evidence to these people if you’ve added up all those examples and compared them with people who haven’t had osteopathic treatment in a large, preferably blinded, even more preferably double blinded, clinical trial. I might have a treatment in the midst of a bad head cold, but if the cold clears up a few days later I don’t attribute my recovery to that treatment. And that’s what skeptics think is happening until we can show otherwise. The CauseHealth group are looking at the problem with demanding RCT type of evidence for unexplained medical symptoms like pain, though, so watch this space for better and more fitting ways to show our efficacy.
A skeptic would say: You are fooling yourself and the patient
3. What we do elicits a placebo response which they wouldn’t have got without coming for treatment.
This has become quite a fashionable argument recently. And I quite like this one. Even people who cast doubt on the strength of the placebo response admit that it might have an effect on pain, which is what we are normally dealing with in practice. I think, too, that the phrase “placebo response” has almost started to be regarded as interchangeable with “healing response”, and that is what we are trying to promote. By hook or by crook, we want that patient to go out of the room improving, and if we do that using compassion, compressions, an HVT, exercise advice, or a combination of different modalities, surely it makes our treatment effective as a package? If there is no other treatment available for that patient, what is wrong with this?
A skeptic would say: Do the same thing but include a scientifically validated treatment.
4. Lots of medical treatments are not evidence-based either.
I was asked about cranial osteopathy by a group of oral and facial surgeons at Charing Cross hospital once. I still cringe to remember how I couldn’t really explain what we did, and apologetically explained that it wasn’t evidence-based. The thing is, I cared more about that lack of evidence than they did! “Oh, I don’t think what we do is usually evidence-based” said one, “It seems to work and that’s good enough for us”, laughed another. Medics on the ground might be relaxed about this, but this is not a good argument to use with a skeptic. It’s the kind of reasoning my kids use to justify not tidying their room or helping clear the table: “Henry hasn’t done it either”.
A skeptic would say: Just because medicine doesn’t yet have evidence for all their procedures doesn’t mean you don’t have to bother.
5. But doctors and medicine kill thousands of people every day
Yes they do, and I am as wary of medical procedures as anyone. And the dangers to our patients tend to be tiny compared to the dangers of major surgery or powerful drugs. Even though skeptics search out and publicize every incident caused by alternative practitioners, they still don’t find that many that osteopaths are involved in. There’s a website called Whats the Harm? devoted to this, and they have uncovered two shocking cases in which serious adverse events occurred as a result of osteopathic treatment in the UK. I don’t want anyone to think I am minimising these tragedies. They were two too many, but fortunately only two. I could give several examples of people I know dying or suffering prolonged complications following medical procedures or doctors’ misdiagnoses, and that’s without even thinking hard. The trouble is, skeptics accept the adverse events in medicine, because they believe the benefits outweigh the risks. Wedded as they are to their RCT-based evidence model, they are yet to be convinced of the benefits of our treatment, therefore they regard any risk as unacceptable, even a bit of soreness after treatment. In addition, this argument is a bit like the last one. Just because medics cause a lot of harm, doesn’t mean we shouldn’t make sure we minimise adverse events in our own. We are not responsible for the medical profession; but we are responsible for ours. Using our reporting system and putting every single thing that goes wrong on PILARS to get some insight is a start.
A skeptic would say: Those medical treatments have shown that the benefit is worth the risk. As you have not convincingly demonstrated the benefit of your treatment to me, I do not think any risk is acceptable.
Increasingly the argument seems to distil down to what is regarded as acceptable evidence, and we might need to look at the foundations of scientific practice and the philosophical basis of scientific reasoning to get to the bottom of this.
Thanks for reading.