What not to say to skeptics

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.

  1.  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.

See my blog on Cause Health here and here to learn more about the evidence discussion.

Thanks for reading.



One thought on “What not to say to skeptics

  1. Interesting post Penny. I wonder why you would not consider yourself a skeptic? You do a lot of questioning in your own right, and have some very skeptical things to say. Or why you see there is an us and them – “these people”. I’m an osteopathic practitioner and a skeptic, and a person.

    As a skeptic I’d add a little to the answers you give.

    “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.”
    – A relationship does not have to be unhealthy or unethical or dependent for a person to come back and receive a treatment that does work to fulfill the claims made of it. A person might feel better and that is important, but has the treatment changed anything on a physiologically measurable level – did they actually get better? And I think this is the crux of it – the claims made of both the mechanism, and outcome of a treatment outcome should be supportable in some way. Claims don’t have to be proven, but claims made to say a condition can be treated by a modality when the evidence shows it can’t are unethical at best.

    “A skeptic would say: You are fooling yourself and the patient”
    I don’t think its likely that a skeptic would say that to the observation that a practitioner sees patients get better every day. Very likely they do. People who are ill get better all the time, treatment or no – self healing as it turns out. Is the practitioner claiming they had a direct influence on the person getting better, and by better see above? Are they including the people they don’t see getting better? Then fooling themselves and their patient would be apt.

    “A skeptic would say: Do the same thing but include a scientifically validated treatment.”
    A skeptic might say do the same thing but you don’t need a scientifically validated treatment, as you mention there are few of those available. You do need at a minimum a plausible treatment that does not deny the known laws of science and you do need a clinical reason for treating. The other thing I would say as a skeptic is that placebo is inherently inert and we should not knowingly (which is deceptively) use an inert treatment to illicit a placebo effect (hopefully not nocecbo, because that’s the other side of the coin) and get paid for it. A treatment is effective as a package if the goals of the treatment are reasonable. Less pain, better mobility. Sure. Manual and physical therapies do have scientific and research support (not proof) for their use toward those goals – there are very reasonable models based in known science for why, and why not. If your package includes treating a ‘condition’, whether real like arthritis, or fake like a subluxation then that would be a different issue.

    “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.”
    That seems accurate. Also new treatments in medicine are not generally based on thin air (well, not anymore). They are derived from prior trial and error, or change in data and information. They are not all scientifically validated, but neither are they completely novel.

    “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.”
    A skeptic would also say that actually benefit and risk are weighed up all the time, and treatment protocols are changed if it is found that the risk outweighs the benefit. The numbers needed to treat (NNT) website is an example – http://www.thennt.com/thennt-explained/. As well medicine saves thousands of people every day that could not have been saved by alt. med. Skeptics not only seek out harm that is done by alt. med. but also by medicine. Harm is harm. But alt. med. is far more harmful in doing nothing than in doing no harm (or no benefit) because it has resulted in people using a treatment that is promised to, but cannot help them, instead of a treatment that could have.

    The question of acceptable evidence seems right – claims made should be supported and if they cannot be supported, they should be withdrawn. Acceptable evidence goes two ways. Acceptable for treatment and acceptable against treatment. When the evidence against outweighs the evidence for …

    Liked by 1 person

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