Big Placebo: An Alternative to Evidence

Although the focus of this blog is on exposing the irrationality of religious belief, there are many different beliefs based on faith or culture (as opposed to evidence) that concern me and can have disastrous results.  One of the most significant and obvious of these irrational beliefs is the growing popularity of ‘alternative medicine’.  In the following post, I will do my best to briefly summarize the tactics used by those who would take advantage of the public distrust in science and particularly science-based medicine.  However, I am not fully qualified to speak on the subject in any detail, so I would encourage additional reading on a popular blog devoted to this subject, http://www.sciencebasedmedicine.org/.

First, it might be useful to establish why people are attracted to so-called ‘alternative medicine.’  It can no doubt be attributed to the growing sense of distrust in the corporate structure of America’s medical establishment.  As the recent health care debate showed us, Americans dislike the notion of profiteering from the sick.  Corporations, many Americans feel, are greedy and only concerned with the bottom line.  They do not give a damn about your health.  In fact, they want you to stay sick so that they can sell you more drugs and unnecessary operations.  It is all part of the medical-industrial complex that is designed to keep you, the average Joe, shelling out money.  There are natural remedies out there that will allow you to live to 150, if only you would stop taking the darn pills and going under the knife.  The ‘alternative medicine’ crowd is, then, the Julian Assange of the situation—taking the tightly kept secrets that the medical establishment doesn’t want you to know and making them public knowledge.  But the evil pharmaceutical companies don’t like this—they use their puppets in the big scientific establishments to try to cover up the effectiveness of natural remedies by demanding ‘clinical trials’ and ‘evidence’.  

Basically, belief in alternative medicine can be attributed to three things:

1. Distrust of capitalism and corporations
2. Distrust of the scientific establishment
3. Contrarian impulses

So, in order to demonstrate that belief in alternative medicines is unfounded, I will have to demonstrate that it is not legitimate to believe something on the basis of distrust in corporations, distrust in the scientific establishment, or contrarian impulses. 

The first two reasons can be written off as ad hominem fallacies.  Simply because you distrust the source of something, for legitimate reasons or illegitimate ones, does not mean that their positions (or in this case medicines) are not reliable.  The third can be viewed as a sort of reverse Argument from Authority.  However, I shall also justify here why there is no legitimate reason to distrust for-profit drug companies and the scientific establishment and what the dangers are of contrarian impulses when it comes to medicine.

Distrust of Corporations

The first reason is actually the most plausible.  After the mortgage bubble, bad derivatives, the Madoff Ponzi scheme, Enron, WorldCom, the bailouts and the seemingly endless tickertape of corporate misdeeds that flows on the news on an almost daily basis, one can hardly be blamed for doubting the honesty of every for-profit company out there. 

However, what is important to remember, is that while we have more dishonest profiteers in the corporate world than we should, they are the exception rather than the rule.  Companies make their profits, massive though they may be, from providing a product or service that is valuable and in-demand.  They live in an atmosphere of intense competition, not cooperation, with other companies in the same field.  If there were a drug company that was somehow setting out to keep the American public perpetually sick, it would be other drug companies that stand to benefit the most from revealing that.  Remember, these guys do not watch each other’s backs—what is bad for one is good for the others! 

That is not to say that we can trust the pharmaceutical industry to be completely self-regulating.  We cannot.  This is why we have established the FDA, one of the largest bureaucracies in the country, to monitor the activities of these companies and the safety of the drugs they put on the market.  The FDA has an annual operating budget of nearly two and a half billion dollars, nearly 10,000 employees, and operates out of 233 different field offices located throughout the United States. 

Any company that wishes to release a new drug, or update the ingredients of an existing drug, has to put their product through a rigorous battery of tests called a New Drug Application (NDA.)  An NDA consists of three or four phases:

Phase 1: The drug is tested in a few healthy volunteers to determine if it is acutely toxic.

Phase 2: Various doses of the drug are tried to determine how much to give to patients.

Phase 3: The drug is typically tested in double-blind, placebo controlled trials to demonstrate that it works. Sponsors typically confer with FDA prior to starting these trials to determine what data is needed, since these trials often involve hundreds of patients and are very expensive.

(Phase 4): These are post-approval trials that are sometimes a condition attached by the FDA to approval on a case-by-case basis.

This process can take several years to complete for a new drug and there is a similar procedure done for any medical device before it can be taken to market.  It is such a long, rigorous and thorough procedure that some people who I have known that start companies to develop new drugs or medical devices do not expect to generate revenue for up to seven years after founding their companies!

But if you are still mistrustful of Big Pharma after hearing this, I suppose I would ask you why you would be so willing to trust Big Placebo?  After all, one can hardly claim that the CAM industry (Complementary and Alternative Medicine, as it refers to itself) is immune to profiteering.  Estimates put it at a hundred billion dollar a year industry worldwide.  Admittedly, this is chump change when compared to the science-based medical sector, but it is still hard to claim exemption from capitalist tendencies when your revenues require twelve figures to describe! 

Distrust of the scientific establishment

The second reason for enthusiasm about alternative medicine is a distrust of the scientific establishment, and science in general.  As someone who engages in debate with the religious, skepticism about science is something I run into frequently.  Oftentimes, it manifests itself as doubt about the fact of evolution or the age of the Earth/universe.  Creationists, while annoying and dangerous to the education of our young people, at least have enough trust in science to take the medicine the doctor gives them when they are sick (although if they get better, they are quick to give credit to the prayers they said, rather than the medicine itself.) 

But the proponents of faith-based, traditional or alternative medicine go a step further even than history-denying creationists.  They deny what is probably the greatest accomplishment of science—the ability to extend and improve the lives of every person on Earth.  And when I say every person, I mean every person, not just those of us in wealthy parts of the West.  Although it is true that preventable diseases ravage the Third World, we have to recognize that the vaccines and cures we have developed here have been disseminated to the poorest countries in the world in such a way that the average child born in Sub-Saharan Africa today can expect to live a longer life than someone in the richest 1% of the world 100 years ago.  There is still a discrepancy in the level of care those people in the impoverished parts of the world receive as compared to the people in the post-industrial world, though, and this is a problem that needs to be dealt with. 

However, this discrepancy does speak further to the fact that traditional medicines and diets don’t work.  Despite all the talk from CAM advocates about how organic foods and traditional medicines are better than Western processed foods and science-based medicine, those countries with access only to the CAM diets and healthcare live, almost universally, shorter lives.  The map from the CIA World Fact Book below shows how very ineffectual CAM is—you can see a sharp discrepancy in the life expectancy of people in Western Europe, North America and Australia from the life expectancy of people in Asia, the Middle East, North Africa and South America, and an even sharper discrepancy when compared to Sub-Saharan Africa.  If the traditional medicines and diets of these places actually worked, we would see the exact opposite of this.   

Furthermore, if CAM did work, there should have been a decrease in life expectancy over the past hundred years or so, when science-based medicine came to the fore and began forcing out all traditional and alternative remedies.  Again, this is the opposite of what we actually do see.  In the early 1900s, the average life expectancy in America was only 45 and the death of both mothers and infants during childbirth was a common occurrence.  Today, the average life expectancy is 79, a thirty-four year gain in only 100 years—the largest gain in life expectancy in human history, corresponding exactly with the advent of science-based medicine and the decline of traditional medicine.

This is because science-based medicine has done something in the past hundred years that traditional medicine has failed to do in its multi-millennia history.  It has actually eliminated diseases.  Afflictions like polio and smallpox that used to be a death sentence are no almost completely unheard of.  Try to get rid of polio using Reiki therapy and see what happens. 

Also, when dealing with people who say they distrust the scientific establishment, one has to make sure they know what, exactly, the scientific establishment is.  It is not some puppet organization for ‘Big Pharma’—far from it.  The scientific establishment is a body of qualified professionals who skeptically review each other’s work for errors and confirmation bias.  A researcher will publish her findings in a scholarly journal, which is then reviewed by her peers, who also work in the field.  Some of those peers will then attempt to perform the same experiments she did to see if they get the same results.  Others will review her work and criticize it if she is drawing false conclusions or using improper methods.  This is an important part of the scientific method called ‘peer review.’  It is designed to weed out bad ideas and it is essential in order to maintain objectivity.  So, when someone tells you that their ideas or treatments are not part of the ‘scientific establishment’, you should recognize that as them saying that their ideas have either been rejected by or not been verified by objective, qualified peers. 

Contrarian Impulses

Now, what about those who have contrarian impulses, who like to go against the medical establishment because it is big and powerful?  Well, we do love a David and Goliath fight, but when it comes to medicine, it is best to stick with the Goliath.  Dangerous things happen when you place your trust in the little guy who is fighting the system.  

One such situation occurred several years ago when a British doctor named Andrew Wakefield—who has now been barred from practicing medicine and is facing criminal charges—spread the vicious rumor that the MMR vaccine, which guards against measles, mumps and rubella, actually was causing autism.  Needless to say, when the research came back from all the major scientific institutions, including the Centers for Disease Control and Prevention, the Institute of Medicine of the US National Academy of Sciences, the UK National Health Service, and the Cochrane Library, these allegations were proven false. 

This data, though, did not stop entire throngs of science-rejecting parents from denying their children vaccines.  They were already mistrustful of doctors and pharmaceutical companies who they believed were just trying to sell them another vaccine to make a buck or, worse, turn a generation of children autistic so that those children would need more medication and treatment throughout their lives—which the medical establishment could provide at a cost.  These people actually believed this nonsense!  Air-headed celebrities like Jenny McCarthy and Oprah Winfrey weighed in on the issue on the side of science denial, preaching ignorance and giving false confirmation to the fears of parents, whose sheer idiocy in this matter can clearly be viewed as child abuse. 

Now, swathes of children in Britain, Europe and America who should have been vaccinated against measles were not, and the effects have already been felt.  The incidence of two of the three diseases increased greatly in the UK. In 1998 there were 56 confirmed cases of measles in the UK; in 2006 there were 449 in the first five months of the year, with the first death since 1992.  Mumps cases began rising in 1999 after years of very few cases, and by 2005 the United Kingdom was in a mumps epidemic with almost 5000 notifications in the first month of 2005 alone.  Measles and mumps cases continued in 2006, at incidence rates 13 and 37 times greater than respective 1998 levels.  Two children were severely and permanently injured by measles encephalitis despite undergoing kidney transplants.  Disease outbreaks also caused casualties in nearby countries. Three deaths and 1,500 cases were reported in the Irish outbreak of 2000, which occurred as a direct result of decreased vaccination rates following the MMR scare.

Another very frightening case is the situation of Herbert and Catherine Schaible, who were convicted in December 2010 of involuntary manslaughter and child endangerment for refusing to get their 2-year-old son medical attention for his pneumonia, causing the little boy to die.  Why?  They believed prayer was a better remedy than medicine.  Obviously, God had the Miley cranked up too loud to hear them that day, but the couple still retained their belief in faith-based healing even after their son’s death. 

Scarily, the church that the couple and their deceased son attended has not distanced itself from the Schaible’s actions, but actually endorsed them.  Their pastor, Nelson A. Clark, came to their defense, saying, "The legal community is trying to force our church group to put [ourselves] in the hands of this flawed medical system, when [we] have chosen to put [ourselves] in the hands of a perfect God who does not make mistakes," Clark said Friday.

Denying a child access to necessary medical attention, fortunately, is illegal, but the church is still allowed to preach that faith-based healing works.  The same for Jenny McCarthy and Oprah and their fear-mongering about vaccines.  While I am one of the biggest advocates for free speech there is, I think that these kinds of statements clearly are limited by law.  If it were the CEOs or representatives of pharmaceutical companies who were telling television audiences that their products worked when the evidence shows clearly they do not, the FDA would slap them with a 7-figure fine within the hour.  Making false claims about a product or service is not protected by the 1^st amendment, especially when that product or service has to do with your health.  How is it, then, that quacks and preachers and celebrities are allowed to get away with it when pharmaceutical companies are not? 

Alternative medicines are a scam.  Simple as that.  Big Placebo is just as much about profiteering from your health and sickness as Big Pharma.  The only difference is Big Placebo won’t help you get better.  After reading this post, I hope you will know that when someone suggests ‘alternative medicines’ to you, you will remember what they are an alternative to:  Science-based, evidence-based, regulated, demonstrably effective medicines that are safe and proven to work.