Why don’t you rant about what I think you should rant about?

I’ve written before about how one of the favorite tactics of those who do not like my insistence on applying skepticism, science, and critical thinking to the claims of alternative medicine or my refusal to accept a dichotomy between “alternative” and “conventional” medicine is to try so smear me as some sort of “pharma shill.” It’s happened so often ever since my Usenet days that I even sometimes joke about it preemptively sometimes when writing skeptical posts or make smart aleck comments asking where I can sign up to get those big checks from big pharma, given that they’d almost certainly be many orders of magnitude greater than the sum that Seed pays me for my little hobby here. This is (usually) enough to keep me in high speed Internet access, cable TV, and beer (and that’s only because I’m usually in the top five ScienceBloggers for traffic), and not much else.

I’m kidding–sort of.

There’s a more subtle form of the pharma shill gambit. Indeed, it’s so subtle that it’s likely that the person using it will not admit that, at its heart, that’s what it is. I may well be that I might get a fairly vociferous reaction to making this statement. So be it. I’m a bit tired of and more than a little annoyed by this sort of insinuation. Basically, this subtle variation on the pharma shill gambit takes the form of asking me why I spend so much time deconstructing woo and so little time taking on the abuses of science by big pharma and the corporate world. In fact, it came from fellow ScienceBlogger Revere and goes something like this:

ScienceBlogs likes to take on quacks. Orac, over at Respectful Insolence, does it every Friday and does it well. It’s a good project and I’m not against it. But there are a lot of quacks around that aren’t called quacks. They have corporate suits and research departments. And advertising and marketing departments. Big companies. Like Nestle.

After discussing several examples of what he considers to be “quacks in suits,” Revere concludes:

There are a lot of charlatans about. I’m not sure we should be putting so much energy in sniping at the marginal players and ignore the big fish. But maybe it’s just me.

Note the obvious implication: That I am somehow insufficiently vocal about corporate malfeasance (“quacks with business suits”) compared to those poor, little picked upon quacks whose woo I take such delight in deconstructing–you know, the little guys (or “little quacks,” if you will). And what’s the further insinuation behind that, I wonder? I’ll leave that one for you to contemplate for a moment. Decide for yourself if I’m reading too much into Revere’s criticism and leave a comment if you think I am. In the meantime, let’s continue.

When faced with such a criticism, I can’t help but notice how much it resembles the infamous “concern troll” of progressive politics. In essence, I’m being told that I’m not sufficiently interested in or vocal about what the person complaining thinks that I should be interested in or vocal about. I will concede that it’s not a perfect analogy. For one thing, if you buy the usual definition of the term, concern trolls are actively working to undermine the cause that they express “concern” about, and I don’t think for a minute think that’s what’s going on here. I do, however, think that the end result can be the same: Fostering divisions in skeptics and critical thinkers who should in fact be of one piece on the question of assaults on evidence-based medicine, regardless of whether they come from quacks with or without business suits. There’s no reason that one should be condemned for choosing to emphasize one over the other, as long as one is not consistently defending one while attacking the other. The only reason for making such an attack is, as far as I can tell, to question the motivations of the one at whom the attack is directed and suggest hypocrisy.

When faced with a concern troll-like complaint like this, my first reaction is often to point out that the person making the complaint clearly isn’t a regular reader of this blog. I have, for instance, gone after unscrupulous physicians who pushed “screening MRI” or “screening CT scans,” tests that are expensive, paid for out of the patients’ own pockets, and more likely to result in harm than help, given how they are based on no good evidence. I’ve also recently had a bit of a run on discussing how tobacco companies have tried to deny the science showing significant health risks due to secondhand smoke. I could point out one of my favorite retorts to alternative medicine mavens who like to portray their favorite woo (particularly nutritional supplements) as the little crusading for “health freedom” being crushed by a combination of big pharma, the FDA, and the AMA, which is that more and more supplement manufacturers are being bought up by big pharma and that it’s become a big business that’s growing briskly. Indeed, I even coined a term for this, “big suppa.” (OK, I admit this wasn’t one of my pithier catchphrases. They can’t all be good.) Sure, I take on woo far more often than I take on “quacks with business” suits, but that’s due more to my inclination more than anything else and also being influenced more and more these days by how woo itself is increasingly becoming big business (more below), aided and abetted by lax laws, the prospect of respectable profits without all those expensive and pesky clinical trials necessary to get FDA approval for new drugs, and the credulity of the masses.

Ironically enough, this accusation of inconsistency with its veiled insinuation of bias reminds me of a discussion that cropped up on this blog just yesterday in response to this post. In it, I expressed approval of a post by Dr. RW adding to my post criticizing the University of Maryland Shock Trauma Center for embracing reiki. This drew a comment:

“They claim to stand for scientific purity, so why do they (with the notable exception of Arnold Relman) remain silent about woo?”

Sorry, but this is the same sort of tu quoque fallacy used by alties, only turned around. The altie equivalent is trying to dismiss concerns about supplement dangers and false claims by saying “Well, why aren’t you talking about drug recalls and other problems with Big Pharma?”.

It’s ethically acceptable to focus one’s efforts in either of these areas.

Exactly.

I thought this comment was spot-on, although I did disagree with its applicability to Dr. RW’s article:

A lot of the anticorporate folks who quite correctly call out big pharma when it abuses science or starts selling non-evidence-based remedies like supplements don’t just ignore woo; they actively embrace it whole-heartedly. AMSA is one example. It touts its “Pharm-Free Day,” while at the same time it actively promotes the adoption of non-evidence-based alternative (or, as it puts it, “humanistic”) medicine in both medical school curriculae and in the alternative medicine retreats that it sponsors for medical students.

In no way do I think that Revere falls into this category. However, I would be lying if I didn’t point out that I think he’s using a concern troll-like fallacy (“It’s a good project and I’m not against it”–but…and the “but” makes all the difference in the world) and that I resent it, particularly since, when it comes to quackery, we are on the same side.

It’s true that my initial interest in quackery and “alternative” medicine started out mainly as a lark, in which the more I read about the various claims the less I could believe what I was reading, followed by a realization of how much harm it can do. However, over time my mission and the mission of this blog have evolved to take on a larger problem. When it comes right down to it, the fact that quackery is increasingly becoming big business is a symptom of this larger problem. Abuses of science by big pharma and other big corporations wouldn’t succeed so well if it weren’t for the poor understanding of science and credulity that are so rampant among the general public. Moreover, as a member of the academic medical community, it pains me deeply to see just how my profession is aiding and abetting this problem through our permitting with little resistance the infiltration of woo into medical schools and academic medical centers (1, 2, 3, 4, 5, 6, 7) and in the mandatory medical curriculum in at least one medical school.

In fact, one could look at it this way: Revere think that I do not go after “quacks with business suits” with sufficient frequency for his taste. To that, I answer: So what? Of course, apparently not being a regular reader of my blog, Revere seems utterly oblivious that over the last year or two I’ve been starting to go after “quacks in lab coats” because the infiltration of quackery into big academic medical centers is something that truly concerns me. In actuality, in my mind, the vast majority of those whom I facetiously term “quacks with lab coats” in a conscious effort to echo Revere’s term are not really quacks. However, in the cause of being “open-minded,” we academic physicians are permitting the influx of non-evidence-based modalities as scientifically highly implausible as reiki and even homeopathy into the bastions of academic medicine and the NIH. In doing so, we are endangering the whole enterprise of scientific medicine by granting the patina of scientific respectability to modalities that do not rate it. Much of the motivation behind this is to “give the people what they want,” but a lot of it is also because woo pays the bills. These days, big academic medical centers seem to see alternative medicine as both a marketing ploy to make themselves look more “humanistic” and a new revenue stream (most insurance companies won’t pay for therapies without solid evidence of efficacy, meaning that it’s usually cash on the barrelhead from the patient for woo, without all that nasty hassle of filling out insurance forms and getting preapprovals from tight-fisted claims handlers). Worse, this virus of credulity is infecting medical trainees from the medical student level, as evidenced by the way that the American Medical Student Association actively promotes woo.

Imagine what will happen when these students, taught that woo is equivalent to scientific medicine, finish their training and start advancing into positions of leadership. I fear they’ll be more susceptible than my generation to both the blandishments of quacks in hole-in-the-wall offices and quacks in business suits. Fear of the consequences of that credulity manifesting itself in 20 years, when I’ll be getting old and susceptible to all the diseases and conditions of age, is one reason for my seemingly increasingly quixotic crusade.

In the meantime, with all due respect, I’ll rant about what I want to rant about, not what anyone else thinks I should rant about.