On teaching the controversy in medicine

The other day, I wrote to express my disappointment with Dr. Kevin Pho, of KevinMD, for posting credulous crap about alternative medicine. I noted in an addendum that he responded with a comment that in essence said that he posts things he “doesn’t necessarily agree with myself to promote discussion and debate”:

Orac,

I appreciate the critique. As readers of this blog know, I often post pieces here I don’t necessarily agree with myself to promote discussion and debate. Your concerns are certainly valid, and will be taken into consideration as I choose future pieces.

Best,
Kevin

My initial response was that I should take KevinMD off of my blogroll and cease to recommend his blog as a reliable source of medical information, so annoyed was I by Dr. Pho’s setting his foot onto the path that has led Dr. Oz to embrace “holistic healers,” quacks like Joe Mercola, and faith healers like Issam Nemeth. True, Dr. Pho’s offense was not nearly as grave as these, but his publication of credulous tripe about alternative medicine in the interests of ginning up controversy and page views is a baby step on the same road towards the Dark Side whose end Dr. Oz has apparently reached in his abdication of professional responsibility. That professional responsibility is to refuse to pass judgment on any treatment modality and to give the implication that pseudoscience is a reasonable scientific alternative to science-based medicine.

But maybe I’m too harsh. Maybe I should listen to Kevin. Maybe he’s shown me the way to more page views, more fame, and more glory! Maybe I should become like Kevin and teach the controversy! Heck, I could even become the Dr. Oz of the blogosphere! I can see it now; the possibilities for “promoting discussion and debate” are endless, and I’m obviously missing out. If I want to elevate my game to become the blogging powerhouse that Dr. Pho is or even surpass him, clearly I need to change my game plan! No more of this skepticism and critical thinking stuff! Sure, I reach the hard core skeptics, but that leaves out most of the population. And no more of that sarcasm and nastiness towards quacks, anti-vaccine loons, pseudoscientists, and woo-meisters of all stripes, either. That’s just too darned…negative! As I’ve been told time and time again, as entertaining as a good Orac-ian rant can be to read, it turns people off! It’s just too nasty, and nasty doesn’t change people’s minds. Even better, I wouldn’t have to worry any more about anti-vaccine loons trying to get me fired from my job through false accusations of undisclosed conflicts of interest. If I converted (or at least treated them as though there was a legitimate scientific controversy over whether vaccines cause autism), they’d flock to me the same way they did to Dr. Bernadine Healy.

Why try to change people’s minds anyway. Why try to educate people as to why quackery is quackery and pseudoscience is pseudoscience? Why not just embrace the woo and ride it to fame and fortune, just like Oprah and Dr. Oz? Or at least like Joe Mercola and Mike Adams? Yes, I think I’m beginning to see the error of my ways.

For instance, I could ask a neurosurgeon and Discovery Institute flack Michael Egnor to write a guest post or two about mind-body dualism and/or evolution in order to “promote discussion and debate.”

Teach the controversy!

Or I could invite Kim Stagliano, Ginger Taylor, Mark Blaxill, Jake Crosby, or even J.B. Handley himself to do a guest post about vaccines and autism, all in order to “promote discussion and debate.” Heck, I bet I could even get Andrew Wakefield if I really tried. He really has fallen so far; if a pseudonymous blogger like myself told him that I was starting to doubt my previous position that he is an unethical, despicable scientific fraud and would like to hear “his side,” I bet he’d go for it. Heck, I bet I could even get Boyd Haley or Mark Geier to expound about how mercury in vaccines is the cause of the “autism epidemic.”

Teach the controversy!

Or maybe I could get Dana Ullman to provide me with a guest post or two on the wonders of homeopathy for the purpose of promoting “debate and discussion.”

Teach the controversy!

Yes, the possibilities are endless, and I’m sure that you, my readers, could even provide me with even more suggestions of guest posters and potential topics that I could use to promote even more “debate and discussion” on this blog? Heck, let’s not forget moon hoaxers and 9/11 Truthers! A couple of posts that produced more comments than any other that I’ve done involved 9/11 Truthers. If I wanted to invoke the nuclear option in trying to promote “debate and discussion,” I bet I could even get David Irving to write a post or two about the Holocaust. He’s a shameless attention whore with an ego the size of the Third Reich at its maximum extent in 1942. I bet he’d do it if I stroked his ego sufficiently.

Teach the controversy!

I think you get my point. “Promoting discussion and debate” is all well and good when there is a legitimate scientific or medical controversy to “discuss and debate.” It’s even acceptable for a physician to do this if one of the positions being “discussed and debated” is on the fringes but still scientifically defensible; i.e., hasn’t devolved into pseudoscience. Let me put it this way. I’ve never seen Dr. Pho permit a post that questioned vaccine safety or in any way justified the pseudoscience behind the anti-vaccine movement, which is very, very good. I also note that he’s linked to me on multiple occasions when I have written posts deconstructing homeopathy. (Damn, I hate to give up those incoming links.) Clearly, allowing guest posters who are apologists for homeopathy or promote anti-vaccine views is a point beyond which Dr. Pho won’t go, either. This tells me that Dr. Pho is not too far gone. He still has limits.

But why not allow posts defending such positions? Think about it this way. Once you start allowing guest bloggers who justify acupuncture and traditional Chinese medicine, why not allow guest bloggers who justify homeopathy, reiki, therapeutic touch, or other modalities as pseudoscientific? Sure, you can justify leaving out anti-vaccine views because they are so obviously harmful and wrong, but leaving out the others is harder to justify. There’s no real scientific or ethical reason; you’ve already opened the door to pseudoscience and might as well get the full benefit in terms of increased traffic. You might as well go all the way.

Very likely, Dr. Pho will think I’m being too hard on him. When he sees this, however, he should be aware that the reason I’m being hard on him is that I know that he used to be much better than this and, more importantly, that he can be that good again. Perhaps a little shock therapy in the form of a post like this will make him think. Perhaps it will lead him to see that what he is doing is not so different from the outrageous examples I suggested above as ways that I could engender controversy (and page views) on my blog. Perhaps it will inspire him to pull back from the woo before he ends up like Dr. Oz. Perhaps he’ll realize that it doesn’t take much support for pseudoscience to taint an otherwise excellent blog.

I’ll be watching and hoping.