David Freedman responds to criticism of his CAM apologia

The other day, I expressed my displeasure at an article published in The Atlantic that, boiled down to its essence, was one long apologia for unscientific “complementary and alternative medicine” (CAM) and “integrative medicine” (IM). Yes, I was quite critical, but, I believe, not unfairly so. Not surprisingly, however, the author of the article, David H. Freedman, was quite displeased, so much so that he actually showed up in my comments to take me to task. He didn’t just take me to task, though. He took all of you to task, as well, at least those of you who piled on. Unfortunately, his arguments in his comment were even worse than the arguments he laid down in his actual article. Let’s take a look.

Freedman begins:

As the author of the Atlantic article that has Orac and this crowd so hot and bothered, let me share a few observations and thoughts that I suspect will be completely lost on you. First, it’s interesting that all of you are deeply confident you know so much more than the dozens of highly credentialed, highly regarded physician-researchers I interviewed at several of the world’s most renowned medical centers and academies. (I only quoted a portion of these interviews in my article, due to space limitations.

As Steve Novella points out, “most ‘highly credentialed, mainstream physician-scientists’ don’t have a clue about CAM.

For someone who is so upset about my alleged use of ad hominems, Freedman is pretty free with the ad hominem himself. “Hot and bothered”? That’s clearly nothing more than a ploy designed to make it look as though I (and those of you who chimed in agreeing with me) are basing our criticisms more on emotion than on Freedman’s bad arguments topped off with bad science. It’s also rather amusing that his first gambit, rather than arguing evidence and facts, is to use a classic appeal to authority. Basically, he’s saying that because he interviewed so many “experts” he must be right. Never mind that it’s quite possible that he picked many of the wrong experts (he did), that he discounted the right experts, such as Steve Salzberg and Steve Novella (which he also did), and that he let his own bias lead him astray (which, as I argued, he appears to have done). He’s also implicitly insulting me because he he has disdain for the medical school where I’m faculty. In his view, apparently, because I’m not on the faculty at Harvard, Yale, M.D. Anderson, or Memorial Sloan-Kettering (for example), my opinion is not worth nearly as much as that of those who are. Never mind that the medical school where I’m on the faculty is well-respected and quite large. On the other hand, I could point out that the University of Maryland is not exactly Harvard or Yale either, and Freedman seemed to use Brian Berman at the University of Maryland as the source of many of his arguments. Besides, being a top tier medical school (such as Harvard or Yale) does not inoculate its faculty against falling for quackademic medicine, as I’ve documented time and time again over the last six years.

Freedman then proves himself a pyromaniac in a field of straw men, starting out by building a Burning Man-size straw man, to which he promptly and gleefully aims a flame thrower:

And let me anticipate Orac’s claim that I misquoted or distorted or spun or quoted out of context, as was his claim with my Ioannidis article, by pointing out that such claims reveal a deep ignorance of the fact-checking process that goes on at most well-regarded magazines, and especially at The Atlantic. Every single person quoted had an opportunity to correct the record ahead of time–as did Ioannidis, by the way.)

Except that I made no such claim. Seriously. Go back and read my original post if you don’t believe me. Nor do I give a rodential posterior about the fact-checking process at a magazine like The Atlantic, at least not in the context of Freedman’s article and the arguments it contains. Let’s put it this way: I more or less assumed that every single quote in Freedman’s article was accurate and fairly represented the views of the person being interviewed. That wasn’t the problem. The problem was framing. It’s how Freedman presents his facts and quotes that’s the problem, not the facts and quotes themselves. It’s the overall structure and argument of the article that’s the problem, not the individual quotes and facts marshaled to support that structure and argument. To recap, Freedman essentially admitted that the vast majority of CAM and IM treatments are no better than placebo when tested in randomized clinical trials, perhaps the only statement about which we unequivocally agree. Unfortunately, instead of concluding that this failure in clinical trials means that the vast majority of CAM treatments don’t work (which it does and which would have been the correct conclusion), Freedman instead tries his very hardest to persuade you that it doesn’t matter that CAM doesn’t work, that it’s really the touchy-feely CAM practitioners bringing the human touch by listening to their patients and spending time with them that matters, all to fire up placebo effects. In fact, he does it again in his reply:

These top scientists almost to a person agreed with my four main points: Most mainstream drugs don’t help most patients much with chronic, complex disease; alternative treatments don’t work better than placebo; alternative practitioners do a better job on average than mainstream physicians in investing time and effort with patients to get them to adopt healthier lifestyles and have better attitudes about health; and these lifestyle and attitude changes can significantly reduce the risk of complex, chronic disease as well as relieve the hard-to-treat pain and discomfort of many different disorders. All of these points are backed up by mainstream studies, aren’t even all that controversial, and, as I say, are endorsed by physician-researchers whose credentials and reputations are, well, let’s be charitable and say “at least as solid as,” those of Orac. (I happen to agree that the Nobel Prize or any other credential or affiliation doesn’t confer a monopoly on insight or the truth, but on the other hand it’s genuinely shocking and appalling to me to see the combined word of so many highly regarded people dismissed with a wave of the hand.)

For someone who says he agrees that the Nobel Prize or other credentials or affiliations don’t confer a monopoly on insight, Freedman sure does like his appeals to authority, doesn’t he? He seems to be all about credentials and affiliations. Again, he takes a not-so-subtle dig at me and my qualifications, which serves to amuse me more than anything else. As I’ve said time and time again, one reason I keep the “Orac” pseudonym even though a lot of people know my real name is, besides the fact that I like the pseudonym and am a bit curmudgeonly about ever willingly giving it up, because I want my arguments to stand on their own without having to rely on any “authority” my credentials give me. I’ve said it time and time again going back at least five years. Sure, I’m a doctor. Sure, I’m also a scientist. So what? None of that matters very much when I sit down in front of my laptop to blog. I like to think that my arguments and track record as a skeptical blogger are all that matter in this particular venue.

The other thing that Freedman does is what Steve Novella and I have characterized as the classic “bait and switch.” In other words, he’s completely fallen for the framing of lifestyle changes, such as diet and attitude, as somehow being “alternative.” They are not. They are, and always have been, part of science-based medicine, and no supporter of SBM that I’m aware of, including myself, denies that they can be very effective tools for improving health. However, CAM apologists like Freedman frequently co-opt these modalities as being somehow “alternative.” They then use them as the “foot in the door” to let the real pseudoscience in, woo such as homeopathy, reiki, and the like. Steve prefers the term “bait and switch”; I, on the other hand, prefer the term “Trojan horse.” Basically, diet, exercise, and lifestyle interventions are the Trojan horse pulled into the bastion of science-based medicine. After it’s there, all the quackery, such as homeopathy, acupuncture, reiki, and “energy healing,” leaps out and takes over.

And Freedman uses these rhetorical tricks with the best of them, whether he realizes it or not.

I’m not even convinced of some of Freedman’s facts. For instance, he claims that alternative practitioners “do a better job on average than mainstream physicians in investing time and effort with patients to get them to adopt healthier lifestyles and have better attitudes about health.” Really? Certainly, he presents no evidence, either here or in his Atlantic article, that this is true, that alternative practitioners routinely produce better outcomes in these areas than “conventional” physicians. In fact, if you’ll excuse my French, I call BS on this statement. When you come right down to it, many CAM practitioners have what are most definitely non-science-based views on what constitutes good nutrition and a healthy lifestyle. All too often, the common sense recommendations that some CAM practitioners make are buried under layers of pseudoscience, the hawking of supplements, and interventions based on prescientific, vitalistic ideas about health. Ideas like homeopathy and acupuncture. Indeed, in the Atlantic article, an acupuncturist is reported to tell a patient sticking little needles in his skin would “‘open blocked “energy pathways’ in his body, allowing a more normal flow of energy that would lessen his pain and help restore general health.” Another dubious “fact” presented by Freedman is the bit about how allegedly “most mainstream drugs don’t help most patients much with chronic, complex disease. I can’t help but note that drugs actually do work with chronic disease in many cases, including diabetes, hypertension, and a number of other chronic conditions. I have no idea what Freedman means by “chronic, complex disease.” It seems to be a buzzword he picked up somewhere in his interviews and research.

I have to admit that Freedman actually rather amused me with his finale:

Frankly, the unwillingness of Orac and this crowd to consider for a moment the possibility that there may be some aspect of alternative medicine other than any direct physical action from its core treatments that might be helpful to many patients, especially in light of all the evidence and widespread, highly informed opinion that this is so, perfectly embodies everything that science is supposed to oppose: closed-mindedness, deep bias, hostility to disagreement, reckless disregard for reason and evidence that don’t support a favored conclusion, and a total lack of humility with regard to what one knows for sure. What you are defending here isn’t science, folks–it’s what I call “scienceology,” a quasi-religious faith in a set of closely held beliefs that are dressed up in the trappings of science and kept immune to any counter-evidence or -opinion. When a person genuinely operating in the true spirit of science hears a counter-argument or counter-evidence, he or she thinks, “Hmmm, let me consider this carefully to see if I need to rethink or modify my position”; when a scienceologist hears a counter-argument or counter-evidence, he or she thinks, “Hmmm, what’s the best way to viciously trash this so I can continue to believe in what I absolutely know to be true?” Which one applies to you, would you say?

At the risk of a tu quoque argument, I can’t help but ask: Which one applies to Freedman, I wonder? He’s also got it wrong. I’ve said time and time and time again that I can be convinced by evidence. In fact, I frequently like to use the example of homeopathy (because homeopathy is so inherently ridiculous from a scientific point of view) and quote Tim Minchin’ awesome nine-minute beat poem (NSFW):

Science adjusts its beliefs based on what’s observed
Faith is the denial of observation so that Belief can be preserved.
If you show me
That, say, homeopathy works,
Then I will change my mind
I’ll spin on a fucking dime
I’ll be embarrassed as hell,
But I will run through the streets yelling
It’s a miracle! Take physics and bin it!
Water has memory!
And while it’s memory of a long lost drop of onion juice is Infinite
It somehow forgets all the poo it’s had in it!

You show me that it works and how it works
And when I’ve recovered from the shock
I will take a compass and carve “Fancy That!” on the side of my cock.”

And I will, too; change my mind if the evidence indicates that I should, that is. As for the other part, I most definitely do not like the thought of sharp objects near my most sensitive parts; so I’ll pass on the compass. Be that as it may, I’ve even said on many occasions that if the anti-vaccine movement managed to produce some high quality studies that indicated that vaccination is associated with an increased risk of autism, I’d have to seriously reconsider my position that vaccines don’t cause autism. I’ve yet to see such a study.

As for the charge of “scienceology,” Mr. Freedman really is out of touch with the very CAM movement he appears to find so compelling. As I pointed out in a followup comment, the correct term is “scientism,” which is a favorite charge against skeptics and scientists favored by all manner of cranks, including CAM practitioners, creationists (yes, creationists), HIV/AIDS denialists, and anti-vaccine activists. I’ve seen the term used by all of these varieties of cranks at one time or another. Mr. Freedman should really not be so eager to join these groups by throwing around terms like “scienceology.” Besides, the whole argument that “your science is a religion” that he makes is so tiresome because it is so easy to refute. It’s not for nothing that this canard has been dismissively (and appropriately) referred to as “doggerel.” Science is only a religion to those who do not understand science, and it is clear that Mr. Freedman does not understand science.

You know, before I saw Mr. Freedman’s response to my criticism, wasn’t going to be all that hard on him. He sounds just like any number of journalists I’ve encountered who have become enamored of the glamor of woo. Unfortunately, his response reveals just how deeply he’s drunk the Kool Aid of pseudoscience. The bottom line is that CAM/IM adds absolutely nothing to medicine. Even Freedman admits that nearly all of it is no better than placebo before lamenting that physicians don’t spend enough time with their patients. Unfortunately, he frames this observation as a false dichotomy: Continue with physicians having too little time for their patients or let the quacks in to provide the empathy and “lifestyle” counseling. That’s completely the wrong approach. The answer to the problem of physicians not having adequate time for their patients is not to let quackery invade science-based medicine and quacks take on the role of empathetic healer. Rather, it’s to find a way within the confines of science-based medicine to bring the human touch back and empower science-based practitioners to be the empathetic healers that the vast majority want to be. If, after all his interviews, Freedman realized that, he might have done a valuable service for the readers of The Atlantic. Instead, he revealed himself to have become yet another useful tool for the CAM movement’s endless proselytization.

ADDENDUM: Steve Novella has responded. He’s at least as harsh as I am and makes an excellent analogy between the CAM movement and the creationism/intelligent design movement.