The ongoing Pain-Topics series, “Making Sense of Pain Research,” has encouraged professionals and patients to develop a “healthy skepticism” toward everything they read in journals, hear at conferences, or see in the news. As it turns out, skepticism regarding modern science, including the field of pain medicine, is somewhat of an international movement. Its mantra might be “Stop the B.S.” (with the irreverent logo at right); yet, there is an apparent danger of skepticism becoming close-minded cynicism falling into the trap of contempt prior to investigation that might preclude truly objective analyses of research.
The community of skeptics, worldwide, serves an important function in modern society, as they always have. It was probably skeptics who asked, “What makes you think the Earth is flat — where’s your proof?” When it comes to healthcare, skeptics at their best evaluate medical treatments and products in a scientific light, promoting the highest standards and traditions of scientific inquiry; however, at their worst, skeptics may merely be naysayers, stirring up the pot of already-established evidence to draw attention to themselves.
The Internet as Breeding Ground
As a group, modern-day skeptics appear to be well-educated, erudite, and certainly opinionated. They largely inhabit the Internet “blogosphere,” which has allowed increasing numbers of skeptics to publicly raise questions, express their views, and create a community of likeminded folks who revel in challenging even the most accepted principles of science and medicine.
In his NeuroLogicaBlog [here], Steven Novella, MD — a clinical neurologist at Yale University School of Medicine — writes “There is no question that the advent of social media, blogs, and podcasts correlated with an explosion in the skeptical community. We went from being a loose collection of small local groups, with a few national groups largely pursuing their own agenda, to a vibrant intellectual community.”
Novella observes, “Skepticism is about promoting science, critical thinking, and reliable information. The abundance of information [on the Internet], will not lead to certainty; it will lead to pervasive skepticism.”
Finally, he concedes, “I have become thoroughly convinced of the axiom that there is no claim so absurd that it cannot attract flocks of true believers. The default mode of human psychology is to think with our emotions, then deftly rationalize our decisions. As a result there do not appear to be any practical limits to human gullibility.”
Skeptics Targeting CAM
Favorite targets in the pain management arena for skepticism include anything having to do with CAM (Complementary & Alternative Medicine), including chiropractic therapies, homeopathy, naturopathy, nutraceuticals, magnetic therapy, acupuncture, energy healing (eg, Reiki, healing touch), and others. In the blog, Science-Based Medicine [here], David H. Gorski, MD, PhD, claims that information about alternative medicine is overwhelmingly naïve and uncritical, and both mainstream media and medical institutions have bought into the hype and failed to ask the hard questions.
Gorski is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery. Academically, he is an Associate Professor of Surgery at the Wayne State University School of Medicine and part of the faculty of the Graduate Program in Cancer Biology there.
He writes, “It’s been a recurring theme on this blog to discuss and dissect the infiltration of quackademic medicine into our medical schools. Whether it be called ‘complementary and alternative medicine’ (CAM) or ‘integrative medicine’ (IM), its infiltration into various academic medical centers has been one of the more alarming developments I’ve noted over the last several years. The reason is that ‘integrative’ medicine is all too often in reality nothing more than ‘integrating’ pseudoscience with science, quackery with medicine.”
Gorski lambasts not only medical schools but institutions such as NCCAM (National Center for Complementary and Alternative Medicine) [here] and the Bravewell Collaborative [here], both of which help to fund a number of integrative medicine initiatives. He laments, “It’s been a depressing slide, and periodically I wonder just how much more pseudoscience can be ‘integrated’ into medical schools and academic medical centers or how much further medical schools can go in pandering to nonsense.”
A Gathering of Skeptics
The community of skeptics has its own annual conference, called “The Amazing Meeting,” or “TAM.” The 9th such gathering, held in July 2011, attracted 1,600 persons to Las Vegas.
TAM — promoted as an annual celebration of science, skepticism, and critical thinking — is organized by the James Randi Educational Foundation (JREF [website here]). This was founded in 1996 by Randi himself, who was once an internationally known magician and escape artist, but today is best known as an investigator and debunker of paranormal and pseudoscientific claims. He has received numerous awards and recognitions, including a Fellowship from the John D. and Catherine T. MacArthur Foundation in 1986.
The most recent TAM brought together skeptics from around the world and a long list of guest speakers and panelists. Workshops included: Defending Evolution, Skeptical Activism , Advancing Skepticism Online, Investigating Monster Mysteries, Raising Skeptics, and others. And, among the sessions discrediting UFOs and paranormal phenomena were the usual attacks against “alternative therapies” in healthcare and pain management.
COMMENTARY: Rethinking Skepticism
Throughout these Pain-Topics UPDATES, and particularly in our “Making Sense of Pain Research” series [here], we have advocated for adopting a healthy skepticism toward medical information coming from any source. More particularly, we have promoted an “educated skepticism” whereby established principles of scientific inquiry and research methodology are applied to the evaluation of evidence in the pain field for decision-making purposes.
Along with that, however, we have acknowledged that it is far easier to criticize science — asking tough questions, pointing out flaws or weaknesses — than it is to do good science. Therefore, we were somewhat dismayed by the writings and posturing of the self-proclaimed community of professional skeptics.
For example, their diatribes against CAM and integrative therapies — which actually can be vital modalities for effective pain management — seem guided more by emotional arguments than a systematic study of all available evidence. Hence, when Novella writes (as noted above), “The default mode of human psychology is to think with our emotions, then deftly rationalize our decisions. As a result there do not appear to be any practical limits to human gullibility,” we wonder if he also is describing how a credulous community of skeptics approach their subjects of scorn.
And, when Gorski asserts that “integrative medicine is all too often in reality nothing more than ‘integrating’ pseudoscience with science, quackery with medicine,” we might assume he has solid evidence to justify such claims; but, if so, he is keeping it secret. And, his far-reaching denigration of NCCAM, the Bravewell Collaborative, and unnamed medical schools adds emotive impact to arguments that might have no basis in fact.
Admittedly, the comments above from Gorski and Novella are mere snippets of their voluminous writings, described out of context. Readers can themselves visit the blogs of these skeptics (linked above) to decide the merits of their arguments. For example, we find using words like “pseudoscience” and “quackery,” as they do, to be rather slanderous and empty invectives.
Elsewhere in their blogs there are tediously verbose and wearisome debates in print about whether “science-based medicine” or “evidence-based medicine” is the more correct approach. As a further example, skeptics argue that the “placebo effect” should more properly be described as a “placebo response.” While words do make a difference, and there may be nuggets of substance in some of the rhetoric, much of it seems to be an intellectual exercise for the entertainment of their fellow skeptics — and, perhaps, the gullible public.
A commenter on one of the blogposts seems to sum up the life of a skeptic: “[S]ometimes being known to your family and friends [and colleagues, we would add] as a skeptic is a bit of a bummer because they may be reluctant to bring up certain topics for discussion, knowing that you will ‘spoil the fun’ by bringing critical thinking and skeptical analysis to the discussion. Usually these are the people who equate skepticism with close-mindedness.”
The lesson in all this is that our understanding of “healthy skepticism,” as advocated in these Pain-Topics UPDATES, may have an objective of “stopping the B.S.,” but it is not necessarily bent on “spoiling anyone’s fun.” And, it is not a close-minded approach that encourages contempt prior to adequate investigation.
Skepticism in pain research should drive a search for truth that recognizes and acknowledges the boundaries of uncertainty. Unfortunately, a great deal of research in the pain field seems driven by political agendas and hidden self-interests, so educated skeptics have much work ahead. We hope our readers are up to the task.