The Scientific Review of Alternative Medicine

And Aberrant Medical Practices

The Golden Age of Quackery and Anti-Science

Author: Steven Novella, MD

Editor’s note: Steven Novella, MD, an associate editor of SRAM, is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society.# He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe.1 He has his own blog, NeuroLogica, where a similar version of the following essay first appeared.2 He recently created another blog, Science-Based Medicine, where he “explor[es] issues and controversies in the relationship between science and medicine” with four other bloggers, including: Wallace Sampson, MD, the founding editor of SRAM; David Gorski, MD, another experienced blogger with a reputation for advocating reason in medicine; and two other SRAM Associate Editors, Harriet Hall, MD and Kimball Atwood, MD.3

Dr. Novella’s essay is particularly timely on the 10th anniversary of the first issue of SRAM.

Sometimes it’s useful and instructive to take a step back and look at the big picture. While many who read SRAM, my blog4 and affiliated blogs,5 and listen to my podcast6 may see them only as sources of information (and possibly as mild amusement), these readers are also deliberately part of a greater struggle for the very nature of human society and civilization. That may seem grandiose (and I am not making any judgments about the scope or impact of our humble efforts), but this has always been part of public intellectualism: engaging in the broader conversation about the nature of knowledge and the human struggle to grapple with it and ourselves.

The big picture is that homo sapiens is a curious species that is pushed and pulled in divergent directions by psychological and cultural forces, both conscious and subconscious. There is a literal struggle for dominance among these various forces—each carving out a niche while often trying to defend and expand its territory. Some of my colleagues have recoiled at this military analogy, but I feel it is apt. It is a struggle for dominance and resources—and that is what all war is about.

Our side in this struggle marches under various banners, all imperfect and faded at the edges, leading to internal struggles as to which banner is best, without any clear consensus. Ours is the side of science, scientific skepticism, rationality, reason, and methodological naturalism. No single label captures all of that, and various attempts to do so have failed spectacularly, in my opinion (remember the “brights”?). But we know who we are and we are increasingly organized and active, thanks largely to the Internet.

Arrayed against science and reason are those who advocate for the virtue of faith, spirituality, post-modernism, anti-intellectualism, pseudoscience, and anti-science.

Whenever I interview a guest for my podcast who has been engaged with science and skepticism for decades I invariably ask: How are we doing? What’s the long view? I have been doing this for about 13 years, so I have some perspective, but I appreciate the insights of those who have been at it for 30, 40 years, or more. Here is the feedback I have received:

Paul Kurtz, arguably the founder of the modern skeptical and secular humanist movements, who has been doing this the longest, is also the most positive. He sees the struggle of science versus unreason as occurring in cycles. Yes, he says, we had a bad patch around the turn of the millennium, but there is no reason to panic.7 There is no crisis, just an endless series of issues. There will always need to be skeptics to defend science and reason. The pendulum will swing back and forth, but he does not feel there is any larger trend toward anti-science.

A much less optimistic view was described in a recent episode of Science Talk, the podcast of Scientific American, in which Argonne National Laboratory director Robert Rosner made many pessimistic observations about science in America: the brain-drain of talent away from this country; the lack of support for science in the government; and the lack of adequately trained technology workers to maintain our science and technology-based infrastructure.8

In the field of medicine the outlook is even gloomier. Wallace Sampson recently wrote in our Science-Based Medicine blog that the trend against reason in medicine over the last 20 to 30 years has been frighteningly bad.9 The FDA no longer fights aggressively against fraud and quackery; the agency is under-funded (perhaps deliberately), incompetent, and uninterested. Medical schools are infested with promoters of implausible methods, corrupting the next generation of physicians.10,11 Politicians are largely ideological and scientifically illiterate. The zealots are winning and science-based medicine is suffering—it is, perhaps, an endangered species.

I recently interviewed Stephen Barrett, the founder of the Quackwatch website,12 for an episode of the Skeptics’ Guide to the Universe.13 He says we are in a “golden age of quackery” created by various forces. He points primarily to the National Center for Complementary and Alternative Medicine (NCCAM), which he believes has falsely legitimized and promoted pseudoscience in medicine. He adds that quackery has been re-branded as
“alternative,” creating a safe haven within medicine for quacks and frauds.14–17

To balance this I will say that during a conference at which I spoke along with Marcia Angell, former editor of the New England Journal of Medicine, she expressed her view that science works, that the public generally understands and respects this, and that over the long haul this advantage of science will win out over nonsense. So we can put her in the optimistic camp.

Where do I stand on all of this? Over time my views have become, if anything, more complex and conflicted. I can see both sides and I am not sure how this will all play out in the future.

Taking the very long-term perspective, I think it is undeniably true that in recent centuries the overall trend has been toward enlightenment, toward a larger role for science in society and a diminishing role for faith-based belief systems. I am hopeful that this large trend will continue, and that we should not be overly worried about what may turn out to be a short-term reversal lasting only decades. I also agree with Angell that science has a distinct advantage: it works.

But my long-term optimism is tempered by two pessimistic possibilities. The first is more dire, if less likely. The long-term trend over the last 600 years or so has been positive—reflecting the rise of science and reason in human civilization. But if we take an even longer view, we see that at other times in human history the light of science and reason has been extinguished. A poignant example was the death of empiricism in ancient Greece and the other historical factors that led to 1,500 years of a scientific Dark Ages.

Is it possible that we are seeing the beginning of a new age of darkness? I certainly hope not, and I think this is very unlikely, for various reasons. The first is that science is much more broadly and deeply institutionalized than it was at any time in human history. The second is that cultures are no longer as isolated as they were. If the light of science dies in one location it is certain to survive elsewhere (even the Dark Ages were largely a European phenomenon, while science and reason survived in Persia).

So over the long run I remain optimistic, but I do think there is a small chance of a reversal that could have substantial implications for some time.

Over the short term—the next few decades—I am less optimistic. While I think that science remains strong and continues to progress at an accelerating pace, there are some scary trends. Scientific literacy in the public is dangerously low and is not improving. The institutions of science have been weakened by an infiltration of anti-scientific philosophy—specifically, notions that science is a “Western” cultural endeavor, a misplaced desire for “tolerance” of “other ways of knowing;” and the post-modernist philosophy that scientific facts are just aesthetic opinions.

Medicine probably has the worst of it right now. Wally Sampson is essentially correct: every medical institution is under siege by nonsense and is now compromised. The defenders of science in medicine are increasingly pushed aside and made to seem as if they are the ideologues.18 This is all happening at a time when healthcare itself is in crisis, burdened by its own success. Technology has given us the ability to deliver more healthcare than we can afford, and we do not have the infrastructure or political will to deal with this problem. Medicine has also become too complex to effectively regulate itself. Between shrinking reimbursement and increasingly meddling insurance companies, doctors are largely just trying to survive. During this vulnerable time in the history of medicine, the scientific underpinnings of the standard of care are under coordinated attack by those who wish to be free to practice their faith and ideology (rather than medicine) or simply want the freedom to commit health fraud.19,20 Effective enforcement of a scientific standard of care is anathema to quacks and con artists.

I agree with Stephen Barrett that we are in a golden age of quackery. The mechanisms of regulation have broken down. The promoters of nonsense have pulled off one of the greatest cons in modern times: convincing the public that quackery, nonsense, and fraud are legitimate “alternatives” to science-based medicine and that they should be “integrated” into every aspect of health care, from the laboratory to the bedside.

While I think that science and reason will eventually prevail, there will be a great deal of damage done in the meantime. Institutions and culture have great inertia, and the infrastructure of pseudoscience now being constructed within government, academia and medicine will be around for a long time. It is like a metastatic cancer—ever spreading and almost impossible to eradicate, constantly sapping the energy and resources of society. I think the patient—scientific medicine—will live, but with damaged health.

Meanwhile, a growing and increasingly organized and energetic skeptical movement is working diligently to defend the integrity of science and to retard the institutions of anti-science. Much depends upon how successful we are in this task. I agree in part with Paul Kurtz that this is an endless struggle and there will always need to be skeptics beating the drum of reason. But we are also at a turning point in history, when the momentum appears to be shifting to the forces of darkness. It will up to our generation of skeptics to shift it back.

References

  1. The New England Skeptical Society website. Accessed 3/08 at: http://www.theness.com/home.asp.
  2. The Skeptics’ Guide to the Universe website. Accessed 3/08 at: http://www.theskepticsguide.org/.
  3. Novella S. A Golden Age of Quackery and Antiscience. NeuroLogica Blog website. March 20, 2008. Accessed 3/08 at: http://www.theness.com/neurologicablog/index.php?p=254.
  4. Science-Based Medicine Blog website. Accessed 3/08 at: http://www.sciencebasedmedicine.org/.
  5. Novella S. A Golden Age of Quackery and Antiscience. NeuroLogica Blog website. Accessed 3/08 at: http://www.theness.com/neurologicablog/index.php?p=254.
  6. Science-Based Medicine Blog website. Accessed 3/08 at: http://www.sciencebasedmedicine.org/.
  7. The Skeptics’ Guide to the Universe website. Accessed 3/08 at: http://www.theskepticsguide.org/.
  8. The Skeptics’ Guide to the Universe website. Skepticast #121: 11/14/2007. Segment #4: Interview with Paul Kurtz. Accessed 3/08 at: http://www.theskepticsguide.org/skepticsguide/podcastinfo.asp?pid=121.
  9. Scientific American Web site. Science Talk. Science and America’s Future. An interview with Robert Rosner. March 12, 2008. Accessed 3/08 at: http://www.sciam.com/podcast/episode.cfm?id=A4A0FB94-EC47-CC46-775B8D65B47CA5AE.
  10. Sampson W. Where are we going? Science-Based Medicine blog. March 20, 2008. Accessed 3/08 at: http://www.sciencebasedmedicine.org/?p=74.
  11. Gorski D. The infiltration of complementary and alternative medicine (CAM) and “integrative medicine” into academia. Science-Based Medicine Blog. Jan. 21, 2008. Accessed 3/08 at: http://www.sciencebasedmedicine.org/?p=28#more-28.
  12. Bravewell Collaborative website. Changing the Way Physicians are Educated. Accessed 3/08 at: http://www.bravewell.org/transforming_healthcare/changing_physician_education/.
  13. Quackwatch website.Your Guide to Quackery, Health Fraud, and Intelligent Decisions. Operated by Stephen Barrett, M.D. Accessed 3/08 at: http://quackwatch.org/.
  14. The Skeptics’ Guide to the Universe website. Podcast #139. 3/19/2008. Interview with Stephen Barrett. Accessed 3/08 at: http://media.libsyn.com/media/skepticsguide/skepticast2008-03-19.mp3.
  15. Halperin EC. The Office of Alternative Medicine/National Center for Complementary and Alternative Medicine Should be Abolished. Sci Rev Alt Med 5;4:223–5 (Fall 2001)
  16. Sampson WI. The Foolish Enterprise of the National Center for Complementary and Alternative Medicine. Sci Rev Alt Med 2003;7,1:5–8. A similar essay is available online: Sampson WI. Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded. Quackwatch website. 2002. Accessed 3/08 at: http://www.quackwatch.org/01QuackeryRelatedTopics/nccam.html.
  17. Atwood KC. The ongoing problem with the National Center for Complementary and Alternative Medicine. Skeptical Inquirer. 2003;27:23–29. Accessed 3/2008 at: http://www.csicop.org/si/2003-09/alternative-medicine.html. 
  18. Gorski D. The National Center for Complementary and Alternative Medicine (NCCAM): Your tax dollars hard at work. Science-Based Medicine Blog. Feb. 4, 2008. Accessed 3/08 at:http://www.sciencebasedmedicine.org/?p=36.
  19. Sampson WI. The braid of the ‘alternative medicine’ movement. Sci Rev Alt Med 1998;2(2):4–11. Available online at: http://www.quackwatch.org/01QuackeryRelatedTopics/altbraid.html.
  20. Barrett S. Pro-Quackery legislation. Updated 5/2001. Accessed 3/08 at: http://quackwatch.org/07PoliticalActivities/quacklaws.html.
  21. American Association for Health Freedom website. Accessed 3/08 at: http://www.healthfreedom.net/.

About the Author

Steven P. Novella, Assistant Professor of Neurology, Yale University School of Medicine. Please send e-mail correspondence to: steven.novella@yale.edu, or mail to: 333 Cedar Street, New Haven, CT 06518.

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