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On not trusting the experts

As I mentioned in a few other articles, I am often suspicious of the medical world. Ben Goldacre has a great book called "Bad Pharma" which goes into great detail in describing the problems with clinical studies, medical research, and the pharmaceutical industry. I'd recommend it for everyone, because it's, you know, important. People shouldn't blindly trust what their doctor says, and doctors shouldn't blindly trust what the drug companies and the FDA say.

But, as I hinted at in "Not that far", there's an additional step many people take which I can't. Many people seem to believe that because drug companies and doctors are sometimes wrong (or worse), it means the people who offer a different opinion must be right. It's really a false dichotomy: Just because "medical science" is wrong (or corrupt) regarding some facet of health, it doesn't mean what someone else says is right.

For example, in "Bad Pharma", Goldacre details the problems with the studies used to promote Tamiflu. In short, it might work, it might not: it's extremely hard to tell. So, I'd place no great faith in the effectiveness of Tamiflu.

On the flip side, some of the same people who decry Tamiflu because it lacks evidence of efficacy and safety will pass around home recipes for "flu shots" with wild enthusiasm. They are rightfully demanding evidence that a medical intervention works, but then seem to be uncritically accepting an "alternative" with almost zero evidence. I say "almost" because that particular article seems to provide evidence in the form of citations, but those "citations" are just links to other sites which merely assert effectiveness with no evidence of any kind (Sorry, anecdotes don't count).

Whenever I'm asked by alternative health proponents why I won't believe their particular belief, I say there's a lack of studies showing they work. The response to this is usually some form of "They won't study it, because there's no money to be made" or "Studies can't be trusted because the FDA is bought out" or similar.

Well, fine. I may disagree with the "there's no money to be made" since millions of dollars of vitamins and supplements and treatments are sold every year, and a few well-designed definitive studies that showed one of them actually helped with anything could rake in millions more (it sounds like there could be money in not showing they don't work), but for the purpose of this argument, let's assume they are correct and there's a conspiracy to not do good studies on "alternative treatments": That still leaves us with a complete lack of evidence for the treatments.

To know if you can rely on kale smoothies and overdoses of cod liver oil to protect your elderly grandfather from a potentially life-threatening case of the flu, you need positive evidence. It doesn't matter why you believe there's no positive evidence, it only matters that there is no positive evidence. To know if it works, you need positive evidence, period.

It doesn't matter that there's a lack of good evidence for the "conventional medicine": that doesn't give us any reason to believe the "alternative" works any better, or at all. Lack of evidence for Tamiflu is simply lack of evidence for Tamiflu, it is not evidence for Traditional Chinese Medicine, it is not evidence for homeopathy, it is not evidence for herbology, it is not evidence for buying a juicer, it is not evidence for anything. It is simply a lack of evidence for Tamiflu. It does not have to be either Tamiflu or cod liver oil: it could be neither.

So no, I don't "trust the experts" (whether they be doctors, the FDA, or pharmaceutical companies), but I also have no reason to trust the non-experts' offerings.


This applies to many other subjects. Think psychology. Think agriculture. Think ecology. Think religion. But what come most readily to mind is politics and economics. Imagine some big wig political expert with years of political experience predicts that if some law is passed (or not passed), some grave disaster will (or won't) happen. Is she right? … Well… now imagine that your cranky Facebook-polluting aunt (who previously spouted her theories about Obama's secret Islamic tendencies and death squads) posts a long essay on the same subject as the political expert, but predicts the exact opposite will happen.

Even if you choose to not believe the expert, it doesn't mean your nutty aunt is correct. (Or if she ends up being correct, it was anything more than a lucky guess.)

I guess what I'm trying to say is, if you have a choice between trusting the experts with shaky evidence, or trusting the non-experts with none, it's totally OK to choose "None of the above."

2014-03-01
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