Ethics (and the origins of woo)

Via SkeptVet, a must-read on ethics, placebo effect, and the dangers of the ‘just do something’ approach:

The Ethics of Honesty in Veterinarian/Client Relationships

Philosophically and personally, I am comfortable with some degree of scientific indeterminism, and I believe it is possible that some things simply can never be predicted or fully understood. But even in the more pragmatic, practical world of applied medical science, the reality is that there is much we don’t know, and pretending that we have all the answers is misleading and wrong.

Unfortunately, people don’t like uncertainty, especially when it involved illness, and they tend to view the claim that something bad happened for reasons we don’t understand, or even possible just by chance and so for no good reason at all, as unacceptable and likely a cover for incompetence. Not being able to identify a clear and simple cause for something means we cannot control or prevent it, and this makes us afraid, and fear makes us angry. Facing this anger and dealing with it compassionately, and yet honestly, is a tough part of our job as veterinarians. [My bolds.]

Recommend reading the whole thing.

It’s as good a description as I’ve read of how and why people come to believe in dangerous woo, too.

Like so: vet won’t give antibiotics to treat a virus. Owner feels helpless. Owner a) demands antibiotics anyway (creating other health risks) or b) starts giving their pet some dangerous snake oil treatment that causes more damage than letting the virus run its course ever could.

Of course, people do precisely the same things with their doctors, and come up with even wackier stuff to project onto illness and health ranging from magical thinking cures to the invention of moral ’causes’ for sickness.

We are living in an age of woo.

Here’s Gilly’s contribution to the cause:

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2 responses to “Ethics (and the origins of woo)

  1. If it works, it isn’t wacky, placebo and woo included.

    But then, I work in woo, so I admit my bias.

  2. Hi Daisy – I actually agree with you that if it works, it isn’t wacky, as long as safety and efficacy has been shown: and from my point of view, when things have been proven effective and safe, they stop being ‘alternative’ and start being ‘medicine.’

    I should probably explain where I’m coming from in calling ‘woo,’ since I haven’t here before.

    It isn’t any blanket rejection of stuff that works, or any intended disrespect for things that do work for people – but instead rejection of scam artists preying on people who are afraid either because they or someone they love – human or animal – is sick.

    In the 1800’s, it was snake oil. In the 21st Century, it’s a wider array of things: abuse of poorly understood at best, unabashedly distorted at worst, quantum physics (The Secret, etc.) designed to bilk people of their money in schemes set up to make vulnerable people feel like they have power they actually lack – romanticizing “Eastern” traditions with a kind of ‘Noble Savage’ racism based, apparently, on the idea that science doesn’t exist east of Europe or that scientific method and ancient treatments for illness can’t be reconciled, outright scams like $900 ‘spiritually detoxifying silent retreat weekends,’ dangerous and cynical cultural co-option of sweat lodges without any respect for or understanding of traditional practices leading to people dying in some white guy’s ‘purification ritual,’ that kind of thing.

    We want a sense of control over outcomes, and we don’t always have it – which makes us vulnerable to exploitation.

    I have sympathy/understanding for that awful feeling of helplessness, but no tolerance for what people do with that sometimes (“if you’d just been less feminist and more positive you wouldn’t have cancer!” “Your 17 year old dog has kidney failure and is suffering terribly, but if you give me tens of thousands of dollars, I’ll do all sorts of treatments that won’t stop her from dying but will at least make you feel like I’m doing something while I pad my bank account!”).

    I also have sympathy & understanding re: profound wariness of the failures of medicine as it is sometimes institutionally practiced (Tuskegee, eugenics, etc.).

    But throwing out the scientific method in response to the malice or mistakes of a few puts the many at too much risk, to me.

    Science fails, sure – and real scientists are humble about that. Self-proclaimed gurus? Not so humble.

    When it comes to animals who can’t give informed consent for themselves, I feel strongly that we have to be doubly responsible in choosing the best, safest health treatments we can – and sometimes, painfully, horribly, as with people, that means accepting mortality. (I like the post on veterinary ethics I linked here because it’s based in the idea that it’s the vet’s responsibility to tell the truth about this.)

    Here are a couple of quotes I like talking about the relationship between ‘alternative’ and ‘mainstream’ medicine:

    “There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”
    — Angell M, Kassirer JP, “Alternative medicine–the risks of untested and unregulated remedies.” N Engl J Med 1998;339:839.

    “There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is ‘Eastern’ or ‘Western,’ is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues-namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy.”
    — Fontanarosa P.B., and Lundberg G.D. “Alternative medicine meets science” JAMA. 1998; 280: 1618-1619.

    So, that’s where I’m coming from.

    And all of that seriousness said: Gilly really does think I should put a steak on his nose if he bumps his knee. “If nothing else, ma,” he says, ‘it will make me happy.”

    Mostly, he gets what he wants. I just might wrap the steak around a buffered aspirin. : )

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