why “starting a conversation” isn’t always the best idea in medicine
We all know that purveyors of woo are popular. Whether they claim to give you tools to live longer and better with the right diet and sexual regimen, or validate your need to believe in something big, as long as it’s not organized religion in a scientific-sounding way, usually by saying “quantum” a lot, they provide easy answers to really, really complicated questions. Their whole gig revolves around false empowerment, telling you that something as simple as what you eat or what you gleam from skimming articles in a pop sci blog can give you the tools to control your future, prolong your life, and assure you that death is really not the end of your existence. People don’t want to hear that science is hard and there are a lot of false starts and failures to find something useful. Not only is it boring, with all the math and strange terminology, it’s also a little deflating because you’re trusting someone along the way to have a good idea that will survive decades of scrutiny until it gives you a direct benefit.
And so, as Orac, a.k.a. Dr. David Gorski, points out, cranks often get invited to all sorts of medical conferences where they have no business being simply for the sake of increasing turnout. The organizer’s defense for the equivalent of the keynote speaker at an astrophysics conference being an astrologer mirrors the cry of the woo faithful to “keep an open mind” and “start a conversation” on the efficacy of technobabble and random pseudo-scientific hokum of modern day snake oil hawkers. Now, I’m all for free speech, but sometimes, the appeal to debate and open-mindedness are a last refuge of a scoundrel, to borrow a phrase. While scientists are obliged to pass peer review and mistakes in their work for which they’ll have to answer could be unearthed decades later, all of the cranks in question essentially want us to suspend our disbelief and require the lowest possible standard of proof, testimonials from their fans, to step on the same stage as actual experts and expound on their nonsense.
And herein lays the problem. They use these “open-minded” invitations to real and serious scientific conferences as a patine of legitimacy when selling their bullshit to their fans. Why is this dangerous? Because their fans are often not subject matter experts who can distinguish convincing sounding tripe and real scientific information. They may well be accomplished experts in their right or even luminaries of their fields themselves, but being an expert in something is not going to immunize you from being taken in by a crank in a field you simply don’t understand. The list of Nobel Prize winning scientists taken in by woo is disturbingly long, so if you really think that I’m somehow talking down to the people buying the woo people like Dr. Oz and Deepak Chopra are selling, that’s not at all the case. Everyone is ignorant about something and that’s exactly what cranks and quacks exploit to slip under the radar.
In economics, there’s the term information asymmetry. It means exactly what it sounds like it means: someone has more knowledge than someone else and can use it to gain an advantage. The greater the asymmetry, the easier it is for cranks to abuse the subject. Think of the gulf between a doctor and a patient when it comes to a complex disease like cancer. Doctors will often have to deal with genetics and biochemistry they had to study over the course of decades to come up with the right treatments. Explaining the precise details of every injection, scan, and test is simply out of the question and would involve a huge investment in advanced education on the patient’s part. This means that a lot of the time, the patients have no idea what their doctors are doing and their doctors can only explain so much under realistic constraints. And this is where the cranks and quacks strike. No need to spend six years in college, they say, just eat these berries and take these supplements, and nature will fix you right up! Why those doctors are [insert conspiracy theory here] and their chemo can kill you while we let Mother Nature gently take you in her hands.
Are we really being open minded when we elevate woo like this into the same space where we gather scientists and doctors who spend their lives trying to find evidence-based answers to questions of life and death? Of course not, we would be just giving some parasite on society who is either lying and knows it, is deluded by his own narcissism, or a combination of the two over time, yet another marketing opportunity, and a way to grow his or her brand. Getting to present expert knowledge you’ve acquired through years of hard work, review by fellow experts, and successful experiments is a privilege, not a right to be granted to every self-important blowhard who thinks he or she solved the mysteries of the universe while watching daytime TV and surfing the web. We may live in a world where legally, in public, someone’s ignorance is deemed of equal value than others’ knowledge, but that doesn’t mean we need to extend this legal principle into the scientific world. In fact, we should oppose it.
