What are the beer goggles of medicine?

In a word, placebo.

As the slang term indicates, the more one drinks in claims of complementary and alternative medical efficacy through the ‘power’ of placebo, the less inhibition and discretion one seems to exercise in critical thinking, making the blurred claims of alternative ‘therapies’ seem all the more attractive.

We describe this power of placebo by a common term: the placebo effect. So let’s take a moment and review what that effect actually is:

changes in how pain or subjective symptoms are perceived, not any physiological change that concretely affects the course of a disease.

Does this mean we can control health outcomes with our minds through belief? No. Placebo effects do not shrink tumors or change the underlying pathophysiology of disease. To be clear, there is no good evidence for any objective responses due to placebo; the placebo effect is the change of a patient’s subjective perception to his or her symptoms. Note the emphasis on perception and not on any change to symptoms themselves. This is the repeated mistake people make about understanding the placebo effect: all we are talking about when we talk about the placebo effect is the change to perceptions.

The CAM (complementary and alternative medicine) schtick is to pretend that the substances and treatments being sold cause symptomatic changes through the placebo effect. There is no good evidence to back that up and much good evidence contrary to it. To be clear, the efficacy of CAM rests not in the treatments but in the beliefs of its patients.

In medicine, when a treatment performs no better than placebo, it means that treatment doesn’t work.

Got that? Placebo means it doesn’t work.

Believers and practitioners of CAM, however, forget – and often intentionally – that placebo treatments are physiologically inert and present them to patients as if they were real efficacious medicine. But they know it’s not. And yet we in the public continue to be inundated with messages that they do. Obviously, something here is out of whack, and it rests with the CAM crowd.

The underlying assumption associated with CAM products and treatments that the use of placebo causes no harm is just as risky as my pathetic little beer goggle analogy; one may think one is going home with a fox (of both genders, let me be clear) but wake up to a coyote ugly morning. The same is true with CAM: that patients are going home with a placebo but wake up to a nocebo ugly morning. By this I mean that promoting belief in placebo efficacy also means promoting belief in nocebo efficacy, which refers to harmful, unpleasant, or undesirable effects a subject can also manifest through perception.

The sum total of the medical efficacy complementary and alternative treatments and many nostrums pretends to have (with the exception of herbal substances that possess chemical properties that can interact with our biology in both positive and negative ways), rests not on the treatments themselves but on the double edged sword contained within the beliefs of its patients. Seeing the world through such faith-based beliefs is not an inherently good, positive, or even neutral perspective but an inherently dangerous one.

How so?

Well, the very real side effects of investing faith in such subjectively sensitive beliefs and acting on them as if they were true in reality can be life-altering when a negative drug interaction occurs because a patient forgets to tell a doctor about some CAM herbal nostrum, or postpones  (like Steve Jobs) real medical intervention in favour of trying out some naturopathic treatment first, mistakenly hoping that wishful thinking through investing in faith-based belief will cause symptomatic changes, or that not vaccinating children will protect them from a perceived inoculation danger far smaller in reality than the very real and larger danger of an actual and highly contagious disease. These are some of the very real dangers faith-belief in CAM promotes. We need to take off our belief-based beer goggles before we do something stupid based on misunderstanding what placebo effect really means.

(h/t SBM)

What ever happened to Baby Joseph, ‘saved’ by the Priests for Life stormtroopers from the evil clutches of Canadian health care?

Back on March 22 of this year, I posted about why Priests for Life are theological thugs, fanatical religious stormtroopers who prey on the hopes of others to aid and abet and revel in the unnecessary suffering of others in the name of  honouring their god. Their latest victim was Baby Joseph Maracchli who, in October of 2010 at 10 months of age developed a brain fever and became vegetative just like another previous child of the Maracchlis. The family wanted a tracheotomy performed so that they could take the baby home to die but the hospital disagreed on compassionate medical grounds:

Eight physicians at LSHC were unanimously of the opinion that Joseph had no hope of recovery, and there was no possible treatment that could reverse his condition. They quite rightly pointed out what was obvious that he would never get out of bed nor interact meaningfully with his environment. As responsible and caring medical professionals, the doctors sought a second opinion from colleagues in Toronto. The director of the critical care unit for Sick Children’s Hospital in Toronto (a world class facility and recognized leader for pediatric medical care) there agreed that further treatment was futile. Joseph’s doctors therefore proposed removing the tube that was assisting his breathing. If he could breathe unaided, he would go home to be cared for by his parents. If not, he would be given medication to ensure that he did not suffer, and allowed to die. A Canadian Superior Court judge ruled in favor of the Canadian hospital, ordering the life support removed.

This is when the Priest for Life entered and through their efforts helped make this sad story into a fundraising campaign, where they spent a considerable amount of donated money to fly the baby to St. Louis and have the tracheotomy. From their warped point of view, the priests were ‘saviors’ of the baby, vilifying the baby’s Canadian health care team in the process. The baby was released at the end of April and went home to Windsor Ontario.

Today, the Windsor Star reports:

Br. Paul O’Donnell, Major Superior at Franciscan Brothers of Peace, posted a message posted early Wednesday reported Baby Joseph had died.

“It is with great sadness that I report to you the passing of our dear Baby Joseph Maraachli. He passed away peacefully at home with his parents and family at his side. Praise God he had seven precious months with his family to be surrounded by love and was not put to death at the hands of doctors. May Joseph rest in the loving arms of his Heavenly Father surrounded by all the angels.”

Back in March, I pointed out that:

What is not reported very widely is that the couple’s first child who suffered from the same condition did receive a tracheotomy, at the parents insistence, and died a horrific death at home. That child suffered from infection, followed by pneumonia and eventually choked to death… it just took six months of additional suffering for this to happen. The physicians were rightly concerned on behalf of the quality of life of their patient to do as the family asked.

This time it took only five additional months for the baby to die after our priestly heroes intervened. They’re slipping as they get older, I guess, but any additional unnecessary suffering is a real feather in their theological caps.

What is the medical version of the Courtier’s Reply?

We find a perfect example of this detestable apologetic accommodationist approach for ‘sophisticated’ thinking over at Sabio Lantz’s popular Triangulations, offered up on platter in his post Why do you reject Homeopathy? This is the medical version of the Courtier’s Reply that invokes the need for some level of sophistication to be exercised in order to reject the tenets of homeopathy properly… while making room for what starts out to be hypothetical efficacy derived from it and morphs into actual efficacy associated with it.

Sabio lists three main categories into which a reader’s rejection may fall: tribal doubt (no other ‘tribe member’ accepts it so, being part of this ‘tribe’, you don’t either) , mechanism doubt (the mechanistic explanation is inadequate), and smattering of science (you believe some studies you’ve heard in passing that claim no evidence of efficacy). A fourth classification is for those who have done in-depth research into the applicable science and waded through all the counter evidence of non-efficacy before arriving at an opinion of rejection (similar to the level of knowledge about the finery that is needed before one is allowed to comment of the nakedness of the Emperor).

He is following the tried and true method of the accommodationist so that he can ask with a straight face, Do you agree that something can work in spite of the explanation offered? Notice the words ‘CAN WORK’. That sounds like a reasonable question, doesn’t it? But then, Poof! ; suddenly we’re talking about homeopathy as if it DOES WORK – even if this explanation is absolute bunk – which is slowly revealed to be Sabio’s position all along… beginning with the comment that “I strongly agree that much is to be learned from alternative medicines which has nothing to do with the science behind their treatments.” Really? And what might that be? How gullible people are? How undermining healthy scepticism helps woo-peddlers? How faith-based belief can be accommodated with conflicting knowledge? Do tell, Sabio; do tell. In this post, of course, we never do find out.

What he means by has nothing to do with the science behind their treatments , of course, is the LACK of good science, plausible science, that informs these alternative, complimentary, integrated, holistic, natural treatments… treatments  that are somehow qualitatively different from what we call efficacious medicine but still cause effect, but once you start down the path to presenting the Emperor as if he could be clothed – that woo treatments CAN WORK even if the explanation is wrong  – it is difficult to regain one’s intellectual footing. But intellectual integrity is never the goal of accommodationism; it’s all about appearing to be non judgmental about woo and hyper-critical of justifiable scepticism. The real goal at the end of the day for the accommodationist is to present himself as both a supporter and defender as well as a reasonable sceptic of woo (unlike those ranters and hyper-rational people who dismiss woo claims out of hand because they have no good reasons to believe them in the first place).  It’s tricky ground for accommodationists when the two – woo and scepticism – are in conflict from the get go (see here for why the treatment should banned according the British Medical Association).

Well, what is the explanation of homeopathy that is being dismissed by some level of ‘sophisticated rejection’?

Orac explains:

Most skeptics are aware of the two main principles of homeopathy, neither of which is based on anything resembling good science. The first principle is known as the Law of Similars, which is commonly phrased as “like cures like.” The concept is that the way to choose a homeopathic remedy is to choose something that causes the symptoms the practitioner wants to alleviate. Of course, there’s no general scientific or biological principle to support the Law of Similars. In reality, it’s nothing more than a variant of ancient concepts of sympathetic magic. Yet it is the main basis of all of homeopathy.

The second big law of homeopathy is known as the Law of Infinitesimals. This is the most famous principle of homeopathy that states that the way to make a remedy stronger is to dilute it, a principle that laughs at chemistry, physics, and biology. Indeed, common dilutions of homeopathic remedies (for example, 30C, which is 30 serial 100-fold dilutions, or a dilution of 10⁶⁰) have been diluted so much that the odds that even a single molecule remains in the remedy are, well, infinitesimal. That’s why it’s not for nothing that skeptics frequently point out that homeopathy is nothing but water. It’s even loonier than that, though. The reason is that dilution is not enough. At each step, we are told by homeopaths in all seriousness that the succussion at each dilution step is critical to “potentize” the remedy. Samuel Hahnemann himself, the inventor of homeopathy, used to succuss his remedies by slapping them against a Bible. These days, in at least one case, a big company like Boiron have machines that do the succussion automatically for remedies like oscillococcinum up to 200C, which represents a 10⁴⁰⁰-fold dilution. Given that there are only around 10⁸⁰ atoms in the known universe, readers can easily see the ridiculousness.

So here’s the thing: what is it that is actually being rejected? I think it’s the central tenet of any woo claim about efficacy  – a faith-based belief that supernatural forces can cause through natural treatment natural effect. Sabio suggests that there really, really, really is evidence of efficacy in some of these woo treatments (“I have demonstrated acupuncture to many folks (not just patients). What is real fun is to get a hyper-rational person to experience things they don’t believe exist”) and that this evidence is available (“But I wager you have not read the studies published by homeopaths showing effectiveness. I worked with an MD homeopath who published in Pediatrics about her research in Guatemala with homeopathic remedies used to treat diarrhea and showed an effect”). See? Homeopathy, says Sabio,  DOES produce evidence of efficacy, and there it is: the switch in language from the reasonable CAN WORK to DOES. But he doesn’t really mean supernaturalism at work, does he?

Let’s look.

Sabio actually means efficacy of placebo when he talk about efficacy: “It is funny how people can allow various placebos (to) work for them and yet now (sic) allow others.” Now think about that comment for a moment because it reveals the sneaky way accommodationists forgive promoters of woo for their lack of specificity… through the subtlety of language.

Sabio is suggesting that placebo is more than what it actually is:  self-reporting of feeling better. He present it as a thing, something you can allow or reject, something that works for you. But that’s not what placebo is, not what placebo means. What placebo means is that mood and belief can have a significant effect on the subjective perception of a treatment’s efficacy. Placebo is not any kind of additional ‘thing’ brought to bear by health care practitioners. Placebo comes only from the patient and its ‘efficacy’ is not directly physiological (although to be clear there are biological mechanisms by which mental processes can affect pain). That’s why placebo is often – and confusingly – referred to as an ‘effect’. But to be equally clear, the more concrete and physiological the outcome, the smaller the placebo effect. At its explanatory extreme, that’s why amputees don’t grow back new limbs no matter how much they may wish it to be.

Notice how Sabio slips in the notion that placebo works ‘for’ someone…as if to say if we build it they will come, that putting efficacy of placebo into the patient’s domain means the same thing as putting efficacy of woo treatments under the control of the patient.  This subtle change in language is insidious because it alters what placebo is – self reporting perception – into something it is not – an efficacious deliverable element of treatment with the patient’s permission. This confusion is rampant in the public domain and, in a nutshell, is the main driver of woo in health care: confusion about causal effect.

From wi-fi fears to chlorination of water, from acupuncture to reiki, from faith healing to anti-vaxers, the confusion about the need to link causal effect is neither clarified nor confirmed by accommodationists who pretend we can put aside causation to better respect faith-based beliefs while maintaining intellectual integrity. We can’t. It’s sneaky, dishonest, and cowardly, and comes at a high cost to respecting knowledge . And here’s why:

I think the notion of what’s true in fact (information that is reliable, consistent, and practical in reality) is knowable and dependable. This is what science is built on and we use practical applications based on exactly this everyday in every way of our lives. Accommodationists and apologists for woo take all this and assume it’s equivalent to some democratic vote. (Sabio: I hope to help interested readers to understand why people practice homeopathy and why millions of patients swear to its effectiveness.  So I am talking to those who are willing to consider not dismissing homeopathy out-of-hand, and instead make an effort to understand why others value it so strongly.) That’s not how reality works. You can’t vote against gravity and expect efficacy because millions want to lift its effects to make room for their anti-gravity beliefs any more than you can vote against evolution to make room for the oogity boogity of creationism or vote against science-based efficacious medicine to make room for homeopathy and expect me to sit by and nod and say how wise that is. It’s not. It’s a denial of what’s true in reality (see above description of what that means)… not a philosophical difference, nor a lack of rejection sophistication, nor any other mitigating term accommodationists would prefer to call it. Belief in woo is a denial of what’s true in reality (remember, see above description of what that means).

And it is downright dishonest to pretend that what’s true in reality (see above description of what that means) is only empirically available in some lab. It’s right in front of our faces all the time and we rely on accurate knowledge about it to function. We really must stop pretending that people who sow doubt about trusting in this knowledge (immediately testable and verifiable) rely on the same kind of faith woo believers exercise to maintain their ‘spiritual explanations’ about the supernatural. It’s not just different; it an exercise of hypocrisy that trusts this knowledge on behalf of their lives on a day to day, moment to moment, basis but then a rationalization using such fallacious arguments like the Courtier’s Reply and sneaky word substitutions to suspends this same knowledge to make room for some woo-soaked apologetic belief in oogity boogity.

Why are Priests for Life theological thugs?

First, who is Baby Joesph Maracchli and second, what’s the big deal about his medical care?

Joseph Maracchli, the son of Lebanese immigrants, was born on January 22, 2010, and his parents say they noticed he couldn’t eat or breathe properly and wouldn’t open his eyes or cry. The family, who lives in Windsor, Ontario on the Canada – United States border near Michigan, took him to a Michigan hospital in June 2010, where he was diagnosed with a metabolic brain disease, which the doctor said would make him developmentally delayed. Maracchli was treated and returned to normal after a month. However, in October 2010 he developed a fever and was breathing rapidly and was rushed to the emergency room and later transferred to the London Health Sciences Centre in London (LHSC), Ontario. The hospital said he was in a persistent vegetative state from which he would never recover. Maracchli’s family wanted the staff there to do a tracheotomy so that they could take him home and he could die in the care of his family instead of a hospital. Sounds pretty reasonable, doesn’t it?

What is not reported very widely is that the couple’s first child who suffered from the same condition did receive a tracheotomy, at the parents insistence, and died a horrific death at home. That child suffered from infection, followed by pneumonia and eventually choked to death… it just took six months of additional suffering for this to happen. The physicians were rightly concerned on behalf of the quality of life of their patient to do as the family asked.

Eight physicians at LSHC were unanimously of the opinion that Joseph had no hope of recovery, and there was no possible treatment that could reverse his condition. They quite rightly pointed out what was obvious that he would never get out of bed nor interact meaningfully with his environment. As responsible and caring medical professionals, the doctors sought a second opinion from colleagues in Toronto. The director of the critical care unit for Sick Children’s Hospital in Toronto (a world class facility and recognized leader for pediatric medical care) there agreed that further treatment was futile. Joseph’s doctors therefore proposed removing the tube that was assisting his breathing. If he could breathe unaided, he would go home to be cared for by his parents. If not, he would be given medication to ensure that he did not suffer, and allowed to die. A Canadian Superior Court judge ruled in favor of the Canadian hospital, ordering the life support removed.

Enter our heroes, the Priests for Life, those celibate men of the cloth who (incredibly and without shame) think their religious beliefs equip them with the kind of god-soaked moral knowledge necessary to determine proper medical treatment over and above a team of highly trained and specialized medical professionals who actually care for children as their daily job. Let us keep in mind that there has never been a suffering life these meddling priests have not tried to prolong. The Terri Schiavo debacle immediately comes to mind.

Peter Singer, professor of bioethics at Princeton University picks up the story:

Little Joseph Maraachli is a new poster boy for the “pro-life” movement. But what has happened to him should instead teach us what to do – and what not to do – if we are really serious about saving human lives. The 13-month-old from Canada, who has been having medical treatment for most of his short life, suffers from a severe neurodegenerative disease. He has difficulty breathing on his own. His head is small for his age and has not grown for three months. He has seizures. His pupils do not respond to light or follow a moving object. His movements are not purposeful.

Then Priests for Life, a Catholic -abortion and anti-euthanasia organization stepped in, chartering an air ambulance to fly Joseph from Canada to Cardinal Glennon Children’s Medical Center, a Catholic hospital, in St. Louis, which will perform the operation the parents requested.

“We Rescued Baby Joseph!” says a page on the Priests for Life website. The organization’s director, the Rev. Frank Pavone, says he has been told that it could cost as much as $150,000 for Joseph’s stay in the pediatric intensive care unit. That doesn’t include the cost of the aircraft, which would have added thousands more to the bill. Priests for Life is, of course, asking its supporters to donate to pay these costs.

Here’s the irony. According to the most rigorous charity evaluation agency in the country, GiveWell.org, you can save a child’s life for about $1,000. All you have to do is give the money to their top-rated charity, Village Reach, which delivers vaccines and other urgently needed medical supplies to rural areas in developing countries.

If Priests for Life were really serious about saving lives, instead of “rescuing” Joseph so he can live another few months lying in bed, unable to experience the normal joys of childhood, let alone become an adult, they could have used the money they have raised to save 150 lives – most of them children who would have gone on to live healthy, happy lives for 50 years or more.

We’ve seen such things happen before. In 2005 the anti-abortion movement put a huge effort, and large sums of money, into “saving” Terri Schiavo. In the end, after Congress had been recalled specifically to enable a federal court to hear the case, she was allowed to die. An autopsy showed her brain had been severely and irreversibly damaged.

We can obsess over Joseph and Terri – or we can make an honest effort to save the lives of countless children whose names we may never know. It is our choice.

But the Priests for Life don’t want to save lives in the sense of protecting the dignity of those who are already alive yet suffering; they want to prolong the biological functioning of a body regardless of the suffering… the younger the better and a fetus especially, even if it kills women to do so. Since becoming involved in the medical treatment of Baby Joseph, the Priests for Life have mobilized support from the likes of the Hope Network and the legions of catholics and christians who think these groups do god’s work. Now the medical staff at LSHC have been the recipients of the kind of faith-based love the anti-abortion crowd – championed as they are by Priests for Life – sends out to those who disagree with their beliefs: hate mail and death threats.

Oh, I can hear the faithful claiming loudly that those extremists don’t represent the mainstream religious.

But they do.

You see, Priests for Life and the anti-choice crowd are no different than the mainstream believers in that they don’t give a rat’s ass respecting your life;  they care only for life, which according to their beliefs belongs not to you but their god. And they will continue to act accordingly not to respect your rights and freedoms as an autonomous individual where dignity of personhood must reside, if the term ‘personal dignity’ is to have any personal meaning, but as god’s Stormtroopers out to protect what belongs to him. That’s why they’re theological thugs and are empowered by those who respect their beliefs about what god owns over and above respecting your personal dignity.

Just how gullible does the Roman Catholic Church want Americans to be?

This is the US we’re talking about, land of the free, home of the brave, the shining city on the hill, the Nobel prize capital of the world. So, naturally, I thought the roman catholic church was so busy vilifying secularists and the great evil they represent – including such theistic affronts as human rights, political freedoms, dignity of personhood, respect for scientific understanding, and all that mundane, temporal jazz – that I assumed this conference was a bunch of modern day catholics poking fun at one of their absurdities from almost-ancient history.

Isn’t that the way most enlightened and educated Americans think about demonic possession?

But when it comes to treating demonic possession, the rc church is all business. It remains steadfast in bringing to bear all the modern weaponry at its disposal for the modern American citizen: exorcisms! That’s right, folks. There is growing need for them and the church needs to step up and do its theological duty. Cast that demon out. Use force if you have to. That very difficult and demanding expertise includes the brute force of using conjugated Latin, too. Very scary stuff to any demon to be sure… and even scarier to young people everywhere who need to learn it. Nevertheless, let us press on and read about what the rc church is doing behind closed doors at a hush-hush Baltimore conference:

There are only a handful of priests in the country trained as exorcists (it IS a university degree after all), but they say they are overwhelmed with requests from people who fear they are possessed by the Devil.

Now, American bishops are holding a conference on Friday and Saturday to prepare more priests and bishops to respond to the demand. The purpose is not necessarily to revive the practice, the organizers say, but to help Catholic clergy members learn how to distinguish who really needs an exorcism from who really needs a psychiatrist, or perhaps some pastoral care.

“Not everyone who thinks they need an exorcism actually does need one,” said Bishop Thomas J. Paprocki of Springfield, Ill., who organized the conference. “It’s only used in those cases where the Devil is involved in an extraordinary sort of way in terms of actually being in possession of the person.

Let’s ponder that last quote for a moment. Exorcism is needed when the devil is involved. Otherwise, one doesn’t really need that directed Latin. I see.

“But it’s rare, it’s extraordinary, so the use of exorcism is also rare and extraordinary,” he said. “But we have to be prepared.”

Yes, I strongly suspect that is rare. And extraordinary. And supernatural, it goes without saying. But the church is on the job. Take THAT, you evil secularist doubter who stands by while that misogynistic Satan has his way with small boys and helps protect the pedophiles in his employ. Oh, wait… I’m thinking of… umm… (diversion is needed)… Squirrel!

Where was I? Exorcism. Right.

So how does one diagnose demonic possession?

Some of the classic signs of possession by a demon, Bishop Paprocki said, include speaking in a language the person has never learned (excluding Latin, I presume); extraordinary shows of strength; a sudden aversion to spiritual things like holy water or the name of God; and severe sleeplessness, lack of appetite and cutting, scratching and biting the skin.

A person who claims to be possessed must be evaluated by doctors to rule out a mental or physical illness, according to Vatican guidelines issued in 1999, which superseded the previous guidelines, issued in 1614.

1999. Yup. New guidelines. 1999. The age of rare, extraordinary, supernatural demonic infestations are being re-defined by Vatican bureaucrats for their version of the disease in DSM IV (under Demonic Possession, no doubt) while atom colliders are being built deep underground, genomes are being catelogued, and missions to Mars are being carried out.

Now that leaves me wondering what kind of doctor rules out mental or physical illness for a bat shit crazy person babbling incoherently (sorry… speaking in ‘tongues’ is the correct lingo I think) and exhibiting violent behaviours including self harm? I would tend to think it must be a bat shit crazy doctor who is no longer able to maintain a living as a general practitioner… for somewhat obvious reasons of having lost his mind and turning to Oogity Boogity! for his professional opinion. I’m glad that such a person is not my family doctor and the church is welcome to him (I assume no women would fit the employment criteria… having the wrong gonads and all).

“People are talking about, are we taking two steps back?” Father Vega said. “My first reaction when I heard about the exorcism conference was, this is another of those trappings we’ve pulled out of the past.”

But he said that there could eventually be a rising demand for exorcism because of the influx of Hispanic and African Catholics to the United States. People from those cultures, he said, are more attuned to the experience of the supernatural.

That’s religious-speak for too damned ignorant to know any better, which is just the way the church likes ‘em. Especially those with an MD after their names. Always room at the inn, dontcha know, if you have the right gonads, the right frequency tuned to bat shit crazy, and the right gullibility to think modern medicine and demonic possession are mutually accommodating.

And people think science and religion are incompatible. I know! Those militant, strident, and arrogant atheistic secularists say the most ridiculous things!

How can we tell if reports about science are biased?

First there was this study from Britain’s National Council for Palliative Care published in the Journal of Medical Ethics titled The role of doctor’s religious faith and ethnicity in taking ethically controversial decisions during end-of-life care, that concluded:

Greater acknowledgement of the relationship of doctors’ values with clinical decision-making is advocated.

In other words, a doctor’s values has an affect on the decisions advocated.

According to the study’s results, ethnicity has very little effect whereas the specialty of the practitioner has the greatest effect. Hospital doctors discuss and use methods that could hasten death in the terminally ill at 10 times the rate of palliative care specialists. Of particular interest is the finding that doctors who are agnostic or atheist are twice as likely to use such methods as deeply religious doctors.

How do we interpret what that means?

Steve Novella at Neurologica explains:

To me the most interesting result is that specialty had a ten-fold influence on decision-making. This does reflect my anecdotal experience – that doctors who routinely treat the terminally ill in an in-patient setting are more comfortable and practiced in raising treatment questions that could influence the duration of life. Palliative care specialists, on the other hand, are focused on palliation and may not be as comfortable suggesting withdrawal of care or measures that might hasten death.

That sounds quite reasonable and makes good sense. But that’s certainly not the conclusion reached by Doctor Seale:

Dr. Clive Seale, a professor at Barts and the London School of Medicien and Dentistry, conducted a random mail survey of more than 8,500 doctors. Almost 4,000 responded and more than 3,000 described deaths of a patient.

Seale found doctors. many of whom care for elderly patients or are neurologists, who describe themselves as “extremely” of “very nonreligious” were twice as likely to report that the care for their last terminally ill patient included euthanasia practices such as deep sedation.

He found religious doctors were also less likely to keep patients in continuous deep sedation or to support legislation allowing assisted suicides.

“If I were a patient facing end of life care, I would want to know what my doctor’s views were on religious matters – whether they are non-religious or religious and whether the doctor felt that would influence them in the kind of decisions they were looking at,” Seale said. According to an AP report, Seale wrote that “nonreligious doctors should confess their predilections to their patients,” so they know they could become victims. (Bold added by me for emphasis.)

Is that doctor Seale’s conclusion or the writer of the article from which I have taken the excerpt? I suspect it is Seale’s when he uses the word ‘confess’ as if a doctor talking about all available treatment options with patients and their families were a sin rather than selecting and discussing only those treatment options that the doctor found agreeable with his or her religious beliefs! And the article’s writer seems to be in agreement with that because he starts his article with:

Patients worried about becoming a victim of euthanasia should ensure they find a doctor who holds strong religious views. That’s because a new study out of Great Britain finds physicians who are atheist or agnostic twice as likely to make decisions taking the lives of terminally ill patients. (Again, bold added by me for emphasis.)

I think we need to pay attention to words that indicate strong bias when we attempt to understand what studies mean and discriminate accordingly. As for this study’s conclusion, I think Novella gets it exactly right:

[...] this is not a controlled study but a self-reporting survey, and so the results are highly unreliable. At best it indicates that follow up research is warranted. But taken at face value, if anything this survey shows that culture in medicine still plays a large role in determining practice. And further it suggests that some doctors allow their religious faith to interfere with their decision-making when it comes to end-of-life care.

Accurate and informative science reporting is becoming something of a lost art these days. We need to be aware of the difference between what a study’s results may mean and how they are interpreted and reported to us. Going to the source is always a good strategy but we can also be much more aware of words that immediately reveal bias to affect our confidence in the accuracy of what we are reading.

Medical ethics or religious policies? Which one is best for health care patients?

There is an excellent article over at Science-based Medicine well worth reading. It’s about how the policies of religious-based hospitals affect physician behaviour, from which I have taken excerpts:

Science-based medicine is, among other things, a tool.  Science helps us sequester our biases so that we may better understand reality.  Of course, there is no way to avoid being human; our biases and our intuition still betray us, and when they do, we use other tools.  Ethics help us think through situations using an explicitly-stated set of values…

And like all professions, these ethical values are spelled out so that each member of that profession adheres to the same ethical rules of conduct. Or, at least, that’s the intention….

Ethical problems are a normal part of medical practice. But ethics are not a weapon used to obtain a result we want; they are a tool to give a framework for understanding and resolving dilemmas. Ethical dilemmas can arise out of may types of conflicts, for example when our personal beliefs clash with those of our patients, or when patients’ and families’ desires conflict.  They can also arise when we as physicians are constrained in our actions by outside forces.

And what might be an example of an ‘outside force’ be? If a government asked a physician to intentionally cause harm to one patient for information that could achieve a greater good for many, should a doctor do so?

I would object on the basis of many of these shared ethics: it violates patient autonomy, it causes them harm, and fails to benefit them.   My responsibility to avoid harming my patient trumps my government’s desire to obtain information via torture.

What about providing appropriate science-based medical advice for something more controversial… like abortion?

There is no set of data that says that “abortion is harmful to women”, so doctors who oppose abortion cannot claim that science supports their bias.  But if  a doctor legitimately felt that a particular abortion would bring physical harm to a particular woman, then they must give her the advice they feel is necessary.  Conversely, if a doctor feels that a particular abortion may help a particular patient, they must tell the patient.

I can see why the emphasis on following a standardized set of ethical guidelines is so important for professionals to frame controversial issues. And this raise a significant question when 20% of American hospital beds are religiously-affiliated: how does this affect the care given by doctors working with these institutions?

Well as luck would have it, a study has been released on just this question in the Journal of General Internal Medicine . For more specific data, please go the article’s link.

From an ethical perspective, these data are mixed.  It is comforting that the polled doctors were more often willing to make decisions based on their patients’ needs rather than institutional policies, but it is disturbing that such significant barriers to care arise from these  policies.

So which should prevail: hospital policies or medical ethics? As the article’s author concludes,

I find the intrusion of sectarian values into health care disturbing, especially since most of these institutions take money from federally-funded programs such as Medicare and Medicaid.  At the same time, many of these institutions provide significant amounts of charitable care.  I do not believe, however, that this creates a balance.  Charity is good, but treating human beings with dignity and allowing for the science-based delivery of medical care should be a minimum requirement.

I would add that medical ethics need to be dominant over religiously inspired policies if we wish to publicly fund religious medical providers. If the religious institutions cannot agree to this hierarchy then they have no business accepting public money while pretending to provide science-based health care; instead, they should be clear that what care is provided will be religiously approved care and not ethical medicine.

Why should we be ashamed of respecting religious belief in the public domain?

Canada is hosting a G8 summit and wants to promote a child and maternal health-care initiative for developing countries. But that will not include any money for funding abortion.

U.S. Secretary of State Hillary Clinton said the health initiative should include access to safe and legal abortion. Why? Because safe abortions reduces women mortality – a fundamental concern when addressing issues about about child and maternal health-care. So access to therapeutic abortions is a health concern.

According to the 1995 Beijing World Conference on Women by 189 participating countries and more than 2100 non-governmental organizations, the resolution passed that access to family planning, safe and legal abortion and maternal health, are essential to achieving gender equality. The UN Treaty Monitoring Bodies (TMBs) have recognized that access to these essential reproductive health services is rooted in international human rights obligations. The Beijing PFA (Platform For Action) highlighted the impact of unsafe abortion on women’s lives and health and the need to reduce recourse to abortion through expanded family planning services. It urges governments to review punitive measures against women who have undergone illegal abortions and calls for women’s access to quality post-abortion care. In turn, over the last decade, human rights bodies and regional and national courts have increasingly recognized that restrictions
on access to safe and legal abortion interfere with women’s enjoyment of their human rights.

So access to abortions according to the UN is a human rights concern.

But rather than follow this previously agreed to PFA, Canadian officials say they will instead focus the G8 plan on other measures aimed at improving the health of women and children in poor countries — including safe drinking water and vaccination programs, an important issue about child and maternal health to be sure. But why not therapeutic abortion?

Access to therapeutic abortion (outside of Canada) according to Harper and his Canadian government is about “clarifying family planning,” which simply does not include any discussion about abortion. One must wonder why when it is widely considered both a health-care concern and a human rights concern. According to Harper, it is not a concern at all and certainly not one open to debate.

This omission is a cop out, a capitulation not to the best practices of modern medicine nor furthering the human rights of children and their mothers. It is a tacit nod of agreement to the religious belief that abortion under any circumstances is wrong. By refusing to fund abortion outside of the country, the Canadian government’s inaction supports the bizarre idea that a zygote is of greater value than is the life of a fully developed mother. This position simply ignores (or at least finds perfectly acceptable) maternal mortality when therapeutic abortions are unavailable. What lies behind the politics of abortion is neither any kind of informed debate about why it is a necessary part of health-care or a necessary plank in furthering maternal human rights; it is a position in favour of appeasing religious sensibilities at home about this controversial topic. And how informed is that sensibility by comparison? I think not at all. It’s simply an uninformed, unjustified belief that has no place at the table of discussion about child and maternal health-care.

And do religious sensibilities stop in areas of public health care?

Umm, no. Are we surprised?

In January (2010), the Ontario government introduced changes to the sex education component of the public school curriculum: Grade 1 children were to be taught to identify genitalia using the correct words, such as penis, vagina and testicle, Grade 5 children were to be taught to identify parts of the reproductive system and describe how the body changes during puberty, and in Grade 7, the plan was to teach kids how to prevent unintended pregnancy and sexually transmitted infections, including HIV. Children in grade 7 are usually 12 years old.

CBC News reported the following:

Religious groups objected to the revised curriculum and raised a voluble campaign against it earlier this week. They promised a huge demonstration on the front lawn of Queen’s Park (the Ontario provincial legislature) to protest the sex education changes.

“It is unconscionable to teach eight-year-old children same-sex marriage, sexual orientation and gender identity,” said Charles McVety, head of the Canada Christian College. “It is even more absurd to subject sixth graders to instruction on the pleasures of masturbation, vaginal lubrication, and 12-year-olds to lessons on oral sex and anal intercourse.”

So we know what McVety thinks is unconscionable and absurd in sex education at these grades and seems quite content to oppose any curriculum that promotes healthy sexuality, counteracts schoolyard misinformation, prevents teen pregnancy, gives information that shows how to avoid STDs, and so on. What does he offer in return as an alternative that still meets the goals of informing ht epublic about these issues? Nada. On what, then, does he base his opposition? His religious belief. And how is that uninformed religious belief comparable to the kind of consideration to what informs best practices in education? On what basis of knowledge is a religious belief about sex education equally worthy of consideration than curriculum development done by professionals and informed by evidence?

Only because the public tolerates unjustified religious interference and unwarranted intrusions in the public domain does ignorance and bigotry of uninformed religious belief become a potent political force, enough to adversely affect informed public policy in education to the likes of the sanctimonious self-righteous morons like McVety and his ignorant ilk, as well as adversely affect funding for promoting the health-care and human rights of women in developing nations. That’s the ongoing gift (and legacy) of religious belief in action in the public domain: promoting ignorance over knowledge, belief over health, misogyny over human rights.

These weak-kneed governments should be ashamed of themselves for appeasing the ignorant and foolish among us (including those within these parties) for political gain. That political behaviour – supposedly done in the name of good governance – is what is  truly unconscionable and absurd. For when we grant guanocephalic clerics and their supporters a place at the table of determining public policy like education and foreign policy aid because of some warped idea that the representatives of the public owe respect to religious beliefs of the few, we are damaging the welfare of all.

Are religious beliefs and scientific knowledge compatible?

Absolutely not. And this incompatibility has direct and dire and very real negative consequences on scientific literacy – a fundamental component necessary for a country to remain competitive in a technological and knowledge based world economy.

We are often told by well-meaning people that science and religion are compatible, that each ‘magisteria’ offers us a different way to know, and that each deals with different but equally important questions while providing us with different kinds of answers about human life. It is no wonder, then, that public education must tread a careful path keeping science and religion relegated to their separate spheres of influence.

As we are well aware, science and religion often are in conflict when their truth claims are in direct competition, and nowhere is this conflict more prevalent and rancorous than when religious belief in special creationism comes up against the theory of evolution that informs the biological sciences. The notion that we are dealing with different kinds of knowledge is simply not true. We are dealing with one kind of knowledge only, the kind that is informed by evidence or uninformed, either true or not true, right or wrong, accurate or inaccurate, probable or improbable. It is no wonder, then, that one of the main battlegrounds between knowledge informed by evidence and religious belief informed only by faith begins in the biology classroom (See the latest biology text book banning story here.)

How do American students compare in academic achievement with students from other countries? You know these studies; advisory panels and boards distribute and then gather the completed surveys and tabulate results which are then used to provide the evidence for educators and their political overlords to measure and compare and contrast how effectively we are passing on knowledge about the world to our children through the curriculum of our education system.

This year (2010) has seen a rather remarkable and intentional omission in the United States: the survey questions about evolution and the Big Bang have been pulled. The National Science Board, which oversees the National Science Foundation (NSF), says it chose to leave the section out of the 2010 edition of the biennial Science and Engineering Indicators because the survey questions used to measure knowledge of the two topics (evolution and the Big Bang) force respondents to choose between factual knowledge and religious beliefs. (Source)

What are we to make of this problem? To start with, if science and religion were truly compatible, no “choice” would have have to be made because each kind of knowledge would be separate. But they are not separate at all. They are in direct conflict. Why does this matter?

Well, if knowledge is based on what is true and truth matters, then only one approach – either science OR religion – yields ‘true’ knowledge. It is this ‘true’ knowledge that informs not only the technologies and medicines that work in the world but the moral and ethical framework in which they take place, and science has a solid track record of yielding exactly this. Religious belief, in stark contrast, yields no new knowledge and informs neither workable technologies nor medical practices in all the various fields of human endeavors, although the religious make claims to hold the higher ground in ethical and moral questions.  But rather than face this blunt problem of allowing competing factual truth claims to both have recognized merit in spite of a revealed averaged knowledge deficit by all, the NSF has decided in its wisdom to avoid presenting the data that informs this evidence altogether by intentional omission.

Previous data clearly shows that Americans are far less likely than the rest of the world to accept that humans evolved from earlier species and that the universe began with a big bang and the reason for this lies squarely at the feet of religious belief. We know, for example, that  science knowledge scores vary considerably across the EU-25 countries, with northern European countries, led by Sweden, recording the highest total scores on a set of 13 questions. For a smaller set of four items that were administered in both 1992 and 2005 in 12 European countries, each country performed better in 2005. In contrast, the U.S. data on science knowledge do not show upward trends over the same period. That lack of progress is alarming, which raises the question why not?

We know that in international comparisons, U.S. scores on two true or false science knowledge questions – “Human beings, as we know them today, developed from earlier species of animals,” and “The universe began with a huge explosion” – are considerably lower than those in almost all other countries where the questions have been asked. In the United States, 45% of respondents answered true to the first question in 2008, similar to other years when the question was asked. In other countries and in Europe, the comparable figures were higher: 78% in Japan, 70% in Europe, 69% in China, and 64% in South Korea. Russia and Turkey were the only countries where less than half of respondents responded correctly (44% and 27% respectively) (Gokhberg and Shuvalova, 2004; EC 2005). Similarly, Americans were less likely than survey respondents in South Korea and Japan to answer the big bang question correctly: one third of Americans answered this question correctly compared with 67% of South Korean and 63% of Japanese respondents . (The deleted text is here.)

In other words, basic scientific knowledge in biology and cosmology informed by overwhelming and mutually supportive evidence shows by this data that the US has been drastically influenced by religious truth claims that compete directly with scientific truth claims informed by enough valid evidence to establish scientific consensus. And that competition has a negative effect on passing on this foundational scientific knowledge to our children.  Clearly, religious belief is not a separate but equal ‘magisteria’ from the findings of science nor a different kind of knowledge; religious belief is a direct competitor that is neither informed by evidence nor a consensus of knowledgeable opinion.

From a recent national survey of high school biology teachers in public schools we find it shows that there is a large variation in how teachers approach the topic of evolution. How they teach evolution, in turn, affects public knowledge. High school teachers who completed the most number of college-level credits in biology and life science classes and whose coursework included at least one class in evolutionary biology devoted 60% more time to evolution than teachers with the fewest credits in these areas. More specifically, teachers who expressed the religious view that “God created human beings pretty much in their present form at one time within the last 10,000 years or so” devoted 35% fewer class hours to evolution than all the other teachers.

This data reveals quite clearly cause and effect: those teachers who hold religious beliefs that compete with scientific knowledge have a direct and negative effect on the quality of teaching that scientific knowledge within the public education system. That is a very important finding. For whatever excuse and rationalization the National Science Board cares to drape over their decision to omit that data from its advisory report to the White House, it is highly unprofessional and, in the words of Joshua Rosenau of the National Center for Science Education, a nonprofit that has fought to keep creationism out of the science classroom, “Discussing American science literacy without mentioning evolution is intellectual malpractice” that “downplays the controversy” over teaching evolution in schools.” I will add that it also downplays how that controversy between scientific knowledge and religious belief regarding truth claims affects in a negative way the scientific literacy of the general population.

So next time you hear that well-intentioned person argue that religious belief and science are compatible but different ways of knowing, remember that such a claim is wrong, and the data to prove it is wrong is available to all.  Such an unfounded assumption of compatibility is doing real harm to the next generation by disarming them of the foundational knowledge necessary to compete in a technological and knowledge based world economy. Unequivocally, religious belief and science are in direct competition, and when all is said and done, I think the words of Matthew Cobb and Jerry Coyne shall prove to be prophetic:

“In reality, the only contribution that science can make to the ideas of religion is atheism.”

And, I will add, the only contribution religion can make to the ideas of science is to actively impede the acquisition of knowledge in all areas of human concern.

Update: there is another terrific post with a slightly different take about this over at Why Evolution Is True by Greg Mayer.

Why is understanding plausibility so important to how we inform our beliefs?

Plausibility is essentially an application of existing basic and clinical science to a new hypothesis, to give us an idea of how likely it is to be true. There are three broad categories of plausibility we need to appreciate:

If evidence for a direct connection between a cause and its effect can be established, then we have a highly plausible explanation upon which we can depend for consistent results.

If we have evidence for an consistent effect from some cause but do not understand the generating mechanism, then we have neutral plausibility for an explanatory hypothesis.

If we have evidence for an inconsistent effect from some perceived cause and suggest an explanatory hypothesis that violates the basic laws of science, then our explanatory hypothesis is implausible.

As Steve Novella writes over at Science-Based Medicine regarding homeopathic treatments that claim to provide efficacy to improve ‘life energy’,

Invoking an unknown fundamental energy of the universe is not a trivial assumption. Centuries of study have failed to discover such an energy, and our models of biology and physiology have made such notions unnecessary, resulting in the discarding of “life energy” as a scientific idea over a century ago.

Essentially any claim that is the functional equivalent to saying “it’s magic” and would, by necessity, require the rewriting not only of our medical texts, but physics, chemistry, and biology, can reasonably be considered, not just unknown, but implausible.

How we inform our beliefs using the plausibility standard is important and depends entirely on the quality of the explanations we rely on to do so,  whether they are about specific ideas in medicine or religion or politics or about more general policies and procedures. If our explanations are plausible, then our beliefs are plausible. If our explanations are implausible, then our beliefs are implausible. If we are considering to act on our beliefs, then we need to first undertake due diligence and establish how plausible they really are.

If the beliefs are implausible, then we know they are poorly informed and, as such, are unjustified. Acting on unjustified beliefs in our personal and private domain is our prerogative. We have the freedom to do so because the founding documents and charters and bills of our liberal secular democracies provide us with the necessary legal framework and state-sanctioned power to protect these equal freedoms. But providing what’s necessary isn’t nearly enough. We must also do our part as individuals to maintain our own equal freedoms.

In stark contrast to the freedom we have to exercise our beliefs in the private domain, acting on our implausible beliefs in the public domain is wrong and richly deserving of sustained legitimate criticism. Whenever we come across those who wish promote unjustified beliefs as if they were informed and plausible when they are neither in the public domain using public offices, we must hold them to account for their abuse of their office’s public power that allows them to cross that important boundary between the what is allowable in the private but forbidden in the public.

Our task is to maintain sustained criticism towards those who abuse public office in this way – whether they abuse the office’s power to support implausible medical therapies, implausible religious truth claims, implausible political solutions, and so on. We must insist that only informed beliefs that are plausible be made into public policies and procedures. Our collective failure to participate in our civic duty in this matter is a failure to be responsible to no only ourselves but to our fellow citizens, which has a cumulative effect of reducing our equal common rights and freedoms. We harm the very fabric of our equal rights and freedoms under a liberal secular democracy when we allow the abuse of public office to promote implausible beliefs. We allow it to continue when we choose to remain silent about this abuse. Even more damning to our equal individual freedoms  is our active support of candidates and office holders who are willing to promote our favoured implausible beliefs… again, whether those implausible beliefs are about complimentary and alternative medicines, favoured religious beliefs, political strategies, and so on. This kind of willing support to the implausible is both unpatriotic and seditious no matter how great may be the popularity of these candidates and their platforms.

The standard of plausibility is a very important concept to inform public policies – useful to each of us to determine our level of support for these public policies and procedures – although we have the freedom (and luxury) to pay it scant attention in our private lives… for now. What is essential, however, is to understand why plausibility matters so much.