critical thinking
It has been reported that a well-known conservative activist, Kelly Canon, from Arlington, Texas, USA, has tragically died. She was famous for peddling COVID-19 vaccine misinformation. The complications caused by the virus—just a few weeks after attending a “symposium” against the vaccines – have killed her. 
“Another tragedy and loss for our Republican family. Our dear friend Kelly Canon lost her battle with pneumonia today. Kelly will be forever in our hearts as a loyal and beloved friend and Patriot. Gone way too soon We will keep her family in our prayers,” the Arlington Republican Club said in a statement.
Her death was said to be “from COVID-related pneumonia.” Canon had announced on Facebook in November that her employer had granted her a religious exemption for the COVID-19 vaccine. “No jabby-jabby for me! Praise GOD!” she wrote at the time.
Canon had been an outspoken critic of COVID-19 vaccine mandates and pandemic-related restrictions. In one of her final Facebook posts, Canon shared several links to speeches she attended at a “COVID symposium” in Burleson in early December devoted to dissuading people from getting the COVID-19 vaccines that are currently available. The event was organized by God Save Our Children, which bills itself as “a conservative group that is fighting against the use of experimental vaccines on our children.”
Canon had shared similar content on Twitter, where her most recent post was a YouTube video featuring claims that the coronavirus pandemic was “planned” in advance and part of a global conspiracy.
As news of her death spread Tuesday, pro-vaccine commentators flooded her Facebook page with cruel comments and mocking memes, while her supporters unironically praised her for being a “warrior for liberty” to the very end.
___________________________
A religious exemption?
What for heaven’s sake is that?
I feel sad for every death caused by COVID and its complications. If the death is caused by ignorance, it renders the sadness all the more profound.
Yesterday, it has been reported that Indian scientists found the mode of action of homeopathic remedies. This is the newspaper article:
And this seems to be the abstract of the actual paper:
Homeopathic medicines contain ultra-low concentrations of metal and compounds, and it is challenging to classify homeopathic potencies using modern characterization tools. This work presents a novel experimental tool for classifying various homeopathic medicines under a low-frequency generated electromagnetic (EM) fields. A custom-built primary coil is used for generating EM fields at different excitation frequencies. The potentized test samples were prepared at decimal dilution scale of Ferrum with α‑lactose monohydrate and exhibited significant and distinct induced EM responses in the second sensing coil. The measured responses decrease logarithmically due to reducing Ferrum concentration. The resolution improved in higher potencies from 0.03 µV at 300 Hz to 0.24 µV at 4.8 kHz. Different compounds of homeopathic medicines were also investigated to produce distinct induced EM characteristics. These results were correlated with Raman spectroscopy, impedance analyser, and FT-IR analysis. The experimental investigation confirmed the classification of potencies and the technique developed to detect ultra-low metallic concentrations.
I might be a bit slow on the uptake – but I don’t see how this investigation proves anything. Perhaps someone can explain it to me?
So-called alternative medicine (SCAM) is widely used in Arabia. One of the commonly used methods is camel urine alone or mixed with camel milk. Camel urine is a liquid by-product of camel metabolism. Urine from camels has been used as prophetic medicine for centuries, being a part of ancient Bedouin practices. Camel urine comes out as a concentrated, viscous syrup because the kidneys and intestines of a camel are very efficient at reabsorbing water. 
Camel urine is consumed and used for treating numerous ailments. Some employ it as a treatment for hair loss, for instance. The camel urine from a virgin camel is priced at twenty dollars per liter, with herders saying that it has curative powers.
A recent paper offers more information:
Camel is one of the important livestock species which plays a major role in the pastoral mode of life by fulfilling basic demands of livelihood. Traditionally, camel urine has been used in the treatment of human diseases. With regard to the health benefits of drinking the urine of camels, it has been proven by modern scientific researches. Camel urine has an unusual and unique biochemical composition that contributes to medicinal values. The chemical composition of camel urine showed the presence of purine bases, hypoxanthine, sodium, potassium, creatinine, urea, uric acid, and phosphates. The nano-particles in the camel’s urine can be used to fight cancer. Camel urine has antimicrobial activity against pathogenic bacteria. Its chemical and organic constituents have also inhibitory properties against fungal growth, human platelets, and parasitic diseases mainly fasciollosis in calves. The healthy status of the liver can be restored through ingestion of diet and minerals in camel urine. Camel urine is used by the camel owners and Bedouins as medicine in different ways. The Bedouin in the Arab desert used to mix camel urine with milk. Recently; the WHO has warned against drinking camel urine due to the modern attempt to limit Outbreaks of Respiratory Syndrome (MRS) in the Middle East. There is no scientific dosage for camel urine to be applied as medicine for different diseases and the ways of camel urine formulation and utilization for the care of patients varies from country to country. Therefore, the purposes of the present review describe the biochemical composition of camel urine will be scientifically extracted and formulated as a therapy rather than drinking raw urine and people’s health impact.
Researchers from the Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia wanted to determine whether camel urine shows promise in the treatment of cancer. The aim of their study was to observe cancer patients who insisted on using camel urine and to devise some clinically relevant recommendations.
The authors observed 20 cancer patients (15 male, 5 female) from September 2020 to January 2022 who insisted on using camel urine. They documented the demographics of each patient, the method of administering camel urine, the reasons for refusing conventional treatment, the period of follow-up, and the outcome and side effects.
All the patients had radiological investigations before and after finishing treatment with camel urine. All patients used a combination of camel urine and milk, and treatment ranged from a few days up to 6 months. The average amount of urine/milk consumed was 60 ml/day. No clinical benefit was observed and two patients developed brucellosis. Eleven patients changed their minds and eventually accepted conventional antineoplastic treatments but 7 were too weak to receive further treatment and died from their disease.
The authors concluded that camel urine had no clinical benefits in cancer patients, and may even have caused zoonotic infection. The promotion of camel urine as a traditional medicine should be stopped because there is no scientific evidence to support it.
I fear that, yet again, ‘ancient wisdom’ turns out to be just ‘old bullshit’.
I have grumbled about prevalence surveys in so-called alternative medicine (SCAM) before, I know. But, as the problem continues to get on my nerves – I estimate that there are about 10 times more surveys in SCAM than in any other field – allow me to do it again. The subject appeared on my screen in the form of a recent article from a minor, not Medline-listed journal. The paper is entitled:
Investigation of Complementary and Alternative Medicine Use in Turkish Patients with Epilepsy
This type of prevalence survey is typical of its genre and stands for hundreds – thousands even – like it. Its findings reveal a high prevalence of use. From that result, enthusiasts tend to draw stereotypical conclusions, namely that we need more research and that we ought to consider the integration of SCAM into routine care.
WHAT A WASTE OF TIME AND EFFORT!
Who really needs to know how many epilepsy patients in Turkey use SCAM?
Nobody!
You disagree?
Fine, then tell me: why Turkey and why epilepsy? If such information were important (and the methodology of the survey were perfect [which it hardly ever is]), then we surely need it for all diseases. How many different diseases are there? Let’s make it easy and say 1000. This means we need 1000 surveys to obtain a valuable picture of SCAM use in Turkey.
And if this sort of information is relevant in Turkey, we need to have it also for all other major countries. How many major countries exist? Let’s make it simple again and say 500. This means that we need 500 x 1000 or 500 000 surveys to generate a meaningful picture of SCAM use.
Since SCAM use changes quickly, we require these articles to be updated regularly; let’s say every 3 years. That means we require half a million surveys every 3 years.
What for?
What would it tell us?
What would we conclude from this enormous body of research?
Yes, of course, we would conclude that we need more research and we ought to consider the integration of SCAM into routine care!
My point is that if we truly need more research, why not get on with it? Why not finally forget about such useless surveys and do the science? Why not determine which SCAM works for what condition and at what risks? And, in case the findings turn out to be positive [but only then], let’s talk about integration into routine care. To put it even blunter:
The survey mania in SCAM prevents progress.
‘Agoro’ is a German (all texts are my translations from German) website that claims this:
“We specialize in alternative methods of treatment from the field of natural medicine. Our mission is to ensure that the ancient wisdom of our grandparents and ancestors is not forgotten.”
Unsurprisingly, this subject interests me. In particular, I was fascinated by an article entitled
Nux vomica Globuli in der Homöopathie
Nux Vomica in homeopathy
Nux vomica is (after arnica) amongst the most popular remedies in homeopathy. Therefore, we should all be keen to learn all about it.
Here is the translation of this article:
Nux vomica is one of the homeopathic remedies that you can get in all pharmacies. It can help you with various diseases, such as stomach pain. You can also use this homeopathic remedy for nausea and heartburn. You can buy it in the city pharmacies, but you can also make it easy for yourself and use the online pharmacy for globules. Here you will be well advised on the dosage of homeopathic remedies. Similarly, you can also contact the homeopath or naturopath for good advice.
Nux vomica is a remedy derived from the medicinal plant nux vomica. You can use the homeopathic remedy in the potencies D6 and D12. In some cases, it can be recommended to you also in C6, C12, or C30.
You can use the homeopathic remedy in many ways, including for constipation or exhaustion. You will find out which dosage you can take if you consult a professional. In this way, you will be recommended the appropriate potency to experience help from it.
It is crucial that you always seek advice before taking the remedy. As already mentioned, you can use several contact points for this. Whether it is the pharmacy, the naturopath, or the homeopath. In addition, there are many family doctors who now also use homeopathy and could recommend you the appropriate dosage. The consultation is important in any case because the homeopathy must be adapted to your complaints. Otherwise, the remedy will not work or will not work properly.
If you want to use the remedy for yourself, you always need patience. Homeopathic remedies need a little time to work, that is their only disadvantage. How long this always depends on the person and the remedy. Sometimes it takes only a few hours, sometimes a few days or weeks. You can also get advice on this.
Indications for nux vomica
Stomach and intestinal problems
You can use the remedy for you in case of abdominal pain, mild biliousness, and various stomach and intestinal problems. The remedy can also be of great help for nausea, flatulence, nausea, and constipation.
Headaches and migraines
The remedy Nux vomica can help you if you suffer from headaches that are located just above the eye. It can also help you with migraines. Even with a hangover, the remedy could help.
Moods
If you suffer from autumn depression or are often easily frustrated, you can use the remedy.
_______________________
Yes, I do get easily frustrated with texts like this!
But I doubt that nux vomica can help me with this or any other problem.
Some might say that doubting is not good enough, evidence is needed!
I agree but was unable to find sound evidence to show that homeopathic nux vomica was better than a placebo for any condition (in case any of our regular defenders of homeopathy know more, please let me know). On the contrary, I only found studies that suggested its ineffectiveness. Here is an example:
In a monocenter prospective randomized double-blind clinical trial the efficacy of homeopathic treatment was investigated on children with adenoid vegetations justifying an operation. Patients were treated with either homeopathic remedies such as Nux vomica D200, Okoubaka D3, Tuberculinum D200, Barium jodatum D4 and Barium jodatum D6 or with placebo. The duration of the study for each patient was 3 months. Examination of the ears using a microscope, rhinoscopy, stomatoscopy and pharyngoscopy, as well as tympanometry and audiometry were performed after 4, 8 and 12 weeks. Out of a total of 97 children studied between the ages of 4 to 10 years 82 could be analyzed. At the end of the study no operation was required in 70.7% of the placebo-treated children and in 78.1% of the children treated with homeopathic preparations. These results show no statistical significance.
So, where does that leave us in relation to the “ancient wisdom of our grandparents and ancestors“? I fear, that this story shows yet again that, when it comes to homeopathy, the scrutiny of ancient wisdom quickly turns it into old bullshit.
Acupuncture is a panacea, we are often told.
But is it true?
Of course not!
This study was aimed at evaluating the effect of acupuncture on myelosuppression and quality of life in women with breast cancer during treatment with anthracyclines (ANT).
Women with an indication for ANT chemotherapy were randomized into two groups:
- the acupuncture group (AG) was submitted to an acupuncture intervention, starting before the first chemotherapy infusion, and continuing throughout the treatment;
- the control group (CG) received no acupuncture.
A quality of life questionnaire (FACT-G) and peripheral blood levels of the participants were evaluated before and at the end of treatment.
A total of 26 women were randomized into 2 groups: AG (10) and CG (16). Of these, 26.9% had a dense dose indication according to the service’s protocol for the administration of granulocyte-stimulating factor (G-CSF) from the first cycle, not participating in the analysis. The need for secondary prophylaxis with G-CSF occurred in 72.7% in the control group versus 12% in the acupuncture group. Regarding quality of life (QoL), it was observed that the groups did not initially differ from each other. At the end of the treatment, there was a significant difference in the AG for the physical (GP) (p-value=0.011), social/family (GS) (p-value=0.018), and functional (GF) (p-value=0.010) domains, regarding the initial and final FACT-G showed a difference between the groups, where the GA average at the end rose from 80.68 to 90.12 (p-value = 0.004) and in the CG the average dropped from 81.95 to 70.59 (p-value=0.003).
The authors concluded that acupuncture was efficient in the secondary prophylaxis of myelosuppression during chemotherapy and the quality of life of women during treatment has increased.
My interpretation of these results is quite different from that of the authors.
Please let me explain.
The improvement of the quality of life can easily be explained via a placebo effect; acupuncture itself has not necessarily any part in it. But what about the effect on the bone marrow? Might it too be due to a placebo response, or the additional attention? Probably not.
Does that mean that this study proves a definite positive effect of acupuncture?
No!
Why not?
Because firstly the study was far too small for allowing such a far-reaching conclusion, and secondly one would need independent confirmation before accepting such a far-reaching conclusion.
During the last few days, several journalists have asked me about ayahuasca. Apparently, Harry Windsor said in an interview that it changed his life! However, the family of a young woman who took her own life after using ayahuasca has joined campaigners condemning his comments. Others – including myself – claim that Harry is sending a worrying message talking about his ‘positive’ experience with ayahuasca, saying it ‘brought me a sense of relaxation, release, comfort, a lightness that I managed to hold on to for a period of time’.
So, what is ayahuasca?
This paper explains it quite well:
Ayahuasca is a hallucinogen brew traditionally used for ritual and therapeutic purposes in Northwestern Amazon. It is rich in the tryptamine hallucinogens dimethyltryptamine (DMT), which acts as a serotonin 5-HT2A agonist. This mechanism of action is similar to other compounds such as lysergic acid diethylamide (LSD) and psilocybin. The controlled use of LSD and psilocybin in experimental settings is associated with a low incidence of psychotic episodes, and population studies corroborate these findings. Both the controlled use of DMT in experimental settings and the use of ayahuasca in experimental and ritual settings are not usually associated with psychotic episodes, but little is known regarding ayahuasca or DMT use outside these controlled contexts. Thus, we performed a systematic review of the published case reports describing psychotic episodes associated with ayahuasca and DMT intake. We found three case series and two case reports describing psychotic episodes associated with ayahuasca intake, and three case reports describing psychotic episodes associated with DMT. Several reports describe subjects with a personal and possibly a family history of psychosis (including schizophrenia, schizophreniform disorders, psychotic mania, psychotic depression), nonpsychotic mania, or concomitant use of other drugs. However, some cases also described psychotic episodes in subjects without these previous characteristics. Overall, the incidence of such episodes appears to be rare in both the ritual and the recreational/noncontrolled settings. Performance of a psychiatric screening before administration of these drugs, and other hallucinogens, in controlled settings seems to significantly reduce the possibility of adverse reactions with psychotic symptomatology. Individuals with a personal or family history of any psychotic illness or nonpsychotic mania should avoid hallucinogen intake.
In other words, ayahuasca can lead to serious side effects. They include vomiting, diarrhea, paranoia, and panic. Ayahuasca can also interact with many medications, including antidepressants, psychiatric medications, drugs used to control Parkinson’s disease, cough medicines, weight loss medications, and more. Those with a history of psychiatric disorders, such as schizophrenia, should avoid ayahuasca because this could worsen their psychiatric symptoms. Additionally, taking ayahuasca can increase your heart rate and blood pressure, which may result in dangerous consequences for those who have a heart condition.
Thus ayahuasca is an interesting albeit dangerous herb (in most countries it is illegal to possess or consume it). Currently, it is clearly under-researched, which means we know very little about its potential benefits and even less about the harm it can do.
Considering this, one would think that any half-intelligent person with loads of influence would not promote or encourage its use – but, sadly, it seems that one would be mistaken.
The ‘keto diet’ is a currently popular high-fat, low-carbohydrate diet; it limits the intake of glucose which results in the production of ketones by the liver and their uptake as an alternative energy source by the brain. It is said to be an effective treatment for intractable epilepsy. In addition, it is being promoted as a so-called alternative medicine (SCAM) for a wide range of conditions, including:
- weight loss,
- cognitive and memory enhancement,
- type II diabetes,
- cancer,
- neurological and psychiatric disorders.
Now, it has been reported that the ‘keto diet’ may be linked to higher levels of cholesterol and double the risk of cardiovascular events. In the study, researchers defined a low-carb, high-fat (LCHF) diet as 45% of total daily calories coming from fat and 25% coming from carbohydrates. The study, which has so far not been peer-reviewed, was presented Sunday at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.
“Our study rationale came from the fact that we would see patients in our cardiovascular prevention clinic with severe hypercholesterolemia following this diet,” said Dr. Iulia Iatan from the Healthy Heart Program Prevention Clinic, St. Paul’s Hospital, and University of British Columbia’s Centre for Heart Lung Innovation in Vancouver, Canada, during a presentation at the session. “This led us to wonder about the relationship between these low-carb, high-fat diets, lipid levels, and cardiovascular disease. And so, despite this, there’s limited data on this relationship.”
The researchers compared the diets of 305 people eating an LCHF diet with about 1,200 people eating a standard diet, using health information from the United Kingdom database UK Biobank, which followed people for at least a decade. They found that people on the LCHF diet had higher levels of low-density lipoprotein and apolipoprotein B. Apolipoprotein B is a protein that coats LDL cholesterol proteins and can predict heart disease better than elevated levels of LDL cholesterol can. The researchers also noticed that the LCHF diet participants’ total fat intake was higher in saturated fat and had double the consumption of animal sources (33%) compared to those in the control group (16%). “After an average of 11.8 years of follow-up – and after adjustment for other risk factors for heart disease, such as diabetes, high blood pressure, obesity, and smoking – people on an LCHF diet had more than two times higher risk of having several major cardiovascular events, such as blockages in the arteries that needed to be opened with stenting procedures, heart attack, stroke, and peripheral arterial disease.” Their press release also cautioned that their study “can only show an association between the diet and an increased risk for major cardiac events, not a causal relationship,” because it was an observational study, but their findings are worth further investigation, “especially when approximately 1 in 5 Americans report being on a low-carb, keto-like or full keto diet.”
I have to say that I find these findings not in the slightest bit surprising and would fully expect the relationship to be causal. The current craze for this diet is concerning and we need to warn consumers that they might be doing themselves considerable harm.
Other authors have recently pointed out that, within the first 6-12 months of initiating the keto diet, transient decreases in blood pressure, triglycerides, and glycosylated hemoglobin, as well as increases in HDL and weight loss may be observed. However, the aforementioned effects are generally not seen after 12 months of therapy. Despite the diet’s favorable effect on HDL-C, the concomitant increases in LDL-C and very-low-density lipoproteins (VLDL) may lead to increased cardiovascular risks. And another team of researchers has warned that “given often-temporary improvements, unfavorable effects on dietary intake, and inadequate data demonstrating long-term safety, for most individuals, the risks of ketogenic diets may outweigh the benefits.”
Norbert Hofer is the former leader of the Austrian right-wing FPÖ party who almost became Austria’s President. Currently, he is the 3rd member of the National Council. Hofer is a man full of surprises; he stated, for instance, that the Quran was more dangerous than COVID-19 during a speech held at a 2020 campaign event. As a result, he was sued for hate-speech.
Hofer’s latest coup is not political but commercial: Hofer is launching his own dietary supplement on the market. It is called “Formula Fortuna” and contains:
- L-tryptophan; a Cochrane review concluded that “a large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5‐HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia‐Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5‐HTP and tryptophan is limited at present.”
- Hydroxypropylmethylcellulose, a common delivery system.
- Rhodiola rosea extracts; human studies evaluating R. rosea did not have sufficient quality to determine whether it has properties affecting fatigue or any other condition.The U.S. Food and Drug Administration (FDA) has issued warning letters to manufacturers of R. rosea dietary supplement products unapproved as new drugs, adulterated, misbranded and in federal violation for not having proof of safety or efficacy for the advertised conditions of alleviating Raynaud syndrome, altitude sickness, depression or cancer.
- Ginseng root extract. Although ginseng has been used in traditional medicine for centuries, modern research is inconclusive about its biological effects. Preliminary clinical research indicates possible effects on memory, fatigue, menopause symptoms, and insulin response in people with mild diabetes. Out of 44 studies examined between 2005–2015, 29 showed positive, limited evidence, and 15 showed no effects. As of 2021, there is insufficient evidence to indicate that ginseng has any health effects. A 2021 review indicated that ginseng had “only trivial effects on erectile function or satisfaction with intercourse compared to placebo”. The constituents include steroid saponins known as ginsenosides, but the effects of these ginseng compounds have not been studied with high-quality clinical research as of 2021, and therefore remain unknown. As of 2019, the United States FDA and Federal Trade Commission have issued numerous warning letters to manufacturers of ginseng dietary supplements for making false claims of health or anti-disease benefits, stating that the “products are not generally recognized as safe and effective for the referenced uses” and are illegal as unauthorized “new drugs” under federal law. Concerns exist when ginseng is used chronically, potentially causing side effects such as headaches, insomnia, and digestive problems. Ginseng may have adverse effects when used with the blood thinner warfarin. Ginseng also has adverse drug reactions with phenelzine, and a potential interaction has been reported with imatinib, resulting in hepatotoxicity, and with lamotrigine. Other side effects may include anxiety, insomnia, fluctuations in blood pressure, breast pain, vaginal bleeding, nausea, or diarrhea.
- Zinc gluconate which has been used in lozenges for treating the common cold. However, controlled trials with lozenges which include zinc acetate have found it has the greatest effect on the duration of coldsInstances of anosmia (loss of smell) have been reported with intranasal use of some products containing zinc gluconate. In September 2003, Zicam faced lawsuits from users who claimed that the product, a nasal gel containing zinc gluconate and several inactive ingredients, negatively affected their sense of smell and sometimes taste. Some plaintiffs alleged experiencing a strong and very painful burning sensation when they used the product. Matrixx Initiatives, Inc., the maker of Zicam, responded that only a small number of people had experienced problems and that anosmia can be caused by the common cold itself. In January 2006, 340 lawsuits were settled for $12 million.
- Pyridoxine hydrochloride (vitamin B6) is usually well tolerated, though overdose toxicity is possible. Occasionally side effects include headache, numbness, and sleepiness. Pyridoxine overdose can cause a peripheral sensory neuropathy characterized by poor coordination, numbness, and decreased sensation to touch, temperature, and vibration.
‘Formula Fortuna’ allegedly is for lifting your mood. If I, however, tell you that you need to pay one Euro per day for the supplement, your mood might even change in the opposite direction.
What next?
I think I might design a dietary supplement against stupidity. It will not carry any of the risks of Hofer’s new invention but, I am afraid, it might be just as ineffective as Hofer’s ‘Formual Fortuna’.
I recently came across this editorial from the NEJM. I find it extremely relevant to the many discussions we have about so-called alternative medicine (SCAM) we have on this blog. I, therefore, take the liberty to copy a small section of it here without further comment, and encourage everyone to read the full paper:
…expertise and authority are increasingly seen as means for elites to establish and support existing hierarchies. There is, of course, some substance to this argument: although orthodox doctors may believe that their dominance and privilege are attributable to the rigor of the methods they use and that other schools of medicine were vanquished because of the superior results achieved by science-based practice, another version of the story sees the suppression of other approaches to healing (e.g., naturopathy, homeopathy, or chiropractic) as the result of ruthless actions by the American Medical Association and other forms of organized medicine. These critiques aren’t new; as Lewis Grossman writes in Choose Your Medicine, “medical freedom” arguments have long been used to oppose institutions intended to protect consumers, such as medical licensure and the FDA.3 The difference today is that the antiexpertise perspective has moved into the mainstream. With Google and Amazon having created a world in which people can frictionlessly obtain both information and nearly any product they want, it’s not hard to portray expert gatekeepers as barriers to patients’ ability to exercise choice.
Perhaps the most substantial threat to expertise is that members of the public are coming to believe that facts don’t exist — that all facts are political and therefore a matter of opinion. This mindset is fundamentally incompatible with the scientific practice of medicine, which depends on a shared commitment to backing up hypotheses with empirical evidence. Indeed, modern medicine owes much of its privileged position to a broad acceptance that the methods it uses can be relied on to make medical choices that are likely to do more good than harm.
A 1902 Supreme Court case, American School of Magnetic Healing v. McAnnulty, offers an instructive example of what could happen if all medical facts were seen as purely matters of opinion. The American School of Magnetic Healing in Nevada, Missouri, received 3000 pieces of mail every day, largely consisting of checks, money orders, and cash to purchase the healing services that the school advertised in newspapers throughout the United States. Patients who sent payments were instructed to lie down at a specified time wherever they were, and the healers at the magnetic school would, from Nevada, channel the healing energy of the universe into their bodies to heal them.3 The Post Office Department (which predated the Postal Service) concluded that this practice was a fraudulent operation using the mail and, after a hearing conducted by the postmaster general, stopped delivering mail to the school. The school sued, and the case went to the Supreme Court, which found in its favor.
Writing for the Court, Justice Rufus Peckham essentially rejected the existence of medical facts. “Just exactly to what extent the mental condition affects the body,” he wrote, “no one can accurately and definitely say.… Because the [school] might or did claim to be able to effect cures by reason of working upon and affecting the mental powers of the individual… who can say that it is a fraud?… Those who might deny the existence or virtue of the remedy would only differ in opinion from those who assert it. There is no exact standard of absolute truth by which to prove the assertion false and a fraud.”4 Although this decision was never expressly overruled, both Congress and the courts have since rejected the premise that the efficacy of treatments is purely a matter of opinion.
Differences of opinion within medicine are necessary for progress, and both licensing and certifying boards must therefore be careful to leave room for the expression of divergent views. Moreover, there is ongoing debate regarding the extent to which free-speech protections cover professional speech. But despite the existence of divergent views and areas for legitimate debate, there are some opinions that have been so thoroughly repudiated by existing evidence as to be considered definitively wrong.5 Constructive debates are possible only within a shared epistemic framework and with a commitment to the idea of verifiable facts. It’s incumbent on licensing and certifying boards to defend the existence of facts and to give the public a way to know when practitioners are making claims that are incompatible with reality.
When it comes to disciplining doctors, boards haven’t always lived up to public expectations — but that’s not a reason they should fall short yet again, especially during a lethal pandemic. Although there are many gray areas in medicine, some propositions are objectively wrong. For example, when a licensed physician insists that viruses don’t cause disease or that Covid-19 vaccines magnetize people or connect them to cell towers, professional bodies must be able to take action in support of fact- and evidence-based practice.
The public relies on the medical profession in times of grievous vulnerability and need. For the profession to earn and maintain the public’s trust — along with the privileges associated with the status of being licensed practitioners — medical boards must be able to differentiate practitioners who are providing fact-based advice from those who are not.
