MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

In the comment section of a recent post, we saw a classic example of the type of reasoning that many alternative practitioners seem to like. In order to offer a service to other practitioners, I will elaborate on it here. The reasoning roughly follows these simple 10 steps:

  1. My treatment works.
  2. My treatment requires a lot of skills, training and experience.
  3. Most people fail to appreciate how subtle my treatment really is.
  4. In fact, only few practitioners manage do it the way it has to be done.
  5. The negative trials of my treatment are false-negative because they were conducted by incompetent practitioners.
  6. In any case, for a whole range of reasons, my treatment cannot be pressed into the straight jacket of a clinical trial.
  7. My treatment is therefore not supported by the type of evidence people who don’t understand it insist upon.
  8. Therefore, we have to rely on the best evidence that is available to date.
  9. And that clearly is the experience of therapists and patients.
  10. So, the best evidence unquestionably confirms that my treatment works.

The case I mentioned above was that of an acupuncturist defending his beloved acupuncture. To a degree, the argument put forward by him sounded (to fellow acupuncturists) reasonable. On closer inspection, however, they seem far less so, perhaps even fallacious. If you are an acupuncturist, you will, of course, disagree with me. Therefore, I invite all acupuncturists to imagine a homeopath arguing in that way (which they often do). Would you still find the line of arguments reasonable?

And what, if you are a homeopath? Then I invite you to imagine that a crystal therapist argues in that way (which they often do). Would you still find the line of arguments reasonable?

And what, if you are a crystal therapist? …

I am not getting anywhere, am I?

To make my point, it might perhaps be best, if I created my very own therapy!

Here we go: it’s called ENERGY PRESERVATION THERAPY (EPT).

I have discovered, after studying ancient texts from various cultures, that the vital energy of our closest deceased relatives can be transferred by consuming their carbon molecules. The most hygienic way to achieve this is to have our deceased relatives cremated and consume their ashes afterwards. The cremation, storage of the ashes, as well as their preparation and regular consumption all have to be highly individualised, of course. But I am certain that this is the only way to preserve their vital force and transfer it to a living relative. The benefits of this treatment are instantly visible.

As it happens, I run special three-year (6 years part-time) courses at the RSM in London to teach other clinicians how exactly to do this. And I should warn you: they are neither cheap nor easy; we are talking of very skilled stuff here.

What! You doubt that my treatment works?

Doubt no more!

Here are 10 convincing arguments for it:

  1. EPT works, I have 10 years of experience and seen hundreds of cases.
  2. EPT requires a lot of skills, training and experience.
  3. Most people fail to appreciate how subtle EPT really is.
  4. In fact, only few practitioners manage do EPT the way it has to be done.
  5. The negative trials of EPT are false-negative because they were conducted by incompetent practitioners.
  6. In any case, for a whole range of reasons, EPT cannot be pressed into the straight jacket of a clinical trial.
  7. EPT is therefore not supported by the type of evidence people who don’t understand it insist upon.
  8. Therefore, we have to rely on the best evidence that is available to date.
  9. And that clearly is the experience of therapists and patients.
  10. So, the best evidence unquestionably confirms that EPT works.

Convinced?

No?

You do surprise me!

Why then are you convinced of the effectiveness of acupuncture, homeopathy, etc?

18 Responses to My treatment works … Because … my treatment works! A crash-course in logic for alternative practitioners

  • Assuming you’re referring to my comments, this is a flagrant misrepresentation. Yes, some of what you say here is true of my opinions, but you have twisted my words and added things that I neither said nor think in order to fit your stereotype of the delusional CAM practitioner.

    I drop by this blog once in a while in the hope of some intelligent, open-minded debate, which I occasionally get. But invariably, things descend towards these tactics, or pathetic jibes (e.g. Michael Kenny). I do believe both sides of this divide can learn from one another if there’s some mutual respect and willingness to listen, but that’s regrettably rare (on both sides).

    • I have not twisted your words because I did not quote you!
      ” I do believe both sides of this divide can learn from one another if there’s some mutual respect and willingness to listen, but that’s regrettably rare (on both sides).”
      yes, that’s what my post is about [in a way]!

  • @ Prof. Ernst,
    As the discoverer and master this new, fascinating CAM therapy, you are now in the ranks of other great minds like Samuel Hahnemann and Daniel David Palmer. Congratulations! It must be a great feeling to be one of the chosen ones.
    🙂
    I know that it is now very common for CAM inventors to provide unambiguous treatment protocols, but if at all possible, it would be great if the master of EPT would at least leave behind specific instruction on the cremation procedure for his future followers, to avoid potential side effects like this:
    https://en.wikipedia.org/wiki/Kuru_(disease)

  • ‘I have not twisted your words because I did not quote you!’

    So are your ‘simple 10 steps’ meant to represent my opinions or not? That’s what you seem to be suggesting, and it’s not appreciated. I know from multiple comments you’ve made here that you don’t like being misrepresented either, so perhaps you could make it clearer which opinions you think are mine? Otherwise this post comes across – to me at least – as a word-twisting exercise.

    • sorry that you don’t appreciate this post

      • I wouldn’t mind the post if it accurately represented what I said. But if you choose to leave it as it is I’ll just have to hope open-minded visitors will read my comments and consider what I actually said, rather than reply on this tabloid-level list.

        • at the bottom of the post you find the key-word ‘SATIRE’ – do you not understand this word?

          • You may believe adding the tag ‘satire’ to the bottom of a post excuses misrepresentation – I disagree. I also fail to see how ‘satirical’ misrepresentation helps move the debate forward, but perhaps it’s silly of me to think that’s what you’re trying to do here.

  • Hi there Tom. I have been following this discussion since the previous post. I think the major flaw in your reasoning is the personal believes/bias that you carry on in the debate.
    In example. I’m acupuncturist also, and I always have thinking that chinese medicine is simple rubbish. How can I conclude that, being an acupuncturist? Easy. It’s called critical thinking. That’s not such a great skill, but a better way to look the life phenomena with humble.
    In first place, chinese medicine is not an ancient (it comes from Mao and his expectations to deliver a cheaper way of medicine) and is always based in a tricky and adjustable intrepretation carried out by the practitioner, because the last confirmation criteria is his “experience” on the field. That criteria is obviously flawed and biased, since all concepts of this kind of medicine are purely based on pseudoscience, and that’s a suitable quacker arena. We are here, 2018, and I can swear you that qi, meridians, yin yang and all of that things doesn’t exist. Why? Because the evidence says. Until the evidence say the opposite, I won’t change my statement.
    Personally I just work in Public Health System here (hospital and primary care centers), and just in knee artrhosis and knee osteoartritis. Despite of my “good” results in the clinical setting, I conclude that those results are rubbish too.
    My clinical practice makes an effort to be bounded by the available evidence. I don’t speak with the patients (to avoid the verbal placebo), I don’t make verbal suggestion, I don’t use traditional criteria for diagnosis, just evidence-based protocols, I use always the same points in all patients, and I just retain the needles 7-10 min. The patients I see (10-15 average daily, since a few years) reports very good results; improvemente in pain scales, better sleep quality, more relaxed, and else.
    Now, is that because the acupuncture works? Sure not, it’s because diverse factors that can conditionate the final result. The most commons are the patients expectations, the regression to the mean and some-unknown phisiological effects that could mediate some antiinflamatory local/central reponse (activation of diffuse noxious inhibitory control system, MAP kinase signaling pathway, purinergic signaling pathway, monoaminergic pathway, mast cell reponse, etc.) in presence of the tissular injury that acupuncture makes. The last point we know that has been researched in animals, but not in humans. There are very interesting research material about the activation of some of that pathways, and they have been conducted in rat models, but there is still unclear and contradictory facts.
    And because of that, the rest of the acupuncture ritual is bullsh*t. We are alive because of the modern medicine research. I give more credit to that than the magical descriptions that appears in the Huang Di Nei Jing.

    Excuse me for my poor english.

    Regards, colleague.

    Tomás.

    • @Tomas I’m confused by your logic. You say the good results you get with acupuncture are ‘rubbish’, and that they are not due to acupuncture ‘working’. But then you list various physiological effects that may be at play (as well as patient expectations/regression to the mean, which of course are factors in any modality). So you see acupuncture working, you understand some of the plausible mechanisms that could at least partly explain how it works, you continue to use it frequently, and yet you say it doesn’t work?

      Also, you conflate TCM (a semi-standardised version of Chinese medicine developed under Mao) with Chinese medicine as a whole. So I agree, ‘TCM’ isn’t ancient, it’s a relatively modern interpretation of ancient ideas. That doesn’t make it worthless any more than it makes it faultless. TCM, Classical acupuncture, Japanese acupuncture, Korean acupuncture, Western medical acupuncture – they’re all road maps trying to make sense of a complex system. You feel most comfortable using protocols, but are you sure these are more effective than other approaches? Perhaps one day we’ll know for sure, but for now it seems sensible to me to at least take into account the principles that led to what you do in your clinic today. Maybe it’s all bullsh*t, but closing yourself to the possibility that there’s some useful stuff in there seems a shame to me. Besides, presumably you use at least some of the point locations that were discovered and honed by this ancient ‘bullsh*t’?

      And just to clarify, I think you’re jumping to conclusions about my beliefs. I’m quite happy to accept that Qi, for example, isn’t ‘real’ in the sense that it can be measured. In acupuncture terms, I think it’s quite likely that the physiological effects you list (and maybe many others) combine to equate to what was being described in the ancient texts.

      • Tom,
        You make a good point about the difference between Chinese medicine as practised over centuries and TCM as cobbled together under Mao.

        It would be interesting to compare them. Anyone with such an interest (and a strong back, those volumes are heavy) might want to look at Needham, J., & Wang, L. (1954). Science and civilisation in China. v.6, pt. 7. Cambridge: Cambridge University Press.

        Of course, that there is and has been Chinese medicine practised for millennia does not mean most or even any of it works. David Wootton in his fascinating book Bad Medicine makes the claim that Western medicine until the late 19th/early 20th Century usually did more harm than good.

      • You have been conned by one of your own!

    • Nice Try!

  • I see a ready parallel with religion here. The follower of goddess A rejects the claims of those following goddess B. An outsider to both cults rejects both goddesses and observes that, were each to apply the same scrutiny to their goddess as they do to others, they’d reject their deity, too.
    John Loftus promotes and writes extensively about this as “the outsider test for faith.”
    I strive to apply equal criticism (often more) to my own tentative views (they’re all tentative) as to any claim or proposal out to me.
    Chemo therapy, germ theory of desease and the advice of medical professionals have all passed tests that homeopathy, accupuncture, crystal therapy have failed.
    It’d be great if those accusing Prof Ernst of misquotes would do a bit of outsider testing.
    It’d be great, but when income streams and prior investment in a beloved idea are blended with the kudos of “doing good,” it’s inevitably hard to expose yourself to the idea that years or decades have been wasted.
    Philosopher Dan Dennett and researcher Linda LaScola spearheaded the now over-subscribed Clergy Project that gives community and resource to those who came to the conclusion that their career path couldn’t survive the outsider test. Now ex-clerics are building new lives, having escaped their income streams, preferred idea and kudos.
    In short, alt med people: there is a way out, there is a return to reality.

    • Rich,
      They are all fantasists, wrapped in their own delusions. They don’t treat cancer or anything seriously life threatening, but, but, but, their fantasy works on something, so they say.

      You can see the delusional thinking above quite clearly.

      • Absolutely.
        Maybe you should see some of my encounters with street preachers.
        Not pleasant, as my contempt for liars contains no compassion. Some are quite funny, though.

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