medical ethics
An interesting and fully referenced (205 references) article caught my attention; it seems highly relevant to the discussions we are having on this blog. Let me show you the abstract:
Medical misinformation has always existed, but it has recently become more frequent due to the development of the internet and social media. Medical misinformation can cover a wide variety of topics, and studies show that some groups are more likely to be affected by medical misinformation than others, like those with less trust in health care, less health literacy, and a more positive attitude toward alternative medicines. Aspects of the internet, like echo chambers and algorithms, have contributed to the rise of medical misinformation, along with belief in anecdotal evidence and alternative remedies that are not backed by science. Some personal beliefs and a lack of media literacy skills are also contributing to medical misinformation. Medical misinformation causes higher rates of death and negative health outcomes, a lack of trust in medical professionals, and more racism and hate crimes. One possible way to combat the spread of misinformation is education surrounding media literacy. Still, there are gaps in this practice that must be addressed like a lack of high-quality research about different educational programs.
The author also offers the following key points:
- Medical misinformation is becoming an urgent issue for United States citizens—leading to increased deaths,
a lack of trust in health professionals, and hate crimes and racism. - Although this is a worldwide issue, the United States has the second highest rate of misinformation of any
country, behind India. - One piece of misinformation during the COVID-19 pandemic stated that highly concentrated alcohol could
disinfect the body and kill the virus. Studies show that 800 people died, 5,876 were hospitalized, and 60
became completely blind from drinking methanol, thinking it would cure coronavirus. - Studies estimate that only 14% of the United States population has proficient health literacy, which makes it difficult to recognize medical misinformation.
- Media literacy education is being pursued in order to combat the spread of misinformation, but more research is needed in order to understand the long-term effects of this education and what programs are best.
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I would like to stress, as indeeed the author does as well, that medical misinformation is a phenomenon that is by no means confined to the US. Like most information, misinformation has become a global issue. Its dangers cannot be under-estimated. My blog offers an abundance of reports where misinformation in the realm of so-called alternative medicine (SCAM) has caused harm and even death. The author advocates media literacy as a remedy for the problem. I would argue that even more important would be to teach CRITICAL THINKING, a task that has to start at school and must continue well into adult life.
This conclusion is so very obvious that it begs an important question: WHY HAS IT NOT BEEN DONE YEARS AGO? The answer, I fear, is simple: for reasons that are self-evident, governments have little interst in the public being able to think critically. On the contrary, governments across the world foremost want to be re-elected, and critical thinking would be a major obstacle to this aim.
In spite of the safety and efficiency of the COVID-19 vaccines and the many promotion efforts of political and expert authorities, a fair portion of the population remained hesitant if not opposed to vaccination. Public debate and the available literature point to the possible role of people’s attitudes towards medical institutions as well as their preference for so-called alternative medicine (SCAM) on their motivations and intentions to be vaccinated. Other potential ideological factors are beliefs about environmental laissez-faire and divine providence insofar as they encourage people to let the pandemic unfold without human interference.
In three cross-sectional samples (total N = 8214), collected at successive moments during the Belgian vaccination campaign, the present research examines the distal role of these psychological and ideological factors on vaccination intentions via motivational processes.
- Study 1 gauges the relation between trust in medical institutions and preference for SCAM on intentions to get vaccinated via motivations.
- Study 2 examines the role of beliefs in the desirability of letting nature take its course (‘environmental laissez-faire beliefs’) on vaccination intention via motivations.
- Study 3 tests whether people’s adherence to environmental laissez-faire and beliefs about divine providence are linked to their motivations for vaccination via trust in the medical institutions and SCAM.
The results show that adherence to SCAM has a deleterious effect on vaccination intentions, whereas trust in medical institutions has a positive effect. Both ideological factors pertaining to external control are only moderately related, with environmental laissez-faire beliefs having stronger effects on SCAM, medical trust and vaccination motivations.
The evidence of an association between SCAM and willingness to get vaccinated is undeniable. On this blog, we have discussed it repeatedly, e.g.:
- Use of so-called alternative medicine (SCAM) and its association with SARS-CoV-2 vaccination status
- Intelligence, Religiosity, SCAM, Vaccination Hesitancy – are there links?
- Andrew Wakefield, Donald Trump, SCAM, and the anti-vaccination cult
- Measles are back – not least thanks to so-called alternative medicine (SCAM), I fear
- Reasons for parental hesitancy or refusal of childhood vaccination
- Endorsement of so-called alternative medicine (SCAM) and vaccine hesitancy among physicians
- Are people who oppose COVID-19 vaccinations intellectually challenged?
- So-called alternative medicine (SCAM) and vaccine hesitancy among physicians: findings from Germany, Finland, Portugal, and France
- Interest in so-called alternative medicine is linked to vaccination coverage
- Misinformation and conspiratorial thinking are at the heart of so-called alternative medicine(SCAM)
- Vaccination rates of Canadian healthcare professionals: those of chiropractors and naturopaths are at the lowest
- Echo chambers of vaccine hesitancy and so-called alternative medicine (SCAM)
- Preference of so-called alternative medicine predicts negative attitudes to vaccination
- What are the reasons for opposing COVID vaccinations?
- Anti-vax arguments used by proponents of SCAM are stupid, or wrong, or both
But what exactly is the nature of this association?
- Does SCAM-use predispose to vaccination hesitancy?
- Does Vaccination hesitancy predispose to SCAM use?
- Is both true?
After reading all this research that has emerged on the subject, I get the impression that we are mostly dealing here with a cross-correlation where a certain mind-set of being
- prone to conspiracy theories,
- anti-establishment,
- anti-science,
- irrational,
- of low intelligence,
- unable of critical thinking,
- etc., etc,
determines both the SCAM-use and the vaccination hesitancy.
It has been reported that 5 people who took a Japanese health supplement have died and more than 100 have been hospitalized as of Friday, a week after a pharmaceutical company issued a recall of the products, officials said. Osaka-based Kobayashi Pharmaceutical Co. came under fire for not going public quickly with problems known internally as early as January. Yet the first public announcement came only on 22 March. Company officials said 114 people were being treated in hospitals after taking products — including Benikoji Choleste Help meant to lower cholesterol — that contain an ingredient called benikoji, a red species of mold. Some people developed kidney problems after taking the supplements, but the exact cause was still under investigation in cooperation with government laboratories, according to the manufacturer.
“We apologize deeply,” President Akihiro Kobayashi told reporters last Friday, bowing for a long time to emphasize the apology alongside three other top company officials. He expressed remorse to those who have died and have been taken ill and to their families. He also apologized for the troubles caused to the entire health food industry and the medical profession, adding that the company was working to prevent further damage and improve crisis management.
The company’s products have been recalled — as have dozens of other products that contain benikoji, including miso paste, crackers, and a vinegar dressing. Japan’s health ministry put up a list on its official site of all the recalled products, including some that use benikoji for food coloring. The ministry warned the deaths could keep growing. The supplements could be bought at drug stores without a prescription from a doctor, and some may have been purchased or exported before the recall, including by tourists who may not be aware of the health risks.
Kobayashi Pharmaceutical had been selling benikoji products for years, with a million packages sold over the past 3 fiscal years, but a problem crept up with the supplements produced in 2023. Kobayashi Pharmaceutical said it produced 18.5 tons of benikoji last year. Some analysts blame the recent deregulation initiatives, which simplified and sped up approval for health products to spur economic growth.
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Anouther source reported that Japanese authorities on Saturday raided a drug factory after a pharmaceutical company reported at least five deaths and 114 hospitalizations possibly linked to a health supplement. About a dozen Japanese health officials walked into the Osaka plant of the Kobayashi Pharmaceutical Co., as seen in footage of the raid widely telecasted on Japanese news. The health supplement in question is a pink pill called Benikoji Choleste Help. It is said to help lower cholesterol levels. A key ingredient is benikoji, a type of red mold. The company has said it knows little about the cause of the sickness, which can include kidney failure. It is currently investigating the effects in cooperation with Japan’s government.
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More recent reports update the figure of affected individuals: Japanese dietary supplements at the center of an expanding health scare have now been linked to at least 157 hospitalizations, a health ministry official said Tuesday.The figure reflects an increase from the 114 hospitalization cases that Kobayashi Pharmaceutical said on Friday were linked to its products containing red yeast rice, or beni kōji.
A Kobayashi Pharmaceutical spokeswoman confirmed the latest hospitalization cases without elaborating further.
Benikoji is widely sold and used; not just in Japan. It comes under a range of different names:
- red yeast rice,
- red fermented rice,
- red kojic rice,
- red koji rice,
- anka,
- angkak,
- Ben Cao Gang Mu.
It is a bright reddish purple fermented rice which acquires its color from being cultivated with the mold Monascus purpureus. Red yeast rice is used as food and as a medicine in Asian cultures, such as Kampo and TCM.
It contains lovastatin which, of course, became patented and is marketed as the prescription drug, Mevacor. Red yeast rice went on to become a non-prescription dietary supplement in the United States and other countries. In 1998, the U.S. FDA banned a dietary supplement containing red yeast rice extract, stating that red yeast rice products containing monacolin K are identical to a prescription drug, and thus subject to regulation as a drug.
It does not happen often, but when it does, it should be aknowledged. I am speaking of papers from chiropractors that make sense. If you are interested in chiropractic, I do encourage you to read the articles of which I will here only present bits of the conclusions:
The chiropractic profession is weighed down by the burden of historical theories regarding spinal manipulative therapy (SMT), which, for some in the profession, have all the characteristics of dogmatic articles of faith. In our opinion, the unlimited scope of practice, which is still advocated by some chiropractors, and which has not been met with unequivocal political rejection, an over-reliance on SMT in the management of MSK disorders, and an over-emphasis on the technical intricacies of SMT represent weaknesses within chiropractic. We argue that these are obstacles to professional development and the major causes of professional stagnation both intellectually and in the market place.
We also discussed what we consider to be threats to the chiropractic profession. Science, the impact of EBM, and accountability to authorities and third party-payers all pose threats to the traditional chiropractic paradigm and, thus, to those within the profession, who practice within such a paradigm. In the marketplace, competition from other professions that provide care of patients with MSK disorders, including SMT, and are better positioned to be integrated into the wider health-care system/market represent a threat. Moreover, finally, the internal schism in chiropractic represents a threat to professional development, as it prevents the profession moving forward in unison with a coherent external message.
We have described those weaknesses and threats, knowing full well, that we do so from our perspective of chiropractic as EBM with a limited MSK scope of practice, i.e. from outside the subluxation frame of reference.
We recognize that for those who look at SMT from the perspective of traditional, subluxation-based chiropractic, things will look very different: What we identify as weaknesses may be seen by others as the pillars of chiropractic practice, and what we see as threats could appear as just peripheral and ephemeral distractions to the enduring core of chiropractic ideas. Such is the character of the schism at the heart of chiropractic.
None-the-less, having described what we identify as serious weaknesses and threats arising from the profession’s relationship to SMT, it has not escaped our attention that it also gives rise to several strengths, which serve the profession and its patients well. In turn, it follows that a number of opportunities are presenting themselves for the future of SMT and chiropractic.
The onus is now on the chiropractic profession itself to redefine its raison d’être in a way that plays to those strengths and delivers in terms of the needs of patients and the wider healthcare system/market. We suggest chiropractors embrace and cultivate a role as coordinators of long-term and broad-focused management of musculoskeletal disorders. We make specific recommendations about how the profession, from individual clinicians to political organizations, can promote such a development.
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For readers in a hurry:
Progress is an inevitable threat to obsolete and useless practices of any kind. In that, chiropractic is no exception.
Some abstracts of medical papers are so bizarre that they must not be tempered with, I find. This is one of them:
Rationale:
This case report aims to provide clinical evidence on the effectiveness of integrating chiropractic and moxibustion techniques for treating pseudomyopia accompanied by elevated intraocular pressure resulting from cervical spine issues because the application of complementary medicine modalities for managing such vision disorders currently lacks adequate investigations.
Patient concerns:
A 6-year-old patient presented with blurred vision, intermittent ocular discomfort, and upper cervical discomfort.
Diagnoses:
Spine-related increased intraocular pressure and pseudomyopia.
Interventions:
The patient received integrative treatment of chiropractic and walnut-shell moxibustion 3 times a week for a total of 10 treatment sessions.
Outcomes:
The patient exhibited progressive improvements in visual acuity and reductions in intraocular pressure over the treatment period, with unaided vision exceeding 2 lines of improvement in visual acuity charts and normalized intraocular pressure after 10 treatment sessions. These therapeutic effects were sustained at 3-month follow-up.
Lessons:
The integrative use of chiropractic and walnut-shell moxibustion demonstrates considerable potential in alleviating symptoms of pseudomyopia, reducing intraocular pressure, and restoring visual function in spine-related pseudomyopia cases.
Pseudomyopia is a spasm of the ciliary muscle that prevents the eye from focusing in the distance. It differs from myopia which is caused by the eye’s shape or other basic anatomy. Pseudomyopia may be either organic, through stimulation of the parasympathetic nervous system, or functional in origin, through eye strain or fatigue of ocular systems. It is common in young adults after a change in visual requirements, such as students preparing for an exam, or a change in occupation. The condition is often transitory and it is necessary to request psychiatric consultation in each case of pseudomyopia. Comorbidity of anxiety and depressive disorders is more common in pseudomyopia cases. In addition, as the severity of psychiatric symptoms increases, the amount of accommodation also appears to increase.
A few question, if I may:
- Walnut-shell moxibustion? Yes, it exists! Moxibustion with walnut shell spectacles is a characteristic therapy of Guang’anmen Hospital, developed on the basis of walnut shell moxibustion, and mainly composed of an eye moxibustion frame, a walnut shell soaked with wolfberry and chrysanthemum liquid, and moxibustion strips. Moxibustion with a walnut shell was first recorded by Shicheng Gu for treating surgical ulcers in the Qing dynasty. Then, moxibustion with walnut shell spectacles was reformed by us, combining Shicheng Gu’s experience with our clinical practice, and is mainly used for the treatment of optic nerve atrophy and myopia.
- The authors state that, “based on traditional Chinese medicine principles, moxibustion is known to warm meridians, dredge collaterals, relax tendons, and enhance blood circulation”. Is this true? Well, based on TCM, anything goes, but it does not make it true.
- How can we know whether chiropractic or walnut-shell moxibustion or both caused the outcome? We can’t!
- Can we be sure what caused the child’s problem? No!
- Do we know whether the outcome was not a spontaneous recovery? No!
- The authors claim that “cervical spine imbalance leads to visual impairment”. Is that correct? Not as far as I know.
- The authors state that “the patient in this case, presenting with pseudomyopia, elevated intraocular pressure, and neck pain, likely had a cervical spine-derived condition. Currently, such spine-derived vision disorders lack sufficient clinical recognition.” Is this true? No, I’d say such spine-derived vision disorders might not even exist.
- Why would anyone publish a paper about the case? Search me!
Lumbar stabilization exercises (LSEs) are said to be beneficial for chronic mechanical low back pain (CMLBP). However, further research focusing on intervention combinations is recommended. This study examined the effect of kinesio tape (KT) with LSEs on CMLBP adult patients.
A randomized blinded clinical trial was conducted. Fifty CMLBP patients of both genders were assigned into one of two groups and received 8 weeks of treatment:
- group A (control): LSEs only,
- group B (experimental): KT with LSEs.
The primary outcome was back disability, measured by the Oswestry disability index. Secondary outcomes included pain intensity, trunk extensor endurance, and sagittal spinal alignment, as indicated by the visual analog scale, Sorensen-test, and C7–S1 sagittal vertical axis, respectively. The reported data was analyzed by a two-way MANOVA using an intention-to-treat procedure.
Multivariate tests indicate statistically significant effects for group (F = 4.42, p = 0.005, partial η2 = 0.148), time (F = 219.55, p < 0.001, partial η2 = 0.904), and group-by-time interaction (F = 3.21, p = 0.01, partial η2 = 0.149). Univariate comparisons between groups revealed significant reductions in the experimental group regarding disability (p = 0.029, partial η2 = 0.049) and pain (p = 0.001, partial η2 = 0.102) without a significant difference in the Sorensen test (p = 0.281) or C7–S1 SVA (p = 0.491) results. All within-group comparisons were statistically significant (p < 0.001).
The authors concluded that the combination of KT and LSEs is an effective CMLBP treatment option. Although patients in both groups displayed significant changes in all outcomes, the combined interventions induced more significant reductions in back disability and pain intensity.
One of the main reason for conducting a controlled clinical trial is to determine whether the intervention, rather than some other factor, was the cause of the observed outcome. Yet, these trials can be designed in such a way that they mislead us on precisely this point. The present study is an example for such a case.
The authors leave us in no doubt that the KT was the cause of the positive outcome. However, they might be entirely wrong. Here are some other possibilities:
- the extra attention might have done the trick;
- the ritual of applying KT must have an effect;
- the expectation of the patient could have influenced the outcome;
- verbal or non-verbal communication between the patient and the therapist would have had an effect.
I know, it is often difficult to control for such influences in clinical trials. But, if it proves to be impossible [and in the case of KT it probably is possible], one should at the very least be cautious when drawing conclusions from the results. I suggest something like this:
The combination of KT and LSEs generated better outcomes than LSE alone. Whether this is due to specific effects of KT or non-specific context effects remains unclear.
Whenever a journalist wants to discuss the subject of acupuncture with me, he or she will inevitably ask one question:
DOES ACUPUNCTURE WORK?
It seems a legitimate, obvious and simple question, particularly during ‘Acupuncture Awareness Week‘, and I have heard it hundreds of times. Why then do I hesitate to answer it?
Journalists – like most of us – would like a straight answer, like YES or NO. But straight answers are in short supply, particularly when we are talking about acupuncture.
Let me explain.
Acupuncture is part of ‘Traditional Chinese Medicine’ (TCM). It is said to re-balance the life forces that determine our health. As such it is seen as a panacea, a treatment for all ills. Therefore, the question, does it work?, ought to be more specific: does it work for pain, obesity, fatigue, hair-loss, addiction, anxiety, ADHA, depression, asthma, old age, etc.etc. As we are dealing with virtually thousands of ills, the question, does it work?, quickly explodes into thousands of more specific questions.
But that’s not all!
The question, does acupuncture work?, assumes that we are talking about one therapy. Yet, there are dozens of different acupuncture traditions and sites:
- body acupuncture,
- ear acupuncture,
- tongue acupuncture,
- scalp acupuncture,
- etc., etc.
Then there are dozens of different ways to stimulate acupuncture points:
- needle acupuncture,
- electroacupuncture,
- acupressure,
- moxibustion,
- ultrasound acupuncture,
- laser acupuncture,
- etc., etc.
And then there are, of course, different acupuncture ‘philosophies’ or cultures:
- TCM,
- ‘Western’ acupuncture,
- Korean acupuncture,
- Japanese acupuncture,
- etc., etc.
If we multiply these different options, we surely arrive at thousands of different variations of acupuncture being used for thousands of different conditions.
But this is still not all!
To answer the question, does it work?, we today have easily around 10 000 clinical trials. One might therefore think that, despite the mentioned complexity, we might find several conclusive answers for the more specific questions. But there are very significant obstacles that are in our way:
- most acupuncture trials are of lousy quality;
- most were conducted by lousy researchers who merely aim at showing that acupuncture works rather that testing whether it is effective;
- most originate from China and are published in Chinese which means that most of us cannot access them;
- they get nevertheless included in many of the systematic reviews that are currently being published without non-Chinese speakers ever being able to scrutinise them;
- TCM is a hugely important export article for China which means that political influence is abundant;
- several investigators have noted that virtually 100% of Chinese acupuncture trials report positive results regardless of the condition that is being targeted;
- it has been reported that about 80% of studies emerging from China are fabricated.
Now, I think you understand why I hesitate every time a journalist asks me:
DOES ACUPUNCTURE WORK?
Most journalists do not have the patience to listen to all the complexity this question evokes. Many do not have the intellectual capacity to comprehend an exhaustive reply. But all want to hear a simple and conclusive answer.
So, what do I say in this situation?
Usually, I respond that the answer would depend on who one asks. An acupuncturist is likely to say: YES, OF COURSE, IT DOES! An less biased expert might reply:
IT’S COMPLEX, BUT THE MOST RELIABLE EVIDENCE IS FAR FROM CONVINCING.
The aim of this study was to establish an international consensus regarding the use of spinal manipulation and mobilisation among infants, children, and adolescents among expert international physiotherapists. Twenty-six international expert physiotherapists in manual therapy and paediatrics voluntarily participated in a 3-Round Delphi survey to reach a consensus via direct electronic mail solicitation using Qualtrics®. Consensus was defined a-priori as ≥75% agreement on all items with the same ranking of agreement or disagreement. Round 1 identified impairments and conditions where spinal mobilisation and manipulation might be utilised. In Rounds 2 and 3, panelists agreed or disagreed using a 4-point Likert scale.
Eleven physiotherapists from seven countries representing five continents completed all three Delphi rounds. Consensus regarding spinal mobilisation or manipulation included:
● Manipulation is not recommended: (1) for infants across all conditions, impairments, and
spinal levels; and (2) for children and adolescents across most conditions and spinal levels.
● Manipulation may be recommended for adolescents to treat spinal region-specific joint
hypomobility (thoracic, lumbar), and pain (thoracic).
● Mobilisation may be recommended for children and adolescents with hypomobility, joint
pain, muscle/myofascial pain, or stiffness at all spinal levels.
The authors of this paper concluded that consensus revealed spinal manipulation should not be performed on infants regardless of condition, impairment, or spinal level. Additionally, the panel agreed that manipulation may be recommended only for adolescents to treat joint pain and joint hypomobility (limited to thoracic and/or lumbar levels). Spinal mobilisation may be recommended for joint hypomobility, joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels among children and adolescents.
Various forms of spinal manipulations are the hallmark therapy of chiropractors. Almost 100% of their patients recieve these interventions. So, what will our friends, the chiros, say about the consensus? Might it be this:
- Physiotherapists are not the experts on spinal manipulation.
- Only chiropractors can do them properly.
- And when WE do them, they are very good*!
(* for our income)
This study aims to assess the feasibility of a pragmatic prospective study aiming to report the immediate and delayed (48-hours post-treatment) AEs associated with manual therapies in children aged 5 or younger and to report preliminary data on AEs frequency.
Between July 2021 and March 2022, chiropractors were recruited through purposive sampling and via a dedicated Facebook group for Quebec chiropractors interested in pediatrics. Legal guardians of patients aged 5 or younger were invited to fill out an online information and consent form. AEs were collected using the SafetyNET reporting system, which had been previously translated by the research team. Immediate AEs were collected through a questionnaire filled out by the legal guardian immediately after the treatment, while delayed AEs were collected through a questionnaire sent by email to the legal guardian 48 h after the treatment. Feasibility was assessed qualitatively through feedback from chiropractors and quantitatively through recruitment data.
Overall, a total of 28 chiropractors expressed interest following the Facebook publication, and 5 participated. An additional two chiropractors were enrolled through purposive sampling. In total, 80 legal guardians consented to their child’s participation, and data from 73 children were included for the analysis of AEs. At least one AE was reported in 30% of children (22/73), and AEs were mainly observed immediately following the treatment (16/22). The most common AEs were irritability/crying (11 children) or fatigue/tiredness (11 children). Feasibility analysis demonstrated that regular communication between the research team and clinicians, as well as targeting clinicians who showed great interest in pediatrics, were key factors for successful research.
The authors concluded that their results suggest that it is feasible to conduct a prospective pragmatic study evaluating AEs associated with manual therapies in private practices. Direct communication with the clinicians, a strategic clinicians’ recruitment plan, and the resulting administrative burden should be considered in future studies. A larger study is required to confirm the frequency of AEs reported in the current study.
It is hardly surprising that such a study is ‘feasible’. I could have told the authors that and saved them the trouble of doing the study. What is surprising, in my view, that chiropractors, after ~120 years of existence of the profession, ask whether it is feasible.
I suggest to do the definitive study on a much larger sample, extend the observation period, and recruit a representative rather than self-selected sample of chiros … or – much better – forget about the study and establich a functioning post-marketing surveillance system.
In recent weeks and months, I have been thinking quite a lot about the various types of scientists. This is partly due to me finishing a book entitled:
1. SCIENTIST
Scientists gather information through observation and experimentation, formulate hypothesis, and then test them. They work in vastly different areas but have certain attitudes or qualities in common, e.g. critial thinking and an open mind. As scientists tend to publish their findings, a very simple (but not fool-proof) way to identify a scinetist is to look him/her up, for example by finding his/her H-Index. (The H-Index is defined as the maximum value of h such that the given author/journal has published at least h papers that have each been cited at least h times. For instance, if someone has 10 papers that were cited 10 times, his H-Index would be 10. If another scientist has 50 papers that were cited 50 times, his H-Index would be 50.)
2. PSEUDO-SCIENTIST
Pseudo-scientists are people who pretend to produce science but, in fact, they generate pseudoscience. The demarkation of pseudo-science from science is sometimes difficult, as we have seen several times on this blog, e.g.:
- Characteristics of pseudoscience
- Science or Pseudoscience?
- Is acupuncture pseudoscience?
- The techniques of pseudoscience
- Pseudoscience revisited
- Tolerance towards pseudo-science?
- How to become a charlatan
The pseudo-scientist does have no or just a few publications in the peer-reviewed literature and no H-Index to speak of.
3. WOULD-BE SCIENTIST
The term ‘would-be scientist’ is not one that is commonly used, nor is it one that has an accepted definition. The way I see it, would-be scientists are aspiring to become scientist. They are on the way to become a scientist but have not quite arrived yet. To the would-be scientist I say: good luck to you; I hope you make it and I look forward to reading about your scientific achievements. The would-be scientist is, however, not the topic of my post.
4. THE PREDEND-SCIENTIST
The predent-scientist (PS) is the one who I want to focus on here. He – yes, the PS is usually male – talks a lot about science; so much so that outsiders would get the impression that he actually is a scientist. Crucially, the PS himself has managed to delude himself to the point where believes to be a scientist.
While scientists tend to be media-shy, the PS enjoys the limelight to generate the impression of being a scientist. He talks eloquently and at length about science. Much of what he says or writes might even be correct. The PS is often quite well-versed and knows (most of) his stuff.
The crucial difference between the PS and the scientist is that the PS produces no or very little science; neither does he intend to. To identify the PS, an easy (but not fool-proof) method is to him look up. Typically, he has published several articles in the popoular press or books for the lay public, but – as he does not conduct scientific research – he does not generate papers in the peer-reviewed scientific literature. This void, however, has never stopped the PS from appearing in the media speaking about science, nor from occupying prominent positions in the world of science, nor from avidly rubbing shoulders with scientists. Few people see anything wrong with that, mainly because the PS has convinced them (most importantly himself) that he actually is a scientist. While the scientist is trained in doing science, the PS is trained in talking about science.
Don’t get me wrong, the PS can have his merits. He often presents science to the public more or less accurately and frequently is rhetorically superior to the scientist. I nevertheless have reservations about the PS (and the recent pandemic has shown us how dangerous PSs can beome). The questions to ask ourselves are the following:
- Does PS have a truly open mind?
- Can he set aside ideologies?
- Will he change his opinion vis a vis new evidence?
- Is he prepared to consider criticism?
- Does he avoid ‘black and white’ thinking?
- Is he sufficiently humble?
- Is he honest with himself and others?
These questions refer to important attitudes that scientists learn – often the hard way – while doing science. If someone lacks this experience, such attitudes are likely to be under-developed. Perhaps, it all boils down to honesty: if a man who has never done any amount of science to speak of has convinced himself to be a scientist, he arguably is dishonest with himself and the public.
In order to make my points as clearly as possible, I admittedly caricaturized the extremes of a wider spectrum; my appologies for that. In reality, the different types of scientists rarely exist as entirely pure forms. Frequently, people are mixtures of two types, either because they did different things during different periods of their lives, or because they simply are hybrids.
To provide a few examples, let me show you 14 H-Indices (according to ‘Google Scholar’) of people (in alphabetical order) who you might have heard of, for instance, because they have featured on my blog. I leave it up to you to decide how well they fit in any of my three categories and who might qualify to be a PS.
- Fabrizio Benedetti – H-Index = 83
- David Colquhoun – H-Index = 78
- Ian Chalmers – H-Index = 84
- Michael Dixon – H-Index = 0
- David Gorski – H-Index = 30
- Holm Hümmler – H-Index = 0
- Ted Kaptchuk – H-Index = 103
- Jos Kleinjen – H-Index = 104
- Andreas Michalsen – H-Index = 0
- Michael Mosely – H-Index = 0
- Dana Ullman – H-Index = 0
- Dale Thompson (alias DC) – H-Index = 0
- Chris van Tulleken – H-Index = 0
- Harald Walach – H-Index = 9
My conclusion: the PS, a person who presents himself as a scientist without having done any meaningful amount of science himself, is a man who is not entirely honest. The H-Index can be helpful for identifying PSs. An index of zero, for instance, seems to send out a fairly clear message. In the case low indices, it is advisable to go one step further and study the actual articles That mede up the index. However, the H-Index tells us nothing about whether someone presents himself as a scientist; this information must be gleaned from the person him(her)self.
