The items in this section can be differentiated from those in the Medical Practices Not Supported by Science section in that most of the concepts and systems presented here begin with very low levels of prior plausibility. Previously, we differentiated Evidence Based Medicine from Science Based Medicine by showing that EBM does not consider prior plausibility to the degree that it perhaps should when evaluating claims. Proponents of SBM feel that prior plausibility should factor heavily when interpreting the results of clinical studies.
The topics presented here serve as examples of the many pseudoscience practices that are still prevalent today. In fact, these pseudosciences are now being 'integrated' into the curriculum of modern medical schools and academic medical centers. They are pseudoscience as they are presented with the trappings and window dressings of science, but are either not grounded in accepted scientific principles (low prior probability), lack significant clinical evidence to support their use, or both.
Some of the examples developed before scientific thinking became standard in medicine. As a result, entire systems of practice developed and are still practiced today that seem to exist in a kind of quasi-parallel reality to scientific medicine. Such systems self-seal themselves to seem internally consistent to those who find themselves within them. Our cognitive biases and our instinct to rationalize our beliefs with logical fallacies prevent us from seeing how things actually are.
One may recall the iconic moment in the movie, The Matrix, when Neo is offered a choice between the red pill and the blue pill. He has been told that he lives in an internally-consistent, seemingly comfortable pseudo-reality (the 'Matrix'). He cannot actually believe this unless he can see the real world for himself. If he takes the blue pill, he will stay in the matrix -- oblivious to the real world, but a slave to the fantasy world. If he takes the red pill, he will emerge from the pseudo-reality into the harsh, dangerous and uncertain real world. In this seen, Morpheus refers to reality as 'Wonderland', as their reality is harsh and unbelievable for those who remain in the fantasy. Neo chooses reality.
In some way, critical thinking in medicine is like taking the red pill. Without critical thinking skills, one may remain in a world that seems real and consistent, but be unable to see reality (at least as far as science can model reality). Those who choose the blue pill (pseudoscience) will take offense to criticism of their world due to cognitive dissonance and continue to defend the world of pseudoscience with denialism, fallacies and conspiracy theories. That is unfortunate. But for those who choose the red pill (or is it that the red pill chooses you?), the world can be seen as an ever-improving model of reality in which real progress can be made.
It is important to keep our skeptical tools in mind. First we must determine if a given claim is even science. Hume's Fork and Falsifiability help us here. Are the results more easily explained by other ideas that require less assumptions? Occam's Razor stands ready to help us decide. If the claim has low prior plausibility, is the evidence presented 'extraordinary' enough to overcome this hurdle? Remember, extraordinary claims require extraordinary evidence. And, is there actually a causative aspect to the claim? Correlation is not necessarily causation.
If you read all of the previous sections and are still here, then you likely have taken the red pill. Let's see how the world of pseudoscience in medicine looks through the lens of critical thinking. We'll begin with the low-hanging fruit, Homeopathy.
John Byrne MD
These items exemplify entire systems of care based on pseudoscientific premises. Click the links to read more.