Steven Novella – Exposing Medical Nonsense

November 26, 2012

One of the first people I ever got to know in skepticism was Steven Novella.

He was a professor at Yale, just starting out as an organized skeptic—I was a student, just getting fired up about the same stuff.

Since then, Steve has become hugely successful as a skeptic leader and as a communicator of skeptical ideas, particularly when it comes to his area of specialty, alternative medicine.

And one thing I’ve always noticed about him over the years is his unending capacity to consider what really works to promote skepticism and critical thinking, and what doesn’t—and to adjust accordingly.

So I asked Steve on the show to discuss this process, and to talk about grappling with one of the toughest issues in skepticism and the issue that is his personal specialty—dealing with false claims about medical cures, or what is sometimes called complementary and alternative medicine (CAM).

Steven Novella is a neurologist at the Yale University School of Medicine. He’s also the host of the podcast Skeptics’ Guide to the Universe, and the president and co-founder of the New England Skeptics’ Society. He writes the blog Neurologica, and contributes to a number of other blogs including Science-Based Medicine.

Links Mentioned in this Episode

This is point of inquiry for Monday, November 26, 2012. 

Welcome to Point of inquiry. I’m Chris Mooney point of inquiry is the radio show and podcast of the Center for Inquiry, a think tank advancing reason, science and secular values in public affairs. And at the grassroots. So one of the first people I ever got to know in skepticism was Steve Novella. He was a professor at Yale at the time, just starting out as an organized skeptic. And I was a student just getting fired up about the same stuff since then. Wow. Steve has become hugely successful as a skeptic leader and as a communicator of skeptical ideas, particularly when it comes to his area of specialty alternative medicine. And one thing I’ve always noticed about him over the years, and I think a key to this is his unending capacity to consider what really works when it comes to promoting critical thinking and to consider what doesn’t work and then to adjust accordingly. So I asked Steve to come on the show and talk about this process and also to talk about how he’s grappled with one of the toughest issues and skepticism and the one that is his personal specialty, dealing with false claims about medical cures or the whole field of complementary and alternative medicine, as it is sometimes called. Steven Novella is a neurologist at the Yale University School of Medicine. He’s also the host of the popular podcast Skeptics Guide to the Universe and the president and co-founder of the New England Skeptic Society. He writes the blog Neurological, and he contributes to a number of other blogs, including science based medicine. Steven Novella welcomed the point of inquiry. 

It’s great to be here, Chris. Thanks for having me. 

It is great to have you on. 

You know, of all the people in skepticism that I feel like I’ve known for a long time, I might have known you the long as it’s hard to remember. But I think we we met in 1998. I was like a pimply undergraduate at Yale, causing lots of havoc by. 

I do. I was the end of the end of the 1990s. That was pretty early in my days as well. As far as activists skepticism goes. You’re running the new on skeptical society. You just try. Right. Yeah. Ninety six. So is. Yeah. Just a couple of years. And you were sort of my hookup in terms of dealing with groups, you know, a skeptical group at Yale. And yet you were a very ambitious young skeptic as far as I remember. 

Yeah, well, I remember that we actually broke mirrors and walked under ladders in the middle of cross campus. You know, everybody walks through on Friday the 13th. And God, largely negative media coverage. Yeah. 

Yeah, oh, yeah, the superstition bash is something fun to do with the time. Not sure how effective it was, but yeah, we we we were experimenting at that time. 


So another thing I remember that I just think is funny is that we actually had Joe Nicole out to speak at Yale, but then he also spoke for the English Skeptical Society. And there was an event, I think it was probably in like I don’t know where it was, Connecticut, maybe where Paul Krugman spoke and then Joe Nichols spoke, who was was quite a combination that you had there. They’re both Democrats, I don’t know else. They have a comment. Yeah, we had we had Paul Krugman speak for president. 

You know, if this is before he won the Nobel Prize, before he was famous, we were just looking for interesting speakers to come speak for our little local group. You know, we got like 40 people there, which is a big deal for us. Joe Nickell was a bigger name within skeptical circles at the time. I remember you hosted Joe for like a tea at Yale. Yes, we had. 

Yeah. Right. Yeah. Like a master’s tea or something. And you were sort of in charge of all the details. I remember, you know, giving you a hard time about the logistics of things. He’s been very particular about things. 

So here’s a question. Why are there so many skeptical novellas? I mean, is it in your genes? Are you guys like a dynasty, like the Mannings in football or the bushes? I don’t think. 

Yeah, I don’t know. I don’t think it’s genetic. I mean, there you know, Bob and Jay worked with me on the Skeptics Guide, and we all got into this together. We have two other siblings. We have a sister that we speak about every now and then who’s actually a born again Christian. Probably know one of the most on skeptical people that I personally know. And another brother who is also very interested in science. 

But you never got into really the thing of the critical thinking, skeptical thing, the way that Bob and J. And I did. So, you know, it’s partly our influence on each other, partly a mutual interest in all things scientific. I think that that got us where we are today. 

So what do you think has changed since we were causing havoc or I was causing I whatever, you know, 15 years ago about how we now go about trying to make the world a little bit more rational? 

I think almost everything has changed. Most mostly in a good way. I mean, the big thing is the Internet, you know. Yeah, definitely. That’s that’s the big thing. I mean, you know, when do you go back in the day when you’re you’re just running the local groups? It was it was really the Internet existed, but it the worldwide web really hadn’t taken hold yet. And I was printing a newsletter and physically mailing it and, you know, holding meetings with people, you know, would which physically show up in a room. 

And, you know, it would eventually like reposting our articles on a very basic Web site, sort of as an afterthought started to come into play. But it was really hard, you know, to be a skeptical activist part time. You know, we all you were in school at that time. The rest of us had day jobs, you know, full time jobs and and then still trying to do this on the side. It was very, very difficult when once, you know, Web 2.0 had part, you know, podcasting, blogs, social media, suddenly instead of sending a newsletter out to 200 people, I was talking to two thousand people. And now, you know, we’re over a hundred thousand people. It’s completely different. I, I, I have ten twenty thousand people reading my blog every day. Just the order of orders of magnitude more reach. And it enables us, I think, to have a very disproportionate effect on the public conversation, whereas before it really felt like we were laboring away in our little tiny isolated circles. So I think it’s really transformed what we do. 

So you sound actually thrilled about, you know, how technology’s empowered your skeptical message. And I agree your platform is is huge. You know, we admire it. 

I mean, it also, of course, empowers everything else, including nonsense. 

Yeah, it’s all your top, really a double edged sword, but it is a forum for the exchange of information and ideas. 

And I do think that we have a very powerful message. That’s our territory in a way. I mean, where we are trading in ideas and we spend a lot of time being very thoughtful in mastering information as much as possible, shaping our message. And so I think that, again, for a very small movement in terms of the number of people who are actually involved, I think we have a huge impact on the conversation. 

Now, it’s also the Internet, you know, then social media, everything is a very fruitful venue for savvy marketing. And I think that all kinds of nonsense has exploited that as well. But it still remains to be seen. I think what the. Effect is on the culture. I’m still hoping that it’s going to be a net positive and I think there are some signs that that may be the case. 

I remember, you know, we were talking is like 2005. I saw you again. Yeah. Read my first book. 

And you said you were throwing out a lot of your old approach for trying to get people to listen to science. You felt that you weren’t convincing people. Do you remember that? 

Yeah. I mean, just. Yeah, we have over the years, we’ve sort of had this hand wringing. What are we doing or are we are we making any progress? 

You know, over the last 10 years, I think the one area in that I’ve been most involved with that I think we’ve had the hardest time with is alternative medicine. And that probably is coloring my views as well. 

And, you know, I think it’s always good to step back and ask the big meta question, you know, what are we doing? How are we going about it? Is it working? Should we change strategy? So I don’t know that. 2005 was right at that transition point. That was. That was the year we started the podcast. So at, you know, beat the last eight years, I don’t know that I accomplished that much personally. 

I did. But I don’t know if I did accomplish that much in terms of changing the world. The next seven years would be very, very different. So I think I was good. It’s good to step back and ask you, is this how we should go about doing things or do we need to be doing something different? 

Well, you mentioned alternative medicine, that’s obviously the area where you play your special kind of whack a mole with all the wrong things people are saying. And you said that this is uniquely hard. What do you mean by that? 

Well, I don’t know that it’s uniquely difficult, but I think that if you look at all the battlegrounds that skeptics are facing, I think that that’s been our toughest fight. Sometimes it feels like we’re losing. And I think by some metrics, we are. But I think it’s because our foe is is ahead of the curve. You know, they are just extremely savvy, you know, looking back at it. I think they were years ahead of us in terms of understanding, of framing the message, really setting a tone that’s advantageous to them, controlling the brand and the labeling. You know, they came out with the term alternative medicine and complementary medicine, then integrative medicine and holistic and natural. They really plugged into a lot of very culturally favorable ideas. And they’ve marketed themselves in a very savvy way. And they’ve also they understood the battleground a lot better than we did initially and that they knew that they had to fight in state legislatures, not just that, not just public opinion, but with medical schools and and universities. And they they just they just knew we we’ve been playing catch up for the last 10 years, to be honest with you. They once they do something, oh, crap, now they’re doing this. Now we have to come up with a response to this and we have to figure out a way to deal with that. But we didn’t really anticipate that they were going to do that like that. They were going to successfully infiltrate the institute, you know, or the the Library of Medicine and get peer reviewed journals dedicated to promoting alternative medicine. And then we would have to fight them on that route. And they were also successful in making themselves the gatekeepers of anything alternative. So that when we tried to get a peer reviewed journal critical of alternative medicine, they were able to block us. They totally checkmated us on that. They were already had infiltrated to the point where they were able to shut us out. And that’s when I essentially gave up trying to get a peer reviewed journal. 

I just went online with science based medicine, which I think, again, changed strategy because what we were doing wasn’t working. But that was also an example of where they were just ahead of us. And, you know, again, we’re still playing catch up, but I think we’ve wrapped our head around their marketing strategy, how they’re manipulating the system in every way, where we’re sort of cutting them off every way that we can. But they’ve so much damage has been done. They’ve infiltrated so much that it’s going to be a generation, I think, before we could turn things around. 

You say, you know, they’ve infiltrated in their strategy and so forth. 

I mean, do you really think that people who promote alternative, complementary, whatever you call it, medicine and a lot of it’s scientifically questionable or maybe all of it, is it some kind of really strategic movement or is it. I mean, it’s sort of they have this great advantage because the stuff really feels nice and warm to people. I mean, isn’t it as much that as any conscious strategy? 

I think it’s both. I think it’s a lot of things that they have a few advantages. One is that they’re not really tied to medical ethics the way we understand it or to science the way we understand it. They can craft their message to be maximally warm and fuzzy, as you say, to be maximal for marketing purposes. 

Also, there’s a lot of money to be made. They make a ton of money. The big, you know, pro alternative Web sites are making millions of dollars selling supplements and all kinds of stuff there. Foes are making nothing. Ask the skeptics, you know, this costs us money to put out science based medicine while they’re making money hands over and over fist. So they’re extremely well-funded. And a lot of the proponents like, you know, the big name proponents, Deepak Chopra, Andrew Weil. Now, Dr. Oz, they’re making a lot of money being proponents of alternative medicine. I don’t know anybody who’s making a dime being critical of it. That’s a massive advantage on their part. And believe me, they know how to. They know how to use it. 

You were on with Dr. Oz, is that right? What was I like? 

Yeah, it was interesting experience. I got the call like a Wednesday or Tuesday asking if I could come into New York to be on the doctor our show on a Friday. 

I dealt entirely with a, you know, some junior level producer, and it seemed like they really wanted to engage me with my criticism zero our criticisms of of Dr. Oz and alternative medicine. But we were immediately very suspicious. You know, obviously got invited, you know, onto a show with somebody that I have been publicly critical of. You have to wonder what the game is. And so we almost you know, to me when I say we have to go, I was talking with my science based medicine colleagues and we talk strategically about whether or not this would be a, you know, a net good or bad idea to go on that show, because, you know, I would be putting myself in their hands and they would have the control of the editing room. You know, I could make it sound like anything they want to. But we you know, we decided that would be worth the risk. And I think in retrospect, it was. So I you know, once I got to the studio and in the whole day, the only time I interacted with Dr. Oz was onstage in front of the camera. He did not come back and see me in the green room. I did not talk to him afterwards. 

I mean, it’s on a lot of shows that happens. 

Well, yeah, I thought it would be a courtesy that I might have a chance to chat with him for 30 seconds. I know you guys busy putting on a show, but I was a little taken aback by the fact that my interaction with him was I was just onstage. But that aside, the you know, I thought the whole show is framed in a very biased way. But I thought I you know, I was able to hold my own because I was as prepared as I could be for anything you could throw at me. 

I think in the end, he wanted a represent representative of science based medicine to sit there so he could lecture at them was what it turned out to be. But I think that that ultimately hurt him. I think, you know, he presents himself as a very likable, positive guy. 

And I think he shot himself in the foot a little bit on that show by being a little lecturing and negative. And I was you know, my job was just to buck the stereotype and just to be a friendly, rational, reasonable, moderate person who was just defending science and in some kind of standard and not be goaded into saying anything extreme or critical or negative. So I. I think I accomplished that. 

Sounds like you were you were smart about this. 

Well, yeah, because I thought it thought it through very carefully, you know, where you have to be very strategic about things like this. I think this is the end result of, you know, 10 years of taking our lumps and and really thinking very deeply about what it means to be an activist skeptic’s to promote critical thinking and skepticism in all different kinds of media. It’s not easy, but, you know. But I do think that, you know, we have our successes when when we take a good approach. 

What I mean, to be honest, I was listening to this. I wish, you know, when it when you told me in 2005 that you were just changing your approach because it wasn’t working, I was like, wow, that’s good. Like, people don’t do that enough. 

And I mean, I’m hearing it again now. I think that a lot of people, even in the world of promoting reason, are not actually that prone to, like, give up on things that don’t work. I mean, a lot of people still want to argue factually, and we know that that basically doesn’t work. 

Yeah, it’s it’s hard and. You know, again, we I think there’s a lot of angst in the skeptical movement about that very question, partly because so many different personalities have radically different approaches. There are those who are very militant. And if they think that ridicule is a is a very effective strategy and I can’t argue with that, I don’t know that we can say that there isn’t a place for entertaining ridicule. I do think there is something to be said for the notion that the ridiculous needs to be ridiculed and any other response gives it respect it doesn’t deserve and elevates it in the eyes of the public. And there’s evidence to support that. But there’s also, I think, a place for very scholarly, respectful, thoughtful approach to nonsense, to pseudoscience, the things that we are critical of. And I think there’s room for for being more entertaining and everything in between. 

So my approach has always been, well, it’s it’s great that we have lots of different people with different personalities, different backgrounds, trying lots of different approaches. Let’s just keep our eyes open and pay attention and see how it all goes down. But I do try to to to to warn against, though, when people get into conversations, you hear a lot of people saying, a lot of skeptics saying this is the way that we should be doing this, that you don’t know, that nobody knows what the way is. Show me the evidence that this is the way that this way is more effective than anything else that anyone else is doing. And then I’ll have a conversation with you about it. In the meantime, just let people do what they’re comfortable with and let’s just see how it turns out. 

That’s gather, you know, some experience and information about that. And then, you know, craft our approach accordingly. But, you know, I try to, you know, not get preachy about the way I say I don’t try to tell other people how they should be doing it. I’m just trying to, you know, control how I’m I’m going about doing it and seeing how it how it works and changing if I think I need to change. 

Do you think it’s productive or worthwhile to call people cranks and quacks and words that you see a lot? I mean, what’s the use? It’s problematic. 

It’s a kind of a double edged sword. So I think that there are some people who are so far out in left field that I think you have to make it perfectly clear that when you’re discussing them, that you are not talking about a fellow scientist who just has a different idea. 

You’re talking about somebody who is maybe a con artist, maybe they are, you know, are a charlatan and that that’s a fair and reasonable description of that person. Or, you know, it also depends on who you’re talking to him, what the venue is. Although with the Internet, you always have to assume, I think, that you’re talking to the whole world. But, you know, and if you if you don’t do that, the worry is that they will use just the very fact that you’re criticizing their their claims to make it seem as if they’re part of the legitimate academic scientific discussion that. Yeah, you have your views. I have my views. It’s all good, you know. And so they really they are very savvy about using just the fact that you’re criticizing them as a way of seeming legitimate. 

Of course, if you if you do say this person, you know, in my opinion, is a complete crank, who doesn’t know the first thing about even basic science to meet you accurately describe a rank pseudo scientist. 

They’ll they’ll do their best to use that, say, well, you’re biased. You obviously have an ax to grind. So, you know, it’s it’s kind of a lose lose when you’re dealing with somebody who’s that far out in left field. And of course, if you ignore them, they’ll use that as tacit agreement. You know, no one’s criticizing me. That’s because I’m legitimate. So I haven’t seen an approach that doesn’t have a downside. And I think you have to just be very careful about individualizing your approach to the person that you’re talking with. So, for example, if I think a crank is obscure, I will ignore them. I’m not I would not. I would even if I think I have something to say about it and they’re totally wrong, I’m not going to give them the attention of even criticizing them. 

I think letting them wallow in their own anonymity is the best approach. If somebody like Dr. Oz or Deepak Chopra or, you know, some of those people already have an audience bigger than what I can give them. And they’re making claims that are incorrect or are they’re making bad arguments that that needs to be corrected in no uncertain terms. 

If it’s somebody who, you know, generally presents themselves in a respectful way but is just making bad arguments, I you know, by default is to always focus on the logic, the facts and the arguments. 

It’s really the people who I think are are real con artists that I feel like I really need to try to take them down, not just their arguments. Them personally. But I I always think about that very carefully before I go that way. So I tend to try to approach things differently depending on the context. But it’s it’s risky. It’s very tricky. Some some skeptics have been sued by saying the wrong things about the wrong people. That’s it’s a risk that we take. 

So what about this has been a longstanding issue in just skepticism and alternative medicine. 

And I guess it would probably be an issue where you would say there was, you know, not success, which is the, you know, the NIH Office for Alternative Complementary Medicine, whatever that name is. Actually, you know, originally there was people saying there shouldn’t be any such office. Well, clearly it exists and it’s going to exist. 

And there’s a budget and there is research and it’s being funded. And and someone said some of the research is very good. So what is your stance on that? 

Yes, there’s the National Center for Complementary Alternative Medicine. And can now, you know, and I and my my colleagues have been very critical of its existence, you know, for as long as we’ve been writing about it, because it sets up a double standard where ideas in medicine that would not be otherwise funded for research are getting funded, not because they deserve to be funded and are being neglected, but because they don’t really deserve to be funded. 

And also some there’s a lot of a lot of projects and centers and studies that are being funded through and cam that are really just promotional. They’re not efficacy trials. They’re not asking the question, does this really work? They’re more being done as a way of promoting alternative medicine. So that’s been a major criticism of ours. We believe that they have funded or participated in studies that are unethical because they’re studying medical interventions that have already been demonstrated not to work. The recent Colation therapy trial, for example, we’ve been very critical of that. We also point out the fact that. Billions of dollars and more than a decade later, the cam hasn’t really accomplished anything. They haven’t shown that a complementary medicine method that was being neglected actually works, deserved to be research. And and they have brought it into the mainstream by doing good science. That was sort of what they said they were going to do. Hasn’t happened. That’s because the things that they’re that they’re studying don’t work. That’s why they’re alternative. You know, if they were plausible and likely to work, they wouldn’t be it wouldn’t be considered alternative. 

But they successfully put the kibosh on some things by doing that. Right. I mean, first. 

So they know thought that the last justification is that the negative studies have then had a negative impact on the marketing of a particular alternative modality. 

But I haven’t really seen that either, you know? No, I don’t think any number of negative studies about acupuncture are going to cause acupuncturist to understand that it doesn’t work or homoeopathy or chiropractic or energy, medicine or anything. 

The people who promote these ideas are not basing their ideas on science. So why would they care if there’s science showing that it doesn’t work? What they do is they just criticize the science or change the rules of science, turn it on top of its head. They don’t listen to objectively to the science. The only area where I think you can argue that the NCAA has done some solid studies that have produced useful information is in the area of herbs like ECan, Asia and ginkgo biloba, etc. And if you talk to or listen to Josephine Briggs, who’s now the director of the encamp, that’s sort of her big defensive of the camps. I got look, we’ve done these great big studies and the marketing of ECan Asia has significantly decreased after we published our negative studies showing it doesn’t work for the common cold. Okay, sure. But I have a couple of things to say about that. One is that you don’t need the encamp to fund studies of ERPs. 

There already is, you know, places within the NIH for the study of plant based pharmaceuticals. It’s not it seats, actually. Why would that need to be done under an alternative medicine center? It doesn’t even make sense. 

And further, the if you look at the supplement industry, the herbal industry as a whole, it’s been relentlessly increasing since it was deregulated in 1994. The end cam has not negatively impacted that industry. Maybe it’s having a little bit of an effect on which drug, which Erb’s are more popular in Asia. Ginkgo biloba, these are still multi-million dollar markets. They may maybe they’ve taken a little bit of a temporary hit from the from the end can, you know, publishing a negative study. But it really hasn’t affected the big picture very much. 

You know, we would argue that investing billions of dollars of taxpayer money into research should be tied to regulation, that if you’re going to spend money studying these modalities, they should be regulated in an appropriate way and to to spend the money on the research when without the regulation or, you know, for for treatments that are used by professions that are not science based. Is a supreme waste of money because you don’t accomplish anything. And I would argue that since the end came has existed, it’s accomplished exactly nothing except increasing that the baseline respectability of alternative medicine, because if it weren’t respectable, why would the government be funding a center to study it? 

Yeah, I guess I only thing that I, I mean that you make a very strong case. 

The only thing that I just don’t completely follow is I mean, I’m not sure how much science can perform based on the standard of not only, you know, being good or bad science, but also having the world change because you did the science. I mean, you know, global warming scientists had gotten their research to lead the regulation. I mean, that would be amazing. 

But, yeah, I saw it all in areas where it’s there’s idea there’s ideology trumping science. That’s where you have a problem. Right. So, you know, global warming is a good, good example, although, I mean, I would argue it with with global warming, having really solid evidence is extremely helpful. But, you know, if if you’d look at, for example, an acupuncturist using acupuncture to treat a specific indication, no number of negative studies are going to keep them from doing that. It literally is a complete waste. It’s it’s a win win for them. If it’s positive, it’s evidence that it works. If it’s negative. You did it wrong. The science is wrong. 

There’s there’s never a situation where they go, oh, look at that. This treatment is not effective. Let’s stop doing it. You know, it’s never happens. I owe you my perpetual challenges, I defy people to tell me, give me a hard core alternative medicine modality where fairly definitive evidence for lack of efficacy caused its proponents to stop using it. I have yet to see that happen. 

Now, the very idea of that happening is sort of absurd. Right. Because it’s because it’s because our ideas of science and what science should accomplish are a little old fashioned and hopeful. 

Right. Right now, you know, again, mainstream medicine has a problem with that as well. I’m not going to make any of false equivalency argument here. It’s completely different level, you know, orders of magnitude we’re talking about. But, you know, UKCS you were talking about. Well, yeah. Wouldn’t it be great if everybody just instantly listened to the evidence? So there you have sometimes physicians drag their heels too, and may not change their practice as quickly as they should. In response to the evidence. But the culture is completely different. There is a culture of evidence based practice and eventually the evidence does win out. And and the practice of science based medicine does change over time, especially at the academic, you know, level where the real thought leaders are that are setting the standard of care. They may take a little bit longer than I would like for it to trickle down to the average practitioner out in the field. And that’s something that is studied to see, like how how are people practicing in relation to the standard of care. So that’s something that we can be better at, better still. But at least we have a culture of science based practice, whereas there are other professions like homoeopathy, for example, that is completely and utterly divorced from anything even remotely scientific. 

Oh, I got one more sort of science question that I’ve just wanted to ask you, which is, of course, mixed up in all this is the placebo effect, right. You know, in other words, you know you know, people are feeling that something’s happening to them. 

And maybe, you know, that feeling itself is involved in actually helping them. And this are seeing the signs of that is going to be critical to understanding alternative medicine. And it’s appeals to. So where do things stand on that? 

That’s a terrifically complicated question. I mean, you know, there’s you know, that’s OK. You know, this is this is the question now that I always get, because now that, you know, 10 years later and billions of dollars of research later, science is not showing how wonderfully effective all these alternative modalities are. 

It’s showing that there are no more effective than placebo. 

Now, the proponents are changing their tune. They’re saying that’s OK because placebo is effective medicine. I’m going to just changing the rules. You don’t get the I don’t get the answer they like. That’s fine. They roll with it. They change the rules. Placebo medicine, it’s all good. So that has forced us again in reaction to that strategy on their part to try to explain very carefully about what we mean by placebo effects and the placebo effect. It’s it’s a problem of definition and of really understanding what’s going on. So I think that they’re exploiting the delay, you know, somewhat naive, colloquial, if you will, interpretation of the placebo effect as a mind over matter. But real physiological effect to the belief that someone is being treated. But that’s actually a very tiny and sometimes even nonexistent component of placebo effects that we see in the context of a clinical trial. The placebo effect has a very specific definition, whatever effect there is in a placebo arm of a clinical trial, when you give subjects and a physiologically inactive treatment, whatever a measured benefit or outcome they have compared to no treatment at all. We consider that placebo. The placebo response. And then we compare that to the active intervention, which is, you know, in order to say that it works, should display effects above and beyond placebo that they’re at the point of the placebo is to represent everything other than the physiological response to an active intervention that includes a lot of things. That includes observer bias reporting bias. You know, the fact that the patient wants to get better. They want to justify the expense of. And the trouble of going through the intervention. Nonspecific effects like just the therapeutic interaction, the hope of being given, being given a possible treatment, regression to the mean statistical illusory effects that aren’t even real. Just, you know, some you take a treatment when your symptoms are at their worst. By definition, they’re going to get better afterwards. So all of these things combine to be what is measured as placebo effects. Most of these are not useful things. They’re just bias and illusion. When you start to tease apart what’s in there, what how much is a real physiological effect versus just subjective reporting? Turns out that there really isn’t much, if any, real physiological response that’s happening due to placebo effects. It’s all just transient and fairly minor responses to subjective reporting of symptoms. Not that useful when you really think about it. Certainly not enough to justify a purely placebo intervention. I also would say that, you know, it’s important to recognize that if there is anything useful in this complicated, you know, collection of effects we call the placebo effect. Any non specific therapeutic effects that are that are useful, you can get them from real treatments, too. You don’t have to give a fake magical treatment in order to get the nonspecific benefits of a positive therapeutic interaction. So it’s still at the end of the day, is not a justification for using nonsense as medicine. 

And it also kind of explains why it’s so important to actually have scientific medicine to to try to control for and untangle all these things, because otherwise it’s so complicated. You’re just going to be completely lost. 

Absolutely. I mean, if if if our goal is to know what really works, what doesn’t work, what’s safe and what isn’t safe, we need really rigorous science to tell us because otherwise are our observations will be overwhelmed by biased confirmation bias and placebo effects. And we really will have no way of navigating through all of that. And we’ll be led to conclusions which are bizarre, which are maybe appealing, but are not true. 

We will it will not be able to figure out what works and what doesn’t work, and we’ll make no progress at all, which basically characterizes the vast majority of human history up until the last hundred years when we started to systematically apply scientific procedures to medical questions. 

Well, see, this has been a really fascinating conversation. 

And, you know, again, thank you for for being, you know, such a good critical thinker on this, but also sort of really willing to try to figure out what works in terms of convincing people. And so I just want to end with one question. I mean, at this point, given all that you’ve learned, what do you think the message is of science based medicine? That can actually I mean, if you think you’ve found it, that can actually make some headway against the really difficult forces that you’re up against? 

Yeah, I think that the other message that we’ve been trying to stick to and again, this is something that we have, you know, evolved over a long time to seeing what works and what doesn’t work is to try to keep positives. We don’t exist to be a.. Something to be A.I. alternative medicine. We simply say we want to use the medicine that’s safe and effective. You know, what works is better than what doesn’t work. The only way we could really know about that is through rigorous scientific examination, you know, objective evaluation, critical thinking. And we just want one fair science based standard to be applied to medicine. I find that people are almost universally open to that, that framing of the issue. You know, except those that are like really spiritually, ideologically dedicated who like don’t even like the idea of science itself. But that’s that’s that’s the minority of people. Most people like you, of course. Of course. You want to use treatments that work. Of course we want to base it on evidence and solid science. Of course we do. That seems to be something that’s a good that’s a good common ground to start with you to get people to that point, then it’s a matter that the hard part is teaching them what good science is, which is really complicated when it comes to something like medicine. 

I’m with you. I think that is brilliant in the words fair and a good standard for all. Yeah. One little anniversary is going to be is going to be fruitful. Know there is I think that’s very effective. And so I just want to I want to thank you for all this and all the great work that you are doing on behalf of reason. 

Oh, thank you, Chris. Thank you. Thanks for everything you do as well. It’s been fun to follow your career since you’re, as you say, the pimply faced undergrad back at. 

Thank you for listening to this episode of Point of Inquiry. Join the discussion about today’s show. You can visit us at point of inquiry dot org. You can also send questions and comments to feedback at point of inquiry dot org. You can find us on Twitter at point of inquiry and on Facebook at slash point of inquiry. 

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One of is produced by atomizing and amrs New York, and our music is composed by Emmy Award winning Michael Waylan. These intro featured Debbie Goddard. I’m your host Chris Mooney. 

Chris Mooney