What's the Difference between Science and Pseudoscience? Part 2

By Michael Edmonds 10/07/2013 26


In a previous blog I suggested that one difference between science and pseudoscience is that pseudoscience can’t move on when evidence comes along which disproves its’ ideas: science does.

Another difference is that science attempts to, and is usually successful, in working out the underlying mechanism to explain the evidence.

Take for example the field of medicine. Early explanations of disease tended to blame it on vengeful gods, evil spirits or on “bad air”. When various herbal or mineral medicines were found to have some beneficial effects, the treatments were thought to work by either pleasing the gods or repelling the evil spirits or bad air, and were often administered with incantations.

As time progressed, observations seemed to suggest that many diseases resulted from disruptions within the body itself. Using the limited knowledge of the time disease was viewed by the Greeks as an imbalance of the four humours (phlegm, blood, yellow bile and black bile), while in Ayurvedic medicine it was viewed as an imbalance of three elemental substances. Treatments therefore sought to rebalance these humours/elements in various ways, some more harmful than others (e.g. bloodletting to remove “excess” blood).

Incredibly the idea of humours prevailed through to the 19th century, and was only disposed off when scientific discovery revealed the real causes of disease.

In 1747, Scottish Naval surgeon, James Lind carried out the first recorded clinical study to discover that the disease scurvy was a deficiency disease which could be treated by consumption of citrus fruit.

The work of Ignaz Semmelweiss, Oliver Wendell Holmes and Louis Pasteur demonstrated that many diseases were caused by microbes which could be killed through the use of antiseptics such as carbolic acid, while Paul Ehrlich develop stains which allowed some of these microbes to be studied under the microscope. By the end of the 19th century many disease causing microbes had been discovered.

The determination of the structure of DNA in 1953 by Watson and Crick opened the door to a better understanding of genetic based diseases, including various cancers, while the development of fields such as biochemistry and molecular biology has revealed the biochemical pathways which can be targeted for treating various diseases caused by errant genetic instructions or by microbes.

The development of techniques which can monitor the environment around us has also revealed how environmental contamination can cause some diseases. Minamata disease, for example, results from high levels of mercury poisoning.

As we move into the 21st century we now understand that diseases can be caused by microbes, genetic malfunctions, environmental contaminants and sometime by deficiencies in various essential substances. An understanding of the biochemistry/ molecular genetics of the diseases also helps us develop targeted approaches to treatment, particularly in the design of new drugs.

If we compare this to various pseudoscientific therapies, their mechanisms have been disproven (Ayurvedic medicine), are contrary to scientific understanding (homeopathy, astrology based herbalism) or both (reikki, faith healing). Other pseudoscientific beliefs can also arise from ignoring the evidence and claiming one cause while ignoring those supported by the evidence (e.g. suggesting that HIV can be treated by vitamins rather than with antiretroviral drugs).

Medical treatments which are supported by evidence and a clear understanding of the underlying biological mechanisms not only provide a better understanding of the disease, they also provide clues to appropriate cures, a claim that cannot be made by pseudoscientific treatments such as homeopathy, reikki, faith healing and Ayurvedic “medicine”.

 

 

 


26 Responses to “What's the Difference between Science and Pseudoscience? Part 2”

  • Michael, these are bold all-embracing claims.

    What do you make of this?

    J Clin Rheumatol. 2011 Jun;17(4):185-92. doi: 10.1097/RHU.0b013e31821c0310.
    Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis.
    Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, Sekar PG, Raveendran KG, Mahapatra A, Gopinath J, Kumar PR.
    Source

    Geffen School of Medicine, University of California Los Angeles, CA, USA. defurst@mednet.ucla.edu
    Erratum in

    J Clin Rheumatol. 2011 Oct;27(7):407.

    Abstract
    OBJECTIVE:

    To compare classic Ayurveda, methotrexate (MTX), and their combination in a double-blind, randomized, double-dummy, pilot trial in rheumatoid arthritis (RA) for 36 weeks.
    METHODS:

    Forty-three seropositive RA patients by American College of Rheumatology (ACR) criteria with disease duration of less than 7 years were assigned to the following treatment groups: MTX plus Ayurvedic placebo (n = 14), Ayurveda plus MTX placebo (n = 12), or Ayurveda plus MTX (n = 17). Outcomes included the Disease Activity Score (DAS28-CRP), ACR20/50/70, and Health Assessment Questionnaire–Disability Index. All measures were obtained every 12 weeks for 36 weeks. Analyses included descriptive statistics, analysis of variance, χ², or Student t test. The unique features of this study included the development of placebos for each Ayurvedic pharmacological dosage form and individualization of Ayurvedic therapy.
    RESULTS:

    All groups were comparable at baseline in demographics and disease characteristics. There were no statistically significant differences among the 3 groups on the efficacy measures. ACR20 results were MTX 86%, Ayurveda 100%, and combination 82%, and DAS28-CRP response were MTX -2.4, Ayurveda -1.7, and combination -2.4. Differences in adverse events among groups were also not statistically significant, although the MTX groups experienced more adverse event (MTX 174, Ayurveda 112, combination 176). No deaths occurred.
    CONCLUSIONS:

    In this first-ever, double-blind, randomized, placebo-controlled pilot study comparing Ayurveda, MTX, and their combination, all 3 treatments were approximately equivalent in efficacy, within the limits of a pilot study. Adverse events were numerically fewer in the Ayurveda-only group. This study demonstrates that double-blind, placebo-controlled, randomized studies are possible when testing individualized classic Ayurvedic versus allopathic treatment in ways acceptable to western standards and to Ayurvedic physicians. It also justifies the need for larger studies.

    • RonL,

      One paper on a small cohort of patients is interesting but hardly conclusive. It would be interesting to see a much larger study.

      It is a pity they don’t mention what the Ayurvedic treatment consisted of. It is quite possible that within Ayurvedic medicine there are some treatments containing active ingredients which may have a beneficial effect. However, this does not mean that Ayurvedic medicine as a whole is an effective treatment.

      Or do you think it makes sense to for a system of treatment to be based on the idea that our bodies balancing three elemental substances of wind, bile and phlegm?

    • Derek,
      Cold fusion was first discussed over 20 years ago. It is surprising that it hasn’t seemed to have developed very far. A working cold fusion system would be a major media story, and a major money earner

  • Michael, I’ve managed to get to the raw data in the MOH database at
    http://www.health.govt.nz/system/files/documents/pages/time-series-oral-health-data-1990-2011.xls

    There are several hidden pages and a macro that contains the primary hidden data.

    When you look at the number of missing teeth and decay in fluoridated/non-fluoridated children there is very little difference… certainly not the differences the public and councilors have been lead to believe… the last 5-6 years of data for the Waikato clearly shows that 5yo in non-fluoridated areas have healthier teeth… an interesting contradiction to what the Councilors were told by the DHB/MOH.

    Science and Pseudoscience?

    What would be interesting would be for a statistician to crunch the numbers and look at statistical significance… of course, any cause and effect is another issue.

  • Michael asks, “do you think it makes sense to for a system of treatment to be based on the idea that our bodies balancing three elemental substances of wind, bile and phlegm?”

    There is a lot about western medicine that doesn’t make sense. The fact is there are hundreds of millions of people whose cultural belief systems are quite different to ours. Who are wee to discount them simply because they may not make sense to us?

    We look back in history… many culture look forward in history… Looking forward makes more sense as we can see what’s ahead of us… we can see our history, therefore we look forward to it. We can’t see our future… so it’s behind us. Makes total sense… but you and I wouldn’t talk in those terms.

    • RonL,

      It’s not about culture, it is about what is supported by the evidence. Evidence based medicine relies on our understanding of anatomy, physiology and biochemistry. Ayurvedic bases it on wind, bile and phlegm – an approach which is not supported by the evidence

      “We look back in history… many culture look forward in history… Looking forward makes more sense as we can see what’s ahead of us… we can see our history, therefore we look forward to it. We can’t see our future… so it’s behind us. Makes total sense… but you and I wouldn’t talk in those terms.”

      That makes no sense.

  • Michael says, “Evidence based medicine relies on our understanding of anatomy, physiology and biochemistry.”

    No it doesn’t… it relies on evidence.

    There are hundreds of treatments that we have no or very little understanding of their relationship between anatomy, physiology and biochemistry… Even treatments that have been in use for a hundred years or so, such as aspirin, are still poorly understood.

    • RonL,

      “Even treatments that have been in use for a hundred years or so, such as aspirin, are still poorly understood.”

      That is a common myth. The majority of drug treatments at least are quite well understood in teams of their chemistry and biochemistry.

      “No it doesn’t… it relies on evidence.”

      And much of this evidence has been gathered using biochemical and other scientific techniques.

  • RonL: “Even treatments that have been in use for a hundred years or so, such as aspirin, are still poorly understood.”

    Michael E: “That is a common myth. The majority of drug treatments at least are quite well understood in teams of their chemistry and biochemistry.”

    You may be correct, Michael, but so am I. Your use of the word majority implies that a minority aren’t quite well understood which is what I said above.

    Evidence of efficacy is mostly based on disease progress, symptoms or various tests… that is called evidence. Some is self assessed, some is physician assessed, some is laboratory/other testing assessed.

    You said above that a study showing an Ayurvedic medicine working does not mean that Ayurvedic medicine as a whole is an effective treatment. That applies equally to western medicine… that’s why evidence-based medicine was developed, because it was known that a truck load of treatments did not/do not work. EBM is an attempt to sort the wheat from the chaff.

    For most symptom-based illnesses, eg, The Dreaded Flu, the patient determines whether a treatment is satisfactory or not, whether evidence-based or not. eg, you have ‘The Dreaded Flu’ and you go to the doctor and he gives you a prescription and you get better… most people would thank the doctor for helping them get better, regardless of the fact that they may well have gotten better anyways… the same applies to all forms of practitioner/treatment.

    Imagine anyone taking their car back to a mechanic to get the same defect ‘fixed’ time after time? Yet we do that with modern medical practice. Is going to an Ayurvedic practitioner any different? If we believe we are better then surely, in most cases, we are. Obviously if it’s a terminal disease we’ll find out soon enough that it doesn’t work… but isn’t that the same with so-called modern medicine?

    • RonL,

      I use the term “majority” because my training has taught me that there is always the exception to the rule. However, I cannot think of any effective treatment that has been in use for a hundred years or so, which is poorly understood. Perhaps you can give an example, as this is your claim not mine?
      With regards to your example, aspirin, is fairly well understood.

      I’m glad you used the term evidence based medicine, because this acknowledges that even in Western medicine there are treatments that have been accepted without good evidence to support them, so they need to be re-examined and discarded if the evidence does not support them.

      However, I don’t think this makes Western medicine comparable to other systems such as Ayurvedic which may include a tiny MINORITY of treatments which may work, and which may work in a completely different way to which Ayurvedic medicine claims they work. For example, if an Ayurvedic medicine contained a mixture of components including willow bark and it was claimed that this worked by rebalancing phlegm, rather than as an anti-pyretic, then a potentially useful treatment is concealed by an ignorance of science. Understanding how a treatment works allows it to be used more effectively, and also can lead to the discovery of other related treatments.
      Burying a potentially useful treatment under myth and magic is not helpful.
      Another example, if we could better harness the placebo effect without tying it to sugar pills and magic water, then more effective treatments might be revealed, as well as a clearer understanding of the limits of placebos.

      Imagine anyone taking their car back to a mechanic to get the same defect ‘fixed’ time after time? Yet we do that with modern medical practice.

      Again, I think this is a biased and unfair view of modern medical practice. My doctor does a pretty good job of sorting out my complaints/questions in a single visit.

      Yes there are some conditions that are difficult to diagnose, but then we haven’t solved every disease and medical condition. However, that doesn’t mean we should accept the claims of alternative medicine that they can solve such diseases, at least not without expecting them to provide reliable evidence to support their claims.

      And with regards to return visits, I hear that is fairly common with homeopaths and naturopaths.

  • Michael, it is generally recognised that approximately 50% of western medicines are used off label… ie, for purposes they have not been approved and lack a recognised scientific evidence base.

    Aspirin is a drug that has been used for over a century. Initially it was thought to be act at the central nervous level… then at the local level… when I started work in medical laboratories in 1970 it soon became apparent that what was thought to be the mode of action wasn’t… the dude who worked out it inhibited prostaglandins got a nobel prize in part for that work. Every few years breakthroughs occur in how aspirin works,,, it’s still not fully understood… you say it is “fairly well understood.” It may be that in a decade or two we look back and say in 2013 it was still poorly understood.

    Silver has a long history of use as an antibiotic… it’s mode of action was not understood so it got trumped by new synthetic antibiotics… now it is known to be effective, but is still poorly understood… even Nike incorporate silver into materials to kills bugs.

    Honey has been used in wound care for centuries… its mode of action has been poorly understood… that doesn’t make it less of a medicine… just closes science minded minds to its usefulness…. Manuka honey has a particular antibiotic ingredient… whilst the german’s discovered a an active ingredient a few years ago there is still a great deal to learn about Manuka’s unique antibacterial functions. What most people don’t realise is that manuka honey is no better at helping wounds heal, unless they are infected. Most honeys have significant antibiotic properties…. but manuka has an x factor!

    During WWII my father was in the medic core for nearly five years mostly in the North African desert… he used maggots to pack wounds while soldiers were transported to hospitals. Science is only now catching up with the evidence that maggots debride infected wounds… you don’t have to understand something to know that it works… just like you don’t have to stick your head in the dunny to know that it stinks.

    There are many herbs and spices in India that have been used for centuries for different conditions… some of these are no being found to be useful in treating diabetes, spices added to foods act as antibiotics and the like. The fact that science doesn’t understand these mechanisms doesn’t mean they don’t work.

    Not long ago science driven public health officials and doctors got brass and copper water reservoirs removed and replaced with stainless steel… with disastrous results… then they realised what Ayurveda practitioners had known for centuries and had tried to tell these ‘science-minded’ experts… copper and brass sterilised water reducing gastro-intestinal diseases.

    Pseudoscience is alive and well in western medical practice… and has been since its inception.

    • RonL,

      There are certainly valuable treatments that have been identified in various “alternative” treatments, the problem is they are in a minority, and tangled up in myth and misinformation.
      With regards to mechanism, I overlooked that there are degrees of understanding in terms of mechanism. While the precise mechanisms of some drugs are still being clarified, more general mechanisms are clear. For example silver, while exact mechanisms are still being sorted, the general principle that it works by killing bacteria is still far more helpful than if it was believed that it adjusted one of three “elements” in the body.
      Understanding mechanisms makes treatments more predictable and can lead to new treatments.

      If evidence based medicine works its way through “alternative” treatments, identifies valid treatments and discovers the real science behind it then that is a useful thing. This does not mean that the whole field is valid.
      Your points that science should not discard all “non-western” treatments out of hand is a fair one, and that western medicine still contains some less than scientific treatments are good ones. But medical scientists are working on improving this, which is one of the other important things about medical science – it continues to adapt and change to take on new, reliable evidence. I don’t see this happening with pseudoscientific areas.This makes sense because if your treatment is based on a flawed view of nature, progress is very hard.

  • By the way, Michael, Ken has censored this post on several occasions. He obviously doesn’t want the facts to get in the way of pseudo-science.

    I gather you just overlooked it in the clutter of my other posts.

    I’ve managed to get to the raw data in the MOH database at
    http://www.health.govt.nz/system/files/documents/pages/time-series-oral-health-data-1990-2011.xls

    There are several hidden pages and a macro that contains the primary hidden data.

    When you look at the number of missing teeth and decay in fluoridated/non-fluoridated children there is very little difference… certainly not the differences the public and councilors have been lead to believe… the last 5-6 years of data for the Waikato clearly shows that 5yo in non-fluoridated areas have healthier teeth… an interesting contradiction to what the Councilors were told by the DHB/MOH.

    Science and Pseudoscience?

    What would be interesting would be for a statistician to crunch the numbers and look at statistical significance… of course, any cause and effect is another issue.

  • Just as an observation, Ron, but I believe Ken has marked those posts as spam because you insist on linking to that data and cherry-picking the figures which you believe best fit your particular agenda.

    The fact that you’ve now moved on to spamming other peoples’ blogs with your particular anti-fluoridation obsession is rather depressing, really.

  • Michael, I wonder if you only read English literature. There is a plethora of scientific research being undertaken in non-western medicine. In 2000 I presented a paper on regulatory systems to an apitherapy conference in Vancouver’s convention centre. It blew me away when I realised there were several thousand scientists and industry folk in attendance. It was there I met Professor Peter Molan from Waikato University who heads their honey research facility. It was there I discovered the science behind the antibiotic properties of propolis… I’d had a chronic fungal toe infection that western medicines failed to heal for a decade. I tried a propolis ointment (Tui Bee Balm actually made in NZ) the toe was devoid of symptoms within three days. Placebo effect? I don’t think so as I’d been wanting the plethora of other things my Dr had tried to work… but they didn’t. I don’t think placebo kills fungi.

    There are plenty of evidence-based journals that publish so-called alternative therapy literature.

    He’s one such review article…
    http://www.hindawi.com/journals/ecam/2013/456859/

    Bee products, for example, are based on generic ingredients so there are no patent generated funds to get research into ivory tower journals.

    Just because it’s not published in ivory tower publications does not make it pseudoscience. There is plenty of pseudoscience published in medical journals… tamiflu would be one such candidate.

  • Chris B, the data on fluoride highlights an excellent example of pseudoscience.

    Have a look at it for yourself. For the last six years of Waikato data the teeth of 5 year olds in non fluoridated areas are healthier than in fluoridated areas. This totally contradicts the message that the DHB and MOH gave to the Council. Look at other areas as well… the differences between the haves and have nots in terms of fluoride are minimal…

    Please explain.

  • In my opinion, one of the more exciting aspects of medical science is where open minded scientists explore the interface between the known and unknown without throwing the baby out simply because it’s deemed ‘alternative’ or ‘pseudoscience.’

    An example of what could be called, “infusion medicine” is the use of honey to give new life to problematic products such as antibacterial resistance. Keep in mind that medihoney is a brand-name for a range of products using active manuka honey… medihoney used in this study is a branded active manuka honey… non-branded AMH had the same effect.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585195/

  • Ron,

    There is no explanation required, as valid conclusions from any data require prior understanding of precision and uncertainty. If you look at the underlying data, the variations over recent years are large, and following are quick visual estimates of Waikato.

    Fluoridated
    Other 1.4 – 2.0, Maori 3.3 – 3.9, Pacific Islanders 2.3 – 4.9

    Non-Fluoridated
    Other 1.5 – 2.2, Maori 3.5 – 4.7, Pacific Islanders 2.6 – 6.8.

    Obviously, the data also includes the numbers of individuals examined, which are used to calculate the significance and precision.

    Consequently, interpreting a summary spreadsheet, such as you offered, is virtually worthless unless the interpretation is accompanied by error bars derived from the source data. I’d also be very wary of some data – as the introduction of ethnicity seems to have also affected trends, suggesting that perhaps other factors were also introduced or modified at that time.

    The source data is freely available as Excel files from the MoH website ( it’s not hidden ), and when I was interested a year or so ago I found similar data ( with error bars ) in a report which also included some commentary and interpretation.

  • Ron, as I have pointed out to you far too many times, I have looked at the data and am perfectly satisfied that you are cherry-picking the points which conform to your bias, and that you have not even considered any kind of analysis to back up your various unsubstantiated assertions.

  • Thanks Bruce. Note how the trends over time wander considerably for all areas for both fluoridated and non-fluoridated teeth got worse for a decade or so and then better… this suggests something else is affecting data… when you drill [sic] down to the detail there are obviously big holes in the data… even data missing… this is the data that the MOH and DHB use to validate fluoridation…. how can F(illed teeth) equal DMF teeth… it’s impossible.

    One data point that I think is wrong is the way the dmft/DMFT is calcuated. It includes caries free individuals in the denominator,,, this means that whilst more kids over the past 5-6 years are caries free (in non-fluoridated areas more-so, if the dmft/DMFT remains constant the teeth of those with caries are actually worse.

    Another anomoly is the fact that fluoridation is allocated based on the water supply at the school… a five year old will have lived most of their life not drinking school water… What percentage of water intake do kids drink at school? Given drink bottles, etc. how many kids drink school water period?

    Other scibloggers have used this data to demonstrate that fluoridated water is beneficial. Ken Perrott analysis stopped when data about a decade ago started showing decay in kids in non-fluoridation was improving at a faster rate than kids teeth in fluoridated areas… but that is valid because he is cherry picking to make his case.

    The MOH put out annual reports for each region showing local data… it’s odd that those advocating fluoridation now scream out that the data is not valid when their use of it is found wanting.

    lol

  • Ron,

    Humans are diverse, and any medical dataset involving humans ( whether measuring raw data or as subjects ) will include the uncertainty. However, because of that, there is a field of science devoted to creating and interpreting such datasets.

    Epidemiology is the study of the patterns, causes, and effects of health and disease conditions in defined populations. I have no such expertise, so can’t comment on cherry-picking or otherwise.

    However, my personal perception after playing with the dataset is reinforced by freely-available published science articles, such as…
    http://www.healthysmiles.org.nz/assets/pdf/NZDJMarch04-Waterfluoridation.pdf

    Then comes my own experience. I was lucky enough to be brought up in Hastings, the first city to fluoridate their water supply. My parents lost all their teeth before 40, many of the adults had very bad teeth. My generation of the family have far superior teeth despite our continual uptake of sucrose and soft drinks unavailable to our parents. Our improved teeth may be attributed to several causes, but one obvious contributing factor is childhood fluoride uptake,

    Today, most toothpastes have fluoride, but still the bulk of the NZ data shows water fluoridation has benefit, which is consistent with overseas science. As alternative fluoride sources increased, so the quantity of fluoride added to water was decreased. My perception remains that potable water fluoridation is still beneficial and economic for many NZ towns and cities.

    During the 20th century, many enlightened councils introduced water treatment to improve citizen health, and it’s a real pity that current councillors are so amenable to vociferous lobbying, rather than accept advice from government experts. It’s the next generation who, in several decades, will show the folly of poor decisions.

    Chemophobia can cause people to make poor decisions simply because they have no experience of life before potable water treatment, which was one of the 20th Century’s greatest advances that is unfortunately still unavailable in many parts of the planet.

    I’m distinctly unimpressed by spurious claims about the quality and toxicity of the water treatment chemicals submitted to some councils by anti-fluoridation advocates, as there are quality standards ( ANSI/AWWA ) for water treatment chemicals, and most pure chemicals are toxic.

    Overall, you are entitled to your views, but mine differ.

  • Bruce, the Lee & Dennison study was one of convenience with the differences known before they undertook the study. These two areas were chosen simply because they used the same software to record data. If they had chosen different areas they could have got results that said the opposite.

    If they’d chosen 1993 data or 2003 they’d have go quite different results. Why did they choose a period eight years before publication? Because they knew the data would suit their message?

    Then again, if you look at the last 5 years, the data shows the teeth in the fluoridated Wellington regions are worse than those of the teeth from the non-fluoridated Canterbury.

    So, if Lee and Dennison showed fluoridated water produced healthier teeth in 1996, then for the last five years the evidence shows fluoridated water is making kids teeth worse.

  • Ron,

    If you want to denigrate researchers, that’s your choice, but I’d really like you to back up your unsubstantiated assertion about their motives for choosing the data. Tossing a question mark on the end doesn’t make your claims any less offensive. Provide the evidence.

    As noted earlier, Interpreting data from large medical datasets is outside my expertise, and you still seem to be selectively subsampling the dataset. Fine, keep having fun.

  • Bruce asked, “but I’d really like you to back up your unsubstantiated assertion about their motives for choosing the data.”

    It’s simple. Read the paper… These two areas were chosen simply because they used the same software to record data.