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Science Or Pseudoscience? an Athletic Trainer’S Guide to Healthy Skepticism

Science Or Pseudoscience? an Athletic Trainer’S Guide to Healthy Skepticism

Science or ? An Athletic Trainer’s Guide to Healthy

Jeremy Simington, MS, LAT, ATC King’s College Director, Athletic Training Program Chair, Department of Sports Medicine Fr. Frank J. O’Hara Distinguished Service Professor “Lack of comfort means we are on the threshold of new insights.”

Lawrence M. Krauss A Universe From Nothing1 A Brief History of Homeopathy2,3

. Samuel Hahnemann . Tiny doses of toxic substances can treat symptoms in sick people, revitalize “vital force” . The smaller the dose, the more powerful the effect (this is done by diluting the substance with water) . Even if tremendously diluted, the substance leaves its “essence” in the water and still causes an effect And now…

A Fun Demonstration or How I Make History at the EATA Annual Meeting Is Bonkers

. The Dilution Problem3,4

 Dilute 1 part substance with 10 parts water, repeat 6 times. That’s 1 part substance in 1,000,000 parts water. . If our parts are cubic centimeters, end product is 1 cc substance in 264 gallons of water. . What is “vital force”? How is it measured? . How does anything leave an “essence” in water? What does that even mean?

 Does sewage treatment somehow remove the essence from toilet water? If not, UH-OH! Homeopathy Is Dangerous

. Encourages lack of critical thinking about health & health care . Contaminants5 . Delays actual medical care . Replaces actual medical care with baloney . Vaccines3,6 . Malaria7 . Asthma3,8 . Cancer3,9 . Patients have died!10,11 Pseudoscience12

. “Non- posing as science” . Two criteria: 1. Not scientific 2. Major proponents try to create impression that it is scientific

 Magnets 

vertebral  Copper

subluxations 

 Craniosacral therapy …and too many more Enter the Skeptic!

. Skepticism: using reason to question and doubt claims or assertions until enough credible evidence exists to warrant accepting those claims and assertions

 Skepticism ≠ Denialism or Cynicism . It is the responsibility of the person making the claim to prove it. . It is NOT the job of the skeptic to disprove claims. You CANNOT prove a negative! Evidence-Based Medicine to the rescue? . Three-legged stool:13,14,15 1. Best available evidence 2. Clinician expertise 3. Patient values & circumstances . Works very well, but there are limitations and this is a big one: “The focus on trial results (which, in the EBM lexicon, is what is meant by ‘evidence’) has its utility, but fails to properly deal with medical modalities that lie outside the scientific , or for which the scientific plausibility ranges from very little to nonexistent.”16 Science-Based Medicine16

. Before clinical trials are performed, ask: Can this intervention work based on what we know of scientific principles?

 If the answer is, “No,” there is no point in wasting resources on studying it. . If it has already been studied and results have been published, ask the same question when appraising the results.

 If the answer is, “No,” you should not consider the results to be the best available evidence. “[Science-Based Medicine] does not necessarily equate to rejecting new ideas out-of-hand, but rather to adjusting the threshold of evidence required to establish a new claim based upon the prior scientific plausibility of the new claim. Failure to do so leads to conclusions and recommendations that are not reliable, and therefore medical practices that are not reliably safe and effective.”16 (emphasis mine) Levels of Evidence (adapted from Oxford Centre for Evidence-Based Medicine)17

Systematic Review of Highest quality Randomized Controlled Trials (RCTs) Individual RCT (of high quality) a. Cohort Study b. Individual RCT (of low quality)

Case-Control Study

Case Series

Expert Opinion Lowest quality The

. Goal: “identify principles that are both explanatory and predictive”2 . How to do it: Observe, form , test hypothesis, evaluate results, refine and retest hypothesis until you can explain and predict something with confidence2 . What is a “”? Depends on context.

 Everyday usage: a guess or hypothesis

 Science usage: “a comprehensive explanation of some aspect of that is supported by a vast body of evidence.”18 The Criteria of Adequacy2

. Testability: Can it be tested? Does it rely on untestable entities, forces, or phenomena? . Fruitfulness: Does it predict new phenomena and lead to new hypotheses? Have any of those hypotheses been proven true? . Scope: Does it explain and predict the most diverse phenomena? Does it answer more questions than it creates? . Simplicity: Does it make the fewest assumptions? Does it rely on mysterious entities, forces, or phenomena? . Conservatism: Does it fit in well with already- established scientific principles? THUNDERDOME! Homeopathy vs. The Criteria of Adequacy . Testability: we can test dilution level but how do we test if the “essence” is still there? How do we measure & test “vital force”? . Fruitfulness: has never led to further advances or applications in medical science . Scope: claims to heal anything, explains nothing (such as what “essence” or “vital force” mean), predicts nothing, & raises far more questions than it answers THUNDERDOME! Homeopathy vs. The Criteria of Adequacy • Simplicity: hinges on several bizarre assumptions (“essence”, “vital force”, dilution beyond 1 part per million/trillion/sextillion but still works, the tinier the amount the more powerful the effect, can heal anything) • Conservatism: concepts of “essence”, “vital force”, effectiveness at extreme dilution, and increasing potency as dose decreases all defy known laws of science Winner & still champion: SCIENCE!

And yet, homeopathy is a multi-billion dollar per year business.19 How does pseudoscience thrive?2

. We rely on unreliable data from unreliable sources:

 Our senses

 Our memory

 Our intuition

 Anecdotes, testimonials, & expert opinion . We are highly susceptible to emotions (and emotional manipulation) . We are highly susceptible to logical fallacies Logical Fallacies (only a few of many)2,20 . Appeal to authority . Appeal to the masses . Appeal to tradition . Appeal to ignorance . Appeal to nature . Hasty generalization . False cause

What are we to do?

. Accept our ethical obligation to our patients and our profession21 . Acknowledge and defend against our own cognitive biases and errors . Become willing to question all ideas, no matter how sacrosanct . Use science-based medicine and evidence-based medicine . Be skeptical!

“Extraordinary claims require extraordinary evidence.” —Carl Sagan

What is asserted without evidence may be dismissed without evidence —Latin proverb Works Cited

1. Krauss L. A Universe From Nothing. New York, NY: Atria Books; 2012. 2. Shick T. How to Think About Weird Things: Critical Thinking For a New Age. 7th ed. New York, NY: McGraw-Hill; 2014. 3. Offit P. Do You Believe in Magic? The Sense and Nonsense of . New York, NY: HarperCollins; 2013. 4. Barrett S. Homeopathy: The Ultimate Fake. Quackwatch. http://www.quackwatch.com/01QuackeryRelatedTopics/homeo.html. Updated August 23, 2009. Accessed December 8, 2015. 5. World Health Organization. WHO Safety Issues in the Preparation of Homeopathic Medicines. Geneva, Switzerland: World Health Organization; 2009. 6. Novella S. Homeopathic Vaccines Revisited. Science-Based Medicine. https://www.sciencebasedmedicine.org/homeopathic-vaccines-revisited/. Published November 28, 2012. Accessed December 9, 2015. 7. Singh S. Homeopathy; what’s the harm? 1023. http://www.1023.org.uk/whats-the-harm-in-homeopathy.php. Accessed December 9, 2015. 8. Gavura S. Should the FDA crack down on homeopathic “remedies”? Science-Based Medicine. https://www.sciencebasedmedicine.org/should-the-fda-crack-down-on-homeopathic-remedies/. Published March 26, 2015. Accessed December 9, 2015. 9. Ernst E. A truly dangerous homeopath. . http://edzardernst.com/2014/10/a-truly-dangerous- homeopath/. Published October 2, 2014. Accessed December 9, 2015. 10. American Council on Science and Health. Homicide by Homeopathy. American Council on Science and Health. http://acsh.org/2015/06/homicide-by-homeopathy/. Published June 19, 2015. Accessed December 9, 2015. 11. Gavura S. Use of Homeopathy Kills Child. Science-Based Pharmacy. https://sciencebasedpharmacy.wordpress.com/2013/11/23/use-of-homeopathy-kills-child/. Published November 23, 2013. Accessed December 9, 2015. Works Cited

12. Stanford Encyclopedia of Philosophy. Science and Pseudo-Science. Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/pseudo-science/. Published September 3, 2008. Updated February 10, 2014. Accessed December 8, 2015. 13. Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine: How to Practice and Teach It. 4th ed. London, England: Churchill Livingstone; 2010. 14. Steves R, Hootman JM. Evidence-based medicine: What is it and how does it apply to athletic training? J Athl Training. 2004;39:83-87. 15. Sauers EL. Establishing an evidence-based practice culture: Our patients deserve it. Athletic Training and Sports Health Care. 2009;1:244-247. 16. Science-Based Medicine. Announcing the Science-Based Medicine Blog. Science-Based Medicine. https://www.sciencebasedmedicine.org/hello-world/. Published January 1, 2008. Accessed December 8, 2015. 17. Centre for Evidence-Based Medicine. Oxford Centre for Evidence-Based Medicine—Levels of Evidence (March 2009). Centre for Evidence-Based Medicine. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels- evidence-march-2009/. Published March 2009. Accessed December 9, 2015. 18. U.S. National Academy of . Is Evolution a Theory or a ? U.S. National Academy of Sciences. http://www.nas.edu/evolution/TheoryOrFact.html. Published 2008. Accessed December 9, 2015. 19. Tozzi J. The FDA Might Finally Crack Down on Homeopathy. Bloomberg Business. http://www.bloomberg.com/news/articles/2015-04-20/the-fda-might-finally-crack-down-on-homeopathy. Published April 20, 2015. Accessed December 8, 2015. 20. Gavura S. False “balance” on influenza with an appeal to nature. Science-Based Medicine. https://www.sciencebasedmedicine.org/false-balance-on-influenza-with-an-appeal-to-nature/. Published February 13, 2014. Accessed December 9, 2015. 21. Novella S. The Ethics of Prescribing Worthless Treatments. Science-Based Medicine. https://www.sciencebasedmedicine.org/the-ethics-of-prescribing-worthless-treatments/. Published December 9, 2015. Accessed December 9, 2015. Additional Resources

Websites . Homeopathy (http://thelogicofscience.com/2015/08/10/its-just-water- how-homeopathy-debunks-itself/) . Logical Fallacies (www.logicalfallacies.info) . Naturowatch (www.naturowatch.org) . Pain Science (www.painscience.com) . Quackwatch (www.quackwatch.org) . RationalWiki (www.rationalwiki.org) . Science-Based Medicine (www.sciencebasedmedicine.org) . Science-Based Pharmacy (www.sciencebasedpharmacy.wordpress.com) . What’s The Harm? (www.whatstheharm.net)

NOTE: watch out for pseudoscience quacks who use website names like “Science Based Nutrition” and “Science Based Health” (both are pseudoscience-promoting sites and are definitely not science based). Additional Resources

Podcasts . Skeptoid (www.skeptoid.com) . Quackcast (www.edgydoc.com) . Skeptic’s Guide to the Universe (www.theskepticsguide.org)

Books . Autism’s False Prophets by Paul Offit . Why People Believe Weird Things by Michael Shermer

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