Appeals to righteous indignation or sanctity—which attempt to shield ideas from contemplation, discussion, investigation, or criticism—are common, impede rational discourse, and should be recognized as logical fallacies.

The following article is scheduled for the January/February 2013 Skeptical Inquirer and is being released pre-publication due to its topical nature.

Riots erupted on the streets in Afghanistan in late February 2012 in response to an apparently accidental burning of a few copies of the Koran. Placed in an incinerator along with other materials confiscated from Taliban prisoners, the singed Koranic remains were discovered later by Afghan workers. Apologies from United States officials were immediately forthcoming. However, rioting continued and reports indicated that at least twenty-nine Afghans and six American soldiers were killed in the violence (Rubin 2012).

For many Muslims, including an influential council of Muslim scholars (Rubin 2012), the apology was greeted with righteous indignation. The response of the rioters was continued (and perhaps even intensified) rage, as demonstrated by the murder of people who had nothing to do with prior events. A second outbreak of such violence in Libya (where the United States ambassador was murdered) and other Muslim countries occurred in September 2012 after a virulent anti-Islamic independent video appeared on the Internet via YouTube.

The problem of righteous indignation is conspicuous in, but not unique to, the Muslim world—it permeates cultures across religious, ethnic, and national boundaries. The destruction of Andres Serrano’s artwork, “Piss Christ,” by Catholic fundamentalist protesters in Avignon, France, is another well-known example.

Profound feelings of insult to a deeply held belief ranks among the most pervasive, powerful, and potentially dangerous failures of human reasoning. This reaction carries with it both practical dangers that threaten harmonious interactions between and among peoples, and also the capacity to insulate not merely a person, but an entire culture, from criticism and self-reflection.

We argue that “Appeal to Righteous Indignation” and the related “Appeal to Sanctity,” warrant recognition as fallacious types of reasoning and should be included in the larger lexicon of fallacies. (See “The Top 20 Logical Fallacies” by Jesse Richardson in the July/August 2012 Skeptical Inquirer for an overview of commonly recognized fallacies.)

Righteous Indignation: A Brief, Incomplete Genealogy

Righteous indignation, perhaps rooted in primitive instincts for social enforcement (Haidt 2001), appears to be an emotional response to perceived injustice (Haidt 2003; Dubreuila 2010; DeScioli and Kurzban 2009). The concept of “the sacred” appears to be more modern (Rossano 2006; Kirkpatrick 1999), but the impulse to sanctity may be rooted in emotions like disgust (as opposed to anger) (Rozin et al. 1999).

Science is only beginning to piece together the potential neurological basis for the impulse behind righteous indignation and its role in human behavior. Scientist and author David Brin, for example, has appealed to the scientific community to study righteous indignation more closely. Brin suggests that dogmatic thinking is driven by the emotional impulse to righteous indignation and the underlying brain biochemistry of behavioral addictive reinforcement (Brin 2011)—such as is involved in gambling (Blaszczynski et al. 1986).

In recent years, related phenomena (e.g., the role of punishment in the evolution of cooperation and the emotional basis of moral judgment) have been subjects of inquiry in anthropology (Sosis and Alcorta 2003), economics (Grant 2008), game theory (Dreber et al. 2008), psychology (Hunter 2005), and evolutionary psychology (Kirkpatrick 1999). Righteous indignation may have evolved to trigger participation in group punishment for non-compliance with group norms, and it may have influenced the evolution of cooperation (Boyd and Richerson 1992; Krebs 2008; Jaffe and Zaballa 2010). There is also a line of research literature suggesting some specific emotional foundations for moral behaviors, with indignation linked to anger, for example (Rozin et al. 1999).

Logical Fallacies: Righteous Indignation and Sanctity

There exists no nonideological reason why any given idea or belief should be placed beyond contemplation, discussion, investigation, or criticism. Two logical fallacies are routinely employed to shield ideas from such inspection. In accordance with the custom of the taxonomy:

Appeal to righteous indignation (argumentum ad probus indignatio); and

Appeal to sanctity (argumentum ad sanctimonia).

An Appeal to Righteous Indignation is a logical fallacy in which a person claims to be offended, insulted, or hurt by criticism of a proposition they hold, or by the advancement of a proposition with which they disagree. The expected consequence of the demonstration of the verbal or physical behavior associated with righteous indignation is that no further discussion or criticism is allowed.

An Appeal to Sanctity is a logical fallacy in which a person attempts to deflect criticism of an idea by claiming that the idea or argument is holy, sacred, sacrosanct, or otherwise privileged and immune from critique.

A few possible rebuttals might be offered. It could be argued that an Appeal to Righteous Indignation is merely an appeal to emotion, which seeks to ignite an emotional response and dampen susceptibility to further reasoned discourse. It could be argued that Appeal to Sanctity is merely an example of circular reasoning. Appeal to Sanctity may be considered a compound fallacy, comprising an appeal to authority and emotion, at least to the extent that the ideas in question are associated with institutionalized dogma. However, Appeal to Righteous Indignation and Appeal to Sanctity have distinguishing traits.

The salient feature of an Appeal to Sanctity is that it is employed as a shield against the critique of an idea or even a wholesale ideological critique. An Appeal to Sanctity is a claim that one must not critique an idea because the idea in question is sacrosanct, holy, or sacred. In other words, an Appeal to Sanctity, reduced to its simplest form, asserts as a moral virtue the claim that an idea is beyond critique. The circular appeal to special privilege frequently carries an implicit and credible threat of violence, for example, the decades-long aftermath of the fatwa against Salman Rushdie for his book Satanic Verses, the Danish cartoon controversy, the murder of Dutch filmmaker Theo Van Gogh, Christian millennium terrorist plots in Israel, and the bombing campaign dubbed “saffron terrorism” in 2008 in Malegon, India.

An Appeal to Righteous Indignation similarly attempts to place an idea beyond the reach of critique, but it employs a different mechanism. Rather than suggesting that the idea itself is privileged and thus must be immune from criticism, an Appeal to Righteous Indignation implies that a critique of an idea is equivalent to an attack on a person. Intrinsic to an Appeal to Righteous Indignation is the notion that attacks on an idea are morally equivalent to verbal or physical attacks on people, that an attack on an idea justifies a response at least proportionate to an attack on a person. Credible threats of violence often accompany displays of righteous indignation and are sometimes viewed as justified by members of the community. Consider the odd case of a man who burned a VFW flag in a drunken fit. He was taped to a flagpole for several hours the next day by an indignant VFW member, who then spoke about his actions openly to a local television reporter (Gardinier and Martínez 2009), apparently unconcerned about any possible legal repercussions.

Those who engage in these fallacies believe that becoming indignant, or refusing to question a particular belief, are virtues. In other words, one should become indignant, and not becoming indignant indicates a moral flaw in one’s character; one should refuse to question privileged beliefs, and persistence in questioning represents a character defect.

In recent years a growing number of public intellectuals, including Richard Dawkins (Dawkins 1996), Salman Rushdie (Duffy 2004), and Douglas Adams (Adams 1998) have asserted the general fallaciousness of Appeal to Sanctity, but no standard label exists, and no attempt to promote these as a standard part of the taxonomy of fallacies has been advanced.

The Harm

Righteous indignation undermines civil discourse and often corrodes efforts aimed at reasonable compromise. When righteous indignation is invoked, conversation stops and violence may begin. For the indignant party, reason may be suspended. Righteous indignation muddles thinking, elevates emotional reactions to primacy in the discourse, and displaces its alternative: impassioned, reasoned, thoughtful analysis.

Righteous Indignation may be a valid emotional experience and response to injustice. As Greta Christina has observed (Christina 2007) anger can be an important tool for motivating social change. However, its use to shield ideas from criticism impedes rather than advances discourse. Appeal to Righteous Indignation is therefore fallacious in the context of rational discourse.

The continuing demonstrations of the pervasiveness and disturbing nature of Appeals to Sanctimony and Righteous Indignation as primary or even sole arguments, and in an effort to end, rather than further, discussion in Afghanistan and elsewhere, make a compelling case for the urgency of this project. It may seem somewhat overdue to skeptics, atheists, and freethinkers that these classifications are necessary, but the cultural, social, and political world situation give these classifications an added urgency.

References

Adams, Douglas. 1998. Is there an artificial god? (Impromptu speech at Digital Biota 2, Cambridge, United Kingdom). Online at http://www.biota.org/people/douglasadams/; accessed February 26, 2012.

Blaszczynski, Alex P., S. Winter, N. McConaghy. 1986. Plasma endorphin levels in pathological gambling. Journal of Gambling Studies 2: 3–14.

Boyd, R., and P.J. Richerson. 1992. Punishment allows the evolution of cooperation (or anything else) in sizable groups. Ethology and Sociobiology 13: 171–195.

Brin, David. 2011. An open letter to researchers of addiction, brain chemistry, and social psychology. Online at http://www.davidbrin.com/addiction.htm; accessed February 22, 2012.

Christina, Greta. 2007. Atheists and anger (blog post). Greta Christina’s Blog (October 15). Online at http://gretachristina.typepad.com/greta_christinas_weblog/2007/10/atheists-and-an.html; accessed February 27, 2012.

Dawkins, Richard. Science, delusion, and the appetite for wonder. 1996. Online at http://richarddawkins.net/articles/3-science-delusion-and-the-appetite-for-wonder; accessed February 26, 2012.

DeScioli, P., and R. Kurzban. 2009. Mysteries of morality. Cognition 112: 281–299. Online at http://www.sas.upenn.edu/psych/PLEEP/pdfs/Kurzban%20DeScioli%20mysteries.pdf.

Dreber, Anna, David G. Rand, Drew Fudenberg, et al. 2008. Winners don't punish. Nature Publishing Group 452: 348–351.

Dubreuila, Benoît. 2010. Punitive emotions and norm violations. Philosophical Explorations: An International Journal for the Philosophy of Mind and Action 13: 35–50.

Duffy, Jonathan. 2004. The right to be downright offensive. BBC News (December 21). Online at http://news.bbc.co.uk/2/hi/uk_news/magazine/4114497.stm; accessed February 25, 2012.

Gardinier, Bob, and Humberto Martínez. 2009. Suspected flag burner pilloried: Alleged offender hunted down, ridiculed after incident at VFW post. Times Union (September 26). Online at http://www.timesunion.com/local/article/Suspected-flag-burner-pilloried-555979.php; accessed March 5, 2012.

Grant, Ruth. 2008. Passions and interests revisited: The psychological foundations of economics and politics. Public Choice 137: 451–461.

Haidt, J. 2001. The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review 108: 814–834.

———. 2003. The moral emotions. In R.J. Davidson, K.R. Scherer, and H.H. Goldsmith (Eds.), Handbook of Affective Sciences. Oxford University Press.(pp. 852–870). Online at http://faculty.virginia.edu/haidtlab/articles/alternate_versions/haidt.2003.the-moral-emotions.pub025-as-html.html.

Hunter, Richard. 2005. Righteous Indignation: Driving Psychology. Bloomington, IN: Author House.

Jaffe, Klaus, and Luis Zaballa. 2010. Co-Operative punishment cements social cohesion. Journal of Artificial Societies and Social Simulation 13: 4. Online at http://jasss.soc.surrey.ac.uk/13/3/4.html; accessed February 23, 2012.

Kirkpatrick, L.A. 1999. Toward an evolutionary psychology of religion and personality. Journal of Personality 67: 921–952.

Krebs, Dennis L. 2008. Morality: An evolutionary account. Perspectives on Psychological Science 3: 149–172.

Rossano, Matt J. 2006. The religious mind and the evolution of religion. Review of General Psychology 10(4): 346–364. Online at http://www2.selu.edu/Academics/Faculty/mrossano/recentpubs/religious_mind.pdf.

Rozin, Paul, L. Lowery, S. Imada, et al. 1999. The CAD triad hypothesis: A mapping between three moral emotions (contempt, anger, disgust) and three moral codes (community, autonomy, divinity). Journal of Personality and Social Psychology 76: 574–586.

Rubin, Alissa J. 2012. Chain of avoidable errors cited in Koran burning. New York Times (March 2). Online at http://www.nytimes.com/2012/03/03/world/asia/5-soldiers-are-said-to-face-punishment-in-koran-burning-in-afghanistan.html?_r=1&ref=thereachofwar&pagewanted=all; accessed March 5, 2012.

Sosis, R., and C. Alcorta. 2003. Signaling, solidarity, and the sacred: The evolution of religious behavior. Evolutionary Anthropology: Issues, News, and Reviews 12: 264–274. Online at http://www.anth.uconn.edu/faculty/sosis/publications/sosisandalcortaEA.pdf.

DAVID H. GORSKI

There’s an old recurring Saturday Night Live sketch in which a Scotsman bellows, “If it’s not Scottish, it’s crap!” As I read Reynold Spector’s “Seven Deadly Medical Hypotheses” (Spector 2010), I couldn’t shake the image of him in a kilt roaring, “If it’s not a randomized, double-blind clinical trial based on the hypothetical/inductive method, it’s deadly crap!” Unfortunately, Spector fails to demonstrate convincingly why most of his seven hypotheses even merit the label “deadly.” Sadly, Spector’s overwrought application of the word deadly to hypotheses that are not even, by Dr. Spector’s definition, “deadly” torpedoes what might have been a provocative exercise in skepticism. What is left are weak or erroneous conclusions based on dubious arguments.

Because there are so many questionable arguments in Spector’s article, I will be forced to “cherry pick” a couple. More complete discussions of other examples can be found elsewhere (Gorski 2011a). His first Deadly Medical Hypothesis (DMH) is as good an example as any. Unfortunately, DMH #1 is not even a hypothesis at all but rather two opinions, the second of which is a straw man tacked on to allow Spector to gleefully attack both opinions as one: “Either the investigator does not need a specific hypothesis and/or can use an inadequate method to test the hypothesis.”

Spector cites an editorial as support for the existence of this DMH (Glass and Hall 2008). However, although the authors of the cited editorial did make the provocative argument that in the age of genomic medicine specific hypotheses might not always be necessary anymore and that instead science can focus on answerable questions, nowhere do they advocate using “inadequate methods” to test hypotheses or answer questions. That is Spector’s opinion, and the straw man that gives him the opening to attack “hypothesis-less” studies. Yet hypothesis-generating studies are very important to the process of discovery, because they are how we develop new lines of investigation that might one day come to fruition as useful treatments that can pass FDA muster, standards designed for a very late point in the discovery process.

It’s a long and winding road from hypothesis generation to hypothesis testing to treatment to treatment validation. Most hypotheses fail and are forgotten, and even for those that succeed, the median time between first publication of a discovery or hypothesis and its validation in large randomized clinical trials ranges from fourteen to forty-four years (Contopoulos-Ionnidis et al. 2008). Compared to this, genome-wide association studies (GWAS) have only been in existence for a relatively short time. Ironically, Spector argues that GWAS should be replaced by “direct sequencing of the portions of the genome of interest, comparing patients with proper control subjects.” That is exactly what is happening now (Berger et al. 2011) as next generation sequencing techniques drive the cost of genome sequencing low enough to make such studies feasible. I also note that many of the assumptions behind GWAS that Spector dismisses are also assumptions behind—you guessed it!—next generation sequencing (NGS) experiments of the sort that Spector apparently approves of. Right now, the National Institutes of Health is funding a huge initiative, The Cancer Genome Atlas (TCGA, see http://cancergenome.nih.gov), in which dozens of cancer genomes are being sequenced—without hypotheses!—generating numerous promising hypotheses to test, the results of which might one day be true personalized medicine (which, by the way, was another of Spector’s misguided not-so-deadly hypotheses).

Speaking of cancer, the most offensive DMH is the last one, namely that “from a public health perspective, cancer chemotherapy (chemo) has been a major medical advance.” Note how Spector is careful to insert the phrase “from a public health perspective.” This, too, is a straw man, as no one argues that chemotherapy is a major public health advance; rather it is an advance in the treatment of individual patients with certain kinds of cancer that respond to chemotherapy. I’ve discussed at length the slanted perspective inherent in this DMH, including its misleading characterization of chemotherapy (Gorski 2011a) and why we “haven’t won the war on cancer yet” (Gorski 2011b). If Spector had simply written that chemotherapy, while capable of curing many hematologic malignancies and a handful of solid malignancies (such as testicular and anal cancer), does a poor job on its own of prolonging life in patients with inoperable solid malignancies, I would have had little argument with him. Apparently such a universally accepted conclusion wasn’t provocative enough, however; so he declared chemotherapy an utter failure—from a public health perspective, of course!—ignoring cancers for which chemotherapy improves disease-free and overall survival and quality of life even when they are advanced (Venook 2005) and the usefulness of chemotherapy in adjuvant and neoadjuvant settings.

No doubt Spector thought he was being provocatively “skeptical.” Unfortunately, most of his DMHs are neither deadly nor, truth be told, hypotheses. At worst, they are the sorts of dead ends that science eventually corrects, which is how science works. Apparently, Spector doesn’t have the patience to deal with the messiness of science-based medicine.

References

Berger, M.F., M.S. Lawrence, F. Demichelis, et al. 2011. The genomic complexity of primary human prostate cancer. Nature 470: 214–20.

Contopoulos-Ioannidis, D.G., G.A. Alexiou, T.C. Gouvias, et al. 2008. Life cycle of translational research for medical interventions. Science 321: 1298–99.

Crislip, M. 2011. Deadly indeed (blog entry). Science-Based Medicine (February 25). Available online at www.sciencebasedmedicine.org/?p=11155.

Glass, D.J., and N. Hall. 2008. A brief history of the hypothesis. Cell 134: 378–81.

Gorski, D.H. 2011a. Skepticism versus nihilism about cancer and science-based medicine (blog entry). Science-Based Medicine (February 28). Available online at www.sciencebasedmedicine.org/?p=11185.

———. 2011b. Why haven’t we cured cancer yet? (blog entry). Science-Based Medicine (February 14). Available online at www.sciencebasedmedicine.org/?p=10761.

Spector, R. 2011. Seven deadly medical hypotheses. SKEPTICAL INQUIRER 35(2): 40–48.

Venook, A. 2005. Critical evaluation of current treatments in metastatic colorectal cancer. The Oncologist 10(4): 250–261.

Wadman, M. 2011. Fifty genome sequences reveal breast cancer’s complexity. Nature (online April 2). doi:10.1038/news.2011.203.

David H. Gorski, MD, PhD, FACS
Managing Editor, Science-Based Medicine
Leader, Breast Cancer Multidisciplinary Team
Co-Leader, Breast Cancer Biology Program, Barbara Ann Karmanos Cancer Institute
Associate Professor of Surgery, Wayne State University School of Medicine

MARK CRISLIP

The article “Seven Deadly Medical Hypotheses” has fundamental flaws. The argument, as I understand it, is that medical researchers fail to use the hypothetical/deductive approach to decide upon research agendas and therefore waste a “vast quantity of resource to disprove them.”

The argument as presented is circular. The author uses information from completed studies to prove the studies should not have been done in the first place. He fails to consider the state of knowledge at the time the studies were done and the cumulative nature of medical knowledge.

The author’s criticism of Hormone Replacement Therapy (HRT) is an example of his reasoning and his ignoring the state of medical knowledge. The benefits and risks of HRT were discussed at length with patients and on rounds in the 1980s when I was a medicine resident. Are the benefits of HRT greater than the potential risk of cancer from estrogen? As noted at the time in assessing HRT risks:

Hip fractures, Colles’ fractures, and coronary heart disease, and breast and endometrial cancers are important conditions in postmenopausal women that might be influenced by the use of hormone replacement therapy. . . . A 50-year-old white woman has a 16% risk of suffering a hip fracture, a 15% risk of suffering a Colles’ fracture, and a 32% risk of suffering a vertebral fracture during her remaining lifetime. These risks exceed her risk of developing breast or endometrial cancer. She has a 31% risk of dying of coronary heart disease, which is about 10 times greater than her risk of dying of hip fractures or breast cancer. These lifetime risks provide a useful description of the comparative risks of conditions that might be influenced by postmenopausal hormone therapy. (Cummings et al. 1989)

And the risk for cancer was uncertain, as discussed in a 1989 New England Journal of Medicine editorial: “Evidence that estrogen increases the risk of breast cancer has been surprisingly difficult to obtain” (Barrett-Connor 1989). In the 1980s the risks of HRT were uncertain and the benefits appeared considerable. I spent significant time convincing my mother, based on the information of the time, to take her Premarin.

At no time does Reynold Spector describe, based upon the information we had at the time, why evaluation of HRT, or the other deadly hypotheses, should not have been pursued. It is the data gathered from the present he uses to discredit the past. If he had used the hypothetical/deductive methods based on information known at the time, or better, information from today, to predict what was and what will not be worth pursuing, it would be more impressive. Hindsight is always 20:20.

Spector makes similar arguments for his other six deadly hypotheses. Well, one deadly hypothesis, five rejected hypotheses, and one opinion. The last hypothesis, “cancer chemotherapy (chemo) has been a major medical advance,” which Spector declared false, is not a hypothesis generated by researchers but by the author’s after-the-fact opinion, and he fails to recognize the benefits of failure.

The author states “when one dispassionately weighs the minimal prolongation of ‘good’ [the quotes around “good” demonstrating there is nothing dispassionate in the author’s analysis] life in patients with metastatic cancer . . . versus the very distressing side effects of chemotherapy with ‘targeted’ chemotherapy drugs, the case is close.”

If it had been 1990, Spector could have been writing about AIDS and HIV therapy. AIDS is infinitely simpler than cancer, yet a decade of false starts and dead ends, of failed hypotheses, led to progressive understanding of the pathophysiology and treatment of HIV and resulted in the era of HAART, where the expected life expectancy of those with HIV is often close to normal.

Medicine advances slowly and erratically, and unfortunately more insights are often gained from failure than success. Only after enormous effort can we retroactively identify which medical interventions warranted the gold standard, large, randomized, placebo-controlled trials demanded by Spector. Doing so prospectively is not as easy as he suggests.

Medicine is pushed forward not by pseudoscientists and worse but by caring, hardworking, and committed health care professionals who are doing the best they can under often tight funding limitations and great uncertainty. Spector’s dismissive attitude toward the blood and sweat expended by the researchers—and, often forgotten, the patients who volunteer their life and health to advance medicine by participating in clinical trials—is disappointing.

References

Cummings, Steven R., Dennis M. Black, and Susan M. Rubin. 1989. Lifetime risks of hip, Colles’, or vertebral fracture and coronary heart disease among white postmenopausal women. Archives of Internal Medicine 149 (11): 2445–48.

Barrett-Connor, Elizabeth. 1989. Postmenopausal estrogen replacement and breast cancer. New England Journal of Medicine 321(August 3): 319–20.

Mark Crislip, MD
Editor, Science Based Medicine (www.sciencebasedmedicine.org)

AVRUM Z. BLUMING and CAROL TAVRIS

In the May/June 2010 issue of the SKEPTICAL INQUIRER, we published “The Alarms of Hormone Replacement Therapy: Are They Supported by the Data?,” which criticized the headlines proclaiming that HRT significantly increases the risk of breast cancer. Readers might understandably be puzzled by the discrepancy between our perspective and that of Reynold Spector’s “Deadly Hypothesis Two,” in which he says that it is a “well-documented fact that estrogen is a carcinogen and causes breast cancer.” To support this claim, Spector relies on the findings of the Women’s Health Initiative (WHI). But the WHI is one of the studies we criticize in great detail, showing that its findings regarding breast cancer have been inconsistent. Virtually all of its alarmist conclusions—that HRT increases the risk of dementia, stroke, cardiovascular disease, breast cancer, and even “deaths from all causes”—were a result of selection bias or post hoc statistical manipulation.

Is estrogen the carcinogen that Spector so unequivocally thinks it is? Our paper reviews the mounting evidence that questions this common wisdom. Even the WHI results have not supported that association, finding a modest (and usually statistically nonsignificant) rise in relative risk only for the combination of estrogen-progestin therapy. In fact, a recent reanalysis of updated WHI data reported that post-menopausal administration of estrogen alone decreases the risk of subsequent breast cancer.

Of course, scientists and other skeptics can and do disagree with one another when it comes to interpreting data. Our primary objection to Spector’s discussion of HRT is not his conclusion but his tone of certainty, his oversimplification of an enormous body of research, and his unwillingness to question received wisdom from the WHI. Even some investigators who share his belief that the relative risks of HRT warrant concern acknowledge that the absolute risks from this treatment are small. In one worst-case analysis, researchers calculated that a fifty-year-old woman taking estrogen and progestin for ten years has a 96 percent chance of remaining free of breast cancer versus a 98 percent risk if she does not take HRT.

We refer interested readers to our SI article and its longer, more detailed version, “Hormone Replacement Therapy: Real Dangers and False Alarms,” The Cancer Journal, March/April 2009, pp. 93–104. This paper contains 210 references and a timeline of studies on HRT from 1942 to the present. The free, full-text article is available online at: http://journals.lww.com/journalppo/Fulltext/2009/04000/­Hormone_Replacement_­Therapy­__Real_Concerns_and.1.aspx.

Avrum Bluming, MD
Oncologist, hematologist, internist
Former clinical professor of medicine, University of Southern California

Carol Tavris, PhD
Social psychologist, writer, and lecturer
CSI fellow, Los Angles, California

HARRIET HALL

When I first skimmed Reynold Spector’s article “Seven Deadly Medical Hypotheses,” I found myself agreeing with most of his points yet feeling somehow disturbed. On a closer reading, I realized my discomfort was because he sounds more like a denialist or a contrarian than like a judicious skeptic. His seven hypotheses are stated in words that subtly misrepresent the truth, and he attacks them with dogmatism where nuance is called for.

His main thesis is that “many medical and nutritional hypotheses are ill-conceived.” That may be true, but scientists are doing the best they can. Does he imagine that they could somehow discipline themselves to only study hypotheses that will turn out to be true?

After falsely characterizing hormone replacement as an avoidable error, he perpetuates the myth that HRT kills 5,000 women yearly from breast cancer. The Women’s Health Initiative (WHI) study showed no difference in overall mortality; so if HRT killed 5,000 women from breast cancer it would have to have saved another 5,000 from other causes of death.

Deadly Hypothesis Four is that “screening tests beyond the standard medical examination are necessary for identifying disease or the risk of disease in apparently healthy, asymptomatic adults.” The utility of screening tests is not an ill-conceived hypothesis, much less a deadly one. A routine history and physical on an asymptomatic patient are next to useless for detecting pre-symptomatic disease or risk of disease.That’s why we have tried to devise useful screening tests to diagnose certain diseases and risk factors before symptoms develop, so early treatment might have a chance of altering the course of disease. No screening test was ever adopted without credible data and plausible reasoning. It is a gross oversimplification to call “screening tests are necessary” a false hypothesis. Instead, Spector should have attacked the myth that screening tests are categorically good and always save lives. Sometimes they fail to improve patient outcomes or even do more harm than good, and we then abandon them. All the tests Spector questions (mammography, PSA tests, genetic screening) were first questioned in the very medical literature he disparages.

What Spector characterizes as “a chronic scandal” is nothing of the sort. It is a reflection of the complexity of the scientific process. Yes, we need to be more skeptical. We need to carefully evaluate the evidence for any medical claim. We need to do better-designed studies. But it’s not always possible to do the ideal study; sometimes we have to go by the best available evidence from epidemiologic and other less desirable studies. We had to figure out that smoking caused lung cancer without forcing subjects to smoke or not smoke in a randomized controlled prospective study.

Spector’s article was doubly disappointing because he had so many excellent points that were sabotaged by the way he presented them. Medical science is far from perfect, but it is a cooperative, self-correcting endeavor that constantly criticizes itself and is constantly improving. We need continued rational skepticism and constructive dialog, not oversimplified contrarian polemics.

Harriet Hall, MD, “The SkepDoc”
Editor, Science-Based Medicine
Contributing Editor, SKEPTICAL INQUIRER
CSI fellow
Contributing Editor, Skeptic magazine

REYNOLD SPECTOR, MD, Responds

It is clear from reading these letters that the correspondents do not understand how to evaluate the medical literature—how to discriminate the wheat from the chaff. They do not understand the hierarchical nature of proffered evidence. For example, I doubt any of the correspondents understand Hill’s criteria for assessing causal relationships in epidemiology/observation studies (see below). I recommend they read Spector and Vesell (2006) or the online methodological supplement to my paper on nutrition in SKEPTICAL INQUIRER (Spector 2009). They should also consult the FDA regulations for what constitutes proof in drug development.

Let me be concrete. Three correspondents claim I don’t understand that the evaluation of clinical science is not easy. Gorski talks about the “messiness of science-based medicine.” Crislip states “medicine advances slowly and erratically.” Hall states that “scientists are doing the best they can.” What they do not understand is that one of the reasons for this sorry state of much of the clinical literature is that many published studies do not have a clear hypothesis, are underpowered, or use inadequate methods (e.g., epidemiology/observation studies attempting to “prove” causal connections). Examples include the hundreds of epidemiology/observation studies on hormone replacement therapy (HRT) (see below) or megavitamin therapy (Spector 2009), most of which yielded incorrect or inconclusive results and essentially none of which satisfied the Hill criteria for validity (Spector and Vesell 2000; 2006). Genome-wide association studies, or GWAS, are another example. We have known for decades how to do good clinical science, but the methodologies are often not followed for reasons previously enumerated (Spector and Vesell 2002); flawed studies are published and confusion reigns. Much of the confusion could be eliminated by practicing valid science. The notion that all these unscientific studies are hypothesis-generating is ludicrous.

Bluming and Tavris challenge the notion that HRT increases breast cancer in post-menopausal women. Let me give a broad overview of the multifaceted and overwhelming data that supports the view that HRT causes human breast cancer:

1. Estrogen causes cancer of the breast in female animals.
2. Unopposed estrogen causes cancer of the uterus in humans with a risk of up to twenty times more than average. That is why unopposed estrogen is not given to any woman with a uterus.
3. The Women’s Health Initiative (WHI) and then the Million Woman Study (Beral et al. 2011) both showed that HRT in women with a uterus increased breast cancer by 40–90 percent. The longer the use and the earlier the start of HRT, the higher the risk of developing breast cancer.
4. The Million Woman Study also showed about a 40 percent increase in incidence of breast cancer for hysterectomized women who took estrogen for eight years (Beral et al. 2011). The much smaller WHI study of unopposed estrogen was stopped early because of increased strokes for women on estrogen. The women in that study were on estrogen for only three and a half years, and the results are inconclusive (Jungheim and Colditz 2011).
5. After the publication of the WHI study on HRT, the use of HRT fell precipitously and soon after breast cancer incidence declined, consistent with HRT causing breast cancer (Beral et al. 2011).
6. Anti-estrogens in post-menopausal women decrease breast cancer incidence by a whopping 60–80 percent (Goss et al. 2011).
7. The International Agency for Research on Cancer considers HRT (either unopposed estrogen or estrogen/progesterone combinations) human carcinogens (cancer causing agents) (Jungheim and Colditz 2011). So do the FDA and U.S. Supreme Court.
8. The labeling of HRT, approved by the FDA, recommends HRT for the shortest possible time at the lowest possible dose.
9. Bluming and Tavris concede that in a worst-case scenario, there might be a 2 percent increased risk of breast cancer in women on HRT for ten years. This amounts to two hundred thousand more cases of breast cancer per ten million women on HRT for ten years. At the peak of HRT use, many times more women were taking HRT. What are Bluming and Tavris thinking?

Crislip writes an apologia for why, before the definitive studies of HRT began to be published in 1998, physicians used HRT broadly. I find his argument unconvincing—in fact worrisome. First, we have known for decades that estrogen causes breast cancer in animals and cancer of the uterus in women. There was also substantial data suggesting but not proving that HRT causes breast cancer in women. Second, the FDA wisely rejected (in the 1990s) the manufacturer’s claims that HRT decreased cardiovascular and central nervous system disease. These claims were based on epidemiology/observation studies, but they didn’t meet the Hill criteria and turned out to be wrong. The FDA approved claims only for HRT decreasing post-menopausal symptoms and fractures. The FDA wisely ignored the unbridled industry-driven hype, unlike many gullible physicians. Third, there were many HRT skeptics, including this correspondent (Spector and Vesell 2000) and National Institutes of Health Director Bernadine Healy, who began the WHI studies in 1991 to answer the HRT questions definitively. Now, twenty years later, we know that HRT causes breast cancer, strokes, clotting, uterine cancer (with use of unopposed estrogen), cardiovascular disease, and so forth. HRT should not be used chronically; excellent nonhormonal ways to prevent fracturing have been available since 1996.

In fact, I believe a good physician should use only proven therapies for which the risk/benefit ratio favors the patients. That was never the case with HRT, a known carcinogen. Fortunately, when my sister asked me if she should take HRT for her menopausal symptoms in the mid-nineties, I said no; it’s too risky and its benefits are uncertain. I also wrote about this over ten years ago (Spector and Vesell 2000).

To answer the questions on cancer chemotherapy, I recommend my SKEPTICAL INQUIRER article “The War on Cancer” (Spector 2010). Moreover, the problems with chemotherapy keep surfacing. For example, it was shown that for lung cancer patients, hospice care with minimalist chemotherapy was better than standard chemotherapy in terms of both quality of care and longevity (Temel et al. 2010). The scandals associated with the so-called targeted chemotherapy—such as the ineffective, incredibly expensive, and risky Avastin in breast cancer treatment—escalate (Tucker 2011). Finally, the authors of a recent long, thoughtful article (Smith and Hillner 2011) argue persuasively, as I did, that there is tremendous overuse of chemotherapy. The authors point out that “some oncologists choose chemotherapy in order to maximize their practice income. A system in which one half the profits in oncology [practice] are from drug sales is unsustainable.” Where is the well-being of the patient in this? A thoughtful, empathetic reader will weep.

References

Beral, V., G. Reeves, D. Bull, et al. 2011. Breast cancer risk in relation to the interval between menopause and starting hormone therapy. Journal of the National Cancer Institute 103: 296–305.

Goss, P.E., J.N. Ingle, J.E. Alès-Martinez, et al. 2011. Exemestane for breast-cancer prevention in postmenopausal women. New England Journal of Medicine, in press.

Jungheim, E.S., and G.A. Colditz. 2011. Short-term use of unopposed estrogen. A balance of inferred risks and benefits. Journal of the American Medical Association 305: 1354–55.

Smith, T.J., and B.E. Hillner. 2011. Bending the cost curve in cancer care. New England Journal of Medicine 364: 2060–65.

Spector, R. 2009. Science and pseudoscience in adult nutrition research and practice. SKEPTICAL INQUIRER 33(3) (May/June): 35–41.

———. 2010. War on cancer: A progress report for skeptics. SKEPTICAL INQUIRER 34(1) ( January/February): 25–31.

Spector, R., and E.S. Vesell. 2000. The pursuit of clinical truth: Role of epidemiology studies. Journal of Clinical Pharmacology 40: 1205–10.

———. 2002. Which studies of therapy merit credence?: Vitamin E and estrogen therapy as cautionary examples. Journal of Clinical Pharmacology 42: 1–8.

———. 2006. Pharmacology and statistics: Recommendations to strengthen a productive partnership. Pharmacology 78: 113–22.

Temel, J.S., J.A. Greer, A. Muzikansky, et al. 2010. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine 363: 733–42.

Tucker, F.C. 2011. Drugs and profits. New York Times (May 25).

Reynold Spector, MD
Clinical Professor of Medicine, Robert Wood Johnson Medical School (New Jersey)

Is the “Arab Spring” that is sweeping nations across northern Africa and the Middle East a liberating force for science and open inquiry?

The links among democracy, freedom, openness, and science were frequent themes at the recent World Conference of Science Journalists in Doha, Qatar, as prominent scientists and science policy leaders spoke to 700 of the globe’s assembled science journalists.

“What happened in Egypt on January 25 has extended the geopolitical boundaries of Tahrir Square to every corner of the Arab world,” Mohammad Saoud, president of the Qatar Foundation, said in his welcoming words. He affirmed “strong support to what happened in Egypt” and its connections to “freedom throughout the whole Arab world.”

That the conference was being held in Qatar was a direct result of the events in Cairo. The 2011 conference was to have been in Cairo. Planning had been under way for two years by organizers in Egypt, the United States, and the Arab world. But the public uprising in January that ousted the Mubarek government and opened a new sense of freedom and possibility also created instabilities and uncertainties not resolved in time to ensure the conference could safely go ahead there. Qatar, a small, modern country on the Arabian Peninsula, and its well-funded Qatar Foundation, which supports science, education, and community development, offered the conference a home in Doha, its capital city. So the conference quickly gained a second home, and the long-sought goal of holding it for the first time in the Arab world was met. Journalists from ninety countries attended.

Arab nations are proud of the fact that Muslim and Arab scientists are credited with keeping alive learning and scholarship from the ninth through the twelfth centuries CE. The subsequent decline and loss of that role is painful to them. But in their view, something similar has begun to happen in the past fifteen years, as a burgeoning sense of possibility sweeps the more progressive parts of the Arab world. Renewed research programs are underway, said Saoud, to “regain some of what we offered the world.”

“There is no ceiling to our aspirations,” he said, referring to the foundation’s intention to bring to Qatar some of the best minds from all over the world. “We want to reverse the brain drain. We want to achieve a ‘brain gain’ in Qatar and across the Arab world.… We want to play a leading role in that Renaissance.”

In fact, the Qatar Foundation’s newspaper shortly before the conference headlined the goal bluntly: “QF Leads Drive to Revive Arab Golden Age of Science.”

Core to that purpose, Saoud said, is “the wisdom to support a genuine and sustainable research community.” The Foundation is pursuing a practical model based on attracting international partners from top institutions throughout the world. (Campuses of Carnegie Mellon and Georgetown Universities, located within sprawling modern multicomplexes of the Foundation outside of Doha, were sites of some conference social sessions. Four other U.S. universities also have campuses there.)

Saoud referred to quality of programs, students, environment, and facilities as key ingredients of a vision that is “bold and far-reaching.” He foresees having “20,000 scientists partnering with us or relocating to Qatar.”

“Diffusing access to science and technology will help people become responsible citizens,” Professor Abdelhamid El-Zoheiry of Egypt’s Ministry of Scientific Research and Technology told the conference attendees. Science is being liberated in Egypt, he said, referring to a new law being drafted there to encourage research. “The Arab Spring promises a gentle rain of change for science and technology.”

Egypt has its own science Nobel laureate. Egypt and the whole Arab scientific world are proud of Ahmad Zewail, who received the 1999 Nobel Prize in Chemistry for his studies of the transition states of chemical reactions using femtosecond spectroscopy. Zewail is the Linus Pauling chairman of chemistry at Caltech, from where he also serves on the President’s Council on Science and Technology. A member of the Qatar Foundation’s board, he was the conference’s opening keynote speaker. He is dedicated to the transfer to democracy in the Arab world.

He offered his own reflections on science and society. Science has witnessed revolutions, he said reeling off a list: visualizing and controlling matter at the level of atoms, deciphering the genetic codes, using stem cells to make new organisms, building precision labs to land on Mars. He noted our level of ignorance as well: “The amount of the unknown in [the] universe exceeds by far the known.” Ninety percent of the universe is “dark”; we don’t know how to unify the forces of nature, and we don’t understand what makes consciousness from atoms and molecules. “We have absolutely no idea.”

Challenges face the world of science and media, Zewail noted, including the rise of the infotainment culture. “Entertainment at the expense of education—it’s a serious problem.” He noted that five hundred television channels are now available in the Arab world. “Is this good for education? … Information doesn’t make useful knowledge. We need new knowledge.” He lamented sensationalism in the public media and that anything deemed bland or boring is expunged.

But he also spoke movingly of the burgeoning Arab Spring. He himself was involved in the Egyptian revolution. For four weeks he was there at the heart of it. “This revolution was unique in the history of mankind,” he said. All communications were through social networking; the media played a significant, positive role; and there was a change of perception of Arabs about the value of a “civil” uprising. “They want the country to be a better place.”

Zewail also insisted that Islam is not in conflict with progress. “One small group [is made up of] fanatics,” he said. Such fanatics “exist in all faiths.” Said Zewail: “There are Muslim fundamentalists. But you have fundamentalists in America too.”

Zewail said he sees “no physics”—nothing validly foundational—in calling what’s been happening a conflict of cultures. It is simpler than that: “People want liberty and good lives to live.”

“There is nothing fundamental in Islam against science…. Let’s go beyond the past and forge ahead to the future. Our focus should be on the future,” he advised.

Zewail’s native country of Egypt is establishing a new city of science and technology outside of Cairo. The goal is to affect basic knowledge. The new city was referred to multiple times at the conference. Zewail modestly noted that “they were kind enough to name it after me.”

“We are working hard to reclaim this glorious past,” Zewail assured the conference audience.

Whether the so-called Arab Spring fulfills all the promises that bring such a feeling of burgeoning hope to the Arab world’s scientists and thinkers is a question that will probably remain open for some time. But the aspirations are certainly there, and that is an essential start. The Western world and the Arab world together can benefit only if at least some of these high ambitions come to fruition.

This is the second of several reports by SKEPTICAL INQUIRER Editor Kendrick Frazier from the World Conference of Science Journalists in Doha, Qatar. The first dealt with conference subthemes of pseudoscience, mythbusting, and evolution.

That is not altogether surprising, considering that science journalists, as the intermediaries between scientists and the public, encounter the same kinds of public misunderstanding and misperceptions (plus outright distortions) about science and the natural world that skeptics combat.

More than 700 science journalists from ninety countries—half of them from Africa, Asia, and the Middle East, an intentional push by the main U.S. and Arab science journalism professional organizations to encourage science journalists from developing countries—are meeting in a new sprawling university/academic/research complex of the Qatari Foundation on the outskirts of Doha to consider all the issues they encounter in their professional lives. Among them: dealing with contradictory medical studies, the burgeoning digital media forums and whether science bloggers are science journalists, bioethical issues, reporting about risks when perceptions of risk are distorted, ethical issues facing science reporters, secret science, managing the transitions of science magazines to the digital age, journalism in the age of denial, and on and on.

I participated in a first morning session on “Investigating Pseudoscience,” together with skeptics and science journalists from Russia (moderator Tatiana Puchigina and Alexander Sageev, who emphasized cases in which pseudoscience can be a criminal activity), Hungary (István Vágó, former head of the Hungarian skeptics group and a prominent Hungarian television host), and Argentina (freelancer and skeptic Alejandro Agostinelli). We all outlined some of the characteristics of pseudoscience and gave some of our experiences battling it, and then we answered questions from other journalists about how best to deal with pseudoscience.

That breakout session was followed by a related one in the afternoon bearing the intriguing title “Warriors Against Claptrap: Are Myth-Busters the New Generation of Civic Scientist?” New myth-busting groups and efforts are springing up all over. The session addressed such questions as, Should we all confront bad science? Will that create public skepticism or cynicism? That panel addressed the impact of some widely publicized myth-busting campaigns that have captured the public imagination. The popular U.S. television show MythBusters (which U.S. President Barack Obama recently appeared on) was just one of the forums described. Julia Wilson and Leonor Sierra of Sense About Science, a U.K. group that promotes public myth-busting by young people, headed that fascinating discussion along with science journalists Ylann Schemm of the Netherlands, Alaa Ibrahim of American University in Cairo, and Pallab Ghosh of the BBC in the United Kingdom. Wilson described an effort in which a group of young people in the United Kingdom decided to challenge companies’ claims about “de-toxing.” They asked what evidence supported the de-tox claims. When the companies had to admit they had none, the group publicized that fact (with transcripts of the responses) and gained wide attention. Veteran BBC science broadcaster Ghosh concluded with some good points of wisdom. Among them: Science journalists’ prime responsibility is to act in the interests of their audience, that sometimes one needs to brave and take on important stories, and that they have a role and responsibility to bust myths. He called it “kick-ass journalism.”

And that session was followed by a plenary on “Evolution and the Evolving World of Science Journalism.” Scientific American Editor Mariette DeChristina, representing the National Association of Science Writers, moderated a panel that included participants from South Africa, Argentina, and the United States. But the lead talk was by our Committee for Skeptical Inquiry colleague Eugenie C. Scott of the National Center for Science Education, who began by noting how the journalistic principle of “balance” can be a problem in reporting on evolution. As she says, fairness and balance applies to opinion. “It is not an opinion that the Earth goes around the sun…. It is not a matter of opinion that living things have ancient ancestors.” (The “balance” problem is well understood by science journalists, but it remains a serious issue in general journalism, in which non-expert reporters frequently feel they must give creationist views equal weight to the long accepted scientific facts of evolution.)

Scott is an anthropologist, not a science journalist, but she is widely respected by science journalists for her efforts in helping them deal responsibly with the evolution/creation issue.

She forthrightly condemned a case in 2009 in which a noted science magazine, the British weekly New Scientist, published a cover announcing in large print, “DARWIN WAS WRONG.” (The article itself was about horizontal gene transfer and, says Scott, wasn’t the real problem.)

“The New Scientist cover is simply wrong,” Scott bluntly told the assembled journalists. “This cover was extremely irresponsible.” She noted that just two days later opponents of evolution on the Texas Board of Education cited the cover as evidence that evolution is wrong. New Scientist Editor Roger Highfield lamely responded at the time that he knew creationists would probably “take it out of context,” hardly any surprise to Scott, who wondered why he then did it. “Cover the science,” she said, “but don’t make it easy for creationists to take it out of context.”

So in the Qatari Foundation’s cool, modern facilities (video camera booms roam overhead, live radio interview programs are underway down the hall) surrounded by the blazing hot desert winds of Doha, science and skepticism was a prominent early theme as this largest ever world conference of science journalists—and the first ever held in the Middle East—got underway.

John Stewart and Steven Colbert organized the Rally to Restore Sanity on October 30, 2010. The media reports of this rally largely described the rally as a light-hearted day of comedy. Having been at the rally, my sense is that the message driving the massive turnout of over 220,000 people was much more profound. It was a rallying cry for reason.

Stewart and Colbert performed for 3 hrs, criticized the irrational and the alarmist rhetoric flooding our media outlets, and appealed for “sanity”. Many, if not all, of the readers of the Skeptical Inquirer are aware of the problem. Many politicians and pundits routinely ignore scientific evidence, and the public follows their lead. Public figures seem to have perfected use of the sound bite to appear thoughtful while irrationally dismissing scientific evidence relating to subjects such as evolution, global warming or biodiversity loss. Even debates on social policy, such as health care, regularly avoid the most obvious, irrefutable truth that the increasing cost of health care is driven in large part by the aging of our population (reflecting the success of medical science), and the elderly have more health care needs, and therefore costs, than the young.

The routine is familiar. Evolution can be dismissed by reference to the bible. Global warming is dismissed with the claim that more evidence is needed. Strategies for avoiding evidence are highly effective for sound bites because they circumvent any need to describe what evidence would be considered acceptable and cogent. This journey into surrealism is particularly upsetting because it leads to bad policies that are ill equipped to cope with the very real challenges facing our society.

Listening to the news, I often get the feeling that my desire for “reason” in the public debate is limited to a tiny, isolated fraction of the population. Attending the rally, though, provided an entirely different, optimistic perspective. The crowd was immense, far larger than any of us who came expected. People streamed into the malls from all sides, filling the streets from blocks away, and packing together, shoulder to shoulder, on the mall. The atmosphere was humorous and festive, but the humor reflected a surprisingly unified message of thoughtfulness. For instance, despite being packed together, requests to pass were met almost universally with the same message as people stepped back, and comically announced, “Yes! I will let you through, because I am a very reasonable person!”

The rally was filled with thousands of homemade signs most of which addressed the theme of the day in a manner that was both poignant and really funny. Some of the signs directly addressed the need for reason in our political debates. For instance, signs proclaimed, “It’s your brain, Use it!” or “What do we want… Evidence Based Change. When do we want it… After peer review!” Other signs mocked the use of signs at rallies to convey extremist views. For instance, one sign read, “God hates signs” and another sign read, “I disagree with you, but that doesn’t mean I think you are Hitler.” And finally, some signs were just nonsensical, such as a sign that stated “Oooh...Shiny!”

John Stewart joked about the diversity of the crowd, saying facetiously that the participants were a “perfect cross-section of American society” and making up the percentages of each demographic. However, the diversity of the crowd was striking. Attendees were young and old; there were many families (including mine) and people from states all across the USA. I was also struck by the large number of women wearing headscarves, in the Islamic tradition. The intolerance that has infected our political debate particularly affects the Islamic and East Asian demographics. I imagine that for some of these attendees, the rally was about much more than light humor.

The use of humor to deliver political messages conveys a lot about how our brains work. Authors such as Antonio D’Amasio, George Lakeoff and Sam Harris have written excellent books on these subjects. Increasing evidence indicates that the beliefs that we espouse are developed through a complex interplay of knowledge, emotion and logic. Many of our conscious beliefs originate from pre-conscious, emotional areas of our brain. Our emotional brain has a surprising and critical role in allowing us to derive conclusions from knowledge that is often incomplete. This system plays a primary role helping us to rapidly evaluate potentially dangerous situations, but interfaces in almost every conclusion derived throughout our thought processes.

The ideas generated by our emotional brain are filtered through our logic centers to create the seemingly rational statements that we use in virtually every aspect of our life. More knowledge, more security, or more training in logic elicits greater reason, while ignorance, fear and appeals to “belief” elicit less reason. Our belief systems also filter acceptance of information. The emotional brain rejects facts that challenge our belief systems. One can immediately see how emotional appeals, such as those inciting fear, eliciting anger or appealing to religious beliefs, could be used to lead the population towards irrational political outcomes by activating the emotional brain to bypass more reasoned responses.

The importance of emotion in our actions, even seemingly rational ones, creates a challenge for “rational” political debate. Information that questions a belief system is difficult to incorporate because our “emotional” brain rejects such material. Knowledge, though, can filter in and impact on beliefs. Framing arguments in the context of childhood or family is a particularly effective means of conveying information, because family and children are emotionally vulnerable topics.

Humor is another effective mechanism to convey knowledge that might challenge belief systems. Knowledge or logic conveyed through humor elicits positive emotions, which makes us feel less threatened and more accepting. The power of John Stewart and Steven Colbert’s messages lies in their skillful use of humor to question the many irrational beliefs and behaviors that pervade our society today. Thus, although the Rally to Restore Sanity was humorous, for many at the rally, humor was the medium, but reason was the message.

Is it possible for a parent to learn from a child’s mistakes? That’s what seems to be happening in the “toning shoe” market: Online claims made by granddaddy-of-them-all MBT (Masai Barefoot Technology) have been rewritten since mid-December, possibly in response to a cascade of legal claims recently made against manufacturers of other thick-soled shoes.

On August 25, 2010, California resident Venus Morga filed a class-action lawsuit against Skechers, makers of Shape-Ups, because she found that she “did not experience any of the benefits described in Defendant’s misleading ad campaign,” including “weight loss, firmer muscles, reduced cellulite, improved circulation, and improved posture.” But Morga’s substantive allegations go further than an attack on a “deceptive marketing campaign”: her federal district-court filing also states that “the scientific community has rejected [Skechers’s] claims” of enhanced fitness effects.

Handily, the burgeoning popularity toning shoes had earlier in 2010 led to a study commissioned by the American Council on Exercise (ACE), “Will Toning Shoes Really Give You a Better Body?” A series of exercise trials pitted three brands of toning shoes against a pair of standard running shoes. Researchers measured subjects’ “oxygen consumption, heart rate, ratings of perceived exertion (RPE) and caloric expenditure” along with muscle-group activity via electromyography (EMG). They found that “across the board, none of the toning shoes showed statistically significant increases” in any of the measurements, stating decisively that “there is simply no evidence to support the claims that these shoes will help wearers exercise more intensely, burn more calories or improve muscle strength and tone” through their foot-destabilizing designs. ’Nuff said, according to this preeminent nonprofit fitness organization.

However, corporate managers will say interesting things when a $1.5 billion market (according to one estimate) is at stake. A group president at Skechers USA fired back at ACE by telling MSNBC.com blogger ConsumerMan that the ACE study is “flawed, flimsy and based on junk science.” He pointed to the more than thirty studies that exist on toning shoes (see www.toningshoestudies.com for some examples). However, it is telling that the studies Skechers cites in its U.K. ads (which are, incidentally, no longer available on its American website) were apparently run by the company itself, as reflected in one “result”: “an average weight loss by our participants of 3.25 pounds” (emphasis added). Although this “result” sounds great, it is rather difficult to assess the true impact of wearing Shape-Ups when no control subjects (indeed, no control shoes) are in place.

Dicey science is at the heart of a similar case, filed after California resident Bistra Pashamova was injured while wearing New Balance’s toning shoes. Pashamova’s class action complaint alleges that the studies behind New Balance’s rock&tone and True Balance shoes are simply not valid. On January 3 of this year, Pashamova claimed in her class-action complaint that “none of New Balance’s purported scientific studies, if any, have been subjected to traditional scientific scrutiny, in that none of them was conducted by impartial, double-blinded third parties, and none was subjected to peer review or other methods traditionally used by the scientific community to ensure accurate results. Rather, these purported studies, if any, were commissioned by New Balance and, from their inception, have been nothing more than deceptive marketing tools. Further, actual scientifically sound studies have found that the Toning Shoes do not provide the benefits claimed by New Balance.” Sound familiar?

No stranger to the party, Reebok’s EasyTone shoes have also been targeted by consumers, twice in November 2010. One filer of an attempted class-action suit, Sandra Altieri of Massachusetts, doesn’t say why she was disappointed in the shoes, but she demands a “corrective advertising campaign” and that money be returned to those who believed Reebok’s claims and spent about $100 on them in the quest for a firmer butt and thighs. Reebok stands by its shoe in a statement to MSNBC.com: “Reebok has never claimed that by wearing EasyTone a person will burn more calories or that EasyTone is a ‘magic bullet’ that will replace exercise.” It’s certainly easier to claim innocence in terms of newly invented claims versus those that have graced one’s advertising campaigns in the past.

Surely those companies charged with making untrue statements will be toning down their rhetoric if they haven’t already. Ironically, it’s possible that the huge market for toning shoes wouldn’t exist if not for MBT, which is lawsuit-free as of this writing despite trumpeting “There can be only one true original” on its homepage. The Skechers spokeman implicitly acknowledged MBT’s claim when he told MSNBC.com’s ConsumerMan that “It’s very intuitive.… Walking on sand will be more effortful than walking on a hard surface.” MBT created their shoes in 1996, their website states, for exactly that purpose: to mimic the effects of walking barefoot in sand like the Masai. MBTs are patented, but apparently their curved, rocker-like sole was one model for the toning-shoe marketplace—hence one reason for the company’s keen awareness of “brand protection.”

If MBT wanted its “pioneering physiological footwear” to remain “unique” though, perhaps it should have left out the two most irresistible (and ultimately refutable) of its four claims: “MBTs activate and tone your muscles” and “MBTs help you burn more calories whether walking or standing.” In mid-December of 2010, this text appeared on the MBT website under the words, “Over 40 scientific studies prove the unique benefits that only MBTs deliver, here are some of the facts.” This text is now gone, replaced by unprovable, emotionally oriented statements like “enjoy the unique feeling” and the tagline “Love the way they make you feel.” MBT’s website and “benefits” video claim that the shoes will “generate muscle activity in the lower body,” which could easily be proved or disproved by EMG tests with or without the shoes—provided that the wearer is actively moving his or her own feet! The same could be said for the claimed “positive effects both when walking and standing.”

Even the heart of MBT functionality has been wrapped in a blasé-sounding claim, with another layer of protection supplied via a telltale asterisk: “The curved sole with its integrated balancing area requires an active and controlled rolling movement that can help the body to improve balance and posture while standing and walking.* … *As every individual is different, results may vary from person to person.” Which results? We can circle back to “increased muscle activity,” which we discover “leads to activation of neglected muscles, improved posture and gait and relief of back and joints” (though if you have a “history of unexplained falls” or other listed medical conditions, you would do best to heed MBT’s “Important Safety Precaution”). “Relief of back and joints” actually pertains to MBT’s other, non-fitness market: the one Skechers is warming up to with its Shape-Ups work shoes, complete with “aluminum alloy safety toe.” Nurses and other consumers—in reviews found all over the Internet—report that they can stand happily for twelve-hour shifts in “toning shoes.” These reports indicate a happy future for this market but not for skeptics.

The MBT website now states that its shoes “Tone your body” rather than claiming the more specific claim that the shoes “tone your muscles.” This latter claim has been taken out of MBT’s literature entirely. It was a wild claim that ended up getting the kids in trouble, so MBT was wise to rethink it.

The Australian manufacturer of Power Balance, the wildly popular rubbery bracelets embedded with holograms claimed to somehow adjust the body’s energy or vibrations, admitted in January 2010 that there is no proof their product works. A representative of Power Balance Australia issued a statement that read in part, “We admit that there is no credible scientific evidence that supports our claims. Therefore we engaged in misleading conduct.”

Power Balance bracelets achieved global popularity, in part because they were embraced by a parade of celebrities. Dozens of professional athletes, movie stars, and musicians use them and have been photographed wearing the bands. Australian researcher Richard Saunders said that “The claims are that these bands will improve your strength, your balance, and your flexibility. They also suggest it will improve your well-being, give you clarity of thought, improve your stamina and sports performance, that sort of thing.”

Saunders, co-host of the Skeptic Zone podcast, was asked by an Australian television show to test the bands on a representative from Power Balance. “I tested the head of the Australian branch, and he failed five times out of five tests. So it was pretty conclusive. These were blind and double-blind tests where he had to tell which one out of six volunteers had the band on. He was pretty shocked when they failed to work.”

Josh Rodarmel, co-creator of the bracelets, tried to explain the “science” behind his product by claiming that everything in nature has a “frequency,” and that the Power Balance bands restore a “natural healing frequency.” Claims like this, though common in New Age and “alternative” health circles, are laughable to scientists and skeptics like Harriet Hall, a retired medical doctor and former Air Force surgeon. Hall, who runs a Web site called SkepDoc devoted to examining dubious medical claims, told Discovery News that such claims about body vibrations and resonance are pure nonsense. “This whole resonance and vibration business is pseudoscience emanating from the myth of the human energy field—not the kind of energy physicists measure, but some vague and unproven life energy like the acupuncturists' qi (or “chi”).”