The Skeptic’s Message Lab
March 24, 2003
Here we go again: The federal government has put together yet another advisory body on complementary and alternative medicine (CAM) policy, and once again, science-based skepticism seems to have been left off the agenda. This time the offender is the Institute of Medicine, part of the National Academies, which has created a committee to investigate the “Use of Complementary and Alternative Medicine by the American Public.” The panel will be studying issues such as the licensing of non-mainstream health practitioners, but it will not bother to first “assess the safety or efficacy of CAM products.” What’s the point, you might wonder.
And it gets worse. The Institute of Medicine committee recently had its first meeting; among its fifteen members are a pseudoscientific naturopath, Leanna Standish of Bastyr University, and Jeanne Drisko of the University of Kansas, whose credentials include signing an anti-evolutionist petition and also, according to a biography provided by the Institute of Medicine, serving as “Program Director” of the American College for Advancement in Medicine. This group, as those familiar with the complementary and alternative medicine field know all too well, promotes EDTA chelation therapy, which is not just unproven but downright dangerous.
So, if you’re a dyed in the wool skeptic, you’re probably getting pretty hot around the collar around now, right? Wait, there’s more: What’s happening at the Institute of Medicine is hardly unique. Recently two more Bastyr University naturopaths, Joseph Pizzorno and Pamela Snider, were appointed to sit on the Medicare Coverage Advisory Committee of the Department of Health and Human Services. It was the first time naturopathic practitioners have been appointed to this five year old body.
The predictable way for me to write this column would be to fume about just how outrageous all this is. But I'm not going to do that, and here’s why: I don’t think it would do any good. Pretty much since the founding of the NIH’s Office of Alternative Medicine in 1992, skeptics have been railing about the tacit or explicit promotion of unproven medical techniques by the U.S. government. And what have been the results of these various protests?
Well, the Office of Alternative Medicine has since been upgraded to the National Center for Complementary and Alternative Medicine (NCCAM), with a much bigger budget. And the pattern that we're seeing with both the Medicare Coverage Advisory Committee and Institute of Medicine—an uncritical approach to CAM methodologies taken by committees that allow self-interested alternative healers to participate—is highly reminiscent of what happened with the White House Commission on Complementary and Alternative Medicine Policy, which released its final report a year ago. Clearly, skeptics haven't been winning the complementary and alternative medicine battle. To be honest, skeptics have been trounced.
So rather than another rant, I think it’s time for some introspection. I mean, sure, CAM has powerful supporters like senators Tom Harkin and Orrin Hatch and congressman Dan Burton. But would skeptics have fared better in this battle if they'd pursued a different strategy? Do they even strategize at all?
Again and again, I watch skeptics grow outraged about the nonsense being peddled by alternative medicine practitioners, debunk these people soundly, and then sit back and wonder why others don’t accept their arguments. Yet it ought to be clear by now that facts alone aren’t enough to defeat non-scientific medicine: If they were, most of CAM would already have crawled into a hole and died. The reason skeptics are losing this fight, I submit, is not because they have bad facts or arguments, but because they have bad tactics and a bad message.
Think about it. Above I listed three separate individuals from that naturopathic bastion, Bastyr University, who have recently been appointed to government panels where they can promote their own techniques. Now, the Committee for the Scientific Investigation of Claims of the Paranormal has a list of distinguished fellows who, in their collective prestige, trounce anything that Bastyr University could put forward. The Council for Scientific Medicine is also a pretty star-studded group. But I don’t remember hearing about any CSICOP fellows or CSM members being nominated to government panels on alternative medicine lately. Why not?
Some may say it’s because skeptics are persecuted. I think a bigger reason is that skepticism has pretty much zero political presence in Washington, D.C., at least that I'm aware of (and I live there). CAM’s invasion of government advisory bodies is a political phenomenon, and could certainly be countered, at least in part, by playing the political game: Lunching with bigwigs, meetings with congressional staff, forging alliances with key media and pundit allies, and setting up an advocacy office with a crack communications team. There are, after all, skeptically inclined politicians; on the alternative medicine front, dietary supplement critics Richard Durbin and Henry Waxman come to mind.
But an even bigger problem than lack of political connections may be a failure to communicate the skeptical message. Here’s a good rule of thumb: If you present your argument in such a way that a non-skeptic will instantly label you a “debunker” or “closed-minded,” then it’s a safe bet you've already lost that person’s trust. So it won’t matter how soundly you critique naturopathy, or chelation, or homeopathy, or whatever. The data you present will go in one ear and out the other, because you will have activated a prejudice against closed-mindedness and debunking that is far more powerful than any rational argument.
Knowing that this is so, why don’t skeptics try being positive for a change? Why not be pro-science and pro-biomedicine, instead of anti-pseudoscience and anti-quackery? Why not contrast the National Institutes of Health’s enormous expenditures on legitimate scientific research with the relatively measly amount of money that’s going into NCCAM each year, and put out a press release along the lines of, “99 Percent of the Government Accepts Scientific Medicine"? Just a thought.
Speaking of positive reinforcement, let me draw attention to one very impressive skeptic-oriented communications campaign that I recently noticed: ”Project Steve.” This was the National Center for Science Education’s way of taking a dig at Intelligent Design theorists who get tons of people to sign their petitions (like the one signed by Jeanne Drisko) and then pretend as if this is somehow representative of science. To show how absurd the whole petition game is, NCSE got “over two hundred scientists named Steve” to agree that evolution should be taught, even though Steves—and Stephanies—are “only about 1 % of scientists.” You can click here to see just how successful this was as a media strategy.
I don’t have either the space or the self-confidence to present a comprehensive message plan for skeptics on the subject of alternative medicine. But I would like to make a few points about things not to do when challenging CAM:
- Avoid a Siege Mentality, and Don't Come Off as Angry or Radical. Skeptics understandably get hot around the collar when their very sound arguments against CAM are completely ignored. But there’s no better way to turn off a potentially sympathetic audience than coming of as angry or intolerant. Indeed, I must say I was surprised when the Scientific Review of Alternative Medicine extended its name to “The Scientific Review of Alternative Medicine and Aberrant Medical Practices.” Um, was calling the other side “aberrant” really necessary? Certainly it’s not an approach likely to win friends or open minds to the skeptical perspective.
- Don't Attack Things You Can't Defeat. Skeptics are constantly whacking the NIH’s National Center for Complementary and Alternative Medicine (NCCAM). I myself have written about how this body isn’t living up to its mandate. But the fact is that denouncing it utterly, and saying it should be disbanded, is a poor strategy. For one thing, it’s pretty hard to convince people that a body of the hallowed National Institutes of Health is biased. For another, not all the research that NCCAM has funded has been bad: Take this study on the dangers of the herb ephedra, for example. Skeptics should encourage NCCAM to sponsor sound scientific research, rather than attacking its very existence.
- Don't Get Bogged Down in Doing Background Checks on Every Last Member of Every Last Panel. Skeptics tend to get personal very quickly in complementary and alternative medicine fights, singling out individual after individual who has no business advising the government about CAM because of various “conflicts of interest.” Now, skeptics may well be right about these conflicts, but the fact is that there’s nothing like a personal attack to shut down rational discussion, make bitter enemies, and create an atmosphere of negativity that will turn people off to the skeptic message. Furthermore, skeptics sometimes target the wrong people and paint with too broad a brush. On the Institute of Medicine panel, skeptics have objected to two MDs that they would have been better advised to leave alone: Alfred P. Fishman and Susan Folkman, of the University of Pennsylvania and University of California-San Francisco Schools of Medicine, respectively. I have interviewed both of these professors in the past, and for what it’s worth, neither struck me as irrationally devoted to CAM. Fishman even confessed to me his view that “almost everything that’s been described with homeopathy is a placebo effect.” Couldn't skeptics find common ground with someone like this?
These are only a few baby steps toward the sort of rethinking that I believe will be necessary if skeptics ever want to start winning on the CAM issue. Much more soul searching will be necessary. But the key point should be clear: Retreating inward, talking only to skeptics, and getting angry and bitter are exactly the opposite way to go. Skeptics should learn to be politic, and practice the fine and subtle art of persuasion—what folks today call public relations. Sad to say, perhaps, but if you do it right, the stuff actually works.