In my last post, I introduced myself as a pharmacist in a small-ish town, eager to combat the growing acceptance of pseudoscience into the mainstream. I love living where I live for a multitude of reasons. But I’ve found it rather challenging to wave the flag of skepticism. I have no problem displaying my preference for science-based medicine at my workplace, but outside of work a rather large road-block has emerged – social isolation. While I have found a few kindred spirits in a public health nurse and a high school science teacher, they, too, remain relatively quiet about their skepticism. I decided a few months ago to push the boundaries, and learned the hard way why others have been forced to keep quiet.
I am very involved in my kids’ school council. Just over a year ago, the principal announced that she was taking a leave of absence for health reasons. Of course, I ran into her a few weeks later around town, and she confided in me that she has been diagnosed with adrenal fatigue by her naturopath. How timely that I had just read this article by Scott so I could at least acknowledge that I’d heard of it. I stopped short of offering my support, but dared not question the diagnosis given that I wasn’t her health care provider, and she was still in control of my children’s education. She has a Master’s degree, by the way. One of the more prominent parents on the council calls himself a “family physician” and specialist in sports medicine. Most teachers call on him for health advice, believing him to be an actual Medical Doctor. Since his practice is in a nearby city, not many actually know that he is a D-TCM, and his sports medicine “specialty” is based on the fact that he does acupuncture on athletes. He even goes as far as joking about being “on-call” at the hospital, and writing prescriptions for some “good stuff” for the teachers, both of which I know are false, but he seems to feel the need to keep up a front. The mother of my kids’ best friends is a Reiki practitioner, and is often inviting us to lectures about how to align our chakras. A local chiropractor is very vocal against vaccination and chemotherapy, but a friend of mine – knowing that his views are extreme – still takes her child there for treatments. Another local naturopath presented a Lunch n’ Learn at my husband’s place of employment, where he promoted the idea that vaccines cause autism and a multitude of other disorders like allergies and ADD, and then advertised that he was a DAN! Doctor so he could cure them! My husband sent me the flurry of e-mails that soon followed, as HR was sent on a pursuit to find out if his services were covered by their health benefits. (They were disappointed to find out his services were not covered as he is not certified as a naturopath by any Canadian organization.) As my son progresses in a competitive sport, I am finding that the coaches encourage (but stop short of mandating) many forms of alternative treatments, such as fire-cupping and supplements to try to enhance the performance of these kids. Guess who the “team doctor” is? Yup, my school council colleague. A team parent even told me that the clerk at a local health food store could give me excellent advice on supplements for my son. I politely stated that I didn’t think a clerk could teach me anything, to which she replied “Oh, of course! You’re a pharmacist!” Even members of my extended family shun medical / pharmacy care in pursuit of so-call “natural wellness”. I am literally surrounded by quackery every single day.
So I don’t know what possessed me to try to take on the anti-fluoride movement in my town. Our town council consists of less than 10 members, none of whom have any sort of degree or background in science – although one of them is a chiropractor. Every 4-5 years the fluoride issue reared its ugly head, and every 4-5 years council had firmly sided with science and either voted to keep it in, or squashed the motion to even have it discussed. This time, however, things were very different. A council member was very involved with the Fluoride Action Network, and began to give public lectures about the dangers of fluoride. She put a motion through council to have fluoride (in her words – the dangerous chemical hexafluorosilicic acid) taken out of our water supply. The language of the motion she put forward left no doubt in my mind that she was going to win. At the very least, I wanted to correct the pseudoscience strewn throughout the public motion. In a few decades time, (hopefully!) someone will look back on that motion and wonder what we were all thinking.
So began the orchestrated letters-to-the-editor in our weekly paper, coming from all reaches of Canada to tell us why we should remove the evil substance that was poisoning our children, causing our cancers, and violating our health freedom. It led up to a public forum, where each “side” would have an expert speak to the issue in front of council. My Mother-in-law wanted to attend, so I agreed to go with her and watch. As I arrived at the standing-room only event, I saw that the expert on the anti-fluoride side was passing his book out to each of the council members. After the experts finished, I was shocked to find that the public was invited to share their views. They would take 2 from one side, then 2 from the other and continue until everyone who wanted to speak had a say. Time was limited to 2 minutes. My Mother-in-law was the 1st one to jump up and speak even though she had nothing at all prepared. My partner-in-crime the public health nurse and I decided to keep our behinds firmly planted on our chairs. I listened as my mother-in-law passionately stated her case on why fluoride should remain. She admitted that her information was anecdotal, but proudly stated that her boys – who grew up with fluoride in the water but did not take good care of their teeth – had very few cavities. This was in contrast to her experience growing up without fluoride, and despite taking obsessive care she has ended up with thousands of dollars of dental care stemming from multiple cavities as a child. I applauded her bravery at taking on the obviously anti-fluoride crowd. When the ring-leader of the local Facebook group against fluoridation stepped up to the microphone, I was struck dumb when she opened by stating that “the lady whose sons grew up with fluoridated water should know that her boys would have had higher IQ’s if they had grown up without fluoride.” That was MY husband she was talking about! Not only am I well-known by council members as a local pharmacist, my husband is also very well-known to them through his profession. As I sat there listening to one anti-fluoride speech after another (the pro side had long since run out of vocal supporters), a slow burn developed inside of me. Those sitting around me nudged me to get up there and defend my husband, as it was becoming painfully obvious that their own efforts were being drowned out.
I started scribbling notes on a scrap piece of paper that would specifically address some of the points that had not already been countered and cautiously stepped up to make my voice heard. Not a great public speaker under pressure, I fumbled a little with my defense of science and medicine, but boldly stated that I thought their fearless leader had dealt my husband a low blow – while looking to council and mentioning that since they all knew him, they could all vouch for the fact that his IQ is just fine. I hurried back to my seat where I received lots of pats on the back, and even a quiet “good one” from the lone radio reporter in attendance. The fearless leader rushed over to me after the hearing had ended to apologize that her words had come out wrong, but it seemed that she was trying to save face after realizing that she had not just insulted a random citizen, but someone who was obviously known to the decision-makers. Not long after, I ran into the mayor and he and I had a good laugh about my defense, and he congratulated me on my stance. Little did I know that a few months later, his would be the lone vote against the motion.
For a month afterwards, the public was invited to send in their letters. One letter was brought to my attention after it landed on the public record. Addressed to the mayor and council, it was a poorly written diatribe about health freedom and democracy, but included a page about the “pharmacist lady” who spoke at the hearing. Using such descriptions as “absurd”, “sheer stupidity” “confused lady who should not have a say on the matters of health” and “someone who sells toxic chemical compounds”, he concluded by saying that pharmacists have a very high rate of cancer due to being around so many chemicals. While he didn’t use my name, it wouldn’t take anyone long to figure out whom he was talking about. Several months prior to the hearing, I had been held up at the pharmacy for OxyContin by a man wielding an 8-inch knife. I lost more sleep over this letter than I did after the robbery. Thankfully, after a few words with the mayor, the letter was removed from the public record. He admitted that it was libellous and should never have been included. I took a step back and tried to figure out what I had learned from this experience. I finally stepped up to call out pseudoscience, and what did I get? Personal, public attacks against my husband, myself, and my profession. What did they learn? That public attacks are not only necessary against those who are more qualified to speak than they are, but they also WORK. Every single one of those council members, save for the mayor, voted with them – albeit mostly for the reason that fluoride should be an individual choice, not because they believed it was harmful.
Every day I read blog posts from skeptics who are not afraid to take the punches in order to defend science. Many of them, if not most of them, have had far worse experiences. Perhaps being part of a larger community is somewhat insulating? For me, it seems that to take my stance public would be to isolate myself from most of the people with whom I have day-to-day involvement. I’ll never adopt the “if you can’t beat ‘em” attitude, but maybe someday I’ll have the courage to get my voice back. Until then, my main focus is to teach my children critical thinking skills – because it’s clear that they won’t be learning them in this village.
Photo credit Trey Ratcliff www.stuckincustoms.com under a CC licence
Science-Based Pharmacy 
I’ve lived in similar towns and experienced similar events. I now live in a large-ish city and still experience social isolation because I challenge (respectfully) the woo that I seem to come into contact with on a constant basis. Even the most casual encounter seems to end up with some mention of superstitious nonsense.
Having thought a lot about this, I’ve concluded that the “belief” in woo is just a by-product of religious belief–which we all know is the majority position, even if it is just a vague idea of “something greater than ourselves”. Then I tried just not saying anything when people started with their tales of woo, but found it unbearable intellectually.
In the long run, I guess I prefer social isolation. My family are on board, so I pretty much stick with them–and the blogs! There is a nice pharmacist at the corner drugstore who I commiserate with when the opportunity strikes and that gives me courage.
It is sad that some of the nicest places, geographically, attract so much woo, but I have found it to be almost as pervasive in larger places, if not as vocal in matters of public health.
The reason my children are “on board” is that I taught them to think critically (which sadly, led to some confrontations with teachers, including science teachers!), so I applaud you for that. It is the best “medicine”.
Thanks Janet – our town does indeed have a lot of church steeples.
Where I’m from, it’s more the New Agers who wouldn’t set foot in church, per se, and yet they are slavishly devoted to some ver cultish ideas and outright conspiracy theories. Sometimes I can’t believe how long I quietly “tolerated” some of these people. One by one I have let them know where I stand and if that leaves me with only my immediate family, a few rational real friends, and the blogging community, well, so be it. You still have children at home, so it’s harder for you to go that route so I truly hope a few rational people will step up and offer their support, because in the end, the kids in your town are losing out on a major public health intervention. I know that fluoride can be obtained individually, but it’s always better and easier in the water supply.
Courage my Dear!
As a retired nurse I find it hard to explain to unscientific minds that
data they have obtained from ” other sources” must be researched
in many blind studies to prove true.
If patients are self medicating they must tell their Dr when they seek
help—-as any substance can cause side effects when ingested with
drugs the Dr has prescribed.
Mario
I completely agree with Janet. You are to be admired for trying to educate the public. Hopefully some of it stuck with the less benighted of them. I too, live in a small town without fluoridated water.
You can probably see the line-ups forming if you had a big sign up in your pharmacy, selling fluoride: “Just add this to water and watch your dental bills disappear.”
People who are sensible will get advice from dentists and dental hygienists, use fluoride toothpaste and use fluoride mouthwash on occasions.
The “woo” merchants are a menace to the public. Please try to feel encouraged to do your bit for public advocacy of Science. You are probably one of the only scientifically trained people that many of your customers meet and they may feel less intimidated by you than a doctor…
This is a major issue you not alone
Sadly, as author Sam Harris says, “Not everything worth saying is worth saying ONESELF”. I’ve also learned this the hard way living in a small village for the past 10 years. Thanks for posting.
There’s no intelligent life in small towns. You just hafta give up and move where there is. It’s not worth the frustration of living among ABJECT IDIOTS who resist genuine scientific education, and make livings from tricking themselves and each other into shortened, less healthy lives.
BUT, one area where you’re probably wrong — fluoridation of water. If you do additional reading you’ll find it typically does more osteo harm than dental good. Toothpaste has it aplenty, as do most food products made with fluoridated water. Fluoridation was necessary when introduced, when it was the only source, particularly in areas of rural poverty. But now it’s simply overkill, and valid, credible, rigorous, peer-reviewed, prestigiously-published studies show that elimination of fluoridation in water supplies produce no increase in dental caries, while incidence of osteo harm due to fluoride’s replacement of calcium in bones had significant increase.
For the lay reader, there was good coverage of this debate in New Scientist magazine, including references to the credible, rigorous studies.
But that issue alone demonstrates how hard it is to keep up on these things. You’re well-educated (at least R.Ph., possibly Pharm.D) and even you were not likely aware of the changing scientific opinion on fluoridation.
Now imagine these local yokels with whom you live trying to keep up. They can’t. Most don’t have the education to even read an article written for a lay reader in a science magazine, much less comprehend a study.
And they’re more interested in other things. Like football, which is crippling our youth. No way you’ll convince them that inoculations are GOOD and football is BAD. People don’t believe what they don’t want to believe.
If they were willing to do that, there’d be no religion, either. (A near-perfect world.)
There is evidence to support community water fluoridation. The Institute for Science in Medicine (full disclosure, I am a Fellow of the institute) has a detailed policy paper which explains why fluoridation provides a demonstrable public health benefit. There are two documents, both published this year, that may be of interest:
The Anti-Fluoridationist Threat to Public Health [PDF]
Community Water Fluoridation [PDF]
The public health campaign I Like My Teeth is also an excellent resource with FAQ’s about fluoridation. And there is a recent article by Dr. Steven Novella at Science-Based Medicine, Antifluoridation Bad Science which summarizes the key issues. Interestingly, Portland, the largest municipality in the USA that didn’t fluoridate its water, just decided to begin fluoridation in 2014.
I don’t want the comments on fluoride to distract from Sara’s overall point of her post. The SBM post still has an active discussion thread on the topic.
@Nelson, I spent quite a bit of time researching the literature, I didn’t find anything that convinced me that it was harmful – but I did go to the hearing with an open mind. After the debate, it was no contest … the public health expert stuck to the facts, presenting excellent data and putting risk of adverse events into perspective by showing differing rates at differing levels of fluoride exposure. The anti-fluoride fellow stuck to propaganda – a small, Chinese study about lowered IQ in a region where fluoride levels are unnaturally high, and theoretical risks, at levels so high that it’s not even an issue.
Mostly, I was concerned about how the motion was written – there was so much mis-information and fear-mongering in it that I thought – at the very least – the language of the motion needed to be changed.
Sadly, the documents that Scott linked to came too late – I would most certainly have sent those to every council member to read.
I agree there are excellent cases for and against. And I agree that the point here is the way that the town handled the matter — admitting junk science, and worse, codifying that junk science into its ordinance(s).
We don’t want to turn this into a question on fluoridation — we can all agree that legitimate, scientifically-rigorous public health studies should have been consulted, as opposed to the VooDoo nonsense your local council chose to use.
It’s frustrating to sit through that kind of thing. I often feel that there’s simply no remedy for kind of ignorance until the federal government controls the science content of the schools, and NOT the idiots on the local school boards.
After that, we still have to wait a few generations for the proper education to take root and grow.
For now, I’m content to see the small-town decline continue, and the lives shortened by the idiocy: let them pay the price for their unwillingness to embrace modernity. That will be a natural consequence which drives them either to abandon the small-town mindset, or die off.
That’s natural selection — the fittest are the most educated in science, and the more clear we make the distinction between the benefits of science vs. the benefits of believing idiocy, the faster we’ll win over the credulous, and, in the end, the more lives we’ll SAVE.
Finally, in fairness to the scientific argument against water fluoridation, you’ll note that this argument is largely settled in western Europe, a place where science dominates government debate to a vastly greater degree than here. Studies there show no increase in dental caries (cavities) where fluoridation is discontinued, but they do show a decrease in bone damage due to fluoride.
The “fluoride is safe” argument rests very heavily on a really OLD report by National Research Council from 1993 which (probably wrongly) found that fluoridation in water didn’t contribute to rates of bone diseases (or infertility, birth defects, and kidney diseases).
But it while it’s unclear on the above parenthetical maladies, the best correlations are with bone disease, most specifically fluorosis.
The problem with the 1993 report, and those subsequent which are based on studies using similar models, is that the amount of fluoride ingested from other sources, such as foodstuffs, are not included. Also, at this time the per-person quantity of bottled/canned beverages is almost triple that of 1993, and virtually ALL contain fluoride because they’re made with water from fluoridated sources.
At this point, a typical person is ingesting vastly more fluoride than the CDC-recommended maximum.
The other problem with arguments by the fluoride proponents is that, since that 1993 study, their argument rests primarily on analyses of studies showing fluoride damage as being “flawed” or not conclusive.
That’s fine — we can’t yet show as definitive a link to bone disease as many fluoride proponents would prefer. BUT, we CAN demonstrate that:
1. There’s no longer a proven benefit to fluoridation in the U.S.
2. There’s growing evidence that fluoridation is a possible health threat.
3. Fluoride is something humans haven’t been consuming until recently – evolution hasn’t yet had its say in defense/detoxifying it, if that’s necessary.
4. When we have determined limited-to-no benefit to a given treatment, and possible-to-probable harm, even if to small populations, we must err on the side of not using the treatment.
We’ve seen way too many bad treatments (overdoes/overuse of radiation, thalidomide, DES) continue in the past as evidence began to mount.
The safest course is what you and other practitioners are sworn to: Do no harm.
——–
CLEAR DISCLAIMER to MORONS who want to end fluoridation without SCIENTIFIC evidence and proper discussion: I’d rather drink STRAIGHT FLUORIDE than give you BUFFOONS any aid or comfort.
The above opinion on fluoridation is strictly my own, gathered from reading credible lay publications which summarize peer-reviewed studies in CREDIBLE publications and which summarize opinions of CREDIBLE experts in the fields of these studies. This is not meant, in ANY WAY to give aid, comfort, or support to the IDIOTS who use unscientific means to cast false accusations at valid treatments, one of which may very well be fluoridation of drinking water.
(YES, I MIGHT BE WRONG! Not enough evidence is yet in.)
Nor in any way do I agree with ANY conspiracy theory regarding healthcare (other than that drug companies prefer to slightly modify existing drugs, get new patents, and profit thusly, rather than develop new classes of drug – a more costly and more beneficial process… but then, that’s hardly a secret conspiracy: it’s a common criticism).
I believe ALL present inoculations are SAFE and EFFECTIVE, and that parents who refuse them for themselves are idiots, and parents who refuse them for their children are CRIMINALS.
I further find that that ALL of the following are 100 PERCENT QUACKERY: Chiropractic, Homeopathy, Naturopathy, “Nutritionism”, Acupuncture, VooDoo, Santaria, Little Green Men from Mars, Cow-tipping, 911 Trutherism, Birtherism, and the idea that the Nazis had anti-gravity devices.
I would also like to say, having lived in a small town, I have come to believe that there is a substantially greater degree of sexual contact with farm animals than generally believed, and that IQ decreases proportionately with distance from the center of a metropolitan area. (Also note: driving a pickup truck does NOT make you look more macho — it just wastes fuel.)
Gawd, I hate small towns. How do you stand it?
This all sounds familiar. The anti-fluoridation group in my small town has been going through similar cycles, including a relay sequence of comments to Town Council (though not the papers) and smearing of local health officials in their propaganda. They haven’t gained traction with Council, but several residents and uni students have put up “Force-Fed Poison” yard signs. Seems like several towns have a small but dedicated group like yours that resurfaces every year or few for another go, and it’s becoming clear that ours has now spawned its own.
(It’s not the church crowd, though, at least not here. These folks seem to come mostly from the university, which is dispiriting in a confounding way.)
Anyway, as someone who’s also fumbled their way through a brief rebuttal to an anti-fluoridation Gish gallup, i want to thank you for taking a stand at all, especially given the higher social cost on your end.
Keep up the good fight! I’m curious, what was the book that was presented as evidence of fluoride being “bad” for the children?
@Nelson
I don’t want to say “concern troll” because that was done to me once and it made me just break down and cry because nothing could be further from the truth and I felt horrible being so misunderstood. Having said that, I am going to refer your links to people who will know and see what they say. Portland has very recently been through all this and has made every effort to get the latest evidence so…..
As to the situation in Western Europe, I was wondering about that as well as the anti flur group in Portland bring them up ad infinitum. It doesn’t convince me of anything. Europe is also rabidly anti GMO technology, which in and of itself (putting aside what Monsanto does with the technology of plant biology) isn’t “eeeeeviiiiilllllll”. But be careful if you want to stand up and argue that–even at a meeting of avowed skeptics in a major US city. Europe (not France!) is also rejecting nuclear power out-of-hand when there are ways to make it a part of the mix, at least. Waste storage is still a problem, but France with its more modern processing, produces much less waste than the US. Europeans are big on homeopathy (Boiron anyone?) and all sorts of other woo–many of their national health systems cover it. I wouldn’t be convinced of something just because Europe is doing it–public transportation and great town planning, yes! Accuracy in public health policy and a science-savvy population–not so much.
The data used in Portland shows much higher caries in untreated Portland than in treated Vancouver, WA just across the river and even in other Oregon communities near Portland that are treated. Sorry, but I’m tired of typing the new “f”-word.
I enjoyed your disclaimer enormously and glad you added it and I will check your links and keep an open mind, but it’s going to take extraordinary evidence at this point. By the way, I nor my children consume bottled or canned beverages, so I’ll take the treated tap water, thanks. I actually raised my kids in Portland (don’t live there anymore) and remember having to give them fluoride pills and take them to the pedodontist and pay for lots of supplemental fluoride treatments for years. Our history as a family with both types of water and older kids partly raised on treated water is only a sample of four kids, but our experience was exactly in line with the data presented in Portland.
One more thing–there are many nice small towns that have a lot going for them in spite of (often) educated people who embrace woo (or New Agey stuff), and I have lived in them by choice. They have much to offer and are not at all small-minded in the pickup truck sense. This is especially true in the Pacific Northwest and even here in Wisconsin. You have to choose your small towns, but you can find some with a nice mix of people with city sensibilities and equally interesting lifetime residents. They can be a great place to raise a family and be close to recreation. I love cities and I love some small towns–just spare me the godawful suburbs!
Peace.
Hey Sara, your article was well received on Hubski. One of the users there posed a question for you:
From: eeweatherly
”
I love it when people stand up for anything they believe in, I hope my children do so one day. The fact that the author of “Skepticism in a Small Town” refers to natural medical practices as “quackery” is just plain ignorant. It is unfortunate that for her medicine has to be natural or not. Both are very important in our lives. I am so thankful for medications when they are needed, but am a strong believer and a customer of “quackery” such as cupping, acupuncture, chiropractic care to name a few. I would be curious to know why some feel that fluoride needs to be in the water instead of given as a supplement from one’s doctor. Why shouldn’t each family be able to choose?”
The link- http://hubski.com/pub?id=41794
Mittenrefugee, I hardly know where to begin, but most people who read Scott’s blog also read sciencebasedmedicine.com which if you visit will give you some insight into why rational people who evaluate things based on the evidence rather than “belief” call the practices you mention “quackery”.
As to fluoride in the water as opposed to taken as a supplement, this is easily answered. Firstly, a steady source from the water is simply a better delivery system. Secondly, it is much cheaper to do it via the water supply. Thirdly, all kids get it, not just the ones whose parents take the time and have the money to provide the pills and dentist provided treatments. Fourthly, there is no credible evidence that fluoride in the water does any harm whatsoever and plenty of solid evidence that it is a superb public health measure that saves time, money and alleviates pain and suffering–especially among poorer children.
Lastly, there is nothing UNnatural about science/evidence based medicine and there is much to recommend it–especially evidence. Nothing is perfect, but I’ll put my trust in the 21st century rather than the Middle Ages.
Afterthought: I, too, like people who stand up for themselves, but I only pay attention to what they say if it’s evidence based. They can “believe” whatever suits their fancy, but there’s little value in my paying much attention to it because it’s just a sample of one.
Hey Janet, just an fyi that I’m not the author of that question posed for sarah. It’s from a thread on another site discussing her writing and I therefore thought she might be interested in it. I tend to agree with you regarding your take on fluoride treatment as well as western medicine. Though I think a good physician will be open to all avenues of burgeoning treatment when, as you say, they are backed with evidence.
Though if someone wants a placebo, let them take one.
Cheers.
Fluoridation should be looked at on a cost benefit basis, not simply a given on next year’s budget. London, ON spends 150 k annually on it. Is the cost of the added water treatment worth it in these tough economic times? I say it is, but in other cities different funding priorities may take precedence.
$150k/yr for 366,000 people seems a pretty good deal. Less than $.50/person. What’s the cost of thousands of poor children getting their teeth fixed on Medicaid–or by the health care system in London, Ontario? Public health is a major function of any city or municipality so to not do fluoride because of the cost is kind of like not having garbage collection because of the cost. Piled up garbage would lead to all kinds of health and hygiene issues fairly quickly. There are some things that are necessary where population is as dense as modern cities.
Still, it is, of course up to each city to make these decisions, but where money is the issue, I would hope that state/provincial or federal government would step in to help. Public health is one of those things we need to all be in together whether village of mega city.
I’m a pharmacist in Toronto. My husband is a musician, and we have many friends in the arts community. CAM is trendy these days amongst intelligent, creative people who have had little or no science education. Of late, naturopaths have become particularly fashionable.
I have tended to be polite, telling the truth if asked, but I usually don’t volunteer advice if folks tell me about, say, the ayervedic remedy they are trying. I am beginning to question all the soft treading I have been doing, and wonder if maybe those of us who have the education to comprehend what quackery CAM generally is should really speak up more. My friends don’t have the training to understand how they are being scammed.
@Denise D
I’m so glad you brought this up because it is a question that goes largely unanswered in the blogs I’ve been reading now for a couple of years. I have lived in at least two very “artsy” communities where the CAM situation is exactly as you describe. Now that I live in a large-ish city, I still see this and come across it in even the most casual conversations.
I have tried every approach and ended a number of what could have been great friendships because of this. I have found that once this kind of belief. You will usually find that most of these people are deeply committed to religion (standard or New Age(y). Some have even been drawn into (or are just of a type) multiple conspiracy theories that go beyond BigPharma and the “evil FDA”. Some only dabble because they see “no harm”. A gentle explanation of possible harm might help in this case.
Since there doesn’t seem to be much you can do once people are way into CAM on a personal level, or perhaps my skills are just not suited to this kind of thing–I tend to be as blunt as the example you give–I have had to simply stop seeing these people. On the flip-side, I have been shunned by them as a group just for asking a skeptical question or two. They can be very cultish, especially in smaller communities where they are close to the majority population.
With the adoption of “integrative” medicine at many prestigious clinics and private practice, it is even getting harder to offer a simple remark like, “I only see MD’s for my health issues”. You will now often get the response that the woo being used was “prescribed” by an MD, although sometimes they say “doctor” and this will mean chiro or naturopath or anyone with a PhD (which may be from Clayton College, the now defunct mail order college of “natural healing”–or some such).
I could go on and there are lots of places people land on the woo-spectrum, but what to do? I joined the local skeptics group more or less as a support group because I was being so inundated by all this. It was fine as far as CAM goes, but then we had a speaker (plant biologist) on GMO, and you wouldn’t believe how aggressive some “skeptics” became! We had another talk where a “skeptic” would not give up on defending the “massive healing potential” of yoga, even though he condemned everything else.
The problem is, as you say, lack of basic science education. Add to this, the built-in respect for religious freedom and you get medicine and religion all tangled up.
All we can do I guess, is educate. I wish we could do it in a bigger way than blogs. It should be a national priority, because it is connected to healthcare and is wasting resources.
As a pharmacist, you have something I don’t–formal credentials! If I were you, I’d look for opportunities to give friendly talks on say, drug safety, where you could work in positive examples of testing protocols, basic principles of logic and its fallacies, and mention how many years you studied chemistry and the like to understand the way drugs really work and what their potential for ill and good really are.
I used to be a shruggie and even dabbled in a bit of woo myself before stumbling on some great books that sorted me out. Luckily I have some good basic science education–enough to understand the history of and the method of scientific inquiry which enabled me to choose the books I read over the ones chosen by the more gullible.
Once of the things I find especially annoying in all this is that public libraries shelve the most rank pseudoscience “health” books on the same shelf space with legitimate medical literature. This lends credibility in a very subtle way. The town I lived in that was very woo-ish had a lot of starving artists who had no health insurance (not a problem in Toronto) got most of their material at the library (now its Google, of course).
These people are sincerely looking for some help with some problem and this is where “what’s the harm” really becomes involved. I have no evidence, but I’d like to propose a study, because in this town I personally was acquainted with several people who died before age 60 from cancers, some of which I have now learned are very treatable.
Sorry this is so long, but your story hit a nerve–one that I have not been able to sufficiently soothe with any balm.
For instance, here’s what a friend put on her Facebook:
“Did you know that liver stagnation can lead to stress and even depression? Monday’s class will focus on a Kundalini Yoga set to help physically and energetically cleanse the liver, and a meditation to help release held stress. Being clear and relaxed is a way to serve and uplift others.”
How do medical professionals deal with this sort of nonsense diplomatically when perpetuated by friends and neighbours? Currently I don’t say anything (usually; I ended up in the middle of a flame war on FB with an old friend who I discovered has turned into an anti-vaccine conspiracy theorist in his middle age).
One friend, a former Shoppers Drug Mart pharmacist who now owns his own independent pharmacy, had this question: “What’s a homeopathic remedy for a child’s earache?” My friend replied, “Take your child to the doctor! What’s the matter with you people?”
I don’t think insulting them wins their hearts and minds. What does?
@mittenrufugee
Yes, I know you were quoting someone else, but perhaps I misunderstood the motivation you had for doing so. It seemed to me that you felt the question was valid and that was why you were passing it on.
At any rate, your use of the term “western” medicine (what other kind is there that is science-based?) and your (unethical) take on doctors using placebo tells me that you are not nearly skeptical enough. Maybe you are a “shruggie”?
I can only ask you to go to sciencebasedmedicine.com and enter “shruggie” and “placebo ethics” into the search box and read up before you reply.
You said: “I think a good physician will be open to all avenues of burgeoning treatment when, as you say, they are backed with evidence.”
I’m not sure what you are getting at there or what “burgeoning treatment” refers to, or to what standard you hold for “backed with evidence”, but I encourage you to investigate further and to be sure you understand what constitutes real scientific, rigorous evidence.
Cheers!
Motivation: (as I stated) To let an author know that their work was being discussed.
Placebo: When did I say it was unethical? I was merely making a humorous observation that some people will use naturopathic methods and receive relief based purely on the placebo effect but will ascribe credit to the naturopathy.
“Burgeoning Treatment”: Refers to burgeoning treatments of all kinds. If allopathic doctors didn’t do this we’d all still be blood-letting. Forward!
Make sure you “understand”: Condescending much? I’m no “shruggie”, I value the scientific method over all forms of intuition. I do realize that in medicine there are shades of grey, things we don’t yet fully understand about our physiology and as such I am open to learning as much as I can -When it is backed by evidence, peer reviewed and born out of the scientific method.
Remember though, allopathy can be a “religion” too. No knowledge is concrete, thank goodness or else we’d still be thinking the world was flat and in the center of the solar system -which was the entirety of the known universe, which was not expanding etc, etc.
Forward!
Mittens, I apologize if I came across as condescending–not my intent, but when you use phrases such as:
Remember though, allopathy can be a “religion” too.
I can’t help but view you as less than scientifically literate. The term “allopathy” is pejorative as used by CAM followers and has no place in a scientific discussion.
It is also a terrible misunderstanding of science to refer to it as a “religion” Nothing could be further from the truth. Science claims certain things to be universally true and accepts that further investigation will probably not change them. The earth is indeed spherical. But it keeps an open mind otherwise and continues to investigate. Science never has claimed to “know everything”. It knows that it always keeps looking and adapts as new evidence becomes available, but this is not the same as continuing to support something like homeopathy with the claim that we “just don’t understand it”.
The fallacies of things like homeopathy are so well documented that rational people can close the door on further investigation without being guilty of a religious devotion to science.
On the matter of placebo effect, you said:
“Though if someone wants a placebo, let them take one.”
Again, sorry if my comment on that was overly accusatorial, but people should make decisions from an INFORMED position and to simply say “let them…” is a “shruggie” attitude. I don’t use the word pejoratively, it simply means that people who know better tend to opt to shrug it off rather than help to better inform those who are being informed by less than credible sources.
You seem to be approaching things from a science-based perspective, and I can only encourage you to continue on that path. I would highly recommend you do some reading at (again). sciencebasedmedicine.com and many others where all this is discussed at length and where you can get a good, solid grounding in what the scientific method really is, how to spot fallacies of logic, and get expert evaluation of studies that circulate in popular media.
I hope we can be friends!
“better inform those who are being informed by less than credible sources”. -Meh… who has the time. (shrugs as he writes this)
I’ve never heard the term allopathic used pejoratively. This seems like a cause you are passionate about and thus are likely having conversations with opposition that I am not. My wife is a doctor (a damned good one too) and she hasn’t taken issue with the term when it’s used in her presence. But again, I’ve rarely entered this debate and I’m guessing you have often. Here is a conversation I had about a year ago: http://hubski.com/pub?id=4775 but I haven’t since. So… I’ll study up 😉
While I’ll admit, my wife is the scientist in the family, I have a rudimentary knowledge of medicine that is probably far greater than the average person. When you’re married to a physician and helped them study through med-school and now in to residency you tend to get a tangential education.
I’ll check out the link. Good luck educating the leach users and snake oil proponents.
“I hope we can be friends!” -Always.
Thanks for the clarification Denise. It’s difficult to include all details in a response post. I agree about context, although I’m not sure in what context the use of allopathic medicine would be acceptable–perhaps when it comes from someone nice who is way behind the curve with basic science?
Mittens, (and that is my friend-oriented nickname for you now) I’m glad to hear you have such an intimate relationship with someone science oriented, although I must remind you that Dr. Oz and Dr. Weill, Dr. Mercola, Dr. Sears, Dr.many others are heavily into the woo. Not saying your wife is–definitely not. But I’ve become skeptical. Too many people lately are telling me their woo was “prescribed” by an MD, or allopath as they often term it. I don’t go off on anyone for saying allopath, but I don’t let it slide either. I try to use it as a starting point to get them reading something besides Mike Adams, Gary Null or the like.
It’s discussed frequently on SBM that many doctors are shruggies and it is part of the mission of the blog, I believe, to get more of them to think about the passive effect that can have on the problem.
Thank you for taking the trouble to carry on the conversation long enough to clear up misconceptions. I will go now and read your conversation that you linked to. Fair is fair. 🙂
“Allopathy” has its roots as a pejorative term originally coined by the founder of homeopathy as a catch-all term for science-based modern medicine. There’s been a certain amount of semantic slippage around it since it has been used frequently to describe modern medicine. Some medical folks are like meh. For others, the use of “allopathy” raises major hackles. I’m kind of in the middle, willing to consider context rather than jump to being offended by it.
I don’t like the term “western” medicine much because it’s simply not accurate. Science-based medicine in both its history and its practice is not at all western.
Oops, I should have replied to you separately. Hope you see my reply to mettenrefugee!
I also live in a “woo” infested small town on Vancouver Island. When I complained publicly about a local naturopath who was selling homeopathic vaccines to young mothers, I was labelled the evil person who was trying to limit choice and was shilling for the pharmaceuticals. . Disclaimer, my father, of blessed memory, was a wonderful man and a pharmacist, but I have no connection in my job to the medical or pharmaceutical industry. My theory of why there is so much woo in small towns is that there is little industry and the easiest type of self employment is opening up a reiki,, reflexology, ear candling, homeopathic, naturopathic, herbal remedy, Chinese medicine etc practice..Science is hard and making a real career in science takes years. Of course some consumers are just plain old dummies. I know one young mother who went to the naturopath and got the homeopathic vaccines because she was finding it difficult to find a GP here t (another problem for another blog) and the local ND advertises with her stethoscope on and white coat and this young, silly mother thinks an MD and an ND are pretty much the same, except that the ND must be better because she charges money.. Glad I found your blog. Makes me feel less alone. .
Hello audrey–and welcome!
I feel for you and your ideas seem spot on although I’d like to see some real research on why people turn to CAM (woo)–I’ve learned not to totally trust my own limited impressions. Here in the States you can add lack of insurance to the list.
Another problem is the libraries–they shelve the woo books right in with the actual medical books. And the bookstores–Eeek! Don’t get me started. Many of the woo books are written by MD’s or, people who list themselves as Dr.Dimwit, ND, DC, or whatever, in teeny print or else a whole string of letters which may look impressive to the ill-informed but usually amount to one correspondence diploma mill after another or weekend course somewhere.
Then there are the “PhD”s who often went to now defunct and highly questionable “colleges”. The MD’s who write these books have, in my view, wasted an expensive and extensive education only to join up with all of the quacks.
I know some of these kinds of people and many of them mean well and truly want to “help people”. They see themselves as “healers”, but of course healing to them is all about the naturalistic fallacy and vitalism–and “spirituality”. They’re really under the illusion (delusion?) that MD’s have wasted their time in medical school for the most part. The worst thing about the small town I lived in that was very woo-ish was the number of MD’s there doing “holistic”, “complimentary”, “integrative” and all sorts of other “alternative” modalities, especially acupuncture. The claims made by many of the massage therapists were way out of their licensing limits.
Well, I could go on, but you get the idea. It’s good to know that I am not alone either because now I live in a largish city in the midwest and it’s almost as bad as the small town on the West Coast.The reason I feel alone is because the more I learn about CAM and how to evaluate studies, etc., the less I want to be around these people. I’ve become somewhat isolated socially and am working on making new contacts in hopes of making some newer and more rational thinking friends.
If you like this blog, check out sciencebasedmedicine.org
Scott Gavura is a contributor there as well.
Thank you Janet for the warm welcome. I’m with you on not wanting to spend time with SCAM believers. It just hurts my brain to argue with them and probably negatively impacts my health (although this of course needs to be studied to be proven).. Fortunately I haven’t met too many woo-ish MD’s in my town. I do wish that more of them would speak up against woo though. I just had to fire my veterinarian though, as she has turned into a real SCAM practitioner. She did this procedure on my Golden Retriever where she had her assistant come in and touch my dog, while she touched different foods and if the assistant’s hand moved in a certain way, she concluded my dog had an allergy to what was in the bag of food. No kidding. She also is promoting some kind of light wand therapy for improving joint pain in dogs, which from what I read, makes no sense at all. She has lots of great anecdotal stories though..
Your poor dog! That allergy test is done on people too–it’s called Applied Kinesiology or “Muscle Testing”, and is not to be confused with the legitimate science that deals with the interrelationship of the physiological processes and anatomy of the human body with respect to movement.
My vets are okay so far, but their staff have given me reason to complain by making absurd claims about pet food and feeding–a subject already full of woo from the marketers and advertisers.
It’s just awful that these people (well-meaning or not) are extending their reach into the non-verbal animal world. At least you or I can say, “no thanks” when offered these “treatments”.
There is a great blog I’d like to share with you. I believe the blogger is an occasional contributor to SBM blog as well.
http://skeptvet.com/Blog/
For some reason I haven’t been able to log in to WP for a few weeks, but now that the problem is fixed, I just wanted to thank everyone for their thoughtful comments! Thanks especially to Janet and Scott for their replies in my absence – although you did a better job than I would have anyway… It seems that I am not alone in my battle, and it has been heartening to receive such support. I am quite amused by the story about the applied kinesiology in the dog – allergy quackery is my main focus, and I certainly hadn’t heard of it being used in dogs! I have 3 goldens, and thankfully no vet we have used has tried to push woo on us. Yet…
Poor you…stuck in an uneducated woo-friendly town. Don’t despair; your comment are appreciated on science blogs.
fondly, lilady
Thanks lilady – this means a lot, especially since you are one of those who is most definitely not afraid to take those punches.
(blushing now, Sara)
I *manage* to give as good as I get.