Phil Plait’s talk at TAM 8 has generated a lot of discussion. He exhorts us to be diplomats, and asks when, in our progression from believer to skeptic, did we ever have our minds changed by being called an idiot. There’s a lot of merit to pointing this out and it is a really quite obvious point to make: why indeed be a dick? If being called an idiot didn’t work on you, why should you expect it to work on anyone else?
I am, by nature, reasonable and diplomatic. I prefer discussions to arguments and talking rather than shouting. If I am ever talking to someone about an issue where they are in the wrong, it would never occur to me to tell them that they are an idiot, as after all, the reasons why people believe weird things can rarely be reduced down to personal idiocy. People, if they believe in a religion, usually believe in the religion of their parents, not because they are intrinsically stupid people and Hinduism just seemed like a good idea to them one day. If someone believes in homeopathy, they probably know someone who has used it and vouched for it, or they tried it themselves because they saw it on a pharmacy shelf, took that to be a sure sign that there was something to it, and attributed their subsequent recovery to the use of homeopathic medicine. Believing weird things is a part of the human condition, and it takes a certain mental discipline and a skeptical mindset to be aware of how we fool ourselves and others. There’s not much that’s easy about skepticism. It’s hard to do, but deeply satisfying, and it is something that I want to share, so why would I want to be a dick about it?
Even so, there are times when dickery works. Such times are rarely going to be in face to face, personal encounters, but the notion that skeptics and atheists should always strive to be diplomats is wrong. That may not have been the point that Phil Plait was making, but here’s the point that I want to make: sometimes being a dick is necessary.
9/11 was a truly awful event. 9/11 also spawned the truth movement, a whinging, drooling shirt stain of basement-dwelling carbuncled teenage and twenty-something conspiracy theorists who believed that the US government was behind the attacks, that the towers were brought down with controlled demolitions and the Pentagon was hit with a missile. This truth movement was met head on by an active skeptical and debunking movement, one which had as its nexus the conspiracy theories section of the forums of the James Randi Educational Foundation. I used to spend a fair bit of time in the forum myself, in the mid-2000s, and it wasn’t the friendliest place to any truther that stopped by. But my point is that, as unpleasant as that forum was to visit for conspiracy theorists, it was effective. Its denizens picked over every conspiracy claim that came their way, and debunked it in no uncertain terms, leaving an extensive amount of material for inquiring minds to find. JREF members also joined conspiracy theory forums, taking them on directly, or at least until they got banned. The 9/11 truth movement was called out for what it was in impolite, intemperate language: the truth movement had zero credibility, and here were a group of people making that very clear. Sometimes, and this is the relevance, really, to what Phil Plait was talking about, the conspiracy theorists would come visit to try to argue their beliefs, and the conversation that ensued would often be, shall we say, less than pleasant. The members of the forum knew their stuff and defended the evidence strongly, often turning to ridicule. Of course some people would remain polite to a fault, but the overall tone of the site was far from accommodationist.
And it worked. Opinions were changed. By way of evidence, here are some comments from JREF members in response to the question: “What convinced you back from truther to non-truther?”
“The first chink in my armour was a forum called Protestwarrior, which I trolled at, and those guys just made me look like a chump…so I avoided dissenting opinions in order to settle my cognitive dissonance. Then the South Park episode…that lead me to Screw Loose change, which lead me here.”
“I expressed some opinions here and received some slaps in the face (some tactful, some not) with good plain information. But – having a good scientific background – I was able to see that at least some of the tripe I was pushing was just flat wrong. This gave pause for serious thought. Plus, here and elsewhere, I was beginning to find links to the debunking sites. Of course a lot of this could have been avoided simply by putting “9/11″ +”debunk” into Google in the first place, but I suppose the desire to believe in something wacky can lead one astray.”
“Once I saw Zeitgeist Addendum I thought I REALLY had it all figured out and tried to start a local Z:Movement chapter. It was then I thought I was equipped mentally to take on the skeptics, whom I thought would love the idea of the Zeitgeist Movement (a “scientific method” pseudo science based, godless society? What’s more to love? Right? WRONG!!!). So I took to JREF with all that I had learned and jumped into the skeptics Zeitgeist forums. I got pwned with questions I couldn’t even begin to answer and when I looked up answers to those questions, it was then I realized that it was all a silly utopian fantasy, sprinkled with pseudo skepticism and a Technocratic, communist-like agenda disguising itself as peace….”
Being impolite is not an impediment to successful skeptical activism. Challenging people directly can change people’s minds, and the tactic of challenging ideas with ridicule should not be kept out of bounds. Let’s say that someone was undecided on a 9/11 conspiracy theory, searched on Google for the term “debunk 9/11”, found their way to hundreds of discussion threads ridiculing 9/11 truth and then decided not to take the truthers seriously after all. Would that not be a success for skeptical activism? So why not use ridicule? Ridicule is an ancient and acceptable tool in the rhetorical arsenal. If Phil’s point is that to be effective, we must be polite and let reason carry the day in order to persuade, then I know the Ancients would disagree. There is more to persuasion than mere logos.
I’ll allow that it is probably true that more minds will be changed with politeness and a kind word than outright dickery, but sometimes anger and emotion, a rhetorical appeal to pathos, are essential partners in persuasion. P.Z. Myers is not the gentlest writer on the internet, but the emotion and indignation of a Pharyngula post can be cathartic, persuasive, and inspiring. Emotive, passionate argument is very effective at conveying the wrongness of the harm that results from giving uncritical thought a free pass. By presenting an emotional point of view with which the audience can empathise, one enables and activates a powerful method of persuasion. We are hardwired to feel emotions and to respond to emotions in others.
I don’t know if the New Atheists are as effective as changing an individual’s mind as would be a cup of tea and a bit of a chat with the local humanist group, but they do play an important role in discourse. There’s a lot to be said for discarding diplomacy and pushing the boundaries of debate. The US has constitutional limits on freedom of religion and the role of religion in the state, so why not test those limits? Go ahead and desecrate a communion wafer, or publish a cartoon of Mohammed. I don’t know that doing those things have persuaded anyone to give up their beliefs, or to become more skeptical about their beliefs, but such actions have pushed the boundaries of deference to religion and tested the extent of secular rights. Any movement needs the strident fringe as much as it needs the moderates, otherwise how else will it gain ground?
The one example Phil provided in the talk was of a conversation with a girl who self described as a creationist. She asked an astronomy-related question that revealed her reliance on incorrect information. In response, Phil was not a dick, pointed her toward a different way of looking at the question and recommended she expand her sources of information to outside the creationist literature. Apparently, after the talk, a number of the attendees – theistic skeptics – expressed gratitude for the message of the talk. Theism wasn’t mentioned, as I recall, but they took comfort from it nonetheless.
I get where the theists are coming from. Skepticism is hard. We aren’t wired to do it well, and doing it well can lead one to confront uncomfortable truths. I am deeply content now to live life without a deity, but I wasn’t at first. Losing god was a dislocating, wrenching experience, and one that I would not wish on anyone else. Nobody took faith away from me; I was cursed with a constant sense of curiosity about the universe, a curiosity that the religion in which I was raised could not satisfy. The moment when I truly internalised the implications of the second law of thermodynamics, the moment when I realised that there was no escape clause for my mortal soul, nor for my species, nor for anything in the entirety of the cosmos, that moment hit me like a bag of hammers. I couldn’t sleep for weeks. So I quite understand how it is that people in the skeptical movement can be deeply critical, rational thinkers, but at the same time also be theists, and I understand if they rankle at having their beliefs challenged by other skeptics, a discomforting experience for anyone. I don’t think that theism limits the effectiveness of skepticism, and religion isn’t an issue that I personally care about. I’d rather focus my energy on science denial, chiropractors, homeopaths and other charlatans than convince someone that there is no god. The same is true for most of the self-identified skeptics that I know; discussing atheism and religion is for the humanists. They care about it a whole lot more. That’s not to say that deistic skeptics don’t have a hard time of it. A Venn diagram of atheists and skeptics would show considerable overlap, so it shouldn’t be a surprise that the topic arises, but then again, theists shouldn’t be surprised if they find skeptics want to challenge their beliefs. It’s a part of the skeptical condition.
Apart from moving me enough to write this post, Phil’s talk just didn’t really move me, as I guess I struggle to see where the problem lies (and he provided no examples). It’s obvious that a kind word and simple consideration is effective and appropriate most of the time, as that is how human beings conduct most of their discourse, most of the time. We really do tend to want to get along. Yet I believe that the skeptical movement is richer for having an argumentative, impolite JREF conspiracy forum, and it is richer for having a boundary-challenging articulate foe of all things religious in P.Z. Myers. Richard Dawkin’s documentary, The Root of all Evil, was so good because it wasn’t nice. Penn and Teller have a delightfully sweary show on Showtime called Bullshit! and you can bet with a title like that, they don’t play friendly with the subjects of their show. For the rest of us, indeed for most of us in the skeptical movement, being friendly, that is, not being dicks, surely that’s really rather easy. It’s just how we live life. Being a dick, and doing it effectively, that’s the challenge, and we are fortunate to have people who are good at it.
I remain unconcerned that skepticism will be tarred by association with the stridency of certain vocal skeptics, or rendered ineffective by discourtesy. Suffragettes turned to militancy, but women still won the vote. Black Power did not prevent the successes of the civil rights movement. And calling someone an idiot will not be the death of skepticism: at the right time, it might be just what the situation demands. That ‘idiot’ may not be le mot juste in a one-on-one conversation hardly needs saying, but in public fora, ‘idiot’ may be the perfect choice of word, and we shouldn’t be afraid to use it.
The British Chiropractic Association took Simon Singh to court for libel. In a stunning example of the Streisand Effect, the criticism that they were trying to suppress – that their claims that “chiropractic can be used to children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying” were unsupportable – have come under new, unprecedented scrutiny.
Richard Brown, chiropractor and Vice President of the BCA, tried to defend chiropractic in the pages of New Scientist. Here is some analysis of his unconvincing defence.
Chiropractors are so misunderstood
Brown: Many critics – including Edzard Ernst – hark back to the origins of chiropractic. This has the clear intention of suggesting that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases. While a tiny minority retain this view, most are aware that such claims have long since been debunked.
Let’s take a look at his first testable claim: that a tiny majority of chiropractors retain the view that “spinal misalignments are responsible for the majority of diseases”. Palmer’s original belief was that subluxations of the spine cause disease, and that correcting subluxations, therefore, will correct the disease. What do UK chiropractors believe?
A survey of chiropractors in the UK (from 2007) found that:
Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.
Far from just a tiny minority, we can see that clear majorities of chiropractors hold the belief that asthma, GI complaints and PMS can all be treated with chiropractic. Large minorities believe chiropractic can help with hypertension, infertility, osteoporosis and obesity. Infant colic, ear infections and childhood muscular problems were believed to be treatable by chiropractic by more than 50%. A fair reading of the survey will see that it shows a majority belief that spinal misalignments play a role in at least these aforementioned, non-spinal diseases.
Of course his actual statement, “that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases” is extreme and exclusionary, and deliberately so. A critic will find it hard to factually dispute, which succeeds in shifting the frame away from the areas of debate where chiropractic is weak, viz. the evidence and the philosophy. One must, on the evidence, accept that his statement is likely to be true, as there surely are but few chiropractors who firmly believe subluxations to be the cause of every disease. However, a majority of chiropractors do still cling to the ludicrous belief that subluxations are the cause of the aforementioned diseases, as the evidence clearly shows.
Brown also uses the rhetorical device of ‘conceding the point’. By admitting that the basic principle of chiropractic has “long since been debunked” – he even uses the language of the skeptic – he hopes to get the readership on his side. But in a scientific publication, defending chiropractic will take more than decorum. One also needs logos.
Cherry picked data
Brown: Claims that chiropractic is dangerous overlook two recent pieces of research. One found no causative association between chiropractic manipulation and stroke. The other concluded that the incidence of stroke after chiropractic was no greater than after a consultation with a general practitioner (Spine, vol 32, p 2375, and vol 33, p S176).
Here is the second testable claim: that there are two research papers that demonstrate the safety of chiropractic that the critics have overlooked. For a skeptical, scientific audience, that’s a sit up and listen moment, but as one is reading the claim and not being Gish-galloped with it in a live debate, the audience has the luxury of testing it out. There are two questions we can ask. First, what do the two papers say, and are they of good enough quality to support the idea that chiropractic does not cause stroke? Secondly, where do the papers fit into the larger body of research on the safety of chiropractic?
Spine, vol 32, p. 2375. Safety of Chiropractic Manipulation of the Cervical Spine. A Prospective National Survey. (2007). This survey was the first national, large scale effort to poll chiropractors and estimate incidence of adverse events arising from cervical spine manipulation. The authors found that minor side effects of chiropractic manipulation were common, including neck pain, stiffness, soreness and headaches. However, no serious adverse events such as stroke or hemorrhage were reported by the chiropractors. So, no stroke, but the paper is far from a ringing endorsement for the safety of chiropractic. They report that manipulation of the neck commonly leads to headaches, a finding that is profoundly concerning. And there are other criticisms: patients were not followed up, it is not known if chiropractors under-reported adverse events, and people may not have told their chiropractor about a serious adverse event after chiropractic treatment. If they found themselves in hospital with a vertebral arterial dissection, they would have more important things on their minds. To keep things in context, a number of researchers have found that there is an association between chiropractic and stroke. A survey of chiropractors, like this one, does not invalidate all the research that preceded it.
Spine, vol 33, S176. Risk of Vertebrobasilar Stroke and Chiropractic Care. Results of a Population-Based Case-Control and Case-Crossover Study. (2008). This paper is very popular among chiropractors, who see in it validation for their practice of manipulating the neck vertebrae. I’ll not recap it in depth, but will just say, again, that one paper does not supercede all that has preceded it, and wonder why it is that it takes a survey or an indirect population study, like this one, to identify the risks of chiropractic. It begets the question: does the profession not want to find out the risks for itself? Apparently not. For a more detailed look at what the researchers found, go here.
So, placed into context, Brown’s cherry picked citations rather reveal that there are risks associated with chiropractic, and chiropractors themselves have done little research, on their own initiative, to quantify these risks. Furthermore, there is a large body of research that shows an association between chiropractic and stroke, and Brown would do well to read up.
More to chiropractic than spine bending
Brown: Our critics also make the mistake of equating chiropractic with spinal manipulation, especially with regard to treating non-spinal conditions such as asthma. This demonstrates a lack of understanding of the fact that chiropractors utilise a range of treatments, including postural advice, reassurance and exercise.
I suppose that if one cannot defend the claim that subluxations cause asthma, one should retreat from the claim. Why argue for something that is factually indefensible? The problem with what Brown says here is that he seems to suggest that chiropractors can utilise postural advice, reassurance and exercise… to treat asthma.
It is no surprise to me that chiropractors do more than spine bending. Practice growth and financial success in the chiropractic business is not held back by the same barriers that real doctors face, like prescribing restrictions or evidence based medical practice. Take a look at a chiropractor’s office and see what they have to offer. In fact, Richard Brown, our valiant defender of chiropractic, offers all manner of wonderful woo at his clinic: aromotherapy, reflexology, ear candling and Indian Head Masssage.
So yes, there’s more to chiropractic, but not much more.
I know you are, but what am I?
Brown: Ernst and others claim that chiropractic lacks evidence, pointing to a paucity of randomised controlled trials. This overlooks the fact that many accepted medical interventions have little or no research evidence to support them.
No, it doesn’t overlook that fact, because that fact is not, in fact, relevant. What is relevant is the fact that chiropractors lack evidence in support of their claims, and ignore the evidence that disprove their claims.
Medical interventions, when found to be unsuccesful, will be discarded. Chiropractic, when found to be unsucessful, will just insist on being tested again and again until the researchers get their sums ‘right’.
The last thing the chiropractic profession wants is scrutiny, but by suing Simon Singh, that’s exactly what they got. This is a profession that chooses to sue a science writer for criticising their claims, rather than countering with the evidence. It is a profession that won’t look for evidence of harm from chiropractic unless first prodded to do so. It is a profession where the majority are adherents to a discredited, bogus 19th century pseudo-medical concept of disease. It is a profession so divorced from reality that the best they can muster in their defence is a grab bag of rhetorical tricks and diversions and the hammer of English libel law, because, as they well know, the evidence for chiropractic just isn’t there.
Chiropractic was invented in the 19th Century by Daniel David Palmer, a spiritual and magnetic healer. In 1895, he claimed to have cured a deaf janitor by ‘racking’ the man’s back. Shortly thereafter, he cured ‘a case of heart trouble’ in similar manner. In a truly epic failure of logic and reason, Palmer decided that all human ailments could be treated by manipulating the spine, and thus was Chiropractic born.
This strange and bizarre fantasy got its name from a brief dalliance with the Greek language, as recorded in Palmer’s book, ‘The Chiropractor’s Adjustor’:
“Rev. Samuel H. Weed of Portland selected for me at my request two Greek words, cheir and praxis, meaning when combined ‘done by hand’, from which I coined the word ‘chiro-practic.'”
But ‘Chiropractic’ is such an unwieldy word. Even people that should know better, those guardians of the English language (okay, journalists) can’t quite believe it is correct. Hence The Independent calls it ‘Chiropractice‘. The Telegraph calls it ‘Chiropracty‘. Clearly there is a need for another word.
‘Chiromancy’ would fit nicely, being constructed from the two Greek words ‘cheir‘ and ‘mantea‘, meaning ‘hand’ and ‘divination’ respectively. It aptly captures the manual manipulation and magical thinking needed for chiropractic to work. Sadly, though, ‘Chiromancy‘ is already in use as an alternative word for palmistry, so that’s out of the question.
‘Chiropraxis’ has the virtue of sounding the way that people seem to expect the word to sound. But the potential for confusion only begins with this construction. In German, ‘chiropraxis’ is in fact osteopathy, a similar and equally as daft 19th Century system of medicine, one that believed the bone was the starting place for all human ailments. But the Germans only add confusion on top of this with alternate spellings. Their homophone to ‘Chiropraxis’, ‘Cheiropraxis’ does in fact mean ‘Chiropractic’, although, rather more helpfully, so does the word ‘Chiropraktik’. In the interest of international relations, perhaps ‘Chiropraxis’ should also be left off the table.
The elegant and derisive portmanteau derived from the words ‘chiropractic’ and ‘quack’, ‘chiroquacktic’, has acquired new popularity, driven especially by the media storm around the British Chiropractic Association’s decision to sue the writer Simon Singh for libel. ‘Chiroquacktic’ does have the quality of conveying the snake oil origins of the chiropractic art. In fact, a very early usage can be found in the Journal of the American Medical Association from 1922:
“To the Editor:
—Noticing that THE JOURNAL, January 14, made reference to an article on chiropractic, which appeared in Leslie’s Weekly, I procured a copy of the magazine.
Might I say that this seems a step in the right direction— articles exposing such quackery as chiropractic. I wish that every Fellow of the American Medical Association would buy a copy of Leslie’s and read Severance Johnson’s article on “Chiro-quack-tic” and then leave it on his waiting-room table for his patients to read, or pass it on to some newspaper editor, in his town or city.”
In addition to the excellent and venerable ‘Chiroquacktic’, I would like to propose, and with apologies and gratitude to that master of manipulation, prestidigitation and magical thinking, Mr. Uri Geller, that Chiropractic also be called ‘Spine Bending’. After all, bending spoons with the power of one’s mind is as plausible as curing deafness by bending the spine with one’s hands.
But whether they are to be called spine benders, chiropractors, chiromancers, chiroquacktors or just plain quacks, for the love of all that is good, let’s not call them Doctor.