Sunday, June 22, 2008

Thai woo

Former Thailand prime minister Thaksin Shinawatra has sagely advice for his troubled country:
Be patient with the headache-inducing situation until July 2. Mars moving close to Saturn causes the headache. When Mars leaves, the situation will ease.

It seems Thaksin relies on the heavens a lot:
Mr Thaksin has long placed his faith in astrology. When Bangkok's new airport opened he had the first plane land at 9.19am, which he believed was an auspicious moment. For a while as prime minister he cancelled his weekly press conferences, claiming that Mercury was not in a favourable alignment.

And you thought the Reagans were nutty.

Saturday, June 21, 2008

A theistic psychologists's letter to skeptics and atheists

I just learned via psychologist of religion Michael Nielsen that later this year psychologist David Myers' new book, A Friendly Letter to Skeptics and Atheists: Musings on Why God is Good and Faith Isn't Evil, will be coming out.

The subtitle "Why God is Good" already makes me uneasy. It sounds as if Myers has already decided that the entity "God" exists and he will now just be providing arguments to establish its goodness. Pray he hasn't done so or he gets an immediate thumbs down from atheists.

From the looks of the pdf files of the preface and first two chapters it's going be a small format work and, given it runs only 160 pages, quite a slim one at that. Shouldn't take more than a day or two to go through it all. And if the substance of the excerpts provided is a preview of what is to come, there might not be much meat and food for thought. Sorry to say but my appetite isn't at all whetted. In fact I'm disappointed. I was anticipating much more from a psychologist, particularly good science.

Moreover, I'm bugged by what he says about his theism. In Chapter 2 he declares that among his assumptions is "there is a God." Perhaps he does so later in the book, but I don't know which entity he's referring to. He doesn't describe this "God" in any meaningful detail. Given his "biblical understanding" we can surmise he's talking of the Judeo-Christian deity. But is it that of the Catholic, fundamentalist, liberal, ... or his own trimmed down / souped up version?

Right after stating his assumptions Myers tells us that he believes "we should hold our own untested beliefs tentatively, assess others’ ideas with open - minded skepticism, and when appropriate, use observation and experimentation to winnow error from truth." Moreover, he tells us he "enjoy[s] casting a critical eye on intriguing claims by asking 'What do you mean?' and 'How do you know?'" Well and good. Those are what skeptics, including religious skeptics, would want everyone to learn to do. But has Myers cast a critical eye on his own theological beliefs? Hopefully he addresses that matter.

I also have a problem with his use of "faith." This early, he seems to be already using the word in at least two senses: religious/spiritual inclination and belief. If faith is understood to be belief without justification or belief highly disproportionate to the available evidence, then I for one find faith and reason irreconcilable. In such a context faith isn't reasonable.

I get the impression that Myers gives us thumbs up to the human activity we call religion including the belief in deities (although not all kinds of gods). The problem of course--and I think Myers is aware of it--is that even if being religious (in the Western world) is associated with goodness and happiness, it doesn't imply that the proposed supernatural entities believed in actually exist. Given the lack of any good evidence for them, it would be delusional to believe that they in fact are real, i.e., having faith in their existence isn't warranted.

I may be prejudging Myers. Hopefully there is more intellectually rigorous material in the rest of the book.

When you wish

Wishful thinking is part and parcel of childhood. The brains of the young are still very much in the process of developing "higher" faculties such as analytical thought. Children are credulous (for survival reasons, Homo sapiens may be evolutionarily selected to unquestioningly believe whatever adults say) and are just getting into grips with reality, distinguishing fact from fiction and fantasy. Hence, the young are given great leeway. In fact when they commit errors in thinking, inference, causal reasoning, and the like, we find it most amusing and sometimes even endearing.

But it hardly is charming when adults drag their childhood (or would that be "childish"?) ways into their adult lives [1]. Ironic, but Paul hit the nail on the head: "When I was a child, I used to speak like a child, think like a child, reason like a child; when I became a man, I did away with childish things" (1 Cor. 13:11) [2]. Wishful thinking is unbefitting of an adult. We either do away with it or suffer the ill consequences.

And nowhere are the consequences more tragic than in the area of health. Daily around the world are millions wishing themselves and others into health. A lot of this takes the form of utterances--both audible and silent--directed at invisible entities whose names have been around for millennia: Buddha, Kuan Ni Ma (Kuan Yin), Vishnu, Allah, Yahweh, Christ, Mother Mary (with the intact hymen). Whether a loved one figures in a vehicular mishap, or is undergoing major surgery, or fighting an invasion by pathogenic microorganisms, petitions flow from the minds and lips of "wishers" in the belief that mere wanting/desiring/chanting (coupled with closing of the eyes, bowing of heads, kneeling, waving of lighted incense, etc.) will in fact result in the intended effect (or fervently wishing that the act of wishing/wanting/praying would lead to the intended effect).

The harm of wishful thinking is readily and incontrovertibly apparent in cases when it is the only option taken for a life threatening condition, as was in the following case.
A 16-year-old boy whose parents rely on prayer instead of medical care died Tuesday [June 17, 2008] following an illness marked by stomach pains and shortness of breath, Gladstone police said.... The boy became sick a week ago and -- like all members of the religious order -- did not receive medical attention. His condition worsened Sunday and members of the church gathered for prayer....

If your disease is not the self-limiting type, if what you have is life-threatening, then taking no other measure except faith healing and prayer--i.e., wishful thinking--will make you very ill and may even lead to death. Why? Because it is no different from holding the hand of the afflicted. It is as (in)effective as Native American shaman chants, sacrificing cattle to Osiris, bathing in the waters of some sacred South Asian river, or reciting Tibetan Buddhist verses while manipulating prayer beads. As with all forms of shamanistic and paranormal forms of treating health problems, faith healing has no efficacy to speak of beyond placebo effects.

Two years ago I proposed the following thought experiment. Let's say that your toddler has accidentally ingested a large dose of poison and is doubled up from unspeakable abdominal pain. Which of the following would you do and which do you think would most probably save her/his life?
1. Do nothing. You carry on as if nothing out of the ordinary happened.

2. You sit beside him and assume the lotus position. You close your eyes, bring your brain waves down to the alpha level, and visualize white light dissolving the poison in his tummy. With more blinding white light you clean his entire digestive and circulatory systems. (For Old Agers out there, that's the Silva Method for treating any and all diseases)

3. You rush your child to a Chinese medicine man or a shaman or a chiropractor or a faith healer or a psychic healer or some "alternative medicine" practitioner.

4. You fall on your knees and start praying to Kuan Yin (the goddess of mercy), Allah, Buddha, Salus (Roman goddess of health), Feta (uh perhaps not), Baal, or whichever deity/deities you subscribe to.

5. In addition to #4 you run to the phone and call all your relatives and friends and ask them to pray with you. You also send SMS (text) messages to everyone in your address book to spread the word and get the whole world praying, chanting, lighting incense, ....

6. You rush her to the nearest ER or clinic and have doctors give her atropine (or whatever it is they give to counteract the effects of the poison) or get the poison out of her.

7. Number 6 and then #2, 3, 4, and/or 5. (#3 is done after her discharge from the clinic/hospital, while #2, 4, 5 can be performed while he's being treated by doctors).

If you choose #7, why do you think performing #2, 3, 4, and/or 5 in addition to #6 will or might help.

In cases where only wishful thinking (e.g. prayer, faith healing, Touch Therapy,... ) is employed those with acute, life-threatening conditions don't become better. Thus, in cases where it is employed in addition to proven evidence-based medical care we know that it is superfluous. It's like dancing while the doctors perform angioplasty on your parent--the jig is irrelevant to the arterial stenosis. Remedies based on wishful thinking are as relevant as the ritual performed by one aboriginal tribe, a ceremony which they believe is what causes the sun to rise everyday. Clearly, this society need only have forgone with the ritual for a week to experience disillusionment and enlightenment. Analogously, (if only it weren't so totally unethical) the delusion of FH could, at least on a rational level, be dealt a coup de gr√Ęce were we to treat with FH alone those patients with conditions that aren't self-limiting and don't spontaneously go into remission (e.g. acute appendicitis). If only we could perform such an experiment, we'd be able to definitively show FH as nothing but wishful thinking [3].

It's most tragic that children are dying because of parents who so unthinkingly rely on magic to treat them. We've already seen it again and again (among the children who've died from being treated with FH alone are Ava Worthington and Madeline Neumann). The faith healing delusion can and does kill! Will we ever see an end to these cases of manslaughter? Perhaps not. There have been and will always be children in adult's clothings who will believe that uttering words and beseeching silent invisible entities from some other dimension can magically make their wishes come true. It seems that Homo sapiens are hard-wired to fall into irrational thinking, magical and wishful thinking. Thus, until our brains evolve into dispensing with these natural predispositions only education in clear, rational, logical, critico-scientific ways of thinking can lead us off the natural path of muddled reasoning and out of the darkness of ignorance.

We all wish for this and that. But let us harbor no illusions. Wishing with all your heart and all your mind will come to naught. Now that you're no longer a child, do away with childish ways of thinking and reasoning.


----

Notes:

1. Interestingly, adults and culture are selective as to which instances of wishful thinking are afforded legitimacy--i.e., not considered to be forms of wishful thinking. Consider, for instance, the proposition "Ask entity X," where X = tooth fairy and X = the god of one's religion. While neither of the two entities are known to be real, one is relegated to fantasy while the other is taken most seriously as factually effective.

2. Since Paul was a supernaturalist, it is clear his assessment of himself was most flawed. Childish reasoning and thinking he most certainly was not able to completely banish.

3. We must not, however, underestimate the psychological power of cognitive dissonance coping mechanisms. Even with irrefutable evidence die-hard believers will still be able to maintain their belief in the efficacy of FH. For instance, in the face of such confuting evidence they may rebut by averring that their deity, say Kuan Yin, had already long ago planned to "bring back home" these very sick people at this time--that's the very reason why they are so ill. Such is the power of the mind to churn up imaginative, albeit unprovable, reasons just to shore up delusions.

Failure of wishful thinking modalities such as faith healing, prayer, animal sacrifices to appease unseen entities will be rationalized with explanations that cannot be tested and proved false, i.e., with nonfalsifiable claims. Thus, if the deity believed in is Apollo, then Apollo does answer prayers and does cure people when prayed to, but when the patient doesn't get well or dies, then it is inferred that Apollo has much bigger plans which we mere mortals cannot begin to comprehend. It is an Apollonian Mystery.

Of course anyone can resort to such a nonfalsifiable claim--a Hindu, a Zoroastrian, a Jew, a Muslim, or a Christian. In each case every deity can be said to answer prayers, implying that all these deities exist, which of course would entail a contradiction. Thus, the fact that your argument or explanation is unfalsifiable and cannot be refuted does not mean you can pat yourself on the back for a job well done. It probably means you've just created and embroiled yourself in a delusion. Religionists are famous for nonfalsifiable claims and rationalizations. It's a case of making delusions airtight. They begun with a far-fetched, unjustified belief (e.g. there are superpowerful, supergood invisible entities from some other dimension) and then made the beliefs irrefutable by making untestable claims to explain away confuting evidence.

Wednesday, June 11, 2008

Persist in asking "How do you know?"

I recently discovered that the Philippine Star has daily theological one-liners printed at the bottom margin of the back page. You can't miss it. It's in large type, with a bright yellow band background to highlight it. Some examples: "Persistence in prayer pleases God" (May 3, 2008), "If you fill your heart with God's Word, He'll bring spiritual health to your soul" (June 5, 2008), "God is always in control behind the scenes" (June 6, 2008). Given these claims, we can rule out the possibility that they're talking about the god of the Deists (who neither gave any commandments nor is interested in the affairs of the universe) or the god of Episcopalian Bishop John Shelby Spong or that of theologian Paul Tillich (a nebulous "force" which he defines as, among other things, the "ground of all being,").

But whoever the deity in question may be, what I'd like to know from those who declare and believe in the above declarations is how they know they are so. What method did they employ to discover these "facts"? How did they arrive at their knowledge of these things? Are they just parroting others? Could it be that they inferred them from various older claims, premises which are not yet known and haven't been evinced to be true? Did they merely find them in some ancient text; if so by what means did the author of that text discover their veracity? How can others--like you and me--determine/confirm the claims? (Can we, for example, have an audience with this entity and get it straight from the horse's mouth? What objective tests can we perform?) Or--Zeus forbid--could it be that those who say the above things merely believe and want/wish them to be true? Until the epistemological questions are answered the claims are unsupported and unsubstantiated. And just to repeat an epistemic heuristic: extraordinary claims demand extraordinary quality of evidence in their favor.

And so it is for all other theological claims. The query "How do you know it's true?" invariably exposes the absence of a valid epistemic grounding for the belief. Thus were we to ask, "How do you know that the phenomena 'God' and 'soul' you speak of in the above claims in fact exist and are real?", we would be met with answers that don't at all substantiate the claims. It goes without saying that it would be imprudent or even foolish to believe in anything lacking sufficient justification/evidence. One can choose to believe or one can prefer to believe rather than withhold belief, but there is no rational imperative to do so. In fact it would either be nonrational or irrational to choose/prefer to believe.

Psychologically, it is intriguing to note that while most people will be skeptical were you to tell them that a new animal species has been discovered, say, a whale with legs and feet, the same people will not blink but instead swallow hook, line, sinker, and even fishing pole when you tell them there exists an invisible, undetectable entity that is over 14 billion years old, one that has an understanding of chemistry, biology, and physics that surpasses a billion Einsteins combined, that has perfect telekinetic, telepathic and clairvoyant abilities, that can speak and understand any language (past, present and future), including all animal talk, and one which wants you to verbally communicate with it regularly but more importantly enjoins you to share with it part of your income every Sunday through human delegates (albeit self-appointed). Thus, while we would expect that the more implausible (the more outrageous) the claim the more skeptical people are, in reality, it doesn't follow. The fact is there are very implausible, extraordinary claims for which there is no good evidence whatsoever that people believe in through and through (quite unthinkingly).

How do you know I'm telling the truth were I to say that I always carry a million Euros--cash--on me wherever I go? Why is it that your gut reaction is to be skeptical? How do you know that you've really been cured by a Touch Therapist after she repeatedly passes her hands 3 inches above your body for several minutes? How do you determine the efficacy of this treatment modality? And even prior to that, given our fund of anatomical/physiological understanding, how do you know whether Touch Therapy is even remotely plausible? How do self-proclaimed "alien abductees" know that the bruises and marks on their bodies were really caused by extraterrestrials and not by some other means? How do you know they've explored and ruled out all other possible explanations? How do you know that goddess Kali is real, alive, and is truly out there somewhere in some dimension? How do you know she isn't? If you don't know she isn't and can't ever prove she isn't, then how do you know that some other deity (perhaps your own) is the real one if the reasons for saying it exists and is the real one are no better, no more persuasive (much less conclusive) than those for Kali?

How do you know it's true? How do you know when you should believe and when you should remain skeptical, how much to believe in claims and how much to question them?

How do you know?

Sunday, June 01, 2008

Ducks unlimited

It's one thing when the man and woman on the street trips and makes a logical booboo. It's brow-raising and elicits incredulity when someone with acronyms suffixed to their name commits a rudimentary fallacy.

Woodson Merrell, MD is a "board member of the New York State Office of Professional Medical Conduct, a member of the American College of Physicians, American Medical Association, New York State Medical Society, and New York County Medical Society, and an Assistant Clinical Professor of Medicine at ... the Columbia University College of Physicians and Surgeons." You'd think that with such stature he'd know better than Tom, Dick and Harry. Unfortunately, Merrell is into "integrative medicine" otherwise known as complementary and alternative medicine (CAM), a phenomenon that before its marketing makeover was known simply and unobfuscatedly as quackery.
The same set of practises that was called quackery or fringe medicine in the mid twentieth century was renamed "alternative medicine" in the 1960s and 70s. The term "complementary medicine" was coined during the 1990s.... Further rebranding has given rise to the notion of "integrated medicine." (Rose Shapiro, Suckers: How Alternative Medicine Makes Fools of Us All, London: Harvill Secker, 2008, p. 1)

However, Merrell's plunge into quackery isn't the error I'm referring to. James Randi reports that, "In an interview with the American Pain Foundation, Merrell said:"
We use whatever is safest, gentlest, and most effective for the patient regardless of what tradition it came from. As much as possible, we use an evidence-based approach, but certainly would consider an herbal remedy that's been around for twenty-five hundred years – that's a significant enough empirical trial.

Merrell was already was on track with the "effective" and "evidence-based" bits, but that last clause sabotaged his entire credibility. Given his argumentum ad antiquitatem, it may be that he doesn't really understand what evidence-based medicine is about, why randomized, double-blinded, placebo-controlled clinical trial (RCT) is the gold standard of medical research, that bias is the number one enemy of objective testing and that the twenty-five-hundred-year "empirical trials" he's alluding to are precisely loaded with such biases.

James Randi elucidates on the fallacy. He's addressing Merrell:
Doctor, the idea of a Flat Earth has “been around” far longer than that, and was tested countless times; the Earth always looked flat, everyone knew that! The fact that a really bad idea has been around for centuries, doesn’t make it correct, it only makes it old. Yes, many, many, herbal remedies work very well, and were discovered by experiment, long ago: digitalis, aspirin, so many remedies we still use today. But we don’t use them because they’re old, we use them because they’ve passed the “evidence-based” trials that you mention are advisable when “possible.” For half a century, calomel was raved over as a cure for just about everything, and doctors prescribed it freely – until they noticed that not only the ailment went away, so did the patients. They died from mercury poisoning, because calomel is mercurous chloride…


In the same issue of Swift, Randi shares with us yet another fallacy (an epistemic one) from the producer of the television program "Healthcast." In one of its episodes the show featured Tong Ren (Chinese origin perhaps?), a quack treatment that essentially consists of "tapping on a doll with a small hammer." After seeing the show, a skeptic wrote and complained to producer Laura Stebbins. As part of her reply she wrote:
Hundreds of people from all over the world have testified that this therapy has helped them...

Hundreds of people have also testified that arsenic, bloodletting, cupping, Laetrile, healing touch, ... have helped them. But there is no objective evidence that any of these are effective. In fact your eyes probably (and rightly) popped when you read "arsenic"--some things that people swear by are in fact downright harmful. Actor Steve McQueen availed of Laetrile (among other snake oil) for his cancer, and yet Laetrile contains a non-insignificant amount of cyanide.

Perhaps Stebbins is unaware that a thousand testimonials is as good (or bad) as a single one. There are very good reasons why the FDA and medical researchers don't accept and don't rely on testimonials or even case studies as evidence for the efficacy or safety of any treatment modality. They are so laden with confounding factors (including the biases we talked about above) that anecdotes are completely useless as evidence. At best they are starting points and incentives for further research.
If one person can commit the fallacy of false cause, so can a hundred. If one piece of evidence is invalid or unreliable, many more pieces of invalid or unreliable evidence don't make the case any stronger. This means that the many testimonials offered by practitioners or users to promote a favorite therapy generally don't prove much of anything--except perhaps that some people have strong beliefs about certain treatments. (Theodore Schick, Jr. & Lewis Vaughn, How to Think About Weird Things:Critical Thinking for a New Age. Mountain View, CA: Mayfield, 1999, p.203)


In other news, Yale University is going to the ducks. It now has an Integrative Medicine program and in April held its first annual Integrative Medicine Scientific Symposium. I think there must've been a typo there. They must've meant "Ist Annual I.M. Pseudoscientific Symposium." There! Now we've done away with the oxymoron.

I'll have Dr. David Colquhoun introduce the premier woowoo during the symposium.
David Katz, MD, MPH, FACPM, FACP, is founder and director of the Integrative Medicine Center (IMC) at Griffin Hospital in Derby, Connecticut. He is also an associate professor, adjunct, of Public Health and director of the Prevention Research Center (PRC) at the Yale University School of Medicine in New Haven, Connecticut.

That sounds pretty respectable. But he is into not just good nutrition, exercise, relaxation and massage, but also utterly barmy and disproved things like homeopathy and ‘therapeutic touch’.


In his talk, Katz rallied for a "more fluid concept of evidence." In other words do whatever is necessary to make sure that candidate modalities that flunk the exam still get to graduate and be certified. This includes accepting case studies and anecdotes as objective evidence for efficacy. In his speech Katz brings up various treatments (e.g.., CoQ10, vitamin therapy, homeopathy) and the lack of solid hard evidence for them and yet he defends them--lamely--with the aphorism "absence of evidence is not evidence of absence." Indeed if I can't see radio waves it doesn't mean they aren't there. However, if treatment X is in fact ineffective then there's nothing else to witness but absence of efficacy! (Likewise with any other claim: if Y doesn't exist and isn't real then you won't find any evidence for Y.) Needless to say, believing that X works (or that Y is real) until good evidence is at hand is unwarranted.

Colquhoun on Katz's speech:
Dr Katz goes through several different trials, all of which come out negative. And what is his conclusion? You guessed. His conclusion is not that the treatments don’t work but that we need a “more fluid concept of evidence.”

Dr. Steven Novella summarizes the Katz approach: "When studies of 'alternative' modalities are negative, proponents want to change the rules after they see the results." When former Chair of the Society of Homeopaths Felicity Lee was asked why she still practices homeopathy after the best studies have shown it to be no better than placebos, Lee replied that science and RCTs aren't suited to testing homeopathic remedies (although when questioned as to why this is so, Lee was stumped).

On the other hand, should a battery of independently performed RCTs unquestionably show that the modality works, the quacks would accept the robust design and methodology and hail the trials as definitive proof. In other words, these CAM and IM practitioners want to have their cake and eat it too. They want to keep their belief whether the evidence is positive or negative. I find psychiatrist M. Scott Peck's observation of psychiatric inmates cogent. According to Peck, in effect these people say, "Don't disturb our delusions." Merrell, Katz, Lee, and other proponents are not loonies. But they're certainly grossly deluded (clinically defined as continuing to believe even in the face of overwhelming rational arguments/evidence to the contrary).

In the same talk Katz describes medical schools' emphasis on evidence as indoctrination. Colquhoun calls this "a pretty graphic illustration of his [Katz's]deeply anti-scientific approach to knowledge." It can't be emphasized enough: there is no other way to test the efficacy of therapeutic modalities except through scientific means, the best and most reliable being the RCT.