I recently came across Science-Based Medicine, which is an absolute treasure trove of articles about a plethora of topics in medicine written by an all-star lineup of physicians in a variety of fields. I have immense respect for physicians who take time out of their very busy days to try to educate the general public and contribute their expertise and knowledge to the public discourse; having lived with a physician for essentially my entire life, I understand just how difficult it is for someone who comes home late at night, mentally and physically drained, to muster the willpower to spend even more time delivering what amounts to a free consultation worth thousands of dollars to the internet. To do this on a regular basis really is something that ought to be commended more often, so it’s fantastic that SBM has managed to pull together such a diverse group of people and keep them writing on such a consistent basis.
That being said, one particularly recent post on SBM caught my eye: Dr. David Gorski recently authored a defense of plausibility bias in medicine in an article entitled “Plausibility bias? You say that as though that were a bad thing!”. In this defense, Dr. Gorski responds to an article published in Medicine, Health Care, and Philosophy that attacked the medical profession as being overly closed-minded with respect to “alternative medicine” such as homeopathy. I don’t disagree with Dr. Gorski’s rationalization of plausibility bias in medicine and science in general; the very goal of the scientific process is to arrive at the mathematical model of the universe that has the highest-possible statistical confidence level of perfectly representing reality. It then makes perfect sense to impose increasingly-stringent requirements on new models as our incumbent models accurately represent larger swaths of the physical universe. “Plausibility bias” is a negatively-framed way of saying, as Dr. Gorski puts it, “extraordinary claims require extraordinary evidence.”
It does, however, seem to me that Dr. Gorski has lost sight of what his goal as a physician speaking on medicine in a public forum should be; his opening bullfighting metaphor seems to me to be especially ironic here. As a physician, his goal ought to be to improve public health. As a scientist, his goal ought to be to improve the public understanding of science. As someone speaking in public who sincerely believes in the correctness of his cause, his goal ought to be promotion of an open, honest environment in which the truth of the matter discussed is laid bare for all to see. Instead, we see Dr. Gorski embark upon a smear campaign, attacking Rutten personally as “so ‘open-minded’ that your brains threaten to fall out” and “nutty”. His tone throughout the piece comes off as condescending and vitrolic, which serves his (otherwise-accurate) assessment of the flaws of homeopathy very poorly. I mean, seriously, look at this:
That’s my plausibility bias. I’m biased in favor of science and reason and against magical thinking like homeopathy and reiki. You should be biased too. After I had stopped laughing in response to seeing homeopaths lecture scientists on what is and is not scientific, I delved into the paper. Rutten et al try (and fail—after all they are homeopaths) to establish their scientific bona fides righ in the second paragraph: [Emphasis added]
Why is this necessary? Is the article really any better off for it? Plus, who exactly is Dr. Gorski writing for here? Clearly practicing homeopaths would be strongly offended by the insults in this article, and somehow I doubt that he’s doing this to provide entertainment for those of us who already don’t believe in homeopathy. Drowning what could be a productive, enlightening conversation in personal attacks and condescension does his entire profession and field of study a disservice. The very next sentence Dr. Gorski writes gets to the heart of the matter:
My first temptation was to point out that the very fact that they are homeopaths means that they are either deluding themselves or lying when they claim that they do not reject any part of the naturalistic outlook. [Emphasis added]
Obviously the vast majority of homeopaths don’t actively live massive lies that they’re consciously aware of! What’s going on here is probably a much more gray case of motivated reasoning - the same motivated reasoning that scientists also have to be paranoid about all the time! So, if your goal is to encourage people to pursue the truth, it doesn’t make sense to actively provoke homeopaths in the way that Dr. Gorski does here - since it’s clear that homeopaths are for the large part not pathological liars, it makes no sense to gleefuly ridicule them for advancing their sincere beliefs. All that will accomplish is to force homeopaths to cling even more tightly to their beliefs and become even more vocal. What does make sense is to point out the flaws with their beliefs in a way that will encourage them to re-examine their beliefs and discourage them from spreading their misinformation any further. As Ezra Klein puts it so well,
In general, I think political debates are both much more sincere and much less rational than most folks believe.
Treat human beings like human beings. Otherwise all you’re doing is making someone else’s job much harder down the line.