Sunday, 28 March 2010

Where's My Big Pharma Money?

Alternative medicine like any other concept has proponents who are seeking its validation. They truly believe it works, and I have no doubt that its proponents are for the most part genuine. This is an industry that has built up mostly around word of mouth, sincerity of those propagating it is vital. Even many who peddle many of these therapies seem to believe they work - even if there's no way it possibly could. And the movement itself for the most part contains intelligent and fairly-well educated people.

So smart, well-meaning people who genuinely believe in the product's efficacy, and do all this without an industry behind them are promoting what could be best for one's health. Why am I not convinced?

Every time I've had a discussion in recent years on the matter, I've had some indicators as to why other people think I reject "alternative medicine". That I'm a shill for Big Pharma is a popular one I've heard especially on the internet. Along those same lines but less extreme is that I trust Big Pharma because I haven't thought through their business model, how can I trust my health to companies that want to keep me buying their product? Then there's the close-minded accusation, that I'm not willing to accept the premise. And that goes hand in hand with my blind devotion to science. One I see coming on more recently, it's not my devotion to science, but scientists like Richard Dawkins who speak ill of "alternative medicine". They say its nonsense, so I blindingly follow them.

It may be that those criticisms are valid, I could be deluding myself into thinking otherwise. I don't think those criticisms are reflective of my position. Furthermore I feel that by putting out those criticisms it demonstrates the underlying motivations I think are behind a lot of the movement. So I want to take each criticism in point and expand to what I think it demonstrates.

Big Pharma
Corporations exist to make money, it cannot be denied. And it's no surprise that much of the alt-med crowd exists on the left side of politics, that there's a genuine distrust of large corporations is no surprise. Politically I'm very left wing too, I'm all for being sceptical of pharmaceutical companies.

Where the denialism exists comes from a very simple argument: pharmaceutical companies want to make as much money from you as possible. So it's in their interests for you not to get better, they want to keep you buying their product. And superficially that argument seems quite valid. But even without looking at many restrictive practices, consider what happens in the case of two corporations competing in the same product.

Company A and Company B have a product that works for a remedy to eczema. Company A's medication only manages the eczema, it keeps the consumer buying and buying. Meanwhile Company B want to sell to that same consumer. If Company B's product is more effective than Company A, then this should lead to people abandoning Company A's product for Company B's. Even though both companies want to get as much profit as possible, that one has a more effective product even though it sells less. Company A would lose business because their strategy relies on them being the only one in the market, while there is competition any product that can best sell to the consumer will create a metaphorical arms race where better products will emerge.

This is the general idea of why competition in the marketplace is good for the consumer. Now there are many ways to cheat the system, such as monopolies and collusion, and perhaps in some small scale these can and do occur. But the general principle from the argument so often presented doesn't hold. They make money by selling products that aid in people's health, thus any treatment that can be put on the market that is more effective breaks the equilibrium of treatment.

There are plenty of reasons to distrust Big Pharma, there are plenty of reasons to distrust large corporations - but to take that distrust and turn it into denialism about the possibility of it working is being absurd. Which leads to exploration of the other side of this argument: Big Alt-Med.

Big Alt-Med
Magicians are professional liars, but there is honesty in their lies. People come to a show expecting a magician to fool them. Meanwhile there are magicians who use the same tricks yet claim to have magic powers. These are dishonest liars, lying about their lies.

The reason I bring this up is because so much of the argument against Big Pharma has the implication that alt-med doesn't have these same problems. We live in a capitalist society, and where there's a market there is money to be made. And in alt-med, despite the numerous claims involving Big Pharma seeing no money in these apparently effective treatments, there is a multi-billion dollar industry. Ben Goldacre in Bad Science does well exposing the hypocrisy of those who ride the Big Pharma hysteria yet have their own business which happens to sell the products they endorse. It's the society we live in, if one is going to be dismissive of Big Pharma then at the same time they need to be dismissive of any treatment involving money.

Being closed minded
Next comes the accusation of being close minded, I'm apparently not open to the possibility of such proposed treatments working. This is a great throwaway statement, one anyone can throw out when someone else disagrees with you. Scepticism at times does seem indistinguishable from dismissive so I think it's no wonder I've had that accusation levelled against me. But is it a valid accusation?

To be dismissive, I think one needs to reject the possibility when there's evidence supporting it. It's not dismissive to ask for evidence, or even ask for metaphysical coherence. Any supposed treatment that relies on vitalist notions should be scrutinised on that alone. It doesn't mean the treatment is not effective, but it does mean that it cannot perform as it is advertised and that is something to be wary of. And treatments that have a physiology that is alien to our own again should be treated with extreme caution. And treatments that don't have any possible mechanisms can very easily be dismissed.

Having said all that it's also important to point out that I don't just sit on the sidelines. I've been administered homoeopathic remedies, had various herbal treatments and even bought herbal remedies of my own free will. I've had acupuncture performed on me, used detox pads on my feet, had massage performed on me, performed (admittedly guided) reflexology, practised yoga, had reiki done on me, etc.

If the evidence is there, I am more than happy to use it. In general, a word of mouth story I regard similar to tales of the miraculous where God has come down and healed someone. That's what they believe happened, but the mind is always capable of self-deception. Which is why I find it important that there's beyond the anecdotal for the efficacy of any given treatment. Which brings me to the final contention: science.

A faith in science
Science works, it's a simple statement of truth that is validated by the fact that you are reading this now. In general we love science, except the parts that we disagree with. And those are when the dismissals of the scientific method are at their loudest. If science as a method fails to validate a cherished belief, then it is the science that is wrong.

Some would like to frame science in terms of methodological naturalism, thus giving an out to any time science fails to demonstrate the validity of a particular treatment. So instead of the obvious conclusion that the idea wasn't efficacious to begin with, it must be that science can't detect what is there because of its metaphysical presuppositions.

Yet the key point there is that nothing significant can be objectively observed. In other words there's nothing to explain away. If homoeopathy works as a treatment, then it shouldn't matter if the mechanism is material or immaterial. The efficacy of the treatment is often what is being measured, and if there's no positive results then there's nothing to explain.

Science in its broadest application means following the evidence, wherever that may lead. If scientific inquiry was to validate a particular treatment such as a herbal remedy, then I see no reason to reject it as a valid means of treatment. The contrast to this are those who will readily use the findings of the scientific method when it backs their view, but will dismiss it when the evidence is against them. To follow the evidence where it leads is the antithesis of faith, to hold it as true despite the evidence against is what distinguishes faith from fact.

A growing frustration
The reason I started writing this entry was to rant about my frustration in dealing with alt-med advocates. Those complaints listed above don't come because I mock and belittle them, but simply because I argue against it. If I argue against what they know to be true, then it must be me who is motivated by some external factor.

The frustration is several fold. Firstly it's that those who advocate alt-med often do so for ideological reasons. Whether it be a distrust of large corporations or a belief in the healing powers of nature, the ideology is there. Secondly it's frustrating because it's making an ad hominem attack in place of an argument. Thirdly it's misrepresenting often how the scientific process works.

But perhaps the greatest source of frustration is that it highlights the nature of information in this modern society. While good health information is not readily available, a lot of pseudoscience is. Information is virtually free these days, so if there aren't good sources of health about then it's easy to fall into bad sources. And who do you trust more than the people who are part of your lives? It doesn't seem rational to accept the advice of a celebrity or even a friend on matters of health, but surely the emotional connection we have allows for trust where there really shouldn't be.

As a society where information is cheap, junk food is even cheaper, and there's a looming health crisis from ageing and obesity - surely this is the point of call for governments and health organisations to start working towards putting good information in the market. As a public service if nothing else, because how it is currently now is clearly undesirable. We are in a society of self-professed experts, and when it comes to matters as important as health it shouldn't be left to those who clearly don't understand to fill the information highway with garbage dressed as the miraculous.

No comments: