"You Have a Degree in Baloney!"
The title of this post is from a Futurama episode in which a man responds to an accident victim gathering a crowd in the street, “I have a degree in homeopathy.” A robot present responds with the quote above – nicely concise and to the point.
It raises a serious issue, however – granting degrees and licenses for disciplines (especially health-related disciplines) that lack a scientific backing. This issue comes up often, as it has recently in the UK with a proposal to register practitioners of traditional medicine. A group of young professionals called the Voice of Young Science decided to protest this proposal by offering diplomas in “old wives' tales” to anyone who could answer some basic questions (like an apple a day keeps who away?). In a statement they said:
“We are confronted with the possibility of misdiagnosis, the failure to provide suitable medical treatment and dangerous drug interactions, which the scheme is more likely to enhance than prevent.
“There is no public benefit from these proposed regulations and the DH [department of health] must not adopt them.”
That is exactly correct, and is the core of the criticism against licensing dubious practices. As Edzard Ernst sais, “If you regulate nonsense, it is still nonsense.”
Unfortunately, the history of this conflict has been a long series of victories for nonsense. Politicians seem easy to convince that regulating nonsense is a good thing. The argument offered is that through regulation we can have quality control, and minimize fraud and the worst abuses. However, without an objective scientific standard there is no reason to think that regulation will help quality control – as Ernst says, in the end you still have nonsense passing off as medicine.
The point that politicians seem to consistently miss is that offering a degree or license to a profession as a means of regulation has the effect of legitimizing the profession or practice. This can have the consequence (intended by practitioners, but often professed to be unintended by politicians) of promoting unscientific practices.
Meanwhile, libertarians like John Stossel point out that these regulations really serve the purpose of limiting competition, not quality control. Psychics in Salem want licensure so that they can protect their lucrative gig. Of course this accusation is easy to aim at any profession.
The question comes down to external validity (as opposed to purely internal validity) – is the profession based upon a transparent and objective set of standards, rather than a purely internal and arbitrary set of standards?
That is where science comes in – science is, by its very nature, transparent and objective. This is partly why medicine should be based upon high quality science; not only because it works but because it provides an objective set of standards by which to maintain quality control.
The Voice of Young Science have it exactly right. We need to clearly and unequivocally champion the role of science in medicine, and ceaselessly point out the risks of bad science or anti-science. This has to occur on every front, including regulation. Otherwise the public will end up with a system of carefully regulated nonsense.
Good point, but I have to put the geek hat on. You got the Futurama quote spot on, (it’s one of my favorites), but you got the context wrong. The homeopath in question is not responding to an accident. In the scene there is a “robot” car travelling around trying to gather the world’s scientists to help solve global warming. The homeopath eagerly runs up to offer his help, waving his degree, and the the car responds with “You’ve got a degree in baloney”, and hits him with a fire hose.
Normally I wouldn’t say anything but I think it’s oddly appropriate given the nature of your post. :)
Hits him with a fire hose? How appropriate. Water that does something.
Homeopathic remedies are regulated by the FDA, and we already see the consequence: their labels list the diseases that the remedies are supposed to treat, and there’s no FDA disclaimer, so they look more like FDA approved drugs than like dietary supplements. And they can still be dangerous, like the “homeopathic” Zicam nasal spray that was reported to kill people’s sense of smell.
The Zicam issue amuses me. Considering that it has a measurable active ingredient (zinc), can’t the makers be charged with false advertising twice (that it cures something AND that it is homeopathic)?
They worded it so it’s homeopathic: Zincum Gluconicum 1X.
And the FDA regulation REQUIRES the label to list the diseases for which the homeopathic remedy is indicated.
By definition homeopathic “medicine” would do no harm (and do no good either). But if you use a homeopathic medicine rather then seek science based health care you are at risk for great harm. Obviously if you have a disease that requires care to prevent a worsening situation or even death then depending on the claims of homeopathy can kill you. And of course as one post-er already pointed out some so-called homeopathic medicine actually contains something and it can indeed cause you harm. Wouldn’t it be better if the FDA and other regulatory agencies just grew some balls and called these things what they are?
Another part of the reason that politicians like licensing, is that it offen ends up as a source of revenue for the state.
That didn’t sound too cynical, did it?
Exactly. I was thinking that a simple answer would be to charge people $20,000 for a Psychic license, $50,000 for a Homeopath license, etc. Then we should add a 90% tax on top of their fees to get some cash from their patients.
No matter what you do, there will always be numbnuts who believe that St Johns Wort is a miracle cure. You might as well make some cash from them. We have a deficit to tackle.
What really astounded me was Randi’s statement in a recent speech in Copenhagen that after exposing the huckster Popoff on Johnny Carson’s Tonight Show, people were ringing in to ask for Popoff’s contact details so that they could pay him to be healed. I never realized that some people really just don’t get it. I’m still not in favor of fleecing those people though; if anything the duty of the government should be to try to protect them (which may already be sufficient via existing laws), not to take advantage of them.
Not at all – you beat me to the point! Regulation leads to (increased) taxation. And while I have no problem with making money off snake oil salesmen, the implied endorsement is IMO not worth it.
Arguably a similar situation exists with state sponsored gambling. I am so lucky that I do not like to lose my money and I have an education in math thus I do not gamble. But many people and usually the poorest people do choose to gamble and the state facilitates it. I was working in a different part of town one day and looking for something a little different for lunch. Saw a sign for “homemade sandwiches” and went into this little storefront place. Appearently it is nothing more then a place to play state sponsored slot machines. So while I ate I saw old poor people putting their SS money into slot machines. Since then I have noticed a lot of these tiny storefront gambling places. Some serve food and others only serve beer, but the main purpose seems to be to bring gambling to everyone thus destroying as many lives as possible.
I would try to promote related laws instead: anyone making a claim which reasonably appears to be a medical claim must substantiate the claim or be classified as a fraud. So I would in fact be for laws which allow the regulation of reiki etc, *but* to meet with regulations they must first come up with definitive proof of efficacy. Hopefully such laws (if properly implemented) would also discourage medical insurers from paying for bullshit like acupuncture and naturopaths.
Sadly that boat already sailed. The Supreme Court has ruled you can say or write whatever you want. There are literally thousands of books promoting bogus cures and diets. And the FDA “compromised” and allowed supplements and other “health” items to be sold as long as the person selling them does not make any false claims about their efficacy. The result is the “mark” gets the pitch from a 1st amendment protected source and gets taken at the health products department of your local supermarket. A perfect plan if you are a snake oil salesman.
I wonder if the FDA prerequisite of labeling is as easy to get around as it is here in Australia. For example, I recall working on a design for a brand of “food” that was labelled as “light”. One small asterisk and very fine print on the back reading “Light in colour” was all it took to get the green light from the legal department.
Possible fine print for homeopathic remedies could be “If symptoms persist, seek medical advice from a witch doctor”
Red Bull makes a bunch of functional health claims without any FDA disclaimer.
http://www.redbull.com/cs/Satellite/en_INT/Red-Bull.com/Products/011242745950125#/product-FAQ
“increases performance, increases concentration and reaction speed, improves vigilance, improves the emotional status, stimulates metabolism.”
I emailed them about it, but they didn’t respond. Next step is to report them to the FDA here.
http://www.accessdata.fda.gov/scripts/email/oc/buyonline/buyonlineform.cfm
Max, as far as I can tell all the quoted statements add up to “Red Bull contains caffeine”, which has been reported to have all those effects.
Red Bull’s website describes other ingredients as well.
“Taurine is involved in vital functions of the human body. Taurine acts as an antioxidant and has been shown to promote detoxification by binding together with harmful substances and thereby accelerating their excretion from the body.”
The bottom line is that Red Bull is marketed as a dietary supplement, so it needs the FDA disclaimer in order to comply with the law.
plus “It gives you wings !”
John Stossel does in fact make that same criticism on a host of professions including, doctors, morticians, funeral home directors, florists, barbers, taxi cab drivers, and little girls who sell lemonade… It’s a valid complaint.
There is nothing wrong with having a voluntary professional service organization which creates its own regulatory framework and provides a license to certify that its members meet certain standards (and that those standards are transparent) – but the problem occurs when government steps in and uses the licensing as a way to prevent people from getting a job – ie, when current practitioners use the government to prevent competition from setting up shop.
How do you feel about Dr. Novella’s point about needing science based regulation? Yes…no…maybe?
I’m gonna get me one of them degree thingies
http://www.eisnerinstitute.org/parapsychology-online-degree.html
I wonder if they do doctorates for a little extra cash. Dr Jose has a nice ring to it.
I have several friends that have recently graduated college and have degrees that can’t yield jobs. Psychology, Art History, Philosophy and so on. These kids or their parents spent a minimum of 20K for there education yet they cannot net a higher paying job than the one they had in high school. I believe that trades are also important and need to be pushed more in the USA
Regulatory capture, where the people who are supposed to be doing the regulating are co-opted by the industry to be regulated, is an issue here. If there is no external objective way of measuring someone’s competence, the problem becomes even more tricky.
On what basis would licenses to practice reiki be granted or denied, for instance? If only reiki practitioners can evaluate other practitioners, it becomes a self-reinforcing clique.
i haven’t been able to find anything to help with my chronic pain. the only thing i haven’t tried is acupuncture. any suggestions?