Wednesday, March 17, 2010
Can anyone tell me why the new generation of "vet skeptics" are so insistent on remaining anonymous? I've been reading "skeptvet" and "skeptivet" but cannot determine from their "about" why they are qualified to question the experience and recommendations of specialists with more scientific training. Can someone help me here?
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Why do you think other veterinarians (or clients for that matter) are not qualified to question the evidence base for specialists recommendations?
ReplyDeleteAs to the pseudonym, there are several reasons;
-the blog is not the first thing clients see if they google my real name-I am not selling skepticism and approach the topic differently depending on how the client views different topics. It also gives my clients some extra privacy if I discuss a topic that a client may have brought up recently.
-it avoids an appeal to authority or the appearance of an appeal to authority-the discussion should stand on it's own merits, not on whatever letters are after my name.
-I am not using my blog to promote my practice or to sell products, unlike some experts.
-a pseudonym serves the above purposes, but does not create any expectation of true anonymity, as you have demonstrated yourself-you did not seem to have much trouble finding me today. I know quite a few pseudonymous bloggers (Orac, Le Canard Noir, The Skept Vet and others) most of whom have similar reasons.
So you would rather your clients not know your true feelings about integrative/alternative medicine, and would want to protect them in case you blogged about an event surrounding an interaction with one of them. That makes perfect sense.
ReplyDeleteThe other points, I'm SO not buying.
About the anonymity thing - I think you did that pretty well as I couldn't identify you. A pet owner who knows of you passed some of your contact information to me.
Finally, you're correct. You do have the *right* to question authority, or specialist recommendations, as it is your patient. I just think that with a specialist's advanced training and access to specialized knowledge even we VIN members don't get, a little open-mindedness about why they choose an unproven remedy is in order.
I am in general practice and have occasionally strongly disagreed with specialists' recommendations with regards to therapy, to correct diagnosis, to appropriate workup, and to therapy. I explain to my clients why I disagree,and I also discuss my disagreements with the specialists. I generally get along well with all the people I refer to. They respect my opinion, and my clients appreciate the open comunication. Occasionally I am correct! Specialists sometimes DO NOT have as much experience in diagnosis as longterm practicing generalists.(the result of 3 years out of school vs 20 something, probably that 10,000 hour thing). I have also been asked my opinion by specialists when the patient reaches a "fork in the road." Please note, I refer to both western and alt/chinese trad specialists, and learn a lot from both. I only wish that the alt med doc would stop recommending raw food diets, esoecially to clents that take their dogs to nursinghomes. Sorry for the typos, I'm getting used to a new net book.
ReplyDeleteSusan,
ReplyDeleteI do tell my clients what I think about alternative medicine, but I approach each one individually depending on what their preexisting position is. If a client is already convinced something like homeopathy works, I would try to find out why without alienating them so much that they don't tell me about other things they might be giving the animal. Clients have a wide range in their ability to process information, and I try to tailor discussions accordingly.
It just seems odd that you would write about reading my blog and find me on twitter and facebook all within a few days, bu I will take you word on the "pet owner". :)
I would certainly hope that a specialist would have a better grasp of their specialty than I would, and I am perfectly willing to be open minded about their recommendations. This may be where our ideas of open mindedness differ though-I would like a brief explanation of the possible mechanism of action or the evidence that a treatment works in the form of a trial or something, and how strong the evidence seems to be. Claiming special knowledge without any further explanation seems like an abuse of authority to me, and is not how science and medicine advance. The best specialists in practice or education seem to have no problem with discussing the type and strength of the evidence for a given treatment.
Claims of special knowledge without any demonstration of evidence also sounds dangerously close to the patriarchal "Dr. knows best" attitude that nearly everyone has rightfully worked to change over the last 40 years or so. The veterinary community seems to have an issue with this kind of discussion though, and veterinary students and graduates are often unable to evaluate evidence, and are often discouraged from doing so. Apparently Dr. Ramey was asked to leave VIN because he asked the "experts" too many questions. I think that type of attitude needs to change.
Complaining about anonymity is just a way of avoiding dealing with the substance of skeptical critiques. Five seconds on google will tell you who most bloggers "really are," but this will tell you nothing about whether their opinions are correct or not. Opinion-based medicine may accept someone's credentials as adequate evidence for the accuracy of their positions, but evidence-based medicine is about critically evaluating the evidence itself rather than taking someone's word for everything. So knwoing who someone is doesn't provide much useful information for evaluating their claims. It merely provides a convenient way to dismiss these claims without really engaging them if you choose to argue that their credentials are inadequate to justify their making the critique.
ReplyDeleteAs for "scientific training," I once believed as you apparently do that specialists had more of it. As it turns out, what they have is more detailed knowledge of facts and skills related to their specialty. However, if these facts are based on the opinions or personal clinical experience of their mentors, or on poor quality research, they are no more likely to be correct than the opinions of anyone else. It is true that many academic veterinarians are more familiar with the evidence for against controversial approaches within their specialties than are general practitioners, who tend to take experts' word for things more readily. However, veterinary medicine is still very much dominated by an apprenticeship model of training in which opinion and clinical experience is given far more weight than it deserves.
Finally, being open-minded is not the same thing as being uncritically accepting of claims without evidence. Skeptics are often open minded in that they accept the possibility of new claims being true, provided adequate evidence is put forward for them. If such evidence is not available, however, they withold judgement. And this means not recommending a treatment one has no good reason to believe is safe or effective. You appear to take the position that in the absence of sound evidence the best course is to believe any claim made by someone who you judge is smart or educated enough to be trusted. Unfortunately, medical history is full of examples of smart and educated people persisting in erroneous beliefs and ineffective practices, and I believe the better course for our patients is to be cautious about utilizing unproven therapies. Primum non nocere is still good advice.
I don't know if this will actually be read. But here goes.
ReplyDeleteMy cat has squamos cell cancer. it is inoperable. I have chosen against cehmo and radilogy for this particular cancer and have opted to instead give hom the following suplements:
ES clear with C Caps
The cancer protocol from vitality Science
Nutrical
Chicken broth (organic)
He was doing Ok until Is tarted him on the cancer protcol which was 3 days ago
He is also on pain meds and I will keep him on these unitl I eunthanize him at home.
oes anyone know if I could possibly be giving him too much? Or perhaps the disease has won out. I even traveled up To Cornell but the risks for the treatment they proposed were too great.
nmace@mac.com
Thanks
Dr. Bartimaeus/Skeptvet:
ReplyDeleteYou said "You appear to take the position that in the absence of sound evidence the best course is to believe any claim made by someone who you judge is smart or educated enough to be trusted."
You have misinterpreted my position. I agree that 'expert based medicine' leads us down the wrong road, but you are mistaken if you think that the credibility of persons participating in an academic or scientific argument is irrelevant.
Of course, it takes a certain amount of education to evaluate the credibility of academics. The good ones are known for their advanced training, years of practice, and exposure to experts at different academic institutions. They are also known by their colleagues for solid research, honest reporting and general good character. They have knowledge that is not accessible to many of us by virtue of their attendance at specialty meetings, learning of new data before it is in the literature.
So I am not fawning at the feet of experts, but I expect to know something about the credentials of any writer if they expect me to take them seriously. Otherwise, if they present a scientifically supported argument, I don't know if they have done a complete literature with balanced reporting of the results, and I might not even be able to determine if they can correctly interpret the results.
Yes, credibility matters.
Dr.Susan Wynn:
ReplyDeleteI think you are ignoring most of the points we have made. I would add to your statement that the best academics are also perfectly willing to discuss the type, strength and weaknesses in the evidence for their claims. (Maybe that is what you mean by honest reporting and good character.) Even some of the most respected scientists can sometimes go of the rails and be spectacularly wrong (Linus Pauling and mega-doses of vitamin C come to mind). Likewise, preliminary and pre-published data also has an annoying tendency to error, no matter how great the scientist. That is why peer-review and replication are so important.
The SkeptVet and I are perfectly happy to admit if we are in error, as long as you can explain what the error is and provide some evidence to back up your claim. I find it interesting that bloggers with a "skeptical" point of view almost invariably provide links to whatever they are blogging about so that anyone can verify their claims. Providing unlinked references is OK, but makes it more difficult to verify. Sometimes an emphasis on titles and a long list of difficult to check references is just another form of an appeal to authority. It is surprising how often those references don't say what a writer claims they say when you check.
What I am trying to say is that there is more to credibility than education and titles and actions speak louder than words. I am sure you can think of some examples of "qualified" persons making poor, unsubstantiated arguments as well as I can. If you want to continue fussing about pseudonyms, go ahead, but I would prefer to have a more substantive discussion.
You said: "What I am trying to say is that there is more to credibility than education and titles and actions speak louder than words." I completely agree. I never argued that knowing that a blogger is an academic was all we needed to decide on their credibility. It just helps alot.
ReplyDeleteI think we *are* having a substantive discussion and I'm sorry you perceive that I am "fussing about synonyms". I asked why the skeptics are anonymous, and you finally decided that it was to protect your clients in case you talked about them. You then defended anonymous blogging by saying that you studiously avoiding an appeal to authority. I argued that putting "vet" in your pseudonym kind of nixes that argument, but that knowing exactly who the blogger is helps to make a determination about their credibility.
If your concept of a more substantive discussion is that I follow every single side argument you make, well, you're right. I don't have time for that. But I'll follow this one:
Linked references? Really? That's a sign of someone who is making a better argument? Please - all you need to do is copy and paste the title into Medline.
Protecting my clients privacy is only one of the reasons I gave, the others you chose to ignore until now. Saying that I am a veterinarian gives a little basic background, and does give people some idea that I am familiar with the field. It is not a claim to any special knowledge that any other vet or an intelligent layperson cannot achieve for themselves.
ReplyDeleteAs to linked references, I was merely observing an interesting difference in style between bloggers. Sure, it is easy to find references when they are listed, but some people seem to think it is worthwhile to link directly, while others don't. Check out some of the blogs on my blogroll for examples. To me, providing links is a courtesy that shows respect for your readers. As I said before, As a general observation, the more difficult someone makes it to check their sources, the more likely it is that those sources either don't say what the writer claims, or are irrelevant to the claim anyway. To your credit, I have not seen you do this.
Dr. Wynn,
ReplyDeleteI think we've gotten a bit off track here talking about credentials. I agree that experts are more likely to have the specific factual knowledge to make sound judgements about the quality and conclusions of the scientific evidence than generalists or lay people. That doesn't mean that they are always correct, of course, since they are as subject to cognitive biases and errors as the rest of us, but I think we agree on this.
The genesis of the conversation, though, was your assertion that you "cannot determine from their "about" why they are qualified to question the experience and recommendations of specialists with more scientific training." This says very clearly that you consider credentials important in judging whether someone can legitimately question the recommendations or experiences of specialists. And this, in turn, strongly implies that people without what you consider to be adequate credentials shouldn't challenge these recommendations or experiences. If that is in fact what you meant to say, I disagree strongly.
A sound, evidence-based critique is legitimate regardless of the source, and whether or not it should be taken seriously or responded to substantively should not depend on the credentials of the person making the argument. If you are corect that specialists are more qualified than the rest of us to have opinions in their particular domain, this should manifest itself in the weakness of the arguments put forward by non-specialists. And responding to arguments or critiques by less-educated non-specialists should be easy for those with a better grasp of the relevant information. But no one should expect to be able to simply ignore or dismiss prima fascie a critique because they do not judge the person making it has sufficient credentials to justify making their critique.
I take my clients questions and concerns seriously and atttempt to respond to them with good arguments and evidence regardles of the fact that I am a professional veterinarian and they are, usually, not scientists. I cannot ignore their opinions, however mistaken, simply because "I am the doctor and I know best." The same logic applies to criticisms of CAM from those who are not CAM rpactitioners or specialists in other relevant domains. The onus is still on those making the extraordinary or exceptional claims to defend them with good evidece, and having professional expertise in an area does not get one out of defending one's positions.
I am hoping that we do actually agree on this and that perhaps you initial comment was not, as it seemed, a statement of the position that you feel you need not respond to critiques unless you can first judge whether the person making them has enough of the right academic background to be taken seriously. It is easy to overstate or misinterpret things in a text-only medium of communication, and I would hate for us to be arging pointlessly over positions neither of us holds. :-)
I'm pretty sure we ARE in agreement. You said:
ReplyDelete"A sound, evidence-based critique is legitimate regardless of the source, and whether or not it should be taken seriously or responded to substantively should not depend on the credentials of the person making the argument. "
I don't exactly recall the original anonymous post that sparked my question, but as I remember, it was really more of a narrative about an experience, and was not an evidence-based, detailed critique. I think I could question the credibility because it was a posting that provided no substance. If I KNEW it was a veterinarian writing that post, I would probably have been more generous.
I agree that we should not have the "doctor knows best" attitude, but I can tell you that I am more tired than you can imagine of having uneducated bloggers make confident statements about, for instance, my favorite area of nutrition. They certainly persuade pet owners and have enough of the scientific language to sound convincing. In the absence of a thorough, referenced critique, I can't give them the benefit of the doubt unless I know some credentials.
As I say, I think we are in agreement.