Absolutism: why people continue to believe what isn’t so

Hello all,

This week’s post was triggered by several things. The brief discussion Roger and I had in the commentary to Roger’s last post, Paul Offit’s excellent new book (Do you Believe in Magic?) and a visit to the pet store. Let me explain…

Following Roger’s posting on science in the UK National Curriculum (and consideration of the possibility jesus rode a dinosaur), we had a short debate on the the issue of when it is and when it isn’t appropriate to challenge beliefs, and of the use of humour to challenge ideas.  Rog made an excellent point with an example from a colleague about guidelines on use of electronic resources. Most of us get this sort of guidance (or similar) from our IT departments:

Users must not knowingly, through use or personal behaviour, cause any annoyance, inconvenience, offence, distress or nuisance to other users of those facilities or individuals within or outside the University.”

As his colleague, Robert, rightly pointed out, this seems to suggest universities are NOT the place for radical thinking that will cause anybody any annoyance or offence!

I find this very pertinent here in Canadian west coast where there is a particularly strong ethos of respect for diversity and plurality. Overall, “dude, its all good” would be an apt summary, but the problem is this neo-liberalsim seems to be taken to such extreme levels now that it has simply become another form of constrained thinking causing more problems than it solves. This reminds me of the time in the UK in the 1990’s when I was told in a diversity seminar that I should not use the term “black coffee” as it was offensive to black people (confused, I actually asked a black colleague if this was so, and he laughed so much he almost fell over).

In the age of Web 2.0 and a variety of blogs of every description we are be seeing some interesting challenges to ideas presented. For example, some opinionated bloggers (such as David Colquhoun,’s Improbable Science, and Ben Goldacre’s Bad Science blogs) have both had complaints and threats to have them closed by opponents, and although I find both rather intolerant at times (and fixated on RCTs as a solution to all) it is good to see they are still running to challenge nonsense and make compelling arguments.

The problem is the division between criticizing an idea and what is seen as a personal attack on an individual. In our view the former should always be open, but the latter is simply bad-form, egregious and uproductive. Nevertheless critiquing and challenging ideas is what science is all about. If ideas become seen as sacrosanct, unchallangable and absolute then it becomes impossible to move forward. Science has long ago abandoned the notion of absolute truths and modern post-positivist science recognizes that our current ideas seem a good approximation of a truthful explanation of a phenomenon, but are flawed by a) our limited understanding of the universe at this point, and b) that the human mind’s understanding of the world is itself a particular interpretation. However, that does not equate to a position that ergo: anything goes. In science, any idea or theory is seen as fair game, as long as you can argue a better theory and demonstrate it represents a better explanation.

However, it seems overall the human mind has a predisposition for absolutes, and concrete thinking and that is where the problem arises. We see it a lot with criticism of religious ideas, which in some countries results in the death penalty, but also in science and my field, nursing. As we know, medicine has dumped many unsatisfactory theories over the years, such as blood letting, putting infants on their front to sleep, or the use of frontal-lobotomies to cure mental illness. The advent of evidence-based practice (EBP) has accelerated this progress; as one theory is shown to be at fault, another one that better explains the phenomenon arises, and supplants it.

This is far from the case in the world of complementary and alternative medicine (CAM) though, where debunked theories are still advocated. Before I go on, I should point out that I have been trying to avoid spending a lot of time on CAM issues in this blog, as numerous others do it so much better (see the links section on the right of the blog main page for good examples) and in nursing here it is like putting a stick in a veritable hornets nest resulting in being labelled as an allopathic dinosaur or similar. Nevertheless,  it is  it is difficult to get around the fact that paradoxically it is from some CAM practitioners (the latest term for which seems to be “Integrated/IntegrativeMedicine”)  that the most extreme forms of absolutist thinking arise.

Firstly let us be clear, there are complementary therapies that make excellent adjuncts to modern medicine, such as massage, exercise-based therapies (such as Yoga) and meditation for relaxation and mental health. On the other hand, if we think about it “alternative medicine” does not really exist. There is simply medicine (things that have been demonstrated to be the most effective treatments/interventions) and the alternative, belief-based health practices: things that currently have no-evidence of efficacy, or even evidence they do not work. Herbs and remedies that are shown to have efficacy become medicine (such as folic acid, to prevent birth defects). As Joe Schwarecz, Director of the Office for Science and Society at McGill University put’s it: “there is a name for alternative medicines that work: it’s called ‘Medicine’ (Offit, 2003).”

Yet people (including intelligent individuals) continue to believe in the absolute ideas of many CAM therapies that have clearly been demonstrated to be nonsense, and CAM practitioners refuse to amend or update their positions, instead claiming the same theories are misunderstood, conspired against by big-pharma, or worse beyond scientific explanation. That brings me to my visit to the pet store. My cat Holmes, has been rather ill over the last few weeks (probably on her last legs poor thing, as she is now 19 years old) and I went to the pet store to pick up some cat snacks. Whilst in aisle with worming remedies I came across the following:

Homeopet, homeopathic pet remedies at $18 a box no less! This raised my ire, as it is basically as clear a case of exploiting peoples health concerns as you will find (admittedly with pets). This is a problem that underpins the whole industry (and make no mistake CAM is a multi-million dollar industry).

Firstly homeopathic theory is barking-mad (sorry could’t resist the pun). The idea that a single molecule of a substance in a volume of material that stretches from the earth to the sun could have therapeutic benefit makes no sense at all. Consider that drinking water from your tap probably has more homeopathic properties than anything costing $18 a pack. Secondly numerous studies over the years have shown no benefits with homeopathic remedies compared to placebo. And yet, homeopaths and naturopaths swear that the theory is sound, and their remedies work, despite clear evidence and theoretical argument to the contrary. Nevertheless, they represent a growing segment of the health care sector here in BC.

The principles behind homeopathy (like cures like) actually arise from medieval belief that there was a causal metaphysical link between a weapon and the wound it caused that persisted after the injury. Even Francis Bacon wrote of it, describing how a salve applied to the weapon, could cure a wound made by it; “bind the wound and grease the nail.” This seems like nonsense now, but the practice of applying weapon salve persisted up until the beginning of the last century with the reported case in the British Medical Journal of a woman, Matilda Henry in 1902 using it for a nail injury (from which she died shortly afterwards from tetanus). Most of the educated world abandoned those beliefs, but a version of the theory persists in homeopathy despite no good theoretical basis, or evidence it works.

Likewise in Chiropractic, there is a battle going on between Chiropractors who simply use spinal manipulation to relieve back and muscle pain (which can be effective in some cases), and those that claim the theory of subluxation works and spinal manipulation can help cure any number of diseases from diabetes to heart disease. There is no evidence (despite numerous studies) to support the theory of subluxation, and yet again practitioners defend the theory as an absolute truth, with no thought of throwing it out or even amending it.

The most extreme example of belief-based heath practice is of course the faith-healer. Recently a very earnest RN sent me a link to this guy (Adam McLeod – the dreamhealer) who claims to be the real thing. She was keen I should attend his show, to see for myself. Now, I admit to a certain degree of skepticism here despite having never seen him work, as these practitioners have been shown to be bogus charlatans over and over again, and he is obviously doing big-business . The usual website testimonials  are present (of the “I was healed by the dreamhealer” variety as well as some from people with postgraduate qualifications). None of this really help dispel the image of quackery. Again this looks like a classic case of exploiting people’s beliefs, particularly when they are in a vulnerable state. Personally, I find this kind of thing highly offensive, and although it is of course possible that  he actually believes he has a gift, I have to consider; what are the odds he really does? The image presented is one of a new-age health guru (complete with mandatory picture with a stethoscope round the neck – to affirm scientific validity). If you were a real believer in your own magical healing powers, why wouldn’t you want to subject this to some empirical trials to show the world this miracle rather than performing private shows at $169 a shot?

Even established nursing organizations condone some of this. An Australian RN colleague Joanne Benhamu, recently tweeted it was embarrassing that North-American Nursing Diagnosis Association (NANDA) still supported the nursing diagnosis of “disturbed energy field” in the latest NANDA diagnostic terms handbook (2012-14). Quite frankly, I find that astonishing and it makes nurses look ridiculous, devaluing the public image of nurses as evidence-based practitioners. That aside from the fact that such a diagnosis is as practically useful to a nurse as the proverbial chocolate teapot. It makes as much sense as diagnosing the patient is “feeling under the weather” or maybe “a bit peaky.” Maybe NANDA would like to add those to its diagnostic statements too? I dispair.

I could go on, but to be frank, it get’s boring, and has no effect on those who believe in this sort of thing despite all the evidence to the contrary. So why do people continue to believe in this sort of thing despite all of the evidence? Worse still why are people happy to be exploited by these sort of shenanigans? It has been going on for centuries, and these folks are still doing big-business. Well, I can understand why the public want these services. As Paul Offit points out in his book, modern technological medical healthcare is far from perfect.  There are many things modern medicine cannot cure, and it is particularly ineffective at helping with many chronic conditions (such as acne, or tendonitis). It is also a victim of its own success. Most patients now receive very depersonalized care with rapid visits for screening, to see physicians or nurses, or for medical and surgical procedures. Also, modern medicine is usually very unpleasant, and as the predominant form of healthcare has rather a significant error rate. Procedures go wrong, people are frequently misdiagnosed, and sometimes people are injured or die as a result of medical practice.

CAM practitioners, on the other hand operate primarily as primary healthcare providers, rarely deal with acute or emergency care, spend considerable time with patients and develop good working relationships with them over long-consultations. Their practices are generally quite non-invasive, often pleasant, and to paraphrase Douglas Adams “mostly harmless.” Likewise contemporary postmodern nursing approaches taught in many Canadian universities are generally supportive of CAM practices so nurses graduate with the notion that these are generally harmless practices, and we should support this plurality. However, we should be clear, accepting a fashionable anti-science agenda and adopting constructivist philosophical arguments about the nature of evidence also has implications for our professional status.  Both homeopathy and opposition to vaccination (naturopaths) are in clear conflict with current EBP, and whilst homeopathy is pretty harmless, opposition to vaccination is certainly not. The “dude, its all good” approach in healthcare can actually result in real suffering, ill-health or worse. That is what academic discrimination is for.

Overall, I think we all want some certainty in our lives, and most practices that support absolute fundamental belief (from religious fundamentalism and cults to modern day magical health practitioners) provide this. Science on the other hand doesn’t provide this or teach us what to think, but focuses on how to think, and sometimes the results can be threatening to our own beliefs and values. Maybe others have some ideas why despite several hundred years of scientific development people still choose faith-based solutions over evidence-based ones, especially with healthcare. I welcome your thoughts.

That wraps up our last post before the summer break as Roger and I are off on various travels for the next few weeks,  but we will be back in September. Have a great summer all (in the northern hemisphere) and a good winter to all you folks down-under: surfs up!

Bernie

References

NANDA (2012) Nursing Diagnoses: Definitions and Classification 2012-14. Available from: http://www.nanda.org/nanda-international-nursing-diagnoses-definitions-and-classification.html 

Offit P.A. (2010) Do you Believe in Magic The sense and nonsense of Alternative Medicine? New York, Harper Collins

It’s not Gravity, it’s sticky feet!

I had a couple of emails from Bernie this week. The usual one reminding me to blog (where does the time go?) and a second suggesting that if I was stuck for something to write about I could pick up on a discussion started by Professor Brian Cox, the UK physicist and a rather cool promoter of science-dude (I’m just jealous) that was taking place on Twitter.

Anyway, I’m not great with Twitter and apparently I only have 17 ‘followers’, so I’m not much of a guru either and I do wonder why they follow me, as the last tweet I made was in May and it was one that I accidently sent to a work colleague that didn’t actually say anything.

Nevertheless, I looked it up and found what Bernie called a ‘discussion’ but looked more like a series of statements, some of which I couldn’t really understand and linked to all sorts of other stuff. This is probably why I’m not a great fan of Twitter as I prefer more linear forms of communication. What were immediately apparent however were two pictures of Jesus riding a dinosaur. I’m not sure of their provenance, but they looked like the daft sort of thing that Creationists (particularly ones in the US) produce. Indeed, one of the links took me to a Creationist Museum in Cincinnati in the US. It actually looked like a lot of fun and strangely I found myself thinking that I’d rather like to visit it one day. Expositions on the Voyage of the Ark and using dinosaurs as work animals, in fact a whole new exhibition on ‘Were dragons dinosaurs?’ and loads of state of the art learning technologies made it look like really good fun and in a way that’s just what it is. It’s funny. In fact it’s so far ‘out there’ that we find it amusing and we can laugh and be derisive about these peoples earnestly held beliefs. Jesus on a dinosaur – what a laugh!

Now there’s something not right there. I felt a bit uncomfortable writing that.

This is something that doesn’t sit easily with my admittedly wishy-washy-pinko-neo-liberalism. These Creationists have every right to believe that the world is 6000 years old and that people co-existed with dinosaurs, just so long as they stay in the world of belief and don’t step into the world of science. Ignoring the evidence and taking the stance “I see/hear what you’re saying, but I still believe” is fine in my book. Flat-earthers actually have my respect for sticking with it. My own belief that gravity doesn’t exist, but that we just have very slightly sticky feet is constantly derided, but I have never lost the faith in it, despite the shed load of evidence to the contrary.

There seems to be a trend to deride creationists as loons and nut cases (UK slang terms for harmless idiots) at the moment and I’m not sure how other religions would react to such sustained criticism, probably badly given another event that took place in England a few days ago.

For this week saw the launch of new plans for the National Curriculum (for England). Given the policy of the present Secretary of State for Education, Michael Gove, has been to return schools in England to the1950’s it was actually heartening to read a very clear commitment to the teaching of evolution to young children.

In Year 6 (10 – 11 years) they need to be taught to:

  • recognise that living things have changed over time and that fossils provide information about living things that inhabited the Earth millions of years ago
  • recognise that living things produce offspring of the same kind, but normally offspring vary and are not identical to their parents
  • identify how animals and plants are adapted to suit their environment in different ways and that adaptation may lead to evolution.

The notes and guidance talks about sources of evidence and that:

“They should also appreciate that variation in offspring over time can make animals more or less able to survive in particular environments, for example by exploring how giraffes’ necks got longer, or the development of insulating fur on the arctic fox. Pupils might find out about the work of palaeontologists such as Mary Anning and about how Alfred Wallace and Charles Darwin developed their ideas on evolution.”

 Well at least that’s something. In fact I’ve just checked and the framework doesn’t even mention ‘creation’ and the only references to ‘the Church’ in the 224 pages are in the history section. Furthermore, all schools in England must teach evolution as a “comprehensive and coherent scientific theory”. Good.

Now what’s interesting here is the reaction, not from mad Creationists, but from a far more worrying and insidious source. In the UK we have what are known as ‘faith schools’. These are allowed under the Education Act (in fact were encouraged under Tony Blair – a devout Christian) for children of specific faiths. One doesn’t have to be a Catholic or a Muslim to go to a Catholic or Muslim school, but it sort of helps. These schools draw down state funding (but are supported by their affiliated religions), deliver the National Curriculum and provide tuition for the English national qualifications taken at 16 and 18. We have over 7000 of them and around 1000 privately funded (about a third of all schools). That’s around 2.5 million children. Add to that the new wave of so called ‘New Schools’ (again privately run ones that do get some state funding) and that’s an awful lot of kids. The faith schools reaction to the new National Curriculum was summed up by Michael Cohen, an adviser to Orthodox schools, who said: “I don’t see Charedi [Orthodox] schools going along with it. It is something that flies in face of their ethos and culture.” If that’s the case what has their ethos and culture been teaching the kids for the last 10 years?

Anyway, they’ll have to as Faith Schools are not exempt from teaching evolution, but then somehow “ethos and culture” sounded familiar. So I went back and had another look and found that officials have explained that evolution can be taught “in a context that reflected a school’s ethos”. Now this is the same arrangement made a few years back with compulsory Sex Education in England. As you can imagine, Catholic schools were somewhat concerned by the fact that they would have to teach about the use of condoms, but are allowed to do so in a manner that reflects the ‘ethos’ of the school. In other words, this is a condom, this is how it works, it’s a sin to use one.

So there we have it. It’s really not the US Creationists we should be spending our time on. If they want to produce pictures of Jesus on a Dinosaur and think the Earth is 6000 years old, well, good luck to them, actually I really don’t care.

What is far more concerning to me is that in England we have up to a third of State schools (funded by me and you!) teaching all the usual covertly dangerous rubbish (this is just one theory, intelligent design is another etc etc) and dressing it up as an education that reflects an ethos, rather than simply calling it an indoctrination, because that’s exactly what it is. If the ethos of a school allows them to determine their own facts as well as their beliefs there is something terribly wrong. They simply forfeit the right to be seen as an institution that has any association with education.

The next thing you know they’ll be teaching that gravity is all about slightly sticky feet. Actually, that would be pretty cool.

Roger

Links

The New National Curriculum Framework (England) can be found here.

The Creation Museum: http://creationmuseum.org/

Jesus on Dinosaurs (likely spoof’s rather than the work of Creationists, as sources uncertain):

https://twitter.com/msmiih/status/355439140462018563/photo/1/large

http://www.flickr.com/photos/bar-art/414998399/