Friday, February 10, 2012

How to debate alternative medicine

I am an outspoken skeptic and when I hear someone mention alternative medicine I have never been afraid to express my doubts about whether a particular alternative treatment actually works.  As a skeptic I generally disbelieve in most alternative medicine because most of it is at the least unsupported if not outright contradicted by evidence and research. Thus I try to show others this lack of evidence to help them avoid risks to their health and the potential waste of money and time.

However, no matter how much evidence I used to support my claims I could not change peoples minds.  I could describe cognitive biases, the placebo effect, and the importance of non-anecdotal evidence all day but even if I could manage to draw out agreement on a few points people always jumped back to "it worked for me."  I debated like this for a long time and my success rates were near 0%.  Even some people who I thought I had convinced I later heard going back to their original beliefs.

So what was the problem?  Why doesn't presenting evidence change peoples minds? Well lets go back to peoples final answer: "it worked for me."  People "knew" alternative treatments work because it worked for them.  Thus in their minds I am clearly wrong; their experience "proves" it works and no matter what point I might make there must be something wrong because they know it works.

Even worse I am attacking them personally.  They just told me that the know it works because of personal experience.  My response in their ears is "you are delusional."  Even though I might be clearly saying we all have problems with bias and perception, the fact is, I am attacking their specific belief and they will take it as an accusation of being delusional.

So who is going to listen to you when you accuse them of being delusion then refuse to listen to what they know is "obviously true?"  The answer to this rhetorical question is, of course, nobody; nobody will listen to you when what they hear is an attack on their credibility and beliefs.

The reason I write this post is to explain how I have tried to get around this problem with mixed success.  There is no sure technique that will convince everyone and some people are beyond convincing.  So without further ado lets get into this...

The non-skeptic view of life
Before you can bring someone to a skeptical point of view you first need to understand where they are coming from.  Most people do not understand science: they do not understand how science works, what it tells us, why we should trust it, or why it is the best tool we have yet developed for pulling truth out of the world around us.  This lack of understanding of science can lead to distrust and disbelief.  Thus providing citations to scientific research to a person who doesn't understand science is unlikely to be convincing.

Additionally, the average person you talk to will hold a simplistic view of how the world works.  I do not mean simplistic in any sort of demeaning sense and by no means am I saying they are unintelligent.  What I am pointing out is that most people do not stop to consider all aspects of a thought they have nor do they pause to examine the details of every phenomena they experience.  Thus most people never go through the process of learning how complex the real world is.  Such simplifications abound: Criminals are bad, a hero is good (criminals often do good, and many heroes do bad things); we need air to breath to live (we don't need to breath we just need enough oxygen in our blood); or the assumption that the earth is flat at short distances when looking at maps (it might be useful but it ignores that the world is round).  We all make these simplifying assumptions in our daily life and it is a necessary part of perceiving and making quick decisions in a complex the world.

Simplifying assumptions become problematic when we use them outside the context where they are useful.  Take for example the claim that we should avoid eating chemicals because they are dangerous.  This myth arises from the fact that there are many synthetic chemicals that are dangerous.  People often use the word "chemicals" to specifically refer to dangerous synthetic chemicals and fail to realize that everything is made out of chemicals.  They also fail to realize that there are many naturally occurring chemicals that are just as dangerous as synthetic chemicals.  Thus this simplistic belief that we should avoid chemicals makes sense when we talk about potentially dangerous synthetic chemicals, but starts to lose its usefulness when we apply it to less dangerous chemicals.  In other words this simplified view saves time by assuming all synthetic chemicals are dangerous rather than analyzing each chemical on its own.

A third problem, as I discussed above, is the fact that people tend to believe strongly in alternative medicine because it is true to them.  They have experiences that, in their belief system, seem to be extremely convincing evidence.  Additionally, they do not understand cognitive biases and problems with perception.  Thus they are less likely to be receptive of you pointing these things out.  Even those of us who know of these problems often forget that we have these biases and faults.  We are all prideful and most of us believe that we perceive the world in a neutral way and that our perceptions and memories are just as reliable as a video camera.  Someone who attacks our perceptions is therefore attacking our credibility and calling us a liar or delusional.

So again the four obstacles most people have to understanding problems with alternative medicine are: 1) they don't understand or trust science, 2) they look at the world in a simplistic way that doesn't take into account real world complexities, 3) they trust their perceptions, and 4) they assume any description of perception issues is an attack on their credibility.

Letting others find skepticism
As I mentioned before not only have I had trouble convincing people alternative medicine does not work but also the people I have convinced have often gone back.  The reason is likely because they were mostly convinced by my rhetoric and they failed to understand the underlying reasons why I distrust alternative medicine.  Attacking any specific belief is likely to be unsuccessful.  Not only do people hold these beliefs dear they also are unlikely to understand your underlying reasoning.  The specific beliefs aren't important anyway.  The important step is the process we use to achieve our beliefs.  If a person does not have the tools to be skeptical then the next person with a rhetorically persuasive though illogical argument will pull them right back.

The solution I have found is letting others find skepticism.  I chose these words carefully.  If you try to "lead" someone to skepticism it may be treated as patronizing.  As it is "letting others find skepticism" is still patronizing but, I hope less patronizing than leading.  And I would make sure to never tell someone that I was leading them to skepticism, I want them to achieve it on their own.  The process of learning by thinking every idea through is much more powerful than having someone else explain it to you.

So how then do we start the process of skeptical thinking?  Here is one way.  It is by no means the right way and I am sure there are many situations to which it will not apply because as we should remember the world is  a complex place.

Step 1: change the subject away from their belief.  When a person tells me that they have been going to an acupuncturist and its been great in healing their back pain I make sure not to attack that belief.  I make sure I don't say: "actually that was probably the placebo effect" which they interpret as "you're delusional."  Instead I say: "wow that's great, I'm glad you got rid of your back pain" and thus I don't lie about my disbelief in acupuncture while at the same time showing that I do believe that they feel better.   After that, its time to divert.

Step 2:  figure out where to divert.  This is the hardest step and there is no specific advice I can give.  You don't want to step in and start criticizing acupuncture because they'll go on the defensive.  Additionally, picking out any specific alternative belief is risky because you don't know what they believe and what they don't believe.  Instead what you want to do is try to find a neutral subject and then address one of the problems I discuss above.  Perhaps you find out they believe in global warming.  That's a perfect place to start.  If you can keep them interested in this subject then keep going on it.

Step 3:  Discuss: science, simplified views, or cognitive biases.  If they believe in global warming bring up one of the opinion pieces signed by "scientists" and discuss how that isn't how science is done and try to do as much as you can to explain and discuss how science is done and why it is a powerful tool.  Or discuss how people's simplified views of the world prevent them from understanding the difference between climate and weather.  Or go into how people become biased against global warming due to political views and thus have a  hard time accepting the evidence of global warming.

Step 4:  Get them interested in something.  Find some subject they find interesting that they want to question and encourage them to research it more.  Say that you are going to research it too.  The if you have a chance to discuss it again you can come back and explain why you believed certain sources and discounted other ones.

Step 5: Be ready to let it go but also try to find a way to bring it back.  People are only willing to listen to a subject so long before they tune out.  Learn to recognize this point and back off so you don't annoy or bother them.  If you can, do your best to get them interested.  Some people genuinely want to learn more and you can often leave the conversation with "lets do this again sometime!" or "I'm out of time but I'd love to meet up for coffee to talk more."  You will never convince someone in a few minutes.  Generally, teaching something as complicated skepticism takes a lot of talking and giving them their own time to think things through.

Although I outlined steps above for teaching skepticism I think it is much more important to simply remember that most people don't understand science and skepticism.  Our goal isn't to convince them that acupuncture and homeopathy are really just snake oil.  What we want to do is give them the tools to explain to us how acupuncture and homeopathy are not supported by evidence and in fact contradict vast amounts of scientifically accumulated knowledge.

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