Evidence-based medicine should include ALL the evidence

Medicine has a dirty little secret: not all clinical trial results for drugs are reported, with positive results being “around twice as likely to get published as negative findings”, according to Dr Ben Goldacre, a medical science writer. Dr Goldacre calls this bias “a cancer at the core of evidence-based medicine” and has written a book, Bad Pharma, that addresses this widespread problem.

Evidence-based medicine (EBM) should take into account all clinical trial results, and not just cherry-pick the outcomes that match the drug manufacturer’s expectations, or quietly sweep the failed tests under the carpet. It isn’t evidence-based medicine if it doesn’t include all the evidence, even the negative ones. Those of us who criticise ‘alternative’ medicine for its lack of rigour and flawed methodology should be just as critical of similar trespasses in EBM. In fact, by claiming to be scientifically committed, EBM should be held to a higher standard of conduct.

There’s a petition calling for private and public medical researchers to publish all clinical trial results, both successes and failures, with test methods clearly described. Please sign it to show your support for evidence-based medicine that truly lives up to its name.

Here’s a TED talk by Dr Goldacre on the pernicious bias shown by drug researchers for positive clinical trial results, and why it has to stop. You will not find a more passionate, or animated, defender of proper evidence-based medicine.

5.2.13

Another good critique of ‘scientism’

In a happy coincidence, I came across this incisive article in The New Atlantis just after posting about science, philosophy and morality. The writer, biologist Austin L. Hughes, is another critic of science’s overreaching in matters that are outside of its purview, a trend known as scientism. A lot of the arguments that Hughes makes are familiar to critics of scientism: the philosophical ignorance and naivety of its boosters, the complacent assumption that science is uniquely resistant to human foibles and error, the failure to recognise the limitations of science in areas like ethics, and the inappropriate application of scientific ideas to matters that aren’t easily reducible to facts and experiments.

The section on science and morality (‘The Eclipse of Ethics’) is pertinent to the debates going on between Sam Harris, Michael Shermer, Massimo Pigliucci and others. Unsurprisingly, Hughes dedicates a fair amount of space to critiquing Harris’s arguments in The Moral Landscape, a book that has become a punching bag for the anti-scientism crowd. In the following passage, Hughes captures the general sentiment of those who oppose the idea that science should be the final arbiter of truth and morality:

Advocates of scientism today claim the sole mantle of rationality, frequently equating science with reason itself. Yet it seems the very antithesis of reason to insist that science can do what it cannot, or even that it has done what it demonstrably has not. As a scientist, I would never deny that scientific discoveries can have important implications for metaphysics, epistemology, and ethics, and that everyone interested in these topics needs to be scientifically literate. But the claim that science and science alone can answer longstanding questions in these fields gives rise to countless problems.

And since philosophy can help clarify the nature of these problems, scientists shouldn’t be so quick to dismiss its relevance.

HT: Philosophy Monkey

25.1.13

Science, philosophy and morality

One of the things that I enjoy about discussions and debates on ideas is when my views are changed by good arguments. Cogent arguments have almost the same visceral effect on me as seeing well-landed hits in a kickboxing match; I am impressed by the skillfully executed maneuver that demolishes, or at least weakens, an opponent. Of course, I prefer being a spectator of intellectual bouts rather than physical ones. The former are usually more enlightening, especially when they cause me to reexamine my position on some subject matter, perhaps even abandon it.

I’ve had my mind changed on the subject of whether science can, and should, determine moral values. When I read Sam Harris’s book The Moral Landscape, I was convinced by his well-articulated thesis that science can determine our ethical values. I agreed with his argument that empirical facts about what contributes to human well-being (and what doesn’t) can be used to inform, even improve, our existing moral codes. And yes, I confess that I was inspired by Harris’s bold claim that a future where moral relativism was a relic of a more ignorant time can be achieved by ever-expanding scientific knowledge of human nature.

Then I read what his critics had to say.

Massimo Pigliucci had one of the more trenchant responses to The Moral Landscape. There were other equally sharp critics, but I’ll stick to just Pigliucci for now because recently he had to school another Harris-like ideologue who believes that “most scientists have conceded the high ground of determining human values, morals, and ethics to philosophers, agreeing that science can only describe the way things are but never tell us how they ought to be,” which apparently is a “mistake”. Sam Harris’s fellow traveler is the skeptic and writer Michael Shermer, who is actually one of my intellectual heroes for his role in promoting science, rational thought and skepticism. Alas, Shermer’s enthusiasm for science has caused him to set greater store in it than it warrants, at least as far as morality is concerned.

Pigliucci’s dissection of Shermer’s arguments is worth reading in full, but here are the main points that I have taken from it:

First, Shermer attacks a straw man when he claims that scientists and philosophers do not believe that science can determine moral values. No reasonable scientist or philosopher would deny that morality can be informed by scientific discoveries in psychology, neuroscience and sociology (for example). But to the extent that such knowledge can ‘determine’ moral values, there is still a need for philosophical reasoning. Science can tell us what factors increase or decrease human well-being, but we still need philosophy to interrogate the assumptions we have about concepts like ‘well-being’ or ‘happiness’. Science is ill-equipped for this crucial task.

Second, Shermer’s assertions are often presumptuous. For instance, his claim that “moral values must be based on the way things are in order to establish the best conditions for human flourishing”, or using the term “human flourishing” itself, presumes a clean-cut definition or solution that doesn’t exist. He takes his particular conception of “the way things are” and “human flourishing” as given premises, when it’s really a bit more complicated than that, and not as uncontroversial as he seems to think. People like Shermer and Sam Harris fail to show philosophical rigour (because one shouldn’t make axiomatic claims on a priori grounds that haven’t been justified) in their haste to make their points. That’s just poor form in argumentation.

Third, no reasonable person, certainly not philosophers, will argue that philosophy is better than science at discovering facts about the world and human nature. As Pigliucci puts it, “That would be like arguing that chemistry is better than history at figuring out things about the Roman empire.” But no amount of fact-finding and data-accumulating by science will obviate the need for a value judgment on certain matters. And here is where moral philosophy is required for us to reason about what the right, or ethical, choice should be. But this isn’t to say that scientific knowledge shouldn’t influence our moral reasoning. It certainly should. It just can’t supplant moral reasoning/philosophising.

The ‘science, philosophy and morality’ issue has been an illuminating one to follow. I definitely think that Massimo Pigliucci has wiped the floor with Michael Shermer in this bout, thereby demonstrating the important role of philosophy in making sure that advocates for a (mostly) science-based morality tighten up their arguments. And start showing philosophy a little bit more respect.

25.1.13

Jerry Coyne has finished reading the ENTIRE Bible

I admire the biology professor and author of Why Evolution Is True Jerry Coyne for many reasons: his scientific knowledge and passionate advocacy for science, his informed criticism of religion and theology, the unabashed love he has for cats and good food in often exotic locales, and his commitment to civil discourse on his website. Now I can add another reason to admire the man – his sheer tenacity in reading the King James Bible from “In the beginning…” all the way through to the last verse of Revelation. Talk about taking one for the team!

Coyne took up this Herculean task in June last year, and only completed it a few days ago. He joins that elite group of people who can claim to have read the Bible from cover to cover (a claim that not many Christians can make, I imagine). Here’s his review of God’s holy word:

I have realized, after finishing the Bible two days ago (congratulate me!), that theology is like modern literary criticism applied to a book by authors no longer alive. Faced with a text that says one thing on its face, but which can be “interpreted” in innumerable different ways, and with no recourse to the “true” meaning beyond what the words say—or to the author’s own take about what she intended (which, of course, can be misleading too!), Sophisticated Theologians™ simply make up their own interpretations. This is such a palpably obvious exercise that I’m amazed intelligent people fall for it. That’s why in some ways I have more respect for Biblical literalists than for clever and sophisticated apologists like John Haught. The former, at least, try hard to stick to what Scripture really says. (Readers don’t need to inform me that even literalists exercise some interpretation.)

Oh, and the Bible is not a great work of literature. There are some good bits—we all know them—but most of it is tedious and boring. In no way is it as good as Shakespeare or Joyce. Yes, it is a cultural touchstone, and yes, I am glad I read it, if for no other reason than I can say I did, and know what a terrible guide to “morality” it really is. But I did not come away with the thought “what a beautifully written book!” There are some good sentences, and a very few good verses, but the book as a whole is leaden. And its vaunted “moral teachings” are, when not repugnant, trite. I’m glad to be done.

In this I disagree with Richard Dawkins. We both agree that everyone should read the Bible for cultural reasons. But to me it’s like learning organic chemistry: painful but necessary. To Richard it is also a chance to be thrilled at the beautiful language. But that beauty is thin on the ground. If you want beautiful language, read Shakespeare or “The Dead”. For morality, try modern secular philosophers like [John] Rawls or [Peter] Singer. At least they don’t advocate genocide or the subjugation of women.

One can almost sympathise with Christians who choose not to read their Bible in its entirety. Apart from the tediousness and uneven literary quality, as Coyne has painfully discovered, there’s also the uncomfortable fact of reading passages where God commands, condones or turns a blind eye towards decidedly immoral actions.

14.1.13

Questions for anti-abortionists

Over at Daylight Atheism, Adam Lee has listed 11 questions for those who oppose abortion. Lee had previously responded to Christian writer Trevin Wax’s 10 questions for pro-choicers, so it was only fair that anti-abortionists* like Wax were asked some tough questions too.

I think Lee gave thoughtful, well articulated answers to Wax’s questions. His answers correct a few misconceptions about the pro-choice position, while exposing some of the underlying presumptions of anti-abortionists (newsflash: pro-choicers don’t think sex-selective abortion is ok). Lee’s questions in turn should make any reasonable anti-abortionist think deeply about their views in attempting to defend them. Many of these questions are intended to draw attention to the inherent contradictions, ignorance, absurdity and hypocrisy in anti-abortion arguments. Let’s see what rhetorical contortions the anti-abortionists will perform to square the circles of their religiously influenced views.


* I refuse to call anti-abortionists ‘pro-lifers’ or to even use the term ‘pro-life’ in reference to anti-abortion views. It’s an insult to both common sense and the English language to call such views ‘pro-life’ when they hold lumps of unconscious cells in higher regard than the lives of conscious, feeling, female human beings with hopes, fears and aspirations.




22.11.12

Now THIS is a real self-help book

No simplistic aphorisms. No New Age mumbo-jumbo. No treacly flattery, or cheery exhortations to ‘think positive’. Just science and philosophy, presented by someone who is adept at both.

I’m a regular reader of Massimo Pigliucci’s blog Rationally Speaking, where he and his co-bloggers take a philosophical approach to topics of common human concern: ethics, politics, religion, economics, education, science, technology, art, culture, emotions, consciousness. Pigliucci is a trained biologist who currently teaches philosophy at the City University of New York, and his new book Answers for Aristotle: How Science and Philosophy Can Lead Us to a More Meaningful Life is essentially a physical manifestation of his life’s work: to show how science and philosophy reinforce each other in creating knowledge and wisdom, in helping us understand both the world and ourselves. As he puts it:

The basic idea is to explore “the big questions” (you know, the usual suspects: morality, relationships, politics) from the joint perspective of the best science and the most compelling philosophy available to date. After all, the standard answers to those questions come from either religion or folk wisdom, the first one being based on imaginary entities and their arbitrary pronouncements, and the second being, shall we say, somewhat more fallible than one would wish.

In this respect Pigliucci differs from notable intellectuals like Sam Harris, Stephen Hawking and Lawrence Krauss, since these three (to varying degrees) place greater store by science than philosophy. Pigliucci has taken both Harris and Krauss to task for their dismissive attitude to philosophy and corresponding glorification of science. I used to be sympathetic to Harris’s argument that science can answer moral questions, but Pigliucci’s counter-arguments were very persuasive. While I still dislike the term ‘scientism’ (used pejoratively to imply a reductionist worldview, which I think is inaccurate and unfair), I do agree with Pigliucci that good science requires sound philosophical premises and justifications, and that the ‘big questions’ cannot all be answered by science alone.

Answers for Aristotle is definitely going on my to-read list. I have a feeling that it will be ‘meatier’ than similar self-improvement books by philosophers like Alain De Botton or AC Grayling, due to the science. Judging by his blog posts and magazine articles, Pigliucci is an eloquent, knowledgeable writer who can bridge the (perhaps illusory) gap between science and philosophy for his readers, enriching their lives in the process.

28.9.12

Ben Goldacre takes on Big, Bad Pharma

Doctor and science writer Ben Goldacre has a new book, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, that exposes in meticulous detail what many of us already suspect: pharmaceutical companies fudge the results of their drug trials in order to sell drugs that don’t work, or that are actually harmful. The cynics are right, though it would give them little satisfaction to learn the depressing extent of Big Pharma’s corruption.

The Guardian has published an extract from Bad Pharma, which contains this passage:

Because researchers are free to bury any result they please, patients are exposed to harm on a staggering scale throughout the whole of medicine. Doctors can have no idea about the true effects of the treatments they give. Does this drug really work best, or have I simply been deprived of half the data? No one can tell. Is this expensive drug worth the money, or has the data simply been massaged? No one can tell. Will this drug kill patients? Is there any evidence that it's dangerous? No one can tell. This is a bizarre situation to arise in medicine, a discipline in which everything is supposed to be based on evidence.

Proponents of ‘alternative’ medicine and other New Age quackery will be quick to pounce. They will feel vindicated for their distrust of modern drugs and the corrupt system that makes and markets them. Goldacre’s findings may prove Big Pharma’s critics right about its unethical practices, but these critics commit the logical fallacy known as ignoratio elenchi, or irrelevant conclusion, if they think that Big Pharma’s unethical actions prove the efficacy of ‘alternative’ medicine. They don’t. What they do show is that more scientific skepticism and rigour is needed, not less. The fact that Big Pharma is largely a corrupt industry that puts profits before patients doesn’t mean that homeopathy works, or that vaccines cause autism.

Goldacre is certainly not an ally of the quacks. In his previous book, Bad Science, he debunked pseudoscientific claims about ‘alternative’ medicine, vaccines and consumer products, and also criticised the way that the media misrepresents science, thereby misinforming the public. I highly recommend it as a much needed corrective to the misconceptions and false beliefs that we all have about health matters. And Goldacre is an engaging writer, leavening his statistical analysis with vivid anecdotes and passionate arguments. His new book will no doubt fulfill a similar purpose; to wake up readers with a splash of cold, hard facts, however unpleasant it may be, and to propose solutions to a chronic and widespread problem that affects us all.

25.9.12

Some thoughts on Atheism+

Well, it didn’t take long for certain prominent members of the community of reason to weigh in on the freshly minted Atheism Plus, or A+, movement. There’s an A+ outline and response to its critics by PZ Myers, and two observations/criticisms by Ronald Lindsay and Massimo Pigliucci respectively. While I agree with Myers that disbelief in gods and religious doctrines would entail “significant consequences for how we should structure our society” and therefore atheism is not just “an abstraction floating in the academic ether”, I also agree with Lindsay’s and Pigliucci’s argument that secular humanism already addresses the same issues and champions the same causes as A+, making the new movement almost redundant.

To me, A+ is largely a branding exercise. One of the movement’s founders, Jen McCreight, has stated as much, saying that the ‘Atheism Plus’ concept is “fabulous marketing-wise and as a way to identify yourself as a progressive atheist.” Proponents of A+ are trying to imbue the word ‘atheism’ with connotations in addition to its mere dictionary definition. Some like Myers actually disdain the idea of a ‘dictionary atheist’, since they see it as a narrow, limited conception of what atheism should mean.

From a linguistic perspective, this attempt by the A+ crowd to shoehorn additional meanings into the word ‘atheism’ seems silly; it would be like trying to make the word ‘teetotaler’ also mean ‘a person who upholds values like temperance, self-discipline and sobriety’. Sure, these things can be associated with the word ‘teetotaler’, just as additional values outside of disbelief in gods can be associated with the word ‘atheist’. But these extraneous meanings are not, strictly speaking, implicit in both words. A teetotaler is someone who abstains from alcohol (for whatever reasons), and an atheist is someone who doesn’t believe in gods (for whatever reasons), period.

So that’s the linguistic perspective. However, from a sociopolitical perspective, A+ proponents have a valid reason for wanting to ‘inflate’ the meaning of the word ‘atheism’ beyond its dictionary definition. Greta Christina has touched on this reason, which is to destigmatise the words ‘atheism’ and ‘atheist’ by impressing the progressive values that A+ stands for upon the minds of the general public, and in a sense teach the public to associate the word ‘atheism/atheist’ with those ethical values. So while pedants may complain, the practical effect is the gradual reduction of the negativity currently attached to atheism, at least in highly religious societies.

Furthermore, from a strategic viewpoint, it makes sense for A+ folks to use the word ‘atheism’ rather than ‘humanism’, even though A+ and secular humanism share similar values and goals: ‘atheism’ is punchier (aka controversial), and the emotional response it elicits from both proponents and opponents makes it a ‘sticky’ word. And as any marketing professional can attest, a good brand is a sticky brand.

As if there isn’t already a glut of atheist/humanist movements, we also have Michael Nugent of Atheist Ireland writing up a manifesto for what he calls ‘Ethical Atheism’. Nugent’s preamble below makes the same argument as PZ Myers did in his blog post: that atheism necessarily entails social and political consequences.

In real life, atheism means more than mere disbelief in gods, or belief that there are no gods. If you disbelieve in gods, it necessarily follows that you also disbelieve that we get our ideas of truth and morality from gods. This is a significant approach to two central questions about life, in a world where most people believe the opposite.

This is a draft manifesto for ethical atheists who care about both truth and morality, and who want to promote reason, critical thinking and science; atheism over supernaturalism; natural compassion and ethics; inclusive, caring atheist groups; fair and just societies; secular government; and local, national and global solidarity.

Ethical atheism is more useful than dictionary atheism, because it applies the consequences of our atheism to real life. Ethical atheism is more precise than secular humanism, because religious people can be both secular and humanist, and because ethics affects all sentient beings and not just humans.

Despite the different labels being tossed around, one thing that Michael Nugent, PZ Myers, Ronald Lindsay, Massimo Pigliucci, Jen McCreight, Greta Christina and other atheists agree on is that regardless of which label we choose to affiliate with, what matters is our ethical, godless commitment to make this world a better place for everyone. Let’s keep this in mind whenever we are tempted to denigrate our allies.

30.8.12