I wanted an article to list some of my grievances with “Science Based Medicine”

I’m a skeptic.  I read “skeptic” blogs sometimes because many times they have valid points and I like to see a diversity of opinions.  Sometimes SBM has valid points and can be a source of information, but people need to be skeptical of SBM as well.

About SBM

SBM is a cult organization that is highly dogmatic.  However, much of what they write I agree with such as when they debunk stuff that is just loaded with crap.

They will take a “quack” that is completely ridiculous and debunk him.  But in the process, they often throw the baby out with the bathwater since even quacks often have some truthful aspect.

True Skepticism vs Selective Skepticism

Science-Based Medicine is an organization that tries to portray itself as skeptical, but I say it’s selectively skeptical.

This is because they are not willing to entertain certain ideas and they form strong beliefs that certain treatments have no value outside of what your doctor recommends.

With regard to health, true skepticism means to be doubtful in a belief that some treatment works, but at the same time also be doubtful in forming opinions that something doesn’t work.

This means you shouldn’t form beliefs one way or the other. Your attitude should be one of not knowing if you want to be truly skeptical.

If you read SBM posts, you will see they are skeptical of ‘alternative’ remedies, but they believe that these remedies don’t work.

If you ask them about any remedy that isn’t proven by science, they will tell you the chance is close to zero that it works.  They believe the people who feel an effect from them are just experiencing the placebo effect.

This is a belief that that goes against true skepticism.

True skepticism would be not forming an opinion that they work or that they don’t work.   ‘I don’t know’ should form the basis of true skepticism, not that XYZ treatments don’t work because it doesn’t fit with our knowledge paradigm or because there’re no large clinical trials.

If there’s no evidence that a treatment works, there’s also usually no evidence that the treatment doesn’t work.  So forming an opinion one way or  another is not true skepticism.

‘Skeptics’, SBM and company need to realize that the absence of scientific evidence isn’t evidence of absence.

When we didn’t have scientific evidence that exercise, vegetables or fasting are healthy, people (‘skeptics’) sneered at you for doing these things to be healthy.

Or how about before we knew that too much sugar is bad for you or that lead is bad for you.

Even just 5 years ago, many people were laughing at me for staying away from added sugars because THERE’S NO SCIENTIFIC EVIDENCE that the quantities we consume are bad.  In reality, there has been evidence, but it’s been confined to small trials, animal studies, etc…

I think the atmosphere is changing with regard to various healthy behaviors and all of a sudden it doesn’t sound crazy that I’ve been trying to stay away from added sugars when there was no strong scientific evidence that it was bad.

Some ‘skeptics’ will argue that there’s still no evidence because we all view the word evidence in a different way.

Skepticism falls along a continuum. I would say that SBM and co. are certainly more skeptical than the alternative health movement, but I can’t consider them true skeptics.

On Implausibility


There is something to be said about things being implausible.  Homeopathy, for example, is implausible.

I can’t say for certain anything is impossible, but homeopathy is one of those things that has such a small chance of doing anything that it’s not even worth it to try it out.

Any given religion is based on many assumptions, and they generally contain doctrines that go against information that we do have a good idea to be true.

For example, believing in Judaism requires the belief in a Bible that contains hundreds of statements that are highly implausible (giants, people living to 1000, the world being 6000 yrs old, etc…), without any evidence to balance out the implausible parts.

But when we get to herbs and supplements, in general, the same case can’t be made.  Every supplement has ingredients that interact with the body in some way.  They are not inert.

The question isn’t if they do something because 99% of them do something.  The exception would be things that can’t cross your gut barrier, but even then they can have a pretty strong effect.

In all of my hundreds of mega-dosing experiments, there were only a few supplements that I hadn’t been able to feel something even after I took the whole bottle – prevagen and GABA.

All 300 or so supplements/interventions that I’ve tried had a noticeable effect. The question isn’t if they have an effect, but what that effect is and if it benefits you more than it harms you.

Sometimes, equipment doesn’t have any noticeable effect, and you can’t increase the dosage (for example, grounding).

I know supplements have an effect because I keep upping the dosage until I’m certain I feel an effect.

So you can bicker about whether the clinical evidence shows that St John’s Wort is effective for depression or not. Whatever the case, it has an effect.

The normal dosage is one pill.  However, when I took one pill I didn’t notice anything.  I had to take 4 pills to notice an effect.  I guarantee you that if you keep upping the dosage you will feel an effect, and it will likely make you somewhat more relaxed.

From my perspective, it makes no difference whether the clinical evidence shows it’s effective for depression.  I know what it feels like and if I ever have a use for it, I’ll take it.  It happens to be that I don’t take it because I find other supplements to be more useful for my specific needs.

On the other hand, if the science shows overwhelming evidence for a given anti-depressant, but it doesn’t work for me, then I’m going to stop it, no matter how many placebo controlled trials were done.

Skepticism as an Attitude


I view skepticism as more of an attitude rather than what you say directly.

You can talk the talk of skepticism, but not walk the walk.  SBM uses the right skeptical linguistics, but they form deep and strong opinions and bonds to their ideas.

To behave like a skeptic, it requires not forming strong beliefs about anything (unless there is strong evidence for that belief).

Developing a skeptical attitude is not merely a result of learning cognitive pitfalls and logical reasoning.  That’s just the beginning.

I’ve found that developing a skeptical attitude required practice in cultivating awareness and letting go.  You need to let go of your convictions.

We all build up strong opinions and convictions over time, but the true skeptics practice letting go of their ideas every so often.

SBM uses skeptical lingo, but they have very strong beliefs.  Anyone who looks at their site will see this.

I can predict their opinion about a subject before they write about it. All of their writers have the same opinions about everything, it seems.

However, you can try to predict my opinion about subjects and you’ll be surprised often because I don’t follow any dogma.

SBM Doctrines and Group Think


Whenever a group bands together for a common purpose, strong beliefs will form.  This includes Atheists, “skeptics”, etc…

I don’t believe in God, but I also don’t belong to these atheist groups, as I find group think takes place there as well.

I would caution the reader to be careful about listening to any ‘expert’ when they are highly predictable in their opinion about a subject.

I actually don’t find SBM writers to be very knowledgeable when they write about certain subjects.  It seems like they suffer from tunnel vision.

Here’s how to know SBMs opinion before you read any article.  If you find that even one of their thousands of articles don’t fit this paradigm, please post it.

  • If it’s natural, it’s not effective.
  • If a study has shown a natural product effective, it’s flawed.
  • If the study isn’t flawed, it’s clinically insignificant.
  • If the FDA claims something is safe, SBM will never disagree.
  • If a drug is FDA approved, it’s effective.  SBM will never question its efficacy or ‘clinical significance’.

What is Considered Evidence?

Science is a method of investigation, with the goal of teasing out a cause.

The type of evidence that SBM advocates is a random threshold of evidence.  There’s no reason it can’t be lower.

There’s no rational basis to say that animal studies, our subjective evaluation, anecdotes, tradition or in-vitro studies don’t constitute evidence.

I think there are flaws with all kinds of evidence, but I don’t think animal studies, anecdotes or traditional knowledge are irrelevant.  I think they can be highly useful and add pieces to the evidence puzzle, albeit there are better forms of evidence.

SBM assumes that all of this evidence is worthless or close to it.  They try to support this by pointing out flaws to these types of evidence.

I agree that these kinds of evidence have flaws, but you can poke holes in any type of evidence.

For example, the majority of medical science can’t be replicated. (R)

Over the past decade, Amgen’s oncology and haematology researchers could not replicate 47 of 53 highly promising results they examined.  (R)  Let that sit with you for  a bit…

There’s a good reason not to believe any study done by a pharmaceutical company because they have billions to gain from it, yet I don’t disregard their studies completely.

The take away is that every form of evidence has flaws, some significantly more than others.

To blindly follow one source of evidence and completely discard the rest is faulty and, I would say, stupid.

National Guidelines

I am more likely to agree with SBM’s threshold of evidence when it comes to forming national guidelines, but not as a guide to individual choices.

Meaning, my experiences might be good evidence for ME, but they don’t say what a random sampling of the population is like.

We don’t want to base national guidelines on animal studies, anecdotes, tradition or other weak forms of evidence.

If a recommendation is to be for a population as a whole, it should be based on large and rigorous clinical trials.

“Science” Based Evidence is a Misnomer


I really don’t like the term science-based medicine, because it paints an inaccurate picture.

Much of the scientific knowledge we have is based on animal studies, yet we call it science.

I include scientific information in my experiments and I use it as the framework for how I understand the body.

However, SBM is not referring to this type of science with regard to medicine.  They are referring to large, replicated, double-blind, placebo-controlled trials, published in the top 3 journals.

This method of investigating is a branch of science, but this definition confuses things by making you believe that nothing else can be considered science.

SBM should be called large-replicated- double-blind-placebo-controlled trials published by the top 3 journals-Based Medicine

The Faith of SBM

SBM worships double-blind, placebo-controlled trials by the top 3 journals and every other form of evidence is pretty much meaningless.   This is a faith.

They like Cochrane reviews, but only when it supports their prior beliefs.

When a study is not published in the top 2 or 3 journals, they will only believe it if it conforms to their prior beliefs.

If a study is published in the top journals, but it goes against their ideology, they will discard it.

SBM isn’t skeptical of the studies done by Big Pharma.  Even if they say they are, they aren’t in attitude.

Most of the best clinical trials are conducted by Big Pharma.  All you need to know is rudimentary psychology to realize that when you have a billion dollars to gain from a drug, you’re going to pull all kinds of ‘shtick’ to make a study say what you want it to say.

I believe the best form of evidence for YOU is to experiment with something and see how you feel.

You obviously want to start experimenting with things that have the most evidence, but you should keep experimenting with interventions that have less evidence if you aren’t cured by the intervention with the most evidence.

Skepticism is not the Same as Rationalism or Better Health

I would like to point out that skepticism is not the same as rationalism.

Skepticism says we should be doubtful of everything (my definition).

Rationalism says we should make decisions based on reason and logic, not emotion (my definition).

Skepticism and rationalism often go to together, but they don’t necessarily go together.

Being skeptical doesn’t necessarily result in better outcomes, but a rational strategy almost always does.

If someone is truly skeptical, they still don’t have a strategy or direction to achieve optimal health.

If you don’t know if a treatment works or not, it doesn’t mean you should refrain from trying it out.    SBM would say to not try it out.

My opinion and the approach that worked for me was to try things out.   Discoveries are often made not by a directed top-down approach, but rather by tinkering and seeing what works.

SBM favors a very top-down approach rather than tinkering.

This is not an approach that will achieve the best health outcome for you as an individual, even if this approach makes more sense with regard to national recommendations.

Selective Skepticism is Fine if You’re Not Forced to Choose

Again, skepticism is an attitude, not necessarily a prescription for a better life.

For example, if you have a health issue, you are forced to act in one way or another.  You can do nothing, try conventional treatments or alternative treatments, or a combination of these.

I am defining the alternative as anything not embraced by the mainstream medical establishment.  This surely includes a wide-ranging spectrum that includes silly quackery to scientifically supported treatments.

Say we have a skeptical attitude of not believing a treatment works or doesn’t work, we are still forced to choose whether to take the treatment or not.  To do nothing is also a choice.

SBM editors would say to refrain from treatments that don’t have evidence, but this is not in my experience an optimal approach to health.

I say even if something only has anecdotal support, it’s rational to experiment with it – if it’s safe and relatively cheap.  This doesn’t mean that if you have a health issue, you’re going to start out trying hyped up, expensive ‘proprietary formulas’ that only has anecdotes behind it.  I actually don’t like these because you don’t know what is or isn’t working.  Maybe one ingredient is making you better and another worse.

Think about it this way:  If there’s even only a 10% chance some treatment with only anecdotal support will work, it would still make sense to try it out.   This is because you’ve now found a treatment that you can use for the rest of your life and over your lifetime this can produce a lot of value for you.

The same calculation doesn’t hold for everyone.  Someone without any health issues should seek out a higher level of evidence for benefit because they have more to lose than gain.  There’s always a risk with every treatment, even if it’s very small (with some exceptions).

Everyone has to make their own calculations and risk/benefit analyses, but the equation will be different for everyone.

SBM is too naive and simplistic to take this into account.  They have one equation for everyone.

If SBM were playing the Monty Hall game in medicine, they would say we’re not choosing!  There’s no evidence to pick one door over another!  True, but even so, there’s a rational strategy to achieve an optimal result.

Why do I Think that Self-hacking is More Reliable in the Long Run?

Imagine the scenario where the best clinical trial came back  as proving that a drug was helpful for a condition, but through your own experimentation, you found it didn’t work for you.  You’d stop taking it, or at least I would.

Now imagine a scenario where said drug came back as ineffective, but you took it and felt amazing.  You wouldn’t give a hoot what some study says, no matter how rigorous it was.

Studies can only tease out effects in a given population.  For example, studies often deal with a given age, gender or people with a specific genetic makeup.

Other times, a study will not select a homogenous group of participants, in which case it won’t be large enough to detect whether certain individuals (say males who are 30 years old with a given lifestyle, diet and genetic  makeup) will benefit from the treatment.  So it’s possible that a study will come back as not statistically significant, but in reality, it could completely cure one individual in 100 without any side effects.

Therefore, it’s impossible for any study to tell you that some substance, drug or food does or doesn’t work for you.

These studies are good in helping you figure out what to experiment with first, but they don’t replace good old self-hacking.

Assumptions Made By SBM

These assumptions aren’t always explicitly stated by SBM, but if you read their stuff, you’ll see that they believe these implicit assumptions.

SBM tends to assume that if some natural treatment will work, then it can always be patented and made better by a pharmaceutical company.

SBM believes that if something hasn’t been proven by double-blind, placebo-controlled trials and published in the top journals and replicated, then it has no value, especially if it’s a natural product or approach.

SBM assumes that synergies don’t play a role in the action of drugs (it’s their attitude, at least).  They believe if a herb works, then you can purify the chemical that works.  This is often true, but not always.

SBM assumes that if there’s no strong scientific evidence for something being harmful, then it’s probably safe (think Aspartame, BPA, Phthalates).  This means they believe in the power of science to unearth negative effects in a given time frame.

I believe in the power of science to do this, but it could take 100 years.  It took 100 years of widespread use to realize that Saccharin may cause insulin resistance.   See my article on artificial sweeteners and recent studies showing that BPA and Phthalates are not safe.

SBM also believes that if some treatment works, a company can make enough money from it to conduct rigorous clinical trials.

I disagree with all of these assumptions made by SBM.

Fallacious Thinking Committed By SBM

1) SBM believes that natural products are just as likely to be harmful as synthetic ones.

They cite the naturalistic fallacy, which is if it’s natural then it must be safe.  This is indeed a fallacy.  There are many natural chemicals that are deadly (ricin, etc..).

However, the naturalistic fallacy doesn’t deal with probability.  I think if something is natural and has a long history of safe usage, then it’s very likely to be safe.  The naturalistic fallacy doesn’t deal with this scenario.

2) SBM believes that correlation doesn’t provide any evidence that something can be effective.

They cite the post hoc ergo propter hoc fallacy.   This fallacy essentially says that correlation doesn’t prove causation.

Correlation certainly doesn’t prove or equal causation, but if something is correlated then I believe it’s more likely to work compared to a treatment that’s not correlated.  So correlation might be evidence for something, but it’s certainly not proof.

Science is actually based on correlation, if you think about it.  You introduce a variable and there is change.  So, a study will find that X drug correlates with Y improvement. However, this is a better form of evidence in the scientific context because they are introducing a new variable and then correlating, and they do this many times.  In addition, there is a control group where a inert variable is introduced, and the effect is comparatively lacking.

Examples of SBM Not Being Skeptical

Phthalates, BPA, Artificial Sweeteners

SBM thinks to be skeptical means to take the position that something is safe because there’s no evidence of harm.

I think this is profoundly unskeptical.  They have written many articles that proclaim the safety of BPA, Phthalates, and Artificial Sweeteners.

But if you click on the links, you’ll see I cite evidence that has only recently come out that shows that these aren’t as safe as we thought.

I don’t think science has the necessary tools to demonstrate that something is safe in all respects and for 100% of the population.  It would take too long to do this.  It’s impossible to take into account how other environmental factors combine (negative synergies).

There’s hundreds of examples in history when we thought something was safe given animal studies, until further evidence revealed that it wasn’t.

To naively think that we can demonstrate something is safe is anti-skeptical in my view.


For example, SBM destroys a quack that talks about oxygen.  I agree with 95% of what this SBM author is saying here, but when you read the article you think oxygen has no use to promote health.

There are many dozens of studies that do show benefit in various domains.  For example, memory is improved by supplemental oxygen in healthy adults. (R)

I use an Oxygen concentrator and it certainly has an effect on mood and calmness.

Again, you’d think after reading this article that unless your doctor recommends oxygen, you won’t be helped by it. False.

So while SBM is good at debunking complete shit by quacks, they never give you a complete picture.  It’s always narrow and simplistic.


One editor, Scott Gavura, wrote a whole post about how it’s implausible that Collagen works for joint pain.

Whether it works or not is beside the point.  To call something “implausible” based on his knowledge is lacking skepticism.   He could say he doesn’t understand how it would work, but saying it’s implausible is anti-skeptical.

Basically, the argument is that we digest the collagen proteins and therefore the only benefit we get out of it would be the amino acids found in there.  Since we consume adequate protein and arthritis is caused by inflammation, this shouldn’t help us.

A scientist in the comments section completely debunks his “implausible” assertion, showing that it is possible for collagen to cross our gut and deposit itself in our joints.

I have a different take.  I think the collagen might be useful for building oral tolerance.  I bring down many scientific studies that support oral tolerance.

Other than oral tolerance, collagen is an extremely rich source of glycine, which functions as an anti-oxidant and anti-inflammatory in the gut and has many other healthful properties.   Many people would benefit from more glycine, I believe.

Whether it will be effective or not can’t be known, but I doubt Scott has done any reading on Oral Tolerance, the studies on glycine or the information presented by the scientist in the comments section. He came to the “Implausible” conclusion only based on his incomplete knowledge of how the body works.

What he’s basically doing is taking his current state of knowledge and coming to firm conclusions based on it, without being skeptical that in reality, we know very little about the universe as a whole.

To assume he knows so much that he can claim confidently that it’s “implausible” is a type of arrogance, and it shows a lack of skepticism.

Mouse Studies Aren’t Good For Demonstrating Safety

The studies used to demonstrate safety for drugs and chemicals use lab rats that are of a specific and tame breed.

It’s hard to see if something is wrong with the mice unless they’re really fucked up.   Imagine if mice experienced an average 10 point IQ loss from some drug (assuming they had an IQ).  There’s no way you’ll be able to see this relatively small change.

For example, mice studies didn’t show any negative effect on the offspring of pregnant mice taking Paxil.  However, human studies have been able to detect deleterious effects on children.

When researchers studied mice in an evolutionary model, they were able to detect differences. (R)

The bottom line is that mouse studies are used to demonstrate the safety of chemicals and these are inadequate. SBM has no problem relying on these highly problematic ways of demonstrating safety.

Other SBM Grievances

When a natural or alternative product is shown to be effective in clinical trials, SBM all of a sudden starts complaining about “clinical significance.”  Two topics that come to mind are acupuncture and EDTA.

I don’t hear them talking about clinical significance when it comes to drugs that barely work.  And who the hell are they to decide what’s significant for us?  It could help each individual differently.

A study that shows a small significant effect could mean some people benefit a lot but the vast majority of people don’t benefit at all.

Also, SBM is highly skeptical of animal studies that show the effectiveness of a natural product.  This is fine.

My problem is that they aren’t skeptical of animal studies that attempt to demonstrate the safety of some chemical.   The FDA declares a chemical safe based on animal studies.  SBM has no problem relying on these when declaring some substance safe.

This is a contradictory attitude and demonstrates their biased thinking.   I don’t think animal studies are reliable to prove a supplement as effective, nor do I believe that animal studies can prove something to be safe.

To come to any safety conclusion based on animal studies demonstrates a profoundly unskeptical attitude.

SBM Resorts to Ad Hominems When I Show Them Reason

If you see their patterns, they are constantly engaging in ad hominems.  When I presented evidence against their position, I was met with the response “you don’t have the necessary authority to investigate these issues.”  Not one of them dealt with my argument.

Since I didn’t have a PhD in a certain topic, it was the end of the debate.  They’ve argued that you need a formal education about a topic to give an intelligent position.  I disagree.  You need to be educated, but not necessarily formally educated.


What is the Incentive of SBM?

Some people think that SBM is a corrupt group paid by big pharma or have some other incentive.  I don’t think this is the case.

First, SBM does create a valuable service in debunking some things that are clearly scams.   They infuse a dose of skepticism (albeit selective) that is often lacking.

Some of their ire is well placed and makes sense.  However, there are other factors at play.

I think they are a group of highly square and dogmatic people, who subconsciously feel that their power is being taken away from them by people without degrees.

People like authority and degrees confer authority.  All of the SBM writers have spent years attaining degrees.  This gives them respect.

This is why people want you to call them Dr so and so.  They spent time getting the degree and they crave the respect and authority.

Then comes the alternative health movement and starts telling people there are other options.  This strips SBM of their power (and respect).

I also think that the whole skepticism movement is composed of people  who try to feel superior in some way, specifically in trying to demonstrate superior intellect (although I am not impressed at all).  Often, they are trying to super-compensate for their insecurities.

I think these are the psychological underpinnings as to why they have such a hatred for anything ‘alternative’.

Supplements Don’t Contain Active Ingredients?

There has been a spate of articles about the study that showed most supplements tested don’t contain the primary ingredient on the label. Read:

“Amazingly, 79% of the supplements tested did not contain the primary ingredient listed on the label.”  A Really Bad Week For The Supplements Industry.

SBM and co have this to say:

“Supplements have no ‘active’ ingredient. Just like every CAM…..A brouhaha the last few weeks has been the realization that there is a disconnect between the label on a supplement bottle and the actual ingredients. Often the supplements contain no ‘active’ ingredients, and I put active in quotes as these substances really do nothing. Supplements producers were substituting one inert substance for others.”

This strikes me as a case of unsophisticated thinking.

The author of the article assumes that herbal supplements don’t have the stated chemicals because they don’t contain the DNA of the plant.  He implicitly assumes, therefore, that they are just placebos with rice in them.

Many of the articles you’ll see will also bunch all supplements together and infer that ALL supplements aren’t reliable.

Probably most of the supplements that I recommend are not even herbal such as Inositol, ZincPQQ, MitoQ, etc..

I buy supplements for the chemicals they contain, not the DNA in it.  Plant chemicals like Honokiol, Curcumin or Fisetin don’t contain DNA.  This is basic biology and chemistry.

I always prefer to buy from reliable companies that have a track record of passing third party testing  from Consumer Labs.   Generally, all of the big companies do well.

I try to buy standardized supplements so that I know what I’m getting.

If they do a study that shows that big companies don’t have the chemicals in them that are standardized, then that’s when my ears will perk up.

Sometimes, I’ll buy the whole herb if I feel a good effect from it.  Generally, you can see if you’re getting the herb in question in the same way you know that you’re buying oregano when you go to the store.  It has a certain smell, look, taste and effect.

I take supplements for the effects of it, not for the DNA that they contain.

It happens to be that I’ve never really had a very powerful effect from the supplements that they tested,  especially ginseng. I’ve tried many types of ginseng and have been disappointed.  I don’t think we’re getting the quality stuff.

What I find fascinating is that those who believe supplements are inert would be scared shitless to ingest them.

 The Placebo Effect: It’s Complex

SBM talks much about the placebo and the nocebo effect.

Obviously, people experience a placebo effect and this is a confounding variable.  However, SBM really overdoes this.

First, a placebo effect is a good thing.  The outcome is to feel your best one way or another.

Now, for national guidelines, the placebo effect should be discounted.  But for individuals, even if we feel better because of a placebo, that’s a good thing.

Second, placebos do not work for everyone or work to varying degrees based on the situation and genetics.

Henry K. Beecher, in a paper in 1955, suggested placebo effects occurred in about 35% of people, although this ranges based on the exact situation (from 0-100%). (R)

People experience the placebo effect much more with higher pain levels than lower pain levels. (R)  So the context matters.

Children seem to have a greater response than adults to placebos.

Expectation also plays a large role.  People with Alzheimer’s, who don’t have expectations because of a degraded prefrontal cortex, aren’t susceptible to the placebo response. (R)

I’m willing to bet the time period also matters.  You can feel better at first from a placebo response, but in the long term, it will dissipate.

I also notice that people differ in how self-aware and introspective they are.

Hormones/peptides such as CCK and endorphins can affect how much we feel the placebo effect.  CCK reduces the placebo effect, while endorphins cause the placebo effect. (R)

So if someone has low endorphins and low CCK, they might be more susceptible to the placebo effect.

Next, there are two famous SNPs that influence how much we are affected by the placebo response.)

A variant of the gene for tryptophan hydroxylase 2 (an enzyme that synthesizes the neurotransmitter serotonin) is linked to reduced amygdala activity and greater susceptibility to the placebo effect.  This likely means that lower levels of serotonin can enhance the placebo response.   (rs4570625 GG is associated with a greater placebo response.)

People with a variation of the COMT V158M gene (rs4680 AA), which increases dopamine in the prefrontal cortex, are more likely to respond to the placebo treatment.  Dopamine is thought to link to reward and ‘confirmation bias’ which enhance the sense that the treatment is working.  This is more prominent in studies with subjective conditions such as pain and fatigue rather than objective physiological measurements. (R)

Response by Science Based Medicine

SBM has responded to this article.

I have invited Steven Novella to a podcast to debate these ideas, and we will see if he accepts.  If they have, I will update this post with a link to it.

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  • guz

    Good article. One thing that I noticed is that the SBM guys do lack critical thinking ability.

    To put it simply, they can’t reason that is why they need to defer to an authority because they can not make use of their brains. They never learned it.

    Their reasoning is just repeating what an authority is telling them and there is only one authority they will accept as valid.

    They are vulnerable and easily manipulated and ultimately just useful idiots for the much smarter business world..

    They are predictable because they are brainwashed like all cultists.

    What they do is not science it is science religion. They defer to priests in white lab coats telling them what to believe. Within that predetermined narrow range they allow themselves to ‘think’ if one can call that thinking. They are also never wrong of course. If you think you are always right, you are in reality blind and live in fantasyland.

    Superficially it looks like reasoning but they have formed their beliefs before they started to reason.

    They love to talk about logical fallacies but their entire activity is not much more than a logical fallacy.

    Argument from authority.

    If you want to know what a ‘skeptic’ believes just look up what authority say. He/she will not deviate from it. I promise.

    To give an example of their irrational views.

    They say natural substances are among the most toxic chemicals known to man, when defending a toxic drug or attacking a natural product.

    Despite that we are supposed to believe that only artificial chemicals can have health promoting effects but the millions of chemicals in nature can not, never can.

    Nature can produce the most toxic substances on earth but it never ever can create a potent health promoting substance. Must be by intelligent design I guess.

    Another example: There is no alternative medicine if something works it is called medicine.

    What they really want to say: Medicine never makes mistakes and always knows what works and what doesn’t. —> Belief in an all-powerful all-knowing entity.(Religion) Amusingly by this definition every medical treatment wasn’t effective at one point and since medicine can not be wrong it could not be effective even today and medical progress could not have happened.

    Truth is that the emperor has no clothes and the so-called skeptical thinkers aren’t even thinkers they are gullible believers and very often fairly irrational people as well.

  • Yuval Levental

    My name is Yuval Levental. I discovered a horribly written article in Science Based Medicine, and searching for critics of this site, I discovered your site and would like to inform you of this issue.
    This is a response to “Neurotribes: A Better Understanding of Autism” by Dr. Harriet Hall on Science Based Medicine

    There are some positives in Neurotribes by Steve Silberman, such as his critical analysis of a period where autism was seen only as a negative, and in which autistic individuals were mistreated, along with the dangerous MMR vaccine controversy. However, in contrast to this positive review, I personally find the book as a whole to be overly verbose, loaded with speculation, and highly biased towards neurodiversity in a fundamentalist sense. These qualities are significant enough in the book to make it not recommended for reading.

    The introduction of this review peppers the reader with endless questions, creating poor flow.

    Much of the history of autism research that Silberman documents which Dr. Hall praises is highly questionable. For instance, Dr. James Harris of Johns Hopkins University, who personally knew Dr. Leo Kanner, writes about how Silberman misrepresented Kanner as someone unempathetic towards autistic children, when he actually advocated for individualized treatment for each child and for ethical standards. Silberman’s overly celebrated portrayal of Hans Asperger is also seen as questionable

    Silberman retrospectively diagnoses many figures, particularly scientists and engineers, such as Henry Cavendish and Nikola Tesla. Professor Fred Volkmar of Yale, who specializes in autism, says that retrospective diagnoses have become a cottage industry, and that ”the trouble for many of our folks is they just engage in an endless acquisition of facts, without doing anything productive”. Professor Darin Hayton, a historian of science, says “Retrodiagnosing any condition or disease or illness is fraught with difficulty… The impediments seem even more significant when trying to interpret a mental condition that requires intensive and sustained clinical observation, especially when the evidence is drawn from biographical information”. The accounts of the figures that he claims might have been autistic are overly verbose, leading the reader to ascertain that those figures were most likely autistic. Dr. Hall compares Cavendish to Sheldon Cooper, a fictional TV character who is a poor caricature of the public’s view of scientists, which is very strange for a skeptic to do so.

    Clearly, Temple Grandin is one of the most successful formally diagnosed autistics today, but studies show that this trajectory is the exception, not the norm. According to two large longitudinal studies, autistic individuals in their twenties were less likely to be employed than their peers with other disabilities, with only 58% of them employed. Those who worked tended to work part-time in low-wage jobs. Furthermore, only 36% of young adults with autism received additional education after high school .

    However, Silberman does not put the accounts of successful autistics like Grandin into this broader context. Dr. Hall stating that “Autism may just be an exaggeration of traits we all have” in this review is providing a distorted portrayal of autism. While Temple Grandin has said she does not want to be cured from autism herself, there is no evidence that she opposes a cure for everyone. In fact, she has written about taking antidepressants to prevent panic attacks. Finally, while Silberman gives suggestions for accommodations, they are mostly trivial, and Specialisterne, an employment program for autistic individuals which he lauds, is dependent on governmental subsidies to survive.

    While there is much pessimistic pseudoscience in the media, Neurotribes is no better, as it presents a sense of false optimism based on anecdotal evidence and speculation, and does not even attempt to refute the criticism of neurodiversity. It seems Dr. Hall just wants positive news, comparing the book’s foolhardiness to “bad news about terrorist attacks, the idiocies of presidential candidates, and celebrities who have proclaimed themselves experts”, which is not up to the rigor of a dedicated skeptic. A far better book to read about the history of autism and the status of autistic individuals is In a Different Key by John Donvan and Caren Zucker.

  • Thomas

    “If there’s no evidence that a treatment works, there’s also usually no evidence that the treatment doesn’t work. So forming an opinion one way or another is not true skepticism.” If that part doesn’t raise some eyebrows, I don’t know what will.

  • Cory Albrecht

    This article is a nice bunch of straw men that says to me you don’t actually read sciencebasedmedicine.org. For example, that you think they just advocate some random threshold of evidence when they actually write about that fairly often.

    They’ve even been nice enough to write a response going through the straw men that about in your article. 🙂

  • joe smithsouth

    Oh with the regard of education

    Jeremy Stuart: Yeah, I think, very much so, especially with the current condition of industrialized education, with the overemphasis on testing and grading and measuring everybody constantly. I think it’s a huge disservice to children everywhere in terms of the way we naturally learn, and it also is not helping teachers in any way or shape or form either. Yeah, I think there many things about the whole notion of this kind of forced system of education that is very mismatched with how we should be evolving and learning together.

    The history of the modern education system
    Chris Kresser: Mm-hmm. It seems like even from a kind of meta perspective the institutionalized education system starts out with this assumption, which is that kids need to be taught to learn.

    Jeremy Stuart: Right. For those people who don’t know the history of public education, it started in 1837 with Horace Mann, who was actually nominated to be the first Secretary of Education of this country. He had returned to the US from a trip to Prussia in 1848, and he had noticed that they were implementing a lot of militaristic style of schooling that he felt would be good for this country, as we were entering the Industrial Revolution. So he quickly implemented that throughout the country and really pushed for that to happen, and in Massachusetts in 1852, they passed a compulsory attendance law, and that was kind of the beginning of what we call our industrial education system.

    Chris Kresser: Right, because up until then, formal schooling was optional.

    Jeremy Stuart: Right.

    Chris Kresser: It wasn’t something that every kid had to do. What was the reaction to that first attempt at compulsory schooling?

    Jeremy Stuart: It was not looked upon very favorably at all because most people learned at home with their families.

    Chris Kresser: Right.

    Jeremy Stuart: They were working on the farm or working in the family business and living and learning together in a natural way. Then along comes this legislation that says, “No, you have to go to school now.” There were instances of children being forcibly removed from their parents and taken to these schools. Of course, there was great opposition to this, but unfortunately it kind of won out, and by the turn of the century, everybody was being made to go to school, whether they wanted to or not, really.

    Chris Kresser: Right. There are so many things that are interesting to me about this. One is that we often look at our current lifestyle, and because it’s so familiar to us, we assume that’s kind of always how things were. It’s hard for us to imagine anything different. I think it’s probably hard for many listeners out there to imagine a time where institutionalized education wasn’t the norm.

    Jeremy Stuart: Right.

    Chris Kresser: Where most people were actually learning just in the context of their own life instead of going to this place called school, where they sat in chairs for the whole day and learned things that were really kind of removed from the context of their life, and yet this has really only been the norm for, it sounds like, about 150 years.

    Jeremy Stuart: Yeah, that’s true. Actually in the context of human history, school is what’s new. Homeschooling or other alternative ways of learning have been around much, much longer than that. But we’re very conditioned, as you said, to believe that the only way you can learn is to be taught in an institution called a school.

    Chris Kresser: Right.

    Jeremy Stuart: And of course, that thought process carries no weight at all, especially now in this age of information. Perhaps in the Industrial Revolution that might have been true somewhat.

    Chris Kresser: Yeah.

    Jeremy Stuart: And even when I was going to school in England, it was hard to get access to information. You had to get encyclopedias or go to the library or go to school and find people who knew about certain things. Now, of course, we can get information at the touch of a button on any device, so it sort of brings into question this whole idea of, well, what is the purpose, then, of having these institutions where you have to go and sit there to get the information for eight hours a day when you can simply find the information in a couple of seconds?

    Chris Kresser: Absolutely. The other piece of that that’s interesting to me, just from a sociological perspective and historical perspective, is that writers like John Holt and others have argued that industrialized education was really a way of conditioning kids to fit into the new system of industrialized labor, kind of conditioning them to be cogs in the machine, really, rather than sort of the more craft-based, artisanal local economy that prevailed before then.

    Jeremy Stuart: Yeah, that’s very true. He had written about it, and also John Taylor Gatto has written about it a lot, who was a New York public school teacher for 30 years and then went on to write an amazing op-ed piece in the Wall Street Journal about why he was quitting, because he no longer wanted to damage children.

    Chris Kresser: Mm-hmm.

    Jeremy Stuart: Going back to Horace Mann, who started all of this in 1852, he believed that school was a great equalizer and that values such as obedience to authority and promptness and attendance and organizing time according to bell ringing would actually help students prepare for future employment in the Industrial Age. The whole purpose of it was set up to train factory workers, to respond to bells, to respond to cues, to be told when to do something and how to do it and for how long so that they would become efficient worker bees in this Industrial Revolution. And of course, in Congress at the time, all the people that were supporting Mann’s vision were all the industrialists, the Carnegie Mellons.

  • Skeptic

    What a great article. The medical industry is so corrupt, and the only thing “regulated” by the FDA are non-Pharma distributors. Science Based Medicine is desperately trying to debunk alternative medicine and the attempts are ridiculous. They have soap opera novelists writing about “Science”. Then they pretend to have interest in something as simple as “probiotics”, then go on to throw around poorly referrenced studies that debunk even probiotics, leaving that impression that they are protecting the public from deadly yogurt. I feel so sorry for doctors subjected to the medical mafia Associations funded by Pharma. They are the ones most affected by the foxes watching the hen house.

  • Arthur feintuch

    They are simply ridiculous in the so cslled”scientific” findings. The especially attack chiropractic. I have known many people who have gone the usual medical route and have gotten no healthier. They saw their chiropractic physician and have gotten better. This so called scientific organization is a fraud and really is the arm of political medicine

  • Doug

    I’ve hung out on the SBM.com site and found the community there to be beastly and reactive and fiercely dogmatic. These are fundamentalists. Dissent is almost always met with angry ad hominem tactics, and personal insults are common. This tells you everything you need to know. Unlike you I consider much of the content there to be bulls**t. Those guys seem the quintessential shameless pharma propagandists. Conning the masses with obfuscating jargon and overbearing articles that are so biased as to be worthless, and which are kept high in google results by way of, presumably, a huge SEO budget.

    1. Nathan

      If you are referring to scientific terms when you say obfuscating jargon, uh, it’s completely readable if you have a basic understanding of scientific vocabulary and the ability to do a 5 second Google search for what a word means. It is “Science” Based Medicine after all, not Supplemental Complimentary Alternative Medicines (SCAM’s) for the ignorant feel-good gullibles who are all too happy to have their ignorance exploited and the bank accounts drained by fake healers claiming to be able to cleanse and heal them of all sorts of ailments, many of which cause more harm than healing and have been thoroughly debunked by science. Why should you trust me or science? You shouldn’t. You should learn how to become a better critical thinker and gain a better understanding of science before you go around having such misinformed opinions about it bc you watched some pseudodocumentary promoting what is obvious sensationalized propaganda to someone who has been trained how to think critically.

      I know I must seem arrogant to someone who lacks my perspective of years of studying science at university, but that isn’t my intention. I just encourage you to be less opinionated about topics you don’t understand and re-evaluate what it really means to be open-minded. Refer to my longer comment below. All the best.

      1. Doug

        Thinking critically has nothing to do with studying science at uni. You develop this skill through diligence, practice, and intellectual rigor. In fact years studying science at uni if anything might blunt critical thinking skills, with all the indoctrination and groupthink. Contrast this with people who come by their positions independently. Anyway, you are pulling an ad-honimem by questioning my character. Same thing I faced at the site in question. LOL.

  • Kevin

    I have found the writers and posters from Science Based Medicine to be elitist, know-it-alls with a God complex. If you disagree with them, they get nasty.

    1. Nathan

      I can relate, bc it pisses me off when so called know-it-alls who doesn’t understand basic science tries to talk as if they know what they are talking about. And beyond understanding basic science, the majority of the country greatly lacks critical thinking skills on many levels making it easy to understand why they are so easily exploited by pseudoscience and conspiracy theorists. It’s not that they are stupid, but they are definitely highly opinionated types that often have little knowledge of what they are so opinionated about. Then they feel you are elitist bc you went to school to improve your critical thinking abilities and can better withstand the constant onslaught of sensationalized propaganda. Science is like an instruction manual for how things work. It is not perfect, but it is the most reliable source of info out there bc if someone tries to publish junk science, like Seralini’s infamous rat study the anti-GMO’er’s like to promote as “proof” that GMO’s are bad when they don’t understand that he manufactured his data, was funded by Greenpeace (an anti-GMO “environmentalis” organization), had a book and a documentary scheduled for release upon the publication of the study (which was later retracted bc Seralini refused to provide the raw data and when he did, it was suspicious to the point of being fraudulent; also, when Seralini’s paper was retracted, it was later republished in an open-source “peer-reviewed” environmentalist “journal” founded by several pseudo-scientists from the Union of Concerned Scientists to which Seralini belonged), and Seralini was to receive royalties from a company that manufactured a pseudo-cleanse for glyphosate bc his manufactured study would boost their sales.

      This is just one example of many that those who have gone to school for science get a bit tired of arguing with opinionated, ignorant (not stupid, but definitely misguided and lacking training in critical thinking) fanatics who think they have all the answers bc they bought into the propaganda films that proliferate the New Agey, hippie, eco communities. They understanding is generally myopic and very brainwashed with propaganda supported mostly by anecdotal information bc they have done very little research or verification of the facts themselves. Then these folks wonder why you are so short fused with them when they pose as an authority, which they are generally not, and you have gone through years of school, studied the sciences well enough to have a broad general understanding, further specialized in an area of science, learned how to do research and judge a sources reliability (and this is getting harder and harder to do in science, let alone for the non-scientific layperson with a limited scientific understanding, with open source journals that can easily publish pseudoscience becoming more available).

      I used to be one of these folks and then underwent a conversion during my 4th year of studying for my bachelor’s in chemistry. I was so pretentious to think that no one had thought of going to school to do the research themselves that no one else was doing do show how bad GMO’s truly were, bc all of the other thousands of papers and studies and people involved were all bought off and there was a conspiracy to hide the “truth”. There is no absolute truth as every measurement has error and our perspectives are not very good instruments bc they are so conditioned by our culture and the environment we are in to be highly biased and subjective. I am pursuing gradschool in neurochemistry, which anyone with the determination can do so I am nothing special in that sense, but I do understand many things about the brain that a lot of people don’t bc this is what I am focusing on. The brain plays tricks on us all the time to make us see the things we want to see to validate our perspective and beliefs. I have been wrong so many times that I no longer place much value in my personal beliefs. I do value data and now I have better tools to evaluate that data and the methods under which it was gathered and presented to make better judgments about it’s reliability.

      Pseudoscience often cites reliable sources to give the appearance of legitimacy, but misrepresents the conclusions and the data of these sources. Often this is done blatantly bc the pseudoscience community, for being so “skeptical” is rather trusting of the information coming from their own sources which validates their ideology. Good scientists are much more skeptical and realize that nothing is to be trusted or taken for granted without being critical, even within science. Science proves nothing, which is contradictory to popular opinion. The purpose of an experiment is to technically falsify your hypothesis with sound methods for the purpose of reducing personal bias as much as possible. Science only gathers supporting evidence for its hypotheses which evolve into theories as more supporting evidence is gathered. The truth and concrete conclusion are never obtained by good scientists bc there is errors present in every measurement as well as our own limited and biased perspective. I like to say that science asymptotically approaches the Truth, but never obtains it.

      I know many scientists seem arrogant to people who don’t understand what we have taken years to learn and sometimes take for granted when talking with people who have not gone to school and have a poor understanding of science. Many people post links that they believe will validate their position, but usually, within one glimpse of the source and skimming the article, we can tell that most of this so-called evidence has exploit the ignorance of the gullible who have not been trained how to be good critical thinkers. Sometimes, even scientists are tricked to bc we do not understand everything and have a limited perspective that makes it impossible to do so.

      I have rambled on for some time, but I encourage no one to trust me bc that is no better than self-proclaimed experts trying to do the same. The information I have provided is anecdotal and should not be considered reliable. Those who lack scientific understanding and think that it is, thanks, but I would rather you learned how to think for yourself and learn how to be a better critical thinker for yourself so that you don’t completely rely on others for you understanding. Sometimes it is necessary to rely on others for our understanding, even in science bc of the degree of specialization that is happening, but at least if one is a critical thinker, they will be much better equipped to judge the reliability of a source. Also, it is not necessary to form an opinion about everything and often this is best. While I seem like I am pro-GMO, I’m not. I am pro-science and if there comes to light evidence that somehow tens of thousands of scientists around the world working on GMOs and researching them happened to miss something, I will be highly skeptical, but if the information and the methods of the research is reliable, I will gladly support it. A good scientist is not emotionally attached to a position and is willing to change their position to that which has the most reliable evidence. But of course we are all human and no scientist is perfect, especially one who has staked a career supporting a certain hypothesis and gathering evidence for it. But as a whole, the scientific community is not emotionally attached to a position, especially one not backed by solid data.

      So please, learn how to better judge your source of both information and misinformation. All the best! It is an information jungle out there and few people innately have the critical thinking skills to successfully navigate it without training on how to be a good critical thinker. I was a valedictorian and thought I was pretty hot stuff when it came to critical thinking, but it wasn’t until I went to university that I truly developed and improved this skill. And it wasn’t bc I was told “what” to believe, like many anti-science people say about those who go to university. I was taught how to think critically. The foundation of my beliefs was completely flipped upside down once I gained a larger and more informed perspective. I know it is hard to be able to understand this, if you lack the perspective and experience. So again, don’t trust me, but don’t completely invalidate my perspective either, unless you truly have some hard evidence as to why I may be wrong. Don’t form an opinion, but learn how to discern the reliability of information and be truly open to new evidence that is sound. For real, gotta git. All the best!

  • Oliver

    Excellently stated! I’ve been reading your site for the last 3 days… unrelated link but may be of interest… https://www.youtube.com/watch?v=v07VZIQyoMc

  • kvsanagi

    “To blindly follow one source of evidence and completely discard the rest is faulty and, I would say, stupid.”
    Yeah, but not everyone has enough time (and other resources, like money, environment, proper development in childhood) to study a topic to its core. I have much trust in you, but as I could, I try to question your statements.

    1. Joseph M. Cohen

      You misunderstood. One source of evidence as in animal studies vs clinical trials vs our own experience.

      1. Nathan

        Personal experience should not be completely ignored, but it is hardly reliable either as the brain plays all sorts of tricks on people so that they see and feel much of what they want or think they should see and feel, especially people who are fanatically convinced of something or hyper-focused upon something. Perspective is full of bias and unless the study is done in a way to make the person blind to what they should be sensing or observing, their testimony isn’t worth much bc of their pre-programmed bias. Researchers have to be especially careful when analyzing and presenting data to make sure that they are accurately representing what is actually happening, or to say that they don’t yet know or have conclusive evidence.

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