Are You A Shruggie?

Shruggies is a term for health care providers, including doctors, nurses, and vets, who fail to challenge practitioners of SCAM (supplements and complementary and alternative "medicine"). Despite knowing there is no scientific basis, or even a chemical or physical basis, for many SCAM claims (e.g., homeopathy, acupuncture) and despite knowing that there is no clinical trial evidence for their efficacy (e.g., glucosamine), shruggies say, if the SCAM performs no better than placebo in well-designed clinical trials, then what's the harm? (More on placebo effects here.)


In the case of human doctors, the underlying deception involved in offering the patient a treatment that may make the patient feel subjectively better for a short period of time but fails to alter in any objectively measurable way their symptoms or condition is a matter of ethical debate. For example, is it ethical to not tell a patient they have a life-threatening illness so their final days will be happy and without stress? That's a deception that will certainly make them feel subjectively better for a short period of time, just like a SCAM. Most doctors would not accept the latter scenario as ethical. Then why would they accept as ethical the deception necessary for all SCAMs? And if they don't think that is ethical, then why are they willing to "shrug" it off?

In veterinary medicine, this deception that allows the owner feel better by "doing something" but leaves the animal to suffer cannot even be a matter of such debate: it is ethically wrong to that we permit this.

There is extensive peer-reviewed literature on the lack of efficacy of SCAMs. Pick any one of them that you like: detoxification, homeopathy, acupuncture, Chinese herbs, naturopathy, touch therapy, supplements. So many to choose from! Either they are described with feel-good woo words (natural, holistic, life force) or with laughably misused sciencey words (energy, quantum) or both. None of them stand up to objective, evidence-based clinical trials with a statistically significant number of participants and properly defined control groups. Some SCAMs are actively harmful, but most are simply no better than placebo. What's the harm? The SCAM of acupuncture is often offered as a pain treatment. It has been repeatedly shown in well designed clinical trials that acupuncture does not objectively and measurably reduce pain. It is ethically wrong for a SCAM practitioner to deceive a caregiver into believing their pet's pain is being reduced. It is just as ethically wrong for a shruggie to look at his colleague sticking needles into an animal and say, well, what's the harm? 

(Don't even get me started on the fact that human and veterinary acupuncturists are consistently photographed sticking needles into the skin of people and animals without wearing gloves. That is incredibly irresponsible and unprofessional.)

We humans do a very good job at finding quick justification for things that happen to us: I ate this berry then I got sick. Therefore that berry is bad. But is that the right conclusion? Does cause directly lead to effect? Perhaps the berry was not ripe--eat it two weeks later and it would not have made you sick. Perhaps you are allergic to that berry but someone else could eat it with no ill effect. Perhaps the berry had a mold or fungus on it that you could not see and that made you sick. Perhaps you ate something half an hour previously that in fact made you sick but you forgot about eating that other thing when you found the berry bush. Perhaps you were already sick with another illness and it was a coincidence that you began to show symptoms right after you ate the berry. We hate coincidences. We prefer the neat explanation, cause and effect tied up with a bow. We prefer explanations that mesh with our previously defined opinions.

Thinking through all the possibilities that could explain an event, that could sort out the cause and effect, is hard work and requires time and discipline. Setting aside our own logical fallacies and biases is even harder. Designing proper evidence-based tests with objective, quantitative measures of all the possibilities to determine which explanation was right is difficult and takes practice and time. (Correlation does not determine cause and effect, by the way. It only suggests two things are related.) Conducting the tests would take even more time. Isn't it simpler to jump to the easiest explanation: that berry is bad. 

What if you take that berry incident further? What if you now attach some sort of magical thinking to the berry or to your experience? For example, what if you concluded that a god didn't want you to eat that berry because the plant is sacred. Now not only is the berry bad for you, you've given it some additional properties. It's bad for you because it is magical.

Just imagine if your doctor or dentist or veterinarian treated your and your pet this way, using pre-scientific magical thinking instead of modern evidence-based medicine? Oops, that's exactly what SCAM practitioners do.
 


When it comes to SCAMs, ethical doctors and veterinarians should not shrug them off. We have the tools and the expertise to evaluate their claims of efficacy. Many studies have already been conducted and the evidence is clear. We need to speak up and educate our clients and our colleagues: belief in and use of SCAMs does cause harm (warning: this link goes to a PDF). 

I've left untouched in this screed discussion of caregiver bias (see additional discussion here), one of the underlying sources of placebo effect in veterinary SCAMs; the reliance on anecdote in SCAMs in place of evidence-based inquiry; and the straw man argument that Big Pharma is only in it for the money (if your SCAM practitioner is selling you a treatment that does nothing and that is based completely and fundamentally on your acceptance of a deception, who's really in it for the money?).