Anti-Doping in Practice from Player's Perspective

[topazg]

An analogy to put across my point:

Most people are now pretty happy that smoking causes lung cancer. Not just associated, but actually causes it. At the moment, the precise causal mechanisms are not really understood (as is the issue with a number of cancers), but the evidence is sufficiently strong that it's accepted by the scientific and medical establishments. That is thanks in part to the work of Sir Richard Doll and others in the 50s pooling large quantities of epidemiological data and collating some experiments involving nicotine and tar and rats.

Does this mean that prior to this, say, the 1940's, that the null hypothesis "smoking does not cause lung cancer" was true because sufficient evidence to suggest otherwise hadn't yet been published? The answer obviously is "no", because smoking does cause lung cancer. At that point, the state of science said "there's not enough evidence to support smoking causing lung cancer" - neither "yes" nor "no" - and it required continued research to push it one way or the other. There is a burden of evidence required for both yes and no, but there is also a neutral middle ground of "no-one knows" that is the default position, for which no burden is required.

There is the more contentious issue is whether treatments in the "no-one knows" should be allowed to be sold as treatments or paid for services. My personal feeling is that the tax payer should not be contributing national contributions to a state funded implementation of non-demonstrated treatments, but I also believe people should have the right to spend their personal money on it if they want to.

[hyperpape]

Attention conservation notice: a bunch of claims about evidence and rational credence/confidence that aren't specifically about acupuncture at all. Mostly disagreeing with topazg.

1) Implications are rarely at issue in scientific practice. What we're interested in are inductive support relations, which are not a matter of implications (quick: how many times does the sun have to rise before that implies that it will rise again tomorrow?).

Similarly, if a treatment (and I am not saying this is true of accupuncture, because of my ignorance) was entirely propounded by known con-men with a regard of selling fraudulent treatments, that would not imply anything about its efficacy, but the rational assumption would be that it does not work.

2) Leaving con-men to the side, if I take some random procedure, say poking at a spot on your elbow with a candy cane, then absent any further evidence, your credence that it has therapeutic benefits should be very low. You can say "you should just withhold judgment" but there's another compelling way to describe things.

You do not merely say "there's no evidence that it's effective" but you should have a reasonably high degree of belief that it's not. After all, there is an indefinite set of things you can do to a person, most of which have no therapeutic effect. If candy cane poking was not recommended by some positive evidence, it is just another randomly selected treatment with nothing to recommend it.

Your belief will lack something called resiliency. Although you have a reasonably high confidence that candy cane poking is ineffective, your belief will not persist if you get contrary evidence. Given one (good) study that suggests effectiveness, your credence that it's effective will be much higher. The contrast is a treatment that's been extensively studied and found to be ineffective. That belief is resilient given one good looking study that suggests it works, you'll tend to believe that it was simple chance. You will require multiple studies to substantially update your belief.

Note that your probability estimate that the treatment is effective can be the same in both cases. In each case, you might think that there's a 10% chance that the treatment is effective. What differs is the conditional probabilities that it's effective, given new evidence about its efficacy.

Ordinary language uses words like "confidence" to cover both credence and resiliency (and probably more things besides). There's a big advantage to distinguishing between them.

3) Obviously the question is not about whether what's true changes. It's about what is reasonable to believe. We won't get very far asking if "smoking doesn't cause lung cancer" was true in 1940--we'll get further asking what scientists should have believed.

[topazg]

Attention conservation notice: a bunch of claims about evidence and rational credence/confidence that aren't specifically about acupuncture at all. Mostly disagreeing with topazg.

1) Implications are rarely at issue in scientific practice. What we're interested in are inductive support relations, which are not a matter of implications (quick: how many times does the sun have to rise before that implies that it will rise again tomorrow?).

Similarly, if a treatment (and I am not saying this is true of accupuncture, because of my ignorance) was entirely propounded by known con-men with a regard of selling fraudulent treatments, that would not imply anything about its efficacy, but the rational assumption would be that it does not work.

2) Leaving con-men to the side, if I take some random procedure, say poking at a spot on your elbow with a candy cane, then absent any further evidence, your credence that it has therapeutic benefits should be very low. You can say "you should just withhold judgment" but there's another compelling way to describe things.

You do not merely say "there's no evidence that it's effective" but you should have a reasonably high degree of belief that it's not. After all, there is an indefinite set of things you can do to a person, most of which have no therapeutic effect. If candy cane poking was not recommended by some positive evidence, it is just another randomly selected treatment with nothing to recommend it.

Your belief will lack something called resiliency. Although you have a reasonably high confidence that candy cane poking is ineffective, your belief will not persist if you get contrary evidence. Given one (good) study that suggests effectiveness, your credence that it's effective will be much higher. The contrast is a treatment that's been extensively studied and found to be ineffective. That belief is resilient given one good looking study that suggests it works, you'll tend to believe that it was simple chance. You will require multiple studies to substantially update your belief.

Note that your probability estimate that the treatment is effective can be the same in both cases. In each case, you might think that there's a 10% chance that the treatment is effective. What differs is the conditional probabilities that it's effective, given new evidence about its efficacy.

Ordinary language uses words like "confidence" to cover both credence and resiliency (and probably more things besides). There's a big advantage to distinguishing between them.

3) Obviously the question is not about whether what's true changes. It's about what is reasonable to believe. We won't get very far asking if "smoking doesn't cause lung cancer" was true in 1940--we'll get further asking what scientists should have believed.

I don't know, are you sure you disagree with me? I pretty much agree with everything you've just written

[kirkmc]

There is the more contentious issue is whether treatments in the "no-one knows" should be allowed to be sold as treatments or paid for services. My personal feeling is that the tax payer should not be contributing national contributions to a state funded implementation of non-demonstrated treatments, but I also believe people should have the right to spend their personal money on it if they want to.

So, as an analogy, people should be free to be, for example, scammed by Bernard Madoff, who told them that they were going to make money when, indeed, they lost money? It comes down to something similar: either you want the truth, or you want to allow anyone to claim anything, and, as long as it money spent by individuals, tough titty?

[hyperpape]

Kirkmc: I think the Madoff analogy is badly flawed. In his case, there were legal requirements concerning disclosure and account keeping, and he was misrepresenting everything there--he claimed to be buying and selling stocks and other assets, producing a certain return, where nothing of the sort was happening.

[kirkmc]

Kirkmc: I think the Madoff analogy is badly flawed. In his case, there were legal requirements concerning disclosure and account keeping, and he was misrepresenting everything there--he claimed to be buying and selling stocks and other assets, producing a certain return, where nothing of the sort was happening.

Well, that's not actually true, because he was buying and selling assets, filing documents, etc. And he was paying out returns. The problem was that he promised high returns, and had to sell off incoming assets to pay them. Many people were getting excellent returns for years, until he didn't have enough money coming in to pay them (that's the principle of a Ponzi scheme - that you use incoming assets to pay out initial investors).

But, whatever; the point is that people selling things (be it a product or service) that are not what they are made out to be shouldn't be allowed to sell them, because the Average Buyer doesn't have the skills to know if the claims are correct or not. I don't think that we should allow people to be duped by anyone, even just if it's "their money."

[tapir]

"Acupuncture is ultimately a shell game of preliminary unreliable results and misinterpreted non-specific/placebo effects."

What is often missing in those discussions is that a positive placebo effect isn't a given. You can have less of a placebo effect, you can even have a nocebo effect... (depends a lot on how patients are handled, on expectations etc.) And a maximum placebo effect with a harmless procedure might be better than what was believed to be the real thing. See e.g. here: http://www.ncbi.nlm.nih.gov/pubmed/12110735 - people were used to have an effect after surgery but we have to recognize it was placebo, Wouldn't it be great if you could achieve a similar effect by needling those people (in the paper it is sham surgery) - even if you scientifically conceptualize it as a cheap way to achieve a nice and welcome placebo effect?

[topazg]

Hyperpape answered you well enough for me.

I believe it is not ethical for someone to offer any services or treatments if they themselves believe it to be ineffective. I believe there are two situations in question here:

a) There are plenty of acupuncture practitioners who genuinely believe in what they do, and their customers believe that it is effective treatment. I do not see anything wrong with this arrangement. If the people are feeling better as a result, placebo or otherwise, that makes the treatment not a waste of money either. I don't mean that this is therefore a treatment that is physiologically effective, but I still have no problem with these things happening. There is no "sham" involved here, which implies an attempt to deceive.

b) There are plenty of people out there, colloquially known as snake oil peddlers, deliberately scamming swathes of the public for a quick profit. This I have never believed is ethical, and fair trading laws should, in an ideal world, be able to mete out an appropriate punishment to these people. I re-iterate, if the person selling the treatment or product knows it is an ineffective product, then I do not consider it ethical practice.

Code: Select all

sham –noun
1. something that is not what it purports to be; a spurious imitation; fraud or hoax.
2. a person who shams; shammer.
3. a cover or the like for giving a thing a different outward appearance: a pillow sham.

I genuinely believe the majority of homoeopathic practitioners and acupuncturists believe whole heartedly that what they are doing helps people. This, combined with the belief of others that there is deliberate deception for financial gain going on, is most likely the core reason that the debates and fights get so downright unpleasant. I may not agree with them, but I don't believe what they are doing is unethical. I reacted to post originally because whilst saying something "doesn't work" is unjustified in a literal sense, in this particular case I think it's a quite reasonable opinion to hold. Saying it's a "sham" also makes an accusation against people's motive, which I feel is not only unsupported but also rather unreasonable.

... the point is that people selling things (be it a product or service) that are not what they are made out to be shouldn't be allowed to sell them, because the Average Buyer doesn't have the skills to know if the claims are correct or not. I don't think that we should allow people to be duped by anyone, even just if it's "their money."

Sure, but the Average Buyer does not believe they are being duped, even being presented with the evidence. They instead go purely on their personal experiences, like magicwand, and couldn't care less whether the effect was a placebo or directly caused by the treatment. From their perspective, they got better and it was worth the money. From the practitioner's perspective, the customer got better just as they had expected. Everyone's happy, and the truth of whether it was really the treatment or not is both unknown and irrelevant - where's the foul?

We fight for free will, free belief, and free speech, and I think market restrictions to prevent these activities is unnecessarily prohibitive unless deliberate deception is shown to be taking place.

ADDENDUM: I'm going to hazard a guess that you're an atheist Kirk. Many Christian denomination churches consider a 10% net income tithe to be an appropriate contribution to the furthering of buildings, staffing, and evangelistic activities. Should we disallow this too, as an atheist would consider the congregation "duped" not only into believing a false faith but also being indirectly deprived of their money out of a sense of obligation?

[kirkmc]

"Acupuncture is ultimately a shell game of preliminary unreliable results and misinterpreted non-specific/placebo effects."

What is often missing in those discussions is that a positive placebo effect isn't a given. You can have less of a placebo effect, you can even have a nocebo effect... (depends a lot on how patients are handled, on expectations etc.) And a maximum placebo effect with a harmless procedure might be better than what was believed to be the real thing. See e.g. here: http://www.ncbi.nlm.nih.gov/pubmed/12110735 - people were used to have an effect after surgery but we have to recognize it was placebo, Wouldn't it be great if you could achieve a similar effect by needling those people (in the paper it is sham surgery) - even if you scientifically conceptualize it as a cheap way to achieve a nice and welcome placebo effect?

Actually, the only double-blind possible with acupuncture is sticking people with needles in places that don't correspond to meridians. It definitely complicates any studies.

The paper you cite, though, is a very interesting one, which totally shocked the medical community, where doctors were convinced that this type of intervention was beneficial. Science is interesting...

[kirkmc]

Re Topazg's last post... I'm not going to quote stuff, because it's annoying.

a) Definitely true. I've seen plenty of them. (I have a fair amount of experience in these things, actually, which is why I am so against them now. Long story...) They are part of a flawed belief system which is perpetuated by different organizations. For example, homeopathy is covered by France's national health system (which is how I got involved in seeing homeopathic "doctors"; I felt that if the state reimbursed it, it must be valid).

B) Definitely true. They should be burned at the stake.

However, regarding motive, take an MD who uses homeopathy. He should be intelligent enough to question the validity of his sugar pills, and read the research. If not, he doesn't do the due diligence that he should be doing. As for manufacturers of sugar pills, it's even worse (IMHO). They should know that they are bilking people, such as the billion-dollar duck liver (http://www.sciencebasedmedicine.org/?p=2005 ; someone calculated that one liver generates 1 billion dollars of income).

Where's the foul? Honesty; critical thinking; look at the US where a vast number of people think that Adam and Eve lived alongside dinosaurs, and that the Earth is 6,000 years old. And see the effects that has on the political process...

As for religion, I think churches should be taxed. If people want to give money to their preferred belief system, that's fine; but let the church pay a fair share of that money to society. But I think that is getting way off-topic...

[topazg]

I'll follow your lead and not quote, just to say I agree completely with all of that post

An MD most definitely should "know better", and do the research himself into what evidence there is for treatments he would choose to prescribe.

And on that happy agreeable note, an over used quote that represents my position on the scenario A people:

"I may disagree with what you have to say, but I shall defend to the death your right to say it."

[kirkmc]

I'll follow your lead and not quote, just to say I agree completely with all of that post

I also totally agree that an MD should "know better", and do the research himself into what evidence there is for treatments he would choose to prescribe.

And on that happy agreeable note, an over used quote that represents my position on the scenario A people:

"I may disagree with what you have to say, but I shall defend to the death your right to say it."

QFT.

[hyperpape]

For some people, a quasi-medical treatment like acupuncture tends to produce emotional responses that favor regulation, but how many personal trainers are offering unscientific advice about health related activities? Is there an obviously relevant difference? For that reason, I

That said, I will differ about the true believers. I think they are often doing something quite wrong: they are believing things based on insufficient evidence in a case where this wastes other people's money. They have a degree of responsibility to get it right, and they make other people worse off by not doing so (perhaps accupuncturists don't make others worse off, because of placebos or because people like the idea that they are helped. This is less plausible for homeopaths). It is akin to negligently harming people, where we don't think that ignorance of the truth is a defense.

Of course, this is generally far less bad than knowingly selling people something useless. Do note that the person who intentionally sells a useless product doesn't thereby compromise any placebos, or even produce any noticeable change in his patients, so long as they don't discover that he doesn't believe.

[hyperpape]

@Topazg: I thought I was disagreeing with you in 2) because I thought you were saying you really should just stick to saying "there's no evidence yet that X works".

[k1ndofblue]

I like Pie!

Oh and this has to rank up there as the worst thread ever .......although I'm sure someone will argue other wise.