Another introduction to White Coat Underground

Welcome all to my shiny, new blog.  As regular readers will remember, I left ScienceBlogs a few weeks ago after becoming uncomfortable with some of the practices there.  I still read ScienceBlogs regularly, and I’m reasonably confident they will recover from this challenge and continue to be a go-to site for online science reading—but without me.

Many of us in the online science writing community know each other, or are at least familiar with each other’s work.  Through these networks, several of us came together to form a new online science writing community run by and for writers and readers.  We are not a monolithic group, as you can see if you browse though who’s here, and many of us may disagree on some pretty fundamental issues.   But we have used our commonalities and differences to put together this new community with a great deal of  thought and effort, and hopefully success.  Browse through our “constitution” if you’re curious what we have in mind.  Or just read what looks good.

First, a little history.  I started blogging on WordPress in May of 2007.  My writing was bad, but I kept at it, and one or two relatives read it once in a while.  Over time, my writing improved, and other medical writers and skeptics occasionally came by and left comments.  I in turn left comments at their blogs, especially at Respectful Insolence, written by Orac, who was a blog mentor and is now a friend and colleague.  I was eventually invited to co-write denialism blog over at ScienceBlogs, and then struck out on my own with a rebirth of White Coat Underground.

From my platform at ScienceBlogs I was able to continue to improve my writing and my reach, and expanded my writing to Forbes.com Science Business Blog and Science-Based Medicine, for whom I write occasional pieces.  Both of those venues are populated by excellent writers who have given me guidance and mentoring.

And now, a new beginning.  To hear the New York Times tell it, science bloggers are just naive science writers, spewing invective and refusing to accept the mediocre standards of the mainstream media (yes, it really says that: “The bloggers evidently write often enough for ad-free academic journals that they still fume about adjacencies, advertorial and infomercials. Most writers for “legacy” media like newspapers, magazines and TV see brush fires over business-editorial crossings as an occupational hazard. They don’t quit anytime there’s an ad that looks so much like an article it has to be marked “this is an advertisement.”)

But science bloggers and science writers are increasingly intersecting sets, with people like Jonah Lehrer, Carl Zimmer, and Deborah Blum writing books, keeping blogs, and mentoring newer writers.  I’ve been fortunate to be on the receiving end of this mentoring, even when folks like Ed Yong, Rebecca Skloot, and David Dobbs don’t know it.  And I’ve learned that not all journalists are willing to see ads disguised as news as just “an occupational hazard.”

But I’m not here because of what’s wrong in other media (or at least not solely for that reason);  I’m here because I love medicine.   And I’m here because of questions like this one:

Dr. Pal,

Tonight, a certain friend of mine stated that she wasn’t eating carbs (including sugar) “because i got myself a little under the weather and they say it makes it worse.”… So here are my questions/comments/concerns:

1) Let it be known that the phrase “they say” peeves me to no end.
2) Is this accurate? It doesn’t seem like something that would be, but what do I know?
3) If this is false, perhaps it is a garbled version of something else? Perhaps someone consumed too many simple carbs once, while sick, and experienced some discomfort unrelated to the original sickness?

As a reminder to my readers new and old, there really is no such thing as “alternative” medicine; there is only that which is plausible and has been proven to work, or is likely to work.  The rest is either embryonic medicine, or nonsense.   Once a truly useful treatment is proved to work, it rapidly takes its place in the armamentarium of modern medicine.   If a healing modality cannot be proved to work, or is clearly based on superstitions such as “qi meridians” or “subluxations”, then its primary utility is profit rather than healing.

Non-scientific medical beliefs fall into two broad classes:  small folk beliefs (or what I call “bubbe meisehs“), such as “chicken soup is good for a cold”, and “eating garlic is good for your heart”; and alternative medicine systems such as naturopathy and chiropractic.

One of the things I love about this email is the identification of a few fundamental concepts.  First the writer notes the problem of “they say”.   Rumors, urban legends, and bubbe meisehs are not the best source for accurate medical information. This also dovetails with the skeptical precept that plural of “anecdote” is not data.  “They say” is certainly a phrase that should raise the skeptic’s hackles.

The writer then asks a loaded question: “is this accurate?”  It may be accurate that her friend feels better better when she avoids “carbs”.  Of course, given the self-limited character of most colds and flus, you can probably find relief from regularly flapping the left hand up and down—it works in about 7-10 days.  To discover if carbohydrate avoidance mitigates cold symptoms (and the common cold is what I’m using as a synonym for “under the weather”), you need a plausible hypothesis, and good data.  Is there a way in which certain foods could make cold symptoms worse? Might avoiding these things make them better?  How can we test such a hypothesis?  “They say” is not a conclusion, but the nidus of an inquiry.

The letter writer then picks out the problem of confounding variables: assuming that carb-avoidance made the person feel better, could it just be coincident with some other factor, a previously unconsidered variable that has real significance?

This is how we need to be thinking about medical questions in the public sphere.  The question should not be, “how do I get me some of that cool reiki?” but, “is there any reason to think reiki should work, and if studies show it appears to work despite its implausibility, what confounding variables might I have missed?”

So if you’re new to White Coat Underground or to Scientopia, welcome!  If you’re a returning reader, thanks for sticking with me.

Consistent with the bad timing characteristic of such things, my yearly trip to the internet-free North coincides with the launch of our new blog network.  I will do my best to give you some new and old posts to keep you reading until I return in a week.

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10 Comments

  1. Love the new digs!

  2. Cambrico

     /  August 2, 2010

    This post and the one about dengue reminds me of the following:
    I live in a Latin American country with high insidence of dengue. My brother in law got it last week and had to be hospitalized for a couple of days because his platelets count was low and the doctor suspected a possible hemorragic dengue. Fortunately the count went up and he is at home now. But just guess what is the fashion medicine for people with dengue: chicken legs soup! It is not plain chicken soup. It has to be made with chicken legs, that according to some undefined origin (maybe from the era of Spanish colonization) contains special marrow that cures dengue.
    The guy at the butcher store told us that we have to buy the chicken legs early in the morning, because after noon they are sold out.
    Everybody is buying chicken legs for people with dengue!
    One of the less tasty part of the chicken has a sales boom thanks to a miserable mosquito. This medicine has all the signals of an old tradition without any scientific base, but try to tell that to all the mothers worried about the health of their children with dengue. You get the following response: “if you ever get dengue you will take the soup. You will see!!”
    Yuck.

  3. cicely

     /  August 2, 2010

    New address bookmarked.

  4. Blogroll updated – again!

  5. Agree with Joseph Hewitt – love the new digs. They’re nicely laid out, and not too busy.

  6. Congratulations on your new place. Looks good

  7. David Dobbs

     /  August 3, 2010

    Welcome to your own new home! Good to see you back a-blogging, Pal.

  8. Nathan Myers

     /  August 4, 2010

    I don’t know how other people got here (blogrolls?), but the link from whitecoatunderground.wordpress.com goes to a dead site at scientopia.com. I got here by guessing.

  9. Chris

     /  August 5, 2010

    Cambrico, I can kind of understand the reason behind the sympathetic magic behind the chicken leg soup. First, chicken soup is a common remedy for colds and other minor viral infections that involve a runny nose. The bit with using legs is because dengue is also known as “bone break fever”… one feels like their bones are going to break. So it fits to use leg bones.

    As an aside: I had dengue fever when I was twelve years old, and it is very painful (we were living in Venezuela). Though I mostly remember the first feverish day of being miserable, the other two weeks is a blur in my memory. It is like I got sick, and then woke up two weeks later.

    I would love to go back and visit Latin America, but getting dengue a second time makes it more deadly. So I will wait a while.

  10. Just wanted to let you know I followed you over here. Hope your trip is/was great!

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