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evidence based medicine, Lasso of truth

The speculum setting or shutting of comments on some posts to limit woo

I do my best to post about evidence based medicine and debunk treatments with no evidence (and often no plausible connection with biology), but it continues to surprise me that despite a well constructed argument that explains why a particular therapy couldn’t possibly work that many people comment on how that particular therapy has worked for them.

And therein lies the rub. While I do love comments and feedback (I have some very thoughtful readers and a few spiteful ones, but they don’t bother me too much as they are largely entertaining and often my readership shuts them down), allowing comments that contribute to the mythology that certain therapies are effective when they are not gives ineffective therapies/woo a platform. Some people could consider these comments credible and they could also affect how my post appears in a search engine. This is all counter to my mission, which is the dissemination of evidence based medicine and the construction of a better medical Internet.

People are desperate to get better and it doesn’t matter to some how much the science says that something is ineffective, if three people comment that something worked for them it lends credence to the notion that the science is wrong. Case in point, there are numerous studies that show a low-oxalate diet is ineffective for vulvodynia, yet many commenters on post I wrote voice interest in trying it regardless. Vaginal Valium can’t possibly work because there are no GABA receptors at the nerve endings (nocioceptors) and a randomized double-blinded placebo controlled trial says it can’t work, yet people post about trying the therapy or how much it helped them. I have learned responding to those comments individually does little good. People want to believe  their therapy worked. End of discussion.

I’m not alone in my concern that biased comments can affect distort the message of the post. Popular Sciencespeculum stopped comments partly for trolls and spam but partly because incorrect comments encourage the perception that scientifically validated ideas are open to debate and that an anonymous N=1 (Hey, it worked for me!) comment from source whose bias is unknown somehow deserves equal weight (or any weight) in a scientific venue.

Now many people, probably most, skip those comments or read them and give them the weight they deserve (i.e. none), but I’ve noticed a trend of other commenters replying and threads about how to get said ineffective therapy start to germinate and now my post has now become a portal to disseminate medical myths and woo. According to Popular Science “Even a fractious minority wields enough power to skew a readers perception of a story.” The comments and responses on some of my posts prove that this is very much true.

So please continue to comment because most posts will allow them. I’ll leave the kitten setting for those who wax eloquently about homeopathy or heavy metals in vaccines. When the science is vague then a hearty discussion is wonderful and very much encouraged, but if I notice scientifically invalid comments that only serve to spread misinformation then I will delete those and close the post to comments, i.e. I will engage the speculum setting. I will probably post a link to this article to explain. Now if only there were a speculum emoticon…

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Discussion

8 thoughts on “The speculum setting or shutting of comments on some posts to limit woo

  1. Clinical science is evolving, and is certainly not mature. The evidence we have is usually better than anecdotes, which are plaguing us in all fields. Discredited research is even worse, as in vaccinations…

    Posted by bob99901 | April 8, 2014, 8:57 pm
  2. Excellent post! I see this too often as well!
    Tracy Sher, MPT, CSCS

    Posted by Pelvic Guru | April 9, 2014, 6:17 am
  3. There is a fascinating trend emerging (maybe not emerging, I am just noticing it) in the FDA review of drugs submitted recently. They are looking for more patient reported outcomes, the biomarkers are great, but the panels want to know how the patients are feeling/perceiving the effect of treatment.
    Now this is not to be confused with the n=1 anecdote problem. These patient perceptions are captured using validated tools and questionnaires and are typically in the context of a double-blind controlled study. I think some folks confuse the importance of patient perception of treatment with actual efficacy. The patient perception relates to efficacy only when it can be substantiated inside a controlled trial.

    Posted by Boogknight | April 9, 2014, 6:20 am
  4. Please keep up the good work. I have personally experienced what you are writing about and continue to do my own research in regards to my own physical challenges. I just can’t take the physician’s word on anything when they come at me with…..”well it has been proven to be effective it our studies”. That statement right there, raises the red flag for me and reading your blogs has helped me to stand my ground and do what is right for me, my body and my mental well being. Thank you.

    Posted by Antonia | April 9, 2014, 10:52 am
  5. I am this close to declaring my undying love for you. Or this post, at least. There has been such an explosion of available health info with no concurrent increase in critical thinking skills of the general readership, and the results are terrifying.

    Posted by araikwao | April 26, 2014, 3:48 pm
  6. Love this post – there has been such an explosion in the amount of readily available health info, without a concurrent increase in critical thinking skills of the general readership. That combined with the tendency to regard the medical establishment with disproportionate suspicion (and anything “alternative” as automatically wonderful/natural/superior) seems to be having some rather terrifying results. I’m glad you are so alert to all if this.

    Posted by araikwao | April 26, 2014, 3:54 pm
  7. Love this post – there has been such an explosion in the amount of readily available health info, without a concurrent increase in critical thinking skills of the general readership. That combined with the tendency to regard the medical establishment with disproportionate suspicion (and anything “alternative” as automatically wonderful/natural/superior) seems to be having some rather terrifying results. I’m glad you are so alert to all of this.

    Posted by araikwao | April 26, 2014, 3:54 pm

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