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 Science 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…