Saturday, November 5, 2011

Who are the Denialists?

In the September issue of The Lancet, several authors known for their research into tick-borne disease attacked those patient advocates, researchers and clinicians who favor treating severe cases of Lyme disease with long courses of antibiotics. Equating them with those who deny that HIV causes AIDS, they used psychologist Seth Kalichman's words in Denying AIDS to describe them:

"'They are deeply skeptical of science and untrusting of government and big business. Some are surely misguided and others seem to foolishly believe that they understand everything there was to know...'.

Then they go on to re-define what Kalichman calls antiscience by including:
"we will define this antiscience outlook to also include the promotion of pseudoscience and science that has weak credibility or validity because of fundamental flaws in its design or poor reproducibility."

The article goes on to use innuendo, ad hominem attack, ad populum arguments, lack of citations for factual statements, and other logical fallacies to say that long-term treatment advocates must be wrong. But is this what Kalichman says?

  1. He defines HIV denialism as a mutation of the first stage of mourning, denying the severity of the illness and the need for aggressive therapy. "The most extreme case of maladaptive denial is malignant denial, during which people completely ignore their physical condition, with potentially irreversible damage (p. 3)." This description does not define the Lyme disease advocates in the Lancet editorial. Rather, these advocates admit to a serious illness and seek therapy.
  2. Kalichman encourages patient questioning. "Research has shown that patients who actively engage in their care and probe their providers with challenging questions actually survive longer than those who remain passive (p. 4)." "Science has made great advances when pushed by outside thinkers (p. 160)." Lyme advocates may not know everything about science or health, but many have spent years studying one subject: tick-borne disease. On the other hand, the articles of the Lancet article have also said that symptoms after short-term treatment are "the aches and pains of daily living (p. 1115)," largely a problem for women, and largely all in their heads. Who are the denialists here?
  3. Kalichman points to the malignancy of the science/denialist debate as becoming personal: "The bickering goes on to this day....The exchanges are personal and bear no resemblance to scientific debate (p. 37)." As in the article in Lancet.
  4. Kalichman's solution to the debate is not more debate (p. 161). Rather, it is trust. "Making science and medicine more accessible to the public will help people distinguish between real science and that which masquerades as science. Trust is also established when doctors, nurses, and other health care providers listen to their patients (p. 162)."

Certainly, there are extremists on both sides of the Lyme debate, as there are in almost every controversy. It is time to get past the rhetoric and on to settling some of the basic questions concerning diagnosis and treatment of tick-borne diseases. According to the Institutes of Medicine, there are still plenty of questions. Solutions will put the need for advocacy to rest.

Kalichman, S. (2011). Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy. NY: Copernicus Books.