Scientists are increasingly frustrated by laypeople’s willingness to embrace pseudoscience. In an age of extraordinary technical achievement, the persistence of nonsense beliefs like creationism, vaccine rejection, and homeopathy is difficult to fathom. But Scott Lilienfeld, a psychology professor at Emory University, argues that we should be anything but surprised.

Explaining Why Scientists Shouldn’t Be Surprised by the Popularity of Intelligent Design, Lilienfeld asserts:

… [F]rom the standpoint of psychological science, the only thing about [intelligent design’s] popularity that should surprise us is that so many scientists are surprised by it…

It’s just a matter of common sense. No, advocates of pseudoscience aren’t lacking in common sense. The problem is precisely the opposite. They believe that they can use common sense to evaluate scientific claims.

The foremost obstacle standing in the way of the public’s acceptance of evolutionary theory is not a dearth of common sense. Instead, it is the public’s erroneous belief that common sense is a dependable guide to evaluating the natural world…

Yet natural science is replete with hundreds of examples demonstrating that common sense is frequently misleading. The world seems flat rather than round. The sun seems to revolve around Earth rather than vice-versa. Objects in motion seem to slow down on their own accord, when in fact they remain in motion unless opposed by a countervailing force.

Fundamentally, this is a problem of scale. What is common sense? It is a body of knowledge derived from common experience. Even toddlers know that objects always fall down not up and objects that are out of sight still exist. These rudimentary scientific observations form the bedrock of common sense. But for something to be common sense, it must take place on a level we can appreciate with our senses. Simply put, common sense can only tell us about events that are common to human experience.

Yet what we can apprehend with our unaided senses represents only a small fraction of what is going on. Our distance vision is limited. Microscopic organisms and particles are invisible to us. No individual has personal experience of a time span longer than 100 years or so. Therefore, many scientific processes take place at a scale that is impossible for us to perceive. Whether that scale is distance measured in light-years, size measure in microns or time measured in millennia, they are entirely outside the realm of common sense.

… The human brain evolved to increase the probability that the genes of the body it inhabits make their way into subsequent generations. It did not evolve to infer general principles about the operation of the natural world, let alone to understand itself. It also did not evolve to comprehend vast expanses of time, such as the unimaginable tens or hundreds of millions of years over which biological systems evolved. Consequently, it is hardly surprising that many intelligent individuals … glance at the remarkably intricate biological world and conclude that it must have been produced by a designer.

Lilienfeld is referring to the “watchmaker” theory of intelligent design: Imagine walking through a barren desert and finding a functioning watch in the sand. Common sense tells us that such an intricate and complicated object could not have arisen spontaneously. Even though we cannot see a watchmaker, we can infer that a watchmaker must exist.

Yes, that is what common sense tells us, because in our common experience, complex objects do not arise spontaneously. But our common sense draws on what humans have learned during the 10,000 years of recent history. However, evolution takes places on an entirely different scale, over hundreds of thousands of years. No amount of common sense can tell us how it works because it is outside the realm of our common experience.

This is the same reason why it took almost all of human existence until we figured out that the earth is round, not flat. Common sense tells us that the earth is flat because it looks flat when we observe it, and it feels flat when we walk upon it. In other words, it seems flat to us at the scale that we are able to observe with our unaided senses. We cannot see vast distances and we cannot feel minute curvature. Take us to a different vantage point, though, the shape of the earth is easy to appreciate. Looking at the earth from space, it is obvious that it is round.

Common sense tells us that the universe revolves around the earth. That’s the way it looks to us, but, again, that is only because we are restricted by the limitations of the human frame of reference. Once the telescope was invented, and Copernicus and Galileo were able to discern other planets and take precise measurements of what happens in the sky each night, it became apparent that the earth was moving through space rather than space moving around the earth.

Common sense is often useless in evaluating scientific phenomena because they take place outside the scale of common experience. Yet scientists have not appropriately emphasized this fact. According to Lilienfeld:

To a substantial extent, the fault in the current [intelligent design] wars lies not with the general public, but with scientists and science educators themselves. Generations of biology, chemistry, and physics instructors have taught their disciplines largely as collections of disembodied findings and facts. Rarely have they emphasized the importance of the scientific method as an essential toolbox of skills designed to prevent us from fooling ourselves…

… [Scientists] must inculcate in students a profound sense of humility regarding their own perceptions and interpretations of the world. They should teach students about optical illusions, which demonstrate that our perceptions can mislead us…

Believers in pseudoscience do not lack common sense. Rather, they lack an understanding of the limitations of common sense. Anything that takes place at a scale too large, too small, or over a period of time too long to be perceived by unaided human senses is not amenable to understanding through common sense. Common sense is helpful in judging only what we commonly experience. When it comes to phenomena that occur on a scale we are incapable of experiencing, common sense is virtually useless.

Alternative health advocates, regardless of their specific beliefs, are all supremely confident about one thing. Whether they are vaccine rejectionists, natural childbirth advocates or aficionados of vitamins and supplements, they are absolutely sure that they are more “educated” than the rest of us. They are not “sheeple” who blindly follow whatever advice their doctor offers; they have done extensive “research” on the internet, and they know things that they did not know before, and that the rest of us do not know at all.

It is certainly true that advocates of alternative health have often done a great deal of reading. And it is true that they have learned lots of new things. But what they fail to understand is that they have acquired pseudo-knowledge. It has the appearance of real knowledge; it uses lots of big words, and it often includes a list of scientific citations. There’s just one teensy problem; it’s not true.

We are surrounded by pseudo-knowledge in everyday life and most of us understand that it isn’t true. Advertisements of all sorts of products, both legitimate and bogus, and filled with pseudo-knowledge. Most of us are quite familiar with the language of pseudo-knowledge:

“Studies show …”
“Doctors recommend …”
“Krystal S. from Little Rock lost 30 pounds in 30 days …”

In the era of patent medicine, claims like these were usually enough to sell a product. But consumers have become more jaded and the language of pseudo-knowledge has become more sophisticated as a result. Consider this explanation of the benefits of acai, the current favorite among the scourge of bogus nutritional claims. According to Dr. Perricone (a real doctor!):

The fatty acid content in açaí resembles that of olive oil, and is rich in monounsaturated oleic acid. Oleic acid is important for a number of reasons. It helps omega-3 fish oils penetrate the cell membrane; together they help make cell membranes more supple. By keeping the cell membrane supple, all hormones, neurotransmitter and insulin receptors function more efficiently. This is particularly important because high insulin levels create an inflammatory state, and we know, inflammation causes aging.

This exerpt is classic pseudo-knowledge. It contains big, scientific words and sounds impressive. It contains actual facts, although they are entirely unrelated to the benefit being touted. It contains completely fabricated claims that have no basis in reality (“they make the cell membrane more supple”) and which, not coincidentally trade on the gullibility of some lay people (if my skin is no longer supple, it must be because the membranes of the individual cells are not supple) and it asserts that “we know” things that are flat out false.

Acai has been little more than a giant credit card scam. After tricking people with such language, unscrupulous advertisers have offered to send a “free supply” in exchange for a credit card number. The acai may or may not show up, but the credit card is billed for a large amount regardless.

Vaccine rejectionists are being scammed in exactly the same way. They are proud that they are not pathetic “sheeple.” Just because their doctor tells them that vaccines are safe, effective and one of the greatest public health successes of all time doesn’t persuade them. They want to “educate” themselves to understand the issues involved.

What might you need to know to evaluate the safety and effectiveness of vaccination? Obviously, you need an understanding of immunology including an understanding of the difference between cellular and humoral immunity, and the formation of antibodies. You need a basic understanding of virology with emphasis on protein coats, and the difference between live, attenuated and fragmented viruses. And of course, you need an understanding of statistics as applied to large populations over long periods of time.

But wait! Science is hard and that’s unfair. Who has the time, the background or the ability to understand the fundamentals of immunology? Not vaccine rejectionists. Their knowledge of virology does not extend beyond a recognition that there are two kinds of “germs,” bacteria and viruses. And their knowledge of math often trails off at basic arithmetic, leaving them no way to understand statistics, even if they bothered to read the relevant texts.

So if they’re not reading about immunology, and if they’re not reading about virology, and if they’re not analyzing statistics, what exactly are they doing when they “educate” themselves? They are simply acquiring a large body of pseudo-knowledge.

Much of what they think they know is flat out false (“the incidence of vaccine preventable diseases was falling before vaccines were introduced”), is anecdotal information proving nothing about anything (“Jenny McCarthy cured her son of autism!”), or goofy conspiracy theories that are ludicrous on their face (the entire medical pharmaceutical complex is aware that vaccines are not safe and not effective but they’re giving them to their own children anyway.).

The natural childbirth crowd, is, if anything, even more aggressive in its ignorance. Vaccine rejection is touted by quacks and charlatans, Playboy bunnies and physicians who stand to profit from encouraging fear of vaccination (Dr. Andrew Wakefied, Dr. Bob Sears). No one in the medical profession takes them seriously; they are professional embarrassments. In contrast, the natural childbirth philosophy is part and parcel of midwifery. Both academic midwifery experts and celebrity midwives spew absolute nonsense and call it “knowledge”.

Barely a week passes on this blog without a lay person parachuting in to boast of all she has “learned” from the likes of Henci Goer, Amy Romano, Barbara Harper or Ina May Gaskin. And don’t even get me started on Ricki Lake; she just makes it all up as she goes along. Their assertions mark them just as effectively as if they had tattooed “gullible” on their forehead.”

“The US ranks poorly on infant mortality.” But that’s a measure of pediatric care, not obstetric care. Perinatal mortality is a measure of obstetric care and the US does very well on that measure.

“The majority of births in the Netherlands are homebirths and it ranks highly on measures of obstetric care.” Only 30% of births in the Netherlands are homebirths and the Netherlands has the highest perinatal mortality rate of any Western European country.

“Johnson and Daviss published a paper in the BMJ that showed that homebirth is safe.” The Johnson and Daviss paper is a bait and switch that shows exactly the opposite of what it claims.

“Homebirth is Canada is safe.” Canadian homebirth midwives have far more education, training, supervision and restrictions than American homebirth midwives.

When it comes to homebirth and natural childbirth advocates just about everything they think they “know” is factually false. The same is true for vaccine rejectionists and most other purveyors or advocates of alternative health.

The truth about health education is both simple and stark. You cannot be educated about any aspect of health without reading and understanding scientific textbooks and the scientific literature. Period!

Don’t waste your time perusing the internet. Unless you are willing to confirm what you read on the internet by reading the scientific literature, you can’t be sure you’ve learned anything.

Don’t bother to tell the rest of us that you are “educated” because you’ve demonstrated nothing more than your gullibility. You haven’t acquired knowledge, you’ve acquired pseudo-knowledge, and it marks you as a fool.

Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it’s worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering. Simply put, I believe that good mothering is about choosing mothering and not about mothering choices.

What does choosing mothering mean? It means actively embracing the role of caretaker, confidante, educator and moral guide that mothering entails. It means worrying, planning, consulting, advising and ultimately letting go. Should he be the youngest in kindergarten or wait a year and be the oldest? How should she handle the playground teasing? Am I expecting too much from him or does he have a learning disability? Should I let her go to the dance with the older boy or is she still too vulnerable?

It is kissing the boo-boos, helping them face the fears, stepping aside and allowing them to talk to the doctor in private when they are old enough. It is piano lessons, orthodontia, religious services, holiday celebrations. It is not responding when she says “I hate you” and never failing to respond when you see him teasing another child. It is hard, damn hard, with weeks or months that leave you exhausted or emotionally drained. Yet it is also rewarding at the deepest level, forging a bond to last a lifetime, launching a happy young adult into the world.

It is NOT about specific mothering choices. Breast or bottle? That’s the mother’s choice and nobody else’s business. Natural childbirth? Irrelevant. Baby wearing? It depends on the baby and on the mother. Extended breastfeeding? Meaningless in the long run (and often in the short run, too).

How do we know a woman is a good mother? We know because she cares; she cares about her children and cares about the impact that she is having on those children. To love a child is to choose mothering. In contrast, specific mothering choices have nothing to do with love, because there is not only one way to express love.

My fundamental objection to the philosophies of natural childbirth and attachment parenting is not the emphasis that they place on mothering; I object to the fact that they privilege specific mothering choices over others. In other words, adherents believe their own mothering choices proclaim their “goodness” and that different choices on the part of other mothers identify them as bad mothers.

Instead of viewing mothering as a service they willingly give their children, they view it as a social identity that they construct for themselves, boosting their own egos in the process. That’s why discussions about NCB, breastfeeding and attachment parenting are such a source of discord between women. None of those discussions are about the best way to mother a baby; they’re all about who is the best mother. It may seem like a trivial difference, but it is an immense difference and most women recognize it as such.

The most critical ingredient of good mothering is love. A child who is loved has the advantage over any other child, regardless of the specific parenting choices his mother made. It’s time to acknowledge and value the power of choosing motherhood and stop judging other women based on mothering choices.

With apologies to Hans Christian Andersen:

Early in this century there lived a Mother who was so exceedingly fond of feeling superior to other mothers that she was constantly searching for ways to distinguish herself from them. She claimed to be the best, most natural, most authentic mother in the world. She took no interest in current events, did not work, and only socialized with other mothers in order to boast of her superior birth, breastfeeding, parenting style.

Now one fine day a swindler, calling herself Midwife, arrived. She declared that she could facilitate the most magnificent birth that one could imagine; better than a homebirth, better than an unassisted birth … an orgasmic birth! Not only was the birth perfect in every way – unassisted, in water, videotaped and painless – but it culminated in the greatest orgasm ever. Even better the orgasm had the special power of being invisible to everyone who was not a super awesome, all natural, authentic woman.

“What a splendid idea,” thought the Mother. “If I had such a birth I could prove that I was the best mother ever, much better than those C-section, formula feeding, unattached mothers.”

So the next time the Mother got pregnant, she gave the swindler Midwife large sums of money to pay for the Midwife’s books and videos and the two week course at her Farm. Day after day the Midwife went home with more money.

Now the Mother was eager to know give birth and have a giant orgasm. She was, however, somewhat uneasy. “Suppose,” she thought secretly, “suppose I don’t have an orgasm at the exact moment of birth. That would mean I am not an awesome, all natural, authentic woman. That cannot be,” she thought, but all the same I will watch videos of orgasmic birth. “I will best be able to see how a birth orgasm looks. After all, I am the best mother and most authentic woman possible.”

So the Mother and her best friend downloaded videos of orgasmic birth from YouTube and watched them together with the Midwife.

The best friend opened her eyes wide. “Shit!” she thought. “I see only women in pain, screaming their heads off at the moment of birth.” But she did not say so.

The swindler Midwife begged the best friend to come nearer and asked her how she liked the videos. “Are not the births painless, and see how rapturous is the orgasm,” she said. The best friend stared and stared. She saw nothing of the kind because there was nothing of the kind. But she did not dare to say she saw no orgasm. “Nobody must find out,”‘ thought she. “I must never confess that I could not see it.”

Instead the best friend said:

“Oh, it is beautiful – most excellent, to be sure. Such a painless birth, such rapturous orgasm. I am now a believer in Orgasmic Birth.” To the Mother the best friend said, “That birth was truly orgasmic.”

Two and a half weeks after her due date, the Mother started having contractions and was looking forward to experiencing painless labor. Accompanied by the Midwife, a doula, the best friend, her college roommate, her husband and her preschool age children, the mother labored in the kiddie pool in her living room. After 4 hours of contractions, painful and getting more painful, the mother was only dilated to 2 centimeters.

“Is not the labor painless?” said the swindler Midwife. “Notice the pleasurable ‘waves’, the glorious ‘tightenings’.” The doula, best friend, the college roommate and the husband looked at the Midwife and nodded. Each thought that the other could see that the labor was painless and pleasurable.

“What can this mean?” said the Mother to herself. “This is terrible. Am I so unnatural? Am I not authentic? This is disastrous,” she thought. But aloud she said, “Oh, the labor is painless and the ‘tightenings’ are wonderful.” She would not, she could not, admit that the contractions were painful, when her doula, her best friend, her college roommate and her husband were watching. “Magnificent.” “Excellent.” “Exquisite,” went from mouth to mouth and everyone was pleased.

Everyone sat up all that night waiting for the labor to progress. By 8 AM, the Mother was entering transition, vomiting into the kiddie pool and screaming with every contraction.

The Midwife issued inspiring statements. “You are doing great,” she said. “You are having a painless labor,” she said. “Let’s tweet your birth progress to your Twitter list. Oh, and could you move a little to the left so that you are not obscuring the videographer’s view of me.”

“Magnificent,” cried the doula, the friend, the roommate and the husband, even as the Mother retched and grunted. Nothing would have persuaded them to admit they were watching a labor that was far from painless, for fear they would be thought unnatural or inauthentic.

And so the moment of birth approached. The doula, the best friend, the college roommate and the husband cheered and cried, “Oh, how painless is the labor. How soothing the waters of the kiddie pool.” No one dared to admit that mother appeared to be in agony and was screaming for the pain to stop.

“Soon it will be time for my orgasm,” the mother thought to herself in scattered moments of rationality.

Finally the baby was crowning and the Mother was screaming, “Get it out of me. Get it out of me now!”

The head was born and then … nothing. “Surely I will split apart in agony,” the mother thought.

The swindler Midwife paled. “Push!” she screamed. “Your baby is stuck!”

“Fuck,” she was heard to mutter under her breath, “another shoulder dystocia.”

The Midwife twisted the baby this way and that. The doula, the best friend and the roommate were screaming, “Push!” and the preschool age children were crying hysterically. The husband was dialing 911.

With an ear splitting howl, the mother pushed with all her might. The baby emerged limp and blue into the hands of the Midwife. It’s right arm dangled at a unnatural angle. The mother fell back into the kiddie pool hemorrhaging into the dirty water.

“Don’t cut the cord,” screamed the Midwife. The doula tried to perform CPR. The best friend burst into tears. The college roommate ran to open the door for the ambulance crew. The husband was heard pleading, “Breathe, baby, please breathe.”

The EMTs bagged the baby who was still unconscious and wrapped him carefully preparing for transport to the hospital.

“Wait,” shouted the Midwife, “there hasn’t been any skin to skin contact. She needs to nurse that baby first!” The EMTs ignored the Midwife and barreled through the door, with the husband grabbing his car keys to follow.

Several hours later, the profoundly anemic Mother was finally settled into bed after passing out several times. The husband had called from the hospital. The baby had regained consciousness and was now intubated and doing well. His arm still dangled limply at his side.

“You pushed out a 10 pound baby with no help at all,” crowed the Midwife, “and you had an orgasm, too.” The doula, the best friend, and the roommate nodded.

From the doorway a little child suddenly gasped out, “But, Mama,” he said,” it looked like it really hurt.”

The Midwife, the doula, the best friend, and the roommate stared at the child. Her little boy’s words seemed to rouse the Mother from her near stuporous state. “What can this mean?” said the Mother to herself. “I did not have an orgasm. I was in agony. Am I so unnatural? Am I not authentic? This is disastrous,” she thought. The Mother made up her mind.

“Oh, no, honey,” she managed to whisper, “I enjoyed it. I had an orgasm.”

She drew herself up and smiled proudly, and the doula, the best friend, the college roommate and the Midwife nodded enthusiastically.

The swindler Midwife collected her multi-thousand dollar fee and headed for the door. “Sorry to run,” she called over her shoulder,” but I’ve got to help the videographer with the footage. A little judicious editing, and we’ll have yet another orgasmic birth video. Check for it on YouTube tonight.”

How many times have we heard this? A lactivist, birth activist, attachment parenting proponent who insists:

Honestly, I don’t understand why other mothers think that I am judging them. If they want to raise their children by doing whatever is easiest for them instead of what’s best for their babies, that’s their decision and I don’t question it. I understand that some women love their jobs more than their children, and, after all, who wouldn’t if she had some fancy-pants career where she made tons of money. It probably makes more sense to her to put money ahead of her children’s well being.

Take my next door neighbor, for example. She makes oodles of money practicing law and leaves her baby each and every day in the care of strangers. I am impressed that her baby welcomes her home by reaching out to her, smiling and giggling. Fortunately, nature designed babies to recognize their mothers, no matter how little time those mothers spend caring for their children.

I’ll admit that I finder it harder to understand how women who aren’t even working give up on breastfeeding so easily, or refuse to allow their children to sleep in the family bed. What’s so valuable about their time or convenience anyway? But I keep my opinion to myself. I don’t let on that I am perfectly aware that there is no such thing as a breastfeeding difficulty that can’t be overcome with enough love and dedication. When other women claim they had a low milk supply or that breastfeeding was excruciatingly painful, I merely feel sad that they never had the unique opportunity to bond with their children that only breastfeeding offers.

And when it comes to childbirth, how can I possibly judge other women who haven’t taken the time to educate themselves the way that I have? I’ve read Henci Goer’s book three times, and Ina May Gaskin is my idol. Everyone knows that the first step to becoming educated on a topic is to join an internet message board. If I hadn’t joined the message boards at Mothering.com, I probably wouldn’t have known that birth is inherently safe and that all that stuff about “risk” was made up by doctors trying to steal business from midwives.

The uneducated women who don’t understand this can’t be blamed for acting like birth is some sort of disease and needs to take place in a hospital. Of course they give in and get an epidural at the drop of a hat because they don’t realize that there’s a difference between good pain and bad pain. And they don’t even understand the real risks of epidurals.

Oh, and don’t accuse me of looking down on women who’ve had C-sections. Sure, they didn’t actually give birth, and they have missed out on the peak experience of a woman’s life, but is that their fault? I know that almost all C-sections are unnecessary, but those poor women actually think that the C-section “saved” their baby’s life.

I don’t judge them, but I do think that I have a responsibility to open their eyes to the ways in which they have been misled. It would be wrong for me to refrain from enlightening them merely because it might hurt their feelings. Women need to understand that anyone who thinks her C-section was “medically necessary” is being duped by those who seek to medicalize childbirth for their own benefit.

Many women don’t realize it, but if they had more encouragement, they’d happily do what’s best for their babies. That’s why I tell my birth story to everyone, whether they want to hear it or not. It may seem unbelievable, but it’s often the very first time they’ve heard that they could have been empowered like me if only they’d made the same decisions I made.

And let’s face it, women don’t get enough encouragement to breastfeed. Some women actually think that a baby who is fed artificial milk (formula) can be as healthy as a baby fed with breast milk as nature intended. I consider it my duty to broadcast the dangers of formula feeding far and wide. It’s unfortunate that we have to scare mothers into doing what’s best by exaggerating the benefits of breastfeeding, but everyone knows that the ends justify the means.

Please do not accuse me of judging those other mothers who don’t love their children as much as I love mine. I’m well aware that different ways of mothering are right for different families. Of course women who are obsessed with their own convenience find that bottle feeding is right for them and their families. Obviously women who have been duped by doctors into fearing birth are going find that hospital birth is right for them. And inevitably those who aren’t really attached to their children are not going to be comfortable with attachment parenting.

I just want to be clear:

To those women who haven’t really given birth because they’ve had a C-section, to those women who gave in to the pain and got an epidural, to anyone who doesn’t understand that only breastfed babies are truly bonded to their mothers …

I am so not judging you.

This piece is satire.

Ten:

One to teach the course “Empower yourself by changing your own light bulb.”

One to whisper affirmations encouraging the light bulb to be in the correct position.

One to photograph the event.

One to twitter the event live.

One to fill the fishy pool. (Note: professional electricians claim that standing in water while changing a light bulb is dangerous, but they just say that to ruin your light bulb changing experience.)

One to call 911 if you get electrocuted while standing in water while changing the light bulb.

One to reassure you that people get electrocuted changing light bulbs even when they are not standing in water, so you shouldn’t let the warnings of those stupid electricians scare you.

One help you eat while changing the light bulb in order to keep up your strength.

One to tell you to turn the bulb only when you get the urge.

And finally, one to actually change the light bulb and pretend to have an orgasm while doing it.

There a new branch of medicine that is providing startling insights into health and disease. It’s called evolutionary medicine and, simply put, it means analyzing health and disease from an evolutionary perspective.

Central to “natural” childbirth advocacy, and, indeed, most forms of “alternative” health is the notion that the human body has been “designed” for optimal function and that disease is a deviation from optimal function. The analogue among “natural” childbirth advocates is that a woman’s body is “designed” to give birth and, therefore, interventions are unnecessary.

But the human body was not designed. We are not created like widgets with uniform internal components that can be depended on to work a certain way every time. As anthropologist and evolutionary medicine pioneer Peter Ellison points out:

We’re trying to … educate physicians who will have a broader perspective and not think of the human body as a perfectly designed machine… Our biology is the result of many evolutionary trade-offs, and understanding these histories and conflicts can really help the physician understand why we get sick and what we might do to stay healthy.

What does Ellison mean by evolutionary trade offs?

Consider sickle cell anemia. Sickle cell anemia is caused by a genetic mutation that leads to “sickling” of the red blood cells. The abormally shaped blood cells clog the small vessels producing the characteristic painful symptoms. Evolutionary biology provides us with a reason why sickle cell anemia is so prevalent. Individuals who carry sickle cell trait (the unexpressed mutation of sickle cell anemia) are more likely to survive malaria and therefore, the trait is actually protective against a disease that is endemic in many parts of the world. When two individuals with sickle cell trait mate with each other and produce children, one quarter of the children will get a “double dose” of the trait and, therefore, suffer from sickle cell anemia. The overall benefit of sickle cell trait outweighs the cases of sickle cell anemia. Hence the trait (and the disease) have persisted.

Experts in evolutionary medicine believe that they may have found an important clue to the origin of auto-immune diseases:

Humans evolved alongside beneficial bacteria and parasitic worms, and so our ancestors built up immunity to such bugs. But nowadays with increased hygiene, we’ve eliminated the bacteria and worms. The result: Since our immune systems aren’t used to these good bugs, our bodies fight them as foreigners. That can result in allergies, asthma and autoimmune diseases …

And evolutionary medicine explains why childbirth is so dangerous for both babies and mothers. One reason is because evolution favors reproduction over health. In other words, the most successful of the species are those who produce more offspring, not perfect offspring. From an evolutionary perspective, it is better to have 10 children and have 5 die, than to have 2 perfect children.

Moreover, childbirth itself represents a compromise between competing evolutionary pressures. On the one hand, a more neurologically mature newborn is more likely to survive, so there is an advantage for a baby to be born more with a bigger head and therefore neurologically more mature. On the other hand, there is a limit to the size of the woman’s pelvis. That’s because a larger pelvis renders walking more difficult and if the pelvis is large enough, walking upright is impossible. There is tremendous evolutionary pressure to increase the size of the neonatal head and equally large evolutionary pressure to limit the size of the maternal pelvis.

As a result, there is naturally and inevitably a significant amount of incompatibility between the size of the baby’s head and the size of the mother’s pelvis. This is built into the system. In other words, a significant amount of maternal and fetal death is built into the system and is unavoidable. Understanding this leads to different conclusions than the erroneous assumption that women are “designed” to give birth.

Human beings are not machines, and we are not “designed.” We have evolved a wide range of strategies to cope with hazards in our environment and these strategies usually represent compromised between competing imperatives. And in each individual, the compromises may be different, leading to dramatically different outcomes depending on the environment. Moreover, our personal goals are very different than the goals of evolution. Evolution favors successful reproduction; it does not favor perfect reproduction and it does not favor health. It is nothing more than wishful thinking to imagine otherwise.

Believers in pseudoscience appear to suffer from a free floating fear. What unites vaccine rejectionsists, organic food devotees, and consumers of “alternative” health? They are united by a pervasive fear of being poisoned. And not poisoned accidentally, either. They are united by a fear of being poisoned surreptitiously, deliberately, and as part of a giant conspiracy perpetrated by Big Pharma and Big Farma. They suffer from toxicophobia, the irrational fear of being poisoned.

It is axiomatic among vaccine rejectionists, organic food devotees and consumers of “alternative” health that vaccines, conventionally grown food and the water supply are filled with “toxins.” Sometimes these toxins are named; often they are not. In all cases, though, there is no evidence that anyone is actually being harmed by “toxins,” but, of course, proof is not a requirement in the fantasy world inhabited by pseudoscience believers.

Vaccines supposedly contain “toxins” that cause autism. (N.B. Toxins always and only cause diseases and syndromes whose etiology is still unknown. No one ever claims that toxins cause strep throat, or sickle cell anemia, or gallstones.) Our food supply is purportedly contaminated by toxins too numerous to even bother mentioning by name. Our water supply is supposedly contaminated by the toxins in pesticides. And, of course, all medications produces by Big Pharma have myriad secret and toxic side effects.

That all pervasive fear would be disabling enough on its own. Apparently, pseudoscience devotees imagine themselves navigating a world pervaded by an unseen toxic miasma. What’s worse, though, is that the entities responsible for creating this toxic miasma know all about it, did it deliberately to make money, and are engaged in a vast conspiracy to keep it secret from the rest of us. Oh, it is a nefarious world indeed!

Big Pharma deliberately adds toxins to its vaccines. Sounds like overkill to me, since vaccine rejectionists also claim that the vaccines themselves are toxic. And vaccine manufacturers know all about this and do it to make more money. And the government knows all about it, too, and insists that we take more and more vaccines every year. And the government pays for it. And the government has granted vaccine makers indemnity from prosecution. It is a wicked world.

Big Farma covers our fruits and vegetables with toxins, and, if that weren’t enough, adds toxins in the guise of preservatives to everything else. And these toxins cause cancer! What kind? Don’t ask, no one knows, and why would that matter anyway? Cancer is cancer. And if all that weren’t bad enough, Big Farma now wants to flood our food supply with … genetically modified food. Horror of horrors, genetically modified foods (they modified the GENES, for chrissakes) are sure to be filled with unnamed toxins of all sorts. And if that weren’t bad enough, Big Farma wants to irradiate our food to kill harmful bacteria (they’re going to expose our food to RADIATION, for chrissakes). Next thing you know we’ll all be gigantic and super-powerful. Oh, wait, maybe we’ll all be stunted and weak. It doesn’t matter; regardless of what they do you can be sure it will “weaken” our immune systems.

We are facing a big problem. Contrary to what the food and medicine toxicophobes believe, it is not the deliberate contamination of our food and pharmaceutical systems. The problem is a sociological problem. Large segments of the populations are suffering from the delusion that industry and the government are colluding to deliberately poison them.

To be clear, I’m not suggesting that medications don’t have side effects or that pesticides or preservatives are theoretically incapable of being harmful. Everything has potential side effects, but there’s a big difference between “potential” and “real.” Vaccines, for example, are known to cause brain damage and death in a tiny proportion of children who are vaccinated. That is real. But vaccines don’t cause autism. That’s fantasy.

What is the source of this toxicophobia? In part it stems for Americans’ apparent inability to understand risk. Americans are so obsessed with side effects that they forget about effects. They vastly overestimate the real risk of side effects and vastly underestimate the effects of the treatment in question. That tendency to overestimate side effects is directly related to the sense of control that Americans do or do not feel. Just as Americans routinely underestimate the risks of driving, they routinely overestimate the risk of plane flight. They believe themselves to be in control while driving, yet they develop irrational fears about the risk of an unforeseen and unforeseeable plane crash.

So Americans obsess over the risk of side effects from medication and the theoretical risk of side effects from agricultural methods that have made the food supply larger and safer. They are consumed with anxiety by the belief that they are secretly being poisoned.

This obsession is magnified by the belief that Big Pharma and Big Farma know about all these side effects and are hiding them. Do large corporations hide damaging information from the public? Yes, unfortunately, they do. But Big Pharma and Big Farma are no different from other large corporations. Yet no one has stopped driving because they fear the auto industry has designed cars that will blow up at the slightest provocation (even though that actually happened with the Ford Pinto) and no one has stopped crossing bridges for fear that shoddy construction will lead them to collapse (even though that has actually happened, too).

Simply put, there is no basis in reality for this pervasive toxicophobia, suggesting that it may be serving a psychological function. I’m going to go way out on a limb here, and raise the possibility that American toxicophobia is psychosomatic. Americans are not being poisoned, but they imagine they are because it is a way to channel their fear of being left behind in an increasingly technological world, and their anger at being so easily manipulated by large corporate entities like banks and other special interests, and their frustration at their perceived powerlessness. Toxicophobia projects this fear, anger and frustration onto medications and food. Unfortunately, rather than being protective, toxicophobia diverts attention from the real problems onto imaginary ones. And, paradoxically, toxicophobia doesn’t improve health, it puts health at risk.

I’m dismayed to discover that I apparently wasted 8 years in medical training. Four years of medical school and four years of residency were over-kill (pardon the expression). It seems that in 2009 the most important requirement for a medical authority is to be a former B movie starlet.

That’s right. Ricki Lake is evidently an expert on childbirth, Jenny McCarthy is an expert on immunology, and Susan Somers is an expert on chemotherapy (in the immortal words of Orac of Respectful Insolence, she is currently carpet bombing the media with “napalm-grade stupid about cancer”).

What, you might ask, are the qualifications of these experts beyond their tawdry celebrity? Well, Ricki Lake completed two (count ’em, 2) semesters at Ithaca College; Jenny McCarthy dropped out of Southern Illinois University in favor of a career at Playboy; and Suzanne Somers dropped out of Lone Mountain College after 6 months.

All three had advanced training as well. Ricki Lake has actually given birth to two children. Jenny McCarthy has a child she believed was afflicted with autism. And, Suzanne Somers actually had cancer. If that’s not enough to make you a medical authority, I don’t know what is.

It’s hardly surprising that celebrity has gone to the heads of these women and made them think they are medical experts (look at Kate Gosselin if you want to see what celebrity can do), but what is the matter with the millions of people who appear to believe the drivel fabricated and spouted by these women? What has happened to us, America?

How can anyone believe anything they have to say on any medical topic? Does anyone seriously think they are qualified to dispense medical advice? Aren’t you embarrassed to be consulting actresses for information on sophisticated medical issues?

Is this part of the dismaying strain of anti-intellectualism that has longed plagued our country? Do people honestly think that those smarty-pants doctors don’t have any knowledge that couldn’t be acquired on “Three’s Company”?

Or should we blame this farcical behavior on the American penchant for conspiracy theories, the more outlandish the better? Do people really have so little faith in organized medicine that they consider Suzanne Somer’s cancer advice more likely to cure them than medical treatment?

Personally, I blame it in part on the Republicans. For the past 30 years we have been subjected to a relentless drumbeat of propaganda insisting that government can do nothing right, while they simultaneously distributed the contents of the public coffers to their personal friends or themselves.

I am a cynical person, but really folks? The government is paying for and recommending the distribution of injectable poisons? Big Pharma wants to create of generation of autistic people? Chemotherapy is a plot to keep you from the real cure for cancer? That’s not cynicism; it is credulousness.

Inquiring minds want to know: How can anyone claim with a straight face to believe that Ricki Lake knows anything about childbirth? How could anyone possibly believe that Jenny McCarthy knows about immunology simply by dint of having a child who she thought was autistic. And Suzanne Somers? Does anyone seriously believe that the purveyor of the “Thigh-Master” just happened to discover the cure for cancer in her spare time?

Someone please explain it to me, because for the life of me I, like other doctors, cannot figure it out.

Kudos to Lindsay Beyerstein of Majikthise for coining a new phrase “Big Placebo.” Big Placebo is the alternative health counterpart to Big Pharma. Both are special interest groups designed to promote their products, whether they are worthy of promotion or not. There is one big difference between them: Big Pharma makes products that usually work (though not always, and sometimes not safely). Big Placebo hawks books and products that never work.

Big Placebo is unsatisfied with the $40 billion it takes in every year on treatments that don’t even work. They’re aiming for a much larger piece of the healthcare pie and to do so they are criticizing modern medicine. I have previously written about the disingenuous efforts to focus attention on preventing diseases in the “worried well” as opposed to curing diseases of the poor and medically underserved.

To hear Big Placebo tell it, virtually all illness can be prevented and anyone who gets sick deserves it because of poor lifestyle choices. If only that were so. Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.

Another axiom in the Big Placebo armamentarium is the notion that contemporary American Medicine cures nothing and merely “manages” diseases. According to “Dr.” John Neustadt (naturopathic doctor) writing in the Huffington Post:

The current system teaches disease management and symptom suppression, which is insufficient to meet our healthcare needs. A reformed system needs a new paradigm that stresses health promotion and treatments that attempt to correct the underlying causes of disease.

Dr. Andrew Weill, of Weil Lifestyles LLC, licensing Weil Nutritional Supplements (vitamins and supplements), Dr. Andrew Weil for Origins (skin-care products), Pet Promise (premium pet food), Dr. Andrew Weil for Tea (premium teas), Lucini Italia Organics(organic extra virgin olive oil and whole, peeled tomatoes), Weil by Nature’s Path (organic cereals and nutrition bars), Weil for Vital Choice, Weil Baby™ (baby feeding systems), Weil by Vita Foods, and Orthaheel™, claims:

By no stretch of the imagination does mainstream American “health care” move us closer to this vision of robust, resilient health. It is a fiscally unsustainable, technology-centric, symptom-focused disease-management system.

To hear them tell it, American medicine cures nothing. It simply manages disease and suppresses symptoms. It is a measure of the astounding success of the American medical system that anyone could listen to that drivel and not fall to the floor laughing hysterically. American medicine cures so much disease, involving so many people, so reliably and so often that everyone takes it for granted.

Evidently American Medicine doesn’t cure anything except … tuberculosis, pneumonia, bacterial meningitis, gonorrhea, any bacterial illness you care to name. American medicine routinely cures previously deadly conditions like appendicitis, ectopic pregnancies and obstetric hemorrhage. Better yet, it can completely prevent many viral and bacterial scourges through vaccination. It’s not a coincidence that American lifespan has increased from 48 years to 77.7 years in slightly more than a century. Much of what routinely killed Americans is now routinely cured.

In fact, cure is so routine that these illnesses rarely enter American consciousness. No one worries about dying from tertiary syphilis, diphtheria or rheumatic heart disease. Those diseases are routinely prevented or cured in their early stages.

And “disease management” is hardly a deficiency, either. Some diseases cannot yet be cured. Until the day that a cure is discovered, we manage those diseases. Juvenile (type I) diabetes was uniformly fatal until the discovery of insulin. Insulin doesn’t cure diabetics; it merely allows them to live an addition 50 years or more. Instead of dying in childhood, type I diabetics routinely live to have and enjoy grandchildren. Such “disease management” is worthy of praise, not the contempt that Big Placebo attempts to heap on it.

Can we do better? Of course we can, particularly in the areas of diseases caused by smoking and alcohol abuse. However, that’s a far cry from claiming that American Medicine doesn’t cure disease. That cynical and disingenuous claim should be understood for what it is, Big Placebo’s attempt to line its own pockets. Alternative health purveyors and practitioners are charlatans and quacks … and liars, to boot.