Tuesday, July 17, 2012

Why aromatherapists are not (and shouldn't be) doctors.

In a guest editorial in the MansfieldNewsJournal, George Cox, an aromatherapist, attacks the status of current health legislation in the US. In particular, he objects to those provisions of US law that prohibit unaccredited individuals (people who aren't MD's) from making unverified health claims (making claims about products when there is insufficient evidence of efficacy). In laying out his argument Cox commits several fallacies: a version of the Ad Hominem and several Hasty Generalizations.

I will begin by looking at the ad hominem. In his article Cox uses a particular version of the ad hominem known as poisoning the well. This is when one introduces negative claims about a person or group as a way to discredit anything that this individual or group might claim in the future. In a sense it is a sort of preemptive ad hominem. We can see this at work when Cox writes:
Traditional doctors and the AMA are not infallible, despite what TV shows have shown us over the years. All you have to do is think of a couple of instances to prove that. Remember, butter is the worst thing you can eat, eat only margarine. Then a few years later, margarine is bad for you, eat only butter. Huh?
Eggs were the worst thing you could eat for a while, or so they told us. Your cholesterol would go sky high and you would die. After a bunch of poor chicken farmers lost everything, they came back and said eggs aren't so bad after all.
Basically, Cox is arguing that because the medical community has made mistakes in the past, we can't trust anything they say in the future. This is a classic rhetorical technique of turning an opponent's greatest strength against hm and treating it as a problem.  One of the greatest benefits of medical science (and science generally) is that it is evidence based. When a doctor makes a medical recommendation, that recommendation is generally based on the best evidence available at the time. However, because the recommendation is evidence based, when new evidence comes in this sometimes forces a revision in the current understanding, leading to new recommendations. If science thinks something is going to work and then it doesn't, the scientist doesn't stick his head in the sand, he bites the bullet and revises his opinion. This is exactly what we would hope for from any medical practitioner: a recommendation based on the best evidence currently available. This is in sharp contrast to many alternative medical modalities in which the recommendation stays the same regardless of evidence. To try to suggest that this responsiveness to evidence is a defect rather than an advantage is simply poisoning the well.

Cox then goes on to commit a hasty generalization when he writes:
To the people who say that aromatherapy -- my business -- is just a bunch of hooey, I would point out that dentists still use clove bud essential oil for dry socket and root canal pain. They have access to all of the narcotics that MDs do, but they still use clove bud oil because it works. It stops the pain.
So if it stops the pain in a tooth, wouldn't it, shouldn't it be helpful for arthritis pain? Both are technically bone pain.
First, it is worth noting that Cox has greatly over-simplified the dental uses of clove oil. Orac has a great deal more to say on this topic, but suffice to say that the picture is significantly more complex than Cox makes it out to be.  Furthermore, dentists use clove oil because there is strong evidence that it serves the purposes for which the dentist uses it. Despite what many alternative medicine practitioners claim, doctor are not opposed to natural or nature derived-remedies so long as there is adequate evidence of efficacy. Regarding the hasty generalization, Cox's argument seems to run like this:
  1. Clove bud oil treats dry socket and root canal pain.
  2. Dry socket and root canal pain are forms of tooth pain.
  3. Teeth are bones.
  4. Therefore, clove bud oil can treat bone pain.
  5. Arthritis is a form of bone pain.
  6. Therefore, clove bud oil can treat arthritis.
Again, ignoring the factual errors discussed by Orac in the above link, this is clearly a hasty generalization. Assuming that clove oil does work as an analgesic, it is being applied directly to the bone (or in the case of a root canal, directly to the nerve). This is very different from a topical application to the skin. To assume that because it works in one very specific situation involving teeth that it will apply to all situations involving bone is a clear hasty generalization.

Cox, however, does not stop there and goes one further, writing:
I need to watch my language and say things like, "it's been shown to" or "historically, it has been used to." Even though there are small clinical studies that prove it and we have tons of anecdotal evidence, it doesn't matter.
In effect, Cox is arguing that because there are small, preliminary clinical studies and anecdotal evidence, he should be able to make the same claims of efficacy for his products that doctors are only allowed to make for products for which there have been large-scale, double-blind, placebo controlled studies. This is a very common hasty generalization that alternative medicine practitioners make when they assume that anecdotes have value. The simple truth is that, for a variety of reasons that I can't go into here, anecdotes are worthless. To draw any conclusion about efficacy for a product based on anecdotes is as clear cut an example of a hasty generalization as one can possibly find.

h/t to Orac

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