Papers for Skeptics
I’m sure everyone has favourite research articles (please tell me it’s not just me). I thought I’d share some of mine. Most are available as free full text, but there are a few where I link to an abstract. Some links will open in PDF, but I’ve tried to make these obvious in the post. I think I’ve saved copies of each paper where full text was available, so if a link to the full text of a paper dies and you can’t get hold of it elsewhere do feel free to email me or leave a comment below and ask for a copy.
Alternative Medicine: Homeopathy, Chiropractic etc
Homeopaths pay no attention to the quality or reliability of evidence and will cite any kind of evidence – anecdotes, customer satisfaction surveys, cell studies, RCTs, anything – as long as it is positive. Shang et al looked at the best quality research available and found that there was only weak evidence for a specific effect of homeopathy. The authors concluded that their findings were “compatible with the notion that the clinical effects of homoeopathy are placebo effects”. This is one piece of evidence that will not be cited by homeopaths. There are several systematic reviews of homeopathy and Edzard Ernst took on the task of reviewing them (systematically). He found that the evidence did not support use of homeopathy, so this is another paper that will not be cited by homeopaths.
Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy: link “Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.” [Abstract only]
A systematic review of systematic reviews of homeopathy: link “It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.” [Full text]
Three systematic reviews that the British Chiropractic Association didn’t see fit to include on their “Research” page, despite finding room for single trials with positive results and guidelines that had been withdrawn:
Spinal manipulative therapy for low-back pain: link “Compared with other advocated therapies for low-back pain, including analgesics, physical therapy, exercises, or back school, therapy that included spinal manipulative therapy had neither statistically nor clinically significant benefits.” [Full text]
The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials: link “Despite claims that spinal manipulation is an effective treatment for headache, the data available to date do not support such definitive conclusions.” [Abstract only]
Spinal manipulation for dysmenorrhoea: link “Overall, there is no evidence to suggest that spinal manipulation is effective in the treatment of dysmenorrhoea.” [Full text]
When looking for research into reiki, I came across a paper that looked at a similar practise – therapeutic touch.
A Close Look at Therapeutic Touch: link “Twenty-one experienced TT practitioners were unable to detect the investigator’s “energy field.” Their failure to substantiate TT’s most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified. ” [Full text] This paper is particularly notable because the Ms E Rosa who “designed and conducted the tests and tabulated her findings” was nine years old at the time of the study.
Vaccination
Real and presumed side-effects of vaccination: link “During recent years a scala of diseases or symptoms have been associated with vaccination (presumed side effects). Careful and extensive investigations have shown that such hypotheses could not be supported.” [Abstract only]
Vaccines and autism: a tale of shifting hypotheses: link “Twenty epidemiologic studies have shown that neither thimerosal nor MMR vaccine causes autism.” [Full text]
Placebo
Is the placebo powerless?: link “We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.” [Full text, click to expand] See also Wampold et al, Hróbjartsson and Gøtzsche, and Hunsley and Westmacott.
Evidence-Based Medicine
Evidence-based medicine: what it is and what it isn’t: link. “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” [Full text] Some practitioners claim to practise EBM but place far too much emphasis on clinical judgement and far too little on current best evidence.
How to critically appraise a paper: link questions for clinicians to ask when reading a paper [Full text]
How to read a paper: one, the Medline database; two, deciding what the paper is about (links on these pages to full text as PDF); part seven, papers that report diagnostic or screening tests [PDF]. I’ve read this series and still can’t read a paper, but that almost certainly says more about me than it does Professor Greenhalgh’s work.
Other
Unskilled and unaware of it: link “when people are incompetent in the strategies they adopt to achieve success and satisfaction, they suffer a dual burden: not only do they reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the ability to realise it.” [Full text PDF] See also: Burson, Larrick and Klayman; Krueger and Mueller; Ehrlinger et al. Sometimes cited by skeptics to explain why the morons they’ve been arguing with still disagree with them. (This paper has probably been cited by skeptics on occasions when it should not have been.) Apparently, all is not lost – “improving the skills of participants, and thus increasing their metacognitive competence, helped them recognize the limitations of their abilities”.
Setting people straight: link “Presumably, erroneous beliefs can be dispelled by confronting them with contradictory evidence. Yet attempts to do so often increase later acceptance of the erroneous beliefs.” [Full text PDF] Schwarz et al write that “any attempt to explicitly discredit false information necessarily involves a repetition of the false information, which may contribute to its later familiarity and acceptance”, and suggest that rather than attempting to combat myths by debunking them it may be possible to make use of the familiarity bias: “The more the facts become familiar and fluent, the more likely it is that they will be accepted as true and serve as the basis of people’s judgments and intentions.”
The bias blind spot: link “Three studies suggest that individuals see the existence and operation of cognitive and motivational biases much more in others than in themselves.” [Abstract only] See also Pronin and Kugler [Full text PDF] Work on the ‘bias blind spot’ may partially explain why awareness of the existence of cognitive biases is insufficient. Once informed of the existence of cognitive biases, people tend to rate themselves as being less prone to these cognitive biases than others. The solution? After being educated about the importance of nonconscious processes in guiding judgment and action, participants ceased denying their relative susceptibility to bias.
Do certain countries produce only positive results? A systematic review of controlled trials: link “Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation.” [Abstract only] I wondered if this might be relevant to this paper: “The association of country of origin and precision with effects sizes complicates the interpretation.” I also wonder how much weight we should give to positive studies of, e.g., acupuncture that originate in the countries studied in the first paper.
Stuff And Nonsense 
david said,
August 12, 2011 at 8:18 am
Thank you, I think. The first three studies under the heading of “Other” are rather depressing. It doesn’t seem to matter if you know something and sincerely what to help others understand–you can’t get past their own defenses and biases. These studies suggest it is often an irrational waste of time to educate others.
If only I had known this 40 years ago, I wouldn’t have wasted decades of my life. Well, no more frustration and wasting my time. Thanks to you I can accept the futility of my efforts.
jdc325 said,
August 12, 2011 at 3:09 pm
Um, sorry about that david.
While you’re not going to get through to everyone, I’m sure you must have changed some people’s minds over a period of forty years. I may be clutching at straws here, but I don’t think those three studies are really that disheartening – apart from anything else, the authors do suggest possible solutions.
Dunning and Kruger found that improving the skills of participants helped; Pronin found that after being educated about the importance of nonconscious processes in guiding judgment and action, participants ceased denying their relative susceptibility to bias; and Schwarz suggested that the familiarity bias could be made to work for facts rather than myths.