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Rational debate is productive; irrational debate, not so much

This blog has been going on for a long time now, and it seems to be popular. Judging from the number of comments it attracts, it must be one of the best-read blogs on Pulse. The quantity of the comments is, of course, the pride of any blogger, but what about their quality?

Most of my readers are healthcare professionals of some type or another, and as such, we all have a lot in common. In a nutshell, we all want to maximise the chances that patients of today or tomorrow will receive the best possible healthcare. This is certainly what motivates me to write this blog and give up my time to do this for no fee or other benefit. At the same time, we are all different in many other respects: we have different professions, backgrounds, education, experience, expertise and knowledge. This means we all have different views, opinions and perspectives. These need expressing, and a blog is a good place to do just that.

Such debates are able to generate progress and might help us reach our ultimate aim, which is to improve healthcare. In order to stimulate a lively debate, I tend to write critically and provocatively about alternative medicine: critically, because an uncritical scientist is a contradiction in terms; and provocatively, in the hope of generating a good response.

For any debate to be productive it needs to adhere to some very basic rules or standards; most importantly perhaps, it needs to be rational. I could choose almost any of my posts from the last two years to demonstrate that this precondition is frequently not met by some of the most vociferous commentators, but let me select my previous post as an example.

You will remember that I discussed a recent randomised controlled trial of acupuncture showing that it was not convincingly effective for whiplash. As acupuncture is often used for this condition, this message seemed relevant for GPs and other healthcare professionals. Therefore, this was roughly what I tried to express in my conclusions.

I also added my view that, in alternative medicine, people continue to make claims that are not substantiated by good evidence, an unfortunate habit that is clearly dangerous and not in the best interest of patients or progress.

What followed was an impressive burst of irrationality delivered by a few proponents of alternative medicine. Don’t get me wrong, I do like an academic or factual or rational argument any time – but I find it tedious to deal with irrationality and, more importantly, I feel that it is not in any way productive trying to do so.

When rational people disagree with someone, they usually voice a relevant counter-argument, produce facts or ask questions that are relevant to the issue at hand.  I do appreciate that some acupuncturists might disagree with my conclusion – which is, in fact, the same conclusion as the study I discussed.

In this case, it would be necessary to produce data showing that the study I had chosen to discuss was in some way misleading or wrong. But nobody quoted a trial that was more rigorous than the one I had discussed that produced a different result. Instead, we had dozens of comments that were irrationally avoiding a factual discussion.

Some commentators claimed that my post was chronically biased; others wrote that I must be wrong because the NHS pays for acupuncture; others again stated that conventional treatments are also not evidence based. Almost comically irrational were the comments praising the effectivity of homeopathy, which obviously had no relation to acupuncture or whiplash and were a distraction from a meaningful discussion about the subject at hand; likewise the plethora of comments questioning my competence, qualifications, and integrity.

Regrettably, such ad hominem attacks are particularly frequent and typical on this blog, and in discussions of alternative medicine in general – so much so that I had already alluded to this issue when writing another previous post, ‘What is Ernst’s Law?’.

All of this could, of course, be fairly trivial. After all, this is just a blog, and not a forum by which to discuss science or anything else in the most serious manner.

But it is nevertheless a great shame because irrational debates do not go anywhere. They are not productive. They are a tedious waste of time, and a missed opportunity for making progress. I for one certainly do not enjoy having to engage in pseudo-debates, particularly when true debate is so badly needed.

 So let’s get real and let’s remember that hot air, irrationality, personal attacks and other distractions do not improve healthcare. Let’s debate rationally or not at all.

Professor Edzard Ernst is the emeritus professor of complementary medicine at the Peninsula Medical School, University of Exeter