Haha. This is an incredibly polite reply, sharpened to a very fine point.

I'm grateful I have something to contribute to a site that I've gotten an incredible amount out of. And it's a powerful reminder that very very smart people can have a hard time critically appraising medical claims. As powerful as the internet is, medicine is really complicated, and it's easy for doctors to forget that.

I'll let the surgeon speak for him/herself, but for my part: I am raising the issue of industry size and quackery to give other readers context. It doesn't make the article wrong necessarily, but I would want to have that context as a non-expert reader trying to understand how it fits into the larger body of scientific understanding. And I would say yes, that does happen (and is appropriate to have happen) in scientific discourse.

On a related note: one amazing site that isn't well known is the OpenPayments[1], maintained by the US government. If you live in the US and have doctor, you can see how much compensation they received from industrial sources. Some of the numbers are shocking. Put your own doctor in, and see where they are. There is no need to resort to conspiracy claims when you can audit them, to some degree, yourself.

The physician mentioned in the article, Dr. Paul Harch, has received $74.48. So way to go Dr. Harch! we can worry much less about getting a skewed opinion based on a industry payments.

But weighing against that is his CV, which lists publications with "D Amen", who I suspect is Daniel Amen - an overly-credulous hyperbaric oxygen physician who has his own page on quackwatch[2], and subscribes to medical theories that are even less credible than the ones in newsweek. When Mehmet Oz[3] is an endorsement on your web site (Amen; not Harch), the public is justified in putting you in the same category. Farther down the CV is "Department of Defense trials for hyperbaric oxygen and TBI: issues of study design and questionable conclusions", wherein I'm predicting he single-handedly dismantles a large federal study of whether HBO is useful for traumatic brain injury. Feel free to find the original article and independently appraise it, if you think it's worth your time... I can barely find 10 minutes to pay back a favor to a good-natured community that has taught me a lot about computers and programming.

Finally: let's not lose sight of the incredibly good thing that happened for this child. Regardless of how or what or why, this is an exceptional outcome, and it's fantastic for this child. I only wish it wouldn't create false-hope for families who are less fortunate, but have thousands (or tens of thousands) of dollars to blow on questionable treatments and false reason for hope.

1. https://openpaymentsdata.cms.gov/

2. https://www.quackwatch.org/06ResearchProjects/amen.html

3. https://www.youtube.com/watch?v=WA0wKeokWUU

I personally prefer propublica's Dollars For Docs data visualization and search features of the open payments dataset, it seems more fluid. However, it does not have the recent update for 2017 that open payments has.

As a medical student I appreciate you all commenting here, it also helps those of us with a general understanding put things into perspective.

https://projects.propublica.org/docdollars/

Pretty amazing! I wish there was Dollars for Docs in Europe (and the rest of the world)! Apparently, "the disclosures were required under the Physician Payments Sunshine Act, a part of the 2010 Affordable Care Act" [1], I hope this doesn't get reverted in the new non-affordable act.

[1]: https://www.propublica.org/article/about-the-dollars-for-doc...

It's an Internet myth that the credibility of an argument's source is out of bounds in a debate. If and only if the arguer's credibility has no logical connection to their argument, then attacking the arguer is fallacious. Otherwise, as is very much the case here, it is not.

> If and only if the arguer's credibility has no logical connection to their argument, then attacking the arguer is fallacious.

The arguer's credibility does not affect the truth value of any statements, so it's always more useful to argue over why someone is wrong. You cannot guarantee that any segment of the population agrees with your credibility assessments. And these assessments should be established via appeals to factual evidence to begin with, anyhow, if we're to believe they should carry any weight at all. Otherwise, we're arguing over feelings instead of facts.

For people with wild, unsupported claims, it's better to simply take the tact that we have not yet seen evidence that establishes those claims and that what's on offer presently does not meet the necessary burden. In that argument, it really doesn't matter who is making the claim, only that the claim itself is not supported.

The arguer's credibility has no bearing on the truth value of purely logical arguments that can be fully evaluated within the four corners of the argument. Very few scientific assertions fit that rubric. In the ordinary case where a conclusion is at some pointed predicated on an unknown fact, then the credibility of the speaker absolutely matters.

Saying that a person's credibility decides the truth value of the statement requires a causal relationship. To say otherwise is to posit a mechanism via which one's opinions somehow shape reality itself. So it seems to me that our notions of 'fact' might not be aligned?

I understand evaluating someone's credibility as a proxy when I have no means of investigating something. I do not understand it when we are talking about scientific assertions, which must be falsifiable in order to be scientific in the first place.

If you aren't the one attempting falsifying it, then you still have to trust somebody based on their credentials.

If you aren't the one attempting to falsify it, then you have no reason to argue over it to begin with, in which case you won't be making any ad hominem arguments to start with.

If that were the case, most people in this thread shouldn't be posting (arguing) but personally running their own medical trials. Any other source would in some way require trust in that source's credentials.

That's of course a bit black/white to say, most arguments don't hold if you push them to their extremes like that. I said it because I believe (your) arguments like "saying that a person's credibility decides the truth value of the statement requires a causal relationship" are similarly black/white.

So yes, in a way the disagreement hinges on a very strict interpretation of the word "fact" versus a less strict interpretation.

It's also to save time in evaluating claims like these. If you've spent any amount of time arguing about pseudoscientific topics (or considered pseudoscience by some), you must have found that yes you can in theory evaluate all[0] (dubious or not) claims in logical, scientific, falsifiable manner. But at some point, especially in pseudoscientific-ish topics, there will be such a great number of claims[1] that you'll find yourself spending most of the time refuting spurious claims rather than actually getting any further.

At that point, you'll never get to the strict definition of the word "fact" (at least, about the particular claim that is the topic of interest), because the claims just keep piling on faster than you can evaluate them. Allowing for a bit less strict definition, allows you to prune the evaluations greatly, and at least allows you to get somewhere.

Now, that struggle doesn't seem to take place in this thread on HN, but according to user "dumbneurologist" it has taken place before elsewhere. And you're still taking that person's word on a matter of (merely claimed) reputation as well.

So yes, there is something to say for taking someone's reputation into account. But it's a pragmatic reason. If you had all the time in the world to dig into everything as deep as you want, you wouldn't strictly need to. But since we do not live in this perfect world, we can and probably should shortcut to the more interesting points of debate by including reputation.

That's the best I can argue this, I think :) It's still a choice, however. You can still choose to only accept strict facts (including "I don't know" when more specific strict facts are unavailable).

[0] ok, not all of them

[1] part of the definition of pseudoscience, where you keep adjusting or special-casing gaps in your hypothesis when it doesn't fit the data, almost necessitates this

> If that were the case, most people in this thread shouldn't be posting (arguing) but personally running their own medical trials. Any other source would in some way require trust in that source's credentials.

We're not discussing the study but logic, so that's really not germane.

> It's also to save time in evaluating claims like these.

You can save far more time by ignoring them.

> The arguer's credibility does not affect the truth value of any statements

It is evidence which you should weigh in deciding how much credence to give their statements.

> so it's always more useful to argue over why someone is wrong.

It's a tradeoff, so there's no obvious bright line with which everyone will agree. But certainly there are some people for which some arguments or claims can be reasonably dismissed out of hand, relative to the preferences of the person making this decision.

If it's evidence, then it must have an effect on the truth or falsity of the statements. So if X says "the sky is blue" then X's credibility must be causally related to whether or not the sky is blue. As there's no such mechanism, this is pointless.

You essentially point out that it's an easy shortcut. And it is, but there's no good reason to take it. One's feelings of credibility do not change the truth value of any statements and so arguments over it are not useful. You will end up arguing over whose feelings are superior and not over observable facts.

When presented with a statement, what matters is the probability that the statement is true. The credibility of a source is strong evidence in this regard and can be used to sway the probability mightily. You're right, of course, that arguing over the credibility is pointless, but an appeal to authority is not fallacious if you and I both agree on the authority.

(Though an appeal to authority is a perfect setup for a motte-and-bailey, so it's important to be wary. Also, it is not, nor ever can be, proof, since that should hold irrespective of authority.)

Yes, I can understand using a mental shortcut by evaluating something simpler that's well-correlated with the truth value. However, this generally runs afoul of Goodhart's law at some point and we invest entirely too much work into something that's meant to be a shortcut.

Moreover, when it's an argument, you want others to agree with you. If you have to take shortcuts and infer the truth of something by proxy because you are either too lazy or not capable of evaluating the matter directly, you probably have no business arguing over it in the first place when you could instead apply your expertise to show how wrong it is.

Worse, your own correlations work against you, as you can now correlate that someone who cannot or will not do that work in making an argument, dragging irrelevant (if sometimes correlated) things into the argument becomes a signal for someone using non-factual means to persuade, which necessarily correlates quite strongly with making false claims.

In short, yes, it can be simpler and it can lead you to being right, if for the wrong reasons. But nobody else has good cause to trust it, it's vulnerable to manipulation, and it's simply better in all cases to be less lazy and fully explain why something is wrong using facts instead of opinions of someone's credibility.

Reality is stochastic. Scientific debates are grounded in probability, not formal logic. If someone has published 38 papers which were complete junk, that gives us a very strong prior about their 39th paper.

Poor researchers are very common. Conspiracies to smear people are very rare. If an academic has a bad reputation, the odds are good that their reputation is deserved.

None of this is conclusive - mavericks do occasionally produce brilliant-but-unconventional research - but it's hugely relevant. There aren't enough hours in the day to give every paper the benefit of the doubt. We have to use Bayesian shortcuts and crude heuristics to filter things for credibility, otherwise we'd be drowning in a sea of junk. The occasional false-positive is a price worth paying.

It's fine to use that to say what is and isn't worth attention. It's not fine to use that as an argument to convince others. You have much better arguments: poor methods, insufficient evidence, lack of controls, etc. and none of those rely on personality.

Good point. I think people may confuse logic with believability.

I could propose in this comment a cure for cancer based on a perfectly sound a logical argument and my (lack of medical) credibility would have zero affect on the cogency of what I was saying.

But it does mean, you should probably not be convinced, or at least not send me all of your money to invest in my cancer research startup.

Also for some reason it's very easy to judge something as reasonable when we actually don't have any domain expertise. Not sure why, it seems built into most of us to feel natural.

I'm not going to give an inch on this. This isn't an issue of logic versus persuasion. It is logically valid to attack the credibility of an argument that depends in any way, implicitly or overtly, on the credibility or authority of its bearer.

The "ad hominem fallacy" is misused on the Internet probably more than it is applied correctly.

I don't think you have to give an inch. I'm agreeing it's legit to judge someone's argument based on credibility.

The reason is imperfect information. If I described here an actual, real, cure for all cancer, people shouldn't believe it because credibility is shit, it hasn't been clinically proven, and it might take 10 years to do so.

If I write in a solid proof for a millennium prize problem, you're probably going to be safe not worrying about my credibility at all because the truth will be known in pretty short order.

Usually the more uncertainty the more credibility has to be weighted.

Contrary to popular belief (and internet logical fallacy experts), attacking the credibility of the speaker is a perfectly fine thing to do. The quality of the speaker is often times a pretty good indicator of the quality of the message.

Indeed. Just because a conclusion is based on logically fallacious arguments doesn't mean it's untrue, or that the arguments should have no persuasive power whatsoever. (Taken to its logical extreme, even a stopped clock is right twice a day.)

Attacking the arguer's credibility isn't fallacious if their argument depends in any way on their credibility, as it clearly does in this Newsweek story.

I'm not familiar with that exception in logical thinking. What argument is logically dependent on someone's credibility?

For instance, this Newsweek article and the claims made by the doctor in it depend on the doctor's own reports of their interpretations of MRI scans. Observing that the doctor making those interpretations is disreputable is an important and logically meaningful point.

Really what you're observing is that the argument in Newsweek sidesteps logic and appeals implicitly to the authority of that doctor. Presented with the argument that the subject of the article is credible enough to be believed on their own terms, we're left with a debate about that subject's credibility.

The weird idea embedded in this meta-debate is that alone among all the innumerable topics we can address with logical argument, from rankings of Led Zeppelin songs to the proper distribution of ownership of the means of production between capital and labor, the credibility of a human being on any particular subject is exempt from scrutiny, lest we fall into the trap of "ad hominem".

It's not necessary to drag one's assessment of their credibility into this at all, though. Points 1-3 of the original post are all that need to be argued.

https://news.ycombinator.com/threads?id=throwaway7890

Credibility is not "exempt" from scrutiny, it simply doesn't change the truth value of any factual statements about whether the treatment works. If it somehow could change the truth of whether this approach worked or not, then if this guy presented the opposite conclusion, somehow this treatment could either start or stop working based only on the person's opinion and reputation.

There's obviously no causal mechanism for that to happen and believing it would require magical thinking. So arguing over it is irrelevant and inserting it into the argument is pointless. We instead can properly say that he hasn't answered a lot of good questions about his approach or presented sufficient evidence to believe in it, which is the rational approach.

Argument from authority. A said X, A is an authority on X, Therefore, X is true.

This is a valid inductive argument. It is valid when A is an actual authority, when they are speaking truthfully, etc. It doesn't guarantee the truth of the conclusion but it is a fine argument. How do you know Booth shot Lincoln? You read it in a textbook, the textbook is written by someone who is an authority on history or that part f history, etc. It isn't deductive (like a proof in geometry or logic) but it is a good argument. Many logic books call argument from authority invalid and what they mean is that it isn't deductively valid but it is an inductively valid argument form (If it were always invalid, we would be quite mired in ignorance).

Other people have made good replies, but this is also a pet peeve of mine, so I'm going to jump in as well.

Another way to think about it is as witness testimony.

When you do a logical, mathematical proof, you are building on a well-defined and well-known set of axioms, using well-defined steps of logical inference. With a few well-known exceptions, we don't argue over mathematical proofs. Either the logic flows from the axioms or it doesn't.

Once you step away from pure mathematics, you no longer have a small number of well-defined axioms or clear inference. Instead you have a lot of what amounts to witness testimony. Sometimes, you recount an observation. "X drowned and was dead for 15 minutes." "X had brain damage." "X fully recovered." It is reasonable to dispute these statements based on the credibility of the person making them.

Some of these statements may be the product of inference, which is also less clear than logical inference. For instance, "X has brain damage." might have been inferred from "An MRI of X looked like Y." and "Y indicates severe brain damage." Now you have a host of ways where the statement could be wrong, based on the reliability of the person making the observation and the inference. Did the person actually take an MRI, or were they lying about it, or did they misread it, or did they actually rely on a third-party who did one or the other? Is the inference method "Y indicates severe brain damage" valid? Did the person in question correctly apply it?

People don't like to attack the credibility of others; it seems mean and it can easily slip into elitism. But examining the credibility of someone presenting evidence is absolutely critical to truth-finding. Personal integrity is an absolute necessity, in science, medicine, and law.

In pure logic, credentials don't matter. However we're discussing something that is not pure logic (i.e. we are relying on the author's expertise and insight, and the publication to accurately represent that), so credibility is certainly relevant.

Yes, when appropriate. Think of it as a Bayesian prior...

Exactly. There's good reason to think that most of human reasoning and the way we attain "knowledge" is not strict deductive logic from firm premises. Rather it's a mixture of Bayesian inference, abductive reasoning "to the best explanation", etc.

Pointing out that someone is a quack is a really effective refutation of their arguments. If you were arguing about WWII history with someone, might it not affect your trust in their credibility if you found out they were a Holocaust denier? Or if you're arguing geography with someone and it's pointed out that they're a flat Earther?

Pointing out someone is a quack is also a great way to keep differing opinions out of a discussion and thus make sure that rational discourse is avoided on issues that are useful to the person pointing.

It's always useful to think of these situation in circumstances where you don't have any emotional involvement because otherwise you mind can play tricks on you.

For example imagine you are a European Scientist who really wants to fit every animal onto tree structure with mammals over here and squid here and all the animals fall into some easy to understand structure that makes total sense to you.

And some weird guy comes back from Australia with natures most awesome animal the platypus. A furry creature that lays eggs with poison feet. Your simple identification chart is totally jacked. It way easier to say he is a quack that evaluate the evidence you don't like. Heck it's totally inconvenient that your life's work is wrong, it's going to cost you money and esteem.

tldr; pointing out a quack is a great excuse for avoiding evaluating their arguments but refutes none of them. Everyone's time is valueable and figuring out what adventures to spend it on is important. Confusing that reasonable justification of where to spend your time with their argument being false is a dangerous habit to get into. You end up always thinking you are right and avoiding things that challenge your beliefs.