« Il est urgent de contrer le développement de la médecine intégrative et de sauver la vraie médecine ». Analyse critique de dix arguments rationalistes sceptiques

Abstract

ContextThe debate about unconventional healthcare practices and their possible integration into conventional medical care presents an inexhaustible subject of polemics and controversy, particularly in France. In this debate, some prefer to openly deny its complexity in favor of simplistic rhetoric: these are the pro- and anti-unconventional medicine activists. Their radical rhetoric provides an ideal realm of discussion in which to analyze the cognitive shortcuts and other reasoning biases they employ. An initial analysis of the arguments put forth by the antis reveals an asymmetry in the use of the critical thinking they claim: the latter is applied to so-called “pseudo-medicine” and very little to their “rationalist” arguments. MethodIn this article, we have chosen to compensate for this shortcoming by providing a critical analysis of the 10 most common “rationalist sceptic” arguments used by opponents of complementary medical practices put forth in the press and media. Given the caricatural nature of certain skeptical positions, we have chosen to use satire and caricature ourselves for didactic purposes. Each of the 10 arguments is presented as follows: 1) a summary of the radical assertion being defended, followed by 2) the partial arguments or rhetorical strategy put forward to justify it, and 3) the counterarguments which are more or less deliberately kept silent. ResultsWe present a short caricatural summary of this argument: “Breaking news in the field of health care! Wired therapies are attempting to invade real medicine! We, rationalist physicians and defenders of true medicine, are concerned about the development of integrative medicine in France. We are sending this 10-point skeptical rationalist argument to the entire medical community and health professionals in order to put a stop to the development of integrative medicine and protect real medicine from heretics. We challenge every health care professional to take a stand; scientific medicine represents Good, because the Truth is on our side and the evidence guides our steps. If there were any evidence in favor of complementary and integrative medicine, we would be aware of it. In fact, these proponents are nothing more than charlatans whose claims are groundless. Let's be serious and proud to be Cartesian, because our country still stands up to all these would-be crooks. This proposal is based on the values of critical thinking, which aims to fight against misinformation in medicine and more generally in science. We have endeavored, as much as possible, to anticipate the objections that might be raised against our arguments.” We then analyze each argument separately. DiscussionIn the last part of our article, we analyze in greater detail the main cognitive biases used in the 10 arguments cited, drawing on the tools of metacognition: confirmation bias, framing bias and overconfidence bias. We discuss the limits of our work, which does not claim to be free of bias and is open to constructive, well-argued criticism. We make it clear that, despite its misleading appearances, our work is in no way a plea for alternative health care practices that challenge conventional medicine, nor is it an attack on conventional medicine, nor a diatribe against scientific skepticism. ConclusionWe argue for symmetrical training in critical thinking and metacognition among health professionals. Questioning and distancing oneself, without relativism, are indeed the best allies in such controversial debates. Uncertainty should be an integral part of the process of scientific knowledge, which is no longer conceivable in the binary and overly simplistic opposition between ignorance and certain knowledge, by overcoming both an acritical positivism and a radical scientific relativism.