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2013 Legislative Review: placenta take out

It’s official in Oregon now. You can take your placenta, along with your new baby, home from the hospital. This was already a practice among the CAM set but apparently new mothers were running afoul of laws designed to protect us from bio-hazards. New legislation exempts “the removal from a health care facility . . . of a placenta by a postpartum mother.”

Now, why would anyone want a placenta? Well, SBM is nothing if not your complete source of all things CAM and Harriet Hall has already covered the subject. The short answer is that in Traditional Chinese Medicine placenta-eating is thought to confer all sorts of health benefits on the new mother. I learned of this new law from USA Today, which explains that “some experts say” it has positive health benefits. Well, thank goodness for that. Wouldn’t want a new law passed without “experts” weighing in.

But if handling a placenta makes you squeamish, not to worry. The Placenta Power Wellness Service in Portland (among others) will steam, dehydrate and encapsulate it into a handy pill form for about $150-$250. (Each placenta will make 80-120 capsules, according to the website). If you wish, you can get raw placenta encapsulation instead. Placenta tincture, placenta salve and a print of your placenta (sort of like those newborn footprints) are available for extra. That would be a real conversation starter, sitting there on the mantel.

According to Placenta Power Wellness Service, anecdotal evidence shows women experience an increase in energy, mood enhancement, milk supply and feelings of elation. Plus, it’s been used in Traditional Chinese Medicine “for centuries.”

And folks, that is all you need to get a statute passed adding practices or products to the legally-available health care armamentarium: anecdotes, sometimes relayed by “experts.” Traditional use is icing on the cake. (Or maybe the placenta.) It’s the reason for the DSHEA, the chiropractic, acupuncture and naturopathic practice acts, “health freedom” laws, and getting the Homeopathic Pharmacopoeia dumped in toto into federal law, with updates courtesy of the homeopathic industry. “I’ve seen it work!” “It worked for me!” Depending on the method, the evidence for the astounding variety of practices and products legally permitted by these laws generally ranges between none and some, with, I’d wager, most hovering in the “it can’t work” to the “we don’t know if it works” range. Not to mention the evidence of safety, or lack thereof.

This past year was no exception. Although 2013 wasn’t an outstanding year for pro-CAM legislation, CAM proponents did manage to gain a bit of ground in the states, especially in Colorado. Of course, one might argue that they have been so successful in legalizing CAM in the past that a saturation point of sorts has been reached and there really isn’t that much more to do except perhaps expand naturopathic licensing.

Chiropractic

Chiropractors have been spectacularly successful in the legislative arena. For example, all states permit the detection and correction of the non-existent subluxation. Insurers, however, are not as generous as the government and policies typically exclude unproven diagnostic and treatment methods they employ as well as limit the number of treatments they can give. Chiropractors must then resort to their friends in the legislature for help.

But whether it is because they think the non-discrimination provision of the Affordable Care Act will take care of this alleged “discrimination” against chiropractors, whether states are afraid of paying for mandates themselves (as the ACA may require in some cases), or whether legislators are beginning to wise up, I don’t know. My Lexis search turned up almost 30 bills that in some way attempted to expand payment for chiropractic services. These included coverage of chiropractic services by Medicaid, worker’s compensation and private insurance, lifting limitations on treatments, and requiring that chiropractors be paid the same reimbursement as medical doctors. None of these bills passed in 2013. This doesn’t mean they won’t pass in states that have not completed their legislative sessions, but only a handful of states have sessions that extend from 2013 into this year.

Chiropractors did enjoy some legislative successes although a couple of them were merely cosmetic. The Pennsylvania legislature adopted Senate Resolution 192, once again recognizing September as “Vertebral Subluxation Awareness Month.” The resolution, which could have been drafted by Daniel David Palmer himself, begins:

Optimum performance and health of the human body depends on the unfettered, free transmission of mental impulses, or nerve impulses, between the brain and all cells, tissues and organs of the body. . .

It goes on to warn of the deleterious effects of “blockages of mental impulses,” which “can occur regardless of the presence or absence of symptoms” and “compromise a person’s health and well-being.” And so on, ending with a commendation of the Chiropractic Fellowship of Pennsylvania “for educating the public about the importance of having spinal checks for vertebral subluxations.” Small wonder, then, that the Pennsylvania House was willing to pass naturopathic licensing legislation which includes “organ repositioning” as a mode of naturopathic treatment. (A naturopathic licensing bill is still pending before the Senate.)

In Rhode Island, the legislature passed a “Joint Resolution Prohibiting Discrimination Against Chiropractic Physicians in Rhode Island.” It affirmed that:

chiropractic physicians are entitled to the same rights and privileges as all other allopathic and osteopathic physicians, consistent with . . . the Federal Affordable Care Act prohibiting discrimination against chiropractic physicians.

I suppose this bit of political theater is meant to boost chiropractors’ arguments that they are primary care physicians under the ACA. It conveniently avoids the messy prospect of actually having to get the legislature to amend their Rhode Island practice act to give them the same scope of practice as a PCP. It just gives them a piece of paper to wave around and declare that’s what the legislature intended.

A number of legislative efforts were directed toward permitting chiropractors to perform physicals. (Harriet Hall has explained why they should not be permitted to perform sports physicals.) An added bonus will no doubt be another pretext upon which to argue they are PCPs.

Nevada added a requirement this year that taxi drivers obtain a certificate from a medical examiner that they meet certain health requirements. “Medical examiner” is defined to include medical doctors and chiropractors. In California, chiropractors were added to the list of health care providers who can perform physicals on school bus and farm labor vehicle drivers.

A new statute in Delaware unintentionally reveals a disturbing aspect of chiropractic practice in that state. Delaware law requires the presence of a parent or guardian, or an adult staff member of the same sex, during examination and treatment of minors who are disrobed. Chiropractors are now required to abide by the law when providing treatment to a minor who is undressed or during an exam “involving the breasts, genitalia or rectum.” I suppose this is both good news and bad news. It is good that chiropractors must now have a guardian or staff member present. The bad news is that any chiropractor would examine the breasts, genitalia or rectum of anyone. Exactly what within a chiropractor’s scope of practice would require such an examination? In Delaware, chiropractors are limited to “manipulation/adjustment of the spine and other skeletal structures and the use of adjunctive procedures not otherwise prohibited.” They are specifically prohibited from obstetrical or gynecological exams or treatment.

Chiropractors see physical therapists as an economic threat to their livelihood. They have been successful in getting legislation passed in a number of states prohibiting physical therapists from performing spinal manipulation even though there is no evidence supporting their position.

In Indiana, a new law contains a limitation (although not a complete ban) on PT use of spinal manipulation. While PTs were able to get a limited right to direct access by patients (that is, without a referral), spinal manipulation was specifically excluded. We can all guess who was among those responsible for that exception. PTs still cannot perform spinal manipulation without a referral from a doctor or chiropractor who has examined the patient before referral.

But PTs are fighting back. A 2014 bill has been filed in Washington State specifically allowing PTs to perform spinal manipulation. It will be considered this year and I hope it passes.

While this post focuses on legislation enacted in 2013, one chiropractic bill still pending before the New York legislature bears mentioning. (Legislation pending in 2013 carries over to 2014 in New York.) Current law requires the director of school health services to conduct scoliosis screenings as designated by regulation. The necessity of scoliosis screening of asymptomatic adolescents is debatable but fortunately administrative regulations can adapt to changes in evidence for or against the screenings more easily than any schedule imposed by statute. (Whether NY regulations actually abide by current recommendations, I do not know.) Assembly Bill 6998, however, mandates that:

a scoliosis screening shall be performed by a chiropractor during child’s third, sixth and ninth year of school. [Emphasis added.]

Considering that New York is the fourth most populous state in the U.S., that is a lot of mandatory screenings. What a boon for chiropractic income! And a great way to get the word out that chiropractors treat childhood scoliosis, as this New York chiropractor’s website tells us:

Who Else Wants to Reverse Scoliosis Without Ugly Braces Or Painful Surgery?

The Scoliosis CLEAR treatment system [“adjustments” of “subluxations” included] that helped thousands of Scoliosis sufferers reverse their conditions and take back control of their lives.

Naturopaths, acupuncturists and assorted others

Colorado became the 17th state to license naturopaths. Licensing bills failed in 4 states and but were carried over to this year in 5 states, where they remain pending. (Another bill, in New Jersey, has until January 14th, making passage unlikely.) A couple of attempts to force insurance coverage and one to expand their prescription privileges failed.

The New Mexico legislature passed a bill to exempt “expanded practice doctors of Oriental medicine” from the requirement of getting a state medical imaging certificate to perform “diagnostic ultrasound or ultrasound procedure guidance.” This intrigued me in two ways. One, learning that there was an “expanded practice” version of the Oriental medicine doctor, and two, that any state would think of permitting them to use these procedures at all. Of course, New Mexico is the birthplace of the “advance practice” chiropractor, whose battles over expanded prescription privileges and other accoutrements of primary care practice are well documented on SBM. We should not be surprised to learn, then, that New Mexico also licenses Oriental medicine practitioners as primary care providers with prescription privileges that echo those of chiropractors in that state. Fortunately, the New Mexico governor had the good sense to “pocket veto” this exemption legislation.

Colorado (them again!) expanded the scope of acupuncture practice. Formerly, acupuncture was defined as being based on “traditional oriental medical concepts.” It now includes “traditional and modern oriental medical concepts,” whatever that means. Actually, it probably means pretty much anything they want it to mean.

Colorado law was also amended to authorize “aricular acudetox by trained mental health professionals.” Aricular acudetox is defined as:

The subcutaneous insertion of sterile, disposable acupuncture needles in the following five consistent, predetermined bilateral locations: (I) Sympathetic; (II) Shen Men; (III) Kidney; (IV) Liver; and (V) Lung.

The mental health professional must:

successfully complete a training program in auricular acudetox for the treatment of alcoholism, substance abuse or chemical dependency that meets or exceeds standards of training established by the National Acupuncture Detoxification Association [NADA] or another organization approved [by the state].

NADA presents this summary, dated 2013, of the evidence for auricular acupuncture on its website. Interestingly, not mentioned is a Cochrane review, published on-line in 2008, finding no evidence that auricular acupuncture is effective for cocaine addiction.

Of course, there is absolutely no reason to believe that sticking needles in the ear, or elsewhere, at the “liver” location or otherwise, will affect substance abuse and one could predict that no well-conducted study would show any effect beyond placebo. Fortunately, the legislatures of Alabama and Wyoming showed better judgment than Colorado (admittedly a low bar) and rejected licensing for acupuncturists altogether.

Colorado also enacted the Quack Full Employment Act, officially known as the Colorado Natural Health Care Consumer Protection Act, which, in fact, substantially weakened consumer protections in that state. Fortunately, it is the only state to pass one of these “health freedom” acts last year, perhaps because the so-called health freedom movement has its hands full trying to stop GMOs, or at least get them labeled.

Must we put up with this?

In case you haven’t heard, the Society for Science-Based Medicine is a new organization formed, in part, in response to you readers who wanted a group to represent their interests in the promotion of science-based medicine. I am proud to be a member, and a Board Member, and you can join too. Too often, legislators hear only the pro-CAM side of proposed laws. Opposition generally comes from medical groups, who can easily be painted (fairly or not) as “protecting their turf.” Sensible citizens who support science-based solutions to health care are rarely heard from. But we can change that. Part of my duties will be to keep you abreast of new pro-CAM legislation pending in Congress and the states or, in the rare case, legislation that actually curbs CAM abuses. We’ll include contact information for your state and federal representatives. My plan is to update the list weekly. (You won’t need to join to access the information, but please do anyway.)

Posted in: Acupuncture, Chiropractic, Homeopathy, Legal, Naturopathy, Obstetrics & gynecology, Politics and Regulation

Leave a Comment (76) ↓

76 thoughts on “2013 Legislative Review: placenta take out

  1. CHotel says:

    Oregan eh?

    I wonder how long it will be between now and when Dr. Crislip writes his first post about treating a post-partum mother with some type of gastroenteritis, intra-abnominal infection, or abcess secondary to consumption of improperly prepared or stored placental, uh, products?

  2. goodnightirene says:

    Regarding placentas: As some of you will know by now, I had three of my four children at home, therefore no need to bring the thing home. I had read about supposed benefits of consumption (after all most other mammals do this), but really wasn’t going to do that in the end. We did various things, from freezing them, forgetting they were in there for ages, planting them with a tree in the child’s name, and just disposing of one.

    Honestly, there is nothing so icky about them. It’s a fascinating thing to develop an entirely new organ to support your fetus and them expel it. We had to inspect ours carefully to make sure it was all there (or so we thought–I have had to reevaluate much of the information I absorbed at the time). As I’ve stated before, home birth wasn’t a woo fad for me, it was simply preferable to delivering in a car en route to a hospital as I have rather precipitous births; however much of the “research” I did at the time I now know was as bad as what I would find today using Google. Luckily, we relied on textbooks mostly and had experienced midwives twice, though only ourselves for one of them. The kids are now age 40 to 28, which proves nothing much, but I thought I’d just throw that in.

    None of this makes the silliness in Portland (one of my former home towns) any less amusing.

    1. Andrey Pavlov says:

      Honestly, there is nothing so icky about them.

      To each their own, I suppose. Yes, in principle I agree. An organ is an organ is tissue is a mass of cells. Yet, for whatever reason, my OB/GYN rotation was the one I found the most… icky. I have delivered 4 babies from start to finish because that is what was required of me to pass the rotation. I hope I never have to deliver one again (though I suppose it is nice that if I had to for some reason I actually could). Inspecting the placenta afterwards was one of the very few things in all of medicine that I have done that made my stomach turn. Another was slicing open the recently removed (and full of… stuff) colon from a patient that had refractory ulcerative colitis to inspect the colonic mucosa for the gross pathology part of our surgical dictation. I’m glad someone can handle birthing babies, the same way they were glad someone could handle sucking out mucous and pus from lungs during bronchoscopies.

      1. Chris says:

        And then after they are born they continue to poop!

        Oh, and they start to move around, speak, insist on eating, and as teenagers will tell you how you are terribly imperfect.

    2. Frederick says:

      Most mammal do it, yes and i guess it must be use as a argument for the “why” to do it. Animals eat it probably just because it like food laying around. Sorry to bring that image, but dog eat their puke ( or cat puke), a lot of mammal do that too, and i’m pretty sure, for human at least, it is not healthy.

      1. Young CC Prof says:

        Animals also eat it because it rots very quickly and will attract predators. The animals that don’t eat it tend to bury it or otherwise get it away from them.

        Personally, if I was living on the savannah with no idea where my next meal was coming from and only my sisters to hold off the leopards as I gave birth, I might eat my placenta. Otherwise, I am SO glad I didn’t even see it.

      2. AngoraRabbit says:

        Another good reason for critters eating placenta is that it’s rich in iron and, moreover, in heme iron that’s highly bioavailable. A human loses something like a gram of iron between the infant, placenta and blood losses. Realistically, eating placenta is a means to replace those losses. All the ladies on list who had to take oral iron supplements know what a treat those are…not. Causes constipation, hence compliance w/pregnancy iron supplements is not good. Mind, we have better dietary iron sources like calf liver, meats, and some of the newer supplements. So I’m not promoting it.

        And frankly, I make it a habit never to eat my research. (Andrey, have I really grossed you out, now?)

        1. Andrey Pavlov says:

          haha, no you haven’t Angora. Of course, yours (and others) explanations of why animals eat their placentas are perfectly reasonably. Likely all are correct to at least some extent. Thankfully we have much better ways to achieve the same things in modern humans so we can skip the whole eating of the placenta bit.

  3. Andrey Pavlov says:

    anecdotal evidence shows women experience an increase in energy, mood enhancement, milk supply and feelings of elation

    Actually changes in these aspects is not entirely implausible with the ingestion of a placenta. It is, after all, a hormonal organ – it secretes its own hormones to maintain pregnancy as it takes over where the ovaries left off shortly after gestation. That said, it is actually more likely to decrease milk production since the HCG it secretes does exactly that when actually in the body and why there is often a small period of time before milk “let down” occurs. The oxytocin surge during delivery stimulates release, but the HCG levels need to decrease in order to allow it to actually happen. Feeling of elation and increased energy could actually be related to the fact that withdrawal of HCG and drops in estrogen post-partum are at least partly to blame for post-partum blues/depression and so supplementing them back could mitigate those effects a bit.

    That said, it is still rather unlikely and short lived if it happens. Most likely a placebo effect and there are better treatments anyways.

    Nevada added a requirement this year that taxi drivers obtain a certificate from a medical examiner that they meet certain health requirements. “Medical examiner” is defined to include medical doctors and chiropractors. In California, chiropractors were added to the list of health care providers who can perform physicals on school bus and farm labor vehicle drivers

    Thankfully annual physicals don’t actually do all that much so mucking it up by having a chiropractor do it is likely to have only a small, if any, effect. And if it is a set of specific requirements, there is a higher chance the chiros will actually look at it. Basically, it should be simple enough that even they can’t screw it up that badly. Not that it justifies it and they likely will still screw it up to some extent.

    Chiropractors are now required to abide by the law when providing treatment to a minor who is undressed or during an exam “involving the breasts, genitalia or rectum.” I suppose this is both good news and bad news. It is good that chiropractors must now have a guardian or staff member present. The bad news is that any chiropractor would examine the breasts, genitalia or rectum of anyone.

    Agreed!

    They have been successful in getting legislation passed in a number of states prohibiting physical therapists from performing spinal manipulation even though there is no evidence supporting their position.

    Funny that, considering chiros love to claim we are maligning them only because of a “turf war.”

    And a great way to get the word out that chiropractors treat childhood scoliosis, as this New York chiropractor’s website tells u

    Once again, likely just spinning wheels. Not only is screening debatable at best, but treatment is essentially nil. Only in very severe cases is any sort of treatment warranted because what we have is not very effective. Likely anyone with that bad of scoliosis who would have benefited from actual medical care would end up getting it. Once again, not a justification and yes, sadly at least some will slip through the cracks (no pun intended) and be unduly harmed by this.

    Small wonder, then, that the Pennsylvania House was willing to pass naturopathic licensing legislation which includes “organ repositioning” as a mode of naturopathic treatment.

    This is the sort of stuff that blows me away. Can you imagine what kind of looks I would get if I walked in and told my attending I was going to “reposition my patient’s organs?” How can something so plainly ludicrous garner anything except raucous laughter??

  4. Frederick says:

    My god, that is disgusting.
    Funny how people are fast to spot financial fraud, and get rich easy scam. But when it is about Cam they believe everything without question as long as ‘it is traditional’. And of course it is always miraculous with no side effect.

    Well they have a lot of money to make, A lot of sCAMmer always blame medicine for money making, 250$ to swallow you own organ that not making lot of money for nothing ?. 250 for 120 pill, more than 2 $ a pills.

    I wonder, normal people are not expert in manipulating bio-hazardous material, at least the placenta, they must be risk.

  5. Thor says:

    While we’re on ‘icky’, I’ll mention that a colleague of mine used to blend a chunk of her frozen placenta in with her daily raw liver smoothie, a’ la Weston Price Foundation guidelines. It was fulfilling for her to do this, because in her mind she was performing a completely ‘natural’ act that most other mammals do. A classic case of the appeal to nature fallacy.

    1. Thor says:

      Eating the placenta, that is—not that other mammals use blenders, lol.
      One can only take this ‘back to nature’ thing so far.

      1. Renate says:

        Imagining an animal with a blender. Can someone draw a cartoon of it?

        1. brewandferment says:

          sounds like Far Side or Argyle Sweater subject matter….

  6. daedalus2u says:

    The placenta is actually part of the fetus, not of the mother. “Cutting the cord” is only symbolic, the placenta is comprised of only infant cells.

    Placenta is likely extremely digestible. They are all human proteins and human proteases need to be able to digest all human proteins.

    The main hormone of maternal bonding is oxytocin, which is a peptide and would be digested.

    The need for nutritive resources is long term. A few pounds of placenta would likely only have very short term effects. It is mostly protein, which does require deamination and oxidation in the liver to supply energy. Carbohydrate consumption would take less metabolic activity and be more efficient. The biggest need in lactation is for glucose to make lactose (which is the major osmolyte in milk).

    I suspect that postpartum depression is due to insufficient liver mitochondria to support sufficient gluconeogenesis to support lactation. I suspect that if that deficiency gets bad enough it becomes postpartum psychosis, an evolved “feature” to shed the metabolic load of lactation.

    1. Young CC Prof says:

      Actually, the placenta contains both fetal cells and maternal cells, although it’s mostly produced by the fetus.

      Your theory about PPD is interesting, but right now it amounts to armchair speculation only, I’m afraid. The precipitous drop in estrogen, combined with the mental stresses of parenthood is the more generally accepted explanation.

      1. Andrey Pavlov says:

        This is my understanding as well. It definitely contains cells from the decidual layer of the uterus which are inseparable from the organ as a whole and the sudden drop in estrogen and HCG (which is a progesterone analogue with additional functions) is the likeliest explanation for the onset of any dysthymia and the subsequent exhaustion, stress, etc can compound this.

    2. WilliamLawrenceUtridge says:

      I suspect that postpartum depression is due to insufficient liver mitochondria to support sufficient gluconeogenesis to support lactation. I suspect that if that deficiency gets bad enough it becomes postpartum psychosis, an evolved “feature” to shed the metabolic load of lactation.

      Bottlefeeding mothers also get PPD.

  7. mho says:

    Apparently, the Colorado Quacks didn’t get everything they wanted from the Naturopathic “Doctors” Act or the Quack Full Employment Act: this bill was introduced yesterday.

    SB14-032
    “Current law prohibits complementary and alternative health care practitioners and registered naturopathic doctors (alternative health care providers) from treating children under 2 years of age and requires those providers to obtain parental consent and make specified disclosures to parents before treating a child 2 years of age or older but less than 8 years of age.
    The bill repeals the restrictions on the ability of alternative health care providers to treat children of any age.”

    1. Jann Bellamy says:

      Thanks for this information. It has not shown up on the legislative tracking service I use but sometimes that takes a few days. It is a perfect example of how CAM legislation can give legal cover to quackery. As well, it shows the naturopaths are determined to keep coming back until they get full PCP scope of practice. It is bad enough to contemplate a naturopath treating a child but the thought of an “alternative” medicine practitioner, who has absolutely no medical training whatsoever, seeing a child is absolutely horrific. As you may recall from my Quack Full Employment Act post, felons, including those convicted of child abuse and sex crimes, can “practice” under that law. I can only assume NDs are supporting this. If true, it shows how little they care about pediatric patients.

  8. irenegoodnight says:

    @AngoraRabbit

    Your explanation of iron is similar to the rationale I read about with my own births. I was anemic as a child and occasionally as an adult, so that was why I considered consuming placenta–cooked in a pot pie I was thinking, but in the end I never got ’round to it and two of them just sat in the freezer and shriveled up until we finally used them to plant the kids’ trees. I said we threw one away, but come to think of it, we gave it the dog.

    @Andrey

    Oh my! I always thought doctors had no limits for ickiness, and I never knew what drew anyone to gynecology to tell you the truth. Totally icky.

    1. Andrey Pavlov says:

      @GNIrene:

      Most of us have something that turns our stomachs. Mine happened to be gynecological medicine. Particularly births. I honestly left that rotation wondering how on earth we managed to become 7 billion strong. I also do not know what draws people to colorectal surgery. That is an additional year of training after 5 years of general surgery, all to do some of the most… unappealing surgeries I ever did (I spent a week doing CRS, which is the other time my stomach turned when I sliced open that colon).

      That is one of the cool things about medicine though… something for everyone! And a never ending list of anecdotes of all flavors to tell at cocktail parties!

    2. Harriet Hall says:

      Different strokes… OBGYN was a large part of my practice, and for me there was no ick factor at all. Delivering babies was a bit scary at times, but overall a joyous occasion. I even enjoyed spending an entire afternoon in Pap Clinic doing routine pelvic exams and Pap smears because I took pride in my proficiency and I used the occasion to give some preventive medicine advice and to get to know my patients better. I did IUDs, colposcopies, diaphragm fittings, etc. Patients were more comfortable being examined by another woman, and I think I had more to contribute than some of my male colleagues who felt uncomfortable examining women and/or had less empathy. The only time I remember experiencing any ick was the time I removed a long-forgotten tampon that had become incredibly putrid and stinky.

      1. Thor says:

        I’m reeling from your last sentence, Harriet. I think you get the prize for the best ick-story of this post.

    3. windriven says:

      Early in my career I spent a lot of time in ORs working with physicians on various technologies. Triples As, CABGs, fem-pop bypasses, some fertility work, my own kids being born, I even saw a state trooper who had shot himself while cleaning his service weapon, his entire bowel reflected to get at deep bleeders* – but none of that ‘icked’ me out. What gets me is major orthopedic work. Not the sights. The sounds.

      *The trooper didn’t make it. But it will remain a vivid memory till my dying day. The OR was on fire with activity when they brought him in. But eventually physicians started coming in without shoe covers or scrubs to see the spectacle. I understood then that the trooper wasn’t going to make it. And then it was over. The lead surgeon called it. The OR emptied in a blink. And the trooper lay on the table as peaceful as if he was just taking a nap. That was about 35 years ago and when I close my eyes and think about it, it could have been yesterday. Earl K. Long Hospital in Baton Rouge, back in the late 70s. If any of the readers happened to be in that OR that day, I’d appreciate any recollections they might have.

      1. Andrey Pavlov says:

        I certainly was not there (I was not anywhere at that time) but it sounds profound. We all have patients that stick with us and a few are burned into my memory as well. I can only imagine what that must be like to someone who is not medically trained and just witnessing the events unfold.

        As for orthopedics, what got me was the use of Bovie electrocautery on bone. Crank that up high enough and it burns through bone like it is nothing, which is handy for making small adjustments, but I’ve rarely experienced a more acrid and stomach turning smell in my life. And I eat durian.

        1. windriven says:

          ” I can only imagine what that must be like to someone who is not medically trained and just witnessing the events unfold.”

          For me the surgical part per se wasn’t home to the profundity. It was more the changing tempo of life’s race to death, the turn of a life on a single stupidity, the powerlessness of the modern over then ancient. The medicine was interesting in the way that plot is interesting in a well-written novel – it traces the path of events. But it was the way that the plot illuminated deeper issues that moved me.

  9. TBruce says:

    I checked this out and it seems that there is a belief out there that the Chinese eat their own placentas. This is incorrect, as stated below:

    Although the placenta is revered in many cultures, there is scarce evidence that any customarily eat the placenta after the newborn’s birth.[4]…

    Human placenta has also been an ingredient in some traditional Chinese medicines,[9] including using dried human placenta, known as “Ziheche” (simplified Chinese: 紫河车; traditional Chinese: 紫河車; pinyin: Zǐhéchē), to treat wasting diseases, infertility, impotence and other conditions.

    This is from Wikipedia, under “placentophagy”, with references provided.
    I suspect that it’s based on the use of dried human placnta in TCM, and common prejudices about the eating customs of Asians.

    1. Calli Arcale says:

      There are cultures which have rituals to be performed with the placenta that don’t involve actually eating the thing; I wonder if that also contributed to the popular perception that some “primitive” or “exotic” cultures routinely ate placenta post-partum.

      Personally, I like irenegoodnight’s idea of using a placenta to fertilize a newly planted tree. A nice symbolic gesture, and, well, a good use of nutrients as well. ;-)

      1. WilliamLawrenceUtridge says:

        Two links:

        1) http://www.sciencebasedmedicine.org/eating-placentas-cannibalism-recycling-or-health-food/

        2) http://www.skepticalob.com/2013/06/unnatural-childbirth-5-goofy-things-that-natural-parenting-advocates-do-that-never-occur-in-nature.html

        The second is fun, far from being an “ancient tradition practiced by wise tribes”, maternal placentophagy seems to be a new hippie practice coming out of (no surprise here) California.

        (While there do appear to be some traditions of processing, keeping and eating the placenta, according to this source from teh wikis they do not involve the mother consuming it for purely post-birth benefits.)

        1. Andrey Pavlov says:

          Hey now! That’s my home state you’re talking about. Portland is way worse with the crunchy hippies. Actually there was a great article I read as an anecdote for the use of vaccines that had a great line:

          I was so freaking crunchy I crumbled

          1. WilliamLawrenceUtridge says:

            Sorry Andrey, don’t blame me – popular culture has dubbed your state as the most howling-at-the-moon crazy of all the union (as far as bizarre health trends; for from-my-cold-dead-hands gun nuts, I’m guessing you’ve got a lot less than Texas).

            I don’t make the rules you know, I just arbitrarily enforce them.

            1. Andrey Pavlov says:

              I contend it is still Oregon. Though it depends on how you define it – for some reason California is a democratic state with the crazy left wing crunchies but Orange County (where I grew up) is a bastion of really hardcore Red with the dyed-in-the-wool Fox News right wingers and one of the largest megachurches in the world (and actually another 3 or so megachurches) all located right there. And plenty of cold-dead-hands-gun-nuts (though PZ Myers is calling them “gun assholes” which seems much more fitting) as well as a bunch of Randian libertarians sprinkled in as well (one of my own friends included… and I was best man at his wedding).

              With yet another tiny island within Orange County called Laguna Beach which is just as crunchy hippie as the Bay Area with a very large and well known gay and swinger community mixed in. Like an island within an island.

              If you go inland to a place called “The 909″ (which is the area code there) you end up with a bunch of hardcore gun toting, off-roading, white tank top wearing, tatted up rednecks.

              If you go North a ways (about 4-5 hours drive from the heart of right-wing Fox Newsdom) you end up in a place called Harmony which is very literally a hippie commune.

              It really is a giant hodge podge. But everyone agrees on one thing – you can’t beat the weather, the scenery, and the outdoor living. Which is why I am looking to end up in the City of Angels in just a few months time. I find out where I will be spending my next 3 years on March 21st.

  10. SepticSkeptic says:

    The placenta bit made me giggle. True story. If you drop a placenta, it explodes like a blancmange.

    1. windriven says:

      I’m pretty sure I don’t want to know how you came to know this :-)

  11. Vicki says:

    The good news is that the New York bill probably won’t pass: the New York legislature is notorious for gridlock over anything, good or bad, that is more substantive than “the official state muffin is apple.” What passes the assembly dies in the state senate, and vice versa.

  12. Most of us have something that changes our tummies. My own occurred to be gynecological medication. Particularly births. I genuinely remaining that spinning thinking how on this planet we handled to become 7 billion dollars powerful. I also do not know what attracts individuals to intestinal tract surgery treatment.

  13. liz de Laperouse says:

    Thank you for the summary and for being willing to keep us all up to date on CAM efforts around the country. I have joined the SBM society and have passed the information on to my many good science behind public policy friends around the country. This is not a democrat or republican threat or a liberal, conservative bias. Bad science is used by all sides. There is an uneven playing field. Good science people know there is no certainty. The scientific community is constantly learning new things that change previously thought best practices. There are many examples. Anyone who professes to know that something will be better, make you live longer and so on. Beware. The public needs to question surprising and or amazing claims, particularly by celebrities with big audiences.

  14. St. Hubbins says:

    As a brief aside, the sponser for the New York bill has been in the news lately – Assmeblyman Dennis Gabryszak . While I am open to elves in the workplace, I can’t support chiropractors in the schools.

  15. RobRN says:

    My neo-hippie daughter-in-law (now my son’s ex) did the placentophagy thing right in front of me one time, all the while gleefully proclaiming the benefits. I’m sure she did it purposefully because she knew well my adversity to Woo and Alt-Med. As a primipara, she delivered in a hospital and was quite upset that they wouldn’t let her take the placenta home. She’s in Portland, OR – She should have waited a few years to have children! Second child delivered at home by a very strange traditional mid-wife in a plastic swimming pool with multiple family members watching. I was invited but declined. She cut up the placental into chucks and froze them in plastic freezer bags – kept them right there in the freezer compartment in the kitchen next to the frozen peas!

    I experienced a whole lot of “ick” over the years I was an Army medic and later as an RN in EDs and critical care! I also moonlighted as a diener while at one hospital. Working evening shift in ICU or CCU, it was often strange to assist on the autopsy of one of my prior patients. Sometimes there were “ah-ha” moments with findings during the autopsy. My worst ick was always the smell and appearance of major full body burn cases, either alive or dead. I did all day gowned/masked/gloved reverse isolation care of an Army sergeant while I was at Madigan AMC. He was stripping the wax off a linoleum floor with a buffer and gasoline – While smoking! The absolute worst was the time I had to pull a crispy corpse out of a still smoldering crashed/burned military helicopter in Korea in the late 1960s. The body melted through the first body bag so we had to wait a while to re-bag.

  16. Lytrigian says:

    People don’t believe me about this stuff until I tell them to Google for placenta recipes.

  17. Kathy says:

    RobRN and the rest of you make me wonder how many stories there are out there that no-one but a few friends and co-bloggers ever hear. Wish I knew how to write them down and make a book out of them. You docs/RNs are amazing!

  18. Andrey Pavlov says:

    @kathy:

    When I was first dating my now fiancee, I took her to our ER Xmas party. Every year they take the 10 best complains, completely de-identify them, and read them off like a Letterman Top 10. She was dying of laughter until she heard someone at the table say “I remember that guy! He was my patient that night!” and she froze and asked me if these were actually real complaints. She thought we were just making them all up. As they say, truth is stranger than fiction. And nowhere is that more true than in medicine, particularly the ER

  19. sheepmilker says:

    My fellow PhD student was working on electrolyte transport in placentas. He had to walk from the University to the Hospital to collect fresh placentas with a Thermos flask full of buffer. He had to cross an incredibly busy and dangerous road, so we used to kid him that one day he would be returning with a placenta and would have an accident where the surgeon would say “You’ve had a terrible accident, but don’t worry, we’ve managed to stuff everything back inside”!

  20. Mani says:

    Great post, excluding the bit on placenta legislation. If there are legitimate reasons why a mother should not be allowed to take home her placenta, let’s talk about them. The fact that eating placenta isn’t a miracle cure doesn’t qualify.

    1. WilliamLawrenceUtridge says:

      It’s a biohazard. Basically the same reason we wouldn’t let a patient bring home a limb that was amputated, or organ removed. The fact that eating the placenta isn’t a miracle cure (more accurately, the fact that eating a placenta has no demonstrated benefits) is quite relevant and does qualify as a reason as it means the risk to benefit ratio is currently set at infinity – there is at current knowledge, 100% potential risk and zero benefit.

      HIV infection, hepatitis, even simply rotting or spoiling like a piece of uninspected meat, all are concerns. Doctors have an obligation to protect their patients, even from their own ignorance. I guess ignorant patients are “lucky” that medicine has reduced its paternalism and now must respect and inform patients.

      Unlike CAM practitioners and those who support placenta consumption.

  21. RobRN says:

    #17. Lytrigian says:

    “People don’t believe me about this stuff until I tell them to Google for placenta recipes.”

    More ICK – Sorry… I once heard (unconfirmed) that some even BBQ their placenta!

    1. WilliamLawrenceUtridge says:

      If all these magical benefits are supposedly based on the physiological properties of the placenta, I’m curious how patients reconcile this with the fact that cooking or dehydration would denature the proteins and thus render them little more than a source of amino acids. Not like the stomach wouldn’t do that anyway, but whatever.

      Of course I know the reason – patients who ask for this either don’t have sufficient understanding of how the body, digestion and absorption work*, or know but have rejected this knowledge in favour some sort of magical approach to the idea.

      *Which is fine, I don’t know how my car, plumbing or grammar works.

      1. Andrey Pavlov says:

        @WLU:

        I’ll take a moment to be fair and say you aren’t quite right on this one.

        Denaturation of proteins does not equate to rendering them into single amino acids of oligopeptides. There is a tertiary and quaternary structure of proteins which is dependent on a lot of different factors but most notably the space filling of water and the electrostatic bonds between amino acids of various charge. This is why changing the pH will denature a protein – the “acid” part of amino acid will either gain or lose a proton depending on its pKa and thus change its ability to bond with other amino acids in the protein and it will lose its 3D shape. Dehydrating will remove the water, cooking will change the stability of the molecule as increased molecular kinetic motion becomes greater than the electrostatic forces holding the 3D shape (it literally shakes apart).

        But none of this is actually breaking up the amino acid chains. Now, in certain cases of dehydration it can for other reasons, but isn’t a huge factor. Give enough acid and enough heat and you can start breaking up the amino acid chain (and it doesn’t need to be that extreme – stomach acid and stove top cooking can be enough). But to really break up the amino acid chains you need enzymes specifically to do that – which is why we use them in digestion.

        The point is that many, but not all, proteins will be permanently denatured by various processes (and the same protein can be permanently denatured by, say acid, but not heat or dehydration). So it is quite feasible that upon ingestion of the dehydrated placenta the proteins actually renature. Or that with cooking you do not denature all the proteins present (in fact, unless you did it as a mince and cooked it at a relatively high heat and for an extended period of time, you are guaranteed to have many completely fine proteins left as you eat them).

        And of course, your stomach does break them down further but, depending on the protein of course, many of them will still get absorbed wholesale. This is why dessicated thyroid works as a hypothyroid treatment (why it is a bad treatment is a different discussion, but it does get thyroid hormone – a protein – into your bloodstream).

        Now, does this translate to anything meaningful in placentaphagy? Probably not. But, in the fairness of science, one cannot just dismiss it out of hand entirely based upon the basic principles of protein denaturation and digestion. You’d have to ask yourself what proteins are in the placenta that we could possibly care about (pretty much just the hormones) are they stable under the conditions of denaturation (I don’t know off the top of my head, but probably to some degree yes), will they survive the gut and make it into the bloodstream (probably yes, in highly variable and likely small amounts), and will this have an actual effect on the human body (in some cases probably yes, but at best they will be rather small effects and definitely very short lived with no lasting effects).

  22. RobRN says:

    #21. Mani says:

    “… legitimate reasons why a mother should not be allowed to take home her placenta, let’s talk about them.”

    I’ll start – It’s bringing a potential bio-hazard home to the family!

    1. Mani says:

      Thanks Rob. I would have preferred it if more time had been spent addressing the potential risks associated with bringing a placenta (bio-hazard) home so that they could be weighed against the benefit of allowing patients possession of their own body.

      1. WilliamLawrenceUtridge says:

        Mani, there are no recognized benefits of a patient owning a part of their own body. Sure, sometimes they can bring home gall stones or a minor organ that was surgically removed – generally preserved in formaldehyde.

        In real medicine, benefits must be demonstrated through research, bare assertion is not sufficient. It’s common among CAM practitioners promoting their worthless or unproven medicines, which has more in common with charasmatic religion than medicine. A lot more in common.

  23. For all of my births I have left every placenta with the doctor because I am not interested in taking it home or burying it in the backyard. I dont want to touch it. I think women who eat it are severely lacking critical thinking skills and are just petting their ego because many of them post photos online of them eating the placenta.

    Disgusting and why do we compare ourselves to animals wild or domestic? They eat each other’s fecal matter and vomit. I dont want to compare myself to animals. Animals cannot reason and do not have intellect.

  24. William Osterberg says:

    I have wanted to leave comments on several discussions that are now closed. I guess this one will have to do.

    I have looked here because, all things being equal, I would prefer to use medical treatments for which there was ‘scientific evidence.’ Unfortunately the agenda here is pretty obvious; a stonewall defense of the U.S. Western establishment. Moreover, I really think that the people that post here do not understand the problems (from the point of view of the patient/consumer) with Western medicine. I will not go off on profit motive and corporatism although I think they are significant. The problem is not the science but the practice. There are numerous examples from my own life but I do not want to bang my head against a wall (too late!).

    Just a few:

    1. A few months ago I mentioned to my doctor that I thought I might have a bone chip in my left ankle that was causing me occasion pain. He threw back his head and laughed “You don’t have a BONE CHIP in your left ankle! I will give you a shot of cortisone and you will feel better right away.” A couple of months later he agreed to ask for an X-ray. However, I noticed that on the form in the area for ‘relevant medical history/diagnosis he had written ‘arthritis.’ Presumably this is supported by scientific studies on the prevalence of arthritis in middle-aged men. When asked about the entry he indicated that ‘arthritis’ was a general term.

    He had done no examination nor asked me about my medical history. In fact I have an unhealed broken bone in my left ankle from a 2009 injury. Back in the early 1980s I sprained my left ankle and chipped off a bone fragment which was removed surgically, completely resolving my problem.

    2. About 5 years ago, during one of my many work trips to Africa, a Kenyan doctor (M.D.) diagnosed me with a bacteria infection. He prescribed some antibiotics which helped a bit for a while. However, back in the U.S. I with the continuation of a variety of gastrointestinal complaints I visited an MD specialized in the area. After listening to me he stated that ‘you obviously have something.’ He ordered a long list of tests but then decided that ‘you don’t have anything.’ I am sure it is all scientific but why would I believe this if I am still having problems? Rhetorical question there. I visited my holistic doctor who orders another series of tests (not covered by insurance) that reveals a bacterial infection (or at excess of klebsiella and deficiency of bifida b). After treatment by something that the readers here would consider ‘sham medicine’ my problem was completely resolved and has not returned. Why would I believe the M.D. that proclaimed that ‘you don’t have anything.’

    3. A few years ago I visited a local doctor about insomnia. He said that he would try Elavil and that if that did not work we would try something else and if that did not work, we would keep going until we found something that did. So, obviously even if each of the medications had been ‘scientifically’ shown to be effective for insomnia he did not know how to prescribe them which I think it is safe to say makes the science more of less irrelevant. Was I suppose to submit to a series of experiments of unknown duration?

    So sorry but I decided to take some ‘voodoo supplements’ that in my experience have worked for me, regardless of the lack or not of scientific evidence on them.

    4. (and the reason I use TCM treatments along with western medicine).
    Back in 1990 I was hit with the usual range of chronic fatigue immune dysfunction symptoms: sudden fatigue, sore throat (it lasted 7 months), muscle cramps, stomach problems; I cannot remember them all, I could not longer function adequately in any aspect of my life. I ended up using 4 M.Ds. including a well-known immunologist. Numerous tests were run, included one that showed that I had had EBV and another retro-virus that I ‘had become immune to.’ After all of this my main doctor told me that ‘you don’t have anything.’ I have shocked and dismayed; none of my symptoms had improved. I objected, listing all of my problems. The response: Laughter and the statement that ‘this is what we call the hypochondiazation of illness.’
    No surprise that I turned to alternative medicine, which in my opinion (and after all I am the one that dealt with all of it) helps me to end of working and traveling overseas. Why would a rational person with these experiences cling to Western ‘scientific’ medicine?

    The bottom line, I think is that the supposedly existence of scientific evidence on the efficacy of treatments is of borderline irrelevance if doctors do not know how to prescribe for individual patients. Moreover, the ‘existence of scientific evidence’ makes some doctors inclined to think that if their tests and/or treatments do not resolve the problem then either there is no problem or the problem is in the patients head. Now that is arrogance that not many patients are going to tolerate for long.

    1. Chris says:

      “I have wanted to leave comments on several discussions that are now closed. I guess this one will have to do.”

      Then wait keep reading this blog and wait for an appropriate article to post specific comments.

      Since I doubt your body has never contained a placenta (though I could be wrong, you could be transgender), your list of anecdotes on this particular topic is frankly odd. Well, perhaps it is a more accurately a list of complaints.

      But a couple of observations:

      You said: “In fact I have an unhealed broken bone in my left ankle from a 2009 injury. Back in the early 1980s I sprained my left ankle and chipped off a bone fragment which was removed surgically, completely resolving my problem. ”

      Did you tell him this? Did you put this on any paperwork before the examination? Like the piece of paper I am given prior to every exam (I still put on that I had dengue fever as a kid, and the doctor is taken aback each time).

      You said: “After treatment by something that the readers here would consider ‘sham medicine’ my problem was completely resolved and has not returned. Why would I believe the M.D. that proclaimed that ‘you don’t have anything.’”

      Well, why would we believe you?

      You said: “So, obviously even if each of the medications had been ‘scientifically’ shown to be effective for insomnia he did not know how to prescribe them which I think it is safe to say makes the science more of less irrelevant. Was I suppose to submit to a series of experiments of unknown duration?”

      Did you know humans are very complicated? Guess which part is the most complicated? Anyway, there is a reason why some things work from some and not for others. Especially since I don’t know anyone who has not suffered from some kind of insomnia. My family doctor just tell us to exercise and stay away from alcohol, and absolutely no meds.

      You said: “(and the reason I use TCM treatments along with western medicine).”

      I hope you are good with statins, varicella vaccine, DTaP vaccine, and other things developed in Japan. Or do you not realized that “Western” is a geographic location, and not a depiction of antiquity? And, yeah, you do sound like a hypochondriac.

      We had a relative much like you. Her alternative med. practitioner made her write down every symptom, take her temp multiple times a day and do all sorts of things that seemed to exaggerate every little kink, burp, itch and twitch. If you keep being reminded to think about them they get bigger, and bigger and bigger.

      Cripes! We all get the symptoms you described, but we don’t let them take over our lives. I get occasional tinnitus. There is nothing I can do about the ringing in my ears except find something to get my mind off of it.

      I have had a sore throat, usually during allergy season. I tend to favor hot broth soups and tea during that period. I have creaky knees in the morning, so I make sure I move around and then I am okay.

      I also have tummy problems, and even worse since I have had to push out three placentas right after three human heads… I have also some rather annoying elimination problems (and it does not help having a non-episiotomy literal rip from stem to stern that included anal muscle). Sometimes I can describe how well my day went by just saying whether it was or was not literally a “poopy day.” Exercise really helps there.

      Wait, exercise helps in other ways. Like my creaky knees, insomnia and even the tinnitus (doing strokes in a pool or listening to interesting podcasts while walking makes me think about something else).

      Also I have twice had to wear a cast on each foot. First when I broke a couple of metatarsal bones in my right foot. Then when I broke my left ankle, where there is still a fragment floating around. I never had surgery. The prescription from my family doctor that has worked has been to wear good shoe inserts. Plus the guy in the hiking shoe department told me to change the lacing of my shoes to not put pressure on the top of my foot. Also, good shoe support really helps with back pain (when I was twenty I could not move my knees because of stupid shoes, I need arch support!… yeah good shoes!).

      So perhaps you should try the simple solutions for your issues. Eat right, exercise regularly, find some good distractions and make sure you have good shoe support. I don’t recommend eating someone’s placenta. Ewww.

    2. weing says:

      “Why would a rational person with these experiences cling to Western ‘scientific’ medicine?”

      Have you considered the possibility that your doctors may have been correct?
      In that case your question should be: “Why would a hypochondriac with these experiences cling to Western ‘scientific’ medicine?” Because it was scientific medicine that removed the actual bone chip.

    3. Chris says:

      Oh, rats! I forgot that there was more to this article than the placenta nonsense.

      Though in my defense I had just been to a Skeptic event where the talk was given by a naturopath. She basically started by saying medicine changes, like testing protocols and such, and that naturopathy is evidence based because they try to deal with lifestyle issues (diet, exercise, etc)… except for that homeopathy stuff even though it is a handy placebo (lying to patients).

      We essentially told her that if they got rid of the stuff that did not work (homeopathy, etc), took the medical boards and stopped lying to their patients, we would be all for it.

      Though we did not have a chance to nail on how on earth do saunas remove PCBs from a person’s body.

      1. WilliamLawrenceUtridge says:

        Heh, what was the response?

        1. Chris says:

          Well, she said they were working on it, but that there are very few naturopaths compared to medical doctors.

          Seriously, I think she did lots of flailing. It did not help her cause when she did declare at the beginning of the talk that she made presentations for supplement companies. She got defensive when we reminded her that they were not tested because of DSHEA, she claimed that their manufacturing was regulated. I did not get a chance to tell her about yesterday’s NY Times article, “Thyroid Supplements With a Kick”, though I really really tried:

          “This supplement could give you as much thyroid hormone as you get in a prescription drug or more,” said Dr. Victor Bernet, chairman of endocrinology at the Mayo Clinic in Jacksonville, Fla., and senior author of the study. He became interested in so-called thyroid-support supplements after seeing a patient with inexplicable test results. The patient eventually admitted that he had been taking a supplement that a friend recommended for “low energy.”
          ….
          Both Mr. Shaw and Duffy MacKay, of the Council for Responsible Nutrition, another supplement trade association, suggested the tested products did not represent all of them, even though nine of 10 contained detectable levels of medication.

          Needless to say, I was not impressed. Mostly her argument was that mainstream doctors do not have time to counsel patients on diet, exercise and stress reduction. She said they could only spend ten minutes while a ND can spend an hour with a patient. Except that counseling does not need a physician, but could be done by a well trained nurse, dietician, physical therapist, physician’s assistant, etc.

          Because once you remove all of the non-science from naturopathy, what you have left is either a physician’s assistant or a nurse practitioner.

          This confirms to me that if an ND wants to be taken seriously, they should go the route of American osteopaths. Which is to rid the curriculum of nonsense like homeopathy, energy methods, etc and pass the same medical licensing exams as the MDs and DOs.

    4. WilliamLawrenceUtridge says:

      Just to join the dogpile…

      1) There is no such thing as “western medicine”. Antibiotics do not cease to be effective when you cross a line of longitude. There may be effective interventions that exist in cultures without a tradition or practice of scientific research – in which case, research on them will demonstrate that they are effective (and what is most relevant, what can be dropped, and iterative improvements to the intervention).

      2) What you are describing is not an issue of “western medicine”. You are describing “medical error” made by individual practitioners. This is of course a problem, and fortunately there are ongoing research projects that attempt to reduce medical errors. And really what you are asking for is for no practitioner to ever make a mistake, to have perfect konwledge of your problem and its solution with no need for testing. That would be great, let us know when you figure out how to achieve it.

      3) The claims made by your holistic doctor are almost certainly spurious (not knowing enough about the topic, and lacking the interest to search pubmed, I’ll just assume this is the case). Basically what you are doing is showing up at a doctors office, taking whatever they say at face value, and paying them. For a conventional doctor, there is an empirical and rational tradition and practice that substantiates their decision making. No similar practice exists for “holistic”, or “naturopathic” or “alternative” medicine and doctors. You’re paying them for what amounts to an unsubstantiated wild hunch.

      4) Your criticism of sleep medication is valid – such medicines are tested at a group level for statistical effectiveness. The reality is we do not have an ability (yet) to determine which medication will work for which specific patient. Perhaps personalized medicine will result in tests to determine which medications interact best with which genomes or proteomes. Until then, doctors must rely on empirical trials wtih single patients. The medicines do work, for some people. At least your doctor was honest in recognizing (and telling you) that some of the medications might not work. That’s called informed consent. I’m guessing your “holistic” “doctor” didn’t tell you that his guess of low ___/high ___ was a guess, I’m guessing he just took your money.

      5) CFIDS is a wastebasket diagnosis, with no objective markers and causes. Scientific medicine recognizes that the etiology and treatments are not well-understood. There is almost certainly a psychogenic component for at least some sufferers. But CFIDS/CFS/ME has no evidence linking it to viral action, merely speculation (some of which was found to be based on spectacularly fraudulent data). And it’s quite possible your symptoms are psychogenic, the intrapsychic response to what appears to be an obviously stressful life of travel and work. Using unproven treatments to address a syndrome of uncertain etiology proves nothing.

      6) The bottom line is, medicine is imperfect and much more work is required. Bodies are the messy result of a sub-optimal evolutionary mechanism. Abandoning everything we know about the body in favour of speculative, unproven nonsense, merely because real medicine has nothing to offer vague, non-life-threatening, subjective complaints (or imperfectly addresses all real problems) is stupid. The people dying of Ebola, or polio, or vitamin A deficiency would look at your problems and laugh. Probably in disgust.

  25. MadisonMD says:

    You are completely off topic.

    I think is that the supposedly existence of scientific evidence on the efficacy of treatments is of borderline irrelevance if doctors do not know how to prescribe for individual patients.

    Of course doctors need to know how to prescribe for individual patients. If you require 100% accuracy, you are falling for the nirvana fallacy. [Actually, your stories demonstrate the doctors are discriminating, because they are choosing not to prescribe at times--though to your chagrin.] I suppose that your Alternative Medicine providers have no problem promising you the 100% accuracy and 100% efficacy that you require?

    Moreover, the ‘existence of scientific evidence’ makes some doctors inclined to think that if their tests and/or treatments do not resolve the problem then either there is no problem or the problem is in the patients head.

    I agree with you absolutely here. However, I can’t help but pointing out that your run-ins with physicians appear to be attributable to poor critical thinking skills coupled with arrogance of ignorance. I infer this from your anecdotes– where to start? Well, one example is your inference that your 2013 ankle pain *must be* from a bone chip because in the 1980′s you had an “ankle sprain” that necessitated removal of a bone chip that completely resolved the problem! (I nearly threw my head back and laughed, too! Maybe you actually saw the bone-chip with your X-ray specs?!) You also fall easy prey to the post hoc ergo propter hoc fallacy, and conclude that voodoo works.

    Yes, I am afraid that you are better off with TCM than “Western Medicine,” Mr. O. I’m not sure there is much you can learn here at SBM.

    1. Sawyer says:

      @Madison

      I thought when I read his post last night I was just tired and getting the dates wrong. The bone chip scenario was the only point he had that at least sounded plausible (although I’m always curious where CAM fans find these doctors that act like cartoon characters). But the time traveling x-ray machine is an invention I’ve somehow missed.

      At least most post hoc ergo propter hoc fallacies are in the correct order.

      1. MadisonMD says:

        @Sawyer
        When I was a child, the back of every comic book had an add for (a) X-ray specs, (b) sea-monkeys, or (c) a chest of toy soldiers. My brother and I actually purchased the soldiers– boy were we disappointed! Didn’t fall for the specs.

        1. Sawyer says:

          Now that I think about it, those products elicited some of my most unskeptical moments as a child. I assumed that the low prices meant that they were low-quality x-ray specs that only worked “some of the time”. Luckily I learned about these products in 1995 rather than 1965, and could not send in the $2.99 to companies that no longer existed.

  26. Bob Goodwin says:

    Hi, I have been writing articles about Lyme disease wars, and it has been easy to get persepectives from the patient advocates, this looks a good collection of people who would understand the mainstream medicine point of view. Dr. Auwaerter had written me and compared Lyme to Chiropractic and Homeopathy, which I went and researched and they look ridiculous to me at face value. I agree that Lyme and Homeopathy both have parallel universes of research, and I agree that Lyme and Chiropractic have used the legislature to protect their providers, but because I dropped in from Mars on this debate, it is the mainstream side which shows more of the signs of pseudo-science (Assertions that do not allow the logical possibility that they can be shown to be false by observation or physical experiment. • Presentation of data that seems to support its claims while suppressing or refusing to consider data that conflict with its claims. • Reversed burden of proof. Failure to provide adequate information for other researcher. • Appealing to the need for secrecy or proprietary knowledge. • Appealing to the need for secrecy or proprietary knowledge. • Tight social groups and authoritarian personality, suppression of dissent, and groupthink. • Assertion of claims of a conspiracy. Ad hominem fallacy)

    I know the minority has some fringe elements in it. I know the neuropsychiatric patient advocates are their own worst enemy. I totally get the quackery in chiropractic and homeopathy. But to put chronic lyme research in the same category only seems possible by decree or credential. I can’t get there from the public record. Is someone willing to have a easy email debate so that I can write about Lyme and quackery in an honest fashion?

    http://prn.fm/bob-goodwin-cdc-trying-block-accurate-lyme-disease-test/
    http://www.nakedcapitalism.com/2014/01/bob-goodwin-mainstream-medicine-capture-wikipedia.html

    Robert_lovejoy_goodwin@yahoo.com

    Thanks in advance to anyone willing to teach. I learn fast.

    1. weing says:

      “it is the mainstream side which shows more of the signs of pseudo-science (Assertions that do not allow the logical possibility that they can be shown to be false by observation or physical experiment. • Presentation of data that seems to support its claims while suppressing or refusing to consider data that conflict with its claims. • Reversed burden of proof. Failure to provide adequate information for other researcher. • Appealing to the need for secrecy or proprietary knowledge. • Appealing to the need for secrecy or proprietary knowledge. • Tight social groups and authoritarian personality, suppression of dissent, and groupthink. • Assertion of claims of a conspiracy. Ad hominem fallacy)”
      You’ve made some assertions here. Can you show examples that validate these assertions?

    2. Sawyer says:

      We had close to a thousand comments on that CLD post and nothing good came of it. I really don’t see any point in continuing the discussion unless the participants have an incredible level of expertise on the topic, as well an intense desire to not mischaracterize the “mainstream” position.

      And a general plea to both critics and fans of SBM – stop bumping old posts with off topic questions.

    3. WilliamLawrenceUtridge says:

      Robert, search for “Lyme” on SBM, there are several articles.

      The overall alternative/chronic Lyme disease position seems to be, at best, “look, here are all these hypothetical scenarios and speculative lines of evidence that substantiate us”. The mainstream response is, “that’s interesting, but what evidence do you have that your petri dish, dog and monkey studies apply to humans?” And then there is silence. The current recommendations are based on the known (i.e. tested and proven) benefits of interventions (which are generally pretty sparse for CLD, particularly the demands for long-term antibiotic therapy, and really amount to “some people feel less tired”), versus the known (i.e. tested and proven) risks of said interventions (antibiotic resistence, people dying from infected central lines).

      Rather than seeing this as a conspiracy, perhaps consider that the researchers who do good work, well-validated empirical work, are accused of conspiracy, threatened and interfered with as part of the patient lobbying and political process. Perhaps they’re a little sick of being called pawns of Big Pharma (which doesn’t make sense – Big Pharma would benefit if long-term antibiotics were an accepted treatment for CLD, they sell antibiotics) and biased merely because they recognize that what happens in a petri dish may have no relationship to what happens in the human body. If the people who claim their vague symptoms are caused by chronic Lyme infection could prove it rather than assert it, there would be a way forward, and an amazing new branch of biology would open up. There would be Nobel prizes, research grants, fame and fortune. Too bad the evidence for CLD is such shit.

  27. Texas Mommy says:

    After being worried about post postpartum depression, low milk supply, etc with my third baby, I decided to encapsulate my placenta. As a trained medical professional, I have a strong stomach when it came to looking at, and touching my own placenta. Not only did the placenta pills save me from taking a pharmaceutical SSRI, I can now save my leftover pills for when I go through menopause! If you are in south Texas, I can encapsulate your placenta so you can reap the benefits too!

    1. Chris says:

      Are you spamming your business? Well looking at your website, I see you are!

      So for this claim: “leftover pills for when I go through menopause”… please provide the appropriate citation.

      Also, I had my kids over twenty years ago in my thirties, I went through menopause in my forties (loved not having to deal with the bloody monthly curse by the time I was forty five!). Not fun at times, but I survived. Dealing with kids going through puberty and hot flashes at the same time seemed to complement each other.

      I believe humor is a better coping mechanism than pills made from medical waste. Prove me wrong!

      1. Sawyer says:

        Um, her name is “Texas Mommy”. We’re not allowed to point out she’s selling something because of her magical mommy marketing powers.

    2. Windriven says:

      ” I decided to encapsulate my placenta.”

      How prosaic. I prefer mine brined and smoked over an applewood fire. Serve with a nice risotto ai funghi and, this time of year, fresh asparagus with a drizzle of hollandaise. The wine pairing is admittedly difficult. Something that can hold its own with the rich smoky placenta could overpower the rice and asparagus. Might be best to serve beer, maybe a pale ale.

      1. Bruce says:

        What about a nice Chianti?

        1. Windriven says:

          Clarissa?

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