Dec 24 2009
“Toxins”: the new evil humours
They say that everything old is new again and that is certainly true in the world of “alternative” health. One of the axiomatic premises of contemporary “alternative” health puts its believers behind the times … by approximately 500 years.
A fundamental premise held by believers in “alternative” health is that we are swimming in a world of “toxins” and those “toxins” are causing disease. Like most premises in “alternative” health it has no basis in scientific fact; makes intuitive sense only if you are ignorant of medicine, science and statistics; and speaks to primitive fears and impulses.
The preoccupation with “toxins” is a direct lineal descendant of the obsession with evil humours and miasmas as causes of disease. It is hardly surprising that prior to the invention of the microscope the real causes of disease went undiscovered. The idea that disease is caused by tiny organisms that invade the body is not amenable to discovery in the absence of scientific instruments and scientific reasoning. And it goes without saying that the same people who were unaware that bacteria and viruses cause disease could not possibly imagine chromosomal defects, inborn errors of metabolism or genetic predispositions to disease.
Instead, people imagined that diseases were caused by excess evil humours, substances that were named, but never seen or identified in any way accessible to the senses. It was recognized that some diseases were contagious, and in that case, people invoked the idea of “miasmas” that somehow transmitted disease.
Even religion got into the act. Rather than attributing disease to evil humors of miasmas, religious authorities often claimed that disease was attributable to evil demons or to sin itself.
These theories shared several important features. The evil humours, miasmas, etc. were invisible, but all around us. They constantly threatened people, and those people had no way of fending off the threat. Indeed, they were often completely unaware of the threat that was actively harming them.
Evil humours, miasmas, demons, etc. were put to rest by the germ theory of disease. That was the first big breakthrough in our understanding that each disease was separate and has its own specific cause. The search for causes has taken us beyond bacteria and viruses, through errors of metabolism and chromosomal aberrations, right down to the level of the gene itself. We now understand that tiny defects in individual genes can cause disease or can increase the propensity to a specific disease.
But fear and superstition never die and the “alternative” health community has used that fear and superstition to resurrect primitive beliefs. It is axiomatic in the “alternative” health community that disease is caused by evil humours and miasmas. They just don’t call it that anymore; they call it “toxins.”
Toxins serve the same explanatory purpose as evil humours and miasmas. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they have be released into our environment by “evil” corporations.
There’s just one problem. “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.
Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).
Nonetheless, “alternative” health advocates persist in subscribing to primitive theories of disease. For those who have limited understanding of science, primitive theories apparently make more sense.
Hence the obsession with “toxins” in foods, in vaccines, even “toxins” arising in the body itself. The height of inanity is the belief in “detoxifying” diets and colon cleansing. The human body does not produce “toxins.” That’s just a superstition of the “alternative” health community. The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed for that purpose such as the kidneys.
“Alternative” health practitioners are nothing more than quacks and charlatans and their “remedies” are nothing more than snake oil. The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.
Evil humours and miasmas have not died, they’ve been reincarnated as “toxins.”
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184 Responses to ““Toxins”: the new evil humours”
Back in the 1970s I saw a friend’s book titled Tissue Cleansing Through Bowel Management by Bernard Jensen. In it, people show off photos of their stools. Not just any stools, psyllium seeded Pythonesque wonders. Read the Amazon reviews, they’ll floor you.
They say people waste their time on the Internet these days; in the good old days, some people stared at stools, compared notes as if wine tasting, and then took off into the stratosphere with profound new knowledge. Kick up yer heels and poop your way to heaven.
I looked the Jensen book up, in a spirit of Christmas fun………rave reviews, as Devoutcatalyst mentions, but there was also an offer in the “new and used” sales section for a used volume at 99p……..why is it a used copy of Tissue Cleaning through Bowel Management doesn’t appeal?………….
Martin Luther King once said, “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.”
I happen to know a couple of quite sincere woo practitioners, one of them a licensed MD. As I’ve probed their beliefs it has become clear that their essential distrust of scientific medicine arises from medicine’s inability to have an answer and a cure for everything.
And it is here that their trains go off the tracks because they see these areas of ignorance not as ripe areas for scientific research, but as voids where science has failed. Unfortunately, where science has no answer woo has answers aplenty: ancient Chinese herbal remedies, acupuncture, colon cleansing (20 pounds of impacted fecal matter!), homeopathy, prayer, detoxification.
Moreover, they are back-to-mother-earth types who loathe capitalism (though they remain interested in Louis Vuitton accouterments), fear industry, and happily sort all of the world’s evils into bins of toxins including an array of industrial and agricultural chemicals as well as gluten(?!).
I do not suggest that all wootitioners are cut from this particular cloth as fear and superstition come in a dizzying array of colors and weaves. But the magical thinking that animates wooies seems to stem from one of two places: scientific medicine is scary (difficult to understand, sometimes impersonal, big latin words, doesn’t claim to have all the answers … yet) and scientific medicine is imperfect (Aunt Mary died and they never did figure out what was wrong with her – it was probably the 20 pounds of impacted fecal matter loaded with toxins and undigested wheat gluten).
The question that we must face is how to bring light to the darkness. How do we replace the fear and superstition with science and reason? We have truth on our side. And we are very good at bludgeoning those on the dark side with the truth. But I question how many of them we convince? As Voltaire noted, “It is not enough to conquer; one must also know how to seduce.”
@DevoutCatalyst
“Not just any stools, psyllium seeded Pythonesque wonders.”
Well you certainly can’t accuse them of being full of …
Amy, as usual, it’s not that you’re wrong, it’s that your declarations are both extreme and unfocussed.
This article would be a much better piece of writing if it were in response to something particular: an article, a book, a television show… anything.
If you had an editor to review your articles for internal contradictions, that might help too.
[quote]The human body does not produce “toxins.” That’s just a superstition of the “alternative” health community.[/quote]
Ok, the human body does not produce toxins. That’s pretty clear and unambiguous.
[quote]The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed* for that purpose such as the kidneys.[/quote]
Ok, so the human does produce toxins, which is why it has two organs essential to life that metabolize and excrete them. These organs are pretty good at their job so we are safe from the toxins we produce. Also clear and unambiguous.
Except that if the human body does not produce toxins (as you state so clearly and unambiguously), then what are the kidney and liver for? Only to manage environmental toxins? Except that you deny the existence of environmental toxins too. Well, environmental toxins don’t exist unless we can name them. Then they exist, but then they aren’t “toxins,” they’re “poisons,” like nicotine, alcohol and opiates. So if we don’t smoke, drink or shoot heroin then I guess we don’t need our livers or kidneys. Right?
Back to my point Amy — it’s not that you’re wrong, it’s that your writing is really bad. If you want to make a name for yourself in science writing, you might want to take some classes in science journalism. I’m saying this as someone who cares about communicating science.
* I take it this is a reference to a creator god? A scientific one, of course. An intelligent designer.
windriven:
“But the magical thinking that animates wooies seems to stem from one of two places: scientific medicine is scary (difficult to understand, sometimes impersonal, big latin words, doesn’t claim to have all the answers … yet) and scientific medicine is imperfect (Aunt Mary died and they never did figure out what was wrong with her – it was probably the 20 pounds of impacted fecal matter loaded with toxins and undigested wheat gluten).”
Or both places at the same time.
“Toxins” have tremendous appeal as “the one true cause of all disease” because it offers a simple explanation that requires no special training to understand. It allows people to condemn the medical “establishment,” it places blame (evil corporations), it is relatively easy to treat (just remove all the toxins) and allows people that they can make sure they don’t get sick (just remove all the toxins).
If only all disease was caused by “toxins.” It would make things a lot easier for everyone.
“Except that if the human body does not produce toxins (as you state so clearly and unambiguously), then what are the kidney and liver for? ”
When alternative health advocates invoke “toxins” they are not simply talking about anything and everything that is toxic. They are referring to environmental toxins, not naturally produced waste products. For example, you won’t hear them refer to CO2 as a toxin, although it is a toxic waste product; they’re not talking about urea in urine either. Medicine recognizes that waste products can be toxic, hence dialysis for kidney failure. The alternative health advocates are not talking about complex treatments like dialysis.
“Toxins” as invoked by the alternative health community are almost always environmental toxins, put into food, water or air for sinister reasons, easily “leached out” by bogus “therapies” that happen to be very simple and can be sold by lay people (preferably over the internet).
@Alison Cummins
I was not aware that toxins and waste products are the same thing. I’m not sure why you conflated them.
And Dr. Tuteur did not state that there are no environmental toxins: “Poisons exist, of course, but their existence is hardly a secret, and their actions are well known.” Her point is that toxins, like subluxations, are not the one true cause of all evil in the universe.
I’m not quite sure what your issue with Dr. Tuteur is but your comment seems to be a willful misrepresentation of her argument. What specifically are you trying to say? Is it that you have no particular disagreement with her position but that you dislike her style of expository prose?
Alison,
Your confusion over what is and isn’t a toxin is exactly what Amy is writing about. The Alt Med definition is that a toxin is whatever the practitioner wants it to be; ask a toxicologist or an industrial hygenist, and they will tell you exactly what is a toxin and at what level it harms an individual. Even Paracelsus understood what a toxin was 500+ years ago based on dose and effect.
Human cells have many regeneration and reclamation pathways that recycle molecules and put them back into biochemical pathways that need them. There are a few pathways that lead to a chemical dead-end, producing molecules that can’t be recycled. It is those molecules that are acted on by the liver and kidneys and eliminated in urine and feces. These are not toxins, despite the amorphous claims of Alt Med practitioners.
As with any molecule, too much can lead to a toxic condition, which is different than saying that that molecule is a toxin. Glucose is absolutely essential to life. No glucose, no life, but too much glucose (as in Diabetes Type I or II) can cause blindness, cardiovascular disease, limb rot and fatal imbalances in salts and acids. So going by a strict evaluation by the Alt Med definition of a toxin, glucose is a toxin, but biochemically the role of glucose is much more complicated. Which view is closer to the truth?
There is a family of enzymes in the liver called the P450 CYP enzymes that oxidize molecules that can (and do) disrupt the normal biochemical function of a cell. The P450 CYP family is very old and can be found in many animals, plants and bacteria. These enzymes have been protecting us for millions of years against thousands of naturally occurring toxic molecules in our environment by 1) altering the chemical properties that makes the molecule disruptive and 2) making the molecule more water soluble, thus more likely to be cleared out of the body by the liver and kidneys. This has been going on without our knowledge or understanding until very recently when we started making artificial chemicals and studying how they are dealt with in our cells.
My thesis involved exposing cancer cells to the drug digoxin (Lanoxin). Digoxin comes from the Foxglove plant, and has been used for at least 300 years to treat congestive heart failure and arrhythmia. At higher concentrations, digoxin killed the lung cancer cells I was working on. But at low concentrations, it actually induced the cells to grow faster. This effect is called hormesis, and complicates the answer of what molecules are toxic and when.
So, is digoxin a toxin or not? The answer is a lot more complicated than being answered with colon cleansers, herbal treatments or diets that make you feel that you have control over what goes on in your body. This kind of critical thinking about toxins is what Amy is writing about, and one that is an anathema to the Alt Med practitioners who make a profit off of their products.
Amy, as usual, it’s not that you’re wrong, it’s that your declarations are both extreme and unfocussed.”
Yep. The problem with people promoting toxins isn’t that they claim toxins (besides nicotine, alcohol, CO2, heroin) exist in the first place. They do, and not just animal and plant based, sorry it’s not black and white.
The problem is that they don’t understand that the dose equals the response, and that these toxins also occur in nature. IOW, the risks are overblown. But I get the feeling that environmental scientists and toxicologists are despised around here.
http://www.epa.gov/riskassessment/
PCBs, mercury (like in lightbulbs), lead, radon, DEET, ddt, greenhouse gases, lawn pesticides, CO, asbestos, dioxins, diesel. I’m sure that some of these are overblown, but I would like to see a discussion of their potential harm to humans and what medicine does for prevention. Or if the consensus in medicine is that environmental toxins (besides nicotine, alcohol) don’t exist or are very rare or are mostly plant and animal based??
What an us vs them mentality. While I’m sympathetic to the cause myself, painting anybody who uses a chiropractor or eats organic as stupid (or whatever) hardly is going to convince anybody. No wonder mainstream medicine is rapidly going the way of integrative ( as one component.)
It also annoys me that people like Dr. Oz and Oprah and Dr. Mercola capitalize on people’s fears and sensationalize the toxin debate.
But I fully admit I’m a hippy dippy recycling, lead testing, DEET avoiding liberal, ftmp.
“PCBs, mercury (like in lightbulbs), lead, radon, DEET, ddt, greenhouse gases, lawn pesticides, CO, asbestos, dioxins, diesel. I’m sure that some of these are overblown, but I would like to see a discussion of their potential harm to humans and what medicine does for prevention.”
This is what I mean about the way that ‘toxins” are invoked. A tremendous number of substances are toxic. But when alternative health advocates refer to toxins, they mean environmental toxins, produced by industry (evil?) for profit (horrors!). Like evil humours, they are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence.
And “discussion of potential harm” is a variation of the fallacy of appeal to ignorance. The implication is that “we don’t know” what harms these toxins can cause and because we haven’t proven that they don’t cause all manner of disease (preferably diseases with unexplained causation like cancer or autism), we haven’t taken the threat seriously.
“painting anybody who uses a chiropractor or eats organic as stupid”
Belief in quackery has nothing to do with native intelligence. People who lack a basic fund of knowledge of science, statistics and medicine are prey to quacks. Their lack of knowledge makes them gullible.
In contrast to “stupidity,” gullibility is easily remedied with education.
Zoe237 beat me to my point exactly. The article as written definitely implies that with very few exceptions (alcohol, nicotine) that “toxin” is a fictitious construct of alternative medicine. This is simply not so. Often times the negative aspects of these toxins are not known for years until birds start laying eggs with thin shells or cancer rates significantly jump.
Where the woo aspect comes in to play is that alternative medical practitioners claim to associate specific (or non-specific) conditions to toxin ingestion in the absence of scientific evidence. Moreover they claim they can then cure you of the condition by “detoxifying” the body through various methods.
For example, does industrial airborne toxin X potentially lead to increased asthma rates in children? Just because no link has been conclusively proven in the literature at this point in time should we all buy houses across the street from refinery row because the real estate is cheaper? I think it is wise to err on the side of caution and not unnecessarily expose ourselves to compounds about which we have little idea of the long-term effects on the human body.
What we do know is that if your child has developed asthma, linked to environmental toxins or not, giving them a colon cleansing or a chiropractic adjustment is not going to make it better.
I fully agree with the points made on alternative medical practitioners, however the article does imply that there are very few toxins out there, those that exist seem to be ingested wilfully and that we must assume that man-made chemicals are safe until proven unsafe by science.
Why?
Seriously. Why would that make a difference? I can see some merit in your criticism that Amy contradicted herself (or at least was not as clear as perhaps would have been advisable) in discussing the differences between alt-med “toxins” and real toxins; I noticed it myself and her attempt to distinguish “toxins” from “poisons” struck me as a distinction without a real difference, at least as explained. It left me scratching my head and saying WTF? However, why would her post be “a much better piece of writing” if it were in response to anything? Quite frankly, from my perspective that’s irrelevant to whether it’s a good piece of writing or not. More importantly, why is her post not good because it wasn’t written in direct response to anything?
Let’s put it this way: The post topic that I’m probably going to publish on Monday is not really in response to anything in particular, at least not anything recent. Does that mean it’s going to be a piece of crap automatically or that it won’t be as good as it could be? If so, you’d better prepare that same criticism for me for Monday.
Actually, that’s not quite true. The key claim of the colon cleanse fad, for example, is that waste products from your body accumulate in the colon and lead to “toxins” leeching out from all the the proverbial “20 lbs” of your own poo supposedly stick to the insides of your colon.= and poisoning you. Supposedly these “toxins” from the poo caked to your colon lining are what make you sick, causing all sorts of diseases, as I wrote about:
http://www.sciencebasedmedicine.org/?p=88
You’re correct that alt-med people don’t generally mean the same thing as physicians when they cry “toxin!” but it’s not true that alt-med promoters limit their toxins to just environmental or ingested toxins. I’ve pointed this out time and time again, as well as how alt-med promoters can never specifically identify which “toxin” or “toxins” they are referring to when they blame disease on “toxins.”
“This is what I mean about the way that ‘toxins” are invoked. A tremendous number of substances are toxic. But when alternative health advocates refer to toxins, they mean environmental toxins,”
I purposefully chose environmental toxins, not plant or animal based toxins, because you seem to be either completely denying their existence or claiming that we know all toxins already and all of their harms.
“And “discussion of potential harm” is a variation of the fallacy of appeal to ignorance. The implication is that “we don’t know” what harms these toxins can cause and because we haven’t proven that they don’t cause all manner of disease (preferably diseases ”
I didn’t claim that toxins are the one true cause of disease, clearly a ridiculous claim. And my use of the words “potential harm” was under the assumption that some of my list had indeed been shown to be harmful to humans and some had not (I used ‘potential’ harm rathe than ‘actual’ harm iow). Apparently you are claiming that none of them are harmful to humans.
My understanding based on reviewing literature and expert consensus was that there are basically three groups. Lead is indeed an environmental toxin, as is mercury in lightbulbs, asbestos, CO, and toxins in cigarrettes. That there are certain chemicals that are up in the air as to their toxicity, particularly in small doses (radon?). And a third group that has shown not to be toxic, particularly in small doses (mercury in vaccines). Yes, we don’t know, and no. And dose equals response.
I think you are oversimplifying, as usual, but if I’m wrong, and there are no iffy, partially unknown environmental health hazards produced by industry, then I’ll admit it.
“Tell that to someone in renal failure or acute hepatic failure.”
As MS, MT(ASCP) points out above, when the body cannot appropriately handle a substance (metabolize it, store it or excrete it), that substance can be toxic, but that doesn’t make it a toxin. For example, in diabetes, glucose accumulates in toxic levels, but that does not make it a toxin. Consider all the inborn inherited metabolic disorders. Babies with phenylketonuria cannot metabolize phenylalanine, but that doesn’t make phenylalanine a toxin. Even water in excess can kill, but that doesn’t mean water is a toxin, either.
” Just because no link has been conclusively proven in the literature at this point in time should we all buy houses across the street from refinery row because the real estate is cheaper?”
This is the fallacy known as the appeal to ignorance, the idea that if we haven’t proven something to be false, we can assume that it is true.
Advocates of alternative health commonly resort to the appeal to ignorance for two reasons:
1. They have a bedrock assumption that they wish to promote. In the case of toxins, the assumption is that something in our environment is making us sick. Often the assumption is more specific: something in our environment causes cancer or causes autism.
2. They are trying to paper over a lack of evidence for their own claims.
Zoe237:
” purposefully chose environmental toxins, not plant or animal based toxins, because you seem to be either completely denying their existence or claiming that we know all toxins already and all of their harms.”
I did no such thing. I certainly am not denying that toxic substances exist.
My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.” However, those who lack basic knowledge of science and medicine are very attracted to theories that invoke “toxins” because they provide the same explanatory power, and they capture the same fears, as evil humours once did.
Zoe237 on 24 Dec 2009 at 12:47 pm “I purposefully chose environmental toxins, not plant or animal based toxins, because you seem to be either completely denying their existence or claiming that we know all toxins already and all of their harms.”
You overlook two things: A) Quacks don’t specify what they mean. Certainly one can be exposed to an environmental pollutant which may be adequately described as toxic; but quacks don’t do real analyses for them. They use quack “analyses” or simply make assertions. B) Quacks don’t perform research to prove that any particular, real toxin is removed by their procedures. Certainly, as Amy Tuteur has written, “The height of inanity is the belief in “detoxifying” diets and colon cleansing.”
Medical professionals do have proven ways of detecting many, truly toxic substances and ways of enhancing the removal of some of said materials.
There’s a difference between the appeal to ignorance of “I don’t know why my child is autistic therefore it must be toxins,” and the precautionary principle of “toxic substances exist, and industry has the theoretical ability to produce high concentrations of novel substances that my body has not evolved to eliminate safely, therefore I prefer not to live in an industrial park (where concentrations of novel substances are likely to be particularly high) until it has been proven safe.”
The reason this piece would be better writing if it were in response to something specific is that by referencing a quote to the effect that “poo and mercury are the One True Cause of all disease and my widget can fix it,” Amy could make her point clearly about “toxin” in this situation merely being used as a modern word for “miasm” and we wouldn’t be getting derailed into discussions of whether Amy thinks we should buy land across from an oil refinery. If Amy wanted to talk about the difference between oil refineries and the possibilities of imaginary toxic poo then a good piece of writing would have — at the least — framed that discussion instead of leaving it to be brought up in the comments.
Yes, the point of my comment really was that I dislike “Amy’s style of expository prose.” I find it unfocussed, excessively general, and generating unclear discussion. If Amy doesn’t explicitly state what she’s talking about then I have to guess, and so does everyone else, and then we guess differently from one another, and then we get into arguments that don’t advance anything.
I fully agree with the concluding statement that “Evil humours and miasmas have not died, they’ve been reincarnated as ‘toxins.’” It’s quite perfect. But I can’t forward this post to all my toxin-obsessed friends because the essay as a whole is so sloppily written.
The term “environmental toxin” is meaningless. Anything in the air, soil or water, regardless of its source that causes a toxic reaction is an environmental toxin. If you’re referring to manufacturing byproducts then “industrial pollution” is a more precise term. I don’t go out of my way to be a buzzkill, but the current buzzwords need to be killed, because they are vague, misleading, misrepresentative and sometimes flat-out wrong. If you want to have a science based discussion, then use terms and concepts that actually mean something and are backed up by hard data. Alt-Med does a wonderful job of marketing a concept by using the latest buzzword(s), because that’s all they can offer. As much as they want you to believe, it doesn’t make that concept right or wrong; it makes the concept meaningless.
My claim is it’s a big (and unjustified leap from acknowledging the existence of toxic substances and claiming that they cause “disease”.
There is some evidence that industry-produced toxins may cause disease. Researchers have long believed pesticides may cause Parkinson’s.
Acetaminophen can be liver-toxic when taken too often or in too high a dose. The most important antioxidant used by the liver during Phase 1 detoxification is glutathione peroxidase. A common antidote to acute acetaminophen poisoning is the dietary supplement N-Acetyl-Cysteine (NAC). NAC is effective precisely because it raises liver levels of glutathione peroxidase. A simple way to reduce the incidence of liver damage would be to include some NAC in each pill containing acetaminophen.
Maybe taking some NAC on a regular basis could help the body detoxify drugs, alcohol and other chemicals, especially for those whose livers might be deficient in glutathione peroxidase.
MS, MT(ASCP),
I used the phrase “environmental toxin.” Are you responding to me in the following?
*** *** ***
The term “environmental toxin” is meaningless. Anything in the air, soil or water, regardless of its source that causes a toxic reaction is an environmental toxin. If you’re referring to manufacturing byproducts then “industrial pollution” is a more precise term.
*** *** ***
I used the phrase “environmental toxin” to mean exactly “anything in the air, soil or water, regardless of its source that causes a toxic reaction.” That is exactly what I meant. Amy said that nothing produced by or in the human body could produce a toxic reaction. (No, I understand, that’s not what she meant. But it is what she said. Hence the complaint about unclear writing.) So I wanted to discuss the possibility that something produced outside the human body might produce a toxic reaction, given that we have a liver and kidneys and all.
You’re right that phrase may be overused in certain circles. Would it be better if I used the term “exogenous poisons”? (I’m asking seriously here. If “environmental toxin” is no longer a technically neutral term, what is the preferred alternative?)
My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.”
Take lead then. Recently there has been testing and recalls of lead in children toys. Medical organizations have recommended testing of children. They ask about lead based paint in homes built before 1970. This is a toxic byproduct of industrial processes. The health effects are still being explored. One effect seems to be possible mental retardation, and it was a toxin that previously was unknown. Does lead really not cause ill effects?
Joe, I am totally with you on colon cleansing and chelation therapy. I’m just skeptical that there are no disease causing toxins produced by industry. IME, the extremists on both sides of this issue are just plain wrong. But I remain open to the possibility that my logic is flawed.
Amy, in the comments you say
“My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause ‘disease.’”
And yet, in the body of your post you say,
“Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).”
So in the body of the post you say that poisons cause diseases, and in the comments you say you said that claiming that toxins cause disease is an unjustified leap.
But in your post, you never said that claiming that toxins cause disease is an unjustified leap. You said the something that sounds very like the opposite: you said that poisons cause diseases. (Yes, I note the crucial difference between “disease” and “diseases.” Important but subtle. You still didn’t say what you think you did.)
In your post you explain that the reasons that people worry about toxins are irrational and pre-scientific. True. But it’s not irrational or pre-scientific to suppose that if some poisons cause some diseases that other poisons might cause other diseases, and you did not in fact address that hypothesis in the body of your post.
Oxygen is a toxin. Our very lives may depend on it diluted in nitrogen and other gases. But at elevated partial pressures chronic exposure is toxic.
It really seems as if we have veered into the weeds in response to this blog. Dr. Tuteur was making a fairly simple statement about a tactic of some in the alternative medicine ‘movement’ to prescribe detoxification as the cure to mankind’s ills.
Her second paragraph says:
“A fundamental premise held by believers in “alternative” health is that we are swimming in a world of “toxins” and those “toxins” are causing disease. Like most premises in “alternative” health it has no basis in scientific fact; makes intuitive sense only if you are ignorant of medicine, science and statistics; and speaks to primitive fears and impulses.”
One might quibble that “held by believers…” should rightly have been phrased “held by (some/a portion of/many) believers…” but the basic point remains: a preoccupation with unnamed toxins is a central theme among some of the woo crowd. These toxins are often referred to generally so that the reader can fill in the blanks with his or her own fears. And when a toxin actually is named it is often portrayed as responsible for all manner of death, disease and indignity.
Have we all forgotten the alar panic of the late ’80s?
Go here:
http://www.acsh.org/publications/pubid.865/pub_detail.asp
to refresh your memories.
The question is: how does the scientific community separate the very real dangers of very real toxins from the toxic pipedreams of alt.med types in the minds of the general public? Aren’t issues like these more important than semantic and stylistic disagreements?
“The question is: how does the scientific community separate the very real dangers of very real toxins from the toxic pipedreams of alt.med types in the minds of the general public? Aren’t issues like these more important than semantic and stylistic disagreements?”
Yep, and Amy could have written about that. Could have been a great post generating great discussion. She only wrote half of it though. And now we’re trying to fill in the other half in the comments, but in a very confused and antagonistic way.
My stylistic concerns are not purely esthetic. I want to have a good discussion but the original post does not lay a solid foundation for one. I wish it did, and I wish Amy would take her posts more seriously. If I didn’t think she had the potential to write better posts I would just unsubscribe.
Alison,
I’m sorry I wasn’t clear: I was responding to Zoe237 and her use of “environmental toxins.” My point still stands, and when I took a class on molecular toxicology the term used was xenobiotics. Whether or not a xenobiotic was toxic or not and how it acted depends on a lot of factors unique to person, place and length of exposure.
Zoe237,
As I pointed out above, anything can be a toxin and and above a certain level and what we consider to be toxic may not be at very low levels because of hormesis. The effects of lead in the body have been well known for some time, and it is now considered a carcinogen. From what I have seen, the debate actually centers on what the lower limit of toxicity is. Some people are completely wigged out over the presence, at all, of lead (or some other toxin-de-jour), ignoring the fact that lead has been around for a long time (remember the anti-knock compound in gasoline up to the early 80s?). Unless you live in a remote location well away from urban/farm areas, you live in an environment with low levels of lead. We have two ways to view the effect of lead in our environment: assign effects to the presence of lead because we know lead is toxic, or look for the mechanism of toxicity at background levels we live in. Which is the more sound approach?
I keep pounding on hormesis, not because its a pet I adopted in my lab work, but because it is a demonstrable phenomenon that is not taken into account when studies involving trace amounts of lead (or the toxin-de-jour) are performed. At such low levels, the body has adequate resources to eliminate atoms and molecules through CYP enzymes as well as glutathione, and hormesis is seen as a beneficial over-reaction of such systems. At some point, *any* atom or molecule can overwhelm and deplete the system (cf. acetaminophen conversion to toxic NAPQI when glutathione stores are all use up), which is a function of concentration. This idea is completely lost or wasted on the Alt-Med followers.
The four HUMORS were spelt thus.
They were also observable entities, especially in the ill: yellow bile, black bile, phlegm, and blood, unlike the airy-fairy “toxins” of alternative medicine, .which have never been identified in, or correlated with the numerous illnesses attributed to them.
The humors were also not regarded as evil or toxic in themselves, but merely out of balance in the ill.
Since Hippocrates, Galen and others probably had similar intellectual resources to ours, the humoral theory of illness was possibly as reasonable a scientific hypothesis as any other for the times.
We very privileged modern physicians should not be too self-satisfied — we are still learning how to best perform and assess the clinical studies that are neeeed to resolve some questions.
All these substances are toxic at the right concentration, and the body makes them. As Paracelsus said hundreds of years ago, the dose makes the poison, and our bodies do make toxic substances but the toxicity does depend upon the concentration and the physiology.
But since in this post you seem to be harping on the difference between “toxins” and “poisons,” if you really want me to get pedantic (and why the heck not at this point?), technically by definition toxins are biologically produced poisons. Look it up in Dorland’s Medical Dictionary if you don’t believe me, and Wikipedia has several links to sources that state that toxins are defined as biologically-produced poisons. Indeed, according to a International Committee of the Red Cross review of the Biological Weapons Convention, “Toxins are poisonous products of organisms; unlike biological agents, they are inanimate and not capable of reproducing themselves.”
So when you say:
you are in fact referring to toxins by definition, because naturally based poisons produced by living organisms are toxins by definition. And, in fact, by the official definition, you are probably as incorrect to do so as I may have been to label certain substances produced by the human bodies as, because another part of the definition of toxins is that they cause a characteristic disease or toxic condition.
Be that as it may, exactly the same thing you said about water, glucose, etc, could be said about…yes, alcohol! The body has very efficient mechanisms to metabolize ethyl alcohol; it is a biological product; and it’s toxic when the body’s ability to metabolize it is overwhelmed. So why do you call alcohol a “toxin” in your post? By your own definition it is not. The same is true of nicotine, which you also label as a “toxin” in your post. We have a whole class of receptors in our body known as nicotinic acetylcholine receptors, or nAChRs. Of course, the primary ligand for these receptors is acetylcholine and they only happen also to bind nicotine (hence the term nicotinic and the effect of nicotine on the CNS), but nicotine at low levels is not toxic, except after prolonged exposure (decades). Again, the dose makes the poison. And don’t even get me started on opiates, which our bodies make and which are critical for pain regulation and all manner of other functions in the CNS. They are not toxic at the usual concentrations present in the body–or even at concentrations quite a bit higher than what is normally found. So, by your own definition above for glucose, water, etc., opiates should not be considered toxins either. Yet you label them as such in your post.
Look, I totally understand the woo that blames “toxins” for everything and I totally agree that the word “toxin” serves the same purpose as “miasma” in alt-med. I’ve written at length myself about this very tendency over the several years I’ve been writing about such things, although I look at the fear of “toxins” to be more on the order of a religion (which much of alt-med is based on) where there are beliefs that warn against “contamination.” However, I must admit that the criticism that you yourself weren’t all too clear on the concept of toxins is not entirely baseless. I realize that most people use the terms “toxin” and “poison” interchangeably, but that’s rather the point, isn’t it? They’re wrong to do that.
In fact, MS, MT(ASCP) is correct in that the concept of “toxins” is far more complicated, and different substances can be (or not be) toxic under different circumstances and at different concentrations. Woo-peddlers don’t even consider these distinctions, and they do appeal to unnamed “toxins” with more or less magical properties.
Surely the humours were actually spelt χυμός – translate into British or American English as you wish.
Come on Amy, don’t hold back, tell us what you really think
Nice article, though would’ve thought you’d learned from your previous articles that people will pounce on any perceived or real ambiguity here.
Happy Holidays
Actually, I think the point is that, whatever the deficiencies of science-based medicine, we now have the tools and the science to know so much more about the cause of disease. That is not in any way to denigrate the ancients; we didn’t have the tools to discover, for example, germ theory until the 19th century. However, the point is that today, in the 21st century, there is no excuse to be invoking vague concepts like “toxins,” which , as Amy correctly points out, resemble ancient concepts of contamination and miasma (for imbalances in the four humors, traditional Chinese medicine and the “unblocking of qi” to cure disease represent probably a better analogy). In other words, whatever ignorance still remains in medicine, there is no excuse to be invoking the ignorance of the past in a time when we now know why such concepts were not operative.
At least that’s the way I see it. I don’t see it as being “self-satisfied.” I see it as wondering why, in this day and age, people cling to prescientific concepts of disease.
Hey, if we want to get really pedantic, a toxin is a poisonous substance produced by a biological process. So, all toxins are poisons, but not all poisons are toxins. Although all poisons are toxic. Stupid English language.
“My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.”
Take lead then. Recently there has been testing and recalls of lead in children toys.”
“Toxins” don’t “cause” “disease.” Specific chemicals can interfere with biological processes in specific ways.
Lead, for example, does not cause “disease.” It interferes with the incorporation of iron into the protoporphyrin molecule; the result is a decrease in heme production. Heme deficiency can have a wide variety of effects.
No one, least of all me, is denying that people can be poisoned. However, being poisoned is not a disease.
“I don’t see it as being “self-satisfied.” I see it as wondering why, in this day and age, people cling to prescientific concepts of disease.”
Amen!
“We very privileged modern physicians should not be too self-satisfied — we are still learning how to best perform and assess the clinical studies that are needed to resolve some questions.”
I would argue that it is the woo crowd that is self-satisfied. One difference between SBM and ‘alternative’ medicine is that SBM is extremely sensitive to the limits of its knowledge while ‘alternative’ medicine wallows in its ignorance and wears self-satisfaction like a cloak. Medical scientists work constantly to expand the borders of knowledge while wootitioners rehash the same tired bromides. SBM is dynamic. Woo is not.
Amy,
From your original post:
“Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).” Emphasis mine.
From your most recent comment:
“‘Toxins’ don’t ‘cause’ ‘disease.’”
Fuzzy thinking leads to careless writing. You say a bunch of stuff and then you say that wasn’t what you really meant. You meant something else which should be obvious.
The problem with the use of the term “toxin,” as commonly employed by alternative medicine advocates, is that it carries the implication that certain substances have some kind of evil “essence,” whereas to the toxicologist, virtually all substances, including nutrients essential to life, have the ability to produce toxicity at sufficiently high dose. The implication that toxicity is somehow inherent in the nature of a substance, rather than a property of the amount of a substance present, is thus misleading at a very fundamental level.
Biologists reserve the term “toxin” for biological substances whose presumed function is to cause injury to other organisms. Many of these substances also are highly potent, meaning that they are able to cause harm at remarkably low doses. Contrary to widespread belief, the most toxic substances known to man are all of biological origin.
quoting Alison Cummins:
“Amy,
From your original post:
“Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).” Emphasis mine.
From your most recent comment:
“‘Toxins’ don’t ‘cause’ ‘disease.’”
Fuzzy thinking leads to careless writing. You say a bunch of stuff and then you say that wasn’t what you really meant. You meant something else which should be obvious.”
Why didn’t you finish her quote?:
““Toxins” don’t “cause” “disease.” Specific chemicals can interfere with biological processes in specific ways.”
I don’t believe Dr. Amy ever calls those chemicals “toxins”.
You seem to have a personal beef with Dr. Amy. Are you deliberating misunderstanding and twisting her words?
@MS, MT(ASCP)
“The term “environmental toxin” is meaningless. Anything in the air, soil or water, regardless of its source that causes a toxic reaction is an environmental toxin. If you’re referring to manufacturing byproducts then “industrial pollution” is a more precise term.”
That sounds fair enough. Does industrial pollution ever cause disease, given a sufficient dose?
The digoxin and hormesis research sound fascinating.
“The Alt Med definition is that a toxin is whatever the practitioner wants it to be; ask a toxicologist or an industrial hygenist, and they will tell you exactly what is a toxin and at what level it harms an individual. ”
My impression was that there is much debate among scientists what exact doses are considered safe. Particularly considering lowering the assumed safe level for exposure to lead in children.
“We have two ways to view the effect of lead in our environment: assign effects to the presence of lead because we know lead is toxic, or look for the mechanism of toxicity at background levels we live in. Which is the more sound approach?”
Absolutely, the latter. This is an argument that involves critical thinking skills and the ability to discern layers of evidence, rather than one handed denials. What do you call an extreme skeptic? A denialist? What do you call somebody who not only goes after alt.med types (rightly so) but goes so far as to deny that toxic substances cause disease at all?
@Amy Tuteur MD:
“Toxins” don’t “cause” “disease.” Specific chemicals can interfere with biological processes in specific ways.
Lead, for example, does not cause “disease.” It interferes with the incorporation of iron into the protoporphyrin molecule; the result is a decrease in heme production. Heme deficiency can have a wide variety of effects.”
Could you define disease then? I thought that lead poisoning was a disease. And I thought that asbestos (one example I asked about wrt to environmental toxins (or poisons if you prefer)) cause/ is correlated with cancer. Is there no such thing then as an industry produced carcinogen then? Is lead not a carcinogen?
Long list of ill effects of lead, including it’s B2 classification as a “probable” human carcinogen.
http://www.epa.gov/ttn/atw/hlthef/lead.html
http://adam.about.com/encyclopedia/001653.htm
http://en.mimi.hu/disease/lead_poisoning.html
“No one, least of all me, is denying that people can be poisoned. However, being poisoned is not a disease.”
No, I guess impaired neurocognitive function (among other effects) caused by lead poisoning is not a disease. Nor is cancer.
Thanks, Dr. Gorski, for the clarification about the definition of a toxin.
I read the original post as conflating toxin, chemical, and poison by this quote:
“Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.
Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).”
And then there was this gem:
“I did no such thing. I certainly am not denying that toxic substances exist. ”
“My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.” ”
Toxic substances do not cause disease? Ever? Really? I must be nuts, because it goes against every EPA study or environmental journal review I’ve read in 15 years. With this exception: the ones linked to from Exxon and junk science.com. And these are the exception. Scientists don’t seem to be arguing about whether toxic substances cause disease. The debate is over how much exposure is necessary and which substances and mechanisms and cures.
I’d really honestly like somebody to resolve the serious cognitive dissonance I have going on here. I have stated at least three times that the dose makes the poison. How on earth can toxic substances never produce disease? And then Dr. Amy mentions tobacco causing cancer in the OP. Yeah, that’s a direct contradiction, and not the first one by a long shot.
@woofighter:
“I don’t believe Dr. Amy ever calls those chemicals “toxins”. ”
You seem to have a personal beef with Dr. Amy. ”
Any personal beef is irrelevant. There were four or five people who were confused about Dr. Tuteur’s original point. If it’s that alt.med types tend to overblow/ in some cases fabricate the risks of industrial pollution/ biological byproducts/ environmental “toxins” I’m 100% on board. If the point is that toxic substances never cause disease, only interfere with biological processes, with no nod to “dose=poison,” I’m not buying it. Even Dr. Gorski was unclear what Dr. Tuteur meant in her original post:
“So why do you call alcohol a “toxin” in your post?”
The precautionary principle as an appeal to ignorance is an interesting argument as well. I can see the logic in that. My question would be should public policy lay the burden of proof on industry to prove the safety of their product (as much as is possible using inductive logic) or on toxicologists who believe that such product (or part of) could be poisonous?
@windriven:
“The question is: how does the scientific community separate the very real dangers of very real toxins from the toxic pipedreams of alt.med types in the minds of the general public? Aren’t issues like these more important than semantic and stylistic disagreements?”
This is an excellent question. I think that it’s *just as* risky to deny the possibility (and historical fact) that toxic substances cause disease as it is to claim that every disease is caused by toxic substances. I hope that makes sense.
As I said above, this requires an ability for critical thinking, more specifically, the ability to see subtle nuances in situations. And it must be taught.
How do I put quotes in italics?
This post has appeared on my own blog and in several other places. It has been read by thousands of people, and I’ve answered many questions about it. Curiously, no one failed to understand what I meant by toxins, not because my definition was ironclad, but because they could understand what I was trying to say.
Moreover, the few who failed to understand my intent on the SBM version initially have had it explained to them by me and by others. At this point, it is not a question of failing to understand, it is an attempt to derail the discussion.
Either way, no post is perfect and there are always people who fail to understand even after multiple explanations. There’s not much to do at that point except to move on with a discussion about the principles of the post, as opposed to allowing the discussion to be derailed by repeated demands for clarification.
“The problem with the use of the term “toxin,” as commonly employed by alternative medicine advocates, is that it carries the implication that certain substances have some kind of evil “essence,” whereas to the toxicologist, virtually all substances, including nutrients essential to life, have the ability to produce toxicity at sufficiently high dose.”
Exactly.
The evil “essence” point speaks to the purpose of a “toxin” within alternative health. It is meant to invoke fear by implying that we are surrounded by harmful substances, belched out into the environment by nefarious corporations, and that these substances are responsible for diseases, particularly diseases whose cause has not yet been identified.
Zoe237,
I think what’s missing here is a distinction between acute and chronic disease, and how they fit into exposure to a potentially toxic compound. For instance, our friend lead (Pb) can cause acute toxicity symptoms of porphyria, colic, ataxia (unsteady gait) headache and anorexia, among others. If detected in time, chelation can reduce the body lead burden and the symptoms subsequently resolve. On the other hand, people can be exposed to levels of lead and have very mild or no accompanying symptoms who later develop permanent chronic symptoms such as nephrotoxicity (kidney failure) and neural damage leading to retardation, aggression and developmental regression (these rarely seen in adults). Unwittingly, people with a high heavy metal burden, but who are otherwise asymptomatic, risk suffering permanent damage during chelation because sequestered heavy metals are liberated.
Toxicity from exposure, then, to a compound is at least a four dimensional problem. It depends on dose, dose duration, rate of elimination and bioavailability (or Vd for the pharmacologists out there). There is an area defined by all four parameters where toxicity occurs, but that area may not always be obvious. There are many documented instances where exposure to industrial pollution has placed a person or a defined population within that four-dimensional space (mercury in Miamata Bay, Japan being the most notorious). Some toxicity data in MSDS sheets has, unfortunately, come from documented human morbidity and mortality caused by the chemical covered by the MSDS sheet.
As far as determining the highest safe exposure level and rate, well that’s really complicated, hence the debate. It depends on
- an individual’s ability to clear a given compound (look up CYP2C9*2 as an example of reduced clearance of certain drugs),
-the form in which the toxin in encountered (e.g. methylmercury vs. ethylmercury),
-general health (e.g. obese people are at risk of retaining fat-soluble compounds such as dioxin; chronic alcoholics are susceptible to toxins because of impaired liver function),
-and the above mentioned four dimensional model of exposure.
Add to that the ethical constraints of deliberately exposing people to a toxic compound to find that highest safe exposure level. The best we can do is to use animal models, but even then it’s an imperfect extrapolation to humans. Examining such low levels also puts us close to the lower limit of detection, where it’s hard to discern the true signal (i.e. concentration of a compound) from random thermal noise that is always present in any measurement system.
I suspect that some of the disagreement in the comments is due to cognitive dissonance. The “organic” food movement is tied up with the idea that chemical fertilizers are bad and their use produces food that is less healthy. The only plausible mechanism could be via the types of “toxins” that Dr Amy is talking about in her post. We know that well prepared (i.e. most) chemical fertilizers don’t have toxic substances in them. We also know that because of how plants take up nutrients (for example nitrogen is only taken up as ammonia or as nitrate), organic fertilizers can only be taken up by plants after soil bacteria have broken them down into the inorganic chemicals that are used in chemical fertilizers.
I think that some of the push-back that Dr Amy is getting is from people who buy and eat organic foods, and who think they are getting something of higher value for the higher prices they are paying. The higher price is to avoid the evil essence of chemical fertilizers; an evil essence that chemical analysis cannot find because it is not present.
There isn’t the time or space to go into the problems of the organic food industry, but the most zealous proponents of organic food are treating non-organic food as having the taint of toxins; the same with genetically modified food. GM foods have a “taint” which cannot be removed. Anti-GM zealots use the same techniques as the quacks in alternative medicine to “prove” that there is unacceptable risk to GM varieties while non-GM varieties pose zero risk. The definitions of what is “organic” food are not science based, they are magical thinking based. Urea from urine is a good fertilizer and is acceptable; urea synthesized in a factory is unacceptable even when it is purer.
This post has appeared on my own blog and in several other places. It has been read by thousands of people, and I’ve answered many questions about it. Curiously, no one failed to understand what I meant by toxins, not because my definition was ironclad, but because they could understand what I was trying to say.
+++++++++++++
That’s not the case. Commenting on your article when it appeared on skepticalob, Katie asked
“Can you define “toxins?” Are you talking about chemicals added to food, about chemicals emitted by cleaning products, glues, paint and the like, or what? Lead is a “toxin” which apparently causes such bad effects on developing minds that paint (and now most electronic devices) can no longer contain it. Does this mean I don’t have to worry about those labels that say a product is known to cause cancer in California, or does that only matter if I’m in California? Antibacterial cleaning products for self and home get rid of “toxins” (bacteria), but may be leading to the rise in more dangerous/powerful bacteria.”
In short, very similar questions that have been raised in relation to this post. Of course, it is your perogative not to make any amendments to further clarify your article before reposting it here. But don’t be surprised if the same questions then arise.
Indeed. Why “disease” becomes a moving target after “toxins” (the latter not causing the former, rather interfering “with biological processes in specific ways”) is simply perplexing. As sympathetic as I am to observing that TOXINNNS are a preposterous joker in the alt-med deck, it’s hard to get excited about a jab that the concept is 500 years behind the times when the associated rhetoric and its defenses seem to be pre-Socratic.
Point 1 – Communicating
Okay. I looked through the comments and then glanced at Amy’s article. No. I didn’t read the comments or the article carefully, but I think I understood the point of the article and agree with Amy.
I also expect that many others who read it will have the same reaction that I had. However, not everyone will. People vary a great deal in how they learn which is why it is a good idea to use different methods in our efforts to teach and communicate or to have different people with different methods present the same topics.
As many of you probably know, Skeptics drive me up the wall even though my BA is in philosophy, or maybe because my BA is in philosophy, and I know I have the same effect on most Skeptics as they do on me. However, I am not alone. I know many people, including scientists, who are driven up the wall by Skeptics. Knowing how sincere, intelligent and well educated so many Skeptics are and knowing what important information they have and want to get out, I hope they will enlist others who have a different style of communicating than they do to help.
Point 2 – Fear Tactics Used by Quacks
Frightening people is one of the major sales tactics used by quacks to sell snake oil. There are two components to their marketing game. One is trying to make people chemophobic, something they actually do quite well. It is gotten to the point where many very rational people ignorant about science will say, “Oh, I don’t want to use any chemicals,” by which they usually mean anything synthetic or “man made”. I have many responses to this but won’t bother you with them here.
The other thing quacks use to scar people with are “toxins” in their bodies which of course require detoxification. And guess who ya have to give ya money to folks to buy the remedies to detox with. The word toxin is used because of the evil association it carries for most people. Quacks often use it vaguely but sometimes they do use it very specifically although not necessarily correctly in that it may refer to something that isn’t really in your body at all or something there that isn’t really harmful. (Yes. I know I haven’t expressed that very well, but writing is not my forte. Speaking is.)
I don’t know if any of your were lucky enough to know John Renner. He once looked at me and said, “Rosemary, aren’t they trying to detox you?” To which I responded, “Why Dr. Renner you are psychic! How did you know?” Again I won’t bother you with the details of quack detoxification here.
MS, MT(ASCP), thanks.
“In short, very similar questions that have been raised in relation to this post. Of course, it is your perogative not to make any amendments to further clarify your article before reposting it here.”
Yikes, I didn’t realize these were reposts… are all or most SBM posts taken from elsewhere? A brief google search showed many commenters wondering about lead as a toxic substance causing disease in response to “Toxins: the new evil humours.” Oh well.
are all or most SBM posts taken from elsewhere?
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As far as I can tell all Amy Tuteur’s posts here have all been published in one form or another at
http://skepticalob.blogspot.com/ or
http://open.salon.com/blog/amytuteurmd or
http://homebirthdebate.blogspot.com/
and sometimes all three.
I might be flattered by all the attention to me, my words, my writing style, but I’m well acquainted with the tactic of focusing on the author as a way to derail a discussion about an idea.
I find it to be a variation of the ad hominem attack, try to prejudice readers by disparaging the person, instead of addressing the topic.
It is surely not disparaging to direct readers to your other blogs.
OK, I read Doctor Tuteur’s last comment as an ad hominem against Alison, to be honest.
I might have been more … ostentatiously courteous in my response than Alison (I came in late and read dozens of comments before writing this) but her point is in my professional opinion as a writer, valid.
That point: that Doctor Tuteur’s original essay could be improved. Not that it’s factually wrong–as Alison repeatedly said, it is not. That it could be more effective.
My own reaction was that this essay is enormously too abstract and too general. It reads like a summary of the introduction to a book on the subject, not a stand-alone essay. There isn’t a single reference to a particular person (e.g. “Dr. Oz”) and that person’s specific doctrines. There isn’t a specific reference to web site that spouts “toxin” gibberish. There isn’t even a named (but fictional) toxin. It’s just very general statements disconnected from anything concrete that they can be related to.
It’s not that it’s wrong–it’s quite correct in the position advocated. It just isn’t structured in such a way as to convince anyone.
Answering a question from upthread:
I put that between [blockquote] and [/blockquote] tags–replace the “[]” with “”. Italics can be typed using [i] and [/i]. Again, replace the square brackets with angle brackets.
OK, the blog software removed the angle brackets between the empty quotes in my comment above. Those are “>” and <".
I daresay that if it wasn’t effective, it would have been ignored. The comments about style, word use, etc. are not charitable efforts to improve my writing; they are attempts to divert attention from the substance of the post.
“Toxins” have become a very effective meme for “alternative” health practitioners. They invoke the same subconscious fears as evil humours: they are insidious, all around us and evil (or at least produced by evil corporations).
Whereas evil humours were understandable given the technical limitations of the time (no one could see bacteria or viruses), “toxins” as a meme are understandable only in light of the educational deficiencies of large parts of the population. “Toxins” as a meme resonates with those who lack basic understanding of science, statistics and medicine.
The idea of “toxins” is used to separate the gullible from their hard earned money, because “toxins” are invoked by those who are peddling products that supposedly remove or protect against “toxins.” Anyone who has bought an product designed to “detoxify” has fallen for a scam.
From people who agree with you? Including David Gorski?
I daresay that if it wasn’t effective, it would have been ignored. The comments about style, word use, etc. are not charitable efforts to improve my writing; they are attempts to divert attention from the substance of the post.
You have it exactly wrong. I want SBM to be a place I can refer people for thoughtful and convincing content-driven essays. If some of the contributors do not meet the standard I have come to expect of SBM, I am disappointed. I don’t want to refer someone to SBM and have them come back to me saying that scientists write insufficiently-thought-through essays full of obvious straw men and gaping holes in logic. You attract my attention because I believe you are not as effective as I need you to be. I believe you are letting down the side.
You are correct with respect to my lack of charity. I don’t care if you are a poor writer for your sake. Keep your own blog and let it sink or swim on its own reputation. I care because I believe you are letting down the side and lowering the standard for SBM. I care because I care about science journalism and science education. You are correct that I do not care about you.
I’m fine with the substance of the post. As I said, your summary statement, “Evil humours and miasmas have not died, they’ve been reincarnated as ‘toxins’” is exactly perfect. But the way you got there is not convincing to any but the converted who can fill in the many blanks and mentally substitute what you probably mean for what you actually say.
Finally, your use of the word “effective” in the quote above. Effective at what? Attracting attention or changing minds? You’re attracting the attention of people who agree with you in the substance. If sellers of detoxifying widgets were complaining that you aren’t sufficiently clear, that would be a different story.
If anything, you seem to be trying to divert attention by claiming that the only reason you are receiving criticism is that people are threatened by your insights. We have heard that kind of defence before, and it’s not usually from scientists.
If you’re a real scientist I expect better of you.
Amy’s superficial essay lumps “toxins and poisons” into a broad and somewhat vague category. Where does one draw the line between “toxins and poisons” and “hazardous substances and contaminants”? This NYT article on contaminated tap water poses some important questions.
http://www.nytimes.com/2009/12/17/us/17water.html?pagewanted=1&_r=1&sq=toxic tap water&st=cse&scp=1
There is a great deal of uncertainty among scientists as to what qualifies as toxicity regarding tap water contaminants. Scientists are finding that many substances are harmful at much smaller doses than originally thought. “These chemicals accumulate in body tissue. They affect developmental and hormonal systems in ways we don’t understand, ” said Linda S. Birnbaum, who as director of the National Institute of Environmental Health Sciences is the government’s top official for evaluating environmental health effects.” Dr. Birnbaum’s cv indicates she knows a little something about the science of toxicology, but her statement could be displayed on any alternative health website, couldn’t it? About toxins accumulating in body tissues…..
And scientists trying to discern more about what constitutes toxicity are faced with animosity from industry and the military about their findings. “Earlier this decade, scientists at the E.P.A. began telling top agency officials that more needed to be done. Dr. Peter W. Preuss, who in 2004 became head of the E.P.A.’s division analyzing environmental risks, was particularly concerned. So his department started assessing a variety of contaminants often found in drinking water, including perchlorate, an unregulated rocket fuel additive, as well as two regulated compounds, trichloroethylene, a degreaser used in manufacturing, and perchloroethylene or perc, a dry-cleaning solvent. Research indicated that those chemicals posed risks at smaller concentrations than previously known. “It’s hard for me to describe the level of anger and animosity directed at us for trying to publish sound, scientific research that met the highest standards,” Dr. Preuss said. “It went way beyond what would be considered professional behavior.” So yes, apparently corporations do object strenuously to science based fact that even minute amounts of the chemical waste substances they release are harmful to humans. Not exactly “evil”, but…….distinctly disquieting.
“Dr. Preuss said “It is our job to follow the science, and when a preponderance of evidence indicates there is a risk, we should say so,” he said.” Follow the science, that sounds familiar
For those interested in the science behind “toxic” tap water this links to a series of NYT articles on the subject.
http://projects.nytimes.com/toxic-waters
The resources section at the bottom of this link includes a section listing links to “Studies Regarding Illnesses and Drinking Water” as well as links to other scientific papers on arsenic, perc, perchlorate, trichloroethylene and herbicides in drinking water.
The NYT article cited previously states “Independent studies in such journals as Reviews of Environmental Contamination and Toxicology; Environmental Health Perspectives; American Journal of Public Health; and Archives of Environmental and Occupational Health, as well as reports published by the National Academy of Sciences, suggest that millions of Americans become sick each year from drinking contaminated water, with maladies from upset stomachs to cancer and birth defects. “ Granted “suggest” does not equal “prove”, but uncertainty abounds. Certainly enough to generate concern in individuals who base their decisions upon science and not fearful beliefs about miasmas.
Wales, “Amy’s superficial essay lumps “toxins and poisons” into a broad and somewhat vague category.”
I think that was Amy’s point. Quacks lump toxins and poisons into broad, vague categories and claim that they are all around and inside of us causing diseases which they can prevent and cure if we pay them for their goods and services.
Wales, “For those interested in the science behind “toxic” tap water this links to a series of NYT articles on the subject.
http://projects.nytimes.com/toxic-waters”
I saw there what is usually considered “good journalism”, articles well structured and well written, but I didn’t see science. I saw broad generalizations and quotes from scientists. (Actually, I’d love to see a critique of the articles by Dr. Novella, who I believe has done a wonderful job with similar articles in the past.)
One example from the other link you provided, “But regulatory records show that fewer than 6 percent of the water systems that broke the law were ever fined or punished…”
In context of the well written article this gave the impression that huge numbers of people are regularly put at risk or made sick by frequently occurring water contamination that the government isn’t concerned about. As a water and sewer commissioner in my very tiny municipality who is not a scientist or even very knowledgeable about the subject, I can tell you the other side. In my state, Vermont, there are many ancient water systems. The government would rather get municipalities to use any money they can cough up to update or fix problems rather than use it to pay fines so often when they find a violation they work very hard with the municipality to get them to do just that, only fining as a last resort.
Also, at least as far as I know, no one is seeing or at least not recognizing, any diseases here in humans that are being caused by the contaminants, not even from the many private wells which are not regulated anywhere near the degree that municipal systems are. (And I can assure you there would be a revolt of the populace if anyone attempted that kind of regulation.)
Wales, “Granted ’suggest’ does not equal “prove”, but uncertainty abounds.”
You are correct. Suggest most certainly doesn’t equal prove. Epidemiological studies are highly unreliable as are toxicology studies in animals when extrapolated to other species. It takes toxicology studies in humans to get the real answers and they obviously can’t be done for ethical reasons.
There is a great deal of evidence showing that in order to accurately evaluate a drug a great many very good clinical studies are required. Bench studies and epidemiological ones alone usually are not sufficient to come up with anything close to a conclusion offering a high probability of accuracy. I believe the same is true with toxicology. Certainly broad generalizations without citations in articles by the NYT just won’t cut it. Unfortunately though they will probably influence public policy.
Okay, we’ll see if this works for italics- thanks nitpicking.
Rosemary-
Except she makes the opposite mistake. Quacks are making that mistake, I agree- lumping toxins and poisons into broad, vague categories, as you say. Very true. Industry apologists, like Tuteur’s post seems to be, otoh, lump toxins and poisons into broad, vague categories, only that they are never or rarely harmful.
And they usually say that environmentalists are chanting “evil corporations” when many understand that corporations are just protecting their bottom line, but that there needs to be a governmental protection against the pure profit motive (i.e. FDA and EPA, among others).
The water argument cited above is a good example of the complicated issues here. I saw a Dr. Oz teaser the other day for a show about contaminated water and how we should never drink it. It was fear based and, although, I didn’t watch the show, probably waaaay exagerrated. Did anyone see Penn and Teller’s bottled water show? Now there’s a big waste of money. OTOH, we can leap to the other extreme and not be watchful for contaminants in our water supply. It does happen, just not nearly on the scale that CAM promoters would have you believe. But people like to be on one “side” or another because it makes for more simplistic thinking.
AmyTuteurMD:
Now this is a demonstrative piece of “logic”: my posts are effective because they garner lots of comments…
“my posts are effective because they garner lots of comments…”
… and readers, and tweets, etc. That’s how effectiveness is measured in the blogosphere.
Of course some comments or tweets are better than others. For example, Ricki Lake tweeted about me this morning, referring to the post on her website, “Amy Tuteur, aka “The Skeptical OB,” Has a Blatant Issue With Home Birth,” and the comment thread that extended for several weeks and 152 entries thus far.
I’m mystified that Ms. Lake is proudly pointing to the discussion since I presented the scientific evidence on a number of aspects of homebirth and no one had an effective response.
Two things come to mind while reading this post and the comments.
First, why all the fuss over style vs. content in a blog post? The author readily acknowledges that this is a blog post in the greater “blogosphere” and thus not a professionally edited and peer-reviewed article published elsewhere. Perhaps the words “science” and “medicine” in the title of this blogging forum lead people to think it will contain only rigorously edited writings? Difficult to say, but there seems to be an inordinate amount of complaining about how things were said instead of what was said. Surely those who care deeply about the quality of writing would serve everyone better by emailing the author directly, or is the public flogging of a writer’s style part of the brave new blog world?
Second, Dr. Tuteur concluded in part:
“The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.”
This is an accurate statement from the point of view of one with a medical degree but should not be confused with the mindset of patients that still see out those peddling “crackpot theories” in search of relief from various ailments. Many people who cannot find relief in science-based medicine turn to just about anything else in search of -something- that will work. Desperation is a powerful motivator and can easily override logic and reason when one is greatly suffering. Every effort should be made to expose the purveyors of toxin-cleansing snake oils while understanding that many people who buy such miasma-removers are in need of compassion.
Zoe, “Industry apologists, like Tuteur’s post seems to be, otoh, lump toxins and poisons into broad, vague categories, only that they are never or rarely harmful.”
I did not get that impression at all from the article.
The article stated:
“There’s just one problem. ‘Toxins’ are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.”
From the context, that, at least to me, quite clearly referred to the way alt. medders use the word “toxin”.
The article further stated:
“Poisons exist, of course, but their existence is hardly a secret, and their actions are well known.”
From context, at least to me, that clearly referred to the way science views toxins and it does not indicate that they are “never or rarely harmful”.
The article ended with:
“Hence the obsession with ‘toxins’ in foods, in vaccines, even ‘toxins’ arising in the body itself. The height of inanity is the belief in ‘detoxifying’ diets and colon cleansing. The human body does not produce ‘toxins.’ That’s just a superstition of the ‘alternative’ health community. The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed for that purpose such as the kidneys.”
IMO, that very clearly states the way alt med uses the term “toxin” to scar the public as well as the insanity of their claims about toxins.
I do agree with Allison who, I believe without checking, mentioned that without a link people she sent to the site would not understand the problem Dr. Tetuer was addressing. People who have not waded through the muck of alt. med. would have no idea how that crowd uses the word “toxin”. However, I hope that if they read the article and wondered they’d google it. No, I haven’t done it myself but suspect that that get a lot of quack hits that would clearly illustrate the insanity.
Regarding the number of responses Dr. Teteur’s articles receive here and elsewhere, I think that PR professionals believe that “any attention is good” and that the more generated, the better for the product, cause or whatever. Whether or not they have solid evidence to substantiate this, I don’t know.
When it comes to giving a voice to someone, both the broadcast and print media generally gobble up those who draw a big audience and usually they don’t care if the audience idolizes or hates the person or topic that is getting the attention.
I find the reactions to Dr. Teteur very interesting and wish that there was a psychologist who would analyze them in an effort to discover what provokes them. I suspect that there are several reasons which include things like a style of writing that doesn’t conform to the rules of what is often considered “good journalism” as well as the fact that she takes on very emotional issues and is not afraid to show her own emotions, something I find all too rare in scientists who try communicating with the general public.
Just my thoughts if anyone is interested.
RE effectiveness: well, that certainly clears things up. Your goal is not to educate or communicate but to collect eyeballs. Why you care only about eyeballs on SBM which doesn’t have advertising I still don’t fully understand, but that’s fine. If eyeballs are your only metric, then being temptingly easy to argue with is a good thing. Cool. Don’t change a thing.
To Rosemary, who missed the “science”. As I noted, you must scroll down to the bottom of the page where there is a list of resources containing links to papers from the Environmental Protection Agency, National Academy of Sciences, National Center for Biotechnology Information, USGS and various other scientific and health journals such as the American Journal of Public Health, International Journal of Epidemiology, etc. Why is it that the important details are always in the fine print at the bottom of the page?
http://projects.nytimes.com/toxic-waters
Alison, perhaps the problem is that Amy’s pieces were originally written for different website venues which are/were not as stringent about the science, and then pasted here. Perhaps she should re-write or tailor her old essays before publishing them on this science based venue in order to satisfy her more demanding audience.
Rush Limbaugh also has a lot of listeners, as do a lot of extremists. That doesn’t make him smart, clear, logical, or effective. It makes him entertaining, and even though I disagree with him 95% of the time, I have to give him that. Same with Michael Moore (if you’re a conservative!)
False cause fallacy, anyone?
As for Dr. Tuteur confusing toxin, poison, chemical substances, etc, using vague, broad usages, I say that because she one, never gave a clear definition in the post, and because, two, Dr. Gorski clarified the use of the word toxin and that alcohol, tobacco, etc, do not technically fall into that definition either, despite the OP. IOW, it was an extremist post intended to demonize and confuse rather than elucidate.
I have never responded to any of Dr. Tuteur’s other blogs, even I’ve read them a few times, because there was nothing about “science” in the title. I respond here because I think that SBM is an otherwise good website. But perhaps I am expecting too much from a random blog post.
Sorry Wales, I checked again, and I still missed the science. I did see the links, most of which are to the EPA, but I didn’t see citations for each specific claim made in the articles, which to me is required in science writing but not in journalism.
A few clicks on at an EPA link, brought this up:
“The report concludes that most Americans received drinking water from public water systems that recorded no significant violations in 2006. Ninety-three percent of America’s public water systems did not have any reported violations of health-based standards, and 73% of the population is served by public water systems which did not have any reported significant violations in 2006.”
Admitting that I only gave the NYTs articles a cursory glance, that statement from the EPA appears to me to show the opposite of what the articles said about the safety of drinking water in the US. Of course, when giving links to anything producing the volume of material that the EPA does, I would guess one could go through the site and find statements supporting either side of the argument which is exactly the reason that I don’t find listing links to things like an agency, institution or large organization to support specific claims as being scientific.
Also in my mind, which is very uneducated compared to most others here, I see a clear distinction between the EPA, a government agency, and toxicology which is a science. That is based specifically on my knowledge of silver, something I do know quite a bit about. I have actually lectured toxicologists on the subject although lecture is probably too strong a word. I suspect the main reason I was invited to speak at their conference was so that they could see me, the specimen, in person.
The EPAs estimates about the amount of silver toxic to a human are fairly useless, based on exceedingly old studies and lack of knowledge about current levels of exposure. The only way to find out what the real toxic amount of silver is for the average person is to have someone do good toxicology studies on humans. Ironically, toxicology studies are being done on silver all over the world as we speak, but they are virtually useless because they are uncontrolled.
Rosemary I am impressed. If you read all 25+ papers, including the National Academy of Science’s 400+ page book on trichloroethylene, you are to be commended on your speed reading skills. That does explain how you may have missed something, reading so quickly.
Rush Limbaugh also has a lot of listeners, but that doesn’t make him smart, logical, clear, or effective in communicating. Extremists usually garner a lot of attention.
They may be right or wrong or effective or not, but this doesn’t depend on the amount of attention. I suppose Alison is right though, if your definition of effective is that you get a lot of attention.
False cause fallacy anyone?
As for the reason I call Dr. Tutuer’s OP as having vague and broad definitions of toxin, poison, chemical substance, etc, is because she doesn’t specifically define any of the terms scientifically in the OP, because the only poisons she mentions are alcohol, tobacco, etc, and because of Dr. Gorski’s real clarification of the term toxin and the non application of tobacco and alcohol.
I have never responded to any of Dr. Tuteur’s blogs in the past, although I’ve read them a handful of times. These blog addresses didn’t have anything about science in the title, and I figured she was entitled to her extremist opinion. When she calls them science, and starts bringing them to an otherwise good website, I’m going to question. But perhaps I am expecting too much from a random blog post.
Okay, I’ll stop belaboring the point.
Amy may have been forthright and simplistic but where is she wrong and the “Detox” merchants right? For Detox is what her post is really about.
These nice, concerned folk are not interested in identifying any toxic chemicals that are really causing human illness so that specific ones can be avoided.
They are not interested in finding out if their methods actually remove worthwhile amounts of anything from the body, or that this is uniquely associated with the amelioration of any illness, or that it is of any long-term benefit for human health.
All that is in the received wisdom — in Detox dogma
Do they even know how much of any Detox activity is necessary for any medical purpose? Have they ever tried to find out? Of course not.
There are in fact strong grounds for believing that the most prevalent DEtox methods are an utter waste of time in terms of human physiology or toxicology. Some are frankly harmful.
The above does not preclude the reality of the intense euphoria some subjects experience after “Detox”, arising form the belief that they are now “clean”, and also from that DYI sense of achievement at completing often arduous Detox programs.
It also does not preclude placebo responses in other illnesses.
But here be science. It is our job to understand what is really going on.
pmoran, nobody said that Dr. Tuteur was wrong that I saw. Unclear, unpersuasive, yes, but not wrong.
I can agree with this. Although I don’t know about nice.
Sorry about the basically double post earlier. I don’t know if one went into moderation.
A question for SBM editors:
As Alison points out, Amy’s writing/thinking is sloppy and bears an eerie resemblance to the extremist writing of the woo’ers. Her avowed goal is clicks/comments and she appears to believe that this is a sufficient contribution to SBM. Calls for more effective communication are ignored and even mocked by Amy.
Are these the goals of SBM? If so, could you recommend some other sources of good SBM material that would enlighten me, rather than simply generate clicks/comments?
Wales, “Rosemary I am impressed. If you read all 25+ papers, including the National Academy of Science’s 400+ page book on trichloroethylene, you are to be commended on your speed reading skills. That does explain how you may have missed something, reading so quickly.”
Oh, Wales, you have so greatly underestimated me. I read everything at all the EPA links that the NYTs so graciously provided and just like the Times did my own little analysis. While the good journalists and editors at the paper didn’t say how long it took them to do theirs, I’ll bet I did mine much faster. Yikes, I even found my own little water company there and checked what the agency reported about us, something I’ll bet the Times didn’t do.
And guess what, after my impressive “research”, I still conclude that the NYTs articles were examples of great writing, wonderful structure and all that stuff, but no science. It was kind of like writing an article about God and giving links to online sites that post the Bible as a reference. Just a tad, general, hazy and vague.
Alison, it seems as if your vision of what the SBM site should be is not the same as that of the founders and editors of the blog. As I’ve said before, different people learn and communicate differently. Perhaps you should start your own site. They might compliment each other.
You do realize, don’t you, that this comes mighty close to being an example of the pharma shlll gambit. My post today was quite timely.
Rosemary said,
“I find the reactions to Dr. Tuteur very interesting and wish that there was a psychologist who would analyze them in an effort to discover what provokes them.”
I agree. I just went back and re-read the post and it reads well and makes sense to me. The whole point was that “toxins” are undefined in CAM; scientists know what the word really means, and Amy made that clear. There is no “science” to be cited about these vague toxins, because the concept is not based on science.
I suspect that if another blogger’s name were on this post, the comments would have been less critical. It seems to me some of our readers are more interested in Amy-bashing than in the substance of what she writes. I find that incomprehensible and very disturbing.
You yourself accused Stephen Milloy, of junkscience.com, of being an industry apologist, if not an outright shill. (comments, Endocrine disruptors, 7:54 am, dec. 8). I didn’t realize it was *never* true or allowed in any circumstances, if not specifically using it to discredit an argument. It’s liking people saying that “appeal to authority” is a logical fallacy when it’s actually “appeal to *unqualified* authority.”
No, it doesn’t discredit Dr. Tuteur’s argument, nor did I accuse *her* of being this (I rather doubt it). But I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science. I never would have even brought it up except for the “evil corporation” remark. Take it as a side note if you will, but I appreciate the even handedness.
That’s because there is copious evidence that he has been (and probably still is) a shill for industry. I do not make that charge lightly. I never do. Unlike the alt-med promoters who use the “pharma shill” gambit. And, even though Milloy is an industry apologist, sometimes he’s right about certain topics (i.e., vaccines and autism). However, his history as an industry apologist does make me look at his arguments more skeptically when it comes to certain issues, and I see nothing wrong with that.
Where, pray tell, did Amy denigrate entire fields of science? I’ve been critical of some of Amy’s comments in this thread (of that there is no doubt), but I don’t recall seeing her do anything like denigrating entire fields of science.
I assure you, our primary measurement of effectiveness at SBM is not collecting eyeballs or comments. Traffic is, of course, essential for getting our message across, and I’d be lying if I said we don’t want more traffic. After all, the more people there are reading us, the more influence we can have. Yes, we like comments, too, just as we like traffic, but we these two things do not necessarily correlate with quality and effective communication. Having been in the blogosphere for five years, I know this to be true. What we hope to do here is to educate in a way that is engaging enough to result in traffic and comments without sacrificing scientific rigor.
“For Detox is what her post is really about.”
+++++++++++
Actually, I’m not sure this is obviously the case. In the entire article, “detox” merits only one line “The height of inanity is the belief in “detoxifying” diets and colon cleansing.” But nowhere does Dr Amy actually take on or nail the ‘detox merchants’ – preferring to spend her time asserting that there are ‘no such things as toxins’.
The more tackling of chelation therapy, colonic irrigation and detox in Singh & Ernst _Trick of Treatment_ is more effective because they are have a more accurate aim on their target. These are not just questions of stylistic preference.
Rosemary you may have read all the EPA links, but you left out many others. I did not find the International Journal of Epidemiology paper, nor the American Journal of Public Health paper, nor the Epidemiology paper, nor the National Academy of Sciences papers to be vague or even remotely lacking in science. I guess it’s just a matter of semantics, to which even science is not immune. I cannot tell if your primary gripe is that the NYT article should have specific citations as in a medical journal paper (not standard practice for newspaper articles) or if you are denying that there is any scientific evidence that tap water contamination is harmful to health. The NYT article has documented its sources in a very thorough manner in the resources section. The fact that you draw conclusions that differ from the article’s does not negate the science.
It is disturbing that a water/sewer commissioner seems to be denying the evidence for drinking water contamination, which is illustrative of why we need the EPA to protect public interests. You repeatedly say there is no science, perhaps bias plays a role in blurring your vision. You will see what you wish to see. I am finished with my comments on this topic.
Zoe237 said,
“I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science.”
I went back and read the article again and I couldn’t find where Amy had said any of those things.
Actually Amy did make reference to “evil” corporations. See paragraph 9, last sentence of Amy’s essay for the comment.
It doesn’t much matter, but since I also made reference to Amy’s comment about “evil” corporations I thought I’d point it out.
I agree with Plonit regarding the “detox” topic. It wasn’t clear to me that detox was the topic. In fact if one is to judge the topic by the number of times a word is repeated in Amy’s essay it’s interesting to note that the word “evil” is repeated even more often than the word “toxin”. Go figure.
Funny, but I thought you said you were “finished with your comments on this topic.”
I was referring to the NYT articles. Sorry to disappoint you.
wales said,
“Actually Amy did make reference to “evil” corporations.”
She wasn’t saying corporations were evil, she was citing the arguments of believers in unspecified “toxins.” She even put “evil” in quotation marks. It was clear from the context that she did not agree.
Harriet Hall:
“I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science.”
The following quote (at the end) is where I got the idea. She posted that toxins were the new evil humors. I asked about lead, radon, asbestos, ddt, and other chemicals/toxic substances/industrial pollution. The response I got was that these don’t cause disease (specifically lead). Then I posted specific reliable medical websites that call lead poisoning a disease.
Toxins and environmental pollution are the entire reason for some fields of science. If I’m wrong somewhere, I’d love to hear where, because I admit I’m confused. Other knowledgeable commenters have posted that of course toxins exist, some are caused by industry, and some cause disease. Dr. Tuteur said that alcohol and nicotine were toxins, but I guess they don’t fit under the true scientific definition (that toxins are the results of biological processes and cause disease BY DEFINITION.)
This doesn’t seem to be a bias by solely Dr. Tuteur either, but toxicologists, epidemiologists, and environmental scientists don’t seem to be respected on this website. Pseudoscientists, iow. I hope I’m wrong. But I’ll let it go.
Amy Tuteur MD (comments):
“I did no such thing. I certainly am not denying that toxic substances exist.
My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.” “
Wales, “Rosemary…I cannot tell…if you are denying that there is any scientific evidence that tap water contamination is harmful to health.”
Wales, that statement hits the nail on the head. It is so general it is silly. I am not saying this to insult you. I realize that I often don’t express myself well and that you may really wonder if I thought that. So let me try to be very clear. Of course I’m not denying that there is scientific evidence that tap water contamination is harmful to health. What I am saying is that science doesn’t pose such broad, general questions as that. It poses specific questions. Such as: Is arsenic dangerous to human health: if so what amount of each specific arsenic compound commonly found in drinking water is safe. (If we are speaking about drinking water, the route of administration doesn’t vary.)
Wales, “The NYT article has documented its sources in a very thorough manner in the resources section.”
The NYTs has listed links to the sites that it used in its study. To know if its conclusions are supported by the evidence, you would have to look through all the material on the subject to pull out what is relevant and review it yourself. That means the whole body of evidence, not simply a few dozen studies, and until you have done that, you cannot conclude that the NYTs had documented its sources. I can give you many examples of quacks giving long lists of citations which they claim document their statements, but if you actually read the articles, you find that they are either on an entirely different subject or say the opposite of what the quack is claiming.
The headlines at the NYT site you sent: http://projects.nytimes.com/toxic-waters
give me the impression that huge numbers of people are regularly put at risk or made sick by frequently occurring water contamination that the government isn’t concerned about.
Just 2 headlines as examples:
“Tap Water Can Be Unhealthy but Still Legal”
“Millions in US Drink Contaminated Water, Records Show”
Those are emotionally charged words that scar the general public and give them the impression that tap water is dangerous for their health.
What I am saying is that I am not aware of diseases in humans caused by drinking contaminated water that indicate that people, in general, should be scared about drinking water or afraid that the government is not sufficiently regulating it. Please do not read into that more than what I’ve said because I am definitely not saying that the EPA should not continue to monitor water to see if there are contaminants in it that they have previously failed to identify. Neither am I saying that contaminants never get into water and that drinking water never makes people sick. But if you want to call it science, you have to be specific. The Times was not. It was general.
I am also saying that bench studies, animal studies and epidemiological studies alone usually are not sufficient to come up with anything close to a conclusion offering a high probability of accuracy regarding a toxin. For that human toxicology studies are required and they cannot be ethically done. Which means that the NYTs has not found any human toxicology studies at any of the resource sites that it used to substantiate its claims. That doesn’t mean that they aren’t accurate, but it does mean that the level of evidence isn’t high.
Which I think brings us to the emotional problem. Americans really want to believe that we can make life risk free, discover all the causes of disease and eliminate them. That just isn’t possible and sometimes in trying to do that you create problems where there weren’t any.
I think perhaps I’ve found the language to express my thought regarding my inability to see any science on the NYT site above: http://projects.nytimes.com/toxic-waters.
If I were to write an article about the danger of drugs and include links to the FDA and NIH websites under the heading of “resources” and throw in a few epidemiological studies, the reader would have no way of telling from that if in fact there was a body of convincing evidence that supported whatever my conclusions were mainly because the topic, the danger of drugs, is too broad but also because the sites are too exhaustive to locate all the specific information they have pro and con.
Quite possibly no one is reading at this point. But if anyone is, it is a very important point since a great many people jump to the erroneous conclusion that whenever an author lists scientific sites or citations from scientific journals that his work is scientific and that the science supports his conclusions. If you have spent any time investigating the claims of quacks and the naive people who repeat them because they take the quacks at their word without ever trying to independently verify what they say, you know how very wrong that assumption is.
I have almost all the English literature on silver drugs, but there was one pharmacology book over 50 years old that I had never been able to locate which is cited as showing that ingesting silver offers benefits. I just located and paid over $200 for a used copy. And guess what, just as I suspected, it states no such thing.
“toxicologists, epidemiologists, and environmental scientists don’t seem to be respected on this website”
They are respected. I think your perception may come from the fact that epidemiologic studies have many pitfalls and are not as reliable a source of evidence as RCTs (which also have pitfalls). Shaky epidemiologic correlations are frequently offered with overblown claims of causation. Recent posts on cell phones/brain cancer and Bisphenol A are examples.
We do not reject epidemiologic evidence nor do we disregard the possibility of environmental toxins affecting human health. We simply require the same rigorous standards of evidence as for any other claim. Epidemiologic and toxicologic evidence was crucial in the recognition that tobacco causes lung cancer, but in that case there was strong, high quality evidence, a dose-response relationship, consistency, plausibility, coherence from all areas of research and all of Hill’s criteria of causation were fulfilled.
Now, there’s an interesting point regarding the effective communication of scientific knowledge: the use of epidemiologic studies where RCTs are either absent or impossible. The woo’ers love to cite these studies and the non-woo’ers love to disparage them.
However, in doing so, the non-woo’ers often appear to paint with a very broad brush and seem to be disparaging epidemiology and statistics in general. Finding a less broad (and bombastic) means for communicating the weaknesses of these studies might help the public better understand the scientific process and the manner in which both accurate and precise conclusions can be drawn from data.
Sometimes it appears that the non-woo’ers want to have their cake and eat it, too. For example, some “studies” are sponsored by advocacy organizations; the non-woo’ers would have us scrutinize their results carefully (and I would agree). But to extend that skepticism to the motives of chemical-producing corporations is to label them “evil” and be positively medieval in our thinking. Really?
Between the woo’ers and the non-woo’ers, it is the use of the sweeping broad brush that makes the communication so blurry, even if the underlying data is not.
David, you say:
“I assure you, our primary measurement of effectiveness at SBM is not collecting eyeballs or comments.”
“Yes, we like comments, too, just as we like traffic, but we these two things do not necessarily correlate with quality and effective communication. Having been in the blogosphere for five years, I know this to be true.”
However, Amy says:
“’my posts are effective because they garner lots of comments…
… and readers, and tweets, etc. That’s how effectiveness is measured in the blogosphere.”
Amy is quite clear. Traffic is the only measure of effectiveness for a blog post. While you may recognize a more complex set of measures that include traffic, Amy says she does not.
… either that, or Amy meant to say what you said, but said something else instead. If it is the latter, and I am supposed to divine what she really meant even though she doesn’t say it, then she is not writing clearly.
Amy,
“Of course some comments or tweets are better than others. For example, Ricki Lake tweeted about me this morning, referring to the post on her website, “Amy Tuteur, aka “The Skeptical OB,” Has a Blatant Issue With Home Birth,” and the comment thread that extended for several weeks and 152 entries thus far.
I’m mystified that Ms. Lake is proudly pointing to the discussion since I presented the scientific evidence on a number of aspects of homebirth and no one had an effective response.”
This seems to be the discussion in question: http://www.mybestbirth.com/profiles/blogs/amy-tuteur-aka-the-skeptical
If effectiveness is measured in traffic and comments, then 152 comments means the mybestbirth post was very effective and of course Ms. Lake is proud.
I suspect that Ms. Lake has no qualms about reposting your posts to her site because she does not find your writing persuasive and does not believe her readers will be persuaded either. If effectiveness is measured in persuasiveness, Ms. Lake believes your writing to be ineffective.
I hesitate to refer people to you for exactly the same reason Ms. Lake refers people to you eagerly. I do not find you persuasive. While your unconvincing writing plays right into Ms. Lake’s hands, it frustrates me.
I believe Revere on scienceblogs referred to the worship of the RCT “methodolatry.” That’s why I asked a few days ago on another SBM blog post how many prospective cohort studies or other epidemiological studies = RCT (knowing of course that the answer is complicated, but unsure how to resolve these complex issues). Of course in carcinogen research (toxins!), RCTs are impossible for the reason Rosemary mentions, so the lesser studies are all we got.
Thanks Dr. Hall.
lkw:
“Sometimes it appears that the non-woo’ers want to have their cake and eat it, too. For example, some “studies” are sponsored by advocacy organizations; the non-woo’ers would have us scrutinize their results carefully (and I would agree). But to extend that skepticism to the motives of chemical-producing corporations is to label them “evil” and be positively medieval in our thinking. Really?”
No. Science based medicine should involve disclosure of the competing interests of the researchers and sponsors. However, the fact that competing interests exist does not invalidate the research.
Ikw, I hope you aren’t including me in either the woo’er or non-woo’er category. I am not a Skeptic and I don’t call nonsense or irrationality “woo”. I call it crazy or silly. Neither do I consider all nonsense to be equal or equally dangerous. To me the silly kind is funny.
Ikw, “the non-woo’ers often appear to paint with a very broad brush and seem to be disparaging epidemiology and statistics in general.”
If that refers to me, I either didn’t express myself well or you have read into it something that wasn’t there. I do not disparage epidemiology or statistics. Neither do I worship RCT. I do my best to “weigh” the evidence in its entirety knowing full well that in the real world nothing is ever certain and that solid new evidence can appear at any time which leads to different conclusions than those previously indicated by the available evidence.
IMO, journalists writing articles like those linked to in the NYT cleverly get the general public to jump to conclusions that are not based on evidence but rather loose associations. I suspect the reason is that some of the journalists themselves jump to those conclusions but that others know that the fear they invoke will sell copy.
Ikw, “Finding a less broad (and bombastic) means for communicating the weaknesses of these studies might help the public better understand the scientific process and the manner in which both accurate and precise conclusions can be drawn from data.”
]
I think that there are a lot of people like the bloggers here and academics who have been trying to do just that for ever and a day yet they are failing horribly to reaching a very large segment of the general public. As I’ve said repeatedly, people learn in different ways. My style is not that of the academic or the Skeptic and I think that there are people, many of whom do not understand or even want to listen to academics or Skeptics, who understand me very well. [Admittedly, that is just my opinion. The evidence is very weak and of the poorest quality.
If any journalists are reading, I apologize. I think, but haven’t checked, that I may have used compliment instead of complement in a previous comment.
rosemary:
” it is a very important point since a great many people jump to the erroneous conclusion that whenever an author lists scientific sites or citations from scientific journals that his work is scientific and that the science supports his conclusions.”
That is an excellent point.
The technique is sometimes referred to as “bibliography salad” and it takes advantage of a common misconception that lay people have about science. Many lay people believe that publication of a scientific paper means that the paper has been evaluated as “true.” But publication means nothing of the kind; it merely means that the paper has been deemed worthy of being included in the discussion. Other scientists, doctors etc. will take it in to consideration when evaluating the overall body of evidence on the topic.
Moreover, as you point out, since the purveyors of “bibliography salad” depend on the fact that lay people will not read the actual papers, many citations do not support the claim or even undermine the claim.
That’s why when someone presents a “bibliography salad” to me, I always ask whether they have read the actual papers (not just the abstract) and whether they can produce a quote that supports whatever claim they are trying to make.
Not true. In fact, many of the studies upon which I rely and about which I’ve blogged about in order to show that there is no correlation between vaccines and autism are epidemiological studies, some of them quite huge.
re: Effectiveness in the blogosphere.
Quality and effective communication are the goals of SBM. While traffic and comments may be the popular measure of success in the blogosphere, they are only an indication that a lot of people are reading and want to express their own opinions. In fact, the number of comments seems to correlate best to the amount of emotion generated by the subject itself. The numbers themselves are a poor indicator for what we are trying to achieve.
I would rather write a high quality post understood by a few people and providing an enduring reference for information not readily available elsewhere than a lower quality popular post read by many. I hope I speak for all the SBM authors.
Speaking of which, this article answered pretty much every single question I’ve had since starting to read at SBM (EBM v SBM, Bayesian stats, RCTs, etc), all in one place. I wish you could pin it at the top of the site and hand it out to all high school students.
http://skepticstoolbox.org/hall/
Oh my, I am so happy to know that Aflatoxins, Ochratoxin, Citrinin, Ergot Alkaloids, Patulin, and Fusarium toxins don’t exist! And that is just the mycotoxins!
Let’s have a look at Ergot Alkaloids for a moment. How great is it that Science-Based Medicine has proved that Ergotism doesn’t exist, and as such the FDA can remove its limits for Ergot contamination of the foods we eat?
…
Or is this a case of a skeptic being as bad or worse than the “believers”?
For example, the author seems to not know the definition of “toxin” and “poison”. Here is a little help:
“Main Entry: tox·in
Pronunciation: ˈtäk-sən
Function: noun
Etymology: International Scientific Vocabulary
Date: 1886
: a poisonous substance that is a specific product of the metabolic activities of a living organism and is usually very unstable, notably toxic when introduced into the tissues, and typically capable of inducing antibody formation”
A toxin is a poison created by the metabolic activity of living organisms. Pretty simple, and I am sure they teach it in medical school…
But of course, in general use the words are interchangeable.
Thus, an environmental toxin would be a toxin that you were exposed to in your environment – in the air, the food, or water you consume – say “second hand smoke”, or contaminated flour.
Seriously is this what you think passes for skepticism? What does the MD stand for anyway? Surely not “medical doctor” when you don’t even know what a toxin is or any of the common environmental toxins we are exposed to?
Sure, if you want to have a go at the “detoxifying treatments” have at it…
But calling the entire gamut of toxins we are exposed to in our environments (not to mention chemical poisons) “imaginary” is the biggest “woo woo” (what a retard phrase that is!) I’ve read in a long time.
Science-Based my ass.
You’re rather late to the party. In fact, these issues were discussed days ago, much earlier on in this comment thread. Did you even bother to read the discussion? The reason I ask is that I pointed out that the official definition of the word “toxin” is a biologically produced substance that is poisonous to living organisms (the abbreviated definition, but more or less the same as what you cite).
This was back around Christmas Eve, actually–nearly a week ago.
Really, if you’re going to jump into a thread, do at least take the time to read what others have said, lest you contribute nothing new, which is what you just did, contributed nothing new.
I suspect, however, that you know full well that what Amy was talking about is how woo-meisters invoke all sorts of unnamed and mysterious “toxins” as the One True Cause of All Disease. They are not talking about Aflatoxins, Ochratoxin, Citrinin, Ergot Alkaloids, Patulin, and Fusarium toxins. Those toxins can be measured and produce characteristic toxic effects when introduced to the body. Not so alt-med “toxins,” which in general often can’t even be defined, much less measured. I also suspect that you buy into the whole “toxin” thing as the One True Cause of All Disease. I could be wrong, but we’ll see soon enough; that is, if your comment isn’t just a drive-by trolling.
So based on the comments here, is this a good time to advocate the banning of dihydrogen monoxide in foods and medicine?
Seriously though, as a person who works in genuine pharma, I know that some “toxins” can have a non-detrimental effect if used in small amounts. There are currently studies ongoing (some may have been completed) about the uses of botulinum in diabetic patients.
The claims that “all toxins are bad” are not only vague but are usually born from fear and lack of understanding.
As a disclaimer, I did used to work for a company that produced a Botulinum Toxin – B, but have not worked for them since 2005.
“You’re rather late to the party. In fact, these issues were discussed days ago, much earlier on in this comment thread.”
Not my fault the same retarded bullshit is still there uncorrected. Where is the errata explaining why the ‘MD’ hasn’t got a clue about what a toxin is? But no, I didn’t read the entire COMMENT thread, I COMMENTED on the article. Sue me.
As for “duscussed” let’s see what you said, (and yes I did read it before, and was one of the reasons I posted):
“I can see some merit in your criticism that Amy contradicted herself (or at least was not as clear as perhaps would have been advisable) in discussing the differences between alt-med “toxins” and real toxins; I noticed it myself and her attempt to distinguish “toxins” from “poisons” struck me as a distinction without a real difference, at least as explained.”
What a mealy mouthed load of bullshit that is!
“a distinction without a real difference”?
Sorry, but there is a clear definition in both the general world, and the scientific world, and neither of them are remotely close to “humours and miasmas”. Are you always this reserved when criticising bad science, or do you only save the “charltan! Woo Woo! Fraud! Quack!” bullshit for the ‘doctors’ you don’t agree with?
“The reason I ask is that I pointed out that the official definition of the word “toxin” is a biologically produced substance that is poisonous to living organisms”
Let’s see shall we:
“But since in this post you seem to be harping on the difference between “toxins” and “poisons,” if you really want me to get pedantic (and why the heck not at this point?), technically by definition toxins are biologically produced poisons.”
“However, I must admit that the criticism that you yourself weren’t all too clear on the concept of toxins is not entirely baseless. I realize that most people use the terms “toxin” and “poison” interchangeably, but that’s rather the point, isn’t it? They’re wrong to do that.”
“there is no excuse to be invoking vague concepts like “toxins,” which , as Amy correctly points out, resemble ancient concepts of contamination and miasma”
Yes, you pointed it out, then mealy-mouthed your way into saying the criticism is “not entirely baseless” (it’s NOT AT ALL baseless) Where are the insults? Is that reserved only for “them” and not “us”?
“Really, if you’re going to jump into a thread, do at least take the time to read what others have said, lest you contribute nothing new, which is what you just did, contributed nothing new.”
I came in late and decided to have a rant. The article is still there and many if not most people WON’T see YOUR correction (where is the author’s?). So I added mine to help make that less likely. Does that make you feel better about it? The fact is, this isn’t a discussion thread, it is a COMMENT thread. I commented on the article. What is your problem with that?
“I suspect, however, that you know full well that what Amy was talking about is how woo-meisters invoke all sorts of unnamed and mysterious “toxins” as the One True Cause of All Disease.”
No, I didn’t, I am not a mind reader (that’s impossible remember) and I don’t assume I know what someone is talking about when their words are so clear. It is not my fault your ‘MD’ friend there has no idea how to explain a concept in her mind clearly on ‘paper’.
Of course you also failed to mention ANY of the myriad REAL toxins we are exposed to on a regular basis, including ones that the FDA has decided we can be exposed to in our food. And that can cause very severe illness or even death. One of them is most commonly associated with long term exposure at low levels… exactly the kind of thing ‘detoxification’ is supposed to help clear up.
No, I am not defending THEM, I am just saying you lot are no better.
“They are not talking about Aflatoxins, Ochratoxin, Citrinin, Ergot Alkaloids, Patulin, and Fusarium toxins. ”
Oh, aren’t they? (nice cut and paste by the way) And you know this how? Are YOU a mind reader?
“I also suspect that you buy into the whole “toxin” thing as the One True Cause of All Disease.”
No, I am sitting here smoking a fag, drinking a beer and laughing my ASS off at your patently obvious attempt to change the subject. This isn’t about me, it’s about how your ‘MD” can’t seem to figure out that toxins are real and we are exposed to them regularly, and they DO cause disease and even death.
They are NOT imaginary, unlike your retard MD seems to think.
“I could be wrong, but we’ll see soon enough; that is, if your comment isn’t just a drive-by trolling.”
Oh, it’s a trolling… just not a drive-by… I am going to have too much fun talking to you True Believers…
Woo Woo!!!
“Seriously though, as a person who works in genuine pharma, I know that some “toxins” can have a non-detrimental effect if used in small amounts. There are currently studies ongoing (some may have been completed) about the uses of botulinum in diabetic patients.”
What the hell? Is that the only toxin you can think of that has been helpful to humanity?
Ever herd of of the mold called Penicillium chrysogenum (aka Penicillium notatum)? It produces a toxin that is probably responsible for saving more lives than all the rest of the pharmaceuticals combined (my own guess – probably wrong).
Man I wish Penicillin hadn’t turned out to be a figment of my imagination!
My problem with it was that you ranted about old stuff that was hashed out a week ago, and I merely pointed that out because you were being tedious.
My problem with it now is that you’re using profanity and referring to Amy as a “retard,” both of which are unacceptable behavior in the comments here. The discussions here can get quite heated at times. That’s fine, as long as some minimal decorum is maintained. If you have something substantive to say, say it. If all you’re going to do is keep throwing insults and profanity around, particularly offensive ones like “retard” (several of our regular readers have children with autism and neurodevelopmental disorders), you will be gone. This is your only warning. You won’t get another.
What about epigenetics? I studied the effects of alcohol on the brain for four years at UCSF. Clearly, it is a toxin and toxicity levels vary for each person. Over time, various cells respond by altering gene expression at the protein level.
I think it is dangerous to disreguard the effects.
I submit that environmental medicine is a western preventative medical approach to dealing with toxins such as mold, heavy metals, and gluten. While not all traditionally “toxic,” they can have adverse effects on individuals. Removal of the toxins requires more than a stupid colon cleanse because your liver and kidneys eventually will remove the toxins, but if you continue to consume the toxic food you will maintain concentrations in your blood and tissues and you will stay in a toxic state. Special chelating agents are required to remove toxins from the body and usually requires the help of a knowledgeable medical professional.
David Gorski
“My problem with it was that you ranted about old stuff that was hashed out a week ago, and I merely pointed that out because you were being tedious.”
Oh yeah… I am sure it is very tedious for you to listen to people correcting your and your friends mistakes… must happen a lot, based on how dumb this article is.
“My problem with it now is that you’re using profanity and referring to Amy as a “retard,” both of which are unacceptable behavior in the comments here.”
Ok, I apologise for the swearing (I thought skeptics wouldn’t be adhereing to the religious view on profanity), and I will refrain from using the word “retard”.
But now can you see how you lot treat other people?
““Alternative” health practitioners are nothing more than quacks and charlatans and their “remedies” are nothing more than snake oil.”
Quacks and Charlatans? Your MD’s whole career has come about because of the commercialisation (and artificial manufacture of) “alternative remedies”.
Ask her if she is one of the 60% of American doctors that have prescribed placebos. Ask her to explain what the difference is between that and “faith healing”.
What if the “woo woo” that makes people believe that “remedies” work actually makes them work? Do you REALLY want to remove what could be one of the most powerful “remedies” we have, that have no bad side effects?
Why is it that medicine is only good when some company has found a way to patent and profit like bandits from it?
Don’t start on the “because they’re tested” bull either – Vioxx was tested and APPROVED by the FDA. Ten years later its been withdrawn because it was killing people, and prozac has recently been re-tested and found to not be that much better than placebo. These companies have pillaged our heath systems, have driven prices through the roof, and in the end are not much better than the guy selling “colloidal silver”.
Why aren’t you screaming “quack and charlatan” at them?
Hypocrites.
“FDA analysts estimated that Vioxx caused between 88,000 and 139,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years the drug was on the market.”
On the low end, that is twenty six THOUSAND people DEAD in 5 years. 5,280 a year, or 14 people A DAY. And that is ONE of the myriad pharmaceuticals sold to us as “medicine”.
Tp put this in perspective, Vioxx was used to treat inflamation and pain – it never saved a single life.
If alternative medicines had a record as bad as that…
By the way, have you Science-Based Medicine people figured out how the Placebo Effect works? Or has “medicine” not bothered to study that because it can’t really be profited from?
“If you have something substantive to say, say it. If all you’re going to do is keep throwing insults and profanity around, particularly offensive ones like “retard” (several of our regular readers have children with autism and neurodevelopmental disorders), you will be gone.”
Firstly, why is a word offensive? The word means “held back” and used the way I have been using it, means “held back mentally”. If that is not an accurate description of this article, then I understand the objection… but like I said I will take note of the delicate senisibilities and I’ll refrain from using words that some might find offensive.
Now, can we talk about “quack” and “charlatan” and “woo woo” etc etc etc?
“This is your only warning. You won’t get another.”
Wow, so forceful! I mean, not asked.. WARNED… Warning recieved and understood… sir!
“Ask her if she is one of the 60% of American doctors that have prescribed placebos. Ask her to explain what the difference is between that and “faith healing”.
You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical.
“What if the “woo woo” that makes people believe that “remedies” work actually makes them work? Do you REALLY want to remove what could be one of the most powerful “remedies” we have, that have no bad side effects?”
You seem to have a mistaken idea of the placebo effect. The placebo effect is not the sign that a treatment is working, it is what happens when the treatment is not accomplishing anything.
“Why is it that medicine is only good when some company has found a way to patent and profit like bandits from it?”
Nothing has a greater profit margin than “alternative” treatments. No money is spent on testing. No money is spent on getting FDA approval. No money is spent on identifying an active ingredient and making sure that each dose contains the same amount. No money is spent on making sure that there is ANY active ingredient in a dose.
If you worry about profiteering, you should start with the “alternative” health industry. It is a multibillion dollar industry that is almost pure profit and offers no benefit.
“You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical.”
http://www.bloomberg.com/apps/news?pid=20601124&sid=ahaD1J6VIA.o&refer=home
I may have misquoted the numbers a bit because I missed that not all the doctors asked to respond, did. So you may be right that most don’t.
However… read the article and tell me I am totally wrong, and that no doctors would ever engage in “faith healing”.
“You seem to have a mistaken idea of the placebo effect. The placebo effect is not the sign that a treatment is working, it is what happens when the treatment is not accomplishing anything.”
Wait. A person gets ill. They get a placebo, They get better. You saying that doesn’t happen? Really?
http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all
“Nothing has a greater profit margin than “alternative” treatments.”
Are you kididng? How many alternative medicines cost THOUSANDS PER PILL? In my country some drugs are not available at our socialised hospitals because the companies that make them charge far more than they are worth.
Read the Wired article about how in the 90’s pharmaceuticals were more profitable than OIL.
I wonder… do you work for any pharmaceutical companies, or have investments in them? Perhaps disclosure is in order? Care to swear that you have no vested interest in protecting the pharmaceutical industry?
“No money is spent on getting FDA approval. ”
You mean no money is spent BUYING FDA approval – unless you think the process worked for Vioxx. This wasn’t some subtle effect that took years to show, Vioxx only lasted on the market for 5 years. and may be responsible for over 20 thousand deaths – for a drug that saved not one life.
“No money is spent on identifying an active ingredient ”
LOL and that is done to make the medicine work better? Or so the drug can be patented? Can’t patent a leaf, but you can patent the artificially produced extract of that leaf….
“No money is spent on making sure that there is ANY active ingredient in a dose.”
Placebo Effect. There doesn’t NEED to be an active ingredient – as long as everyone thinks there is.
“If you worry about profiteering, you should start with the “alternative” health industry.”
Why? Why not the mainstream industry? They have far more effect (and steal far more money).
See: Vioxx!
“It is a multibillion dollar industry that is almost pure profit and offers no benefit.”
Vioxx, vioxx, vioxx.
And that is only ONE RECENT drug scandal. Remember Thalidomide?
What “herbal remedy” has done THAT? Care to name one?
There seems to have been an error while posting, because this post hasn’t shown up but it tells me it’s a duplicate. I’ll try again:
“You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical.”
http://www.bloomberg.com/apps/news?pid=20601124&sid=ahaD1J6VIA.o&refer=home
I may have misquoted the numbers a bit because I missed that not all the doctors asked to respond, did. So you may be right that most don’t.
However… read the article and tell me I am totally wrong, and that no doctors would ever engage in “faith healing”.
“You seem to have a mistaken idea of the placebo effect. The placebo effect is not the sign that a treatment is working, it is what happens when the treatment is not accomplishing anything.”
Wait. A person gets ill. They get a placebo, They get better. You saying that doesn’t happen? Really?
http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all
“Nothing has a greater profit margin than “alternative” treatments.”
Are you kididng? How many alternative medicines cost THOUSANDS PER PILL? In my country some drugs are not available at our socialised hospitals because the companies that make them charge far more than they are worth.
Read the Wired article about how in the 90’s pharmaceuticals were more profitable than OIL.
I wonder… do you work for any pharmaceutical companies, or have investments in them? Perhaps disclosure is in order? Care to swear that you have no vested interest in protecting the pharmaceutical industry?
“No money is spent on getting FDA approval. ”
You mean no money is spent BUYING FDA approval – unless you think the process worked for Vioxx. This wasn’t some subtle effect that took years to show, Vioxx only lasted on the market for 5 years. and may be responsible for over 20 thousand deaths – for a drug that saved not one life.
“No money is spent on identifying an active ingredient ”
LOL and that is done to make the medicine work better? Or so the drug can be patented? Can’t patent a leaf, but you can patent the artificially produced extract of that leaf….
“No money is spent on making sure that there is ANY active ingredient in a dose.”
Placebo Effect. There doesn’t NEED to be an active ingredient – as long as everyone thinks there is.
“If you worry about profiteering, you should start with the “alternative” health industry.”
Why? Why not the mainstream industry? They have far more effect (and steal far more money).
See: Vioxx!
“It is a multibillion dollar industry that is almost pure profit and offers no benefit.”
Vioxx, vioxx, vioxx.
And that is only ONE RECENT drug scandal. Remember Thalidomide?
What “herbal remedy” has done THAT? Care to name one?
Maybe a little more information might be warranted:
“The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as many as 20% to 30% of patients receive contraindicated care.1 In addition, with the release of the Institute of Medicine (IOM) report “To Err Is Human,”2 millions of Americans learned, for the first time, that an estimated 44,000 to 98,000 among them die each year as a result of medical errors.”
http://jama.ama-assn.org/cgi/content/extract/284/4/483
Care to tell me how many people die from alternative medical care each year?
By the way, it turns out this MD doesn’t know what the Placebo Effect is either…
“The placebo effect is the measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered.”
http://www.skepdic.com/placebo.html
” * In recent decades reports have confirmed the efficacy of various sham treatments in nearly all areas of medicine. Placebos have helped alleviate pain, depression, anxiety, Parkinson’s disease, inflammatory disorders and even cancer.
* Placebo effects can arise not only from a conscious belief in a drug but also from subconscious associations between recovery and the experience of being treated—from the pinch of a shot to a doctor’s white coat. Such subliminal conditioning can control bodily processes of which we are unaware, such as immune responses and the release of hormones.
* Researchers have decoded some of the biology of placebo responses, demonstrating that they stem from active processes in the brain. ”
http://www.scientificamerican.com/article.cfm?id=placebo-effect-a-cure-in-the-mind
It seems to me that you (the people who have responded to me) seem to think I am some airy-fairy “my crystals protect me” spirtualist.
Bet you regret making that assumption…
Nothing I have said comes from the ‘alternative medicine’ people.
You will note my links are to Wired, Scientific American, The Skeptic’s Dictionary, and the JAMA.
Funny how this doctor seems so out of touch with modern medicine, isn’t it?
Karmakaze asked “how many people die from alternative medical care each year?”
A few. Take a look at the What’s The Harm website. But first, how about you tell us how many lives are saved by alternative medical care each year.
It is a fallacy to compare the risks of the two systems without putting them into perspective with the benefits of those systems. Alternative medicine is distinguished from scientific medicine by the fact that it hasn’t been proven to work. If it had, it would have been incorporated into mainstream medicine and would no longer be called alternative. Mainstream medicine saves lives and has a risk/benefit ratio; alternative medicine doesn’t.
This has been discussed on this blog before. See http://www.sciencebasedmedicine.org/?p=136
Of course, KK conveniently forgets to mention that thalidomide was never approved in the U.S. as a morning after pill. FDA reviewer Frances Oldham Kelsey refused approval for the applicatio to market thalidomide in the U.S. on the grounds that more study was needed. In the case of thalidomide, the FDA approval process worked fairly well. At least it worked better than the process did in several other countries.
Moreover, in recent years, thalidomide has been shown to be quite a useful drug in treating multiple myeloma.
[Editor note: ERROR, brain fart. "Morning after" was supposed to read "morning sickness."]
Actually, now you come across as your garden variety Mike Adams-style “critic” who’s simply hostile to and suspicious of scientific medicine in general and big pharma in particular. You may think your “critiques” are brilliant or novel, but your ilk is nothing we haven’t seen here many, many times before.
Oh, give me a break with the disingenuous nonsense.
If you don’t already understand why using the term “retard” the way you did as an insult is offensive, I doubt I can explain it to you. Simply don’t use it again. Whine about the warning all you want, but this discussion forum is not a democracy. We’re pretty lax in what we permit, but we do have limits, and, yes, as editor I get to decide in consultation with Steve Novella when a commenter has crossed the line. Don’t like it? You can go elsewhere.
Actually, it’s not true that Vioxx didn’t benefit many patients. Even Dr. Eric Topol, the strongest detractor of Merck and Vioxx, concedes that Vioxx was a useful drug and helped a lot of people. Indeed, in an interview in Michael Spector’s recent book Denialism, in what was otherwise a very harsh chapter about Merck and in essence a paean to Dr. Topol’s crusade against Merck, I was surprised to read Topol quoted as saying flatly that Vioxx should not have been taken off the market. In his opinion there should have been issued a black box warning regarding patients with diabetes or preexisting cardiovascular disease. In reality, Vioxx was a pretty good drug except for patients who fell into a couple of high risk categories. The idiocy of Merck’s leaders in trying to cover up these categories was an enormous self-inflicted wound from which Merck may never fully recover.
“Of course, KK conveniently forgets to mention that thalidomide was never approved in the U.S. as a morning after pill.”
Nor anywhere else either, as I understand it. Morning sickness, yes. And currently in the US for leprosy and multiple myeloma. (Doesn’t take away from anything you’ve said.)
“They get better. You saying that doesn’t happen? Really?”
No, that’s not what I am saying. Some people will get better if nothing is done for reasons we might or might not understand. Treatments are tested against placebo to judge the true effect of the treatment.
Let’s say that after receiving Vioxx, for example, 50% of patients reported a decrease in pain. That makes it sound like 50% of the people who received Vioxx benefited. However, if we know that 35% of the people reported a decrease in pain after receiving placebo, we can see that the Vioxx benefited only 15%.
In other words, the placebo effect is not a treatment; it gives us a better idea of who would have improved without real treatment.
Deliberately invoking the placebo effect depends on a lie; the patient believes he is getting effective treatment when he is not. In the case of a randomized controlled double blind study, no one is deliberately lying to the patient, since the doctor doesn’t know what the patient is getting, either.
However, deliberately invoking the placebo effect in the absence of blinding of the doctor means that the doctor is knowingly lying. I can’t imagine anything more likely to destroy the doctor-patient relationship than encouraging doctors to lie to patients “for their own good.”
Moreover, you haven’t explained why quacks and charlatans should profit by deliberately lying to patients about the efficacy of their “treatments.” It is difficult for me to imagine a legitimate reason to reward entrepreneurs for lying.
” How many alternative medicines cost THOUSANDS PER PILL? ”
I said profit margin, not profit.
Consider those medications that cost thousands per pill. What is the profit margin? How much money went into research and development, testing and obtaining FDA approval? How much money goes into creating each pill, making sure that each pills has the exact same amount of active ingredient? How much money was lost developing treatments that never gained FDA approval? Millions? Tens of millions? Hundreds of millions?
How much money goes into research and development of an alternative “treatment”? Zero dollars. How much money goes into testing and obtaining FDA approval? Zero dollars. How much money goes into making sure that each dose contains the same amount of active ingredient? Zero dollars. And how much money is lost developing treatments that don’t gain FDA approval? Zero dollars, since treatments are marketed whether they work or not.
When it comes to alternative “treatments” only a minimal amount of money is invested and the returns are pure profit. If your real concern were profiteering, you’d be appalled by the “alternative” health industry.
Amy, both profit and profit margin take expenses and investment into account and could be used interchangeably for the purposes of this discussion. Profit is expressed in absolute terms (the number of dollars); profit margin is expressed as a percentage of revenue.
What our agitated KK is lathering on about is the revenue. As you correctly emphasize, revenue tells us nothing about the profit or profit margin.
Nice bit of pedantry there, but mea culpa for a brain fart.
Yes, sorry, I am sadly pedantic. I tried to keep it short, and I repeat that the brain fart doesn’t take away from your point that the FDA works.
Just from a business perspective, when comparing a supplement business with a pharmaceutical business, one must also consider return on investment as well as the speculative nature of the investment for a drug company.
Pharmaceutical companies must and do invest huge sums of money to develop drugs, yet there is no guarantee that any of the drugs they work on will be successful. If I remember correctly, the chances of that are actually quite slim, and if there is a return on investment, it usually takes years for it to come. Most investors will not invest in something speculative with any potential profits a long way off unless they hope that the return will be worth the risk and the wait.
Supplement companies, on the other hand, start on a shoestring. (Hey, Joe, ya got some space in ya garage I can rent? I wanna mix up a bunch of weeds. My wife doesn’t like the smell in her kitchen.) My guess is that most of their investment goes into marketing, lobbying and packaging, but mostly marketing. Many make millions very quickly after opening. In other words their return on investment is excellent and the amount of time it takes to get it is very fast.
Furthermore, given the present legal climate, their risks, unlike those of drug companies, are miniscule.
Of course, none of that means that drug companies are loving, caring altruistic corporations. But neither are the supplement companies. Which is the reason that they all need to be regulated to a degree that will keep them as honest as possible in our imperfect world which is not the standard we have today when, for all practical purposes, supplement companies are unregulated and often get away with murder, and I don’t mean that figuratively speaking either.
Dr. Gorski:
I thought it was a very interesting chapter, but my reading was that not only did Vioxx cause all these deaths (many more than any CAM I’ve ever heard of), but it was also shown not to be any more effective than aleve at reducing pain. (Where’s the benefit there?). However, that it DID reduce the risk of GI problems. I believe the studies showed a risk factor for more than just those with prior history of heart disease. So I didn’t follow his conclusion about why it should have been left on the market.
He seemed to be saying that Vioxx is an isolated incident (along with the rest of the skeptics). While I’m not sure it’s common, I don’t for one minute think this is an isolated problem, or it wouldn’t have taken YEARS for it to be taken off. Topol wouldn’t have been fired. The FDA wouldn’t have been complicit. And Merck would have been forced to make some admissions of guilt. These are systemic problems. (not that I think the solution is to abandon modern medicine or trust quacks). Specter mentions than nothing substantial has changed either.
All in all, though, I pretty much agreed with this review of the book. I liked Shermer’s “The Borderlands of Science” MUCH better in terms of bringing the message to a wider audience, not demonizing people, or engaging in a “nature vs. science” false dichotomy. “Science as a candle in the dark” to quote Sagan.
http://www.amazon.com/review/R2PQ9XRJ5RY1JQ
Dr. Tuteur:
There was some discussion of using a surgical procedure as placebo here. Could the authors/commenters been joking? And actually, I’ve seen this [phrase] before on SBM. As long as you are honest about it, is there a harm? General question I’ve wondered. Do almost 50% of doctors really prescribe placebos 2-3x/month, as referenced above?
Dr. Gorski, from vertebroplasty post:
http://www.sciencebasedmedicine.org/?p=665
http://www.sciencebasedmedicine.org/?p=665
Dr. Gorski:
Criticisms of acupucture and chiro are a dime a dozen these days too. So what? Even though I don’t like the poster’s style, he brings up some good points (red herrings and strawmen though, some).
(I think profit and profit margin are pretty much the same thing).
Most of the money from drug companies goes to marketing, not research. Vioxx had a profit somewhere around 6 billion over the several years. I seriously doubt there has ever been a CAM drug that profitable, even if they didn’t have all of the costs.
http://www.sciencedaily.com/releases/2008/01/080105140107.htm
@ zoe237
a minor quibble
“(I think profit and profit margin are pretty much the same thing).”
i’m sure an accountant would disagree with you, hence the distinction in name. for good measure…
Profit:
The positive gain from an investment or business operation after subtracting for all expenses. opposite of loss.
Profit Margin:
Net profit after taxes divided by sales for a given 12-month period, expressed as a percentage.
So…sorry, they are not pretty much the same thing.
Thanks Eric. I’m still not sure it makes any difference to a discussion of whether Big pharma companies or Big Alties make more money. Both profit and profit margin take into account expenses and sales of either business.
It really does make a significant difference, because one of them (profit) is a function of scale and the other (profit margin) is not. Depending on the precise question at hand, either one might be the more relevant measure.
For example, you cite Vioxx making a profit of $6B, and I’ll accept that figure for the sake of discussion. It makes a huge difference whether that’s $6B after costs of $600B, or after costs of $1B (numbers selected to make a point, with no claims of accuracy or even reasonability).
In the former case, the profit margin is 1%. The conclusion would be that the $600B could have been far better employed elsewhere (just sticking it in the bank would typically do better), and that the drug was actually a flop.
In the latter case, a profit margin of 500% is truly massive, and will attract a great deal of interest in matching it. People would pile into that business, even if they have to be dishonest to do so.
Profit is greatly affected by how much money is available to be sunk into the business. But profit MARGIN determines how much money a particular venture (with a particular amount of funding available) might be able to make, and hence is far more relevant to the question of how much incentive there is for mendacity.
If you wanted to address simply “which industry is bigger”, profit would be a not unreasonable measure. But for the question “who has more incentive to peddle snake oil”, profit MARGIN is the proper thing to look at.
Scott, you’ve described me a good reason to use profit margin ( as a percentage return on an investment) as a good comparison to that of a bank. It’s certainly valuable for investors and producers. But comparing companies or industries to each other seems iffy. Health insurance companies have traditionally low profit margins (2-3%) but so what? BCBS is still yanking my chain about paying for my knee surgery, six months later, for no other reason other than they screwed up on the year of my birth. 3% profit margin on 20 billion dollars is a lot different than a profit margin of 3% on $100,000. Basically you claim to be saying that because the investors are putting less into the product that they are more likely to lie about it. You could make the opposite argument too. That doesn’t make any sense. But maybe I’m missing something.
Moreover, this article mentions that pharmaceutical companies have profit margins of 17%. Other sources I’ve read put it as high as 19%, and that pharmaceuticals are the most profitable industry on the planet, more profitable than oil (where PM are somewhere around 9%). Does CAM really have as high a profit margins as this?
http://www.time.com/time/magazine/article/0,9171,993223-2,00.html
I can see why some people would believe that profit margin is more relevant and I admit my mistake. Still seems like splitting hairs to me though.
Can I just say I hate economics about as much as I love science?
@ Zoe237
“Can I just say I hate economics about as much as I love science? ”
absolutely, I would say most on this blog are of similar sentiment
“I can see why some people would believe that profit margin is more relevant and I admit my mistake. Still seems like splitting hairs to me though.”
true, it teeters on splitting hairs, but it is important. your point seems to be that profit margin is irrelevant because of scale, in that a margin of 10% in a billion dollar industry is of greater concern than a margin of 20% in a million dollar industry (as an example only).
I could, if I wanted, go to the store (or heck, the woods), assemble a random concoction of herbs and vitamins, throw up a website and be in business. I could post a variety of sham testimonials and never even call the FDA. I could charge 40x what it took me to make the “formula” and tie it up nice with a bow promising all sorts of miracles. Kevin Trudeau basically did this but, he is even more clever – he never even delivers the goods, just leads you on a fool’s errand to find them yourself…by paying him first. As mentioned earilier, his only expense is cranking out his infomercials with the hope (and success) that enough will buy his useless book and perhaps even subscribe to his website. I would imagine his margin is pretty insane, as the infomercials are still running.
What we are talking about here is essentially barriers to entry. It would be much harder for me to develop a drug…for 1000 different reasons, one of which is notably capital.
so in discussion of margins, it is a useful tool. In this scenario it sheds light on barriers to entry and the potential for any old schmoe to make dishonest money hand over fist with little investment while simultaneously making a pittance compared to competing treatment options from an industry leader/competitor such as a large pharma org.
Let me try to clarify with an example. Suppose Joe has some money to invest in something, and he’s trying to decide what. One opportunity will provide him with a profit margin of 5% honestly. Another will provide him with a profit margin of 5.5% dishonestly. Unless he’s really unscrupulous, he’ll probably go with the former.
But if there’s a third option with a profit margin of 200%, which is dishonest, there’s a quite good chance that he’ll go for that one.
The point I’m trying to make is that the incentives to do something dishonest are a greater if the gains which will be obtained are larger. And for a given individual making a decision how to invest a given amount of money (the usual real-world situation), the profit margin available in an industry is a much better measure of the gains the individual can expect than the profits of a particular company (or even the whole industry) of unknown scale.
Put yet another way, what’s important to Joe is how much profit Joe can make given the amount of money Joe has to invest. Whether Merck makes profits of $6B or $5B is irrelevant to him, but Merck’s profit margins are relevant because they suggest how much he might be able to make with his money if he invests in pharmaceuticals.
And for the pedantic, yes, I’m completely and deliberately ignoring the fact that profits most definitively do NOT scale linearly with investment; the key points are clearer that way.
Or to more directly address your comment, the key point is not that they’re spending less; it’s that they’re making more profit for a given investment. If you fix profit at a constant level, then yes, higher profit margin implies lower investment, but that’s never the real-world situation.
I wouldn’t be at all surprised if they were 100% or even higher, though I’m not aware of any specific figures. Any statement along the lines of “most profitable industry on the planet” can be pretty much completely discounted. What it really means is “most profitable of the industries I have numbers for, with industries defined in the way used for calculating those numbers.” In most such statistics, CAM would either not be counted at all or would be counted as part of the larger pharmaceutical/health industries. It would be quite unlikely that it was considered separately unless that was the point of the calculation.
I think it’s unfortunate that the author put this in such black and white terms and there seems to be some confusion regarding new agey detox diets and the very well documented (by science, thank you very much) pollution of the planet and the effects on the health of all of us animals. It’s, of course, just this conflating of two unrelated things that makes it easy for woo-meisters to sell detox diets to relatively intelligent (if not scientifically literate) people. Most of the more mainstream woo is sold in this way.
These kinds of false dichotomies help no one nor to they get to the truth or actually support good science. It’s like the fake Big Pharma vs Big sCAM gambit – both Big Pharma and Big sCAM are primarily in business to make money for their owners or shareholders (at an ever increasing percentage), both use corrupted/pseudo-science and lobby the government to avoid consumer safety regulations, neither actually cares about the people they’re selling things to. Industry uses science, it isn’t actually science itself.
While detox diets are total rubbish and are part of a rather narcissistic and obsessive need to be “pure” (which is as prevalent amongst right wing Protestant Christians as it is amongst bourgeois boomers and new agers, both are equally into woo), pretending all environmental toxins/poisons are “natural” just seems silly. (And, to be realistic, if someone is living off of fast and packaged food and driving everywhere then switching to a healthy diet and getting some exercise will make a big difference to their health and consequently to brain function and mental state.) To make out that anyone concerned about the environment and industry is just anti-industry or anti-science is living in another type of fantasy land (which presumes industrialists aren’t motivated by increasing their bottom line, talk about a naive take on the world!).
What I’ve noticed with some people into extreme diets (who aren’t genuinely allergic or intolerant to something) is that it’s really a means to control people around them. I’m not talking about vegans or people into special diets who just pack their own lunch – there are plenty of vegans who are just quietly doing their own thing as a personal choice that they don’t impose upon others – I’m talking about people who get mad that others and society don’t bend and conform to their desires and needs. It’s pure narcissism really, as is the desire to be “pure”. To me it seems totally linked into the general weird American obsession with killing germs and sanitary insanity that equates being “good” and “safe” with being clean. The “dangerous world” meme in the US is spread throughout society, the “detox diet” is only one manifestation of it. An even more prevalent one is the total paranoid fear of terrorism and the Other who is out to get America. Germs, terrorists, toxins….all the unseen bad just waiting out there to pounce on Americans to steal away the American way of life and defile the purity of American children!!!!! Oh nooooooooo….it’s really just a fear of death, and life for that matter.
Of course environmental toxins exist and, in general, industry has proven itself over and over again to wildly disregard public health if there’s a buck to be made. It’s why we have environmental protection laws, to try to force industries to minimize the toxicity of what they emit as by-products of industrial processes. Of course, everyone who drives a car contributes as well, and the vast majority of us by the products made by industry, so we’re all responsible. (Since we’re all on computers, we’re all contributing in one way or the other to both pollution from mining and exploitation of other people.)
“Or to more directly address your comment, the key point is not that they’re spending less; it’s that they’re making more profit for a given investment. If you fix profit at a constant level, then yes, higher profit margin implies lower investment, but that’s never the real-world situation.”
Ah, yes, that makes more sense to me. I’m still not sure I agree that it is more relevant than actual profit, but I’ll have to let it go for sake of time. But I do understand the original comment much better.
Fifi, I do believe I agree with every word you just wrote. I’m not trying to defend CAM at all. I just think the debate is oversimplified by some on both sides.
“Poisons exist, of course, but their existence is hardly a secret, and their actions are well known.” Au contraire, as pointed out in this January 3 Washington Post article.
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/03/AR2010010302110.html
“Of the 84,000 chemicals in commercial use in the United States — from flame retardants in furniture to household cleaners — nearly 20 percent are secret, according to the Environmental Protection Agency, their names and physical properties guarded from consumers and virtually all public officials under a little-known federal provision.”
“Although a number of the roughly 17,000 secret chemicals may be harmless, manufacturers have reported in mandatory notices to the government that many pose a “substantial risk” to public health or the environment. In March, for example, more than half of the 65 “substantial risk” reports filed with the Environmental Protection Agency involved secret chemicals.”
“Of the secret chemicals, 151 are made in quantities of more than 1 million tons a year and 10 are used specifically in children’s products, according to the EPA. The identities of the chemicals are known to a handful of EPA employees who are legally barred from sharing that information with other federal officials, state health and environmental regulators, foreign governments, emergency responders and the public.”
“The handful of EPA officials privy to the identity of the chemicals do not have other information that could help them assess the risk, said Lynn Goldman, a former EPA official and a pediatrician and epidemiologist at the Johns Hopkins Bloomberg School of Public Health.”
Eric and Scott,
Your discussions of the different uses of absolute profit and profit margins are well taken.
The reason I said that they could be used interchangeably for the purposes of this discussion was that it came up in repsonse to a barely coherent troll by KK commenting on Amy’s statement that “Nothing has a greater profit margin than ‘alternative’ treatments.”
“Are you kididng? How many alternative medicines cost THOUSANDS PER PILL?”
Amy is completely correct and KK’s response is a non-sequiteur. If the price of a chemotherapy drug is a thousand dollars and it costs a thousand dollars to deliver it, profit (both margin and absolute) would be low. All the price of an expensive drug tells you is that revenue per dose for that drug is high. For all we know that drug is being sold at a loss. It’s also possible that they have us by the short hairs and we are being charged thousands for a life-saving drug that costs very little to deliver. We would need an understanding of both margin and absolute profit to understand what was really happening. (5% margin with high volume and fast turnover is better than 50% margin with low volume and slow turnover. If I can sell something that costs me $100 for $105, that’s an annual rate of return of 5% on a $100 investment if I sell one a year. If I sell one a week, it’s an annual rate of return of 260%.)
Correcting KK by emphasising margin over absolute profit is not wrong, but since KK was talking about revenue, not profit, his error was at a more fundamental level.
fifi – *clap* *clap*
yea, im on board with that.
Allison Cummins and Zoe237
to be completely honest, I lost where the “purpose” of the distinction came in. I merely saw an opportunity to interject that they are in fact different and that distinction could be usefully applied to what we are discussing atm. i ’spose that gets a bit pedantic at some point.
what you get into, Allison, I fully concede as important to acknowledge.
@Zoe
“Moreover, this article mentions that pharmaceutical companies have profit margins of 17%. Other sources I’ve read put it as high as 19%, and that pharmaceuticals are the most profitable industry on the planet, more profitable than oil (where PM are somewhere around 9%). Does CAM really have as high a profit margins as this?”
I don’t know where that information came from. I’m a regular investor, always looking for attractive equities – and I don’t own a single pharmaceutical stock right now. It is a very tough business. Later I’ll pull some charts and tell you what the real numbers are.
Here’s some Forbes data on Merck: pre-tax profit margin of 30.6%; after tax profit margin of 22.5%
http://finapps.forbes.com/finapps/jsp/finance/compinfo/Ratios.jsp?tkr=mrk
Pfizer after tax profit margin 18.8%….Glaxo 21.8%….
“Here’s some Forbes data on Merck: pre-tax profit margin of 30.6%; after tax profit margin of 22.5%”
You do realize that Merck is a major purveyor of “alternative” remedies as well as pharmaceuticals, right?
“You do realize that Merck is a major purveyor of “alternative” remedies as well as pharmaceuticals, right?”
Of course they are, which is why Big Pharma vs Big sCAM is about marketing and ideology and not actually about science or medicine. It’s also why it’s so important to have scientific research that isn’t tethered to profit or industry but, instead, is done in the public interest.
Here in Canada, our disgustingly pro-industry NeoCon PM (not that NeoLiberals are any better really) appointed a chiropractor to be Minister of Science and Technology and appointed a Pfizer exec (who still works for Pfizer) to a body that oversees health research funding. The only ideology at work is political corporatism and finding ways to channel public funds into private pockets. The whole Big Pharma vs Big sCAM thing is merely to distract us plebians – it’s the dog and pony show to distract us while science and any other reality based practice that may interfere with corporate profit is dismantled or co-opted.
Amy, care to break out the profit margins for the various divisions of Merck, Pfizer, Glaxo, etc. (by vaccines, pharmaceuticals, etc.?) Your comment is meaningless if not documented quantitatively.
Also gotta love the % of sales spent on SG&A v. R&D…
SG&A R&D
Merck 32.5% 19.3%
Pfizer 32.0% 15.6%
Glaxo 32.1% 14.5%
Remember that the next time you hear pharma execs whining about how much they spend on R&D.
“care to break out the profit margins for the various divisions of Merck”
No, that’s YOUR job if you wish to claim that profits come largely from the pharmaceutical division.
Amy, it’s not my “job”. However it is your job to substantiate your claims to maintain credibility. But in the interest of education (always a good cause) I will take the bait. Page 66 of Merck’s 2008 10-K filing with the SEC breaks out profits by division thus for 2008, 2007 and 2006 respectively:
Pharmaceutical segment profits $12.4 billion, $13.4 billion and $12.5 billion
Vaccine segment profits $2.8 billion, $2.6 billion and $1.3 billion
Other segment profits $419 million, $453 million and $381 million
Pharmaceuticals and vaccines account for 97.4% of profits. Yes those billions are profits, not gross revenues. So it is true that “profits come largely from the pharmaceutical division” as you put it.
My comment (brief, no links) from 5 hours ago appears to be held up for some reason. One point I made was that according to public SEC documents (Merck’s 2008 10-K) the company’s pharmaceutical and vaccines segments accounted for over 95% of revenues and profits. The point is that Merck enjoys both high profit margins and high absolute profits, the overwhelming majority of which are generated by pharmaceuticals and vaccines, regardless of the company’s status as a “purveyor” of alternative health products. Thus, it is correct that “profits come largely from the pharmaceutical division” as Amy phrased it.
That doesn’t necessarily answer the question, though. Does that filing make clear whether Merck’s sCAM offerings fall under the pharmaceutical division, or are they counted as their own?
If the latter is demonstrably the case, you’ve proven your point. If not, it’s still open to some question.
I assumed that the readers and commenters on this site had actually waded through the muck produced by the supplement industry, the engine that fuels the billion $$$ alt. med industry, However, reading these comments, I suspect that I was wrong.
Based on my attempts to investigate supplements, I have come to suspect that the industry developed when some very savvy marketers realized that by making health claims they could sell all kinds of garbage at terrific markups. They found products used by what was and may still be called “the lunatic fringe”, things like “natural and homeopathic remedies”. Initially, the marketers used outrageous, insane claims, testimonials and characters to get the attention of a large portion of the public who effectively lobbied the government to give them “freedom of choice” by creating an entire legal category of virtually unregulated products promoted for human consumption.
Then they started to clean up and water down the outrageous claims to make them sound plausible to the general public, the mass market. Homeopathic remedies were sold next to OTCs in pharmacies giving the erroneous impression that they too were regulated OTCs rather than well shaken water. A supplement like silver was sold in health fraud stores by clerks claiming that it was the “natural” antibiotic granny took to prevent and cure colds and the flu. (A very uneducated public didn’t notice that colds and flu are caused by viruses which antibiotics don’t work against or that granny actually suffered from lots of colds and flu because she didn’t have a remedy that worked against them.)
In the beginning while demonstrating outside my local health fraud store one of the normally ever so pleasant saleswomen came out to speak with me leaving her “retail smile” behind in the store. I distinctly remember her disgruntled look as she walked back into the establishment in a huff after I told her what damn fools they were, how they were being used by the supplement industry explaining that while they were opening up the market and taking all the hits on the front lines, they were not going to be the ones who made the big bucks. The profits would be made by a few of the little guys, the very few who had the skill to actually develop large profitable businesses, by the drug companies who were probably salivating in the wings at the thought of all they could earn in the unregulated supplement industry, and by other large industries such as those who supply the supplement industry with its raw materials as well as those who produce its “educational” material like books and magazines promoting the stuff.
As Fifi has pointed out, that has happened.
I’m really sorry. I just don’t have time to cover this in a comment, but I would strongly suggest that those of you who have not waded through the supplement muck start doing so to educate yourselves. I think if you do, you will stop thinking in terms of drug companies vs. supplement companies and start thinking of regulated vs. unregulated. You will also see the way supplement salesmen use the term “toxin” and how they promote chemo-phobia to sell their “natural” products.
To give you a general idea of what I’m talking about, I will include a few links on the silver fraud, the one I know best, starting with my own webpage, followed by just a few comments.
http://rosemaryjacobs.com
http://www.quackwatch.org/14Legal/hinkson.html
http://www.justice.gov/opa/pr/2005/January/05_crm_039.htm
There are several unconfirmed reports of Oz Water causing argyria. This is the site with the claims for its silver supplement as it appears today, after the founder went to jail.
http://wateroz.jeffotto.com/products/silver.htm
While Oz may sound extreme, IMO, the only part that really is is the effort by the owner to have 3 federal officers killed. I myself have been threatened and am absolutely certain that at least one of the major silver quacks suffers from a very serious, untreated mental illness. Yet I also know how with his sites, now down, and books, he has fooled a good many intelligent people.
Regarding supplement profits. From PR Newswire, Dec. 8, 1998, “Clifton Mining Company (OTC-Bulletin Board: CFTN; Alberta: CFB) is pleased to announce that the company obtained the majority interest in American Silver LLC, in a cash transaction, which is a new private company that manufactures and distributes health supplement – colloidal silver products…a perfect fit, multiplying silver values at least 50 fold, and at the same time making a product that many significantly benefit mankind.” It really says 50 fold, not 50%.
I’m sorry. I don’t have the time to even tell you about American Silver although I do mention it in an FAQ in which I have posted comments from the head of microbiology at BYU.
I’m not clear why alt-med offerings by Merck would *not* be counted under the pharmaceutical division. It’s the most logical place, from a business perspective, to put them. It’s not like there’s anything fundamentally different from a manufacturing or business perspective.
I think it’s funny that you’re arguing about where Merck’s biggest profits come from when Merck doesn’t care, they just want to profit from selling people things (if they can get the government to mandate their product all the better). Both Big Pharma and Big sCAM lobby governments to try to avoid consumer protection and/or get government money – not based on evidence – both are profit driven and could care less as long as they’re making cash. A drug/treatment has deadly side effects and is recalled? Neither Merck or Guru’s Miracle Tonic care if they lose in court as long as they’ve made more in profit than they paid (or avoided paying) in fines. Really, all these ideological battles are just diversions and a means to suck people into consuming one brand or the other. Or, better yet, to consume both. Ideologues on both sides seem totally blind to the fact that both Big Pharma and Big sCAM are about integration and getting consumers to use both. They BOTH want to get rid of pesky science that’s done in the public interest and get the public to fund their research (which they’ll own the results of, of course, and then sell back to us). It really is entirely irrelevant whether Merck currently makes more selling one product or the other – but keep up the dog and pony show so that no one notices what’s really going on!
I find it interesting that the focus here is always on Big Pharma and there’s rarely any discussion of generic drugs and their manufacturers (whose interests are often in conflict with Big Pharma’s, they’re not part of the Big Pharma lobbying consortium). It’s not like a drug is better or more appropriate simply because it’s newer and still under patent. Certainly in the case of medications for depression, this is becoming glaringly obvious.
Scott, in the Merck 10-K all $23.5 billion in pharma and vaccine sales are itemized by product name. The remaining “other” revenues are about $400 million. BTW,10-Ks and proxy statements (interesting for executive compensation information) are available for all to read on Merck’s website.
Calli, never underestimate the amount of obfuscation that occurs (intentional or not) in financial statements. As disclosure documents they often leave much to be desired. Merck lists “other” as “nonreportable human and animal products”. Generally that means they are not a primary source of revenue.
Fifi, who’s arguing? I am merely stating fact.
The different regulatory environment, and the different way the products are developed (research & science vs. make it up) would be plausible reasons to separate them. I could honestly see it going either way – and even if I were sufficiently motivated to try and find out, I wouldn’t know where to start.
Calli you said “It’s not like there’s anything fundamentally different from a manufacturing or business perspective.” Really? No difference in manufacturing process for pharmaceutical and herbal products? Not knowing exactly what “alt-med” products are being referred to, I cannot say. The business perspective is also very different. For pharmaceuticals and vaccines Merck has an army of drug reps selling to doctors. For “alt-med” I would assume those are products that just appear on store shelves….what exactly are these alt-med products anyway, by name?
We cross-posted, I see, but that does indeed answer the question. I appreciate the information.
Wales – “Fifi, who’s arguing? I am merely stating fact.”
Oh, so the “fact” that you claim you’re stating isn’t to make a point? You’re trying to promote the idea that there’s some kind of big difference between Big Pharma and Big sCAM and only Big Pharma is motivated by greed and only Big Pharma is really making a profit and engages in nefarious business practices. That’s rubbish and the usual gambit of those who pretend that there’s really some huge ethical and practical difference between the two overlapping industries.
The whole Big sCAM pretense about being oppressed by Big Pharma (and is just some wholesome mom and pop operation, not just more pills/potions being churned out in China) is purely a marketing ploy and aimed at creating astroturf activism as a means to avoid basic consumer protection regulation. You’re trying to propose this is an ideological battle to obscure the fact that Big sCAM is just as nefarious as Big Pharma, lobbies government just as intensely as Big Pharma and ultimately cares as little about peoples’ health and as much about profit as Big Pharma. You’re focusing in on one rather irrelevant detail as a means to distract from the big picture.
Wales – “The business perspective is also very different. For pharmaceuticals and vaccines Merck has an army of drug reps selling to doctors. For “alt-med” I would assume those are products that just appear on store shelves….”
Nice, you “assume” what you want after claiming to be stating “facts”. No, alt med potions and pills don’t just sit on shelves. In the case of alt med there’s just no person between the salesperson and the patient. In the case of medicine, doctors aren’t allowed to sell what they prescribe so they don’t profit from writing a prescription. However alt med practitioners often make a large percentage of their profit from selling the products they’re telling their patients to take. In the case of alt med, the practitioner and the salesperson are often one and the same. All one has to do is look into the incredibly sketchy and misleading practices of a hugely profitable Big sCAM company like Juice+ to see how corrupt and unethical – consciously and calculatedly so – Big sCAM is on a hundred and one levels. Big sCAM uses MLM techniques, practitioners to prescribe and sell their products and astroturf activism so any claims that alt med products “just sit on shelves” is dishonest. For someone who’s claiming to know what they’re talking about you’re either woefully uninformed or pretending to be naive to the reality of how Big sCAM functions.
The other big alt med scam is getting people to pay for expensive and useless tests BEFORE they prescribe expensive products or cargo cult treatments. You know, wacky stuff like “chelation” (outside of the true medical usage) to remove “toxins”. It’s no small irony that alt med practitioners in the US and Canada have aggressively lobbied for the right to prescribe pharmaceutical medicines. It really is all about money and getting rid of science in the public interest and universal healthcare (because universal healthcare systems engage in science in the public interest and are naturally not into pseudomedicine, pseudomedicine being much more profitable than real ethical medical care and basic evidence-based preventative medicine that generally comes down to eat well and exercise, not buying and taking the supplements or pills of either Big Pharma or Big sCAM).
On a lighter note, I wonder how many people get Botox injections while on detoxification diets (and who drive their SUV to Wholefoods to buy organic supplements). I’m sure the crossover is huge amongst aging Boomers. So much for it really about being about a fear of toxins. It’s really much more about narcissistic “purity” and fear of aging/death for a lot of people into this kind of thing, especially the majority in the mainstream.
Fifi seems to have a habit of attibuting ideas and arguments to others, perhaps she can read minds? I have no axe to grind about “pharma” profits v. “alt-med” profits, my point simply was, if you go back to my original comment, that pharma companies enjoy substantial profit margins and profits. This was in response to earlier commentators who had questioned whether or not the large pharma profit margins they had “heard of” in the 17-19% range were accurate. I posted information showing they are accurate. Then Amy pointed out that Merck was a “major purveyor” of alt-med products (still no named products, what are they?) as if to suggest that segment of the business was a major source of Merck’s profits (actually Amy did not explain the reason for her comment, so I can only guess about the intention). I pointed out that is not true. Fifi seems to be generalizing about “alt-med” products, while the topic was Merck’s “alt-med” products in particular. Not knowing what those products are for Merck, I have no clue about what the selling arrangements are via “alt-med” practitioners v. health food stores v. Walmart.
wales:
It’s not that I don’t think numbers can be obfuscated; I just don’t know why Merck would have any reason to do so.
Apart from the approval process that happens at the beginning for something legally defined as a drug, no, there’s no real difference. Oh, the specifics are different, like how the particular substance is purified and what binding agents are used, etc, but the equipment is all pretty much the same. Claritin (which I use, though I prefer the generics for obvious cost reasons) is one of their products. It’s sold as a small tablet. The same basic technology can be used to make a vitamin tablet. The FDA does actually inspect facilities for non-drug products such as vitamins and herbal remedies, but there it’s more a question of assuring safe manufacturing practices than anything else, and they do that same sort of inspection for facilities making drugs as well. (Note: the FDA has been criticized for not doing a good enough job of this, which is mainly a funding problem.)
And the business side is pretty much the same too, though for non-drug items, they don’t have to go through quite as many regulatory hoops. Once development is over and it goes into production, it’s basically the same, though there are different restrictions for the marketing side.
You were curious about what they make. I did find a list on their website, but haven’t yet read through it. (Skimmed it briefly.) It doesn’t appear to say which business unit is responsible for which product, though. That information may be available elsewhere, though they may obfuscate their internal organization for the purposes of frustrating information thieves. (The target of such thieves would mostly be pricing information and marketing strategies, which would be useful to competitors.) A few random examples:
Claritin (pharmaceutical)
Dr Scholl’s (non-drug, non-medical device, AFAIK)
MMR II (vaccination)
Coppertone (probably classed as a cosmetic)
The vast majority of their business is straight-up pharmaceuticals, though.
I was a bit surprised to see that they have a product called ANTIVENIN (it’s black widow antivenin) which is a registered trademark. They’ve seriously registered “antivenin” as a trademark. *shakes head* That’s silly.
Looks like most of the supplements they manufacture are not for human consumption, but for animals; they have a line of various supplements for livestock, some injected but most intended to be added to feed. Most “alternative” product I saw in a casual perusal was the Dr Scholl’s line. It’s not a drug, nor a medical device — just a line of shoe inserts. If you believe the advertising, they’re better than Valium.
No Wales, you’re focusing in on the detail of where Merck makes the most profit to distract from the fact that both Big Pharma and Big sCAM make huge profits. You want to focus on and argue a largely irrelevant detail to distract from and avoid discussing the big picture. Plus you’re making assumptions and assertions about alt med products – which certainly aren’t just herbs like you naively/dishonestly make out – while claiming to be presenting “just presenting facts”.
Oh, forgot the link:
http://www.merck.com/product/home.html
When I get time later, I’m going to look at the product lines of some other big pharmaceutical companies, because I’m curious which ones are players in the supplement business. Bayer’s gotta be up on the list; they’re the ones who make the highly successful “One-A-Day” series. (Of course, working out Bayer’s profit margin from that may be difficult. They aren’t so heavily focused on pharmaceuticals, having been a fairly diversified chemicals manufacturing company from the get-go.)
Fifi, since you make several inaccurate assumptions about my “dishonest” intentions to “distract” (distract from what I have no idea, the topic of this thread for considerable length of time was profit margins and absolute profits). If you are convinced of my dubious motives, why respond to my comments? Best to leave it to the intelligent reader to extract valuable information, rather than assign unknown motives to others. What your motives are I can only guess, therefore I will not express my intuitions here as my opinions about your motives are worthless to others. Digressions based upon personal feelings (yours included) are not very educational.
Calli, thanks. I don’t know what the rationale would be for intentional obfuscation, either, and I didn’t claim that’s what Merck was doing. I too have perused the Merck site for “alt-med” products and could not find any. I am well aware of Merck’s pharma and vaccine product lines from reading the financials. I agree with you that the closest thing to “alt-med” is the Dr. Sholl’s foot pads. Funny to think of that (or sunscreen) as “alt-med”. You make a comment on Bayer’s “One-a’day” vitamins I believe? Are you including vitamin supplements in the “alt-med” category? If so, I had better reprimand my physician for recommending vitamine supplements to me.
Fifi, you make several inaccurate and disparaging assumptions about my “dishonest” intentions to “distract” (distract from what I have no idea, the topic of this thread for a considerable length of time was profit margins and absolute profits). If you are convinced of my dubious motives, why respond to my comments? Best to leave it to the intelligent reader to extract valuable information, rather than assign unknown motives to others. What your motives are I can only guess, therefore I will not express my intuitions here as my opinions about your motives are worthless to others. Digressions based upon personal feelings (yours included) are not very educational.
I am also curious to what alternative medicine Merck engages in. I wouldn’t count Dr. Scholl’s. I have heard this claim several places, but never any examples.
My 17-19% profit margin came from the Time magazine article I linked to. I could have looked at Forbes or Fortune 500, but ran out of time. The point is that it was consistent with what I’d read in the past. Thanks Wales, for more recent numbers. I still haven’t seen any profit margins for alt med, even though people keep claiming how insidious they are. I’m guessing that the numbers aren’t readily available.
There was also an AP article today stating the Americans had spent 2.2 trillion on healthcare in 2008, or $7000 something /person. I also would be curious to know if this includes alternative health care.
The number of people engaging in alt medicine, and the amount of money being wasted, is highly relevant because it dictates how much attention skeptics should devote to the topic. If one person spent one dollar on a supplement in 2009, nobody should care. I realize that it’s lots more, but I suspect that people who go to chiros are just a lot easier to scorn than people taking lipitor or whatever. That’s the whole point of many skeptics- drawing the line between science and pseudoscience. Obviously there is a false dichotomy there, Michael Shermer (editor of Skeptic mag) in his book “The Borderlands of SCience” puts chiro and acupuncture in the “bordelands” rather than outright pseudoscience category (with astrology and creationism).
And are things like prenatal vitamins considered supplements and alternative medicine? It would be interesting what is altie, what is conventional, and what is integrative (and why some are so opposed to the latter).
Depends on the purpose, I’d say. Taking supplements for an established deficiency (e.g. iron for anemia) definitely isn’t CAM. Supplements for known important nutrients, for which deficiency is common, in amounts similar to the RDA, I’d also put on the side of science-based. (Though inferior in both cases to improved diet, presuming that is feasible.)
Massive doses of vitamin C to cure cancer, or anything along those lines, absolutely CAM.
@Harriet Hall
“But first, how about you tell us how many lives are saved by alternative medical care each year.”
Why? I am not defending alternative medical care. I am simply saying this is a case of the pot calling the kettle black. For every case of a ‘quack’ or ‘charlatan’ selling ’snake oil’, I can come up with a ‘doctor’ selling ‘medicine’ that is every bit as fraudulent (anti-shyness drugs anyone?) or dangerous, and often a hell of a lot more expensive.
It’s not ME saying that 40 to 90 thousand people are killed by their doctors or medicines each year in the US. I’m just pointing that out and saying THIS MD is not only totally wrong about her “toxins are imaginary’ claim, but that she belongs to a profession that seems far worse than any ’snake-oil’ salesman.
“Alternative medicine is distinguished from scientific medicine by the fact that it hasn’t been proven to work.”
Was Vioxx proven to work? A pain and anti-inflamatory drug, that never saved a single life, killed possibly 20 thousand people in 5 years according to the FDA.
“Mainstream medicine saves lives and has a risk/benefit ratio; alternative medicine doesn’t.”
Oh? How sure are you of this? Did you carry out your own studies, or did you rely on the drug companies to tell you? Remember, the FDA is there to protect the pharmaceutical industry, not you, otherwise Vioxx would never have been approved.
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@David Gorski
“Of course, KK conveniently forgets to mention that thalidomide was never approved in the U.S. as a morning after pill.”
Decided not to talk to me any more?
“In the case of thalidomide, the FDA approval process worked fairly well. At least it worked better than the process did in several other countries.”
You mean drug companies might sell their killer medicines to people not protected by a first world legal system in order to profit, regardless of human misery? Funny that.
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“Actually, now you come across as your garden variety Mike Adams-style “critic” who’s simply hostile to and suspicious of scientific medicine in general and big pharma in particular.”
Oops. Wrong again. I have been DEFENDING science based medicine – what YOU call ’science-based medicine’ is actually corporate-profit-based medicine. There is a big difference.
“You may think your “critiques” are brilliant or novel, but your ilk is nothing we haven’t seen here many, many times before.”
My “ilk”?
Funny that the ONLY answer you have for my arguments is “well the FDA didn’t approve Thalidomide” while forgetting they did nothing to stop its sale, and vague ad hominem arguments that my “ilk” somehow makes me ‘bad’.
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“If you don’t already understand why using the term “retard” the way you did as an insult is offensive,”
Do you often have trouble following simple concepts? What I was saying is that *I* don’t find the word offensive, but what *I* think about it is not important. Likewise the fact YOU don’t find “charlatan” or “quack” or “woo woo” offensive is meaningless.
I was simply doing what YOU do.
“Simply don’t use it again.”
I didn’t, YOU did.
“Whine about the warning all you want”
I wasn’t whining, I was simply pointing out that the word provoked a strong reaction – sort of like being called a “charlatan” provokes strong reactions. Now you’re getting upset about me pointing out that you leaped straight to the threats rather than even trying to ask me not to do it.
“We’re pretty lax in what we permit, but we do have limits, and, yes, as editor I get to decide in consultation with Steve Novella when a commenter has crossed the line.”
Well, except for swearing and certain offensive words… and well any disagreement with YOUR idea of “science-based” medicine.
“Don’t like it? You can go elsewhere.”
I believe I already agreed not to do it… why the need to threaten me again?
“Actually, it’s not true that Vioxx didn’t benefit many patients. Even Dr. Eric Topol, the strongest detractor of Merck and Vioxx, concedes that Vioxx was a useful drug and helped a lot of people.”
Oh yeah, it reduced their inflamation and pain… it just KILLED THEM.
“I was surprised to read Topol quoted as saying flatly that Vioxx should not have been taken off the market. In his opinion there should have been issued a black box warning regarding patients with diabetes or preexisting cardiovascular disease.”
Well, he may have had a problem with the drug, but he was still part of the club…
Let’s put it this way – was there no other way to reduce pain and inflamation WITHOUT kiling patients? Or was this just the most profitable way?
“In reality, Vioxx was a pretty good drug except for patients who fell into a couple of high risk categories.”
Which it killed.
“The idiocy of Merck’s leaders in trying to cover up these categories was an enormous self-inflicted wound from which Merck may never fully recover.”
The same idiocy that seems to be repeated every few years, and is not prevented in the slightest by “science-based medicine” or the FDA (and other govt. organisations around the world).
As I said, Vioxx is a recent, but it is a LONG way from being the ONLY such scandal.
@Amy Tuteur, MD
“No, that’s not what I am saying. Some people will get better if nothing is done for reasons we might or might not understand. Treatments are tested against placebo to judge the true effect of the treatment.”
Did you even bother to read any of the links I sent?
“In a study last year, Harvard Medical School researcher Ted Kaptchuk devised a clever strategy for testing his volunteers’ response to varying levels of therapeutic ritual. The study focused on irritable bowel syndrome, a painful disorder that costs more than $40 billion a year worldwide to treat. First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who declined to engage in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition.
Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.”
http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all
Tell me, how did THAT happen if the placebo effect wasn’t a REAL effect? Surely all three groups should have shown the same (lack of) response?
Did you also notice that a placebo plus some encouraging words did better than the TWO leading prescription medicines? How did THEY pass FDA approval?
“In the case of a randomized controlled double blind study, no one is deliberately lying to the patient, since the doctor doesn’t know what the patient is getting, either.”
Ah, I see. Your objection is the “lie”. Of course Vioxx came with a lie too – that it was safe. And it ISN’T a lie to give a sugar pill and say “this may help ease your pain” when we know that it MAY. Think of it this way: if you are harnessing the body’s natural ability to ‘heal’, whether it is with a chemical, or a ‘lie’, you are still providing health care… are you not?
“I can’t imagine anything more likely to destroy the doctor-patient relationship than encouraging doctors to lie to patients “for their own good.””
You mean like when a doctor doesn’t tell an accident patient that they are likely to die? Is that kind of lie ok?
But let’s say I agree with you. I was not talking about the placebo effect as an alternative to other pharmaceuticals. I was saying the placebo effect is ALREADY a part of pharmaceuticals. Most of the world has come to believe that a doctor with a drug can cure them (even if it turns out the drug did nothing more than placebo, as in the quote above).
So many if not most of them WILL be cured, even if the drug does NOTHING. The belief of the patient is what is key. If I don’t believe you can help me, it will be far harder for you to help me, even with all the drugs in the world. On the flip side, if I think some herbal remedy will help me, it is likely that it will.
“Moreover, you haven’t explained why quacks and charlatans should profit by deliberately lying to patients about the efficacy of their “treatments.””
Vioxx: tell me that there were no deliberate lies told simply to protect the profits of Merck…
And don’t even get me started on the fake diseases that have been invented just so that another drug can be sold for extortionate prices…
The pharmaceutical industry is telling us that we are sick, even if we aren’t, and then saying they have the remedy to make us better…
And you say they are better than “snake oil” salesmen?
“It is difficult for me to imagine a legitimate reason to reward entrepreneurs for lying.”
OK seriously. Have you paid ANY attention to the pharmaceutical industry lately?
Drugs to cure shyness for ****’s sake! Need I say more? By the way, there is a natural remedy for that… it’s called “beer”. And its a lot cheaper I bet! Probably safer too…
“I said profit margin, not profit.”
Oh? I see. As long as they spend billions bribing the FDA… err I mean getting approval from the FDA, then their profits are ok… even if the end result is the patient pays a lot more for treatment that is often no better or even worse than doing nothing?
Makes sense!
“How much money goes into research and development of an alternative “treatment”? Zero dollars.”
How do you know? Seriosuly, you think these poeple just grab some random ingredient and say “oh a new cancer drug”? Bull.
“Zero dollars, since treatments are marketed whether they work or not.”
Anti-shyness drugs… Oh and those prescription medicines that did no better than the placebo in the quote above, that was in the link I gave, and that you seem to have not read.
“When it comes to alternative “treatments” only a minimal amount of money is invested and the returns are pure profit.”
Once again, it’s all well and good to make that CLAIM, but when you put it up against say Vioxx, then all I see is a company that paid billions to bribe the FDA, and then made billions killing people… until enough people had died to FORCE the FDA to act… but oh wait, they didn’t – Vioxx was withdrawn voluntarily by the company – so if they hadn’t been confronted by people like me, they would STILL be killing people.
Remember how the FDA refused thalidomide because it was worried about how safe it was – half a century later, now the FDA doesn’t even force a drug off the market that even the manufacturer recognises is dangerous. Funny that.
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@Alison Cummins
I was going to let that pass, because the MD doesn’t claim to be a businessman – but yes, profit and profit margin are the same thing – except one refers to the difference between the cost of a product and the expected proft… and the other is the profit.
“What our agitated KK is lathering on about is the revenue.”
No, no, no. I am not a … oops almost… I know the difference between profit and revenue. In the 90’s, the pharmacuetical industy was MORE PROFITABLE than the Oil industry – its revenue was nowhere near though. As an example, this article claims that pharmaceuticals have an estimated 157 billion in sales:
http://www.pharmaceutical-technology.com/features/feature2086/
While this report to congress estimates ExxonMobil alone as having a revenue of 400 billion…
http://docs.google.com/viewer?a=v&q=cache:8dTm1QB90esJ:fpc.state.gov/documents/organization/103679.pdf+oil+industry+revenue+90%27s&hl=en&gl=nz&pid=bl&srcid=ADGEESgh3_qgZ4i4GsUujrD0bTPBnNp2fpaig87vuLnQ0SrONMRe0hs2UWwIeVxqYbNZytJ_s7YlbLXzOwvo00LMK1VvUtEP-fmIlEI-UhJ8aeLa6Sr-AB5XjocwuN_grvKRFbDzJPww&sig=AHIEtbQcZ6oF4nwxkKYPNhNP8fcDpZpCTQ
The difference in revenue is truly vast – but the profit margins were such that drug companies made more per dollar spent than even the oil companies…
But thanks for trying to correct an error you THOUGHT I made (and trying to turn it into an insult…)
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@David Gorski
“Nice bit of pedantry there, but mea culpa for a brain fart.”
Wow. You really don’t like even a HINT of criticism, do you? Alison Cummins was trying to protect you from me having a go at your error, and you attack her?
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@Alison Cummins
“I repeat that the brain fart doesn’t take away from your point that the FDA works.”
Oh really? Merck thought Vioxx was bad enough for them to throw away all their R&D (or they had already profited enough) that THEY took Vioxx off the market… but the FDA did nothing. Except a few studies to estimate how many people died from their lack of oversight…
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@rosemary
“Most investors will not invest in something speculative with any potential profits a long way off unless they hope that the return will be worth the risk and the wait.”
In the 90’s at least Pharmaceuticals were more profitable (not higher revenue by a long margin) than oil according to the Wired article I linked. For example, Vioxx was on the market for only 5 years and is expected to end up costing the company billions, yet the CEO saw it as nothing more than a severe blip rather than a company threatening liability.
Now, to highlight just how iffy this ‘business’ is, here are some quotes from a recent WSJ article:
“Both companies reported a decline in sales for their cholesterol-drug joint venture, which continues to be under pressure because of clinical studies last year that raised questions about the safety and effectiveness of Vytorin and Zetia.”
“Merck’s biggest product, allergy and asthma medication Singulair, posted sales growth of 5% to $1.09 billion, continuing a rebound that picked up in the second quarter. Last year, sales were under pressure partly from safety concerns prompted by U.S. regulatory alerts.”
http://online.wsj.com/article/SB10001424052748704224004574488881670601574.html
Notice how this company alone has at least two questionable medicines on the market that it is still profitting from.
Further to my claim about profit, I found this post:
http://everydayecon.wordpress.com/2006/04/26/oil-profit-margins-vs-other-industries/
where you can see a graph attributed to Business Week and Oil Daily. In that graph pharmaceuticals and biotech are listed with a >19% profit margin (19 cents profit per dollar of sales). To put that in perspective Oil & Gas is just over 8% and even banking only hits 18%!
More profitable than banking – the industry that actually DOES have a ‘license to print money’? Really?
“(Hey, Joe, ya got some space in ya garage I can rent? I wanna mix up a bunch of weeds. My wife doesn’t like the smell in her kitchen.)”
There is a company in my town that manufactures alternative medicines like homeopathic remedies. I have been into that factory (in a previous life I was a commercial cleaner specialising in special jobs – such as disinfecting surgical theatres etc) and I can tell you that company was every bit as high tech and sanitary as any pharmaceutical factory.
You lot always have to add a lie to put your point across, don’t you?
“My guess is that most of their investment goes into marketing, lobbying and packaging, but mostly marketing.”
LOL, you want to talk about marketing and lobbying? I’ve seen docotrs that are offered free tropical holidays for prescribing a certain amount of a company’s drug (I actually read the brochure in my doctors office) – the interesting part, is they were trying to push OFF LABEL prescriptions of this drug for ailments for which the drug wasn’t specifically approved. It was clear from the wording that the only thing the company cared about was volume, not effectiveness.
“Furthermore, given the present legal climate, their risks, unlike those of drug companies, are miniscule.”
Oh, you can’t sue alternative medical companies? I mean you can’t be talking about the lap-dog FDA, so you must be refering to the potential for lawsuits…
“supplement companies are unregulated and often get away with murder, and I don’t mean that figuratively speaking either.”
Ok. Give us ONE example of an alternative medicine that killed 14 people a day in the FDA’s estimation, that didn’t result in criminal charges.
I’ve given Vioxx. What do you have that comes even CLOSE, to that?
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@Zoe237
“I believe the studies showed a risk factor for more than just those with prior history of heart disease.”
It is my understanding that the risk factor that caused the removal of the drug was the greatly enhanced risk of heart attack in long term users (18 months or more) – the kind of users drug companies love…
Notice, that it was only studies done AFTER the approval that showed this, seeming to imply that it was never even tested as a long-term medication!
“(not that I think the solution is to abandon modern medicine or trust quacks)”
I never said, or intended to imply that. All I am saying is that these claims about how dangerous alternative medicines are have to be put up against how dangerous ‘normal’ medicince can be, that the mechanisims people like this MD say protect us in the ‘normal; health industry don’t, that pharmaceuticals are HIGHLY profitable, and it is seeming more and more that drugs we thought were actually doing something turn out to be no better than placebo – an effect that works whether you’re talking about Vioxx or ’snake oil’.
“And actually, I’ve seen this [phrase] before on SBM. As long as you are honest about it, is there a harm?”
The question is, are you being DISHONEST when you say a placebo will help a patient. Do doctors tell patients what the active ingredient of Vioxx is and how it works? No. They say “Here, take this Vioxx, it will help you.” How is that any different from saying “Here take this hensbane, it will help you.”? Of course the MD will jump in and say that the FDA made sure there was an active ingredient – but what if the active ingredient is the patients own brain chemistry and the influence the patients state of mind has on it?
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@Scott
You of course made up the ‘costs’ to illustrate your point. Do you REALLY think it cost OVER HALF A TRILLION DOLLARS to develop Vioxx? Seriously?
I showed a source for my claim, and it suggests that Vioxx would have cost around 5 billion dollars to develop (if its profit margin was the industry standard).
I quantified my claim (and supported it with a source) that pharmaceuticals are highly profitable (>19%, better than banking!) does anyone care to show the profit margins for any alternative medicines?
After all you (not you specifically, in general) have made a positive claim that alternative medicines are FAR more profitable. Where are the figures? Or are you just making that claim up?
“If you wanted to address simply “which industry is bigger”, profit would be a not unreasonable measure. But for the question “who has more incentive to peddle snake oil”, profit MARGIN is the proper thing to look at.”
Yes. So why haven’t you? You simply claim alternative medicines are more profitable, without even a scintilla of evidence…
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“The point I’m trying to make is that the incentives to do something dishonest are a greater if the gains which will be obtained are larger.”
Yes, I get your point. You have a valid argument… but is it TRUE? Have you ANY evidence AT ALL, that alternative medicines are more profitable (higher profit margin)?
“Any statement along the lines of “most profitable industry on the planet” can be pretty much completely discounted. ”
Are you kidding?????
You make a claim without any evidence, then simply “discount” a claim that is SUPPORTED BY EVIDENCE?
How skeptical of you…
“It would be quite unlikely that it was considered separately unless that was the point of the calculation.”
So you won’t even bother trying to support your claim with evidence?
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@Alison Cummins
“The reason I said that they could be used interchangeably for the purposes of this discussion was that it came up in repsonse to a barely coherent troll by KK commenting on Amy’s statement that “Nothing has a greater profit margin than ‘alternative’ treatments.””
Troll? Barely coherent? So far, I am the ONLY person to provide ANY evidence for his/her claims. *I* am a troll? Man you lot make me laugh! (I notice that a couple of newer posts include evidence… all supporting my claims.)
>19% is the profit margin for pharmaceuticals and biotech – care to support your (or the MD’s) claim with ANY EVIDENCE???
“Amy is completely correct and KK’s response is a non-sequiteur. If the price of a chemotherapy drug is a thousand dollars and it costs a thousand dollars to deliver it, profit (both margin and absolute) would be low.”
No, Amy’s point is NOT correct. She made an unsupported claim (that the profit margin was higher for alternative medicines) in response to my question. I did not make myself perfectly clear that I was talking about the cost to the consumer. However, I have since checked her claim and found that pharmaceuticals are more profitable than oil and even banking. Where is her (or your) evidence that alternative medicines are more profitable?
I can make claims all day, and you won’t accept them unless I can provide evidence – so why should I accept hers (yours) without evidence?
“All the price of an expensive drug tells you is that revenue per dose for that drug is high.”
Unless we know the profit margin, which I have shown is said to be higher than banking at around 19%.
So, to support your argument, care to show what the profit margin on alternative medicines is? Or do you not want to quantify your claim so we can actually compare and contrast and see if your claim has any merit?
“Correcting KK by emphasising margin over absolute profit is not wrong, but since KK was talking about revenue, not profit, his error was at a more fundamental level.”
True, emphasising margin isn’t wrong… now I’ve shown my figures… where’s yours?
I am not the one making the positive claim (that one is more profitable than the other), I am being SKEPTICAL of the claim, and asking for evidence. ANY evidence. So far not one of you has done it. All you do is keep repeating the same claim that as far as I can see is total bull.
Also, consider this – profit margin doesn’t actually take account of the true costs. The profit margin may have been 100% or 1% on Vioxx.. but over 20 thousand people died according to the FDA. Can you put a price on the deaths of 20 thousand people? Sure we can include the legal costs, but even that doesn’t represent a TRUE picture of the cost to humanity in general and the patients in particular.
Those 20 thousand people will never get a dime of any legal pay out – they are dead – and all because a drug that was unecessary and was rushed through FDA approval (no studies of long term use?) and was highly profitable. The CEO of Merck was particualrly galling when he answered questions about the damage it would cause to Merck’s share prices – basically that it was a blip and that the company would not suffer in the long term… and TWENTY THOUSAND DEAD PEOPLE rolled in their graves…
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@Amy Tuteur, MD
“You do realize that Merck is a major purveyor of “alternative” remedies as well as pharmaceuticals, right?”
WTF? Now YOU are criticising the pharmaceutical companies? And wait! I thought alternative medicines were cooked up in people’s garages from weeds?
Will you lot stick to one story?
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“No, that’s YOUR job if you wish to claim that profits come largely from the pharmaceutical division.”
Ok, so why not support YOUR claim that alternative medicines are more profitable? YOU made it, support it! I and others have given figures WE found. But you have not even TRIED. Why is that?
(nice one wales, by the way!)
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@Calli Arcale
“It’s not like there’s anything fundamentally different from a manufacturing or business perspective.”
Hang on! We’ve been told that there IS a significant business difference – that alternative medicines COST more to manufacture and are thus LESS PROFITABLE. Surely, if that was the case, Merck would shut down its pharmaceutical manufacturing and stick to alternative remedies? After all they are trying to maximise profit, aren’t they?
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@Fifi
“In the case of medicine, doctors aren’t allowed to sell what they prescribe so they don’t profit from writing a prescription.”
Not true at all. Have you never seen any of the ‘incentive’ programs the pharmaceutical comapnies offer doctors? Like free holidays etc…
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One last thing: I noticed the MD did not TOUCH my question regarding her interest in pharmaceuticals.
I’ll ask again – does she care to declare that she has NO FINANCIAL INTEREST in the industry she is trying to defend? It seems to me that this would be an important piece of information (after all SHE claims the profit motive is strong enough to overcome humanity in the alternative medical industry…), of course as a doctor she does have a financial interest in medicine in general… but what about pharmaceuticals in particular?
I will declare right now that I have no financial interest in either industry.
Zoe makes some good points. Interesting what Shermer’s take is on chiro and acupuncture. As a political libertarian perhaps he would agree that the consumer’s freedom of informed choice is important in a “free” society.
Still waiting for Fifi and Amy, who are both certain that Merck is a “major purveyor of altenative remedies” to enlighten us with specific product information…….
wales:
Well, that’s just it — define “alt-med”. I dislike the term largely because it’s too vague. When we’re talking the distinction between drugs and non-drugs, I prefer to use the legal distinction between the two, which is basically how the FDA decides to regulate them. If a medical claim is made, it is considered a drug (or a medical device, if it’s a thing rather than a substance). If not, it’s not a drug (by the legal definition).
One-A-Day falls in the “non-drug” category. It is regulated as a dietary supplement. (Also, quite a few questionable* claims are made for it, though Bayer is careful to keep them “structure function” claims. For instance, I’ve seen them push Men’s One-a-Day for “prostate health”.) Truthfully, that’s the logical place for it — but that’s also the category for stuff like St John’s Wort, and it allows them certain liberties in the marketing department.
Of course, just because something’s a drug doesn’t mean it’s not “alternative medicine” (or at least not science-based medicine). Bayer, and other aspirin makers, has also been known to make questionable claims about aspirin, which *is* regulated as a drug. And we’ve discussed elsewhere the propensity of big pharma companies to encourage doctors to prescribe offlabel, which is often not science-based either. So it’s probably impossible to say how much these companies profit from alternative medicine, in large part because the term is so nebulous.
*I say “questionable” because it raises the question of whether these claims have been proven, since there’s little evidence provided. They *might* work, but the manufacturers haven’t attempted to prove it adequately to allow them to make the claim directly (so instead they hint at it).
Karmakaze:
It’s not as simple as that. For most remedies, the manufacturing methods are basically the same, not counting isolation of the active ingredient(s). And for herbal remedies, that latter has a fair bit in common with food processing, so it’s not really exotic technology.
The real differences are in marketing. Getting FDA approval opens up huge new areas. You can really say “this product treats this condition” and not get busted. Insurers are more likely to pay for it, especially if it’s prescription-only. Patients are more likely to think they actually need it, rather than just want it. And so on. With supplements, you have to restrict yourself to wishy-washy “structure function” claims and suggestively waggling eyebrows. Doctors will be more skeptical. Insurers will likely refuse to pay, since it’s OTC, or at least make a big stink about it. What’s more, the public generally tends to regard them as less potent (rightly or wrongly) than “real” medicine.
Pharmaceuticals represent a big risk for a big payoff. The development costs are huge, though the production costs usually are not. Supplements don’t usually have as much of a payoff, but they also have less risk. A lot of companies will specialize in one or the other, optimizing their business model for high or low risk, and others will dilute the risk by doing a bit of each. Of course, be wary of generalizations — it is certainly possible to get very large profit margins from a dietary supplement while someone else gets very low profit margins from a pharmaceutical.
Wales – You’ll get no argument from me that Big Pharma is corrupt and out to make money, I’ve been saying that all along. My argument with you is your slippery and faux naive assertions (alt med = herbs…wrong, you “assume” that there’s no marketing of vitamins and supplements…wrong, etc) and dishonest claim to be just reporting “facts” (when you’re “assuming” and so on).
I’m saying it’s the nature of industry to put profit first, you’re trying to make out that it’s only the industry you have a bias against that does this and that Big sCAM is all herbs, no marketing and innocence and light. Merck is only one of many pharmaceutical companies, it’s very common for companies that make pharmaceuticals to also make vitamins and supplements, as well as other industrial ingredients.
Merck buys French vitamin producer
http://www.nutraingredients.com/Industry/Merck-buys-French-vitamin-producer
http://www.merck.co.in/en/company/merck_in_india/merck_ltd_india/merck_ltd_india.html
Major products – Pharmaceuticals Vitamins, Nutritional supplements, Cardiovascular Diseases, Respiratory, Hematinics, Cough & Cold, Anti-malarial, Non-Steroidal Anti-inflammatory Drugs (NSAID), Antibiotics, Oral Rehydration Salts and Encephalotropics
And then there was that big legal fuss back in 2001 for price fixing on vitamins by pharmaceutical companies…
http://findarticles.com/p/articles/mi_m0999/is_7324_323/ai_n27572491/
http://www.quackwatch.org/02ConsumerProtection/rochefine.html
Fifi this is the last comment I have for you. When I am stating facts I state them and supply supporting documentation. When I am assuming or guessing about something I announce that fact too. Read through my comments, they are consistent in that regard. That is not dishonest.
You however assume far too much about the accuracy of your pseudo-psychological analyses and mistakenly state your assumptions and personal prejudices as fact. Is that honest? A bit of parting advice: your credibility would be enhanced greatly by omitting the colorful adjectives like “slippery” and “faux naive”. Good luck.
@Calli Arcale
Thanks for the reasonable post.
“it is certainly possible to get very large profit margins from a dietary supplement while someone else gets very low profit margins from a pharmaceutical.”
Oh yes indeed!, It is ALSO possible that the profit margins from pharmaceuticals are higher than supplements (people will pay more for a ‘real’ drug, so greater margins could be built in). So the question is, which of the two possibilities is correct (at least in general).
I and others have given figures we found to support our contention that pharmceuticals have phenomenal margins (better than banking), but all we get from the other camp is the same unsupported assertion repeated over and over again, and then one of them even told one of us that WE had to go find HER evidence.
Seriously? Is that what passes for ’science-based’ debate around here?
I am still waiting fo the MD to support that contention, and to declare she has no financial interest in pharmaceuticals.
I have a feeling I’ll be waiting a LONG time.
Kamakaze,
“WTF? Now YOU are criticising the pharmaceutical companies?”
Why not?
Why does a criticism of Alternative medicine automatically mean that you will not criticise the pharmaceutical industry? Or that you unquestioningly support the pharmaceutical industry?
I don’t know this particular MD, but the well known Ben Goldacre, often gets accused of being in league with Big Pharma, despite the fact that his book “Bad Science” gives equal space to the evil practices of the pharmaceutical industry and makes the point also made by this MD that the big drug companies are busy taking over the profitable alternative medical companies.
Hell, there is even an alternative medical apologist who works for an alternative medical company who has accused Ben Goldacre of being in cohoots with Big Pharma whose own company is 30% owned by a large pharmaceutical company!
BillyJoe – “Why not? Why does a criticism of Alternative medicine automatically mean that you will not criticise the pharmaceutical industry? Or that you unquestioningly support the pharmaceutical industry?”
Funny how some people can only see things in black and white, it’s a hallmark of being an ideologue and close minded. Apparently a lot of people don’t actually understand that medicine and science are used and often abused by various industries – from Big Pharma to Big sCAM – but aren’t actually those industries. And many people don’t understand that by promoting ideology over actual science they’re merely being industry propagandists. It’s a great way for both industries (which are often the same industry, as you so accurately point out) to pretend that they’re not both out to destroy science done in the public good because it gets in the way of them selling their products. The irony of astroturf activists screaming about the evils of industry while promoting Big sCAM or pseudoskeptics pretending they’re promoting science when they’re defending Big Pharma seems to be lost on many. I suspect a lot of people believe critical thinking or being skeptical is about being against something and not actually trying to figure out the reality of what is. Both Big sCAM and Big Pharma have been waging an all out war on reality-based thinking and have been actively promoting pseudoscience, one of their most effective tactics has been pretending they’re at war with each other and not both trying to destroy good science because it is what allows people to actually make a choice based on the best evidence available. True freedom of choice regarding healthcare requires good science so we can all make choices based on reality and not marketing propaganda.
Taken in the context of Dr Tuteur’s recent intentionally inflammatory post on circumcision and her obviously ideological and not SBM approach in that matter, her apologist approach to industry and conflating of Big sCAM “toxins” with the very real and well documented dumping of toxic waste by industry in this post indicates that Dr Tuteur is not actually a defender of good science or reality-based thinking.
This is a very good little video about industry promoted pseudoscience and how it relates to global warming (which may seem off topic but many of the same people involved in global warming denialism were also involved in promoting Big Tobacco’s interests against the public interest, and global warming is also a public health issue).
http://www.youtube.com/watch?v=Py2XVILHUjQ
Dr Tuteur really is doing damage to the credibility of SBM (both this blogging collective and in terms of being an obvious ideologue who abuses science rather than defending SBM). Really, she’s part of the problem and not part of the solution!
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