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“Alternative Medicine: Sense and Nonsense” Upcoming Lecture by Dr. Paul Offit

For those of you in the NYC/LI area:  An Invitation from the Cold Spring Harbor Laboratory for a Free Public Lecture!

Please join us for the 2013 Lorraine Grace lectureship on societal issues of biomedical research:

Alternative Medicine: Sense and Nonsense

Saturday, June 8, 2013

3:00pm

Grace Auditorium

One Bungtown Road

Cold Spring Harbor, NY 11724

Americans love alternative medicine, and they are paying a high price for that devotion. From regular visits to acupuncturists, chiropractors and naturopaths to the daily ingesting of homeopathic remedies, Chinese herbs, and megavitamins, the use of alternative therapies has become a $34 billion-a-year business. Fifty percent of Americans use some form of alternative medicine, with ten percent using it on their children. Celebrities routinely hawk their benefits. But, does any of it really work?

In the upcoming lecture, Alternative Medicine: Sense and Nonsense, Dr. Paul A. Offit will take a critical look at the field of alternative medicine and separate fact from myth. Drawing on current research he will examine popular alternative therapies and discuss the issues of medical ethics involved in alternative medicine, which is a largely unregulated industry under no legal obligation to prove its claims or admit its risks.

“Making decisions about our health is an awesome responsibility,” writes Dr. Offit. “If we’re going to do it, we need to take it seriously. Otherwise we will violate the most basic principle of medicine: first do no harm.”

Come join us for a lively discussion!

The recipients of many awards and honors, Paul A. Offit, M.D. is Chief of the Division of Infectious Diseases and Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, as well as the Maurice R. Hilleman Professor of Vaccinology and Professor of Pediatrics at the University of Pennsylvania School of Medicine. He has appeared on The Today Show, Good Morning America, The Early Show, The Colbert Report, CNN, 60 Minutes, MSNBC, Dateline NBC, the Jim Lehrer NewsHour, CSPAN, FOX News, and National Public Radio, and is often interviewed in the New York Times, Washington Post, LA Times, Wall Street Journal, Chicago Tribune, and USA TODAY.

NOTE: In June,  Dr. Offit’s book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine will be released by Harper Collins.  Our own Dr. Harriet Hall has a review in an upcoming issue of Skeptical Inquirer.

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53 thoughts on ““Alternative Medicine: Sense and Nonsense” Upcoming Lecture by Dr. Paul Offit

  1. From regular visits to acupuncturists, chiropractors and naturopaths to the daily ingesting of homeopathic remedies, Chinese herbs, and megavitamins, the use of alternative therapies has become a $34 billion-a-year business

    That sounds like a lot of money doesnt it..

    until you put into proper perspective. Yearly healthcare spending in US is $2.7 trillion, “alternative” spending is just 1% of the total. And most of that is in over the counter vitamins and sports supplements, which is not exactly alternative medicine in itself.

  2. Chris says:

    I have just put a hold on Dr. Offit’s new book at the library. They already have it ordered, and I am first in line!

  3. ARD says:

    @FBA: It’s more than the annual budget of the NIH, or NASA, or the entire cost of ITER (which, if successful, would greatly reduce global health spending by beginning the end of the coal industry and all its lung-damaging side-effects), or any number of much, much, much more worthy science or engineering programs. Alternatively, that’s enough to increase spending on food stamps some 25%, or lift 1.47 million American families above the poverty line through simple redistribution. If spending is cut in some places (‘alternative’ medicine, for example), then we can divert the funding to things more worthy.

    Sure, compared to total spending, it’s not much. But compared to things which are more worthy but don’t get the funding they deserve? It’s far too much.

  4. WilliamLawrenceUtridge says:

    That sounds like a lot of money doesnt it..

    until you put into proper perspective.

    It sounds like a whole lot of money when you put it into the proper perspective – most modalities have essentially zero chance of working as anything beyond an expensive sort of self-soothing, and those with some prior probability are unproven. That’s $34 billion of pure, unmitigated waste. At $200,000 per year, that’s another 170,000 doctors, perhaps going a long way towards freeing up a lot of time for doctors to spend with their patients – a common complaint of patients, doctors and quacks.

  5. annettej says:

    Has Dr. Offit ever experienced chiropractic care, acupuncture, massage, homeopathy or any other drug and surgery free therapy? Has he actually studied any of these systems? Has he ever spoken with anyone who was not helped by medical care and whose life was changed positively by alternative care?
    Berating “alternative” therapies because of your own prejudice, financial incentive and personal ignorance about them is simply spreading ignorance and dogma. Is this really what you want your legacy to be?

    1. rogue medic says:

      annettej,

      Do you need to take cyanide to know that it is dangerous, or can you learn that from reading the research?

      It is true that “alternative” medicine is not as dangerous as cyanide, but that is hardly a reason to expose yourself to quackery. I do not need to expose myself to the dangers of “alternative” medicine to know that it does not work.

      There is over a quarter billion dollars of research done each year at NCCAM that demonstrates that “alternative” medicine is a dangerous placebo. This is research done by “alternative” medicine practitioners.

      This criticism of “alternative” medicine is based on research.

      Research is the opposite of ignorance.

      Ignoring the failure of “alternative” medicine to work is ignorance.

      We need to criticize the nonsense of “alternative” medicine and protect patients from quacks.

      .

  6. Grant Jacobs says:

    Any chance this is being recorded? (For YouTube or whatnot.)

  7. ebohlman says:

    All these monetary comparisons are suffering badly from malic/citric confusion: when you try to compare the size of a particular form of discretionary consumer spending with the size of real or hypothetical program budgets, you’re comparing numbers but not quantities. You’re also improperly assuming fungibility: unless money spent by consumers on “alternative medicine” would otherwise be paid in taxes or donated, you can’t really argue that it’s taking away money that could otherwise be used for societal benefit. Instead, for the most part, it’s competing with other forms of discretionary consumption, mostly of the “lifestyle/entertainment” sort (Obviously, this only applies to spending by the “worried well” but that’s the overwhelming majority of it).

    Also, we need to remind ourselves that the high-end estimates of AM usage come from counting people who pray regarding their health, and provide little evidence that most such people regard their prayers as an actual treatment modality (i.e. most such people don’t make life decisions that rely on assuming that their prayers will be answered).

  8. Chris says:

    Grant Jacobs:

    Any chance this is being recorded? (For YouTube or whatnot.)

    I hope so. There is video of last year’s Lorraine Grace lectureship by Richard Leakey.

    I wonder if young Master Jake Crosby will show up?

  9. goodnightirene says:

    @annettej

    I think Dr. Offitt’s legacy is already established and very safe.

  10. ConspicuousCarl says:

    FastBuckArtist on 27 May 2013 at 2:30 pm
    Yearly healthcare spending in US is $2.7 trillion, “alternative” spending is just 1% of the total.

    But most “alternative” medicine is just a BS scam. You may as well say, “that pickpocket stole my wallet, but the total US spending on healthcare is $2.7 trillion so it doesn’t really matter”.

    And most of that is in over the counter vitamins and sports supplements, which is not exactly alternative medicine in itself.

    If people buy 10 times the required amount of a vitamin because some lunatic said it would prevent cancer without any evidence, that is alternative medicine.

  11. ConspicuousCarl says:

    annettej on 27 May 2013 at 6:03 pm

    Has Dr. Offit ever experienced chiropractic care, acupuncture, massage, homeopathy or any other drug and surgery free therapy?

    Personal experience is not good evidence…

    Has he ever spoken with anyone who was not helped by medical care and whose life was changed positively by alternative care?

    …and neither is the personal experience of another person.

    Has he actually studied any of these systems?

    You accuse him of ignorance , but it is obvious that you are ignorant of the most basic principles of evidence and research. If you had a clue what it meant to study something, you wouldn’t have asked about anecdotes.

    your own prejudice

    Ironically, the prejudice is all among the alt-med nuts. They judge their nonsense and conclude that it works even though they have not yet done the research you pretend to demand of others.

    The only dogma here is that all medical care should be subject to the same rules of research, logic, and evidence. People like you, whether you are informed enough to know it or not, are the ones who want biased treatment for dogmatic unproven claims.

  12. @annettej

    Berating “alternative” therapies because of your own prejudice, financial incentive and personal ignorance about them is simply spreading ignorance and dogma.

    Dogma, prejudice and personal ignorance is par for the course here when it comes to alternative medicine. Comes with the territory.

    1. rogue medic says:

      FastBuckArtist,

      Evidence that a treatment works is what matters here.

      Dogma, prejudice and personal ignorance is what “alternative” medicine, used car salesmen, and other fast buck artists rely on to sell their products.

      .

  13. WilliamLawrenceUtridge says:

    Dogma is par for the course for alternative medicine, because it’s inherently unproven. Proven medicine is incorporated into mainstream care. The entire profession of alternative medicine is based on conjecture, premature evidence or tradition – none of which constitute proof that the interventions used are effective.

    If CAM treatments were as effective as CAM promoters seem to think they are, it would be easy to demonstrate. The signal would rise from the noise with even small-n studies. Instead there are borderline results, just at the far edge of p=0.05, which encourage “further research”. Or in the rare case where something new is found (vis. St. John’s Wort) it is integrated as a part of regular medicine, but the adverse effects, previously unrecognized, also come to light (vis. again, St. John’s Wort – photosensitivity, most of the adverse effects of conventional antidepressants, and drug interactions).

    So, if CAM is so great, you shouldn’t have any problem proving it – which would make such interventions availale to the rest of us. So quit complaining, and test using well-designed, randomized controlled trials.

  14. ConspicuousCarl says:

    The moon is made of ground up leprechauns, and anyone who doubts that or expects me to provide proof is a dogmatic and ignorant bigot.

  15. stanmrak says:

    “Making decisions about our health is an awesome responsibility,” writes Dr. Offit. “If we’re going to do it, we need to take it seriously.
    Otherwise we will violate the most basic principle of medicine: first do no harm.”

    “Do no harm?” Seriously? Dr. Offit promotes a medical industry that has been shown to be responsible for over 750,000 deaths every year.

    http://www.webdc.com/pdfs/deathbymedicine.pdf

  16. ConspicuousCarl says:

    Ugh, I was just wondering if this bagel wart wasn’t due for an appearance. Sell anything stupid yet today, Stan?

  17. Harriet Hall says:

    @stanmrak,

    Please read this:
    http://www.sciencebasedmedicine.org/index.php/death-by-medicine/

    And then tell us how many lives were saved by conventional medicine and by alternative medicine, respectively.

  18. Xanthippe says:

    I hope that Dr. Offit’s lecture will be videotaped and uploaded for those of us who are unable to personally attend.

  19. Todd W. says:

    @annettej and @FastBuckArtist

    Want to change minds here? Post links to quality research showing that your modality of choice is at least as effective and safe as current medicine.

    And as others already pointed out: alternative medicine that is proven to work is called “medicine”.

  20. stanmrak says:

    How does 750,000 unnecessary deaths equate to “First, do no harm?” We’re not talking about how many lives are saved – that’s irrelevant to the point.

  21. Harriet Hall says:

    @stanmrak,
    “First do no harm” does not mean the whole of medicine should be discarded. The only way to ensure no harm is done is not to treat at all. But not treating would itself do harm by omission, because people would suffer and die.

    And the number of lives saved is not irrelevant to the point. Did you even read my link?

  22. stanmrak says:

    Someone in Dr. Offitt’s position shouldn’t go around spouting the Hippocratic oath if he, or anyone else, is going to add their own meaning to it. My dictionary defines “first” as “foremost in position, rank, or importance”. “First” according to Hippocrates does not mean that it’s more important how many people you help in relation to how many are harmed. No, it’s DO NO HARM. period. It’s a 4-word sentence, with kindergarten-level words!

    So stop using the Hippocratic oath as it applies to the medical profession; it’s not applicable. Maybe a more appropriate slogan would be, “We help way more people than we hurt; trust us.”

  23. Scott says:

    Do you have any actual substantive or meaningful comment to make, or are you just harping on irrelevant semantics of a traditional phrasing because you have nothing to say?

  24. Jann Bellamy says:

    @ Grant Jacobs:

    “Any chance this is being recorded?”

    I asked that question and here is the reply I got from the sponsor:

    “We do not know for sure yet – normally we would, but with budget cuts we have less to work with in terms of funding for our public lecture series this year. It’s still a possibility though.”

  25. Grant Jacobs says:

    Jann -

    Thanks for asking. Let’s hope they can – perhaps someone might be able to sponsor this?

  26. Todd W. says:

    @stanmrak

    Here’s the Hippocratic Oath (modern version). The oath calls on the physician to treat the patient to the best of their ability, applying established science to their practice. “First do no harm” is a general summation of principles, but is not actually part of the oath itself. The meaning behind it is to do one’s best to care for and treat the patient for the greatest benefit to them while minimizing, as much as possible, any possible harms. This acknowledges the reality that everything in life involves risks and benefits, even inaction, as noted by Dr. Hall.

    So when looking at modern medicine in general and making sweeping statements as you have done, then the number of lives saved is very much relevant to the discussion. Had medicine taken your route of simply not treating, as you seem to suggest it do, then far greater harm would befall the patients. That, stan, is an unconscionable violation of the “do no harm” principle.

    On topic, I second Grant. Hope they can record the talk for those who can’t make it.

  27. Sawyer says:

    Thank you for the throwback to the Death by Medicine piece Dr. Hall. I smiled while reading a very prescient comment from Vinny. The more things change in medicine, the more quacks stay the same.

  28. Jan Willem Nienhuys says:

    Has Dr. Offit ever experienced …

    Suppose someone wants to support theory that the moon is made of Swiss cheese.
    “Has Dr. X experienced the taste of moon dust? Has he ever spoken to someone who has tasted it? …”

    Logically this seems to me the same type of argument.

  29. pmoran says:

    stanmrak is, right, sort of. A sceptic referring the “first do no harm” principle does suggest some lack of understanding of the CAM subculture Offit expects an audience of the largely like-minded, I think. For others this will be a jarring note.

    As we all know, whenever we refer to the real and potential dangers of CAM, its supporters invariably point to adverse drug reactions, or to numbers relating to conventional medicine’s own “deaths in custody”. These last are substantial however you wish to look at them. We then play the perfectly valid, but tattered old “risk vs benefit” card. Matter closed — with both sides no closer to any understanding.

    It is more complex than that.

    CAM users and supporters rarely think deeply about what they are doing and why. If they did they might point out that they are no less guided by cost/risk/benefit objectives (as they see them). Most CAM use is resorted to because they see no entirely satisfactory conventional treatment for the purpose, either and very commonly because there IS no truly effective treatment known to science, or because the user has made a conscious decision that the uncertain word-of-mouth benefits from CAM are worth exploring before exposing themselves to the more definite and perhaps not yet fully known risks of conventional methods. They may exaggerate those a little, and have muddled perceptions regarding chemical “toxins”, but they are part right — there are indeed few free lunches in pharmacology, or surgery, — or any branch of medicine really, and few months get to pass without some new side effect being attributed to some drug or other.

    So this is another potential source of misdirected sceptical effort. The argument that CAM is all danger and no benefits can have little traction in such an environment. We need to think more about what we want to achieve and how to do it.

    Perhaps Offit intends to point out specific areas of CAM where there are proven dangers. That might be a better strategy than trying to make the case that CAM is more generally dangerous than conventional medicine. The least rabid CAM sympathiser would regard that as ludicrous.

  30. Harriet Hall says:

    @pmoran,

    Don’t jump to conclusions. In my forthcoming review of his book I said “Those who are put off by the hostility of other authors toward alternative medicine may be receptive to Offit’s approach, since he thinks there is a place for alternative medicine (if only as placebo medicine).” He does not focus on the dangers of CAM. He focuses on instances where CAM crosses over into quackery and recommends against conventional therapies, fails to tell patients about possible side effects of their treatments, drains their bank accounts, and promotes magical thinking.

    I think you, in particular, would appreciate his book and I’d be interested in hearing whether you approve of his approach, and whether it would exempt him from the criticisms you have directed at the approach of authors of this blog.

  31. pmoran says:

    Don’t jump to conclusions. In my forthcoming review of his book I said “Those who are put off by the hostility of other authors toward alternative medicine may be receptive to Offit’s approach, since he thinks there is a place for alternative medicine (if only as placebo medicine).” He does not focus on the dangers of CAM. He focuses on instances where CAM crosses over into quackery and recommends against conventional therapies, fails to tell patients about possible side effects of their treatments, drains their bank accounts, and promotes magical thinking.

    Actually I approve of focusing on the areas where there are real dangers from CAM, and intentional fraud, so that everyone knows to be wary about those. That is where we may do most good with least effort. I would still query his choice of the “first do no harm” slogan, depending upon the audience he envisages.

    I think you, in particular, would appreciate his book and I’d be interested in hearing whether you approve of his approach, and whether it would exempt him from the criticisms you have directed at the approach of authors of this blog.

    I recall reading some material of Offit’s that reflects more tolerance of CAM’s existence than is usual in SBM writings and comments. It’s not irrational, if CAM use is looked upon as stemming from the expression of certain otherwise, sometimes, desirable aspects of human behaviour, rather than as an entirely excisable pathological process.

    I look forward to your review.

  32. Harriet Hall says:

    My book review will be published in Skeptical Inquirer, in the next issue.

  33. WilliamLawrenceUtridge says:

    So stop using the Hippocratic oath as it applies to the medical profession; it’s not applicable. Maybe a more appropriate slogan would be, “We help way more people than we hurt; trust us.”

    That’s a rather stupid statement. It ignores medicine’s constant comparison of old treatments to new, or in the case of new treatments, to placebo. There’s no trust involved, the whole point of having control and comparison groups is to ensure there is differential benefit.

    CAM, on the other hand, asks you to trust them. Trust them that vaccines aren’t necessary, that vaccine-preventable diseases aren’t that bad, that vaccine-preventable diseases can be prevented merely through nutrition, that a positive outlook can prevent or cure cancer, that humans have an energy field that can be manipulated, that doctors are just in it for the money, that the vitamins, minerals and supplements they are selling you will work like medicines. You don’t have to trust doctors, the information is there – it’s just in the background, informing the teaching and learning of medicine. You very much have to trust CAM, since their approach is based purely on criticisms (or in rare cases, rat studies that they assume can be extrapolated to humans).

  34. stanmrak says:

    It appears as if Dr. Offitt is actually aligning himself with one of the most famous practitioners of ‘quackery’ in history. It was Hippocrates who allegedly said, “Let food be thy medicine…” If it supposedly doesn’t work today, it didn’t work back then either.

  35. Harriet Hall says:

    stanmrak said,

    “It appears as if Dr. Offitt is actually aligning himself with one of the most famous practitioners of ‘quackery’ in history. It was Hippocrates who allegedly said, “Let food be thy medicine…” If it supposedly doesn’t work today, it didn’t work back then either.”

    He isn’t. It doesn’t. It didn’t. What is your point?

  36. pmoran says:

    Hippocrates who allegedly said, “Let food be thy medicine…” If it supposedly doesn’t work today, it didn’t work back then either

    Well, those times aren’t renowned for sound principles of medical practice, even if some ethical precepts have stood the test of time.

    Physicians have always fussed about diet when not having much else useful to do. It keeps everyone busy and thinking they are doing some good, while generating spurious “this seemed to work last time” perceptions of efficacy. It faded within the mainstream over the last century or so, as the real causes of many illnesses were better understood.

    Hippocrates believed a lot of things: that female hysteria was due to “the wandering womb”, which could be enticed back to place by exposing the vagina to sweet smells and the nostrils to unpleasant ones. I guess that puts him in the aromatherapy camp?

  37. DavidRLogan says:

    I guess I am in some ways sympathetic with Stan and the CAM entourage here, if only because the SBM powers-that-be are probably not representative of the “typical” (whatever that means) American MD.

    Take side effects, for instance. When we talk about a drug’s relative safety on this board we are talking about it in regards to (in the case of Dr. Hall) someone who is a lifelong skeptic and prepared an 2,000 word post about the issue. When we argue on this board we are arguing about the peer-reviewed studies from that same post. I am not sure that is representative of the length to which the “typical” American doctor thinks about side effects.

    Another. Dr. Gorski is probably at home right now typing an 8 billion word essay about next generation sequencing. And so it is fair when he claims an “argument from authority” around here, especially regarding hardcore pathophysiology. But I am not always sure that is the level at which your typical (?) doctor thinks about pathology (does it need to be?)

    I am not saying, for instance, vaccines have not saved millions of lives, because they have. All I am saying is that some of you spend thirty posts talking about whether there was enough evidence for prior probability, and the p-value fallacy thread was competitive with an upper-level college stats course. I just don’t think that is representative of the way the “average” American doctor goes about things. What do you all think?

  38. Coot says:

    “I just don’t think that is representative of the way the “average” American doctor goes about things. What do you all think?”

    The doctors who write at this blog are doing it right with respect to Bayes. All doctors should do the same. If they don’t, we should either educate them or spank them.

  39. WilliamLawrenceUtridge says:

    It appears as if Dr. Offitt is actually aligning himself with one of the most famous practitioners of ‘quackery’ in history. It was Hippocrates who allegedly said, “Let food be thy medicine…” If it supposedly doesn’t work today, it didn’t work back then either.

    I’m not really certain what kind of medicine they had in ancient Rome or Greece, but their theories led to bloodletting and purging as cures. Compared to cutting someone open to let out some not-inconsiderable portion of their blood out (and let bacteria in), or giving someone powerful laxatives or emetics, “just stay home and eat some fruit” is pretty good advice – much like the way homeopathic hospitals had superior survival rates compared to conventional care before modern, scientific and biology-based medicine came about. And for essentially the same reasons.

    Of course, once empirical research and science began to show results in biology, homeopathy was revealed for what it was – no treatment whatsoever.

    If Hippocrates had had penicillin, I’m pretty sure he would have allegedly said “Holy shit, this stuff is awesome!”

    Anyway, an adequate diet high in fruits and vegetables is a foundation of good health, both in ancient Rome and in modern times. Fortunately now we have vaccines, medications, sterile surgery and above all the scientific method building upon that base – and look at the results! Healthy life expectancy into your 80s, more than double what the ancient Romans had! We friggin’ eliminated smallpox! Polio almost doesn’t exist! Doctors don’t even recognize scurvy anymore! We can cut out someone’s hip and put in a new one! We bank stem cells of infants in order to treat diseases decades in the future!

    If Hippocrates lived today, he would doubtless be sharing the stage with Offit, or applauding him in the audience. After all, fewer babies die every year because of Dr. Paul Offit, and if you don’t think that’s a good thing, clearly there is something wrong with you.

  40. Scott says:

    @ David:

    You’re quite right – it’s not representative. But it should be, and that’s what SBM is trying to promote.

  41. norrisL says:

    Fast Buck Artist, hmm, interesting website comes up there when clicked on FBA

    http://www.homeopathicdirectory.com/

    Anyway, the alternative (ie: quackery) may make up 1% of the total expenditure, but that still leaves a huge scope for harm caused to overly credulous suckers by quacks such as homeopaths etc

  42. Artour says:

    It is pity that this lecture will unlikely review any evidence related to abnormal breathing parameters (breathing too much air) present in nearly 100% of people with common chronic diseases (diabetes, cancer, heart disease, asthma, and so forth) and even in normal subjects.

    Meanwhile, growing number of studies claim an important (often leading) role of low body oxygenation in development of health problems.

    What makes the problem with breathing worse is that over 90% of people believe that breathing more air provides more oxygen for body cells, and that CO2 is a toxic gas…

  43. WilliamLawrenceUtridge says:

    Dear Artour,

    Yeah, low blood oxygen is a real pain. It’s good therefore that the body is tremendously overbuilt with regards to oxygenation, and oxygenation of the blood is nearly 100%.

    Breathing is not the cure for all diseases, you are a quack. Go away.

  44. Dave S says:

    Artour, nothing other than a cardiac arrest or hypotension will generate as much activity in an ER or hospital as hypoxia.

    I probably cannot speak for the “typical American doctor” but I am a hospitalist and have almost 40 years of experience, so can say something about the thought processes of myself and most physicians in my group. We agonize a lot over drug side effects. Every drug addition goes through a risk-benefit analysis. For some drugs the decision is easy – pneumococcal sepsis warrants antibiotics, the exact choice depending on the patient’s allergy profile. For others, such as giving TPA in the face of a acute stroke, the pucker factor is extremely high. TPA, for those who are not familiar with it, in certain stroke patients, but not all (the criteria are pretty stringent) can improve outcomes and significantly lessen the chance that the patient will wind up in a nursing home. It can also cause intracranial hemorhage and death, although the global mortality in patients who are treated vs untreated is the same. The NNT for this drug is actually pretty good but the medication is one that no physician gives without a LOT of concern, I would say even fear, and only after an extensive risk/benefit discussion with the patient. For most medications the decision difficulty is in between, particularly when the diagnosis is still unclear. I don’t think we consider p-factors and statistical probability per se but are aware of studies regarding, to use an example, beta blockers for MI’s or ACE inhibitors for chf, have an idea of the major side effects, use a computerized drug interaction warning program and have an idea of the number needed to treat. I heard a description of evidence based medicine phrased as “If I give this drug to 100 people I’ll help 10 of them, hurt one of them, and not affect the others. I don’t know which group you’ll fall into”. The lay public has trouble with this. Actually, so do I, but until we have better ways of identifying which individuals will receive benefit from a drug (we’re getting there with some cancer agents) and which individuals will have an adverse effect, this is where we are.

    Also speaking as an average MD, I am distressed by the cost of drugs, especially the newer biologicals, am frustrated when a drug gets approved based on studies using surrogate markers rather than patient-important end points, and angry when relative risk reductions are reported without absolute risk reductions and raw figures. I am not aware of any conspiracy to supress effective treatment (we and our families get sick too, for Christ’s sake, and taking care of a patient who’s going down the tubes is a bloody awful experience. We like it a lot when our patients do well). I also feel that guidelines should be written by experts with no financial incentives, but also realize that a guideline written by experts with financial incentives still might be a good guideline. By the way, I am salaried and have NEVER received any financial incentive for using or not using any drug, nor did I when I was in private practice in primary care. Just a voice from the trenches.

    Allopathic medicine grew out of a situation very similar to how some CAM are practiced. I live near the town of Elkhorn, a ghost town in Montana which has a graveyard well worth visiting if you are in the area. There are many gravestones from 1898-99 of young children. One gravestone is an arch with a child at the base of each pillar. Another gravestone is a pillar with multiple children buried at the base. The cause of these deaths was a diphteria epidemic which pretty much wiped out the youth of the town. The horror of the parents seeing their children die right and left can only be imagined. I also have a series of medical texts written in 1898. These books would fill a bookshelf, and give excellent descriptions of physical syndromes, and even some good advice. The section on diphteria, for example, advises quarantining ill kids, shutting schools and libraries during epidemics, etc. The treatment sections however are full of anecdotal reports of mostly useless treatments- painting diphteria membranes with solutions of potassium chloride, for example. EBM has been useful in sorting out which treatments really work and which don’t.

    It is a tribute to the advances of medicine that in 40 years of practice I have never seen a case of diphteria.

    Sorry for the long-winded post.

  45. WilliamLawrenceUtridge says:

    Dave, have you read Bad Pharma? It’ll distress you even more. The only “good” news I’ve seen so far is that the problems of Big Pharma’s impact on research is in many cases one of degree, not absolute bias (i.e. the drug still has an effect, but it’s overstated). Of course, his discussion of missing trials indicates an issue of potential absolute as well.

  46. lilady says:

    I just returned from Paul Offit’s excellent lecture at the Cold Spring Harbor Laboratory. His newest book “Do you Believe in Magic” was the subject of his lecture. And no, his personal stalker Jake Crosby did not show up to harass Dr. Offit.

    Dr. Offit mentioned that The Guardian has already published his article about mega vitamins and that there will be a Book Review published tomorrow:

    http://www.guardian.co.uk/lifeandstyle/2013/jun/07/vitamins-stop-taking-the-pills

    Dr. Offit has an Op-Ed piece about supplements, scheduled to be published in tomorrow’s NY Times.

    (I’m thrilled that I actually had the opportunity to meet him…he’s one of my heroes).

  47. Jeannie says:

    It appears to me that “MD”‘s are in fear of their professions being taking over by “original medicine” before the Pharmaceutical companies and Health Insurance took over their paycheck. This site only uses sources to prove their argument so this is a poor representation of so called research. Totally biased and it’s obvious to us “underlings” who are getting wise to this practice.
    Get with it MD’s because continuing on your resistant path of toxic drug poisoning will put you out of a job in the next 10 years. There are alternatives that are as effective as meds with side effects. Say good bye country club!

    1. lilady says:

      Jeannie: I’m really, really interested in your remarks about medical doctors being in the pocket of *Big Pharma*…to the detriments of “us underlings”.

      Could you expand on you comments, with um, some links to websites to “alternatives that are as effective as meds”?

      - How about commenting on “alternatives” for prevention/treatment of hematological tumors? Links to your *sources* are required.

      - How about commenting on “alternatives” for prevention/treatment of vaccine-preventable-diseases? Please be specific about diseases that are contracted by exposure to infected blood/body fluids, those diseases that are spread through the fecal-oral route of transmission, and, those diseases that are spread via the airborne or droplet route of transmission. Again, links to your *sources* are required.

      “Say good bye country club.”

      Let me FTFY Jeannie…

      “Say good bye Troll.

  48. WilliamLawrenceUtridge says:

    Jeannie, if alternatives are as effective as real medications, why do they consistently fail in properly controlled scientific testing? My assumption is that it is because they don’t work (which makes sense – there’s no reason for plants or other “alternative” cures to have evolved to counter-act specific human ailments; in some cases by pure chance specific molecules will be produced that do have effects, and we can use them in purified and modified forms as biologically active compounds). Yours seems to be “there is a massive conspiracy that renders all scientific testing wrong unless it validates my pre-existing notion”. Your pre-existing notion might be completely wrong. Certainly it’s not parsimonious. It assumes all doctors are malicious, all scientists are malicious, there are no whistle-blowers, or the scientific method has some sort of hitherto-unrecognized flaw that renders it ineffective only when testing alternative medicines. Further, insurance companies are in the game too (because they certainly would prefer cheaper natural cures over expensive drugs if they worked), as are all regulators (though you might have something there given the double-standard for drugs versus herbs, supplements and the like), and everyone who has taken said “alternatives” and found them not to work.

    Maybe “alternatives” fail scientific tests because they simply don’t work. Maybe when the “alternatives” seem to make you feel better, there’s another explanation. You should read Snake Oil Science to see why this might be the case.

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