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Be careful what you wish for, Dr. Dossey, you just might get it

If there’s one thing about the so-called “complementary and alternative medicine” (CAM) movement that I’ve emphasized time and time again, it’s that its adherents have a definite love-hate relationship with science. They hate it because it is the single greatest threat to their beliefs system and the pseudoscience that underlies it. At the same time, they crave the legitimacy that science confers. They crave it not because they have any great love for science. Quite the contrary. It is simply that they recognize that science actually delivers the goods. Of course, they believe that they deliver the goods too, but they come to this belief not through science but rather through all the cognitive shortcomings and biases to which humans are prone, such as confusing correlation with causation, confirmation bias, not recognizing regression to the mean, and being fooled by the placebo effect. Whether it’s through a misunderstanding of science or less innocent reasons, they go to great lengths to torture it into superficially appearing to support their claims through a combination of cherry-picking of studies that seem to support them and misrepresenting ones that don’t, discussions of which abound right here in this very blog.

The other thing I’ve emphasized about the CAM movement is that, even more than scientific credibility, they crave legitimacy. To them, however, science is but one pathway to legitimacy, because, unlike practitioners of science-based medicine, they are more than willing to bypass science to obtain the legitimacy–or at least the appearance of the legitimacy–they so crave. If it means doing an end run around science by trying to hijack the Obama health insurance reform bill that is currently being negotiated to resolve the differences between the Senate and House versions, so be it. Indeed, earlier this year, I described how Senator Tom Harkin has tried to promote CAM through the National Center for Complementary and Alternative Medicine (NCCAM) and trying to insert provisions into the bill that would mandate that government-subsidized insurance exchanges pay for CAM. Meanwhile, prominent CAM advocates have been carpet-bombing the media with dubious arguments in support of CAM, as in when Deepak Chopra, Rustum Roy, Dean Ornish, and Andrew Weil teamed up in different combinations to promote the idea that CAM is all about “prevention” and that science-based medicine, in all its reductionistic evil, is nothing more than pushing pills.

They’re at it again.

This time around, Deepak Chopra and Rustum Roy have apparently ditched Andrew Weil, but their replacement, although not nearly as famous as Weil, is more than capable of holding up his part of the woo. I can only speculate that Andrew Weil, who is clearly one of the cleverest CAM advocates, recognized a loser argument when he saw it and declined to participate. No problem. They managed to sign up Dr. Larry Dossey, and the hostility towards science-based medicine flows apace without interruption. In fact, Dr. Dossey is more than “qualified” for this honor:

Dr. Larry Dossey is a former physician of internal medicine and former Chief of Staff of Medical City Dallas Hospital. He received his M. D. degree from Southwestern Medical School (Dallas), and trained in internal medicine at Parkland and the VA hospitals in Dallas. Dossey has lectured at medical schools and hospitals throughout the United States and abroad. In 1988 he delivered the annual Mahatma Gandhi Memorial Lecture in New Delhi, India, the only physician ever invited to do so. He is the author of ten books dealing with consciousness, spirituality, and healing, including the New York Times bestseller HEALING WORDS: THE POWER OF PRAYER AND THE PRACTICE OF MEDICINE, most recently THE POWER OF PREMONITIONS. Dr. Dossey is the former co-chairman of the Panel on Mind/Body Interventions, National Center for Complementary and Alternative Medicine, National Institutes of Health. He is the executive editor of the peer-reviewed journal EXPLORE: The Journal of Science and Healing. Dr. Dossey lectures around the world. He lives in Santa Fe with his wife Barbara, who is a nurse-consultant and the author of several award-winning books.

So Dossey’s the executive editor of EXPLORE? Truly, the woo is strong in this one. Remember, EXPLORE is the “journal” that publishes allegedly scientific papers on topics such as “distant healing” in cancer patients and, even more hilariously, imbuing chocolate with “intent.” His editorial standards, suffice it to say, do not impress me. However, he’s just the man for the job of helping Deepak Chopra and Rustum Roy launch what is nothing more than an all-out attack on science-based medicine in an article that is breathtaking in its concentration of logical fallacies and its naked hostility towards science-based medicine entitled The Mythology Of Science-Based Medicine (crossposted on Deepak Chopra’s very own Intent Blog). It appears in that repository of quackery, woo, and pseudoscience, The Huffington Post. This article is depressingly similar to an article that was published in the Wall Street Journal almost exactly a year ago, even recycling some of the same dubious arguments.

The article is an exercise that combines cherry-picking, logical fallacies, and whining, raising the last of these almost to an art form. It begins with a false dichotomy:

The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

Note the dichotomy. To Dossey, Chopra, and Roy, it’s all “big pharma” and incredibly expensive hospital care versus the “thousands of treatment modalities not taught in medical school”; i.e., big medicine, big pharma, and technology versus “natural cures.” If there’s one thing boosters of unscientific and pseudoscientific treatments want, it’s to be viewed as on par with science-based medicine, as an “alternative” but equal system. Framing the issue this way from the first paragraph is likely an intentional strategy to implant right from the beginning in the reader’s brain that there really is a dichotomy. Actually, I’ve argued time and time again that the entire concept of “alternative medicine” versus science-based medicine is a false dichotomy. There is no such thing as “alternative medicine.” Well, actually, there is, but by definition “alternative” medicine is medicine that either hasn’t been scientifically validated and shown to work or medicine that has been shown not to work. “Alternative medicine” that is shown to be effective and safe through science ceases to be “alternative” and becomes just “medicine.” If Dossey, Chopra, and Roy could show that their preferred nostrums work through science, I’d happily add them to the armamentarium of science-based medicine. In fact, they’d become science-based medicine! That brings me to another issue, the massive straw man behind this article:

When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.

If a pill or surgery won’t do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.

I like the bit about “grudging concession to placebo effect.” In reality, I think that’s a huge case of projection. CAM relies almost exclusively on the placebo effect, and only recently has grudgingly started to attempt to include placebo controls. The plethora of acupuncture studies with sham acupuncture where the results show that sham acupuncture is just as effective as “real” acupuncture are more than enough evidence of that. Acupuncturists don’t like it, though, because they don’t like being shown that their woo is no more effective than a placebo, and they certainly don’t like being shown that it doesn’t matter where you stick the needles (making the acupuncture concept of “meridians” meaningless) or that it doesn’t even matter whether needles pierce the skin. The bottom line is that science-based medicine has incorporated placebos into its clinical trials for decades now. It’s CAM that’s late to the game, and its practitioners don’t much like how, when valid placebo controls are included, almost inevitably it’s found that the vast majority of CAM procedures don’t do any better than a placebo.

Then there’s the straw man. Dossey et al seem to be claiming that science-based medicine practitioners show disdain for “alternative” medicine. In any case, note the subtle use of the word “procedures.” Not “treatments.” Not “medicines.” Not “therapies.” Procedures. Note how that is then juxtaposed against “alternative medicine” or “indigenous medicine.” This framing intentionally makes another false dichotomy: Between “procedures” of science-based medicine and the nice, fuzzy, happy “treatments” of alt-med. And, of course, they’re “enormously popular,” leading to the classic logical fallacy of argumentum ad populum.

More annoying is Dr.Dossey’s nonsense about medicine being unrelentingly hostile to alt-med. In fact, in a case of being so open-minded that its brains are falling out, academic medicine is embracing woo wholesale. How many times have I complained about just that right here on this blog, be it about NCCAM wasting $120 million of taxpayer money every year studying woo or the infiltration of woo into academic medical centers? The problem isn’t that “mainstream medicine” is hostile to alt-med. It used to be, but no more. The problem is that, at the same time mainstream medicine is promoting “evidence-based” medicine, it is also embracing non-evidence-based medicine. It is embracing a “more fluid concept of evidence” in order to allow CAM to obtain legitimacy.

The next part of the article consists of a whole lot of special pleading, topped off with some serious cherry-picking and deception by omission. First up, Dossey et al make a huge deal out of the British Medical Journal‘s attempt to evaluate mainstream medical treatments and determine which ones have solid evidence to support them. Unfortunately, I do not have access to the website, and neither does my institution; so I can’t evaluate much of it. From what I could evaluate, Dossey et al make much of the observation that 46% of treatments were “unknown” in their effectiveness or that, if you believe BMJ‘s analysis, only 36% are likely to help. Even if this were true, I notice one glaring omission. Notice how Dossey et al don’t mention comparable numbers for their treatments. Even if scientific medicine performed this poorly, it’s virtually certain that alt-med performs far more poorly. Moreover, I’d be willing to bet that the evidence base in favor of the woo that Dr. Dossey favors is pathetic in comparison to that supporting science-based medicine. In other words, this is a massive case of the pot calling the kettle black, except that the kettle isn’t even black in this case.

I also notice another glaring omission in this statement:

This left the largest category, 46 percent, as unknown in their effectiveness. In other words, when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial. This is remarkably similar to the results Dr. Brian Berman found in his analysis of completed Cochrane reviews of conventional medical practices. There, 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”

There’s a huge and deceptive assumption behind this rather amazing claim. Can you see what it is? It’s the assumption that all these treatments are equivalent in terms of how common they are and how common the diseases and conditions for which each therapy is designed are. If that were true, then one could conclude what Dossey et al just concluded. But it’s not. Some conditions are far more common than others and are far more studied than others. If, for instance, a child is brought to the ER with the classic history, symptoms, and signs of appendicitis, it’s far more than a 36% chance that the intervention (an appendectomy) will take care of the problem. In fact, it’s close to 100%.

Dossey et al then start to get sloppy with their claims:

We all marvel at the technological advances in materials and techniques that allow doctors to perform quadruple bypass surgeries and angioplasties without marveling that recent studies indicate that coronary bypass surgery will extend life expectancy in only about three percent of cases. For angioplasty that figure sinks to zero percent. Those numbers might be close to what you could expect from a witch doctor, one difference being that witch doctors don’t submit bills in the tens of thousands of dollars.

Wow! Dossey compared us practitioners of science-based medicine to witch doctors. The wag in me can’t resist pointing out that the CAM crowd includes actual witch doctors in its ranks.

In any case, this is the study to which Dossey is referring. However, it is not exactly as Dossey represents it, as you can see if you read the abstract. I’ll paraphrase what I said before about it the last time Deepak Chopra and his merry band of woo-meisters abused this study for their ends. What this particular study did was to compare one science-based percutaneous coronary intervention (PCI, otherwise known as angioplasty) with another science-based medical therapy, namely optimal medical therapy plus PCI. Again, let me hammer home the point that both sets of interventions are science-based and not in any way “alternative.” The study concluded that adding PCI to medical therapy with drugs and diet only provided 3% additional benefit in terms of survival. Also note how Dossey et al, as Deepak Chopra did last year, misrepresents one conclusion of the study by claiming that coronary artery bypass graft (CABG) surgery prolongs life in only 3% of those who receive it as though that was a conclusion of the study. It wasn’t, and, as Chopra didn’t cite his source last time, Dossey et al don’t cite their source this time. (That this error is repeated makes me think that Chopra probably wrote this section of this article.) In any case, what Dossey et al also fail to mention was that patients in the PCI plus medical intervention group required fewer procedures (32% of the medical therapy required additional revascularization procedures to 21.1% of the PCI/medical therapy group at 4.6 years) and a higher likelihood of being free from angina, albeit modest (42% versus 36% at 5 years). Moreover, Dossey et al conveniently forget to mention that these results were derived from studying patients with stable coronary artery disease, not with unstable angina. They are not in any way blanket evidence that “angioplasty and CABG don’t prolong life.”

Dossey et al do a bit of similar prestidigitation by citing a meta-analysis and characterizing it as concluding that antidepressants don’t work:

The theory behind standard antidepression medication is that the disease is caused by low levels of key brain chemicals like serotonin, dopamine, and norepinephrine, and thus by manipulating those imbalanced neurotransmitters, a patient’s depression will be reversed or at least alleviated.

This turns out to be another myth. Prof. Eva Redei of Northwestern University, a leading depression researcher, has discovered that depressed individuals have no depletion of the genes that produce these key neurotransmitters compared to people who are not depressed. This would help explain why an estimated 50 percent of patients don’t respond to antidepressants, and why Dr. Irving Kirsch’s meta-analysis of antidepressants in England showed no significant difference in effectiveness between them and placebos.

Dr. Dossey needs to learn proper scientific terminology. It’s breathtakingly sad that an the journal editor of an allegedly scientific journal would confuse genes, which are the DNA that codes for proteins, with the gene products (namely the proteins themselves) so carelessly. You can’t “deplete” genes, at least not in humans. (Knockout mice are another issue, but that takes genetically engineering and breeding a new mouse strain.) You can deplete gene products, but not genes. Dossey et al thus show a complete lack of understanding of how cDNA microarray studies are performed and analyzed, which hardly gives me much confidence in the rest of their analysis. In any case, I find it curious how Dossey characterizes the Kirsch meta-analysis as saying just that “antidepressants don’t work.” There may be evidence that this is true for patients with mild to moderate depression, for severe depression even the meta-analysis cited supports the efficacy of anti-depressants, albeit more weakly than previously believed.

Finally, of course, the ever popular “medicine kills lots and lots of people” claim, so beloved of quacks like Gary Null and discussed by our very own Harriet Hall in 2008, rears its ugly head. (I loved how Harriet compared the “death by medicine” claims to “death by food.”) First, there’s the claim that “Dr. Barbara Starfield, writing in the Journal of the American Medical Association, estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes, or physician error, making this number three in the leading causes of death for all Americans.” Quite frankly, this figure has actually always bothered me, as it’s clearly the highest of the usual apocalyptic estimates for how many people doctors supposedly kill through error or negligence, and the reason is simple math. Each and every year in the U.S., approximately 2.5 million people die. If Dr. Starfield is to be believed, approximately 10% of all deaths are from iatrogenic causes, which would make iatrogenic death the third leading cause of deaths in the U.S. after heart disease and cancer.

Patients in hospitals tend to be sick and more prone to complications, otherwise they wouldn’t be in the hospital, and hospitals do have systemic problems. For instance, Starfield counts 80,000 deaths from nosocomial infections in hospitals. Nosocomial infections (hospital-acquired infections) are a big problem, no doubt, but lumping them in with medical error is rather questionable. Many nosocomial infections can’t be prevented easily and are not the fault of the physicians treating the patient. (Many can be, however, the most striking example of which is a recent study showing how a checklist before inserting a central line leading the physician through careful, sterile technique can dramatically decrease the number of catheter-associated infections.)

Similar considerations apply to non-error adverse reactions, which are said to claim 100,000 deaths a year. Remember, these were not medicines given in error. They were medicines given for correct clinical indications that happened to produce an adverse reaction. Again, in very ill hospitalized patients on multiple powerful medications, the likelihood of this happening increases. Consider the example of aminoglycoside antibiotics. These are used for very serious infections, but they produce a risk of renal failure, and renal failure can be life-threatening, particularly if added onto other organ system failures. Yet, if a critically ill patient has a serious infections, sometimes you have to bite the bullet and give them Tobramycin or Gentamycin. At least, we didn’t back when I was a resident. Fortunately today, thanks to science-based medicine, there are less toxic alternatives. The point remains, however. Consider another example: Cytotoxic chemotherapy. If a patient comes in with acute leukemia, he is likely to die if not treated. However, the medicines used to treat acute leukemia are toxic and can cause complications that will kill the patient, such as severe neutropenia and its attendant immunosuppression. Yet the patient will surely die without treatment, and the drugs save far more people than they kill; so the benefits outweigh the risks and we treat with these drugs — and, these days, we do it with careful informed consent. In other words, to compare these apocalyptic numbers honestly, you have to look at them in comparison to the number of lives saved every year by scientific medicine. In other words, as Peter Lipson put it, you have to compare the risks versus the benefits:

But there is a more important fact that should keep you from being scared away from real medicine.

Advances in the treatment of coronary artery disease, the number one killer of Americans, reduced the number of deaths by over 340,000 in 2000 alone. And that’s just one disease.

So, in one year, medical errors may cause a few tens of thousands of deaths (and these are preventable deaths), but real medicine, in one disease alone, saves an order of magnitude more.

And, as Harriet Hall put it:

Drug reactions? All effective drugs also have side effects. It’s meaningless to count the side effects without counting the benefits. An insulin reaction counts as an adverse drug reaction, but if the patient weren’t taking insulin he probably wouldn’t be alive to have a reaction. Some of the counted drug reactions are transient minor annoyances like a rash. People have iatrogenic infections in the hospital, for instance post-op infections; but without hospitalization and surgery they might have been dead instead of infected.

Iatrogenic deaths? How many of those were of people who would have died many years earlier without modern medical care? How many of those iatrogenic causes were high-risk treatments in high-risk patients who had no other option?

Let’s take another example. I’m a surgeon. Although I haven’t taken general surgery call for over a decade now and have subspecialized, I did used to do trauma and general surgery call, however, and as recently as two years ago I did surgical oncology call in a hospital where the medical oncologists didn’t call the general surgeons whenever general surgery problems cropped up in their cancer patients. They called us. The effect, as I used to joke, was that when I was called for a patient with a hot gallbladder, it wouldn’t be the straightforward patient with cholecystitis; it would inevitably be a septic patient in the bone marrow transplant unit on a ventilator with no white blood cells and no platelets — in other words, very high risk patients. If I operated on such a patient and he died within 30 days or before getting out of the hospital, that counts as a postoperative mortality; i.e., an “iatrogenic” death. Yet, that patient would surely have died without surgery; surgery would be his only chance of survival. Moreover, going upstream to the patient’s original chemotherapy, which is what likely rendered his bone marrow so suppressed, the patient would surely die without chemotherapy. Chemotherapy, which has the risk of fatal bone marrow suppression, is his only chance at survival, contrary to what certain cancer quacks I’ve lambasted on this blog may say. None of the statistics cited by Dossey et al take any of this into consideration; without that information we’re left with large numbers whose significance is unclear. Moreover, when criticized for these lapses with regard to the Starfield article and the selective representation of two studies in their original blog post, they posted a follow-up in which they basically regurgitated the same points about the Starfield article and completely ignored the criticisms of how they misused the angioplasty study and the antidepressant meta-analysis.

Don’t get me wrong. We ought to be doing everything we can to decrease complications and death due to medical errors. The Institute of Medicine suggests the number may be from 44,000 to 98,000. By any measure this is far too many, but remember this: it wasn’t Chopra, Dossey, Roy, or any of the other celebrity physicians promoting alternative medicine or the promoters of alt-med who did the studies to derive these estimates. It was science-based physicians trying to improve the practice of medicine, and there is nothing even coming close to a similar data set maintained by alt-med practitioners.

Dossey and pals then finish up with a heaping helping of straw man, trying to outdo our previous pyromaniac in a field of straw men with this claim:

You have a right to be shocked by these findings and by the overall picture of a system that benefits far fewer patients than it claims. The sad fact is that a disturbing percentage of the medicine we subject ourselves to isn’t based on hard science, and another percentage is risky or outright harmful. Obviously, every patient deserves medical care that is evidence-based, not just based on an illusory reputation that is promoted in contrast to alternative medicine.

Do I detect the scent of burning martyr here?

Promoters of science-based medicine do not deny that there is a disturbingly high proportion of medicine practiced that is not based on firm science and evidence. It’s not as high a percentage as woo promoters like Dossey like to exaggerate it to be, but it is too high. In fact, that’s one of the very reasons we promote science-based medicine, because we believe, based on what we think is good evidence, that more SBM will decrease those complication rates and rates of iatrogenic injury and death while increasing the likelihood of doing good. In other words, we’d like to shrink that percentage to as close to zero as is feasible.

Of course, another element to this highly disingenuous response is, I suspect, that Dr. Dossey is conflating dismissing a treatment based on prior scientific probability as being so incredibly unlikely to work that it is not worth testing anymore (homeopathy, of course, comes to mind right away as one of the best examples) with “dismissing out of hand.” A commenter by the ‘nym “anxiousmedic” put it well in the comments of a follow-up post when he pointed out that “the interventions used in modern medicine are not practiced because doctors saw them in a dream one night” and that “physiology, genetics, the germ theory etc. all point to interventions which are more plausible than others.” Indeed, there is a pathway to discovering what “works” in medicine that begins with basic science. Let’s take the example of homeopathy again. For homeopathy to “work,” our understanding of huge swaths of well-established science in physics, chemistry, and biochemistry would have to be shown not just to be in error, but in massive error. For remedies diluted and succussed to the point that not even a single molecule is likely to remain, water would have to have a magical “memory” that remembered the remedy and, as Tim Minchin so brilliantly put it, forgets all the poo that it’s been in contact with. To overcome such massive amounts of evidence and science and lead scientists to start to think that the principles of homeopathy might have something to them would require compelling evidence at least somewhere within an order of magnitude in quality and quantity of the evidence showing that homeopathy can’t work. Dubious studies in cells and occasional clinical trials showing effects barely distinguishable from placebo responses that could easily be due to random chance alone do not qualify as being sufficient in quantity or quality to overturn the two hundred years of physics and chemistry since Samuel Hahnemann first conceived the idea of homeopathy.

Dossey et al then conclude with a statement that I can totally agree with, just not in the way they think:

We are not suggesting that Americans adopt any and all alternative practices simply because they are alternative. These, too, must demonstrate their effectiveness through objective testing. But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders.

This, too, is a straw man. We do not “dismiss out of hand” alt-med modalities, nor has the criticism of CAMsters like Dr. Dossey based on thinking that they are “suggesting that Americans adopt any and all alternative practices because they are alternative.” In fact, as has been documented on this very blog time and time again, NCCAM spends $120 million a year studying and — yes, promoting — these modalities. Hospitals are rushing to add “integrative” and CAM programs to their portfolios. Given how little evidence supports these modalities, I’m sure that The Cherrypickers Three would be happy to join me in condemning this push to fund useless studies that waste taxpayer money and as yet have produced nothing of value, to teach non-evidence-based woo in medical schools (even Harvard) and residency, and to offer non-science-based (at this time) treatments. (I won’t hold my breath waiting.)

I also find it highly disingenuous of Dr. Dossey to claim that they are not promoting any particular alternative therapies. Deepak Chopra is most definitely promoting his “quantum consciousnessnonsense and many CAM modalities, and Rustum Roy promotes homeopathy every chance he gets (hence my choice of homeopathy as an example of a therapy with nearly zero prior probability). Dr. Dossey himself in his books promotes something he calls “Era III medicine (nonlocal medicine),” which “incorporates all the benefits and warnings we have gleaned from intensified understanding of the effects of prayer and intention,” as well as “distant healing.”

Let’s put it this way. If a reader knew nothing about Dossey, Chopra, and Roy, that reader might believe their claims that they aren’t promoting any particular “alt-med” treatment. But this reader does know a bit about these three, and he can Google. In context, we have three people who elsewhere are actively promoting “alternative” medicine modalities teaming up to write an article attacking promoters of science-based medicine for dismissing CAM based on science. Moreover, the article’s entire argument can be boiled down to: “Science-based medicine has a lot of problems and does a lot of harm; so don’t dismiss our woo as being ‘unscientific.’” Sorry, but that’s a non sequitur. Whether SBM has problems and even if the apocalyptic figures cited by Dossey et al were exactly correct, that SBM is not sufficiently science-based does not mean that any of the alt-med modalities promoted by Dossey and his merry band are science-based. Even if the British Medical Journal estimates are correct and 46% of treatments have unknown efficacy when subjected to stringent science, I’d be willing to bet that the equivalent number for CAM modalities is south of 1%.

That’s why, if Dr. Dossey wants us to compare science-based medicine with “alternative medicine,” then I daresay that I speak for everyone here at SBM when I say, “Bring it, dude!” In fact, right here, right now, I challenge Dr. Dossey to live up to his own words in the comments:

We are not promoting any particular alternative therapy. We are promoting a level playing field for the evaluation of ALL therapies and the abandonment of the double standard that now exists, as we described. We are promoting a ruthless adherence to science and objective methods of evaluation. We are promoting an elevation of the standards of efficacy and safety for ALL treatments, whatever they may be.

All of us here at SBM have argued time and time again for a level playing field for the evaluation of all medical treatment modalities, whatever they may be and from wherever they may have been derived. Certainly, I have. The problem, of course, is that CAM is actually being given a free ride, being introduced into hospitals on the basis of nonexistent evidence or the thinnest of evidence. It’s being taught in medical schools and residency programs even though the evidence base to support doing so is just not there. Meanwhile, NCCAM spends $120 million dollars a year studying CAM not based on compelling evidence, but rather the advocacy of a woo-friendly Senator, and provisions mandating reimbursement for modalities not validated by science are being inserted into health care reform legislation, again, thanks to woo-friendly legislators.

Dr. Dossey just spent two articles whining that his beloved CAM is being treated so very, very unfairly by promoters of science-based medicine, but from my viewpoint it’s being treated more than fairly these days; it’s being given a free pass, by and large. Again, that’s why I’ll repeat it one more time. If Dr. Dossey really wants CAM to be evaluated on a truly equal scientific footing with science-based medicine, I have one thing to say to him one last time:

Bring it on!

Oh, and that Dr. Dossey might want to be careful what he wishes for. He might just get it. At least, I sincerely hope he does.

Posted in: Energy Medicine, Herbs & Supplements, Homeopathy, Medical Academia, Neuroscience/Mental Health, Politics and Regulation

Leave a Comment (27) ↓

27 thoughts on “Be careful what you wish for, Dr. Dossey, you just might get it

  1. Mojo says:

    I like the bit about “grudging concession to placebo effect.”

    Especially from Rustum Roy, who has in the past attempted to downplay the role the placebo effect plays in homoeopathy relative to real medicine:

    But the main thrust of Goldacre’s argument is the role of the “placebo effect”. Yes, this works. And, yes, it is without doubt present in every homeopathic intervention; but it is far more powerfully present in orthodox medical pills because they are advertised so widely in billion-dollar campaigns.

  2. windriven says:

    I would like to suggest that the New Improved Health Care System be established as a bifurcated system. All adults would elect to either be treated in the science/evidence-based medical system or the homeopathic/chiropractic/prayer/anti-vax/hope-based system. The choice, once made, would be irrevocable.

    There would be disadvantages in the short term, of course: failures to achieve herd immunity because the vaxers cause viruses to become more infectuous and lethal, people hobbling in agony because of untreated subluxations, ugly scenes of wretched suffering and death for want of a simple 200k dilution. Oh, the horror, oh the humanity. But Nostrum Roy and friends are tough, they can persevere through watching the agonies of the science-based losers in their death throes – or maybe they’ll even offer to treat them for free. They all seem such selfless fellows’ Deepockets Chopra, especially, I’m sure that is what would happen.

    Before long so-called allopathic medicine will have gone the way of of the dodo and a millennium of truth, light, and healthfulness will reign. Truly it will be the dawning of the age of Aquarius.

  3. Lawrence C. says:

    I appreciate your focus on the language used by Dossey et al in their attempt to promote their case. It is most telling that they have to rely on setting up so many falsities and rely on disingenuous pairings such as “treatments” versus “procedures.”

    Dossey et al seem to be sly propagandists rather than wanting any sort of clear and reasoned thinking about their position to take place. It is unfortunate that they work so hard to place tricky words in key places so that the uninformed reader’s imagination has so much to run with. In this they are slackers and their readers should be mad, as they are asked to do the lifting for Dossey et al instead of having it presented to them clearly and fairly.

  4. daijiyobu says:

    Okay:

    I’m going to be a dick — in your direction — while simultaneously, I paraphrase you on my own blog profile because to me you are a paragon.

    But, you are so f’n long-winded as a pattern that it is making me angry, in terms of your public facet.

    Mind you too, I was there at the last TAM when you spoke [should I say, at the pre-TAM?].

    Sorry, didn’t get to say hi personally, though Kim Atwood was a hoot to chat with. I guess the difference was that Kim as sipping ETOH [ethyl drinks] with the masses, and I didn’t have the desire to grovel in your direction as a fanboy wherever you were.

    Loosely, I count 5457 words in this specific post. Much like others. Is it possible to instead be concise, instead of over-the-top in that Jean-Paul Sartre amphetamine kind of style?!?!

    Thought, I do elect you as a potential editor for a Prometheus Books compilation of past-couple-of-years SBM blog posts!

    But, the average Skeptic Joe loses you after paragraph 4.

    Me, personally, and I’m not an idiot and I am average [oh, I love the irony], jump to the end of each of your posts after paragraph 4 every entry.

    Now, here’s where I conciliate. Everything you write bears upon the issue. I guess I’m arguing about overall length / style: it dilutes.

    But, I’ll not exclude myself from criticism: my average post is merely a citation, when I could flesh it out.

    Audience: discuss this amongst yourself.

    -r.c.

  5. wertys says:

    I started reading the article in question and had to stop. I can’t stomach the effrontery and hypocrisy of these frauds. Every time I start feeling bad about persecuting the honest and compassionate sCAM artists in my area, something like this article comes along and gets me so riled up I go straight out and report another couple of websites to the local authorities here in Australia. So keep it up Dossey and pals, you’re my inspiration…

  6. superdave says:

    They also use the placebo effect in its common language use (unfortunately so) as some kind of inert ability for the body to heal itself, and not what it actually is, the collection of effects not controlled for in a study.

  7. DevoutCatalyst says:

    The type of poison ideas these guys are using were effective with me back in the day. Kept me away from the doctor. Buying into this crap is like being admitted to a secret club where special knowledge is granted. So that when I did have occasional contact with a regular doctor, a knowing, self-satisfied unspoken feeling was there with me as I listened to the conventional medicine “hogwash”. I KNEW BETTER. But in retrospect, all the secret cautions and pitiful worries were at the level of Mr. Whipple intoning, “Please don’t squeeze the Charmin”. Alt-med is hokey like that.

    We must be needling the alt-med establishment rather enough lately, I see today’s poison pen stuff as so much melting witch monologue. If we can achieve a herd immunity of critical thinking in the general populace, the sheer silliness of these buffoons will be their own limiting factor. At some point the alternative machine says Tilt. Game Over. Until then, keep shaking.

  8. David Gorski says:

    @daijiyobu

    Two comments/questions:

    1. Why on earth would you even consider “groveling” in my direction or think I’d want that? That just blows my mind. It really does.

    2. If you’re going to mention Kim, I’m curious why you wouldn’t notice that his posts often average at least as long mine do, and he even strings them together in multipart epics spanning three to six posts of lengths equal to or greater than mine. So why get annoyed at the length of my posts, especially since you even admit that every part of the post addresses relevant points? I could also mention that not infrequently Steve Novella’s posts run close to as long as mine.

    Just curious. I’m puzzled.

    Jean-Paul Sartre on speed? I kind of like that characterization…

  9. daijiyobu says:

    Of course I ‘set-off’ as abrasive and should accept your responses as appropriate to that…[defend thyself!!!].

    Yet, I do have to “admit” that at TAM you seemed to be ‘out-of-touch’ with the proles [and I'm truly just-a-blacksmith].

    I admit that my language is inflammatory so thank you for acknowledging my assness [yes, I can be a dick, to entertain meself...].

    And Kim, well, yes you more-so are right than wrong but the ground he treads upon is so f’n anti-naturopathy!

    So, I’ve a leg to stand on?

    No.

    That’s my life. I enjoy that.

    Perhaps I was just instigating.

    In a non-troll way.

    -r.c.

  10. daijiyobu says:

    Oh, and regarding JPS, supposedly [and i know I'm opening myself to 'urban myth' criticism which I ENJOY], part of his demise was due to the amphetamine that he employed to produce his copious literary masse.

    BTW, I am fully Satrean, so I’d never defoul his legacy.

    The fact that you take a JPS reference as apparent homage,

    gratis.

    -r.c.

  11. windriven says:

    @daijiyobu

    If you are looking for simple-minded prose delivered in small bites and using small words, try one of the many manga sites. I’m sure you’ll find it intellectually stimulating without taxing your cognitive staying power.

  12. daijiyobu says:

    @ windriven

    thank you for your condescension.

    -r.c.

  13. pmoran says:

    Dossey quoted thus : “We are not promoting any particular alternative therapy. We are promoting a level playing field for the evaluation of ALL therapies and the abandonment of the double standard that now exists, as we described. We are promoting a ruthless adherence to science and objective methods of evaluation. We are promoting an elevation of the standards of efficacy and safety for ALL treatments, whatever they may be.”

    Now why is he unable to “promote” any particular alternative therapy? Surely some are more likely than others to attain the standards he is proposing. I’ll also wager that he nowhere nominates any medical condition where he expects alternative medicine to perform beyond present expectations.

    Medicine is a practical field. If you cannot produce examples that illustrate your case, you have no case.

  14. Mojo says:

    Now why is he unable to “promote” any particular alternative therapy?

    Solidarity.

  15. windriven says:

    Perhaps Dossey et.al. should put their therapies where their mouths are and abandon the free regulatory pass given to many quack.treatments. By submitting, say, ginko biloba, to the FDA and demonstrating safety AND efficacy, they would righteously earn the mantle of scientific approval they crave.

    But they are certainly too shy and retiring to bully their way to the fore of public consciousness to demand this equal treatment in front of the FDA. So why aren’t we doing more to help them earn FDA recognition?

  16. In Dr. Gorski’s defense regarding the TAM scenario, he had his wife with him and thus can be excused for not having been so accessible as I was. I believe they did couple-things such as attending a show or two. Not that there’s anything wrong with that. Even we remaining SBM bloggers didn’t see as much of him as we did each other.

    O’course, I also like to drink.

  17. David Gorski says:

    Of course, there’s also always the other possibility, namely that, in contrast to my outrageously gregarious online persona, in person I’m a bit of a shy geek who is not particularly comfortable being the center of attention or making small talk with people whom I’ve never met before.

    Unlike Kim, of course, who clearly loves being the center of attention. :-)

    Maybe I should drink more.

  18. Archangl508 says:

    ““We are not promoting any particular alternative therapy. We are promoting a level playing field for the evaluation of ALL therapies and the abandonment of the double standard that now exists, as we described. We are promoting a ruthless adherence to science and objective methods of evaluation. We are promoting an elevation of the standards of efficacy and safety for ALL treatments, whatever they may be.”

    Somehow I think they would be against leveling the playing field by requiring the FDA to demand the same safety and efficacy data from any alternative medicine treatment prior to it being allowed to be prescribed or used, as they would any pharmaceutical product. That would indeed create a level playing field for both conventional and alternative treatments and at the same time raise the bar for alternative treatments to the point where many of them would simply disappear. Somehow I don’t think arnica montana is going to generate a sufficient level of efficacy to garner FDA approval.

  19. Unlike Kim, of course, who clearly loves being the center of attention.

    I have no idea how you could EVER have imagined that!

    But in all seriousness, you should drink more.

  20. micheleinmichigan says:

    # daijiyobuon 11 Jan 2010 at 9:27 pm

    “Okay:

    But, you are so f’n long-winded as a pattern that it is making me angry, in terms of your public facet.”

    Hmmm, I enjoy Dr. Gorski’s posts. I do not read them all the way through. Probably read the first 2 or 3 paragraphs, then skim for tidbits that attract my attention. For interesting tidbits, I read more. I like the fact that I CAN read more on the things that interest me (even if I chose not to.) I’d rather it be that way, than him editing more out.

    Oh well, some people are Hemmingway, some are Dickens. I enjoy both on occasion.

  21. Lawrence C. says:

    David Gorski wonders: Maybe I should drink more.

    Yes. To paraphrase a wonderful old poem,

    “Drink does more than Chopra can
    to justify CAM’s ways to man.”

    And for those objecting to the relative wordiness of Dr. Gorski’s posts, this is a blog after all, not an edited paper or publication. In most of the blogging world, blog posts usually come out more like a transcript of someone thinking about a subject rather than anything edited for concision. James Joyce is probably to blame for this, but so what? There are plenty of books on evidence-based medical matters but not so many blogs out there. Take it for what it is and enjoy this rational mug of sanity amidst a sea of tepid waters.

  22. David Gorski says:

    But in all seriousness, you should drink more.

    The SBM conference might be more…interesting that way. On the other hand, the result might be even less contact with my adoring public than last year. Unconsciousness will have that effect.

  23. weing says:

    David,
    You gotta know your limits.

  24. *psst* David– come to DragonCon. There, if you feel like blending into the crowd, just wear a costume! Only don’t dress up as an undead pirate or everyone will think you’re Bob Novella. :D

  25. BillyJoe says:

    I think maybe that daijiyobu is jealous of Dave’s length.
    I bet he drives a really big automobile.

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