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Bravewell Bimbo Eruptions

This is yet another response to the recent “Integrative Medicine in America” report published by the Bravewell Collaborative. Drs. Novella and Gorski have already given that report its due, so I won’t repeat the background information. Inevitably, I’ll cover some of the same points, but I’ll also try to emphasize a few that stand out to me. Most of these have been discussed on SBM over the years, but bear repeating from time to time. Let’s begin with:

If it Ducks like a Quack…

Misleading language is the sine qua non of ‘integrative medicine’ (IM) and its various synonyms. The term itself is a euphemism, intended to distract the reader from first noticing the quackery that is its distinguishing characteristic. As previously explained, Bravewell darlings Andrew Weil and Ralph Snyderman, quack pitchmen extraordinaires, recognized nearly 10 years ago that if you really want to sell the product, you should dress it up in ways that appeal to a broad market.

Let’s see how this is done in the latest report. Here is the very first sentence:

The impetus for developing and implementing integrative medicine strategies is rooted in the desire to improve patient care.

Who would disagree with improving patient care? (Try not to notice the begged question). Here’s the next paragraph (emphasis added):

The Bravewell Collaborative, a philanthropic organization that works to improve healthcare, defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.”

Who would dare to disagree with those points? Other than biting off more than it can chew (see below), the definition applies to modern medicine, which tries to be patient-centered, holistic (in the honest sense of the term), “personalized,” scientific, etc. You have to be pretty savvy to recognize the misleading hype in that paragraph:

  • “The Bravewell Collaborative…works to improve healthcare.” That would require that highly implausible medical claims—the only things that distinguish IM from real medicine—actually do what their proponents claim. They don’t, as we at SBM have been explaining for years.
  • “…puts the patient at the center.” That implies “patient-centered care,” which requires that practitioners provide honest, comprehensive information about the methods in question. IM practitioners are universally dishonest about such matters. They have to be, because otherwise they’d have to tell patients the truth: that the methods are worthless. In a subsequent post I’ll provide examples pertinent to this report.
  • “…an array of scientific disciplines.” This is standard quackspeak for “an array of pseudoscientific disciplines.” Here’s an example from that Mother of All IM centers, Andrew Weil’s Arizona Center for Integrative Medicine:

[Iris Bell, MD, PhD] is a clinical researcher with an emphasis on systems theory as a conceptual framework and the use of psychophysiological methodologies (EEG, cardiovascular) to study the linear and nonlinear effects of homeopathic remedies and low level environmental chemicals.

  •  ”…to heal illness and disease.” The standard muddling of everything that might bother anyone, whether medical or not, other than being strapped for cash. This effortlessly leads to offering anything that might make someone feel better, whether medical or not, other than money. See how easy IM is?
  • “…maintain optimum health.” Another standard IM gambit: its special and specious claim to preventive medicine.

Making Promises they can’t Keep

A recurrent theme is that IM can do, well, everything. We saw evidence of that above:

…an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health.

In the very next paragraph, the Bravewell Report makes it explicit (emphasis added):

…very little information had been collected regarding the actual practice of integrative medicine, which by definition treats the whole person.

It may not immediately occur to many readers, in this Era of Hype, but such a claim is ridiculous. Philosophers Clark Glymour and Douglas Stalker recognized this nearly 30 years ago in their essay about ‘holistic medicine,’ previously discussed on SBM here and here:

Another doctrine said to be holistic is that one’s state of health is affected by everything. Whatever this means, it has nothing to do with any possible practice of medicine, for no one can attend to everything. If physicians cannot distinguish relevant from irrelevant factors, important from unimportant causes, then they can do nothing.

Glymour and Stalker’s next few sentences, by the way, were these:

A variation of this doctrine is not vacuous but merely vapid: ‘Fundamental to holistic medicine is the recognition that each state of health and disease requires a consideration of all contributing factors: psychological, psychosocial, environmental, and spiritual.’ [It would seem not to be a new revelation about ‘integrative medicine,’ either; just a repackaging of the same old stuff by a different label. Even the authors are the same.

An Established Part of Healthcare?

From the Bravewell report’s conclusion:

The strong affiliations to hospitals, healthcare systems, and medical and nursing schools as well as the centers’ collaborative work with and growing referrals from their own health systems reveal that integrative medicine is now an established part of healthcare in the United States.

Being “an established part of healthcare” is not the same as being accepted as valid in any important medical sense. I suppose one would be technically correct to write, “chiropractic is now an established part of healthcare,” but that would ignore the only interesting question about chiropractic.

There is no question that some of the centers looked at in this report are affiliated with hospitals and healthcare systems. Some that claim to be so affiliated are not, however. The Marino Center for Integrative Health in Cambridge and Wellesley, Massachusetts, is identified in the report as having a “hospital affiliation” with the Newton-Wellesley Hospital, which is where I work. In fact, some but not all of the Marino Center physicians have been granted staff privileges at my hospital—a mistake, in my opinion—but there is no institutional affiliation whatsoever. In two weeks I’ll look at the Marino Center in some detail.

More from the Bravewell conclusions:

…high levels of concordance of interventions for specific conditions suggests that integrative medicine practice is informed by a common knowledge base.

The naive reader might assume that a “common knowledge base” suggests something about medical validity. It does not. It suggests something about faddism.

The data from the survey reveals that integrative medicine centers embrace a group of core values that inform and radiate through their practice and interactions with their patients.

Ah, ‘embrace,’ ‘inform and radiate’: you don’t need a baloney detection kit to notice that such metaphors inform and radiate through quack treatises everywhere.

Ultimately, Bravewell Quacks

Here’s the final paragraph of the conclusion in the Executive Summary:

One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with nonconventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community.

Don’t you just love how spin doctors occasionally slip, and admit to what you knew was the case all along? I’ve been referring to what Bravewell calls “nonconventional or non-Western therapies; ancient healing wisdom” by the useful and accurate shorthand, “quackery.” For a somewhat broader treatment, let’s go to Glymour and Stalker:

The therapies described and recommended in a typical book of the genre include biofeedback, hypnosis, psychic healing, chiropractic, tai chi, iridology, homeopathy, acupuncture, clairvoyant diagnosis, human auras, and Rolfing. One of the larger books of this kind was even subsidized by the National Institute of Mental Health.

What ties together the diverse practices…? In part, a banal rhetoric about the physician as consoler;… In part, familiar and rather useless admonitions about not overlooking the abundance of circumstances that may contribute to one condition or another. Such banalities are often true and no doubt sometimes ignored, with disastrous consequences, but they scarcely amount to a distinctive conception of medicine. Holist therapies can be divided into those that are adaptations of traditional medical practices in other societies—Chinese, Navajo, and so forth—and those that were invented, so to speak, the week before last by some relatively successful crank.

Insofar as it extends beyond banality, the holistic medical movement constitutes both a deliberate attempt to substitute a magical for an engineering conception of the physician and an attack on scientific understanding and reasoning. Although the holistic movement does not contain a conception of medicine distinct from those we have discussed, it does contain a reactionary impetus to return the practice of medicine to the practice of magic and to replace logic and method with occultism and obfuscation.

“Welfare for the Rich”

The two philosophers warned of what Bravewell calls “integrative medicine” becoming “an established part of healthcare”:

If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason. Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign. At times, physicians may find themselves in sympathy with the holistic movement, because some fragment of the rhetoric rings true, because of certain practices and attitudes they encounter in their daily work with colleagues and patients, or because of dissatisfaction with the economic and social organization of medicine. One hopes they will speak bluntly, but it does no good to join forces with cranks and quacks, magicians and madmen.

Bravewell is what can happen when ditzy rich people who know little about medicine or science get it into their heads that they know something—some crucial secret or secrets, little known to most in medicine except for a few cranks who themselves have found the secret to easy money. That would be maddening enough, although we must expect it as part of living in a free, democratic society. What we shouldn’t have to accept is that those rich people haven’t been using their own money. They’ve been using ours.

 

Posted in: History, Medical Academia, Medical Ethics, Politics and Regulation, Science and Medicine, Science and the Media

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85 thoughts on “Bravewell Bimbo Eruptions

  1. William B'Livion says:

    * I’m not going to defend the woo-miesters here, but frankly the line “, the definition applies to modern medicine, which tries to be patient-centered, holistic (in the honest sense of the term), “personalized,” scientific, etc.” is a load of organic, pesticide free, naturally derived fertilizer. It’s been 20 years since I worked in a hospital (in the kitchen and as a clerk), but my entire life I’ve been a customer various medical systems, both in the US (Military and Civilian) and now in another anglosphere country. I think most doctors DO care about the patients, and I think they DO want the best outcomes, but frankly the idea that modern medicine, with its HIPPA regulations and various other acronyms of compliance and the bureaucratic focus on getting the right forms filled out and waking the patient at 4 in the morning to take their temperature etc. etc. are NOT looking at the problem holistically. I’ve never spent much time in a hospital as a patient (never stayed overnight), but most of my family has. They are far more concerned (as is any bureaucracy) about their process and their needs than they are the whole health of the patient. Some of this is the nurses, some is the doctors, much of it falls on the hospital administrators. I’ve witnessed this same focus in private clinics, dental offices and ophthalmologists. I’ve bitched out a few “nurses” for keeping me waiting, and I’ve walked out of doctors offices because clearly they weren’t interested in being on time for appointments OR communicating their problems.

    In short, while researchers and advocates may assert or believe that modern medicine attempts to treat the patient and as much of the patient as is relevant to the problem (tell me why again pediatricians in many states were asking their patients parents about firearms in the home and not about 5 gallon buckets?) where the rubber meets the road there’s still a lot of problems.

    * Again, this is not to support the claims of accupuncturists, accupressurists, aromatherapists, chiropractors, reiki gropers and snake-oil salesman of various stripes. Modern medicine is, aside from being rather impersonal, cold and bureaucratic INCREDIBLY effective in the vast majority of cases when you work with your doctor to focus on solving the problem. Unfortunately you usually have to MAKE your doctor do this (and your physical therapist, who I’m convinced could have a LOT greater impact on the lives of most people if the patients WOULD FUCKING PAY ATTENTION AND WORK). I have a friend who is type 1 diabetic and has been since childhood. He made some dumb choices over and over when he was college age, and did bad things to his body. Yes, peripheral neuropathy (which the idiot web-browser I’m using wants to correct to homeopathy). He’s on a trial treatment of some kind and claims to be feeling the nerves “waking up”. Homeopathy couldn’t do this for him. No amount of spinal manipulation would get his feet feeling again. Chi Needles? Yeah right. As someone with a lot of (mostly self-caused) health issues I want to see “Big Medicine” and “Big Pharma” do what they do best–innovate, improve and overcome. This doesn’t mean I won’t (like you here) call them as I see them.

  2. windriven says:

    @William B’Livion

    “I’ve bitched out a few “nurses” for keeping me waiting, and I’ve walked out of doctors offices because clearly they weren’t interested in being on time for appointments OR communicating their problems. ”

    Dude, you need to get a grip on yourself. If you want your physician’s appointment to start on time, book the first appointment in the morning. I do. I confronted my very good internist about chronically late appointments and he explained that during the course of his day some patients require longer visits than expected and that there are interruptions from a thousand sources that drag on his time. He was understanding, apologetic, and suggested the early morning or immediately-after-lunch bookings. It also gave me a bit of appreciation for the difficulties faced in his practice. His advice on booking appointments has served me very well.

    You also seem to ignore the financial realities of running a practice. Rent has to be paid; nurses, clerks and aides have to be paid; charges disputed by insurers have to be resolved; all those neat diagnostic tools have to be paid for. Physicians in private practice are both medics and business owners. They have only one commodity: their time (and it isn’t just the time they spend with you, it is the time they invested developing the skills to treat you). They necessarily maximize the return on their time.

    There is a difference between quality of care and petty inconveniences to you. Yes, hospitals run on schedules. Without some organization there would be chaos and that would not accrue to anyone’s benefit.
    A patient-centered approach to medicine does not suggest being met at the door with a flute of champagne and whisked tout suite to a physician who has waited patiently for your arrival.

  3. WilliamLawrenceUtridge says:

    William B’livion, your points are valid, but they’ve frankly nothing to do with the post. Yes, modern medicine can always be done better – but what you’re seeing and complaining about has more to do with the relative wealth of patients than it does the split between medicine and CAM. If you were a millionaire and could pay a doctor solely out of your personal fortune rather than an insurance or public health plan, you wouldn’t have these problems. In fact, these are the primary clients of Bravewell-type ideas, the wealthy and middle-class, the worried well, those who have the luxury of paying out of pocket for better services rather than having to share the time and attention of doctors, and the funding pool of other patients.

    Patient care can be improved, but it takes money. That money has to come from somewhere. Lacking a national health care plan (which is a shame, it’s really an excellent idea) it must come from personal savings (which the patient controls) or insurance companies (who want to pay for the minimum in services and medicine, which means skimping on patient attention).

  4. BobbyG says:

    I love SBM, come here every day to learn, both from the accomplished authors and the commenters. But, I’ve have you reconsider this headline. A sexist slam at a good-looking “ditzy” rich woman, referenced only by a link at the bottom, is an unbecoming ad hominem attack. Yes, maybe she’s a nicely dressed and coiffed wealthy do-gooder dilettante. But, in a free society, we have to suffer them equally.

    “Dilettante” would have perhaps sufficed to make your rebutting point.

  5. windriven says:

    “But, in a free society, we have to suffer them equally.”

    Perhaps, but we don’t have to suffer them silently.

    I find nothing unbecoming about the title and there is nothing ad hominem about use of the term bimbo in the title. An ad hominem requires the feature attacked to be irrelevant to the argument. Bimboism is in fact quite germane to the issue at hand. If an interlocutor in a debate about ethics earns his living as a confidence man, it is fair and proper to raise the point.

    The word dilettante suggests some actual knowledge about a subject though on an amateur rather than a professional level. That Cristy Mack holds a third degree black belt (or whatever) in reiki does not, in my book, rise to the level of actual knowledge about medicine. Reiki mastery does not suggest even an amateur level understanding of medicine. It suggests a level of delusional self deception that strains credulity.

    What is it about these poseurs that makes them think themselves competent to change the practice of medicine without knowing much of anything about it? Why is it that we don’t have integrative aeronautics or complementary particle physics or Traditional Chinese Chemistry but we have imbeciles dabbling in medicine?

    Why is it that we should eschew pejorative terms like bimbo but countenance rank bullshit?

  6. cervantes says:

    As I have said here before, we do need to take comments such as William’s seriously. People are drawn to the rhetoric of “integrative medicine” for a reason. The truth is that even though the public norms of medical professionalism, supported by the science of public health and medical sociology, do indeed recognize the importance of the social and physical environment, and people’s psychology and behavior as determinants of health; and even though “patient centered care” and “shared decision making” are the language of the day, the reality of how medicine is practiced and how people experience the health care system as a whole still falls far short of the ideals of holistic, patient centered medicine.

    I think we need to spend at least as much energy on how science based medicine can live up to its promises as we do no trashing the frauds and con artists of “integrative medicine.” Their appeal is not based on reason, and arguing against them rationally is largely a waste of time. Their appeal is mostly based on people feeling that something is missing from medicine. For example, William’s complaint about hospitals being organized for the convenience of staff and providers, rather than for the comfort and rest of patients, is 100% justified. I have been hospitalized, for major surgery, and they kept waking me up at 4:00 am to weigh me — an agonizing process with a huge surgical wound in my abdomen — so they could give the info to the residents who came around at 6:30. That is not holistic, patient centered care.

  7. BobbyG says:

    @windriven -

    “Perhaps, but we don’t have to suffer them silently.”

    Agreed. But, we have a choice as to how to rebut effectively.

    Not that I take any issue with the rest of your points.

  8. windriven says:

    “I have been hospitalized, for major surgery, and they kept waking me up at 4:00 am to weigh me — an agonizing process with a huge surgical wound in my abdomen — so they could give the info to the residents who came around at 6:30. That is not holistic, patient centered care.”

    Patient centered care does not mean care that is without discomfort or inconvenience. The interns rolling in at 6:30 were there for a reason: to learn something about your condition and its treatment. They come in early so that assignments can be made, diagnostics and treatments ordered and so forth, not so that the attending can make 9:30 tee time.

    Temps and weighings and pressures and whatnot are also done early so that nurses can give accurate and up-to-date information to their peers during report at shift change – usually at 7:00am for first shift.

    The attention of a small army of highly skilled physicians, nurses, technicians, phlebotomists, therapists and dieticians focused on the diagnosis and care of their patients seems pretty patient centered to me. An aging trophy wife waving her hands over someone while chanting secret reiki mantras*, maybe not so much.

    *Going for humor here; no flames about mischaracterizing the ancient and honorable sport of reiki, please :-)

  9. BobbyG says:

    @windriven -

    OK, have to admit, you’re getting on a roll here. That was funny at the end.

  10. windriven says:

    @BobbyG

    Thanks. A little humor is sometimes a good way to keep things in perspective.

  11. Janet Camp says:

    I don’t mind (as much) if the idle and neurotic rich keep CAM going, but there are lots of the less well-off (many with no health insurance at all) who figure they “may as well try it”, when they may actually have dangerously high cholesterol, high blood pressure, or a tumor quietly growing somewhere.

    I think doctors could do more to be directly involved in health care reform that benefits EVERYONE (a public health plan) which would eliminate this type of CAM adherent from getting started in the first place. It is true that many do BOTH (“complementary”) and truly believe they are enhancing their “wellness”, but at least they get checkups and are offered rational alternatives, whether or not the exercise them.

    What to do about doctors and nurses who dabble in all this is a problem I have no answer for except for much harder hitting efforts in first year medical school–and perhaps even in the evaluation process; just weed them out from the get go.

    Thanks to this blog, and others, I can no longer even enjoy a trip to the bookstore, by the way. Each visit takes me past the self-help table piled high with all kinds of CAM books, many written by doctors or PhD’s. Yesterday, the person in front of me at the help desk was earnestly looking for books by Dr. Weill, complete with effusive comments to the clerk about all kinds of woo-related anecdotes and misinformation. I finally just had to leave the line and then try to avoid the self-help table–which isn’t easy because they move it all the time. Even the library mixes all the woo books right in with actual scientific medical books. “Let people make up their own minds” is always the response I get when I complain.

    Note to B’blivion: My doc schedules every ten minutes now. In addition to the advice above, I would add that you make a list and work through it methodically. I haven’t had my doc cut me off yet. Of course, I realize that if the person ahead of me has done the same, I will have to wait a bit to get seen–seems fair enough. I have lots of gripes about some of my hospital experiences, but I wouldn’t trade the life saving and life-enhancing results for a dose of woo just to make me feel more “special”.

  12. EricG says:

    perhaps some of you have come across this video. To me, it provides a perfect analogy to CAM. shame there is no way to make such a clear statement, as “kicking someone in the teeth” and “providing incontrovertible refutation to ineffective and improbable practices that anyone can understand an accept” require overcoming slightly different thresholds of tolerance for cognitive dissonance.

    seriously, watch it. it is quite unbelievable that a group of people could display this level of delusion.

    http://www.youtube.com/watch?v=gEDaCIDvj6I

  13. EricG says:

    as a side note, i find it continually ironic that the content of this blog informs the advertising algorithms that the following advertisements are anticipated to resonate with the readers…

    Holistic Health Degree
    Invest in a Lifelong Career, with an MA in Holistic Health Education.
    JFKU dot edu/Holistic-Health

    Ask a Homeopath
    A Homeopath Will Answer You Now! Questions Answered Every 9 Seconds.
    Health dot JustAnswer dot com/Homeopathy

    Holistic Nutritionist
    Our Nutrition Graduates Earn Up To $200/hr – 40 week Program Online!
    www dot IntegrativeNutrition dot com

  14. windriven says:

    @EricG

    “i find it continually ironic that the content of this blog informs the advertising algorithms that the following advertisements are anticipated to resonate with the readers…”

    The good news is that (I believe) they pay for the placement. I hope it is that and not by the click. If anyone knows. please pass it on. If they pay by the click … I’ll get to clickin’

  15. cervantes says:

    “The interns rolling in at 6:30 were there for a reason: to learn something about your condition and its treatment. They come in early so that assignments can be made, diagnostics and treatments ordered and so forth, not so that the attending can make 9:30 tee time.

    Temps and weighings and pressures and whatnot are also done early so that nurses can give accurate and up-to-date information to their peers during report at shift change – usually at 7:00am for first shift. ”

    What did I say? Hospitals are organized for the convenience of the staff, not the comfort and rest of the patients. You just proved my point. I’m not there for the interns to learn, and I’m not there so they can make a 7:00 am shift change. I’m there to heal, presumably, but that is not the objective of anything you defend.

  16. Scott says:

    If you don’t want to be part of teaching, don’t go to a teaching hospital. And ensuring that shift change happens properly is critical to your proper care.

  17. Scott says:

    And I think that even at teaching hospitals, you can ask not to be part of such things.

    Also, did you object and ask why it was necessary for the weighing to happen then?

  18. DW says:

    “I’m not there for the interns to learn, and I’m not there so they can make a 7:00 am shift change. I’m there to heal, presumably, but that is not the objective of anything you defend.”

    Yes, of course it is. High-tech, highly complex care delivered by professionals who took many years to get advanced degrees and the highest specialized training takes a great deal of organization and even regimentation to deliver. If you want them to help you heal you’re going to have to let them organize it, schedule it, etc. and not complain that you had to get woken up at 4 a.m. Presumably you are in the hospital for some serious reason – being awake at 4 a.m. is the least of your problems. You shouldn’t confuse going there to “heal” with going to some sort of spa where your comfort and convenience will be tended to minute by minute, and you’ll get to sleep exactly the hours that suit you. Being seriously sick isn’t for sissies.

    And to my mind the attitude that “I’m not there for the interns to learn” is quite selfish. Sorry but you are indeed there for the interns to learn. You’re not the only patient who will ever have exactly the problem you have, and you need to let the interns learn from you. The doctors treating you were once interns who learned from other patients just like you!

    All that said, I do agree with the posters who feel that this blog should probably eschew the sexist jokes. References to bimbos and “aging trophy wives” are offensive. The age of the wife or whether she is the first or second or third wife has nothing to do with susceptibility to CAM, which I thought was the point here. “Bimbo” is definitely a sexist pejorative. Find another term.

  19. qetzal says:

    … integrative medicine practice is informed by a common knowledge base.

    This is plainly false. Belief in things that are not adequately supported by evidence, or that are strongly contradicted by evidence, is not knowledge.

  20. windriven says:

    @cervantes

    “Hospitals are organized for the convenience of the staff, not the comfort and rest of the patients. You just proved my point. I’m not there for the interns to learn, and I’m not there so they can make a 7:00 am shift change. I’m there to heal, presumably, but that is not the objective of anything you defend.”

    Convenience of the staff may mean different things to each of us. Every organization that works around the clock has shift changes. If you would like to make the case that shift changes should happen at, say, 1000, 1800 and 0200, go for it. But it suggests that the night shift nurse is going to jack with you at 2300 or midnight to prepare for report at the 0200 shift change.

    And we are not islands, cervantes. The doctor treating you was once an intern shuffling into some poor guy’s room at 6:30 in the morning; it was part of the process by which s/he acquired the skills that are now so valuable to your care. By the same token the interns crowded around your be may one day be treating your daughter or grandson. That doesn’t make rounds something for their convenience.

    Finally, doing rounds early so that days can be planned is simply good management. Hospitals may never sleep but some of their departments, especially in hospitals that aren’t major medical centers, do sleep. If you need an MRI and that MRI is ordered at 6:30 you may well get it today. If the MRI is ordered at noon you might not get it until tomorrow. You have occupied a fairly expensive hospital bed for an extra day and have achieved little beyond another delightful meal of mashed peas and juice. It runs up the cost of care without improving outcomes a whit.

    You have a point that the hospital experience can be a little … industrial. But that does not translate to care that is not patient centered. Patient is the operative word. The patient is in the hospital presumably for diagnosis or treatment of some malady. The comfort and psychological well being of the patient is important but those considerations are trumped by the diagnostic and therapeutic realities.

    Some years ago the hospital experience was rather less pleasant than it is today. Patients not that long ago stayed in wards of 4 or more beds. Wealthier patients might opt for semiprivate rooms. Most hospital rooms in my recent experience are private so you don’t have an audience every time you waddle to the restroom. Most nurses are better educated and better trained. I suppose that hospitals could staff up with cruise directors (and I honestly don’t mean that snidely) to improve the overall experience, but that costs a good deal of money too. It also shifts the focus away from the actual mission at hand: diagnosis and treatment.

  21. EricG says:

    @windriven

    yep – i’d do some clicking too. funny, as i was wondering if those who frequent anti-vaxer sites have to tolerate advertisements for Paul Offit’s latest book (or whatever) it occured to me that it would be much harder to create a glitzy, eye-catching ad for SBM.

    “want to spend 8 years (undergrad counts, i guess, right?) years learning the intricacies of the human body, read mountains of dense academic prose and donate tons of loan money to the atheletics program of a private institution!? Click here!” lol

    even worse upon re-check. 5 for 5 woo ads

  22. rork says:

    I agree the “common knowledge base” sentence was weasel-worded, but behind the mangling, the idea that variation in treatment for the same condition should cause fire alarms, is good.

    I very much appreciated the pointer to Glymour and Stalker. I’ve never read it. 1983.

    I’m grumpy about how I get handled by docs too. It may get better as doc’s compensation is tied more to their success, and there is less time wasted on situations that were avoidable. Do some of the grain-of-truth statements of CAM artists act to inspire real docs to have better ideas on how to deliver care? I’m not sure if they matter, the complaints of the patients being sufficient.
    I do think we are making progress. We are doing much better being caring, efficient, and convenient in my cancer center, and thinking about that more. Sometimes what we thought was saving or wasting money, wasn’t. I am very excited about what we might win by looking more through patient’s eyes (and having a “lean” wonk around – and btw it’s not me).

  23. @William B’Livion and cervantes,

    Your points are taken. My reply is that medicine is not hospitals, etc. By “medicine,” I refer to the ideals of the medical profession, as taught in medical schools, as written by its heroes, eg, Osler and Peabody, and as sanctified in its ethics treatises. This may seem a cop-out, but it is exactly how the same ideals are claimed by IM enthusiasts. If Christy Mack and her cabal are really interested in changing the experiences of patients “where the rubber meets the road,” why don’t they commit their considerable wealth to that project, rather than to woo? There are foundations and other initiatives out there trying to do just that, and they could use some financial help.

    @BobbyG,

    I understand that everyone finds sarcasm distasteful in some circumstances, but that there isn’t universal agreement about matching sarcasm and circumstance. I understand that some readers, and even some SBM authors, prefer to avoid sarcasm altogether in SBM posts, because they believe that using it defeats one of our perceived purposes, ie, to convince people that we are right and proponents of pseudomedicine are wrong. I’m happy that we have a spectrum of views about this. I’ve discussed my own several times in the four years that SBM has been in existence, and they boil down to this: I’m not here to convince people that we are right, although it would be nice if it turned out that way. I’m here to tell the truth and let readers decide for themselves. That, it seems to me, shows more respect for people than does feeding them large helpings of fantasies (a la Bravewell), all the while being oh, so genteel. I’m old enough to have noticed the recent social creep of ‘treating people with respect’ at the expense of truth, and I think that public discourse has lost something important in that process. Look here under “The Changing Etiquette of Criticism” for a bit more discussion.

    Regarding your assertion that I made a “sexist slam”: this is in the mind of the beholder. Words like “ditzy” and “bimbo” almost always refer to women, and indeed I was referring to a few women–mainly Christy Mack, as you assumed, and to a lesser extent Penny George and the rest of the Bravewell Board of Directors, which includes 10 women and 2 men. I don’t consider my use of those terms in this context any more sexist than are common uses of terms such as “thug,” “buffoon,” “bully,” or “crook,” which almost always refer to men. Sometimes such terms are merely indicative of social realities: women really are more drawn to woo than are men, according to many surveys, and men really are more drawn to violent crime than are women. I try to be careful not to assume the truth of every such bit of ‘conventional wisdom,’ but when the shoe fits…

  24. rork says:

    I also am again thankful for pointing to ancient (1983) literature. I found another 1983 opinion about alternative stuff that made me realize how ignorant I was about the history:
    “Current Controversy on Alternative Medicine”, John Lister,
    http://www.nejm.org/doi/full/10.1056/NEJM198312153092422
    It has some responses a few months later.

    I feel I owe some tuition. That is not rare here.
    Oh, you forgot “crooked weenie”.

  25. BobbyG says:

    @Kimball Atwoodon 17 Feb 2012 at 3:10 pm-

    Thanks. Appreciate your POV, notwithstanding that I would still quibble with what I see as a few red herrings. No biggie. I love SBM and will continue to.

    No one can every accuse me of shying away from rhetorical sarcasm (which is putting it, uh, mildly), a lot of which I render visually in Photoshop, to wit:

    http://march2Madness-TheFinal4.blogspot.com/

    It gets worse as you click on the images.

    Or, how about

    http://sharronangle.blogspot.com/

    Lots more where those came from.

    “I’m here to tell the truth and let readers decide for themselves.”

    Which you did rather thoroughly — no, dispositively — absent the “bimbo” word choice.

    Again, no biggie. That was just an early-morning just-starting-the-first-sip-of-coffee gut reaction.

  26. windriven says:

    @BobbyG

    March2Madness is funny stuff! What the hell is sticking out of Romney’s jacket? I’ve got a pretty decent sized monitor but I can’t make it out. Looks like Minee Me’s hand or something.

  27. ConspicuousCarl says:

    I am less bothered by the sexism than the extrapolation of some Rolling Stone article about a couple people to conclude that rich people are taking our money as a general statement. And even if the situation in the article were common (the article does not demonstrate that it is, either in the recent bailouts or in general), the federal money they are taking comes mainly from other rich people. The whole thing doesn’t make much sense.

    “Bimbo” is used to describe women, but so is the word “women”. I don’t think “bimbo” implies that all women are stupid, or that the individual in question is stupid because of their gender, any more than the word “actress” implies that all women make movies. It is merely a feminine form of the concept of idiocy. There are also such words typically used for males, such as “jack@ss”.

    The same is true of “trophy wife”. You could also say “trophy husband” if the roles were reversed, or the woman could be described as a “trophy spouse” if you insist on gender-neutral descriptions. But then all you are doing is demanding that we pretend not to even know or notice a person’s gender, which would be a Colbertian absurdity.

  28. yizz says:

    Nope, sorry. “Bimbo” is a loaded word. At worst it is offensive, at best it is distracting. The problem is that it is by definition gendered — it refers specifically to a stupid woman. Most of the other terms you cited (e.g. thug) are ones that usually associated with men, true, but the definition has to do with the actions of the person, not who they are; an aggressive woman could be a thug and *certainly* a bully, but a man can never be a bimbo (unless you are intentionally trying to make a point about his masculinity). By using the term, you are highlighting both that she is dumb AND that she is a woman, when her gender is irrelevant. There are plenty of ways to convey a lack of intelligence (or more precisely, a lack of critical thinking) that are entirely gender-neutral.

    Additionally, though you presumably mean to refer to only a certain class of woman, there are plenty of people who use the term “bimbo” to mean “woman”, with the connotation, of course, that all women are stupid. Though the former may be controversial, the latter is decidedly sexist. Into which category you fall is not something that someone who doesn’t know you (i.e. a reader) would be able to tell with any certainty. Why give people room to wonder about you?

    P.S. At least in my experience, the word ditz is an equal opportunity word used to describe airheads of both sexes.

  29. windriven says:

    @Carl
    “[T]he extrapolation of some Rolling Stone article about a couple people to conclude that rich people are taking our money as a general statement.”

    I missed whatever is the antecedent to this remark. Could you direct me?

    I read the Rolling Stone piece that Dr. Novella linked and certainly agree that some of it trashed the line between journalism and polemic. But it was used to illustrate where some of the money behind Bravefart comes from. I thought that was appropriate.

    As to your point, I would agree that Rolling Stone is not a first order source for economic data. CBO however is and their data supports the notion that the wealthy are growing wealthier (a rather different assertion than that “the rich are taking our money”). http://cbo.gov/ftpdocs/124xx/doc12485/10-25-Householdincome.pdf addresses growing income disparity. Wealth (as opposed to income) distribution figures are easy to come by too, but from less certain sources. Still, everyone left and right agrees that the top quintile controls an increasing share of wealth in this country, they just argue over the importance.

  30. BobbyG says:

    @windriven-

    ‘What the hell is sticking out of Romney’s jacket?”

    Looks like yet one more $100 bill.

  31. ConspicuousCarl says:

    windriven on 17 Feb 2012 at 5:48 pm

    @Carl
    “[T]he extrapolation of some Rolling Stone article about a couple people to conclude that rich people are taking our money as a general statement.”

    I missed whatever is the antecedent to this remark. Could you direct me?

    I read the Rolling Stone piece that Dr. Novella linked and certainly agree that some of it trashed the line between journalism and polemic. But it was used to illustrate where some of the money behind Bravefart comes from. I thought that was appropriate.

    I refer to the last paragraph of the original post here, but after reading it again I have to agree that he is not generalizing. I am not sure why I read it that way initially.

    If the rich are getting richer, good for them. I could use more money for myself. But my lack of money is not caused by other people being rich. That money was never mine.

  32. windriven says:

    @Carl

    “If the rich are getting richer, good for them. I could use more money for myself. But my lack of money is not caused by other people being rich. That money was never mine.”

    I generally agree … so long as the playing field is level.

  33. William B'Livion says:

    Windriven:

    Because the medical system is “patient centered”, they only have office hours M-F, usually 8 to 5:30. This means that I have to take time off work to be there.

    I ALWAYS request the first appointment in the morning. However in many cases those are booked months in advance as I’m not the only one who’s figured that out.

    I also understand that sometimes doctors get behind schedule, all snark aside they would rather their patient get better than not, and they often really do want to help. This sometimes means emergencies etc.

    But the medical care system is not just the doctors. To leave some just sitting in the waiting room–someone who (probably) took time off work to drive over, who in many cities is paying by the hour for their parking, someone who is losing wages while sitting there (or will have to make the time up)–without keeping them informed is ridiculous.

    Your attitude towards my time is exactly what I’m (routinely) pissed off about. It is massive arrogance for a doctors office to value their time above mine.

    And no, it’s not really what the OP was about, but really there is nothing to say about what Dr. Atwood is ranting about. The notion that our federal government hands fruitcakes money left and right is why many of us OPPOSE national health care. Once it’s owned by the Government, once they’re in charge it’s (1) inherently political meaning the Christie Macks and the Shirley Maclaines of the world have MUCH more influence than the Dr. Atwoods and Mr. B’Livions. (2) managed by bureaucrats for the benefit of bureaucrats (as you’ve so ably demonstrated in your defense of the medical bureaucracy) and secondarily for the benefit of the politicians. Doctors and Patients will be third.

    Bureaucrats and politicians are at least as susceptible to CAM and woo as anyone, maybe (in the case of politicians) even more so. Even if liberty isn’t a concern putting the politicians in charge is a REALLY bad idea.

    And lastly Dr. Atwood, sorry for hijacking your thread, but while I understand your position that ‘medicine is not hospitals…”, I will have to at least partially disagree. While medicine is not hospitals, hospitals are supposed to be about medicine. Towering intellects like Arnold Schwarzenegger have known for decades that a good nights sleep is ESSENTIAL to tissue repair, but hospitals continue to run on the same schedules they have since I was a teenager doing volunteer work.

    And yes, I know conditions have changed. There were wards in the hospitals back then, and MRSA was in the near future. Now almost everyone has their own room, or is in a semi-private. Great. They still get woken up at 4 in the morning (about 3 hours earlier than what some studies suggest is the optimal time for tissue repair).

    And I know partially why doctors do rounds early–they need to get them done before surgery starts at 7 or 8. And yes, the residents and interns are there to learn. I don’t object to that at all–when given the option I’ll generally opt FOR a teaching hospital for that reason–I’ve even offered to let visiting residents do a fairly painful joint manipulation (shoulder separation) on me after the primary was done just so they could get the experience. I’m cool with that.

    But see, this isn’t 1980 any more. These days you don’t NEED to wake someone up to get their weight, the bed should be able to tell you within a few ounces. Just go in their quietly, move any cups or other cr*p off the bed and it can KNOW their weight. And their temperature etc. That shiznet can be tracked in real time (I can’t really talk about what my place of employment does, but frankly you’d be shocked what we can get telemetry off of if you try hard enough). I expect a medical *system* that claims to be patient centered to be, well, centered on the health of the patient. I do think that most CAM “practitioners” also believe they’re patient centered. At least those who don’t know they’re peddling bullshit.

  34. mikee says:

    I would like to suggest that comparing medicine practices in hospitals to those who practice alternative medicine is not a fair comparison. Most people in hospitals are being treated for quite severe conditions that alternative medicine wouldn’t have a hope of treating.

    It is more appropriate to compare alternative medicine practitioners with a general practitioner. My own GP talks with me about the broader aspects of my health – my diet, exercise etc. this is the reason I have him as my GP.

    I have nothing against integrative medicine so long as it consists of consulting genuine medical experts – GPs, dietiticians, physiotherapists, psychologists, podiatrists etc.
    Consulting homeopaths, reikki practitioners etc is not integrative medicine, it is not even medicine.

  35. BillyJoe says:

    Kimball Atwood: “I’m old enough to have noticed the recent social creep of ‘treating people with respect’ at the expense of truth, and I think that public discourse has lost something important in that process.”

    Amen to that.

  36. David Gorski says:

    The notion that our federal government hands fruitcakes money left and right is why many of us OPPOSE national health care. Once it’s owned by the Government, once they’re in charge it’s (1) inherently political meaning the Christie Macks and the Shirley Maclaines of the world have MUCH more influence than the Dr. Atwoods and Mr. B’Livions. (2) managed by bureaucrats for the benefit of bureaucrats (as you’ve so ably demonstrated in your defense of the medical bureaucracy) and secondarily for the benefit of the politicians. Doctors and Patients will be third.

    I frequently hear this from opponents of universal health coverage through the government, but I rarely, if ever, see any actual evidence to back up such statements. What I do see is an even more hideous bureaucracy than the one you fear, except that it’s not one bureaucracy but many. I’m referring, of course, to the many health insurance companies. In fact, I used to think the way you do, but 13 years in the trenches with a patient population that includes a lot of uninsured patients at both of the cancer centers where I’ve worked during my career have changed my mind. In fact, in so many measures, countries with universal health coverage do better than the U.S.—and not just a little better. For example:

    http://content.healthaffairs.org/content/27/1/58.full

    Believe it or not, we would do well to emulate France. Yes, France:

    http://scienceblogs.com/denialism/2009/05/what_is_health_care_like_france.php

    Or the Netherlands, which, believe it or not, looks a lot like the dreaded “Obamacare” in that citizens are required to purchase health insurance from heavily regulated insurance companies:

    http://scienceblogs.com/denialism/2009/05/what_is_healthcare_like_Neth.php

    Personally, I like the way Mark Hoofnagle puts it:

    It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated.

    (From: http://scienceblogs.com/denialism/2012/02/more_evidence_that_universal_h.php)

  37. windriven says:

    @William B’Livion

    “These days you don’t NEED to wake someone up to get their weight, the bed should be able to tell you within a few ounces.”

    True enough again. But all of these technologies cost money. We already spend nearly 20% of GDP on medical care and our outcomes are not at the top of the international heap. An administrator of a 200 bed hospital, faced with spending $200k to upgrade beds to weigh in place or $200k for an upgrade of the diagnostic ultrasound system is going to go with the ultrasound. It will bring greater value to more people. He can save you being woken in the wee hours to be weighed or he can save the life of an infant whose mother’s placenta is detaching from the uterine wall. William, she doesn’t have unlimited $200ks to spend. She has to make choices.

    In a world where cost doesn’t matter you could be showered with hot and cold running nurses, be served hot, gourmet, dietarily correct meals prepared to your personal liking, have many of your vital signs recorded and logged remotely. But cost does matter.

    Bringing this back to the topic of the blog, patient centered can mean Christy Mack waving her hands over you in a back room at the yacht club cotillion while you sip a very nice California chardonnay or it can mean being the focus of the best diagnostics and treatments that medical science can assemble delivered by exquisitely trained physicians, nurses and technicians in reasonably comfortable surroundings.

    Your choice.

  38. windriven says:

    @ Dr. Gorski

    I hope that you or one of the others will burn a blog or two comparing healthcare delivery models in depth. There are certainly lessons to be learned from other countries – both positive and negative. I would argue that this fits well within the SBM rubric; a scientific approach to delivering and paying for care is every bit as important as a scientific approach to diagnosing and treating disease.

    Hoofnagle has it right – at least partially so. We don’t have people dying like flies because they don’t have health care insurance. They ankle on down to the ER and the medical problem is taken care of, though perhaps in the most expensive possible way. But smartening up on healthcare insurance is only nibbling around the edges. The deeper problem – and by far the more difficult to solve – is the delivery system itself.

    We have patients like William B’Livion who want the best of everything that world class medicine can offer and they want it delivered at the time and circumstances of their choosing. That pretty much rules out the French and Netherlands models. We have physicians who rage at the idea of being told by some bureaucrat how to practice medicine (various best practices systems, i.e. cookbook medicine). We have entrenched interests at every point in the system where money changes hands.

    All the self-congratulatory backslapping and photo-oping that accompanied PelosiCare (hey, give credit where it is due) struck me as empty posturing. They put a little lipstick on a pig and declared it Miss America. Hooray.

    The real work of healthcare reform has barely begun and the politicians have already declared victory.

    Good grief.

  39. lilady says:

    I quite agree that it is high time we resolve as a country, to implement a national health care plan.

    Just when will the opposing forces stops their campaigns of disinformation? During the last election cycle we had the Alaskan Diva with her “death panels” and “pulling the plug on granny”. During this election cycle we have a physician who wants to bar the doors of the hospital to people without health care insurance. Here is an outline of the program that was passed by the Democratic Congress and which every Republican presidential candidate wants to eliminate:

    http://www.healthcare.gov/law/index.html

    Just who pays for people who by choice or by circumstances do not have health care insurance? We all do, in the form of lesser staffing in hospitals, the delaying of purchasing “state of the art” diagnostic equipment and the higher rates hospitals must charge those who have coverage. Small wonder then, why private insurance premiums are astronomically high and the Medicare/Medicaid program is in danger of failing.

    Just what is about the American psyche that we discount the benefits of a national health care plan and cling to the inefficiencies and waste in our present splintered health care delivery system? We would have a golden opportunity to fashion a national health care system, were it not for our collective xenophobia (American=good, foreign=bad).

    BTW, I am very sensitive to anything that hints of misogyny. Dr. Atwood’s use of certain words to describe the activities of Mrs. Mack to fund and promote pseudoscience is appropriate here. I have used the same words to describe the anti-vax activities of Jenny McCarthy and the pseudoscience activities of Suzanne Sommers regarding “nutrition” and breast cancer.

    Great article, Dr. Atwood.

  40. sarah007 says:

    Kimball said “one of our perceived purposes, ie, to convince people that we are right and proponents of pseudomedicine are wrong.”

    This statement sums up what is wrong with this site. If I have arthritis and go to a conventional doctor the first line of ‘treatment’ is painkillers, this is pseudomedicine, this is like taking your car to a garage with a knocking noise and being given ear plugs. A lot of people who try alternatives do so because modern medicine has failed them, yes there is a lot of crap out there but not all of it is found within the alternate movement.

    This site is failing to convince anyone, it should be about presenting balanced evidence for methods to address health issues that society is failing.

    David said “The real work of healthcare reform has barely begun and the politicians have already declared victory.”

    Have to agree with this but reform is not about dismissing anything that is not currently orthodox.

  41. WilliamLawrenceUtridge says:

    Sarah, what other treatment should you receive for arthritis? And please specify which kind of arthritis you mean since there are more than 100. Some of these types come and go unpredictably. If you read Snake Oil Science by R. Barker Bausell, you’ll have a bit more insight into why CAM seems to work.

    Also, we have no idea who the site convinces. We do know, however, that you lack any sense of balance, not to mention completely lacking understanding of medicine and science.

  42. lilady says:

    “If I have arthritis and go to a conventional doctor the first line of ‘treatment’ is painkillers, this is pseudomedicine, this is like taking your car to a garage with a knocking noise and being given ear plugs. A lot of people who try alternatives do so because modern medicine has failed them, yes there is a lot of crap out there but not all of it is found within the alternate movement.

    Really Sarah? I have osteoarthritis and have been to “conventional” doctors, who examine me and might prescribe an OTC NSAID or a prescription NSAID. They don’t even have to order an x-ray, because my bilateral osteoarthritic hands look like this:

    http://www.cedars-sinai.edu/Patients/Health-Conditions/Osteoarthritis.aspx

    I am fortunate that the osteoarthritis is limited to my hands, but if you read the text on the link, I see no mention (that the) “first line of ‘treatment’ is painkillers” for severe debilitating cases of osteoarthritis.

    “This site is failing to convince anyone, it should be about presenting balanced evidence for methods to address health issues that society is failing.”

    If you find (that) this site is “failing”, why do you continue to post here?

  43. sarah007 says:

    Lilady. What is the difference between a NSID and a painkiller effectively. The point here is that osteoarthritis is not a disease it is a compensation. I genuinly am sorry that you have this condition.

    what have you done with your diet?

    I find it fascinating that there are still some people who have such blind faith in their doctor.

  44. sarah007 says:

    William I have no wish to read a book with such a stupid title, maybe you should judge a book by its cover.

    The first thing I would do with arthritis is look at the diet. I have no idea what CAM is either.

  45. Chris says:

    Sarah, you have repeatedly shown that you have difficulty reading this blog. So I agree that WLU was expecting too much when he suggested an entire book. It is actually a very good book, but I doubt you’d understand it.

  46. lilady says:

    Sarah…if you don’t know the difference between a NSID (sic)/NSAID and a painkiller, you have only yourself to blame. Try to go to a reputable website to see the difference.

    Too bad you lack any education in pharmacology, human physiology and other sciences.

    I’m not about to get into a contest with you about my diet versus your theories of “nutrition”…your favorite diversionary tactic to avoid providing citations. And, I’m getting tired of providing the actual citations for your “cherry-picked” statements and to disprove your citationless factoids.

  47. David Gorski says:

    I hope that you or one of the others will burn a blog or two comparing healthcare delivery models in depth. There are certainly lessons to be learned from other countries – both positive and negative. I would argue that this fits well within the SBM rubric; a scientific approach to delivering and paying for care is every bit as important as a scientific approach to diagnosing and treating disease.

    I agree. It’s something I’ve been meaning to do for a while now but just haven’t gotten up the guts to delve into it. The literature is vast and there are a lot of land mines there for the unwary. Then, of course, there’s the likely fallout. Antivax trolls are nothing compared to political arguments that would erupt in the wake of such a post, particularly in an election year. :-)

    Perhaps I should stop being such a wimp…

  48. Quill says:

    @windriven & Dr. Gorski:

    I think you’re both partly off. While science certainly has an enormous role to play in delivering health care, unless you’re counting the math in accounting there is no such thing as a “scientific” approach to paying for it. That’s politics. And politics, distilled, is the practice of who collects what money to spend on what for whom.

    This is perhaps why Dr. Gorski’s guts are remiss to engage this part of the question: it’s not a domain of science. (But yes of course, there is this thing termed political science, but that’s not science as is understood in medicine.)

    @the sarah007 phenomena: I’ll pay your cab fare if you go home right now.

  49. weing says:

    Maybe she would buy it if she thought it wasn’t a chapter book.

  50. David Gorski says:

    @Quill

    I strongly disagree. Deciding how to pay for universal health care is within the realm of politics, but I strongly believe that politics on issues for which science is important, such as medicine and how the health care system is set up, should be heavily informed by science. Science can most definitely inform politicians what their options are, what the potential tradeoffs would be for various systems, etc. They can and do certainly reject the science, but I believe the science should be laid out. I also believe that science can tell us what sorts of systems are likely to bring us the best quality care at different prices. Then it’s up to the political system to do what it will with that information.

    I view this question as being rather like anthropogenic global warming (AGW) in that the science is the science, and it shows that human-caused CO2 is making the earth warmer. What to do about AGW, however, is a political issue. However, that political response must be informed and guided by science.

    It’s the same with health care.

    There are, for example, numerous studies showing that in key health outcomes our system actually does worse than those of nations with universal health care and that we spend a lot more money per capita and that other systems do better. Should we ignore that data?

    Think of it this way: If how we were entirely a political construct, then I probably shouldn’t care whether politicians decide to fund pseudoscience like NCCAM or try to get the government to pay for quackery like alternative medicine. Why bother if how to pay for medicine is a purely political issue?

  51. Quill says:

    @ Dr. Gorski:

    I should have fleshed out my remark more clearly, as I’m in agreement with much of what you wrote. I could have also written “…I strongly believe that politics on issues for which science is important, such as medicine and how the health care system is set up, should be heavily informed by science.” Exactly so! But in the end, the role of science is to inform a political decision. It finally comes down to the politics.

    When windriven wrote and you agreed with “a scientific approach..paying for care” I was thinking that science itself isn’t the deciding domain in payment, politics is. Of course one hopes that politicians will actually make the best use of informed scientific opinion but in the end, as you say, science’s role in the process is to inform.

    In the best circumstances, just like your AGW example, how to pay for healthcare should be informed and guided by science. But science is a part of the “approach” not the whole shebang. There are a host of other factors such as ethics, tradition, laws, etc., that are part of the approach. Once the approaching is over it is hoped by many that science will prevail in areas where the evidence is clear but again, in the end, politics will decide.

    Regarding the political constructs and the funding of things like NCCAM, it is a similar situation to the “billionaire bimbos” in a previous thread. Some current members of congress cultivated constituencies to stay in power but don’t actually know much or care much about what these constituencies are doing. People who have not had the “fun” of being in Washington’s halls would be astonished at how much the public pronouncements of various senators and congresspersons are so much necessary theater for them. What is terrible, and where I hope science will inform enough for change, is as you say when pseudoscience is funded and real living people are not just badly served by it but also harmed, even killed.

  52. DW says:

    “If I have arthritis and go to a conventional doctor the first line of ‘treatment’ is painkillers, this is pseudomedicine”

    Eh???? I guess you’re made of stern stuff; if I am in pain, a painkiller is certainly in the first line of treatment I want. Hello.

  53. DW says:

    Seriously … I wrote that flippantly but the scorn and derision heaped on people who want relief from pain is one of my serious gripes with CAM. I am always supposed to feel morally inferior if I would rather, you know, NOT SUFFER, rather than learn the spiritual meaning of my illness or have my chakras renovated or learn about my karma or endure agonies in the name of “natural remedies,” when a fast-acting steroid, for instance, would end the agony in a couple of hours.

    Thanks CAM hucksters, but some of us LIKE having our symptoms treated, as crass and materialistic as it sounds. Sarah’s scorn for pain relief as a “first line of treatment” is telling. There’s sadism mixed into CAM.

  54. lilady says:

    @ DW: Whenever I am bothered by osteoarthritic pain in my hands…I do take meloxicam (generic of Mobic)…which is, (for me) a powerful pain reliever and a prescribed NSAID:

    “Meloxicam is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). Meloxicam is also used to relieve the pain, tenderness,swelling, and stiffness caused by juvenile rheumatoid arthritis (a type of arthritis that affects children) in children 2 years of age and older. Meloxicam is in a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.”

    But the troll, wrongly assumed that doctors push opiates on patients who are only too willing (they have “drug-seeking behaviors”?), to dose themselves…without the benefit of anti-inflammatory medicine.

    P.S. I consider myself “fortunate” to only have osteoarthritis in my hands…my sister is a train wreck with osteoarthritis throughout her body…it’s a genetic trait we share.

  55. Narad says:

    The point here is that osteoarthritis is not a disease it is a compensation.

    Pure Shelton. Hey, “Sarah,” how do you feel about combining melons with other foods? Is it possible to have “too much carbon” in the diet?

  56. sarah007 says:

    “Eh???? I guess you’re made of stern stuff; if I am in pain, a painkiller is certainly in the first line of treatment I want. Hello.” DW

    If you are in pain because metabolites are backing up in your system surely that is the route out. There are many good ways to do this. The alternative to painkillers is not as you imply to bite on a piece of wood and bear it.

    So perhaps you could tell us what you have had for breakfast, dinner and evening meal and I will do my best to suggest something that you may be surprised to find has a significant impact on your pain.

    “Meloxicam is in a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.” Lilady

    Pain is produced for a reason, this medical idea that pain is a problem in its own right is not scientific at all.

    The pharmaceutical action of painkillers and anti inflammatories is a distraction. The point is shooting the messenger is not scientific, calling the condition genetic because others in the family have it isn’t either.

    “Thanks CAM hucksters, but some of us LIKE having our symptoms treated, as crass and materialistic as it sounds. Sarah’s scorn for pain relief as a “first line of treatment” is telling. There’s sadism mixed into CAM.” DW

    I cannot apologise for your lack of understanding about what an alternative means, dealing with the reason that pain is there is about negating the need for pain. If I put my hands into boiling water it hurts, using painkillers to keep them in the water is not logical. Because the modern medical hypothesis has decided to discount reasons for pain beyond factors that you can’t change ie genetic, mystery etc. the idea that you can change your diet is discounted, that is not scientific nor is taking supplements in isolation either.

    The alternative solution to these problems is not a single factor it is about doing an audit of the total condition, taking a proper history and understanding the context of the condition. Modern medicine does none of these and claims the scientific highground for reasons only known to itself, choosing to palliate symptoms for tempory relief whilst the condition continues the proficy of degeneration, all of this is unnecessary. The degenerative progress of arthritis must have in some part a connection to the inhibition of collagen formation that is a side effect of anti inflammatories.

    I am amazed and surprised that there are still people who accept that all you can do is block pain and see this as a ‘treatment’. It is neither addressing the condition or treating it.

    If I can get scurvy by vitamin C deficiency why can’t I get arthritis for other dietary deficiencies?

  57. DW says:

    “So perhaps you could tell us what you have had for breakfast, dinner and evening meal and I will do my best to suggest something that you may be surprised to find has a significant impact on your pain.”

    Who said I was in pain? Again, the lack of empathy is telling. It doesn’t occur to you I’m not talking about myself.

    “Pain is produced for a reason, this medical idea that pain is a problem in its own right is not scientific at all.”

    Pain is not a problem in its own right????? Hello again. Could only be spoken by someone not in pain, and unable to imagine the pain of others.

    Let me try to explain something to you – something important: Pain doesn’t have to be the “cause” of something to be worth treating “in its own right,” and no one in the medical profession thinks it is. Pain relief is often job 1, however, and for good reason: it hurts.

    “The pharmaceutical action of painkillers and anti inflammatories is a distraction.”

    And a damn good one.

    “The point is shooting the messenger is not scientific, calling the condition genetic because others in the family have it isn’t either.”

    You aren’t in a position to speculate on what’s scientific, if you believe that a condition is called genetic “because others in the family have it.”

    “I cannot apologise for your lack of understanding about what an alternative means, dealing with the reason that pain is there is about negating the need for pain.”

    Yes, but there’s such a thing as delusion and psychological projection. Where the “healer” pretends to him/herself and to the patient that we are “dealing with the reason for your pain” when what we are doing is unconsciously practicing sadism. Sit tight through screaming hell and we’ll soon have this sorted out … just a few weeks or months …

    “The alternative solution to these problems is not a single factor it is about doing an audit of the total condition, taking a proper history and understanding the context of the condition.”

    Right. Like probably it’s a past life, or it’s an imbalance of chi, or it’s my chakras.

    “Modern medicine does none of these and claims the scientific highground for reasons only known to itself,”

    Known to those who went to medical school, too. Maybe you could apply?

    “The degenerative progress of arthritis must have in some part a connection to the inhibition of collagen formation that is a side effect of anti inflammatories.”

    Well, if it “must,” I’m sure you have studies that show that, right? Or you’re in the process of applying for NIH funding so you can prove it? Right? If it “must” be that, then you will have no problem showing it, scientifically.

    “I am amazed and surprised that there are still people who accept that all you can do is block pain and see this as a ‘treatment’.”

    Who said that? Try re-reading the post to see what it actually says.

    “If I can get scurvy by vitamin C deficiency why can’t I get arthritis for other dietary deficiencies?”

    LOL. I don’t know, why can’t you? Again, I suggest you apply to medical school. In a few short years you’ll be able to actually show all these things you say “must” be true, after you establish your career as a researcher and publish these studies.

    Remember – they “must” be true. Therefore you can show them.

  58. David Gorski says:

    But in the end, the role of science is to inform a political decision.

    And because science is involved, as far as I’m concerned it’s fair game on this blog. I construe the term “science-based medicine” in a broad manner. If it touches on the scientific basis of medicine, the medical system, etc., it’s an appropriate topic.

  59. sarah007 says:

    DW it is difficult to be empathetic with someone who is so angry. Who said you were in pain, I like you supposed a scenario, are you that out of touch with semantics?

    DW said: “Well, if it “must,” I’m sure you have studies that show that, right? Or you’re in the process of applying for NIH funding so you can prove it? Right? If it “must” be that, then you will have no problem showing it, scientifically.”

    I don’t have to prove it, collagen inhibition is a side effect of anti inflammatories. If in arthritis the collagen is falling apart it is not too difficult to come to the conclusion that the early use of NSID medication may be part of the pathway of collapse. Knowing many people who have not gone down this route and recovered without medication that suggests to me that there is a link.

    DW said:”Where the “healer” pretends to him/herself and to the patient that we are “dealing with the reason for your pain” when what we are doing is unconsciously practicing sadism. Sit tight through screaming hell and we’ll soon have this sorted out … just a few weeks or months … ”

    This is your projection, there are no ‘healers’ to my knowledge and I made it clear earlier that the alternative is not doing nothing, why can’t you read a post beyond your own drunken rage?

    It is sadistic of a doctor to tell someone with arthritis that they can do nothing cos thats what they told me at med school so in the meantime take this, it will hide the pain for a while whilst we line you up for joint replacement and claim on your insurance for that. In countries with a national health system it’s even better because the cost of this mistreatment is shared by the whole nation.

    Mercola’s so called profit pales in this shadow, one can also follow good suggestions without spending focused money and get a result without the meddling of a doctor.

    DW said:”I suggest you apply to medical school. In a few short years you’ll be able to actually show all these things you say “must” be true, after you establish your career as a researcher and publish these studies.”

    Now you are taking the piss, med school isnt about learning anything, its about cramming protocol lists. The idea that doctors spend their spare time researching for new cures is the stuff of disney.

  60. lilady says:

    Good morning D.W. As you can see the troll now claims “expertise” in pharmacology, while still holding on to the belief that diet can change the course of all diseases and disorders…if only.

    It would be nice if the troll had any citations that confirm what her aimless, ignorant blather means.

    “The degenerative progress of arthritis must have in some part a connection to the inhibition of collagen formation that is a side effect of anti inflammatories.” No, your collagen “connection” and your “theory” are both wrong.

    AND…

    “If I can get scurvy by vitamin C deficiency why can’t I get arthritis for other dietary deficiencies?” Wrong again. Troll. See:

    http://www.sciencebasedmedicine.org/index.php/collagen-an-implausible-supplement-for-joint-pain/

  61. DW says:

    “I don’t have to prove it, collagen inhibition is a side effect of anti inflammatories.”

    That pretty much sums up your position: “I don’t have to prove it.”

    “If in arthritis the collagen is falling apart it is not too difficult to come to the conclusion that the early use of NSID medication may be part of the pathway of collapse.”

    LOL we can see that you did not find it too difficult to come to this conclusion. The ease with which quacks and hucksters reach their conclusions has little do with their validity. Those who research things BEFORE presenting findings don’t find it so easy. Maybe you could try it?

    “The idea that doctors spend their spare time researching for new cures is the stuff of disney.”

    Most doctors aren’t researchers. I was suggesting that YOU become one. Since all of your theories are most certainly true, it should be supremely easy for you to get yourself all trained up and SHOW that your theories are true. Let us know! Even if I am in one of my drunken rages at the time, I’ll applaud you when you come back here reporting the results of actual research, as opposed to ignorant gleanings from the Internet.

  62. windriven says:

    @lilady

    “Just when will the opposing forces stops their campaigns of disinformation? During the last election cycle we had the Alaskan Diva with her “death panels” and “pulling the plug on granny”. During this election cycle we have a physician who wants to bar the doors of the hospital to people without health care insurance. Here is an outline of the program that was passed by the Democratic Congress and which every Republican presidential candidate wants to eliminate:”

    Rhetoric that demonizes one imperfect perspective while glorifying another imperfect perspective is precisely why healthcare reform and most of the other critical issues of our day prove so politically intractable. When you walk in to what one hopes will be a thoughtful hashing out of goals and interests wearing your team T-shirt, lines get drawn, positions harden and the whole process degenerates into finger pointing and finger giving. Now that might be great for team spirit but it really doesn’t move the ball forward very much.

    This is exactly what gives Dr. Gorski reason for trepidation exploring this on SBM.

    Death panels and pulling the plug on granny are exactly the kinds of inflammatory metaphors that don’t belong in the debate. Neither does “Alaskan Diva” and the trope “we good, they bad” – no matter how fervently you might believe it. The winners are usually those who keep their eyes on the objective.

    “Death panels” is ridiculously inflammatory. But the underlying notion – the necessity of managing healthcare outlays (read: rationing) – is going to have to be discussed and some sort of consensus reached or our grandchildren will be having the same arguments that we have today.

    Everybody wants to go to heaven but nobody wants to die. A fem-pop bypass on your 88 year old semi-comatose grandmother is a waste of scarce healthcare resources but a prostatectomy on my 88 year old semi-comatose grandfather is an essential, life-saving procedure.

    Lines are going to have to be drawn and darned near nobody is going to like them no matter where those lines fall. And that is just one tiny part of the problem to be solved.

  63. weing says:

    “Lines are going to have to be drawn and darned near nobody is going to like them no matter where those lines fall. And that is just one tiny part of the problem to be solved.”

    I get the impression that these lines will not be drawn by gutless politicians. They expect the doctor to draw them in the trenches. All without the, to continue the analogy, aerial support against the onslaught of the attorneys.

  64. lilady says:

    @ windriven: I’m sorry if you don’t care for my calling out Sarah Palin for her empty-headed comments about a national health care plan and the physician-presidential candidate who wants to bar the doors of hospitals for the uninsured. I also have seen the spectacle of elderly Medicare/Medicaid recipients who attend rallies and carry their placards “Keep Government out of My Health Care”.

    I readily admit that I have certain “political leanings”…solidified by my experiences while working as a public health nurse. In fact, providing primary and preventive health care for the uninsured and under-insured and observing first hand the dire consequences of not having a primary medical care “home”, cause me to advocate for a national health care plan.

    I do strongly agree that unlimited and inappropriate health care has to be rationed. It is high time that the political dialogue is used to synthesize and develop a workable national health care plan…now if we could only convince both “sides of the aisle” in Congress about that.

    We have a golden opportunity to use the experiences of the rest of the developed world’s national health care plans. We might be able to decrease the budget deficit to make certain that future generations aren’t paying for our out-of-control health care costs.

  65. sarah007 says:

    Lilady incorrectly assumed “No, your collagen “connection” and your “theory” are both wrong.”

    The SBM article on eating collagen or taking supplements is exactly what I do not mean with regard diet. You have to stop seeing part of a point and jumping to a nonsensical conclusion. I know medicine is only capable of thinking one dimensionally but condritin supplements are not what I would call nutritional advice.

    Changing your diet is about not eating processed food. It has nothing to do with eating some processed supplement which was a vague attempt for some companies to try and cash in, it failed.

    Now get your finger out of your arse and tell us what you had to eat today and I can guarentee that part of the reason why your body has decided to start triaging raw materials will be very obvious.

    Lilady on your rant on providing health care in the US

    America is the most overfed, undernourished country in the world, the obscene overeating, 2 million yanks are over 40 stone in weight and all the programmes I see with doctors they just talk about sexy surgery! How about taxing the fat per pound over 20 stone and not allowing fast food to use the term food. All parents with fat kids should be treated as food abusers and sent to correction centres. Any one with a deficiency disease should be sent back to school to learn to eat properly.

    You know the line drawing will be the scariest for people like you, depending on a failing system to stay alive.

  66. sarah007 says:

    DW there are no healers, I don’t know where you get this idea from, I have never met one, what do they look like?

  67. Quill says:

    And because science is involved, as far as I’m concerned it’s fair game on this blog. I construe the term “science-based medicine” in a broad manner. If it touches on the scientific basis of medicine, the medical system, etc., it’s an appropriate topic.

    It certainly is! For example, I would love to see more things like an SBM commentary on the various studies you noted, the ones that show other countries get better health care outcomes than the US while spending less per capita. Many posts so far have clearly shown where science is not simply debated but ignored, such as in the whole NCCAM sphere.

    It would also be wonderful to read more about elements of health care payments and their effects on overall outcomes. For instance it seems to be the case in Europe that the more money put into primary care the better the overall outcome. To me this is one of those “no brainer” sorts of things but in the US there have been some wacky arguments put forth by the CAM folks, basically saying that these better outcomes in Europe aren’t about primary care but including CAM in that primary care. Debunking that sort of stuff would be really useful.

  68. lilady says:

    All purpose-all knowing Troll now claims to have “expertise” in dietetics and is a self-appointed political pundit.

    Clearly we are in the presence of greatness here, folks.

    Why doesn’t Troll run for Parliament…surely there must be a constituency in the U.K. that might be impressed with “expertise”, her intellect and her draconian policy of imprisonment, denial of civil rights and “re-education” for the crimes of being overweight or having a “deficiency disease”.

  69. Narad says:

    All purpose-all knowing Troll now claims to have “expertise” in dietetics….

    Well, sure. Look, let’s test it out: “Sarah,” what happens if starch is eaten with protein?

  70. windriven says:

    @lilady

    “I’m sorry if you don’t care for my calling out Sarah Palin”

    Don’t be sorry. As it happens, I share your disdain. But building workable healthcare reform isn’t about Sarah Palin. I was simply pointing out that your hyper-partisan rhetoric is no more helpful than hers. Building meaningful and lasting reform is going to take a bit of compromise; some giving on both sides. Its just a lot easier to do that when the parties involved aren’t spending most of their time thinking up creative insults to hurl at their opponents.

    As to the rest, you and I agree far, far more than we disagree.

    I’d be particularly interested to know your thoughts on how a politically realistic public discussion about rationing might be shaped.

  71. DW says:

    Sarah:

    “How about taxing the fat per pound over 20 stone and not allowing fast food to use the term food. All parents with fat kids should be treated as food abusers and sent to correction centres.”

    Holy hell. Is this a joke? Or was I more right than I realized about the sadism thing? If you mean these things seriously, you’re a scary lady.

  72. lilady says:

    @ windriven: Upstream on this thread, I did link to the health care plan passed in the Democratic-controlled Congress…which was attacked by *Palin in 2009 via a series of e-mails and public statements…during her feeble attempts to remain relevant and in the public eye. Palin chose to “interpret” a piece of the legislation that provided reimbursement to physicians who take the time to engage their patients in end-of-life care discussions. Palin deliberately and with malice, lied about that section of the legislation. She “personalized” her misinterpretation by accusing the President, the Congress and physicians of potential genocide of her disabled child and her aging parents. Every media outlet roundly criticized her for this blatant lie:

    http://www.politifact.com/truth-o-meter/statements/2009/aug/10/sarah-palin/sarah-palin-barack-obama-death-panel/

    This years crop of Republican candidates (including Gingrich and Romney who have veered far-to-the-right), have promoted that Palin lie and each of them has vowed to overturn that legislation. They all are appealing to the basest emotions of their constituencies.

    The problems we as a society face are monumental, but not impossible to solve.

    We need to be persistent to educate people about the limitations of science-based medicine, the appropriateness of specialized high tech medical care as people contemplate their own mortality…and the benefits of comfort measures for end of life care.

    * I will continue to refer to Palin as the Alaskan Diva….you wouldn’t want me to use my “other” labels for the opportunistic brainless twit.

  73. sarah007 says:

    So DW freaked out ““How about taxing the fat per pound over 20 stone and not allowing fast food to use the term food. All parents with fat kids should be treated as food abusers and sent to correction centres.”

    Holy hell. Is this a joke? Or was I more right than I realized about the sadism thing? If you mean these things seriously, you’re a scary lady.”

    So can I take it you are overweight then? There is supposed to be a world shortage of food, if some people are unable to curb their appetite and put massive stress on health care systems and unable to teach their kids to eat responsibly what is the difference between someone unable to deal with alcohol and bringing up their kids as an alcoholic?

  74. DW says:

    Like I said, you are a scary lady. Not that my weight has anything whatsoever to do with this discussion, but I’m not even a pound overweight. Your posts simply give away your mode of relating to other people, which influences your reasoning, which is poor. Your reasoning is ad hominem. If I write about pain, you figure I’m in pain. If I object to punishments for fat people, you figure I’m fat. You are mean. You don’t realize your meanness influences your thinking, but it does and it makes you reach very poor conclusions, conclusions that are dangerous to other people.

    There is no way I could ever take seriously a person who advocates as public policy that fat people be taxed by weight, or that parents of fat children should be thrown in jail.

    Beneath fluttery spiritual language about holism and balance and integrated this and that, I find that zealous CAM proponents are often motivated by meanness.

  75. DW says:

    Do you seriously believe that food shortages occur because some people are unable to curb their appetite?

  76. EricG says:

    DW

    c’mon, didn’t you know that those in the Congo starve because McDonald’s exists? what are you, the CEO of McDonald’s? As the CEO of McDonald’s, how can you be so callous as to the obvious connection between hamburgers and rampant obesity? I don’t have to prove it, if you just looked around – instead of hiding your head in the only website you’ve probably ever read – it’d be obvious. I know tons of people who know this. they are all really smart. wake up to reality you corporate fascist.

  77. EricG says:

    Sarah

    question for you. my brother is 26 and has osteo arthritis in his elbow. what should he do?

  78. DW says:

    Heh. He should just ask Sarah what to eat for breakfast, lunch, and dinner. And it’s probably his own fault because of his diet, so perhaps we should just throw him in jail.

  79. iggy says:

    @DW – Or throw his parents in jail

  80. iggy says:

    @Sarah – I also have a question. I have a massive headache. Now. I had cereal with youghurt for breakfast, yesterdays lunch was fish and potatoes, dinner was a green salad. What shall I do? Take a painkiller or change my eating habits?
    Fredrick

  81. Linda Rosa says:

    In looking a larger institutions, Bravewell may have overlooked where integrative centers were expected to pull their own weight financially. In the city of Loveland, Colorado (pop. about 50,000), a “holistic center” at the local hospital closed after about two years because it flopped financially.

  82. Narad says:

    I have a massive headache. Now. I had cereal with youghurt for breakfast, yesterdays lunch was fish and potatoes, dinner was a green salad. What shall I do? Take a painkiller or change my eating habits?

    Oh, that’s dreadful. You’re combining protein with starch. Everybody knows that starchy foods require and alkaline digestive medium and proteins an acidic one. What happens when you combine acid and base? Exactly–digestion slows to a crawl, and the undigested food ferments (rots) inside you. Did you put vinegar on that salid? Pre-rotted stuff. The yoghurt? Pre-rotted and mucus-forming. You’re swimming in poisons, and you wonder why you have a headache? It will just come back once the poison that you want to use to “fight” it wears off. Like an addict, you will repeat the cycle.

  83. Narad says:

    ^ “an alkaline”

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