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CAM In Medical Schools

A recent US News and World Report article on the incorporation of complementary and alternative medicine (CAM) into US medical schools credulously repeats the pro-CAM marketing hype. There is no evidence that the author, Meryl Davids Landau, spoke to a single critic of CAM, or is even aware that such criticism exists. The result looks more like marketing copy than serious journalism.

She begins:

Now that nearly 40 percent of American adults swear by some form of complementary and alternative medicine, or CAM—from nutrition and mental relaxation to acupuncture, magnet therapy, and foreign healing systems like traditional Chinese medicine and Indian ayurveda—a growing number of medical schools, too, are supplementing medication with meditation.

There is much to deconstruct just in this first paragraph. The entire article in an argument from popularity. This is a game the pro-CAM community has been playing for years. People are using CAM because it’s popular; medical schools should teach it because people are using it; the government should research it because of all the interest in it; and CAM should be popular because it’s being researched and taught in medical schools. CAM is like Paris Hilton – famous for being famous.

What’s missing from this circular argument for popularity is evidence that any particular CAM modality actually works, or even has scientific plausibility or the potential to teach us something new about the human body and healing.

The argument is not only fallacious – it’s wrong, or at least highly deceptive. This stems from the core fallacy of CAM, and that’s the very concept of CAM itself. It is a false category, which does not describe any cohesive philosophy or approach to medicine but rather exists solely as a marketing ploy to carve out a double standard – to exempt certain modalities from the rigors of science, evidence, and logic. This false dichotomy results in lumping a wide variety of treatments under one umbrella, and then claiming that the entire category is popular.

When we look a little closer at the numbers we find that the vast majority of so-called CAM use in the US is either massage (16%), chiropractic or osteopathic manipulation (21.9%), and yoga (9.5%). (There is overlap in use so you can’t simply add these percentages, but the vast majority of the mythical “40%” figure comes from these categories.) So some form of exercise, stretching, or muscle manipulation accounts for the vast majority of CAM use. Throw in some other modalities that are not really CAM, like relaxation and nutrition (since when has the science of nutrition been alternative to science) and that accounts for even more.

What’s left for the real hardcore CAM modalities like homeopathy and acupuncture? Not much. These modalities have been languishing in the single digits and not significantly increasing. But by lumping them in which relaxation and massage you can generate the false impression that the whole category is popular. The entire exercise is intellectually sloppy and deceptive – by design. And this deception is being used to convince medical schools that “CAM” deserves access to the limited resources of the school, which is then used to convince patients that it’s legitimate (more circular reasoning).

And we’re just at the first paragraph. She continues:

Interest in teaching alternative approaches “has exploded, especially this last year,” says Laurie Hofmann, executive director of the Institute for Functional Medicine, which is based in Gig Harbor, Wash. The nonprofit institute educates healthcare professionals to look for underlying systemic imbalances as a cause of illness rather than focus on treating symptoms and, when possible, to correct with lifestyle changes and mind-body techniques.

No evidence is offered for this alleged “explosion” in interest. What’s missing from the article is any mention of the Bravewell Collaboration – a funding organization that pays medical schools to open up CAM centers. This is part of a very deliberate “quiet revolution” that Wally Sampson has written extensively about, an attempt to change the practice of medicine by influencing medical education (rather than through compelling evidence).

Landau then repeats, without the slightest hint of journalistic skepticism, the claim that “integrative” medicine looks for underlying causes of illness, while mainstream medicine simply treats the symptoms. This is pure CAM marketing mythology, having no basis in reality. Science-based medicine is built upon a systematic attempt to understand the underlying cause of illness. Of course, when scientific medicine searches for underlying causes this is denigrated by CAM proponents are “reductionist.” When they do it, it’s “holistic.”

The difference between the scientific approach and the typical CAM approach is that science is based in reality. It slowly builds a knowledge base that is internally consistent. Whereas most CAM modalities are philosophy-based – they are based on pre-scientific superstitious notions of health and illness that have not been subjected to any kind of systematic study, or that have been left behind by scientific advance (such as the notion of life energy). These philosophies are often mutually exclusive, which doesn’t seem to bother the “big tent” CAM movement. In the end, the alleged underlying “imbalances” sought for by CAM practitioners are illusory and not based in reality. That doesn’t stop them from being smug in their dismissal of scientific medicine.

What follows is a long list of medical schools integrating nonsense into their curriculum – as if this is a good thing. Landau admits that many medical schools find it difficult to find time in their busy curriculum for CAM teaching. This is because there is a large body of medical knowledge that needs to be crammed into four years of medical school. At Yale where I teach every department is clamoring for one more hour here or there to teach their material. There just isn’t enough time, and we have to be creative in maximizing classroom time for the students. This just highlights the importance of not wasting this limited resource teaching the fads of the day.

This gets to the deeper question that is not even addressed in the article – what is the responsibility of academic medicine in determining the standards that should be followed in medical education? Medical schools are being offered what are essentially bribes, and are being told that CAM is popular as reasons to spend precious time teaching (often really promoting) CAM. This is often accomplished without open debate and discussion, and many faculty members are shocked to find out what is going on in their own institution (quiet revolution indeed). But isn’t it the responsibility of medical schools to maintain high standards of science and academia, to resist the forces of pseudoscience, sectarian beliefs, and popular culture? Perhaps I am being too idealistic.

In the end Landau’s article was devoid of any serious discussion of the actual issues. The result was a propaganda piece (intentional or not) for the sectarian beliefs and economic agenda of CAM, at the expense of academic integrity.

Posted in: Medical Academia, Science and the Media

Leave a Comment (38) ↓

38 thoughts on “CAM In Medical Schools

  1. windriven says:

    “Perhaps I am being too idealistic.”

    Perhaps some of your colleagues are not being idealistic enough. Or even idealistic at all.

    It beggars my imagination that an educated person, much less someone educated in medicine can actually believe in this quackery. So is it just about money?

  2. plurie says:

    We should teach CAM in medical schools so that future docs will understand the nonsense that their patients believe in and are using. We should also be teaching medical students critical thinking skills so they’ll be able to recognize woo when they see it.

  3. ConspicuousCarl says:

    Landau appears to be using a ninth-grader’s trick for throwing together a pathetic excuse for a report.

    The process is simple. Find something another party has already written (the first thing one grabs is usually biased trash, but that’s OK). Then just copy it, alternating between quoting and paraphrasing, and you’ve instantly got what appears to be a summary of a subject peppered with supporting quotes.

    The output is obvious trash, and you will probably get a ‘C’ or ‘D’, but the teacher can’t accuse you of not doing the assignment.

  4. windriven says:

    @plurie

    “We should also be teaching medical students critical thinking skills…”

    We are given to believe that medical schools accept only the best and brightest. How is it that Johnny can get into medical school but Johnny can’t think?

  5. GLaDOS says:

    Thanks for taking one for the team, Steve. Those two paragraphs you quoted were painful. I’m not sure I could have endured the entire article.

  6. daijiyobu says:

    It would be interesting to know where US News stands regarding the Code of Ethics of the Society of Professional Journalists

    (see http://www.spj.org/ethicscode.asp ).

    -r.c.

  7. Alexander Han says:

    @windriven

    As a current medical student, I’d like to say that if you think fact-checking a Gish Gallop is hard, try fact-checking 2~4 hours of faculty lectures every day. It’s even less appealing when you realize that the information is largely correct, so if fact-checking isn’t a great study method for you (or if it’s so time-consuming you can’t get through all the material), it’s mostly a waste of time. You may think things get better during the clinical years, but fact-checking after being on call is also not terribly popular.

    The only things that will motivate med students to think critically are if it’s actually on the test (good luck, all our tests are multiple-choice board style questions) or if it’s something which is both obviously contrary to medical science and likely to cause patient harm (good luck, few of us have the time and inclination to learn what CAM actually entails, and the rest tend to get suckered by NCCAM methodolatry). The fact that we occasionally get professors saying that patients can try acupuncture to manage various conditions doesn’t help at all.

    I think that as medical students, we aren’t totally helpless (shoutouts to Kreider et al.), but I really think that faculty need to take the lead, since they’re the ones setting the educational agenda. Without lectures devoted to confronting CAM disinformation and accompanying questions on exams (preferably USMLE exams!), most med students will not even think about CAM for longer than it takes to realize that it’s not on the test.

    Also, I know our society hates ‘teaching to the test’, but that’s really only a problem when the test isn’t testing valuable skills. Knowing a huge pile of medical facts is a valuable skill and the multiple choice tests we take are a pretty effective way to bludgeon them into us. My main regret is that “CAM is bullshit” isn’t usually in that pile.

  8. egstra says:

    Windriven asks: “We are given to believe that medical schools accept only the best and brightest. How is it that Johnny can get into medical school but Johnny can’t think?”

    Our students are not taught how to think; they are taught how to memorize and to take tests. Thinking actually may be discouraged.

    Years ago, I was the TA for a class in Educational Psychology. I found that a number of the students were unable to write a simple paragraph using correct grammar. Many of them, however, told me that they were getting As in their education classes, and they couldn’t understand why I was critical of their writing.

    Those students are now our high school teachers. The universities may offer more challenge, but I’m skeptical.

  9. Geekoid says:

    I wish Yoga would divorce itself from the woo. It’s a fine way to strength and strength muscles. So its a good exercise type, and exercise is good for people.

    I would love to take yoga, but I can’t stand all the woo that gets attached to it.

  10. Ed Whitney says:

    It was a little hard to tell from the article whether students were being taught to do CAM or being taught about what CAM is.

    I assume that today’s pharmacology courses would have material on herbs that interact with medications (e.g., garlic, fish oil, etc with warfarin) . This was not taught in earlier years, but is relevant to practice today (and was back then, though we did not know it). I assume it is also standard now to emphasize the need for eliciting this information in history-taking, and to list which herbs are being taken and in which doses (rather than “OTC vitamins” or “herbs” which passed for adequate history-taking at one point in recent history).

    A couple of electives in the fourth year can acquaint physicians with what the hey their patients are talking about when they mention CAM. Since this facilitates doctor-patient communication, I assume that there are no objections to doing this. Do these electives teach only the upside and never the downside of some CAM interventions? Hard to tell from the article, but objections are warranted if so. Are there objections to teaching students ways to de-stress? I assume not.

    Diabetologists lament the way that the approach to Type II diabetes emphasizes, in order of priority, medication, medication, medication, lifestyle, and surgery, rather than lifestyle, lifestyle, lifestyle, medication, and surgery. Exercise and a diet centered on plants is being taught at Loma Linda; how much outrage is warranted at this?

    I see some cause for concern, but without further information, alarm seems premature.

  11. Scott says:

    Diabetologists lament the way that the approach to Type II diabetes emphasizes, in order of priority, medication, medication, medication, lifestyle, and surgery, rather than lifestyle, lifestyle, lifestyle, medication, and surgery. Exercise and a diet centered on plants is being taught at Loma Linda; how much outrage is warranted at this?

    Any citations for this? Assuming you’re right, that would potentially be an interesting topic for a post. The science, as I understand it, certainly supports the central role of diet and exercise. So if practice were overemphasizing medication that would be a failure of medicine to be properly science-based. Maybe one of the bloggers here would pick it up.

  12. Ed – I did not get into this because it has been covered before, but the CAM courses that are being taught are largely credulous. They are turned over to believers (because they are the alleged experts) who then promote CAM (which I alluded to).

    I would be all in favor of teaching about pseudoscience in medicine, sectarian beliefs and practices, etc. from a scientific point of view. This happens in spots, but is largely not what is happening.

    My personal experience (with all the caveats that implies) is that most medical students think it’s all hogwash, and the minority of ideologically predisposed think it’s great (something like 5%, which reflects physicians in general). Although many are afraid to voice their concerns out of political correctness.

  13. pmoran says:

    “The global market, on the other hand, is expected to increase around 14 percent in the next five years, with sales reaching $2.3bn.”

    We don’t have to look far for proof that popularity doesn’t prove intrinsic efficacy for a medical treatment. The above statement refers to glucosamine.

    Nevertheless, if we wish to dispute the popularity of CAM, it is deceptive to look at whole population studies. Most of those interviewed will not have been sick enough to use ANY medical treatments over whatever period the surveys cover.

    There is also some specificity to CAM use. Brendan recently pointed out that acupuncture is mainly used for musculo-skeletal complaints and headache.

    So if you want to know how popular CAM is, you should look at what sick people do,

    A very different picture then emerges, especially with chronic conditions.

  14. egstra says:

    To Geekoid:

    Check with your local Y… many of them offer good yoga classes, minus the woo. They are excellent for balance, flexibility and some degree of strengthening. There may be a “namaste” at the end, but that’s generally about it.

    Stay away from “fitness yoga” however; that’s an oxymoron.

  15. nybgrus says:

    As a medical student I can tell you that we have CAM classes and that the extent of them is rather limited. The problem is that the best of them tell us to watch out for drug interactions and that is about it. Most of them are quite creduluous and continue to stress the dichotomy. I literally had a lecturer tell us (vehemently) that nutrition is CAM, pharmocognosy (he didn’t use that word) is CAM, and that it is crazy that mainstream med doesn’t incorporate that (plus acupuncture and meditation and energy healing) into the curriculum and clinical practice. And exactly like Alexander Han said – not many people have the desire, time, or even think they should be looking this stuff up. On one slide re: acupuncture from the IM lecturer he had 6 or 7 journal articles to cite as proof of efficacy and told us how great it was and crazy that med isn’t using it. They were impressive looking citations. So I looked them up. The number one reference began with a big red paragraph that said “the following information is out of date and kept up only for historical purposes” a couple were equivocal studies and the rest were articles he had written! Yes, most of my colleagues are aware that most of CAM is BS – but some don’t. And most don’t even know what exactly is a lot of CAM. Or “what’s the harm?” And when you are taught, by those in authority, that this dichotomy exists, that certain ideas are credulous, and then leave the door open for the crazy stuff it allows some to take on the woo and others to stand idly by while it comes in. He never endorsed it outright, but he did mention energy healing and reiki as having “some” evidence behind it. And when I talked to him after class he tried to tell me that since experienced reiki practitioners get better results than inexperienced ones there “must be something” to it since attending physicians get better results than residents and interns. That is a very dangerous attitude to have and give creedence to in a medical school.

  16. Ed Whitney says:

    @ Scott:

    “Any citations for this? Assuming you’re right, that would potentially be an interesting topic for a post. The science, as I understand it, certainly supports the central role of diet and exercise.”

    No citataions, just hearing some diabetes specialists on a panel deploring the priorities with which they see patients being treated in the community, in precisely those words. Time constraints on physicians is part of the problem; it takes moments to write a prescription but a long time to talk about how to find ways to confront the barriers to lifestyle change.

    What I am driving at is that this does not sound like CAM–I think we agree that it sounds mainstream what they are teaching at Loma Linda. Looking at the whole patient is CAM?

    It is as if Paris Hilton were not even Paris Hilton.

    As for treating Type 2 diabetes, http://www.medpagetoday.com/MeetingCoverage/EASD/22352 looks like the right way to go. Fecal transplants for everyone!

  17. Ed Whitney says:

    pmoran:
    “Nevertheless, if we wish to dispute the popularity of CAM, it is deceptive to look at whole population studies. Most of those interviewed will not have been sick enough to use ANY medical treatments over whatever period the surveys cover.

    There is also some specificity to CAM use. Brendan recently pointed out that acupuncture is mainly used for musculo-skeletal complaints and headache.

    So if you want to know how popular CAM is, you should look at what sick people do,

    A very different picture then emerges, especially with chronic conditions.”

    I need a clarification. Do people turn away from or toward CAM when they are seriously ill?

    Cancer was always the disease around which quackery clustered, although calling it CAM is not a good designation. Laetrile (which its proponents called “Vitamin B17″) was what the desperately ill turned to back in its heyday. It has had its successors, of course.

    As for chronic conditions, it seems as if diseases with exacerbations and remissions were the honey that drew many of the flies; rheumatoid arthritis and multiple sclerosis come to mind. Timing was the key: give the snake oil at the peak of the exacerbation. I have no data on this impression, but there must be some data about the kinds of conditions that attract more kinds of unproven treatment.

    When healthy, most people are satisfied with their health insurance, but become disenchanted when they have to call on it in a major way. Are you saying that people are satisfied with CAM when relatively well, and turn toward SBM when seriously ill, or are they indifferent to CAM when healthy and turn to it when a major illness strikes?

  18. moderation says:

    It should not be a surprise to see Loma Linda University promoting functional medicine, as it is a Seventh Day Adventist institution. Adventist are very focused on a holistic approach with significant dietary restrictions. When I spent some time there the entire hospital was vegetarian, no pepper, no mustard, no caffeine …

    http://en.wikipedia.org/wiki/Seventh-day_Adventist_Church

  19. pmoran says:

    Ed:”When healthy, most people are satisfied with their health insurance, but become disenchanted when they have to call on it in a major way. Are you saying that people are satisfied with CAM when relatively well, and turn toward SBM when seriously ill, or are they indifferent to CAM when healthy and turn to it when a major illness strikes?

    Well, there is CAM for the well person, who may be induced to do things that supposedly will make them feel better, live longer, and avoid certain diseases.

    The shotgun use of supplements would belong to this category. This must be one of the commonest.uses of CAM, but it is not always included in the surveys.

    CAM use is otherwise largely shaped by medical needs. Where medicine has highly effective treatments e.g. peptic ulcer, there is little “quackery”. Wherever the mainstream lacks entirely effective or safe treatments (or good explanations for illness), CAM thrives.

  20. Jamie M. Dagg says:

    Slightly off topic, but relevant….

    Here’s a link to an interesting article written by Matt Taibbi on Master reiki practitioner, Christy Mack, Co-founder and president of the Bravewell Collaborative (mentioned in the article above as a funding body for CAM [mis]eductation in medical schools), and wife of John Mack/Morgan Stanley CEO.

    It always amuses me when critics of ‘western’ medicine suggest WE follow the money to see the corruption. Yes, perhaps we should follow the money…

    http://www.rollingstone.com/politics/news/the-real-housewives-of-wall-street-look-whos-cashing-in-on-the-bailout-20110411?print=true

  21. Scott says:

    The shotgun use of supplements would belong to this category. This must be one of the commonest.uses of CAM, but it is not always included in the surveys.

    It’s also a lot trickier than most other forms of CAM, because some uses of supplements are firmly science-based. Folic acid is known to have benefits for pregnant women (even though the science is still evolving, as discussed in a recent post, it’s still a science-based intervention). Iron supplementation for blood-test-proven anemia is certainly science-based. More broadly, supplementation of micronutrients in which the person’s diet is deficient (e.g. vitamin A in the developing world) is science-based. (Inferior to dietary modification where that is practical, but still science-based.)

    Taking a pile of pills labelled as “nutritional supplements,” some of which aren’t recognized nutrients, others of which are in doses which bear no resemblance to nutritional requirements, and still others taken on an assumption that everyone is deficient despite an absence of evidence for that, is certainly CAM. This is what you mean by “shotgun use of supplements,” I think, but how would one craft a survey question to distinguish the cases?

  22. Diane Jacobs says:

    @Jamie – thank you for posting that Rolling Stones article. I was going to post it as an example of money talking, but you beat me to it.

    @Geekoid, either keep looking for a yoga teacher you can stomach or else just pick up a yoga book and select out what you want, teach it to yourself (as I did). You have the right to move, hold position, breathe, make new sensory-motor connections in your own brain and feel good in your own body. Ignore the crud.

  23. geekoid – I think another poster already mentioned this, but the best yoga class I’ve had was through the Y. There was a meditation session at the end of class, but it wasn’t at all “chi” (is yoga chi? can’t remember) focused.

    DVD, etc can be good, but a good instructor can help a lot by looking at you and telling you how your positioning can be corrected, as well as giving you good ways to get into position (eg: think about lifting your kneecaps). Another place to check out might be the community education that some hospitals have. They might be more inclined to hire more “mainstream” instructors. I’ve seen yoga featured in some of our hospital’s pamphlets, but have never tried it.

    Also, once you take a couple classes, you’ve learned how to do some of the main positions well, then you can start using mostly DVD instruction, that’s what I do.

    Yoga is great for stretching, it’s also great for lower body strengthening (all those standing positions) and relaxation. I’ve even found that those twisting poses are helpful with the GI issues that I get after a long plan/car ride.

    I never have been able to get the knack of tai chi though. It’s the woo plus everything going very slowly. It tests two levels of my patience.

  24. nybgrus “I literally had a lecturer tell us (vehemently) that nutrition is CAM, pharmocognosy (he didn’t use that word) is CAM, and that it is crazy that mainstream med doesn’t incorporate that (plus acupuncture and meditation and energy healing) into the curriculum and clinical practice.”

    I know you know this, but – piffle! Our pediatrician asks about our children’s diet every annual appointment and our son’s cleft team has a nutritionist that goes through growth, what he eats and how well and offers recommendations for improvements. Perhaps the difference is, she doesn’t sell us a lot of supplements, she makes recommendations of foods to serve.

    Crazy, huh?

  25. nybgrus says:

    michele: We have these things called “dieticians” and “nutritionists” that roam the hospitals selling us their woo. Especially in the cystic fibrosis wards. Those magical-thinking woo-meisters have to sneak in without the doctor seeing and “prescribe” good healthy foods and devise personalized diet plans for patients such as post-MI or type II diabetes. They also have to come up with creative and personalized high fat, high calorie, high nutrient, well absorbed diets for our CF patients. But they have to do it in the middle of the night, wearing masks, because otherwise we doctors would spot those CAM shysters and boot them right out of the hospital!

    Oh wait… or maybe we actually call them and ask them for help to best manage our patients diets and nutrition since they tend to be more expert at it than we are and we recognize how important and science based diet is. Darn. I keep getting the two confused.

  26. Nybgrus: “But they have to do it in the middle of the night, wearing masks, because otherwise we doctors would spot those CAM shysters and boot them right out of the hospital!”

    oh, this is a good chance to use the other word I’ve been wanting to use all day.

    Poppycock!

    Although I like the image of a vigilante nutritionist, sort like the heating and cooling repair guy in “Brazil”.

  27. Bogeymama says:

    I remember learning about homeopathy in 1st year pharmacy school over 20 years ago – the course was titled “History of Pharmacy”. I didn’t encounter it in the real world until about 10 years later, and now it’s everywhere again.

    On the upside, this Ipsos-Reid poll (article from today’s paper) seems to indicate that there is hope …. and that sites like this one are getting through to people. Still a long way to go….

    http://www.calgaryherald.com/health/Confidence+natural+health+claims+decline+Survey/4603371/story.html

  28. GLaDOS says:

    Nybgrus, I believe “dietician” is legally protected while “nutritionist” is not.

    People who define themselves as “nutritionists” are probably not science based.

    I wrote my own damn TPN orders, back in the day. It’s not that hard.

  29. weing says:

    Jamie,

    I just checked out that article. Unfortunately, I don’t see a non-violent resolution to this problem. We are living in interesting times.

  30. herbs4health says:

    I agree popularity should not count as a valid argument for including CAM teaching at med school.

    Steven Novella asks: Since when has the science of nutrition been alternative to science? Well, it always has been! Conventional medicine routinely ignores and has traditionally opposed the notion that nutrition and nutritional supplementation are more important in restoring health than drugs. Patients are nutritionally deficient, not drug deficient.

    There are a range of interventions, such as meditation and homeopathy, that have not been fully elucidated in terms of the mechanisms behind their healing effects. Nor do these healing modalities lend themselves to the scrutiny of the blinded and randomised clinical trial (how would you blind for meditation?). Nonetheless, meditation has been widely accepted by the medical orthodoxy as being able to change a patient’s physiological parameters for the better; homeopathy is as yet rejected as a valid treatment modality. Introducing an outcomes-based medicine model would validate modalities not yet fully explained – seeing is believing.

    Steven further claims: “Science-based medicine is built upon a systematic attempt to understand the underlying cause of illness.” That’s not the feedback I receive from patients. Example: I’m currently treating a patient (with homeopathic medicines) who had been struggling with what she thought was a skin complaint (daily episodes of itching welts along her legs following hot showers or sudden changes in temperature) for over 20 years. She’d been seeing doctors for this condition, both in the UK and in Australia, without any of them ever having been able to help her or having made an attempt at finding the underlying cause. The final straw for her came when her last GP wanted to put her on antidepressants! At her second appointment, three weeks following her initial consultation, she reported that the reactions she’d been having were reduced to 3 per week as early as during the first week of treatment…

    What I found most appalling when speaking to this patient was the blatant disrespect for the patient by her doctors, combined with an obvious failure to diagnose the underlying problem and doing something about it or referring the patient on to someone more competent.

    Re Plurie’s comment: “We should teach CAM in medical schools so that future docs will understand the nonsense that their patients believe in and are using,” I’d like to point to a couple of texts so this ignorant forum contributor may better inform him or herself.

    - Clinical Naturopathy – An evidence-based guide to practice by Jerome Sarris & Jon Wardle

    - A Guide to Evidence-based Integrative and Complementary Medicine by Vicki Kotsirilos, Luis Vitetta & Avni Sali

    Re Ed Whitney’s comment: “Cancer was always the disease around which quackery clustered.”

    Yes, that’s right – the use of chemo-quackery being a case in point – see the Australian Prescriber’s editorial ‘The Emperor’s New Clothes”

    http://www.australianprescriber.com/magazine/29/1/2/3/

    and the original study, “The Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies” is available here:

    http://www.drrathresearch.org/health_news/The_Contr_of_Cytotoxic.pdf

    Ralph Moss’ book “Questioning Chemotherapy” is also very enlightening in terms of understanding such medical concepts as “survival’ and how survival statistics are manipulated.

    While we’re on the subject of quackery, Flu vaccination has also been debunked:

    According to a 2005 Lancet article, the effectiveness of vaccines against influenza was found to be non-significant

    (http://www.ncbi.nlm.nih.gov/pubmed/16198765)

    and a more recent Cochrane review found that “reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies.”

    Moreover, the reviewers found that “Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines.”

    (http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001269/frame.html).

    In other words, industry-funded trials are biased and, since most research is nowadays industry-sponsored, true evidence-based medicine is scarce. Snake oil, indeed.

    Good grief, you have a bunch of ignorants posting here – are all of these people going to be doctors?!

    Which brings me to Scott’s post:
    “Taking a pile of pills labelled as “nutritional supplements,” some of which aren’t recognized nutrients, others of which are in doses which bear no resemblance to nutritional requirements, and still others taken on an assumption that everyone is deficient despite an absence of evidence for that, is certainly CAM.”

    It’s nice to see some creativity in this forum and that you’ve come up with your own definition of CAM.

    However, what do you mean by nutritional supplements which aren’t recognized nutrients? Recognised by whom?
    If you don’t recognise nutrients found in TGA-approved nutritional supplements, get an education!

    Moreover, nutritional requirements aren’t reliably read off some table devised by government officials decades ago; they’re actually assessed on the basis of individual patient needs. Hence, CAM is often referred to as patient-centred medicine, as opposed to disease-centred medicine.

    Patient needs vary according to age, sex, special needs (e.g. in pregnancy), lifestyle (e.g. alcohol, coffee, sugar consumption; stress levels, occupational hazard exposures, level of physical activity, etc.) and illness.

    Your claim that CAM practitioners are making the assumption that everyone is (nutrient) deficient, despite an absence of evidence for that is a false assumption on your part. If a patient is sick he or she is nutrient deficient. Correcting the deficiencies helps them recover from their illness. Correcting deficiencies must always take into account parameters, such as the patient’s digestive functions, bioavailability of any nutrients given and much more. So, just throwing supplements at a patient or patients’ self-prescribing may not be the most effective way to go.

  31. nybgrus says:

    necromancer (aka herbs4health): you are wrong. Now go away. Thanks for playing.

  32. Scott says:

    Conventional medicine routinely ignores and has traditionally opposed the notion that nutrition and nutritional supplementation are more important in restoring health than drugs. Patients are nutritionally deficient, not drug deficient.

    Citation needed. In general, what conventional medicine ignores and opposes are the claims that the miracle food of the week will cure all that ails you, advanced metastatic cancer can be cured by wheat grass smoothies, etc. If you wish to argue that these claims are true, you need to provide evidence for them.

    There are a range of interventions, such as meditation and homeopathy, that have not been fully elucidated in terms of the mechanisms behind their healing effects. Nor do these healing modalities lend themselves to the scrutiny of the blinded and randomised clinical trial (how would you blind for meditation?).

    Some notable differences:
    – “Meditation” under various guises has good evidence supporting its efficacy.
    – There is no particular reason to believe meditation couldn’t work.
    – There is a huge mountain of evidence proving beyond any reasonable doubt that homeopathy has no effect whatsoever beyond placebo.
    – For homeopathy to work, all of physics, chemistry, and biology would have to be utterly wrong. Dropping a book and having it fall upwards is far more likely.

    That’s not the feedback I receive from patients.

    Anecdotes completely devoid of detail or supporting evidence have no evidentiary value.

    I’d like to point to a couple of texts so this ignorant forum contributor may better inform him or herself.

    How about some actual science? PMID references will suffice.

    It’s nice to see some creativity in this forum and that you’ve come up with your own definition of CAM.

    Well then, how about you provide some sort of argument or evidence that I’m wrong?

    However, what do you mean by nutritional supplements which aren’t recognized nutrients? Recognised by whom?

    Consensus of the scientific community based on good evidence.

    If you don’t recognise nutrients found in TGA-approved nutritional supplements, get an education!

    Pure straw man. You’ll note that I didn’t list specific examples. So you have no idea whether they’re TGA-approved or not, which makes you a liar.

    If a patient is sick he or she is nutrient deficient. Correcting the deficiencies helps them recover from their illness.

    Citation needed.

    I’ll also note that your entire post couldn’t have been DESIGNED as a better proof of my points. Dogmatic assertions that everything can be cured with “nutrition,” complete failure to distinguish between actual nutrition and untested drugs, all backed up by not a single shred of evidence whatsoever. The only bit of evidence you did come up with (flu vaccines) not only doesn’t say what you think it says, it has absolutely no relevance whatsoever to the discussion.

    Thank you for proving that you and your ilk really are pure quacks with no understanding of the human body, science, or indeed anything at all.

  33. herbs4health says:

    Why do I need a citation for everything when you don’t bother with it?

    The fact that the vast majority of doctors disregard nutrition / nutritional supplementation as powerful healing agents actually came from one of my classmates, a GP, who goes to a lot of lectures and conferences and regularly challenges the opinions of the day, the response usually being that nutrition “has nothing to do with it.”

    Naturopaths do not believe in “miracle cures” either and it would be unethical to suggest to a patient that these exist. Nor do we prescribe or recommend a patient take one specific nutrition alone; as I said, the body requires more than one miracle nutrient.

    As to advanced metastatic cancer, that is indeed a very difficult scenario and it would be unethical for any doctor or naturopath to make any definitive suggestions to the patient as to his or her chances of survival. However, many a doctor does exactly that. They point the bone of doom at the patient and tell them to get their affairs in order, at which point many a patient comes either to a holistic, medically trained doctor or sees a naturopath. In the latter case, I do not know of any practitioners who would make any inappropriate promises or claims that their medicines can produce miracles.

    As regards less advanced stages of cancer, there is a good, fully referenced book written by a biochemist with strategies for supporting cancer patients: CANCER – NUTRITIONAL-BIOCHEMICAL APPROACH by Henry Osiecki (2003), in case you’re interested.

    I think you may be confusing inappropriate claims on the internet posted by laypersons – i.e. your claim that wheat grass can cure advanced cancer – with what qualified naturopaths actually advise their patients.

    Nonetheless, there have been spontaneous or, at least, unexplained cures of serious disease. Ian Gawler cites a case in one of his books from memory.

    The two books I mentioned:

    - Clinical Naturopathy – An evidence-based guide to practice by Jerome Sarris & Jon Wardle

    - A Guide to Evidence-based Integrative and Complementary Medicine by Vicki Kotsirilos, Luis Vitetta & Avni Sali

    are both fully referenced if you’d care to study them.

    Anecdotes are valid in this forum, since we’re not working on a scientific paper here; it’s a debate.

    And, given your earlier drivel, to which I originally took objection, I think my ‘anecdote’ when citing what my patients tell me about their experiences with doctors are valid.

    You can define CAM as anything you like. Your particular definition above just shows how ignorant you are, however.

  34. nybgrus says:

    gotta be a Poe

  35. pmoran says:

    HErbs4life: Why do I need a citation for everything when you don’t bother with it?

    I will settle for some specific claims. What do your methods actually do? What does it mean when you say you “help” patients?

    Only with the details can we judge whether you are likely to be observing significant therapeutic activity from your methods, as opposed to the benefits that seem to arise with any sympathetic medical attention, through placebo responses, the self-limiting nature of many complaints, and patients’ desire to please those trying to help them.

    You mention cancer. I contend that there is no body of evidence, even of anecdotal evidence, for nutrition having any impact upon invasive human cancer, once established. Show me why, if you think otherwise.

    Don’t refer us to books. If there is published research we can find it, if we have not already examined it. Some of us have been following naturopathic claims for many years.

  36. Scott says:

    Why do I need a citation for everything when you don’t bother with it?

    Because anybody can spout any garbage they like online or in a book. Peer-reviewed research is far more reliable.

    The fact that the vast majority of doctors disregard nutrition / nutritional supplementation as powerful healing agents actually came from one of my classmates

    Oh wow, one student’s opinion. Really conclusive stuff there.

    You can define CAM as anything you like. Your particular definition above just shows how ignorant you are, however.

    Pray tell, exactly when did I define CAM? Do you not comprehend that “X is an example of CAM” is fundamentally different than a definition of CAM? If you can’t even understand that, why should I accept that you’re an unquestionable authority on these matters? (Which is effectively what you’re saying, since you provide no actual evidence beyond “I say so.”)

    The rest of your post is completely and utterly content-free, providing no evidence or argument to support your claims.

  37. kulkarniravi says:

    I would like to ask Steven this question: for how many hours do the students of medicine study nutrition. Do you believe it is adequate? If not herbs4health has a point.

    -RK

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