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Response to a “CAM on campus” post

I only recently began contributing to SBM, bringing not any particular expertise or scholarship but rather the perspective of a student. My goal in blogging is not to focus on issues specific to my school, of which I am quite fond and proud in general. Instead I hope to use my experiences, which SBM editors and readers tell me are not unique, to illustrate how CAM can interact with medical education. When writing, I constantly remind myself, “Everything you know about homeopathy and naturopathy was heavily influenced by the SBM docs, so try not to parrot their arguments lest you look like a brainwashed fanboy. Focus on relaying your experiences and trust readers to reach their own conclusions.” As a result, some have called my critiques a bit mild, but I can accept blandness to avoid seeming arrogant beyond my qualifications.

I was surprised, therefore, to be told by leaders of a campus CAM group that my most recent SBM post was full of personal attacks.They advised me to remove the post or at least whitewash it of names and links that identify the naturopath PB. They told me that the naturopath was upset and felt that my post misrepresented him. (Neither I nor anyone at SBM has been contacted by him yet, so I am taking their word that he was upset.)

Here is a sense of our back-and-forth as they tried to cajole me:

Me: My criticism focused on my experiences, relying on notes I took during his lecture and information on his website. Any corrections, clarifications, or other responses from him are more than welcome, either by email or posted as comments on SBM.

Them: Consider the naturopath’s need to manage his reputation online, which is an issue for physicians as well. Potential patients may be scared off by your post.

Me: I described his beliefs and practices as I was led to understand them from his own words. He is welcome to respond in this or another public forum.

Them: We need to apologize to the naturopath, and we will probably be unable to convince him to speak again. How will our lecture series survive if guests are afraid of being attacked online?

Me: Why should you apologize for some jerk who attended an open lecture? I am not affiliated with any of the groups that sponsored the lecture, nor do I represent our school when I blog. Anyone who promotes a controversial practice at a university should be comfortable dealing with criticism.

Visibly uncomfortable with this next step, they told me that if I did not cooperate they would feel forced to bring the issue to a school administrator. They assured me that they had no desire to see me disciplined, but they felt this was an issue of professionalism that needed to be addressed somehow. A bit shocked, I promised to think about their concerns, solicit advice from neutral faculty, and make a decision the following week.

Please, read my previous post and tell me what you think. I am open to negative feedback. While considering the appropriateness of my critique, however, remember that its subject is not simply a nutritional counselor who does cosmetic acupuncture; PB is a leader of a political lobbying effort to license naturopaths as primary care physicians. I believe that this activity makes his description of naturopathy more than fair game for public criticism. If I failed to understand him after listening to his lecture, then he is invited to clarify his arguments in the comments section, where any concerned patient could see. Such discourse and debate is encouraged on this website.

Back to the story: They emailed me five days later, warning that the situation had become more serious and that they would have to go to the administrator tomorrow if I did not self-censor. I replied with my conclusion that my post was reasonable, particularly in light of the lobbying. I welcomed responses in the blog comment section, and I promised to make appropriate corrections if any specific statements were identified as false or malicious. Their response was vague and hinted at possible consequences beyond their control.

After speaking with the administrator, they emailed me that he was waiting to hear back from university lawyers about whether my post could be considered libel or defamation. Hopefully not, they said, in which case it would just be a “matter of professionalism” to be handled on campus. Again I was advised, for my own sake, to remove the post at least temporarily. Again I was told that my critique veered into unacceptable personal attacks. No examples were given.

My family and friends were on edge with me…but the story just fizzles out. The administrator seems uninterested in regulating my speech, and neither he nor any other faculty member has told me I was inappropriate. The naturopath may still be upset, but I have not been contacted by him as of today, which is two weeks after I was first approached and one week after I emailed that I would modify the post in response to specific feedback. I have heard nothing from the naturopath except vague reports secondhand. The SBM editors, also responsible for the post, have not been contacted either.

Based on what I was told, I wonder if the naturopath pressured my classmates to lean on me. Their veiled threats surprised me, because they had been good sports in the face of my previous writing, even inviting me to attend events and ask challenging questions. I speculate that he told them something like, “forget about getting local naturopaths to speak for you if you don’t deal with this post.” This is merely my guess from their words and behavior. On the other hand, perhaps the naturopath doesn’t actually care as much as I was led to believe; presumably he would email me or the site editors if he did.

What can other students learn from my experience, which I am told by SBM veterans is not unique? Do not be afraid, but do be prepared. First, find allies among faculty as early as possible. I didn’t mention it earlier, but I acted proactively by visiting the administrator myself before the other students did, which enabled me to present my framing first (free speech, scientific standards) and gauge how he might react to their complaints. I chose a few other influential faculty and sent them my post; the more positive responses I got, the more confident I became that I would have local supporters if a credible threat materialized. Second, if you write publicly, be familiar with how to write opinion critiques in a way that is not defamatory. I was not exactly accused of libel, but it was hinted at, and I felt much more secure after getting advice from friend and family lawyers. In the event of an actual lawsuit, the SBM docs know organizations that help students or bloggers threatened with speech suppression. Third, when you are in the right, hold true to your principles! Apparently sometimes complaints will be nothing more than groundless bullying. A community like SBM can be a great source of strength.

I do not tell this story for retaliation or in defensiveness, but simply to show that I will not be cowed by unreasonable demands. I am of course still willing to hear complaints or corrections, and I will respond appropriately; I have no desire to be malicious or misleading. I have a great desire, however, to discuss and debate ideas relevent to the practice of medicine, and in that spirit I welcome anyone who would refute me with persuasive arguments.

To the editors and staff of SBM: I thank each of you very much for your advice, support, and patience over the past two weeks.

Posted in: Medical Ethics, Politics and Regulation

Leave a Comment (50) ↓

50 thoughts on “Response to a “CAM on campus” post

  1. Citizen Deux says:

    Internet speech is a critical extension of free speech in general. Having been involved in a few debates over the”appropriateness” of my own postings, I sympathize. Providing that there was no malicious intent or falsehoods, you are within your rights to make reasonable challenge.

  2. Citizen Deux says:

    You may also take a look at this. Everything is fair game.

    Barrett’s Naturopath Article”

  3. weing says:

    We need to apologize to the naturopath, and we will probably be unable to convince him to speak again. How will our lecture series survive if guests are afraid of being attacked online?

    This can only be a good thing. You don’t need CAM propagandists. How about getting lecturers that will inform you about what CAM is practiced out there in order to familiarize you with the nonsense that your patients will be bringing you? If a pharmaceutical company came to your campus and touted its drug, should it also expect to be accepted just as uncritically?

  4. Consider the naturopath’s need to manage his reputation online, which is an issue for physicians as well. Potential patients may be scared off by your post.

    Let’s damn well hope so. Medical schools promoting woo might consider not only that it flies in the face of science and reason, which ought to be what students are being taught, but that it flies in the face of medical ethics. Those ethics, moreover, REQUIRE that physicians expose pseudomedicine when they see it. Thus it is not Tim who should be called onto the carpet, but the “CAM” group.

    See:

    http://www.sciencebasedmedicine.org/?p=169

  5. DrBadger says:

    Thanks for your post. A similar thing happened to a med student that I know (an attending said something inappropriate, she posted it online, the administration got upset at her and got lawyers in an attempt to punish her for libel… but it was all an attempt to bully her into apologizing and saying that she didn’t mean it). She stood her ground and the lawyers eventually said that free speech protects her. I’m very upset at hearing medical schools threatening their students for standing up to inappropriate or irresponsible things that faculty members say or do.

  6. durvit says:

    Receiving your first legal letter is a rite of passage (particularly in the UK with a libel-friendly laws).

    I am startled at the reaction of your Campus colleagues. I understand that they probably feel that they won’t be able to get speakers but such speakers should be able to accept robust, well-founded criticism.

  7. David Gorski says:

    As managing editor of SBM, let me just reiterate that at no time did Dr. Peter Bongiorno or any of the CAM group students ever contact me or Steve Novella, who is the founder and executive editor, to complain or to inform us of any specific parts of Tim’s post that were in error or defamatory. The reason, I suspect, is because there is nothing in Tim’s post (at least, nothing that I can see as a nonlawyer) that is erroneous or defamatory. Indeed, from my perspective Tim’s post is more mild than what I would have written–or, I daresay, what most other members of SBM who are established physicians would have written.

    I can only speculate based on the behavior of the students who apparently served as Dr. Bongiorno’s messengers that he complained only to the campus CAM group and, as Tim speculated, either leaned on them to try to get Tim to remove his post or at least remove his name from the post. Either that, or the CAM students took it upon themselves to do so out of fear that they would have difficulty getting speakers in the future if Tim were likely to show up at their talks and–gasp!–actually record what they are saying and report on it in this blog in skeptical terms. Failing to intimidate Tim with vague threats and insinuations, they bumped it up to complaining to the office responsible for enforcing the rules of student conduct. Personally, I’d consider it a major victory for science-based medicine at Tim’s school (to which, as Tim knows, I have a special affinity) if the mere possibility that Tim might show up to take notes and blog about CAM talks given by various “alternative” practitioners strikes such fear in their hearts that they will no longer give talks there. If Tim has struck such fear in the heart of the leaders of the student CAM group at his school just from his two previous posts, he should be very proud indeed. Certainly we at SBM are proud of him, and we believe that the students who served as Dr. Bongiorno’s messengers should be ashamed of themselves. Their behavior was unprofessional and craven.

    Once again, we at SBM are dedicated to science and, as a consequence of that, to accuracy in whatever we post here. If anything Tim has written (or, for that matter, that I have written) is inaccurate or defamatory, the door has always been open to Dr. Bongiorno to write a rebuttal for posting here at SBM. The door still remains open for him to do so now or in the future. He may publish it in the comments of this post or the original post that Tim wrote. Alternatively, he may e-mail it to me and/or Steve to be posted. If he makes a compelling case, because we are interested in accuracy we will certainly consider asking Tim to change the parts of his post that are in error or defamatory. However, we will not in any case that I can foresee ask him to remove Dr. Bongiorno’s name from the post. That Dr. Bongiorno has never directly contacted Tim, Steve, or me but instead apparently has chosen to communicate through surrogates who were willing to carry his water for him speaks volumes, in my opinion. Come to think of it, the campus CAM group students are also welcome to comment here if they so desire.

    If Dr. Bongiorno chooses to try to rebut Tim’s posts, he should be aware that we as editors of SBM are interested in specific examples of errors or defamation in Tim’s original post and clear explanations of why they are in error or defamatory. Vague complaints on the order of “Tim just doesn’t understand naturopathy,” “Tim didn’t represent what I said accurately” without specific examples of inaccuracies, or complaints that his tone was negative (what I refer to as the “Tim was mean to me” gambit) will be taken as seriously as they deserve.

  8. TsuDhoNimh says:

    The vague “bad things will happen if you don’t delete the post” and “we’re going to bring in a higher authority and then you’ll be sorry” is a classic way of dealing with critics.

    Think of Uncle Guido saying, “Nice little medical career you’ve got, kid”, or a bratty sibling’s “I’m gonna tell Dad what you did.”.

    If you stick to making a factual criticism of the science or lack of science in the treatments being presented it’s neither slander nor libel. It’s REPORTING!

    Clearly label opinion as your opinion, facts as facts, and stay away from the personality of the presenter.

  9. Consider the naturopath’s need to manage his reputation online, which is an issue for physicians as well. Potential patients may be scared off by your post.

    You did a good job then by helping him manage that online reputation to the exact level that it deserves. Thanks!

  10. Versus says:

    As an attorney, I am appalled that medical students would tell you to remove your post, even temporarily, until the university administration had a chance to look at it. Are they attending medical school after getting J.D.s? I can well imagine that it took the university’s attorney about 2 seconds decide your post was not defamatory. He/she was likely irritated that they were wasting his/her time.

    If your university has a law school, you might consider using it as a resource. Often they have free clinics for students with legal issues. They most certainly have one or more professors who teach constitutional law, upon which defamation law is based.

    Keep up the good work!

  11. Well done for sticking to your guns, Tim.

  12. qetzal says:

    Mr. Kreider,

    I could not find a single thing in your earlier post that warranted censure of any sort, and I think you’ve conducted yourself most admirably in this situation.

    To members of the CAM group at Mr. Kreider’s campus:

    On the off chance that you read this, you should be ashamed of your conduct in this matter. Pressuring Mr. Kreider to remove his post was unprofessional, unethical, and wrong.

    Please re-read the post. Yes, he’s openly critical of Bongiorno, but based on his description of the talk, Bongiorno deserved that criticism. You should be embarassed that Bongiorno gave such a fatuous and unsupported talk, and even more embarassed that you (apparently) invited him back to give the same talk for a second year!

    Of course, if you disagree with Mr. Kreider’s descriptions of the talk, you are more than free to express that disagreement here, and explain why you think Mr. Kreider is wrong. That is the appropriate way to address contrary opinions in the medical and scientific fields.

    It’s noteworthy that for all Mr. Kreider’s criticisms, he never says that Bongiorno should not be allowed to speak. Rather, it is you who wish to censor Mr. Kreider.

    I hope this incident gives you some cause to reconsider your actions.

  13. daniel says:

    You are being bullied, and not very effectively. “No, seriously, we talked with an administrator, you better do what we say!”

    If a campus administrator really think you’ve done something wrong, he’ll talk directly to you.

    Call their bluff. Ask them who they talked to about your behavior, so that you can talk to that administrator, too.

  14. David Gorski says:

    Actually, Tim did just that:

    I didn’t mention it earlier, but I acted proactively by visiting the administrator myself before the other students did, which enabled me to present my framing first (free speech, scientific standards) and gauge how he might react to their complaints.

    The best defense is a good offense; call their bluff and, by doing so, don’t let the CAMsters frame their complaint first.

  15. daniel says:

    ah, thanks.

  16. YAY, Tim!!! This is a shining example of the right way to confront CAM on campus– address their arguments, explain why they are wrong, and never cave to inappropriate pressure to self-censor!

    Glad you’re on the SBM team, and thanks to David and Steve for supporting him.

  17. Scott says:

    It really says something about somebody when they respond to a perfectly civil, rational criticism with threats. Usually, in my experience, it means that they don’t have any evidence with which to formulate a civil, rational response.

  18. Canucklehead says:

    Good work Tim, don’t let them get to you and keep posting!

  19. Harry says:

    I’m a first year and at my Osteopathic school the kool-aid runs heavy and thick here. Thanks for reminding me to be careful. After all, those who do not have facts behind them have to resort to emotional attacks, peer pressure and vague/veiled threats including but not limited to law suits and silly demands.

  20. Karl Withakay says:

    It’s amazing how effective threats of action, regardless of how hollow they are, tend to be in suppressing free speech.

    Youtube, for instance, has a very knee jerk response to any DMCA claims made, regardless of their merit. Youtube’s typical response tends to be pulling the videos and freezing the poster’s account until they can disprove the infringement claim.

  21. daniel says:

    (Given that a person filing a DMCA claim is testifying under threat of perjury that it is indeed a violation, it’s best for everyone if YouTube just complies. The censored party can pursue charges as they wish if the claim was fraudulent.)

  22. David Gorski says:

    Exactly–unfortunately. It’s the law that’s a bad, bad law; it leaves companies like Google little choice but to comply first, verify later.

  23. daijiyobu says:

    Good work Tim.

    I just finished teaching a week of medical ethics, and here is one of my favorite consensus quotes regarding the epistemology of medicine

    (see http://www.annals.org/cgi/content/full/136/3/243 ):

    “physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.”

    Of course, you’re here dealing with CAM and the naturopaTHICK: they don’t care much about delineation, reason, logic, ethics, the integrity of knowledge.

    Science, to them, is just a letterhead, and they feel that they can fill the paper up with whatever they wish and magically the letterhead makes the contents of the page science.

    Where else can you find the hugely science-ejected (see http://www.bridgeport.edu/ub/nm/Six_Prithree.htm ) labeled science (see http://www.bridgeport.edu/ub/nm/Today's_Nat.htm )?

    And per:

    “in the event of an actual lawsuit, the SBM docs know organizations that help students or bloggers threatened with speech suppression.”

    A large issue of civil liberties will have parties beating down your door willing to participate.

    And, if needed, I’d gladly provide primary source material regarding naturopaTHICK absurdity particularly.

    -r.c.

  24. tmac57 says:

    Way to go Tim! What a pathetic attempt at bullying. Can you imagine how little science would have ever advanced if every time an idea was challenged someone would go running to an authority figure and claim “no fair, so and so is criticizing me!!! Make him stop!!!”.
    Dr Gorski- nice to see the word ‘craven’ being used.I like it!
    Keep up the good work.

  25. Dr Benway says:

    Another unforseen consequence of academic “integrative” medicine: religious warfare.

    It’s painful enough when the fight is with a naturopath. Imagine how you’d feel if you were up against a board-certified MD touting nonsense.

    When our standard of care rests upon science, we can resolve our differences with science.

    But when we fuzz up the standard, when personal clinical experience or philosophy are granted greater merit than are due, we’ll get stuck. Then we’ll need some other social authority (e.g., school administrators or civil courts), to mediate between us.

    “Professionalism” only counts when your science-fu is sound. Or, for accountants, when your arithmetic-fu is sound.

    Tim, I’m sad that your classmates are mere science-fu white belts. They are young and may yet learn the true path of peace:

    Corroboration
    Falsification
    Logic
    Parsimony
    Onus

  26. overshoot says:

    Ask them who they talked to about your behavior, so that you can talk to that administrator, too.

    No, no, no!

    Call the bluff by immediately offering to make a joint appointment with that administrator. Don’t take “no” for an answer. Insist that if you’ve done anything wrong, you want to take your medicine [1] immediately and get it over with.

    [1] Sorry — couldn’t think of a better phrase

  27. marilynmann says:

    This is ridiculous. In science, having a debate is what it’s all about. Those med students have a lot to learn, both about their profession and about life.

  28. daedalus2u says:

    This may be the solution to the problem of CAM on campus. It won’t take very many science based students to show that the CAM promoters have no clothes.

    CAM promoters can’t take the scrutiny that EBM or SBM demands.

  29. MBoaz says:

    Dr. Kreider wins. If this CAM group is so averse to reason, I’m sure they can get accepted to Bastyr where it will never bother them again.

  30. Dr Benway says:

    I’m guessing the hinted civil liability is tortious interference.

    So long as Tim and SBM are CLEARLY motivated by a wish to promote good science AND NOT by any specific wish to damage another’s reputation or capacity to earn a living, there should be no problem.

    It may seem a subtle distinction, for the promotion of science will harm the careers of anti-science practitioners. However, that’s a mere side effect, not a primary objective.

    The remedy for bad science is freely available to any and all: stop doing it and start doing good science instead.

  31. JoshS says:

    Tim, that was just great. Keep up the good work, and keep on the pressure.

    A favor, please – break your writing into paragraphs. One large wall of text is very, very hard to read.

    Thanks!

  32. Tim Kreider says:

    JoshS, sorry about that! WordPress hiccup; fixed now.

  33. Dacks says:

    Keep fighting the good fight! You were right, you knew you were right and you called their bluff. It’s good to hear that you have been alerting faculty members, etc. about the goings on – threats like this one often fade in the “sunshine” of exposure.

  34. Aaron S. says:

    Agh, looks like CAMers using Scientology Tactics…

  35. Dr Benway says:

    After consulting with my attorney, I decided to comment upon this issue myself.

    Peter Bongiorno ND is a douche bag.

  36. Andrew86 says:

    JoshS,
    On my browser it is in paragraphs already (unless Tim only just changed it) and very easy to read. ?

  37. Joe says:

    Tim,

    Someone above suggested making the sCAMmers aware of Dr. Barrett’s article at http://www.quackwatch.org I would also point them to http://www.naturowatch.org and in particular (because of its focus and brevity) Dr. Relman’s review of the ND Textbook. Then ask them why they think a naturopath was appropriately presented as a health professional.

    The sCAMmers response will be instructive. If they are amateurs- they will argue that everyone has the right to be heard and let the attendees decide. (Although, if you decide in the negative you should, apparently, keep that to yourself.) If they are pros- they will tell you that Dr.s Atwood, Barrett and Relman are really, really mean people, and not to be trusted. In that case, you can ask them to choose an article and show how it is significantly incorrect.

  38. sanjiva86 says:

    If naturopaths cannot accept non-libellous criticism in the Web 2.0 age, then they are as outmoded as their treatment practices.

    With respect to your original article, the only thing that could remotely qualify as defamatory (IMO, of course) is when you link to his website while describing it as “woo”. Other than that, the rest of it is just a report of what he said and not an extensive commentary. If your university decides to discipline you for simply expressing a few opinions about the scientific validity (or lack thereof) of Bongiorno’s claims, then that would truly be an assualt on free speech and the integrity of open inquiry.

  39. Joe says:

    Joe on 10 Apr 2009 at 12:18 pm “In that case, you can ask them to choose an article and show how it is significantly incorrect.”

    Perhaps you should warn them that many chiros have accepted that challenge, and never been heard-from again. There may be a death-ray involved. Perhaps, a reiki type of thing.

  40. yeahsurewhatever says:

    “Third, when you are in the right, hold true to your principles! Apparently sometimes complaints will be nothing more than groundless bullying.”

    Where “sometimes” means “virtually always”. If they had a clear basis to censor you, they wouldn’t have approached you first. They’re not “nice guys” trying to “do the right thing”.

    If it wasn’t an attorney who told you to desist, you’re being lied to. If it was an attorney who told you to desist, you’re probably still being lied to, but will inconveniently have to appear in court and demonstrate (rather easily) a frivolous, vexatious, SLAPP-oriented lawsuit.

  41. Tim, I congratulate you on your successful foiling of the baseless threats lobbed against you. It is common for people like that to attack you personally, and even try to get other people who have power over you to get you to comply. But it was all a lot of hot air, as it always is. I hope this encourages you to redouble your efforts and make sure that your school doesn’t invite any more CAM proponents! If they were all collectively too afraid to be critiqued that they would stay home the day would be won!

    Your story was also heartening to me as I’m in a similar situation, blogging about genetic engineering while being a plant breeding grad student. No one has come after me about any of my posts, but it is only a matter of time! If anyone is interested, the blog is http://www.biofortified.org

  42. Joe says:

    There is a report featured at this blog http://anaximperator.wordpress.com/2009/04/09/cam-courses-universitie669/ that students in the UK are abandoning sCAM courses and the courses are closing.

  43. storkdok says:

    Well done, Tim!

  44. Mojo says:

    I was surprised, therefore, to be told by leaders of a campus CAM group that my most recent SBM post was full of personal attacks.

    Having re-read the post, I think they were using the definition of “personal attack” that often seems to be used by proponents of CAM. They appear to have trouble distinguishing between criticism of a person and criticism of his arguments.

  45. beatis says:

    @ Mojo,

    There is no such thing as criticism in CAM-thinking; when you don’t agree with them, that’s always a personal attack.

  46. Lemonade Lily says:

    Tim: Well done indeed. I am very wary of stating my opinions openly in my own name online. Good for you.

    Beatis: 100% agree that any critique in CAM is seen as aggressive, viscious and personal. I can speak from personal experience. I am studying at a CAM university. I am called aggressive and narrow-minded. It is like being in a seminary or church. There is very little understanding of scientific debate (well – we never have debates about anything so not really surprising – what we are told we are meant to believe and not question). There is a culture of fear. It is the worst place I have ever studied.

  47. Mojo says:

    @ beatis,

    Precisely what I was trying to say – you put it more elegantly.

  48. beatis says:

    That’s very kind of you Mojo, thank you!

  49. beatis says:

    @ Lemonade Lily,

    I feel for you! It would make me feel very out of place and very lonely, having to be around those people every day.

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