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Consumer Reports and Alternative Therapies

Consumer Reports (CR) and its Health Newsletter provide sound advice about nutrition and medicine, with one exception: their recommendations concerning alternative therapies, especially dietary supplements. With regard to dietary supplements, part of the problem is the failure of CR to make a distinction between authentic dietary supplements, such as multivitamins and minerals, and non-vitamin, non-mineral medicinal products. For example, the September 2010 issue of CR contains a table listing “Eleven supplements to consider”. The list includes calcium and vitamin D supplements, and St. John’s wort and Pygeum herbals.

The nomenclatural confusion was created by the Dietary Supplement Health and Education Act of 1994 (DSHEA), which was termed “The Snake Oil Protection Act” by the New York Times. DSHEA, which was passed after a massive lobbying campaign by industry, arbitrarily designated herbals and other traditional medicinal products as dietary supplements. Herbals are used worldwide as medicines and in Europe some are available by prescription only.

The purpose of the Act was to prevent the Food and Drug Administration (FDA) from effectively regulating those products, and it succeeded brilliantly. Sales of dietary supplements rose from $4 billion annually in 1994 to $28 billion in 2007, and reports of severe adverse events caused by those products rose in parallel (1). Another consequence of DSHEA is that designating herbals as dietary supplements misleads consumers about their medicinal nature and conceals their potential for causing severe adverse effects.

The selling points for herbals are that as “natural” products they are safer and gentler than the powerful “foreign” chemicals in purified medications, and they possess unique qualities not found in conventional medications. Dr. Varro Tyler, an expert in the medicinal use of plants, termed those unfounded claims “paraherbalism”, and described herbals as “crude drugs of vegetable origin” (2). In reality, the active ingredients of plants are chemicals that are similar or identical to conventional medications, and many of the latter were first identified in plant extracts. It is no more “natural” to swallow dozens of chemicals in a plant extract than to ingest a single purified chemical – a drug is a drug. Before discussing CR’s advice about supplements, it is necessary to consider briefly basic differences between herbals and conventional medications.

The first issue is: what’s in the bottle? Safe and effective use of medications requires consistency in composition and biological activity. Prescription and over-the counter medications approved by the FDA are purified compounds whose activity is known. By contrast, the biological activities of herbals can’t be standardized because for the most part their active ingredient(s) have not been identified. Some herbals are standardized based on marker compounds, such as ginsenosides in ginseng. However, Consumer Reports (November 1995) found a 10-fold variation in the ginsenoside content of ginseng products, and aptly termed the variability “herbal roulette”. Moreover, many “all-natural” herbal remedies, especially those sold for sexual dysfunction or weight loss, are adulterated with undeclared prescription drugs. In a letter to supplement manufacturers, FDA commissioner Dr. Margaret Hamburg noted that in recent years the FDA has issued consumer warnings about nearly 300 products (3). She stated that “These tainted products can cause serious adverse events, including strokes, organ failure and death.”

A second concern is: what is the evidence that herbals are effective? Belief in the efficacy of herbals is based partly on their traditional use and partly on clinical trials funded by manufacturers. Reviews of those trials have pointed out their poor quality and very strong positive bias (4,5). Recent independently-funded trials of popular herbals, including echinacea, black cohosh, saw palmetto and ginkgo biloba, have been uniformly negative.

A third issue is the safety of herbals. Unlike clinical trials of purified medications, herbal trials have not included laboratory tests to detect damage to the liver and kidney, and until recently manufacturers were not required to report adverse effects to the FDA. Despite the lack of an effective reporting system, there are numerous reports of severe adverse effects caused by herbals, and the FDA recently estimated their annual frequency at 50,000 (6). Herbals may also cause adverse effects because of their interaction with conventional medications. St John’s wort decreases the levels of many common medications because it increases the activity of enzymes that inactivate them. The elderly are at particular risk because of chronic illnesses and their frequent use of prescription medications.

In summary, in the absence of sound evidence about the efficacy of herbals beyond a placebo effect, uncertainty about their activity and purity, and growing information about their adverse effects, their use should be discouraged.

There is a striking difference between CR’s critical, evidence-based evaluation of conventional medical treatments and health beliefs, and its soft standards concerning alternative therapies. An example of the former is a critique of conventional “health truths” in the January 2012 issue, in which the limitations of routine screening for prostate cancer were noted, as well as the lack of evidence for the health benefits and possible hazards of multivitamins.

In contrast, recommendations for considering the use of herbals and non-vitamin, non-mineral supplements are hedged by noting that “there is some evidence supporting their use” or that “small trials suggest benefit”. Some recent recommendations include black cohosh and soy for relief of menopausal symptoms, saw palmetto for benign prostate enlargement (February 2012), and glucosamine for arthritis. Those recommendations are based on industry-funded trials, whose deficiencies were noted above, and the negative findings of more rigorous independent trials were overlooked. Moreover, potential hazards, such as the association of black cohosh consumption with severe inflammation of the liver are overlooked.

In its recommendations for herbals to consider, CR states repeatedly that a mark of approval from the United States Pharmacopeia (USP) verifies “the quality, purity and potency of its raw ingredients or finished product”. That is the standard terminology USP uses for products that it analyzes and approves, but it is only partially accurate when applied to botanical products. The USP analysis uses chromatographic procedures to verify the source of the botanical extract, and the absence of contamination with microbial products and heavy metals (7). However, since the active ingredients of most botanicals have not been identified, analysis of marker compounds provides no information regarding the pharmacological activity or “potency” of the product. Moreover, the USP does not test for the presence of purified drugs, which are potentially dangerous contaminants.

Consumer Reports also promotes the use of other alternative therapies. The September 2011 issue contains an article entitled “Alternative Therapies. More than 45,000 readers tell us what helped”. In an online survey subscribers were asked to rate how well conventional and alternative therapies worked for 12 common health problems. For osteoarthritis, 46% of responders who used chiropractic felt the treatment helped a lot, as did 25% of those who used glucosamine/chondroitin. For back pain, 65% who used chiropractic and 41% who used acupuncture felt that those therapies helped a lot. An assessment of the evidence supporting those treatments was provided by the Natural Medicine Comprehensive Database (NMCD). The NMCD assessment of evidence, which is based on their review of published clinical trials, doesn’t take into account the poor methodological quality and strong positive bias of most of those trials (4,5). Glucosamine was rated by NMCD as “likely effective” for osteoarthritis, but an analysis of published trials revealed that all industry-supported trials were positive and all independently-funded trials were negative (8). Chiropractic and acupuncture were rated as “possibly effective” for back pain. There is little evidence for a specific effect of chiropractic manipulation, and recent evidence indicates that acupuncture for pain is a placebo treatment (9, 10). The article also contains testimonials to the dramatic benefits provided by chiropractic and acupuncture.

What significance should be attached to the responders’ belief that they received specific benefits from alternative treatments? Many health problems are self-limited, and placebos may be effective for relief of pain. In a clinical trial of glucosamine for osteoarthritis of the knee, 60% of patients who received a placebo pill met the criteria for a positive outcome, and glucosamine was no better than placebo (11). A recent study of patients with asthma provides another illustration of placebo effects (12 ). Patients received treatment with either an inhaler containing a bronchodilator, a placebo inhaler, sham acupuncture or no treatment. Patients in all three treatment groups reported equal subjective improvement compared to no treatment, but only patients who received the bronchodilator exhibited improvement in an objective test of lung function. Another problem with article is that conventional medications, such as “mainstream vitamins and minerals” and stress reduction, were included in the category of alternative therapies. Although the article does note that “our results do not take into account the power of the placebo effect”, the message conveyed by the survey is that some alternative therapies are effective. Moreover, the article provides information to assist readers to locate acupuncturists and chiropractors

The different standard used by CR Health Reports to evaluate conventional and alternative treatments is based, in part, on its choice of consultants. A list of some of the experts consulted, “health authorities and medical researchers”, is included in each issue. Most consultants are highly qualified academics and health professionals. However, in the April 2011 issue, which contains an article on popular nutritional supplements, one of the consultants listed is the editor of NMCD, whose shortcomings were noted above.

Another CR medical adviser is Joseph Mosquera, MD, who is the clinical director of an integrative medical program. The terminology used to describe belief-based medical practices has evolved from “alternative” to “complementary and alternative” to “integrative”. The agenda of integrative programs is to introduce safe and effective alternative therapies into education for health care professionals. I recently reviewed the poor quality of integrative curricula, and pointed out the lack of oversight of integrative programs by health profession schools (13).

The selection of alternative medicine advocates as consultants, rather than independent scientists and physicians, is a decision made by the editorial boards of CR and CR Reports on Health. That is a departure from CRs’ policy of avoiding bias and conflicts of interest, and from its mission to “empower consumers to protect themselves”. Empowering consumers to make informed decicisions about health care requires providing them with the soundest information available. The need for better consumer education was noted in a recent report from the United States Government Accountability Office that documented the prevalence of deceptive marketing practices and illegal health claims made for dietary supplements (14). As a respected source of information for consumers, CR should use the same high standard of evidence for evaluating alternative therapies that it employs for other medical treatments.

 

About the Author

Donald M. Marcus is an Emeritus Professor of Medicine and Immunology at Baylor College of Medicine in Houston. A graduate of Columbia University College of Physicians & Surgeons, he did his medical residency and postdoctoral training in Immunology at Columbia. He is a rheumatologist and formerly directed Rheumatology divisions at Albert Einstein College of Medicine and at Baylor. For the last 12-13 years he has taught medical students and physicians an evidence-based approach to complementary and alternative medicine (CAM), and published papers about CAM, especially dietary supplements.

 

References

 

  1. Bent S. Herbal medicine in the United States: Review of efficacy, safety and regulation. J Gen Intern Med. 2008;23(6): 854-9.
  2. Robbers, J.E. and Tyler, V.E. (1999). Tyler’s Herbs of Choice. – The Therapeutic Use of Phytomedicinals. The Hawthorne Press, Inc. New York.
  3. Hamburg, MA. Letter to manufacturers of dietary supplements. HYPERLINK “http://www.fda.gov” http://www.fda.gov December 15, 2010.
  4. Bausell, RB. Snake Oil Science. The Truth About Complementary and Alternative Medicine. Oxford University Press, New York, 2007.
  5. Singh S., Ernst E. Trick or Treatment? The Undeniable Facts About Alternative Medicine. W.W. Norton & Co., 2008
  6. Dietary Supplements. FDA Should Take Further Actions to Improve Oversight and Consumer Understanding. United States Government Accountability Office. GAO-09-250, January 2009
  7. United States Pharmacopeia, USP Dietary Supplement Compendium 2009-2010, 1st edition.
  8. Vlad VC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis. Why do trial results differ? Arth Rheum 2007; 56:2267-77.
  9. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009;338:a3115 doi:10.1136/bmj.a3115
  10. Marcus, DM. Is acupuncture for pain a placebo treatment? The Rheumatologist 2010; 4: 27-35
  11. Clegg DO, Reda DJ, Harris CL, Klein MA, O’Dell JR, Hooper MM et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006; 354:795-808
  12. Wechsler ME, Kelley JM, Boyd IOE, Dutile S, Marigowda G, Kirsch I et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Eng J Med 2011; 365:119-26.
  13. Marcus DM, McCullough L. How good is the evidence in evidence-based integrative medicine? Acad Med. 2009; 84(9):1229-34.
  14. Herbal Dietary Supplements. Examples of Deceptive or Questionable Marketing Practices and Potentially Dangerous Advice. United States Government Accountability Office. GAO-10-662T, May 2010

Posted in: Herbs & Supplements, Legal, Science and the Media

Leave a Comment (60) ↓

60 thoughts on “Consumer Reports and Alternative Therapies

  1. marilynmann says:

    I subscribe to Consumer Reports and I used to subscribe to Consumer Reports on Health. I support Consumer Reports as an independent voice to represent consumers. However, I have not found the quality of their health coverage to be consistent. On occasion, when I have known something about the topic being discussed, I have found statements in CR or CR on Health that are either incorrect, inconsistent (including inconsistencies within the same article), or so vague as to be meaningless. That makes me distrust articles on topics on which I have no prior information.

    So, I did not renew my subscription to CR on Health. I still subscribe to Consumer Reports but I would never, ever take their health coverage as the last word on anything. Trust but verify. Do your homework and consult other sources and/or get second or third opinions before you make a medical decision.

    It pains me to be so critical of an organization that is generally a force for good.

    On one occasion I actually contacted three of the experts that were listed in an issue of CR on Health. This was in 2008 I believe. The experts did not support some of the content in the article. They weren’t too happy being listed as experts having been consulted for an article parts of which they disagreed with.

    Caveat emptor.

  2. tmac57 says:

    My thoughts on this parallel those of marilynmann above. I have been bringing this up from time to time over the last couple of years on skeptic blogs,so I am glad to finally see that it has gotten some attention.
    I too,recently cancelled my Oh Health subscription even though I generally find CR’s health advice to be better than the mainstream,I just got tired of them taking such a ‘squishy’ approach to CAM.
    I still remain a supporter of Consumer’s Union (since 1976),and their publications for the most part,and I hope that they can fix this issue in the future.

  3. pmoran says:

    The terminology used to describe belief-based medical practices has evolved from “alternative” to “complementary and alternative” to “integrative”.

    Has it? For whom? Am I (again) mistaken in holding that a substantial proportion of what was initially called “alternative” medicine is strongly opposed philosophically and theoretically to conventional medicine. It sees itself as a true “alternative” to it, whereas the proponents of integrative medicine sees it as having a supplementary and supportive role to mainstream care.

    The medical implications are vastly different. (Please don’t bother telling me that they may employ similar methods — the “Quackery Index”, also the risks and potential benefits from CAM lie in the nature of the claim and the clinical context. )

  4. David Gorski says:

    Has it?

    Yes. You obviously haven’t been paying attention. It’s not as though we haven’t been pounding this point home for over four years now.

    For example:

    http://www.sciencebasedmedicine.org/index.php/why-would-medical-schools-associate-with-quackery-or-how-we-did-it/

    http://www.sciencebasedmedicine.org/index.php/integrative-medicine-a-brand-not-a-specialty/

  5. pmoran says:

    Well, David, I suppose some owners of the term could be engaged in an evil conspiracy to promote something that they don’t really believe in. Can you point some out to me, and advise how you know this?

    I personally deplore this paranoid frame of mind within a supposedly scientific forum. Surely we medical scientists understand what is going on, and can approach the questions raised with a little more detachment. We have ourselves had to come to grips with the powerful illusions that dominate many areas of everyday medical practice, and consider the extent to which the human mind can influence illness-related perceptions and well-being. Every time we perform a double-blinded, randomised, controlled trial we are testifying to these areas of uncertainty.

    So I suggest that of course, and at least on the whole, these MDs truly believe they have something to offer — also, notably and especially when the medical going gets tough. For integrative medicine is surely concerned with those areas where scientific medicine (as usually defined) lacks entirely satisfactory approaches, as it must almost by definition when dealing with patients’ spiritual concerns.

    I am not saying the approach is proved. I am saying that the hostility to IM (as I define it) is out of proportion to any certainty concerning patient well-being as a consequence of its activities. This is illustrated by the need to recruit ethical concerns (unjustified in this context) and slippery slope arguments in support of the basic underlying stance that all such medical activity is worthless.

    NB The point of my question was different, anyway. Consider this question – are Dr Mercola and Hulda Clark now to be described as practicing “integrative” medicine?

  6. jt says:

    God forbid someone would recommend that people be educated about alternatives to a system of thought which has produced the world’s sickest populations at the highest costs.

    The rates of obesity, diabetes, heart disease, and cancer continue to rise along with the many thousands of dollars spent on medications and their direct-to-consumer advertisements.

    The paradigm of health care is shifting away from easy acceptance of “side” effects and untested combinations of synthetic drugs towards a better understanding of the Hippocratic oath: “First, do no harm”.

    I implore you to ignore these words and continue on with your life, satisfied in your superiority. Continue to help people realize that the use of alternative medicine “should be discouraged”. You are doing God’s work.

    I wish you the very best. Here’s to hoping you don’t help to push the next Vioxx on a few thousand unsuspecting consumers. And if you do, here’s to hoping you can cover it up better than Merck did and make a couple of million in the process.

  7. Chris says:

    jt, please tell us why we should care about the comment that you spammed on at least three threads?

    This blog is read by those who live on several continents. Could you be specific on which population is “the world’s sickest populations at the highest costs”, please?

    And when you do, please provide verifiable scientific documentation that the health of that country has deteriorated over the last century. Be sure to be clear on the average lifespan. The minimum requirement is the title, journal and dates of PubMed indexed papers to support you statements that the population of the specific nation is worse than it was a century ago.

    And, by the hammer of Thor, when you make statements like “You are doing God’s work”, make sure you specify which “god”. Include actual verifiable evidence the specified spiritual entity exists.

    Thank you.

  8. Jann Bellamy says:

    @pmoran

    “So I suggest that of course, and at least on the whole, these MDs truly believe they have something to offer — also, notably and especially when the medical going gets tough. For integrative medicine is surely concerned with those areas where scientific medicine (as usually defined) lacks entirely satisfactory approaches, as it must almost by definition when dealing with patients’ spiritual concerns.”

    What you seem to be arguing is that if scientific medicine “lacks entirely satisfactory approaches,” then, instead of having an honest discussion with the patient about how and why that is so and engaging the patient in making choices from the available science-based options (that is, treating the patient as the autonomous grown-up he or she is) the physician should offer implausible and unproven treatments? As for “patients’ spiritual concerns,”these can be dealt with without resort to “CAM” or “IM” — that is why we have ministers, rabbis, imams, and the like, who are much more well-suited than MDs in addressing a patient’s spiritual concerns in a manner that comports with the patient’s belief system. And as someone who was raised in a deeply religious Christian tradition (the “Bible Belt”, no less) I can vouch that any claim to what is essentially a supernatural power (such as reiki, therapeutic touch) would be offensive to a Christian patient.

  9. Harriet Hall says:

    When scientific medicine has nothing specific to offer, physicians can say so and offer comfort care. They can also offer untested treatments while clearly identifying them as experimental. Or they can misrepresent the true state of knowledge and influence patients to try something in the belief that it really works. The last option is unethical.

  10. David Gorski says:

    Well, David, I suppose some owners of the term could be engaged in an evil conspiracy to promote something that they don’t really believe in. Can you point some out to me, and advise how you know this?

    I personally deplore this paranoid frame of mind within a supposedly scientific forum.

    Nice straw man, Peter.

    It’s not so much a “conspiracy” as more savvy marketing of unscientific and pseudoscientific treatments than their advocates used in the past. I am impressed, however, with your framing of the skeptical viewpoint and science-based medicine as “paranoid.” Well played, sir! You’ve learned well from the advocates of the CAM you defend these days.

    NB The point of my question was different, anyway. Consider this question – are Dr Mercola and Hulda Clark now to be described as practicing “integrative” medicine?

    Dr. Mercola, maybe. Certainly, he promotes the term enough on his website these days and clearly craves respectability (hence his appearances on Dr. Oz as a “hero of integrative and alternative health care”). That’s what the term “integrative medicine” is all about: Achieving seeming “respectability.”

    Hulda Clark, no, mainly because she’s been dead a couple of years now and isn’t practicing anything.

  11. David Gorski says:

    As for “patients’ spiritual concerns,”these can be dealt with without resort to “CAM” or “IM” — that is why we have ministers, rabbis, imams, and the like, who are much more well-suited than MDs in addressing a patient’s spiritual concerns in a manner that comports with the patient’s belief system. And as someone who was raised in a deeply religious Christian tradition (the “Bible Belt”, no less) I can vouch that any claim to what is essentially a supernatural power (such as reiki, therapeutic touch) would be offensive to a Christian patient.

    That’s why the U.S. Catholic bishops have declared that reiki is not to be practiced in Catholic hospitals in the U.S. There have also been fundamentalist preachers who have attacked reiki. This makes a lot of sense, as these clergy recognize reiki for what it is: faith healing, a competing religious system. Indeed, I’ve frequently made the point that I wouldn’t mind reiki practitioners in hospitals if they were properly identified not as valid health care providers but rather as clergy.

    In any case, I’m with Jann here. There is no need to resort to quackery to attend to a patient’s religious or spiritual needs.

  12. jt says:

    Without resorting to the ad hominem attacks that seem to be customary here, I will direct your attention to a study supporting Chiropractic which you will undoubtedly disparage and ignore:

    http://www.ncbi.nlm.nih.gov/pubmed/22213489?dopt=Abstract
    http://www.annals.org/content/156/1_Part_1/1.full.pdf+html

    I know you will disregard this because this information is dissonant with the cognition “Chiropractic is unnecessary and possibly harmful” which you have accepted and internalized based on negative anecdotes and perhaps an old epidemiological study showing a mild correlation between Chiropractic and a rare form of stroke.

    In addition, it is helpful to you to protect your in-group at all costs to ensure your survival and improve your positive self concept–which is understandable. After all, fundamentally there is a competition taking place here which you are uncomfortable to admit you may be losing. After all, alternative health care is a fast growing phenomenon which is out of your control to subdue (15188733, 9820257).

    Modern medicine has helped a great many people, but it has hurt them as well. There is a certain balance at play here which should be considered. Unfortunately, this balance has tipped in the wrong direction–Iatrogenic deaths outnumber all other deaths in this country:

    http://orthomolecular.org/library/jom/2005/pdf/2005-v20n01-p021.pdf

    Condition Deaths Cost Author

    Hospital ADR 106,000 $12 billion Lazarou,1 Suh 31
    Medical error 98,000 $2 billion IOM 6
    Bedsores 115,000 $55 billion Xakellis,7 Barczak 8
    Infection 88,000 $5 billion Weinstein,9 MMWR 10
    Malnutrition 108,800 ———— Nurses Coalition 11
    Outpatient ADR 199,000 $77 billion Starfield,12 Weingart 70
    Unnecessary Procedures 37,136 $122 billion HCUP3,13
    Surgery-Related 32,000 $9 billion AHRQ 71

    TOTAL 783,936 $282 billion

    You have no legal power to continue your conspiratorial boycott of the Chiropractic profession since federal District Court Justice Susan Getzendanner ordered that you stop in 1987 with this permanent injuction order:

    http://jama.ama-assn.org/content/259/1/81.extract

    She asserted, “The final question is whether this concern for scientific method in patient care could have been adequately satisfied in a manner less restrictive of competition. It would be a difficult task to persuade a court that a boycott and conspiracy designed to contain and eliminate a profession that was licensed in all fifty states at the time the Committee on Quackery disbanded was the only way to satisfy the AMA’s concern for the use of scientific method in patient care.” ( http://www.chiro.org/abstracts/amavschiro.pdf )

    Ouch. So, where do you go from there? It seems you have moved to the internet to preach to the congregation; extolling the virtues of the scientific method as a way to cover up your deep seated hatred of the competition.

    That’s a shame, because what is in the patients’ best interest is multidisciplinary patient-centered care. All health care providers should be working together with open minds to achieve the best outcomes for patients. Look in the mirror and ask yourself if you are putting the patient first.

  13. pmoran says:

    Jann, and David, substitute “existential concerns” for “spiritual concerns” and you may have a better idea of what is going on in my mind. There is a well-documented drift away from the major religions, yet people still seek other ways of understanding their status/role/meaning in an often hostile and uncaring universe.

    Life is such a vivid personal experience. It seems incredible that it should not have cosmic significance <i< of some kind, yet science finds not even trace evidence that it does. I can accept that, but it took me a very, very long time to shake off all traces of my own extreme fundamentalist Christian upbringing. That experience, and the near-universal indulgence of mankind in religious and quasi-religious activities compels me to see them as an instinctive, highly ingrained aspect of human behaviour, as is the compulsive seeking of aid and similar existential comforts when faced with disabling and mortal illnesses.

    Harriet, I agree we doctors can help . We can provide some sense of personal worth with our empathy, our individual attentions, and though our culture of the indiscriminate saving of life wherever humanly possible. Nevertheless, at a certain point we stop being physicians for which the needs of the individual are our whole raison d’etre no matter what, and certain scientific considerations take over.

    Mostly that can be justified. I have myself given several reasons why this should be so. What is not justified is bad manners and unfairness, and misrepresentation of the motives of sincere colleagues who think they have something extra to offer, and probably do in some ways.

    We scientists understand d

    http://naturalhealthcenter.mercola.com/

  14. pmoran says:

    David Dr. Mercola, maybe. Certainly, he promotes the term enough on his website these days and clearly craves respectability (hence his appearances on Dr. Oz as a “hero of integrative and alternative health care”). That’s what the term “integrative medicine” is all about: Achieving seeming “respectability.”

    Hulda Clark, no, mainly because she’s been dead a couple of years now and isn’t practicing anything.

    Perhaps listeners will find this glib dismissal satisfying but there is something wrong with you all if you actually believe that “integrative” medicine is a mere marketing ploy, but then meekly intend to go along with this devious misapplication of the English language.

    We have adopted “CAM” because of common usage and so that everyone understands what we are talking about. I cannot see a case for using “integrative” for anyone other than practitioners who practice in a subordinate role to mainstream care. The public should also be made very aware of this crucial distinction.

    I can find no use of the term in the early pages of Mercola’s site and there is a video there that within the first minute shows how far Mercola is far from being “integrative”. (See under “our clinic”.)

    http://naturalhealthcenter.mercola.com/

  15. deltajordan says:

    Hi Pmoran. I want alternative therapies like accupressure, accupuncture, chiro and Gerson legal and part of our future Single Payer healthcare system.
    I would like subsidies for organic produce farmers and no more subsidies for Too Big to Fail Banks.
    I would like the FDA to take MSG and aspartame and put them in little bottles on a shelf at a pharmacy that people are welcome to buy and put on their personal food–but disallowed to be put into commercially prepared foods.
    I have a dear friend who owns a restaurant who claims that the oil she uses there is “deadly”. I would like the FDA to find out what oils at how much heat and reused how often improve the nation’s health. Then I would like the FDA to tout these oils and their usage.
    Until doctors are protesting outside of Publix about the deleterious foods sold there, I don’t believe much that they say on the subject of chronic disease.
    The foods I prepare for my family affect their health and mood every day.
    A doctor saying that drinking kale juice could not possibly help against cancer makes the doctor look foolish.
    I think we can drop fewer bombs and use the money to study the effect of organic kale juice on disease.
    As for me, I started juicing veggies before healthy meals and my health is better.

  16. pmoran says:

    David: <iI personally deplore this paranoid frame of mind within a supposedly scientific forum.

    Nice straw man, Peter.
    It’s not so much a “conspiracy” as more savvy marketing of unscientific and pseudoscientific treatments than their advocates used in the past. I am impressed, however, with your framing of the skeptical viewpoint and science-based medicine as “paranoid.” Well played, sir! You’ve learned well from the advocates of the CAM you defend these days.
    .

    David, I still think it is paranoid to see only sinister intent in practitioners who truly believe that they are helping people. It is certainly an ad hominem attempt to discredit them, as is the above in relation to myself.

    While you criticise others for their straw men and other logical errors, you quite commonly try to support your stances with ad hominems against me and others. You don’t seem to know you are doing it.

    You are by no means alone in this. The present views of Andrew Weil and Ted Kaptchuk can be dismissed on these pages (it is implied) because of things they may have said decades ago. Why bring that up if the disputed matters can be adequately resolved by referring to present evidence? If they can’t be entirely resolved by the available evidence we should be honest enough to admit that and moderate our opinions accordingly.
    —–

    But I mainly wanted now to post an objection to being classed as a “defender of CAM”.

    I see myself as drawing attention to and seeking a personally satisfying resolution to the tensions that can exist between the patient needs that we are supposed to wholeheartedly serve and the strictly mechanistic physicochemical model of medicine that correctly applies to many of the most important medical questions. It roughly corresponds to what we used to refer to as “the art versus science” of medicine, and it is only modern scientific studies concerning placebo-related responses, not any sympathy for pseudoscience that has caused me to rethink the subject.

    I apologize for allowing myself to get diverted from the terminological matter I initially tried to bring up.

  17. Harriet Hall says:

    @pmoran,

    “I still think it is paranoid to see only sinister intent in practitioners who truly believe that they are helping people.”

    What blog are you reading? I don’t see SBM as seeing only sinister intent, but as pointing out when well-meaning but misguided people believe things without adequate evidence. Some are well-meaning, some are intentional frauds, and we try to make a distinction whenever possible rather than making knee-jerk accusations.

    The “art of medicine” is the art of applying imperfect scientific knowledge to the needs of an individual patient in a caring way. It does not require the use of placebos or of questionable, unproven remedies nor does it mandate acceptance of CAM.

  18. pmoran says:

    Deltajordan, I can’t support your wants because these are optional (when not also unproven) add-ons to more essential areas of medical care. Someone else will want their Reiki covered, or a Hulda Clark cancer clinic for their city. It can’t be done.

    If you want these less well-established areas of medical care you will have to either pay for them yourself, or through higher insurance premiums with insurers who choose to subsidise them.

    I am sorry to tell you that no alternative cancer treatment has shown that it can cure cancer. That includes Gerson. I have studied that clinic closely, including some personal exchanges with the current principals that gave me a clear idea of their reliability.

  19. lilady says:

    @ Delta Jordan:

    “I want alternative therapies like accupressure, accupuncture, chiro and Gerson legal and part of our future Single Payer healthcare system.”

    Yeah, and I want my massages, lotions and manicures “legal and part of our future Single Payer health care system”, as well. Have you got any citations about cancer cures using the Gerson Protocol?

    I would like subsidies for organic produce farmers and no more subsidies for Too Big to Fail Banks.

    Any citations about the nutritional value of organic produce versus non-organic produce? And, get a clue about the bank bailouts; try looking into Wall Street regulations such as the Sarbane-Oxley Act and the NINJA (No income, no job, no assets) mortgages that were handed out during the Bush II administration.

    http://searchcio.techtarget.com/definition/Sarbanes-Oxley-Act

    “I would like the FDA to take MSG and aspartame and put them in little bottles on a shelf at a pharmacy that people are welcome to buy and put on their personal food–but disallowed to be put into commercially prepared foods.”

    Do I detect some restraint of trade here? How about some citations about the deleterious effects of MSG and Aspartame?

    “I have a dear friend who owns a restaurant who claims that the oil she uses there is “deadly”. I would like the FDA to find out what oils at how much heat and reused how often improve the nation’s health. Then I would like the FDA to tout these oils and their usage.”

    Tell your “friend” who owns a restaurant to stop re-using cooking oil and check the “smoke point” of cooking oils in any cookbook or on the Wikipedia website:

    http://en.wikipedia.org/wiki/Smoke_point

    “Until doctors are protesting outside of Publix about the deleterious foods sold there, I don’t believe much that they say on the subject of chronic disease.”

    Why should they be protesting outside of Publix…they *know* there is no nutritional difference between organic-grown and non-organic grown produce. If that is the manner in which you judge a physician’s competence to treat chronic and acute-onset diseases, then you are a fool.

    “The foods I prepare for my family affect their health and mood every day.”

    Well I cook from scratch and I don’t need a juicer to provide a balanced, nutritious and tasty meal.

    “A doctor saying that drinking kale juice could not possibly help against cancer makes the doctor look foolish.”

    Any citations? We really want to know about the anti-cancer properties of kale juice.

    “I think we can drop fewer bombs and use the money to study the effect of organic kale juice on disease.”

    Citations?

    “As for me, I started juicing veggies before healthy meals and my health is better.”

    I guess you have a fiber-less diet, then. Do you toss the fiber into a compost pile…or in the garbage?

  20. David Gorski says:

    It is certainly an ad hominem attempt to discredit them, as is the above in relation to myself.

    You really don’t know the difference between criticizing something you say (i.e., your framing of our criticisms of CAM as being “paranoid” and pointing out quite correctly that they borrow a page from CAM advocates themselves) and attacking you as a person. I refer to you as a CAM apologist because that’s what your words, including in this very thread, strongly suggest that you are. I’m not saying, “Don’t listen to your arguments because you are a CAM apologist.” That would be an ad hominem. Rather, I’ve saying that you are blatantly framing skeptical arguments as “paranoid” and using as a basis for your characterization a straw man that we are claiming nefarious motives for CAM believers (and it is a straw man, Peter). I then pointed out that such framing is a favorite tactic of CAM apologists, which is true.

    There’s a difference.

  21. David Gorski says:

    What blog are you reading? I don’t see SBM as seeing only sinister intent, but as pointing out when well-meaning but misguided people believe things without adequate evidence. Some are well-meaning, some are intentional frauds, and we try to make a distinction whenever possible rather than making knee-jerk accusations.

    Thank you, Harriet. I’m getting very tired of Peter’s straw man that we are somehow arguing that CAM believers are acting out of nefarious motives.

  22. pmoran says:

    David:You really don’t know the difference between criticizing something you say (i.e., your framing of our criticisms of CAM as being “paranoid” and pointing out quite correctly that they borrow a page from CAM advocates themselves) and attacking you as a person. I refer to you as a CAM apologist because that’s what your words, including in this very thread, strongly suggest that you are. I’m not saying, “Don’t listen to your arguments because you are a CAM apologist.” That would be an ad hominem. Rather, I’ve saying that you are blatantly framing skeptical arguments as “paranoid” and using as a basis for your characterization a straw man that we are claiming nefarious motives for CAM believers (and it is a straw man, Peter). I then pointed out that such framing is a favorite tactic of CAM apologists, which is true.

    Oh, go on! I don’t believe that your referral to me as a “CAM apologist” was not intended to undermine me in the eyes of readers. There was no need to characterize me in any way at all, in order to address what I said. You could have simply pointed me to somewhere demonstrating your broader understanding of the CAM phenomenon.

    Nevertheless, I will withdraw the paranoid term, since it is a little contentious and leading to scarcely cogent debate. I will merely say that CAM practitioners are virtually always portrayed as having sneaky agendae on these pages. I only speak up because this is a recurrent theme here, whether fully intended or not.

    Harriet is about the only one who doesn’t engage in this somewhat unbalanced portrayal of CAM, so that she is quite correct when she says that ” I don’t see SBM as seeing only sinister intent, —”.

    Read what Wally Sampson said in the piece that you referred me to and see if you can find any hint that that a major cause of what he is deploring is simply well-meaning people being misled by known factors, and others not wanting to overlook anything that might help some of their more difficult medical problems even if it is from a combination of non-specific influences.

    And what does this statement in you own piece convey, ” As I said, first and foremost, IM is all about the marketing.” ?

    I know that SBM does seem to be largely targeting a scientific audience, but others are obviously reading it.

  23. nybgrus says:

    I don’t know how much more clear it can be made pmoran –

    there is a contingent of CAM apologists with nefarious motivations. They are small indeed, but they exist.

    But the crux is that the larger motivating force is that of ideology. These people like their ideas and feel that “evil reductionists” have it all wrong… or at least don’t have the full story. The personal experience and ideology of the apologist and active proponent determines what woo-du-jour they attempt to pass as useful and necessary to teach and implement.

    Since, as you rightly point out, the majority of the public and of course the vast majority of the scientifically literate want evidence in order to justify the teaching and use of medical treatments, they then find ways to inject “evidence” into the rhetoric. Hence the continued demonstration that the danger is pseudoscience – i.e. BS that superficially resembles science and evidence.

    As Dr. Hall points out, it then becomes the well meaning but otherwise poorly informed (want to guess how many of my colleagues can accurately dissect a study?) that then promulgate the pseudoscientific garbage. The rationale becomes intrinsic to the initial acceptance, and logical fallacy becomes accepted as reasonable.

    That has been demonstrated more than adequately in the pages here. It has also been demonstrated in vivo in my own educational experiences, which I have outlined many times before.

    Your continued denial of this well documented progression of quackery to AM to CAM to IM, along with the multiple motivations and tactics employed to engender false legitimacy does not chaneg the facts. Also, you see us proclaiming sinister motivations. They certainly exist, but are vastly the minority. I see myself and the authorship here speaking of insidious motivations. Small steps taking us further and further away from rational science based discourse, and gradually becoming more accepting of fallacious and tortuous arguments in favor of quakery.

    If Dr. Gorski and the other editors here would like, I can create a blog post of the highlights of a long email exchange between myself, an underclassman in my program, and the director of Memorial Sloan Kettering Cancer Center’s Integrative Medicine department (led by a PhD in anthropology, not a medical doctor) to illustrate these points.

    You have many other points to address, but I won’t waste my time or yours rehashing them. However, I will point out one interesting illustrative point. You continually claim that we here are seeing the wrong things, making poor arguments, incorrect in our assertions, and otherwise use a blanket dismissal of things we don’t like. You even say:

    You are by no means alone in this. The present views of Andrew Weil and Ted Kaptchuk can be dismissed on these pages (it is implied) because of things they may have said decades ago.

    Which is utterly removed from reality. Kaptchuk is dismissed based on current statements and papers of his. Yes, his past qualifications and credentials were also explored. But I can assure you that if he was an utter quack decades ago, and then began publishing genuinely scientifically literate work, the comment here would be “Bravo!” (ahem, Edzard Ernst, anyone?) If you further look at the chronology of the Kaptchuk discussion you will note that it was his most recent cogitations that were panned, then an exploration of his past. There is absolutely no implication nor explication here that Kaptchuk may be dismissed because of past crimes as you would have us believe in your comment.

    So yes, you are superficially correct that Kaptchuk is dismissed because of things he said decades ago. However, that is additional to the real reasons he is dismissed. The hallmark of apologia is the selective use of truth (referred to as cherry picking, which I know you are familiar with) to evince yourself despite the reality of the context.

    This is but one tiny example on this thread and a mere drop in the swimming pool of past posts of your (inadvertent perhaps?) use of poor rhetorical tactic and thus earning you the moniker of CAM apologist. Your intentions matter not to us – what actually comes out in your writing does. And, by accident or design, your writing is consistently in concordance with that of the CAM apologist. I’ll conclude by adding that never once has Dr. Gorski or anyone here dismissed your arguments based on the notion that you are an apologist. Every time and without fail it has been pointed out why the argument is incorrect and then labeled as characteristic of said apologia.

  24. pmoran says:

    Nybgrus: I don’t know how much more clear it can be made pmoran –
    there is a contingent of CAM apologists with nefarious motivations. They are small indeed, but they exist.

    Thankyou for that admission, if you are allowing that much of CAM is carried on by well-meaning and honest people who may be, for all we know, just as concerned about patient welfare as we are.

    I still say that this is not generally reflected on these pages. Observe how this post of yours treats me, a largely like-thinking colleague, as deserving of disdain, simply for daring to suggest that there is an unbalanced portrayal of the motives of CAM proponents on this site and drawing attention to blatant ad hominem tactics against them.

    But the crux is that the larger motivating force is that of ideology. These people like their ideas and feel that “evil reductionists” have it all wrong… or at least don’t have the full story. The personal experience and ideology of the apologist and active proponent determines what woo-du-jour they attempt to pass as useful and necessary to teach and implement.

    So you are saying that the ideology comes first? I say that this is rubbish. There are a few armchair CAM theorists around, but CAM is unquestionably driven mainly by unmet medical needs and the power of the personal testimonial. A few seconds thought, along with a minute’s observation, leads one to that.

    A variety of intellectual justifications may follow post hoc, possibly encouraged by the truly fraudulent elements of CAM, but they are not sufficient on their own to sustain such a large and variegated social phenomenon.

    You do mention “personal experience” as a factor, and with that I agree. Medical practice is full of illusion including those related to placebo responses. We doctors have proved to be no more immune to them than anyone else, which is why we need the clinical studies.

    All I am saying is that we should not react to inferior understanding of medicine as if it was driven by evil intent. That is a waste of breath and no one gets to learn anything from it. It can create a battle ground when there remains some potential for well-intended minds to meet.

    We, on our part, also need a clearer understanding of the role of placebo responses when evoked by agencies outside of the mainstream, those which lack our specific scientific, ethical and economic responsibilities. We seem to have a de facto pluralistic medical system whether we like it or not.

    And, strewth!, now I have properly earned the “moniker of a CAM apologist”? Give me strength! David, bless him, did not quite say that as I WAS one of those. This is the worst kind of ad hominem because it can serve only one purpose, to deflect serious consideration of anything I say.

  25. Harriet Hall says:

    @pmoran,
    No, you aren’t a CAM apologist, but you do seem to be an apologist for broad toleration/acceptance of CAM on the grounds that scientific medicine can’t meet patients’ needs, that something is needed to compensate for medicine’s inadequacies, that patients derive real benefit from placebos, and that CAM might do the job. Also that some things in CAM, notably acupuncture, just “might” have real effects and we mustn’t be too hasty to dismiss it. At least that’s what I think I’m hearing. Correct me if I’m wrong.

  26. nybgrus says:

    Thankyou for that admission, if you are allowing that much of CAM is carried on by well-meaning and honest people who may be, for all we know, just as concerned about patient welfare as we are.

    I believe that we here all have “admitted” that long ago. But you don’t go after the symptom of the problem – you go after the underlying etiology. Those that aren’t just the well meaning but otherwise dim practitioners but are either particularly influential and/or those that are not so well meaning and actually have an agenda.

    Observe how this post of yours treats me, a largely like-thinking colleague, as deserving of disdain, simply for daring to suggest that there is an unbalanced portrayal of the motives of CAM proponents on this site and drawing attention to blatant ad hominem tactics against them.

    No Peter, you aren’t treated with disdain “for the mere suggestion.” You have left the realm of “mere suggestion” aeons ago. But moreover the disdain comes from the fact that it has been shown here (at least we certainly seem to think so) repeatedly that you are wrong in your “mere suggestion” that is really a long standing and long winded assertion. The disdain comes from the fact that you repeat the same general statements, usually while denying the extent of your assertions, and claiming that each time is just a “mere suggestion” – one that we deem is incorrect.

    So you are saying that the ideology comes first? I say that this is rubbish

    Well documented rubbish. Yes, I am saying that the ideology comes first. Unequivocally and demonstrably. But it didn’t take me just a “few seconds thought, along with a minute’s observation” to conclude that. It took a number of years of reading and thinking deeply, constantly seeking to be proven wrong.

    All I am saying is that we should not react to inferior understanding of medicine as if it was driven by evil intent.

    Sometimes it is. But most of the rhetoric here is attacking the idea not the intent. The intent matters little when the idea is so poor.

    This is the worst kind of ad hominem because it can serve only one purpose, to deflect serious consideration of anything I say.

    Once again, I defy you to find a single instance where anything you have ever said here was dismissed with “Peter must be wrong, he is a CAM apologist after all.”

    No, it is “[X,Y,Z] are wrong Peter. Here is why. Saying otherwise makes you sound like a CAM apologist.” It is a very clear distinction.

  27. pmoran says:

    I don’t have to buy into your fantasies about CAM and how intellectually honest you are either, Nybgrus.

    Well documented rubbish. Yes, I am saying that the ideology comes first. Unequivocally and demonstrably. But it didn’t take me just a “few seconds thought, along with a minute’s observation” to conclude that. It took a number of years of reading and thinking deeply, constantly seeking to be proven wrong.

    It’s rubbish. Some nut may have a bright idea and try it out but thereafter acute medical needs, various illusions, and patient testimonial is all that is needed to keep the ball rolling. Ideology concerning conspiracy, mainstream bias etc accretes to explain mainstream disinterest..

    Have you not also observed how perfectly malleable the various intellectual justifications for CAM are when it is under attack? The ideology and attempted scientific justifications surface once there is a degree of belief that medical needs are being met in ways that the mainstream cannot. There will then be a smooth transition from attempts at scientific justification into more mystical explanations of why it “works”, as position after position is demolished.

    The ideology is definitely secondary to the belief that it probably works but is being treated unjustly.

  28. nybgrus says:

    you don’t have to buy into anything about me peter.

    but feel free to keep making claims that don’t stand up to the literally mountain of evidence presented on this very blog, documented with primary sources, and written by multiple authors, all demonstrating the contrary.

    You even admit that modalities are invented wholesale and then propagated by testimonial… where do you think that testimonial comes from? True believers who are now convinced… not based on anything other than subscription to the initial ideology presented to them, most commonly the naturalistic fallacy. They wail and rail that their woo is so much superior because it is [fill in the blank]. That is ideology. When scientific evidence trumps what they say, they claim it is wrong, or that we are closed minded, or that our evil reductionist science can’t test their woo. That, peter, is ideology. When that sort of tack and rhetoric makes it to the level of a Yale professor who claims we need to change the standards of evidence specifically and only for CAM…. that is ideology framing the worldview of assessing the validity of [insert woo here].

    Ideology doesn’t just mean a secret cabal of Illuminati type shadowy figures controlling the world’s supply of CAM. It means promoting, enshrining, and viewing the world (i.e. the evidence) through a different set of woo-colored glasses. That is called ideology.

    If it were just individual testimonials, a few illusions amongst the population at large, and acute medical need leading to desperation I’d concede the point.

    But it is not. There are countless examples of actual medical doctors, scientific doctors, and many others in academia actively trying to claim that the “evil reductionist” way of looking at things works great for “acute illness” but simply does not have the capacity to evaluate their specific woo in light of “chronic illness.” They attempt time and time again to demonstrate why pragmatic studies are useful tools, why it is reasonable to change the standard of evidence to make it easier for CAM to achieve the same level of scientific status as actual medicine, and they teach students that concepts like the naturalistic fallacy and irreducible synergy are valid scientific constructs.

    That is ideology leading the discussion. Everything else flows to fit the woo. The conclusion is made – this woo works. The discussion around it is entirely framed on how to demonstrate that is true. Once again, that is ideology.

  29. pmoran says:

    # Harriet Hallon 06 May 2012 at 10:10 pm

    @pmoran,
    No, you aren’t a CAM apologist, but you do seem to be an apologist for broad toleration/acceptance of CAM on the grounds that scientific medicine can’t meet patients’ needs, that something is needed to compensate for medicine’s inadequacies, that patients derive real benefit from placebos, and that CAM might do the job. Also that some things in CAM, notably acupuncture, just “might” have real effects and we mustn’t be too hasty to dismiss it. At least that’s what I think I’m hearing. Correct me if I’m wrong.

    Wow! On those specifications, perhaps I do quallfy as a fully fledged “CAM apologist”! Nevertheless, they are all a little off-target.

    e.g. — you do seem to be an apologist for blroad toleration/acceptance of CAM on the grounds that scientific medicine can’t meet patients’ needs

    Not quite. I am more tolerant of some aspects of CAM use than most here because I suspect it is an inevitable, instinctive, highly evolved human response to unmet medical needs, and that you may as well try to stop the bad weather.

    This is not meant as a major criticism of the mainstream, which does its best , and extraordinarily well in many respects. Nor does it carry any expectation of intrinsic efficacy for any CAM method.

    Nor is it a basis for inaction. It suggests smarter more targeted action. less rampant judgmentalism and more overt empathy and understanding , if we are to try to protect the public from harm to the degree that is possible. It implies that we need to better understand the public mind and our true status and function in their eyes, not the ones we imagine we are entitled to. It would treat well-meaning colleagues as well-meaning colleagues, not pariahs to torn aprt strip by strip.

    Placebo responses are not critical to the viewpoint but they very plausibly do provide a bonus for some over and above the satisfaction of the compulsion to take action when sick , and to seek succour wherever it is offered, and probably also the satisfaction of other deep human needs. It is, however, the possibility of placebo responses that first started me asking certain “what if– ” questions, and finding that a lot of my own bog-standard skeptical dogma did not stand up to minimal close examination.
    .
    Another matter — . When I say “acupuncture probably does help some patients with some conditions through a combination of non-specific influence” that is intended to be taken as an evidence-consistent scientific statement. Anyone can challenge it if they choose.

    Instead, it is portrayed as “defending acupuncture” as though “enough said — “, — as though anything that is not totally condemnatory of acupuncture is evidence of unsound skeptical credentials and a subversive influence that the public needs to be protected from, that can be excluded from our vaunted “fully informed” consent .

    That reflects a too simplistic concept of CAM — as a set of methods with fixed (bad) qualities, rather than as a collection of quite diverse medical claims, some of which are defendable.

  30. pmoran says:

    Nybgrus, simple observation reveals that the vast majority of CAM use is the result of pressure or advice from friends and relatives, or something that someone has found on the Internet when seeking relief from a medical problem.

    For very few CAM users is there a firm prior commitment of belief on ANY basis, ideological or scientific. CAM is for most merely something to try out because it has been claimed to help others. As desperation increases increasingly unlikely methods (to the user’s mind) will be tried out.

    Another illustration of the lack of specific ideology within most CAM users is the sheer variety of methods, often having different, even conflicting theoretical bases, or associated ideology, that individual users will try out even alongside their conventional treatment. How does that fit into your theory of an ideologically driven process?

    (That was a rhetorical question. Don’t bother answering unless you can produce the mountains of evidencce you claim supports your opinions.)

  31. Harriet Hall says:

    @pmoran,

    “I am more tolerant of some aspects of CAM use than most here because I suspect it is an inevitable, instinctive, highly evolved human response to unmet medical needs, and that you may as well try to stop the bad weather.”

    It seems to me we all suspect that (as one of the reasons although not the only reason people use CAM). And we do realize we can’t stop it. But that doesn’t mean we should be any more tolerant of charlatans and misinformation.

    “acupuncture probably does help some patients with some conditions through a combination of non-specific influence”

    Translated: acupuncture’s effects are non-specific and therefore no better than placebo. That’s what we’ve been saying. Are you arguing that we should offer placebos?

    “smarter more targeted action. less rampant judgmentalism and more overt empathy and understanding”

    You think we are being too mean? Maybe that’s how our articles sound to you, but we don’t mean to be mean. I don’t think we should have to repeat in every article that we understand and empathize with patients and that we are not being judgmental about people, but only about unsupported claims. What, should we insert a formal disclaimer in everything we write, analogous to the one saying “this product has not been evaluated by the FDA…”? If an article is about the claims, we write about the claims. If an article is about the reasons patients believe false CAM claims, that’s the place to discuss that.

    “as a collection of quite diverse medical claims, some of which are defendable.”

    OK, please tell us: which ones are defendable?

  32. Harriet Hall says:

    @pmoran,

    “the lack of specific ideology within most CAM users”

    Maybe, but I’m sure hearing a lot of ideology. “I want something natural.” “I don’t want any of Big Pharma’s dangerous products.” “I want a remedy that doesn’t involve cutting/burning/poisoning.” “Science doesn’t know everything.” “I don’t trust the medical establishment.” and so on.

  33. nybgrus says:

    For very few CAM users is there a firm prior commitment of belief on ANY basis…

    Oof. Here we are again. Every single time we discuss this issue, you seemlessly shift gears between CAM purveyors and propagators to individual CAM users.

    And every single time I remind you that I am not discussing the individual CAM user. I have previously agreed with you that, in general, most people don’t have a particular agenda or ideology to dogmatically defend their use of CAM.

    Although Dr. Hall adequately points out that many indeed do. Your claim that there is no ideologically driven promulgation of CAM is completely off the mark when you rebut me by citing individual users when I am discussing academic teaching and authoritative statements. It also falls completely flat the moment that someone using echinacea gets mad when you point out that it really isn’t effective for cold symptoms and retorts “Well, it must be better! It is all natural!. It falls completely flat when you walk down any pharmacy (or chemist, if you prefer) or even grocery store and are assailed by the “Boost your immune system!” and “All natural! Helps your body heal itself!” banners everywhere.

    Where do you think the individual CAM user gets the idea to use whatever CAM it is they are using? Do you think they sit in a vacuum and then mysteriously decide that today they are going to try reiki for back pain or vitamin C for their cold or acupuncture for their cancer? Of course not! The look for answers… and guess who supplies it to them? The people with ideologies to promote CAM! You know, those selfsame people to whom I am referring to in our conversations. The ones that are indeed that actual targets of the authorship here. The ones that make it reasonable for the average individual CAM user to confidently state “This is better because it is all natural!” which is a completely and utterly nonsensical and non-scientific statement. That is the ideology I refer to.

    But it doesn’t just end there! Indeed, there exists a population of the average individual CAM user who actively seeks out CAM because of his or her own specific ideology!. I won’t quibble about the percentage of total users – I concede it may well be extremely low. It is certainly not non-existent and it is certainly not insignificant.

    Either way, the concept of teaching medical students that science cannot answer the question of why glucosamine sulfate “works” for OA but glucosamine hydrochloride doesn’t is ludicrous. Yet that was precisely what a lecturer of mine stated. We are now discussing a supposed scientist, teaching supposed medical scientists in training, and the conclusion reached is not “this is an example of signal in the noise.” No, it is a flippant “This works. Science can’t say why. Go ahead and prescribe it to your patients.” Where do you think that recommendation came from? Cochrane says that it has some evidence of efficacy but more studies are needed. NaturalStandard says that it has “Class A” evidence and should be prescribed to patients. But clearly, no ideology at play here.

    So yes, peter, the crux is still ideology. It is a group of people convinced of scientific fallacies and tricked by their own anecdotal experience promulgating the false validity and incorporation of a different set of standards which then appears to the individual CAM user as the imprimatur of legitimacy.

    Or are you about to argue that ICU patients asked their nurses and doctors (whom had never heard of Reiki before) to practice Reiki on them because they were so desperate and needed to fill an unmet medical need and that led to an article in the <a href="http://journals.lww.com/ccnq/Abstract/2011/07000/Reiki_Therapy__A_Nursing_Intervention_for_Critical.7.aspx"Journal of Critical Care Nursing touting it as an effective and safe healing modality to use?

    I mean seriously! A desperate patient will only find what is presented! You cannot seriously argue that creating an integrative medicine ICU that incorporates Reiki into critical care routines is purely a patient desperation and “highly evolved” intrinsic need driven initiative!

  34. nybgrus says:

    oh, and I’ll add an afterthought that occurred to me.

    Those colleagues of ours that are misguided and are merely genuinely trying to help people and ultimately incorprate unscientific woo into their practice… those colleagues of ours that are misguided and merely genuinely trying to help people by researching and writing articles on woo that are slipshod and further argue for a change in the standards of evidence….

    why do you think they are misguided and can look at a study and find it reasonable when it is clearly garbage? Or write a study they think is reasonable when it is clearly garbage?

    because a bunch of credulous professors and/or professors with an ideology taught them it was ok. because a bunch of otherwise scientifically literate professors didn’t want to be “too mean” and point out they were doing sloppy work. credulity and sloppiness begets credulity and sloppiness. but you know science yourself – where do bad scientists end up? in the bin. Why are they now featured in brand new academic departments? Ideology driving people to campaign for it.

  35. pmoran says:

    Harriet: @pmoran,

    “the lack of specific ideology within most CAM users”

    Maybe, but I’m sure hearing a lot of ideology. “I want something natural.” “I don’t want any of Big Pharma’s dangerous products.” “I want a remedy that doesn’t involve cutting/burning/poisoning.” “Science doesn’t know everything.” “I don’t trust the medical establishment.” and so on.

    It is hard to know how much of that is primary, or secondary (post hoc attempts at self-justification).

    Also, wanting medical treatments to be simpler and freer of complications and side effects is a legitimate public desire, and a component of “unmet medical need”. I think our generation of doctors has suffered a backlash because of unrealistic expectations of mediicne, aroused by our earlier successes with some of the more tractable medical problems. That has left us with the more difficult problems, unfortunately some of the most common ones.

  36. pmoran says:

    Nybgrus: For very few CAM users is there a firm prior commitment of belief on ANY basis…

    Oof. Here we are again. Every single time we discuss this issue, you seemlessly shift gears between CAM purveyors and propagators to individual CAM users.

    The discussion has drifted, but this all began with my assertion that many of the proponents of CAM are not given sufficient credit for their belief that the methods do work for them. We can even understand perfectly well why they might genuinely believe that, yet we invariably imply that they have other unspecified presumably unworthy motives for trying to find ways in which their methods can fit in with or around normal scientific mores.

    Bear in mind that the real frauds aren’t interested in coming here and debating the issues with us. They won’t risk exposing ideas that they could not care less about to dissection by speaking in public places, publishing them in medical journals or teaching them to medical students. They won’t help with the design and performance of clinical studies that have the potential to undermine their profit base.

    We are letting ourselves get carried away with our own — well — propaganda when we do this. And it is not even sound propaganda. Most users of CAM practitioners and probably also much of the public will either believe that these practitioners are well-meaning or be prepared to give them the benefit of the doubt on that. They can even also understand that people can feel better for such ministrations for a variety of reasons unrelated to the intrinsic efficacy of the methods used.

    So it is bad tactics, not merely bad manners, to set up an unnecessary conflict in tehir minds up front. By all means treat people as frauds when we are certain of that.

  37. nybgrus says:

    How about my own professor who teaches credulous integrative medicine crap… and runs his own workshop to certify physicians in the application and use of a completely unproven, highly implausible test to provide their patients? One that they can charge $300 a pop for? And the seminar runs around $3k to attend. Do you think there mightn’t be a bit of an agenda there?

    Or how about Andrew Weil who has his own line of alternative medicine therapies and is teaching medical students about how useful and wonderful these “integrated” therapies are? Any agenda there?

    Or how about Dr. Oz….. or Mercola…. or even Ornish, the least offensive of the lot.

    You see where I am going with this. There are myriad examples of people with conflict of interest leading a charge.

    But you also assume that I refer to an actively recognized ideology. As in “I am someone who believes that the naturalistic fallacy is not a fallacy and therefore I will act to convince everyone else as well.” But that isn’t how ideology works. They view it as intrinsic truth – as the basis for a worldview – and then, genuinely and rationally, act on that. But that is still ideology – a wrong one – guiding and motivating the action.

  38. Scott says:

    The discussion has drifted, but this all began with my assertion that many of the proponents of CAM are not given sufficient credit for their belief that the methods do work for them.

    Oh, they’re given sufficient credit. The appropriate amount of credit is close to zero, though.

    Whether they ACTUALLY know their fields are fraudulent is beside the point; they SHOULD know, and have a moral obligation to know before they promote them. Ignorance and incompetence are not convincing defenses.

  39. pmoran says:

    Scott: “The discussion has drifted, but this all began with my assertion that many of the proponents of CAM are not given sufficient credit for their belief that the methods do work for them.”

    Oh, they’re given sufficient credit. The appropriate amount of credit is close to zero, though.

    Whether they ACTUALLY know their fields are fraudulent is beside the point; they SHOULD know, and have a moral obligation to know before they promote them. Ignorance and incompetence are not convincing defenses.

    So it is now also unethical to be ignorant and incompetent?

    There are several other problems with that stance, which I suspect lies at the back of many other minds here —.

    1. There is also an ethical obligation on medical practitioners to put patient needs first, so that even if a medical adviser is somewhat uncertain as to whether a method might work or not he is might be justified in suggesting a trial of it if there is nothing better available.

    That does not apply so much to members of the medical profession proper, as it has evolved within our generally science-oriented society, because it labors under additional public expectations. Also note that we are not in this asking for any ordinary standard of certainty/uncertainty to be applied. We are expecting near-absolute certainty to be applied by people who through no fault of their own may be ill-prepared to sift through a lot of often conflicting information. Being certain on relevant matters requires either a prior bent towards trusting prevailing scientific consensus, or a highly sophisticated and rare understanding of many different areas of science and medicine.

    2. We also know how medical practice is prey to powerful illusions pointing to the intrinsic efficacy of any methods used. Entirely ethical and experienced doctors are misled by them. We expect scientifically naive practitioners and users to be misled by them. This is the main reason for the “many splendours” of CAM. If you want these methods never to obtain a following or new methods to stop emerging you will have to have some kind of social or legal constraint that stops people from ever starting to use them in the first place (impossible).

    3. Finally, modern research suggests that there may even be more to one of those “illusions” i.e. placebo responses, than we thought a few decades ago. There are studies showing comparable effects of some versions of CAM to FDA approved drugs in some populations. There are studies suggesting “therapeutic’ neurophysiological effects from placebo-induced expectations. There are studies showing remarkable apparent benefits in some of the sham arms of sham-controlled studies.

    These studies need further confirmation and understanding. They may, for example, only apply to selected populations, but even that would offer support for the opinion of CAM users and practitioners that the methods “work” for them.

  40. Oh my god, “the power of the placebo”. Sometimes I feel like peoples brains are placebos.

  41. Harriet Hall says:

    @pmoran,

    “if a medical adviser is somewhat uncertain as to whether a method might work or not he is might be justified in suggesting a trial of it if there is nothing better available.”

    Of course he would be justified, but ethics would require that he present it to the patient as experimental and not exert undue influence in its favor.

    “We are expecting near-absolute certainty”

    No we aren’t. Science doesn’t produce that degree of certainty. We’re talking probabilities.

    “If you want these methods never to obtain a following or new methods to stop emerging you will have to have some kind of social or legal constraint that stops people from ever starting to use them in the first place (impossible).”

    Straw man. We know we can’t stop them. We are arguing for informed consent and patient autonomy, not coercion.

    You wonder why people confuse you with a CAM apologist. Just listen to yourself: it sure sounds like you’re saying we should prescribe placebos because they might really work and CAM use is justifiable as placebo treatment.

  42. fledarmus1 says:

    @PMoran

    Whether they ACTUALLY know their fields are fraudulent is beside the point; they SHOULD know, and have a moral obligation to know before they promote them. Ignorance and incompetence are not convincing defenses.

    So it is now also unethical to be ignorant and incompetent?

    Absolutely! Read the Code of Medical Ethics. It is also unethical to treat with a placebo without informing the client that you are treating with a placebo, or to use treatments which have no medical indication and offer no benefit to the patient, or to use treatments which have been determined scientifically to be invalid. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?

  43. fledarmus1 says:

    Actually, perhaps it isn’t, strictly speaking, unethical to be ignorant and incompetent, but it is unethical to practice medicine if you are ignorant and incompetent.

  44. pmoran says:

    Harriet: You wonder why people confuse you with a CAM apologist. Just listen to yourself: it sure sounds like you’re saying we should prescribe placebos because they might really work and CAM use is justifiable as placebo treatment.

    When I mean that I will say it.

    Do you think any part of what I have said is untrue (in its original meaning, not as your selected sentences taken out of context) ?

  45. Harriet Hall says:

    @pmoran,

    The problem is that you are hard to pin down: you keep making vague philosophical statements with lots of caveats (“we don’t know enough about placebos: they might provide real benefits,” “we shouldn’t be so negative,” “CAM might fill a need and be helpful to some patients”) that are open to different interpretations and that can come across as pro-
    CAM or as contrarian disagreement just for the sake of controversy. It seems to me you are subtly misrepresenting our position in order to attack it, and that what you say is not concrete enough to make any real progress towards a meaningful dialog.

    OK, you’re not exactly saying we should prescribe placebos, but you are saying
    “modern research suggests that there may even be more to… placebo responses, than we thought a few decades ago. There are studies showing comparable effects of some versions of CAM to FDA approved drugs in some populations. There are studies suggesting “therapeutic’ neurophysiological effects from placebo-induced expectations. There are studies showing remarkable apparent benefits in some of the sham arms of sham-controlled studies.
    These studies need further confirmation and understanding. They may, for example, only apply to selected populations, but even that would offer support for the opinion of CAM users and practitioners that the methods “work” for them.”

    You’re not really saying what we should do, except in the most vague terms. We’ve tried to get you to commit to something more concrete, but you keep slipping away into uncertainties. Of course we should be sympathetic to patients’ needs and perceptions, and of course we should do more research on placebos, but what does that mean to practical patient care today?

  46. pmoran says:

    Harriet, it’s all in the specifics. I have challenged many different aspects of standard skeptical rhetoric, including the notion that CAM use stems mainly from poor public science education, the use of juvenile name-calling, and (just now) the routine implication that anyone who promotes CAM has unworthy motives with no credit being given for sincere belief. Sometimes,as in the present instance, I am responding to attitudes expressed in the comments, but ones that would certainly otherwise go entirely unchallenged.

    The usual response to my challenges is to accuse me of “straw man!” and to say “we are not like that at all”, which I accept applies in relation to your good self.

    Well, I allege that we can get so accustomed to listening to certain modes of speech and lines of thought that we no longer notice them, let alone think of checking whether they actually correspond to “reality”, which has somewhat ironically become one of our latest buzzwords.

    Thus it is that just about anything is fair comment so long as it portrays CAM and CAM supporters in the worst possible light. Conversely, anything that looks as though it might be a defence of anything to do with CAM, as with some of what I say , is either rejected or ignored. “You look as though you are defending CAM”, I am told, as though that is somehow more important than whether what I say is true. (You have still not answered that question).

    That too, suggests that there might be a problem here.

  47. Harriet Hall says:

    @pmoran,

    There is still something subtle going on here that is interfering with our ability to communicate with each other. You are saying things that are basically true, but I keep getting irritated by the way you say them.

    You say, “standard skeptical rhetoric, including the notion that CAM use stems mainly from poor public science education, the use of juvenile name-calling, and (just now) the routine implication that anyone who promotes CAM has unworthy motives with no credit being given for sincere belief”

    I don’t accept that this is the “standard skeptical rhetoric” or even that there is a “standard skeptical rhetoric”. I don’t think CAM use stems mainly from poor public science education, but from beliefs and poor critical thinking skills. After all, some highly educated doctors believe crazy things. I don’t think CAM use will ever go away, and I think improved education (not so much in science but in critical thinking) will help but can only solve part of the problem. I don’t accept that name calling is a skeptical standard; some skeptics go out of their way to be polite and to understand human failings. Every issue of Skeptic magazine starts with the quotation “I have made a ceaseless effort not to ridicule, not to bewail, not to scorn human actions, but the understand them.” I don’t think skeptics routinely think CAM proponents are insincere; quite the opposite. Sometimes CAM does involve outright fraud or pseudoscientific fantasies from someone who really ought to know better, and then it is appropriate for us to speak out strongly. Sometimes we vent our anger because we see patients being harmed and there is nothing else we can do. I agree that that can be counterproductive, but it’s only human.

    Maybe your criticisms would come across better if you confronted specific commenters with these accusations in specific instances rather than tarring all skeptics with the same generalizations.

  48. pmoran says:

    This is why healthfraud activities should not get too personal. This poor woman has gotten caught up in justifiable hostility towards cancer quackery, when she might yet have been persuaded not to commit herself irretrievably to method after method that we can predict will not work.

    She is no “alternative” zealot — she has said herself that she knows that conventional treatment might save her life. She merely doesn’t realize (yet) that the treatment offered is almost certainly not going to be “worse than the disease”.

    One of the worst outcomes for the purposes of our reeistance to quackery might be if she were persuaded against her will to undergo surgery, radiotherapy and the full gamut of adjuvant treatments including chemotherapy and still finds herself facing recurrent cancer within a year or two. Imagine how that would be portrayed by all those who are currently supporting her decision.

  49. pmoran says:

    Sorry, that was directed at the wrong thread, but it illustrates another way in which we can be right in theory but wrong in the way we use it.

    Maybe your criticisms would come across better if you confronted specific commenters with these accusations in specific instances rather than tarring all skeptics wit the same generalizations.

    That’s unfair, because I invariably do so at the time. I have also just now indicated that your writings don’t bother me.

    1. Harriet Hall says:

      @pmoran,

      “I have also just now indicated that your writings don’t bother me.”
      When you talk about “standard skeptical rhetoric” you are generalizing about the entire group of skeptics and you go too far. Saying I’m an exception to the rule doesn’t excuse you. Instead of “standard skeptical rhetoric” you might have qualified it by saying “many skeptics…”

      “One of the worst outcomes for the purposes of our resistance to cancer quackery might be if she were persuaded against her will to undergo surgery, radiotherapy and the full gamut of adjuvant treatments including chemotherapy and still finds herself facing recurrent cancer within a year or two. Imagine how that would be portrayed by those currently supporting her decision.”

      I find this really offensive, as if we should judge a patient’s tragedy on the basis of how it might affect our own goals. We are responsible for explaining the realities of cancer treatment to patients; we can’t be held responsible for how others might misinterpret the facts. This is another example of how what you say is true but the way you say it is objectionable.

  50. nybgrus says:

    with no credit being given for sincere belief.

    Sincere belief deserves no credit. Acklnowledgement, sure. And we all do. But credit? For what?

    Perhaps I should tell residency programs I sincerely believe they should accept me.

    The usual response to my challenges is to accuse me of “straw man!” and to say “we are not like that at all”,

    Actually the usual response has been to demonstrate why your arguments are straw men and how we are not like that.

    Thus it is that just about anything is fair comment so long as it portrays CAM and CAM supporters in the worst possible light.

    The thesis of this blog is that CAM is a meaningless designation, created to espouse a lower set of standards to pass it off as useful alongside or in replacement of actual medicine. It is used as a bastion of belief to escape from the revealing eye of scientific inquiry, not as a useful construct to understand anything. There, nothing useful can come from CAM, since the basic methodology of understanding is either false or simply undescribed – thus useful things are rare, by accident, and only elucidated post hoc by science… and thus incorporated into actual medicine. So yes, CAM and CAM supporters have no redeeming qualities whatsoever – some are just more benign than others.

    “You look as though you are defending CAM”, I am told, as though that is somehow more important than whether what I say is true.

    Once again, every criticism leveled at you has had specifics of why that is incorrect and, if appropriate, that it appears as a defense of CAM. Do note that as I explicated above, the thesis of this blog is such that CAM is indefensible so yes, both points are important. But never is the fact that you appear to be defending CAM the basis of the rebuttal. And the fact that you continually take it as such, ignoring the actual criticisms leveled at you, is the source of confusion and frustration on my part, and I reckon perhaps Drs. Hall and Gorski as well.

    I think it is safe to say the we here view CAM as a descriptor of poor thinking, bad standards, and a politicoideological construct – i.e. something that cannot be worthy of defending in any way. Substitute the words “jihad” or “bigotry” or “racism” for words that I would find similarly indefensible, even though you could find more benign versions and people with “sincere beliefs” that they are doing the world good by acting in ways deserving of such descriptors. I do not feel they deserve “credit” for their “sincere beliefs” any more than CAM and CAM supporters do.

  51. David Gorski says:

    Peter generalizes about skeptics in much the same way he accuses skeptics of generalizing about CAM supporters. It’s a major case of the proverbial pot calling the kettle black.

    The disappointing thing is that Peter doesn’t see that he is doing exactly the same thing he accuses others of doing; it’s just that the target he generalizes about is different. It’s skeptics about whom he characterizes “standard skeptical rhetoric” as “the notion that CAM use stems mainly from poor public science education, the use of juvenile name-calling, and (just now) the routine implication that anyone who promotes CAM has unworthy motives with no credit being given for sincere belief,” all of which are very much straw man, Peter’s lamentation at having his arguments as straw men notwithstanding. Meanwhile, for reasons that remain unclear to me, Peter bends over backwards to defend supporters of CAM and castigates skeptics in general for being mean, nasty, arrogant, and intolerant whenever they have the temerity to point out that quackery is, in fact, quackery and why, no matter how polite and respectful they are about it. His bit about “standard skeptical rhetoric” is doing just that, because Peter has made it very clear time and time again over the last two or three years that he views “standard skeptical rhetoric” as being—yes—mean, nasty, arrogant, juvenile and intolerant. And you know what? I think that his sarcastic use of the phrase “standard skeptical rhetoric” is not a mistake or a slip-up on Peter’s part. I think that he means it. He views nearly all skeptics in that way, with precious few exceptions, Harriet being perhaps the only one. Certainly on many occasions Peter has made it crystal clear that he views me in that way.

    Your dislike of me aside, BTW, here’s your chance to demonstrate that your methods work better than mine. Danielle’s husband Brad has shown up in the comments of my cancer quackery post. Maybe you can succeed where I failed. I’m deadly serious here. I’m not so proud that I care that much who persuades Danielle to forget the quackery. I only care that she receive standard-of-care therapy and have her best shot. If you can do it, you will have done a great service, and I’ll salute you for it.

  52. pmoran says:

    David, you may be right. We should accept differences of personal opinion within the limits allowed by the available evidence. Nevertheless, Dr Young’s methods could have been taken apart without reference to this lady, and her case perhaps should have been referred to anonymously on these particular pages.

    Underlying my somewhat protective attitude of her is that I have never seen anyone in her situation change their minds once they have started on alternatives.

    Those with earlier cancers will often accept some conventional care such as excision-biopsy, but they won’t usually accept the chemotherapy.

    Many others eventually do come around after the cancer has progressed but typically only after many months, further complicating treatment and seriously worsening prognosis. Others get swallowed up entirely by the “alternative” subculture and they can suffer terribly in consequence.

    Avoiding these last two outcomes should be our realistic aims. That may entail trying to avoid too much embattlement with them once this present point has been reached. It is desirable that they keep at least one foot in the conventional camp.

    That is why I would be trying very hard to get them to put a time limit on her trial of “alternatives”.

    1. Harriet Hall says:

      @pmoran,

      “Dr Young’s methods could have been taken apart without reference to this lady, and her case perhaps should have been referred to anonymously on these particular pages.”

      I submit that the post would not have been nearly as effective without this personal touch, putting a face to the victim. It provides “case study” evidence and serves as an example of people who are actually being harmed by misinformation. Much better than an unsupported statement that “Young’s misinformation might harm people.” Since she publicized herself on her blog, she has no claim to anonymity.

      You say you have a “somewhat protective attitude” towards her. Is it a “protective” attitude or a paternalistic assumption that you know best about how she might feel? If you saw someone failing to look both ways and stepping into traffic, would you want to “protect” their feelings by not shouting out a warning, out of fear that pointing out their carelessness might make them feel bad? Even if you thought she might hear your warning but fail to act on it and get hit by a truck anyway? The best protection is the truth.

  53. It irks me that Pmoran refers to Dr. Gorski as David, but refers to psychopath Robert Young, who is in no way a doctor, as Doctor.

  54. pmoran says:

    Sorry Skepticalhealth. David and I know each other from many years of involvement with cancer are old friends, and have been involved with cancer

  55. pmoran says:

    Sorry Skepticalhealth, David and I know each other from many years of resistance to cancer quackery. Calling him by his given name is not disrespectful. Our opinions also coincide exactly on what is quackery and what is not.

    The thing is that I have clearly spent far more time than ,i>anyone here becoming familiar with the “alternative” subculture — essentially understanding how they think. When you have that insight you cannot help, rightly or wrongly, feeling more sympathetic to the plight of some of those driven to use “alternatives”. You also understand better why they are so deeply resentful of the mainstream for not living up to those expectations that were aroused early last century and that are constantly reinforced by medical researchers desperate for funding and by the press.

    You get to realize that despite the fact that one in three or four of the population will get cancer and everyone will have a relative who gets it most people reach adulthood with only the vaguest notion of what it is, what it looks like, and what it can do. They are thus desperately ill-prepared to understand the conflicting notions they will encounter when they or a family member gets cancer. In contrast, David and I know cancer intimately , having held in in our hands during surgery and seen what happens to pateints who don’t get adequate treatment (and unfortunately to too many who do get it –we have to acknowledge that).

    You also get to see that a lot of them are reasonably sensible people who simply do have genuine difficulty understanding how we are so sure these methods won’t live up to their expectations. That being so .there is no respect for, and even suspicion of our attempts to exert scientific authority over them.

    As David rightly points out I am less sure how to stop people coming to harm from this phenomenon. We probably should try to understand each individual case intimately before getting directly involved in them.

  56. gretemike says:

    I don’t know what can be done for the type of patient who actually thinks he/she can become as educated as you doctors by using Google for a couple hours; maybe nothing. In my opinion your greatest effect could be in legislative advocacy, opposing the apparent increasing codification of CAM practices like naturopathy. Given the immense damage that was done by Wakefield’s one bogus study, imagine the legitimacy (and increased number of patients) that government-sanctioned licensure gives CAM practitioners.

  57. pmoran, I apologize for bringing that up. I did not know you two were old acquaintances. I’m still pretty new around these parts.

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