Articles

Dialogue on “Alternative Therapies”

A recent opinion piece in The New York Times is an invitation to a dialogue on so-called alternative therapies, written by James Gordon. Gordon directs the Center for Mind-Body Medicine and was chairman of the White House Commission on Complementary and Alternative Medicine Policy appointed by President Bill Clinton. The piece, unfortunately, represents many of the common misconceptions about mainstream medicine and CAM (complementary and alternative medicine).

He begins:

Even more distressing, the Affordable Care Act will likely reinforce current practice, which dictates surgical and pharmacological interventions that can be expensive, inappropriate, burdened by side effects and, often, ineffective.

His piece is doomed right from the start. Current practice does not “dictate” drugs and surgery, no matter how often CAM proponents claim that it does. This is simply a straw man designed by CAM advocates to create a niche for their brand. Mainstream medicine uses treatments that are backed by sufficient plausibility and evidence, regardless of modality. At least, this is what mainstream medicine strives for. We acknowledge the implementation is imperfect, and improving the standard is part of what we strive for at SBM.

Philosophically, however, mainstream medicine is not married to any particular type of treatment. It utilizes whatever works. Surgery and pharmacological therapy are certainly important parts of modern medicine, but there are many other treatments as well. These include nutrition, exercise, physical therapy, behavioral interventions, electromagnetic therapies, light-based therapies, radiation, avoidance of risk factors or triggers, and many physiological interventions such as hydration, electrolyte adjustments, oxygen supplementation, positive pressure for breathing, and more.

To portray the full range of medical interventions as “dictating drugs and surgery” is not only demonstrably wrong, it is practically libel against the medical profession. The purpose of this misdirection becomes clear in the next paragraph:

Forty years ago, as a researcher at the National Institute of Mental Health, I began to study inexpensive self-care strategies — then called “alternative therapies” — that might address the underlying biological and psychological imbalances that contribute to chronic conditions. These included nutrition, exercise and “mind-body” techniques like meditation, guided mental imagery and biofeedback.

Nutrition and exercise are squarely in the science-based mainstream medicine camp, but Gordon and others would like to rewrite history and rebrand these interventions as “alternative” in order to lend legitimacy to far more dubious treatments and the overall CAM brand.

He repeats the other very common trope of CAM propaganda, that alternative treatments address “underlying” causes, the implication being that mainstream medicine does not. This accusation always strikes me as ironic, for CAM proponents simultaneously decry science-based medicine for being “reductionist” and not addressing underlying causes. Of course, the purpose of taking a reductionist approach is to find underlying causes. In fact, science is the only tool that has uncovered real underlying causes of illness and allows us to address them.

CAM interventions, on the other hand, are often symptom-based, are overtly not reductionist, and have no hope of addressing true underlying causes.

Gordon’s list of alternative therapies, which he is now trying to rebrand yet again as “self-care strategies” (we’ll add that to the list that includes complementary, integrative, holistic, and functional medicine), includes meditation, guided-imagery, and biofeedback. These interventions all have one thing in common – they are basically indistinguishable from relaxation. There is good evidence to support the conclusion that taking time out of your hectic day to relax is good for your health. This basic physiological truth has been endlessly repackaged by CAM advocates with countless rituals, supported by research showing yet again the benefits of relaxation. What the research generally does not do is identify what is specific to the intervention and show that those specific variables have any specific advantage.

The research is generally of low quality, many studies are uncontrolled are constitute anomaly hunting. They essentially show that when you meditate “stuff happens” in the brain or body. A 2007 systematic review of the meditation research concluded:

Scientific research on meditation practices does not appear to have a common theoretical perspective and is characterized by poor methodological quality. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence.

Gordon goes on to oversell the benefits of nutrition for cancer prevention and “mind-body” interventions (i.e. relaxation) for HTN and diabetes. He concludes:

What was unexamined and alternative 40 years ago is now well researched. It should be fundamental. If we are going to reduce our ruinous costs and improve our declining national health, we must make self-care and group support central to all care.

What is well-researched and supported by evidence are those treatments that are already incorporated into mainstream medicine – which I briefly listed above. We don’t need to come up with a new label for diet and exercise.

Conclusion

The strategy here is clear, it is what I have referred to as the “bait-and-switch” of CAM, and Scott Gavura and others here have called a Trojan Horse. Pretend that science-based medicine only deals with drugs and surgery, then rebrand everything else as alternative, complementary, integrative, holistic, functional, patient-centered, self-care, or whatever. You can also take proven interventions and surround them with a useless ritual or with specific features that add nothing to the overall therapeutic effect, but do create a unique brand.

Then use the legitimate science-based treatments that you have rebranded as alternative as the thin edge of the wedge (choose your metaphor) in order to open the door to a host of truly unscientific nonsense, like homeopathy and acupuncture (which don’t work).

There is one point on which I agree with Gordon – the rising costs of health care are a definite problem in this country and more generally. The most beneficial way to address this problem is to optimize the efficiency of modern medicine – to avoid wasting money on interventions that do not work, on rituals that add nothing, or on specialists based on dubious philosophies of medicine.

We also should strive to get the most out of our biomedical research, which means we should not waste resources researching nonsense that has essentially no chance of yielding useful interventions.

Pseudoscience, sloppy definitions, poor research, marketing hype, and ineffective regulations should be the targets of any effective strategy at reducing waste in medicine in order to lower health care costs.

Posted in: Science and Medicine

Leave a Comment (198) ↓

198 thoughts on “Dialogue on “Alternative Therapies”

  1. goodnightirene says:

    I have stopped reading NYT “health” articles for the most part, so missed this one. You didn’t mention if there were comments, but I have learned that if there are, to skip them when I do read an article if I don’t want to start the day with a big dose of despair. Perhaps alties are more inclined to read, or to comment, on such articles, and I hope that is the case, because the overwhelming majority of comments are very pro CAM. The only skepticism usually comes from some beleaguered MD (or me), who is then verbally assaulted/insulted for his lack of “knowledge” about CAM. One time, I did get a reply that thanked me for my many sensible attempts to inject reason into NYT comments.

    I always link to SBM!

  2. Windriven says:

    It is disturbing to note that Gordon is a medical doctor. A Hah-vahd man, no less. One wonders about a medical education that produces doctors like Gordon who so deeply and completely misunderstand (or willfully misstate?) medical science and clinical practice. One also wonders about the motives of the educated in promoting speculative modalities grounded in hope and superstition. There is clearly something disturbingly wrong in the medical selection/education process that produces these doctors and fails to prevent their rising to positions of authority.

    —-

    “Forty years ago, as a researcher at the National Institute of Mental Health, I began to study inexpensive self-care strategies…”

    Forty years ago a self-care strategy usually involved Playboy magazine and we had a rather graphic term for it. Come to think of it, that word still fits this practice.

    1. Frederick says:

      Maybe, but the same medical education also produced a lot a good doctors, and People Like ( you? you are a doctor I don’t remember) Dr. Novella, Dr, Gorski, Dr Hall’ Andrey pavlov, and all the others great commentators here on SBM. Yes there is this guy and Doctor OZ, and they have reach, that’s the problem. Media and the “normal” persons who give them too much space and credibility they don’t deserve, is, in my opinion, a bigger problem.

      I don’t think that the Medical education is perfect, I think they try too much to pump the ego of doctors, they are “the elite” the “best human around” so some of them start to think that they cannot be wrong.

      1. Windriven says:

        Frederick, I am not a doctor. And I certainly agree that the medical education system has produced many outstanding doctors.

        But something has gone askew in the medical establishment. Silliness and nonsense is embraced as equal to the spectacular advances that science has enabled. Departments of Woolgy are ubiquitous in medical schools and Woology Centers are popping up at every major medical center.

        To my mind something is seriously broken.

        1. Frederick says:

          I do agree with you, but I try to be a little more optimistic, but you indeed have a point.
          In Quebec things are a different with WOO, there’s a lot of woo provider, and Chiro is regarded most of the time as Legit, but i don’t think there’s any hospital with a woo woo center ( I could be wrong, this is a ‘as far As i know’ affirmation) although I know that nurses who do a bachelor degree have somw presentation of woo. One nurses i met already told me she saw a demonstration of a osteopath doing cranial manipulation on bb. Their professor want them “to have a open mind”. She was horrify by this, She also don,t like Woo, but lot of them buy it, unfortunately.

        2. Shari Hoffman says:

          Actually, I know what you are saying but in all seriousness our current health care system IS broken. Did you know that recently in a study: http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries, with one being the best and 48 being the worst, the United States came in 46th place. Countries who have better systems than ours, utilize acupuncture and Chinese Herbs on a daily basis and even in their hospitals. This is because acupuncture and chinese herbs help the body to heal! =)

        3. Shari Hoffman says:

          I accidentally responded to your comment after the next comment. Please see my remark below regarding our health care system that is broken…
          http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries

      2. Shari Hoffman says:

        I am trying to reply to Windriven’s comments but it’s not getting in the right place – Please see my remark below regarding It’s our health care system that is broken…see the following study and the other comments I made about it.
        http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries

  3. Kevin Brown says:

    Steve,
    You should write the rejoinder or just send in this post. Good job.

    Editors’ Note: We invite readers to respond briefly by Thursday for the Sunday Dialogue. We plan to publish responses and a rejoinder in the Sunday Review. Email: letters@nytimes.com

  4. Alexa says:

    I agree. Send it in!

  5. Beth says:

    “Nutrition and exercise are squarely in the science-based mainstream medicine camp, but Gordon and others would like to rewrite history and rebrand these interventions as “alternative” in order to lend legitimacy to far more dubious treatments and the overall CAM brand.”

    I’m not sure this is their intention although it may have that effect. Nutrition and exercise may qualify as SBM, but our current health care system does not appear to give such approaches much in the way of support. Doctors may mouth platitudes to their patients about eating less/better and exercising more, but making gym memberships and healthy nutritious food available and affordable are not generally considered part of the American health care system.

    Belonging to motivational self-help groups like weight watchers in not subsidized. I think it’s easier to get referrals and insurance reimbursement for acupuncture treatments than gym memberships. That puts it in CAM from the perspective of this consumer of health care services.

    1. Windriven says:

      ” Doctors may mouth platitudes to their patients about eating less/better and exercising more, but making gym memberships and healthy nutritious food available and affordable are not generally considered part of the American health care system. ”

      How is encouraging appropriate diet and exercise behaviors “mouthing platitudes?” Doctors aren’t in charge of who pays for gym memberships or what foods are stocked at Safeway. You are confusing political failures with clinical ones.

      1. Windriven says:

        @Sean Duggan

        I want you to see that I’m trying with some success. But on the inside I’m feeding what little is left of her to piranhas.

        1. Sean Duggan says:

          I definitely appreciate that you’re trying, Windriven. I give this one a B. You go a bit on the offensive, but it’s strictly to her points rather than going right to accusing her of being various flavors of alt med from the get-go. :)

      2. Beth says:

        “You are confusing political failures with clinical ones.”

        No, I’m not confused about that. I’m saying that CAM is defined not by whether or not something qualifies as SBM, but how something is supported by our healthcare system. When things like nutrition and exercise and other lifestyle habits are treated as something that is outside the medical care system (which they generally are), then it isn’t unreasonable for people who want to integrate them into healthcare to consider them part of CAM rather than traditional medicine.

        1. Windriven says:

          “No, I’m not confused about that. ”

          Then your words do not say what you mean.

          “I’m saying that CAM is defined not by whether or not something qualifies as SBM, but how something is supported by our healthcare system.”

          Now I understand:

          “When I use a word,” Humpty Dumpty said in rather a scornful tone, “it means just what I choose it to mean – neither more nor less.”

          “When things like nutrition and exercise and other lifestyle habits are treated as something that is outside the medical care system …”

          For those of us who don’t make up our own definitions, lifestyle elements like diet and exercise are not outside the medical care system. Essentially every primary care physician incorporates lifestyle direction in his or her practice.

          Diet isn’t sCAM unless it is diet promising miraculous weight loss from ‘this one simple trick.’ Exercise isn’t sCAM unless it promises six-pack abs in only 5 minutes a day. The fact that your insurer won’t pay your gym membership or lock the door to your local Taco Bell isn’t a medical issue no matter how hard you stomp your feet and insist to the contrary.

          Grow up.

          1. Beth says:

            “When things like nutrition and exercise and other lifestyle habits are treated as something that is outside the medical care system …”

            For those of us who don’t make up our own definitions, lifestyle elements like diet and exercise are not outside the medical care system…The fact that your insurer won’t pay your gym membership or lock the door to your local Taco Bell isn’t a medical issue no matter how hard you stomp your feet and insist to the contrary.

            For those of us who don’t make up our own definitions, lifestyle elements like diet and exercise are outside the medical care system BECAUSE they are not supported and subsidized by the medical care system. That makes them complimentary medicine rather than a standard and integrated part of healthcare in America.

            1. Windriven says:

              ” lifestyle elements like diet and exercise are outside the medical care system BECAUSE they are not supported and subsidized by the medical care system. ”

              Apologies to SD in advance.

              What kind of vapid, indolent thought process leads to that conclusion? Is it not enough that you doctor prescribes doxycycline? You need a subsidy for someone to insure that you take one capsule bid? Where does that end, Beth? Do you need someone to watch you while you brush and floss?

              Will a time come in your life when you don’t need a minder, when you take some responsibility for your actions and for your failures to act?

              1. Neil says:

                That is bad reasoning. Just because you think diet and exercise don’t fall under SBM it makes it CAMs??

                The public needs to take responsibility for themselves. Both diet and exercise are very much Science based and are funded by the state on most countries. The intervention normally comes on the form of counselling / advice / education and sometimes supplements.

                They only become CAMs when a magical property is ascribed to a product. Most claims are just that – claims. No, or very little substance / evidence to explain how the product works.

                Most evidence that does exist for CAMs has been poorly collected and really offers nothing to the credibility of the field.

              2. CHotel says:

                Further on the drug part, I guess medications aren’t a part of the medical care system in North America since neither Canada or the USA have a national drug coverage program?

            2. Sawyer says:

              “That makes them complimentary medicine rather than a standard and integrated part of healthcare in America.”

              I think I see the dilemma here – there’s literally no words left to describe sensible suggestions that would be based on science but not currently employed by major hospitals. The quacks have co-opted every single phrase possible. Alternative. Complimentary. Integrative. Holistic. Personalized. Individualized.

              So while you are technically correct in asserting that some (although certainly not all) doctors are not doing enough to promote proper nutrition and exercise, there is not even a way to accurately describe the problem anymore. The mere act of using a word like “alternative” gives free advertising to cranks, and usually doesn’t help all that much at providing a path for improvement anyway.

              My only hope is that people recognize that the cynical marketing jackasses that came up with all these terms should be ridiculed for dumbing down the conversation about medicine for an entire generation.

              1. Beth says:

                there’s literally no words left to describe sensible suggestions that would be based on science but not currently employed by major hospitals.

                I think you have articulated this issue well.

              2. Windriven says:

                Beth, he’s making fun of you. Exactly how clueless are you? Read Sawyer’s next sentence.

            3. Denise B says:

              And in what sense are elements like diet and exercise supported or subsidized by the CAM system?

              1. Windriven says:

                Oh, nice point.

              2. Beth says:

                They aren’t subsidized by CAM but they are supported by people working in the CAM (such as Dr. Gordon) that provide assistance with it. My point was that the lack of support and subsidy by the healthcare industry is why nutrition and exercise are appropriately classed as CAM.

              3. weing says:

                “My point was that the lack of support and subsidy by the healthcare industry is why nutrition and exercise are appropriately classed as CAM.”

                Oh. I see now. It is CAM because some people in CAM support it. It is not mainstream because mainstream docs just support and prescribe their patients diet and exercise. They, the docs I suppose, would also have to subsidize diet and exercise for therapeutic lifestyle changes (TLCs) to be part of mainstream medicine. Quite a double standard wouldn’t you say? So now, by prescribing TLC for my patients, I am classified as a CAM practitioner? Dang it. I’ve been doing it for free. How do I charge for that?

              4. DW says:

                It seems to me like both sides want to “claim” nutrition and exercise as their turf, since nutrition and exercise really are shown scientifically to do a body a lot of good, yet really can’t be prescribed by a doctor. (I mean, they can be prescribed, but not the way a drug is prescribed; the doctor may advise it, but you don’t need a doctor’s Rx to eat right or exercise).

                The main differences are:

                1) The CAM folks kind of want it both ways – they are often indignant that “doctors don’t care about diet and exercise,” yet if doctors gained some kind of power to ACTUALLY prescribe diet and exercise, imagine the righteous howls of fury.

                2) So … basically doctors just go ahead and do it – advise you to exercise and eat right – without charging for it. CAM artists essentially want to tell you the same thing – what everybody knows – and charge you for it. You’ll never walk away from one of these people without being sold a giant bottle of some extremely expensive substance that you could probably get just from having a spinach salad with lunch or a banana every morning with breakfast.

                It’s called a turf war. It simply pisses CAM-ers off no end that they can’t grab this (diet and exercise) and make money off it, since doctors weren’t already making money off it, because (round in circles) you really don’t need either a doctor OR a “CAM artist” to tell you to exercise and eat right.

              5. DW says:

                Putting that more simply, both sides want to claim what medicine has a legitimate claim to, yet can’t really make money off of. This makes CAMMers mad, b/c they don’t see why they shouldn’t make money off what is essentially a ginormous cash cow, which doctors weren’t using anyway.

                It comes down to clean air, fresh water, fruits and vegetables that grow in the ground or on trees … being outside the purview of what anyone ought to stake a claim for as “treatment.” Do not pack it up for me in a fancy bottle and yammer at me about enzymes or antioxidants (especially when you don’t really know what the F you are talking about), then at the same time complain that “Doctors don’t focus on nutrition and exercise.” Yeah, no they don’t – that’s cus all you need to do to “focus on nutrition and exercise” is get out of the house a bit, and you can stop at the grocery store for the fruits and veggies.

              6. weing says:

                @DW,
                “yet if doctors gained some kind of power to ACTUALLY prescribe diet and exercise, imagine the righteous howls of fury”
                Actually we do prescribe cardiac rehab programs, referrals to dietitians for weight reduction, etc. The prescriptions often don’t get filled as the patients may not value them or the insurance company doesn’t cover them.
                I wouldn’t say it’s a turf war. If a practice shows benefit to the patient beyond placebo, it becomes part of mainstream medical care. If it doesn’t, it becomes or stays CAM. I have no problem with alternative medicine. Sometimes a patient is allergic or intolerant to the recommended drug or not a surgical candidate. Then we use an alternative drug or a non-surgical approach to treatment.

    2. WilliamLawrenceUtridge says:

      I’ll never understand how doctors can be blamed for the failure of patients to eat properly and exercise. It’s not difficult – cook your own food, eat raw fruits and vegetables regularly, and go for walks. Boom, recommendations met.

      1. Beth says:

        I don’t think doctors are to be blamed for that any more than they are to be blamed for any other non-compliance behavior. I’m saying that our healthcare system doesn’t generally treat those things as integral to medical care so you can’t blame people for thinking they are CAM rather than part of SBM.

        1. Lytrigian says:

          And what exactly would make it “integral to medical care”? Do you want the doctor to come to your house and cook your meals for you?

          At some point, individual adult human beings have to take responsibility for their own health and their own behavior. The doctor isn’t your daddy. He’s a professional YOU hire to treat your diseases and advise you about how to prevent disease. If you choose to tread his advice as “outside the medical system”, that’s your problem.

          1. Beth says:

            No, I’m not asking that anyone cook my meals for me. What I’m saying is that if you want diet and exercise to be consider part of SBM rather than CAM, then the healthcare profession needs to take ownership of these issues and discuss how they can contribute effectively to improving the situation.

            For example, making sure vaccinations are available to everybody, regardless of their access to doctors, insurance, etc. is a recognized part of public health. Eliminating food deserts is not.

            1. Lytrigian says:

              Doctors are particularly concerned with access to services that doctors themselves ordinarily provide. They are not well-placed to solve very broad-based and pervasive social problems, such as access to fresh food.

              It’s weird that you consider gym membership essential for getting exercise. Walking will suffice. It’s also weird that you think desserts (note spelling) per se are the problem.

            2. Lytrigian says:

              Derp. Talk about misreading.

              Yes, “food deserts”. It’s not a phrase I encounter often. Again though, that’s a major social issue which medical professionals are not well-placed to address. You can’t lay every such problem at their feet.

              1. Beth says:

                It’s weird that you consider gym membership essential for getting exercise. Walking will suffice.

                I wouldn’t call gym membership ‘essential’. I would call it effective yet unsupported. Sure, walking will suffice. For people who can manage that because they are ambulatory, live in a place with safe spaces to do so and appropriate climate most of the year. Not everyone does.

                If ‘exercise’ was considered part of standard medical treatment for some conditions (like depression), then providing what is needed to successfully integrate the treatment into one’s life would be supported within the system. Generally, it isn’t. That’s why I think its reasonable for people to consider it CAM.

                Again though, that’s a major social issue which medical professionals are not well-placed to address. You can’t lay every such problem at their feet.

                I agree, but I think that if the healthcare profession is not front and center in advocating for solutions to such problems, then they can’t claim that diet and nutrition are part of their bailiwick and therefore, not CAM.

                It’s not that I expect doctors to solve those problems. It’s that I don’t think it’s reasonable to claim diet and nutrition are part of the standard medical care and, at the same time, abdicate responsibility for addressing the issue.

              2. Harriet Hall says:

                I’m afraid I don’t understand what you mean by doctors “abdicating responsibility.” What exactly would you have them do?

              3. Beth says:

                I’m afraid I don’t understand what you mean by doctors “abdicating responsibility.” What exactly would you have them do?

                That’s a good question Harriett. I am not a professional in the medical field, although quality improvement is a specialty of mine.

                Consider the comparison of TV watching with small kids. A potential health problem for kids was identified and pediatricians started asking parents how much TV watching their kids did. Just having them start asking the question had a positive (or rather negative :) ) impact on the amount of time parents allowed their children to watch TV. That’s the sort of positive advocacy I think that individual practitioners might implement.

                I’m sure there are industry guidelines already developed about what important points a good physician will cover during a well-person visit, what blood tests are recommended for a particular person, based on their age, gender, etc. They don’t ask probing questions about diet and exercise – how much fiber they eat? what percentage of calories come from fat? How many times did you exercise last week?

                I don’t know what the right questions are to ask, but I know there’s some professional body tasked with developing standard procedures for medical exams including what questions are asked.

                If diet and exercise are important for good health, giving people the advice like:

                If it’s as simple as “It’s not difficult – cook your own food, eat raw fruits and vegetables regularly, and go for walks. Boom, recommendations met.

                is what I mean by ‘mouthing platitudes’.

                If it’s as important as it is claimed to be for good health, then I expect physicians to be either asking me something like the questions above or including tests that will give them the answers they need to provide recommendations.

                Look, I understand that time is limited AND nutrition and exercise affect the body in many interrelated ways, etc. I don’t even know that nutrition and exercise are so important, that they should crowd out other, more technical tests and evaluations.

                BUT if those habits are as important an indicator of potential health problems as say, high blood pressure or smoking, shouldn’t your professional organizations be figuring out what indicators to check regarding them and if they’re not good and the patient doesn’t improve, following up with connections to supportive services to help them manage the problem?

                The fact that these questions aren’t asked (at least my doctors haven’t, with the exception of my kids pediatrician), my interpretation is that doctors do not consider diet and exercise important enough to include checking up on patients habits in those areas as part of their professional duties.

              4. Harriet Hall says:

                “my interpretation is that doctors do not consider diet and exercise important enough to include checking up on patients habits”

                My interpretation is that doctors consider diet and exercise very important but they don’t spend much time checking up on patients’ habits because they have limited time. Doctors know they can’t be all things to all patients. There are others who can work with patients on specific details of nutrition and exercise; a team approach is far better than a doctor trying to go it alone. The time limitation is a problem of the entire health care system and there is no easy fix, but meanwhile doctors tend to inquire about what they perceive as most important. Smoking is the biggest preventable cause of death, far more deadly than poor diet, obesity, or inactivity, and I am asked about my smoking status every time I see a doctor. I think a lot of doctors get very frustrated by lack of compliance with lifestyle advice: you can lead a horse to water, but you can’t make him drink; and after he has refused to drink a hundred times, it is only natural if you are no longer so motivated to lead him to water. Also, doctors are unwilling to be too dogmatic about things that have not been well established by scientific evidence. For instance, I think it would be a big mistake at this point to preach to patients about Taubes’ lo-carb diet.

              5. MadisonMD says:

                I think Beth asks a good question about whether primary care doctors could improve health by changing how they address diet and exercise.

                The truth is, however, that this could best be addressed by research to answer the questions, viz: (a) what is the optimal recommendation to actually improve health outcomes? (b) how can the information be delivered most effectively (e.g. the TV example with children).

                I’m not sure how labeling it CAM really helps the issue. CAM/alt med/int med etc. are marketing terms for interventions not in the purview of medicine because they lack sufficient evidence.

                It has already been said, but bears repeating, that Dr. Weil and his ilk don’t buy you fresh food or pay for gym memberships either, so it is odd calling those things CAM because they are not covered by insurance. In fact, Dr. Weil sells you vitamins that don’t improve your health and are not covered by your health insurance.

            3. MadisonMD says:

              For example, making sure vaccinations are available to everybody… is a recognized part of public health. Eliminating food deserts is not.

              I think public health officials would beg to differ. See what these public health organizations have to say: CDC, USDA, HHS. I haven’t drilled down to state and city health departments. There is also a good deal of activity on this front in schools of public health around the US.

              1. Beth says:

                Thank you. I’m glad to hear that the problem is getting some attention by the healthcare profession. I think that is a sign that nutrition/diet is moving into being part of standard medical care. But I don’t think it’s there yet.

          2. Shari Hoffman says:

            Beth,
            I agree with you wholeheartedly. I think that our doctors should get more involved with the foods we are eating. They should provide lists of what the best foods are for our “type.” FOOD IS MEDICINE and should be considered so…Stay with your thoughts and pursue them!!!
            =)

        2. DW says:

          That’s ‘cus they AREN’T “integral to medical care.” Neither is, say, getting a good night’s sleep, or trying to get a little sunshine every day, or doing deep breathing exercises for relaxation or stress reduction. Neither side “owns” this, Beth. The doctor might, for instance, say very simply that health-wise you probably need to drop a few pounds. They don’t then whip out a prescription pad for this because no prescription is needed to try to reduce calories or avoid a sedentary lifestyle, and if doctors COULD prescribe this we should all be legitimately outraged. It’s like trying to sell air. Doctors sell MEDICINE because that’s what a doctor IS – a medical expert and that’s what his/her training has equipped him or her to offer to you: medical advise for medical problems.

          Cammers are simply outraged that they can’t earn equally big bucks selling air, or little bottles of sugar water (homeopathy), or the like.

    3. Dave says:

      If we want healthier people as a society we could make sure we have safe bike trails, plenty of recreational areas to jog or hike, municipal tennis and basketball courts, roads geared to cycle commuters as well as automobiles, etc. Good luck with that in a fiscal economy where even the essentials are underfunded. To expect your insurance company to pay for a health club membership I think pushes the boundary a bit about what health care insurance is for. I’m not sure what you expect doctors or nutritionists to do other than advise people (I don’t see this as mouthing platitudes). We aren’t parents or policemen, and we can’t go to the grocery store and make sure our patients buy good food. We also can’t demand they spend part of their paycheck for a health care membership. People have to take some responsibility for their own behavior.

      1. Beth says:

        I agree with what you have said, but I do think that if the medical profession wants people to consider nutrition, exercise, etc. to be part of SBM rather than CAM, then the healthcare industry needs to support access to those things for all Americans. For example, food deserts are not considered a problem that needs to be addressed by the healthcare system. If the traditional medicine industry is going to neglect lifestyle approaches to dealing with chronic health issues, then you can’t blame the rest of society for considering to be CAM.

        1. Windriven says:

          I just love how you say you agree and then promptly disagree. And really, enough with the strawman, k?

          “For example, food deserts (sic) are not considered a problem that needs to be addressed by the healthcare system.”

          When your doctor tells you to push your fat ass away from the dessert cart or learn how to self-administer insulin, the dessert problem is being addressed by the healthcare industry. Do you really need your insurer to pay for someone to come to your home and take away the twinkies?

          Diet and exercise are not sCAMs. We have entire scientific disciplines devoted to diet and exercise. Repeatedly setting up this strawman and knocking it down does not make it true, does not make it profound, does not even make it less transparent.

          1. Beth says:

            You can claim that diet and exercise are not part of CAM all you want, but that’s not how most people, who are not part of the medical profession, view the term. The writer of the New York Times article, the director of the Center for Mind-Body Medicine who was chairman of the White House Commission on Complementary clearly considers them part of CAM. Why is your definition the only one that should be used?

            I’m sorry, but if you don’t understand the difference between suggesting that food deserts are a public healthcare problem is equivalent to asking that insurance “pay for someone to come to your home and take away the twinkies” then I don’t think we can have a productive conversation.

            1. Dave says:

              You might be correct that these aren’t regarded as part of mainstream medicine, possibly due to CAM continually shouting that it isn’t – just as they continually shout that mainstream medicine does nothing to keep people healthy (ignoring the repeated warnings doctors continually give re smoking cessation, diets as we are discussing, vaccinations, and control of conditions which are risk factors for serious health problems, hypertension being an example – you don’t think we treat hypertension just to lower a number, do you?). The dieticians, diabetic nurse educators and physical therapists in charge of the weight loss program and cardiac rehab programs at my facility might disagree. This might be a marketing problem for mainstream medicine.

              So what do you think is the solution? Standard medical advice is to exercise, limit portion sizes, eat lots of fruits and vegetables, eat whole grains rather than refined flours, and limit sugar intake to less than 10 % of calories, as well as avoiding too much fatty red meats. What more do you expect?

              1. Beth says:

                In general, I think what you describe at your facility is the direction the medical community needs to move if they want to bring diet and exercise to be considered part of mainstream healthcare. I’m not sure I would call it a ‘marketing’ problem, but I think marketing is part of the whole situation. I also think our cultural attitudes are part of it.

                I’m not sure what the “solution” is, assuming there is one. But education – i.e. standard advice – isn’t enough. Lifestyle changes are hard for people to accomplish and maintain Systematic support and direction can be instrumental in getting it done.

                It doesn’t have to be expensive, self-help and group-help can
                be both cheap and effective. But they aren’t always available. If assistance in accomplishing such lifestyle changes aren’t available to consumers via supported medical providers, they aren’t going to be considered part of mainstream medicine.

              2. Windriven says:

                Jesus Dave, really?

              3. Dave says:

                Running tracks, cycling paths, etc should be part of community planning. They should not be part of hospital grounds – hospitals are strapped enough as it is. Similarly, health clubs should be available but I don’t see they should be supported by already stretched health care dollars. A thirty year old who wants to join a tennis club should be able to without engaging the health care industry. Dietary advice, phusical therapy and exercise advice are readily available now through mainstream medicine. I don’t expect my health care insurance to buy my running shoes or rock climbing gear, nor do I expect my doctor to be pandering exercise equipment.
                His job is to encourage healthy behavior. It’s up to the patient to do it.

                Personally I think lifestyle education should be part of the school system. Schools pour enormous resources into basketball and football teams, which benefits maybe a dozen students from a health standpoint (and who sees a 40 year-old still playing football?). A better use of money would be to get all the kids involved with sports they can continue to do into their 70′s such as tennis, handball, cycling, etc. Running has been great for that. Instead of 10,000 people in a stand watching 5 athletes who can run a mile in 4 minutes, a road race may have thousands of people who are running at an 8-10 mile pace.

          2. MadisonMD says:

            Win, Beth did mean food desert. It is a common urban problem in this country. It is being addressed by public health authorities, contrary to Beth’s assertion that “food deserts are not considered a problem that needs to be addressed by the healthcare system.”

            I’m not sure what constitutes the healthcare system to Beth, I linked fed public health authorities CDC, USDA, HHS here. If she means professional societies, this is covered by the American Nutrition Association, and by many schools of public health. The American Medical Association has focused on teaching physicians how to improve patient counseling on obesity and even <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/community-health-leadership.page?"trains physicians to become community health advocates, because of the obesity epidemic. But unlike the public health authorities, I don’t see any AMA position on food deserts.

            1. Windriven says:

              Indeed, I misread that, but it is trivial and secondary to Beth’s apparent argument that political cowardice and fecklessness are medical issues. They aren’t. They are political issues with medical consequences. Medicine has plenty of serious core problems to solve without being drawn into battles over gym memberships and the availability of fresh fruit in the inner city.

              Refer back to Beth’s original comment at 6. These threads tend to wander off in many directions.

              1. MadisonMD says:

                Yes, I agree with you, Win. I have been so persnickety of late, but, in defense, I have come to expect >95% accuracy from you.

                Defining CAM as anything not covered by med insurance is odd. Brushing teeth, laser eye surgery, bowling, and a drink of fine bourbon apparently qualify as CAM under this strange definition.

              2. Windriven says:

                And Madison, I was sincere in thanking you for the wake-up. I am a person of strong positions and sometimes I read what I expect to read instead of what is written. It is something I’ve been working on all my life. You’d think I’d have gotten a bit better by now!

          3. NotADoc says:

            To make sure everyone here is arguing about the same thing: a “food desert” (NOT dessert) is an area, often in low-income sections of inner cities, where there is no decent grocery store within walking or reasonable public transportation-accessible distance. If a bodega stocking sodas, chips, and candy and three fast food outlets are your only reasonably convenient sources of food, you live in a food desert.

            1. Windriven says:

              Agreed, NotaDoc. I misconstrued that particular comment and perhaps others echoed my thought without revisiting the original. For that I am truly sorry.

              That said, food deserts are a political problem with health consequences -among several others. Living in an inner city shithole isn’t just about limited food choices and crummy playgrounds. It isn’t even mostly about that. It is about being a perpetual target for crime, crappy educational opportunities, constant exposure to substance abuse, marginalization of women through, among other causes, prostitution, and a general degradation of any notion of self worth because if you live in an inner city shithole it must be because you belong there. So when some little snot lectures about how diet and exercise are sCAM because doctors don’t open green bodegas and health clubs on Hough Avenue* I start to delaminate.

              The fact that we are even talking about food deserts in 21st century America is absolute proof of the abject failure of the political class, and of our own failure for voting those cowardly morons into office. Repeatedly. We can drop a trillion dollars on Wall Street so that Jamie Dimon’s bonus check doesn’t bounce but we can’t make sure that a 10 year old girl in Detroit has decent food, decent educational opportunities and decent health care?

              Sorry for the tirade. But this sort of socio-political cluster-f*ck is the product of the same sloppy thinking that gives us naturopaths clucking about vaccinations and homeopaths ‘curing’ syphilis with water.

              And on this one teensy-tiny point Beth and I might agree: a country that spends a fifth of GDP on healthcare but feeds its poor Slurpees and potato chips is preparing itself for the Caligula for President campaign.

  6. STeven says:

    I would argue that biofeedback *is* distinguishable from meditation and guided-imagery and is not merely a form of relaxation.

    Relaxation is often a component of biofeedback training, but biofeedback is about making demonstrable, real-time physiological changes, assisted by the, well, feedback about specific physiologic states.

    In 1974, by using biofeedback, I learned to control the temperature in my hands as a possible cure for migraines (after the medication I was taking stopped working and my neurologist had no other recourse).

    In short, within a couple weeks I could rapidly change the temperature in my hands by +/- 5-8 degrees, and when I would increase my hand temperature when I noticed the onset of migraine symptoms, the headaches would not follow and, eventually, stopped completely.

    1. weing says:

      “But they aren’t always available. If assistance in accomplishing such lifestyle changes aren’t available to consumers via supported medical providers, they aren’t going to be considered part of mainstream medicine.”

      Interesting take. So if your insurance plan doesn’t cover the BP med or chemotherapy regimen or colonoscopy I prescribe for my patients, then that medication, chemotherapy regimen, or procedure are not going to be considered part of mainstream medicine?

      1. Beth says:

        So if your insurance plan doesn’t cover the BP med or chemotherapy regimen or colonoscopy I prescribe for my patients, then that medication, chemotherapy regimen, or procedure are not going to be considered part of mainstream medicine?

        No. My take is that Complementary and Alternative Medicine are those health strategies other than those prescribed by doctors. Smoking cessation aid is considered medicine these days. It wasn’t always. Asking if you smoke and how much is a routine question for medical exams. The % fat content of my diet is not something that my physician takes note of as part of my routine medical exam. Nor does she ask about the frequency, duration and intensity of my exercise routine.

        This is for that reason I think nutrition and exercise are making their way into standard medicine, but they aren’t part of it yet.

        There is no reason to assume ridiculous interpretations of an off-the-cuff description of why I don’t find things like nutrition and exercise part of routine medical care. I would appreciate it if you didn’t do that to me.

        But I’ve said my piece. The author of the NYT piece, who can be considered a legitimate authority on what is and isn’t CAM, agrees with me and was arguing that the medical profession needs to accept it as a legitimate part of medical care. Why would he be making that argument if it was already the case as the OP claims?

        1. Windriven says:

          “The % fat content of my diet is not something that my physician takes note of as part of my routine medical exam. Nor does she ask about the frequency, duration and intensity of my exercise routine.”

          If you are of reasonable BMI, height and weight proportional, and your lipids are in order, your cardiovascular health good, why should she. If they aren’t, you need a new PCP. My internist asks me about exercise every visit despite my being in good health. And when my weight bumps up a few pounds she inquires pointedly about changes in diet or exercise.

        2. Lawrence says:

          Beth – are you advocating the doctors enforce strict rules (and perhaps enact laws) that force people to eat they way they would like them to & also force them to exercise?

          That sounds a bit fascist to me…..

        3. weing says:

          “There is no reason to assume ridiculous interpretations of an off-the-cuff description of why I don’t find things like nutrition and exercise part of routine medical care. I would appreciate it if you didn’t do that to me.”

          I’m sorry, but all of CAM is ridiculous to me. The logic is just impossible to follow, as you yourself demonstrate. CAM is not legitimate medical care. If it is legitimate and works, it becomes routine medical care and stops being CAM. Diet and exercise have always been part of medical care, at least for my 30+ years of practice. Your NYT friend is full of it.

        4. Dave says:

          A few years ago in my state some legislators came up with the idea that medical professionals needed to assure that their patients had a place to live when they were discharged. Of course, they didn’t create more homeless shelters. This didn’t go very far. It’s not the duty of the health care profession to fix the homeless problem, though you’d be amazed at how much of discharge planning revolves around this issue and around making sure patients have adequate resources when they go home. Other tasks the health care field have been asked to address is gun violence, domestic abuse, and child abuse. These, like poor access to good food, are societal problems which are beyond the capability of the health care profession to solve.

          Beth, despite all the comments I think most of us agree with you that access to good food is important and that exercise is important. But the solution to these problems lies outside the doctor’s office. Part of it lies with the patient himself, part with society ensuring safe places to live and exercise and adequate access to good food. In the 1950′s it was discovered that American children were less fit than kids in Europe and the President’s physical fitness program was initiated. This was shortly after sputnik was launched, which caused a big political push for better science and math education. Sadly, studies have shown that current kids are less fit than kids in the 50′s, but there’s no political will to address this or much of anything else right now. If there was will it would be derailed by the current confrontational Congress. The only thing they can agree on is to give themselves raises.

          One of the funniest political cartoons I’ve seen was several years ago, after a 4 year old child fell past guard rails into a gorilla compound at a zoo. One of the female gorillas went to the child and cuddled it until zookeepers could retrieve it. At the same time Congress cut funding to a program for indigent children. The cartoon showed a toddler facing a gorilla and a prosperous congressman with the caption, “Who is this child safest with?”

          Diet and exercise have been recommended by mainstream medicine for ages. Gordon has a skewed viewpoint – “Gordon directs the Center for Mind-Body Medicine and was chairman of the White House Commission on Complementary and Alternative Medicine Policy appointed by President Bill Clinton”. And just because he’s in a major newspaper doesn’t mean anything other than that he’ll sell copies.

        5. Andrey Pavlov says:

          My take is that Complementary and Alternative Medicine are those health strategies other than those prescribed by doctors. Smoking cessation aid is considered medicine these days. It wasn’t always. Asking if you smoke and how much is a routine question for medical exams.

          You do realize you just said exactly what our argument is as to why CAM is not a valid (or at least not useful) category?

          Before evidence that it was reasonable to do, of course smoking cessation and questions about smoking wasn’t part of the regular medical care.

          You are re-iterating that CAM is whatever hasn’t been proven or has been disproven and medicine is everything that has been.

          You may wish to complain that certain types of medicine (like nutritional advice) is not done routinely enough or that it was too slow to be adopted. That is a valid indictment of the system of medicine. It is not in any way relevant to, nor validate, CAM.

          agrees with me and was arguing that the medical profession needs to accept it as a legitimate part of medical care

          And that’s the problem. If there is no evidence to support it, we can’t ethically do that. But once the evidence is there, we aren’t trying to “do CAM.” We are trying enforce best practices. The data shows that smoking cessation counseling is effective. So we do it. We learn it in medical school and are tested on it and expected to do it. If we do not, and it is learned about, we are reprimanded and told to shape up.

          That is not the practice of CAM. That is the practice of best practices in medicine.

        6. simba says:

          So if CAM strategies are those other than those prescribed by doctors, then paracetamol is now CAM? And if you mean it in the sense of reccommended, then acupuncture and homeopathy now aren’t CAM because some doctors recommend them?

          How, exactly, could one prescribe exercise? Why would one need to?

          Every time I go to my GP they ask me about my weight, my sleep, how I’m eating, and encourage me to follow a healthy diet, have I taken up smoking… All of these are part of the remit of science-based medicine. If it’s based on science, it’s part of science-based medicine, and thus not CAM. Because it doesn’t need to complement anything, or be an alternative to anything, and can be incorporated into general medical practice. Now, those who support CAM will attempt to broaden this definition.

          Your argument is based on your definition of CAM, which doesn’t seem to be either useful or well-defined. Perhaps if you clarify this would help, as at the moment it gives the impression that you are not quite clear yourself what you intend to express. At the moment you are reinforcing the idea that CAM is a nebulous and not useful distinction, which means whatever the person using it decides it does for that discussion.

          It’s also interesting that you seem to define ‘not CAM’ as those interventions supported, presumably in the U.S., by a notoriously flawed health care system. It’s a big world out there.

  7. stanmrak says:

    As someone who has meditated intensively every day for 9 years (using a science-based audio technology that eliminates the discipline and effort!), I can tell you that there’s waaaaay more available from meditation than “relaxation.” Way more. Of course I can’t prove it, but don’t need to. I just call it magic. : ))

    1. DW says:

      The real question is who ought to make money off of that – your meditation routine. When you say that you are using a “science-based audio technology that eliminates discipline and effort!” my spidey senses tell me SOMEONE made money off you for this, and I bet it wasn’t an MD.

    2. Shari Hoffman says:

      Good for you! =))

  8. TBruce says:

    The main reason for the “ruinous costs” of the US health care system is the absence of a single-payer system. Health costs as a percentage of GDP in the US is almost twice that of any of its peer-group nations (Canada, Australia, Western Europe, Japan etc), with arguably worse results as a whole. SCAM isn’t going to do a thing except add to those costs without measurable results.

    1. Windriven says:

      “The main reason for the “ruinous costs” of the US health care system is the absence of a single-payer system.”

      I would agree that the wasteful and inefficient US health insurance system is one reason though I’m not sure it is the main one – or that a main one can even be identified. There are so very many inefficiencies and so much blatant profiteering that the costs are assured to be ruinous.

      1. Carl DiGregorio says:

        The best analysis I have read is Steven Brill’s TIME mag article, 4 Mar 13. In the several pages, he dissects the mess we’re in because of ” outrageous prices, egregious profits” etc. and details much of what is wrong with the health care delivery system. His closing comment quotes Gerard Anderson, a health care economist at the Johns Hopkins Bloomberg School of Public Health who says the obvious and only issue is: “All the prices are too damn high.”

        1. Windriven says:

          Thanks Carl. To be honest I didn’t know Time was still in business. But I’ve read some of Brill’s other work and I’ll definitely try to find the Time piece.

          1. Windriven says:

            Found it. But you have to subscribe. You can’t just buy the article. Time’s missing a bet.

            1. SteveJ says:

              Windriven,
              I downloaded a copy from the library. Can I send it to you?

              1. Windriven says:

                I would be most thankful. In fact I was going to do the 1 week subscription so that I could get it. Your generosity is much appreciated.

                Windriven at gmail dot com

      2. The main cause of high health care costs is chronic disease, which results from unfortunate combo actions of gene types and toxins. They are reversible when you remove toxins, and support health. No patents involved, so pharma doesn’t promote thos

        t

        1. Chris says:

          “They are reversible when you remove toxins, and support health.”

          List those toxins and explain clearly how they are removed. Make sure to include the supporting scientific evidence. PubMed Identification Numbers will suffice.

          I am particularly interested in obstructive hypertrophic cardiomyopathy and complex migraines.

  9. steney01 says:

    On the one hand Dr. Gordon’s editorial is the most benign alternative medicine stump speech I’ve ever heard. “We should all take care of ourselves and seek support groups!” (oh whoops, I forgot, we’re calling it “self-care” and “group support” now).
    But on second thought, I’d love to know under which circumstances Dr. Gordon expects us to shun actual medical care in favor of meditation and support groups? Is it when we have a cold? Is it when we’re depressed? Is it when we have cancer?

  10. RobRN says:

    “… ALTERNATIVE interventions that can be expensive, inappropriate, burdened by NO effects and, ALWAYS, ineffective.” :-)

    1. Shari Hoffman says:

      On the contrary, Alternative interventions are incredibly useful but they need to come down in price. The only medicine that has been helpful to me has been alternative/holistic but I am on SSD and cannot afford it. Something must give!!!!

      1. Shari Hoffman says:

        P.S. The reason I’m on SS Disability to begin with is because we have such a poor medical system. They let me fall through the cracks. That is the ONLY reason I am on SSD. And THAT is pathetic.

  11. Vicki says:

    It’s not my doctors (or their nurses and other assistants, or the dentist and hygienist, or the physical therapists I have seen) who decide what will and won’t be covered by my health insurance.

    So it’s not fair to blame them for the fact that my spouse’s employer covers visits to doctors, medication, dental cleanings, and imaging and other tests for both of us, and a gym membership only for him.

    If you think the public health budget should include lessons in healthy cooking from scratch, or making sure that everyone has access to a working kitchen and a decent grocery store, I’m not going to argue with you. But I’m also not going to accept your claim that my doctor is somehow more responsible for getting that changed than my legislators, the owners of the various chains of grocery stores, or even the people who drive the buses.

    1. Beth says:

      I’m not saying that doctors *should* be responsible. I’m saying they IF doctor’s are going to claim diet and medication as part of standard medical care for their patients and not part of CAM, THEN the healthcare industry need to accept responsibility for dealing with those issues and figuring out solutions.

      1. Tired says:

        Oh, Beth. How cute!

        British Columbia offers free visits and a free hotline to nutritionists and dieticians. Alberta is considering adopting the system, as well as other provinces.

        Ultimately, though, they’re lifestyle specialists, not healthcare practitioners.

      2. Missmolly says:

        I guess the US must have a very different system from Australia. Here, preventative medicine (largely focused on diet, exercise and smoking/alcohol cessation) is pretty massive* (no pun intended), and is primarily driven by medical research groups and medical professional lobby groups (ie the NH&MRC and the AMA). There are a broad range of public guidelines on drinking, eating and exercise- considered a medical emergency due to our increasing levels of obesity and endemic alcohol abuse issues.
        25% of the cardiac rehabilitation program I attended in 2011 was dietary information provided by a dietician; 50% was exercise based & run by physiotherapists- both groups clearly a part of SBM and nothing to do with CAM.
        With so many chronic diseases of adulthood rooted in modifiable health behaviours, it would be retarded if doctors had no interest in these issues. Which is why the majority of health recommendations for common lifestyle related medical issues recommend addressing the lifestyle issues well before resorting to medIcation.
        So how much attention from doctors is ‘enough’ to place ‘lifestyle advice’ in the medical domain rather than the CAM domain? Just this week, my cardiologist interrogated me on the number of standard drinks I partake in each week, the ethics of my marathon training and the number of servings of legumes I currently consume- seriously! And I can’t escape my GP without a discussion in some aspect of diet, be it maintaining b12 levels or increasing iron and calcium consumption during training. I always ask about physical activity and dietary habits in my long term follow up clinics for leukaemia survivors, because I know that these kids are at statistically greater risk for metabolic syndrome.
        And I think that if your GP doesn’t ask about lifestyle issues or palms off your concerns about these subjects, then they might be … a little bit, well, shit. I know that’s a bit harsh, but it actually doesn’t take that much extra time. Addressing these issues IS standard medical care. No magic required.
        *Please ignore the fact that the new Aus federal government just slashed the preventative health budget. They are clearly moronic vandals- as evidenced by the rest of the budget.

  12. “open the door to a host of truly unscientific nonsense, like homeopathy and acupuncture (which don’t work).”

    Please do not place acupuncture into the same basket as homeopathy.
    Acupuncture has a profound truth associated with the discipline.
    I have no idea about Homeopathy.

    That is totally irresponsible, wrong, deceptive, confusing to your readers and maybe liable if they take the statement as true and delay a beneficial therapy which will do harm.

  13. Kiiri says:

    To address Beth and her single minded persistence about food deserts and the like, yes public health folks are working on those issues. The problem comes down to one thing – money. Most federal, state, and local health departments have seen their funding slashed in recent years with estimates of around 20-30% of the public health workforce being lost. With so many PH professionals scrambling to pick up the slack (many entire programs have been lost the HD I worked for lost our entire tobacco education and public outreach section) and work on core mandates (vaccination, outbreak control, food safety) all other work is simply not being done. Not because we feel it shouldn’t be done but because there are no resources to support it. And not because we don’t know what to do, the science is pretty clear on that point. With every state and local government still trying to drum up revenue you try convincing politicians to PAY for it. If you really want to have an impact organize your community, petition your legislators, and do something! It shouldn’t all be left up to the professionals in the field to find the solutions. Yes we know diet and exercise are important. Yes we know interventions exist to help people but we have no resources to implement them! We need people to get engaged and advocate on their own behalf. And most of us in this fight do advocate on our own time (you have to be careful about that if you work for state or local government, we are restricted in what we can do) for change. You can too, instead of complaining doctors aren’t doing enough. They are doing their best and my hat is off to them.

  14. Rigid medical orthodoxy harms more patients because doctors lose the ability to read, think and learn outside the box, where advancements are moving at the speed of light.

    Generic glitches and toxins are indeed the causes of inflammation, oxidative stress and chronic diseases. Functional medicine does effectively compensate for many genetic glitches by supplying the right byproducts.

    1. Missmolly says:

      General glitches and toxins- sounds super-duper technological advancementy. Enlighten me- are the general glitches quantum? And what are the byproducts OF?

    2. DW says:

      Right, but YOU still have the ability to read and learn outside the box, all at lightening speed? Snort, and let me guess I ought to buy your product, ‘cus it does something groovy like repel toxins or “oxidative stress.”

  15. FredJ says:

    I will repeat what I said on Dr. Crislip’s article from today. This is not a regular article or op-ed, where comments are rarely seen unless you search them out. This is a “dialog”. The Times will publish a decent response right below the article. It’s a major opportunity to get the word out–not to mention counter the garbage that was originally published. They always let the article’s author have the last word, so any response has to be brief though carefully crafted, with an effort to assume what the final response would be, and cut it off in advance. This is not easy, but the SBM board and contributors are a bright bunch, and I know they can do it. Don’t pass up this chance. It may not come again in such a gift-wrapped fashion. No excuses. If the SBM authorities cop out, then one of the better and most articulate commenters, like Windriven, should pick up the ball. Please.

  16. Shari Hoffman says:

    Dr. James Gordon is right on target. My health problems cannot be resolved through our Western medicine. But they can be resolved through alternative and Chinese / Indian medicines. Western medicine does not come even CLOSE to what acupuncture and Chinese herbs can do for me. The same with Functional Medicine. My whole life was ruined because I grew up with deficiencies in my digestive system and a hormone imbalance. I was in pain and unable to function and yet my regular doctors did not even know about any of it. This is a nightmare. Now all that needs to be done is to make Functional Medicine and Alternative medicine and supplements AFFORDABLE!!!

    Shari Hoffman
    New Haven, CT

    1. Chris says:

      Wow, that is racist.

      You are discounting the work in real medicine done by the Chinese and Japanese (artemisinin for malaria, statins and the DTaP vaccine), and the great leaps done by Indian medical programs to eliminate polio in their country.

      Have you no shame? Or sense of geography?

    2. Harriet Hall says:

      Thank you for enlightening us! We will immediately give up the scientific method and adopt alternative and Chinese/Indian medicine just because someone we know nothing about provides a vague, undocumented testimonial. :-)

      1. Shari Hoffman says:

        I will let you know when my book comes out. And you will find out what it was like for me to grow up here in the USA without Chinese medicine. As a result I never had a childhood and I am just starting my life at age 50 because of the poor medical care in this country. No, I’m not racist at all. I appreciate the vaccines I had when I was a child and the antibiotics when I had strep but that was pretty much any doctor has done for me. And THAT is sad!

        1. Chris says:

          No, what is sad is that you have not read the articles on this website, and cannot make any substantial comment based on evidence.

      2. Shari Hoffman says:

        See my comment below. You will know about me when my book comes out. It tells about how I had to live without ever having access to Chinese medicine and Holistic Medicine. I was so exhausted I could no longer function, walk, or stay awake while driving. And our Western doctors who I would go to for regular check ups would not even be aware that I was living like that. That IS an embarrassment to our country’s medicine.

        1. Harriet Hall says:

          Send me a review copy of your book when it comes out, and I will review it here on the blog.
          For the time being, one question: if you were so unable to function, whose fault was it that your doctors were not aware of it?

          Also: if you couldn’t walk, how did you get to the car and to the doctor’s office? Surely if you were unable to walk into the office, the doctor would have had some awareness of your condition.

          1. Shari Hoffman says:

            Your comment is pitiful and you do not sound very educated.
            The fault is that of our US Health care.

            “The concept of holistic medicine is not new. In the 4th century B.C., Socrates warned that treating one part of the body only would not have good results. Hippocrates considered that many factors contribute to the health or otherwise of a human being, weather, nutrition, emotional factors, and in our time, a host of different sources of pollution can interfere with health. And of course, holistic medicine existed even before ancient Greece in some ancient healing traditions, such as those from India and China, which date back over 5,000 years. However, the term “holistic” only became part of everyday language in the 1970s, when Westerners began seeking an alternative to allopathic medicine.”

            But Western doctors did not listen to people like Socrates and so they really do not know what is going on inside our body. They think that listening to your heart and lungs is all that matters.

            I had deficiencies in my Digestive System that caused me to grow up being hungry constantly, and barely being able to learn as a result. i.e. when your digestive system doesn’t work it effects how your mind works. If your brain is not being fed it does not have the energy to think.

            Eventually stress like that everyday on the body causes additional problems and so when I was 11 a hormone imbalance started that made me so exhausted that eventually my arms and legs felt like lead. That’s what I mean when I say I couldn’t walk. I fell asleep in my college classes and the whole time I was diagnosed with a psychological problem instead of PHYSICAL problems. That’s SAD.

            I didn’t know any other way to feel so I could not voice to a doctor how poorly I felt. I needed them to know ME and they couldn’t.

            BUT NOW Holistic medicine can peform SCIENTIFIC / FUNCTIONAL testing that provides incredibly on target results that provide the patient with details about what kinds of supplements they need to be able to function. Unfortunately, the cost of going to holistic doctors is prohibitive and so can the costs for the supplements and they are not covered on any medical insurance, which is very frustrating.

            So you have to be RICH to be WELL, is how I see it now. Which is very very sad, We really need to change this around so that EVERYONE has access to WELLNESS :) across the board – no matter who you are or what you do – This would promote happiness and harmony I am SURE :) !!!

            1. Harriet Hall says:

              1. However I “sound” to you, I am in fact very educated: 11 years of education after high school, Phi Beta Kappa, magna cum laude; and I am educated in how to write proper English. I know better than to confuse “effects” with “affects” and to write “I couldn’t walk” if I meant “My limbs felt heavy.”
              2. Yes, the concept of holism has been around since Socrates and has always been an essential part of good mainstream medicine.
              3. Functional medicine is defined as “a form of alternative medicine [not science-based medicine] which encompasses a number of unproven and disproven theories and treatments.” You could learn what has been written about it on this blog if it were not harder for you to read than to write.
              4. Do you really not realize how incorrect it is to say doctors “do not know what is going on inside our body. They think that listening to your heart and lungs is all that matters”? Surely you’ve heard of x-rays, blood tests, ultrasounds, MRI, endoscopy, surgery, and all the other things doctors do to know what is going on inside our body. Doctors spend a year dissecting a human body in the gross anatomy lab and they see every part of internal anatomy with their own eyes as well as seeing cells under the microscope and learning about histology, pathology, microbiology, physiology, and more; acupuncture began in a pre-scientific era and was based on imaginary anatomy.
              5. Do you have any understanding of the many ways people can come to believe bogus treatments are effective? Do you understand why rigorous science is the only way to prevent errors in interpreting personal experience? If you keep reading this blog and can set your prejudices aside, you might learn a thing or two.

              1. Shari Hoffman says:

                You have no idea what I have been through.
                And your comments are far from compassionate.
                And if doctors have access to all those tools than why did they not know there was something wrong with me. You really do not know what some people experience. And doctors cannot identify Digestive Imbalances by X-rays. Today I am so tired from my Imbalances hat it was hard for me to write certain things in such great detail. But I really wanted to participate so I gave it whatever I had.

                The worst part of my life back in the early to mid 2000′s was that my legs were so weighted down from my hormone imbalance (I did not know I had) that I had to CRAWL up a flight of steps in my house to get upstairs. I was in pain. Does that qualify to you as not being able to walk???

              2. Harriet Hall says:

                “And if doctors have access to all those tools than why did they not know there was something wrong with me. ”
                The question is, without such tools, and without scientific studies, how could CAM practitioners possibly know how to diagnose and treat you? And how could we know for sure whether you got better because of what they did or whether you might have gotten better without their treatments? That is a legitimate question that only science can answer.

                “I had to CRAWL up a flight of steps in my house to get upstairs. I was in pain. Does that qualify to you as not being able to walk???”
                How could you expect your doctor to understand your degree of suffering if you didn’t communicate it clearly to him? You were not even able to communicate clearly to us that you actually were able to walk, but that sometimes you crawled because of pain – or was it “heaviness” as you first said? Doctors are not mind-readers, and diagnoses depend about 70% on getting an accurate history from the patient.

            2. weing says:

              “Your comment is pitiful and you do not sound very educated.”

              I never heard of Socrates being a doctor. Here are a couple of applicable quotes from Socrates:

              “When the debate is lost, slander becomes the tool of the loser.”

              “The only true wisdom is in knowing you know nothing.”

      3. Shari Hoffman says:

        No, do what helps you.

    3. @chris and hall; Wow, dogma, anger, resentment, blame and shame. Those are the words used by radicals and extremist.

      @Shari I read the statement as full of truths and yet confusion. The reasons why SBM failed and CAMs were successful are documented in texts and research papers from the last century. I have witnessed countless similar cases! The people on both sides can see the links due to distractions and bias.

      The only way forward is to be respectful and communicate.

      1. Shari Hoffman says:

        We must combine both medicines and our doctors need to be trained in both areas. And Functional medicine should start when a child is born to make sure he or she is getting the proper care.

        1. Health and wellness needs to be a part of primary and secondary school curriculum..

          Plus logic, truth, humanities and ethics.

          1. Shari Hoffman says:

            Explain what you mean…

      2. Shari Hoffman says:

        YES. See above. Earlier I was very tired as a result of imbalances I have that I cannot resolve via my “regular doctors.” Only through doctors that I cannot afford. Wouldn’t you be frustrated and upset if YOU were in that position? I read your comment though and I hope I made up for it.

      3. Shari Hoffman says:

        Dr. Rodriguez
        Please send me your email address and I’d love to chat off line if you would like…But not tonight, I am beat.

  17. Shari Hoffman says:

    Dr. Novella,
    I hate to tell you this but:
    ACUPUNCTURE WORKS AND SO DO CHINESE HERBS.
    I am a patient of Acupuncture and it most certainly resolves health problems that Western Medicine cannot even begin to address. I live in New Haven, CT and have been to Yale for health issues…

    1. Windriven says:

      “Dr. Novella,
      I hate to tell you this but:
      ACUPUNCTURE WORKS AND SO DO CHINESE HERBS.
      I am a patient of Acupuncture and it most certainly resolves health problems that Western Medicine cannot even begin to address. I live in New Haven, CT and have been to Yale for health issues…”

      I thought you were so disabled that you were on SS!!! How is that possible if these have “resolved” your issues? Are you scamming the system?

      1. Shari Hoffman says:

        HARDLY. AND YOU PEOPLE ARE REALLY SCARY. Allow me to explain, I went to Yale when I was on regular medical coverage. I also go to Yale now on Disability to clinics they have for poor people like me.

        Years ago I experienced super great healing of imbalances I had from going for acupuncture ($20/visit) and from alternative plant based hormone creams.

        One thing also is that where a horrible endocrinologist (at Yale) put me on huge amounts of Premarin that caused me terrible panic attacks and other kinds of problems I no longer have to have any of those kinds of issues – because I go for acupuncture – when I can – and use the all natural plant based hormonal creams.

        But in more recent years now that I am getting older and my body is going through female changes, once again, I am having a horrific time of keeping up with it all. I’m in a terrible place right now as a result –

        Maybe instead of being rude you should try having compassion. Thank you for your time.

        1. Chris says:

          Why don’t you just give yourself acupuncture. Apparently toothpicks work just as well:

          This latest study, one of the largest to date, supports this conclusion. The three acupuncture arms – placing needles in a standard pattern, placing needles in an individualized pattern according to acupuncture philosophy, and touching the skin with tooth picks without penetrating the skin – showed almost exactly the same degree of symptom relief both short and long term.

          1. Shari Hoffman says:

            I’ll have to get a package of toothpicks on my next visit to the grocery store – thanks for the tip!!!!!!!!

            1. Chris says:

              \(◎o◎)/!

              Seriously? Did you read the article?

              Though I do admit, twirling toothpicks on yourself would be cheap and fairly risk free.

              Good luck to you. I hope you find your solutions, or at least a “happy place.” My “happy place” is my garden, and today I spent much of it tending to the very needy apple trees and the extremely needy pear tree.

              In order to prevent apple maggots I need to wrap each developing baby apple with a nylon sock, the exact same sock given to you to try on shoes in a shop. This is apparently a bumper crop of apples, so I had to cull apples as I put the socks on the selected apples. I still may be providing a large bag of apples to the local food bank in the fall.

              Then the one pear tree (with four kinds of pears) required my attention to pull every leaf with a yellow spot. Because that spot was the beginning of pear rust. It was almost a third of the leaves, mostly because I did not do a winter lime-sulfur spray. Le sigh.

              We all have our mental issues. I have learned to focus mine into my edible garden. I lost a parent at a young age, the remaining parent made some interesting choices which involved growing up in thrown together step-family. I have survived dengue fever because I lived in weird places. Plus I have at least one kid with interesting medical issues (which included surgery at the Mayo Clinic!). Of course his birth ripped me from “stem to stern”, so over a quarter century later I have issues with “damaged anal muscles.” Woo hoo!

              Really, what makes you so special? I mean, why should we care? You provide no specifics other than real medicine is “bad.”

              Well that’s great. It kept my oldest alive and even fixed his heart. My youngest still hates me on a regular basis. It seems to be a mixed bag, and you are picking and choosing your data, without even explaining that data.

              And really, why should we believe you? For all we know you are just trolling to get stuff for a future fictional book. Perhaps a medical romance or some kind of sob story. Why should we care?

          2. “The toothpick article ”

            That is a poorly conceived and designed study, anyone with any knowledge of medicine, science, biology and/or common sense would disregard it completely.

            1. Windriven says:

              “That is a poorly conceived and designed study, anyone with any knowledge of medicine, science, biology and/or common sense would disregard it completely.”

              What are your precise objections? How do you think those perceived shortcomings bias against acupuncture? Specifically. And hopefully concisely.

            2. n brownlee says:

              Why do you think so? No one has any reason to credit your opinion if you NEVER EXPLAIN WHY. It’s just an opinion. No proof, not even a half-hearted attempt at justification. I simply do not believe you’re that stupid.

              Don’t you remember the first principle of your very first science class- maybe in junior high school? “If you cannot explain it, you do not understand it!”

              1. Windriven says:

                ” I simply do not believe you’re that stupid.”

                Believe it, Nancy. I’ve been through a long journey with Dr. Rodrigues, first thinking he couldn’t possibly be that stupid, then thinking he was taking crazy positions to provoke a response, then thinking he was a total troll*, and finally coming full circle to the conclusion that he really is that stupid ignorant. The guy is smart enough to have graduated medical school, got a Texas license and passed his boards. He is living proof that one can be schooled without being educated.

                *Technically, he is a troll. Ignorance is often an asset for trolls. Nothing mutually exclusive there.

              2. Kinda interesting to see how “smart” seemingly sane people can be programed by an idea or belief and put into a delusional trance.

                If you were only playing this game with yourselves that would be fine. If your intent is to deceive, distort and distract laypeople than that is reprehensible. :(

              3. Windriven says:

                As I’m sure you’ve already noted, Dr. Rodrigues’ response to you is a total non sequitur.

        2. Windriven says:

          “Maybe instead of being rude you should try having compassion.”

          I have no compassion for nitwits. It’s a character flaw.

          1. Harriet Hall says:

            I have plenty of compassion for suffering patients who ask for help or information. I can’t drum up much compassion for someone who comes on our science-based website to deliberately attack us and insult everything we stand for, especially one who demonstrates her ignorance, who will not even take the time to read what we have written and try to understand why we don’t accept her beliefs about CAM and functional medicine, who prefers fantasy-based treatments to reality, who ranks her personal opinions above all the evidence from scientific studies, and who can’t even seem to relate her own testimonial coherently or consistently.

            1. Windriven says:

              I absolutely concur.

            2. From the evidence I have read, you and your cronies have no compassion at all. NONE.

              There are no scientific discussions here, just personal conclusions and attacks on anyone who disagrees.

              NOT skeptical or cynical, just sadistic.

              Sadist Based Medicine!

              1. Harriet Hall says:

                The fact that you are still tolerated in these comments argues for our compassion.
                The fact that you think there are no scientific discussions here says a lot about you and nothing about us.

              2. weing says:

                “There are no scientific discussions here, just personal conclusions and attacks on anyone who disagrees.”

                Can you give us an example of a scientific discussion? Or what you imagine to be a scientific discussion?

              3. Windriven says:

                “From the evidence I have read, you and your cronies have no compassion at all.”

                That is because you seem to define compassion as ripping off vulnerable patients by taking their money for theatrical placebos.

              4. WilliamLawrenceUtridge says:

                My idea of being compassionate to a patient is to give them the truth about their condition, then providing the best treatment available, based on the most solid evidence, in order to have the highest likelihood of resulting in a positive cure.

                You seem to mistake the desire for high-quality evidence for a lack of compassion. Your definition of compassion seems to be giving the patient what you personally believe to be the most effective treatment, no matter what the evidence is. You seem to think that we are sadistic not because we refuse to endorse patients being given false, unjustified hope, but that we refuse to endorse your particular favoured strain of false, unjustified hope. So you take self-entitled douchebaggery to a whole new, paternalistic place. You would have loved being a doctor in the 50s, lying to patients and giving them placebos was all the rage.

  18. Shari Hoffman says:

    Dr. Novella,
    I hate to tell you this but:
    ACUPUNCTURE WORKS AND SO DO CHINESE HERBS.
    I am a patient of Acupuncture, TCM, and it most certainly resolves health problems that Western Medicine cannot even begin to address. I live in New Haven, CT and have been to Yale for health issues…and I have also been for Acupuncture.

    1. Chris says:

      Before you go any further with your N=1 sample size, go the right hand side of this webpage and click on the words listed there. For instance, this one:
      http://www.sciencebasedmedicine.org/category/acupuncture/

      Try actually reading the articles. Though it have helped if you had actually read the article on this page and clicked on the blue links.

      1. Shari Hoffman says:

        Because our regular good ol’ USA Medicine allowed me to be dysfunctional my entire life I am now on Disability. Because I am now on Disability I cannot even afford to get the Alternative Medicines my body needs so that I can function at peak performance so I may have the energy to read everything here. How ’bout that? That’s really not fair – is it??? So I can only read and write what I have the energy for. Sorry folks, but that’s what our country’s medicine did to me. And I am writing a book about what I have been through so you can see what I am talking about.

        1. Chris says:

          Why should I believe you when you obviously failed to understand what I wrote?

        2. Chris says:

          “So I can only read and write what I have the energy for.”

          Then stop typing and start reading. That should take much less energy than the nine comments you posted in the past hour.

          1. Shari Hoffman says:

            Honestly – t’s actually easier for my to type than to read. And you should really listen to people like Dr. James Gordon and also Dr. Bernie Siegel who know that LOVE helps people to heal =)

            1. WilliamLawrenceUtridge says:

              It’s funny – love has existed as long as humans have existed. People have always loved their children, and their parents, and their friends and their spouses. Which is why it was so painful to watch parents, children, friends and spouses die of diseases, infections, genetic disorders, anatomical malformations, childbirth and the like.

              If love was enough, we wouldn’t need medicine. But you give a vaccine to someone you hate, and they’ll still be protected. And you prevent someone you love from getting chemotherapy because you can’t stand to see the side effects, and you’ll watch the person you love die a lingering, agonizing death.

              If love healed, we wouldn’t need doctors because priests would have been enough.

        3. MadisonMD says:

          Because I am now on Disability I cannot even afford to get the Alternative Medicines my body needs so that I can function at peak performance

          Maybe you can cut a deal with your acupuncturist. Once s/he can get you back to peak performance, you get off disability. Once employed you agree to pay back a monthly retainer fee. Fair deal. S/he promises you’ll be better. You promise to pay back. Of course, you may want to read the acupuncture articles here because if s/he cannot possibly keep the promise that acupuncture works, well….

          1. Shari Hoffman says:

            YOU SHOULD REALLY LEARN TO BE PLEASANT and to understand that Acupuncture alone would not help all of my conditions. It’s a variety of things that would help. And I cannot afford them. It’s really a terrible situation.

            1. weing says:

              I second MadisonMD, make a deal with your CAM providers to pay them once you are no longer disabled and can make a living by an honest day’s work.

              1. Shari Hoffman says:

                They don’t work that way. I’ve tried. In fact recently one of the providers I considered going to raised her fee from $200 to $275. She said, she used to make “deals’ with people. She would treat them and they would pay her back and she said she got stiffed every time so she doesn’t do that anymore. I don’t blame her.

              2. weing says:

                “She said, she used to make “deals’ with people. She would treat them and they would pay her back and she said she got stiffed every time so she doesn’t do that anymore. I don’t blame her.”

                Would you stiff her if, as a result of her treatments, you were no longer disabled and could work? Were the “deals” she made of that nature? Could it be because they were still disabled and unable to return to work?

        4. Shari Hoffman says:

          I’m not saying we should get rid of Western medicine. I AM however saying that we should integrate it with holistic medicine.

          1. WilliamLawrenceUtridge says:

            This happens automatically whenever scientific tests show that the “holistic” (i.e. unproven) medicine actually works. The problem is, alternative medicine providers want a double-standard to be applied. They want the right to deliver, and charge for, treatments and medicines that have no proof, or have actually repeatedly failed scientific testing.

            Would you let Pfizer sell a novel drug to kids with cancer that has never been tested, or has been tested and failed to show any benefit? Because that’s what you’re demanding alternative practitioners be allowed to do – just substitue Gary Null or Joe Mercola for Pfizer. It’s the exact same greed- (and often ego-) driven practice, just gussied up with some lies and false dilemmas. Null, Mercola and others drape themselves in the rhetoric of “natural” (ignoring the fact that concentrating vitamins into pills is not natural, not to mention death due to smallpox is naturla) and patient freedom (ignoring the fact that it’s not the patient’s freedom to buy, but their freedom to sell, that they demand).

            You are being exploited, and I’m sorry your desperation is being milked by these unethical practitioners.

          2. @WilliamLawrenceUtridge
            you are being dramatic and impractical and not using common sense.

            CAMs needs the same scrutiny and attention as all of medicine and let the free market and longterm outcomes determine what is best.

            What we have now is favoritism, nepotism, cronyism, politics, power, greed and dogma control the what YOU guys think. All someone has to say is pseudoscience and your noses turns up.

            Mr Pfizer gives money to key decision makers who have painted healthcare into a corner. They will get paid out of our pockets.

            1. WilliamLawrenceUtridge says:

              you are being dramatic and impractical and not using common sense.

              How is not asking for special treatment for CAM dramatic and impractical? Drugs require testing before they are licensed and permitted to make medical claims, why does CAM get to avoid the benefits of oversight and burdens of legislation designed to protect consumers from shucksters and unscrupulous companies selling useless homeopathy and ineffective, contaminated and unproven herbs?

              CAMs needs the same scrutiny and attention as all of medicine and let the free market and longterm outcomes determine what is best.

              Um…are you stupid? DSHEA ensures that many CAM claims are exempt from the scrutiny and attention of medicine. Herbs and supplements need no proof of efficacy to be sold. Homeopathy was grandfathered in explicitly and specifically to avoid needing any burden of proof for safety and efficacy. I would love it if CAM actually underwent the same scrutiny and attention as medicine.

              Also, the free market obviously supports the selling of homeopathy, and was responsible for the massive success of the snake oil era of medicine before the FDA was created. The free market fails in cases of asymmetric information, such as medicine where one requires a specialist expert to navigate treatment options.

              What we have now is favoritism, nepotism, cronyism, politics, power, greed and dogma control the what YOU guys think.

              Actually, you’re kinda describing how nearly every form of government support or oversight for CAM was created. DSHEA? NCCAM? You should look into their history. Start with Dan Hurley’s Natural Causes, you might learn something.

              Mr Pfizer gives money to key decision makers who have painted healthcare into a corner.

              Which has no bearing on the lack of evidence for the safety and effectiveness of CAM, and, oh, is also an enormous factor in how CAM oversight has been designed and implemented. Again, read Dan Hurley’s book. Utah is replete with pork projects and lobbyists for the supplements industry, which is now valued at tens of billions of dollars. CAM is not being exploited or kept down by nasty medicine, it’s playing Big Pharma’s game with even greater success and even less oversight.

              Why the hypocritical double-standard?

            2. MadisonMD says:

              @SSR: Shari says that acupuncture costs $275. How much do you charge for one session?

              1. WilliamLawrenceUtridge says:

                Any answer is “too much”. Even “free” means a net drain on the critical thinking of his customers.

              2. It depends on the circumstances, case, time, effort and tools.

                You see a narrow view of the discipline, 275 is what the free market will bare in her case.

                I will have to reassess my charges.

                Zero for Macular Degeneration. (Can you imagine helping someone vision improve and slowing the progression of this disease!!)
                50 for simple cases.
                75-125 for pain.

                The cost is priceless if you can get your knee or hip restored. ==> saving the system $100, 000 and no need to incinerated viable human tissue.

              3. WilliamLawrenceUtridge says:

                Your statements assume, as always and in the absence of evidence, that acupuncture does anything for the conditions listed. For instance, where is the evidence that acupuncture helps with macular degeneration? Even if you charge nothing for it, what justifies the risk of stabbing someone in the eye with a needle? What if infection takes away what sight they have remaining?

                What justifies charging $75 for pain when the results are unpredictable, transitory and short-term only? Versus, say, an aspirin?

                What evidence can you present that acupuncture can prevent a hip or knee replacement? A 2013 review suggests that the use of acupuncture for osteoarthritis is not supported. I can’t find anything indicating support for avascular necrosis beyond case reports. Including this one, which hilariously suggests that four years and 130 rounds of acupuncture caused the kid’s femoral head to heal. Why is this hilarious? Because the usual time to heal is 2-3 years. So acupuncture may have actually delayed healing. Good job!

                So maybe rather than whipping out those needles and stabbing your patients in pursuit of a quick buck, perhaps you should do a little research before you permanently injury them, or even just delay natural healing.

      2. Shari Hoffman says:

        I dont have to read about acupuncture. I’ve experienced it to know how effective it can be in many situations =)

        1. Chris says:

          Okay, then provide the verifiable documentation that is works. But before you do make sure that it is not a study that has been torn to shreds on this blog, like say this one:
          http://www.sciencebasedmedicine.org/acupuncture-vignettes/
          or this one:
          http://www.sciencebasedmedicine.org/a-very-special-issue-of-medical-acupuncture/

          One way to find if a paper has been discussed is to use the search box at the top of this page.

          1. Shari Hoffman says:

            Have a good night to all of you. It’s been a pleasure but I am beat.

          2. “A very special issue of Medical Acupuncture … Posted by David Gorski on April 22, 2013 (74 Comments)”

            I miss that discession. The article is simply wrong biased and sensational.

            A narrow view of Acupuncture.

            Irresponsible for any scientist who has a reputation worth a future. I would assume an ulterior motivated article.

            1. WilliamLawrenceUtridge says:

              Well then please, broaden our view of acupuncture. Perhaps submit a guest post, telling us what is wrong with the acupuncture research that consistently converges on the conclusion that it is elaborate placebo and little else. How is “your” acupuncture different, what is everyone else doing wrong?

              Irresponsible for any scientist who has a reputation worth a future. I would assume an ulterior motivated article.

              Given that most scientists and doctors view acupuncture as a medical curiosity, not a mainstream treatment, that’s a rather amusing statement to make.

              And again, this is little more than the pharma shill gambit – you can’t say anything of substance about the criticisms of acupuncture, you can’t refute any of the logical or factual points, so you assume that we must be paid by…who exactly? Who hates acupuncture so much that they would pay bloggers and commenters to talk to your incoherent ass day-in and day-out? Just a question, how many imaginary dollars do you think I rake in each day? Is it per post, or per word perhaps? Do I get paid extra if my spelling and grammar are good, and do I get a bonus if my arguments are logical?

              Maybe focus on why your arguments are unconvincing and why you are unable to come up with any science to back them up, rather than trying to smear those who disagree with you with unsubstantiated accusations.

            2. MadisonMD says:

              I would assume an ulterior motivated article.

              Says the man who makes a living off telling patients that acupuncture works for macular degeneration, all kinds of pain, and just about all that ails ye.

        2. Andrey Pavlov says:

          I dont have to read about acupuncture.

          And thus signals your departure from the realm of adult and scientific discussion. If you’ve simply decided that the answer is already there without even the consideration that more reading and knowledge is necessary, you’ve not lost the game you’ve simply decided not to play it. But instead of being forthright in that, you decide to stand off to the side and throw things at those actually playing the game and doing the real work of it, like a petulant child upset at the rules.

  19. Shari Hoffman says:

    Relaxation, Dr. Novella, at the end of a busy day is completely different than what one would experience during certain forms of meditation such as guided imagery and or (Asian) group music meditation, as I just recently experienced. If you have your health and are not in need of these kinds of meditation that ARE in fact SOOO helpful, how can you possibly say they are the same thing as relaxation. You can’t.
    You have to let the PATIENTS who experience the BENEFITS of these forms of alternative medicine decide that. Why don’t you approach some of these people and ask them about the benefits rather than make silly decisions based on nothing.

    1. Windriven says:

      “You have to let the PATIENTS who experience the BENEFITS of these forms of alternative medicine decide that. ”

      There are no benefits. You may imagine there are benefits. More likely you are a simple troll. Why else would you be here? You certainly can’t imagine that you will sway scientists with your pathetic anecdotes. And you aren’t seeking information. That leaves trolling. And if you are trolling it is either because you have an axe to grind – you’re a naturopath or some other kind of pseudo-flake, or you’re a delusional. Either way you add nothing to the discussion here.

      1. There you go again dehumanizing bloggers who have a positive massage you are told not to believe. Kill the messenger and thus the message.

        CAMs are valid and are here to stay.

        I bet someone behind this site is distorting the truth for some type of gain. Quintner, Wolfe and Ingraham???

        1. WilliamLawrenceUtridge says:

          If CAMs are so valid, why do they consistently fail to show any evidence that they work when subjected to scientific testing?

      2. Shari Hoffman says:

        Your comments are rather uneducated and I AM a patient, not a doctor! I know from my experience what works and what doesn’t and so does Dr. Gordon who wrote this article! =) And I thank God for him! Dr. Gordon knows his stuff. Maybe you should read some of his books. Go on Amazon and check them out!

        1. WilliamLawrenceUtridge says:

          If Dr. Gordon is so great, why do genuine experts, people who do nothing but work on and study pediatric vaccinations, disagree with him and think he is dangerous? If he’s so smart, why was he at the epicenter of a measles outbreak?

  20. Matt Fluger says:

    Certain therapies are consider alternative and often it is speculative if the patient will get any results. Of course each patient is different and has unique requirements for overall well-being. That being said, proper diet and exercise are cornerstones to better health.

    1. “Certain therapies are consider alternative and often it is speculative if the patient will get any results.”

      This statement is incomplete, I’m in primary care and I find that a lot of meds that are standard do not have a benefit to the patient. Then I have to try an “alternative” medicine from the list.

      Having alternative is powerful!

      The words we use are twisted into a biased mix of uncommon sense.

      I think the people here want to control cost and do not want to pay for something that does not work. I agree!! I have a list of crap I have been told to do in my practice that are worthless.

      1. WilliamLawrenceUtridge says:

        Having alternative is powerful!

        What about when your alternative is useless? What if your main choice is, say, vaccination, and your alternative is prayer? What if it’s the false dilemma that so many quacks love – either drugs are perfectly safe or homeopathy works? What if one alternative is actually proven, and the other is an assertion made by someone like you, who makes money off of the pain of others and has no proof?

        I think the people here want to control cost and do not want to pay for something that does not work. I agree!! I have a list of crap I have been told to do in my practice that are worthless.

        Is acupuncture on your list? Because studies consistently show no benefit beyond placebo.

        Why do you think that is?

        1. Your view of science and all the methods are narrow and you make too many assumptions.

          Studies are not flawless

          1. WilliamLawrenceUtridge says:

            Studies are not flawless, that’s why replication and extension are crucial, as well as interpreting the whole of the literature rather than individual studies, and looking for convergence across multiple studies and multiple ways of studying a phenomena. For instance, one would test:
            - needling locations (turns out the location doesn’t matter)
            - skin penetration (it does not matter)
            - practitioner demeanor (matters greatly, far more than location and penetration)
            - needle depth and manipulation (doesn’t make a difference)
            - chronic (useless) and acute (short-term benefits indistinguishable from placebo) results
            - disease (no disease-modifying effects, only symptoms are affected, and only two symptoms – pain and nausea, both highly susceptible to placebo)

            So, when you remove the needling location, the needle penetration, and the practitioner experience from “acupuncture”, what are you left with? Particularly when you note that the only two symptoms it has any impact on are also symptoms that are susceptible to placebo? And when you add to that the fact that the original explanation (manipulation of qi) is meaningless, the paradigm and historical period where acupuncture was developed was prescientific, and the fact that the only known mechanism that explains these bits of data is placebo, the most parsimonious conclusion is that acupuncture is placebo.

            But please, feel free to suggest a scientific test that would fairly test acupuncture in a way you are confident acupuncture would be found different from placebo. Present to us a scientific protocol, including control groups, blinding and randomization, that is a fair test of acupuncture according to you. Ideally, you should also reconcile and explain why previous tests have failed (i.e. how your protocol is different from past tests).

            Help us improve the science, help us get better methods, and clarify our assumptions – lay them bare for us to examine.

            Or, y’know, just bitch and moan that we’re too stupid to see your genius, and flounce and sulk like a preteen who isn’t getting any ice cream for dessert. Whatever.

            1. Flawed logic and conclusions are based on: Faulty collection of data, missing data points, inexperienced collectors, incomplete concepts and narrow pools.

              - needling locations (turns out the location doesn’t matter)
              Almost correct; precision is not as important as one may think.

              - skin penetration (it does not matter) AND – needle depth and manipulation (doesn’t make a difference)
              Vitally important and will affect outcomes! This is where all the power in located!

              - practitioner demeanor (matters greatly, far more than location and penetration)
              NOT important. We could get very good results just with a robot. Optimal result require human interaction..

              - chronic (useless) and acute (short-term benefits indistinguishable from placebo) results
              Your definition and concept of placebo is flawed. Placebo results should be nullified with time, maybe a singular or isolated occurrence and supposedly not reproducible. If a placebo completely cures or is effective therapeutic, than is it placebo? How does one separate out nature, placebo and an effective therapy?

              - disease (no disease-modifying effects, only symptoms are affected, and only two symptoms – pain and nausea, both highly susceptible to placebo)
              This is a very good observation; What is a completely accurate diagnosis? I see a lot of people with a false or incomplete diagnosis. This therapy will ignite healing and will alter or mitigate the secondary detrimental effects of the disease process. ie myofascial disease will alter molecular and mechanical design of the body leading to DJD and neuropathy.

              I really can not explain this therapy in a few paragraphs, not even after a few years of study.

              1. David Gorski says:

                That’s funny. I can explain virtually any therapy that I administer in a few paragraphs, or at most a blog post. Your inability to do so implies either that you don’t understand it very well or it does not have a clear basis in science. My guess is that it’s both.

              2. MadisonMD says:

                @SSR: Show the data for your claims.

              3. @David Gorski
                “I can explain virtually any therapy that I administer in a few paragraphs, or at most a blog post.”

                Ouch!!! Your attempt to poke me in the eye falls short. You have not been able to explain dry needling, Acupuncture or Travell/Simons in any of your writings. Especially if you have not read any of the authors. It would be impossible. NICE TRY!!!

                I have explained this therapy over and over but there is a “block” of some type; political, emotional, financial, scientific, cultural, psychological etc. So I’m not surprised you can not comprehend Acupuncture, dry needling, Gunn-IMS, Travell/Simons injections, neural-injections or biopuncture.

                I’m just a messenger, so you will have to disparage a large segment of the population of people, patients who find that these therapies help them have a better quality of life, providers, MDs, Chiropractors, Massage therapist, Active tissue specialist etc. … Gee all of the world of CAM.

                Disparaging me or anyone else does not add to the weight of an argument. Besides all of you should be disparaging orthopedic surgeons for continuing to perform procedures that are ineffective, replacing natural joints with hunks of metal and Big-Pharma for confusing people with TV ads.

                Living a duplicitous life allows one to make illogical scientific statements to foster a deception… The questions are why? Money? Fame? Prestige? Revenge?

                Being duplicitous is easy for you huh?

              4. MadisonMD says:

                I have explained this therapy over and over but there is a “block” of some type; political, emotional, financial, scientific, cultural, psychological etc.

                The block is scientific. Show the evidence for your assertions.

              5. Windriven says:

                SSR: “You have not been able to explain dry needling, Acupuncture or Travell/Simons in any of your writings. ”

                Dr. Gorski didn’t say he could explain the delusions that boil in your brain, he said that he could, “explain virtually any therapy that I administer in a few paragraphs, or at most a blog post. ”

                And Steve, you haven’t explained anything. You’ve told stories, you’ve named books. But you have never laid out the basic science that underlies your treatments. How can you possibly expect to be taken seriously? Simply reiterating your belief in acupuncture doesn’t prove its efficacy.

              6. Andrey Pavlov says:

                Simply reiterating your belief in acupuncture doesn’t prove its efficacy.

                If religion has taught us anything it is that saying something enough times with enough conviction is just as good as actually being true. If only SSR could throw in the threat of eternal hellfire and/or the promise of heaven we’d have a Truth that the majority of the world believes in.

              7. WilliamLawrenceUtridge says:

                Flawed logic and conclusions are based on: Faulty collection of data, missing data points, inexperienced collectors, incomplete concepts and narrow pools.

                Yes, that’s why we don’t trust your experience. Your logic is flawed, your conclusiosn are faulty, you don’t collect any systematic data, you have no research experience and your pool of evidence is solely drawn from patients who self-refer and return to you. Hence, your conclusions are not scientific or reasonable.

                Vitally important and will affect outcomes! This is where all the power in located!

                Where’s your evidence for this? And if you say “my patients”, then you’re still not getting it.

                NOT important. We could get very good results just with a robot. Optimal result require human interaction..

                Um…you realize these statements are contradictory? Also they have explicitly tested demeanor as a variable and the results showed that it makes an immense difference, far more than any other aspect tested (don’t have the link handy – anybody else?)

                Your definition and concept of placebo is flawed. Placebo results should be nullified with time, maybe a singular or isolated occurrence and supposedly not reproducible. If a placebo completely cures or is effective therapeutic, than is it placebo? How does one separate out nature, placebo and an effective therapy?

                Again, you miss the point – if a treatment completely cures, it’s not a placebo. If a treatment does nothing but give a patient patience while they get better anyway it is. Placebo results are nullified with time, that’s why they are short-term, and generally decline with repeated treatments. That’s why you track patient outcomes over a long term. One determines this through proper controls and follow-up, which is basic to medical research and the key difference between what a researcher does, and what you do (and the reason why your anecdotes are not reliable information).

                This is a very good observation; What is a completely accurate diagnosis? I see a lot of people with a false or incomplete diagnosis. This therapy will ignite healing and will alter or mitigate the secondary detrimental effects of the disease process. ie myofascial disease will alter molecular and mechanical design of the body leading to DJD and neuropathy.

                Citation needed.

                I really can not explain this therapy in a few paragraphs, not even after a few years of study.

                Well feel free to submit a guest post. Two further points:
                - you’ve generally never even tried to explain the therapy
                - the real problem is not your explanation, it’s your data sources; you spinning a theory is not the same thing as being able to demonstrate it is accurate through reference to the literature.

                Something isn’t true merely because you type it out.

              8. WilliamLawrenceUtridge says:

                Ouch!!! Your attempt to poke me in the eye falls short. You have not been able to explain dry needling, Acupuncture or Travell/Simons in any of your writings.

                Unverified assertions and placebo effects.

                Boom, done!

                I have explained this therapy over and over but there is a “block” of some type; political, emotional, financial, scientific, cultural, psychological etc.

                It’s funny, antibiotics will work on a susceptible bacteria irrespective patient political views, emotional status, wealth, scientific beliefs, cultural background and psychology. Ditto surgical excision of a solid tumor (or chemotherapy for a blood cancer).

                What it really looks like you are doing here, is citing an internal list you have to explain away your failures. A set of conveniently mobile goalposts.

                I’m just a messenger, so you will have to disparage a large segment of the population of people, patients who find that these therapies help them have a better quality of life, providers, MDs, Chiropractors, Massage therapist, Active tissue specialist etc. … Gee all of the world of CAM.

                Why do none of their therapies stand up to controlled scrutiny then?

                Disparaging me or anyone else does not add to the weight of an argument. Besides all of you should be disparaging orthopedic surgeons for continuing to perform procedures that are ineffective, replacing natural joints with hunks of metal and Big-Pharma for confusing people with TV ads.

                I largely disparage you for your failure to cite any relevant scientific evidence. Having done so repeatedly, with no evidence of you learning from my criticisms, I think that it’s not longer accurate to claim that pointing out you are stupid and biased is an ad hominem attack, I think it’s merely factual. And I don’t refer to any pharmaceutical ads as a starting point for my criticisms, making your final point rather spurious. Perhaps others do and I’ve missed it?

                Living a duplicitous life allows one to make illogical scientific statements to foster a deception… The questions are why? Money? Fame? Prestige? Revenge?

                Intellectual honesty, respect for science and disgust at those who would systematically exploit the public for their own gain. That’s why I do it.

                Also, what’s duplicitous about pointing out your assertions are not backed by good quality evidence, and that you don’t seem to understand the scientific process? It seems like you are being the duplicitous one for consistently claiming evidence but never citing it, and never, ever responding to matters of substance.

                Show us the evidence. Personal experience is not evidence. What’s hard to understand about that?

  21. Impasse!!!
    Sorry I can not convince you all of the benefits of CAMs. We all see things differently; I see patients in the office who have failed Science Based Medicine/Traditional Medicine. In actuality the SBM/TM used in these cases caused delays in effective therapy which can contributed to further pain and suffering.

    CAMs, the therapy that I have discussed are the only options for these failed cases.

    Denial of CAMs in these failed cases would be inhumane.

    hopefully I sincerely hope you choose to gracious to these people in chronic pain and or have weird dysfunctions, please direct them to these sites;
    http://www.medicalacupuncture.org/
    http://www.istop.org/
    http://www.myopain.org/default.asp
    http://homepages.sover.net/~devstar/sheets.htm

    Remember Myofascial Pain and Dysfunctions can masquerade as classic traditional diagnoses but do not respond as predicted. Don’t let them wait too long, there maybe consequences of accelerated more stubborn chronic pain.

    1. WilliamLawrenceUtridge says:

      Impasse!!!

      Yeah, we’re totally stuck. We keep asking you for evidence, and you keep not providing it. It’s totally irresistable force and immovable object.

      Sorry I can not convince you all of the benefits of CAMs. We all see things differently; I see patients in the office who have failed Science Based Medicine/Traditional Medicine. In actuality the SBM/TM used in these cases caused delays in effective therapy which can contributed to further pain and suffering.

      All we need is evidence that is not based on your personal experience. Your hysterical “but think of the patients” doesn’t excuse the fact that your claims are not backed by, are in fact contradicted by, the scientific literature. If we relied solely on clinical experience to determine medical interventions, we would still be using lancets and leeches, or debriding knee cartilage, because in all these cases – exactly like your situation – doctors swore they were supporting patient health.

      CAMs, the therapy that I have discussed are the only options for these failed cases.

      You know, if there were evidence supporting this assertion, they would cease to be CAM and become merely medicine. Your ongoing shrieking that we can’t wait for the research actually prevents people from taking you seriously. Really man – just do the research.

      Denial of CAMs in these failed cases would be inhumane.

      But lying to them about the evidence, concealing the lack of evidence – that is humane? We clearly have different standards.

      1. My conclusions are different because my life is different. Doing the gritty scutwork overtime allows one to experience the trials and errors to find all the data points even the hidden points and realized the ones that are pure BS. Spoon fed data, conclusions, groupthink will yield false and erroneous conclusions. Without this intensive process you are perpetuating being a scientist.

        Negating any data point because YOU choose to be lazy in your research and data collection is YOUR choice and should not be consider scientific — only YOUR choice.‏ If a short sighted choice is pawned off as being Science Based Medicine, YOU may do irreparable harm to unsuspecting people.

        Think again!

        1. WilliamLawrenceUtridge says:

          Your conclusions are different because you don’t seem to even be aware of two substantial bodies of research:

          - that showing acupuncture to be indistinguishable from placebo

          - that showing just how much personal experience can deceive

          All that real-world experience and “gritty scutwork” you are so proud of is little more than a series of uncontrolled observations, and you have no way of knowing if they represent valid information or a systematically distorted set of observations that subconsciously exist to validate your self esteem and current beliefs. I realize you are incredibly confident that your beliefs are true, but there is a massive body of social psychology research showing that this confidence is incredibly misplaced. Read Mistakes were made (but not by me), or The Invisible Gorilla, or You are not so smart and you will find out just how error-prone uncontrolled thinking is.

          Without this intensive process you are perpetuating being a scientist.

          You say that like it’s a bad thing.

          Negating any data point because YOU choose to be lazy in your research and data collection is YOUR choice and should not be consider scientific — only YOUR choice.‏ If a short sighted choice is pawned off as being Science Based Medicine, YOU may do irreparable harm to unsuspecting people

          What data point? You’ve provided no data, merely uncontrolled observations.

          What research? You’ve provided very few citations to support your assertions, and those citations I have reviewed and found poor.

          Also, I treat no patients, I’m not a doctor. I don’t own or contribute to this site beyond comments.

          Have you considered that you, who actually do treat people, may be doing harm? What if a patient is impressed by your unscientific claims and decides to see a naturopath, who convinces them to avoid vaccination, and their child dies of pertussis? Or they decide to see a chiropractor, who adjusts their cervical vertebrae, and they die of cervical artery dissection? Or they decide to see an acupuncturist who convinces them to avoid insulin in favour of acupuncture for their diabetes and they die of gangrenous infection to their extremities? Or even a patient who has a tumor causing their back pain and they spend so long getting treatment from you that it ends up metastasizing and killing them?

          But yeah, I’m dangerous because I put my faith in a system based on extensive empirical research.

      2. Reference again … there are thousands if you look:
        Wheeler AH. Myofascial pain disorders: theory to therapy. Drugs 2004; 64(1):45-62.
        Skootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. West J Med 1989; 151(2):157-60.
        Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985; 60(6):615-23.
        Gerwin RD. A study of 96 subjects examined for both fibromyalgia and myofascial pain. J Musculoskeletal Pain 1995; 3 (suppl. 1):121-5.
        Fernandez-de-Las-Penas C, onso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache 2006; 46(8):1264-72.
        Fernandez-de-Las-Penas C, onso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Man Ther 2006; .
        Ardic F, Gokharman D, Atsu S, Guner S, Yilmaz M, Yorgancioglu R. The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis. Aust Dent J 2006; 51(1):23-8.
        Hwang M, Kang YK, Kim DH. Referred pain pattern of the pronator quadratus muscle. Pain 2005; 116(3):238-42.
        Treaster D, Marras WS, Burr D, Sheedy JE, Hart D. Myofascial trigger point development from visual and postural stressors during computer work. J Electromyogr Kinesiol 2005; .
        Simons DG. Myofascial pain caused by trigger points. In: Mense S, Simons DG, Russel IJ, editors. Muscle Pain: Understanding its Nature, Diagnosis, and Treatment. First ed. Philadelphia: Lippincott Williams & Wilkins; 2001. 205-88.
        Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1983.
        Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65(4):653-60.
        Graven-Nielsen T, Arendt-Nielsen L. Peripheral and central sensitization in musculoskeletal pain disorders: an experimental approach. Curr Rheumatol Rep 2002; 4(4):313-21.
        Arendt-Nielsen L, Graven-Nielsen T. Central sensitization in fibromyalgia and other musculoskeletal disorders. Curr Pain Headache Rep 2003; 7(5):355-61.
        Borg-Stein J. Cervical myofascial pain and headache. Curr Pain Headache Rep 2002; 6(4):324-30.
        Gerwin RD. Myofascial pain syndromes in the upper extremity. J Hand Ther 1997; 10(2):130-6.
        Travell J, Simons D. Myofascial Pain and Dysfunction: The trigger point manual, Volume 2. Baltimore: Williams & Wilkins; 1992.
        Rivner MH. The neurophysiology of myofascial pain syndrome. Curr Pain Headache Rep 2001; 5(5):432-40.
        Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil 2002; 83(3 Suppl 1):S40-S49.
        Rudin NJ. Evaluation of treatments for myofascial pain syndrome and fibromyalgia. Curr Pain Headache Rep 2003; 7(6):433-42.
        Hong C-Z. Considerations and Recommendations Regarding Myofascial Trigger Point Injection. J Musculoskeletal Pain 1994; 2(1):29-59.
        Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil 1994; 73(4):256-63.
        Huang KC. Acupuncture: the past and the present. New York: Vantage, 1996.
        Ma KW. The roots and development of Chinese acupuncture: from prehistory to early 20th century. Acupunct Med 1992;10(Suppl):92–9.
        Basser S. Acupuncture: a history. Sci Rev Altern Med 1999;3:34–41.
        Chen Y. Silk scrolls: earliest literature of meridian doctrine in ancient China. Acupunct Electrother Res 1997;22:175–89.
        Dorfer L, Moser M, Bahr F et al. A medical report from the stone age? Lancet 1999;354:1023–5.
        Baldry PE. Acupuncture, trigger points and musculoskeletal pain. Edinburgh: Churchill Livingstone, 1993.
        Kaplan G. A brief history of acupuncture’s journey to the West. J Altern Complement Med 1997;3:5.
        Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. In: Ernst E, White A, eds. Acupuncture: a scientific appraisal. Oxford: Butterworth Heinemann, 1999:11–30.
        The Academy of Traditional Chinese Medicine. An outline of Chinese acupuncture. Peking: Foreign Languages Press, 1975.
        Han J, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220.
        Bivens RE. Acupuncture, expertise and cross-cultural medicine. Manchester: Palgrave, 2000.
        Anon. Acupuncturation. Lancet 1823;November 9:200–1.
        Osler W. The principles and practice of medicine. New York: Appleton & Co., 1912.
        Ulett GA. Conditioned healing with electroacupuncture. Altern Ther Health Med 1996;2:56–60.
        Reston J. Now about my operation in Peking. New York Times 1971;1:6.
        Dimond EG. Acupuncture anesthesia. Western medicine and Chinese traditional medicine. J Am Med Assoc 1971;218:1558–63.
        Marwick C. Acceptance of some acupuncture applications. J Am Med Assoc 1997;278:1725–7.
        Mann F. Reinventing acupuncture. Oxford: Butterworth Heinemann, 1992.
        Ulett G. Beyond Yin and Yang: how acupuncture really works. St Louis: Warren H Green, 1992.
        Cho ZH, Chung SC, Jones JP et al. Proc Natl Acad Sci, USA 1998;95:2670–3.
        Abstract/FREE Full Text
        Travell JG, Rinzler SH. The myofascial genesis of pain. Postgrad Med 1952;11:425–34.
        Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain 1977;3:3–23.
        Ezzo J, Berman B, Hadhazy V, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 2000;86:217–25.
        Ernst E, White AR, eds. Acupuncture: a scientific appraisal. Oxford: Butterworth Heinemann, 1999.
        http://rheumatology.oxfordjournals.org/content/43/5/662.long
        http://www.acupuncture.com/research/

        1. WilliamLawrenceUtridge says:

          See my comment below.

  22. MadisonMD says:

    Gee. Copypasta from a myofascial pain website. That’s clever, SSR. Really saves you the trouble of actually considering the evidence therein. Also you muster up big numbers “thousands” of references. Well, a pile of irrelevant or crappy references does not convince, even if you provide a list of a million. The British Chiropractic Association tried that, remember? It didn’t work.

    It’s laughable that you cite a paper that says acupuncture is 5000 years old. Even if we concede the conclusion of that study, it has no relevance to the argument at hand. Moreover, you cite Edward Ernst in 1999, and link to his review in 2004 as supporting your claims. Here is what he said more recently.

    Here’s your homework. Provide the single citation which provides the most convincing data that acupuncture is effective for any one condition you use it for. Yes, this will require you to actually read and understand the citations you post.

    If you cannot do this, you will not surmount the scientific block. Your time here is wasted, except to demonstrate the misbegotten logic of a CAM practitioner.

  23. WilliamLawrenceUtridge says:

    New comment, for spacing.

    You want to do this? OK, here we go. Some starting comments. Simply dumping a list doesn’t mean anything (which is why this link – http://www.acupuncture.com/research/ – is just as useless). As I am about to show, a massive list is meaningless if the individual items don’t support your point. All you’re doing is trying to give the impression of support without actually doing any of the hard work to show how the individual points actually support it. I mean, do you not understand the difference between quality and quantity? If I ask for an apple, and someone hands me a pile of dog shit, I’m not going to be happy if their response to “I asked for an apple” is even more dog shit. I mean seriously, you have knee pain and a surgeon suggests cartilage debridement, if you object are you placated if they offer to do both knees plus the elbows and wrists? Second, age is crucial, and often allows you to be deceptive – for instance, you might cite a Cochrane review from 2006 that was positive, and ignore the Cochrane review from 2009 that was negative. Third, theoretical pieces are interesting starting points, they are not proof. For proof, you have to take the theory and turn it into a clinical trial that explicitly tests it. If someone says “I think X is caused by Y” but never tests it, they’ve done essentially nothing scientific. This is how medicine was practiced for millennia, theory without testing, and it did nothing to help patients. And fourth, I believe we are arguing about treatment. I have no real beef with the existence of muscle pain and trigger points – I just don’t think your treatment modalities and faith in unproven medicine (CAM) is unjustified, unethical, and exploitative.

    Oh, and you generally lack critical thinking skills.

    Too old to be useful

    -Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1983.
    -Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985; 60(6):615-23.
    -Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain 1977;3:3–23.
    -The Academy of Traditional Chinese Medicine. An outline of Chinese acupuncture. Peking: Foreign Languages Press, 1975.
    - Han J, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220.
    - Reston J. Now about my operation in Peking. New York Times 1971;1:6.
    -Dimond EG. Acupuncture anesthesia. Western medicine and Chinese traditional medicine. J Am Med Assoc 1971;218:1558–63.
    - Travell JG, Rinzler SH. The myofascial genesis of pain. Postgrad Med 1952;11:425–34.

    I didn’t even bother to look these up. They are so old that by relying on them you’re basically committing medical malpractice. I mean seriously, if you practice medicine based on what was current 30 years ago, you’re killing patients. And to look at it another way – if I showed you a clinical trial from 30 years ago saying knee cartilage debridement was just the best thing ever, would you be convinced? No? Then why should I take your 30-year-old papers seriously? What if I had a case report on bloodletting from 1847?

    Anon. Acupuncturation. Lancet 1823;November 9:200–1.
    Osler W. The principles and practice of medicine. New York: Appleton & Co., 1912.

    These deserve special mention, because I mean really, what the fuck? Are you kidding? You seriously think these are worth even discussing? You consider something more than a century old to be relevant evidence for contemporary practice? OK, well then – just to let you know, make sure to strip the silicone off of your acupuncture needles because they just used plain steel back then. And by “back then” I mean close to the turn of the century. When acupuncture was actually popular in China, like, a thousand years ago, they used thick needles and knives – bloodletting, not what we think of as contemporary needles. Filiform steel needles didn’t exist until about two centuries ago.

    Prevalence studies

    -Skootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. West J Med 1989; 151(2):157-60
    -Ardic F, Gokharman D, Atsu S, Guner S, Yilmaz M, Yorgancioglu R. The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis. Aust Dent J 2006; 51(1):23-8.
    -Gerwin RD. A study of 96 subjects examined for both fibromyalgia and myofascial pain. J Musculoskeletal Pain 1995; 3 (suppl. 1):121-5

    These are prevalence studies. Further, they are prevalence studies of muscle pani – they say that muscle pain is common, not what causes it or how to treat it. They certainly don’t justify your unproven or disproven interventions. I know muscle pain is common. I have muscle pain. We’re not arguing whether muscle pain exists. That muscle pain exists doesn’t mean acupuncture works. These are irrelevant to the point you are trying to make.

    Irrelevant

    Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache 2006; 46(8):1264-72
    -Fernandez-de-Las-Penas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Man Ther 2006

    Both of these show a difference between controls and those with chronic headache. Seems like reasonably well-defined pilot studies, which is emphasized in the abstracts to show that the clinical entity of TPs exists, not that your preferred treatments are effective. In fact, the second study suggests that posture would be a better place to start than needles. Certainly safer. It’s from the same research group, and doesn’t say anything about treatment, which is really what we are arguing about.

    Hwang M, Kang YK, Kim DH. Referred pain pattern of the pronator quadratus muscle. Pain 2005; 116(3):238-42.

    This shows that referred pain exists – more specifically that muscles may be able to cause referred pain. And amusingly, this pain was caused by a needle (through injected saline, but still). But the real conclusion is that the referred pain is through dermatomes, which means muscles could cause nerve pain. Again, unsurprising, and irrelevant.

    Treaster D, Marras WS, Burr D, Sheedy JE, Hart D. Myofascial trigger point development from visual and postural stressors during computer work. J Electromyogr Kinesiol 2005

    You need to update your list to include this also irrelevant article. All this says is that stress positions might cause trigger points. Well duh. Does not justify acupuncture being the best, or even a, treatment for trigger points.

    -Graven-Nielsen T, Arendt-Nielsen L. Peripheral and central sensitization in musculoskeletal pain disorders: an experimental approach. Curr Rheumatol Rep 2002; 4(4):313-21.
    -Arendt-Nielsen L, Graven-Nielsen T. Central sensitization in fibromyalgia and other musculoskeletal disorders. Curr Pain Headache Rep 2003; 7(5):355-61.

    These theoretical pieces (by the same researchers, published in almost the same year, suggesting they’re milking previous publications to produce more) discuss central sensitization. What does this have to do with acupuncture? Further, how does peripheral acupuncture help with central sensitization?

    -Borg-Stein J. Cervical myofascial pain and headache. Curr Pain Headache Rep 2002; 6(4):324-30
    - Gerwin RD. Myofascial pain syndromes in the upper extremity. J Hand Ther 1997; 10(2):130-6.

    Trigger points could cause headaches or other types of pain. So what? Unrelated to treatment options.

    -Rivner MH. The neurophysiology of myofascial pain syndrome. Curr Pain Headache Rep 2001; 5(5):432-40.
    -Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil 2002; 83(3 Suppl 1):S40-S49.
    -Rudin NJ. Evaluation of treatments for myofascial pain syndrome and fibromyalgia. Curr Pain Headache Rep 2003; 7(6):433-42.
    -Wheeler AH. Myofascial pain disorders: theory to therapy. Drugs 2004; 64(1):45-62.

    Do you think I don’t think myofascal pain or trigger points exist? Because I have little problem with the existence of myofascial pain or trigger points. I just don’t think there is evidence to support any CAM treatments and I think your confidence is unwarranted.

    -Ma KW. The roots and development of Chinese acupuncture: from prehistory to early 20th century. Acupunct Med 1992;10(Suppl):92–9.
    -Basser S. Acupuncture: a history. Sci Rev Altern Med 1999;3:34–41.
    Chen Y. Silk scrolls: earliest literature of meridian doctrine in ancient China. Acupunct Electrother Res 1997;22:175–89.
    -Dorfer L, Moser M, Bahr F et al. A medical report from the stone age? Lancet 1999;354:1023–5.
    -Kaplan G. A brief history of acupuncture’s journey to the West. J Altern Complement Med 1997;3:5.
    -Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. In: Ernst E, White A, eds. Acupuncture: a scientific appraisal. Oxford: Butterworth Heinemann, 1999:11–30.
    - Huang KC. Acupuncture: the past and the present. New York: Vantage, 1996.
    - http://rheumatology.oxfordjournals.org/content/43/5/662.long

    These are all about the history of acupuncture. So what? If I gave you a book on the history of bloodletting, would you pull out the lancets and leeches and start treating everyone through exsanguination? If I gave you a book on the history of joint debridement, would you start recommending it to patients?

    Cherry picking

    Ezzo J, Berman B, Hadhazy V, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 2000;86:217–25.

    Did you actually read this article? “We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care.” This is the conclusion for many similar meta studies that are more recent than 2000. Further, the validity of combining such varied trials into a single meta-analysis is questionable.

    Ernst E, White AR, eds. Acupuncture: a scientific appraisal. Oxford: Butterworth Heinemann, 1999.

    I’ve read Ernst’s far more recent Trick or Treatment in which he concludes that acupuncture is a placebo, and since the development of a sham needle to control for skin penetration, the evidence base has gotten worse. Why cite the old information, when the new information is newer (and more critical)? Don’t answer, I know why.

    Misc.

    -Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65(4):653-60.

    A review article. Interesting. Recommends several treatments, despite the statement “The long-term clinical efficacy of various therapies is not clear, because data that incorporate pre- and post-treatment assessments with control groups are not available.” Astonishingly, Alvarez and Rockwell also say “While relatively few controlled studies on trigger-point injection have been conducted, trigger-point injection and dry needling of trigger points have become widely accepted” and then go on to recommend injection! I can see why you like them. “There’s no evidence but lots of people like it” is a reason to get more evidence, not to jump on a bandwagon.

    -Marwick C. Acceptance of some acupuncture applications. J Am Med Assoc 1997;278:1725–7.

    This is a news article about the 1997 NIH report on acupuncture, which was itself horribly flawed, chaired by an acupuncturist, and drew on mostly old, now supplanted evidence (see here), and now the NCCAM doesn’t pimp the NIH report anymore.

    -Ulett GA. Conditioned healing with electroacupuncture. Altern Ther Health Med 1996;2:56–60.

    Acupuncture isn’t electroacupuncture. Further, this is a theoretical piece, not a clinical trial or even systematic review.

    -Cho ZH, Chung SC, Jones JP et al. Proc Natl Acad Sci, USA 1998;95:2670–3.
    Abstract/FREE Full Text

    This is apparently a reference to this paper, which is about using fMRI to test historical acupuncture points. Do I need to go into why this is irrelevant? Do you think needling location matters, beyond limiting one’s self to trigger points? If so, Felix Mann, whose book you cite, disagrees. Also, proving a link between a needle in the toe and the activation of the occipital cortex, even if true, doesn’t mean you can treat blindness by needling the toe. It’s possible (but unlikely), but it’s also a totally separate question that requires separate testing. This is like saying because you can use pure bleach to kill tumors in a test tube, cancer patients should replace their blood with bleach.

    Books

    -Travell J, Simons D. Myofascial Pain and Dysfunction: The trigger point manual, Volume 2. Baltimore: Williams & Wilkins; 1992.
    -Baldry PE. Acupuncture, trigger points and musculoskeletal pain. Edinburgh: Churchill Livingstone, 1993.
    -Bivens RE. Acupuncture, expertise and cross-cultural medicine. Manchester: Palgrave, 2000.
    -Mann F. Reinventing acupuncture. Oxford: Butterworth Heinemann, 1992.
    -Ulett G. Beyond Yin and Yang: how acupuncture really works. St Louis: Warren H Green, 1992 -Simons DG. Myofascial pain caused by trigger points. In: Mense S, Simons DG, Russel IJ, editors. Muscle Pain: Understanding its Nature, Diagnosis, and Treatment. First ed. Philadelphia: Lippincott Williams & Wilkins; 2001. 205-88.

    I’m not going to read whole books, thanks.

    Actually relevant
    The shortest section here.

    Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil 1994; 73(4):256-63.

    Yeah, this one is a relevant, small-n preliminary study. It’s interesting, it has implications for further research, and requires replication for other areas of pain. However, what is missing from the abstract – what does it take to inspire a local twitch response? Were the 17 no-local-twitch-response patients identified a priori, or were they merely 17 people who showed no such twitch response upon stimulation – in which case, you don’t know if the treatment or the person was responsible for the reduced pain. Also, how long did it last? What about the post-treatment soreness 2-8 hours after? And doesn’t this suggest, quite strongly, that acupuncture is far less effective than lidocaine injection?

    Hong C-Z. Considerations and Recommendations Regarding Myofascial Trigger Point Injection. J Musculoskeletal Pain 1994; 2(1):29-59.

    Did Hong ever do any further research? Because he seems to actually give a crap about science and I approve. Also, I wasn’t aware that the ancient Chinese used to inject lidocaine into acupuncture points. Has anyone else replicated or extended his work? I’m less enamoured of this article though, since it’s a theoretical piece, not clinical research and trials.

    1. n brownlee says:

      Oh, Thank You, WLU. I was SO hoping you’d do this. You entirely rock, I mean like Monument Valley.

    2. MadisonMD says:

      Wow, WLU. You deserve a medal for reading all SSR’s citations–he clearly did not bother–to demonstrate that they do not constitute evidence for his claims. The onus is on him to demonstrate it, but somehow he keeps trying to put the effort on everyone else by pasting lists of mostly irrelevant citations on acupuncture websites.

      1. WilliamLawrenceUtridge says:

        he clearly did not bother

        I would guess he clearly did not bother to read them at all; some were markedly negative. For instance, this one is a brief history of acupuncture written by Edzard Ernst, which rather clearly states what I have been saying for months – that “acupuncture” has been a varied thing throughout time, not some sort of Platonic eternal. Also, it looks like wherever he cribbed the list from, it in turn cribbed the first half-dozen citations from that article as they are the same ones, in the same order.

        Research is clearly not his strong suit.

    3. Andrey Pavlov says:

      Seems you’ve taken a page from my book, WLU. Not sure if that is a good thing or not ;-)

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>