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Foolishness or Fraud? Bogus Science at NCCAM

Voodoo science is a sort of background noise, annoying but rarely rising to a level that seriously interferes with genuine scientific discourse… The more serious threat is to the public, which is not often in a position to judge which claims are real and which are voodoo. Those who are fortunate enough to have chosen science as a career have an obligation to inform the public about voodoo science.

– Robert L. Park, PhD, 20001

Imagine you are an ordinary person with limited knowledge of science and medicine, and you see this 2010 video on tai chi and qi gong by the National Center for Complementary and Alternative Medicine (NCCAM) — one of the agencies that make up the National Institutes of Health (NIH). I am certain that the solemn voice of the Director of NCCAM, Dr. Josephine Briggs, talking about “rigorous scientific research” and “accurate, authoritative information on complementary and alternative medicine,” will leave you with a strong sense of confidence in her message.

In addition, despite the fine-print and the disclaimer, the appearance of Dr. Briggs in the video could be broadly viewed as a sign of tacit endorsement. Often, the very fact that a treatment is associated with the government is already a de facto stamp of approval and a warranty of efficacy. For instance, the publication below by the California Department of Consumer Affairs states that the NIH formally “endorses” acupuncture, simply because in 1997, a panel of scientists assessed its use and effectiveness for a variety of conditions. Since 1997 the scientific review of acupuncture by NIH has become synonymous with its endorsement, despite the fact that as a federal research agency, the NIH does not endorse any product, service, or treatment.

In October 26, 2011, a few weeks after Steve Jobs’ death, Josephine Briggs decided to do something she has never done before: she put an explicit disclaimer on her blog:

When making treatment decisions, unproven “alternative medicine” approaches should not replace conventional medical care approaches known to be useful or helpful. Simply put, the evidence is not there (emphasis added).2

Three paragraphs down the page, she goes on — with a candor rarely seen from her — that given the recent news about Steve Jobs’ choices for cancer treatment, all health decisions “should be guided by the best available evidence.”

If you recall, Jobs put off surgery in favor of juice fasts, cleansing, acupuncture, herbal medicine and other remedies he found online. Job’s biographer, Walter Isaacson, writes that he also followed a doctor who ran an alternative medicine clinic.3 Obviously, Dr. Briggs’ new-found skepticism did not get to him on-time.

Josephine Briggs’ sudden confession actually raises more questions than answers: did she have an enlightenment, an “Aha moment” in October 2011, and she suddenly realized that the evidence was not there? Or perhaps she knew all along, and while her institute was spending over $2 billion of US taxpayers’ money, she conveniently looked the other way? The question is pertinent because — despite the overwhelming criticism from the scientific community — Briggs and her staff have refused to admit that most research in alternative medicine is a reprehensible waste of public funds. If she has willingly looked the other way, then we are dealing here with bad faith and the betrayal of the public’s trust.

And waste and betrayal, there is. Skeptics Eugenie Mielczarek and Brian Engler write in the January/February 2012 issue of the Skeptical Inquirer that since 1992, there have been over 1000 monetary awards by NCCAM to fund hundreds of clinical trials. None of them has revealed anything new that would justify the current annual expenditure of $134 million. Some of these funded studies are beyond absurd: $250,000 was wasted to determine whether waving hands over fatty rabbits will decrease their cholesterol. Did it? Almost ten years later, we still don’t know! Public funds were also wasted to study the efficacy of prayer to cure AIDS or to hasten recovery from breast-reconstruction surgery. Other funded studies involved the use of ancient Indian remedies for type 2 diabetes, magnets for arthritis, carpal tunnel syndrome or migraine headaches, and coffee enemas for pancreatic cancer. It is not surprising that none of these studies showed any efficacy beyond the placebo effect.4

After examining hundreds of grants, dozens of scientific papers, 12 years of documents and advisory council meeting minutes, the Chicago Tribune also reports that NCCAM has spent millions of taxpayer dollars on studies with “questionable grounding in science.” The Tribune cites a grant for $374,000 to find out if inhaling lemon and lavender scents would improve wound healing. NCCAM has also wasted funds in studies of various forms of energy healing, including one based on the ideas of a self-described “healer, clairvoyant and medicine woman” who says her children inspired her to learn to read auras. The cost to the taxpayer was $104,000.5

All that is proven by these studies is that that most alternative “cures” work no better than placebo. It is also the case for acupuncture: a 3-arm randomized clinical trial on chronic back pain with 638 subjects showed that both acupuncture and sham control were better than usual care in managing low-back pain. However, the acupuncture regimen was not found to be more effective than a sham procedure that did not penetrate the skin. In other words, there is no difference between any type of acupuncture, and a placebo control procedure that does not involve real needles. This study was published in 2009 in the Archives of Internal Medicine.6

Well, here’s Josephine Briggs’ reaction to this acupuncture study:

This adds to the growing body of evidence that there is something meaningful taking place during acupuncture treatments outside of actual needling.

In other words, Briggs states that a treatment is useful because something meaningful is taking place outside of the treatment itself! But, isn’t this the very definition of the placebo effect? Based on her outlandish argument, needling voodoo dolls should also be considered as treatment — and perhaps qualify for funding — because something meaningful is taking place outside of actual needling!

But now that acupuncture, herbal remedies and a vegan diet did not help an American icon, Josephine Briggs is having an Aha moment, and is suddenly realizing that the evidence is not there! Why didn’t she admit to it earlier? Why did her agency omit credible evidence against the efficacy of these remedies for over a decade? Is her forced admission — or rather confession — some kind of proactive measure? These questions remain unanswered. But what is now certain, is the fact that NCCAM’s claim of being “dedicated to exploring complementary and alternative healing in the context of rigorous science,” is in flagrant conflict with its actual practices-on-the-ground.

Besides, let’s also not forget that this conflict is first and foremost politically motivated.7 It is the work of “alternative-medicine purveyors” and their powerful allies who seek to legitimize their anti-science agenda through a federal agency, and to maintain government funding for the promotion of “willful ignorance.”

Willful ignorance is certainly the hallmark of some of NCCAM’s Advisory Board members. Take a good look at their credentials and you will notice one element universally lacking: rigorous scientific training. Even worse, some have been entirely dishonest about their credentials or have a record of disregard for science- and evidence-based medicine, altogether.

Since 2009, Kimball Atwood, has written several posts on this site about the former member of NCCAM’s Advisory Council, the “AltMed Superstar,” Ted J Kaptchuk. According to Atwood’s investigation and also documents obtained from the California Acupuncture Board, Kaptchuk not only does not have real academic training, but he also has grossly misrepresented his credentials. Atwood suggests that Kaptchuk may have violated federal law by lying about his credentials when applying for federal grants.

Atwood adds in his November 11, 2011, comments that:

The revelation that this degree never existed now undermines all of those things, with ramifications that go way beyond Kaptchuk himself. The lie is so fundamental that it casts suspicion on all of his trial reports, for example. That affects all of his co-authors.

Be noted that even real credentials are not necessarily indicative of aptitude for scientific inquiry. Consider another former member of the Advisory Council, Adam Burke, PhD, MPH, MS, LAc. Despite what reads like a string of illustrious credentials, Burke doesn’t have any biomedical training: his graduate degrees are from UC Santa Cruz and UCLA in Social Psychology and Health Education. His healthcare “degree” doesn’t even come from an academic institution: it’s from the American College of Traditional Chinese Medicine in San Francisco (a private vocational school, where he is presently on faculty).

Here’s testimony to Adam Burke’s contempt for science:

If you biomedicalize it all, my big fear and this is why I’m in the university and one of the reasons why I went back to the university is if we strip the history and the philosophy and the understanding of that, we have shut out millennia of understanding of human illness that could enrich our understanding of healing people.

What follows is just crazy talk:

Distant healing — They don’t know how, but some of the people at the Institute of Noetic Sciences, which was founded by an Astronaut up in Marin, they are doing research on distant healing. Their principle investigator is a physicist — they are getting their research published in the best physics journals in the United States.

– Adam Burke, California Acupuncture Board Meeting Minutes, June 20, 2008

Burke also boasts the rather awkward honor of serving as Editor-in-Chief of The American Acupuncturist, the official publication of the American Association of Acupuncture and Oriental Medicine (AAAOM). Here below is a photo of AAAOM representatives meeting with Director Josephine Briggs in 2008:

Image 1. Front Row (L-R): Will Morris, Josephine Briggs, Martin Herbkersman, and in the back Row (L-R) Partap Khalsa, Misha Cohen, Adam Burke, Rebekah Christensen. Image Source: The American Acupuncturist, Fall 2008.

It is certainly not due to their concern for “rigorous science” that the above met with Josephine Briggs. It is because in this New Age of ignorance, hocus-pocus is big business, and getting the government involved can create the false perception of endorsement for any nonsense. This is a common charade that has been played by alternative-medicine purveyors for decades, with the public’s safety at stake.

But no matter — what we see recorded here is a 2008 meeting between an advocacy group and NCCAM. They were assembled to present Briggs a wish-list that included an increase in herbal research; grants to support AAAOM conferences; and the placement of acupuncturists on university research, grant review teams, and research advisory panels. The wish-list also requested “the expansion of the NCCAM Advisory Board to include individuals versed in mixed research methods, including qualitative, population-based research, quality and other approaches.”8

Now fast forward to 2010, about two years after the photo, and AAAOM’s candidate, Adam Burke, is appointed to NCCAM’s Advisory Board. Immediately after, the AltMed wizards from the above picture write in the January 2010 issue of Qi-Unity Report:

We look forward to the in-depth professional and research acumen Dr. Burke will bring to the NCCAM Advisory Council and to the benefits that will accrue to the AOM profession as our medicine transitions into the mainstream of U.S. health care delivery.

“In-depth professional and research acumen” and “our” medicine?! I just cannot refrain from laughing out loud.

But this is no laughing matter. The NCCAM budget for 2011 was $127.7 million.9 They requested a $3.4 million increase in funding for 2012.10 This is over $131.1 million taken away from serious medical research. Fortunately, Adam Burke was not re-nominated in 2012, and cannot influence the channeling of funds for “herbal research” or “grants to support AAAOM conferences” — especially now that we know the evidence is not there.

But despite Dr. Brigg’s disclaimer, many key questions still remain unanswered. How much more money is NCCAM going to waste for studying remedies where something meaningful is taking place outside of the actual treatment? How many more self-proclaimed experts with fabricated or unfit credentials are going to feed off the taxpayer? How many more Steve Jobs need to die before we realize that alternative medicine is in essence foolishness?

In my opinion, none, absolutely none. Once we become aware that the evidence is not there, a transgression takes place; this is when a legal line is finally crossed, and — as Robert Park has argued — foolishness becomes fraud.

With many thanks to Daniel Bederian-Gardner, Kristen Koster, Dawn Martin, Eugenie Mielczarek and Robert Slack for their valuable comments. The opinions expressed here are the author’s.

REFERENCES:

  1. Park RL. Voodoo Science: The Road from Foolishness to Fraud. Oxford University Press. 2001. Return to text
  2. Briggs JP. A Role for Complementary Medicine? NCCAM. 26 October, 2011. Retrieved 8 April 2012. Return to text
  3. Isaacson W. Steve Jobs. Simon & Schuster; First Edition edition. 2011. Return to text
  4. Mielczarek EV, Engler BD. Measuring mythology: startling concepts in NCCAM grants. Skeptical Inquirer. Volume 36.1, January/February 2012. Return to text
  5. Tsouderos T, Federal center pays good money for suspect medicine. Chicago Tribune. December 11, 2011. Return to text
  6. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009 May 11;169(9):858-66. Return to text
  7. Mielczarek EV, Araujo DC. Power Lines and Cancer, Distant Healing and Health Care. Skeptical Inquirer. Volume 35.3, May/June 2011. Return to text
  8. AAAOM Meets with the National Center for Complementary and Alternative Medicine (NCCAM). American Acupuncturist. Volume 45 FALL 2008. Return to text
  9. NCCAM Funding: Appropriations History. NIH. 12 September 2011. Retrieved 8 April 2012. Return to text
  10. Fiscal Year 2012 Budget Request. NIH. 12 September 2011. Retrieved 8 April 2012. Return to text

Posted in: Acupuncture, Basic Science, Health Fraud, Politics and Regulation, Public Health, Science and Medicine

Leave a Comment (67) ↓

67 thoughts on “Foolishness or Fraud? Bogus Science at NCCAM

  1. David Gorski says:

    Sorry, everyone (and Ben). For some reason the comments were turned off when this post published. I should have noticed earlier. I’ve turned them on again.

  2. marcus welby says:

    For those who want action regarding NCCAM defunding, I suggest the following:
    1. if your Congressperson is on any committees relating to NIH or health funding, please visit with them on this issue. The presentation of this post, along with a copy of Paul Offit’s commentary from JAMA, the resolution of the Center for Inquiry recommending defunding of NCCAM, along with the January-February issue of Skeptical Inquirer should be useful supportive materials. The fact that Obama’s proposal for increasing funding of Alzheimer’s research efforts at NIH calls for a figure close to the amount NCCAM wastes annually should be supportive of this effort. The point that none of the NCCAM funded research proposals would likely be funded without the “protective carve-out” at NIH that is presently in existence should be influential. And likewise, that if a truly meritorious research proposal comes forth in the absence of NCCAM, and wins funding in competition there, it would still be funded.
    2. Know that Sen. Tom Harkin, one of the two originators of NCCAM 20 years ago, is also evidently a staunch defender of NIH funding overall, thus it is difficult politically for Francis Collins and NIH, I would expect, to withdraw support for NCCAM.
    3. Budgetary wheeling and dealing in Congress are set to gear up in the next 6-8 weeks, so now is the time to become pro-active.

  3. Jan Willem Nienhuys says:

    My favorite example of meaningless research is the University of Arizona !) that spent three years (2006-2009) trying to find out whether succussing or not made any difference in the preparation of homeopathic highly diluted stuff. Now that is an easy test for which you don’t need a university at all, except the University of Arizona was trying to use EEGs to find out. I found it on the list of projects for 2008 of the NCCAM, but I can’t find that list anymore on their website.

    Here is the research plan:
    step 1. Try to do a so-called proving with a properly prepared homeopathic remedy. Don’t use the homeopathic method of an unblinded n=1 trial without control, but do it properly with, say 40 healthy volunteers and rigorously randomized and blinded. Also the people (homeopaths) classifying the reactions as noted down in diaries should be blinded to who is in the verum and who is in the placebo group.

    Step 1 doesn’t cost anything. An skeptical organisation would be happy to do it for free. The only problem is getting homeopaths to cooperate, because they will adamantly refuse to get involved.

    step 2. If step 1 succeeds, apply for the Randi 1 million dollar prize and repeat.

    step 3. If step 2 succeeds, use the method of step 1 to figure whether there is any difference between succussed or not.

    step 5. repeat step 1 successively for all 1000 or 3000 homeopathic preparations such as Natrum muriaticum LMK (100 to the power 50.000 times diluted), South Pole Magnetism (Polis magnetis australis) and also newer preparations such as Oscillococcinum and Jupiter Light (Lux Jupiteris stellae errantis).

    Of course if step 1 fails, then the researcher is told to come back if he knows how to make step 1 succeed.

    This scheme doesn’t cost a single penny to the tax payer.

    Note: In step 1 you can skip Belladonna 30C, that has been done already:
    http://www.ncbi.nlm.nih.gov/pubmed/14651731

    Actually Natrum muriaticum 30C has been done also (in 1835), but you might want to try again.

    This whole NCCAM research reminds one of the scientific projects Gulliver saw in the Lagado Academy:
    - making gunpowder from ice
    - extract sunrays from cucumbers
    - teaching blind people to recognize colors by touch (taught by a blind proect leader)
    - giving enemas with compressed air
    - softening marble so it could be used to stuff pillows
    - examining faeces of politicians to see what plots they are hatching

    May be NCCAM can be renamed Lagado Academy Division of America, LADA – also easier to pronounce.

  4. cervantes says:

    My guess — Briggs is planning to step down from the gig and is hoping to get a real job. So she’s trying to de-wacko herself.

  5. Eugenie Mielczarek says:

    Re Marcus Welby’’s suggestion
    Since April 2011 Brian Engler and I have sent policy analyses to Chairs and Member s of all committees with responsibilities which oversee funding for NIH. In addition The Center for Inquiry has sent all our policy reports and analyses written in 2011 and 2012 to legislators. The response has been zero—except now, almost daily I receive pleas for money from both parties. The grasp of the Alternative Medicine industry on deluded congressmen or any elected official is strong. I also appeared before PCAST — President’s Council of Advisors on Science and Technology in January 2010–specifically on this subject. One impression I have taken away from all this –is that both our legislative branch and executive office are deluded.
    Eugenie Mielczarek

  6. ConspicuousCarl says:

    Simply put, the
    evidence is not there

    Neither is the plausibility. Maybe Briggs will add that bit to her disclaimer if Larry Page dies from listeria while being treated by a homeopath.

  7. Ben Kavoussi says:

    @ ConspicuousCarl,

    I entirely agree. The fundamental assumptions in many of these remedies were formed before modern times. For instance, acupuncture and Chinese medicine were formed during the geocentric worldview, when alchemy and vitalism were mainstream “science.” Since the fundamental assumptions of most CAM modalities are based on outdated worldviews, most of the remedies that NCCAM is investigating – and indirectly promoting – are inherently implausible. This is something NCCAM has never taken in consideration.

  8. DavidRLogan says:

    Well I’m terrified to post anything even neutral about QiGong on this board. So let me qualify…

    I do NOT think QiGong invokes the supernatural, nor do I think it should be studied with public funds. And I think many claims of its efficacy (cancer curing!) strain credulity. QiGong should NOT be used as a first line treatment in place of the medicine you all practice.

    That qualification given (!), I don’t find QiGong nearly as offensive as accupuncture, or flower therapy, or drinking bleach, etc. I think when QiGong is offered as a series of gentle exercises and deep breathing, it is extremely protective, in my view moreso than jogging or some other popular exercises which can be hard on metabolism (jogging’s protection depends, of course, on the mileage and level of effort). Also QiGong does not present the dangerous possibilities of accupuncture or some of these other crazy interventions.

    I have not done QiGong, but I meditate everyday and find it extremely valuable…perhaps the most valuable intervention I have. I hope meditation and QiGong can gain some acceptance outside of the quack/charlatan community (maybe you all would know if they have…).

    Again, I point out that I qualified my statement! I do NOT support a supernatural, cancer-curing, taxpayer-endorsed culture of QiGong. But I don’t think QiGong is “voodoo” anymore than any other healthy physical activity (although exagerrated claims of its efficacy/mechanism may be the “voodoo”). On the contrary, I find it likely to be very protective.

  9. DavidRLogan says:

    BTW this post and the comments were outstanding…particularly Jan’s comment on homeopathy.

  10. Solandra says:

    I just had surgery for a follicular thyroid tumor. It had a 30% chance of being cancer, so I didn’t screw around with Tai Chi or vitamin therapies. I had that mother effer cut out! So glad I did! It was, at that moment, fully encapsulated and classified as benign. If I had decided to go screw around with herbal hoohaw, it could have invaded surrounding tissues, lymph nodes and even my bone and lung in as little as two years, maybe. They don’t know for sure, it could have or maybe not. But the good folks at Providence St. V’s here in Portland, and my SUPER AWESOME surgeon, Edsel Kim, got it out, and I’m fine. It was still scary, and I had the best doctor around, but if I had run away and tried other things, it could have maybe been worse in the future. Makes me sad that Steve Jobs didn’t do the right thing in the beginning, he could have been OK maybe, and it makes me sad that my dad didn’t get traditional treatment for his cancer.. He tried alternative therapies and that didn’t end well.

  11. Solandra says:

    And David, I think QiGong should just be classified as another exercise.. bike riding lowers my blood pressure and makes me feel good and lose weight. Meditation is relaxing for some people, but sitting still drives me crazy.. I think those things ARE recognized as subjectively helpful, though, but I agree that people need to stop attributing crazy supernatural curing powers to them. You can still say something is valid without saying it’s magical. :)

  12. Ben Kavoussi says:

    @ marcus welby

    Thank you very much for the suggestions. I tend to agree with Eugenie Mielczarek. The legislator and government executives in US are both deluded, ignorant and resistant to change. This is why ideas such as Intelligent Design, persist in America and some states are considered a valid point of view. I am afraid that the appeal to politicians is not going to get us very far.

    There are other solutions we could explore. One is to show that CAM remedies could be dangerous, The toxicity of certain herbs, contamination by heavy metals and pesticides, and the adulteration of herbal remedies are good examples. In this case the FDA will intervene, as it did in the case of Ephedra and many other toxic herbs. The other way is to go to court and sue. This is what the opponents of Intelligent Design did and they won in many states. For instance, spending federal funding for the investigation of prayer for AIDS or recovery from surgery entangles the federal government with religion. Many of the underlying ideas behind acupuncture are related to Taoism, which is a religion.

    What I suggesting here is that if Dr Briggs knew all along that “the evidence is not there,” then we should view some of NCCAM’s expenditures as Fraud, Waste & Abuse and report it. Perhaps this leads to an investigation and a public hearing.

  13. Ben Kavoussi says:

    @ DavidRLogan

    I some ways I tend to agree with you. We can put tai chi and qi gong in the same category as water aerobics, gentle stretching and yoga, and view them as gentle exercises, which could be beneficial for improving balance and increasing the metabolism. If we strip the supernatural and the voodoo, I do not have any problem with them.

    What has unfortunately happened, is that the investigation of tai chi and qi gong has become an implicit endorsement for Traditional Chinese Medicine and the obscurantism and anti-science narrative that goes with it. This is where the problem resides.

  14. Ben Kavoussi says:

    @ Solandra

    Thank you for your comments, and I am very glad you are recovering well from surgery. Indeed, it is quite sad that Steve Jobs didn’t do the right thing from the beginning. And yes, tai chi and qi gong are just bike riding and water aerobics, they might be beneficial for may conditions because they are a type of exercise, and not because the improve the flow of Qi and other such nonsense.

  15. It’s fascinating that we don’t really bother funding astrology or alchemy anymore, but prescientific medicine is alive and well funded by the NCCAM.

    Why don’t we have National Centers for Complementary and Alternative Chemistry or Astronomy?

  16. Ben Kavoussi says:

    @ Karl Withakay

    We are actually funding research in Medical Astrology! It is called traditional acupuncture. Here’s the detail:

    The acupuncture theory tells us that they are around 360 acupuncture points in 12 meridians. Each meridian is connected to a House of the Chinese zodiac system. Each meridian has 5 special points named after the 5 visible planets. Vital energy (qi) stays in each meridian for 2 hours, just like the Sun stays in each zodiac for 2 hours.

    This is nothing but Medical astrology, also known as Iatromathematics!

  17. Oh, good point. I wasn’t thinking of the astrological connection of acupuncture, which I know you have blogged about here previously: an excellent post that is linked to in the “Good Points by Other Bloggers” page of my blog.

    I propose we create a National Center of Complementary and Alternatives Sciences where prescientific medicine, astrology, alchemy, creationism, free energy, etc can all be freely studied in a nurturing environment devoid of the stifling influence of Big Science.

  18. David Gorski says:

    My favorite example of meaningless research is the University of Arizona !) that spent three years (2006-2009) trying to find out whether succussing or not made any difference in the preparation of homeopathic highly diluted stuff. Now that is an easy test for which you don’t need a university at all, except the University of Arizona was trying to use EEGs to find out. I found it on the list of projects for 2008 of the NCCAM, but I can’t find that list anymore on their website.

    Here’s the project. Its principal investigator was Iris Roberta Bell at the University of Arizona, and it was an R21 entitled Polysomnography in Homeopathic Remedy Effects. Interestingly, here’s its abstract:

    DESCRIPTION (provided by applicant): The purpose of this revised R21 exploratory grant to NCCAM in response to PAR-03-153 is to extend the PI’s previous human olfactory psychophysiology research and develop a quantitative electroencephalographic (qEEG) bioassay for registration of individually active (salient) versus inactive homeopathic remedies or placebo. Homeopathy’s founder, Samuel Hahnemann MD, originally proposed olfactory sniffing as a valid route for clinical remedy administration. Convergent basic science evidence suggests that succussion (vigorous shaking) in the preparation of homeopathic remedies from animal, mineral, and plant sources, may persistently modify the physical structure of solvent to generate order, i.e., a unique informational signal, even in ultra-diluted solutions beyond Avogadro’s number. Torres and Ruiz (1996) proposed that stochastic resonance in sensory systems is a model for optimizing detection of a weak signal (homeopathic remedy information) by addition of noise (succussions). No previous research has directly examined the effects in human populations of a given remedy dilution prepared with different numbers of succussions. Specific aims for the study are: I. To evaluate the feasibility of using acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy (Sulphur) at different numbers of succussions per dilution step, prepared at a given dilution; II. To determine the feasibility of using the magnitude of acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy at two different homeopathic serial dilution factors (prepared with a given number of succussions per dilution step); III. To evaluate the generalizability of findings for a separate polycrest remedy (Pulsatilla). Subjects will be N=108 (n=54/remedy) young adult volunteers with moderate (not excellent global health) prescreened for potential remedy salience of either Sulphur or Pulsatilla and tested in a two-phase study (one remedy per phase). Each participant will undergo pre-screening with the Homeopathic Constitutional Type Questionnaire for high criterion scores for symptoms of one of the two test remedies, followed by three laboratory sessions spaced one week apart (dilution sequence subject allocation balanced within each remedy type for 6c, 12c, and 30c potencies). Each session will involve eight presentations within a complete block design of randomized double-blind, placebo- controlled (both succussed remedy-free solvent and succussed plain distilled water) olfactory sniff tests (using time-locked sniff-EEG recordings via an airflow pressure transducer), using a given remedy dilution prepared with stirring only, 10, 20, or 30 succussions. The present study fills a major need in homeopathic clinical research to explore and understand remedy-related and remedy-person interactive factors that could contribute to well-known problems in replicability. Findings from this and follow- up studies via subsequent R01s could improve standardization of homeopathic remedy manufacturing and prescribing used in patient care and thereby advance the quality of clinical treatments and research for this leading form of complementary and alternative medicine worldwide.

    Now, I know R21 grants are supposed to be exploratory grants, which the NIH characterizes as “high risk, high reward” projects, but this is ridiculous. Bell got $226,500 for this two-year project.

    I wrote about this particular project (among other dubious NCCAM projects) way back in one of my earliest posts for SBM.

  19. Ben Kavoussi says:

    @ Karl Withakay,

    Great idea. After creating the National Center of Complementary and Alternatives Sciences we can publish the Book of Imaginary Medicines, which would be similar to Jorge Luis Borges’ Book of Imaginary Beings (Manual de zoología fantástica).

    What you are proposing is not that farfetched: in 2009, the Center for Inquiry-Los Angeles did a mock continuing-education course for nurses, which included:

    - Möbel Kinesiology (Möbel is the German word for furniture, so möbel kinesiology is, essentially, furniture moving.)
    - Feng Shui (a practice in which a structure or site is chosen or configured so as to harmonize with its qi, or life energy)
    - Chinese ShŽy—u (translation: snake oil)
    - Vapor and Reflective Surfaces (another way to say smoke and mirrors)
    - Apophenia (the experience of seeing patterns or connections in random or meaningless data)
    - Anthropomancy (divination through human entrails)
    - Canupiary Flexibility (The word canupiary exists in no language we could find. It was made up.)

    This course was intended to expose the overly relax and irresponsible policy of approving continuing-education course in California. You can read about it later

    http://www.csicop.org/si/show/state-sponsored_quackery_feng_shui_and_snake_oil_for_california_nurses

    This move was quite successful because it caught the attention of the the California Senate Standing Committee on Business, Professions and Economic Development. The matter was debated during the last oversight hearing on the Board of Registered Nursing.

  20. Ben Kavoussi says:

    @ David Gorski,

    I actually met Iris Bell during a conference at UCLA. She thinks acupuncture points are energy “nodes,” whatever that means…

  21. I fear, though, that if Briggs steps down, she will be replaced with someone who has less scientific integrity. She seems to at least keep the research methods somewhat honest (if not misguided).

  22. Ben Kavoussi says:

    @ cervantes

    She might also be retiring.

  23. Ben Kavoussi says:

    @ Skeptical Medicine

    This is a big area of uncertainty. The only certainty it that NCCAM will be defunded at some time and will go away. It has to. We just cannot continue to waste public funds to find out if waving hands over chubby rabbits lowers their cholesterol! At some time, someone will shut the ongoing nonsense down. Until then, we just have to keep informing the public about the ongoing waste.

  24. BillyJoe says:

    Solandra,

    “I just had surgery for a follicular thyroid tumor…It was…fully encapsulated and classified as benign.”

    That means, does it not, that it was a benign follicular adenoma, not a malignant follicular carcinoma?

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

    If follicular cells are found on cytological testing, it is common to carry out hemithyroidectomy to distinguish between follicular adenoma and follicular carcinoma on histopathological examination, proceeding to completion thyroidectomy and postoperative radioiodine ablation where carcinoma is confirmed.

    “If I had decided to go screw around with herbal hoohaw, it could have invaded surrounding tissues, lymph nodes and even my bone and lung in as little as two years, maybe.”

    Correct me if I am wrong but, if it was a benign follicular adenoma, it could not have invaded surrounding tissues, lymph nodes, bone, and lung could it? That could only have occurred if you had a malignant follicular carcinoma.

    “But the good folks at Providence St. V’s here in Portland, and my SUPER AWESOME surgeon, Edsel Kim, got it out, and I’m fine. It was still scary, and I had the best doctor around”

    By what criteria did you judge him to be the best doctor around!
    (just kidding!)

    “Makes me sad that Steve Jobs didn’t do the right thing in the beginning, he could have been OK maybe”

    Here’s the nuanced opinion of David Gorski on this question:

    …chances are that surgery right after his diagnosis probably wouldn’t have saved Jobs, but there was no way to be able to come to that conclusion except in retrospect, and even then the conclusion is uncertain.

  25. BillyJoe says:

    BTW, CAN WE PLEASE PUT “RECENT POSTS” BEFORE “RECENT COMMENTS”
    It annoying having to scroll down each time.

  26. mousethatroared says:

    I’m with BillyJoe – I preferred recent posts above recent comments.

  27. mousethatroared says:

    @BillyJoe- I’m sure Solandra will have a better answer if they check back, but. I think Solandra was saying that they had a tumor. It was removed and turned out to be benign, but could have been cancerous or could have become cancerous in time.

    I don’t know much about FTC, but I have papillary thyroid thyroid nodules that my Endo suggest I have ultrasound on occassionally to watch for growth, because they are at a higher risk of becoming cancerous than normal thyroid tissue.

  28. David Gorski says:

    I actually met Iris Bell during a conference at UCLA. She thinks acupuncture points are energy “nodes,” whatever that means…

    I’m just annoyed that in this really tight funding situation right now I’m struggling to keep my lab funded and quite possibly might have to shut it down next year if I fail to secure new funding, while grants like this R21 are being granted. No doubt the woos will accuse me of sour grapes, but sometimes sour grapes are justified.

    I know. Maybe I should apply to NCCAM.

  29. David Gorski says:

    I fear, though, that if Briggs steps down, she will be replaced with someone who has less scientific integrity. She seems to at least keep the research methods somewhat honest (if not misguided).

    I actually agree. Every time an NCCAM director retires or moves on, the forces of pseudoscience try very hard to push for a director who is an actual believer, a CAM practitioner or “researcher” of some type. Other than dismantling NCCAM (which will never happen as long as Tom Harkin is in the Senate, and probably never), an NCCAM director like Dr. Briggs, who had a track record in real science before being appointed NCCAM director, is probably about the best that can be hoped for.

  30. nybgrus says:

    @BillyJoe:

    First off, before anyone jumps down Billy’s throat, I think he was just trying to be his usual skeptical self in saying that perhaps solandra’s details didn’t quite mesh up and that it may have been an exaggerated post. Correct me if I am wrong BJ. Though I do laud attempts at being legitimately skeptical, even when the skepticism is directed at posts that would be in line with our message.

    Second off, even benign thyroid adenomas are neoplasms. And, as I am sure you know, they cannot be distinguised from the malignant carcinoma cytologically. From that alone, Billy, you should be able to infer that there may indeed be some malignant potential in the benign adenoma. Either some adenomas become malignant, or some carcinomas are caught early before the become malignant. The point being that if you cannot tell them apart on cytology that the cells must be similar enough to either share a common ancestral lineage towards malignant evolution or that we simply cannot divide them accurately until invasion occurs and some carcinomas will be called adenomas when caught early enough.

    In the case of solandra then we could either have caught her thyroid nodule early enough that it actually was a carcinoma and we will never know for sure, or that had we left the adenoma long enough it could have turned malignant. That’s all on inference though. How about that evidence we love so much?

    <a href="http://www.ncbi.nlm.nih.gov/pubmed/18327528"Do benign thyroid nodules have malignant potential? According to this 2008 review of 10 years of patients, yes. 2% of malignant thyroid cancer arises from a pre-existing benign thyroid nodule.

  31. nybgrus says:

    ack. sorry for the missed html tag

  32. daedalus2u says:

    As someone who comes to SBM multiple times a day and tries to follow some of the comment threads, I prefer recent comments to be above recent posts.

  33. nybgrus says:

    I use a program called Vienna (Mac only, as far as I know) that organizes all my comments and posts so that I never have an issue. Every thread I have ever commented on is in my window on the left, and every one gets checked for new comments. New comments are always at the top and in their own subsection. New posts are also always at the top an in their own sub-section. I have all my regular feeds going through this and it is extremely nice. I suggest Mac users give it a try and PC users find something equivalent.

  34. tbirdzuko says:

    I find it strange that he derides as nonsense a treatment that

    “a 3-arm randomized clinical trial on chronic back pain with 638 subjects showed that both acupuncture and sham control were better than usual care in managing low-back pain.”

    Shouldn’t we be challenging the “usual care” as unscientific instead?

    Why aren’t results the important thing? The placebo effect is real. Why deny this fact except that you FEEL strongly that you just don’t like it?

  35. @BillyJoe, perhaps you should at least read the entire Wikipedia article (which seems to be your primary reference) before you question and instill doubt into someone who underwent treatment for a thyroid neoplasm. There is such a thing as being “too skeptical”, and when it comes to the practice of medicine, of which you clearly know nothing, your statements and suggestions are just wrong. You are trying so hard to be a skeptic, but with too little foundation, and you just keep bumbling about with wrong assumptions, statements, etc.

    Ugh.

  36. Ben Kavoussi says:

    # tbirdzuko

    Why aren’t results the important thing? The placebo effect is real. Why deny this fact except that you FEEL strongly that you just don’t like it?

    The placebo effect is indeed real. But this is not the point. The physician’s white coat, the colorful diplomas on the wall, the stethoscope around the neck, his authoritative tone of voice, or the color of the pill he gives you, all could induce a placebo effect. Are we going to spend millions of dollars of taxpayer’s money to study them? The number of things that could have a placebo effect is unlimited. Are we going to spend an unlimited amount of money to look into each modality? This is absurd.

  37. ConspicuousCarl says:

    tbirdzukoon 09 Jun 2012 at 10:30 am

    I find it strange that he derides as nonsense a treatment that

    “a 3-arm randomized clinical trial on chronic back pain with 638 subjects showed that both acupuncture and sham control were better than usual care in managing low-back pain.”

    Shouldn’t we be challenging the “usual care” as unscientific instead?

    From that study:

    Usual Care Comparison Group: Participants in the usual care group received no study-related care—just the care, if any, they and their physicians chose (mostly medications, primary care, and physical therapy visits). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832641/

    And…

    Participants in the usual care group were twice as likely as those receiving real or simulated acupuncture to report a physician or physical therapist visit (21% versus 11%; P=0.001)

    So the participants in the acupuncture groups were actually given real or placebo (babying and prodding) treatment. Participants in the “usual care” group WERE NOT GIVEN “USUAL CARE”, they were booted out to do anything or nothing on their own. And only 21% of them actually went to a real doctor or therapist even once.

    Furthermore, though the poorly-named “usual care” group did worse, figures 2 and 3 in that paper show the confidence intervals beginning to overlap halfway through the study.

  38. ConspicuousCarl says:

    And by “real” treatment in the post above, I mean according to acupuncturist standards for selling fake treatments.

  39. mousethatroared says:

    I’m not sure where BillyJoe was going with his questions, but I hope I didn’t come across as jumping down his throat.

    I like his approach. I think it is challenging without being malicious.

    But, thyroid tumors, nodules and cancers, endocrinology, etc. That’s a whole lot of information to go through for risk/benefit and then, ultimately, it’s hard to compare to Steve’s Jobs situation, since, I believes, Job’s treatment options where much higher risk than the typical thyroidectomy.

  40. mousethatroared says:

    Regarding comments vs posts on top. The comments are dessert, the posts are the meal. You really should have to go past the meal before dessert…really, it’s all about decorum and decency, for gods sake. :)

    Also I’m finding that I’m losing track of which comments go to which article. I never had that problem before.

  41. BillyJoe says:

    nybgrus,

    “I think he was just trying to be his usual skeptical self in saying that perhaps solandra’s details didn’t quite mesh up and that it may have been an exaggerated post.”

    Yes, with an emphasis on “perhaps” and “may have been”.
    Which is why I put it as a series of questions such as “that means, does it not”, “correct me if I am wrong”, and “could it”.
    What puzzled me in her post was the word “benign” followed by “invasion” which didn’t seem to gel, and which is why I looked up the wiki reference.

    “2% of malignant thyroid cancer arises from a pre-existing benign thyroid nodule”

    That is the missing bit of information that now makes sense of her post. Thanks.

    ——————————————————-

    Skeptical Health,

    Perhaps, in the light of nybgrus’ post, and my comments above, you should read my post again and see if your still think your criticisms are justified.
    Nybgrus seems to have had no trouble interpreting it and politely showing me the missing piece of the puzzle.

    “perhaps you should at least read the entire Wikipedia article ”

    Perhaps you could show me where that article refers to that missing piece of the puzzle.

  42. nybgrus says:

    … but I hope I didn’t come across as jumping down his throat.

    Your post wasn’t the prompt for mine. It was pre-emptive. And it failed. I didn’t have Skeptical Health solely in mind, but certainly specifically in mind.

    I hate “tone police” myself, which is why I generally refrain from making such comments – it is not my place to tell other people how they should post or what they should say… well that and I do myself become rather hostile at times and do not appreciate being tone policed myself.

    But I did witness the PSA fray betwixt the two and anticipated this coming about. And I do have a rather long history with BJ here and at neurologica so it becomes much easier for me to infer his intent.

    That said, I agree with mousethatroared that his general skeptical attitude is one that I admire and that when he is out of his depth he appropriately makes caveats and questions things, always willing to amend his view when presented with the necessary evidence. I saw absolutely nothing wrong with his post, but at the moment I read it realized that someone without any history with BJ could easily interpret it differently. Hence my (failed) attempt at pre-emption (if that’s not I word, I just coined it).

  43. BillyJoe says:

    “I hate tone police”

    The problem is that tone has to be inferred.
    It says more about the police than the policed.

  44. pmoran says:

    # tbirdzuko

    Why aren’t results the important thing? The placebo effect is real. Why deny this fact except that you FEEL strongly that you just don’t like it?

    BK: The placebo effect is indeed real. But this is not the point. The physician’s white coat, the colorful diplomas on the wall, the stethoscope around the neck, his authoritative tone of voice, or the color of the pill he gives you, all could induce a placebo effect. Are we going to spend millions of dollars of taxpayer’s money to study them? The number of things that could have a placebo effect is unlimited. Are we going to spend an unlimited amount of money to look into each modality? This is absurd.

    With acupuncture there is also the likelihood of distractant and counteriritant effects, also potential benefits form the spells of enforced rest and relaxation while the treatment is applied. The invasiveness of the procedure (or the thought of the needles in its sham versions) may make it more effective in inducing the release of endorphins or the other neurotransmitters that have been linked with placebo responses in some neurophysiological studies. Yes, all this is still largely conjecture, nevertheless those striking results from sham acupuncture are greater than those seen with any other placebo.

    So there is a real risk of us going just a tad too far with our hostility towards this quaint combination of elements, simply because of its association with scientifically undefensible TCM theory and the likelihood that much of any benefit is from placebo (as with some weakly active pharmaceuticals?). .

    We also need to be cautious about being spoilsports if certain populations are deriving real benefits from such methods, even if we feel we would not be able to produce comparable effects in our own practices or have insurmountable ethical barriers to our use of anything that even smacks of placebo. It is not as though we have obviously better treatments to offer for LBP and some other conditions.

  45. @BJ, I will happily try to do a better job of giving your posts the benefit of the doubt.

  46. mousethatroared says:

    I prefer to be called a tone watchman*…possibly in this crowd renegade tone guerilla.

    *But who watches the watchman?

  47. BillyJoe says:

    mousethatroared: “But who watches the watchman”

    http://www.youtube.com/watch?v=tS9D7RtB47o

    “And the way he stares….feel like locking my door….
    and pulling my phone from the wall.
    His eyes, like lights from a laser, burn….
    making my hair stand….making the goose-bumps crawl.

    He’s watching me watching you watching him watching me
    I’m watching you watching him watching me watching.”

    (Watching Me Watching You – Ian Anderson/Jethro Tull)

  48. BillyJoe says:

    “those striking results from sham acupuncture are greater than those seen with any other placebo. ”

    But do not forget that…
    sham acupuncture placebo real acupuncture.
    And do not forget to tell your patients that, otherwise they may try to use if for…I dunno…asthma?
    …not that that will stop them from doing so, once they have perceived a benefit for their back pain.

  49. BillyJoe says:

    Hmmm…try again….(didn’t like the arrows on either side of the equal sign)

    “those striking results from sham acupuncture are greater than those seen with any other placebo. ”

    But do not forget that…
    sham acupuncture = placebo = real acupuncture.
    And do not forget to tell your patients that, otherwise they may try to use if for…I dunno…asthma?
    …not that that will stop them from doing so, once they have perceived a benefit for their back pain.

  50. nybgrus says:

    With acupuncture there is also the likelihood of distractant and counteriritant effects

    No there aren’t. As BJ pointed out in ample room for a tweet sham acupuncture = placebo = “real” acupuncture.

    If you have the same effect size without needles, there is no room for counter irritant effects. Stop trying to grab for straws with acupuncture. It is not the association with TCM that makes it unpalatable. It is the fact that it is a ludicrous premise and it doesn’t actually work any better than talking nicely to a patient and twirling toothpicks over them that makes it unpalatable.

    It is not as though we have obviously better treatments to offer for LBP and some other conditions.

    Yes. We do. The better treatment is to encourage patients to be active, move past mild to moderate pain, and stay mobile. Acupuncture is not an effective treatment – it is a way to trick the patient into doing exactly that. Maybe I should do the study, because it would be interesting, and I would be willing to bet that if you compare acupuncture (real or sham – doesn’t matter, since they are the same thing after all) to standard treatment to a group where I give them any ol’ homeopathic pill off the pharmacy shelf but tell them it is a new experimental drug that specifically targets molecular recepters found aroud the spinal cartilage which will relieve their pain + instruction to take it BID & up to twice PRN while staying active and mobile…. my pills would do at least as well as acupuncture. If I do such a study, I will dedicate it to you.

    The point is that the corpus of the data on acupucnture demonstrate quite clearly that pain perception is highly suggestible (duh) and that it offers a new “excuse” for people to go past pain and be mobile which is exactly what we already knew takes care of back pain.

    Look at the “standard care” arm in this trial in question as deconstructed by ConspiciousCarl and also look at every study that shows any sort of effect size significantly greater than standard treatment. You will find that either the “standard care” arm is lacking or that the study population in question is one that has already failed “standard treatment” and now is getting that “excuse” to mobilize and ameliorate the back pain. I got a jug of Coopers that says my special new pill would do the same.

  51. Ben Kavoussi says:

    @ nybgrus

    I agree with you, except for one thing. Many acupuncturists hook up a low voltage device to the needles. In other words, they are practicing TENS under the guise of acupuncture and Chinese medicine. Although this has nothing to do with traditional medicine, it is routinely done. The effects seen in many acupuncture treatments is due to the effects of the electric current, which interferes with nerve conduction.

    Concerning the comments by pmoran on the possibility of distractant and counter-irritant effects, we have to be mindful that these effects would exist if the treatment causes pain. This is the idea behind Capsaicin and mustard oil ointments. Most acupuncture treatments today are done with extremely fine needles, where the patients barely feels the insertion. As such, it is a useless remedy, done in the name of a 5000-year-old tradition that has never existed because the technology to mass produce ultra fine needles is only a couple of hundred years old!

  52. Ben Kavoussi says:

    @ pmoran

    We also need to be cautious about being spoilsports if certain populations are deriving real benefits from such methods…

    You certainly have a point. An enormous portion of the population believes in prayer and miracles. It seems that faith might even help with living with chronic pain. However, are we going to spend millions of US taxpayer’s dollars studying them? Certainly not. This post is truly not about the benefits of certain CAM modalities for a special population; it is about foolishness becoming fraud, one we become aware that the scientific evidence is not there.

  53. @nybgrus nailed it re: acupuncture.

  54. nybgrus says:

    @Ben:

    Oh, I agree. I have had said electro-acupuncture. I have also had “traditional” acupuncture. In the latter case I felt complete local anesthesia (it was an “emergency” acupuncture treatment – I was a kid practicing kung fu and managed to step on glass. The Shifu did acupuncture to numb my foot to dig it out). In the latter I felt actual euphoria – as if I were on a narcotic or something. I was also in my early 20s and had multiple treatments.

    But that is not what I was referring to – I fully recognize that electro-acupuncture can have actual intrinsic effects. But, as you said, that is not acupuncture. It is TENS.

    And yes, even the counter-irritant effects must be gone in “real” acupuncture because the needles are so fine you can’t feel them in the first place! I’ve tried. I twanged the damned thing after it was inserted and barely felt anything beyond a mild tug from the needle head swaying back and forth.

    And as for those that derive something from the placebo effect… that is a really poor excuse for perpetuating a delusion. Such rationale is something to to sheepishly comment when you’ve got nothing left to say. Hardly even worth a response.

    @SH: Thanks.

  55. Solandra says:

    @BillyJoe – From what I learned from a couple of actual pathologists, and my surgeon who is at the Oregon Clinic which, if you call and listen to their message, emphasizes “evidence based medicine”, it had a 20-30% chance of being cancer. The initial report from the FNA and ultrasounds showed the tumor had the look of cancer. They told me, with Follicular cells, the ONLY thing differentiating between carcinoma and a benign neoplasm was if the cells were invading the capsule. That’s it. Wikipedia is probably not the best source of medical advice. :) So, luckily, in my case, even though the cells looked like they were iffy, they were fully encapsulated, so it was classified as benign. That’s the difference between a benign follicular neoplasm and a malignant one. So, at some point, yes, it could have turned into cancer. But from the initial reports where everything matched up to cancer, especially the overlapping cellular structure in the original pathology report, I wasn’t going to take my chances. Better out than in!

  56. WilliamLawrenceUtridge says:

    And yes, even the counter-irritant effects must be gone in “real” acupuncture because the needles are so fine you can’t feel them in the first place!

    In some cases; Japanese acupuncture uses very fine needles, but other types of acupuncture use thicker needles (in different spots, made of different materials, lit on fire, with a different diagnosis, etc. ad nauseum). This is part of the difficulty of studying acupuncture, it’s very heterogeneous, even within China itself, let alone the rest of Asia.

    I’ve seen as a criticisms of the acupuncture/back pain studies is both the type of patient and the nature of “usual care”. Back pain is recurrent, frustrating and badly treated – there simply are very few interventions for it that work, particularly in the absence of obvious biomechanical dysfunction. Most patients have been given “usual care” for years, which simply isn’t very helpful, and patients tend to be cynical about it. Anything beyond usual care would have an enhanced placebo effect since many patients have viewed “usual care” as worthless for a long time. So comparing acupuncture to “usual care” may be less a measure of how good acupuncture (sham or real) is, and more an indication that “usual care” is pretty ineffective and frustrating for patients.

    I think Edzard Ernst may have made this point.

  57. BillyJoe says:

    Solandra,

    Actually, you sort of missed my point.
    (If you read on through the comments it should become clearer)

    “Wikipedia is probably not the best source of medical advice.”

    Actually, that link was pretty accurate.
    (It did, however, fail to tell me that the benign tumour has a 20-30% risk of becoming malignant)

  58. mousethatroared says:

    BillyJoe -I was going for a Terry Pratchett, Commander Vimes reference. But the Jethro Tull is good too. :)

  59. Solandra says:

    No, it was a 30% of BEING malignant, which is why I got it out.. Maybe I didn’t explain it well enough. The only way to tell for sure if it was malignant was to look at the capsule, which involved getting the tumor out. Cells invading the edges of the capsule = malignant. Cells contained by capsule = benign. There’s no way to tell if it will invade other tissues in the future, so for that thing they generally recommend surgery.

  60. Solandra says:

    I saw two different surgeons, an Endocrinologist and a regular doctor, FYI. The surgeon I went with is an ENT who does 100+ of these surgeries a year and also teaches at OHSU. I did not, however, take herbs or pursue acupuncture.

  61. BillyJoe says:

    BJ: “the benign tumour has a 20-30% risk of becoming malignant”
    SA: “No, it was a 30% of BEING malignant”

    Yep, I messed up my percentages.
    A thyroid tumour has a 20-30% chance of BEING malignant
    Benign thyroid tumours have a 2% risk of BECOMING malignant.
    My problem was with you saying that your tumour turned out to be benign but then adding…

    “it could have invaded surrounding tissues, lymph nodes and even my bone and lung in as little as two years”

    What I said originally was that that could not have happened if your tumour was benign.
    What I didn’t realise at the time is that your benign tumour had a 2% chance of becoming malignant in which case it then could have invaded surrounding tissues, lymph nodes, bone, and lung.
    (I wondering now whether you realised that)

  62. @BJ, the more you post, the worse and worse you sound. First you wrongly instill doubt in the mind of a person who underwent the best possible treatment for thyroid cancer. Then after you pointlessly and wrongly ask them questions, you write that they “missed the point”, as if your line of questioning had *any* purpose whatsoever, and you’re trying to educate yourself about thyroid cancer from Wikipedia. Sigh. Just stop. (I fully expect @nybg to come along and try to interpret your posts and make sense out of them while playing tone police.)

  63. BillyJoe says:

    SH,

    As I explained before, I was asking questions of Solandra, because she seemed to be saying that her benign tumour could have invaded and metastasised. That did not gel with my understanding of the meaning of “benign”. A benign tumour (by definition) does not invade or metastasise. We call such a tumour a malignant tumour.

    Correct me if I am wrong.

    The solution here, as nybgrus pointed out, is that, although a benign tumour (by defintion) does not invade or metastasise, it can, on the other hand, transform into a malignant tumour which, in turn, can invade and metastasise.

    Again, correct me if I am wrong.

    “you wrongly instill doubt in the mind of a person who underwent the best possible treatment for thyroid cancer.”

    Exactly where did I do that?
    It seems to me that you are trying to protect someone who does not impress me as needing any protection.
    In other words, she doing alright on her own.

    “you write that they “missed the point”…”

    I said “you sort of missed the point”.
    What I meant was that I felt she sort of missed the point of my questions (see below)

    “as if your line of questioning had *any* purpose whatsoever”

    My purpose was to clarify for myself what she meant when she said that her benign tumour could have invaded and metastasised. I acheived my purpose by being informed by nybgrus that 2% of benign thyroid tumours can become malignant. Case solved!

  64. Solandra says:

    Ok, I will correct you, BillyJoe.. There is NO WAY TO KNOW what percentage it had of metastasizing. NO WAY. Wikipedia is wrong. My surgeons, doctors, and pathologists are right. The ONLY DIFFERENCE with a follicular tumor on benign vs malignant is whether or not the cells are invading surrounding tissue, and the ONLY WAY to tell that is to take the tumor out and look at it under a microscope. The cells are the same whether or not they are contained.. all they would have to do is grow outside the capsule of the tumor and it would be malignant.. I have no doubt I did the best possible thing.. you have a 3cm tumor in your neck that is growing and can invade your lymph nodes, lungs, bones, etc..? Have fun treating that with acupuncture or watching and waiting. I wouldn’t want to live with that doubt. I don’t know where the 2% figure comes from for follicular neoplasms.. there’s just absolutely no way to tell and why you are arguing with me about it I will never know.

  65. Solandra says:

    http://emedicine.medscape.com/article/278488-workup#a0723

    ++ Histologic and cellular patterns of endocrine tumors do not allow diagnosis of carcinoma; therefore, this diagnosis is made by finding pseudocapsule and/or blood vessel invasion, not by cellular morphology.

  66. nybgrus says:

    I am actually finding this kind of funny. Being skeptical and precise is good BJ, but being overly pedantic is not.

    Just for your future edification, benign only means “cannot metastasize for the most part” and the same is true for malignant.

    Carcinoids are beningn tumors that can metastasize and basal cell carcinoma of the skin is a malignant tumor that almost never metastasizes.

    The point here with thyroid tumors is that the only difference one can detect between “benign” and “malignant” is whether it has spread outside the capsule or not. The cytology will look identical. Which means, in this case that the “benign” tumor has spread for all intents and purposes.

    The percentage solandra is speaking of is the prior probability that a follicular neoplasm of that size would be malignant. The posterior possibility of it becoming malignant is 2%

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