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Harkin’s folly, or how forcing insurers to cover CAM undermines the ACA

Bloodletting: a good reason to discard disproven therapies

Bloodletting: a good reason to discard disproven therapies

All of us at SBM have repeatedly expressed frustration at the continuing influx of pseudoscience into the health care system. Judging from comments posted on this site and private communications we receive, our readers share this frustration but are at a loss to figure out how to get through to legislators and other policy makers. Unlike naturopaths and chiropractors, we don’t have the money to hire professional lobbyists. Fortunately, an opportunity to sound off against SCAMs has presented itself, completely free of charge.

How?

Now that the Affordable Care Act enrollment debacle is dying down, the Department of Health and Human Services (HHS) is turning its attention to divining just what the heck Section 2706 of the ACA, the non-discrimination provision, means. (Actually there are other federal agencies involved; to simplify things, here we’ll refer to them collectively as “HHS.”) HHS has opened the issue to public comment, but only until June 10. Let’s take a look at why this is important and what you can do about it.

(There are providers other than chiropractors, naturopaths and acupuncturists involved in this fight. For example, you’ll see public comments from nurse anesthetists and nurse practitioners. But I’m not worried about providers who stick to science.)

I’ve discussed Section 2706 before, but a brief review is in order. Here’s what it says:

(a) PROVIDERS.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

Section 2706 was inserted into the ACA under the stewardship of Sen. Tom Harkin, whose CAM-friendly inclinations are well known. It was not in the original ACA bill but became part of the Senate’s version without the benefit of any sort of committee hearing. Perhaps that was by design.

Via a set of “FAQs,” HHS issued its interpretation of Section 2706′s requirements for the guidance of insurance companies devising ACA-compliant health care benefits:

to the extent an item or service is a covered benefit under the plan or coverage, and consistent with reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service, a plan or issuer shall not discriminate based on a provider’s license or certification, to the extent the provider is acting within the scope of the provider’s license or certification under applicable state law. The FAQ also states that section 2706(a) of the PHS Act [that is, the ACA] does not require plans or issuers to accept all types of providers into a network and also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.

Sen. Harkin was not pleased. Here’s what HHS was told by a Senate Committee:

The goal of this provision is to ensure that patients have the right to access covered health services from the full range of providers licensed and certified in their State. The Committee is therefore concerned that the FAQ document issued by HHS … advises insurers that this nondiscrimination provision allows them to exclude from participation whole categories of providers operating under a State license or certification. In addition, the FAQ advises insurers that section 2706 allows discrimination in the reimbursement rates based on broad ‘market considerations’ rather than the more limited exception cited in the law for performance and quality measures. Section 2706 was intended to prohibit exactly these types of discrimination.

HHS is asking for your help in resolving this dilemma:

Pursuant to this [Senate] report, the Departments are requesting comments on all aspects of the interpretation of section 2706(a) of the [the ACA]. This includes but is not limited to comments on access, costs, other federal and state laws, and feasibility.

But, again, you have to comment by June 10, so get going.

How the state legislators got us into this mess

First, I suggest that HHS and the public be made aware of the extent of damage Section 2706 might do as it has been interpreted by Sen. Harkin’s committee. They need background, and you are just the person to give it to them.

Of course, CAM providers have always depended on government largesse to survive, whether it be NCCAM-funded studies (none of which CAM practitioners apparently paid the least bit of attention to), state licensing, Medicare coverage (of chiropractic, for the detection and correction of subluxations), state insurance coverage mandates and Medicaid coverage. (Washington just became the third state to include naturopaths in Medicaid. Naturopaths are also lobbying for Medicare coverage, a subject I’ll return to in a later post.) There are also government-backed student loans, as well as DSHEA and the legalization of fraudulent homeopathic remedies. Section 2706 is just another example of substituting political clout for the rational application of science to health care practices. Or, put another way, it pours the public’s money into the coffers of practitioners of pseudoscience.

As we’ve talked about before, chiropractors, naturopaths and acupuncturists are all claiming, to some degree or another, that they are primary care physicians. (Both Harriet Hall and I have discussed the deficiencies of chiropractors as PCPs, and Mark Crislip took on the naturopaths.) Acupuncturists seem sort of half-hearted about it, but DCs and NDs are dead serious, especially the latter. And it is here that the profligacy of the state legislatures in defining DC, ND and acupuncturists‘ scope of practice comes home to roost.

In para materia

First and foremost, Section 2706 must be read as one part in a larger whole. (Or, as the lawyers would say, in para materia with the entire ACA.)

In interpreting Section 2706, HHS must keep in mind the overarching purpose of the ACA, as well as the fact that it is but one paragraph in nearly 1,000 pages of text. As the U.S. Supreme Court said in National Federation of Independent Business v. Sebelius:

The Act aims to increase the number of Americans covered by health insurance and decrease the cost of health care. The Act’s 10 titles stretch over 900 pages and contain hundreds of provisions.

Obviously, Section 2706 does nothing to fulfill the Act’s intent of increasing the number of covered Americans. But its provisions can be judged against the goal of decreasing the cost of health care. Of course, decreasing costs must be measured against outcomes. As Harriet Hall has pointed out, eliminating health care altogether would reduce costs to zero. What we are really seeking here is cost effectiveness.

For example, the Patient-Center Outcomes Research Institute (PCORI)’s purpose is (as described by the Urban Institute Health Policy Center, citations omitted):

There are a number of other provisions in the ACA that have the potential to contain costs. The ACA authorizes the establishment of a nonprofit corporation, the Patient-Centered Outcomes Research Institute, to conduct and broadly disseminate comparative-effectiveness research. This research effort is intended to inform “patients, clinicians, purchasers, and policy-makers in making informed health decisions” regarding relative health outcomes, clinical effectiveness, and appropriateness of medical treatments and services.

A mechanical application of Section 2706 without considering cost effectiveness sacrifices the larger goals of the Act for the private gain of individual practitioners and political ideology. Which brings up an interesting possibility. What if there is no evidence that chiropractors, naturopaths or acupuncturists can deliver cost-effective care? What happens then?

In one sense, forcing inclusion of CAM providers is already undermining the market-oriented managed competition strategy employed by the ACA. Insurers are already offering ACA-compliant plans, as required by law, under the assumption that CAM providers need not be included. To the extent these plans do not include chiropractors, naturopaths and acupuncturists, it reflects a decision by insurers that these practitioners are not able to offer health care services required by the Act at the best price for the result achieved. Obviously, were that not the case, CAM practitioners would have been included in provider panels. Mandating inclusion will send insurers scrambling to recalibrate plan benefits and costs, another glitch in the system we don’t need.

Essential health benefits

The ACA’s tying cost reduction, in part, to improved health outcomes, is based on the theory that healthier people will utilize fewer health resources and that catching a problem early reduces the need for more expensive treatment down the line. In order to achieve these goals, the ACA requires coverage of “essential health benefits:”

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

The ACA centers the delivery of these services on the patient’s “medical home,” which is headed by a primary care physician, who coordinates the patient’s care. Chiropractors and acupuncturists, despite claims to the contrary, cannot provide the full scope of primary care required by the ACA. Naturopaths claim, falsely, that they have the education and training to practice as PCPs and they are, in fact, licensed as primary care practitioners in a handful of states, although they do not have hospital privileges. They are covered Medicaid providers in three states but are not covered by Medicare.

The fact that naturopaths are licensed as PCPs in a few states does not override the ACA’s primary concern with reduced costs and improved outcomes. The truth of the matter is that naturopaths do not practice evidence-based medicine and the majority of their treatments are not supported by an acceptable level of evidence or, for that matter, any evidence at all. In fact, some of the mainstays of naturopathic practice are thoroughly discredited, such as colonic irrigation homeopathy, the use of dietary supplements to manage many diseases, and the like. There is evidence, however, that naturopathic care results in worse outcomes. Most disturbing is the naturopaths’ opposition to vaccination, an opposition that sees its logical outcome in the association between naturopathic care and undervaccination, as well as an increased risk of acquiring a vaccine-preventable disease.

In short, despite their claims otherwise, there is simply no evidence that naturopaths can safely and effectively (much less cost-effectively) diagnose and treat the undifferentiated patient, a basic skill necessary for all primary care practitioners. (Basically, the undifferentiated patient is any person of any age with any condition who might walk in the door.) In fact, there is only one study in all of the medical literature which purports to show a benefit to naturopathic care. Even there, patients were under the care of a medical doctor and naturopathic care was in addition to usual care, and, in fact, there was nothing in their care that was uniquely naturopathic or could not have been provided by any other medical professional.

Even where specialty care is concerned, chiropractors and acupuncturists suffer from a similar dearth of evidence and the risk that patients will be exposed to unproven and disproven diagnoses and treatments. For example, some chiropractors continue to diagnose and treat “subluxations”, a thoroughly discredited prescientific notion that the human spine requires “adjustments” to “misaligned” vertebrae to maintain health. (This has been a huge cost burden on Medicare.) To be fair, other chiropractors limit themselves to evidence-based treatment of musculoskeletal problems. However, insurers would do well to institute a detailed vetting process to choose only those willing to stick to the evidence.

There is simply no reliable evidence that acupuncture is effective for any condition. Even the National Center for Complementary and Alternative Medicine admits acupuncture may be no more than an elaborate placebo. (Actually, that is exactly what it is.) Yet, given their full range of options under state practice acts, acupuncturists subject their patients to all sorts of prescientific practices like moxibustion and “Kirlian photography.”

Harkin’s folly

Thus the folly of Section 2706′s premise – that simply because a state has given a particular type of practitioner a broad scope of practice, those practitioners can deliver safe and cost-effective health care commensurate with their practice act – is fully revealed. We already have a substantial body of evidence (some of it from the federal government itself, via NCCAM) that the services CAM providers offer do not improve health outcomes, yet Section 2706 forces insurers to include these practitioners. Given this, insurers must be given wide latitude to exclude practices that do not benefit, and may in fact harm, the insured. Yet, this remedy itself poses its own problems.

Another cost control measure imposed by the ACA is a limitation on the percentage of administrative costs an insurer can include in premiums. When contracting with medical doctors and allied health professions such as nurses and physical therapists, insurers can rely on a body of medical literature that either includes or excludes diagnoses and treatments based on the current evidence. Chiropractors, naturopaths and acupuncturists, however, have the liberty of simply creating new diagnoses and treatments out of whole cloth, unhindered by basic scientific plausibility, much less published literature supporting or rejecting it. It is thus that CAM providers have come up with such novel diagnoses and treatments as IV vitamins for flu prevention and other IV “cocktails”, functional endocrinology, chronic yeast overgrowth, adrenal fatigue, green tea suppositories for cervical dysplasia, treatment of disease with homeopathy, organ repositioning, applied kinesiology, food “intolerance” testing, cranial sacral therapy and moxibustion to name just a few.

If all insurers are forced to include CAM practitioners in their provider panels, they will have to be eternally vigilant in excluding these exotic creations, thereby simply adding to administrative costs. They must already do this to a certain extent due to state insurance mandates, but Section 2706 simply compounds the problem by increasing the number of CAM providers which must be included. (While chiropractors often have insurance mandates in their favor, naturopaths and acupuncturists generally do not. There are exceptions, however, such as Washington state.)

Given all of this, it is clear that Section 2706 undermines the very purposes of the ACA and should be repealed. But we don’t get to decide that, nor does HHS. The best we can go for at this point is damage control. Here’s what I recommend:

  • Issue a report setting forth the dilemma caused by Section 2706 (see above) and use this as a basis for stringent limitations on coverage of CAM provider services.
  • Allow insurers to require that all providers sign an agreement that they will employ evidence-based practices. Breach of the agreement is grounds for exclusion from the provider panel.
  • Further allow insurers to require that all providers advise patients to follow CDC-recommended schedules for vaccination and prohibit them from advising patients not to vaccinate based on discredited reasons. Again, failure to follow the rules should be grounds for exclusion from the panel.
  • Make it clear that chiropractors, naturopaths and acupuncturists cannot advise patients to ignore their medical doctors’ advice unless there is an evidence-based reason for doing so.
  • Make it clear that no medical doctor is ever required to compromise his or her judgment by referring to a practitioner when he or she feels that doing so is not in the best interest of the patient. For example, medical doctors should be free to refer to physical therapists instead of chiropractors.
  • Allow insurers to institute preventive measures to combat the bundling of unproven treatments with covered services. For example, make it clear that treatment of a cold by a naturopath will not be covered if the naturopath uses that time to advise patients to use (or sells) unproven treatments like homeopathy, dietary supplements and herbs.

Feel free to comment on the HHS’s website by using any, all or none of this post. (You can certainly add your own reasons.) Even if you don’t think HHS will pay a bit of attention, you’ll feel so much better afterwards. Click here to proceed.

Posted in: Acupuncture, Chiropractic, Legal, Naturopathy, Politics and Regulation, Science and Medicine, Traditional Chinese Medicine, Vaccines

Leave a Comment (114) ↓

114 thoughts on “Harkin’s folly, or how forcing insurers to cover CAM undermines the ACA

  1. Carl says:

    None of the exemptions to 2607, either HHS’s FAQ or that on 2607 itself, mentions a lack of evidence. It’s all performance and market considerations, which implies that insurance companies have to evaluate fake medicine by assessing individual or local conditions, which they can only do by paying quacks for some length of time and evaluating it. Basically, it requires insurance companies to do their own experiments on everything and every quack.

    HHS should “clarify” that a lack of supporting evidence can be used by insurance companies to form their opinion of the performance of a practice.

    1. Jann Bellamy says:

      I agree. Insurers do that now by classifying treatments as “experimental” and excluding coverage and I don’t think that will change. (Of course, who thought this forced coverage would happen in the first place?) But, as you point out, insurers will have to figure that a treatment is worthless in the first place. Given the creativity of CAM and the increased number of CAM practitioners covered by insurance, that will be a never-ending process.

      1. irenegoodnight says:

        NCCAM might be helpful here! Surely their (lack of) results can be used to eliminate mist of these “therapies”?

        If we can’t afford a lobbyist, we need to recruit a Senator or two to counter Harkin, Hatch, Sanders, and Mulkulski. Perhaps it’s time for me to contact Tammy Baldwin.

        I’m headed for the link and will do my best to make an impact. I’m going to use my (well-managed) chronic disease status and contrast it to what a ND would offer.

  2. mho says:

    the numbers are transposed. Its 2706, not 2607.

    1. Jann Bellamy says:

      Thank you so much, mho. And there it was, 2706 right in the quotes and my other posts.

  3. Sean Duggan says:

    While I can definitely see where the SCAM groups benefit from this section, I can’t help but wonder if there’s also an element of the current battles over religion and medical care. I’ve seen the religious claim that their insurance company shouldn’t include medical providers who suggest abortions. I’ve seen other people claim that pregnancy care facilities that advise against abortions shouldn’t be covered. As I understand it, section 2706 would suggest not discriminating against either set of providers.

    1. irenegoodnight says:

      I don’t know of any “facility” that “suggests” abortion. Even in a case of severe abnormalities, abortion might be presented as an option, but only in the context of an option. Perhaps it’s only semantics, but I just wanted to clarify.

      1. Sean Duggan says:

        You’re right. Depending on who’s speaking, cases of either putting it forward as a possibility in non medical emergencies or ones who put it forward at all. I phrased that awkwardly. It sounded a lot clearer in my head.

  4. R.w.Foster says:

    I’d love to help out, but all I was able to understand from this post was that somehow a bill was going to allow Woo pushers to scam Medicaid. The rest caused my mind to fog. Would someone be willing to translate this for a dummy like me? Thanks.

  5. Kathy says:

    The number of woo-based ailments and treatments that can be invented is only limited by the human imagination, seems to me. Will the insurers have to cover removal of the wondrous “rope-worms” dealt with by Dr Hall a couple of days ago? What if this gets bundled with naturopathy? Naturopathy seems to accept anything at all as being a valid treatment, so why not this?

    I’d love to see what the newspapers/TV programs would have to say if it was, and they found out it was being paid for by the insured or by taxes. Obama’s already taken a lot of flak about Obamacare – this would be a great big rock to chuck at it and him.

  6. dan chamney says:

    Quote; ‘Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures. ‘
    This should give insurers a right to refuse to pay woo providers based on scientific evidence of the lack of success for their treatments. I’m sure that insurers would rather not pay for useless treatments.

  7. steney01 says:

    Thanks for bringing this to our attention. For what it’s worth, here was the comment I chose to post.
    “I agree with the Departments FAQ interpretation of 2706.
    By this definition, I believe appropriately trained medical professionals practicing evidence based medicine such as doctors, nurse practitioners, nurse anesthetists and physical therapists will not be discriminated against, while individuals who may be licensed by the state, but who are unfortunately not providing evidence-based, cost-effective care will rightly be left out of a network.
    For example, in states where naturopathic licenses are issued, plans and issuers should not be compelled to accept those individuals into their plan given that naturopathic providers practice techniques such as colonic irrigation, homeopathy and unregulated herbal treatments in addition to being much more likely to discourage the use of vaccines, which are our best protection against many dangerous diseases. Naturopathic treatments are at best unproven and at worst dangerous both as a technique itself and as a diversion from seeking appropriate medical care. Issuers should not be compelled to include providers of any license who practice deceptively or against mainstream medical practices.
    The provision allowing for non-acceptance of some providers is therefore also a measure in cost-cutting, in quality assurance and in consumer protection. Consumer choice will not be affected by the department’s interpretation because there are adequate numbers of providers practicing “reasonable medical management techniques” with appropriate licensing without having to also embrace non-scientific practitioners irregardless of their state certification. Choosing between appropriate medical care and snake oil is a dangerous choice and need not be protected. I do not agree with the Senate Committee’s interpretation.”

  8. Fred McKay says:

    Some say that chiropractic is 100% bullshit. Chiropractic is only about 70% bullshit. A chiropractor is helping me with a problem that multiple medical doctors could not find. Multiple CAT scans, X-rays and MRIs didn’t show it. Most of his practice is complete crap.

    1. Harriet Hall says:

      When chiropractors use spinal manipulation for low back pain or use modalities like massage and exercise, that is not bullshit. When they claim to find and correct subluxations by chiropractic adjustments, treat non-musculoskeletal conditions with spinal manipulation, and advise patients based on applied kinesiology, that is bullshit.

    2. Andrey Pavlov says:

      Even a blind squirrel can find a nut.

    3. Think again!
      Chiro adjustment and the practice is effective for certain problems.
      SBM “magic pill” is effective for certain problems.
      Traditional “cookbook” medicine is effective for certain problems.
      CAM is effective for certain problems.
      EBM is effective for certain problems.

      A lot of us do them all, so the our outcomes are better.

      We don’t disrespect our patients with our personal beliefs.

      1. WilliamLawrenceUtridge says:

        Chiro adjustment and the practice is effective for certain problems.

        More accurately, chiropractic adjustments has been proven effective for one problem – low back pain. And there’s nothing “chiropractic” about it, physiotherapists can do the same thing with minimal training – but one vertebrae at a time rather than all of them.

        SBM “magic pill” is effective for certain problems.

        There is no “magic pill”, certain drugs are effective for certain conditions, but have side effects that are well-advertised.

        Traditional “cookbook” medicine is effective for certain problems.

        I believe you mean “proven”, not “cookbook”. You use that term pejoratively as if your “whatever I think will work, no matter how illogical or unproven” were better. It also ignores the fact that doctors will prescribe medications off-label, attempt clinical trials, and the fact that patients do better when consistent medicine (i.e. best practices) is applied.

        CAM is effective for certain problems.

        Really? Which ones? What problems are homeopathy effective for? Moxibustion? Megavitamin therapy? Echinecea? What’s your proof that any of these are more effective than conventional medicine, or even effective at all?

        A lot of us do them all, so the our outcomes are better.

        Again, evidence?

        We don’t disrespect our patients with our personal beliefs.

        You always finish big, I’ll give you that – of course, this is big hypocrisy, because your CAM interventions are supported by your personal beliefs, nothing more. Certainly you are unable to point to any scientific evidence to support them.

        1. You are mixing ideas, concepts and confusing yourself due to your shallow educational background.

          I posted a long list of references so you can get up to speed with CAMs, Acupuncture, Gunn-IMS, dry/wet needling and Travell/Simons.

          Please try to read the references so you do not get so confused with all the terms, concepts and descriptions. Once you begin to read through the topics you will understand that my personal beliefs do not factor into the disciplines. Actually my descriptions are take squarely out of all the textbooks and articles.

          1. WilliamLawrenceUtridge says:

            i looked at your references, they justified nothing. But tell me again how i am uneducated.

            Once you begin to read through the topics you will understand that my personal beliefs do not factor into the disciplines. Actually my descriptions are take squarely out of all the textbooks and articles.

            Did you actually read the references you provided? it looks to me that you just copy-pasted a long list of references you didn’t actually read. The best thing you can justify with that massive, inchoate turdpile is that myofascial pain and trigger points are controversial concepts that are still in fairly preliminary stages of scientific research. You aren’t cutting edge, you are using preliminary findings as a post hoc rationalization to avoid having to think about the treatments you charge for. This is the second time you have dumped a list of low quality or irrelevant sources and pretended you had emerged victorious. Maybe try a little harder than blindly pasting whatever you find on the internet.

      2. Windriven says:

        If your outcomes are so much better, why aren’t they reflected in your patient satisfaction ratings? That is a valid question, Steve. One that you really ought to spend a little time thinking about.

        You may believe – you almost certainly do believe – that you have better outcomes than, say, Stephanie McCann or Sara Tranchina. But where is the objective evidence? The patients that rated them score trust in their decisions above the national average, your patients score trust in your decisions below the national average.

        I’m not bringing this up because I’m trying to be an a$$hole* but because you should step away a few paces and reflect on the care that you offer. You’re an outlier, Steve. You’re a true believer** and you’re an outlier. You might find greater personal satisfaction to say nothing of better patient satisfaction by moving your practice toward more conventional care.

        Just a thought offered in peace.

        *Mrs. Windriven will tell you that I needn’t try, that assholery comes to me as naturally as brown eyes. I’ve put it away for purposes of this comment. What you hear is just the echo.

        ** This is not a compliment.

        1. Don’t believe what you read without confirmatory info and further investigations.

          “Be careful about reading a health book. You may die of a misprint.” —Mark Twain (1835–1910)

          1. Windriven says:

            What exactly is that supposed to mean?

            1. WilliamLawrenceUtridge says:

              It means he can’t come up with a real reply so he is trying to change the conversation.

        2. WilliamLawrenceUtridge says:

          Not to defend Steve, he’s an idiot, but patient satisfaction ratings should be treated with the greatest of care. A great doctor, with great health outcomes but terrible bedside manner, could get very bad patient outcomes because they don’t feel cared for. But I will agree with Pete Moran on this one – in principle, given the boutique-type services and non-evidenced nature of the what he delivers, given how important placebo is to these treatments, if he’s screwing up enough to get substantial thumbs-down, then he may suck even for a CAM practitioner.

          1. Andrey Pavlov says:

            Not to defend Steve, he’s an idiot, but patient satisfaction ratings should be treated with the greatest of care. A great doctor, with great health outcomes but terrible bedside manner, could get very bad patient outcomes because they don’t feel cared for. But I will agree with Pete Moran on this one – in principle, given the boutique-type services and non-evidenced nature of the what he delivers, given how important placebo is to these treatments, if he’s screwing up enough to get substantial thumbs-down, then he may suck even for a CAM practitioner.

            Agreed fully. It was in response to Peter saying:

            Moreover, we know from our own history how compelling are the various “therapeutic illusions” that dominate everyday clinical practice of any kind. So there is usually a semi-rational and non-fraudulent basis for some degree of belief. SS demonstrates this in action — in spades actually, because his style of practice probably does recruit a lot of the non-specific therapeutic influences that can operate with prolonged, hands-on, mildly invasive programs of treatment.

            If you are going to use an argument in your favor, and cite a specific anecdote, at least make that anecdote worth citing. He continues to try and argue for the legitimate and honestly intentioned therapeutic benefit of non-specific actions and then uses SSR as an example. My counterpoint was that for those that do elicit such responses there are at least as many who fail to do so. And SSR supports my assertion, rather than his. Because when one is discussing a legitimate physician, yes – patient satisfaction is a very poor metric (though it may well align with positive outcomes). When the entire point of the discussion is the non-specific interactions then patient satisfaction sort of is the metric one should be interested in. Peter agrees with me that SSR is not doing anything specific for his patients, but argues that all those non-specific effects are beneficial to them. What are those non-specific effects if not being satisfied at the interaction?

            1. It is not very scientific to attack the messenger which is the easy way out of a debate or discussion.

              The data you all are using is flawed so using it would not be productive.

              Read the references and formulate your own conclusions.

              1. WilliamLawrenceUtridge says:

                Hi Steve, the thing is, I did look at your references and they were terrible. They didn’t justify acupuncture at all. You dropped in a list of dozens of references and strutted about like you had just cured cancer, and upon review it turns out the only ones that had anything to do with acupuncture were about the history of acupuncture (bar one that was an experimental trial that suggested lidocaine injection was superior to acupuncture). So I’ve reviewed your references and found them mostly irrelevant and the one sole clinical trial that was relevant actually undercut your position.

                What do you have to say about that?

            2. All of medicine, SBM, EBM, Traditional Medicine, the VA, medicaid/Medicare etc..
              are all a sad representation of science, humanity and healthcare. Why? Profits, egos and prestige are at the root. So please do not overlook these sad state of affairs.

              This SBM site has few redeeming qualities. Too full of dogma. Actually plan old dogma would be nice, you guys are cutthroat, vengeful, resentful and down right sadistic. This site is full of what people belief, mis-information, people perpetrating scientist and science, faulty data and dogma.

              Why just blame me and my Traditional and CAM practice! OH … you all have overlooked that fact that I’m versed in both, so I know where the skeletons are located. No one here has these credentials, experiences and awareness.

              My goal is to discover what works and how am I or we going to find out the truth if everyone here is stubborn and will not read the references so they can rethink their own conclusions.

              Gotta give this a rest.

              1. WilliamLawrenceUtridge says:

                All of medicine, SBM, EBM, Traditional Medicine, the VA, medicaid/Medicare etc..are all a sad representation of science, humanity and healthcare. Why? Profits, egos and prestige are at the root. So please do not overlook these sad state of affairs.

                Why are they sad representations of science? And how can you claim that when the alternative you present is completely unscientific? It has been obvious for a while that you don’t even understand science.

                I’ll also note that your practice and your comments here seem to be rooted in maintaining your practice (and thus profits), ego-based, and prestige-seeking (given you keep trying, but failing, to impress us with your reasoning and evidence).

                This SBM site has few redeeming qualities. Too full of dogma. Actually plan old dogma would be nice, you guys are cutthroat, vengeful, resentful and down right sadistic.

                Why? Because we keep asking you for evidence, then pointing out the evidence you provide doesn’t actually support what you claim? How is it “vengeful” to present honest criticisms, or to point out that the sources you claim to support your point, are actually totally irrelevant? Is it mean to be honest with you? Is it “sadistic” to challenge a manifestly false idea? Are you claiming that because we are hurting your feelings, our criticisms are invalid? Jebus, man up! You’re claiming the ability to treat serious illness with needles that consistently fail under controlled testing. Don’t you think the truth, a well-validated empirical system, is worth a little challenge?

                This site is full of what people belief, mis-information, people perpetrating scientist and science, faulty data and dogma.

                This isn’t even a coherent sentence, so I don’t know what to say beyond “asking for evidence is the very opposite of dogma”. If you’re too lazy or too uneducated to identify evidence that supports your beliefs, that’s your fault and your problem. We’re merely pointing out that you’re doing it wrong.

                Why just blame me and my Traditional and CAM practice! OH … you all have overlooked that fact that I’m versed in both, so I know where the skeletons are located. No one here has these credentials, experiences and awareness.

                One does not need credentials to cite and interpret the scientific evidence. You keep claiming powerful effects with CAM treatments, we keep pointing out this is wildly at odds with the research base, then you flounce off like a spoiled child. Geez, grow up.

                My goal is to discover what works and how am I or we going to find out the truth if everyone here is stubborn and will not read the references so they can rethink their own conclusions.

                I looked at the references and they didn’t support anything you have ever claimed. You want truth? The truth is your practice is unscientific and you waste the time and money of your customers on placebos. Go actually read the sources you cite and see which ones support acupuncture.

                Gotta give this a rest.

                Don’t let us keep you here.

              2. brewandferment says:

                except that as has been pointed out to you on numerous occasions, when you do science the wrong way, there is no possible way to find out what works.

                And since your references have also been faulted for doing science wrong (or not at all) then you still cannot use them to find out what works.

                But you refuse to consider how you are doing science wrong, so your dogma–not science, you don’t accomplish science with anecdote (ie experience)– is a terrible fit for this site. You can leave, you know.

              3. @ WilliamLawrenceUtridge
                “I looked at the references and they didn’t support anything you have ever claimed. ”

                Good distraction and deception, but you missed something in the complexity. You just can’t look at the conclusions at the end of the articles. You must spend time and go further into the details. The articles are for a professional’s eye, sorry you are not in this category. Default to one of the unbiased clinical MDs who treat chronic pain and dysfunctions or …. gee Ingranham is the only one but he does not want to review or understand Gunn/Cannon.

                True statements:
                Acupuncture is a valid part of CAM.

                Some forms of Acupuncture are more effective than others.

                In essence, Acupuncture is NO different than dry needling when viewed with the the mechanic of action as per Gunn/Cannon.

                Sadistic means that you would actually discourage a patient suffering in chronic pain from a possibly effective therapy like the above.

                So let me add up all of those who would discourage this therapy. Raise your hands and be counted!!

              4. WilliamLawrenceUtridge says:

                Good distraction and deception, but you missed something in the complexity. You just can’t look at the conclusions at the end of the articles. You must spend time and go further into the details. The articles are for a professional’s eye, sorry you are not in this category.

                Um…actually the problem is that almost none of them had anything to do with acupuncture. And if you’re dumping a list of references with the claim that it’s the ultimate be-all and end-all of acupuncture-supporting research, “having to do with acupuncture” would seem like a pretty fundamental starting point.

                The reference that did discuss acupuncture were primarily historical in nature – not clinical trials. A point you haven’t acknowledged to date. Only one, by Hong, seemed to be a relevant clinical trial – and it found that lidocaine injection was superior to needling.

                Default to one of the unbiased clinical MDs who treat chronic pain and dysfunctions or …. gee Ingranham is the only one but he does not want to review or understand Gunn/Cannon.

                Paul has read, and understands Gunn – he just disagrees.

                See, your definition of “unbiased” is hermeneutic, since your definition gives every evidence of being “someone who agrees with me”. Anyone who agrees with, say, me, that there isn’t much evidence for acupuncture is automatically considered “biased” and therefore discarded.

                If you repeat enough times, you’ll find that eventually you are the only unbiased person around!

                Acupuncture is a valid part of CAM.

                Well, except for the “valid” part, which is redundant since CAM is inherently made up of unproven modalities. But yeah, acupuncture is definitely part of CAM. This isn’t a point in its favour.

                Some forms of Acupuncture are more effective than others.

                Which ones? How do you know? Any references to support this?

                In essence, Acupuncture is NO different than dry needling when viewed with the the mechanic of action as per Gunn/Cannon.

                I would agree with this – but that merely shifts the game to whether or not Gunn/Cannon dry needling is effective. Any references to support this?

                Sadistic means that you would actually discourage a patient suffering in chronic pain from a possibly effective therapy like the above.

                I don’t treat patients, so this isn’t a concern. But given acupuncture has equivocal benefits only in some subsets of patients that are short-term and fade over time, yes, I would discourage a patient from seeking acupuncture. For muscular pain and trigger points, I would encourage self-care with a hard rubber ball and a hot bath however. It’s almost free, and they can control the intensity of the stimulation, and they can find the knots themselves. Plus, it doesn’t break the skin, so there’s that.

                So let me add up all of those who would discourage this therapy. Raise your hands and be counted!!

                Oh, my hand is up motha-fukka! I think it might be stuck actually. I would ask you for medical advice, but it would probably be something stupid and ineffective like rubbing it with a striped cat during a new moon.

              5. “since CAM is inherently made up of unproven modalities.”
                This is a personal belief and inherently unscientific and wrong.

                Acupuncture is a word and has different meanings in different venues. So using the word as an all inclusive discipline is improper.

                Paul is free to belief whatever he wishes. He is not free to sway a suffering patient away from a viable therapeutic option. That would be immoral and unethical of which he is neither.

                Dry/wet needling, Gunn-IMS, Biopuncture, Neural injections Travell/Simons injections and acupuncture are all effective therapies when used properly. All the data is online or in the library. If you chose not to accept the data … that is your choice. I would caution doing harm to an unsuspecting blogger based on your opinions.

                “For muscular pain and trigger points, I would encourage self-care with a hard rubber ball and a hot bath however. It’s almost free, and they can control the intensity of the stimulation, and they can find the knots themselves. Plus, it doesn’t break the skin, so there’s that.”

                This is absolutely why all of these therapies work! They all are a on a spectrum of intensities and effectiveness. Some knot will not release with a ball and must be released with a “metallic instrument” as per Gunn/Cannon. Many knots devolve into dense masses and will not budge to external pressure. Guess what? I also suggest do-it-yourself needling to those souls. The needles cost 2 pennies and can be used at home = dirt cheap!

                If you believe knots and tennis balls, then the next evolution of this therapy is with needles. GET your hand down!

              6. WilliamLawrenceUtridge says:

                Replied below.

  9. t groan says:

    And who benefits the most from the ACA? The insurance companies and probably Big Pharma, both of whom I would suspect of providing or have provided largesse for many of the authors here.

    The ACA is a joke but unfortunately this type of pseudo healthcare reform is what you can expect from a government controlled by corporate interests.

    1. WilliamLawrenceUtridge says:

      The insurance companies and probably Big Pharma, both of whom I would suspect of providing or have provided largesse for many of the authors here.

      Two points:
      1) Despite repeatedly being asserted by a variety of bad-faith commenters, this assertion has never been substantiated (and ignores contrary evidence such posts about how bad Big Pharma is, such as this one or this one.
      2) Yes, this fact has been pointed out by several of the bloggers, whom have repeatedly advocated for better health care in general and a better health care option than Obamacare’s insurance reforms.

      But hey, you’ve complained about something on the internet, so you’ve done your part, right? No need to do something actually useful like writing to your state representative or running for office yourself.

      1. Sean Duggan says:

        Options which, unfortunately, probably will do about as much good as complaining on the internet unfortunately…

        The ACA is broken, but I’ll argue that it’s still a good step in the right direction. I think there will be a period of pushback and churn as we figure out what exactly to do with cases where one patient’s expenses could pay for the health care of thousands (we’re already hitting a few of those, although the action so far as been for companies to kick those people to health exchanges and let the government soak it up), but ultimately, I think we’ll get it to work out. And yeah, there will be a few people who will make a ton of cash gaming the system, but honestly, these people are more or less built for that. If a CEO weren’t finding a way to make money off of loopholes in the ACA, he’d be doing it via real estate loopholes, or by becoming a successful self-help speaker. It’s their nature.

        1. WilliamLawrenceUtridge says:

          I just wish Americans could experience what a true health care system is, you are really missing out.

            1. irenegoodmight says:

              Ditto!

        2. The entire healthcare system is broken … the ACA just makes it a little more equitable.

          This site is broke too!

          Both are stuck in a power and dogma struggle.

          1. WilliamLawrenceUtridge says:

            Feel free to leave.

            How is it ‘dogma’ to ask for evidence before supporting a medical treatment? isn’t ‘dogma’ closer to what you do, demanding we ignore the evidence in favor of you unreferenced assertions and complete inability to understand the scientific process?

    2. MTDoc says:

      “Who benefits the most from the ACA?” Well, it is not going to be the taxpayer, and certainly not the physician. As I see it, the insurance companies will also be out of the business of insuring, as they will not be able to administer the program on 20% of the premium, since the feds create the regulations that govern their costs. I expect that they will then simply administer the programs under contract with the government. We will then have a “single payer system” run by a federal bureaucracy. I don’t see what Big Pharma has to do with this. If I wanted to profit from pharmaceuticals I’d simply buy their openly traded stock. (Although Apple has much higher earnings).

      When I started practice I had a six dollar office call that provided on average 30 minutes of my time. And I made a living. 18 years later, my overhead was $60 per hour. Part of this was for the full time insurance clerk needed to file claims for the office visits! The rest was a ten fold increase in liability insurance and general inflation. Some of us were willing to “go bare”, but the hospitals wouldn’t allow us on staff if we did.

      I think you have the wrong villains in your post, but I have to agree that the ACA will not reform US medicine. There seems to be no place for individual responsibility in a system that provides free everything. Sorry, I’m off thread.

      1. MTDoc says:

        Correction on the increase in malpractice insurance costs over 18 years, That should read a hundred fold. $300 to $30,000. Is that not a problem that should have been addressed in the ACA?

        1. Andrey Pavlov says:

          MTDoc:

          I don’t know personally as it will be many years before I have to think about it, but I recall from working in the ER before starting med school one of the attendings saying his malprac was on the order of $65k per annum. And I know it is much higher for other specialties, with OB/Gyn being on the very high end. To my understanding, that is part of why the solo and even small group practice is dying out – the cost of malprac is too high and needs to be distributed across larger groups and systems.

        2. Windriven says:

          ” Is that not a problem that should have been addressed in the ACA?”

          At a minimum we need some variant of the ‘safe harbor’ idea. And I wouldn’t mind seeing a plan that bought down the premiums for primary care physicians and for specialists working in under-served communities.

          While we’re playing pie in the sky, I’d like to see much more state control of reimbursement and a federal incentive to innovate. 50 states approaching these problems in different ways would be a wonderful laboratory to demonstrate what works and what doesn’t.

  10. weing says:

    I just saw Tim Ryan from Ohio interviewed by Neil Cavuto. He was ranting how the VA should stop giving veterans medications but give them CAM treatments instead.

    1. Windriven says:

      Proof once again that stupidity is bipartisan. The Dems have sCAM and the Reps have young earth creationism and climate change denialism. These are the people who run our country, pass the laws that govern us, spend the money that we pay in taxes.

      Makes me proud.

      1. Andrey Pavlov says:

        Stupidity knows no boundaries whether they be national, political, cultural, or religious. But you know that, Windriven. As for our politics… I came across this today and thought it summed it up pretty well.

        1. Windriven says:

          I LOVE it! What makes it work is the fiercely partisan scowls on the faces of the sheep at the head of the line!

          1. Andrey Pavlov says:

            Yeah, it made me laugh. And then cry a little, inside.

    2. Ed Whitney says:

      What was the context for the discussion between Ryan and Cavuto? Before the current scandals of VA scheduling, there were major concerns about pain management at the VA, where veterans were being dosed with higher and higher doses of multiple narcotics. This has provoked a search for non-pharmacological strategies at the VA, some of which are supported by clinical evidence, some of which could sound like CAM (e.g., self-hypnosis).

      Faux News regularly says the stupidest things known to man, but the VA’s approach to chronic pain was sorely wanting before the waiting times became a national story, and “alternatives” to polypharmacy could be just what the doctor ordered. If Ryan was saying that the VA should give herbs rather than chemo to its cancer patients, that is one thing; if he was saying that they should give their chronic pain patients interventions like yoga and exercise rather than OxyContin (as they are doing at the Minneapolis VA, that is a different discussion.

      I will believe anything you tell me about Ryan and Cavuto; I just wondered about the particulars of that specific interview

      1. weing says:

        “What was the context for the discussion between Ryan and Cavuto?”
        It was about the VA scandal and then antidepressants and he mentioned Acupuncture. Check it out here

        1. Ed Whitney says:

          Thanks for the link. It appears that Ryan was a bit confused about the VA Opioid Safety Initiative, which is focused on reducing narcotic use and not so much antipsychotic or antidepressant use. Former Sec. Shinseki spoke of “ joint pain management guidelines”, which could sound like guidelines for the management of joint pain but probably meant guidelines involving multidisciplinary approaches to all kinds of pain.

          BTW, Faux News is about to get some competition on its right. NewsMax is teaming up with DreckTV to have its own cable news outlet. Quackery, goldbuggery, and conspiracy theories are about to get a new lease on life. NewsMax has been warning the public about fluoridation and vaccines and other matters for a number of years in its online version. Sean Hannity is going to look like Edward R. Murrow by comparison.

  11. My view is different.

    SBM, high technology and the business of medicine is contributing to failures in medicine and the ACA can not address those issues.

    Don’t just blame the ACA.

    1. Windriven says:

      No one is “just blaming ACA.” Most people here seem to recorgnize ACA as modest insurance reform. It addresses few of the structural issues that make the system so very inefficient but if it succeeds in getting more people into the system and keeping them there a small percentage of health care cost will shift from the government column to the private column. I’m not entirely sure that is a good thing but it tidies up some of the accounting. EHRs should help once the technology matures. Most of the rest of it is sound and fury.

      1. The major losses, waste, fraud, abuses and deceptions are related to the invisible problems of pain, pain therapy and mental illness. — NOT touched and will lead to the demise of the entire system.

        EHRs will not pan-out to be of any benefit any time soon. Too cumbersome, expensive and interferes with a true face to face patient encounter. Once you chose a vendor you are stuck and are a prisoner to their system because switching all data to a new system is impossible. Pen and paper still is the simplest. Works great prescription.

        1. Windriven says:

          Your first paragraph is self serving bullsh!t. It doesn’t merit a response. So I won’t.

          Lots of physicians are struggling with EHRs. And it is certainly true that some of the technology isn’t quite ready for prime time. But the idea of medical records instantly available regardless of temporal or geographic variables is worthy of pursuit. Pen and paper may be the simplest but it is clearly not the best. The fact that some EHR systems currently stink on ice does not demonstrate that hand-written charts are the pinnacle of medical records.

          1. The problems of health care , VA, Disability and Worker Compensation systems are not being addressed are:

            Self Serving?? Not worthy of a response???

            Wow, think again!

            1. Oops … sorry yall don’t have second thoughts because yall don’t think again.

              1. WilliamLawrenceUtridge says:

                That’s hilarious coming from the guy whose response to criticisms is to copy and paste a list of resources he’s obviously never read. I mean seriously, that’s how unthinking spambots get past unthinking filters.

            2. WilliamLawrenceUtridge says:

              The health problems of all citizens are worth a response, our issue is that your response is a terrible, self-serving, ultimately damaging one that consists of hoping patients get enough of a placebo effect to come back for another visit.

          2. Windriven says:

            Oh Steve, don’t reshuffle the deck in the middle of the hand. The first paragraph of yours that I commented on was barely coherent. Now you’ve shifted to the VA, disability and Worker’s Comp – none of which will be transformed by playing with needles.

        2. WilliamLawrenceUtridge says:

          The major losses, waste, fraud, abuses and deceptions are related to the invisible problems of pain, pain therapy and mental illness. — NOT touched and will lead to the demise of the entire system

          See, the thing is Steve, promoting and delivering unproven medicine is inherently wasteful, fraudulent, abusive and deceptive, and leads to losses of patient time and money.

          Further, the problems of pain, pain therapy and mental illness are not invisible, they are intractable. Currently there is significant attention paid and research ongoing for these items, real research to arrive at real solutions, not your placebos which are little more than pats on the head and telling people to buck up there champ!

          EHRs will not pan-out to be of any benefit any time soon. Too cumbersome, expensive and interferes with a true face to face patient encounter. Once you chose a vendor you are stuck and are a prisoner to their system because switching all data to a new system is impossible. Pen and paper still is the simplest. Works great prescription.

          My doctor uses electronic health records. They work quite well. I’ll also note it doesn’t interfere with doctor-patient encounters, he has always taken me seriously and given me all the attention I require. Not much generally, since I eat quite well and exercise at least six days a week.

          I’ll also note the premium you place on doctor-patient interactions, which is unsurprising since in many cases all you seem to be really offering is such an interaction devoid of actual treatments. Your comment about pain is particularly grating, since again all you appear to be offering are placebos, but despite this get on a high horse about how poorly chronic pain patients are treated.

    2. WilliamLawrenceUtridge says:

      My view is different.

      Who cares?

      SBM, high technology and the business of medicine is contributing to failures in medicine and the ACA can not address those issues.

      In the past, medicine wasn’t science-based. Low-technology solutions were the only thing available. Medicine was a calling, not a business. And people died younger, in worse health. Currently people are living longer, and fatter, leading to much more complicated interventions to stave off morbidity and mortality. Outcomes would be better if patients took better care of themselves in terms of their diets and exercise regimens. The ACA won’t address these issues, but neither will aspiring to a simpler, better time, where medicine was less complicated (and less evidence-based) and business more honest. Such a time did exist, and was marked by significantly shorter lives and more preventable deaths. The fact that you have no grasp of history, and use science as a drunk uses a lamp post, merely points to the fact that there is little merit taking your opinions seriously.

  12. PMoran says:

    ” __ are at a loss to figure out how to get through to legislators and other policy makers.”

    This is a sad eventuality and one where a review of our understanding and attitudes towards CAM might have helped.

    I think the best reason for objecting to funding for CAM practitioners is not that “it doesn’t work”, yet I suspect almost every skeptic thinks that this is the message that had to be gotten across to politicians and to the public.

    In my view that approach is very likely to fail while ever there are a lot of voters insisting that “it works for me “, and while nearly everyone on the planet (apart from one or two SBM authors?) can accept that the methods probably can provide non-critical symptomatic benefits and other comforts for some, via non-specific influences and psychological processes. So on compassionate and political grounds politicians and bleeding hearts (which I am not, despite prevailing opinion) are inclined to give way to what seems the kindest thing to do.

    So you have to give everyone a less confronting and more “saleable”, reason for say “no” to this.

    What about something like this?: ” Yes, it is probable that some people are deriving help from these methods, but it is just not possible to run a cost-effective health care system while also trying to fund every option that the public might choose to resort to, or the very wide range of treatments that most licensed CAM practitioners are eligible to try out, possibly one after the other, and for almost any clinical condition. There has to be a cut-off somewhere, and the only practical one is the one that most of the public actually expects from their doctors and from organised medicine, and that is that the methods used should as far as possible have passed some standard of intrinsic clinical efficacy. ”

    Also emphasise that these practitioners are mostly used by patients as optional add-ons to more regular medical care — they rarely replace it. This can make the medical care of what are already high consumers of medical attentions open-endedly expensive with progressively less likelihood of adequate returns for the extra dollars spent.

    In addition, very many, perhaps the great majority, of the public are dubious as to the usefulness of such methods and never resort to them; it is unfair that they should be required to pay more, or face less generous services themselves , through supporting optional medical choices of others.

    If any CAM service were to be paid for it should be specified precisely which and under what circumstances, as Jann also suggests.

    I know most of these points will not be unfamiliar to those here. But I will bet that that line of argument has never been widely presented in quite the above terms, simply because it goes against the grain for most sceptics to overtly allow that CAM it does anything for anyone and there is the deep compulsion to try and bring everyone around to that way to thinking whenever any matter to do with CAM arises.

    1. Jann Bellamy says:

      On the one hand, I see the political expediency is taking this approach. On the other hand, it seems like a bargain with the devil. What CAM proponents have done is make their position seem “reasonable,” therefore we need to be “reasonable” about it and give in a bit to mitigate the damage. But I don’t think that proponents of CAM will ever stop pushing because they are driven by profit, or ideology, or both. As soon as we agree to help them move the goalposts, they will simply push the goalposts further from science. You can see excellent examples of where this might end by reading some of the comments to this post from a certain person who wants to chuck science for pseudoscience, damn the consequences. Don’t think things would ever get that bad? Think again. Who would have dreamed that we’d need a blog called “Science-Based Medicine” advocating, well, science-based medicine, in the first place. This is why I don’t like accommodation.

      1. PMoran says:

        I don’t see that anything I have said is “accommodation”. It denies CAM practitioners what they want. It is consistent with the scientific evidence to do with some of the phenomena associated with medical interactions (as accepted by most scientists and practitioners, if not on my say-so), plausibility, and common perceptions as to how psychology affects illness and symptoms. It in no way endorses pseudoscience.

        The “it is probable that some people are deriving help from (the use of) these methods” is as scientifically accurate as “they don’t work” and helpful in defusing in advance allegations of bias or turf protection, but the other arguments can stand on their own feet if you wish. You can use “even if —- ” if you wish.

        I suppose my main point is to show how what to me is an unwarranted focus upon the supposed utter worthlessness of CAM to those using it, and the determination to try and drive home that point, distracts from more telling arguments, which resolve into who should pay for basically optional, add-on forms of medical care.

        1. Andrey Pavlov says:

          The “it is probable that some people are deriving help from (the use of) these methods” is as scientifically accurate as “they don’t work” and helpful in defusing in advance allegations of bias or turf protection, but the other arguments can stand on their own feet if you wish. You can use “even if —- ” if you wish.

          One key point you are unwarrantedly assuming here is intellectual honesty and logical rigor in those who purvey CAM. The problem is that your approach and overall tack works only when all parties are equally vested in the best outcome for people and patients. And that is simply not true of CAM proponents and Jann points out (yet again).

          We here at SBM – yourself included – are not only happy to but will often rejoice at being proven wrong and giving up treatments shown to be on the wrong side of risk:benefit. With rare exception, those in CAM are not. And not only often not willing but not able. For much of CAM is a very narrow focus. It would be like declaring the entire field of, say, neurosurgery useless. What will a neurosurgeon do then? And what then will a homeopath do since the entire field of homeopathy is indeed 99.99% utterly useless? Your solution begs of the homeopath to be content continuing to practice his trade while acknowledging publicly the extreme level of disutility of it. Between ego and simple business that is an untenable position. And the same goes for every CAM practitioner out there.

          Which is precisely why they crave the validation of science and cling to even the tiniest of footholds – just like Dr. Atwood elucidated in the closing caption of his post today about TACT – to continue to triumphantly purvey their chelation. This is a “give a mouse a cookie” situation, not a “sit down and rationally discuss the limits” situation.

          And even the True Believers, who honestly and genuinely feel they are helping people (as opposed to the knowing frauds and scam artists), don’t save your argument. In fact, they are likely to present an even larger problem to your approach – when you truly believe you are helping someone and perceive any diminishment of that as a vile and biased attack (as Dr. Gorski elucidated recently in his “How they perceive us” post) what would a rational person do? This is, once again, entirely the same as religion. People like to think that “radical fundamentalists” are crazy and irrational, but they are in fact the most rational of all believers because they are actually acting in concordance with their stated beliefs.

          Put another way, if you as a legitimate physician find yourself in a bizzarro world where science has been marginalized and completely bogus and quack cancer treatments are marginalized, surgery for cancer is effectively barred and considered “fringe,” but you had the knowledge, skill, and (for the purposes of the hypothetical resources) to do actual cancer surgery and treatment would you just sit back and accept the majority view that your treatments are of only marginal benefit at best and contentedly relegate yourself to watching people you know you could save die at the hands of the majority quack establishment? I should hope not.

          So when you try and argue that these True Believers should not be maligned because they are intending to help people… true enough. We don’t malign the people but the ideas they purvey and represent. Which, as you should know, is different but commonly perceived as the same. But the point is not that we should fight dirty since they are fighting dirty, but that we should be completely stalwart and firm in our stance. If you tell a patient a diagnosis over 10 minutes and only 1 word is “cancer” what do you think that patient will remember of that 10 minute conversation? When you tell the public – and the CAM practitioners – a 10 minute spiel on the limitations of the CAM in question and only 1 sentence is “it is probable that some people are deriving help from (the use of) these methods” what do you think they will remember from that spiel?

          And yes, of course you are indeed technically correct as has been acknowledge many times by many people here, myself included. However, it is also correct – to a very reasonable first approximation – to say quite simply “CAM doesn’t work.” Only after that if someone wishes to engage in deeper and intellectually honest conversation is it necessary to go into the fine nuance and explanation you wish to have. In the same way that when you consent patients for surgery you don’t go on and list and discuss every single one of the multitudinous possible risks, but limit yourself to the largest and most relevant (both to your patient and the situation) and consider that a reasonable first approximation of the discussion of risk, so it is with CAM.

    2. mho says:

      I agree that merely presenting evidence of how bad or useless CAM is won’t win the day. When we were talking abut needing a blueprint for presenting ideas, Yodelady had sent me links to the Debunking Handbook. (free) Here: http://www.skepticalscience.com/Debunking-Handbook-now-freely-available-download.html

      pulling a quote

      ” an effective debunking requires three major elements. First, the refutation must focus on core facts rather than the myth to avoid the misinformation becoming more familiar. Second, any mention of a myth should be preceded by explicit warnings to notify the reader that the upcoming information is false. Finally, the refutation should include an alternative explanation that accounts for important qualities in the original misinformation.”

      I’ve been trying all day to get my outline down:
      bascially, I’m thinking I want to say
      1. Treating late stage illness is often expensive and the diseases may be manageable but not curable. Keeping costs down is a central goal in the ACA. Scientific medicine is medicine that works; insurers should be able to determine who is in their networks and what services are covered based on evidence of what works and what doesn’t.
      2. Myth: Based on perception that real medicine is only expensive surgery or drugs, alternative med. frames the lie that unproven med. is a better choice and cheap.
      3: Myth succeeds because the parts of medicine that address real prevention: exercise and good nutrition, and screening for early disease detection, have been underutilized.

      then, I plan to write solutions to the problems–i.e. pretty much Jann’s list above.

  13. So this list of references is not enough to sway your beliefs about the validity of Acupuncture?

    http://www.sciencebasedmedicine.org/dialogue-on-alternative-therapies/comment-page-1/#comment-233227

    1. WilliamLawrenceUtridge says:

      So this list of references is not enough to sway your beliefs about the validity of Acupuncture?

      Oh my Dog, that list was specifically meant to support just acupuncture? My word, that makes it even worse. See, I reviewed that list, and most of them aren’t even tangentially related to acupuncture. Most relate to myofascial pain, and of that set, only perhaps three relate to needling. And of that needling set, only two even allude to acupuncture. Of the ones that are related to acupuncture, the vast majority are about the history of acupuncture, which is of course irrelevant to the efficacy of acupuncture, just like a history of bloodletting can’t ever be used to support the current employment of lancets and leeches.

      I mean really, did you even understand what you were posting? Could you take even a single article from that list and explain how it supports the current use of acupuncture as a treatment modality? Because most really just discuss pain, not acupuncture, and those that discuss acupuncture don’t support its widespread adoption as a treatment.

      I mean, it’s kinda sad the way you keep trying to do science, but just end up fucking it up so badly. I mean, you really are the classic pseudoscientist at this point, a real crank. Why even bother pretending you care about science since you clearly don’t understand how it works?

  14. Bill Schulze says:

    Sorry to be off topic here, but can anyone recommend a good blog/book/website/whatever that discusses the opinions and thoughts of medical professionals regarding the ACA? Or, simply make comments on this thread.

    Thanks so much in advance for taking the time to answer.

  15. Ed Whitney says:

    Historian Garry Wills wrote A Necessary Evil some years back, with the subtitle A History of American Distrust of Government. He identified some themes which date back to the days of the Revolution, with its antagonisms between the militias and the Regular Continental Army. The ragtag militias did nothing to win independence; the professional army under General Washington accomplished that goal. But the myth of the amateur minutemen endured and is with us to this day. Wills suggests some contrasts whose echoes can still be heard in our politics, but which, I suggest, also can be heard in CAM vs. SBM disagreements.

    Wills includes anti-governmental values/governmental values with such contrasts as provincial vs. cosmopolitan, amateur vs. expert, traditional vs. progressive, populist vs. elite, and organic vs. mechanical. For example, frequent rotation in office kept the legislative process in the hands of amateurs and out of the hands of experienced legislators who have mastered the basic competencies required for lawmaking. The new Constitution allowed for indefinite tenure in office, as if it pays to know what the hell you are doing in a representative body. We have all heard certain CAM operators appeal to our beliefs that we need not be bound by the opinions of the medical elites whose only advantage over is expert knowledge and long experience. Similarly, traditional modes of healing have status simply by virtue of being traditional; if they have been practiced for generation after generation, there must be something to them, and in any case, we as individuals know what is best for us.

    Science is cosmopolitan, expert, progressive, elite, and mechanical. Its role in a democracy is likely to collide on occasion with the provincial, amateur, traditional, populist, and organic. A bit of historical perspective can offer us a long view of a debate we happen to be in the thick of right now.

    Whether Wills’ book is relevant to this particular discussion could be disputed, but it is a fine book which sheds much light on current politics.

  16. Yodel lady says:

    When I first read up on this, I found a pdf explaining the guidelines to insurers which I thought was an official government document, but apparently I didn’t bookmark it and now I can’t find it. It said one purpose of the non-discrimination clause was to make sure the providers available under the ACA represent the demands of the community. I’m sure we’ve cited statistics here showing that fewer than 1% of U.S. residents feel any need to visit a naturopath, so it seems to me that could be a strong argument against Harkin. But perhaps I simply dreamed that I read that. Does it ring a bell with anyone?

    1. Jann Bellamy says:

      This may be what you are thinking about:

      Lafferty, WE et al, Insurance coverage and subsequent utilization of complementary and alternative medicine providers, Am J Manag Care. 2006 Jul;12(7):397-404. In Washington (state), where naturopathic services are covered by insurance, of 600,000 insureds in database, only 1.6% made claims for naturopathic services in 2002.

      Barnes P, et al, Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, National Health Statistics Report, 2008. Children: 0.3% (2007); Adults: 0.2% (2002), 0.3% (2007)

      The bottom line is: almost no one uses naturopaths, even when seeing one is covered by insurance.

    2. Windriven says:

      Yodel lady, the article Ms. Bellamy referenced is here.

      1. Yodel lady says:

        Thank you, Jann and Windriven!

  17. PMoran says:

    “One key point you are unwarrantedly assuming here is intellectual honesty and logical rigor in those who purvey CAM. The problem is that your approach and overall tack works only when all parties are equally vested in the best outcome for people and patients. And that is simply not true of CAM proponents and Jann points out (yet again).”

    What do you mean by “works”? My suggestion is more truthful (as you allow) and consistent with common perceptions, and on those accounts alone it is likely to be more effective for the purpose under discussion.

    If you critically examine your “good and wise” versus “evil and ignorant” characterisations of the matter you will find a near-comparable degree of over-simplification of reality. You will thus encounter similar unresponsiveness when talking to those who will almost instantly sense that you are presenting a distortion of the truth. They will again (as with the unqualified pronouncement “it doesn’t work”) start wondering what your angle really is.

    We are supposedly evidence-based. It is actually extremely difficult to judge for certain, let alone prove, what mixture of true belief, self-interest, delusion, and other motives may guide any individual or group.

    I agree some CAM behaviour looks self-evidently fraudulent or mischievous to us, when judged by the very strict standards that we aspire to (but rarely quite reach — look at the chelation thing, which could,, without much stretching, be regarded as a mainstream phenomenon). However, it is futile trying to reason from that characterisation of a whole group when it is not so self-evident for others — especially CAM clients, who rightly or wrongly sense (or I suppose sometimes project such a fiction onto their “healers”) genuine interest in their welfare.

    Moreover, we know from our own history how compelling are the various “therapeutic illusions” that dominate everyday clinical practice of any kind. So there is usually a semi-rational and non-fraudulent basis for some degree of belief. SS demonstrates this in action — in spades actually, because his style of practice probably does recruit a lot of the non-specific therapeutic influences that can operate with prolonged, hands-on, mildly invasive programs of treatment.

    when takingto eople who don’t share]]]]]]]]]]]]]]familiar concptsomething which is only largely true I their own midns and which ends up shooting them in the foot when they try to use this to “win friends and influecethey have convinced themlseves is true, despite ich other

    1. PMoran says:

      The ” ]]]]]]]]” and premature send derives on this occasion from a visit to my laptop from my nine-month old grandson.

      1. Andrey Pavlov says:

        Enjoy your time with your grandson. That is vastly more important than hashing it out yet again with me. I still respect your challenges and, just like Dr. Gorski, still take them as impetus for self reflection from time to time, despite how heated we may get. To me, that is a sign of how close we are in thought and goal.

        But this reminds me that I have some amends to make myself and salvage my own evening.

    2. Andrey Pavlov says:

      What do you mean by “works”

      Has intrinsic action which meaningfully change the course of or ameliorates a pathological state.

      My suggestion is more truthful (as you allow) and consistent with common perceptions, and on those accounts alone it is likely to be more effective for the purpose under discussion.

      On this we disagree. As does just about everyone else here. You really seem to not actually understand how the psychology of humanity works, despite your protestations otherwise.

      They will again (as with the unqualified pronouncement “it doesn’t work”) start wondering what your angle really is.

      Sure. Some will. But some will also be lost in the nuance of your statements and some will take your statements to be active endorsements. I am not the one falling for a Nirvana fallacy where I think any single or combination of tacks will somehow capture all people. Our only disagreement is which strategy will capture the most. My argument has always been that a plurality of tacks, including yours, is the best. Your argument seems to be that your tack and yours alone is the best, and is otherwise polluted by any other tack. The evidence from other realms of public discourse as well as other sources support my stance more than yours (obviously I would think so). But regardless you’ve yet to proffer any evidence that your tack is definitively superior besides your own personal lucubrations and it goes against historical precedent to assume that only a single tack is ever the most effective regardless the cause.

      It is convenient how you disregard the testimonials of those who have come out of lurking recently in support of us. Granted it could very well be a self selected group, but you act as if those sort of people don’t exist. I also happen to have been privy to a number of emails Dr. Gorski has received in the same vein.

      It is actually extremely difficult to judge for certain, let alone prove, what mixture of true belief, self-interest, delusion, and other motives may guide any individual or group.

      Agreed. Which is why it is best to proceed as if one cannot know, which is precisely what I (and others) have outlined and argued.

      I agree some CAM behaviour looks self-evidently fraudulent or mischievous to us, when judged by the very strict standards that we aspire to

      Once again, we have many times discussed why True Belief vs fraud doesn’t really matter.

      (but rarely quite reach — look at the chelation thing, which could,, without much stretching, be regarded as a mainstream phenomenon)

      Hardly. You are now playing the same BS games as the CAM proponents. The vast majority of the medical establishment felt this was not a fruitful course to pursue – that is clearly documented here and by Dr. Briggs. The only reason it happened is precisely because what you have oft claim cannot happen actually is. That pseudoscience and quackery is invading the mainstream. This trial never would have happened had the NCCAM not existed, had it not been pushed by political agendas, and had the NCCAM and the trialists themselves not been stocked heavily with CAM practitioners. You are either blind or disingenuous when you try and assert it was arguably mainstream. The only reason it even has a whiff of mainstream to it is because of precisely what we here are fighting and you argue simply cannot be. Open your eyes Peter.

      SS demonstrates this in action — in spades actually, because his style of practice probably does recruit a lot of the non-specific therapeutic influences that can operate with prolonged, hands-on, mildly invasive programs of treatment.

      You are very selective in your thoughts and readings. That’s often called cherry picking. I don’t read SSR’s drivel because I can’t stomach it, but I do catch some of it and the responses to it. Did you perhaps miss the part where either MadisonMD or Windriven actually looked him up and found his patient satisfaction ratings to be rather low? This also fits with the data that shows a fair bit of CAM use is a one off thing where people try it and are put off by it. It is marketing – with a lot of bad experiences after the fact. Followed by some post hoc rationalization or just moving on.

      I simply don’t know how else to try and explain to you that you are genuinely missing a fundamental aspect of the argument and the state of things. You aren’t wrong Peter. You are just focusing on such a narrow subset of the issue that you are missing the forest for the trees. The mistake you make is that you try and assert that only those trees are important. I’m saying we may lose some of the trees you are looking at, but the forest is at stake and much more important.

      1. PMoran says:

        “Did you perhaps miss the part where either MadisonMD or Windriven actually looked him up and found his patient satisfaction ratings to be rather low?”

        If this was not supporting what you want to believe there is no way that you would submit an online survey as firm evidence of anything.

        Because of factors that are familiar to us all, a practitioner in his line of work would have to work very hard to induce a low satisfaction rating. Perhaps SS is being too cocky — arousing unrealistic expectations, having attracted the wrong kind of patient.

        So no, I am not yet convinced that a slightly distorted perspective on reality is not helping to defeat medical scepticism’s own objectives, or encouraging the pursuit of unrealistic objectives to an unrealistic degree for present times.

        I would remind you that SBM authors are commonly lamenting the inability to get “our message” across. So I make no apology for questioning the content of the message on scientific, strategic and stylistic grounds.

  18. CommonSenseBoulder says:

    re: “The truth of the matter is that naturopaths do not practice evidence-based medicine”

    Yup, that is a problem. A parallel one is that some people don’t rely on policy analysis which takes into account the scholarly work done on the issue of how governments operate in reality vs. naive wishful thinking about them. One nationally prominent GMU economics professor refers to this as “witch doctory”. James Buchanan won his nobel prize for founding work on public choice theory, which he described as “politics without the romance”. It is to be expected that special interests will have undue influence over politics (including alternative practitioners). George Stigler won his nobel prize for regulatory capture theory, writing a few decades ago that:

    http://web.missouri.edu/~podgurskym/Econ_4345/syl_articles/Stigler_TheTheoryOfEconomicRegulation.pdf
    “as a rule, regulation is acquired by the industry and is designed and operated primarily for its benefit”

    So to refer to “sacrifices the larger goals of the Act for the private gain of individual practitioners and political ideology.” is to indicate a naive view of the nature of this huge bill which despite claimed noble intent should be assumed to not be magically different from other laws and to in reality have been created to benefit special interest groups rather than the general public. To expect otherwise is to ignore scholarly work on how governments work, and to engage in as much wishful thinking as alternative medicine adherents.

    The post claims: “In interpreting Section 2706, HHS must keep in mind the overarching purpose of the ACA,[...]Obviously, Section 2706 does nothing to fulfill the Act’s intent of increasing the number of covered Americans”.

    This is a vast bill, at most a miniscule fraction of it is for that claimed “purpose” (and often runs counter to it). In reality, it was passed by logrolling, passing it around and adding favors to it for groups to gain votes to get the resulting huge monstrosity passed. Unfortunately a handful of arguable benefits are pointed to in order to sell the thing to a public, ignoring most of the bill.

    In general re: ” But its provisions can be judged against the goal of decreasing the cost of health care.” The act includes a medical device tax (apparently other special interest groups were more powerful). In what fantasy universe does that decrease the cost of health care? Anyone claiming that was really the purpose of this law knows little about it and has fallen for the equivalent of popular media stories about alternative medicine that the poorly informed fall for.

    re: “Another cost control measure imposed by the ACA is a limitation on the percentage of administrative costs an insurer can include in premiums.”

    This is going off a bit further on a tangent, but you need to understand the games politicians play to mislead people in order to reason effectively about policy. Unfortunately many people who know little about business were misled by that provision, since in reality its goal is to have insurers not object to healthcare price increases to let costs continue to rise. To increase the % of premiums that go to care they can do one of two things: decrease profit&overhead, or increase payments to healthcare providers. If they increase payments to providers they can increase their profits. Administrative costs of insurers aren’t the real issue, incentives are, and this provides incentives to see costs rise, and premiums with them, and profit along with that. Before this was enacted, there was a chance some insurer might start a price war and find ways to cut back on costs to gain customers with lower premiums, and this is intended to prevent that. To call that provision about “cost control” is as much Orwellian double speak as “war is peace”.

    re: “In one sense, forcing inclusion of CAM providers is already undermining the market-oriented managed competition strategy employed by the ACA”

    Unfortunately “managed competition” isn’t “competition”, it is a way for politically connected groups to win out over their competition and prevent new entrants into a field. The very notion of “managed competition” undermines competition, which the government has been doing in myriad ways for decades, which has lead to price increases in part due to lack of a real competitive market.

    re: “How the state legislators got us into this mess”

    What got us into this mess are naive people who wish to entrust a political process to determine appropriate treatments as if it would do so objectively rather than based on political influence. It is medical doctors who insisted on state licensing that granted politicians credibility on the issue. The government shouldn’t be stating what good medicine is, that should be up to private entities. You have the naive hope that science based medicine will win in the political realm, but history seems to show otherwise and there is little reason to expect that to change. The more likely scenario is that alternative practitioners are eventually granted stamps of credibility by government, as they already have been. Politicians aren’t experts on medicine and science, even if the public is duped into thinking they should pronounce the “winners” in that realm. By involving politicians in the first place doctors helped create the mess we are in now.

    1. Ed Whitney says:

      Boulder: This is a very valuable comment, reminding us of how regulations work for the benefit of the regulated. If new public policies were required to be evaluated with the same rigor which is applied to new drugs and devices, we would be living in a very different world; your comment is a compelling argument that this is a dream world. Rather, these policies are evaluated with an eye to the need for buy-in from politically well-connected lobbies. Hence the sausage-making quality of the new law to which you refer.

      I wonder if I could pick your brain on a related political/policy matter. The USA is the last industrialized economy, we are repeatedly told, to be without a national health care plan. Do you happen to know whether other countries with such plans grant access to naturopathy other forms of care which the SBM community generally deplores? If you can suggest a book or other resource which addresses this question, I would be grateful.

      1. CommonSenseBoulder says:

        re: “Do you happen to know whether other countries with such plans grant access to naturopathy other forms of care which the SBM community generally deplores?”

        I haven’t researched it, but that is a useful issue point to look into.

        Unfortunately much of the public falls for the siren song of having government be the arbiter of “truth”, which isn’t the way science works. Over time theories that best match reality win out, rather than those which are emotionally appealing. If politics attempts to decide an issue, it isn’t what is most rational that will necessarily win, its often that which is emotionally appealing which wins out.

        Ideally we would have competing private certification labels which aren’t given some government stamp of legitimacy. We would trust a “science based medicine” certified doctor, and would choose insurers who only paid science based medicine providers. There would unfortunately of course be private naturopath certifications, and insurers who paid for them. We would argue against using such providers, but people need to be free to make even bad choices. At least in that case the bad choice is their own, they wouldn’t be able to get government’s help in pretending to the public that their choice is a good one, which is a danger with the current approach.

        The certification agencies would compete with each other to demonstrate to the public which is best using evidence, rather than competing in back room political deals to try to get politicians to endorse their approach for non-scientific reasons.

        Science evolves over time as people create competing theories and we see what works in reality. Free markets similarly evolve solutions to problems over time, as people come up with competing theories about what is best for customers, and we see what works in reality. In both cases perfection isn’t an option, there are temporary mistakes made due to limited information (e.g. a company with a nice ad campaign may get sales at first, but if it doesn’t work people will eventually go elsewhere. The same is true of medical certifications).

  19. WilliamLawrenceUtridge says:

    This is a personal belief and inherently unscientific and wrong.

    Nope, CAM is inherently made up of unproven treatment. CAM treatments found to work are adopted by medicine – it just doesn’t happen often. For instance, physiotherapists now offer spinal manipulation for low back pain, since testing showed it to be effective. St. John’s Wort is used for mild to moderate depression, with the caveat that it interferes with AIDS medications and can cause photosensitivity. But all the other CAM shit out there is merely unproven (often impossible) speculation being sold by unethical shills.

    Acupuncture is a word and has different meanings in different venues. So using the word as an all inclusive discipline is improper.

    And despite repeatedly being asked, you’ve never been able to point to or provide a definition of what “real” acupuncture is. But you did crap out a giant, irrelevant list of non-acupuncture sources as an attempt at distraction.

    So I’ll ask again, what is “real” acupuncture then?

    Paul is free to belief whatever he wishes. He is not free to sway a suffering patient away from a viable therapeutic option. That would be immoral and unethical of which he is neither.

    But meanwhile what you do, offering unproven, in fact disproven treatments to desperate patients is the height of virtue? Why? At least most of Paul’s advice is free – you charge for your unsubstantiated nonsense.

    Dry/wet needling, Gunn-IMS, Biopuncture, Neural injections Travell/Simons injections and acupuncture are all effective therapies when used properly. All the data is online or in the library. If you chose not to accept the data … that is your choice.

    I haven’t seen any such data, and when you claimed to provide some, it turned out your list almost uniformly didn’t even discuss acupuncture. If it’s all online, and you’re so familiar with it – why are you consistently unable to provide any links to it? Why, whenever you finally get around to providing references, do they turn out to be irrelevant?

    This is absolutely why all of these therapies work! They all are a on a spectrum of intensities and effectiveness. Some knot will not release with a ball and must be released with a “metallic instrument” as per Gunn/Cannon. Many knots devolve into dense masses and will not budge to external pressure. Guess what? I also suggest do-it-yourself needling to those souls. The needles cost 2 pennies and can be used at home = dirt cheap!

    Two points:
    1) References?

    2) So now you’re recommending patients to buy these needles and use them as a form of self-treatment? Wow, that’s terrifying. What happens if the patient punctures an artery? Or hits a nerve? Or severs a tendon? Or drives a bit of MRSA deep into their tissues and it starts turning their muscles into pus and goo? Jesus, you’re dangerous.

    If you believe knots and tennis balls, then the next evolution of this therapy is with needles. GET your hand down!

    Oh, well since you put it that way where are your references? That’s why my hand is in the air by the way – to make it easier for you to had me a fat stack of valid references that actually justifies your claims. To date, it’s still empty you quack.

    1. Circular logic ending in a black hole.

      What r your credentials again?

      1. WilliamLawrenceUtridge says:

        What do my credentials have to do with your inability to reference the scientific literature?

        Are you just bringing this up because you can’t think of anything meaningful to say?

        If I had an MD/PhD and was a practicing clinician-scientist, would that mean you would supply me with the references you allegedly have? OK, fine.

        I’m a practicing clinician-scientist with an MD/PhD, specializing in internal medicine. Please provide me with your scientific references.

        1. I did list many! I honestly think no one here chose to read any of them.

          By default you have chosen to have a narrow view of science which makes your conclusions only personal beliefs. That is OK, just let the uninformed know that you have a personal agenda.

          Don’t feel left out, I really do not think anyone has cracked open any of the textbooks or read any of the clinical references.

          1. WilliamLawrenceUtridge says:

            I did list many! I honestly think no one here chose to read any of them.

            Oh for fuck’s sake. If nobody read them, how do you explain this comment, which you never replied to despite being flagged for your attention multiple times now. So it looks like I will have to bookmark my comment to keep shoving in your face, because apparently you are either conveniently ignorant, or deliberately pretending it doesn’t exist because it brutally undercuts your claim of having your references ignored. To rehash, your list of references was a copy and paste from another website, and did almost nothing to support your assertion that acupuncture does anything, let alone is a miracule cure for musculoskeletal complaints.

            By default you have chosen to have a narrow view of science which makes your conclusions only personal beliefs. That is OK, just let the uninformed know that you have a personal agenda.

            1) You don’t even know what science is; you think science is something you use to support what you already believe, and it is quite the opposite; science is inherently iconoclastic.

            2) You have never cited any science to support your position. You have tried to – but your best efforts were either books of assertions backed by clinical experience (which is not science) or totally irrelevant. So please stop talking about science as if you even pretended to respect it.

            3) You are the one attempting to support a personal agenda – the income and ego gratification you get from your practice, despite lacking any empirical basis for it, and a complete ignorance of how deceptive clinical experience is.

            Don’t feel left out, I really do not think anyone has cracked open any of the textbooks or read any of the clinical references.

            Fuck you because I did and they were utter dog shit. Stop pretending you’re some poor, persecuted science-based practitioner, because you’re not and you don’t even have the honesty to read the sources you try to throw in other people’s faces.

      2. Jopari says:

        Stephan S. Rodrigues, by the fact that you wrote the words MD behind your name shows that you credentials have not a lot to do with credibility. Logic does, something you appear to severely lack.

        Were you to truly be an MD, not just in name but in thought, you’d give up the argument, the previous commenters have disproven your claims, and yet you cling to them.

        Your idea on buying needles to use is ridiculous, as people would only wound themselves, already stated. You resort to very personal attacks, even going as far as to claim that no one gives a second thought, though they’ve obviously shown you up, in both evaluating and addressing your claims with evidence and logic, things you failed to do when challenged.

        Please, think before you type.

        1. @Jopari
          Sir who are you to determine anyone’s credibility or logic? So you have all the answers?? Let’s see, Can a radiologist find noncancerous-noninfectious- pain on a scan?

          “the previous commenters have disproven your claims”
          NOPE, they used unscientific tactics and twisted word and belief.

          , and yet you cling to them.”
          I’ll cling until I find other data to assumulate.

          “wound themselves”
          If you have been reading you would know that this is exactly what is needed.

          What is your background … mr superior person?

          1. Windriven says:

            “Sir who are you to determine anyone’s credibility or logic?”

            That’s sort of a pointless question. Your logic is as idiosyncratic as your spelling and you have no credibility at all. Therefore, the issue of anyone’s assessment credentials in regard to either is moot.

            But go ahead Steve, prattle on. You started as a physician to be reasoned with, disintegrated into a repetitive annoyance, and now, by virtue of indefatigable repetition of entirely vacuous nonsense, you have become sort of an inside joke – kinda like the ‘Kilroy was here’ graffiti common during WWII.

            1. Credibility is important when making a clinical judgement or any conclusion that you want to impose on the public.

              1. Windriven says:

                SSR: “Credibility is important when making a clinical judgement or any conclusion that you want to impose on the public.”

                Merriam Webster: “Credibility: the quality or power of inspiring belief”

                Do you think that you inspire belief, Steve? Do you think anyone here believes in you or in your clinical judgment?

                Credibility is earned by learning what is real, what is factual, what is probable and what is not. Credibility is earned by learning to marshal that knowledge to great effect.

                Your arguments are not credible. They are not even incredible. They are anti-credible. This has been explained to you repeatedly and at considerable length.

                There is a clear method that science uses to tease what is real from what is imagined. Acupuncture has been tried against this method. Repeatedly and in many different arrangements. And acupuncture has been found to offer little beyond placebo.

                If there has been an error in the way that acupuncture has been tested, describe the error in scientific terms and propose a more accurate protocol. Arrange a trial that is scientifically rigorous and that proves the efficacy of the modality. You will be a hero.

                But don’t simply keep repeating that you know it works because you see the results. When you make that claim you align yourself with John of God and Benny Hinn; you look a fool. There is no credibility to be found there.

              2. WilliamLawrenceUtridge says:

                Credibility is important when making a clinical judgement or any conclusion that you want to impose on the public.

                Credibility here rests on the ability to show an understanding of the scientific method and relevant body of empirical studies. Clinical judgement uninformed by the scientific literature stand a much higher chance of being wrong. Do you know who based all of their practices on clinical judgement? Bloodletters, and surgeons who debrided knee cartilage. They both swore that what they did helped – just like you. Why are you right when they are wrong?

            2. MadisonMD says:

              I am surprised at the number of new posters who have responded to SRR’s prattle. I think he may inadvertently do more for the SBM cause than anyone else here by displaying his vacuous reasoning.

              1. Windriven says:

                ” I think he may inadvertently do more for the SBM cause than anyone else here by displaying his vacuous reasoning.”

                Yes, a living, breathing primer in logical flaws. And like dissecting the flatworm in high school biology, there is enough there to make it interesting for a newbie without unnecessary complexity to muddy the lesson. The bonus is there is little chance of losing a debate to someone who tops out at the rhetorical equivalent of, “nuh-uh.”

          2. WilliamLawrenceUtridge says:

            Sir who are you to determine anyone’s credibility or logic? So you have all the answers?? Let’s see, Can a radiologist find noncancerous-noninfectious- pain on a scan?

            S/he’s yet another person who finds your certainty, coupled with your lack of understanding of science, to be baffling and sad. However, like most ideologues, rather than seeing this as evidence of your own failure to convince, you see it as yet more persecution and conspiracy.

            NOPE, they used unscientific tactics and twisted word and belief.

            How is pointing out your lack of understanding of the scientific method, and your lack of familiarity with the scientific evidence, unscientific tactics? 90% of my replies to your comments consist of “what evidence do you have”, and you’ve only replied twice. With embarrassing results. What exactly is scientific about insisting your clinical experience and one book over-rides 3,000 empirical studies?

            I’ll cling until I find other data to assumulate.

            How do you assimilate this data?

            If you have been reading you would know that this is exactly what is needed.

            What studies support this statement, not your mere assertion? What study shows that injuring a muscle or tendon further makes it heal faster and better? Can you link to any? Pubmed IDs are fine as well.

            What is your background … mr superior person?

            What does it matter? Will the arguments be more convincing when accompanied by more degrees? Why don’t you show us the evidence supporting your claims? Even though I’m not an MD And because I’m a mixed MD/PhD, I’ll totally have enough authority to assess them, and you’ll have to believe me because I’m an MD/PhD and I outrank you.

      3. Windriven says:

        “What r your credentials again?”

        Intelligence warmer than yesterday’s tea. He trumps you on that score, Steve.

        1. Hmmm did you know that it does not take much intelligence to know that you all do not focus on the data and are using deceptive tactics of personal attacks.

          Focus on the data!

          1. Windriven says:

            “Hmmm did you know that it does not take much intelligence to know that you all do not focus on the data…”

            Apparently more than you can muster, Buster.

            “Focus on the data!”

            Yes, well of course we do. The problem Steve is that you imagine anecdotes and wishes to be data. We have asked repeatedly for the data that supports the efficacy of acupuncture. And we’re still waiting. Real papers, please. In real journals. Peer reviewed. You know the drill.

  20. IsThatYouAgainMrKnowItAll says:

    I thought this was going to be a place where there would be some honest discussion.. Only to find some idiot trying to force his opinion on everybody else through bullying tactics. So I thought .. What’s the ulterior motive? Then you gave your credentials…. Intellectual bigotry… If you don’t conform to my standard … You’re wrong… Hahaha.. What an a__hole… I don’t think your degree can fix that…

    I think I’ll climb to the top of your ego and jump down to your IQ … If you become king of the world.

    1. WilliamLawrenceUtridge says:

      Hank?

      Could you identify the “bullying tactics” you say are present?

      Why do you see ulterior motive, rather than an honest dislike of efforts to force unproven treatments through the ACA?

      Where is there “intellectual bigotry”? Because Jann correctly notes that there is little evidence supporting CAM? Isn’t that merely a fact, not bigotry? If CAM wants to be taken seriously – shouldn’t it test its approaches rather than assuming they work, and abandon the ones that don’t work?

      At what point does Jann state we should believe her because of her degree, or brag about her IQ?

      What I find funny is the number of people who come here “asking for an honest discussion” and then attack the author or commentors with nary a single bit of substance. It really looks like you’re not here for an honest discussion, you’re just here to insult people.

    2. Marion says:

      IsThatYouAgainMrKnowItAll:
      I assume you are speaking about that idiot Stephen Rodrigues, since you speak about 1 person (being the minority) trying to force his opinion on everybody else (the majority), the majority on this forum being intelligent caring SBM-minded people.

    3. Windriven says:

      Hey Hank-
      Jann’s going to have a hard time becoming king of the world. Empress maybe. Tsarina. Queen is out of the question ever since Freddy Mercury died.

  21. Marion says:

    Mr Stephen Rodrigues, professional Circus Clown, is just a money-grubbing SCAMmer.

    1. @ Marion why the name calling and why the bias, “money-grubbing”
      is not exclusive to some CAM providers, gee we see this in Trad. Med and even the most supposedly highly moral careers.

      Anger and resentment is a sign of overt mental instability, have you seen a Psychiatrist yet?

      1. WilliamLawrenceUtridge says:

        @ Marion why the name calling and why the bias, “money-grubbing”

        Because you’re a lying, deluded fool with delusions of grandeur and a propensity for hypocritical lectures, and we’re all tired of you.

        is not exclusive to some CAM providers, gee we see this in Trad. Med and even the most supposedly highly moral careers.

        Oh, I get it, because some doctors exploit their patients, that means an entire field of alleged medicine gets to do it?

        Maybe rather than excusing your bad behaviour with “but other doctors do it”, you could focus on being a better doctor and using real medicine instead of placebos?

        Or, y’know, ignore the science and copy-paste random lists of sourcse in the hopes that nobody ever reads them.

        Anger and resentment is a sign of overt mental instability, have you seen a Psychiatrist yet?

        Why, are you prepared to give out mental health advice over the internet, just like you hand out financial advice in your medical office?

      2. n brownlee says:

        ” “money-grubbing” is not exclusive to some CAM providers, gee we see this in Trad. Med and even the most supposedly highly moral careers.”

        ‘Look, real doctors do it sometimes too… and lawyers.. that means it’s okay!’

  22. “Oh, I get it, because some doctors exploit their patients, that means an entire field of alleged medicine gets to do it?”

    Well no!!! But some knowingly will replace a knee joint to treat knee pain just because they have the authority to do so. All blessed by the powers that be. Some know that it is not in the best interest of the patients and some don’t care to find any alternatives … they are free to do so without reprisals.

    1. WilliamLawrenceUtridge says:

      Well no!!! But some knowingly will replace a knee joint to treat knee pain just because they have the authority to do so.

      So in your mind, no orthopaedic surgeon will ever refer a patient if their pain doesn’t appear to be mechanical? All surgeons do is blindly cut open their patients?

      Maybe that’s how you do it, which is why you reach for the needles all the time, but evidence-based doctors like to have evidence before they do stuff.

      And speaking of evidence, where’s yours that this happens? Or is this the story you tell yourself to justify treating your patients? Where are the studies of post-surgical pain and recovery that you are basing this on? Because there’s a good chance you’re basing it on your own experience, or rationalization for your services. And you may convince yourself that surgeons are completing hatchet- jobs all over the US, but let’s not forget – you will never, ever know about all the satisfied patients of those surgeons. You never see them. Your opinion is purely based on who walks through your door, and strongly, strongly informed by who comes back for a second visit. If you can’t see why that’s a problem, I won’t be surprised.

  23. “So in your mind, no orthopaedic surgeon will ever refer a patient if their pain doesn’t appear to be mechanical? All surgeons do is blindly cut open their patients?”

    Without CAMs as an option, yes this is malpractice.

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