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How “they” view “us”

Over the weekend, I was perusing my Google Alerts, along with various blogs and news websites, looking for my weekly topic, when I noticed a disturbance in the pseudoscience Force. It’s a phenomenon I’ve noticed many times before, but, as far as I can tell, I haven’t actually blogged about it here, at least not specifically, although I have mentioned it, particularly in posts about Stanislaw Burzynski. I have, however, blogged about it over at my not-so-super-secret other blog, which means that some of the thoughts (if you can call them that) that I plan to lay down in this post will likely seem familiar to some of you, but I think this is an important enough topic that I should cover it here, too. As arrogant as I might sometimes seem, even I’m not so deluded as to think that the fraction of SBM readers who are regulars at my not-so-super-secret other blog is anything greater than a clear minority, and even for those of you for whom there’s overlap I’ll try to make things different enough to be interesting.

On Friday, Sharon Hill published a post over at Doubtful News entitled Chiropractors get their spine out of place over critique. It’s about how chiropractors have reacted to a post by Steve Salzberg over at Forbes entitled New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors. Salzberg’s blog post was basically about just that, namely the amount of money billed Medicare by chiropractors, information that’s possible to obtain since the government released Medicare billing data for individual practitioners. Salzberg pointed out that half a billion dollars is a lot of money, more than twice as much as what is wasted every year on the National Center for Complementary and Alternative Medicine (NCCAM) and the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine (OCCAM). The result was rapid. Chiropractors swarmed, complaining to Forbes.com, and making the usual threats to sue, much as they actually did sue Simon Singh and, fortunately, saw their lawsuit blow up in their faces.

This, of course, can be looked upon as a purely mercenary protection of turf and livelihood not unlike how Daniel Kopans attacks any study that finds mammography to be less effective than thought (or even ineffective) in decreasing deaths from breast cancer. There is, however, a form of backlash against criticism of pseudoscience that is different and, when I first encountered it, more disturbing to deal with. It’s a level of pure, visceral hatred that is difficult to understand; that is, until you try to put yourself into your “enemy’s” shoes. Consider this post an exercise in doing just that, an exercise that will no doubt shock at least one of our readers.

How lots of “them” really view “us”

Those of us who dedicate considerable time and effort to combatting quackery generally do it because we think we’re doing good. Certainly, I wouldn’t spend so much time blogging the way I do, both here and at my not-so-super-secret other blog, if I didn’t think so. It’s true that I also enjoy it, but if I were doing this just for enjoyment I’m sure I could manage to find other topics that I could write about. In actuality, way back in deepest darkest beginnings of my blogging career, I did write about a lot of other things. My skeptical topics were more general in nature (rather like the way Steve Novella’s topics still are at NeuroLogica Blog), encompassing not just medicine but evolution versus “intelligent design” creationism, religion, Holocaust denial, history, and even the occasional foray into politics. Over time such diversions became rarer, to the point where I hardly ever write about topics other than medicine anymore, even at the not-so-super-secret other blog. I think that the reason for that is simple: It’s what I’m most passionate about, and I think it’s where I can do the most good. Like most bloggers supporting skepticism and, in particular, science-based medicine, I think of myself as doing my part to educate, hopefully in an entertaining fashion, and I’ve been rewarded with one of the more popular medical blogs out there and a small degree of notoriety. Indeed, I sometimes think of myself as a microcelebrity (or even nanocelebrity), because I have a little bit of fame, but it doesn’t really extend outside of the blogosphere. That’s fine with me, as it’s enough that occasionally a reporter will contact me for a quote about a story I’ve blogged about.

It’s often instructive, however, lest I become too smug or comfortable, to take note of how the “other side” thinks of those of us who try to promote SBM and, in doing so, educate the world about quackery. The way we think of ourselves does not resemble in any way what the quacks and antivaccinationists think of us. At some level this is not surprising. After all, any of us who’ve been at this for a while and managed to accumulate enough of an audience to be noticed by the “other side” will be subject to charges that we are “pharma shills,” hopelessly in the pay of big pharma. To the “other side,” obviously that must be why we do what we do, because we can’t possibly be doing this because we’re passionate about our beliefs. It’s such a common (and specious) attack that more than seven years ago I coined a term for it (at least I think I coined the term—I can’t find its use before my first post on it), the “pharma shill gambit,” a post I later appropriated for this very blog.

However, how we are seen by our opponents is much worse than mere specious allegations of undisclosed conflicts of interest, in which (apparently) nefarious drug companies are paying us to sit at our computers in our underwear turning out attack after attack on antivaccinationists and practitioners of “natural healing.” I was reminded of this last year perusing the various blogs and attacks written about those of us who have been so critical of Stanislaw Burzynski. As you recall, I’ve been very critical of Burzynski on a number of occasions for his peddling of ineffective “antineoplastons,” his promotion of what I have referred to as “personalized gene-targeted cancer therapy for dummies,” his playing fast and loose with human subjects protections in the numerous clinical trials he runs, and his arrogance of ignorance. Basically, I’ve made no secret of the fact that I view Burzynski as someone who is incompetent as an oncologist and highly unethical as a researcher who charges patients huge sums of money to be in his clinical trials that never seem to end up being published.

So, about a year ago, when I noted that a patient’s family that reported that apparently the FDA was in the process of auditing the Burzynski Clinic (an audit whose results we now know), that Burzynski hadn’t been able to use antineoplastons in children for a few months then, and that apparently he had also been banned from administering antineoplastons to adults as well. I kept the identity of the patient confidential, as did other bloggers writing about the family’s post. Not long after, however, I learned that the family had learned about how their post has leaked out. More importantly, I learned how they viewed those of us trying to report on Burzynski’s activities:

It has come to my attention that there are some uninvited guests following our posts about [REDACTED]. Even with all our progress and good news, anti-Burzynski weirdos find ways to take information I privately post and exploit it as negative criticism. I will be upping the security on our site and removing certain users from allowing access to our account. If I block you by mistake, please take a moment and send me a message. Friends, family, friends of friends.. you should know how to contact me. I will gladly add you back. If I have never met you, and you have good reason to follow our page, even if you are just curious about Burzynski and have come across our story, I will add you back if I can verify your intent is not malicious.

Yes, there are anti-Burzynski groups. Makes no sense to me why these people waste time and want to take away our freedoms. Fortunately, they only have each other and no one really cares about all the effort they put into creating articles and web pages and blabber. I never even heard of such people! I wonder if these cavemen even have iPhones yet, I’m surprised they can work the computer. I debated making [REDACTED]‘s page public, but I am not into exploiting my child, as these groups are into exploiting children and adults, mainly those who are no longer with us who happen to be patients of the clinic. What I have found in following some facebook pages of kids with terminal illnesses, it seems there are always those people that think they know everything and post really evil, heartless comments. Apparently, I’m not immune to this.

Please do not waste a second of your time trying to avenge are [sic] little hero and Dr. Burzynski. It really would do them great satisfaction to know that they rubbed someone the wrong way. Evil people feed off of aggravating others. Bad people have no place in our healing journey.

Yes, that’s right, and it might be jarring to some skeptics. In marked contrast to how I view most believers in pseudoscience and quackery, such as antivaccinationism or patients pursuing dubious cancer therapies, which is that they are wrong, that they’ve made a horrible mistake but I can to some extent understand it on the basis of human nature, believers such as Burzynski patients and their families view us skeptics as downright evil. To some extent, one can understand this. (Here’s where I try to put myself into their shoes.) These parents believe that Burzynski has either saved their child or loved one or is the only hope for their terminally ill relative to survive. They know they’ve made a decision that their doctors almost certainly tried to talk them out of. Rather than let in a modicum of doubt about that decision, it is easier to view those of us who are trying to combat the misinformation that is used to support the Burzynski Clinic and his activities as heartless monsters, enemies who are actively trying to prevent their children from being cured of cancer. And, yes, that is really how they view us.

Don’t believe me? Take a look at what Stanislaw Burzynski’s propagandist Eric Merola writes on his website about the “anti-Burzynski” bloggers:

Overall, you need to be able to think for yourself. Question everything, including me and this film. Feel free to verify all sources used for this film for yourself via the Sourced Transcript [link]. You will notice the “anti-Burzynski bloggers” refuse to do that or adhere to reputable sources. You might say, “they are preying on desperate cancer patients and families of cancer patients” by carelessly misleading their readers about Burzynski and his invention. This is a natural course of history when scientific innovation like this occurs, and is something that is to be expected. Never underestimate the irrationality of the human brain when it is confronted with something it doesn’t understand. These bloggers have an agenda, and are not open to rational discourse.

Our society is built on propaganda wars, and wars of information and disinformation. The fact that most people will basically believe anything they are told without bothering to find out if what they are told is true or not—makes them for easy prey, especially when they are dying of cancer. The writers of the “anti-Burzynski” bloggers know this—and take full advantage of this.

Of course, I did just that, going over Merola’s “sourced transcript” two and a half years ago in my original review of his movie. Be that as it may, notice the message being promoted. “Anti-Burzynski bloggers” are out there to keep you from being cured of cancer! They’re “preying on desperate cancer patients and families of cancer patients”! Why? Who knows? The best Merola can come up with is a variant of the Galileo Gambit, in which we skeptics apparently reflexively resist anything that’s different. It’s a common message among Burzynski supporters, having more recently shown up a Facebook post supporting McKenzie Lowe, whose parents were among those who successfully lobbied the FDA to allow a “compassionate use” exemption to let her receive antineoplastons, although the FDA did stipulate that it had to be a physician not associated with Burzynski administering the drug. In reality, if Burzynski had the goods, he could persuade us, which is why seeing Merola accuse us of “not being open to rational discourse” fried another one of my irony meters.

It’s not just Burzynski supporters, either. Antivaccine activists also believe that skeptics and supporters of SBM are out to get them. I don’t hide the fact that I sometimes amuse myself (and seek blogging material) by lurking in the comment sections after posts on antivaccine blogs. It doesn’t take much lurking in such corners of the blogosphere to discover that antivaccine activists really, really, really hate “science bloggers,” at least as much, if not more, than supporters of Burzynski. For example, take a look at some of the comments after this post on the antivaccine crank blog Age of Autism, epitomized by this one about “ScienceBloggers”:

They really go so out of their way (mounting hate campaigns like “ditchJenny” etc. etc. and this is why I honestly doubt their “Oh we’re not paid shills,” claims. Real, open minded science people wouldn’t be so militant and many scientists/doctors actually disagree with them anyways! Someone mentioned that most of them are either young, impressionable types or older has-beens who get off on bashing others with social media. The more that I think about it, they’re above all, bullies, not pro-science people. I have several friends with MS and it makes me sick as to how they malign anything to do with CCSVI (when MS drugs have killed SOOO many more people than angioplasty ever will) – I believe 3 people have died due to angioplasty- mostly due to having been given stents which they don’t even put in veins anymore. There’s a jerky journalist in our town who actually uses “Science” blogs as his source of information to write on health topics which is really scary (and lazy). It is beyond pathetic that grown up people waste time trying to prop up the status quo in healthcare when it is so obvious that there are serious questions that need to be asked and answered to do with vaccines and questions also to issues of MS cause and treatment.

Meanwhile, as if to give me more fodder just when I needed it, on this very blog in a comment after my post about the traditional Chinese herbal clinic at the Cleveland Clinic, Howard Wallach chastised me:

Thank God you rigid would-be totalitarians are losing the battle (in the US and Canada, anyway) to keep useful natural treatments and cures out of the hands of the general population! If you want to spend the hundreds of millions of dollars to perform studies that meet your satisfaction on hundreds of natural medicinals which have been used for millennia, go ahead and do it. You know darn well that few people are going to do so when there’s no huge financial gains to be made from non-patentable natural substances. I, personally, have had excellent, I would say tremendously successful results from Chinese and Tibetan medicine as well as Western neutriceuticals for a variety of conditions with nary a side effect. On the other hand I suffer permanent shoulder tendon damage from a fluoroquinolone and chronic gastritis from a prescription NSAID. I wish you every failure in your despicable cause.

Yes, as I said before, they really, really, really do hate us. They view us as The Enemy, evil people who are actively trying to keep them from healing their children of autism, every bit as much as the parents of Burzynski patients view us as actively wanting to kill their children by preventing them from being treated by the Savior Burzynski, or Mr. Wallach apparently views us as wanting to keep him from his health-preserving herbal remedies. It is an attitude and view that is actively promoted by Wakefield and his ilk, as well as their supporters, the way Eric Merola tries to whip up paranoia about what he calls “anti-Burzynski bloggers.” Indeed, it’s become a major meme in antivaccine circles to attack supporters of SBM who defend vaccine science and refute antivaccine pseudoscience as “bullies” and to characterize posts and articles that criticize antivaccine beliefs and activists as “hate speech.” In particular, antivaccine activists are unhappy that over the last couple of years the mainstream media appears to have started to figure out that, while “telling both sides of the story” is a good policy for politics and many other subjects, it’s not a good policy for stories about science and medicine in which one side is supported by massive evidence from multiple disciplines that all converges on a single conclusion, and the other side consists of pseudoscience and quackery. In other words, what Dara O’Briain describes in his immortal comedy bit appears to be becoming less common than it was, and antivaccinationists don’t like it.

We have to remember that, contrary to the way that we view most of the militant supporters of quackery, which is mistaken, wrong, misled by a combination of normal human cognitive characteristics such as confirmation bias and characteristics of disease such a placebo effects and regression to the mean, supporters of pseudoscience having to do with medicine not-infrequently view those of us who argue for SBM as not just wrong, but as vile, contemptible, less than human pharma shills who are out to prevent The Truth from being revealed to The People. To many of them, we are actively out to prevent lives from being saved or autistic children from being “recovered” by “autism biomed” based largely on the idea that vaccines cause autism That’s also why, like Burzynski patients, antivaccinationist go into full attack mode whenever there is criticism of their heroes, in particular Andrew Wakefield. One can’t help but remember a particularly telling quote about Wakefield from a story about the antivaccine movement three years ago. The quote came from J.B. Handley, founder of the antivaccine group now led by Jenny McCarthy, Generation Rescue, in a New York Times story: “To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one. He’s a symbol of how all of us feel.”

Handley’s choice of words was very telling, and the implication clear: To him, attacking Andrew Wakefield is akin to attacking Jesus Christ or Nelson Mandela. If you’re a Christian, how do you react to people who attack Jesus Christ? Not favorably, that’s for sure. What do you call such people? Infidels, heretics, apostates, atheists, that’s what. To people like J.B. Handley, these practitioners of antivaccine pseudoscience represent hope, and to attack them is to attack not just their beliefs but to attack hope itself. We have to remember that criticism of people like Wakefield or Burzynski only serves drive their worshipers closer. However, it is not their worshipers at whom I’m targeting my message, as I’ll discuss at the end.

Now “we” are “holocaust deniers” and “dirty rotten scoundrels”

“They” really do believe that “we” (i.e., skeptics and supporters of science-based medicine who criticize the various modalities they passionately believe in) are not just wrong, but downright evil. To some of them we are promoting a “vaccine-autism Holocaust.” If you don’t believe me that antivaccinationists not infrequently use this term, Google “vaccine autism Holocaust.” You’ll find posts lamenting this risibly hateful meme, but you’ll also find examples of antivaccinationists using just this meme. Indeed, one parent has even stated:

For me, the denial that there is an autism epidemic is the medical equivalent of denial of the holocaust. In the spirit of protecting the vaccine industry from any linkage to autism, the pro-vax side not only denies that vaccines may be linked to autism but denies that there even is an autism epidemic.

That’s right. If you accept science and medicine, along with all the evidence that has failed to find a correlation between vaccines and autism, you’re the equivalent of David Irving, a Holocaust denier. Or worse. In the comments at the antivaccine propaganda blog Age of Autism I found a real gem about the 1977 swine flu vaccine campaign, right after this post:

None of us understood that the people behind the swine flu vaccine fiasco were criminals who were experimenting on the public just like the Nazis.

To antivaccinationists, not only are supporters of vaccine programs just like Holocaust deniers, but they’re the equivalent of Nazi doctors carrying out horrific experiments on concentration camp prisoners. It only makes sense, of course. Holocaust deniers are almost always Hitler admirers or Nazi sympathizers; so it’s only a small step to go from calling someone a Holocaust denier to calling him a Nazi.

Visions of pro-vaccine Nazis dancing in antivaccinationists’ heads aside, it didn’t take long for me to become aware of one more example of just how evil antivaccinationists think “we” are. It comes from Mama Mac at the Thinking Mom’s Revolution in the form of a post entitled Dirty. Rotten. Scoundrels. Mama Mac’s post consists of a list of people that she views as pure evil (or as “dirty rotten scoundrels).

Be that as it may, with one exception, the fourteen people listed as, apparently, “dirty rotten vaccine scoundrels” by Mama Mac are in actuality generally admirable people. We’ll dismiss one actual scoundrel first: Poul Thorsen. Antivaccinationists really, really like Poul Thorsen, not because he participated in (not ran) the Danish studies that failed to find a link between either the MMR vaccine or thimerosal in vaccines and autism. Thorsen, it turns out, has been accused of misappropriation and misuse of U.S. federal government grant money, and about a year ago the antivaccine movement went wild, trying to use the Thorsen case to distract from the inconvenient science that does not support their case. He was a convenient bogeyman, and they labored mightily to hold him up as “proof” that the Danish studies were hopelessly tainted by his fraud. Of course, even if Thorsen is guilty, that doesn’t invalidate the Danish studies, as he was a “middle of the pack” author. Moreover, there’s a lot more evidence out there than the Danish studies that support the safety of the vaccine program and the lack of correlation between vaccines and the dire outcomes antivaccinationists attribute to them. Even if the Danish studies were hopelessly tainted, it would not alter the scientific consensus, because the Danish studies are not the be-all and end-all of vaccine safety studies. They are just, to quote a cliché, another scientific brick in the wall supporting the safety of vaccines. In any case, if Thorsen is guilty, he really is a dirty, rotten scoundrel and should be locked up for a long time if convicted. He is not, however, a dirty rotten scoundrel who is the face of the vaccine program, as much as antivaccinationists stretch to try to convince you that he is.

The rest of Mama Mac’s list includes people who are, for the most part, people I admire: Paul Offit (of course!) is there, because to antivaccinationists like Mama Mac he is Sauron, Darth Vader, Voldemort, Hitler, Stalin, and Pol Pot all rolled up into one. Why? Because he invented a vaccine for rotavirus that has saved lives and prevented suffering, and for that he is considered pure evil. For his contribution and (more directly) for his unflagging promotion of vaccines and his willingness to call the nonsense promoted by antivaccinationists exactly what it is, nonsense, he’s been subjected to the vilest attacks and slander at the hands of the antivaccine movement. It’s not surprising that on a couple of occasions the pressure got to him a bit, and he lost his cool. I only wonder at how he could have kept his cool for so long, given what he’s put up with. Bill Gates is also there, of course. Since he retired from the active management of Microsoft and dedicated his great wealth to philanthropy he’s become another Dark Lord of Vaccination, mainly because a large focus of the Gates Foundation’s work has been to promote vaccination campaigns in Third World countries as a means of promoting health and ending the scourge of preventable disease and death there. He also has no patience for the nonsense of the antivaccine movement, which is a plus.

It’s hard not to conclude that “they” see “us” as narcissistic, lacking compassion, corrupt, and, yes, downright evil. Is it any wonder that they would come to the conclusion that virtually any tactic is justifiable in their crusade against medical science? It’s not hard to find similar quotes elsewhere about topics other than vaccines or Stanislaw Burzynski, either. Indeed, if you can stand the craziness and hostility, just wander on over to Patrick “Tim” Bolen’s website, and you’ll see even more hostile language directed at skeptics over not just vaccines, but cancer therapies, alternative medicine, supplements, and pretty much any other quackery you can think of. This hostility, this “us versus them” attitude is a feature, not a bug. Whipping it up is how quacks keep their supporters enthusiastic and how they continue to sell useless products. We’re not likely to penetrate such tribalism or to change the mind of people like Mama Mac, although on rare occasions we can.

What “our” real targets should be

When blogging about SBM versus quackery, my target is not people like J.B. Handley, Mama Mac, the bloggers at AoA or The Thinking Moms’ Revolution, or Eric Merola. These people are the very people who believe that I am an evil person hopelessly in the thrall of big pharma, which rewards me richly for crushing their hopes. (If that’s the case, I ask: Where is all that filthy lucre? Where is my Maserati? Where is my yacht? Where is my private jet? As an academic surgeon, I make a comfortable living and can afford a nice house and car, but that’s about it.) Speaking of filthy lucre, it’s also absolutely critical to distinguish between the reasons “they” attack “us.” If it’s a bunch of chiropractors protecting their turf, as far as I’m concerned, the gloves are off, and they’re fair game. Ditto if we’re talking about Stanislaw Burzynski or his propagandist Eric Merola. On the other hand, if it’s the desperate parents of a child with a terminal brain tumor or the terrified husband of a woman dying of a brain tumor, who are clinging to Burzynski as the only hope of saving her child, a much gentler approach is called for.

In any event, it’s far more important to get the fence-sitters and make sure good science-based information is out there for them. I also use a variety of techniques, ranging from the more—shall we say?—”insolent” to more dispassionate discussions of science, and everything in between. True, I do tend to lean more towards the more sarcastic end of the spectrum (which is why I admire Mark Crislip’s tone and posts so much), but, to be honest, I used to be a lot snarkier and nastier, no matter how much it might be hard for one of our readers to believe. (Go back and read some posts from around 2005-2008 at my not-so-secret other blog, if you don’t believe me.)

None of the backlash from believers in quackery should, however, deter us from deconstructing their icons. Andrew Wakefield, for example, has done great harm, and as a cancer doctor and researcher I simply can’t abide Burzynski’s activities—and rightly so, in my opinion. Certainly, I’ve never pulled any punches. On the other hand, we do have to remember who are targets are and what our goals are. I have no expectation that I will ever be able to convince someone like the parents whom I quoted at the beginning of this article, and there’s only about the same chance of active substance remaining in a 30C homeopathic remedy as there is of my persuading Eric Merola that his hagiographies of Stanislaw Burzynski are misguided, misinformation-packed propagandistic nonsense or that I don’t have a hidden tail and horns. Occasionally, I actually do get through to such people, but it’s so infrequent that I can’t count on it. My goal is instead to put science-based information out there, so that the fence sitters and undecided can encounter it. If the occasional true believer listens, then I’ve done far better than I would ever expect.

In the meantime, I don’t make the mistake of thinking that in return for my efforts I will ever receive anything but hatred and contempt from the “other” side. I’ve tried to put myself in the shoes of parents who have a dying child and believe that Stanislaw Burzynski can save him, parents who believe passionately that vaccines caused their child’s autism and that only “biomed” treatments can “recover” him, and even of people like Mr. Wallach, who passionately believe that whatever herbs he’s taking are responsible for his doing well right now. That’s why I know that I’ll almost certainly never change their minds, which just makes those all-too-uncommon occasions when I receive e-mails from former believers in quackery telling me that I started or contributed to the process of their rejecting pseudoscience and quackery that much more sweet. We at SBM do, however, have a hope of persuading the fence-sitters, and so do you—at least, as long as we remember always to ask ourselves Are we the baddies? and to remain able to answer honestly that we are not.

Posted in: Cancer, Chiropractic, Critical Thinking, Genetically modified organisms (GMOs), Science and the Media, Vaccines

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127 thoughts on “How “they” view “us”

  1. If Meryl Dorey and her cabal of conspiracy theorists think I am evil, and they really, really hate me; I’ll sleep well every single night for the rest of my life.

    “I never have and never will harass or hurt a grieving parent” – Meryl Dorey:
    http://reasonablehank.com/2013/05/26/i-never-have-and-never-will-harass-or-hurt-a-grieving-parent-meryl-dorey/

    “Shaken Maybe Syndrome”:
    http://reasonablehank.com/2012/02/11/shaken-maybe-syndrome/

    1. Guy Chapman says:

      Wasn’t it Wallace Sampson who coined the term “sectarian medicine”? The most bizarre thing about these cranks is that they will support each other uncritically. Today, Merola is shilling his interview with Ralph Moss. Moss promotes laetrile, Merola shills for Burzynski. These are two mutually inconsistent One True Cures, but they both agree on who the true enemy is: science.

      The AVN is a nexus for chiroquacktors, homeoquacks, naturopaths, all kinds of loons. They all carefully tapdance around the mutually exclusive doctrines of their religions in order to fight the True Enemy: medicine.

      It would be fascinating to see what happened if these quacks ever had to defend their own ideas against their fellow travellers, rather than joining together in attacking science.

  2. Guy Chapman says:

    In fact, David, you are still blogging about religion, it’s just a different religion. These are True Believers. You are assaulting their faith head on. Many of them do not believe the rules of scientific evidence apply – homeopathists, for example, think they are exploiting profound truths unknown to science.

    Patients of Burzynski especially will suffer massive cognitive dissonance because they have literally invested everything in their belief. This is the medical equivalent of the Rapture believer who has given everything to charity and pitched up on a mountain top on the appointed day.

    And then there’s the real vested interests, like chiropractors. They make so much money selling worhtless maintenance adjustments that of course they have to push back against anybody who points out that the Emperor is actually naked.

    We understand fallacious reasoning, cognitive errors and the like. We should (and generally I think do) treat patients with compassion and hucksters without mercy.

  3. Andrey Pavlov says:

    If it’s a bunch of chiropractors protecting their turf, as far as I’m concerned, the gloves are off, and they’re fair game. Ditto if we’re talking about Stanislaw Burzynski or his propagandist Eric Merola. On the other hand, if it’s the desperate parents of a child with a terminal brain tumor or the terrified husband of a woman dying of a brain tumor, who are clinging to Burzynski as the only hope of saving her child, a much gentler approach is called for.

    I’ve said the same thing, many times (in so many words), and one commenter here has felt that is duplicitous or hypocritical, belying an inconsistent stance on the matter. I predict that same said commenter will pop up here and somehow manage to bluster out a response that both denies and endorses this in a comment rife with nebulous language.

    But anyways, an anecdote, a personal one in fact since I feel it apropos to this post (shortened and without some detail).

    My mother last year told me that my grandmother (her mother) was getting cold-called by hucksters trying to sell her sCAMs for her diabetes and she didn’t know what to do about it. She said she was pretty sure that it was crap, but didn’t know and didn’t know how to find out or even if she did to be able to explain it. I reminded her that this sort of thing is precisely what SBM is all about. In the past, she was actually more on the negative side of things regarding SBM and my own vocal opposition to quackery and woo (e.g. I came home and found a homeopathic placenta based weight loss “supplement” in her kitchen drawer – talk about mixing all the woo you can! – and was dismissive and told her to stop wasting her money). Think “The Skeptic in the Room“. Anyways, fast forward to this chat and I am explaining it to her a bit more. I reminded her that she buys and uses Consumer Reports to inform her decisions on all sorts of things, so why wouldn’t she do the same thing for health and medical claims? Her response? “There is nothing like that out there!” And I explained that, in a very real way, that is what SBM is – like a consumer reports for medical claims. I pulled out my laptop and showed her my own posts here as well as others and she was impressed. Then, being my ever-critical (in a good way that has always been supportive and pushes me to excel) mother she said, “Well… you guys need to be more well known! And recognized! And used!” Since then, I’ve noticed when I go home to visit that the random smattering of things like that homeopathic placenta garbage are no longer in the house.

    But she also makes a good point. One we here are all aware of – we (in the royal sense of medical skeptics) are still just a small voice in a giant stadium of woo-peddlers and quacks. And the fact that there are some who hold our same professional station (Weil, et al) that endorse such woo and quackery is a huge obstacle. One we are slowly, but surely, overcoming. But our presence is growing. Our voice is growing. I just read the Friends of Science in Medicine newsletter (I am an individual member, along with a number of professors from my med school alma mater) and they are making truly excellent headway. Turning the fence sitters and motivating the shruggies is paramount.

    My point is to hearten us to soldier on. Things are slow until critical mass is reached. We aren’t quite there yet. But the surest way to make sure we are successfully ignored is to be the quiet, cowed, overly polite voice in that stadium tugging at the shirt of the woo-meisters asking kindly for our turn to speak. Of course patients and their families deserve our compassion, deserve a different tack, and different circumstances (particularly individual ones) warrant a softer approach. But our larger voice should be unbending, uncompromising, and clear without mincing words. In the game of getting heard, the quiet wallflower loses. The person who unabashedly states the plain truth – that quackery is quackery and woo is woo – gets noticed. Getting those True Believers riled up is the proper strategy. Being in the public spotlight, however much we can as a group and individually, to explain why we are so “strident” in fact furthers our cause. Being in a position to flat out call Chopra a quack or the CCF herbalism center what it really is affords the opportunity to have people actually look at the issues critically. We cannot and do not force our ideas on others, but we should position ourselves to make those ideas heard and be clear that not only are our ideas good (and for good reasons) but that the other ideas are bad.

    Superficially that can come across similar to a political smear campaign. It can trip that pattern recognition switch, and we should also be aware of that to proactively and pre-emptively defuse that perception as best we can. But we have the benefit of it not actually being a smear campaign (rather it is we who are, in fact, at the brunt of smear campaigns in many cases).

    One thing I personally cannot countenance is trying to lure in the unsuspecting masses with sugary platitudes and blind-eye tolerance of woo in some benighted attempt to somehow get people to “trust” us before gently steering them away from pseudoscientific bunkum. That is not only paternalistic, but duplicitous in the highest order and, I argue, a failing proposition.

    1. Frederick says:

      Dr. Gorsky Did a Excellent Post, and I think you comment also deserve a thump up. I totally Agree with you. ( you post are excellent all the time, of course I don,t read them all there is some much to read In here, time is not infinite :-) ). ( I also think you should be a guest writer here, In fact a lot of followers should)

      We have to be soft with the desperate people, it will blaming the victims. Of course if those people become active promoters of Quackery they might be in the fire fight, but we have to be careful. But the real quack, I think you should not be as kind with them. Guys like Wakefield, not only are dangerous ( I my opinions he should have end up in prisons as much as any person who have done a fraud), they are really bad, Wakefield know he is lying, We all know here that he did it for the money, ( 55 000 paid by the lawyers, and he plan to sell his own vaccine, making millions) same with Burzynski. They are as criminal as a man stealing money from peoples with miraculous investments ( no risk/side effect, they don’t want you to know about it! ) turning out to be Ponzi Schemes.

      I have some friends you are into woo, but I can’t discuss that with them, they are passionate about it, and I’m too passionate myself, it’s always endung badly. I’m not the best in those situation. Other friends are fence sitters, they don’t believe in quacks, But they have a friend who his a Chiro, so they automatically go see her for back pain, and because she’s a friend ( she also kind of my friends) they don’t really even doubt about Chiropractors. And I really don’t want to make a fuzz about it, fearing of losing friends. It is hard to be the Skeptic in the rooms.

      1. Andrey Pavlov says:

        <blockquote. and I think you comment also deserve a thump up. I totally Agree with you. ( you post are excellent all the time, of course I don,t read them all there is some much to read In here, time is not infinite :-) )

        Thank you for the kind words. I have actually posted a couple of times here and here. I keep saying one of these days I’ll be more regular in posting up, and I will, but it just hasn’t happened yet. It’s been a strange limbo time for me, but once I get settled back into a groove and have a routine I tend to be more productive. Ideally, I’d like to put out more frequent posts and I have some ideas queued up for it when I do get around to it.

        1. Thor says:

          I’m with Frederick, as you already know Andrey.
          I, for one, am still waiting for the long-ago “promised” debate/discussion between you and WLU on routine infant male circumcision, ha! (I can almost see and feel the face-palming and eye-rolling—”Just what we need another session of quatsch on circumcision”.) Hey, I’m just the reminderer;
          it wasn’t my idea. But, I think it’s a good one, pertinent to SBM and perhaps of interest to future parents of sons. At the least it would be entertaining
          (if perhaps potentially heated).

          1. Andrey Pavlov says:

            Much too kind Thor.

            As for that debate… oof. LOL.

            I think it was laid out reasonably well before and I see producing much more heat than light. And ultimately it boils down to subjective value judgments. My only argument is that to be fully consistent one must abjure routine circumcision. The entirety of my argument would be hinged on that – trying to demonstrate that it is inconsistent with the rest of our (me and WLU) shared beliefs to give a pass to circs.

            Plus…. it is low on my priority list. In the next 2 months I am looking to buy a house, a car, travel back to California, then to Costa Rica, then to Chicago, and begin my residency.

            Yes. I’m satisfied with those excuses ;-)

            1. Windriven says:

              Andrey, I really think you are right to peel back the the circumcision issue and lop off the excess chatter. Each time the subject arises. swollen tempers emerge.

              1. Chris says:

                Groan…

              2. Andrey Pavlov says:

                You’re on a roll windriven…

                (I do appreciate puns though. particularly very bad ones. I am infamous for my own in social circles)

              3. Windriven says:

                @Chris

                “Groan…”

                Andrey started it on a cannabis related thread. Like a twelve year old, I can’t let it go.

              4. Thor says:

                Four for four in this one! You are rolling, LOL. You may be in the wrong profession.

            2. Thor says:

              I hear you, and was sort of pulling your leg.
              Agreed on the consistency argument. Not to pursue the issue, I do think, though, that the argument comes down to if there is, in fact, objective, medical, evidence for a basis of a value judgment.

              Anyway, you go, kiddo! I wish you success in your upcoming plans.
              Many of us will enjoy a future guest post, when the time comes.

              1. Andrey Pavlov says:

                I do think, though, that the argument comes down to if there is, in fact, objective, medical, evidence for a basis of a value judgment.

                As Dr. Hall has pointed out, the objective medical evidence shows that there are no real benefits to (routine) circs that cannot be achieved through other means. And even then those benefits are small. There are real medical indications for circs (e.g. hypospadias, severe phimosis) but those are distinguished from routine, and I have no issue with those.

                The value judgment is – how much “harm” arises from permanently altering the body of someone unable to consent? Are earrings OK? What about tattoos? What about a Prince Albert (google it, NSFW)? I think that to be entirely consistent all of these practices should be no-noes. However, I’m much less ruffled about ear piercings, and much more ruffled about tattoos and Prince Albert’s. So that is what WLU and I would be arguing about – where is that inflection point? I would be more apathetic about ear piercings, he feels the same about circs. I believe I have good reasons for that, but really it is all a continuum.

                Anyway, you go, kiddo! I wish you success in your upcoming plans.

                Thank you kindly. It is strange to be a “grown up.” LOL. After a day of house hunting or doing other “adult” things, my lovely and I feel we need to maintain our inner child and will often eat sugary cereal for dinner and play video games to provide balance :-P

                And then we will be baffled at each other that I get to stick large tubes into people’s hearts via the jugular and she gets to do analyses and designs that dictate how the next $20 million of NASA’s budget will be spent. And both of us make decisions where people’s lives hang in the balance (I more directly than she). And then we drink beer and play more video games. Or watch cartoons.

                Many of us will enjoy a future guest post, when the time comes.

                Once again, thank you. I will endeavor to make it so, most probably starting late summer, though who knows what will be going on then! I have the utmost admiration for the regular contributors here who balance being attendings, researchers, teachers, having families, etc with regular offerings here.

          2. WilliamLawrenceUtridge says:

            I, for one, am still waiting for the long-ago “promised” debate/discussion between you and WLU on routine infant male circumcision

            I won. Cut cock tastes better*, end of discussion. All of the other factors are irrelevant as the appearance of harms and benefits are so low they can be essentially discounted.

            *Direct quote from Dan Savage, I take no credit – merely glee that I get to repeat it as often as I do.

            1. Andrey Pavlov says:

              I won. Cut cock tastes better*, end of discussion

              [citation needed] :-P

              All of the other factors are irrelevant as the appearance of harms and benefits are so low they can be essentially discounted.

              Here I almost agree. A fine point and mostly academic, resting primarily on principle. My distaste* lays primarily with the fact that pretty much the only reason it is routine, the only reason you can quote Dan Savage, is because BS religious practices made it so. Go to Europe and you will find that the women there find cut cocks to be strange. And I simply don’t agree with a permanent procedure, typically done without anesthesia (though at least that is slowly changing), purely on religiocultural whims.

              I am torn about the idea of preventing it across the board, thus banning Jews from doing it. On the one hand it is for BS magical reasons. On the other, it is a deeply rooted sociocultural practice, the banning of which would cause real and genuine mental anguish, which is a real harm that must be considered. The AAP’s stance is probably best, pragmatically, though academically I would be all for an outright ban (as they attempted to do in Germany not too long ago; that went over well).

              As I said before – how many uncut men will sign up for it at the age of majority? Mel Brooks illustrated the point nicely.

              Ultimately, in this case, I think I won the academic argument, but that pragmatically it makes more sense to let it die a natural death as religion and superstition go the way of the dodo. In the meantime, I will be content to voice my opposition when solicited (rather than going to rallies or otherwise seeking out fora to announce my views) and debunk or properly contextualize medical myths and stats about the benefits when necessary.

              And there I’ve gone and done exactly what I said I wouldn’t.

              *yes, I said it.

              1. Windriven says:

                Mmmmm, smegma. Tasty!

              2. Andrey Pavlov says:

                Mmmmm, smegma. Tasty!

                If you’ve got smegma, you’re doing it wrong. I never have and am happy to say I’ve never had a single part of my body removed.

              3. Windriven says:

                Not a problem for me Andrey, I’m in the other camp.

              4. WilliamLawrenceUtridge says:

                Not a problem for me Andrey, I’m in the other camp.

                And how does it tas-

                Never mind.

              5. Andrey Pavlov says:

                Not a problem for me Andrey, I’m in the other camp.

                Just seems to me rather… excessive as a means to an end which a minimal amount of soap and water will take care of handily. Like chopping off your nose because boogers build up in it rather than just blowing your nose periodically.

              6. Thor says:

                Yes, you have. Like a kid in a candy store. And we even got WLU to chime in (geez, I wonder how often he gets to say that).
                There, now we can put that “project” to rest (at least until it raises its head again).

              7. Andrey Pavlov says:

                at least until it raises its head again).

                Ba-dum-psshh

              8. Windriven says:

                @WLU

                “And how does it tas-

                Never mind.”

                I was going to give you a smart answer invoking various women in my life and delusions of grandeur but we’ve probably already found the edge of the abyss ;-)

        2. Frederick says:

          Cool, i have not notice, I did start reading this blog in 2013, That why i haven’t notice.
          I will have to read at those article.
          thanks.

          1. Andrey Pavlov says:

            Pas de problème, mon ami.

            Et oui, dans le passé, je parlais français presque couramment et sans accent, mais je suis maintenant très à la pratique.

            1. Frederick says:

              Wow, c’est excellent! Il y a que la dernière phrase qui manque quelque chose, Ça devrait être quelque chose comme : Mais maintenant je manque de pratique ( Well I guess you meant that you didn’t have much occasion to use it lately ? )

              1. Andrey Pavlov says:

                Well I guess you meant that you didn’t have much occasion to use it lately ?

                Yes, precisely. I spent a few months in France many years back and by the end of it I had no difficulties speaking, without an accent, and without fumbling for words or getting my conjugations right. I was also much more facile with idiomatic phrases.

                These days, it is only in tiny snippets that I speak French. So purely because I have not practiced it (essentially at all) in many years, it has become very rusty. If I were to go back to a French speaking country for a month or two, I am certain it would come back. It was actually my 4th language, right after English, and I spoke it routinely by the age of 7 or 8. So it is buried in there somewhere. Which is why I end up translating more directly in my head, leading to convoluted sentences like the one above, when yours is much more simple and direct. J’ai simplement oublier le mot “manque.” And forget about the more difficult conjugations. LOL.

              2. Frederick says:

                Lol Well french is hard language to write, It is my mother tongue and I make a lot of mistakes myself, Languages is not my best skills, I’m more in science and Tech head ( I studying networking and electronic).

    2. MTDoc says:

      Just an aside on Consumer Reports supplement publication On Health. I found this publication very disappointing, often suggesting such things as acupuncture “may be helpful”. This is a foot in the door which just lends credibility to more woo. Anyway, CU needs to be more science based when it deals with medicine. As for me, I’m even a little more critical of their product evaluations, now that they opine about something I do know about.

      1. Andrey Pavlov says:

        Just an aside on Consumer Reports supplement publication On Health. I found this publication very disappointing, often suggesting such things as acupuncture “may be helpful”

        I see that as a symptom of the fact that biology and medicine are messy, whereas crash tests and engineering are much more clear cut. That’s where SBM comes in and gives us the tools to cut the BS and be more critical and confident.

    3. CHotel says:

      I consider the fact that Mr. Oz no longer appears on the TV at my parents’ house a great personal accomplishment. I’m not sure how I would classify my mother, she seems to agree with me on what is bullshit and what isn’t, but doesn’t understand why I get so upset when I see that quack on the TV or a copy of Wheat Belly that she borrowed from the library on the coffee table. An informational-shruggie, I suppose.

      1. The Dave says:

        After quitting my physical labor job to start pharmacy school, I’ve put on significant wait which exacerbated some long-standing GERD to the point H2RA’s prn were no longer sufficient and I needed a daily PPI. My MD recommended the Wheat Belly book to help me lose wait and I never went back: when it was time more refills for my prescription, I found a different doc.

  4. Sue says:

    I agree with your distinction between desperate parents or patients (who deserve our empathy and understanding) and the people who take advantage of these vulnerable people (for whom gloves should be off).

    Many parents of children with disabilities or developmental issues appear to blame vaccination and Big Pharma/Big Medicine/Government as a way of coping with their distress and creating an external locus of blame. It is understandable that they might hate the people who seek to demolish these coping mechanisms.

    Those who take advantage of these vulnerable families stand to gain in either financially, by respect or reputation, or all of these. They also hate the people who seek to demolish their status. It is this group we should have no hesitation in opposing.

    1. Badly Shaved Monkey says:

      Many parents of children with disabilities or developmental issues appear to blame vaccination and Big Pharma/Big Medicine/Government as a way of coping with their distress and creating an external locus of blame. It is understandable that they might hate the people who seek to demolish these coping mechanisms.

      The real dilemma arises when those distressed patients and their families become ardent advocates for the woo-du-jour. it is very easy for them to play the “don’t touch me I’m hurting” trump-card if one aims even the mildest criticism at their beliefs. It is this that makes them such effective human shields. Well, they’re more like Explosive Reactive Armour than simple shields.

  5. The Dave says:

    A couple months ago, my current state legislature was debating whether or not to legalize cannabis oil to treat kids with epilepsy. The FB page for the local news station asked a survey question whether its viewers thought it should be legalized. I made one comment about how I disapproved because not enough evidence of safety and efficacy and the entire comment section turned into a full on assault on me, calling me every name in the book, telling me to watch various youtube videos, asking where I work so they can avoid me, etc. etc. ad infinitum, ad nauseum.

    The other day, I noticed a twitter conversation between Scott Gavura and a “true believer” about cannabis oil to cure cancer. I briefly chimed in and mentioned (in 140 characters or less) my experience above. The “true believer” asked why I tried to speak out against cannabis oil, to which I responded not enough evidence of efficacy and benefit does not outweigh the risk. I was then immediately attacked and called a moron by a twitter handle “cure.your.own.cancer”. It was kinda shocking, but not surprising.

    1. goodnightirene says:

      I have had very similar responses whenever posting any science-based response to “health” articles at the NY Times. I get a lot of “you need to educate yourself” which I find particularly ironic.

      I have also written most of the contributors here at SBM asking one of them to address this whole pot for epilepsy issue as it keeps coming up in any discussion of pseudoscience/medicine and I don’t know how to argue anything other than what you mention–the lack of tested safety. Even some of my family (who are very skeptic-oriented) are wondering about this one. Does anyone have any links to share?

      1. Andrey Pavlov says:

        I have also written most of the contributors here at SBM asking one of them to address this whole pot for epilepsy issue as it keeps coming up in any discussion of pseudoscience/medicine and I don’t know how to argue anything other than what you mention–the lack of tested safety. Even some of my family (who are very skeptic-oriented) are wondering about this one. Does anyone have any links to share?

        MadisonMD and I had a… hash-out on the topic in the comments a couple weeks ago or so. I think we would both agree that there is a paucity of evidence to really say. It is not implausible, but not demonstrated, with no real ability to tell who would be able to benefit (not only which type of epilepsy, but also which individual with a specific type of epilepsy). Plus the side effects. Most people, particularly those naive, don’t like being stoned all day. To my knowledge there is no synthetic version with minimized side effects that has demonstrated any efficacy (primarily a paucity of studies, rather than studies showing a lack of efficacy). There are at least a couple of case studies showing benefit in intractable cases, but that is probably the strongest evidence out there (and that ain’t very strong).

        The flipside is that there is also a documented entity of “cannabis induced psychosis” which is not particularly well characterized and is likely comprised of precipitating psychosis in individuals with a predisposition as well as idiosyncratic reactions (cannabis induced hyperemesis is a thing as well). By no stretch of the imagination can it even be thought that cannabis in any form would be a panacea for any condition, including epilepsy.

        One thing that is reasonably well demonstrated is the relative safety of cannabis, such that I think the best anyone can reasonably say is that it is a plausible but unstudied option which might be appropriate to try in certain extreme cases as a last resort option. Worst case scenario is it does nothing of value and is discontinued. All the usual caveats apply, of course (should be studied in a controlled setting, individual use can be confounded by many things and should not be extrapolated to general efficacy claims, etc).

        Personally, I would speculate that while possible that there may be a role for cannabis in certain subsets of epilepsy, I do not envision it would have a large role nor do I think it would be anything more than end-of-the-line therapy for intractable cases (at best). However, rigorous pharmacognostic study of the myriad compounds and a better understanding of their effect on the brain could prove fruitful for drug discovery in the long term (and I stress could).

        Which is a really long-winded and hifalutin way of shrugging the shoulders. We just don’t know, but all the standard prior plausibilities and caveats of any untested pharmacognosy apply, with arguably a slightly higher prior probability since we know this particular plant is at least highly psychoactive (unlike, say, echinacea which does a whole lotta nuthin’).

        I’m sure Dr. Gorski will post up his take on the matter in due time.

        Squirrel!

        1. CHotel says:

          “MadisonMD and I had a… hash-out on the topic ”

          So it was a… joint effort?

          1. Andrey Pavlov says:

            So it was a… joint effort?

            I must admit that I did not appreciate the ramifications of my word choice at the time, as obvious as it was in retrospect.

  6. Teri says:

    Apologies as I’m not sure where to ask this, but this blog has been pretty instrumental in turning me away from biomed treatments for my son’s autism. (I even did GAPS!) Whenever I see an anti-vaccine or pro-alternative medicine sentiment pop up on facebook, I usually search here to get the science-based take.

    However I can’t find a skeptical viewpoint on something called “ASIA” (here or on pubmed): http://www.ncbi.nlm.nih.gov/pubmed/20708902 . Is this a real thing?

    It’s spawning articles like this one that are facebook-shareable friendly: http://healthimpactnews.com/2014/a-new-autoimmunity-syndrome-linked-to-aluminum-in-vaccines/ .

    Thanks in advance,
    Teri

    1. janerella says:

      From the RI blog : http://scienceblogs.com/insolence/2013/08/09/antivaccinationists-against-the-hpv-vaccine-round-5000/

      “….an entity called ASIA (Autoimmune/Inflammatory Syndrome Induced by Adjuvants). From what I’ve been able to tell, ASIA is basically a made-up syndrome that isn’t generally accepted….Even more dubious are the clinical criteria, four major and four minor, that are used to “diagnose” ASIA. The idea is that either two major criteria or one major and two minor criteria are required for a diagnosis of ASIA. Out of curiosity, I went back to what appears to be the original article in which ASIA was defined by Yehuda Shoenfeld, who is known for testifying for “vaccine injury” victims and running a journal sympathetic to antivaccine views, even publishing works by quacks like Mark and David Geier. The “syndrome” appears to have been made up of whole cloth based on unfounded assumptions.”

      1. Chris says:

        Isn’t that similar to the guys in France that claimed they discovered some horrible side affect from aluminum adjuvants, that they named with some fancy Latinized name?

        Though when you read the papers, it just turned out they discovered vaccines can give you a sore arm.

    2. WilliamLawrenceUtridge says:

      If you look at the conditions for which ASIA is supposed to be a factor, they tend to be vague, controversial and “quacky” for lack of a better term:

      - siliconosis (“breast implants are bad” I believe, but while initial publications suggested a link, I think later ones found it to be spurious)
      - the Gulf war syndrome (proposed, never proven, no etiology, no specific case diagnosis, a whole bunch of vague supposition with nothing hard to back it up)
      - the macrophagic myofasciitis syndrome (the use of “syndrome” basically means “we don’t know what it is”; also note that the WHO calls bullshit, and it’s basically another way of saying “vaccines are evil”)
      MMF)
      - post-vaccination phenomena (another “vaccines are evil” bit)

      So ASIA appears to be a questionable speculation that a series of dubious, possibly imaginary conditions are linked by a common thread, promoted by people who believe vaccines are inherently harmful and are looking for both harms and possible mechanisms, in the absence of solid evidence (and in the presence of lots of evidence to suggest that vaccines are in fact not harmful at all).

  7. Eugenie Mielczarek says:

    Dr. Gorski, Readers of your informative post may be interested in our recent article Skeptical Inquirer May/June 2014 (Mielczarek and Engler) SELLING PSEUDOSCIENCE–in which we detail Federal funding via NCCAM for –naturopathy, acupuncture and chiropratic. From 2000-2012 this waste of taxpayer money totals $65 million. We also listed the clinical trials and research grants . Anyone choosing these therapies should realize that there are no positive results. One bright spot was a published paper by Bronfort etal on 272 subjects which concluded that long term home exercise with advice was as effective as manipulation. Eugenie Mielczarek

  8. Sarah says:

    Remember the “My Kid Beat Up Your Honor Student” bumper stickers? Those kids grew up believing they can bully their way through any argument, no thinking required.

    Interesting that the science and reason proponents of these arguments often pause to consider the suffering of those on the other side. That compassion is never reciprocated.

    1. mouse says:

      Really? I always thought of those bummer stickers as a tongue in cheek response to the hyper competitive parenting that those “proud parent of an honor student at X school” came to symbolize. In reality, I never noticed a big difference in bullying habits between honor students and lower achieving students when I was in school. In fact, some of the advanced placement honor students were the worse in terms of picking on the odd students, gay students or “nerds” (non-atheletic or not stylish kids).

      Maybe using a joke bummer sticker about parenting to analyze the interaction between a skeptical and non-skeptical approach to medicine is a bit of a stretch?

      1. n brownlee says:

        Yes- more about the parent than the child, though all part of the “Good job, Corky, good job, Melisande! Excellent job passing the salt! Way to go!”
        philosophy of parenting.

        How about “My vaccinated kid is probably going to outlive your little parasite on the Herd immunity”? Oh god, way too mean. I’m a mean old lady.

        1. mouse says:

          I could never use such a bumper sticker because I am afraid of jinxes. I know, I know, the S in SBM doesn’t stand for superstitious, but, it’s how I am.

          1. n brownlee says:

            I just think it. Though as I get older (and older and older) and the thoughts have increasing difficulty slogging through the amyloid plaque, the thought sometimes becomes a mutter. Stocking up now on polyester kimonos and ginger syrup. Just call me Mother Goddam.

            1. mouse says:

              When I mix my drink tonight I will toast to Mother Goddam.

  9. Angora Rabbit says:

    I take comfort in understanding that anger is a coping mechanism when the listener/reader gets too close to having their confirmation bias pinged. Rational information approaches, and the amygdala kicks in to override. I have learned through experience that folks use anger as a wall to avoid hearing an unpleasant truth or something that counters faith/confirmation bias. People get louder and angrier, the more frightened they become. In a perverse sort of way, I take the anger as a good sign – they are desperate to fight against the message, and so attack the messenger (because it is much easier to blindly lash out).

    I don’t get angry at them in return. I feel sorry for them, and understand why they need to react as they do. It’s a defensive response, terror and fear mixed together. Because if they are wrong, then the subsequent cost may be incalculable or at least emotionally devastating.

    So I take heart. The angrier the opposition, the closer I know that I am to making change.

    The anger that comes from those who make money off these folks is a different story. That’s cruel and immoral, and that financial immorality deserves a strong response, not compassion.

    1. Sean Duggan says:

      Honestly, I’d also say that the anger is sometimes in how the SBM person is expressing their opinion. We’re getting a bit better, but we do tend to jump on people with both feet on certain topics, and, since we feel the facts are on our side, we can come off as a bit pompous and know-it-all even if we’re not opening by accusing the other person of being a superstitious idiot who’s the problem with our country. It’s difficult, because we know that the facts really are on our side, and so many of us are passionate about the truth.

      1. WilliamLawrenceUtridge says:

        It’s frustrating when you have done the work, when you have read both the claims and the counter-claims, and are then “forced” to argue with someone who has done none of it and refuses to even look. Complicated by the fact that even your starting premises for not just “what is evidence” but “what is an argument” is different.

        I say “forced”, but with some tongue in cheek – nobody forces me to argue, but what am I supposed to do – let someone on the internet be wrong?

      2. Frederick says:

        I agree, with W.L.U. Also, And I hate fraudster, con artist, swindler, whatever you want to call them. Because people selling woo are guilty of fraud as much as someone selling false claims about money or beat up cars that they make look good, but are lemons with 50 000 miles more that what on the counter.

        Of course some who sells Woo really believe in it, but it is still a fraud. So yeah When you know people get screwed it is frustrating! And a lot of CAM bloggers use all the trick in the “how to manipulate mind for dummies” book as they can. Woo sellers make thousands, millions of dollars with arguement like “pharma do it for the money”. The irony is so ridicule that it can get to you.

  10. I was defending a post of mine against TCM on Twitter and was called a racist for that. Even we pico-bloggers are not immune from the attacks.

    I think there are several reasons we are attacked. First there are the True Believers™ who are the religious type. Separate from them are those, like many Chiropractors, Naturopaths, and others who have a vested interest in not being convinced. Then there are those who are probably smart enough to know that SBM actually works, but, much like celebrity psychics, are deliberate con artists. For these, attacking SBM supporters is free advertising

    For all of them we are the enemy for threatening their beliefs, their profit, or both.

    1. Birdy says:

      You likely don’t know me, but I’m a student at your alma mater. I missed the “Coffee with a Stranger” event with you at the university due to weather. Think you’ll be back for another, or possibly if the Students for Science-Based Medicine (my group) were to host a workshop on pseudoscience in the fall?

      1. Hi Birdy

        I was disappointed that we had to cancel that night. I would be more than happy to meet with you guys any time at all. I appreciate the interest,

        Thanks
        john

  11. Windriven says:

    “Our society is built on propaganda wars, and wars of information and disinformation. ”

    On this one point, Eric Merola and I are in agreement. This is a polarized and polarizing issue. I have often resorted to calling woomeisters every kind of human scum and their followers nitwits, pinheads, and rubes. It is not surprising that partisans on the other side see us as tools of Pharma. It is less understandable that many accuse us of a form of religiosity. Science is not a religion and asks little in the way of belief. One would expect that any high school graduate would have learned the difference. Beyond that I am at a loss to imagine the motives they impute for our opposition.

    In the comments following yesterday’s post, both Dr. Gorski and Missmolly presented compelling challenges to my somewhat libertarian approach to sCAMs. In those exchanges I stood firmly on the side of caveat emptor in all cases involving adults and the absence of fraud. Of course fraud, like art, is often in the eye of the beholder.

    All this tiresome intro to ask the question: if adults were appropriately educated in the fundamentals of science and critical thinking, would we be having this discussion? Woophilia takes root in the dark corners of fear and it thrives in the certainties of ignorance. For this brand of credulity, websites like SBM close the gate on an empty corral. Arguments to science and rationality fail without a shared language.

    And this leads to the next question: should a society expend its efforts telling its members what they can and cannot do, or in building a society where its members are equipped to make sensible judgments on their own?

    1. Missmolly says:

      I just made the same comment in response to you on the other post!
      Given the amount of unexpurgated information we’re now exposed to from an early age, it is crazy that we don’t firmly prioritise the explicit teaching of critical thinking and evidence appraisal, ideally from primary school. That’s definitely where the money is if you’re talking about creating a society that makes educated decisions.
      Of course, it won’t totally stop people continuing to make (stupid) irrational decisions. The only solution to that is a benign dictatorship run by me :)

    2. Sean Duggan says:

      I do think that there are parallels with religions. Several years back, I read a good treatise on biblical analysis and the main point was that the subject is so complicated between historical variations and translation issues that you either have to be an expert or you have to trust the experts. Similarly, how many of us can really work out the results of a paper? How many of us instead cite one of the authors here in an appeal to authority and state that the science is good without really knowing for certain? Sure, we can apply some degree of critical analysis — some of us can even go the distance and do some statistical analysis — but we’re largely parroting experts, much like the people we’re trying to convince.

      1. Windriven says:

        @Sean Duggan

        “you either have to be an expert or you have to trust the experts.”

        The difference is that an expert in intracellular energy transport knows rather more about molecular biology than I do whereas a bible expert knows no more about a god or his will than anyone else. It isn’t the bible that is important.

    3. WilliamLawrenceUtridge says:

      All this tiresome intro to ask the question: if adults were appropriately educated in the fundamentals of science and critical thinking, would we be having this discussion?

      Yes, yes we would, because we are not so smart. Humans are inherently rational animals, and the more I learn about how poorly our decision-making is supported, the more I despair at being able to do anything about it. We are fighting a battle against many inherent, inborn, genetically hardwired traits that will last until they are bred out of the species.

      Which, given a sufficiently long timespan and enough people embracing quackery, could actually happen!

  12. Andy says:

    I for one feel like all of the SBM posts are super helpful for me to have information and perspective to bring to other people. I work hard to educate college kids on these topics and they are a great target audience because lots of them haven’t spent much time thinking about these things. They are also smart, reasonable people in general and tend to come to the right conclusions. High school students would probably be a good audience too, but you would have to pay me a lot to teach them, lol.

  13. Angora Rabbit says:

    To counter a disheartening topic, there are positive things happening. One you might like to know about is last week’s USA Science and Engineering Festival, held in Washington, D.C. Maybe some of our readers attended? The organizers expected half-a-million visitors per day – yes, you are reading that right – at the event. I was quiet last week as I was fortunate to be one of their speakers. Our audience was 6th to 9th graders and their energy and excitement and curiosity were phenomenal. There IS a hunger for science and critical thinking, and they showed us clearly that, if you offer it, they will come.

    The question is, how do we keep up that energy and not let it be lost as they enter high school and college? How do we keep them from turning into confirmation bias huggers? I can tell you, the kids at our session were intellectually fearless. We made a safe environment where any question could be asked and respected, and they played their best game. I’d bring them into my lab in a heartbeat. Here’s a shout-out to the students and faculty at Cesar Chavez Middle School and the School without Walls in D.C. – you guys rock!

  14. NotADoc says:

    Not long ago I wrote a post (not on this website) suggesting that an acupressure-ish technique, touted as a cure for everything from poverty to cancer, might not be the best approach to treating a potentially crippling autoimmune disorder. That opinion got me labeled a “fascist”, among other epithets. I swear, I’m not a racist, homophobic nationalist out to control government, commerce, and the means of production. I’m actually a very nice, midwestern-raised, politically liberal, middle-aged woman, and not a fan of Mussolini at all. Heck, I even bought an Obamacare policy!

    I’m also not a fan of magical thinking, which is what so much of this boils down to. When supposedly well-educated people honestly think that bad thoughts cause cancer and think that homeopathy and Bach flower remedies really are a thing, and that any pharmaceutical is intrinsically evil, I despair. throw in the vileness, anger, and hatred which often accompanies, and it gets a little scary.

    1. Windriven says:

      “That opinion got me labeled a “fascist”, among other epithets.”

      Neither nuance nor reason has any place in debate these days. If one disagrees with you then you must, perforce, be evil.

    2. Republicus says:

      Don’t worry, I’m a southern white male, and I can’t seem to muster a decent amount of facism either.

      Even with these government-issued pajamas, I just can’t seem to get into the mindset.

  15. The Old Portland says:

    From Dr. Gorski’s post: “My goal is instead to put science-based information out there, so that the fence sitters and undecided can encounter it…We at SBM do, however, have a hope of persuading the fence-sitters, and so do you.”

    I wonder how many fence-sitters and undecideds there are…

    As a medical consumer and information seeker, I have some thoughts for how to advance the above-stated goal:

    Cut down on the snarking and back biting. The words stupid/stupidity, idiot/idiocy and worse get used a lot in comments posted by SBM supporters. This just reinforces the belief that skeptics are a bunch of smarter-than-thou know-it-alls. Or get rid of the comments all together. They rarely contribute useful information and they just perpetuate the appearance that everything is up for debate, that it’s all just a matter of personal opinion.

    Perhaps do away with the blog format Blogging is a very ego-centric medium (I’m not saying that all who blog are egotists), and it sets up the author as a target. You also have to read through a lot of narrative to get the medical info. Instead, expand the Reference section to include more topics, and have links from there to blog-style articles by individual experts. The Reference section should be the heart of the site, not the blog.

    Include more info on other medical topics. There are plenty of medical topics that people want good science-based info about that don’t deal with CAM, e.g. breast and prostate screening, statins, dieting. Focusing so much on countering CAM tends to come across looking like it’s all about us-versus-them.

    Just some thoughts.

    1. David Gorski says:

      I lost count of the number of posts I’ve done on cancer screening, mammography, overdiagnosis, overtreatment, the complexity of cancer, the evidence base behind various surgical techniques. And that’s just me. It doesn’t even count what all my other co-bloggers have been writing about other than CAM. If you think that all we write about is CAM, you really haven’t been paying attention, or you’re suffering from a bit of confirmation bias. It’s true that CAM probably is the single most common topic that we write about, but it’s far from the only topic.

      Not that we apologize for focusing on CAM, nor is our focus going to change any time soon. That is the single area in medicine where rank pseudoscience has infiltrated medicine.

    2. Windriven says:

      “Perhaps do away with the blog format”
      “get rid of the comments all together.”
      “The Reference section should be the heart of the site”

      Yes. Brilliant. I think Wikipedia has pretty much covered that. Let’s pack up the tents and go home.

      “Focusing so much on countering CAM tends to come across looking like it’s all about us-versus-them.”

      It is. There is a battle, a tug-of-war, between medicine grounded in science and the delusionals and worse who prey on the uninformed and the vulnerable. When those who have feces for brains advocate against vaccination or promote fraudulent ‘cures’ they do very real damage to very real people. That offends me. If you object to my calling them scum, tough. Calling them poor misguided souls whose hearts are in the right place doesn’t quite capture the reality.

      The internet is replete with sources of medical information good, bad and indifferent. This site is about clinical medicine based on science. That implies that it is also about frauds and dimwits offering medical treatments that are not science-based. If that isn’t what you’re looking for, try here.

      1. David Gorski says:

        “Perhaps do away with the blog format”
        “get rid of the comments all together.”
        “The Reference section should be the heart of the site”

        Yes. Brilliant. I think Wikipedia has pretty much covered that. Let’s pack up the tents and go home.

        And, of course, we are doing a Wiki. Several of us are involved with the Society for Science-Based Medicine (sfsbm.org), and Steve Barrett has kindly agreed to allow us to turn Quackwatch into a wiki. Once the articles are converted to a wiki format, they’ll then be more open to editing as a wiki, so that the out of date articles can be updated and kept up to date from here on out. That wiki will serve as the reference section of SBM and SfSBM.

        Yes, contrary to what some think, we can walk and chew gum at the same time.

      2. kaitch says:

        I understand the Cochrane Collaboration have made some sort of agreement with Wikipedia to ensure that the health info entries are accurate.

    3. Chris says:

      “Or get rid of the comments all together. ”

      Even the ones from those whose lives have been affected by medical issues, and sometimes by medical treatments (good or bad)? Why do you not think those are informative?

      1. Andrey Pavlov says:

        Or get rid of the comments all together. ”

        I, for one, have learned a great deal from the comments. Honestly perhaps even on par with the posts themselves.

        1. WilliamLawrenceUtridge says:

          The beauty and wonder (and horror) of comments section is the ability to crowdsource critical analysis and expertise. The universe self-sorts to attract expertise (and lunatics) such that we can have Angora Rabbit pop in here and discuss how the specific biochemistry of a molecule prevents it from curing all cancers, which can feed into subsequent posts and be referred to in the future.

          And because all things have bad sides, you also get Stan showing up to proclaim we should all hail the alien lizard hybrid overlords who rule us in secret and want to take away his vitamin C. Or something equally batshit crazy.

    4. Sawyer says:

      The words stupid/stupidity, idiot/idiocy and worse get used a lot in comments posted by SBM supporters.

      I’ve thought about this a lot. I occasionally cringe when some of my favorite commenters go for the jugular when I would employ a gentler approach. I’m sure some of the even more polite reader feel the same way about a few of my posts. If there was a way to make the conversations here rosier I’d be all for it. I’ve gone to bed frustrated too many times after watching the yelling matches.

      However, I think before trying to initiate a change it is imperative to realize the impossible dilemma that has cropped up here:

      Getting less aggressive conversations would be fantastic, but for some reason the so-called “moderate” opponents of science-based medicine hardly ever leave comments here. They sometimes will leave one or two posts, but that’s it. And they aren’t leaving because anyone called them an idiot. They just don’t have a sustained interest in this site. If these readers would but forth greater effort in asking questions, I’m sure people would happily and politely answer them.

      The regular detractors of SBM are in an entirely different ballpark. They aren’t the slightly misinformed cancer patient, or the worrisome parents, or your neighbor that really likes organic vegetables. With the possible exception of Pmoran, pretty much every regular critic of this site is living in Bizarro World. I do not want anyone to be fooled into thinking their paranoid rants are supported by science. How are we supposed to be both polite and honest to these folks at the same time? There’s no way to do it. I have observed some of our favorite resident quacks that do not appear to have even passed middle-school science classes touting their favorite brands of nonsense. This is unacceptable. There is no softer word than “stupid” that I know how to use in this scenario. Blatant quacks and con-artists are not yet accepted by the general public as contributing members to society, and I want that trend to continue.

      If we could somehow increase the ratio of slightly misinformed readers to full-fledged crackpots, the “idiot” comments would disappear very quickly. To my knowledge, no one has come up with a reliable way to force that change.

      1. Andrey Pavlov says:

        They just don’t have a sustained interest in this site. If these readers would but forth greater effort in asking questions, I’m sure people would happily and politely answer them.

        An excellent point and an observation supported by the evidence. If one peruses the comments, it is patently obvious that even our most vociferous commenters do precisely that. I myself countenance not these quacks and charlatans, though I typically moderate my language more (as a physician, I feel I cannot comment as WLU does, despite wanting to). But when that “moderate” type comes along, it is immediately obvious and I (as well as others) do take the time for a different tack.

        Just look at my own recent discourse with Hank the VitC man.

        I would aver, though without evidence, that the majority of those “moderates” find it sufficient to read and lurk, benefitting without the need to comment and engage. It is well documented that people are vastly more likely to engage and take the effort to write something if they are voicing negative opinions even if their positive opinions are equally strong. Which is why I also make it a point to comment in thanks and support for those who do take the time to stop lurking and write a positive comment (as just today with Echo).

        And yes, I also agree in calling a spade a spade. A quack is a quack. A willfully ignorant person is a buffoon. That is a shift from what is generally the norm. However I do not think it is such a dramatic shift, and I think it is also where the norm should be. As Dr. Novella said so well (paraphrasing), we are sacrificing standards at the altar of geniality. When asked about my thoughts on CAM by colleagues and classmates I mince no words and simply say it is BS. That starts the conversation or gives people the out to avoid it. But offering weaselly worded, mealy mouthed answers simply enables the status quo and offers paths of less resistance to charlatans opening up herbalist clinics in prestigious medical institutions.

    5. Thor says:

      I couldn’t disagree more. Even though I’m not a prolific commentator myself, I thoroughly enjoy most of the comments and learn quite a bit from them. It’s wonderful to hear people’s take on issues besides the post itself. The scope gets broadened and more perspective is brought to bear. Wisdom, experience, knowledge (and personality, expressiveness, humor), all come out in the comments. SBM comprises a storehouse of these qualities with science and medicine being the connected beating heart. I’ve learned more here than in college.
      SBM blog has made a huge impact on me.

      Plus, I see very little mean-spiritedness or back-biting. Among subscribers to science-based medicine there is nothing but respect. When some woomeister comes along spouting nonsense, they are duly called out. I find the milieu one of intelligence, honesty, wit, irony, critical/rational thinking, and all vociferously science-based.

      Finally, it doesn’t seem like you’ve explored the site. It contains a wealth of information on all manner of pertinent topics, powered by some remarkable writers and professionals in medicine. Visiting this blog is one of the highlights of my day. Not to overly gush…..

  16. Pmoran says:

    In my opinion David and some others spend too much time reacting to the more extreme elements of CAM. (They are also very likely to be our patients one day, Andrey, so I don’t buy the distinction you seem to be making.)

    We should be above this kind of stuff. It suits CAM to sustain a probably only half-believed mythology about the mainstream, just as it suits us to sustain an excessively dogmatic mythology about CAM when it comes to questions as to precisely why people use it, what they truly believe, and what they might get out of it. We don’t have to dignify their mythology with more attention than it deserves, and we should be prepared to constantly re-evaluate our own.

    Merely presenting the facts that we possess and leaving it at that can arouse enough passion in certain quarters. Any judgments beyond “this is what we think and why” are thus risky, no matter how good it may feel to be feeding into to our own sense of superiority, and self-righteousness, and a possibly deceptive clarity of purpose.

    Poking around in the heart of the ant’s nest can thus merely arouse additional passions, while conferring on extreme personages and viewpoints an undeserved pride of place in our considerations.

    It took me a long time to learn that among CAM users and supporters there is a wide variety of opinion and degrees of commitment and that the highly vocal extremists, while influential, are not quite as representative of opinion or as influential as we sceptics think. Indeed, CAM necessarily operates in a misty world of what “might — just possibly — be true” rather than what “IS true”.

    It is the interest of this majority of more moderate adherents that we need to be engaging, for we may have some chance of modifying their more unwise uses of CAM. This is where any dialogue with CAM should be targeted, I suggest.

    Hubris is also an enemy of what we are trying to achieve. Even when unconscious, It can come through like a bright flame, producing a reflex urge to “take the piss” out of us, and invariably prompting a divergence of debate into “pot/kettle/black kettle” irrelevancies (such as the comments about the side effects of drugs for MS above).

    We in the mainstream do also have a fair amount to be humble about, despite our undoubtedly noble aspirations. Various factors in our own psychology lead us to minimise their importance in CAM use, just as mirroring factors in CAM psychology make them often loom larger than they merit.

    1. David Gorski says:

      In my opinion David and some others spend too much time reacting to the more extreme elements of CAM.

      That’s interesting. You complain when I take on the “more extreme elements of CAM,” and you clutch your pearls when I take on the less extreme elements of CAM, such as acupuncture and the like, because you see me as too mean and nasty. It seems I just can’t do anything right “in your opinion.” Of course, that’s largely why I’ve largely ceased to listen to you. Despite my practically begging you to explain on many occasions, you still can’t seem to provide a coherent critique and an alternative strategy for how it should be done, other than advocating turning into a shruggie.

      Of course, you could potentially change that. The offer to have you write a guest post telling us how it should be done that I made a couple of years ago still stands. You’ve yet to take Harriet and me up on it. I figured this is as good a time for a reminder as any.

      1. Windriven says:

        “and you clutch your pearls when I take on”

        Consider that turn of phrase stolen, David. Very evocative.

      2. Dave says:

        I’m not sure there’s one proper way to address CAM promotors. Like Sawyer, I get discouraged by some of the interchanges I see. Some of the chronic CAM promotors here harp endlessly on the same themes – either ad hominem attacks about big pharma shills, using the high profits of drug companies to justify using untested and unregulated herbal preparations, pointing out the problems of mainstream medicine as if that justified alternative medicine (the IOM report certainly shook mainstream medicine up and led us to emphasize patient safety but it also fueled CAM big time, judging by the comments on this website), regurgitations of the same issues about medical studies, guidelines, NNT’s etc. I’m not sure it is even worth it addressing these same issues in the comments again and again. Some of the commenters mounting personal attacks deserve an abrupt comment.

        There’s a resort near where I live which offers “retreats” involving mainly yoga, and their website is loaded with phrases like “nurturing, healing, positive energy vortexes, spiritual growth through meditation” etc. One of their weeks is led by an accupuncturist, another by a “shaman”, and I’m sure they’ve had reiki specialists, etc. The website proudly lists Andrew Weil as a former attendent. Don’t get me wrong, I see nothing wrong with just spending a week doing yoga and relaxing in the rocky mountains – it’s probably better for you than spending a week on a cruise ship. But I notice this resort never has a week led by mainstream doctors, nutritionists, sports medicine people etc. Somehow CAM has gotten itself allied with the idea of a nurturing, healing alternative way of seeing the world that mainstream medicine and western society as a whole seems to lack. Mainstream medicine in fact is viewed as profit driven, cold and uncaring. I am dead certain that therapies should have as much evidence as possible of effectiveness – otherwise it’s fraud. At the same time we shouldn’t ignore the contribution of personal care, time, and ritual to the effectiveness of a therapy. Example, there’s nothing wrong with having a birth center with compassionate midwives in a comfortable setting, with immediate access also to anesthesiologists, obstretricians and neonatologists. If for no other reason than this I think we should try to temper our remarks when possible. I admit to not following this advice on one or two occasions myself.

        As an aside, it’s interesting to me that I know a whole group of other people, mainly mountain climbers and ultrarunners, who feel that their personal growth is best developed in the most demanding and uncomfortable of endeavors when they are stressed to the limits. Different strokes.

    2. Andrey Pavlov says:

      They are also very likely to be our patients one day, Andrey, so I don’t buy the distinction you seem to be making.

      When that person becomes my patient, the distinction will be made for me Peter. And clear as a bell.

      We don’t have to dignify their mythology with more attention than it deserves

      Which leads to quack herbal centers at the Cleveland Clinic. Do we wait until the medical board exams begin asking questions on aligning chakras before it rises to the level of dignifying the mythology with our attention?

      Merely presenting the facts that we possess and leaving it at that can arouse enough passion in certain quarters.

      Yes, clearly Dr. Briggs’ merely presenting the fact that the evidence base for the herbal center is “extremely thin” has done the job.

      Any judgments beyond “this is what we think and why” are thus risky

      Less risky than getting a mixture of 8 random herbs for your inflammation at your physician referred in-house herbalist center. But hey, at least they sign a waiver saying it isn’t real medicine, it just has all the trappings of it.

      while conferring on extreme personages and viewpoints an undeserved pride of place in our considerations.

      So you argue that they are so beneath us that we shouldn’t be bothered? Well if that isn’t mean spirited I don’t know what is.

      It is the interest of this majority of more moderate adherents that we need to be engaging, for we may have some chance of modifying their more unwise uses of CAM

      So… welcome the quack herbal centers into our hospitals and then try and convince those moderates that, even though it is in our own hospital and we can (and sometimes do) refer to them, they really are bunkum? Winning strategy.

    3. Echo says:

      Last year, I started to see an acupuncturist who told me that he could cure the problems that I had been having with severe vertigo accompanied by vomiting. This had been happening, on & off, over the course of 7 – 8 years. (I had originally been diagnosed with labyrinthitis and then BPPV. My current diagnosis, which I got this past October and I believe is accurate, is Meniere’s Diesase.) The acupuncturist had been recommended by a friend. I was desperate to get better. I had lost faith in my medical doctors because my diagnosis kept changing and, honestly, I felt like I was suffering greatly and nobody cared. Anyway, long story short, I plunked down thousands of dollars from my savings up-front for an acupuncture treatment plan. I was given a really hard sell and I was just coming off of one of the worst period of months that I had ever experienced with the vertigo. I was worried that I was going to lose my job, then my house, etc. The “treatment plan” was to take a bunch of Chinese herbs that I purchased at a high cost through the acupuncturist, and also receive acupuncture treatments for three times a week, then two times a week, then tapering off to one time a week over the course of 5 – 6 months. I saw a lot of improvement in my symptoms during the course of this treatment and I became a true believer. As my treatment was winding down, I was told that I’d need to go on a “maintenance” schedule in order to keep my illness at bay. I was also told that I would need to stay on the herbs, which was not something that I had been told at the beginning of my treatment, and that the only place to get these herbs was through his office because the company that he bought them from made sure that they weren’t contaminated with lead, etc. At this point, I was feeling much better, and my critical skills were kicking in. I no longer trusted this acupuncturist, so I skipped the last two visits of my treatment plan, knowing that I was going to get another hard sell. I decided to go to a different acupuncturist for my maintenance. Surprisingly to me, though I’m sure not to any of you, her treatments didn’t seem to do much for me. So I left acupuncture. At this point, I was starting to notice a hearing loss in my left ear as well as a roaring sound in that ear. I went to the ENT and was ultimately diagnosed with Meniere’s. I was put on a diuretic, but after a few days on that, I started to get weak and was often close to fainting, so they took me off of it. Looking for something else that might help me, I read an article on Dr. Weil’s web site about how cranial osteopathy could be helpful for Meniere’s disease. I went for two appointments to a DO for cranial osteopathy treatments. She was a really comforting person, but after two visits it seemed like just a really nice, gentle head massage, which was relaxing but expensive. I was pretty much broke from the acupuncture, and even though my insurance would cover some of the costs for the cranial osteopathy out of network, I decided not to continue. (Throughout this time, I was on a low-salt diet as instructed by the ENT.) I haven’t had vertigo since November, but I continue to have intermittent hearing loss and balance issues. All of this is background to get to my real point which is that I think that it is very important that all of the doctors on this blog continue to be just as honest and blunt as they can about any quackery that they encounter. While niceties are well and good, the important thing is to provide good solid information. Sick people are often desperate, as I was. They can be so ill that they make poor decisions for themselves. Who is it helping to have the doctors and other skeptics on this site offer watered-down posts heavy on the niceties? Nobody. I knew nothing about the skeptics until I started becoming alarmed at the recent outbreaks of childhood diseases. I found a post about vaccines on Respectful Insolence and then started reading that blog, SBM, and now other skeptic blogs. I wish that I had found these blogs before I shelled out all of that money for the acupuncture and herbs. Maybe I would have been resistant to the message here, so it wouldn’t have mattered. I don’t know. All I know is, at this point, I appreciate reading the unvarnished truth. Keep up the good fight, skeptics. You are making a difference, one person at a time.

      1. CHotel says:

        Thanks for sharing your experiences, Echo. I think yours is an excellent example of the slippery slope that can lead to people having an increased belief and, in some cases, dependency on CAM. People with difficult to diagnose, waxing and waning conditions, may turn to alt med as a last resort in the darkest hours of their ailment, a completely understandable reaction. Then after months of treatment when their symptoms wane once more (through a corollary of time rather than causal effect of therapy), they have a decision to make: do I blindly credit this discredited treatment with my recovery, or do I critically evaluate the whole situation with a level head and come to a different conclusion?

        I would like to say, and while I don’t speak for the other commentors here I feel they’d likely agree, that I have great respect for you and your ability to make the decision to question your situation and to move away from such treatments. I can only imagine how difficult it would be to do so after having such a frustrating course of illness finally improve.

        1. Echo says:

          Thanks for the kind words. Since many people seem to think ,”What’s the harm” when it comes to CAM, I wanted to share my story.

        2. Calli Arcale says:

          It reminds me of the story of a fellow who was posting either here or at RI (I think at RI) who swore up and down that alternative treatments were working on his gout. But oddly, each time it would be a *different* treatment, and sometimes it would take him weeks to find the “right” treatment for this particular attack.

          Guess how long gout attacks typically last….

          When you have a disease that comes and goes, it’s very hard to tell if something is working or if you were going to be getting better anyway. I have asthma, and I’ve met people who swear that acupuncture or cupping or whatnot cured it. But asthma comes and goes. If you do any treatment long enough, an effect may seem to appear, but with most conditions, people will eventually get better (or at least adapt to life with the problem) and that may look like the treatment cured them. It’s very alluring, and very hard to not conclude the obvious but wrong thing.

        3. Andrey Pavlov says:

          I would like to say, and while I don’t speak for the other commentors here I feel they’d likely agree, that I have great respect for you and your ability to make the decision to question your situation and to move away from such treatments. I can only imagine how difficult it would be to do so after having such a frustrating course of illness finally improve.

          Agreed.

      2. Andrey Pavlov says:

        @echo:

        I am sorry to hear of your woes, but thank you for sharing your story.

        1. Echo says:

          Thanks.

    4. Windriven says:

      “it suits us to sustain an excessively dogmatic mythology about CAM when it comes to questions as to precisely why people use it, what they truly believe, and what they might get out of it.”

      Where is the ‘dogmatic mythology’ that you see evidenced? I suspect that there are a wide variety of reasons that people use sCAMs from the idle dabblers to the dyed-in-the-wool true believers. I think something like that recognition is to be found in substantially all of the posts here.

      Is it style that you are criticizing, or content?

      1. pmoran says:

        “Is it style that you are criticizing, or content?”

        They are inextricable, I guess. The mythology determines the style of discourse. This is why attempts to characterise the CAM mind are always risky, too easily revealing unhelpful subtexts. It can have about the same scientific status as gossip — “– come sit by me —” (– if you want your prejudices massaged) .

        Of course I also often give my interpretation of the CAM mind, but in a charitable way that I honestly hold to. My “narratives” include the perception, obvious enough, but nevertheless invisible to some sceptics, that much use of CAM occurs because of real and perceived limitations to mainstream methods. Medical scepticism is thus often trying to control what people do when we doctors have no very satisfactory solution to their problems. That does not mean that they will fare any better with CAM, of course, but it is good “narrative” to keep in mind if you want to write stuff that is going to be read by, and hopefully have influence within the CAM sub-culture.

        I am, sort of, working on a guest post. It is not easy because of all the disparate threads that have to be drawn together (and some prevailing ones discarded) if we are to reach a coherent, rational and realistic approach to what is a very complex and even sometimes paradoxical medical arena.

        There can be no exclusive or simple rules, because there is almost no statement that you can make about medicine that does not have exceptions. However, there can be guiding principles and an alertness to which attitudes and impulses and lines of argument are most helpful or unhelpful. I am not sure that I can do any more than nibble away at this mountain.

        Not that I don’t have my own uncertainties. My misgivings about the style and content of some SBM material largely stem back to how we interpret a huge body of often conflicting evidence in relation to medical outcomes: as being claimed by individuals, as also reported in clinical studies, as demonstrated to have substance within laboratory studies, all of which have to do with psychological responses to the “theatre” of medicine — the treatment ritual.

        To me, and possibly also to the otherwise respected institutions that are trying out conditional rapprochements with aspects of CAM, that evidence has not yet provided us with a solid handle on either the entirety of the human needs that patients bring into medical interactions or of all the psychological and neurological processes, beneficial and otherwise, that can occur with sometimes dramatic and complex medical interventions.

        There is also room for doubt that for the foreseeable future we will have a medical workforce that can consistently deal with psychosocial needs under the many constraints that now apply at the medical coalface including those rightfully imposed by EBM/SBM (which have actually reduced rather than enhanced a doctor’s management options for many common conditions, while leaving patient expectations unchanged or enhanced.)

        This all adds up to some likelihood that CAM may sometimes provide helpful care to patients who fall through inevitable cracks within mainstream care.

        I say that with no illusions about CAM. It very often doesn’t live up to its own pretensions, either. We are talking about medical systems, or de facto medical variants within the one complex system, that share certain aims, certain good qualities and flaws, but in very different proportions.

        The most stark and critical difference with many important illnesses lies with the intrinsic efficacy of the methods that are employed. Yet even in that regard remember that at least 20% of mainstream medical activity is not yet shown to definitely have intrinsic medical activity. These evidence deficiencies are accordingly worthy of at least equal objection and intolerance as many CAM methods — if not more so given some of the narratives we w want to lash CAM with e.g. “all of medicine should be held to the one standard” (frankly an impossibility) and “there is only one medicine — that which works and that which doesn’t” (not as clear as it once seemed unless you apply a selective semantic purity to “works”). . .

        These are just a few of the “threads of thought” I refer to above..

        1. Windriven says:

          I can’t wait for your guest post, Dr. Moran. And I think I speak for many in saying that. Your comments elicit strong responses because they sometimes touch tender spots – and those are always worth deep exploration. It will be interesting to see how the various threads that have appeared in your comments weave together into a coherent philosophy.

        2. Harriet Hall says:

          “I also often give my interpretation of the CAM mind, but in a charitable way that I honestly hold to”

          Do you really not realize that this statement reeks of hubris and insults the rest of us?

          “at least 20% of mainstream medical activity is not yet shown to definitely have intrinsic medical activity.”

          How much of that 20% is based on pseudoscientific nonsense like the memory of water, mythical subluxations, or undetectable qi? If you’re going to lump that 20% in with CAM, you will meet with a lot of opposition here.

    5. Badly Shaved Monkey says:

      It took me a long time to learn that among CAM users and supporters there is a wide variety of opinion and degrees of commitment

      You must be right, but my consistent experience is that people whom one might judge as merely uncommitted ‘soft believers’ turn out to be quite tough at the core if you present even the mildest challenge to their views. I think there is a reason for this. No matter how marginal is the use of sCAM in their lives, any use depends on the existence of a number of cognitive errors to sustain that use and is tied to a whole set of issues around how people define their identities. Criticism of the use cannot help but confront those cognitive errors, so criticism of the occasional purchase of a homeopathic remedy cuts very quickly to confronting those flaws in the person’s thinking processes. No wonder they fight back. In reality, in the consulting room, I tend to break off in order to deal with the current clinical problem while the issue of the inapplicability of SCAM hangs unresolved in the air.

  17. R.w.Foster says:

    Anyone out there consider how ironic the anti-vax crowd is? I mean, consider (my dates are probably wrong) since the 1960′s most vaccines have been mandatory for public schools. So, that means, most of the anti-vax crowd have been vaccinated!

    I’ve seriously been so irritated with the “vaccines are bad” trope that I’ve actually said, “If vaccines are so bad, why aren’t you dead, ya flipping dummy?!” Except the word I used in place of “flipping” rhymed with “ducking”…

    1. Badly Shaved Monkey says:

      most of the anti-vax crowd have been vaccinated!

      which is obviously why they seem to suffering from some form of brain damage, which proves that vaccines are evil.

      [There may be a flaw in that piece of monkey-logic.]

      :)

    2. CHotel says:

      My brother and I have joked about creating a line of homeopathic products called UnVaccines to reverse the effects of the shots those people likely regret having had. Completely immoral and unethical a product, not to mention medically impossible based on my limited knowledge of immunology (sans a very drastic intervention, presumably), but I have a hard time caring about the people on whom our market would be based. It would, unfortunately, likely sell quite well.

  18. renoB says:

    I thought this would be a good time to come out of lurk mode and comment on what an impact this blog had with me. I’ve never really subscribed to any pseudo-science, but there’s definitely a lot of clouded misinformation out there. This website gave me the opportunity to sort through the bs and understand the reality of medicine and the various impacts it has (positive, negative, ethical, etc.).

    I’m sure you can imagine the amount a layperson hears about “this special new treatment”, “this new diet”, “aspartame is linked to having holes in your brain”, and so forth. I’m honestly surprised how much I hear it. This website gives me the confidence to tell those people they’re wrong, and gives me sources with scientific integrity to back it up.

    Btw, Dr. Gorski’s comment about turning quackwatch into a wiki got me to subscribe to SFSBM. Sounds like an awesome plan, and I can’t wait to see the outcome.

    1. Andrey Pavlov says:

      @renoB:

      Just wanted to take the time to say thank you for unlurking. These sorts of comments are valuable, IMHO.

      Also – is it safe to assume you are from/currently live in the Reno area? My fiance is from there and we often visit her family out there. As is typical with most places, getting to know it from the locals’ perspective has shown it to be actually a very fun and interesting place with many activities in and around that most tourists do not partake in.

  19. Andrés says:

    First a personal disclosure. I don’t think any medical treatment is above the scientific method.

    What you are not aware is that personal experimentation is a valid approach towards doing a preliminary filtering of hypothesis. Of course confirmation through an experiment trying to refute them over a broader population is still necessary to prove it effective.

    There are those of us (not your “us”, certainly not “they” either since I don’t think there is any evil SBM supporter at all around here) who don’t abide to your rules. Of course it is safer to have a big RCT proving the efficacy of an intervention. But if an intervention is low risk and have other supporting evidence (and no falsifying one) we think it is reasonable to experiment and check for ourselves while patiently waiting for those RCTs that no one is pursuing (except vitamin D ones). I have put “we” in these sentences instead of giving credit to those MDs defending this position because those MDs differ for each intervention. I have already said which main interventions I am interested in. Of course low risk may be a quite deceitful definition for something that has not passed a big RCT check. Hence my personal focus on (almost) only human endobiotic substances.

    Not that this approach is without risks. Last Saturday Professor Emeritus Seth Roberts passed away perhaps due to one of his self-experiments. Certainly I wouldn’t have done some of them. I try to be quite thorough researching both positive and negative effects of those interventions I am interested in.

    Call me stupid if you must. If I wouldn’t have got mostly positive and consistent results I would have concluded myself that and I wouldn’t be defending such things as vitamin C.

    Of course I go a step forward and if both the available evidence and the results that I get seem to support the effectiveness of the intervention I extend it to those near me that appreciate my approach and are willing to do it. Some interventions I have checked mainly thinking about my father’s health. Some of them are somewhat extreme and my father is not going to do them if his health doesn’t deteriorate much. I have checked them just in case.

    Call me arrogant if you please. If my father’s health wouldn’t have improved (not only on self-limited diseases) since he began to do some of them (yes, I am aware that his improvement is not a prove of anything) then I would agree and my life would likely be more comfortable.

    I am open to change my position too. I have discontinued some supplements either on adverse effects alone or new evidence. One of them was chromium. I discontinued it after reading about its negative effects on healthy individuals (references within the blog post). Thereafter my fasting blood sugar came down from 101mg/dl to its original level 94mg/dl and even lower (86mg/dl nowadays).

    Dr. Pavlov said:

    It is well documented that people are vastly more likely to engage and take the effort to write something if they are voicing negative opinions even if their positive opinions are equally strong.

    Certainly. I don’t comment on posts bashing homeopathy or acupuncture around here although I have engaged some defending them on Spanish blogs (here about homeopathy, here about acupuncture).

    Now to the point. How I see “you”?

    I think that your intentions are good. I think that you think that abiding to experts’ consensus and to the quality evidence scale (RCTs and their meta-analysis on top and needed before any active intervention is possible) is the correct way to go. Of course if I would abide to the same principles I would be on your same camp too. I don’t have to and I don’t abide to them though.

    I think that there are areas where the experts’ consensus should focus mainly on defining what experiments should be conducted in order to falsify hypothesis. Those experiments that are never conducted to check presumably positive interventions derived from clinical experience. That clinical experience that you dismiss with a quick wave of hand as the most dangerous three words. For me the most dangerous set of words is “it is not my responsibility to check it” instead: it ends up been no one’s responsibility.

    Call me hubristic if you have to. I will wait for falsifying evidence that the clinical experience of late Dr. Klenner about vitamin C on viral and bacterial diseases and that of Dr. Davis about cardiovascular disease are wrong.

    Finally. I don’t see neither much scientific curiosity nor a genuinely intention to falsify your own hypothesis around here those times you don’t end bringing up the consensus gambit (if there is a way to bring a complete halt to a conversation that is it). There have been at least two times that people around here (or in their personal blogs) arrive to a plausible explanation of some things and let it stay at that without any intention to check them. Of course it would suppose work and it is easier to say that it’s the other’s responsibility to check their hypothesis first.

    One is Dr. Crislip’s hypothesis that researchers didn’t keep on the vitamin C track after positive results because they must have found negative results afterwards (without publishing them) and abandon it all together. Some time in the future I would try to contact Dr. Banič or someone that had worked with him to check it but not being an MD myself I am not having much success on getting a response.

    The other is Dr. Gorski’s hypothesis about the appearance of an increase in autism incidence being due to change of diagnostic criteria. I am not sure if there is enough available data to be processed in order to check it though.

    1. David Gorski says:

      For cancer, at least, vitamin C has been a colossal failure:

      http://www.sciencebasedmedicine.org/the-return-of-the-revenge-of-high-dose-vitamin-c-for-cancer

      http://www.sciencebasedmedicine.org/vitamin-c-strikes-out-again

      http://www.sciencebasedmedicine.org/high-dose-vitamin-c-and-cancer-has-linus-pauling-been-vindicated

      Even if you believe the best results out there, any effects of vitamin C on cancer are so small as to make it the proverbial long run for a short slide. Basically, though, the most parsimonious interpretation of the data is that vitamin C does not have significant antitumor activity.

    2. Windriven says:

      “What you are not aware is that personal experimentation is a valid approach towards doing a preliminary filtering of hypothesis.”

      Andres, I don’t think many here would try to stop you from engaging in personal experimentation. But it is quite a different matter when a physician engages in experimentation on her patients – even with an effort at informed consent. The structure of a formal trial under the eye of an IRB seems a minimal inconvenience in the effort to assure meaningful informed consent.

    3. Andrey Pavlov says:

      Andres, many of the premises you state are not something I disagree with. It is the extensions and conclusions you make from these that are faulty.

      What you are not aware is that personal experimentation is a valid approach towards doing a preliminary filtering of hypothesis. Of course confirmation through an experiment trying to refute them over a broader population is still necessary to prove it effective.

      Sure. My very good friend has even written about <a href="http://www.studentdoctor.net/2011/09/know-thyself-the-future-of-medicine-part-one/the Quantified Self idea. The key is he knows and abides by the limitations of it. You do not.

      The fundamental error you are making – specifically with your Vitamin C ideas – is that there is a hard ceiling as to what certain types of evidence can tell you. Meaning that doing self-experimentation can give you information. But it cannot demonstrate something to be the case (except in very rare, extreme, and typically contrived circumstances, but for all reasonable purposes, may as well be zero in reality). You cannot take a whole mountain of lower order evidence and have it be equivalent to a smaller amount of higher order evidence. 10 billion n=1 trials will not give you the same level or quality of evidence as a single well conducted large RCT.

      So when you say:

      I will wait for falsifying evidence that the clinical experience of late Dr. Klenner about vitamin C on viral and bacterial diseases and that of Dr. Davis about cardiovascular disease are wrong.

      That isn’t hubris, that is a lack of understanding of that fundamental fact. Those kinds of lower order evidence do not provide a platform from which to then demand higher order evidence must falsify. It can only provide a platform on which to say higher order evidence is needed to confirm. In other words, it does not allow sufficient cause to change the null hypothesis as you are claiming.

      Even more so, you are oblivious to your own stated ideas when it comes to conclusions you already hold and favor.

      But if an intervention is low risk and have other supporting evidence (and no falsifying one) we think it is reasonable to experiment and check for ourselves while patiently waiting for those RCTs that no one is pursuing

      Sure, I would agree. We can quibble about what “low risk” means and if you are even qualified to evaluate that, but the key is what I bolded above. There is copious data to falsify your VitC ideas. But since you already like that conclusion, instead of recognizing this you move goalposts and combine evidence from very disparate studies of quite different things to try and bolster the claim. I cannot stress enough how painfully obvious it is that you are not following a scientific process, but are taking a conclusion and then back-filling it with evidence in an illegitimate manner. As the old saying goes, you use the science like a light post – but for support, rather than illumination.

      I am open to change my position too. I have discontinued some supplements either on adverse effects alone or new evidence.

      And yet you refuse to do the same for VitC. The only difference being that you accept the harms for chromium, but refuse to acknowledge the complete lack of benefit for VitC. Yet the harms from chromium and the harms from VitC are, to a first approximation, essentially the same – none. The signal in the chromium data is minuscule. The signal in the VitC data is all noise. Yet, because you are infatuated with your VitC you are plainly applying different standards of evidence.

      I think that you think that abiding to experts’ consensus and to the quality evidence scale (RCTs and their meta-analysis on top and needed before any active intervention is possible) is the correct way to go.

      Not even close. We here absolutely do not beleive that RCT’s and meta-analysis are needed before any active intervention is possible. In fact, the term of “methodolatry” has been discussed on this very blog as the perverse idea of holding RCTs as the only valid metric for determining the validity. But when lower orders of evidence are not wholly convincing then yes, an RCT is needed. Or conversely if an RCT appears to demonstrate something that is contra to extremely well established lower orders of evidence (e.g. homeopathy), it is equally wrong to ignore the lower order evidence in favor of the RCT.

      We here take a vastly more nuanced and rigorous approach to the evidence than you give us credit for or seem to understand yourself.

      Those experiments that are never conducted to check presumably positive interventions derived from clinical experience.

      Yes, that happens. The enterprise of research and science is a human endeavor and one that is limited by resources, interest, and often political will. In an ideal world I can assure you that every one of us would love to have unlimited resources to allow people to study absolutely everything even remotely promising. But that is not reality.

      However, the fact that this is the case does not grant higher status or credibility to those yet untested claims. And when it comes to VitC that data is actually there, and negative. It is simply that you refuse to accept this.

      The other is Dr. Gorski’s hypothesis about the appearance of an increase in autism incidence being due to change of diagnostic criteria. I am not sure if there is enough available data to be processed in order to check it though.

      That is extremely well demonstrated and established. The fact that you can end by questioning that is further evidence that you do not fully appreciate the state of evidence on the things you reading/writing about.

      1. MadisonMD says:

        Well said, Andrey.

        1. Andrey Pavlov says:

          Thank you, Madison.

    4. Andrés says:

      Dr. Gorski said:

      Basically, though, the most parsimonious interpretation of the data is that vitamin C does not have significant anti-tumor activity.

      I have already conceded that. I am quite critical about Pauling (I haven’t read any of his books about vitamin C though) because focusing on the common cold (and later on cancer) has contributed in my view to keep Dr. Klenner’s work unverified as I have already said.

      Windriven said:

      But it is quite a different matter when a physician engages in experimentation on her patients – even with an effort at informed consent.

      I suppose those engaged at Dr. Davis’ Track Your Plaque group are not so common patients. I see your point about the difficulties about applying that approach generally without previous confirmation though.

      Dr. Pavlov said:

      My very good friend has even written about the Quantified Self idea.

      Thanks for the link. I am not interested on keeping track of such things as calories burned or consumed. I am not even interested on keeping track daily of anything. Quite interesting the device to track sleep though.

      What I do. For example, I have checked my postprandial blood sugar level at one and two hours after my most common meals and proceeded accordingly. That approach is recommended by MDs as Dr. Davis, Dr. Bernstein or Dr. Eenfeldt and I don’t think that any RCT is needed to apply it broadly to diabetic type II patients. There are those patients doing just like that.

      Dr. Pavlov said:

      There is copious data to falsify your VitC ideas.

      I suppose you are referring to effects of vitamin C deficiency first on the immune system before on connective tissue (scurvy). I think it is falsified that it is a big enough effect on the majority of the population even if it exists (I would have prefered to read those two papers by myself though). I think that it is possible on some sub-populations though. Certainly some results are confounded by using intravenous route like those of the Vanderbilt study.

      The original hypothesis derived from Dr. Klenner’s clinical experience (high doses —lets say 0.4g/kg per day— of intravenous/intramuscular vitamin C has a powerful virucidal effect) stands unrefuted though as I have already pointed out.

      Dr. Pavlov said:

      We here absolutely do not believe that RCT’s and meta-analysis are needed before any active intervention is possible.

      Of course I have a biased focus on vitamins and minerals. In that topic I am only aware of Dr. Crislip somewhat embracing a more out of the box position and advising to be vitamin D replete (apart of getting the flu shot too) during the flu season. I don’t know if he checks vitamin D levels in his practice though.

      Dr. Pavlov said:

      That is extremely well demonstrated and established.

      Have diagnostic criteria of ASD changed? Certainly. Does that explain all the increment in prevalence? I haven’t seen an analysis focusing on those less likely to be excluded in previous diagnostic criteria such as perhaps those autistic children with intellectual disabilities. Does it exist something like that? Citation please.

      I think that the prudent thing to do is acting like the hypothesis linking vitamin D insufficiency, acetaminophen and autism is correct while waiting for confirmation. That doesn’t include stopping vaccination of children (I am still unconvinced about flu shots when vitamin D replete though).

      1. Andrey Pavlov says:

        I suppose you are referring to effects of vitamin C deficiency first on the immune system before on connective tissue (scurvy). I think it is falsified that it is a big enough effect on the majority of the population even if it exists (I would have prefered to read those two papers by myself though). I think that it is possible on some sub-populations though. Certainly some results are confounded by using intravenous route like those of the Vanderbilt study.

        That is exactly my point Andres. The results are not confounded by the Vanderbilt study. The Vandy study is completely different to the question at hand, particularly the Klenner paper. Seriously, trying to tie in the Klenner paper to the Vandy study is like trying to tie in colon cancer with inhaled corticosteroids. You are desperately grabbing at anything that can string the words “VitC” and “immune” in the same sentence, regardless of whether that is a valid comparison or not.

        The original hypothesis derived from Dr. Klenner’s clinical experience (high doses —lets say 0.4g/kg per day— of intravenous/intramuscular vitamin C has a powerful virucidal effect) stands unrefuted though as I have already pointed out.

        And yet again you completely fail to understand my points (and other esteemed colleagues here). Let me put it in bold so it is beyond clear:

        Dr. Klenner’s clinical experience is not in a position to be refuted

        Period. It is a hypothesis that must be established. It has never even remotely reached the point where it must be refuted. You are putting the cart in front of the horse yet again.

        Have diagnostic criteria of ASD changed? Certainly. Does that explain all the increment in prevalence? I haven’t seen an analysis focusing on those less likely to be excluded in previous diagnostic criteria such as perhaps those autistic children with intellectual disabilities. Does it exist something like that? Citation please.

        Seriously? There are plenty right here and here. You really shouldn’t bloviate about topics you clearly haven’t even done a smidge of due diligence to research, particularly when they are prominently research right here at SBM.

        I think that the prudent thing to do is acting like the hypothesis linking vitamin D insufficiency, acetaminophen and autism is correct while waiting for confirmation.

        Yes, well you’ve further established that what you think is prudent is completely nonsensical from a scientific standpoint. That is an even weaker case than your VitC tropes. Astounding.

        1. And says:

          Dr. Pavlov said:

          Seriously, trying to tie in the Klenner paper to the Vandy study is like trying to tie in colon cancer with inhaled corticosteroids.

          Both approaches used (not consistently in the Vandy study) intravenously delivered vitamin C. Both of them decreased mortality.

          Dr. Pavlov said:

          Dr. Klenner’s clinical experience is not in a position to be refuted

          Your opinion. We have come full circle to the need of RCTs since any other evidence is being ignored. I think that the somewhat case series reported by Dr. Klenner deserves it as I have already pointed out.

          Dr. Pavlov said:

          There are plenty right here and here.

          Second link empty. I suppose you are referring to Dr. Gorski’s last take on the autism subject that drove my comment. From the first one, Dr. Gorski said:

          if there is a “real” increase, it’s probably a relatively small one. Show me strong evidence of a “real” increase, and I’ll change my mind.

          Exactly my point about not doing a thing to check the hypothesis.

          At least from the CDC prevalence studies linked in those posts (the 2008 report that I hadn’t read before your link and the 2010 one) it is possible to check the incidence of “those autistic children with intellectual disabilities”. From Table 5 in the 2008 report we have an incidence of ASD with IQ<70 of 3.2 per 1,000 in 2002 and of 4.6 per 1,000 in 2008. They give the rate ratio as 1.5 with 95% CI of 1.4 to 1.6. From the 2010 report:

          Combining data from these seven sites, the prevalence of ASD with co-occurring intellectual disability was 4.7 per 1,000 children aged 8 years

          It seems to have reached a plateau.

          Dr. Pavlov said:

          Yes, well you’ve further established that what you think is prudent is completely nonsensical from a scientific standpoint.

          Really? The case for the vitamin D deficiency connection with autism has arrived to the causative mechanisms: Vitamin D hormone regulates serotonin synthesis. Part 1: relevance for autism (via Dr. Cannell). There are plausible mechanisms for the acetaminophen connection via its glutathione depletion effect. I beg to differ from your sensical interpretation.

          1. Andrey Pavlov says:

            Both approaches used (not consistently in the Vandy study) intravenously delivered vitamin C. Both of them decreased mortality.

            Exactly my point and why you, at this very moment, have completely lost. That is the loosest association possible and ignores incredibly huge swaths of knowledge and conditions that are incredibly relevant. You may as well be arguing that that decreased amounts of pirates are causing global warming.

            Your opinion. We have come full circle to the need of RCTs since any other evidence is being ignored. I think that the somewhat case series reported by Dr. Klenner deserves it as I have already pointed out.

            Sure. And the opinion of many others here. And each of our opinions, mine included, are worth a lot more than yours on this topic.

            But hey, nice job on reducing your intellectual discourse to, “<a href="Yeah, well, that's just like, your opinion man”

            Another loss.

            Exactly my point about not doing a thing to check the hypothesis.

            I know English is not your first language, but the point Dr. Gorski was making is that the evidence doesn’t exist. That the increase in prevalence is almost entirely explained by broadened criteria and improved surveillance. As with all data, there is a gray zone in which it could be that there is a true increase in prevalence but it could also just as easily be explained by broadened criteria and increased surveillance. You don’t get to claim that the gray area is definitely an increase in prevalence. The same way Dr. Gorski, being intellectually honest (unlike some people here), must also admit he cannot definitely say it is not. What we can say is that if it is a real increase in prevalence, it is a tiny minority of the cases. And considering that the diagnosis of autism can be made as early as 6 months and there is increasing evidence that it is very predominantly a genetic condition that begins early in gestation, it is extremely unlikely that there are environmental factors that have a significant influence which further makes it unlikely that the aforementioned gray area is a true increase in prevalence.

            Really? The case for the vitamin D deficiency connection with autism has arrived to the causative mechanisms: Vitamin D hormone regulates serotonin synthesis. Part 1: relevance for autism (via Dr. Cannell). There are plausible mechanisms for the acetaminophen connection via its glutathione depletion effect. I beg to differ from your sensical interpretation.

            Yes, really. And beg to differ all you want. I hate to do this but the reality is that I have a lot more relevant education, training, and expertise than you. You are continuing to string things together in utterly nonsensical ways (like your Vandy and Klenner connection).

            And seriously, what on earth is your purpose here Andres? If you are already convinced, think you know more about the relevant medicine, science, and study design than a group of physicians, scientists, and physician-scientists, what the hell are you doing here? Are you trying to come educate us? Because you genuinely think your education and expertise is so vastly beyond ours that you should set us straight? Why don’t you just get a job as a professor of medicine somewhere then? Why don’t you actually publish articles in respected journals instead of coming over here and trying to convince us that your nonsensical connections actually make sense?

            You’ve come to a place with relevant experts. If you don’t like what you are hearing (which is perfectly reasonable, nobody like being told they are wrong) then either change your ideas in concordance with the (free!) expert analysis you have been given or just go somewhere else where loons and alties will love your lucubrations over VitC.

            I mean for heaven’s sake! I have been doing sepsis research for over two years, I’ve won awards and presented my posters at international conferences, I’ve actually worked in actual ICU’s and treated actual ICU patients, and I am currently writing another paper and have another poster on sepsis accepted to a research symposium. And you have the hubris to come here and try to tell me – and others vastly more qualified than even myself – how research methodology on sepsis is supposed to work and how bacterial septicemia in critically ill patients is related to a case series report on a viral infection on young outpatients done 70 years ago are related?

            I just don’t get your end game, Andres. But it is certainly not on track to get you to actually understanding the stuff you are so interested in understanding.

          2. Andrey Pavlov says:

            Dang, screwed up the link:

            Yeah, well, that’s just like, your opinion, man

          3. Andrés says:

            It seems that I have touched a nerve, haven’t I? Seriously, I don’t try to be impolite.

            I have already conceded the obvious, that you are vastly more educated than me on most subjects dealt on this blog. The problem resides in that there are people with enough background on human biology and medicine that reviewing the literature deeper than you has come to a different prior probability about (for example) vitamin C therapy than yours. Those are Dr. Hemilä (I will try to point out several worse statements when I have a little time), Hickey and Roberts and Dr. Levy.

            Dr. Pavlov said:

            And seriously, what on earth is your purpose here Andres?

            As I have already said I wouldn’t bother to comment around here if this blog were called “SCAM Bashing”. This blog is called Science Based Medicine. I think that the Science part obliges to higher standards of refutation than simply hand waving those results you don’t like.

            Dr. Pavlov said:

            And you have the hubris to come here and try to tell me – and others vastly more qualified than even myself – how research methodology on sepsis is supposed to work and how bacterial septicemia in critically ill patients is related to a case series report on a viral infection on young outpatients done 70 years ago are related?

            Well, it bothers me that it is no one’s responsibility to check once and for all if vitamin C in high enough doses given intravenously as defended by late Dr. Klenner is a highly efficient antiviral/(adjuvant)antibacterial/antitoxin. I see highly unlikely (but possible) that Dr. Klenner was a deluded individual arriving to the conclusion that vitamin C was a great antiviral but mostly ineffective as antifungal for example. It being true would be consistent with everything (not so much) I have read about intravenously delivered vitamin C including the Vandy study. I would like to have results stratified by delivery route been published so I could see if the positive results are associated with intravenous route or not. What bothers me is the quick approach everyone else takes of dismissing everything about vitamin C that doesn’t fit with your world view. What bothers me is that no one shows any curiosity about that Expected Deaths group NNT of 2.13 and RR of 0.47 that may be pointing out to a distinctive intravenous route effect and not to it have been brought up by sheer chance.

            I have no ego to protect. I have been wrong before and I will go where the scientific method (not speculation) will lead. I don’t wait to have complete information to act though.

            Where do my hubristic self come from? I have arrived to the painful conclusion that I have been the credulous tool in harming several of my most near, dear kin by following professional medical (and nutritional) advice blindly. Whenever I now get positive results (that doesn’t proof anything) it strengthen my old guilt. I don’t dodge it. I trust guilt and doubt to keep my mind sharp. Dumb as it may be, it is the one I have. Of course I experiment first on myself. I don’t implicitly trust expert advice anymore, sorry. Moreover in those cases where there are dissenting voices of other MDs. While I keep getting positive results I am precluded from stopping.

            Dr. Pavlov said:

            I know English is not your first language, but the point Dr. Gorski was making is that the evidence doesn’t exist. That the increase in prevalence is almost entirely explained by broadened criteria and improved surveillance.

            What we can say is that if it is a real increase in prevalence, it is a tiny minority of the cases.

            I don’t think likely that those autistic cases severe enough to show IQ lower than 70 had been missed before. My critique stands.

            Dr. Pavlov said:

            And considering that the diagnosis of autism can be made as early as 6 months and there is increasing evidence that it is very predominantly a genetic condition that begins early in gestation, it is extremely unlikely that there are environmental factors that have a significant influence which further makes it unlikely that the aforementioned gray area is a true increase in prevalence.

            You haven’t read even (Patrick and) Professor Bruce Ames’ paper abstract, have you?:

            The proposed mechanism explains 4 major characteristics associated with autism: the low concentrations of serotonin in the brain and its elevated concentrations in tissues outside the blood-brain barrier; the low concentrations of the vitamin D hormone precursor 25-hydroxyvitamin D [25(OH)D3]; the high male prevalence of autism; and the presence of maternal antibodies against fetal brain tissue.

            Paraphrasing Warren Buffett:

            Only when vitamin D deficiency gets a hold do you discover who’s been having faulty genes.

            I stand by my completely nonsensical prudent approach. As a matter of fact it is not mine, it is Dr. Cannell’s one.

            1. WilliamLawrenceUtridge says:

              there are people with enough background on human biology and medicine that reviewing the literature deeper than you has come to a different prior probability about (for example) vitamin C therapy than yours. Those are Dr. Hemilä (I will try to point out several worse statements when I have a little time), Hickey and Roberts and Dr. Levy.

              What’s that saying by Huxley? “Science is organized common sense where many a beautiful theory was killed by an ugly fact”. See, the thing is – all their review of the literature is useless if they ignore contradictory evidence; for instance, vitamin C does not reduce the duration of the common cold, does not treat cancer, and the facts seem to support little to no use for high doses of vitamin C beyond perhaps in those running a marathon in the high arctic in the middle of winter. So Drs. Hemlia, Hickey, Roberts and Levy may have beautiful theories about why vitamin C is a miracle, but actual testing seems to refute them.

              I think that the Science part obliges to higher standards of refutation than simply hand waving those results you don’t like.

              Am I the only one who finds this rather hilarious coming from Andres?

              I would like to have results stratified by delivery route been published so I could see if the positive results are associated with intravenous route or not.

              See…when you get a negative result, and your response is to ask for subgroup analysis and stratification, it really just looks like you’re moving the goalposts. Put another way, if you have to say “sure, this study didn’t support my hypothesis, but if it were designed properly then it would have”, you’ve basically just conceded that your beliefs are based on ideology, not evidence.

              I mean, at least it’s high-dose vitamin C, not laetrile, but still – recommending IV ascorbic acid is not warranted at this point for any condition. Further, it doesn’t seem to be particularly promising either.

              I have no ego to protect. I have been wrong before and I will go where the scientific method

              If you’re chasing method at the expense of recognizing results, that’s not a feature, that’s a bug.

              I have arrived to the painful conclusion that I have been the credulous tool in harming several of my most near, dear kin by following professional medical (and nutritional) advice blindly.

              So…you’re allowing a personal emotional experience over-ride your willingness to listen to empirical results? At least you admit it.

              I trust guilt and doubt to keep my mind sharp.

              And what if that guilt is paradoxically causing confirmation bias? What if you chasing down “if only” you end up chasing down blind alleys and ignoring contradictory data?

            2. Andrey Pavlov says:

              It seems that I have touched a nerve, haven’t I? Seriously, I don’t try to be impolite.

              No, you aren’t impolite. Which is why I have bothered to continue responding to you. What you are doing is science wrong and refusing to learn why.

              The problem resides in that there are people with enough background on human biology and medicine that reviewing the literature deeper than you has come to a different prior probability about (for example) vitamin C therapy than yours. Those are Dr. Hemilä (I will try to point out several worse statements when I have a little time), Hickey and Roberts and Dr. Levy.

              You are doing steps 1, 3, 4, and 5 rather well.

              Picking a few esoteric examples of people with differing opinions does not make your case. Did you know that there are people who disagree with climate change and evolution? And that these people are published and have letters after their name? Perhaps we should be trying to prove them wrong, since their hypotheses haven’t been tested sufficiently?

              This blog is called Science Based Medicine. I think that the Science part obliges to higher standards of refutation than simply hand waving those results you don’t like.

              There has been no handwaving Andres. There has been significant careful discussion and reviews of the literature, including discussion of basic physiology and biochemistry. All that despite the fact that it wouldn’t be unreasonable to actually handwave such incredibly minority and fringe ideas anyways.

              Well, it bothers me that it is no one’s responsibility to check once and for all if vitamin C in high enough doses given intravenously as defended by late Dr. Klenner is a highly efficient antiviral/(adjuvant)antibacterial/antitoxin. I see highly unlikely (but possible) that Dr. Klenner was a deluded individual arriving to the conclusion that vitamin C was a great antiviral but mostly ineffective as antifungal for example.

              And this, right here (plus the Vandy trial) are why you are doing science wrong. You try and indict us saying we aren’t doing science based medicine and yet you still can’t wrap your head around why this proposition of yours is completely and utterly unscientific. A single, uncontrolled experiment done 70+ years ago, with admitted errors in experimental measurement and design is not suddenly the definitive gold standard that must be disproven. The fact that you can’t seem to get that is beyond me.

              It being true would be consistent with everything (not so much) I have read about intravenously delivered vitamin C including the Vandy study.

              No. No. N. No. NO. NO. NO. NO. Is that enough Noes?

              Klenner’s work and the Vandy study have absolutely nothing to do with each other. They are completely different in every way imaginable except that they both used VitC. You may as well be saying that an experiment in mitochondrial function should be related to the LHC because electrons are moving around in both of them. I’m not even going to waste my time explaining yet again why this is completely and utterly wrong. It is clear you have no desire (I believe you have the capacity) to understand this.

              What bothers me is that no one shows any curiosity about that Expected Deaths group NNT of 2.13 and RR of 0.47 that may be pointing out to a distinctive intravenous route effect and not to it have been brought up by sheer chance.

              What the actual f$%^? Both MadisonMD and I have clearly expressed interest in these findings. We both agreed that it is an interesting pilot study worth following up. As someone interested in sepsis and critical care medicine, I would be very interested to see if I could administer IV VitC to my septic patients to benefit them.

              What we are saying is that this is completely different to anything else you are trying to say and has absolutely no applicability to Klenner’s work or to the notion of supplementation in non-critically ill individuals. Which you, once again, refuse to wrap your head around.

              I have arrived to the painful conclusion that I have been the credulous tool in harming several of my most near, dear kin by following professional medical (and nutritional) advice blindly. Whenever I now get positive results (that doesn’t proof anything) it strengthen my old guilt. I don’t dodge it. I trust guilt and doubt to keep my mind sharp. Dumb as it may be, it is the one I have. Of course I experiment first on myself. I don’t implicitly trust expert advice anymore, sorry.

              At least your motivations are clear. The problem is that you are letting them prevent you from actually following science and doing the scientific process properly. You may not wish to trust expert advice, but you do not have the ability to do better yourself.

              I may have been injured by an auto mechanic doing poor work on my car and no longer wish to deal with them anymore. But that doesn’t magically qualify me to do the work myself.

              I don’t think likely that those autistic cases severe enough to show IQ lower than 70 had been missed before. My critique stands.

              No, it doesn’t. Drs. Gorski and Novella have both demonstrated quite clearly why. I won’t rehash it, save to say that, yet again, you aren’t doing it right.

              I stand by my completely nonsensical prudent approach. As a matter of fact it is not mine, it is Dr. Cannell’s one.

              As I said above, why don’t you choose to stand by Dr. Georgia Purdom’s approach to evolutionary biology?

            3. Andrés says:

              @MadisonMD: Since comments to the measles post are closed now and we are still talking about the Vandy study I will post here my response to you and Dr. Pavlov too.

              WLU said:

              See, the thing is – all their review of the literature is useless if they ignore contradictory evidence; for instance, vitamin C does not reduce the duration of the common cold, does not treat cancer

              Specially Hickey and Roberts are very thorough with their (and late Dr. Cathcart’s) dynamic flow model trying to encompass all of the evidence available. Perhaps they are wrong but certainly they haven’t dodged the subject. As a matter of fact even a maximum of 8g/day of orally delivered vitamin C shortens the common cold duration.

              I am not so convinced about its effectiveness on cancer though, as I have already said.

              WLU said (my bolds):

              See…when you get a negative result, and your response is to ask for subgroup analysis and stratification, it really just looks like you’re moving the goalposts.

              You are talking about the Vandy study. It was a positive study even before adjustment for confounders (my bolds):

              Mortality was significantly lower in the AO+ group (6.1% vs 8.5%, P = .001), translating into a 28% relative risk reduction for mortality in patients exposed to high-dose antioxidants. After adjusting for age, gender, and probability of survival, AO exposure was associated with even lower mortality (OR 0.32, 95% CI 0.22-0.46). Patients with an expected survival <50% benefited most (OR 0.24, 95% CI 0.15-0.37).

              I asked for more information because they were not consistent with the delivery route of vitamin C (my bolds):

              Ascorbic acid was administered as a bolus over 1 hour (0600-1400-2200 time schedule) and selenium as a bolus over 2 hours (1000 time schedule), although both were permitted to be changed to an enteral dosage form once enteral access was established.

              I wasn’t lucky though. I always prefer information to the lack of it.

              WLU said:

              And what if that guilt is paradoxically causing confirmation bias?

              Possible. But there enters doubt. I am keen on revisiting toxicity symptoms of vitamin D and selenium for example just to feed it. Anyways, not all of what I try has the expected outcome as I have already said.

              Dr. Pavlov said:

              You are doing steps 1, 3, 4, and 5 rather well.

              Point 1:

              First, cast doubt on the science.

              No, there is no negative intravenously delivered vitamin C intervention where to cast doubt upon that I am aware of. Point 3:

              Third, magnify genuine disagreements among scientists, and cite non-experts with minority opinions as authorities.

              I suppose the burden of this point is on the non-experts part, because it being a minority opinion has nothing to do with its unrefutedness state. Point 4:

              Fourth, exaggerate the potential harm caused by the issue at hand.

              If it is effective it has no potential harm but only past (by omission) one. If it is not effective it has neither. Point 5:

              Fifth, frame issues as a threat to personal freedom.

              I don’t see my personal freedom jeopardized yet. Even if vitamin C got banned as a supplement I could get it by starting up a bakery.

              Dr. Pavlov said:

              Did you know that there are people who disagree with climate change and evolution?

              I am not convinced that Earth’s climate change (it is not static) is driven mainly by our impact. I have no doubt that the acidifying of our oceans is our fault though. So we would agree in the CO2 problem anyways. I don’t think an intelligent conversation is possible with someone negating evolution though.

              Dr. Pavlov said:

              Klenner’s work and the Vandy study have absolutely nothing to do with each other.

              Perhaps I haven’t been precise enough in some of my comments. When I am comparing the Vandy study with Klenner’s work I am referring to all of his clinical experience using mainly intravenously delivered vitamin C that he concluded was a efficient antiviral, efficient antitoxin and a good adjuvant as antibacterial.

              Dr. Pavlov said:

              There has been significant careful discussion and reviews of the literature, including discussion of basic physiology and biochemistry.

              and:

              You do realize that the only difference between IV and oral administration of any drug is the bioavailability? And that achieving and equivalent serum value will produce equivalent outcomes regardless of route of administration?

              We are arriving to the heart of the matter. Of course achieving an equivalent serum value should produce equivalent outcomes. Ironically I think that the Vandy study is the only one (apart clinical experience by Drs. Klenner, Cathcart and Levy) with (unprocessed) mixed data about both routes of delivery. It seems that models of oral vitamin C absorption are usually optimistic. From Pharmacokinetics of Vitamin C: insights into the oral and intravenous administration of ascorbate (the file doesn’t show μM but M alone):

              Model-derived overprediction of plasma ascorbate concentrations with respect to the observed ones in several different literature reports could be the result of incomplete absorption of administered vitamin C at daily doses higher than 200 mg (1.1 mmol). Otherwise, it could also be a result of inappropriate timing of actual measurements.

              For example in the paper by Long et alter they explained how they selected the parenteral dose:

              The 3000-mg ascorbic acid level was selected based on a 30% absorption of an oral megadose of 10 g/day [26].

              This [26] is the paper by Hornig et alter stating:

              A male non-smoking volunteer increased his daily intake of ascorbic acid continuously by ingesting in a single, oral dose 1, 2, 3, 4 and 5 g crystalline ascorbic acid.

              The urinary excretion of unmetabolized unlabelled ascorbic acid per day was taken as index for the absorption of ascorbic acid. It decreased from 75% (1 g), 44.0% (2 g), 39%, (3g), 28% (4 g) to 20% (5 g) of the ingested ascorbic acid.

              These data are about a healthy individual. Clinical experience of Dr. Cathcart points toward quite different dynamics under illness. I will look for published data about it.

              I said:

              What bothers me is that no one shows any curiosity about that Expected Deaths group NNT of 2.13 and RR of 0.47 that may be pointing out to a distinctive intravenous route effect and not to it have been brought up by sheer chance.

              and Dr. Pavlov answered:

              What the actual f$%^? Both MadisonMD and I have clearly expressed interest in these findings.

              I am explicitly talking about the Expected Deaths group results. I think that delivery route data should be cross checked with mortality outcomes. The petition to the authors would have had more possibilities of been considered favorably if issued by some MD dealing with ICU/infection patients such as either Dr. Crislip or yourself.

              MadisonMD said:

              Andres, you place an awful lot of faith on a single non-randomized trial of a drug without mechanism.

              I think that its effectiveness should be checked first. If positive we may clarify why afterwards.

              Nevertheless there was some hypothesis about its mechanism behind the Vandy intervention:

              Despite the continuing improvements in resuscitation and overall delivery of care in critically injured patients, many who survive their initial injury will often succumb to multiorgan dysfunction (MOD). Though the mechanism of MOD has not been completely elucidated, there is good evidence that reactive oxygen species generated from ischemia/reperfusion injury play a significant role.

              From my point of view it is not important if it is the correct one or not though.

              MadisonMD said:

              Imagine how many similar trials went unpublished due to negative results.

              Possible but unlikely. They should have surfaced by now even just as letters to the editor of the Vanderbilt study. Moreover, even before adjusting for confounders as age, gender and probability of survival the reduction for mortality in the AO+ group (6.1%) versus the retrospective control (8.5%) had a p-value of 0.001.

              1. Andrey Pavlov says:

                I won’t go through this in detail since it is all a dog chasing it’s tail with you. A few points of note, however:

                As a matter of fact even a maximum of 8g/day of orally delivered vitamin C shortens the common cold duration.

                Yes, and we’ve discussed (as you linked) why this is not the case. Shortening a cold by 6ish hours is meaningless and is nothing more than noise in the study. Period.

                You are talking about the Vandy study. It was a positive study even before adjustment for confounders (my bolds):

                No. WLU was correct. You ignore the negative studies and focus on the positive ones, regardless of whether they are actually applicable to the topic at hand. Like you just did again with the Vandy study.

                I am not convinced that Earth’s climate change (it is not static) is driven mainly by our impact. I have no doubt that the acidifying of our oceans is our fault though.

                Which further belies your inability to appropriately parse and understand the data. It is about as resoundingly clear that climate change is real and a direct cause of human activities as we can possibly hope to have. You would only be slightly less silly to argue against that as you would evolution.

                If you can’t take something that is as scientifically clear cut, robust, and so universally agreed upon by the relevant experts and accept it as correct… well, no wonder you go on and on about VitC as you do. Pretty much only physics and evolutionary theory have such large and complex models that are as well supported as climate change.

                Perhaps I haven’t been precise enough in some of my comments. When I am comparing the Vandy study with Klenner’s work I am referring to all of his clinical experience using mainly intravenously delivered vitamin C that he concluded was a efficient antiviral, efficient antitoxin and a good adjuvant as antibacterial.

                And that still still has no relation to the Vandy study. What part of “ICU patients are a unique and special population, completely different from other populations, even when they are harboring the same pathogens” is difficult to understand? Nevermind the fact that Klenner’s work is weak evidence at best.

                I am explicitly talking about the Expected Deaths group results. I think that delivery route data should be cross checked with mortality outcomes

                Uh, so are we buddy. And doing the cross check that you want would be yet another sub-group analysis that would be even less well powered and even more prone to spurious results. It would be nigh impossible to demonstrate any actual difference given the study limitations in respect to that analysis.

                Imagine how many similar trials went unpublished due to negative results.

                Possible but unlikely.

                Actually extremely likely. That is why Ben Goldacre is leading the OpenTrials campaign. That is why there is article after article about publication bias. That is why Ionnidis is able to demonstrate that 50% of published literature is wrong (even higher in neurosciences). The fact that you think it is unlikely further belies not only your lack of knowledge on the topic but a fundamental lack of understanding about how the enterprise of research works. People are not going to make an effort to send their failures to someone who (seemingly) has a success. And even if they were so inclined, in many cases there are non-disclosure agreements in place that prevent it (depending on the source of the funding). You are very naive on this topic, Andres.

                probability of survival the reduction for mortality in the AO+ group (6.1%) versus the retrospective control (8.5%) had a p-value of 0.001.

                Which still has an actual error rate of 1.8% at a minimum. As I said, still worth following up since that is actually pretty darned good. But far from conclusive of anything except that another study (not a replicate, not more subgroup analysis from the existing study) is warranted. That’s it. It tells us nothing more useful than that.

              2. WilliamLawrenceUtridge says:

                Andres, the fact that you have to cherry pick studies and experts really, strongly suggests that you’re wrong. Maybe you’re right, but I have to wonder about the lack of signal in the noise. At least you sort-of admit it, but continuing to cite islands of isolated results in the sea of unrelenting negativity doesn’t impress me. Not that you’re trying to, but still – I object to your approach.

  20. Peter H.Proctor, PhD, MD says:

    Poster “Gleevec” comments on another Dr Chat group when I brought up the subject of Riluzole, Dr.Gorski’s drug.

    “@pproctor- They didn’t use RECIST or any of the traditional measures, maybe because the trial is too small. Either way worth investigating in phase 1 and phase 2, but if I had a dollar for each of these promising phase 1 (or 0!) trials that flamed out in phase 3, I would could retire now!”

    “@pproctor– can’t imagine any self-respecting oncologist using this off label based on this phase 0 (not even phase 1) data. All it takes is 1 patient to get dizzy off the rilozole and fall down stairs and your career is over.”

    My reply: “I agree. Just pointing out something promising that somebody (not me) could use “off label” for melanoma.”

    BTW, I am semifamous in melanoma research. See: http://smithsonianchips.si.edu/proctor

    1. David Gorski says:

      Riluzole is already being tested in a clinical trial against melanoma.

      http://clinicaltrials.gov/ct2/show/study/NCT01303341

      1. Peter H Proctor, PhD,MD says:

        Yes, I understand that Riluzole is currently in trials. Just making a point about “alternative medicine” and a great gray area. BTW, the above interchange is on Sermo.com, where “Gleevec” is considered something of a crank.

        One more targeted anticancer drug. Moreover, specific for a target (the EAA system) that in the CNS acts by oxidative signaling. So well-characterized MOA, entirely-consistent with what we now know about redox control of the cancer process.

  21. Bree says:

    I know I’m a little late to the party with this post, but I have been lurking here for 2 years and this article has moved me to respond.

    Just over two years ago I had a medical problem come on suddenly and was miserable. The doctors couldn’t make a diagnosis with vague abdominal symptoms, but I heard ulcer, gastritis, IBS, functional dyspepsis, and reactive gastropathy thrown around. My family doctor was happy to prescribe anything i asked for for the nausea, a high dose PPI and T3′s for pain. That soon got old as lots of tests were done, and I still felt like crap. Being in Canada, I am still waiting for an MRI while taking a PPI twice a day.

    I got drawn in to the whole ‘Doctor’s only treat symptoms, not the root cause’ line of thinking and went for acupuncture. It worked for the nausea (placebo, I know) and I was angry that my doctor hadn’t recommended it in the first place. I thought if an alternative remedy is available and backed by Health Canada, it must be safe and effective. Then I started looked at other alt med rememdies and bought supplements and even thought about going to see a naturopath. I was going to try the ‘alkaline diet’ too.

    Then I came across this site and was drawn in by the quality of the articles. I have always had a scientific mind, but for some reason my critical thinking skills went out the window when I got sick. I had no idea about the lack of evidence for all the alt med stuff out there and I was particularly horrified that I was being drawn in to it. The science presented here is so pure it can’t be argued with. I dumped all the supplements I bought (did nothing anyways) and will happily take my PPI until I can have and MRI because my doctor has based his treatment on the best available options.

    I started sharing the articles here with my mom as she was big into alt med with detox diets, gluten free diets (not a celiac). She has seen the light, so to speak, and is so proud when she can point out any alt med red flags (one treatment cures all diseases, and so on). I am now sharing information with my aunt who is amazed by foot detox baths.

    The scary thing is I was a nurse. I had the medical training and knowledge to recognize a scam. In school, we did have classes on alt med and we were encouraged to tell our patients to seek alternative therapies if we thought it would help them. I’m horrified looking back on that now. Every single student, even the teacher, supported alt med.

    So to Dr. Gorski and all the other writers here, you are making a difference. I shudder to think what altie stuff I would have gotten into if I had never found this site.

    1. Andrey Pavlov says:

      I am sorry to hear of your medical troubles Bree. I can only imagine how frustrating it must be. Actually I also have a tiny bit of insight – I also developed a problem with my gut back in my first year of med school. I ended up in the ER with bloody diarrhea. Since then I’ve had MRI/MRA, CT angiograms, and been worked up by a number of physicians. No diagnosis, but at least I know it is nothing that will lead to my early death. It is also frustrating because it is brought on by exercise, so I cannot exercise as strenuously as I used to. It is also capricious – sometimes I can run or cycle just fine, sometimes I barely make it 1km before I am very literally crippled and cannot continue. Twice I tried pushing past it and was in agony and then even eating caused me severe pain; to the point where I was curled up with tears streaming down my face after dinner. I have some plausible stories that may explain it, but nothing definitive and certainly no treatment options available. However, knowing that I have exhaustively ruled out anything deadly or sinister has given me peace of mind. From there it is just the realization that, to whatever extent it manifests itself, I must simply adjust my lifestyle accordingly and manage it. That, to me at least, is comfort in and of itself. I feel like I would go mad trying to go from one alt-med “therapy” to another ad infinitum. And, of course, me being the kind of person I am if I did something and the pain went away I would be forever wondering if it really did have some effect or if it was just random correlation.

      But really, I wanted to thank you for sharing your story. I can assure you that it heartens me and I would be willing to bet the others here as well.

      Best of luck and I hope your condition departs as suddenly as it came (and soon!)

  22. EBMOD says:

    I just wanted to point out that there is a very real and personal sadness to this for me, and I’m sure for many others who believe in a rational approach to medicine. My own sister is a die-hard anti-vax/SCAM supporter. I myself am in the medical field. This issue is one that I wish could be resolved through simply talking through the evidence and logical pitfalls, but this post sums up well that our two sides have a very different mental picture of the other.

    With my sister, I view her as a bit naïve and prone to logical fallacy. I don’t consider her evil, or conniving, or conspiring to take away people’s health for profit. Yet that is how WE are perceived.

    I gave up a long time ago in trying to talk to my sister about these issues; I have a niece and nephew who are unvaccinated and for a while I tried quit ardently to convince her that vaccination is a safe and advantageous. They are currently living in an area of the nation with one of the lowest rates of vaccination and I am worried that my neice and nephew will suffer if a pandemic of any sort starts.

    So coming full circle, it makes me extremely sad that many of the people I love and care about simply can’t be reasoned with. We can’t sit down and go over things and come to a mutual understanding as long as their belief is based on conspiratorial ideation that implicates us as actively being evil.

Comments are closed.