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How to Talk to People About CAM

Recently a correspondent asked me for advice about his parents. He said they use things like homeopathy, acupuncture, and copper bracelets. They use conventional medicine too, but it seems to be a 50/50 approach that gives each an equal weighting. He has tried to talk to them about things like homeopathy and the placebo effect, but the shutters come down hard and fast. He tries to criticize the alternative treatment itself without offending or attacking the person, but his mother still sees it as a personal attack. He worries that as they get older and in need of more medical care, his parents may not make the best decisions. He asks about how to tactfully have these conversations and perhaps change their point of view.

That’s a very tough question that gets asked a lot, and I don’t have any good answers; but I do have some thoughts and untested ideas that could serve as the starting point for a discussion, and I hope readers will pipe up in the comments and tell us what has or hasn’t worked for them.

In the first place, you can’t change another person’s mind. They can only change it for themselves. If you can get them thinking to where they have an “Aha” moment and realize something for themselves, that’s far more effective than trying to tell them. I bet Socrates would have been good at that, but I’m certainly not. I did succeed once by accident. I had written an article about acupuncture in Skeptic magazine, and an acupuncturist wrote to me afterwards. He said:

Your article about acupuncture made me angry. I thought that you had to be wrong because (of course) I had heard about so much research about the evidence for acupuncture… got me to actually look at the literature instead of just ‘knowing’ that it exists. In trying to prove you wrong I proved myself wrong. One textbook made a claim that acupoint such and such is good for stimulating the pituitary to produce anti-diuretic hormone for patients with polyuria. I thought, “wow that’s really interesting I wonder where the reference is.” I looked for a reference and was struck by the fact there were no references at all anywhere in the book for any of the claims.

I have gradually let go of the belief that acupuncture has any basis for treating anything.

He decided to change his occupation to something based on reality. He was a rare person to be able to question the basis of his livelihood and change his mind in response to facts. All I did was create an opportunity (by making him angry) for him to think for himself.

You can’t change a person’s mind with science if their beliefs were not based on science in the first place. They may not understand or trust science. We are tempted to think that if someone only knew the facts as we know them, they would have to agree with us; but it doesn’t work that way. Instead of throwing science at them, you might try to understand their thinking. How did they come to form those beliefs? Can you trace the thought processes that led them to use CAM? Is CAM filling some emotional need for them? Does it give them hope? Do they feel frightened and helpless in the face of seemingly unpredictable disease? Do they “need” to believe that they can have some degree of control over their own health? That they can control their own fate rather than submitting to the whims of kismet? Did they have a bad experience with an MD? Are they rebelling against a medical system that betrayed them in some way? Are they frustrated because conventional medicine can’t offer a cure or complete relief of their symptoms? Did they have side effects from pharmaceuticals? Do they like to try new things and experiment? Do they hate to be told what to do? Do they have a knee-jerk rebellion to any source of authority? What have they been told about CAM? Were they influenced to try CAM by someone they trust implicitly? Do they have some basic misunderstandings of anatomy or physiology? Do they have any understanding of the many ways our minds tend to lead us to falsely conclude that a bogus treatment works? Unless you can get inside their head and understand how they think, what experiences they have had, what they don’t know, and what they know that isn’t so, it’s hard to communicate on a common level.

Do they have good critical thinking skills about other subjects? It might be useful to ask if there any kind of quackery they reject. If so, you could ask them to explain why they rejected that one but don’t reject others. Do they make fun of any of the late-night TV infomercial scams or laugh at advertisements for miracle products that make promises too good to believe? Do they distrust used car salesmen? Do they know anyone who has been victimized by a con artist? Are they skeptical about anything like Bigfoot, psychics, 9/11 conspiracy theories, AIDS denialism, anti-vaccine propaganda? Would they accept a subscription to either of the magazines Skeptic or Skeptical Inquirer to read about the things they are skeptical or curious about? That might incidentally expose them to articles about things they are not currently skeptical about. Do they accept the advice of Consumer Reports for buying cars and appliances? Would they read Consumer Reports on Health?

I had an illuminating experience involving dowsing. I met a man who firmly believed in it, and I lent him the book Water Witching USA, by Evon Vogt and Ray Hyman, which explains all about the ideomotor effect, the forces acting on a forked stick, proof that the dowser is moving the stick without realizing it, the tests that have repeatedly and consistently shown that dowsing doesn’t work, the psychology of belief, etc. It’s a skeptical classic. I naively expected him to give up his belief when he read the same facts that had made me reject dowsing. We were scheduled to give a public presentation with him on the Pro side and me on the Con side. I was dumbfounded when I realized his presentation boiled down to only two arguments: he had seen it work, and lots of other people believed in it. I presented a summary of the information in the book, but no one was impressed. One woman commented afterwards, “I wanted to hear more about how it works and less about how it doesn’t work.”

I know better now. Facts and rational arguments have no effect on a true believer. People hear only what they want to hear. Most people refuse to listen to anything that contradicts their beliefs. Their confirmation bias accepts only confirming evidence to protect their ego from having to admit they were wrong. And there’s a real danger in arguing with them. They will come up with rationalizations that allow them to reject everything you say, and that only serves to reinforce their beliefs. They come out of an argument believing even more strongly than when they went in.

You could tell them that you are willing to change your mind, and explain what it would take to make you change your mind and accept that a CAM treatment was safe and effective (Essentially the standards for scientific proof: positive scientific studies that are well-designed and replicated, leading to a scientific consensus of experts based on a critical evaluation of all the published evidence; with more rigorous standards of proof for treatments that don’t have a plausible mechanism of action). Then you could ask them what it would take to make them give up their belief: what kind of evidence would convince them? What if several well-designed new studies found strong evidence that it didn’t work? I’ve had people say that couldn’t possibly happen, because it works. End of discussion.

If you read about someone who was harmed by X, it wouldn’t hurt to share the information as long as you preface it with something like “I read this and it made me worry about you. I’m not asking you to stop using X, but I know you care about me and how I feel, and I wanted you to understand why I feel this way and why I’m so concerned.”

Drops of water can eventually wear away stone, and they may also hear criticism of CAM from other sources and eventually begin to doubt some of their beliefs. You may be planting a seed that others will water and eventually a sprig of doubt may sprout.

There is hope. On both Quackwatch’s Healthfraud discussion list and in the SBM comments, quite a few people have said that a constant exposure to fact and logic on those websites had gradually had an impact over time. They said that they had learned how to think more critically about CAM and had given up prior beliefs.

Some people are true believers who will never change their minds. There’s really nothing we can do to alter their religious-like beliefs, just as you couldn’t expect to argue a Catholic or a Muslim out of their beliefs and into atheism. But lots of people are fence-sitters; they may not really have thought seriously about the subject before, or they may have heard arguments on both sides and still be undecided. If they haven’t irrevocably made up their minds, they may listen to what we have to say.

There’s a flip side to this question. If you have cancer, how do you answer well-meaning friends who want you to stop your chemotherapy and try their brand of snake oil instead? You can’t very well say you think their advice is stupid. How can you reject their advice without damaging the friendship? Is there some diplomatic sound-bite answer we could keep in mind for those occasions?

When talking with a loved one, it’s important to emphasize that you love the person and only hate what they are doing, and it’s important to help them understand why you are worried about them. Let them know that you will have to agree to disagree, but that you respect their right to make their own decisions, and that you will continue to love them and support them no matter what they decide or how unhappy it makes you.

Conclusion

As I said, I don’t have answers, just thoughts and suggestions. Maybe you can help. Let the discussion begin!

Posted in: Science and Medicine

Leave a Comment (136) ↓

136 thoughts on “How to Talk to People About CAM

  1. MargieM says:

    I agree that you can’t change peoples minds, but take opportunities to propose an alternative view. For example a friend who is very susceptible to CAM is reading a newspaper and sees an ad for a supplement. She says “oh my goodness I might be deficient in this nutrient, I must go buy it!” I respond: “please don’t worry, they are just making you afraid as a ploy to sell you the supplement,” I know she won’t stop believing, but at least I may have saved her some money on that occasion. On another occasion I fought with a friend when I said I didn’t believe in homeopathy, she said “Well I saw a homeopath and got better!” It really is similar to religious belief.

    I have a chronic illness and have come up with a strategy to deal with unwanted advice. Simply: “Thank you for your concern, I trust my medical team and they have informed me of all my treatment options.” and an optional addition “I will ask them about the treatment you suggest” The last part might be a lie. It is of course essential that ill people do find a medical team they can trust

    I also made a list of friends and family who I can speak to without them pushing quackery on me and people who I should avoid speaking to about my illness. Its difficult because my illness is quite visible so CAM people expect me to try things to fix it. Its a little sad I no longer feel it is safe to share my troubles with some significant people in my life, but noticing the people I can trust has helped me feel less isolated.

  2. MargieM says:

    On a humorous side note, my subconscious seems to have not resolved this dillema, last night I dreamed my brother was telling me about a serious symptom he was having and that he didn’t need to see the doctor because he was treating it with yoga. I woke up furious.

    I was further horrified and flabbergasted the other day when hearing about a hippy friend who walks around the inner city barefoot and was limping because he’d stepped on glass. Apparently he didn’t want to go to the doctor because he believes his body will “absorb the glass”

    Sometimes perhaps we should rely on natural selection to deal with these things.

  3. I think another very important thing to consider is peoples egos. They may ultimately be willing to give up on a failed and falsified belief, but find it hard due to the judgement they might experience or feel like they are going to experience from others after they previously have put themselves out there (often proudly) as a proponent of prior woo. These people should be made to feel comfortable in the transition.

    1. Iolaire says:

      This is a good point, because it can be your entire social life, not just your ego, that is hard hit in the process. Some adverse judgement is inevitable, and it isn’t comfortable.

      I was once involved in a fairly innocuous form of woo, but when I returned to the real world (it was essentially the same process that Harriet’s acupuncturist went through), my former colleagues and a lot of my friends were not only extremely angry but refused to talk to me any more. In the long run this has turned out to be a good thing, but it was very upsetting at the time.

      For these people, belief in woo was an essential part of belonging to their particular social group. Anyone expressing disbelief or dissent automatically became One of Them, rather than One of Us. It was quite frightening to have former friends suddenly start treating me like an alien, just because of this one thing.

      I did try to talk about why I’d changed my mind but nobody was willing to listen, let alone think.

  4. I get to talk on this topic often – what exactly is integrative holistic medicine? How does it complement standard medical care?
    It’s a question that is often asked by patients, their relatives, students of the medical arts.
    IHM is more than medicine, it’s a framework for a healthier way of life :

    - Vis Medicatrix Naturae: Holistic medicine identifies and removes obstacles to healing and recovery, facilitates and enhances the inherent ability of the body to repair damage.

    - Tolle Causam: The holistic approach will identify the underlying causes of the disease not just suppress the outer symptoms, The search for the true cause of disease must be thorough before a treatment can start.

    - Primum non Nocere: Holistic physician will first and foremost seek to avoid causing harm, by using treatment therapies and substances with minimum impact necessary to aid the healing ability of the body.

    - Integram Sanitatem: The holistic physician will take into account the health status of the entire body, the environment and lifestyle of the patient not only the particular ailment the patient came to complain about.

    - Praeventionis: Integral holistic medicine puts a strong emphasis on prevention of diseases before they occur. We are interested in health care, not disease management.

    Other medical schools practice some of the above principles, but integral holistic medicine puts it all together in a seamless framework of healthcare that is more than treatment, its a way of life. This is what makes us different.

    1. oldmanjenkins says:

      “- Primum non Nocere: Holistic physician will first and foremost seek to avoid causing harm, by using treatment therapies and substances with minimum impact necessary to aid the healing ability of the body.”

      Bwahahahahahahahaha!!!!!!! Minimum impact, yeah that’s the ticket. Well they are successful as their “therapies” will have no impact on any real or imagined disorder.

      How about this one: “caveat emptor” which should be placed in a very visible manner on anything a holistic “physician” plans to do.

    2. Naming everything in Latin doesn’t make it true.

      1. Lytrigian says:

        Omnia dicta fortiora si dicta Latina.

      2. It all sounds better in Latin! what would you rather say,
        Larynx or Lower throat cavity?
        Oesophagus or Gullet?
        Anaesthesia or Loss of senses?
        Ambidextrous or Bothhanded?

        1. windriven says:

          Some people use Latin or Greek to obscure the fact that they’re full of shit.

          1. DayneATC says:

            ….or to make laymen think they know what they’re talking about by using fancy scienc-y terminology. Its not like altmed proponents use specific, broad, and vague language to bring the appearance of credibility while those that actually understand the use and context of such terminology know they’re full of shit….but hey we’re the ones misleading the public right?

        2. WilliamLawrenceUtridge says:

          That’s using specific terminology to name specific anatomical structures, where precision is key, the unique features must be distinguished and the historical use of a separate language allows greater comprehension between specialists. It’s not the same thing as stating or explaining a general principle that is easily understood in English (or Greek in Greece, or German in Germany) and doesn’t need a unique identifier. It’s the pretentions of a failed science attempting to grasp at the window dressings of real science to better market to the ignorant.

    3. WilliamLawrenceUtridge says:

      Medicine generally abandoned a lot of its Latin a while ago in favour of the local language, so it could actually be understood through rational means rather than through false authority. Your points are all mainstream:

      Treat the cause – yup, as best possible this is what real medicine does, often going a step further by recommending prevention (vaccines, regular exercise, adequate nutrition). In cases where the cause can not (yet) be addressed through evidence-based medicine, treatments are focussed on quality of life. What is often meant by disingenuous quacks here, is “I’ll sell you a bunch of crap to address an illness that I made up with a fake cause that doesn’t exist” (yeast overgrowth, adrenal fatigue) or “I’ll claim doctors don’t recommend losing weight and exercising, and pretend I’m somehow being innovative (and sell them some raspberry ketones that haven’t been proven to work but I claim will increase weightloss)”.

      First do no harm – yup, all interventions are accompanied by an empirically-based risk:benefit review. While imperfect since medicine is art as much as science, it still draws upon evidence and clinical trials.

      Whole body – yup, physicians will undertake a differential diagnosis and treatment plan that includes the impact of the disease, and the treatment, on all organ systems that there is evidence of an impact on.

      Prevention – yup, standard recommendations are for a healthy diet, active lifestyle, adequate sleep and minimal stress. In addition, interventions like vaccination and screening tests are strongly preventive.

      “Vis Medicatrix Naturae” actually means “the healing power of nature”. You claim this point is about removing obstacles to healing and facilitating the repair of tissues – well, that’s what medicine does through drugs, surgery and other treatments. Kill the bacteria, prevent the infection, remove or correct the anatomical defect. Not always possible, but nobody claims medicine is perfect and able to deliver solutions to all problems. What you really mean is “I’ll sell you a bunch of roots, twigs and leaves and pretend they’re medicine, even though I don’t know if it works, I don’t know if it contains any active ingredients, and I don’t know if they’ve been contaminated”. This isn’t about “removing obstacles” or “fostering healing”, it’s about you selling unproven crap.

      Your “system” certainly is different, and markets itself as different. The difference is evidence. You don’t have any, or you are parasitic on real medicine.

      1. AnObservingParty says:

        “Vis Medicatrix Naturae” actually means “the healing power of nature”.

        Why on earth do CAM practitioners think they hold the monopoly on “nature?” Paclitaxel, aspirin, vancomycin, penicillin, vincristine, etc are all derived from “nature” in the very same way CAM denies SBM of doing.

        The difference is, those WORK. “You know what they call alternative medicine
        That’s been shown to work? Medicine.”

        1. Who said we have a monopoly on nature? What does that even mean?? Integrative Holistic Medicine is not a product franchise, it’s a methodology framework of medical practice emphasizing harm minimization, preventive measures, search for true causes of disease and focus on whole body health.

          The spinsters love to paint IHM as “anti-science”, this is political spin, Merda taurorum animas conturbit, excuse my Latin.. integrative medicine welcomes science. The difference is in methods and therapeutic approach.

          1. AnObservingParty says:

            You, yourselves assert that. And the ads for supplements and nonsense on many holistic websites show that yes, it is being franchised.

            Merda taurorum animas conturbit Bull$h*t disturbs people, yet CAM throws it left and right. Please show your peer-reviewed evidence that CAM techniques such as acupuncture, homeopathy, etc are not bull$h*t and that you welcome science.

            it’s a methodology framework of medical practice emphasizing harm minimization, preventive measures, search for true causes of disease and focus on whole body health.

            You just described SBM. Again, the difference is, SBM works.

          2. WilliamLawrenceUtridge says:

            it’s a methodology framework of medical practice emphasizing harm minimization, preventive measures, search for true causes of disease and focus on whole body health

            …except it’s not. CAM is based on unproven modalities that are asserted to work. The statements you make describe medicine, and the key distinction is “treatments are tested in well-controlled studies for safety and efficacy before being adopted”. CAM abandons that completely in favour of, whatever sells I guess.

            integrative medicine welcomes science. The difference is in methods and therapeutic approach.

            Integrative medicine welcomes science when it confirms their prejudices. Otherwise, they are uninterested. And when science shows that a “natural” (or unnatural, foreign, genetically modified or any) treatment works, it is adopted as medicine. The difference between integrative medicine is shoddy methods, untested approaches and an abysmally poor standard regarding what qualifies as “good” evidence.

  5. Jeff says:

    This reply has nothing to do with this article.

  6. Chris Hickie says:

    Last week a relative was in the hospital for what should have been a straightforward pediatric admission. I was there most of the time for support, but what we went through was the type of experience that could turn people to this CAM crap. First, a consult that was called as part of the admitting orders never occurred during the 2 1/2 days of hospitalization. DID NOT OCCUR. Instead, we kept getting different stories from the attending and residents and nurses about when and then why it didn’t happen. That no one had the same reason made me suspect no one knew or cared what was happening. Additionally, this was a hospital that does lots of advertising about how great it is and how bright and cheery it is and how they take care of their patients and how child life services are wonderful for the kids. Well, child life didn’t come by once, and due to isolation precautions, this patient was stuck in that room for 2 1/2 days. Now, to be fair, the main goal of the admission (IV antibiotics) was accomplished and the patient is much better–but if I weren’t a physician, I would have been completely pissed and turned off by this whole experience (as it is, I’m still angry). Now picture, instead going to a chiropractor or naturopath or some other quack. They can’t do anything for you but listen and talk–so that is what they do, and it makes people feel that someone cares for them and is taking care of them. This point was driven home the other day when someone told me (not patients of mine) how they saw a “holistic doctor” who prescribed them NAET (“Nambudripad’s Allergy Elimination Techniques” http://en.wikipedia.org/wiki/Nambudripad's_Allergy_Elimination_Techniques) to “cure” their seasonal allergies. What stunned me is the folks telling me I should try this for my seasonal allergies have advance science degrees, yet they still believed this crap works. But they felt like this holistic quack had really spent some time with them on this, and I guess their allergist didn’t.

    In my own practice I’ve reached the point of simply telling parents (if the subject comes up) that there is no scientific evidence in support of homeopathy, chiropractic, naturopathy, acupuncture, etc when it comes up. I tell them this is why I am an allopathic physician and not one of those other things. I tell them I hope they don’t subject their children to those other things. And then I move on with the visit. I don’t have time to debate them on those things, as I’m trying my darndest to be an SBM physician who explains the science behind what I want to do to keep their child healthy.

    1. MargieM says:

      there are pamphlets that helped me as a patient, like this one:

      http://www.senseaboutscience.org/resources.php/11/ive-got-nothing-to-lose-by-trying-it

      I wish more doctors would share this, as I commented in another post, people don’t understand the epidemiology of science, so scientific evidence is not seen as different from anecdotal evidence. Your answer is one many doctors have given me, but I had to do my own research to understand clearly why science based knowledge is superior.

  7. nyudds says:

    This is a good addendum to Harriet’s article. Although it is more politically-based, it can be applied to health care (as it mentions) and several other areas:

    http://www.boston.com/bostonglobe/ideas/articles/2010/07/11/how_facts_backfire/?page=1

    A sample excerpt: “Mankind may be crooked timber, as Kant put it, uniquely susceptible to ignorance and misinformation, but it’s an article of faith that knowledge is the best remedy. If people are furnished with the facts, they will be clearer thinkers and better citizens. If they are ignorant, facts will enlighten them. If they are mistaken, facts will set them straight. In the end, truth will out. Won’t it?Maybe not. Recently, a few political scientists have begun to discover a human tendency deeply discouraging to anyone with faith in the power of information. It’s this: Facts don’t necessarily have the power to change our minds. In fact, quite the opposite. In a series of studies in 2005 and 2006, researchers at the University of Michigan found that when misinformed people, particularly political partisans, were exposed to corrected facts in news stories, they rarely changed their minds. In fact, they often became even more strongly set in their beliefs. Facts, they found, were not curing misinformation. Like an underpowered antibiotic, facts could actually make misinformation even stronger. ”

    We might all feel like Sisyphus each time we try to discuss CAM with true believers, but the efforts continue and don’t we all persevere just to have at least one rock stay at the top of the mountain?

  8. windriven says:

    “Are they rebelling against a medical system that betrayed them in some way?”

    It amazes me that more people don’t flock to the welcoming arms of quacks and posers like Foney Baloney Above. The medical system betrays everyone everyday. Timely appointments with primary care physicians can’t be had. I think 6 weeks* is the best I’ve gotten with my current, very good, internist unless I play the ‘emergency card’ and contact her directly without going through the office. Compare and contrast with your attorney or your CPA. And no, it isn’t just my particular internist. When I moved here I went through a process of getting recommendations, then making appointments and interviewing likely candidates. It took me a year and a half and I was a motivated shopper.

    But hospitals make primary care physicians offices look fabulous by comparison. Go on down to your patient accounting office (speaking to physicians here) and ask to review a handful of random bills. Look at the charges for common devices and medications. Compare and contrast with what you know you would spend at Walgreen’s. If you want to bring health care costs under control, force hospitals to operate with maximum margins on commodities and labor. Keystoning is the general rule in most retail; the regular price is roughly double what the store pays wholesale. Hospitals should also be allowed to recover capital expenditures in much the same way as public utilities earning, say, 8% on investment in physical plant.

    And let’s not even get started on pharmaceutical companies’ marketing excesses.

    We spend nearly double what other countries spend on a health care system that treats patients like unfortunate inconveniences and then we wonder why on earth anyone would go to a naturopath or a chiroquackster. That, my friends, is delusional.
    End rant.

    In My Experience (TM Mark Crislip, MD), the true believers are unmoved by appeals to reason. Others can sometimes be moved by taking them through a tour of other sciences. There is only one electronics. Apple, Sony, Frigidaire and Panasonic all use the same science of electronics for exactly one reason: no other version of electronics produces working, useful products. There is only one aeronautics. Boeing, Airbus, Lockheed-Martin, all use the same science of aeronautics for exactly one reason: no other version of aeronautics produce airplanes that fly reliably and safely. There is only one medical science. The practice of science applies to medicine just as it does to aeronautics and electronics. What is proven to work is medicine. What’s left isn’t. You wouldn’t fly in an airplane that was designed using alternative aeronautics. You wouldn’t buy a cell phone that claimed to work by magical forces. Why would you trust your health, your life, to something not based on medical science?

    That often gets resonable people thinking. But then you get all of the griping about callous physicians that you can’t get appointments to see, gouging hospitals, drugs that cost more than a car payment, yada, yada, yada. Sisyphean. And we don’t do anything to make it easier for ourselves.

    *Yes, I could see one of her partners sooner. But I spent a considerable amount of time and money selecting her for a reason. Further, it is perfectly reasonable to expect continuity of care. How long would you stay with a law firm if you saw a new lawyer every time you stopped by to discuss a contract or litigation? How long would you stay with a CPA firm if you saw a different accountant each time you had a question about your tax strategy?

    1. Chris Hickie says:

      Of course, some physicians “sleaze” on into the quackery, taking advantage of parental frustration: http://www.thornburgpediatrics.com/ . Here we have a “concierge pediatrician” with the rather patronizing attitude that other pediatricians don’t care, don’t have time, don’t know anything, etc. But for an extra fee ($2,500 per year per child), Dr. Thornburg will listen to you and care and blow sunshine up your ass. Pathetically he somehow got some award at an AAP meeting for being one of a few pediatricians “making a difference” (http://www.parents.com/health/doctors/doctors-making-a-difference/). And yes, he is anti-vaccine (http://www.zoominfo.com/CachedPage/?archive_id=0&page_id=-1863118900&page_url=//swfl.naturalawakeningsmag.com/resources/articles/aug07/brianthornburg&page_last_updated=2008-09-25T00:50:48&firstName=Brian&lastName=Thornburg, https://www.facebook.com/events/405993039511347/?ref=22, http://www.naplesnews.com/news/2009/oct/18/parents-health-care-workers-question-safety-swine-/?partner=popular). Forgive me, but it just disgusts me to see someone slimey like this.

      1. windriven says:

        “Forgive me, but it just disgusts me to see someone slimey like this.”

        You and me both. The distinguished Dr. Thornburg pronounces:

        “I’m telling my patients [influenza vaccine] has not been tested adequately,”

        Yet he gleefully sells garlic capsules for $21.23 on his website as a “body booster” and some crap called Biocidin that is marketed as “nutritional support associated with intestinal ecology, systemic wellness and detoxification” for $59.97.

        BTW, did you notice that Thornburg is trying to market the whole ‘concierge peds’ thing? From the website:

        “Thornburg Pediatrics is a company powered by Innovative Pediatrics, LLC. “InPeds” helps pediatricians build companies that practice Better Medicine, Better Business & Better Outcomes® and was founded in 2011.”

        Funny thing: Innovative Pediatrics is headquartered in … wait for it … Naples, FL. A quick search at the FL Secretary of State’s office discloses that the managing member of the LLC is:

        THORNBURG, BRIAN
        5091 SYCAMORE DRIVE
        NAPLES, FL 34119

        The guy should have been a chiropracter. He’s got that flair for marketing.

  9. Carl says:

    “You can’t very well say you think their advice is stupid.”

    Hmmm… I didn’t actually say that, but I’m pretty sure that was the look on my face. The person offering up the stupid idea was only making a general statement about some idiotic crystal thing (I was not ill). One glance from me, and they retreated to “that’s just what they said” while giving a shrug. That person really does believe lots of wacky things, but hacked off on this particular stupid thing.

    1. Nema Tode says:

      I have the look-on-my-face problem too. I’m in a delicate situation where my father’s new wife is deeply embedded in woo. She’s a lovely person and I can talk openly with her about my beliefs, or lack thereof, because she has a sense of humor and doesn’t take it as a threat. But I have a hard time with her friends, who form a tight, family-like, woo-spouting circle. One of her close friends is a chiropractor who has a big charismatic personality and sees herself a a healer–apparently believing that she heals through her personal power as much as through chiropractic techniques. She makes grand pronouncements about health and medicine, like “all brain injuries can be healed” and “I cured someone of MS.” But if I counter with my own opinion, it is taken as a personal attack. And in a way it is, because I can’t help getting an “I can’t believe you just said something so ridiculous” look on my face. I don’t want to be a wimpy silent listener, but I also don’t want to alienate them, because I want to keep being part of my Dad’s social circle. Also almost everyone in their town is woo-soaked, including others in my family. It’s one of the big woo-vortexes of the US.

      I should mention that my dad is old but in great shape, and I want to have good times with him while I can. He doesn’t believe in woo either, but he avoids arguing about it. How can I handle these people? Is it possible to teach them (through example) how to have a friendly debate? Any suggestions?

  10. jason says:

    Is it at all possible that someone’s genetic make up could also determine how effective their critical thinking is? If intelligence can be encoded in DNA, why not how gullible they are? No matter how much math I practice, my comprehension remains poor. Clearly there is a limit to how good I can ever be at math, much the same as genetics set apart olympic gold medalists and weekends warriors.

    1. Chris says:

      Unfortunately, no. I have family members who are very intelligent (including my dad) who fall for the woo. At least one very intelligent family member is getting a copy of Dr. Offit’s Do You Believe in Magic book for Christmas.

    2. Bruce says:

      Unfortunately intelligence (in whatever form you want to measure it) seems to have little to do with critical thinking skills. The following Steven Novella blog post dips into it:

      http://theness.com/neurologicablog/index.php/the-undervaccinated-and-motivated-numeracy/

      I too have intelligent family members (my brother in particular) who are embroiled in all kinds of woo, from Tarot to Accupuncture to 9/11 Conspiracy Theories.

      1. Young CC Prof says:

        Definitely. One of the smartest people I know is a naturopathic physician, the kind who believes his own sales pitches completely. (I admit, he must understand something about nutrition, as evidenced by the fact that he’s the biggest fittest vegan I’ve ever seen.)

        He’s very well-read, good writer, good memory, quick thinker, he just has no high-level critical thinking skills. Whatever embryonic reasoning skills he had, Bastyr buried them under loads of credulity, so now he can entertain and promote multiple mutually contradictory theories of health.

        I don’t think it’s genetic, I absolutely think it is learned. Sure, there may be a few people without the intellectual chops to understand some principles of critical reasoning, but most can, assuming you start young and continue regularly.

  11. goodnightirene says:

    I have taken a (perhaps) radical approach. I have begun dumping all “friends” who won’t even listen to reason, let alone change their ways. I have a much smaller social network than I did a few years ago, but I am less stressed about my interactions with stupid people–yes, they are stupid and never learned critical thinking. There, I’ve said it.

    A success story: One friend has begun bringing things she hears about to me for my opinion and has become a lot more skeptical. She has recently decided to quit watching the Oz quack. Success! She has a degree in botany (she is 70 and never worked in any capacity related to her degree) so perhaps that’s the basis for her being at least open-minded. She still takes most stuff she hears about on faith, but once I inform her otherwise and send her a reference, she comes around. It is possible. She is religious but feels that God gave us brains to discover medicine. I can tolerate that.

    1. Gawdam says:

      I know tat skeptic doesn’t always mean rational. Are your own convictions so week and your mind so closed that you actually believe you have all the answers and that your friends are stupid because they don’t agree with you? Wow. Quite an interesting approach to critical thinking. I would think a critical thinker would welcome the conversation and friendships with those who do not share your views. Well I am sure your former friends are just fine and you are probably better off with that smaller, homogenous group of friends. After all, they agree with you and that must make you feel awesome.

      1. The main trait of a religious cult is fear and xenophobia of outsiders, and intolerance to views different from their own. If you look at this blog through that angle, you’ll see a bunch of priests dressed in a lab coat shepherding the faithful flock to daily sermon.

        1. Bruce says:

          Do you know what Ad Hominem means?

          Because I think likening everyone here a xenophobic regious crank qualifies.

          What you have here Mr FBA is actually the opposite… you have people here who will question any priest, scientist, sCAM artist or anyone who identifies themselves however they like and actually ask them questions like:

          “Can you show me unbiased proof that your claim works?”

          You have not done so, and in my time lurking here have only seen you try to use the same old arguments that all sCAMmers use. Perhaps you should actually read the articles you so vociferously comment on.

        2. WilliamLawrenceUtridge says:

          The main trait of a religious cult is fear and xenophobia of outsiders, and intolerance to views different from their own. If you look at this blog through that angle, you’ll see a bunch of priests dressed in a lab coat shepherding the faithful flock to daily sermon.

          Those are the main traits of all humans, we’re descended from the common ancestor of territorial chimps.

          You may see this blog that way – I see this blog as asking the simple question “what proof do you have for your assertion” and CAM proponents immediately attempting at distraction. For instance, they might blather about how “science is a religion”, never mind the role empirical evidence plays in scientific research.

          You know who demands that you believe without good evidence? Homeopaths. Naturopaths. Herbalists. Acupuncturists. Chiropractors. Orthomolecular practitioners. Reiki masters. In short, people who want to sell you CAM.

      2. windriven says:

        It would seem that you have a poor grasp of critical thinking. Let’ see if I can help.

        “[Do] you actually believe you have all the answers and that your friends are stupid because they don’t agree with you? ”

        Goodness no. Critical thinking demands a clear understanding of what one doesn’t know. But knowing what one doesn’t know does not imply that all possible ‘answers’ have equal weight. If you come upon a traffic accident at a busy intersection one can infer that one or more of the drivers ignored or short cut, thus precipitating the event or that some distraction contributed to the cause. That would be rational. Or you could ‘believe’ that evil spirits snatched the steering wheel out of one of the drivers’ hands and caused the accident. That would be irrational.

        Science is a fabric of knowledge woven through the years on the loom of the scientific method. All of this knowledge fits together and excludes alternative hypotheses which have been tested and found to not describe reality.

        Now it is possible that some new bit of knowledge will appear that falls far outside the bounds of the existing fabric of scientific knowledge. That would be called an extraordinary claim. Science makes room for extraordinary claims but demands that those claims be supported by extraordinary proof. The burden of that proof lies with those making the extraordinary claim.

    2. JRed says:

      I have done the same. Those stating that this somehow makes you close minded are being absurd. Should you be friends with a person who argues one race is better than another or that we are being controlled by lizard people just to keep an open mind? Where do you draw the line? Personally I am offended by claims of cover ups, suppressed cures, corruption etc. made by many woo pushers, corruption of such scale would involve thousands upon thousands of people. Why would I want to be friends with somebody with such a sickening view humanity?

  12. Carl Galante says:

    True Believers
    Indeed, there are true believers on both sides of this issue. How do you convince the “scientific” medicine believers that the industry is driven by high-profit margin drug companies and medical institutions? That they fund many of the “scientific studies” so they will show exactly what they want them to show? That overtesting and the vast expense that goes with it is driven by fears of liability caused by the “ambulance chasers” that can now advertise nationally? Or that patient welfare is always second to following protocol, regardless of the effect on health?

    There is a middle ground here, but people have to always find it for themselves. Of course nutrition and presence or absence of certain vitamins and minerals has a huge effect on the functioning of the human body. But the fact that standard medical practice all but ignores that vital area leaves room for all the quacks to make their exaggerated claims. We personally research everything thoroughly and prefer non-prescription solutions to our issues if they exist. Glucosamine has saved my knees for 6 years beyond the point that a surgeon wanted to do knee surgery. Saw palmetto keeps prostate problems from becoming a major issue. While “standard” prednisone treatment that my wife did require for a very serious condition has created more problems than it solved. We’ve had to pull the plug ourselves on excessive medical and surgical procedures that were recommended by AMA certified doctors just because that is what they do for a living. If your only tool is a hammer, everything looks like a nail to you.

    None of this means we will resort to voodoo to cure an infection. But overuse of antibiotics by the standard medical industry has led to resistant bacteria and other problems that they now own up to. How many medical myths get debunked every year? Eggs are good for you then bad for you then good for you. Eating the yolks causes cholesterol then no, it doesn’t. Eat margarine instead of butter – whoops, bad move.

    Become knowledgeable on your own and don’t leave something as important as your health to profiteers on either side of this fence.

    1. Chris Hickie says:

      Yes, because, of course, I became the lowest paid of MDs, having done 4 years of med school and 3 years of residency after 4 years of college all to become a “profiteer” at your expense.

      1. Carl Galante says:

        So after reading this entire article, you’re approach is “well I’m one exception, so what you said wasn’t true!”? Anecdotal proof, similar to “well I had acupuncture and now I feel better!” Very scientific.

        I don’t know your particular motivations. Don’t insult me by telling me that even half of all doctors go into medicine for altruistic reasons. But hopefully, all that education taught you how to read, at least. My comment was “drug companies and medical institutions”. I did not mention individual doctors.

        Go ahead and describe to me the extensive education you got on the non-pharmaceutical methods of treating diseases. I bet you had to take more courses on legal issues and standard protocol. Is the expense of all that schooling going to be your excuse when you take money from big pharma reps and prescribe drugs with side effects that have yet to be discovered? Will you also be disparaging every sort of nutritional or natural solution to a problem because it doesn’t come from someone who spent as much money as you becoming educated? Someone in a previous comment mentioned treating symptoms rather than causes of disease. Let’s hope you have some inkling of the difference. From what I’ve seen over many, many years, most do not. Especially the young, starry-eyed new recruits. Because of the huge time and money investment, they are most susceptible to this quote from the article:

        “Most people refuse to listen to anything that contradicts their beliefs. Their confirmation bias accepts only confirming evidence to protect their ego from having to admit they were wrong. And there’s a real danger in arguing with them. They will come up with rationalizations that allow them to reject everything you say, and that only serves to reinforce their beliefs. They come out of an argument believing even more strongly than when they went in.”

        1. windriven says:

          “How do you convince the “scientific” medicine believers that the industry is driven by high-profit margin drug companies and medical institutions?”

          What does the profit margin of drug companies or medical institutions have to do with science based medicine?

          Are you just now coming to the realization that science isn’t always used for noble ends??? That fact that shitbags sometimes use science to their advantage does not make science bad it just makes shitbags bad. And it certainly doesn’t make quackery good.

        2. windriven says:

          QUACK ALERT:

          “Someone in a previous comment mentioned treating symptoms rather than causes of disease. Let’s hope you have some inkling of the difference.”

          Tell us Carl, what are the five most significant diseases that your favored quackery has mastered and be sure to cite replicated, peer reviewed studies supporting your contention. Just five.

          That is a hard list to compile for science based medicine – because there are so many to choose from. How to pick the most significant? HAART for managing AIDS patients? That certainly has affected countless lives. Eliminating smallpox? That transformed humanity. How about all but eliminating polio? Surgical repair of an aortic aneurysm? Have you ever seen one performed? Breathtaking. Or we can gaze in another direction and think about oral contraceptives that have freed generations of women from unplanned and unwanted pregnancies. Or how about Operation Smile. That is the group of money-grubbing doctors, nurses and others who perform free cleft palate repairs on needy children around the world.

          Tell me again about how shitty science based medicine is?

        3. WilliamLawrenceUtridge says:

          Go ahead and describe to me the extensive education you got on the non-pharmaceutical methods of treating diseases

          You are creating a false dichotomy here. Also, weight loss for arthritis and joint pain, type II diabetes, vaccination, St. John’s Wort for depression (though it’s basically a dirty drug with its own set of side effects), dietary changes and exercise for obesity, high blood pressure and cholesterol, joint replacement surgery, organ transplantation, hot and cold packs for muscle strains, sprains and knots, massage. There’s probably more.

          The distinction is between “proven” and “unproven”. Many non-pharmaceutical methods are merely asserted by proponents of “natural” cures. If these cures work, this should be discernable through clinical trials. However, because of the DSHEA, sellers of supplements and related products don’t need to, and therefore don’t bother to, test their products. They just sell them (and you can’t even be sure that the products contain what they say on the label – all testing is voluntary and self-enforced).

        4. AnObservingParty says:

          Quite frankly, I would ask you to look at the practitioners of CAM and explain to me how they aren’t driven by profit margins. At least SBM profits have science behind them.

        5. Chris says:

          “Go ahead and describe to me the extensive education you got on the non-pharmaceutical methods of treating diseases.”

          Well my son got surgery to remove the extra muscle in his heart due to obstructive hypertrophic cardiomyopathy. Does that count?

          Oh, and my “evil” family doctor has prescribed show inserts for foot pain, plus exercises for my back and also for hiker’s knee. Not really big on dosing on the glucosamine if you can balance the muscles with exercises. I also have to remember to not bend my knees when doing the flutter kick in the pool.

        6. Chris Hickie says:

          Oh, yeah, I get soooo much money from drug reps. Try like 1 drug rep lunch this whole past year. Oh, yeah—I’m in their pocket with that sub sandwich they gave me. Are you going to tell me no one bought you a flippin’ lunch sometime in the last year to talk business?

          Frankly, I don’t give care who you see for care, but get off your high horse on “profit”–for unless you don’t need to work for living, then you rely on “profit” to live your life. I run my own practice, and profit for me is what I have left after I pay my staff, my rent,, my suppliers, etc. Trust me, there are easier ways to make amount of money I do, as I routinely hear from relatives and friends who are engineers and lawyers and accountants.

    2. WilliamLawrenceUtridge says:

      Of course nutrition and presence or absence of certain vitamins and minerals has a huge effect on the functioning of the human body. But the fact that standard medical practice all but ignores that vital area leaves room for all the quacks to make their exaggerated claims.

      How does standard medical practice ignore this vital area? Nutritional deficiencies have been studied, defined, they are taught in medical school and subject of ongoing research. In cases where current recommended daily intakes are found to be inadequate, they are revised (i.e. vitamin D). If you are talking about the alleged miracles of megadosing vitamins, most aren’t proven to work – and those that are proven to work, those that treat vitamins as drugs, turn out to have side effects.

      Glucosamine has saved my knees for 6 years beyond the point that a surgeon wanted to do knee surgery. Saw palmetto keeps prostate problems from becoming a major issue

      Actually, glucosamine doesn’t appear to be very effective. It’s quite possible your knee simply healed on its own. Ditto saw palmetto. May I suggest that your hammer/nail analogy applies to your own nutruaceuticals?

      None of this means we will resort to voodoo to cure an infection. But overuse of antibiotics by the standard medical industry has led to resistant bacteria and other problems that they now own up to. How many medical myths get debunked every year? Eggs are good for you then bad for you then good for you. Eating the yolks causes cholesterol then no, it doesn’t. Eat margarine instead of butter – whoops, bad move.

      What you are describing is not science – it is the practice of the lay press, and the occasional celebrity physician, overselling the latest research as well as subsequent corrections to the research as more studies are released. Science changes, this is a feature, not a bug. If you go to the original sources, the expert panels and even researchers who haven’t caught the fame bug, often you’ll find the firmness dissolves, or never existed in the first place, and instead you will see the results expressed as cautious, tentative, and contextualized information. Not always. But particularly over decades – yes.

      The existence and problem of antibiotic resistant bacteria is one well-known to the scientific and medical community. They are the primary drivers of knowledge on the topic, as well as the search for a solution.

      Become knowledgeable on your own and don’t leave something as important as your health to profiteers on either side of this fence.

      Did the producer of saw palmetto and glucosamine give you their products for free? Or did they sell them? Profit motive exists in myriad forms, and one must be cautious regarding where you get your information from. I would venture most of the places that tout the benefits of these interventions also sell them.

  13. Andy says:

    I’ve been strongly considering giving some local public presentations on CAM, giving a scientists perspective. I hope to educate people a bit but worry a little about confrontation. Any suggestions on do’s and do not’s?

    1. windriven says:

      Embrace confrontation. Don’t initiate it. But don’t flee it either.

    2. goodnightirene says:

      Plan to hear everything that Carl G has said above. I’m sure he means well, but he has fallen into every logic trap that can be put on a list. He mixes apples and oranges to the point of it not being edible. I can only hope we can persuade him to spend some time in the archives of this site. It’s a process and he may still be on the fence enough to be open to understanding more about how science and proper medical studies work–and how to tell the difference between good and bad studies (such as the ones that are causing the “confusion” he sees in the example of advice about eggs.)

      Certain memes (doctors know nothing about nutrition, for example) are so ingrained that they are accepted without a second thought–and it’s a second thought that has to be encouraged. Another common meme is the argument from antiquity–people treated themselves with herbs for thousands of years before modern medicine so there must be something to it. NO! They died young and often–only the occasional success was retained and created the folklore. Those that work have been accepted into modern practice (such as aspirin–willow bark).

      I think these simple types of things have to be cleared up before you can stand up and say, alt med is a waste of time other than offering comfort and more time with a practitioner. I also think one of the mistakes science-based people make is saying, “there is no scientific proof that (blank therapy) works. The target audience needs to first be relived of the notion that science is just a “way of thinking” or that it only produces “contradictory studies”. This thinking comes from a lack of basic understanding of science. Everyone doesn’t have to be a scientist; the study of the history of science can be very helpful and is accessible to most anyone. That’s usually where I try to begin. My problem has been getting an individual to make enough time to hear the whole message and that’s where I think addressing groups might be a better approach. A casual conversation over lunch just isn’t enough time and you end up being too abrupt and sounding disrespectful of the person’s “beliefs”.

      Good luck!

      1. Andy says:

        Thanks! This was all very helpful. I manage to reach about 25 or so college students in a class every year when I have Michael Specter’s Denialism as required reading. That book is how I found this website in the first place. I’m hoping to get out to the public next semester for some talks.

    3. Jann Bellamy says:

      I think talking about homeopathy is a great way to engage the audience and show them how science is used in evaluating health claims. I have used oscilliococinum as an example, and put up a slide of the product label showing its claims and ingredients: anas barbarae hepatis et cordis extractum 200C, followed by an explanation of the dilution and succussion process – showing all the zeros is very effective. (See Mark Crislip’s post for details: http://www.sciencebasedmedicine.org/ososillyococcinum-and-other-flu-bits/) Next, have them guess what anas barbarae (etc.) is. Finally, throw up a photo of the Muscovy duck and translate. You will hear “ewww!” from the audience. It is a good lesson in why they shouldn’t trust CAM claims and how to do a proper evaluation using science. Of course, I always recommend SBM as a reference. Good luck — I hope you follow through.

      1. Harriet Hall says:

        Do you tell them that the duck is so dilute that all that’s left is the quack? :-)

        1. Kathy says:

          Oh, very sharp! Nice one, Doc!

      2. goodnightirene says:

        Fabulous suggestion! I used this on a pharmacist who was very “shruggy” when I complained about the display of the duck liver garbage. He was intrigued and apparently had no prior knowledge of this scam. I would think they cover homeopathy (negatively) in pharmacy school?

        1. CHotel says:

          They did in my faculty at least. We actually had 2 lectures on homeopathy in our Natural Products class (I believe we had to take it so we could understand WHY people in the Alt-Med world had all these non-scientific beliefs, and so that we would be better equipped to know the few things that work, and how to properly refute the many that do not).

          The first lecture was given by a practitioner of homeopathy so that we could see her side of the coin. The second was given by our PharmD, MSc(Epidemiology, Oxford) professor who also taught the Scientific Literature Evaluation course and lists Evidence-Based Healthcare among his research interests, and was basically a refutation of every word of the first.

          I work in hospital now so I don’t have to deal with as much Woo on a day to day basis, but I did spend a lot of my free time during one of my community store practicums wandering through the herbal/supplement aisle of the store trying to stop people from wasting their hard earned money. I wish I could say that all of my peers do the same.

    4. WilliamLawrenceUtridge says:

      May I recommend the talk.origins archive pages on debates? The topics are different, but the same principles should apply.

  14. gewisn says:

    My new (probably former) financial advisor: If I told you that my Chinese herbalist could cure you of all your illnesses without any of those harmful medications, would you say I was crazy?
    Me: Yes. If I told you I saw a flyer stapled to a telephone pole advertising that some guy could teach me how to become rich in six months if I sign up to be his student, would you suggest I give him all my money?
    Her: No
    Me: Let’s move on to what you know about.

    1. WilliamLawrenceUtridge says:

      This comment needs a like button.

      1. goodnightirene says:

        *Like*

    2. Edith Prickly says:

      Two thumbs up!

    3. Calli Arcale says:

      *more like* Gewisn wins the thread. ;-)

    4. Hakainokami says:

      Like

  15. Denise B says:

    I tried acupuncture four times with four different practitioners for four conditions before concluding that it was a hoax. I would have figured it out sooner if I’d read more, but all I’d seen in the media led me to believe it was effective.

    I tried chiropractic even more times – six or seven different ones, dozens of sessions. It helped me exactly once; I felt something pop in my back and the pain I’d had for six weeks was instantly gone. But that was the only time.

    That said, I do understand why people like these therapies. I liked going myself. It’s a nurturing experience, which going to the doctor isn’t. First of all because you’re touched physically. The visits aren’t rushed. You’re listened to and told you’re going to be helped. The office staff is nice and friendly. It costs less. With the acupuncture was herbal tea and soothing music and incense and you get to lie there and relax. It all feels healing.

    I missed these things when I stopped going. I now get this experience from massage therapy when I can afford it.

    My best friend is a homeopath. Don’t ask me how this could be – we worked together as computer programmers, and she’s very, very smart and otherwise very rational. She tells me she needs to know all about a person’s physical and emotional state before she prescribes, so she spends hours with her clients, encouraging them to talk about every symptom, every relationship, every mood. Is it any wonder that people like this? Only your psychotherapist listens to you this way, but he doesn’t say he can make you well.

    I’m no doctor-basher. I want scientific medicine practiced on me. But like many people I find going to the doctor to be a pretty negative experience in comparison. I rarely if ever feel adequately listened to or given the chance to get my questions answered. Well, once I did. I saw a GI doc who didn’t take any insurance and paid her $500 for the initial visit. She spent an hour and a quarter with me, let me tell her everything I had to say and answered every question I had. She also told me she wanted to leave the country because she was fed up with the American medical system. When I called for a follow-up appointment I found she’d closed her practice.

    1. Trading massages with a friend is a way to get around the expense. You will get to know each other’s preferences pretty quickly.

    2. WilliamLawrenceUtridge says:

      …and that’s why CAM works. All those lovely, reassuring nonspecific effects. I’ve said many times in the past – all CAM practitioners could and should retrain as health-focused counselors. They would do less harm, while still permitting people to practice a form of emotion-focused coping to address the stress of their health problems.

      The time spent with doctors is another unfortunate legacy of the American health care “system”. It’s different where I live, my appointments don’t feel rushed and my doctor has the time to listen carefully and undertake the various tests and assessments he needs to help. Yet another reason why Obamacare is sub-par. Americans deserve a true universal health care system. Your costs would drop, your health would improve, your doctors would stay and people wouldn’t have to declare bankruptcy over a lump.

    3. Kathy says:

      I only tried a chiropractor once … back pain … on the basis of ecstatic recommendations by a work colleague … I had to pay upfront, he spent maybe three minutes listening, didn’t ask for or advise X-rays, did no examination at all, put me on an uncomfortable table, connected me to some machine, and vanished to the next patient. After that one I heard him move on to patient #3, all of us in little cubicles. Only then did he come back, connect me up to another machine, and vanished again. Music, tea, incense? You are joking.

      Afterwards, when I walked out to my car, I couldn’t feel underneath my right foot. Did I get a fright or what? I went to my boring old GP who asked a whole bunch of questions, listened till I’d finished, sent me for X-rays, showed me on the plates (it was very visible) what was wrong and sent me for an operation. When I told him what the chiro had done his eyes went sort of dark but he said nothing.

      When I hear people moan about regular medical practitioners and boost alternatives I also feel my eyes going sort of dark, but I’m not handcuffed into saying nothing, oh, no! I say plenty. I’m trying to learn to be tactful about it but it don’t come easy to me.

  16. Ken Hamer says:

    Sometimes perhaps we should rely on natural selection to deal with these things.

    I used to think that, then I saw the introduction to the movie Idiocracy:
    http://www.youtube.com/watch?v=icmRCixQrx8

    The whole movie is worth a watch.

  17. Luara says:

    Here’s one thing that is very important: Science needs to do the research necessary to find out what is the truth in the claims of people who try alt-med and feel they have been helped.
    For example, there are all sorts of exotic diets that people try and they rave about how much better they feel.
    Gluten-free diet, raw vegan diet, paleolithic diet, low-carb diets …
    I think a lot of the reason these diets score successes, is that people have non-classical food allergies – which are very poorly understood – and foods they’re allergic to, are eliminated on the diet.
    There’s been a lot of recent research on non-celiac gluten sensitivity, which affects a lot more people than the roughly 1% who have celiac disease.
    So if you can rationalize people’s experience for them – tell them, here’s why this helped you, you probably don’t need the entire “alternative” protocol – maybe they will hear it.
    Someone came along on the RI blog and said she’d been helped by the Gerson anti-cancer protocol – which is partly, a special diet. Not that it had cured the cancer she presumably had, but she said it helped her osteoarthritis a lot and had many other benefits. So I said, I had done various elimination diets/food challenges and MY osteoarthritis got much less painful after I eliminated foods that made me sick after food challenges …
    She answered that she had “experience” (whatever that means) with celiac disease and hypothyroidism. Which made me think I might have hit the nail on the head, because the main cause of hypothyroidism is the autoimmune disease Hashimoto’s, and people who have Hashi’s are more likely to have celiac disease, and celiac disease can cause people to have non-classical food allergies.
    She apparently had become a Gerson-believer – possibly a lethal choice! – based on good changes on the Gerson protocol. But since I pointed out that she might simply have non-classical food allergies, she has another way to interpret her experience that does NOT involve being a Gerson-believer.
    If someone is genuinely being helped by some alternative protocol, it is very unlikely they’re going to believe you if you tell them they’re fooling themselves. You will only antagonize them.
    If an alternative protocol helps in some way, that is going to make it much more powerful. Lies work much better with a little truth mixed in.
    And, it is going to make the person more open to the next alternative protocol they come across!
    So it is super-crucial to figure out these things like non-classical food allergies (they do sometimes pass double-blind placebo-controlled food challenges, so they exist).
    And don’t tell people that such things don’t exist just because science hasn’t nailed it down. For example all the people who say they are helped by gluten-free diets – you are just going to antagonize them if you tell them they don’t need to be on a gluten-free diet unless they have celiac disease. It would be a lie, since you don’t actually know such a thing.
    With the anti-vaxxers, all I can say is to ask them to look up the arguments against their beliefs. I would mention Paul Offit’s website on vaccines for example.
    For alternative protocols where there’s definite evidence it can’t work, like homeopathy, I don’t know. It is obviously very easy to do a double-blind challenge with “homeopathic water”, even a one-person double-blind – since it looks exactly like water! I got nowhere suggesting that to a homeopathy-believer.
    Nor did the argument “if you believe this on so little evidence, why not believe in THIS and THAT etc. etc. work for me. I tried that on a guy who was arguing for ghosts and all I got back was “that’s an interesting psychological question”. An evasion.
    So all I have to offer is, try to rationalize their experience if you can – offer another plausible explanation for why it helps, than the one they’ve accepted. And challenge them to check out criticisms of their views – kind of as a matter of honor.

    1. windriven says:

      Luara,

      “For example, there are all sorts of exotic diets that people try and they rave about how much better they feel.”

      The easy check is to find 100 ‘ravers’ about a given diet, then follow them for 5 years. How many are still on the diet?

      “I think a lot of the reason these diets score successes, is that people have non-classical food allergies”

      You are probably referring to food sensitivities. Allergy has a specific medical meaning and allergies are, by and large, identifiable without overmuch trouble.

      And finally, people think they feel better or worse for lots of different reasons. This is often the magic of the placebo effect, nothing more.

  18. Anon says:

    Forgive me for choosing Anon as a name but, in the interest of full disclosure, after a career in something real, I left it and, in what must have been a fit of insanity, became a CAM practitioner. (Massage).

    Knowing these people intimately (not that intimately), I think we can safely say much of the modern popularity of CAM comes from a massive failure of science education even at the grade school levels. They don’t know how science works. They don’t know much about medicine. Their logic and reasoning skills, if they ever existed, have atrophied beyond use. (Don’t indict everyone. There are some of us who recognize the limitations of massage and all the other garbage you may see under the heading.)

    How bad is it? Y/L Essential oils recommends replacing children’s ADD/ADHD meds with a mixture that includes lavender. When I pointed out to one of their reps lavender may cause gynecomastia in prepubescent boys, I was informed oils may not be for me.

    I guess what it boils down to is “Give it up. The true believers are lost causes.”

    Yes, I still practice massage. As one of the SBM authors pointed out, at least it feels good. And I hope I am one of the good therapists who recognizes the limits of my skills so I can recommend a real MD instead of oils, energy work, or homeopathy.

    1. WilliamLawrenceUtridge says:

      Massage isn’t CAM. It’s a great way to loosen muscles and help with chronic or acute pain.

      It’s when you bring in craniosacral therapy, reiki, aromatherapy, therapeutic touch, quantum anything, homeopathy and all that other nonsense that it becomes CAM. It’s when you think you can cure cancer, or anything but musculoskeletal complaints that it becomes CAM. Paul Ingraham’s saveyourself.ca site is an example of how massage therapists can be non-CAM, in fact strongly science-based.

      Don’t sell your profession short.

      Don’t oversell it either.

      You seem to have found the value in your field and are sticking to it. Good on you.

    2. Young CC Prof says:

      If you do massages well, and tell people only that it feels good and can relieve stress and muscle pain, you are not a SCAMer. If you tell your clients to see a real doctor for stuff that sounds like it might be serious, you are not a SCAMer. If you do not make inappropriate claims, like curing cancer or allergies, you are not a SCAMer.

      You are a properly trained massage therapist who makes people feel a bit better.

  19. Donna B. says:

    Following are the ways I’ve dealt with some close family members who are susceptible to being swayed by CAM:

    1. Make a deal with them. I promised one of them that I would stop telling her why her chiropractor was a quack if she promised me that she would never let the chiropractor touch her anywhere near her neck. She agreed and occasionally tells me that she’s sticking to the agreement when I have not brought up the subject. It’s those times I have the most hope because it means she’s been thinking about it.

    This tactic was even more successful with another relative who was seeing a chiropractor for a serious problem with her neck. The deal I made with her was that if she would go to an MD, I’d shut up. She did and had surgery which alleviated most of the problem.

    2. Laugh at them and tell them I’ll do the same thing for them for free. This one was going to what he himself called a witch doctor and he certainly did feel better after relaxing and napping in her *special* room for an hour. Physical comfort, soothing music, dim lighting, cell phone removed, etc. I told him my free service didn’t include waking him up and kicking him out when his hour was up, driving, and a sales pitch for expensive supplements to gather dust in the cabinet. Yeah, he was easy, but he’s spread the tale to others. Who knows who might listen? (Caveat: I also created a benign monster who calls me to tell me I need to visit so he can have another treatment.)

    3. Threaten to move in with them. This one worked best with the one contemplating going the no vaccine route. I said I couldn’t bear the thought of her precious babies suffering from all the illnesses that vaccines prevented and the only other way I knew to prevent that was to keep them isolated from carriers — all other children. Her husband immediately took my side of the argument, the children are being vaccinated on schedule and they still let me come visit.

    4. I pick my battles carefully and in private. In groups, when someone starts promoting any sort of woo, I try to change the subject and if not successful there, I find a reason to leave. If it’s my house, or somewhere I can play hostess, I choose that time to refill coffee cups, offer food, or create some other diversion.

    Sometimes #4 is the best I can do in social situations. I try very hard not to alienate or embarrass anyone which would mean they would probably never again listen to anything I had to say on the subject.

    1. Harriet Hall says:

      Thanks, Donna. I like your ideas!

      1. goodnightirene says:

        Nice ideas, but Donna is dealing with family in #1 and #2. My family are all on board and sane already. Number 1, seems to have potential for some situations, although I don’t think the outcome would always be as successful as in Donna’s example.

        I’m with windriven. I can only make nice so long. I follow Donna’s lead in social situations, but I also don’t see such people again. The only exception was my (allergy) shot nurse who one day after two congenial years of what came close to friendship, she announced with enormous delight and pride that her daughter was starting Chiropractic College–Palmer, no less. I bit my tongue so hard it bled and offered a very tepid, “that’s nice”.

        I think Donna is simply a very nice person who suffers fools way better than me.

    2. windriven says:

      Me too. But I struggle with #4.

      OK, that’s BS. I don’t try very hard on #4. I’m with Irene somewhere up above. I don’t have a lot of time for the willfully credulous. I always begin gently and thoughtfully and try to lead them to an understanding of science versus woo.

      But there are always the ones who talk about their spirituality (what exactly does that mean anyway and what does it have to do with being a rube?) and that science doesn’t know everything (true, but woo doesn’t know ANYthing), and that Aunt Matilda was cured of Stage 11 pancreatic cancer by burning St. John’s Wort while taking a double latte up the poopchute.

      So they get both barrels. They stop being my friends. I don’t need friends like that anyway.

      Good for you that you are able to maintain your equanimity in the face of projectile stupidity. I’ve tried but I don’t have it in me.

      1. MadisonMD says:

        That is funny, Windriven. Experiment: Sign Windriven up for Bastyr ND school. How many classes of semester 1 homeopathy before he gets expelled? Or maybe he doesn’t actually make it to the first class.

        Well, actually doesn’t test anything but it would be fun to watch.

      2. Donna B. says:

        I’m not all *that* nice. I’ve been known to spill that coffee sometimes. It’s a great diversion. Plus, those are the tactics I use with people very dear to me, who I love even if I do think they are nuts.

        Except for the one paying to take a nap, my concern for all of them was that they would die, become seriously ill, or not prevent an easily prevented serious illness. If the tender, teasing tactics hadn’t worked, I’d have let go with the other barrel too.

        And thanks to SBM, that other barrel is loaded with high caliber information.

  20. DJDenning says:

    As a pharmacist, I’ve had many CAM-related discussions with coworkers and patients alike. Basically, you only get anywhere with the fence-sitters who are wavering on the question of, say, getting accupuncture for lingering soreness following a leg injury. I have convinced coworkers to get flu shots and talked people out of buying homeopathic remedies.

    But if you’re dealing with the true believers, your best argument bounces off their craniums like alpha rays hitting tin foil.

    What works, if they’re receptive: people get defensive when challenged, so don’t challenge them; challenge the idea instead. I like using the “Regression to the mean” fallacy to frame my explanation; eg, “Some people find that homeopathy works because they tend to seek treatment for a chronic condition when it is at its worst, so when they improve, they credit the fake treatment rather than realizing it’s just their condition going back to its usual level of severity.”

    Also: learn some vivid facts to counter their vivid anecdotes. For instance, most people are surprised to learn that influenza causes Guillaine-Barre syndrome at a rate higher than the flu shot. Or the brain damage resulting from congenital rubella frequently results in autism, so the MMR is actually preventative rather than causative. Or if the science behind homeopathy was valid, we’d all be poisoned by water every time we took a drink (or at the very least we’d all be cheap drunks).

    The most successful SCAM artists are gifted storytellers, so let’s tell some stories of our own. The facts don’t have to be dry and boring, and you don’t have to insult people to teach them something.

    1. goodnightirene says:

      Great ideas. I think some of them might even work with true believers–at least get them thinking a bit.

      Scott Gavura has a great story on his blog about an infant car seat analogy that inspired me to keep trying.

      http://sciencebasedpharmacy.wordpress.com

      1. Iolaire says:

        I agree. People who dismiss the science tend to be the ones who are particularly susceptible to the vivid stories. I’ve made CAM-sellers really cross, and made some of their clients at least stop and think, by relating negative testimonials. Anti-anecdotes, as I like to call them.

        For example, some time ago my father-in-law and his partner came to visit. She is very into the woo. On this occasion she was reclining on the sofa, expatiating on the wonderful effects of chiropractic on her various aches and pains. Then she asked me why I didn’t go to see one.

        Me: I’d never go to a chiropractor. They can kill you.
        She: (jerking upright at a speed that belied her previous story of back pain): What?????!!!!!
        Me: Oh, it doesn’t happen very often, but once is enough, if you’re the one it happens to.

        She was very quiet and thoughtful after that.

  21. MargieM says:

    I’m a lay person and I can describe many non drug treatments registered doctors have suggested to me- exercise, vitamin d, folic acid, rest and meditation, talk therapy, weight loss diets, reducing caffeine and alcohol, keeping the home dust and animal dander free not to mention a good deal of encouragement and sympathy.

    In addition they are also able to offer me effective medicines should I not be able to manage the lifestyle changes necessary, nor do they deny the risks of taking these medicines. A quote from my doctor “no drug is perfect and people respond differently to different medications, all we can do is try and you can always stop the treatment and we can look for something else”

    Yes there are shitty doctors, but lets not generalise please.

  22. Liz says:

    I’m having a bit of cognitive dissonance on this subject. Ordinarily I’m of the mindset that any form of CAM which is proven to work becomes “medicine”, and would usually try and talk people out of using anything CAM-based on lack-of-evidence. However… I have an 80 year old grandfather, who is somewhere between being “worried-well” and a hypochondriac. His schedule revolves around appointments with various physicians, for his every minor ailment, and he is only really “happy” when he is booked in for some form of surgery. I believe he’s of the mindset that if he can have all the surgical procedures he feels he is entitled to, he will live forever (although he also enjoys the sense of importance he gains from all his medical appointments). For an 80 year old he is doing incredibly well by any means (especially for one who apparently has one-hundred-and-one things wrong with them) – he still lives independently (with my grandmother) and has all his mental faculties. The stress of taking him to various appointments and surgical procedures is wearing out my grandmother. I’m starting to think that my grandfather may umm…benefit from some sort of CAM, in the hope that it might replace his doctor-shopping for surgical procedures…. Hate to admit it, but I’m actually thinking of pointing him at homeopathy, since at least it’s harmless even though it’s quackery. *waiting for the pitchforks*

    1. DJDenning says:

      I used to think homeopathy was a harmless outlet for the worried well, but these days I advise against the use of CAM in any context. There’s so much SCAM out there, such a strategy could open the floodgates, and the next thing you know, your grandpa is being driven by your grandma to his appointments for chelation, reiki, accupuncture, etc, assuming he has the funds to pay for these things. And he could end up squandering his retirement savings, leaving him and your grandma high and dry when they require extended care when they get very elderly.

      Don’t do it!!! I also have a hypochondriac in my family, and it’s stressful for everybody. But introducing hypochondriacs to the wide world of CAM only serves to broaden the scope of their obsessions.

    2. No pitchforks needed! There are many homeopathic remedies at an attractive cost that will make your gramps a happier man.

      Ambra grisea will tone his mood and relief confusion and forgetfullness.
      Baryta carbonica will bring more calm to his day, I give it to elderly anxious about many small and trivial tasks and easily irritable.
      Rhus toxicodendron: Dont be alarmed by the name, there are no toxic ingredients in this remedy, diluted till the dosage is completely safe. Great for restless seniors.
      Lycopodium – relieves stress and emotional burden of worry, boosts self confidence and optimism.

      Thats a generic sampler to have a pick from, you can add other tinctures and nostrums to the mix for specific complaints. It will be a lot cheaper than surgery, I assure you.

      1. CHotel says:

        ” there are no toxic ingredients in this remedy”

        Nor is there anything else of substance left in it. Or at least, I hope not; I for one wouldn’t want to drink a bottle of poison ivy.

      2. Harriet Hall says:

        It will be a lot cheaper, but here’s a way to make it cheaper still:
        Put those labels on vials of tap water or tiny sugar pills. They will work just as well.

        1. Tap water may contain pollutants and contaminants, depending where you are in the world – Chlorite, Barium, Fluoride, Lead, Dichlorobenzene, Chlorine dioxide, even Cyanide and Uranium in some areas.. for safe consumption use professionally distilled homeopathic products.

          1. MadisonMD says:

            Sorry FBA. Everyone knows you potentiate these tap-water toxins by distilling them from 1ppm to 30C. You need to remediate your metaphysical mystery tour through 18th century nonsense.

          2. WilliamLawrenceUtridge says:

            Tap water monitored by regional authorities would contain only levels that are safe for consumption. You can’t eliminate all atoms of uranium or lead from water, and there’s no reason to bother since below the recognized safety threshold no harms are associated. If the harms are so subtle that you can’t detect them, you’re much better off spending your time and money on things genuinely linked to better health – healthy food, adequate sleep and exercise, spending time with family and friends.

            How do you feel about homeopathic preparations contaminated with lead, arsenic, cadmium, mercury, chromium, nickel and zinc? Considering homeopathic preparations have never been proven to work, provide no consistent relief of any symptom or treat any disease, and are also unsupported by any mechanism by which they could treat disease or symptoms (beyond the fact that you spend an hour talking to a homeopath, a form of nonspecific benefit that doctors provide anyway), do you think it’s worth the risk of consuming these potential sources of dangerous heavy metals?

          3. DayneATC says:

            I’m confused as well. How do you deal with the “memory” of those ‘contaminants’? Wouldn’t distilling and dilution activate their “vital energy” making them more potent? Maybe I have a skewed idea of “dynamisation”.

            I suppose another option for Liz’s grandfather is to just print out that list of ingredients and symptoms, then pin it to his shirt since it came directly from a practitioner treating patients on an internet forum. Would that not have as much efficacy according to some homeopaths?

      3. Sawyer says:

        I’m confused. Are you using these comments primarily to dispense serious medical advice to strangers, or as a free billboard to sell your snake oil? As much as I enjoy reading FBA’s posts for entertainment value, he is tiptoeing across a dangerous line here.

        1. Liz says:

          I am concerned that FBA is willing to suggest treatment (to use the term very loosely) without having ever met my grandfather. But furthermore, from what I understand homeopathy is based on the premise of having to examine the person’s psychological state, emotions, life history, personal traits etc… meaning that a homeopathic remedy which is supposedly meant to suit one person will most definitely not suit another, even when the symptoms are the same. Thus I am perplexed why you are suggesting specific homeopathic remedies for someone you have never met.

          1. Oh absolutely, I havent prescribed him anything yet! Just listing a sampler of what is commonly taken by elderly patients. He may take some of it or none at all depending on the condition.

            Your gramps should have a chat with a homeopathic practitioner (click on my username to find one in your area). It’s not that taking the wrong remedy will have a bad effect on his health, product safety is the shining strength of homeopathy; the physician consultations are important for a different reason – it will instill confidence and the will to get better, and thats what really matters, We heal our wounds thanks to our body’s internal ability to heal, the tinctures and pills are just a distraction really.

          2. WilliamLawrenceUtridge says:

            Your gramps should have a chat with a homeopathic practitioner (click on my username to find one in your area).

            I could almost agree with this. You can pay the homeopath to listen to his woes and symptoms. Your grandpa will feel better. Just stop listening whenever the homeopath talks, and don’t buy anything. If CAM promoters retrained as health-focussed counsellors who offered no advice or treatments, they would be an actual force for good.

            It’s not that taking the wrong any remedy will have a bad any effect on his health, product safety ineffectiveness and inertness is the shining strength of homeopathy;

            Fixed that for you.

            the physician consultations are important for a different reason – it will instill confidence and the will to get better, and thats what really matters, We heal our wounds thanks to our body’s internal ability to heal, the tinctures and pills are just a distraction really.

            I could agree with this, were it not for what lays beyond this simple statement – the corrosive effects of CAM’s magical thinking on skepticism, and its relentless determination to attack real medicine in an effort to drum up business and avoid having to test its own interventions.

            And, of course, the complete waste of time and money once you get past the patient discussing their symptoms.

        2. windriven says:

          I absolutely agree, Sawyer.

      4. WilliamLawrenceUtridge says:

        Ambra grisea will tone his mood and relief confusion and forgetfullness.

        No it won’t. And what does “tone mood” even mean?

        Baryta carbonica will bring more calm to his day, I give it to elderly anxious about many small and trivial tasks and easily irritable.

        No it won’t. You’re giving them a false sense of security and control over their day, that is what calms them. The homeopathic remedy adds nothing but 9 kcal of sugar to their diet.

        Rhus toxicodendron: Dont be alarmed by the name, there are no toxic ingredients in this remedy, diluted till the dosage is completely safe. Great for restless seniors.

        No it isn’t. There’s nothing but sugar in the pill, and it does nothing but waste money.

        Lycopodium – relieves stress and emotional burden of worry, boosts self confidence and optimism.

        No it doesn’t.

        There, now I’ve contextualized your reply.

  23. DayneATC says:

    In my experience in discussing CAM, it always starts talking about chiropractics. As an athletic trainer, I’m in a battle with chiropractors on a daily basis. I try to explain their methods of treatment, the emphasis on manipulations, and why the patient is seeing benefit in their particular injury or condition by going to them.
    I’ve made it a hobby to attempt to understand why people do as they do and why they believe what they believe, the depressing venture of solving the human puzzle. This leads me into many discussions and debates on religion and conspiracy theories. CAM has common ground between both of these, with the superstitious and supernatural ideologies that accompany CAM treatments and the rampant conspiracy theories that CAM proponents often regurgitate from the “Truth” blogs, youtube videos, documentaries, and “alternative” news reports they use as sources.
    To paraphrase Mark Walberg from “The Other Guys”, when he learns ballet just so he can make fun of men that do ballet, I feel one should learn as much as possible about the ‘other’ side in order to ridicule them or be able to criticize their ideologies.
    Anyway, after my shpeel on chiropractics, which involves distinguishing between evidence-based practitioners and those that adhere to vertebral subluxation “theory”, i express my disdain for alternative medicine in general. I bring up homeopathy first generally because its the more obvious and easily explained practice, and dealing with high schoolers, I recommend they discuss it with their chemistry and physics teachers. Then I’ll mention reiki or other (vague, nonspecific)”energy” treatments to show the superstitious mentality and appeal to tradition involved. Usually by this time my athletes will start asking about specific practices like reflexology, acupuncture, etc. Once they grasp the lack of evidence, and appeal to emotion and distress to trigger placebo effects, they start to understand it. At the end of every one of these discussion, I make it clear that I KNOW very little and that they should always seek out evidence and science-based information. If they find anything on their own that they think I said was wrong or inaccurate, I welcome them to bring it to me to discuss. I also attempt to instill that its not my job to tell them ‘what is’ but how to figure out ‘what is’. I give them sources like how to use google to refine terms then use a specific search engine like PubMed or other evidence-based sites and search engines. I also recommend this site, but emphasize the importance of reading the comments and checking sources….ALWAYS CHECK ORIGINAL SOURCES! is what I’ll tell them and see if it sends you on a goose-chase through blogs or a circle of rhetoric and propaganda.

    I also recommend that they never be afraid to ask questions and challenge their medical practitioners’ knowledge. They do it to me every day and I try to avoid speaking outside my scope of practice, by telling them that I don’t know something if I really don’t instead of just giving them a comforting answer. This is confusing to teens because adults bullshit them or treat them like they don’t have the capacity to comprehend what they’re saying. My best advice would to not treat the people like their idiots and it just takes more coddling and patience to lead them in a better direction. One thing I don’t say is to not go to CAM practitioners, but when they are there, to be observant of their methods to report back to me or their doctor. As was said earlier, I say its fine to go the chiropractor but don’t let them touch your neck.
    I’ve rambled enough.

  24. Susan says:

    What an incnredibly sad, inaccurate, but sincere article. I really understand that you have a desire to change people’s opinions, and that you believe you have the edge on the truth which you believe gives you the authority to do that. But what if yo’re wrong? That’s the part that is glaringly obvious…you leave no room that your narrow take on the world may be….just plain wrong. There is more to believe in this world than to disbelieve. And there is no argument that will penetrate because you made “science” into some kind of godlike structure, and I’m not sure even you know what you’re talking about. Did it occur to you that science is sometimes wrong? science is corruptable? science can only prove something if the hypothesis is correct, tested correctly, free of bias, and interpreted correctly? Science, in my view, is a weak tool. Empirical evidence rules the day…and I have news for you, acupuncture works! Oh? You had someone stick a needle in you and you weren’t cured of all disease and so decided 4 thousand years of empirical experience was useless? What kind of Hollywood thinking is that?

    CAM works. CAM has (your exhaulted) SCIENCE behind it. You can’t trace references because most of the studies are done outside the US. And shame on that person for trying to talk his wonderful and wise parents out of using alternative therapies. They seem like someone I’d like to meet.

    No worries…this type of forum seldom changes opinions. But someone has to tell you that you are wrong. And so the whole article comes off kind of …just….sad.

    1. DJDenning says:

      (Kind of testing to see if I can do this properly…)

      Science, in my view, is a weak tool….CAM works. CAM has (your exhaulted) [sic] SCIENCE behind it.

      So science is weak, but you like CAM because you think science backs it up?

    2. DJDenning says:

      What an incnredibly sad, inaccurate, but sincere article.

      If this article is inaccurate, prove it.

      And shame on that person for trying to talk his wonderful and wise parents out of using alternative therapies.

      I’ve been a front-line health care worker for 27 years. Just doing my job.

    3. DayneATC says:

      I’m pretty they never claim to have the edge on truth. Who are the ones again that proclaim “Truth” majority of the time? They do rightfully claim to have the edge on the process of obtaining the closest plausible truth. You can’t demean something then attempt to use it to add credibility to your claims, as DJDenning points out.

    4. CHotel says:

      “You can’t trace references because most of the studies are done outside the US.”

      And there I was yesterday, sitting at my computer in a hospital in Canada, reading the abstract of a study done in Spain with collaborators from Germany, completely unaware that if I drove 4 hours south such a feat would be impossible. I had no idea how priviledged I was, I should have given more thanks last holiday weekend.

    5. windriven says:

      So Susan, tell me the five most important disease entities that a “non-allopathic” therapy has cured or eliminated. Your assertion isn’t enough. You’ll need to show meaningful data to prove your assertion. Roll out your big guns here, Susan. You’ll be competing with things like eliminating smallpox, all but eliminating polio, surgical repair of aortic aneurysms, development of birth control pills, development of nuclear magnetic resonance imaging of soft tissues, regularly saving 2 kg premies. You know, science stuff.

      But I’m sure that homeopathy and chiropractic and acupuncture have a list of accomplishments that dwarf medicine’s list. So just give us your five best picks.

    6. WilliamLawrenceUtridge says:

      But what if yo’re wrong?

      That’s why medicine emphasizes testing before prescribing, continued testing and monitoring in the form of postmarketing surveillance, and the systematic collection of toxicity and outcome data. One day, hopefully we will also include direct comparisons and genetic/proteomic testing to better align outcomes with individual genotypes and phenotypes.

      What if CAM proponents are wrong? There are definite harms associated with CAM, both direct (how do you feel about kidney failure?) and indirect (how do you feel about dying of untreated cancer?).

      That’s the part that is glaringly obvious…you leave no room that your narrow take on the world may be….just plain wrong. There is more to believe in this world than to disbelieve.

      What do you find wrong with asking for evidence before believing, in particular asking for evidence before trusting your money and life to someone whose sole evidence for their beliefs is faith? People had faith in Thoth, the Egyptian God of healing, and bloodletting, and the flat earth, and egocentricity. What is glaringly obvious to me is – evidence is better than faith. Why do CAM promoters insist they don’t need any? If their nostroms are so potent, surely it would be easy to demonstrate this – yet they consistently fail to do so.

      And there is no argument that will penetrate because you made “science” into some kind of godlike structure, and I’m not sure even you know what you’re talking about. Did it occur to you that science is sometimes wrong? science is corruptable? science can only prove something if the hypothesis is correct, tested correctly, free of bias, and interpreted correctly? Science, in my view, is a weak tool.

      And your substitute is…what? Blindly trusting the person selling you the alternative? Why are pharmaceutical companies so greedy you can’t trust them, but homeopaths aren’t? I would suggest the difference is one of marketing, not reality.

      It is recognized that science is fallible, which is why the insistence is on repeated testing, convergence of evidence, disclosure of conflicts of interest, meta-analysis, preregistry of clinical trials and ongoing, ceaseless efforts to improve. What happens if you make the following substitution?

      And there is no argument that will penetrate because you made “science CAM, based on untested assertions” into some kind of godlike structure, and I’m not sure even you know what you’re talking about. Did it occur to you that science CAM, based on untested assertions is sometimes wrong? science CAM, based on untested assertions is corruptable? science CAM, based on untested assertions can only prove something if the hypothesis is correct, tested correctly, free of bias, and interpreted correctly? Science CAM, based on untested assertions, in my view, is a weak tool.

      Now there’s a paragraph I can agree with.

      Empirical evidence rules the day…and I have news for you, acupuncture works! Oh? You had someone stick a needle in you and you weren’t cured of all disease and so decided 4 thousand years of empirical experience was useless? What kind of Hollywood thinking is that?

      For me, it’s the idea that if 4,000 years of empirical experience was correct, it would show up in the testing. It’s not that acupuncture failed to cure a single disease. It’s that acupuncture has failed to cure any disease, in fact it only “works” to alleviate two subjective symptoms that are extremely prone to placebo effects (pain and nausea). Why would acupuncture suddenly cease to work after 4,000 years? Perhaps the answer is – this prescientific modality, with more in common with astrology than science, established with no knowledge of anatomy and physiology, and wildly different from current practice (historical acupuncture involved bodkins, fleams and lancets, not delicate, filiform, silicone-coated steel needles that were only manufactured let alone used in the 19th century) simply doesn’t work except as an extremely effective placebo.

      CAM works. CAM has (your exhaulted) SCIENCE behind it. You can’t trace references because most of the studies are done outside the US. And shame on that person for trying to talk his wonderful and wise parents out of using alternative therapies. They seem like someone I’d like to meet.

      How do you know it works? Why do the modalities consistently fail testing? Why are successful studies generally coming out of only a small number of countries? Why doesn’t acupuncture work better than placebo when tested with good controls in the United States? Antibiotics, vaccines, surgery and nutrition all work irrespective latitude and longitude. Why does CAM fail once it passes out of a certain geographical area? Why does CAM work only in isolated instances, but fail when the studies are repeated? Why can you cherry-pick supporting sources, but can’t conduct a meta-analysis that arrives at the same conclusion? Why do you have to cherry pick?

      No worries…this type of forum seldom changes opinions. But someone has to tell you that you are wrong. And so the whole article comes off kind of …just….sad.

      Well if we’re comparing the whiff of words, yours come across reeking of arrogance, hubris and ignorance. Just my opinion. Your appreciation of CAM seems notably one-sided.

    7. Chris Hickie says:

      Hi Susan,

      If CAM works so great, unplug your computer and try posting using some of your reike energy.

      Say what?!? You can’t? So sorry, keep that computer unplugged and you keep on trying to channel your nonsense without the use of electrons and a voltage gradient.

  25. DayneATC says:

    I should add about going to CAM practitioners, that I’m referring to minor injuries or conditions in which most CAM treatments are somewhat harmless (because they don’t actually do anything). If its something like cancer or a potentially fatal/permanently debilitating condition, I’ll never recommend CAM. I’ve always said though for myself that if I ever have a form of cancer, I would do one or more of the proclaimed cancer “cures” and document everything, knowing they don’t work. Dying isn’t a concern for me but leaving an everlasting stain on the reputation of alternative medicine would be considered a success for me. Although I suspect it wouldn’t have much impact.

    1. Bruce says:

      Dayne,

      This sounds like a very noble thing to do, but I guarantee you sCAMmers will then point to comments like this that you have made and will say that you never truly believed it so your life force wasn’t aligned and your chakras were too boingy boingy to give their naturalisticatastic healy-wealy doo-dah a chance to let you heal yourself.

      In the mind of a sCAM artist, there is always an out.

      1. DayneATC says:

        Good point. It’s similar to the “No true Scotsman/christian/insert religion here” fallacy. It didn’t work because I never believed in the first place. One would think that’d throw a big red flag that it’s necessary to truely believe it works in order for something to “work”, but maybe I’m the crazy one.

  26. DayneATC says:

    Susan,
    You have heard of the internet right? What studies done outside of the US aren’t known again? Do you really think that those promoting science and evidence-based practices, being under the highest scrutiny for doing so, would just bury their head in the sand to avoid looking at those so-called “studies” that support your ideologies?
    It also appears you haven’t read this blog much based on your interpretation as to what classifies as “empirical”. I think you’re confusing it with “anecdotal”.

    I recommend that you notice how conspiracy theorists and CAM proponents use ad hoc arguments, rhetoric with no citations, and insults when responding to ideologies that disagree with their sources. After you go on a binge of searching through conspiracy blogs reading the type of responses I’m referring to, come back and read your own comment.

  27. Greg says:

    Interesting subject matter. I think many of you have hit on valid points as to why people believe in CAM.

    One of the main ones is losing faith in conventional medicine, due to the incompetence or indifference of one or more doctors and due to published reports of the number of avoidable deaths caused by doctors.

    Religion is another factor – people who are religious usually believe in miracles and apply that same faith to treatments which have been touted as such.

    The third and probably worst factor is the placebo effect – people just don’t understand that it is possible that because they believe in it, a particular treatment or supplement will have the desired effect. Of course in cases of dire illness a placebo won’t have any effect at all but that’s besides the point – state of mind can have a powerful effect on healing.

    Last but not least, people mistrust pharmaceutical corporations, so by extension they have come to mistrust the purveyors of pharmaceuticals.

    I’m sure there are many others but these ones seem to stand out as the main reasons people embrace quackery.

  28. jennyt says:

    I have been involved in palliative care and community nursing for many years. I have come to the conclusion that one of the reasons people use alt. med, such as reiki, is based on the fact that they are able to take the treatment and not have to have any responsibility for the outcome ie the practitioner tells them that they will improve just by lying down and relaxing. They also have the added plus of being the focus of the treatment for a length of time. Medicine is much less likely to tell them that they will be cured and it often expects them to undertake actions that might be uncomfortable, such as having a PICC inserted. Lesser illnesses, in the general population, will generally resolve themselves, with or without treatment. Take a cold cure and you will be better in 7-10 days!!

  29. Dan says:

    I had a TIA patient just the other day – a retired professor of anthropology – who had seen a homeopath and was started on hawthorne root extract. But he was willing to also give conventional medicine a try, and he accepted my prescriptions willingly (he’s a long-time patient of both the homeopath and I). I do not try to talk my patients out of seeing homeopaths or naturopaths because that is counterproductive. As long as the homeopath is not canceling my prescriptions, the worst thing that can happen is that they are giving false hope to patients and wasting their money. I find that by vilifying homeopaths to patients (and they are almost always pre-warned by the homeopaths and naturopaths that this will happen), they just end up losing trust in us MD’s.

    I can argue with them until I’m blue in the face that eye of newt and lizard tongue don’t do any good, but it ends up being a total waste of time. Unless there is something physically or biomedically harmful being applied to the patient by the homeopath/naturopath, I do not intervene. We have to try and keep our patients’ trust, even if it means playing the game. Certainly I would never copy an alt med physician on one of my consultation reports, nor call or converse with them about patient care, but beyond this, I have grown to reluctantly accept the fact that many, many patients will seek false hope with these shysters. At one time I did try strenuously to point out that these ‘therapies’ (if one can even call them that – assumes efficacy) are at best placebos and at worst (occasionally) doing harm, certainly wasting money. It just turned off patients.

    1. Andrey Pavlov says:

      My experience is very limited so I say this with the utmost realization that my following comment is unequivocally anecdotal and very easily changed based on evidence or even future experience.

      Throughout my interactions with patients, I have been very forthright and unflinching in my commentary about CAM. I do so as objectively as possible, take into context my read on the level of ideology behind the patient’s decision/question, and been matter-of-fact yet genuinely caring in my deliveries. There have been exceptions; a notable one during my ophthalmology rotation the patient began going on and on about Protandim and asked the attending to take a flyer and share it with his patients. I sorely wanted to pipe up but I did not… and neither did the attending. I think he was correct in simply taking the pamphlet and saying he’d look at it. I think he was incorrect (but not egregiously so by any means) when he volunteered that his mother “liked that alternative medicine stuff too.”

      I’ve never heard a negative comment about me from my patients or through any sort of channels or persons whatsoever. Obviously the absence of evidence is not the evidence of absence, particularly in such a circumstance. However I have commonly heard very good things about my interactions and recommendations to my patients, both directly and through residents, attendings, and nurses who have passed that along to me. I say this only to illustrate why I am encouraged that my tack is working, despite the fact that I am uniformly disapproving of all the CAM practices and ideas my patients have mentioned. The degree of disapproval and specific tack is moderated by how much harm (first health, second wallet) it is likely to cause the patient.

      I think it can be done, especially if you approach the patient the right way. Absolutely there will be those that are obviously simply not going to change their minds and indeed that will lead to certain cases where letting it go or even ignoring it is the right thing to do. But that is simply part of a larger risk benefit analysis in your assessment of the best way to manage that specific patient.

      But (once again, the three most dangerous words in medicine) “in my experience” most patients will listen to you if you are genuine and clearly frame your discussion from the perspective of caring for the patient in the best possible manner. One of my favorite phrases is “within the confines of reality.” I use this for discussions about why no further treatments are at all likely to further ameliorate their condition, both as a preemptive move to inoculate against CAM use and to psychologically prepare the patient for the outcome (managing expectations). I explain that I am forced to work within the confines of reality to act as a highly specialized expert to give the best known options and allow the patient to choose which amongst them are the best for the patient, based on his or her values. If CAM is mentioned as a possibility amongst those options, I freely discuss how it is an option, just one with very little likelihood of benefit. If they seem more devoted to the idea, I discuss that I believe what I do about their options because I have worked hard over many years to determine the best evidence to inform my opinion and that my goal is to have them agree with me not because of authority, but because I believe it for very good reasons. I take extra time to explain my reasons (not an easy task, but one I actively work on) and have yet to meet with disagreement (though of course they could be disagreeing but lying for myriad reasons, I would aver that at least a majority are genuine). I speak very plainly, with minimal jargon but I still do it at a higher level than most of my colleagues would, as I believe (and find) people would rather you speak to them at slightly above their level (and the key is to adjust appropriately and graciously by careful attention to non-verbal cues) and as an equal with different areas of expertise than have them think you may perceive them as a dullard.

      And I’ve gotten very good feedback about that tack so far. I’m always open to changing it, or even leaving it should it become evident that is harmful or not best. But so far I think that the evidence generally tends to support my ideas. I think it is best to be consistent about CAM and not be afraid to be vocal about it, bearing in mind that the one true art of medicine is conveying that understanding to your patient and that some will be more difficult than others (though I like to think of it as “many are better than some”). I am my patient’s advocate and I don’t sit here and whinge pointlessly about the harms of CAM because I have too much free time on my hands, but because I believe it to be true based on the best quality evidence available. How can I not act on that in good faith, for the express purpose of enabling the best outcome possible, to the limits of my capabilities and the totality of my patient as a person?

      OK… enough procrastinating….

      1. Dan says:

        Dr Pavlov,

        Kudos to you for being so up front with your patients about CAM. Again I have not found this approach to be helpful in the long run. I don’t know if you’ve had the chance to follow any of these patients longitudinally to see if it’s making a difference (giving up CAM for EBM).

        I had one patient who was actually married to a naturopath. There’s no way I’m going to be able to debunk naturopathic care with such an individual. It would just undermine their trust in me.

        Another woman brought in a bagful of supplements and vitamins – about 30 or so bottles. Without debunking naturopathy, she let me go through each and every bottle and allowed me to throw out those that might be harmful (such as high dose vitamin supplements). This is a relative rarity though. I must have caught her on a good day.

        Most CAM practitioners seem to warn their patients that medical doctors will attack CAM to their face — and thus when this happens, the patient will say something like “Naturopathic Dr X. told me you would say exactly that. I understand the medical establishment is a bitter rival of “. Good luck trying to build a therapeutic relationship on top of that sort of reaction.

        In large part, these patients feel they are gaining something from seeing a naturopath (they are paying for it, after all), while free medical care (as provided in Canada) is their God-given right and they may not see it as much of a boon to them (they are not paying for it, after all). I have so many other priorities in the limited time I have with patients that dissuading them of the inclination to spend money on useless CAM providers just cannot be one of them.

        Most patients, as you know, hate to take pharmacological medication but have no problem popping naturopathic supplements. That’s a major impetus for them to seek CAM.

        1. Andrey Pavlov says:

          Dr. Dan,

          As you may not be a regular here I wish to clarify that I am not yet doctor. In 3 weeks and 1 day (but who’s counting?) I will be graduated and have earned that title. Perhaps it is close enough to not matter, but I still feel awkward when referred to as “doctor” (my attending has been doing this lately as we round in the ICU and he introduces me to patients).

          In any event, I digress.

          You are absolutely right – I have not had opportunity for good longitudinal follow up. When that time comes I will certainly be paying attention to it for exactly that reason.

          And I wholeheartedly agree that in some cases – as you mention – the right play is to simply let it be.

          I also hope that I will have the time to keep up what I have been doing as I progress in my training, since I believe that to be one of the larger (if not largest) factors to hinder an ability to foster such a relationship and conversation with our patients. But even as my time is limited I will still attempt to do it as much as possible. I just may shift my “cutoff point” such that I let it be with more patients than I have been.

          As for the pharmacological intervention… I find that to be a mixed bag. Many certainly don’t like taking a pill and do indeed fall for the naturalistic fallacy. But many want me to just “fix them” and give them a pill to cure their problem. I’d probably agree that it leans more towards the former than the latter, but I also see a lot of desire for quick fixes and magic pills to drive a lot of the consumerism that is shared by CAM.

          1. Dan says:

            I hope you do not take this comment to be paternalistic or patronizing – perhaps it is really just depressing – but when I was a medical student and resident, I had much more time to be idealistic and true to my values with each and every patient. The real world of primary care and subspecialty medicine is often very different (though not always). In my clinic I am often balancing a junior resident with (always) no nurse practitioner and up to 14 patients in a morning, with follow-ups seen every 15 minutes. Medication review, blood pressure checking, review of labs and imaging, tweaking of the management plan, documentation, asking the patient (this is crucial) if they have any lingering questions or thoughts in their mind that need addressing — all this has to be done in 15 minutes. And yes we run behind.

            When I was a medical student or resident I sometimes took an hour or more with patients — I had that luxury. It is golden. It is wonderful. It’s an awesome training opportunity. As a consultant, I’ve learned to compromise and prioritize – what are the three most important decisions that need to be made, how best to make them, how to involve the patient’s priorities and preferences and values so that we see eye to eye and I am not just imposing decisions on the patient (the days where you could just write a script and nod the patient off are long gone, if they ever even existed – people nowadays demand information, rightly so).

            In my first couple years of practice, I broached the issue of fallacies of naturopathy, homeopathy and chiropractic with my patients and in follow-up I found that they were still seeing these practitioners. To be perfectly honest, perhaps I was too blunt. Many physicians will say things like: “You are just flushing expensive urine down your toilet by taking herbal ‘remedy’ X” — we got that talk from our attendings. Are patients put off by that? I wouldn’t be, but then, I am not my patient. I thought it was best to be blunt and truthful with my patients, rather than hedging my language – also, I didn’t have time to hedge. I am not cynical though – I occasionally deliver a well-needed hug to some of my patients.

            About drugs. Perhaps again I am biased (clinical pharmacologist here), but most of my patients hate taking them. Especially when more than one chronic therapy is prescribed. I am very lifestyle modification-oriented in my practice – I believe many diseases can be ameliorated with proper nutrition and exercise – but when it comes to drug therapy, I see that it is the patients who are most resistant to pharmacotherapy that are first to take up the useless vitamins and herbals and nutraceuticals promulgated by quack alt. med. providers. Statins, in a sense, are just as natural as something like hawthorne root extract – the first statin was a metabolite produced by fungi (‘endostatin’). That’s actually how it was discovered. I sometimes tell this to my patients. They look at me blankly. I do not know if they are convinced. Long-term studies show discontinuation rates of around 50%. The 50% who do not discontinue are compliant about 25% of the time. There are a few highly compliant patients – they tend to be the most educated, have the highest socioeconomic status – in other words, the least likely to see naturopaths and herbalists and quack ‘doctors’.

            My hope is that you carry your optimism and idealism into your residency and clinical practice. The scary thing is that it does not drop away suddenly when you enter practice. It can be a very, very gradual erosion that is nearly impossible to perceive until one self-reflects and writes blog posts like these (!) – just like the sea lapping at the shore. And I am willing to admit that I may be wrong and should spend more time detecting background CAM care (patients don’t often admit it) and debating it with them.

  30. James says:

    I am not sure if there is one single way of talking patient to help move away from CAM.

    My only suggestion for a doctor is to do like they do in marketing.
    Use psychology and A-B test their talking points with patients.

    Take note if you sitting or standing when talking to the patients.
    As usual record age, sex , gender, race blah blah.
    And practice your talking points make it seem as natural as possible.

    Use the tools of science available to you.
    Like it has been said here before words are important.
    Use the tools science to find the best way to talk to patients

  31. Mark DiDomenico says:

    Sorry if this was already covered, but can you add Chiropractic to the list as examples of CAM? I have several family members who swear by it, and would like to know how to talk to them.

  32. MissDemeanor says:

    Recently I gave my Mother-in-law a pep talk about Chemo outcomes (largely based on information from Dr. Gorski) and how, if her biopsy came back positive that we would insist on the best science based practices for her treatment so that she will someday have the opportunity to meet my children. Afterward we talked about my upcoming MRI and she spent two hours telling me that Chemo was too damaging to younger people and that I should look into faith-based healing and try to preemptively cure myself through the power of prayer. *headdesk*

    So I’ve been trying to implement the “can you believe this crap?” method. I’ll find something sCAMmy on HuffPo or in Woman’s World and I’ll blog about it – I’ll research the referenced studies (if there are any), comb through Pubmed, and start to tear down the offending article. I will then “let” myself be found by my mother-in-law while I am mid-rant, and start explaining to her why the bad science makes me angry. This will probably only work on people you’re around a lot (I live with my mother-in-law so I have lots of opportunities to turn around and deliver a painstakingly researched “can you believe this crap” diatribe) but it does deliver some okay results. I am still periodically waylaid with faith-healing, power of prayer BS, but she’s totally stopped watching Dr. Oz and is letting me teach her how to use Pubmed.

    People are terrible at changing their minds. One of the reasons that science is so controversial (to those who don’t get it) is because it comes off as “wishy-washy” or “flip-flopping” to people who have been taught that changing their mind is WRONG. True Believers in CAM are probably True Believers in other things – they may be die-hard for their political party, or their religion, or even just SuperFans of one band; they are the kind of people who think that if you vote against party lines once you can never be a true supporter of either party, or that if you bought one VanHagar album you can never be a VanHalen fan. The best way I’ve found to subvert the True Believers is to celebrate the science conventions that they find so unconventional. I’ll make comments like, “oh look, a few years ago we thought X but now we figured out Y – isn’t that great? I love that science keeps searching for answers.” Eventually it does get through to some of them.

    1. WilliamLawrenceUtridge says:

      If your MIL is using prayer as truly complementary, if she’s getting chemo and praying at the same time – take it as a win. Prayer is only harmful if they substitute it for real treatment, otherwise it’s a form of emotion-focussed coping. Personally, I’m happier watching a movie or eating ice cream, but to each their own.

      You could also have her read Mistakes were made (but not by me), it might help. Maybe. Probably not :(

      1. MissDemeanor says:

        She can be convinced to trust her doctors (which is a relief) and I don’t want to totally step on something that comforts her because that would just make me a jerk, though I do wish she’d stop attributing all of the hard work her doctors do to miracles. ;)
        Thanks for the recommendation – I’ll try. I was actually thinking that I might get her “Science Left Behind” for Christmas – I know it’s not a balanced book but the science seems okay and maybe if I can get her siding with science against a political party I can get her a little more on board with science in general.
        It’s so funny – her husband is an engineer and my husband is in R&D in heavy industry; sometimes I think she goes in for the woo just to be contrary.

        1. WilliamLawrenceUtridge says:

          Paul Offit’s Do you believe in magic? might be a good, or better choice. I found SLB a trifle cheap and unconvincing, and the references were poor. Plus, it’s quite a political book, and from your brief description it sounds like your MIL isn’t basing her decisions on whether Obama or Boehner (huh, boner) endorses CAM.

          If it’s just prayer, while visiting the doctor, meh. I have a similar situation with another family member, it’s all “woo plus doctors”. As long as the latter is involved, it’s not worth the acrimony. I don’t mind arguing with strangers, but I will fully cop to treading lightly and being a coward for the sake of family harmony.

          1. MissDemeanor says:

            I’ve been meaning to read Do You Believe in Magic? for a while now, maybe my husband and I will vet it before trying to pass it on to her – if the “can you believe this bs?” trap works on her, the “oh, look at this cool story” trap should work as well.

            As to SLB, it’s just that I’m trying to get her behind science at all. During one of my first talks with her about this I tried to point her at Malcom Gladwell and said “the only problem is that his ‘evidence’ is anecdotal, so take it with a grain of salt.” Her response was “oh, that’s my favorite kind of evidence! I love to hear stories – they’re really more important than studies, you know.” I let the subject drop for a while after that, but once she started stockpiling food for the end of the world in our house and cornering me in the middle of the night to reassure her that there aren’t shadow-people ruling the world I once more started to see the value of teaching some critical thinking skills. And moving out of my in-law’s house, of course. :D

          2. WilliamLawrenceUtridge says:

            It’s a very fast read, I finished it in a day in a half. Despite that, it’s very comprehensive and well-written. Offit at his best. He also uses a lot of well-chosen anecdotes to illustrate his points, which is always a good (if scientifically invalid :( ) way of convincing people so it would probably play well with your “audience”. I personally can’t stand Gladwell; like so many journalists, he substitutes interview and anecdote for science. And apprently doesn’t appreciate the importance of confirmation bias and post hoc ergo propter hoc. But it sounds like you agree :)

            If you’re looking at a discussion of science itself, you might be better off with Bad Science by Ben Goldacre (the book by Gary Taubes is interesting, but probably too much for your MIL). Another good option, aimed at consumers, is Snake Oil Science by R. Barker Bausell. Bausell goes into method explicitly, showing why each step of randomization, control, sample size and publication is selected. I found it a bit superficial, but then again I’ve seen most of the issues raised here and am already familiar with them. Trick or Treatment has a similar approach, but explicitly delves into the major quackeries (acupuncture, chiropractic, homeopathy, etc. with single-page summaries of other approaches).

            If you’re looking for any “check out this cool science” books, I would highly recommend The Emperor of All Maladies by Siddhartha Mukherjee. Incredibly readable, and goes into the science of cancer research with good, but not overwhelming detail.

            Dan Hurley’s Natural Causes wasn’t bad, but it’s more about politics and lobbying for herbal medicine.

            Robert Park’s Voodoo Science was good, and pretty readable (but not focused on medicine).

            Bill Bryson’s A Short History Of Nearly Everything is astonishingly good, and nicely intersperses science, history and biography.

            And if I’m recommending books, everything I’ve read by Simon Winchester and Michael Lewis has been good. Winchester, in particular, is just…well he’s just tops. His Meaning of Everything made the Oxford English Dictionary interesting, and The Man Who Loved China was an amazing history of modern China and Joseph Needham – the rake.

            But if you’re thinking specifically of your MIL, definitely get a copy of Offit’s book, it sounds almost tailor-made for your situation.

          3. MissDemeanor says:

            Thanks! That should keep everyone in the house busy for a while. And you’re right on Gladwell – I wish that I was interested in reading anything he wrote, but it’s pop science and I just get frustrated by the first few pages. (Also for some reason the page wouldn’t let me comment after your last comment, so this may be a bit out-of-line.)

  33. Jayla says:

    This site is a joke, reading through these articles one can see there is nothing more but a strong opinions with no sound source to back up the trash talk and other claims.

    Nice try in selling your legitimacy by selecting a slick site name, science based medicine? Nothing here but more B.S.

    1. Chris says:

      Perhaps, Kayla, you should educate us by providing us the verifiable scientific evidence that your favorite CAM works better, or at least more than a placebo. We anxiously await enlightenment from your wise words.

      1. Chris says:

        Urg, I was on my tablet and did not notice the auto-correct. Sorry, Jayla.

        Though please come back and tell us how this SBM article on asthma, placebo and acupuncture is B.S.

    2. weing says:

      “This site is a joke, reading through these articles one can see there is nothing more but a strong opinions with no sound source to back up the trash talk and other claims.”
      Why not back up your strong opinion and trashing with some examples?

      1. Chris says:

        Or some actual verifiable scientific citations?

  34. windriven says:

    “I have prided myself on NOT asking him why his mother hasn’t cured HIM.”

    I wonder if you have done him a disservice?

  35. nutr prof says:

    I thought I’d wait until the end of the semester when I have the SCAM presentation, and see what happens. I certainly have him in mind when I show the information on Emily Rosa and her study

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