Mar 14 2011
A University of Michigan Medical School alumnus confronts anthroposophic medicine at his alma mater
I graduated from the University of Michigan Medical School in the late 1980s. If there’s one thing I remember about the four years I was there, it’s that U. of M. was really hardcore about science back then. In fact, one of the things I remember is that U. of M. was viewed as being rather old-fashioned. No new (at the time) organ system approach for us! Every four weeks, like clockwork, we’d have what was called a concurrent examination, which basically meant that we were tested (with multiple choice tests, of course) on every subject on the same morning. The medical curriculum for the first two years had been fairly constant for quite some time, with a heaping helpin’ of anatomy, histology, biochemistry, and physiology in the first year and the second year packed full of pharmacology, pathology, and neurosciences. Nowhere to be found was anything resembling “energy medicine” or anything that wasn’t science-based!
Of course, back in the 1980s, the infiltration of quackademic medicine into medical schools and academic medical centers hadn’t really begun in earnest yet, although the rumblings of what is now called “complementary and alternative medicine” (CAM) and, more frequently these days, “integrative medicine” (IM) were starting to be heard in East Coast and West Coast schools. Even there, though, the incipient CAM movement was viewed as fringe, not worthy of the attention of serious academic physicians. Indeed, in the late 1980s, even at what are now havens of quackademic medicine if someone had suggested that diluting substances until there is nothing left, as in homeopathy, or waving your hands over a patient in order to channel the “universal source” of energy into a patient in order to heal a patient, as in reiki, had any place in scientific medicine, he’d have been laughed out of medical school–and rightly so.
Not so today, unfortunately. Although the problem of infiltration of quackademic medicine into academic medical centers goes way beyond this example, I can point out that faith healing based on Eastern mystical beliefs instead of Christianity is alive and well and ensconced in academic medical centers such as the University of Maryland School of Medicine Center for Integrative Medicine, where reiki masters are roaming the halls of the University of Maryland R. Adam Cowley Shock Trauma Center and Bonnie Tarantino, a Melchizedek practitioner, holographic sound healer, and an Usui and Karuna Reiki Master holds sway. Meanwhile, all manner of woo, such as acupuncture, homeopathy, craniosacral therapy, reiki, and reflexology are offered. Truly, you know that when an academic medical center has gone so far as to offer homeopathy, reflexology, and reiki, it’s all over as far as academic credibility is concerned, and it has become a center of quackademic medicine. Sadly, even a hospital where I trained, MetroHealth Medical Center, has succumbed to the temptation to add the quackery that is reiki to its armamentarium. That aside, I had never expected that my old, hardcore University of Michigan would go woo in such a big way.
I was wrong.
Over the last decade, the University of Michigan Medical School has gotten into alternative medicine, adding IM to its curriculum and even having a fellowship in IM. At the time I first learned of this a few years ago, as disturbed as I was, I reassured myself that at least U. of M. seemed to be sticking to the milder woo, like acupuncture and massage. Then, while browsing the blogs last month, I came across reports by P.Z. Myers and Tufted Titmouse, both of which contained a link to the University of Michigan Integrative Medicine (UMIM) resource page. And what to my wondering eyes did appear? (Actually, I should rephrase that as, “What to my despairing eyes should appear?”) The answer: Anthroposophic Medicine. Yes, it’s anthroposophy, Rudolf Steiner’s mystical, magical system that is the bottom of a lot of quackery and anti-vaccine beliefs. Indeed, outbreaks of vaccine-preventable disease have been distressingly common at Waldorf schools, where the educational philosophy is based on the teachings of Rudolf Steiner, which is why they are sometimes called Steiner schools or Steiner-Waldorf schools. Although the European Council for Steiner-Waldorf Education, which represents approximately 700 of the 1000 Waldorf schools world wide, has stated unequivocally that opposition to immunization forms no part of the goals of Waldorf education, Waldorf schools are magnets for parents opposed to vaccination. One example occurred in California in 2008, when there was a measles outbreak at the East Bay Waldorf School in El Sobrante. Given that the UMIM program, although interdisciplinary, boasts heavy involvement of family medicine faculty, I can’t imagine the cognitive dissonance that must be going on. After all, many family medicine doctors also take care of children and are responsible for making sure they are properly immunized just as much as any pediatrician.
But let’s look at what UMIM’s webpage on anthroposophy says about it:
Anthroposophic medicine views health as a matter of mind-body-spirit balance. It is centered on the idea that humans are not independent organisms but, instead, beings composed of the interactions of physical body, inner life body, soul (mind and emotions), and spiritual ego (self-awareness). Whereas conventional medicine focuses on “fixing” the part of the physical body that is “broken,” anthroposophic medicine prescribes treatment for the whole being through conventional methods in combination with holistic methods. As such, anthroposophic medicine integrates theories and practices of modern medicine with alternative, nature-based treatments and a spiritual-scientific understanding of the human being. The practice is based on Austrian philosopher Rudolf Steiner’s concept of anthroposophy, a scientific and philosophical world view that connects the spiritual within the human being to the spiritual in nature, the world and the cosmos.
This is consistent with what the Holistic Health Internet Community says about anthroposophic medicine:
Austrian scientist and philosopher Rudolf Steiner (1861-1925) refused to accept the contemporary scientific view of the body as a purely physical entity. From that conviction was born the doctrine of anthroposophy, a word he coined from the Greek words for “man” and “divine wisdom.” Steiner believed in the uniqueness of each human being, and contended that health and well-being deteriorated without that belief. Trained as a scientist and a mathematician, he was influenced by Hindu and Buddhist beliefs and founded a school in which his theories became practice.
Anthroposophical medicine determines the nature of illness based on Steiner’s principal of polarity. His system attempts to link and harmonize both the upper and lower poles of the body. Good health then depends on a harmonious relationship between the physical, etheric and astral bodies, and the ego. Practitioners are trained as medical doctors and may treat childhood infections, hay fever and asthma, anxiety, depression, cancer, musculoskeletal problems and fatigue.
If twenty years ago someone had told me that one day that not only would my medical alma mater be publishing dreck like this, but that it would have formed an interdisciplinary program devoted to it, I would have told that person he was delusional. If you had told me that anthroposophy would be part of a larger program of woo run by a physician who is described as having “studied herbalism and spiritual healing for 14 years with a Native American Healer” and as having research interests that include the “use of herbs, energy healing, environmental healing, and the therapeutic relationship” or that a physician trained in “functional medicine” would be a big part of a program in anthroposophic medicine there, I wouldn’t have believed it. All I can wonder is what Bill Kelley, the infamously hardcore scientific chair of the Department of Internal Medicine while I was at Michigan, would think or say if he were still at U. of M. In fact, having read the section on anthroposophy on U. of M.’s website, I wish I were delusional. But I’m not. The section is real, and the medical school from which I graduated has not only started to tolerate such nonsense, but begun to embrace it.
Anthroposophical medicine, it turns out, is rooted in prescientific vitalism. Rudolf Steiner, before he came up with the idea of anthroposophy, had led the German section of Theosophy. When he became enamored of his spiritual concept of anthroposophy, Steiner in essence caused a schism. Anthroposophy, it further turns out, is far more a religious and spiritual philosophy than a scientific or medical one. Based on his philosophy, Steiner created Waldorf schools, anthroposophic medicine, and biodynamic farming, the last of which would be a suitable topic for an amusing post on a non-medical blog. Suffice to say that some of the practices of biodynamic farming involve stuffing Yarrow blossoms (Achillea millefolium) into urinary bladders from Cervus elaphus, Red Deers, placing them in the sun during summer, burying them in earth during winter and retrieving them in the spring, all to strengthen the “life force” of the farm. There’s also a lot of use of cow horns, based on Steiner’s rationale, “The cow has horns in order to reflect inwards the astral and etheric formative forces, which then penetrate right into the metabolic system so that increased activity in the digestive organism arises by reason of this radiation from horns and hoofs.” Moreover, many of the concepts of homeopathy are combined with Steiner’s woo, such that many of the concoctions of biodynamic farming, which consist of various bits of dead animals plus or minus ground quartz crystals, are diluted into many tons of compost, to be spread over acres of farmland.
But let’s get back to anthroposophic medicine, which is based on the same sort of mystical philosophy that biodynamic farming is. Simon Singh and Edzard Ernst characterize this form of medicine thusly in their book Trick or Treatment?:
Applying his philosophical concepts to health, he [Rudolf Steiner] founded, together with Dr. Ita Wegman, an entirely new school of medicine. It assumes metaphysical relations between planets, metals, and human organs, which provide the basis for therapeutic strategies. Diseases are believed to be related to actions in previous lives; in order to redeem oneself, it may be best to live through them without conventional therapy. Instead, a range of other therapeutic modalities is employed in anthroposophic medicine: herbal extracts, art therapy, massage, exercise therapy, and other unconventional approaches.
Perhaps the most common example of anthroposophic medicine is the use of mistletoe extracts for the treatment of cancer. Perhaps you’ve heard of Iscador? While Iscador might actually have some activity against, for example, breast cancer, it is not without toxicity, and the evidence for its efficacy in cancer is at best conflicting. Even if Iscador turned out to be an effective treatment for breast cancer, it would be an example of being right for a reason that is spectacularly wrong. That’s because Steiner argued that mistletoe is a parasitic plant that eventually kills its host. To him, this represented a striking parallel to malignant tumors, which, like mistletoe, are parasitic entities that eventually kill their hosts. Steiner’s conclusion? Because of this resemblance, mistletoe must be an effective treatment for cancer. Readers knowledgeable about homeopathy will immediately recognize that Steiner clearly must have believed in the homeopathic principle of “like cures like.” In fact, he even went beyond that to generalize that “a plant is a healing plant when it has a distortion or an abnormality in its physiology and morphology,” presumably related to human disease. Indeed, according to Dr. Peter Hindenberger this represents a “modern, scientific reformulation of what, in former times, existed in the ‘doctrine of signatures‘”; i.e., the belief that God has marked everything he created with a sign (signature) that is an indication of the purpose for which the item was created.
Although you can read more about anthroposophic medicine, either at a Steiner website or the Physician’s Association for Anthroposophic Medicine (to get it right from the horse’s mouth, so to speak) or over at The Skeptic’s Dictionary and Quackwatch, including a description of what being a student at a Waldorf school is like, because this is about UMIM’s apparent embrace of anthroposophical medicine, I think that I will close by discussing what UMIM says about it. But, before I do so, let me quote a passage from what PAAM says about it in a PDF booklet. After all, U. of M. includes a link to PAAM on its website, which leads me to assume that the UMIM program in anthroposophic medicine endorses PAAM. So does the fact that PAAM is based in Ann Arbor. But back to the PAAM pamphlet:
Medicine based purely on material science is limited to explaining an illness solely on the basis of the laws of physics and chemistry.
I’m sorry. I can’t help but interject here that PAAM says this as though it were a bad thing. Personally, though, I’m curious as to how we can explain illness not based on the laws of physics and chemistry. Unfortunately, PAAM is more than happy to tell us how anthroposophic medicine is “more ambitious” than us mere practitioners and proponents of science-based medicine. I suppose it is, casting off, as it does, all those inconvenient laws of physics and chemistry that took hundreds of years to discover and understand:
Anthroposophic medicine is more ambitious. It takes into account additional factors, both general and individual, that may affect the patient’s life, mind, and soul, and their physical manifestation: in growth, regeneration, microcirculation, fluid retention in the skin, muscle tone, biorhythms, head distribution, posture, uprightness, gait, mental focus, speech. When illness occurs, examination of the above may reveal deviations, imbalances, and extremes–additional diagnostic parameters that need to be considered when selecting a therapy. Anthroposophic medicine also has a different understanding of the role played by the patient in overcoming illness. The patient is not simply a passive recipient of medical skill, but an equal partner with the doctor. After all, nobody can know the patient better than the patient. During an illness, the patient has the opportunity to recognise the state of imbalance body and soul have reached, to understand this and rectify it. The illness can provide an opportunity to learn new modes of behaviour, to develop further insights, and acquire greater maturity.
And, yes, anthroposophic medicine embraces homeopathy:
In addition, other substances tailored to the patient’s unique characteristics are administered. These are frequently homeopathic substances designed to stimulate the organism and its powers of self-healing.
Science-based medicine, anthroposophy clearly is not. Of course, that’s quite obvious from what UMIM itself says about the anthroposophic view of health. According to UMIM, this consists of these tenets, with my comments in brackets after each item:
- Health involves a dynamic balance and high functioning of all aspects of a person’s life. [This is so vague as to be meaningless and all but impossible to argue with, but it's the sort of trope common in alt-med circles.]
- Illness is the result of disharmony and imbalance amongst the three systems of the body and their related forces and effects. [This sounds very much like attributing disease to imbalances in the four humors. Teach the controversy! about the Four-fold Man!]
- Illness is a tragedy, but also an opportunity for learning and transformation. [This sounds very much like the quackery that is the German New Medicine and Biologie Totale to me; that is, if you strip away Steiner's belief in reincarnation wherein illness isn't the working through of unrecognized emotional traumas in this life (as German New Medicine teaches) but is rather the working through of issues from previous lives.]
- The signs and symptoms of an illness are often the body’s attempts at healing and, in general, should not be suppressed, but rather, aided, observed and resolved. [More German New Medicine- and Biologie Totale-like gobbledygook. Again, odd how U. of M. leaves out Steiner's belief that these body's attempts at healing are related to past life experiences.]
- Many illnesses, especially benign ones, should not be artificially prevented, but should be allowed to occur and be treated and healed. The patient thereby gains strength and experience, both biologically and spiritually. [This would appear to be the basis for so many anti-vaccine beliefs that permeate every aspect of anthroposophic medicine and the education taught in Waldorf schools. After all, what is vaccination, but preventing illness? I guess your kids get so much stronger, spiritually and biologically, if you just let them, take their chances with measles, mumps, whooping cough, and Haemophilus influenzae type B. Because, you know, that worked out so well for children in terms of childhood mortality back in the days before vaccines could prevent these diseases. Oh, wait. No it didn't.]
- True prevention of illnesses involves a healthy lifestyle with positive habits, strengthening the biological, psychological and spiritual aspects of a person, and avoiding the detrimental and illness-producing effects of much of modern civilization. [Do I detect a reference to "toxins" here? I think I do.]
UMIM even goes on to link to a company that produces skin care products and medicines based on Steiner’s biodynamic farming (including Iscador and homeopathic remedies), as well as to point out that many anthroposophical remedies can only be administered as an inpatient at a facility like the Rudolf Steiner Health Center in Ann Arbor, Michigan. There, you can find a video about anthroposophic medicine:
Check out the part around 24:25, where a chemist describes how anthroposophic medicines are made, including the part about how he “potentizes” many of them in decimal fractions, just as homeopaths do with their remedies. His goal is, as he puts it, to “strengthen the vital forces within the living organism while at the same time respecting its natural rhythm.” He also heads out to the French border at 4 AM during the summer so that he can harvest Arnica plants at dawn, thus allowing the “morning strength” to be maintained in them. I kid you not. Then, get a load of this description of anthroposophic medicines, right off the U. of M. website:
Many anthroposophic remedies are specially prepared using homeopathic or modern alchemical pharmaceutical processes to naturally stimulate healing processes in the ill person.
Yes, it would appear that alchemy is alive and well at U. of M.!
Fortunately, the Rudolf Steiner Health Center does not appear to be affiliated with the University of Michigan, at least as far as I can tell. Unfortunately, it’s still very disturbing that UMIM would recommend such an institution and even more disturbing that “anthroposophic physicians at the University of Michigan” appear to be partnering with the Rudolf Steiner Health Center to research anthroposophic medicine as supportive care for cancer patients.
Personally, I think that Robert Carroll gets it exactly right when he characterizes anthroposophic medicine as being “even more out of touch with modern, science-based medicine than homeopathy.” Think about it. Homeopathy is based on just two magical ideas: The Law of Similars and the Law of Infinitesimals, which together can be viewed as an expression of the ancient principles of sympathetic magic. In marked contrast, anthroposophic medicine is based on many ideas with no basis in science that can best be described as pure magical thinking. Indeed, to me at least, anthroposophic medicine resembles more than anything else naturopathy in that there doesn’t appear to be a form of unscientific, prescientific, vitalism-based woo that it doesn’t embrace. In fact, anthroposophic medicine appears to go far beyond naturopathy in that respect. It also brings into play a veritable cornucopia of mystical concepts, including the etheric body, the astral body, and the ego. It postulates that the soul, the senses, and the consciousness are beings that have an independent existence outside of the body and further asserts that herbs, essential oils, and movement therapy known as eurythmy can bring these things into harmony and balance with each other and the physical body. Reading about anthroposophy and anthroposophic medicine, I had some serious acid flashbacks to my youth, when I used to be an avid Dungeons & Dragons player. My personal oddities during my high school and college years aside, anthroposophic medicine openly denigrates science-based medicine for only being able to diagnose and treat disease according to its understanding of the laws of physics and chemistry, to which I respond: Upon what else would a physician base his understanding of disease? As Carroll put it:
Steiner approached medicine the same way he approached everything else from astrology to Atlantis to education to farming to metaphysics: He dictated his visions. Why anyone considers him a scientist is a great mystery. His notion of science as involving the explanation of how immaterial entities affect material entities is the very opposite of science.
Indeed, and the medical school from which I graduated over 20 years ago now has a program dedicated to teaching physicians and medical students as fact the medical philosophy of this very man, whose philosophy is not only far more religion and mysticism than science but is indeed antiscience at its very core despite its superficial declaration of allegiance to science. Indeed anthroposophic medicine’s assertion of relationships between the various bodies (physical, etheric, etc.) and astronomical bodies is far more akin to astrology than science. Would that it were only homeopathy U. of M. were teaching and practicing!
I used to be very proud to have graduated from the University of Michigan Medical School. When I was there, it was one of the top public medical schools in the country and compared quite well with any private medical school in the U.S. you could name. In many ways, it still does. Unfortunately, like those other top medical schools, including Harvard, Yale, Stanford, and Columbia, U. of M. appears to have embraced quackademic medicine. I only wish it had, instead of imitating such schools, resisted the siren call of unscientific, prescientific, and pseudoscientific medicine. Unfortunately, as its embrace of anthroposophy demonstrates, it has not. As a result, the pride I have as a U. of M. alumnus is now tarnished with the knowledge that, even though the vast majority of what happens at the medical school and its affiliated hospitals is still solidly science-based and U. of M. boasts some of the best medical research programs anywhere, there now exists section within it that teaches pseudoscientific nonsense as if it were science. It makes me very sad and depressed to contemplate.
No doubt the U. of M. faculty and leadership responsible for this travesty will say that they pick and choose only the bits from anthroposophic medicine that are evidence-based and ignore all the woo. Quite frankly, to me anthroposophic medicine is pretty much all woo as far as I can tell. Or perhaps they would argue that the anthroposophic medicine program is a tiny part of a vast enterprise of science-based medicine. This is almost certainly true. It’s also probably true that relatively few U. of M. faculty even know about the existence of a Steiner-inspired program at their school. To me, however, there is zero place for such religious- and mysticism-inspired nonsense in any reputable medical school, other than as a footnote in courses in the history of medicine. Certainly there is no place for it being taught or practiced as though it had any validity whatsoever anywhere near medical students, residents, or fellows–and especially nowhere near patients.
Finally, knowing that U. of M. is teaching and practicing anthroposophic medicine makes me very irritated whenever I get mail soliciting donations for its medical school. From here on out, I think that, whenever a U. of M. Medical School solicitation arrives in the mail, I’ll send it back with a link to this post as the reason why I must decline.
151 Responses to “A University of Michigan Medical School alumnus confronts anthroposophic medicine at his alma mater”
The tl;dr version: anthroposophy = homeopathy + ghosts
which means anthroposophy is even MOAR STOOPID than homeopathy.
Nice sciencey machine and white coat!
I am glad you are writing about this. My experience with Mott, U of M Children’s Hospital has been very good. I have talked with other parents who had similar good experiences. Luckily, I have not experienced any hints of metaphysical mumbo jumbo there*.
It is sad to me that U of M would undermine their accomplishments in children’s health with this sort of destructive nonsense.
I am curious if anyone with decision-making responsibilities at U of M will have a response to this.
oops, ignore that * I meant to delete it.
Dr Benway – Ghost should stay in their place. Around campfires, in moody gothic films, even wandering through my bedroom at night,* are all acceptable places.
A doctor’s office is not.
*hallucinations (hypnopompic or hypnagogic)
“This would appear to be the basis for so many anti-vaccine beliefs that permeate every aspect of … the education taught in Waldorf schools.”
I was wondering about this. My two nieces used to attend the East Bay Waldorf School. My brother told me the school had no policy against vaccination. Rather, the kind of parents who send their kids to a Waldorf School are less likely to vaccinate their children. They tend to be liberal crunchy granola types of people, as you would guess.
I am curious if anyone with decision-making responsibilities at U of M will have a response to this.>>>>>
those who control the school is to busy trying to fiqure out a way to beat OSU at football and basketball. We need a new sport on TV where intra state quackery is measured by FDA officials and the biggest quack college team looses the game.
art malernee dvm
osu 73
Quackademic medicine is having a “trickle down” effect. A local hospital now has an “Integrative Medicine Committee” of the Medical Staff. The “IM” committee recently recommended that the hospital allow acupuncture for pain and now the issue is before the Credentialing Committee, the Medical Staff Executive Committee having approved the idea. This hospital has a family practice residency program so the residents will see this nonsense going on during their training. One of the rationales for allowing acupuncture given by the “IM” Committee is that Harvard, Stanford, etc., now employ “IM.”
I and others are trying to stop this from going forward. Step # 1: a meeting with the hospital’s Medical Director today.
I have to wonder just how much money the embrace of woo is bringing in. At the end of the day our trusted institutions seem to be unwilling to forgo a new “profit center”. They can use the excuse that people want these treatments. I now have trouble finding a drug store that does not offer homeopathic products. The stores I have complained to use this very argument. Familiarity with these products and having woo accepted by major institutions only adds to the belief on the part of the public that there must be “something to” these treatments.
I wonder if some well publicized wrongful death suits would take the luster off these “money makers”. Unfortunately the deaths caused with quacks seem to stay off the radar. In the meantime I wonder if attending a Harry Potter film could now be used toward my continuing education requirements. After all they do talk about potions in these films and how to use them. Whether or not they work in the real world seems no longer to have any relevance.
I agree that anthroposophic medicine (AM) is not to be trusted, but I will say something in defence. One of the tenets of AM is that it is only possible to practice AM if one is a fully licenced MD.
In homeopathy and so on (insert here 400 most popular forms of quackery) the healers don’t have to be physicians. Not so with AM (at least in Europe as far as I know): to become a practitioner of anthroposophic medicine one must be a fully trained MD.
One of the reasons why anthroposophic health care is popular (at least over here) is that these anthros have very high opinions about what it means to be human. So their care for retarded children, the demented and the insane is – as far as I know – based on the idea that these people all have a precious soul and have the right to be respected just like any other person. Steiner gave the example by acting as tutor for the hydrocephalic child (Otto Specht, 1873-1915) of a wealthy Jewish family. When Steiner started, the ten year old boy was ‘difficult’ and could hardly read. Later Otto became a dermatologist.
AM is full of incomprehensible occultism. One of the ideas is (all hearsay) that if a patient is given, say, a highly diluted preparation of a plant that was harvested at full moon at a particular position of Saturn and that had grown on lead containing soil, all this should be carefully explained to the patient, so the patient really understands how the Saturn powers or the lead force or the moon process or whatever is going to improve his health. Just a prescription without an explanation won’t do. How a fully trained MD can do this I don’t know. Maybe the idea is that you reserve this treatment for patients that are willing to believe this.
Among AM there is a remarkable theory about how the heart works. The heart (dixit AM) is not a pump. No, the beating of the heart should be compared to the action of a water ram. You may not be familiar with a water ram. It is a simple system of pipes and valves, which converts the kinetic energy of fast flowing water into potential energy of part of the water. It works all by itself and doesn’t need an external source of power. This theory is not thought up by AM, it is borrowed from a certain K. Smith (1882). Of course the ram equation: “fast flowing water -> slow flowing water + water with high potential energy” is quite different from the heart energy equation: “slow flowing blood + muscle energy -> fast flowing blood” but this kind of physics is lost on AM. For Steiner it was the analogy that counted: the sun is the ulterior source of energy for the fastflowing water, just like the spirit is the source of energy for the blood. Blood moves by itself. Mixed with this are also opinions that the heart is necessary to stop the blood for just a moment, to make the existence of the spirit possible in this endless alternation of death and rebirth every second. Beings with a continuous fluid flow, like plants, cannot be conscious. And so on. Even in the 1960s and 1970s there appeared scientific papers on this subject (incomprehensible stuff where the hydrology of the Rhine and Donau basins featured as well as schemes about solar energy and blood).
Now for the optimistic bit. Because AM teaches that humans are completely autonomous free beings, it is required of the faithful that they not mindlessly parrot what others have said: one must be held individually responsible for what one believes. So an AM physician is at liberty to believe or discard any part of AM. So if s/he thinks the ‘heart is a water ram’-theory of the Saturn powers of medicine to be nonsense, that is quite OK. AM is not like RC doctrine. That is why it is so difficult to grasp: all these AM doctors think differently. Most of them believe in reincarnation, probably, because that is also one of the principal parts of anthroposophy. Some of them give this a rational twist: ‘because I know I will be reborn, it is in my own interest to make the world a better place’.
So if you want to do something against AM, insist that all MDs get a rigorous scientific training. If that doesn’t help, I don’t know what will.
It is quite possible to have a high opinion of what it means to be human and to care for the ill and disabled with respect and compassion without embracing pure astrology-grade mystical nonsense. Just sayin’.
If you want a good laugh about the denial going on over homeopathy at the University of Minnesota Academic Health Center, have a look at this:
1. Why Would an Academic Health Center Support Homeopathy? (Chronicle of Higher Education) link: http://bit.ly/ea9qNI
2. Response to: Why Would an Academic Health Center Support Homeopathy (present and immediate past med school dean/Academic Health Center VP, Cerra and Friedman) link: http://bit.ly/goqI79
3. My comments on #2 in Minneapolis Star-Tribune:
link: http://bit.ly/fdrrIq
I’d be happy to write a post for SBM outlining the ludicrous situation at the University of Minnesota Academic Health Center with respect to homoeopathy.
Bill Gleason
Dept Lab Med & Path
U of Minnesota Medical School
and U of M alum
I guess you’ll have to compare anthroposophic institutions for retarded children with non-anthroposophic ones. I think that if you point out quite correctly that a certain ideological drive has many undesirable effects (you could add the silly blood crystallisation tests of the AM) then you shouldn’t ignore that the same drive can have some positive effects too. If only because the anthros will use such ignorance against you. That’s a nasty part of the anthros: they extremely vigilant about people attacking them.
I doubt the anthros have anything on antivaxers as far as attacking critics. I guess we’ll find out.
Oh, wait. Most anthros are antivaxers…
Hey. Hey. Hey. At least Dungeons and Dragons admits that it is a fantasy world which anthroposophy refuses to acknowledge.
There is one fundamental tenet of anthroposophic medicine not mentioned thus far that is crucial to understanding what anthroposophic physicians are trying to do.
Anthroposophy is based on karma and reincarnation. Illnesses have karmic explanations; they are often straightforward punishments for transgressions in past lives. Steiner outlined numerous direct karmic meanings; smallpox, for instance, comes from “unlovingness” in a past life. Epidemics occur because large groups of people have shared karma to work out, or shared “spiritual tasks” to accomplish. Suffering is good for the soul. Suffering pain in one lifetime may even make you physically very beautiful in the next life.
It is particularly important to understand how this works with vaccination. Steiner did not assert unequivocally that vaccination should be avoided, but he did state that since many diseases are karmic, if you avoid the disease by means of vaccination, you are simply postponing the working out of that karma until another lifetime. Many Steiner teachers and Steiner parents logically conclude that it would actually be better for the child to get the disease. “Chicken pox parties” are popular in Waldorf communities, i.e., deliberately exposing children to the disease.
This is *not* done because “natural healing” is thought to be better. Illness is seen as actually karmically *beneficial*. This is really important to understanding the philosophy. The goal is not necessarily to avoid or treat an illness at all, in the way the rest of us would understand.
I can provide quotes from Steiner on all these topics a bit later, if desired.
It’s very important to understand that this form of “medicine” does not necessarily always have the goal of healing the patient. Children who suffer illnesses or die young are thought to have simply completed their life’s “task” in the current lifetime.
These bullet points:
• Illness is the result of disharmony and imbalance amongst the three systems of the body and their related forces and effects.
• Illness is a tragedy, but also an opportunity for learning and transformation.
• The signs and symptoms of an illness are often the body’s attempts at healing and, in general, should not be suppressed, but rather, aided, observed and resolved
… purporting to explain the principles of anthroposophic medicine are thus a bit deceptive. They’re leaving out quite a bit of their philosophy that they know will be extremely unpalatable to a lot of people. Most people reading those innocuous talking points (even physicians, obviously) will not have a clue what is actually meant by calling illness an “opportunity.” Most parents would really prefer their children have the opportunity to GROW UP rather than die of a vaccine-preventable illness.
Obviously, the “natural healing” rhetoric appeals to a lot of people, apparently even medical school faculty, probably owing to the anthroposophical community that grew up around the Waldorf school in Ann Arbor. Perhaps though, if the people who are responsible for letting this stuff get a foothold at the University of Michigan medical school took a FULLER look at these doctrines, at the underlying world view, it might help to get the point across as to why this practice is completely unacceptable.
Anthroposophic medicine fails on the most basic ethical principles of medicine – the goal of actually curing disease or at least alleviating suffering.
Do you know anything about the personalities/politics at U of M that led to this? Who’s responsible? And how did they get anything this bizarre past the rationalists who are presumably still on duty at U of M? I mean it’s one thing for an institution to come down with the a touch of the touchy feelies, but crikey: anthroposophy?!
It’s baffling and disturbing. You must feel a bit like the Trojans felt: “Hey, how did these assholes get in here?”
Well, I’d bet the farm that they’re doing this because there’s money for it. Have you investigated the funding behind this? In addition to the chance for NCCAM funding, of course, I presume there is some wealthy alum who is making it happen. Universities have a very hard time turning down filthy lucre.
or
David Gorski “Reading about anthroposophy and anthroposophic medicine, I had acid flashbacks to my youth, when I used to be an avid Dungeons & Dragons player.”
Actually, reading this article, I had flashbacks to my youth too. Unfortunately it wasn’t to pleasant memories of D&D, it was to memories of a small time metaphysical guru who some of my friends became involved with. The abuses that can be rationalized and propagated with that kind of “compassionate” all encompassing mind/body/spirit/soul metaphysical healing doctrine boggle the mind.
One would hope that a trained doctor has more ethics than this guy did (one would hope a turtle has more ethics). But I still think that anyone who suggests that they can help you heal your mind/body/spirit/soul(altogether) is a dangerous person to be around.
I don’t know. I haven’t had much connection with the medical school in years. It would be interesting to find out, though.
The Integrative Medicine fellowship at U. of M. is supported by a grant from the Fannie E. Rippel Foundation:
http://www.med.umich.edu/umim/education/fellowship.htm
UMIM is also a member of the Bravewell Consortium.
The fact that UMIM lists links to Weleda, a company that manufactures and sells anthroposophic medicines, at the end of its page, makes me wonder if Weleda has provided any support to its AM program:
http://www.med.umich.edu/umim/education/fellowship.htm
http://usa.weleda.com/
NCCAM has also supported UMIM in the past with a training grant:
http://projectreporter.nih.gov/project_info_details.cfm?aid=6952264&icde=7399332
Perusing the Web site of the Anthroposophical Society in Ann Arbor gives a good indication of just how organized this group is in this geographical area, and the extent of their activities. This probably has hints of where some of the influence at University of Michigan comes from.
http://www.anthroposophy.org/index.php?id=156
Under Articles, check out “The Seven Levels of Illness & Healing” by Dr. Philip Incao.
Does anyone have any information on the Rippel Foundation (funders of woo at U of M)?
This from the “Founders and Members” page of their website:
“Since 2007, the Foundation-led effort has grown from an initial exploration of the relationship between health and energy…”
The relationship between health and energy? It is all quite vague, at least at a first glance at their site.
@Jan Willem Nienhuys
AM practitioners may have one MD more than homeopaths, but from all that talk of red deer kidneys stuffed with yarrow and the position of Saturn in the sky, I doubt it makes much difference. Kind of like a geocentrist with an astronomy degree.
Having read the Quackwatch account of attending a Waldorf school, I must say I know a lot of crunchy people who would not be discouraged in the least by that account. They’d count it all a positive and rationalize away the racism as a thing of the past.
My own public (“secular”) elementary school experience involves group punishment by denied lunches, Christian prayer, and talk of creeping invasion by Chinese Godless Communists. I got the impression early on that schools are mostly a political battleground over who gets to indoctrinate who into what.
A reality based education of knowledge instead of dogmas would be a refreshingly novel idea. Might even prove useful to graduates. Awful shame for a medical school to be moving away from that.
I just want to be clear that my screen name is short for:
ANTHROPOLIGIST
–not Anthroposophy
We study this stuff and sadly, there is some contamination currently going on in my field too, but generally, we don’t confuse respecting someone’s cultural practices with adopting them without question as our own. Don’t these people (who adopt all these “ancient practices”) realize that the most successful way to make contact with a different culture was to offer medical treatment? Cultures will hang on to their traditional practices (just as we hang on to ours; i.e., religion), but most individuals will quickly line up to see the real doctor, especially if they are actually sick or suffering form some chronic condition.
This phenomenon (using medicine alongside traditional belief systems) gets to the heart of all this. The average person, with a limited scientific education, isn’t much different from the recently contacted “primitive” person in the (perhaps hard-wired) need for belief-centered healing. I’m certainly not condoning what’s going on in major universities. They are in a position to combat this trend and should be ashamed for encouraging it instead. The NIH definitely needs to stand up to the dimwits in Congress who fund the absurd Alt Med division and get rid of it. It’s mere existence just adds to the confusion of fence-sitters and gives a seeming stamp-of-approval to the already reality-challenged.
I am just thinking out loud, but if a large number of graduates of the medical school started an online petition to the “medical school accreditation authorities” to have the school delisted because it has become a force for quackery and a blanket recommendation than no med students apply there because it teaches quackery, would that put the fear of de-accreditation in them?
It would be a death sentence for the school, but better to kill it than to let it become a force for evil.
@wbgleason
I followed your links and was particularly struck by this from Dr. Aaron Friedman, DEAN of U of Minnesota Medical School:
“The University of Minnesota’s Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers. In 2011, what we don’t know about improving human health still exceeds that which we do know. Perhaps this will always be the case.
But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.”
I almost choked on the irony. Friedman finds arrogance in the presumption that ‘Western’ medicine has all the answers but apparently finds no arrogance whatsoever in abandoning the scientific framework that upon which virtually every important medical advance in the last 100 years rests – in favor of mysticism and wishful thinking.
Bravo, Dr. Friedman. You are a credit to your profession and your university.
I just read wbgleason’s articles too.
The response is truly dreadful, and incredibly evasive. The comments can basically be summed up as argumentum ad populum (lots of people use CAM / a billion Chinese people can’t be wrong) ad hominem (Western science is arrogant and all Pharma Shills motivated by greed) and argument from ignorance (How can we really be sure it doesn’t work?) with a bit of concern trolling. Which is, apart from the extreme evasiveness, not much different from Dr. Friedman’s response.
Anthro said:
My guess is Deans of Medicine and University amdins are in the same painted bamboo boat.
Anthro on 14 Mar 2011 at 12:30 pm wrote “… The NIH definitely needs to stand up to the dimwits in Congress who fund the absurd Alt Med division and get rid of it. …”
Actually, that has been tried and it failed due to Sen. Tom Harkin (D, IA) holding the entire NIH budget hostage till they relented. Harkin is still there.
In addition, when Gonzalez’s clinical trial (mentioned in the main article, above) was rejected by the NCCAM, Rep. Dan (The Loose Cannon) Burton (R, IN) called the head of NCCAM to his office. We don’t know what Burton said; but Gonzalez’s trial was funded. And Burton is still there.
The following was taken from SkepDoc, Harriet Hall, MD site. It would seem to be a fitting, if somewhat coarse, response to Dr. Friedman:
“It’s very common, and very silly, to point out that there are many
questions as yet unanswered by science, and then to claim it’s legitimate to
fill in the gaps with whatever arbitrary shit you want to make up.”
@Joe-
Harkin has been in the Senate for nearly 30 years. Burton has been in the House for nearly 30 years. Darryl Issa, another Luddite, has been in the House for a decade.
Good grief.
@NYUDDS,
“It’s very common, and very silly, to point out that there are many
questions as yet unanswered by science, and then to claim it’s legitimate to fill in the gaps with whatever arbitrary shit you want to make up.”
I’d like to clarify that I was quoting one of the commenters on this blog. He or she goes by a screen name, so I can’t provide proper attribution.
You are too late. The bad people have stacked all the decks. CAMsters sit on accreditation committees, JCHAO, the IOM, and state licensing boards. Since the IOM report in 2005, the teaching of CAM to med students “at all levels” is required.
Dan Burton’s right-hand man for many years was Scientologist Beth Clay. She likely still has Burton on speed dial.
Just sayin’.
As so often the problem is slightly different in the UK. Steiner (Waldorf) High Schools have been pushing hard for government funding.
I had on my blog recently, three seriously scholarly guest posts on Steiner education.
The first part was The true nature of Steiner (Waldorf) education. Mystical barmpottery at taxpayers’ expense. Part 1
The part 2 is The Steiner Waldorf cult uses bait and switch to get state funding. Part 2.
The part 3 is Steiner Waldorf Schools Part 3. The problem of racism.
Yeah, it’s unfortunately not like the newcomers have a monopoly on scientific illiteracy.
Indeed.
@David Colquhoun
Oh, we have lots of Waldorf schools on this side of the pond, as well. However, giving public money to private schools is a lot more problematic here, I suspect, than it is in the UK, although certainly lots of legislators, particularly those who want to support religion, sure enough do try by advocating vouchers that can be used at religious schools.
@Scott-
Yes, and my larger point was that there seems little political cost – at least in their districts.
These days it seems like an actual advantage. People who THINK won’t necessarily agree with the extremists’ knee-jerk prejudices. (True on either side.)
The insidious danger is largely contained in the words, “AM teaches that…”
Those words are anti-science. They are not okay.
Authority based upon spiritual intuition deserves a kick in the shins.
I am probably nearly as uncomfortable at this kind of thing as anyone here. But I worry that that feeling in my gut derives from how we scientists habitually analyse the world, rather than a complete awareness of how the world of medicine actually operates in 2011.
Medicine once had a much clearer scope. Priests handled our existential angst, and large, extended families provided any other support that the sick might need.
Society is different now. CAM may not merely be a response to those areas where conventional medicine performs weakly. It may reflect people having to turn to medicine for other human needs.
This could be a key to understanding CAM. It explains the touching, the long seemingly medically irrelevant interviews, the intense practitioner-patient bonds, and that “spirituality crap”. .
The implication is that if we succeeded in restricting ourselves to a more narrow “working better than placebo” model of medicine we would not solve anything. We may find ourselves forced to work alongside less fettered and more dangerous elements of AM.
It’s worth a thought before entirely condemning those who seem to be selling science out.
Well here’s their problem right here:
Limbs and digestion are one system? These people literally don’t know their assholes from their elbows.
Surely, given that it’s obviously possible for a paediatrician with thirty years of clinical experience™ it must be possible for others as well.
This is wandering bit afield but
@davidgorski
It’s more pernicious than that in the US . For many years, the Waldorf Education movement has had an ambitious scheme to open Waldorf charter schools (publicly funded schools with a particular mission or organizational apparatus). The scheme was handicapped for years by litigation from People for Legal and Non-Sectarian Schools (PLANS) a group specifically organized to counter “Waldorf influenced” charter schools.
Dan Dugan, part of PLANS leadership, wrote a list of “What can be taken from Waldorf” http://groups.yahoo.com/group/waldorf-critics/message/17476 and a much longer list of “What Can Not Be Done In Publicly Funded Waldorf Schools” http://groups.yahoo.com/group/waldorf-critics/message/17597.
There’s bad news and good news on the Waldorf-influenced charter front: The bad news:
Alliance for Public Waldorf Education
*Did you know there are 44 public charter schools inspired by Waldorf education and another 15 new emerging school initiatives?
The good news: the financial crisis means that most of the “15 new emerging” have stalled for lack of funding.
Back to the issue of Waldorf & vaccines: no, there’s no public anti-vaccination policy at Waldorf schools. What there is, is incredible peer pressure to cease vaccination for younger students, and never to begin vaccination for subsequent siblings.
pmoran,
Let the priest come visit the patient at the bedside, if that is helpful to the patient emotionally. Just do not call him “doctor” and imbue him with “scientifically proven” healing gifts.
Let the people have their CAM. Just don’t “integrate” it with science.
Science is a system for saying “no.” Remove the “no” and and you get Lysenkoism instead of science.
OK, I’ve thought about it.
And I’ve rejected it.
What Dr. Benway said.
But maybe you can change my mind; so I’ll ask again: What, specifically, would you have SBM do in the face of anthroposophy infiltrating academic medical centers? I hear lots of hand wringing about how we practitioners and advocates of SBM are so very, very insensitive to human needs compared to you and so tied to scientific “dogma” that we dismiss out of hand, but little or nothing in the way of suggestions for concrete solutions.
Dr Benway, if you called him/her a Witch Doctor, I think it would be appropriate.
PM, what is needed is a better “placebo”. Trigger the placebo effect pharmacologically and there won’t be a need for Witch Doctors, or the need will be greatly reduced. That is what my nitric oxide bacteria can do.
I’m not sure I could bring myself to sit through a lecture on quackery in medical school, regardless of the requirements. I also don’t think I would have an easy time of keeping my mouth shut if some of this nonsense were taught as fact.
I wonder how much of an ethical obligation I have to these quacks’ future patients. I also wonder if I can file complaints to the medical school that will be taking approximately $172,000 (avg. med school cost) of my money. If I am giving them that much of my time and money, perhaps it is not outrageous to suggest that I be taught science and not idiocy.
-RF
But maybe you can change my mind; so I’ll ask again: What, specifically, would you have SBM do in the face of anthroposophy infiltrating academic medical centers? I hear lots of hand wringing about how we practitioners and advocates of SBM are so very, very insensitive to human needs compared to you and so tied to scientific “dogma” that we dismiss out of hand, but little or nothing in the way of suggestions for concrete solutions.
Good question — perhaps better directed at those constantly lamenting situations that have developed on their/(our?) watch.
I seem to be the only one with enough confidence in medical science and in even my American medical colleagues
to be somewhat relaxed about what is happening.
I know the pendulum will swing back and that integrative medicine has little potential for harm. The patients are receiving proper medical care under proper supervision, and there will be a reaction the instant that ceases to apply to any patient’s detriment.
So I don’t see the same slippery slope potential.
But I would not be inactive. I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine. They seem able to help some people with some kinds of illness, but the systems have not the least connection to the underlying physical basis of any illness. That, in a few words, is all they need to know.
“I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine. They seem able to help some people with some kinds of illness, but the systems have not the least connection to the underlying physical basis of any illness. That, in a few words, is all they need to know.”
And how would you do this pmoran? I am here to tell you that it is not being done and that it is being taught with credulity in medical schools. It is not being taught in a manner to indicate that you speak of. Things like nutrition and exercise are being taught to students as falling within the domain of CAM and that other modalities therefore must “have something to them.” I was personally told by the director of our “Integrative Medicine” department and lecturing professor that there “must be something” to reiki since more experienced practitioners get better results than less experienced. He said this was exactly analogous to an attending getting better outcomes than a first year resident.
So your “plan,” it seems, has failed.
I now ask anyone here – especially Drs. Groski and Benway – what should I, personally, do about this? What could I do about it? I have been contemplating writing a letter complaining about the lectures and their lack of basis – but I do not know what the repercussions may be or even if it would be effective at all
Nybgrus:” So your “plan,” it seems, has failed.
My plan? Plan A was the same as yours and most SBMers, i.e. not giving an inch to alternative practitioners, or to CAM, or to IM — anywhere, anyhow.
Plan B, if it matures, may be more subtle.
It probably won’t take the theories of alternative medicine so seriously as to dignify them with more than perfunctory rebuttal and an explanation of how misleading their anecdotal foundations can be .
It will recognize that the public already shows considerable discrimination in their employment of CAM and try to build upon that.
It probably won’t waste a lot of time arguing science with CAM practitioners. It will simply allow that they can help people via other mechanisms that are well-known to science, while reacting with vigour at any suggestion that they can go beyond symptomatic relief of some conditions.
pmoran: My comment was essentially saying that you don’t have a plan. You responded to Dr. Gorski’s direct question for what, specifically, you would do.
“What, specifically, would you have SBM do in the face of anthroposophy infiltrating academic medical centers? I hear lots of hand wringing about how we practitioners and advocates of SBM are so very, very insensitive to human needs compared to you and so tied to scientific “dogma” that we dismiss out of hand, but little or nothing in the way of suggestions for concrete solutions.“
Your response:
“But I would not be inactive. I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine.”
First off – that is not a concrete plan that is a generalization. How would you go about ensuring every medical students understands? But I did not need to even ask you that question – I gave you an illustration of exactly how the exact opposite is actually taking place… so whatever concrete plan you may have been attempting to imply in order to achieve your goal has failed.
How to stop CAM? Teach med students the proper things. Then CAM becomes further marginalized. That is how I am interpreting your response to Gorski – correct me if I am wrong.
Since it is clear from myself, Tim Krieder, and numerous other med students that med students are not being taught the proper things what is your solution? That answer is what I am searching for from you and what I believe Gorski was as well.
“… integrative medicine has little potential for harm.”
That’s certainly not true. First, “integrative medicine” involves a wide spectrum of practices and remedies, and if a medical school, or their own doctor, appears to endorse it, patients aren’t necessarily going to go on ALSO seeing their regular physician. It sends the message that these other therapies are viable options. (U of M is sending this message now *institutionally*.) Some patients will feel it’s just like getting a second opinion, and will then dispense with regular medical care. That’s the first place the possibility for harm comes in.
Secondly, some “natural remedies” interact in harmful ways with other drugs the patient may be taking, and because people think they’re “natural” they’re harmless, and therefore don’t even report them to their doctor. Third, there have certainly been plenty of cases where some bogus “remedy” actually harmed someone, again often because people think they’re harmless they take vast quantitites, other times because the stuff is actually toxic.
“The patients are receiving proper medical care under proper supervision, and there will be a reaction the instant that ceases to apply to any patient’s detriment.”
Not so simple. If the doctor is sending the message that the “integrative” treatments are just as good, some patients will believe they are equally valid options. Who’s to say they then go on seeking “proper medical care”? Some don’t. People who take quack remedies talk like this all the time: “Well, I decided chemotherapy wasn’t right for me … for ME, mistletoe is better.” As if they had weighed two options with actual evidence.
“I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine. They seem able to help some people with some kinds of illness, but the systems have not the least connection to the underlying physical basis of any illness. That, in a few words, is all they need to know.”
No, that is hardly all they need to know! They also need to know how potentially dangerous some of these treatments are, and that they have an obligation to warn patients of this. Endorsing them is the very opposite of the physician’s responsibility.
Doctors also have a responsibility to advise patients against taking treatments such as homeopathy that not only clear don’t work, they literally *can’t* work as there is no active ingredient.
Finally, doctors have a responsibility to not sit back and do nothing when patients are getting ripped off by con artists or snake oil salesmen. Even when it’s a harmless sugar pill, there is harm being done to the patient’s pocketbook. This is morally wrong and definitely within the physician’s responsibility to protest it and to advise his/her patient away from it.
Especially with health care costs in such crisis, doctors have a responsibility to speak out overall against blatant waste of resources. Funding a whole frickin’ department at a medical school for useless treatments is an unconscionable waste of resources.
I wish I could be as blithe as you in dismissing the potential for harm. Nor am I as confident as you are that the “pendulum will swing back,” at least not any time soon. In fact, having watched the trend for about a decade and then spent the time studying what’s happened since the 1970s and the 1980s, there is no sign of the pendulum even slowing down, much less swinging back. If it’s going to swing back, at the rate it’s going, it’ll happen long after I’m either retired or dead (probably long after the latter given my age). Judging by its velocity right now, the pendulum is still early in its swing, picking up speed as it swings towards quackery.
I don’t think we can afford to wait 40 or 50 years for things to right themselves. Moreover, Kimball at the very least has provided plenty of examples as to how quackademic medicine has directly harmed patients or placed patients in harm’s way. His posts on the Gonzalez protocol and the TACT trial are perfect examples. In other words, if you think that this stuff doesn’t harm patients, you are putting your fingers in your ears, holding your eyes shut, and chanting, “Lalalala, I can’t hear you.”
As for “teaching medical students proper things,” what, exactly, would you do to ensure that? Let’s say that you’re faculty at a medical school, and you find out that there is a program there teaching anthroposophy. What do you do? Do you go to the dean and try to convince him that a science-based medical school shouldn’t be practicing or teaching mystical gobbledygook? Do you shrug and look the other way, happy it’s not your department? Steve Novella has faced this very problem at his own university, albeit not with something as loony as anthroposophy. Thus far, I have been fortunate enough not to have to have faced this problem at my university (which, the wag in me can’t help but point out, is at least one way that my university is better than U. of M.), but it’s coming some day. The tide in medical academia is running that way, and I’m under no illusion that my university will escape the tsunami of woo now engulfing many of the bigger centers.
In the meantime, if your comment here:
http://www.sciencebasedmedicine.org/?p=9912#comment-63111
is any indication, your solution seems to be to acquiesce and let woo in that you don’t consider harmful. In fact, you yourself said:
I’m sorry, but I reject this solution.
pmoran “It may reflect people having to turn to medicine for other human needs.
This could be a key to understanding CAM. It explains the touching, the long seemingly medically irrelevant interviews, the intense practitioner-patient bonds, and that “spirituality crap”. .”
pmoran – as a patient and parent of a child with medical needs, my concern is not fully that anthro is non-scientific, I believe that the blend of medicine and spirituality give the doctor an undue influence over the patient’s decision making process. I also believe it is highly questionable, ethically, for them to attempt to play spiritual leader and doctor at the same time.
I don’t know about AU, but here in the states there is some belief that a person should have the freedom to accept OR reject medical options without physical or emotional coercion. There is also the belief that people should be able to accept OR reject religious or spiritual options without physical or emotional coercion.
But I do not believe that a doctor can both advocate for a particular spiritual approach (as anthro seems to do) and maintain the neutrally needed for a patient to make independent medical decisions.
Being a doctor and being a spiritual or religious leader both given a practitioner power over the patient or flock. Doctors are supposed to be trained to recognize how to ethically handle this power. Many religion train their leaders how to ethically handle that influence as well.
But, is it ethical to advocate, even in a gentle compassionate way for a particular spiritual approach to end of life, abortion, cancer, a chronic illness and at the same time be the doctor who the patient hopes will carry through with the patient’s decision or wishes?
If a patient is halfway through a course of chemotherapy that their life may depend upon, that their doctor is managing, does that patient really have the emotional autonomy to reject the doctor’s spiritual advocacy, even if it is subtle?
I do not think it’s a good solution for fulfilling spiritual needs that a patient might have. The doctor as a non-judgmental neutral party gives the patient the room they need to arrive at their own decisions or seek help from a religious or spiritual adviser, who has probably done more advising than any doctor and who may have special training in dealing with those issues.
A kind voice, taking the patient seriously, being thoughtful, a gentle gesture when needed*, those things can be tremendously helpful when a patient is dealing with a shock or illness. Real knowledge and expertise can also be tremendously helpful, one doesn’t need to be a spiritual guide to be a compassionate helpful human being. And being a spiritual guide may actually cause harm to the patient.
*And talk slower. What’s up with the young doctors talking so fast these days?
worth mentioning is that Stockholm University successfully managed to close the Steiner Waldorf (Anthroposophy) teacher training course in 2008 after being alerted to the course materials. Stefan Nordland, dean of Stockholm University’s faculty of natural sciences said:
“The syllabus contains literature which conveys scientific inaccuracies that are worse than woolly; they are downright dangerous.”
http://www.thelocal.se/13944/20080826/
Statement from the VC here: http://bit.ly/g07tn8
@pmoran
“So I don’t see the same slippery slope potential.”
I would have heartily agreed with you right up to the point that doctors, medical schools and hospital systems started buying and selling woo. That wasn’t a slippery slope, that was an event horizon that we may never escape.
Indeed. I’ll give you an example. The Samueli Center at UC Irvine:
http://www.sscim.uci.edu/
This center sells FirstLine Therapy, which is a line of supplements marketed by Metagenics:
http://www.sscim.uci.edu/Content/Clinic/WhatWeTreat.html
http://www.metagenics.com/practitioners/programs/firstline-therapy-program
http://www.metagenics.com/products/product-categories
The founder of Metagenics is Jeffrey Bland:
http://www.quackwatch.com/04ConsumerEducation/bland.html
Is this bad enough to set off Peter’s quackery alarms?
Where is the patient harm?
Well, in the USA there’s a limited amount of money available for medicine (this may not be true in Australia, but I assure you it is true here.) The budget for physical therapy, reiki “therapy,” and for that matter surgery is at best a zero-sum game where patients get less effective treatment thanks to dilution by ineffective treatment.
However, that’s a best-case scenario.
In actuality, it’s a negative-sum operation because stirring in homeopathy with real medicine doesn’t make real medicine stronger (what a shock!) and as a result the patient outcomes per dollar get worse. Which means that the benefit/cost results for real medicine drop below the “worth reimbursement” level and aren’t covered at all (something that US insurers love to rule.)
Where do people go when they can’t afford real medicine? You got it: full-up “alternative care [1].” It’s less expensive, even if it doesn’t work.
I’m not saying that this is all part of the plan, but it’s the way things work: “integrative medicine” is a pipeline for moving patients clear out of SBM.
[1] Not speculative, although anecdotal: e.g. ephedra for ADHD or asthma may be relatively ineffective and have undesirable side effects, but it doesn’t require a quarterly $100 out of pocket appointment for prescription refill either. Lest people forget, that’s more than 10% of some people’s take home pay and comes straight out of the grocery budget.
What micheleinmichigan said.*
There’s also something else micheleinmichigan said in another thread:
“Often people are more committed to a plan that they understand and have been allowed to arrive at themselves.”
I think this is a fundamental appeal of CAM. Reality is hard. Lots of people have minds that work in vitalistic ways. Thoughtful counselling by a reality-based MD will help most people feel as though they understand the rationale for their care – and have made enough decisions about it – to commit to it. Other people will reject reality-based explanations because they just don’t think that way. That doesn’t mean that they want their doctor to be a spiritual guide, it means that they may be more likely to follow counsel by someone who is able to communicate a plan using metaphor.
I’ve never heard anyone tell me they wanted their MD to be a spiritual guide. I really think this is a distraction. MDs can offer compassion, use different approaches to help people understand their situation and their care, and help people make choices.
Woo-practitioners will still often be more effective helping people follow weight-loss diets that call on (for example) atavistic concerns about purity.
That doesn’t mean that MDs should be teaching their patients things that just ain’t so. It probably means that they will always need to hold back if someone is engaging in desirable behaviour supported by a magical worldview. But holding back is different from offering spiritual leadership, and different again from making shit up.
*And said very, very well.
*** *** ***
Sorry for the incoherent comment. I’m not at my best these days.
I had never thought that I would have to pose as a defender of anthroposophic medicine, sort of.
Let me be clear.
1. Steiner was a nut, scientifically speaking. He put a lot of energy in educating his fellow humans, and everything he said in lectuires and so on was taken down and still can be read in his almost endless collected works. Anyone with a smattering of scientific knowledge can make a rich harvest of total nonsense. This includes the so-called racist remarks. His knowledge of biology and evolution was more inspired by the nonsense of H.P. Blavatsky than by what was known in his time. It is just utter dumbness all over.
2. Anthroposophical agriculture and anthroposophical philosophy of education, as implemented in their Waldorf schools, are of equally dubious quality.
3. However, anthroposophical medicine (AM) was developed by a real doctor, Ita Wegman . The things anthroposophical physicians say and do should be judged on their own merit, not by pointing at Steiner or Waldorf schools. Maybe the fact that she was Dutch makes me feel that it can’t be all bad.
4. There is enough to criticize in AM:
A. their use of fermented mistletoe preparations (Iscador by Weleda, there are other brands too) against cancer.
B. Blood crystallisation tests.
C. Ultra diluted (homeopathy style) medicines.
D. Crazy and occult theories about how the human body works (I mentioned their theory of how the heart works); also views on so-called types.
E. Opposition to vaccination in combination with the theory that being sick is good for your spirit.
Maybe there is more. I mentioned that AM has a tradition of putting a lot of effort into care for the mentally handicapped, but here I also saw that some anthroposophs have a callous attitude (‘your problems are karmic, good for you’) towards mentally hadicapped. I don’t know whether this is what AM doctors learn in their courses on AM medicine.
5. AM is also known for recommending art (painting in pastel colors) and dancing as therapeutic modalities. I cannot judge whether this is helpful for people who feel miserable or is just some kind of lesser woo.
6. I know of cases where people had created an own form of quackery vaguely resembling AM, which amounted to advising cancer patients to avoid regular treatment, but eat wheat grass and play the piano – much to the embarassment of real AM doctors.
7. It is very difficult to get an understanding of what AM is. This is compounded by the fact that many of these AM doctors all have their own views. People believing anthroposophy may find it reassuring to have phsyician that shares their views. It is not certain that AM physicians will try to proselitize non-anthro patients, or try to look for karmic explanations or cures for their patients.
8. In the Netherlands a government report on research in alternative treatments (the term medicine was avoided) was issued in 1993. The chapter on AM was incomprehensible to me. In comparison homeopathic theory is a paragon of lucidity. There was lots of crazy philosophy (see D above), but the only connection with treatment seems to be that all this philosophy supposedly broadens the view of the AM doctor and improves his or her ability to intuit what’s really wrong with a patient. This general introduction was followed by examples of and proposals for research. I cherry pick a few:
- how can one use the blood crystallization test to establish the AM diagnosis of hysteria and neurasthenia;
- the effectiveness of treatment of patients with AM diagnosis ‘weak kidney radiation’. (Supposedly the name for a symptom complex of which lassitude is a major component; one has to be very familiar with AM to understand what this means; AM doctors seem to have little difficulty in diagnosing this. Look at
http://www.anthromed.org/Article.aspx?artpk=811
where weak kidney radiation is used as a term that is self evident. For more explanation see:
http://system-sat.de/anthroposofie.htm
It has lots of literal quotes of Steiner in relation to medicine.
I don’t understand this, but I am not a doctor. )
- investigation into the prevalence of rachitis among patients of AM general practictioners.
- investigation of Arnica montana, more specifically the difference between cultured and wild plants if used in rubbing gels for muscle pain.
- Iscador as immune stimulant in cancer patients.
Summarizing: there is enough to criticise in AM, one doesn’t have to bring in Steiner’s nuttiness (unless it is of direct consequence for the training of AM physicians) or Waldorf schools or reincarnation. This is just common sense. If we judge people we hold the opinions of others that look like them not against them.
On the other hand Big AM Pharma may be involved. Possibly Weleda is playing an active role in getting AM into US universities.
“there is enough to criticise in AM, one doesn’t have to bring in Steiner’s nuttiness”
Steiner’s nuttiness is the origin of all those theories, regardless of whether Wegman was actually an MD.
Karma is the philosophical basis of it. Things like, getting sick may be good for your soul, are not minor points, they’re the *basis* of the theory and the treatments. Particularly in regards to vaccination. With a karma theory there is dubious motivation for certain treatments in the first place, but *preventive* measures in particular appear contraindicated. Preventing someone getting a disease they’re “supposed” to get or have “chosen” to get is a dire mistake in anthroposophy.
The stuff about upside down plants and the four humours (sanguine, melancholic, choleric and phlegmatic) etc. are *derived* from the theories of karma and reincarnation. Diseases you don’t survive make you stronger in the next lifetime. Karma is not tacked on as an afterthought, “Oh, and maybe it’ll be good for you.” Karma is the starting point.
I am not a doctor, but it seems to me it these theories are incompatible with medical ethics.
DW – just a nitpick and a sidetrack. There are different approaches to karma and Buddhist philosophies. You are succinctly stating one of them, apparently followed by some of the anthroposophic folks, but there are other approaches too.
“Dalai Lama launches anti-polio campaign
The Dalai Lama administers pulse polio drop to an infant in Bodh Gaya, India, on 10 January 2010. India is observing National Immunisation Day today to eradicate polio.
[snip]
The Tibetan leader, who has been in Buddhism’s holiest site of Bodh Gaya since 4 January, administered a few anti-polio drops to two infants on India’ National Immunisation Day, observed on 10 January.
He said he saw a few polio-affected youths in the streets of Bodh Gaya. “Preventive measure is very important for protection of the children for good and normal life.”
http://www.tibetsun.com/archive/2010/01/10/dalai-lama-launches-anti-polio-campaign/
Not a Buddhist myself, but have family/friends who are attached to the philosophy and they do vaccinate and they do not let their children get sick for spiritual reasons.
Well pmoran, I suppose it’s helpful to the discussion to have someone representing the “what’s the harm?” position. However, it’s my understanding that you had been a practicing physician, now retired. Thus I am distracted by the dog that is not barking –I am distracted by the lack of physicianly feeling toward, for example, the autistic children under my care right now. I am distracted by your disinterest in the problem of communicating with Dr. Woo regarding a shared patient.
Do you have a first degree relative or some other important figure in your life who is invested in cultish healthcare practices?
@micheleinmichigan Buddhist ‘Karma’ (translated from the Pali) is measured by one’s present actions – the birth and death of each moment.
Anthroposophical ‘Karma’ is measured by one’s past – the birth and death of each lifetime.
@horse – interesting – thanks for that.
Thanks Michele and horse, very interesting. Yes, I know there are different understandings of karma, and Eastern and Western perspectives can be very different. I was referring specifically to anthroposophical beliefs. Steiner culled a lot of things from Eastern philosophies, but he may not have really understood Eastern notions of karma, which, from what I understand, are cylical while Western notions are more linear. Steiner’s version of karma is firmly retributive (not sure that’s the right word …) – meaning events in one’s life are either consequences of earlier deeds or misdeeds, or sometimes they are thought to be spiritual “preparation” for future lifetimes (i.e., illness isn’t necessarily a punishment, but sometimes a way of strengthening a person spiritually for future lifetimes). Either way, not a notion I want a doctor applying to my child.
DW regarding retributive karma – “not a notion I want a doctor applying to my child.”
Yes, I certainly agree. Conflict of interest
@Dr. Gorski – I am ashamed of my alma mater. I did my undergrad at UCI (both degrees) and did post-grad pharmaceutical research there. The director of pharma sciences at UCI is a friend of mine and was begged to teach the medical students pharmacology. She didn’t want to stating she had too much work to do on her own projects. Perhaps this was another reason why but she didn’t want to say so. After all, she is not the kind of person who would like to market the effects of “SuperGarlic 6000″
http://www.metagenics.com/products/a-z-products-list/SuperGarlic-6000
The science program at UCI undergrad was extremely robust – in fact I started out there as an anthropology major and when I went to add biosci as a major they were very snide and said “Our program is extremely hard are you sure you want to add this?” and went on to say “It will take us a week or so to let you know if you are approved or not.” I was called the next day and said I was in – they checked my transcripts and saw that I had already aced a year of ochem and physics. 5 nobel laureates were on the faculty when I did my undergrad. It was all taken extremely seriously. How is it that the medical school, which is literally 100meters across the street from where I had some of the most intense science classes ever, can just chuck the science out the window? I know they do science over there – I once had to walk over and borrow some lab supplies to do my assay!
pmoran: I await your concrete response as to how to educate us medical students properly or to refute what I have said. And just in case you want to claim it is an American thing and that the Aussies have your ideology well in place and it is working… I am here in Australia as well. At what is considered to be a top 50 worldwide medical school. At a “sandstone” uni (the Aussie version of “Ivy League, I’m told). And I am being taught by a guy who goes to conferences to sell a “7-hormone saliva test” in order to administer and monitor anti-aging therapy to your patients. And he charges $595 to attend the session and gives you a free saliva test (valued at $300).
http://www.accs.org.au/pdf/antiageing.pdf
Yep, that guy told me reiki must be doing something to help our patients.
I am gob-smacked that so many have so little faith in their institutions and their colleagues. Or is there something I don’t know about? Has someone come across “the Hulda Clark version” of integrative medicine? I have the more measured Andrew Weil version in mind.
We can be fairly sure that anthrosopophy was the worst aspect that David could find in his local version, and we have as yet little information as to what will actually be taught about that and in what context in relation to the rest of medicine.
We merely assume it will all turn out badly, even that an obviously scientifically naive IM tutor like nybgrus’s will be able to persuade medical students out of the rational approaches to medicine that they are encountering elsewhere for six years(?) or so. If he can do that in such a way that they will go on to do real harm to their patients later then there IS no hope for us.
I reiterate that my whole point is risk vs harm, but in a more global sense than the approaches I see displayed here i.e. what attitudes, rhetoric and strategies can optimize any benefits that our public may derive from CAM, while minimizing its risk?
Offering selected elements of CAM under the supervision of proper doctors could be a rational approach, unpalatable as it obviously is to those for whom the science of it all (actually selected aspects of the science) is of such overriding importance that they see only an unlikely slippery slope, not the intricate cost/risk/benefit judgment it probably should be.
This is an extremely complex field. It demands at least normal levels of scientific caution and precision in our judgments.
“Some aspects of CAM can sometimes be dangerous” leads to effective strategy only if you can convince everyone, or nearly everyone that CAM is totally useless. That is impossible while there are unmet medical needs driving a lot of people to try them out and being liable to conclude that perhaps they do work (“so are those scientists full of it, or what?”).
We must understand what we are dealing with.
“We merely assume it will all turn out badly, even that an obviously scientifically naive IM tutor like nybgrus’s will be able to persuade medical students out of the rational approaches to medicine that they are encountering elsewhere for six years(?) or so. If he can do that in such a way that they will go on to do real harm to their patients later then there IS no hope for us.”
4 years – UQ is now a 4 year postgrad MBBS degree. However, for me and my cohort it is only two years. I spend years 3 and 4 doing my clinical rotations back in the States at Ochsner in New Orleans.
But more to the point – this is not a “scientifically naive IM tutor” this is a full professor and if you are in Australia you should know what that means. He was a graduate of Uni of Melbourne and worked at USyd as well. He is considered to be very well credentialed and a full fledged physician. He comes to lecture pounding the desk and yelling that homeopathy is crap but that there is evidence for a lot of CAM. He goes on to co-opt pharmacognosy (as Gorski has pointed out numerous times) and has these huge charts he makes us look at about how much evidence there is for all sorts of CAM modalities. He generally sticks to bioactive herbals, probiotics, and the like but also puts acupuncture as having “high levels of evidence” that it works quite effectively. He also lists chiropractics as having positive evidence. He says that there is plenty of garbage out there, but that for the stuff that has evidence for it we should “integrate” it. And then he tells me that reiki works.
He does not teach that there is no scientific basis for these CAM modalities. He does not teach “every medical student [to] understand that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine.” He teaches them with full credulity and teaches that indeed, there is a dichotomy between “western medicine” and “alternative medicine.” He is the head of the department and teaches directly to the second year students. However there are others and we had similar lectures during first year.
“If he can do that in such a way that they will go on to do real harm to their patients later then there IS no hope for us.”
Now you are starting to understand.
pmoran “I am gob-smacked that so many have so little faith in their institutions and their colleagues.”
I think this is not really not addressed in my direction, but I would make the observation that “Hope for the best, plan for the worst.” is a pretty good motto, that is applicable here.
We have made great progress in medical care through science based medicine only for a short period in our history. Unfortunately, we have become infected by incompetents in our centers of learning that, for whatever reason, are condoning and even promoting cargo cult medicine. I wonder, if any pilots ever mistook a cargo cult landing strip for a real one? The outcome would have been similar to mistaking cargo cult medicine for science based medicine by a patient with a real disease. In order to prevent harm, it behooves us to identify this nonsense as such and warn our patients and to eliminate it from our institutions. Would it help if a medical student would sue the school for fraud? He/she expected to be taught something that really works but was given a counterfeit instead.
And:
Peter:
You’ve been reading this blog since it began. You must be aware of the numerous examples of harm that we’ve reported. Almost all of it has been aided and abetted by the medical academy’s recent, childish fetish with what only 20 years ago was still recognized as snake oil. How many examples are too many? Whatever happened to “first, do no harm”? Where, other than here and a few other places whose efforts have been mostly unheeded, is the reaction that you prophesy?
The Andrew Weil version? Did you notice that about a year ago several people died in Arizona during a ‘sweat lodge ceremony’, the same sort of “facilitated sessions [for] examining [one's] humanity” that “occur regularly” for Weil’s “integrative medicine” fellows? Can you imagine other risks of the unmeasured drivel that Weil feeds to these trainees (look under “The Wooification of Health Care”)?
There’s a real-life example in this post:
“Integrative Medicine Experts”: Another Barrier to Effective Discipline
KA
Sure: diet and exercise. Relaxation techniques. Those would totally revolutionize scientific medicine.
I don’t want to repeat anecdotes about patients who have been diagnosed with adrenal fatigue, chronic Lyme, chronic candidiasis, and gluten enteropathy –all with reams of results from labs running expensive non-FDA approved tests.
I remain gob-smacked by your lack of feeling toward the little bedwetters under my care. Maybe you are not actually Dr. Moran but someone borrowing his account?
A real doctor would understand that we are judged by the quality of our history taking, exam, diagnostic formulation, and medical decision making. The outcomes we leave to Allah and His mercy.
What Kimball said. Seriously, I’m a bit puzzled and frustrated here. Have you actually been reading this blog since the very beginning? Or even over the last year? It’s not as if we haven’t listed examples of harm that can come about because of the infiltration of quackademic medicine into medical academia. To Kimball’s response, I’d add my own emphasis: Read our posts about the Gonzalez trial for pancreatic cancer. Patients with pancreatic cancer were subjected to an ineffective treatment and ended up living only 1/3 as long as patients undergoing standard-of–care science-based medical therapy.
The reason I have so little faith in our institutions is because they’ve betrayed that faith!
“Offering selected elements of CAM under the supervision of proper doctors could be a rational approach.”
No it would not.
It’s one thing for a patient to ask their doctor about acupuncture and be told, “It might help you feel better but can’t actually treat anything.” Another for the doctor to refer them to the acupuncturist in their own clinic. The first is rational. The second is not.
A third option would be to refer them to the massage therapist in their own clinic. Also likely to help them feel better. Less likely to be taken as an endorsement of a treatment modality.
Nutrition classes offered by or through the clinic – great! Referrals to swim gym workouts – wonderful! But there is nothing rational about a doctor offering acupuncture.
This seems to be related to what you said earlier about doctors needing to offer spiritual leadership. You want to be the source of everything for your patient. Can’t you be happy for a patient who is getting their needs met elsewhere? Do you really have to meet all of them yourself? (Sex is likely to help your patient feel better too, and is too often an unmet need, but it would not be rational of you to have sex with your lonely patients.)
I think there’s an epistle of Paul where he says something along the lines of not being jealous if someone is healed by herbs gathered by another. (You’re familiar with the reference, I’m sure.) In this case we aren’t even talking about healing. Just feeling better.
I couldn’t agree more. When I say I want the physician to do everything the patient needs, I mean from science-based medicine perspective. To me, that also includes being compassionate, listening, having empathy, including the patient in decision making, taking the time to explain risks and benefits well, and referring them to proper sources for anything else they might need. If you are an internist you would refer them to an orthopod, not try and do it yourself. You would also refer them to a grief counselor or a chaplain if they needed that as well. Or even to a priest/rabbi/what have you if they needed that. A nutritionist or psychiatrist. The point is that as a physician you can embody those non-specific traits that makes CAM so alluring by actually listening to your patients and then properly referring them to quality and qualified allied health groups.
In no way, shape, or form, ever should a physician also be the spiritual guidance for a patient. Besides the fact that I am an atheist, even if I were also a doctor of divinity it would be an inappropriate thing to do. Period.
I think you are losing some serious ground here pmoran. And the fact that you have supposedly been reading this blog for so long, and are reading all this different critiques from everyone here (from lay people to med students to physicians) and still not budging an inch on what you say makes me think the evidence and argument for you is moot. Anyone who cannot change their mind when faced with good evidence and argumentation is no friend of mine.
@nybrgus
Currently I wouldn’t expect to be faced with such a situation, but you can not always predict what will happen. Imagine you know somebody is devout in their religious beliefs. Now consider the possibility that they are tempted to try a CAM therapy that has it’s origins in an ancient religion. Would you not warn them that they are trying a therapy based on a religion different from the patient’s professed beliefs? Wouldn’t an individual who believes in one of the Abrahamic religions be embarrassed to find out they are considering a therapy with its basis in a pagan religion? That is spiritual guidance even an atheist should be able to provide.
@JMB: I see your point, but I don’t think that will ever be an issue for me. I have been in a situation before working trauma in the ER when an older lady whom I was attending to suddenly grabbed my hand and thanked me for saving her life (not that I had really done it – I reckon the physician did more than I did, I was just closest at hand). I said that it was a team effort and she was welcome – then she said, “Isn’t God great? Pray with me” and grabbed my hand and began to pray. I wasn’t even inclined to say, “I’m an atheist, I don’t do this.” I merely looked down and waited till she was done. It is easy enough to respect someone else, even when their beliefs are completely contradictory to mine. It is, after all, about the best for the patient, not proselytizing.
As for dissuading a patient because the woo they are considering is opposite the religion they are currently ascribed to – definitely not what I would consider proper or ethical. For me, religion is woo. So to say “Don’t go do that woo because the woo you currently believe in is actually from a different mystical authority.” If I can’t make the case against the woo based in science, evidence, and reason I certainly would not resort to spiritual extortion.
Regarding woo that is contrary to a patient’s religious beliefs, there is also the ironic (and amusing) issue of woo that is contrary to the woo-practitioner’s religious beliefs—even if she doesn’t know it. In my region (Greater Boston), Reiki is offered mainly by nurses, and nurses—including those who do Reiki, as far as I can tell—are mainly Roman Catholic. But look at what the United States Conference of Catholic Bishops has to say about Reiki:
http://www.usccb.org/doctrine/Evaluation_Guidelines_finaltext_2009-03.pdf
KA
Indeed. There is this amusing little article about how an Assembly of God pastor was upset at reiki being offered at Pocono Medical Center:
http://healing.about.com/b/2011/02/18/assembly-of-god-pastor-fears-reiki.htm
http://www.poconorecord.com/apps/pbcs.dll/article?AID=%2F20110218%2FNEWS%2F102180330%2F-1%2Frss01
My “good buddy” Orac wrote about this a while ago:
http://scienceblogs.com/insolence/2009/04/reiki_versus_the_catholic_church.php
DWon 15 Mar 2011 at 11:12 am
and
DW on 15 Mar 2011 at 1:55 pm
has stressed that the ideas of anthroposophy on karma and reincarnation form the basis of the rest of anthroposophy and more in particular that this is a socalled ‘retributive’ form of the belief. He implies that it is also the basis of anthroposophic medicine (AM).
Now I know that Ernst and Singh said so on their one page summary of AM on p. 298 of their book, but I disagree. Rudolf Steiner’s collected works encompass 89,000 pages. The man was trained as a philosopher (he studied also mathematics and physics around 1880, but must have forgotten most of that) and he had an opinion about everything, and from a scientific point of view these 89,000 pages are a hotchpotch of the most diverse nonsense.
The whole idea that anthroposophy is a rigorously thought out system with a simple basis is unsupportable.
The main idea in the Steiner writings is what it means to be human. His reincarnation ideas are subordinate to this. According to Steiner people have all kinds of different bodies (astral, etheric and so on) with an upper and an lower pole and after death some of these bodies survive and are cleansed or destroyed and then the supernatural core essence (the ‘I’) looks for a new incarnation, usually in another sex and another ethnic group and starts preparing the ancestors of its new birth by modifying their genes. It takes several centuries. I don’t know how Steiner thought he knew this, but I think he just made it up or stole the idea from H.P. Blavatsky. What would happen if five souls were working on the same ancestors of five children I don’t know. The whole idea is that the soul should gradually evolve by having a very wide experience. Like a wealthy westerner who every year takes a vacation in another far far away country.
Here is what one anthroposopher (an MD, but not one that practiced AM or had been trained as AM practitioner) wrote (I’ll translate and summarize, because anthroposophers tend to be longwinded and woolly):
“Reincarnation is mainly a general idea, not something related to experiences with individuals. So an AM doctor on the one hand believes that in every human there is a supernatural core, but on the other hand he would be very reticent to talk about anything in a patient that might be related to reincarnation, let alone to translate this into explanations of disease. So in AM there is no regression therapy.”
It seems that at least half of the anthroposophers really believe this karma stuff in whole or in part. (Not all of them do, because every person must decide for himself what to believe.) Now in almost every religion with ideas about afterlives you will find ‘retributive’ variants and ideas about immortal souls. After all, this afterlife business supposedly accounts for the sad fact that life is unjust. So if someone is in pain you can believe that the pain will be compensated for in heaven. Or, if someone drowns in a tsunami, that it is a punishment by a Higher Authority. You’ll find that in all religions with an afterlife belief (and you’ll also find writings like the book of Job that say that it isn’t that simple). That doesn’t imply at all that even devout adherents of such religions will think the sick and disabled don’t need treatment.
There is much more in antroposophy (consult Wikipedia: http://en.wikipedia.org/wiki/Anthroposophy and http://en.wikipedia.org/wiki/Anthroposophical_view_of_the_human_being ) and the only thing all these things have in common is that they stem from the Steiner hotchpotch. I admit that I haven’t had the courage and energy to read all those 89,000 pages, I gave up when I tried The Philosophy of Freedom. But in what I have read, there is not an all pervasive odor of karma and reincarnation in anthrosophical writings. (Incidentally, in the US and Western Europe about 20-25 percent believe in reincarnation.)
AM is full of nonsense (all this upper and lower pole and different bodies and threefold and fourfold aspects and much more) and on top of that one has Iscador, homeopathy and strange blood tests. It is impossible to make a direct link between karma and reincarnation with the idea that copper chloride crystallisation patterns say something about the diseases of the person who contributed a drop of blood that is mixed into the solution.
If you want to convince a school that they shouldn’t have AM, it seems best to stick to what is medically unsound, rather than emphasizing one aspect of the anthro religion.
Kimball Atwood “In my region (Greater Boston), Reiki is offered mainly by nurses, and nurses–including those who do Reiki, as far as I can tell–are mainly Roman Catholic.”
I have to be brief, so I will just say Christmas trees, Easter eggs.
OK, I just checked out Orac’s 2009 post (linked above). Not only does it include Reiki practitioners’ rebuttals to the Catholic Bishops, it also has a not-to-be missed comment section.
Jan,
“The whole idea that anthroposophy is a rigorously thought out system with a simple basis is unsupportable.”
I didn’t say it was simple; I said reincarnation and karma are central in anthroposophy, and that’s correct. Nothing to do with the number of pages Steiner wrote.
“The main idea in the Steiner writings is what it means to be human. His reincarnation ideas are subordinate to this.”
Reincarnation and karma are the center of what Steiner thought it meant to be human.
“The whole idea is that the soul should gradually evolve by having a very wide experience. Like a wealthy westerner who every year takes a vacation in another far far away country.”
LOL – never thought of it that way, but that’s quite an apt description!
“Here is what one anthroposopher (an MD, but not one that practiced AM or had been trained as AM practitioner) wrote (I’ll translate and summarize, because anthroposophers tend to be longwinded and woolly):
“Reincarnation is mainly a general idea, not something related to experiences with individuals.”
That’s disingenuous. It most definitely applies to individuals. The doctor is trying to say something soothing to distract critics from the parts of his/her belief system that they find worrying.
“So an AM doctor on the one hand believes that in every human there is a supernatural core, but on the other hand he would be very reticent to talk about anything in a patient that might be related to reincarnation, let alone to translate this into explanations of disease. So in AM there is no regression therapy.”
It’s true they’re not at all into regression therapy. IMO, though, this is more about flying under the radar than an actual difference in beliefs. Anthroposophists do not want a lot of publicity for their beliefs. The success of their enterprises actually depends on a lot of customers not really knowing much about the underlying beliefs. Holding a regression therapy workshop would “out” them. They want to be considered intellectuals. Their beliefs differ only in detail from the folks holding regression therapy workshops where everyone closes their eyes and breathes deep and suddenly remembers they were once Cleopatra or Aristotle. (Steiner’s followers, btw, believe he was the reincarnation of Aristotle.)
“It seems that at least half of the anthroposophers really believe this karma stuff in whole or in part. (Not all of them do, because every person must decide for himself what to believe.)”
Anthroposophists love to insist they’re all really free thinkers, but really statements about “everyone must decide for himself” are just boiler plate. True of any religion.
“Now in almost every religion with ideas about afterlives you will find ‘retributive’ variants and ideas about immortal souls.”
I am not sure if we have some disagreement here. My issue is that these notions should not be applied as part of a medical treatment plan. Patient and doctor are both free to follow their own beliefs.
“After all, this afterlife business supposedly accounts for the sad fact that life is unjust. So if someone is in pain you can believe that the pain will be compensated for in heaven. Or, if someone drowns in a tsunami, that it is a punishment by a Higher Authority. You’ll find that in all religions with an afterlife belief (and you’ll also find writings like the book of Job that say that it isn’t that simple). That doesn’t imply at all that even devout adherents of such religions will think the sick and disabled don’t need treatment.”
It doesn’t, but karma is different. Christians (some) believe you’ll be punished or rewarded in an afterlife. They are not looking at you in *this* life and thinking maybe you got cancer as a punishment for something in an earlier life.
“There is much more in antroposophy (consult Wikipedia: http://en.wikipedia.org/wiki/Anthroposophy and http://en.wikipedia.org/wiki/Anthroposophical_view_of_the_human_being ) ”
Consulting Wikipedia would be a bad idea. The Wikipedia pages on Steiner, anthroposophy, Waldorf education, anthroposophic medicine, biodynamics, etc. are all entirely controlled by anthroposophists. They watch those pages around the clock and block any attempts to introduce outside perspectives. Wikipedia is never a neutral source on controversial matters such as religion.
“and the only thing all these things have in common is that they stem from the Steiner hotchpotch. I admit that I haven’t had the courage and energy to read all those 89,000 pages, I gave up when I tried The Philosophy of Freedom. But in what I have read, there is not an all pervasive odor of karma and reincarnation in anthrosophical writings. (Incidentally, in the US and Western Europe about 20-25 percent believe in reincarnation.)”
Philosophy of Freedom has no “odor” of karma and reincarnation because it was written before Steiner’s turn to theosophy, and later founding of anthroposophy. It’s a strictly philosophical work.
As to how many people believe in reincarnation, I don’t see that as having any purchase in these arguments. Isn’t that just recourse to the “3 billion Chinese believe it so it can’t be wrong” argument?
“If you want to convince a school that they shouldn’t have AM, it seems best to stick to what is medically unsound, rather than emphasizing one aspect of the anthro religion.”
That may be good advice; I just wanted to set the record straight on some of the actual beliefs. Karma and reincarnation are central, not just “one aspect.”
Also, I believe it’s important that people trying to block or combat the creep of AM into mainstream medicine understand that this philosophy is not just about “natural remedies.” It’s not just an even stranger version of homeopathy. The notion that you may be SUPPOSED to be sick – actually, karma means you CHOSE to be sick – or that the illness may be good for you spiritually is central.
I believe it is hard to reconcile a practice based on this philosophy with medical ethics.
Again, I should clarify that other versions of karma do not necessarily imply that you choose to be sick or that sickness is a punishment. In Steiner, however, these connections are explicit. He outlined specific connections between various diseases and their karmic meanings.
DW “It doesn’t, but karma is different. Christians (some) believe you’ll be punished or rewarded in an afterlife. They are not looking at you in *this* life and thinking maybe you got cancer as a punishment for something in an earlier life. ”
It is different, but it’s appropriate to add that it least one Catholic figure may have had an approach that was similair in the “it’s good for your soul to experience suffering.” and possibly erring on the side of helping the soul. Here’s a criticism of Mother Theresa from Wikipedia
“She has also been criticized for her view on suffering. She felt that suffering would bring people closer to Jesus.[44] Sanal Edamaruku, President of Rationalist International , criticised the failure to give pain killers, [snip] On principle, strong painkillers are even in hard cases not given. According to Mother Teresa’s bizarre philosophy, it is ‘the most beautiful gift for a person that he can participate in the sufferings of Christ’.”[45]
http://en.wikipedia.org/wiki/Mother_Teresa
Precisely. That is why they are a good source if you want to find out what they think. DW disagrees because he insists that the anthros have their own special brand of reincarnation theory which is (1) of the retributive kind and (2) central to their whole world view and (3) of importance in the practice of AM physicians and (4) carefully kept secret from the public.
I have argued that retributive ideas occur in other religions too. In the Netherlands strict protestants in ‘our’ Bible Belt are against vaccination because this would limit the power of God (to either punish or test piety); for the same reason they refuse insurance and lightning conductors. But they don’t hide the fact that they think like that.
I have argued that belief in reincarnation is widespread. DW counters it by suggesting that the anthroposophic version is of a special kind, but the anthros keep it secret.
I have argued that Steiner had so many opinions that were quite unrelated to each other on all kinds of subjects that necessarily reincarnation was just one among many, maybe an important one, but not the basis of it all.
I have argued that the writings of anthroposophers go on and on about how man is composed. They are a garrulous lot. But reincarnation isn’t a major part, let alone a foundation of it. DW says the opposite, and the fact that Wikipedia proves my point is countered by stating that this is what the anthroposophers say themselves, implying that they keep this aspect of their views a secret.
I could add that in criticisms of anthroposophy I have read karma and reincarnation were mentioned, but not prominently. Most criticism was directed at the stupidity of Steiner’s remarks. Example: Steiner makes a remark about white women who get a colored baby after reading ‘negro novels’. Modern anthroposophers think this is a reprehensible remark because of the suggestion that being black or colored is something bad. Critics say that this is a typical example of utter dumbth: dumbth of Steiner, whose writings are riddled with dumbth, and stupidity of the anthros who don’t notice how silly their idol is. Neither the critics nor the defenders relate this to karma.
It smacks too much of a conspirational theory of the type that suspects or suspected the Catholics, Jesuits, Freemasons, Illuminati and many more groups of having a secret agenda to take over power.
I think the burden is on DW to provide evidence of the importance of karma and ‘retributive’ reincarnation for present day American physicians who practice AM.
Quoting Steiner won’t do. The doctors themselves should believe it too. Doctors have a tendency to think that the opinions of lay people in medical matters don’t have to be taken seriously, and maybe AM doctors are not different. If I may give an example from outside of anthroposophy: Roman Catholics are required to adhere to the official views of the RC Church on birth control. Whether they do so is quite a different matter, and it is doubtful whether RC gynecologists toe the official line. (What do RC obsgyn think about the virgin birth?)
Incidentally there aren’t many of these AM doctors in the US: the PAAM lists 33 MDs in the whole of the US. The McMullen-Laird couple that runs the Rudolf Steiner Health Center in Ann Arbor is not on that list, and there may some more. That’s about 1/4 of the number of AM physicians in the Netherlands and about 0.5% of the 6,000 in Germany.
A German consumer’s union guide to alternative medicine (written by two skeptics, Krista Federspiel and Vera Herbst, first ed. 1992, many updated new editions) gives the following explicit criticisms of AM:
1. use of heavy metals in not very high dilutions;
2. the precancerosis diagnosis: this diagnosis is often made, and then treated with many years of injections with fermented mistletoe;
3. AM is an incomprehensible occult science;
4. medicines of AM are not tested by scientific methods, merely anecdotic reports are known;
5. the system for determining which medicine a patient should get is only understandable by AM itself; it is incomprehensible;
6. diagnostic tests like blood crystallisation test are nonsense;
7. mistletoe medicin is rubbish.
The authors mention that AM considers illness as a positive opportunity to learn from conquering a disease and so obtain new powers and abilities. They also mention that some critics think Steiner was crazy and that his theories are those of a madman.
@JMB: Michelle touched on it, and I was posting late last night before going to bed so I forgot to add:
Besides all the other reasons for not telling a patient their woo is incompatible with their religion is that most people are cafeteria religious. Meaning that they pick and choose the bits of religion that they like the best and eschew the rest – and are completely oblivious or in denial about the cognitive dissonance inherent to that. So I doubt that me telling them that would serve any purpose except to maybe piss them off, since talking about religion is a big no-no.
previous comment “The Wikipedia pages on Steiner … etc. are all entirely controlled by anthroposophists. ”
# Jan Willem Nienhuyson responded “Precisely. That is why they are a good source if you want to find out what they think. ”
Ahhh, it is a good source if you want to know what they want the general public to think they think (I think).
i>”Peter:
You’ve been reading this blog since it began. You must be aware of the numerous examples of harm that we’ve reported. Almost all of it has been aided and abetted by the medical academy’s recent, childish fetish with what only 20 years ago was still recognized as snake oil. How many examples are too many? Whatever happened to “first, do no harm”?
Having come into this field via cancer quackery, I am aware of very frustrating, horrible examples of where quackery can lead. Such cases trigger the same “down with CAM!” reflex in me that they do in anyone else.
Yet that is what it is — an emotional response to worst case scenarios many of which can never be prevented within the limitations of reasonable personal freedoms.
Nevertheless, when combined with justifiable outrage at medical beliefs that are (to us) transparently ridiculous, what more do we need? Who can argue against giving free reign to the instinct to demonize and destroy CAM wherever we encounter it? As Dr Benway asks, why am I being so weird?
Well, bear with me. There are quite direct ways of drawing attention to the precise areas where CAM is dangerous. Most of us are already so engaged. If those approaches are not working well, even within our hallowed halls, it is not clear that an instinct-driven all-out assault on pseudoscience will do any better. The underlying causes of the CAM phenomenon will still be there.
I have elsewhere tried to convey that CAM has little to do with science. Arguments from the harm also don’t work well.
CAM users and sympathizers rightly or wrongly see their personal versions of CAM as a low-risk but potentially beneficial activity.
It should then be no surprise that whenever we try to alert them to the harm the response is an instantaneous: “Ha! Look at all YOUR deaths!”. We are immediately on the back foot trying to justify ourselves on risk vs benefit arguments that I will come back to in a little while.
The intensity and the aggression behind some skeptical attacks is also beyond their comprehension. It can seem to them WE feel threatened by CAM and they wonder why. It cannot be for wholesome reasons.
So perhaps we would be better off showing them we don’t care much about it so long as it remains a harmless and possibly beneficial bit of “let’s pretend medicine” (not in those words, obviously).
We might even display some impartiality by checking whether selected bits of CAM might help patients with some very serious problems of our own such as cancer pain or chemotherapy side effects. (This is why I can find pragmatic real-world studies of acupuncture and some other modalities tolerable in some contexts even though I understand precisely why they are anathema to the “working better than placebo” model of medicine. )
In all settings, even within academia, the “potential for harm” argument faces two major hurdles.
1. Can you prove that CAM is of no value to its users? Whenever you are asked this, or to “prove it doesn’t work” that is not a plea for you to prove a negative. The average skeptic is with every breath implying that everything about CAM is so useless that it can be peremptorily discarded. Asking for the basis of that stance is only fair.
In my opinion that is an untenable position, but we can argue that out elsewhere if you like. Even followers of astrology are presumably satisfying some human need.
2. Yet once you allow that CAM is of value to some, you are faced with a very complex cost/risk/benefit assessment, especially when dealing with CAM’s more benign manifestations.
In fact skeptical rampages can look a little silly when applied to matters that have about as much cosmic significance as a cosmetic commercial. “Why do they get so excited about those harmless little homeopathy pills? What are they in fear of, if not trying to protect their turf?”
There are also ways of expressing sound scientific opinions on such methods without making people feel small or stupid for doing things that everyone does at some time or other, unless they never had a mother “kiss it better”.
We are on more solid ground when discussing who should pay for it or whether there are better uses of funds. It may often also be a trifle easier to discredit a cancer “cure” than a placebo treatment for anxiety, but with cancer there is the additional burden of having to be convincing enough to counter the willingness of desperate people to try out dubious methods. That is never an easy task and one of the reasons why sciency arguments are of limited effectiveness in countering CAM.
And a probably far more important than any of this as an overall objective is the need to foster trust, such that patients will use effective methods whenever they are available, regardless of what they may do about CAM. To do that we should try to behave like reasonable people in their eyes not as blundering zealots. Among other things we should neither oversell the effectiveness of mainstream care nor downplay its side effects, things that the average skeptic also does much of the time.
If we had a clearer case that the risks of CAM outweigh any benefits, we would also get more support from politicians. the legal system, and , probably, other academics. Although SD would disagree, a partial answer to some of the bad aspects of CAM almost certainly will be better regulation and legislation, just as applies to conventional medicine. This is another arena where there will be reactions to CAM if the instances of harm exceed present tolerances.
If you talk to the people on an alternative medical newsgroup for a while you will see that even the moderates think we greatly exaggerate the risks of CAM while refusing to allow it any benefits even when it tests “positive” according to our own demands. At least that is how it seems to them.
The scientific argument is tortured and sophisticated. We may think we are presenting a clear, irrefutable case. What so easily comes across is double standards, bias, shifting the goalposts and blindness to some of the medical realities that lead many quite rational people to dabble in CAM. How many times have we seen all this on these very comments pages?
So it is all about perceptions and where people are prepared to invest their trust. Yes, it has more in common with politics than the scientific disputation that is our usual stamping ground.
Kim, you are also asking me to accept that the dangers have some direct linkage to academic circles trying to reach some kind of rapprochement with (hopefully) selected elements of CAM.
For all I know there are some integrative centres that have made a poor choice of personnel, or have inadequate input into what is taught and practiced. But any thread connecting integrative medicine as usually defined to the dangers of CAM extremes is surely long and tenuous, and entwined with other much stronger influences. They include human foolishness, irresponsibility and delusion. These are not unique to CAM and you will never stamp them out.
With regard to the pseudomedical? paramedical? activities of aging hippies like Andrew Weil (is he still into all that?), perhaps we need to also start debunking “pseudo-spirituality” if that term is not itself something of an oxymoron. But it would be wise to understand what human needs are driving people to seek pseudo-enlightenment.
Some telling comments from others — I will try and respond, unless people prefer that I shut up for a while.
I have no problem with people using CAM because they think it makes them feel better. I draw the line at claiming it is supported by scientific evidence when it isn’t. I think we can find a way to support rigorous science without interfering with patients’ rights to autonomy and to choices based on non-scientific considerations.
Michele: “It is different, but it’s appropriate to add that it least one Catholic figure may have had an approach that was similair in the “it’s good for your soul to experience suffering.” and possibly erring on the side of helping the soul.”
Sure. Anthroposophy isn’t unique in any of this. Unusual, but not unique. Yes, Mother Theresa was also criticized for allowing a little sadism to slip into her lovingkindness now and then. I think it’s exactly the same problem – a religious ethic that is in conflict with the medical one.
About wikipedia:
“That is why they are a good source if you want to find out what they think. DW disagrees because he insists that the anthros have their own special brand of reincarnation theory which is (1) of the retributive kind and (2) central to their whole world view and (3) of importance in the practice of AM physicians and (4) carefully kept secret from the public.
I am not sure why the idea that karma is central in anthroposophy seems like a point worth arguing over. Do you see that as some extravagant claim? What difference does this make? If you don’t believe me that it’s central, you need to read a little Steiner. I think you said you only read Philosophy of Freedom. That book is from before Steiner’s turn to occultism/invention of anthroposophy.
“I have argued that retributive ideas occur in other religions too.”
I haven’t disputed this, and am really not sure why I would need to. We just happen to be talking about anthroposophic medicine here. We could talk about other religions, but the subject of the blog post was anthroposophic medicine. If you want to get a handle on anthroposophic medicine, examining the underlying philosophy is a good idea, I think. Yes, many other religions include punishment of sins.
” In the Netherlands strict protestants in ‘our’ Bible Belt are against vaccination because this would limit the power of God (to either punish or test piety); for the same reason they refuse insurance and lightning conductors. But they don’t hide the fact that they think like that.”
Mainstream religions don’t generally hide their beliefs. Anthroposophy is not a mainstream religion; it’s a small sect, with a history of secrecy like many small sects.
“I have argued that belief in reincarnation is widespread. DW counters it by suggesting that the anthroposophic version is of a special kind, but the anthros keep it secret.”
That’s a bit of an exaggeration, but like many small sects or cults, they do definitely downplay their stranger beliefs in public. Note that before I brought it up, a lively discussion had gone on for quite some time with no one mentioning the role of this central belief in anthroposophy. It is definitely central to the understanding of disease in anthroposophic medicine.
“I have argued that Steiner had so many opinions that were quite unrelated to each other on all kinds of subjects that necessarily reincarnation was just one among many, maybe an important one, but not the basis of it all.”
Reincarnation and karma are tied. There are other religions that believe in reincarnation, but it isn’t necessarily tied to your karmic progress from lifetime to lifetime. In anthroposophy, this is a big part of the explanation for why you would get a particular disease. It also explains accidents, injuries, and disabilities. It is thought that immediately before birth, the soul about to incarnate is allowed a brief “preview” of the life to come. Some souls “hesitate” before this tableau, and this is the explanation for disabilities.
I guess we could have a big argument about which beliefs are most important in anthroposophy, but I’m not sure why we should. Yes, anthroposophy is complex and includes a lot of very complicated doctrines. In terms of explaining health and illness, karma is important.
“I have argued that the writings of anthroposophers go on and on about how man is composed. They are a garrulous lot. But reincarnation isn’t a major part, let alone a foundation of it. DW says the opposite,”
Yes, and DW is right. If you’ve only read Philosophy of Freedom, you haven’t read any actual anthroposophy, so I’m not sure how you would know.
” and the fact that Wikipedia proves my point is countered by stating that this is what the anthroposophers say themselves, implying that they keep this aspect of their views a secret.”
I think we’re going in circles. I’m not sure I understand the point of your arguments in circles here. The rest of your post seems to just go on reiterating that karma is not so important in anthroposophy and you are simply uninformed on this point.
“I could add that in criticisms of anthroposophy I have read karma and reincarnation were mentioned, but not prominently. Most criticism was directed at the stupidity of Steiner’s remarks. Example: Steiner makes a remark about white women who get a colored baby after reading ‘negro novels’. Modern anthroposophers think this is a reprehensible remark because of the suggestion that being black or colored is something bad. Critics say that this is a typical example of utter dumbth: dumbth of Steiner, whose writings are riddled with dumbth, and stupidity of the anthros who don’t notice how silly their idol is. Neither the critics nor the defenders relate this to karma.”
You haven’t read much of the criticism, then.
“It smacks too much of a conspirational theory of the type that suspects or suspected the Catholics, Jesuits, Freemasons, Illuminati and many more groups of having a secret agenda to take over power.”
To the extent that most small unpopular religious groups have such an agenda, they do, basically. This isn’t some big conspiracy theory. Are anthroposophists some huge threat in the sense they will likely take over the world? No. The danger is the type of thing we are discussing on this blog – creeping “woo” in medicine, for instance.
“I think the burden is on DW to provide evidence of the importance of karma and ‘retributive’ reincarnation for present day American physicians who practice AM.
Quoting Steiner won’t do. The doctors themselves should believe it too. ”
I don’t think it’s quite reasonable to suggest that adherents to the philosophy, maybe don’t believe in the philosophy. if they’re *anthroposophic* physicians, it is likely they adhere to anthroposophy. If you’d like I can post some quotes; I disagree that “quoting Steiner won’t do.” Steiner founded anthroposophy.
I don’t want to tie up this blog with endless disputation on just this point. I agree that it is not necessarily the most useful angle in combating AM’s infiltration into mainstream medicine. I do think it’s important to understand this point in understanding AM.
“Doctors have a tendency to think that the opinions of lay people in medical matters don’t have to be taken seriously, and maybe AM doctors are not different. If I may give an example from outside of anthroposophy: Roman Catholics are required to adhere to the official views of the RC Church on birth control. Whether they do so is quite a different matter, and it is doubtful whether RC gynecologists toe the official line. (What do RC obsgyn think about the virgin birth?)
Incidentally there aren’t many of these AM doctors in the US: the PAAM lists 33 MDs in the whole of the US.”
I have to say I get the impression your basic gist here is to downplay the significance or seriousness of this problem. Am I correct? Otherwise why are we playing this numbers game? Percents of people who believe in reincarnation, now “Well why worry there’s really only a few anthroposophic physicians anyway?” See the original blog post: they’re institutionalized at the University of Michigan medical school. One of the best medical schools in the country. That was kind of the point.
“The McMullen-Laird couple that runs the Rudolf Steiner Health Center in Ann Arbor is not on that list, and there may some more. That’s about 1/4 of the number of AM physicians in the Netherlands and about 0.5% of the 6,000 in Germany.”
Okay so let’s just not worry then. This is your point?
“A German consumer’s union guide to alternative medicine (written by two skeptics, Krista Federspiel and Vera Herbst, first ed. 1992, many updated new editions) gives the following explicit criticisms of AM:
1. use of heavy metals in not very high dilutions;
2. the precancerosis diagnosis: this diagnosis is often made, and then treated with many years of injections with fermented mistletoe;
3. AM is an incomprehensible occult science;
4. medicines of AM are not tested by scientific methods, merely anecdotic reports are known;
5. the system for determining which medicine a patient should get is only understandable by AM itself; it is incomprehensible;
6. diagnostic tests like blood crystallisation test are nonsense;
7. mistletoe medicin is rubbish.
The authors mention that AM considers illness as a positive opportunity to learn from conquering a disease and so obtain new powers and abilities. They also mention that some critics think Steiner was crazy and that his theories are those of a madman.”
A very good list. Is there some disagreement we have on this point? I am unclear why it is important to you to make it seem karma is *not* important in anthroposophy.
When anthroposophic physicians state that illness is a “positive opportunity” for the patient to “learn from conquering” a disease, they’re not speaking of one lifetime. They’re speaking of multiple lifetimes. What you learn from it, you may not make use of until the next lifetime. You may not literally “conquer” it in this lifetime but in the next. When they mention new powers and abilities, similarly, they don’t necessarily mean in this lifetime. Karma means that in one lifetime, one is developing powers and abilities that will manifest in future lifetimes. I’m sorry, you can dispute this if you like but it was one of Rudolf Steiner’s central teachings.
If you’ve gotten your information about anthroposophy off wikipedia, that explains your confusion. Karma and reincarnation are definitely downplayed in the discussion there. For a reason. Anthroposophists downplay it.
Strikes me as ironic, having to argue on a “science-based medicine” blog that we shouldn’t be taking stuff off wikipedia at face value. Do you know how wikipedia works? Peer review it ain’t.
“1. Can you prove that CAM is of no value to its users? Whenever you are asked this, or to “prove it doesn’t work” that is not a plea for you to prove a negative. The average skeptic is with every breath implying that everything about CAM is so useless that it can be peremptorily discarded. Asking for the basis of that stance is only fair.”
Yes, that’s a demand to prove a negative. You’ve just added ad hominem to the situation, basically, characterizing those asking for proof of effectiveness in negative terms (they’re asking “peremptorily” and “with every breath”). Doesn’t matter how they’re asking; they’re right to be asking for proof. Science based medicine *does* mean that until it is proven it’s useless. So if you want an answer to the basis of that stance, that is it.
Exactly. I look at it from the angle of health fraud and professional ethics, the former of which a lot of CAM (but not all) is and the latter of which much of CAM violates. I’ve said time and time again that people can do whatever they wish with their own bodies. They can choose the rankest quackery if they wish. They can choose no treatment at all. However, it is a physician’s duty to provide to patients his best assessment, based on evidence and science, of whether treatments are potentially effective. Physicians who promote CAM fail in this and promote misinformed consent among patients.
Yes, I agree. Peter is indeed demanding that we prove a negative, his protestations otherwise notwithstanding. Also, I, too, noticed that Peter’s description of skeptics is unrelentingly negative and has been for a long time. To him, in just this comment thread alone, skeptics are characterized as demonstrating “emotional responses”; “giving free rein to the instinct to demonize and destroy CAM wherever we encounter it”; engaging in an “instinct-driven all-out assault on pseudoscience”; showing “intensity and aggression”; taking part in “skeptical rampages” (what are we, The Incredible Hulk or something?); and all manner of other mean and nasty things. Why is that? Never is heard a good word from Peter about skeptics; or at least so it seems. Something emotional is going on here, every bit as emotional as the reactions to CAM Peter attributes to skeptics. Something visceral. Peter really detests skeptics, and it shows. I want to know why.
One can’t help but note, as well, that Peter is also engaging in a massive strawman argument when he says, “The average skeptic is with every breath implying that everything about CAM is so useless that it can be peremptorily discarded.” I challenge him to read some of my analyses of acupuncture studies and see if I “peremptorily discard” acupuncture claims. I do not. I spend a lot of time analyzing them seriously. Maybe a bit sarcastically at times, but seriously. I wouldn’t bother to go through so many studies examining CAM modalities if I was “peremptorily” dismissing them. Quite frankly, I find it insulting to have my efforts characterized in that way.
CAM is more a verb than a noun. The nouns are merely the result of the verb.
The verb is something like, “thinking” but with more holes in it than ordinarily.
Maybe the bad people did an Anthony Flew OP on Dr. Moran.
Or maybe he has a kid in Hollywood trying to get into the entertainment biz. Touchy nutters all over the place out there.
Or maybe the person posting here isn’t Dr. Moran at all. Maybe it’s a family member. Or maybe someone stole his laptop.
If Dr. Moran goes to TAM and tells me, “Yeah that was totally me the whole time,” I will believe him and buy him a drink. Until then, I suspect trollin’. But that’s just me, the most paranoid person I know, lol.
Oh, my vigorous disagreements with Dr. Moran aside, I’d be more than happy to buy him a drink. Unfortunately, it’s a long way from Australia to TAM, and, given his opinion of skeptics, I highly doubt that Peter would be interested in coming to TAM anyway. A shame. He could learn a lot about what skeptics are really like.
The doctor does this bit:
-Subjective
-Objective
-Assessment
-Decision
Providence in her wisdom does this bit:
-Helpful/not helpful
Before you prescribe CAM you have to do some part of the SOAD process wrongly. So if you get a “helpful” as the result or your CAM intervention, that’s just dumb luck which nobody cares about.
“Once you allow that CAM is of value to some, you are faced with a very complex cost/risk/benefit assessment, especially when dealing with CAM’s more benign manifestations.”
I don’t understand that statement. Who is faced with a cost/ risk/ benefit assessment? Not doctors, because the practice of medicine does not include non-medical practices (which CAM is, by definition) or unethical practices (such as misleading patients). So who, then? Users would seem to be the people who need to make the cost/ risk/ benefit assessment, which in fact they do based on the limited information available to them. If I understand correctly, you are saying that information about the true nature of unsupported practices should be withheld from the public, and that these unsupported practices should be offered by doctors themselves. As a member of the general public who has no choice but to trust and depend on doctors, I cannot express how upset this makes me.
“Kim, you are also asking me to accept that the dangers have some direct linkage to academic circles trying to reach some kind of rapprochement with (hopefully) selected elements of CAM.”
I’m not Kim, but how do you interpret Columbia’s clinical trial of the Gonzalez regimen as not being an example of the dangers of rapprochement?
You keep saying that acupuncture and health food stores still exist, which proves that educating the public and protesting loudly against the teaching of things known to be untrue in medical scool has failed. I don’t understand that argument. Is it different from “medicine obviously doesn’t work because people still get sick”? Because I don’t see a difference.
Mr. Titmouse and I have our TAM tickets. Hopefully this time we will get in on the jacuzzi and/or party action. Last year we were only invited to see pictures of the skeptical frolicking after the fact, and we was all like, jelus.
I hate Vegas. My eyes feel dusted in flour the entire time I’m there (h/o Lasik). But I can grudgingly deal with it for the chance to see y’alls.
I hate Vegas too and really wish TAM weren’t in Vegas every year. (Shhhh. Don’t tell Steve, D.J., or Randi.) Especially Vegas in July. But hanging out with fellow skeptics is really fun, and I’ve loved helping to put on the SBM workshop the last couple of years. Such a nice change from my usual situation of being the only skeptic in the room.
DW:
“Yes, that’s a demand to prove a negative. You’ve just added ad hominem to the situation, basically, characterizing those asking for proof of effectiveness in negative terms (they’re asking “peremptorily” and “with every breath”). Doesn’t matter how they’re asking; they’re right to be asking for proof. Science based medicine *does* mean that until it is proven it’s useless. So if you want an answer to the basis of that stance, that is it.
”
I hoped I was giving a little insight into the mind of the typical CAM user, who certainly has never heard of any issues surrounding “proving the negative”. Instead, you have helped explain why such interchanges usually end more badly than they may need to.
For another of the things that the usual CAM user cannot comprehend is why, when it comes to people with sometimes difficult medical problems, perhaps even ones that the mainstream has no satisfactory answer for, and there are some practitioners and patients saying that a particular approach helped, the default is not to give that the benefit of the doubt.
To them any other approach seems contrary to what medicine should stand for. If it even only has a small chance of working, why make the patient wait for years until studies have been done, if they are ever done?
Now, I know why that should be so. Medicine has responsibilities that go far beyond the care of the individual patient and there is potentially an overwhelming number of claims of equal merit, or lack of it.
CAM, however, with some small claim to having a superior focus for the day to day practice of medicine, is only ever thinking of the patient who is here and now. It does not have the same responsibility for medical science or the advancement of medical knowledge.
And the scenario that I see played out over and over again is a little different to the one you imagine. The CAM user is not usually aware that they have made a statement with such profound scientific implications that someone might suddenly be asking them to “prove” it. This is hobby-level medicine upon which we are intruding.
It is eminently reasonable for them to inquire how the intruder can know with such certainty that certain methods “don’t work” — especially when. as implied by your
” Science based medicine *does* mean that until it is proven it’s useless. ”
— it may not have yet been subjected ANY proper scientific study.
pmoran – your argument only leads me to conclude that better education is necessary. Something we already know to be true. Pandering to the uneducated is pointless, backwards, deceitful, and underhanded. You are not proposing a way to fix the problem, merely to live with it better. Not good enough.
I would rather have a cure for a disease than a way to live the rest of my life with it. As I have said in our previous exchanges – you feel free to throw up your hands and say that is impossible or that you are content with that as the status quo. I am not. Nor are the contributors to this blog.
Alison:
“Once you allow that CAM is of value to some, you are faced with a very complex cost/risk/benefit assessment, especially when dealing with CAM’s more benign manifestations.”
I don’t understand that statement. Who is faced with a cost/ risk/ benefit assessment?
Everyone. We justify deaths from NSAIDS with their ability to relieve suffering. We should apply the same standard to the methods of CAM, even if we think any benefits are derived from placebo and other non-specific elements of that kind of care.
You can include remote risks, if you like, such as the contribution of the use of a homeopathic remedy to the corruption of the progress of science.
I’m not Kim, but how do you interpret Columbia’s clinical trial of the Gonzalez regimen as not being an example of the dangers of rapprochement?
That was the OAM, now the NCCAM, not the academic circles Kim and I were referring to. There are arguable matters concerning that, also.
I don’t follow your last paragraph. I have never mentioned health food stores.
,Oh, my vigorous disagreements with Dr. Moran aside, I’d be more than happy to buy him a drink. Unfortunately, it’s a long way from Australia to TAM, and, given his opinion of skeptics, I highly doubt that Peter would be interested in coming to TAM anyway. A shame. He could learn a lot about what skeptics are really like.
Let’s all have an imaginary beer together, anyway, before we resume.
My “shout” ——-.
But now — . Oh dear! I had forgotten that it is some months since I have pointed something out.
As my frequent use of the word “we” should have hinted at, every one of the failings(?) that I have referred to as possibly impairing skeptical communications I have observed in myself, and in spades.
If I seem to be using unnecessary strong language I am verbally lashing my back, too, for what I now see was some sloppiness and arrogance in my early dialogues with CAM users and practitioners. As I said to Nybgrus, “you are ME!”.
I hate it that I am now being perceived as on the side of those who I, too, understand are away with the fairies so far as their medical theories are concerned. They simply don’t understand why their methods seem to work so well.
“We”, on our part, are reluctant to allow that at worst they are merely the victims of powerful illusions within medicine, and that they may indeed be satisfying certain medical needs, in ways that science permits us to understand.
It’s not hard, you know. With so much day-to-day medicine you just have to turn up for work on time, listen well, reassure those who need it, be confident in what you say, and have a reasonably credible collection of remedies. If you can also exploit the fact that people love to be doing things that they think are good for them, and will feel great for doing so, you’ve got it made. Science, schmience! You don’t even have to turn up for work on time, if you can pretend that you were delayed by an homeopathic emergency .
The CAM practitioner also has the immeasurable advantage of being able to select and be selected for the conditions that he chooses to treat, or at least what level of clinical responsibility he will assume. Proper doctors are obliging them by doing what another commenter here described as the “heavy lifting” of medicine.
See? I understand all this but still think we need to sensitive to the possibility that CAM may have a niche role in medicine as it stands, today.
If you don’t accept that, at least try to develop realistic objectives concerning CAM and put some thought into what aids those and what doesn’t.
pmoran:
“another of the things that the usual CAM user cannot comprehend is why, when it comes to people with sometimes difficult medical problems, perhaps even ones that the mainstream has no satisfactory answer for, and there are some practitioners and patients saying that a particular approach helped, the default is not to give that the benefit of the doubt.”
Of course give the benefit of the doubt, but only after tested known remedies have been tried and failed. Or make sure the patient fully understands that this remedy has no evidence to support it and if there is a remedy that *does* have evidence to support it, the physician cannot in good conscience endorse the patient’s taking the remedy that doesn’t. Ethically the physician cannot encourage the patient to drain his/her bank account and waste his/her time and get hopes falsely elevated. The physician has an active responsibility to advise the patient *against* this.
I don’t think the point is that no one should ever take a CAM treatment of any sort under any circumstances. The point is what is the physician’s responsibility.
“The CAM user is not usually aware that they have made a statement with such profound scientific implications that someone might suddenly be asking them to “prove” it. This is hobby-level medicine upon which we are intruding.”
I get that. The question is not whether there are understandable reasons people turn to these remedies, and effectively practice “hobby medicine.” The question is whether a *physician* should be practicing or endorsing hobby medicine.
“It is eminently reasonable for them to inquire how the intruder can know with such certainty that certain methods “don’t work” — especially when. as implied by your
” Science based medicine *does* mean that until it is proven it’s useless. ”
— it may not have yet been subjected ANY proper scientific study.”
Yes, it’s quite a reasonable question, and surely most physicians know the answer to it?
@ DW on 17 Mar 2011 at 9:01 pm
In Germany the Anthroposophische Gesellschaft has 20,000 members. The number of Waldorf Schools over there is over 200. I mentioned that Herbst and Federspiel say that there are 6,000 physicians practicing AM. The Gesellschaft a Anthroposophische Ärtzte in Deutschland (GAÄD) lists 501 members, so apparently there are many more physicians that practice AM than GAÄD members. There is even a bank that does business on anthroposophic principles.
That is not a small cult. I haven’t seen any proof (by DW) that ideas of karma are important in the practice of AM physicians (AMP). He keeps repeating the fact without adducing proof.
I can easily imagine that these AMP have lots of anthroposophic patients, or at least patients that have some kind of vague reincarnation of karma belief and that they try to accomodate these beliefs. I don’t know. I have given a list of the major criticisms of AM from a German source, and refusal to treat patients on account of their karma is not on that list. Neither is a rejection of vaccination, although some critics of AM say that the AMP are not actively endorsing vaccination. Officially Waldorf schools also don’t reject vaccination. Maybe the karma stuff is hidden in ‘incomprehensible occult’. Some of the strange remedies are chosen to accommodate the cure of the soul as well.
Of course AMPs don’t treat well: they scare one group of patients with the diagnosis ‘precancerosis’, inject them with useless mistletoe, and when they prescribe their Weleda stuff, it amounts to not treating.
Yes, anthroposophy is much bigger in Europe (particularly in Germany and Switzerland) than in the US. I am not sure what your point is.
“I haven’t seen any proof (by DW) that ideas of karma are important in the practice of AM physicians (AMP). He keeps repeating the fact without adducing proof.”
I’m not a “he.” I find it a peculiar request that I should be asked to prove that anthroposophic physicians believe in anthroposophic doctrines. I don’t know how I could prove that or why I should. If people would like quotes from Steiner indicating the centrality of karma in his worldview, I am happy to do that but it will take me a few days as I am presently not where my books are. (Quite a bit can be located online, too, but it’s not as systematic for me; I know what’s where in my underlined books. rsarchive.org – check under “Lectures” – letter “K” for karma, and you can find quite a bit.)
But again it seems that what you are asking is proof that individuals believe it; no one’s going to be able to provide that. Do you ask mainstream doctors for proof that they believe what they were taught in medical school?
Also I am not sure how long the blog authors want this discussion to go on and I write pretty long posts anyway. If people want specifics on Steiner’s karma doctrine please let me know.
“I can easily imagine that these AMP have lots of anthroposophic patients, or at least patients that have some kind of vague reincarnation of karma belief and that they try to accomodate these beliefs. I don’t know. I have given a list of the major criticisms of AM from a German source, and refusal to treat patients on account of their karma is not on that list.”
I have not suggested that anthroposophic physicians refuse to treat patients on account of karma; not sure where you got that idea.
“Neither is a rejection of vaccination, although some critics of AM say that the AMP are not actively endorsing vaccination. Officially Waldorf schools also don’t reject vaccination.”
No, they don’t, officially. Obviously you have never been a Waldorf parent! There is nothing official about this. Nevertheless the schools are hotbeds of antivaccination and the teachers often strongly discourage it; our Waldorf school had a teacher who started crying every time she heard that a child had been vaccinated (she felt their soul had been damaged). It is about the culture in Steiner communities, not about a decree or explicit policy.
I am wondering why you are defending them. It usually turns out it’s because the defender has a close friend or relative affiliated with a Steiner school. That seems to make it important to insist that all these criticisms are vague, unproven etc.
I suggest you simply read Rudolf Steiner if you think I’m misrepresenting this. And if there are lots of anthroposophic physicans who don’t actually believe in anthroposophy, why are they calling themselves anthroposophic physicians? Wouldn’t that be a strange situation?
“Maybe the karma stuff is hidden in ‘incomprehensible occult’. ”
Huh? Try reading the books. It’s incomprehensible all right, but the texts themselves are easy to come by. googlebooks has quite a bit.
“Some of the strange remedies are chosen to accommodate the cure of the soul as well.”
Yes, of course. Karma doesn’t always mean you’re going to die from your illness. Obviously some illnesses are curable.
“course AMPs don’t treat well: they scare one group of patients with the diagnosis ‘precancerosis’, inject them with useless mistletoe, and when they prescribe their Weleda stuff, it amounts to not treating.”
There we agree.
Maybe–just maybe–that “perception” exists, oh, because you’ve been saying lots and lots of things recently that appear to be nothing more than apologetics for CAM and and because you have been castigating skeptics for being too “strident” or “militant” about CAM for your liking. You may not perceive ourself as being on the “CAM side,” but more frequently than I like your words sure do give many of us that impression–and not without reason, I might add. It may not be your intent to be perceived thusly, but given your arguments recently it’s not entirely unreasonable for some of our readers to develop such a perception of you as being a CAM apologist.
You think we don’t do that? Jumpin’ Jesus on a pogo stick! Seriously, you really think that? I’ve said many times that CAM isn’t going away. Several of us here have also pointed out many times that CAM must be filling some need that SBM is not. The answer to that problem is not to allow fairy dust to fill those needs but to find a way through which SBM can fill those needs as well or some other discipline that doesn’t use religion, mysticism, fairy dust, and Tooth Fairy science should be found to fill those needs.
Of course, I suspect that where we differ here is in the definition of “realistic objectives.”
Be that as it may, your criticisms remind me very much of the criticisms against “new atheists” made by science communicators whom the “new atheists” sometimes disparagingly label “accommodationists.” It’s a debate about how to deal with religion (usually in the context of teaching evolution and other sciences that religious views conflict with) that erupts fairly frequently these days in skeptical and/or atheist blogs, podcasts, and meetings. Your criticisms sound almost identical to those of, say, Chris Mooney or Joshua Rosenau against, say, Richard Dawkins, P.Z. Myers, or Ophelia Benson when it comes to religion.
Here’s a primer on this particular debate:
http://www.examiner.com/atheism-skepticism-in-new-york/revisiting-the-confrontationalist-vs-accommodationist-feud
There was also a recent podcast in which the two sides squared off:
http://www.pointofinquiry.org/pz_myers_jennifer_michael_hecht_chris_mooney_new_atheism_or_accommodation/
It’s even made it into the NYT:
http://www.nytimes.com/2010/10/16/us/16beliefs.html
Sound familiar?
You seem to labor under the delusion that the issues that bother you so much are ignored by the skeptical community and among those of us who promote SBM, but they are most definitely not. In fact, they are a major topic of debate, often heated and sometimes rancorous. It’s a debate that I am now loathe to enter on my other blog anymore. Having seemingly argued both sides of the issue and every position in between at various times, I now mainly see a lot of heat but little light.
My current willingness to pick and choose tactics as I see fit aside, you clearly come down on the “accommodationist” side. Personally, my views have evolved from being more “accommodationist” to more like this:
Or this:
http://skepticalteacher.wordpress.com/2010/10/17/the-question-of-whether-skeptics-should-accommodate-or-confront-religion-is-a-false-dichotomy/
There is a lot of truth in that. Personally, to me there are many ways to skin the proverbial cat, from “accommodationism” to the “stridency” that seems to disturb you so. You seem to have conclude that there is only one way, or at the very least concluded that one large category of strategies is worthless. I have not, and in fact I pick and choose among the entire range. For example, I appreciated the mockery of homeopathy inherent in the recent 10:23 campaign,” where groups of skeptics took “overdoses” of homeopathic medicines in order to demonstrate in a simple, easily accessible manner that “Homeopathy: There’s nothing in it.” It was simple, direct, and fun, but–oh, no!–it did mock homepathy and homeopaths as utterly ridiculous and pseudoscientific! Perish forbid!
In any case, one wonders if you’ve become burned out somehow. You sound to me, more than anything else, as though, after 30+ years of the fight and seeing quackery stronger than ever, you are tired and have decided to become a shruggie because you can’t bear the struggle anymore. Is this a fair characterization, or am I reading too much into your change of heart over the last few years?
Jan Willem Nienhuys and DW:
My reading of your exchange is that it’s “What is anthrosopophy?” vs “What is likely to happen if an anthroposphic school sets up in the US, and what niche is it likely to fill?”
Compare “What do we understand about the true nature of Christianity from our readings of the New Testament?” vs “What is likely to happen when the Pope gives Spain the right to convert South America to Catholicism?” or “What is the impact of Protestant missions on health care delivery in the Sudan?”
These are simply two different types of questions. If AM has such wide acceptance in Germany because they feel it supports a humane approach to the care of people with cognitive disabilities, that fact might be relevant to understanding what AM might be doing on the other side of the Atlantic. Perhaps the appeal of AM in the US is a completely different niche, that of preventing cancer.
The histories and religious underpinnings of Germany and the US are different, so perhaps the writings of Steiner are more relevant than observed AM practice in Europe.
Presumably it makes sense to have an understanding of both.
Hi Alison,
Good points.
I’ll be away a few days and if the topic has not died when I get back I’ll post some more on karma in anthroposophic medicine.
Here very quickly is one anthroposophic physician’s statement on vaccination in relation to karma:
http://www.anthromed.org/Article.aspx?artpk=764
Anthroposophy and Vaccination
“Following are personal reflections on some ideas that may be found in anthroposophic medical literature. The viewpoints expressed do not exhaust the literature and it is important to point out that there is no formalized policy on immunization within the practice of anthroposophic medicine. Anthroposophic medicine sees humans as passing through successive earthly lives incarnated in a physical body, “laying one’s karmic foundation in one incarnation for the next.”‘ Illness comes to an individual not by chance but as an opportunity to come to terms with one’s karma from previous incarnations. Illness provides an individual with a message which ultimately assists in self-growth and development. The responsibility of a healer is to assist the human being experiencing the illness to deal with it karmically. Thus, prevention of an illness may be beneficial in the course of one incarnation but may not be for the entire soul life and development of the person. Anthroposophy views that in early childhood years, soul-spiritual forces permeate the organism and have an organizing effect involving growth.”
@Alison Cummins, Jan Willem Nienhuys and DW
Although, I take JWN point that original philosophies of the founder of a group does not necessarily translate into practitioners that embody all of the founders original intentions (see Marx and Stalinist communism), I think the the UMIM website is relevant. (sorry long quote for convenience)
“-Many illnesses, especially benign ones, should not be artificially prevented, but should be allowed to occur and be treated and healed. The patient thereby gains strength and experience, both biologically and spiritually.
-True prevention of illnesses involves a healthy lifestyle with positive habits, strengthening the biological, psychological and spiritual aspects of a person, and avoiding the detrimental and illness-producing effects of much of modern civilization.”
http://www.med.umich.edu/umim/resources/anthroposophic_medicine.htm
While this may not reek of retributive karmic philosophy, it does show a definite spiritual treatment viewpoint, with a presentation of the practitioners as being the experts or guides in what is spiritually healthy. See my above concerns regarding this.
JWN – I appreciate your interest in anthro’s use of dance and art for theraputic purposes.
You might be interested in knowing that when my son had surgery at U of M’s conventional medicine children’s hospital, volunteers brought around craft projects for children to do before surgery (during parent paperwork). They also have playrooms on the inpatient floors that are staffed by play and art therapies. They are supplied differently, but generally there are traditional building/train type toys as well as a sensory tables, bubbles, coloring, the staff usually has a craft to bring out if the child is interested.
No dance though, since surgery and dance don’t usually mix.
But, my son’s public preschool, kindergarten (for hearing impaired) uses a program called Music and Movement, daily. They sometimes combine with the preschool, kindergarten autism class. The program uses music, dancing and singing to work on speech and motor skills. The kids really enjoy the music, singing, dancing, games, so that makes the work of speech and motor exercises more entertaining for them.
Just, couldn’t let folks go away with the impression that Waldorf is the only one doing art and dance in their programing.
So, like, is illness a good thing or a bad thing? If it’s good, then why not seek it out? If a cold is like preschool, presumably cancer is like a PhD for the soul?
But the trial was carried out by academic faculty at an academic medical center, specifically Columbia University. The patients recruited to the trial were recruited in academic settings. Columbia University received a million dollar-plus grant (probably two million-plus if you add in indirect costs) to carry out the study from NCCAM, to be sure, but many clinical trials at academic medical centers are funded by the NIH. You can’t separate the two. NCCAM might have funded the trial, but the research into the Gonzalez protocol could not have been done without the full support of Columbia University, whose faculty carried out the clinical trial with Dr. Gonzalez’s assistance.
Name them, please.
You know how you can get a song stuck in your head? I feel like pmoran has a theatrical scene stuck in his head that goes something like this:
A nice little old lady has pancreatic cancer. She heard that a series of coffee enemas might help and is intent on giving the idea a try, along with some dietary changes and OTC supplements. She also wants the best chemo program available.
1. Tell the patient that coffee enemas “don’t work.”
2. Say, “There’s no scientific evidence showing coffee enemas work, but some patients have reported subjective improvement.”
The kindly doctor in this scene selects option number two. Then Drs. Gorski, Atwood, and Benway burst into the room and beat the living crap out of him, before calling the Board of Medicine to have his license yanked for promoting quackery.
Well you know, in the scene above I would go for #2 myself. I’m not going to take a comforting lucky rabbit’s foot from a frightened and dying patient if I don’t have to.
But that’s a derail from our primary concern here: what to do about MDs actively promoting unproven or disproven therapies to the public.
CAM is nothing more than bad maths. We are never going to stop humans from doing math badly. But why would we ever want to promote bad maths to the public?
What standard do you use to separate good from bad personnel? What standard do you use to decide good teaching from bad teaching?
My standard is demonstrated competence at reviewing the scientific literature and weighing evidence of risk and benefit correctly. “Integrative” is an obvious dodge around that standard so WTF.
Even if every CAM therapy resulted in happiness and puppies for everyone, CAM itself would not be justified. It is a category without rational boundaries.
um, Dr Benway – happiness AND puppies? I don’t care if it’s CAM, I’m in.
There has to be beer too. Happiness and puppies are not enough.
Dr Benway’s understanding of pmoran’s scenarios:
1. Tell the patient that coffee enemas “don’t work.”
2. Say, “There’s no scientific evidence showing coffee enemas work, but some patients have reported subjective improvement.”
The kindly doctor in this scene selects option number two. Then Drs. Gorski, Atwood, and Benway burst into the room and beat the living crap out of him, before calling the Board of Medicine to have his license yanked for promoting quackery.
I understand them a little differently.
***
1. Tell the patient that coffee enemas “don’t work.”
So far so good. Might or might not be technically a true statement depending on your definition of “work,” but I believe we all agree this is unlikely to be a helpful part of the doctor-patient encounter.
***
2. Say, “There’s no scientific evidence showing coffee enemas work, but some patients have reported subjective improvement.”
I would hope a doctor would also add, “Something that can happen with coffee enemas is they might keep you from sleeping. Sleep is a very important part of staying healthy, and if coffee enemas interfere with that it’s a sign they aren’t right for you. Can you let me know how it’s going for you at our next appointment?”
Either way, I think we all agree that the idea of anyone yanking anyone’s license after a compassionate and commonsensical exchange like this is absurd.
***
3. Say, “Sure, they might help you feel better but they won’t cure your cancer by themselves. I was taught in medical school how to administer coffee enemas correctly, so howsabout you make a series of appointments with my receptionist and we’ll get you started on your coffee enema therapy right away?”
The latter is what pmoran seems to be advocating. And as nice a person as pmoran seems to be, anyone who advocates Option 3 deserves a good thrashing. And their license yanked, because that isn’t medicine.
I don’t remember pmoran clearly stating what his approach would be. Would he recommend CAM if the patient didn’t mention it, or would he merely condone its use if the patient brought it up? I think we can assume he wouldn’t just say “That’s nonsense!” but it’s not clear to me whether he would support its use or merely support the patient. It’s not clear what he would tell the patient about the lack of science. Perhaps he would be willing to clarify.
Harriet Hall, I quote pmoran:
“Offering selected elements of CAM under the supervision of proper doctors could be a rational approach.”
That sounds awfully like coffee enemas in the medical clinic to me.
I wish you guys would stop talking about doctor-patient and help me with the doctor-doctor problem.
I think if the doctor-doctor problem were fixed, the doctor-patient problem would fix itself.
3. Is the doctor-doctor version in the sense that our kindly doctor was taught the correct administration of coffee enemas in medical school.
If this is what pmoran advocates then there is no doctor-doctor problem. Doctors can do whatever they want in the name of patients liking it and call it good. No other doctor should care, because that would be counterproductive. Science will fix itself in the end without any actual people involving themselves in the process.
As a vulnerable patient, this really upsets me. I think there is absolutely a doctor-doctor problem, and it’s frightening.
I don’t remember pmoran clearly stating what his approach would be. Would he recommend CAM if the patient didn’t mention it, or would he merely condone its use if the patient brought it up? I think we can assume he wouldn’t just say “That’s nonsense!” but it’s not clear to me whether he would support its use or merely support the patient. It’s not clear what he would tell the patient about the lack of science. Perhaps he would be willing to clarify.
As usual discussion gravitates to “what the average doctor should do”. I am not thinking primarily of that, although I can tell you that what happens in practice is that doctors respond to the pressures of medical practice in different ways. The pressures are same ones that have given rise to CAM, mainly unmet or difficult-to-meet medical needs .
So, fifty per cent admit to the use of placebos, and a substantial number use herbal remedies, homeopathy (in Europe) or acupuncture (in Australia), probably often also with the understanding that they mainly “work” as placebo.
If nothing else, treatment programs such as acupuncture provide “tincture of time” and a structure for ongoing supervision and nurture of patients that may be difficult to sustain in other ways.
Not likely coffee enemata, for Pete’s sake!
The important thing to understand is that whatever doctors do has inevitable repercussions for CAM.
I accept that there is a solid argument for the mainstream confining itself to a strict evidence-based shell. That is an absolute in the treatment of a lot of serious medical conditions, if not so clearly in the relief of the subjective symptoms and ubiquitous psychosomatic complaints. .
However, the more the mainstream retreats into such a shell, the fewer the options it has in dealing with the entire panoply of human complaints, and the more room it leaves for CAM, which is never stuck for an answer and never stuck for a remedy.
Is that going to expose more patients to its dangers? I don’t know for sure, but I have to consider the possibility.
I am also certain, Kimball, that the recent upsurge in CAM has more to do with conventional medicine withdrawing into its evidence-based shell and eschewing “the old ways” than academic circles belatedly dipping their toes into those waters.
I also have to seriously challenge the convenient assumption that the problem will go once we have the public properly educated (so we don’t have to try and understand what we are up against).
The doctor-doctor problem- I suppose featuring the problem doctor in a set-up of one of those James O’Keefe (Acorn) style entrapment/gotcha videos and releasing it on youtube would be too evil.
[sigh] it’s sad to have a soul (even a non-metaphysical one).
If there is beer, count me in!
As for the assessment of pmoran’s argument, I think Alison is pretty spot on with #3. Yes, he now says “Not coffee enemata, for Pete’s sake” – but where is the line drawn? Acupuncture, sure we as docs can do that in our own clinics and get money for doing it, but coffee enemas are a no-no? Why on earth draw the line there? They both have the same “non-specific” effects you seem to love so much.
And as Dr. Gorski has said – you do sound (to put it bluntly) like a burnt out shruggie. I have been back and forth with you on the topic extensively, and if it were only my opinion that would be one thing. But many more experienced and knowledgeable individuals are seconding and thirding my assessment, as are a number of our non-medical posters. I would think by now it would be time to own up or change your rhetoric if it doesn’t actually describe your stance and thoughts well.
Also, as per Gorski, I have also been advocating the “pick-and-choose” ideology of combating CAM. There are different relationships, scenarios, and mitigating circumstances to which we should be able to adapt and employ whatever tack is best suited. However, all of these should be rooted in a firm understanding of what, exactly, CAM is, why it is (on the whole) harmful, and within the boundaries of medical ethics and duty of care.
As I said previously, I find it personally uncomfortable and innately useless to pray for healing. It is the same as CAM – evidence shows it doesn’t work, it has no plausibility, and in the case of Christian Scientists can lead to direct and extreme harm.
So when I am speaking to classmates and colleagues, if they present an idea that they think prayer is a reasonable alternative treatment, I will strongly dissent. If they say it is a reasonable adjunct, I will question why they feel the need to systematically use it over something else. If they teach it as a credible modality in lecture, I will be upset and actively campaign against it in the way pmoran calls “harsh” and unaccepting. However, if a patient asked me to pray with him/her, depending on the circumstance, I would (and have). If it were a trauma or critical situation, I would do it without much hesitation. If it were in my consultation room, I would kindly explain that I believe prayer to be a very personal experience, one that I just do not find appropriate for a doctor-patient dynamic (and go from there depending on the response). And lastly, if the patient said they would rather go pray instead of sound evidence based treatment, I would try and explain the dangers of that and dissuade them from using prayer alone – the tone, style, intensity, etc of my rhetoric varying in accordance with the severity of the disease in question and the patient’s response.
Now, substitute your favorite CAM “treatment” for prayer, and you have a general outline of how I would pick and choose my tactics.
Yes, David, the Gonzales study was performed by Columbia.
There are arguable matters concerning that, also.
Name them, please.
If you don’t mind, I would rather not get involved in a second lengthy argument right now. It relates to subtle differences in how the Gonzales study has been portrayed and none of it is worth my time or yours at this point.
I just noted your “accomodationist” comments. It continues a prevalent pattern in – well, any kind of debate, really — wherein the finding a demeaning name for an opponent or an alternative explanation for their behaviour reduces the need to listen to them or to try to understand what they are on about.
I would prefer you regarded me as having more of a “what your best friends won’t tell you” relationship to medical skepticism in general.
Actually very few of my remarks directly relate to you, even though you seem to take them very, very personally and defensively. I don’t want to mention the names of some that I think might be best kept on a leash when it comes to talking to some of the people we badly want to listen to us. Surely you are aware of the vitriol with which some not-too-unreasonable newcomers have been greeted on these comments pages. Yet the very same people go on about educating the public!
This post does relate to you, but I would still like us to be friends. I fully understand how extreme my views seem for a professedly science-based skeptic and how easily words can convey things that are not intended. And who am I, anyway? A humble provincial surgeon! Who cares what I think? Look on it that way if you wish.
I am happy to let my arguments and insights speak for themselves and for people to pick holes in them if they can.
pmoran: it is clearly me that you are referring to. I have explained that in my view this forum is the hard line. It is the place where people so inclined (as myself) can hold that hard line. When a person on the fence googles a CAM modality and finds this page and reads about it I do not think it behooves us to let them scroll down and have every post read “yes, it has some subjective benefit, so go on ahead and do it.” I’ve made that point clear and that is about me specifically.
However, Dr. Gorski is quite correct that you rhetoric generalizes that to skeptics as a whole. Innumerable times you have referred to physicians like Gorski and skeptics in general in that sort of light.
And we DO try and listen to your arguments. Gorski has gone to more pains to try and engage you than I have seen with just about anyone else. The only one to come close it Dr. Jay Gordon and he holds a much more collegial and respectful tone with you than Gordon. Numerous posters here have tried to actually pick apart and understand your arguments and ask how they may be actually applied. The fact that you get the label “accomodationist” is not a handwaving tactic to dismiss you – if that were the case certainly Gorski would not still be writing responses to you and asking more direct questions! If he (we) had indeed “[found] a demeaning name for an opponent or an alternative explanation for their behaviour reduces the need to listen to them or to try to understand what they are on about” then he (we) would not be listening to you and trying to engage you to further understand your points! You cannot claim to be dismissed while being questioned and asked for clarification. The label you so describe comes from your responses – it is our interpretation that you are indeed a shruggie.
You take on the defensive unnecessarily:
“And who am I, anyway? A humble provincial surgeon! Who cares what I think? Look on it that way if you wish”
We do – hence why we keep asking questions. The fact that you keep fawning hurt and attack makes me even more inclined to confirm my prior assessments of your stance.
Nybgrus, I never doubted that you or Dr Gorski would show discretion when talking to your patients.
But many more experienced and knowledgeable individuals are seconding and thirding my assessment, as are a number of our non-medical posters.
Have a chat to Dr Gorski about logical fallacies some time.
They both have the same “non-specific” effects you seem to love so much.
Which you acknowledge, only to then completely disregard them when formulating your policy towards CAM, which is based upon —
evidence shows it doesn’t work, it has no plausibility, — .
In fact the evidence suggests “it” can “work” as placebo and quite strongly if within an otherwise favourable environment. Plausibility is provided by ordinary human suggestibility and even by some of the findings of modern neuroscience.
Moreover the people who most need to be made aware of the limitations of CAM have often just told you that it DID work, for them.
What is your policy now?
We are using the word works in two different senses , but the patient doesn’t give a fig. Why is one more valid than the other?
I say for the eighteenth time that this is not a recommendation that doctors use placebos. It is to do with how we view CAM.
PM
The fact that you get the label “accomodationist” is not a handwaving tactic to dismiss you —
Oh, pull the other one! The use of “shruggie” and other demeaning labels is usually a way of deriving some reassurance that one’s own views are the correct ones. It serves no useful function in debate.
Except — the labels, if not too loaded with other implications, may serve as a useful shorthand to describe people who hold certain views or attitudes. But has not the least bearing on whether the views are correct or not.
LOL, nybgrus. Imma help you out with some Trolling 101.
Troll technique #21: Vaguely criticize persons “who shall remain nameless.” 9/10 times several parties will personalize the criticism and react accordingly, thereby enturbulating the remainder of the discussion (see “don’t be a dick” aka the Phil Plait affair).
Troll technique #22: Accuse anyone responding to your vague criticisms of “defensiveness.” They will then defend themselves, lol.
Troll technique #43: When called upon to clarify vague criticisms, take a rain check due to other important duties, a plane to catch, dinner being almost ready, etc.
Anyway, I still want y’alls to help me figure out how we can get doctors to police their own a little better. Although the public are not in a good position to judge the scientific literature, they do play an important role in this effort.
If people were to say, for example, “We want our folk remedies, but we also want some place where doctors are careful about the science,” then maybe we could roll back the recent changes to state laws making “integrative” medicine non-actionable.
Maybe.
Maybe if you lot from the land downunder didn’t tell Prince Charles to piss off when he wanted to become Governor-General, he wouldn’t have been so vulnerable to Scientology’s flirty-fishing mission and love bombing from the Roma community. Without Bravewell or Prince’s Trust, I doubt we’d be here now.
Oh I notice there’s a heartwarming movie out that says the royals are just like us only moreso.
pmoran: harriet hall commented on it already. I’ll refresh your memory:
“I say for the eighteenth time that this is not a recommendation that doctors use placebos. It is to do with how we view CAM.”
“Offering selected elements of CAM under the supervision of proper doctors could be a rational approach.”
You are either getting nuanced to the verge of pointlessness, or, more likely, your missing the cognitive dissonance of these two statements.
Is CAM placebo? You say it is and that this placebo “works” under some operational definition you ascribe to. You choose to say “non-specific” benefits instead of placebo – same thing (as I am about to illustrate).
“‘They both have the same “non-specific” effects you seem to love so much.’
Which you acknowledge, only to then completely disregard them when formulating your policy towards CAM, which is based upon —
‘evidence shows it doesn’t work, it has no plausibility,’ — .
In fact the evidence suggests “it” can “work” as placebo and quite strongly if within an otherwise favourable environment. Plausibility is provided by ordinary human suggestibility and even by some of the findings of modern neuroscience.”
Now lets repeat:
“I say for the eighteenth time that this is not a recommendation that doctors use placebos.”
and again:
” ‘it’ can ‘work’ as placebo and quite strongly if within an otherwise favourable environment.”
I won’t use those labels you find so offensive and completely untrue. But perhaps you would like to rectify the cognitive dissonance here?
Oh, and more specifically, apparently, “it” can “work” and offering “selected elements of CAM under the supervision of proper doctors could be a rational approach” but “Not likely coffee enemata, for Pete’s sake!”
Where is the line, Dr. Moran? I am absolutely certain that there are plenty of people who would claim that coffee enema most certainly worked for them. And since, apparently, “Plausibility is provided by ordinary human suggestibility and even by some of the findings of modern neuroscience” and that means that “it” indeed “works” why not coffee enemas? Besides, one thing that any doctor’s office has more of than soap is coffee. Seems like a great and rational approach to meet those unspecified needs that CAM fills while under the supervision of a “proper” doctor.
Until you can specifically address these critiques my labeling stands. It is not an a priori stance to dismiss you. It is a post hoc assessment to describe you. And I am well aware of logical fallacies. My invocation of others agreeing with my post hoc assessment was to further strengthen the likelihood of my claim, not prove it. It is proved quite handily by your responses, as Dr. Benway has just pointed out.
Interesting. After referring to skeptics as “rampaging” and “emotion-driven,” among other rather derogatory descriptions, now you clutch your pearls simply because I utilized shorthand? Now you accuse me of demonizing my opponents? Seriously? That’s some serious chutzpah there, my friend.
Note that I included links that told both sides of the “accommodationist” versus “angry atheist” thing, the whole point being that the argument between you and me, you and some of the readers here very much reminds me of the same debate. Naturally, instead of addressing that, you zeroed in like a laser beam on the one thing that would allow you to claim the role of the aggrieved, wronged voice of reason among all us “emotion-driven” “rampaging” skeptics.
Yes, I’ve seen this tendency before, just as often as you think you’ve probably seen a tendency to “label” people.
I beg to differ. I’ve taken this much time already; so why wouldn’t it be worth my time to read your critique of the Gonzalez study? I’m sure Kimball would be interested too.
Well, You’ve got me, Nybgrus. Bravo! Or have you? Let others judge.
This is the bit of musing from which the “offering selected elements of CAM” quote is borrowed — .
“I reiterate that my whole point is risk vs harm, but in a more global sense than the approaches I see displayed here i.e. what attitudes, rhetoric and strategies can optimize any benefits that our public may derive from CAM, while minimizing its risk?
Offering selected elements of CAM under the supervision of proper doctors could be a rational approach, unpalatable as it obviously is to those for whom the science of it all (actually selected aspects of the science) is of such overriding importance that they see only an unlikely slippery slope, not the intricate cost/risk/benefit judgment it probably should be.”
Now I have previously referred to how any reference to the potential value of CAM through “placebo and other non-specific effects of medical interactions” (to use the full intended meaning) nearly always gets diverted into discussing the ethics of doctors using placebos. This is somewhat cogent within the above context, but not when CAM is carried on as an independent activity by believers.
So when I set up the above challenge to YOUR stated policy on CAM, which you have so far sidestepped, I did not want this to happen (for at least the seventh time — I admit I exaggerated). This is why I said —
“I say for the eighteenth time that this is not a recommendation that doctors use placebos. It is to do with how we view CAM.”
You omitted the second sentence.
Where to draw the lines is a valid point, although it needs to be pointed out that the actual modality is probably of less importance than the additional doctor-patient interaction. That can be difficult to sustain under the conditions of modern medicine.
Well, David, I will leave the irony of being accused of inappropriate ad hominem by yourself and some others here alone. The phrases you have selected were never intended to refer to other than the specific contexts in which they were used and I have made it clear that I refer as much to my own sometime responses to CAM as those of anyone else.
Do you seriously want to debate the Gonzales study? I have summarised my overview of the actual results below. I think some of the outrage at the study here is a bit overdone, and puzzling to cancer patients having to make critical decisions.
From my web site –
“The final results of that study have been published http://jco.ascopubs.org/cgi/content/abstract/JCO.2009.22.8429v1
They are disastrous for the Gonzales/Kelley (“enzyme”) approach. Due to small numbers of suitable patients accepting randomisation, the study had to be completed on the basis of patients choosing which treatment to receive. This can introduce bias and there were small biases towards sicker patients in the Gonzales/Kelley group such as more with distant metastases. Gonzales also alleges that some of the patients allotted to him were too sick to follow or complete his treatment. This is certainly possible. Inoperable pancreatic cancer is a rapidly progressing and debilitating condition, and patients may have also exaggerated their ability to consume the required diets and handfuls of supplements in their eagerness to be accepted for the study.
Yet even if we doubled the survival of the Gonzales/Kelley patients at 10 months so as to completely exclude some obviously excessive early mortality in this group, there is still no indication of any beneficial influence from this complex regime over the average medical care that the SEER figures reflect..
The benefits of chemotherapy are admittedly rather modest with this condition.“
pmoran,
I think we’ve got it: we misunderstand you.
Can you help us out here? Could you specifically address Dr Benway’s and my kindly doctor examples and say where you stand on them? You’ve declined to comment on them because the example CAM practice is coffee enemas which are so obviously absurd, so please mentally substitute acupuncture. Folks here want to understand and are making huge efforts to find common ground, but personally I don’t understand how your statements would translate into practice.
Got a direct link? I can’t find the article on your website. In any case, what you’ve posted makes me wonder if you ever actually read our posts on the matter.
The issues you bring up were all discussed by both Kimball and me (more by Kimball, whose posts on this particular topic outnumber mine by several-fold, in all their nauseating detail). Seriously. We discussed the potential for selection bias. Kimball discussed the randomization issue in detail. I assume that you recall that the trial was originally a randomized trial but changed to the final non-randomized design because of recruitment issues. Patients didn’t want to be randomized. In any case, every aspect of the trial design was discussed in extreme detail, particularly by Kim. Every single one. You have said nothing that we haven’t mentioned numerous times before. So, yes, I’d be more than happy to seriously debate the Gonzalez study because I wouldn’t have to write much at all. All I’d have to do is quote relevant parts of Kimball’s or my posts on the topic, because we’ve discussed all these issues ad nauseam many times before in far more detail than you seem to appreciate.
Kimball also went into extreme detail about the genesis of the trial, which was in essence foisted on the NIH. (The NIH’s scientific reviewers thought the trial was poorly supported scientifically and unethical, to boot.) He also described in exquisite detail the lack of ethics in the trial and how the “inconvenient” results were hidden for four or five years before they were finally published a year and a half ago.
So, no, Peter. I strongly disagree with you here. Strongly. In fact, if anything, the outrage at the Gonzalez trial has been utterly lacking, given its level of offense against medical ethics. It is to our profession’s shame that there hasn’t been much of an outcry against this unethical, poorly designed, harmful trial that took advantage of desperate cancer patients.
Here are the relevant posts on SBM:
The Ethics of “CAM” Trials: Gonzo (Part I)
The Ethics of “CAM” Trials: Gonzo (Part II)
The Ethics of “CAM” Trials: Gonzo (Part III)
The Ethics of “CAM” Trials: Gonzo (Part IV)
The Ethics of “CAM” Trials: Gonzo (Part V) (Note here that Kimball discusses the randomization issue as well as the ethics of the trial.)
The Ethics of “CAM” Trials: Gonzo (Part VI)
The “Gonzalez Trial” for Pancreatic Cancer: Outcome Revealed
“Gonzalez Regimen” for Cancer of the Pancreas: Even Worse than We Thought (Part I: Results)
“Gonzalez Regimen” for Cancer of the Pancreas: Even Worse than We Thought (Part II: Loose Ends)
Tom Harkin, NCCAM, health care reform, and a cancer treatment that is worse than useless
Evidence-Based Medicine, Human Studies Ethics, and the ‘Gonzalez Regimen’: a Disappointing Editorial in the Journal of Clinical Oncology Part 1
Evidence-Based Medicine, Human Studies Ethics, and the ‘Gonzalez Regimen’: a Disappointing Editorial in the Journal of Clinical Oncology Part 2
Note that only one of these is my post; that’s because Kimball has covered the Gonzalez trial for so much longer and in so much more detail than I have.
I have no idea what the present argument is about David, What on earth ever gave you the impression that I was defending the Gonzales treatment? It’s rubbish and this study more or less proves it.
Though one thing — your earlier statement something to the effect that the survival at an unspecified end point was three times better with the chemotherapy than with Gonzales cannot be supported by this study, due to its obvious problems. I refrained from pointing that out at the time when I could have if I had any axe to grind with you. Why are you so anxious to leap all over me?
The weak benefits of chemotherapy with this condition is one of the reasons that I think some of the criticisms of the decision to perform the study are overblown. Perhaps I was not clear enough that I was referring to such peripheral matters as “arguable” in my very casual response to Alison (I think it was).
I was reacting to the suggestion that this was an exceptionally egregious example of what can happen when academic circles go even so far as to investigate an alternative method, let alone endorse or use it . I was not suggesting that the Gonzales treatment had worth.
Another arguable matter is the value of such studies but that would take up several more days of our time if we choose to swap opinions on that.
This is the relevant web page. Sorry, I thought I had supplied that.
http://www.users.on.net/~pmoran/cancer/Alternative_studies.htm
Alison: Can you help us out here? Could you specifically address Dr Benway’s and my kindly doctor examples and say where you stand on them? You’ve declined to comment on them because the example CAM practice is coffee enemas which are so obviously absurd, so please mentally substitute acupuncture. Folks here want to understand and are making huge efforts to find common ground, but personally I don’t understand how your statements would translate into practice.
Alison, would you mind giving me a specific example so I am sure what you want? I may have overlooked them because what individual doctors do within their own practices is not my focus.
I did point out that I was sure that ALL doctors display discretion when talking to patients about CAM (though I confess I didn’t do that well when talking about cancer cures); also that doctors (and even institutions) are free to make individual decisions as to whether they will use elements of CAM, whether others may like it or not.
That is probably how it should be, on my understanding of the present state of medicine. The tensions between EBM and the old ways are such that there probably cannot be a 100% overriding single principle for all settings. Medicine is too complex.
pmoran,
You say, “old ways,” but for me CAM is new.
When I was in med school in the 1980s we just called CAM quackery and avoided it. At the same time we didn’t actively oppose it, provided the person prescribing the unproven therapy were not an MD and the therapy was not obviously dangerous.
I want to go back to those good old days. That’s all. Does this make me an intolerant person with an improper attitude toward superstitious medicine aka CAM?
The APA site uses “CAIM” rather than “CAM” perhaps to avoid “sCAM.” To be pro-active, I propose a challenge for SBM readers:
Become famous forever by thinking up a snarky tweak to “CAIM” that goes viral before CAIM itself takes root, lol.
Oy. Go Green!