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“Integrative oncology”: The Trojan horse that is quackademic medicine infiltrates ASCO

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You might have noticed that I didn’t produce a post last week, something that’s unusual for me, given how prolific I have been in the blogosphere. One reason was personal. The other reason was that last weekend I was attending the annual meeting of the American Society of Clinical Oncology (ASCO) meeting in Chicago. I also must confess that, while I was there, I caused a bit of a stir on the meeting hashtag (#ASCO14) in the name of science-based medicine (SBM) on Twitter under my handle @gorskon. (What? You aren’t following me on Twitter? Get thee hence to my Twitter feed and add me. I’ll wait. Did you do it yet? Good. Now we can move on.) Of course, I know what you’re thinking: Cuddly, lovable me? Causing trouble? Making sure that I’ll almost certainly never be invited to be an official social media doc or to participate in panels on social media at ASCO, despite my extensive experience blogging, using Twitter, and just in general being a pain in the rear online to those who promote quackery and quackademic medicine? Perish the thought!

Of course, it was for just that reason that I was making a bit of a stir on Twitter. ASCO is one of the biggest (if not the biggest) and most organized oncology meetings out there, and there were several people considered “social media rock stars” in the world of oncology such as Mike Thompson, Deanna Attai, Matthew Katz, and Robert Miller live Tweeting the meeting, along with those viewed, correctly or incorrectly, as lesser lights, such as myself. In any case, on Sunday I noticed that a lot of people, including the official ASCO Twitter feed @ASCO, were Tweeting and re-Tweeting a link to this official story from ASCO, “Integrative Oncology Can Add Benefit to Traditional Cancer Treatments.” It was a description of a session that had been held on Saturday morning, Integrative Oncology: The Evidence Base, which, unfortunately, I had missed due to circumstances entirely beyond my control. Fortunately, however, ASCO is benevolent (not to mention that it also justifies the high cost of meeting registration) by providing immediate access to recordings of every major session, not to mention the slide sets used. If I couldn’t be there in person, at least I could cruise on over to the ASCO website and use my access to the 2014 virtual meeting to see what sort of quackademic medicine was being featured at ASCO.

There were three presenters and a panel discussion. Two of the presenters I was well familiar with, making me sad that I had missed the opportunity to be in the same room with them. First up, was Barrie Cassileth, PhD, whom we have met several times before and who is a big name in “integrative oncology,” as befits her position as the chief of the integrative medicine service and current holder of the Laurance S. Rockefeller Chair in Integrative Medicine at one of the greatest cancer centers in the world, Memorial Sloan-Kettering Cancer Center and her having founded the Society for Integrative Oncology (SIO), her topic being an introduction and overview, entitled, appropriately enough, “Integrative Oncology: Overview.” Next up was another big name whom we have met before, Lorenzo Cohen, PhD, who is basically Dr. Cassileth’s counterpart over at the other most famous cancer center in the US, the University of Texas M.D. Anderson Cancer Center, holding the titles of Professor and Director of the Integrative Medicine Program and having co-founded SIO with Dr. Cassileth. His topic was “Mind-Body Practices in Cancer.” Finally, to complete the trio, there was Michelle Harvie, PhD, with whom I am not familiar. She described on the website of the research institute where she works, the Manchester Breast Centre, as a research dietitian at the Genesis Breast Cancer Prevention Centre, University Hospital South Manchester Trust. She’s obviously nowhere near as big a name as Drs. Cohen and Cassileth, but she’s sure enough working on it.

Dr. Barrie Cassileth: “Integrative oncology isn’t quackery. Really, it isn’t!”

Dr. Cassileth seems to have a bit of a chip on her shoulder over “integrative oncology.” Clearly, she resents its being referred to as quackery, quackademic medicine, and not science-based. Indeed, of late, she has labored mightily to try to convince oncologists that “integrative” oncology isn’t cancer quackery, something I first noticed her doing with vehemence a couple of years ago in a review article that was, in part, a broadside against cancer quackery, such as Essiac, the German New Medicine, Entelev, shark cartilage, oxygen therapies, energy therapies, electrical devices (such as Hulda Clark’s “zapper,” prayer, and “healers” using therapeutic touch. That part of her article was something that anyone supporting SBM could appreciate. She also did, as I phrased it, question the “central dogma” of “complementary and alternative medicine” (CAM) or, as I like to call it, “wishing makes it so.” Unfortunately, some of that central dogma was evident in Dr. Cohen’s talk, as I will discuss in the next section. Much to my disappointment, there was no throwdown in the panel discussion between Dr. Cassileth and Dr. Cohen over this.

In any case, this same insistence that integrative medicine is evidence-based, in contrast to all that other cancer quackery, bubbled up again near the end of Dr. Cassileth’s talk in the form of a series of slides, one of which can be seen here, in which Dr. Cassileth, to her credit, emphasizes that alternative medicine is mostly quackery. In the accompanying article on the ASCO website, Cassileth says:

The first step in unraveling the beneficial from the detrimental may be a new understanding of the terminology used to describe these additive therapies, Barrie Cassileth, PhD, of the Memorial Sloan Kettering Cancer Center said during the session. Whereas complementary and adjunctive therapies may have beneficial therapeutic effects, it would be inappropriate to allow them to replace traditional interventions. The term ‘alternative treatments’ more aptly describes those modalities that proffer to replace medical or surgical intervention—although the word quackery may be even more fitting, Dr. Cassileth added.

To me, the “money slide” in the whole series was:

Cassileth quackery slide

And that’s what bothers Dr. Cassileth the most. To her, quacks are “usurping” or co-opting the term “integrative oncology” in order to peddle cancer quackery. Of course, that’s not the way I saw it. The way I see it is that “integrative oncology” is integrating quackery into oncology. To paraphrase one of my Tweets at the meeting, the only thing “integrative” oncology adds to traditional cancer treatments is pseudoscience. To that, I now add that, if anyone is usurping or co-opting anything, it’s practitioners of “integrative oncology” and “integrative medicine.” They are co-opting perfectly science-based modalities, such as exercise and diet as somehow being “alternative” (word choice intentional, because something has to be “alternative” to fit into the paradigm of “integrating” non-standard therapies into conventional medicine) and then giving the appearance of “integrating them” into conventional medicine when they are already part of conventional medicine.

Indeed, it is not a coincidence that Dr. Cassileth broke down “integrative oncology” into six categories that the session would address:

  1. Meditation and other “mind-body” therapies (Dr. Cohen)
  2. Optimal nutrition, special diets, and supplements (Dr. Harvie)
  3. Massage therapies
  4. Music therapy
  5. Acupuncture treatment
  6. Exercise

Tellingly, Dr. Cassileth spent more effort discussing acupuncture, citing more studies, than she did for any other treatment listed above. It’s understandable that she didn’t discuss mind-body” treatments or nutrition, given that other speakers were going to address these, but, compared to acupuncture, she barely touched on massage and music therapy. She did discuss exercise a bit more, but, of course, from my perspective part of the reason she didn’t discuss exercise more is because it’s largely uncontroversial that at least mild-to-moderate exercise benefits cancer patients and that obesity is associated with a growing list of cancers. Again, there’s nothing “integrative,” “complementary,” or “alternative” about exercise. It’s science-based medicine. The same is true of nutrition. As for massage and music, I tend to agree with our co-editor and co-blogger Kimball Atwood, who simply says that he has no objection to massage, as long as there’s no medical contraindication, because it feels good, and what’s wrong with making patients feel better using something non-invasive? Back in the old days, we used to call such services “supportive” services, things done for patients to take their minds off being in the hospital and the sometimes painful and invasive treatments they require. The problem only comes when something like massage or music is “medicalized,” as in claiming that it treats specific diseases, or “woo-ified,” an all-too-common phenomenon for massage in particular in which massage becomes coupled or conflated with various forms of “energy healing.”

But what about the acupuncture studies? None of the studies presented by Dr. Cassileth provided any compelling evidence that acupuncture is anything more than what Steve Novella and David Colquhoun called it, a theatrical placebo. To this, I would add, given the claims that acupuncture can work to relieve symptoms or reverse virtually everything, be it infertility, nausea and vomiting from chemotherapy, pain, xerostomia, hot flashes, insomnia, lymphedema, and peripheral neuropathy due to certain chemotherapy drugs like taxol, chances are that means that it works for nothing. Dr. Cassileth’s presentation included the usual studies such as this study with no sham acupuncture control claiming that acupuncture relieved symptoms due to neck dissection. Indeed, in the discussion, Dr. Cassileth justifies this design thusly:

For our control arm, we opted for a pragmatic rather than a placebo control. A pragmatic control arm has the advantage of providing an estimate of effect size most consistent with the questions of greatest interest facing patients and clinicians. These questions include: What effects will an acupuncture referral have on a patient’s pain, and will the patient use less pain medication as a result? One disadvantage of a pragmatic comparison of acupuncture with usual care concerns lack of blinding and potential placebo effect.

Yup, which makes me ask: Why even bother doing this study? It shows nothing, Jon Snow. (Sorry. Game of Thrones is getting exciting as it nears the season finale.) She also cited a study indicating that acupuncture is helpful for post-surgery lymphedema in breast cancer patients, a conclusion that I characterized as: Keep those acupuncture needles away from my lymphedematous arm!

Other studies presented included a meta-analysis from 2005 that demonstrates the principle of GIGO as well as most acupuncture meta-analyses do with respect to relief of chemotherapy-induced nausea and vomiting. A more recent Cochrane meta-analysis, although still mildly positive, was a lot less so, concluding, “Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval (CI) 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control.” That would be barely statistically significant, with the relative risk coming close to including 1.0. GIGO, indeed, plus theatrical placeboes!

If the studies she cited were the best that Dr. Cassileth could come up with for acupuncture, either she wasn’t trying very hard, or the evidence base stinks because acupuncture is nothing more than a theatrical placebo. Take your pick, but I pick the latter. In any case, there was nothing in Dr. Cassileth’s talk to change my opinion of either integrative oncology or acupuncture. “Rebranding” the others, such as diet and exercise, as being “additive,” “nonpharmacological,” or somehow “integrative” doesn’t change the fact that what Dr. Cassileth was doing was the same thing that “integrative practitioners” have been doing for a couple of decades now: Rebranding science-based modalities as somehow “integrative” or “alternative.” It is admirable that Dr. Cassileth can and does on occasion attack quackery in a way that would do SBM proud. Unfortunately, it is equally frustrating that she doesn’t seem to grasp that much of the “integrative” oncology she promotes, such as acupuncture, is based on the very same pre-scientific, vitalistic concepts as the cancer quackery she so rightly detests.

Dr. Lorenzo Cohen: Wishing makes it so!

Of all the modalities that Dr. Cassileth introduced in the first talk, the two that have traditionally been considered “alternative” were acupuncture, which she discussed, and various “mind-body” modalities, which Dr. Cohen discussed. I’ve discussed on multiple occasions how M.D. Anderson, sadly, has delved deeply into woo. Unfortunately, Dr. Cohen is the Delver-in-Chief, and he showed why in his talk. He’s definitely good. Sadly, what he’s good at is “integrating” pseudoscience into science-based medicine. He’s also good at “rebranding.”

One thing that has always bothered me about so-called “mind-body” modalities is the dualism inherent in the very name used to categorize these modalities. Think about it. The very term “mind-body” implies that the mind is somehow separate from the body. The assumption behind such modalities seems to be that training the “mind” to control what the “body” is doing will result in prolonged survival in cancer patients. It’s the very concept that Dr. James Coyne argued so eloquently against on this very blog a couple of years ago. To be honest, it’s also a concept that Dr. Cassileth herself argued against in the very same review article that got her into hot water with the “integrative medicine” crowd a couple of years ago as well. Let’s just cite some of her words:

Many of these ideas were promoted by a former Yale surgeon, a popular author who advocated special cancer patient support groups in his books. The importance of a positive attitude was stressed, as was the idea that disease could spring from unmet emotional needs. This belief anguished many cancer patients, who assumed responsibility for getting cancer because of an imperfect emotional status. Among alternative modalities, the mind/body approach has been especially persistent over time, possibly in part because it resonates with the American notion of rugged individualism.

To be fair, in the article Cassileth stated that there were “complementary” therapies that could improve quality of life, but she also stated that some promoters of “mind-body” treatments “overpromise,” by “suggesting that emotional stress or other emotional issues can cause diseases like cancer and that correction of these deficiencies through mind-body therapies can effectively treat major illnesses.”

That is exactly what Dr. Cohen suggested, albeit in a somewhat more subtle way than, say Ryke Geerd Hamer of German New Medicine fame, but, make no mistake, in his talk Dr. Cohen was arguing that mental states and stress contribute to cancer development and progression and that reversing those “bad” mental states can contribute to improved survival. Indeed, he started right out making that very argument, citing a study suggesting that depression is associated with decreased survival in cancer patients, an interesting but highly speculative eight year old review article on potential mechanisms by which stress can contribute to cancer (an article he kept coming back to again and again and again), a ten year old PNAS article contributed by Elizabeth Blackburn (a relatively newly converted proponent of “integrative medicine” whom we’ve met before) claiming that stress leads to shortened telomere length and thus diminished lifespan, and a study relating high social attachment to increased survival in ovarian cancer (which, ironically enough, also reported that “no significant association was found between access to instrumental social support and survival,” meaning that support groups weren’t correlated with increased survival). Why would he have mentioned these studies if he weren’t arguing that somehow the mind influences cancer mortality and that his “mind-body” interventions could potentially result in better survival?

I got the distinct feeling from Dr. Cohen’s talk that yoga is his big thing. He presented multiple studies of yoga in women with breast cancer. As I’ve said before, stripped of its spiritual elements, yoga is nothing more than a specific form of exercise involving stretching and various other body motions; so it’s not surprising that it would have potentially beneficial effects. Of course, that’s what Dr. Cohen noted, citing this recently published study from his group that compared women with breast cancer undergoing radiation therapy, dividing them into three groups: yoga, stretching exercises, and a wait list control. Of course, that means the study was not blinded, making it pretty much useless for saying much of anything about the effect of yoga, given that most of the measurements were subjective measurements of fatigue and health using self-reporting through survey tools. One change noted to be better in the yoga group was cortisol slope, which is a dubious measure, as Dr. Coyne and I have pointed out before. Cohen also cited another recent study that omitted the stretching control and was also similarly unblinded, that looked at inflammatory markers in the wait list control versus the yoga group. It reported much higher vitality and lower fatigue in the yoga group, along with a decrease in some inflammatory cytokines.

The list went on, including animal studies that related chronic stress to tumor progression, a progression that was reversed by beta blockers (drugs that block the effects of epinephrine signaling), an interesting finding, but one that hasn’t yet made it to the level that we recommend beta blockers for cancer patients. If this finding ends up being validated, it would then also become science-based medicine, and oncologists would start prescribing beta blockers to appropriate cancer patients, no woo needed.

Color me unimpressed. Also color me disappointed in that, yes, Dr. Cohen was arguing for exactly the sorts of contentions that Jim Coyne has refuted so well, both in the literature with his colleagues, and here on SBM.

Michelle Harvie: One of these things is not like the others

The last talk came from Dr. Michelle Harvie. To be honest, there’s really not a whole lot for me to say about it or to object to. Here are a couple of the key slides:

WCRIF ACS

Her conclusions:

dietconclusions

As I said, it’s hard for me to argue with most of this. It’s all pretty well evidence-based and unremarkable. She even showed data in which dietary interventions, including vegan diets, failed to arrest or slow the progress of prostate cancer, pointed out that the evidence that observational data regarding whether obesity and/or intentional weight loss has an effect on cancer progression is shaky at best (although it’s better for breast cancer and maybe prostate cancer), and cited a study that high fruit and vegetable intake appear not to affect the outcomes in breast cancer patients. She did point out, however, that a healthy diet can reduce overall mortality, but appears not to affect cancer-specific mortality much, if at all. That, of course, is not particularly surprising, given that healthy diets can definitely impact cardiovascular disease, diabetes, and other lifestyle-associated conditions. Basically, her overall message was that the data regarding diet and cancer survival are a lot less strong than we would like, although it is fairly clear that alcohol intake more than relatively low consumption, is associated with worse outcomes. She even cited an animal study in which nutraceuticals containing antioxidants decreased lifespan, pointed out that the evidence for ketogenic diets and cancer are inconclusive and that intermittent fasting probably has little effect on chemotherapy efficacy, and cited an abstract presented at ASCO that suggested that underweight patients with kidney cancer do worse than overweight patients.

In the end, Dr. Harvie’s talk was largely science-based medicine. Including it in a session on “integrative oncology” was nothing more than rebranding what should be a science-based modality, the effects of nutrition and diet on cancer treatment and survival, as being somehow “alternative” or “integrative.”

Yet another bit of “rebranding,” this time at ASCO

As is frequently the case in sessions like this at academic medical meetings, the last part of the session was a 20 minute panel discussion, in which members of the audience asked questions. What was incredibly disappointing to me was how little there was in the way of any sort of challenge to the assertions made by panel members in their talks or the assumptions underlying those talks. There were questions about green tea and whether it was beneficial, whether yoga has any benefit in relieving the symptoms of chemotherapy, leading to Dr. Cohen promoting a poster discussion he was going to present in a couple of days reporting the results of just such a study, and a question about how to keep “patients honest” about the supplements they’re taking. All of these warnings about dietary supplements not always mixing well with chemotherapy are useful, but it doesn’t really address whether integrative oncology is evidence-based, particularly given the bon mot delivered by Dr. Cohen that somehow it’s better to get antioxidants from foods than from supplements, even though, if antioxidants truly do interfere with chemotherapy action in some cases, chemically it would be the same and only the dose might be different. There was a question on juicing, which was generally not recommended.

I will point out that there was one hilarious question, in which an audience member asked how one can differentiate who is a good acupuncturist who will get the sorts of results claimed in the randomized clinical trials, from an acupuncturist who is a “charlatan.” Dr. Cassileth answered by saying that—of course!—MSKCC has six acupuncturists on staff, making her lucky that she can count on all of them as being highly skilled and doesn’t have to worry about “charlatan” acupuncturists. She also fried yet another of my irony meters when she declared quackery to be a huge problem in acupuncture, proclaiming that there are many acupuncturists who are not well-trained and who are not trained to work with cancer patients and that there’s a big difference between treating adults who might have some “aches and pains” and treating cancer patients. I, of course, agree, but not in the way that Dr. Cassileth meant her statements. There is indeed a big difference between treating benign aches and pains, which will almost always get better, and treating patients with serious disease, like cancer patients, for whom acupuncture is pretty much never appropriate. Come to think of it, acupuncture is pretty much never appropriate for anyone, because it doesn’t work.

And, of course, MSKCC offers a 21 hour Internet course for acupuncturists teaching how to use acupuncture for cancer patients! At only $495, it’s a total bargain! Helpfully, Dr. Cohen chimed in about how there’s a national credentialing board for acupuncturists, and you can look up acupuncturists online to see if they are trained and skilled. Yes, that’ll totally keep you away from quacks and charlatans! Oh, wait. Acupuncture is quackery; so maybe that won’t work so well. Sadly, none of this stopped Dr. Cassileth from suggesting acupuncture for postoperative pain right after this question.

Integrative oncology: Wanting to have it both ways

After having indulged myself in this session, I left very disappointed. On the one hand, I wished that I could have made it to the actual session instead of having to review it online, even though, given the credulity of the questions and the utter lack of challenge by anyone to the scientific basis of what was presented, I’m not sure I would have had the guts to get up there and say what needed to be said. On the other hand, it’s very clear that, for ASCO at least, the session was planned to scream as loudly as possible, “Pay no attention to the man behind the curtain (or prior plausibility or biology)! Integrative oncology is science!” To do that, the session focused pretty tightly on actual science-based modalities, such as diet and exercise, that could easily be “rebranded as somehow being “alternative” or “integrative,” while cherry picking data selling acupuncture as more than an elaborate placebo and implying that “mind” can control body and improve cancer survival based on animal studies and highly selective observational evidence. In essence, Drs. Cassileth and Cohen want to have it both ways, claiming for “integrative oncology” anything about diet, stress, and exercise that might be science- and evidence-based, “rebranding” them and lumping them together with the woo, like acupuncture, which, as mightily as they strive to make it appear evidence-based, remains prescientific, vitalistic nonsense.

ASCO, like many other medical professional societies—I’m talking to you, American Academy of Pediatrics—has a problem. Quackademic medicine is not only infiltrating oncology in the form of “integrative oncology,” but it’s becoming increasingly accepted. It’s not for nothing that we frequently refer to diet and exercise (rebranded as “integrative medicine,” of course!) as a Trojan horse that, once in the fortress of science-based medicine, opens up to disgorge pseudoscience. Sadly, oncology is not immune, as the increasing popularity of “integrative oncology” demonstrates. Unfortunately, “integrating” pseudoscience into science-based oncology does no good for cancer patients, the imprimatur of MSKCC, M.D. Anderson, and, yes, ASCO, notwithstanding.

Posted in: Acupuncture, Cancer, Medical Academia, Traditional Chinese Medicine

Leave a Comment (341) ↓

341 thoughts on ““Integrative oncology”: The Trojan horse that is quackademic medicine infiltrates ASCO

  1. Maria says:

    I think alternative medicine is rubbish, but did you ever wonder why people are so attracted to it in the first place, unless you look at the underlying factors in any society you will never get an answer to that question. Look at the bizarre conspiracy theories that emanate form the US, or the denial of evolution and so on.

    You will never get an answer unless you fundamentally look at American culture and society.

    1. Stephen H says:

      Maria, as much as I would love to blame the US culture and society in this case I cannot. I recommend reading “Extraordinary popular delusions and the madness of crowds” – a book I’m pretty sure was English (it has been a while. As for the persecution of “witches”, that was definitely started in Europe – although Americans seem in some cases to have happily adopted this latest fad.

      And of course there are plenty of superstitions to go around still in “the old country” – whether that be England, France, Italy, Russia or even further east.

      So don’t beat up on one society, when there is plenty of blame to go around.

      1. goodnightirene says:

        Don’t forget the Prince of Wales–a woomeister if ever there was one! The whole Royal Family have used homeopathy forever. And don’t forget that Europe has outlawed GMO.

        1. Richard Abbott says:

          Europe has not “simply banned GMO.”

          They are much more regulated than in the US. And each has to be examined by food safety regulators on a science based case by case basis.

          EU wide there are about 50 individual GMOs approved.

          Any signficant (>1%) GMO contained foods must be labelled as such.

          Individual countries can take stricter lines than these, but most of Europe follows closely to the EU standards.

          1. irenegoodnight says:

            Thank you for the reply, Mr. Abbott–I stand happily corrected. :-)

          2. irenegoodnight says:

            Thank you for the reply, Mr. Abbott–I stand happily corrected. :-)

          3. Garrett Moffitt says:

            Do they test all food? food changes all the time, and even ‘natural’ items have there DNA changed by bacteria.

            Or does good that randomly has changes made to it’s DNA get a pass because its ‘natural’?

          4. WilliamLawrenceUtridge says:

            Europe’s antiscientific opposition to gmo is not something to brag about or defend, it is irrational. They are ignoring their own scientists.

      2. Frederick says:

        A french Sociologist, Gerald Bronner, wrote couple of book about, belief ans rumour, and why is so popular, he use cases from french, US, UK, Spain. Woo is popular in france too, The whole ANTI-GMO fear is super strong there, EMF fear too, all that BS. Conspiracy theories too, But in France the Evil are the Jews, and in the us it is the CIA ( or FBI).

        His last book ( I’m trying to finnish it, I but never have time) “La Democratie des Credules ( The democry of the credulous) is very interesting.
        So yeah it is world while. We have all those In Quebec too. They are a mix a US/europe style Conspiracy and beliefs.

    2. Windriven says:

      Sadly Maria, one can find sCAM practices everywhere, not just the US. You may recall that Prince Charles has been a consistent advocate for various medical idiocies. Boiron, one of the world’s largest manufacturers of homeopathics is headquartered in France.

      1. Serge says:

        As a British subject, I’m ashamed of our future King. One can overlook (to a certain extent) his propensity for talking to plants and (to an even more limited extent) his advocacy of the organic movement. But, I’m afraid, anyone who truly believes in the benefits of sugar pills and magic water needs sectioning. The Madness of King Charles anyone? The ravens will soon be flying.

        1. CHotel says:

          Mum will probably outlive him.

        2. WilliamLawrenceUtridge says:

          Why overlook his obsession with organic food? it’s profoundly wasteful and antiscientific. I can’t imagine the horror of trying to feed the British isles using organic farming, and even worse is their forced exporting of antiscience food standards to the African countries they import their food from, particularly given the implications for local farming.

    3. Thor says:

      Germany is the main home of homeopathy. Go into any German pharmacy and witness the abundance of remedies available. Basically, an Apotheke is divided into two main compartments—prescription and OTC medicines, and homeopathics and health-food store nutraceuticals and supplements.

      Having faulty belief (non-evidence based) is a human condition, not limited to geography or specific culture.

      1. DW says:

        Germany is also the home of anthroposophic medicine (which is basically homeopathy + a very convoluted spiritual philosophy).

    4. @Maria
      “alternative medicine is rubbish”??
      Where do you get your insights because you are looking at modern medicine thru rose colored glasses.

      Traditional medicine is failing esp in the US and it is because we have made illness into a “commodity” and the healthcare system is supporting the economy. The proof are all of the failed back, neck, knee and nerve surgeries!!!

      Both CAMs and Traditional medicine have highly effective therapies that we need to uncover but due to dogmas and profits we will not experience the benefits for a while.

      The global problems in society and medicine are inherent in human nature, we believe with absoluteness w/o any foundation in reality.

      1. Windriven says:

        “The global problems in society and medicine are inherent in human nature, we believe with absoluteness w/o any foundation in reality.”

        You’re a scream, Steve! You talking about ‘any foundation in reality’ without any recognition of the irony is just hysterically funny.

        You are an empty hat, Steve. You claim great results for acupuncture but when asked for proof you dissolve into a fog of anecdotes and noxious fumes. Like a vinyl record with a skip, you are one long refrain of sha-woo-bop-bop-click-sha-woo-bop-bop-click

        So man up, Steve. Show us the evidence. Move the needle off the groove with the skip. Or shut up and go away. Because this is just painfully boring.

        1. You have the links and references. Have anyone studied any of the concepts?

          You will not find a “truth” in them, what you will find are all the evidence you need to form logical scientific conclusions. (remember include all of the data, not just the ones that hall, novella, groski, criplip or ingraham uncovered.)

          Would you like me to post one of them here for discussion?

          1. WilliamLawrenceUtridge says:

            You have the links and references. Have anyone studied any of the concepts?

            Would you like me to post one of them here for discussion?

            I would very much like you to post some links and references to support your beliefs. Your constant inability to provide such relevant citations is a constant source of irritation and disappointment to me.

            Worse, of course, are your long lists of irrelevant citations that you appear not to have read.

      2. WilliamLawrenceUtridge says:

        “alternative medicine is rubbish”??
        Where do you get your insights because you are looking at modern medicine thru rose colored glasses.

        What has Maria’s statement about alt med being rubbish have to do with modern medicine?

        The global problems in society and medicine are inherent in human nature, we believe with absoluteness w/o any foundation in reality.

        The problem with alternative medicine is that they lack a foundation in reality and any empirical evidence for effectiveness such that we would consider whether our knowledge of reality requires revisiting.

      3. Richard Thomas says:

        Well said!
        A voice of common sense amongst the vague beliefs of quackpots
        (quackbuster-crackpots)

    5. Tazia Stagg says:

      Yes.

      I generally don’t blame patients for credulity. And with respect to my field, it makes sense that they perceive their needs aren’t being met, don’t know where to turn, and then find “anti-establishment rhetoric” appealing.

      1. “anti-establishment rhetoric” appealing.” Interesting how you view CAMs??!

        It is my impression after using Traditional Medicine (that work) with CAMs (that work), both will have to be a part of the future of medicine because they compensate for the deficiencies of the other.

        I’m 100% certain of this, and I’m never 100% certain of anything except the truth.

        1. Kathy says:

          “I’m 100% certain of this, and I’m never 100% certain of anything except the truth”.

          Wow, that is some statement, Steve! Turn it around and see what conclusion it leads to: “I’m 100% certain of this, so it must be the truth because I am never 100% certain of anything that isn’t.”

          Steven, Steven, it won’t fly you know. It is a pig and will never be anything but a pig, no matter how many times you declare it is a bird. However deeply and sincerely 100% certain you are that it is a seagull not a hog, it is not any sort of bird and it will not fly. It’s no use resenting us for pointing out to you the evidence of snout and trotters, the absence of wings, and it’s inability to sing.

          You are certain that what you believe must be the truth, because you believe it? It isn’t. The rest of us know how uncertain our certainty is, how easily we can be misled, so we take precautions. It’s called the Scientific Method. So please, Steve, take a deep breath, laugh at yourself, and rejoin the human race.

        2. Windriven says:

          “I’m 100% certain of this, and I’m never 100% certain of anything except the truth.”

          With all that certainty and all that truth, why is it that when acupuncture is studied IT DOESN’T WORK beyond placebo????

          You just don’t get it, Steve. Maybe Nancy is right.

          One reason that we do studies is to remove confirmation bias – the kind of bias that says ‘I’m 100% certain’ that acupuncture works and that stomach ulcers are caused by stress and stomach acid.

        3. cloudskimmer says:

          Dr. Hall reviewed this book, which will be of value if you are capable of following an evidence-based discussion (which I doubt):

          On Being Certain by Robert A. Burton, M.D. Belief that you are right often has little to do whether or not the evidence supports your position. However, it would appear that you are incapable of accepting any evidence, however strong, which refutes your position and prefer to continue with confirmation bias. That is why your contributions here will never persuade anyone. Instead you say that if we accept what you say, we will agree with you, but you refuse to present reputable studies to show that there is any evidence to support your positions. If you kept good records at your practice and did thorough follow up, you’d probably find out that many of those you treated failed to return because you weren’t helping them. So long as your sample includes only those who think they got better despite your poking them with needles and ignores the ones who didn’t, you can pretend to be a success. There is also the group that wouldn’t come to your practice in the first place because they were scared off by the unsupported craziness you practice. You may be making a living, but it is effectively by having victims instead of patients.

          Your 100 % certainty is an indication of delusion! not correctness.

          1. Windriven says:

            @cloudskimmer

            HELP! I can’t find our original thread on Harpold but since we started I’ve become obsessed. I think I found the record and he crashed at the origin – Fernandina Beach, Amelia Island, FL, not in Biloxi. Time fogs the memories. The crash that I think it was involved a Mooney 20J, tail number N4781H. Unfortunately, my Google-fu isn’t good enough to get me any farther. If you can help me get more info on this I’d like to do a little time travel. You can contact me directly at windriven at gmail dot com. The accident date (if this is indeed the correct one) was 3/14/1988.

            Many, many thanks in advance.

        4. WilliamLawrenceUtridge says:

          It is my impression after using Traditional Medicine (that work) with CAMs (that work), both will have to be a part of the future of medicine because they compensate for the deficiencies of the other.

          How do you know which CAMs work? Clinical experience isn’t a valid answer, bloodletters and orthopedic surgeons were both convinced by their clinical experience that lancets and knee tissue debridement were effective therapies, and they were both wrong.

          I’m 100% certain of this, and I’m never 100% certain of anything except the truth.

          Statements like this just show why you shouldn’t be trusted. I’m not 100% certain of much and nearly everything in my life is subject to revision in the face of appropriate evidence. Even my name is questionable, in case my parents decided on a different birth name then changed it later on and didn’t tell me.

          The other reason your bare opinion shouldn’t be trusted is your constant failure to cite scientific evidence (or in the rare occasion when you try – it is obvious that you haven’t read the sources or did not match them to the question at hand).

  2. Stephen H says:

    For the people who believe in mind-body interventions, have a look at the study that was done comparing prayer and non-prayer in helping patients. Then talk to your psychiatrist about why you’re “not good enough at it” to cure yourself – along with the people from that study.

    As for acupuncture, as soon as its exponents are happy to demonstrate its pain suppression abilities in roughly the same manner by which its “wonders” were widely advertised to the West (i.e. by using acupuncture as primary means of pain relief in or immediately following surgery) I will start considering that maybe it needs a closer look. Unfortunately, there is a big gap between that initial sales pitch and subsequent performance – and an apparent lack of volunteers to demonstrate acupuncture’s benefits in a clinical (in-theatre) setting.

    1. @Stephen H
      I can tell from the way you worded your statement that you are skeptical of CAMs and have not managed any treatment failures of Traditional Medicine. Like failed backs/multi failed back pain x2 or x3, cervical, knee, neuropathy, Migraine, IBS, chronic Pelvic pain, vulvodynia CTS, TTS, RSD/CRPS, Tinnitus, vertigo etc.

      These case are complex and all have some neurotransmitter burnout so they require Mind-Body-Spirit work. read kabat-zinn

      ” acupuncture, as soon as its exponents are happy to demonstrate its pain suppression”
      There are many forms of Acupuncture and all should be used properly. Myofascial Acupuncture treats pain, meaning the pain that is embedded in the myofascial tissues may be “cured.”

      1. Windriven says:

        ” read kabat-zinn”

        Why? Where is the evidence?

        Do you know the old joke: what do they call the worst guy graduating medical school? Could it be Stephen Rodrigues? Could it be that you ended up in a crappy job out of residency and that this has colored your view of the practice of medicine? Could it be that your fecklessness in the practice of real medicine led you to dabble in the kind of smoke and mirrors where you never have to face accountability? That’s my theory, Steve.

      2. Stephen H says:

        @Stephen Rodriguez I suffer interminably from RLS. I have tried all of the recommended treatments, and had six weeks of relief about five years ago. I also have arthritis, and have had since my twenties, but manage it pretty well (and conventionally) so don’t have many problems. In other words, don’t give me that crap about “treatment failures of Traditional Medicine”. The fact that science has failed me does not logically mean I should turn to non-science. The fact that we know there are all sorts of things that we have yet to learn does not mean we should forget learning and turn to superstition.

        Can you please let me know when you’ll be going under the surgeon’s knife, using acupuncture to relieve your pain? I’d like to book a front row seat to see the experimental results first-hand.

        Alternatively, I will happily hear you tell of previous occasions when you have or have witnessed surgery without anaesthesia.

      3. Missmolly says:

        Stephen, can you please never, ever mention vulvodynia and poky stabby needles, sorry, acupuncture, in the same post? It causes anxiety and distress in my lady regions.

        1. mouse says:

          Too true!

      4. WilliamLawrenceUtridge says:

        There are many forms of Acupuncture and all should be used properly. Myofascial Acupuncture treats pain, meaning the pain that is embedded in the myofascial tissues may be “cured.”

        What is the “proper” form of acupuncture and how do you know it “treats pain” better than placebo?

  3. Amy says:

    Music therapy has uses in other areas, but I can’t imagine it being useful for cancer. Re-learning to use your body symmetrically after a stroke is easier if you’re trying to “clap” or walk in rhythm than telling your left hand to move in a certain way. Singing is good for the lungs and mouth in the same way. If in cancer it’s used post-surgically in that way it would make sense. Otherwise… uhhh what?

    1. denise says:

      Is music therapy different from listening to music?

    2. Missmolly says:

      We use music therapy all the time in paediatric oncology- it’s great for distraction, good for gross motor skills and gentle rehab for deconditioned littlies (think tambourine, drumming) and pretty awesome for giving teens a way of expressing emotions they don’t really want to talk about. Does it impact on their cancer? I doubt it. Do they love it, light up after every session and ask for more? Absolutely!

      1. Andrey Pavlov says:

        Do they love it, light up after every session and ask for more? Absolutely!

        Which has immense value and is reason enough to do it.

        1. Missmolly says:

          Exactly! Doesn’t need magic to be valuable, & doesn’t pretend to be something it isn’t.

      2. Nell on Wheels says:

        I found the “motivating music” playlist I put together immensely helpful during my chemo for breast cancer. Without it, I found it very difficult to even think about getting up and moving around, given the overwhelming fatigue, muscle pain, peripheral neuropathy, and shortness of breath upon simple exertion. The upbeat mix of show tunes, 50s and 60s hits, and bluegrass got me singing and up and dancing, remembering and experiencing the simple joy of moving in time to music. I also had several relaxing and soothing mixes that, along with yoga breathing exercises, got me through some serious pain and allowed me to avoid some trips to the ER.

  4. Jann Bellamy says:

    “Dr. Cassileth answered by saying that—of course!—MSKCC has six acupuncturists on staff, making her lucky that she can count on all of them as being highly skilled and doesn’t have to worry about ‘charlatan’ acupuncturists.”

    So, in exchange for the 6 acupuncturists MSKCC (and, what, maybe a total of 50 others who are employed at high-end medical centers?) we as a society have to suffer the thousands who are licensed in 43 states and daily perform their quack diagnoses and treatments for the rest of us? This is why integrative medicine can’t plausibly claim that integrative medicine doesn’t have anything to do with quackery. They pick a few chiropractors, naturopaths, reiki practitioners, and the like, keep them under tight supervision, and ignore the huge “alternative” medicine industry that is their supply pipeline.
    http://www.sciencebasedmedicine.org/integrative-medicines-collateral-damage/

  5. Angora Rabbit says:

    “Dr. Cohen that somehow it’s better to get antioxidants from foods than from supplements, even though, if antioxidants truly do interfere with chemotherapy action in some cases, chemically it would be the same and only the dose might be different.”

    Dr. Gorski, you’re correct and this is largely the issue. The lower levels in the food are physiological and will meet needs. The supplement megadoses are an all-at-once bolus that, as soon as they hit the liver, induce detoxification enzymes* that increase the disposal of the vitamin or mineral. In other words, the supplements run the risk of inducing deficiency.

    Plus intake in the food takes advantage of all the other nutrients and micronutrients that enhance bioavailability and absorption; for example, iron loves ascorbate.

    I’m pleased to learn that Dr. Harvie’s talk was science-based and didn’t jump the shark. Without reading her slides, it sounds like she adhered to AND guidelines.

    *The classic example being beta-carotene, the CARET study and related studies. Whoops, beta-carotene supplements increased cancer rates! This was because it induced a liver P450 that also enhanced procarcinogen activation. I’m very glad to see Dr. Harvie emphasized that point.

    1. WilliamLawrenceUtridge says:

      I’ve long wondered about the fact that a vitamin is such a huge bolus compared to the low and slow dose you would get from food. I’d never guessed at such a mechanism though. So i guess i’m saying … guest post?

  6. Serge says:

    From personal experience (anecdote alert!) I’m sure most of these people are suffering from cognitive dissonance. I have to admit that I refused to vaccinate my son in 2001/2 because of all the publicity that Andrew Wakefield managed to generate with his unproven hypotheses. I was also sucked into AGW denialism. It is immensely difficult to get your head around such a (seemingly) cogent argument. I’d like to thank you all on this site for giving me such a wonderful grounding in SBM (particular thanks to Andrey Pavlov, WLU and Windriven). Even for people immersed in academia, the attraction of alternative ideas must be difficult to ignore, regardless of prior plausibility. I had a discussion at the club that I run today about vaccinations and was amazed about the levels of ignorance about the efficacy of the vaccination schedule for the last 60 years (and two of those people had contracted polio as children!). Anyway, ramble over! This site should be required reading for anybody wishing to enter the medical profession (and anyone wishing to enter politics for that matter!). Please keep up the good work guys (and gals!), you all keep me entertained every morning during my ablutions!

    1. Andrey Pavlov says:

      I’d like to thank you all on this site for giving me such a wonderful grounding in SBM (particular thanks to Andrey Pavlov, WLU and Windriven).

      First off thank you for the kind words. I can say it genuinely helps to hear such things, knowing that time and effort spent actually did go to something useful, however small it may seem.

      Which brings me to the second thing, thank you for taking the time and effort to comment positively at all. It is well known that people are willing to spend more effort to espouse negative ideas and complaints than praise, but the latter is extremely important as well.

      So thank you!

      1. Frederick says:

        Yeah To Quote That Gerald bronner I was talking about
        « les croyants sont généralement plus motivés que les sceptiques »

        But I the staff off SBM and the great person here, ( the ones Serge thank, and i agree with him) kind of prove that quote wrong. at least here!

    2. WilliamLawrenceUtridge says:

      I’m claiming this as evidence of my growing femtocelebrity :)

      But seriously, thanks for the compliment, it is nice to know all those electrons didn’t die in vain. Pay it forward, please point out my errors and challenge my excesses.

    3. Windriven says:

      ” I’d like to thank you all on this site for giving me such a wonderful grounding in SBM (particular thanks to Andrey Pavlov, WLU and Windriven).”

      That is very kind but I think Angora Rabbit, MadisonMD, weing, or any of several others would be more deserving of my spot in your list of mentions. They have real depth in the life sciences. I’m just a physicist with a big mouth.

      1. Andrey Pavlov says:

        That is very kind but I think Angora Rabbit, MadisonMD, weing, or any of several others would be more deserving of my spot in your list of mentions. They have real depth in the life sciences. I’m just a physicist with a big mouth.

        No doubt and even more. Missmolly is rapidly becoming one of my favored commenters for her insight and wit.

        But, to be fair the whole point is that different people, styles, and frames of reference resonate with different people. For whatever reason Serge found you and WLU to resonate with him. Lending even more credence (as if it needed any) to my consistent argument that a multi-faceted approach is the only viable one.

  7. Tazia Stagg says:

    My erstwhile medical professional society has an ND on its staff.
    http://www.prweb.com/releases/2012/10/prweb9976040.htm

  8. Eldric IV says:

    She also fried yet another of my irony meters when she declared quackery to be a huge problem in acupuncture, proclaiming that there are many acupuncturists who are not well-trained and who are not trained to work with cancer patients and that there’s a big difference between treating adults who might have some “aches and pains” and treating cancer patients.

    You might have missed the California Acupuncture Board Exam stats from 2014.

    “The Pacific College of Oriental Medicine, South Baylo University and Dong-guk University also posted some of the highest California Acupuncture Board exam pass rates at 70%. Five Branches University had the third highest pass rate at 59%.”

    The overall pass rate was 62% for first-time test takers. This is compared to 96% for the USMLE step 3 (physician exam) and NAPLEX (pharmacist exam).

    Fingers crossed that my HTML tags work ….

    1. Test scores are important and need to be improved, but this does not address the most important topic and that is the “truths” of discipline. Test scores can also reinforce false logic and concepts to further foster poor clinical outcomes. These false concepts are promoted in my Family Practice CME reviews.

      I would retool all of the CAM schools into the updated new paradigms of Gunn/Cannon, so everyone will be on the same page and all of the ancient concepts and mythologies would be less important.

      1. WilliamLawrenceUtridge says:

        Test scores are important and need to be improved, but this does not address the most important topic and that is the “truths” of discipline.

        What, the fact that needling location doesn’t matter, nor does depth, nor does skin penetration? The fact that after 3,000 studies, they still can’t tell if acupuncture works beyond placebo? The fact that acupuncture does have adverse effects, sometimes significant ones like pneumothorax, infection, cancer and even death? Those are important truths for me to know, as well as any customers of acupuncture.

        Test scores can also reinforce false logic and concepts to further foster poor clinical outcomes. These false concepts are promoted in my Family Practice CME reviews.

        It’s too bad they don’t test basic scientific knowledge, because then you’d be drummed out of the profession.

        I would retool all of the CAM schools into the updated new paradigms of Gunn/Cannon, so everyone will be on the same page and all of the ancient concepts and mythologies would be less important.

        Considering Gunn and Cannon don’t seem to actually publish in scientific journals, merely in proprietary books, you’ve just added one more unproven school of thought to the mix. What is actually needed is a precise definition of Gunn and Cannon’s ideas so they can be tested to determine if they work, not to assume that they do work a priori.

        Unless such references do exist and you merely haven’t provided them yet?

        But seriously – if you want everyone to be on the same page, prove your claims in the scientific literature with well-controlled clinical trials. Then the medical profession will follow you, just like it did in abandoning bloodletting, knee cartilage debridement, and adopting statins, antibiotics, chemotherapy and diet and exercise.

  9. Shane says:

    Stephen none of your comments make sense.

    ” Both CAMs and Traditional medicine have highly effective therapies that we need to uncover ”

    If they haven’t been uncovered yet how do you know they are effective.? The evidence so far referenced by numerous articles and research references on this site demonstrates that once most of these alleged therapies are investigated honestly to uncover their properties they appear to have no real world effect. And there are many papers referenced here supporting that. I notice you provide only blind assertions for your claims.

    As a radiographer I see many patients with successful orthopaedic procedures. And the results continue to improve both in outcome and longevity. If you wish I can provide research showing the effects.

    Indeed some procedures are unsuccessful for a variety of reasons. However proven lack of benefit isnt one of them. Perhaps you could provide some evidence for your claims ?

    1. Windriven says:

      “Perhaps you could provide some evidence for your claims ?

      Hah! There’s a better chance of a Beatles reunion tour.

      1. DW says:

        Nah … won’t happen, Paul is dead.

        1. Windriven says:

          Only if you play Abbey Road backwards.

          Reminds me of an old joke: what happens when you play a Loretta Lynn record backwards? You get your truck back, your dog back, and your no good cheating husband back.

    2. Hmmm excellent concept. Question!

      What is the probability of YOU or any of your colleagues being able to pick the correct patient in pain, 1 of 10, with only the radiographs? The radiographs were all age matched, males and all about the same age approx 50 y/o.. Remember only one (1) has a history of chronic back pain, with no prior invasive procedures.
      What about the location or level of the pain?

      Same scenarios with films of the knees, hips, cervical, shoulder or elbow?

      1. Missmolly says:

        Why would you want to? Surely it would be more appropriate, not to mention quicker, to take a history from the patient?

      2. simba says:

        Sidestepping the question, yet again.

        “If they haven’t been uncovered yet how do you know they are effective.?… Perhaps you could provide some evidence for your claims?” were the questions. Any answers to them? The list of citations you’ve posted before is not convincing.

        If you continue to fob off challenges like this it will make you look like you have nothing substantial to answer them with. Notice how his challenges followed directly from what you have said. You, on the other hand, picked up ‘radiologist’ and then asked a question completely unrelated to anything he had said, and to the discussion at hand. Classic attempt at distraction.

        If you want to prove this wrong, it’s easy. Answer the simple questions, providing evidence for your claims.

        1. Windriven says:

          “Sidestepping the question, yet again.”

          A typical modus operandus of a charlatan. Never confront an uncomfortable question directly. Besides, it has become quite clear that Steve couldn’t mount a logical argument if his life depended on it. His every utterance is a dog’s breakfast of anecdote, delusion, wishful thinking, and evasion.

          1. brewandferment says:

            you forgot “grammatically incoherent” and/or undecipherable

      3. WilliamLawrenceUtridge says:

        What is the probability of YOU or any of your colleagues being able to pick the correct patient in pain, 1 of 10, with only the radiographs? The radiographs were all age matched, males and all about the same age approx 50 y/o.. Remember only one (1) has a history of chronic back pain, with no prior invasive procedures.
        What about the location or level of the pain?

        Same scenarios with films of the knees, hips, cervical, shoulder or elbow?

        What does any of this have to do with Shane’s polite request for you to provide references for your statements? I quote, “I notice you provide only blind assertions for your claims. [snip] Perhaps you could provide some evidence for your claims ?” That was what Shane was asking, surely your ability to provide reference is not based on his skill as a radiologist, is it? If so, could you explain this curious relationship? I mean, it’s almost as if you can’t provide the references Shane politely asked for, and instead you are trying to change the topic of conversation.

  10. Shane says:

    Yay the Beatles.

    Go John Paul George – and the other one…

  11. Shane says:

    Tell me Stephen, because once again your comments make no sense.

    Why would we want to do that?

    Radiographs are only one element of a patients clinical orthopaedic evaluation.

    No practioner would recommend an intervention without a full clinical history including pain evaluation sleep disturbance the patients occupation age clinical examination etc. Then decide what would be the minmum intervention needed, taking into account the patients wishes.

    Contrary to what your obvious prejudices may perceive the clinical evaluation of the person is far more important than any tests in fact only about 20% of diagnosis is made on tests alone. What the person says is far more important. I am not an orthopod so cant give you a detailed analysis of the clinical pathway but once again your statements do not reflect what actually happens in the real world.

    Could you explain exactly what you are trying to say ?

    1. Eldric IV says:

      Contrary to what your obvious prejudices may perceive the clinical evaluation of the person is far more important than any tests in fact only about 20% of diagnosis is made on tests alone. What the person says is far more important.

      As the elder Dr. Crislip (by which I mean hip, young, edgy Dr. Crislip’s dad) once said, “if the tests do not support the diagnosis, it is the tests that are wrong.”

  12. 99bonk says:

    Anecdotal evidence (sorry) suggests that acupuncture works for pain relief in animals – hence placebo effect can be ruled out. Any veterinarians on line who would like to comment?

    1. Andrey Pavlov says:

      @99bonk:

      Conveniently that was discussed right here on SBM. Basically, there is some room for placebo effect in animals but that there are other explanations for what might appear to be a placebo effect (conditioning and expectancy). In essence, the idea that animals cannot have placebo effects therefore any effect on them must be real is simply not tenable. There are many other reasons why an apparent effect that is not really there would manifest itself in animals. Including the fact that measuring outcomes is also much more difficult in animals, and also itself subject to placebo effects (just like the hyperactivity in children due to sugar myth).

      A short summary from Dr. Hall via Dr. Crislip in his post here:

      (14) Thanks to Dr Hall:
      “animals ought not to have a placebo effect”
      Maybe they “ought not” but they clearly DO. The veterinary literature recognizes that.
      “I wonder how this can be explained.” Here’s how:
      (1) They can develop a learned physiologic response to a drug and then respond similarly when a placebo is substituted.
      (2) They respond to attention and care from humans.
      (3) Human owners can experience the placebo effect for their pets by perceiving a response where there really is none.
      (4) Since animals can’t talk, we have to interpret an animal’s behavior as indicating relief of pain; this may not always be accurate.

      In a nutshell while it is likely that animals do not have the same placebo responses and effects as we do, they likely do have some form of it along with all the other confounders noted. Thus it does not follow to say that if a dog responds favorably to acupuncture there must be some intrinsic effect to it since placebo can be entirely ruled out as a possibility. Even if it could that would still leave myriad other reasons for the apparent effect.

      1. DW says:

        I have never understood why people think there would not be a placebo effect in animals, or why it would need some special explanation. Granted, animals can’t be told in so many words (or expected to understand) what the pill they’re getting is supposed to do (although of course, many animals DO understand a lot of humans’ spoken language). But the placebo effect doesn’t really rely entirely on verbal understanding in humans, either. In fact, the basic idea behind the placebo effect is that our minds, not always being perfectly rational, play tricks on us and so we sometimes get better just because we expect to get better.

        Why would there be any reason to doubt this happens in animals? Of course an animal associates the treatment or attention it receives from caregivers with relief from pain or discomfort (assuming the treatment it receives is successful). That’s really all there is to it, doesn’t matter whether human or (other) animal.

        1. Andrey Pavlov says:

          @DW:

          Well said!

    2. Harriet Hall says:

      Glad you asked! A veterinarian has written an article on this blog addressing that very point. http://www.sciencebasedmedicine.org/is-there-a-placebo-effect-for-animals/

  13. Artful dodger says:

    David Gorski is half right. CAM is largely nonsense and quackery to be sure. But he misses the fact much of SBM is also largely nonsense. In fact SBM really stands for Seriously Bad Medicine.

    The reason why both CAM and SBM contain equal amounts of nonsense is not because they are not really science based. It is because neither of these modalities have any idea of the profound self-healing capacities of the human body.

    The human body can do very well thank you in restoring health, provided certain conditions are provided, the elaboration of these being beyond the scope of this post.

    Gorski is also very wrong in stating that nutrition and exercise are already incorporated into mainstream medical advice. Is he serious?

    I am a doctor and these critical elements of health and recovery are virtually never mentioned in any medical consultation, especially by oncologists, at least not in my country.

    And besides, medical doctors know virtually nothing about nutrition anyway. Their ignorance is truthfully embarrassing.

    Put CAM and SBM in the same category, especially in cancer treatment, where SBM has such an abysmal record of failure since Nixon declared “war on cancer” in 1971.

    1. DW says:

      ” … the elaboration of these being beyond the scope of this post.”

      Well, that’s convenient.

      I would very much hope an oncologist would not start advising patients about nutrition. That would be virtually malpractice, as diet won’t cure your cancer. All well and good if he/she advises them that of course a proper diet is bound to help them feel better overall, at least in small ways. But one hardly needs a medical specialist for that advice.

      The role for nutritional advice in medicine is PREVENTIVE and indeed there are many doctors who focus on it quite a bit.

    2. Missmolly says:

      “Put CAM and SBM in the same category, especially in cancer treatment.”
      Really? Coz I have a textbook from the 40s saying the treatment of childhood leukaemia is to give blood transfusions and wait for the kid to die (Good going, self- healing capacity of the human body).
      In comparison, in 2014 we cure upwards of 85% of acute lymphoblastic leukaemia of childhood – as many as 98% of some subsets of that disease. How? Through combinations of chemo that are tested in RCTs (thanks, SBM!) and proven to be superior to previous gold standard therapy.
      We don’t cure everyone yet- that’s why we keep using trials (SBM) to improve our therapies- but we are incrementally improving. Through SBM. The fact that we haven’t won the ‘war on cancer’ (and shame on you for using that phrase if you are a doctor, which I doubt- as if cancer is one disease which we can ‘fight’ using one strategy) doesn’t mean that SBM is nonsense. It means that more learning is needed. Preferably in a way that focuses on plausible mechanisms, tests them and can be replicated. Ie by SBM.
      As for CAM and SBM belonging in the same category- show me ONE example of CAM making a comparable difference to people’s health outcomes as SBM has done with childhood ALL- survival rate going from negligible to 85-98%. I’ll wait.

      1. Windriven says:

        Yes Molly, but you’re forgetting the most important factor: CAM works. Stevie Wonder Rodrigues has seen it with his own eyes. How does that not trump SBM?

        1. Missmolly says:

          I am in awe of his magical 100% truth eyes! He’s like Derren Brown, only ineffectual :)

          1. Andrey Pavlov says:

            Sounds like Rodriguez ex cathedra to me.

            Ladies and gents, some white smoke please. We have a new Pope of Acupuncture!

    3. Andrey Pavlov says:

      The human body can do very well thank you in restoring health, provided certain conditions are provided, the elaboration of these being beyond the scope of this post

      Absolutely! Those conditions are that the disease is mild and self limiting. The healing powers of the body work fabulously with a rhinovirus or a minor laceration.

      Gorski is also very wrong in stating that nutrition and exercise are already incorporated into mainstream medical advice. Is he serious?

      Well… considering that it was on my board exams and on most of my medical school exams and a required component of my patient interviewing (meaning that if I did not mention and discuss diet and lifestyle modifications during mock patient encounters I would fail)… yeah. I’d say it is pretty well incorporated.

      I am a doctor and these critical elements of health and recovery are virtually never mentioned in any medical consultation, especially by oncologists, at least not in my country.

      Then based on what you have said thus far I fear for your patients. And am curious as to how you managed to make it through medical school, residency, and board exams without learning about the role of diet, exercise, and nutrition in your patient consultations. And managing to not learn how incredibly far we’ve come since 1971 in treatments of all diseases, let alone cancer. Perhaps you were too busy trying to align your chakras during those lectures.

      1. WilliamLawrenceUtridge says:

        The Emperor of All Maladies talked about why the war on cancer failed as well – at that point they simply didn’t understand enough about human cellular replication and genetics to understand cancer. They lacked an understanding of some fairly basic underpinnings of the topic. Instead of trying to walk slowly towards grasping why cancers behave the way they do, scientists ran ahead to treatment strategies – essentially empirically testing highly cytotoxic chemotherapy cocktails in various combinations and doses in an effort to find the most curative. This is part of the reason chemo has such a reputation for toxicity – it’s based on the public perception of science from the 1980s when doses were way higher than what was required. The “set point” was “as close to killing the patient as possible” rather than “the minimum needed to kill the tumor”, so lots of barfing and horrible pain. Current doses are much lower and far more tolerable. In addition, now that people are studying the molecular basics of how tumor cells work, there is the possibility of targeted therapies adapted to specific gene mutations.

        The war on cancer was like an attempt to reach the moon while still lacking a basic understanding of gravity and thinking heavy objects fell faster than light ones. Or like trying to win the Indy 500 when you’ve only ever ridden a bike.

    4. Windriven says:

      “I am a doctor and these critical elements of health and recovery are virtually never mentioned in any medical consultation, especially by oncologists, at least not in my country.”

      Which country and what type of doctor? These details matter. You make the kind of sweeping statements that mark you as shallow and dogmatic: “[M]edical doctors know virtually nothing about nutrition anyway. Their ignorance is truthfully embarrassing.”

      You clearly haven’t met my internist who is, in fact, an actual medical doctor. Then you say:

      “Put CAM and SBM in the same category, especially in cancer treatment, where SBM has such an abysmal record of failure since Nixon declared “war on cancer” in 1971.”

      And there you expose yourself to be a liar and an ass. Survival rates for many cancers have improved dramatically since the 70s. You could Google it ;-)

    5. Chris says:

      “I am a doctor…”

      No, you are not.

      Hmmm, similar comments have been posted elsewhere by Greg/Emily, which was an Australian chiropractor. Chiropractors are not real doctors.

      1. Chris says:

        Hmmm, maybe not. I was going on this comment. But still, this guy is not a real doctor, but someone who likes to troll with sock puppets.

  14. PMoran says:

    Reading through the summary of what the Integrative Medicine Program presented I wonder why this group would be deserving of this group’s ire to the degree that they get lumped in with quackery.

    They allow that no “alternative” treatment and none of the measures they are considering have any effect on cancer survival. That, in my view, makes them an ally of ours. Nothing is more important than that in determining MY attitude towards this kind of practitioner.

    With some of the methods mentioned it is a matter of ownership of the methods: whether they should be called “integrative” rather than “mainstream”. That is not quackery.

    Adopting a preferred name for themselves to try and distinguish themselves from quackery is not quackery.

    They have modest and I agree mostly underwhelming evidence from RCTs suggesting symptomatic benefits for acupuncture, a complex intervention that probably can recruit a variety of non-specific therapeutic influences in addition to those normally regarded as “placebo” by placebo researchers. It is not quackery to make the claim that this may be of benefit to some patients with otherwise difficult-to-treat conditions and to continue to explore that. It would be if they were invoking TCM theory as an explanation, but they are not (Andrey please note!).

    It would be stepping a little over a line if they were suggesting that on the basis of those studies the methods are cost-effective or going to be applicable or practical in all oncological practices and in all populations. Would that deserve the label of “quackery”? Probably not yet unless you are prepared to stifle all dialogue with them at the beginning and present yourself in a certain light to people who almost certainly, rightly or wrongly, think they have a more sophisticated and humane understanding of what’s what in medicine than you do. You will be marginalised as someone not worth talking to.

    So what is the basis of such antipathy to colleagues who, so far as we can know, are trying hard to deal with the miseries of cancer?

    What other sinister agenda do you see for them, David Gorski?

    And how is possible to make these considerations simplistic enough as to be able carry on a fruitful dialogue on Twitter of all places? I think I can imagine the kind of exchange of insults and name-calling going on there. What a lark! “We’ll show them who’s got science!!!” I do wish you could see temperate debate as a more useful solution to some problems than rabble-rousing.

    The only definition of quackery which might be useful to scientific study allows that it is a property of claims, not of methods as such, otherwise drugs such as chelating agents and artemesinin would be quackery no matter how they were employed.

    Stephen Barrett had the right idea when he defined it in terms of “overblown medical claims”.

    SBM seems committed to different notion: quackery is quackery by SBM definition and its own common usage and everything, and I mean everything, flows from that. You can thus make a perfectly valid scientific claim concerning a method (e.g. “it may help some people via a variety of common generic therapeutic influences”) and still be regarded as promoting quackery.

    1. David Gorski says:

      With some of the methods mentioned it is a matter of ownership of the methods: whether they should be called “integrative” rather than “mainstream”. That is not quackery.

      You entirely missed the point, as usual. It’s not as though it hasn’t been explained to you numerous times. The reason “integrative” practitioners try to claim ownership of science-based modalities is because they give cover to all the other quackery (like acupuncture) that they can lump together with them.

    2. Andrey Pavlov says:

      It is not quackery to make the claim that this may be of benefit to some patients with otherwise difficult-to-treat conditions and to continue to explore that. It would be if they were invoking TCM theory as an explanation, but they are not (Andrey please note!).

      Fine then Peter. If you wish to split hairs it is no longer quackery it simply doesn’t work, unless, once again, homeopathy also “works.” And, once again, the common lay person when explained what homeopathy actually is will respond quite adamantly that it cannot then “work.” And if you try to tell them it “works” via “no-specific therapeutic interactions” they will rightly say it is bollocks to charge money for that since it isn’t actually working in any sense they think of as working.

      And yes, Dr. Gorski also makes the very valid comment that you have, yet again, entirely missed the point. For someone who consistently claims a holier-than-thou attitude and proclaims he knows the right way to do it, you sure don’t seem to have any clue of how actual people perceive things and interact, the power of language and word choice to shape public opinion, the utility of debates and how they are actually won or lost (hint: it’s not based on the science!), and so on.

      You are an entirely unconvincing broken record of a school marm who can’t see past the end of his nose telling us to play nice.

  15. Gina Divan says:

    Hmmm, well after seeing the very disappointing effectiveness of chemotherapy as shown in a “science-based” study ….I’d say we should be looking for alternatives to “science -based” therapies.

    http://www.burtongoldberg.com/home/burtongoldberg/contribution-of-chemotherapy-to-five-year-survival-rate-morgan.pdf

    1. Harriet Hall says:

      That doesn’t make sense. We should be continuing to look for better science- based alternatives, not giving up on science and switching to something with a far worse track record.

    2. Windriven says:

      “well after seeing the very disappointing effectiveness of chemotherapy as shown in a “science-based” study ….I’d say we should be looking for alternatives to “science -based” therapies.”

      Well you go right ahead, lady. You have scrounged around for a study on a single component of science based cancer care with – in the broadest measure possible -marginal utility. But note that if you break this into specific chemotherapy for specific cancers you will get a much more compelling picture. Peruse Table 1 in the study that you linked. Did you bother to read more than the abstract?

      Even more important, look at the change in cancer survival rates since, say, the 1970s. Those aren’t because of homeopathy or acupuncture or reiki. Better diagnosis, surgical interventions, radiology and, yes, chemotherapy all combine to yield better outcomes. But if you expect a silver bullet, try naturopathy for your budding carcinoma.

      So go ahead, look hard for “alternatives” to science based medicine – preferably before you breed.

      And a note to those who find my response to this braying a$s offensive: tough crap. I’m tired of giving mealy-mouthed responses to idiots. Dolts like her comment here in an effort to persuade lurkers and fence sitters and might very well persuade one of them to eschew or postpone state of the art care in favor of some sCAM stupidity and thereby contribute to damaging their quality of life or even to their unnecessary – or unnecessarily early – death. These dupes may mean well but their actions can have horrific consequences.

      1. Andrey Pavlov says:

        And a note to those who find my response to this braying a$s offensive: tough crap. I’m tired of giving mealy-mouthed responses to idiots

        [punch on the arm]

        There’s the ol’ Windriven! (almost)

        1. WilliamLawrenceUtridge says:

          Kinder, gentler Windriven lasted, what, a week? I bet he gave himself a GI bleed in the process. Double my bet if I’m allowed to count the tongue as part of the GI tract :)

      2. n brownlee says:

        “I’m tired of giving mealy-mouthed responses to idiots.”

        I’m okay with that, actually…

      3. mouse says:

        @Windriven – Not sure if this is the right place to insert this comments, but….

        God – I stop reading the blog obsessively for a few weeks and you apparently had a life revelation and go from not kind and gentle to kind and gentle to not kind and gentle…and I missed it all?

        I doubt that it mattered deep down, where it seems to me your are just the smart guy who enjoys life, a good argument, is proud of what he has accomplished and taking care of his employees.

        Since my attention got pulled into the discussion by pmoran’s comment, though – I would say that IMO “before you breed” Ehhhh? Bit less classy, titch too heavy on dehumanizing tactics and I think it took away from the rest of your comment, which had strong points. Bit of a stumble on the end of the triple lutz. You could have just as easily said “before you have children who might suffer from your risky decisions”* and sounded more concerned, less – you know – like the skeptical version of a neo-nazi.

        IMO of course, and apologies if I missed some relevant backstory.

        *well, not JUST as easily.

        1. Windriven says:

          Mouse, I always welcome your criticisms. In fact I welcome everyone’s so long as they are more or less on point.

          I have absolute certainty about very, very few things; my ability to be wrong is one in which I have absolute confidence. Wrong in fact, wrong in tone, wrong in approach. When someone points out a flaw, real or perceived, I think about it. Sometimes I conclude they are correct and change. Sometimes – probably most of the time – I conclude that there is incomplete data to draw a meaningful conclusion and I may or may not change my thinking. Reading SBM has shaped my thinking on a number of issues, not all of them directly related to science based medicine or even to science at all.

          I am but one voice in the peanut gallery of SBM. I bring a rather different perspective from that offered by many other commenters here. I am not a physician or a life scientist, I am a hard sciences bench guy and, practically speaking, more of an engineer than a scientist. I choke on the magnitudes of uncertainty sometimes inherent in medical science.

          But scientific objectivism is shared by all scientists. It is nothing more or less than the constant, often recursive, comparison of what we think we know against objective reality. Those who pontificate in these pages without any commitment to science are trespassing. And those who appear in order to sell snake oil and pipe dreams are vermin. IMHO.

          Finally, getting around to your point (this being appended to a Gorski post I feel no requirement to be brief ;-) ) I used the ‘breed’ imagery intentionally and pejoratively. Sometimes things slip out and I don’t go back and rethink and edit before I ‘Post’. This was uttered with malice and forethought. I meant it then and I mean it now. She spun that study to present a lie. In my heart of hearts I think she did it intentionally to deceive. A truncated version of a more complete truth was right there in Table 1 of the study she cited. She chose to ignore it. I’ve no idea if she is a sociopath or a moron. I don’t really care. But that is why I responded as I did. You are one of the last people I’d want to offend so I’m sorry that this did. But not sorry enough to take it back.

          1. mouse says:

            Well no apologies expected or needed. My comment was not so much an exclamation of offense as an unsought* critique of your insult word smithing. Having heard your explanation, I suspect that the imagery that you intended with the word “breed” was not the image that immediately leapt to my mind. At a different time, I might get into a meandering discussion on the topic of insult imagery and perhaps what the social sciences might tell us about consequences of insults, but I’m not feeling it today.

            *unsought critiques are always the best** kind, aren’t they? I appreciate your tolerance.

            **sarcasm.

    3. Thom H. says:

      > “disappointing effectiveness of chemotherapy”

      Maybe Gina Divan finds it disappointing but I’ve been thrilled by its effectiveness. Fifteen years ago, at age 12, my younger daughter was diagnosed with Hodgkin’s Lymphoma. She was treated with a combination of chemo and radiation therapy. Both were nasty and it was difficult to watch her suffer through it but now she is 27 years old with a college degree, a decent job, a boy friend and prospects for a long future. My older daughter came down with MS a couple of years ago. She is now part of a clinical trial using chemo to reset the immune system. She has had much better results with this than she did with the standard, injectable drugs that were first prescribed. I hope science finds better ways to treat/cure these types of diseases but in the meantime I’m glad that chemo is available and works as well as it does.

    4. David Gorski says:

      @Gina:

      That study is very deceptive, as it conflates adjuvant chemotherapy with chemotherapy for curative intent and leaves out cancers that are sensitive to chemotherapy. I’ve discussed it several both here and at my not-so-super-secret other blog in the context of discussing the efficacy of chemotherapy. Indeed, it’s such a common trope among alternative medicine believers that I’ve dubbed it the “2% gambit.” Behold:

      http://www.sciencebasedmedicine.org/chemotherapy-doesnt-work/

      http://www.sciencebasedmedicine.org/chemotherapy-doesnt-work-not-so-fast-a-lesson-from-history/

  16. PMoran says:

    I’d agree that a lot of chemotherapy is used when it is not likely to help much. That happens for the same reasons that many turn to CAM for cancer — everyone, patient, doctors and relatives is motivated to try anything that might help, even if only rarely.

    Nevertheless this paper is a little unfair. It ignores the palliative benefits of chemotherapy in some cancers. It does not include paediatric cancers and leukemias, in which high permanent cure rates occur.

    The attention-getting average of 2.3%, the only figure quoted in the abstract. obscures the fact that In 7 of the 22 types of cancer considered the five year survival is increased by about 5% or more and in two of those the survival gains were over 30%.

  17. PMoran says:

    I said: “I’d agree that a lot of chemotherapy is used when it is not likely to help much.”

    I should qualify that. This paper is ten years old, and it is referring to results published as far back as 1990, which of necessity refer to treatments being applied over 30 years ago.

    While not much has changed in relation to some bad cancers, that is a long time in medicine. Over this period chemotherapy has been improving in effectiveness and sometimes also in side effect profile.

    The evidence base is also improving all the time making it possible to be more sure when chemotherapy will not be helpful and what it can do when it is. So I would expect that chemotherapy is now being used more rationally and more cost-effectively than it was when I retired from medicine over a decade ago. I hope so. There will still be the tendency towards “overuse” it for understandable reasons.

  18. Bill says:

    1) To reiterate my comment on another thread a couple of days ago: Thank you all so much for what you do. You reach an unknown number of people, but whether it is only dozens or many, many more (hundreds of thousands?), it is invaluable and it does eventually spread beyond readers. Your work is the work of the Lord (coming from an atheist). I periodically write a letter to the editor to debunk our local, letter-writing creationist. I KNOW it won’t change his mind (he’s my personal version of Stephen Rodrigues), but I am hopeful that it will catch the eye of a few folks who might other wise never think about how lame and stupid young earth creationism really is.
    2) My sympathy to you all for enduring Mr. Rodrigues and others of like kind. An “open” mind can be nothing more than a trash bin.
    3) I’m probably recommending a book that y’all are aware of, but “Mistakes Were Made (But Not By Me)”, written by Tavris and Aronson, is OUTSTANDING.

    1. Andrey Pavlov says:

      Once again thank you kindly Bill. I know I am only a small part of things here, but I do feel like it is a great community.

      As for your book recommendation… you’ll fit right in. Particularly with WLU. I can’t begin to count how many times he has recommended that book.

      1. WilliamLawrenceUtridge says:

        I’m reading The Invisible Gorilla and it’s coming in at a close second now.

  19. Bill says:

    By the way, I am pretty new to this site, but I am keenly aware of the fact the Stephen Rodrigues appears to never supply any real evidence. It’s kinda funny…and sad.

    1. @ bill
      The easy medicine is still easy, the 1 to 1 cases where you apply a treatment to a problems and the problem is cured or managed. A PA or nursed, gee for that matter an darn computer program can do these cases.

      The complex and hard cases were and are still where we fall short they do not fit the standard paradigms. Forcing a fit will wreak havoc on a patients. This is the main reason why I’m here, forced fitting a treatment on people is malpractice and inhumane especially with the most invisible of all ailments, chronic pain.

      For information on all the most effective alternatives you must read over the vast amount of data from the past 100 or so years. Remember what we did 25-50 yrs ago was the “standard of care” and at that time had great outcomes, were safe, simplistic, low tech and now dirt cheap. It took me 10 yrs to uncover, study and practice these concepts so it should take you much less time — if you are a MD practitioner. If you are not, them it will be very difficult to impossible to comprehend.

      If you disavow any morsel, your conclusions will be incomplete. Each text if full of vivid details and every little morsel is important when you reach a block. PLEASE if you are in an administrative or authoritative station do not apply your incomplete concepts into practice, they will more than likely do harm.

      Before you pass judgment on my intent look over my prior post for the references. If you have inquisitive or investigational questions, ask.

      Why are you here?

      1. WilliamLawrenceUtridge says:

        The easy medicine is still easy, the 1 to 1 cases where you apply a treatment to a problems and the problem is cured or managed. A PA or nursed, gee for that matter an darn computer program can do these cases.
        The complex and hard cases were and are still where we fall short they do not fit the standard paradigms. Forcing a fit will wreak havoc on a patients. This is the main reason why I’m here, forced fitting a treatment on people is malpractice and inhumane especially with the most invisible of all ailments, chronic pain.

        So what you are saying is, your work is too important to bother with something as trivial as “evidence”. Great.

        The thing is – doctors do deal with difficult cases, by applying the science of medicine and biology to the art of clinical practice. But their starting point is still an understanding of how the body actually works.

        For information on all the most effective alternatives you must read over the vast amount of data from the past 100 or so years. Remember what we did 25-50 yrs ago was the “standard of care” and at that time had great outcomes, were safe, simplistic, low tech and now dirt cheap. It took me 10 yrs to uncover, study and practice these concepts so it should take you much less time — if you are a MD practitioner. If you are not, them it will be very difficult to impossible to comprehend.

        Um…are you saying that all previous medicine was more effective and less expensive than current medicine? Or are you merely saying that it was less expensive? Or are you oblivious to the fact that the target of medicine has wandered – now there are more obese patients, more elderly patients, fewer infectious diseases (vaccines say “you’re welcome”) and in general the ability to treat a whole bunch more diseases that in the past would have led to an early death. And, of course, if treatments in the past were so effective, why did life expectancies continue to climb with the development of new treatments that you allege are more expensive and less effective?

        Before you pass judgment on my intent look over my prior post for the references. If you have inquisitive or investigational questions, ask.

        Steve, I looked at your references, twice actually. They were garbage and didn’t support your assertions at all, a fact you have never acknowledged. Are you going to now?

        Why are you here?

        Mostly to point out how wrong you are, but I can’t speak for Bill.

        You appear to be here to justify your sub-par medical practices, a task you consistently fail at.

  20. PMoran says:

    “I’m tired of giving mealy-mouthed responses to idiots.”

    And everyone piles on in agreement. This is how groups like this can gravitate towards extreme and potentially self-defeating positions without being aware of it. (Is that “mealy-mouthed” — I am no longer sure in view of the way I am commonly represented)

    Given the perversity of human behaviour in some settings I have to admit that forthright dismissal rather than reasoned argument may induce the more easily led to reconsider their commitment to some attitudes and beliefs. However, depending on what is meant by “forthright”, it can also risk the reinforcement of damaging perceptions in others.

    Also, in the end all this comes down to where people are prepared to invest their trust under perhaps very stressful conditions, and when bombarded by many voices. We need more than superficial acceptance of the soundness of our understanding of medicine if people are to act wisely. We need an extraordinary level of trust if patients are going to complete those chemotherapy courses in the face of sometimes extremely distressing symptoms, without certainty of cure, and with an awareness of some potential for later problems even if cured of their first cancer.

    So I dare to suggest that there are less self-indulgent, more general purpose “happy places” between being “mealy-mouthed” and the immediate resort to insult and name-calling that seems to be being put forward as the obvious and only alternative. Most of the principal authors of this site display how that is possible.

    You might, moreover, expect to find this more rational approach on a site committed to science as the answer to all medical questions. Scientific language is by nature cautious, precise and highly qualified.

    1. WilliamLawrenceUtridge says:

      And everyone piles on in agreement. This is how groups like this can gravitate towards extreme and potentially self-defeating positions without being aware of it. (Is that “mealy-mouthed” — I am no longer sure in view of the way I am commonly represented)

      One thing that people here tend to pile onto is that you’re a vague, tone-trolling betrayal of the principles you espouse on your own website, and we find it a bit incomprehensible how far you’ve drifted from the rather simple idea that identifying nonsense as nonsense isn’t counter-productive. The fact that you claim there is only one way to interact with people, politely and sincerely, I suppose “your way”, is also a rather staggering demonstration of your lack of appreciation for the diversity of human experience.

      Further, the consensus, which you seem to claim is monolithic, is anything but, and is based on a common empirical and scientific understanding that is the source of the world’s past century of progress. I can’t see this as a bad thing.

      1. PMoran says:

        “One thing that people here tend to pile onto is that you’re a vague, tone-trolling betrayal of the principles you espouse on your own website”

        Precisely what principle is the objection to instant insult and name-calling betraying in the name of , WLU?

        Your last paragraph suggests that I am betraying science in some way. Would you mind spelling out how?

        1. WilliamLawrenceUtridge says:

          Precisely what principle is the objection to instant insult and name-calling betraying in the name of , WLU?

          You annoy me.

    2. Andrey Pavlov says:

      So I dare to suggest that there are less self-indulgent, more general purpose “happy places” between being “mealy-mouthed” and the immediate resort to insult and name-calling that seems to be being put forward as the obvious and only alternative… You might, moreover, expect to find this more rational approach on a site committed to science as the answer to all medical questions. Scientific language is by nature cautious, precise and highly qualified.

      This is what I mean Peter. You do realize that 1) this is a blog, 2) this is specifically in reference to comments in the blog, 3) this is specifically in reference to a commenter who is not a scientist nor a physician.

      You really can’t seem to grasp the idea of difference audiences and different speakers. Do you think we would have had the same response had Dr. Hall said the same thing and proceeded to write like Windriven in her posts? I can tell you the answer. Did you miss my own comments where I explicitly stated how I feel I personally can’t write in that manner precisely because I am a physician?

      Did you miss the fact that windriven is not an author here, not an official member of the site, not on the board of editors, and is, in plain fact, a random person of the internet?

      Also, in the end all this comes down to where people are prepared to invest their trust under perhaps very stressful conditions, and when bombarded by many voices. We need more than superficial acceptance of the soundness of our understanding of medicine if people are to act wisely. We need an extraordinary level of trust if patients are going to complete those chemotherapy courses in the face of sometimes extremely distressing symptoms, without certainty of cure, and with an awareness of some potential for later problems even if cured of their first cancer.

      Precisely. Which is why we cannot be seen to give countenance to bullshit like Reiki or other types of quackery. Because the fastest way to make a patient lose trust in you is them figuring out for themselves that CAM is crap and you either didn’t care or were too dumb as their physician to know it. Or to find out that you are weaseling around trying to convince them something “works” in a way in which most people don’t think of things “working” but some convoluted “it ‘works’ through non-specific therapeutic interactions and placebo effects.”

      Hey doc! Does it actually fix my sciatica or not??

      The best way to win your patient’s confidence? To fiercely stand up for them at all costs and be happy to admit your errors if and when they occur.

      I’m not sure which meme is more fitting, this one or this one.

      1. Windriven says:

        “not a scientist”

        Actually, I am. Just not in the life sciences.

        1. Andrey Pavlov says:

          Actually, I am. Just not in the life sciences.

          My apologies windriven. I think the grist of my comment still stands though.

          1. Windriven says:

            ” I think the grist of my comment still stands though.”

            Did I argue? Just correcting a tiny misstatement.

            1. Andrey Pavlov says:

              Did I argue? Just correcting a tiny misstatement.

              Fair enough. I did not mean to sound tendentious.

              1. WilliamLawrenceUtridge says:

                I find it amusing that SBM editors and commentors are lumped together into a single monolithic mass that exists in an echo chamber, despite being willing to argue over the smallest of minutia – the meaning of “spirituality”, the superiority of the OED vs. Merriman-Webster, the ability to even ask about anecdotes, and so on. And let’s not forget the great circumcision debate.

                Actually, not amusing. Annoying, tendentious and deceptive.

              2. Andrey Pavlov says:

                And let’s not forget the great circumcision debate.

                You mean the one I’ve won? :-P

              3. WilliamLawrenceUtridge says:

                You mean the one I’ve won? :-P

                Well, we could argue about that…

    3. n brownlee says:

      Oh sweet jesus. I mean that in the nicest possible way, of course.

    4. Windriven says:

      “forthright dismissal rather than reasoned argument may induce the more easily led to reconsider their commitment to some attitudes and beliefs”

      Peter, I’m sorry but that is a characterization I will not accept mutely. I am happy to meet a reasoned argument with a reasoned argument. The idiot in question did not mount a reasoned argument, did not pose a reasonable question, did not approach her issue in a reasonable way. She pissed all over the floor and then smiled smugly. I gave a response that was appropriate to her comment.

      1. Andrey Pavlov says:

        Yes, I did mean to actually comment on that as well.

        You do make it plain and live up to it that people who are merely wayward do not get the wrath of windriven. It is only the true trolls (of which you are indeed apt at spotting, definitely much more so than Peter) that get the windriven of story and legend. And even then it is nearly always just returned in kind.

    5. Sawyer says:

      What you are asking for is not only an improvement in this community, but basically that SBM have a professional publicist. Someone that will respond to the never-ending tirade of nonsense without ever showing frustration, fatigue, or anger. You keep insisting that comments not only be scientifically accurate, but that they ALWAYS stimulate productive discussion and NEVER offend anyone. This of course means completely stripping away any defining personality traits, quirks, and jokes. Okay, sounds great. I wouldn’t mind having someone like that around. Universities and large businesses often hire people to do this type of writing. Care to guess their salaries?

      Unless you’re willing to personally fund this endeavor (or take it on yourself), stop complaining that the rest of us don’t meet your standards. I’ve earned every penny of my $0 commenting stipend, along with the corresponding blank space on my resume. Sorry you don’t feel the same way.

      1. David Gorski says:

        Hey, if someone wants to fund our hiring a professional publicist, I’d be all for it. Of course, the output of professional publicists tends to be rather dry and dull, crafted as it is to offend as few people as possible.

        Until that time, Peter’s stuck with us.

        Sorry, Peter. You haven’t convinced us; so we’re not changing, at least for now. Show us better arguments than the same ol’, same ol’, or provide us with concrete strategies that aren’t so vague and are more specific than, “Be super nice and don’t piss people off,” and maybe we’ll listen.

        1. WilliamLawrenceUtridge says:

          Heck, perhaps Pete Moran wants to volunteer! He seems intent on offending the least number of people possible, as long as they aren’t, well, an editor, contributor, or commentor willing to point out factual and logical inaccuracies.

          Such a disappointment. Every time I’m tempted to read one of his comments, I should just go to his website instead.

          1. Andrey Pavlov says:

            He seems intent on offending the least number of people possible…

            Which is always a failing strategy. Unless one wishes to contend that how things are at the moment are exactly optimal, then change is necessary. When we agree change is necessary, people will get offended. Period. People don’t like change. The best of us get over that and react appropriately and change when necessary. Most of us get our knickers in a twist over it. Not offending people means you aren’t actually doing anything.

    6. David Gorski says:

      Yawn. I see Peter’s arrived to tone troll again.

      Seriously, Peter. Harriet and I have offered many times to publish posts by you in which you teach us how to do it right. I have yet to see anything other than the same ol’ same ol’ in the comment threads of new posts, the vast majority of which, coincidentally, appear to be my posts.

      I wonder why that is?

      1. PMoran says:

        No one has established why insult is the only possible answer to anything, and calling me a “tone troll” is another juvenile way of trying not to think about criticisms that might just have some little merit.

        Sawyer, there are several simple resorts if you are sure that someone is merely trying to push buttons, including ignoring it. Or, you can reference a site that deals dispassionately with the matter, preferably one that doesn’t sound too much like drug company propaganda.

        David, I have sent you one post which establishes some of the groundwork for a subtlety different perspective on CAM, its practitioners and sympathisers. I warned you that this involved drawing together many threads — too many for one post (and also for any short term success, I expect).

        One of those threads is that dialogue is not only is a means of persuasion, it is a two-way thing. It is a means of learning –especially about the minds of others.

        The less that SBM supporters engage in serious one-on-one dialogue with CAM users and sympathisers, thereby being forced to think about why people are doing what they do and to discern the various perceptions that underlie those choices, the less they will truly understand CAM.

        I am no smarter than anyone else here, but I know that I have done more listening and talking to such people than anyone else here and I believe I do have a better understanding of them as a result. I have even had to ask myself whether I have become involved in a kind of Stockholm syndrome, but I reassure myself that even if that were so it would give me a good understanding of how the CAM mind works and how they will react to various arguments and approaches.

        I am also without bias, other than that which derives from some genuine underlying affection and regard for humanity in all his weirdness. I think this sometimes gives me a better sense of “what is most important here?”.

        For example, I think that demonstrating that I understand the CAM user’s predicament and that I am on their side against sometimes great odds almost no matter what, is an infinitely better approach than the instant aggression and alienation that is often tacitly tolerated in the comments section of this site.

        Windriven is calling someone an idiot, a braying ass, and adding other insults to someone making a not wholly unreasonable comment about chemotherapy. Yet there is definitely something to answer in the paper cited.

        The irony of W’s assault on that poster is that he has so little understanding of medicine that MTR and I had to point out to him the limitations of mainstream treatment of asthma, which are clearly the main reason why many sufferers turn to CAM. He has similarly completely missed the central importance of the chemotherapy matter to the problem of cancer quackery.

        For it is the side effects and erratic effectiveness of chemotherapy in common perception that are probably the number one reason for the inadequate treatment of cancer from the unwise resort to “alternatives”.

        Whenever you even mention mainstream treatment of cancer the CAM mind turns instantly to the “evils” of chemotherapy, as though that was all we ever used. “How can we trust those who seem content with such a monstrosity of a treatment?” (we aren’t, of course, and its not quite THAT bad, but it’s perceptions, perceptions — )

        So —- WTF?

        Why would we not take every opportunity to explain how things REALLY are, in a neutral fashion (for listeners as well as the poster), before giving vent to the self-indulgence that I am sure mostly lies behind such attacks.

        I just don’t buy the fantasy of those criticising me, including yourself, that have you have thought this through to reached a well-reasoned decision that insult and name-calling are the best and only solution to anything. You are fooling yourselves in a way not befitting self-proclaimed ultra-rational people. (I am following prevailing advice to not be “mealy-mouthed”, so if you are now even MORE offended, — “tough crap”, as W says. I am taking his advice that giving way to my own private impulses is all that matters )

        As Sawyer partly admits, the insult and name-calling mostly derives from exasperation that some people are not bowing down to our superior wisdom. Should we not be seriously examining all possible reasons why that might be? Or have some of you given up on persuasion altogether, while still wanting to enjoy the cheap thrills of the righteous battle you think you are engaged in. ( — musn’t be “mealy-mouthed” — remember?)

        1. Harriet Hall says:

          ” decision that insult and name-calling are the best and only solution to anything.”

          I must have missed something. Who said that?

          1. David Gorski says:

            No one, Harriet. That’s who said it. No one. Peter is attacking a massive straw man.

        2. Windriven says:

          “The irony of W’s assault on that poster is that he has so little understanding of medicine that MTR and I had to point out to him the limitations of mainstream treatment of asthma, which are clearly the main reason why many sufferers turn to CAM”

          I’ve not set myself up to be an expert on medicine and especially not on asthma. My interest is in therapies that have scientific evidence of efficacy. The fact that sometimes there are no good medical interventions available does not make sCAMs somehow better. Putting a magic carpet next to an out-of-service elevator doesn’t make the magic carpet more effective.

          “For it is the side effects and erratic effectiveness of chemotherapy in common perception that are probably the number one reason for the inadequate treatment of cancer from the unwise resort to “alternatives”.”

          And it is exactly the kind of smug misleading bullcrap that woman unloaded that stokes that “common perception.” What exactly did you write to set her straight, Peter? I pointed out that going beyond the abstract in the very study that she linked disclosed significant results for specific cancers.

          Your next two paragraphs – beginning with Whenever and ending with WTF? leave me wondering what is your point. I’m sure it was pure genius and I’m just too dense to appreciate it.

          “Why would we not take every opportunity to explain how things REALLY are, in a neutral fashion (for listeners as well as the poster),”

          Yes, Peter. The ones I go off on are just honestly confused. All they need is a calm explanation to set them right and whistling on their way. That has worked flawlessly with Steve Rodrigues, stanmrak, FastBuck and the others, hasn’t it.

          You are being tone deaf to every tone except the one that offends you. You want to be offended, be my guest. I am offended by those who come to these pages to sell nonsense and delusion to the vulnerable and the uncertain and I’ll damned well give them both barrels until David pulls my plug. You want to hold hands with them and sing Kumbaya, be my guest. The Comments pages hold multiple responses.

        3. n brownlee says:

          “No one has established why insult is the only possible answer to anything”

          No one here has said that it is- no one. The regular commenters here range so widely in style, from the quietly reasonable (even unto utter exasperation) Dr. Hall to the more volatile Windriven- and all points in between, that no single element could possibly be attributed to every commenter, and certainly not that of ‘insulting’.

          It is, in fact, the stated principle of those who moderate the site that a wide, wide variety of ideas, and virtually every kind of verbal exchange, is tolerated. That is, they don’t tell anybody what to say, or how to say it.

          YOU are the only person here doing that. You whiny, passive-aggressive, supercilious old man.

        4. mouse says:

          pmoran ““The irony of W’s assault on that poster is that he has so little understanding of medicine that MTR and I had to point out to him the limitations of mainstream treatment of asthma, which are clearly the main reason why many sufferers turn to CAM”

          Oh jeez – leave me out of this discussion. I’m too busy loosing money hand over fist at an art fair to give my side of the story.

          1. PMoran says:

            Well, I stand by what I have said. Don’t complain about people thinking the way they do and being hard to budge if you have never tried to fully understand how they think — and you won’t ever get to do that with insult and name-calling.

            Understanding them is also not the same thing as sharing false beliefs.

            W, and others, the true frauds, those wanting to “sell” something, or otherwise act in bad faith, won’t come here to test out their beliefs. They don’t care in the slightest what we say. Even trolls wanting to push our buttons have a resentment of mainstream medicine that it would be worth trying to understand the origin of.

            1. Harriet Hall says:

              “if you have never tried to fully understand how they think”

              SSR has pretty much told us how he thinks. What we are missing about him? Please explain to us how we should deal with his nonsense.

              1. David Gorski says:

                I second that request. Peter, SSR has been very clear about how he thinks. Do you think he’s lying? I don’t. So educate us. How do we deal with him? Please be specific.

            2. Windriven says:

              ” the true frauds, those wanting to “sell” something, or otherwise act in bad faith, won’t come here to test out their beliefs. They don’t care in the slightest what we say. ”

              And yet come here they do. Perhaps they don’t care what we say. But they do care that others read their words and are influenced by them. Many of the bloggers and commenters care too. And I will note that, with a handful of notable exceptions, most of those who get a well-deserved rough ride here don’t come back. That’s OK with me. I don’t care about saving their souls. I just don’t want the contagion to spread.

              1. David Gorski says:

                Quite true.

                Also, because SBM now has respectable traffic and its posts have a tendency to be widely linked to, SBM posts on various topics frequently show up high on Google searches for relevant topics, which really irritates the quacks. They sometimes think that they need to come here to tell their side of the story. Alternately, sometimes they threaten to sue.

            3. David Gorski says:

              Well, I stand by what I have said. Don’t complain about people thinking the way they do and being hard to budge if you have never tried to fully understand how they think — and you won’t ever get to do that with insult and name-calling.

              But I have done exactly that—try to understand how they think the way they do and why—including you. For example, I daresay that I understand why parents think vaccines cause autism far better than you do. Strike that. I know I do.

            4. mouse says:

              @pmoran – Okay I have a bit more time now, so I have to ask. If Windriven is so intimidating and insulting, why did I feel comfortable enough to point out the limitations of mainstream medicine with asthma? and what was his response? As I recall, it was to thank me for the information.

              The overall tone of the commenting section on this blog is controlled by how much effort and time people of various styles are willing to contribute to the addressing the topic at hand. I feel your narrow focus on criticizing negative comments from a small group of posters does little to change the overall tone of the conversation. In fact, I suspect it is only an addition to any pre-existing negativity.

              IMO your time, efforts and intellect could be much better spent addressing the topics at hand* in a genial manner and engaging with other commentors (new and established, SBM and CAM proponents) in a friendly manner. This would go a lot further toward shifting the tone of the blog in a more positive direction.

              As to the question of whether viewers are being forced into expressing more negative opinions of CAM due to bullying or “peer pressure”. I would encourage all readers to remember this is an online forum, not a job interview or mortgage application. If you can not write in what you think is right (rather than popular), anonymously in an online forum for fear of someone saying something mean to you…then what is going to happen when you need to defend an unpopular viewpoint in person or even to a person in a position of authority?

              Really to all the anonymous users who are afraid to post. – If you are interested in the the topic, but don’t like the tone of the forum, use a different tone and post a reasonable amount. I’d certainly welcome some fresh viewpoints. I’m sure others would as well. Be brave (!). BE the change you wish – and all that kinda thing.

              1. WilliamLawrenceUtridge says:

                IMO your time, efforts and intellect could be much better spent addressing the topics at hand* in a genial manner and engaging with other commentors (new and established, SBM and CAM proponents) in a friendly manner. This would go a lot further toward shifting the tone of the blog in a more positive direction.

                And it must be emphasized – Pete has done exactly this, and it was Great. Fucking. Work. I think I read his entire webpage and found it humane and compelling throughout. That’s exactly why I am so disappointed he wastes his time here tone trolling rather than updating his actual website.

              2. n brownlee says:

                Excellent comment, Mouse. A mouse like Mrs. Frisby!

              3. mouse says:

                WLU “And it must be emphasized – Pete has done exactly this, and it was Great. Fucking. Work.”

                Agreed WLU. I’ve also come across archives of discussions on other forums with pmoran’s excellent comments. Which is why I suspect he might make more progress in shifting the culture (perhaps that is a better word than tone) as a role model, rather than a critic.

              4. mouse says:

                n brownlee “A mouse like Mrs. Frisby”

                Oh hey, I should check out that book to read to my kids. They like stories about animals and adventures.

              5. n brownlee says:

                Okay, I am COMPLETELY LOST in this maze of threads, but I do want to confess that I DID call PMoran whiny and supercilious and passive-aggressive. Because he is, and that’s the least of it.

                Look at the way he’s repeatedly sucked everybody into yet another long, drawn-out, multi-part, totally and completely useless and self-defeating WHINE about how nobody treats him fairly, he’s the only one here who really understands the real problems of these poor misunderstood nimnulls, whine whine whine. He’s fucking good at it, I’ll give him that- he’s pulled endless patience and forbearance from every senior contributor and commenter, and NEVER does he actually respond to direct confrontation. He’s mean and snarky in his attacks on others, but claims he’s mightily wounded when they reply in kind.

                It’s deliberate. It’s classic passive-aggressive attention-seeking and controlling behavior. You will notice- no matter what the ostensible subject is, inevitably the focus of each of the Moran orchestrated perambulating barsoomian clusterfucks is Moran.

        5. David Gorski says:

          No one has established why insult is the only possible answer to anything, and calling me a “tone troll” is another juvenile way of trying not to think about criticisms that might just have some little merit.

          No, Peter. Calling you a “tone troll” quite accurately describes what you do in nearly every comment thread here that you decide to infest.

          And no one—I repeat, no one—has argued (or even suggested) that “insult is the only possible answer to anything.” No one. Seriously, Peter, can you not even see that that is a massive straw man?

          1. PMoran says:

            “And no one—I repeat, no one—has argued (or even suggested) that “insult is the only possible answer to anything.” No one. Seriously, Peter, can you not even see that that is a massive straw man?”

            To me, gratuitous insult of people you barely know is not obviously a good thing. Yet it is being so strongly defended here that one might assume that it is regarded as essential to the presentation of the scientific approach to medicine.

            If you read back you will observe that I let W’s original comments pass, and only commented after Andrey had punched him on the shoulder in congratulations and WLU also expressed approval. Insult and name-calling is not only being tolerated here it is being admired and encouraged with unthinking childish glee. That reinforces my suggestion that there is no serious thought behind it — it is self-indulgence.

            The worst thing about this practice is that it is a way that people who know least about anything can engage themselves. thinking that they helping “the cause”. They may merely be reinforcing damaging perceptions. Most of the doctors and medical scientists don’t do it much.

            Windriven’s very vehemence is cowing people and obscuring the false dichotomy implied by his self-defence — basically that if you are not being insulting you are acquiescing in and supporting distorted and false beliefs.

            1. n brownlee says:

              ““And no one—I repeat, no one—has argued (or even suggested) that “insult is the only possible answer to anything.” No one. Seriously, Peter, can you not even see that that is a massive straw man?”

              To me, gratuitous insult of people you barely know is not obviously a good thing. Yet it is being so strongly defended here that one might assume that it is regarded as essential”

              You’re doing this on purpose, aren’t you. You are not answering the question asked, just oozing away at a tangent, posing another oily, whining false premise. You just keep doing it and doing it, under the guise of being the “reasonable voice”. Ewww.

              You’re as bad as Rodrigues.

            2. Windriven says:

              “if you are not being insulting you are acquiescing in and supporting distorted and false beliefs.”

              That is an insulting and trivializing characterization.

              First, we are talking about a small subset of commenters here: those whose mission is to attack scientific medicine or to promote practices devoid of evidence supporting efficacy and safety. You have implied in earlier comments that I attack confused CAM users who come to these pages with valid questions and a serious desire to learn. I don’t. And in that rare case when I misconstrued someone serious with a SCAMster I apologized.

              Second, you suggest that I somehow object to the careful, rigorous responses often mounted by Pavlov, Utridge, Madison, Rabbit, and many others. I don’t, I haven’t. I never will.

              I don’t even object to commenters like you who believe that committed sCAMsters are simply misguided or confused and that a little trimming of their sails will have them sailing smooth and strong.

              I DO object to being told that there is one “right” way and that your way is that way. You’re going to have to mount some stout evidence to support that contention.

              “The worst thing about this practice is that it is a way that people who know least about anything can engage themselves. thinking that they helping “the cause”.

              About anything??? I am not a physician or a biologist or a nutritionist, I am a physicist. I do not hold myself out as an expert in any area where I lack expertise. Ever. But I will happily stack my bona fides next to yours when it comes to science.

              Whether or not I am helping “the cause” is not yours to decide, Peter. At least not beyond your personal assessment.

              1. PMoran says:

                W “That is an insulting and trivializing characterization. ”

                You, and others have indeed suggested that my objections to insult and name-calling necessarily means wishy-washiness in confronting erroneous views. There is plenty to say and even ridicule about some aspects of CAM while attacking the ball and not the man.

                And, n brownlee, I think it is rather sad if personal insult and name-calling are the most inventive ways that can be found to make this web site entertaining.

                There is much else I could say, for example about flow-on effects, about how this approach has been used in these comments by some, not only against trolls but also (by a very few admittedly) against patients eagerly wanting to tell us of their experiences, and about how such tendencies will be taken from here and presented in caricature by well-intended persons in other forums.

                Look at how n brwonlee felt entitled to let loose upon me, presumably in the belief that exceeding others in variety and hurtfulness of personal insult was the way to ingratiate yourself with SBM’s in-crowd (did you not find that just a little “despicable”, Harriet?). We can express a policy on such matters without trying to “tell people what to say” as I am accused of doing.

                But I find it depressing that I should be here trying to explain to intelligent people why personal insult and name-calling might be found sparingly on a science-based site, especially when commonly directed at representatives of those who we most wish to influence, concerning issues that a lot of people need reassurance about.

              2. Windriven says:

                “And, n brownlee, I think it is rather sad if personal insult and name-calling are the most inventive ways that can be found to make this web site entertaining.”

                I don’t think that is at all what she said unless you refer to a comment of hers that I haven’t seen. Maybe I’m so batsh!t crazy that I can’t see it but Nancy’s seems to me to be a moderate and calm voice. She did take you to task for avoiding the question of whom exactly suggests that insult is the only answer to … anything.

                I hate where this thread has gone Peter. I hate it because you have important things to say. But they get all tangled up in your obsession with other people’s choice of expression. You’ve made your point. I’ve heard it. Repeating it won’t make me understand it any more clearly. I’m sure that is true of the others of whose tone you disapprove. I hope we can all move beyond this and learn your thoughts on the putatively appropriate use of acupuncture and other placebo-ish modalities.

              3. mouse says:

                pmoran “Look at how n brwonlee felt entitled to let loose upon me, presumably in the belief that exceeding others in variety and hurtfulness of personal insult was the way to ingratiate yourself with SBM’s in-crowd (did you not find that just a little “despicable”, Harriet?). We can express a policy on such matters without trying to “tell people what to say” as I am accused of doing.”

                Woah! pmoran – you need to get a gripe and stop thinking that you can read people’s minds. To believe that nbrownlee made those comments to impress others is very condescending. Why are you assuming that n brownlee isn’t just very angry with your approach and genuinely expressing that?

                This is not the first time I’ve seen you approach commentors this way. A few months ago were you acting like I was just some duffus being lead astray by the tactics of folks like Andrey Pavlov and David Gorski. You need to understand, we non-medical commentors are not just puppets or sheep, waiting to do the bidding of your “real” opponents. We are real people with real lives and our own REAL opinions and the consequences of being sold scam medical treatments have very real consequences for us.

                If you took a few minutes away from searching for the undesirable statements that you focus on and actually read people’s comments about their life experiences and interacted with them you would see that. But you don’t seem to do that much.

                I can see that you are very angry and that you feel attacked and feel the victim. You don’t seem to get that you keep throwing the first punch, then being amazed that people are punching you back.

                I really wish that you would take a break, think about why you keep coming back to this forum, whether it’s actually even good for you, try to find a fresh perspective and then regroup, try something different, whether it be on this forum or somewhere else. Because this ain’t working and I get the sense that you are making yourself miserable and will regret it.

              4. mouse says:

                pmoran “We can express a policy on such matters without trying to “tell people what to say” as I am accused of doing.”

                Anyone who has frequented forums knows that an expressed policy is useless without an active moderator who will delete posts that violate the policy.

            3. Harriet Hall says:

              Peter,
              I have offered you a chance to put your ideas into practice and set an example for us all: engage with SSR, try to understand his thinking, and try to show him the facts in a ” nice” way without insulting him or alienating him. And show how we shouldn’t be so certain he is wrong. Explain how you think his therapies are actually benefitting patients.

              1. PMoran says:

                Actually I have already had some cordial exchanges with SS, and given time that I am not prepared to invest at the moment I think I could eventually enable him to at least better understand why his assertions and his “evidence” is not having much impact here.

                I might even be able to get some of those on the sceptical “side” to better understand the power of the illusions and other influences that lead him and other CAM practitioners to be so very sure that their methods work — somehow.

                That of course, is not a unique feature of CAM practitioners. It was the discovery of how pathetic we all are at judging the true worth of treatment of some kinds of conditions simply via daily use of them that led to the evolution of clinical trials.

              2. Harriet Hall says:

                “I think I could eventually enable him to at least better understand why his assertions and his “evidence” is not having much impact here.”

                That’s far more than anything the rest of us have been able to do. If you can do that, you really do have something to teach us. And if you can get SSR to understand, he might stop cluttering the comments with his tedious barrages of unsupported assertions. Your time would be much better invested engaging with him than writing comments or guest posts. Instead of trying to tell us what we are doing wrong, show us by example how to do it right. I hereby throw down the gauntlet; will you accept the challenge?

              3. Windriven says:

                Dr. Hall: “I hereby throw down the gauntlet; will you accept the challenge?”

                Dr. Moran: “given time that I am not prepared to invest at the moment I think I could eventually enable him to at least better understand why his assertions and his “evidence” is not having much impact here.”

                In other words, “I could but I have weasels in my garden that I simply must attend to.”

              4. Andrey Pavlov says:

                Actually I have already had some cordial exchanges with SS… I think I could eventually enable him to at least better understand why his assertions and his “evidence” is not having much impact here.

                O RLY?

                You mean like this one where his response to your comment was:

                I’m a witness to the failures of SBM and the success of Alternatives — I know the difference as does my patients!!! Yall are dumb or aware of the flaws in the science methods used my many on this site. Y’all are blissfully ignoring these issues.

                Or perhaps this one where his response was:

                All good points. But flawed logic due to cherry picking… In your view or world, YOU decide what is best for a person and YOU have no idea what the other options are available if YOUR therapy fails. Remember a diagnosis is a guess and the treatment is trial and error.

                Or maybe this one where he never even bothered to respond to you.

                After some extensive Google-fu those were the only examples I could find of you directly addressing SSR at all. And in only one of them did he actually (somewhat) respond directly back to you. And in no case did he give even the slightest tiniest inkling that he had actually considered anything you said.

                So how is it that you’ve managed to come to the conclusion that you’ve had cordial exchanges that give you belief that he would eventually come around?

                and given time that I am not prepared to invest at the moment

                I second Dr. Hall’s challenge. Put up or shut up. You’ve got plenty of time to bandy back and forth with us. You’ve apparently taken at least some time for a guest post in submission. The proof is in the pudding. Stop wasting your time responding to us and go to work on SSR.

                Of course all it would actually demonstrate is that your strategy will work on this particular person after extensive 1-on-1 work. Not that only your strategy will work on all people. But I posit that your strategy will not work at all on SSR. Prove me wrong.

                I might even be able to get some of those on the sceptical “side” to better understand the power of the illusions and other influences that lead him and other CAM practitioners to be so very sure that their methods work — somehow.

                This is laughable. We do know why. And it is precisely because we know why that we also know your attempts will fail well over 95% of the time with his ilk. And the 5% of success will not be a resounding one and will take incredible amounts of effort that are simply not worth it, even if we here had the time and inclination to take on every SSR, FBA, Stanmrak, Th1Th2, and other troll and True Believer (TM) types.

                After having dealt extensively with theists and, most especially, creationists I can assure you that it is you that does not have the proper understanding of the motivations of types like SSR.

                I was able to convince a creationist he might be wrong. Once. And it took me a total of over 6 months and roughly 80 pages of typed, single spaced argumentation and explanation from my side of things. And even then it was only enough to convince him to re-examine his premises and the science.

                You must realize that creationists also believe that they are being scientific. That they are looking at the evidence, just that we are looking at it in the wrong way. That certain of our evidence is invalid and that we are giving unfair short shrift to their evidence and science. That is precisely what SSR is doing; he believes our evidence is flawed, the way we approach the problem is flawed, and that we are not valuing the evidence he values appropriately. He has a firm conclusion in his mind and everything else must comport to that.

                I mean seriously, you think you can change the mind of someone who believes he is “a good scientist or researcher” and that we “have the wrong idea about clinical medicine” and feels amazed that we “can favor test tube-academic-researched medicine , and leave out the most important part of medicine and that is on the front lines in it office-based clinical practice” and makes stunning proclamations such as “I’m 100% certain of this, and I’m never 100% certain of anything except the truth.”

                He is not a bit wayward that you can just let him see the error of his ways. He has a fundamentally different idea of truth, evidence, and reality that is irreconcilable with yours (and ours). And he is absolutely certain of this to the point of religious conviction.

                But please, Peter. Show us how wrong we are, me especially. Take those cordial conversations you’ve already had with SSR and build on them. Show us how wrong we are and how much value there is in it. So much value, apparently, that you aren’t prepared to invest it at the moment but instead spend that time repeating the same admonitions to maintain your holier-than-thou-ness at us.

                So please, demonstrate to SSR precisely that

                It was the discovery of how pathetic we all are at judging the true worth of treatment of some kinds of conditions simply via daily use of them that led to the evolution of clinical trials.

                I promise to change my ways if you do.

            4. Louise Lubetkin says:

              Right on. The vehemence and escalating rudeness on display here, egged on and cheer-led by the group’s senior membership, is highly intimidating and excruciating to witness. It amounts to bullying, pure and simple: it reminds me of Lord of the Flies.

              In stark contrast to those who denigrate PMoran’s posts so relentlessly, I find his to be one of the few truly rational voices to be heard here. His comments are always measured and interesting, and the fact that he continues to post at all in the face of such boorishness is a testament to his courage.

              1. David Gorski says:

                How long have you been following? There is a much longer history here than just this comment thread. It goes back at least three or four years. I’d be willing to bet that you are not aware of it.

                Be that as it may, please tell us what we are doing wrong in the posts. Comment threads are often free-for-alls, but posts are carefully written. If you can make a more compelling argument than Peter has as yet been able to make, perhaps you’ll persuade.

              2. brewandferment says:

                I’ve been following this blog for a little over a year, commenting on occasion. I’ve finally started at the very beginning of the archives from the inaugural post and am slowly working my way forward–I’m only in Apr 08 at present.

                I have to say, there is still the same fussbudget style in Peter’s comments in those early blogs–although it is possible that I’m somewhat prejudiced by what I’m reading in current blog comments (but I don’t think so).

                I think it pretty much all boils down to personal style preferences whether you find this blog to your liking or not. My late mother, had she ever gotten internet capable, would have found this blog highly offensive due to language, attitude and such. But here’s the thing: no matter how gently, respectfully, and lovingly her daughters (our brothers were usually too chicken) tried to point out the reasons why she should ditch the chiropractor and toss (or at least quit buying) the insanely expensive battery of supplements, she wouldn’t have any of it!

                The thing is, her offense at this style blog would simply have been a handy and socially acceptable reason to avoid examining the issues with her woo and having to admit she was wrong–it would be a self-justifying out from the hard truth.

                But anyone who has ever found the likes of Saturday Night Live, Jon Stewart, PJ O’Rourke and others of that ilk to be funny will find this blog much more their style. A bland, gentle, inoffensive, and oh sooooo reasonable in tone blog will put them to sleep and they won’t engage–if they return at all.

                Why doesn’t Peter go start his own kind and gentle blog–if nothing else it seems like a much more productive approach than feeling sorry for himself that everyone is getting tired of being scolded because we won’t play his game his way? Maybe he should take his toys and go play somewhere else so we can get on with our game the way we want to play it!

              3. Windriven says:

                “In stark contrast to those who denigrate PMoran’s posts so relentlessly, I find his to be one of the few truly rational voices to be heard here. ”

                It is wonderful, don’t you think? There is a panoply of opinion and a chorus of different voices on display at SBM. You find Peter’s to be the voice that resonates for you. Others will find Dr. Gorski’s most compelling, others still Dr. Hall or Dr. Pavlov, or Billy Utridge*, or Angora Rabbit.

                *Sorry William, I couldn’t resist.

              4. Andrey Pavlov says:

                It is wonderful, don’t you think? There is a panoply of opinion and a chorus of different voices on display at SBM.

                Precisely.

              5. mouse says:

                windriven “Others will find Dr. Gorski’s most compelling, others still Dr. Hall or Dr. Pavlov, or Billy Utridge*, or Angora Rabbit.”

                The exception would have to be Angora Rabbit – I’m pretty certain that everybody likes her. Because well spoken, genius, fluffy bunnies are irresistible.

            5. David Gorski says:

              To me, gratuitous insult of people you barely know is not obviously a good thing. Yet it is being so strongly defended here that one might assume that it is regarded as essential to the presentation of the scientific approach to medicine.

              That would be your assumption. And when you assume, you know what happens, don’t you?

              1. Louise Lubetkin says:

                “How long have you been following? There is a much longer history here than just this comment thread. It goes back at least three or four years. I’d be willing to bet that you are not aware of it.”

                Then you’d be wrong. I’ve been reading this blog since its inception.

              2. David Gorski says:

                Then you’d be wrong. I’ve been reading this blog since its inception.

                That’s great.

                Have you been following the comments since this blog’s inception? In depth? Continuously? If you have, then you must be aware of the issues between Peter and us, issues that date back almost to the beginning of this blog?

              3. Andrey Pavlov says:

                I genuinely find this interesting. On the one hand Louise L feels that we are much too boorish. Perfectly reasonable as a subjective impression. And nobody here has made the claim that there is never anything here that isn’t at some point offensive to someone (or at least something that someone will find rude).

                But our goal here is not to be as inoffensive as possible. Our goal is to work hard to spread good science, good understanding, combat quackery, woo and so-called “CAM,” and to engage both the internets and the public at large with a (hopefully) ever larger audience. To whit, there has been much success in that regard since the inception of the site. I can credit a fair bit of my success in medical school to SBM. The goal is not to be offensive merely for the sake of offense, of course. And the comments are always a (very nearly) completely open free for all with banning being very uncommon and only for the most egregious of commenters. So the focus of any criticism really should be the posts themselves. But if offense comes along the way, so be it. We here, unlike Peter, recognize that someone will always find offense at something. So trying to always be inoffensive is a fool’s errand.

                But the part I find interesting is how Louise finds us “excruciating to witness” and yet she has

                …been reading this blog since its inception.

                So clearly there is some value to you, no? At least in the posts themselves, if not the comments. Which makes it a rather simple solution – don’t read the comments if you find the open, uncensored, and unfettered dialogue from all comers to be so excruciating.

                And Dr. Gorski is absolutely correct. There is at least a 4 year history here such that these last few months of dialogue with Peter specifically is necessary to contextualize.

            6. n brownlee says:

              “The worst thing about this practice is that it is a way that people who know least about anything can engage themselves. thinking that they helping “the cause”. ”

              And who would those people be, hmmm? Those people who ‘know least about anything’. Do enlighten us.

            7. WilliamLawrenceUtridge says:

              To me, gratuitous insult of people you barely know is not obviously a good thing. Yet it is being so strongly defended here that one might assume that it is regarded as essential to the presentation of the scientific approach to medicine.

              At this point, I think the regulars can all say that we “know” the standard trolls – stan, steve, FBA and our very favourite tone troll – you. Generally a new commentor will be met with at least some who venture a rational, science-based discourse with their illogic and factual inaccuracies, which is the approach adopted when steve first showed up. However, dozens if not hundreds of interactions has demonstrated that these commenters are uninterested in factual and coherent discourse, they just want to wax eloquent about how great their preferred form of quackery is. So calling them stupid, biased, incoherent, greedy and hypocritical, is not “gratuitous”, at this point it seems merely accurate. Unless you want to defend steve’s complete scientific illiteracy, stan’s complete lack of understanding of the vitamins he shills, and FBA’s rampant and strategic pharmanoia? I mean really – calling long-term trolls who have never learned a single thing from any criticism ever ventured their way “scientifically illiterate morons”, how is that anything but a valid assessment of their behavior.

              Meanwhile YOU Pete, YOU are such a disappointment to me. I’ve said it before, I’ll say it again – you have a WEBSITE dedicated to debunking cancer QUACKERY, which you certainly do politely enough, and you did it well – but you spend your time here, griping about how mean we all are? We are a TERRIBLE WASTE OF YOUR TIME. Please go back to your personal webpage and expand and improve it. It would be of far greater benefit to everyone. And as much as it sounds like I’m saying “go away and stop bothering us”, I really do think your work on your own site was excellent, worthy and useful to consumers. It’s a shame that you spend so much time here trying to convince us all that we should just be nice and hold hands.

              If you read back you will observe that I let W’s original comments pass, and only commented after Andrey had punched him on the shoulder in congratulations and WLU also expressed approval.

              I assume you mean this exchange?

              http://www.sciencebasedmedicine.org/integrative-oncology-the-trojan-horse-that-is-quackademic-medicine-infiltrates-asco/comment-page-1/#comment-238474

              http://www.sciencebasedmedicine.org/integrative-oncology-the-trojan-horse-that-is-quackademic-medicine-infiltrates-asco/comment-page-1/#comment-238519

              http://www.sciencebasedmedicine.org/integrative-oncology-the-trojan-horse-that-is-quackademic-medicine-infiltrates-asco/comment-page-1/#comment-238554

              One might note that I’m not actually encouraging Windriven here. I’m actually mocking him, relatively gently, about his inability to maintain civility. That’s not approval, one could even say that it is a small rebuke. I meant it jokingly, because I disagree for the most part with Windriven’s approach (even though mine is indistinguishable in many comments), but if there is approval there – you are reading it into the comment.

              I will also note that I have several times offered criticism of things said by other commenters, such as here where I call Andrey to task for his implied belief that skeptics are smarter than non-skeptics, and here where I essentially criticize Windriven for even asking for an anecdote and note here where mouse calls me out for my criticism).

              1. Windriven says:

                “pharmanoia”

                An excellent neologism! Consider it stolen.

              2. WilliamLawrenceUtridge says:

                As so often happens, it’s not my idea. As far as I can tell, Slate was the first to use it…but Wikipedia does have a page on it which has an oddly-familiar tone and writing style…

              3. mouse says:

                “So calling them stupid, biased, incoherent, greedy and hypocritical, is not “gratuitous”, at this point it seems merely accurate. ”

                So it seems now the main argument is which stranger insults are appropriate and which are gratuitous. I really think we are making progressing here. ;)

                I’m not sure about this, but I suspect that in many cases insults to strangers are not particularly effective or compelling. It seems to me that the best Daily Show bits are when Stewart or the cast just ask questions or show clips that show up the hypocritical, self serving, greedy, etc nature of the subject. As an audience member, it’s more fun when you have to work a bit to get the conclusion.

                But this is probably more of a personal esthetic and maybe difficult approach to translate from TV comedy to online commenting.

        6. David Gorski says:

          David, I have sent you one post which establishes some of the groundwork for a subtlety different perspective on CAM, its practitioners and sympathisers. I warned you that this involved drawing together many threads — too many for one post (and also for any short term success, I expect).

          If you have submitted a guest post, I have not received it. Seriously. I just searched my e-mail in case I missed it in the 200+ e-mails a day that I routinely receive. I did not find anything from you. When did you send it? Alternatively, just resend it to Paul Ingraham and myself.

          1. PMoran says:

            On 27th May I sent it to sbmeditor@cloud.com .

            I will send it again, but will take the opportunity to edit some formatting errors first. Or is there a better address to use?

            1. David Gorski says:

              I received nothing. I checked again. The last e-mail I have from you dates back to December 2013. Just try it again.

        7. Andrey Pavlov says:

          Well firstly much thanks for finally ceasing to be mealy mouthed. It has finally made some things rather clear to me (and the others here). Which in and of itself is hilariously ironic. Because you have been so muddied and waffly that everyone here who has earnestly and genuinely tried to understand you has failed until you finally did precisely what you said was the wrong thing to do – be clear and unapologetic.

          No one has established why insult is the only possible answer to anything… is an infinitely better approach than the instant aggression and alienation that is often tacitly tolerated in the comments section of this site…. Why would we not take every opportunity to explain how things REALLY are, in a neutral fashion (for listeners as well as the poster), before giving vent to the self-indulgence that I am sure mostly lies behind such attacks…. that insult and name-calling are the best and only solution to anything

          And so on. As others have already pointed out, you are burning a straw man the size of a blue whale here. And it is absolutely unfathomably ridiculous that you would even begin to think anyone here has ever even remotely come close to a suggestion that insult is “the only possible answer to anything.” And the only way you can possibly think such is thing is if you are willfully ignoring the at least 90% of comments and posts here that are distinctly otherwise. Even by windriven himself.

          With this finally non-mealy mouthed assertion here I think it is safe to say you have lost the last shred of credibility you may have had. It is an outrageous charge of a magnitude similar to denying evolution and claiming the earth is 6,000 years old.

          As windriven said, you are choosing to focus only on what offends you and nothing else and pretending as if that is all there is to this site and these comments. And that is insulting.

          Sawyer, there are several simple resorts if you are sure that someone is merely trying to push buttons, including ignoring it. Or, you can reference a site that deals dispassionately with the matter, preferably one that doesn’t sound too much like drug company propaganda.

          Sure, those are options. Options which you have failed to produce a single shred of evidence are better than any other options. Options which we have used and continue to use. The irony of all this is that you are the only person here advocating for a single strategy and tack whilst accusing us of all having a single strategy that is, in plain fact, a tiny portion of the overall tack seen here.

          One of those threads is that dialogue is not only is a means of persuasion, it is a two-way thing. It is a means of learning –especially about the minds of others.

          You know what Peter? Ever heard of a black swan? Well there are a flock of them flying in your face right now.

          Did you conveniently miss the comments I linked you to about Claudia where she entered the conversation saying this:

          This site strikes me as too dogmatic

          And after both windriven and myself conversed with her she had this to say:

          Thank you for taking the time to sharpen my thinking skills and ways of categorizing and analyzing these various issues and treatments

          Or how about this response of mine to Stan which was still cordial, despite him not deserving it?

          Or this one of mine to YogaLady in which not a single insult was bandied and I even began the damned thing by saying “welcome back!”

          Or how about Karen, the Christian Scientist who came to these pages attacking us and the post about Christian Science and who ended up having to say this:

          Ahem. So last week I had to go on the Science-Based Medicine website and offer an apology. …

          and

          A couple months ago, while visiting the Science-Based Medicine website, I made the acquaintance of a brilliant young medical doctor named Andrey Pavlov… Andrey has given me permission to share our dialogue here. I think you will find Andrey brilliant, articulate, eloquent, and well-learned – as I have found him. If I ever were in need of a doctor specializing in internal medicine, Andrey would be the kind of doctor I’d try to find for myself.

          Boy! No doubt my overbearing, insulting, and fit-in-with-the-groupthink commentary here is such a failure!

          But your narrative is so much better when you completely ignore examples like these (and many more, this is just what I pulled up in 5 minutes from within the last couple of months here).

          But the real howler is this:

          I am also without bias…

          The level of hubris necessary to make such a claim is astounding. We all have biases and trying to deny they exist is the necessary and sufficient for utterly succumbing to them. Nobody here that you are trying to indict would ever dream of making such a claim, myself included. Instead we recognize that we have biases and try to work around them as best we can.

          But that’s enough of my time wasted on your airy strawmen. Until you reconcile you blatantly wrong comment that we “reached a well-reasoned decision that insult and name-calling are the best and only solution to anything.” with the concrete examples I have given above, you’ve relegated yourself to being completely ignored without an ounce of credibility to your writing.

  21. PMoran says:

    Harriet: “Instead of trying to tell us what we are doing wrong, show us by example how to do it right. I hereby throw down the gauntlet; will you accept the challenge?”

    If you like, when I have other things off my plate. I would begin with something similar to the following –

    “SS, the scientific medical community has an unwritten contract with society to produce secure medical knowledge, which is also used as the basis for advising on the most cost-effective use of scarce public and insurance finances.

    This leaves little room for giving methods the benefit of the doubt, as patients commonly urge, and indeed all practicing doctors are constantly tempted to do. There are simply too many weakly-supported practitioner claims and too many patient-sworn-by yet dubious methods, while resources remain finite.

    This rather harsh, but necessary, standard is the one by which some of your claims of are being judged and found wanting.

    You can argue that this is a narrow viewpoint, that should not necessarily be able to entirely dictate what patients and practitioners might choose to do at their own expense and risk, but this is how it is.”

    That is not much different to what others are saying, but it casts light upon the very different perspectives involved and the reasons for them. It is explanatory of something which is otherwise a mystery to the honest CAM practitioner and user.

    They are the centre of their own universe (as doctors are in theirs) and cannot comprehend why doctors are not interested in exploring anything that might help and however it might help, when it seems to be helping others . Not knowing better, they conclude there must be some kind of bad faith, extreme bias, or corruption.

    Harriet, you still have the wrong end of the stick, though. I have made no criticism of how you personally approach CAM matters. Nor that of Stephen Barrett on his Quackwatch site. Nor that of most principals and commenters here.

    This is about the necessity for personal insult and name-calling and it began with a challenge to Dr Gorski to rethink an approach which verges on the former even when dealing with colleagues that are no major threat to any patient. .

    1. Harriet Hall says:

      “Harriet, you still have the wrong end of the stick, though. I have made no criticism of how you personally approach CAM matters. Nor that of Stephen Barrett on his Quackwatch site. Nor that of most principals and commenters here.”

      So I guess the first thing you need to do to help us understand you is to name names. Who exactly are you criticizing and which of their statements do you specifically object to? Are you now saying you generally approve of the methods of SBM? I certainly haven’t gotten that impression from your previous comments!

      1. David Gorski says:

        We all know whom Peter’s talking about.

        1. Andrey Pavlov says:

          Indeed we do.

  22. Andrey Pavlov says:

    “SS, the scientific medical community has an unwritten contract with society to produce secure medical knowledge, which is also used as the basis for advising on the most cost-effective use of scarce public and insurance finances.

    This is utterly laughable Peter. SSR’s contention is not that we should accept less secure medical knowledge but that his medical knowledge is perfectly secure. Literally 100% unquestionably secure. How can you even think to approach that sort of rhetoric with such an opening volley?

    cannot comprehend why doctors are not interested in exploring anything that might help and however it might help, when it seems to be helping others

    Again, he is not arguing that these these could help or even are likely to help. He is arguing that they absolutely 100% do help. And as if that wasn’t enough he is further arguing that what we do does not help and that the methods of science that you are arguing provide secure medical knowledge don’t themselves work to give medical knowledge!.

    I’ve only read maybe 10% of the effluvium that spouts from him and can see that. Are you that blind to his actual stated beliefs or do you genuinely believe that your comment to him would somehow provide any sort of basis for a dialogue?

    Refer to my comment here.

    This is about the necessity for personal insult and name-calling and it began with a challenge to Dr Gorski to rethink an approach which verges on the former even when dealing with colleagues that are no major threat to any patient.

    Precisely. Which is exactly best described (not necessarily pejoratively) as a tone troll. Say the same things just don’t use words that I find rude or distasteful. We’ve known this is what you are saying for ages now and you still act like we are missing some profound and subtle truth only you can apprehend.

    1. PMoran says:

      Andrey, I despair that you cannot see that my words go to the heart of the difficulties in communication with CAM users/practitioners/supporters.

      “Tone troll” is just another bit of juvenile name-calling. It counters no argument. Insult and name-calling are not only “rude and distasteful” in many settings, they reveal character — and not the character that we doctors ought to be displaying to those we regard as our rightful clientele and who we will also meet in our offices.

      1. WilliamLawrenceUtridge says:

        “Tone troll” is just another bit of juvenile name-calling.

        No, it’s a handy neologism for a type of behavior that didn’t really exist before the internet. It quite neatly summarizes why we object to most of your comments here – they are content-free, bar the objection to how things are said, with nary a peep about what is said. And you spend so much time tone trolling. Yes, tone and wording can be important, but you seem to be of the impression that it’s everything, and that if we’re nice to people they’ll change their minds. Unlikely – for the most part, committed ideologues won’t change their minds. Of course, that holds here as well – you are unlikely to ever change your mind, and I, mine. So why don’t we all just agree to disagree and move on? You are free to respond politely and substantively to steve, stan and fasty’s comments, and you can leave the potty-mouth to me and Windriven. It’s win-win, and you get to practice your skeptical chops rather than your Ms. Manners chops.

        1. Windriven says:

          Goddammit William!

          1. Windriven says:

            @WLU and David Gorski

            _|_

            1. Andrey Pavlov says:

              Now, now Windriven. That is just rude and uncalled for. :-P

              1. Windriven says:

                I can’t begin to tell you how badly it pisses me off when William beats me to the punch. I don’t care all that much when his take is different than my own. But when we say the same gd thing and he says it first …

        2. PMoran says:

          “Yes, tone and wording can be important, but you seem to be of the impression that it’s everything, and that if we’re nice to people they’ll change their minds.”

          Well, that’s a turn up — to even have someone agree that they matter at all!

          But it’s not clear to me why personal insult and name-calling comes under the heading of “tone”, anyway. Calling people an “idiot” and “a braying ass” (barely defendable if you are quite sure someone is both an idiot and a disruptive troll)? Likening the enterprise that a colleague heads to a “turd”? Lumping another colleague who is trying hard in at least some respects to oppose quackery, to a quack?

          I cannot change how I feel. I think these things demean us, as well as making it less likely that we will be viewed as sound, level-headed resource for information.

          I am sorry to arouse so much heat, but I remain baffled that such practices could be so staunchly defended, even encouraged, and I can only attribute it to the fact that familiarity can desensitise us to almost anything. Yes, insult has always been part of the currency of the Internet, especially Usenet, even to the extent that the exchange of insult is a kind of competitive sport on some forums, but this is “Science-Based-Medicine” — surely it has higher aspirations!

          1. David Gorski says:

            But it’s not clear to me why personal insult and name-calling comes under the heading of “tone”, anyway. Calling people an “idiot” and “a braying ass” (barely defendable if you are quite sure someone is both an idiot and a disruptive troll)? Likening the enterprise that a colleague heads to a “turd”? Lumping another colleague who is trying hard in at least some respects to oppose quackery, to a quack?

            Let’s be very blunt and clear about this. Anyone who’s been paying the least bit of attention knows that your ire is directed at least 95% at me, maybe 4% (or less) at Mark Crislip, and 1% at everyone else. So let’s not pretend it’s otherwise. You have a problem with me. Just admit it.

            Of course, there’s a simple solution, Peter. If you don’t like my “tone,” “style,” or “insults”—or whatever you want to call it—then don’t read my posts on SBM. It really is that simple. If my writing offends you so and produces in you an irresistible urge to clutch your pearls, then just don’t read it. Over and over and over during the last four years or so, you’ve made it crystal clear that, for you, the issue of “tone” in blog posts about CAM and quackery overrides virtually every other aspect of blogging, including factual accuracy, scientific accuracy, and medical reasoning, such that anything that offends your sensitive ears automatically turns you off so much that the message gets lost (at least to you). And that’s OK. Nothing’s forcing you to read. Others (indeed, as far as I can tell, the majority of our readers) don’t seem to have a problem with my style. And that’s OK too. Different strokes for different folks.

            Just don’t lecture me any more. Quite frankly, I’m sick and tired of your sanctimony on this issue and have been for at least a couple of years. I hid my growing irritation for a very long time due to my deep respect for your past efforts and accomplishments fighting cancer quackery 10 or 15 years ago, but beginning a couple of years ago I couldn’t hide it any longer because you’re unrelenting. The main reason this comment thread has grown so long isn’t due to a freewheeling discussion of the issues and science (or lack thereof) of “integrative oncology.” It’s primarily because you have spent at least 20 comments complaining about “tone” and “insults.” Would that you could, as suggested elsewhere, put all that energy and effort into updating and adding material your website, which is excellent!

            Oh, and send me that guest post.

          2. Andrey Pavlov says:

            Likening the enterprise that a colleague heads to a “turd”? Lumping another colleague who is trying hard in at least some respects to oppose quackery, to a quack?

            I’m sorry Peter but that is perfectly reasonable and you are incredibly overly sensitive. The NCCAM is a turd. There are many worse things that could be said that would fit just as well. But more to the point, it is a commonly used expression. “Polishing a turd” is an American colloquialism. I had thought it was also an Australian one. And yes, it is – quite rightly – intended to be a bit inflammatory. The idea is to generate some heat to shed some light on the issues we find important. It is our feeling (and well argued here, IMHO) that a large part of the reason why CAM is becoming quackademic medicine is because people turn a blind eye to it. Shruggies, as it were. I 100% agree. Non-confrontational rhetoric will only be seen by those who already agree with us and be twisted by those who don’t. Clear and unambiguous language with some intended incitation is what gets the attention of others and forces the conversation.

            Your tack may be to merely drone on dispassionately and hope that eventually someone will listen. We feel, with copious evidence to back it up, that this is a losing proposition. For example, when I am asked about CAM by fellow medical students and residents my simple answer is “It is all crap.” Period. That usually surprises people and initiates a conversation where I can expound further. If tried just saying “Well, you see there are some modalities labeled as CAM that aren’t really, others that have some promise but need more investigation, and still others….” and so on. Either the person rapidly becomes disinterested or they are happy to see that I approve of CAM. No, I learned my lesson. Tell them it is all complete crap (which it is) and those who are interested to listen will. Those who don’t – for whatever reason – are the ones who wouldn’t have listened in any case, nor would they have been interested to.

            Sure you may argue that some are cowed and may dig their heels in further. Besides the fact that I also intentionally say it with no malice or spite in my voice and as a simple matter of fact statement (as if the person should already be in agreement with me), those people are already lost to begin with. And even if they aren’t, I haven’t the time to try and carefully win over every single person. I need to win over as many people as possible, and there will be (a small amount) of collateral damage (so to speak) along the way. And I’ll tell you that I have convinced a large number of people to come around to our way of thinking.

            And yes, when people who should know better like Dr. Oz and Dr. Katz and those at the NCCAM are acting as if they do not, it is perfectly reasonable to call them out on it in plain terms. I know in Australia it is considered extremely rude to do so. But this is not Australia nor are we Australian. Plus, the best of us welcome that clear and unambiguous commentary. The absolute best of my friends are the ones who will return my writing with more edits than original work and will tell me I am being an idiot (and much worse). It is a sign of respect to be so forthright.

            I cannot change how I feel. I think these things demean us, as well as making it less likely that we will be viewed as sound, level-headed resource for information.

            No, and nor are we asking you to. All we are asking is to acknowledge that we heard you, understand you, and disagree with you. And that this is not your site and you are welcome to (and already have) your own. You get a lot of of us bending over backwards for your because of your history and because you do have genuinely valuable things to say. But if you don’t realize that you have utterly failed to convince us on this topic and continue to bleat out the same broken record ad nauseum, you’ll be relegated to being ignored. Which will be a shame because the actually valuable things you have to say and insights you can provide us will be lost as well.

            I am sorry to arouse so much heat, but I remain baffled that such practices could be so staunchly defended, even encouraged, and I can only attribute it to the fact that familiarity can desensitise us to almost anything.

            Once again, you need to distinguish the comments from the posts. And also realize that the author’s voice in the posts is his or hers and can be what the editors and managers choose. Including Dr. Gorski himself. I think I can speak for him when I say that he has also heard you, understands you, and disagrees with you. You may think or wish or believe that SBM should have “higher aspirations.” But your definition of “higher aspirations” does not comport with those of us here, including those who matter (the editors here).

            So once again, you are heard and understood. You’ve failed to convince us. Endlessly repeating the same will not change that. If you find it so astoundingly unbecoming, nobody is forcing you to stay here or read anything. You can even choose to just eschew Dr. Gorski’s posts from your readings. That’s the beauty of it – you may do as you wish, but you may not demand others do as you wish. You can try and convince us, but you’ve failed. Whether that is our failure or yours is immaterial.

            Move on.

            (Oh, and I was and still am very serious about my and Dr. Hall’s challenge to you with SSR. Seriously – put your money where your mouth is. No matter the outcome I can absolutely guarantee you it will be a much more fruitful expenditure of your time)

            1. PMoran says:

              Dr Gorski: “You have a problem with me. Just admit it”

              I have made no secret of it.

              I wish you would point out the arguments that actually counter mine.

              I don’t buy the one that personal insult and name-calling is necessary, and/or justified, to maintain interest and attract attention. Quackwatch was always at the top of search engines and Dr Barrett was always being sought by the media without resorting to that kind of thing.

              I also had the understanding that on SBM you are representing Science, a field that I am prepared to support and defend relentlessly, including when I think a dominant voice on such a blog as this is putting an inferior and unworthy face upon it. So I am not apologising for being a tad persistent about this.

              I have not been asking for censorship, indeed I expect that one voice occasionally pointing out that certain debating habits are rarely justified or effective for any purpose might be all that is needed to have most people thinking twice about it.

              So you might have to get used to it, David. The twenty or thirty posts could be avoided by people either ignoring me, or mounting more telling arguments in favour of what in most circles is regarded as bad behaviour and poor debating ploys.

              The pity is that you have so much knowledge to impart on so many important subjects.

              The irony is that you are so keen on pointing out the logical fallacies of others while being totally oblivious to “straw men” of your own.

              What I do regret is too often trying get the point across by speaking in generalities, which has upset others who felt that they were under attack for that kind of thing.

              1. David Gorski says:

                I wish you would point out the arguments that actually counter mine.

                Oh, bloody hell. I’ve been doing that for four years now, many of the times when you show up in the comments clutching your pearls. You don’t listen. Next post, you show up recycling the same concern trolling. Rinse lather repeat for four years. Is it any wonder some of us have gotten a bit exasperated with you?

                The irony is that you are so keen on pointing out the logical fallacies of others while being totally oblivious to “straw men” of your own.

                Not a single one of which I can recall your ever having convincingly demonstrated.

                But, hey, time to remind you again: Where’s that post you promised? Let’s have it. You say you sent it to me, but I searched my e-mail and couldn’t find it. So please send it again.

      2. Windriven says:

        Actually, tone troll is the correct phrase for someone who repeatedly objects to the tone of a writer, a thread, or a post. It may be uncomfortable but it does not seem to be inaccurate. What is juvenile about it? And it does counter an argument: the implied argument that ad nauseum bitching about the tone of commentary is somehow substantive. It isn’t. We’ve all heard your argument about tone. Repeating it doesn’t make it clearer or more powerful.

        1. David Gorski says:

          Indeed. It’s a two-word slang term that started out meaning people who complained about the tone of a person making an argument in order to intentionally undermine it or to stir up trouble (hence the use of the word “troll”) but then, as these terms frequently do, became broader in definition. Now “tone troll” applies to anyone whose predominant complaint about an argument is not based on the actual evidence or reasoning behind and argument (i.e., the actual substance of the argument) but rather at the aggressive, dismissive, or sarcastic “tone” of the argument or the anger expressed by the person making the argument, regardless of the motivation, good, bad, or indifferent of the person complaining about the tone.

          Which describes what Peter does very accurately. His motives are pure, but he’s still a tone troll.

      3. Andrey Pavlov says:

        Andrey, I despair that you cannot see that my words go to the heart of the difficulties in communication with CAM users/practitioners/supporters.

        And I despair that you fail to understand that with some individuals communication is simply impossible, no matter how wonderfully nice you are. Particularly with your genuinely laughable claims about your previous and proposed future conversations with SSR.

        But please – show me the error of my ways. Do the work for a change instead of just whinging incessantly about how we aren’t doing it. Lead by example. Show us how you can get through to SSR.

        No excuses now. Put up or shut up.

        “Tone troll” is just another bit of juvenile name-calling.

        As windriven and WLU both already said, no it is not. But of course you had no idea what the term even meant and then, instead of looking it up, decided to try and assume the meaning and go off for a couple of days until Dr. Gorski set you straight on it. And ever since then you’ve simply ignored the fact that it is simply an accurate description of your behavior.

        It counters no argument.

        It is not intended to. Not alone. It is used as a descriptor to accurately sum up the totally of your argument. That totality is what we have all argued back and forth. It is simply shorthand to say that your argument continues to be unchanged and has already been refuted.

        and not the character that we doctors ought to be displaying to those we regard as our rightful clientele and who we will also meet in our offices.

        Perhaps it is old school vs new, but I am under no obligation to be unwaveringly kind and genteel to everyone I may possibly encounter in every single forum or social setting merely because they may conceivably one day by some stroke up luck become my patient.

        When they are my patient, that is an entirely different story.

        And WLU and windriven shall never have a patient are are thus under even less obligation.

        1. David Gorski says:

          Perhaps it is old school vs new, but I am under no obligation to be unwaveringly kind and genteel to everyone I may possibly encounter in every single forum or social setting merely because they may conceivably one day by some stroke up luck become my patient.

          When they are my patient, that is an entirely different story.

          Exactly. Peter seems unable to grasp the simple concept that context matters, and different behaviors are more or less appropriate in different situations. For instance, when I’m hanging out with friends at a bar watching a baseball game, frequently there’s lots of cussing. That’s something that would never happen when I’m at work. This is no different. On the blog, some of us “let our hair down” a bit in a way that we never would with an actual patient or even with our colleagues at work.

          Oh, and I’ve had a few patients who knew of, or even regularly read, my blogs. It didn’t interfere.

      4. David Gorski says:

        Tone troll” is just another bit of juvenile name-calling.

        No, the term has a specific meaning that accurately characterizes much of your behavior in SBM threads, particularly this thread.

  23. George Locke says:

    What’s a pragmatic control, exactly, and why is our hero so deflated by them? They seem to be rather common…

    1. WilliamLawrenceUtridge says:

      It’s basically a code term for “we didn’t bother with a real control group”. It essentially means “we compared it with no treatment”. Whenever you see “pragmatic ______” in any scientific publication, that means “we took the easy way out and got shitty data as a result.”

      Examples:
      - For a drug trial, a good placebo control would be a pill that mimics the smell, taste and colour of the actual drug (and you would ask patients to guess if they got the real drug or the placebo); a pragmatic control would be either nothing, or a sugar cube
      - For a surgical trial, a good placebo control would be a mock surgery where they put you under, cut through your skin, then sew you up; a pragmatic control would be people on the waiting list, or given a pill instead.
      - For an acupuncture trial, a good placebo would vary depending on what you wanted to test; retracting needles controls for skin penetration, random locations control for needling location, toothpicks twiddled over the skin control for needle manipulation; a pragmatic control would be “usual care” or a simple placebo pill.

      Actually, in a lot of cases “usual care” is essentially a pragmatic control, depending on how sophisticated your audience is. For back pain patients who have experienced usual care (which is itself simply not very good, we don’t have very good treatments for back pain) “usual care” is almost a nocebo.

  24. PMoran says:

    “Perhaps it is old school vs new, but I am under no obligation to be unwaveringly kind and genteel to everyone I may possibly encounter in every single forum or social setting merely because they may conceivably one day by some stroke up luck become my patient.

    When they are my patient, that is an entirely different story.”

    Bully for you, Andrey. So it’s OK if some OTHER doctor has to face the effects of adverse perceptions reinforced by encountering brutish behaviour on sceptical forums? (Not that you do that anyway. This has very little to do with you.)

    Look, I am not the puritan I may seem in this regard. I only responded to Windriven’s comment because you and WLU were reacting as though that kind of response was something that everyone should try and emulate. From past experience the use of insult in SBM comments is often highly inappropriate, for example when some patient comes here innocently and eagerly wanting to tell us of their experience with some form of CAM. Most commenters react with appropriate consideration, but there are usually one or two who misread this as a cue for insult. There needs to be a lid on that (in an advisory way).

    1. Andrey Pavlov says:

      Bully for you, Andrey. So it’s OK if some OTHER doctor has to face the effects of adverse perceptions reinforced by encountering brutish behaviour on sceptical forums? (Not that you do that anyway. This has very little to do with you.)

      Well, thanks for the nod, I suppose. And yes, it simply is not my responsibility, ethical, or professional onus to make sure every other physician doesn’t have the chance of encountering someone to whom I may have been less than Peter Moran levels of civil. In the grand scheme of things it is such a trifling contribution to how a future patient will interact with a given physician it is truly hardly worth considering. And even if it weren’t I’d still be under no obligation.

      I only responded to Windriven’s comment because you and WLU were reacting as though that kind of response was something that everyone should try and emulate.

      I genuinely think you’ve misread the situation. I gave him a virtual punch in the shoulder and welcomed him back. I enjoy windriven’s unflinching commentary. In part because I feel I cannot do the same but he is under no such similar restrictions. It’s all about recognizing the audience and the speaker. I agree with windriven in principle – braying asses should be called braying asses. Sometimes he does take it a bit too far and even I wince a bit. But that is infrequent at best. And you can’t fault him for that – everyone, even you, loses it sometimes. I just hold myself to a higher standard than he needs to because I am a physician. And at least you seem to recognize that.

      So no, it was not us saying “Look everyone! Be like windriven!” it was a “Welcome back windriven!” a perhaps subtle but nonetheless important distinction.

      Most commenters react with appropriate consideration, but there are usually one or two who misread this as a cue for insult. There needs to be a lid on that (in an advisory way).

      Yes, that has happened. To windriven, in fact. And he apologized afterwards. Sometimes he and WLU and others (myself included) are taken to task. Mouse just recently did with windriven.

      That said, it is the policy of this site that the comments are open for all comers with almost zero restrictions on comments. Besides the fact that doing otherwise would require a very significant amount of effort I also believe that such a policy is the best. Nobody – nobody – gets censored. Period. Nobody gets admonished to be nice, with only a few exceptions for the most egregious of offenders which you have also been witness to.

      So once again it boils down to you personally feeling that the level and type of rhetoric here is unbecoming and then demanding that the site actively work to enforce your standard when, in fact, it is expressly the policy that only the most egregious of commenters are asked to tone it down.

  25. simba says:

    It’s the internet. When faced with the situation where one or two people are misreading situations and insulting people there are three major options: onecan censor comments, apply social pressure via reprimands, or lead by example.

    Censoring comments, any comments, would leave the site too open to accusations of prejudice and censorship. It’s a bit too food-babian, really.

    You can reprimand people, which you have been doing at length for some time, and which does not appear to be working. You could perhaps try reprimanding in a different way?

    Or you can lead by example, which will (if it seems to have results) mean that others will follow, and will alter the culture of the place to suit.

    I’ve had responses on this site which I felt to be a bit harsh. But hey, no big deal, I didn’t take offense at it. From what I’ve seen here when people get upset it’s usually not because of the tone, but because people are saying outright that, say, homeopathy doesn’t work. You can say that plainly, and they will get upset, no matter how polite you are about it, or you can waffle and say ‘well homeopathy does provide some good effects wink wink nudge nudge placebo effects…’ and they will go away with ‘homeopathy works and I should use it on my child’s allergies’. It’s a sad fact that for many people it’s not rudeness that’s necessary for taking offense, it’s disagreement.

    If you feel that certain tones are unhelpful, you have every right to feel that. Clearly others disagree or they wouldn’t use them. Why not just demonstrate the efficacy of your approach? Anyone who isn’t completely new to the internet, or who has adequate social skills, will go ‘okay, that guy was rude, but this person isn’t, so…’ People who come in without having read the threads “innocently and eagerly” are going to meet with a much kinder response here than most other forums I’ve been on. You’re expected in most places to lurk first.

    I was pretty CAM-y, brought up in it, and it was Gorski (among others) who really helped me turn away from it. Testimonial alert, I know, but there is a lot to be said for a diversity of approaches, and that particular approach really helped me. I appreciated the passion and honesty, and yes, that includes calling a spade a spade and calling people names who are promoting unethical things. It also meant for me I was empowered to take more control of my own health care, to discontinue the acupuncture for example, because it was okay to be strongly opposed to useless treatment even at risk of upsetting others. That can be a hugely important message for people. It was for me.

    I wouldn’t have been helped by any ‘we can all get along’ message because that wasn’t what I needed, even though I was in the group you think will be offended.

    I understand your gut response is to dislike that tone, and I empathize with that. Clearly that tone wouldn’t work on you. But it can help other people.

  26. Boris Makharov says:

    This article displays amazing ignorance on so many levels. It displays an establishment mindset that is unable to cope with the emergence of a new paradigm. This is sad because the old paradigm clearly isn’t really helping a lot of people with cancer. For a good opening read on integrative oncology, people could consult Dr. Keith Block’s book entitled “Life Over Cancer.” Rather than reviewing it myself, consider those below found on the back cover of the book. Please note that many of the reviewers are trained and experienced in one or more aspects of oncology:

    “Life Over Cancer is the compilation of Dr. Block’s three decades of research and development of his optimal model of integrative cancer treatment. As Chief of Surgical Oncology from a major medical institution, I have sent many patients to the Block Center. They experienced less treatment toxicity, improved treatment response, better quality of life, and improved outcomes. In my opinion, Dr. Block’s clinic is unique and what I consider to be the top integrative oncology center in the US. It is where I would go if I was ever diagnosed with cancer.”— N. Joseph Espat, M.D. Professor and Chief, Surgical Oncology Roger Williams Medical Center

    “Life Over Cancer is a must- read for anyone combating this disease. It provides genuine hope, as well as the evidence, rationale, and instructions in how to live a healthier, fuller life with cancer, while providing a broader array of treatment options that improve quality of life.”—Nick Vogelzang, M.D., Director, Nevada Cancer Institute Professor of Medicine, University of Nevada School of Medicine, Las Vegas

    “Here is cancer care as it should be: person-centered, integrated, individualized and science-based. If you or your loved ones have been touched by cancer, or if you care for those with cancer, read this book.”—Wayne B. Jonas, M.D., President and CEO, Samueli Institute Director (1995-1999), Office of Alternative Medicine, National Institutes of Health

    “Keith Block is one of the great pioneers of integrative oncology. This important book is essential reading for patients and health professionals alike. Block’s approach is indicative of much of the future of this critically important field of medicine.”—Michael Lerner, Ph.D., President, Commonwealth Cofounder, Commonweal Cancer Help Program

    “Life Over Cancer provides the reader with an accessible and comprehensive program that combines the best of conventional cancer therapy with effective complementary interventions. It is this ‘whole person’ approach to patient care that Dr. Block brought to the University of Illinois Integrative Medical Education program which he established in the mid-nineties. His dedication and efforts have transformed the school’s medical education curriculum, and inspired future physicians to view integrative medicine as a truly significant component of health care.”—L. J. Sandlow, M.D. Senior Associate Dean for Academic & Educational Affairs Professor and Head, Department of Medical Education University of Illinois College of Medicine

    “In Life Over Cancer, Dr. Block demonstrates his huge depth of knowledge of the comprehensive management of patients with cancer and illustrates the wealth of opportunities and choices available to them. This is a book about optimism, soundly grounded in science.”—Stephen M. Sagar, M.D. President, Society for Integrative Oncology Associate Professor Oncology & Medicine, McMaster Univ., Hamilton, Ontario

    “Life Over Cancer provides countless strategies to enable the patient to regain some of the lost sense of control that a diagnosis often carries, empowering them to be a true partner in their fight for life. Dr. Block’s counsel and guidance have assisted countless medical professionals hoping to provide their own patients with a comprehensive integrative approach to care.” —Donald I. Abrams, M.D., Chief of Hematology-Oncology San Francisco General Hospital Prof. Clinical Medicine, Osher Center for Integrative Medicine, UCSF

    “How refreshing to come across this thoughtful book.…With the boldness of a carpe diem, this evidence-based integrative approach should serve as a wake-up call for oncologists to overcome their obsession with treating cancer as an isolated target and to pay attention to the cancer patient whose own faculties need to be harnessed as agencies to win this war.”—Azra Raza, M.D. Director of the Myelodysplatic Syndrome Center St. Vincent’s Comprehensive Cancer Center, New York, NY Former Chief Hematology-Oncology University of Massachusetts

    “Keith Block is the foremost integrative oncologist in North America. In Life Over Cancer he shares his incomparable depth of knowledge and experience with us and presents a comprehensive, scientific, and practical program for helping people with cancer effectively fight the disease.”—Leo Galland, M.D., Author, Power Healing Director, The Foundation for Integrated Medicine

    “Life Over Cancer is a training manual for cancer patients, their families, cancer nurses, oncology pharmacists and oncologists. [It] provides patients with insight and a series of concrete steps to help them live better and longer, despite a cancer diagnosis. —William JM Hrushesky, M.D., Senior Clinician Investigator, Medical Oncology Professor, Schools of Public Health and Medicine, University of South Carolina , WJB Dorn VA Medical Center, Columbia SC

    “Patients who have taken the Life Over Cancer sojourn have generated an impressive track record. While we have much to comprehend about the inner workings of cancer it is reassuring to know that personalized state-of-the-art care is within reach.—Debu Tripathy, M.D. Clinical Professor of Internal Medicine Former Director of the Komen / UT Southwestern Breast Cancer Research Program President and CEO, Physicians Education Resource

    “Without doubt, Life Over Cancer can be singled out as the most authoritative book in integrative cancer medicine available for the cancer patient. I highly recommend it for patients and caregivers.”—Jacob Shoham, M.D., PhD, Medical Oncology Professor Emeritus of Life Sciences Bar-Ilan University, Israel.

    “Life Over Cancer is the program every cancer patient deserves in order to have the best chance for recovery and restoration of health.”—Andrew Weil, M.D.

    “Keith Block is a pioneer and leader in integrative cancer care and one of its premier practitioners. This clear, meticulously documented, practical book is a lifeline for anyone who has cancer. It should be required reading for all oncologists.”—James S. Gordon, M.D., former chair, White House Commission on Complementary and Alternative Medicine Policy; author of Unstuck: Your Guide to the Seven Stage Journey Out of Depression

    “To this day, the Block Center for Integrative Cancer Treatment remains the best and the only truly comprehensive integrative cancer center in the country. This generous book is the exact blueprint for that program and the recipe for its success: hope and science.”—Mark Renneker, M.D., Associate Clinical Professor, Unviersity of California, San Francisco, Medical School

    “Dr. Keith Block shares his decades of research and clinical practice, and presents a powerful, practical, and accessible approach for patients, loved ones, caregivers, and health professionals. This book beautifully reveals the depth of his dedication and commitment to helping people heal.”—Jeremy Geffen, M.D., medical oncologist and author of The Journey Through Cancer: Healing and Transforming the Whole Person

    “Keith Block, M.D. is the most prominent integrative cancer specialist in the United States. His new book, Life Over Cancer, is the manifesto of the movement for a kinder and more effective form of managing this terrible disease.”—Ralph W. Moss, Ph.D., Director, The Moss Reports

    1. Harriet Hall says:

      Ha ha! You offer us “evidence from book blurbs.” And blurbs by promoters of integrative medicine, no less.

      “They experienced less treatment toxicity, improved treatment response, better quality of life, and improved outcomes.”

      Where is the evidence for that claim? What studies has he published?

      1. Windriven says:

        “What studies has he published?”

        He seems to have published a bunch. Unfortunately, they are all in journals of quackology. Search Pubmed on Block, KI

      2. Boris Makharov says:

        Just read the book, Harriet. Get out of your comfort zone. Read a substantial, evidence-based discussion of how there is much more to be done for cancer patients than merely cut, radiate and poison.

        1. Harriet Hall says:

          I don’t need to read a book to know that. Much more can be done for cancer patients within the standard medical paradigm: nutrition, comfort measures, emotional support, etc. I have found that it is seldom worth my time to read a popular book by someone with an ax to grind. If the book shows evidence that “integrative oncology” offers some special objective benefits, you might persuade me to want to read the book by citing some of the controlled studies showing that his claims have been tested and proven true.

          1. Boris Makharov says:

            Nice to hear you agree that there is more to be done than just the big three. You mention nutrition. I don’t believe that most oncology patients ever hear a word about nutrition from their practitioner.

            1. WilliamLawrenceUtridge says:

              Do you know what causes cancer? it’s genetic damage. While nutrition certainly has a role in prevention, what role do you see in it repairing damaged genes? are ýou aware of high dose vitamins showing some evidence of interfering with chemotherapy? and have you heard of the studies performed on rodents that poorly nourished subjects actually do better than well nourished? which makes sense given the metabolic rates of cancer cells?

              Can you provide evidence that well nourished people survive cancer better, rather than, say, merely being more comfortable?

              1. Andrey Pavlov says:

                are ýou aware of high dose vitamins showing some evidence of interfering with chemotherapy?

                And, as you well know but I’m just going to add on here, cancer cells are still cells. Cells that are growing out of control, but cells none the less. And guess what growing cells need? Nutrition and vitamins. At higher levels than cells growing normally.

                I’ll let that one sink in.

            2. Harriet Hall says:

              If mainstream oncologists are not doing a good job, the thing to do is improve mainstream oncology. Letting “integrative oncologists” take over that part of their jobs while adding non-science-based treatments is a bad idea all round.

              1. WilliamLawrenceUtridge says:

                Something I would be really interested in seeing would be a clinical trial of nutritional interventions on cancer survival. I tried looking on pubmed and couldn’t find anything, but I don’t know what the search terms are. It would be complicated – you’d basically have to give one group olive oli and vegetables, the other group isocaloric twinkies, and see which survived longer. The only study I can think of that did something like this was catastrophic Gonzalez regimen, but that didn’t include isocaloric twinkies as far as I know.

        2. WilliamLawrenceUtridge says:

          Boris, you do realize that the Block clinic actually supports the use of the “cut, burn, poison” trope you so eagerly repeat? how does that square with you beliefs about the greatness of the clinic?

      3. weing says:

        “They experienced less treatment toxicity, improved treatment response, better quality of life, and improved outcomes.”
        Is someone’s say so really good enough for you?

    2. Frederick says:

      So promotion “critic” for a book is evidence to you? Those guys could be biases and defending their own turf, for all we know. It’s like that joke in the Simpsons with Marge’S book, and the editors manage to manipulate Tom Clancy to give good critic quote, although he did not want to, these kind of quotes are worthless. Your comment is kind of absurd.

      Anyway I prefer Ken Block to Keith block. :)

      It also reminds of a Family Guy’s joke about the name Keith lol

      1. Boris Makharov says:

        You guys are reactionaries, the whole lot of you. Just as has happened so often in the history of science, you persecute and bullwhip the innovators with the brilliant minds who actually have something to offer. It’s lamentable but also pathetic. You should all be deeply ashamed of yourselves. Instead of actually having a look at what Keith Block has to say, you just pile on with ridicule, sarcasm and ill-disguised rage. After all, you have an industry to protect. Remember that, it’s not science you’re protecting but an industry. And the cost of that stupidity is paid out in increased suffering of many … Seriously!

        1. WilliamLawrenceUtridge says:

          Just as has happened so often in the history of science, you persecute and bullwhip the innovators with the brilliant minds who actually have something to offer

          Boris, that’s not the case. What is being asked for is a level playing field and a common standard. A new chemotherapy drug needs to be proven safe and effective before it can be licensed. Meanwhile, supplements can be sold without proof of either, despite considerable evidence of dangers and contamination (if not outright dosing with drugs). Asking for the ability to offer unproven treatments isn’t “innovative”, it’s exploitative and unethical. If the treatments don’t work, then it’s a waste of everyone’s money and time. If they do, then a tiny number of customers are receiving the benefits compared to the millions who could benefit. In either case – those providing the product or service have an ethical obligation to test for safety and efficacy before charging people for this.

          How can you object to this? What are your grounds?

          After all, you have an industry to protect. Remember that, it’s not science you’re protecting but an industry.

          As I pointed out earlier today, this website does criticize Big Pharma – it’s not about industry protection. And say what you want about Big Pharma, they’re lying assholes but at least they produce a standardized product that has been evaluated for safety and efficacy. It could be improved, it needs to be improved, but that doesn’t mean Block’s “integrative” practices automatically work.

          If “integrative oncology” works, then testing it in controlled trials will prove it. And generally when these methods are tested – at best they help with vague, hard-to-prove, hard-to-measure scales judging perceived quality of life. They don’t improve lifespan, they don’t increase cure rates, and often they require a considerable investment of time and money when it is most precious. Further, they are often accompanied by considerable erosion of quality of life, as patients spend their last days feeling guilty for being unable to stick to an impossible, unpalatable diet, daily bucket of supplements, agonizing exercise routine or draining visits to “support groups” that cram good cheer in everyone’s faces in the desperate hope that somehow happy thoughts will make their tumors disappear.

          Seriously.

        2. Frederick says:

          First I am science Nerd, Not a doctor, So i don,t care about your book, I don’t have the time, ( I studies I work and I have a life you know), to read book about magik. Books are good to give idea, and push reflections, but in medicine they are not proof that something work, Because I could myself right a book about new miraculous ideas, and sell millions of them, that will still be BS. And since the serious scientific literature mostly disprove those claims, sorry but those have more weight than you do, and that a book has.

          Sorry If i offended you, but your post was arrogant, and like I Said, positive critic of a book tells nothing, maybe there’s 10000000 negatives critics, but we don’t know since you posted only the positive ones.

          And you are right, stupidity can make people suffer, and believing in nonsense and magik is one of those.

          1. Boris Makharov says:

            You honestly don’t know what you’re talking about. And the amazing fact is that you openly admit it and still expect readers dropping in here to take you seriously.

            1. WilliamLawrenceUtridge says:

              Bori, you do know how science works, right? through admitting and exploring ignorance? also, do you think ‘cancer’ is one thing? can you define it? can you tell me how cancers are distinguished from one another? do you know the difference between conventional and adjuvant chemotherapy?

              Real scientists have to work their asses off to keep up with incredibly narrow subsubsubspecialties. Do you really think you know enough about cancer to lecture anyone? do you know what the Dunning Kruger effect is?

              1. Andrey Pavlov says:

                do you know the difference between conventional and adjuvant chemotherapy?

                I’ll pick a completely inconsequential nit:

                it is adjuvant and neo-adjuvant or conventional and targeted.

                Your point still stands, just being pedantic ;-)

              2. WilliamLawrenceUtridge says:

                Ha, no offence taken Andrey, as I was typing that up on my damned tablet keyboard I was thinking “is it worth googling the proper terms? Naw, Boris won’t even know there are different types of chemotherapy, and I’m sure someone will correct me.”

                I should apply for the Randi prize, because apparently I can predict the future :)

    3. WilliamLawrenceUtridge says:

      What are the scholarly reviews of that book? A brief look on google scholar finds nothing but perhaps I missed it.

      Fun fact – the Block Center doesn’t actually provide chemotherapy or radiation, but they can refer you to someone who does. They also have specialists on-staff to ensure they can shoehorn their treatments into your insurance plan.

    4. Windriven says:

      Wait right here Boris. I’d like to see if we can hook you up with Peter Moran, a no-kidding, for real oncologist with some real experience dealing with cancer and with cancer quacks. It will be instructive to watch him engage you in serious discussion of the merits of Dr. Block’s methods. I’ve no doubt you’ll come away a new man with a renewed trust in real medicine.

      If that fails, you and I can chat.

      1. Boris Makharov says:

        You know, I’ve debated oncologists on numerous occasions. They are brilliant, kind, they do much good, they are to be admired in many ways but most of them suffer from the limitations of all specialists: they can’t think outside the box. I also know that oncologists suffer frequently from depression and I know a number of them who changed fields because they couldn’t stand working in an area where they really could make no great difference for the sick and the dying.

        1. Windriven says:

          “You know, I’ve debated oncologists on numerous occasions.”

          My invoking that particular oncologist was a test to see if you were a regular just now posting or a new arrival with an axe to grind about Dr. Hall’s post. Mission accomplished.

          “but most [oncologists] suffer from the limitations of all specialists: they can’t think outside the box.”

          And this is based on … your personal assessment of “most” oncologists?

          “I also know that oncologists suffer frequently from depression”

          Interesting and plausible. Do you have hard information to demonstrate this or are you guessing?

          “I know a number of them who changed fields because they couldn’t stand working in an area where they really could make no great difference for the sick and the dying.”

          Wow. If that is the reason they changed fields, one wonders why they entered oncology in the first place. Oncology has made broad gains in the last 50 years. Unfortunately, some cancers remain difficult: pancreatic, hepatic, gliomas, etc. But others that were death sentences in my lifetime are now usually manageable: some leukemias, many breast cancers, many melanomas, to name a few.

        2. WilliamLawrenceUtridge says:

          They can’t think outside the box

          “Thinking outside the box” is merely the first step, you realize. After one has a thought (or “hypothesis”, as it is also known), the next step is to test to make sure one’s thought is valid. There’s a reason why the Greeks, despite their brilliance, didn’t have life expectancies and child mortality rates equivalent to that of modern people – pure thought without testing means you are unaware if your thoughts actually represent reality or merely an internally consistent framework.

          I also know that oncologists suffer frequently from depression and I know a number of them who changed fields because they couldn’t stand working in an area where they really could make no great difference for the sick and the dying.

          Sure, that’s because curing cancer is hard. I mean, not only has cancer only reached the point of causing symptoms by evading the body’s immune system, those bastard tumors evolve in response to challenge. Further, oncologists realize that they can’t offer a cure to many of their patients, merely incremental improvements in quality of life.

          Of course, cancer being hard to cure doesn’t mean integrative practitioners like Keith Block are actually capable of curing it – it just means they are willing to offer unproven treatments to all the customers who can pay. They wouldn’t be the ones delivering the news that the cancer has progressed, or metastasized, they aren’t the ones who administer palliative care, or watch wasted patients shrink further into skeletal death, those people are the depressed oncologists you have such contempt for.

          Do you know what’s missing from the Block center’s webpage? A research section, listing the publications that support increases in longevity of cancer patients. Probably because they don’t exist.

          1. Boris Makharov says:

            I don’t have contempt for oncologists. I only wish they would be open to increasing the efficacy of their labors by considering the options open to them. I think most of them are completely ignorant of any options outside of the big three. My oncologists were and so were most of the ones I’ve read and spoken with over the years.

            Integrative oncologists make no bold claims of being able to cure all and sundry cancers. They have shown, however, that there is more to be done for the typical cancer patient than radiating the tumor or trying to eradicate cancer cells with toxic chemicals.

            As for thinking outside the box, yes, it’s only the first step but it’s a vital one and not frequently witnessed in the realm of established oncology.

            I have no disrespect for science. I do observe, however, the evident control of some aspects of scientific research by interests which are not purely scientific. And, as I noted above, science has its weaknesses which sometimes block practitioners from seeing new things.

            1. Andrey Pavlov says:

              I have no disrespect for science. I do observe, however, the evident control of some aspects of scientific research by interests which are not purely scientific.

              I’m sorry Boris but you’ve demonstrated this is not the case. I spent a bit of time showing you how to properly use PubMed and how there simply is not even remotely enough evidence to make the claims for turmeric that you are making. You chose to completely ignore that. Which speaks volumes about your respect for science and understanding of what “integrative oncology” is all about.

              You haven’t lost the game of science and evidence. You just aren’t even playing, but knocking over the pieces on the board like an angry pigeon.

            2. weing says:

              “I have no disrespect for science. I do observe, however, the evident control of some aspects of scientific research by interests which are not purely scientific.”

              Really? And you have not observed the evident control of quack claims by interests which are not scientific?

            3. WilliamLawrenceUtridge says:

              I only wish they would be open to increasing the efficacy of their labors by considering the options open to them.

              But oncologists do exactly that, adopting new approaches and treatments as soon as they are proven to work in well-controlled trials. All they ask for is proof that a main or adjuvant treatment works better than the current best option, before they start using it. That’s not an unreasonable request.

              I think most of them are completely ignorant of any options outside of the big three. My oncologists were and so were most of the ones I’ve read and spoken with over the years.

              Which approaches outside of surgery, chemotherapy and radiation have been proven to work in humans? There are lots of studies showing effects in cell cultures and rats, but people aren’t cell cultures or rats. So if you are basing your claims of “better treatments” on anything but humans, in trials compared to other, proven options, you’re not “improving oncology”, you’re asking patients to risk their lives, time and money, and insurance companies to expend scarce treatment dollars, on something that could be an expensive waste of time.

              Integrative oncologists make no bold claims of being able to cure all and sundry cancers. They have shown, however, that there is more to be done for the typical cancer patient than radiating the tumor or trying to eradicate cancer cells with toxic chemicals.

              Sure, and that’s great – but are you talking about improved quality of life, or improved length of life. Both are useful and valuable, but both should be honestly disclosed – “this won’t cure you, but it will make you suffer less”. And real oncologists also don’t claim to be able to cure all cancers – but they are honest in conveying the odds. Are “integrative” oncologists? Or are they weaselly claiming or hinting at improved cure rates, without making any solid claims because they lack the data to back them up?

              As for thinking outside the box, yes, it’s only the first step but it’s a vital one and not frequently witnessed in the realm of established oncology.

              Well…yeah – but that’s because we know an awful lot about cancer already. We know it is due to genetic damage (hence you can’t “fix” a tumor, because you’ll never be able to repair the damaged DNA). Antioxidants won’t help – the DNA damage can be caused by oxidation (among other things, there’s far more to DNA damage than mere free radicals) but once the damage is done, antioxidants won’t help anymore than buckling a corpse into a smashed car will bring it back to life. You can support the functioning of the immune system, but aside from the fact that being well-nourished might help tumors grow, most Americans aren’t nutrient deprived.

              Further, there are some “outside the box” thoughts happening – infecting tumors with viruses, injecting them with strips of RNA that will bind to key proteins, and cancer vaccines. These show a deep understanding of cancer, but all are extremely complicated and are still in the early stages of safety and efficacy testing. “Eat your veggies and meditate” sure sounds like great advice – it just doesn’t really have any proof of increasing lifespans or curing cancer.

              So thinking outside the box is great, but first you have to know what’s in the box, how specific cancer lines and stages come about, then you have to find out if your novel therapy actually does anything by testing it. Integrative oncologists are mostly asking for the right to skip testing and say that because something is “natural” (a stupid claim, if nothing else there is nothing natural about steel needles or homeopathic preparations) it’s therefore magical.

              I have no disrespect for science. I do observe, however, the evident control of some aspects of scientific research by interests which are not purely scientific.

              Question – is the Block Center a for-profit entity? Do you think that there are perhaps some nonscientific concerns that cause them to maintain “insurance billing specialists” on-site? Conflicts of interest appear in “integrative” practices too.

              And, as I noted above, science has its weaknesses which sometimes block practitioners from seeing new things.

              What, asking for proof of efficacy before telling patients it can cure their cancer? That hardly seems like an unreasonable goal, and attempting to bypass it seems rather unethical.

    5. simba says:

      You do realise that you are doing exactly the opposite of promoting this book, right?

      If I were the author of that I would be jumping up and down in the comments thread waving my arms trying to dissociate myself from you.

      1. Boris Makharov says:

        Why? Your logic eludes me. Probably because there is none to be found.

        1. simba says:

          Hey, you asked:

          If you’re desperately shilling a particular book, there are a few rules to follow: find a receptive audience, make the book sound useful enough to buy, and make it sound interesting.

          Thus far we have you coming onto a science-based-medicine website (see that title?) without providing any actual science, which will instantly alienate your audience. If you want to sell the book here tell us (a) what his specific claims are and (b) what scientific evidence is being used to support that.

          You’ve provided us with no indication that the book is useful, no information about what exactly it brings to the table: seriously, read over your posts again because the only thing you’ve said is that it’s about ‘integrative’ treatment of cancer- which ‘integrative’ practices, for what purpose, for what types of cancer, what’s the intended audience? You give us a lengthy, repetitive list of quotes from the book’s own cover; an independent review by an expert who lists the pro’s and con’s of the book would be more convincing.Every book will have weak parts, an uncritical review looks like a shallow or incomplete one, we’ve all read a bad book with a glowing back cover.

          And you make it sound dull as ditchwater.

          If I was the author I would not be happy with this sales pitch. I haven’t read the book, it could be the best book ever, I have no opinions on it either way, but I would definitely be discouraged from buying it by your poor attempt at promoting it for the reasons above.

          1. mouse says:

            Simba You are on a roll in this thread!

            I need a cardboard sign. “Will work for SBM like button.”

            I know it might not be feasible with the technical difficulties and limited time of the volunteer staff, but if I could just lobby for a moment.

            Like and dislike rating functionality can discourage trolling when low popularity items are shifted to the bottom of the page…That would be very nice!

            1. simba says:

              Thank you, Mouse!

              You guys will all lose your Mean Skeptics badges if you keep treating newbies like this. :P

    6. Windriven says:

      @Boris Makharov

      - You come to these pages with a pissy attitude toward Dr. Hall. If you reckon that will buy you many converts here, you should re-reckon. It takes a special kind of low-life to come to a science website with an attitude and a comment devoid of scientific underpinning. Few first time commenters make it right to the candidate list for asshole-of-the-year. Congratulations on your achievement.

      - Why is it that Dr. Block is not, so far as I have been able to learn, board certified in anything? The guy is 60. Steve Rodrigues, who I wouldn’t let treat a dead cat, is board certified in internal medicine. Not saying that makes Block a quack but it raises a flag. Most physicians seek board certification in their field of specialty. Block’s field is apparently internal medicine. Not, I might add, oncology.

      - Stephen Barrett at QuackWatch isn’t altogether negative about Block. I’ve ordered a sample of the book for one of my e-readers. If it holds promise, I’ll read it. Because of Barrett. Most certainly not because of you.

      1. Boris Makharov says:

        It’s amazing that you’re on this website pontificating about the matter when you haven’t even looked at the premier book in integrative oncology. That speaks to arrogance and blindness.

        1. Windriven says:

          Boris, is it your mission in life to convince everyone that you are much, much less than you suggest? Do you harbor some fantasy that all of this arch boloney impresses anyone?

          You’ve said: “It’s amazing that you’re on this website pontificating about the matter when you haven’t even looked at the premier book in integrative oncology.”

          In the first place, while I am a man of strong opinions, I avoid pontification on this site as I am neither a physician not a life scientist. You might look up the word. Physics is my area. That said, a scientist is a scientist; it is a philosophy and a method.

          I don’t often spend time reading books that are about ‘integrative’ approaches to medicine. I’m always wondering, what are we integrating medicine with? We don’t have integrative aeronautics. We don’t have integrative physics. We don’t have integrative proteomics. Life is very short and there are a thousand subjects to pursue. Why would I invest my time reading about the integration of something nebulous into medicine?

          Now then, this may be the premier book on integrative oncology. But if integrative oncology is a pile of steaming ferret shit, who really cares? You must first establish that there is something to integrate. Then we can talk about ‘premier’ books.

          I’ve no doubt that huge strides will be made in cancer treatment in the coming decades. But I expect those strides to come from advances in genomics and other fundamentals of core biology. Some advances may come from the areas that you imagine ought to be ‘integrated’ into current oncology practice. I’d be fine with that. Pleasantly surprised. But fine with it.

          But what I’m looking for is hard evidence of efficacy and safety. I can’t imagine anything that I would care less about than someone’s anecdotes. If this book is all heart-warming stories and the triumph of the human spirit over cancer, I’ll smile and toss it in the fire*. If it is a careful explanation of a new view of cancer care and is supported by quality, peer reviewed research, we’ll have something to talk about.

          Anyway, you are a singularly disagreeable little shit. It will annoy me deeply if you’ve put me onto something worth considering. Happily, your entire approach suggests little likelihood of that happenstance.

          *A metaphorical fire as this is on my iPad.

        2. WilliamLawrenceUtridge says:

          Most here prefer their evidence come from pubmed, not popular books from fringe clinics.

          1. Boris Makharov says:

            No, most people on this website don’t prefer their evidence from places like pubmed. Instead, they prefer evidence that fits their own ideological beliefs. If this website promoted “pure science”, it would not publish ill-informed information about topics like cancer and curcumin as it did recently. I spent a day reading articles found at pubmed on this topic and found a very different story than the one told on this website.

            1. Andrey Pavlov says:

              Sorry Boris, you can’t say that because I outlined the PubMed information and you (still) completely ignored me.

              You are only interested in peddling whatever you already think is the case and ignore all contradicting evidence.

            2. Windriven says:

              Seconding Dr. Pavlov, if you’ve spent the day trolling Pubmed, how about sharing the top 5 or 10 journal articles you found that tell “a very different story than the one told on this website.”

            3. Harriet Hall says:

              @Boris,

              “I spent a day reading articles found at pubmed on this topic and found a very different story than the one told on this website.”

              You chose to read a different story based on preclinical studies. Do you not understand the need for controlled clinical trials in humans, or are you just ignoring that fact and stubbornly looking for any data that tends to support your beliefs?

              1. Windriven says:

                “or are you just ignoring that fact and stubbornly looking for any data that tends to support your beliefs”

                Yes, our Boris has been off picking cherries in the Pubmed orchard.

            4. weing says:

              “No, most people on this website don’t prefer their evidence from places like pubmed. Instead, they prefer evidence that fits their own ideological beliefs.”
              Please don’t assume that most of us use your approach. Please learn to critically evaluate papers first. Don’t just assume you are already qualified to read them.

        3. WilliamLawrenceUtridge says:

          It’s amazing that you’re on this website pontificating about the matter when you haven’t even looked at the premier book in integrative oncology. That speaks to arrogance and blindness.

          Claiming someone or some clinic is the “premier X in integrative oncology” is about as meaningful and convincing as claiming to be the freest press in North Korea, or the smartest patient in a head wound rehabilitation facility. Integrative oncology is an inherently flawed field because it exists to offer treatments based on claims unproven in humans – often at a steep price. There are complaints on the internet about how expensive the vitamins sold at the Block Clinic are, which is a huge conflict of interest – real doctors are prohibited from selling the drugs they prescribe, which is why pharmacies exist. And if a treatment has been proven to work for a specific type and staging of cancer (and specifics are important because “cancer” is about as meaningful a category as “vehicles” when you’re trying to figure out how to get from the Mariana Trench to Pluto) they are rapidly adopted by oncologists who follow developments in their specific fields.

          I hate to break it to you, but “integrative” just means, at best, “this kills tumors in beakers and rats”. Humans are not beakers and rats. Thalidomide is perfectly safe in rats, and chocolate is deadly to dogs. You can’t move from cell cultures and animal studies to selling treatments to humans if you have anything resembling ethics.

          If Dr. Block wants my respect (and he probably doesn’t, he probably wants my money) then he will prove that his approach works in humans before he sells it. To drive the comparison home – would you buy a drug sold by GSK on the basis of “well it kills tumors in test tubes”? I wouldn’t. If you wouldn’t, ask yourself why such an approach is laughable when it’s Big Pharma, but is a slam-dunk when it’s someone shilling expensive vitamins?

          1. weing says:

            “real doctors are prohibited from selling the drugs they prescribe, which is why pharmacies exist.”
            I wonder why it doesn’t work the other way? Real pharmacies are not prohibited from prescribing the drugs they sell. Nobody but me see that as a COI?

            1. Andrey Pavlov says:

              I think that depends on your country. In the US, to my knowledge, pharmacists are not allowed to prescribe anything.

              In Australia there are certain prescribing privileges that they have, but they are limited and are basically things that people would need quickly and getting to a physician would take too much time (for example albuterol inhalers or metoclopramide for migraine). They are trained to evaluate the presenting symptoms and check for interactions and give a pharmacist script.

              I’m not sure how it works in other countries.

              1. weing says:

                “In the US, to my knowledge, pharmacists are not allowed to prescribe anything.”

                Think again.
                http://www.minuteclinic.com/
                http://www.walmart.com/cp/Walmart-Clinics/1078904
                More are on the way.

              2. Andrey Pavlov says:

                @weing:

                Those are not pharmacists prescribing. They are NP’s and PA’s inside a mini-clinic in the pharmacy (and Wal-Mart). A quick search shows that there was an attempt by the FDA to get pharmacist prescribing rights but the AAFP denounced it. As of now, pharmacists (PharmD) do not have prescribing right:

                Only licensed doctors of medicine, osteopathy, dentistry and podiatry have the statutory authority to prescribe drugs

                Granted that post is 2 years old but I could find nothing newer. NPs and PA’s can prescribe but only under the license of a physician (though I think that is a bit different in some states recently where they have gained some authority to operate entirely independently).

                Is there something else you know of that I am unaware about PharmD’s specifically?

              3. Andrey Pavlov says:

                BTW, I should add that I am not actually against pharmacists having prescribing rights. I think the way they have it set up in Australia is actually quite good. There really is no reason why a person should have to see or even contact their physician for a refill of an albuterol inhaler or other rather common and low risk drugs. In Australia the system is such that while pharmacists can prescribe they can only do so for certain specific drugs (not even entire classes of drug, but a list of specific ones). It is done to remove the burden of simple refills on physicians.

              4. Windriven says:

                Weing, those seem to reflect prescriptions written by PAs and NPs rather than pharmacists. I’m not aware of any prescribing privileges for US pharmacists.

                Statins, I believe, can be gotten in the UK with a pharmacist’s order. That strikes me as a worthwhile halfway step between physician’s visit requirement and OTC.

              5. weing says:

                “Those are not pharmacists prescribing. They are NP’s and PA’s inside a mini-clinic in the pharmacy (and Wal-Mart).”

                Most pharmacists are employees of chains like Wal-Mart, CVS, etc. So are the NPs and PAs working in those clinics. It is the the corporations prescribing by proxy. That to me is a COI.

                “There really is no reason why a person should have to see or even contact their physician for a refill of an albuterol inhaler or other rather common and low risk drugs.”

                I disagree. Albuterol is one of the drugs I prescribe without a refill. I want to be called when the patient is refilling it. If he/she just had it filled a month ago and is asking for a refill, that is a red flag that the patient needs to be seen and re-evaluated.

            2. Andrey Pavlov says:

              Most pharmacists are employees of chains like Wal-Mart, CVS, etc. So are the NPs and PAs working in those clinics. It is the the corporations prescribing by proxy. That to me is a COI.

              It may be a COI, but the original point was about pharmacists writing scripts which is what I was addressing.

              I disagree. Albuterol is one of the drugs I prescribe without a refill. I want to be called when the patient is refilling it.

              In Australia the pharmacists are trained to take that into account. It is not meant to replace physicians, but to allow patients who run out or forgot theirs to get one. I actually very much needed it – I was back in Australia and went on a heavy workout. My asthma acted up enough that I was very concerned. I didn’t happen to have my inhaler on me. I ducked into the nearest pharmacy and got it taken care of. In the US I would have had to go to an ER and be seen.

              The pharmacist asked me many questions about it and if I had told her that I ran out of my new script in just a couple of weeks she would have told me that I needed to see my doctor. If I wasn’t in immediate distress she would have denied the script and said that such a pattern of use should be overseen by a physician.

              I think that there is a role for pharmacist scripts with proper training and instruction.

              1. n brownlee says:

                I was thinking about asking Weing if, when a patient or a minor patient’s mother calls his number on a weekend, say with a kid in bronchospasm, does she get a recording that says, “Our office is closed. If this is a life threatening emergency, please call 911 or go to the nearest hospital emergency room. If not, please call the office during our next office hours, Monday, Wednesday and Friday from 9am to 3pm, or Tuesday afternoon, 1pm to 3pm. We are closed Tuesday mornings and all day Friday…” but I thought it might be too snarky.

                My doctors do not return patients’ calls anymore, except for my oncologist. Who I am crazy about, and to whom I feel great loyalty. I wonder why?

              2. weing says:

                @n brownlee,
                Not snarky at all. Yes, you will get that message about calling 911 for life threatening emergencies, but there is also the option available of getting to me or a covering doctor. We all have access to your electronic record and can quickly see when the last refill was and electronically transmit the prescription to your pharmacy of choice. We all want to avoid unnecessary ER visits if at all possible.

              3. weing says:

                BTW, you should never be out of your rescue inhaler.

              4. weing says:

                @Andrey,
                “It may be a COI, but the original point was about pharmacists writing scripts which is what I was addressing.”
                Actually, my original point was about pharmacies prescribing.
                And I still see it as a COI. I have no desire to sell the meds that I prescribe to my patients. I see the COI there. I seriously doubt that Wal-Mart, CVS, etc are better than I am at resolving such COIs.

              5. Andrey Pavlov says:

                Actually, my original point was about pharmacies prescribing.

                I re-read the comments and you are correct. My apologies – I misread it once and continued framing it that way in my head.

                And I still see it as a COI. I have no desire to sell the meds that I prescribe to my patients. I see the COI there. I seriously doubt that Wal-Mart, CVS, etc are better than I am at resolving such COIs.

                I do see your point. In the case of Wal-Mart the clinic that prescribes is independently owned and contracted.

                But windriven’s point is also correct. The hospital system were I am has a pharmacy in-house. Patients can get their scripts filled there. The physicians obviously don’t get a direct kickback, but if the pharmacy does well, it certainly helps the hospital’s bottom line, which helps get better and nicer facilities, better computers, pay raises, etc. It does indeed indirectly come back around.

                Is the amount of COI that would be likely in a pharmacy setting generate enough harm to outweigh the benefits of having easy access to some scripts? I don’t know. I feel like they wouldn’t. You make some decent arguments as to why they may. I don’t think this is a question that can be settled without data and I don’t think the data exists.

                We all have access to your electronic record and can quickly see when the last refill was and electronically transmit the prescription to your pharmacy of choice. We all want to avoid unnecessary ER visits if at all possible.

                Sure, this is a solution, but it doesn’t strike me as particularly good. Not all people are under the care of a physician with an EMR. Even if they are, getting the number, getting you on the phone, looking it up, and so on takes time. You could also be unreachable – in a place with no cell reception, you just missed that one call (it happens, no matter how good one is), and so on. Much less time would be needed to just go directly to a pharmacy. In my case, I was given the inhaler immediately since I was in obvious distress and asked for it. The paperwork was filled out after I took a few puffs and was breathing better. Plus, being woken up in the middle of the night or having the call while in the middle of a patient consultation is not the most desirable thing if it can be avoided.

                BTW, you should never be out of your rescue inhaler.

                There are many things that should never or always be done or had. But we can’t argue about and build systems on the fact that one should never be out of a rescue inhaler and always have it handy. I didn’t and I am a pretty well educated and still managed to. There are situations outside of people’s control.

              6. weing says:

                @Andrey,
                I guess there are no perfect solutions. The pharmacy could have been closed. I see no problems refilling it and my staff is instructed to refill it automatically. It’s just that I need to be made aware of it. If it’s been 6 months or so, I let it rest, if it’s a month or less, I will call the patient and ask what’s going on? Did they lose it, etc or is their disease flaring up?

              7. Andrey Pavlov says:

                @weing:

                I guess there are no perfect solutions.

                I think we can agree on that.

              8. CHotel says:

                Adding to the Pharmacist prescribing discussion, speaking as a pharmacist with limited prescribing rights. Our province recently introduced programing to be certified for minor ailment prescribing (nasal steroids for AR, nystatin liquid for thrush, treatments for tinea infections to name a few). There are also laws in place to allow for advanced prescribing for specialists (say a PharmD with a Board Certification in Cardiology Pharmacy) but I haven’t heard of anyone getting that so far (fairly new legislation). Even without any either of these further certification options (though I do have the former) I am able to “prescribe” OTC products or medical devices (ie. so they could be covered by insurance), adapt a precription to correct a strength (not change a dose at will, but if a doc mistakenly wrote a dose that couldn’t physically be created from the commercially available tablets) or formulation, or use what we call a Continued Care prescription to give a refill of a chronic and stable medication (with some exceptions like narcotics) when someone has no refills left and can’t make it to their MD for a length of time (or if their MD recently passed).

                I don’t really have to worry about COI as I work in a hospital that doesn’t have any outpatient script filling. But if I did work in a store and was to prescribe something, I would have to physically write out the script, hand it to the patient, verbally inform them they have the choice to take this script wherever they wanted, and then they could either hand it back to me to be filled or take it elsewhere if they so desired. It’s also recommened that if they give it back to me to be filled that I get a coworker to fill and check it. We have to keep pretty rigorous records of everything as well.

            3. Windriven says:

              @weing

              “Most pharmacists are employees of chains like Wal-Mart, CVS, etc. So are the NPs and PAs working in those clinics. It is the the corporations prescribing by proxy.”

              Many physicians these days are employees of for profit hospital groups, some of the more rapacious corporations to be found. And each of these hospital groups has an established formulary that physicians are expected to prescribe from. And those hospital groups negotiate discounts for approved drugs. That is a kick-back for prescribing in all but name.

              1. weing says:

                @windriven,
                I don’t know about these kickbacks as I don’t work for a hospital group. I know the hospitals have their own formularies and patients would have to supply their own non-fromulary drugs if they were prescribed such in the hospital. I get patients all the time coming from the hospital on a med that was started there and their insurance won’t approve it and I have to change it to something their insurance covers.

  27. PMoran says:

    Simba: “From what I’ve seen here when people get upset it’s usually not because of the tone, but because people are saying outright that, say, homeopathy doesn’t work”

    Well, those insulted commonly just disappear and lots of insult didn’t work on SS, FBA etc — so — ?.

    But this would support part of my case is that any kind of challenge to cherished beliefs can be sufficiently confronting. That is one reason why I wonder about the need for personal attacks.

    Yet you think the “passion and name-calling” helped you? I am prepared to take that on board.

    Would I be right, though, in assuming that you already had prior misgivings about CAM before coming here? My theory is (or was) that those who are likely to be “converted” by such easy means are not the ones that are at any real risk from CAM.

    1. Harriet Hall says:

      I challenged you to try out your methods on SSR. Put up or shut up.

    2. Windriven says:

      This thread has come to bore me to tears. Nothing new has been said for quite some time.

      “My theory is (or was) that those who are likely to be “converted” by such easy means are not the ones that are at any real risk from CAM.”

      The comment section offers a broad range of opinion and style. Not everyone is convinced using the same arguments. Sometimes it takes diligence, sometimes novelty, sometimes a rose. Sometimes a splash of ice cold water.

      1. David Gorski says:

        This thread has come to bore me to tears. Nothing new has been said for quite some time.

        Sadly, that appears to be a frequent consequence whenever Peter decides to engage at a high level in a comment thread on SBM. It’s problem that’s particularly evident after any of my posts that he finds too “shrill” and “insulting” to the point that it inspires him to pontificate on what a horrible, horrible person I am and how terribly, terribly counterproductive to the cause of science-based medicine I am, complaints he makes without actually aiming them directly at me. This boredom is a consequence of Peter’s unrelenting repetition of the same complaints over and over and over and over again.

        Peter just said elsewhere in this thread that “I’d better get used to it,” suggesting to me he has no plans to stop. Maybe I should see if I can find a way to divide the comment threads after my posts into Peter threads and Peter-free threads, so that people who are bored by this repetition can participate without having to wade through all the concern trolling. I do not know how to make WordPress do this, though.

    3. Andrey Pavlov says:

      Agreed. Show us the way. Use your Jedi powers on SSR.

      But this would support part of my case is that any kind of challenge to cherished beliefs can be sufficiently confronting.

      We all already agree on that Peter. You aren’t building some profound “case” here. It is, in fact, something I’ve been arguing with you for ages. Which is precisely why I have consistently compared CAM belief to religious belief. I mean seriously – your ponderously wondering about your case for this when it is a long settled skeptical starting point!

      Would I be right, though, in assuming that you already had prior misgivings about CAM before coming here? My theory is (or was) that those who are likely to be “converted” by such easy means are not the ones that are at any real risk from CAM.

      Your theory is whatever contorted amalgam of things that will allow you to find a way to continue saying the same things over and over again.

      1. Windriven says:

        “Agreed. Show us the way. Use your Jedi powers on SSR.”

        This created the mental image of Yoda trying to hypnotize a grazing goat.

      2. n brownlee says:

        “Your theory is whatever contorted amalgam of things that will allow you to find a way to continue saying the same things over and over again.

        You are so elegant, Andrey.

        As for me, I’m not going to read his comments anymore because I get hysterical and start calling him names. (Truthfully descriptive names, but still. Lacks dignity.)

        1. Andrey Pavlov says:

          You are so elegant, Andrey.

          LOL. Like a ballerina :-P

          But thank you for the kind words.

    4. simba says:

      The approach helped me because it showed at first that someone felt strongly about this as being wrong, and not just wrong, but unethical. That was what spurred me to research further, because I hadn’t even come across much opposition to these ideas. So no, I didn’t have prior misgivings about CAM because CAM was ‘standard’ for me (lots of types but most notably regular homeopathy with the local homeopath). I initially started reading Gorski’s writings on the holocaust.

      And I have already said that this approach was helpful where a more ‘polite’ one wouldn’t have been, because of the message that the truth is worth risking offending others. Again, that is hugely important for people like me, where some degree of CAM has been the norm. That’s something that the approach you dismiss brings to the table, which your approach doesn’t address. Any answers to that? It’s a classic example of the need for a number of voices, because they will serve slightly different purposes.

      I would question the “at any real risk” categorisation- are only those ‘at real risk’ to be educated, and how is that defined? And I was using CAM for conditions which could threaten health and life, so ‘at real risk’ is applicable. Your comment could easily be interpreted as attempting to dismiss benefits from other approaches based on your assumptions, which were in this case entirely wrong. So my experience does not support your theory, in fact contradicts it.

      You say that ‘lots of insult didn’t work on SS, FBA etc’. But you haven’t demonstrated that your approach is any better. These are the regular trolls that will infest any topic if it goes on long enough (other sites get similar raw food faddists, creationists). If you convinced them it would be support for your argument. As it stands it simply looks like they are unwilling to be convinced by any means.

      1. brewandferment says:

        not to mention the latest, Boris, whose immediate approach was pissy and nasty flame-spraying in response to civil replies.

      2. PMoran says:

        Ok, Simba. I must accept that insult and name-calling can influence some CAM users favorably. I actually allowed that possibility at the beginning and everyone seems to agree it can go too far even in that scenario which is enough for me.

        What function do you think it serves with medical colleagues like Barrie Cassileth or Josephine Briggs, and numerous others like them? They will be very familiar with all the scientific considerations, yet they almost certainly think they have just as sophisticated and humane viewpoint as ours.

        Where does the “multiple approaches to CAM” lose validity at the other end of the scale?

        1. Harriet Hall says:

          When are you going to demonstrate your approach by engaging with SSR?

        2. Harriet Hall says:

          “What function do you think it serves with medical colleagues”

          It just might get their attention.

        3. MadisonMD says:

          What function do you think it serves with medical colleagues like Barrie Cassileth or Josephine Briggs, and numerous others like them?

          I think it is more likely to persuade the Simbas. I don’t think Briggses and Cassileths are the target audience of this blog. But, do you have an approach that would change the mind of Cassileth? of Briggs?

        4. Andrey Pavlov says:

          What function do you think it serves with medical colleagues like Barrie Cassileth or Josephine Briggs, and numerous others like them?

          Firstly, (and I do not mean this at all pejoratively) I think your Aussie sensibilities are hyper attuned to any perceived negative commentary. I could be wrong here, but my experience living in Australia for 2 years jibes with your reactions on the matter. Meaning, that the commentary towards the likes of Briggs and Cassileth are, by general American standards, rather mild. Particularly since phrases like “polishing a turd” are extremely well known and commonly used colloquialisms.

          But more to the point – it is useful in that it makes it clear that there is a serious and fundamental disagreement. As Dr. Hall said – to get their attention. Being extremely soft spoken is easy to overlook. Mild rebukes sticking dispassionately to science are easy to dismiss. People on the “outside” are much more likely to just think the soft spoken dissent is just a minor objection, not significant, and continue on.

          We are trying to say that these are serious problems. And making that clear with some mildly insulting language will give pause. It will give outsiders pause to wonder what the heck is going on and the insiders cause to address our points. It is a starting point. A platform to leap from.

          And considering that Dr. Novella has been on the Dr. Oz show, that Dr. Gorski has spoken at many events and at many school and hospitals, that he has been contacted by media outlets for statements and comments, and that SBM has even caught Cochrane’s attention, I’d say it’s at least not preventing our message from getting out and getting heard. Dr. Hall has similarly been on news and radio programs and invited to write articles in other media outlets. Additionally, the media likes to have sensationalism. There is nothing inherently wrong with pandering to that (a bit) to get our science based message out.

          They will be very familiar with all the scientific considerations, yet they almost certainly think they have just as sophisticated and humane viewpoint as ours

          Agreed. Which is why they would (hopefully) find our strong dissent, using somewhat strong language to be jarring. And that is the point.

          Once again, not the only means to achieve the goal (as you agree Dr. Hall demonstrates). And if it were the only voice here I would agree with you that improvement would be necessary. But it isn’t, and that is the point.

          Where does the “multiple approaches to CAM” lose validity at the other end of the scale?

          It’s not about the scale. The multiple approaches is always valid. The specifics will change depending on the audience and the forum. I think Dr. Gorski would agree that being on TV with Dr. Briggs would not be the forum bring up imagery of turds and fetid dingo kidneys. But you seem to fundamentally disagree that we can (and should) take on different voices in different situations. I don’t know what else to say to that except that everyone here disagrees with you.

          1. David Gorski says:

            And considering that Dr. Novella has been on the Dr. Oz show, that Dr. Gorski has spoken at many events and at many school and hospitals, that he has been contacted by media outlets for statements and comments,

            Indeed.

            For example, I got a lot of media requests regarding “right to try” laws because I wrote that piece on it where I didn’t pull any punches. A major cable news channel and a major network asked me to do on-camera interviews. Unfortunately, the leadership of my cancer center didn’t want me to do a televised interview on such a controversial topic; so none of these offers could be accepted and I had to settle for a couple of print interviews that were done before the requests for TV interviews had to be declined. Jann Bellamy also got several interview requests.

            In the wake of Dr. Oz being grilled by Senator McCaskill, I got several media requests based on my posts at my not-so-super-secret other blog (where, I note, I am, if anything, less “restrained” than I am here) about the Senate hearings. Maybe I should crosspost the latest one to complement Scott’s post today. This week, I also got multiple interview requests based on my post this week about the Food Babe and her assault on beer, a post that you would no doubt consider incredibly rude and insulting. (It was intentionally so.) Unfortunately they were very badly timed (like wanting me to do live radio interviews when I have commitments at work), which is the curse of having a demanding day job with respect to the media. (I don’t know how Paul Offit does it.) And let’s not forget how many requests for media interviews Bob Blaskiewicz and I got from our work exposing Stanislaw Burzynski, one of which was a national news network news magazine.

            True, this sort of stuff only happens sporadically, maybe a few times a year, if that, and mainly when a post of mine happens to align with something that’s hot in the news. It also has a highly annoying tendency to happen exactly when I’m most overextended and least available. (This week, for instance, is right before a grant deadline, and I have a couple of manuscripts that editors are bugging me for.) In any case, I was totally shocked over all the requests that came to me over “right to try” laws and very disappointed that I couldn’t do TV interviews, even though the thought of doing TV interviews (which I have only done once or twice in my entire career) scared the crap out of me. The point, of course, is that SBM gets noticed these days, leading to chances to reach a larger audience in mainstream media outlets, where, of course, I tend to use a bit less—shall we say—”flowery” language. (Yes, I’m channeling Dr. Oz with the “flowery” bit.)

            In any case, several of us SBM editors have had similar experiences. We don’t have to go all Ann Coulter (she of the calling all liberals atheistic terrorist sympathizers who want to destroy America and similar) or anything, but unequivocal language with colorful turns of phrase get our message noticed. We just have to be careful not to overdo it.

        5. simba says:

          It might make them stop and think. Some might have a similar reaction to mine: in the health care setting especially, the idea that it is appropriate to strongly oppose CAM can be very useful in acting against the pressures (by patients and colleagues, for example) which might lead people to recommend or defend it. For the ‘shruggies’ a stimulus to thought or interest would be useful. Others might be turned off by it, some it won’t affect.

          If you mean specifically those medical colleagues who are like Cassileth or Briggs, well, a gentle rebuttal of someone who believes their viewpoint is sophisticated, humane, and right doesn’t seem to be much more likely to succeed than a forthright one: a polite argument for homeopathy would be unlikely to convince many in this group simply because it’s obviously wrong. The same will presumably hold true for those who absolutely ‘know’ CAM works based on many years of belief and practice. Are those the group we should be tailoring our message for, considering how much they are in the minority and that they will be the most difficult to reach?

          Even if there were evidence both that the approach you criticize is ineffective (or counterproductive) and that yours is effective for these people, should everyone write to target this small specific group and forget about all the other audiences?

          Even at the risk of losing those parts of the message which could be vitally important to others?

          If you agree that the tone you object to can influence some CAM users favorably, then why not let those who use that tone use their methods, and offer your own voice as an alternative, as has been suggested?
          If you can demonstrate that your approach is more effective, that will convince others to follow.

          1. simba says:

            Damn it, Andrey said it so much better than I did.

            It is important to show people that this is an issue we feel strongly about because it is actually important and really affects people. If the person writing doesn’t feel strongly about it, why should anyone else?

            1. Andrey Pavlov says:

              I thank you for the kind words Simba, but I disagree.

              I think you made your point very well and both supported my comments and made additional and complimentary ones.

              I can add briefly with something I have told Peter many times in the past: in my own experience in the hospital setting saying something jarring and surprising is actually rather important. The topic of CAM and research on it comes up with some regularity. There is often little time to discuss things at great detail and rarely opportunities to continue conversations over multiple encounters.

              With colleagues, saying definitely “CAM is crap” or something to that effect often jars them into asking me to explain myself. And I can explain myself rather well. If I just give a wishy-wishy but ultra polite response, the conversation never happens. If the person is extremely put off by it to the point of just me disagreeing is upsetting (as Peter has recently said and insinuated we don’t realize but we actually do) then its a moot point – no tack would have worked. But at least with some brutish finality it might get the person upset at me. And spur him or her to do the work to research why I am wrong. That will either lead them to discover why (s)he is wrong or to come back and further the conversation. I see only a very small subset in which it is a losing proposition.

              With my patients, I do not use brutish language. But I do use definitive language – like “acupuncture doesn’t work.” Once again, depending on the setting and the patient. As Dr. Hall has said, and I agree, there are times when I will let such things slip and do exactly as Peter says and enable the patient to continue on with a mild and likely harmless delusion. But that is a judgment call to be made on an individual basis and an exception to the rule.

              In any event, I can second Mouse’s commentary and say welcome. Your contributions thus far have been excellent and much appreciated.

        6. Windriven says:

          I swore to myself that I wasn’t going to play this anymore, but one final thought occurred to me. The art of the insult has a long and distinguished history with such luminaries as Shakespeare, Twain, Churchill, Wilde, Faulkner, and many others using it to great effect.

          “Curse the blasted, jelly-boned swines, the slimy, the belly-wriggling invertebrates, the miserable soddingrotters, the flaming sods, the sniveling, dribbling, dithering, palsied, pulse-less lot that make up England today. They’ve got white of egg in their veins, and their spunk is so watery it’s a marvel they can breed.”

          That was penned by none other than D.H. Lawrence. I aspire to be 10% that good.

  28. Harriet Hall says:

    @Peter Moran,

    Simba has given us a testimonial that David’s approach can be effective. Now it is your turn to show that your approach can be effective with the likes of SSR. Put up or shut up!

    1. brewandferment says:

      and Peter, I really am getting curious: why do you keep on fussing and scolding here when you could just write your own material on your website the way you think it should be done? It seems like a good example of the definition of insanity being to keep doing something the same way and expecting different results, with a huge dollop of frustration on both sides of the matter on top.

      1. David Gorski says:

        I wonder that myself. Peter’s Cancerwatcher website is really good, but it desperately needs updating and a facelift to make it look less like a product of 2000 and more like 2014. Some new material would be awesome, as well. That would be a fantastic project that we would all welcome and rely on for information. Also, maybe he would be interested in helping Mark Crislip, Harriet Hall, Steve Novella, and me with supplying the sort of dispassionate material he craves to the Society for Science-Based Medicine (SfSBM) website, our other project. We’re making a wiki out of Quackwatch and adding the sort of more dispassionate analysis that he says he wants.

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

      2. Windriven says:

        I suspect that this tone thing is a metaphor for the real problem Dr. Moran has with Dr. Gorski. I’ve no idea what the real problem is. But it beggars credulity that this is about Gorski expressing his contempt for some quacks with less than genteel characterizations.

        1. n brownlee says:

          Passive-aggressive attempt at exerting control. Repeated, forced confrontations over minor matters moves the attention of posters and commenters from the stated purpose of the blog to Moran’s complaints, therefore, to Moran. Over and over and over, for years. Same old shit. And yet, the commenters never tell him to kiss their asses.

          You know how, at corporate meetings, there can always be that guy who wants ‘clarification’? Again?

          1. David Gorski says:

            Yeah, I wondered about that.

            Peter will insist that he is not a concern troll, but what is trolling? In some cases, it’s the act of derailing the discussion by making the discussion all about whatever it is the troll considers So Incredibly Important, thus drowning out all other topics. Whether consciously or unconsciously, Peter has consistently managed to do exactly that on more threads than I can remember over the last four or five years.

            Control of discussion threads is power over the discussion to bend it to be about what you want it to be about. On a blog like SBM, that’s not trivial, given our traffic.

          2. Windriven says:

            I have to study the passive-aggressive thing a bit. I have a general understanding of what it means but don’t understand the underlying psychology at all.

          3. mouse says:

            Noooo! It’s taken me 12 years and countless cocktails to erase the memories of corporate dramas. I was already having flash backs upthread, because pmoran reminded me a great deal of one employee who spent so much time in my office with various complaints about coworkers, company politics, managements, etc. Now you bring up meetings! Upon reflection, more than the naysayer, I am reminded of the sea gull manager, who is too busy to participate at concept and production, but then comes in at an advanced stage meeting (before a pivotal presentation or milestone of production) with complaints that the project doesn’t meet their “vision” in some way. The required changes are always at the expense of carefully planned budgets, timelines and everyone’s else’s evenings and week-ends, of course.

            The important difference is the fact that no one’s getting paid, here.

            1. Windriven says:

              “I am reminded of the sea gull manager, who is too busy to participate at concept and production,”

              That is a failure of upper management. Any manager with a controlling voice in a project who has not managed the development process closely shouldn’t have ever been a manager. That is flagrant dereliction and a vast waste of resources. Any CEO who allows that is condoning theft from his shareholders.

              1. mouse says:

                Oh well. It happened to some extent at every corporate design/illustration job I ever had. It was just a question of degree. Even when we didn’t have a sea gull manager on our side, there might be one on the client side. Then it’s all a question of scope and renegotiations and how much the company needs the clients.

                I don’t know about in other industries, but it seems like sea gull managers are particularly good at making themselves look good. So, they are good at getting high level jobs in creative/marketing and they can be good in getting clients, but beyond that, urgh.

            2. n brownlee says:

              Yeah, Mouse. Those guys. I had a director, a freaking Managing Director at the Botanical Research Institute of Texas who was so inept at doing any actual managing and so adept at your listed activities that I had dreams about stabbing him in the head.

              Mrs. Frisby and the Rats of NIMH! And for later, the video- The Secret of NIMH. Genius rodents.

      3. simba says:

        I just realised that website is the same Peter Moran’s (after following a link upthread somewhere), I never made the connection before.

        I have linked to that webpage for so many people. It is an absolutely fantastic resource, and a good read too.

        1. David Gorski says:

          I’ve always said so. Indeed, Cancerwatcher was one of the things, besides my experiences in Usenet, that caused me to make the jump from Usenet to blogging in December 2004. A couple of my very earliest posts from those days cite Peter.

          1. Windriven says:

            So … David … are we gonna have to wait till Monday?

            1. David Gorski says:

              Wait till Monday for what?

              1. Windriven says:

                I guess not. I asked 11 nanoseconds before Scott’s blog went up this morning.

                I think I’ll wander over to see if Orac has anything to say.

  29. Bill says:

    Thinking outside the box…

    Another useless, empty phrase intended to imply wisdom. See: integrative, holistic, mind-body, invisible energy, toxins, diversity, non-judgmental, yada, yada, yada.

  30. PMoran says:

    David: “Peter will insist that he is not a concern troll, but what is trolling? In some cases, it’s the act of derailing the discussion by making the discussion all about whatever it is the troll considers”

    It takes two to tango, and there are always these self-reassuring little discussions as to what might be wrong with me adding to the traffic by a factor of four or five. If you think I am a common or garden troll just ignore me.

    If you want an idea of what is at stake, look at the insult, name-calling, psychiatric diagnoses and other unfair characterisations that I have had to endure as the result of regularly expressing something that I cannot help feeling uncomfortable about.

    I have a thick enough skin to take it — most people haven’t — and I still believe that treating people with a default of respect is in the long run most consistent with the standards of ethics, humanity, fairness and rationality that I though we all aspired to and perhaps wished to have on display here.

    Medicine is based upon the worth of the individual. We look after our enemies and wrongdoers as if they were our own. CAM is rarely if ever of such critical importance that we should ever look like losing sight of that, even if certain tactics seem to be able to produce desirable ends in some.

    I am sure that Americans are familiar with the term “playing the ball, not the man”. Surely that provides adequate opportunity for the expression of passion, ridicule, satire, extreme concern — whatever. ,

    1. David Gorski says:

      It takes two to tango, and there are always these self-reassuring little discussions as to what might be wrong with me adding to the traffic by a factor of four or five. If you think I am a common or garden troll just ignore me.

      Not a bad idea at all. In fact it’s an excellent idea. In case you hadn’t noticed, I do do exactly that from time to time, sometimes for fairly long periods of time, just for the sake of my sanity and blood pressure. Maybe another such period of benign neglect of your concern trolling is due. Usually what interrupts such periods is someone e-mailing me about what you’re saying in the comments of one of my posts. That’s what happened this time. I need to learn to ignore those.

      However, I will make an exception for now. Every time you post, I’m going to remind you that Harriet and I have asked you to contribute a guest post that tells us how to do it right, with concrete recommendations. Earlier in this thread you said you sent it in late May, but apparently you sent it to the wrong e-mail address. Please send it again now to sbmeditor@icloud.com, my editorial e-mail address. I’m waiting. I promise I’ll put its processing on fast track.

      Also, as Harriet has challenged you, please lead by example. Show us the way. Engage either SSR or FBA or one of the pro-alt med people who show up and argue for their favorite woo. Show us how your way is the better way. I’m not dogmatic, at least not as dogmatic as you appear to be. If you show me that you can do what you say your method is capable of, I might rethink.

      Your failure to provide us with your guest post and to show us the way by leading by example make me wonder: Are you willing, as we Americans like to say, to put your money where your mouth is? Sniping is easy, after all. What about my suggestion, made upstream in this comment thread, regarding the Society for Science-Based Medicine? We are converting Quackwatch to a wiki to provide exactly the sort of resource full of constantly updated authoritative and dispassionate information that you say you want. (As I said, yes, we can walk and chew gum at the same time.) I invited you to help. In fact, several articles from your Cancerwatcher website would make fantastic additions to the wiki, particularly your analysis of Gerson’s 50 cases and discussion of why alternative cancer cure testimonials are so misleading. I learned a great deal from them and use the principles described in them frequently. Your articles, properly updated and cleaned up into wiki format, would be excellent additions. By letting us convert them to wiki format and add them to the wiki, you could “immortalize” them so that they live on long after you’re gone.

      Think about it. Will you do it?

      Also think about this: You’ve spent thousands upon thousands of words over the last four or five years castigating me as a major asshole who’s destroying the reputation of SBM and driving fence sitters away with my assholery. In contrast, apparently you no longer have the time or will to do something positive, like showing us how it’s done or helping us do something you say you support while at the same time ensuring that your contributions on Cancerwatcher live on. I see a contradiction here. Indeed, it’s hard for me not to wonder whether you get far too much enjoyment out of complaining about my rudeness, as, here, at least, it appears to be what you spend by far the vast majority of your time and verbiage.

    2. Andrey Pavlov says:

      If you want an idea of what is at stake, look at the insult, name-calling, psychiatric diagnoses and other unfair characterisations that I have had to endure as the result of regularly expressing something that I cannot help feeling uncomfortable about

      I’m sorry Peter, but what psychiatric diagnoses? Seriously, point out when that was said. If by me, I unreservedly apologize. If by someone else, I (and I imagine the others here) will publicly condemn it. But to the best of my knowledge nobody has leveled charges of psychiatric illness at you.

      As for name-calling – yet again, tone troll is not “name calling.” It is simply accurately describing a set of behaviors.

      Insults…. sure, I’ve flung a few and you have as well. It doesn’t matter who shot first, we are both culpable in that regard. But we’ve both got thick skin.

      And I too will also close every comment to you with the same challenges as Drs. Gorski and Hall:

      Show us the way with SSR. Submit your guest post. Spend your time helping with SfSBM to become precisely what you are advocating for. And allow your truly excellent Cancerwatch material to be added to its repository of information, with full credit, so that the immense good you have done will be updated and live on.

    3. n brownlee says:

      ” look at the insult, name-calling, psychiatric diagnoses and other unfair characterisations that I have had to endure”

      Pointing out that you have a four-year history of comment that is indistinguishable from trollery, and characterizing that behavior as a passive-aggressive pattern, are not “psychiatric diagnoses”.

      “there are always these self-reassuring little discussions as to what might be wrong with me adding to the traffic by a factor of four or five”

      Oh, I hardly think so.

      1. Windriven says:

        Yeah, I choked on that “adding to traffic by a factor of four or five” too.

        His modesty is as genuine as the love of a prostitute.

        1. David Gorski says:

          I think he’s mixing up traffic with number of comments. Arguably he does probably double, triple, or maybe even quadruple the number of comments thanks to his incessant complaints about tone, but I highly doubt he detectably affects SBM traffic.

  31. mouse says:

    pmoran “I am sure that Americans are familiar with the term “playing the ball, not the man”. Surely that provides adequate opportunity for the expression of passion, ridicule, satire, extreme concern — whatever. ,”

    Oh – World Cup is it? Here you go.

    “12.7 TACKLING
    The referee must judge whether the tackle of an opponent is fair or whether it is careless, reckless, or involves the use of excessive force. Making contact with the opponent before the ball when making a tackle is unfair and should be penalized. However, the fact that contact with the ball was made first does not automatically mean that the tackle is fair. The declaration by a player that he or she has “got the ball first” is irrelevant if, while tackling for the ball, the player carelessly, recklessly, or with excessive force commits any of the prohibited actions.

    A foul committed while tackling an opponent with little or no concern for the safety of the opponent shall be cause for the player to be sent from the field and shown the red card for serious foul play.”*

    In soccer, a foul. In skeptics ad hominem. (I guess). But Windriven certainly made contact with the ball first, since he addressed the problems with the claims of the commenters before insulting them. While the tackle was rough, it certainly wasn’t going to endanger the safety of the other player. So I say “play on”.

    You skeptic don’t have offsides, do you? Because I still can’t get that. The offense can’t be ahead of the opposing defense when the ball is passed or they have to be in control of the ball before they pass the defense? Sheesh, I don’t know.

    *http://www.askasoccerreferee.com/?s=tackle

  32. PMoran says:

    “However, I will make an exception for now. Every time you post, I’m going to remind you that Harriet and I have asked you to contribute a guest post that tells us how to do it right, with concrete recommendations”

    I have done my best to show that personal insult and name-calling are undesirable for many reasons: for the people that they will repel, for the character they project, for the perceptions they may reinforce, for their unreasonableness and unfairness if directed at people who think differently on account of sheer lack of privilege or because of justifiable grouches with the mainstream that they need to get off their chests.

    It is undesirable because of all these things and also because it is a grubby and fallacious debating tactic It is perverse if it is truly necessary for the welfare of some people and that should be weighed against potential unintended consequences and how far you are prepared to go towards ends justifying means.

    The fact that you can find half a dozen like minds defending it on a site which will concentrate a certain kind of person is irrelevant to the truth. You are simply not listening to me and others who make similar criticisms, despite being as ardent in scepticism (remember the talk on a sceptical conference _- “Don’t be A Dick!”).

    You use the very same tactics to cow the rest of the group into accepting dubious behaviour as normal, needed and admirable. If you are going to dish it out be prepared to cop some.

    And it is not clear that it is even necessary — .

    W, you did not bother to find out what “matters I had on my plate” before you accused me of “weaselling out” of the stupid “SS challenge” (all I have claimed is that I could probably help him understand better why his views are not having much impact), but I will still talk to you, since you are one of the ring-leaders in this respect..

    You found justification in the insults of literature. Here is an example from literature how really smart people (Goethe) can elegantly and effectively skewer a CAM concept.

    “THE DARK-HAIRED LADY

    The crowd are pressing round to squeeze you dry.
    “I ask a cure! For a frozen foot                                                                   
    That hinders me in dancing, walking by,
    And I curtsey awkwardly to boot.”
     
    Mephistopheles
     
    Permit a little kick from my foot.
     
    The Dark-haired Lady
     
    Well, between lovers that’s occurred before.
     
    Mephistopheles
     
    Child! My kick means something more.                                                     6335
    Like cures like, when one’s suffering:
    Foot heals foot, and so with every member.
    Come! Pay attention! No retaliation there.
     
    The Dark-haired Lady (Crying out.)
     
    Ouch! Ouch! That hurt! I call that kicking
    Like a horse’s hoof.

    Mephistopheles

     With that the cure I bring.                                               6340
    You can indulge in any amount of dancing,”

    I do think that

    1. n brownlee says:

      “Don’t think of retiring from the world until the world will be sorry that you retire. I hate a fellow whom pride or cowardice or laziness drives into a corner, and who does nothing when he is there but sit and growl. Let him come out as I do, and bark. ”

      Samuel Johnson

      1. Windriven says:

        High five.

        1. n brownlee says:

          :)

  33. PMoran says:

    “I’m sorry Peter, but what psychiatric diagnoses? Seriously, point out when that was said. If by me, I unreservedly apologize. If by someone else, I (and I imagine the others here) will publicly condemn it. But to the best of my knowledge nobody has leveled charges of psychiatric illness at you”

    I’ll revise that. It was a bit strong. I was referring to being called passive aggressive, but mainly the not so subtle implication, mainly from Dr Gorski, that my recurring complaints must necessarily derive from some recently developed aberrance of mind. That’s cheap, but illustrative.

    I have in fact held these views since I first got involved in sceptical activities. You will have to look hard to find anywhere that I have indulged in personal insult and certainly not in schoolyard name-calling (beyond the occasional use of “quack”).

    If any of you truly want to see my approach, there are examples on my web site and on Quackwatch. You will find that it is much the same as that used by most writers here, merely lacking some of the characteristics that I think are questionable, and on balance probably counterproductive for the function of this site, in others.

    The accusation of trollery also implies some kind of psychological aberrance, or otherwise bad intentions that I do not in fact possess.

    1. David Gorski says:

      I’ll revise that. It was a bit strong. I was referring to being called passive aggressive, but mainly the not so subtle implication, mainly from Dr Gorski, that my recurring complaints must necessarily derive from some recently developed aberrance of mind.

      Bollocks. (A British term I do so like.) I never said any such thing. Because of that, I’m calling you out here. Prove I made such an implication. Put up or shut up.

      The accusation of trollery also implies some kind of psychological aberrance, or otherwise bad intentions that I do not in fact possess.

      No. It. Does. Not. Seriously. It doesn’t imply psychological aberrance. Again, I’m calling you out for this one. As for bad intentions, how many times have I said that your intentions are pure in this thread alone? That doesn’t mean that what you’re doing isn’t concern trolling. Go back and see. Read it again. If you don’t, I’ll go back and find my quotes and repeat them yet again.

    2. Andrey Pavlov says:

      I’ll revise that. It was a bit strong.

      So it is OK for you to be “a bit strong” and bandy around such serious accusations when it suits your needs?

      that my recurring complaints must necessarily derive from some recently developed aberrance of mind. That’s cheap, but illustrative.

      I think this is entirely inaccurate and unsubstantiated. It is clear that he (and everyone else, including WLU, who makes reference to this) is pointing out that there is an undeniable difference between your previous writing and work and your current and ongoing commentary here. The cause of that is nothing but pure speculation on your part which you are intentionally (consciously or not) taking in the worst possible manner and additionally amplifying it in order to create an image of a persecuted Peter Moran.

      People change their minds and act and think differently for myriad reasons that have nothing to do with an aberrance of mind. You first assume that Dr. Gorski must be referring to an aberrance and then additionally overinflate even that to call it a “psychiatric diagnosis.” That is patently disingenuous and unreasonable. Particularly since Dr. Gorski has very reasonably stated many times quite clearly that he does not know what has brought about your change in mind and has speculated only a handful of things about it, none of which have anything to do with mental aberrancies.

      The accusation of trollery also implies some kind of psychological aberrance, or otherwise bad intentions that I do not in fact possess.

      Honestly Peter, I cannot believe you are still on about it like this. How many times must it be explained to you by how many different people before you stop bandying about this false accusation?

      Yes, troll can refer to psychological aspects of a person. But it also refers to behavior. Specifically the behavior of dominating the comments of a post with specific content that is not on topic with the original post. The type of content can be anything and varied, or specific and consistent. In your case it is specifically and consistently about tone and concern. Hence, “tone troll” is merely and only a description of the actual behavior you are engaged in without any necessary insinuation of the motives or psychological state engendering it. That said, it is entirely reasonable for you to assume there was that implication given the other meanings of troll, but once it was explained to you – quite clearly and by multiple different sources – that those implications were not involved in the usage of the term you should have dropped it. Unless you think we are trying to outright lie to you about our intended usage of the term and gaslight you, of course. We are using one very specific and perfectly legitimate use of the term and it is unreasonable for you, after having had that explained numerous times, to simply ignore that and continue to levy such charges against us. It is nothing but allowing you to feed into your persecution complex in the same way you have wildly extrapolated Dr. Gorski’s comments to mean he has levied psychiatric diagnosis at you. Both are patently unfair and uncalled for.

      You will also notice that you are never merely dismissed without further qualification as a tone troll. Your points are addressed, usually at great length by myself, and only then concluding that your comments are still nothing more substantive than tone trollery.

      Nobody doubts your intentions. But we are saying that you are not realizing your own biases (despite your protestation that you are completely unbiased, which as a skeptic you should know is utterly impossible) and the utterly repetitive nature of your complaints. That is all we have been trying to say – we heard you, we get it, we disagree with you, move on. What else would you call someone who continues to repeat the same things over and over and over and over again after his interlocutors have said we’ve heard you, understand you, and disagree with you?

      1. David Gorski says:

        So it is OK for you to be “a bit strong” and bandy around such serious accusations when it suits your needs?

        Of course. Peter fights on the side of Right and Civility. If he has to be a rather uncivil himself to his allies, more so than he says we should be to our opponents, in order to fight that fight, well…a man’s got to do what a man’s got to do, right? Even if it means accusing an ally of something nasty that he clearly never did? It’s all for the cause of Civility, after all. You can’t make an omelette without breaking a few eggs, you know.

    3. Andrey Pavlov says:

      I should have also commented on this:

      I have in fact held these views since I first got involved in sceptical activities.

      If so, it was not as evident in your previous work. No doubt you were always more genteel than Dr. Gorski, but the point is that you are now vastly more so. Perhaps a “change of mind” is not the best descriptor but certainly a change in degree. Either way, the points and commentary stand.

      1. David Gorski says:

        It would be rather interesting to go back to misc.health.alternative and find some of Peter’s old posts there. I remember him being quite a bit more…strident…than he is now. The time period of interest would be between around 1999 and 2004.

  34. PMoran says:

    David: “Prove I made such an implication. Put up or shut up.”

    “Quite frankly, I’m sick and tired of your sanctimony on this issue and have been for at least a couple of years. I hid my growing irritation for a very long time due to my deep respect for your past efforts and accomplishments fighting cancer quackery”

    This is the only bit in this present thread that echoes past attempts to portray my case as due to “some recently developed aberrance” of mine.

    When and why did your respect for my judgment stop? I’ll tell you –, it is when I began to be critical of you bringing a misc.health.alternative style of gutter-brawling, including all the sneering at the “alties”, that you clearly enjoy for reasons unrelated to any noble purpose, to THIS blog and even started applying them to colleagues deserving of more respect.

    You say that different scenarios warrant different approaches — show it.

    Unless provoked this will be my last comment on this thread.

    I have submitted (again) a blog post to David, but as I do have a lot of other things on my plate at the moment (including an analysis of Nicholas Gonzales’ “One Man Alone” fro Dr Barrett), I do not want to get involved right now the torrent of comment I expect that article will provoke from this circle. So I have asked him to hang onto it for a while before putting it up. To prove it exists I have put it up on my own web site at

    http://www.users.on.net/~pmoran/cancer/a_perspective_on_cam.html

    and you are all free to examine it if you like.

    1. Windriven says:

      I will withhold comments on your post until it appears on SBM.

      1. David Gorski says:

        I have received it and will look it over this weekend. If it needs editing, I will ask Harriet, Steve, or another editor to do it. I don’t want to give even the hint of conflict of interest interfering with the editing of it. In fact, I think I’ll have several editors look at it in any case and basically take its processing (mostly) out of my hands.

        1. Windriven says:

          If what he submitted is identical to what he posted, it shouldn’t need much.

    2. Andrey Pavlov says:

      it is when I began to be critical of you bringing a misc.health.alternative style of gutter-brawling, including all the sneering at the “alties”, that you clearly enjoy for reasons unrelated to any noble purpose, to THIS blog and even started applying them to colleagues deserving of more respect.

      In addition to the fact that “gutter brawling” and “sneering” are subjective terms that most others here (including Dr. Hall, whom you still supposedly respect) would disagree with, the key point here is that it is not your blog. If Dr. Gorski wishes to have a truly gutter brawling and snide post… that’s his prerogative. I’d be willing to bet that Drs. Novella and Hall would take him to task for it though.

      So once again, it boils down to a question of subjective degree. It is your assessment that Gorski is “gutter brawling.” Nobody here agrees with you. Yelling it louder and more incessantly will not sway our minds. Saying something over and over does not make it true. And at the end of it all, you do not get to dictate the content or style of this blog any more than I do. Continuing to do so is, once again, the behavior of a tone troll. We heard you, we get it, we disagree with you, you don’t get to dictate the content and style of the blog. If you don’t like it that is perfectly reasonable! But you can also not read it and leave! Nobody is forcing you to come here and be so grievously offended.

      You say that different scenarios warrant different approaches — show it.

      Besides the fact that we have, he doesn’t need to. He can be completely 100% wrong and yet it is still his blog (along with the other managing editors) and that’s that. Nobody is under any obligation to prove to Peter Moran anything. Yet we have diligently and patiently attempted to do so over 4 years out of respect – both for you and the process of SBM. At some point though, enough is enough. Einstein said that the mark of insanity is doing the same thing over and over and expecting different results. We’d both be guilty of that.

      As for your post, I will await it’s publication on SBM. In the meantime, feel free to finally change tack and lead by example with SSR. You want us to prove that different scenarios warrant different approaches, but expect us to change our minds simply because Peter Moran says he can definitely do something we believe you can’t. Hardly seems science based to me.

      1. David Gorski says:

        I’d be willing to bet that Drs. Novella and Hall would take him to task for it though.

        And you would be correct, too. Harriet would never let me get away with something she objected to strongly. Steve is a bit more “above the fray” and hands-off, given his many other commitments, but I have no doubt that he’d take me to task if he thought something I wrote crossed a line. And I would listen to them both, too, because I respect and trust their judgment.

    3. David Gorski says:

      You say that different scenarios warrant different approaches — show it.

      You can’t be serious, can you?

      There is no need for me to do this, because I have done it already. I have over several years demonstrated that I am capable of using different approaches in different scenarios more times than I can count. Go back and read my posts on mammography, chemotherapy, cancer screening and overdiagnosis, analyses of various clinical trials, ruminations on the nature of cancer and why we haven’t cured it yet, etc., etc., etc., etc.

      You yourself have even praised some of those posts. You’re asking me to “prove” something that I’ve already demonstrated time and time again, even to you. Or don’t you remember?

    4. Harriet Hall says:

      Peter, why are so blind to your own behavior? You are using the same tactics you deplore. You call David’s style “gutter brawling” and you accuse him of having no noble purpose. You ask him to show that different scenarios warrant different approaches, when he has already done that and when commenters have provided testimonials to the effectiveness of his approach. Your comments have become progressively more offensive. And you have ignored my challenge to demonstrate that your approach is superior by engaging with SSR. None of us have been able to make any headway with him, and we would be very impressed if you could. You are missing out on a perfect opportunity to persuade us.

      1. David Gorski says:

        BTW, I started to look up some of Peter’s posts from 10-15 years ago. I hear an echo of myself. Perhaps I’ve been influenced by Peter Moran c. 2004 more than I thought I was. For example, here’s Peter in 2005:

        But it is not the role of patients to publicise cancer treatments. They truly do not have a clue – see http://www.home.gil.com.au/~moringa/cancer/BCtestimoniali.htm . Nor do oncologists have to be on the lookout so as to be ever-ready to hail anyone who is quietly beavering away somwehere treating cancer patients without letting anyone know about it.

        It is Holt’s job to promote his work, as has always applied to any scientist or physician. If his results were anywhere near what he is allowing Martin and others to claim he should have hundreds of cases of proven active cancer that clearly remitted with his treatment. Even a handful of such would create great interest if published.

        I have nothing but contempt for such behaviour, especially from a doctor with the training and experience to know better. They are either pathetic wimps, or prefer the role of the persecuted public hero to that of effectively propagating their treatment, should it is anywhere near as effective as claimed.

        Sounds rather…insolent…to me.

        So does this post, from 2009, which, I note, is not long before the time Peter started chastising me for being too blunt. I really like it, and Peter really does demonstrate some good online “gutter brawling” abilities in the followup posts:

        “Earlier this year, N. D. s in B. C. earned the right to prescribe medications such as painkillers, antidepressants and antibiotics. Jones said they can write prescriptions for most drugs, apart from some of the most unique chemotherapy drugs. ”

        http://www.standard-freeholder.com/ArticleDisplay.aspx?e=2142811

        Why? And why register naturopaths in the first place?

        It is difficult enough to ensure responsible prescribing of powerful drugs by well-trained medicos. And if the naturopath’s diets, Detox and supplements are not working, it is surely time the patient was looked at by REAL physicians.

        As it is, naturopaths, chiropractors, TCM and other CAM practitioners get away with what they do because nearly all their clients are also seeing proper doctors, who take full responsibility for their more serious complaints. With many other conditions it doesn’t make much difference anyway.

        So we get the occasional death when some idiot naturopath stops a diabetic’s insulin, or a homeopath tries to treat meningitis with crap, but such deaths are rare enough at the moment to support the illusion that primary medical care is easy — as it is, with many everyday complaints.

        The problem is the wannabee doctor who takes his own “shtick” about “toxins” and “natural” remedies and supplements and the evils of conventional medicine too seriously. I know from much observation that few “alternative” supporters trust this stuff enough to entrust their lives to it, but it can be a different matter when it is someone else’s life, and you want to try and prove a point.

        I particularly like this gem from a little later in the thread:

        A good naturopath is one that knows his limitations. He suspects deep down that he is practising “make-believe” medicine with an admixture of borrowed conventional medical knowledge. He understands that he is satisfying some medical needs but not influencing the course of any serious illness.

        So bluntly saying that naturopaths practice “make believe” medicine? I also like the term “admixture of borrowed conventional medical knowledge,” which sounds very much like how I describe “rebranding” science-based medicine by naturopaths as somehow “alternative.”

        Why, Peter, I approve! Well done! As I do of this post by you in 2007 about Patrick “Tim” Bolen’s defense of arch cancer quack Hulda Clark:

        Tim is, as usual, making things up — the “big, brazen lie” tactic he has used since day one. This extract from an actual court judgement against those selling Clark products lists the Clark claims that the FTC didn’t like and that no one, not even Tim Bolen her main defender, could substantiate in court.

        And, perhaps my favorite, from 2003:

        The websites posted have nothing whatsoever to do with Jan’s mind.

        On the contrary!! They show that you approve, or ar least do not condemn, cancer patients being induced to forgo potentially curable medical treatment.

        They show you approve of the propagation of lies to achieve that end.

        The posting of the web sites without comment shows that you have insufficient grasp of the issues to contribute anything.

        It shows that, despite such admirable and unexpected self-awareness and despite the depth of that ignorance you still will support anything that you think somehow damages doctors and conventional medicine, ignoring the possibility that the only people being harmed are cancer patients.

        Need I go on?

        thanks for showing us once again the angers and nastiness of organized medicine.

        Of course I am angry. Having been a regular target of your venom, I don’t much care if you think I have been nasty.

        Also in 2003, Peter said about Jan Drew, the woman he addressed above:

        Jan, I may know with some certainty, along with others here, that you are a very ignorant person and a religious bigot, that you frequently lie for effect, and that you have not the slightest ability to understand medical or scientific issues. But I have never said that in a post heading. Do you think I should start that, now that you have reduced your standards of contribution to this new low?

        All of which I know, as a former regular in misc.health.alternative around that time, to have been true about Jan Drew. Peter was absolutely correct in his assessment and quite right to lash out at her, given that she titled the thread the “despicable Peter Moran.” Of course, that was before Peter became so concerned with civility. What about after? Another thing that I found while searching more recently (i.e., after Peter had turned to his current kinder, gentler ways) I found threads with titles like

        Clearly, Peter’s “kinder, gentler” approach has failed to keep the quacks from hating him just as much as they did in the old days 10 years ago when he was a lot more like me.

        1. Andrey Pavlov says:

          Interesting indeed.

          Perhaps the naturopaths and homeopaths he was referring to were the ones that weren’t genuinely believing they were trying to help their patients to the best of their abilities?

        2. PMoran says:

          Oh, David, really?

          After yourself referring to “horses for courses” you think that what I said 15 years ago in the seething cauldron of MHA somehow justifies dubious behaviour now, on a much more public blog called “science-based medicine”?

          Not that I don’t have other defences for some of this. I pointed out to Jan when she used my name in an insulting fashion in a post heading that I had always shown restraint in dealing with her (despite the fact that the exchange of insult was an art form and the principal form of dialogue on that newsgroup!).

          I was obviously very angry at another time — and the interest in that instance lies mainly lies in Jan’s response, –
          -
          “- thanks for showing us once again the angers and nastiness of organized medicine.”

          – showing how easy it is to “project character” and “reinforce adverse perceptions”.

          We were able to prove that Tim Bolen was lying by reference to court documents.

          Other statements of mine do not involve either insult against individuals or name-calling, although they may speak forthrightly about a class of people. Our present difference is not about the forthright expression of views, it is about the use of personal insult and name-calling in a context that suggests that this is the way science is carried on.

          The Holt case? Actually I might speak just a little differently in front of a different audience.

          The longer you hold my blog post the better. Give me the opportunity to review it before putting it up.

          1. Andrey Pavlov says:

            So, let me get this straight Peter….

            You open up by flat out admitting that different tone is appropriate for different audiences (even when said audiences could very well be those hypothetical future patients of ours) and then you proceed to justify exactly the same wording and behavior as excusable for you, but somehow not for Dr. Gorski.

            How much more credibility do you have to lose?

            1. David Gorski says:

              Sigh.

              It’s clear that Peter is unpersuadable on this point. That’s fine. He doesn’t have to agree with me. I can respect that. I only wish he would show me the respect he claims he shows everyone else and just agree to disagree. If my posts offend him so deeply, the solution is simple. He should stop reading SBM on Mondays. It really is that simple, because he’s failed to persuade me, and I’m not likely to change. But he won’t do that, because—or so it would seem—he is Right and I am Evil.

              BTW, I did another radio interview about Dr. Oz yesterday evening, thanks to my posts about him.

          2. David Gorski says:

            After yourself referring to “horses for courses” you think that what I said 15 years ago in the seething cauldron of MHA somehow justifies dubious behaviour now, on a much more public blog called “science-based medicine”?

            No, I’m simply pointing out that, for all your pearl-clutching about civility, you were quite capable of some major gutter brawling in the trenches when you thought it necessary. It’s one of the things I admired about you back then that’s disappeared. Actually, it hasn’t disappeared. You’re still good at “gutter brawling.” You’ve just set your sights on a different target, for whatever reason or reasons.

            Not that I don’t have other defences for some of this. I pointed out to Jan when she used my name in an insulting fashion in a post heading that I had always shown restraint in dealing with her (despite the fact that the exchange of insult was an art form and the principal form of dialogue on that newsgroup!).

            I beg to differ about your “restraint” back then. Sure, you were still probably more “restrained” than I was on average, but you didn’t hesitate to tell it like it was. I found other examples that I simply didn’t use because my comment had become too long. Would you like me to post them?

            Other statements of mine do not involve either insult against individuals or name-calling, although they may speak forthrightly about a class of people. Our present difference is not about the forthright expression of views, it is about the use of personal insult and name-calling in a context that suggests that this is the way science is carried on.

            More bollocks. Basically you’re now arguing about how many angels can dance on the head of a pin. So let me get this straight. It’s OK for you to sneer—yes, sneer—at “naturopaths” and characterize them as not being real doctors (something I myself frequently call them) and dismissively refer to some “idiot naturopath” killing a diabetic by stopping his insulin, but if I characterize defending NCCAM as “polishing a turd” in what most readers considered a fairly humorous fashion, I’m committing some horrible, horrible offense against civility that so offends you that you feel utterly compelled to post dozens of complaints in the comments about it and to keep arguing when it’s clear that almost no one agrees with you? And you can say you have nothing but contempt for a man like Holt, referring to him as a “pathetic wimp” or someone who wants to be a self-made martyr, but when I refer to “integrative oncology” as “quackademic medicine,” I’m the the horrible one.

            In fact, tell me in this particular post, where did I “insult” anyone? Where did I do anything but attack arguments. Sure, I referred to “integrative medicine” as “quackademic medicine” and “integrative oncology” as “quackademic oncology,” but that’s not an insult to a person. It’s, as you put it, “forthrightly speaking” about what I consider to be a dubious (at best) medical specialty. About the worst thing I said about, for example, Barrie Cassileth was:

            It is admirable that Dr. Cassileth can and does on occasion attack quackery in a way that would do SBM proud. Unfortunately, it is equally frustrating that she doesn’t seem to grasp that much of the “integrative” oncology she promotes, such as acupuncture, is based on the very same pre-scientific, vitalistic concepts as the cancer quackery she so rightly detests.

            What do you find in that characterization that is so “insulting”?

            The worst thing I said about her in that post is really only a criticism of her arguments and failure to grasp that what she is promoting is not at all unlike the cancer quackery she so rightly deplores. I said nothing worse than that about Dr. Cohen, either. Basically, I spent the entire post arguing why I thought they were wrong, not “insulting” them. Dr. Harvie was praised as being science-based in her talk; I only complained about the context and how her talk on nutrition and cancer was a “rebranding” of a science-based modality.

            I also went back and reread my post on “polishing the turd” that is NCCAM. There are no personal insults against NCCAM director Dr. Briggs, just forthright—word choice intentional—refutations of her arguments. Don’t believe me? Go back and read it, but strip out the whole “polishing the turd” metaphor that you find so horrifically offensive. You’ll find no insults. The “turd” being polished is NCCAM, and no insult is directed at Dr. Briggs. In reality, that term appears to be pretty much your sole objection to the post, as there are no personal insults in that post. Finally, I even went back to my Food Babe post. Yes, I characterized her as scientifically ignorant, but that is an utterly accurate characterization of her, as I proceeded to demonstrate in detail.

            I’ll be honest. Your reaction to my posting some blasts from the past by you surprised me. I expected that, faced with some rather intemperate language by you from the past (some of it not even that distant) you would admit that, yes, you used to be fairly “insolent,” like me, back then, but then you changed your mind. Instead, you contort logic and word definitions into a pretzel to try to justify what you routinely did back then as being somehow different and therefore more much more “pure” than what I’m doing. You point out how your characterization of Tim Bolen as a liar was evidence-based. You’ll get no argument from me there. However, if you read my posts over many years, you’ll find that I almost never call anyone a liar, even when I either know or have strong evidence to believe that he is, in fact, a liar—not even Tim Bolen. In that, you have been more “forthright” than I have.

            In any case, I think I get it now. You now seem to confuse strong language attacking concepts that certain people are promoting with personal insults. The two are not the same. You also seem to think that this is some sort of high brow academic journal, where such metaphors as “polishing a turd”—or, for that matter, “sCAM,” “beer goggles of medicine,” and metaphors favored by Dr. Crislip, whom, interestingly, you rarely criticize—are never to be found. It isn’t. It is a blog. Its purpose is to educate in an entertaining and, yes, science-based fashion. And I’m tired of your sanctimony. Still.

    5. David Gorski says:

      I do not want to get involved right now the torrent of comment I expect that article will provoke from this circle.

      Will three weeks be a good amount of time?

      Then we could run it while Steven, Harriet, and I are all at The Amazing Meeting from July 10 to 13.

  35. WilliamLawrenceUtridge says:

    So I decided to review the comments for this post from top to bottom, to see if there was anything I missed. I saved an immense amount of time with one simple rule – any comments thread started by Pete, I ignored.

    Far, far too much time has been spent on this. Far too much.

    1. David Gorski says:

      Agreed. And I apologize for letting myself get drawn into it and thereby perpetuating the threads.

Comments are closed.