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Modern shamanism—naturopathy for hypertension

I’m a primary care physician. What I, other internists, pediatricians, and family medicine docs do is prevent and treat common diseases. When we get to diseases that require more specialized care, we refer to our specialist colleagues. There is a movement afoot to broaden the role of naturopaths to make them primary care doctors. The big difference between naturopaths and real primary care physicians (PCPs) is that naturopaths haven’t gone to medical school, completed a post-graduate residency program, and taken their specialty boards. Why is this important? If a naturopath wants to be a PCP, then they must provide the same services as other PCPs. They do not. What, you don’t believe me? The thing is, naturopaths have an incorrect understanding of human biology and do not understand how this is applied in a science-based fashion to prevent and treat human disease.

Naturopathic “physicians” claim that “the human body has an innate healing ability” and that they “teach their patients to use diet, exercise, lifestyle changes and cutting edge natural therapies to enhance their bodies’ ability to ward off and combat disease.”

I must admit that I don’t get it. As a primary care physician (the real kind) I talk to my patients every day about diet, exercise, and lifestyle changes. I’m not sure what “natural therapies” are—all of the medications that I prescribe are “natural”. What is the opposite of natural? Unnatural? Supernatural?

As a primary care physician, I see a lot of common, serious problems, like diabetes and hypertension, and coronary heart disease. Coronary heart disease (CHD) is the biggest killer of Americans, and hypertension (high blood pressure) and diabetes are two of the primary causes of CHD. The next most common killer of Americans is cancer. If naturopaths want to be allowed to practice primary care medicine, they better be prepared to diagnose and treat these conditions in a way that is proven to help patients.

Let’s take a look at the website of their main professional organization, and see what they recommend for, for instance, hypertension. I’m choosing hypertension because their website doesn’t have a section on diabetes or on disease prevention.

First I’ll tell you a little bit about how doctors approach hypertension. High blood pressure leads to heart attacks, strokes, kidney failure, and blindness. Untreated hypertension is one of the biggest health problems in North America. Because hypertension is so common and has so many disabling and deadly consequences, it has been studied quite well. We have learned over the years which type of patients benefit from which blood pressure goals and from which interventions. For example, the ALLHAT trial was released a few years ago. This study followed tens of thousands of people with hypertension and found that a simple and inexpensive intervention (a thiazide-type diuretic pill) was very effective at preventing serious coronary heart disease.

When I tell a patient that they should start a blood pressure medication, they are often hesitant. They often ask if there is another way to lower blood pressure. This has been studied as well. For example the DASH diet has been found to lower blood pressure significantly (from about 4-7 mmHg for the systolic pressure). If I have a patient with mild hypertension, this may do it, if they can stick to the diet. However, most of my patients don’t have stage I hypertension (a systolic BP from 140-159), and even in those who do, the gains from following the DASH diet are minimal. If I get a patient to really stick to it, maybe I can get their BP from 158 down to 152. That’s not very good. Most practicing PCPs know that diet and exercise will achieve good blood pressure goals in a minority of patients. Still, when it’s safe, and the needed goals are modest, we recommend it as first line therapy, especially for pre-hypertension.

In summary, the evidence tells us that we must lower blood pressures to save lives, and that diet and exercise are good enough in a small percentage of patients. We screen for hypertension and its complications, and then prescribe diet, exercise, and/or medications to lower our patients’ risk of becoming ill.

What do naturopaths have to offer? It’s not clear to me from reading their literature how they approach screening, but let’s say they have identified a patient with hypertension.

The website of their national organization gives some good information about what hypertension is and why we should care. What it doesn’t do is explain how they will effectively treat it.

To treat hypertension, naturopaths might counsel patients on eating a healthier diet. Following the DASH (Dietary Approaches to Stop Hypertension) diet includes lowering sodium intake and eating nutrient-rich foods like fresh fruits and vegetables, low-fat dairy, and eating a diet rich in potassium, magnesium, calcium, and fiber. Again, prominent national studies have shown the DASH diet has been shown to be as effective as drugs at reducing blood pressure.

Well, real doctors make those same recommendations. The last sentence is simply false. DASH is not as effective as medication for many hypertensive patients. For some, sure, for others, not at all.

Supplements are also a low-cost and effective way to reduce high blood pressure. Natural diuretics, dandelion and parsley can be used to control blood pressure, although evidence suggests they must be taken in high doses to be effective, (Alternative Medicine Review, 2002). Increasing potassium consumption has shown to reduce the risk of stroke in patients with hypertension by 41 percent (Journal of the American Nutraceutical Association, Houston study, 2002).

Let’s review our goal here. Our goal is to treat hypertension in such a way as to reduce the risk of cardiovascular disease and death. This needs to be done in a way that is proven to work, and is tolerable to the patient. Here, rather than recommend medications that have been proven in large, randomized controlled trials to not only lower blood pressure to to actually achieve these goals, they recommend “natural diruetics”. I also reviewed the article that is (barely) cited. The article is a review of hypertension and the naturopathic approach to its treatment. It is frankly quite frightening. It reviews the biology, and then makes fantastical claims. For example, it ironically compares various nutrients in their ability to “mimic” various classes of blood pressure medication. Then, rather than comparing the efficacy of the supplement to the known efficacy of the drug, it simply recommends using the supplement. If a real doctor did this it would be called “malpractice”.

I can find no naturopathic references that explain what the “doctor” should do when the unproven concoctions fail to control blood pressure. Does this mean that their potions work on everyone, that they have no failures? More likely, they have nothing to offer. Perhaps the good ones refer to a real doctor at this point.

This brings up an important question. If a naturopath wants to be a primary care physician, and yet must refer patients to a real doctor for common problems, what’s the point? A PCP must be able to effectively treat common conditions such as diabetes and hypertension. If they can’t, they’re in the wrong field.

There is no justification for allowing naturopaths to be primary care physicians, and if what they print is accurate, there is no justification for them to treat any patient for any condition. Naturopathy is modern shamanism, and should be banned.

Posted in: Science and Medicine

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230 thoughts on “Modern shamanism—naturopathy for hypertension

  1. Mandos says:

    “Natural” is a philosophical claim. It means, as far as I can tell, minimally altered by industrial processes, based on the notion/feeling that industrial processes are the source of modern illness.

    There is some validity to that claim in the big picture but what they can do about it in the “little” picture is the question.

  2. weing says:

    The NDs are busy performing a valuable procedure called a wallectomy.

  3. DevoutCatalyst says:

    “If a naturopath wants to be a primary care physician, and yet must refer patients to a real doctor for common problems, what’s the point?”

    No kidding. Someone recently posted a great link demonstrating that chiropractors want to wear this same “primary care” hat. Some of the services chiropractic already claims to offer I find rather Kafkaesque. A quick Googling reveals a number of chiropractic clinics who have hung out their shingle with some variation of the name “primary care” on it.

    Pinch me, but there seems to be an evolution of tactics of nomenclature surfacing from alt-med, making me wonder what grand hubris is in store for us next.

  4. Molly, NYC says:

    I think naturopaths and other “alternative” practitioners and their clienteles have (and give) the impression that these guys use methods that, for reasons that have entirely to do with differences in personal and professional culture, allopathic docs don’t know or have access to.

    However, the pattern that I keep seeing is, if a method looks like a CAM, walks like a CAM and quacks like a CAM, but still shows a significant benefit in a well-designed study, the allopaths take it to their nerdy bosoms, which should (theoretically) extract all the alternativeness right out of it.

    “Stop eating so much crap and try to get some exercise” sounds like a naturopathic prescription (and also like my mom), but MD clinicians say that sort of thing every day (as you point out). The efficacy of niacin for blood lipids has all the earmarks of a CAM–cheap, over-the-counter, practically a home remedy–but no, the NHLBI did the research there (and also found out that it works even better if you add a statin). (1) It’ll take some work to convince people that naturopaths and their ilk basically have the same therapeutic chops as, say, Grandma.

    Basically, the alleged advantages of naturopathy are based on a put-down: MDs, (presumably) are squares, (2) much too brainiac to appreciate Nature in All Her Wise Simplicity. This appeals to the kind of people whose idea of a scientist is Lex Luthor. But there are a lot of those around too.

    (1) There’s been a lot of NCCAM-bashing in this blog, but they do have it tough; any off-the-wall therapy that actually works gets investigated by the relevant Institute; NCCAM gets stuck with all the dogs.)

    (2) Not you.

  5. daedalus2u says:

    A thought that has been running through my head recently is the idea of “holistic” treatments. To be “holistic”, a treatment has to treat the “whole” individual. That means treating the physiology too. CAM practitioners don’t have a clue as to the physiology of humans. They may understand patient psychology (or maybe not), but treating only the psychology of patients with placebos is not treating the whole patient.

    Even if “energy therapy” was something real, treating someone only with energy therapy is not treating the “whole” person. People have material bodies too, and if one doesn’t have the knowledge or doesn’t do the tests to find out how to treat those material bodies, one cannot be doing “holistic” treatment.

  6. weing says:

    Dang it. I thought ‘holistic’ meant you treat the hole in the middle of the person. You give medications and exercises that affect the alimentary canal.

  7. mr. grieves says:

    Great post, and very timely. British Columbia just yesterday expanded the roles of naturopathic ‘doctors’ to prescribe meds.

    http://www.cbc.ca/canada/british-columbia/story/2009/04/10/bc-naturopaths.html

    The same legislation also permits midwives to treat labour pain with acupuncture. All very troubling, and batshit crazy…

  8. Mandos says:

    I think that this article by an MD-turned-IMist actually kind of explains the mentality (bold mine, hope I’m not quoting too much):

    While functional medicine is exciting and is an important piece of an emerging field in CAM, it does not and should not represent the whole of the CAM/IM movement. Many physicians naturopathic and allopathic gravitate to functional medicine because it fits more easily into an allopathic world view of the body and puts biochemistry at the forefront of disease. That’s comfortable for most medically-minded practitioners, but there is much that this model fails to address. Acupuncture does not fit nicely within this model, nor does homeopathic medicine, yet both of these disciplines have a long history of success.

    I originally went into allopathic medicine with a very altruistic intention. I wanted to relieve suffering. Once I realized that allopathic medicine was quite ineffective for most chronic illnesses and in fact were doing more harm in the long run, I subsequently abandoned that ship and went in search of a better way. The CAM movement in the early 90’s for me seemed to promise a better way to practice medicine and deliver on my mission. That is when I discovered integrative medicine and have never turned back.

    These learnings translated to my practice and I felt that these healing principles and wholistic philosophies led me to a profound and reverent appreciation of the wisdom of the body. I shared everything I was learning with my patients and got them engaged in their own journey to health. It felt like a Renaissance was happening in Healthcare back then. I had hope then that CAM/Integrative Medicine would shake the very foundations of healthcare to the core and help it to rise again rooted in these ancient healing arts. Since we now have the technology to allow us to scientifically validate many of these disciplines, I had hoped medical practice, honoring the wisdom of these traditions and moving away from the allopathic model of simply treating symptom after symptom with more and more substances (whether they be neutraceuticals or pharmaceuticals), we would forge ahead and transform the foundations of medicine.

    Let’s have conferences about HEALING and healing philosophies. Let’s not call it integrative or CAM. And if we do use the term “integrative,” then let’s do just that, INTEGRATE disciplines. Let’s treat that as the verb it is meant to be. Let’s be more inclusive of the other disciplines. And please, let us have all our future conferences in green environments filled with natural light and provide wholesome organic foods.

    Let’s build HEALING CENTERS instead of hospitals and let’s be sure that folks from all walks of life and culture can work there and be healed in them. Let’s get back to the basics with regards to clean food and air and water and strengthen our constitutions mentally, physically, emotionally, and spiritually. Let’s experience hands-on healing from gifted practitioners who channel love. Let’s use the word Soul more. Let’s be sure to create working environments that are healing in every way and lobby for things that will also heal our Earth. Alignment with these principles should be the goal of our movement and any future conferences. Let’s work cooperatively together and practice compassion, love, and kindness. Let’s find meaning and purpose in our work and lives and help our patients and clients to connect with the same. Let’s practice self-love until we ARE love.

    Leaving aside the empirical claims which I see are well-discussed on this blog, the bolded segments I think reflect the mindset of IM supporters. Phrases like “symptom after symptom”, “wisdom of the body”, and the “word Soul.” “HEALING.”

  9. Dr Benway says:

    Ah, the IM docs are Jedi Knights.

    Fantasyland is a nice place to visit but I wouldn’t want to live there. It always seems like fun and games… until someone loses a clitoris.

    When you leave science behind, you’ve no rational argument against candles in your ears, clitorectomies, or human sacrifice.

  10. Joe says:

    The Farce is strong with you, Dr. Benway.

  11. Mandos says:

    DrBenway:

    When you leave science behind, you’ve no rational argument against candles in your ears, clitorectomies, or human sacrifice.

    This is not quite true. There is a bulwark in the IM philosophy against things like clitoridectomies—a general horror of altering the things we were born with to achieve some other result (and the concomitant belief that medicine is too free with this). They would consider clitoridectomies to be an extreme that is morally contiguous with mainstream medicine.

    This general horror has a deep philosophical roots, some of which are defensible moral positions. The application of sound science has not always been morally guided, and examples of this are painfully obvious around us. The fallacy they entertain is to connect this to the epistemological standpoint of science, which some blame for creating a culture of destructive knowledge.

  12. Mandos says:

    In other words, alternative medicine in its most sincere incarnation is actually a facet of the search for an alternative epistemology, under the belief that scientific epistemology is insufficiently protected against abuse. Truth and methods of truth-finding are seen as non-neutral and re-perceivable in a better moral framework.

  13. weing says:

    I wonder what epistemology is sufficiently protected against abuse? How is it possible to know it non-scientifically? Merely believing it is enough?

  14. daijiyobu says:

    Meanwhile, back on early in 2009, where modern day medicine uses the best of scientific knowledge to deal with ‘the thing itself’…

    a) ‘Allopathy’ has been bandied about a lot in the comments, and I’d just like to emphasize that modern medicine isn’t allopathy, and labeling it so is incorrect.

    To label it [falsely] so is quite a win for the health sectarians — after all, allopathy is a term originating from homeopathy, that wacko belief system which gives sick people empty remedies and calls it medicinal.

    It is how they fallaciously attempt to level the playing field: such sectarian posturings are basically arguing for knowledge relativism and blending / conflation, but [and I'm not punning]:

    we don’t call Einstein’s accomplishments in physics “Jewish physics” and we don’t call modern geography ‘spheroidism’ [in terms of acknowledging the earth being roundish].

    The labeling of modern medicine as based on allopathic belief is the same sort of error / strategy that creationists perpetrate when they say that evolution is ‘just a theory’: the claim is that other ideas are equal in status — since all are supposed [when not all of such type].

    b) ______-pathy in healthcare is most often a BELIEF SYSTEM: suffering due to ______.

    Etymologically, because this is a post about naturopathy, I must point out the great ‘blending’ thing that is their essence, per the term naturopathy, at its core coincidentally:

    -path is Greek, natur- is Latin. It is exceptionally rare that Greco-Roman terms are hybrid: either the classical representation is all Latin, or all Greek in science, law, medicine, and technology.

    Somebody correct me if I’m wrong, because I’m not a classicist.

    Paralleling this in terms of language, I’m quite sure — having lived it — that naturopathy ‘in action’ is a hybridization of science and belief.

    You can’t make this stuff up!

    c) AND, I cannot see how modern medicine is a belief system, overall — it may be more scientific in some matters than others, but I don’t see how this ND fabrication of ‘MDs only treat the symptoms and not the underlying cause’ [per naturopathic claim] is true.

    But, keep in mind, their underlying cause is imaginary, strongly believed to be TRUE: that a ‘purposeful life spirit’ is in charge of physiology, per naturopathic doctrine. That giest is their central precept.

    That is, boil it all down, their underlying cause. Be careful that they don’t disguise that fact, as they often do, and pretend to be experts in physiology.

    They seek to be physicians, but they are METAphysicians [per metaphysicalisms like their sectarian beliefs].

    -r.c. [wow, a comment without links]

  15. daijiyobu says:

    [that's earth, not 'early]!!!

  16. daijiyobu says:

    And one last thing, a question:

    who’s up for NDs getting to call themselves primary care metaphysicians?

    There’s another term for that…

    shaman – so, PCMP aka shaman.

    And they’d get to where some kind unique of ministerial uniform:

    priests, nuns & such got black nailed down,

    Jedi Knight’s got their light saber and flowing ocher-brown robes,

    perhaps an appearance, and I’m not kidding because ‘green is all good, and lifely’, like the Green Knight

    http://cchs.shcsc.k12.in.us/academic/HONORS12/project/gawain.htm

    who is a hybrid of wilderness and humanity.

    And, like naturopathic competence regarding medicine……….a figment.

    -r.c.

  17. daijiyobu says:

    [that's wear not 'where]

  18. weing says:

    I think the NDs and homeopaths really think they are still living in the 19th century when allopathy was still around. Nowadays allopathy clearly belongs to CAM just like them.

  19. SD says:

    Regarding the statement above that naturopaths are in some instances obtaining prescription authority, here’s a (heavily loaded) question and economic analysis for the crowd:

    Question: Given that the ostensible goal of this blog and movement is to establish the use of scientifically proven treatments contra “alternative” medicine, why not maximize penetration of these treatments by doing away with prescription requirements entirely?

    Economic analysis: You wish to create a situation where “correct” behavior reinforces itself, where “good medicine” is used, and “bad medicine” abjured. It seems to me that maintaining a monopoly grant over the provision and rationing of medicine runs counter to this goal: ceteris paribus, a more available treatment (“leaves and twigs”) will be more frequently used than a less available treatment (“Dynamethahydropornazine, a blockbuster direct renin inhibitor from LillyGlaxoSmithPfizerZeneca!”), even if that less available treatment is substantially more effective.[1]

    Suppose that I, Patient X, have a choice between L’n'T Medication N, and badass space-age medchem product P. I can actually *get* N for a reasonable price (say, $25/bottle of 30) at my local supermarket while I’m shopping, whereas obtaining P requires that I block out time for a trip to the doctor, explain my ailment, see if he agrees with me, pay the man ($100+ for an office visit, at least, not counting opportunity cost for lost time), and then go to the pharmacy, have the prescription filled, and pay for it (anywhere from $4-$150 for a month’s supply of whatever I’m getting). P loses on time, convenience, *and* cost, and this is very nearly always the case. It is far simpler to obtain N. I lose less if I try N and it fails to work (the rate of failure is beside the point; the placebo effect applies, if nothing else, and the effect itself *is* real). Why is it, from my perspective, more difficult to obtain the more effective P? This difficulty is invisible to medical practitioners – MDs have drug manufacturers dropping off cartons full of samples in their offices, RNs and techs get them from the MDs, nobody *within* this system suffers any inconvenience at all, nor scarcely ever real cost, in obtaining these goods. The rest of us do, however. Can anybody provide a good reason for why I shouldn’t be able to simply walk down the “Health Products” aisle of my local Kroger’s and pick up an attractive glossy cardboard box with Pantone-colored surrealistic outdoors scene silkscreened on the outside containing Dynamethahydropornazine (from LillyGlaxo…Zeneca!), with the option *if I so choose* to bounce this off the doctor and see if I really need it, or if I should really be using Pornamethahydrodynazine from AstraGlaxoWellcomeMerckDow instead? Can this be reasonably justified with a straight face?

    [1] Psychic Prediction: Somebody’s going to trot out that tired, patronizing old “self-medication” canard and piously declare that it is the doctor’s duty to stand firm between the imbecilic patient and free access to medications on the theory that the idiot (sorry, “patient”) may give himself an owie with whatever he’s taking, as though that stops him in the first place, or as though it’s okay if the doctor gives him the owie instead. Just, um, don’t. Not in the mood. Try something different, please.

    “psst! buddy! you want some beta-blockers? I got some right here, primo grade!”
    -SD

  20. overshoot says:

    In other words, alternative medicine in its most sincere incarnation is actually a facet of the search for an alternative epistemology, under the belief that scientific epistemology is insufficiently protected against abuse.

    There is a problem with SCAM as “Schroedinger’s Medicine.” In the end, all of the “alternative ways of knowing” still ultimately collapse their wave functions when someone does an unambiguous measurement: “is she still breathing?”

    We’re left with a long trail of cancer quacks who died of cancer, atherosclerosis quacks who died of MIs and CVAs, acupuncturists who nonetheless ended up using opiates for pain control, etc.

    The bottom line on “alternative ways of knowing” is that in the end, the reality check is going to go in for collection.

  21. I find allopathy to be a pejorative term that attempts to make it sound like modern medicine incorporate some type of belief system. Creationists call scientists “evolutionists”, because they want it to appear that evolutionary biology is based on a belief set.

    As for blood pressure, I have so many friends with everything from mild to very high hypertension, and they all believe with a bit more exercise, better food, and cutting out coffee (apparently, the bane of all evil) will lead to lower BP. I’ve pointed out the DASH studies too, knowing in my heart that there is little shot that they’ll actually keep to the diet, finally convincing them that if all goes well, they’ll cut their BP from 165 to 155, which will kill them fairly quickly. At that point they listen.

    With the University of Google out there to educate them, everyone seems to miss the scientific facts, and move to the easier choice. They think that walking a mile will help (it will, but not enough). They think that take a few pills from GNC will help. It won’t. Everyone wants to take the easy way.

  22. weing says:

    SD,
    What you want is the patient to prescribe for himself? If so, I do have a canard for you that may apply. The doctor who treats himself has a fool for a patient.

  23. SD says:

    weing,

    Would you trust a doctor that draws conclusions not in evidence?

    When did I say that I “wanted” anything? I seem to be having trouble finding the portion of my post in which I expressed a “want”.

    I asked a question (“does this not seem counterproductive to you?”), made an observation about human behavior (“people prefer, ceteris paribus, to do easier things than harder things”), and suggested a cheap and easy remedy that enures to the benefit of science-based medicine (“remove the ‘prescription’ requirement for drug purchases, thereby making access to science-based treatments easier, thereby encouraging their acceptance”).

    Note carefully that you are assuming a second fact not in evidence, as well: you are assuming that “unrestricted access to medications” == “self-prescription”. I gently suggest that while these two activities may overlap, neither can be credibly claimed to be a proper subset of the other, and furthermore, that this is entirely secondary to any conceivable point that you might be able to make. That it may be folly to treat yourself – a fact itself not in evidence, as this is not a statement of fact, but a pithy bon mot (who else is more motivated than you to get well?) – has absolutely nothing to do with whether or not it is a good idea for a prescription to be a prerequisite for access to treatments which are said to be critical, lifesaving, and superior to their alternatives.

    If we are going to diverge from discussions of fact to discussions of inferred intent, we might profitably ask why my suggestion – at the risk of repeating myself, “dispensing with prescriptions and restoring the right of unrestricted access to medications” – is total anathema to the supermajority of MDs, to the extent that broaching the idea is met with incredulous laughter and fatuous mouthings (e.g. “the doctor who treats himself has a fool for a patient”). Should we have that discussion? I have plenty of really neat guesses as to why MDs don’t like that idea. Or would you prefer to stick to facts?

    “choose… but choose wisely.”
    -SD

  24. Newcoaster says:

    A timely piece! I’m also PCP living in a place overrun with sCAM

    Also, I can’t believe I had to find out about British Columbia’s enhanced privileges for Naturopaths and Midwives in this blog!
    http://www.cbc.ca/canada/british-columbia/story/2009/04/10/bc-naturopaths.html
    The Health Minister, George Abbott as much as admits the decision was based on surveys of what people wanted, not science. This is populism.
    The government released this decision on Thursday, just before the long religious holiday weekend. Co-incidence? I don’t think so.
    When the new privileges were first being offered as legislation, last December, (hmmm. Isn’t there some sort of religious holiday event then too?) it was announced after the close of Legislature and just before the long Christmas break. There was no warning, and no prior consultation with any of the physicians groups.
    Again,a religious holiday, and again the Legislature is closed. This means there can be no Question Period, a time honoured parliamentary procedure where the government has to face the opposition (literally) on any topic.
    Soon there will be a campaign underway for a provincial election, May 12. Other issues-the economy and the environment-will be getting all the attention.
    Government employees of course, get BOTH Friday and Monday off, so there’s nobody available until Tuesday to take calls. That’s 4 days for people to forget about it, and then the campaigning starts.
    I’ve sent Mr Abbott an angry email, which I’ve copied to JREF, so hopefully they may run with it and publicize this travesty to a wider audience.

  25. weing says:

    SD,

    I take that to mean that you didn’t like my old canard.

    Why do you equate a taking a medication with science based medicine? Just because a medication was produced using the tools of science? If you think that it’s all there is to science based medicine, then be careful what you wish for.

  26. skeptyk says:

    Michael’s Insight wrote: “They think that walking a mile will help (it will, but not enough). They think that take a few pills from GNC will help. It won’t. Everyone wants to take the easy way.”

    Actually those are NOT the easier way. Easier way is to take science-based medicine to really lower your BP to a healthy level.

    Not so easy (but, oh so empowering) is special trip to GNC to pay OOP for what is likely to be an onerous schedule of several different supplement pills several times a day. Not “a few pills from GNC” because many different “systems” need to be “enhanced” or “supported” or “boosted” or “balanced” and the supplements are natural, blah blah. Lots of bottles. All OOP.

    And if you are one of those at the edge of woo, the “can’t hurt, might help” conventional wisdom masses, beware. The “few pills from GNC won’t work even as a placebo because part of Big SCAM’s marketing is that more is always better, and if you don’t do as much as possible, you are shortchanging yourself. In other words, you can buy ALL the woo, but when you sicken it will be your fault anyway. You didn’t take the right dose, you didn’t use all the adjunct therapies, you didn’t have faith, you only ran 4 miles a day, you ate meat, you didn’t eat meat, not enough red brocade in your prosperity corner…and so on.

    (If you want to walk some more, nice. Do it for pleasure, not puritanism.)

  27. Tim Kreider says:

    SD,

    Are there any modern examples (i.e., since the advent scientific medicine, not in the era of “allopathy”) of such an unregulated or lightly regulated health care market as you imagine? I can appreciate in theory that markets are efficient, but I’m nervous about the human costs of that efficiency.

    In any event, I do sympathize with your arguments about the possibly overlooked costs to a patient of seeking SBM-quality care. I also agree with skeptyk that CAM-style advice can be even more costly, though it has better marketing. Here’s an interesting take on the costs of preventative care from an economist who does cost-effectiveness analysis: http://nchc.org/documents/nchc_report.pdf

  28. David Gorski says:

    Are there any modern examples (i.e., since the advent scientific medicine, not in the era of “allopathy”) of such an unregulated or lightly regulated health care market as you imagine? I can appreciate in theory that markets are efficient, but I’m nervous about the human costs of that efficiency.

    There sure was, right here in the USA! Before the creation of the Food and Drug Administration, there was essentially no regulation of drugs. Patent medicine sellers could basically sell whatever they wanted and make whatever claims they could get away with. Quackery was rampant and legal.

  29. Prometheus says:

    SD ponders the idea of letting patients self-prescribe what are now prescription medications. An interesting proposition…..

    The only problem I can see is this. How will the patient – who we must assume is as medically ignorant as the average citizen, know which of the myriad drugs to take?

    Now, you can argue that with all of the pharmaceutical advertising on the telly these days, the “average consumer” will have the knowledge they need. Once untied from their dependence on physicians (and naturopaths, in many states and provinces), pharmaceutical companies will no doubt flood the media with advertising aimed at helping the consumer make a reasoned choice.

    Just like the automobile companies.

    Of course, that presumes that the consumers know what their medical problems actually are and that they aren’t mistaking angina pectoris for esophageal reflux (Zantac will do nothing to help cardiac ischemia). But I’m sure that a simple sort of Wikipedia will manage that (“If the pain radiates [see: pain, radiating] into your jaw or left arm, it may be a sign of cardiac ischemia [see: ischemia].”)

    In Mexico, when I last visited, it was possible for non-physicians (i.e. average folks) to purchase a wide variety of pharmaceuticals without a prescription. The exceptions, as I recall, were narcotics and stimulants. But anybody could walk into the Pharmacia and buy antibiotics, statins, even injectible drugs that are available only in hospitals or doctors’ offices here in the US.

    This pharmaceutical egalitarianism had some “interesting” effects. Not the least were the higher rates of antibiotic resistance seen in community-acquired bacterial infections. Another “interesting” effect was the large number of renal failure cases from using aminoglycoside antibiotics without proper monitoring. I’m sure there were other “interesting” findings that I was not privy to.

    But the most interesting part of this discussion is the part that – until now – hasn’t occurred.

    Why would naturopaths want the privilege to prescribe nasty artificial “drugs”, anyway? If their leaf-n-twig juju is so strong, why do they need to prescribe real pharmaceuticals?

    Could it be that they realize – under their bluff and bluster about “natural” this and “holistic” that – that their leaves and twigs don’t do squat?

    Or, could it be that they’ve come to the realization that the few “natural” remedies that do work are more toxic and less effective than the “un-natural” (?) and “artificial” remedies that real doctors use?

    Finally, since the naturopathy curriculum doesn’t include anything even remotely similar to the degree of pharmacology that the average medical student has to learn, why do lawmakers (and, for that matter, the naturopaths, themselves) think that naturopaths are capable of safely (let alone effectively) prescribing real drugs?

    Prometheus

  30. SD says:

    You know, it’s interesting. For a blog full of doctors – ostensibly trained in logical thought, doubly expected due to the nature of the blog – there appears to be an appalling lack of reading comprehension and/or lack of critical analysis.

    When did I say anything about an “unregulated” health-care market, Mr. Krieder? Cde. Gorski? I’m quite sure that neither that word nor that concept passed through my fingers. You can reread my posts above to verify that (spoiler: it isn’t there).

    For people who bloviate at length about the virtue of seeing what’s really there, you appear to avoid doing so when the answer is not to your liking. I suggest some careful self-examination about why precisely that is.

    I proposed no such “madness” – as such it would no doubt be styled – as obstructing the role of the FDA in “regulating” drugs. (That would be a different post.) That you suggest this as an endpoint is a twisting of the actual question. The question, again, was: “If your desideratum is increased use of science-based treatments, then why not ensure that those treatments are easier to obtain, by supporting the removal of the artificial added costs of prescription and other obstructions standing between patient and treatment?” In other words, “Why the hell should I *have* to see a doctor to obtain a prescription for something? Why can’t I just buy it?” This says nothing about the FDA or other agencies controlling purity, quality, or efficacy.

    I defy you to refute the idea that the added costs (financial and opportunity) of obtaining prescription medication – again, I stress, a problem that doctors and other medical practitioners *do not generally have*, being immune to it by circumstance and their position within the health-care system – do not deter ordinary patients from seeking other treatments, regardless of how efficient those treatments are.

    Can you answer those questions? (I already know these answers – most of the crowd does, actually, whether they want to admit it or not – but I would be extremely gratified to hear them verbalized, because, well, it’d be funny.)

    “heads, I win…”
    -SD

  31. Peter Lipson says:

    “If your desideratum is increased use of science-based treatments…

    Well, the quest is really to increase the importance of science-based medicine, and encourage its dominance in medical thinking and practice. It’s not just “increased use”. Your argument is going the way of “well, if you want to increase the use of steel frames in buildings, why not simply make steel girders more widely available?”

    …then why not ensure that those treatments are easier to obtain, by supporting the removal of the artificial added costs of prescription and other obstructions standing between patient and treatment?”

    This begs a number of questions. Is there really an “artificial added cost of prescription”? Is that what stands in the way of SBM?

    No.

    What stands in the way is infiltration of non-SBM. The reason drugs are prescribed is not so that non-SBM practioners are limited, nor is it to add costs. It is to keep biologically active, potent, and potentially dangerous chemicals from being improperly used by people who are untrained in the necessary profession, medicine.

  32. Tim Kreider says:

    My bad if I put words in your mouth, but to this economic layperson:

    “doing away with prescription requirements entirely” = “lightly regulated health care market”

    I was honestly curious about your position, not hostile.

  33. Peter Lipson says:

    No, Tim, I’m fairly certain he’s using a rhetorical device whereby he lures you into making a logical assumption that he can then deny, and then castigate you for being such an idiot. It’s a pretty sadistic and nasty type of discussion.

  34. Prometheus says:

    Gee, SD – I thought I did answer your question. Was my delivery too subtle? Or was it that I didn’t provide the answer you wanted?

    Let me see if I can boil it down to a few bullet points, so that you won’t accue me of “bloviating”:

    [1] The “average person” isn’t educated, trained or experienced enough to know what their symptoms mean, in terms of a diagnosis. Nor are they able to accurately diagnose their friends or family members.

    [2] Without an accurate diagnosis, it is very unlikely that the “average person” could choose the correct medication.

    [3] Even with an accurate diagnosis, the “average person” won’t know which medication – if any – is appropriate. They would be at the mercy of “Wikipharmacopeia” and drug company advertisements to guide their decision.

    As it turns out, the “artificial added cost of prescription” are not artificial, added or cost. A physician takes a history, does an examination, makes a diagnosis and prescribes treatment. This is a “holistic” process that cannot be “deconstructed” into its parts.

    The “cost” is the same whether they write a prescription or not. If you doubt that, refuse the prescription at your next visit and see if that lowers your bill.

    I have to wonder why you would want to self-diagnose and self-prescribe unless you feel that the physicians’ skill are over-rated. If so, try your hand at it for a while. Let us know how you do.

    Prometheus

  35. David Gorski says:

    I proposed no such “madness” – as such it would no doubt be styled – as obstructing the role of the FDA in “regulating” drugs. (That would be a different post.) That you suggest this as an endpoint is a twisting of the actual question. The question, again, was: “If your desideratum is increased use of science-based treatments, then why not ensure that those treatments are easier to obtain, by supporting the removal of the artificial added costs of prescription and other obstructions standing between patient and treatment?” In other words, “Why the hell should I *have* to see a doctor to obtain a prescription for something? Why can’t I just buy it?” This says nothing about the FDA or other agencies controlling purity, quality, or efficacy.

    Thank you for your clarification and making it clear that you’re not against a lack of FDA regulation; rather you’re against the government determining what drugs do and do not require a prescription. Of course, in practice yours is a distinction without a significant difference.

    You’re just playing rhetorical tricks.

  36. David Gorski says:

    No, Tim, I’m fairly certain he’s using a rhetorical device whereby he lures you into making a logical assumption that he can then deny, and then castigate you for being such an idiot.

    That’s exactly what SD’s doing.

    I’ve been blogging for over four years now and before that I was a regular on Usenet for five or six years. I’ve seen it before numerous times.

  37. SD says:

    “SD ponders the idea of letting patients self-prescribe what are now prescription medications. An interesting proposition…..”

    Quite.

    “The only problem I can see is this. How will the patient – who we must assume is as medically ignorant as the average citizen, know which of the myriad drugs to take?”

    Who knows? For that matter, who cares? Maybe the patient is a doctor with a license violation. Maybe she’s a librarian, perhaps a savant. Maybe he – gasp, horror – *actually went to the doctor anyway* to find out what was wrong. Nothing in my question suggested that this could not happen, only that it doesn’t *have* to happen. How the patient selects the treatment is irrelevant to the question.

    “Now, you can argue that with all of the pharmaceutical advertising on the telly these days, the “average consumer” will have the knowledge they need. Once untied from their dependence on physicians (and naturopaths, in many states and provinces), pharmaceutical companies will no doubt flood the media with advertising aimed at helping the consumer make a reasoned choice.”

    … And selfless doctors like you will make blog posts in your spare time describing in which general cases particular treatments are appropriate (always with the caveat, “GO SEE YOUR DOCTOR”, in big bold letters on top). Perhaps there will be a Wikiesque phenomenon, where patients can click and see basic globally-assembled information about the drugs in plain language, when they can probably be used safely, when they should be buttressed by diagnostic tests (and which tests), perhaps which specialist consults are required to effectively use them…

    Provocative observation: In the age of the Internet, a reasonably intelligent and moderately-educated layman with access to Google knows as much about what a given drug will do as most non-specialist physicians.

    “Just like the automobile companies.”

    Cute, and nice try at a cheap shot, but completely irrelevant. Also, incoherent. What do the automobile companies have to do with anything? Are you suggesting that consumers have “improperly” purchased automobiles? (Next question: “Which ones *should* they have purchased?”) Are you suggesting that the automobile companies bought things under the influence of media advertising? (Next question: “Are you all fucked up on little pills right now?”)

    This bears the stigmata of a thought-terminating cliche, a soundbite that you hope will score some kind of telling point without actually saying anything meaningful. I prefer meaningful conversation. Stick to the point, please.

    “Of course, that presumes that the consumers know what their medical problems actually are and that they aren’t mistaking angina pectoris for esophageal reflux (Zantac will do nothing to help cardiac ischemia). But I’m sure that a simple sort of Wikipedia will manage that (”If the pain radiates [see: pain, radiating] into your jaw or left arm, it may be a sign of cardiac ischemia [see: ischemia].”)”

    There is a fallacy embedded in the questions I’m being asked, and that is the fallacy of equivalence; the assumption is that Joe Blow will act the same way for, e.g., chest pain or general malaise as for a snot-filled head or hypertension.

    Now, frankly, even in the presence of an all-night all-you-can-buy pharmacy stocking everything from nitroglycerin to carbamazepine on the shelves with convenient self-checkout kiosks in the front, most patients confronted with crushing chest pain aren’t going to self-diagnose a heart attack and go to the pharmacy to get some nitro, because they’ll be too busy panicking and calling the ambulance. The idea that critical emergency situations will be affected by Freedom of Purchase (abbreviated FoP for short) is, um, laughable.

    Next up: non-critical acute situations. Here we’d have angina, say, or REALLY bad heartburn. Assuming that you’re dealing with someone who doesn’t know the difference between heartburn and angina, he’ll probably find out in short order when the Zantac doesn’t do anything. Could this lead to a bad end? Yes, if we are assuming that the angina, after ineffective treatment with Zantac, is immediately followed by a massive MI, as opposed to the patient going “Well, that didn’t work”, and trying something else. That *could* happen. Question: How many “what-ifs” are we prepared to base policy on?

    Antibiotic resistance may be a sticking point, of course. I would say that we need significantly better fact-based justification than the possibility of increased future antibiotic resistance to justify the continued difficulty of access to science-based treatments, however. I also remind you that resistance applies to antibiotics, not all medications.

    Next up: critical chronic conditions. Let’s say, arguendo, that we were going full-bore, and that *everything* was available on the shelves. I gently suggest that the idea that someone is going to buy a half-dozen badass chemotherapy agents – oh, hell, let’s go for one of those nasty platinum salts, maybe cisplatin – and try a home-brew lymphoma cure even if they already knew they *had* lymphoma is, um, not plausible. The idea that someone would do so when they had no idea is, um, really not plausible. Yes, I’m sure there would be one, and it would be a tragic case. Outliers are not a good justification for establishment of rules, something which (as a scientist) you should appreciate.

    So what do we have left? Non-critical chronic conditions. These are the usual ones, the bread-and-butter of modern medicine, the biggest bang for the buck (or so is the story told). The example used was hypertension, so let’s stick with that one for a moment.

    Hypertension is something that *can* be self-diagnosed. I find a blood-pressure cuff, I look at the “recommended” reading ranges (up to 120/80), and pop it on my arm. Numbers greater than 120/80 indicate the likelihood of a problem unless there’s a good reason for them. Numbers greater than that for an extended period of time indicate a problem that needs to be fixed. I don’t think there’s anybody who’s not a Mongoloid or coma patient in the US that hasn’t gotten that message: “HIGH BLOOD PRESSURE KILLS, AND IT KILLS IN NASTY WAYS.”

    So how do we deal with an epidemic of high blood pressure?

    At present, I need at least two doctor’s office visits (initial visit + 24-hour BP monitor + followup), *and* a prescription, just to get the treatment. In order to continue it, I need continuing visits essentially forever (recurring followups being the price for prescription renewals), whether or not those visits have any probative value for my treatment. I could spend fifty bucks on a decent automatic BP cuff and know – with the same certainty as the doctor – whether or not the medications are doing the job, or if they needed to be changed or augmented. I could change my dosages myself (I can sort-of do this now, but only with difficulty); I could add or subtract medications myself. Further, I could do so in ways that I will assert are materially identical to the ways in which an MD would change my treatment (“X doesn’t work, increase X; if it still doesn’t work, add Y; u.s.w.”) What’s more, anybody could do these things, and for significantly less expense and inconvenience than is now required.

    However, as it stands now, we *cannot* do this. The doctor serves as gate-guard for this treatment, and he demands recurring payment for what is styled the privilege of doing business with the companies that make what are purportedly the only effective treatments for whatever ails you, and the vig for that access is eye-poppingly huge. All this is ostensibly for my own good and worlds better than all other arrangements, assertions of which I remain dubious, as they appear to enure only to the benefit of select others, and not to me or the general public in any non-risible way. The solution to the “problem” of competing treatments offered here is – with all pretense and euphemism ripped away – “Shoot the providers of those competing treatments in the neck”, broadly speaking. I suggest that there may be a better and more civilized way of accomplishing the same goal, albeit a slightly less (ahem) personally lucrative one. And so, I ask: Why *not* support the free sale of science-based treatments?

    There are greyish areas here, of course – antibiotics form one such area, psychiatric medications another. (That last may not, however; patient compliance is a major issue with a wide variety of medications, innit?)

    “In Mexico, when I last visited, it was possible for non-physicians (i.e. average folks) to purchase a wide variety of pharmaceuticals without a prescription. The exceptions, as I recall, were narcotics and stimulants. But anybody could walk into the Pharmacia and buy antibiotics, statins, even injectible drugs that are available only in hospitals or doctors’ offices here in the US.”

    This pharmaceutical egalitarianism had some “interesting” effects. Not the least were the higher rates of antibiotic resistance seen in community-acquired bacterial infections.”

    Hm.

    I think, Prometheus, that I will ask for an actual study detailing this assertion, broad and nebulous as it is. Which antibiotics? Which bacteria? How much higher?

    “Everybody knows” that antibiotic resistance is rampant in Mexico, of course. What I find when I look at the NHSN for 2008 and compare it to some results for UTIs in Mexico City is resistance to fluoroquinolones at ~25% in the US on average and ~32% in Mexico City, not exactly a smoking gun.

    (Granted, this is not an ideal comparison – I have limited data to work with, and limited interest in the topic – but the notion that FQ resistance is a sort of apple-to-apple off-the-cuff comparison of resistance rates is not prima facie unreasonable.)

    I will then also ask about its comparison in toto to antibiotic resistance seen in nosocomial and iatrogenic infections in the US. Using resistance allegedly generated by free access to antibiotics as an argument for restricting access to antibiotics does not make sense if the only thing it accomplishes is to “push” all the resistance generation from the home to the hospital without a significant change in resistance change rates, in that there is no qualitative difference in my dying of some loathsome disease whose origins were originally an ICU instead of a brownstone on Fifth Avenue.

    In other words, while the topic is plausible, it is not a universal refutation, and needs much more evidence even to be a particular refutation of the principle of FoP applied to antibiotics.

    “Another “interesting” effect was the large number of renal failure cases from using aminoglycoside antibiotics without proper monitoring. I’m sure there were other “interesting” findings that I was not privy to.”

    Again, study? Or statistics? Differences between total renal failure rates in controlled aminoglycoside prescription regimes vs. free-access?

    Asserting that you’re sure there were other findings does not mean that there were any.

    Individual self-inflicted tragedies do not justify bad policy.

    “ballroom blitz!”
    -SD

  38. weing says:

    SD,
    When did you stop beating your wife?

  39. SD says:

    “No, Tim, I’m fairly certain he’s using a rhetorical device whereby he lures you into making a logical assumption that he can then deny, and then castigate you for being such an idiot. It’s a pretty sadistic and nasty type of discussion.”

    No, Peter, I’m not. I have not asked anybody to make any assumptions at all. What I have done is, again, *ask a question*, and moreover one that is in closed form and easily understandable. What I’m doing right now is using a rhetorical device to split the audience and to highlight a particularly loathsome type of avaricious hypocrisy.

    Nobody – and I mean nobody – has brought forth anything even resembling a refutation of my main point, which is that cheaper and easier access to proven treatments (we will take this, for the time being, to be a synonym for “SBM” treatments), ceteris paribus, means greater adoption of those treatments. That’s because there is no such refutation, because that observation is irrefutable. It is an observed, immutable law; easier things happen more frequently than harder things. This principle stretches all the way from physics to psychology.

    Can we accept this as true, then? Good.

    I have highlighted one way in which SBM’s adoption may be increased with respect to CAM – make it easier to get to SBM. One major added cost to SBM is the requirement that one go through a “gatekeeper” to get it, even for something as simple as hypertension medication, something for which better access and use could purportedly save many lives. Economics lives on the margin: there do exist those whose hypertension remains untreated because the added cost (in time and money) to run that gauntlet exceeds their tolerance for that cost, with all known and believed future sequelae factored into that decision. “Yeah, I might go blind fifty years from now”, thinks the 30-year old construction worker, “but who fuckin’ cares? I can’t afford the $100 or the time off work to go see the doctor. Screw it.” Those costs keep those people from this treatment. From this smaller pool of people, there are some that will follow that thought by: “… but my wife says that this one Indian guy she reads on the Internet says that high blood pressure is caused by caffeine and bad juju, and that taking St. Juan’s Venereal Wart will drop my blood pressure, and it only costs $10 for a bottle. Screw it, I’ll give that a try instead. Might work.”

    An honest SBM practitioner, observing this state of affairs, might commence a thought process that looks something like this: “Hypertension is bad. Even though it would be a better idea for this person to go see a doctor and get his treatment titrated to him personally, on the off chance that there’s something weird about him that would dictate the use of a different medication or combination than he would choose himself, the odds are pretty good that, given the types of medications available, he’ll be able to find something that works, especially if a few basic guidelines are published in unambiguous language that highlight Stupid Things To Not Do. This is an acceptable solution, *although it means that I will not personally reap the benefit of being in a gatekeeper/rent-seeker position, controlling access to treatments*. Perhaps I shall have to reduce my fees to encourage more people to seek me out before commencing treatment, since, ceteris paribus, *lower costs tend to increase demand for a good*. But that is a small price to pay to serve the purpose of Public Health. And it means that people will have less incentive to try bogus treatments, instead getting something that actually works.”

    Do we hear this? Nope. What we do hear: “DESTROY OUR COMPETITORS!” This is proposed not through improvement of services or reduction of costs, i.e. by efficiency improvements, but by coercive fiat, i.e. concerted efforts to legislate those competitors out of existence. To say that this leaves a bad taste in the public mouth is to put it mildly, and to say that it does not optimally serve the public’s interest is a comedic masterpiece of wry understatement. The situation speaks for itself: given the choice between SBM treatments and CAM, the public chooses CAM, and in increasing numbers. Whether CAM is bullshit or not is irrelevant. The public can afford more attempts to get bullshit to work than it can afford to run the SBM gauntlet. This gets more true the more the economy contracts. A plan of action that involves squeezing the public harder by excluding competitors rather than by improvements of service is doomed to spectacular failure.

    Of course such improvements of service by cutting unnecessary beak-dippings sounds like a bad idea to a doctor. It is a formula to reduce the prestige and income of a doctor from that of a CEO to that of an ordinary craftsman, more or less. As such, only a homeopathic percentage of doctors would acquiesce to such a plan. While this is not unexpected – I understand that my audience thinks that this is craziness! preposterous! inconceivable! – it amuses me to highlight this hypocrisy in the hopes that it dilutes further arguments from these sources and along these lines.

    “looking for an honest man”
    -SD

  40. SD says:

    Govorit’ my old droogie Cde. Gorski:

    “Thank you for your clarification and making it clear that you’re not against a lack of FDA regulation; rather you’re against the government determining what drugs do and do not require a prescription. Of course, in practice yours is a distinction without a significant difference.

    You’re just playing rhetorical tricks.”

    Christ’s wounds, how hard is this? Are you people educated, or not? I seem to recall reading something about that being a requirement for doctorhood, somewhere. Might have been on the Internet. I forget.

    Is the “ready-fire-aim” principle a staple of medical curricula these days? Do you, on the basis of ten seconds’ glance at a patient, infer that he requires cardiac bypass surgery and slam him on the operating table? (Please don’t answer that.) Do you read all the tests, then ignore them and make a diagnosis based on what you think is really going on? (Again, now that I type that, please don’t answer it.)

    I am asking a *question*. They are easily identifiable, owing to the squiggly mark at the end of the sentence, and their purpose is to invite the reader to answer them. Occasionally – as in this case, apparently – that invitation strives in vain and dies alone and unrequited, for want of companionship in the form of an answer. Questions are not statements. Questions are questions. Statements are statements. Learn the difference, please.

    Again, I did not say that I am against the government determining what drugs do or do not require a prescription. Whether I am or not is, again, irrelevant. What is relevant is the question: “If you would like more SBM, why not make it easier to get to?” That question has an infinity of possible answers, which I am interested in hearing verbalized. If you are capable of so doing, I invite you to do so at your leisure.

    I am playing rhetorical tricks – see the other message for details – but see no reason why that is an impediment to answering this question.

    Provocative question: What studies exist to demonstrate favorable outcomes from the requirement of a doctor’s exam and prescription vs. free access to medications? One would assume that somebody has done a study to verify this article of (ahem) faith.

    “groundhog day”
    -SD

  41. SD says:

    “Gee, SD – I thought I did answer your question. Was my delivery too subtle? Or was it that I didn’t provide the answer you wanted?”

    No, you’re not subtle, and no, you are not answering the question. (I will refrain from restating the actual question, it’s available above.) What you are doing is answering a straw-question with straw-answers, which, while a curiously symmetric juxtaposition, does not provide much valuable insight.

    “Let me see if I can boil it down to a few bullet points, so that you won’t accue me of “bloviating”:

    [1] The “average person” isn’t educated, trained or experienced enough to know what their symptoms mean, in terms of a diagnosis. Nor are they able to accurately diagnose their friends or family members.”

    ‘Everybody is an idiot. Well, except me.’ Okay, got it.

    “[2] Without an accurate diagnosis, it is very unlikely that the “average person” could choose the correct medication.”

    Um, how many options do they have? Is there a forest of thousands of medications for each ailment, all of which are indistinguishable? Does only one of them work? Is this one of those “try-to-find-the-True-Grail” situations, where if I pick the One and Only Right Treatment, I live, but if I choose wrong I die a horrible, grisly, instant death?

    Let’s go back to the primary example, hypertension. What classes of drugs are available to treat it? Not that many, I can count the big classes on one hand. Which ones are preferred within each class? Again, not that many. A reasonable pharmaceutical intervention treatment tree for hypertension could fit on an 8.5×11″ sheet of paper, with room for broad caveats (“diabetics should pick an ACE inhibitor”, that sort of thing) and dosing recommendations on the back. The manual for picking which drugs are good choices would be smaller than the one for picking which headlights go to which model car.

    (Keep being obtuse, and I’ll pull out one of my favorite dirty tricks: the surprising success of relatively simple medical expert systems, and the differences in computing power between now and when those expert systems were developed.)

    You’re assuming that someone’s going to try to treat their own disease with the average incidence and criticality of those featured on “House, MD”. I gently suggest that outliers of this type are not a good basis for policy. You are further suggesting that there is only one treatment that is effective (false), that there are too many to choose from (false), and that the patient’s odds of finding the right treatment in the sea of wrong treatments is astronomical (false), thereby meaning that the convergence time on the *right* treatment is somehow negatively impacted (arguable, probably false), all presumably with a really cool CGI “Nazis-opening-the-Ark-of-the-Covenant” mental movie of the failure-mode for choosing the wrong treatment or treatment(s). Yeah, uh, what happens in the real world: patient tries one or two treatments, and they either work (so the patient keeps doing it, indicating that the patient chose correctly; whether this is accidental or not is irrelevant, since I doubt that you’d argue that being treated properly by accident is a bad thing) or the patient gives up and stops (putting us back to the same place we were before – “patient not treated” – with some extra information about what didn’t work, meaning no net negative), or the patient goes to see the doctor with complaint and a list of stuff that didn’t work (a net positive, since the doctor now has information about what treatments didn’t work, presumably aiding diagnosis and future treatment).

    Somebody who has a brain tumor gets headaches, which they treat first with aspirin. When aspirin doesn’t cure the headaches – i.e. when self-treatment fails to be effective – then they go to the doctor. Somebody who has a gaping wound in their leg puts gauze and Neosporin on it. When the wound turns green and starts oozing pus – i.e. when self-treatment fails to be effective – then they go to the doctor. Why is the patient assumed to be competent to self-treat in some cases, but not in others? What is the difference – moral or practical – in self-treatment in one instance, but not in another?

    “[3] Even with an accurate diagnosis, the “average person” won’t know which medication – if any – is appropriate. They would be at the mercy of “Wikipharmacopeia” and drug company advertisements to guide their decision.”

    WOOT!

    BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS

    PSYCHIC PHENOMENA VERIFIED AT SKEPTICS’ BLOG! FILM AT 11!

    BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS

    Recall the original post, ladies’n'gents:

    “[1] Psychic Prediction: Somebody’s going to trot out that tired, patronizing old “self-medication” canard and piously declare that it is the doctor’s duty to stand firm between the imbecilic patient and free access to medications on the theory that the idiot (sorry, “patient”) may give himself an owie with whatever he’s taking, as though that stops him in the first place, or as though it’s okay if the doctor gives him the owie instead. Just, um, don’t. Not in the mood. Try something different, please.”

    Damn. I am good. GOOD, I tell you. Nailed the tired part, the patronizing part, the part about how the patients are idiots… YES! Eat it, James Randi! I’m comin’ for that check, baby!

    (Disclaimer for the irony-impaired: the above is tongue-in-cheek, and to be taken with a grain of salt, not that this will stop anybody from making some kind of jackass comment about it.)

    (Second disclaimer: “irony-impaired” does not mean that you are anemic. There is no need to ask your doctor about it.)

    Ahem.

    Anyway.

    Question: Exactly what’s wrong with Wikipharmacopoeia + drug-company adverts? Do you mean to tell me that this differs in any material way from the way treatments are selected now, except in the sense of who’s doing the selecting? Do you mean to tell me that trial and error isn’t a major part of treatment titration? Is there some magical doctor-juju without which the medication won’t work? Do you mean to tell me that it isn’t possible to develop a reasonable recommended universal treatment plan that is simple to apply and works in the majority of cases?

    “As it turns out, the “artificial added cost of prescription” are not artificial, added or cost. A physician takes a history, does an examination, makes a diagnosis and prescribes treatment. This is a “holistic” process that cannot be “deconstructed” into its parts.”

    Ohhhhhhhhh, okay. It’s *holistic* and *mysterious*. It’s *magic*. Laymen cannot be expected to understand it, or to draw basic, generic knowledge that can be understood easily and commonly applied, because each snowflake is *different*.

    Well, that puts me in *my* place.

    (Disclaimer for the irony-impaired: the above is not tongue-in-cheek, but a cryptic observation about similarities between Prometheus’ defense and a popular justification given by the Lords of Woo when questioned.)

    (Second disclaimer: “irony-impaired” still does not mean that you are anemic.)

    Question: What if I am reasonably sure that I have hypertension, being sufficiently numerate to read the numbers “160″ and “100″ on my WizBang BP WristCuff, and wish to skip participating in this “holistic” process and go straight to a personal (yes, N=1) trial of a treatment that is statistically demonstrated to be effective in most cases, like an ACE inhibitor or HCT?

    Question: In how many instances would the outcome of a random choice from the current first-line treatments for hypertension differ substantially from the outcome of this doctor’s office visit in their outcome? An order-of-magnitude guess is reasonable.

    Yes, the cost stated is artificial – the only reason the cost exists in the first place is a law which stipulates that FDA-approved medications may not be dispensed except by prescription.

    Yes, this cost is added – it increases the total cost of my access (sigh, *again*, including *all* costs, to include actual dollar costs, opportunity costs [time spent at the doctor cannot be spent working, for example], &c.) to medication.

    And yes, there are costs. Are you insane? Is a trip to the doctor “free”? On what planet?

    (Christ. I feel like I’m dealing with Archimedes Plutonium here.)

    “The “cost” is the same whether they write a prescription or not. If you doubt that, refuse the prescription at your next visit and see if that lowers your bill.”

    Way to not understand the point, jackass.

    The difference in cost described involves the difference between “just getting the drug” and “paying the doctor and spending the time so I can get a note from my mother[delete]doctor to give the pharmacist so that I can just get the drug”.

    If you do not think that this cost drives people away from science-based treatment to alternative treatment, then you are a fool. If you think that raising the cost of alternative treatment by legislative fiat or increased regulatory pressure will encourage more people to seek science-based treatments, then you are an even bigger fool. This does not surprise me, of course, but it is a mitzvah to at least make an attempt to dissuade the fool from his folly, never mind that he returneth to it as a dog to its vomit…

    “I have to wonder why you would want to self-diagnose and self-prescribe unless you feel that the physicians’ skill are over-rated. If so, try your hand at it for a while. Let us know how you do.

    Again with the “want”. When did I say I “wanted” something?

    “simple man, simple questions”
    -SD

  42. SD says:

    And here we see the Naked Truth, or some strategic parts of it, anyway:

    “Well, the quest is really to increase the importance of science-based medicine, and encourage its dominance in medical thinking and practice. It’s not just “increased use”.”

    Ah.

    ‘increase the importance…’
    ‘encourage its dominance…’

    So, in short, you want to “win”, to crush your enemies and to see them driven before you, and to hear the lamentations of their women… Well, at least you’re honest. Do you admit any moral or practical limitations on the means and methods by which you can “win”, or is it “anything goes”?

    “Your argument is going the way of “well, if you want to increase the use of steel frames in buildings, why not simply make steel girders more widely available?”

    Er, no. There was no argument made, I stress. (God, that’s getting tiresome to say. Why, God? Why? Do they know not what they read?) The *question* – again, let me say that word again, *question* – rephrased as a construction or engineering question, would be more like “If you are worried about the use of Styrofoam and balsa-wood ‘alternative’ structural building materials in construction, then doesn’t it make it sense to avoid a requirement to get a consultation with a licensed architect just to *buy* steel structural building materials?”

    “then why not ensure that those treatments are easier to obtain, by supporting the removal of the artificial added costs of prescription and other obstructions standing between patient and treatment?”

    “This begs a number of questions. Is there really an “artificial added cost of prescription”?”

    Uh, yes, there is. Barriers to trade impose both direct and opportunity costs. If they don’t, then there is absolutely no point to the legislation compelling those barriers. QED. Thanks for playing.

    Another thing barriers to trade do: create large favored groups who profit directly from the maintenance of those barriers.

    “Is that what stands in the way of SBM?

    No.”

    Well, it’s certainly one thing that doesn’t help, I’ll put it that way. In fact, it is one non-trivial component of the reason people *choose* CAM in the first place.

    “What stands in the way is infiltration of non-SBM.”

    Yes, those infiltrating enemies. From within. Like a Fifth Column, and stuff, like termites, eating at the foundations of the people’s progress, there must be a Solution to these subhuman vermin, sneaking in the dark, if only we have the will…

    *shakes head* Oh. Sorry. Picked up an odd memetic harmonic, there. Infiltration, you say? (Yeah, that doesn’t sound paranoid or anything.) But even “infiltration” (*chuckle*, *snort*) doesn’t explain why people pick CAM in the first place. Nothing explains that, not even the usual self-stroking explanation, “Well, everybody’s just dumber than we are”, because single explanations don’t cut it, because there are a multitude of reasons why people choose to do things, not all of which are easy to describe in closed form. Without reservation, however, one can say that *one* reason why *some* people may choose CAM over SBM, and one reason that makes it *easier* for people to choose CAM over SBM, is that CAM, and particularly self-prescribed CAM, is easier, and in many cases cheaper, to get to.

    “The reason drugs are prescribed is not so that non-SBM practioners are limited, nor is it to add costs.”

    Yes, it’s all for the best of reasons, I’m sure. Did I *ask* “why”?

    I can state with equal authority that the reason drugs are prescribed is to maintain a profitable monopoly for the benefit of the prescribers, which is called “rent-seeking” in the technical sense, or several colorful adjectives in layman’s terms. Again, do we want to talk about “why”? I assure you that my explanation is about a million times more believable, and more popular.

    “It is to keep biologically active, potent, and potentially dangerous chemicals from being improperly used by people who are untrained in the necessary profession, medicine.”

    I hate to tell you this, but untrained people use biologically active, potent, and potentially dangerous chemicals every day. Housewives have entire gas chambers’ worth of these things under the kitchen sink. Somehow, most people get through the day without dying.

    (Christ, take a look at what some people use to prepare some exotic or ethnic foods sometime. Take one look at lutefisk. Okay, so this perhaps does not buttress my point that unrestricted access to dangerous chemicals is a good thing, but at least nobody usually immediately dies during a Lutefisk Experience, which is the important thing to take away from this.)

    Your statement is not an argument, it is another thought-terminating blandishment, meant to evoke the idea that there are some things that only The Experts among us can and should dole out, and that it is right and proper to maintain this privilege in their hands and theirs alone, and to pay handsomely for it. Surprise: CAM has flanked you on this front, in a colossally amusing fashion, by correctly ascertaining that nobody believes this line of bullshit, because its utterer is statistically guaranteed to be a Bernie Madoff character using it to reel in a sucker for a good screwing. Until you realize how Madoffian some of your positions sound and remedy this state of affairs, you are doomed to proposing bad policies that at best can be forced on an unwilling public, later to invite backlash. (And one such backlash we are *already* seeing, in the current ascendancy of CAM after the quackhunts of the early 20th century.)

    “say no to medical bailouts!”
    -SD

  43. weing says:

    SD,
    Come on answer.
    When did you stop having sex with sheep?

  44. vargkill says:

    I have something to add for all of you who bash acupressure ect.

    I had an issue not far back and no doc i went to was able to
    help fix my problem.

    I went to an asian healer and let him do some acupressure
    on me and oddly enough it seemed to fix the problem.

    I know some of you prolly think cause im not a doc or did
    not go to med school its prolly the placebo effect, but all i can
    say is im not suffering anymore with the problem i was having.

    I am a person who is pretty well in tune with my body as well.
    None of your meds worked, but yet this man was able to fix
    me in a 20 minute session involving acupressure.

    And whats even more funny is all he had to do was put a few
    fingers in a few spots and he knew where i was hurting and
    what my problem was.

    Im not saying that these folks should be able to shell out
    meds or anything like that but what i am saying is from what
    i seen with my own 2 eyes there are some people who can
    help using this method.

    Thanks for all of your time!

  45. SD says:

    weing,

    “Stop”? Why would I stop having sex with sheep? I am unfamiliar with this concept.

    Seriously, way to fanboi, there, weing. Way to lame-flail the opposition without actually doing all that hard work of, um, you know, “reading”.

    Keep up the good work. You are an example to everyone on this blog.

    “barbie sez, reading is *hard*!”
    -SD

  46. weing says:

    SD,

    I was serious. You are one sick person. You have shown that you have difficulty reading. I never asked you to stop having sex with sheep. Where did you read such nonsense? Please read the question, if you can, and answer it.

  47. SD says:

    weing,

    I was serious too. Why would I stop having sex with a sheep? I am married to a sheep, sir, and resent the question about whether I ever stopped beating her. It. Whatever. The point is that we’re in love, dammit, regardless of your scorn. How dare you mock our love!

    (Hint: if you think my humorous and unexpected exposition on the topic of bestiality is sick, then perhaps you shouldn’t have dragged it into the discussion to begin with, even as a half-assed ham-handed attempt at making something that you thought resembled a point? And incidentally, trying the “ask-a-question-then-burn-the-other-guy-for-not-answering” trick works better if you (a) do it properly, (b) identify when the question is actually unanswered, (c) have some rudimentary grasp of humor, and (d) are not a complete idiot. Now, I’m not saying anything; I’m just sayin’.)

    (Note to the irony-impaired: no, I am not married to a sheep, nor do I have sex with them.)

    “baaaaaaaaaaaaaaad to the bone”
    -SD

  48. weing says:

    You still refuse to answer the question. I did not ask whether you are married to a sheep. I did not ask whether you has sex with them either. Can’t you read? All you do is attack me in order to avoid answering a simple question.

  49. Dr Benway says:

    An unlicensed builder might put up a structure according to code. But many do not. Communities generally want all buildings to meet certain standards. And thus we license builders.

    A non-MD might prescribe for himself or others appropriately. But many would not.

  50. Prometheus says:

    I get it now – “SD” has all the answers and simply wants to let the experts “humiliate” themselves trying to assail his massive intellect (ego?).

    Well, all-mighty and all-powerful SD, what is your answer? You’ve had your fun twisting and straw-manning your way through other people’s arguments, now it’s time for youi> to put your cards on the table.

    Why is it a good idea to let everyone buy the medications they think they need without the need for a prescription? How would this improve health care and/or reduce health care costs?

    Be specific – and be prepared to justify your answers.

    Oh, and just in case you were planning on saying “I’ve already answered that question – see above.”, that isn’t an answer; it’s a dodge.

    You’re up.

    Prometheus

  51. David Gorski says:

    He won’t be able to. The reason, I suspect, is that he’s approaching it from an ideological viewpoint, namely libertarianism, rather than a scientific viewpoint. (SD’s been around SBM before.) Consequently, very likely it wouldn’t matter to him whether eliminating the need for prescriptions actually improved health care and/or reduced costs. I suspect that’s not the crux of his objection to the government’s possession of the power to determine what drugs should require a prescription and what drugs should not. I also suspect that, to him, any damage that would be caused by deregulating prescription drugs would be worth it in the name of “freedom.”

  52. weing says:

    This guy is equating prescription medications with science based medicine. He asks a loaded question and throws a hissy fit when clarifying questions are asked. His goal is not to shed light but to generate heat.

  53. vargkill says:

    I think what i see is both sides dancing around the questions
    and issues at hand.

    You’re both bitching about him dancing around yet i see all the
    same from everyone else on here.

    Be fair people! You’re both in the wrong so lets get some
    straight answers!

  54. weing says:

    “I think what i see is both sides dancing around the questions
    and issues at hand. ”

    What do you think the questions and issues at hand are? Are prescription medicines equivalent to science based medicine?

  55. David Gorski says:

    I think what i see is both sides dancing around the questions and issues at hand.

    Really?

    How about some specifics?

  56. vargkill says:

    I see why SD gets so frustrated. You really need me to point
    out the fine lines? I do not think i need to. You are all grown
    big boys/girls on here i think you know what im talking about.
    You do not need me to point out both sides are dancing around
    the issues and no one seems to want to stay with the focal
    point of the conversation.

    Last thing i want to do is get into
    some useless argument with some docs on this site here.
    What is that going to get me or you? Come on people!
    Even if i make a good point its not gonna matter to you
    cause your a doctor, and i respect that. At the same time
    your opinions are not going to mean much to me either
    because i see the point i am making and really, lets face it
    guys, sometimes we only read or hear or see what we want to
    see.

    All i was doing was pointing out the fact that you’re both
    avoiding answering question or even making any relevant
    points to each others questions, hence everyone contributing
    to the problem of people doing to much talking and not enough
    listening.

    Anyways my original post was that i had some acupressure
    done and it worked better then your “SBM”. Placebo effect
    or not it worked and i am no longer in pain.

    Can anyone answer why this might have worked yet your
    SBM did not? I have seen many people go to this asian healer
    for acupressure and have great success. I believe the focal point
    of this entire blog in the first place was does this really work
    and should they be able to proscribe meds to their people
    whom get treatment from them.

    If you all seem to think this is bullcrap, then please offer to
    me a reason why for some people it does work?
    This man can place his hands on someone without knowing
    them and tell them where they are hurting without any prior
    knowledge of the issue.

    How is he able to do this? lucky guessing himself for over 30 years? I really want a good answer from someone who practices
    meds not some bullshit answer, i want something solid!
    Prove to me that acupressure does not work! Tell me i am insane for feeling better after leaving this mans office with
    my mind blown!

  57. vargkill says:

    Sorry if my comment posts twice, having issues posting!

  58. Karl Withakay says:

    >>>
    “No, Tim, I’m fairly certain he’s using a rhetorical device whereby he lures you into making a logical assumption that he can then deny, and then castigate you for being such an idiot.

    That’s exactly what SD’s doing.

    I’ve been blogging for over four years now and before that I was a regular on Usenet for five or six years. I’ve seen it before numerous times.”
    ——————————————————————————–
    +1
    I’d say SD is making a lame attempt to use the Socratic method of philosophical inquiry to lure people into creating a straw man for him to burn down.

  59. vargkill says:

    Look your all grown folks on here so i dont need to sit here
    and point out whats going on. Its a waste of time and what
    are we getting done by going back and forth?

    Anyways my original post was that i had some acupressure
    done and it worked better then your “SBM”. Placebo effect
    or not it worked and i am no longer in pain.

    This man can place his hands on people without prior knowledge
    of the issue and tell them where the pain is. How does he do this? Can someone offer a good explination?

    Weing

    “What do you think the questions and issues at hand are? Are prescription medicines equivalent to science based medicine?”

    Does my opinion really matter to any doctor on here?
    It does not matter what i think and on top of it i was never
    trying to argue this point so why ask me?

  60. Karl Withakay says:

    vargkill,
    To beat a horse that was dead on this site long ago,

    Are you sure he had no prior knowledge of the issue?
    Did you just walk into his office and say, “Guess what my problem is.” or “give me some acupressure for no specific reason.”?

    Is there any chance you unintentionally gave him knowledge of your condition without realizing it? Could he have done some cold reading on you without you realizing it?

    Mentalists are pretty good at extracting information from people without them even realizing it, just ask James Randi.

    “The first principle is that you must not fool yourself and you are the easiest person to fool.” -Richard Feynman

  61. LindaRosaRN says:

    Thanks to Dr. Lipson for his essay. It’s timely for us SBM-types in Colorado where the state Senate will vote on a bill that would regulate “degreed” NDs. As opponents likely will only have three minutes each to testify, I will only have time for a few sound bites and I will shamelessly lift a few of the zippier lines used here. By the way, the Colorado Medical Society (CMS) is not only continuing to support ND licensure, the traditional NDs claim that CMS leadership is trying to convince them to support the bill, as well. CMS is telling them that while the bill would prohibit the traditional NDs from doing “naturopathic diagnosis AND naturopathic treatment,” it would not pose a legal problem for them if they did “naturopathic diagnosis OR naturopathic treatment”! Naturopathic diagnosticians?

    Someone above mentioned chiropractors also going after PCP status. Actually the “mixer” chiropractors are very similar to naturopaths.

    I’ve lived in some Latin American countries where prescriptions for most drugs are not necessary. However, the pharmacists in these countries tend to take a much larger role in treatment and recommending medications. Not ideal, but a help. Also, hospitals may be able to afford their own pharmacies. In areas where I worked, someone having surgery would need to have his family go outside the hospital to buy all the necessary supplies. I once took a woman who needed a cesarean to a hospital with a bag of supplies, including size 7 and 8 gloves, from a clinic where I worked. The doctor, idle at the time, wouldn’t do the surgery until I got size 7 1/2 gloves for him, which took me a couple hours.

    I’ve been very disappointed with libertarians who have a terrible track record when it comes to science and medicine, but they shouldn’t because they’re supposed to be strongly anti-fraud. Instead, they have actually gone to bat for the worst of the quacks, as the Kentucky Libertarian Party did for Hulda Clark not long ago.

  62. vargkill says:

    Dear Karl Withakay

    No he did not have any way of knowing.
    For someone who has been doing this for 30 + years
    im sure hes that good at playing the guessing game?

    Naw man theres no way for him to know and iv seen him
    do it to many people. You sit down in his office and he begains
    to examine you mostly by placing his fingers in places on the
    hear or neck, he then told me where i was hurting and basically
    what my problem was. On top of it, the issue seems to be 100%
    fixed so how do you explain that?

  63. vargkill says:

    I almost forgot to mention…

    Im not a fucking dumb ass ok, i would know if there was
    tricky involved and on top of it this man travels around the
    country and treats many people.

    Why is it that some people just cant admit that science cannot
    explain everything? If it cured what ailed me then whats the
    big deal? The man didnt offer me drugs or say he could. Nor
    did he claim to be a doctor.

    The fact is science cannot disprove acupressure and until you
    can then your opinion or your quotes from dead people make
    mean nothing to me.

    Funny thing is, there is science to say it works and science
    to say it does not.

    Kinda like God, cant prove it and cant disprove it.

  64. Tim Kreider says:

    vargkill,

    I’m a student and only a recent contributer to the site, but I’ll take a shot at your question.

    Bloggers here can talk about why acupressure likely does not work, but it’s not possible for anyone to say why acupressure seemed to work for you in this instance. We could offer guesses to explain your experience, but there’s no way to know for sure. Similarly, there’s no way to know for sure that a conventional therapy actually does what we expect in a particular instance; maybe a usually useful drug had no effect this time, but luckily the symptoms vanished for another reason. People are different, the butterfly flaps its wings, etc.

    However, the responsibility of a physician is to use those treatments that have been shown to work reliably and reproducibly. Medicine is an art of applying population data to individuals, and we must take great care in how we generate that population data. Personal stories like yours or the fact that acupressurists stay in business seem compelling, but they are not acceptable as scientific evidence because we know that even honest, well-meaning personal stories can be misleading (think UFO sightings, or witness testimony overturned by DNA evidence) and that businesses can persist despite not really working (weight loss industry, 12-step programs, psychics). The best way we humans have to sort out what reliably works from what seems to work is the scientific process.

    Of course science cannot be used to prove that acupressure doesn’t work, but it can still do a lot. Scientific theories about physiology and pathology can be invoked to explain why acupressure is not expected to have particular effects. Scientific evidence (meaning controlled and hopefully blinded) can be wielded to show that the practice has specific effects, or a lack of positive evidence can strengthen the suspicion that no such effects exist. If a practice is very old and yet does not have a firm base in scientific theory or evidence, then physicians should be very cautious about accepting it.

    If seeing your acupressurist makes you happy and is worth the cost, then by all means do it. I won’t speak for my fellow bloggers, but I have no interest in crusading against acupressure in the marketplace. What upsets me is if acupressure is incorporated into medical education or physicians’ practice without meeting the same rigorous standards that we try to apply to all non-CAM therapies.

    Hence outrage over naturopaths presenting themselves as “primary care physicians” if their practice depends on nonscientific ideology.

  65. vargkill says:

    I agree with you that there is a fine line between practicing
    an art and trying to be PCP. I am not advocating to make
    Naturopaths PCP’s but i am trying to say that its rather obtrusive to think that just because it does not fallow what
    we learned in med school that it does not work.

    You seem to have a good sense of understanding and i like
    that about you because you face the question head on and
    dont like to beat around to make it seem like i am wrong.

    I in fact do have plently of medical knowledge under my belt
    so your not talking to a medically ignorant person. So needless
    to say i know it worked for me and many many other people.
    Its amazing to say the least.

  66. Karl Withakay says:

    vargkill

    I didn’t accuse you of being “a fucking dumb ass”, however the conceit that you would know if there was trickery involved could be part of the problem. Frauds like Uri Geller thrive on people who are convinced that they would be able to tell if trickery was involved. People more intelligent than I am have been fooled by cold and hot reading con-artists.

    I did not in any way address whether the treatment you received was effective or attempt to explain the nature of your relief and whether the effect was due to placebo or not; I dealt exclusively with your claim, “This man can place his hands on someone without knowing them and tell them where they are hurting without any prior knowledge of the issue.”

    I suggest you do some research on randi.org and elsewhere to see how you might have been tricked into believing he figured out the problem entirely on his own without any input from you.

  67. Karl Withakay says:

    vargkill

    I didn’t accuse you of being a f’ing dumb ass, however the conceit that you would know if there was trickery involved could be part of the problem. Frauds like Uri Geller thrive on people who are convinced that they would be able to tell if trickery was involved. People more intelligent than I am have been fooled by cold and hot reading con-artists.

    I did not in any way address whether the treatment you received was effective or attempt to explain the nature of your relief and whether the effect was due to placebo or not; I dealt exclusively with your claim, “This man can place his hands on someone without knowing them and tell them where they are hurting without any prior knowledge of the issue.”

    I suggest you do some research on randi.org and elsewhere to see how you might have been tricked into believing he figured out the problem entirely on his own without any input from you.

  68. vargkill says:

    I understand where you are coming from and i do respect
    your point, however if you just walk into a place and the
    only thing you know about each other is he sees you in
    his resturant once and awhile, how could he be able to
    tell so many people what their issues are and be correct
    100% of the time? He knew my friend had a female issue
    her whole life, he didnt suggest anything nor did he play
    any kinda game other then touch my face and head in a few
    places and tell me what the issue was.

    Trust me, I know how people are able to coax others and
    play mind games ect. And for someone who has seen and
    been through a lot in my short life i can assure you this
    was and is the real deal.

    Do you think this form of practice can or does work if the
    person know what they are doing? Do you admit that
    there is a possibility? Or are you one of these narrow minded
    Doctors who thinks your training is the end all be all of medicine?
    Im not even sure if you are a Doctor, but ill just assume.

    As i stated before, there is no scientific evidence that can disprove acupressure. I also admit there is not enough evidence
    to say it really does work and so there is no happy medium
    hence they issue we are having. All i can say is Doctors follow
    the science in which there practices apply. The flip side is, this
    science still cannot disprove that alternative medicines work
    which should maybe suggest us to all keep an open mind
    and maybe try it yourself to develop a proper opinion.

    You know, more and more doctors are starting to practice
    acupressure ect. They are even offering it to med students
    here in WI as part of medical training being optional. I believe
    there are those whom are good enough and know what they
    are doing to be able to provide real results for people who have
    problems. I also believe there are people whom practice
    this form of meds and dont have a clue what they are doing
    and those are probably the kinda people who think they deserve to be a PCP. These kinda people i would stay away
    from because they have no clue.

    “People more intelligent than I am have been fooled by cold and hot reading con-artists”.

    Was i supposed to know how “Intelligent” you are?

  69. SD says:

    “I get it now – “SD” has all the answers and simply wants to let the experts “humiliate” themselves trying to assail his massive intellect (ego?).”

    … And I’d like to hear the answers, don’t forget that part. (Though not from you. You are dumb. I am sorry.)

    Unlike you, I admit the possibility of changing my mind, although that requires a convincing argument.

    “Well, all-mighty and all-powerful SD, what is your answer? You’ve had your fun twisting and straw-manning your way through other people’s arguments, now it’s time for you to put your cards on the table.”

    My cards already are on the table, and are apparently being ignored. Well, okay, I guess.

    I defy you to show at which point I engaged in a twist or straw man, too.

    “Why is it a good idea to let everyone buy the medications they think they need without the need for a prescription?”
    “How would this improve health care and/or reduce health care costs?”

    I take some exception to this; I am being asked to justify the abolition of a cozy rent-seeking niche, an act that frankly *needs* no justification, and whose opposing principle (“keep that tit a-flowin!”) is justified more or less by being fait accompli. I further note that there is a certain hypocrisy in demanding that I answer your questions while repeatedly refusing to answer mine.

    You are under the mistaken assumption that I am here to convince you of something. I already know that that is impossible, having read sufficiently to convince me that this blog is populated by equal portions smarmy ideologues and shrieking latahs, whose sacred cows and shibboleths are every bit as untouchable as those of, say, a hardcore alternative-medicine practitioner. No, Prometheus, I am not here to convince you; I am here to provide you the framework upon which to embarrass yourself, and you are performing right on cue. If I do convince you of anything, it is purely by happenstance, I assure you.

    Here’s a question (not that you ever read or answer them): Go up and read the responses to the original post; isn’t this a topic that you would expect some neutrality and impartiality on? It isn’t as though “get rid of prescription-based drug availability constraints” is a clarion-call to burn down the edifice of modern medicine, is it now? It’s amazing how people here see a plan that suggests maybe not filling certain people’s rice bowls quite so full and immediately equate it with Satan-worship and a confession of baby-eating.

    “Be specific – and be prepared to justify your answers.

    Oh, and just in case you were planning on saying “I’ve already answered that question – see above.”, that isn’t an answer; it’s a dodge.”

    Yes, I am, and no, it isn’t. It’s an invitation to read what I actually wrote, instead of glossing over it, and throwing out some keyword-based non-sequiturs. I have no hope that you will do this, of course. Working the “patients are idiots and might hurt themselves with drugs if we didn’t control them” trope is not an answer, it’s a soundbite.

    Here’s a hint: This began with a question. Answer the question. Then I’ll answer yours.

    Here’s a question: Why does this idea bother you so much? What *scientific* basis do you have for supporting the status quo? For that matter, what moral basis do you have for doing so? Do you have one that doesn’t partake of the notion that patients are children to be supervised?

    “all-mighty and all-powerful”
    -SD

  70. SD says:

    Cde. Gorski:

    “He won’t be able to. The reason, I suspect, is that he’s approaching it from an ideological viewpoint, namely libertarianism, rather than a scientific viewpoint.”

    Your faith is touching.

    I suppose you’re right; I probably cannot justify the idea of unobstructed access to medicine in any way that would be considered legitimate to this audience. I doubt I could justify it to the satisfaction of anyone here even if I had a ten-foot stack of studies unambiguously demonstrating that conclusion, because it cuts a ragged path straight across the prestige, power, and income streams of a majority of MDs, and would be fought on that basis alone. I do not know if this study has been done. (Note carefully that a question regarding extant studies on this topic – supporting *or* refuting this hypothesis – has gone unanswered.)

    I suspect that this study has *not* been done, as it is presumably considered to be pointless, since “everyone knows” that rationing medications by prescription is the best thing to do, right?

    I note that other countries do not appear to have problems with unfettered access to medications. I note no major exterminations in Mexico, Canada, or Europe, where medication availabilities vary drastically from the US. Perhaps there are statistics of epidemics of ACE-inhibitor abuse and insulin-huffing (or whatever) in these countries that I am not aware of. Seeing no evidence of it, I will ask for proof, in the form of credible hard numbers.

    “Consequently, very likely it wouldn’t matter to him whether eliminating the need for prescriptions actually improved health care and/or reduced costs. I suspect that’s not the crux of his objection to the government’s possession of the power to determine what drugs should require a prescription and what drugs should not. I also suspect that, to him, any damage that would be caused by deregulating prescription drugs would be worth it in the name of “freedom.”

    Well, now, here’s where we get into a forest of sticky wickets. You are assuming that (a) there would be damage, and (b) that the damage would be greater than any benefits obtained. (You also assume that freedom is valueless, a belief I shall not even try to dissuade you of.)

    Now, we can go back and forth on this issue. You will say, “Patients could hurt themselves!” I will say, “Some patients might hurt themselves, but the majority would not, and the majority reaps benefits in lower costs for medical treatments.” You will say, “There’s no evidence of lower costs!” I will say, “Yes, there is – getting rid of prescribers’ monopoly grant for control of access to treatments will force them to charge lower prices to encourage patients to seek what valuable services they do provide, in addition to making that added cost of a doctor’s consultation optional instead of mandatory.” You will say, “We don’t know how many people will be damaged by self-treatment of the wrong condition due to a lack of proper diagnosis!” I will say, “We also don’t know how many people might benefit anyway from cheaper access to the treatments for common ailments (e.g. hypertension), even if they are selected somewhat randomly; nor do we know how many fewer people might be damaged by fewer physicians treating the wrong condition due to a lack of proper diagnosis, i.e. in how many instances the patients will get it right where the doctors would have gotten it wrong. There have been studies in disparate fields involving complex and subtle phenomena (e.g. finance) suggesting that in not all cases does expertise translate to competence or to successful outcomes. Medical studies about self-treatment outcomes, by design, exclude the possibility of the patient having access to the same range of treatments that a doctor has access to, forcing the patient into a choice between less effective treatments (e.g. CAM), thereby introducing a bias that leads to an improper evaluation of the concept of self-treatment.”

    We can go back and forth on this all day long, in other words. I don’t want to, because I’m tired of the “patients are stupid” trope. This invites a response of “doctors are assholes”, and encourages patients to find ways to fuck doctors over, individually and as a group. I can guarantee you that that is where you will wind up – wished away to the political equivalent of the Cornfield – if you don’t clean up your bad attitude and start finding ways to support the demystification, propagation, and frank economization of your treatment methods *without* indulging in the false victory of political domination of your enemies. That means that you don’t get to suck the tit any more, my son, I’m sorry. You don’t get to beg the omnipotent State for favors, either. I know you want to, because I know that you worked hard for your knowledge and it seems amazingly unfair that people who *didn’t* get to profit from flogging bullshit to the credulous, but most of your reward for having knowledge is just to have it. And that’s the way the world works, unfortunately.

    Just for shits’n'giggles, let’s restrict the scope of the argument slightly. Instead of saying that *all* drugs should be available without prescription, let’s narrow our focus a bit and say that *just* the following classes of medication be exempted from the requirement for a doctor’s prescription:

    (a) Hypertension medications
    (b) Diabetes-control medications, including insulin
    (c) Cholesterol-lowering medications, including statins

    Now, these are three popular targets for CAM, one might almost say their bread and butter. This is not a surprise, because these illnesses are highly prevalent. Bigger market == bigger money.

    So what SBM treatments are available for these?

    (a) Hypertension:
    * ACE inhibitors
    * ARBs
    * Beta-blockers
    * Calcium-channel blockers
    * Diuretics

    (b) Diabetes
    * Thiazolidinediones
    * Sulfonylureas
    * Insulin
    * Those new protein thingys (ex. Byetta)
    * Misc.

    (c) Cholesterol-lowering medications
    * Statins
    * Absorption inhibitors (although these got a solid nutshot not too long ago in a study)
    * err, one other class that inhibits cholesterol synthesis, ISTR

    I’ve missed some, but these are very probably the most popular. I can find out more in about twenty seconds with Google. Wiki shows me a whole slew of diabetic medications, for example, that I missed. So does the PDR. Oh well.

    So here are a few critical points:

    (a) *EVERY SINGLE ONE* of these conditions has a non-weaselable test to determine whether the condition is present.
    (b) *EVERY SINGLE ONE* of those tests is available at reasonable cost to individuals without recourse to a MD. In at least two of those cases, reliable home testing kits are available.
    (c) *EVERY SINGLE ONE* of the recommended lab values for those tests is widely known, in fact, is hammered on a regular basis in all media sources, with changes being broadcast regularly. (ex. new recommended targets for blood pressure)
    (d) *EVERY SINGLE ONE* of those conditions is bad news.
    (e) *EVERY SINGLE ONE* of those conditions is ostensibly permanent; once you start exhibiting symptoms, you’re on the Medication Train for life, usually.

    So you stand a pretty good chance of knowing, with some degree of certainty and without much outlay, whether or not you have one of these conditions. Pop a high blood sugar? Yeah, that’s not supposed to happen, ever. Show 160/100 two or three times in a day? Probably a good idea to figure out a depressurization strategy, then. These are not the Ineffable Mysteries of the Universe, they’re something that can be figured out by a mouth-breathing beer-sponge with a 3×5″ instruction card using rudimentary electromechanical devices fabricated in China, which are, coincidentally, precisely the same tools and information that doctors will use to determine the presence of these conditions and to monitor them. Does the doctor add value to this process commensurate with his cost?

    Well, what about the side effects of these treatments? Yeah, there are some, that’s true. You can get pretty well jacked-up on any one of these medications, sometimes in some really ugly ways. However, you can also get jacked up on Claritin, acetaminophen, Epsom salts, or any of the fifty thousand other things sold on the shelves. The possibility of self-damage with these medications is relatively remote (isn’t that why we use them, because they’re safer than the alternative of the disease?), is detectable in most cases *by the patient* before damage is done (“I don’t feel so good”), and can be summarized neatly (“If you take this statin and your muscles begin to hurt, STOP TAKING IT AND GO TO THE ER.”) While it is profitable to contact an expert to have some idea of what’s happening while you’re taking these medications, and it’s probably a good idea to have some monitoring, is monitoring a *requirement*? Is it better to have “treatment and no monitoring”, or “monitoring and no treatment”? If you want to eat your cake and have it too – “treatment *and* monitoring” – then at what cost do we enforce monitoring?

    I will now drop the “question” portion of this exercise and move to the “soapbox” phase, where I suggest that *requiring* a visit to a doctor in order to access the above medications is practically a criminal enterprise, in that it *unjustly* increases the costs necessary for the afflicted to obtain the treatments for these conditions compared to a situation where they could simply buy the treatments without intervention by a doctor. I don’t think that you would argue that a diabetic or hypertensive patient stands to be more damaged by the process of self-treatment and trial-and-error with these medications than they are now, where patients remain untreated due to opportunity and inflated dollar costs of these treatments. I don’t think you can argue against basic supply-demand mechanics, which lead us to the conclusion that cheaper treatments are more widely adopted, unless you’re planning on writing your own Bailout Economics textbook and going for the Sverige Riksbank Nobel prize. I don’t think you can argue that it is better to require $500 worth of lab tests and office time to diagnose a condition that a patient can catch and treat earlier at home with a $25 BP cuff, even if a patient screws it up once in awhile. Hell, I don’t think you can argue that a diabetic or hypertensive stands to be more damaged by unrestricted trial-and-error with SBM medications than with trial-and-error-and-error-and-error with CAM medications, can you?

    Screwing up and mistaking a zebra for a horse – a statistical unlikelihood – can be expected to occur with much less regularity than the current situation where patients pretend that horses don’t exist because they can’t afford the existence of a horse in their lives.

    I will suggest that giving the general public the tools to defeat flocks of deadly rampaging wild horses (hypertension, diabetes, heart disease) is justification enough for the free sale of these medications. Cutting off CAM’s air supply is, from your perspective, just a free added bonus.

    Is that justification appealing? (Psychic Prediction #2: “NO.” Whyzzat, Cde.?)

    “…and I’m not gonna take it any more!”
    -SD

  71. vargkill says:

    Dear DS

    Asking for a serious response on this board is like asking a kindergarten class to discuss the theory of relativity.

    This board i have noticed not everyone but is inhabited
    by a core group of arrogant, sarcastic, sardonic, immature,
    and anal retentive prick doctors or other people with opinions
    larger then themselves.

    Their idea of answering a question only seems to be achieved
    by dancing around the questions and trying to answer a simple
    question with nothing more then expletive laced diatribes.

    My point is, why even try? You can plainly see for a bunch of
    educated people somewhere somehow they seem to have
    lost basic conversational skills.

    Good luck!

  72. Peter Lipson says:

    Oh, SD, you’re so funny!

    Let’s say a new hypertensive comes to see me. ALLHAT data suggest that a thiazide type diuretic would be a good first choice. Of course I’d have to check their creatinine and potassium first.

    But let’s say i dip their urine and there’s protein? Well, then, perhaps an ACE inhibitor is a better choice. But I still need those labs.

    But wait, my physical exam reveals a quiet abdominal bruit. Not so fast. What if they have renal artery stenosis? Hmmm…better get a doppler first.

    Srsly, this is the kind of thinking that goes on for even one little decision.

  73. weing says:

    vargkill,

    What was your diagnosis? I don’t see how you had SBM if there was no diagnosis. My take is that you had some undefined issue that resolved after you had some acupressure done. Post hoc ergo propter hoc. How the hell are we supposed to know what the problem was? That reminds me of the time a guy fell off a ladder at home and his wife called the ER. The doctor asked a few questions that she relayed to her spouse and he answered. Questions like does it hurt when you hurt your head, chest, arm, belly, legs. The guy answered yes to all the questions and an ambulance was sent for the critically injured gentleman. The ER valiantly evaluated him, splinted his broken finger and sent him home.

  74. David Gorski says:

    Srsly, this is the kind of thinking that goes on for even one little decision.

    I know. SD is depressing me with his arrogance of ignorance.

    He’s also annoying me with this outrageously blatant straw man:

    You also assume that freedom is valueless, a belief I shall not even try to dissuade you of.

    Uh, no. Where did I ever say or imply that freedom is “valueless”? SD seems to have conflated overall freedom with the ability to get basically whatever drug he wants without having to get a prescription. I love the overwrought hyperbole, though. I point out that his belief that his not being allowed to procure nearly any drug he wants (or even just antihypertensives or diabetes drugs) for purposes of “trial and error” self-treatment without first seeing a doctor is, as he put it most recently, a “criminal enterprise” happens to be way off the plantation and based on libertarian ideology rather than science. SD’s response? That I must therefore consider freedom “valueless”!

    Priceless. Dude, step away from the hyperbole.

    Of course, the really amusing thing is that, by saying what he did, SD only helped confirm what I said about him, namely that his views are indeed based far more on ideology than any sort of science. I’d also point out that Mexico is not exactly the nation we’d want to pattern our drug safety and prescription laws after. There’s a reason why quack clinics flourish in Tijuana. I also find it rather amusing that he also references Canada and Europe, which do allow more drugs to be available over the counter, but also have what’s anathema to SD (if I recall correctly from previous encounters), government health care. Tell you what, SD, we can appropriate Canadian and European laws on medicine, but how about we also appropriate their universal health care? Just a thought.

  75. weing says:

    SD,
    If you get rhabdomyolysis from a statin, why bother going to the ER? Why not just to Wikipedia and treat yourself? Order a home dialysis machine and do it yourself.

  76. weing says:

    I don’t know if it’s true but there is a story about Tesla where he was asked to consult on a machine that wasn’t working. He took a look, took out his sonic screwdriver and turned one of the screws and the machine worked just fine. He submitted his bill for $1 million. The factory owner demanded an itemized bill for such a simple procedure. It came out to be 1 cent for turning the screw and $999,999.99 for knowing which screw and how much to turn it.

  77. Karl Withakay says:

    vargkill,
    “Trust me, I know how people are able to coax others and
    play mind games ect. And for someone who has seen and
    been through a lot in my short life i can assure you this
    was and is the real deal.”

    So you couldn’t be fooled, and you’ve figured out the trick to every magic trick you’ve ever seen?
    Barbara was also likewise convinced the Uri Geller was the real deal, and that it wasn’t possible she was being hoodwinked.
    http://www.randi.org/site/index.php/jref-news/513-randi-speaks-conjuring-with-barbara-walters.html

    “Do you think this form of practice can or does work if the
    person know what they are doing? Do you admit that
    there is a possibility”

    I consider it possible that every single proton in the universe will instantly and simultaneously decay into positrons and neutral pions, but I also consider this extremely implausible and improbable. I’m not really talking about POSSIBILITY, I’m talking about PLAUSIBILITY and PROBABILITY.

    “The flip side is, this
    science still cannot disprove that alternative medicines work
    which should maybe suggest us to all keep an open mind
    and maybe try it yourself to develop a proper opinion.”

    Science can show that various alternative medicines have no effect greater than placebo, which is effectively the same as showing they don’t work.

    Do you have an open mind that will allow you to consider that alternative medicines might not work; do you have an open mind that will allow you to consider you might have been fooled?

    If you think you really do have an open mind, please watch the following video and at least consider to the message:
    http://www.youtube.com/watch?v=T69TOuqaqXI

    “Was i supposed to know how “Intelligent” you are?”

    Was that supposed to be some sort of veiled insult? I can’t expect you to accept that I am very intelligent, but my point was really that I am at least intelligent enough to understand my own limitations, and understand that I can be fooled.

  78. Calli Arcale says:

    Regarding the notion of freedom being valueless……

    Freedom is extremely valuable. But unregulated medicine, counter-intuitively, does *not* give us freedom. It may give us the illusion of freedom, and certainly those wishing to profit off of patients like to encourage that illusion. But it is just an illusion, as the time before the FDA demonstrates so brilliantly.

    There are serious consequences to using the wrong treatment, or to not getting treatment at all. Is it freedom when you are persuaded that you do not need to see a doctor, but instead can just believe everything Quack A feeds you, devote yourself entirely to his regimen to cure your disease, and then find yourself penniless and dying of cancer a few years later?

    The most dangerous drugs should be kept prescription only. This is not because people are stupid. It is because people are *trusting*, and there are those who will (and in fact do) take advantage of that to their own profit. In order to minimize abuse, the most dangerous drugs need to be kept prescription only. This is not so much because patients are stupid but so that there is a means of stopping the abusers. Unethical doctors can be stripped of their privilege to prescribe medicine. This is too important to throw out in the name of “freedom” or “choice”, which, as history shows us, really only improves the freedom of those who aren’t constrained by ethics.

    How free are you, really, if you are addicted to cocaine or morphine, as happened all too often in the pre-prescription days?

  79. Citizen Deux says:

    So dizzy – must get oxygen….

  80. weing says:

    Freedom is just another word for nothing left to do.

  81. Calli Arcale says:

    I just thought of a better, more concise way to put my argument, and one which should resound with the CAM-types, if they are willing to listen.

    Medicine is regulated not because we distrust the patients. It is regulated because we do not trust the doctors/nurses/Big Pharma/etc. Society therefore requires that they prove themselves worthy, and retains the right to strip them of their privileges should they later prove otherwise.

  82. pec says:

    I say give this patient a barrel full of pills. She has metabolic syndrome, which has led to type 2 diabetes and hypertension, caused by physical inactivity and addiction to refined carbohydrates. It’s obvious she will never stop eating processed junk food, and of course she will never have the discipline to exercise. So just pour drugs into her.

  83. vargkill says:

    Ok there is a lot to address here. For lack of time i will get right
    to the point.

    Weing,

    SBM, My symptoms showed 2 things, Acid reflex persisting for
    2 weeks, along with other symptoms which could have been
    a number of things including a very common Hiatal Herrnia,
    which included pains moving to the upper chest and down the
    arms and only releaved with painful BM’s and or cutting wind.
    Which indicates GERD or some form in that family. Hard to tell
    without tests but any educated person in medicine would know
    the likelyhood of it being a combination of all of the above
    would indicate just that. Again your talking to someone with
    extensive medical knowledge here. If you had these symptoms
    you might not treat yourself but then again why have someone
    else diagnose you if you know what it is? Is there a need for
    me to have gone to a doctor? Did i really need to have them
    refer my to a specialist and give me a bunch of tests?

    Again if you walk up to someone and they figure out what
    your issues are and what your pain is without you telling them
    how is this possible? How can you trick someone to know where
    the pain is? He told me flat out and then fixed the problem.

    Why are more and more doctors starting to practice alternative
    medicine? Im not advocating these people be able to proscribe
    meds or become PCP’s do you understand this? Just to make
    sure we are on the same page. If it was the Placebo effect
    then what i do know is it worked. I also know other things i was
    having issues with got fixed in the process, so again doctors
    cant fix, acupressure fixed. what other conclusion am i left with?

    Karl Withakay

    Science can show that various alternative medicines have no effect greater than placebo, which is effectively the same as showing they don’t work.

    No Karl, That just like saying because science cannot prove
    the existence of God he does not exsist. If it did not work then
    Your science should be able to disprove it beyond a shadow
    of a doubt. I respect where you are coming from on this
    but at the same time why can we not admit there is a little
    more to life then just what we can prove. sometimes that
    is the only thing that makes life a lovely thing. Is there are
    things we cannot explaine.

    I do believe there are people who are good enough to be
    effective in there field. I think the man i seen was one of the
    few people around here that can do what he does and be very
    effective at it.

    You keep bring up the “you might have been fooled” argument.
    Again fooled is when you call a phychic hotline and they make
    assumptions based on a question asking bullshit process.
    Again time and time again a man examining people and being
    correct 100% of the time. Not asking but telling you where
    and what hurts or what the issue is. With all due respect you
    still have not convinced me that he has any way to trick
    people into lucky guesses. It would be one thing if he asked
    questions or made suggestions. But this is not the case.

    Peter Lipson

    You know hypertension is the most overrated diagnosis
    in the medical field today. Lets get everyone filled up with
    beat blockers which in a lot of cases dont do a fucking thing.
    Some have even proved to be no more effective then a placebo
    pill. Im sure many of you know about this. Lets say you take a
    man with a reading of 160/80 what if that was his bp almost
    his entire life? Lets not forget the white-coat syndrome. why
    are we not taking readings when a person is at home relaxing?
    Why is it in my study i seen a drop in bp and normal ups and downs at different times of day in many people?

    Like i said overrated! If you really want to argue this with
    me i have tons of facts im ready to throw your why.

  84. SD says:

    “Uh, no. Where did I ever say or imply that freedom is “valueless”? ”

    Right here:

    ‘I also suspect that, to him, any damage that would be caused by deregulating prescription drugs would be worth it in the name of “freedom.”‘

    Note the quotation marks around “freedom”, indicating ironic intent. (To the audience: for optimal understanding of the semantic content of this sentence, picture Cde. Gorski flashing a pair of air-quotes and a wry smirk around the word “freedom”.)

    Having read your writings, and in the same way that you correctly observed that I am informed by libertarian beliefs, I observe that you are significantly informed by collectivist beliefs and practices, which beliefs by their very nature consider individual freedoms to be negotiable depending on the needs of the group (“needs” being indistinctly and mutably defined according to the whims of the moment).

    “SD seems to have conflated overall freedom with the ability to get basically whatever drug he wants without having to get a prescription.”

    There is no conflation. Freedom from interference in private dealings *is* freedom. I wish to buy directly from the people who produce pharmaceuticals, without paying the “prescription tax”. They own the pills; I own the money; I want to trade my money for their pills. This is a basic and fair trade, in that it does not materially affect anybody else, no fraud is involved, and in that I do in fact and can reasonably, as an adult, be presumed to stand fully-informed of the consequences of making an error, and have available ample opportunities for assistance should I choose to avail myself of them. Why can I not do this? Why is this trade verboten?

    “For my own good”?

    Loaded questions to illuminate this issue by way of analogy: Do I have the right to refuse treatments that you, as a doctor, *know* will cure me? Do I have an unlimited right to do so, or can it be overridden by external agency? Do I have the right to choose between two treatments of unequal efficacy, even if I select the one that is less likely to work? How do these rights differ in any material way from being able to select my own treatment without recourse to a doctor’s opinion? How much autonomy do I get to have, guys? Where does my right to self-determination end? Riddle me that.

    I am told, by some on this blog, that it isn’t freedom if I believe a quack who recommends a bad treatment. Assuming that that incoherent thought means anything in the first place – spoiler, it doesn’t – then is it freedom when I am only “free” to be treated if I ask you nicely first, and have only a choice of the options you provide me or “nothing at all”?

    “I love the overwrought hyperbole, though. I point out that his belief that his not being allowed to procure nearly any drug he wants (or even just antihypertensives or diabetes drugs) for purposes of “trial and error” self-treatment without first seeing a doctor is, as he put it most recently, a “criminal enterprise” happens to be way off the plantation and based on libertarian ideology rather than science. SD’s response? That I must therefore consider freedom “valueless”!

    Priceless. Dude, step away from the hyperbole.

    Of course, the really amusing thing is that, by saying what he did, SD only helped confirm what I said about him, namely that his views are indeed based far more on ideology than any sort of science.”

    Not to put too fine a point on it, it seems that your views on this topic are every bit as lacking in scientific support as mine, and without even the benefit of a plausible a priori argument in their favor to boot. I note that again that some questions I have asked have not been answered:

    “Precisely what *scientific* evidence do you have to support the status quo? What study or studies support the notion that obstructing free access to medications with prescriptions leads to a better result than self-treatment? Are there any such studies? Were there any such studies when the law was enacted? Have you ever read these studies, or is this just one of those things that ‘everybody knows’?”

    The plural of anecdote is not data, Cde. Gorski.

    “I’d also point out that Mexico is not exactly the nation we’d want to pattern our drug safety and prescription laws after.”

    Why the hell not? Mexicans generally don’t have problems with counterfeit drugs; they sell them to the Americans instead. Why do they sell them to the Americans? Because it’s cheaper and easier to buy them from Mexico than it is to get them from the pharmacy. One part of that cost is the “prescription tax”. (There are others, of course.)

    Here’s an observation about drug safety: A major problem with the pharmaceutical supply chain is that it includes multiple middlemen. In the United States, between the pharmaceutical company and the customer, there are at least two entry points for counterfeit drugs: at least one distributor and a pharmacist. Typically there are multiple distributors. Now, in this age of the Internet, it seems reasonable to me that one could, say, open a store – call it “merck.com” or whatever – that featured a nice slick SSL-enabled “click-to-buy” interface with FedEx shipping, and get this, this is the important part, *straight from the manufacturer to the customer*, eliminating the possibility of counterfeiting, or at any rate reducing it to the absolute minimum. That seems like it would cut down on that pesky counterfeiting and safety problem, by enabling the customer to get it *directly from the manufacturer*, with the nice added bonuses of reducing patient cost and increasing pharmaceutical company profit margin. How’s that for a win-win, huh?

    Except that we can’t do that, because the logistics of working around this whole “prescription” thing are, well, too complex. How would we get the Mother-May-I note from the doctor to the company? How could we verify that the patient really had permission to treat himself for his ailment? How would we ensure that the doctor got paid[delete][delete]was able to ensure that the treatment was appropriate?

    “There’s a reason why quack clinics flourish in Tijuana.”

    So what? In what way do prescription laws materially affect the availability or prosperity of “quack clinics”? There’s a reason why tea is popular in China, too. If you don’t understand what that has to do with the point, well now, how does that feel?

    At least those “quacks” are making use of something approximating an efficacious treatment, even if misapplied. I note that – again, *sigh* – my question was not answered: “Which is better: treatment and no monitoring, or monitoring and no treatment? If we choose both – monitoring *and* treatment – then at what price monitoring?”

    Shit, every other post on this blog laments the increase of “quack clinics” in America and/or Great Britain, except that they happen to be handing out granola bars instead of Coreg. Good thing we have those prescription laws to put some speed-bumps in the way of that quackery, huh?

    “I also find it rather amusing that he also references Canada and Europe, which do allow more drugs to be available over the counter, but also have what’s anathema to SD (if I recall correctly from previous encounters), government health care. Tell you what, SD, we can appropriate Canadian and European laws on medicine, but how about we also appropriate their universal health care? Just a thought.”

    No, for the same reason that appropriating Soviet chess curricula does not mean that it is a good idea to appropriate their penal system. It is possible to get one thing correct (or correct-ish), and get the rest of it wrong, a fact with which I am certain you are well-acquainted by long practice of half-cockery and hipshooting.

    Christ, I feel sorry for your patients. Do you have any left, do you just teach other would-be doctors the finer points of smarm these days?

    “clowns to the left of me, jokers to my right”
    -SD

  85. Prometheus says:

    As I predicted, SD simply said “read my posts” instead of giving his answer in a concise, coherent fashion.

    He also stated that he was waiting for my/our answer, which was already given.

    My provisional diagnosis is that SD is the type of troll who just likes to tell people how “stupid” they are, but doesn’t know enough about the topic to actually contribute.

    Well, I went back and read all of SD’s posts. I’m still trying to figure out what he’s on about. Maybe I’m just too thick to “get it”, but I can’t find a coherent response.

    So, SD, if you have something to contribute, how about a concise and coherent answer? Tell us what you think.

    In case you’ve forgotten the question, here it is again:

    Why is it a good idea to let everyone buy the medications they think they need without the need for a prescription? How would this improve health care and/or reduce health care costs?

    If you can’t answer that one simple question without a smokescreen of pseudo-righteous indignation, I’m going to assume that you don’t have an answer and that you’re just “stirring the anthill”.

    Prometheus

  86. Karl Withakay says:

    vargkill,
    You’re remarkable close minded about things. You seem absolutely convinced of your positions and the infallibility of your own powers of observation and recollection.

    “No Karl, That just like saying because science cannot prove
    the existence of God he does not exsist. If it did not work then
    Your science should be able to disprove it beyond a shadow
    of a doubt.”

    You apparently don’t understand how science and the scientific method works; science doesn’t disprove things beyond a shadow of a doubt. Science can not prove there are no purple cows; it can only say that none have ever been observed, no known means of producing purple cows exists, and there is no basis for believing in purple cows. If I were to tell you that I have a tiny elf living on my shoulder that cannot be detected by any means known to man, could you disprove this position? The point is that I cannot prove or provide evidence that this elf exists and there is therefore no reason for anyone to believe this it does.

    While the existence of (scientifically undetectable) Chi or life energy is implausible, the possibility that acupressure is genuinely effective beyond placebo is less implausible. I haven’t yet come across any good quality evidence that shows it is effective beyond placebo, but I can’t say it’s impossible.

    Also, you have gone way beyond claims of clinical efficacy for acupressure and claimed 100% reliable paranormal diagnostic powers for this acupressure healer you describe.

    Are you actually claiming this man is correct 100% of the time, and that this is not an exaggeration? Why is this man with such an amazing, 100% reliable gift for diagnosing ailments without input world famous?

  87. SD says:

    “Oh, SD, you’re so funny!”

    I know, but looks aren’t everything.

    “Let’s say a new hypertensive comes to see me. ALLHAT data suggest that a thiazide type diuretic would be a good first choice. Of course I’d have to check their creatinine and potassium first.

    But let’s say i dip their urine and there’s protein? Well, then, perhaps an ACE inhibitor is a better choice. But I still need those labs.

    But wait, my physical exam reveals a quiet abdominal bruit. Not so fast. What if they have renal artery stenosis? Hmmm…better get a doppler first.

    Srsly, this is the kind of thinking that goes on for even one little decision.”

    I’m sure it is. And this is to your credit as a physician, that you do the ground work to reduce the odds of making a bad treatment decision.

    However, you’re still thinking about this incorrectly. I assume you are familiar with the concept of “triage”? Sometimes we don’t get to have the perfect, and we must take care not to make the perfect the enemy of the good.

    We’ll craft an example case to illuminate this point: Bob, a 40-year-old man, tests his blood pressure four times in one day, randomly, with a store blood-pressure cuff. Each time, it comes up over 160/100. The store owner checks it, and the machine appears to be calibrated properly.

    This is *all* the information available.

    Now Bob, watching the news on occasion, knows that a high blood pressure is bad news. While he realizes he should go to the doctor – this is option (a) – *for whatever reason*, he is not inclined to do so. This may be due to cost, inconvenience, personal dislike, whatever.

    Given that that option is off the table, then what is Bob’s next-best move?

    (b) Treat himself by selecting a common first-line therapy without a doctor’s supervision
    (c) Remain untreated

    (a) is better. You think (a) is better. I think (a) is probably better in most cases too, with some qualifications, although that betterness does not to me imply moral justification for exclusion of option (b). That’s beside the point – Bob doesn’t think (a) is better. Bob’s the patient. It is Bob’s ass. Tough luck, doc. But what about Bob? What can we do for Bob?

    Given that in at least some instances Bob will select (b), what are his odds of getting it wrong? Moreover, how can those odds be improved cheaply? Let’s say that Bob lives in Freedonia, where his local supermarket has a “Blood Pressure” section in the medical aisle. Let’s say that there are two of each of the following classes of medication available (doctors in the audience, please fill in blanks for recommended first-line therapies):

    (a) ACE inhibitors (Lisinopril, ???)
    (b) ARBs (Valsartan, ???)
    (c) Calcium-channel blockers (???)
    (d) Beta-blockers (Metoprolol, ???)
    (e) Diuretics (HCT, ???)

    You provide a portion of the decision tree here:

    (a) You suggest HCT is a good option, generally speaking, except that it can cause potassium loss, and may be a problem in patients with kidney disease. Okay, so that’s two lines on the outside of the box: “(1) This medication may cause low potassium, a potentially dangerous condition. Ensure that your potassium intake is adequate by eating foods rich in potassium, such as potatoes, bananas, and oranges. If you feel faint, ill, or weak, or develop cramps, chest pain, or palpitations (irregular heartbeat) while taking this medication, discontinue use and seek medical attention immediately. (2) Seek medical advice before taking this medication if you have or may have kidney disease.” (1) is the same warning that comes with the prescription instructions. (Why is it considered sufficient to warn the patients with a paper insert in prescriptions and other OTC medications, but that this is considered insufficient for the medications under discussion?) What are the odds that someone self-dosing with HCT will develop serious hypokalemia with (or, hell, even *without*) those two warnings attached? What are the odds that they won’t figure that out until it does serious damage?

    (b) You suggest a urine dip for protein, as an ACE inhibitor might be a better idea in that case. Okay, so an ACE inhibitor might be better (but see below), but is that a contraindication for a thiazide, or is a thiazide a “reasonable” choice for hypertension in this instance when compared with “nothing”? Fine: the thiazide gets a fifty-cent urine dipstick in it, with a third line on the box: “FOR YOUR SAFETY: Please follow the instructions inside to perform a simple urine test with the enclosed strip. If the strip turns blue, then there is a chance that you may have kidney disease. It is recommended that you seek medical advice before taking this or any other medication, as kidney disease is a serious medical condition, and another blood-pressure medication may be more suitable for your use.”

    (c) An ACE inhibitor may toast your kidneys if you have an undiagnosed renal artery stenosis. Okay: How often is that the case? What is the prevalence of hypertension secondary to renal artery stenosis rather than some other cause? P(patient has renal artery stenosis) * P(ischemic damage to kidneys due to ACE inhibitor treatment in the case of undiagnosed renal artery stenosis) * P(patient selecting ACE inhibitor as treatment) * P(patient doesn’t stop treatment before some undesirable endpoint) == X. How big is X? Let’s say that X is large enough to be concerned about. Proteinuria is common in ischemic kidney damage, yes? That means you package your ACE inhibitor with a package of thirty urine dipsticks with a big bold line on the outside of the box: “FOR YOUR SAFETY: Please follow the instructions and the enclosed dipsticks to test your urine on a regular basis while taking this medication. If any strip turns blue, then there is a chance that this treatment is damaging your kidneys due to an pre-existing undiagnosed condition. Discontinue use and seek medical attention immediately.” How often will this fail to catch damage? (Hell, how often would this catch a stenosis that was missed during a physical examination?)

    Sure, lab values are a great idea. (Ask me sometime about what I think about the requirement for a doctor’s prescription for lab tests.) If a patient isn’t going to permit a doctor to do the workup anyway, then moral considerations of liberty aside, why not let that patient at least *try* to benefit from self-treatment with proven medicines? (And if the patient is going to ask the doctor first *anyway*, then what does the law accomplish in the first place?) I submit to you that for almost any constellation of “maybe” you can come up with that leads to Bob damaging himself with these medications owing to an incorrect guess about the nature of his condition or the presence complicating factors, there are simple mitigations that substantially improve his odds of getting the right answer, *or* the odds of that constellation occurring are so small as to be negligible compared to the benefits. You add value to this process, but nothing near what you cost, I’m sorry to say, and that cost is only justified if people are *freely* willing to pay it. Evidence suggests that people are disinclined to pay it in increasing number, because they (a) can’t afford to and (b) smell something intrinsically wrong with ths situation. That last is common among Latinos, who quite properly wonder why the hell they have to pay the doctor every time they want to get a treatment for something they’re already pretty sure they have, and conclude that while this makes sense to the doctor, who wants a good income, it does not make quite as much sense to them, who want to simply get treated and get on with business.

    Finally, keep in mind one thing: I didn’t say that he *can’t* go to the doctor. I said that he didn’t *have* to go to the doctor, although the assumption was that he didn’t want to anyway. That may not seem like much difference to you, but in the words of the immortal XKCD, “it is the difference between thirty seconds and a glass of wine with your daughter, and a bottle of gin and a night with her”.

    “split a bottle of gin, my dear?”
    -SD

  88. weing says:

    You keep saying if such and such develop seek medical attention. Where? Why not do it yourself? Why not run your own tests and treat yourself as you self-diagnosed?

  89. SD says:

    “As I predicted, SD simply said “read my posts” instead of giving his answer in a concise, coherent fashion.”

    That was a clear, concise answer. That you didn’t like or weren’t able to finish the reading assignment isn’t my problem.

    “He also stated that he was waiting for my/our answer, which was already given.”

    Yes, you gave exactly the answer that I excluded from consideration in the first post. Yay, reading comprehension.

    Why did I exclude it, you wonder? Because I’m tired of hearing it, and because I would expect that such a brilliant idea as a rent-seeking privilege grant from the State would have more than one decent answer in support of it, and particularly one of better quality than “We have to do it this way because people are stupid”. Wow, I guess that showed me, huh?

    Although I knew that there would be no such thing as impartiality on this topic – discussing ways to break a man’s rice bowl doesn’t lead to rational discussion – I’d hoped that at least some here would approach the question from a scientific perspective, maybe invoking things like “studies” and “statistics” instead of “how I’m an ideologue” and “how stupid SD is”. Gee, I guess that showed me, huh? >;->

    “My provisional diagnosis is that SD is the type of troll who just likes to tell people how “stupid” they are, but doesn’t know enough about the topic to actually contribute.”

    I note that for people who are capable of contributing, there is a surprising dearth of answers to the volume of questions I’ve asked. Most responses have been some variation on “Pshaw, what a CAMtard! You want to self-medicate! You want people to die!” The number of assertions I’ve seen about things I haven’t written has been astonishing.

    “Well, I went back and read all of SD’s posts. I’m still trying to figure out what he’s on about. Maybe I’m just too thick to “get it”, but I can’t find a coherent response.”

    Very simple: it started with a question, “Why not end the requirement for a prescription to purchase effective to medications?” That’s pretty simple for even someone as thick as you to “get”, huh?

    “So, SD, if you have something to contribute, how about a concise and coherent answer? Tell us what you think.”

    Uh, wow. I’d think that was fairly obvious by now, but I guess there’s no accounting for some people’s impermeability.

    “In case you’ve forgotten the question, here it is again:

    “Why is it a good idea to let everyone buy the medications they think they need without the need for a prescription? How would this improve health care and/or reduce health care costs?”

    … Because it isn’t your job to tell other people what they can sell, or what they can buy, because you are not their daddy?
    … Because it *especially* isn’t your job to make money by interfering in that transaction with the threat of force, because in any other context, that’s called “extortion”?
    … Because, contrary to your operating hypothesis, patients are neither morons nor your wards?
    … Because nobody suggests that you not be available for consultation, or that it’s a bad idea, only that it not be a statutory requirement?
    … Because it gives SBM a strategic and moral victory over CAM, denying them important ground to occupy, and provides momentum to SBM treatments without taint of profiteering or persecution?
    … Because nobody so far has produced any credible scientific evidence that the prescription requirement is a good idea, instead basing their defense solely on the fact that it’s fait accompli and a stream of “Well, what if [bad thing] or [bad thing] or [REALLY bad thing] happened, huh? What then, huh?” Neologism/portmanteau: “The plural of ‘What if?’ is not ‘data’.”
    … Because nobody has produced any *moral* justification that does not draw from the poisoned aquifer of slavery (one good definition for which is “denial of self-determination”), instead producing a stream of blandishment about how it’s really better for your options to be limited because you might hurt yourself by choosing the wrong one, a well-known, well-trodden, and highly-polished cobblestone on the road to Hell?

    “If you can’t answer that one simple question without a smokescreen of pseudo-righteous indignation, I’m going to assume that you don’t have an answer and that you’re just “stirring the anthill”.”

    Clearly you didn’t read my response. I invite you to do so again. Spoiler: I don’t care *what* you assume. You bore me, fanboy. Go away.

    “wishing that the gods really *could* chain people to rocks and have a giant eagle gnaw their livers for eternity”
    -SD

  90. vargkill says:

    Karl Withakay

    First lets address the acupressure guy. Yes the man is known
    and travels around the US treating hundreds of people at a time at seminars. His name is Sik Kin Wu. If you’re ever in
    Wisconsin and would like to put his skills to the test then
    ill glady share his contact info with you. Why not try it for
    yourself Karl? At which point you can contact me and let
    me know what you think.

    Some people who are good at what they do might not wish
    to be in the spot light as much as other people.

    I think you where missing my point about the science of it.
    Science can disprove things and has been proving and disproving for a long long time now. If things can be proven
    then things can be disproven. If you want to put it into terms
    of Purple Cows and Elfs on your shoulder then its a nice
    metaphore but theres no need for it because i get your point
    yet i feel like your not trying to get mine. I fully understand
    your reason for not believe it can work yet this situation made
    a believer out of me. My point in the whole science things is
    that just because science cannot confirm this does not mean
    it does not work. Yes i know typical response right? As you
    pointed out in your metaphore. But there are a lot of people
    who are finding relief from this form of practice. What could be
    the reason? Maybe its not that there is the whole “Chi” thing
    but that the acupressure helps by doing other things with
    the body.

    Heres a good example, If your head hurts why does pushing
    the web of the thumb or the area between the eyes help?

    You get where im going with this?

    I still would like you to respond to this question so i can make
    my point.

    I am suprised that you did not address the fact that more and
    more doctors are practicing alternative medicine. What are your
    thoughts on that?

    “I haven’t yet come across any good quality evidence that shows it is effective beyond placebo, but I can’t say it’s impossible”.

    You admit that you cannot say its impossible right?

    Im telling you that yes the man can diagnos 100% of the time.

    Example, I have a female friend with a cyst on her Ovaries.
    How is it that when he put his hands on her stomach that
    he said in broken english…

    You have a female problem… You have a bump on your ovarie.

    Tell me how he was correct? Or that he not only knew i had
    a bad knee but knew what the problem with it was and right
    away knew what knee it was.

    What form of tricky was involved with this?

    PS
    The man also has studied modern medicine as well.

  91. SD says:

    Oh, yes, forgot a couple of things, Cde. Gorski:

    (a) Wow, my prediction was right. (SD’s Wayback Machine: “(Psychic Prediction #2: “NO.” Whyzzat, Cde.?)”) Two in a row, huh? I’m a shoo-in for that fat check from Randi and company, huh?

    (b) You know, you totally buffaloed me. It’s like magic, y’know, I’ve, like, never seen the tactic of reading a long post, picking one sentence out of it – in this case, my statement about your assumption that freedom is valueless – and harping on it while ignoring all the other points in the post. That makes you look like a total badass, Cde. I am so totally not bullshitting you right now. No, seriously. I am totally seriously right now, guys. Cde. Gorski is, like, totally the winner. srsly.

    “shocked and awed”
    -SD

  92. weing says:

    “SBM, My symptoms showed 2 things, Acid reflex persisting for
    2 weeks, along with other symptoms which could have been
    a number of things including a very common Hiatal Herrnia,
    which included pains moving to the upper chest and down the
    arms and only releaved with painful BM’s and or cutting wind.
    Which indicates GERD or some form in that family. Hard to tell
    without tests but any educated person in medicine would know
    the likelyhood of it being a combination of all of the above
    would indicate just that. Again your talking to someone with
    extensive medical knowledge here. If you had these symptoms
    you might not treat yourself but then again why have someone
    else diagnose you if you know what it is? Is there a need for
    me to have gone to a doctor? Did i really need to have them
    refer my to a specialist and give me a bunch of tests?”

    I can’t tell what you had based on that. Some of it sounds like GERD. Some sounds like diverticulosis and flatulence. You had empiric treatment for GERD that didn’t work? Makes GERD unlikely. You are correct that it is hard to tell without tests but if you are going to try to indict SBM, then you have to follow its rules and get a diagnosis. Anyway your symptoms resolved with acupressure, which to me means it was a self-limited condition that spontaneously resolved. I doubt there is anything I could tell you that would change your mind that you were cured by a miracle worker. You suffer from conviction or should I say you are enjoying it. Just one doc’s opinion.

  93. David Gorski says:

    You know, you totally buffaloed me. It’s like magic, y’know, I’ve, like, never seen the tactic of reading a long post, picking one sentence out of it – in this case, my statement about your assumption that freedom is valueless – and harping on it while ignoring all the other points in the post. That makes you look like a total badass, Cde.

    No, it means I’m tired of your trolling nonsense. Nothing more, nothing less.

  94. SD says:

    “I just thought of a better, more concise way to put my argument, and one which should resound with the CAM-types, if they are willing to listen.”

    Don’t mistake me for a CAM adherent. While I don’t care what they do, and do not a priori exclude the possibility that they may be right in some instances (though what instances those are elude me), I don’t buy it.

    On the other hand, I don’t think doctors and organic chemists are quite as clever as they make themselves out to be; there are a lot of demons and surprises in the areas of human physiology that we know less than nothing about, and half of the things we *think* we know are probably wrong. Complex systems have a habit of resisting pat answers, and we are still basically at a half-assed “sticks-and-stones” understanding of complex chemistry (i.e. “life”). This is not an attack on life sciences; we’re doing the best we can, but we are not in any realistic sense at a level where we can claim “good” understanding of life processes and their failures yet. It is this fact which makes me skeptical when I see people bloviating about things they “know” with a certainty that a half-inch piece of rebar could be bent around – e.g. some of the posters here – because I am ever mindful of the old saying that pride goeth before a fall.

    Nobody else has to believe that, of course. It is a free-ish country, after all. >;->

    “Medicine is regulated not because we distrust the patients. It is regulated because we do not trust the doctors/nurses/Big Pharma/etc. Society therefore requires that they prove themselves worthy, and retains the right to strip them of their privileges should they later prove otherwise.”

    You are thinking in terms of groups. Think in terms of *people*. There is not a “we”, incidentally. I do not consider myself part of a “we” involving anybody on this blog in any meaningful fashion. I do not care about “society”, because I have never seen “society”; what I have seen is “people”. People, as individuals, have rights. One of those rights commonly-infringed, but no less a right – is the right to trade freely amongst themselves without fear of force or fraud. This right does not absolve them from the duty to exercise due diligence in savvy trading, however. There is no fraud in selling someone a medicine which *may* help them, *if* the purchaser is made reasonably aware of the possibility of failure. There is no fraud in selling someone a medicine which may harm them, *if* they are reasonably aware of the possibility of harm beforehand. People buy and do things regularly that may not help them, and may in fact harm them. They use things that they do not possess full understanding of the operation of. So what? Are they to debarred the use of those things because they *may* be harmed?

    On this theory – that the public needed protection from “harm” – was the modern medical regulatory framework erected. This framework has, mirabile dictu, provided the support for assaults on SBM, which we see on this blog on a regular basis. Exactly how good an idea was that, then? Perhaps a change of operating theory to one that reaffirms the patient’s fundamental rights – the right to be free of coercion, in *all* its forms – and pushes the realm of combat from squabbles over regulatory leverage to a plain competition of the cold, hard facts is in order?

    (Yeah, I know. “What is this madness? What language is he speaking? I cannot fathom this insanity!” Yeah, okay, whatever. You don’t have to believe my recommendations for, ahem, “treatment”, of course. It is a free-ish country. Just remember that I suggested this course of action to you.)

    If you don’t trust the doctors, nurses, Big Pharma (God, I loathe that term), or whoever, then the solution to their untrustworthiness is to remove them from this process as controllers and gatekeepers and return them to their rightful role as *consultants* and *advisers*. Access to medicine is something that is wholly under the control of doctors, by legislative fiat. Removing this obstruction to treatment, among other things, minimizes doctors’ attractiveness to Big Pharma as targets for advertising and bribery into overprescription of medications, since there is no requirement that a doctor’s recommendation be followed. (It will in most cases by default, but it’s not a requirement.) Doctors therefore become more impartial, having no control over this process: “Well, I *think* you should do X, but Y might work too. Pick one and let me know how it works. I suggest the following labwork so we make sure it’s working and not making you sicker. It’s your body and your health, so it’s your call.”

    Note that I don’t like licensing either – licensing accomplishes nothing, basic English tort law principles cover medical malpractice more than adequately – but abolition of prescription law has absolutely nothing to do with physician licensing. That you do not require a physician’s permission to purchase medication does not imply that anybody else can recommend treatment to you; the two principles are separate.

    “what is this ‘we’, white man?”
    -SD

  95. SD says:

    Govorit’ Cde. Gorski:

    “No, it means I’m tired of your trolling nonsense. Nothing more, nothing less.”

    Actually, you *love* it. It feeds into your Remnant fantasy: “We, the elect, the scientists, laboring tirelessly to bring light to mankind, are persecuted and hunted, but we shall triumph over the forces of darkness one day, oh yes, we shall, we shall overcome… but they pursue us and hound us, attacking us ceaselessly, yerhonor, we’re just *defending* ourselves…” This “hold the last bunker” mentality is not healthy, because it refuses to acknowledge the possibility of error, or even of a better strategic plan than you currently operate from. Open the bunker doors; it’s the last thing your enemies expect.

    You *personally* operate with an steel-reinforced sense of certainty, and refuse serious challenges or even the most cursory discussion of your articles of faith, preferring to dismiss them with – dare I say it – “cheap rhetorical tricks”. This is the behavior of a man who knows that his beliefs will not stand the test of the fire of inquiry. That means that, as a scientist, you are functionally already dead, and probably sucking the life and genius out of some lesser-known junior to maintain your status until you can retire comfortably. (I don’t know that for a certainty, of course, but I don’t doubt it; the pattern is prevalent enough that it wouldn’t surprise me. Epidemiology of scientific senescence, one might say.)

    I note that your philosophy seems to be that “if you know you’re right, then there is no point in arguing”; what does that say, then, about your participation in this blog, where you *virtually* argue with CAM practitioners on a regular basis? Why not stick to your knitting, secure in the knowledge that your enemies will prove their own undoing?

    I am well aware that *I* might be wrong. Can you convince me of that?

    “let he who is without Error…”
    -SD

  96. vargkill says:

    weing

    Where is i believe the man helped me im still not open minded.
    I will admit there is a chance it was right place at the right time
    thing going on. but what i do know is it resolved as soon as i
    walked out.

    Now Weing how do you explain everything else i posted
    in the last post?

    PS
    I went to med school myself so your not talking to a medically
    ignorant person.

  97. SD says:

    “You keep saying if such and such develop seek medical attention. Where?”

    … Uhh, at the doctor’s office, or the hospital? Or somewhere else that you’d find a doctor?

    Why do you assume that a lack of coercion to use a particular alternative equals a lack of use of that alternative? Must people be forced to do everything that they do?

    “Why not do it yourself? Why not run your own tests and treat yourself as you self-diagnosed?”

    Why not, indeed? At the present time you can’t just go and pay the lab and get a test, like you could in a civilized country, but if we’re going to assume that medications have been freed of any obstruction to their use, why not assume that labs have been opened up too?

    And who says that one *has* to self-diagnose, not that there’s anything wrong with the idea? I’ll jerk out that dirty trick now: tests of diagnostic automation tools (i.e. medical expert systems) in the 80s were astonishingly successful within the small domains in which they were applied. (MYCIN, anyone? CADUCEUS?) Interestingly, the chief constraint of those expert systems was computing power, in which the difference between technology available in the early 80s and today is, um, astonishing. Want to guess how well a *modern* medical expert system with full user interaction would perform, and how frequently it would get the right answer, especially compared to a human PCP, or even a specialist?

    “at 7:30am, on October 12, 2009, Docnet became sentient…”
    -SD

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