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Motivations

We received the following letter:

Your blog, the SBM page, has come up for me several times in my research. I’m an RN trying to research cancer treatment, for myself, I am the patient. I’m also a licensed massage practitioner with a 30 year history using “alternative” or “complementary” medicine successfully to treat myself for various things. When your blog has come up I’ve read into it, picking up some useful information.

My question is, why the sarcasm? Why do you and the responders on your site have such disdain and anger? Why do you feel threatened? Your physician status gives you the top of the totem pole, the extensive training, the authority and the privilege. Very doubtful you are going to be knocked off the top of that totem pole in this or any several more lifetimes to come.

I say that I’ve picked up a few useful tidbits from your site, but in the main I am troubled by the anger and disdain that is expressed toward practitioners who obviously are helping other human beings. Patients who have to pay cash for a service because their insurance does not cover it do not keep going back to a practitioner who does not help them. What are you afraid of?

I am served well by a naturopathic oncologist who ordered me some homeopathic cream for my breast surgery, as well as a pharmaceutical grade supplement of multiple vitamins. My breast suffered a hematoma post op, and it turned black. The opposite breast also turned black from blood that drained to it as I lay on my unaffected side. In 24 hours I had one and one-half black breasts. The post op nurse and my PCP both stated it was the worst bruising they had ever seen in their careers, and neither of them are less than 40 years of age.

With the help of the cream and supplements, the bruising is resolving in days. Not weeks. Days. The post op nurse told me to expect this dark bruise to linger for weeks or months. I credit the cream and the supplements, neither of which the surgeon ordered. A top surgeon at a top university hospital.

Something is wrong with the premise or the presentation on your site. If physicians have this much disdain for others who are obviously helping their patients, then something needs to be dialed in, dialed back, or the baby thrown out with the bath water.

First, do no harm.

Since the holidays tend to fill my alleged free time with family commitments and I need to rewrite some RSS feeds (am I lucky or what?), I thought I would take this opportunity to answer the letter since it will require zero research. The other contributors on the team probably have their own motivations for participating in this blog and in science-based medicine in general. Perhaps they will weigh in in the comments. This is why I spend my time working away in the endless field of SCAM.

First, I like to write. I enjoy the process of trying to explain a complex topic but also like to be clever or humorous in the process. I like to make me laugh and, I hope, others. It is an enjoyable intellectual process. This brings up issues of tone in the blog, and there will be disagreements amongst the participants in the blog as to tone. I look at the blog as tending towards the informal and the personal. The entries should reflect the author and the few blogs I read regularly are less due to the content and more due to the personality behind the blog. I want style AND content and the former is rare. Many people can write well organized and reasoned essays; few can do it with personality. So I try to have my entries reflect something of who I am and express my personal reaction to the topics covered as honestly as I can.

It can, and should, come across as disdainful and sarcastic, for reasons that will become clear later in the essay. Disdain not for the people involved, I hope, but the ideas and concepts of SCAM. It is the sin, not the sinner, that I hope is the target of some of my loathing.

I like to learn, and there no is better process to help one learn than to try and explain a topic someone else. It helps in my infectious disease world and it helps as well in the world of SCAM.

I am also endlessly fascinated in the almost-too-numerous-to-count ways humans think and think badly. The variations of human cognitive pathology represented by SCAM proponents are amazing. The SCAM world has endless examples of how to reason poorly and the inability for people to recognize that they are thinking poorly. I remain amazed that humans are consistently horrible at understanding the natural world without the support of the scientific method.

I have become a better physician as a result of understanding all the logical fallacies to which humans are prone and applying them to myself. That, I would suspect, is the main issue that separates the SCAM world from the skeptical world. Those who participate in pseudo-medicine are generally unable to apply the concepts of critical thinking to themselves. I suspect that to do so is an unnatural act that most cannot, or will not, do.

But the main reason I spend my time writing and podcasting on pseudo-medicine derives from why I originally became involved in the SCAM world.

It was in the early 1990’s, my first year or two in practice, when I received a consult for a case of gangrene, not a typical cause of infection in the industrialized West.

The patient was a female in her mid-twenties. Sometime earlier she had been diagnosed with a tumor of her leg; I remember it as an osteosarcoma but that detail could be mistaken. It was some sort of musculoskeletal tumor. Rather than an amputation and chemotherapy, which could have been curative, she opted for the care of a naturopath who treated her cancer with alkaline therapy, since, as the naturopath told her, cancer is due to acid.

The cancer progressed, grew and parts of it outgrew the blood supply, leading to dead, infected tissue. Her naturopath told her this was her body rejecting the tumor. By the time I saw her, most of her leg was black, ulcerated, dead and with a stink that I hope you never experience. There are few smells as foul as rotting human flesh.

The only reason she was in the hospital was that she had fainted from anemia and continued to refuse any medical or surgical interventions for her leg, which she told me was going to be cured. She believed in the pseudo-medicine she was receiving. She bet her life on it. That night the tumor eroded into a major artery and she bled to death in her sleep.

One of the curious phenomena is the demonization of those of us in science-based medicine: we are big pharma shills or insurance company shills or we are motivated by fear of our position being removed. Or we are angry. Yeah. I will cop to that last one. Anger. At people spending their time, their hope, their money, their health and their lives on worthless nonsense.

Reality, as I have mentioned in the past, is a honey badger. It don’t care what you think, if you misstep or are unlucky, reality will hurt or kill you. Life is short. Health is rare.

There is a reality that proponents of pseudo-medicine deny but we are all subject to its rules. You may think you can harness the energies of the universe to make yourself invulnerable to harm. The sword don’t care, it still cuts. That martial artist is the archetype of all believers in un-reality. We have not evolved to understand or comprehend reality. For understanding we need science.

The SCAMs about which we write on this blog and elsewhere are based on fantasy and the endless ability for people to fool themselves and others. And if you spend your time treating illness with fantasy you could end up bleeding to death in the middle of the night from what could have been a curable cancer.

Yes. I know. Medicine kills. But less so every day. Since 2006 in my hospital system we estimate that we have prevented over 2 000 infections and 200 deaths. How? By applying reality-, science-, and evidence-based medicine to the treatments of our patients. As Chair of Infection Control for my hospitals I have seen the enormous work we have done to improve care and make medicine safer. None of the infections we have prevented or the deaths we have avoided have been in any way due to any SCAM.

As far as I know there has yet to be any quality improvement in any SCAM except for the use of disposable acupuncture needles. Then just watch a video of acupuncture and see if you can see anything that resembles good infection-control techniques. A key feature of reality/science-based medicine is that it reacts to information and changes slowly, painfully, erratically, for the better. What we do works. Sometimes. And when it doesn’t it is abandoned or improved.

I am a doctor. As I mentioned in another entry, I see medicine as a calling. I, and many of my colleagues, have literal responsibility for the health, life and wealth of people. We see people every day who lose all three because of bad decisions or a lack of insurance.

I am always more than a little saddened by the intravenous drug users I see. There are those whose main attitude is that IVDUs made a choice and get what they deserve. I see a life wasted and it is sad. Or the AIDS patient who does not come in due to a lack of insurance until the immune system is beyond salvage. Or the middle-aged black female whose first manifestation of high blood pressure is a large stoke. Every day can be a reminder of how fragile and transient life is.

I am not worried about me and medicine. I am not worried about my position, I worry about the next person who may needlessly die or be injured by a treatable illness because they opted instead to treat their cancer with alkaline or deny that HIV causes AIDS or treats their diabetic foot infection with honey.

So when people throw away their life, their health and their wealth pursuing alternative interventions that do not work, that cannot work, it tends to be a motivator. Most SCAM is based on fantasy and fantasy kills and maims and bankrupts. And that makes me angry. And so I continue to always, scribble, scribble, scribble.

Often we get the phase ‘do not throw the baby out with the bathwater’. In the world of SCAM, I am not certain what is the baby (the result?) or the bathwater (the SCAM therapy?). It is a non sequitur. There is no pseudo-medical bathwater that will clean any baby. A more apt cliché concerns emperors and his new clothes.

And as to the idea of ‘first, do no harm’, it is a concept that has never been true in medicine. All actions, and inactions, can have consequences that can lead to harm. There is no way to avoid harm. Glib aphorisms may be a nice way to avoid considerations of complex phenomena, but, like much of SCAM, have little to do with reality.

My job, my responsibility, my calling as a physician is, to the best of my ability, diagnose and treat your illness. That cannot be done by applying ideas that are based on fantasy to problems that come from reality.

I do not doubt that most of those practicing pseudo-medicine have nothing but good intentions. That does not make what they do good, correct, or effective. This blog and its cousins exist because we care that people suffer and die and lose money and hope and time by participating in nonsense. It is a waste of lives that will never have a surfeit of the characteristics that pseudo-medicine steals from the people who use them. As Terry Pratchett noted:

The road to hell is paved with good intentions. (This is not actually true. The road to Hell is paved with frozen door-to-door salesman. On weekends, many of the younger demons go ice skating down it.)

Others have summarized my position far more elegantly than I am able:

No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee.

Posted in: Science and Medicine

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228 thoughts on “Motivations

  1. vadaisy says:

    Very moving and inspiring blog entry, Dr. Crislip. Thank you for writing, and personally, I rather enjoy a bit of sarcasm.

  2. Chris Hickie says:

    SCAM is SCAM. It reeks from miles away with its promises of cures for everything and being “all-natural” and “no side effects”. Homeopaths, naturopaths and chiropractors (to name a few of the SCAMmers) have little if any science behind what they claim works. Their rationales for what they do have little if any basis on human anatomy and physiology, too. And I think a larger number of them than we would like to believe are knowingly well aware that they are not helping anyone other than their own selves. I have no problem admitting disdain for them, especially as they are almost always anti-vaccine–and the problems with declining vaccine rates in the US in terms of record numbers of vaccine-preventable disease outbreaks this year are becoming readily apparent. I think more physicians need to speak out and be openly against SCAM.

    1. windriven says:

      “And I think a larger number of them than we would like to believe are knowingly well aware that they are not helping anyone other than their own selves.”

      I absolutely believe this and where it exists it is a special type of evil because it steals not just money but health. One can always earn more money. Life or health, not so much.

  3. windriven says:

    “That night the tumor eroded into a major artery and she bled to death in her sleep.”

    And the naturopath was sentenced to be Big Bubba’s bunkmate in Attica for 30 years, right? Right? No????

    Naturopaths claim to have ‘the same’ education is doctors.
    “as the naturopath told her, cancer is due to acid.” And then my head exploded.

    In this week’s column, Jann Bellamy related that some chiropractors were doing gynecological exams. Apparently, they have found vaginal subluxations that require adjustment. Apparently there are some women who let them. And goodness knows chiropractors are at least as well educated in gynecology as naturopaths are in oncology.

    I really wonder just wtf goes on in the heads of state legislators who condone abet this gross malpractice?

    1. Tallise says:

      You have to be kidding me! Chiropractors aren’t being charged with practicing medicine without a license for theses gyno inspections? There’s got to be some way of shutting that crap down…

      1. Tallise says:

        Just read Jann’s article, I just gave blood and am already feeling dizzy, but this nearly put me out of my seat!

  4. Mojo says:

    First, do no harm.

    Second, ?
    Third, profit

    1. WilliamLawrenceUtridge says:

      Are we talking doctors, or naturopaths? For naturopaths, it’s more like “First, do nothing, second, take credit for regression to the mean and inevitable recovery, third, profit, fourth, badmouth real doctors.”

      For doctors it’s more like “First, study very, very hard in school. Second, begin going into debt to the order of $10,000 per semester. Third, participate in several years of grinding, incredibly stressful, sleep-deprived patient care as the only way of being exposed to sufficient patients to develop competence. Fourth, enter practice with hundreds of thousands of student loans. Fifth, have patients challenge your judgement and training on the basis of pages printed off of medically illiterate websites. Sixth, watch your malpractice insurance steadily increase. Seventh, watch a genuinely talented cardiac surgeon betray his education and learning in favour of ass-kissing and pandering.”

      Frankly, I’m surprised doctors wait so long to retire.

      1. JohnL says:

        As for when we can retire, see “fourth” above.

      2. mousethatroared says:

        WLU – So I walk into a doctor’s office and he tells me I have Chronic Lyme and I need to take long term antibiotics. He’s gone through all your steps…education, long hours, debt, etc. Who am I to abuse the poor, suffering, debt ridden doctor by bringing up some information I read on the internets that long term antibiotics don’t help?

        Also, where’s the step where the doctor prescibes chemotherapy to patient’s who’s cancer is in remission and the state medical board ignore the reports of suspicious practices?

        Doctor’s are a diverse group, some are competent, some are not, some are competent, but having a bad day, some are honest and caring some are money grabbing sociopaths. I doubt that many are money grabbing sociopaths, but boy, the sociopaths can be good getting a lot of patients, eh?

        I don’t think it’s helpful to act as if doctor’s are saints and that paitents shouldn’t have the terminity to challenge their recommendations. It IS the patient who is taking the physical risks, after all.

        1. Jane Cobb says:

          But where is the step when the patient learns enough real science to understand why the doctor is prescribing ongoing chemotherapy for a cancer that is not at that point detectable? When does the arrogant know-all patient accept that the Internet is not always a good source of information? And when does the semi-literate patient understand that the plural of “patient” is “patients” and not “patient’s” amongst other examples of a poor education and lack of knowledge?

          1. mousethatroared says:

            Jane Cobb – Wow – you are correcting my punctuation as if that proves some point.

            I was referring to the reasonably recent charges of the Michigan oncologist that was featured here on SBM in a post by David Gorski and in the news.

            http://www.mlive.com/news/detroit/index.ssf/2013/08/doctor_arrested_accused_of_ord.html

            I’ll await your educated explaination on how patients should avoid such doctors, without challenging them or questioning their “authority”. It appears to be up to the patients. The Michigan medical board either overlooked the case or chose to do nothing.

            1. MadisonMD says:

              @MTR
              You make an important point. Physicians are fallible and few are downright bad. How can a patient know if their physician is one of the bad guys? In the ideal world, medical boards would put these docs out of business. But this doesn’t happen very quickly, and sometimes not at all.

              Jane Cobb’s post is not diplomatic and I find it difficult to defend. But there is a core truth: it would be hard for even the brightest patient to quickly develop sufficient relevant expertise to direct her own care without the advice of a physician. For example, the counterpoint to the bad doc you posted about is the Hershberger case, also documented on this blog.

              So what to do when faced with a serious illness such as cancer, and you wonder if you are getting the best advice?

              (1) Look up or ask your physician for the evidence-based guidelines. In oncology, the NCCN publishes evidence based guidelines for patients and for physicians. Similar guidelines are available from other groups. (In your case the IDSA guidelines on chronic lyme would have been good to have; luckily you were aware enough to steer clear of this physician).

              (2) Get a second opinion.

              You could also look up your physician on your state medical board’s website to see if s/he has been reprimanded. But this is not foolproof.

              A personal note: I am a medical oncologist, frequently give second opinions and fortunately have found the large majority of the first opinions to fall within the acceptable standard of care.

            2. mousethatroared says:

              Thanks All! I’ve been wandering Universal Studio in a holiday crowd today, so please excuse the looseness or rambling quality of my response.

              I completely agree that trying to self-educate to the point of creating my own treatment plan for any potentially serious illness is a fool’s errand. I believe the same could be said for many literate, knowledgable people. Medicine today is so specialized. I have family members who have doctorates in very technical non-medical fields and I don’t believe that they would be well served attempting to act as experts in their own medical care either.

              My approach is generally what MadisonMD alludes to. I look for the standard of care within the applicable specialty and try to ask enough questions to understand whether or not the doctor seems to be deviating from the standard of care and if so, the rational behind the deviation. I think, it can be important to inquire about an inconsistency in a doctor’s explaination or between two medical people who are working on your case. Inconstincies might be reason to be suspicious that a doctor is problematic, but there might also be an innocent misunderstanding that is helpful to correct. I educate myself on the topic, but not so that I can attempt to take the place of that specialist. Instead my goal is to have enough of an understanding of the topic to be able to ask questions and understand the answers, from a laymen’s perspective. There’s nothing worse than trying to discuss a medical topic with a doctor when appointment times are short when you are swimming in unfamiliar vocabulary.

              I will also add that it’s not so unusual to get two different opinions from medical people on the same topic/test results. Somehow, you, the patient, are going to have to decide who’s recommendations to follow…regardless of how illiterate or knowledgable you are.

              Looking back, I’ve been more happy with my care when I researched the topic, asked questions and checked to insure that the care I or my children was receiving seemed similar to the recommendations for that specialty.

              I think that the reason that some patients get bad results with internet medical research is because they are not focusing on finding the standard of care for their symptoms from the most reliable source possible, they are focus on finding a new miracle cure for their symptoms or disease. That is a very different approach.

              In conclusion, I’d like to clarify that to me “challenging” means being willing to ask questions and point out concerns that you have, as well as keeping an eye open for irregularities (rather than being blindly trusting). It does NOT mean being rude, yelling, cursing or demanding that a doctor act as a script writing or test ordering peon.

              Wish me luck, tommorrow we storm the gates of Hogwarts.

              1. MadisonMD says:

                @MTR: From what you said, I suspect any good doc would be happy to work with a patient like you. It’s fair to challenge.

                I should add one more thing to my ‘to do’ list (apropos to the purpose of this blog):

                (3) If it is an option, enroll in a clinical trial. Clinical trials have the standard of care embedded within them. They are written and agreed upon by multiple experts–often national/international academic leaders. The eligibility and treatment plan is codified and pre-specified. Charts are audited in detail by trial monitors and other physicians to make sure your doctor adheres to the protocol. When you participate in a research study, several people are looking over your doctor’s shoulder to make sure everything is done just so.

                Have a good time in the land of wizards, MTR.

              2. MadisonMD says:

                I will also add that it’s not so unusual to get two different opinions from medical people on the same topic/test results.

                I missed this in my initial read. It is possible to get two different recommendations and both to fall within standard of care. This can be frustrating and difficult to understand. But I would hope your doctors should be able to explain it if there is such a discrepancy. Some things are just not clear cut. (However both opinions should fall within bounds specified by standard-of-care guidelines, if a guideline exists for the given situation.)

              3. Al says:

                To Madison, do you believe a fairly intelligent layman, as myself, shouldn’t educate himself to the point of keeping their doctor in line?

                If so, I’m sorry to burst your arrogant bubble but since my doctor has no education in nutrition, like most doctors that practice strictly under the AMA, I usually end up coming up with the right suggestions, before he does, to maintain and heal my hepatitis c and liver.

                Because my enzyme levels were off the charts, he wanted to start me on those fairly new and improved liver treatments, a couple were, telaprevir (Incivek) and boceprevir (Victrelis). I know what these drugs do to a person and came to the conclusion that they’re no better than chemo and radiation. Just another poison. Went to another doctor, same thing!

                So, I educated myself, in short, healing nicely. Besides a strict diet with no sugars or carbs and high in fiber, vitimins, raw veggies and possibly most of all, milk thistle, I started exercising!

                Enzyme levels down to normal and quite frankly, I’m very confident about curing myself. Without a doctors help or advice except for a couple I’ve found online that knows and believes that what God gave us to use on earth is all we need to take care of ourselves.

                Just one question about something that bothers me. Why do you think you need to make sooo much money to help people that are sick, especially when your methods don’t work all that well? And let’s be honest and not talk about, “it’s not about the money”! lol You would just be insulting yourself and the intelligence of others.

              4. Harriet Hall says:

                “most doctors that practice strictly under the AMA”

                No doctor practices “under the AMA.” We practice under state licensing regulations. The AMA has no power to determine what treatments are allowed and no influence over state licensing boards. And the majority of doctors do not even belong to the AMA.

                I’m really glad you’re doing better, but how can you be sure your enzyme levels wouldn’t have gone down to normal anyway? You say you are “confident” about curing yourself. I’m not convinced that your confidence is justified. The only way to know would be to do a controlled study to look at final outcomes. We have heard too many sad accounts of cancer patients who were confident that alternative medicine would cure them but who died anyway, often faster and with more suffering than if they had accepted conventional treatment.

              5. weing says:

                “To Madison, do you believe a fairly intelligent layman, as myself’…”
                The truth of that premise is very questionable. Hep C is known to also affect the brain. If I were you, heaven forbid, but if I were you, I would take to questioning the validity of my own assumptions.

              6. MadisonMD says:

                @Al

                To Madison, do you believe a fairly intelligent layman, as myself, shouldn’t educate himself to the point of keeping their doctor in line?

                Absolutely. You always have the right to educate yourself and to ask questions. If your doctor isn’t providing standard of care recommendations, then you (and the licensing boards) have the right to keep her in line. You also have a right to get another opinion.

                However, if she and every other physician is practicing according to standard of care guidelines, and you disagree, it is worth second guessing whether you know more than the experts who made the guidelines. Yet, it is also your right to not follow the doctors’ advice, as you are doing. After all it’s your life and you are the one who has to deal with the consequences of treatment or lack of treatment.

                Incidentally, I’m curious what evidence you have that diet and nutrition can treat or cure hepatitis C?

              7. WilliamLawrenceUtridge says:

                Doctors learn about nutrition. It is stitched throughout their curriculum in the form of microbiology, learning where the vitamins are used, how minerals are deposited and excreted, and how macronutrients are processed as part of metabolism. The level of detail is in fact extremely high, but at a microbiological level. The fact that they can’t give you a diet plan is not really a failing of theirs. If you want a diet plan, you need to see a dietitian. Really most people don’t need a dietitian, they need to follow the conventional guidelines for healthy eating – lots of fruits and vegetables, avoid processed foods, easy on the butter, fish is good for you, whole grains (plus, exercise, don’t smoke, get enough sleep). It’s the quacks who try to sell you miracles that you should worry about, because they will tell you it is easy – all you need is a credit card and their website. Living healthy isn’t hard in principle, but it can be difficult in practice. There are no quick fixes.

                Also, I highly doubt any form of hepatitis can be treated with diet, references please?

          2. vadaisy says:

            And when does the semi-literate patient understand that the plural of “patient” is “patients” and not “patient’s” amongst other examples of a poor education and lack of knowledge’?

            I’ll interject, or at least offer an attempt at expanding the scope of that comment in a most productive and hopefully literate way. A good doctor would know whether the patient’s behavior, and spelling/grammar, are due to a true lack of education and illiteracy, or due to illness, fatigue (perhaps from generously helping too many other people), undiagnosed adverse drug reactions, or symptoms of countless other causes. I’d say that any doctor who hastily makes the diagnosis of assumption that a patient is illiterate based on a few short interactions should be dumped.

          3. agitato says:

            To Jane Cobb
            Please tell me you are not a doctor or any other kind of credentialed medical professional. Anyone who passes judgement about a person’s (did I get that apostrophe right?) education, literacy and ability to find good information on the internet, based on a misplaced apostrophe is an arrogant condescending idiot as well as just plain wrong. Aim your venom at the doctors Mouse described in her comment. She made valid points. You just made me mad.

        2. jj says:

          So let me put it this way. There’s a difference between having an open-minded conversation with your doctor about the evidence for something you read on the internet and disregarding evidence based treatment recommendations. My doctor and I have a disagreement about breast cancer screening, she would rather I have mammography every year now that I’m 40 (following the evidence based recommendations of the American Cancer Society), whereas I prefer to follow the guidelines of the U.S. Preventive Services Task Force, which also consider evidence balancing the harms of overzealous mammography and biopsy against the agressive detection of very small cancers. Her and I can disagree on that because we’re both having a conversation about science and evidence. In some cases (like treatment of chronic Lyme disease) there’s legitimate disagreement among doctors and researchers about the best way to proceed… so when that’s the case there’s room for discussion and hopefully open minded discussion. I also think most doctors would consider a patient’s values and concerns about possible treatment options, in situations where there are open scientific questions about the best way to proceed.

          OTOH, if my doctor were to find a cancer, we both know I wouldn’t be messing around with alkaline therapy or weird creams. I’d follow evidence based treatment guidelines and maybe go get a massage if I’m feeling crappy from chemo. You’re getting Lyme disease treatment from someone who’s educated enough to be able to prescribe antibiotics, and may be prescribing them simply as one part of a lengthy treatment plan (as in, try this first because knowing if it works or not is an important piece of the whole puzzle.)

        3. Al says:

          You are correct! Also, It never ceases to amaze me how arrogant MOST doctors are, thinking because they went to school for 50 years and went into debt 20 Million dollars, think they know more than the average person. I’ve read articles, written by doctors, that have stated that the average person on a diet knows more about nutrition than the average doctor, being that in most states, the nutritional classes taken in med. school is minimal, usually only requiring as little as a few hours. That’s over approximately 12 to 16 years of schooling!

          Now, tell me doctors! What excuse is there for that?! What’s in the oath? “Let thy food be thy medicine and thy medicine be thy food.” – Hippocrates

          There’s no excuse for ignorance of the law, for even the average layman. How can there be ignorance allowed for doctors when our lives depend on them?

          So, like I did recently, because my doctor didn’t know nothing about diet is, I took my health into my own hands and cured myself!

          Tell you what doctor person, answer me this. And I’d ask you to be honest but I know how hard that is for doctors. If doctors were only paid $50,000 per year, would you still have gone to school? To save people’s lives? Strangers lives? If yes, do you think most doctors would?
          Would you go to med school for free to help people to make a meager living, but was able to save lives too? lol, I doubt it.

          Oh, and you don’t have to pay back any loans! Would you still do it? I doubt it very much! Reason? Because if most doctors were really practicing medicine to help people, they’d put more effort into studying nutrition and alternatives to save lives! But of course, you’d have to go against the grain of the AMA, wouldn’t you? Lose y our license? Probably. I suppose you’re going to deny this though, aren’t you? If not, then you know the truth and are dancing around it!

          Alternatives work! It worked for me and still is. It works for tens of thousands across the globe, every single day, with many of them telling their stories online.

          GO, GOOGLE UNIVERSITY!!!

          1. Chris says:

            Why should we believe you? Or any of those stories you find online?

          2. Sawyer says:

            “thinking because they went to school for 50 years and went into debt 20 Million dollars”

            Why should anyone here take you seriously about science when you distort financial figures by a factor of 400?

            Has natural medicine helped get your resting heart rate down to 50 beats per hour? Has your lung capacity expanded to 1.5 cubic meters?

          3. Harriet Hall says:

            ” What’s in the oath? “Let thy food be thy medicine and thy medicine be thy food.”

            No, that’s not in the oath. Look it up!

            “If doctors were only paid $50,000 per year, would you still have gone to school?”

            I would have. I would have been able to live pretty well on that salary and I could even have paid back my student loans, which only amounted to a couple of thousand dollars (keep in mind that I graduated in 1970). I practiced in the Air Force, and the highest my salary ever got was a little over $80,000 a year as a full colonel (including bonuses). And I saved and invested part of that. You probably won’t believe it, but financial considerations played no part in my decision to study medicine; I chose it because it was what interested me the most.

            “you’d have to go against the grain of the AMA, wouldn’t you? Lose y our license? ” The AMA doesn’t have a “grain or a party line.” It has no regulatory power and has nothing to do with licensing. In reality, lots of licensed MDs are practicing integrative medicine and no one is trying to take their licenses away no matter how silly some of the things they do.

            1. Chris says:

              (I just noticed that my comments disappear into the ether when I post a link to a Blogger article… is WordPress restricting my links to other types of blogs?)

              “In reality, lots of licensed MDs are practicing integrative medicine and no one is trying to take their licenses away no matter how silly some of the things they do.”

              It is actually very difficult to revoke the license of an MD, even when they are dangerous. It took years to revoke the license of one that chemically castrated autistic children.

              That article is from 2011, Dr. Geier’s license was finally revoked in 2013. I tried to link to a May 23, 2013 blog post about it titled “Mark Geier: Not a Leg to Stand On” on the Harpocrates Speaks blog. But WordPress will not let me post links to a certain blog platform (it is not just SBM, it happened on another WordPress blog).

      3. Mojo says:

        @WilliamLawrenceUtridge

        I suppose I should have made it a bit more clear that I was quoting the Homoeopathic Oath.

  5. Sawyer says:

    I’m quite happy with the current mix of science, sarcasm, and subtlety employed on this site. Mark and David’s posts are usually quite barbed and probably difficult to read as a SCAM enthusiast. Harriet’s posts are drier but she still goes for the jugular when needed. Steve and the other Thursday/Friday contributors are a bit more dialed back and generally stick to hard science. Occasionally the comments sections get too rude and we could try a little harder to treat others with respect, but this is relatively rare.

    If you count the number of prestigious organizations that have sold out to alternative medicine and quackery, I don’t see any evidence that “toning it down” would be a step in the right direction. Ridicule is indeed the only weapon that can be used against unintelligible propositionsr

  6. leeann says:

    I teach nutrition as well as a class called “health and disease.” At the end of the semester, in both classes, I have a class called “skeptics guide to CAM” (I’m sure I”m plagiarizing someone..but for the sake of education, it’s ok, right?!?-I give you folks credit in all my slides).
    I use the distinction of Science based vs Faith based when I talk about these SCAMS. I express my concerns about wasting time/money/health. I use Dr. Crislips caution – the problems with “in my experience.”-and when I use my experiences, I tell them to listen with caution. My hope is that when their grandmother, friend at the gym, Reiki master mother (one student.) tells them what to do, they will ask the important questions involving critical thinking.
    I do get mad, I do get frustrated-but in front of a class of young folks hearing about this for the first time, I don’t want them to walk out and forget what I’m saying. I haven’t quite figured that part out yet. Any suggestions? “in your experience”?

    1. WilliamLawrenceUtridge says:

      One suggestion/criticism I like to employ is when someone pulls out the “Big Pharma is greedy” gambit, to ask if the person making the statement (or to ask about the ultimate source of the statement) is trying to sell you something as an alternative. If so, then why is Big Pharma greedy, but Joe Mercola’s $40, 250 ml bottle of cold-pressed coconut oil isn’t? Why is it bad for Pfizer to make a profit, but great for Gary Null to do so?

      I also like to point out that Big Pharma, as much as they are assholes, also puts a considerable amount of money into testing whether their drugs work, meanwhile the quacks do not. They just keep the money.

    2. MadisonMD says:

      I do get mad, I do get frustrated-but in front of a class of young folks hearing about this for the first time, I don’t want them to walk out and forget what I’m saying. I haven’t quite figured that part out yet. Any suggestions? “in your experience”?

      I’d recommend you quell the anger and use humor with maybe even a touch of sarcasm. It’s really not difficult to show how ridiculous some of these claims are–get them to laugh. Amazing Randi does some great demos in his talks (see videos of presentations on youtube). He makes it clear to the audience how easy they are to fool. Another one from Randi: swallow a bottle of homeopathic sleeping pills at the beginning of your lecture– that’ll wake ‘em up.

      1. Calli Arcale says:

        The homeopathic sleeping pill thing is always a great gag, but I’d really think twice before doing it. After all, a lot of hucksters have discovered that marking something “homeopathic” is a quick and dirty way of getting the FDA off their backs while simultaneously improving the product’s cachet among a certain portion of the market — and a lot of them have also realized that products sell better if people think they work, and covertly adding some actual sleep aids might do the trick.

    3. Angora Rabbit says:

      Leeann (I hope you see this!), I also teach dietitians and have incorporated EBM/SBM into a lecture (the students are seniors).* Maybe some of what I do will help you? I spend ~20min with the scientific definitions of Theory, Hypothesis, and then the Peer-Review process for research and publication. Then I shamelessly borrow from the fantastic book “Snake Oil Science” by R. Barker Bausell to explain the basic methods by which people fool themselves and each other, in derailing their critical thinking skills. Bausell also has several wonderful graphs and tables that clearly explain the placebo effect.

      In a later lecture, I invite the students to submit supplements and supplement claims they are curious about. I take a few days to research them, and then we discuss the composition and findings in class. I pick products that contain compounds or nutrients we’ve already discussed, so they can use their existing knowledge to interpret the commercial claim. Once they are comfortable doing it for something they know about, I hope they gain confidence to then research semi-knowns or unknowns (so Rumsfeldian). I think there is no greater way to enhance their critical thinking than to have them do an analysis. And with wired classrooms, this can be done in real time with the students going on-line to research and discuss the claims and findings with each other.

      *It’s an ADA/AND learning objective.

  7. Nerdista says:

    This is excellent, thank you!

  8. Stacy says:

    This blog helped me grow! HAHA. I might sound sarcastic but I’m being 100% honest.

    When I first starting reading the letter I thought to myself “yeah, these guys do come across really sarcastic and rude sometimes! Yeah!” and I was all ready to jump on this RN’s boat. Until I read the part about the homeopathic cream…then I kinda went into a SCAM coma and stopped letting my brain absorb the info.

    Here’s what I learned about myself today: I only dislike the sarcasm when it is pointed at me.

    I am a community pharmacist working for a mass merchandiser. In Canada. I LOVE my job. I love my patients and I am fortunate to have very few negative experiences that people often attribute to community pharmacy. I’m a Certified Diabetes Educator, I do injections and I have Additional Prescribing Authorization. I get the opportunity to do a lot of clinical work as our pharmacy isn’t super busy. That said, I really like to get my hackles up at articles and/or people that attack community pharmacists for the – pardon my language – bullshit we sell in our stores. I don’t really want to get into that topic right now but to be fair, I get mad because it’s true. We sell complete HS on our shelves. I don’t get to choose what crap goes out and I used to tell myself I was too busy working on my clinical practice to worry, but all that has changed.

    So, yeah, SBM/SBP bloggers, I hate it when you’re mean to me or the sins committed in pharmacy practice. But you know what you taught me? Stop posting whiny comments about what mean people you are and do something about it!

    1. Never give in to the easy path and let someone buy BS because you’re too busy to educate them.
    2. Make it my life goal (big goal right?!) to work with Alberta regulatory agencies (my college, the universities, my pharmacists’ association) to get rid of the garbage on the shelves. I am not disillusioned enough to think I can accomplish this in my life time but hey, a girl’s gotta have a dream right?
    3. Keep reading these blogs and others like it
    4. Continue to develop my inner skeptic – might I recommend the list of “recommended books” by the contributors to this blog?
    http://sciencebasedpharmacy.wordpress.com/2009/12/01/recommended-skeptical-references/
    They are a bit heavier of a read than Robin Cook and Game of Thrones (haha) but at least I don’t have a lower IQ when I’m finished :)

    I think ALL of the contributors on this blog are funny, sarcastic, way smarter than I’ll ever be and an inspiration to my practice. You are all fantastic writers! That goes for most of the people that leave comments. You know who you are.

    Thanks guys, keep up the great work!

    1. MadisonMD says:

      @Stacy:
      If I blamed you for what your pharmacy is selling, I would have to blame myself for working at a hospital with acupuncture and healing touch. This is the marketing side of the business of medical business (hospitals and pharmacies). When I ask administration about this, they tend to talk about business strategies. If I push it, they just point out that people will go elsewhere if we don’t have it (CCTA for me; I suppose to GNC in your case).
      So, fight ignorance, help people out, and when you are in a position to make these decisions. The sarcasm is clearly not directed at you.

  9. goodnightirene says:

    Dang! When Windriven gets in ahead of me, it’s hard to find anything to add.

    I would ask the letter-writer something at the outset: Why are you “researching” cancer for yourself? You are an RN (I am beginning to wonder if training for such involves any critical thinking at all, as the writer is not the first RN I’ve met or read of who has jumped way into woo), who should understand what your doctors have told you. Why do you think that the naturopath has anything more to offer? Why do you think that being a massage person (can’t bring myself to attach the word “therapist” and apologize for any sarcasm that may engender) offers anything more than relaxation?

    I hope our letter writer will hang around and get to know us better. I found some content off-putting in the beginning. The comments can seem a bit cliquish (even more so over as Respectful Insolence) and newcomers who express any concern at all over “tone” are often attacked out of proportion to the offense. I have seen this and been subject to it, although the core group has changed a lot since I started. I went away for a while but came back (new name) because I wanted to learn more and get into the club! :-)

    1. Joanne Benhamu RN says:

      Sadly, tertiary level nursing qualifications do not incorporate a great deal of critical thinking beyond a basic course in research methods. Many of the nursing theorists are steeped in postmodernism. Never mind the embarrassment to the profession that is TT.

      I can however reassure you that there are many RNs who are exceptionally good critical thinkers and who reject and actively work to remove this type of nonsense from the profession. The Australian organization Friends of Science in Medicine has a growing number of both senior nursing academics and nursing clinicians as named supporters. (Full disclosure – I’m on the executive) and of course the wonderful Linda Rosa in the US who works tirelessly challenging pseudoscience within nursing. See also @SkepNurse on twitter and FB group Nursing Skeptically if anyone’s looking for like-minded nurses. I highly recommend Assoc Prof of Nursing Bernie Garrett’s book: Science and Modern Thought in Nursing: Pragmatism and Praxis for Evidence-Based Practice.
      https://itunes.apple.com/au/book/science-modern-thought-in/id661274052?mt=11 and blog http://blogs.ubc.ca/realscience/.

      However, the number of naturopaths and homeopaths out there with RN after their names as well as those practising as RNs who offer reiki and TT to patients is worrying and it’s high time this was addressed.

  10. KayEn says:

    Nice use of John Donne. Excellent end to excellent post.

  11. Harriet Hall says:

    “Patients who have to pay cash for a service because their insurance does not cover it do not keep going back to a practitioner who does not help them. ”

    Oh, yes, they do! They keep going back because they falsely believe they are being helped. They go back to the homeopath when they get worse because the homeopath tells them the aggravation of their symptoms is a sign of healing. They keep going back to the naturopath for alkaline treatment until the cancer kills them. Some go back to the chiropractor hundreds of times, long after they would have given up on a medical doctor if the pain kept recurring like that. Some are frankly delusional and imagine that their cancer is improving when it is obviously ulcerating out through the skin.

    1. Greg says:

      I suspect that much of the healing that people attribute to natural remedies is due to the placebo effect, which could also explain why some people continue to endure treatments that in reality do nothing.

    2. WilliamLawrenceUtridge says:

      Carol Tavris’ Mistakes were made (but not by me) discusses this – once you start down a road, your brain becomes a self-justifying machine that normally resolves the conflict of “I’m smart” and “I’ve made a mistake” in favour of the former through a series of special pleadings and rationalizations. The nonsense spouted by homeopaths and naturopaths, healing crises and the like, are simply fuel for the machine.

  12. Dave says:

    I saw a similar but less dramatic episode as a medical resident – a young woman who had been diagnosed at the age of 17 with limited stage Hodgkin’s disease, a curable condition, whose parents took her to Mexico for leatrile therapy. She was admitted to us with terminal disease.

    It doesn’t bother me too much when someone pushes echinacea for colds and that type of thing. People waste money on all sorts of stuff, including alcohol, illicit drugs and cigarettes for me to get bothered by that. However, convincing people to forego therapy for possibly curative cancers or to avoid vaccinations, which puts their children and others at risk, is where major harm is done. There is also a more insidious evil. A lot of these alternative practitioners instill in their clients the idea that mainstream medicine is a monster to be regarded with suspicion and distrust, interested in keeping people sick and only interested in the bottom line. This idea permeates some of the reply posts in this forum. This idea makes delivering effective care much more difficult. God knows there’s a lot about the “business” of medicine that’s not good and SBM has a job to do in getting rid of some of the mainstream practices which are not very effective. Being informed (properly) about your condition and the risks/benfits of treatment is important, but the fact is that perhaps other than your spouse and mother, nobody in the world is more invested in you getting better than your doctor. These practictioners make our jobs so much harder.

    1. windriven says:

      “A lot of these alternative practitioners instill in their clients the idea that mainstream medicine is a monster to be regarded with suspicion and distrust, ”

      And this, Dave, is why I respectfully disagree with you about getting one’s knickers in a twist about echinacea and the like. These are the gateway drugs of serious woo, the crossing of the credulity event horizon into the embrace of delusion. Breaking that embrace can be impossible as demonstrated by Dr. Crislip’s hapless patient.

      1. irenegoodnight says:

        WD, you did it again! Great minds….

        I would only add that letting ANY useless treatment get a pass, only serves to open a door that should have been slammed way back when chiros got organized enough to succeed in getting insurance reimbursement.

    2. MTDoc says:

      “nobody in the world is more invested in you getting better than your doctor” I believe this with all my heart. When I entered medicine 53 years ago, the general public did too. In fact it was this esteem that motivated me to work hard to be worthy of the title “doctor”. About the mid 1960′s, the “king of torts” and others began to turn this trust into an adversarial relationship. And now with TV ads no less. I note that the ACA did not attempt to deal with this issue. As a bit of trivia, my professional liability insurance premiums went from $300 to $30,000 a year in two decades. And no, I’ve never had a claim.

  13. KillCurve says:

    Beautiful essay.

  14. Thor says:

    Well done, Herr Crislip!! I relish sarcasm, irony and humor in your (and others’ writing).
    It takes skill to apply these, especially in an appropriate manner and style, which you exhibit mastery of. Using them, subjects are less dry, and points can be made in a creative way, providing perhaps more enjoyment for the reader. Tone-trolling is a cop-out. So often, important points are ignored or not absorbed simply because a certain type of reader can’t get past a black and white interpretation of the writer’s motivation and use of language. The subject (message) is what really counts, not the personal writing style of a contributor.

    1. windriven says:

      Echoing Sawyer above, each of the contributors brings his or her own style to the party and that adds texture to the content. Dr. Crislip always delights as polymath masquerading as class clown. You’ve gotta love it.

  15. Arrogance, dogma and ignorance

    Into this pond were flushed the ashes of some four million people. And that was not done by gas. It was done by arrogance, it was done by dogma, it was done by ignorance. … When people believe that they have absolute knowledge, with no test in reality, this is how they behave. This is what men do when they aspire to the knowledge of gods.― Jacob Bronowski, The Ascent of Man

    Science is a very human form of knowledge. We are always at the brink of the known; we always feel forward for what is to be hoped. Every judgment in science stands on the edge of error and is personal. Science is a tribute to what we can know although we are fallible. In the end, the words were said by Oliver Cromwell: “I beseech you in the bowels of Christ: Think it possible you may be mistaken.”
    ― Jacob Bronowski, The Ascent of Man

    You folks actually scare me because you think science in medicine is not fallible. I’m in family practice and for 30 yrs I have witness the carnage of broken souls who have been sacrificed by the scientific methods. I have a few hundred patients who have been “fixed” by surgeons, poisoned by internist because of knowledge and science. I have to admit, I was one of those physicians, who was duped into the program. I was young and naive, but still ashamed that I actually did harm to so many souls. Even today, patients and people are being sacrificed by what Bronowski states, “arrogance, dogma and ignorance” plus complete indifference and utter disdain for the suffering folks you are supposedly helping or protecting. The best word to describe this mental state is delusional.

    The delusional mind will read this and withdraw into the illusions and find blame and start belittling and name calling.

    An enlighten healthy mind will wonder and ask questions to figure out this point of view, how did the guy arrive at it his paradigm, what are his experiences and references.

    1. MTDoc says:

      Not sure you fully comprehend what SBM is all about. If you follow along for awhile, I’m sure you will see it in a different light.

    2. WilliamLawrenceUtridge says:

      Actually Stephen, we recognize the tentative nature of science and its conclusions. It is you who insists your personal experience is correct, and the thousands of studies of acupuncture and alternative medicine are wrong. It is you who appears to have no corrective mechanism to your certainty. You merely believe we are dogmatic because we refer to the evidence and refuse to simply accept your testimonials as evidence of efficacy.

      We know how you arrived at your point of view, and it’s through your personal experiences remaining unchallenged. That’s why we keep challenging it through reference to the scientific literature.

      I’ll ask again – how do you reconcile your personal experience with the consistent failure of science to find any benefit?

      And if your experience and expertise are so amazing, why not conduct a program of research and testing to determine exactly what it is that makes you more effective than your peers. You can add to the general medical knowledge, improve care, and ultimately help far, far more patients indirectly than you ever could in your day-to-day practice. Jonas Salk saved far more lives than even the most talented surgeon, internist or GP, ever.

      1. The raw science methods are NOT very practical or logical in the real world office setting. It is only practical in a vending machine approach, push the indigestion button and out pops a pill. that works in some cases and is very economical and cost effective. Actually why not set these up in kiosks at drug stores. That would save billions!!

        The patients who slip thru the cracks will have to be assessed on a different system. The old fashioned one where you sit and talk to someone who is listening and has you interest at heart. In this setting the trial and error or try and see methods would be standard. This is my experience that is completely disregard and having no validity.

        How are all those SBM approaches going to be implemented?? In a vacuum! What good is this site to anyone except to validate this game you guys are playing.

        1. MadisonMD says:

          SSR:
          Look. I for one am actually sympathetic to several of the things you have said here and elsewhere. I’ve looked at your website and am also sympathetic to some of the things you do.

          You treat patients with fibromyalgia and pain when they are not helped by physicians who practice in a more mainstream way. You point out rightly that some of these patients have back surgery for an abnormal MRI without good scientific evidence that the surgery will relieve pain. Others may receive narcotic pain medications which might provide some short-term relief but which ultimately may be more harmful than helpful.

          Some of these ‘unwanted’ patients come to you. You are kind. You listen. You do not expose them to the dangers of surgery or narcotics. Then you do something to them with needles or myofascial release (I’m still not sure exactly what–no mind). They feel better without surgery or narcotics. Your intervention is clearly safer and no less evidence based than surgery and narcotics. Your happy patients come back.

          You know, I agree that you are doing some good for these folks– probably better than more mainstream practitioners in some cases.

          You might ask then why we appear to be defending the mainstream instead of your better approach?
          Well, actually I don’t think folks here are defending the mainstream practitioners when they use interventions not supported by evidence. Instead, we are advocating a careful method of evaluating different approaches to find the best. [You see a neurosurgeon could could here and tell us that in her experience spinal fusion is the best thing for back pain. Who are we to believe-- you or her?]

          Since you seem sincere, I would propose you consider the following:
          (1) Could science-based medicine accept what you do?
          YES. But it would be important to carefully select your patient population then spell out what interventions (including spending time listening to patients) you make for specific conditions, and then test them out carefully against a different approach (e.g. surgery vs. narcotics vs. SSR plan). If your approach is turns out to be superior, it then we would be 100% behind it! If you are correct, your accumulated wisdom would be disseminated and adopted by practitioners worldwide. (If surgeons disagreed with you then too bad for them– the evidence prevails.) However, your approach turns out to be inferior, then we’d expect you to abandon it and to adopt the superior approach.

          (2) Could research help you improve what you do?
          YES. You may discover, for example, that it wasn’t the needles that helped your patient, but your caring, listening, and kindness to them when other doctors didn’t listen. If that were the case, maybe, through careful research, you could do still better by omitting the needles and spend still more time listening. And other doctors could learn from this as well.

          Yes, we are skeptical of needles, skeptical of ‘in my experience,’ and for good reason. Some of your rationale for what you do seems–well– more based on mysticism than reality. Often you seem to not read or to not understand many of the responses you get here– and I myself have poked some fun at you for this.

          But I don’t doubt you are being kind to your patients, you listen, and that ultimately you help them feel better.

          Folks here are not your enemy. We are advocating the use of careful method that allows us and you to identify the best way to help patients and, just as importantly, to dispense with the things we do that are not helpful. Dr. Hall is trying to help you understand that method. We know that all doctors could do better. You, me, everyone else.

            1. MadisonMD says:

              Ugh, but did you actually think about it? Or do you reject the idea that you could possibly improve your own practice?

              1. You must be completely in academic, a faction of what you guys are talking about trickles down to one on one office based medicine.

                I spent 15 yrs in vending machine medicine … it is a failure! We are 40/100 in health care wise. It needs to be redesigned and yes I have some good ideas.

                90% of my new patients have failed medication cocktails and surgeries!!! 75-85% get better with the seat of my pants and needles. The other 15% I shoot and put in a grave out back.

              2. windriven says:

                @SSR

                “The other 15% I shoot and put in a grave out back.”

                Yeah, I’m guessing they are the lucky ones.

              3. They are so miserable from the science of medicine … yes they are lucky.

              4. MadisonMD says:

                The other 15% I shoot and put in a grave out back.

                yes they are lucky.

                Now I am very scared. I take back my foolish assumption that you are good to your patients. Are you mentally ill? If so, is your medical board aware of your illness?

                Please tell me that this was some sort of a sick joke.

              5. Sawyer says:

                a faction of what you guys are talking about trickles down to one on one office based medicine.

                This is the first interesting idea you’ve presented, but it is at odds with pretty much ever other complain you’ve offered. You realize this is an argument for MORE people reading this site and giving MORE credence to the ideas presented, right? Every person here with even the most cursory knowledge of medicine wants to shrink that communication gap. Of course in Bizarro CAM World the fans of this site are called “cynical” because we refuse to throw in the towel and give up.

                Sorry, we’re not giving up.

            2. Chemmomo says:

              Stephen S. Rodrigues,
              I’ve been following your exchanges with the contributors and regular commenters here as long as you’ve been posting. I’ll note that I have not found your point of view compelling.

              I am not a medical professional. You claim to be one, yet you post this (from December 29, 2013 at 9:54 pm):
              ” The other 15% I shoot and put in a grave out back.”

              It horrifies me that someone involved in patient care would post that on a public forum.

    3. Chris Hickie says:

      I never said we weren’t fallible. Chill, please.

      1. Yall are infallible indeed, in this blog.

        1. Chris says:

          You, sir, even more so. So do a double chill, please.

        2. Calli Arcale says:

          People who think themselves infallible do not use science.

          Science is *about* being fallible. The only reason to reject science is if you believe you are infallible and therefore do not need a correction mechanism.

          I do not believe you understand what science is.

    4. Harriet Hall says:

      SSR never disappoints: Now he has provided a validation of Godwin’s Law!

      We want to test treatments to find out what really works so we can avoid using ineffective treatments. He thinks that means we have “complete indifference and utter disdain” for suffering patients. Nonsense!

      And he believes we “think science in medicine is not fallible.” What crazy thing is he going to imagine next? I honestly can’t understand how someone with the ability to read English could derive that message from this blog. It truly boggles the mind. Our message is exactly the opposite. Science in medicine is a flawed and fallible process, and the whole project of SBM vs. EBM is to show why we can’t just automatically accept the evidence of every positive RCT. Still, science is better than any other method, and is obviously far better than SSR’s methods. If we followed his methods, we’d all still be watching shamans go into trances or balancing the 4 humors with bloodletting.

      SSR: You have much to learn. I gave you a homework assignment. http://www.sciencebasedmedicine.org/why-we-need-science-i-saw-it-with-my-own-eyes-is-not-enough/ Please read it and report back as I asked. The message is that sometimes we get it wrong, and we need science to keep us straight. I eagerly await your explanation of how that doesn’t apply to you, and how you can be so sure you never get it wrong.

      1. YES, We are trying to examine the same things and I agree with these!
        The disease may have run its natural course.
        Many diseases are cyclical.
        We are all suggestible.
        There may have been two treatments and the wrong one got the credit.
        The original diagnosis or prognosis may have been incorrect.
        Temporary mood improvement can be confused with cure.
        Psychological needs can affect our behavior and our perceptions.
        We confuse correlation with causation.

        Plus the the science method has inherent problems:
        regression to the mean.
        The peer review process is flawed.
        Financial gains.
        Humans hate being wrong, so selective reporting, significance chasing and personal bias.
        Poorly designed studies.
        And again the science methods are vital with unnatural therapies but once you use humans with our fickle nature especially with people are under duress as with pain and miserable, expect lots of variations and errors.

        “The first principle is that you must not fool yourself–and you are the easiest person to fool.”sbm
        Try to understand the journey and not fool yourselves just because I’m who I am. (little ole me)”The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.” -Stephen W. Hawking
        “A good scientist is someone who knows that a point of view is destructive and points of view are constructive.” -?

        1. Harriet Hall says:

          Unbelievable! He understands all the ways people can get things wrong, but he refuses to realize that he is one of those people. He rejects science and imagines that he knows better and can somehow figure things out all by himself. My patience has been exhausted.

          1. Now I understand, this is a game you guys are playing and it has no practical significance in the real world, just in the imagination.

            Yall are peeved that since the ACA is in effect you will have to pay for someones massage and tissue and joint adjustments and peeved that we spend all this money and resources in the US and only ranked ~40 out to 100 countries with outcomes and peeved that we are insignificant blips on the radar screen.

            1. windriven says:

              OK Doctor Rodrigues, Tell us which disease entities are now recognized as best treated by acupuncture – even in China? Citations to support, please. All those years of needle twisting while medical science wallowed in its own stupidity – whatcha got to show for it? Dazzle us.

              1. I see I have to repeat my self. It is not about just a single pill or treatment vs another in the clinic. The vast majority of the time no case fits in a nice academic box. In the office if you are going to survive solo, you need referrals so you have to produce good outcomes. A new mess-up patient may take months or yrs to figure out what is going on and get them better. You can’t write that down the details are unnecessary (except if you want to get paid). You establish a step by step try and see approach. My process is actually from the 50′s I learn by reading and practicing, try and errors. Easy now that I have the keys, so my errors are softer and innocent.

                So blinded by the fog in your brains.

              2. windriven says:

                Yeah, that’s what I thought.. You have nothing.

              3. @windriven … the research and study is your job, I have already list the textbook for clinical use.

              4. windriven says:

                Prescribe yourself a coffee enema, Rodrigues. You need it. What I’ve asked for is simple. No theories. No anecdotes. Just a verifiable demonstrated history of anything besides your jaw flapping.

              5. My job is to use the tools I have available to help the suffering from the utter failures of science based medicine.

                Your job as a researcher, scientist and academic is to find the reasons and if you have any clout make the necessary changes to better the system. (what are your credentials anyway?)

              6. windriven says:

                “My job is to use the tools I have available to help the suffering from the utter failures of science based medicine.”

                You aren’t using the tools that you have available- presuming you’re actually a licensed MD. You are guessing. You are experimenting on live patients. You have absolutely zero evidence that anything that you do has the slightest bit of objective benefit.

                And then you have the unmitigated gall to talk about failures? When you talk about the “utter failures of science based medicine” I want to reach through this screen and drag your sorry ass to a real hospital with critically ill patients, people in agony, families in fear. I want to rub your face in the miracles of anesthesia, surgery, respiratory therapy, neonatology, oncology, radiology and good old internal medicine that have done more to transform the human condition this afternoon than acupuncture has done in centuries. That is science in action. That is science based medicine. We can pick the diseases or conditions that you want and I can give you real data on what science can and cannot do about it. But when I ask you about your proof and acupuncture’s history of success, all you offer is butt-gas.

                There are many here who think we should engage quacks with velvet gloves – let’s not hurt any feelings or make anyone too uncomfortable. I don’t see it that way. There is medicine and there is exploitative, predatory, delusional bull-ya. There are measurable results and there are fantasies. There is a path to a better future and there is a path of return to a failed past.

                You’ve made clear which path is yours. Acupuncture is a fraud. Chiropractic subluxation is a fraud. Homeopathy is a fraud. What does that make you, Stephen?

            2. “You aren’t using the…presuming you’re actually a licensed MD. You are guessing. You are experimenting on live patients. You have absolutely zero evidence… objective benefit.”

              I am a licensed MD, you should have verified my credentials as a good scientist or researcher. Education and reality point; The definition of an assessment it a guess under the circumstances, what makes you think otherwise. You have the wrong idea about clinical medicine.

              Once a physician gets a diploma and license we actually have a legal right to experiment with people’s lives. The scary part is when you experiment with just a narrow view you will fail and do significant harm. I am downstream from the SBM apparatus and I see too many casualties of this paradigm. I’m attempting to give my views here because there is a huge disconnect.

              SBM is a necessary part of traditional medicine but it is not 100% effective. If a provider does not use his intellect, wisdom and experiences we all lose because of this truth. Yes, SBM can not give us all the answers. It is in this environment that the aging process allows a person to grow, think broadly and gain insight. The only place you gain this is face to face in the office with patients, so patient outcomes are the objective evidence we use in this regard. Science, technology and all the scientific methods PLUS the wisdom gained over the millennia is actually keeping our healthcare system afloat. We must not discounted, disrespected and marginalize the contributions of common sense and wisdom.

              Who are you windriven anyway? You have no ID readily available! Avatars are like strangers, My Dad told me not to speak to them and I have told my son the same. You don’t exist in the real 3D world, until you prove you are a real person.

              1. MadisonMD says:

                Once a physician gets a diploma and license we actually have a legal right to experiment with people’s lives.

                You are one hell of a scary dude, Rodrigues.

              2. windriven says:

                “Who are you windriven anyway?”

                I am nobody. I am not a physician. I am not even a biologist. I’m an entrepreneur and scientist (physics) with an abiding interest in the intersection between medicine and public policy.

                “My Dad told me not to speak to them”

                I’ll remember that when I’m drinking prosecco* tonight and breathe a sigh of relief.

                *I have always been a real fan of Moet et Chandon White Star champagne but the buggers stopped bottling it a couple of years ago. I’m far too cheap for the hip-hop brands so I drown my sorrows in prosecco these days. There is even a fairly decent one from Zonin that one can get for under $10 at Trader Joe’s. One can afford to drown a lot of sorrows in $10 wine ;-)

    5. windriven says:

      “In the end, the words were said by Oliver Cromwell: “I beseech you in the bowels of Christ: Think it possible you may be mistaken.””

      Interesting that you would pick an arguably genocidal religious nut to quote. That said, and seconding Mr. Utridge and Dr. Hickie, science is, in a sense, the very study of fallibility. Scientists are always cognizant of the limits of current knowledge. But you need to understand that there are differences between an open mind and an empty mind.

      1. MadisonMD says:

        windriven: I found the quote enlightening. I was wondering where all his BS comes from– well, turns out it is plentiful at at ready hand because he does the beseeching from the bowels.

        1. windriven says:

          Yeah, I was struck by that too. My only experience with ‘beseeching from the bowels’ was after I ate bad sushi at a restaurant in Shanghai. ;-)

          1. Rokujolady says:

            FYI, during Cromwell’s time, “the bowels” was more of a generic expression meaning something deep inside one’s body. It’s one of those things that just sounds WTF to today’s meaning of that word

    6. Lytrigian says:

      “You folks actually scare me because you think science in medicine is not fallible.”

      You don’t actually read this blog much, do you?

      No one ever said scientific medicine was infallible. But it’s the best we have. It’s certainly better than modalities of unproven safety and effectiveness, or of proven riskiness and ineffectiveness.

      1. LOL that is what yall see up stream is perfect science. Well downstream all I see are the failures and the carnage that is the result of science. many of my patient have failed the science methods. Tell me scientist what do we do next, I look to you guys to interview instead of review? (besides hiding in front of your computer screens proofreading blogs).

        :( I feel so abandoned, neglected and ignored :’(

        1. windriven says:

          What is your success rate with Morgellon’s?

  16. irenegoodnight says:

    I just saw this post over at SkepVet and thought I’d share it as it dovetails very nicely with our topic today.

    http://skeptvet.com/Blog/2013/12/cam-vets-attacking-conventional-veterinary-medicine/

    SkepVet is worth exploring even if you don’t have a pet–he’s a marvelous writer!

    1. MTDoc says:

      Thanks for the link. An excellent article, and most appropriate.

  17. I like the sarcasm, personally. I was a nurse for ten years, and not all my nursing education was good. I was taught a lot of crap about vaccinations that was dead wrong, and went out into the world, and educated my patients with bad information. Total nurse fail, there. Same with massage, chiropractic, and the rest. There’s this part of nursing where we really want to make our patients feel better, and if it “doesn’t hurt” them, then what’s the harm, right?

    Except when it does hurt them. I guess I am so very angry that I was taught bad information, and it was reinforced through my ten years of nursing by others in the nursing profession that had the same bad info. I feel I utterly failed my patients in those respects because I was ignorant.

    It wasn’t until I switched careers, and started becoming a science fanboy that I learned how wrong I was. That is a crappy realization that you were responsible for people, and you steered them in the wrong direction.

    So, I like the sarcasm, and the anger, that get occasionally exhibited. It matches my frustration about the pervasive nature of bad information out there, and how these SCAM treatments take advantage of this bad education. It could be because I felt my education about all this was so wrong headed, that it hurt patients that relied on me for better information, though.

    1. WilliamLawrenceUtridge says:

      What were you taught about vaccinations in nursing school? I’m curious, because nursing seems to be a profession that ends up being prone to erroneous beliefs about the value and dangers of vaccination. It’s supposed to be a science-based profession, what goes wrong?

      1. Our instructor liked to bandy about the “too many, too soon” myth about childhood vaccinations. She, and the other instructors also liked to talk about how flu vax’s were made by selecting all the outdated variants of the flu from the previous year, and if you already lived through the year without a vax, then you were already fine. No discussions on herd immunity at all. I think some schools are better than others, of course. Mine was a small town school with teachers that hadn’t been in the field for decades.

        My area of the country has one of the highest levels in whooping cough, and it’s easy to see why with this kind of systemic breakdown in education.

        I think you might be surprised at how much woo filled crap gets through in nursing. Nursing as a profession kind of embraces practices like Reiki massage. I can see why. You have a patient in pain, and scared, and it allows you to have a billable reason to spend one-on-one time with them. Sometimes just showing that bit of face to face time to a patient can change a patients experience. That doesn’t mean that Reiki massage is the thing that’s helping through.

        My nursing education was in 1998, and our nutrition section was all about the right foods to feed patients to help them get better. Some of it is fine, and some of it is really just more crap filled wishful thinking. This kind of leads into the echinacea, herbal supplements, etc.

        When I was a floor nurse for an inpatient psych facility, the nursing staff would offer up advice on herbal supplements, or the latest and greatest fad pill to patient’s families on a routine basis. I hated it. It’s hard enough to get a paranoid possibly violent patient to take their meds without adding fish oil, vitamin pills, and ginko biloba to the mix.

        I think the culture of nursing is more on the the side of “what’s the harm” than on the science. I think a lot of nurses just want to offer anything to make patients feel better, and that comes through in a lot of the culture in nursing.

        1. WilliamLawrenceUtridge says:

          Thanks for the reply. Reiki massage, a wonderful contradiction in terms :)

          Sounds like they had a germ of a point with the ‘flu vaccine, and extended that to imply a similar weakness to all vaccines.

        2. goodnightirene says:

          Thanks for the thoughtful reply Jello. I have been wondering about nursing training here and elsewhere for some time, and your comments are insightful.

          I’m wondering why people don’t say outright where they’re from as “my area of the country” isn’t very helpful (and you aren’t the only one to do this) when trying to understand why something might be regional. But thanks anyway for shedding some light on the (sad) state of nursing, which I fear may not be restricted to your small town.

  18. AnObservingParty says:

    SBM–and some of the notsosecret other blogs–provide forums on which I can use my inside-commentary, rather than the professional sugar-coating we’re required to do IRL. For example (ANECDOTE ALERT), the other day someone actually called our office to complain of the state mandatory mask policy, and actually went full-on Godwin in SPOKEN WORD CONVERSATION (a first for me), and I had to play nice. I feel in these places we can almost vent and at the same time learn something; the only people who offend me are the ones who come and play SCAM/Antivax/Homeopath/Naturopath/whatever bingo in their posts.

    Plus, it’s more entertaining to read. Thank you, you sardonic, sarcastic, meanies you!

    1. windriven says:

      SCAM Bingo! A neologism I’ll shamelessly plagiarize :-)

      1. AnObservingParty says:

        Not mine! I think Lawrence on the notsosecret other blog coined it. Credit where credit it due. :)

    2. Birdy says:

      I’ve actually made up a SCAM Bingo card. The free space is ‘It’s all natural!’ I was bored after exams, heh.

  19. Dave says:

    You make lots of statements SR. To ask again, for the umpteenth time, what evidence can you present which demonstrates that whatever you are doing has a better outcome than a placebo therapy?

    Anecdotal and personal experience are inadequate. Mainstream medicine has much experience with this as it is what used to guide care in the not so distant past. I would like to quote from the text, Twentieth Century Practice of Medicine, Volume XVI (Infectious Diseases, page 114, published before SBM in 1899:

    “Squire reports a case of pneumonia occurring in the hospital practice in which the patient became apparently moribund and was given up as hopeless. Brandy was given steadily by the intern and nurse until in 24 hours 32 ounces had been taken with decided benefit. By following up this treatment the patient recovered.
    Abbott reports a case of double pneumonia in a young woman of 18 years, with both lungs being consolidated. All nourishment was refused, even milk, but she was induced to swallow Brandy properly diluted, and was carefully watched for any evidence of overstimulation. 16 ounces of brandy were given her daily for 3 successive days. On the fourth day whiskey was substituted, and of this she was given 24 ounces daily 4 days in succession without even seeing symptoms of discomfort or overstimulation. On the morning of the eighth day she was much improved and refused absolutely to take further stimulants. These were, therefore, discontinued, and she then took milk and other light nourishment without objection and made a prompt and complete recovery.
    I have myself employed very large doses of alcohol in several cases and sometimes with marked benefit.” – Andrew H Smith, MD Emeritus professor of Clinical Medicine ands Therapeutics, New York Post-Graduate Medical School

    Fortunately, mainstream medicine has gone beyond using such anecdotal reports to guide therapy.

  20. lilady says:

    “I am served well by a naturopathic oncologist who ordered me some homeopathic cream for my breast surgery, as well as a pharmaceutical grade supplement of multiple vitamins. My breast suffered a hematoma post op, and it turned black. The opposite breast also turned black from blood that drained to it as I lay on my unaffected side. In 24 hours I had one and one-half black breasts. The post op nurse and my PCP both stated it was the worst bruising they had ever seen in their careers, and neither of them are less than 40 years of age.”

    You do realize, don’t you, that homeopathic cream contains zero medication and that your hematoma would resolve without the application of that homeopathic cream?

    @ theocraticjello: “I was a nurse for ten years, and not all my nursing education was good. I was taught a lot of crap about vaccinations that was dead wrong,…”

    What wrong information were you taught about vaccinations?

  21. David Gorski says:

    I am served well by a naturopathic oncologist who ordered me some homeopathic cream for my breast surgery, as well as a pharmaceutical grade supplement of multiple vitamins. My breast suffered a hematoma post op, and it turned black. The opposite breast also turned black from blood that drained to it as I lay on my unaffected side. In 24 hours I had one and one-half black breasts. The post op nurse and my PCP both stated it was the worst bruising they had ever seen in their careers, and neither of them are less than 40 years of age.

    With the help of the cream and supplements, the bruising is resolving in days. Not weeks. Days. The post op nurse told me to expect this dark bruise to linger for weeks or months. I credit the cream and the supplements, neither of which the surgeon ordered. A top surgeon at a top university hospital.

    As a breast surgeon myself, I wondered about this. This sort of thing is highly unusual in patients with adequate clotting. It makes me wonder if this nurse was taking something that was “thinning her blood,” something acting like warfarin (coumadin) or Plavix. The giveaway was the bruising on the other breast. Certain herbal preparations can do this. Occasionally when doing breast conserving surgery, there will be some subcutaneous bleeding and hematoma that can make a purple breast, but it would be very unusual to see it in both breasts the way described unless there was some sort of generalized defect in clotting. The explanation about the blood “draining to” her unaffected breast sounds like nonsense to me.

    As for the resolution, some ecchymoses (bruises) resolve faster in some people than others. You can almost always see changes consistent with resolution within a week or so, but it will take weeks for complete resolution. I bet that’s the case with her.

    The whole thing sounds pretty fishy.

    1. Chris Hickie says:

      I know someone who had a surgery last week to remove a benign but large mass that is being allowed to heal by secondary intention due to the size and location of the hole left by removal of the mass. There was some impressive bruising in the first 24 hours that was all but gone by the 4th day post-op. Nothing special was done….imagine that.

    2. WilliamLawrenceUtridge says:

      The part I love most about the story is how she had treatment for potentially lethal breast cancer – and the amazing, life-saving potential of that surgery is completely skipped over in favour of “my bruises got healed!”

      Well, as long as your bruises got better, who gives a crap about the tumor that would have gradually eaten its way out of your breast, eroded your bones, muscles and nerves, and eventually turned your entire chest into a liquid. Nope, BRUISES! That’s where the focus should be.

      1. Frederick says:

        LOL Yeah i notice that to… I mean.. A tumor.. that nothing man, i had BRUISES, the size of a football!

        And of course she healed faster than what the nurses said ( they probably base that of average person/ experience) so = homeopathy word, nothing about “yeah maybe bruise heal faster on me” That post reek with logical fallacy and bad thinking

        1. Frederick says:

          homeopathy WORK not word.

    3. Denise says:

      My surgeon gave me some arnica cream to supposedly reduce bruising. I forgot to use it. Even if I had, I’m sure I would have no opinion on whether it helped or not; how could I, when I wouldn’t have known how much bruising I would have had without it?

      For some reason this type of product is called homeopathic, but it isn’t: there’s no magic water, no treating like with like, just a cream containing arnica. I suppose calling it homeopathic is a selling point for lots of people.

      I assume that’s probably what this person is talking about. As far as I know, homeopathy doesn’t involve rubbing medicinal herbs on your skin.

      1. LDoBe says:

        It’s probably labeled “homeopathic” for the same reason Zicam is labeled homeopathic: Homeopathic “remedies” don’t have to undergo proper testing, labeling or quality control, and thus can be sold at the same price as real drugs while being produced much more cheaply.

        When your product gets to make all the claims of drugs and can have similar indications to drugs, but not have the regulatory obligations of real drugs, you get a much larger slice to take home as net profit.

    4. Young CC Prof says:

      When the writer described her hematoma and breasts turning totally black from bruising, I thought, “What was in that cream, and was she using it before the surgery?”

      If it was actually homeopathic, no harm done. But there are quite a few herbs that increase bleeding risk, and I doubt she thought to mention it to the surgeon.

    5. DJDenning says:

      As a pharmacist, the two black breasts put me to mind of warfarin-induced skin necrosis.

  22. dh says:

    I do wish you would stop using the acronym ‘SCAM’. It is dogmatic, abusive, judgmental and preconceiving. It reminds me of ad hominem attacks. Each modality needs to be weighed on the evidence rather than disregarded/labelled right from the outset as “SCAM”.

    If some technique or modality or therapy in particular is found not to be evidence-based, then yes you can say those practitioners who continue to use it despite knowledge of the lack of utility, are scammers. But if you use the acronym ‘SCAM’ to describe the entire complementary medicine system, you are falling victim to your own form of defamatory bias.

    1. David Gorski says:

      Perhaps you could tell us what parts of the entire “complementary medicine system” is not “sCAM” and the evidence that leads you to conclude that.

      1. mousethatroared says:

        I shouldn’t speak for DH but techniques that people group under complementary medicine seems to be wide ranging. When we received our discharge papers after our son’s surgery along with other medical care and prescription directions they had a heading “complementary” with non-medication based suggestions. It included things like distraction, cuddling, massage, etc. It was not implied to be given instead of medication, but in addition to and it was completely innocuous.

        Also in articles talking about Complementary Medicine, they often include meditation, breathing exercises, massage. While none of these things are going to cure cancer, they are not necessarily SCAMS either as long as they are not being presented as cures for cancer.

        Just a thought.

        1. MadisonMD says:

          @mouse,
          Agree with you except….this is exactly why we need the moniker SCAM. I suppose you could find areas where it seems grey, but I’d call it a SCAM/scam when there is profit coupled with false claims. Examples.

          Not a scam or SCAMNonpharmacologic management of pain, stress, insomnia such as distraction, meditation, massage when not claimed to do more than it does.

          SCAM and a scamFalsely claiming that acupuncture or hypnotism treat pain and insomnia, then charging the patient to

          I disagree with your idea that it’s OK if the claim isn’t that they “CURE CANCER.” Most of the scamsters avoid such claims–too easy to disprove and too hard for them to survive. If it costs money and the claim is that healing is more rapid or you don’t get colds or that it lessens nausea or treats constipation when in fact there is no good reason to think it does– well, then THAT is a SCAM/scam.

          1. mousethatroared says:

            madisonMD – Yeah, well said. I’m comfortable with the description SCAM when it is calling out specific disproven treatments.

            I thought that DH’s complaint was against SCAM being used as a general replacement for CAM. I may have misread. Seeing as how people identify a wide range of activities, from pet therapy to yoga to listening to music as CAM, I think a generalized relabel of SCAM is less helpful.

            “I disagree with your idea that it’s OK if the claim isn’t that they “CURE CANCER.” Most of the scamsters avoid such claims–too easy to disprove and too hard for them to survive.”

            Well said! I was being sloppy there. I meant that most of those therapies that I would consider okay (not SCAM) are focused on lowering the emotional stress of illness or making the medical process more comfortable, not actually treating disease and that, if they don’t make claim beyond that, then I’m kinda okay with it (depending upon details, of course). But, I’m on a long road trip, my brain is even fuzzier than normal.

    2. MadisonMD says:

      @dh: Deep breath. Don’t go SOB on us now.

    3. windriven says:

      “Each modality needs to be weighed on the evidence rather than disregarded/labelled right from the outset as “SCAM”.”

      Yes, we do that. The stuff that is science and evidence based is called medicine. The stuff that isn’t falls under the SCAM rubric.

    4. davdoodles says:

      “Each modality needs to be weighed on the evidence rather than disregarded/labelled right from the outset as “SCAM”.”

      But “SCAM is shorthand for entirely that: Modalities which, on the evidence, should be disregarded.

      If it works, it’s not “SCAM”, see? If it doesn’t work, and couldn’t work, and yet some quack continues to peddle it, then it is both SCAM and, very likely, a scam.

      Or, to put it another way, there is no “alternative” medicine, nor any “supplementary” medicine, nor any “complementary” medicine. There is just medicine, and non-medicine. What works, and what doesn’t.
      .

    5. Sawyer says:

      Ordinarily I’d be on your side about avoiding ad-hominems, but in this case I feel it’s completely appropriate to employ the moniker “sCAM”. The abbreviation “CAM”, along with the term “Integrative Medicine”, are nothing but marketing BS to begin with. They shouldn’t be accepted as a legitimate descriptions of medicine by anyone. The implementation of supplements into the already way-too-broad world of alternative medicine SHOULD be mocked. Some of these treatments are mutually exclusive after all, and the term “sCAM” highlights this.

      Now, if Mark employed a term like “NaTurdopothy” on a regular basis I would object, because the joke has nothing to do with decisions made by naturopaths. Well, unless they are prescribing coffee enemas ….

      1. Mark A Crislip says:

        As an aside, it would be nice to have a term for SCAMs that was less derisive and at the same time did not give inadverent support like CAM or integrative medicine. Quack is off putting and while I will continue to use SCAM it is not a good term for more formal situations.

        I keep remembering the Bright brouhaha in search for a term.

        Pseudo-medicine is my current favorite. Nice parallel with pseudo-science and the silent p makes it science-y. I would love other ideas.

        1. BillyJoe says:

          It’s ironic, isn’t it, that those who threw their support behind “brights” weren’t actually bright enough to realise it was never going to catch on.

          But I think SCAM should stay. I think there is no longer any excuse for altmed practitioners to be ignorant of the nonsense they are peddling. Knowingly or not, they are scamsters.

        2. windriven says:

          “it would be nice to have a term for SCAMs that was less derisive and at the same time did not give inadverent support like CAM or integrative medicine.”

          Amplifying BillyJoe’s comment, a good deal of the reason that sCAMs are such a problem is that they have been accepted in polite company. Quackademic medicine. Playing nice with terminology is, in my mind, nothing more than praising the bright colors and beautiful embroidery of the emporer’s clothes. The emporer is naked as a mole rat and half as attractive.

        3. David Gorski says:

          Personally, I think Mark is starting to persuade me. I like the term “pseudomedicine” as well. However, it does have a drawback in that not everything that is medicine is necessarily pure science. Maybe “pseudoscience-based medicine” (PBM)? :-)

          1. windriven says:

            BSBM?

    6. WilliamLawrenceUtridge says:

      DH, you rather miss the point. SCAMs are inherently unproven, generally unlikely, sometimes wildly improbable, and homeopathy basically impossible. Real medicine must prove itself effective before it can be used. SCAMs are scams because they insist on their effectiveness in the absence of testing.

      The fact that practitioners uncritically accept the claims of their teachers (and the fact that the teachers sell their training services) without proof of efficacy is why they are judged. None are evidence-based, all of the practitioners use them without any evidence of efficacy beyond “their own experience”, which is wholly inadequate. If these practices were validated scientifically, they would be used by real doctors. They would be part of real medicine. CAM is inherently defined as “unproven assertions about the efficacy of a treatment”, so calling it a SCAM is, to a certain extent, accurate. Patients and proponents of SCAMs may not may not realize this, to their detriment.

  23. lilady says:

    I can’t say that any of my nursing education was based in alternative medicine and all of it has served me well whenever Dr. Jay Gordon…or any other anti-vaccine proponent has come to post on SBM…or on Dr. Gorski’s no-so-secret-other-blog.

    I continually check out the nursing curriculum at the university where I was educated, and there is no evidence that any woo-based subjects are taught there.

    1. MadisonMD says:

      Agree. I have the privilege of working with many excellent well-educated RNs.

      (There does seem to be a semi-marginalized RN or two practicing healing touch– but this is proportionate to the small number of woo-loving integrative medicine MDs)

      1. davdoodles says:

        Same here, though my nursing was hospital-based in the days before nursing became a university degree (Western Australia, 1980s), and most of my learning therefore came from ward-hardened veterans with no patience for love-ins or pixie-dust.

        I suspect it’s not so common that the universities and schools of nursing are teaching specifically woo-based subjects, but that woo is “integrated” into non-woo courses by individual muddle-headed lecturers with personal bents towards the sparkly-side.

        A little like how, when I was a kid at a catholic school, the teacher could somehow turn a mathematics class into a missive about the soul-dangers of masturbation. Good times!
        .

    2. goodnightirene says:

      I am very relieved to hear this! I trust your experience is the norm, even though I run into so many of the type that seem to have trained with Jello. My neighbor is a nurse (RN), and she smokes–very discouraging–lots of them huddled at the back door of the hospital I drive past regularly as well, though I can’t be sure all are RN’s.

  24. Jed Sutherland says:

    Sarcasm … it’s what makes life worth living.

    1. Sastra says:

      Yeah, right.

  25. Richard says:

    I hate alternative medicine because it corrupts and pollutes the field of medicine. Science is the standard of care in medicine, and alternative medicine erodes that standard, which harms people. Woo is too nice a word for alternative medicine. I can think of a much better word.

  26. Birdy says:

    I’m trying very hard to make my love of science and medicine into a career. Not for money (my grand plan involves rural family practice. Not exactly lucrative) but because I see the amazing things medicine can do, and the limits it has, and I want to help people to the best of my ability to navigate this world that can be confusing and overwhelming and, sometimes, very sad.

    There’s my motivation for opposing SCAM, at least from my place amongst the as-yet uninitiated. It’s not to protect some cushy little place for myself at the top of the totem pole, it’s because I’m an honest person and want to actually help people, not lie and give them false hope.

    When children are dying from treatable illness because of parental medical neglect, when people are suffering serious illness and injury at the hands of ‘providers’ who offer no real, measurable benefit aside from warm fuzzies, I’m betting that’s pretty hard for physicians who have dedicated their lives to lessening human suffering. I know that’s what I’ve chosen to do, though I’m still on my way, and I think it’s probably easier to aim some sarcasm at the quacks than tear one’s hair out in frustration.

    1. Birdy … who are you guys hiding behind the avatars. I not that tech savoy is there a way to discover who is here to make sure I not arguing with a sock-puppet.

      You are wasting your time here, there is nothing practical to learn if you are going in to office based medicine. If maybe epidemiology or research. I stumbled on this place when I thought these were level headed scientist who would consider listened the life and times of a front-line providers who have tried everything available to help suffering. True scientists would be curious not dismissive and tyrannical.(I know some of you will think those are complements)

      Good luck on your decision.

      1. Angora Rabbit says:

        Speaking as a real scientist, what we would say is, “That’s curious. Now show me the data.” When my grad student brings me a sensational finding, he has to back it up with the data* including multiple replications and ALL the appropriate controls. Otherwise we’re talking cold fusion. Cold fusion is what one gets from a scientist who is curious and uncritical.

        * And notice that data is the plural.

  27. mousethatroared says:

    Very nice post. I have mixed emotions about sarcasm. Personally, I was raised in a home where disdain and sarcasm were quite common from some members of my family and very uncommon from others. The folks who were habitually disdainful were generally the ones who were very emotionally invested in a particular theory or in being right and very unwilling to admit it when they were wrong. Because of this, I grew to distrust this tactics. It seems to me, in addition, there is a danger that one can avoid seeing your errors, because your behavior will make admitting that error more embarrassing. People who argue in a more level way, often are less investing in being right….That is completely my personal observations. And I don’t believe that all sarcastic commentary is bias, only that it raises alarms for me.

    On the other hand, it’s clear in political journalism and literature that biting commentary does have a place in any debate and a well turn retort is always entertaining. Churchill, anyone? In addition, as I have said in the past. I think that patients get a lot of pressure from friends and relatives to try many of these unhelpful therapies. I think that some of the stronger/biting commentary may actually ignite some patients with the emotional impetus to stand up for their desire to focus on the therapies most supported by science and evidence.

    In opposition – I do have friends that I wish I could send to this site, but I know that the tone would turn them away. Face it, if you are wrong, the last way you want to be told you are wrong is in a biting sarcastic way. That’s the trade-off.

    I need a gentle, earthmama SBM for those occassions. ;) I guess.

    Personally, I enjoy the writing, obviously. It would be kinda insane if I read the blog as much as I did and didn’t enjoy the writing.

    Also – Season’s Greeting and an awesome New Year, all. – Cheers!

    1. BillyJoe says:

      Sarcasm should not be a first resort but, when something is so obviously nonsense (eg homoeopathy), or has been shown time an again to be useless and altmed practitioners continue to extol its virtues, then there seems no alternative but humour and sarcasm.

    2. windriven says:

      “I need a gentle, earthmama SBM for those occassions.”

      You make an important point: sometimes convincing arguments are best mounted dispassionately. But it is not hard to find dispassionate expositions of science and the scientific method – if not specifically science based medicine. Unfortunately, dispassionate often means dry and lifeless. That will nonetheless convince some – but I suspect they will have long been convinced before they stumble on this site.

      Those on the sparkly side* are adept at manipulating people by exploiting their ignorance, their fears, and their sometimes desperate need for miracles. We have only facts, history, and the force of argument. Delivered in a Joe Friday monotone, that can be a difficult ‘sell’.

      As I’ve thought about this I’ve tried to imagine a gentle SBM “earth mama” doing battle with an attractive, articulate quack peddling tincture of stardust and a relaxing afternoon of aromatherapy and massage – and I have a hard time making that work. I’d love to hear your thoughts on how it might.

      * * *

      But your point remains, mouse. So my New Year’s resolution is to be a little less combative with some of the airheads who appear here from time to time. I think that it might be self-defeating in the battle to win hearts and minds. The exception will be the JAQ**-offs and the professionals.

      *Thanks to davedoodles for that evocative locution
      ** JAQ – just a question; convinced of their precious cleverness, they attempt to promote some idiocy by wrapping it in a bland question thereby setting the table for a long debate on terms they’ve preset.
      The professionals are obvious and have shown up, for instance, when e-cigarettes or chiropractic are discussed.

      1. Young CC Prof says:

        I frequently engage with CAM proponents in the comments section of various mainstream articles, and I almost always use a gentle tone. Acknowledge your opponent’s point of view. “That must have been so terrifying when your child was diagnosed with cancer. I’m very sorry.” I use words designed to win over, especially to win over fence-sitters, NOT words designed to win debate points. I sometimes have luck leaving the science entirely out, since it’s too hard to understand, and focusing on the money side of things.

        I used to do this over on Joe M’s website, until I got banned for gently pointing out that a book about vaccines written in 1920 was probably not a good source of information about the vaccines in use today. Nope, they’re not anti-free-debate there. (speaking of sarcasm.)

      2. Andrey Pavlov says:

        “I need a gentle, earthmama SBM for those occassions.”

        I find that quackwatch works well to fill that need.

        1. mousethatroared says:

          Good point, AP. I used to use quackwatch as a reference, but I haven’t been there in so long, I kinda forgot about it.

    3. Dave says:

      There is a book I read a few years ago called “Monkey Girl” about the Dover school board and the parents who filed a lawsuit against it to prevent creationism (aka “Intelligent Design” from being taught in their public school. The book is very well researched, pointed out to me exactly why the idea of evolution is so frightening to some people (I never got that before), but also made the statement that calling your intellectual opponent an idiot is not the way to win a person over to your point of view. I’ve let my irritation show through in my comments when I see someone accuse physicians of being close-minded automatons of the drug industry or greedy bastards only interested in the bottom line. These type of comments about physicians are meant to be insulting and not worthy of a polite response. Generally, though, reasonable arguments will win over heated ones.

      1. windriven says:

        “calling your intellectual opponent an idiot is not the way to win a person over to your point of view. ”

        Mea culpa, mea culpa. But what does one do when one’s opponent IS an idiot and the exchange is not intended to be a contest of ideas but an exposition of quack ideology?

        Our friend Rodrigues comes to mind. He claims to be a physician, he misuses and abuses science, he indulges in the most bizarre forms of quackery and magical thinking, and is totally impervious to logic and reason. We can engage in an exchange arguing whether water is dihydgrogen oxide or it is chocolatey magic for only so long. From there … where does one go?

        1. MTDoc says:

          Gee, my response to Rodrigues must sound pretty silly. I really thought he was someone who misunderstood what science was all about, and that he could be enlightened. Apparently he is not newly exposed to this site.

        2. Dave says:

          There’s a saying – “never argue with someone who is crazy or drunk”. It’s a waste of effort. I believe SR does this website a lot of good with his posts as a perfect example of fallacious thinking.

          1. windriven says:

            I’ve heard it as:

            Never try to teach a pig to sing. It wastes your time and it annoys the pig.

        3. Define “Science” please so it gets through a thick skull.

          Of course, I will use science based, high-tech vending machine medicine!!! I’m not completely stupid. I have to keep my license and answer all those arcane Family Practice board questions written by the most erudite head up their stratosphere administrators. Gee, one of you guys can do that, all you do is plug in the answers to the questions, push button and out pops the pill. “Here take this pill and you will be fine” A week later, the patient is in your office “that pill did nothing for me and actually made me worse.” So push the F/U button and the same.

          What to do?? In my first few years you asked your preceptor, now I just know better. This patient is counting on you to help them so now I really have to think and problem solve, flying by the seat of your pants and start real-time, true to life everyday office based medicine. Tried and true and try and see what happens. I think you guys are watching too much science fiction.

          Science works great for 50% of folks, 25% will get better anyway … that leaves … 30 pts/day x 300 day/yr = that’s only a couple thou patients who you have to treat by experience and wisdom.

          Don’t forget pharmacology, in a nutshell is the science of finding a man-made chemical to see if it has benefits to humans that outweigh the toxicity. Here science it vital to the bottom line so that the company can gain a profit and not get sued out of business by dead patients trial attorneys.

          Did I tell you guys that a few doctors in the 50-60s discovered that hip back and knee surgeries were unnecessary at the rates they were doing them. Read Travell, MD. The reason is elementary and overlooked and ignored even by some very wise-guy scientist and researchers.

      2. WilliamLawrenceUtridge says:

        Monkey Girl was a fantastic book. Everyone should read it, I found it almost paced like a novel.

  28. Frederick says:

    Nice read again. I all for the anger and sarcasm, i know it is not the way of convincign people out of scam, but i tired of playing too soft. So Go Mark Crislip Go!

    Chris Griffin have a excellent quote for my thought right now : http://www.youtube.com/watch?v=WEtRoZ5FWNc . Chiropractors doing gynecology ? the back is on the other side of the body… ah yeah right, all sickness are due to vertebral subla-whatever. Damn I forgot :-)

    My post will not add anything really more brilliant that M. Crislip or others People. but I wish to pile on anyway. lets some steam out

    That Women ask why some people hereare angry. Well CAM patient are getting screwed, those scams are fraud. It is like a Bank fraud. A guy make you believe in a miracle investment that gonna pay 100x. It is gonna heal all your money problems, no risk at all. But then “oups”, the guy is gone, with your money. People get angry, of course that’s totally normal, they were rob, there is law against that. But with scam, the guy, don’t flew away, he is still there making you pay for some fantasy treatment. Of course He/she is nice and well behave, listen too you. That person, in some cases, might even be really convince she/he is helping you ( I think there’s a lot of narcissism of self blinding in those, like others I believe less and less that they don’t know). They are also brainwashed to believe in the crap they sold/do. of course they also learn all the Conspiracy monbo-jumbo to be sure they don’t question the teachers ( or mentor or whatever), and they pass it up to their patients. If they was a conspiracy ( but there is not) why it cannot be or there side of the fence? The cams have a lot to waste. Man a lot of them make money like cats lose fur ( at least my cats ). And of course the profits margin are high, with natural product being barely regulated, the production cost are low, no research needed etc. and homeopathy… I really need to comment on the cost to produce that? Yeah. All those are proven wrong by science. so they have a huge interest of kicking science and reason OUT of their turf. they politician who believe in them . Anyway we could revert they whole Story.

    As we can see often on this blog, the scam lobby is strong and powerful, medical board are sleeping and none are arrested for fraud. Chiro wound people and nothing happens. In Germany heath care pay for freaking homeopathy, my older sisters, who lived in germany for couple of years, use that as a “proof” that it work.

    of course we are angry, they always claim about the evil big pharma having all the power, and they are the poor poor little ones. ok so why all those strong regulations on REAL medicine, ( which could also be improve of course) if they were as powerful as they are suppose too and that they could buy millions of people all over the world, how they did not manage to get free pass like “natural” product. And oh yeah Big pharma is in natural product big time, lots of money to make in those cam, and low cost/high price no question ask.

    Some people have spend decade of their life in research and in understanding the human body. But suddenly all this is all false because of some random person with knowledge pass up for a era were there was no way of telling what was what? And that those thing can always explain everything? I always distrust things/method that work for all, all the time, and know all with NO risk . But people need answers. And health and money are two sensible things that can have good or dramatic effect on someone live, and you have those people offering all those answers easy to understand, all wrap up in nice talking. But they are just Fraud.

    Of course we get angry damn it.
    well That felted good :-)

    1. windriven says:

      ( I think there’s a lot of narcissism of self blinding in those, like others I believe less and less that they don’t know).

      I agree. There is a very real difference between ‘not knowing’ and not wanting to know.

    2. Chris Hickie says:

      Is it more appropriate to use the term sCAM or SCAM?

      1. windriven says:

        I’ve always preferred sCAM because CAM exists as a standalone acronym and the lower case prepend leaves CAM in place, adds supplements to the mix, and brands the whole mess for what is. But ultimately I think it is just a matter of personal preference.

        1. Andrey Pavlov says:

          Interesting. For me they have had subtly different meaning. sCAM is “so-called Complimentary and Alternative Medicine” and SCAM is “Supplements, Complimentary and Alternative Medicine” to me.

    3. David Gorski says:

      Nice read again. I all for the anger and sarcasm, i know it is not the way of convincign people out of scam, but i tired of playing too soft. So Go Mark Crislip Go!

      Hey, how about a little love for the dark lord of SBM sarcasm himself (i.e., me)? After all, a certain commenter keeps relentlessly telling me that I’m way too mean and therefore Doing It All Wrong. :-)

  29. dh says:

    So if it gets proven it becomes “medicine”, but if it is disproven, it is “SCAM”. This is just labelling, nothing else. The mind’s tendency to label and resort to certainty where none (or little) exists. It is lovely to shore up an orthodoxy but know what you are doing at the same time, and have an ironic self-regard (I hope).

    There are lots of modalities outside mainstream medicine that are not scams, that do in fact have plenty of empiric evidence behind them; to name just three: acupuncture, certain herbal medicines, and mindfulness-based stress reduction (MBSR). I suppose these are all “SCAM” to a hard-core, narrow-minded, reductionist traditional medicine practitioner (and one, to boot, who does not realize how little of what s/he practices as “traditional medicine” has even had basic evidentiary testing to support it – e.g. the study in Annals which showed that 90% of what pcp’s do is not evidence-based).

    1. Vicki says:

      If it is disproven and people keep promoting it, and making money by doing so, it is sCAM.

      Some things are shown not to work, and most doctors stop doing them. That’s how it ought to work: if you have what you think is a new and better design for a car engine, and those cars all break down in the first hundred miles, you should either abandon it or try to figure out what’s wrong. Not insist “but my uncle’s works!” and “it’s a Big Oil Conspiracy” while trying to sell those cars.

      The sCAM approach is to start with “hey, I have an idea!” then immediately start selling it without testing for safety let alone whether it works, and then ignoring tests that show that it doesn’t work. That’s the problem.

    2. windriven says:

      “So if it gets proven it becomes “medicine”, but if it is disproven, it is “SCAM”. ”

      How is this ‘just labeling’? This is the crux of science and woo. That which is proven is, by definition, science. That which is disproven is woo. A less generous person than I might say fraud.

      “that do in fact have plenty of empiric evidence behind them; to name just three: acupuncture, certain herbal medicines, and mindfulness-based stress reduction (MBSR).”

      Now here we might engage in actual debate. You see I don’t believe there to be “plenty of empiric(al) evidence” supporting acupuncture, I think science has mined and continues to mine pharmacognosy for useful compounds (which are then necessarily refined and purified so that dosage can be precisely delivered) and that MBSR probably doesn’t fit into the realm of medicine whether efficaceous or not.

      If you’d like to persue this you might marshal your evidence supporting acupuncture. But it might be in your interest to read the postings on acupuncture here first because this has been covered in some depth. but maybe you have new information to discuss.

      Or you can try to mount a case that herbal medicines are better in some way than their scientifically refined descendants – or that science has missed the boat on some important herbal that cures, say, glioma. But we’ll be looking for data not anecdotes to support these claims.

      I, for one, am agnostic about MBSR. I’m not at all sure that it falls into the medicine category even if it works. If you have compelling evidence, share it with us.

      ” the study in Annals which showed that 90% of what pcp’s do is not evidence-based).”

      Citation, please.

      The thing here is that medicine is pretty self-critical. Apparently the piece you reference is in a medical journal, not the Annals of Woo. Let’s say for a moment that 90% of PCP is not evidence based – though at first blush that seems a wild overstatement. The point is that medicine takes that as a challenge to do better. 100% of woo is not evidence based and it is not remotely self-critical about its failings.

      There is a reason that we have only aerodynamics and not “alternative aerodynamics.” There is a reason that we have physics and not “alternative physics.” These sciences work. Would you fly in an airplane designed by someone who thought lift was magic?

      What precisely has acupuncture done to improve the lot of mankind? Have acupuncturists eliminated major diseases? Is acupuncture the ‘go-to’ modality for appendicitis, cholecystitis, coronary artery disease or cirrhosis? Does herbal medicine have a cure for AIDS that science has missed? A cure for malaria, herpes, tuberculosis?

      Step back for a moment and look at the arc of the human experience from, say, 1800 to today. This arc has been propelled by science not by magic. Lifespans have nearly doubled. Many debilitating diseases have become manageable. Medical science has not yet slayed every dragon but on what basis can you suggest that some other approach has slain any?

    3. weing says:

      “This is just labelling, nothing else.”
      That’s right. Like the labels “sugar” and “strychnine”. It’s good to know which is which. If you don’t label the containers, you have no right to certainty. I can’t find the study in Annals that you are referring to. Can you be more specific? Were they advocating abandoning science-based medicine or more studies and abandoning what does not work?

    4. WilliamLawrenceUtridge says:

      No, wrong. Real medicine is tested before use, and has a prior probability to work. It’s not that SCAMs are tested and disproven – SCAMs are never tested before being implemented wholesale. In fact, many have been used for centuries without being tested – homeopathy has been around for 200 years, chiropractic has been around for more than a century, acupuncture has only been around for something like 50 years in its current incarnation (previous incarnations used blades, not fine needles, and was really a form of bloodletting). And there is no excuse for this. Add to that the fact that most of these modalities have essentially no reason to believe they work:
      - there are no meridians or acupuncture points, testing shows it doesn’t matter where you put the needle or even if you penetrate the skin
      - homeopathy alleges to correct “energy” imbalances or whatever, but that “energy” is undefined and its principles violate the laws of chemistry and physics
      - chiropractic subluxations can’t be shown to exist, and there’s no reason to believe that nerve impingement would have a substantial effect on the organs or immune system

      It’s rather more than labeling, it’s fundamental intellectual dishonesty and a disparagement of the huge amount of scientific discoveries made over the past several centuries that have lead to massive leaps in life expectancy, quality of life and tremendous drops in child mortality. It’s ignoring those gains and pretending they are somehow unrelated to how our fundamental understanding of the universe has increased exponentially during that time.

      To address your specific claims, acupuncture doesn’t work. Certain herbs do work – and have been integrated into mainstream medicine (St. John’s Wort for depression is the only one that leaps to mind, though scientific investigation also found out that it causes photosensitivity and interferes with the effectiveness of certain drugs). But they’re also problematic – their pharmacokinetics and pharmacodynamics are often not understood, their toxicities are often not appreciated (and if an herb has a biological effect, it is likely to have adverse effects), and you don’t know what is in them because they are not subject to quality control. Not to mention, there is a real science that studies herbs (pharmacognosy) and it’s a lot more effective. Finally, when you know what the active ingredients are, you can purify and refine them (much like what was done with aspirin – actual willowbark strongly contributes to stomach bleeds, modern aspirin is much gentler on the stomach lining). Mindfulness-based stress reduction is a mainstream modality used as part of psychotherapy. It’s not alternative, unless it’s used for something it is unproven for, like curing cancer (for which it doesn’t work).

      As for the claims about the unproven nature of the PCP activities – can you provide the actual study title and author? Or are you just repeating some talking point you heard someone else say? Not to mention – what does it matter? If real medicine is unproven, it needs to improve. It doesn’t automatically validate SCAMs. Also note that this particular claims is frequently tossed about, without reference to the actual study. If you had given the article information, I could have looked it up here or on a related blog and given you the deconstruction of the article. From my vague recall, the study is from the early 80s, and was a call for more randomized controlled trials of medical science to improve them – which has since occurred.

      Maybe you look up the actual claims and analyze them a little more before you just repeat them uncritically.

      1. Harriet Hall says:

        Steven Novella wrote a good article explaining that the idea that only 15% of medicine is evidence-based is a myth based on a misunderstanding of an old study that was done to measure something else entirely. http://theness.com/neurologicablog/index.php/how-much-modern-medicine-is-evidence-based/ The actual evidence-based percentage is 78%, and some of the things that are not based on published studies don’t need to be. We don’t need a controlled study to justify putting broken bones in casts. Anyway, the real argument here is that even a 15% evidence-based practice would be far better than a practice based on no evidence at all.

    5. BillyJoe says:

      “e.g. the study in Annals which showed that 90% of what pcp’s do is not evidence-based”

      I’m pretty sure DH is merely repeating what he heard someone say who heard it from someone else who heard it from someone else…
      The actual source is here:

      Congress of the United States, Office of Technology Assessment: Assessing the efficacy and safety of medical technologies. Washington, DC: US Government Printing Office, 1978:

      Quote: “‘It has been estimated that only 10 to 20% of all procedures currently used in medical practice have been shown to be efficacious by controlled trial”

      R Imrie and D W Ramey tracked down the above source of this claim and published their results in “Complementary Therapies in Medicine (2000)”.
      They commented as follows:

      (reprinted here: http://www.veterinarywatch.com/CTiM.htm#3)

      “The claim stems from the comments of OTA advisory panel member and noted epidemiologist, Kerr White. Dr White based his informal ’10-20%’ estimate on a 1963 paper that reported on two surveys of the prescribing practices of 19 family doctors in a northern British town for 2 weeks (one conducted in December 1960, and another in March 1961).”

      Note the following:
      - the estimate was based on a survey of 19 doctors over a 2 week period.
      - the survey was performed in a single town in the UK.
      - the survey was done over 50 years ago.
      - it refers only to efficacy proven by RCTs
      - it neglects all other forms of evidence.
      - it neglects plausibility.
      - DH has chosen the lower figure of this estimate.

      Since then, evidence has accumulated about the evidence base of what doctors do.
      From the same source above:

      - 96.7% of anesthetic interventions (32% by RCT, UK)
      - 77% of dermatologic out-patient therapy (38% by RCT, Denmark)
      - 64.8% of ‘major therapeutic interventions’ in an internal medicine clinic (57% by RCT, Canada)
      - 95% of surgical interventions in one practice (24% by RCT, UK)
      - 77% of pediatric surgical interventions (11% by RCT, UK)
      - 65% of psychiatric interventions (65% by RCT, UK)
      - 81% of interventions in general practice (25.5% by RCT, UK)
      - 82% of general medical interventions (53% by RCT, UK)
      - 55% of general practice interventions (38% by RCT, Spain)
      - 78% of laparoscopic procedures (50% by RCT, France)
      - 45% of primary hematology-oncology interventions (24% by RCT, USA)
      - 84% of internal medicine interventions (50% by RCT, Sweden)
      - 97% of pediatric surgical interventions (26% by RCT, UK)
      - 70% of primary therapeutic decisions in a clinical hematology practice (22% by RCT, UK)
      - 72.5% of interventions in a community pediatric practice (39.9% by RCT, UK)

      Thus, published results show an average of 37.02% of interventions are supported by RCT (median = 38%). They show an average of 76% of interventions are supported by some form of compelling evidence (median = 78%).

      So much for the 10% myth.

      1. windriven says:

        Well done.

  30. LisaB says:

    I read this blog religiously but have never commented before. I know a lot of people who are science illiterate, and are anti vaccine, believe in chem trails, take tons of supplements, that sort of thing. Maybe because I live in Southern California? I find SBM has the best info to debunk these things but I am often hesitant to post links or refer them because of the disdain/sarcasm. Because of the tone, this site is can seem like a club for the already converted and that is too bad because I haven’t found better information anywhere.
    SBM can seem more like a support group for us frustrated science heads, and that is fine and necessary too. It has also trained me about how to respond verbally when my friends say these ignorant things. But I find to convince anyone to change their mind you also have to be diplomatic and sensitive and not make them feel like too much of an idiot, no matter your own frustration.

    1. goodnightirene says:

      Thank you very much Lisa, for your very insightful comment. I agree wholeheartedly with you and have tried to express your ideas in these pages, but have never managed to do so as succinctly as you have done. I have the same problem providing links from this blog. As much as I admire many of the comments here for their “tone”, I realize that many people will be put off by the same, especially many of those we should be trying to reach.

      Telling the truth in an unvarnished way just isn’t appreciated by everyone. I’ve been accused of having Asperger’s simply for being–well… blunt. It seems to come down to basic personality differences between magical thinkers and the more pragmatic among us.

      1. Andrey Pavlov says:

        I actually full agree with both you and Lisa. As BJ points out, however, kind diplomacy is a long game on an individual scale. You aren’t going to be able to link to an article written in [fill in specifically appropriate tone for target individual] and expect that to really make much of a difference. If it does, then I would aver the individual would have responded to most any tone. The kind diplomatic side is how you approach your patients or your family and friends – people you will have continued contact with over time to be able to present more information and convince over time. The problem is that for every “diplomatic” science based post there are myriad non-science based ones that range from diplomatic to (very oftenly) shrieking lunacy with a much more viscerally appealing story.

        There are those who do not quite fit into the above paradigm I’ve built up and they will indeed be lost by us where they would have been won over by a “diplomatic” post. I argue that those are a small portion of the population (based on the paucity of information we have on the topic plus extensive experience online and IRL trying to convince others out of ridiculous ideas they hold) and that more to the point that is not the driving force we should be targeting.

        Sad as it is, a “controversy” is how to get things going. Just look at multivitamins now. I don’t have television but was with family over the holidays that do and noticed how many news reports are talking about how “scientists now find there is no benefit to vitamins.” They get some important nuance wrong, but the point is it has been raised to the level of public consciousness. Finally. I can’t assert with confidence why, but it seem to at least correlate with the relatively recent spate of completely unabashed and unapologetic articles on the topic.

        I say write to force the masses to argue over it and let the science win the day. Those who truly believe will believe no matter what. But if they read our writing here it can spur them into angrily and loudly arguing their position and in the process showing how bankrupt it is. It gets the authors here invited to nationally syndicated TV shows to discuss the topic. Heck, it even works in my own field with my colleagues. I do not mince words whenever I mention CAM – I do not just call it “CAM” I say something to the effect of “oh, that CAM tripe?” or however is most appropriate to clearly show my disdain. I often get a surprised “wait, you think ALL of it is crap?” (or something to the effect). Which gives me the opportunity to explain why . I’ve had “converts” (those who would have likely been shruggies) and I’ve even had cases where I earned the rep of being anti-CAM and had the big time supporters of it come seek me out. Little did they know what they were in store for ;-)

        The point is that we need to actually force the conversation to happen. All such beliefs and ideologies slink away from the light so only their shiniest parts pick up the gleam and look attractive from a distance. The rest of their ideas are so ratty and tattered that if we bring them into our circle and really dive into it it shows just how ludicrously bankrupt the ideas are. Most people in the USA do not know what homeopathy actually is. They think it is “all natural medicine” or some such nonsense. Tell them what it REALLY is and explain it to them and they are incredulous.

        My last anecdote: A friend in med school has parents who are both PhD’s in chemistry. He comes home and sees his mom using a bunch of homeopathic remedies. He explains what they are and they are dumbfounded – how could something so absurdly and obviously ridiculous be sold in a pharmacy? Well, the marketing tricked PhD’s in chemistry into wasting their money on magic.

    2. BillyJoe says:

      The problem is that you’re assuming that diplomacy works. But it is possible that diplomacy only helps after you’ve been convinced by other means. Such as confrontation. Diplomacy (on its own) mostly results in everyone agreeing to disagree. Even with obvious nonsense such as homoeopathy. Some people have erected barriers and the only way is to crash through. At least initially. They’re unlikely to announce their immediate conversion to your point of view, but you’ve sown seeds that may germinate. They have not gotten off lightly by agreeing to disagree. And you’ve also appealed to the fence sitters. The message will spread as it has to you and through you to your friends and acquaintances.

  31. MadisonMD says:

    @dh

    So if it gets proven it becomes “medicine”, but if it is disproven, it is “SCAM”.

    This thread keeps on and on about sarcasm. Well, there is a clever double meaning of an acronym sCAM, but it’s not at all sarcastic.

    From Merriam Webster:
    “scam = a dishonest way to make money by deceiving people”

    If disproven or even unproven therapy is sold by deceiving people into believing it works, well, by golly, this is a scam is it not?

    —–
    I agree with windriven 100% on the other points. If you want to show us that acupuncture works for something and is not a scam when used for that purpose, then please do provide your best citation.

    I too am agnostic about MBSR and I am actually enrolling patients into a trial evaluating the role of MBSR in managing cancer pain. However, I’m not telling patients that MBSR does relieve pain and then charge them for a training session– now that would be a scam, no?

    1. Ward says:

      Mindfulness Based Stress Reduction will never be shown to be beneficial. It is scientifically impossible to devise a study that would lead to a definable or measurable outcome. Of mindfulness. In order for an intervention to be studied it must be quantified.

      When one does a study of the benefits of an antibiotic for example, the drug is defined to the molecular level before it is used in a trial. So you can know who received the drug, in what schedule, in what dosage. The outcome is definable as well: clinical improvement, microbiological cure, survival.

      How does one measure mindfulness? When I participated in MBSR teacher training half of the participants were snoring fifteen minutes into one of the sessions. So if an outcome is measured, is the response due to the benefits MBSR or to those of a good nap? You don’t know what someone is thinking so you can’t know when the state of mindfulness is present. Therefore any outcome in a study of mindfulness by the very nature of the beast is unreliable.

      That isn’t to say that meditation is not beneficial or should not be taught. Indeed some brain responses are the most important aspects of being human. Love, compassion, kindness. But because they can’t be quantified, these emotions aren’t able to be studied scientifically. Mindfulness is one such entity…vitally important perhaps..but scientifically obscure.

      1. MadisonMD says:

        @Ward
        I agree that you could not test whether mindfulness leads to improved health outcomes without an objective measure of it. However, you could determine whether an intervention– providing a teaching tool about mindfulness– reduce perception of pain.

        Well.. I’ve always been a *bit* skeptical of
        MBSR. It definitely has guilt by association with the woo-meisters. But, our study is being led by an RN team that doesn’t seem to associate with the Integrative Medicine folks…

        Its funny to think that MBSR might work by boring folks to sleep. Not sure THAT is being controlled for.

        1. Angora Rabbit says:

          I gotta ask – are you doing this with Richard Davidson? If so, should be pretty interesting study!

          Here’s where I think much of what’s going on is psychology and a powerful influence upon patient perception and interpretation. I will bet dollars to donuts this is what SSR is actually experiencing as well.

          1. MadisonMD says:

            Hi neighbor,
            No– he’s not the PI, but I am able to find some of his work cited by the PI. I need to learn more about Richard– haven’t run across his work much yet.
            Agree with you on what SSR is seeing. But there is a sinister side. When it doesn’t work, he claims toshoot them and bury them out back.

  32. Lynn says:

    “I too am agnostic about MBSR and I am actually enrolling patients into a trial evaluating the role of MBSR in managing cancer pain. However, I’m not telling patients that MBSR does relieve pain and then charge them for a training session– now that would be a scam, no?”

    I did a course on MBSR — it would have been more helpful if the instructor had not included a lot of woo. For example, we were doing some xi gong movements (movement is almost always good), and she kept talking about our chakras (spell check wanted to correct this to charades), gathering in the xi, and so forth. She made frequent comments disparaging conventional medicine, and talked a lot about the advantages of herbs over pills.

    Overall, I found it positive. If I were to do another course, however, I’d investigate the instructor a bit more, first.

    My favorite other member, btw, was the chiropractic student was started out very skeptical because, as she said, she was in a “science-based” program.

    1. MadisonMD says:

      Well, I had better look more closely on that MBSR intervention in the study.

  33. Rose Taberner says:

    I am served well (very) by my Medical Oncologist, Radiation Oncologist and Specialist Breast Surgeon who have at worst prolonged my life to enjoy my children and who at best have saved my life.

    SBM and Doctors are my heroes!

    Thank You

  34. David K says:

    I typed a lot and then deleted it all and found it’s just easier to call you out for what you are doing and not what you said since I don’t have the patience of those around me to deal with your every sentence.

    What you are engaging in besides ad hominem attacks is known as poisoning the well. It’s an attempt to discredit the opinions and research of others by claiming that they are flawed or biased in such a way that would make their points invalid.

    “The peer-review process is flawed.”

    Sure but its self correcting. Everything we do is flawed to some extent that’s why statistics is a very important field of mathematics. But it doesn’t invalidate the process. You don’t prove your claims by proving that other claims are wrong. You must show with evidence and research that your claim is true.

    1. windriven says:

      @David K

      Threading here can be a bit … non-intuitive. Could you clarify which comment you are responding to? As a stand alone it is a bit incomprehensible.

      1. Chemmomo says:

        windriven:
        David K quotes Stephen S. Rodrigues at December 28, 2013 at 2:33 pm, in reply to Harriet Hall from December 27, 2013 at 6:16 pm, which was in return a reply to comment #16 Stephen S. Rodrigues from December 27, 2013 at 2:27 pm.

  35. Roman100 says:

    As a former (now healed) patient at one time brought low by colorectal cancer and — later — by bladder cancer, whose life was prolonged/saved by dedicated doctors using the methods of medical science, I want to very warmly echo that sentiment, as well as to express appreciation for this superlative blog & appended knowledgeable comments. What a fascinating education it is for me, and truly a service to humanity. I wish the best of the New Year to all!

    1. Roman100 says:

      Groan … Looks like I’ll never get the hang of that “blockquote” coding thing! The foregoing is actually my own comment, not a cite; but I wanted it to refer to Rose Taberner’s post immediately preceding mine. Sorry about that.

  36. Dan Chamney says:

    What scares the crap out of me is wondering what kind of medicine will be available for my Grandkids and beyond. I have the knowledge to be able to tell SBM from SCAM, but will they be able to to so? Idiotic politicians, medical facilities and universities keep allowing SCAM practitioners to gain the appearance of legitimacy and as this continues, it is going to get tougher for the average person to be able to separate the bullshit purveyor from the legitimate practitioner.
    We tend to put our faith in our institutions (Government, Hospitals and Schools for example) and when they let us down, the entire system falls apart.

  37. David K says:

    @Chemmomo

    Thank you.

    @Windriven
    I am relatively new to this forum and don’t post much so my ability to reply in the correctly seeded manner is rather lacking. You are correct i was responding to SSR. I will hopefully get better at this.

    1. windriven says:

      @David K

      WordPress has trained me, like one of Pavlov’s dogs, to hit the reply twice and to be sure, of course, that it is the reply following the comment and not the general reply. It still does odd things sometimes but I believe this is because Paul (the SBM computer guru) is not conscientious about placing the entrails of a freshly slaughtered goat on his keyboard every night at moonrise.

      1. Andrey Pavlov says:

        @windriven:

        Funny. I actually never have an issue posting anymore (no matter what I do it with) but I still have an issue finding all the comments. Many times I find one interesting that was clearly in reference to another comment that isn’t showing up in my RSS reader and I have to go back to the page to search through for that comment. Plus, the threading is completely useless unless you are actually looking at the page, which is why I have also gone back to use the @username to start posts, since I particularly appreciate it when I find that tag for myself.

        1. windriven says:

          I agree Andrey, the @username is the best bet. But I do still have issues when I’m replying to a comment that is also the last one in the queue. Sometimes it ends up in odd places.

          That said, the problems now are insignificant. Paul and company have done a great job of rectifying the initial difficulties.

  38. Roman100 says:

    Monkey Girl was a fantastic book. Everyone should read it, I found it almost paced like a novel</blockquote/

    Thanks for the recommendation as to Dr. Utridge, this has now become my reading for the holidays.

    Incidentally there is some fascinating Darwiniana to be found in the book Ever Since Darwin by Stephen Jay Gould. It’s available as an ebook here:

    http://www.amazon.com/Ever-Since-Darwin-Reflections-Natural/dp/0393308189/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1388326245&sr=1-1-catcorr&keywords=ever+since+darwin

    1. irenegoodnight says:

      I am a huge fan of Gould and especially love “Ever Since Darwin”! I miss Gould very much and thank you for reminding me to revisit his work.

  39. matt mcauley says:

    thank you for showing the compassion that the alt med people claim to never see in medicine. i would love for a magic bullet that cures all ills, i would also like to meet santa and the easter bunny.

  40. PMoran says:

    BJ:”The problem is that you’re assuming that diplomacy works. But it is possible that diplomacy only helps after you’ve been convinced by other means. Such as confrontation. ”

    Maybe, yet does no one else find Lisa and MTR’s comments troubling? They are reluctant to refer CAM users they know to this site.

    Question: is there not sufficient confrontation for current CAM users the instant we begin explaining how CAM doesn’t/cannot/may not work in the manner claimed?

    A simple “this is what we think and why”, will either work some magic or not, should such persons come here to find out “what science thinks” before they make a decision on a medical matter.

    Coating an already bitter pill with insinuations concerning likely flaws in the character, intelligence, or motives of anyone who gets tangled up in CAM is always going to be risky. It is bound to clash with the self-perceptions of the individuals concerned, devaluing anything else we say as likely due to bias or turf warfare..

    I allow that there may be a totally different population of readers who will be deterred from involvement in CAM by an atmosphere of disdain.

    Perhaps there is a happy compromise somewhere. I have not found Mark’s usually gentle, self-disparaging mocking of aspects of CAM too troublesome but, of course I, and most of the other regular readers here don’t matter a lot. We are at no risk.

    Was this letter directed at Mark, or the SBM blog generally?

    1. Andrey Pavlov says:

      Maybe, yet does no one else find Lisa and MTR’s comments troubling? They are reluctant to refer CAM users they know to this site.

      No, I do not find that troubling at all. Firstly please note that they clearly stated that they are reluctant to send some of their CAM user acquaintances and family here. In the past they (mostly Mouse) have stated that a large part of that in some instances is because they know it will precipitate an argument that they do not wish to participate in. Secondly, your (continued) argument is that somehow we should make a page here (or at least that all authors on the topic should strive for) that is completely non-offensive to everyone.

      I responded to Irene before seeing this, so read that when it comes up (I’ll be happy to copypasta it for you if you like) as it is pertinent as well. But fundamentally it is ridiculous to focus on a narrow subset of those who would be offended and use that to lambaste the work here. You conveniently ignore all the comments that come in thanking us here (even the amazingly mean and awful Dr. Gorski) for laying it out plain and giving them the answer they were looking for. In fact, I’d be willing to bet that comments to that effect VASTLY outnumber comments such as Irene and MTR’s. Yet we should find that minority to be disturbing whilst ignoring the slew of positive comments and thanks received at these pages.

      The rest is in the other comment I posted. Suffice it to say you are working some sort of nirvana fallacy mixed in with the “drugs kill 100,000 people” line of reasoning. Yes, we may be off putting to some and harden some against scientific medicine. But we also recognize that this will inevitably happen at some minimum level no matter what approach is used and the number helped is vastly more. Granted there is a paucity of hard data to prove this conclusively but I would say that the data available much more supports us and you have provided none contrary except your own particularly subjective interpretation.

      1. David Gorski says:

        Secondly, your (continued) argument is that somehow we should make a page here (or at least that all authors on the topic should strive for) that is completely non-offensive to everyone.

        Which is, of course, impossible. :-)

        1. Andrey Pavlov says:

          Yes, it is unquestionably impossible

          1. David Gorski says:

            As an interesting aside, I have on occasion noticed that some of the most vehement reactions to some of my posts are directed at parts of the post where I write something that wasn’t even actually meant to be sarcastic or insulting and seemed to me at the time I wrote it to be innocuous. Oh, well…

            1. Pmoran says:

              That’s my point. Soundly based factual material is confronting enough to the staunch CAM supporter.

              When sceptics shift from that to trying to explain away CAM use, or to characterising its users, or analysing motives, in-built biases and misconceptions creep In, unnecessarily muddying debate and potentially seriously changing how this site is perceived.

              Perhaps I should mention examples that others have put about e.g. the commonly expressed notion that CAM support/use is due to poor education is not supported by any evidence.

              Steve has tended at times to talk as though the intrusion of CAM into some of our institutions is the result of a sinister conspiracy to corrupt medical science. It is patently MAINLY due to the fact that some influential people and a lot of patients think it has something to offer. Their expectations may be wrong, and we can point out why that is likely to be so, but they are not being insincere or furthering sinister agenda.

              I objected when Steve put forward the “main” reasons why people turn to CAM without mentioning unmet medical needs and the power of personal testimonial, which would almost certainly sustain some kinds of CAM in the absence of any other influence.

              If we are going to encroach upon such subjects, let’s have a bit more scientific rigour. This is not only to do with “tone”, and not at all about being nice (although some patients will probably choose according to which adviser seems nicer), it is largely about getting things wrong.

              Being experts on some aspects of science does not make us experts at understanding human behaviour. Tread lightly in that arena.

              1. Andrey Pavlov says:

                When sceptics shift from that to trying to explain away CAM use, or to characterising its users, or analysing motives, in-built biases and misconceptions creep In, unnecessarily muddying debate and potentially seriously changing how this site is perceived.

                How is this relevant to either this post or the cellphone and bra post? In the latter the only inference about motivations was on the part of Dr. Oz which is, undeniably, a reasonable avenue of inquiry properly hedged and developed over time using evidence of actions and statements made in that same time. Yes, we CAN call people like Oz and Weill shysters because they are. It is documented well enough in hard objective data to say that. Now can we infer their deep down motivations? Are they TRULY malevolent folks knowingly using modalities that they KNOW are crap PURELY to hawk goods and line their pockets or do they truly believe that what they are doing is helpful and just deluded and misguided? That we cannot answer. Nor have we ever pretended to. And we have clearly stated that, in our opinions, it doesn’t matter. The end result is the same and being bilked by a sinister agent or a deluded one is still being bilked.

                Perhaps I should mention examples that others have put about e.g. the commonly expressed notion that CAM support/use is due to poor education is not supported by any evidence.

                Perhaps I should point out that you have misunderstood what we tend to say around here to make a convenient talking point to fit your narrative?

                It was myself – and Dr. Gorski specifically – who noted quite well that the majority of CAM use is primarily by more-than-average educated middle class white women (as the data shows us). Just enough education to think they know better than experts and enough money to throw at useless treatments. Funnily enough the truly poor and uneducated tend to use CAM when they have no other recourse but clamor for actual medicine (or whatever they are TOLD is actual medicine a la “Homeopaths Without Borders” after the Haitian earthquake disaster) and readily defer to the (perceived) expertise of the physician.

                So no, CAM support/use is NOT a direct product of poor education. It is a product of poor critical thinking primarily (regardless of education) and, in many cases, being differently educated than what is necessary to evaluate the health claims made by CAM shysters (companies or individuals) and accepting them as valid. Which brings me to….

                Steve has tended at times to talk as though the intrusion of CAM into some of our institutions is the result of a sinister conspiracy to corrupt medical science.

                Yes, precisely. Nowhere has anyone ever said that this is the ONLY reason, but it is A reason and a particularly dangerous one. It is organized, monetized, and has a specific politicoideological agenda. Organizations like the Bravewell Collaboration come to mind. Actions like Weill trying to get ““Integrative Medicine” approved as a specialty by going to a board with lesser standards and trying to essentially “back door” it in, and piggybacking off an already BS board certification that essentially requires no training or expertise, just money. (BTW, Dr. Gorski – I may actually go for it myself. I think it would be interesting and I can blog the process. If all goes according to plan I will actually be licensed in the next few months since through a nifty loophole I can exploit I am actually able to take the Step 3 and achieve licensure without any GME at all, but we’ll see how it goes). If their was such a strong conviction on Weill’s part about the legitimacy of the field, why not go for the most legitimate and rigorously recognized board for approval? Why push it through if he obviously KNOWS that it wouldn’t meet the standards of rigor? Hmmmm…..

                <blockquote. It is patently MAINLY due to the fact that some influential people and a lot of patients think it has something to offer.

                Which doesn’t differ from anything we have said, really. “Some influential people” falls under the umbrella of “sinister conspiracy” and “lots of patients…” falls under the lack of RELEVANT education and critical thinking skills to evaluate bogus claims by CAM proponents. This is precisely why we are very much against the imprimatur of legitimacy granted CAM by being “studied” and “practiced” at elite institutions. Such as the NCCAM, which has been documented clearly to have stemmed from two senators using politics to essentially save the “Office of Alternative Medicine” from being dismantled because they weren’t actually doing legitimate science. One senator has a clear ideological agenda and the other just so happens to be one of the longest standing senators in US history and is senator to the state with the most industry in a position to benefit from legitimization of CAM. Hmmmmm….

                So yes, there is a “sinister conspiracy” out there. The difference is that you seem to think that a “sinister conspiracy” can only mean an evil super-villian type plot to muck up science based medicine. You neglect the fact that making money and wielding influence are actually the motivations and that the mucking up of SBM is an acceptable side effect. You paint some cartoonish picture which nobody here really ascribes to whilst ignoring the reality of the political and monetary agendas ACTUALLY fueling these elements of CAM advocacy.

                Then, of course, is the average CAM user. The reason why the “sinister conspiracy” exists in the first place – most are people who believe in the legitimacy because they find it popularized in the press, see supposed scientists working on it, see it funded by the NCCAM, see it taught and offered at prestigious universities, and see it on the shelves at pharmacies and stores. They are dumb or poorly educated. They are hoodwinked by double talk and political moves allowing useless treatments and bad ideas to gain traction so that people can make money.

                I objected when Steve put forward the “main” reasons why people turn to CAM without mentioning unmet medical needs and the power of personal testimonial, which would almost certainly sustain some kinds of CAM in the absence of any other influence.

                In other words, you object to us not addressing what we consider – based on evidence presented here – to be a minor contributor to CAM use and one that is, overall, very difficult if not impossible to assail? So because we focus our efforts and attention on an arena of CAM use and advocacy that is (in our opinion) a larger driver of use and false legitimacy AND one that we could actually DO something about, we are…. what exactly? Every one of us here has stated that there will undoubtedly be some baseline level of CAM usage just as there are some people who still genuinely believe the earth is flat. But that is a statement of the obvious and even worse a statement that takes us nowhere and provides us nothing to do. It is a dead end and only a minutely interesting observation about human behavior on a population level. In other words, who really cares when there is simply nothing to do about it? Yet somehow because we don’t focus our energies there (doing what, exactly, Peter?) we are terrible people and don’t understand CAM use and how to approach it.

                That would be analogous to you complaining that we focus on preventable risk factors for cancer while ignoring the fact that no matter what we do there will always be a baseline incidence of cancer. An interesting observation and yet banal at the same time. Why focus our thoughts and energies on dealing with NON-modifiable risk factors? So why focus our energies on the ineradicable base level of magical thinking and CAM usage that will always be with us?

                Their expectations may be wrong, and we can point out why that is likely to be so, but they are not being insincere or furthering sinister agenda.

                And now the meat of your complaint. You realize that “sinister agenda” does not mean “cartoonish super villiany to muck up medical science” right? It can – and does for us – mean “a political and/or ideological agenda to further a conclusion in the absence of evidence or in the presence of contrary evidence.” You seem to think that we are trying to say that the motivation of these CAM proponents (individual and organizational) is to cripple medical science. No, Peter, the goal is to advance CAM *despite* medical science. They could, in general, care less about actual medical science. Their “sinister agenda” is to promote their particular CAM above all else – putting the cart before the horse. Now, when this abuts medical science they are FORCED to denigrate it. Like David Katz at Yale arguing for a different standard of evidence for CAM. The “sinister agenda” there was not to make it so that legitimate medical science is reduced to bunkum but to find an out for CAM modalities that FAIL the standards already in place to still somehow “work.” The INTENT is to find a way to prove an ideological construct, the BYPRODUCT is to undermine medical science.

                The fact that you could somehow miss this distinction demonstrates to me that you are reading what we here write with your own subjective bias.

                If we are going to encroach upon such subjects, let’s have a bit more scientific rigour… it is largely about getting things wrong.

                Then demonstrate where the actual rigor lacks. You have yet to do that – after endless back and forth it always, always, ALWAYS, boils down to tone for you. We here present evidence and ultimately you can’t actually assail that and so it turns into a complaint about how mean we are. And in my case you tend to flounce by becoming the stereotypical old-gaurd attending talking down to an underling. Hardly scientifically rigorous. I’ve disagreed with the authors here before and commented as such – with documentation of evidence. Funny how it gets settled rather quickly in contrast to discussions with you which go on endlessly and ALWAYS devolve to us being mean or, in YOUR opinion, invalidly assigning some motivation to some specific agent (as above). Well, we’ve offered evidence as to why. You have not offered evidence as to why not.

                Being experts on some aspects of science does not make us experts at understanding human behaviour. Tread lightly in that arena.

                No, but being skeptics does give us a LOT of insight into human behavior. And yet we STILL tread appropriately lightly. It is just NEVER light ENOUGH for YOU. Which is precisely when the conversation devolves into one of tone because that is all you have left at the end of the day.

      2. mousethatroared says:

        AP “In the past they (mostly Mouse) have stated that a large part of that in some instances is because they know it will precipitate an argument that they do not wish to participate in. ”

        Just to be clear, I have settled on a choose your battles approach to friends and CAM*. I have found that people listen to unsolicited advice better if it is rare and only given for more risky concerns.

        I can’t imagine this is an approach that is particularly useful in blogging, though.

        * As a result, I have all this instinct for giving unsolicited advice that I need to vent…that’s what online commenting is for. ;)

        1. Andrey Pavlov says:

          @mouse:

          That was what I had gathered from your writings. And what I do in my personal life as well. And precisely for that reason. I save my unsolicited critiques (for some – I have other friends that are much more critical and enjoy being challenged) for those cases where there is clear and documented likelihood of harm from a practice. It gives more “punch” when I do it less frequently and let the small things slides. Just a matter of picking battles. Which is what I hope came across in my comment regarding you.

          1. mousethatroared says:

            Apologies if I was being a bit defensive. With my family and friends (and I’m sure others have similar experience) it ain’t easy to know which are the right battles to choose, between SCAM use and other concerning habits/choices.

            1. Andrey Pavlov says:

              @mouse:

              Not at all! I didn’t want to put words in your mouth and I certainly did not want to misrepresent you. At the time, in my conversation with Peter, I felt obliged to make the reference with the full knowledge that you would come in and correct me if necessary. Hopefully you do not feel that I misrepresented you or incorrectly used what I thought you would mean to serve my own purposes in the conversation. If so, please let me know and I will be corrected.

              I do fully agree with you that it is difficult to know which battles to pick and have gotten myself into a quagmire from time to time as a result. Thankfully I don’t have any abject failures leading to actual harm. I figure that I’d rather err on the side of being a little too gadfly than allowing harm to pass. But I have managed to cultivate the image of doing it out of caring and genuine concern and actually knowing what I am talking about. So when my friends and relatives have a serious question about something that they are unsure of, they come to me knowing that I will give a thorough, researched, and referenced response to help them make a decision.

    2. David Gorski says:

      Perhaps there is a happy compromise somewhere. I have not found Mark’s usually gentle, self-disparaging mocking of aspects of CAM too troublesome but, of course I, and most of the other regular readers here don’t matter a lot. We are at no risk.

      Another statement of an interesting dichotomy on Peter’s part. Mark frequently writes things every bit as “dogmatic,” “inflexible,” “insulting,” and “dismissive” about CAM (he even calls it “sCAM,” something I personally virtually never do) and those who promote it as I do—more insulting, sometimes. Yet, Peter finds Mark’s mocking of CAM acceptable and mine unacceptable, even though I’m known to be pretty self-disparaging (I prefer the term “self-deprecating”) myself. Similarly, Harriet and, not too infrequently, even Steve write things that are no less “dogmatic,” “inflexible,” “insulting,” and “dismissive” about CAM than what I write, but Peter finds them cuddly and inoffensive while I’m apparently the personification of everything he finds wrong in medical skepticism.

    3. mousethatroared says:

      pmoran “Maybe, yet does no one else find Lisa and MTR’s comments troubling? They are reluctant to refer CAM users they know to this site.”

      Late to respond, but I have a diverse selection of friends. If this blog was suitable for the group that needed an earthmama approach, it would be too soft for the more critical friends.

  41. Badly Shaved Monkey says:

    With the help of the cream and supplements, the bruising is resolving in days. Not weeks. Days. The post op nurse told me to expect this dark bruise to linger for weeks or months.

    This is a pattern that I have seen very many times. The SCAM-fan takes at absolute literal face value a prediction for poor outcome that has been offered by a practitioner of real (but fallible) medicine. When they apply some useless therapy to themselves and they do better than that bad prediction then it ‘proves’ to them that the SCAM worked.

    It often seems that the only thing that SCAM-fans accept from real medicine is the bad prognoses it sometimes predicts, but only so that when the odds swing their way they can credit their most recent SCAM.

    This is where I first entered into interaction with SCAMsters. A radio programme about SCAM in vet medicine introduced listeners to a hyperthyroid cat on which homeopathy had been used and it was alive 14mths after diagnosis. The homeopath was very happy to show the programme’s presenter all the classic features of untreated hyperthyroidism. The “success” was that the poor cat’s original vet had said to the owner that the life expectancy was about 6 months. On many occasions and for various reasons I have allowed hyperthyroid cats to go without treatment. Many have lived well beyond a year with their condition slowly deteriorating but with their quality of life being reasonable right up to the end.

    We see similar stories all the time. In this thread the alcohol/pneumonia case reports are of exactly the same sort: patients beat pessimistic odds, so credit gets given to useless treatment instead of leading to doubt over the original prognosis or relief that the patent just got lucky.

    As a minimum, I have learned to avoid giving narrowly quantifiable prognoses, no matter how much clients want them and I am left to wonder where all these “doctors said I had 6 months to live” stories come from. Is it as simple as sheer ignorance that if you have a median survival of 6 months, then 50% will live longer and some will live a lot longer?

    SCAMsters and people like SSR seem to make their living off the far end of the survival curve even though they do nothing useful.

    SSR seems to have carved out a living with patients who have fallen out of medicine with their unpleasant, but non-fatal, condition still troubling them. What he clearly fails to recognise is that the play of percentages still applies to this group. Some will still get better, some will stay the same (which could be spun as being ‘stabilised’) and some will get worse. Unfortunately he infers that he is responsible for helping the first two groups, and he is happy to fertilise his roses with the last set. I know (hope) he was joking, but it was highly revealing that he so clearly dismisses bad outcomes and locks them out of his mind rather than allowing them to feed back into reflection upon his methods. Again, this is a familiar pattern in all SCAMsters I have met. Bad outcomes are excused or ignored. They do not inform future practice.

  42. pam hart says:

    Thank you for your work.

  43. Gemman Aster says:

    You cannot humor the purveyors of scam. They operate in a mental world where one fallible/malcontent/vicious/greedy doctor instantly devalues and disproves all of medical science. Yet a single lucky remission that occurs around the time a patient with medulla blastoma happens to visit a ‘massage therapist’ gives truth to every scam ever whispered. All you can do is continue to explain and hope the message gets through to some.

    Those few who would have gone to a scam artist with their skin cancer, but instead perhaps read this blog and then visited their GP can only be considered a win. The rest… Sadly, John Donne had it right.

  44. Elizabeth says:

    Dear Doctors,
    I am an engineer, very educated person, phd, Polish nationality
    I see human body as bio-machine. And I use logic to understand that.

    I would like to address liver flush: mentioned and laughed out on this forum.

    PLEASE LETS BE JUST LOGICAL !
    What we see on photos from link?

    http://curezone.com/ig/f.asp?f=136

    We see Humans livers with stones in bile ducts. Easy to conclude that stones can be produced in gallbladder as well in liver.

    Here is me : I check in hospital for any possible stones in gallbladder/liver. Everything is perfect . They see nothing there. So why my stool is orange/yellow in colour for weeks now and i feel kicking pain just under my right rib ?

    Guess what : I do liver flush, and next day stool is beautiful dark chocolate and pain is gone. So what happen in your opinion? In my engineer phd opinion: it was obstacle IN BILE DUCTS , AND LIVER FLUSH MOVED IT OUT and now bile CAN flow easily.

    It is logic drawn from hydraulic . If it is obstacle fluids don’t flow, no obstacles fluids flow. It is what I learn in long hours of my engineer study. Human liver/gallbladder is nice piece of design hydraulic . As engineer I think that I am very well quadruped to understand it.

    Did you spend hours and hours to study :hydraulics AS i DID?????

    hydraulics- branch of science concerned with the practical applications of fluids, primarily liquids, in motion. It is related to fluid mechanics, which in large part provides its theoretical foundation. Hydraulics deals with such matters as the flow of liquids in pipes, rivers, and channels and their confinement by dams and tanks.

    1. Mark Crislip says:

      My car didn’t start this am.
      Plenty of gas, battery working.
      But
      The right front tire was low in air

      I know from my extensive knowledge of the medicine that it is the legs that make the human go. And so with the tire. Common sense, a logic drawn from medicine.
      So I filled the tire up with air and the engine turned over.
      If you had spend hours and hours studying medicine, as I have you too could have fixed my car

      Just being logical

    2. MadisonMD says:

      @Elizabeth
      That’s odd. Somehow you imagine that you discovered choledocholithiasis because of your extensive history of hydraulics. Jean-Martin Charcot actually described the syndrome when these stones lead to cholangitis– in the 19th century.
      You need only read the wikipedia entry on gallstones to be better informed.

    3. windriven says:

      If it is obstacle fluids don’t flow, no obstacles fluids flow. It is what I learn in long hours of my engineer study.

      ? Just how many hours did it take you to learn that fluids cannot flow through obstacles? I know a couple of Polish engineers and they are very good. I don’t think it took them long at all to learn that. Now some of the details of the Reynolds number and the transition from laminar to turbulent flow – that probably took long hours to really understand.

      So I guess I’m wondering if you’re really an engineer. Maybe you’re a troll pushing ‘liver flushes’.

    4. Chris says:

      Elizabeth: “I do liver flush,”

      Which one?

      I assume since you linked to CureZone it was oil combined with something acidic. A procedure that produces nice lumps in your feces, making you think you are getting rid of gallstones.

      But you are not. It has been addressed here before:
      http://www.sciencebasedmedicine.org/would-you-like-a-liver-flush-with-that-colon-cleanse/

      By the way, being an engineer provides no added stature. I can say that because I am also an engineer, but I know my limitations. There is no way I would debate any of the medical health professionals (and lawyer) here on their areas of expertise as anything but an interested party. I also know full well that they most likely do not have the in depth knowledge of eigenvalues, eigenvectors, Euler’s equation and Fourier Transforms that I possess. This should help explain Dr. Crislip’s response to your comment.

      Oh, and I am not happy that some engineers have decided that they have special knowledge just because they are engineers. One in particular, Andy Cutler, has made my life with a disabled kid more difficult because he thinks as a chemical engineer he can decide that thimerosal in vaccines is dangerous. Erg. And he is only one of many that annoy me (some of the worst are computer engineers, including one who thinks homeopathy cured her kid’s autism… which was never diagnosed by anyone but herself!).

      1. MadisonMD says:

        I’m not an engineer. But I imagine that an engineer with sense–like Chris or Windriven– would actually try to develop the following approach to remove stones blocking a bile duct:

        -make a long flexible tube with light/camera on the end, as well as devices to inject contrast and to make precise cuts.
        -pass this tube through the mouth of a sedated patient
        -pass the tube carefully through stomach to the place where the bile duct drains into the intestine
        -squirt some contrast dye into the bile duct, and image with Xray to see if there are stones in the duct or any other source of blockage (e.g. tumor)
        -If there are stones, make small incision in the ampulla of the duct to allow them to pass.

        This would be cool, right? Well, it exists. This tool was developed progressively since 1968 by biomedical engineers in cooperation with doctors. If you show up at your local ER with a bile duct blockage, a specialist will be able to relieve that blockage. Its called ERCP.

        Because there are risks of ERCP, it’s important to know that the problem involves the biliary tree in the first place. Fortunately, this is readily possible noninvasively through physical diagnosis, blood tests, and ultrasound or CT scan.

        Drinking a liver ‘flush’ is an obvious humbug. How would it even get into through a one-way valve and into a blocked duct? If it did get in there, what would it do? It’s akin to pouring lemonade into your sink to relieve a clogged dishwasher drain.

        1. Chris says:

          Actually when I was in college some of the folks in the building where I was lab technician* were working on ultrasound to break up kidney stones. I assume something like that at a certain frequency can break up waxy gallstones.

          * A lab working in high end fluid dynamics. I sometimes made cuts into sheets of foil that would break a certain pressure, and was mostly a human graphics device. I took the large computer printouts and drew the plots of the data (it was the late 1970s).

          1. MadisonMD says:

            I’m familiar with lithotripsy for kidney stones– it is not a simple or benign procedure though. I hadn’t heard it being used for gallstones. But here’s what uptodate* says:

            Extracorporeal shock wave lithotripsy (ESWL) is widely used for kidney stones but has fallen out of favor for the treatment of gallbladder stones. Only a few centers worldwide continue to offer it. It uses shock waves to break gallstones into smaller fragments and “sand,” which can then be dissolved more easily with an oral bile acid pill.

            I imagine this has to do in part with anatomy. The kidney stones in the renal pelvis, relatively fixed structures close to your back. The gallbladder deeper to the skin, is less fixed. and is tucked under the liver which might be prone to trauma from high-power shock waves.

            Although it looks like lithotripsy was developed for gallstones, I’m not able to find any evidence that this was used for stones in the bile duct.

            *uptodate is a widely-used online medical reference with frequently updated articles with references, and written by experts in the topic.

            1. Chris says:

              Thanks for the updated information. I think I will try to prevent them by watching my diet to reduce cholesterol.

    5. Badly Shaved Monkey says:

      Elizabeth

      As an engineer, you would not be expected to know that the colour of faeces derives from stercobilin. Orange faeces do not not indicate biliary obstruction or gallstones, but altered gut transit rate, which changes the time available for processing of stercobilinogen in the bowel. Altered gut transit time may result from many causes. Abdominal pain may result from many causes.

      Absence of biliary flow causes clay-coloured stools.

      https://en.wikipedia.org/wiki/Stercobilin

      I don’t particularly wish to play qualification trumps, but my PhD and post-doc work were in gastroenterology. It’s not, however, qualifications that count in exchanges such as this, but the quality of understanding and the evidence.

    6. PMoran says:

      “Guess what : I do liver flush, and next day stool is beautiful dark chocolate and pain is gone.”

      Your negative investigations don’t entirely rule out tiny gallstones, but tiny gallstones are most unlikely to cause the changes you describe. Stones up to 5mm in diameter will normally pass out of the bile duct into the duodenum without any great problem.

      Also, if they cause pain, tiny gallstones will usually cause brief attacks of quite severe pain, most typically, and contrary to what most people think, centrally in the upper abdomen and often going through into the back.

      I have written on the flushes from a surgeon’s perspective.

      http://www.quackwatch.com/01QuackeryRelatedTopics/flushes.html

      This comments thus on liver stones: “However, stones within the small liver ducts are very rare, at least in Western communities, as might be expected because the bile produced by the liver is 5-10 times less concentrated than gallbladder bile.”

      Some flushes incorporate herbal products including Cascara or liquorice, They could affect the colour of your stool, but otherwise inducing intense gallbladder contraction with the typical flush could temporarily darken the stool through changing the concentration of and composition of bile salts.

      Many factors can influence or get to seem to influence what is from our perspective an as yet undiagnosed pain. Pain in that area is commonly musculoskeletal.

      These are some of the reasons why your experience is not going to carry much weight here.

      1. David Gorski says:

        Liver flushes are pure quackery. As I pointed out several years ago, what comes out from such “flushes” is entirely explainable through simple chemistry that has nothing to do with liver stones or gallstones being flushed away:

        http://www.sciencebasedmedicine.org/would-you-like-a-liver-flush-with-that-colon-cleanse/

  45. MadisonMD says:

    Absence of biliary flow causes clay-coloured stools.

    Absence of biliary flow also causes jaundice… which is rather difficult to miss.

    1. Badly Shaved Monkey says:

      Indeed.

      I’m not sure what inference our Polish engineer was trying to draw from having orange poo. It seemed that she was inferring something was wrong with her biliary system, whereas orange poo is perfectly consistent with a normal biliary system and merely implies a reduction in gut transit time, which may have many causes without having to invoke obscure hydraulic processes in the biliary system.

      She seems to have gone away.

      Off to strain her poo, perhaps. Possibly to look for the not-gallstones that Dr G cited in that linked article of his.

      Oh, well.

  46. Smitty says:

    I ran across this blog while looking for seriously credible evidence to convince my cousin to come back home from a cancer clinic in Tijuana while she can still have surgery and further treatment with a good or even decent outcome. Anyone willing to offer up advice?

  47. Smitty says:

    @Harriet – thank you. I read all of the blog post and comments and have forwarded a link to my cousin. Hopefully, this will help. I think I know her motivations to try this first being she lost her 45 year old son to pancreatic cancer, chemo and all that goes with it about 8 months ago, her daughter is extremely woo woo and pushy. Plus she has tongue cancer and is looking at having to have half of her tongue cut out and all the little ups and extras that go with it. I can understand why she would attempt/consider an easier way out since the SBM she is looking at would be a hard row to hoe.

  48. jill says:

    Carry on, please. I find myself consulting this blog now for every medical situation. We are reading and learning, you’re doing a great service. Carry on.

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