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What’s in a name?: NCCAM tries to polish a turd

turdpolish

What’s in a name? that which we call a rose
By any other name would smell as sweet;
So Romeo would, were he not Romeo call’d,
Retain that dear perfection which he owes
Without that title. Romeo, doff thy name,
And for that name which is no part of thee
Take all myself.

William Shakespeare, Romeo and Juliet, Act II, Scene 2

You can clean up a pig, put a ribbon on its tail, spray it with perfume, but it is still a pig.

You can paint a turd red, but it’s still a turd.

There’s a colloquial phrase commonly used to describe an effort to sell or promote something that is so inherently awful or at least so flawed as to be unsalvageable without either a radical rethinking or such a major overhaul that it would be impractical or impossible to do: Polishing a turd. In this, advocates of so-called “complementary and alternative medicine” (CAM) have been very successful. Mark Crislip, in his usual inimitable fashion, just reminded us why CAM is a turd that needs polishing. Unfortunately, on Friday, I learned that the National Center for Complementary and Alternative Medicine unveiled a proposal to help it be more efficient in polishing the turd that is CAM through the clever use of language, and it wants your feedback. There were lots of other things that happened over the last few days that tempted me to write about them that will likely have to appear over at my not-so-secret other blog, but this one caught my attention and held it, given that it goes to the very heart of the deceptive use of language that is at the heart of giving CAM the appearance of legitimacy. In this specific case, NCCAM wants a new name. Dr. Briggs wants to rename NCCAM the National Center for Research on Complementary and Integrative Health (NCRCI). (I have no idea why the abbreviation of the proposed new center name isn’t NCRCIH.) Here’s Dr. Briggs explaining the rationale for the proposal and urging feedback by June 6 at http://nccam.nih.gov/about/offices/od/comments. I urge you to watch the whole video, or at least read the transcript:

Thus does Dr. Briggs propose polishing the turd that is NCCAM.

The power of language in CAM

That we at the Science-Based Medicine blog aren’t exactly fans of NCCAM is not exactly a secret. So confident am I of this contention that I daresay that I speak for us all at SBM when I point out that NCCAM is a source of research funding that has been dedicated to pointless studies of quackery, “rebranding” science-based modalities, such as diet and exercise, as somehow being CAM, and “educational” grants clearly designed to promote CAM. After all, several of us have at various times called for its dismantling, with its potentially useful components (for example, the study of natural products pharmacology currently disguised as studying herbal medicines and supplements, to be absorbed back into various Institutes and Centers of the NIH more appropriate to study them.

A couple of years ago, in response to Dr. Briggs’ discussing the same matter, albeit without the discussion of a potential name change, I asked a simple question with respect to NCCAM: What’s in a word? In fact, I asked that question in response to the very first blog post that Dr. Briggs wrote, in which she welcomed readers to the new NCCAM researchblog and, more importantly (and tellingly), her second post “Integrative — What’s in a Word?” At the time, I thought it was a very good question, albeit not in the way that Dr. Briggs intended. The reason was that advocates of so-called “complementary and alternative medicine” (CAM), despite having been the ones to have coined the term in order to soften the negative connotation of the word “alternative” applied to medicine, are no longer happy with the term “CAM.” Indeed, government entities being government entities and tending to move slowly, I’m only surprised that it took NCCAM so long to want to change its name to be more in line with the new, hipper thinking (if you can call it that) that says that there’s nothing “alternative” in CAM. If we’re to believe CAM advocates, CAM involves it’s “integrating” only the good stuff from CAM, the stuff that allegedly can be proven scientifically. Never mind that much of it is what Dr. Crislip called type 1 CAM: pure fantasy, which might be useful if CAM practitioners could admit that the only studies such modalities are useful for is to demonstrate the noise inherent in the clinical trial process and to measure placebo effects, which have, not surprisingly, been “rebranded” as “powerful mind-body effects.”

So let’s take a look at Dr. Briggs’ justification for this proposed name change. In it, you will see the misuse of language, the clever verbal prestidigitation, that underlies so much of CAM. I don’t think that Dr. Briggs’ is doing this intentionally, but, after six years at the helm of NCCAM, she seems to have imbibed deeply of the culture of CAM and its chosen word use that it’s now second nature to her:

Today, I’m asking for your input regarding the name of our Center. In the 16 years since NCCAM was established, we have funded more than 3,800 research projects examining the safety, efficacy, and use of a very wide array of interventions and practices with origins outside mainstream medicine. At the same time, large population-based surveys have reinforced the fact that the use of true alternative medicine—that is, the use of unproven practices in place of treatments we know to be safe and effective—that that is rare. Also during this time, the field of research has progressed, and a much more defined set of research opportunities has emerged. We see the growth of integrative health care within communities across the US, including hospitals, hospices, and military health facilities. With these changes in the research and practice landscape, we believe that our current name no longer accurately reflects our Congressional mandate, which is, in part, to study the integration of these practices as a complement to conventional care.

We also recognize that our current name is not explicit about our research mission, and that it may be misconstrued as advocacy or promotion of unproven practices.

And so, we are proposing that the name of our Center be changed to “NATIONAL CENTER FOR RESEARCH ON COMPLEMENTARY AND INTEGRATIVE HEALTH.” The goal of this change is to better align the Center’s name with the evolution in health care and our research focus, and thus best address our Congressional mandate.

I don’t know whether Dr. Briggs knows it or not, but this is the very same rationale that’s been used since time immemorial (or at least over the last 30 years or so that has seen the rise of CAM and quackademic medicine) every time a name change for “alternative” medicine has been proposed. As I once put it in far more detail three years ago, once upon a time—maybe three decades ago—there was quackery. Physicians, actually caring about prior plausibility based on basic science considerations, intuitively “grokking” Bayesian thinking without necessarily having had any formal training in it, recognized that modalities such as homeopathy, reflexology, and various “energy healing” methodologies were based on a combination of prescientific vitalism, magical thinking, and/or science that was incorrect, distorted, misunderstood, or misrepresented. Physicians weren’t afraid to call a quackery quackery, quacks quacks, and charlatans charlatans. The first step for advocates to change this perception clearly involved language.

Arguably, the first ill-fated attempt to change the language landscape of quackery was to start referring to it as “alternative medicine,” medicine that was (and still is) medicine that does not fit into the current scientific paradigm, a term used to describe medical practices not supported by science and evidence, and were used instead of effective therapies. As Dr. Crislip reminded us just last Friday, there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. “Alternative medicine” was not a rubric that could long stand, at least not in a form that would ever gain credibility in mainstream medicine.

Thus was born, around 20 or 25 years ago, the term “complementary and alternative medicine” (CAM). The arguments used for the name change were virtually identical to those that Dr. Briggs is using in favor of her name change: Almost no one uses alternative medicine instead of science-based medicine, thus making it not “alternative.” That’s the very reason why the word “complementary” was added to the term “alternative medicine” in the first place. Alternative medicine would “complement” conventional medicine, not replace it! As before, CAM was (and is) medicine that does not fit into the current scientific paradigm, including treatments that are not supported by evidence and are ineffective and/or potentially harmful. The difference? As the name implied, CAM therapies are used in addition to rather than instead of real medicine. Over a relatively brief period of time, the name change had its intended effect. No longer did many physicians automatically view modalities that were once considered quackery, later considered “alternative,” and now considered “CAM” as quackery, and those that still did were dismissed as close-minded, stubborn, and dogmatic, relics who were trying to swim against the coming wave of wonderful CAM magic.

Into this world, with this then-new nomenclature in ascendance, the precursor office to NCCAM, the Office of Alternative Medicine (OAM), was reborn as a full center, the National Center for Complementary and Alternative Medicine, with an abbreviation almost as pithy as “CAM,” namely NCCAM. That name has endured for 16 years. Ironically, the name has endured as CAM has moved on. The reason CAM has moved on, with the word “CAM” increasingly being shunned by its former advocates, is simple. The word “alternative” is still there. The very name of CAM still implies that its treatment modalities will forever be considered not quite right, not quite in the mainstream, not quite “real” medicine. At the very least, the word “complementary” implies that CAM is not the real medicine, that it only “complements” real medicine. Medicine was the cake, and their wares were just the icing. That this is simultaneously both a correct and incorrect perception—most CAM is not real medicine, but it also “complements” nothing—is irrelevant to CAM advocates. They believe; so they want a name that eliminates that inference. They craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine.

Thus was born the term “integrative medicine.” The term “integrative medicine” (IM) served their purpose perfectly. No longer were CAM/IM treatments merely “complementary” to real medicine. Now they were “integrating” their treatments with those of science- and evidence-based medicine! The implication, the very, very, very intentional implication, was that alternative medicine was co-equal to science- and evidence-based medicine, an equal partner in the “integrating.”

As I said before, I’m only surprised that it took the NCCAM Advisory Board and Dr. Briggs so long to decide that a name change is in order for NCCAM.

Polishing the turd to a high gloss

Of course, the appeal to “integrative” health and denial that anyone uses CAM instead of real medicine are not the only arguments that Dr. Briggs uses. She also uses the logical fallacy known as argumentum ad populum, the appeal to popularity, which argues in essence that because something it popular there must be something to it. In this case, in addition to the claim that CAM is not “alternative,” Dr. Briggs is arguing that the popularity of CAM justifies the name change, in which “we see the growth of integrative health care within communities across the US, including hospitals, hospices, and military health facilities.” Even if true (and, unfortunately, the infiltration of quackademic medicine into both medical academia and community hospitals like so much kudzu is a fact), how that justifies a name change, I don’t know, but apparently to Dr. Briggs it does.

The other point that Dr. Briggs makes that caught my attention was her statement that “the field of research has progressed, and a much more defined set of research opportunities has emerged.” When I heard her utter that phrase, I started thinking. What on earth was she talking about? NCCAM has a hard time even defining what “CAM” is, which makes me wonder how the definition of its mission will change when the term “CAM” is no longer even part of its name. First, let’s look at NCCAM’s definition of CAM:

Defining CAM is difficult, because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted.

“Complementary medicine” refers to use of CAM together with conventional medicine, such as using acupuncture in addition to usual care to help lessen pain.

Can any of you tell from this what practices would and would not be CAM? I can’t, other than that by this standard certain things that are considered CAM shouldn’t be, such as diet and exercise, as well as herbal medicine, the latter of which is, as I’ve repeated more times than I can remember, nothing more than the old and respected branch of pharmacology known as pharmacognosy, or natural products pharmacology. NCCAM further divides CAM into these five categories:

  1. Alternative medical systems: Complete systems outside of mainstream medicine based on concepts that vary widely depending on the whole medical system. Includes: Homeopathy, traditional Chinese medicine, Ayurvedic medicine, Native American medicine, naturopathy.
  2. Mind-body interventions: Influencing physiology through influencing the mind. Includes: Meditation, yoga, guided imagery, deep breathing exercises, progressive relaxation, and tai chi.
  3. Biologically-based treatments: Use of substances found in nature, including diet. Includes: Herbal medicines, dietary supplements, probiotics, nutrition and diet manipulation.
  4. Manipulative and body-based methods: Manipulation of musculoskeletal structures to affect physiology. Includes: Osteopathy, chiropractic, craniosacral therapy, massage therapy.
  5. Energy therapies: Manipulation of “life energy” fields, sometimes called “biofields.” Includes: Therapeutic touch, reflexology, rolfing, reiki, acupuncture, qi gong.

Lifestyle interventions, such as exercise, clearly fall under “mind-body” while diet and natural products clearly fall under biologically based therapies. Yet all of these can be and, when not infused with CAM magic, are science-based. There is no need for a separate “complementary,” “alternative,” or “integrative” category to account for them. Doing so does nothing other than ghettoize these modalities by making them seem less than respectable because they’ve become associated with pseudoscience. Of course, one thing I noticed while doing the web research for this post is that it’s actually hard to find a table of CAM subtypes on the actual NCCAM website, although lists and tables are common elsewhere. The most recent CAM Basics brochure from NCCAM lists only natural products, mind and body medicine, and manipulative and body-based practices, while relegating energy therapies and alternative medical systems to “other.”

To be honest, I fail to see what Dr. Briggs means when she says that “a much more defined set of research opportunities has emerged.” The snarky skeptic in me can’t help but wonder whether this “much more defined set of research opportunities” came about as NCCAM was so continually embarrassed over the years because of its funding of studies into what can only be described as magic and mysticism, such as homeopathy, reiki, therapeutic touch, and distance healing that under Dr. Briggs’ leadership the most blatant of these have been (mostly) discarded. As I put it when discussing the recent five-year strategic plan for NCCAM for 2011 through 2015, this amounts to saying, “Let’s do some real science for a change!” In other words, let’s concentrate on modalities like diet, pharmacognosy (excuse me, herbal medicine and supplements), and exercise, where we might actually find something, rather than on type 1 CAM like energy medicine, which even CAM practitioners at some level seem to recognize as pure fantasy and magical thinking. Of course, if that’s what NCCAM does, then the need for NCCAM disappears, because there is nothing inherent in any of these things that requires a separate center or institute within the NIH to study it. NCCAM was created through Senator Tom Harkin’s (D-IA) efforts to study magic like energy medicine, not mundane, science-based interventions that have been “rebranded.”

Finally, Dr. Briggs claims that the proposed name change is necessary because NCCAM’s current name “may be misconstrued as advocacy or promotion of unproven practices.” The problem is that there is nothing “misconstrued” here. NCCAM has promoted unproven practices, particularly through educational grants to teach CAM, the teaching of which is almost always done not in a science-based fashion but in a credulous fashion that assumes CAM works. Indeed, it was an NCCAM grant that funded the initial effort to “integrate” such credulous CAM education into the standard medical school curriculum at Georgetown and other medical schools, even up to encouraging the partnering of real medical schools with schools of naturopathy.

No doubt this “rebranding” of NCCAM is intended as the first step in developing its next five-year strategic plan for 2016 to 2020. After all, the current NCCAM five year plan has only a year and a half left to go.

So what should we call NCCAM, anyway?

I was half-tempted to make this post about proposing names for NCCAM that would be better than the proposed new name National Center for Research on Complementary and Integrative Health. While the proposed name is a perfect example of the move away from acknowledging anything “alternative” or less-than-evidence-based about CAM, it does not describe what NCCAM really is about, whether its director and the officials who run it will acknowledge it or not. Observing some discussions where this has come up, I’ve seen proposed names such as the National Center for Research on Supplements, Complementary and Alternative Medicines (SCAMs), the National Center for Research on Tooth Fairy Medicine (I like this one), National Center for Research on Snake Oil and Science Denial, National Center for Unprovable Therapies, and National Center for More Research is Needed (I would suggest a slight alteration to this one to National Center for More Research Is Always Needed). Personally, I like Harriet Hall’s suggestion, seen on the HealthFraud mailing list, of Center for Studying Things Scientists Wouldn’t Otherwise Bother Studying. I don’t mind if you try to outdo these suggestions in the comments, but let’s not do just that. NCCAM, unfortunately, isn’t going anywhere any time soon, so I urge all SBM readers to head on over to the link for public comments regarding the proposed name change and submit your thoughts to Dr. Briggs. Feel free to cite this post. Remember, you only have until June 6.

The bottom line, however, is that it really doesn’t matter that much what NCCAM is called. Sure, removing “alternative” and adding “integrative” somewhere in the name might make it less offensive to its stakeholders, the alternative medicine practitioners whose purpose it serves, and more palatable for a different reason to science-based physicians, but unless the underlying mission and structure are changed radically, it’ll just be putting lipstick on a pig or polishing a turd, or whatever metaphor you like for trying to make something that is fundamentally flawed beyond easy redemption seem attractive.

Speaking of polishing a turd, Adam Savage and Jamie Hyneman once demonstrated on their most excellent television show MythBusters that it is indeed possible to polish a turd to a high gloss. However, doing so takes a lot of work:

Basically, polishing a turd requires breaking the turd down into a slurry, completely remolding it into a sphere, and letting it dry, followed by many hours of constant buffing. The current leadership of NCCAM appears not to want to go that far, which, if we carry the metaphor a bit further, would involve actually breaking NCCAM down to the proverbial slurry and reforming it, something that is highly unlikely to happen. Until the day that NCCAM is either completely rethought on a basis of science informed by prior plausibility that would eliminate completely the magic or dismantled, there’s nothing to do except polish the turd to a brighter sheen and hope no one notices the smell.

Posted in: Clinical Trials, Medical Academia, Politics and Regulation

Leave a Comment (138) ↓

138 thoughts on “What’s in a name?: NCCAM tries to polish a turd

  1. Posephine Gribbs says:

    This greedy bullshitter is just trying to sound relevant so she can keep her paycheck. Whatta bench hole.

  2. Jeff Rubinoff says:

    Today I read again the Voltaire quote “The art of medicine consists of amusing the patient while nature cures the disease.” This was certainly true in Voltaire’s day. While mainstream medicine now is able actually to do something (often) , we could argue that CAM has carried on this older tradition.
    Therefore, I propose that NCCAM rename itself the National Center for Research on Amusing Patients, or NCRAP.

    1. Renate says:

      I love that one.
      I wish I could come up with something forming the acronym DUCK, or QUACK.

      1. Young CC Prof says:

        Best I can do for QUACK is: Quarters of Unproven, Alternative and Complementary Knowledge. Not quite satisfied with that one.

        TURD: Totally Useless Research Dollars

        DUCK: Disproven and Unproven Cure Kit (I want to put that on one of those homeopathic first aid kits)

        1. cloudskimmer says:

          Quest for Unproven Alternative Complimentary Knowledge?

          1. Young CC Prof says:

            Perfect!

    2. Frederick says:

      NCRAP, And all this from Voltaire’s Quote, wow I’m Mind blown ! :)

  3. Gary Layng says:

    I vote for naming it after an august member of the Quackaverse: the Lendon H. Smith Centre for Alternative Medicine Studies, or S.C.A.M.S.

    Some details on the late Dr. Smith are here:
    http://www.quackwatch.com/04ConsumerEducation/lendonsmith.html

  4. Laurenak says:

    To continue Dr Gorski’s metaphor, I propose:
    National Centre of Terribly Unscientific Ridiculous Deceptions (NCTURD)

    Also for Renate:
    National Centre for the Distribution of Unscientific Crap and Kookiness (NCDUCK)
    National Centre for Quarrelsome Unscientific Abominable Charlatans and Kooks (NCQUACK)
    :)

    1. Frederick says:

      NCTURD lol, nice one too, it reminds me of the American dad : Tactical Urban Response Division lol.

  5. Tazia Stagg says:

    Thanks for presenting this. If I had heard about the name change independently I probably would have interpreted it as a step in the right direction, instead of thinking carefully about it.

    After reading the transcript of her video, I’m curious about what the Congressional mandate says (but not enough to look it up) and how she defines rare.

    I imagine that if our healthcare system were adequate, there would be less unmet need, and less perceived unmet need, and therefore less demand for quackery.

  6. Perrianne Lurie says:

    By all means, coment. My suggestion was the “Center for Quackery and Pseudoscience.”

  7. rork says:

    National Center for the Study of Highly Implausible Techniques.

    PS: Check out “our own” Andrey Pavlov letting them have it last fall:
    http://nccam.nih.gov/research/blog/perspectives
    Outstanding public service.

    1. MTDoc says:

      I agree. Excellent discussion and thank you for the link. Is that a morel you are holding?

      1. Andrey Pavlov says:

        @MTDoc:

        I agree. Excellent discussion and thank you for the link.

        And thank you for the kind words.

    2. Serge says:

      Thanks for that link. I always love hearing Andrey’s responses. Would that I were so eloquent!

      1. Andrey Pavlov says:

        @serge:

        I always love hearing Andrey’s responses. Would that I were so eloquent!

        You are much too kind, thank you!

    3. Andrey Pavlov says:

      @rork:

      PS: Check out “our own” Andrey Pavlov letting them have it last fall:
      http://nccam.nih.gov/research/blog/perspectives
      Outstanding public service.

      Much too kind and thank you for the shout out. I do try and venture out, so to speak, in an effort to expand the SBM sphere of influence as well as offer an opportunity to have those outside of what Peter Moran calls our groupthink offer a reasonable challenge to my thoughts.

  8. Cervantes says:

    Too easy. National Center for Research on Absurd Practices, NCRAP.

  9. Eugenie Mielczarek says:

    Unfortunately changing the name of the center will not solve the problem. The only solution to stem this waste of scarce federal will be to dismantle NCCAM and transfer its funds to another Center. The National Institute of Aging would be the best good choice. Its staff is familiar with the problems of Alzheimer’s and how seniors fall prey to marketing of Non-evidenced Based Medicine. The staff of NCCAM who do not hold degrees in science from recognized universities and /or are not graduates of medical schools should be given early retirement . Obviously their and Dr. Briggs’, philosophy will not change. She and her staff could easily find employment within the commercial alternative medicine industry.

  10. goodnightirene says:

    Can they not say “TURD” on the Mythbusters channel? “Poop” just doesn’t have the same punch.

  11. Etatro says:

    Tazia – the Office of Alternative Medicine was created in the National Institutes of Health Revitalization Act of 1993. A lot of IC’s were expanded and altered in that act, which, I believe began the so called doubling phase, and also created other offices like minority/women, research integrity, etc. I think if you’re a researcher getting NIH funds, it be behooves you to know the history of your IC. (Eg, why is NI on Alcoholism separate from NI Drug Abuse?). The OAM expanded into NCCAM in its current form through various new budget and spending reauthorizations, whose history you can follow if so inclined. The original bill is here. The site lists Ted Kennedy as its sponsor https://www.govtrack.us/congress/bills/103/s1/text.

    1. David Gorski says:

      Although it’s more than a decade old, I find Wally Sampson’s discussion of the history of NCCAM more informative:

      http://www.quackwatch.org/01QuackeryRelatedTopics/nccam.html

      It didn’t occur to me that the year that OAM was elevated to a full center within the NIH and renamed NCCAM corresponded with the first year of the five year doubling of the NIH budget that occurred from FY 1998 and 2003.

      1. Etatro says:

        Thanks!

    2. Angora Rabbit says:

      “(Eg, why is NI on Alcoholism separate from NI Drug Abuse?)”

      I can actually answer this. NIDA’s focus is on the negatives of addictive drugs. While NIAAA’s title encompasses “Alcoholism and Alcohol Abuse” or visa versa, the mission is also very interested in benefits of ethanol exposure, such as the ability to reduce CVD at moderate intakes. The mission acknowledges that there are benefits to alcohol use. It also acknowledges that alcohol has many effects distinct from addiction, for example its impact on liver, bone, or fetal development. NIDA emphasizes addiction and brain. Several years ago there was discussion of formal merger, which thank goodness was nixed as short-sighted bean-counting and missing the complexities of the two missions. If the merger had gone thru, those other portfolios would have vanished or merged into other institutes, and then vanished into them. Part of the rationale for having an institute is to show political commitment (in the loose sense of the word).

      I say this as a NIAAA recipient, so watched this ringside.

      1. Etatro says:

        And I am NIDA recipient…. Agree It was an interesting debate to watch (I am too low on the totem pole to have any influence), though I am concerned that brain pathways & genetic variants re addictive behavior in general, which overlap among “drug” abuse, alcoholism, and behavior (eg gambling), doesn’t have a logical home at any particular IC that I can think of. Many psychiatrists are even afraid of the word addiction, favoring substance use disorder (blame the DSM). Just a minor quibble. Perhaps the BRAIN initiative will help here.

        1. Angora Rabbit says:

          Cool! I completely agree about the need for increased interaction between institutes, which I think you are arguing for. It doesn’t make a great deal of sense, sometimes, how portfolios are created and to which institute a proposal will be plucked and sent to. The PIs can influence this but as you know it is not always an obvious choice, at least from the outside. One of the nice things about the failed merger was the agreement that there needs to be more coordination between NIDA and NIAAA specfiically, and hopefully expanded to other areas of addiction research as well. I’m not the first to notice that many of those same pathways also contribute to appetite and control of food intake, for example.

          Cheers!

  12. WilliamLawrenceUtridge says:

    The National Centre for Medical Research Waste

  13. RectoFossa says:

    While you can’t polish a turd you sure can roll it in glitter…

  14. Gregor Samsa says:

    A quack is immediately branded as such when using the word “allopathic”

  15. In 2014, Quack Medicine is a medicine or procedure that does have a benefit as predicted, as out lined by the person selling the medicine! A Quack is someone who keeps telling me that his drug works despite all the evidence presented.

    I’m on the front-lines of healthcare in family medicine in a solo practice. Over the decades I’ve been seeing more and more cases of polypharmacy, failed standard of care protocols, failed orthopedic and neurologic surgeries, ineffective medications, bizarre rules and regulations get in the way of patient’s health and wellness.

    The upstream decision makers seem to be oblivious to the distress calls we downstream have sent out. In my desperation to help these failed cases and patients, I have concluded that there is something wrong with our present system of healthcare and some CAMs are remarkable effective.

    The problems of both disciplines are deeply rooted in the business of medicine and healthcare where profits are the goal and not the wellbeing of people. The turf battles are only about profits and not people. To win more profits, the truth has to be undermined and distorted.

    There are some truths in both — Where are these truths???

    The human body can automatically heal without human intervention in the majority of cases.
    Proactive and preventive care, education, wellness, and a reasonable healthy lifestyles saves money and lives.
    Exercise, yoga, jogging, stretching, stress management and a good night’s sleep will also save lives and money.
    Mental health services will save lives and money.
    Curtailing advertisements direct to consumers will save lives and money.
    No lies or distortion from any the healthcare industry officials.
    Verify studies with repeated studies and have long-term data collections to review prior conclusions.
    Adopt effective full spectrum physical therapy will help to restore neuromuscular and skeletal problems which will decrease the need for ordering expensive high-tech MRIs, Nerve Studies, CT Scans, polypharmacy, joint replacement and back surgeries.

    What is Physical Therapy?? (This is going to ruffle some feathers!)
    Thanks to a rare find by C. Chan Gunn, MD, who uncovered a profound biological truth in the world of chronic pain, myofascial pain and dysfunction and the ancient discipline of Traditional Acupuncture. He wondered why chronic pain patients failed the standard of care options and even intensive PT. In these cases, the muscles viciously autonomously contract to “lock out” movement, corrupt joint functions, compress nerves and vessels to cause odd dysfunctions. He was able to linked or bind the old types of Physical Therapy to modern day vetted procedures of needling and injection therapies.

    Cannons’ Law of muscle depolarization is a neuro-chemical-electrical metabolic function that can release a tight stubborn muscle, relax and allow healing to be more effective. All it takes is a metallic wire, any size or shape as long as it will conduct electricity. With this concept you can now understand how Acupuncture might work and then extrapolate this concept into the world of modern medicine.

    So now one can visualize PT on a spectrum; Self care. wellness, magnesium, simple stretching, yoga, massage, Rolfing, Active Tissue Release, Myofascial Unwinding and Chiropractic adjustments.

    If needed, step up to Acupuncture and all of the various types, Gunn-Intramuscular Stimulation, Travell/Simon’s wet/dry needling to finally Neural-Injections, Bio-Puncture, Hackett’s Prolotherapy and other hypodermic needling.

    1. Tazia Stagg says:

      (in response to the only part I did read)
      Some worthwhile preventive services save money and some do not.

      1. What is your point!?

        Some traditional medical standard of care protocols work and some don’t!

        Why disparage/disavow/impugn/cherry pick one and not the other?? What is your motivation and intentions?

        My motivation is to find what works, use it and discontinue what doesn’t!

        Too bad you did not read the entire few paragraphs, it’s loaded are some gems.

    2. Lytrigian says:

      The long-term track record for phenomena which only one researcher is even able to identify and reproduce, let alone research is, to put it mildly, not good.

      1. Yes the track record of one should be questioned.

        If you want you can go on the Amer. Acad. Medical Acup, prolotherapy, neural therapy, Gunn-IMS, biopuncture sites and find a wealth of data and track records.

        Please Do take my word for it!

        1. Lytrigian says:

          “Please Do take my word for it!”

          Um. No.

          1. And apparently you are not taking the initiative to look further either.

            I’m waiting on someone to break free from this dogma spell and venture out into reality.

            1. Lytrigian says:

              It has become evident that you suffer from a significant language barrier, and do not understand either much of what you say, or much of what is said to you. When you invited me to “take your word for it”, you were using an expression that means you DON’T want me to investigate. that you want me to simply believe you without looking any further at all.

              As I’ve explained to you in the past, I’ve already investigated this, and I’ve already looked into Gunn’s ideas. They’re not particularly convincing.

            2. Windriven says:

              “I’m waiting on someone to break free from this dogma spell”

              And you know what Steve, we’re waiting for the same thing. You cling to a failed, hidebound superstition. In fact, speaking only for myself, I’m waiting on pins and needles!

              1. Cute. I actually want to use that idea.
                “Don’t wait on pins and needles and get stuck without Acupuncture! Go today!
                :) I like that one!

    3. WilliamLawrenceUtridge says:

      In 2014, Quack Medicine is a medicine or procedure that does have a benefit as predicted, as out lined by the person selling the medicine! A Quack is someone who keeps telling me that his drug works despite all the evidence presented.

      No, quack medicine is medicine that isn’t proven to work but is still sold by the unethical. Your second sentence is correct, but replace “drug” with “supplement or physical intervention”, that way it accurately incorporates accupuncture and chiropractic as well.

      I’m on the front-lines of healthcare in family medicine in a solo practice. Over the decades I’ve been seeing more and more cases of polypharmacy, failed standard of care protocols, failed orthopedic and neurologic surgeries, ineffective medications, bizarre rules and regulations get in the way of patient’s health and wellness.

      My god, it’s almost like you practice medical care in a country with an aging, wealthy population that lacks a federal health care system and overall standard of care where patients place more emphasis on pills and interventions than they do on basic medical care.

      I have concluded that there is something wrong with our present system of healthcare

      Well stop the presses, because nobody else has apparently realized that. Except for anybody who has ever had the slightest interest in US health care. Rather than treating patients, you could do a lot more good advocating for a public health care option.

      and some CAMs are remarkable effective.

      Then how come when tested in clinical trials they consistently fail to show any benefit?

      Also, any CAMs that are proven to work are adopted by real medicine. So really what you’re asking for is an unfair double-standard that supports your livelihood.

      Also, your list of “truths” are not really important, insightful or special – they are well-recognized. What you’re doing here is bait-and-switch, you mouth these reasonable things while your real agenda includes shoving significant amounts of unproven modalities into patient care because, despite the evidence to the contrary you think they work. This is called “confirmation bias”.

      If Gunn’s clinical entities exist, then it should be easy to demonstrate this fact. What a shame nobody has done so yet. If they had, then we could have thousands, or millions of patients benefiting rather than the bare handful that you work your alleged miracles on.

      1. To anyone outside of this site, your augment is moot.

        You refuse to venture outside of your comfort zone and that is not a good habit for a scientist.

        http://www.uwmedicine.org/health-library/Pages/gunn-ims-intramuscular-treatment.aspx

        1. Windriven says:

          “To anyone outside of this site, your augment is moot.”

          If it is an argument it is, by definition, moot. But in this instance the point is only arguable in the minds of the hopelessly credulous. That would be a sphere with which you have some familiarity.

  16. Frederick says:

    It’s obvious that their only concern is to keep the mill running, to keep their funding. All the cash lost in there could return to taxer payers, or better injected in real sound science, even not medical science! NASA could use more, any real science research will have been 100time more useful than this.
    I can’t think of a Acronym. I’m not good at this :-)

    1. Jeffrey Rubinoff says:

      The humanities would be a better recipient of this money than NCCAM.

  17. brewandferment says:

    National Center for Researching Anomalous Peculiarities (NCRAP)

  18. Lytrigian says:

    I wonder if freeze-drying would be a good alternative to Mythbusters’ method of pre-turd-polishing preparation.

    And you can also simply dry a turd in the sun and then apply a few coats of spray varnish, which would do almost as well, I’d think.

    1. Windriven says:

      I have the necessary equipment including a large dog to furnish the requisite turdage. But I fear I’d never get the stink out of my vacuum system.

      But you have given me a BRILLIANT idea: freeze dried homeopathic remedies!!!! Just add water ;->

      1. Lytrigian says:

        “Sure, we may charge as much as for a full homeopathic preparation, but it’s concentrated! One vial of Windriven’s Condensed is the same as 10 vials of an ordinary 30X preparation! Try it today!”

  19. Echo says:

    I say keep the acronym NCCAM and call it the National Center for Crapping Away Money. That’s what happened to me, anyway. I’m a woo survivor. Lots of money wasted on acupuncture. Added bonus – potential money saved on letterhead, logo design, t-shirts, mugs – you name it!

    1. DevoutCatalyst says:

      If it were up to me, the winner is YOU.

  20. THeo Howard says:

    I would have to disagree with you. I agree that medicine that is not effective or deleterious should be discarded. However, not all things that are CAM are not effective; some of it needs more research to determine if and when it is appropriate. For instance, mindfulness meditation is a complimentary approach, and within its scope, it is effective at relieving stress, managing pain etc. Will it cure cancer? Highly doubtful. Does regularly swimming in a cool swimming pool help people with MS stay active and healthy? Maybe not conclusively, but most of the little evidence supports it. Does swimming in a pool involve drugs or surgery? No, thus it is a CAM, depending on how rigid one’s definition of medicine is. I am all for doing away with ineffective therapies, but not all healthy therapies happen inside a doctors office or hospital, and CAM can be a horizon for useful research. Additionally, patient-centered finding ways for people to actively contribute to their own health in positive ways helps people take control of their bodies.

    1. Harriet Hall says:

      “patient-centered finding ways for people to actively contribute to their own health in positive ways helps people take control of their bodies.”

      Yes, and we don’t meed CAM for that.

      1. David Gorski says:

        Exactly. That stuff, if it is validated scientifically, becomes no longer CAM. It isn’t “alternative” anymore because by definition alternative means unproven. As for “complementary,” you don’t need a separate category for science-based modalities; they’re just part of the treatment regimen. The only way something can “complement” medicine is if it’s not part of real medicine.

        Science-based medicine doesn’t just include drugs and surgery. That’s just a straw man version of SBM that CAM advocates promote.

        1. @Groski
          You have not been to a continuing education event in a while!
          They are all about pharmaceuticals and establishing a rigid standard of care protocol that funnels everyone into a specialist or surgeon’s office.

          NO talk of alternatives options which is a conflict of interest and malpractice.

          NO talk of getting into legislative realms to improve diets, lifestyles, nutritions, activity, mental healths, the court systems which are at the root of poor health.

          This site is weird in that the definitions of words and topics are so narrowly viewed that they are useless to society as a whole. Example “validated scientifically” ???!!! How is that going to factor in common sense, person responsibility, free will and a cutthroat free market?

          Deception is the name of the game here!

          1. David Gorski says:

            You have not been to a continuing education event in a while!

            You really think so?

            Funny, but I was just at the American Association for Cancer Research meeting in San Diego in April, and I’m going to be attending the American Society of Clinical Oncology (ASCO) meeting in Chicago at the end of May. Oh, and I go to CME conferences pretty much every week held right at my cancer center, the hospital complex that surrounds it, and the medical school affiliated with it.

            1. How often do they cover CAMs?
              Who funds most of the research in the US?
              Why are we settling therapeutic options from faulty research and data?
              Why are the opinions and observations of real world providers trashed?

              Being on the front lines of cancer and surgery you must understand the significance and dangers of a rote or mechanical therapeutic option. Why would an intelligent scientist allow such complex biology to be distilled into a yes or no situation?

    2. Lytrigian says:

      Does swimming in a pool involve drugs or surgery? No, thus it is a CAM, depending on how rigid one’s definition of medicine is.

      There’s nothing “alternative” about exercise.

      1. Sean Duggan says:

        I dunno about that… it’s about as far out of the mainstream as “alternative music”. :-P

        1. Lytrigian says:

          Wait a sec. I need my “hipster glasses” for this…

      2. WilliamLawrenceUtridge says:

        Also nothing “alternative” about relaxation, and it’s a valid question whether meditation adds anything beyond simply sitting down with a good book or sympohony for an equivalent amount of time.

        The real rigidity is Mr. Howard’s assertion that mainstream medicine is solely drugs and surgery, as if doctors never reset a dislocated elbow, recommended diet and exercise changes, or simply talked to their patients. That kind of rigidity is what CAM wants to engender, that’s what CAM wants you to believe, because then they get a sweet little niche market carved out for themselves where they can take free things – like diet and exercise – and charge you money for it.

        Patients taking control of their own health doesn’t need to involve supplements, yoga or herbs, it simply needs patients to follow the conventional recommendations made by doctors for centuries. It’s been mainstream since Classical times, postdating at least homeopathy by over a milennia.

        But hey, keep swallowing that marketing hype, because at least you pay taxes on those overpriced supplements.

      3. @Theo Howard
        Thank YOU … a sane thought!!

        “rigid one’s definition”
        Rigid and bizarre definitions are what makes deceiving the public easier.

        I’m beginning to see clearly, these folks are angry and resentful that they have to pay for someone elses health care and issues. Duh this system is what we have!

        I’m going to Congress to make reasonable changes.

        1. WilliamLawrenceUtridge says:

          Rigid and bizarre definitions are what makes deceiving the public easier.

          That’s funny, because I think the nebulous terms and bizarre appeals to authority, age, popularity and false dilemmas that characterize CAM to be incredibly deceptive. You, yourself, Steve, keep insisting that acupuncture is not really what everyone claims it is – but you never provide an actual definition.

          I’m beginning to see clearly, these folks are angry and resentful that they have to pay for someone elses health care and issues. Duh this system is what we have!

          I don’t live in the US, I’m not angry about anything happening there, beyond the trite lies spread by CAM advocates.

          Also, perhaps you could consider changing the system you have rather than trying to shoehorn your preferred brand of quackery into the payment stream, you greedy wretch.

          1. “you greedy wretch”
            Without CAMs you are promoting a system that is exactly what you seen to be angry with.

            Not from the US? So that also proves the gullibility and blindly following a lost cause is a universal common genetic flaw.

            I’ve posted enough info here to research and study for a few months and since you have not asked any appropriately inquisitive questions, I will assume you have done no homework.

            That puts you in a group of followers who are just being used to deflect and distract. You are doing a good job.

            1. WilliamLawrenceUtridge says:

              Without CAMs you are promoting a system that is exactly what you seen to be angry with.

              CAM adds exactly nothing to the system. I am not angry with anything regarding the US health care system, I don’t live in the US, but I do feel sorry for its citizens. Did I live in the US, I would be angry about the lack of a public health care option. Unrelated to the system, the unwarranted support for CAM and its deluded or dishonest practitioners does annoy me.

              Taking a flawed system then forcing it to support a series of totally unnecessary, indeed harmful and wasteful practices, simply makes the system worse.

              you have not asked any appropriately inquisitive questions, I will assume you have done no homework.

              Why would I ask you any questions? The only interesting questions to me are “what research supports it”. Months back, you finally answered that question, and the “research” was opinion backed by little in terms of what matters – well-controlled trials converging on a single answer.

              Again – I looked at what you provided, but what you provided was garbage. Don’t play coy that we “didn’t ask the right questions”. Jesus, we’re not courting middle-schoolers. If you can’t be straightforward and clear, how can you ever help to convey a convincing point?

              Of course, you aren’t trying. You’re trying to insist your clinical experience outweighs all other concerns. It doesn’t. If clinical experience were an accurate guide to medical treatment, then bloodletting, knee cartilage debriedment, spinal fusion and acupuncture wouldn’t ever have been considered viable treatment options.

              Seriously – man up and admit you don’t have any evidence, you douche.

              That puts you in a group of followers who are just being used to deflect and distract. You are doing a good job.

              Again, this is a barely-disguised Pharma Shill Gambit. You’re saying that because you can’t refute my points, or support yours, that means I’m a paid shill for Pfizer or GSK or something. Wrong. You can’t support your points because they are based on a flawed overestimation of the importance of your opinion, and your deceptive clinical experience, and your ignorance of the scientific literature. It’s not my fault you can’t form a cogent factual or logical argument.

              1. I’m embarrassed for you.
                If you only had some clinical experience.
                :(

  21. David Westenkirchner says:

    Unbelievably, tomorrow morning at the American Thoracic Society Int’l conference there is a session entitled “The Case for Complementary Therapies.”

    1. WilliamLawrenceUtridge says:

      Did you attend? What case did they make? Infusing homeopathic preparations into banana bags?

      1. All CAMs are not equal and use the same options.

        Some are worthless and some are profound. Practice helps to clarify the truth.

        1. WilliamLawrenceUtridge says:

          All CAMs are not equal and use the same options.

          Some are worthless and some are profound. Practice helps to clarify the truth.

          All CAMs are unproven. Many are disproven. Research is what clarifies the truth, practice is based on experience and is therefore deceptive. You have a gross under-appreciation for just how flawed human cognition is. Again, priests, bloodletters, orthopedic surgeons, they all had equal certainty that their prayers, lancets and cartilage graters were effective – research proved them wrong. Research proves many of your claims wrong, but you aren’t even aware of that fact and you’re too arrogant in your certainty to even look for it.

          1. I am so glad you know these things with absolute certainty.

            Sorry what you know is only what you believe and that it totally uncertain = You are someone who has deceived by your own brain or you are just playing the roll of a front, pawn or minion.

            Expand your research parameters!

    2. @David Westenkirchner
      I’m from Indy and will be there this weekend if you would like to talk about what
      are the truths in CAMs. There are truths and there are deceptions as there are in traditional medicine.

      1. WilliamLawrenceUtridge says:

        As David appears to be a research-savvy medical professional disgusted with the presence of CAM at a scientific conference, I’m going to go out on a limb here and say he’s probably uninterested in anything that might come out of your mouth.

        1. There you go again being a pawn or subordinate of the “academics.”

          It will not be long before you will look back at this day and wonder why you were so shortsighted. I’m not here for me, I’m just a messenger. Get the references, talk or interview real people, walk into and observe a few alternative offices and formulate your own conclusions.

          Anything less on your part is just plain stubbornness.
          or
          If you are doing this for pay or reward — good job!

          1. WilliamLawrenceUtridge says:

            There you go again being a pawn or subordinate of the “academics.”

            So, what you’re saying is academics are only worthwhile if they confirm what you already believe? Science. You’re doing it wrong. Really, you’re not doing it at all.

            It will not be long before you will look back at this day and wonder why you were so shortsighted.

            Medicine must always walk a line between approving new, live-saving interventions in a timely manner, and holding back on approvals due to fears over waste or harm. In regards acupuncture, we are far, far past such a line. Millions of dollars have been expended just on research, to essentially no benefit. But it’s possible you are right. Time will tell I suppose, though time has not been kind to acupuncture so far.

            And again, rather than promoting this lucrative and satisfying part of your personal practice, you could spend time actually researching and publishing on it so more than just your patients could benefit (assuming you could even plan a scientifically-meaningful test – you seem like you’d be more of the “I took 10 people and gave them acupuncture and all got better” type).

            I’m not here for me, I’m just a messenger. Get the references, talk or interview real people, walk into and observe a few alternative offices and formulate your own conclusions.

            You’re not a messenger, you’re explicitly and apparently a promoter. A messenger conveys a message, you are unable to provide any research that would make your posts worth reading. You merely insist that your unsubstanitated assertsions, often based on the unsubstantiated assertions of others, are enough to revolutionize medicine. It’s not.

            My own uncontrolled observations would be just as unreliable as yours, or any other human’s, would be. That’s why I want expert-vetted controlled observations, to challenge my preconceptions and provide reliable information.

            Anything less on your part is just plain stubbornness.

            Repeatedly asking for proof before I believe you, when you repeatedly fail to provide any proof, is not stubbornness. I’m holding you accountable for the unjustified nature of your beliefs. You are the one who refuses to admit your beliefs lack any reasonable, trustworthy empirical justification.

            If you are doing this for pay or reward — good job!

            Again, you retreat to distraction – because you can’t refute my points or substantiate your own, the problem (in your mind) must be that I am biased. You completely fail to see that the problem is your own lack of good evidence. Even were I a paid shill, which I’m not, that would not stop you from providing evidence or doing research. Yet you persist in not doing any research. How is that my fault?

  22. Marion says:

    I suggested to NCCAM to throw out their congressional mandate entirely (it’s bullshit anyway) and become a center for exploratory frontier research instead.

    I told them to get rid of the crap that has been proven NOT to do anything of value:
    faith healing, chiropracty, homeopathy, accupuncture

    and instead push to investigate that which has not yet been proven to work,
    ( but which has not been disproved, either, obviously) .

    Become a center for high-tech genomics, nanotechology, deep physics trying to make use of all those subatomic particles we read about in physics but never get put to use in a practical way (how often does the tau neutrino get used, or the weak nuclear force?). The positron is a nice example of a lesser-cared-about subatomic particle, the positron, getting put to use in Positron Emission Tomography.

    Find alternatives to testing on fully sentient animals.
    Become a full-fledge government-sanctioned Animal Rights Center at the NIH,
    if they’re really interested in having a distinct purpose from the rest of NIH.

    If not, then their department is unnecessary deadweight. They should either return all their money to the taxpayer, or (since we know no bureaucracy will EVER do that) simply merge with the rest of NIH and do whatever the rest of NIH does (i.e do any of the thousands of projects NIH works on).

    1. David Gorski says:

      I suggested to NCCAM to throw out their congressional mandate entirely (it’s bullshit anyway) and become a center for exploratory frontier research instead.

      Interesting idea. However, how long would it be before the CAMsters tried to co-opt “frontier research”:

      http://scienceblogs.com/insolence/2008/03/04/the-frontier-science-of-homeopathy/

      http://scienceblogs.com/insolence/2010/11/09/mark-hyman-mangling-cancer-research/

  23. simba says:

    Imagine an NCAM that actually honestly assessed lots of complementary and alternative therapies for safety and efficacy, and then went out of its way to promote those results to health care workers and the general public. Weekly press releases saying that such-and-such a supplement had been found to be contaminated, reminders that homeopathy does not work and daily multivitamins are unnecessary, critical examinations of diet pills…

  24. PMoran says:

    You know I try to hold my tongue, but I find myself compelled to again suggest that this style of polemic might have a place on a personal web site, but not when intended to be the considered opinion of a body wanting to be respected for its opinions on matters to do with science and medicine.

    The name-change is sound for the reasons Dr Briggs supplied, and she does not deserve to be castigated for motives that we cannot know that she possesses beyond her duty to adhere to the brief of the body she heads..

    The following would seem to indicate some of the future direction of NCCAM activities. They do seem to be areas where the mainstream could use some help. It can also be argued that certain aspects of CAM use are worthy of further study.

    http://nccam.nih.gov/about/offices/od/directortestimony/0414

    1. windriven says:

      Really?

      Dr. Moran: “It can also be argued that certain aspects of CAM use are worthy of further study. ” Citation follows

      Dr. Briggs (from Dr. Moran’s citation): “They include both self-care practices like meditation, yoga, and dietary supplements, and health care provider administered care such as acupuncture, and chiropractic, osteopathic*, and naturopathic medicine.”

      WTF, Peter? NCCAM has spent a billion dollars studying this crap in just the last 10 years alone. Even by Washington standards that’s a lot of money. And what has that money bought? What earth shattering discovery has emerged? Reiki is the one true cure for toenail fungus? Not even.

      NCCAM needs to keep its name and change its budget. Zero would be a good number.

      Think about the impact of $1 billion dollars in research funding for esophageal cancer or osteoarthritis or macular degeneration. Christ, the money would be better spent researching treatments for painful rectal itch.

      When is enough, enough? What is the quantity of dollars that need to be pissed down this particular rat hole before sensible people say: “OK, nobody home.”?

      And why stop at medicine? Let’s fund studies to prove that the world is 6,000 years old. Lots of people believe that. And let’s fund transmutation of lead into gold. Its only $100 million a year. We have children growing up on Cokes and potato chips and attending “schools” that I wouldn’t send a doberman in a flack jacket into. But hey, little Bonnie Pureheart thinks burning paper tubes in her ears will – Christ, what? – cure boredom, so we really need to fund a serious study of candling.

      This is what I don’t get about you Peter: just how stupid does something have to be before you are willing to stand up on your pegs and scream bullsh!t?

      *Most of the DOs that I know would object violently to being branded “alternative”.

    2. windriven says:

      “I find myself compelled to again suggest that this style of polemic might have a place on a personal web site, but not when intended to be the considered opinion of a body wanting to be respected for its opinions on matters to do with science and medicine. ”

      What ever we do, let’s not offend anyone. When the chiropractor claims to cure Morgellon’s with spinal manipulation, we nod sagely and intone that this deserves careful study and evaluation. When the acupuncturist claims to cure appendicitis with needles in the eyeball, we nod sagely and intone that this deserves careful study and evaluation. When the naturopath claims privileges to act as a PCP and prescribe drugs, we nod sagely and intone that this deserves careful study and evaluation. When Cleveland Clinic opens a Chinese herb stand, we nod sagely and yadda, yadda, yadda.

      When some idiot Congressman from Iowa says, “hey, we don’t need MDs, we have a constellation of alternatives” are you going to nod sagely? What about when the idiot is an Australian MP?

      Actions have consequences. So does inaction.

      1. PMoran says:

        That’s a humungous misrepresentation of my often stated positions on those matters. Nowhere have I suggested acquiescence in such things.

        It is also ridiculous to suggest, as you are getting so close to doing, that only Gorski-style invective stands in the way of bad outcomes from CAM.

        Anyway, do what you will. I will certainly not join a “science-based” society that chooses to demean itself this way when there is no obviously proportionate gain to be seen in lives saved from ruin.

        No loss, I am sure many will say.

        1. David Gorski says:

          Anyway, do what you will. I will certainly not join a “science-based” society that chooses to demean itself this way when there is no obviously proportionate gain to be seen in lives saved from ruin.

          No loss, I am sure many will say.

          There was a time when I genuinely would have thought it a loss. Sadly, that time was years ago. More’s the pity.

    3. David Gorski says:

      You know I try to hold my tongue, but I find myself compelled to again suggest that this style of polemic might have a place on a personal web site, but not when intended to be the considered opinion of a body wanting to be respected for its opinions on matters to do with science and medicine.

      No, you don’t try to hold your tongue. I’ve never known you to try to hold your tongue, even 12 years ago on Usenet. What is appropriate for SBM is what we, the editors of SBM, decide is appropriate for SBM. You are under no obligation to agree or to support us, just as we are under no obligation to listen to you.

      There was a time when I did try to listen to your concerns, but over time and your repeating the same thing over and over again ad nauseam I realized that there’s very little there there in your concerns, and what might be useful is buried under pearl clutching over whether people will be offended.

  25. PMoran says:

    Windriven, I said quite deliberately “– certain aspects of CAM use are worthy of further study”, and I stand behind that.

    I assumed everyone here knew me well enough by now to know that I am not advocating more study of implausible medical theories, although occasional very well done studies may help confirm that plausibility is as predictive of outcomes as we claim. We are, after all, constantly referring to such studies ourselves, even as we condemn NCCAM for doing some of them..

    I never got around to sending a reply I constructed to a previous question of yours. It may help explain how I see your present question.
    ————————–
    Windriven: “Are you not saying in effect that astrology is fairly harmless; that it is the money-grubbing astrologers who make unrealistic claims for its abilities that mark the evil?”
    ————————————–
    No, not really, but it is worth thinking about astrology. Like CAM it requires a collusion of minds between client and practitioner, and it evokes similar responses in the sceptic: “it’s ridiculous, it has no right to exist, it’s not good that people are doing it, so let’s help people understand “the science” and it will die out — just like homeopathy did when we educated people about that ” :-)

    Who is being most irrational here? There is ample evidence that mankind is not a rational being. Look at the ridiculous vicarious pleasure we couch-potatoes derive from our favourite sports team winning! How come so many movies are about super-heroes and vampires? Why is gambling a less interesting target for sceptical energies than astrology? — it does far more harm to many people.

    I am yet to mention that virtually universal irrationality, religion, and its modern “spiritual” substitutes, which at least don’t as often lead to murder and oppression.

    What a difference it might make if the sceptic asked the right questions before self-importantly rushing to the rescue of mankind from his irrationality on his great white charger, battle standards waving in the breeze — e.g. why do people do this and what do they get out of it? Then it all might make a little more sense, as well as possibly guiding more rational and realistic solutions, if any such exist. It might lead to the next rational question: — “what can I offer that replaces this?”

    It will almost certainly be found that astrology probably does help satisfy certain human needs in some people (I can think of several possibilities), just as similar open-minded questioning can afford us a far more sophisticated slant on the meaning of CAM use than mere fraud or human stupidity or lack of education, or that it is something that we have a right to try and stamp out at all costs.

    We have experienced how people feel when we try to take away their pet CAM methods without offering something that they can be sure is superior. What do we offer people if they give up astrology? There is probably nothing suitable or practical in most cases, but it is the fact that we have probably never asked ourselves that question, that is most important here.

    1. Harriet Hall says:

      Well duh! It is obvious that people think they have good reasons for trying CAM or astrology, in fact for everything they do, and that people think CAM satisfies what they think they need. That doesn’t mean we should encourage satisfying nonsense like astrology. Understanding why people believe in astrology doesn’t make it real and doesn’t tell us what we could do that might satisfy the believers’ needs without departing from reality. Peter, just stop with the fuzzy comments and explain yourself clearly once and for all: write that guest article we have been begging you for. Tell us exactly what you think we should be doing and stop preaching to us from your stance of superior wisdom about what you think we are doing wrong.

      1. David Gorski says:

        I second Harriet’s request. Yet again. For the umpteenth time. More times than I can remember.

      2. PMoran says:

        ” Well duh! It is obvious that people think they have good reasons for trying CAM or astrology, in fact for everything they do, and that people think CAM satisfies what they think they need. That doesn’t mean we should encourage satisfying nonsense like astrology.

        — stop with the fuzzy comments — ”

        The subject matter is fuzzy. So is the scientific evidence on some matters relevant to CAM.

        I am in effect arguing against overly simplistic understandings of CAM that are being used to justify bad manners, mean-spiritedness and insult towards people who don’t deserve it.

        They don’t deserve it because they are either members of the public who are immensely less privileged than us in some respects, or they are colleagues who are just as clever and knowledgeable as us but trying to find their own ways of dealing with some of the paradoxes that medicine dishes up.

        We are in danger of losing sight of our own humanness and compassion, without which there is no point to all this at all.

        I cannot possibly compress all the matters that led me to question some of my own attitudes to CAM into one post.

        1. David Gorski says:

          I cannot possibly compress all the matters that led me to question some of my own attitudes to CAM into one post.

          Then write two posts. Or three. However, it is now my turn to mention a criticism that I’ve had leveled at me for my tendency towards logorrhea. Not being able to express one’s thoughts concisely is a sign of sloppy thinking and sloppy writing. Of course, me being me, I don’t entirely agree with that sentiment because some thoughts are too complex to be expressed effectively in less than a certain amount of verbiage. I do, however, note that it is not particularly uncommon for posts here to exceed 5,000 words. Occasionally, there are even posts approaching and exceeding 7,000 words. I have a hard time imagining that anyone (even myself) couldn’t express in 5,000-7,000 words at least a primer or introduction to the thoughts we are asking/challenging you to express. They aren’t that complicated. So, basically, unless you write a book on the topic or post your essay to your own website, you are highly unlikely to be offered that much space anywhere else. Moreover, you seem to be excusing yourself from the challenge by saying, in essence, that it would require a book for you to lay down your observations on this issue.

          The invitation/challenge stands. And I’m going to remind you of it every time I notice you coming here attacking us for “incivility.”

          Seriously, though, Peter. I seem to be the one who drives you crazy. I don’t see you going after Mark Crislip for a post like last week’s:

          http://www.sciencebasedmedicine.org/more-dialogs

          And many more.

          He routinely refers to CAM as “SCAM” (even I don’t go so far in my invective as to impute fraud to most CAM!), calls NCCAM useless, dismiss SCAMs as a “Trojan rabbit,” calls CAM the “beer goggles of medicine,” and is the one who coined the phrase likening CAM to cow pie being “integrated” into apple pie, not making the apple pie better. (Yes, Mark compared CAM to a turd long before I ever did.)

          Yet, I don’t see you wringing your hands about his flights of invective the way you do with mine. I can only conclude it is because you have some particular dislike of me compared to Mark or maybe because I don’t make my sometimes over-the-top criticisms as entertaining to you as Mark does his.

          1. Windriven says:

            ” I can only conclude it is because you have some particular dislike of me compared to Mark or maybe because I don’t make my sometimes over-the-top criticisms as entertaining to you as Mark does his.”

            I suspect that this has more to do with your postion as Managing Editor and chief adult in the room than any personal animosity. In fact, it is probably the opposite that is true. If Dr. Moran didn’t like you or SBM he wouldn’t have hung around all these years absorbing considerable abuse along the way.

            1. David Gorski says:

              I always thought Steve Novella was chief adult in the room. :-)

        2. Harriet Hall says:

          “being used to justify bad manners, mean-spiritedness and insult towards people who don’t deserve it.”

          That is an unfair characterization of what we do. We have consistently demonstrated empathy for the patients who are misled; we try to educate those who don’t know any better; we only attack those who should know better because of their scientific training or who are blatant charlatans or who have attacked us with mean-spirited insults and bad manners.

          I could argue that you have been mean-spirited and insulting, particularly to David, who doesn’t deserve it.

          Again (I’m getting tired of saying this) I beg you to write that guest post and use your great wisdom to guide us in exactly what we “should” do rather than harping on what you think we “shouldn’t” do.

          1. David Gorski says:

            You know. Because Peter was so violently clutching his pearls, I asked myself if perhaps I had gone too far. So I reread the post. (Yes, I actually sought to see if perhaps I had erred—an actual attempt at self-examination!) After re-reading it I fail to see the “attacks” on Dr. Briggs. I point out that under her leadership the studies of magic have declined. I went out of my way to say that I didn’t think she was intentionally using CAMspeak to deceive, concluding that she’s just probably picked it up because she’s been working at NCCAM for six years as its director and needed to pick it up to function. In fact, rereading the post after Peter’s attacks on me for thuggishness and nastiness I was surprised at how mild it came across to me.

            The funny thing is, I mentioned a lot of things that Peter castigated me for supposedly not mentioning, such as the lack of findings. I included links to discussions of the lack of NCCAM findings after 16 years. I pointed out how NCCAM can’t even really define what CAM is. And, of course, as I pointed out elsewhere, it’s not as though we haven’t addressed NCCAM in the past multiple times the way Peter supposedly wants, pointing out its lack of productivity and failure to validate any treatments. I was puzzled. What seemed to get Peter in a tizzy is simply my one choice of metaphor. One wonders if he would have reacted so violently if I had simply stripped out the metaphor but otherwise said exactly the same thing or if I had substituted, for example, the metaphor that you “can’t put lipstick on a pig.”

            No one else seemed to have a problem with my post (with one exception, of course), and it’s not as though our readership would be shy about expressing offense if anyone were offended. No doubt Peter would dismiss that as groupthink, but I doubt that’s it. Perhaps he should look at the only other person complaining about my post besides him and ask himself about that.

            1. Sawyer says:

              I would take Dr. Moran’s suggestions more seriously if he had evidence to back them up, but unfortunately all we have is speculation. It’s possible that more smiles and handshakes from the SBM writers would be a good thing, but unfortunately we don’t have another planet to run a controlled experiment. There are so many factors that affect the public’s perception of medicine that there’s no way to determine the ONE communication strategy that works. Where’s the evidence that calling the NCCAM out on its gobbledygook is a bad idea?

              As I’ve pointed out before, the scant information we do have on successful communication methods is several decades of hospitals, universities, and government agencies all trying to play nice with CAM. And how has that worked out?

            2. PMoran says:

              It IS groupthink. When people first enter a community like this they are naturally cautious about expressing any misgivings about the style or content they encounter. By the time they might have the confidence to challenge anything it may have all become so familiar as to be taken on as the norm. The matters which once grated are no longer noticed. They have become the currency of everyday discourse.

              There are other influences, such as that the most vocal people in discussions are invariably the most opinionated. Very strong opinions ARE extreme when dealing with some of the complexities of medicine.

              Yet, even so, some have had the courage to challenge your style, haven’t they? It might also be interesting to have a vote on how many followers would prefer your pieces to be shorter and more to the point. I would. I value your knowledge greatly on some matters but the days get shorter and the mind capacity narrows as you get older.

              Be wary of those who praise us. The reason most people enter into any kind of exchange of ideas is to reinforce their own prejudices. Do that for them, exciting their senses of self-worth and superiority, and sure — they will tell us what a great job we are doing, even as those who might desperately need reassurance as to our trustworthiness in some matters may be having quite contrary opinions of us reinforced, perhaps as closed-minded bullies, bent upon having total control over important aspects of their lives.

              I think this site has to expect a very wide audience and I am pleading for it to take that into account.

              I must say David, I respect you enormously for at least taking the time to consider my criticisms and being only moderately snarky in response. I did not expect you to abruptly accept my take on things, but I hope you and others to continue to think on this and other matters. I did think you might on second thoughts regard likening her institution to a turd was just a little bit insulting to Dr Briggs.

              I do challenge other authors. That piece of Mark’s that you linked to occurred immediately after I had bluntly challenged his approach. He did not deign to respond and it seemed as though my comment simply spurred him on. I suppose he might have missed it. Here it is —

              Quote —

              (Mark:) “Perception is altered, not underlying pathology.”

              So — what, Mark? Do we eschew all symptomatic treatment because it doesn’t correct pathology? I know you can’t mean that, since perhaps fifty per cent or more of all treatment episodes are to relieve symptoms and that is all that a lot of drugs do.

              Treatments probably often “work” mainly through us paying less attention to symptoms, once having taken action regarding them and getting on with life and its many distractions. ANY treatment can do that much with moderate discomfort. This is just one of many ways in which human psychology/neurology can influence subjective or psychosomatic complaints but by requiring some kind of treatment ritual to be brought into play.

              Now why is this to be regarded from the get-go as a bad thing, as the demeaning “beer goggles” analogy implies when combined with the above statement?

              To do so implies somewhat off-kilter priorities when discussing a medical outcome, hinting at a value judgement that science alone cannot make and which should be being kept at a distance when trying to get a handle on the actual facts. It suggests bias — that you have an angle.

              That you do is amplified by the fact that you describe trying to elicit the same phenomena in your own patients, but that you regard that as somehow more “truthful”.

              Surely it would be equally “truthful” and even more informative regarding certain aspects of CAM to allow that true believers such as SS are able to elicit the same responses.

              End quote

              1. Harriet Hall says:

                Stop. Go away. Come back with that guest article we have been begging you to write.

              2. David Gorski says:

                Heh. Harriet beat me to it. Somehow, Peter can find time to write cumulatively thousands upon thousands of words over the last few years complaining how mean and nasty we are and how We’re Doing It All Wrong, but somehow can’t manage to accept the invitation Harriet and I have repeatedly made to do a guest post explaining his position.

                Again, we were, have been, and are dead serious about this invitation.

              3. David Gorski says:

                That piece of Mark’s that you linked to occurred immediately after I had bluntly challenged his approach. He did not deign to respond and it seemed as though my comment simply spurred him on.

                You know, Mark is a smart guy and probably has the right idea. Perhaps I should emulate him. My problem is that I remember how awesome you were as a supporter of on Usenet 10-15 years ago. So every so often I respond. It’s always pointless and disillusioning. So I don’t respond for a while. Until I do again.

              4. Mark Crislip says:

                It is not that I do not deign to reply more that I have no time. I had a 14 hour, 14 consult day today, I write slowly and have a growing multi-media empire to manage and a family. If I can’t reply in 4 or 5 sentences I usually do not bother. But I do read and think about all the replies to my posts and the posts of others.

              5. This place is infected with the stench groupthink.

                “Well duh! It is obvious that people think they have good reasons”

                Exactly “think” is the key word. Your thinking is flawed by a narrow source of your data. So by default narrow data means narrow conclusions.

              6. WilliamLawrenceUtridge says:

                This place is infected with the stench groupthink.

                Why? Because we refuse to debase ourselves whenever you say “believe me because of my clinical observations”? Bloodletters had huge, enormous clinical observations to support leeches and lancets. Patients calmed after bloodletting, fevers abated, suffering was eased. Of course, many also died of infected wounds, blood loss and inability to fight off diseases, but their immediate responses gave enormous support to the claims of Galen.

                Asking for good-quality evidence is the opposite of group think, and many here have disagreed with the bloggers and each other. What you see as “groupthink” is merely the recognition that evidence should be necessary to change one’s mind, and you have provided essentially nothing that could reasonably be portrayed as good evidence.

                Exactly “think” is the key word. Your thinking is flawed by a narrow source of your data. So by default narrow data means narrow conclusions.

                I would rather rely on narrow, well-controlled data than the uncontrolled, systemically biased data that personal experience and observations provide – yet personal experience and biased observations are what you keep presenting as evidence that you are right and we are wrong. So please stop doing it. Produce something worth reading or shut up.

            3. fastbuckartist says:

              After re-reading it I fail to see the “attacks” on Dr. Briggs.

              I see a picture of a giant turd above a picture of Dr Briggs captioned Dr Briggs is polishing a turd.. I didnt actually read the article, I am sure I didnt miss anything “science-based” :)

              1. David Gorski says:

                One notes that FBA seems confused about the difference between criticizing something someone is doing as part of her job and “attacking” that person. Same as it ever was.

        3. Andrey Pavlov says:

          @Pmoran:

          I am in effect arguing against overly simplistic understandings of CAM that are being used to justify bad manners, mean-spiritedness and insult towards people who don’t deserve it.

          Yes, we get that you mean that. And it is stupendous how much wasted verbiage you’ve expounded to continually relay such a profoundly simple and well understood point.

          The argument we have made here, myself most incessantly and explicitly, is that a multitude of approaches are always warranted. You instead feel that you need to tell us here that only one approach is valid (or at least that some specific approaches are invalid) and that we should cater to your thoughts on the matter.

          I still read up on the state of religious affairs in the US, since we have an astoundingly perverse religiosity here, and a relevant post came up over at Hemant Mehta’s blog The Friendly Atheist. Since you yourself have explicitly admitted that CAM use is much like any other faith-based or belief-based system of thought, including religion, it seemed apropos to to reference it here. I think you would agree that if there is anything more likely to cause people to dig in their heels and shut their ears at snark than CAM use it is religion. The title of the post linked is:

          You Don’t Have to Give Up Your Manners When You’re the Only Atheist in the Room

          Which is very much in line with what you (at least seem to be) trying to convince us of. However, the author also notes:

          Is the choice, then, between being well-mannered but silent or uncouth but true-to-self? Put more bluntly, must Atheists always appear as clumsy, ill-bred bullies?

          Of course not. (Though some of us do delight in our reputation for coarse disregard, as we consciously cultivate a punk sneer.) I’m supremely glad that we have people who are cut from that provocative cloth, because I believe they are absolutely necessary. But I admit to never being comfortable in that role.

          [emphasis mine]

          You are not comfortable in that role. That is perfectly fine and absolutely reasonable. The issue is that others are, it is arguably necessary, and once again, this is not your blog and all of your complaints boil down to nothing more than tone trolling.

          I do look forward to reading your guest post that you have finally gotten around to submitting. But I’ll admit that I will be surprised if it is anything more substantive than “I think everyone should be nice.”

    2. windriven says:

      Peter,
      NCCAM is not studying why people use sCAMs. At least not as a primary objective. That would be a far more reasonable investment in research than, say, homeopathy for the treatment of pancreatic cancer.

      In a world of unlimited funds and unlimited researchers it wouldn’t be much of an issue. But that is not our world. Ours is a world of embarrassing disparities between rich and poor, embarrassing differences in our own wealthy countries, more embarrassing still between our rich and the impoverished of the third world. Spending $100 million a year on stuff with zero prior plausibility while wrenchingly real needs exist untouched is ethically incomprehensible to me.

      This is a political issue, not a medical one. But political actions and inaction have consequences and sometimes they are medical consequences. $100 million tossed as a sop to saps is $100 million not spent on more promising research, not spent on education, not spent on prenatal care for the poor, not spent on retraining the unemployed, and certainly not spent on next generation antibiotics to replace those increasingly lost to resistance.

      I can’t find it in my heart to see that $100 million every year carted off to the middle of the desert and burned. Think of it as 500 quality researchers stilled. Or 2,000 first rate lab techs. Zeroed out. Nullified.

      For what?

      1. PMoran says:

        The NCCAM is a product of earlier times, when a great many people had higher and more unrealistic expectations of CAM than I suspect is currently the case.

        It is obvious that NCCAM has produced negligible useful results for all the millions spent, even though presumably most of the more promising avenues within CAM would be among the first to be explored. The results speak for themselves.

        What more is needed, if wanting to make a case for its rationalisation or curtailment? What does brutish bad-mouthing of its director, who is merely doing what is demanded of her if her institution is not to be considered yet another arm of mainstream obstructiveness (as some CAM supporters indeed do — mainly as a try-on I suspect), contribute?

        If this kind of thing is truly the result of a joint decision by the board or committee that runs SBM then I wonder where its heads are. It reinforces my suspicions largely from my own journey within it, that healthfraud activities encourage extremist rhetoric and sloppy debate because there is no internal critical mechanism, such as applies to the rest of science. The cause seems so just, the villains seem so deserving, and there are few opponents able to go toe-to-toe with us in rational debate.

        And those who might think slightly differently can be dismissed as “shruggies”, or “accommodationists”.

        Voila! We have a recipe for the preservation of ill-judged notions and angles of attack regardless of merit.

        1. David Gorski says:

          It is obvious that NCCAM has produced negligible useful results for all the millions spent, even though presumably most of the more promising avenues within CAM would be among the first to be explored. The results speak for themselves.

          Which we have argued time and time and time again over the last six years, or hadn’t you noticed? It’s not as though we haven’t written about just this very issue so many times that I’ve forgotten how many since the founding of this blog, starting from the very beginning:

          http://www.sciencebasedmedicine.org/the-nccam-strategic-plan-2011-2015-the-good-the-bad-and-the-ugly/

          http://www.sciencebasedmedicine.org/the-national-center-for-complementary-and-alternative-medicine-nccam-your-tax-dollars-hard-at-work/

          http://www.sciencebasedmedicine.org/getting-nccams-moneys-worth-some-results-of-nccam-funded-studies-of-homeopathy/

          http://www.sciencebasedmedicine.org/our-visit-with-nccam/

          http://www.sciencebasedmedicine.org/nccam-criticism-from-a-not-quite-opponent/

          http://www.sciencebasedmedicine.org/my-nccam-wish-list/

          http://www.sciencebasedmedicine.org/president-obama-defund-the-nccam/

          http://www.sciencebasedmedicine.org/nccam-is-a-victim-of-its-own-history/

          http://www.sciencebasedmedicine.org/dismantling-nccam-a-how-to-guide/

          http://www.sciencebasedmedicine.org/yes-we-can-we-can-abolish-the-nccam/

          http://www.sciencebasedmedicine.org/yes-we-can-we-can-abolish-the-nccam-part-ii/

          http://www.sciencebasedmedicine.org/yes-we-can-we-can-abolish-the-nccam-part-iii/

          Of course, thinking that the argument that NCCAM hasn’t produced anything of use will have any sway with politicians is naiveté at its finest:

          http://www.sciencebasedmedicine.org/senator-tom-harkin-disappointed-that-nccam-hasnt-validated-more-cam/

          The cause seems so just, the villains seem so deserving, and there are few opponents able to go toe-to-toe with us in rational debate.

          And those who might think slightly differently can be dismissed as “shruggies”, or “accommodationists”.

          Voila! We have a recipe for the preservation of ill-judged notions and angles of attack regardless of merit.

          And, of course, the moral superiority that criticizing “extremists” brings to the one doing the criticizing is just so satisfying, and those who think differently can be dismissed as “harsh,” “rude,” “thuggish,” “extreme,” and “uncompromising.”

          Voila! We have a recipe for the preservation of ill-judged notions and fuzzy thinking regardless of merit.

          See how easy it is to impute self-satisfaction and sanctimoniousness to people? You’re quite good at that while being far more sanctimonious than I could ever imagine being.

          BTW, Peter, have you written that post yet in which you teach us all your wisdom and how we should really be doing this? I’m going to ask you this every time I notice you showing up in the comments clutching your pearls.

        2. Windriven says:

          “Voila! We have a recipe for the preservation of ill-judged notions and angles of attack regardless of merit.”

          I’m not sure which notions you mean are ill-judged. Are there specific modalities that you believe are unjustly maligned in these pages? If so which are they?

          I understand the “angles of attack” better, I think. You would rather avoid confrontational language. Others of us find it useful; necessary even. I’m not sure that can be resolved in a way that pleases everyone as it is more a matter of style than of fact.

        3. Andrey Pavlov says:

          The NCCAM is a product of earlier times, when a great many people had higher and more unrealistic expectations of CAM than I suspect is currently the case.

          No, it is not. It is well documented that the NCCAM is a product of a political move from politicians who had a vested business/political interest in promoting the use of so-called CAM rather than actually investigating rationally what seemed at the time to be more worth investigation. The fact that you can even make such a comment after this has been so well documented here and elsewhere tells me you aren’t actually reading or caring about what is written here and merely want to prattle on about your already concluded ideas on CAM.

          It is obvious that NCCAM has produced negligible useful results for all the millions spent, even though presumably most of the more promising avenues within CAM would be among the first to be explored. The results speak for themselves.

          Yes. Which is precisely why the NCCAM first explored things like the effects of intercessory prayer on HIV titers. Because of all the things that could be investigated first, that is certainly very high on the “most promising avenues” list.

          Once again, you are arguing what you believe the NCCAM to be rather than what it actually is.

          What does brutish bad-mouthing of its director, who is merely doing what is demanded of her if her institution is not to be considered yet another arm of mainstream obstructiveness (as some CAM supporters indeed do — mainly as a try-on I suspect), contribute?

          As Dr. Gorski said, there was no brutish bad mouthing. And as I was going to say in response to his comment, but will here and hope he reads it, the Australian sensibilities of what is brutish is far out of tune with the American version. The Aussies are, in my experience and that of others, vastly over-cautious about being perceived as brutish. I’ve personally experienced one rather important Aussie flat out lie to a group of us rather than say what he perceived would be something “brutish.” And I’ve personally seen how the most innocuous comment can be perceived as rude and garish. That, coupled with Tall Poppy Syndrome is, I would venture, a large contributor to your commentary here.

          Which, yet again, boils down to nothing more than tone trolling.

    3. David Gorski says:

      What a difference it might make if the sceptic asked the right questions before self-importantly rushing to the rescue of mankind from his irrationality on his great white charger, battle standards waving in the breeze — e.g. why do people do this and what do they get out of it? Then it all might make a little more sense, as well as possibly guiding more rational and realistic solutions, if any such exist. It might lead to the next rational question: — “what can I offer that replaces this?”

      Jumping Jesus on a pogo stick! You clearly haven’t been paying attention. This sort of thing is discussed all the time on skeptical blogs and at skeptical conferences. Books have been written about it.

      1. PMoran says:

        “Jumping Jesus on a pogo stick! You clearly haven’t been paying attention. This sort of thing is discussed all the time on skeptical blogs and at skeptical conferences. Books have been written about it.”

        I think I have heard all that and I don’t think the answer included being as bad-tempered as you feel like when entering into dialogue with those with whom you have differences —- (“Feel free to cite this post.”).

        At least save that for your own site. I don’t want to be associated with it, even if Windriven and Andrey and some others do.

        Not that we don’t have legitimate differences with the NCCAM. If we had been smarter we managed to use some of its resources to explore matters that are of interest to us as sceptics.

        1. Lawrence says:

          IF NCCAM actually wanted to be relevant, it would perform this research (which essentially disproves that any of the hocus-pocus stuff works at all), and then hand the results over the FDA to take action against those that push, sell, exploit these bogus treatments for money…..

          1. n brownlee says:

            Damn straight.

        2. David Gorski says:

          At least save that for your own site. I don’t want to be associated with it, even if Windriven and Andrey and some others do.

          And yet you have remained associated with it for at least four or five years as the resident constant scold.

        3. WilliamLawrenceUtridge says:

          I don’t want to be associated with it

          To paraphrase Dear Abby, you could always leave.

    4. Andrey Pavlov says:

      @PMoran:

      We have experienced how people feel when we try to take away their pet CAM methods without offering something that they can be sure is superior.

      Well, at least you’ve found a way to feel superior to everyone.

  26. Laurenak says:

    Just for the record Dr Gorski, although I have only recently started commenting I have been reading this blog for nearly a year now and I really enjoy your posts and style of writing. :)
    As far as the debate above, I consider myself a skeptic who tries to be evidence based in my own practise as a speech pathologist however I was also sucked into several CAM theories until I came to this blog. The blunt, direct style of these articles challenged some of my ideas and were a refreshing change from the wishy washy advice I’d received in the past e.g. It might be useful, some people find it helpful etc. As a result I feel much more confident making decisions for my health. I’m only one voice but I think you are all doing a fantastic job at SBM and wouldn’t change a thing :)

    1. David Gorski says:

      Thanks. I would change a couple things, actually. We could use some fresh blood in the form of bloggers who could contribute regularly about areas that we don’t have experts in, such as mental health, women’s health and reproduction, etc., as we are currently stretched a bit thin and have some holes in our areas of expertise that would be good to fill. We’re always on the lookout, but this year more than in a long time.

      1. DevoutCatalyst says:

        Could WilliamLawrenceUtridge write a guest post on the art of commenting ? Seems there’s a method to his craft that would likely be instructive.

        1. WilliamLawrenceUtridge says:

          The secret is to vacillate between being a straight man so polite as to rival the Queen of England, and an exasperated potty-mouth who calls people stupid. And the extensive use of a thesaurus. Oh, and lots of parenthetical comments.

  27. PMoran says:

    I am not sure what the point is, and perhaps it is bluff that my views cannot possibly be taken seriously unless I present them in a blog post..

    I have one prepared that contains some of my views.

    To whom do I send it and in what format?

    1. Harriet Hall says:

      We are taking you seriously. The point is that you have not been able to explain yourself in a coherent message that would allow us to understand what you’re trying to say. At times you sound like you’re advocating CAM because you think it is doing patients some kind of objective good, but you haven’t presented any supporting evidence. You consistently criticize our approach without specifying what you think we “should” be doing instead.
      For submission guidelines, see http://www.sciencebasedmedicine.org/about-science-based-medicine/submission-guidelines/

      1. PMoran says:

        Thankyou.

        Harriet, for the record, when have I ever “consistently criticized” your approach? I believe you are doing what is needed, with little if anything to object to.

        When also have I not made it absolutely clear that I am talking about the mainly subjective and psychosomatic complaints that comprise most of everyday medical practice for primary care doctors, and almost all of that of many CAM practitioners? I cannot count the times I have spelled that out.

        As I have predicted, it has proved difficult to draw together every thread in one blog post, but what I am sending is some groundwork for a somewhat different perspective.

        1. Harriet Hall says:

          @PMoran,

          ” when have I ever “consistently criticized” your approach?”

          Whaaat!? When I read that I didn’t know whether to choke on my coffee or roll on the floor laughing. Almost every comment you have posted has objected in some way to what we are doing, the language we use, our rigorous stance against treatments that are not based on science, our supposed failure to understand why patients use CAM, our supposed insensitivity to the needs of patients, etc. Granted, your attacks often amount to naive “wondering” whether there might be more to these issues than we realize, and “wondering” whether our approach might alienate people or deprive them of comfort. Yes, you have made it clear that you are talking about mainly subjective and psychosomatic complaints, but you have suggested that acupuncture should be offered to those patients, and you have suggested that it will benefit them, without providing any credible evidence or convincing reasoning. What you have posted has led more than one reader to assume you are a proponent of CAM, which I realize you are not. You have not made your stance clear. I have made mine clear: I do not object to patients using acupuncture; I only object to providing them with misleading information. I don’t think it is ethical to offer placebos to patients, but if a patient brought it up, I would try to explain that it is not supported by science, that some people think it has helped them but they may have been fooled by the placebo effect or the natural fluctuating course of illness, and if they choose to try it I would like them to report back and tell me what happened.

        2. David Gorski says:

          Harriet, for the record, when have I ever “consistently criticized” your approach? I believe you are doing what is needed, with little if anything to object to.

          This has to be a joke. You can’t be serious. You’ve been consistently criticizing Harriet’s approach for at least five years.

          1. Harriet Hall says:

            To be fair, he has criticized the whole approach of the SBM blog, not me personally. In fact, he seems to be particularly irritated by Dr. Gorski and he has characterized me as being less objectionable than others, which I don’t appreciate. The SBM authors are individuals who write in different styles and from different perspectives, but I want to make it clear that I strongly support all of them. I stand for what we are doing, so criticism of the blog is like criticism of me personally.

        3. WilliamLawrenceUtridge says:

          Harriet, for the record, when have I ever “consistently criticized” your approach?

          Yeah, I’m going to add to the list of people who did a spit-take upon reading this comment. Pete, either you have zero insight into your own behaviour, or you might want to get your cognitive function checked.

          I believe you are doing what is needed, with little if anything to object to.

          Perhaps this question turns on the definition of “you”. If you mean just Dr. Hall, then perhaps you criticize her slightly less than others. But the collective “you” that most here seem to read into your comment, as in “you the contributors to SBM” are collectively amused and startled.

          Given Dr. Hall’s approach and paradigm varies only minorly from the other contributors, whom you have no problem repeatedly criticizing, I would judge this a surprising statement.

          Perhaps reconsider your approach.

          1. Pmoran says:

            It is clear that I have been creating a wrong impression, then. I must unreservedly apologise to you, Harriet, if you thought comments which have genuinely been intended to be about others, were meant to include you.

            I actually do think your style is appropriate for a science -based group hoping mainly to inform and perhaps be influential. You do show a willingness to try and fully understand the views of others as with your recent piece about “natural” medicine. You also understand some of the complexities of primary care medicine in a way that I think not all principals do. (That is not to say that I necessarily agree with you on everything. )

            I have always thought this. I realise that I should have made clearer before, although I do recall explicitly saying so a few times in the past when I first started reacting to one blogger and you reacted in a similar way to which you are now.

            WLU, you seem to be implying that criticism of present personages is automatically bad. Better to show that the criticisms are unjust or unwarranted, which they are indeed if interpreted as applying to Harriet and some others. I am prepared to listen to your argument in relation to other matters.

            I think you and I have different audiences for SBM in mind and different notions as to how they might be reached (or alternatively be put right off by tone or subtext), IF they can be reached at all.

            The blog post I have now sent contains a perspective which is permissive of much more peaceful and constructive dialogue with a whole range of the people with whom SBM engages in debate. I have written it in haste and I hope it is intelligible

            1. WilliamLawrenceUtridge says:

              You do show a willingness to try and fully understand the views of others as with your recent piece about “natural” medicine.

              And other contributors to SBM don’t? Dr. Hall is perhaps subtler about calling their beliefs wrong and stupid, but all contributors make a good-faith effort to understand others’ points of view, though the amount of time they spend pointing out how and why these quacks opinions are wrong varies. I mean really, should every single post about CAM focus strongly on just how far it diverges from the scientific understanding of basic biology?

              WLU, you seem to be implying that criticism of present personages is automatically bad. Better to show that the criticisms are unjust or unwarranted, which they are indeed if interpreted as applying to Harriet and some others.

              Criticism of the contributors should be valid. Tone-trolling wastes time. I can’t recall a time where you’ve ever presented a criticism that didn’t ultimately resolve to disliking how an accurate statement was presented, which is essentially tone-trolling in my book.

              But then again, I’ve stopped reading most of your comments as repetitive and so vague as to be pointless. Perhaps I’m too stupid to understand the nuances you convey. No matter what, I look forward to the lucid genius of your guest post. I kinda expect it to be little more than “we should be nice to the deluded practitioners and their patients”, which is little more than opinion.

              I suppose I’ll see when it arrives.

            2. David Gorski says:

              I have always thought this. I realise that I should have made clearer before, although I do recall explicitly saying so a few times in the past when I first started reacting to one blogger and you reacted in a similar way to which you are now.

              And we all know which blogger that is.

    2. David Gorski says:

      Send it to me or to Paul Ingraham. HTML or raw text format would be fine.

  28. sixtyorange says:

    I can’t speak to how NCCAM has spent their money in general and over time, but at least lately I have observed that they do fund at least some legitimate, non-woo basic research in biology. I don’t disagree that this research could probably be folded into, say, NIGMS, but I do worry that in today’s political climate, if NCCAM were disbanded its money would probably just disappear from the NIH budget, as opposed to being channeled somewhere more respectable.

    1. WilliamLawrenceUtridge says:

      That small, non-woo basic biological research is accompanied by a massive waste of taxpayer money in the form of all the staff and infrastructure around providing those limited number of useful, real-science grants, as well as the unwarranted status that CAM gets from being associated with a National Institute of Health.

      You’re investing hundreds of millions of dollars for perhaps millions of dollars of good research and in the bargain you’re increasing the number of people who turn to CAM as an adjuvant or genuine alternative to real medicine. Is it worth it? I would say no, but reasonable people can disagree.

    2. MadisonMD says:

      but at least lately I have observed that they do fund at least some legitimate, non-woo basic research in biology.

      Can you please link some examples?

  29. Kurtis Rader says:

    This is the comment I left for the NCCAM director:

    Of those 3800 research projects how many have shown CAM to be as good or better than science based medicine? It appears to be something on the order of 0.1% The few modalities that do show positive results are clearly part of mainstream, not alternative, medicine. Those modalities can, and should, be investigated by the other NIH centers. So a better name for your NIH center is “National Center for Wasting Money”. Or perhaps “National Center for Polishing Turds”.

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