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NCCAM on “integrative medicine”: What’s in a word?

I don’t know how I’ve missed this, given that it’s been in existence now for a month and a half, but I have. Regular readers (and even fairly recent readers, given that I write about this topic relatively frequently) know that I’m not a big fan of the National Center for Complementary and Alternative Medicine (NCCAM). (Come to think of it, neither is anyone else writing for this blog.) Just search this blog for “NCCAM” if you don’t believe me. I’ve explained the reasons many times, but the CliffsNotes version is that NCCAM is an enormous waste of taxpayer money, dedicated as it is to the study of modalities that are at best highly implausible and at worst break well-established laws of physics (i.e., “energy healing”). I do concede that, since the latest NCCAM director (Dr. Josephine Briggs) took over, there has been a noticeable attempt to bring more scientific rigor to NCCAM, and to some extent Dr. Briggs has succeeded. At the very least she is a legitimate scientist with an impressive pre-NCCAM track record, and I do fear who will succeed her when she moves on or retires given that there is enormous pressure from the CAM community to appoint one of their own as director.

Unfortunately, as rigorous a scientist as Dr. Briggs was in her former life, since coming to NCCAM she has gradually been assimilated into the culture of the place. Indeed, although it is good that NCCAM has backed away from studying woo like homeopathy and distance healing, the co-optation of science-based modalities such as exercise, diet, and natural products pharmacology has continued apace. Worse, the recently released five year strategic plan for NCCAM admitted that the science funded by NCCAM in the past was crap and, in essence, promised to do some real science for a change. That’s why on occasion I’ve jokingly said that we should take off and nuke NCCAM from orbit. It’s the only way to be sure. On the other hand, no doubt someone would think I seriously mean that we should nuke NCCAM. Of course, I’d never advocate that! NCCAM is located right smack dab in the middle of the NIH campus. The collateral damage would be unacceptable.

I keed. I keed. I’m not kidding, though, when I echo the questioning of why NCCAM still exists.

What’s in a word?

But back to the new initiative by NCCAM that I started out the post with. I’m referring to the new NCCAM researchblog. Dr. Briggs welcomes readers to the blog in the first post:

Like all of the NIH, our mission is to conduct the highest quality biomedical research to improve the health of the Nation. NCCAM’s special charge is to bring rigorous science to the broad array of health practices that have arisen from outside of mainstream medicine. This covers a lot of tough territory! Not surprisingly the conversation about complementary and alternative health practices has often become polarized, with competing views about what makes good sense. I hope to use this blog as a place for a conversation about these challenges.

Sounds like a plan! It’s also one reason why I encourage SBM readers to take part in that conversation, both here and on the NCCAM blog (although you should note that the comments on the NCCAM blog are moderated). I also thank Dr. Briggs for providing me with additional blogging material. In particular, I’d like to join the discussion started in the very first substantive post after her welcome. It’s about the word, “integrative,” which Dr. Briggs discusses in her second blog post, “Integrative” — What Is in a Word? It’s a very good question, although probably not in the way that Dr. Briggs intended it. What is in the word “integrative”? I’ve discussed the use of this word many times before, in particular how “integrative medicine” is a brand rather than a specialty, but before we get to my blather, let’s take a look at Dr. Briggs’ blather. Fair’s fair, after all.

First, Dr. Briggs tries to have it both ways, being a good skeptic but still accepting the CAM framing of science and language:

That seems simple enough but there are a lot of rough edges at the interface between conventional medicine on the one hand and use of complementary/alternative health approaches on the other, and “integrative” can get caught in a highly polarized debate. From one end, “integrative medicine” offers a holistic, gentle, patient-centered approach that will solve many our Nation’s most pressing health care problems. At another end, “integrative care” represents an evasive rebranding of modern equivalents of “snake oil” by practitioners who raise unrealistic hopes and promote approaches that are not sensible, supported by evidence, or proven safe.

This is the classic false equivalency. Notice how Dr. Briggs characterizes “integrative medicine” on the one hand as being all soft and fuzzy, the equivalent of mom and apple pie. Who could argue with “holistic, gentle, patient-centered” approaches? Well, actually, I can, because the word “holistic” is meaningless in this context. A good science-based primary care doctor is “holistic.” You don’t need to buy into woo to be a holistic doctor. Similarly, you don’t need to buy into woo to be patient-centered in your approach. In addition, as I’ve pointed out before, “patient-centered” is a wonderfully flexible term that can mean so many things to so many people, and the woo-meisters have certainly taken advantage of that in order to promote the idea that patient-centered care necessarily involves their favored quackery.

Now here’s the false equivalency. Dr. Briggs equates the above wonderfully Orwellian verbal prestidigitation that describes CAM (or “integrative medicine” or whatever you want to call it) as the path to holistic care with skeptics who point out that integrating quackery with real medicine makes no sense. As Mark Crislip so famously put it, “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

And if you “integrate” pseudoscience with science, it does not make the science more rigorous. If you mix quackery with real medicine, you do not make the real medicine better—or even more “holistic.” Much of “integrative medicine” represents, more than anything else, a return to pre-scientific beliefs, such as vitalism, miasmas, and illnesses being caused and cured by, in essence spirits or gods or magic. After all, reiki is nothing more than a form of faith healing, and most energy medicine is nothing more than magic, the belief that if you wish for something really, really hard, you can bend the universe to do your bidding and provide you with that thing, in this case, healing.

Dr. Briggs then asserts three “very well documented facts.” Unfortunately, none of these facts are unequivocally true—or even that particularly well documented. I’ll show you what I mean.

Here’s “fact” one:

Individuals, their health care providers, and their health care systems are all, on a large scale, incorporating various practices which have origins outside of mainstream medicine into multi-pronged treatment and health promotion approaches.

Well, yes and no. First the no. As I’ve explained many times, the evidence for this assertion is weak at best. Most surveys of CAM use include spirituality and prayer, which artificially inflates the numbers. It also includes exercise and meditation, both of which are arguably not from “outside the mainstream.” As I’ve pointed out before, when you look at the hardcore woo, such as homeopathy and the like, the numbers of people who use them are actually quite small and haven’t changed that much over the last decade. Now the yes. It is true that quackademic medicine has infiltrated medical schools and that many hospitals whose leaders should know better have embraced it.

Now here’s “fact” two:

This “integrative” trend among providers and health care systems is growing. Driving factors include perceived benefit in health or well-being, emerging evidence in at least some cases that perceived benefits of integrative are real and/or meaningful (e.g., management of chronic pain), and marketing of “integrative care” by health care providers to consumers.

OK, I’ll give Dr. Briggs this one—partially, anyway. The reason, however, is because Dr. Briggs cleverly worded it. Note how she refers to “perceived” benefit rather than actual benefits. She’s also right that the marketing of “integrative care” plays a large role in its current popularity. As I’ve pointed out before as well, “integrative medicine” is a marketing term, not a term that describes anything real. It’s more about keeping the customer satisfied rather than actually helping the patient. It’s a sham. It’s also quite arguable whether in the case of the management of chronic pain the perceived benefits of “integrative care” are real or meaningful. Indeed, some “integrative” modalities touted as effective are in fact science-based treatments, such as exercise and lifestyle interventions.

This leads to “fact” three:

With few exceptions, data to guide evidence-based decision making about safety and efficacy are at best preliminary.

No, no, no, no. With few, if any exceptions, data to guide science-based decision making about CAM or “integrative medicine” are negative. They do not work, by and large. As Kimball Atwood so famously described CAM modalities:

A spectrum of implausible beliefs and claims about health and disease. These range from the untestable and absurd to the possible but not very intriguing. In all cases the enthusiasm of advocates vastly exceeds the scientific promise.

Unfortunately, Dr. Briggs remains inordinately impressed with the concept of “integrative” medicine, calling it “simple” and “pragmatic” while declaring it a “very useful construct” that “focuses on major trends in 21st century health care.” In actuality, most CAM modalities focus on major trends in 17th or 18th century health care or even earlier. They are modalities steeped in prescientific beliefs because they have their origins in a time before we understood enough about how the body works and how health and disease occur not to attribute disease and health to mystical concepts. That is the reality of what CAM “integrates” with science-based medicine.

Oh, the pain, the pain…

One notes that Dr. Briggs emphasizes multiple times “nonpharmacological approaches” to pain management. No doubt this is because pain management is where placebo effects are most common. Be that as it may, she’s already produced one post on pain management. She begins by exulting about the science presented NIH Pain Consortium 7th Annual Symposium on Advances in Pain Research, which she attended, mentioning various targets and promising new pharmacological therapies. What impressed her inordinately (much as the word “integrative” appears to do) were the potential nonpharmacological approaches that, of course, fall under the rubric of complementary and alternative medicine (CAM). The reason she uses to justify this promise is recent data that find a serious problem with the abuse of prescription pain medications. This is indeed a serious problem, although one notes that in fields such as mine (cancer) there is considerable evidence that many patients are undermedicated for their pain as well. Be that as it may, this is how Dr. Briggs views the landscape:

Clearly, drugs are, and will remain, critically important in managing pain, but drugs alone are not enough. There is another important piece to pain management—patients also need strategies for self-care and ways to harness the huge impact that context, attention, emotional state, and reassurance can have on pain. NCCAM is bringing a special contribution to pain research by pursuing promising, nonpharmacological approaches to pain management; about 30 percent of our total research budget is focused on pain. Our research is built on evidence, still incomplete, that various mind and body approaches, such as meditation, guided imagery, yoga, tai chi, massage, and spinal manipulation, may have value as adjuncts in pain management. Some of these techniques are being integrated into pain management in health care facilities around the country. And, while there is a growing evidence base for their value, and a number of “real world” testimonials, there are still many areas of uncertainty. It’s my belief that NCCAM, by funding the kind of research that builds a critical, rigorous evidence base, can truly have an impact on pain management.

I find it rather revealing that NCCAM spends one-third of its budget on pain research. After all, pain is one symptom where placebo effects play a huge role. Consequently, if there’s an area where CAM modalities would be most expected to appear to show an effect, it would be in treating pain. Of course, if there’s one research area where it’s really hard to separate placebo effects from real effects it’s in pain research as well. Without really rigorous research design, any clinical study looking at the effect of a CAM modality on pain, particularly chronic pain, will be prone to many confounders, such as recall bias, regression to the mean, placebo effects, various biases that can creep into the design of clinical trials, and the like. Note how Dr. Briggs points out how there are a “number of ‘real world’ testimonials” supporting the efficacy of CAM modalities. No doubt there are. There always have been. Unfortunately, as we’ve documented time and time again for CAM modalities, in particular acupuncture, when CAM modalities are tested under truly rigorous conditions with appropriate controls the result is nearly always that they are indistinguishable from placebo.

There’s another consideration, and it goes to the heart of why NCCAM should even exist. Once again, there is nothing inherent in pain research that requires a separate institute dedicated to CAM, or “integrative medicine,” or whatever you want to call it. NCCAM is completely unnecessary for this sort of research; worse, it’s counterproductive. The reason is that it overlays woo on what should be rigorous scientific research. Worse, if the next blog post is any indication, NCCAM doesn’t even really want to do truly rigorous research.

Reversing the progression

If the pain research carried out at or funded by NCCAM were indeed highly rigorous, then I wouldn’t have much problem with it. I’d still argue that NCCAM as a center is completely superfluous, but I’d be more willing to accept its continued existence. Unfortunately, if the most recent post on the NCCAM blog is any indication, Dr. Briggs’ promise of building a “critical, rigorous evidence base” is a lot of hot air. This post was not written by Dr. Briggs, but rather by Richard Nahin, Ph.D., M.P.H., who is Senior Advisor for Scientific Coordination and Outreach at NCCAM and is entitled Observational Studies and Secondary Data Analyses To Assess Outcomes in Complementary and Integrative Health Care. I’m guessing that from the title alone you’ll be able to tell where this is going. You won’t be wrong. Dr. Nahin wants to encourage “pragmatic” trials of CAM modalities. It’s rather sad to see his rationale because he describes well the problems with observational trials and then concludes that they’re useful anyway:

Although observational studies cannot provide definitive evidence of safety, efficacy, or effectiveness, they can: 1) provide information on “real world” use and practice; 2) detect signals about the benefits and risks of complementary therapies use in the general population; 3) help formulate hypotheses to be tested in subsequent experiments; 4) provide part of the community-level data needed to design more informative pragmatic clinical trials; and 5) inform clinical practice.

The main difficulty with causal inference in such observational studies has to do with the fact that participants or their providers choose which therapies the participants receive. Invariably, this “choice” means that participants choosing one therapy may not have the same characteristics as participants choosing another therapy; one or more of these differences may be the true cause of any observed effects rather than the use of one therapy or another. This is, of course, very different than a well-designed randomized clinical trial of sufficient size, where the same process that randomly assigns participants to one treatment or another also helps to balance the characteristics of individuals in each group.

Here’s the problem. Nahin is putting the cart before the horse, as so many CAM apologists do. Pragmatic “real world” trials can be useful, particularly in terms of comparative effectiveness research, which will be more and more important in the coming years. There’s a caveat, though. It’s only useful to do pragmatic or observational trials after treatments have already had their efficacy and safety demonstrated in well-designed randomized clinical trials. In other words, for comparative effectiveness studies, there’s no point in comparing the “real world effectiveness” of two studies that haven’t yet been shown to be efficacious in randomized clinical trials. “Pragmatic studies,” which try to examine the “real world” effectiveness of a treatment are pointless if the treatment under study hasn’t actually been demonstrated to be efficacious yet in rigorous randomized clinical trials. And observational studies are right out, as we say, when randomized clinical trials of a modality have already failed to demonstrate efficacy, as is the case for the vast majority of CAM treatments that have been subjected to randomized clinical trials.

None of this deters Nahin. He proposes a number of methods to try to control for treatment self-selection, such as regression modeling or employing propensity scores or instrumental variables to match samples. Don’t get me wrong; I have nothing against these methods when they are appropriately used. However, they are utterly unnecessary for the sorts of questions that Nahin apparently wants to ask. They could just do randomized clinical trials, which would be less prone to the biases and shortcomings that necessitate all that statistical prestidigitation in the first place.

Steve Novella has made an excellent point multiple times on this blog and on his own about the normal progression of clinical trials. Usually, what happens is that clinical observations are made (or something is discovered in the laboratory and tested in preclinical models). Next come small pilot trials in humans. If those are promising, then larger, rigorous clinical trials are performed. These are the classic randomized clinical trials, either with placebo control or comparing the new therapy to standard of care therapy. Once large randomized clinical trials demonstrate efficacy, then, and only then, are “pragmatic” trials indicated in order to examine “real world” effectiveness. Indeed, frequently, as we have found out, treatments are less effective in the “real world” than they are under the idealized conditions under which randomized clinical trials are carried out. CAM advocates, however, tend to flip the order. Basically, when more rigorous randomized clinical trials fail to demonstrate efficacy, they tend to start advocating things like “pragmatic” trials because such trials are far more likely to be confounded by placebo effects and the various biases that randomized, double-blinded trials are designed to try to avoid. That appears to be exactly what Nahin is doing here.

In a way, I’m rather happy that NCCAM has a blog now, and it’s not just because it provides me with extra blogging material. The reason is that, even after just four posts, this blog demonstrates the very problems with “integrative” medicine (or CAM) in general and how NCCAM does research in particular. Despite Dr. Briggs’ attempts to portray NCCAM as doing only the most rigorous research and even though to some extent Dr. Briggs does appear to have succeeded in tightening up the scientific rigor of the center, in this blog we still see that NCCAM is steeped in the pseudoscientific attitudes that underlie so much of CAM. Dr. Briggs buys into the language of CAM, which is one of the most potent tools CAMsters have to make it seem as though they are not quacks, and the scientific leadership clearly buys into the idea that it’s acceptable to put the cart before the horse and do pragmatic trials and “real world” observational studies before they’ve actually demonstrated that CAM modalities can actually do anything above and beyond placebo.

All of this is why, more than ever, NCCAM should be dismantled, defunded, and its personnel absorbed into the rest of the NIH, where they could do some good.

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

Leave a Comment (23) ↓

23 thoughts on “NCCAM on “integrative medicine”: What’s in a word?

  1. nybgrus says:

    The comments so far are… interesting.

    In particular is the acupuncturists who are very excited that their woo is being investiaged and those relying very heavily on argumentum ad populum and anecdote.

  2. Janet Camp says:

    As I often tell my woo-inclined “friends” (they are all now in “s as their numbers dwindle), go ahead and set up (clearly labeled) Placebo Healing Centers and practice your magic–put them in your church basements. They should be free, of course, but if the grateful “patients” want to leave money in the donation box, okay I guess. Just don’t claim that it’s been studied, or that it’s medicine, or worst of all, try to get it reimbursed by insurance–and that is their goal.

  3. tgobbi says:

    Not exactly on topic, but since Orac mentions holism in this entry, I have a question on the subject that’s never been answered to my satisfaction. As I understand it, holistic practitioners treat the whole person, right? So, if that’s the case, how can there be “holistic dentists?” No kidding, they exist; I see their ads frequently.

    Several years ago one of these “holistic dentists” spent a short time participating on the Health Fraud discussion list. When I posed my question at the time, the guy’s response was typical of most pseudoscientific practitioners: he insulted me!

    So what’s the rationale behind purportedly “holistic” practitioners claiming such narrow specialties as dentistry?

  4. Eugenie Mielczarek says:

    I’m gratified to see continued acknowledgement of the need to defund NCCAM. When Derek Araujo and I submitted our policy report ‘A FRACTURE IN OUR HEALTH CARE ‘ to the Center for Inquiry in 2009 we were surprised when this concept was challenged. The report had been sent for editorial review to a leading scientist (skeptic) who objected to defunding because ‘we need to continue to test alternative interventions’. At that point I decided to download all grants issued from NCCAM 2000 -2010 and study all the numbers. This led to MEASURING MYTHOLOGY –Startling Concepts in NCCAM grants. MIELCZAREK/ENGLER published by the Skeptical INQUIRER Jan / Feb 2012. Where a study of the grants and the use of taxpayers’ dollars made the case for defunding more convincing. Interestingly one letter to the editor chided us for a call for defunding. He wrote “CAM is folk medicine which fills a gap when people lack access to or are failed by conventional medicine.” Strange reasoning –our argument (coauthors, Araujo and Engler) has always been that NCCAM’s funds would be better put to use funding scholarships for MD General Practitioners willing to work in rural areas. Summaries of our analysis were sent to congress in April 2011. We’re still waiting for Congress to consider this idea for a funding initiative. The problem revolves around the power of the CAM industry to block this health initiative.

  5. Harriet Hall says:

    I posted a comment to Dr. Nahin’s blog entry. No one else has commented. I urge others to do so.

  6. cervantes says:

    “Most surveys of CAM use include spirituality and prayer, which artificially inflates the numbers.”

    I don’t understand why you don’t consider prayer to be woo. How is it different from Reiki exactly?

  7. cervantes says:

    Well tgobbi, the idea of “holistic” medicine doesn’t mean you can’t have a biomedical specialty. It means the health care provider is concerned with people’s emotional well being, social and physical environment, and makes an effort to understand their goals, fears, wishes and preferences. In other words that they treat people as “whole people,” in the sense of having psychological and social as well as biological dimensions. I agree that dentistry would seem to offer less room for that than primary care, but I don’t see the idea of holistic dentistry as necessarily absurd.

    Of course, whether this guy uses the term the way I do, or whether he means that he includes acupuncture and magical chants in his practice, I don’t know.

  8. windriven says:

    “With few exceptions, data to guide evidence-based decision making about safety and efficacy are at best preliminary.”

    “No, no, no, no. With few, if any exceptions, data to guide science-based decision making about CAM or “integrative medicine” are negative.”

    I read Briggs’ third point differently (and perhaps incorrectly). I believe her to be saying that rigorous safety and efficacy information on many mainstream therapies are incomplete. In some ways this reading is no less disturbing than Dr. Gorski’s reading; in my reading Dr. Briggs seems to suggest that while sCAM modalities lack rigorous evidence, so do many modalities accepted by mainstream medicine. This conflates therapies grounded in myth and superstition with those that have evolved with at least some basis in science.

  9. Janet Camp says:

    He wrote “CAM is folk medicine which fills a gap when people lack access to or are failed by conventional medicine.”

    This is how many of the uninsured get started with woo–all the more reason to support and implement the ACA! There is a (sometimes) unspoken acceptance, even by some science-minded people that “folk medicine” is real–or better than nothing–or must work simply because it’s old–or that people wouldn’t have used it if it didn’t work (how did they know?).

    The other problem is books written by celebrities–and worse yet–MD’s (books that are in the “medical” section at the library and prominently featured in bookshops. Can you blame people for thinking this stuff is valid and looking to a book written by a doctor when they have no health insurance, haven’t met their huge deductible, or can’t afford the ever-rising co-pay? The ACA is already addressing these issues and I sincerely hope that some member of Congress will take up your funding initiative idea and frame it as debt reduction/gov’t waste so it may stand a chance of being “bi-partisan”.

    Thank you Ms. Mielczarek for your work on this topic, and for sharing it with this blog.

  10. cervantes says:

    Windriven writes: “Dr. Briggs seems to suggest that while sCAM modalities lack rigorous evidence, so do many modalities accepted by mainstream medicine. This conflates therapies grounded in myth and superstition with those that have evolved with at least some basis in science.”

    Well yes, but what Dr. Briggs says is literally true. I would actually like to see SBM spend a bit more time on the evidence base for standard medical practice and a bit less time on trashing quackery. We do get some of both here but the balance is off, in my opinion. The former is probably more important than the latter. In fact, the future of the health care system in the U.S. depends critically on cutting down on overdiagnosis, overtreatment, and ineffective treatment. Driving out the woo is actually less urgent.

  11. windriven says:

    @cervantes

    So would I. In fact my original comment included 2 paragraphs exploring that theme but I ultimately decided that it was slightly off-topic so I deleted them.

    Mark Crislip has addressed over- and mis- use of antibiotics and Harriett Hall has explored some entrenched unscientific positions taken by some physicians. Drs. Gorski and Novella have drawn a few sharp comparisons between EBM and SBM. But in general SBM seems far more concerned with the antics of the lunatic fringe than with practicing physicians.

    For instance I did a search of SBM a while back looking for references to Dartmouth’s Atlas Project but didn’t find anything. Their work would seem to provide foundation for some really interesting blogs. I would also be interested in seeing some critical analyses of some of the ‘best practices’ work being done.

    There are limits to the fraction of GDP that a country can spend on healthcare. Some would argue that the US is at – or beyond – that limit now. Overdiagnosis, overtreatment and ineffective treatment very likely consume a higher fraction of health care expenditures than all the hand-waiving, needle-tweedling and subluxation-chasing combined.

  12. Harriet Hall says:

    “Overdiagnosis, overtreatment and ineffective treatment very likely consume a higher fraction of health care expenditures than all the hand-waiving, needle-tweedling and subluxation-chasing combined.”

    I have written about overdiagnosis, overtreatment, and ineffective treatments. The reason you don’t find more of those articles on SBM is that the medical profession is already highly self-critical and these topics are regularly addressed in medical journals. We concentrate on topics that are not well-covered elsewhere. And this is a science-based blog rather than an economics-based blog. Cost-effectiveness is important, but we are more concerned with establishing efficacy and safety.

  13. David Gorski says:

    What Harriet said. Also, I too have written fairly extensively about overdiagnosis, overtreatment, ineffective treatments (such as vertebroplasty), USPSTF guidelines, as well as the difficulties of translating everybody’s favorite buzzword in medicine (“personalized treatment”) into practice. If you haven’t seen these sorts of posts from Harriet, Steve, myself, and others, you simply haven’t been paying attention. There are plenty of other places to get discussions of cost-effectiveness, extensive discussions of the shortcomings of “conventional” medical treatment, etc. We do discuss such matters, but they are not what we spend most of our verbiage on and I doubt that they ever will be. If that’s what you want to see a lot more of, you’ll have to go somewhere else, to some other blogs or websites, to get it. We write this blog about topics that interest us, and we make no apologies for that.

  14. David Gorski says:

    BTW, John Weeks of The Integrator Blog has commented on Dr. Briggs’ “integrative medicine” post. He doesn’t like her use of the term “integrative medicine” because he feels that the purpose of NCCAM is to explore alternative medicine (type his name into the SBM search box). I was actually surprised by this comment, because I’ve taken on some of Weeks’ blather before. He’s very much in favor of “integrative” medicine.

  15. NYUDDS says:

    @tgobbi: There are dentists who label themselves as “holistic” so that they attract a “new-age” type of patient by signalling that they treat “the whole patient.” They use hair samples, cranial orthopedics, vitamins and herbs, kinesiology, bracelets, magnets, massage, suggestion and many other modalities.
    http://naturaldentistry.us/holistic-dentistry/what-is-holistic-dentistry/

    Most of this is centered around treatment of “TMJ dysfunction” or clenching or grinding, habits or headaches, poisons and supplements….and woo. Much of the treatment, for instance, the Gelb Pain Center at Tufts U, started by a psychologist and periodontist, is rooted in chiropractic and trigger point therapy, food allergy and herbs. All this stuff evolves, not toward entropy as one would imagine, but toward validation(!) be it chiropractic, acupuncture, naturopathy, homeopathy etc. (My own training re: TMJ disorders is based on the Dawson Institute for Advanced Dental Studies and surgical work by Dr. Mark Piper, both heavily science-oriented.) Excellent dentistry can be done without being labeled “holistic.” When I had questions about “treating the whole patient”, I had a secret weapon: referral to the appropriate practitioner. Holistic dentistry is mostly based on fear and misinformation. For instance, Mercola recommends holistic dentistry.
    http://articles.mercola.com/sites/articles/archive/2012/02/18/dangers-of-root-canaled-teeth.aspx

  16. weing says:

    Thanks for explaining that. For a moment, I thought it was because they get rid of the holes in your teeth.

  17. windriven says:

    Dr. Hall said, “The reason you don’t find more of those articles on SBM is that the medical profession is already highly self-critical and these topics are regularly addressed in medical journals. ”

    Dr. Hall wrote: “How do you feel about Evidence-Based Medicine?” which discussed a Medscape Connect discussion among physicians who argued, among other things:

    “Experience trumps EBM”

    “Allopathic medicine doesn’t have a monopoly on knowledge”

    “EBM is code for rationing and cookbook medicine such that experience doesn’t matter.”

    These are medical professionals. Some of them probably have privileges at medical centers with “Integrative Medicine” units. A few may have gone to major medical schools which have incorporated sCAM into their curricula.

    It would appear, Dr. Hall, that the medical profession may have a way to go on the highly self-critical highway.

  18. Harriet Hall says:

    @windriven,

    “It would appear, Dr. Hall, that the medical profession may have a way to go on the highly self-critical highway.”

    Well, duh! That’s why we have to constantly write about integrative and quackademic medicine. What I meant was that if you read medical journals, you will find plenty about “overdiagnosis, overtreatment and ineffective treatment” in conventional medicine.

  19. windriven says:

    “If you haven’t seen these sorts of posts from Harriet, Steve, myself, and others, you simply haven’t been paying attention.”

    Gee, I actually cited contributions from Drs. Hall, Novella, Gorski and Crislip (aka ‘others’). I guess I have been paying attention.

    “If that’s what you want to see a lot more of, you’ll have to go somewhere else,”

    Touche’.

  20. Scott Gavura says:

    @cervantes – You may have missed my recent posts:
    - How do we avoid harming the elderly with prescription drugs?
    - Gold mine or dumpster dive? A closer look at adverse event reports
    - Drug Interactions, Polypharmacy, and Science-Based Medicine
    - Tylenol: Safe painkiller, or drug of hepatic destruction?
    - Good Idea, Bad Execution: Dosing Errors, A Preventable Harm

    All are critical of different components of the current medical model, or of approved drugs. These types of topics are covered frequently in medical journals as well. If there’s an SBM angle I’ll try to cover it. But I’m like Mark Crislip, and I generally rely on The Secret to prioritize for me. That, or walking through a pharmacy, never fails me.

  21. herbalgram11 says:

    Speaking of “collateral damage”, it seems that drug-based medicine is as dangerous to life and limb as fighting in a war: //www.anh-europe.org/sites/default/files/UK_Bubbles_Graph_2012_9_July_Fin.pdf .

    Add to this the cost to society – the massive waste of public funding, without corresponding improvements in public health over the past 50 odd years – and the cost of widespread fraud prevalent in this sick(ness) industry –

    http://www.anh-europe.org/news/gsk-have-admitted-they-are-guilty-of-fraud-let’s-boycott-their-products

    and you get an idea of what “collateral damage” is: the loss of human health and life.

    It’s not a coincidence that war mongerers and proponents of using toxic chemicals as medicines use this pejorative so easily.

  22. WilliamLawrenceUtridge says:

    Speaking of “collateral damage”, it seems that drug-based medicine is as dangerous to life and limb as fighting in a war: //www.anh-europe.org/sites/default/files/UK_Bubbles_Graph_2012_9_July_Fin.pdf .

    Of course, unlike fighting a war, illness is inevitable (and generally not voluntary). Also, “fighting a war” is not a side effect with a benefit, unlike drugs. Insulin may cause a diabetic coma if used improperly, but it’ll prevent you from dying of diabetes. Warfarin is a very, very dangerous drug that can cause people to spontaneously bleed from all orifices but it is only used in extreme cases where blood clots are themselves posing a danger to patients (and fortunately there is research on different compounds that will hopefully be safer). So yes, drugs have side effects, which can be deadly. But the math isn’t simply side effects = death, the math is more like untreated condition + drugs – side effects = recovery. Drugs are used when needed, not simply on a whim. And efforts to reduce adverse effects are an ongoing topic of research.

    Add to this the cost to society – the massive waste of public funding, without corresponding improvements in public health over the past 50 odd years – and the cost of widespread fraud prevalent in this sick(ness) industry –

    Really. No corresponding improvements in health in the past fifty years. That’s funny, because the World Bank suggest that over the past 50 years life expectancy has increased by a decade. Going back even further, it looks like it has increased from 50 years in 1900 to nearly 80 now.

    Yes, GSK committed fraud, yes drug companies are bastards, but that doesn’t mean drugs are ineffective or herbs are the answer.

    It’s not a coincidence that war mongerers and proponents of using toxic chemicals as medicines use this pejorative so easily.

    If you have an alternative that is as effective at saving lives, but has fewer adverse effects – please, let’s hear about it. Please provide links to pubmed.

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