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On the “individualization” of treatments in “alternative medicine”

One of the claims most frequently made by “alternative medicine” advocates regarding why alt-med is supposedly superior (or at least equal) to “conventional” medicine and should not be dismissed, regardless of how scientifically improbable any individual alt-med modality may be, is that the treatments are, if you believe many of the practitioners touting them, highly “individualized.” In other words, the “entire patient” is taken into account with what is frequently referred to as a “holistic approach” that looks at “every aspect” of the patient, with the result that every patient requires a different treatment, sometimes even for the exact same disease of very close to the same severity. Indeed, as I have described before, a variant of this claim, often laden with meaningless pseudoscientific babble about “emergent systems,” is sometimes used to claim that the standard methods of science- and evidence-based medicine are not appropriate to studying the efficacy of alternative medicine. Of course, this is, in nearly all cases, simply an excuse to dismiss scientific studies that fail to find efficacy for various “alt-med” modalities, but, even so, it is a claim that irritates me to no end, because it is so clearly nonsense. As Harriet Hall pointed out, alt-med “practitioners” frequently ascribe One True Cause to All Disease, which is about as far from “individualization” as you can get, when you come right down to it. More on that later.

A couple of years ago, before I became involved with this blog, I was surprised to learn that even some advocates of alt-med have their doubts that “individualization” is such a great strength. I had never realized that this might be the case until I came across a post by naturopath Travis Elliott, who runs a pro-alt-med blog, Dr. Travis Elliott and the Two-Sided Coin, entitled The Single Most Frustrating Thing About (Most) Alternative Medicine. In this article, Elliott referred to a case written up by a fellow naturopath, who used an anecdote about the evaluation and treatment plan by a naturopath of a pregnant woman with nausea to show what is supposedly the “unique power of our medicine.” Unexpectedly (to me at least at the time), Elliott did not quite see it that way:

The physician who wrote the article is a chiropractor and naturopath whose practice is nearly 100% musculoskeletal issues. He said that he nearly always refers patients out for other issues, but this case was a woman who requested that he treat her pregnancy-related nausea.

This physician tried, in a series of appointments: ginger root, raspberry tea, pre-natal vitamins, a blood-type diet, acupuncture, acupressure, and spinal manipulation. None of these treatments worked, but the patient persevered.

Finally, the physician reached further in to his toolbox and prescribed a homeopathic remedy that cured her on the spot. The physician noted, “we are so fortunate as naturopathic physicians to be trained in many modalities. … This case reminded me that [we can treat on a much more personalized level] when we are equipped with so many different tools.”

This particular aspect of alt-med reminded me of a disparaging parody of the various nonsense to which many alt-med practitioners subscribe, namely:

If you try bazillions of cures until symptoms go away, then declare the last one to be a cure, you might be an alt-med believer or practitioner.

Which is most likely what happened in the case described, particularly since the last “remedy” tried was homeopathy, arguably the most utterly ridiculous and scientifically implausibly risible “treatment” ever conceived by a human mind. Most likely, what happened is that this patient’s symptoms either regressed to the mean or resolved on their own through the natural course of the condition, and this improvement just so happened to correspond with the trial of a homeopathic remedy. Be that as it may, however, Elliott brought up an interesting point, one that I’ve never heard an alt-med practitioner or promoter bring up before:

This case can certainly be hailed as a success, since the patient was healed and no harm was done by the initial treatments that didn’t work. But I can’t help but feel badly for the woman for having to go through so much trial and error to get results. I mean, it probably cost a significant amount of money to keep returning to this physician for his next guess.

This is exactly the kind of situation that frustrated me when I practiced naturopathic medicine. How did I know what would work for a patient? (I didn’t.) And just like this physician, I didn’t think that there was any way to know, either. I could try and learn from each patient and apply that knowledge to the next one with similar symptoms, but each patient was so unique that what cured one person might have no effect on the next.

Meanwhile, patients are forced to try treatment after treatment, doctor after doctor in search of a solution that works.

Of course, I can’t help but marvel at the irony here. Indeed, the above passage fried my irony meter until nothing was left but a smoldering, smoking, quivering blob of metal and rubber crying out feebly, “¡No mas, no mas!” If such a patient went to a conventional doctor (or to multiple conventional doctors) with a complaint of nausea, and various remedies were tried and didn’t work, just imagine the reaction of various defenders of alt-med to that! This same case, if it had been handled by “conventional medicine” would be cited by alternative medicine aficionados as “evidence” of how ineffective “conventional medicine” is or how it can’t deal with common problems! Indeed, how many times have you heard “testimonials” that begin with a patient describing a trek from doctor to doctor, all of whom were unable to diagnose the problem or find an adequate treatment to relieve the patient’s symptoms? I can just hear it now: The sarcastic commentary about how poorly conventional medicine does with problems such as nausea in pregnancy and how superior “alternative medicine” is in dealing with such complaints. Yet, here we have a case being presented by a naturopath in which the hapless patient was forced to try remedy after remedy, none of which worked until the end, in which it is not clear whether the “homeopathic” remedy actually did anything (chances are, for obvious reasons, that it did not) or the nausea simply resolved on its own thanks to the tincture of time, as nearly all nausea and vomiting during early pregnancy does. Indeed, this problem will resolve in 90% of women by the 20th week of gestation. (How many weeks did this woman try naturopathic remedy after naturopathic remedy?) And this case is presented as a success! Now that I think about it, hanging around the alt-med Usenet newsgroups years ago, I heard similar stories time and time again. If you lurk on the CureZone message boards, you’ll find hardcore alt-med believers discussing trying various remedy after remedy, touting some and dismissing others contemptuously, all on the basis of little or no evidence.

After praising some sort of alternative medicine diagnostic modality called the BodyTalk system, which, supposedly greatly decreases this extensive “trial and error” approach, Elliott concluded:

Two years ago, I would have wholeheartedly agreed this case of nausea was a great success. But now that I know better, I see it as another sign of how far alternative medicine needs to go.

Yes, “individualization” of treatments is touted as the greatest strength of alternative medicine. Who can argue that this is a wonderful thing?

I can, at least to a point.

Here’s the problem with “individualized” treatments. Taken to an extreme, as many alternative medicine practitioners do, “individualization” becomes in essence an excuse to do whatever the heck the practitioner feels like and not to have to list diagnostic criteria or show actual efficacy of their treatments in a way that others can replicate. Look at Dr. Elliott’s statement: “Each patient was so unique that what cured one person might have no effect on the next.” Certainly, organisms such as humans can and do show considerable variability in their biology and response to treatment, but rarely so much that what “cures” one person will have no effect on the next. Such extreme emphasis of “individualization” is virtually custom-designed to lead to exactly the sort of marathon trial-and-error treatment histories he described.

Let’s compare and contrast. In “alternative medicine,” it is very frequent that consultations by different practitioners for the same patient with the same symptoms will result in completely different diagnoses and courses of treatment. In contrast, although there can certainly be disagreement among conventional doctors about the diagnosis and/or treatment for an individual, at least in cases that are atypical or represent uncommon diseases or conditions, such disagreements tend to occur within a much narrower range of possibilities. That is because science-based practitioners will have more standardized diagnostic criteria based on scientific evidence, rather than the individual idiosyncrasies and beliefs of different practitioners. In essence, science-based medicine, through clinical trials and research, has done a lot of the trial-and-error work already, so that individual practitioners don’t have to. The result is protocols that work for a majority of patients. Even when those protocols do not produce the desired results, the choices for “individualization” of therapy are much narrower and based on science and evidence gleaned from clinical trials of large numbers of patients. True, one danger is that this can devolve into “cookbook medicine,” but in reality, as long as the protocols are not too rigid, the good of such protocol-based medicine very likely outweighs the bad. In alt-med, however, what is tried first depends almost entirely on the individual practitioner, as does what is tried next — and next and next and next. There is no standardization and no scientific basis on which to choose treatments.

This emphasis on “individualization” in alternative medicine is particularly ironic when we consider certain specific alternative medicine practitioners, in whose practice disease causation all too often devolves into ludicrous commonalities in which there is claimed to be a single cause for many diseases. For example, the late Hulda Clark used to claim that “all cancer” is caused by intestinal flukes and that “the cure for all cancers” is in essence the same for everyone, a degree of standardization that even the most dogmatic practitioners of evidence-based medicine would find hard to swallow. (It should also be noted that, in an amazing bit of irony, Hulda Clark died of multiple myeloma; i.e., cancer.) After all, no practitioner of science-based medicine who actually knows something about cancer would ever claim that “all cancer” has a single cause. Similarly, Clark claimed to have the cure for AIDS based on similar principles, even though the causes of AIDS and various cancers are clearly different. Meanwhile reiki therapy, acupuncture, and a wide variety of other alternative medicine modalities claim that all disease is due to an “imbalance” in your life energy (qi) or a blockage in the flow of qi that needs to be eliminated; the only way that they differ is in the methods that they use to alter the flow of qi in order to cure. Or consider the case of the frequent alt-med claim that some therapy or other “boosts the immune system,” as if that were always a good thing and there were no such things as autoimmune disorders due to the excessive or in appropriate activation of the immune system. Truly, Harriet was right on target when she lampooned the tendency of different “disciplines” of alt-med to ascribe One True Cause to all disease.

Indeed, one of the most hilariously over-the-top example of this is “Dr.” Robert O. Young, a man I mentioned at my talk during the SBM conference at TAM7 last year, a man for whom acid is the disease and baking soda (in essence) is the cure for all disease. I’ve been meaning to write about him; he has some amazing gems, such as when he claims that cancer is a acid. So are viruses. And acid is the cause of all disease. I’ll add Young to the queue of topics I want to blog about. In the meantime, for your edification here is the slide in which I featured him at TAM7:

Robert O. Young

And Young is just one example of an “alt-med” practitioner who ascribes all disease to in essence a single cause.

In the end, this fetish for “individualization” in alternative medicine is a sham. It’s invoked when it is convenient to do so, particularly in the cases of “treatments” like homeopathy, in which any therapeutic effect perceived is due to the placebo effect. However, if you think about it, many alternative medicine modalities are far more rigid than conventional medicine in ascribing a specific cause to disease. When you come right down to it, the emphasis of alt-med on “individualization” and “treating the whole person” consists of little more than marketing buzzwords. There’s no evidence that alt-med does any better at treating the “whole patient” than conventional medicine and considerable evidence that, by lumping many diseases of unrelated pathophysiology together and using the same treatments for them, alternative medicine’s claim of “individualization” means the freedom to keep trying stuff until the patient’s symptoms get better on their own.

Posted in: Clinical Trials, Energy Medicine, Homeopathy, Science and Medicine

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46 thoughts on “On the “individualization” of treatments in “alternative medicine”

  1. jimpurdy says:

    You said:
    “In “alternative medicine,” it is very frequent that consultations by different practitioners for the same patient with the same symptoms will result in completely different diagnoses and courses of treatment. In contrast, although there can certainly be disagreement among conventional doctors about the diagnosis and/or treatment for an individual, at least in cases that are atypical or represent uncommon diseases or conditions, such disagreements tend to occur within a much narrower range of possibilities.”

    Maybe that’s the way it should work with “conventional” medicine, but it can be very revealing sometimes to seek a second or even a third opinion.

    I have sometimes had two “conventional” doctors, from the same medical group, looking at the same data, arrive at very different diagnoses and treatment plans.

    I’m certainly not defending bizarre methods like homeopathy, but I’m just pointing out that “conventional” medicine is far from infallible.

    The 50 Best Health Blogs

  2. BillyJoe says:

    “In the end, this fetish for “individualization” in alternative medicine is a sham. It’s invoked when it is convenient to do so, particularly in the cases of “treatments” like homeopathy”

    I suppose everyone here knows of Dana Ullman.
    He is heavily into “individualisation” by homoeopaths but, through his website, he sells all manner of “standard” remedies which you can buy yourself without any “individualisation” by a homoeopath.
    For example, oscillococcinum can be taken by everyone to treat flu like symptoms regardless of your actual symptoms and with no need for “individualisation” by a homoeopath.
    Cognitive dissonance anyone?

    David Gorski,

    “Most likely, what happened is that this patient’s symptoms regressed to the mean”
    “Indeed, this problem will resolve in 90% of women by the 20th week of gestation”

    Just a little nit pic here:
    Regression to the mean is not the same as the following the natural history of the disorder. Regression to the mean is applied to chronic conditions that wax and wane in severity. Your second explanation seems to be correct in this case – nausea of pregnancy resolves naturally by about the 20th week of pregnancy in most cases.

    regards,
    BillyJoe

  3. Mojo says:

    Indeed, as I have described before, a variant of this claim, often laden with meaningless pseudoscientific babble about “emergent systems,” is sometimes used to claim that the standard methods of science- and evidence-based medicine are not appropriate to studying the efficacy of alternative medicine. Of course, this is, in nearly all cases, simply an excuse to dismiss scientific studies that fail to find efficacy for various “alt-med” modalities

    For some reason homoeopaths never seem to cite this systematic review: Linde K, Melchart D: Randomized controlled trials of individualized homeopathy: A state-of-the-art review. J Altern Complement Med. 1998 Winter;4(4):371-88.

    …when the analysis was restricted to the methodologically best trials no significant effect was seen.

    They often prefer to claim that such trials have never taken place, for example here (NB – keep your irony meter away from the headline):

    There has never been a proper trial of homeopathy. There have been countless trials based on the methodology applied to orthodox medicines, as if homeopathy is a form of orthodox medicine. Some have been positive, most negative. This proves nothing, because what they have tested was never homeopathy in the first place. In orthodox trials, all patients in the “real” group are given the same drug for the same length of time. Homeopaths do not work like that. For one condition, they may select one of a dozen or more remedies, chosen after long and detailed interviews. They see patients repeatedly over the course of months or years, refining and changing prescriptions, and watching a steady development that follows a strong internal logic. It is a long process. But this is how homeopathy works: mangling it for the chance to jump on the clinical trial bandwagon is not science. No scientist of repute carries out tests of A by running trials of B. All the vaunted meta-analyses that proclaim the ineffectiveness of homeopathy are scientifically illiterate, as Ben Goldacre seems to be in this instance.

  4. Nescio says:

    Blogging about Robert O Young might be a little like shooting fish in a barrel. Apart from “acidity is the cause of all diseases”, you have pleomorphism, live blood analysis, curing type 1 diabetes, red blood cells being made in the intestinal villi, hormones as acidic waste products, urine pH reflecting tissue pH, the stomach should not be acidic, antibiotics do not kill bacteria, and much more mind-numbing stuff… Where would you start?
    http://articlesofhealth.blogspot.com/search?q=seventeen+lies

  5. Beowulff says:

    In the end, this fetish for “individualization” in alternative medicine is a sham. It’s invoked when it is convenient to do so, particularly in the cases of “treatments” like homeopathy, in which any therapeutic effect perceived is due to the placebo effect.

    Never mind that it doesn’t take a medical scientist to come up with a protocol for a double-blind test for “individualized” homeopathic prescriptions.

    For example, you could just let the homeopath prescribe whatever individualized homeopathic pills they want. Then, when it’s time to pick up the pills, secretely switch the pills for placebo pills for half the patients. It’s really that simple.

  6. DevoutCatalyst says:

    “The physician…is a chiropractor”

    Can the physician also be a rutabaga?

  7. Gabor Hrasko says:

    I like how you describe that CAM practitioners are actually performing – non randomized, non blinded – clinical trials on their patients every day. That is what I experience also. They see it as a virtue. Of course due to the “holistic”, “personalized” approach no real experience can be gained from this “trial” as the next patient will be different again.

    Even in homeopathy the real life practice is not-so-personalized. It is the same as for astrology. It is – in theory – highly personalized, but in fact 99.9% of its believers read their horoscopes from the magazines where they are simply grouped into 12 signs. That is not very much a personalized service! In homeopathy there is a so called “clinical homeopathy” version which is highly simplified. Of course, as otherwise it would not be such a good business. Furthermore see the huge advertisements of Oscillococcinum (at least here in Hungary). It is against flu. Also the general web pages promoting homeopathy sell homeopathic remedies for individual illnesses and not for individual people.

  8. David Gorski says:

    Regression to the mean is not the same as the following the natural history of the disorder. Regression to the mean is applied to chronic conditions that wax and wane in severity. Your second explanation seems to be correct in this case – nausea of pregnancy resolves naturally by about the 20th week of pregnancy in most cases.

    Fair enough; my wording was somewhat poor. I had meant to mention both regression to the mean and the natural course of an illness or condition as possibilities. I’ve altered the text to do just that. Thanks.

  9. Mojo says:

    Beowulff: see the review I cited above, which found, as of 1998, 32 trials of varying design and quality.

    Some were carried out pretty much as you describe while others, for example, allowed prescribing from a limited number of remedies that would be commonly given to patients with the particular conditions/symptoms being studies. One of them (as far as I remember) used a single remedy and only admitted patients with overall symptoms corresponding to that remedy.

  10. David Gorski says:

    Blogging about Robert O Young might be a little like shooting fish in a barrel.

    True enough, but sometimes it’s necessary to shoot fish in a barrel in order to reveal the depths of a form of quackery. In any case, I’d start with his “acidification” as being the One True Cause of All Disease.

  11. superdave says:

    The logic here is so twisted, reading about it is almost like looking at the sun. If I stare too long it hurts my eyes.

  12. Calli Arcale says:

    Indeed, as I have described before, a variant of this claim, often laden with meaningless pseudoscientific babble about “emergent systems,” is sometimes used to claim that the standard methods of science- and evidence-based medicine are not appropriate to studying the efficacy of alternative medicine

    Of course, this isn’t nonsense because emergent systems are nonsense. It’s nonsense because emergent systems most certainly can be tested scientifically, and frequently is. It cheeses me off when pseudoscientists use it as a cop-out — or, more frequently, merely as the lastest “quantum”. A marketing buzz-word to make them sound sciency.

  13. Calli Arcale says:

    Er, I mean “frequently are“. Number agreement fail.

  14. Harriet Hall says:

    Another glaring irony in the case described: the practitioner was clearly treating a symptom. CAMsters usually claim that conventional medicine “only treats symptoms,” while they treat the underlying cause of disease!

  15. Zoe237 says:

    Hey, this pregnant woman could have just tried some pot- that’s supposed to relieve nausea.

    I’m amazed at the amount of money this woman probably wasted trying to cure her nausea, but don’t really see the big deal other than that. If she has money to waste, go for it. Frustrating, but not dangerous.

    I’d be careful of throwing out a good idea (individualizing treatment plans, in moderation) just because it comes from a quackster.

    Totally agree with the characterization of these CAM arguments though. Thanks for the article.

  16. cervantes says:

    When making this argument it is important to acknowledge — and you do skirt around it a bit — that much of medical practice is empirical trial and error. It took three or four tries for my doctor and me to get a hypertension regimen that worked — I wasn’t very responsive to beta blockers, thiazide left me prone to postural hypotension — and simvastatin made me sick so I ended up on lovastatin. That sort of thing. Happens all the time.

    Diagnosis often proceeds similarly. Maybe it’s this, we’ll try that — nope, that didn’t work, let’s move down the list.

    Now, the list consists of remedies that have been shown to be superior to placebo in clinical trials, but that doesn’t mean they worked for everybody — usually they didn’t! And the diagnoses have solid ontological status in most cases, although not necessarily in psychiatry, and there are also physical syndromes of unknown etiology that aren’t necessarily “real” either. So we aren’t always on such solid ground ourselves.

    We’re trying to learn more and get more solid, which the woomeisters aren’t doing, but we shouldn’t overreach with our smugness.

  17. Calli Arcale says:

    It’s only a big deal because of people making money off of her desperation.

    It’s not really about the individual cases, though. It’s easy to go for the libertarian argument (as I am usually wont to do in other contexts) and say “what’s the harm?” and “buyer beware” when it’s just one person getting fleeced. But it’s not just one person. It’s millions. Collectively, real economic damage is being inflicted, and that means that the system as a whole is less efficient.

    And, of course, this is a case where no material harm results. There are definitely cases where real material harm does result (visit What’s the Harm for more information). Just because she got off okay doesn’t mean the next person will too, and her apparent success may be exploited to encourage others to believe in things that are outright frauds. Even seemingly harmless therapies can cause harm, through inaction, because they can delay the pursuit of effective therapies.

    So it’s not so much that she tried a bunch of garbage that didn’t work. It’s more that her case is emblematic of a larger problem.

  18. EricG says:

    @ HH

    “Another glaring irony in the case described: the practitioner was clearly treating a symptom. CAMsters usually claim that conventional medicine “only treats symptoms,” while they treat the underlying cause of disease!”

    um…see, they box themselves in there – wouldn’t that be abortion?! I believe the symptoms are, in any variety of cases, *exactly* what we ought to treat, no?

  19. Zoe237 says:

    “And, of course, this is a case where no material harm results. There are definitely cases where real material harm does result (visit What’s the Harm for more information). Just because she got off okay doesn’t mean the next person will too, and her apparent success may be exploited to encourage others to believe in things that are outright frauds. Even seemingly harmless therapies can cause harm, through inaction, because they can delay the pursuit of effective therapies.

    So it’s not so much that she tried a bunch of garbage that didn’t work. It’s more that her case is emblematic of a larger problem.”

    Hmmm… yes, I can see that. I’m someone who has combatted intelligent design in science class for a few years. The problem isn’t that some people believe the earth is 6000 years old, people are free to believe what they want. The problem is that they changed “creationism” to “intelligent design” and tried to infiltrate science classrooms. Believe what you want, but don’t call it science and try to force it down everybody’s throats. So in that vein, I can understand that the problem with some of these practices is that the CAM audience is trying to define their methods as “medicine” before it’s been proven as such. I can see that is has been far more successful than intelligent design in infiltrating the mainstream of medicine. And really, it’s more like religion in that way as well.

    So the M in CAM is more of a misnomer.

  20. pmoran says:

    One of the most annoying aspects of “alternative” medicine is the pretentiousness of many of its claims.

    The advertising promises “treatment as an individual” and a “holistic” approach, but the therapeutic model employed is almost invariably identical to the science-based one, with judgments being made as to the nature and causes of the illness, and treatments being selected on that basis.

    The only difference is that the diagnoses are speculative and the treatments unproven, wherever they are not both frankly silly.

    The holistic approach has one possible advantage for the practitioner, however. It is a license to delve more deeply into the patient’s psyche and life circumstances than some patients with psychosomatic complaints may tolerate from their mainstream doctors.

  21. Lawrence C. says:

    I appreciate the focus of this post and the examples cited. Of all the claims made by CAM this is one of the most disingenuous and one that is definitely about advancing “marketing buzzwords’ on the credulous and innocent.

    But if the CAM folks could be right, I really wonder what kind of appointment I’d have at a CAM practitioner as compared to the visit to my (board certified) internist two weeks ago. I was reasonably sure I had a sinus infection so I called and made an appointment. I was addressed by name and seen individually. My doctor examined me including looking in my ears and nose with an otoscope, not just poking it in anyone wandering down the street. We discussed several treatment options and he prescribed a course of treatment specifically based on my individual medical history and currently presenting symptoms. I was given two scripts with my name on them. The pharmacy dispensed them for me and also went over the instructions again with me to be sure I understood everything. I am assuming the diagnosis and treatment were accurate as the symptoms have completely resolved, all confirmed at follow-up visit that went much like the first one except that I did not need any more prescriptions.

    Yes this is anecdotal stuff, but how could a CAM practitioner not consider this an “individualized” experience for this patient? The only thing I can think of that might be a legitimate criticism in other places is that some people do feel like a rushed and hurried “number” in many managed care plans (HMOs) and maybe CAM folks take advantage of this unfortunate situation to market these “individualized” treatments. If so, it’s not the fault of the medicine or medical practice but the financially driven system that schedules too many people for too few doctors and nurse practitioners.

    (As a side note, my doctor’s receptionist and I share the same joke at the end of each visit. I always ask for my “homeopathic cure” and she hands me a lollipop. I suppose some might assume that there was a diluted cure in that random, yummy sugar that did all the work (the candy was from Germany!) but I’m placing my bet on the individually prescribed medications.)

  22. Fifi says:

    Really, what a lot of alt-medicine does is simply take a scientific breakthrough or new field of research and then exaggerate about it and make outlandish claims that no SBM researcher or MD ever would.

    As research has started to reveal the genetic basis for many different illnesses – for instance, that certain genes make some women more likely to develop certain kinds of breast cancer, etc – the possibility arises of a more targeted (personalized) diagnosis and a treatment that more effectively targets a certain genetic form of an condition in a more focused way. We ARE all an N of 1 (this doesn’t mean general statistics aren’t useful, they are often likely to apply to us as individuals but there will be times they may not). This is why MDs ask for family histories of disease as a means to be alert to that potential in a patient. Why disparage personalized medicine when it’s actually an exciting area of SBM research? Why not reclaim it and explain why it’s not a fantasy in SBM but is in alt-med?

    It’s a bit like bashing lifestyle as a contributor to disease and ceding this ground to alt-med when it’s actually SBM that’s doing all the research and making all the real discoveries (that then get claimed by alt-med!). The research on Vitamin D is a very good example of this. Vitamin D wasn’t even on the alt-med radar until SBM research started publishing studies showing that many people in Northern latitudes are Vitamin D deficient and the relationship between Vitamin D deficiency and cancer. Then alt-med took these studies, exaggerated the claims (ie. “cures cancer” rather than noting that vitamin D deficiencies may contribute to the development of cancer so adequate levels can be preventative) and started to use SBM research to “prove” that real medicine and real cancer treatments suck and to claim that doctors are ignorant about nutrition, lifestyle and disease.

    So, while alt-med is doing a lot of hand-waving and conjuring rituals about personalized medicine – and claiming that it inhabits that territory – it’s actually SBM that’s showing true potential to deliver personalized medicine.

  23. BillyJoe says:

    Cervantes,

    “When making this argument it is important to acknowledge…that much of medical practice is empirical trial and error.”

    The difference is that medicine based on science has plausibility (or high prior probability) and an evidence base (or, at least, that is the aim – not yet fully realised of course).

    “It took three or four tries for my doctor and me to get a hypertension regimen that worked ”

    The other part of medicine is for the doctor to apply that evidence to patient he has in front of him. Trials are done on healthy people (except for the condition being treated of course). The doctor’s patient is rarely so fortunate. There are also the patient’s social, religious, ideological, and financial situations to take into account.

    “Diagnosis often proceeds similarly. Maybe it’s this, we’ll try that — nope, that didn’t work, let’s move down the list.”

    Of course, but there ARE well defined diseases. The art of medicine is to find the correct one for the patient. In altmed there aren’t any diagnoses to start with so it’s impossible to get the diagnosis right

    “Now, the list consists of remedies that have been shown to be superior to placebo in clinical trials, but that doesn’t mean they worked for everybody — usually they didn’t!”

    No, but it is acknowledged that not everyone will respond and percentages are even attached. In altmed, no one responds to the treatment. It’s all placebo.

    “…and there are also physical syndromes of unknown etiology that aren’t necessarily “real” either. So we aren’t always on such solid ground ourselves.”

    There are diagnoses where not everyone agrees there is a disease (for example, Chronic Fatigue Syndrome and Fibromyalgia) because there are no diagnostic tests, just a constellation of symptoms. I would say they are in a minority though.

  24. Ken Hamer says:

    [quote]“The physician…is a chiropractor”

    Can the physician also be a rutabaga?[/quote]

    The real question is can a rutabaga be a physician?

    The answer is yes, if it’s a homeopath.

  25. nord says:

    Oh the acid! it all makes sense now… since exercise can reduce the pH of your blood, you are just increasing your chances of disease. I’d better stop telling overweight clients to exercise. Little did I know I was giving them cancer! YIKES.

  26. Mojo says:

    @Cervantes:

    When making this argument it is important to acknowledge — and you do skirt around it a bit — that much of medical practice is empirical trial and error. It took three or four tries for my doctor and me to get a hypertension regimen that worked — I wasn’t very responsive to beta blockers, thiazide left me prone to postural hypotension — and simvastatin made me sick so I ended up on lovastatin. That sort of thing. Happens all the time.

    This, along with what Lawrence C. and BillyJoe have written above, highlights the strawman attack on medicine that is implicit in CAM’s claims of “individualisation”. Doctors (if they are any good at all) don’t treat all patients the same.

  27. Mojo says:

    @Fifi: what makes you think that anyone disparages personalised medicine, or bashes lifestyle as a contributor to disease?

  28. Mojo says:

    @Zoe237:

    So in that vein, I can understand that the problem with some of these practices is that the CAM audience is trying to define their methods as “medicine” before it’s been proven as such. I can see that is has been far more successful than intelligent design in infiltrating the mainstream of medicine.

    You also have to remember that less than a lifetime ago the mainstream of medicine was little better than CAM is these days. Doctors “knew” what worked, and were highly resistant to the idea that their personal observations (and authority) could be overruled by the results of RCTs. So culturally, the medical profession is still used to accepting that things work on what is effectively anecdotal evidence. For an account of the process by which medicine has been (and in fact still is being) dragged, kicking and screaming, into the scientific age, I can recommend Druin Burch’s book Taking the Medicine.

    As CAMsters are so fond of reminding us, many orthodox treatments are still not backed up by rigorous evidence. Of course, CAM uses this as an excuse for not testing itself, and only sees it as a problem for real medicine.

  29. yeahsurewhatever says:

    This case can certainly be hailed as a success, since the patient was healed and no harm was done by the initial treatments that didn’t work.

    I believe the patient’s pocketbook would tend to disagree.

  30. Beowulff says:

    @Mojo:

    see the review I cited above, which found, as of 1998, 32 trials of varying design and quality.

    Yes, I noticed your reference after I posted my comment – you must have written it while I was writing mine. I knew that such trials have been done (and have been less than spectacular), but I didn’t bring it up, because I didn’t have the references to back it. So thanks for posting that.

    Also, my point was mostly that even a lay person like me can come up with ways to test “individualized” treatment in a double-blind randomized way, and can explain how to do it in a few simple sentences. This makes the claim of some homeopaths that you couldn’t test their treatment because it is “individualized” completely laughable.

  31. Mojo says:

    @Beowulff:

    What is even more laughable about the example I posted was that in the article it was replying to Ben Goldacre described precsely the same type of trial you did:

    Here is a model trial for homeopathy. You take, say, 200 people, and divide them at random into two groups of 100. All of the patients visit their homeopath, they all get a homeopathic prescription at the end (because homeopaths love to prescribe pills even more than doctors) for whatever it is that the homeopath wants to prescribe, and all the patients take their prescription to the homeopathic pharmacy. Every patient can be prescribed something completely different, an “individualised” prescription – it doesn’t matter. Now here is the twist: one group gets the real homeopathy pills they were prescribed (whatever they were), and the patients in the other group are given fake sugar pills. Crucially, neither the patients, nor the people who meet them in the trial, know who is getting which treatment. This trial has been done, time and time again, with homeopathy, and when you do a trial like this, you find, overall, that the people getting the placebo sugar pills do just as well as those getting the real, posh, expensive, technical, magical homeopathy pills.

    And then we get the homoeopathy proponent (describing himself as “a fellow sceptic”) replying with “I would challenge the good doctor to prove that his vaunted trials had anything to do with homeopathy at all. It would be to his credit to come clean on this and to help design trials that would match the homeopathic way of prescribing.”

    I think my comment with the reference to the review in it got caught in moderation for a while because it included more than one link, BTW.

  32. A. Noyd says:

    For some of the woo-pushers, the individualization of treatment is part of their whole worldview. In one of Mike Adams’ responses* to the Shorty Awards debacle over, he made it pretty clear that he believes in the individualization of reality. “Free thinkers respect the freedoms of others to arrive at their own truths,” he says. So you can have whatever truth you want, and Mikey respects that. Unless, of course, that truth happens to contradict what Mikey believes. Then you’re one of those ebil, ebil skeptics: “If you, in your own experience, find that herbs and massage therapy and nutrition are all utterly worthless, and you want to join the skeptics camp, then go for it!” This, after a previous article making it clear how stupid he thinks “skeptics” are for believing in all sorts of moronic things he just plain made up**.

    So anyone can have whatever reality they want. Except when they can’t. So very postmodern. So very Orwellian.

    ………………………
    * I won’t link to his bastion of drooling idiocy, but searching his site for “holistic thinkers” should bring the article up.
    ** Of course, in Mikey’s world, what a freethinker like him “makes up” can’t be told apart from “truth.”

  33. A. Noyd says:

    the Shorty Awards debacle over

    Whoops, that “over” should have been deleted.

  34. micheleinmichigan says:

    Interesting. From my small sample of stories I’ve heard about CAM I had the impression that most practitioners were working from a particular (skewed and flawed) logic.

    For instance I had one friend who told me that her acupuncture practitioner was using pressure points on her ears for her menstral cramps, but they would never disappear until she resolved her emotional trauma from childhood. How did he know about her emotional trauma? Well all women with cramps had emotional trauma from childhood. The cure was pressure point therapy and emotional healing.

    I had no idea that some practitioners were just trying #$&* until the symptom disappeared. Seems like a tougher sell.

    It was also interesting to read about the SBM approach to individualized treatment. From my personal experience I would rate my experienced with SBM and individualized treatment as Fair (or needs improvement). My experience with my childrens’ care I would rate as good.

    My definition of individualized treatment would be that the Doctor is aware of and is considering the patient’s medical history, family medical history and risk factors when prescribing medication or treatment. Also that the doctor is aware of ALL the side effects of medication or treatment and is willing to consider and investigate a patient’s report of a side effect.

    I think that systematic changes could improve my rating. I have already noticed an improvement since our health network implemented a new computer records system. Longer appointments times could be helpful, maybe.

    Obviously, my rating could just come down to having one or two not great doctors, hitting one or two doctors on a bad day or being a shoddy patient.

    Even with that “fair” rating, I still prefer SBM.

  35. micheleinmichigan says:

    # A. Noydon 26 Jan 2010 at 12:30 pm

    on Mike Adams’ “Free thinkers respect the freedoms of others to arrive at their own truths,” he says.

    I do respect their freedom to their own truths. That doesn’t mean I will let them be my climbing partner. Just in case their “truth” about gravity is different than mine. :)

  36. Mojo says:

    @micheleinmichigan:

    I had no idea that some practitioners were just trying #$&* until the symptom disappeared. Seems like a tougher sell.

    Not really, because most conditions will get better, or at least improve to some extent (in the case of chronic conditions the patient will almost inevitably have sought help when the condition was particularly bad, so regression to the mean will come into play), without any effective intervention. And even if the patient’s condition doesn’t actually improve the attention paid to the patient will make them feel better about it as a result of the placebo effect.

    In some cases the practitioner can even claim successful “individualisation” if the patient’s condition worsens. Homoeopaths call this “aggravation”, for example.

  37. rosemary says:

    BillyJoe, your comments on the “art of medicine” nicely explain what I was trying to say on another thread about the need to take into account the experience of people in specific fields when reviewing evidence and the inability of people with no hands on experience in a particular field to draw accurate conclusions from reviewing the med. lit. alone.

    IMO, the fact that fraudulent articles sometimes manage to be published in reputable journals is another reason why practical experience is necessary to get the whole picture since someone with it will often see red flags that others will miss.

    I don’t want to belabor the point, but it is a topic I intend to cover in a book I’m writing. Since I want to be accurate, I would appreciate input from anyone who thinks I am off the mark.

    rosemary@rosemaryjacobs.com

  38. Fifi says:

    Mojo – “And even if the patient’s condition doesn’t actually improve the attention paid to the patient will make them feel better about it as a result of the placebo effect.”

    This is actually something a bit different than the placebo effect, or so it seems to me. I think we need to coin a new term for the comfort people get from interacting because it’s quite distinct from the placebo effect of rituals or procedures or things that appear “sciency” or medical. I’d suggest “the social effect” since it’s more about simple, basic psychology than it is faith or belief. We all, well most of us at least, feel better when we feel as if we’re being heard and understood and that someone cares. It’s the “tend and befriend” response to stress and fear, and basic social psychology. Being ill, particularly when we don’t know what we’re ill with or if it’s something chronic and incurable, is stressful. A bit of tending and befriending can reduce the stress for many people – particularly women but it also seems to work for some men the same way – which does make us feel better. We’re social animals so this isn’t particularly unexpected.

  39. EricG says:

    @ fifi

    “I think we need to coin a new term for the comfort people get from interacting because it’s quite distinct from the placebo effect of rituals or procedures or things that appear “sciency” or medical”

    i believe its called “woo”

  40. micheleinmichigan says:

    @ fifi

    “I think we need to coin a new term for the comfort people get from interacting because it’s quite distinct from the placebo effect of rituals or procedures or things that appear “sciency” or medical”

    EricG “i believe its called “woo”

    Huh, I thought it was called a good bedside manner. :)

    But if you want to be able to use a word to describe both effect in both CAM and SBM, I guess social effect could work. Rapport effect, Validation Effect, I know what you mean there is probably already a term in sociology or psycology for this, but I don’t know what it.

  41. Mojo says:

    Huh, I thought it was called a good bedside manner. :)

    Or in another context, “Mummy will kiss it better”.

  42. micheleinmichigan says:

    Huh, I thought it was called a good bedside manner. :)

    # Mojo on 28 Jan 2010 at 3:48 am
    Or in another context, “Mummy will kiss it better”.

    I was confused by the comment. But I think it is because I am thinking in the context of a good patient/physician relationship with beneficial communication and you are thinking in the context of a patient and a CAM practitioner who uses warmth and concern to scam the patient.

    All I can say is any practioner trying to kiss my complaints to make them better is in for it. :)

  43. armando says:

    i wonder what parameters alt med people say make up a person, and how do they learn what specific individualized treatment goes with a specific individual’s parameters?

    if im a 6’1 male age 27yrs and eat 1 serving of fruit a day, does my treatment change if im 6’1 male age 27yrs and eat 2 servings of fruit a day? now what if im 5’7 age 27yrs and eat 1 serving of fruit a day? you can see how this can get out of hand.

    in fact, in SBM, you try to account for potential differences between controls and cases, in order to best determine if a significant difference exists between a treatment and control. you try very hard to eliminate confounding variables and try to compare individuals with similar basic parameters. I just cant imagine how much more individualized alt med people want.

    in the future, sure, maybe genetic profiling may allow for more individualization. but if i were offered a treatment based on my personal data, but then mentioned “oh I forgot to say I felt stressed out last week” and then was given a new individualized treatment, i’d feel insulted that this person presumed to know how to exactly treat that exact situation.

  44. Zetetic says:

    Re: Curezone

    I ventured into Curezone a couple of weeks ago and posted a few well supported medical facts to counter some particularly absurd posts. WOW – Venomous attacks and extremely personal! So much for an “Open Debate” forum!

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