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Quackery Then and Now

“The forces of graft and unrighteousness are peculiar to no country or clime, and they have their champions in the high places and the low. Until the people themselves are better educated concerning the danger and iniquity of quackery, they must be protected from the forces that prey. The popular understanding of these matters is becoming better every day, and, aided by proper laws, the time will come, perhaps, when quackery will be unprofitable.”

The above quote is from a recently published JAMA (Journal of the American Medical Association) article. I should say that it is republished, because it first appeared on June 8, 1912. The brief article outlines the issues surrounding the regulation of medical practice so as to protect the public from “quackery.” It is interesting to see that the issues faced 100 years ago are virtually identical (in broad brush strokes) to those we face today. Despite the fact that so much has changed in medicine over the last century, in this regard very little has changed.

To put this article into historical context, it was published just two years after the Flexner Report, generally recognized as the turning point in American and Canadian medical education when it truly embraced scientific and evidence-based practices. Mainstream medicine in 1912 was barely making the transition from being based upon tradition and authority to having scientific backing and genuine standards. Life expectancy in the US had just passed 50, up from a low of around 40 thirty years earlier. Phrenology was still practiced by mainstream psychiatrists and neurologists – although it was on the way out (having recently been refuted by scientific studies) and was increasingly being pushed to the fringe. The last purely homeopathic medical school in the US would not close until 1920. Patent medicines were still the norm, and the 1906 Pure Food and Drugs Act had only recently been enacted to establish some standards of safety in the medicine marketplace (this would essentially transform into the FDA in 1930).

Although nascent, a science-based standard of care was being embraced by the medical establishment in the early 20th century. The problem of quackery, or falsely pretending to have medical knowledge and expertise, was recognized for centuries. In 1912, as now, one key issue is regulation and the standard of care. The 1912 JAMA article states:

In Germany during the early part of the nineteenth century, laws against quackery were stringent and effective, but curiously enough, at the instance of the medical society of Berlin in 1869, the regulations against irregular practice were much relaxed and the result was a tremendous development of quackery in Germany. Berthenson1 says that in 1869 the number of quacks in Berlin was twenty-eight. In twenty-four years the number was over a thousand and the whole number practicing in Prussia was over five thousand.

We appear to be experiencing the same exact phenomenon now.  As soon as regulations are lightened, dubious practitioners come out of the woodwork and thrive. There is a great deal of money to be made making false medical claims to people desperate for relief or a cure. The potential for profit is an effective an powerful force that will generate quackery to whatever extent it is allowed to exist. The article also mentions that the scope of practice for “unqualified practitioners” was greatly expanded in Prussia, leading to an explosion of quackery there.

In modern times the profit motive is coupled with the ability to lobby the government. This creates a situation in which non-scientific practitioners have a motive to persistently lobby the government for recognition, coverage, and expansion of their scope of practice.  Even when those who seek to protect the public from unsafe practices oppose such lobbying efforts, it is often a losing game. Dubious practitioners ratchet up their privileges by tirelessly lobbying that overwhelms well-meaning vigilance. There is no money to be made in defending the science-based standard, while those who seek to erode that standard have a tremendous profit motive.

The only solution is for governments to recognize the need for effective regulation to protect the health consumer from fraud and from unsafe and ineffective practices.

It seems that those lobbying for a weakening of such regulations have been using the same strategy for at least a century – claim that such regulations are anti-freedom. The article notes:

This has led to strongly organized opposition, similar to the League for Medical Freedom in our country, and, as in the case of our own Congress, the opposition has found support in the Reichstag. This feeling was shown by the chilly reception which the first reading of the proposed legislation received in that body, the same reason being ascribed as here, namely, that the measure would create a “medical trust.”

The National League of Medical Freedom (1884 to 1956) served the same purpose as many “health care freedom” movements and organizations do today – to oppose any regulation that attempts to establish a standard of care. A 1910 editorial in the New York times by a Dr. Lyman Abbot demonstrates that the issues faced then were then same as now:

It is not easy to conceive any commercial interest opposed to the organization of such a bureau except the interests involved in the sale of quack medicines. The great issue of our time, perhaps of all times, is that joined in various forms between special interest and the public welfare. It is difficult to conceive any special interests more dangerous to the public welfare than those which are opposed to efficient measures for the protection of public health, unless it be those which are organized for the promotion of public vice.

Dr. Abbot was discussing the opposition by the National League of Medical Freedom to the creation of a National Bureau of Health specifically for the control of epidemics that were plaguing the country at that time, such as hookworm, bubonic plague, and “consumption” (tuberculosis). The National Bureau of Health apparently never came into being, and the Department of Health, Education and Welfare was not created until 1953.

We can see the core conflict between those attempting to promote public health through regulation and those opposing any government regulation of health care because it is inconvenient to dubious practices and health products. Today we have “health care freedom laws” in many states, the purpose of which is to erode the standard of care in medicine so that fraudulent practices cannot be regulated. Their rhetorical strategy is to convince the public that they are defending their freedoms, when in fact they are defending their own freedom to practice health fraud without government protections for the public. Health care freedom laws and anti-regulation movements are generally anti-consumer. They are designed to remove protections for the consumer from fraudulent and misleading practices and claims made by the “quack” medical industry.

DSHEA is another example of this – a law passed in 1994 as a gift to the supplement industry.  In my opinion, this law is anti-consumer, and it demonstrably lead to an explosion of worthless supplement products with dubious health claims.

We can also see in the JAMA editorial another anti-regulation strategy – categorizing establishing a standard of care as elitism. The editorial refers to this as fears over establishing a “medical trust.” Of course any regulation that attempts to establish reasonable standards, quality control, and professionalism can be dismissed as elitism.

Finally, it was also interesting, and perhaps a bit disheartening, to see that the proposed fixes to the problem of quackery are the same as has been proposed by those of us defending science-based medicine today. The JAMA article concludes:

“The popular understanding of these matters is becoming better every day, and, aided by proper laws, the time will come, perhaps, when quackery will be unprofitable.”

In other words, the control of quackery is a matter of public education and effective regulation. That, in a nutshell, is exactly the agenda of Science-Based Medicine, the Institute for Science in Medicine, and other organizations dedicated today to opposing pseudoscience and quackery in health care. Our perspective tends to exist in a temporal bubble – we think that the conflicts of today are unique to us, and that we innovated the ideas we use to defend our causes. History, however, tells a different story. The conflict between reasonable standards in medicine and quackery is as old as medicine. It is no wonder that the notion of “eternal recurrence” is so common in literature and popular culture, from Peter Pan to Battlestar Galactica:

“All this has happened before, and all this will happen again.”

Posted in: Health Fraud

Leave a Comment (631) ↓

631 thoughts on “Quackery Then and Now

  1. Katlagter says:

    Similarly, C. Louis Leipoldt, a South African pediatrician and well known Afrikaans poet, wrote in the South African Medical Journal in 1927:

    “Nowhere perhaps is the public so ill educated concerning quackery as in South Africa. Our chief cities are honeycombed with faddists, sects and denominations, and the countryside still welters in original ignorance, superimposed on a stratum of bigotry and prejudice.” He also slated the “… gross stupidity of legislators who are fit representatives of a public that delights in quackery.”

    Little has changed here.

  2. windriven says:

    “The popular understanding of these matters is becoming better every day…”

    A nice sentiment but I wonder how true? The basics of science are taught in every school. The relative merits of medicine and quackery are plain for all to see. Yet quackery thrives.

    JAMA may pontificate against it once a century but the fact remains that quackery is embraced – even promoted – by the medical establishment. How exactly does that promote ‘the popular understanding of these matters’?

  3. cervantes says:

    Well now, I do not agree that quackery is embraced or promoted by “the medical establishment.” It certainly is not by any of the medical specialty societies, consensus panels, or the vast majority of the leadership in academic medicine. The “Quackademic medicine” that Dr. Gorski so often complains about is so far the exception, although troubling.

  4. Janet Camp says:

    People are wired to believe, apparently–except for a percentage that is now a little more willing to publicly say they don’t. It’s kind of like being left-handed–or gay perhaps, to not fall for some level of belief/quackery. The sad part is, as windriven says, a lot of quackery is embraced and promoted by MD’s. The AMA would do well to start with its own–not that Oz, Weill, Ornish or Hyman are even members.

    It’s pledge time (seems to be almost ongoing) on PBS and here they are are re-airing (for the umpteenth time) Hyman’s program, complete with promos with close-ups of enraptured audience members hanging on his every word. I want to be clear that PBS does not produce these programs and that each local PBS outlet is completely independent and makes its own program acquisitions. I complain every pledge cycle and receive just as regular replies that these programs are very “popular” and bring in the pledge dollars. But, of course, if we had more PUBLIC support dollars for PUBLIC television, we wouldn’t have to do this, would we? Oops! Wrong blog.

  5. Quackery now:

    According to a study in leading US medical journal Journal of the American Medical Association (JAMA), the US sees 106,000 deaths annually from medications correctly prescribed and correctly taken by patients. That’s about 290 every day, or one every five minutes. [JAMA 14/4/1998]

    http://www.vivisectioninformation.com/index.php?p=1_4_Adverse-reactions-humans-injured-by-animal-tests

    That’s under the ‘strict regulation’ of FDA..now.

  6. windriven says:

    @cervantes

    “I do not agree that quackery is embraced or promoted by “the medical establishment.”

    Then you and I disagree. First rank medical schools, top university medical centers and large community medical systems across the country feature quackery in the guise of alternative and complementary “medicine”.

    If this is not the medical establishment it certainly is an easily embraced stand-in in the minds of the public at large. And if quackery is not embraced by the medical establishment where is the professional censure of those who traffic in Woo, MD?

    Save me your disagreement. Your fig leaf is far too small.

  7. annappaa says:

    Janet, do you mean Fuhrman (not Hyman)? I caught some of Joel Fuhrman’s lecture on PBS last night — I just couldn’t resist. We really need to teach kids in school that a series of anecdotes taken out of any context (such as the numerator and the denominator) really don’t mean anything!

  8. cervantes says:

    “Save me your disagreement. Your fig leaf is far too small.”

    In the first place Windriven, I did not insult you or adopt a condescending tone. That is inappropriate and I ask you to refrain from being rude in the future.

    I will not “save you” my disagreement. I have every right to disagree with you, as you have a right to disagree with me. Please grow up.

    Now, as to substance. Yes, there are some universities and medical centers that tolerate quackademic medicine in their midst. It is a minority. Even where it is tolerated, it has it’s critics. The sin is not committed by “the” medical establishment — however you want to define it — but by a minority of institutions. That is what I said, what I said is true, and you have not refuted it.

  9. daijiyobu says:

    Re: “in my opinion, this law is anti-consumer”…

    What’s interesting is this predicament: nonscience falsely posed as science by licensed healthcare types which blatantly violates consumer protection / advertising standards yet is not pursued by any executive branch / enforcement because it is seen as legalized fraud, or, as I call it, licensed falsehood and therefore ‘permitted’.

    We issue permits that allow the public to be fleeced.

    In some sense, therein, legislation does this by ABSURDLY de-science-ing science and along the way totally kneecap consumer rights.

    Take the OBNM for instance, and how they explain naturopathy (see http://www.oregon.gov/obnm/Pages/Aboutnaturopathy.aspx ), it’s amazing. This isn’t the NDs stating their nonsense, this is the State of Oregon placing their seal upon it as an accessory.

    -r.c.

  10. nybgrus says:

    @cervantes:

    In substance, but not in style, I tend to agree with windriven.

    You will have an easier time listing medical schools that don’t have “integrative medicine” centers and have credulous CAM lectures than don’t. And it includes the top schools. And top medical centers also have introduced “integrative medical” wings. It really is quite widespread.

    And if medical schools and medical centers aren’t “the medical establishment” then what is?

    According to an April 2011 US News report:

    The Consortium of Academic Health Centers for Integrative Medicine, which encourages the spread of CAM education, was founded in 2000 after an initiative by eight academic medical centers; it now boasts 46 medical school members.

    That is 46 out of 137 accredited medical schools in the US for that one organization from that one article I found. That is over 1/3 of all the schools.

    And if UCSF SoM is not considered in the top of the medical “establishment” I don’t know what is:

    Still, students want to add complementary methods to their black bags because they “know their future patients are going to be using them,” says Shelly Adler, director of integrative medicine education at the University of California–San Francisco School of Medicine, which has a long history of teaching the topic.

    Georgetown is considered a top medical school, and here it is listed as #2 of the Top Schools for Alternative Medicine right behind Bastyr.

    I could toss in a few more links, but it would hold up my comment and basically just say the same things.

    Memorial Sloan Kettering Cancer Ceneter offers Reiki and reflexology to cancer patients.

    The Journal of Critical Care Nursing published and article stating Reiki was a useful adjunct to ICU care.

    The University of California at Irvine has the Samueli School of Integrative Medicine.

    Yale University School of Medicine’s professor David Katz calls for a “more fluid concept of evidence” and promotes CAM.

    Harvard has the Osher Center for Integrative Medicine and offers a fellowship in it.

    Stanford has a Center for Integrative Medicine.

    University of Washington, MD Anderson Cancer Center, Duke, Columbia, the Mayo Clinic, Tufts, Boston University, Johns Hopkins, Norwestern, U of Illinois, Pritzker, UCLA, and UCSD all have integrative medicine departments and offer teaching and electives in it.

    It seems to me very widespread and not just among poor (academically or financially) schools and medical centers. I’ll add one more comment right after this with a link to “The Consortium of Academic Health Centers for Integrative Medicine” (which is supported by the Bravewell Collaboration, BTW).

  11. nybgrus says:

    ack. Sorry for the bad formatting above.

    The Consortium of Academic Health Centers for Integrative Medicine

    Which is now up to 51 member schools (so 5 more in the last year since the article above was published).

  12. windriven says:

    @cervantes

    My initial response was perhaps a bit more strident than I had intended. If I offended you I apologize.

    “The sin is not committed by “the” medical establishment…”

    Really? I ask again, where is the censure from any of the “medical specialty societies, consensus panels, or the vast majority of the leadership in academic medicine”? Even attorneys, that most maligned profession, have as I understand it a code of ethics that forbids attorneys from knowingly allowing perjury and other sins against the bar. Where is the FACS when Oz drifts off into the tall brush?

    Sins of omission by those who are expected to lead are far more egregious than those of scabby charlatans who hype coffee enemas as the one true cure of all disease. “The medical establishment” should expect to be held to a rather higher standard than the common crook.

  13. weing says:

    We need to clean up our own house first. What can we do when our institutions have sold out to the scamsters? Who am I to tell Harvard that they are full of crap? I think we are lost. It looks like politics and money have trumped science.

  14. weing says:

    The downfall probably started after the AMA got its butt kicked by the courts with the chiropractors.

  15. nybgrus says:

    I apologize for the very poor in formatting and typographical error post from before. I was in a rush to go out and run some errands. Hopefully the point still stands well.

    I agree that we need to clean up our own house. I do my part as best I can by actually confronting attendings and residents with a few facts when I see them obviously acting non-scientific. I will tell you that it is always very daunting and my heart rate always goes up. I can also tell you most of my classmates don’t have the chutzpah or often the knowledge to do so. And I will also say that I don’t always do it for myriad reasons. The point is we need to change the culture of challenging superiors… though I can say that is certainly changing for the better with my generation of physician. I also chat with my classmates and colleagues whenever the situation avails itself and rather enjoy watching them get blown away when I explain things of which they were only dimly aware before (and thus felt it was “no big deal”). I have even had some flat out say I was lying or exaggerating. Thankfully in the world of smart phones my vindication – and their astonished education – is a mere few fingerswipes away.

    As for who you are to tell Harvard they are wrong? You are a physician are you not? Talk to colleagues, at conferences, whatever venue you can. It may seem like a small drop in the bucket, but I am a firm believer that big changes require tiny and humble beginnings.

    I am a listed member of the Friends of Science in Medicine. I am working to get the medical student organization of which I am an executive member to be officially affiliated as well. I think the biggest problem for us cleaning house in this sense are the “shruggies.” Those of us that are not aware of how pervasive and important the problem is, or those who are not aware of what “reiki” or “homeopathy” or “naturopathy” actually are and thus assume it must be harmless or perhaps even mildly interesting to pursue. Bringing it up in conversation from time to time yields productive and interesting results (at least in my experience).

  16. PJLandis says:

    “The downfall probably started after the AMA got its butt kicked by the courts with the chiropractors.”

    What case is that? I haven’t read anything about US Chiropractor’s in court.

  17. Harriet Hall says:

    That was Wilk, the chiropractic antitrust suit:

    http://www.chirobase.org/08Legal/AT/at00.html

  18. windriven says:

    @weing

    Who am I to tell Harvard that they are full of crap?

    Gee, it is they who are full of crap. They have made no effort to hide their full-of-crapness, in fact they brag about it. All you are doing is pointing to the sign that they themselves have erected.

    Seems to me you have all the moral authority you need.

  19. “The popular understanding of these matters is becoming better every day, and, aided by proper laws, the time will come, perhaps, when quackery will be unprofitable.”

    “Integrative Medicine” is the new label for the false legitimization of quackery by academic medical centers. The line between scientific medicine and nonsense is again blurry because nonsense sells. Unfortunately, quackery IS profitable.

    The ‘Flexner Report’ that preceded this JAMA article is truly worth the read. The chapter “The Medical Sectarians” has as much relevance today as it did in the early 20th century.

    https://sites.google.com/site/skepticalmedicine/alternative-medicine/-integrative-medicine

  20. pmoran says:

    When the JAMA published that piece in 1912 it would still be forty or fifty years before many published medical studies had control groups or randomization. Partly in consequence of that, if you went to a medical school in Manchester you would learn a different set of treatments, mostly now known to be ineffective or even dangerous, at the feet of its esteemed professors to those being learnt by medical students in Strasburg, or in Moscow, or Boston. They all thought they were right.

    So I wonder whether the JAMA editorialship might not feel a little sheepish about their references to the “unrighteousness” and “iniquity” of quackery if they knew what we know today about the value of the methods that they wished to confine public usage to?

    I don’t think our hundred-year hindsight will be like that, but I suggest that unless history gets rewritten as a basis of writings like Steven’s and some other skeptics, the upsurge in CAM will be seen to be a worldwide phenomenon that occurred without there being any general relaxation of regulatory standards in medicine and one which certainly antedated both the DSHEA and medical schools dabbling in CAM, both of which were responses to an already well-established grassroots movement.

    There might also be a different vision as to the reasons for it: less emphasis upon the convenient, self-exonerating suspects of fraudsters and conspirators: more recognition of real shortcomings in the medicine of the times such as the lack of effective and safe methods for many common and many serious conditions, and this in an era of greatly heightened public expectations: medicine’s habit of regularly changing of its mind on important matters: recurring evidence of corruption and scientific misbehaviour in its supposedly lofty workings: along with others to do with characteristics of everyday medical practice. (I know, I know! — all these can be exaggerated but we are judged by how we appear, not by what we aspire to).

    CAM’s upsurgence may thus come to be attributed mainly to a largely understandable erosion of public confidence in the mainstream.

    If that is so, what would our 2112 descendants think of the assumption that it would be a good idea to apply coercion as part of the the solution, in the form of tighter government regulation, in an attempt to prevent the public from using methods other than those we offer them even when we have nothing better to offer? It might not make much sense to them as a way of gaining general public cooperation with our aims.

    If this view is correct it should be no surprise that attempts at tighter regulation provoke stiffening public as well as supplement industry resistance. No wonder also that it provokes questions as to our true motives, if not also as to our state of mind when we express extreme, relentless hostility to some pretty harmless methods that even most of the public already regards as being rather goofy, or at least suspect.

    We need regulation in medicine but it should be focused clearly upon realistic concerns regarding public safety, not so much on the somewhat quixotic task of rooting out pseudoscience! The public can understand us wanting to do the former but is justifiably wary of us wanting to establish too tight a medical monopoly.

    I know how hard it is to see this from the internal medical and scientific perspective. It seems so obviously not right to be at all tolerant of medical treatments that are not proved to work by our standards. But there is a real world out there that has already proved itself tnot to be responsive to how we think it should behave.

  21. weing says:

    “If that is so, what would our 2112 descendants think of the assumption that it would be a good idea to apply coercion as part of the the solution, in the form of tighter government regulation, in an attempt to prevent the public from using methods other than those we offer them even when we have nothing better to offer?”

    I would much rather exterminate it from our institutions in order to clearly separate us from sCAM. We should simply say that we do not do that (sCAM). It has no place in medicine and diverts valuable resources. Let us be judged by our outcomes. If any new therapy outside of the mainstream wants to be accepted as medicine, then it must be judged by our criteria and meet the standards we hold ourselves to. Acceptance of this nonsense by our prestigious institutions shows they don’t have any standards but the profit motive or political appeasement. That’s the way I see it.

  22. BillyJoe says:

    I’m with weing. We should not dilute the truth by accommodating alternative/complementary/integrative nostrums (I will not say “medicine”). Where is the evidence, anyway, that accommodation helps rather than hinders the cause of SBM. Where is the evidence that firm uncompromising opposition would not more effectively achieve the desired result. At the very least, it is the more honest approach.
    SBM may even need a few militant combatives to more effectively publicise the problem.

  23. nybgrus says:

    I agree with weing.

    I do understand what you are saying pmoran. And you aren’t wrong. I just don’t think you are right either. Making our own house not stand for CAM is bare minimum. Advocating for consumer protection is not going to be viewed poorly by our grandchildren. We aren’t advocating for making these things illegal for people to consume – merely illegal to market fraudulently.

    There were problems when people wanted to institute child labor laws, engineering safety restrictions, and even the FDA. Do you think anyone (save the cranks, of course) are looking back at our forebears and whinging about how horrible they were to institute such restrictions on freedom of commerce? Is Upton Sinclair maligned for his exposure of the terrible conditions in the meat packing industry and bringing to bear new laws and regulations to make things stricter, more laborious, and more expensive? I don’t think so.

    The only interesting part of your argument is the reference to “…in an attempt to prevent the public from using methods other than those we offer them even when we have nothing better to offer? I think Dr. Hall as well as I would dispute that we have nothing better to offer. Genuine care, support, and realistic management and expectations whilst preserving their financial stability (i.e. not throwing good money after bad on quacks and schysters) is better than false hopes. Your statement there implicitly requires that false hope and acceptance of being swindled is better than doing nothing. But even if I were to concede that point and say it was moot, I would have to echo weing’s sentiment that we will be remembered for our outcomes and in 100 years people will have a better understanding and, much like the new regulations of 100 years ago, people will see them as a positive move to improve care and protect the consumer.

  24. Jann Bellamy says:

    @ pmoran

    “We need regulation in medicine but it should be focused clearly upon realistic concerns regarding public safety, not so much on the somewhat quixotic task of rooting out pseudoscience! . . . I know how hard it is to see this from the internal medical and scientific perspective.”

    It is also hard to see from a legal perspective. Misrepresentation about the effectiveness of a product or service in the face of evidence to the contrary is at best negligent misrepresentation and at worst fraud. Lack of physical harm is not the only issue. There is also economic damage. Unfortunately, misrepresentation in the form of “CAM” is too often protected by laws such as DSHEA and the state practice acts for naturopathy, chiropractic and acupuncture, which water down or eliminate a science-based standard of care. For example, even if there were no safety issues in “detecting” and “correcting” subluxations by chiropractors (which is not the case), this massive fleecing of the public is a proper cause for concern.

  25. marcus welby says:

    @pmoran:

    In addition to the waste of money on ineffective therapies (economic harm mentioned above) look at the troublesome detritus along the CAM highway: recent examples:
    1. confusing the public, who grasp at “natural” remedies…see discussions on SBM regarding Steve Jobs’ delay in needed surgery for his insulinoma of the pancreas.
    2. I can refer you to groups of accupuncturists and chiropractors who are allied in lawsuits and support groups alledging inability to earn a living after persuing their CAM degree. They are upset with projections made by the for-profit schools and failure of the Dept. of Education to warn them of the danger presented by such an educational pathway (as I understand it, such schools are accredited by outsourced “in-group” bodies).
    3. The recent PIP auto insurance debacle in Florida is instructive. With soaring costs for auto insurance and “PIP clinics” on every street corner, but declining auto accident and injury rates, the Florida legislature commissioned a study to identify drivers of cost. The published results within the Dept. of Insurance earlier this year showed the majority of the 10K funds in PIP was being spent on chiropractic, massage therapy, and accupuncture, rather that expeditious trauma treatment. The legislature stepped in and eliminated accupuncture and massage therapy from coverage under PIP, and drastically slashed chiropractic coverage. Immediately, the livelihoods of hosts of CAM practitioners were threatened and accupuncturists marched on the Capitol. The taxpayer-guaranteed educational loans…entire life career pathways…in shambles, overnight.

    Best to stick to solid science, in my opinion.

  26. Harriet Hall says:

    People who are having a run of bad luck in their businesses and personal relationships are in distress and we have nothing to offer them. Does that mean we should allow psychics and scam artists to take their money under false pretenses? News of the Weird reported a psychic had charged a woman $19,000 each for seven tabernacles to vanquish her family’s negativity and had talked her into putting a grapefruit under her mattress to attract and isolate the evil. Should we prosecute such scam artists, or should we maintain a policy of tolerance just because we don’t want people to misperceive our motives, or because we blame ourselves for not having relieved the victim’s suffering ourselves, or because we realize that there will always be scam artists and people will always be vulnerable?

  27. I have to completely disagree with pmoran. Others have already pointed out his major logical fallacies. But in addition – I think the major problem with his premise is a failure to recognize the magnitude of the difference between science-based practice in good faith, and rank health fraud. The problems with modern medicine are real, but they are teeny tiny compared to the massive instrinsic problems with CAM. There is simply no comparison.

    That is the equivalent of using the failings of the current legal system in order to justify tolerating mob lynchings.

  28. I have an idea, which may be unpopular. Completely outlaw and ban the practice of rank quackery such as chiropractic, acupuncture, and naturopathy. Any taxpayer-guaranteed loans these people owe would be completely forgiven, and then give them a $10,000 severance to allow them time to find a legitimate job or start pursuing legitimate education. Also, the institutions that teach this quackery should have their assets immediately frozen and turned over to the government (so that the government can waste it in a half second.)

    @Dr. Hall, we should prosecute the shit out of them.

  29. I have an idea, which may be unpopular. Completely outlaw and ban the practice of rank quackery such as chiropractic, acupuncture, and naturopathy. Any taxpayer-guaranteed loans these people owe would be completely forgiven, and then give them a $10,000 severance to allow them time to find a legitimate job or start pursuing legitimate education. Also, the institutions that teach this quackery should have their assets immediately frozen and turned over to the government (so that the government can waste it in a half second.)

    @Dr. Hall, we should prosecute the crap out of them.

  30. stanmrak says:

    “It is interesting to see that the issues faced 100 years ago are virtually identical (in broad brush strokes) to those we face today.”

    The real issue here is giant business interests doing everything they can to destroy the competition. To assume that JAMA is more interested in protecting the public health than it is in protecting the profits of its members is quite naive.

  31. Chris says:

    Stan, except CAM is big business. That includes the companies that manufacture the supplements you sell, since they and their friends lobbied for DSHEA, like Orrin Hatch (see DSHEA: a travesty of a mockery of a sham).

    And JAMA is a journal, it has nothing to do with public health. That would be part of the FDA, an agency that has come under fire by several big business interests. It is not a a coincidence that Orrin Hatch has tried to gut the FDA, along with Tom Harkin and Ron Paul. Apparently regulations seem to hurt their financial interests.

  32. Scott says:

    When “the competition” is composed of a pack of liars and frauds who provide no benefit to anyone but themselves, getting rid of them should be applauded.

  33. pmoran says:

    Steven: I have to completely disagree with pmoran. Others have already pointed out his major logical fallacies. But in addition – I think the major problem with his premise is a failure to recognize the magnitude of the difference between science-based practice in good faith, and rank health fraud. The problems with modern medicine are real, but they are teeny tiny compared to the massive instrinsic problems with CAM. There is simply no comparison.

    1. Which logical fallacies? Much of what I said had to do with public perceptions and I have never ever stated that CAM has scientific validity beyond placebo influences and possibly other beneficial human interactions.

    2. I am simply looking at the same period of medical history that you are, but showing how a minor difference in its interpretation leads to a subtlely different overall strategic understanding of “the CAM problem”. The different interpretation explains why the one-dimensional “all CAM is fraud” approach is doomed to fail and has so far achieved none of its presumed aims. It may even be a counterproductive influence, making us appear both unconcerned with the patient needs that basically drive CAM and poorly informed concerning the phenomenon.

    3. If you compare frank, knowing, dangerous health fraud having no redeeming features with the best that medicine aspires to, then of course you have made your case. Nowhere have I opposed applying the full force of regulation when those criteria are fulfilled.

    4. The apparent inconsistency in your stance is that you can allow how doctors can easily be misled by the illusions of daily medical practice, as they were still (largely) in 1912, yet regard them as practicing in good faith, but you are not prepared to offer a similar courtesy to CAM practitioners or the users of CAM.

    Even otherwise orthodox medical practitioners who profess to a holistic approach to medicine, but one that is tainted by aspects of CAM are portrayed in your writings as having sinister agenda — when they clearly feel confident that they are actually helping people with otherwise difficult medical problems (and we cannot say definitely that they are not — but that is not part of my present case).. This clashes with your clear thinking on scientific matters generally and at least begs further clarification from you.

    It complicates matters enormously once you allow that a lot of CAM is also carried on in good faith (even more so if it may also be helping some people), but are we dealing with reality here or some convenient construct of our own minds? We should know very well by now how even we scientists can be misled by our own biases and false presumptions. Let this be a truly science-based forum, one that can approach even unpalatable fresh ideas with a clear mind. I am testing out my working hypotheses and preconceptions– are you all testing yours?

  34. @stanmrak, do you give your sCAM away for free?

  35. @pmoran, are you familiar with the NCCAM? You know, the US organization that is funded with tax payer money that tries to “approach even unpalatable fresh ideas with a clear mind?” The organization has spent $1.4 billion testing these very ideas that you are asking us to consider.

    - Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn’t do a lot for our ability to heal a wound.

    - With $666,000 in federal research money, scientists examined whether distant prayer could heal AIDS. It could not.

    - The National Center for Complementary and Alternative Medicine also helped pay scientists to study whether squirting brewed coffee into someone’s intestines can help treat pancreatic cancer (a $406,000 grant). The coffee enemas did not help.

    - NCCAM also has invested in studies of various forms of energy healing, including one based on the ideas of a self-described “healer, clairvoyant and medicine woman” who says her children inspired her to learn to read auras. The cost for that was $104,000.

    No, all ideas should not be approached with a clear mind. In fact, this open-minded to the point of your brains falling out attitude is part of what is responsible for the proliferation of rank stupidity.

  36. pmoran says:

    SH, see my point 1.

    We can predict that those methods will not perform better than placebo, so that there is no scientific point to most such studies. They may, however, have some small value in reassuring the public that we can make such predictions without having the direct evidence that we (seemingly paradoxically) insist upon in relation to other medical questions.

    We are largely reliant upon that kind of public confidence when trying to protecting the public against the dangers of quackery. If we have that confidence we don’t need much in the way of regulation.

  37. nybgrus says:

    Which logical fallacies?

    less emphasis upon the convenient, self-exonerating suspects of fraudsters and conspirators: more recognition of real shortcomings in the medicine of the times such as the lack of effective and safe methods for many common and many serious conditions, and this in an era of greatly heightened public expectations: medicine’s habit of regularly changing of its mind on important matters: recurring evidence of corruption and scientific misbehaviour in its supposedly lofty workings: along with others to do with characteristics of everyday medical practice.

    Tu cocque.

    … in an attempt to prevent the public from using methods other than those we offer them even when we have nothing better to offer?

    False dichotomy (“we have nothing better to offer”).

    …if not also as to our state of mind when we express extreme, relentless hostility…

    Judgemental language

    The public can understand us wanting to do the former but is justifiably wary of us wanting to establish too tight a medical monopoly.

    Straw man.

    The apparent inconsistency in your stance is that you can allow how doctors can easily be misled by the illusions of daily medical practice, as they were still (largely) in 1912, yet regard them as practicing in good faith, but you are not prepared to offer a similar courtesy to CAM practitioners or the users of CAM.

    Straw man again.

    There is no inconsistency here. The issue is not that we refuse to allow others what we allow ourselves. We know that homeopathy, reiki, reflexology, TCM, chiropractic, and acupuncture do not have efficacy beyond placebo. Practicing something that is widely known to be wrong is not the same as having genuine scientific debate on the topic. The fact that you can even attempt to equivocate the two concepts demonstrates by how far you have missed the boat.

    Doing something because you genuinely believe it to be true and helpful is not sufficient – for a CAM practitioner or a medical doctor. In case you haven’t noticed we here at this blog regularly skewer bad medical practices as well – including poor practice in medicating patients, adhering to new data for screening guidelines, etc. As has been pointed out to you many, many times before CAM proves to be obvious, low hanging, and poorly addressed fruit. Internal improvements to actual medical practice are ongoing and in the right direction. The introduction of CAM as “Integrative Medicine” is exactly opposite of that and thus is the focus of commentary and deconstruction.

    Unless you would like to tell my attending physicians that I no longer need to study for exams and can write whatever orders I want on patients because I “am genuinely practicing in good faith and believe it to be helpful to my patients.” That would certainly make getting top marks for the remainder of my schooling much easier!

  38. nybgrus says:

    If we have that confidence we don’t need much in the way of regulation.

    Now I know you are dreaming of some imaginary utopia. You do realize that the majority of people buy into this supplement/homeopathy/CAM stuff because it is all over the pharmacies and they genuinely believe that if it was BS it wouldn’t be sold to them??

    “It must do something! After all it is sold at my pharmacy… you know, where my pharmacist works… that guy with one of the most trusted professions

  39. Harriet Hall says:

    @pmoran,

    “the one-dimensional “all CAM is fraud” approach is doomed to fail”

    Can you point out where anyone has said all CAM is fraud? I don’t think so.

    “It complicates matters enormously once you allow that a lot of CAM is also carried on in good faith.” Can you point out where anyone has said all CAM is not carried on in good faith? I don’t think so.

    I think we all recognize that many CAM and integrative medicine providers really believe in what they are doing and are operating in the best of faith, but that doesn’t excuse them.

  40. @nybgrus, thank you for mentioning pharmacies. I hadn’t actually browsed the medicine isles in a pharmacy in quite a while. I recently had to go pick up something for my wife and took me time to look through everything offered at my closest Walgreens. I could not believe how much homeopathic crap they were selling. I just wanted to shake the store manager and say “what are you doing?!” Quite a few items are rather deceptively packaged too.

    (One of the worst was at the local big-box pet store. A brand called Homeo-Pet or Homeo-Vet, they were selling a “heart worm preventative.” How many poor dogs die because of these blood-sucking bastards. There was nothing on the label indicating “this will not actually protect your pet from anything”.)

  41. pmoran says:

    Nybgrus :If we have that confidence we don’t need much in the way of regulation.
    Now I know you are dreaming of some imaginary utopia. You do realize that the majority of people buy into this supplement/homeopathy/CAM stuff because it is all over the pharmacies and they genuinely believe that if it was BS it wouldn’t be sold to them??
    “It must do something! After all it is sold at my pharmacy… you know, where my pharmacist works… that guy with one of the most trusted professions“

    Remember my focus on safety? And what are you saying — that pharmacies should stop selling them altogether? If so, please tell Harriet that you do support the “stamp-it-all-out” school of medical skepticism.

    Those materials are reasonably safe because of current regulations and oversights in most Western countries. We should warn the public to be very wary about materials that are directly imported or provided outside proper pharmacies.

    Secondly, there must be very few people who do not twig that there are major differences between the potency and utility of such over-the-counter remedies and prescription medicines that only a doctor can prescribe. We should reinforce that by insisting that such remedies be kept in a special section, not mixed in with over-the-counter pharmaceuticals.

    One of the counterproductive aspects of the stamp-it-all-out school of healthfraud is that it treats the CAM using public as gormless fools. Our skeptical view of the public is heavily influenced by confirmation biases: our interest in healthfraud brings us into frequent contact with its worst elements — which encourages overreaction, even though those extremes can be the most difficult areas to do anything constructive about. The true zealots will always find some way to foolishly risk their lives.

  42. pmoran says:

    BTW, Nybgrus I don’t accept your characterization of my supposed logical fallacies. I am in the above neither defending CAM nor attacking mainstream medicine. My only claim was that we cannot have a rational and realistic strategy towards the very real problems that CAM poses unless we have the fullest understanding of ALL the reasons for it.

    Steve’s platform is clear –

    ” In other words, the control of quackery is a matter of public education and effective regulation”.

    I agree with the regulation to a degree, but I am not sure that much more than we presently have is either feasible or a sound aim tactically in the present environment.

    The educational aspect is just as doubtful with the evidence suggesting that the better educated are more likely to turn to CAM, and we have only just heard how Nobel prize winning scientists are unusually susceptible to it.

    I think the overriding consideration should be the regaining of public trust and to that end I don’t think coercive measures are very helpful. Neither is too much medical hubris, self-righteousness or paternalism. The areas where CAM threatens lives can be approached directly and individually.

  43. @pmoran, can you please explain how suggesting that a pharmacy, which could be widely considered a trustworthy place to purchase medicine and get relatively good advice, should stop selling worthless quackery is equivalent to a “stamp-it-all-out” school of medical skepticism?

    I surely hope you can see the problem with a pharmacy carrying quackery products. A supposedly respectable facility selling quackery gives credibility to said quackery. And considering how these useless turds are labeled, the average joe who has no idea what they are looking for in the pharmacy has pretty good chance of accidentally purchasing a homeopathic preparation. From my recent visit, for the specific therapy I was looking for, there were 3 versions of the product: 2 normal versions (one brand name, one store brand/generic) and 1 homeopathic version.

  44. Jann Bellamy says:

    @ pmoran:

    I don’t understand why you fail to consider economic harm in your analysis. Merely because a CAM pratice or product isn’t dangerous doesn’t mean the consumer hasn’t been harmed — he has paid good money for an ineffective treatment. The intent (or “good faith”) of the practitioner or seller is irrelevant in this regard. The consumer is equally harmed financially whether the practitioner is an evil quack or simply misguided.

  45. Scott says:

    One of the counterproductive aspects of the stamp-it-all-out school of healthfraud is that it treats the CAM using public as gormless fools.

    More correctly, it treats the CAM-using public as people without specialist knowledge, who are being conned by slick salesmen into accepting a lie.

    Does arresting Bernie Madoff treat the investing public as gormless fools? It’s exactly the same principle.

  46. nybgrus says:

    Remember my focus on safety?

    Yes, of course I remember it. Remember how we are supposed to be thinking beyond simplistic and provincial goals?

    Allowing [X] because it is useful but “safe” in your assessment whilst trying to disallow [Y] because it is useless and “dangerous” is entirely stupid. That selfsame public you are trying to characterize will not have any clue why [X] is OK by us, but [Y] isn’t (isn’t it simpler to just have one simple criterion rather than require higher order thinking as to what is “safe” or “dangerous”?). The further point I am trying to make is that when the public – which, as you have repeatedly said, does not have our level of scientific nuance – goes to a pharmacy and sees [X] on the shelves, that will lend the imprimatur of legitimacy to [Y]. You call us provincial for trying to “stamp everything out” but you continually miss that blatant fact. The public at large does not make the distinction between homeopathy, vitamin supplementation, herbal concoctions, and TCM nostrums. It is all “CAM” and “All Natural (TM)” to them. They also do not realize the lack of oversight and regulation of these products. So when they see homeopathy and domestically produced supplementation – which you consider “reasonably safe” – they equate it quite readily with everything else hawed at them. And since it is on the shelves right next to NSAIDs and other actual medications how can we expect them to recognize that one is legit, the other is BS but harmless, and the third is BS but possibly harmful? Your own arguments preclude such a simplistic conclusion as you have reached. As SkepticalHealth pointed out, you can go to the pharmacy and see Nyquil, “wall-quill,” and “homeo-quill” all advertising in almost the same exact language that they can relieve the same symptoms.

    And of course, we haven’t even gotten to the more far removed and nuanced discussion of whether those “safe” supplements really are safe (selenium in Western oversight and regulation produced “Men’s Health Vitamins” anyone?) and the extent to which validation of “safe” quackery leads to more ready adoption of unsafe quackery in more serious conditions.

    Your “focus on safety” is about as far reaching as the tip of your nose.

    The rest of your response was quite nicely addressed by Jann and Scott.

  47. nybgrus says:

    sorry, that should be “allowing [X] because it is “safe” but not useful in your assessment…”

  48. well..I posted this much earlier, but somehow it’s been overlooked..held for moderation..

    # rustichealthyon 06 Jun 2012 at 12:01 pm

    Quackery now:

    According to a study in leading US medical journal Journal of the American Medical Association (JAMA), the US sees 106,000 deaths annually from medications correctly prescribed and correctly taken by patients. That’s about 290 every day, or one every five minutes. [JAMA 14/4/1998]

    http://www.vivisectioninformation.com/index.php?p=1_4_Adverse-reactions-humans-injured-by-animal-tests

    That’s under the ‘strict regulation’ of FDA..now.

    Going over some of the comments above..considering the amazing ‘outrage’ over supplements and alternatives..once again..I wonder what you all will say…of the 100′s of 1000′s of deaths each week from those taking correctly prescribed drugs and still dying. “The dose makes the poison” formular not working too well it seems. And you all still wonder why people are waking up to alternatives and being very happy with them. Yet you want to force your monopoly on free Americans still, in the name of ‘care’ and ‘concern’..lol.

  49. pmoran says:

    @ pmoran:

    I don’t understand why you fail to consider economic harm in your analysis. Merely because a CAM pratice or product isn’t dangerous doesn’t mean the consumer hasn’t been harmed — he has paid good money for an ineffective treatment. The intent (or “good faith”) of the practitioner or seller is irrelevant in this regard. The consumer is equally harmed financially whether the practitioner is an evil quack or simply misguided.

    I confess I haven’t fully thought through every last ramification of my positions even as they strengthen in other respects. But some quick thoughts — .

    I suspect there will be answer to that once we examine why we don’t go harder after economic harm from cosmetics or astrologers. Many health care claims are of about the same order of import. I also don’t believe that the the public is as unknowing and/or passive in these matters as we like to think. I don’t pretend to know where lawyers will draw the line with caveat emptor but it will surely click in at some point and probably well before “here, you will find this Reiki relaxing!”..

    Yesterday I watched as a very obese older couple, who probably have equally obese and unhealthy children, unloaded eight bottles of Coke off their shopping cart at the checkout along with what looked like a meagre single day’s worth of other provisions and thought “why do we tolerate that in a rational society – let’s have health warnings on Coke!?”

    So part of the answer might be that as we tighten regulations up there will be diminishing returns for the level of legal suppression required. There will also be a lot more interminable and costly legal argument concerning vague medical claims and a few of the specific ones (as we have seen in recent cases) , also stiffening public resistance as fans of antioxidants feel under threat and get added onto all the fans of homeopathy and of naturopaths, chiropractors, and massage etc.

    Can you even assure us that either politicians or the law courts will be sympathetic to our case when confronted by pleas from the public that thier arthritis flares up as soon as they stop their glucosamine?

    Finally, are we sure that people are not genuinely feeling better for taking these products? A lot of science allows for that possibility.

    There is a lot to take into account in relation to what can look on paper to be an obvious, open and shut case.

  50. Harriet Hall says:

    @pmoran,

    “are we sure that people are not genuinely feeling better for taking these products?”

    Are we sure that people who are scammed by psychics are not genuinely feeling better? False hopes and personal support can be very comforting.
    Are we sure that people who are obese from drinking Coke do not genuinely feel better than if they were required to eat a healthy diet? Drinking Coke brings a lot of pleasure to their lives.
    Are we sure that drug addicts don’t feel better when they inject their heroin? After all, isn’t that the reason they started using it?
    A lot of science allows for those possibilities.

    Should we hesitate to legislate against sellers of heroin and psychics who rob people of their life savings? What if the politicians and law courts are sympathetic to pleas from addicts that they suffer when denied their heroin and pleas from victims of psychics that they are hurt by being denied those hopes? Should we worry that we are stiffening resistance and adding to the fans of psychics and drug pushers?

    Can’t you see your double standard?

  51. Harriet…it’s their choice… their decision…their freedom. Who are you to say what’s working for anyone and what isn’t? The audacity and arrogance of conventional meds gets insaner every day.

  52. pmoran says:

    Inappropriate analogies, Harriet. We were talking about economic harm from “healthfraud”. It is assumed that no person derives their money’s worth of the desired benefit from the disputed activity.

    However, just try taking these remedies away and consumer protests are definitely one of the hurdles you will come up against. The next hurdle is having to explain how we know better than the user whether they have been truly helped or not and why no one should care what the latter thinks.

  53. nybgrus says:

    I think they are perfectly appropriate analogies. Genuine intent is the bare minimum to not be considered a vile person. Genuinely feeling better without actually being better is the minumum to not be considered a blithering idiot. You are advocating for some very low standards.

    And yes, we should explain how and why we know better than the user. That is the entire point of being educated experts on a topic. Why should climate scientists explain how they know better than your average Republican that anthropogenic global warming is a real phenomenon of legitimate concern? Why should evolutionary biologists explain how they know better than creationists of the validity of evolution and the completely bankrupt nature of creationism? Why should we even bother to try and maintain the teaching of that in schools? Why not let whomever teach whatever? Being a creationist and buying into their false dogma sure does make them feel better, after all.

    Not only are you advocating a double standard but you are also advocating for such a basically minimal set of standards and expectations for society that it boggles my mind. Give me one example of a society that progressed with such a lackasadaisical attitude towards standards. There really aren’t any – progress is hard won and there will always be opposition. Citing that said opposition exists is not a reason to say we shouldn’t pursue the goal.

  54. pmoran says:

    Allowing [X] because it is useful but “safe” in your assessment whilst trying to disallow [Y] because it is useless and “dangerous” is entirely stupid. That selfsame public you are trying to characterize will not have any clue why [X] is OK by us, but [Y] isn’t (isn’t it simpler to just have one simple criterion rather than require higher order thinking as to what is “safe” or “dangerous”?).

    I understand what you are trying to say and it has some vallidity ( once having disposed of the question of whether we are entitled to “disallow” anything that the public chooses to do entirely at their own expense and risk, and wondering whether more conventional skeptical approaches have been so successful as to make it extraordinary that anyone would think of challenging them.)

    As I have stated here before, my tentative proposal is to allow that “people do seem to feel better for using these methods, but they should not be relied upon as the treatment of any serious illness”.

    This stance hints at permissiveness and tolerance, whereas the typical SBM one is unquestionably seen by those we most wish to influence as intolerant , oppressive, disrespectful of genuine medical needs, and even as a manifestation of turf protection or malign drug company influences. For they cannot grasp all the (largely) legitimate considerations that go into formulating it while also sensing some ways in which our understanding of CAM is off-kilter. Is that not evident in every dialogue we have with CAM sympathizers? (Yes, Harriet, I know that your writings don’t reflect that so much.)

    On the other hand, the public can understand, indeed already “knows” that people can think themselves into feeling better when sick. That is not in the least a foreign idea to them. Why then, would we supposedly intelligent scientists not factor that into our dialogue with CAM, when a good deal of our own research points in the same direction? Why would we not use this ready-made starting point towards the public’s better understanding of medicine and how inert treatments can gain a following, and where some of those spectacular testimonials come from? .

    They can also understand that feeling better is not quite the same thing as a cancer going away, or getting over a serious infection. It is the forgoing of effective treatments where CAM mainly costs lives and most people also can understand that. How do I know this? Because studies show that all but a few per cent of CAM use is complementary to orthodox medical care. That even applies to most CAM cancer treatments.

    We can build upon that base, too. Once we make it clear that we are not going to oppose their use of such treatments if they really, really want to, despite any opinions we may have as to their likely efficacy, we may find a more responsive audience for an explanation of why they themselves should be demanding a much higher quality of testimonial evidence and documentation from anyone offering them cancer cures (not frigging RCTs! — as many skeptics rather stupidly request!). We cannot do much about those who give themselves over entirely to make-believe but in the interests of regaining public trust we should go to greater lengths in showing precisely why we think the way we do, as I have tried to do on my own amateurish web site. That includes understanding the absolutely critical role that anecdotal material plays in the field of cancer quackery.

    I think we do underestimate the overall level of good sense in the public, and misunderstand why they can be so susceptible to the promises of dubious practitioners. We think they are making scientific judgements when they are not. They are mainly responding to medical needs and the fear of missing out on effective treatments.

    1. Harriet Hall says:

      @pmoran,

      “Once we make it clear that we are not going to oppose their use of such treatments if they really, really want to, despite any opinions we may have as to their likely efficacy, we may find a more responsive audience … we should go to greater lengths in showing precisely why we think the way we do,”

      Would you require us to preface every post with a disclaimer that we are not going to oppose patients trying anything they really want to try, and that we understand why they might want to, but that we want them to have the necessary scientific evidence to make a truly informed decision? That might at least be feasible, but going to greater lengths in showing why we think the way we do would require a book-length treatise, neither appropriate nor possible in a blog post.

  55. weing says:

    “I think we do underestimate the overall level of good sense in the public, and misunderstand why they can be so susceptible to the promises of dubious practitioners. We think they are making scientific judgements when they are not. They are mainly responding to medical needs and the fear of missing out on effective treatments.”

    Where is your data to support these claims? I don’t agree with most of them. I think the public, just like us, can be and is easily fooled. There is plenty of psychological literature to explain how we can be so susceptible. In general, the public is incapable of making scientific judgement. The fear of missing out on an effective treatment, however unlikely, is exactly what the frauds are using to take advantage of the public.

  56. BillyJoe says:

    weing: “I think the public, just like us, can be and is easily fooled.”

    I think there would be no one here, including the blog’s authors, who have not been fooled.
    Even after learning about SBM, we still need to be on constant guard.
    But I have a sneaking suspicion that accommodationism is raising its ugly head here.
    I feel we need a Christpher Hitchens or a Richard Dawkins to tell the uncompromising truth about CAM, and to put that truth firmly in the public arena.

  57. nybgrus says:

    I understand what you are trying to say and it has some vallidity ( once having disposed of the question of whether we are entitled to “disallow” anything that the public chooses to do entirely at their own expense and risk

    Are we not entitled (and indeed have an ethical onus) to “disallow” many things that the public might otherwise choose to do entirely at their own expense and risk? Raw milk for example.. or any other food which is found to have sub-standard handling processes. We have strict regulations as to supply chain structure and identification, procedures for recalls and source elimination for contaminated foods, and regular inspection and penalties for producers who fail to meet these standards and regulations. The public actually expects that of us. So why is it that food – which is “all natural” as it were – is reasonable to regulate in such a fashion, but any combination of herbs, vitamins, and minerals slapped with an “all natural” label and a quack miranda warning is suddenly exempt from these basic standards and regulations which the public already accepts and expects for food?

    I am not advocating for some SBM gestapo to stand guard at pharmacies and club people over the head as they attempt to buy echinacea to treat their flu. I am merely advocating something as simple as repealing the DSHEA, which a law that allows less regulation than is currently accepted for everthing else (there is a similar law in Australia which I don’t recall the acronym for off the top of my head).

    People go to the store and buy milk and spinach expecting it to be safe to drink and eat. If they get sick from it they expect there to be means to find out why, fix the problem, and receive recompense for it. If it is on the shelf, they expect it to meet those requirements regardless of the brand name, manufacturer, or source. Can you imagine introducing a law that suddenly allowed for certain companies to slap a couple of innocuous labels on it and thus exempt them from such basic consumer protections?

    Yet that is exactly what we have with the supplements and herbs on pharmacy shelves. The consumer expects that all the bottles they buy from their pharmacy shelves to be equally safe and verified as to their contents. They further expect that if it says something like “helps alleviate cold symptoms” that there is some actual science behind that much like an actual FDA approved and tested medication would have. In many cases the former is lacking and in all cases the latter certainly is.

    The raw milk crowd is always angry that we disallow it. And the supplement crowd will be angry if we were to repeal the DSHEA and disallow the indiscriminate sale of their favorite bogus pill. That is no reason to cow and allow such an obvious double standard in consumer protection.

    On the other hand, the public can understand, indeed already “knows” that people can think themselves into feeling better when sick. That is not in the least a foreign idea to them.

    Because that is not the basis by which these things are marketed, nor the basis by which people elect to use them. The bottles do not say “take this and you will think you are better!” And people do not take them on the assumption that it is a placebo response. The marketing claims and the consumer believes that there is actual effect from these supplements… and in the vast, vast majority of these cases that is entirely false. The problem is that if the marketing was legitimate then even the perceived effects of placebo would evaporate.

    Because studies show that all but a few per cent of CAM use is complementary to orthodox medical care. That even applies to most CAM cancer treatments.

    I am not sure what studies you are citing, and I would disagree that it is as low as few percent, but I will agree at least in spirit with your comment. That doesn’t change the fact that evidence based medical establishments have no place condoning let alone using such “complimentary” and ineffective therapies (a la Reiki at the MSKCC). And it further doesn’t address Jann’s very valid point about consumers being financially harmed.

    You commented: I suspect there will be answer to that once we examine why we don’t go harder after economic harm from cosmetics or astrologers.

    We should go after astrologers and psychics. And in fact, it has been done. Most nowadays have the caveat “For entertainment purposes only.” But that matters not – the fact that there isn’t more strict consumer protection against such obvious fraud does not justify a lack of consumer protection for healthcare fraud. We here are in healthcare so does it not seem obvious our focus would be on healthcare fraud? I can lament that psychics are not pursued for their economic harms, but my interest is healthcare harms and the fact that somebody else hasn’t taken up the torch that I have for astrology does not invalidate my pursuit. James Randi has been working at it as have others. I leave it to them. We don’t need an “all fraudulent economic harm or none” approach, and we certainly don’t need to sit on our laurels and abide by healthcare fraud economic harms because you have decided that we as a society haven’t yet addressed astrological fraud economic harms. Your argument is a non-argument.

    why they themselves should be demanding a much higher quality of testimonial evidence and documentation from anyone offering them cancer cures (not frigging RCTs! — as many skeptics rather stupidly request!)

    Yet you just commented recently that the NCCAM is useful because it provides exactly that level of evidence to show that we are dismissing CAM in good faith. So which is it? Do we waste public money to determine whether prayer can cure AIDS so we can point out it doesn’t or don’t we?

    We cannot do much about those who give themselves over entirely to make-believe but in the interests of regaining public trust we should go to greater lengths in showing precisely why we think the way we do,

    And that is how I treat my patients. I explain to them why I don’t think CAM [X] would reasonably work, comment that it may help them but only superficially, and close by saying it is their money and choice (for those CAMs you and I would agree are “safe”).

    I think we do underestimate the overall level of good sense in the public, and misunderstand why they can be so susceptible to the promises of dubious practitioners.

    I disagree. The public does not have good sense in these regards and nobody here misunderstands why they are susceptible. We recognize that it is intrinsic to human nature to fall victim to cognitive biases, logical fallacies, and the power of anecdote. We also recognize something which you seem not to – that people, as a whole, tend to put trust in authority and thus if it is sold in a store take a massive mental shortcut and assume it must be effective not just harmless. The definitive way to address these issues is to make everyone a scientist. You will be the first to point out that is impossible. I will agree. Which is why repealing laws that allow loopholes around already accepted standards and additional laws to create more stringent consumer protection (which includes financial protection) are not only necessary but reasonable. It is the only way to actually address these things. And yes, we do have an onus as the educated experts on the matter to tell the public which things fall into this category. Reality is not something we could or should vote on.

  58. David Gorski says:

    Indeed. Peter seems to demand so many disclaimers, exceptions, and caveats that it becomes impossible to make our points.

  59. pmoran says:

    Weing:“I think we do underestimate the overall level of good sense in the public, and misunderstand why they can be so susceptible to the promises of dubious practitioners. We think they are making scientific judgements when they are not. They are mainly responding to medical needs and the fear of missing out on effective treatments.”

    Where is your data to support these claims?

    That most CAM is used in a complementary fashion to orthodox care. as the studies show.

    Moreover, lurk on even the most extreme cancer quackery forums and you will find that this is still so. Nearly all new visitors have had at least some mainstream care. In fact, there are even indications of less strident opposition to conventional care by the more extreme voices on the main one that I monitor (the one I have been booted off twice) .


    I don’t agree with most of them. I think the public, just like us, can be and is easily fooled. There is plenty of psychological literature to explain how we can be so susceptible. In general, the public is incapable of making scientific judgement. The fear of missing out on an effective treatment, however unlikely, is exactly what the frauds are using to take advantage of the public.

    Did you miss my point that the CAM-using public is NOT making a scientific judgment, or at least not one beyond the hypothesis-forming stage? Most are responding at a primitive instinctive level to acute medical need and an external prompt, such as a testimonial, advice from a relative, or something they read somewhere.

    Also, many of the cancer quacks truly believe that their methods are helping, and their clients sense that belief. Some may be knowing frauds who are able to put on a convioncing show for their clients, but eirhter way we won’t win many sympathizers over with the bald claim that they are being defrauded. Part of the typical CAM-users illusion is that one that we all share that while others might fall prey to fraud, we personally are too smart.

  60. Pmoran where is your proof that most CAM users believe their useless treatments are helping them?

  61. pmoran says:

    @pmoran,

    “Once we make it clear that we are not going to oppose their use of such treatments if they really, really want to, despite any opinions we may have as to their likely efficacy, we may find a more responsive audience … we should go to greater lengths in showing precisely why we think the way we do,”

    Would you require us to preface every post with a disclaimer that we are not going to oppose patients trying anything they really want to try, and that we understand why they might want to, but that we want them to have the necessary scientific evidence to make a truly informed decision? That might at least be feasible, but going to greater lengths in showing why we think the way we do would require a book-length treatise, neither appropriate nor possible in a blog post.

    You MUST be aware how very strong subtexts can be sent by the way we talk about CAM, even by the vocabulary that we use. Whether you can see it or not, there is no question that we are regarded as desirous of stamping out CAM if we could, some skeptics even saying as much outright in the comments without exciting comment.

    The begrudging allowance that we can sometimes tolerate it in the privacy of our consulting rooms changes that little. That is seen as facing up to the unavoidable.

    If you want a specific example of showing in more detail “why we think the way we do” look at my attempt to explain how anecdotal evidence has its uses but how everyone, CAM users as well as its practitioners is allowing themselves to be misled by the generally poor quality that as come to be accepted as the CAM standard.

    (I need to tighten this up, but you may get my drift) http://www.users.on.net/~pmoran/cancer/Brenneranecdote.htm

    .

  62. Harriet Hall says:

    @pmoran,

    “You MUST be aware how very strong subtexts can be sent by the way we talk about CAM.”

    Some people will always misunderstand (sometimes deliberately, sometimes because of poor scientific education) what we are really trying to say. That doesn’t mean we should dilute our message or bend over backwards to accommodate them. CAM proponents are putting out a strong message, and there is a good argument for our presenting an equally strong one. Nothing we do will touch the true believers, but we can hope to reach the fence-sitters.

  63. Millions are dead because of convention medicines. That’s a public “safety” issue. You’re all ‘concerned’ about vitamins and natural alternative methods … that you presume (without scientific proof by the way), is all in the patient’s mind. And, you want to take control of it …denying people the right to choose what they want to take for their own healing, in their own bodies…in the name ‘concern’ and safety of course, while handing out deadly prescriptions made of chemicals and toxins. You conventional medical students are dangerous to the public health…in my opinion of course.

  64. @rusticyhealthy, wow, that link… :) I gave it a good ten seconds before closing the window. But I did see the first link on the site, it says “NFL cheerleader suffers brain damage after flu shot.” You should look up what happened to Desiree Jennings, the person mentioned. She either faked the entire thing or it was a psychogenic reaction. It was not a dystonic reaction as claimed. Our own Dr. Novella commented on the case. (You get around, Dr. Novella – I just re-watched the P&T BS! about ghosts and saw you on there!) Now she claims to speak in a different accent (british and australian?). She’s a complete whacko.

    http://www.youtube.com/watch?v=wcrIqOr9Bsw

    By the way, do you believe in lizard people?

  65. @BJ, I dare you to click on that site’s home page and read it without your brain exploding from quackery overload. I couldn’t do it!

  66. @Skeptical…a few links down it she speaks of her own recovery…

    http://healthfreedoms.org/2009/11/07/desiree-jennings-on-the-road-to-recovery/

    but, there are plenty of other links on there to go through.

  67. and, Skeptical..hypothesizing is not proving/disproving anything.

  68. Chris says:

    It is like SBM is being visited by tourists from Htrae.

  69. pmoran says:

    ” @pmoran,
    “You MUST be aware how very strong subtexts can be sent by the way we talk about CAM.”
    Some people will always misunderstand (sometimes deliberately, sometimes because of poor scientific education) what we are really trying to say. That doesn’t mean we should dilute our message or bend over backwards to accommodate them. CAM proponents are putting out a strong message, and there is a good argument for our presenting an equally strong one. Nothing we do will touch the true believers, but we can hope to reach the fence-sitters.”

    So, what? — you actually don’t mind supporting the impression that we intend to stamp out CAM as soon as we can? That is what we were actually talking about and .what you were previously saying we did NOT intend.

    And what does a “strong message” mean when dealing with factual matters such as what medical treatments can do or don’t do and why? Everything else is venting, and massaging the egos of the like-minded, and probably counterproductive ad hominem, and inaccurate misrepresentations of the “opposition” because we have not bothered to examine it and all the influences within it in the detailed and dispassionate way we might any other problem in medicine.

    The net effect of all this accretion is precisely those messagse that you say we don’t intend.

  70. pmoran says:

    Millions are dead because of convention medicines. That’s a public “safety” issue. You’re all ‘concerned’ about vitamins and natural alternative methods … that you presume (without scientific proof by the way), is all in the patient’s mind. And, you want to take control of it …denying people the right to choose what they want to take for their own healing, in their own bodies…in the name ‘concern’ and safety of course, while handing out deadly prescriptions made of chemicals and toxins. You conventional medical students are dangerous to the public health…in my opinion of course.

    Rustic, I know you are here mainly to jerk chains but you may have also misunderstood my intent when I said that public safety should be the main focus in our approach to CAM. That was not intended to mean that CAM is extraordinarily unsafe; I agree with you that most CAM use is not especially dangerous.

    The focus I am suggesting could mean that there would be less attempts to “control” safer CAM methods, even when unproven or implausible. That would include most supplements, so long as basic quality standards are met. Surely most consumers would support those.

    You must know that most medical claims arising from within CAM are eventually proved to be wrong or at least never consistently meet normal tests for efficacy. Find me some that went the other way, if you disagree. This, and the fact that the methods are available over-the-counter to be used in any amount by people of any intelligence is why there is an added burden on CAM to be safe.

    We are quite unable to “control” most of CAM, anyway. All we can do is offer opinions and advice concerning it.

  71. Harriet Hall says:

    @pmoran,

    “you actually don’t mind supporting the impression that we intend to stamp out CAM as soon as we can?”

    I can only think you are deliberately trying to misunderstand me and playing the role of a troll. You know perfectly well by now that my goal is not to “stamp out CAM” but to provide facts and evidence so patients have the information required to give informed consent. The CAM websites strongly state “this works” or “vaccines cause autism” and offer heart-wrenching stories. I only meant that our presentation of science should be equally strong and need not be in the business of offering excuses for people who reject science.

    And when have I offered “inaccurate misrepresentations of the “opposition”?

  72. BillyJoe says:

    I think the aim should not be to “stamp” it out, but to assist its death through exposure.
    Headline: “Stripped of its clothing, CAM freezes to death”.
    Part of the process should, however, involve legislation against products that have no evidence of any beneficial effect (placebo doesn’t count) because that amounts to people ripping people off and people need to be protected against charlatans.
    Part of it should also include ridicule (eg acupuncture) and laughter (eg homoeopathy).
    Uncountable man hours are being wasted on this nonsense.

  73. pmoran says:

    Harriet: And when have I offered “inaccurate misrepresentations of the “opposition”?

    I never said that you personally did.

    Look at Billyjoe’s comment above. How does his leap from an educational approach to healthfraud to ” — legislation against products that have no evidence of any beneficial effect (placebo doesn’t count) because that amounts to people ripping people off and people need to be protected against charlatans.” not add up to, in effect, the intent to suppress CAM in its entirety?

    It is superficially sound from the skeptical perspective, indeed consisting of oft-quoted, unchallenged skeptical “truisms” , but why would the affected members of the public i.e. those inclined towards the use of CAM NOT see that as an affront, an unasked-for assault on their right to take in all our advice but to still make up their own minds concerning what medical treatments they will try out if the need arises and (usually) if conventional care proves unsatisfactory?

    Yet whenever I point out that the public might legitimately formulate such perceptions as the direct result of what we say, I get “straw man!” thrown at me by yourself, and David, and others. “We are not like that at all!”, I am told.

    This is my only issue with you personally — that you can’t acknowledge that it takes hardly any reading between the lines of what we say to get a quite different impression of our objectives to that which you personally profess to when challenged.

    Billyjoe, your position is not merely likely to be a tactical failure, it is faulty, because it assumes that CAM is almost entirely the product of knowing fraudulence. That is not so. It is sustained by a solid core of belief.

    It is faulty also because it assumes that users derive no benefits at all from CAM use, an unsafe proposition given what we know about human psychology, mankind’s existential concerns, and the potential for placebo and other non-specific factors from medical interactions. Even if we believe that the mainstream can satisfy the same needs, we still need to justify restricting public choice.

  74. David Gorski says:

    Yet whenever I point out that the public might legitimately formulate such perceptions as the direct result of what we say, I get “straw man!” thrown at me by yourself, and David, and others. “We are not like that at all!”, I am told.

    And whenever we point out to you how some of your remarks reasonably be interpreted as CAM apologia, you ruffle up your feathers, become all indignant, and insist that you’re being misrepresented. I realize that’s a tu quoque argument, but those who live in glass houses shouldn’t throw stones, and you’re most definitely throwing stones.

  75. David Gorski says:

    I can only think you are deliberately trying to misunderstand me and playing the role of a troll. You know perfectly well by now that my goal is not to “stamp out CAM” but to provide facts and evidence so patients have the information required to give informed consent.

    You are correct, Harriet. Peter has become a tone troll. His only concern seems to be his perception that those of us who oppose quackery are too “shrill” or “mean” or otherwise not nice enough for his taste.

  76. David Gorski says:

    This stance hints at permissiveness and tolerance, whereas the typical SBM one is unquestionably seen by those we most wish to influence as intolerant , oppressive, disrespectful of genuine medical needs, and even as a manifestation of turf protection or malign drug company influences.

    So tell me, Peter. How should I respond to practitioners who subject autistic children to bleach enemas to try to rid them of “parasites” causing their autism? Is it “intolerant” to point out that this is rank quackery that can harm children? Clearly, the parents seem to think that they are helping their children. Clearly, the parents get a “benefit” out of it in that they see hope of “recovering” their autistic children.

    Is it “oppressive” and “disrespectful of genuine medical needs”? How do you describe such practitioners in a way that will convince parents that their nostrums are useless without being perceived as “intolerant” and “oppressive”? Be specific. I want to know exactly what you would say. Pretend you are writing a letter to a parent who’s been giving her child bleach and bleach enemas in an attempt to treat autism, and show us your wisdom. What would you say that would convince her?

    I’m tired of your vague generalities coupled with lamentations about how we just don’t understand CAM users coupled with insinuations about how mean and intolerant we supporters of SBM are. I want specifics this time. How do you deal with a parent falling for MMS quackery?

  77. weing says:

    @pmoran,

    There is no “real” improvement from CAM or placebo that is not present in conventional medicine already. We are about medicine that is above and beyond the placebo effect. You would have us treat the public like children who are told that Santa Claus is real. Even when parents do that, they will not let their children out of sight just because a guy in a Santa suit is with their child. What if Santa wanted to be alone with their child? Would you restrict him? Are you for removing restrictions on the the practice of real medicine? Would you allow an internist to do a CABG if he/she felt the patient needed it? Would you restrict the patient’s choice if he wanted his internist to do the procedure?

  78. BillyJoe says:

    “Billyjoe, your position… assumes that CAM is almost entirely the product of knowing fraudulence. That is not so. It is sustained by a solid core of belief.”

    I meant ‘charlatan’ in the broader sense. A quack.
    In any case, whether they are deceivers or believers, the effect is the same – the erosion of the scientific basis for medical treatments, and a waste of time, money, and effort for all concerned.
    Why not add placebo effects to treatments that actually do something.

    “Even if we believe that the mainstream can satisfy the same needs, we still need to justify restricting public choice.”

    How about “it doesn’t work” and therefore “it should not be offered” to Joe because “Joe is not in a position to evaluate this for himself”.

    “Billyjoe, your position…is…likely to be a tactical failure”

    There is no evidence that that is so.
    And the big plus is that it is the honest position – telling the truth!
    In the long run that has to be the right move.

  79. Harriet Hall says:

    @pmoran,

    “you can’t acknowledge that it takes hardly any reading between the lines of what we say to get a quite different impression of our objectives to that which you personally profess to when challenged.”

    Oh, I acknowledge that. I just think that if people try to read between the lines and misinterpret what I write, that’s their failure, not mine. We have had many examples in the blog comments of readers who read what they wanted to think I said rather than what I actually said.

    “Harriet: And when have I offered “inaccurate misrepresentations of the “opposition”?
    I never said that you personally did.”

    So it appears I read between the lines and got the wrong impression. That must be your fault for not explaining in great detail and putting in all the caveats. You are guilty of what you accuse us of.

  80. pmoran says:

    David: “Yet whenever I point out that the public might legitimately formulate such perceptions as the direct result of what we say, I get “straw man!” thrown at me by yourself, and David, and others. “We are not like that at all!”, I am told.”

    And whenever we point out to you how some of your remarks reasonably be interpreted as CAM apologia, you ruffle up your feathers, become all indignant, and insist that you’re being misrepresented. I realize that’s a tu quoque argument, but those who live in glass houses shouldn’t throw stones, and you’re most definitely throwing stones.

    So I am, but I am talking about third party perceptions that can be confirmed within five minutes by listening to any “alternative” newsgroup or mailing list. “Rustichealth” has kindly provided some examples in recent comments..

    We can argue about the extent to which those perceptions inhibit us getting a useful message across, but if you have any basis for disputing them as fact I would like to hear it.

    It is also a gross example of ad hominem-style debate to even raise the question of my involvement in CAM apologetics. The question should be whether I speak the truth or not, i.e. whether what I say is consistent with the science and also the observations we have, or that can easily be made regarding CAM users.

    I am ready to argue that through, too, any time you wish to move the discussion forward.

  81. pmoran says:

    “Harriet: And when have I offered “inaccurate misrepresentations of the “opposition”?
    I never said that you personally did.”

    So it appears I read between the lines and got the wrong impression. That must be your fault for not explaining in great detail and putting in all the caveats. You are guilty of what you accuse us of.

    Perhaps I am. I wish I had better verbal skills.

    Or perhaps some don’t understand the implications of what they say. If someone here says “alternative methods should be held to the same standards of evidence that we apply within the mainstream”, that seems an obvious objective. No one here would dispute it. Yet in practical effect it is the same as saying that no form of “alternative” medicine should be tolerated. That is what the CAM sympathizer will hear.

    There follows instant opposition from those who think that they should be entitled to try out any medical treatment they like at their own expense and risk and through applying their own standards of evidence. And there is, believe it or not, no law that says that everyone has to trust what the medical professions says in all matters.

    Neither point of view is entirely incorrect, but they are immiscible without some qualification or caveat.

    When I first came here a few years ago I said that healthfraud activities are being hampered by a lack of clear rational and realistic objectives and that this leaves the public that we most wish to influence to place their own warped interpretations on our intentions. That still holds.

  82. weing says:

    “When I first came here a few years ago I said that healthfraud activities are being hampered by a lack of clear rational and realistic objectives and that this leaves the public that we most wish to influence to place their own warped interpretations on our intentions. That still holds.”

    Applying the same standard is not rational and realistic? Do you really think it’s possible to prevent some, like rustichealthy, from placing their own warped interpretations on our intentions or anything for that matter?

  83. pmoran says:

    “When I first came here a few years ago I said that healthfraud activities are being hampered by a lack of clear rational and realistic objectives and that this leaves the public that we most wish to influence to place their own warped interpretations on our intentions. That still holds.”

    Applying the same standard is not rational and realistic? Do you really think it’s possible to prevent some, like rustichealthy, from placing their own warped interpretations on our intentions or anything for that matter?

    That standard can stick only if nearly everyone agrees with it, even when in dire medical need and when “evidence-based” treatments have been exhausted. It requires a very high level of trust in the medical profession and in scientific consensus Those conditions are unlikely to apply to the necessary degree any time soon.

    We should therefore be thinking about optimal, “rational and realistic” strategies for a partly consumer driven pluralistic medical system. This is unfamiliar territory for us.

  84. pmoran says:

    # pmoranon 11 Jun 2012 at 4:30 am

    So tell me, Peter. How should I respond to practitioners who subject autistic children to bleach enemas to try to rid them of “parasites” causing their autism? Is it “intolerant” to point out that this is rank quackery that can harm children? Clearly, the parents seem to think that they are helping their children. Clearly, the parents get a “benefit” out of it in that they see hope of “recovering” their autistic children.

    Is it “oppressive” and “disrespectful of genuine medical needs”? How do you describe such practitioners in a way that will convince parents that their nostrums are useless without being perceived as “intolerant” and “oppressive”? Be specific. I want to know exactly what you would say. Pretend you are writing a letter to a parent who’s been giving her child bleach and bleach enemas in an attempt to treat autism, and show us your wisdom. What would you say that would convince her?

    Delighted to help — .:-)

    — no, I am not sure why you would assume that I would not say much the same things as you would . The only difference is that I might apply more emphasis to safety aspects.

    I would assume at the very beginning that whatever I say desperate parents of severely autistic children would want to try this treatment and it is unlikely that any single article will dissuade them from it . So I would, like you, say frankly that there is no earthly reason to expect this treatment to be helpful other than through extra non-specific attention and distraction for the child (or whatever else happens with autistics, – it is not my field) , but I would also say up front that if you do decide to use it against all advice understand that it is extremely dangerous to expose any part of the human body to this product unless very, very dilute and that some children have been hospitalised through using too much. I would also mention that enemas regularly cause serious anal or rectal damage even when given by hospital nursing staff.

    I would at the very beginning advise it definitely NOT to be used in concentrations above X (I would work out what looks safe).

    (BTW there is an error in your calculations — one drop is .05 ml, I thought, not 1 ml.)

  85. Hey, really honestly, do you all actually believe people put their money into something that doesn’t work for them?? I started taking Vitamin C., I continued..I don’t know what quality it was ..but it worked! My asthma subsided, to the point that I rarely have to take it..over 3 years now. There are other things I added, and I found better results ..something to deal with infection. And it works better!..yet conventional “science” based meds would only accuse me of being a liar, a fraud? , duped, etc..etc…. I started taking calcium for my arthritis, I continued, why?? Because it worked! I haven’t had to take anything for my arthritis since. Ok, so, you all want “proof”.. There are clinical tests done, and I appreciate them myself…that give evidence, most only confirming my own experience as well..before I ever got on the internet looking for them. Tests, and indications of certain herbs, vitamins, etc. but, they’re impossible,(in my opinion), to represent all the different variables possible. In any case, this is all up to the individual. Whether you choose to believe they work,.. or not. Whether you think we’re all lying, idiots, etc. …or not. That’s not up to you to decide actually..that’s what’s great..people learn and think for themselves..and decide for themselves..in a free country …that is. See?

    pmoran, sorry, I still am not sure about monitoring/control over things from the government or conventional meds. especially seeing what comes out of government control and conventional meds. Sorry, no, I don’t see them proven wrong. I see more and more dangerous chemical based medicines coming out. It seems again odd, considering that, once again, to be so concerned over what people put their own money and trust in when it comes to vitamins and other less dangerous alternative methods..even in Danielle’s case. If they didn’t work, they would not buy them, or put their trust in them. Maybe you all can rest your concern with that. That’s the problem I have here, and now with government taking control in anything. It’s coming off very arrogant, and fascist. I’m not saying in you personally pmoran…I like quality vitamins, but, again, what I buy, if they didn’t work, I would not buy them. But, I certainly can see the arrogant fascist attitude in some others here though.. like weing, and Skeptical, etc.

    All of you pontificating what is in the interest of others, assuming and deciding that you really do know that?? it is astounding to me, listening to most of you and your judgement in Danielle’s life decisions for example. You all need to let go…seriously…let GO. Maybe learn what works, with far less disastrous results, doing less harm, not more harm, (what you all call “quackery”) than what conventional medicine turns out first, before saying anything about what everyone else should do/not do with their money and lives. But, all I’ve seen and heard so far is trashing everything and anything that is not a toxic chemical! CAM comes up with things like cinnamon for diabetes instead, Vit. C for respiratory instead. There are many other things I’ve found out just looking online. No I don’t know if they all work, but I’d personally be willing to try. If there is any more careful monitoring and overseeing needed, it’s in what conventional meds turns out in the chemical based medicines and other dangerous methods. I respect the ability to diagnose..that’s what I go to the doctor for. If one prescribed things like home remedies and vitamins instead.. I would go more often:)

  86. nybgrus says:

    That standard can stick only if nearly everyone agrees with it

    History demonstrates you to be wrong. Standards stick when rational people demonstrate their validity and necessity and then enforce them over the shrieks of those with an agenda and those with true belief.

  87. BillyJoe says:

    rustichealthy,

    “do you all actually believe people put their money into something that doesn’t work for them?”

    (This is reposted from another thread in reply to a similar comment by jbvtme)

    Testimonials are not evidence (or an extremely weak form of evidence).
    This is why we do clinical trials.

    If you look on the internet, there are literally thousands of presumed treatments. For each of them, there are people who think it worked for them. If you think about how these treatments are supposed to work, most of them are mutually exclusive – they can’t all be right. It takes a clincal trial to sort out which work and which don’t.

  88. BillyJoe…if I waited for conventional meds to come up with ‘clinical trials’ that suited their idea of what works and what doesn’t, I’d still be on 4 asthma meds, and the conventional arthritis meds..if I weren’t crippled by now first. Instead, I chose to follow my own common sense, think Vit. C for respiratory, etc…and..it worked. Apparently, many many others are doing the same. What conventional meds are telling us is, if THEY don’t find a clinical trial that satisfies THEIR idea of ‘proof’ and ‘evidence’ then we must be duped, quacks, and idiots..and we should have no say in what we put in my own body.

    You simply dismissing ‘anecdotal’ claims as false, lying and ‘quackery’ is really not ‘scientific’ either. If I told you, a tree fell in the forest..and you simply say..well..”that’s a Lie, you’re an idiot..you must be psycho’..without going to see for yourself, then you’re not being scientific either, you’re going on presumption. If you all go by your own waiting for clinical trials that satisfy you, and the chemical meds that come out to alleviate symptoms..(yet cause others)..that’s your choice. Not millions of others. Again, the problem is..conventional meds trying to denigrate (by labeling us all idiots, liars and quacks) and dictate and actually stop those who don’t believe in their (conventional med) clinical trials with their chemical based ‘medicine’.

  89. And, just to add to my…(What conventional meds are telling us is, if THEY don’t find a clinical trial that satisfies THEIR idea of ‘proof’ and ‘evidence’ then we must be duped, quacks, and idiots..and we should have no say in what we put in my own body.)

    ..All in the name of imploring… “governments to recognize the need for effective regulation to protect the health consumer from fraud and from unsafe and ineffective practices. :) sorry..I kind of have to :) on that…

    the only ‘unsafe and ineffective practices’ I’ve encountered are in conventional meds thus far. I am sure there are some in alternatives..but, I don’t see millions dead because of them. We need gov to actually recognize in conventional meds..” the need for effective regulation to protect the health consumer from fraud and from unsafe and ineffective practices”…and to stop leashing on the population poisonous chemical based meds with the “it’s the dose of the poison” excuse.

  90. Holy crap, did you discover non-chemical Vitamin C????

  91. Skeptical..I discovered it works for asthma in a less toxic way, something you con meds still haven’t ‘discovered’.

  92. David Gorski says:

    It is also a gross example of ad hominem-style debate to even raise the question of my involvement in CAM apologetics.

    Pot. Kettle. Black. Given that you routinely refer to SBM supporters as being arrogant, dogmatic, and too shrill.

    And, no, it’s not an ad hominem attack. Let’s review the logical fallacy of the ad hominem, shall we? An ad hominem attack goes something along the lines of:

    Dr. X is wrong because he is a (communist, CAM apologist, not a nice person, etc., etc., etc.)

    In other words, the argument is based on the person. Because that person is something considered unsavory, goes the fallacy, his argument is wrong, not because his argument is wrong based on reason, logic, facts, and/or science. Contrast a true ad hominem to our pointing out that your words can be interpreted as CAM apologia. We don’t say you’re wrong BECAUSE you’re a CAM apologist. We are simply pointing out that your words sound like CAM apologia, and they do. This is more a fellow skeptic trying to point out to you how you’re going wrong, not trying to persuade those reading our exchanges that you’re wrong. In any case, to me my pointing out things you say that come across to several of us as CAM apologia is no different from your frequent assertions that skeptics’ statements are perceived as dogmatic, uncaring, “oppressive,” against freedom, and all the other things you keep accusing us of.

    Yes, pot, kettle, black indeed.

    Tell you what. I’ll make you a deal. You stop harping on how “shrill” and “mean” skeptics are, and I’ll stop telling you you sound like a CAM apologist. I guarantee I won’t be the first to violate such an agreement. :-)

  93. David Gorski says:

    no, I am not sure why you would assume that I would not say much the same things as you would . The only difference is that I might apply more emphasis to safety aspects.

    And I didn’t expect that. In fact, I expected that you would say something similar to what I would say because in the end that is what has to be said and our approaches are actually pretty similar in most respects. Consider my question the first step. Now for the second step:

    What, specifically, would you say if you were charged with writing a blog post about MMS designed to try to persuade fence sitters that it’s rank quackery? How would your approach be better than mine?

  94. nybgrus says:

    Hey, really honestly, do you all actually believe people put their money into something that doesn’t work for them??

    Yes. Abundantly. Constantly. Unequivocally. Reliably. Power Balance anyone?

    ROFLcopter

  95. nybgrus says:

    We don’t say you’re wrong BECAUSE you’re a CAM apologist. We are simply pointing out that your words sound like CAM apologia, and they do.

    And it took me all of 60 seconds to pull up two recent comments of mine that said exactly the same. pmoran should know this is not the case:

    7 May:

    Once again, I defy you to find a single instance where anything you have ever said here was dismissed with “Peter must be wrong, he is a CAM apologist after all.”

    5 May:

    I’ll conclude by adding that never once has Dr. Gorski or anyone here dismissed your arguments based on the notion that you are an apologist. Every time and without fail it has been pointed out why the argument is incorrect and then labeled as characteristic of said apologia.

    There are more, but I think the point is made.

    And more interestingly, those responses go completely unanswered. Not once, ever, has pmoran ever been able to quote an example which demonstrates anyone here dismissing his arguments by means of ad hominem. Yet, we keep hearing that again and again.

    If it happens so often, why can’t you simply copy and paste an example which, in context, demonstrates clearly anyone here dismissing your arguments solely on the basis of “being a CAM apologist?”

  96. pmoran says:

    If that was not ad hominem by some people’s conveniently chosen definitions, it was an entirely unnecessary distraction from the matters I raised, which also happens to have the sly implication, “don’t listen to him he might be a CAM apologist” . So I don’t buy that the remark was made in all innocence. It is a pointless remark to make unless you have run out of more cogent argument.

    The question that this distracts from is whether it is true that CAM sympathizers do have a distorted perception as to the intentions of skeptics.

    No one has chosen to contradict that.

    The question logically follows: “to what extent, if any, is this perception hampering our ability to communicate effectively with CAM sympathizers and fence-sitters?”

    I contend that skeptics have never even stopped to consider the impact of those perceptions and how they arise. It seems they still aren’t and I am now even suspected of being a troll for wanting to bring it up. This is not good enough in a supposedly rational forum.

    1. Harriet Hall says:

      @pmoran,

      “CAM sympathizers do have a distorted perception as to the intentions of skeptics.”

      Of course they do: their pet beliefs are being challenged and they KNOW they are right so they rationalize that it must be pharma shilling, turf protection, evil intentions, financial motivations, personal animosities, and conspiracies. I don’t think there is any way we could avoid that, no matter how “nice” we were and how carefully we tried to spare their feelings. Their failure to understand us is their fault, not ours. I say that from the experience of many long discussions with true believers.

      You are very free with your doubting and questioning and with telling us what we shouldn’t do, but you have never offered an example of what we should do that would satisfy your objections. Please do as David asked and tell us what you would have us say about treating children with MMS. You might even consider submitting a guest post that presents a CAM topic in the way you think we should be doing.

      I accused you of acting like a troll not because you brought up the impact of perceptions, but because of the way you went about it. You have managed to seriously antagonize people who are basically on your side.

  97. pmoran says:

    The irony is that we have here Rustichealth, a true-blue, classical example of a CAM adherent confirming many of the matters that I would like skeptics to think more carefully about, including the perception that we are rampaging, overly self-righteous zealots, willing to trample all over individual rights and perfectly entitled inclinations in pursuit of God-knows-what ends.

    David, when I use language like that, it is usually a wholly accurate reflection of how we are seen within CAM. You must know this from your own experience, but you choose to let your righteous (and I agree largely justified) indignation about certain matters dominate your writings. That is fine if your intent is to gee up fellow skeptics. I am not sure that it is wise if you expect your writings to have a wider reach.

    I don’t pretend to have the answers, but I think we should be trying to find out.

  98. mousethatroared says:

    “Hey, really honestly, do you all actually believe people put their money into something that doesn’t work for them”

    Apparently our latest economic crisis still hasn’t under minded the fallacy that people use their money rationally.

    Drug addictions, gambling habits, my father’s GM stock that he would not sell, pyramid schemes, credit card debt, designer handbags, people make all sort of bad decisions with their money AND that’s when they understand the risks.

    Then there’s things like health insurance policies, exotic mortgages, incredibly complex CAM regimes and diets, and the derivatives market, that are infernally complex, one might suspect, in order to hide deception.

    How people spend their money is a bad measure of product worth.

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