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Six reasons CAM practitioners should not be licensed

States license “complementary and alternative” (CAM) practitioners (chiropractors, naturopaths, acupuncturists/TCM practitioners and homeopaths) via the magic of “legislative alchemy.” Ironically, licensing statutes are enacted based on the states’ constitutional power to protect the health, safety and welfare of the public. Yet these CAM practice acts actually increase public vulnerability to unsafe and ineffective health care practices.  It is, in short, a bad idea.  (A point we’ve discussed many times on SBM.) Here are six reasons why.  Feel free to add to the list.

1. Practice acts grant CAM practitioners a broad scope of practice, including legalization of scientifically implausible and unproven (or disproven) diagnostic methods, diagnoses and treatments.

Like medical doctors, dentists and nurses, CAM practitioners must practice under licensing legislation, also referred to as a practice act. Otherwise, they risk prosecution for the unlicensed practice of medicine or other licensed profession unless they are exempted by one of the so-called “health freedom” laws, which basically give everyone the right to practice medicine.

Chiropractic practice acts incorporate the absurd notion that patients are suffering from “subluxations” that adversely affect their (or their children’s) health. Acupuncture practice acts are based on the equally absurd notion that the body contains “meridians” which, when blocked, cause ill health, but can be relieved by sticking people with needles. Naturopaths can diagnose and treat conditions they invented out of whole cloth, such as chronic yeast overgrowth, ubiquitous “food sensitivities,” and adrenal fatigue. Homeopaths can treat patients with expensive little bottles of water. (You can find out much more about these CAM practices in the pull-down menu accessed via the “Categories” tab to the right of this post.)

Although there are exceptions, most practice acts grant CAM providers the right to diagnose and treat any patient, no matter what age or physical condition, suffering from any disease or condition, as long as the disease or condition is described in the terms of the practice act and the treatment is within the scope of practice. This is perhaps best illustrated by examples. Suppose a patient sees a chiropractor for vertigo. The chiropractor is legally allowed to diagnose the cause of vertigo as one or more subluxations of the spine and to treat the patient with adjustments. What if the patient sees an acupuncturist? If the acupuncturist diagnoses blockage of “qi” as the cause of vertigo and performs acupuncture to unblock the “qi,” the acupuncturist has done nothing outside his scope of practice. And if the patient sees a naturopath? The naturopath is free to diagnose, for example, “toxins” as the cause of the vertigo and proceed to treat these toxins with colonic irrigation. How about a homeopath? Same result: the patient is treated with what is essentially water. None of this will address the patient’s vertigo but it is all perfectly legal.

There is no better way to demonstrate the legalization of quackery accomplished by licensing legislation than to quote from the law itself. A few examples:

Nevada: Defines “homeopathic medicine” or “homeopathy” as

employing substances . . . [p]repared according to homeopathic pharmacology by which the formulation of homeopathic preparations is accomplished by the methods of Hanemannian dilution and succession or magnetically energized geometric patterns applicable in potencies above 30X, as defined in the official Homeopathic Pharmacopoeia . . . and . . . prescribed . . . in accordance with the principle that a substance which produces symptoms in a healthy person can eliminate those symptoms in an ill person.

Nevada’s homeopathy practice act also permits “cell therapy, neural therapy, . . . neuromuscular integration, [and] orthomolecular therapy. . .”  [As is the case with other terms in CAM practitioner statutes, I do wonder what “magnetically energized geometric patterns” are and how they are “applicable in potencies above 30X.”]

North Carolina: Defines the practice of chiropractic as

[T]he science of adjusting the cause of disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.

Colorado: It is distressing to report that the Colorado’s naturopathic licensing bill was passed by the legislature and signed by the governor. It defines the practice of “naturopathic medicine” in a broad fashion typical of naturopathic licensing statutes:

A system of health care for the prevention, diagnosis, evaluation, and treatment of injuries, diseases and conditions of the human body through the use of education, nutrition, naturopathic preparations, natural medicines and other therapies, and other modalities that are designed to support or supplement the human body’s own natural self-healing processes.

2. CAM practitioner education is inadequate preparation for the scope of practice permitted.

Almost without exception, state statutes simply require that a CAM practitioner have graduated from a school accredited by an accrediting agency approved by the U.S. Department of Education. These accrediting agencies are run by the schools and practitioners themselves. And while the Department gives lip service to the goal of assuring educational “quality,” it does not address the scientific validity of what these schools teach. Nor does it have jurisdiction to determine whether further clinical education is necessary for practice after graduation. While medical doctors and osteopaths must complete an additional three years to practice as primary care providers in a grueling residency program, no such residency requirement exists for CAM providers. In addition, these CAM schools have low admission requirements compared to medical schools. For example, unlike medical and other professional educational institutions, there is no admissions test.

CAM providers also create their own licensing exams – exams which are not vetted by, or have even been seen by, outside sources. And, because there is no residency requirement, unlike medical doctors there is no further testing for licensing eligibility during residency training.

Yet, as noted elsewhere in this post, some states specifically allow practitioners to practice “primary care” – like M.D.s and D.O.s – without nearly the quality, or quantity, of education and training medical doctors must have. As discussed in a previous post, chiropractors are now promoting themselves as primary care physicians, in the form of “advanced practice chiropractors.” This includes the right to prescribe certain drugs, including drugs no respectable physician would use, based on a flimsy prescription drug education course.

The only fact-based, well-reasoned analysis of CAM practitioner education I’ve ever seen was done by SBM’s own Kimball Atwood, M.D. In 2001, he authored a scathing analysis of the practice of naturopathy and the insufficiency of naturopathic “medical” education. Unfortunately, he and Arthur Relman, M.D., members of a 2001 committee created to vet the possibility of licensing naturopaths in Massachusetts, ended up issuing a minority report opposing naturopathic licensing due to the bias in favor of licensing apparent in other members of the committee. Dr. Atwood chronicled his experience for SBM readers, as well as the many foibles of naturopathic practice, in posts collected here. (Fortunately, naturopaths still aren’t licensed in Massachusetts, although they came awfully close last year. This year brings a fresh attempt.)

3.  The fox is allowed to guard the henhouse (self-regulation).

CAM practitioner licensing acts typically allow self-regulation via boards empowered to enact rules governing practice and to discipline practitioners, in the same fashion as medicine, nursing, optometry and similar boards regulate the practice of other professions. These boards are usually made up of practitioners and a couple of public members. In turn, the boards, in some cases, simply default to the CAM schools and trade associations to set standards for education and practice. In addition, via their authority to enact rules, the boards are able to approve even more quack practices not specifically mentioned in the practice acts. Boards can administer, without answering to anyone, a light hand in disciplining practitioners even in the most egregious of cases. In other words, the fox guards the henhouse.

Some examples:

Nevada: In case you have not heard of some of the homeopathic practices permitted by Nevada law (see above), these Nevada Administrative Code regulations enacted by the Board of Homeopathic Medical Examiners fill in the gaps.

“Neuromuscular integration” is “the progressive harmonization of the endocrine system, immune system, autonomic nervous system, skeletal system and smooth muscle system of a patient with the cognitive and noncognitive faculties of a patient.”

“Orthomolecular therapy” is “the treatment and prevention of disease, including, without limitation, infection, malignancy and degenerative illness, by adjusting the natural chemical constituents of the body on the molecular level.”

Other permitted homeopathic treatments are defined as well, including the use of “bio-oxidative substances” which are “used to promote healing at the cellular level by the use of oxygen in its various forms” and “thought field therapy,” defined as “a technique that uses the energy meridians of the body which are used in acupuncture . . . to treat abnormal patterns of thought that cause emotional and psychophysiological distress.”

Alaska: Chiropractic-board-approved “specialty programs” include the “Chiropractic Diagnosis and Management of Internal Disorders (DABCI) program administered by the American Chiropractic Association Council on Family Practice” and the “Certificate in Chiropractic Pediatrics program administered by the International Chiropractors Association (ICA) Council on Chiropractic Pediatrics.” (The “D” in “DABCI” stands for “Diplomate.”)

California: Regulations enacted by the chiropractic board state that a “duly licensed chiropractor may treat any condition, disease, or injury in any patient, including a pregnant woman, and may diagnose, so long as such treatment or diagnosis is done in a manner consistent with chiropractic methods and techniques and so long as such methods and treatment do not constitute the practice of medicine by exceeding the legal scope of chiropractic practice . . .”

Oklahoma: The chiropractic board defines “scope of practice” to include all diagnostic methods and treatments “taught by an accredited chiropractic college and approved by the Board of Chiropractic Examiners.” As well, chiropractors are authorized to use naturopathic and homeopathic remedies.

4. Mandatory public and private insurance coverage

Once licensed, CAM providers inevitably lobby for mandatory public and private insurance coverage. (This sharing of CAM costs via insurance premiums and tax dollars is in addition to the billions Americans spend each year on “alternative medicine.”) For example, Florida law mandates that whenever an insurance policy “provides for the payment of medical expense benefits or procedures” the policy “shall be construed to include payment to a chiropractic physician who provides the medical service benefits or procedures which are within the scope of a chiropractic physician’ license.” Coverage of such services under Florida’s no-fault insurance law saw chiropractors, acupuncturists and massage therapists become the top-paid providers under the program, an unsustainable situation recently addressed by the state legislature.

As another example, in Oregon naturopaths and acupuncturists are covered providers under a publicly funded medical assistance program for Native American patients. As we have seen, naturopaths are now demanding that they be permitted to practice in coordinated care practice groups serving Medicaid patients, even though they reject evidence-based medicine, a quality and cost-saving requirement of all practitioners per Oregon law.

The Affordable Care Act (ACA) may exacerbate this problem via its non-discrimination provision (Section 2607), which prohibits discrimination against any health care provider who is acting within the scope of his or her license. Inclusion of CAM in essential health benefits and as providers in practice groups per the ACA may offer additional means of accessing insurance dollars. California already includes acupuncture as an essential health benefit under the ACA and other states include chiropractic.

5. Licensing confers undeserved legitimacy causing public confusion.

Once licensed, CAM practitioners enjoy an imprimatur of legitimacy as “doctors.” This causes public confusion about who is a medical doctor and who is another type of practitioner. This is no doubt exacerbated by the fact that many statutes defined CAM practitioners as providers of “primary care.” And some statues permit practitioners to call themselves “physicians.”

This status as “doctors” and “physicians” allows practitioners to insinuate themselves into other situations formerly denied them. For example, some states allow chiropractors to perform sports and school physicals. Arizona’s regulations governing child care group homes includes in its definition of “physician” persons licensed to practice “naturopathic medicine” and “homeopathic medicine.”

6. Licensing decreases important health care consumer protections.

Incorporating pseudoscience into practice acts and permitting self-regulation decreases consumer protection. Obviously, if the state chiropractic practice act permits the detection and correction of subluxations, a chiropractor is not going to be disciplined by the state chiropractic board for detecting and correcting subluxations, even though there is no such thing as subluxations and they cannot be detected. If the patient attempts to sue a chiropractor for fraud in a civil action, the chiropractor can raise the affirmative defense that he is permitted to detect and correct subluxations under state law.

Once CAM practitioners are licensed and governed by their own boards, the medical boards have little authority to prosecute these practitioners for the unlicensed practice of medicine. Even in the rare case where the medical board might attempt it, the CAM practitioner will raise the defense that his practice is exclusively under the jurisdiction of their state board.

And there is that most egregious assault on the health care consumer in the form of “health freedom” statutes. Unfortunately, another state’s citizens are now subject to the imaginative treatments of charlatans: the “Colorado Natural Health Consumer Protection Act, or, as I prefer, the Quack Full Employment Act, recently passed the Colorado legislature and was signed by the governor. This statute (as do others) almost completely removes the despicable snake oil salesmen who prey on the sick from the jurisdiction of the medical board.

A couple of cases highlight how consumer protection has been sacrificed by the legalization of quackery.

In Yow v. Dept. of Health, the Washington Court of Appeals upheld a state medical board finding that Yow, a practitioner of colonic irrigation who did not hold any sort of health care practitioner license, was engaged in the unlicensed practice of medicine. The court also upheld a fine of $444,000.

Testimony before the medical board revealed that Yow claimed colonic irrigation would purge accumulated “toxins” and referred to irrigation as a “detoxification process.” He sometimes added herbs to the water used for irrigation.

Yow admitted that the benefits of colonic irrigation were “anecdotal.” A gastroenterologist testified that the procedure carries the potential for colonic perforation and that introduction of herbs into patients’ colons could cause side effects, such as difficulty breathing, and may result in allergic reactions. This expert also testified that irrigation creates a risk of electrolyte shifts and subsequent cardiac arrhythmias.

But note that colonic irrigation is perfectly legal in Washington if performed by a licensed naturopathic doctor, as is true in any state that licenses naturopaths. In Florida, massage therapists are licensed to perform colonic irrigation. The facts have not changed: there is no evidence of effectiveness (anecdotes are not evidence), “toxins” are not removed by the procedure (not that toxins are present in the first place), and there are recognized risks. The only difference is the legality of the procedure.

In Ames v. Dept. of Health, the Washington Supreme Court upheld the state’s imposition of sanctions against Ames, an M.D., for falling below the standard of care for medical doctors and use of an ineffective device. Ames used a galvanic skin response device to diagnose and treat patients. The inventor of the device himself testified at the hearing that the machine – called “LISTEN” – was a biofeedback device and not approved by the FDA for the diagnosis and treatment of disease. According to testimony at the administrative hearing:

Ames instructed P1 [Patient 1] to lie on his back while holding a small brass probe in his hand. The probe connected to LISTEN. While P1 lay prone, Ames performed a basic muscle resistance test by asking P1 to resist downward pressure on his upraised forearm, which P1 ably achieved. Next, Ames typed the word “eggs” into LISTEN’s computer interface and performed the resistance test again. Apparently, Ames was able to force P1′s arm down.

Based on this absurd test, Ames diagnosed the patient with egg allergies.

The LISTEN machine, as employed by Ames, is a type of electrodermal diagnostic device. According to Quackwatch:

Thousands of practitioners use “electrodiagnostic” devices to help select their recommended treatment. Many claim to determine the cause of any disease by detecting the “energy imbalance” causing the problem. Some also claim that the devices can detect whether someone is allergic or sensitive to foods, deficient in vitamins, or has defective teeth.

Yet the Arizona Board of Homeopathic and Integrated Medicine Examiners not only approves the use of electrodermal testing, it also permits “homeopathic physicians” to train persons not registered by the Board in this testing by providing “180 hours of homeoptherapeutic instruction and 100 hours of supervised clinical experience.” Likewise, the Florida Board of Acupuncture rules provide that “traditional Chinese medical concepts and modern oriental medical techniques shall include . . . electrodermal screening.”

There is also the problem posed by an amorphous standard of care when a patient sues the CAM practitioner for malpractice. As Bob Baratz, M.D., D.D.S., pointed out in a recent discussion of CAM practitioner licensing acts:

One only has to go as far as the basic textbooks of naturopathy to see that these are not centered on a theme of method, so much as they are a collection of a hodge-podge of “treatments” without following the basics of medical care. At a minimum these should be: defining the condition with a set of criteria which any practitioner could see and evaluate, defining the condition being treated with knowledge of the natural history of this condition/disease/malady when untreated, and then confirming a diagnosis with physical examination and confirmatory tests, followed by a treatment plan which could then be objectively assessed with objective criteria of success or failure of the treatment.

This is equally true of subluxation-based chiropractic, acupuncture and homeopathy. And this lack of a systematic approach presents a problem: an incoherent system necessarily creates an incoherent standard of care. If each naturopathic treatment is “individualized,” how can there be a standard of care applicable to all patients? How could a chiropractor possibly fall below the standard of care for detection of subluxations when there are no reliable parameters for diagnosing a subluxation? And how would one ever determine whether “qi” is successfully unblocked when there is no “qi” in the first place?

Conclusion

An Institute for Science in Medicine policy statement, “State Licensing and Regulation of CAM Practitioners,” succinctly summarizes many of the points I’ve made in this post and correctly concludes:

The world’s health care systems need to be rooted in a single, science-based standard of care for all practitioners. Effective, reliable care can only be delivered by qualified professionals who practice within a consistent framework of scientific knowledge and standards. Practitioners whose diagnoses, diagnostic methods, and therapies have no plausible basis in the scientific model of medicine should not be licensed by any government, nor should they be allowed to practice under any other regulatory scheme. Any statute permitting such practices should be amended or repealed as necessary to achieve this policy. Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities.

Posted in: Acupuncture, Chiropractic, Health Fraud, Homeopathy, Legal, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

Leave a Comment (97) ↓

97 thoughts on “Six reasons CAM practitioners should not be licensed

  1. Stephen H says:

    If these laws are based on a state’s “constitutional power to protect the health, safety and welfare of the public” (something that is really all states’ constitutional responsibility and purpose), then why not mount a legal challenge to the laws? Surely if the laws are demonstrably causing detriment to the health of citizens then any sensible court would have no option but to overturn them.

    Point three, regarding foxes and hen-houses, is not something any medical practitioner (or lawyer, or member of several other professions) is really able to argue convincingly unless you also admit the problem in your own profession.

    1. elburto says:

      The difference being, of course, that medicine and surgery have actual codes of practice that are universal. For example, if you require surgery then you know with absolute certainty that any incisions will be made with surgical tools like scalpels, and not with a steak knife. If you develop an infection that requires treatment with 50mg nitrofurantoin pills you can measure what 50mg is, and nitrofurantoin is a specific compound with a unique molecular structure.

      The same cannot be said of chiropractic or naturopathy.

  2. Keith says:

    Many of the points here are valid. I feel like the author gives chiropractic care an unfair shake. From my own personal experience chirpractic has kept me off narcotic pain killers and anti-inflammatories. I saw MD’s for over a year before getting fed up and seeing a chiropractor, it’s one of the best decisions I’ve ever made.

  3. windriven says:

    Six great reasons, Ms. Bellamy. How then do we counter the facts that:

    Chiropractic is now licensed in all 50 states (Louisiana was last (imagine that) having finally succumbed in 1974).

    Acupuncture is licensed in 43 states and DC.

    Naturopathy is now licensed in 17 states, DC, Puerto Rico and the Virgin Islands.

    Even idiotic homeopathy, a woo so outrageous that no one with 14 functioning neurons could possibly believe it, has licensing requirements in 3 states.

    Then we have – and this is just a tiny sampling:

    -Johns Hopkins Integrative and Holistic Medicine
    -Integrative Medicine at Yale
    -Osher Clinical Center for Complementary and Integrative Medical Therapies
    at Harvard/Brigham and Women’s and at UCSF
    -UW (groan) School of Medicine Integrative Health Program
    -Benson Henry Institute for Mind Body Medicine at Mass General

    One is hard pressed to find a major medical school or medical center that does not have an ‘integrative’ medicine program.

    At some point proselytizing can become raging into the wind. The professional medical hierarchy has already gone to the dark side as evidenced above. State legislators are largely of the mind that people want sCAM so it is better to license and regulate it than to let it operate in the shadows. And the Feds have enshrined it in PelosiCare.

    Talk is all well and good but reason and logic do not seem to be carrying the day. What actions can we take to reverse the trend of integrating nonsense into medicine? And if that is a lost cause, what actions can we take to mitigate the damage?

    1. Dolly says:

      “a woo so outrageous that no one with 14 functioning neurons could possibly believe it” — HA! Best thing I’ve read all day. And I read for a living. And it’s been a 16-hour day.

  4. Eugenie Mielczarek says:

    Jann,
    thank you for the excellent post. Unfortunately NIH’s National Center for Complementary and Alternative Medicine has contributed to the imprimatur of legitimacy by awarding millions of dollars to fund curriculum and training to colleges of Naturopathy, Oriental Medicine and Chiropractic training. Taxpayers are funding
    beliefs in Qi, subluxations, and homeopathy.
    Eugenie Mielczarek

    1. windriven says:

      Eugenie, for what very little it is worth, I have changed my position pretty completely on NCCAM. The forest is fully engaged in fire. We are going to have to put it out tree by tree, study by study. Homeopathy is worthless for appendicitis. Homeopathy is useless for bee sting. Shift target and repeat, ad nauseum until every smoldering ember has been thoroughly wetted. Only then will the medical establishment, the various legislatures, the kooks and their enablers, have nowhere to hide. We might even pick up a useful bit of science along the way.

  5. WilliamLawrenceUtridge says:

    Many of the points here are valid. I feel like the author gives chiropractic care an unfair shake. From my own personal experience chirpractic has kept me off narcotic pain killers and anti-inflammatories. I saw MD’s for over a year before getting fed up and seeing a chiropractor, it’s one of the best decisions I’ve ever made.

    Chiropractic is somewhat confounded by the fact that there are essentially two types – the ones who think manipulating bones and joints can cure cancer, colic, asthma, ear infections, and nearly any other disease (let’s call them “the crazies”) and the ones who think that they can help with muscle, joint and bone pain through physical manipulation (let’s call them “the physio-wanabees”)*. The crazies get the most attention here (deservedly) because they can do the most damage. The physio-wanabees get little attention, and the most defence in the comments, because they provide a reasonable, plausible service. The flaw in the physio-wanabees though, is that they are little more than physios who have adopted high-velocity, low-amplitude manipulations as a primary intervention (and they call themselves “chiropractors”, thus sharing a name with the crazies). Many phyios are now testing and adopting high-velocity, low-amplitude manipulations, and thus the physio-wanabees are offering essentially no services that couldn’t be found elsewhere. The crazies are still crazy and simply wrong. And crazy.

    So consistently, to the physio-wanabees and their patients who show up on this thread proclaiming that they are not crazy, I ask why they don’t just become physiotherapists, since they no longer offer a unique service and this would distance themselves from the crazies. I rarely get naught but crickets in response to my points.

    Also, personal experience is unreliable (how do you know your pain wouldn’t get better on its own?), you might have been better off seeing a physio, your comment isn’t clear on the approach taken by the chiropractor, and we don’t know if you’re simply lying. If you are really curious about how your personal experience reflects chiropractic overall, and which strand of thought, you might try investigating a little deeper. It’s possible you saw a physio-wanabee who fixed a musculoskeletal problem, and truly this group attending to this problem doesn’t deserve much of the grief heaped upon them by skeptics. It’s possible you saw a crazy who “fixed” a non-musculoskeletal problem, which means either you don’t understand human anatomy, physiology and biology and thus don’t understand that the “fix” probably wasn’t, or you do understand these issues and are yourself rather deep in woo, thus rendering us unable to change your mind because your mind is not based on evidence. Details would help.

    You should read Sam Homola’s guest posts, it might clarify the issues a little more.

    *They are more properly called “straights” and “mixers”, but my terms are funnier, and I don’t remember which is which.

  6. magnetically energized geometric patterns???

    That’s a quote from the Nevada practice act on homeopathy. If homeopathic treatments are prepared in that way (way?) they’re within the act. WTF?

    1. Pareidolius says:

      The mind reels . . .

  7. windriven says:

    “and the ones who think that they can help with muscle, joint and bone pain through physical manipulation (let’s call them “the physio-wanabees”)*.”

    Not to quibble William, but the physio-wannabees should become accredited physical therapists.

    The problem is that chiros who choose the non-crazy path are making a conscious decision to ignore a significant underpinning of their training: subluxation theory and all that accompanies it. They are picking and choosing which parts of their education to accept. But on what basis do we expect them to discard the nonsense and fill in the spaces with solid science, not other nonsense? The point of a professional education is to not have to ‘make it up as you go’, at least within the confines of the existing state of the art.

    In effect you are semi-condoning a ‘fixer-upper’ education. It would be as if taking a degree in alchemy and ignoring the parts that don’t work and replacing at least some of them with parts that do. Would you hire such a person to do biochemistry? If your health depended on it?

  8. LindaRosaRN says:

    Windriven wrote: “Talk is all well and good but reason and logic do not seem to be carrying the day. What actions can we take to reverse the trend of integrating nonsense into medicine? And if that is a lost cause, what actions can we take to mitigate the damage?

    Much can be done at the state level:

    Organize to prevent new licensure of CAM practitioners (e.g. naturopaths) and block “Health Freedom” bills.

    For those CAM practitioners already licensed, work to prevent further privileges and mandatory reimbursement.

    Testify at legislative hearings when CAM “professions” have their practice acts are reviewed or revised.

    Make a website advising citizens in your state about CAM.

    Picket CAM fundraising and other events.

    Question local candidates for political office about their views on CAM.

    Help healthcare professionals in your state stay aware of CAM intrusions.

    Challenge hospitals and colleges about CAM programs.

    Work on the state medical societies to oppose pro-CAM legislation (offer to speak at their meetings).

    File complaints against CAM practitioners who openly violate their practice act.

    Try to convince local skeptic groups that they should join you in actively opposing CAM licensure and intrusions.

    Urge national skeptics groups to do more to promote anti-CAM activism.

  9. Aaron says:

    These are all terrible arguments. Why is it any of your business if delusional people want to waste their money on imaginary services? Shall we outlaw “psychics” and “tarot” as well, since they are equally fake? It is wrong to try to protect people from their own stupid choices. Medical licensing requirements should be abandoned altogether as fundamentally incompatible with freedom. If people want a service, and others are willing to provide it, they should have every right to receive that service without being told that they are doing something wrong and you know better than they do. Even if you do.

    1. windriven says:

      Yipes! I thought I had libertarian tendencies.

      No, we don’t have to outlaw psychics and card readers. But let’s not license them.

      “Medical licensing requirements should be abandoned altogether as fundamentally incompatible with freedom.”

      I hope you’ll think through some of the ramifications of that proposal. Assume I believe in faith healing. My 3 year old is dying of scarlet fever. I take her to some idiot preacher and she dies for want of a week or ten day treatment with a beta lactam. The daughter pays for the stupidity of the father?

      Or let’s say that anyone can play doctor (Groucho Marx eyebrow wiggle). My son has influenza. I prescribe vancomycin – a drug that is useless against a viral infection – and it contributes to the growing problem of antibiotic resistance.

      I’m all for letting fools be launched by their own petards. Not so much their children or other innocents. My personal preference is for adults, upon reaching the age of majority, to choose between medicine and sCAM. No turning back. Your choice. Iridology or MRI. Eye of newt or colorectal surgery. Make the decision as if your life depends on it :-)

      1. Pareidolius says:

        I think Aaron is a poe, or a truly insane drive-by.

    2. Chris says:

      Because the next step is to require insurance coverage for these imaginary services, and for some places that is tax-payer money.

      Also, in my state a country council member actually pushed for state funding of clinics offering the nonsense. Though his beliefs may have contributed to his untimely death.

      1. windriven says:

        Chris,
        How do you embed links in text as you have above? Very nice.

        1. Chris says:

          Okay, replace the square brackets with the angle brackets:
          How to embed links: [a href="http://www.sciencebasedmedicine.org"]Put page title in here.[/a]

          1. windriven says:

            Domo arigato. I should have realized it is simply html.

    3. Chris says:

      Aaron:

      Medical licensing requirements should be abandoned altogether as fundamentally incompatible with freedom.

      I am sorry, but that is hilarious. You must think John R. Brinkley was a hero.

      Do you also oppose driver’s licenses? Though I will tell you that I know someone who was injured by an unlicensed driver,. The driver who must have been expressing his freedom by ignoring motor vehicle laws ended up paying almost everything he owned to my friend (a poor college student), and some very substantial fines. If he had been caught again, his freedom would have been curtailed.

  10. WilliamLawrenceUtridge says:

    Not to quibble William, but the physio-wannabees should become accredited physical therapists.

    Completely agree, though this would require a great deal of bravery on the part of the elders, administrators and instructors of chiropractic education. Still, osteopaths did it.

    The problem is that chiros who choose the non-crazy path are making a conscious decision to ignore a significant underpinning of their training: subluxation theory and all that accompanies it.

    Not necessarily, it’s not like you learn about subluxations in conventional schools. They are repeating what they are taught. They may not be ignoring the problems because they may not realize there is a problem with their learning. I studied anatomy and physiology, but also went to a chiropractor for years. It’s only recently I stopped going (but Canada has more of the physio-wanabees than the crazies, the sole college is of such a type) and started going to a physio instead, mostly because even though my chiro acted like a physio, he still insisted on adjusting my cervical vertebrae. It was awkward.

    In effect you are semi-condoning a ‘fixer-upper’ education. It would be as if taking a degree in alchemy and ignoring the parts that don’t work and replacing at least some of them with parts that do. Would you hire such a person to do biochemistry? If your health depended on it?

    The earliest history of real, modern medicine in the US was such a “fixer-upper” history, as was osteopathic practice. So it can be done. But yes, it does require a lot of crow-eating, and probably a hit to the pocketbooks of a lot of chiropractors. That’s why I try to engage with the defenders of chiropractors in these comments, at least the ones who stick to muscle, bone and joint problems, to try to get them to question their practice. It’d be nice if we could just replace them all in one fell swoop with physios, or force them out of practice, but that’s unrealistic. Still, you might be able to if you can convince your congressperson. In my opinion we gain by being precise and avoiding straw men in our arguments and posts (recognizing that it’s only a straw man for the physio-wanabees, for the crazies it’s accurate) and discussing things from a scientific perspective when the opportunity presents. We may even be in a unique position here, I can’t even remember a crazy chiro showing up in the comments, but I can remember at least one physio-wanabe(e?) who has engaged and discussed. And for him (her?) I kept poking and asking socratic questions – how are you different from physios? Do you think you can cure cancer? Don’t know if I succeeded. It’d be interesting to ask Sam Homola if he has more success, or less, because he used to be a chiropractor, and with what group.

    I see it as progress, not perfection, but opinions can differ.

  11. Ben Kavoussi says:

    Excellent post: it summarizes everything that’s wrong with the licensing of voodoo- doctors as healthcare providers!

  12. Egstra says:

    “Why is it any of your business if delusional people want to waste their money on imaginary services? ”

    It isn’t… until and unless it impacts my insurance payments and the cost of medical coverage. If people pay for it out of their own pockets, that’s fine with me.

    1. Malcolm McIntyre says:

      Should sporting injuries be covered by health insurance then? After all, it’s a personal choice to take the known – and unavoidable – risk.

      1. Chris says:

        Except that insurance companies and real medical doctors encourage exercise. It would seem that the sports injuries are less of a risk than a sedentary lifestyle.

        I would assume that motor vehicle accidents cause more injuries than playing sports, but I cannot find any comparative statistics. I mostly find separate pages on motor vehicle deaths (not morbidity), and how to prevent sports injuries. But my guess that motor vehicles cause more is bolstered by the fact that the “Injury Center Focus Areas” of http://www.cdc.gov/injury/ has motor vehicle accidents, and nothing on sports.

        It does have a link that provides this:
        http://www.cdc.gov/Injury/wisqars/pdf/National_Estim_10_Leading_Causes_Nonfatal_Injuries_Tx_Hospital-ED_US2010-a.pdf

        Unfortunately it does not tell if the “unintentional fall” is from a ladder or whiffing a soccer ball. Or if the “unintentional struck by/against” is walking into a wall or being hit by a baseball after a power hit down the center. Also what causes the “unintentional overexertion”? Is it trying to ride a bike up a particularly steep hill or shoveling the sidewalk after a heavy snowfall?

        1. WilliamLawrenceUtridge says:

          Insurance companies don’t usually cover diseases or injuries on the bass of how you got them. They usually reimburse for specific types of treatment. Irrespective how you get an injury, they should reimburse a physio, not a homeopath, naturopath or chiro.

          1. Chris says:

            WLU, are you replying to me or Malcolm McIntyre?

            Actually, I am not quite sure what is point was in relation to this article’s subject. Because if he was really concerned about insurance payments, then he would prohibit insurance from paying for injuries due to automobile accidents or vaccine preventable diseases.

          2. WilliamLawrenceUtridge says:

            I was responding to Malcolm’s comment.

  13. weing says:

    “Why is it any of your business if delusional people want to waste their money on imaginary services? ”

    Unfortunately, these delusional people waste not only their money but mine as well. When they end up requiring actual medical care for neglected problems the costs go up for all of us. If they came to require real medical care and the frauds and people like you had to foot the bill for it, that would be something else.

    “Medical licensing requirements should be abandoned altogether as fundamentally incompatible with freedom.”

    So are laws against fraud by banks and financial advisors.
    They are all incompatible with freedom to defraud others. You are always free to be defrauded.

  14. LindaRosaRN says:

    “Why is it any of your business if delusional people want to waste their money on imaginary services? ”

    Well, there are a lot of repercussions to legitimizing CAM practice. Adding to Egstra’s comment regarding the public cost of CAM licensure in $$$, which can be substantial, I would add the problem of children being subjected to CAM practitioners. One of the things activists for SBM can work for is rolling back the privilege that any licensed CAMsters may have for diagnosing/treating anyone under the age of 18.

    A large study in Washington – a state that has given its imprimatur to NDs via licensure – found that if a child (or even one of his family members) was seeing an ND, he was significantly less likely to have his childhood vaccinations.

    CAMsters oppose other public health measures, as well, such as fluoridation, and spread healthcare myths among the populace.

    1. Egstra says:

      ” I would add the problem of children being subjected to CAM practitioners. One of the things activists for SBM can work for is rolling back the privilege that any licensed CAMsters may have for diagnosing/treating anyone under the age of 18.”

      Good point… the very thought of chiropractors working on infants makes me angry, especially when I see the ads claiming that they can cure ADHD and autism through … what? … rectifying the subluxations?

      I’d also like to see them sued for false advertising.

  15. NorrisL says:

    So, while the American State Governments are busy legislating in favour of these dangerous quacks, we in Australia have banned numerous quack therapies from being allowed to receive private health insurance payments.
    What the? I always though Americans were smart. And of course, many of you are. But I firmly believe that legislators at local, state or federal level need somehow to be brought up to some degree of scientific speed as to the ramifications of legislating what can only be described as medial male cow poo. And, yes, I know I’m living in fairy land on this, but you just gotta have hope….don’t you

    1. Pareidolius says:

      Ah, Norris. You’ve never been here, have you? While there are many fine, smart people in our fair land, sadly, they are outnumbered and the US is ground zero for the Derpocalypse.

  16. Jann Bellamy says:

    @Stephen H:
    I’ve tried to think of a way to attack these statutes as unconstitutional but courts are deferential to the legislatures’ judgment (such as it is) in this area. I certainly see your point about doctors and lawyers regarding self-regulation but I would argue that we have been far more responsible with our power.

    @Aaron:
    “Why is it any of your business if delusional people want to waste their money on imaginary services?”

    States have no business legalizing lying to purchasers of goods and services. That is not a legitimate government purpose although it is certainly done, as you can see here. Which is why I am complaining. Deregulation will cause great public harm and I happen to think government can serve a useful purpose if regulation is done properly. As an economic issue, I don’t want to pay for worthless treatments via increased health insurance premiums and tax dollars or for the illness and disability caused by deregulation.

    @Keith:

    Your treatment isn’t really relevant to the point I am making. Perhaps you are seeing one of the few chiropractors who limit themselves to evidence-based treatments. But that doesn’t mean the states should legalize their nonsensical notions about human anatomy and allow many millions of people to be defrauded by them.

    My own personal anecdote: Just this past Saturday I was at a local farmer’s market where a “straight” chiropractor of the type WLU describes had a booth set up. A large sign claimed chiropractic could help with many conditions, such as heart disease and gastrointestinal problems — about 30 total — which went far beyond back pain and the like. She wasn’t an old fogey either — very young. I asked how chiropractic could help with gastrointestinal problems and the answer was straight out of the straight chiropractic playbook — remove nerve interference to help with healing (or something to that effect).

    @ windriven:

    Ditto to everything Linda Rosa said. Linda and all of us who write for SBM have done these things. Get going!

  17. Ex-Acupuncturist says:

    When I chose to become an acupuncturist in the 1990s, the State’s licensing of acupuncture with a broad scope of practice made it seem legitimate. Also, Federal student loans added to the government stamp of approval. Frankly, at the time it seemed like research was supporting many of the claims of acupuncture, particularly the special pain relieving properties. Since I have been learning more about research and reading skeptical materials, I now know that acupuncture is a placebo therapy, and the points which are needled aren’t important, merely the confidence and caring communication from the practitioner.
    Acupuncturists should keep up on research in their profession (as they are supposed to be the ‘experts’), but now that the best research clearly shows it is equal to sham acupuncture, acupuncturists who continue to practice while preaching either traditional or modern justifications for ‘how acupuncture works’ have to hope their patients don’t search too much on the internet and learn that it is equal to confidently twirling toothpicks on the surface of the skin. In this sense, the ignorant acupuncturists may maintain ‘ethical congruity’ but the ones who learn the truth about the best research on acupuncture will either have to be intentionally deceptive, live with unhealthy cognitive dissonance, or phase out of acupuncture practice.
    It has taken me a few years of researching, double-checking, and contemplating to reach this point. SBM, Randi, Ernst and the skeptical blogs/books have been very important to me.
    I recently announced a sabbatical and that I’m not taking new patients. I’m explaining gently to my few remaining dedicated patients (who were ‘true believers’ before they came to see me) that while acupuncture may help with their perception of pain, they should work on their health with sensible lifestyle choices and if needed, science-based care from a good MD.
    It is scary to make this transition, as I haven’t totally replaced my acupuncture income. But the feeling of freedom from a clinic of theatrical placebo acupuncture and the possibility that I will soon have a professional self-identity other than ‘acupuncturist’ is worth the risk and uncertainty.
    I have tried to talk a couple prospective acupuncture students out of following that path, but both of them were already starry eyed and had made their choice. I tried to equip them with skeptical insights, so perhaps they won’t wind up with tens of thousands of dollars of student loans which are difficult to repay given the marginalized place of acupuncture in the healthcare world.
    Since I had started and stopped a couple other academic paths before choosing TCM, I made a commitment with myself to finish acupuncture school no matter what it took. Doubts about the system were in my mind from day 1, but I soon focused on just learning what was needed to reach my goal, and skeptical questioning wasn’t on the exam. Emerging from school with the need to make a living and pay basic bills also didn’t encourage me to question or reject the TCM system. It took years before I was in a space to allow that to happen, and I had to put a lot of time into reading and research to untangle the mess of ethics, economics, science, religion, and medicine.
    It is telling that so few pro-TCM practitioners post on SBM with any sort of reasonable defense of TCM. I’m posting to thank most of you skeptical writers for what you’ve done, and to let you know that it has made a difference in my life as I transition out of TCM.

    1. NorrisL says:

      ExAcupuncturist

      Mate, you’ve given me heart. I’ve blathered on for years about the many and various quack “therapies” to numerous people, and while I have pulled a few people down to the scientific side of the fence, I am sure that I have EVER seen a quack hop the fence to the scientific side of the fence.

      It must have been very difficult to walk away from what you did every day, but even more so to abandon an entire belief system

      Thank you for telling your story.

      Stuart

    2. windriven says:

      Congratulations. What you did took courage and intellectual honesty. I hope your new path brings you happiness and success.

    3. Rob Davison says:

      Well done

  18. RobRN says:

    Anecdotal.

  19. NorrisL says:

    I have a friend (ooh, lucky me) who, when he was much, much younger, really wanted to help people in some health related way. He felt that by becoming a chiropractor who could fulfill this dream. So off he went to a chiroquactor “college”. He lasted several weeks, his dream in tatters. All that he learned was how to scam people Nothing else. And so he left the quack college.

  20. Homeopathy has been available on the National Health Service in Britain since 1948. Then the Government pledged that homeopathy would continue to be available on the NHS, as long as there were “patients wishing to receive it and doctors willing to provide it”.

    1. Rob Davison says:

      I think you will find that a recent decision by NICE, the National Institute for Clinical Excellence and the Science and Technology Committee in the UK Parliament, has cut down the credibility of homoeopathy, and we hope that soon it will be taken out of state funding altogether. You will still be able to seek homoeopathy as a private patient.

      http://www.sciencebasedmedicine.org/homeopathy-gets-a-reality-check-in-the-uk/

    2. NorrisL says:

      In reply to Nancy Malik

      Which of course does not make the lunacy of homeopathy work in any way, shape or form. The lunacy of homeopathy even extends to dispensing homeopathic moonlight. 2 words in that sentence being intentionally linked. :)

  21. WilliamLawrenceUtridge says:

    Why is it any of your business if delusional people want to waste their money on imaginary services?

    Because one of the delusions these people hold is “vaccines don’t work” or “vaccines are dangerous” and their decision to avoid vaccines curtails herd immunity. Their failure to get the pertussis vaccine can kill my baby.

    1. NorrisL says:

      But of course, William, these people don’t give a flying proverbial about your baby

  22. Carl says:

    Indeed, you can find “doctors” willing to prescribe homeopathy.

    Too bad the title “doctor” so often gets snatched up by complete morons who ought to be patients of psychiatry rather than doctors of medicine. Or does the Dr. before your name stand for “drivel”?

    1. Chris says:

      It does if it is then followed by any of the following names:
      Mercola
      Wakefield
      Geier
      Oz
      Chopra
      … and a few others.

      Actually, going to medical school and getting licensed to practice medicine does not necessarily cause some to not believe in nonsense, or just sell nonsense for the cash. Also, it is not fair to brush all doctors with the same brush. They are individuals, some good and some bad.

      1. Carl says:

        Malik’s website says she is a “Bachelor of Homoeopathic Medicine and Surgery”, whatever that horrifying string of words could possibly mean, so it’s not quite the same as a misguided real doctor. Driveling actually is her official job.

        1. WilliamLawrenceUtridge says:

          So what happens in homeopathic surgery? They touch the skin with a scalpel, shake the patient, then repeat? Or do they put in a bit of whatever they were going to remove, shake the patient, take a bit of that patent, put it into another patient, shake that patient, then repeat? Do tell, inquiring minds want to know.

        2. Chris says:

          Many, many, many years ago on a UseNet newsgroup (either misc.medicine or sci.med), someone in India asked what he needed to do to practice medicine in the USA. He had gone to one of the homeopathic medical schools.

          He was pointed to several websites on the the American requirements were, and then came back a few days later and was quite furious. He apparently found out that his degree in homeopathic medicine was worthless in the USA. He was upset that they kept telling him the entire four years he was there that he could be a doctor. And then he also listed another website that he was upset for misleading him: Dana Ullman’s http://www.homeopathic.com/

          I’ve looked, and I cannot find the conversation, sorry. But, needless to say: a homeopathic doctor would not be licensed in the USA.

        3. Chris says:

          Great, my last comment just went into the ether.

          Short version: on UseNet many years ago I remember a some guy in India who had just spent four years becoming a homeopathic doctor. He wanted to know what he had to do to get licensed in the USA. He was given several links to on the American requirements.

          Then he came back angry because he learned his education was worthless, despite being told by that school he could become a doctor in the USA. Which pretty much tell you all you need to know about Nancy Malik’s education.

          1. Regular full time 5.5 years (not four) graduate medical degree [Bachelors in Homoeopathic Medicine and Surgery (BHMS)] that includes one year compulsory internship (approx 4800 hours in total)is absolutely necessary for becoming qualified & to get license to practice homeopathy medicine in India. And to do regular full time M.D. in any one of the 7 specialisations (Medicine, Paediatrics, Psychiatry, Pharmacy, Organon, Materia Medica, Repertory) of homoeopathic medicine, you have to spend three more years after BHMS.

          2. WilliamLawrenceUtridge says:

            Spending 5.5, or even 10, or even 50 years learning about dragons, in order to find one, is still time wasted. Expertise in nonsense is still nonsense. Merely because someone may spend a decade learning to properly blood let or balance the humors does not mean the bloodletting is a real medical treatment, or that the humors exist. The most meticulous regulation or learning about nonsense is still nonsense.

            If you don’t see this, I’m not surprised you have never managed to drag yourself out of the intellectual and scientific quagmire that is homeopathy.

          3. Chris says:

            Still worthless in the USA.

            The USA does license doctors trained outside the country. What you need to do is list those homeopathic medical schools in India that actually are approved as accredited universities to become real doctors in the USA at https://imed.faimer.org/ .

  23. 2005: 60% of the UK doctors who use homeopathy do so because of good experience of homeopathy as effective treatment and anxiety about hazards of conventional treatment

    Ref: Halvorsen R. Alternative therapies in the practice. The General Practitioner Magazine. Feb 2005

    2007: 14.5% of the population say that they trust homeopathy

    Ref: Samarasekera U; Lancet. 2007 Nov 17; 370(9600):1677-8.

    2007: 206 MPs signed Early Day Motion 1240 to acknowledge the positive contribution made to the health of the nation by the NHS homeopathic hospitals.

    1. NorrisL says:

      As homeopathy is just water, there is zero chance of it having any therapeutic effect on anything. The contribution to health in the UK is not zero, it is less than zero. What I mean by that is that there is no positive effect of homeopathy, but the illness and death caused by homeopathy is a large negative. Thus, the total effect of homeopathy is a large negative.

      1. Pareidolius says:

        Wait! It helps with hydration in sufficient quantity.

    2. Stephen H says:

      Because these “doctors” who use homeopathy are not actual doctors. They are the British equivalent of “Doctor” Nancy Malik, and use some quack certificate as proof that they have a clue about the human body and its treatment. Randomised. Control. Trials. It’s not hard, just run a few, and publish the results. Oh wait, that’s been done, and we can say for certain that homeopathy is crap and practitioners should be locked up for the damage they do. Have you used a Homeopathic Accident and Emergency lately (http://www.youtube.com/watch?v=HMGIbOGu8q0)?

      14.5% say they trust homeopathy? That’s… wow, double the number of people who believe Elvis is still alive. Add in the number of people who think he could still be alive, and he’s got more believers than homeopathy. Just because a significant portion of the population believes stupid things doesn’t make those stupid things true.

      Finally, your “206 MPs signed…” some idiotic motion. Great, so there are 206 members of parliament who are not doctors. Ten years ago they were saying that Andrew Wakefield must be right – while most of the medical profession was trying desperately to repair the damage he did to parents and their children.

      1. 2008: Dr Sara Eames, President of The Faculty of Homeopathy, “The pilot is promising and confirms my own experience of treating NHS patients with homeopathy. The homeopathic hospitals are conducting meaningful treatment and observation of patients that is absolutely in line with the recommendations of the (Lord) Darzi Report.”

        The Department of Health, UK, commissioned a CAM Pilot Project in two primary care trusts in Northern Ireland, implemented by Get Well UK. There was a 79% improvement in the level of health for those who had homeopathic treatment

        2010: 9 MPs signed EDM 1164 calling Government to look at the experiences of India when formulating homeopathy policy in the UK

        1. Harriet Hall says:

          That CAM Pilot Project was successful, but not in the way you’ve heard. It did not show that homeopathy was effective. See http://www.a-r-h.org/Publications/Journal/sampleArts/CAM%20study%20NI%20Heidi%20Stevenson.pdf

          1. Egstra says:

            “That CAM Pilot Project was successful, but not in the way you’ve heard. It did not show that homeopathy was effective”

            Unfortunately, the article at the link you posted says nothing negative about homeopathy or other forms of alt-med, but simply raises the question at the end, “Are we making claims that cannot be supported? Part two examines whether these claims are valid and what they mean for homeopathy”

            Given that the article is written by a homeopath, is contained in the journal Homeopathy in practice, and contains a number of ads for homeopathy, I really doubt whether there is going to be any debunking anywhere.

            Or, perhaps there is something I’m missing here?

            1. Harriet Hall says:

              Maybe the Pilot Project doesn’t say anything negative about homeopathy, but the positive things it says are not helpful. It doesn’t say anything to show that homeopathy is effective or is better than conventional treatment. It’s more about patient satisfaction and attitudes.

            1. Harriet Hall says:

              The Darzi report only tells us that patients improved after homeopathic treatment. Sometimes patients improve with no treatment at all, due to the natural course of the disease and regression to the mean. Sometimes they improve because of placebo responses and nonspecific effects of interaction with the provider. An uncontrolled study like that one can’t say anything about the efficacy of homeopathy. And the statement in the press release that “only 4 trials were negative” is hilarious: that’s demonstrably untrue. See http://www.ncbi.nlm.nih.gov/pubmed/12492603

        2. NorrisL says:

          Nancy, in my country you would be prosecuted for claiming to be a doctor when you patently are not. In fact, you are as far from being a doctor as it is possible to be.

          1. The legal status of homeopathy medicine in India is on an equal footing with conventional [Bachelor of Medical and Bachelor of Surgery (MBBS)], Ayurveda (recognised since 1969), Unani, and Siddha medicine. It is recognised by Central Council of Homoeopathy , Deptt. of AYUSH, Ministry of Health & Family Welfare, Govt. of India since 1973.

      2. Carl says:

        14%? Isn’t that also the same percent of men recently found not to have the sense to use soap after peeing on their fingers?

      3. Pareidolius says:

        206 MPs signed something stupid? What a shock, here in the USA some idiots in the Nevada legislature didn’t think that “magnetically energized geometric patterns applicable in potencies above 30X” was utter word salad bullsh!t.

      4. The British Royal Family has been under homeopathic care since 1820 and there has always been a Royal Homeopathic Doctor. The post is currently held by Dr. Peter Fisher. The Queen carries her ‘black box’ of homeopathic remedies that includes 60 vials of homeopathic medicines with her on all her travels.King George VI named one of his prize racehorse ‘Hypericum’

        1. WilliamLawrenceUtridge says:

          So the British Royal Family has been under the treatment of a medical system that hasn’t changed despite the discovery of the germ theory of disease, the human genome, the proteome, the development of MRIs, or even X-rays, the ability to transplant human organs, the ability to cure cancer, the ability to re-attach severed limbs, modern scientific obstetrics and gynecology, and I could go on.

          Is there any part of human scholarly endeavor that hasn’t changed since 1820? How can you brag about this? Even novels have evolved towards new ways of conveying tone, character and plot.

          And that’s not even getting into the fact that the British Royal Family is not made up of doctors (they’re historians by training I believe), they hold no substantive power, and they’re heavily inbred. The last is more cruel and amusing than relevant, but still.

          The fact that you have to rely on famous people and fake claims of regulation of nonsense to justify your belief in homeopathy, rather than pointing to any research demonstrating your claim, shows how poor your grasp of what proof is. I might talk to the British Royal Family about manners, etiquette, history and international politics, but I would laugh if they tried to explain something as simple as plumbing to me, let alone medicine.

          1. Hahnemann said in 1832, “On board ships – in those confined spaces, filled with mouldy watery vapours, the cholera-miasm finds a favourable element for its multiplication, and grows into an enormously increased brood of those excessively minute, invisible, living creatures, so inimical to human life, of which the contagious matter of the cholera most probably consists millions of those miasmatic animated beings, which, at first developed on the broad marshy banks or the tepid Ganges– on board these ships, I say, this concentrated aggravated miasm kills several of the crew …[ref].

            It was another 9 years before Henle called these micro-organisms as “germs” in 1840 in his persuasive germ theory.

            Ref: Samuel Hahnemann, Appeal to Thinking Philanthropists Respecting the Mode of Propagation of the Asiatic Cholera (20 pages), Leipzig, 1831, republished in The British Journal of Homoeopathy, Oct 1849, translated by Roberet Ellis Dudgeon, M.D. in The Lesser Writings of Samuel Hahnemann, 1851 edition, B Jain Publishers, reproduced edition, 2002, p. 758.

          2. WilliamLawrenceUtridge says:

            Three points:
            Looking at the actual reference it appears he was discussing cholera alone, not all diseases. And second, more importantly, his response was still “homeopathy”, which doesn’t work. Third, most importantly, it’s 200 years later and you are still using and defending homeopathy despite a complete lack of proof.

            You are practicing cargo cult science and cargo cult medicine. All the trappings of both, without actually being science or medicine. You mouth the words as if they meant something. You cite books and references as if you believed they said something of substance. You point to governing bodies that regulate the most meticulous points of nonsense. You point to irrelevant proof as if it were worth looking at. But you never, ever point to what matters – a consistent set of randomized, controlled trials that converge on a single response: homeopathy reduces symptoms, cures disease or in any way works as anything but placebo. If homeopathy worked, then it wouldn’t be 200 years of null results later with no proof of efficacy. If they were as effective as people claimed, it would show up in well-controlled trials as clear signal, not as murky statistical fishing results in uncontrolled, open-label nonsense. Hahnemann could have independently deduced the existence of bacteria and viruses as separate causes of disease, but if his response was still “homeopathy”, he still got it wrong.

        2. Chris says:

          The British Royal Family is a lousy example for an “argument of authority” or even “argument of popularity.”

          I should note that Nancy Malik was banned from the JREF forum in just a couple of weeks. She posted her first comment on 11 March 2008, and was banned on 19 March 2008. The warning message sent to her pretty much shows she is closed minded and does not interested in honest discussion:


          Your account has been suspended since nearly every single post you have made since you started posting here breaches your Membership Agreement.

          I am giving you the benefit of the doubt that this was not intentional and you did not bother to read the Registration Agreement before you joined up therefore I am only making the suspension last for 24 hours. I have edited the content that breached your Membership Agreement from your posts…

          In short: her intellectual content and honesty have been diluted by homeopathic proportions.

          1. WilliamLawrenceUtridge says:

            …if only you could repeatedly hit her with a bible until something good happened…

    3. WilliamLawrenceUtridge says:

      If homeopathy worked, particularly if it was as effective as homeopaths claimed, wouldn’t we see this in randomized controlled trials?

      Also, whether or not someone believes something works doesn’t really mean it actually does work. Believing bloodletting helps people doesn’t mean it actually cures anything – and when tested, we stopped doing it.

      Doctors have prescribed placebos, knowingly, for a long time. Placebos are effective in easing patient concerns for mild, self-limiting illnesses. That doesn’t mean they are effective, it just means doctors are willing to use them to shut people up, and people don’t know better. This goes for worthless vitamin injections, or low-dose antidepressants, or homeopathy.

      1. Stephen H says:

        If any licensed medical practitioner knowingly prescribed a placebo, I would expect them to lose their licence. You can tell the patient that a treatment is not appropriate for their condition (antibiotics for a viral infection), but then prescribing the antibiotic is not equivalent to some quack’s expensive vial of water. The patient has been told that the treatment is not appropriate, but is pressuring the doctor to prescribe it regardless.

        This is not the same as homoeopathy or other quackery, where all the evidence says “it doesn’t work”, while all the science says “you are selling your patients water”.

  24. WilliamLawrenceUtridge says:

    The legal status of homeopathy medicine in India is on an equal footing with conventional [Bachelor of Medical and Bachelor of Surgery (MBBS)], Ayurveda (recognised since 1969), Unani, and Siddha medicine. It is recognised by Central Council of Homoeopathy , Deptt. of AYUSH, Ministry of Health & Family Welfare, Govt. of India since 1973.

    You have provided little beyond evidence for a damning condemnation of the Indian medical system, and it’s regulation. Being recognized by the “Central Council of Toothfairy Orthodontal Magic Pixie Root Canal Service via your Rectum” since 1629 doesn’t make you a good dentist, but it does raise questions about the validity of whatever system your country uses to vet dentists.

    Legislative alchemy doesn’t prove that medicine works, only that politicians are not doctors. If homeopathy worked, we would see evidence in the scientific literature. We don’t. Homeopathy is water. There is no “quantum” involved. Homeopathy is a form of emotion-based coping that helps people feel like they are doing something while they get better on their own (or, delays treatment until they die).

  25. LindaRosaRN says:

    CAM in the USA has been legitimized politically because CAMsters are tireless activists. Of course their motivation may largely be pecuniary, but nonetheless, they are relentless, politically savvy, effective, and well-funded.

    Why isn’t the desire for science-based healthcare to enough to motivate skeptics to be activists and at least try to match the CAMsters’ efforts?

    I have my own opinions on this matter, but I’d really like to hear from you all regarding this question.

    1. WilliamLawrenceUtridge says:

      Part of it is probably that most of our incomes are not based on our skepticism. I also think that on this blog in particular, we have an overestimation of the effects and widespread nature of CAM. The actual rates of CAM use are low, even lower if you factor out bait-and-switch CAM like exercise. I would also expect that most CAM places emphasis on the “C” – it’s used complementary to medicine, so it’s pretty rare to see someone just use CAM instead of regular medicine.

      In addition, I’m from Canada, with a public health-care option that doesn’t reimburse for CAM care (insurance does) so while I find CAM intellectually offensive, few people are forced to turn to CAM for care due to expense. I wonder at what would happen to the CAM rates if the US had a functioning public health care option. On the other hand, perhaps it would force CAM to become even more mainstream.

      1. Egstra says:

        ” I also think that on this blog in particular, we have an overestimation of the effects and widespread nature of CAM.”

        I don’t know about this… it seems as if most of the people I know (generally well-educated, well-informed) buy into some aspect of SCAM. Acupuncture is the apparent favorite, followed closely by the nutritional bogosities of Oz and others. The “immune support” stuff also seems very poplar.

        I’m not sure that anyone I actually know in RL would do alternative stuff for cancer, however.

        1. Andrew says:

          As a chiropractor, I do not believe that I can cure cancer. But if a patient with cancer came into my office, I would try to get that person out of pain as much as possible to try and enjoy life as much as possible

  26. Andrew says:

    I think this link can shed some light on the educational background of chiropractic schools against medical schools. http://www.yourmedicaldetective.com/drgrisanti/mddc.htm
    Also, aren’t MDs governed by MDs? This article is showing the reason chiropractic is unregulated is because they govern themselves. That is how the whole health system works.
    Dentists aren’t primary care physicians, yet they are still called doctors and it is not confusing. But yet for some reason if a chiropractor does it, no one can figure it out?
    As far as chiropractors prescribing medicine, that should not be happening. As a chiropractor, I do not have the pharmacological education to prescribe medication and would not even think to try that. There are always some bad eggs in every group.
    MDs prescibe medications constantly that are being recalled several years later because patients were getting life threatening conditions and even dying. So to say that MDs have a proven method is greatly exaggerated.
    Chiropractors do not cause strokes! Instead of just saying it and hoping everyone will believe me, like the writer of this column, I will provide research that backs up my point. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922298/

  27. WilliamLawrenceUtridge says:

    Andrew, please see my comment on June 27th above, starting with “Chiropractic is somewhat confounded by…” Some chiropractors do indeed believe they can cure cancer, though you may not be one of them.

    I think this link can shed some light on the educational background of chiropractic schools against medical schools

    That may be true, but that does not speak to the quality of education. For at least a portion of chiropractors, their education seems to consist of erroneous information, or for lack of a better word, “deprogramming” of conventional beliefs about the body. Beliefs in the ability to manipulate the sutures of the skull for instance, and the existence of “subluxations” overall. Do you believe subluxations exist? Do you believe they cause disease?

    Also, aren’t MDs governed by MDs? This article is showing the reason chiropractic is unregulated is because they govern themselves. That is how the whole health system works.

    Ultimately MDs are governed by the evidence, changing practice in response to changing evidence. The history of chiropractic is essentially based on an idée fixe dating back to ol’ Dad Palmer in the 19th century, and for some, hasn’t changed much since. You say you do not think you should be able to prescribe drugs, and bully for you – but do you think you are trained experienced enough to be a primary care physician? Or are you basically a variation of a physiotherapist who focuses on musculoskeletal complaints?

    Dentists aren’t primary care physicians, yet they are still called doctors and it is not confusing. But yet for some reason if a chiropractor does it, no one can figure it out?

    Dentists restrict their practice to the teeth and gums, and again are evidence-based. A dentist is unlikely to attempt to fix a hemorrhoid, or set a bone, or suggest nutritional changes (beyond those that impact the health of the teeth and gums). A chiropractor who restricted themselves to just mechanical problems of the skeleton and muscles would meet with little objection from me – though I would question what they added to personal health that a physiotherapist wouldn’t.

    As far as chiropractors prescribing medicine, that should not be happening. As a chiropractor, I do not have the pharmacological education to prescribe medication and would not even think to try that. There are always some bad eggs in every group.

    So what do you think of efforts to grant DCs prescribing rights? Do you advocate against that, and call for a limited scope of practice for your profession?

    MDs prescibe medications constantly that are being recalled several years later because patients were getting life threatening conditions and even dying. So to say that MDs have a proven method is greatly exaggerated.

    Hardly. First, the medication normally actually does what it says. Say what you want about Vioxx, it did indeed relieve pain. Not to mention, you are actually citing a strength of the medical system, a strong central body that monitors the safety of medications and has the authority to pull them from the market in the light of new evidence. While it would be nice to have perfectly safe medications that only do one thing, the reality is that is not the case. In addition, they are imperfectly tested – both in terms of drug companies biasing their testing, and in terms of the limited duration and unrealistic populations on which late-stage clinical trials are performed. Superior testing (in terms of larger groups of representative patients followed for longer periods) would be better, but unfortunately would delay and drive up the cost of new drugs considerably (though personally I am strongly in favour of clinical trials being conducted by a truly third-party testing that involves drug companies giving paying the government for the cost of the clinical trials while the actual work is done by independent academics in universities). Drugs are managed through a complicated combination of factors that acknowledges the flaws in the current system and attempts to mitigate them. It’s an imperfect system for certain, one that tries to balance between safety, effectiveness and efficiency, which does mean that not all adverse effects are recognized when the drug is approved.
    And, of course, the failures of medicine to be perfect in no way justifies the safety or effectiveness of chiropractic, that’s a false dilemma.

    Chiropractors do not cause strokes! Instead of just saying it and hoping everyone will believe me, like the writer of this column, I will provide research that backs up my point.

    I think you’ll find it’s a bit more complicated than that and there is certainly disagreement.

  28. William:

    Here in the USA, the CAM practitioners fondly expect to cash in on mandatory third party reimbursements under ObamaCare.

    And yes, anti-CAM activism is not a lucrative pursuit; it can actually be a financial hit, e.g. requiring taking off work to testify at hearings or talk with legislators. But much can be done that requires no financial backing at all.

    One of the arguments we have used in countering naturopath licensure bills is your point that only a small number of people seek ND care (using NCCAM survey results). But “degreed” NDs, employing the Big Lie, have claimed that over 60% of the public use their services.

    The NDs certainly do their homework: They work for pro-CAM candidates and soften up legislators months before a bill is introduced. They hire professional lobbyists. They bring their patients and the odd physician (emphasis on “odd”) to testify on their behalf. They work on the leadership of state medical societies. They work relentlessly to create a self image of wholesome, highly educated physician-equivalents. They malign their few opponents as cranks.

    It’s hard to win on facts alone when so few people actively oppose CAM licensure and other pro-CAM bills. Concerned citizens could probably stop these bills if they put out just half the effort the CAM proponents do.

  29. average citizen who doesn't appreciate being lied to by someone with obvious bias says:

    what a load of unscientific crap, when did medical diagnosis become the holy grail of diagnostic criteria. From my experience with my acupuncturist, chiropractor and nutritionist, they all have their traditional and philosophical jargon to explain their understanding of the physical signs and symptoms presenting to them clinically. They use a different understanding to examine and diagnose but essentially they are in “LATIN Terms” assessing autonomic regulatory pathways.

    Your inability to open your eyes to anything outside your pathetically sheltered minimalist understanding of language, cripples your ability to grow outside your medical fraternity and self-proclaimed “best evidence”. Autonomic function or core undergraduate physiology is what allows these practitioners help people regulate their bodies without the use of drugs, radiation or surgery. Wow magnesium it’s such a “way out claim”, if you embraced the core cellular function of living organisms as an approach to fixing disease, you would see that you can help people restore function with nothing more than the basic building blocks of life.

    I am disgusted that with 7 years of medical training doctors can’t realize that they still don’t fix anything. No practitioner fixes or cures anything. It is the human body that fixes itself. The same way it brought itself into existence, form a sperm and egg replicates 70 trillion times and develops into a functioning human being 99% of the time. So what triggers the changes in function, the ENVIRONMENT. If you don’t know the work of bruce lipton then your really haven’t done your best to understand the cellular mechanisms of life. Whatever your training or understanding..it really doesn’t matter because practitioners don’t do anything besides create an environment for cells to either live or die, simple as that.

    ALL practitioners really work with the body within the limits of the body, which has a limit.
    Example -
    1. If you crash your bike and tear your head off – medicine can’t save you
    2. If you break some bones and lose some blood – medicine can help patch you together.(they are really good at this)
    3. If your have chronic pain and dysfunction on either a physical chemical or emotional level – medicine CAN’T help you – (most doctors can’t see past their arrogant model of crisis care) – go see someone who really can deliver personalized care.

    There are some amazing doctors out there from all disciplines that really care about the the health and well being of their patients. It is a known culture within the medical profession to actively and maliciously slander anyone who questions the crisis care model of drugs, surgery and radiation. If a profession who is apparently so caring and helpful can do that to their own colleges just imagine what kind debauchery they would try to swindle past the uneducated public citizens. Oh and did i mention that your tax dollars are paying for every one of their mistakes.

    At least when I go to see my chiropractor I know they are intently putting all their knowledge, care, love and best interests into me because I am their source of income. It is in their interests to provide me with the care I pay for out of my own pocket. I wouldn’t trust a doctor i wasn’t paying good money for. Don’t you expect the same form any other service you pay hard earned money for. I always feel under serviced, under appreciated and cheated when I see a run of the mill GP. If the medical system was a privately run business and didn’t rely on stealing corrupt money form the healthcare sector of your taxes, it would collapse under it’s own disgraceful reality of poor patient satisfaction. Even with the benefits of the placebo effect, the medical system is at best, a cheap Fast Food industry model of business, taking money for supplying addictive, low quality crap with poor service and “dollar comes first” values.

    GO friends of a self proclaimed “best evidence” science in medicine.

    By the way the word medicine actually means – the science of diagnosing, treating and preventing disease. – all of which apparent CAM practitioners do in their clinics so technically aren’t they doctors medicine too?

    just saying, maybe because you obviously have a large innominate object lodged firmly up your rectum causing you to view the world in a sad and cynical manner, maybe you should resign from your position to allow some more level headed and clearly more intelligent people to promote the co-operation and successes with the healthcare arena.

  30. WilliamLawrenceUtridge says:

    I am disgusted that with 7 years of medical training doctors can’t realize that they still don’t fix anything. No practitioner fixes or cures anything. It is the human body that fixes itself.

    Actually, antibiotics are pretty good at fixing something by eliminating the bacteria causing infection. Vaccines are even better, preventing infection from ever causing problems. Surgery to remove solid tumors fits my definition of “fix”. Not to mention, chiropractors only “fix” musculoskeletal complaints, acupuncturists and naturopaths don’t fix anything, and nutritionists are merely refinements of training for conventional dietary advice any doctor will give you – fresh fruits and vegetables, lean meats, whole grains.

    So what triggers the changes in function, the ENVIRONMENT.

    Have you ever heard of “congenital defects”? Do you know what Huntington’s disease is?

    If you don’t know the work of bruce lipton then your really haven’t done your best to understand the cellular mechanisms of life.

    Bruce Lipton, the guy who thinks you can cure disease by thinking about it really hard? So anyone who dies of cancer, it’s their fault because they just didn’t want to get better?

    Do you seriously think that doctors can (or want to) somehow act on a microcellular scale to heal wounds and cure diseases? For that matter, do you think quacks can do so? You seem to be arguing for some sort of vitalism, the idea that there is an essential life force within the body responsible for health and illness. This claim is either trivially true, referring to molecular cascades that regulate energy and cellular activity, or simply false – centuries of biological research has yet to identify a novel form of energy that infuses only living things. But they have managed to synthesize biological compounds out of inanimate atoms.

    If your have chronic pain and dysfunction on either a physical chemical or emotional level

    Again, either trivially true (medicine can’t cure all diseases) or simply false – there are treatments for chronic pain and emotional suffering, though they are imperfect. And again, if you’re claiming quacks are any better at this, that’s dubious at best. They might be better for psychogenic conditions where patients are unwilling to engage with the mental health system (which itself does need improvement) but they are basically engaging in a form of placebo-based counselling for patients with irrational beliefs about their physical health. Certainly they’re not doing anything to objectively improve the health of their customers that a real doctor couldn’t.

    At least when I go to see my chiropractor I know they are intently putting all their knowledge, care, love and best interests into me because I am their source of income.

    A proper, federally-funded health care system would go a long way towards improving patient care in the US, I agree. A lot of people object to the managed care model current in the US. I just don’t think paying someone out of pocket for a lesser degree of care, for a lesser degre of expertise, and lacking the ability to treat anything but self-limiting illness or musculoskeletal complaints, is a solution. I would rather improve real medical care than pretend customer satisfaction is a substitute for real treatments.

    I always feel under serviced, under appreciated and cheated when I see a run of the mill GP.

    I don’t. My first visit with my doctor was a full physical, subsequent visits never felt rushed and my doctor always took the time to address all of my complaints and answered any questions I had about my medical records. Then again, I am in Canada (federally-funded health care) and I am in good health because I follow mainstream recommendations for health (regular exercise, healthy diet, adequate rest). I always feel sorry for Americans who are forced to engage with the sub-par medical care forced upon them by the managed care system. Perhaps you could advocate for a real health care system like the rest of the developed world has. Even Obamacare, while an improvement, seems less than ideal.

    By the way the word medicine actually means – the science of diagnosing, treating and preventing disease. – all of which apparent CAM practitioners do in their clinics so technically aren’t they doctors medicine too?

    Not really, since the diagnoses they make are either redundant to real medicine, or completely made up (chronic lyme disease, candida overgrowth, imaginary food sensitivities), their treatments are nonsense and don’t work, and their preventive care is either actively dangerous (opposition to vaccination) or redundant (food, sleep and exercise recommendations). Not to mention, they lack the training and experience to identify and treat rare, serious complications like cancers, aortic aneurysms and exotic infections. You can play word games to pretend they’re equivalent, but that’s like claiming a PhD in history can treat patients because they’re a “doctor” too.

    1. Hank says:

      “Again, either trivially true (medicine can’t cure all diseases) or simply false – there are treatments for chronic pain and emotional suffering, though they are imperfect. And again, if you’re claiming quacks are any better at this, that’s dubious at best.”

      So what is really indicated (based on the evidence) for a patients in chronic pain …. for example, with low back +/- radicular symptoms…or “Fibromyalgia?” It would be interesting to see what can really be justified and a diagnostic and therapeutic modality based on the evidence available. There are many patients at incredible expense that are being treated for chronic pain.

      Diagnostic Tests:
      EMG/NCS
      Plain X-rays
      MRI
      CT

      Treatments:
      Psychology
      Physical Therapy
      Laser Therapy
      Ultrasound
      Heat/Ice
      Massage
      OTC meds/ Anti-inflammatories
      Muscle relaxants
      Gabapentin
      Lyrica
      Cymbalta
      Opioids
      Benzodiazepines
      Muscle injections
      Joint injections
      Epidural injections
      Surgery
      …and more?

      Anyone want to get the ball rolling on this one? There are many a feather to be ruffled.

  31. WilliamLawrenceUtridge says:

    So what is really indicated (based on the evidence) for a patients in chronic pain …. for example, with low back +/- radicular symptoms…or “Fibromyalgia?” It would be interesting to see what can really be justified and a diagnostic and therapeutic modality based on the evidence available. There are many patients at incredible expense that are being treated for chronic pain.

    I don’t know, I’m not a doctor or pain specialist. Pain, purely as a symptom, is a difficult problem – it’s intensely subjective, it has significant chronic effects, the treatments are often addictive and interfere with functioning. Fibromyalgia specifically is poorly understood, I haven’t looked into it but I would suspect it is a wastebasket diagnosis like chronic fatigue syndrome. And like CFS, it is difficult to do research on because you have a diverse population, with no real reason to expect they all have the same thing, and as far as I know no objective diagnostic test (I could be wrong, again I haven’t looked into it). I agree with your implied statement, it would be best for chronic pain treatments to be cheap and effective and it’s a shame that they are not. Sadly, the best I can manage is to say there should be more research. Specifically, there should be more basic, hypothesis-generating research that tries to identify the etiology and biology of specific conditions, from which possible treatments can be developed and tested. Unlike CAM cries for “more research” in which basic biology is ignored, as are the consistently negative research results that high-quality trials find when looking into most CAMs.

    1. Hank says:

      Thanks for your response. It would be interesting to actually make heads or tails of the data/research out there. We know CAM leaves much to be desired. But what about current management techniques in main stream medicine? I don’t have chronic pain and I’m not in favor of CAM. But what actually does work, if anything? Society sure is paying for it. Do you know if this has been addressed on this website? I’m searching for truth.

      1. WilliamLawrenceUtridge says:

        It’s pretty easy to make heads or tails of CAM research as long as you examine the data as a whole and keep in mind that one explanation for CAM being “effective” is that it isn’t, beyond placebo. The lack of effective treatments for chronic pain in no way means that CAM is effective. All it means is we need to continue researching chronic pain and improving our ability to understand and treat it. CAM doesn’t need to enter the equation.

        Science is not particularly useful in a search for The Truth(TM), only increasingly accurate representations of reality, with a considerable margin for error and no guarantee we’ll ever get there. But it’s better than the alternative.

        From my understanding of chronic pain, which is again hugely limited, it’s just not that well understood. My work on the pain wikipedia page, several years ago, wasn’t particularly fruitful because there’s a lot of theories and little consensus on the basics. Pain, due to its huge liability and subjectivity, with a considerable placebo component (witness for instance the ability to ignore pain in appropriate social settings such as religious rituals), is a complicated topic. Moreso with chronic pain, which actually becomes less amenable to placebo effects over time.

        1. Hank says:

          True. Yet 600 billion dollars a year are spent in this country to treat chronic pain with little or no evidence that anything helps that I know of. However I am willing to learn. Should society be paying for treatments that involve such a hugh subjective component with no cost effective reliable treatments? Heck many treatments do harm. However a hugh industry is built on this. Just think of all the expensive back surgery done that shows no benefit to the patient (yet significantly benefits hospitals, physicians, employees of those organizations…).

          http://www.apta.org/PTinMotion/NewsNow/2012/9/11/ChronicPain/

  32. WilliamLawrenceUtridge says:

    Yet 600 billion dollars a year are spent in this country to treat chronic pain with little or no evidence that anything helps that I know of. However I am willing to learn. Should society be paying for treatments that involve such a hugh subjective component with no cost effective reliable treatments?

    No matter what, the answer is not and will never be placebos and SCAMs (supplements, complementary and alternative medicine). There is often a false dilemma – if real medicine can’t help with a condition, that means SCAMs work. Obviously wrong – if real medicine can’t help with a condition, more research is needed. SCAMs may work – and if they are promising, they should be tested and integrated into mainstream medicine so they can benefit the millions of sufferers rather than the tiny percentage of SCAM users who currently avail themselves of it. But another option is – SCAMs do not work. The two ideas – medicine works and SCAMs work, are separate. You do not prove one by disproving the other.

    Otherwise your comment is one I agree with – it would be great if we were better at treating chronic pain, it would be amazing if we had evidence-based treatments that could help. I am not a specialist so I do not know of any. An evidence-based distribution of medical resources would probably cut down significantly on those ineffective treatments, and I would be in favour of this. This would also, rather neatly, eliminate all SCAMs because they are by definition unproven, often untested. I would also be in favour of this. No special treatment simply because the popular media and layperson is too credulous to realize what is being asked for is a double-standard.

    However a hugh industry is built on this. Just think of all the expensive back surgery done that shows no benefit to the patient (yet significantly benefits hospitals, physicians, employees of those organizations…).

    Yep, that’s a problem and should be stopped. No disagreement. It’s hard as a doctor to say you can’t help someone, it must be harder as a suffering patient to hear it. However, a SCAM promoter who promises the moon but can never deliver is not the answer. Unfortunately most patients don’t realize that the patient, kind man who claims he can help will just take their money and they will have little beyond wasted money and short-term, subjective benefits to show for it.

    But again, the two are separate – the lack of safe, effective, proven treatments does not justify embracing untested nonsense.

    1. Hank says:

      “No matter what, the answer is not and will never be placebos and SCAMs (supplements, complementary and alternative medicine). There is often a false dilemma – if real medicine can’t help with a condition, that means SCAMs work. Obviously wrong – if real medicine can’t help with a condition, more research is needed.”

      Agree. If a patient has a medical problem such as chronic pain, then they should know, based on the evidence, that whatever treatment they try offers benefit (and certainly should do no harm). I think most folks watch too much TV, read misinformation on the internet, in newspapers and magazines, and listen to friends, family, and ill informed health care providers. They think there is a pill, shot, or surgery for every problem and it just isn’t true. Unfortunately if one goes to the doctor and doesn’t get a magic pill, shot, or more, they feel cheated. Todays patients just can’t deal with the idea that there is no good treatment for their problem. They want something, anything done and the more expensive the better as usually “insurance” (someone else) is paying for it. They just don’t realize the potential adverse effects of what they step into….and the $$ wasted. If they don’t get what they want or what their impression is as to the correct treatment, then they try another doctor or “spine center.” Sad.

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