If there’s one thing about the so-called “complementary and alternative medicine” (CAM) movement that I’ve emphasized time and time again, it’s that its adherents have a definite love-hate relationship with science. They hate it because it is the single greatest threat to their beliefs system and the pseudoscience that underlies it. At the same time, they crave the legitimacy that science confers. They crave it not because they have any great love for science. Quite the contrary. It is simply that they recognize that science actually delivers the goods. Of course, they believe that they deliver the goods too, but they come to this belief not through science but rather through all the cognitive shortcomings and biases to which humans are prone, such as confusing correlation with causation, confirmation bias, not recognizing regression to the mean, and being fooled by the placebo effect. Whether it’s through a misunderstanding of science or less innocent reasons, they go to great lengths to torture it into superficially appearing to support their claims through a combination of cherry-picking of studies that seem to support them and misrepresenting ones that don’t, discussions of which abound right here in this very blog.
The other thing I’ve emphasized about the CAM movement is that, even more than scientific credibility, they crave legitimacy. To them, however, science is but one pathway to legitimacy, because, unlike practitioners of science-based medicine, they are more than willing to bypass science to obtain the legitimacy–or at least the appearance of the legitimacy–they so crave. If it means doing an end run around science by trying to hijack the Obama health insurance reform bill that is currently being negotiated to resolve the differences between the Senate and House versions, so be it. Indeed, earlier this year, I described how Senator Tom Harkin has tried to promote CAM through the National Center for Complementary and Alternative Medicine (NCCAM) and trying to insert provisions into the bill that would mandate that government-subsidized insurance exchanges pay for CAM. Meanwhile, prominent CAM advocates have been carpet-bombing the media with dubious arguments in support of CAM, as in when Deepak Chopra, Rustum Roy, Dean Ornish, and Andrew Weil teamed up in different combinations to promote the idea that CAM is all about “prevention” and that science-based medicine, in all its reductionistic evil, is nothing more than pushing pills.
They’re at it again.
Warning: If you are offended by humor that depends on psychiatric and medical diagnoses, read no further.
Disclaimer: Before anyone complains (and in this age of exaggerated political correctness, someone surely will), let me make it clear that I mean no disrespect to people suffering from the illnesses mentioned below. I have the greatest empathy for sick people, and I have encountered several of these conditions in my own family and have actually experienced four of them myself. Humor about them doesn’t offend me, and I hope it will not offend you. Also, my mention of Christmas and Hanukkah songs is not intended to endorse any religious belief.
After a year of serious talk about mostly discouraging things, I thought it was time for a totally frivolous post to cheer us up with a little holiday humor. A friend sent me a list of “Christmas Carols for the Psych Ward.” I thought they were funny, and I’ve copied the best of them below. I’ve added a few of my own for other medical diagnoses, and then I added several about complementary and alternative medicine. (more…)
That’s the title of a new book by Melvin H. Kirschner, M.D. When I first saw the title, I expected a polemic against conventional medicine. The first line of the Preface reassured me: “Everything we do has a risk-benefit ratio.” Dr. Kirschner took the title from his first pharmacology lecture in medical school. The professor said “I am here to teach you how to poison people.” After a pause, he added, “without killing them, of course.”
He meant that any medicine that has effects has side effects, that the poison is in the dose, and that we must weigh the benefits of any treatment against the risks. Dr. Kirschner has no beef with scientific medicine. He does have a lot of other beefs, mainly with the health insurance industry, the pharmaceutical industry, and alternative medicine. (more…)
It’s rather amazing how sometimes the best laid plans of mice and men (and bloggers) come to naught. I had planned on doing a followup post to my previous post about the cancer quackery known as the German New Medicine by discussing a particularly nasty French variant of it. Unfortunately (or fortunately, depending upon your point of view), events conspired to move my blogging ire towards another target, particularly since I had addressed this isse before. Specifically, I’m talking about 2009 Recipient of the Richard Dawkins Award, comedian and HBO talk show host Bill Maher.
As you may recall, about a month ago, I wrote a rather long post (par for the course for me, I know) detailing ad nauseam how Bill Maher not only embraces germ theory denialism, anti-vaccine nonsense, and alternative medicine, in particular his apparent belief that “aggregate toxicity” or the typical unnamed “toxins” that alternative medicine mavens are so fond of blaming most disease on or, as Maher likes to call it, the “poisons” that we are eating and otherwise exposed to every day, but has been preaching this pseudoscience since at least 2005. Maher then followed this up a mere week before receiving his award named after a famous scientist with a hideously irrational promotion of cancer quackery. At that point, I thought I was done with the topic, at least as far as this particular blog goes (others know that elsewhere I’ve not been so quiet). At least, I had intended not to deal with this again on SBM.
Unfortunately, Bill Maher had other ideas. This is the perfect description for how I felt having to blog about this again:
Yes, it fits, particularly after Maher Tweeted to his fans:
If u get a swine flu shot ur an idiot.
One of the more frustrating things about practitioners who promote unsafe and scientifically discredited medical practices is their tendency to change their message for different audiences. One day they’ll tell you that they espouse only evidence-based practices and the next they’ll be promoting snake oil. This double talk is hard to combat, since to disprove them one would essentially have to provide a video of their contradictory remarks.
One day I participated in a series of business meetings with a CAM practitioner in attendance (he was an MD who graduated from UCSF). During one meeting he boldly proclaimed his support of scientifically rigorous research, and praised the Cochrane Collaborative’s efforts to provide systematic reviews of the evidence (or lack thereof) for various practices.
Several hours later we were sitting together in another meeting in which I objected to the publication of a consumer article that would assist parents of children with autism in finding a DAN! practitioner who could provide chelation therapy to their children. I explained that there was no evidence for the efficacy of such treatments, and plenty of evidence for their harm (including the death of at least one child that I’d read about in the news). I suggested that an article describing these dangers might be in order, but that an article encouraging chelation use for autism was simply unethical and I would not allow it to be published.
Instead of agreeing with me, the CAM MD suggested that I was being “narrow” and that I should allow consumers to “explore all their options.” I was stunned. This was the same person who had just said that he fully supported scientific inquiry. So I asked him how he could say that he supported evidence-based medicine, and then turn around and ignore evidence at will – even at the peril of human life.
His response dumbfounded me:
“I am just as comfortable practicing within an evidence-based framework as I am outside it.”
After my fairly recent awakening from shruggieness (i.e. a condition in which one is largely unaware of or uninterested in CAM) I decided to discuss my concerns about pseudoscience with my friends. One particular friend is a nationally recognized physician who believes in the importance of accurate health information and the promotion of science. However, he sees no urgent need to warn people against snake oil, and so long as it’s correctly labeled he doesn’t seem to mind it co-existing with scientific alternatives.
My friend and I had dinner a few weeks ago, and our conversation was both animated and disappointing. I somehow felt inadequate in conveying my objections (both ethical and scientific) to the promotion of pseudoscience. My best explanations were met with cheerful rebuttals, and while not intellectually convincing to me, those retorts satisfied my friend just fine. I guess the bottom line was that he was more interested in maintaining his position than reconsidering it… and so it left me feeling rather frustrated and a little sad.
In this space we’ve read about the efforts of “alternative” practitioners such as naturopaths to gain the moniker “primary care provider”. I’ve been wondering a bit about this. I’m a primary care physician. Specialists in internal medicine, pediatrics, and family medicine provide the bulk of primary care in the U.S. They attend a 4-year medical school, complete a 3-4 year residency, take their specialty board, and then work as experts in the screening, prevention, diagnosis, and treatment of common diseases.
So, what I’d like to do is give you a typical scenario from an internal medicine or family medicine practice. It’s a simple one, one you might see on Step II of the USMLE boards or on a shelf exam for an internal medicine rotation. I’d like to offer alternative practioners, especially naturopaths, an opportunity to show how they would approach the clinical scenario so that we can see what kind of primary care they provide.
Yes, every patient and every situation is different, but there are some general ways to approach health and disease based on the evidence.
More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly.
~ Woody Allen
No good deed goes unpunished.
The website whatstheharm.net is a depressing recitation of the harm that humans do to themselves and others from participating in various forms of nonsense in the attempt to do good. It my backfire, and instead pain and death result.
I would bet that most practitioners of medical woo are true believers. They do not intend to harm people, and believe they are doing good for their patients. Certainly the consumers of alternative therapies intend to have good benefits from their use of sCAM modalities. Most want to get better, and do not intend to hurt themselves or others.
Unfortunately, actions always have unintended consequences. Sometimes the harm is directly to the patient. Sometimes the harm in indirect, with collateral damage to people or the environment. My hospital system has an extensive recycling program to handle the huge amounts of waste generated by the need to insure that all manner of materials are sterile. Patients in isolation consume large amounts of paper and plastic to keep infection confined. My hospitals actively look for ways to decrease their environmental impact and carbon footprint and still deliver high quality medical care. Legacy Health System, where I work, is an award winning leader recycling medical waste, which is a lot more difficult to dispose of than the pop cans and paper bags in your house. Hopefully the trash in your house is not covered with pus, blood and other potentially hazardous medical waste. We try to be good global citizens.
I wonder if some branches of the alternative medical industrial complex are so environmentally conscious.
It is not uncommon for Science Based Medicine to receive complaints about the tone of our writing. Some people feel that it is indelicate to use the “q” word (for the uninitiated, “q” is for “quack”) when describing practitioners who promote disproven therapies with jubilant fervor. Others believe it unkind to lump “well meaning” alternative medicine experts in with those who are engaged in overtly illegal activities.
We are all affected by the tension between wanting to call a spade a spade and respecting our cultural need to be polite. Perhaps one of the clearest examples of this inner conflict is Orac’s Respectful Insolence blog. As the name implies, Orac is both thoughtful and brutally honest – he expresses our communal reticence to make waves, but follows up with a reasoned hostility that is quite understandable, given the circumstances described in each post. Respectful Insolence is fun to read because it is educational, persuasive, and expressive – and it captures how many of us feel about various forms of hucksterism. However, snake oil salesmen and their sympathizers are unlikely to enjoy the blog.
Here at Science Based Medicine, readers find a wide range of expression with a common commitment to science and reason. Just as physicians have different practice styles (some are more nurturing in temperament, others offer “tough love”) so too do we authors vary in tone. For those readers who favor one style over another – I hope you’ll find the voice that suits you and return regularly for more. Please don’t assume that one particular post is representative of the entire blog, and please don’t be offended by the legitimate exasperation of writers who have suffered through decades of observing swindlers swindle.
Last week I discussed the book Healing, Hype, or Harm? edited by Edzard Ernst. I was particularly struck by one of the essays in that book: “Healing but not Curing” by Bruce Charlton, MD, a reader in evolutionary psychiatry at the Department of Psychology of the University of Newcastle upon Tyne.
Charlton proposes a new way of looking at CAM. He describes three common attitudes:
- CAM does good and should be integrated with orthodox medicine.
- CAM is worthless and should be discarded.
- CAM may or may not do good and this should be decided using science.
He rejects all three. In his view,
- Alternative therapies do good.
- From a strictly medical perspective they are worthless.
- They should not be integrated with orthodox medicine.
- Because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science.
He suggests that alternative therapies be regarded as spiritual practices. They are about making people feel better (‘healing’) not about mending their dysfunctional brains and bodies (‘curing’). (more…)