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The CAM Worldview

Harriet has written some excellent recent posts about how to talk to CAM (complementary and alternative medicine) proponents, and answers to common CAM fallacies. I have written about this myself numerous times – we deal with the same logically-challenged claims so often that it’s useful to publish standard responses.

In fact, I often wonder about the seeming uniformity of poor arguments put forward by advocates of CAM and critics of SBM. Do their arguments represent common problems of thought, pathways of mental least resistance, or are we seeing the repetition of arguments resonating in the echochamber of a subculture? I suspect it’s all of those things, which all feed into a particular world-view.

Actually CAM proponents seem to fall into one of several common world views, or flavors, as I like to call them, ranging across the spectrum from pseudoscience to anti-science. There is substantial overlap, however, with common anti-scientific themes.

I recently had an exchange with an SBM reader who was demanding that a particular post be taken down, because “every single fact in the article is wrong.” I responded as I always do – please point out the factual errors, with proper references, and I will make sure that all appropriate corrections are made. This did not satisfy the e-mailer who insisted that the article was 100% false and libelous.

Eventually I did persuade them to give me specifics – the long response that resulted did not actually point out any errors in the article (surprise, surprise) but rather was a long and fairly typical anti-SBM rant. Here is the full response in pdf. I will pull out some specific claims, the ones that I encounter most often, and respond.

Buteyko breathing technique

For background, the article that the e-mailer was so upset about was this one by Joseph Albeitz about the Buteyko breathing technique. You should read the full article for details, but briefly, Buteyko was a Russian doctor who “discovered” that voluntarily slowing one’s breathing could cure asthma. Over the years he came to realize that slow breathing could cure scores of disorders – it seemed to work for everything. He believed, apparently, that humans evolved to chronically hyperventilate. (If you are basing your claims on anecdotal experience, then any treatment will seem to work for anything and everything.)

Joe nicely argued in his article that Buteyko’s original experience with slow breathing was likely just treating hyperventilation resulting from a panic attack. Buteyko extrapolated from this one experience into an entire form of medicine, all without doing any actual scientific research to substantiate his grandiose claims, which are physiologically implausible. Fifty years later, evidence for either a mechanism or to substantiate efficacy remain lacking.

This, of course, is a common story in the pages of SBM. The e-mailer is a Buteyko advocate who believes this technique saved their life. They “know” this to be true, and therefore take it as an iron-clad premise. If science disagrees with what they know to be true, then science must be wrong. If we are criticizing the treatment that saved their life, then we must be evil Pharma shills.

I do not think, however, that the e-mailer’s experience is enough to explain their opinions. They seem to be fueled by CAM propaganda. This is a consequence of CAM that is often overlooked – fomenting an anti-scientific and anti-mainstream medicine world view. This is an ugly fact that “integrators” willfully ignore.

The rant

The e-mailer opens with this:

Your article attempts a scientific analysis of the Buteyko Breathing Method (ie of ‘normal’ breathing or ‘correct’ breathing), in the form of a critique of Ira Packman’s explanation. In this analysis you are clearly unable to form a theoretical understanding of why the method works (indeed Buteyko himself may not have fully understood it), and thus finding it to make no sense within the realm of your own understanding, you respond like a chimpanzee who has just examined a modern tablet computer and, finding it to be useless, tosses it over their shoulder, declaring it to be worthless.

This is the, “Your science is too primitive to grasp the brilliance of my woo,” gambit. This is convenient, because you don’t have to actually engage with evidence, with a coherent explanation, or with specific criticism. You can simply dismiss criticism as being ignorant.

I half expected the e-mailer’s next paragraph to contain a hand-waving explanation for how they think Buteyko’s method works, but instead:

You completely fail to appreciate that no-one cares HOW the method works, only THAT it works. If you were honest for one moment you would admit that this is how ALL science works – as admitted by noted physicist Richard Feynman with regard to physics – ‘we do not understand it, nobody does’.

The most effective lies are wrapped around a kernel of truth. It is true that in medicine we do not need to know how a treatment works, if there is sufficient evidence for safety and efficacy. The problem here, of course, is that there is evidence for neither a mechanism nor efficacy. Also, this statement represents the common CAM confusion of lack of knowledge about mechanism vs. good scientific reasons to believe there is no plausible mechanism.

In this case the Buteyko method flies in the face of basic physiology. It’s not just mysterious, we have good reason to believe it is nonsensical.

The e-mailer also misunderstands Feynman (but it is rhetorically useful to throw around the names of famous scientists). This discussion is a bit out of the scope of this article, but in brief, while science is about forming predictive models, it also is based upon an understanding of how things work. Scientific models all have to work together in a coherent fashion, and the only way for that to be the case is if we try to understand the big picture, not just make narrow predictions.

You can already see, however, where the e-mailer is going – your science is too narrow and primitive to penetrate the brilliant mind of my guru. Next stop – conspiracy town.

Increasingly, in an age of much greater information flow, many people are beginning to question the credibility of scientific journals and publications which are under the complete control of powerful vested interests in pursuit of the three P’s – power, prestige, and profit – it is these same interests which suppress any studies reporting the carcinogenic properties of pesticides which affect virtually all of our food, and who produce grade A rated research recommendations for highly profitable yet completely ineffectual and highly dangerous drugs such as chemotherapy, and who have a long and utterly disgraceful history of hugely expensive legal campaigns to prohibit highly effective BUT UNPATENTABLE herbal medicines such as the Hoxsey cure for cancer.

The institutions of science are far from perfect. In fact we spend a great deal of time at SBM pointing a critical eye to all of the components of science from funding to publication. You can look at any system and overhype the flaws into an argument that the entire system is fatally flawed, even when a more fair and balanced assessment would indicate that it is functional, if imperfect.

I recently wrote about this topic here – arguing that science is imperfect, but it is self-corrective. Despite its flaws, we can eventually mount sufficient evidence to form reliable conclusions based on repeatable evidence.

What the e-mailer does not do is question their own conclusions as strenuously as they do those of mainstream science. How do they know that chemotherapy does not work and that the Hoxsey cure does work? I guess science only works when you want it to. This, of course, is a classic denialist strategy. Whenever you encounter a bit of inconvenient scientific evidence, launch into an attack against the institutions of science.

The dangerous and wreckless treatments of allopathic medicine have a long and distinguished history, including the administration of toxic minerals such as lead, arsenic, antimony, and mercury, and the practice of ‘blood-letting’ (from which the ‘respected’ medical journal ‘The Lancet’ derives its name). George Washington founding father of the United States himself died promptly following treatment by blood-letting and fatal dosage of mercury for a minor illness.

I will compare the history of science-based medicine up against CAM any day. What the e-mailer is doing, however, is another common anti-scientific ploy, using historical examples that are no longer relevant to criticize modern medicine. In fact, the examples they give are from a distinctly pre-scientific era of medicine. We now know that humoral theory and mineral-based treatments are worthless to harmful because of science.

Of course, CAM retains the pre-scientific treatments of the past, so arguing against the pre-scientific treatment of the past does not really work in their favor.

A key element in the tyrannical monopoly of present-day allopathic medicine is the widespread practice of ‘clinical’ trials (its no accident that the word ‘clinical’ is a pejorative term in our common language – meaning devoid of emotion, analytical, unattractive, and soulless). Clinical trials deserve to have absolutely no place in medicine. They represent nothing more than a collosal waste of resources and systematic means of suppression of ‘alternative’ medicine and convenient means of manipulation of the truth to allow such scandalously ineffective and dangerous treatments as chemotherapy to gain acceptance in the mainstream.

Clinical trials are all a conspiracy, and you can dismiss them out-of-hand whenever they are inconvenient. This is quite a claim, of course completely unsubstantiated. This is also a common CAM position, although the e-mailer is being more candid and less nuanced than savvy CAM marketers, but the sentiment is the same.

If clinical trials are not to be trusted, then how do we know what works? The answer, of course, is anecdotal evidence. The e-mail actually directly advocated reliance on anecdotes over careful scientific evidence (sentences in quotations are from the original article, followed by the reply). They write:

“And finally, what evidence exists within the literature that BBT is an effective treatment for asthma?”
Why do you require evidence ‘from the literature’ ? When compelling evidence is available from real living people.

Who are you going to believe – soulless numbers on a page, or real living people?
I had to laugh at this next one:

Herbal medicines have been suppressed purely because they are UNPATENTABLE, NOT because they do not work. They are extremely cheap and generate virtually no profit.

The herbal remedy market is a multi-billion dollar market. Think of how effective the mom & pop marketing scam has worked, however. Herbal products are sold by big corporations, with significant overlap with the pharmaceutical industry. They generate billions of dollars in profit. They are drugs. They simply are poorly regulated drugs.

Tylenol, by the way, is long past its patent, and still generates hundreds of millions of dollars of profit.

“Buteyko himself never published a single paper”
It is most likely he was too busy trying to cure people.

This response is very common, and it’s a complete cop-out. Buteyko had 50 years to do research. If his claims are true, as the e-mailer believes, and it’s critically important to inform the world about this life-saving technique, then it is malfeasance not to do at least basic research to establish that his claims are valid. There is no excuse.

“but no improvement in pulmonary function tests” AND “Even more consistent however is the utter lack of any change in the participant’s pulmonary function tests.”
Frequently clinical trials of BBT asthma treatment report this as a finding. However pulmonary peak flow measurements are IRRELEVANT to asthmatics. EASE of breathing is all that is important to asthmatics. Fitness level or lung capacity are IRRELEVANT TO ASTHMA – asthma is constriction of airways – that is the problem we are trying to solve.

Pulmonary function is not irrelevant to asthmatics – it is life. Peak flow is a measure of the constriction of airways. The danger is in believing that a treatment works because of placebo effects when in fact lung function is not improved. This could delay effective treatment and even result in death with a severe asthmatic attack.

Conclusion

It is still amazing to me that someone can have a world view that is so divergent from my own, and that appears to be so discordant with reality. It should not be surprising, however, because everything we know about human psychology points to the fact that our cognitive functions conspire to build and maintain belief systems.

The hardest thing to do is to question the mental constructs we have erected. Open discussion, self-criticism, and external validation are important in this process. These principles are the core of the scientific method.

The world of CAM, however, wants you to believe in conspiracies, to reject science, to believe in the wisdom of gurus and the power of anecdotal experience and stories. They have created a nice narrative in which the promoters of science and standards of care are corporate villains, while the sellers of snake-oil and magic beans are saviors.

This is a destructive world view, and it cannot be separated from the nonsense that the world of CAM peddles.

Posted in: Science and Medicine

Leave a Comment (90) ↓

90 thoughts on “The CAM Worldview

  1. oldmanjenkins says:

    I am very glad my medically trained parents sought out SBM for my asthma attacks as a child in the 70′s and not this BBT hokum. With almost 100% certainty I would not be alive without SBM treatment for asthma.

    “pulmonary peak flow measurements are IRRELEVANT to asthmatics.” I’ll have to let my pulmonologist know this as quick as possible. Dr. Novella this person appears to be so emotionally invested in this being true, they cannot see the truth that:

    1. BBT is garbage
    2: They have panic attacks (something they may not want to admit) and not asthma.

    When I am having an asthma attack, I don’t need to slow down my breathing, my constricted airways do that nicely all my themselves. To believe this BBT works for asthma is to have a serious misunderstanding of the mechanism of asthma.

    1. Flower says:

      Here’s a link to buteyko research if you’re interested http://www.buteyko.info/scientific_research.html

      1. WilliamLawrenceUtridge says:

        Wow, eight studies. And this for an approach claiming to cure, what, everything? Sarcastic clapping. And actually, at least a couple of those appear to be press releases, not actual studies. And the first two studies basically show people used their inhalers less, not that there were objective improvements in their outcomes. This pile of shit found as an outcome less use of medication and reduced symptoms – but didn’t conduct any objective tests. It’s only of value if you consider “use less drugs” to be an improvement – which I’m sure you think, but that’s because of your dogmatic belief that natural is better and drugs are evil. The objective tests for improved lung function for asthma are simple, why weren’t they used? This one has a similar outcome – no objective tests, just whether medication use was decreased. Oh, and the control group who learned merely relaxation techniques improved too. Considering stress can exacerbate asthma symptoms and controlled breathing can reduce stress – what does this show? This study doesn’t prove Buteyko helps with anything, it’s only suggesting that a lot of people have symptoms of the made-up health problem that Buteyko pretends exists. What’s up with CAM types inventing illnesss? Oh, that’s right – marketing. You know, like Big Pharma does. If you can create an illness, you can sell a cure. Please, tell me how it’s different when CAM promoters do it, versus Big Pharma?

        This one doesn’t even mention Buteyko. Neither does this one.

        I can see why you believe in CAM, it’s because you apparently are incapable of understanding the scientific literature.

        1. Flower says:

          Of it’s a good thing if asthmatics can reduce their drug use by using simple Buteyko techniques! What’s not to like?

          Especially since corticosteroids have such horrific, long-term side-effects.

          Asthmatics are in need of more than just proper breathing techniques; Buteyko does not claim to be a cure-all.

          Additional natural treatment strategies would include addressing poor gut health, low nutritional status, the compromised immune system, hypochlorhydria (80% of asthmatics), etc.

          1. mousethatroared says:

            You didn’t mention identifying your triggers and avoiding them. Not everyone can do that, but I have know people who were able to get down to only occasional rescue inhaler use because they’re trigger was something like cats.

            Funny you missed that, avoiding triggers is “natural” and much more evidence based then ‘addressing a compromised immune system’ – however you plan on doing that.

          2. WilliamLawrenceUtridge says:

            Of it’s a good thing if asthmatics can reduce their drug use by using simple Buteyko techniques! What’s not to like?

            The fact that patients can be deceived by their experience and end up dying of an asthma attack, which is a medical emergency?

            Additional natural treatment strategies would include addressing poor gut health, low nutritional status, the compromised immune system, hypochlorhydria (80% of asthmatics), etc.

            And the evidence behind any of that would be…

          3. Greg says:

            My wife has done all of that and her asthma persists – so much so that she is regularly recruited for clinical studies. I seriously doubt any breathing technique would improve her asthma.

  2. My son, now 30, was diagnosed as severely asthmatic when he was 3 years old. Over the years, he has taken almost every prescription medication available including bronchodilators, steroids (oral and inhaled), cromoglycate, leukotriene receptor antagonists, and others. Some he tolerates very well, some not at all.

    The result of careful management of his asthma, both with lifestyle awareness and medically have worked to an amazing degree. He is an accomplished trumpet player and 2 years ago, cycled from Vancouver Island to PEI. He still takes medication when needed, but his asthma does not control his life.

    1. oldmanjenkins says:

      And key with my parents education was empowering me with my asthma. To know my tigers, symptoms, and the intervention. The litmus test for me with these alt med theories is their lack of predictive power. Also their lack of understanding in the mechanics of what they are talking about. If someone like the Health Ranger lacks the training in a particular scientific discipline (as he appears to in every discipline he blabbers on about), then he lacks the ability to differentiate fact from fiction.

      1. KuiperBelter says:

        I love that you know your tigers.
        Autocorrect FTW!

        1. oldmanjenkins says:

          Well you know, the wonderful thing about tigers, are tigers are wonderful things..

          1. WilliamLawrenceUtridge says:

            Excuse me, tigers are dangerous wild animals. Tiggers are delightful, bouncy fun. Please get your research right.

  3. Salty Dog says:

    I often use a similar explanation to discuss CAM with patients. If anecdotal reports of success are all you need to accept a “treatment” then don’t worry, just take any of the wide variety of CAM “treatments”, for each and every one has this same “evidence”. It really doesn’t matter if it is homeopathy, energy healing, TCM or faith healing, they are all reported to work for someone.

    What really interests me is many CAM proponents belief that nearly 1,000,000 physicians in North America are all in the pocket of Big Pharma and really know the truth, but like a super-mafia have suppressed it for decades without a leak. To do this they have denied these “cures” to not only themselves but their children, all in the name of the almighty dollar and with no one breaking the code of silence. When you realize this is the world view of some believers you know that no evidence will convince them, but there are those on the fence who are still open-minded and this is where my energy goes.

    In every jurisdiction I am aware of it is unethical for a physician to sell their recommended prescription except in rare and unusual circumstances and then it can’t be sold for a profit. This is one reason for the development of pharmacies. This is to remove personal gain as a factor in decision making, for every human is subject to promoting what benefits us. Not so for many if not virtually all CAM practitioners. Their offices are retail outlets and judging by the amounts paid by some of my patients, the profits enormous. How can they possibly justify this? I have often thought that instead of dealing in a scientific debate the real way of exposing much of CAM for what it is would be to ban this practice. Call it the Al Capone strategy.

    1. windriven says:

      “If anecdotal reports of success are all you need to accept a “treatment” then don’t worry, just take any of the wide variety of CAM “treatments”, for each and every one has this same “evidence”.”

      Outstanding intuition pump!

      “In every jurisdiction I am aware of it is unethical for a physician to sell their recommended prescription except in rare and unusual circumstances”

      Apparently this does not include Florida where our friend from yesterday, Dr. Thornburg, sells “supplements” on his concierge pediatric practice web site.

      1. Chris Hickie says:

        I’ve always wondered about that. But it could just be no one in Florida is bothering to enforce any regulations that may be in place.

        1. James says:

          FLorida Recently started fighting
          drug mills.

          So maybe they not did get around to this guy yet?
          In general things are also a little crazy in florida.

    2. Young CC Prof says:

      “In every jurisdiction I am aware of it is unethical for a physician to sell their recommended prescription except in rare and unusual circumstances and then it can’t be sold for a profit.”

      Most colleges have a policy that a professor can’t assign his own published book as course textbook unless he can demonstrate that it’s the only suitable book on the market, and even then he’s expected to refuse royalties on sales at his own institution, or donate them back to the school. Same idea. (If you write your own book and share it with students for free or at printing cost, that’s totally different and totally fine.)

    3. James says:

      Incompetence usually trump conspiracies.
      This tends to be true for most institutions .
      Health care, Education, Police, …

      However at least with SBM there is a self correcting mechanism.

      I would love to see the day when it is a standard practice that doctors use software to diagnose and track patients.
      That is the only way I see to reduce doctor’s biases when treating difficult patients.

      Being called hypochondriac was not helpful in getting to the root cause of my problem.
      In my naiveté I assumed that doctors needed a full scope of all of the symptoms but this only made them think I was crazy.
      So I went for a while not being treated because I was able to self medicate (not drugs but just habits and coffee).

      When things got really bad for me I made the decision during the process it me or him (being the doctor).
      So I pushed and pushed the doctor until it was figured out what I had.
      This was tiring and annoying however I felt it was necessary.
      Since there was no guarantee that the next doctor I saw would not do the same thing.

      This should not be taken an endorsement of CAM but the reality of the current state of the Medical System in the US.

      1. windriven says:

        @James

        “This should not be taken an endorsement of CAM but the reality of the current state of the Medical System in the US.”

        I don’t know how many physicians you saw or what you were ultimately diagnosed as having but I question whether your experience is all that common. That said, you ultimately have primary responsibility for your healthcare. You did exactly the right thing by working with your physician until a diagnosis and treatment that provided relief were found.

        1. James says:

          I was diagnosed with narcolepsy (yes I am that guy).

          I saw 5 doctors and two shrinks in florida when was younger.
          However since I found ways around my condition mainly always standing, constant movement, constant mental activity and coffee.
          I did not see the reason to continue being annoyed by doctors.

          However when things got bad and had a family to provide for I decided to tap my inner asshole.

          So I would not say I worked with my doctor it more like kicking him in his ass and emotionally manipulating him.
          Of course our relationship ended very badly as a result of this.

          I would say it is common for people with narcolepsy.
          Since most doctors do not know what to look for if cataplexy is not present or so subtle that it is not noticed.
          It is hard to figure out which is the real problem.

          I heard of people being misdiagnosed with schizophrenia, depression and ADHD (this was my original diagnosis adderal is a hell of drug).
          Some patients are even accused of doctor shopping looking for drugs.

          The reality is that I had to change my diet and lifestyle habits also.
          If I try to do it without medication or diet I will fall on my face.

        2. James says:

          Windriven thank you for the reply.

          I was diagnosed with narcolepsy (Yes I am that James)

          I saw 5 doctors and 2 shrinks in florida when I was younger.
          Since I was able manage my symptoms by constant standing, movement and mental activity and coffee.
          I did not bother with doctors for a long while since the process was irritating.

          However when things got bad and I had a family to provide for I decided to tap into my inner jerk.
          So I would not say I worked with my doctor more like I kicked him in his rear and emotionally manipulated him.
          So let’s say our relationship did not end well.

          You bring up a good point about responsibility.
          My only problem with saying patients are responsible for their health.
          When you trust your doctor but never get better because your doctor made a mistake in the diagnosis.
          Who is at fault the doctor or patient?

          I would say for some subset of the population there is a big problem with misdiagnosis or dismissal of symptoms.
          For instance narcolepsy without cataplexy is very difficult to figure out because of the vagueness of the symptoms.
          It could be misdiagnosed as schizophrenia, depression, AD(H)D (which was my initial diagnosis adrenal is a hell of a drug) and many other things.
          As given my father was diagnosed with schizophrenia and depression so yes it happens (fun trips to the VA psych ward in my youth).
          I not saying my father did not really have schizophrenia or depression but since my diagnosis I wonder the doctor were wrong.

          So in the end I did get better I had to change my diet and other lifestyle habits and take my medication.
          I have to do all the above if I do not I will fall on my face.

        3. James says:

          Sorry for the double post my use of “string language” in my first post cause it to be moderated.

          1. mousethatroared says:

            James “So I would not say I worked with my doctor it more like kicking him in his ass and emotionally manipulating him.
            Of course our relationship ended very badly as a result of this.”

            This made me laugh. Visiting a doctor looking for help with wide ranging constellations of symptoms (some of which will be non-specific*) is a pain in the rear for the patient, but somehow we patients are supposed to make sure that the doctor is not made uncomfortable, by questioning their process, conclusions or stepping on their toes, etc. (Obviously some doctors are more toughskinned then others) At the same time that we are supposed to recognize when the doctor has missed something, is incompetent or a quack.

            It’s also the patients’s responsibility to make sure that the doctor gets the information that they need when they need it, regardless of the facts that the patient has no idea what’s relevant. With some doctors, tell them too much, they immediately start down the road of psychological causes, but if you don’t tell them everything, then they maybe missing an important piece of the puzzle or underestimate the impact your illness is having on your life.

            If the doctor tells you that your symptoms aren’t cause by disease, you should stop bothering them and maybe see a therapist, unless it turns out that you actually had asthma or thyroid disease** or something else, in which case you should have been more insistent with your doctor.

            Doctors, what’d ya gonna do?

            *Non-specific is not supposed to be code for psychological…but some health professionals seem to forget that.

            **Or both, plus a couple other things.

          2. James says:

            @mousethatroared

            If I ever have to down this road again for myself or wife & kids.
            My plan is the following.

            * Tell them I am stupid and since I do not know is relevant here are the symptoms and family history written down summarized and organized.

            * Ask them how do they correct their mistake explaining to them I was misdiagnosed before.

            * Also ask how do they avoid their biases when accessing a patient

          3. James says:

            This why I would prefer diagnoses and treatment plans would be done by software and not doctors.
            I work as a programmer so I know software get it wrong also but at least there is a reduce chance of basis.

          4. mousethatroared says:

            @James “I do understand that doctors should never look at Narcolepsy as the first condition but it should not be the last either.”

            Sorry James, my comment “I suspect that if you have a common ailment or a typical presentation of a serious ailment, then the experience is less common than if you have something less common or an atypical presentation.” Was meant to be a response to windriven’s question of how common difficult relationships with doctors are. It wasn’t meant as a comment on your experience with doctors. I should have quoted windriven to make that clear.

            I don’t know anything about narcolepsy or it’s diagnoses, but I didn’t meant to imply that your trouble being diagnoses was because it was incredibly obscure.

        4. mousthatroared says:

          I suspect that if you have a common ailment or a typical presentation of a serious ailment, then the experience is less common than if you have something less common or an atypical presentation.

          1. James says:

            I do understand that doctors should never look at Narcolepsy as the first condition but it should not be the last either.
            My experience made me realize how easily I could have fell into the CAM world.
            My fear is that doctors are making new customers for CAM everyday.
            Because of their dismissal of patients symptoms or incompetence.

            And since some CAM practitioners may get it right because of dumb luck since they always check for the less common conditions first.
            Or even worse make the patient feel better even when he is not.
            So when CAM practitioners are dealing with the particular subset that was brushed off by the “Medical System” this subset may have an increase chance having an undiagnosed symptom.

            Then since the CAM practitioners diagnosed this “rare condition”.
            They then get to say to the world how great they are because they saved this person that the doctors failed to heal.

            I fear it is the doctors themselves that are feeding CAM.

          2. mousethatroared says:

            @ James – urgh, I made a threading mistake look up^^^^

          3. mousethatroared says:

            James – I agree that patients dealing with undiagnosed or poorly diagnosed conditions who have been either brushed off or fallen through the cracks of the medical systems are CAM fodder. This come from both CAM practitioners and friends and family with “helpful” advice.

            As an aside, the “helpful” advice from friends and family isn’t all CAM related. I’ve had people tell me that my symptoms were all due to lack of exercise, that my symptoms were probably due to stress or depression and I should taper of the medication the doctor prescribed and start taking anti-depressants instead, that my pain symptoms are caused to by guarding, dietary advice for anemia, how often stomach pain just goes away… all things that could be helpful for a individual patient, but given without having the any idea of my health history, imaging, test results, etc, not actually useful.

            So to me it’s not about CAM vs conventional medicine therapies, because poorly applied conventional medicine is just as bad or worse than CAM It’s about who actually knows what the heck they are talking about or at least know when to not offer advice when they don’t know what they are talking about.

          4. James says:

            Because the enormous amount of data that is collected during this process.
            And the ease at which things can be overlooked or dismissed is why I believe using software to diagnose patient is probably the best route to go.
            As humans we are too biased or unreliable as a whole to be trusted to make the right decision every single time.

            I am not saying there are not extremely good doctors out there that will really take the time to figure out what you have.

            I am just saying they are rare.
            To expect every single doctor to be perfect every single time is just not practical if you do not arm them with the proper tools to do so.

        5. James says:

          Windriven after contemplating a while I realized my anger against doctors was misplaced.
          Narcolepsy is a difficult condition to diagnose.
          I now realize how lucky I am to even be diagnosed properly.
          Because of my diagnosis my older brother also diagnosed .
          So now we both are able to improve our lives.

          The problem with my case was not the doctors or SBM but not having the proper tools to apply SBM correctly.
          SBM does not stop with the clinical trails or statistically proven treatments.

          It also needs to applied to the non-treatment side of medicine.
          * How doctors talk to patients.
          * The order in which test are preformed.
          * Hospitals ensuring patients get enough sleep to recover.
          http://www.theatlantic.com/health/archive/2013/06/sleep-deprivation-in-hospitals-is-a-real-problem/276960/
          * How to encourage better habits.

          Just to name the few.

          SBM can be applied to so many parts of treating the patients.
          It would great to see the day when it is.

          1. windriven says:

            Jamws,
            The most important thing is that you solved your problem. Narcolepsy is a bitch. Glad it is under control.

  4. windriven says:

    One thing that I appreciate about SBM is that it forces me to think about the epistemology of scientific knowledge, how we know what we know, and just as importantly how we know what is bogus.

    Words are important. They are symbols that we arrange not only to express what we think to others, but also to examine our own thoughts and test what we think in a structured way. Mark Twain is quoted as having said, “The difference between the right word and the almost right word is the difference between lightning and a lightning bug.”

    So it is in all of life; the differences are in the details. There are those who examine their knowledge and put it to the test because the truth of what they know is important to them. And there are those who don’t.

    I apologize for the long preamble but reading the PDF that Dr. Novella linked – perhaps in such close proximity to Dr. Hall’s post yesterday – gave me to hypothesize that the credulous fall into two categories and two categories only*: the casually ignorant and the willfully vacuous.

    The casually ignorant are those who lack education in a given subject, understand their ignorance in that area, but are not particularly motivated to become educated until some exigency forces interest. I, for instance, am all but totally ignorant of the ballet form. I can appreciate its beauty in a casual way. But I have no depth of understanding of the form and would be incapable of rendering judgment about any given performance of, say, Swan Lake. Life is short and there is much to learn. Ballet, for me, will have to wait.

    The willfully vacuous are those who lack education in a given subject but, sticking with the arts analogy, “know what they like.” I have referred to this elsewhere as projectile stupidity but that turn of phrase is entirely pejorative. It lacks precision. Unfortunately, English lacks a word – or my vocabulary is too sparse to know it if it exists – that entirely captures the blithe dismissal of education in a subject coupled with the towering arrogance of certainty in delivering pronouncements on that subject. So I have settled on willfully vacuous. If someone knows a more elegant locution I hope they will share it.

    And now to the point – and yes, I actually have one: the casually ignorant are fair game; these are the minds that we fight for. Perhaps they have lived their years without much need for more than routine medical care. Perhaps medicine isn’t a subject that particularly interests them. But when forced to make a decision they recognize that they don’t have the tools and will either take the time to acquire those tools or will defer to the judgment of those who have taken the time. These are worth a substantial investment in time and effort.

    The willfully vacuous, like Dr. Novella’s correspondent, care not that they haven’t the tools and care less for the judgments of those who do. They know what they like. Facts are immaterial. Two centuries or more of scientific progress don’t matter. Research, studies, and the breathtaking litany of medical triumphs over human misery all dissolve in the face of arrogant, refractory, willful vacuity. For these there is, I fear, no investment in time, reason, effort that will light the lamp. I wouldn’t much care but that they too fight for the minds of the casually ignorant.

    We can argue that better education in science and critical thinking skills will help. And it would, I believe, thin the ranks of the casually ignorant. But it seems that the willfully vacuous operate outside the envelope of educability.

    *My hypothesis intentionally excludes the predatory who sell woo at a profit with no illusion that their woo actually works. These are not individuals who lack the tools to discriminate between fact and fiction.

    1. bilyz says:

      Try, “The arrogance of ignorance.”

      1. windriven says:

        I like it but to my ear it doesn’t catch the willfulness of the ignorance which, I think, is an important characteristic.

    2. Paul says:

      Nice blog post WindDriven. I don’t think Willfully vacuous is the right phrase for those who have the “arrogance of certainty”. Saying vacuous underestimates how smart these people can be while still being swept up in an irrational belief. How many scientists and doctors turned cranks can you name after all?

      In relation to Harriet’s how to talk to CAM Proponents. I think if you press a casually ignorant person too aggressively they will defensively become your “willfully vacuous”. I feel like it must be some emotion driven defense of their kind healers from a skeptic who is aggressive towards them and their healers. We can create them as well.

      1. windriven says:

        I’m not happy with ‘willfully vacuous’ either because the ‘willful’ part doesn’t do justice to the arrogance while ‘arrogance of ignorance’ doesn’t capture the willfulness of the ignorance. English is such a rich language. It is rare to hold a concept and not have an English word that captures it. I wish my German was better. I suspect there might be an appropriate word lurking there.

      2. pvandck says:

        Many CAM practitioners are without doubt charlatans. But I wouldn’t be at all surprised to find many CAM advocates and practitioners are displaying an emotional response to a failure to acquire any grasp on science and the scientific method during formal education. The honest ones, that is. It would account for the usual emotional responses when challenged for real evidence.

        I do wonder how many practitioners are secretly in awe of science, real medicine and real doctors. And how many took up practising out of some sense of inadequacy coupled with a desire for public recognition and respect most of the medical profession are accorded – without, of course, the need for years of rigorous medical and science study.

        CAM, or as I prefer to call it Complementary and Alternative Reality Medicine, has all the hallmarks of organised religion – another activity entirely based on emotion.

    3. David Hollen says:

      For me, the tell is the underlying narcissism inherent in the paranoid conspiracies. For they alone, among all the people out there, can perceive the “truth”. It gives them such a comforting sense of importance. The internet reinforces this narcissism by leveling out any hierarchy of knowledge or expertise. They say: “If science is just another way of knowing things, then why isn’t my crackpot theories just as valid than one of those so called experts?” And add to this a lot of support from an echo chamber, and it becomes self-reinforcing.

      1. windriven says:

        “If science is just another way of knowing things, then why [aren't] my crackpot theories just as valid than one of those so called experts?”

        Science, of course, is a broad tapestry of knowledge running to the horizon. It is staggering to contemplate how well everything fits together, integrating knowledge from astronomy to zoology.

        And then we have some dufus who was told by the Archangel Gabriel that tincture of horseshit is the one true cure for all disease. It might not be much of a tapestry but it sure worked for Uncle Cletus so it must be true.

        Indeed, that is pure narcissism.

    4. mousthatroared says:

      Windriven, very thoughtful comment. A couple concerns. I think it’s important to avoid prescribing a particular motivation when one can only observe behavior. For this reason I am concerned with the label willful vacuous. If I am reading you correctly, seem to be observing someone that is blind to information that does not fit their preconceived notion. This blindness could be due to willfulness, but it could be due to some other non-willing mechanism. Some people may just be less cognitively flexible in changing a view based on evidence, some people may be distracted by an emotion such as anxiety, anger, feelings of granduer…

      A second concern. It seems that you are characterizing people into one group or another, but often people’s behavior can change situationally. It’s important to consider actor-observer bias when attributing a behavior to a personality rather than a situation. My apologies if I misinterpreted.

      But, I think I know what you mean. One does see people who seem much more focused on maintaining a particular belief than they are just learning about the world around them or finding a workable solution to their problem. I often think of this in terms or preferring certainty over curiosity…but that is not particularily useful.

      1. Windriven says:

        @mouse

        “I think it’s important to avoid prescribing a particular motivation when one can only observe behavior. ”

        I hope I didn’t descend into amateur psychology. I intended to comment specifically on behavior as defined by those amenable to education and those embracing sCAM as received wisdom.

        “It seems that you are characterizing people into one group or another, but often people’s behavior can change situationally. ”

        This is probably a fair criticism but I have seen the casually ignorant shift position readily while those who, adopting WScott’s improvement, are virulently vacuous are quite refractory.

        At least in my experience ;-)

  5. Carl says:

    “Who you gonna believe, me or your own eyes?”

    In fact, go ahead and just re-read the entire email while imagining it in Chico’s voice. “Heyyy, you not wanna no high-priced literature. I sella you a booka instead.”

    1. windriven says:

      A friend of mine misquotes Chico as saying, “who you gonna believe, me or your lying eyes” and I must say I like his better.

      1. Carl says:

        Yeah, the wrong version is better.

  6. goodnightirene says:

    Could we not refer to the subject as “he” or “she” rather than the very distracting “they”? They is more than one person, so I keep picturing the crank in question as a three-headed hydra. Sorry to nitpick, but you are otherwise such a good writer.

    Without giving any credence to one word of the subject emailer, or disputing oldmanjenkins, I find it interesting that one of my frequent complaints to my allergist (don’t have a pulmonologist–yet) is, “ how can I pass the peak flow tests so well and still have so much difficulty breathing?” I get no answer, only instructions to use inhalers more often (even though I say this isn’t helping). I take that in stride, but put a typical SCAM person (or even a fence-sitter) in that situation; how long do you think it would take her to find someone who does have answers?

    1. TL says:

      It is grammatically correct to use “they” as a gender-neutral singular pronoun, going, if my sources are correct, back a couple of hundred years.

      Whether or not you like it used as such is a matter of personal preference, but it is good grammar to do so.

    2. windriven says:

      “how long do you think it would take her to find someone who does have answers?”

      or claims to have answers.

    3. Young CC Prof says:

      @Goodnightirene: This is going to sound weird, but it’s totally mainstream. Do you get heartburn? Cough after meals? Sore throats or lose your voice a lot? Acid taste after meals? Acid reflux can cause shortness of breath, either by actually invading the airways or by irritating the vagus nerve.

      I was dealing with mild allergic/environmental asthma and severe uncontrollable reflux for a couple years. My lung numbers were usually good, but I just could not get breathing comfortably until I had the reflux under control, which ultimately required surgery. (Most people don’t require surgery, just diet, lifestyle tricks and/or drugs)

      A really bad asthma day after the surgery was like every day before the surgery, and I am so glad I did it.

      It’s something to think about and maybe ask your allergist about. If you go to a pulmonologist, he’ll almost certainly ask about any upper digestive issues.

  7. Taurus says:

    Ughhh…
    Take a look at what was just put out by BUSM…

    http://www.bumc.bu.edu/busm/2013/10/10/busm-investigators-identify-barriers-to-implementing-complementary-and-integrative-medicine-curricula-into-residency-programs/

    I wish I knew how in the hell I’m supposed to react to this other than to throw my hands up in disgust…

    Sad. That’s all I can say.

    1. Carl says:

      “This research was funded in part by a grant from the National Center for Complementary and Alternative Medicine. ”

      The NCCAM can’t find evidence for any of their BS, so why are they helping with this push to teach it? It’s nothing but a propaganda machine.

      1. pvandck says:

        It’s the business of medical fraud.
        What better way to give credibility and respectability to a deliberate deceit than to take advantage of popular ignorance?

        1. James says:

          This how I feel about lotteries

    2. windriven says:

      Stories like this drive me to despair. There is no hope when willful vacuity is taught in mainstream universities.

    3. NorrisL says:

      What is wrong with prestigious universities who choose to bring worthless cam quackery onto their campuses. Oh, I know, money!

  8. Frederick says:

    Always like how you can be so objective and admire you rational thinking.
    I read your article On james Randi site about flaws in sciences, it was petty good and really coherent. A good read.

    ONE thing a always find FUNNY about those Alt-Conspiration-pseudo science believer, is how the LOVE to put CAP EVERYWHERE. You know because what they say is IMPORTANT AND SO TRUE!!! yeah it just make reading annoying. I must admit that i had this tendency some years ago ( my sarcasm in this post does not count of course :-) ). It come back sometimes but i always correct myself and take a deep breath ( a normal one i guess). and use normal letters.

  9. pmoran says:

    “Clinical trials deserve to have absolutely no place in medicine. They represent nothing more than a collosal waste of resources and systematic means of suppression of ‘alternative’ medicine — ”

    Not in the least. They arose because it was realised that neither mainstream doctors nor its esteemed professors could be relied upon to form reliable impressions of the effectiveness of their pet treatments from casual observations of their use.

    For example, the first use of randomisation in a mainstream study is thought to be this one testing a serum treatment for diphtheria Fibiger J. Om Serumbehandling af Difteri. Hospitalstidende 1898; 6: 309-325, 337-50. Doctors had been giving conflicting views as to its effectiveness.

    At that time nearly all of everyday medicine involved dubious or unproven methods. There was no “alternative”/mainstream divide..

  10. Davdoodles says:

    “Increasingly, in an age of much greater information flow, many people are beginning to question the credibility of scientific journals and publications which are under the complete control of powerful vested interests in pursuit of the three P’s – power, prestige, and profit – it is these same interests which suppress any studies reporting the carcinogenic properties of pesticides which affect virtually all of our food, and who produce grade A rated research recommendations for highly profitable yet completely ineffectual and highly dangerous drugs such as chemotherapy, and who have a long and utterly disgraceful history of hugely expensive legal campaigns to prohibit highly effective BUT UNPATENTABLE herbal medicines such as the Hoxsey cure for cancer.”

    This is one sentence. I think one would need some pretty impressive breath control just to read this thing aloud without experiencing at least a mild hypoxia.
    .

  11. MeisterEckhart says:

    Dear Dr. Novella, please allow me to draw attention to a formal fallacy in which you incur at one point of your post.

    Stating, as you do, that “historical examples are no longer relevant to criticize modern medicine”, completely misses the point. Which is, or should be, that allopathic medicine administered a century ago (or even less) was as certain as it is today’s allopathic medicine that their methods are right/good and the only right/good ones, whereas they were anything but.
    As you should very well be aware, what is considered scientific today could be considered pre-scientific in the not so distant future.
    Please note that I am not trying to make the case for CAM or the author of the letter to which you are replying. But the fallacy remains.

    (Please forgive my less than perfect English: I am Italian, writing from Italy)

    1. WilliamLawrenceUtridge says:

      SBM and the contributors recognize that science is imperfect and subject to change. That doesn’t mean it’s worthless. The fact that knowledge and treatment changes over time is a feature, not a bug. While the future may regard individual current treatments as primitive and imperfect, I highly doubt they will regard the framework as completely worthless. Infections will still be seen as caused by bacteria and viruses, though doubtless the specific routes and treaetments will be different. Life will still be seen as having evolved. DNA will still be mapped to RNA which will code for proteins that produce tissues that combine to organs which ultimately form the meat sack that carries around, protects and informs our brains.

      No matter what, it is invalid to say “300 years ago doctors were bloodletters” when doctors currently are not bloodletters. Bloodletting was proven to not work and was abandoned. Homeopathy has never been proven to work, and has been proven to not work, but it’s still used. That’s the larger problem with homeopathy and all CAM.

      1. James says:

        It is all about dosage.
        Blood letting as a cure all is a very bad thing.
        However there is some evidence that donating blood can improve your health.

        1. WilliamLawrenceUtridge says:

          I would say it’s more the recognition that bloodletting isn’t a cure for anything except haemochromatosis. That it might help with general helath is a fringe benefit (one I’m happy to hear about, I donate blood and consider it part of my weight loss/maintenance regimen) but it has no acute benefits.

          1. mousethatroared says:

            Blood donation, weight loss? Huh?

            You posted that just so people would ask what the heck you were talking about. Didn’t you?

          2. James says:

            He loses the weight of the blood

        2. mousethatroared says:

          pfft – 1 pint of blood weights what, a pound? (Then you just replace it.)

          WLU, I won’t be waiting in line for your patented weight loss program. :)

          1. WilliamLawrenceUtridge says:

            You posted that just so people would ask what the heck you were talking about. Didn’t you?

            Pfft, no!*

            pfft – 1 pint of blood weights what, a pound? (Then you just replace it.)

            It’s not quite that simple, the blood is primarily comprised of water, which contributes the weight. However, it also contains red, white and clotting cells, fats, sugars and proteins. Not only do you have a net reduction in these macronutrients, your body must spend time and energy regenerating the cells, which itself requires a net expenditure of metabolic energy.

            Look, I’m not saying it’s a good weight loss plan. It’s up there with severing a limb. But still, anything to promote blood donation!

            *Yes. Very much so.

          2. mousethatroared says:

            What, cookies, juice and karma aren’t good enough incentives for donating blood?

            I never thought of the calorie consumption, though, interesting angle. :)

          3. WilliamLawrenceUtridge says:

            Medicine is a vampire, it always needs more blood. Anything to feed the system :P

    2. Eckhart,

      I am sorry but that is incorrect.

      Pre-scientific is not the same thing as obsolete or outdated science. Bloodletting is part of philosophy-based medicine, specifically Galenic philosophy. It is not science-based.

      The science of today is imperfect, but will not become prescientific no matter how much science advances in the future.

      My point remains valid – the methods that were used hundreds of years ago were different than today’s, not just the conclusion. The institutions have changed. The farther back in time you have to go the less relevant examples become because the system has changed, and if you have to go all the way back to before science was applied to medicine, your point is simply wrong.

      As has already been pointed out, science is not certain. It is build on tentative conclusions and uncertainty. This is categorically different than the ideology-based belief systems of the past.

      1. MeisterEckhart says:

        Thank you for your reply.
        I get your point and, as far as I am concerned, I find it pretty convincing. Debatable perhaps by more critical souls, but good enough for me. Being that the case (i.e. that today’s SBM cannot, in any way, be mixed up with older “philosophy-based” approaches), could you specify at which point exactly you would put the transition to SBM historically? What occurrence, discovery, procedure or scientist had the role of seminal initiator of SBM? Where and when do you put the break point, talking specifically about the practice of medicine?
        Thanks again for your time.

        1. WilliamLawrenceUtridge says:

          could you specify at which point exactly you would put the transition to SBM historically

          There are a lot of dates that you could pick, because it was a process rather than an event.

          Evidence-based medicine, the precursor to science-based medicine, started in 1992. Science-based medicine as used here, still doesn’t really exist as a systemic practice (if it did, homeopathy wouldn’t be researched since it’s such an obvious waste of time).

          The Flexner Report revolutionized the teaching of medicine in the United States through an emphasis on laboratory knowledge and the importance of empirical data. It was published in 1910. Over the next generation, inadequately trained doctors died, retired, retrained or changed jobs, replaced by doctors who knew how to use a microscope.

          Koch, Pasteur, Snow and Semmelweis, plus some researchers who conducted preliminary research and theorizing created the germ theory of disease, probably the most key underpinning of real medicine. They date to the 19th century for the most part.

          In 1823 Pierre Charles Alexandre Louis published the first results that compared different treatment groups on the basis of simply counting who survived in each.

          In 1796 Edward Jenner tested the use of cowpox to innoculate against smallpox. However, skin-to-skin variolation against smallpox has a history that can be traced to Ethiopia with uncertain origins, 10th century China and possibly Vedic religious texts that date to 1500 BC.

          3rd century BC Greece were ardent empiricists, valuing experience over dogma.

          It depends on what you mean by “science-based medicine”, and given its various components you can argue for different origin dates. I would even argue, as I did above, that it’s still a theory held by a small number and medicine hasn’t transitioned yet, because of the value placed on clinical trials over prior knowledge.

          1. MeisterEckhart says:

            Evidence-based medicine, the precursor to science-based medicine, started in 1992. Science-based medicine as used here, still doesn’t really exist as a systemic practice

            Thank you for your explanation. I didn’t think there was a single event or date to point to either.
            Your sentence here above does tell a lot.

  12. Alex says:

    …thus finding it to make no sense within the realm of your own understanding, you respond like a chimpanzee who has just examined a modern tablet computer and, finding it to be useless, tosses it over their shoulder, declaring it to be worthless…

    This statement from rant e-mail is ad hominem. What else could be said about logic in the argument?

  13. Chris Hickie says:

    I think a lot of CAMmers know they are scammers. But they wouldn’t be doing this if they couldn’t pay the bills doing this. Which means there are enough people out there letting themselves be scammed. This morning I’m getting ready for clinic and I overhear the TV saying “next on the Today Show, Matt Lauer looks at the the latest in acupuncture–acupuncture without needles.”. Unfortunately an either clueless or simply ratings-driven media promotes the scam of CAM to the populace. If you hear something enough, you start to believe it is true. Then people today have this incredible need to believe in “total cures” for everything. Maybe because it is easy to get depressed over all the things they hear on TV/radio/newspaper/internet. But they start to basically want a magical cure. Magical as in it is “natural”, with “no side effects” and “100% safe”. They want it so much they don’t seem to notice the “these statements have not been evaluated by the FDA” disclaimer. I also think people today don’t get the needed education in science and math and critical thinking to see through the fallacies CAM.

    1. James says:

      The scary ones are the one who really believe it what they are doing.

  14. mousethatroared says:

    On Buteyku breathing. I have mild cough variant asthma, that seems to mostly give me trouble on the tail end of a virus. A few times I have found, when caught without my inhaler, that slow nose breathing with an emphasis on exhaling can be somewhat helpful in preventing a coughing binge. Urgh, inhaling through the mouth (particularity dry air) is about the best way to start a coughing fit. I suspect it’s just the irritation that the dry air causes on the airway that triggers the coughing/asthma. The nose breathing offers no where near the relief that the inhaler does, though.

    Since Buteyku breathing focuses on slow nasal breathing, I suppose that a person with asthma similar to mine might see some short term results with it. But nothing comparable to the benefit of appropriate medication. The nasal breathing helps me to not have coughing fits, it doesn’t help me carry a box of art or climb the stairs without getting ridiculously short of breath.

  15. pmroan says:

    Eckhart: “Which is, or should be, that allopathic medicine administered a century ago (or even less) was as certain as it is today’s allopathic medicine that their methods are right/good and the only right/good ones, whereas they were anything but.”

    Yes. That is probably so in terms of practitioner opinion on many matters. We can nevertheless be quite confident that we are closer to the truth on most things.

    We now know many of the ways in which doctors were being misled as to the intrinsic effectiveness of treatments and how to guard against those.

    Modern science is characterised by the use of careful procedure and emergent technology. It unarguably leads to a better understanding of and a greater ability to influence external reality.

    As Steve Novella says, all knowledge is still tentative to some degree or other. It is inconvenient to have to spell that out all the time in normal discourse, especially when there is a high degree of certainty. Nevertheless it is usual in scientific publications, wherein the language is typically studded with little equivocations: ” the evidence suggests — “, “it is likely that —”.

  16. WScott says:

    @ Dr. Novella: “It is true that in medicine we do not need to know how a treatment works, if there is sufficient evidence for safety and efficacy. The problem here, of course, is that there is evidence for neither a mechanism nor efficacy.”
    That’s an important point. One problem I see in the broader skeptic-blogosphere (not necessarily here at SBM) is a tendency to use the No Mechanism rebuttal to end arguments, without continuing on to “…which might not matter if we had evidence of efficacy, but we don’t.” Standing alone, the No Mechanism argument is not going to convince many believers because it just plays into their bias that scientists dismiss anything they don’t understand.

    @ windriven questioned how common James’ experience was (of going undiagnosed for years and finally having to push and push to be taken seriously).
    No idea if there’s actual data on this, but anecdotally I suspect his experience is depressingly common. My wife had consistent shoulder pain for years, and was told “take Advil every day for the rest of your life.” For. Years. Finally someone took the time to actually look at her and figured out it was the result of undiagnosed scoliosis. I have numerous friends with similar stories.

    As James says this isn’t a problem with SBM itself, and as in any profession not all doctors are actually very good at their jobs. But I do see it as a problem with our healthcare system, which often rewards doctors for quantity of care (ie – more patients) over quality of care (ie – did they actually get better). One of the things SCAM proponents always relate about why they love their SCAMers is “he actually takes time to talk to me and get to know me as a person.” Unfortunately many of them attribute that to a flaw in SBM rather than maybe they need to find a better doctor.

    Re willfully vacuous: I like the term virulently ignorant, because once they’ve been infected with misinformation, they become actively resistant to the truth.

    @ MeisterEckhart: “As you should very well be aware, what is considered scientific today could be considered pre-scientific in the not so distant future.”
    I know Dr. Novella already addressed this, but you’re thinking of science as a body of knowledge, rather than a methodology. Bloodletting was never scientific knowledge, because it was never tested systematically to see if it worked. It was used because it had always been used and no one had any better ideas. That’s not science.

    “could you specify at which point exactly you would put the transition to SBM historically?”
    I’m not sure there’s one specific incident or discovery you can point to, but I’d say it started evolving in the late 1800s and reached its modern form in the mid 1900s. And of course the process continues to evolve.

    @ Chris Hickie: “I think a lot of CAMmers know they are scammers.”
    My experience is just the opposite; the vast majority I encounter strike me as true believers. Or else they’re REALLY good actors.

    1. Windriven says:

      @wscott

      “virulently ignorant”

      I like it! I might modify it to virulently vacuous because ignorant has, for me, the connotation that it can be easily erased with education. Those we speak of seem immune to reason.

      ” the vast majority [of CAMmers] I encounter strike me as true believers. ”

      In my experience it strikes me as closer to 50-50. I guess that is why we don’t put weight on anecdote.

  17. Jason says:

    I very much appreciate everything this site does. I discovered a wealth of knowledge I did not know existed and I have learned so much. It has been both exciting and upsetting to see things I once thought plausible totally debunked because I was not able to see certain blind spots or lost critical thinking about certain topics. But surely I must be in the minority. I mean it has been talked about already in some of the posts about how people, when confronted with evidence that challenges their beliefs, do not change their beliefs, they become more entrenched. Doesn’t it get tiring and feel hopeless constantly fighting a battle against people who simply are not able to think critically and are simply refuse actual facts and evidence?

    1. WilliamLawrenceUtridge says:

      Everyone needs a hobby, mine is arguing on the internet.

      1. vadaisy says:

        Everyone needs a hobby, mine is arguing on the internet.

        And you’re so good at it!

  18. Anthony Leet says:

    I would like to thank Dr Novella and SGU. I had a faulty baloney detector and i was happy to believe whatever felt good. Then one day i asked myself, how do i know what i know is true? It has been a long and difficult road to educate myself but i can smell baloney a mile away now. So thank you, thank you, thank you.

    1. Kathy says:

      AL … good to hear. For myself, I had a well-developed nose for baloney, but didn’t feel justified in saying, “I don’t believe you”, especially as all my family and friends thought CAM was the best thing since bottled beetroot. This site has given me some understanding of both the CAM method and the scientific method, so that I’m not so vulnerable any more.

  19. Marion says:

    The fact is that the vast majority of people do not deserve medical care.
    I have urged medical doctors & nurses to stop giving medical treatment to anti-science types and homeopathic believers and god believers & extreme free-market anarchists/capitalists who keep voting to give financial terrorists even more money (Although, I can respect TRUE anarchists who are 100% consistent about having no laws about anything.)

    There is no scientific nor mathematical proof that trivial things like pancreatic cancer or heart attacks are “bad” for them. To say that requires putting a NUMBER on how bad moving atoms around certains are. And to do that, requires a mathematical model of those atoms.

    Anything less is bullshit.

    I have no sympathy for the non-existent stress of medical doctors and nurses who advocate taking away the licenses of other doctors & nurses who would choose not to work on the religious. For example, i have NO sympathy for the non-existent “stress” allegedly suffered by doctors who support intrusive laws that require somebody pick up a patient from the hospital when they leave. This burdensome regulation has made it impossible for me to get certain surgeries done, because I can find no one to pick me up. The few times I have been able, it has caused unimaginable extra time and effort.
    But, that’s the way doctors & nurses like it, because they don’t have stressful time-consuming jobs like we mathematicians do.

    This is how you have to talk. This is how you have to pressure your colleagues to pressure their colleagues to pressure patients to pressure other patients to pressure politicians. Nihilistically.

    To drive through to them the one law that outranks all other laws, ethics, rules, regulations, constitutions, etc of the universe: the Principle of Explosion in Logic (yes, it’s called that – look it up): from one logical inconsistency, everything follows.

    And if anyone complains about such a political position,
    then play dumb and pretend that you could not have possibly known that pancreatic cancer, or heart attacks, or not giving a patient food or water for a year, or moving atoms around in any such way, could possibly have had any negative effect.

    1. This burdensome regulation has made it impossible for me to get certain surgeries done, because I can find no one to pick me up.

      While I understand that somebody with your wonderful view of the world might have no friends or family to ask for a free pickup, calling a taxi service is not that difficult? The burdensome regulation is there to stop you driving yourself around while doped up on painkillers. Nanny-ish but understandable.

      1. Harriet Hall says:

        When I reported for colonoscopy, my husband was still parking the car, and they wouldn’t even let me sign in until my designated driver was actually present. This is for patient safety after sedation. I doubt if you could get a taxi driver to sign in with you and wait through the whole procedure. If I didn’t have a driver, I wouldn’t hesitate to ask neighbors or even slight acquaintances. Most people are glad to help if asked, and you could “owe them one.” I’ve been asked to drive and accompany neighbors, and I was glad to help.

  20. windriven says:

    @CannotSay2013

    “Steven Novella will ban you when you begin to question his credentials given that his opinion on the matter contradicts that of much more credentialed scientists like Jerry Coyne or, on some issues, even the opinion of chair of the DSM-5 task force David Kupfer (who is supposed to be the standard bearer of American psychiatry) .”

    Dr. Novella is a board certified clinical neurologist, not a psychiatrist. While both require MDs they are wildly different specialties.

    I suspect your banning had more to do with your inability to mount and sustain coherent arguments than questioning Novella’s credentials. I tried to follow your diatribe about the rollout of HAART in countries with socialist-style health care but your reference was both incomplete and tended to undercut your assertion.

    We’re all pretty stupid here and only semi-literate as well. If you have an argument you need to lay it out linearly and completely, supported by clear citations that are actually relevant to your point. I’m sure if you’ll do that we’ll stand in awe of your brilliance.

  21. WilliamLawrenceUtridge says:

    Ouch, cross-posting error!

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