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The “central dogma” of alternative/complementary/integrative medicine

There is something in molecular biology and genetics known as the “central dogma.” I must admit, I’ve always hated the use of the word “dogma” associated with science, but no less a luminary than Francis Crick first stated it in 1958, and it has been restated over the years in various ways. Perhaps my favorite version of the central dogma was succinctly stated by Marshall Nirenberg, who said, “DNA makes RNA makes protein,” which about sums up all of molecular biology in five words. Or at least it did until the last ten or twenty years, when we’ve been finding exceptions to this dogma.

I don’t want to dwell on the central dogma. As I’ve said, I loathe the use of the term “dogma” to describe anything in science, although a discussion of the central dogma and its exceptions might make for a decent post one day. What brought the central dogma to mind is a series of articles I saw recently in ONCOLOGY: Perspectives on Best Practices that let me to ponder the question: What is the “central dogma” of “alternative medicine”? I realize that alt-med is an unwieldy gmish of ideas that range from the semi-plausible but unproven to the completely ridiculous (i.e., homeopathy or reiki), but after reading these articles and thinking about it, I do believe that there is in actuality a “central dogma” of alternative medicine. I also believe that it is entirely appropriate to call it a “dogma” in this situation, because it is far more a matter of faith than it is of science. Moreover, the more that quackademic medicine infiltrates academic medicine, the more this “central dogma” has infiltrated academic medicine with it. Indeed, as you will see, when this central dogma is questioned, even by someone sympathetic to “complementary and alternative medicine” (CAM; i.e., “complementing” medicine with quackery) or “integrative medicine” (i.e., the “integration” of pseudoscientific medicine with medicine).

If you want a hint about what I’ve come to believe that this “central dogma” is, you need go no further than a recent post by our latest recruit to Science-Based Medicine, Jim Coyne. If you haven’t read his inaugural post for SBM, you should go back right now and do so. I’ll wait. Once you come back, think about that post for a moment. Basically, it is a discussion of how poor the evidence is to support the contention that psychotherapy and/or patient support groups increase cancer-specific outcomes, up to and including the prolongation of survival. In other words, whatever the value of psychotherapy or strategies to improve mood or happiness might have in improving the quality of life of cancer patients, there is no good evidence that such strategies improve concrete, objective outcomes, such as patient survival.

Which brings us to what I think to be the central dogma of alternative medicine and “integrative” medicine.

The central dogma: The Secret, or wishing makes it so

Before I deconstruct the articles, let me expound a bit (or more than a bit) upon what I mean by “central dogma.” Like molecular biology, alternative/complementary/integrative medicine has a central dogma. Also like molecular biology, this dogma doesn’t fit in all situations but is a reasonable rule of thumb to get the basic idea across, after which it becomes easier to discuss exceptions and clarifications. In otherwords, it’s a rough scaffolding upon which we can hang the various beliefs, treatments, and ideas that undergird alternative medicine. I’ll try to boil it down to as simple a sentence as Marshall Niremberg’s statement of the central dogma of molecular biology:

Wishing for healing heals.

Alternatively, it can be stated somewhat more accurately as: You attract health to yourself. Note that this is just like The Secret, only for health.

That’s right. The central dogma of many, if not most (if not all) alternative medical systems seems to be that, if you wish for healing hard enough, your mind/spirit/energy can heal you of almost anything, just as, according to the Law of Attraction from The Secret, you “attract” things to you from the universe according to your thoughts, intents, and desires. Of course, in one way, The Secret is trivial in that there is no doubt that if you want something badly enough you will be more likely to take action to go after it and therefore more likely to get it. However, action based on desire is not what The Secret is about; it’s about thoughts and attitudes. Two such examples in the infamous movie about The Secret include a man worrying about being late for work ending up getting stuck in a traffic jam and a man locking up his bicycle because he is worried about its being stolen, only to return later to find out that it has been stolen. As stated by Rev. Dr. Michael Beckwith, a version of this idea reads, “It has been proven scientifically now that an affirmative thought is hundreds of times more powerful than a negative thought.”

The similarity with much of alt-med should be obvious and embodied in the idea, which I’ve seen so many times on so many alt-med websites, that you – yes, you! – are completely responsible for your own health by your own lifestyle choices. Anyone who’s read this blog (or my other, super not-so-secret blog, or Steve Novella’s blog, or the blogs of any of our other regular contributors) has almost certainly seen discussions of claims that all it takes is living the right way, doing the right things, and you can be not just healthy, but virtually immune to serious diseases up to and including cancer. This sort of concept is inherent in the antivaccine world, in which it is frequently stated that vaccines are unnecessary because healthy people don’t get sick. One famous example of this was Bill Maher stating that he can’t get the flu on an airplane because he lives the right lifestyle and keeps himself free of “toxins.” It’s also inherent in the germ theory denialism so common in alt-med systems such as naturopathy and homeopathy. This denialism most often takes the form of the 21st century embrace by antivaccinationists and alternative medicine mavens of a hypothesis from the 19th century by Antoine Béchamp that it is the “terrain,” not the microbes, that make us sick. Never mind that in the influenza pandemic of 1918 it was the younger people who tended to die at a higher rate and the pandemic got its start in the U.S. in a military barracks. The basic concept is that the terrain is all, and, of course, you control the “terrain” with your thoughts.

As with The Secret, there is a germ of truth in the concept that your thoughts can make you healthy, just not in the way it’s stated or implied by alt-med practitioners. Again, if you have a genuine desire to be healthy, it is more likely that you will exercise, lay off the unhealthy habits such as drinking to excess or smoking, and eat a healthy diet. However, as reasonable people know, it’s a matter of probabilities; diet and a healthy lifestyle are no panacea. Worse, the corollary of the central dogma appears to be that if you are ill it is your fault for not having the right “intent,” attitude, and thoughts and therefore not doing the right things and/or not believing hard enough.

We see strains of this sort of thought in many types of alt-med, from traditional Chinese medicine, to naturopathy, to the quantum flapdoodle promoted today by people like Deepak Chopra, for whom “intent” is all, so much so that he even named his blog “Intent Blog” and has for years been touting a “universal quantum consciousness” that you can influence with your thoughts to bring healing to yourself. The same sorts of ideas are found in other areas, for instance in What the Bleep Do We Know?, a movie that abuses quantum physics to argue that we literally create reality with our thoughts. The implication, of course, is that our thoughts create health or disease, because that is a big part of reality for each and every one of us.

Think I’m exaggerating? Well, then. Let’s go to the articles.

Barrie Cassileth questions the Central Dogma

Barrie Cassileth is a major figure in the “integrative” medicine movement that has been insinuating itself into academic medicine, as befits her position as the chief of the integrative medicine service and current holder of the Laurance S. Rockefeller Chair in Integrative Medicine at one of the greatest cancer centers in the world, Memorial Sloan-Kettering Cancer Center and her having founded the Society for Integrative Oncology, a specialty and society about which I’ve complained about on more than one occasion. It was thus a pleasant surprise when I saw that she had written an article for ONCOLOGY: Perspectives on Best Practices entitled Cancer Quackery: The Persistent Popularity of Useless, Irrational ‘Alternative’ Treatments. Yes, Dr. Cassileth actually uses the word “quackery” in the title and in many parts of the article.

In this article, Cassileth provides a rather standard discussion of bogus cancer treatments that almost could have been written by yours truly, were it not for the complete and utter lack of snark, even the subtle snark that academics sneak into papers. Cassileth does, however, complain that quacks have appropriated the term “complementary” in order to “use it [the term] incorrectly.” This complaint derives from how many cancer quacks don’t actually advocate using their nostrums in addition to conventional therapy but rather in lieu of science-based medicine. Personally, I find this amusing, given that promoters of quackademic medicine have no one to blame but themselves for this development, given the specific modalities they have tried to “integrate” with science-based medicine. It rather reminds me of the “intelligent design” creationists, craving respectability and crowing to high heaven that they aren’t pseudoscientists but real “scientists,” taking umbrage at being lumped together with fundamentalist creationists who believe that the earth was created 6,000 years ago with all animals in their current forms. No, Cassileth seems to be saying, we don’t associate with that riff-raff. They’re fundamentalist loons. We’re scientists!

I’ll give Cassileth some credit for this article, though, and why not? Cassileth lists a fairly standard bunch of quack treatments, the majority of which have been covered on this blog at one time or another, and rips into them. The litany should be familiar: laetrile, shark cartilage, Entelev/Cantron, various oxygen therapies (such as hyperbaric oxygen or various means of administering hydrogen peroxide, “energy therapies,” which Cassileth admits have no evidence to support them. Her article is actually pretty good, by and large, although even though I must concede that I found it a little hard to ignore that she is in charge of overseeing quackademic medicine at one of the greatest cancer centers in the world.

Now here’s the statement that got Cassileth into trouble with her erstwhile allies:

Many alternative approaches to healing are premised on the concept of the mind/body connection, and specifically on the theory that patients can harness the power of their mind to heal their physical ills.[4] Many mind/body techniques, such as meditation and biofeedback, have been shown to reduce stress and promote relaxation, and are effectively and appropriately used as complementary therapies today. However, some proponents of these techniques overpromise, suggesting that emotional stress or other emotional issues can cause diseases like cancer and that correction of these deficiencies through mind-body therapies can effectively treat major illnesses. Such claims are unsupported.

Many of these ideas were promoted by a former Yale surgeon, a popular author who advocated special cancer patient support groups in his books. The importance of a positive attitude was stressed, as was the idea that disease could spring from unmet emotional needs. This belief anguished many cancer patients, who assumed responsibility for getting cancer because of an imperfect emotional status. Among alternative modalities, the mind/body approach has been especially persistent over time, possibly in part because it resonates with the American notion of rugged individualism.[4]

Cassileth is correct that there is no compelling clinical or scientific evidence evidence that these therapies impact the natural history of cancer to produce a survival benefit (I note that Dr. Coyne will be publishing more blog posts to explain in detail why), and I have to give her props for carpet-bombing the quackery that is the German New Medicine (and let’s not forget its bastard offspring, Biologie Totale). These are cancer quackeries that at their heart claim that cancer is a reaction to “unresolved psychological conflicts” and that curing cancer requires resolving these psychological conflicts. In other words, to the German New Medicine, cancer is a disease of the mind, and the “mind-body” connection is the only thing that can “heal” it. In fact, aside from her excessive credulity towards acupuncture, there’s little in Cassileth’s article that would trouble most skeptics and promoters of science-based medicine overmuch. However, her two paragraphs that I cited above apparently did much trouble her fellow travelers in the “integrative medicine” movement promoting quackademic medicine. This is evidenced by the editors’ decision to accompany her article with not just the usual single commentary, but rather with two commentaries, both of which castigated Cassileth primarily for her statement above about mind-body “healing.”

The Central Dogma strikes back

Of the two articles criticizing Cassileth for her heresy, the first is less harsh; so I’ll start with that one. It is by a radiation oncologist and practitioner of “integrative oncology” who was not explicitly mentioned by Cassileth in her article, Brian D. Lawenda, MD. According to his practice’s website, it appears that he happily refers patients to receive all manner of “integrative services,” including acupuncture, reiki, and herbal medicine. (I was relieved not to see homeopathy on his list.) In this video segment (beginning at around 19:30), he is introduced as a “radiation oncologist, integrative oncologist, and medical acupuncturist” and discusses the “anticancer diet.” I hate when that sort of term is touted as being somehow part of “integrative medicine”; all it is (and, to be fair, all Dr. Lawenda says that it is) is a healthy diet along with exercise. It’s science-based medicine, pure and simple, nothing “alternative” or “integrative” about it!

But enough. Let’s take a look at Dr. Lawenda’s editorial, Quackery, Placebos, and Other Thoughts: An Integrative Oncologist’s Perspective, in which, besides touting unproven placebo therapies like acupuncture, he remonstrates with Cassileth over her characterization of “mind-body” medicine:

One area of controversy that comes up often in integrative oncology circles is whether or not there is an association between chronic stress and cancer-specific outcomes. Dr. Cassileth asserts that the association between chronic stress and cancer development, progression, and recurrence has not been definitively established. Those who support this view might categorize as quackery the claim that stress reduction (eg, through lifestyle changes, mind-body therapies, etc) can improve cancer-specific outcomes.

Those who believe that chronic stress and cancer are linked cite data that support this claim. In particular, there are clinical studies [7] that report improvements in cancer-specific outcomes in patients who are taught stress management techniques. Furthermore, researchers continue to identify chronic stress as a causative factor in numerous pathophysiologic processes that are known to be associated with the development, progression, and recurrence of various cancers (eg, stimulation of systemic inflammation and oxidation, impairment of immune function, increases in insulin resistance and weight gain, etc).[8]

Lawenda overstates his case massively. The evidence that improving “attitude” improves cancer-specific survival is of shockingly low quality. Expect to see more posts right here on SBM explaining why. It turns out that there is almost certainly no “there” there, as we say. That’s not to say that psychotherapy and other modalities designed to improve a patient’s mood and mental state are not useful. Certainly, they can improve the quality of life of cancer patients when used in the proper situation. However, there just isn’t any evidence that is even mildly convincing that such modalities improve a patient’s chances of surviving his cancer or decrease the odds of developing cancer in the first place.

I also know that Lawenda also repeats a favorite alt-med trope (“absence of evidence is not evidence of absence”; i.e., the logical fallacy known as an appeal to ignorance) and claims that “many alternative therapies, once believed by conventional medical practitioners to be merely placebos, have now been shown to have proven therapeutic value (eg, acupuncture, numerous botanical extracts, meditation).” Well, no. Acupuncture has not been convincingly shown to have therapeutic value above that of placebo for any condition. It’s also no surprise that botanical extracts might be effective for some things; they are, after all, drugs. Adulterated drugs with lots of impurities whose potency can vary widely from lot to lot, but drugs nonetheless. The appropriation of herbal medicines as “alternative” is in essence the appropriation of the longstanding subspecialty in pharmacology known as pharmacognosy, or the isolation of drugs from natural products. Lawenda even attacks antidepressants based on more recent evidence suggesting that they might not be as effective as previously thought and in some cases might not be better than placebo, an idea ably countered by James Coyne.

In actuality, Lawenda is attacking Dr. Cassileth because she speaks heresy in the world of “integrative” medicine.

Lawenda’s rebuke, however, is nothing compared to what comes next. Remember Cassileth’s dismissal of the findings of a certain “Yale surgeon” who claimed that support groups improved cancer survival? Next up comes that very Yale surgeon! Yes, indeed. It’s Bernie Siegel, and he’s not happy. No, he’s not happy at all, proclaiming that The Key to Reducing Quackery Lies in Healing Patients and Treating Their Experience. I will admit that Siegel probably has a point when he says that better communication could potentially reduce the incidence of cancer patients turning to quackery, but in making even this reasonable point Siegel overstates his case when he says that quackery would “diminish greatly” if doctors would just learn to communicate better. At this point, I can’t help but note that Siegel apparently believes that homeopathy works; so whatever quackery disappeared due to super communications skills of physicians would likely be reborn by those same physicians credulously recommending it. Be that as it may, as we’ve discussed many times before on SBM, there’s a lot more to the appeal of quackery than its being a reaction to doctors who can’t communicate. Much of it almost certainly wouldn’t even come close to disappearing, even if every doctor turned into a super-empathetic Bernie Siegel clone.

Siegel then dives right in, relying on the sheer force of that awesome empathy of his to rip Cassileth a new one for daring to criticize his work, even if she didn’t actually mention him by name:

Our emotions govern our internal chemistry, and hope is therapeutic. We know that laughter enhances survival time in cancer patients, while loneliness has a negative effect. When a Yale graduate student did a study on our support group members and it showed increased survival time for the group’s members, his professor told him that couldn’t be true and made him change the control group so that everything came out equal. Doctors don’t study survival and the power of the mind.

Actually, we know nothing of the sort. Believe it or not, I wish we did know this to be true. Who wouldn’t want to be able to increase his or her chances of surviving by finding a way to overcome depression or negative thoughts. There’s also more than a little bit of of conspiracy mongering in Siegel’s article. In any case doctors and scientists have been studying the “power of the mind” to affect survival for a very long time. What Siegel doesn’t like is that in general they haven’t found that the mind is nearly as powerful at preventing death as Siegel would like to believe. Cassileth was right; there’s a reason for the central dogma of alternative medicine; it’s very appealing to believe that sheer force of will or thinking happy thoughts can heal us of serious diseases. Talk about the ultimate form of “empowerment”! Unfortunately, the flip side of that “empowerment” is the implication that if you are not doing well or, if you are a cancer patient and are deteriorating, it must be because you don’t have a “positive” enough attitude. Barbara Ehrenreich pointed out the toll this sort of thinking takes on actual cancer patients in her book, Bright Sided: How the Relentless Promotion of Positive Thinking Has Ruined America, even going so far as to entitle a chapter Smile or Die: The Bright Side of Cancer.

Sadly, it doesn’t take long for Siegel to go completely off the deep end, stating that the “mind and energy will be therapies of the future,” complete with anecdotes about patients supposedly healing themselves of cancer through the mind. Siegel’s article is full of alt-med tropes and pure woo. Siegel even recommends The Energy Cure: Unraveling the Mystery of Hands-On Healing by William Bengston, The Biology of Belief: Unleashing the Power of Consciousness, Matter & Miracles by Bruce Lipton, and The Psychobiology of Gene Expression by Ernest Rossi. Lipton, as you might know, is a cell biologist who abandoned “conventional” biology after having some sort of mystical revelation about cells that led him to conclude that God must exist and that “holistic” therapies work. I hadn’t heard of the other two, but Siegel describes Bengston thusly:

Bengston cured mice of cancer in a controlled study with the energy conducted through his hands. I was healed of an injury in the same way by healer Olga Worral many years ago. We definitely need to test potential therapies to verify whether or not they are useful, but we also have to keep an open mind to what might be possible, and we must understand that we are treating a patient’s experience and not just a disease.

It turns out that Bengston preaches exactly the sort of quackery that Cassileth quite correctly castigated, namely that energy healing can cure cancer! Elsewhere in his article Siegel says he had chronic Lyme disease and was helped by homeopathic remedies. He even says that he “knows they work” because of his “experience of having the symptoms of the disease alleviated.” It doesn’t get much quackier than energy healing and homeopathy, and Bernie Siegel is promoting them both.

Siegel concludes:

I was a pediatric surgeon and a general surgeon, and I know how powerful my words were to the children—and adults—who believed in me. I had no problem deceiving children into health by labeling vitamin pills as medications to prevent nausea and hair loss, or telling them the alcohol (Drug information on alcohol) sponge would numb their skin (and of course, sharing this with their parents, who helped empower their child’s belief). The mind and attitude are powerful healing forces. The mind and body do communicate, so I work with patients’ dreams and drawings and have diagnosed illnesses from them. I have yet to meet a physician who was told in medical school that Carl Jung correctly diagnosed a brain tumor by interpreting a patient’s dream.

This may not seem related to the subject of quackery, but it is—because it is about how to train doctors so that they know how to provide hope and potential to patients and how to use the mind and placebo effects. Doctors’ “wordswordswords” can become “swordswordswords” and kill or cure patients. I know a man who had cancer and needed cataract surgery so he could enjoy the life that remained to him with restored vision. His health plan denied the surgery because they expected him to die within 6 months and didn’t want to spend the money. He died in a week. The Lockerbie Bomber was released by the Scottish authorities because he was dying of cancer. He went back home to the Middle East and survived for over 3 years— and that is no coincidence.

Note the implication of mind-body dualism (“the mind and body do communicate”), as though the mind were separate from the brain. Now, remember how I discussed some time ago the way the increasing emphasis on placebo medicine among promoters of “integrative medicine,” to the point that “thought leaders” in CAM and “integrative medicine” have been furiously rebranding CAM as “harnessing the power of the placebo” in order to produce “powerful mind-body healing,” as Ted Kaptchuk frequently does. One can’t help but note that even Dr. Cassileth’s department offers a variety of mind-body therapies, along with acupuncture and pure nonsense like reiki. As I’ve said so many times before, the reason integrative medicine fans have taken this position is because they’re finally being forced to accept that high quality evidence shows that most alt-med nostrums rebranded as “CAM” or “integrative medicine” produce nonspecific effects no better than placebo. So these nonspecific effects are cleverly relabeled as the “powerful placebo,” as proponents of “integrating” quackery into real medicine pivot on the proverbial dime and say that’s how their favored therapies worked all along, by firing up placebo effects, which are now rebranded as the manifestation of “mind-body healing”! It also neglects the fact that no placebo has ever been convincingly shown to prolong the life of cancer patients. So much for “mind-body” healing in cancer!

Siegel claims he’s “unleashing the healing power” in each of us, but what he is really doing is advocating a return to the paternalistic, unquestioned, shaman-healer so common in so many societies in pre-scientific times. As Kimball Atwood so aptly put it, it’s pure paternalism, as well, with a dollop of what I like to call “keeping the customer satisfied.” In ancient Egypt, physicians were also priests; both functions were one, which made sense when medicine was so ineffective that praying to the gods for patients to get better was in most cases as good as (or better than) anything ancient physicians could do for them. Also notice how, to Siegel, apparently the end justifies the means. Siegel knowingly deceives patients about vitamins and alcohol sponges because he thinks it’s all for a greater good, really believing that he is such an all-powerful a shaman-healer that his words alone can have a huge effect in curing or killing patients. That’s how he appears to be justifying the deception. He needs to get a clue (and some humility) and realize that, although placebo effects are important confounders in clinical trials, it’s a huge stretch to ascribe such awesome power to their effects. What Siegel is describing is more akin to magic, not science; religion, not medicine. Thinking does not make it so.

Unfortunately, Cassileth doesn’t seem to realize that, at their core, the “unconventional” aspects of the “integrative medicine” that she is promoting are little or no different than what Siegel promotes. In essence, “integrative medicine” is all about “integrating” magical thinking into scientific medicine. Acupuncture, “mind-body” interventions, reiki, and all the various quackademic medicine that has infiltrated medical academia relies on the same ideas, the same magical thinking, that we see on display from Bernie Siegel. Cassileth might think herself so much more rational and “evidence-based” by attacking the most egregrious cancer quackery, but she’s only fooling herself.

The price of the Central Dogma

As is the case with the central dogma of molecular biology, the central dogma of alternative medicine/CAM/integrative medicine does not cover all cases. For instance, the arguments made for herbalism do not invoke the power of the mind or “mind-body” effects. They are basically claimed to be drugs. True, the claims are usually massively overblown and rely on invocations of “synergy” that are difficult to prove and almost certainly do not exist in the vast majority of cases, but they do not require belief or thought. Nearly all the other major modalities of alt-med do, to greater or lesser extent, depend on the central dogma, particularly if you accept that the the transformation of placebo effects into “powerful mind-body healing” is a consequence of the central dogma.

This central dogma has a price, and that price is paid by both medicine and patients. In terms of medicine, the more we “integrate” various forms of woo (a phenomenon I like to refer to as “quackademic medicine”), the more we integrate the Central Dogma into conventional medicine. It’s tempting to repeat Mark Crislip’s immortal quip about “integrative medicine” that “if you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse” (oh, wait, I just did). Indeed, through the influence of people like Ted Kaptchuk and Bernie Siegel, among many others, mind-body research institutes and programs are popping up like so much kudzu between the bricks of what should be bastions of academic medicine, places like the University of Rochester, Johns Hopkins University, Washington University, and the University of Maryland, the last of which oversells the potential benefits of “mind-body” medicine, quoting Hippocrates, who said “The natural healing force within each one of us is the greatest force in getting well.” Of course, this is prescientific vitalism; so one wonders why an ostensibly science-based university would cite vitalistic beliefs to support the Central Dogma. Whatever the reason, the influx of prescientific vitalism, magical beliefs, and New Age woo disguised as “mind-body medicine” can’t help but have a destructive effect on science-based medicine.

It’s also harmful to patients as well. Ironically, it’s harmful psychologically, the very area where the Central Dogma is supposed to help by producing a fitter, happier, more productive immune system. Perhaps the best discussion I’ve found about the negative results that flow from accepting the Central Dogma too strongly comes from a sermon by the Rev. Tom Goldsmith of the First Unitarian Church of Salt Lake City, who invokes Ehrenreich’s book to make a point:

She [Ehrenreich] begins her book with a chapter on the world she confronted after her diagnosis of breast cancer. I was very moved by her words because it reminded me of one of the more challenging times in my ministry following the 1986 publication of surgeon Bernie Siegel’s Love, Medicine, and Miracles. His thesis was that a vigorous immune system can overcome cancer, and emotional health toward greater self-acceptance helps keep immune systems strong. The underlying message which made my ministry so terribly difficult in that time period stated quite simply that our own inability to govern our emotions with a more positive attitude leads to our own demise with cancer. In other words, we bring cancer on ourselves by allowing immune systems to acquiesce to stress, tension, and negativity in our lives.

I had to deal with enormous guilt among cancer patients who believed they brought on their cancer themselves, and also a suspicion among family members that this could have been avoided altogether if only he or she had better control over his or her emotional life.

After telling the story of an assistant pastor who believed in Bernie Siegel and tried very hard to use positive thinking to cure himself of advanced prostate cancer but still died of his disease believing right to the end that he could heal himself, Rev. Goldsmith points the harm such thinking can cause, recounting how Ehrenreich described feeling a “sense of drowning in all the positive thinking and cheeriness of support groups” and pointing out that her lament was “really about positive thinking distorting reality.” And so it was, as is much of “integrative medicine” itself.

No one, least of all I, would argue that positive thinking and wishing for something are necessarily inherently bad things. After all, the path to doing begins with thinking. However, taken as far as someone like Bernie Siegel takes it, the central dogma has a price, and that price is sick people blaming themselves for their disease and, even worse, blaming themselves for not getting better. Sometimes there might be some truth to such beliefs (for instance, when a longtime smoker develops lung cancer), but what is the value of hitting the patient over the head with it? What’s done is done, and pretty much every lung cancer patient stops smoking soon after diagnosis. Dwelling on the self-inflicted cause of a disease doesn’t help the patient beat it. It promotes unrealistic thinking, magical thinking even, and guilt. This might be justifiable if the case for arguing that the mind could heal the body were as strong as it’s claimed, but unfortunately the case for linking emotional health and attitudes with cancer outcomes is very, very weak. Finally, although the “power of positive” thinking might in some cases help a patient improve his quality of life, expecting it to heal serious diseases is expecting too much and “integrating” the central dogma into science-based medicine, more than anything else, contaminates it with magical thinking.

Posted in: Cancer, Neuroscience/Mental Health, Science and Medicine

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73 thoughts on “The “central dogma” of alternative/complementary/integrative medicine

  1. mousethatroared says:

    Excellent article. Initially I was not convinced that “wishing makes is so” could be the central dogma of alternative medicine, but you do make a very persuasive argument. The whole mind/body thing does seem integral to much of alternative medicine.

    Setting aside herbal remedies helps, but I wonder how all the special diets come into play with “wishing makes it so” dogma. It seems there are so many special diets with prominately exaggerated health claims, there’s the anti-inflammatory diet, paleo, grain free, detox, etc.

    Are they part of the central dogma or are they set asides as well?

    As an aside, The SBM stand against quacks versus Dr. Cassileth’s approach of complementary medicine reminds me of discussions I’ve heard from parents on their approach to controlling alcohol or pot use with their teens. Some think strictly forbidding substances is best. Others think that teens experimenting with alcohol or pot is inevitiable. They conclude it’s best to allow teens to drink or smoke pot in their homes because then the kids will be in a safe environment, not driving, etc.

    Don’t mean to over simplify, but the similarity struck me.

  2. Jan Willem Nienhuys says:

    Very good! But is this Central Dogma not also the center of all religion? Magic also works like that: focussing the mind plus the proper rituals is what makes spells work. Supposedly. As a matter of fact lots of this altmed is just religion. Many people don’t see it thus, because they think a religion has to resemble one of the major religions. But altmed offers salvation by invocation of various invisible things like qi or meridians or the power of potentized poppycock. They have holy books (the Organon of Medicien, or the Huangdi Nei Ching), gurus and rituals in combination with strong advices about good living witrh the right attitude. And they are trying to make converts and they split up in sects. If you don’t agree with them, they don’t bring out the hellfire and the stake, but they become pretty vituperative. Instead of a underground abode where devils dwell in an atmosphere of molten sulphur and hydrogen sulphide, they have Big Pharma and the Medical Establishment.

    Major religions are sprouting under our nose (ufomism is another one) and we don’t see it because it doesn’t conform to the classical religions (in which miraculous healing is also an important motif).

  3. Eugenie Mielczarek says:

    Studying all NCCAM grants from 2000 -2011 Brian Engler and I found six hundred funding awards totaling $157 million which had mind -body protocols as a healing focus. Unfortunately our Affordable Health Care in its present legislative form will cover services from the mind -body centers of the hospitals mentioned in the blog.
    Sad results of legislative ignorance of science.

  4. Earthman says:

    “…a vigorous immune system can overcome cancer….”

    I am not a doctor, or in the medical field at all, yet it seems to me that the immune system cannot be effective against cancer, as cancer tumours are ‘self’ and the immune system works against foreign invaders. Please correct me if I am wrong.

  5. Jan Willem Nienhuys says:

    cancer tumours are ‘self’ and the immune system works against foreign invaders

    neither of the two are entirely correct. There are various instances when body turns against itself. Look for autoimmune diseases.
    Wikipedia lists many. Cancer is a disease where the DNA goes awry. The latter is not a one step process, but a multistep process, probably helped by the destruction of various repair mechanisms and also of the ‘emergency brake’ apoptosis – programmed cell death when there are serious errors. Cancer cells often contain hundreds of mutations. Some of these mutations may change the way cells make themselves known as ‘self’. Some therapies (still experimental, as far as I know) can ‘train’ a part of the immune system (the dendritic cells) to recognize cancer cells, but this works only for certain types of cancer.

    Of course it is possible that some of these mutations that change the expression of ‘self’, occur early in a cancer process, and then the cancer is destroyed by the immune system before we even know it was there. I guess.

    Mark Crislip has explained on this blog

    http://www.sciencebasedmedicine.org/index.php/boost-your-immune-system/

    that ‘boosting the immune system’ is a vacuous notion. The only reliable boosting of the immune system known to medical
    science is vaccination.

    From Crislip’s article and the exposition on autoimmune diseases I guess that a very vigorous immune system means
    - a higher chance of strokes, heart attacks and pulmonary embolisms
    - a higher chance of diabetes I, rheumatoid arthritis, lupus erythematosus, psoriasis, pernicous anemia and many many more.

    As a chronic inflammatory state (caused by a locally active immune system) is believed to contribute to excess mutations and hence
    increase the chance of getting cancer (that is presumably how asbestos fibers cause mesothelioma, and how ulcers develop into stomach cancer and hepatitis C into liver cancer) a vigorous immune system is not at all beneficial with respect to cancer.

    Please correct me if I am wrong.

  6. Blobulon says:

    Alt med is the religious practice of post-modernist new age spiritual thought. The central premise being mind-body dualism, and quantum woo. It really is like ‘the Force’ from Star Wars, but without the light sabers and midichlorians.

    If you understand that their central point of view is that we are ‘spiritual’ beings who are connected to the universe by a benevolent powerful conscious energy (which is all anything ‘really’ is, to them), and that thoughts are powerful to affect change in your body and your environment, then their actions seem less baffling.
    Still very silly, and completely out of touch with reality, but somewhat understandable. As understandable as a Christian scientist praying over their dying diabetic child instead of taking her to hospital. Gross to us, but we understand their ‘reasoning’, ie. God is all powerful and will heal my child.

    There is also a bit of conspiracy theory thrown into the mix with the Big Pharma, conventional farming using chemicals, evil reductionist western medicine et al tropes we all know and love. It is very appealing to them to think they have seen the truth about these ‘evils’ and are living the enlightened, pure way.

    The truly gross thing, to me, is that thinking like this keeps one from ever being happy with oneself. You must always be taking something or getting a treatment to maintain health and prevent illness.
    This is not just someone deciding to stop smoking and start some gentle exercise and eat more veges. This is someone who goes to the chiropractor once a week, naturopath once a month, takes a bunch of vitamins and herbal supplements, has homeopathic sleep aids and stress reducers and immune boosters, and also pays someone to ‘send’ reiki to them remotely.
    What do they think would happen to them if they stopped all this at once? How sick or fragile do they think they are if they need all this just to be normal?
    That and the implied victim blaming when someone actually is ill, that they unintentionally brought the disease on themselves because they had negative thoughts, or an energy blockage, or repressed emotions, or even unresolved past life issues; that is revolting to me.

    Why this religion is presented as a valid option to actual medicine is because very few people recognize it as a religion. It is the religion of post modernist anti-science with a whole lot of arrogance masquerading as humility.

    We are beyond the thin edge of the wedge. They have infiltrated our hospitals and universities and our governing bodies with their woo. And it is because very few people recognize the tremendously faith based underpinnings.

    The public knows bugger all about the scientific method, prior plausibility, and confirmation bias.
    I was in the medical field for years before I truly knew about them.
    I even thought integrative medicine was about a more multidisciplinary approach – having input from MD, RN, RD, PT, etc. I did no know it meant alt med.

    I’m so very glad there are people like Dr Gorski and the SBM team. If I can get out of the woo, anyone can.

  7. evilrobotxoxo says:

    There’s a classic experiment where there were two groups of rats in cages. I don’t remember the exact details, but basically they were exposed to light flashes followed by electric shocks. In one group, the light flash was followed by a shock 50% of the time, no matter what the rats did. In the other group, the light flash led to a shock 100% of the time, unless the rat pushed a lever, in which case it was shocked 50% of the time. Since the rats quickly learned to press the lever every time, both groups of rats got exactly the same number of light flashes and shocks. However, the rats without levers had a massive stress response, but the rats with levers did not because they were able to maintain the illusion of control over their environment.

    I agree with Dr. Gorski’s assessment of the central dogma of alt med, and I would take it a step further and argue that the psychological need for control over one’s environment is the primary driver of magical thinking in all of its forms. At least in non-psychotic people.

  8. mousethatroared says:

    @JWN – regarding immune system boosting – Apparently alternative medicine marketing has figured out the flaws of claiming to boost the immune systems, seems like most of the claims I see these days “regulate”, “balance” or make the immune system “smarter”.

    Personally, I would love a smarter immune system…just think if someone had figured that out there’d be a heck of a lot more folks with auto-immune disorders dancing in the streets.

  9. Alia says:

    Just a small side note, as this one sentence caught my attention: “pretty much every lung cancer patient stops smoking soon after diagnosis”. Well, if it only were so. My mother used to work as a nurse on a pulmonology ward. They had the usual tuberculosis, pneumona and asthma patients, but the majority were cancer patients. And she told us about patients after lung cancer surgery, who would drag their drips and hide in toilets to smoke. In addition, while my mother never smoked, many of surgeons did, so they would finish cancer surgery and then go out of the hospital to smoke. One of her colleagues even died of lung cancer himself. The power of addiction.

  10. Jan Willem Nienhuys says:

    The central premise being mind-body dualism

    That’s a philosophical idea of the thoroughly western mathematician Descartes. I write mathematician, because pretty much of what he thought up outside of mathematics was rubbish, more in particular that the world is made of bigger and smaller pieces of space (because space is all there is) and that the motions of the planets are due to vortices caused by the sun.

  11. Janet Camp says:

    I enjoyed the comments a great deal today and found them very “complementary” to the post.

    The relationship of sCAM (I like to include Dr. Crislip’s ’S’–for supplements–as this is a huge moneymaker part of alt med and one that has wheedled its way through the system to gain even more credence with larger numbers of people than most of the other dubious practices.) to religion in general is the crux of the problem. In a country that so values “freedom” of religion (the quotes because the word has become so contorted in popular political use), it is difficult to combat anything based strictly in belief. Add a dose of post-modernism and you have the current mess.

    The difficulty in reaching many victims of sCAM is to try to get them to give up their health/medial “beliefs” without insulting their religion–and many of them are very committed to “spirituality” even if they don’t do organized religion anymore. It seems a bit disingenuous to point out the irrationality of sCAM treatments, but draw the line at mocking their faith in prayer. Some of my saner sCAM acquaintances (at least the churchgoing ones) are able to rationalize through this with the idea that, “God gave doctor’s a gift and we should use that gift”, hence they avoid the “evil allopathy/pharma” trap.

  12. fledarmus1 says:

    @evilrobotxoxo – an interesting experiment indeed. Were there any cases in which the rats that were only shocked 50% of the time learned to pull the lever anyway, and thought that the reason they got shocked was that they didn’t pull the lever properly?

  13. Zetetic says:

    Yes… Alt med as a religion.

    For quite a while, I’ve surfed in and out to irritate the regulars on a number of alt/nat med forums. I often bring up the religious cult like aspects of alt med and I sometimes get the retort that science is a religion too because it only “believes” in the dogma of the scientific method!

  14. Galadriel says:

    The flip side of “wishing makes it so” is that if you didn’t get your wish, you weren’t wishing hard enough. This is the loophole that can be exploited by just about any alternative medicine practitioner: “Your belief wasn’t solid, so the treatment was ineffective.” Basically, “You did it wrong” even if you did it exactly as they said to do. (Sometimes there’s “you didn’t sacrifice enough for your belief to have been worthy” although that’s usually implied more than outright stated, unless you’re talking to a faith healer.) This is clearly bunk.

    Alternative medicine relies on you believing in it enough to wait until you get better on your own, then lay the credit at the practitioner’s feet. Sure. And if you don’t get better, then the alternative practitioner can just say that you didn’t do it right.

    …This unfortunately has flavored my view of modern medicine, as well. If I’m told that I didn’t improve because *I* didn’t do it right, then I begin to suspect that my doctor/psychologist/physical therapist/etc is a quack. I’m not really sure how to deal with this issue, because I follow the medical practitioners’ orders to the letter, and I continue to get better and worse[1] with no discernible pattern[2]. Sometimes doctors take credit for me being better /at the moment I am in their office/ even though it is clearly fluctuating over time, sometimes they blame me for getting worse, and no one can put a finger on exactly why the fluctuation happens.

    I *know* doctors are working with the best information that they have. I know they’re generally just trying to help and trying to stay optimistic in view of a difficult case. But mimicking the behavior of quacks does absolutely nothing for the appearance of validity of the profession. How does one maintain the courage to keep going back to doctors, when doctors seem to feel like if you’re getting worse, it must somehow be your fault? This is magical thinking at work from licensed medical doctors!

    Please, advocates of science based medicine, find some way to educate the everyday medical practitioners about what they are doing with this kind of attitude. Please help them understand that when they suggest that getting worse is entirely the patient’s fault–with no evidence of noncompliance–that they look like quacks. Please help them understand that when they insist that the patient getting worse is absolutely-for-sure-never-ever related to any potential flaw in the treatment (or even inability to treat with the current state of medicine), that they look like quacks. Please, please help them understand that jumping on any miniscule squiggle of improvement and saying, “Aha, see, the treatment is working!” *really* looks like serious quackery. “If you do it RIGHT, you’ll get better!” “If you get worse, you must not be doing it right.”

    If your general practitioner or specialist demonstrates this kind of magical thinking, why *wouldn’t* patients believe that alternative medicine practitioners might have something to offer, too? Why *not* believe Dr. Oz’s loony claims? Why *not* pick up one of those pamphlets somebody left in your doctor’s waiting room about acupuncture or TCM? Why not follow the various latest health fads, each one assuring you that if you do it RIGHT you’ll prevent all disease? I know I see a lot more doctors than most people do, but if I see it almost everywhere I go, then I know my friends and family see it too, even if they see it less often.

    And then SBM advocates wonder what would make otherwise intelligent and well-informed people try alternative medicine.

    ~~~
    [1] Chronic pain due to way too many injuries is my primary issue; I’ve pursued all the paths my doctors have suggested, therefore I have seen a LOT of medical professionals in a LOT of fields. But there are a lot of conditions that gradually degenerate over time while fluctuating as they progress. I’m hardly unique.

    [2] I keep a journal of symptoms and anything that might possibly be related. Would be nice if someone could spot a pattern or a cause.

  15. evilrobotxoxo says:

    @fledarmus1: I’d have to look back and find the original study (which I’ve forgotten the details of), but I think only the lever-pressing rats had a lever in their cage, and the other group didn’t have a lever at all. I’m not 100% sure, though.

  16. Jan Willem Nienhuys says:

    learned to pull the lever anyway,

    experiments with pigeons made them superstitious. The pigeons got random rewards (from Skinner) and then soon started repeating whatever they were doing when they got the rewar (a food pellet).
    Similar experiments have been done with children and with students. The children got a marble and the students some kind of points they needed to obtain. The subjects were led to believe that they had to do something special to make the reward come. They didn’t know that the ‘something special’ was: wait a certain number of seconds. Both the children and the students developed extraordinary behavior. One student thought that jumping up an touching the ceiling did the trick. After half an hour she was totally exhausted.

    Now the rats. Not getting a shock is of course also a kind of reward, so the superstitious behavior of ‘pressing the lever’ might develop
    in some rats. So it may not be very strange that at least some rats learned to press the lever.

  17. Jan Willem Nienhuys says:

    science is a religion too because it only “believes” in the dogma of the scientific method!

    That is of course stretching the word believe. Belief usually means that there is no evidence. Anyone who uses any of the modern
    products, anything that is made by machines, or uses electricity, is experiencing proof that science works.

    Moreover, the scientific method is a bunch of tricks to avoid very many errors of human judgement. Using it implicitly means that one recognizes the fallibility of human knowledge, and the necessity of checking one’s ideas with reality as thoroughly as possible (I skip the point that ideas may not contain internal contradictions or crummy math).
    Basically the insight that we all make mistakes all the time if we aren’t properly checked is also based on evidence not on belief. Only the very dumb think they don’t make mistakes and that their intuition is always right.

    Oner wonders: do the people that pontificate on the dogmatic nature of ‘the scientific method’ have any idea what this method actually is?

  18. science is a religion too because it only “believes” in the dogma of the scientific method!

    Of course, this is completely false. As Jan said, belief is accepting something without any logical reason for doing so. This is what makes religious beliefs so “beautiful” (please look past my sarcasm for the message) – that someone has a belief in a god, when there is no fundamental reason to maintain such a belief. They believe it despite the complete lack of evidence. If there were any sort of legitimate proof that a god existed, then religious beliefs would be worthless. If we could test for and prove the existence of a god, then religious beliefs would be no more interesting that noting that your desk is white, or that grass is green.

    Science is the exact opposite. I don’t “believe” in science, just like I don’t “believe” my desk is white, or grass is green. I don’t “believe” in science, because the things that I accept are based (more or less) on sound reasoning and evidence. It’s simply not the same thing. To liken the state of science to the question of whether or not a god exists is purely ignorant.

  19. William M. London says:

    Methinks you have described a common theme in the dogmatic rhetoric of promoters of the pseudo-field of alternative/complementary/integrative medicine, rather than THE central dogma. There are several other common dogmatic themes offered by this pseudo-field, as noted in the SBM archives.

    1. Harriet Hall says:

      Another dogma candidate: testimonial evidence and speculation are sufficient.

  20. David Gorski says:

    @Harriet

    I wouldn’t call that a “dogma.” Rather, it’s a manifestation of the faith-based nature of CAM/IM/alt-med. How does one “convert” others in religion? By “testifying”; i.e., through “testimonials.” I would therefore argue that the acceptance of testimonials as evidence dovetails quite nicely with my thesis.

    @William London

    I don’t argue that there aren’t other dogmas underlying alt-med. I do argue that none of them permeates so much of alt-med as pervasively as my proposed central dogma does. That’s why I dubbed it the “central dogma.” And I want credit for it too, having been unable to take credit for coining the term “quackademic medicine. :-)

  21. Alia says:

    @Galadriel
    While I mostly agree with you, there is one point where I disagree and this is psychological therapy. The thing is, in psychotherapy you really have to do most of the work yourself. The therapist is there to show you what your problem is, explain some of your pathological mechanisms that you use to cope with your problems and guide you on your way to change. But they cannot do the work for you. And yes, I’ve been in therapy, so I know it firsthand.
    Of course, if you also go to a psychiatrist and get a prescription, then take your prescribed drugs regularly and nothing changes, it’s different.

  22. mousethatroared says:

    @Galadriel – Great point, as a patient, it has also occurred to me that there are habits and attitudes that seem pervasive in conventional medicine that seem more related to CAM philosophies than SBM. That these CM habits and attitudes train patients to accept CAM more readily…because if their doctor does it, it must be okay.

    I haven’t experiences the ‘you must be doing it wrong’ approach. I haven’t dealt with that sort of chronic condition. One thing I have noticed is the ‘try this and see if it works as diagnostic’ approach. Since my symptoms also wax and wane, trial and error began to seem rather pointless. And it was hard to argue with friends who suggest I try a new diet or supplement…to see if it works, when my doctors weren’t doing much different.

    From anecdotes of friends and associates, I also suspect that conventional doctors emphasis the role of stress more in health than is supported by science. Once again we have that easy transition into CAM philosophies.

    I sometime wish that SBM would focus more often on these “gateway” habits in conventional medicine or on pushing conventional medicine more in the science based direction.

  23. mousethatroared says:

    @Alia – It’s true that in cognitive therapies the patient does the work and but it is the therapist’s job to give the patient effective therapies that they are capable of implementing. If the patient is trying to participate in therapies and it is not working, then I would suggest that it’s likely the therapist is making incorrect recommendations.

    I will give you an example from my history, sorry if it is TMI. I initially worked with a therapist years ago. Diagnoses social anxiety and dysthymia. Medication was very helpful although I experience quite a few side effects, but I found the automatic thought exercises the therapist recommended somewhat ineffective. Once I went off medication (due to side effect) I found the exercises really ineffective, but I had experience a lull in my symptoms, so no need to pursue.

    Years later, with a symptom flare, I went to another therapist. When he recommended the same exercises, I exclaimed “I can’t do those!” Luckily, he did not say ‘You’re doing it wrong.’ With some discussion, we found that my main discomfort is related to ruminating. The automatic thought correction exercises reinforced the ruminating rather than diminishing it. The therapist then recommended a four step cognitive approach used with OCD. This was much more helpful, as are other therapies related to OCD treatment. Kinda strange since if you met me there is no way you’d relate me to typical OCD behaviors, but oh well, brains are funny.

    Based on this experience, it seems to me if the patient is actively trying to implement the therapy and they are willing to take medication, if needed, and the patient is not getting the expected benefit, then the therapy or medication is not correct.

  24. Jan Willem Nienhuys says:

    How does one “convert” others in religion? By “testifying”; i.e., through “testimonials.”

    Civilisation has advanced, it seems. It used to be that converts were made with the sword. Charlemagne did that, Islam (about the same time) did that and many religious wars have been fought as recent as four centuries ago. In some parts of the world this is not considered the correct method anymore. In other parts of the world acts that are considered blasphemous carry the death penalty and even suggesting that this death penalty is not civilised can result in being assassinated.

    So CAM is not only a religion, it is even a civilised religion, because CAM believers don’t kill people who disagree with them.

  25. David Gorski says:

    They do, however, harass them and try to get them fired from their jobs.

  26. evilrobotxoxo says:

    someone has a belief in a god, when there is no fundamental reason to maintain such a belief

    @skepticalhealth: they do have a fundamental reason to maintain their belief; it’s just an emotional reason, rather than a rational reason. That was what I was trying to get at with the example of the rat experiment. The saying “there are no atheists in foxholes” has a grain of truth to it. I think Gorski’s law (which is what I’m going to start calling his “central dogma”) is a good example of this same phenomenon.

  27. DugganSC says:

    Honestly, I think that one of the fundamental problems with this whole dismissing faith thing is that science based medicine looks no different from the outside for laypersons. Seriously, contrast someone being told by their high muckety-muck that his mystical formula will appease the gods and thereby cure the illness with the doctor who states that this particular drug excites protein antagonists to adjust the level of serotonin to more viable levels (yes, that latter is probably nonsense). In both cases, most people have little hope of knowing if the authority in question is indeed correct or if they’re talking out of their ass. Ultimately, to borrow the line from Twelve Step programs, they have to “put their lives in the hands of a higher power” either way. You could argue that every patient has the ability to go out and learn the science involved, but a) that takes serious amounts of time, and frequently still hits that wall where at some point they have to take assumptions on faith and b) frankly, not everyone is up to understanding the intricacies of biology.

    Me, I’m a strong believer in scientific medicine, but I feel like we’re back to blaming the patient for not trying hard enough because they’re unwilling to spend a few years getting a degree in medicine so that they know what’s medical and what’s quack science.

  28. Alia says:

    @mousethatroared
    I agree with you in that not all therapeutic approaches work for all people and you sometimes need to look for another therapist or another approach. But I know some people (and I certainly do not imply it’s you or Galadriel) who go to a therapist and expect that it will be just like with an ordinary doctor – you tell what’s wrong with you, they give you a prescription and lo! everything is back to normal. And then they get out of therapy after two or three sessions because “It’s not working!”

  29. mousethatroared says:

    @Alia – sure that’s true, but Galadriel was pretty specific in talking about a compliant patient.

  30. Jan Willem Nienhuys says:

    science based medicine looks no different from the outside for laypersons

    Gorski based his analysis not on the views of the lay persons, but on the views of ‘experts’ with enough knowledge about how science works.

    Incidentally, in the Netherlands author Karin Spain (MS-patient herself) wrote a book in 1992 in which she introduced (in already in the subtitle) the term ‘orenmaffia’ (ears mob) for the collective of authors that maintain that sickness and healing all happen between the ears. She specifically mentioned Louise Hay (You Can Heal Your Life, 1984, and many more of this kind of books), Thorwald Dethlefsen (The healing power of illness, German original 1983) and Bernie Siegel and others.

    These ears mobsters make disease into punishment for the sin of not living acording to the guru’s precepts and into translations of psychological conflicts: bladder problems = psychological pressure; throat problems = swallowed anger + the idea of not having the right to speak up; syphilis = made too many impulsive choices; diabetes = lack of love / not being able to take responsibility / strong desire to control everything – take your pick; vomiting = non-acceptance. I kid you not. Naturally the cure for all these ailments is that the mind should be attuned to the guru’s views of how to behave.

    Being seriously ill is unpleasant enough. People trying to tell you it’s a kind of punishment for a sin, that you are basically guilty of being sick, makes it worse.

    This is one more aspect of some kinds of ‘religion’: the great role of sin (= transgression of rules set by Supreme Being) and the idea that recognition of guilt opens the way to Salvation by subjugation to the will of the SB.

    The word ‘orenmaffia’ quickly become a household word in the Netherlands and even made it into an authoritive dictionary.

  31. David Gorski says:

    Too bad “ears mob” doesn’t quite have the same ring as an English translation. It’s a great term for getting the concept across. Perhaps we can think of a term that works better in English.

  32. mousethatroared says:

    kinda gotta keep the mafia bit though.

  33. Alia says:

    My father used to claim that all my ailments (and there weren’t that many) were my fault. Like – got the flu? That’s because you went to that concert yesterday and it was so cold. UTI? You sat on a cold stone, etc., etc., etc. Well, I hated that – which is perhaps now I’m immune (pun intended) to “orenmaffia”.

  34. mousethatroared says:

    Alia “My father used to claim that all my ailments (and there weren’t that many) were my fault. Like – got the flu? That’s because you went to that concert yesterday and it was so cold. UTI?”

    LOL – recently I was at a party where an uncle claimed my cousin was always getting sick because he was a hypochondriac. This is the cousin who needed a hip replacement in his thirties due to an unexplained nephritis of the joint and recently had a rather severe MRSA infection… I genuinely couldn’t figure out if my uncle thought my cousin was imagining his ailments or if he thought that they would just go away if my cousin didn’t pay so much attention to them (the stray dog approach to health).

    I took that opportunity to thank my lucky stars that he wasn’t my father and open another beer.

  35. pmoran says:

    If it is said often enough and left unchallenged present sentiments could become part of SBM dogma (in every sense of the word) but through familiarity, and the authority of the speaker(s), rather than any close correspondence to reality. I think DugganSC has a valid point.

    David is quite right that much CAM use involves wishful thinking — or long-odds gambling, depending how you look at it. Some of its authors, such as Seigel, DO have grossly unrealistic expectations of mind-body medicine.

    It is also true that very many of those resorting to CAM for serious illnesses such as cancer will employ mind-body practices. However this is typically as part of a portfolio of methods that includes diet, supplements, “immune boosters” and a variety of other dubious pharmacological or herbal agents that are claimed to help in quite conventional therapeutic ways. Try and find me a “believer” in mind-body approaches who is not also hedging their bets with at least half a dozen other healing agencies.

    It can therefore at least equally be argued that CAM is as eclectic as the mainstream in both theory and practice. Its patent reluctance to reject ANY medical claim out of hand (including those of mind-body extremists) makes it so.

  36. agitato says:

    I think DugganSC has a valid point too. Since many people genuinely find it difficult to distinguish between science-based medical experts and CAM experts, measures could be taken to make it easier. First, stop calling CAM medicine. Call it Complimentary and Alternative Care OR Integrative Care or whatever. Just not medicine. Then move all those who adhere to this belief system to the Pastoral Care department in a hospital where it clearly belongs. At universities, I’m not sure where it belongs…Religious Studies? Physics? (all that energy stuff…I’m joking…I’m joking!) Just far far away from Schools of Medicine and Departments of Health Sciences.

  37. Chris says:

    Dr. Gorski:

    Too bad “ears mob” doesn’t quite have the same ring as an English translation.

    All I can think of are variations of “ear worm.” Of course that leads to “ear parasite” and “brain jelly.” Okay, there may have been steps in between, but it is bed time. Be imaginative.

  38. Chris says:

    This part was not supposed to be in the secondary blockquote (which had an extra letter, can we please have preview?):

    All I can think of are variations of “ear worm.” Of course that leads to “ear parasite” and “brain jelly.” Okay, there may have been steps in between, but it is bed time. Be imaginative.

  39. Jan Willem Nienhuys says:

    I guess that ‘between the ears’ in English doesn’t have the strong connotation of ‘imaginary / purely psychological / entirely subjective’ with a negative ring to it, like in ‘she isn’t really sick, it’s all between the ears’

    But what about

    psycho mafia? (psychic mafia is already taken, but psycho does have a negative feeling to it,. doesn’t it?)

    mind mafia?

  40. BillyJoe says:

    Michelle,

    ” unexplained nephritis of the joint”

    Did you mean unexplainable :D

  41. “nephritis of the joint”, ahh, the elusive nephropathy of the knee. This is a rare condition in which the kidneys fail to migrate to the retroperitoneum during embryogensis and instead migrate down the femurs and settle in the synovial joints of the knee, just behind the ACL. It’s a painful and odd condition, because you end up with excessive amounts of urine in your knees. Fortunately, there is a quick and easy fix, 3 spinal adjustments per week by a qualified and skilled chiropractor can help your kidneys move back up into your abdomen where they belong. If you have feelings of tiredness or weight gain, this is likely the reason and you should consult with your local chiropractor. Other less evidence-based treatment options include Arnica at 10^300 dilution or treatment with alternative red and green lights over a six week period.

    :)

  42. Ok, that leads to this question:

    What is the most ridiculous fake disease that you’ve ever seen a CAM practitioner diagnose someone with?

  43. mousethatroared says:

    oh jeez, one the only times I use a technical medical term without thougoughly looking it up and of COURSE I get it wrong.

    necrosis, NOT nephritis okay? Avascular Necrosis.

    See I looked it up – http://www.mayoclinic.com/health/avascular-necrosis/DS00650

    You guys are merciless, (although “painful and odd condition, because you end up with excessive amounts of urine in your knees”, is pretty funny)

  44. mousethatroared says:

    I keep thinking “sunshine mafia” a take off from the title of the book “Brightsided”, and the focus on thinking positive. But maybe that ignores other aspects of the “wishing makes it so” groups.

  45. David Gorski says:

    If it is said often enough and left unchallenged present sentiments could become part of SBM dogma (in every sense of the word) but through familiarity, and the authority of the speaker(s), rather than any close correspondence to reality. I think DugganSC has a valid point.

    [...]

    Its patent reluctance to reject ANY medical claim out of hand (including those of mind-body extremists) makes it so.

    Obviously my “authority” is slipping (or was nonexistent in the first place), because I see no reluctance by you or anyone else to criticize me, sometimes harshly, and, after all, compared to an “authority” like Dr. Oz, we here on SBM are homeopathically diluted in our impact. As always, show me the evidence, and if it’s compelling enough I’ll start to rethink my position. Certainly you haven’t succeeded in that; your complaints, as always, boil down to “tone” and appeals to be so open-minded that my brains fall out.

    In any case, please point out where I have “rejected a medical claim out of hand.” I have simply pointed out that there is no convincing evidence to support the mind-body claims being made, and that is not only a defensible position, but a highly defensible position, as you will see as Dr. Coyne posts on the topic appear. I also pointed out how echoes of the “central dogma” are obvious in how these “mind-body” practices are being described.

  46. mousethatroared says:

    @ David Gorski – I probably shouldn’t get in between you two, but when pmoran said

    “It can therefore at least equally be argued that CAM is as eclectic as the mainstream in both theory and practice. Its patent reluctance to reject ANY medical claim out of hand (including those of mind-body extremists) makes it so.”

    I don’t think it was meant as a criticism of SBM rejecting some therapies. He merely seemed to be saying that since CAM seems to accept any medical claim, no matter how implausible, it’s unlikely that one will be able to find a true commonality or guiding principle to all of CAM.

    @pmoran – please correct me if I’m wrong. I did struggle with what you were saying in this statement a bit.

  47. Alia says:

    Funny enough, just this week there appeared on one of my favourite forums a post about miraculous cancer cure capsaicin (together with a recipe on how to make capsaicin extract with Budwig oil). Then it evolved into a discussion on cancer in general, alt-med and, yes, mind-body practices. So I turned onto SBM, searched for appropriate material and started debunking. I think it worked quite well and if some users put me on their “ignored” list, that’s their problem, not mine. I won’t link – it’s a registered user-only forum and not in English, anyway.

  48. David Gorski says:

    I don’t think it was meant as a criticism of SBM rejecting some therapies. He merely seemed to be saying that since CAM seems to accept any medical claim, no matter how implausible, it’s unlikely that one will be able to find a true commonality or guiding principle to all of CAM.

    Except that I think I made a compelling argument that in the case of CAM you can. Certainly Peter hasn’t shown it to be so flawed that it’s obviously incorrect. :-)

    It’s possible I misinterpreted, and I ask forgiveness if that’s true. However, Peter really didn’t express himself very clearly, and as a result I think my interpretation of what he said is probably equally valid to yours, in this one case anyway.

  49. mousethatroared says:

    You DO make a compelling argument.

    But to me there is also that aspect of CAM that reminds me of my Grandma’s house…can’t throw anything out because, you know, it might be useful someday (can of hardened paint) THAT seems to defy the idea of any central dogma or theme. Sure, you can see a pattern in the chaos, but is it really there?

    Then there is also the “anything that sells” side that will refuse to comply to any central dogma that might get in the way of their profit margin.

    But, pmoran’s comment is vague, maybe I am reading my own ideas into it.

    Maybe he will clarify.

  50. mousethatroared says:

    correction (LIKE THAT can of hardened paint)

    Kinda going off an E.E. Cummings deep end, there.

  51. pmoran says:

    “It can therefore at least equally be argued that CAM is as eclectic as the mainstream in both theory and practice. Its patent reluctance to reject ANY medical claim out of hand (including those of mind-body extremists) makes it so.

    Hands up those who think this statement of mine accuses Dr Gorski of having “rejected a medical claim out of hand.” I need to know — are my powers of expression as bad as I am being told?

    David, I do think you are taking an extreme and relatively rare version of mind-body theory and trying to make it apply to the whole of CAM.

    If your generalization is as inaccurate as I believe, it will have a great many people reacting just as we doctors do when we are described as being hide-bound by germ theory, or entirely in the thrall of drug companies and their shenanigans — that is, with great annoyance, a deep sense of injustice, and reduced respect for the claimant.

    Why make communication more difficult than it already is?

    But the very worst thing about most of SBM’s attempts to characterise CAM in terms that conveniently “explain it away” is that they tend to trivialise the unresolved medical misery, desperation and last-ditch struggles that drive a great many people into trying out “alternative” methods.

    I deeply admire what my profession has achieved in the last century or so, but from the perspective of individual patients we have to accept that many desperate and suffering people will want to try out dubious methods without necessarily having any strong scientific or philosophical commitment to them.

    CAM would survive without a central dogma.

  52. mousethatroared says:

    Oh, does that mean I was right? Cause I’m not right very often. I want to mark it on my calender, if I am.

  53. pmoran says:

    MTR, you were the first of several who expressed reservations about this post’s approach. You also did read me correctly.

  54. Harriet Hall says:

    @pmoran,

    You are a broken record. We understand what you think we are doing wrong, but we are still waiting for you to provide a guest post or a concrete example of how you think we could do it right. Put up or shut up.

  55. mousethatroared says:

    pmoran – thanks!

    HH – Maybe it’s just me, but I think that was unfair. (Oh god, I sound like my kids now) David Gorski put forth a new idea on CAM having a central dogma. It’s a new idea. One would expect people to poke at it and question it and come up with criticisms for David Gorski to refute or explain. Isn’t that how new ideas get fine tuned or discarded?

    While pmoran may often be more critical of the blog’s tone than many would like, I didn’t read this was a tone criticism. It was a criticism of the idea that CAM has a central dogma. I thought being skeptical of ideas is one of the things this blog is about.

    Also pmoran is not a broken record. His criticism of chiropractic care are some of the best criticisms I have seen in comments on this blog.

    I genuinely don’t mean to offend, because I admire both your and David Gorski’s work. But, that’s just my two cents.

  56. Harriet Hall says:

    @mouse,

    I see pmoran’s comment as repeating his previous assertions that
    1. CAM believers will react badly to Dr. Gorski’s way of expressing things.
    2. We are trivializing or failing to understand the things that motivate people to try CAM
    3. We don’t understand that patients will want to try dubious methods

    He talks about “SBM’s attempts to characterise CAM in terms that conveniently “explain it away”. I don’t think that’s fair. Trying to understand the underlying thought processes of CAM is not the same as “explaining it away.” In fact, it seems to me that it supports pmoran’s goal of trying to understand where CAM proponents are coming from.

    Whether or not Dr. Gorski’s idea of a central dogma is valid, it helps explain the underlying philosophical currents in various forms of CAM.

  57. mousethatroared says:

    @HH – Okay, I think I see at least some of your points. Particularily in the last part of pmoran’s last email.

    But this part… “If your generalization is as inaccurate as I believe, it will have a great many people reacting just as we doctors do when we are described as being hide-bound by germ theory, or entirely in the thrall of drug companies and their shenanigans — that is, with great annoyance, a deep sense of injustice, and reduced respect for the claimant.”

    I think is at least somewhat of a valid criticism. If the idea of a central dogma to CAM is an inaccurate generalization and someone basis a criticism of all CAM on a criticism of this central dogma, then that becomes a straw man argument. Yes?

    Yes, I do agree that Dr. Gorski explained many of the underlying currents of at least some forms of CAM really well. I’m just trying to figure out how far that “wishing makes it so.” philosophy extends within CAM.

    As an aside I also wonder if it actually is sometimes at play in conventional medicine, although not in any standardized way, just as a part of individual doctors idiosyncrasies.

    As another aside, one of the reasons I’m so facinated with this idea is due to my past experience with infertility. Now, there is an area where it is very difficult to discern (at least for the patient) fact from fiction in that whole mind/body interaction.

    Thanks for your explaination. I’ll leave you all alone on your dispute over communication approaches

  58. pmoran says:

    Harriet: He talks about “SBM’s attempts to characterise CAM in terms that conveniently “explain it away”. I don’t think that’s fair. Trying to understand the underlying thought processes of CAM is not the same as “explaining it away.” In fact, it seems to me that it supports pmoran’s goal of trying to understand where CAM proponents are coming from.

    Ah, yes, but those explanations can serve less noble purposes. If CAM can be characterised as a dogma-driven quasi-religion there is less need to acknowledge that very, very often it is serious weaknesses in mainstream medical care that drive people into it (a major point of mine that you ignored and cut out, in yet another example of the selective quoting I have had cause to repeatedly complain about. )

    They can be a cheap way of boosting our sense of intellectual superiority and having grounds for despising those who may merely be less privileged than us in some ways.

    They can be used to score points in the game version of “Healthfraud Activist” wherein the objective is as much to put opponents down as to inform people as to the processes of science and their merits (observe how the almost reflex, self-indulgent insults of Skepticalhealth are tacitly tolerated, if not defended, on this supposedly science-based forum).

    So I agree the task of understanding CAM is critical to our purposes, as well as being a legitimate area of scientific study in its own right. But if we are to do that effectively we have to start off by re-examining our comfortable, familiar, “group-think”, especially trying to get a feel for where our (largely legitimate) biases may mislead us into gross over-generalisations and unhelpful exaggerations, as well as to looking in only the safest, most non-threatening areas for answers.

    We also need forthright debate. David showed no sign of any willingness to reconsider his highly contentious position even after four or five polite demurrals, including one from you. I was actually trying to keep quiet until then.

  59. Harriet Hall says:

    @pmoran,
    “those explanations can serve less noble purposes. If CAM can be characterised as a dogma-driven quasi-religion there is less need to acknowledge that very, very often it is serious weaknesses in mainstream medical care that drive people into it”

    The explanations themselves are important and can be used for noble purposes, even if some people misuse them for less noble purposes. And I don’t see that pointing them out implies any less need to acknowledge the many factors that drive people into CAM. And I disagree that the weaknesses in mainstream medical care are the driving force: they are only part of the equation. CAM will always be with us because of human nature. They will coexist alongside the most optimum medical care you can imagine, precisely because of the kind of belief systems David writes about. And it’s vitally important that we understand those underlying thought processes, both for our own illumination and in order to try to devise a better approach than just presenting scientific data.

    “after four or five polite demurrals, including one from you”

    Mine was not a demurral, but an addition. If you wanted a debate and thought David was wrong, you should have shown why he was wrong, and not by just mentioning counter-examples, because he himself made it clear that the central dogma doesn’t cover all cases. Instead, you chose to attack him for ” a cheap way of boosting our sense of intellectual superiority” and accuse him of “despising those who may merely be less privileged than us in some ways” and accuse him of trying to score points in a game. I don’t know if you realize how insulting and offensive such comments are. And you accuse us of defending Skepticalhealth’s insults, when you know we have a no-censorship policy and when in the past you have seen me repeatedly call for civility and discussion of issues rather than personal attacks. Now I’m calling on you to set an example and stop insulting SBM in general and David in particular.

  60. David Gorski says:

    Thanks Harriet, but I’m used to it by now; water off the proverbial duck’s back. I should have realized when I stayed away more than a day because work had gotten so crazy.

    Quite honestly, I figured when I was writing this that Peter would probably show up sooner or later, clutching his pearls, all offended, accusing me of arrogance and despising those who use CAM. I have to admit though, that I’m really surprised and disappointed that he would somehow think I despise people who are less privileged; that was a low blow to which I will not respond right now other than to say that, once again, Peter has not refuted anything I’ve written.

    As usual.

    Peter, you obviously despise me. No, no. Don’t try to deny it. It’s flamingly obvious from your comments, both here and in many previous of my posts that you simply can’t abide me or my views; they offend you to your very core. Given how much you clearly dislike me, how much I clearly get under your skin (without even intending or trying to), why do you bother reading my posts?

  61. Janet Camp says:

    @DugganSC

    “most people have little hope of knowing if the authority in question is indeed correct or if they’re talking out of their ass. Ultimately, to borrow the line from Twelve Step programs, they have to “put their lives in the hands of a higher power” either way. You could argue that every patient has the ability to go out and learn the science involved, but a) that takes serious amounts of time, and frequently still hits that wall where at some point they have to take assumptions on faith and b) frankly, not everyone is up to understanding the intricacies of biology.”
    ———
    You don’t have to become a medical expert or major in biology to know the difference between real medicine and CAM claptrap. You need only look to those who are bona fide experts in the field and consult with them when in doubt. For example, you hear about a diet, therapy or treatment that may seem reasonable. First thing I would do is go straight to Quackwatch and see what Dr. Barrett or Dr. Hall (and others who write there) have to say about it. Then, if I still had questions, I’d surely look at the archives of SBM, Respectful Insolence, Skeptiblog, or any of the sites these blogs list as useful.

    I may not know everything about whatever subject that may come up, but I can certainly be skeptical of anything that sounds out of the mainstream and consult with known authorities. If a doctor I am seeing says or recommends something that sounds odd, I immediately ask him/her point blank if that idea is based on evidence or if it is some kind of alternative mumbo jumbo. The answer to this tells me pretty quickly if I have a science-based doc.

    I admit that some basic knowledge of the scientific method (and the history of science) is useful, and I have this at the college level, but only at the BA level–30 years ago, but most of what I know about sorting quackery from SBM has come from following up on a natural skepticism. I have fine-tuned this through this blog and the reading of dozens of books–many of which are recommended here and at places such as Skeptiblog. These have honed my critical thinking skills that were primed in high school and college and added new skills in interpreting scientific studies.

    Don’t sell yourself short. If you read this blog, you are “getting it” and you can pass it on to others who may not feel they have sufficient knowledge to sort out the crap from the facts.

  62. pmoran says:

    Well, I hope some are considering my words and examining attitudes, rather than dismissing my suggestions as part of some kind of pathological “set” against David.

    I am sticking my neck out, prepared to take any lumps you wish to inflict on me, in order to lay certain viewpoints before this group.

    When I suggest that most CAM use is dictated by unmet or poorly met medical need and by the power of the personal testimonial, who can deny the truth of that?

    Why, then, try to make it into a religion — even if it has religion-like features for a few? What useful purpose does that serve, other than to support more sneering at folk, some of whom already wretched enough?

    If we think we are clever enough to fully understand CAM, let’s do what we normally would, gathering and looking at ALL the evidence before passing judgment.

    I wish I had the subtlety of language needed to get points across while causing less offence. Too late, I am afraid, after decade upon decade of writing little more than medical correspondence. I have to use the vocabulary I am stuck with.

  63. Jan Willem Nienhuys says:

    I try to make sense of what pmoran and Gorski and others have adduced in this discussion.

    pmoran has doubted that there is a central dogma of CAM. In fact CAM is a ratbag of very many totally different methods, he seems to say. ‘Eclectic’ is the polite word. He sees a similarity with regular medicine. Regular medicine also consists of very many different methods. Gorski gave as example of a central dogma the one from molecular biology (DNA->RNA->protein)

    Gorski did not discuss whether SBM (or EBM) has a central dogma at all. But would ‘you must have decent proof’ do? The word ‘must’ indicates that it is not a statement of fact but an ethical imperative. The word ‘decent’ is differently interpreted by SBM and EBM. In EBM it means ‘by RCT or better, by a meta-analysis or review of RCTs’, and SBM recommends total commitment to all of science, not merely to some practices of statistical testing; more specifically (a) that you can’t call something decently proven if it is in conflict with any other part of science, and (b) that other proofs than statistical proofs might be acceptable too.

    pmoran explained why he thinks CAM is eclectic. He gives as evidence ‘patent reluctance to reject ANY medical claim out of hand’. That is acutely observed. One even can find practitioners that at the same time give megadoses of vitamins and minerals AND ultradiluted ‘spiritual’ medicines. Even in homeopathy one finds practitioners that insist on following founder Hahnemann to the letter (ultradiluted stuff on the basis of an interview of an hour about subjective feelings) next to companies selling OTC concoctions of diluted stuff next to practitioners relying on ‘remedy makers’ next to researchers that are venerated for making ultradiluted irradiated heavy water ice do tricks in liquid nitrogen.

    I don’t think Gorski was justified in thinking that ‘patent reluctance to reject ANY medical claim out of hand’ referred to anything but CAM.

    pmoran seems to doubt that there is a central dogma. He points to two reasons of patients to turn to CAM:
    1. medical need
    2. personal testimony

    But this does not contradict that the purveyors of CAM, as diverse as they are, seem to have a single idea that is greatly at odds with the central dogma of EBM/SBM, namely with the ethical imperative ‘you must have scientific proof’.

    I have rephrased Gorski’s idea as ‘CAM is just religion’ and I will now integrate pmoran’s points into this. His point 2 is easy. I have already observed that personal testimony is an important motor in religions. ‘Martyr’ is just Greek for witness.

    An essential part of religion is that it concerns veneration of an invisible boss (father, tribal head, king, …). I suspect that it is an innate tendency in any group of animals that live in hierarchical communities, that every individual tries to determine his or her position in the ‘pecking order’, and tries to move up. In human society this means on the one hand a certain love for authority, a desire to have someone to venerate (if only a movie star) but on the other hand keeping up with the Joneses, running for President, making a career, or trying to become a guru, with followers of one’s own. Note how Twitter appeals to this sentiment.

    The gurus in spe by necessity need an authority to challenge. So one sees that all kinds of rebellious movements challenge the highest authority. (Students of pseudoscience note that physics cranks always try to outwit Einstein.) Conspiracy theories challenge government agencies. Scientific medicine by its very nature and success elicits rebellion in the form of gurus that claim that they can do what science can’t. The very success of scientific medicine raises expectations beyond the possible. One might call that: medical need that scientific medicine cannot fulfill. The gurus appeal to wishes of his or her potential followers and the followers don’t ask for proof, or they feel that personal testimony, word of mouth etc. are good enough for them. Note that medical conspiracy theories aim at Big Pharma: a huge and powerful entity. So the so-called pharma shill argument actually is an implicit recognition of the fact that the accused belongs to an ‘organisation’ with enormous authority and success – the organisation of Science.

    So the social mechanisms that produce religion, and that make that these religions are splitting up in sects, are the same mechanisms that produce the bewildering diversity of conspiracy theories and CAM sects – each with its own guru who derives a lot of satisfaction and income from his ‘leadership’. And by and large, religion is appealing to wishes. You wish eternal life? you got it! You wish rewards for your hardships and your virtue? you got it! you wish that the baddies are punished? you got it! You want forgiveness for what you did wrong? you got it! (and so on ad lib).

    The answer of scientific medicine to ‘I am sick’ is in many cases: ‘sorry, can’t do’, or ‘we can alleviate a bit, but no more’. CAM says: ‘you wish to be cured? you got it!’. And when the cure doesn’t come, one is told ‘you wish to be cured? you must wish harder!’.

    The classical religious defense in case of failure is that the faithful must have more faith. Belief in whatever the faith promises makes it so. All the religions want from their followers is loyality, so the central dogma of all religion is: you must believe and all will be well.

    I am quite sure that the religions don’t think this is their central dogma. But look up the first of the Ten Commandments.

  64. mousethatroared says:

    JWN – “I am quite sure that the religions don’t think this is their central dogma. But look up the first of the Ten Commandments.”

    Well, you may not know the religious folks I know. My observation, a large part of religion can be boiled down to casseroles. A very elaborate society to insure that people who participate will recieve a casserole (or pie, mac and cheese, words of comfort, etc) when they need it.

    Really, anyone who belongs to a church AND doesn’t feel that, if they really need it, a casserole will be delivered to their door, needs to find another church.

    Yes, it’s true, there are many other groups that engage in casserole delivery behaviors. But really those casseroles always come with strings attached. The trick is finding the casserole exchange group who’s strings you are the most comfortable with.

    My experience with folks (friends) who are INTO alternative medicine… Actual casseroles when you are sick are very rare! What you get instead is someone suggesting you cut wheat out of your diet, or some gift jars of supplements/herbs or (God forbid) someone coaching you on how to think positively so you will feel better (whoops, that person is no longer a friend). Clearly this is a casserole exchange group that has completely jumped the rails. They want to help…but don’t have time to make and delivery a casserole, so sadly, they share the (often ineffective) remedies that they rely on.

    And so many people don’t have time to make and deliver a casserole! And so many people are too far away from their casserole exchange group to share actual casseroles. Many people now live most of their social lives ON the Internet. There are no actual casseroles on the Internet! I can’t confirm this with data, but I’m pretty sure it’s true. The number of people substituting ineffective health advice for casseroles has increased substantially since the advent of Facebook.

    I’m convinced, really, that’s the core of the issue.

    The resolution – First ecasserole.com (a freezable casserole, pie or mac and cheese delivered to your friends door in 24 hours or less) advertised on FB, of course.

    Also a worldwide effort to educate people that unrequested health advice is not an appropriate casserole substitute. Kitten videos, expressions of support and memes from George Takei ARE appropriate casserole substitutions (okay, maybe George Takei isn’t for everyone).

    There, I’m glad I’ve solved the whole CAM problem. Now I can get on with my day.

  65. mousethatroared says:

    I’m sorry for the multiple posts, but since the topic of tone has been mentioned, I just want to add.

    Alot of people comment on this site for various reasons. A very few obviously come here with the desire to bait the SBM contingent. Those few post predictable, inflammatory comments and some routine commentors (myself included, occassionally) respond in predictably insulting ways. When reprimanded the response is often some variation of ‘they were asking for it.’

    It’s occurred to me that many of those (rare) trolls are delighted to be insulted by SBM folks. What a wonderful confirmation of their beliefs. ‘Look how mean and superior they are.’

    Obviously it would be impossible to get such a diverse group of people as those who comment on SBM to behave in an organized way, but just once, I would love it if EVERYONE responses to an obvious troll with a sweet and reasonable tone, throughout the whole exchange.

    I suspect it would totally freak them out. Possibly ruin their whole day. ;)

    Okay, now I’m going to stop procrastinating and get some work done.

  66. @Pmoran

    “When I suggest that most CAM use is dictated by unmet or poorly met medical need and by the power of the personal testimonial, who can deny the truth of that? ”

    “Alternative practitioners have a big advantage. They can lie to patients. I can’t.”

    -Dr. Steven Novella, M.D.

    As long as there are medical needs that can’t actually be met, there will always be people claiming to be able to meet them. Do we criticize financial institutions for not meeting the needs/desires of people to get rich quick with no risk and driving people to Nigerian scams and pyramid schemes?

  67. pmoran says:

    @Pmoran
    “When I suggest that most CAM use is dictated by unmet or poorly met medical need and by the power of the personal testimonial, who can deny the truth of that? ”
    “Alternative practitioners have a big advantage. They can lie to patients. I can’t.”
    -Dr. Steven Novella, M.D.
    As long as there are medical needs that can’t actually be met, there will always be people claiming to be able to meet them. Do we criticize financial institutions for not meeting the needs/desires of people to get rich quick with no risk and driving people to Nigerian scams and pyramid schemes?

    Yes, knowing fraud is another element of CAM, but without being an adequate summary of the whole.

    Most homeopaths believe their methods work. We know why that might genuinely be so, through a mixture of well-known illusions and the possibility/likelihood? of genuinely beneficial placebo influences. Can we call beliefs that are known to arise as a virtually inevitable accompaniment of any kind of medical practice fraudulent?

    There is little doubt that Gonzales and the very ignorant principals of the Gerson clinic have convinced themselves that they are helping some cancer patients. Their “fraud” lies in allowing their patients have much more unrealistic expectations.

    These are tricky waters in other ways. I think that CAM sympathizers can more easily take on board the possibility that treasured “healers” may be sincere but misled, than that they are actually out to willfully defraud.

  68. pmoran says:

    JWN, I think I follow your argument.

    CAM is many, many things to many different kinds of people. The considerations you mention may well be true for many of those for whom CAM is a hobby, or a kind of lifestyle choice. These are the people who may vow in advance that they will try “natural” methods first for most illnesses. But they do that partly through yet another set of CAM dogmata(?), and partly through the not unreasonable understanding that most effective drugs can have side effects and they would rather try a favourite CAM first.

    My counter-contentions to your proposition would be that 1. studies show that the vast majority of CAM use is complementary to mainstream care, so that the limitations of mainstream care would again seem to be the primary influence and 2. many CAM users would almost certainly have none of those thoughts at all until they find themselves being crippled by rheumatoid arthritis, or in pain, or dying from cancer and conventional methods are not resolving the problem adequately. The urge to find relief, or being urged by others to try out something that might help, comes first. They might secondarily get involved in these religion-like sentiments as rationalizations or self-justification.

    It is true that CAM gurus will find any excuse when their methods don’t work, but again, “you didn’t wish hard enough” would be one of the rarest. Most often a frankly physical reason is found, such as not following the diet properly or being poisoned by mainstream care, or modern life.

  69. Pmoran, “Yes, knowing fraud is another element of CAM, but without being an adequate summary of the whole.”

    As far as the end user, there’s often very little practical difference between knowing fraud and well intentioned quackery. When it comes to objective endpoints,ineffective treatment is ineffective treatment regardless.

    I agree that many cam practitioners are not knowing frauds when they offer bogus treatments and remedies. Proper understanding and embracing of the concepts of science based medicine should reduce that somewhat.

  70. Flo says:

    Off topic:

    Help, I’ve lost my post…. I’m seeking Krebiozen’s posted answer to my post about the link between acidosis and cancer. Can anyone point me in the right direction?

Comments are closed.