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The facts of the alternative medicine industry

People have been living on earth for about 250,000 years. For the past 5,000 healers have been trying to heal the sick. For all but the past 200, they haven’t been very good at it.

- Dr. Paul Offit

Twenty years is a long time in medicine. I celebrated my 20th pharmacy class reunion last weekend. Of course reunions are time to reflect back to our early years as pharmacists. Lots has changed. Much of the therapeutics I was taught is now obsolete. In 1993, HIV was a death sentence and there were only three, largely ineffective drugs available. Thanks to new drugs, HIV can now be managed like a chronic disease, and some of my colleagues have HIV-focused pharmacy practices. The same dramatic changes have occurred in fields like cancer and transplant medicine. And in some cases, the cause of disease has become more clear – my old textbooks make no mention of Helicobacter pylori as a cause of ulcers.

The practice of pharmacy has changed, too. On the positive side, pharmacists are working in new settings where they can focus on medication management, and not just dispensing prescriptions. Regulators are granting pharmacists the ability to take on new roles, and pharmacists are being compensated for more than simply “count, pour, lick and stick.” From that perspective, it’s a promising time to be a pharmacist. But there’s a much more disturbing side to the profession that’s emerging, too. Community (retail) pharmacy practice is under pricing and competitive pressure, and smaller pharmacies are being subsumed into big retailers where the pharmacy department is buried in the back – a loss leader to bring in patients, but hardly with a health-care focus. And most disturbingly, I see a move within retail pharmacy practice to leverage its professional credibility to sell all types of modern-day snake oil, ranging from detox kits and “cleanses” to dubious “food intolerance” testing. Homeopathic remedies (an elaborate placebo system of sugar pills) are increasingly found on pharmacy shelves, alongside real medicine. And don’t forget the enormous wall of vitamins that seems to get larger and larger. Yes, complementary and alternative medicine is booming, and pharmacy wants its share. Pharmacy regulators turn a blind eye. What do my pharmacy colleagues tell me? They’ll tell me it’s customer demand, and that they don’t recommend the quackery. To me, I see this trend as damaging the credibility of pharmacists in the eyes of the public and of other health professionals.

I understand that medicine is a business and that alternative medicine is a business; but part of the difference in medicine is that we’re supposed to have professional norms, professional values, and professional commitments. If you keep telling people it’s just a marketplace and that they’re just clients and that autonomy of the patient is what must be served to make them happy customers, they you have a collapse of professionalism in the face of consumer demand.
- Art Caplan

do you believe in magicThe progress of medicine, the changing face of pharmacy, and the growing demand for alternative medicine all been percolating in my mind over the past few weeks. It’s almost inconceivable that in 2013 the same pharmacist that dispenses your targeted cancer treatment, one that cost hundreds of millions to develop, and is literally saving your life, may also sell homeopathic remedies and other alternative medicine nostrums, some of which are based on medieval ideas of disease. In integrating alternative medicine into what should be a science-based practice, pharmacists aren’t improving patient care, but doing the opposite. They’re promoting magical thinking, and damaging the profession.

I’ve been writing about, and advocating for, science-based medicine since I spent an early part of my pharmacy career in pharmacy with a strong focus on alternative products. Not having learned much about these products in pharmacy school, I did my research. And what I found was disturbing. Not only were most of these products not backed by good evidence, but some were highly questionable – even risky. Yet the entire regulatory structure was tilted in favour of manufacturers. There was little manufacturing oversight, and even less oversight of the treatment claims being advertised. And never any mention of potential risks. Yet their popularity continued to grow.

If the lack of science supporting alternative and complementary medicine isn’t self-evident to health professionals, is it any surprise that the broader public can’t see the problem? And what explains its popularity in the face of the scientific evidence? Dr. Paul Offit’s new book, Do You Believe in Magic? is an attempt to address that. It’s a concise, comprehensive and highly readable summary of the facts of complementary and alternative medicine. While I’ve never met Dr. Offit, I’ve been an admirer for several years. It’s not just the real science he’s done, like leading the invention of the RotaTeq rotavirus vaccine, preventing infectious diarrhea which killed hundreds of thousands of children every year. And it’s not the fact that he’s a pediatric infectious disease physician. He continues to be a strong and vocal advocate for the safe and effective use of vaccines, which drives the anti-vaccine movement to distraction. He doesn’t flinch, he doesn’t hide, and he calls a spade a spade. One of my favorite references on the autism-vaccine manufactroversy is Offit’s 2008 book, Autism’s False Prophets, which exposes the anti-vaccine movement and its tactics. Not surprisingly the release of his new book is driving antivaccinationists even more apoplectic. Unbelievably, he’s even received death threats for his pro-science, pro-vaccine stances. It’s amazing he continues to take the heat of the public eye. But we’re lucky he does, because Offit is a gifted writer, with the ability to summarize complex topics in ways that are engaging and simple, without being simplistic or dismissive. It’s one of the reasons why I enjoyed his newest book so much. (In the interest of full disclosure, I should note that I received a copy of the book from Dr. Offit.)

Offit opens the book with a revealing and quite personal chapter – his own experience as a patient in the health care system. He describes the disappointing care he’s received throughout his life which is astonishing given Offit’s a physician himself – an insider. From being born with clubfeet (the treatment of which left him with chronic pain) through a cancer misdiagnosis in his twenties followed by orthopedic and prostate problems, he describes his medical care, its limitations, and the alternative medicine advice he received from others, ranging from acupuncture to chiropractic to naturopathy. Offit looked closely at the scientific evidence supporting these practices – and found them lacking or non-existent, which mystified him given their growing popularity.

Offit describes the rise and eventual fall of an alternative medicine treatment from the 1970′s called laetrile to illustrate the factors driving the popularity of alternative medicine. Laetrile is something SBM’s own Kimball Atwood described as “the most lucrative health fraud ever perpetrated in the United States.” And while Atwood and other have written at length about this quack cancer remedy, I admit that I didn’t fully understand the social and political context that drove its popularity. Offit describes the case of Joey Hofbauer, a seven-year-old child diagnosed with Hodgkin’s disease, a highly treatable cancer which can be cured (yes, cured) in many cases with chemotherapy and radiation. When Hofbauer’s parents decided to use a laetrile, a “natural” remedy derived from apricot pits, it set off a legal battle of medicine versus alternative medicine where ultimately, quackery prevailed – in the court, at least. A health victory, however, was denied to poor Joey who quickly died of the cancer; an unnecessary cancer death, and a young life cut short by the laetrile movement. Offit describes the contributors to laetrile’s popularity that he believes continue to drive alternative medicine’s popularity today:

  • a distrust of modern medicine
  • the idea that vitamin supplements are beneficial
  • the belief that natural products are safe and effective
  • the charisma of purveyors of natural products
  • the power of celebrity
  • the influence of the natural products industry

The remainder of the book weaves an analysis of these factors with a critical appraisal of alternative medicine practices, and its proponents.

Dr. Oz, Deepak Chopra, and the distrust of modern medicine

In a sense, The Dr. Oz show is a voyage back through the history of medicine, starting with our most primitive concepts of disease: supernatural forces.
- Dr. Paul Offit

I’ve called Dr. Mehmet Oz the biggest purveyor of health pseudoscience and bad health advice on television, and I stand by that description. He’s an accomplished surgeon who brings reiki into the operating room. Oz is the perfect host for a daytime television show that seems to prove each episode that there is no alternative health practice so absurd that it doesn’t deserve a breathless description (“miracle!”) and endorsement. The show, watched by millions daily, regularly promotes debunked, ineffective and even dangerous practices like homeopathy, naturopathy, acupuncture, and chiropractic. He’s profiled psychics and faith healers, too. Offit argues that common thread is Oz’s interest in the supernatural and the occult, which he seems to believe are equally legitimate as science-based treatments. In that way, Offit argues, Andrew Weil and Deepak Chopra have the same schtick – albeit with different approaches. For Weil, it’s Spontaneous Healing, where health is a manifestation of good and evil. For Oz, it’s Ageless Body, Timeless Mind, and what seems to be a never-ending collection of meaningless platitudes that are seem so inane that a bot can generate them.

Why are these gurus so popular? Offit argues it’s what they offer to the public: empowerment and certainty. Medicine is changing constantly as new scientific evidence emerges. It’s confusing and complicated. So why not try a healing system that hasn’t changed since it was invented – like homeopathy? Rather than appreciate the complexity of medicine, why not empower yourself with simplistic ancient wisdom, instead? Feel like you’re being treated with a cookie cutter approach to your health issues? Personalize your own care with what feels right to you. Follow the mantra, buy the book and watch the episode, and you will live a happier, more successful life. It’s natural, and natural is good.

The vitamin con

Do we need vitamins? Yes. Do we need vitamin supplements? In most cases, no. I’ve previously described one of the biggest contributors to the fallacious perception that vitamins are beneficial – Linus Pauling, a truly brilliant scientist whose descent into quackery was as impressive (yet unfortunate) as his scientific contributions. Offit uses Pauling as the starting point for a comprehensive yet concise overview of the current state of the evidence for vitamin supplementation. (There is a substantial excerpt available in a piece published in The Atlantic. What’s most baffling is not that most vitamins are useless at best and harmful at worst. What’s surprising is the sales of vitamins seem completely immune to negative publicity. One negative clinical trial can kill a drug, but Offit notes that vitamin sales seem to be impervious to the evidence. The reason will be well known to regular readers of this blog: a weak ineffective regulatory structure has been designed by the supplement industry to keep consumers as ignorant as possible about the evidence supporting these products.

Natural doesn’t equal safe or effective

One of the consistent arguments put forward by contributors to this blog is that all products need to be held to a consistent, science-based standard of evidence. Simply because a product is naturally-derived doesn’t mean it is safe or effective, or merits a waiver of scientific scrutiny. Consequently, the impact and consequences of the American Dietary Supplement Health and Education Act of 1994 (DSHEA) has been the topic of many posts. The DSHEA established the American regulatory framework for dietary supplements and effectively excludes manufacturers of these products from virtually all regulations that are in place for prescription and over-the-counter drugs. Remarkably, the DSHEA puts the requirement to demonstrate harm on the Food and Drug Administration, rather than putting the onus on the manufacturer to show a product is safe and effective. Offit dedicates a chapter to supplement regulation, contrasting it with drug regulation to illustrate how the current framework evolved. It wasn’t by accident: The natural products industry explicitly and deliberately set out to ensure it would be exempted from any requirement to demonstrate that their products were either safe or effective. While branded with a message of “health freedom” for consumers, it was really about the freedom for manufacturers to offer products without the testing expected of other products. The lobbying and politics were stunningly effective, which today leaves consumers largely in the dark about the products they’re buying. The result? A perpetuation of the dichotomy that supplements natural and therefore safe. On the other side are drug products, held to completely different standards.

The consequences of a weakened regulatory structure

Today, there are thousands and thousands of supplements for sale. Do any work? The evidence is lacking for most. With little incentive to test their products, manufacturers often bring products to market without any credible evidence of efficacy. And the contrast with science-based medicine can be striking. There’s no effective drug treatment for dementia, but there are plenty of supplements with claims of benefit. Echinacea doesn’t prevent or treat colds, but it’s a $130 million-per-year business. Today you find supplements to treat most serious medical conditions, and even made up diseases, like “adrenal fatigue”. Offit discusses the duds but also the products that do have some promising evidence, including omega-3 acids to prevent heart disease, calcium and vitamin D for osteoporosis, and folic acid during pregnancy.

Another consequence of a regulatory structure where the scientific evidence isn’t relevant is the influence of celebrity endorsements and even political pressure. Offit profiles three cases:

  • Suzanne Somers, who promoted dangerous misinformation about cancer while also hyping bioidentical hormones as an anti-aging panacea.
  • Jenny McCarthy, one of the most outspoken anti-vaccine advocates in the media today whose antics have been well documented at this blog. Offit explains the harms of her actions and describes how her anti-vaccine advocacy continues to threaten public health.
  • Attorney General Richard Blumenthal, who tried to legislate “Chronic Lyme Disease” into existence. Offit illustrates how the battle over Lyme disease has become politicized, illustrating the pseudoscientific and dangerous treatments that are offered in the absence of good evidence.

The Burzynski Clinic

There is unlikely to be larger collection of articles on cancer quack Stanislaw Burzynski and his urine-based cancer treatments, (branded as “antineoplastons”) than those written by SBM’s very own David Gorski, who has dedicated thousands of words to the topic. Offit dedicates full chapter to Burzynski’s story, illustrating his promising beginnings, his move away from credible science, and his current cancer practice. Importantly, Offit summarizes what multiple independent reviews of Burzyski’s treatments have concluded: that there is no convincing evidence that Burzynski’s antineoplastons work. The consequences are grim: these treatments continue to be sold for hundreds of thousands of dollars to desperate patients in life-threatening circumstances. Perhaps not surprisingly, one of the biggest boosters of Burzynski is Suzanne Somers.

The chelation cure-all

The name Rashid Buttar may not be as familiar as Stanislaw Burzynski, but his medical practice is equally dubious. Buttar is a strong proponent of chelation, treatments which bind and eliminate heavy metals from the body. According to Buttar, virtually every medical illness is due to “toxins”, and chelation is the universal solution. Offit describes the lack of science underlying Buttar’s ideas, and how Buttar illustrates the hallmarks of today’s medical huckster: offering unproven, scientifically questionable treatments, stating that mainstream medicine is wrong and out to get him, and that his solution (while untested) should be trusted without any doubts.

Why we think alternative medicine works

Offit concludes his book with a thorough discussion of placebo effects, summarizing some of the research that has established that treatments like acupuncture lack any objective effects. That is, acupuncture is a theatrical placebo. As better-quality research increasingly confirms that the effects from alternative medicine appear to be attributable to placebo effects, it is important to note that there is no persuasive evidence to suggest that placebo effects offer any meaningful health benefits. If I had one quibble in this book, it is that Offit doesn’t discuss the newest tactic of alternative medicine promoters – as it becomes increasingly clear that many alternative medicine approaches have no therapeutic effects, “treatments” such as acupuncture or homeopathy are increasingly promoted as strategies that ”harness the power of placebo” without all the pesky costs or side effects of real medical interventions. We are seeing proponents spinning placebo effects as meaningful and worthy of pursuit. Offit’s arguments are somewhat congruent with this position, though he argues this can be done better with real medicine rather than the theatrical rituals and magical thinking offered by alternative medicine purveyors today.

Conclusion

Do You Believe in Magic? is a comprehensive and compelling analysis of the alternative medicine industry, which will appeal to both the regular and the casual SBM reader. More generally, it would be an excellent read for anyone with a passing or deep interest in alternative medicine. Importantly, Offit’s book nicely explains the problems with the continued false dichotomy of describing “alternative medicine” as an entity of treatments and products. Alternative medicine that actually works is no longer alternative: it is simply called medicine. The rest is unproven, or proven ineffective. I’m often asked for resources on science-based medicine for people that don’t read blogs. Offit’s book is an excellent single reference that accurately and concisely summarizes the facts of the alternative medicine industry.

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69 thoughts on “The facts of the alternative medicine industry

  1. I recommended the book to my latest “friend” who adores Dr. Oz. Her response: “What makes you think your doctor Offit knows any more than Dr. Oz?”

    It’s a real problem that Oz IS a real MD, a credentialed cardiologist to boot. Any ideas for a sound bite that puts Oz’s relationship to real medicine in perspective?

    To the question posed in the title, sadly the answer for the majority is a resounding “yes”. People, especially those already accepting of religious beliefs, are very willing to believe in magical “cures”, in any kind of personal testimony, and be equally UNpersuaded by seemingly dull logical analysis.

    I am trying to accept that my old age is going to be spent as a social recluse, other than my immediate (and rational) family. :-)

    1. Albert says:

      Might want to relay the story that James Randi posted here: http://bit.ly/1datYrx

    2. mousethatroared says:

      Her response: “What makes you think your doctor Offit knows any more than Dr. Oz?”

      Could you just suggest something like…

      “It doesn’t matter who I think knows more. Why not just compare what each doctor has to say and decide for yourself who has the stronger argument based on logic and evidence?”

      Really, a good argument should hold together and be pretty convincing regardless of the credibility battle. Of course, it’s not going to convince someone who isn’t willing to look at the arguments with an open mind…but it gives someone the opportunity, if they are willing.

    3. Kathy says:

      @goodnightirene – “People, especially those already accepting of religious beliefs, are very willing to believe in magical “cures””. No, not necessarily. They may or they may not. Citation please. It would be a fairly easy study to do, I’d think.

  2. When a relative recommended this: http://www.social-consciousness.com/2012/07/science-of-healing-you-can-heal-any.html, I countered with Dr. Offit’s book. She replied, “TCM has been around for thousands of years and the herbal medicines used in this system, too. Just depends on one’s pov and inclinations as to which path to follow. I choose using the system that suits my health situation. Is it fear that closes minds? That’s my guess.” My guess, too, but at that point I gave up on her.

    1. lordshipmayhem says:

      Except that science, being based on evidence and analysis, doesn’t care WHAT your point of view is. If your POV isn’t reality, your POV is incorrect.

      1. mousethatroared says:

        Just an idea, while a POV may not change the laws of physics, in medicine, a POV can change the treatment recommendations. People may have different priorities and feel differently about the risks or benefits of particular treatments or interventions. Some side effects or consequences of treatment may be intolerable to some, but tolerable to others.

        I wonder if the POV argument may be taking this into consideration, then conflating that consideration into a fantasy where people get the facts that they like most, without realizing where they jumped from realistic consideration of personal differences to fantasy.

    2. Michael says:

      // “TCM has been around for thousands of years//

      Why does this argument inevitably get brought up by these folks, every .. single … time.

      The length of time xyz has been around, in and of itself, has absolutely nothing to do with efficacy. This is what we call a non sequitor. Logically incoherent.

      1. WilliamLawrenceUtridge says:

        When all you have is a hammer…

  3. WilliamLawrenceUtridge says:

    @notsecurelyanchored

    You could point out that despite the existence of TCM for two thousand years, the life expectancy in China only started increasing with the introduction of modern medicine. You could also try my favourite counter-argument to “age is better”, that prayer to Thoth is older by a good 3,000 years so they’re better of switching to that.

  4. lilady says:

    @ goodnightirene: One small correction to your excellent post. Dr. Offit is a pediatrician and infectious diseases specialist. He is also the medical director of the Infectious Disease Division at CHOP (Childrens Hospital of Philadelphia).

    A while back there was a small blurb on SBM about Dr. Offit’s scheduled seminar to be conducted at the Cold Spring Harbor Laboratory on June 8th. I immediately reserved seats for my husband and me to attend…but deliberately avoided posting information on this site that I planned to attend, because Dr. Offit has a personal stalker who “lurks” on science blogs to plan his stalking activities. The “stalker”, who is a “journalist” at a notorious anti-vaccine blog, monopolizes the Q&A sessions with his accusatory libelous statements, has accosted his “target” after the Q&A session, then blogs about his exploits.

    My husband and I arrived early at the Seminar, taking seats in the second row to be close to Dr. Offit and with a good view of the auditorium entryway doors to see if “the stalker” would make an appearance. He was a “no show”, but my husband and I had our notebooks ready to document any interaction between Dr. Offit and his stalker.

    Dr. Offit is one of my heroes because his oral presentations and his writing skills are superb. He has devoted his life to the care of children and to educate parents about vaccines, in spite of the personal danger he has faced from the vicious anti-vaccine groups.

    Before the book was released, the anti-vaccine bloggers were attacking its content and attacking Dr. Offit personally. Other alt/CAM groups were busy doing “damage control” on the internet, without seeing the content of the book. Both groups panned the book…sight unseen. Such nice groups, eh?

    The book is excellent, well written and footnoted. So buy the book and don’t forget that the royalties Dr. Offit receives are all donated to the Childrens Hospital of Philadelphia.

  5. stuastro says:

    Mehmet Oz, what a sellout. I just cannot understand what motive he has……oh whatthe heck, it’s all about the money for Oz! And THAT is what is so disgusting. I am certain that he does not believe in most of the crap that he purveys on is ridunculous TV show. It’s all about the money!

    1. Kathy says:

      He has a new “miracle cure” every week. So yes, I doubt he believes in any of them.

  6. David Gorski says:

    The name Rashid Buttar may not be as familiar as Stanislaw Burzynski, but his medical practice is equally dubious.

    Actually, in some circles (mainly having to do with vaccines), Rashid Buttar is far more famous than Stanislaw Burzynski. In fact, Buttar has been battling the North Carolina medical board for decades and winning. Not only is he an antivaccine quack, but he’s a cancer quack as well. Moreover, he and his fellow “CAM” practitioners pushed to get a law passed in North Carolina that prevents the medical board from disciplining doctors who practice “non-traditional” or “experimental” medicine unless it can prove they are ineffective or more harmful that prevailing treatments. They succeeded, and as a result the medical board couldn’t shut Buttar down. The best they could do was to get him to promise to stop treating cancer patients and to provide patients with a disclaimer about his methods.

  7. Homeopathy is “nanopharmacology” [ref]. Medicines are prepared through a specific pharmacological process of potentisation which results in nanograms of fine nanoparticles of the original starting material in the final product (upto 200c potency) administered in treatment of any disease.

    Each potency is prepared in the same sterilised vial (20 ml), and the earlier step is simply poured out, so the remedy carried on is that which sticks to the inner surface of the vial. Benoit Mur built the first potentisation machine based on karsakoff method. Automatic potentizer ensures that each succussion is performed with the same number of strokes and with the same force on each stroke.

    Ref: The Emerging Science of Homeopathy.Complexity, Biodynamics and Nanopharmacology. Paolo Bellavite, Andread Signorini. North Atlantic Books. Berkeley, California. 1995. ISBN 1-55643-384-0

    1. Chris says:

      Nancy Malik, “nanopharmacology” only refers to things at around 10^(-9) (or 0.0000000001) scale.

      In reality it has nothing to do with homeopathy, especially with 200C. Which is 10^(-400), or one part of remedy to several magnitude times the number of atoms in the known universe.

      And you still need to prove homeopathy is effective for rabies. Andre Saine made the claim, so that needs to be independently verified.

      (Checking HTML… 10-9 and 1 part in 10400)

      1. Chris says:

        No, X[sup]n[/sup] with angle brackets does not work. Erg.

      2. Research by IIT Bombay published in 2010 indicates the presence of1-4000 picograms/mililitre of fine nano-particles (5-15 nanometer) of the original starting material in 200c potency of metal-derived homeopathic medicines.

        Research by IIT Delhi and Central Council for Research in Homeopathy (Govt. of India) published in 2011 indicates the presence of crystalline nanoparticles (100 nano-metre) in 15c potency of plant-derived homeopathic medicines

        The levels of hormones in our body is also in the picograms/mililitre range, 1 drop=o.o5 ml

        1. Chris says:

          So any proof it cures rabies? And try actual scientific studies, not proclamations by Andre Saine.

          And you still have no idea want a nanometer is, or that 200C is silly.

        2. WilliamLawrenceUtridge says:

          Sure, hormones do exist in extremely low (but still mesurable) doses in the human body. But hormones are also ideally shaped to target specific receptors in specific tissues in the human body. Hormones also increase in effect, sometimes to lethal levels, as you increase their concentration and dose. So why are you comparing them to homeopathy? By that comparison, low-potency dilutions would be more powerful than high-potency dilutions but the dogma of homeopathy is the reverse.

          Also, why not link to these articles, so we can suggest alternate interpretations and, above all, ways to conduct better-controlled trials that may generate data that is more firmly supportive of your assertions? I mean, if homeopathy really works, if dilution and succussion has a real effect, then don’t you want the most stringent tests available, so you can be confident in your results?

          See, you keep grasping at individual, often mutually-contradictory statements or findings or analogies, and expecting them to support your argument. The nice thing about science is that it all hangs together and Occam’s Razor handily applies. You don’t have to cobble-together arguments, unrelated tangents and special pleading to handwave away challenges to a pre-existing belief system.

          Stop pretending you’re doing science, stop pretending science means anything to you, stop pretending science matters. Just accept the fact that you’re attempting to use magic. It’s dishonest to yourself, and offensive to those who understand science.

          1. stuastro says:

            Well said William. Much better than I could have said it!

          2. Hormones which are in picograms/millimeter range have profound effect on our body. Likewise nanoparticles of original starting material (which are also in the same range) do have considerable effect on our bodies.

            Nanoparticles can cause hormesis [ref].

            ref: Iavicoli I, Calabrese EJ, Nascarella MA: Exposure to nanoparticles and hormesis. Dose Response 2010, 8(4):501–517. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990066/

          3. Chris says:

            Homeostasis has nothing to do with homeopathy. This is your problem, Ms. Malik, you do not have the proper scientific English vocabulary to understand the papers you post.

        3. stuastro says:

          Nancy do you really expect that 90+% of the people here are going to give ANY credence to an article published in a homeoquackery “journal”.

    2. stuastro says:

      Oh, come on Nancy, pull your head out of the sand and just see if you can actually catch up with reality. You know that homeopathy is just water, or whatever solution you start with. You know that water does not have memory. If you DO believe this, I would love to hear you scientific explanation of how water memory works, how succussion adds “a special kind of energy” to your homeoquackery solution, how any dilution above 24X or 12C, and these 2 are one and the same, can possibly contain a single molecule of your so called “treatment”. Your ‘science” is based on magic, it is meaningless, useless and potentially very dangerous.

      Other than that, have a VERY nice day. :)

    3. WilliamLawrenceUtridge says:

      Wow, 1995. That is truly some cutting edge science there.

      Of course, when you’re still invoking Hahnemann, 1995 is pretty recent.

      “Dr” Malik, you seem to be saying that it is particles of the mother tincture that are responsible for the alleged physical effects of homeopathy. Acknowledging that you haven’t provided any proof that homeopathy has any specific effects, how do you explain the presence of enough particles to have an effect after a 12C dilution, let alone a 200C dilution? What does the potentisation accomplish? Does it break the mother tincture down into smaller units? What happens when they are broken down to the individual molecules, does it break them into individual atoms? How are those atoms different from any other carbon, oxygen, sulfur, nitrogen, hydrogen or silicon atom in the mixture? How does a physical strike breakdown the binding energy of the molecules?

      And if you are attributing these alleged effects to actual particles, why do less concentrated doses allegedly work better than higher concentrations? Are the molecules found in the water other than the mother tincture potentized as well? Wouldn’t that mean all homeopathic remedies are basically all undiluted potentized water from wherever you are getting your water from?

      1. Research carried out by a team from the Department of Chemical Engineering, Indian Institute of Technology Bombay (IIT-B) and published in Homeopathy (Elsevier) in 2010 indicates the presence of 1-4000 picograms/mililitre of nano-particles of the original starting material (one molar concentration) in 200c potency of metal-derived homeopathic medicines [ref].

        This study concluded that by using transmission electron microscopy, electron diffraction and atomic spectroscopy it is possible to measure the quantity of nanoparticles found in homeopathic medicines which retain their potency even when diluted to a nanometre.

        ref: Chikramane PS, Suresh AK, Bellare JR & Kane SG. Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective. Homeopathy, 2010; 99: 231-242 http://www.homeoint.ru/pdfs/Extreme%20homeopathic%20dilutions%20retain%20starting%20%20materials-A%20nanoparticulate%20perspective.pdf

        1. Chris says:

          Again, another study where noise is interpreted as significant. Which it isn’t.

          It makes as much sense as thinking signals in an fMRI from a dead fish are real. They are not.

        2. Harriet Hall says:

          Please see this: http://www.sciencebasedmedicine.org/homeopathy-and-nanoparticles/ The results may well be due to contamination or other experimental artifacts.

          Some medical tests report results in picograms per milliliter (not millimeter). If those amounts were present in highly dilute homeopathic remedies it would be easy for labs to distinguish between the remedy and plain water. They can’t.

          Even if the presence of nanoparticles could be verified by other labs (it hasn’t), that would in no way substantiate the clinical effects of homeopathic remedies.

  8. stuastro says:

    Nancy you know very well that a 12C solution contains nothing other than the original solution but not a single molecule of the original solute is present. On the other hand, a 15C solution is 1,000,000 times more dilute, which, in your fanciful world that means more potent. One million times more dilute than the point at which there is nothing but water! Stop kidding yourself. Get back to reality before you can’t.

  9. Nikki says:

    As far as I can tell Dr.OZ is mostly focused on diet plans and things to help you lose weight… if you did them all they would contradict themselves. But he puts on a good show for the peoples. I saw the one he did on FM and actually he did better than I thought he would, but that isn’t saying much. When you are chronically ill it is like people expect you have to buy vitamins and supplements and do alternative treatments… because you Want to get better don’t you? People seem to think if you don’t then you are at fault for being ill and not trying Hard enough to Get Better.

    In reality we understand supplements come with their own side effects and can conflict with medications and you cannot always trust their quality. We must take what our doctor suggests. I’m on 2000mg of D for migraines. It is recommended I take magnesium as well, same reason. And I must take calcium because I have lower bone density than I should. So I do. Nice that those ones work together well. However when it comes to others it is buyer beware and also do a lot of research into if there is any research done on that supplement for your condition and how valid was that research. And then look at it and see what sort of side effects occur and see if it conflicts with any medication. And then maybe give it a go but buy from a manufacturer you trust, knowing still the regulations suck at best. However, in my view, that means minimal is better for buying these things. There is no magic here. There are so many you could take for so many different things that likely won’t do a thing but will cost you a fortune. I remind people all the time… all this? Out of pocket. All those alternative treatments? Out of pocket. Yes, people expect us to help ourselves ‘get better’ but they don’t seem to realize the cost of this hypothetical ‘better’. I’m afraid these supplements and vitamins simply do not work that way.

    1. WilliamLawrenceUtridge says:

      Dr. Oz doesn’t get a lot of respect here, if you use the search box you’ll turn up several articles by Dr. Gorski alone.

    2. stuastro says:

      Nikki there is a very good reason why William Lawrence Utridge said that Mehmet Oz “doesn’t get much respect around here”. “Dr” Oz is prepared to back any and every form of alternative quackery, all in return for a good pile of money from his weekly TV scandal sorry TV show. He doesn’t care what he is purveying, he only cares how much money he will earn from his ridiculous TV show with the hyper-credulous numb brained audience members. I would confidently say that there has never been a single thing presentedon his TV show that could possibly have any therapeutic effect at all.

  10. Reading articles like this, I get quite nervous.

    I take several vitamins, at higher doses than the manufacture recommends, at the direction of my doctor. I have short-gut syndrome (I only have around 3ft of small intestine left after my intestine ruptured) and so have some pretty severe nutritional deficiencies if I’m not very careful. And part of being careful, along a very regulated diet, is vitamin supplementation. But all at advice of my doctor.

    However, between reading Orac and SBM, I know that it’s getting more common for regular doctors to become interested in CAM, or at least “shruggies”. And I know my doctor leans that direction, because he recommended acupuncture to deal with my chronic pain. (Hopefully, he just thought I’d get some placebo benefit and doesn’t actually think acupuncture really works.) And his nurse practitioner suggested I try herbal medicines and TCM. Granted, I do live in Marin County, which is about as woo-woo as it gets, but still…it makes it hard to trust him. Unfortunately, he’s the only gastroenterologist in the area that I can see. And when it comes to managing my care (it’s quite complex), he’s done a good job so far.

    I’ve tried doing some research on my own, but I don’t have a background in medicine and I barely have any in science, so I don’t understand 2/3rds of what I’m reading. Which is why it’s so important to have a doctor I can trust about these things! And he may be completely right, that I need these vitamins to survive…

    Ugh. I’m sorry. I don’t mean to whine. This has just been really bothering me for a long time, and I felt more and more uneasy as I read this article. (Which was great, btw. Thanks.)

    1. lilady says:

      I wouldn’t worry too much about your lack of formal education in the study of nutrition. After reading your comment, I’m impressed that you have an interest in vitamins.

      I would caution you to avoid taking advice about “supplements” from a nurse-practitioner (and I am a registered nurse), as well as any advice from a self-styled “nutritionist”. A “Registered Dietician” is far more competent to provide advice for those who, like you, have a condition/disorder that may lead to malnutrition. Registered Dietician is a “protected title” in the United States (and in many other countries); it is an indication that a person has a minimum of 4 years of university education and has had rotations (internships) at hospitals/nursing homes and is therefore qualified to sit for National examinations to qualify for that title.

      Recently, my own GP has told me to double up on the calcium + vitamin D supplements that I have been taking for (a lot of) years since I am post-menopausal. I now take one of those Calcium + Vitamin D tabs in the A.M. with breakfast and the second tab later in the day either with my mid-day snack or with dinner…the latest information about calcium + vitamin D is that there is better absorption by the body with split doses.

      I’ve always relied on, as a first reference the NIH-ODS (National Institutes of Health-Office of Dietary Supplements), for easy to read (and comprehend) information about Vitamins and Minerals. There is ample information at this site as well, about commonly marketed “supplements” of the type that are hawked by internet venders and sold OTC…they appeal to the “worried well” who credulously believe marketing ploys such as “boosts your immune system”, “increases brain power” and the very appealing “enhances sexual performance”.

      http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

      So, do not discount your ability as a layperson to understand your unique nutritional needs…you’d be amazed how “civilians” are able to adapt to newly emerging health problems such as Type I diabetes, digestive tract and bowel surgeries and malabsorption syndromes.

      1. Lynn says:

        lilady – “the latest information about calcium + vitamin D is that there is better absorption by the body with split doses.”

        I’d suggest tht you search SBM for the latest concerns about calcium supplementation.

        1. lilady says:

          I’ve read Scott Gavura’s recent articles about Calcium + Vitamin D Supplementation and I am quite confident that the total daily Calcium Carbonate 1200 mg. + Vitamin D as Cholecalcitrol 800 IU, is suitable for me. I have a rather small frame with a prior h/o R. hip osteopenia and now osteopenia is present in L. and R. hips. I am presently undergoing physical therapy for R. anterior tibial shin splints and an “impending stress fracture” has not been totally ruled out. I have to use strong sun blocks, as well, because of some pre cancerous lesions.

          Thanks for your advice.

          1. Lynn says:

            “I am quite confident that the total daily Calcium Carbonate 1200 mg. + Vitamin D as Cholecalcitrol 800 IU, is suitable for me. ”

            I figured you were probably aware of the recent literature, but just wanted to make sure. I cut my calcium to 600, but (on the advice of the MD) raised the D. It requires too much paying attention to the literature. SBM helps.

            “I have to use strong sun blocks, as well, because of some pre cancerous lesions.”

            Sigh… me, too.

      2. Thanks. Y’know, I saw a dietician in the hospital, right before coming home permanently, after they finally took me off TPN (intravenous feeding). But that was over a year, now, and really just covered the basics of tracking my food and planning balanced meals. I don’t think we discussed supplementation much at all. Maybe I should see if my insurance would cover another visit–making sure to see an RD, and thanks for the reminder. (Just on my street, there are three places advertising “nutritionists”…one is an accupuncture/herbal place, another is a yoga studio/”wellness center”, and another is a weight-loss clinic. Glad I have a heads-up about the nutritionist/dietician difference.) But that might be a way to get more information, from someone who would have the details of my case and the education to understand it.

        I wish SBM-only providers advertised themselves like CAM-friendly doctors do! It would help when trying to find someone I can trust. I know there’s a Secular Therapist Project…is there an equivalent Science Based Medicine Physician Project? If not, someone should start one! ;)

    2. WilliamLawrenceUtridge says:

      The most useful course I ever took was basic anatomy and physiology. Any textbook of that nature, which should be around 1,000 pages, should give you sufficient background to understand a lot of medical information. You learn what the organs do, where they are, some of the main biochemical paths, there should be information on vitamins, nutrition, infectious disease and the like. I’m guessing your understanding would increase considerably. A short small intestine would lead to less vitamin absorption (in particular, depending on where the shortening occurred, if it’s the duodenum, just outside the stomach, that’s where a lot of absorption occurs). But a gastroenterologist would know orders of magnitude more than I.

      If your doctor recommended acupuncture specifically for pain and nothing else, that is not necessarily an indication of quackery, it could be a good sign. There are multiple reviews confirming that it is a good treatment for pain as a symptom. To get deeper into why the literature doesn’t necessarily support acupuncture as a specific intervention requires borderline-obsessive interest (or willingness to spend months reading this blog). He may not distinguish between acute pain (for which acupuncture works) and chronic (for which it doesn’t, bar acutely). Pain is a difficult thing to deal with as a doctor, so long as he doesn’t go further into woo than acupuncture and he’s using real medicine for the rest of your treatments, then acupuncture might not be an indication of doom.

      TCM and herbal medicines though, less so. Good luck.

  11. CK says:

    Quick question: CAM, I understand to be the acronym for “Complementary and Alternative Medicine”. Nowhere in the website do I see the definition for the acronym SCAM – is the added “s” merely there to point out that virtually all “CAMS” are scams?

    1. Harriet Hall says:

      SCAM is used for “so-called complementary and alternative medicine” and also “Supplements, complementary and alternative medicine.”

  12. Tina Johnson says:

    I used to take a lot more calcium than I currently do. It was suggested to me that I might not be absorbing properly and that I should do a cleanse to help with that. Since that time I’ve noticed that I get the same positive effects from about 3/4 of the calcium I used to take, and that’s with my somewhat larger frame. Just some food for thought.

    1. Andrey Pavlov says:

      What positive effects are you noticing Tina?

    2. Harriet Hall says:

      @ Tina. Your post is a bit vague. Details, please! How much calcium did you use to take and how much do you take now? What was the basis of the suggestion that you might not be absorbing properly? Why do you think a “cleanse” could be expected to improve calcium absorption? What positive effects do you get from calcium?

  13. Tina Johnson says:

    I’m rewriting this as there was some sort of error when I
    tried to comment the first time. Hope I get it all down like I had
    it. My joints and just bones overall tended to feel sore. When I
    say bones I mean deep in my arms and legs. Since supplementing with
    the calcium for the past 6 months that’s all gone now. No soreness,
    no joint pain. It wasn’t until the cleanse that I started to really
    notice the benefits from the calcium, though. I did that about 2
    months after I started adding calcium to my diet. The cleanse was
    to help with some buildup on my intestinal wall that prevented me
    from absorbing nutrients as well as I could. Essentially I started
    taking a lot of psyllium combined with cascara (fiber + herbal
    laxative) to do this. Hope that answers your questions, Andrey and
    Harriet. :)

    1. Harriet Hall says:

      Bone pain is one of the symptoms of high, not low, calcium levels. Joint pain is not known to be a symptom of high or low calcium levels. You don’t tell us what your actual calcium level was before and after treatment; didn’t you even get a blood test? We have no way of knowing what might have caused your symptoms, but it is very unlikely that they were due to a calcium deficiency. I can only conclude that you made a post hoc ergo propter hoc error. You had the symptoms, you used calcium, you got better; but you don’t know that you wouldn’t have gotten better anyway without the calcium.

      There is no such thing as “buildup on the intestinal wall.” The intestinal wall cells renew themselves every couple of days, and anything adhering to the wall would slough off with them. No one has ever documented any kind of “buildup” – in fact, surgeons, endoscopists, pathologists (doing autopsies) and radiologists are constantly observing the intestinal wall and they have never seen any such thing. You have no evidence that you weren’t “absorbing nutrients as well as you could.” In fact, your self-treatment is more likely to have impaired nutrient absorption than to have improved it. Fiber speeds the passage of food through the GI system and allows LESS time for nutrient absorption, and taking laxatives regularly can cause harm in various ways.

      I can only guess that you have been getting false information from some quack source. The misinformation hasn’t hurt you yet, but it might. I suggest you find a science-based doctor to advise you.

  14. Tina Johnson says:

    @Harriet If the pain were a result of high levels of calcium, wouldn’t taking calcium supplements just make it worse, not better? Why do you seem so quick to go on the attack for everything other than what you think is right?

    Sure, getting better at the same time could’ve been what happened. However, the fact that I was dealing with this pain for a very long period of time, and that it wasn’t until I started all of this that I started feeling better leads me to believe otherwise. Correlation is not causation, I know, but still. I tend to rely on my body to tell me what is working for it and what is not. If I eat a piece of fruit and feel energized, I tend to believe that the energy is coming from the fruit.

  15. Harriet Hall says:

    @Tina,
    Yes, if the pain were due to high calcium levels, the pills would have made it worse. That was my point. Only high levels of calcium, not low levels, can cause bone pain. Therefore we must assume that your pain had nothing to do with calcium.

    I didn’t mean to “attack” you, but only to correct the misinformation you have been given and point out your errors in thinking. Please see items 5 and 6 on today’s post. When I am wrong about something, I appreciate having it pointed out to me. It is a great source of joy to me to learn that I have been wrong and have been able to correct my errors and learn more about how the world really works.

    This is a science-based medicine website. When you make a statement here that is based on false information or faulty thinking, you must expect it to be challenged. Even if you are not willing to question your beliefs, we want to try to correct the record for the benefit of others who are reading the comments.

  16. Dr. Hall beat me to it, but the reason for my question was identical to hers.

    Yes, correlation does not equal causation yet you are stating it does and acting as if it does. You literally just stated something correctly and then stated you choose to ignore it.

    And yes, high calcium actually does cause pain. The point was that anything you were feeling was very unlikely to be because of the calcium since it simply doesn’t fit the picture.

    And it is not what Dr. Hall thinks – it is what many decades of science and understanding tell us. I do find it so strange that people will watch a court/legal drama on TV and chime in readily when the evidence doesn’t fit the perp’s story and be happy to go along with how the story must fit the evidence and the facts of reality as we know them. But then when it comes to their body they think that all those principles just go to the wayside and whatever we can imagine happens and whatever we think works does.

    If I eat a piece of fruit and feel energized, I tend to believe that the energy is coming from the fruit.

    There is simply no rational basis for this conclusion. The only reasonable conclusion from this is that you liked the fruit and the yummy taste lifted your spirits.

  17. Tina – If I eat a piece of fruit and feel energized, I tend to believe that the energy is coming from the fruit.

    AP “There is simply no rational basis for this conclusion. The only reasonable conclusion from this is that you liked the fruit and the yummy taste lifted your spirits.”

    @AP – Are you being ironic? You not actually saying that calories can’t give you energy, right?

    1. No, I am not being ironic. I was reading a little bit into the comment though. The implication was that there was a lack of energy and then eating fruit in very short order “energized” the person. It is simply physiologically impossible for those calories to be the cause of it. It takes – in the most ideal of circumstances – a minimum of 30-60 minutes to even begin getting the calories from something you just ate. I could be wrong, but I doubt that Tina meant that she felt lethargic and then ate a piece of fruit and an hour later felt “energized” because that would be rather mundane, wouldn’t it?

      It is similar to when I didn’t have time for my coffee in the morning before heading off to the hospital. I am quite lethargic and get a headache (I readily admit I have a caffeine addiction and really need my 2 cups in the morning every day). When I get a coffee, I take a few sips and immediately feel better. That is actually a specific type of placebo effect, induced by Pavlovian classical conditioning (which I may know a thing or two about and is a constant topic every time I meet someone new…). I know to expect to feel better after getting my caffiene so I get an anticipatory boost in my mood. Interestingly enough, I found out not too long ago that at my hospital most of the free “coffee” (yes it deserves quotes) dispensers are decaf. When I have a sip of that I immediately feel better and then lethargic again later. The anticipatory placebo effect is short lived. And now that I know which ones are decaf, I don’t even get that from them anymore.

      1. @AP
        Firstly
        “I found out not too long ago that at my hospital most of the free “coffee” (yes it deserves quotes) dispensers are decaf.”

        This is just cruel. Clearly the person who came up with that plan should be tested for psychopathic tendencies.

        Secondly – I guess I had assumed that Tina was expressing a similar experience to that of my shaky/food/better experience. Which isn’t an immediate response, just an observable correlation.

        I guess, In my mind the central idea is this. TJ wrote “Correlation is not causation, I know, but still. I tend to rely on my body to tell me what is working for it and what is not. ”

        The over all point, that I suspect we would agree to is that sometimes correlation does equal causation. Sometimes it does not. If a person notes right quadrant pain awhile after eating greasy food, there is a good chance there is causation…maybe not so much if they note right quadrant pain after see a zebra (this is supposed to be an example of an implausible mechanism). One would either suspect that the pain/zebra connection is either coincidence or a conditioned autonomic nervous system* response. Your average joe or jane, like me, has very little idea which correlations are plausibly causative, although we might suspect – pain/zebra, not so much. But, sometimes it even takes the knowledge of a specialist to tease out more difficult conditions.

        So, my main concern is that, as a patient, I want to be able to tell my doctor about correlation’s that I’ve noticed with symptoms or symptom relief. I don’t want that information to be ignored. But it’s important for me to keep in mind that being committed to the idea that the correlation is important, equal to causation, or causative by my preferred mechanism** may undermine a doctor’s attempt to find a real solution to my problem.

        As an aside, from a laymen’s perspective anyone who’s experiencing significant, ongoing, unexplained “bone pain” should see an MD to rule out dangerous conditions…not mess about with self prescribed supplements and cleanses.

        my apologies AP – I’m afraid this will come across as a lecture. It’s not. I doubt you very much disagree (although you are fee to disagree). It’s just a thought process I’m working through that was triggered by the exchange between you and TJ.

        *I am learning that the autonomic nervous system is very mysterious. I suspect it is the next quantum.

        **such as – zebra’s cause right quadrant pain due to an allergic reaction to air borne e-coli.

        1. ^^ On pain/zebra correlation. well, unless the zebra kicks you in the gut, that would be a plausible causative trigger of abdominal pain…I just knew that example would fail in some way.

      2. AP “When I get a coffee, I take a few sips and immediately feel better. That is actually a specific type of placebo effect, induced by Pavlovian classical conditioning (which I may know a thing or two about and is a constant topic every time I meet someone new…). I know to expect to feel better after getting my caffiene so I get an anticipatory boost in my mood.”

        As an aside – I was under the impression that expectancy and classical conditioning were considered separate mechanisms of placebo effects that could combined, could create larger effects, but could operate independently. Meaning, that even knowing the coffee is caffeine free, the stimuli of hot, morning coffee tasting beverage may provoke a conditioned caffeine like response. But, having interrupted the conditioning with non-caffeine hot morning coffee tasting beverages, your conditioned response dwindled. I only make this observation because I think conditioning is very interesting and useful concept, expectancy…I admit, I feel is overrated. At least IME. Sorry, know that’s a big tangent. Perhaps food for discussion another time.

  18. weing says:

    @MTR,
    The subjective sensation of being energized has nothing to do with the energy content of the food. Most of us have plenty of energy stored as fat to meet the needs of the cellular machinery. The sensation could be a reward for bringing in more energy to the body.

  19. @weing – “The subjective sensation of being energized has nothing to do with the energy content of the food. Most of us have plenty of energy stored as fat to meet the needs of the cellular machinery. The sensation could be a reward for bringing in more energy to the body.”

    Am I weird, then? I sometimes get that weak shaky feel when I skip a meal. When I eat, I feel better – takes about a 1/2 hour, though. Of course that’s not particular to fruit, just about any non-sugary food will do.

    1. duggansc says:

      Same here. I’ve occasionally even gone through a rush and a crash from items that don’t have a huge amount of sugar in them. But then again, I was also one of those kids who risked fainting if he skipped breakfast due to low blood sugar. It’s gotten better as I’ve gotten older (and probably as I’ve gained more fat to tide my body over), but I still burn through my energy reserves from eating really quickly.

      Of course, that could all be psychological from years of considering myself a “big eater”.

      1. A couple times I have eaten very sugary foods (like a large donut) on an empty stomach and felt very ill, intense nausea, shaky. Now I just don’t eat sugary food on an empty stomach. I know many people can, though. But it certainly didn’t seem psychological (I wasn’t thinking – “oh this donut is so sugary it will make me sick.” I was thinking “oh breakfast, a donut sounds good.”)

        Oh course, once you have an intense nausea reaction, the conditioning is pretty strong to repeat (think about the food you ate that caused you food poisoning) So further testing of morning sugary food exposure seems pointless.

        Regardless, I thought that a physiological reaction (as opposed to a purely cognitive reaction) to sugary food on an empty stomach was within the “normal” (although not necessarily healthy) range of human biology.

        1. weing says:

          “A couple times I have eaten very sugary foods (like a large donut) on an empty stomach and felt very ill, intense nausea, shaky.”

          It may vary with the type of donut, but usually the majority of calories in a donut come from fat.

          1. weing – you are not helping ;) The first bad donut was some sort of glazed spiral thing. The second bad donut was a crispy creme type chocolate frosting donut. In both cases the reaction was not immediate, it was more like: eat donut (yum), wander up to class, sit and draw for awhile, gradually feel shaky, nauseous, weak, etc. The first time I went home and laid down and felt better eventually. The second time I ate something that seemed less sugary and felt better eventually.

            I can eat any kind of donut I want if I’ve eaten something like peanut butter and toast maybe a 1/2 hours or more before.

            I guess I always assumed it was the sugar and that it wasn’t unusual. Not that I’ve looked into that much, beyond reporting it to my doctor to make sure it wasn’t something like diabetes. It’s kinda like the joke. Doctor, doctor, it hurts when I do this!

    2. Harriet Hall says:

      Sometimes I get that weak shaky feeling, and it is relieved by eating something. I assumed it meant my blood sugar was low until I tested it during one of those episodes and it was smack dab in the middle of the normal range.So now I have no explanation.

      1. WilliamLawrenceUtridge says:

        …and because you are a skeptic and trained critical thinker, you admit ambiguity and uncertainty, rather than reaching for a soothing but ultimately arbitrary explanation.

        Here endeth the lesson.

      2. agitato says:

        Interesting. I’ve always assumed that weak shaky feeling relieved by eating was due to low blood sugar too. Did you only test yourself once?

        1. Harriet Hall says:

          Only once. I had no reason to suspect the test might be wrong, and I thought I had proven my hypothesis wrong. Now that you have asked, I think I will repeat the blood sugar test the next couple of times I feel that way, just to be extra sure.

          1. I’m not particularly committed to the blood sugar idea, but I wonder if the feeling could be caused by a drop in blood sugar that is still in the normal range (from high/normal to normal). Seems like that could require a lot of testing though. :)

            For me I don’t know. I’ve never been tested when feeling shaky. I do know, from standard blood tests that my glucose levels are typically normal range.

            Alternately, I wonder if it could be a blood pressure issue similar to visovagel synocope, that is neutralized by triggering the body to increase blood supply to the digestive track?…(but maybe that is a silly idea, my biology isn’t strong enough)

            Regardless, I will assume that I am genuinely feeling shaky then better after eating (regardless of the biology behind the feeling) until shown other wise.

  20. Andrey Pavlov says:

    Mouse:

    You should know me better by now. You especially always deserve the principle of charity, so no I do not feel you are lecturing me or any other such negative idea.

    Also pardon errors and brevity, I am on my tablet on an airplane. And my tablet does not play so nice with the new format here. I love wifi on the plane though. Can’t wait to implant a chip in my head. :-D

    As for the coffee thing… Yes, very cruel. And truly a terrible coffee substitute with no caffeine to boot. Thankfully I discovered that the ICU has real coffee and I like to spend my time there anyways.

    I suppose I could have been reading into Tina’s comment unfairly. But in the same vein as your discussion of the word holistic, the same with mine of such correlations and using the word energized.

    I absolutely agree that most people do not have an understanding of what is reasonable correlation to causation in human biology. That is why we go to medical school, after all. So I very much encourage my patients to tell me every little thing they can. It its their job to tell me everything the know and feel and mine to put that together into a diagnosis and management. I actually got into an argument with sometime last year who claimed that he knew more about his body than I ever could. I that was ridiculous. He knows things I don’t and can’t, but certainly not more. He disagreed. To prove my point I put my finer on his chest and asked him to name every single tissue layer, anatomical structure, the histology, molecular make up, in order from front to back and what could go wrong in each layer. So yes, tell me everything and don’t be worried that you might be making poor associations. Just let me put the pieces together at the end is all.

    As for the conditioning and the coffee, yes. Initially the effect would remain. But it fades over time. For me it was pretty quickly. The technical term – which doesn’t sound so technical – is extinguishing. The key is consistency. If the negative association its consistent then it can be extinguished. If there are randomly times when caffeine actually was there it would be harder to extinguish. Which is the entire basis of slot machines. So you are pretty spot on. Is just that in my case I need that damned caffeine!

  21. AP “I actually got into an argument with sometime last year who claimed that he knew more about his body than I ever could. I that was ridiculous.”

    Seems to me there is your typical Dunning Kruger, where people over estimate what they know because they are not familiar enough with the field to know all they don’t know. In that form, people are generally amiable enough to admit it (at least to themselves) when they see evidence of their knowledge deficet.

    Then there’s some kind of pathological form of Dunning Kruger where people are blind to that deficit, regardless of the evidence presented to the contrary.

    In my mind it all comes to this, which is more important to you, curiosity or certainty?

  22. @AP – Also, I never thought you were uncharitable. Sometimes I’m just not sure how well my writing has conveys the tone I’d like.

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