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The infiltration of complementary and alternative medicine (CAM) and “integrative medicine” into academia

A few years back, my co-blogger Wally Sampson wrote a now infamous editorial entitled Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded. When I first read it, I must admit, I found it to be a bit harsh and–dare I say?–even close-minded. After all, plausibility aside, I believed at the time that the only way to demonstrate once and for all in a way that everyone would have to accept that many of these “alternative” therapies were no more effective than a placebo would be to do high-quality randomized clinical trials to test whether they worked, and NCCAM seemed to be the perfect funding agency to see that this occurred. Yes, this attitude in retrospect was quite naïve, as I have since learned the hard lesson over several years that no amount of studies will convince advocates of complimentary and alternative medicine (CAM) that their favored therapy doesn’t work, be it chelation therapy for autism or cardiovascular disease, homeopathy, reiki, or various other “energy” therapies that invoke manipulation of qi as a means of “healing,” such as acupuncture, but that is what I believed at the time.

Why are CAM or “integrative therapies” so immune to evidence? One reason, of course, is ideology or even a religious component to devotion to these therapies, which is not surprising given that the whole concept of qi, a “life force” that science thus far has been utterly unable to detect but that “healers” claim to be able to manipulate for therapeutic effect, is far more religious in nature than scientific. Another reason is that many of these therapies were developed in pre-scientific cultures, long before germ theory and a much better understanding of human biochemistry and physiology led to therapies, both pharmacologic and surgical, that actually cured disease. Finally, according to the research studies of John Ioannidis, who has pointed out that it is not uncommon for random chance alone, coupled with the definition of statistical significance of p less than 0.05 can for hypotheses with an 80% chance of being false result in a 25% false positive rate, even if the studies are designed perfectly. Given that the prior probability of most CAM therapies being more effective than a placebo, based on scientific plausibility alone, is almost always less than 20%, that means the false positive rate for CAM research will be even higher, producing many studies that advocates can cite, while ignoring the totality of the evidence. Indeed, as I write this, we have a commenter pointing to such studies for purely “energy” medicine.

Dr. Sampson reminded me of this problem in his post last week about the infiltration of CAM into academic medicine. I’m extremely grateful for the historical perspective for a relative newbie to this debate. While I have only started to become alarmed at the infiltration of unscientific nonsensical CAM therapies being promoted and administered in academic medical centers as though they had evidence supporting them anywhere near the level of evidence expected for “conventional medicine,” Dr. Sampson first noted this trend in the 1980s, when I was in medical school and too busy learning medicine to bother worrying about trends in medical education and academia. It was a trend that continued into the 1990s, when I was similarly too busy doing my residency, PhD, and fellowship. It was only a couple of years ago that I started to become alarmed at this increasing acceptance of non-science-based and non-evidence-based therapy when I noticed them being offered at my own hospital.

Let’s get one thing straight right at the outset. I’m not opposed to teaching about CAM modalities in medical school. After all, many of our patients take various herbal remedies, and it’s important to know how they might interact with drugs or other treatments that we prescribe. Other patients may be using other CAM modalities besides herbs or supplements, and it is important to be able to discuss them. The key, however, is to think critically about these modalities, and, unfortunately, teaching the next generation of medical students to do this is something that academic centers teaching CAM (or, as it is being called more and more lately, “integrative medicine,” which to me is “integrating” unproven therapies with the proven to no benefit that I can detect) appear to be failing at utterly. Indeed, as Dr. Sampson and others have documented, very few CAM or “integrative medicine” programs actually teach a critical, evidence- and science-based appraisal of these therapies. Sadly, this teaching seems to be having an effect. There is at least some evidence that far too many medical students appear to be enthusiastically embracing non-evidence-based CAM therapies, as was reported by Chaterji et al in 2007, in which they found that 91% of medical students agreed that “CAM includes ideas and methods from which Western medicine could benefit.” (I wonder what ideas those are. The concept of qi, the undetectable life force that, it is claimed, various therapies can manipulate to therapeutic intent, perhaps?) Nor am I ideologically opposed to studying the more plausible therapies in randomized clinical trials. My concern about the current situation is that it is wasteful to allocate scarce research dollars to study after study therapies that are so highly implausible on the basis of science (such as homeopathy or reiki, for instance) when such money could be used to study more promising therapies and that the introduction of the less outlandish CAM therapies serves as a Trojan horse to let in the whole package, homeopathy, reiki, and all.

But how entrenched has CAM become in academic medicine in the U.S.? Certainly it’s become entrenched enough that alternative medicine mavens in the media, such as Julie Deardorff of the Chicago Tribune, have noticed. In fact, it’s becoming so noticed that national news magazines, such as the U.S. News & World Report, have published articles about the seeming embrace of these therapies by academia, articles that start out like this:

To be blunt, if my wife and I didn’t think it was helping him, we wouldn’t have continued with it,” says Dan Polley. He’s talking about Mikey, the Polleys’ 2½-year-old in the next room, who was diagnosed with acute lymphocytic leukemia when he was 6 months old. Chemotherapy, radiation, and a bone marrow transplant have been crucial elements of Mikey’s treatment. But the “it” his father speaks of is nothing like these aggressive, costly, and heavily researched exemplars of western care—it is a kind of touch therapy, from the camp of alternative medicine. Gentle and benign, “healing touch” is intended to rebalance the energy field that its practitioners believe surrounds the body and flows through it along defined pathways, affecting health when disrupted. Several times a week, therapist Lynne Morrison spends 20 minutes unblocking and smoothing Mikey’s energy field, which energy healers like Morrison say they can feel and correct.

This scene took place at, of all places, Children’s Memorial Hospital in Chicago, which is affiliated with Northwestern University. Moreover, this article is peppered with quotes from believers like Andrew Weil, who says: “I teach and urge people to use a sliding scale of evidence…The greater the potential to cause harm, the greater the standard of evidence should be.” One can hardly fail to note that, by that standard, homeopathy, which is, after all, nothing more than water, should require no evidence whatsoever. However, the article, in my mind, provided a more compelling reason than Wally Sampson’s original article, why NCCAM should be defunded and its functions folded into the rest of the Institutes and Offices of the NIH: NCCAM is actively promoting the teaching and adoption of “alternative” medicine in academic medical centers before science has validated the vast majority of its therapies:

Until the mid-1990s, most academic centers treated CAM like a pack of scruffy mutts, noisy and unworthy of notice. A large pot of federal and foundation research funds—now close to $250 million per year just from NCCAM and the National Cancer Institute, plus tens of millions more from private donors such as the Bravewell Collaborative—helped turn that sniffy attitude into solicitous attention, says longtime CAM commentator Donald Marcus. “The funding gave them respect from the medical school community,” says Marcus, a professor of medicine and immunology at Baylor College of Medicine in Houston, where he has long taught a CAM course. A survey of hospitals found that 27 percent offered CAM in 2005, up from 8 percent in 1998. At the Cleveland Clinic, for example, NIH money is behind a clinical trial to see whether reiki, another energy therapy, can reduce stress and anxiety in prostate cancer patients.

Enough money will do things like that, and the results have been startling. As an exercise, I set out to get an estimate by looking for centers of “integrative medicine” or CAM. It didn’t take me long to find at least 44 different such centers that offer and/or teach CAM. Indeed, I’m sure that the list that I am about to present to you is nowhere near complete, given that it includes only CAM or “integrative medicine” centers that are easily locatable through web searches and given that I didn’t wade too deeply into Google to find every last one. With those qualifications, here is the list that I came up with:

  1. The Cleveland Clinic
  2. The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, Columbia University
  3. Cornell University Center for Complementary and Integrative Medicine
  4. The Continuum Center for Health and Healing, Albert Einstein College of Medicine of Yeshiva University
  5. Duke Integrative Medicine
  6. Henry Ford Health System (affiliated with the University of Michigan)
  7. Georgetown University Medical Center (discussed here)
  8. Harvard Medical School Osher Institute, Division for Research and Education in Complementary and Integrative Medicine
  9. Jefferson-Myrna Brind Center of Integrative Medicine, Thomas Jefferson University
  10. Mayo Clinic Complementary and Integrative Medicine Program
  11. Memorial Sloan-Kettering Cancer Center
  12. MindBody Patient Care Program, New York University
  13. Integrative Medicine Program, Children’s Memorial Hospital (Northwestern University)
  14. Northwestern Memorial Physicians Group Center for Integrative Medicine (Northwestern University)
  15. Beaumont Hospitals Integrative Medicine Program, Oakland University
  16. The Ohio State University Center for Integrative Medicine
  17. Oregon Center for Complementary and Alternative Medicine in Neurologic Disorders, Oregon Health and Science University (Also, the OHSU Center for Women’s Health Integrative Medicine Program)
  18. Scripps Center for Integrative Medicine
  19. Stanford Center for Integrative Medicine
  20. Complementary & Alternative Research and Education Program, University of Alberta (pediatrics, yet!)
  21. University of Arizona Program in Integrative Medicine
  22. Susan Samueli Center for Integrative Medicine, University of California, Irvine
  23. University of California at Los Angeles Collaborative Centers for Integrative Medicine
  24. Osher Center for Integrative Medicine, University of California, San Francisco
  25. University of Colorado
  26. University of Connecticut Health Center (where a “debate” about homeopathy was recently held)
  27. Department of Integrative Medicine, Hartford Hospital, University of Connecticut
  28. University of Maryland Center for Integrative Medicine
  29. The Integrative Care Project, University of Kentucky Colleges of Medicine and Health Sciences
  30. University of Massachusetts Medical School Center for Mindfulness
  31. Institute for Complementary & Alternative Medicine, University of Medicine and Dentistry of New Jersey (UMDNJ-ICAM)
  32. University of Michigan Medical School
  33. University of Minnesota Center for Spirituality and Healing
  34. University of New Mexico School of Medicine, Section of Integrative Medicine
  35. Program on Integrative Medicine, University of North Carolina
  36. PENNCAM, University of Pennsylvania
  37. Center for Integrative Medicine, University of Pittsburgh Medical Center
  38. University of Texas Medical Branch Complementary & Alternative Medicine Project
  39. University of Texas M. D. Anderson Cancer Center Integrative Medicine Program
  40. University of Washington School of Medicine Integrative health Program
  41. University of Wisconsin Integrative Medicine (whose webpages seem to have been deleted but still come up when a search is done using the University web page’s search engine; what this means is unclear)
  42. Vanderbilt Center for Integrative Health
  43. Wake Forest Baptist Medical Center Program for Holistic and Integrative Medicine
  44. Center for Integrative Medicine at the George Washington University Medical Center

Of course, sheer number of programs matter relatively little. What really matters, at least to me, is what is being offered to patients and/or taught to students, residents, and fellows through these programs. So I did a little perusing. The first thing that became immediately apparent is that nearly all of the centers or programs above either offer to patients or teach all or most of the following CAM modalities:

  1. Acupuncture
  2. Guided imagery
  3. Massage therapy
  4. Nutritional counseling
  5. Tai Chi
  6. Yoga

The inclusion of these modalities as first choices in “centers of integrative medicine” is not surprising for two reasons. First, they are fairly harmless for the most part. Second, there is some evidence to support some of them. Indeed, some of them (guided imagery and nutrition, for example) are not necessarily even “alternative” but really should be considered part of “conventional” medical therapies. And, of course, massage therapy, outside of the possibility that it might have a therapeutic effect in certain conditions, at the very minimum feels very good, while Tai chi and yoga can be viewed as low impact exercise, and are probably also at the very least not harmful. Finally, who can argue with nutritional counseling? And why is nutritional counseling considered “complementary,” “alternative,” or “integrative,” anyway? Nutrition is a part of conventional medicine, whether alternative medicine mavens believe it or not. Of course, it depends upon what exactly patients are being told. If they’re being told that megadoses of this supplement or that will treat cancer, then that’s what I call “alternative” nutrition, rather than good, old-fashioned, boring, science-based nutrition. Overall, though, among CAM therapies, the above subset appears to include modalities chosen because they are the least bizarre and therefore the most “safe” for consumption by academic physicians.

To go a step further and find out how much truly unscientific medicine there is in academic medical centers, I decided to identify which centers, if any, either offered to patients or taught uncritically two of the most scientifically implausible of all CAM modalities: homeopathy (which is nothing more than a highly ritualized placebo in which a “remedy” is, as homeopaths will now admit, diluted to the point where there is not a single active molecule left) or reiki therapy (which postulates that a reiki master can somehow manipulate the flows of qi, or the life energy of the patient for therapeutic effect). Note that therapeutic touch, “healing touch,” and a variety of other “energy-based” healing modalities are very similar to reiki in that they postulate that there is some sort of “life force” that the healer can manipulate for therapeutic intent. Neither of these treatment modalities are supported by science. For example, for homeopathy to work, much of what we know about physics, chemistry, and biology would have to be wildly wrong. I therefore chose these two modalities, which are probably the most common of CAM/integrative medicine modalities with the least scientifical plausibility as a weathervane of sorts, to see which way the wind was blowing with respect to seriously non-evidence-based mystical fluff finding its way into medical schools as serious treatment options. The results were disturbing, to say the least, particularly what some of these ostensibly “academic” centers wrote about these modalities on their websites. Here are the medical centers that offer and/or teach reiki or some other form of “energy medicine,” along with what the each program’s web page says about it, if anything:

  1. Cleveland Clinic: “Reiki is a method of energy-based healing involving the laying on of hands by the practitioner, promoting a deep sense of relaxation for the client. Reiki can help patients access their abilities to promote their own healing in body, mind and spirit.”
  2. Integrative Medicine Program, Children’s Memorial Hospital, Northwestern University: “Our bodies are always trying to move toward balance and health. Energy healing encourages the flow of our natural energies. The term “energy healing” covers a wide range of styles and techniques which serve to positively affect the human energy field. Hands-on energy work assesses disturbances in the human energy field, and helps to aid the individual’s body to enhance the natural flow of healthy life force. Patients and their families report that energy healing often provides a sense of deep relaxation, and reduction in the experience of pain. Energy healing is also called “touch healing” in our studies. Research is presently being conducted to provide evidence to show how the disturbances and movement of these subtle energies may affect the physical condition of the human body.”
  3. Albert Einstein College of Medicine: “I use Reiki in addition to other healing practices to help my patients activate their innate capacity for self-healing. By promoting a relaxed and peaceful state, stress is decreased, immune function is enhanced and the body has a greater ability to heal. As a practitioner I also benefit from this work; through centering myself I feel both calm and energized.” Aurora Ocampo, MS, RN, CS
  4. Duke University: Reiki is a spiritual healing practice that helps restore emotional, mental, physical, and spiritual balance. “Rei” means universal or highest and “Ki” means subtle energy. Practitioners learn to channel primordial chi (or Tao), which may be thought of as universal consciousness. Essentially, both practitioner and client enter a space of meditation so that spiritual, mental, emotional, and physical healing is facilitated…The practitioner lays hands on several different places on the body for several minutes at a time as the individual lies fully clothed on a massage table. People typically feel very relaxed and peaceful during a treatment, and sometimes fall asleep. After a one of two day class from a reiki master, individuals can begin to practice reiki on themselves and others. This is recommended for people with chronic illness or chronic stress so that daily practice is possible to create more peace and support the ability of the physical body to heal itself.”
  5. Beaumont Hospital: Energy balancing is a complementary method that focuses on promoting health and well being and decreasing responses to stress, anxiety and pain. During these relaxing, non-invasive techniques, the practitioner very gently places her hands in a series of positions on what are believed to be the energy centers/pathways of the body. Contemporary research in this area show some of common responses to treatment include: induced relaxation and calmness; reduction in stress and pain; promotion of wound healing.”
  6. Scripps Center for Integrative Medicine: “In use at Scripps since 1993, Healing Touch is an energy-based, non-invasive treatment that restores and balances energy to help decrease pain and relieve associated anxiety. Healing Touch is performed by registered nurses who recognize, manipulate and balance the electromagnetic fields surrounding the human body, thereby promoting healing and the well-being of body, mind and spirit. Healing Touch is often used as an adjunct to surgery and other medical procedures to assist in pain reduction, relaxation and healing.
  7. University of Connecticut Health Center
  8. University of Maryland
  9. UMDNJ: “Reiki is the natural healing energy that flows through the hands of the Reiki channel in a powerful and concentrated form. Reiki functions on all levels of a person’s being and adjusts itself according to the needs of the recipient, helping them to take responsibility for their life and to make changes in attitude and/or lifestyle to promote a happier and healthier life.” (At least they say that electromagnetic therapy is not scientifically unproven.)
  10. University of North Carolina-Chapel Hill
  11. University of Texas M.D. Anderson Cancer Center
  12. University of Wisconsin
  13. George Washington University: “The purpose of Reiki is to promote the client’s own natural healing process by providing deep relaxation, abatement of signs or symptoms of distress, or a sense of harmony or balance. Reiki can be used in conjunction with any other treatment to enhance and accelerate its effectiveness.”

Next, here are the medical centers that offer and/or teach homeopathy, along with what they say about it on their websites (that is, if they say anything at all):

  1. Thomas Jefferson University: “Homeopathic medicines are intended to stimulate the body’s own healing abilities. Homeopathy utilizes a wide range of mostly naturally occurring substances such as plants and minerals. These medicines are prepared through a specific process of stepwise dilution. Many homeopathic medicines contain only an infinitesimal amount of original substance. Although the mechanism by which these “ultradilutions” can work is unexplained, studies have been published in medical journals showing homeopathic medicines may provide clinical benefit.”
  2. University of Connecticut Health Center
  3. University of Maryland
  4. UMDNJ It doesn’t appear that UMDNJ actually offers homeopathy, at least not as far as I can tell, but this is what its website says about it: “Samuel Hahnemann, a German physician conceived the practice of homeopathic medicine, in the late eighteenth century. It was developed in response to the horrific medical practices of the time and is based on the Law of Similars, or ” like cures like”. It embodies the idea that large doses of a substance cause a symptom, and very small doses of that same substance can cure it. Hahnemann and colleagues gathered volumes of descriptions of the symptoms caused by the ingestion of various plants, minerals, animal products, and other substances. When a patient came into the clinic with a series of complaints, these texts were consulted, and the preparation that caused the most similar response was given to the patient. These books, called Homeopathic Pharmacopoeia, are the basis of modern homeopathic therapy. The focus of homeopathy is on the symptoms. Symptoms are seen as attempts by the body to restore health…It works slowly and is thought to have a number of systematic benefits. Homeopathic medicine is very individualized. Treatment is based on the person’s response to the disease, so the actual cause of the disease is not a focus. Remedies are very dilute substances, which are prepared through a process of potentization, which involves repeatedly diluting with either water or alcohol and shaking a remedy (perhaps 100 times). Some solutions are diluted as low as (10)-30 or (10)-20,000. Various homeopathic medicines have been incorporated into modern conventional medical practice. Nitroglycerin was first used as a medicine by a homeopath. Digitalis and gold salts are other examples.”
  5. University of North Carolina-Chapel Hill
  6. University of Washington School of Medicine: “When dilutions greater than 24x or 12c are prepared, basic chemistry holds that it is unlikely than even a single molecule of the original substance is still present in the remedy, leading many to question how such a therapy could work. Homeopathic theory explains that the vigorous shaking or succusions leave an imprint of the substance being diluted, and that it is this imprint which can stimulate healing in the body, stimulating the body’s own healing responses.”

This is by no means a complete list of schools offering “energy medicine” or homeopathy. One reason is that many of the sites don’t list the actual modalities that are offered. Instead, they describe their programs using vague generalities about offering multiple CAM modalities or about “integrative consultations.” Also, I didn’t exhaustively peruse each website, although I do note that in my surfing not a skeptical word was found. Some may say that it’s really not so bad that I found five, maybe six at the most, medical schools or academic medical centers that offer homeopathy to patients and/or teach it to trainees. That anyone in academia would think that shows just how far we’ve fallen. Personally, I found it truly depressing that even a single medical school teaches homeopathy uncritically and offers it to patients. After all, even NCCAM admits the scientific implausibility of homeopathy and has funded only one study of homeopathy.

I also looked at miscellaneous CAM modalities while perusing all these websites and noticed that there are even a couple of centers offering reflexology, including the University of Maryland and the University of Pittsburgh, the latter of which advocates it for migraines, hypertension, fibromyalgia, and menstrual cramps, among other things. One (the University of Wisconsin, whose integrative medicine pages appear to have been removed since I first started researching this post) even made a totally unsupportable statement about CAM for cancer about “choosing therapies that help prevent cancer or prevent a recurrence,” where preventing a recurrence is something for which there is no good evidence that CAM do. One other (Thomas Jefferson University) even touts Rudolf Steiner’s anthroposophically Extended Medicine. Sadly, that’s not all. I found the University of Maryland offering craniosacral therapy, while UCSF offers spinal manipulation. Meanwhile, the Susan Samueli Center for Integrative Medicine at UC Irvine claims to be able to treat depression, hypertension, leukopenia, schizophrenia, allergies, diabetes, and cornucopia of other conditions.

After looking over these websites, I came to the conclusion that the vast majority of university hospital-based CAM programs appear not to apply a critical, scientific view to CAM modalities. Rather, the impression I get is that the faculty in most of these programs are probably believers. Indeed, I found very few indications of any serious scientific examination of whether these CAM therapies actually work (i.e., result in more of an effect than a placebo for real disease or pathology). Worst of all, instead of first asking, “Do these therapies work?” these programs seem to be assuming that they do work and then asking either “How do these therapies work? or “How can we combine these therapies with conventional therapies?” A quote from the U.S. News & World Report article epitomizes this attitude:

Those who work in academic CAM programs freely concede there is much about CAM that they do not comprehend—yet—but they also argue that the standards of western medicine should not block its use. Just because all of the evidence isn’t in, says Donald Abrams, director of clinical programs at UCSF’s Osher Center, “should I never try these therapies with my patients?”

Not only is that a combination of a straw man argument and an appeal to other ways of knowing, but it’s also putting the cart before the horse and of questionable ethics to boot. One of the most accepted principles of medical ethics is that, unless a therapy has solid evidence to support it, that therapy should not be offered to patients outside of the context of a clinical trial designed to study its efficacy. Yet, here we have a respected physician arguing that unproven therapies shouldn’t be denied to his patients. He would have a point if there were compelling, but imperfect, evidence that they might work, but such is not the case. I would respond to him by saying that he could do basic science and randomized clinical trials to test these therapies but that he shouldn’t be offering them to patients outside the context of a clinical trial.

One question that remains after looking at the increasing acceptance and even boosterism for CAM and integrative medicine in academia is a simple one: Why? Insurance doesn’t pay for the vast majority of these therapies, insurance companies, whatever their greed and other well-known shortcomings, having decided that there is no evidence that they work. Consequently, it’s cash on the barrelhead for academic medical centers reeling from recent cuts in Medicare and Medicaid reimbursement.

Still, that’s not enough to explain it. So what is? It turns out that, if you look closely at these centers, many of them are the result of a donation or endowment from a wealthy donor (or donors), as is the case for Duke University, Thomas Jefferson University, Columbia University, UC Irvine, Children’s Memorial Hospital, just to name a few. If it’s not a wealthy donor, it’s the Bravewell Collaborative. Also not to be underestimated is the publicity and marketing clout that having a famous media doctor, such as Andrew Weil or Mehmet Oz on the faculty provides. Alternatively (if you’ll excuse the term), it’s NCCAM funding that drives the creation of these centers, which is a reason why I’ve become less hostile to Dr. Sampson’s view than I used to be. As he points out, the assault on science-based medicine being taken to the very heart of academia appears to be part of a broader agenda designed to transform the very nature of medicine away from science and evidence, and, either willingly or as a useful but unwitting ally, NCCAM appears to be doing a lot to promote this transformation. Remember, NCCAM was not created because scientists or doctors clamored for it; it was created because powerful politicians with a penchant for alternative medicine demanded it.

The final question that inevitably comes up in discussions of offering CAM at academic medical centers is: What’s the harm? Why be so negative? After all, patients seem to want it, and if it makes them happy, what’s the problem, as long as the therapies being offered appear to be harmless?

Academic medicine is supposed to be different. It is supposed to exist for the purpose of applying scientific principles to medicine and thereby making new discoveries to use to treat disease, testing them in clinical trials to find out if they are effective, and then applying them systematically. Uncritically introducing therapies that are by their very nature unscientific, therapies like homeopathy, reiki, reflexology, and “energy medicine” taints the entire scientific enterprise at these institutions. Worse, offering such therapies outside the context of a clinical trial in academic medical centers gives the patina of scientific credibility to therapies that have not earned it, promoting the impression that science supports their efficacy. Moreover, it is bandwagon medicine, where the therapy is offered and evidence is sought post hoc to demonstrate its efficacy. That this happens in “conventional” medicine as well (the rapid introduction of laparasocopic cholecystectomy 15-20 years ago, for example) and that it is driven by patient demand are not justifications for allowing it to happen for CAM as well. Neither is the fact that sometimes therapies adopted before clinical trials demonstrate efficacy (laparoscopic cholecystectomy again) do turn out to be an improvement. The adoption of CAM in so many medical schools, with many more clamoring to jump on the bandwagon, appears to be a step backward. Medicine has finally, after over a hundred years, evolved to the point where it can actually become truly science- and evidence-based. From my perspective, the growing uncritical acceptance of CAM in academic medicine is a major threat to the continuation of that evolution. There should be no such thing as “alternative” medicine, anyway. There is medicine that is effective, as determined by science and clinical trials, and there is medicine that is not or is as yet unproven. We should not be “integrating” the latter with the former, and especially not in academia.

Posted in: Basic Science, Clinical Trials, Energy Medicine, Medical Academia, Public Health, Science and Medicine, Science and the Media

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81 thoughts on “The infiltration of complementary and alternative medicine (CAM) and “integrative medicine” into academia

  1. inkadu says:

    Orac just blogged that article to over at insolent comment.

    Just a question to clear up some statistics. If there’s something that has absolutely zero credibility, as I’m assuming homeopathy does, how does it come out with 20% false positives? Shouldn’t it be closer to 5% with the .05 probability?

    I also think your points about the NCCAM needs to be sharpened into an actual political goal that can be pursued by doctors and anyone concerned with medicine. The fact is, as you point out, that NCCAM will continue to waste money on studies, they will continue to find (and produce studies) that point to “evidence,” and they will use this evidence both to promote CAM and to fund further studies. The rest of NCCAM’s money will be used to promote alternative medicine. You’re right — there is no good that will be coming out of this.

    So, any ideas of political allies? Maybe Concerned Scientists? National Medical Organizations? I think it’s important, when you have a movement with such broad-based appeal as CAM to have very specific targets.

  2. pec says:

    I had not realized that CAM had been infiltrating to this extent. Very encouraging to learn!

    You complain that CAM therapies are being used without adequate research, and at the same time you want to stop the funding! At last medical science is beginning to take energy medicine seriously, and are allocating money to research its claims. That’s great news.

    But you want the funding cut because you’re afraid people will believe the 20% of successful studies, with a p value of .05, that are false positives. Do you think anyone considers one p=.05 study to be conclusive evidence for a treatment?

    You are probably far less critical and skeptical of conventional cancer treatment, most of which causes great suffering and at best prolongs life a few months or years. The statistics that back up cancer claims are deceptive and misleading and have been fooling MDs, and the general public, for far too long.

    But the increased acceptance of CAM is evidence that people are getting tired of your false claims and your “any day now we’ll have the cure” promises.

    Life energy is real. Instruments designed to detect fields and energies already known to physics are not likely to detect it. Why would you expect an instrument to detect life energy that has not been designed for that purpose?

    If it’s true that living cells respond to life energy, then it should be possible to design methods of detecting and measuring it. Now that, as you pointed out, funding for CAM is increasing maybe these methods will be developed.

    You want to squash CAM because you’re afraid everything known to science will turn out to be wrong. That’s ridiculous. Some of it may need to be revised, and science is never complete and is, or should be, continually evolving. Why are you horrified at the possibility that fields and energies not yet acknowledged by mainstream science may exist?

    It’s great that they are researching reiki. Why does that offend you? If the research fails to show any benefit, reiki will be forgotten. You’re afraid the research will show positive results and the use of reiki, and other energy treatments, will be encouraged.

    Well if you’re so sure life energy is an illusion, then why try to pull the funding? Let it fail if you’re so sure it will fail.

    Your whole attitude is utterly dogmatic and unscientific.

  3. HCN says:

    Inkadu said “Orac just blogged that article to over at insolent comment.”

    I believe Dr. Gorski is aware of that.

  4. pec says:

    “If there’s something that has absolutely zero credibility, as I’m assuming homeopathy does, how does it come out with 20% false positives? Shouldn’t it be closer to 5% with the .05 probability?”

    .05 probability is twenty percent. When statistics show reliability with a probability of less than .05, that means there is an 80% probability that positive results occurred just by chance.

    However, scientists would never, or should never, cite the result of one study with a p value of less than .05 as definitively proving anything. .05 is the conventional cutoff point, with anything at or higher than .05 considered to be supportive of the null hypothesis.

    Of course there can also be false negatives = the p value may be greater than .05 even if there is a real effect. Either high variance or a low N can result in false negatives.

    Anyway, experimental science is difficult and seldom gives simple answers. We can gradually increase our knowledge, but the process tends to be slow and expensive.

    So let’s have more funding for CAM research!

  5. pec says:

    “there is an 80% probability that positive results occurred just by chance.”

    I meant 20%, not 80%.

  6. Harriet Hall says:

    David Gorski said he initially thought Wally Sampson’s article was “a bit harsh” but that he changed his mind about that.

    I’ve had the same experience with several of Wally’s statements over the years; every time I have disagreed with him and have investigated the facts further, I have been forced to admit that Wally got it exactly right. Every time I have thought he was too cynical, I’ve discovered that I was the one who was too naive.

  7. PalMD says:

    “It’s great that they are researching reiki. Why does that offend you? If the research fails to show any benefit, reiki will be forgotten. You’re afraid the research will show positive results and the use of reiki, and other energy treatments, will be encouraged.”

    That would be great, but for two problems.

    1) There is no scientifically plausible basis to wish to investigate Reiki.

    2) Woo is rarely, if ever, abandoned for lack of proof. For example, despite homeopathy’s having been disproven, it is still in wide use.

  8. inkadu says:

    Pec — Thanks. I took stats a while ago. Wikipedia is also helpful. I apparently fell victim to Common Misunderstanding #2 about p-values. (http://en.wikipedia.org/wiki/P-value)

    Also, I think what is meant by CAM being used without adequate research is that the research has been done and found seriously lacking and the treatment is used anyway.

    If you’d like to propose a new way to filter out treatments that are completely fanciful from those that are effective, I am sure we would all like to know what this new method might be. Otherwise, there’s only proven and unproven medicine.

    HCN – It wasn’t an accusation that Orac also posted it. But thanks for giving me that deep insight into Dr. Gorski’s mind.

    I’m also slightly embarrased for the skeptical community that the woo advocate is the only one kind enough to refresh my stats knowledge.

  9. BlazingDragon says:

    One useful point to remember when considering all “woo-based” treatments is this: Why do they have such widespread acceptance among patients? I understand why idiots push them when they have a financial interest and I understand the religion-like aspects that cause some people to believe…. but I don’t think both of these explain why so many people are so credulous to the claims of CAM.

    My experience is that medical doctors usually dismiss a symptom that they cannot easily measure with a lab test. This bias leaves patients who do not have clearly defined illness with “classic” symptoms out in the cold. When all these woo-based idiots make these grandiose claims that “modern medicine cannot heal in ways we can,” people who have been ground up and spit out by evidence-based medicine are likely to fall for their snake-oil.

    This is NOT a diatribe against evidence-based medicine, but in the way it is being applied in common practice. Most of the members of my family have been affected by this lack of caring about “finding out what is wrong so it can be treated properly” attitude, sometimes with disastrous results.

    I am keenly aware of how insurance companies and their profit motive make testing for “hunches” a pain in the neck and I am also keenly aware that insurance companies don’t pay for office visits (the kind of in depth questioning that would be needed to find out what is wrong). But this doesn’t excuse what is happening in medicine as it is applied today.

    Evidence-based medicine will fail utterly if doctors are not willing to look past the tests for easily diagnosed conditions. Doctors seem to be willing to label people “hypochondriacs” and/or prescribe anti-depressants and/or anti-anxiolytics with very little evidence that the people in question have either depression or anxiety. Any solution for the current crisis in medicine will have to address this issue. It would also help cut down the number of people pre-disposed to believe “woo-based” crap therapies.

  10. HCN says:

    Inkadu, if you look on the right hand side of this blog you would see that Orac is on the very short blogroll. You may also wish to read the book Dr. Hall reviewed on this blog. Snail Oil Science gives a more in depth look into the testing and statistics (it is written by a biostatistician).

    I also think that this graph on the Pharygula’s blog illustrates exactly what happens when most CAM is competently studied with a well designed experiement:
    http://scienceblogs.com/pharyngula/2008/01/id_wear_that_on_a_tshirt.php

  11. HCN says:

    Oops, that was supposed to say “Snake Oil Science”, I must have been thinking of the speed of my laptop!

  12. mjranum says:

    It seems to me that the obvious way to slash back on this is for a few people who have been harmed (or rather non-helped) by CAM to start lawsuits naming the institutions that supported the CAM as co-defendants.

  13. Harriet Hall says:

    I just noticed that pec said. “05 probability is twenty percent.” Did my math teachers lie to me? They told me .05 is equivalent to one in twenty, or 5%.

    And he is a PhD in experimental psychology?!!!

  14. David Gorski says:

    I think he’s referring to this, which I linked to.

  15. pec says:

    I made a mistake Harriet. I was trying to explain how the rate of false positives increases as an experiment is repeated. As you repeat the same experiment the odds of ONE of them being a false positive increases, while the odds of ALL of them being false positive decreases.

  16. pec says:

    Researchers tend to under-report experiments that fail to support their hypothesis, so we have to be skeptical of all reports. This “file drawer” effect is a problem for meta-analyses.

    Replications by skeptics are very convincing. However, skeptics can easily come up with false negatives if the number of subjects or trials is too low.

    These problems plague all scientific areas that use experiments and statistics.

  17. P value .05 is 5%. But you also have to consider the number of theories tested that are correct.

    If we assume that for research into new ideas 20% will be correct and 80% wrong AND use a p-value of .05, then 5% of studies into ideas that are actually wrong with be false positive, or 4% of the total. Ioannidis further assumed that 60% of true ideas would be positive – 60% of 20% is 12%. Therefore 16/100 studies will be positive, and 4 of them (or 25%) will be false positives.

    This assumes also perfect methodology and no publication bias – and we know that both of these assumptions are false. The worse the methodology the more likely a study is to be positive. Also there is a documented bias toward publishing positive results. So the 25% is likely a gross underestimate.

    The problem becomes far far worse as the prior probability drops. The numbers above are for a prior probability of 20% – but what if we use a prior probability of 1%? Then of all positive studies (again assuming perfect methods and no publication bias) 87% will be false positive.

    For these reasons you simply cannot interpret a single study – you have to interpret the entire literature on any question, you have to consider the pattern of evidence within the literature and you have to consider prior probability.

  18. pec says:

    “despite homeopathy’s having been disproven, it is still in wide use.”

    It was never dis-proven. What are you referring to?

    By the way, I have never tried homeopathy and have no opinion on whether or not it works. It’s very possible that most homeopathic remedies are useless.

    However, the principle behind homeopathy, that water is capable of recording information, has not been dis-proven.

    I am confused by the idea that a substance which causes a particular symptom can be used to cure a disease that causes the same symptom. Why? Lots of diseases cause pain, but a substance that causes pain would never be used as a cure.

    I don’t know much about homeopathy and am skeptical about it. But as I said I think it’s very possible that water can record information, and this has never been dis-proven.

    Benveniste’s research was supposedly debunked by Randi, but that does not prove the concept is wrong. And I doubt Benveniste spent his whole career making stupid mistakes. I find it hard to believe that Randi, a non-scientist, is better at research methodology than scientists with decades of experience, so I don’t have blind faith in his de-bunking stunts.

  19. Wallace Sampson says:

    A few comments.
    First thanks for the confidence my colleagues have expressed. It has been a long and sometimes lonely travail, for I also was trained to trust and believe , not to question. I doubted the skepticism of those before me.

    I first approached Laetrile as a scientific medical problem. I received a few raised eyebrows and more “Ahem”s. Although I finally decoded the promoters’ fairy tale science and biology their psychopathology and criminal backgrounds and lying finally turned me around – but it took several years. It turned out that health idologues are harder to deal with.

    We all have to learn what is wrong with medical ideologues and pseudoscientists at our own rates. The “pecs” of the world apparently take longer than a lifetime. My former partner called them not reachable; I call them “The Unteachables.”

    The reasons are there are so many false positive early clinical trials, is because: 1) They are done on small groups, and not adequately randomized, blinded, etc. 2) They are done by advocates, who introduce a plethore of conscious and unconscious biases, including the ways they set up the studies, their end points, and the way they select and analyze the results. 3) As Dr. Gorski (and Dr. Ioannidis) point out, even when the best trials are analyzed, many implausible claim trials turn out positive. That is because medical/biological methods cammot be controlled like molecules in a flask or cells in a dish. But even atomic and subatomic particles obey statistcal laws , their behaviors” being variable in all systems.

    Thus, in a series of well done trials of ineffective or negative methods, the results come out in a spread, with somewhere near half being negative, and half positive. Given the inherent errors and biases in the system, we expect a certain greater number of positive results. Add the file drawer effect on negative studies. The advocates’ and (supplement, herb…) promoter biases produce the rest.

    Next, upside down thinking. We don’t have an instrument to detect pec’s energy. that’s the reason we can’t find his energy. Wait a minute. A junior high student would stop and think there is something wrong with that .

    As I recall, scales were invented after weight differences were found. Voltmeters and ohm meters were deveroped after electricity was shown to exist. Same with nuclear scintillation counters and radioactivity. So, ISSSEEMers please find the energy for us. J Randi had a million dollar prize for anyone who could demonstrate paranormal events or energy. No winner after over ten years.

    As for Dr. Gorski’s survey, I hope he continues. We have been surveying this problem for nearly a decade. It is time to formalize the surveys, publish them, and expose the greed of med school faculties and administrations. the sectarians are a moving target, changing forms and quantity year by year.

    WSampson

  20. Harriet Hall says:

    OK, technically it’s hard to really “disprove” anything. But we can say that homeopathy proponents have never yet succeeded in distinguishing a dilute homeopathic remedy from plain water.

    Randi is not a scientist, but he is an expert in how people can be fooled. As I understand it, Benveniste’s positive results only occurred when one particular technician was involved in the testing, and the Nature team (including Randi plus real scientists) didn’t “debunk” anything: they simply made sure the researchers repeated their protocol with adequate double blind procedures.

    The Benveniste study wouldn’t have supported homeopathy even if it were valid. The titers varied up and down with progressive dilutions rather than following the homeopathic idea of greater dilutions producing progressively greater results. And they were supposedly producing basophil degranulation with a dilution of a substance that causes basophil degranulation when used full strength. When diluted, it should have prevented degranulation by homeopathy’s like treats like rule.

  21. pmoran says:

    Does this trend really reflect a significant change in approach to the science of medicine or is it a pragmatic one dictated by the quirks of coal-face medical practice? Does it recognise that the science-based model of medical practice is an ideal we aspire to rather than anything yet supplying entirely reliable, safe answers for all mankinds ills? Have we prematurely given up the option of using the placebo-type medicines that, despite obvious limitations, have sustained medical practice and provided medical for hundreds of thousands of years.

    Science itself has caused the problem of alternas by arousing high public expectations while at the same time reducing doctors’ options, especially the ability to use placebo-type medicines ine, by trying to confine doctors to styrictly evidence based options, ignroing any possible benefits from palxcebo medicines and at the same time arousing public expectations.

    to i near fufilment. It assumes that for every complaint there is a defined diagnosis, which determines what treatments are going to be effective, and that for all complaints there is a reliable and sufficiently safe evidence-based treatment.

    Perh

    Or is due to a desire to take back from alternative practitioners earlier styles of medical practice where doctors were able to satisfy many of the medical needs of the public with scarcely a single truly evidence-based treatment method? May it include a recognition that the science-based idealistic model of medical practice (diagnosis–> treatment —> cure) just does not fit many of the conditions for which medical treatment is sought, and that n many clear-cut disease states current treatments do not provide entirely adeqaute or even entirely safe relief.

    So, in short, buying time and limited relief with medicines that work mainly as placebo is being reconsidered.

  22. Wallace Sampson says:

    Dr. Hall got it but the unteachables may not.

    Benveniste spent his llast few years doing exactly what pec states: making stupid mistakes.

    Examine the curves as Dr. hall describes. The 1X10/\ -120th dilution showed the same activity as the original 1X10/\-3 dilution. What both did was to release histamine from basophils at the same rate. Histamine release from stimulation by IgE/ anti-IgE as in the experiment…produces asthma. So the homeopathic dilution would have produced as much asthma as an allergic stimulus in nature.
    But Benevniste was not smart enough to draw the right conclusion from his own experiment. Some remedy. No wonder they call it a “healing crisis.”

    that wasn’t all. The Benveniste story is even funnier.

    If one looks at the descripton of the findings in the methods section, one sees that B says that the peaks and trough values varied from one run to another. The values varied as much as 2 dilutions either way.

    So if one simply measures off 2 dilutions from each peak degranulation value, one finds the value at the adjacent trough. What would that middle school student conclude from that?

    Two things: First, a homeopath would not know which diltion to use for each day or each dose. By the time one could figure that out (one could not) , the asthma episode would be over or the patient dead. Each dose might cause as much asthma as the stimulus, or not…there is no way to know. Second, as Dr. Hall stated, the maximum (highest dilution) dose would produce as much asthma as the allergenic substance originally did.

    Isn’t it interesting how ideological belief can so warp a person’s mind as to miss this simple exercise?

    Not only that, but M. B’s belief led him to outrageous claims of sending homeopathic information from one solution to another over the telephone and the Internet. Also, he and two Italian homeopaths developed the theory of information borne by water – a fluid, which by definition can do no such thing.

    I have the statements and information of the four “other independent” labs claiming to have repeated his experiments. That was untrue. Some of this was published in Skept Inq in 1989. There’s more. It was another scandal of false publication.

    WS

  23. pec says:

    All the complaints about CAM research applies to conventional medical research as well. People tend to find evidence that confirms their beliefs, whether those beliefs are orthodox or not.

    “scales were invented after weight differences were found. Voltmeters and ohm meters were deveroped after electricity was shown to exist. Same with nuclear scintillation counters and radioactivity”

    Many people claim to have ways of detecting and measuring life energy. Since most are probably non-mainstream, you won’t believe them.

    I, and I assume many others, perceive it visually and always have. Oriental philosophy and medicine have always assumed it exists, and before the current era of scientific materialism it was also believed in the West.

    It is probably true that all people everywhere at all times believed in something like life energy — EXCEPT in current Western science.

    You feel that your group alone has transcended the ignorance and superstition that has pervaded all cultures. And even our own modern Western culture resists your denial of life energy. The walls around your fortress are cracking as “superstition” keeps leaking in. You try frantically to prevent the infiltration with your political power, with the help of “skeptical” friends like Amazing Randi.

    Modern science can take credit for many great things, but that does NOT mean its current prevailing philosophy of materialism must be true.

    Why did materialism, or naturalism, become so popular among scientists during the latter 20th century? We would expect an opposite trend, since physics has shown that we actually have no idea what matter is. The more physicists learn about nature, the less they can claim to understand it.

    And if non-living matter is so poorly understood, how can you think that living matter is understood any better?

    It’s not that physics and biology are wrong about everything. They have made many accurate observations. But they are not complete, not anywhere near complete.

  24. Harriet Hall says:

    pec,

    You can perceive life energy visually? Wonderful! That is a testable claim that can be easily demonstrated. Please, please, apply for James Randi’s million dollars. You can be rich, famous, turn the scientific community on its ear and revolutionize our understanding of the world. Once the ability has been demonstrated, we can begin to study it seriously. We can test things like whether it obeys the inverse square law.

  25. Harriet Hall says:

    pec,

    Why did materialism or naturalism become so “popular” among scientists? Well, duh! – That’s what science means! Science is a way of studying the natural material world. If there is anything supernatural or immaterial going on, it either has a measurable effect on the material world or it doesn’t. If the effect is undetectable, there is no way to know whether it really exists, but it might just as well not exist, since it has no effects. If it is detectable, it becomes part of the natural material world and can be studied by the methods of science just as any other phenomenon.

    And yes, we know the same criticisms can (and should!) be leveled at medical research on even the most plausible topics. Apparently you still haven’t grasped the whole point of this blog. Science is the best method we have found of learning how things work in the real world; it must be conducted with rigor to be useful, and the same standards must be applied to evaluating any claim. We are trying to keep science honest. If you continue to read this blog, you will find many critiques of “conventional” science. I’ll be writing about cholesterol, glucosamine, and antibiotics for sinusitis in future entries.

    You say, “It is probably true that all people everywhere at all times believed in something like life energy.” Sure. It’s also true that humans have a universal tendency to believe in souls that can leave the body and in gods (and historically have been more likely to believe in multiple than in single gods) and that humans universally exhibit irrational, superstitious behavior. None of that has any significance for the truth or falsity of beliefs.

  26. David Gorski says:

    If you continue to read this blog, you will find many critiques of “conventional” science. I’ll be writing about cholesterol, glucosamine, and antibiotics for sinusitis in future entries.

    Indeed.

    In my past life, I used to rail against the misuse of CT scans for “screening” and MRIs for breast cancer screening by unscrupulous radiologists out to make a buck. There will be more such discussions in the future. Perhaps I’ll recycle some of my material, with timely updates and a bit of editing to make them read better. You’ll just have to be patient. I only post once a week, and there’s so much to post about.

  27. marblue says:

    I couldn’t agree more with the author of this blog post.

    However, conventional medicine researchers also need to clean up their act. If not, the woo community will jump all over conventional medicine research and they’ll be the first to use the misinformation to their advantage.

    Just this week, a major smackdown of statin research could be found in an intriguing article in Businessweek, so much so that statin benefit was presented as “pseudoscience.”

    http://www.businessweek.com/magazine/content/08_04/b4068052092994.htm

    And, now this:

    A congressional subcommittee is investigating celebrity endorsements in direct-to-consumer drug ads, including Lipitor’s ads featuring Robert Jarvik, inventor of the artificial heart.

    http://www.abcnews.go.com/GMA/OnCall/story?id=4138702&page=1

    Talk about the pot calling the kettle black.

    Let’s clean up our act.

    Andrew Weil, in that US NEWS cover story last week:

    “I teach and urge people to use a sliding scale of evidence. The greater the potential to cause harm, the greater the standard of evidence should be.”

    In other words, for the alt med practitioners out there, pretty much anything goes. We need to be held to a higher standard or the Andrew Weils of the world will win this one.

  28. AdkMusing says:

    Reiki Masters claim to be able to heal from a distance. They claim they can heal you at any time, even at a time in the future. This healing requires no belief on the part of the patient. Even Reiki level 2 people can do this and it’s my understanding that it is not difficult, or expensive, to become a Reiki level 2 disciple.

    What I don’t understand is how come Reiki practitioners aren’t healing the sick and injured throughout the world? They could start healing those individuals infected with HIV and work their way down to Malaria and Tuberculosis.

  29. daijiyobu says:

    Well, I’ll chime in on two fronts (medical ethics, sCAM nonethics):

    a) I don’t think medicine has to clean up its act in the sense of ‘something missing’ / ‘huge overhaul.’

    It has exceptionally high professional standards emphasizing the integrity and proper use of scientific knowledge – at least in terms of its panprofession ethical code (see http://www.annals.org/cgi/content/full/136/3/243 ):

    “commitment to scientific knowledge. Much of medicine’s contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards [...] the profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.”

    Implementation / enforcement of that stringent ethical code is another matter entirely.

    b) Speaking of sCAM infiltration into higher education, I’ve had my eye on Australian naturopathy for some time:

    Here’s an example of a naturopath in Oz whose degree is a “Bachelor of Health Science in Naturopathy” [yes, naturopathy as a health science!!! (not)] and who “is a lecturer in naturopathic clinical medicine and a supervisor at the college clinic of the Southern School of Natural Therapies, Melbourne” (per http://gregconnolly.com.au/about_greg.htm ).

    He tells us (per http://gregconnolly.com.au/naturopathy.htm ):

    “natural therapies are based on vitalism and holism [...per] vital force [...& the] physical, mental and spiritual.”

    Well, there you go folks, what is profoundly not science {the vitalistic, the supernatural} is unabashedly labeled health science.

    Participate in my digg of this at http://digg.com/general_sciences/Naturopathy_s_Essential_Vitalism_Connelly_G_ND_AU

    I call such a menace to the public’s understanding of science, and it’s a shame.

    -r.c.

  30. pec says:

    “Why did materialism or naturalism become so “popular” among scientists? Well, duh! – That’s what science means! ”

    Harriet, you are misinformed. Most of the great scientists have not been materialists. Materialism — disbelief in the possible existence of anything but the fields and energies already discovered by science — is a current fad.

    Recent generations of scientists are somehow being indoctrinated into believing that materialism equals science. The word “naturalism” has been substituted, but the meaning is the same.

  31. pec says:

    “If there is anything supernatural or immaterial going on, it either has a measurable effect on the material world or it doesn’t.”

    Many things have been discovered by science that had never been known or detected before. You are wrong to assume that there is nothing left to discover, that the current instruments are capable of detecting everything that exists.

  32. BlazingDragon says:

    marblu, cleaning up conventional medicine is a big topic, one that I hope will be addressed on this blog sometime in the near future. The conflicts of interest and the outright lack of caring on the part of many physicians is something that will need to be addressed, or the health-care delivery system will continue to fall apart. Insurance reform will be a big part of the necessary fix as well.

    If these issues would be addressed, especially the part where many doctors simply stop trying to find an answer when the “easy” stuff fails to show conclusive results, there would be many fewer people receptive to the ideas of woo-based therapies.

  33. BlazingDragon says:

    Pec, you keep parroting ideas that have no basis in fact with lovely straw-men argument like “current instruments are capable of detecting everything that exists.” The problem is, you are correct, in a way. Of course, you then use the fact that you’re “correct” to go off on huge tangents and into absurdity. Usually new things are detected when instrumentation becomes sensitive enough to detect them. “New” fields and energies are usually detected when the higher sensitivity of an instrument starts to show a subtle (or sometimes dramatic) difference with current theory. They aren’t pulled out of “thin air” by scientists and they aren’t created by anything mystical or magical.

    I second Harriet Hall’s motion that you take up James Randi on his offer… a million bucks is a lot of money. Either apply for the prize and prove conventional science wrong, or stop saying such inanities. If you could demonstrate under controlled, reproducible, conditions that you can “see” these things, then scientists would know what to look for and would be able to design an instrument specifically to look for them. Otherwise, you are being stupid.

  34. Harriet Hall says:

    pec,

    Do you know what “straw man” means? Now you are saying I am wrong to assume there is nothing left to discover. It is impossible for a rational person to read what I wrote and conclude that I assume that.

    And you are wrong that materialism is “disbelief in the possible existence of anything but the fields and energies already discovered by science.” No true scientist would ever hold that view. Materialism is a philosophy, and many scientists do hold the philosophy that things like consciousness will eventually be understood as natural phenomena of matter. Some scientists believe otherwise. Some are religious and believe in the soul. But all scientists have to abide by what the evidence shows. If something is immaterial and has no effect on the material world, we have no way of knowing whether it exists.

    You claim to be able to see energy. If you can, that doesn’t refute materialism. It puts that kind of energy squarely in the material world where it can be studied. Win Randi’s million dollars and convince us all. Otherwise, stop making a fool of yourself.

  35. pec says:

    I’m sure there is nothing unusual about seeing life energy. I mentioned it as one more little reason why I believe it exists. But as we know so well, personal experiences do not count as scientific evidence. How could I prove that I see it? It’s just a direct sensory experience.

    In order to prove life energy exists we need objective measurements. And I do think CAM should work harder on this, if they have not yet come up with anything that will convince you.

  36. Harriet Hall says:

    pec,

    How could you prove that you see it? If it is life energy, it would only be detectable in the presence of life. All you would need to do is demonstrate by a blinded test that you could detect it only in the presence of a living entity, and could detect it even when all conventional visual, aural and other confounding clues were eliminated.

    I don’t know what you think you see, but people who believe they can see auras have been tested. They claim that an aura extends all around a person, and that they can see part of the aura extending above a screen if a person is behind the screen. They can’t.

    I once met a woman who claimed she could see an angel beside every person. I asked her if she had ever noticed the angel coming through a door before the attached person, so that she would have been able to predict the emergence of the person. She said she had never noticed and she was not the least bit interested in finding out.

    If you are open to testing your belief, I’m sure the authors and readers of this blog could help you devise a proper test. First you would have to describe exactly what you experience.

  37. PalMD says:

    It is quite possible to devise tests of CAM, and many have been done. Some homeopaths have argued that they should not be held to regular standards of medical evidence, since they have failed any real tests.

    Anything that cannot be tested is irrelevant, since it would then have no predictable uses.

  38. darwiny says:

    Here is an example of CAM advocates discussing their infiltration to hospitals and universities:

    http://quantumtouch.groupee.net/eve/forums/a/tpc/f/3901071811/m/9841048662

    In this case, “Quantum Touch Healer” woowoos planning their strategies.

    Note how they think that, because a university teaches quantum mechanics, that they thus are open to healing touch… like the two are related?!

  39. PalMD says:

    They are related—they both have vowels.

  40. pec says:

    Harriet,

    Life energy is everywhere. I’m sure you will think the idea is ridiculous, but the universe is alive.

  41. Harriet Hall says:

    pec,

    If you are saying that your claim can’t be tested, then it becomes a meaningless claim. You claimed you could “see” energy. If you can see it, we ought to be able to find a way to test it. Psychology has many ways of testing human perceptions.

    If you are claiming “everything” you see is life energy, or if you want to “define” the universe as “alive” then we have nothing to discuss.

    I think it’s time you described your experience of “seeing” life energy.

  42. darwiny says:

    Some experiment ideas to test pec’s ability to see woo:

    1) Sight is based on photoreceptive cells of the retina responding to photons. Thus, “life energy” must include electromagnetic radiation in the spectrum detectable by photoreceptive cells. How many different ways can we measure electromagnetic radiation? How many different types of EM barriers can we use to test pec’s ability?

    2) I often hear woowoos claim they can detect quantum events, quantum energy, life force energy, etc and blah blah. So if we shoot a ray of quantum events into their hand (say, a huge ray of photons (aka flash light)), they should be able to detect these massive quantum events, right?

    Pec, can you detect flashlights while blinded? Does ‘life force energy’ contain EM in the visual range? X-Ray maybe? How is it we have never discovered photoreceptive cells that are able to detect magic photons? Is it because we haven’t studied you yet?

  43. pec says:

    “If you can see it, we ought to be able to find a way to test it.”

    Harriet, I only mentioned it in passing, as one of many reasons I believe it exists. And yes, I certainly think there should be ways to measure life energy. I think I already said that if it has an effect on living cells then it should be possible to develop a reliable detection technique.

  44. Joe says:

    pec,

    Someone I know likes to say “If you can’t understand; maybe it’s you”: http://www.apa.org/journals/features/psp7761121.pdf
    The article is titled “Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments”

  45. darwiny says:

    Pec, can you detect flashlights while blinded? Can you see life force energy when the person is behind a wall, maybe a lead wall?

    What is your explanation as to why life force hasn’t found its way into physics literature? What is the Nobel Prize in Physics missing that only the you/woos understand?

    Is there conspiracy at the Royal Swedish Academy of Sciences that, once again, only you know about, and that is why there is no prizes being award to life force woo?

    Do you have special photoreceptive cells that I don’t have? Is this how you see new, yet undetectable forces?

  46. David Gorski says:

    Just this week, a major smackdown of statin research could be found in an intriguing article in Businessweek, so much so that statin benefit was presented as “pseudoscience.”

    Perhaps you’d be interested on this take on the latest research on statins. Suffice it to say, neither the New York Times nor Businessweek is publication to which I look for sober and scientific analyses of clinical trials. What we got was sensationalism.

  47. Oldfart says:

    I read the Businessweek article and it was quite informative. I didn’t find it sensationalized at all. For me. I take 80 mg Simvastatin a day. I have no idea if it is “helping” my LDL because I rarely see my VA physician who also rarely tests me. From the article, it would seem I could save the $8 a month and spent it on Quaker Old Fashioned Oats. And walk more.

    Not to mention the possible side effects. Many of us (laymen patients) have been jacked around by the medical community and the drug community for years.

    From the article:

    “Winn’s doctor, James M. Wright, is no ordinary family physician. A professor at the University of British Columbia, he is also director of the government-funded Therapeutics Initiative, whose purpose is to pore over the data on particular drugs and figure out how well they work. Just as Winn started on his treatment, Wright’s team was analyzing evidence from years of trials with statins and not liking what it found.”

    Hmmm…. You support evidence based medicine except …. when… reference to it appears in Businessweek? The reference you provided above did not directly contradict or speak to this particular article.

    BTW, have not commented on a WordPress blog before so forgive any formatting errors. Not sure if it supports HTML or BBCODE or what.

  48. Oldfart says:

    I followed through on the this take mentioned above. Among the many links it contained was included a blog with an entry that contained this quote:

    Steve Lucas, in a comment to DR DB’s posting on the Enhance trial, makes a very quotable comment – namely that this is another instance of marketing overtaking science.

    And it is not only the medical bloggers that are contemplating what we may really maybe doing with statins for almost everyone, Business Week has a lengthy article on statins as well, raising the question of oversell- replete with NNT numbers.

    So, some of the EBM community does not believe Business Week sensationalized anything. Nor do some of them speak disparagingly about the NYT article.

    Why do I bother with all this? Well, I’m one of the subjects in a sense. If I read the BW article correctly, not having heart disease (that I know of) or Arteriosclerosis (that I know of) means I may be taking Simvastatin just for the side effects……And, since I am planning on walking the Appalachian Trail this spring-summer-fall, I don’t need any side effects……..

  49. pec says:

    oldfart,

    I agree with you. They gave you statins just because they think statins are wonderful and everyone should take them. Even though they really do not know the long-term effects, or even the short-term effects for that matter.

    Artery disease is not caused by cholesterol, as far as I know, but is the result of inflammation. The body tries to heal the damaged blood vessels by laying down cholesterol, which adds to the plaque and results in heart attacks or stroke. It is a complex process and, like most biological processes is barely understood.

    Why did the medical industry make the decision that lowering cholesterol is the way to treat artery disease? Maybe it seemed the easiest and most profitable route. Scientists are humans, not gods.

    I understand that some patients may have some genetic defect resulting in dangerous levels of cholesterol, but as far as I know these cases are uncommon.

    A major cause of artery disease, aside from cigarette smoke, is type 2 diabetes. The problem is not caused by cholesterol yet these patients are given cholesterol-lowering drugs. For some reason elevated insulin in some way contributes to artery disease. But it’s easier to lower the cholesterol, and sell more drugs, than get to the root cause of diabetic artery disease.

    The idea is to rake in as much money as possible while conserving mental calories. Figuring out the real cause of disease, educating patients about lifestyle, looking for treatments that actually restore health — that means working harder for less.

    It’s easier and more profitable to push drugs. And ever since the 1960s Americans have been in love with drugs, so it isn’t hard to sell them.

  50. pec says:

    No, you aren’t taking it just for the side effects oldfart. You are also helping to make the Big Drug companies even bigger. Something to be proud of.

  51. Harriet Hall says:

    There is clear evidence that statins reduce the incidence of cardiovascular events in certain groups of people and reduce overall mortality in certain other groups. Decisions to use statins should be based on this knowledge in the context of the patient’s other risk factors. If statins are being prescribed inappropriately to the wrong groups of people, that is not a defect of evidence-based medicine, but of individual practitioners ignoring the evidence.

    Statins may work in other ways besides the cholesterol-lowering effects, but the evidence shows that lowering cholesterol is associated with reduced risk, and the degree of risk reduction is proportionate to the degree of cholesterol lowering.

    One thing that is frequently misunderstood is the NNT (number needed to treat). Many patients will have to take statins to prevent one death. If you are not the one whose death is prevented, it may seem that you are taking a drug for no benefit – but there is no way to predict whose death will be prevented. It’s like fire insurance: we all pay premiums, but few have fires and collect the benefits.

    To put NNT into perspective, before we had antibiotics, pneumonia didn’t kill everyone. So when we treat with antibiotics, those who would have survived anyway didn’t really “need” treatment. I don’t think any rational person would use that argument to refuse antibiotics.

  52. I just posted a blog entry on this topic in which I discuss reasons for the woo infiltration and possible solutions. You can access it here:

    http://doctorrw.blogspot.com/2008/01/exposing-quackery-in-medical-education.html

  53. pec says:

    Not everyone agrees that lowering cholesterol is such a great idea:
    http://www.spiked-online.com/Articles/0000000CAE78.htm
    http://www.thincs.org

    Statins may be of some use in slowing artery disease because of an anti-inflammatory effect, since artery disease is caused by inflammation, NOT cholesterol. But there are better and more natural ways to reduce inflammation.

  54. pec says:

    “the evidence shows that lowering cholesterol is associated with reduced risk, and the degree of risk reduction is proportionate to the degree of cholesterol lowering.”

    Where is that evidence? We know, or should know, that artery disease is not caused by cholesterol. So maybe your source is mistaken. Isn’t it possible that a higher dose of a statin reduces artery disease and ALSO at the same time lowers cholesterol, resulting in a meaningless correlation between cholesterol level and disease?

    Don’t they teach you in medical school to avoid mistaking correlations for causal explanations?

  55. jupiter9 says:

    The US News & World Report article has a video segment by the senior health editor. He seems to be more skeptical than the article’s author.

    He says CAM is being allowed into hospitals because they fear that, if they reject woo, their patients will reject them, and thereby avoid EBM and real treatment. They want their patients to get their bogus treatment in a real medical setting so that any negative medical events can be addressed as quickly as possible.

    This seems a deal with the devil.

  56. marblue says:

    “….which I look for sober and scientific analyses of clinical trials. What we got was sensationalism.”

    The link provided to Dr. RW’s site above has itself a link to the study about lowering LDL to <70 for greatest benefit. Yet, this was a study on secondary prevention. The BusinessWeek piece was critical of pharmaceutical companies pushing statins for primary prevention, certainly a larger community. I don’t think it was that sensational at all. Could I not fault Pfizer for being a bit sensationalistic about Lipitor’s benefits for primary prevention?

    I believe a balanced discussion can be found here:
    http://www.medscape.com/viewarticle/551324

  57. Oldfart says:

    To be honest, Pec, they give me statins because I pointed out to my doctor the high (to me) levels of LDL in my blood test. My total cholesterol was below 200 – no where near that of the people in the study – more like 180 if I remember correctly. At the time I was only taking blood pressure medicine. Since I showed some concern, he gave me 40mg of simvastatin. I pay $8 a month for those. That is the standard VA price for drugs. The drug companies are not gonna get rich from that. Granted I could get it at Walmart for $4 a month but the VA won’t put the prescriptions in your hands. No drug company is going to get rich off of that. When I returned to my doctor in several months I pointed out that my LDL was not much lower. He gave me more Simvastatin. Left alone, he might not have given me any.

    When I was being “balanced” (the only term I can think of) for high blood pressure control, they almost killed me (so it seemed to me) with Atenol(??) which drove my pulse rate down into the 20′s before I stopped taking it. They kept cutting the prescription and the pulse kept going down. Strangely, there were no symptoms on my end so I had nothing to complain about. But, instead of proving that something is wrong with mainstream medicine, this proves that they can react and adjust to suit the needs of individuals all of whom are slightly different both in the course of their disease and their reaction to different drugs. This takes a tremendous amount of knowledge and experience. Non of the woo you support can or does do that.

    BTW, is your moniker from the movie Willow?
    “Outta da way, Pec!”

  58. pec says:

    oldfart,

    I have the impression that most middle-aged and older Americans are on some kind of medication. And many young people are psychiatric drugs, for depression, ADD, etc. Many people are starting to realize that something is wrong. I don’t think there is any evil conspiracy. I just think that medical science and medical industries have, naturally enough, taken advantage of the trust and respect people have, or had, in them.

    I do not think there are any simple answers to some of our worst health problems. But lifestyle is extremely important, and too many Americans are waiting for new drugs and surgical proceedures to solve their obesity and health problems.

    And too many healthy people are taking synthetic drugs that may eventually affect their minds and bodies in unforeseen ways.

    And too many people are anesthetizing themselves with the new anti-depressants. These drugs are bad, addictive and harmful, and should only be used for serious clinical disorders. You might as well prescribe cocaine or opium.

  59. Harriet Hall says:

    pec has exhausted my patience. I think it will be obvious to readers why I am not going to respond to any more of his comments.

    Any further discussion of cholesterol and statins would be better left for after my blog entry on THINC where I discuss the errors of the Cholesterol Skeptics and go into more detail about exactly what the evidence really shows.

  60. darwiny says:

    Hall,

    pec believes a human can naturally detect events at the quantum scale, and even intentionally interact with them.

    You’d be better off debating salves with a tribal shaman.

  61. Prup aka Jim Benton says:

    I’m not going to comment on the substance of the debate here, the rest of you have done a fine job of that.

    But as Dr. Gorski (Hi, Dave, glad to know your last name at last) knows from comments I’ve made to him on his blog and in e-mail, I am trying to get the Skeptical Community — and especially the Medical Skeptics — to stop using the term CAM. Medicine is what the bloggers here do, and my family doctor does. What these quacks do is no more medicine than what creationists do is ‘alternative geology.’

    But by letting them use the CAM term — or by diluting the term medicine by referring to it as ‘allopathic medicine’ — we are conceding the ‘linguistic high ground’ to the (religious or non religious) faith healers who give us homeopathy, reiki, magic ‘purifying’ foot wipes, etc.

    Even worse, we let the innocent believer respond ‘what do you mean X is not medicine? See, even the government calls it medicine.’

    I have suggested the terms ‘ATM’ (for alternative therapy methods) or ATP (Alternative Therapy Practices).

  62. Roy Niles says:

    How about calling it QAP (questionable alternative practices)

  63. PalMD says:

    How ’bout “modern shamanism”? They’d like it, I’d like it, and it’s accurate.

  64. isles says:

    It would be interesting to come up with a list of promising research projects that didn’t get funded by NIH, and see how many of those studies could have been funded using NCCAM’s budget. Is there a good place to find that information?

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