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139 thoughts on “The Prince of CAM

  1. pmoran says:

    I gave it to my son for his earaches, many times with success, mixed it with olive oil and placed a number of drops of the mixture directly in his ear. But you, having put your trust in solid scientific research, avoid it like the plague because you know by what the experts tell you that it can’t work.

    The majority of earaches in young children settle within a matter of minutes or hours even when untreated. I am sure some warmed olive oil that smells like medicine is as good a reaction to the pressure to
    “Do something mummy!” as any.

    Let’s not confuse that with serious scietnfic knowledge.

  2. Scott says:

    @ libby:

    I have no particular opinion (yet) on tea tree oil because I’ve not had cause to look at it. Your claim, moreover, is a complete straw man – nobody claims that such CAN’T work, only that they haven’t been shown to work. And that if they DO get shown to work, it tends to be possible to improve on nature. Indeed, it’s practically impossible NOT to improve on nature by purifying and standardizing the active ingredient(s) into a known dose, which has well-established efficacy and safety profiles. Actively preferring an impure concoction with variable dosing, which hasn’t had anybody look carefully into what side effects might be expected, what dose is needed to produce a therapeutic effect, etc. simply doesn’t make the least bit of sense.

    What I can say for certain, beyond that, is that you are grossly factually wrong wrt aspirin. Not recognizing that the molecules are not the same is a dead giveaway that you don’t really understand what’s up on that issue.

    Finally, my “level of adherence” to science is firmly grounded in an appreciation of how completely unreliable “try it” is as a method for determining what works and what doesn’t. “Try it” is what produced bloodletting, as one typical example. “Try it” is part of why mental illness was treated by exorcism. “Try it” is why homeopathy persists. There are simply too many confounders for an individual experience to tell us ANYTHING meaningful about the safety or efficacy of a treatment, aside from the most extreme cases. (Anything self-limiting or with a variable course is certainly out, as are any but the most dramatic effects.)

    I cannot comprehend why anyone would willfully blind themselves to logic, facts, and reason. Yet clearly some people do.

  3. WilliamLawrenceUtridge says:

    Libby, on occasion I use tea tree oil for minor cuts and pimples where it does a reasonable job, in my experience, of drying them out. Can you tell me where you get your free tea tree oil from? Since you are so ardent in criticizing drug companies for making and being motivated by profit, I assume you adhere to the highest standards in this regard. Where did you find a company or individual who is willing to produce and sell tea tree oil either completely for free, or at cost? Because if you bought it from a company that makes a profit after criticizing Big Pharma so heavily for making a profit, you’d be an enormous hypocrite.

    Also, how do you know it was the tea tree oil that cured your son’s earache, and not simply regression to the mean, his body fighting it off on its own, or simple placebo effect? How long does it take for an earache to disappear without intervention? Have you tried adding just olive oil to his ear and seeing if that also makes the earache go away? Or just salt water? You’ve a great opportunity to undertake an admittedly imperfect trial of one, though you risk having to change your mind based on the results.

    Oh who am I kidding, you wouldn’t change your mind based on something like evidence or an empirical method designed to eliminate bias! You know the answer already!

  4. libby says:

    It was medical science that convinced us that putting a known neuro-toxic metal in our mouths so we could suck on it 24/7 was a smashing idea.

    There goes your theory on how careful medical science is with your health.

  5. WilliamLawrenceUtridge says:

    Are you talking about mercury amalgams? You realize that mercury amalgams are used because they are incredibly durable, right? The very reason they are used is because they last for decades. It’s not like people are swallowing a glass full of mercury, the amalgam is around 50% mercury, is tiny, and the amount of mercury actually shed into the body is tiny, spread out over a lifetime. At worst an amalgam would crack and need to be replaced, rarely it might be swallowed, but would probably be excreted whole in a bowel movement.

    Mercury amalgams are used because they don’t break. They’re not suckers. My mother has mercury amalgams and she’s had them the entire time I’ve been able to remember her because I see them every time she laughs – they don’t dissolve in the mouth.

    Why on earth would dentists put a toxic metal in someone’s mouth for fun anyway? They’re used for the reason i stated above – they’re incredibly hard unlike the fillings used to replace them which wear out after a decade.

    Let me put it another way – would you put a lead ball into your mouth and suck on it? What if it was enclosed in glass? The danger isn’t from putting something in your mouth – the danger is from swallowing or inhaling mercury in significant amounts. The maximum safe daily dose is measured in fractions of a milligram per day. Meanwhile ceiling estimates for the daily dose of mercury from fillings is measured in micrograms, 100 or more times less than the safe daily dose. Contrary to your concern trolling, mercury isn’t instantly poisonous – it’s a cumulative risk that is well recognized. As ever, you miss the fact that the danger is found in the dose, not the substance. Water kills in sufficient quantities, mercury is safe in tiny amounts.

  6. libby says:

    The WHO reports that 50% of mercury levels in adult humans comes from mercury amalgam fillings. The following is a study 20 years ago warning of the dangers of such substances being used.

    FASEB J. 1990 Nov;4(14):3256-60.
    Whole-body imaging of the distribution of mercury released from dental fillings into monkey tissues.
    Hahn LJ, Kloiber R, Leininger RW, Vimy MJ, Lorscheider FL.
    Source
    Department of Radiology, University of Calgary, Faculty of Medicine, Alberta, Canada.
    Abstract
    The fate of mercury (Hg) released from dental “silver” amalgam tooth fillings into human mouth air is uncertain. A previous report about sheep revealed uptake routes and distribution of amalgam Hg among body tissues. The present investigation demonstrates the bodily distribution of amalgam Hg in a monkey whose dentition, diet, feeding regimen, and chewing pattern closely resemble those of humans. When amalgam fillings, which normally contain 50% Hg, are made with a tracer of radioactive 203Hg and then placed into monkey teeth, the isotope appears in high concentration in various organs and tissues within 4 wk. Whole-body images of the monkey revealed that the highest levels of Hg were located in the kidney, gastrointestinal tract, and jaw. The dental profession’s advocacy of silver amalgam as a stable tooth restorative material is not supported by these findings.

  7. libby says:

    Toxicology. 2003 Mar 14;185(1-2):23-33.
    Placental transfer of mercury in pregnant rats which received dental amalgam restorations.
    Takahashi Y, Tsuruta S, Arimoto M, Tanaka H, Yoshida M.
    Source
    Department of Dental Material Science, School of Dentistry, Aichi-Gakuin University, 1-100 Kusumoto-cho, Chikusa-ku, Nagoya 464-8650, Japan. yoshi@dpc.aichi-gakuin.ac.jp
    Abstract
    Mercury vapor released from one, two and four amalgam restorations in pregnant rats and mercury concentrations in maternal and fetal organs were studied. Dental treatment was given on day 2 of pregnancy. Mercury concentration in air samples drawn from each metabolism chamber with a rat were measured serially for 24 h on days 2, 8 and 15 of pregnancy. On each day of pregnancy, the amount of mercury in 24 h air samples was in proportion to the amalgam surface areas. Linear regression analysis showed relatively high correlation coefficients between the mercury content and amalgam surface areas, and the coefficients were statistically significant. A highly significant correlation was also found between the number of amalgam fillings and their surface areas. Mercury concentrations in major maternal organs with one, two and four amalgam fillings tended to increase with the increasing amalgam surface areas. Spearman’s rank correlation test revealed significant correlations in the brain, liver, kidneys and placenta but not in the lung. Furthermore, significant correlations were also found between the mercury concentrations in all maternal organs and the amount of mercury in 24 h air samples on day 15 of pregnancy. Mercury concentrations in fetal brain, liver and kidneys were much lower than those of the dams but liver and kidneys showed positive correlations between the mercury content and maternal amalgam surface areas. Similar correlations were observed between the mercury concentrations in fetal organs and the amount of mercury in 24 h air samples on day 15 of pregnancy. In fetal brain, no significant correlations were found between either maternal amalgam surface areas or the amount of mercury in 24 h samples on day 15 of pregnancy but significant uptake of mercury was found in the samples from the dams given four amalgam fillings. The results of the present study demonstrated that mercury vapor released from the amalgam fillings in pregnant rats was distributed to maternal and fetal organs in dose-dependent amounts of the amalgam fillings.

  8. libby says:

    (The Swedish Gov’t has put a total ban on mercury amalgams as of 2009. A summary of the report submitted to the government appears below)

    On Dental Amalgam and Mercury

    Title: Dental Materials and Health
    Author: Maths Berlin

    Introduction
    In April 2002, the Swedish Government appointed a Special Investigator to propose measures aimed at boosting knowledge of health problems relating to amalgam and other dental materials. The Investigator’s duties also included reviewing current regulations concerning individuals’ scope for having their dental fillings removed at a subsidised price, and proposing measures to improve care and consideration for patients who associate their symptoms with dental materials.
    The Investigator submitted a final report (in Swedish) to the Minister for Health and Social Affairs, Lars Engqvist, on 3 June 2003. Enclosed with the report were annexes that made up part of the documentation compiled by the Commission. One of the annexes is an account of the past five years’ scientific publications concerning amalgam, mercury and health, including a risk analysis in terms of environmental medicine. The author of this report is Maths Berlin, a Professor Emeritus of Environmental Medicine.
    An English translation of this internationally acclaimed annex is published here, with a summary of the final report.
    Summary and conclusions
    The past five years’ research has yielded further evidence that amalgam can give rise to side-effects in a sensitive portion of the population. Thus:

    Research in molecular biology has elucidated mechanisms that may underlie the toxic effects of mercury.

    Studies of the effects of mercury on the immune system in rodents have enhanced knowledge of the mechanisms whereby mercury affects the immune system. Clinical studies of occupationally exposed employees have objectively confirmed subclinical influence of mercury on the immune system at low levels of mercury exposure.

    The thyroid has been identified as the target organ for the toxic effect of mercury in occupational exposure to mercury vapour in low doses.

    Experimental studies of primates and rodents have revealed that mercury is accumulated and persists for years in the retina as a result of exposure to mercury vapour. The consequences of this accumulation are, however, unclear.

    Clinical studies of the effects of mercury on occupationally exposed workers, using modern diagnostic methods, have elucidated the connection between dose and effect. They have also identified and quantified neuropsychological symptoms at low exposure levels.

    The lowest exposure, in terms of urinary mercury secretion, that has been found to give rise to a demonstrable toxic effect has fallen from 30-50 mg/l till 10-25 mg/l Accordingly, the safety margin that it was thought existed with respect to mercury exposure from amalgam has been erased.

    Studies Of Workers previously exposed to mercury have shown that prolonged exposure to mercury vapour, with mercury concentrations in urine of some 100 mg/l, may result in symptoms emanating from the nervous system that persist decades after exposure has ceased. This suggests that exposure causes lasting damage to the central nervous system, which complicates the interpretation of results of low-dose studies of occupationally exposed populations.

    Clinical reports of acute or subacute cases of mercury intoxication where modern diagnostic methods have been applied have revealed a remarkably high degree of polymorphism in human reactions to toxic mercury exposure.

    Both animal experiments and clinical observations have demonstrated gender differences in the toxicokinetics of mercury.

    Additional facts have come to light that may indicate that mercury vapour can affect human foetal development.

    Clinical provocation studies, with exposure to small quantities of mercury through skin exposure or inhalation, have confirmed that individuals with deviant high sensitivity exist.

    With reference to the fact that mercury is a multipotent toxin with effects on several levels of the biochemical dynamics of the cell, amalgam must be considered to be an unsuitable material for dental restoration. This is especially true since fully adequate and less toxic alternatives are available.

    With reference to the risk of inhibiting influence on the growing brain, it is not compatible with science and well-tried experience to use amalgam fillings in children and fertile women. Every doctor and dentist should. where patients are suffering from unclear pathological states and autoimmune diseases, consider whether side-effects from mercury released from amalgam may be one contributory cause of the symptoms.

  9. libby says:

    For years dentists characterized mercury amalgams as only silver fillings. Later they came to be known as amalgams. However 50% of these ‘silver’ fillings or amalgams are made of mercury by weight.

    For those who insist that placing their faith in medical science is the best way to play it safe need only review the sordid history of mercury amalgams to find out how little medical science cares about your safety.

  10. Chris says:

    And tooth fillings is relevant to the Prince of Wales, also known as Prince Charles, how? (okay, I call him “Prince Chuck) Does the Foundation for Integrative Health have a Cuban connection?

    (sometimes it helps to read the actual article on top of the page)

  11. weing says:

    I thought amalgam use dated back to the 19th century, but I am not a dentist. I am not even sure if big pharma produces amalgam. I suppose the enlightened Cuban health system has banned its use? Anyway, what does dentistry have to do with science based medicine and with homeopathy working?

  12. WilliamLawrenceUtridge says:

    This thread has nothing to do with Prince Chuck and everything to do with Libby’s rampant paranoia that the medical system and Big Pharma apparently wants solely to kill people. That whole “healing professions” thing is apparently a bluff in her mind.

    Libby, do you know what cherry picking is? Have you looked into recent review articles? Like these ones?

    http://www.ncbi.nlm.nih.gov/pubmed/17044804

    http://www.ncbi.nlm.nih.gov/pubmed/16448848

    http://www.ncbi.nlm.nih.gov/pubmed/19425270

    Mercury amalgams are being discouraged on the precautionary principle – there might be harms to some populations. Far from this issue being a slam-dunk, the levels of mercury found in dental amalgams have not been proven to be dangerous to anybody. If there were genuine evidence that dental amalgams were actually dangerous, a lot more countries than Sweden would have done something about it.

    Science is complicated. Deciding on a bad guy and compelling conspiracy narrative in advance certainly makes it easier to justify the conclusions you’ve already made. It doesn’ t mean it’s right, it just means you prefer a pre-existing opinion over reality. But that doesn’t surprise anyone here.

  13. WilliamLawrenceUtridge says:

    Weing, at least one of the sources I just read, possibly linked in the post awaiting moderation, did say mercury amalgams were 200-ish years old.

    The only link between dental amalgams and Prince Chuck is Libby’s unshakeable opinion that Big Pharma is evil, medicine is deadly, and only kind, loving, generous ministrations of homeopaths, acupuncturists and naturopaths can ensure our health.

    Oh, and apparently they must do it for free. Because the problem with Big Pharma is Big Profits – so Libby must obviously get all of her CAM-care for free. Otherwise she’s just a cherry-picking hypocrite blind to the flaws of the side she’s already decided to stick with no matter what.

  14. libby says:

    HaHaHaHaHaHaHa!!!

    We’re talking about mercury amalgams and all of a sudden, after I present damning studies on their toxicity from sources that you might conceivably recognize, you then slide like a well-greased condom back to talking about the evils of alternative medicine.

    We really can’t say anything nasty about the religion of conventional medicine, can we?

    If nothing else you’re all damned entertaining. HaHa!!

  15. Scott says:

    Well, let’s take a look at what PubMed tells us. I searched for “amalgam fillings safety” and started from the top. Based on title, these looked relevant:

    PMID: 17044804, “The safety of dental amalgam in children.” I can only access the abstract, which notes a lack of high-quality evidence but doesn’t say what they found in the two RCTs examined.

    PMID: 16448848, “Mercury amalgam dental fillings: an epidemiologic assessment.” Abstract states in part “Studies show little evidence of effects on general chronic disease incidence or mortality. Limited evidence exists for an association with multiple sclerosis, but few studies on either Alzheimer’s or Parkinson’s diseases. The preponderance of evidence suggests no renal effects and that ill-defined symptom complexes, including chronic fatigue syndrome, are not caused by amalgams. There is little direct evidence that can be used to assess reproductive hazards. Overall, few relevant epidemiologic studies are available.”

    PMID: 15713345, “Amalgam exposure and neurological function.” The conclusion from the abstract, “Overall, we found no association between amalgam exposure and neurological signs or clinically evident peripheral neuropathy. Our findings do not support the hypothesis that exposure to amalgam produces adverse, clinically evident neurological effects.”

    PMID: 9496919, “Mercury concentrations in urine and whole blood associated with amalgam exposure in a US military population.” Finds an association, but the concentrations given aren’t compared (in the abstract, again all I can get) with any reference range.

    The rest were pretty old. Overall summary: the evidence is limited but what there is doesn’t support claims of harm.

  16. WilliamLawrenceUtridge says:

    Yep, my post is currently in moderation because of the three links I included to pubmed review articles indicating the risks of mercury amalgams are not considered serious. Scott got two of the three I found as well as two others. I also included PMID 19425270 which had the same broad conclusion.

    Don’t worry Libby, I don’t give a crap what you think – I criticize your analyses for the benefit of other people, to demonstrate that they are flawed, biased and one-sided. My post in moderation addresses your concerns about mercury amalgams more directly, so stay tuned.

  17. weing says:

    “We’re talking about mercury amalgams”

    No, we are talking about the homeopathy scam.

  18. WilliamLawrenceUtridge says:

    I’m talking about Libby’s hypercriticality of medicine in general and utter lack of criticality regarding “alternative” “medicine”; mercury amalgams illustrates the former, homeopathy the latter, but both are overall flaws in her reasoning and taken together they demonstrate the bias in her position that makes all her comments suspect.

    I think Libby’s a “she”, my apologies if not.

  19. libby says:

    Scott:

    Re mercury amalgams:

    If I am wrong, then patients are needlessly using a more expensive alternative for fillings. If you are wrong, patients are needlessly contaminating their bodies when there are safer alternatives.

    Spending a bit more money is not equivalent to introducing toxins into the body (a false equivalent).

  20. pmoran says:

    Libby: For those who insist that placing their faith in medical science is the best way to play it safe need only review the sordid history of mercury amalgams to find out how little medical science cares about your safety.

    Oh, come on! Mercury amalgam came to be widely used as dental fillings well before there was such a thing as organised medical science, and at a time when mercury compounds were widely used as medical treatments and in cosmetics (and homeopathy) without obvious toxicity with the methods of the times. There was also no easy way in those days of knowing how much mercury was released from what is otherwise an extremely stable metal-like chemical combination.

    Even now, when it is realised that mercury IS slowly released, and that it can cause subtle, mostly subclinical (non-symptomatic) effects at lower levels of exposure than previously thought possible (from a vast experience of occupational and dietary exposure), it is difficult to demonstrate them at the levels of exposure from amalgams alone.

    Even if organised medicine should have cottoned on to some potential risks sooner, it is ridiculous to think that anything other than the methods and technologies of science can answer the questions raised or that no one cares.

  21. Harriet Hall says:

    The biggest argument in favor of amalgam fillings is not cost, but duration. They last longer than the new materials, so it would benefit the dentist’s bank account to use the newer fillings and be able to charge the patient for replacement when they fail with age. Hard to see any evil conspiracy there!

  22. WilliamLawrenceUtridge says:

    C’mon Dr. Hall, you’re not looking hard enough! See it from Libby’s perspective, doctor’s aren’t just after money – they also actively hate and want to harm their patients! Because of Big Pharma! That’s how deep it goes!!!!

    Also, Libby, again note the levels of mercury amalgams release during a normal day’s service – between 1-10% of the maximum safe dose for people who work with it on a daily basis. It’s the dose that makes the poison. Just like fish is a healthy source of protein and fats, it also has a safe dosage due to recorded levels of mercury. The dose makes the poison, not the substance. Water is fatal in sufficient doses, as is oxygen, fiddleheads (the plant), willow bark and foxglove.

    You note a false equivalence, I’ll give you another one – any mercury is just as bad as an overdose of mercury. It’s not. There is a dosage that the body can process and excrete without adverse effects, and above that dose, mercury is dangerous. Once again you are selectively ignoring evidence that contradicts your beliefs because you’ve already chosen your position, don’t care it if it has any basis in fact, and are uninterested in changing your ideology.

  23. libby says:

    HH:

    I agree. It is hard to find conspiracies within the corporate free market world.

  24. libby says:

    pmoran:

    Mercury was documented as a toxic substance 200 years ago, around the time it started to be used as an amalgam. Nothing sordid about that, right?

    (An Account of the Effect of Mercurial Vapors on the Crew of His Majesty’s Ship Triumph, in the year 1810. By Wm. Burnet, M.D. one of the Medical Commissioners of the Navy, formerly Physician and Inspector of Hospitals to the Mediterranean Fleet)

    Conventional medicine has for decades misrepresented what they were sticking in patient’s mouths by calling them silver fillings. They then called them amalgams or silver amalgams. Calling mercury amalgam silver is like calling brass copper. Amalgams are 50% mercury, so why the deception?

    If conventional was confident that mercury was safe to suck on then why weren’t people told that THAT is what was going into their mouths, an amalgam of mercury and silver? Ignorance is bliss? What they don’t know won’t hurt them? I’m just curious about the strategy.

  25. weing says:

    You should be ashamed of yourself for contributing to mercury pollution of the environment by your use of the computer. I bet you are using compact fluorescent light bulbs that contain mercury vapor. You are the reason I can’t have sashimi every day.

  26. WilliamLawrenceUtridge says:

    Mercury fillings are silver, correct? Ergo, calling them “silver filings” is accurate, correct? Because if you called them “mercury”, stupid people who don’t understand toxicology might think they’re dangerous. Just like people did with Thiomersal. And you might get people showing up on the internet concern-trolling over substances that are known to have no effects below a certain level.

    Yeah, I can’t imagine why they wouldn’t draw attention to the fact that the fillings are mercury. Because the general public is sooooooooo well informed and understands toxicology and medicine well enough to differentiate real medicine from CAM’s “pixie dust, propaganda and placebo” treatments.

  27. WLU, While I agree with you general, I wanted to point out, the names of fillings seem standard enough to me without attributing the names to some effort to avoid incorrect assumptions about toxicity. Filling are referred to by my dentists by color. Silver, gold or tooth colored.

    Just as one would generally understand that silver colored doesn’t mean 100% silver, same for gold (although I think those may have quite a high gold content) and tooth colored doesn’t mean 100% tooth.

    But perhaps we should start calling tooth colored fillings “composite resins containing crystalline silica, a known cancer-causing substance.

    Of course if we start requiring people be informed of every risk that has the same risk profile that silver/mercury amalgam fillings have (incredibly tiny) we will become completely inundated* with risk warnings and it will become increasingly difficult to decern substantial risks from insubstantial risk. In that sort of environment many people are likely to just filter out ALL risk warnings. In my mind this could have the real consequence of increased exposures to things like asbestos fiber insulation, lead paints, air pollutions, work related chemical exposures, etc that we know can pose a substantial risk to some people.

    *If this hasn’t already happened.

  28. WilliamLawrenceUtridge says:

    MIM, I don’t know for sure but I’m guessing the naming is a combination of colour and to avoid people linking the fillings to mercury and it’s reputation for causing illness. My main point is that the colour of the fillings is just as valid and factual way of describing them as their contents – but without the disadvantage of making people worry unnecessarily. I strongly, strongly doubt that referring to amalgams as “silver” was intentional deception, and I’m guessing any dentist who was asked would inform their patients of their actual makeup – in addition to the fact that merely containing mercury doesn’t mean they are dangerous. It’s the molecule that matters, not the individual components. Raw sodium (Na+) is explosive. Chlorine gas (Cl-) is a corrosive poison. Table salt (NaCl) is delicious and essentially harmless. Should we label all boxes of table salt as made up of explosive and poisonous ingredients? If not, why shouldn’t we treat amalgam fillings the same way? This is a rational approach to contents labeling because it reflects the overall makeup and chemistry of the ingredients.

    But really, it doesn’t matter anyway – your final paragraph is the real point. Risks and recommendations should be made on the basis of empirical evidence, not on how dangerous non-experts think they are. Or how loud and repetitively alarmists with no understanding of toxicology beyond “I heard mercury is dangerous!!!!” can screech. We have to trust experts – real experts, people who spent years in universiteis and labs, not people who spent hours on google – to provide the best evidence-based recommendations on safety.

    Here is a post discussing trust and expertise in more detail. Very good (but focussed primarily on vaccines). The overall point is – actual experts know what they are talking about and collectively work towards the common good. We have to trust them because nobody can read all the literature on their own.

  29. Scott says:

    If I am wrong, then patients are needlessly using a more expensive alternative for fillings. If you are wrong, patients are needlessly contaminating their bodies when there are safer alternatives.

    Beyond the fact that I have not advanced the position “amalgam fillings are safe” as you imply, this would actually be a decently reasonable argument.

    You however seem determined to go beyond that into “ZOMG mercury is killing us all Big Pharma is EVUL!!!1!1!eleventy-one!!1!”

  30. libby says:

    I accept your criticism.

    It is my fault if I have characterized big pharma as evil, because I don’t think that is true at all. Nor do I think that mercury amalgams are necessarily dangerous.

    I am however taking the position that corporations act in predictable ways given the structure of the free market system, and that pharma corps are no exception to this.

    As for mercury amalgams, there is enough doubt given reputable sources on both sides of the argument that it would be foolish to take one position as infallible. Which brings me back to the concept of false equivalents.

  31. libby says:

    Re corporations:

    Wendell Potter, former head of public relations for CIGNA and an employee there for 20 years, explains well how the corporate picture operates. HMO’s are not evil because they deny coverage through contrived loopholes, but because the system demands it. If the rate of indemnification to premium is altered only by a small fraction in favour of clients, stockholders will airlift out and shop elsewhere. CIGNA would then be scrambling to stay afloat.

    That in a nutshell explains that the epithet “evil” is inappropriate when applied to a corporation, including pharma corps. However because of this, profit is a far more important requisite than any other area. This is simply a reality for every company.

    For example the gifting of doctors makes perfect sense to a company when they see, and this has been documented, that these gifts translate into more prescriptions by doctors for their products, and therefore more profit for the company. When McNeil Ph continued to market Zomax knowing people would die it was a perfectly sound financial decision to maximize the profit from the drug until someone turned them in. When GSK ignored manufacturing quality concerns at their Cidra plant by quality assurance manager Eckhart, she was fired and the company continued its unaltered ways until caught. The pursuit of profit explains all these actions.

    These were all planned financial decisions, weighing the opportunity for profit against the element of risk.

    So what is this kind of profit-oriented, risk taking structure doing in the health care business? That is a good question.

  32. weing says:

    “These were all planned financial decisions, weighing the opportunity for profit against the element of risk.
    So what is this kind of profit-oriented, risk taking structure doing in the health care business?”
    OK. I am not saying this is not a legitimate topic to discuss. But, what does this have to do with homeopathy working?

  33. Scott says:

    If that’s not what you meant to be implying, I apologize since apparently I misunderstood you. Yes, all businesses are profit-driven; this is the only way the system can work. Regulation is hence necessary to protect the common good.

    CAM is equally profit-driven, however, and if you don’t intend to use the amalgam question as a means to attack all of SBM I don’t see any connection between it and anything in the original post or the rest of the comment thread.

  34. WLU- “Here is a post discussing trust and expertise in more detail. Very good (but focussed primarily on vaccines). The overall point is – actual experts know what they are talking about and collectively work towards the common good. We have to trust them because nobody can read all the literature on their own.”

    I’d like to offer a different perspective. For some people trust just doesn’t work.

    I suspect that a reasonable number of folks that avoid and argue against vaccines, medications, flouride, silver fillings, doctors, etc are fueled by reasonably common anxiety issues.

    Unfortunately anxiety issues just don’t respond well to evidence or expert knowledge. The sufferer will only be comfortable with a 100% guarantee of safety from the feared object or event, something that can not be supplied in real life.

    Even worse, rather than diminishing the anxiety, arguing with or attempting to reassure the anxiety sufferer that the feared thing is safe can actually reinforce the anxiety but increasing catastrophizing of a feared event and ruminations on the fears. For example by arguing that the mercury in filling does not cause brain damage one reinforces the belief that brain damage must be avoided at all costs because it is an incredibly terrible condition the the sufferer could not cope with AND locks the anxiety sufferer into repetitive thought on the topic of mercury, brain damage, etc.

    (I hope I am making sense)

    Most of the effective treatments for anxiety do not focus on getting the patient to understand that the feared object is safe, they focus on helping the patient to catastrohize less, considering the possibility that they could manage the feared situation, as well as increasing the patience tolerance their symptoms of discomfort and fear.

    This is often very difficult process for the anxiety sufferer, which they just as soon avoid. As far as I can see, the only motivaton to tolerate the discomfort is if avoiding the feared thing makes your life miserable or unmanageable. This definitely happens with a lot of folks with anxiety, the constant worry or GAD or time consuming checking or washing in OCD or social isolation of some phobias are good motivation to overcome those fears. This is one way to convince someone with anxiety, try to help them see how avoiding their fears is negatively impacting their or their loved ones quality of life.

    But, with some luck, one can often avoid things like silver fillings, flouride, medications or vaccine for long periods of time without decreasing ones quality of life.

    So there is a conundrum. If someone has one of these anxieties, arguing about safety probably won’t work and they may not be motivated to change, since change will be far more uncomfortable for them than staying the same.

    Cheers, Michele

  35. WilliamLawrenceUtridge says:

    MIM, that may be an issue for people with anxiety (my wife has anxiety issues, I know it can be awful and hard to deal with). But because some people are nervous (and don’t understand the actual risks in the same way an expert does) that doesn’t justify spending, say, twelve years and millions of dollars investigating a vaccine and preservative that nobody with any real expertise thought was the actual cause of autism. The system and society can’t, and shouldn’t, respond to the demands or fears of its most alarmist members.

    Though your response makes sense from the perspective of someone with anxiety, I believe (and I admit it sounds quite heartless even as I type it out) that the best way to deal with this is through the individual experiencing the anxiety doing something to reduce it – not by making the rest of society more anxious about a non-problem. On an individual level, those with anxiety may be able to avoid those things in their personal life, but the opportunity (and financial) cost is steep. Non-amalgam fillings are more expensive and must be replaced more often. You have to buy unfluoridated water since you are nervous about the tap stuff. Organic food versus regular. Being sick for longer (personal note – I used to get seasonal bronchitis and because I avoided medications in general in my youth it took literally months to go away and one year gave me hemorrhoids due to the coughing; I got it this year and went to the doctor – three days later I was normal). Spending money and time on “worried well” conditions like “adrenal fatigue”, and so on. On a societal level, those costs are magnified millions of times over and somehow we have to pay for it – normally through taxes. As a taxpayer, I’d much rather my health care dollars went to treating someone for anxiety than finding an alternative to thiomersal that is more expensive, less useful and/or results in vaccination becoming more expensive overall – for no rational reason since thiomersal has never been associated with adverse effects in the doses given during routine vaccination.

    I understand your point, on an individual level for someone with anxiety these are valid issues to be dealt with – but society overall should listen to the experts, not a worried nonexpert. I think this is an issue very close to the heart for you (I believe you mentioned anxiety of some sort in a previous post, my apologies if not) and I’m not saying this to be mean – only to examine it from a practical perspective when one considers the well-being of an entire society (or in the case of infectious disease – the whole world).

  36. WilliamLawrenceUtridge says:

    Libby, corporations are driven to maximize profits and in cases of non-monopoly, this generally results in cheaper, higher quality products. A considerable portion of that reduced cost is due to greater efficiencies which corporations are driven to seek out in order to stay competitive while retaining a higher profit. Vaccines are one such product. However, driving companies out of that market results in less competition and more expensive products – or no produts whatsoever (that’s what almost happened with vaccine manufacturers in the 80′s).

    The alternative is the government making the product, which I believe Denmark does for vaccines. There is a downside though – there is very little incentive for the government to innovate, improve products, or drive down the cost. And we all pay for that cost – either through higher taxes or through lost opportunities. Denmark’s state-owned factories may make vaccines, but all that money (which must run into the hundreds of millions of dollars) could have gone somewhere else. Better health care, national defence, more funding for the arts or sciences, and so on.

    A good (or at least one of the only) solution is normally government regulation, but this also can create problems.

    The perfect is the enemy of the good. You’re never going to get a perfect system, ever. Any action will create a reaction, any system will be bucked and manipulated as soon as its put into place. All you can do is keep trying, and use evidence to make decisions. Using rhetoric, logical fallacies and ignoring evidence in favour of a pre-concieved conclusion doesn’t help. In the case of health care, it will result in waste, deaths, and the widespread return of dangerous or merely inconvenient but avoidable infectious disease.

  37. WLU- sorry, I wasn’t clear, I completely agree with you that public health recommendations should be made by expert and those decision should be based on science, not worries as well as the issue of dollars spent on research, ect. Spending money to accommodate anxiety disorder driven avoidance of would be a waste of money and would validate the fears of the anxious…not good for the public or the people suffering from anxiety.

    I was speaking purely from a perspective of what communication tact to take when attempting to convince someone (an individual) that using a particular feared substance, therapy, medication is a reasonable solution to a health problem (once that therapy, etc has been recommended by experts).

    Sorry, I know I jumped in with a pretty unrelated comment, which I only addressed to you because your comment sparked the idea for me. It pretty tangential, but I thought I’d just throw it out there.

    I just meant to note that the popular method of giving evidence for safety is sometimes not particularly helpful for anxiety based substance aversions. Although, I am struggling to come up with a really good approach as a replacement, since CBT, Exposure therapy require the sufferer to seek and participate in therapy, they don’t seem that helpful…

    hmmm, if it comes to me I’ll jump in with another tangential comment on another thread.

  38. WLU, also, you didn’t sound heartless at all. I appreciate your considerate approach.

  39. WilliamLawrenceUtridge says:

    I thought that was a little narrowly-focused than most of your comments :)

    I don’t know if most of the antivax and CAM loons have anxiety issues. I suspect they do not. I am more inclined to believe the arrogance of ignorance (or the Dunning-Kruger effect) starts the behaviour, and cognitive dissonance (as so ably explained in Mistakes Were Made) is responsible for perpetuating it. While someone with chronic anxiety amy ruminate, discuss, remain awake and obsess over the topic, I get the feeling that most of the antivaxers and CAM loons sleep the sleep of righteious angels because they completely insulate themselves from any doubt that they are wrong.

    There’s no guarantee I’m right, it’s possible that opposition to science, medicine, empiricism and experts can be used as part of the diagnosis of anxiety disorders. But the reaction to argument is usually smugness, anger, rejection and logical fallacy – not engagement. If it were rooted in anxiety, I’d expect more details and fewer broad-strokes pronouncements.

    But again, I could be wrong, I often am.

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