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The Truth?

Facepalm
Summertime and the living is easy. I am in Sunriver, Oregon for the week and I though, hilariously, that I would have plenty of time to write a post. Between the hiking, the biking, the golf, the food and the beer, there has been little time to sit in from of a keyboard. There may be no better place to spend a week if you like the outdoors, but they do not have internet on the hike around Paulia Lake. So while a caramel banana cake bakes for a dinner tonight, I have an hour or so churn out a post. Do not expect much.

One person’s ethics is another’s belly laugh, but in medicine ethics are formalized. The basic principles in the US are

  • Respect for autonomy – the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex)
  • Beneficence – a practitioner should act in the best interest of the patient (salus aegroti suprema lex)
  • Non-maleficence – “first, do no harm” (primum non nocere)
  • Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

These are guidelines, not mandated, but if you get an ethics consult in my institutions the above concepts are the framework within which the consult will be completed.

Patients can only be autonomous if they are given accurate, truthful information with which to make a decision about their treatments. You can’t lie to patients, but we all know how you phrase an idea can subtly alter the response. Do you say an 80% success rate or a 20% failure rate? I tend to say both. And not everyone can handle the unvarnished, blunt truth. Part of the art of medicine is trying to tell each patient the truth, the whole truth and nothing but the truth in a manner palatable for the individual patient. It is not easy and I am certain I do not always do a good job.

What troubles me is how much what is written about SCAM’s is to my way of thinking, not truthful, or shaded in a way as to be, at best, disingenuous. I am not referring to the Natural News or Dr. Oz. I long-ago realized those are not sources for a reality-based understanding medicine. I am referring to major medical centers that offer what I would consider misinformation. As an example, take the Mayo Clinic. Please.

I did my residency in Minneapolis at the county hospital. Occasionally a patient would go to the Mayo Clinic in Rochester for a second opinion, get all their tests repeated and more, and come back with the same diagnosis and treatment plan. We would say if you want a Rochester Sandwich, hold the Mayo.

That started my skepticism about big name clinics and famous hospitals. There are good and bad doctors everywhere. Judging from the metastasis of pseudo-medicine into many of the prominent medical institutions in the US, I suspect that these institutions are more interested in income than science-based medicine.

Which brings us to “Complementary and alternative medicine” from the Mayo Clinic, with the subtitle:

You’ve heard the hype about complementary and alternative medicine. Now get the facts.

Given that they have an Integrative Medicine Department, I was wondering how they would spin ‘the facts.’ As always in a CAM article, they start with the disingenuous.

Nearly 40 percent of adults report using complementary and alternative medicine

It’s actually 38.3 %.When I was in grade school I would have been told to round to 38. I am surprised they did not round it up to “nearly 50%”. And you only get to that number by including interventions that are not alternative, like diet and exercise.

The use the National Center for Complementary and Alternative Medicine (NCCAM) classification:

  • Whole medical systems
  • Mind-body medicine
  • Biologically-based practices
  • Manipulative and body-based practices
  • Energy medicine

What all of these have in common, with the exception of “biologically based” which includes herbs, is a complete disconnect from reality as it is understood by the sciences. You would not know that from the Mayo.

Homeopathy is described as using

minute doses of a substance that causes symptoms to stimulate the body’s self-healing response.

Most homeopathic nostrums have zero active substance in them and the ideas behind homeopathy are totally nonsensical.

Energy medicine is an

Invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. The goal of these therapies is to unblock or re-balance your energy force.

No such energy has ever been measured and none of these interventions have been shown to have efficacy beyond bias. Credulity is the order of the day at the Mayo.

They continue:

Many conventional doctors practicing today didn’t receive training in CAM therapies, so they may not feel comfortable making recommendations or addressing questions in this area.

Could it be that conventional doctors, based in realty and science, know it would be unethical and fraudulent to recommend therapies that are fanciful delusions with no efficacy?

However, as the evidence for certain therapies increases, doctors are increasingly open to complementary and alternative medicine…While scientific evidence exists for some CAM therapies, for many there are key questions that are yet to be answered

What these ‘certain therapies’ are goes unmentioned, since the NCCAM has yet to support a study that demonstrates any benefit from the pseudo-medicines mentioned in the article. And there is the old saying, what do you call alternative medicine that has been proven to work? Medicine. BTW, I am not a conventional doctor, I am a doctor. I do not need the adjective.

They continue with the question

Why is there so little evidence about complementary and alternative medicine?

One reason for the lack of research in complementary and alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional therapies are often funded by big companies that develop and sell drugs. Fewer resources are available to support trials of complementary and alternative medicine. That’s why NCCAM was established — to foster research into complementary and alternative medicine and make the findings available to the public.

Perhaps there is a paucity of funding for these modalities because prior plausibility would suggest that since they are based on fantasy, not reality, it would be unethical and a waste of resources to study them? Not that the numerous well-done studies that show a lack of efficacy prevent the expansion of integrative medicine programs.

That’s in-depth consumer health at the Mayo. I can’t see that they have done much to improve since I was a resident. I would still hold the Mayo on my Rochester sandwich.

That is not unusual. How can you offer, as does the Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women’s Hospital, moxibustion, laser acupuncture, and craniosacral therapy without lying to the patient or by being so disingenuous about these therapies disconnect from realty that it amounts to the same thing?

Or, as at UCSF, can you ethically say

While Ayurveda places greatest emphasis on preventing disease before it occurs, scientific research suggests Ayurvedic treatments have positive effects on a range of conditions and disease. Ayurveda is believed to have positive results in the treatment of diabetes, asthma, attention deficit disorder, osteoarthritis, Parkinson’s disease, management of hyperlipidemia and schizophrenia, as well as prevention of certain types of cancer.

While I would not be surprised when any intervention has an effect of diabetes or hyperlipidemia (for many patients any change away from the standard US diet is probably beneficial), schizophrenia and cancer? Really? I can’t find any clinical trials on PubMed to support that contention.

Oh wait. Believe. Believed to have positive results. That is the kind of disingenuous statement that, to my mind, is the moral equivalent of a lie.

Pick an academic Integrative Medicine program, any academic Integrative Medicine program. Are they fully compliant with truth and reality? If so, I cannot find one.

My hospital system, and the hospital systems in Portland in general, are surprisingly SCAM-free. I had long thought that Portland was a mecca of pseudo-medicine, instead we are a bastion of reality-based medicine.

So I lack the opportunity, but it would be interesting for someone to ask for an ethics consult concerning the appropriateness of the information and services offered by their Integrative Medicine. Perhaps the year you plan on retiring.


Posted in: Medical Ethics, Science and Medicine

Leave a Comment (115) ↓

115 thoughts on “The Truth?

  1. Neil Neumann says:

    This article raised the question: if top medical institutions are going to promote CAM as medicine, then shouldn’t CAMs be more regulated by the FDA? Having medical institutions put their ‘stamp-of-approval’ on these treatments connotes a level of acceptance and approval that implies to a patient that CAMs are effective the same as FDA-approved therapies. Physicians would gladly prescribe FDA-approved CAMs, but as you said, they would just be called medicines.

    1. Windriven says:

      “shouldn’t CAMs be more regulated by the FDA”

      Certainly sCAMs that involve biologicals and devices should be. For the rest (homeopathy, reiki, therapeutic touch, etc) an aggressive FTC would be more appropriate. That is to say, for instance, most homeopathic remedies are an issue of fraud rather than medical safety or efficacy.

  2. Windriven says:

    “[I]t would be interesting for someone to ask for an ethics consult concerning the appropriateness of the information and services offered by their Integrative Medicine [program]. Perhaps the year you plan on retiring.

    Way to finish with a .50 cal bullseye! The problem, one surmises, is that these programs are husbanded by administrators and directors of marketing whose interests are more focused on revenue per patient-contact than with the intricacies of not being smarmy snakeoil peddlers. They are aided and abetted, of course, by physicians whose mastery of their craft is so tenuous that they feel compelled to augment their medical skills with appeals to unseen forces, prestidigitation, and thaumaturgy. Or perhaps it is their grasp on sanity that is tenuous.

    Folding back around to the closing sentence, the embarrassing nakedness of the emperor is an uncomfortable eccentricity to discuss with him or her because she is, well, the emperor. But until his peers laugh at him and point out the those with tiny penises and only one testicle invite ridicule by parading around naked, little is going to change.

    Sandwiches must not be haute cuisine in Rochester, MN. In Portland, OR one can get everything from pork belly banh mi to a gourmet PB&J while on a casual stroll through downtown. The top ten in Dr. Crislip’s Rochester link include two Jimmy John’s, a Subway, and Domino’s Pizza. High livin’ in Rochester.

    Note to Eds: Taboola? Really?

    1. WilliamLawrenceUtridge says:

      Hey, at least it isn’t the incredibly intrusive eyesores that were present a couple days back, a feature I’m extremely surprised to have seen no comments about.

      1. mouse says:

        Grooooaaan – I was trying to withhold comment on the ads because I know SBM’s gotta pay their bills too. Not sure if they have any better options.

        1. Windriven says:

          I’ll be happy to shake a cup on the corner ;-)

      2. goodnightirene says:

        I–groan–saw them but was in the trailer tethered to the iPhone trying not to use up all my data.

        1. Windriven says:

          AT&T – unlimited data plan.

      3. DevoutCatalyst says:

        I haven’t seen an ad on the Internet in years. Products do exist that take care of this, just sayin’…

        1. WilliamLawrenceUtridge says:

          I don’t mind the ads being there, gotta pay the bills. And for that matter, I even click on then sometimes out of a mostly prurient interest in the link (as long as it wasn’t one of those god-awful flash-stuffed pages that take forever to load up and uses a slideshow that delays each page entry by a good 15 seconds). But the size of the ads was making it hard to appreciate the content.

          1. DevoutCatalyst says:

            I prefer a Taboola rasa, as it were. SBM looks great ad-free, Ad Muncher removes the space the ads took up. I pay to get the SGU ad-free, wonder if the overlords could offer the same here.

            As an aside, any chance we’ll see your commentary over at the Neurologica Blog, WLU ?????

            1. WilliamLawrenceUtridge says:

              As an aside, any chance we’ll see your commentary over at the Neurologica Blog, WLU ?????

              Have you seen how many comments I leave here? When exactly am I supposed to find the time! :P

    2. Calli Arcale says:

      There’s haute cuisine in Rochester, certainly. You can pay quite a lot for your meal at some restaurants. ;-) It runs the whole gamut. That restaurant review site that he linked to doesn’t seem to have things sorted very sensibly, so I wouldn’t put a lot of bearing on what the first ten items were.

      1. Windriven says:

        @Calli Arcale

        I was just going for the humor. Rochester is a perfectly nice city. Just not as perfectly nice as Portland. Or maybe even Schenectady.

        1. n brownlee says:

          Or… Austin…

          1. Windriven says:

            Some of the best music you can find. Hayes Carll. Bob Schneider. Sam Baker. Gillian Welch. Tom Russell passes through there a lot.

            We have a pretty decent music scene in Portland as well with a couple of first rate small venues including the Aladdin and Mississippi Studios. Plenty of good local talent including the incomparable Brandi Carlile (Seattle, actually). Todd Snider, a local boy, lives down your way now. Snider ain’t all that and a bag of fries but he has some funny stuff.

            1. n brownlee says:

              Boy, do I miss Austin music. A dozen or more independent radio stations. Eat pancakes at an IHop and they got Little Doyle Bramhall on the PA. Walk next door and it’s Townes Van Zandt, walk a block, go into an art gallery and it’s Nigel Kennedy playing Hendrix on an electronic fiddle. Music everywhere.

              1. Windriven says:

                !!!Nigel Kennedy does Hendrix? I know him as a classical violinist though he is not entirely traditional in that role.

                I just went to Youtube and checked some of his stuff out. Far out. Third Rock From the Sun. Too bad Hendrix isn’t alive to see it.

              2. n brownlee says:

                @Windriven
                There’s an old Hendrix tribute album called “Stone Free” – Kennedy Plays “Fire” – it’s great! The CD is great- there’s not a loser on it. I’m on my third copy, the children keep “borrowing” it.

                One of them has also, apparently, borrowed my triple CD Otis Redding Stax compilation, and the Jim Kweskin hapa-haole jug band stuff. At least they have good taste…

              3. Thor says:

                Great reference—”Stone Free” is a hell of a tribute album! How about The Cure’s “Purple Haze”? Now that’s an original interpretation!
                A childhood friend, Steven Doster, is a well-known musician and producer in Austin. Know of him?
                Sorry SBM, off topic (again) but I can’t help myself. I mean, we’re talking Jimi here.

              4. n brownlee says:

                @Thor
                They’re going to throw us off… ‘Stone Free’ is in my top ten driving albums; I like every cut.

                Sorry, do not know of your friend- haven’t lived in the Hill Country for a good while- but I have kids in Wimberley and do visit pretty often. I usually manage a side trip to Austin, with a side-side stop in Waterloo Records. There’s no city like it, for music.

          2. Thor says:

            Always wanted to go to Austin because of the thriving, eclectic music scene. And I love the public access TV show from there, The Atheist Experience, whose main host, Matt Dillahunty, is a gem.
            I’ve heard it called a separate state within Texas. An island hub of progressive thought and attitude surrounded by a sea of….well,
            Texas.

            1. n brownlee says:

              Fooey. As the late Molly Ivins said, “Texas does have liberals. Every town has at least one.”

              Austin is a joy, in many ways. But- Remember, Austin is the capitol. Plenty of Republican politicians, too.

              1. Thor says:

                Absolutely. I hear about the battles. The secular community, and reality-based politicians are forced to act as bulwark against staunch, fundamentalist Republicanism. Some scary shit happening. Man, talk about off topic, huh?

      2. Chris says:

        “There’s haute cuisine in Rochester, certainly. You can pay quite a lot for your meal at some restaurants.”

        As of two years ago there were none within walking distance of St. Mary’s Hospital. There was a nice restaurant in an old house down the street that tried, but it paled against the choices in my neighborhood that is pretty much between a regional Children’s Hospital, university and the university’s teaching hospital.

        There do seem to be better choices near the downtown area next to the main Mayo complex. Except our hotel was across the street from St. Mary’s where son’s surgery was performed. The Barnes and Noble is worth a visit just to look at its ceiling:
        http://en.wikipedia.org/wiki/Chateau_Theatre

        1. Windriven says:

          Too bad Wikipedia only shows the facade.

          1. Chris says:

            I’ve seen some pictures on someone’s blog, but it is not easy to find.

  3. Cory says:

    Well, I used to be an ICU doc, which is about as reality-based as medicine gets – altho that’s not to say we didn’t hurt a lot of people, too. I also use to teach medical ethics and watched it devolve into a bureaucratic, political mess (for instance why did autonomy become a preferred system to the old model of paternalism? At the time that seemed like a bad idea to me. Now it seems like a good idea but for reasons different than you would think. When doctors become irresponsible, autonomy is the last refuge).
    Having been involved in both and watching the phenomenon Dr. Crislip describes metastasize, I can summarize it pretty succinctly and echo the previous commenter.
    Somewhere along the way in the last 25 years, medicine changed from a virtue-based model to a profit-based model.
    Please don’t tell me that profit was always a major part of the system and scams were always a part of it. Yes, that’s true. But the working model used to be virtue and now the profit model has been institutionalized, which is why we have Integrative Medicine Departments.
    The older generation of physicians, whatever their faults, never would have gone for this bumfuzzle. But, hey, autonomy tells us it’s the patient’s choice, isn’t it?

  4. mouse says:

    Dishonesty is very frightening to me. Worse than spiders or heights. It is probably the easiest way to undermine a person’s freedom of decision making (sorry, the right word escapes me). Luckily, it’s so common in life constant exposure therapy is unavoidable.

    1. n brownlee says:

      Oh yes Mouse; I’m with you. Scares me- and infuriates me.

    2. Reno Hates Me says:

      Dishonesty has become so prevalent that my first assumption is that people are lying to me. I’ve become Dr. House…

  5. Christopher says:

    Honestly Marc, how has it come to this? Some of the best and most prestigious medical schools and hospitals have wholly embraced nonsense. I just can’t fathom it. I even hear rumblings that quackedemia is penetrating my alma mater, the University of Queensland. I am just gobsmacked.

    1. Sawyer says:

      Has anyone ever done a simple survey on the age of CAM doctors and patients?

      I’m sure some of it just comes from the stubbornness of getting older, but I’m always struck by my grandparents’ attitudes towards medicine. As comforting as it would be for them to believe there are magical treatments for all the pains of old age, they have no illusions whatsoever that alternative medicine would enrich their lives. My grandfather is a retired scientist so I can understand how he came to this conclusion, but my grandmother does not possess the same training. Is there something about the “Greatest Generation” that has hardened them against charlatans and bad science? I think we’ve speculated before that seeing diseases like polio in combination with living through the Depression makes you appreciate the wonders of science, but I wonder if there’s any definitive data on this.

      Of course my parents and I are the same way, so perhaps it just runs in the family. I’d still like to see a quality breakdown between the Greatest Generation, Baby Boomers, and Gen Xers acceptance of CAM.

      1. KayMarie says:

        I suspect it varies with what it is. Mom was a nurse (dad a scientist) and “greatest generation” and they took a few vitamins and occasional old-timey herbal concoctions you could occasionally still find that they remembered taking as a kid. Although I did kind of like some of the old-timey home remedies I was given as a child that relied on brandy, bourbon or creme d’ menthe. that seem to have fallen out of favor these days.

        I suspect the baby boomers are a bit more back to nature and more interested in CAM of other ethnic groups than the older crowd.

  6. mahdz says:

    We don’t do clinical trials on CAMS for the same reason we don’t send a satellite to Mercury to disprove the penguins which are believed to reside there.

  7. Calli Arcale says:

    “Nearly 40 percent of adults report using complementary and alternative medicine”

    The funny thing to me is that I read that as “less than half of all adults will even consider dabbling in alt med,” which makes it even less impressive than just pointing out their disingenuous rounding.

    So you started at HCMC? It’s a hospital that turns up in the news a lot, thanks to their trauma center and the city’s reputation as Murderopolis…. I hope you enjoyed the Twin Cities, though. ;-) The Aquatennial is just around the corner now.

    My grandmother was a very devoted user of the Mayo Clinic for many, many years. She’s confined to the memory care unit of an assisted living facility these days, and is too fragile to go anywhere at all. But when she was in better shape, she’d insist that my grandfather drive her to Rochester for all of her work. She has struggled with severe asthma for a long time, and so, wanting what she perceived as the best, she selected an asthma specialist down there. Eventually she added other doctors too for other issues, though her GP was local, in the St Paul suburbs. I am not impressed by the work the Mayo did; they tended not to talk to one another, to pile treatment on treatment, and to agree to do anything she asked for. Like what I think was a misguided knee replacement that went very badly because her orthopedist either wasn’t familiar with what long-term oral steroid use does to the skin or wasn’t told about her history. He started the incision at the knee and it promptly split all the way to her ankle. (She bruises if you even look at her funny, and the last time a well-meaning paramedic gave her a Band-aid, she needed a skin graft to repair the damage.)

    When I was a little girl, sometimes she’d bring me along on her annual trips to visit her pulmonologist. I’d have to sit in the waiting room during her appointment, but I’d bring a book and then we’d make a fun outing out of the rest of the day. She’d take me to a restaurant or take me shopping in the underground shopping area they have there. (The city is practically honeycombed undernearth by a fully enclosed pedestrian subway system that links up most of the hospitals and clinics. (It’s very handy in the winter. Our downtowns have a skyway system instead, for the same purpose — allowing folks to get around without having to put coats and mittens on.) It’s more than just the Mayo, of course; there are other hospitals there too.) Mayo used to have a cool (if slightly gruesome) medical museum too, free to the public, but I believe it has since closed.

    I’ve been down to Rochester a number of times as an adult, for various reasons, or driven through it en route to other places; it’s amazing how the city has been growing, and slightly disturbing at the same time. It’s kind of like a medical version of Las Vegas in a way, only instead of gambling and sybaritic pleasures as the main draw, it’s medicine. Huge hotels have been springing up, and shopping complexes and leisure activities geared towards the comfort and amusement of either patients or their travelling companions. Although MSP airport is just an hour’s drive away, Rochester has its own international airport as well; for a brief time in the 90s, they’d flirted with possibly bringing Concorde in to that airport, or perhaps to MSP, which should give some idea to how seriously damn big business medicine has become in that town. It never happened, in no small part because nobody really wants supersonic airliners overland, but you do see traces of the VIPs who come in there, swept tidily from one place to another fully ensconced in their entourage. A lot of them come in their own private jets, and it’s very popular with Middle Eastern royals. The city has grown fat off of that, and while it’s surely good for public coffers there, it is a somewhat disquieting feeling being there these days. The city isn’t as small and lovely as it used to be; it’s disappearing under frenetic development that all looks a little too much like resort development for my tastes. The growing use of alt med there to me is no surprise; they’re offering conceierge services, essentially, so it’s like the hospital version of having a minibar in your room. A way to give you want you want and charge you for it.

    1. Chris says:

      “(The city is practically honeycombed undernearth by a fully enclosed pedestrian subway system that links up most of the hospitals and clinics.”

      We wandered through there in the downtown area. They do also have skyways, but some of them are bit difficult to navigate. When we were looking for their travel agency in a long twisty hallway all I could think of was the old 1970s text computer game where you end up in a cavern with “twisty winding passages” were you only options to leave.

      “Mayo used to have a cool (if slightly gruesome) medical museum too, free to the public, but I believe it has since closed.”

      We found two historical museums in Rochester. In the Gonzo building downtown there was one on the Mayo Clinic which had much on the Mayo family. The smaller one in St. Marys Hospital focused on the Sisters of Saint Francis of Rochester connection as providing nuns for nursing and care of the patients. A relationship that was formally severed this year, though the chapel will still be used.

      “The growing use of alt med there to me is no surprise; they’re offering conceierge services, essentially, so it’s like the hospital version of having a minibar in your room. A way to give you want you want and charge you for it.”

      One thing we learned at the little Mayo museum in the Gonzo buildings is that the Mayo Clinic is the largest non-profit in the country. As you go through the buildings you will see lobbies, waiting rooms, a spiritual center (as a non-Catholic option at St. Marys) and other amenities with plaques thanking the wealthy donors who provided the funding. I assume that any alt-med offerings are to cater to those who will donate to the clinic. Because we sure did not see much offered to us.

      (there is a big waiting room above the main entrance with a huge window with one of those donor plaques… it is the best place to see the helicopters come in an land above and to watch the absolutely awesome storm with lightning and tornado warning… despite warnings to stay away from the window, the chairs were lined up in front of the window)

      From the Monday morning line for the blood draw to the next Monday finally getting the last echocardiogram to clear son for a flight out that afternoon I only saw two alt-med bits. One was a CD of relaxing music that came with the schedule packet, and then a teeny tiny sign on the wall across from the nurses station for acupuncture in the cardiology recovery ward (about three by two inches). Oh, and I forgot, a priest came in to the surgery prep room seeing if son wanted to pray (he did not). We did not eve see anything on the Mayo Clinic TV cardiology channel (though lots of on demand videos on diet, exercise and how to recover from heart surgery, they also gave those to us on DVDs to watch repeatedly at home).

      Seriously, we had no freaking time for any alt-med with all the real medicine that was being done.

      1. Calli Arcale says:

        Well, that’s why I compared it to the minibar in a hotel room. It’s more of a “pull” model. You can get the extras if you want, but it’s not part of the standard package.

        And yes, it is nonprofit. Minnesota hospitals are all non-profits. Even the ones operated by corporations; those corporations are non-profits as well. But this in no way relieves the need to get funding. I’ve been to a lot of hospital fundraisers and such through the years; they tend to be glamorous affairs and a lot of fun, but again, it shows how much money is involved in all of this. The city of Rochester owes a lot of its wealth to the Mayo, which is actually one of the biggest employers in the state. There’s a lot at stake in maintaining it.

        BTW, just for a quick random factoid, did you run into anything explaining how the Mayo got started? It’s kind of an interesting story. The Mayo family (three doctors: a dad and his sons) had a private practice in Rochester, then quite a small town but important as a major railway stop. Then a massive tornado ripped through and obliterated it. There were no hospitals to deal with the many wounded, so the Mayos started treating them wherever they could. The local convent agreed to provide space, and soon the hospital of St Mary’s was born, adjacent to the Mayo Clinic. It’s one of the oldest freestanding hospitals in the state, if not *the* oldest.

        So if you come again, and there is a tornado warning, maybe don’t stand by the windows. ;-) Rochester’s been hit before.

        1. Calli Arcale says:

          BTW, my grandmother was never offered alt med either, to my knowledge, and honestly I’d argue that she received an excess of conventional med. She didn’t get any better care than she would’ve gotten here in the Cities for her condition, and using fewer practitioners would’ve reduced the risk of miscommunications.

          1. Chris says:

            The reason we were referred there is that the type of surgery requires an experienced surgeon, who are really only available there and in Cleveland. To get to Cleveland means actually flying over Rochester, so might as well land in Minnesota.

        2. Chris says:

          “BTW, just for a quick random factoid, did you run into anything explaining how the Mayo got started? It’s kind of an interesting story.”

          All over the place. There is huge plaque in front of St. Marys older main entrance with the explanation, in both museums and elsewhere:
          http://www.mayoclinic.org/patient-visitor-guide/minnesota/clinic-hospital-buildings/mayo-clinic-hospital-saint-marys-campus/history

          Actually I spent the time during the tornado warning in the family lounge which is in the middle of the cardiology ward, no windows. I’ve lived in the midwest, I know better. It was after the storm that I saw the chairs lined up towards the huge picture window above the new main entry (it is actually a complex of several connected buildings).

          1. Chris says:

            I hope that the reality of the experience of patients who neither time nor money to indulge in alt-med nonsense is noted by the SBM authors.

            We know these large medical meccas need to make money, and sometimes that includes fleecing the wealthy worried well. But the Mayo Clinic did help someone who we helped to her temporary apartment… she had no health insurance, but was airlifted there from Wisconsin, had surgery for an invasive bacterial infection and given vouchers by their social services program to live near where she could get followup treatment.

            Perhaps one way to keep alt-med out of medical centers would be to replace the extra fees for idiotic therapies is a government single payer heath insurance system that exists in almost every other first world country. Which was actually suggested by one of the Supreme Court judges in the recent infamous Hobby Lobby ruing.

            One of the cogent analyses that I have listened to (available in both podcast and video versions) a UK interpretation:
            http://www.skepticcanary.com/the-skeptic-canary-show/ep58-helen-dale-skeptic-canary-show/

            And as an aside on the Hobby Lobby ruling, please do not by Eden Organic Food products. Thank you.

            Presently I am imagining the conversations at TAM over the Hobby Lobby and Eden Foods. Mostly because I have three kids in college and am too old to stay up late at any TAM!

      2. Maria says:

        I think you are missing the point, I am sure the not hospital is forcing CAM on people who don’t want it, however by having it available at a hospital they are giving it legitimacy.

        it is very hard to escape it, at my mothers funeral my cousin who is a nurse was giving out rescue remedy, which is a homeopathic remedy, I took it because I did not want to be rude to someone who was trying to help. I know a science teacher who totally believes in lots of this stuff.

        1. Maria says:

          Edit, I meant to say, I am sure hospitals are NOT forcing CAM on people.

  8. goodnightirene says:

    How much would each of us need to donate to get rid of “You May Like”? Having these eyesores on this site is simply an example of the creeping rot of commercialism into every aspect of life–right along with SCAM.

    1. Thor says:

      I was surprised to see them, as I’m sure most of us were. But, I’m so used to ignoring ads by now that I just scrolled past them giving them no mind whatsoever.
      Today, I barely noticed they were there. They don’t like people like me, but too bad.
      I hope SBM doesn’t dislike me either—ha—for not clicking on them, because isn’t their revenue from this source dependent on my opening them up, at least?
      My ire gets stimulated by the content of Crislip’s post, not by the “You May Likes”.

      1. Windriven says:

        ? What did Crislip say to piss you off?

        1. mouse says:

          The content of the post, I think. Meaning, reading an article about ivory poaching may raise your ire, not at the reporter, but at the poachers.

    2. Frederick says:

      Yeah I saw that appear thise weak, I thought I had a Virus or something. The worst thing about them, is where they are, right after the Post, and super big, On the right or left side could be better. The site owner can not filter the content of those freaking add. A lot science site have those stupidity “miracle” ad.

  9. goodnightirene says:

    By the way, enjoy your holiday Dr. C, but beware of caramel cake!

  10. NSC says:

    “…the hospital systems in Portland in general, are surprisingly SCAM-free.”

    Not entirely. OHSU offers CAM treatments through its Center for Women’s Health, and also claims: “OHSU is a national leader in complementary and alternative medicine (CAM) research for neurological (brain and nervous system) disorders. Our experts use science to test CAM treatments such as fish oils, meditation, stress reduction, diet changes, antioxidants and nutritional biomarkers…”

    1. Windriven says:

      How depressing. When one follows the links it is even worse than your comment suggests.

      My internist is associated with the Legacy Health program in Portland and I am proud to say that this morning when I visited their website and searched on “CAM” and “Alternative Medicine” and “Acupuncture” the worst I found was links to some physicians and paraprofessionals who dabble in stupidity as a sideline.

  11. Maria says:

    Why are some people attracted to and choose CAM in the first place? my husband was at his GP recently who told him about a patient of her who had breast cancer and refused chemotherapy and instead she was having CAM, now you have to ask yourself why would a rational adult with no mental health issues do that?. Has there ever been any psychological research in to this.

    I never understood asking for a second opinion for relatively common diseases, in the era of modern communication patients can look up the recommended treatment themselves, doctors talk and communicate to each other. If you have for example a relatively common cancer that is well researched and understood you will be offered the same standard treatment no matter where you go. I suspect it is to do with money, people want to believe if I go to a famous hospital I will get better treatment, my money will buy me better treatment.

    1. Windriven says:

      “Why are some people attracted to and choose CAM in the first place?”

      Conjectures abound but Pubmed offers little guidance. I’ve just spent some time trolling there but found nothing of consequence.

      1. KayMarie says:

        I’ve been rebuilding our research group’s website and there are a couple of who uses CAM papers in our mix of things.

        Complementary Therapies/Utilization may be a useful MESH term if you want to dig around some more.

        From our group’s papers (relatively old) and a couple things that popped up on Pubmed with that term (and a lot of this is in who uses what in other countries) with that I found a few things linked.

        1. Medical Skepticism (don’t think the doctor can help you). I would say that is true of some of my woo friends. Some do have loved ones who died way to young, etc who did the usual medical treatments and they didn’t work out that time. Even if 99% of the patients lived, statistics mean nothing to the 1% who died. I think the belief is something should have been able to save them and many CAM promoters assure people that had they only seen the light earlier and bought that vita-mix and organic kale and followed this diet or took these herbs their loved one would have lived and been active until the bus runs them over at 110.

        2. Rate their health worse than people who don’t seek out CAM. Probably fits a lot of our “just wait until you are sick” posters I’ve seen here. And I think that makes some sense. The worse you feel the more you will tend to “try anything”. Or the more desperate you are the more people just waiting to prey on you.

        3. From more recent pubmed quick look…and may fit in with rate their own health poorly. Higher usage of standard medical care overall. Makes some sense, if I go to the doctor over and over and try thing after thing after thing and that doesn’t work, maybe something else will.

        I do think some of the “I can do it myself” and “problems with authority” play into it for some people. I mean who do you trust, the guy with all the degrees on their wall or the guy who followed the American Dream of putting together a few plant extracts in his garage who healed himself and went from rags to riches. And may be why some of our woo are also into conspiracy theories. Whatever the people who look like experts say just has to be wrong (and that goes back to #1 as well)

        1. Windriven says:

          KayMarie, if you’ll send me links I’ll see what I can do to get them up on the SFSBM wiki.

          1. KayMarie says:

            1. http://www.ncbi.nlm.nih.gov/pubmed/18525432 – Medical skpeticism
            2. http://www.ncbi.nlm.nih.gov/pubmed/18364653

            3. http://www.ncbi.nlm.nih.gov/pubmed/24127466 is the one that isn’t our groups I found playing with the MESH terms from ours this one actually had higher use of standard medical care

            “Complementary Therapies/utilization”[MAJR] is the MESH term that seemed to bring up these kinds of papers.

            1. Windriven says:

              Thanks!

        2. Young CC Prof says:

          Rate their health worse? Interesting. Because I’ve noted a certain amount of “wellsplaining,” that is, the arrogance of those who use natural health products and enjoy reasonably good health. Obviously, their clean eating is the reason why, and the occasional cookie is the only reason why you have a problem that requires actual medical treatment!

          1. KayMarie says:

            Well there may be differences between those who have always been healthy but get into CAM and those who have disease (the study was on patients with arthritis) and probably the worried well where nothing is wrong, but they aren’t matching some expectation of what healthy is like for your average human.

            While I know some of the always been healthy and gloat types, but I know a lot more of once I got sick I was willing to try anything types as well. Of the got sick first I do think that those that aren’t doing so well are more likely to get desperate enough to try anything.

            The amount of betrayal felt by those who believed that healthy living would prevent every single possible illness or accident that could ever happen can be pretty devastating.

    2. Thor says:

      Great question! Steve Jobs comes to mind. I think it is an evolved human condition to need/want to believe, have belief—God, “nature”, life-force, supernatural. No one is immune, some just more prone to it, perhaps through various conducive input in formative years. Then, factor in the naturalistic fallacy (among others) as a very human psychological culprit behind our openness for CAM.
      We weren’t taught critical thinking skills, logic, epistemology as our brains were developing. As adults, we are left helplessly unequipped to make sound choices, decisions, assessments, modes of action (even if they subjectively appear to be so).
      And once the door of the mind is opened for believing strange things not based in reality, the infiltration persists. Strange, a baby human with full potential develops into an adult believing in homeopathy, or virtually anything.

      1. Windriven says:

        “I think it is an evolved human condition to need/want to believe, have belief—God, “nature”, life-force, supernatural. No one is immune, some just more prone to it,”

        I would speculate that it is more complex than that, that humans have an evolved compulsion to fill in patterns just as the brain ‘fills in’ parts of the visual image that aren’t always actually there (as a number of illusion experiments have shown). When the necessary data isn’t there we stretch to fill the field with … Something. God works pretty well for that – sort of like Finagle’s Constant – a general purpose explanation for whatever needs ‘splainin’.

        And yes, from there the sky’s the limit. At the risk of offending my theistic friends out there, once you’re willing to believe in god, you’ll believe in anything given just a little push.

        1. Thor says:

          Yes. Expressed with more detail and nuance.
          One must believe or die. Shermer’s rustling grass comes to mind. It could be the wind; it could be a tiger. “Screw it: I believe it’s a tiger! I’m outta here”. Now, if the guy’s wrong, who cares. But, if he waits to verify what the rustling really is, he could easily become dinner.

          1. Windriven says:

            Amen. ;-)

  12. kathryn says:

    I recently saw a rheumatologist with University Hospitals in Cleveland. She’s also some sort of professor at Case.

    She asked me if I had considered acupuncture for my chronic pain. I looked at her like she had three heads and calmly told her I had no interest in treatments based in fantasy. I don’t think she appreciated the comment.

    Why yes, this is why I’m getting a second opinion from someone who came highly recommended. I have no patience for SCAMs. If the government is going to pay for my health care, I want to make sure they aren’t wasting money on crap.

    1. mouse says:

      -Fun with doctors who prescribe placebos.

      With a completely open and ernest face say. “Sure, I’d try acupuncture, but do you have one of those non-penetrating needles? because I’ve heard they work just as well without the risks”

      Watch them try to figure out what to say next.

    2. Reno Hates Me says:

      Yep, I recently switched doctors after the physicians assistant at my old practice recommended Reiki (and after my doctor recommended some questionable vitamin supplements and that I go gluten free despite have only occasional stomach issues, probably due to multiple prescriptions. I’m now down to one prescription and, strangely, my stomach issues have gone away. Fancy that…)

    3. Your loss.

      See my other comments if you would like to understand all of your options.

      Don’t fool yourself.

      1. Missmolly says:

        ‘See my other comments if you would like to understand all your options’.
        HAHAHAHAHAHAHAHAHAHAHA!!!! *wipes eyes*

        1. WilliamLawrenceUtridge says:

          Is it the “understand” part you find so funny, or the implication that there are multiple “other options”?

          1. Missmolly says:

            Oh, just the idea that one might increase one’s understanding of anything by reading SSR’s comments- you might as well suggest someone read Penthouse to learn about algebra!
            Also, all the most reasoned responses have merely fuelled his persecution complex, made him increasingly incoherent and ‘remind(ed him) of the evils of mankind’, so I felt that a good dose of well-deserved derisive laughter couldn’t damage my chances of furthering the conversation.

            1. WilliamLawrenceUtridge says:

              you might as well suggest someone read Penthouse to learn about algebra!

              Well, you would implicitly learn something about the relationship between radius, diameter and perimeter. Absolutely nothing about gravity though.

      2. Frederick says:

        Yeah Don’t listen to SSR, don’t fool yourself.

        I Would not worry for her, unlike you Steve she seem to be grounded in reality.

      3. Windriven says:

        “Your loss”

        How is not wasting money a loss? The only loss is to the quacks.

  13. rork says:

    Cancer Treatment Centers of America have had adds on the radio lately, touting integrative stuff. (For weeks before that is was sequencing.) Web site mentions homeopathy, herbal extracts. My own cancer center (U of Michigan) seems to be getting cleaner actually. (Gorski had lamented it’s demise either here or on another blog, with good reason, perhaps two years ago.) Maybe things were creeping toward the dark side without folks really noticing, until finally people noticed, perhaps with horror.
    Ah, yes, the old post I was thinking about was:
    http://www.sciencebasedmedicine.org/a-university-of-michigan-medical-school-alumnus-confronts-anthroposophic-medicine-at-his-alma-mater/
    In my letters to my superiors, I had noted how we were being pointed out as fools, and that wasn’t good. Perhaps I was not alone. I did not feel I was risking very much by complaining (I’m not a doc). Doc Gorski may have helped, by direct or indirect means. Thankyou. Others, take heart. You might help change things.

    1. Sawyer says:

      I got a bad case of road rage listening to NPR this week. After wincing at the sponsorship from Cancer Treatment Centers of America, I had to listen to a doctor on All Things Considered documenting the abuse of opiate painkillers in the military. His solution? Acupuncture and spa treatments. That’s apparently how we’re going to treat our veterans in the future. What could possibly go wrong?

      One more of my favorite shows, slowly giving in to the world of CAM.

      1. WilliamLawrenceUtridge says:

        It’s always amusing to see the intersection of “likes NPR” and “hates CAM”. Another bit of evidence that red/blue, left/right is too simple of a division to be meaningful. Science Left Behind had an interesting discussion, dividing people into the degree of fiscal and social control the government exerted. Classic republicans were low fiscal, high social control, classic democrats were high fiscal control and low social control, libertarians were low fiscal and low social, and progressives were high fiscal and high social. High social control were the groups that tended to ignore more science, think an evolution-denying republican and a vaccine-denying progressive.

        Of course, my stereotype of a libertarian also incorporates denial of both, so I guess what I’m saying is “go democrats”.

      2. Sawyer here is some info that will hopefully allow you to see all the pain treatment options. Spa treatments are vital and are part of the patients responsibility.

        Here are most of the safe options, I have researched and have personally used for a decade:
        Muscle, tendons, ligaments and bursae are all in a class called Myofasical Tissues and the treatment of these tissues is called Myofascial Release Therapy. MFRT can be grouped into 2 forms, hands-on and then with needles.

        Hands-on options you do at home:
        Stretching, Active Isolated Stretching, Foam rollers, Graston Technique, Acupressure with your hands or a T-cane, Brushing and Cupping.
        Hands-on options with an assistant or therapist:
        Craniosacral Therapy & Core Synchronism, Rolfing, Reflexology and related options.
        Gua Sha, PT specialist who can perform “Spray and Stretch,” Professional massage, John F. Barnes Therapist, etc..

        With various Needles:
        Acupuncture and all of the various types.
        C. Chan Gunn, MD has a patented procedure called Intramuscular Stimulation, which is a very active Myofascial type Acupuncture.
        Dry/Wet Needling or Trigger Point Injections based on the protocols of Janet G. Travell/David Simons, MD or Edward Rachlin, MD.
        Prolotherapy is a good options but to be should be used in combination with all else.
        Note:
        Injection therapy with various substances; Steroid, Biopuncture, Neural Injections and Botox Injections. Then there are Platelet Rich Plasma Injections which are a high-tech injection but not really much better.

        Cautions:
        Modern high-dose Steroid Injections into sensitive dynamic tissues of a joint should be used with profound caution. Steroids, modern doses, will shut-down all the healing, repair, restorative and rejuvenating ability and possible cause the joint structures to atrophy and wither away. These “poisoned” joints may never recover. IMO, Steroids should only be used when they can balance out a high level of inflammation; hot, red swelling and fever and all else have failed.

        Unfortunately as you move up the intensity it takes much more time, effort and costs, so it would be ideal to address pain in the early stages which will save lives and misery. Notice almost ALL of the options are NOT routinely covered benefits and will not be anytime soon because your pain is invisible to the people who make the regulations. So call your legislators and make your pain be heard!

        1. WilliamLawrenceUtridge says:

          I have researched and have personally used for a decade:

          Well, personal use can be discounted immediately – bloodletters were personally convinced by their personal use of leeches and lancets for thousands of years, and it turns out they were wrong.

          As for your “research”, where is it? I’ve asked you for pubmed-indexed journal articles for months now, and the few times you’ve provided them, they’ve been useless, irrelevant, speculative or old. Why do you have such a hard time providing citations for something you insist is well-researched? Why, if these treatments are so effective, do the results of clinical trials end up being so disappointing?

          Stretching, Active Isolated Stretching, Foam rollers, Graston Technique, Acupressure with your hands or a T-cane, Brushing and Cupping.
          Hands-on options with an assistant or therapist:
          Craniosacral Therapy & Core Synchronism, Rolfing, Reflexology and related options.

          Dr. Hall has a post on the the Graston technique, and there’s absolutely no evidence it works. Cupping is also unproven, and dangerous – it can cause significant bruising and burns if you use a match to generatethe vacuum. How is craniosacral therapy supposed to even work, considering the bones of the skull are fused together and the pressure used is equivalent to the weight of a nickel? Not to mention the lack of good evidence to support it. Why do you keep believing in such poorly-supported methods? It’s like your criteria for deciding on an intervention is looking for the ones least supported by scientific evidence? For instance:

          Prolotherapy is a good options but to be should be used in combination with all else.

          Despite 58 years of history, there is no good evidence prolotherapy works.

          Modern high-dose Steroid Injections into sensitive dynamic tissues of a joint should be used with profound caution. Steroids, modern doses, will shut-down all the healing, repair, restorative and rejuvenating ability and possible cause the joint structures to atrophy and wither away. These “poisoned” joints may never recover. IMO, Steroids should only be used when they can balance out a high level of inflammation; hot, red swelling and fever and all else have failed.

          Do you really think you should be giving advice over the internet? Particularly when you seem blatantly ignorant of what “evidence” means?

          Notice almost ALL of the options are NOT routinely covered benefits and will not be anytime soon because your pain is invisible to the people who make the regulations. So call your legislators and make your pain be heard!

          The main reason they are not covered by insurance is because there is no evidence to substantiate their effectiveness. So what you are in essence saying is “when the science doesn’t support you, try politics!” Which makes you just another dishonest CAM shill trying to protect your income stream at the expense of patients and science.

          Ugh, so boring.

  14. “You can’t lie to patients”

    These were lied to and I have hundreds more, they all were given risk and benefits of only traditional medicine options and they all failed. Then they were lied to again when they do not offer them any alternatives. This is the standard of care in the US so everyone wins except the patients who have been betrayed and left to suffer in vain.

    https://www.dropbox.com/sh/hnojq9d8ig892bo/AAC4wS5oOQxscyVJBFLsYC66a

    1. WilliamLawrenceUtridge says:

      Who were lied to? The patients’ stories in your drop box? That carefully-selected set of anecdotes that only support your position?

      If an alternative works, then it will show up in clinical trials. Why do the benefits for most alternative treatments disappear as soon as you have an adequately-blinded control group?

      1. If you believe all of medicine has all the answers why is healthcare in ruins?

        Those pictures are real people who have real problems and have were not given all options. Just like modern medicine, you care not to see them as people, only numbers and codes. Easy to make people you don’t know or care about fade into tortured or obedience ghosts. (as per j. bronowski)

        Don’t care why did those people fail the surgery that was offered to them and then given not recourse? Then why do you care about blogging your believes?

        1. Windriven says:

          “[W]hy is healthcare in ruins?”

          Healthcare is in ruins???? You have a vivid imagination.

          Healthcare is not perfect. But whatever problems healthcare has, acupuncture and moxibustion are not the answers.

          “Don’t care why did those people fail the surgery that was offered to them and then given not recourse? Then why do you care about blogging your believes?”

          You have some disturbing photos. But what were the actual histories, what were the alternatives, what would the outcomes have been without surgery? Your approach to medicine is as incoherent and incomplete as your approach to language. How do you expect anyone to take you seriously?

        2. WilliamLawrenceUtridge says:

          If you believe all of medicine has all the answers why is healthcare in ruins?

          Many countries throughout the world have excellent health care that strongly supports the health of most or all of their citizens. You appear to be appealing to a particularly American problem of a lack of a publicly-funded health care system. I agree, it’s terrible, wasteful and inhumane. Doesn’t mean CAM has any answers, merely a vast body of contradictory theories and a dearth of evidence.

          Those pictures are real people who have real problems and have were not given all options.

          Yeah…the thing is the options you want to charge for all seem to be unproven. That’s an issue in my mind.

          Just like modern medicine, you care not to see them as people, only numbers and codes

          Go fuck yourself you condescending douchebag.

        3. weing says:

          “If you believe all of medicine has all the answers why is healthcare in ruins?”
          All of medicine? What does that mean? That would include CAM? I have no illusions that medicine has all the answers. We do have a lot of questions though. I am not sure they are all the right questions, though. Why do you think healthcare is in ruins? Is it because current care is not 100% effective? What medicine needs to do is to work on those for whom it has not been effective. To find out why and make corrections. That way they won’t be preyed upon by the con artists of alternative medicine that promise 100% cures.

        4. Sawyer says:

          Easy to make people you don’t know or care about fade into tortured or obedience ghosts. (as per j. bronowski)

          No SSR, you’re not getting away with pulling a fast one like that. You don’t get to sully the name of wonderful science writers many of us adore and admire by pretending they believe the exact opposite of what they’ve actually written. You tried this multiple times now with Goldacre, Bronowski, and several psychologists (Carol Tavris maybe?). This is a fantastic way to piss off the few people here that still have an ounce of respect for you.

          I have Jacob Bronowski’s The Ascent of Man sitting on a bookshelf behind me and it’s fairly high on my summer reading list. What do you want to bet that I will find absolutely nothing in there about completely abandoning science and careful record keeping in healthcare? I’m not psychic but I’m fairly confident I’m not going to discover any ringing endorsements for acupuncture. Are you going to apologize or feel the slightest bit of guilt if I find out you’re just making this crap up?

  15. Brian Buchbinder says:

    scientific research suggests Ayurvedic treatments have positive effects on a range of conditions and disease. Ayurveda is believed to have positive results

    The first sentence is just a lie. That there are weasel words in the second does not redeem the lie. Why a “medical” institute needs to lie when they can let credulity do the work for them is beyond me. I’m hoping that the medical staff doesn’t actually believe any of this crap. On the other hand Ayurveda probably doesn’t do any more harm than having the local witch doctor go at it with the rattles and dances. But do they charge for this? What’s the code? Does the patient pay out-of-pocket?

    1. MadisonMD says:

      beLIEve

    2. mho says:

      in my state’s University, the Integrative medicine dept. chair and probably the massage therapist and the acupuncturist get salaries and I suppose the clinic floor space is just racked up to hospital overheard. Accupuncture is covered by a number of insurance plans. Much of the “treatment” costs are paid by grants from non-profits. Sad use of money that could be going toward useful medicine.

    3. Vicki says:

      You’re better off with rattles and dances–they won’t give you heavy metal poisoning. (By the same token, homeopathy, being just water, and the completely substance-free reiki are also safer than ayurvedic “remedies.”)

  16. Elroy says:

    How do you academics deal if someone in your home Dept practices woo? At my recent faculty meeting, it was announced that someone got a grant from a woo-foundation. It infuriated me, but I haven’t said anything. This individual has publish bizzaro-land stuff too involving contact with “the dead.” I’m just a lowly assistant adjunct still trying for my first big break in NIH land but this mid-career academic is going off the rails in my own department. I fear for our integrity, but all I can do is focus on my own work and hope things work out.

    1. MadisonMD says:

      I could not possibly resist a bit of snark. Maybe you should ask him to have Al Einstein and Isaac Newton look over your next grant proposal and make suggestions. The possibilities are virtually endless when you have a colleague who talks to the dead. I mean if he can prove it scientifically he has the answer to all the big questions and poof your philosophy dept becomes superfluous. I have so many many many questions for the guy, but then I suppose the dead only give him vague answers like horoscopes, eh?

      1. Elroy says:

        Well, it’s others communicating with the dead, and only specific, non-famous people. I haven’t seen this person at faculty functions since the dead people publications. Your plan of action seems passive aggressive, probably people wouldn’t understand my actual criticism if it was veiled in snark, which I don’t think would win affection when this person has a two decades of collegiality with these folks on me. Science is a social endeavor and I can see (in my own situation) why highly hierarchical organizations with insecurity at the low levels contributes to groups ending up doing the wrong thing. Like letting woo be practiced / taught in their own medical schools. Idealists have no power and those in power know they gotta keep the lights on.

        1. MadisonMD says:

          Yes I can’t advise snark only to state I would find it irresistible. I’m guessing some of your colleagues are friends of the guy and are genuinely sad he has gone off the deep end… like Syd Barrett and Brian Wilson.

          If he doesn’t go to faculty meetings then it suggests that something is amiss. So I agree with you that your best bet is to do nothing. Still I like to find the humor… with no aggression intended. Just yuks.

        2. WilliamLawrenceUtridge says:

          Well, it’s others communicating with the dead, and only specific, non-famous people.

          Well of course it is…

  17. Peter S says:

    At least as to acupuncture, there seems to be a paradox in play. The more studies that come out that confirm it’s all BS, the more mainstream doctors and institutions seem to be embracing it or at least suggesting it. Are the doctors and institutions just unaware of the research? For the institutions, is it just about supplying what is in demand to make a profit? Or do they just cynically figure that some people may be helped by the placebo effect and the risk Is low, so what the hell?

    1. Peter S says:

      I should add that back in the day I saw quite a few acupuncturists, several of whom were reputed to be the best in a major medical city. There seemed to be no rhyme or reason to what any of them did — I was paying pretty close attention and as far as I could tell the needle placements for the same general issues bore no resemblance to each other in terms of number or location. I had absolutely no results from any of it except loss of money.

      1. @peter
        Do you actually think you can figure out Acupuncture as a patient, without training in theory and technique?? WOW!

        It took an average physician, me, a few years of practice to understand that Acupuncture is not what it is stated to be, that it is a surgical procedure.

        There are usually reasons why a treatment fails and it is up to the provider to work through that process. Traditional acupuncture is an accumulative and discovery process, not a quick fix.

        If you would like to understand the science behind the process read C. Chan Gunn, MD.

        1. Windriven says:

          “It took an average physician, me…”

          You flatter yourself.

        2. Serge says:

          There is no science behind the process.

        3. Peter S says:

          I did not purport to figure it out, I merely report my observations that each of these supposedly leading acupuncturists did completely different things. Certainly as a patient I was able to observe how many needles were used, and where they were placed, and to note the similarities and differences.

          I would have been delighted if it worked. I had no a priori views on its efficacy, and the fact that I kept going to different recommended practitioners (for multiple visits) shows that to a point I kept an open mind. After thousands of dollars out of pocket, though, I lost faith.

          1. simba says:

            No no no, you don’t see it. Patient experiences only count when they are in FAVOR of acupuncture. We don’t listen to them if they didn’t find any effect.

            I had acupuncture too, did absolutely nothing. Heck, I was used as a pin-cushion to demonstrate myofascial trigger point therapy, also didn’t change anything.

            If I had had conventional medicine and the like results, I would be incontrovertible proof that conventional medicine is hopelessly useless. If I have acupuncture and have the same results, that’s because ‘it’s not a quick fix’.

            On the contrary, anyone I know who’s used acupuncture with good results has seen it as a quick fix- temporary pain relief with pain returning to normal after a week at most.

        4. Peter S says:

          So I looked up Dr. Gunn and from what I can tell he advocates “Intramuscular Stimulation” which, while it does use acupuncture needles, appears to be a form of dry needling, not traditional acupuncture at all. His theory appears to be that by directly stimulating contracted muscles, they will relax. That doesn’t sound to me — of course an uneducated patient — anything like acupuncture theory.

          1. weing says:

            “That doesn’t sound to me — of course an uneducated patient — anything like acupuncture theory.”

            That’s because you’re not conflating.

          2. @peter

            You are correct it is not Acupuncture theory. That is because there is no one theory but many based on your wishes. yes the concepts are totally in the mind and belief systems.

            What Gunn has done is profound, he took the stainless steel needle and uses it as a surgical instrument to probe into the muscles thus igniting the healing cascade, depolarized muscle (Cannon’s Law) and stir or stimulating the flesh. This is an important key … all simultaneously. Then Mother Nature does the rest.

            He has in essence modernized the needle as a surgical tool with an irrefutable mechanism of action.

            I’m sure in the future we will add clarity and specificity but today it is as simplistic as that ( to reasonable minded people that is)

            1. Windriven says:

              Yeah Peter, what Steve-o means is that acupuncture is whatever he wants it to be. It is kind of like the guy that trips over a tree root, gets up, brushes himself off, and says: I meant to do that.

              “He has in essence modernized the needle as a surgical tool with an irrefutable mechanism of action.”

              Yes, that irrefutable mechanism is called magic (Ann Wilson singing: ) ’cause Steve’s a magic maaa-aaaa-aaaannnnnn.’

            2. WilliamLawrenceUtridge says:

              You are correct it is not Acupuncture theory. That is because there is no one theory but many based on your wishes. yes the concepts are totally in the mind and belief systems.

              The nice thing about reality is, it doesn’t care about your belief systems – it just is. If “acupuncture” actually has an effect on a biological system (the hardware rather than the software), it should be possible to demonstrate this effect. Over 3,000 studies now have tried to find such an effect with acupuncture and failed. It doesn’t matter where you put the needle, it doesn’t matter whether you penetrate the skin, you don’t even have to use needles – but it does matter if the doctor is nice or not.

              What I just described is a placebo.

              What Gunn has done is profound, he took the stainless steel needle and uses it as a surgical instrument to probe into the muscles thus igniting the healing cascade, depolarized muscle (Cannon’s Law) and stir or stimulating the flesh. This is an important key … all simultaneously. Then Mother Nature does the rest.If depolarization is necessary, why doesn’t simple contraction work? It depolarizes the muscle. In fact, it has to – that’s how the muscle contracts. Why wouldn’t TENS work better? And what supports this claim? A bit of looking on the googles turns up a bunch of blogs circle-jerking each other, where’s the science? Where’s the testing?

              He has in essence modernized the needle as a surgical tool with an irrefutable mechanism of action.

              Where has it been tested in a refutable way? Where are the efforts at falsification that underlie all scientific inquiry? Can you link to any actual scientific tests?

              I’m sure in the future we will add clarity and specificity but today it is as simplistic as that ( to reasonable minded people that is)

              You’ve been saying this for months and so far nothing has popped up. But hell, feel free to submit a guest post, that should be amusing.

        5. WilliamLawrenceUtridge says:

          Do you actually think you can figure out Acupuncture as a patient, without training in theory and technique?? WOW!

          Yeah, but Peter S wasn’t the one placing the needles, the allegedly trained acupuncturists were, and they apparently put the needles in different places.

          It took an average physician, me, a few years of practice to understand that Acupuncture is not what it is stated to be, that it is a surgical procedure.

          You’ve said this before, but never defined acupuncture or stated how you know your version is “right” and everyone else’s is wrong.

          There are usually reasons why a treatment fails and it is up to the provider to work through that process. Traditional acupuncture is an accumulative and discovery process, not a quick fix.

          Sounds like you’ve got a whole bunch of ready-made excuses to pull out whenever “your” acupuncture doesn’t work. And that in turn means are you’re doing is killing time while your customer gets better anyway.

          If you would like to understand the science behind the process read C. Chan Gunn, MD.

          What science? I looked on pubmed, they didn’t seem to have any peer-reviewed publications, just a book full of clinical impressions. And just like you, their clinical impressions can be selectively misleading. That’s why you need scientific research. If your work is actually effective and not merely placebo, then controlled trials will demonstrate this. Why haven’t you undertaken any?

  18. Tj says:

    How is 38.3% not “nearly 40%”?? Wow you really took them down with that snipe!

    1. Serge says:

      It’s nearly 38%.

    2. Serge says:

      38.5% at a push.

    3. KayMarie says:

      Depends on the power of the data that generated the figure.

      If you are saying the study is of so little power that the most you can know is one significant digit than yeah, it’s 40%.

      But studies where you can get 3 significant digits usually are better quality. However you do get a lot of people who report precision when they don’t have the data to be accurate. I mean it isn’t uncommon for people to really only be able to say 3% and report 3.0124%

      Of course a lot of this is the how to lie with statistics fundamentals. You want to make something look better than it is (or worse than it is) say you only have one significant digit so you can round up (or round down) as much as possible.

      I’m wonder if the number was 34.4 and we rounded it down to only 30% of people use CAM if the same people would be insisting we use more significant digits rather than less.

    4. Jopari says:

      Commonly, the most you can get away with is up to the ones in percentages, and that’s stretching credulity. That 1.7% is easily a huge figure if placed to ratio based on human population. Heck, quarter the populace and you’d still have a massive number.

    5. Frederick says:

      Well, It is also Psychological warfare, 40 look better than 38. It look more convincing, Like 199 Instead of 200. That just a small manipulation tricks, probably not that efficient but still work. it’s marketing, All about cam is just marketing.

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