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Why Do People turn to Alternative Medicine

Any sociological question is likely going to have a complex answer with many variables that are not easy to tease apart. We should therefore resist the temptation to make simplistic statements about X being the cause of Y. We can still, however, identify correlations that will at least inform our thinking. Sometimes correlations can be triangulated to fairly reliable conclusions.

When the data is complex and difficult to interpret, however, evidence tends to be overwhelmed by narrative. The recent Sandy Hook tragedy is an excellent example. No one knows exactly why the shooter did what he did, so it is easy to insert your own preferred narrative as the explanation.

Another example is the phenomenon of so-called complementary and alternative medicine (CAM). Why has it been increasing in popularity (and is it, really?). Is it slick marketing, relaxed regulations, scientific illiteracy, a gullible media,  or the failures of mainstream medicine? You can probably guess I think it’s all of these things to some degree. The most common narrative I hear by far, however, is the latter – if people are turning to CAM it must be because mainstream medicine has failed them. This version of reality is often promoted by CAM marketing.

The evidence that we have, however, simply does not support this narrative. Studies show that satisfaction with mainstream medicine is not an important factor in deciding to use CAM, that CAM users are generally satisfied with their mainstream care, and they use CAM because it aligns with their philosophy, and they simply want to expand their options.

None of this is to imply that mainstream medicine has no problems or failings – it does. We should, however, be working toward keeping and improving what works and fixing what doesn’t, not discarding science and reason to embrace fantasy as an alternative. This is often the false choice presented by CAM proponents, and is analogous to creationists pointing out alleged weaknesses in the theory of evolution as an argument for creationism as an alternative.

We have to acknowledge how deeply the narrative has penetrated and resonated with the public. Even among those who are generally skeptical, pro-science, and scientifically literate, this is the default narrative. Further, many people have personal experiences with illness and health care, and personal experience can have a powerful influence on our beliefs (even if we are generally science and evidence-based in our thinking). We are apparently hard-wired to find anecdotes compelling, and nothing is more compelling than our own personal anecdotes.

I recently received an e-mail from a person generally skeptical of alternative medicine. The e-mail begins:

I am a skeptic; have been an active Randi reader for over a decade.   I don’t believe in acupuncture, homeopathy, chiropractic, energy healing or virtually any form of snake oil.

But I have had personal experience with ‘alternative medicine’.

That’s a powerful “but.” He then goes on to describe his 20 year experience with back pain. He was told that he needed surgery for a herniated disc, but was skeptical of this option. I should add this occurred 20 years ago, and much has changed since then. The e-mailer concludes that the recommendation was based on the surgeon’s greed, which certainly may be the case, but even well-meaning and honest surgeons doing their best to practice according to the evidence were probably performing too many back surgeries 20 years ago. In the last two decades published studies have narrowed the range of patients in whom such surgery is deemed appropriate. Like many such questions in medicine, when to do surgery is complicated and the subject of intense research.

The e-mailer decided to forgo surgery and opted instead for John Sarno’s book on Healing Back Pain:

I followed his treatment program, which involved completely foregoing standard treatment (throw away the meds, do serious back exercises etc; because those mainstream treatments reinforce to the mind that the problem is physical and not psychosomatic, and this perpetuates the process).  Within a couple weeks, I was completely pain free and have been for the past 20 years.  I do not accept some of Sarno’s hypothesis (that the pain acts as a “distraction from repressed tension) but I am 100% convinced in the underlying cause in my own case; there is simply no other explanation for the evolution of my pain and how it reacted to ‘treatment’ (the pain switching locations, and a number of sensory symptoms that would be impossible for me to verbally describe to you…).

It is clear from above how powerful the experience was for the e-mailer, who is “100% convinced” of his current narrative.  There are other possible explanations, however. The e-mail admits to engaging in back exercises as part of the program. In my opinion, that alone is likely what resulted in his improvement. In fact that is perhaps the most effective long-term treatment of chronic back pain, and what I recommend to almost every patient with back pain. The surgeons I refer to when needed want patients to undergo an exercise regimen before they will consider surgery (this does not include those with certain neurological complications that require immediate treatment).

In other words, the e-mailer undertook what is now standard therapy for chronic back pain and it worked. Everything else is likely incidental and not important. It is the equivalent of telling someone who wants to lose weight, eat less, exercise, and say my magic phrase once a day, and you will lose weight because of the magic phrase. This is why we do studies that properly control for variables. Regarding Sarno’s book, my impression is that it takes one possible factor in the etiology of chronic back pain (psychological stress) and raises that to “the” cause of back pain.

The e-mailer goes beyond just interpreting his one personal anecdotal experience to make some broad conclusions about medicine and illness:

Psychological stress.  Stress that did not exist 50, 100 or 200 years ago because our society has become so altered in recent years due to the internet, increased communications and technology. We as a species see not only the very worst actions of our species on a daily basis, we also are presented with the very best or most lucky individuals (we see the lottery winner on tv; we don’t see the 100,000,000 individuals who lost…) as if it is expected of us.  Hence the rise of ‘fame obsession’ seen in social media and ‘mainstream media’.  Be extremely wealthy/famous, or be a loser… There has been no time for our human psyche to evolve to adapt to this stress.

It is very difficult to measure, especially historically, something as vague as “stress.”  What the psychological literature shows is that stress is relative. We tend to adapt and normalize to our situation, and find happiness and stress relative to our norm. I think it’s naive, however, to argue that people living one or two centuries ago were under less stress that today. They had to deal with problems that are much greater than our own – the death of many of their children, many more untreatable and common illnesses, harder and longer working conditions, etc. We have it comparatively easy today, but obviously many people do not realize how relatively brutal life was in prior centuries (and likely future centuries will look back at how brutal our lives are).

Toxins. You heard me right! Sorry, but if you read the labels of most of the food this nation consumes (not to mention how it is produced, processed etc) you cannot tell me with a straight face that it is as healthy as the food of 100 or 200 years ago. Add the water we drink, the air we breathe that in most cases is worse than in generations past, and there is definitely a problem.

The “toxin” meme has penetrated far. In terms of industrial pollution, that peaked in the middle of the 20th century. We have much less pollution today (at least in many developed countries – developing countries are still reaching their peak). Yes, I can say with a straight face that there is no compelling evidence that the modern diet is less healthy than in previous centuries. In fact, the modern diet is better in many ways. We have access to fresh fruits and vegetable year round. We have refrigeration. We have a more varied and nutritious diet. Our problem is one of excess – mainly excess calories. Our food and water supplies are generally safe, safer than in the past. New York city water is famously pure and good tasting, for example. Water supplies are tested and treated – not so in the past.

He concludes:

I believe one if not the main reason snake oil is so popular with the masses is that there is a recognition that medical science has failed us. We have wondrous technology, especially the computerized devices that dazzle us all. Yet, we have no good explanation for the most common maladies, such as acne, back pain, allergies etc. We have no complete understanding of some of the most dangerous and common ailments such as cancer or the common cold. That is why, when you go to a mainstream doctor (and I’ve seen my share!) there are dubious diagnoses, and either more dubious treatments (the ever-so-common prescription for antibiotic comes to mind…) It is sad, but It explains why the public is so gullible when it comes to alternative treatments.

As I pointed out above – this is simply not true. The evidence shows that it does not explain gullibility to CAM treatments. Further, the e-mailer makes the mistake of listing the limitations of modern medical science and its application as if that implies that it has “failed.” We certainly lack a “complete understanding” of many diseases and symptoms, just as science in general lacks a “complete understanding” of just about everything. Our understanding is always partial and tentative, but can still be quite powerful and predictive. Some things in medicine are understood very well, and the application is so standardized and effective that people no longer even think about it. It is the complex and difficult problems that people focus on when discussing the “failures” of modern medicine.

This is partly a “glass half full or empty” issue. There is no question that modern medicine has many effective treatments that prolong and improve the quality of life. There is also no question that there remains much we do not know and cannot fix.

The way forward is with science-based medicine, not abandoning science for a fantasy (I know the e-mail is not suggesting this, only that others follow this logic). While some may commit this fallacy, most people still respect the role of evidence in medicine and want their treatments to be evidence-based. In my opinion the big problem with CAM is that its proponents are telling the public that their treatments are based on evidence, when they aren’t. They are distorting the process and findings of science to meet their ideological agenda, and supporting that further will propaganda meant to confuse the public about the nature of medicine itself. Unfortunately they have been somewhat successful in causing precisely the kind of confusion they need to sell implausible treatments that don’t work as if they were a viable alternative.

Posted in: Science and Medicine

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111 thoughts on “Why Do People turn to Alternative Medicine

  1. DugganSC says:

    An interesting narrative. I don’t know if I’d agree that we have more stress today than we did a hundred years ago, but I think that the stressors are definitely very different, and arguably, our hard-wired instincts mean that we suffer more from the stress than we probably ought to. We have a lot of information to process these days, and part of the price of widespread education is that we have to work harder to stay on top of our chosen field (with a frequently changing environment meaning that the skills that we learned ten years ago are obsolete now in many ways, and it gets harder every decade to adapt as we get older). Our reflexes are hardwired to deal with immediate dangers, but so much of our stress comes from vague things that we can’t directly control from the economy to mortgage rates to wars in countries thousands of miles away. *half smile* I would argue that human psychology doesn’t help either. Increased efficiency means we can get more work done in less time, but while the amount of physical effort decreases, much of it still requires as much mental work, and we compensate for increased efficiency by finding ways to cram more work in.

    Eh, I think that in the end, CAM spreads for much the same reason that regular medicine does, all it has to do is to seem to work once. We’re creatures of habit, of patterns. In the back of our brain, it doesn’t matter that acupuncture doesn’t actually work, or that a knee surgery consistently works to solve problems of screwed-up joints. In our brain, they’re both marked as “Hey, this worked that one time” and until we get significant negative feedback (even neutral results don’t tend to make a dent), they’re equivalent in our minds.

  2. MikeW says:

    About twelve years ago I was experiencing some horrible lower back pain – so bad I would sometimes start weeping. My doctor referred to a hospital spinal clinic in the Seattle area. After a long wait, I finally got my appointment and had the most bizarre meeting with a specialist (and his student), who sat on the other side of the room and theorised about my pain. They didn’t ask about my personal or medical history, or ask me to remove my clothing and make an inspection of the area – they just ran through a list of related ailments and sent me off for tests. So I ended up having barium meals and colonoscopies and all the time my pain got worse. I had several horrifically expensive spinal injections that made no difference either.

    I couldn’t go back to the specialist because he changed the list of insurers that he would accept and my employer’s (one of the largest in the Pacific Northwest) was no longer accepted, and so I would have to find an alternate clinic, and presumably get in a months-long queue with all the others similarly rejected who would have to start over.

    The only other sort of treatment that my insurance allowed was chiropractic, and despite my skepticism I went off to see one of them for a few months. That was pointless but at least it felt like I was doing something.

    Coming from Australia, I was accustomed to having access to manipulative physiotherapists working with my doctor to work on such problems. In the US, I found that physiotherapists weren’t allowed to touch you and just wanted to sell you expensive home stretching equipment. It was all rather medieval. Meanwhile my doctor prescribed hydrocodone, oxycodone and muscle-relaxants without informing me of their side-effects. Luckily I’m rather pain-killer-averse so didn’t wind up with any addictions.

    Out of my own pocket I paid for a masseur to come to my house weekly and work on my back. He advertised under the banner of being a craniosacral masseur (which was all BS to me), but I actually found that he was a good masseur with a proper understanding of anatomy and he gave me more relief than all the mainstream folks offered.

    A year or so later after leaving my job, my back pain just went away. I wondered if it was a stress condition that simply manifested in that area.

    Overall the experience of having medical practitioners and an insurance system that worked completely mechanically without any interest in solving the problem drove me towards seeking treatments lying outside my treatment philosophy. I’m not likely to ever seek out CAM practitioners again, but the prospect of being locked out of respectable mainstream solutions and passively accepting pain is hardly a decent alternative.

  3. Harriet Hall says:

    It’s not so much that mainstream medicine has failed patients as that patients have failed modern medicine. They readily revert to prescientific superstitions, prefer stories to studies and experience to experiment, don’t use critical thinking, and fail to understand the importance of testing beliefs with science.

    CAM will always be with us, as long as humans are humans. We can only hope to limit the damage through education and other means.

  4. stanmrak says:

    Personally, I don’t want to use conventional doctors because they use prescription drugs as their primary source of treatment. I would have to be extremely desperate to do this – like, in constant excrutiating pain. Much of the ‘science’ behind prescription drugs is untrustworthy and fraudulent, based on studies paid for and manipulated by the pharmaceutical industry for the sake of profit. There’s so many unnecessary, ineffective and even worthless drugs out there with horrible side effects – sold to treat conditions that could be cured with lifestyle and dietary changes. Start on one drug, soon have to add another one to manage the ‘side effects’ from the first one, eventually, you become an average American senior, filling 20-30 prescriptions a year. No thank you.

    Most people, however, seem to like using drugs for their symptoms, and come away disappointed if they don’t get a prescription at the end of their visit. These people don’t want to make any effort to improve their health, so drugs are the easy answer for them. I wouldn’t consult with a conventional doctor on how to improve my health, either, since most of them know much less than I do about this.

  5. Harriet Hall says:

    Q.E.D.
    Thank you, stanmrak, for providing such a good example of what I was talking about.

  6. mho says:

    Dr. Hall, I always appreciate your thoughtful responses, but I don’t agree with you today. Perhaps we’re just reading different meanings into the same words. Medicine may not have failed, but the system that delivers it is difficult to navigate, expensive, inefficient and sometimes impersonal–which constitutes “failure” from a patients point of view, especially if that patient has a chronic condition or co-morbidities and doesn’t get total relief.

    If patients want stories, why not take the studies and the evidence and GIVE the patient a story that brings home the message? Hearing a doctor say, I chose this course for my mother is often the exact thing a patient NEEDS to hear–we’re happy to have doctors be the experts if they can relate that expertise to our very personal fears.

    Most of us have forgotten the real science we probably didn’t learn very well in the first place. Naturopaths and chiropractors make inroads because they use mystifying jargon-y words that sound like science. And, the alternative practitioners tell stories that resonate with our hopes.

  7. Sawyer says:

    @ stanmrak.

    Even if we accept your grim interpretation of mainstream medicine (most SBM readers probably will not), you’re committing the very fallacy this entire post is based on. If you want to improve our current system, the best way to do it is through careful scientific research and by offering a realistic pathway for change, not to flush all of our understanding and achievements down the toilet. As Dr. Novella stated,

    “We should, however, be working toward keeping and improving what works and fixing what doesn’t, not discarding science and reason to embrace fantasy as an alternative.”

    Just because it’s an uphill battle dealing with pharmaceutical manufacturers, insurance companies, and incompetent doctors does not mean we should take the downhill route back to 16th century medicine instead. That is incredibly lazy, childish, and in the long run it won’t solve a damn thing.

  8. Harriet Hall says:

    @mho,

    “the system that delivers it is difficult to navigate, expensive, inefficient and sometimes impersonal–”

    Yes, the system has failed to be as good as it could/should be; but it’s a failure of logic to turn from the imperfect to the less perfect.

    “Hearing a doctor say, I chose this course for my mother is often the exact thing a patient NEEDS to hear”

    I’ll be addressing this and related issues in my next post. Watch for it.

  9. Janet says:

    @stanmrak

    I’m a senior (I guess–I’m over 60) and I take one pill a day,cheap and genric (for blood pressure–which improved a great deal when I lost weight, but still needs treatment, especially with a family history of early-onset heart disease) plus a baby aspirin, which is a drug, but hardly one you could describe as you have above. This proves nothing in and of itself, but it does show that your assumption about seniors is not always true. Lifestyle certainly matters, but so do genes and the passing of time.

    You make a number of sweeping generalizations that would indicate you did not absorb any of Dr. Novella’s very concise points in the post–perhaps you did not read it and only responded to the headline.

  10. The Dave says:

    “You make a number of sweeping generalizations that would indicate you did not absorb any of Dr. Novella’s very concise points in the post–perhaps you did not read it and only responded to the headline.”

    stanmrak has a long history of either not reading or not comprehending what has been read. It appears nothing has changed. Perhaps responding to their comments will be another exercise in futility.

  11. Quill says:

    Well now, if you’re going to go to the bother of typing narrative instead of the more compact story, it seems fair game to explore that term a little as it is used, especially as it is how CAM operates to promote itself as equal to science based medicine.

    By that I mean that many people turn to CAM’s narrative because CAM promotes itself as one of many narratives with plausible meaning in the reality of day to day life. Science has its own narrative, based on empirical process, and CAM has one, too, based on other kinds of processes, usually referred to by another big word, modalities. These often involve allegedly ancient knowledge, history, folklore, marketing, imagination, supposition, correlations and a generous topping of fecal material from Bos Taurus.

    So how do the narratives compare? In terms of presentation, the CAM ones win hands down for marketing and sheer loveliness of their materials. Lots of pictures to go with the narratives, usually bordered in soothing colors. Poor SBM is relegated, with the possible exception of the gloriously-cinematic Cancer Centers of America tv ads, to a relatively black and white presentation of often dull-looking materials. Even Medtronic’s DVD-laden brochure sets that adorn pain management clinics look, well, terribly clinical.

    The comedian Eddie Izzard has observed that how you say something weighs more on the mind than what you are actually saying, that style and presentation overwhelm substance. So of course a slick campaign promising something, guaranteeing certainty of outcome, will attract many a person who isn’t bothering to weigh the actual evidence and make a sound decision informed by basic scientific principles.

    The narrative matters, but how it is packaged and presented, matters more to a significant group of people, those who turn to CAM despite there being no evidence it works.

    This is not to say that SBM should alter its narrative to fit presentation, but that if medical science wants to reach out to the CAM-infused, the subluxed, and the chi-imbalanced, they must present in a way that the person they want to reach will take note of, that will penetrate the fogs already produced by CAM.

    So when Dr. Hall writes with glorious arrogance* that “It’s not so much that mainstream medicine has failed patients as that patients have failed modern medicine” she is right in that it is a two-way failure but fails to note that the failure of modern medicine is not one of narrative but one of presentation. And the failure begins with modern medicine and the result is the patient failing modern medicine so it is clear where the fault lies. Any teacher or anyone with something to present a student or another person must first be able to speak in a way that student or person will understand. While education has failed to give us a public with good science background, it does not excuse those who have that background many times over from failing to present their narrative in a comprehensible way.

    *Glorious because the point she is making is true.

  12. ConspicuousCarl says:

    Mrak is in the house. Now if only that thinga1ma2jig one would show up so I could enjoy being the third dumbest guy here.

    I know someone who would almost certainly be dead if not for modern drugs and surgery, despite the horrid hiccups in the process. He doesn’t use fake medicine, but he does spout some typical “modern medicine is no better than the fake stuff” nonsense. I couldn’t get a coherent answer as to why he still pays his real doctor. This person is otherwise intelligent, but he knows nothing about science and medicine and will recite some rather boring clichés about those subjects.

  13. Chris Repetsky says:

    “ALL BIG PHARMA DOES IS WANT TO SELL YOU PILLS”

    “…….Buy my supplements” http://www.antioxidants-for-health-and-longevity.com/

  14. pmoran says:

    Steve: The most common narrative I hear by far, however, is the latter – if people are turning to CAM it must be because mainstream medicine has failed them. This version of reality is often promoted by CAM marketing.

    The evidence that we have, however, simply does not support this narrative. Studies show that satisfaction with mainstream medicine is not an important factor in deciding to use CAM, that CAM users are generally satisfied with their mainstream care, and they use CAM because it aligns with their philosophy, and they simply want to expand their options.

    Yes. Mind you, CAM users also express comparable, or even higher satisfaction with their CAM providers.

    This suggests that patient satisfaction as measured here is not as strongly associated with treatment effectiveness as you imply. It may merely measure empathy and “doing the best you can with what you’ve got”.

    It is rather risky to suggest that people are consuming CAM treatments in considerable quantities despite symptoms being already adequately controlled by mainstream methods. Certainly certain mind-sets would make some more likely to seek additional control over symptoms, or over final outcomes.

    CAM use is complex, as you say, but limitations to mainstream medicine in a period of heightened public expectations is surely a critical factor.

  15. MikeW says:

    @Harriet Hall: “It’s not so much that mainstream medicine has failed patients as that patients have failed modern medicine.”

    Coming on the heels of my own reported experiences, the tone of that remark feels just like the remote clinical observations of the medicos that failed me. The merest hint of bedside manner in any of them might have given me a bit more hope in enduring the pain rather than look for alternative solutions.

    “it’s a failure of logic to turn from the imperfect to the less perfect.”

    That may be so, but sometimes desperation drives one to make imperfect choices, or perhaps given the lack of choice presented by the medical system, one is simply driven out of that system.

    If an intelligent, scientifically trained person who is willing to engage with their primary provider and relevant specialist physicians is consistently failed by all of them, what hope is there for the less informed?

  16. BillyJoe says:

    As we all know anecdotes like the one recited in this article, are almost totally useless. I have my own anecdote. My episode of back pain had me on lying on the floor incapable of even sitting let alone standing. It resolved completely in four weeks – without any treatment whatsoever!

    As for mainstream medicine, I’m afraid Australia is turning the way of America. Impersonal big clinics where docs are employed rather than own the practise. The big impression I get from those who attend them is that the docs just don’t care. The old personal family physician, it seems, is dead.

    Fortunately, I have had no need for medical care myself. But, if I ever do, I will never use treatments that have no evidence base. That, at least, has been the success of science-based medicine for me.

  17. Gregory Goldmacher says:

    My take on this complements the comments several people have made about the cultural narratives around science and CAM. I think that aside from this, one reason that CAM does so well is that its practitioners are masters of manipulating and managing the illness narrative of each individual patient. We all think of our course of illness as a story. CAM people can’t really treat the illness, but they compensate for this by being excellent at narrative management.

    In some types of illness, of course, the patient’s narrative matters more than in others. Offhand, I’d say that its importance grows in inverse proportion to the availability of definitive medical treatment of the disease. For a patient with acute appendicitis, there is little need to mess with narrative. However, when an illness is poorly understood, and there is no good treatment, narrative takes on a greater role. Several broad categories come to mind immediately – fatal disease with little chance of cure, illness that causes chronic pain/suffering with no reliable relief available, illness with an unpredictable course (maximizing regression to the mean effects), and some psych/semi-psych illnesses.

    Science-based physicians pay attention to the patient’s narrative too (the good ones), but the CAM types make management of patient narrative their entire specialty, using various forms of ritual, metaphor, and other psychologically powerful tools. I think this has some real explanatory power when discussing why CAM enjoys such success. I am not trying to excuse its deceptions, but we should at least be aware of CAM practitioners’ expertise in this area.

  18. Chris says:

    Chris Repetsky:

    “ALL BIG PHARMA DOES IS WANT TO SELL YOU PILLS”

    The link Chris R posted is where Stan Mrak pushes pills, it says so here:
    http://www.selfgrowth.com/experts/stan_mrak

  19. Chris Repetsky says:

    I just found it rather funny ;)

  20. Chris says:

    I just noticed that Stan’s name was not on the website you linked to… and I also thought it was very funny.

    I love the bit about “superfoods.” While buying groceries in a high end grocery store which prides itself on its selection of fresh fruits and veggies I made a remark to my spouse about how silly the “Airborne” (“created by a teacher”) was. The clerk overheard me and asked why I did not like supplements. I told her I would rather get them from eating tasty fruits and veggies than creating expensive urine. She then told me that some “superfood” thing was great. Except I remember gagging on some horrible “superfood” crud made by Odwalla, and that I actually like eating fruits and veggies as they are, but I do not like them dried, ground up and stuffed into capsules.

    Our Christmas dinner included a lovely green been casserole with mushrooms, artichoke hearts, onions and roasted red pepper, then some cauliflower that was sliced thin and cooked down until slightly browned with salt, pepper and paprika, plus parsnip mashed with pear and finally some corn. I have no idea why people like Stan prefer to get their vitamins from pills rather than tasty food.

  21. I’m not going to bore you with my usual screed against free-market narratives as causes for the rise of CAMs in the US. Dr. Novella already summarizes my point more succinctly with his mention of CAM marketing. I’m more interested in when CAM modalities were introduced into Western society, whether it’s chiropractic, homeopathy, Christian Science, or TCM (as summarized by Ben Kavoussi in this post on the resurrection of acupuncture as the mistranslation work by Soulié de Morant), the late 19th to early 20th century, where you find opposing societal forces. One, modernism, recognized urbanization, industrialization, and modern science (almost to a fault, as shown in scientism and Italian futurism). The other was a reactionary antimodernism, exemplified by Pius X’s Oath against Modernism, Richard Wagner, or the Southern Agrarian Poets (Allen Tate et al.) that embraced an edenic, mythic past and the prescientific superstitions that Dr. Harriet Hall mentions. This is a very simple reduction, of course, and I don’t think this is a conflict that will ever be resolved.

  22. stanfr says:

    “As we all know anecdotes like the one recited in this article, are almost totally useless.”

    BillyJoe, not “totally useless” Maybe useless as a scientific conclusion, but certainly not useless to the narrator. Personal experience is what drives scientific testing.

    For example, If an alien spacecraft landed in my backyard, I could either dismiss it as some deviation in my brain due to stress, chemicals, whatever–or if I were convinced the spaceship were real (which I might in the absence of stress, chemicals etc) I could set out to prove it’s existence scientifically. I probably would fail, but if I were to succeed it would most certainly advance our understanding of the universe–not useless!

    A skeptic might chock it up to being unprovable, but might consider the particular hypothesis of the shiop being ‘real’ along with other possibilities.
    Someone who is simply close-minded would dismiss the spaceship hypothesis outright, and might just check into a mental hospital.

    If you fall into that latter category–fine! But be advised that knowledge is often advanced by those who challenge the status-quo of belief.

  23. stanfr says:

    In regards to the article–I agree with some if not most of the conclusions.
    A couple points:
    1) Interesting to hear you (Steven) say that “exercise” is a standard treatment for sciatica/herniated/bulging/ruptured discs. I haven’t studied the literature lately–but I know that in previous decades the literature was almost 100% REST, REST, and more REST as the most important treatment for herniated discs and such. If “mainstream medicine” can change course that drastically in 10-20 years (I don’t think it has)–then I question the value.
    2) Citing a “qualitative’ (their words) study of 46 individuals as “evidence” for usage of CAM is silly.
    I can turn right now to any ‘alternative’ medical forum, and point you to literally THOUSANDS of testimonials from CAM users who will tell you outright that they turned to CAM because they found no relief from conventional medicine. Cancer treatments are the classic example of this: those who testify as to the ‘efficacy’ of an alternative treatment do so because they were given a death sentence by conventional medicine. Pure and simple. Does this prove the ‘alternative’ treatment ‘cured’ them? Of course not! But it is most definitely WHY they turned to alternative therapy.

  24. Harriet Hall says:

    “knowledge is often advanced by those who challenge the status-quo”
    Incomplete. Should have continued “and produce evidence.”

  25. Harriet Hall says:

    @stanfr,

    “in previous decades the literature was almost 100% REST, REST, and more REST”

    That was a long time ago. It’s been at least a couple of decades since we realized rest made things worse and started encouraging patients to remain active.

  26. MikeW says:

    @Billyjoe: “As we all know anecdotes like the one recited in this article, are almost totally useless.”

    I am not trying to make a scientific point about evidence-based medicine, but one about the culture of (American) medicine, which addresses the topic. When you have pain that goes on for years (not for one month), and there is no serious attempt to address it medically, what would be your response?

    As an analogy – suppose that one day you find yourself locked in a tiny dark room, and there is just a telephone. You call the obvious services like the police or the fire brigade. The police officer simply runs through a list of dark rooms he’s aware of and the fireman suggests you make some contributions to the fireman’s fund. Neither even bothers to ask any questions which might help them find you and no alternate police or fire agent is available to you. At some point you may start trying to futilely scratch your way out of the room, just to remind yourself that you’re alive and trying to do something.

  27. elburto says:

    Medicine may not have failed, but the system that delivers it is difficult to navigate, expensive, inefficient and sometimes impersonal–

    Can I just point out that America =/= The World. This is ‘Science-Based Medicine’ Stanny Boy, not ‘Evil American Allopaths’.

    The vast majority of the world are not American, and are not subject to American “healthcare” practices.

    Difficult to navigate

    I call the surgery, I ask “Could I see Dr M on Thursday?”, and I’m booked in.

    At the appointment I tell him my symptoms, we discuss my options, and he prints out a prescription.

    Now, there is one instance of “difficult to navigate” upon leaving the surgery. The door from Dr M’s office leads onto a corridor at an angle, and my powerchair sometimes needs to be manoeuvred through the exit at an odd angle.

    With that sorted, it’s a 50 metre scoot to the pharmacy. I sign the prescription, mark the ‘controlled drugs’ box, and hand the slip over. Ten minutes later, I have my medication.

    WRT your “expensive” claim, you may notice that no money changed hands. That’s because I make an electronic payment at a health service website once a year. That £104 covers every prescription for twelve months.

    “inefficient and impersonal”

    My prescriptions are managed online, by me. Same goes for appointments. The prescriptions are renewed online, sent electronically to the pharmacy, and waiting at the counter within 48 hours. For no extra charge the pharmacy will deliver them to my front door, as soon as they’re made up.

    The GP surgery and pharmacy staff know my name, where I live and who with. I trade pet-related anecdotes with the pharmacy assistant, and she often asks for advice. When my father-in-law died earlier this year, a representative from each place attended the funeral.

    I would never generalise this experience across the entire county where I live, which is why it irritates me to see American sCAM artists painting the experiences of seven billion people with a star-spangled brush. There’s a whole world outside your borders.

    WRT your fear of old people taking pills that aren’t your magical Omega 3 potions, or Glucosamine Joint Formula or whatever, you do realise that some of us won’t live that long, right?

    Dandelion extract and raspberry leaf tea cannot treat those of us with neurological issues and intractable, agonising pain. Given that fentanyl only just damps the pain down enough that I’m not screaming 24/7, I can say, without fear of error, that evening primrose extract or acupuncture would not be of much use.

    Do my medications have side-effects and interactions? Of course, but that still beats being dead.

    Modern medicine and pharmacology are world-altering marvels, saving and improving lives. Only someone lucky enough to be healthy and pain free would foolishly write off the whole enterprise because side-effects! big pharma! American “healthcare”!

    sCAM is all well and good for convincing someone with functional disorders that they’re miraculously “cured”, or for soothing the minds of the “worried well”, but other than that it’s a fraud, a joke.

    Sick people need medical care. The only people who need sCAM are those who earn money by peddling their lies and magical nostrums to the deluded and desperate.

  28. MikeW – maybe, but I wouldn’t try calling the tooth fairy.

    I think there is some confusion between satisfaction with mainstream medicine and being adequately treated/cured of ones symptoms/condition. These are not necessarily the same thing. I never said or meant to imply that patient who try CAM are not motivated by illness that is no treated to their satisfaction by existing science-based treatments.

    There are plenty of patients who are happy with the attention and treatment they receive by mainstream medicine, and understand that we cannot cure everything. They don’t always search for fantasy treatments out of desperation. Those that do seem to have a certain philosophical bent.

    Of course looked at another way, those who are completely treated or cured by standard care have less of a motivation to seek out alternative.

    But (and here is another factor dramatically affecting the statistics) many users of CAM are part of the “worried well” – they don’t actually have a disease, and may just have so-called “symptoms of life” or are seeking health promotion. They follow their world view, and response to treatment is not necessarily a factor.

    The question is – what most predicts CAM use? It’s not being poorly treated or disappointed in science-based medicine. It’s having disposable income, having a spiritual or new agey world view, or simply hearing good things about CAM and wanting to increase one’s available options.

  29. weing says:

    I thought I would add my 2 cents worth.

    SCAM is for people who have more money than sense.

  30. Harriet Hall says:

    @MikeW,

    In your locked room analogy, if rational methods are not enough to get you rescued, it is even less likely that resorting to superstitious practices will do the job. Reciting magic spells will not unlock the door. Makes more sense to keep trying that phone until you reach someone who will help.

  31. MikeW says:

    @Harriet Hall – I suspect that only international phone calls would have helped. I’ve lived under four different medical systems (Australian, US, British and French*), and only the American system locked me in to the extent that I could not get an alternate primary provider. After I moved to the US, I quickly learnt that the first question asked by mainstream providers was not “what’s the problem”, but “what insurance do you have?” The first time I ever needed a doctor in the USA, I spent two days calling around Seattle to find ONE who would see me.

    @Steven – I would say that in this matter, my US mainstream providers were so poor compared to my experiences in other countries that I found they wanting long before I’d done months of rounds of them pushing ineffectual solutions.

    The combination of insurance restrictions and provider lock-in meant that I could not choose alternate specialists, but ironically the system makes available a whole catalogue of CAM providers that are “approved” by US health insurance.

    I’m not about to go calling the Tooth Fairy or reciting magic spells, but I detect here a distinct lack of empathy (bordering on scorn) for what severe chronic pain will do to someone making day to day choices. Undoubtedly for medical professionals who are not so locked in as regular end-users, the system looks very different.

    I don’t think I was getting “evidence/science-based treatment” or “rational methods” from the mainstream folks but something more akin to “alchemy”- the providers pushed their favourite solutions without any attempt to systematically look for evidence. That doesn’t excuse the CAM folks, but be careful about dividing the world into two camps of mainstream/evidence and CAM – the labels and the practices don’t always match up.

  32. Harriet Hall says:

    @MikeW,

    So phone calls wouldn’t work. Do you think there is an “alternative” method that would work?

  33. weing says:

    “After I moved to the US, I quickly learnt that the first question asked by mainstream providers was not “what’s the problem”, but “what insurance do you have?””

    That is an unfortunate thing about this country. I’m sure if the insurances start paying for SCAM, they will say the same thing. All the more reason not to have insurance cover SCAM. So you had a bad experience with some mainstream docs. You are willing to judge all of them by your limited experience? Would you have listened to one, if after a careful history and physical, he told you to see a physical therapist and if that failed to quit your job?

  34. BillyJoe says:

    BillyJoe: “As we all know anecdotes like the one recited in this article, are almost totally useless.”
    Stanfr: “BillyJoe, not “totally useless””

    Maybe you need to read a little more closely (;

    Stanfr: “Personal experience is what drives scientific testing.”

    Yes, anecdotes are hypothesis generators. They are useful In this regard. As evidence, however, they are almost totally useless.

    “Someone who is simply close-minded would dismiss the spaceship hypothesis outright”

    Someone whose open mind is not almost totally closed by the almost totally zero plausibility of this scenario probably needs a little education in cosmology and physics.

    “If you fall into that latter category–fine! But be advised that knowledge is often advanced by those who challenge the status-quo of belief.”

    Be advised that Galileo had a plausible idea plus evidence.

  35. Halfmoonie says:

    My own experience with sCAM-fans reflects Steven’s comment above that many are of the worried-well and dissatisfaction with real-world medicine is not the biggest factor. I’ve lived in Canada and Australia, both with good public health systems (Oz with affordable private healthcare as well). I also lived 5 months in San Diego recently.

    In all three countries, I know people (and am related to a few) who use sCAM despite not being sick with anything. They claim various vague ailments that involve being too acidy, full of toxins, allergic, intolerant or the bizarre like needing to drain one’s lymph nodes by jumping on a trampoline.

    They spend a pretty penny on various potions, pills and contraptions and despite that, never claim to be well. Or at least not for very long as there’s always something new to suffer with or worry about. It’s as if they revel in believing they are unwell or under attack from all those nasty “chemicals and toxins” of modern life. It’s definitely more of a world view, imo.

    Their social community is predominantly populated with fellow sufferers & believers so they feel validated. They will not accept basic facts or common-sense, like why alkalizing your drinking water is a waste of time & money, that homeopathy is water or sugar, that vaccines were responsible for the decrease in diseases and not for autism, that the soil is not so depleted that you need to spend $100s on supplements every month, etc. They’ll have none of that. It’s like a religious cult of conspiracy theorists and hypochondriacs.

  36. BillyJoe says:

    MikeB,

    I was actually responding to the anecdote in the article.
    However…

    “I am not trying to make a scientific point about evidence-based medicine, but one about the culture of (American) medicine, which addresses the topic. When you have pain that goes on for years (not for one month), and there is no serious attempt to address it medically, what would be your response?”

    I did have a subsequent episode of back pain that lasted just over one year. I was unable to sit or lie down without pain. Standing was okay. I ate standing up. It started just before one summer vacation and ended just after the next summer vacation, so it seemed like I had worked for three years without a break. I could work only because I have a light job where I can either sit or stand.

    What I did was explore options via the Internet. Possibly dangerous I know, but what I did find is that you need to keep moving with the proviso that you don’t do anything that might strain your back. You need to keep your back straight while bending at hip and knees and avoid anything that has previously aggravated the pain. You need to avoid analgesics because they cover the pain and pain normally acts as a warning that you are doing something you should not be doing. And also because you develop tolerance to analgesics so they’re useful only for a short time anyway. You also need to slowly and gradually stretch your back avoiding stretch and hold techniques (ie you do not need to hold).

    Throughout the twelve months, I never sought any help from either mainstream or alternative medicine because I could not find any evidence that either helps. Since then I stretch my back every day and do some back and abdominal exercises to build up muscles that support my spine. These days I can run and cycle through the local hills for hours on end, and the only problem I sometimes have is sore quads and calves. Never back pain.

    “As an analogy – suppose that one day you find yourself locked in a tiny dark room, and there is just a telephone. You call the obvious services like the police or the fire brigade. The police officer simply runs through a list of dark rooms he’s aware of and the fireman suggests you make some contributions to the fireman’s fund. Neither even bothers to ask any questions which might help them find you and no alternate police or fire agent is available to you. At some point you may start trying to futilely scratch your way out of the room, just to remind yourself that you’re alive and trying to do something.”

    It sounds like you have had an entirely different experience. I’m just luckily my condition was reversible. My brother developed back pain after helping someone lift a pool table. He had a prolapsed disc. He has never really totally recovered and cannot run or cycle but manages to walk. He did enrol in an exercise/physio program which he thought helped, but I think he could have achieved the same result at home at no cost. He has not continued with physio but has followed my lead of daily muscle stretching and strengthening exercises.

    Don’t know if any of this helps answer your question.

  37. LMA says:

    If there is an increase in the number of people seeing CAM “specialists” as proposed, I would bet the most common reason is ironically, the increasing social acceptance of cynicism and skepticism.

    During the immediate post-war era, it was accepted that doctors were trustworthy experts who knew more than the average person did about health and illness and whose advice should be taken almost without question. This kind of thinking was supported by the many astonishing new and seemingly miraculous cures be they antibiotics or polio vaccinations. Plus, society itself was largely conformist — the goal was to keep up with the Joneses not to be different from them. Time moves on and suddenly we find that many new “medical miracles” are actually profoundly harmful — thalidomide and the Dalkon Shield come to mind. The conformity of the 50s and early 60s melts away into the “me generation” of the ’70s. If I’m OK and you’re OK, then surely my uneducated opinion is as good as that of any white-clad, government funded doctor who now represents “square” society instead of the ideal. Follow that strand of individualism and cynicism through to today when you’re considered a sap if you don’t do your own internet “research” and look into “alternatives” and where we have the idea that simply being skeptical of other people’s motives is the equivalent of being educated, and you have a whole lot of people going to doctors but rejecting their difficult advice of good diet and exercise for the latest “discovery” of some obscure fruit that will be the key to weight loss AND the cure for cancer.

  38. rokujolady says:

    I have a relative who has turned to woo as a last resort. He has had persistent tinitis for over six months. He’s had three complete courses, serially, of antibiotics from different doctors after each didn’t do anything. He’s been to two ENTs who offered a steroid injection, but couldn’t even give a diagnosis. He’s pretty much exhausted the real medicine contingency, and paid through the nose for it. At this point it’s like, we’ll, go to the chiropractor. Nothing to lose and at least they make you feel like you can do SOMETHING. I don’t agree with the decision, but I really can’t say anything. If I were in his situation, I’d probably be in the psych ward.
    There are persistent chronic issues to which there isn’t even good palliative care, and when you live in a small town with few cutting edge specialists it gets very very frustrating when every doctor in town is like ‘I dunno, errr, maybe steroids would do something? How ‘Bout we pin another antibiotics tail on the donkey without culturing or anything? That will be 3K kthxbai.’
    Sorry about the hyperbole, but I’m really concerned and I really think the only solution for this is modern medical science but when this relative is in pain and decides to turn to TCM, I just can’t condemn it.

  39. coastview says:

    Dr Novella I believe you should look a little closer at what your e-mailer wrote. His writing is garbled, but he says he did not do the back exercises, which are (as you say) part of standard treatment because Dr Sarno advised against them. Yet, he improved tremendously. Strictly a placebo effect after 20 years 0f pain? Would you say there is no psychological element to long-term pain?

  40. pmoran says:

    The question is – what most predicts CAM use? It’s not being poorly treated or disappointed in science-based medicine.

    Well, it is sometimes.

    It’s having disposable income, having a spiritual or new agey world view, or simply hearing good things about CAM and wanting to increase one’s available options.

    The publishers of these studies will have been thrilled to have found some statistical associations or unexpected non-associations to report. That doesn’t make them important. Other variables such as personal tolerance for illness or for potential mortality, or levels of trust/mistrust in mainstream medical science may be at least as important but less easy for researchers to measure.

    And might the most constant element still be unsatisfied medical needs or wants (some admittedly futile), which these studies are generally not well designed to assess? They typically examine overall CAM use in the general population, wherein most people will be reasonably well or have only minor medical problems over any given period. This must bias findings towards the softer, more “lifestyle” aspects of CAM.

    Even so, many such studies do find correlations of CAM with general health, number of illnesses, and specific illnesses such as arthritis or cancer.

    See: http://www.ncbi.nlm.nih.gov/pubmed/15699021

    also http://www.tandfonline.com/doi/abs/10.1080/14768320500444216

    It is a not a serious criticism of mainstream medicine to allow that its glass is half full. It is a matter of fact that despite many medical triumphs, and through the difficulty of the subject matter more than any lack of will, there are many areas where the mainstream does fall well short of offering entirely effective, easy, and safe solutions, even when practised in an optimal way..

    To my mind, placing an emphasis on these weakly informative statistical correlations is not improving anyone’s understanding of CAM much and potentially trivializing the suffering and the desperation and the family pressures that drive some reasonably sensible people into CAM. The vast majority of CAM users that have serious illnesses have also been through conventional medical care before resorting to CAM.

    We have to be able to talk to these people or those with the potential for CAM use, and if we start off by minimising the problems they face who will listen?

  41. Alia says:

    Well, my mother-in-law is a fan of CAM (mostly the newest stuff that her best friend brings in – like ginseng supplements, noni, energy healing). She has access to very good healthcare facilities and doctors and she uses it to the max (one doctor is not enough, she frequently visits three or four before she starts to believe the diagnosis). But it seems that for her mainstream medicine simply does not deliver results fast enough and big enough.
    And it’s also easier to take this or that magical supplement instead of changing her lifestyle dramatically – she is obese, she almost never moves, short walks with her dog notwithstanding (she had huge knee joint problem because of that), in addition she is on a gluten-free diet (recommended by a gastroenterologist, with a real medical reason) but she can’t stop herself when she sees cake, even though it’s made with wheat flour.

  42. nybgrus says:

    The question is – what most predicts CAM use? It’s not being poorly treated or disappointed in science-based medicine.
    Well, it is sometimes.

    What a non-statement.

    It either is or it isn’t. How and of whom you ask the question determines the answer.

    Overall though, in the US specifically since that seems to be where Dr. Novella was focusing the discussion, it would seem pretty evident that while disappointment in science based medicine is a driver for CAM use and there could be reasonable argument about how large a driver that is, it doesn’t seem to be the largest driver. At the very least removing that variable entirely wouldn’t suddenly end the conversation we’ve been having, nor the purpose of SBM, nor limit the number or type of posts that go up here.

  43. pmoran says:

    Overall though, in the US specifically since that seems to be where Dr. Novella was focusing the discussion, it would seem pretty evident that while disappointment in science based medicine is a driver for CAM use and there could be reasonable argument about how large a driver that is, it doesn’t seem to be the largest driver. At the very least removing that variable entirely wouldn’t suddenly end the conversation we’ve been having, nor the purpose of SBM, nor limit the number or type of posts that go up here.

    Perhaps not, but Steve’s “focus” did enable this, from Harriet :”It’s not so much that mainstream medicine has failed patients as that patients have failed modern medicine.” — which encountered no objections from the flock.

    Now, we all say careless things that sound right on the spur of the moment, and I am sure this is an example of that from the ever-sensible Harriet.

    But apart from this not being at all justified by the information we have concerning CAM use, it would do irreparable harm to whatever the purposes of SBM are if this became entrenched skeptical dogma, or caught up in our penchant for catchy slogans. It would be held against us every time we opened our mouths.

    This is an extreme example of the ease with which we can caught up in our own cosy, self-reassuring “narratives”, at the expense of our scientific objectivity. I strongly believe that SBM cannot go far wrong in our dealings with CAM and with CAM users if it is scrupulous and consistent in its dealings with the relevant science, and is seen to be so.

  44. ZenMonkey says:

    I wrote a blog post on this exact subject once, from the point of view of chronically ill patients, back when I was still hoping for more compassion and less anti-disabled sentiment from skeptics. (It’s a little outdated now that there is immensely more good biomedical research on my own illness.)

    http://newly-nerfed.net/2010/06/22/bitten-and-shy/

  45. BillyJoe says:

    coastview,

    “Strictly a placebo effect after 20 years 0f pain? Would you say there is no psychological element to long-term pain?”

    When you have chronic pain, your whole life is dominated by it. Everything you do aggravates your pain. And you develop rituals to avoid aggravating that pain. All your movements are slow and deliberate. You avoid all those things that you know will aggravate the pain because, once aggravated, you know it will take three days of agony before you return to your usual level of pain. You are sitting, or you are lying down, or you are standing up and the pain and stiffness in your back is constantly on your mind. You can never let up. You must keep to the ritual or you will be in agony for three days.

    The problem is that you get locked into this ritual. And what you don’t realise is that, although the ritual keeps you from suffering more, it also prevents you from improving. At some stage you have to begin to relax just a little and start doing things that might aggravate your pain but that might also just ease it little. You don’t know which, but you have to try. You have to risk three days of agony. And mostly you do get those three days of agony. It is possible that some sufferers get stuck at this stage and could possibly remain there for twenty years. The original cause of their back pain has long ago resolved and now their pain is purely psychosomatic.

    Of course I’m not talking about people with pathological back conditions. Like all chronic pain sufferers, there is a psychsomatic component to their pain but, if that psychosomatic component was relieved in some way, they would still have the pain of the underlying condition. However, if the pain is eventually completely relieved, there cannot have been any ongoing pathology. My pain lasted twelve months. I thought it would be forever. But within weeks I was completely back to normal and now I can cycle and run though the hills for hours without a care in the world. I can’t have had a pathological condition. It must have been all psychosomatic. You cannot go from twelve months of disabling pain to painless unrestricted activity within a few weeks unless that pain was psychosomatic.

    Anyway, that is my impression based on my personal experience for whatever that is worth.

  46. Harriet Hall says:

    I’ll say once more: whatever the flaws of conventional medicine, it doesn’t make sense to reject science and replace it with more seriously flawed methods.

  47. BillyJoe says:

    ZenMonkey,

    I don’t get it. There are protocols for the treatment of thyroid disorders. And there are blood tests to monitor progress. Your GP could surely have handled this. How could the specialist have stuffed it up. You say he didn’t care, but he would not have needed to care to get this one right. Just follow the protocol. Of course I am speaking form ignorance and perhaps there was something unusual about your case.

  48. Chris says:

    BillyJoe, there are those who don’t want to follow the given protocols because it is too much work.

    I knew someone whose conventional doctors told her to get out of the house and exercise. They wanted her to actually move her body and to eat real vegetables. What she wanted was a solution in a capsule. Instead of moving and eating the veggies she hated (she would only eat corn and sometimes peas), she sought naturopaths who would sell her expensive supplements. I heard her once complaining to her mother about her constipation at a family gathering and then cheerfully suggested that she go for a walk to help her since it loosens everything up… the glare I got from her could freeze the Sahara.

    She was definitely in the Stan Mrak camp of supplements instead of exercise and healthy food.

    I should also add that when my back went out my evil family doctor prescribed exercises. And he did the same when I had hiker’s knee. So I have learned to keep walking, but to be careful going downhill and to keep up with the swimming (and to switch kicks, but make sure my knees are straight during the flutter kick).

  49. rokujolady says:

    Chris, I don’t think it’s fair to imply that all people who have had a poor experience with their doctor are lazy and unwilling to follow instructions. I might be wrong, but I don’t think thyroid disorders and tinnitus can be solved by eating veggies and excercise, though those might make you feel better in other ways and make it easier to cope. So, stop blaming the victim.
    I think the solution to this all is better education. If junior high and highschool science were marginally less terrible, and by that, I mean they taught critical thinking, basic logic, and scientific method along with memorisation of names we might have more of a population equipped to call bullsh1+ on things like TCM and chiropractic. People are bombarded daily by watered down science and health news so far removed from things they learned in school that they might as well be magic and yet we expect them to be skeptical of nonsense clothed in sciencey words. We can’t expect non scientists to keep up with and understand the latest health news, or genetics terminology, but we can give people the logical foundation to dismiss the vague explanations of the naturopath or to question a study that boils down to N is a toxin that produces tumours in rats prone to lots of spontaneous tumours.
    Doctors aren’t off the hook. Premed and med programs are boot camps designed to thin the herd and they don’t weed for compassion and problem solving skills or even caring about mechanisms. The result, in Crislip’s dangerous “in my experience” is that a good many doctors could be easily replaced by computers which are very good at storing facts in memory and finding solutions to problems along the lines of “if n then diagnose y”. Computers also don’t need to be paid, and I don’t expect them to care about my problem.

  50. Alia says:

    @rokujolady – My mother in law holds an M.Sc. in pharmacy, she used to work for a pharma company, later for a cosmetics company and her last job was for a pharmaceutical wholesaler. And all her education does not stop her from falling for each new woo that appears, be it homeopathy, energy healing, hypnosis or supplements to help her lose weight. And yes, she is lazy and unwilling to follow instructions. She went to a certified dietitian once and came out full of outrage – “one egg a week? one teaspoonful of sugar a day? What was she [dietitian] thinking? It’s impossible!”
    And I wouldn’t really mind it, it’s her life after all, the problem is, she wants to drag her own son and me into woo with herself and it’s really tiring at times, debunking another quackery that she comes with. To explain – my husband and her son is suffering from a chronic illness, well-managed by mainstream pharmaceuticals. But she seems to believe he would get fit at once, if only he tried homeopathy/energy healing/ate more omega-3, etc.

  51. DWATC says:

    …. Patient education, patient compliance, emphasis on preventative measures, proper media/PR coverage of sciences, proper distribution of research funds, insensitivity to ideology-based policy/treatments ….. <— severely lacking in our current system, any questions….

  52. Chris says:

    Rokulady:

    Chris, I don’t think it’s fair to imply that all people who have had a poor experience with their doctor are lazy and unwilling to follow instructions. I might be wrong, but I don’t think thyroid disorders and tinnitus can be solved by eating veggies and excercise, though those might make you feel better in other ways and make it easier to cope. So, stop blaming the victim.

    Okay, not all people. That was one anecdote about one person. And unfortunately there really is no cure for tinnitus, I know I also have it (but fortunately infrequently, it started when I was five years old). It helps to not think about the ringing and to not let it control your life. The person I am speaking of let her issues control her life. She even kept a diary of what every single ache she had, with her daily temperature… plus what supplement she was trying out that week/month.

    The problem is that many are trying for the easy road, and sometimes miss the real messages. And that is even if they had a good education. They get swayed by the dodgy ads for the supplements and the quick energy pick ups, or the way to a “happier healthier you!.”

  53. pmoran says:

    I think the solution to this all is better education

    This is a reflex skeptical response to CAM use, but it is another prevalent skeptical “narrative” that is not well supported by the evidence, or by plausibility, given the level of sophistication of the science that often has be covered when countering CAM claims.

    You may be right to the degree that what you personally have in mind as “better education” may help some minds to be more trusting of science, and of scientists, and of doctors, and of authority in general. The Professor Sumner Millers probably engage some minds.

    But I suspect that most people are either born with such a bent or not, or they acquire it in early life from family and peers, and less often through later life experiences — and even less often through any thorough personal weighing up of all the evidence.

    SBM will certainly helps some, but mainly by reassuring or tipping the balance for those who already want to trust science; it helps them to know that someone, somewhere has “debunked” a CAM claim — the details of the debunking are of less importance on this hypothesis.

  54. 2Healthy says:

    I’m usually against alternative medicine but it can’t be negated that some parapharmacy works. That, if you consider parapharmacy alternative medicine, else I’m 100% against. Regarding parapharmacy the scary thing is that it sometimes work but you really have litle control about the dossage and side-effects. I’ve seen some of this stuff recommended by meds because they do infact work, for example for reduccing cholesterol. But the scary part is, ok it does reduce cholesterol but what is happening behind the scenes? why hasn’t it been approved? That is quite scary. That’s why even if it works it can be dangerous. One coffe is one thing a pill of concentrated caffeine is something else…

    For funding, research and peer finding please refer to the non-profit Aging Portfolio.

  55. Chris says:

    What is parapharmacy?

    And I noticed you have been posting several sequential comments on this and another blog with the same ending sentence. Are you some kind of spammer?

  56. WilliamLawrenceUtridge says:

    A pharmacy without all the pharmaceuticals possibly. Probably something closer to nonprescription biologically active drugs. The spam line seems to lead to agingportfolio.org, which does look like a legit web portal to aging research and doesn’t seem to link to much of the “live forever by dosing yourself into the hormone profile of a 20 year old” nonsense that so plagues the smarmy underbelly of aging research.

  57. nybgrus says:

    @pmoran:

    Perhaps not, but Steve’s “focus” did enable this, from Harriet :”It’s not so much that mainstream medicine has failed patients as that patients have failed modern medicine.” — which encountered no objections from the flock.

    First off, it was objected to. However, the objections were unjustified. Granted, I believe Dr. Hall’s brevity did her message a disservice in this case, but the meaning and statement was pretty clear to me. Perhaps because I see a parallel to Sam Harris’ comment on religion:

    If someone doesn’t value evidence, what evidence are you going to provide that proves they should value evidence.

    If someone doesn’t value logic, what logical argument would you invoke to prove they should value logic?

    To me, Dr. Hall’s statement was a parallel of this thought:

    “If someone values so-called “CAM” and “other ways of knowing” what can we do in SBM/EBM to prove they should value SBM over the magical hand waiving of CAM?”

    In other words, SBM is doing what it is supposed to – it hasn’t “failed” people in the same sense that it would be unreasonable to say I failed at flying because my arms can’t flap fast enough. The “failure” is in people failing to appreciate and realize this, and thus erroneously reject SBM or (correctly) consider it incomplete and thus erroneously believe that magical CAM thinking will somehow complete it.

    Please correct me if am incorrect, Dr. Hall.

    This is a reflex skeptical response to CAM use, but it is another prevalent skeptical “narrative” that is not well supported by the evidence, or by plausibility…You may be right to the degree that what you personally have in mind as “better education” may help some minds to be more trusting of science, and of scientists, and of doctors, and of authority in general…But I suspect that most people are either born with such a bent or not, or they acquire it in early life from family and peers, and less often through later life experiences…

    So let me get this straight… your argument against the apparently flawed “skeptical narrative” is that most people are already set in their thinking from an early age due to their family and peers so educating people and thus creating an atmosphere in early life conducive to acceptance and understanding of scientific principles makes no sense?

    Your only leg to stand on is that education alone is certainly not sufficient and certainly won’t instantaneously resolve the issue for exactly the reasons you correctly stated. But to then say that education won’t significantly ameliorate the “problem” of CAM because people are set in their ways and thus dismiss the argument on grounds of implausibility is nothing more than extremely provincial and short-sighted thinking.

    How do you think the early life experiences come about Peter? Do you not think educating people and thus changing their children’s early life experiences and then their childrens’ early life experiences would actually effect change? Or are you only interested in solutions that will work on a (short) time frame of your liking and when you provide evidence it won’t work on that time frame decide that the whole thing must be worthless and implausible?

  58. pmoran says:

    @pmoran:
    Perhaps not, but Steve’s “focus” did enable this, from Harriet :”It’s not so much that mainstream medicine has failed patients as that patients have failed modern medicine.” — which encountered no objections from the flock.
    First off, it was objected to. However, the objections were unjustified. Granted, I believe Dr. Hall’s brevity did her message a disservice in this case, but the meaning and statement was pretty clear to me. Perhaps because I see a parallel to Sam Harris’ comment on religion:
    If someone doesn’t value evidence, what evidence are you going to provide that proves they should value evidence.
    If someone doesn’t value logic, what logical argument would you invoke to prove they should value logic?
    To me, Dr. Hall’s statement was a parallel of this thought:
    “If someone values so-called “CAM” and “other ways of knowing” what can we do in SBM/EBM to prove they should value SBM over the magical hand waiving of CAM?”
    In other words, SBM is doing what it is supposed to – it hasn’t “failed” people in the same sense that it would be unreasonable to say I failed at flying because my arms can’t flap fast enough. The “failure” is in people failing to appreciate and realize this, and thus erroneously reject SBM or (correctly) consider it incomplete and thus erroneously believe that magical CAM thinking will somehow complete it.
    Please correct me if am incorrect, Dr. Hall.

    Introducing yet another arguable skeptical “narrative” that assumes that CAM use it is the result of a considered, weighing-up-the-evidence type judgment. I think it often isn’t. There can be an unresolved medical need and perhaps only the faintest of reasons for thinking that a different treatment might help. So the cancer patient takes curcumin, and the autistic parent seeks chelation, without having any personal assurance that these methods work, merely not being prepared to take the risk that they might later have to regret not doing so. The process is probably helped along by a touch of wishful thinking.

    This is the antithesis of how science-based medical practice works, but it is nevertheless understandable in ways that do not require too much disrespect of the CAM user, certainly not to the degree of “patients failing medicine”.

    If you understand this, you will also appreciate one of the reasons why better education will have less impact than is generally thought upon CAM use. That was the other skeptical belief you wished to defend.

  59. nybgrus says:

    Introducing yet another arguable skeptical “narrative” that assumes that CAM use it is the result of a considered, weighing-up-the-evidence type judgment

    You are barely able to see in front of your own nose.

    Regardless of whether the judgement is of the “considered, weighing-up-the-evidence type” or not, the judgement is influenced and determined by the preconceived notions of the person in question. Why would some people actively seek out the woo-iest of woo whilst others actively shun it, regardless of their profession (just look at the commentariat here)? Take a look at the commenter Mouse who is an artist, argues with me about the finer points of Type II vs Type I thinking and yet still recognizes the need for informed decision making and is not likely to use woo regardless of the fact that she (admittedly) is not adept at the scientific aspects of medicine.

    Take my own example, where I used CAM, have a degree in CAM, and advised many friends to use it and now am so vehemently against it. I was a smart enough guy – and I was concurrently obtaining a degree in biological sciences to boot! – but because the common narrative is one of “natural is better,” “Western Medicine vs Eastern Medicine,” etc, etc it seemed imminently easy and reasonable to “integrate” CAM with “Western Medicine.” In fact, one iteration of my medical school personal statement talked about my goals to do exactly that! I even used the phrase “take the best from each healing modality.” It was not my learning about the details of biochemistry, physiology, genetics, etc that changed my outlook. It was understanding the general principles of the fallacies employed by sCAMsters. My deeper understanding of the science of medicine allows me to do detailed analysis and accurately refute claims, but is not necessary to reject the pseudoscientific claims of CAM (at least the majority, I admit that some of the slicker claims that at least have some prior probability would be more difficult to reject).

    So you see, Peter, “education” doesn’t mean making sure everyone in the world can do a peer review on novel adenoviral constructs with suicide genes to target neurondocrine tumors. It just means knowing enough to understand that the correct narrative eschews the naturalistic fallacy, recognizes the (general) limitations SBM/EBM, and valuing the use of logic, reason, and evidence in making decisions. This is something that you accurately ascribed to being heavily (and sometimes irreparably) influenced in early childhood. But unless you are about to claim that behaviors simply cannot change on a population level then yes, education is indeed a very powerful tool in the long term battle for rationality and against pseudoscience, CAM, and yes, religion as well (they are all varied manifestations of the same underlying human cognitive failings).

    So perhaps “education” wasn’t clearly explicated in the course of our (collective) conversation. And certainly having in depth education in the relevant sciences is useful. But that is not the sole extent of what at least I mean by “education” in regards to decreasing CAM usage.

    If you understand this, you will also appreciate one of the reasons why better education will have less impact than is generally thought upon CAM use. That was the other skeptical belief you wished to defend.

    So then what, Peter? Education won’t do it. Stridency (even the extremely mild stridency seen here) won’t do it. Coddling won’t do it. Accomodationism by definition won’t do it. So what? We will always have the poor and the CAM users? I accept decreasing both, knowing that absolute elimination of either is a near impossibility. You seem to argue close to a nirvana fallacy where any tactic that falls short of complete resolution in a short enough time frame is not worthwhile. And you don’t ever seem to offer any other solutions except to be strident when it comes to cancer woo and accept everything else since we can’t possibly do anything about it. That’s just ridiculous.

    And it doesn’t even come close to addressing the problem of teaching it credulously in medical schools and other academic institutions (like my own degree). To me it seems like you are content just throwing your hands up and accepting defeat all while prattling on endlessly here about how terrible we all are for actually trying to do something about it, especially when it doesn’t live up to your unspoken but seemingly nonsensical standards.

  60. weing says:

    “The process is probably helped along by a touch of wishful thinking.”
    I think it is helped even more by allowing the SCAM artists to make fraudulent claims. SBM may say that we have nothing to offer but palliation at this time. The SCAMers will claim that they can cure them, if they follow their regime. If the cure doesn’t come, it’s the patient’s fault for not following the regime correctly.

  61. elburto says:

    @rokujolady – as Chris says, tinnitus seems worse than it is if the sufferer focuses on it, worries about it, puts it at the centre of their existence.

    I’ve had it for fifteen years, two different types. Like Chris, I’ve learned to block it out. If I think about it,as I am now, it becomes distractingly loud.

    But while it’s incurable, while nobody even knowswhy and how it works, it’s always going to be a case of “Sorry, sh¡t happens, build a bridge and get over it”

    Turning to sCam will do nothing but lighten your relative’s wallet. Retraining his brain and altering his mindset is the only way forward, but that takes effort and a willingness to change.

  62. pmoran says:

    Weing: “The process is probably helped along by a touch of wishful thinking.”
    I think it is helped even more by allowing the SCAM artists to make fraudulent claims. SBM may say that we have nothing to offer but palliation at this time. The SCAMers will claim that they can cure them, if they follow their regime. If the cure doesn’t come, it’s the patient’s fault for not following the regime correctly.

    Jann Bellamy also seems to think that the legal system could be used to stop fraudulent claims altogether. I am not sure about the practicality of that beyond more glaring examples, nor its wisdom, if the intention were to try and suppress CAM altogether .

    I need more details.

  63. pmoran says:


    “Introducing yet another arguable skeptical “narrative” that assumes that CAM use it is the result of a considered, weighing-up-the-evidence type judgment”

    You are barely able to see in front of your own nose.

    Regardless of whether the judgement is of the “considered, weighing-up-the-evidence type” or not, the judgement is influenced and determined by the preconceived notions of the person in question. Why would some people actively seek out the woo-iest of woo whilst others actively shun it, regardless of their profession (just look at the commentariat here)? Take a look at the commenter Mouse who is an artist, argues with me about the finer points of Type II vs Type I thinking and yet still recognizes the need for informed decision making and is not likely to use woo regardless of the fact that she (admittedly) is not adept at the scientific aspects of medicine.

    Nevertheless there is little correlation been education levels and CAM use. Look at those studies, and many individual examples. Perhaps the less scientifically-well-educated are less likely to challenge medical or scientific authority.

    CAM use is also not due to a preceding interest in more mystical forms of medicine (“woo”?), other than for a few extremists. Most CAM claims pertain to diet (some admittedly mystical), herbs or supplements. Though I suppose prayer is a biggie, if you want to include that.

    There must be something else going on. So, back to basics. I have suggested that more general prerequisites for the resort to CAM methods include unmet medical needs or wants. There is also the matter of where people are prepared to invest their trust.

    For CAM to be used there has to be some level of mistrust, not necessarily of mainstream science as such (as skeptics commonly assume) but merely of the intense skepticism that has become an integral and in some respects necessary part of mainstream medical science.

    There are good reasons for that, but it is not well understood by outsiders. When the extreme error-aversion is coupled to blatant hostility towards CAM and the merest suspicion of some turf protection it is little wonder that many ailing people prefer to keep all options open, feeling that there is a genuine risk that sound treatments arising from within CAM could be overlooked. Linus Pauling was an example of a very smart, well-educated fellow who was unable to work his way past this suspicion. This also helps explains why some ways of trying to “educate” the public might have the opposite effect to that intended, as some studies have found.

    It is also likely that many sensible people have a breaking point. My normally skeptical wife tried acupuncture when driven to distraction by ongoing neck pain (it didn’t help). She also tries just about every popular arthritis “cure” as it comes along. One look at her hands and you might understand why.

    So then what, Peter?

    As indicated previously, it seems fairly clear to me that we are fundamentally dealing with public trust, a very fragile resource.

    So my advice is, firstly, to work out some rational and realistic objectives (such as my emphasis upon patient and public safety?). Stick closely to the science in all its ruthlessness (testing out my views to destruction if necessary), not what feels right. You will then not make snap judgments about CAM which are so wide of the mark as to demean and turn away the very people that are most in need of our advice. It is better to make no comment at all as to why people use CAM, than to get it wrong and thereby demonstrate exactly how “scientists DO get things wrong”.

    We can still explain why we think certain methods don’t do what is claimed, and why others might only do so via placebo responses. By daring to take apart our own dubious “narratives” we could also demonstrate how good science operates, that it truly can have neither fear nor favor.

  64. nybgrus says:

    I have suggested that more general prerequisites for the resort to CAM methods include unmet medical needs or wants.

    And yet what about all that data which demonstrates that the majority of CAM use is complimentary rather than entirely alternative to actual medicine? And that satisfaction in both is rated highly?

    That speaks to the general mentality of people wherein “other ways of knowing” are just as valid as a scientific inquiry. Appropriate education would demonstrate that to be false and people would be less likely to engage in frivolous CAM use.

    But more to the point, I actually don’t disagree with the things you have said in your last post. I just don’t see evidence that that is all there is to it. Just like the different tacks the New Atheists and secularists take – from Myers to Hitchens to Dennet to Mehta and Epstein – there are different fronts to be attacked and defended in medicine. Education is unquestionably a relevant front. We can argue about just how big and how fast a change it would make and what the best way to go about it, no doubt. And I have never said it will wholly solve the issue. The only contentious thing I have said is that I believe it will go a very long way to solving the issue – only in degree can we reasonably argue.

    Lets also focus on your comment of “needs or wants.” “Needs” can – and are – created by marketing. Wants are, well, obviously just wants. So yes, if someone “wants” a magical pill to cure their cancer with no side effects, they can go chasing after it. If someone is led to believe they “need” to have a coffee enema and chelation to remove the “toxins” from their body the will chase after that too.

    But education would enable people to realize that the former is outside the realm of reality and the latter is a manufactured sense of need for the worried well. Perhaps I am using the term “education” too broadly.

    In any event, yes, Jann Bellamy is quite correct – legislation and rational regulation would go a long way to solving the problems and improving it. How about the evidence which demonstrates that many people trust “alternative practitioners” because they are licensed by state boards? Or who think that homeopathic medicine must have efficacy because it is sold on pharmacy shelves? Sure, buying random crap off someone on the street or from a sketchy website raises the eyebrows of most reasonable people. But a pharmacy is a place to go and get legitimate medications which people will benefit from.

    Or how about the fact that essentially everything around us is now regulated because unscrupulous people would sell anything to anyone willing to part with their money? The world is a safer place and people value and trust the regulations that made it so, regardless of whether they actively realize it to be the case. Just because now the harms are much harder to detect (baby pacifiers made of lead and drinking liquid mercury are much easier to note the harms of than acupuncture or supplements) doesn’t mean they are any less valid to regulate against. Especially taken in context of laws like the DSHEA which are fundamentally a way to skirt the regulations (something else most people don’t know).

    So yeah, our narratives here are not “dubious” they are quite accurate. Admittedly there is no one single narrative to fully describe the entirety of the issue, and we here as commenters and authors (and myself in my own life) tackle which ones we can whenever we can.

    So if you just want us (me) to admit that educating everyone (whatever that means in practice) won’t completely absolve the problems of CAM and wishful thinking, you have it. I admit it, have always known it, and fully believe it to be the case. But it is a large part of the issue and one that is very relevant, very useful to target, and has side benefits as well.

    For CAM to be used there has to be some level of mistrust, not necessarily of mainstream science as such (as skeptics commonly assume) but merely of the intense skepticism that has become an integral and in some respects necessary part of mainstream medical science.

    I’ll close by saying that for this to be true, CAM usage and wishful thinking must have arisen as a result of people like myself and the authorship here. That is demonstrably false – it has always been there and has, in fact, been on the overall decline…. until the succesful marketing campaigns starting largely in the 80′s to rebrand quackery as “CAM” and “integrative medicine” etc. People use CAM in large part because they hear about it and all they hear are positive anecdotes, logical fallacies, appeals to wishful thinking, and marketing like Dr. Oz’s bullshit.

  65. Marlinman says:

    I’m a little confused what we are describing as alternative medicine. Is it any practitioner who doesn’t immediately turn to “modern medicine” first? Are we so nieve that we honestly believe the only options for healthcare come from a pill, or surgery or some other exogenous source? To group CAM practitioners into one category I feel is a strong injustice. To say that a reiki master, an iridologist, or an herbalist should be grouped together under one label is, in my opinion, asinine. They have vastly different beliefs and explanations as to why their therapies work so why should we talk about them under one title?

    1. Harriet Hall says:

      @ Marlinman,

      “To group CAM practitioners into one category I feel is a strong injustice”

      Is it an injustice to lump into one category people who claim that 2+2=5 and those who claim 2+2=833? They are both wrong.

  66. Chris says:

    Marlinman:

    To say that a reiki master, an iridologist, or an herbalist should be grouped together under one label is, in my opinion, asinine. They have vastly different beliefs and explanations as to why their therapies work so why should we talk about them under one title?

    Except they have one very important thing in common: they do not work as advertized by their proponents.

    They all make claims that are not supported by evidence or reality. And that includes the herbalist that makes claims their wares are safe, when there is no way to accurately assess the dosage.

  67. weing says:

    “Are we so nieve that we honestly believe the only options for healthcare come from a pill, or surgery or some other exogenous source?”
    Are you implying that is what we do? What is your endogenous source of healthcare?

  68. pmoran says:

    Nybgrus, I never claimed those were the only factors, merely that they are the main prerequisites.

    I have said all I wish to say, except to challenge this rewriting of medical history: -

    – it has always been there and has, in fact, been on the overall decline…. until the succesful marketing campaigns starting largely in the 80′s to rebrand quackery as “CAM” and “integrative medicine” etc.

    You are soaking it all up without further thought, aren’t you? I doubt if these term changes were ever considered seriously by CAM’s major commercial interests. They would worry that attempts to align themselves more closely with the mainstream can only subject them to greater scrutiny..

    The term “integrative” was certainly initially put forward by a group of conventional doctors, who were probably already making a good living from medicine, but who believed that the addition of CAM could help some of their patients. I suspect that if you went back to the earliest suggestions for the use of the term “complementary” you would find something the same. .

    But that’s not all.

    By 1980, largely unnoticed by most of us, CAM was already on the upswing, dominated at the time by orthomolecular medicine (mainly megavitamin consumption). Who popularized that? Not scammers. Not CAM practitioners. It was a true-believing Nobel-prize winning chemist (Pauling), along with a psychiatrist (Hoffer), and a surgical oncologist (Cameron). Their case was moreover not based upon the “usual suspects” of SBM: “woo”, cultural relativism, or the demented urge to corrupt mainstream medical science — it was the belief that scientists were not adequately taking into account or interpreting correctly the evidence that did exist and that they might be displaying bias against certain methods. By 1980 Pauling had already written six or seven very popular books on the subject.

    By 1980 the Laetrile controversy was also in full swing, with true-believing doctors Contreras, Manner, Navarro and others being the main advocates and the matter being confused (in the public mind) by reports of occasional positive results in laboratory animals. There was probably little need to ever actively market this apricot seed extract; in fact it was banned in the US. Yet the human desperation that you and many other SBMers seem unable to give proper respect to ensured that within a few years many thousands of cancer sufferers had used Laetrile. US citizens were obtaining it wherever they could (and still are).

    In 1980 also the journalist Ralph Moss PhD first published his highly influential “expose” of the Cancer Industry — mainly a biased account of the Laetrile controversy and a few other “alternative” cancer treatments. He along with Linus Pauling probably did more than anyone else to erode public trust in the medical profession (the other main pillar of CAM). Sections of the public were now asking new questions, probably helped along by heightened expectations of medicine, and a sense that mainstream medical science was not quite living up to its initial promise.

    Sure, scammers, and other hangers-on then piled onto the CAM bandwagon, but CAM use is always a collusion between the user and a facilitator. . The facilitators include well-meaning people, and many with high levels of integrity, as well as the villains and the seriously deluded.

  69. BillyJoe says:

    What? They are not scamsters because they are qualified medical practitioners?

  70. rosross says:

    People use Traditional Medicine, or alternative or complementary as it is sometimes called because it works. Not only that, Traditional Medicine does no harm in the way that Allopathic or Modern Medicine does where iatrogenic, doctor-induced deaths now runs into millions worldwide and jostle for second place amongst the big three killers.
    Allopathy is brilliant at some things … the main ones being anything mechanical which is not surprising because science/medicine is materialistic and mechanistic and sees the body as a machine so anything which can be treated from that perspective is likely to be successful … crisis or emergency situations and surgery. Although a lot of surgery is interventionist and unnecessary as studies have shown where patients recovered better from knee and heart ‘surgery’ although nothing had actually been done, and therefore less effective.
    In the best of worlds, and it will come, Allopathy will remember where it began and realise the body is not a machine, nor a bag of chemicals but a complex organism which needs to be treated as a whole with emotional, physiological, psychological and spiritual factors taken into account.
    Both Traditional Chinese Medicine’s use of acupuncture and Homeopathy will lead the way in understanding of energy medicine in years to come. True healing will begin when the medical system utilises all healing methodologies and recognises that there is no ‘one size fits all’ and people are unique individuals with unique and differing needs and unique and different causes of illness, including the same illness. This latter is something which Homeopathy has always recognised.

  71. pmoran says:

    They are not scamsters because they are qualified medical practitioners?

    No. Are you saying these persons were all out to defraud for personal gain? (Assuming “scammer” =”scamster”)

  72. weing says:

    “People use Traditional Medicine, or alternative or complementary as it is sometimes called because it works.”
    You forgot to add, that it works just like placebo. Fine, if you’re not really sick. Doing nothing works just fine. Entertaining the patient with your mumbo jumbo is not medicine.

  73. nybgrus says:

    @marlinman:

    I’m a little confused what we are describing as alternative medicine. Is it any practitioner who doesn’t immediately turn to “modern medicine” first? Are we so nieve that we honestly believe the only options for healthcare come from a pill, or surgery or some other exogenous source? To group CAM practitioners into one category I feel is a strong injustice. To say that a reiki master, an iridologist, or an herbalist should be grouped together under one label is, in my opinion, asinine. They have vastly different beliefs and explanations as to why their therapies work so why should we talk about them under one title?

    Your confusion will be allayed, though not entirely alleviated, by reading more of this blog.

    CAM itself is incredibly hard to define and nebulously includes just about anything at any time with the proper hand waving and just-so stories. The best definition to my knowledge is “CAM is anything marketed as ‘medicine’ that hasn’t been shown to be effective or has been shown to be ineffective.” Just look at the NCCAM blog and witness that even Deputy Director Dr. Killen agrees that defining CAM is so difficult as to not even be something the NCCAM cares to do (which boggles my mind that the National Center for Complimentary and Alternative Medicine sees fit to not bother defining rigorously “Complimentary and Alternative Medicine.”

    The other commonly used definition is “anything called ‘medicine’ that is outside the ‘mainstream’ of medicine used within a society.” This is also problematic, because then modern scientific medicine becomes CAM in societies that practice witchcraft or TCM or any other such “CAM” to us. The relativism doesn’t help define study or even inform the usage that is common in the rhetoric around this topic from anyone, CAM believer or otherwise.

    It is the contention here, that the first definition I put forth is the best, since it makes no sense to an actual practitioner of real medicine that diet and exercise are CAM just like Reiki and Homeopathy are CAM. The common link between things like Reiki, Homeopathy, TCM, herbalism, etc is that the origin of the ideas are pre-scientific and the modalities have either not been tested for efficacy (many herbal concoctions) or have been shown to be completely ineffective beyond placebo (Reiki, Homeopathy). As such it makes no sense to “integrate” CAM into actual medicine, since once efficacy of a treatment or modality is established it ceases to become “CAM” and is simply “medicine.”

    Furthermore, your simplistic and quite frankly denigrating definition of what actual medicine is has no bearing in reality. If you genuinely think the only thing I am taught in medical school is how to give pills and do surgery you are seriously blinkered. The biopsychosocial model of medicine along with the notion of medical partnerships with patients to treat not only the root cause of disease but the symptoms of it, the impact it has on the patients’ lives’, the family of the patient, and the psychological impacts of a disease has been the standard medical model for at least 25+ years. I am required to understand and implement these facets of medical care (in fact, as an anecdote during one of my oral exams for succesful completion of my internal medicine rotation it was expressly told to us that failure to adequately describe the social and personal impacts of my patients’ condition would lead to failure of the entire rotation. While perhaps not as huge a point during the schooling and training of Drs. Gorski and Novella I know for a fact that they were also educated in this model as well).

    Lastly as weing pointed out, they are lumped together not because the nostrums and ideologies of iridology and homeopathy are the same, but because they are both pre-scientific and use patently false understandings of human physiology and pathophysiology and are based in belief systems rather than evidence and rationality. And that is why it is not only reasonable but required to talk about them under one title (well, that and the fact that the CAM believers and hucksters like to lump all these disparate modalities together because they also incorporate science based modalities like diet and exercise under the same umbrella to gain a false patina of legitimacy)

  74. nybgrus says:

    @pmoran:

    I have said all I wish to say, except to challenge this rewriting of medical history: -

    – it has always been there and has, in fact, been on the overall decline…. until the succesful marketing campaigns starting largely in the 80′s to rebrand quackery as “CAM” and “integrative medicine” etc.

    You are soaking it all up without further thought, aren’t you? I doubt if these term changes were ever considered seriously by CAM’s major commercial interests. They would worry that attempts to align themselves more closely with the mainstream can only subject them to greater scrutiny..

    I have said all I wish to say as well then. Except for one little bit – I will remind you yet again that I hold an accredited undergraduate degree in this nonsense. From a well recognized American university. And what you label as the re-writing of medical history is what I was actually taught. I am not “soaking up” anything – I experienced it myself, I saw it first hand, and while I didn’t recognize it at the time since I was blinkered by the credulousness of the teaching and assumption that my institute of higher learning wouldn’t teach me bullshit, what I have written above is indeed correct and an accurate (though of course not 100% complete) description of the reality of the transition quackery has made into “integrative medicine.” This is also well documented and well referened both here and by Orac at RI.

    You further make the mistake of assuming that just because the originator of a particular idea is an MD or PhD (like Andrew Weil or Dr. Oz) means that it is not CAM or that it is not part of the afore described history. Nonsense. That’s like saying that just because the Nazi collaborator was French means it couldn’t have been part of a Nazi agenda or propaganda (sorry for the Godwin’s law, but my intent was a reasonable analogy rather than merely a pointless invocation of the law)

    Sure, scammers, and other hangers-on then piled onto the CAM bandwagon, but CAM use is always a collusion between the user and a facilitator. . The facilitators include well-meaning people, and many with high levels of integrity, as well as the villains and the seriously deluded.

    Agreed. Except that you should realize that those plying the utility of CAM who are the “well meaning… with high levels of integrity” are the seriously deluded ones, regarldess of what letters come after their name. And further that the villians and scammers happily utilize the former to further their goals and market the inanities of CAM to grant undeserved legitimacy. Thus your attempt to separate out these sub-groups and define them as somehow different from each other and thus undermine the narrative I have described fails.

  75. nybgrus says:

    People use Traditional Medicine, or alternative or complementary as it is sometimes called because it works.

    What a quaintly naive and incorrect statement. So, the thousands of years long medical practice of blood letting and the 100+ year practice of drinking mercury to cure ailments came to be used by so many for so long because they worked? Bollocks.

    doctor-induced deaths now runs into millions worldwide and jostle for second place amongst the big three killers.

    Interesting. When automobiles were first introduced there were 36 deaths from car accidents in the entire United States. Now there are 32,267 per year. Cars must have gotten a lot more dangerous between 1900 and 2011!!

    Oh wait, if you look at it as fatalities per 100,000 population you find an increase from 1900 to ~1980 and then a decrease ever since. Funny how that correlates to the increase in cars and people driving them and then the increase in auto safety….

    So when you look at mortality data from, say, 1935-2010 you find that “the age-adjusted risk of dying dropped 60 percent from 1935 to 2010″ and “The risk of dying decreased for all race subgroups of the U.S. population from 1935 to 2010″ and “Although the number of deaths increased over the 75 years, the risk of dying decreased”

    In 1935 the total number of deaths was 1.4 million. In 2010 it was 2.5 million. Clearly people are dying more, right? That is nearly double the number of deaths! But if you look at the age-adjusted death rates per 100,000 we find 1,860 in 1935 and 746 in 2010. Even the crude death rate (i.e. no controls for age) went from 1094 to 799. Also, average life expectancy went up from 69.77 in 1960 to 78.24 in 2010. No matter how you slice it people are living longer and dying less.

    Clearly, this is because the vastly predominant system of medical care in the US (modern scientific medicine) is failing and things like TCM are what is actually saving and extending the lives of US residents.

    Allopathy will remember where it began and realise the body is not a machine, nor a bag of chemicals but a complex organism which needs to be treated as a whole with emotional, physiological, psychological and spiritual factors taken into account.

    First off, we are a machine made up of a bag of chemicals. We are also a very complex chemical based machine. And yes, as I explained in a comment above, we are also cognizant of and trained in the fact that while treating the chemical machine is minimally necessary it is not sufficient to practice good medicine and the emotional, psychological, and spiritual factors must be taken into account. I’ll repeat it once more since it is important – I would have failed my third year of medical school if I had practiced medicine the way you seem to think we do.

    True healing will begin when the medical system utilises all healing methodologies and recognises that there is no ‘one size fits all’ and people are unique individuals with unique and differing needs and unique and different causes of illness, including the same illness

    And of course we also know this, and are taught this, and once again I would fail medical school if I didn’t actually apply it. I have had exams and courses around the concept of PICO – Population, Intervention, Comparison, Outcome. In other words, if I wrote on my exams in a manner that treated all my patients the same and used a “one size fits all” approach I would also fail medical school (as would Drs. Gorski and Novella and all the other physician authors and commenters here).

    Sure, homeopathy recognizes this. The difference is we recognize it and actually do it in a manner consistent with reality to produce actual improvements in outcomes. Homeopathy (and other so-called CAM) uses magical thinking to wish they actually did the same.

  76. nybgrus says:

    No. Are you saying these persons were all out to defraud for personal gain? (Assuming “scammer” =”scamster”)

    Are you saying that intent to defraud is necessary to actually have committed fraud and be a scamster or scamster?

    Does Dr. Oz need to think in his head that he is knowingly spouting bullsh!t in order to be a fraud?

    No, intent makes it worse but well intentioned people still hawk CAM for personal gain – do you think Dr. Oz has no vested personal gain in the BS he markets and sells? His (asumed for the sake of argument) lack of intent to defraud makes it less egregious, but no less a scam or a fraud. The fact that he is a legitimate medical practitioner makes up for the lack of egregioussness because he should know better.

  77. Chris says:

    rosross:

    People use Traditional Medicine, or alternative or complementary as it is sometimes called because it works. Not only that, Traditional Medicine does no harm in the way that Allopathic or Modern Medicine does where iatrogenic, doctor-induced deaths now runs into millions worldwide and jostle for second place amongst the big three killers.

    Uh, huh. Prove it. Show us exactly how well it works for type 1 diabetes, epilepsy, obstructive hypertrophic cardiomyopathy, strep infections, etc. Make sure you use real scientific citations. Because here are plenty of examples of alternative medicine causing harm ranging from kids dying from untreated ailments, to deaths from treatable cancer and even poisoning from special herbs.

  78. pmoran says:

    Nybgrus:
    I have said all I wish to say, except to challenge this rewriting of medical history: -

    – it has always been there and has, in fact, been on the overall decline…. until the succesful marketing campaigns starting largely in the 80′s to rebrand quackery as “CAM” and “integrative medicine” etc.

    You are soaking it all up without further thought, aren’t you? I doubt if these term changes were ever considered seriously by CAM’s major commercial interests. They would worry that attempts to align themselves more closely with the mainstream can only subject them to greater scrutiny..

    I have said all I wish to say as well then. Except for one little bit – I will remind you yet again that I hold an accredited undergraduate degree in this nonsense. From a well recognized American university. And what you label as the re-writing of medical history is what I was actually taught.

    You misunderstand. The “soaking up” referred to your apparent absorption of SBM’s sayings about CAM without serious consideration of their accuracy. (Never mind, I was the same when I first joined skeptical groups, despite some uneasiness about some that was said — tribal pressure and all that.)

    You were presenting something resembling the Steve Novella/”St James” version of the history of CAM, wherein shady forces are arraigned against us, intent upon corrupting medical science and furthering venal self-interest. There being little place for honest belief, any CAM advocacy becomes “marketing”.

    This is why it is important that everyone understands what REALLY went on in 70s and 80s, when CAM boomed as the result of its sincere protagonists as much as any commercial interest. Admittedly every man and his dog soon had a web site selling vitamins, but that, too, would have reflected varying degrees of belief in the product, as the results of the influence of Pauling and others.

    I assume the degree you are referring to is your degree in sociology. Actually the universality and extraordinary variety of medical cultures can tell us a great deal about the influences that sustain CAM. For example, they are illustrative of a universal compulsion to “do something” when sick, and how absolutely anything can become credited with healing powers and the subject of “true belief”.

  79. pmoran says:

    Are you saying that intent to defraud is necessary to actually have committed fraud and be a scamster or scamster?

    Yes.

    Does Dr. Oz need to think in his head that he is knowingly spouting bullsh!t in order to be a fraud?

    Yes.

    I suspect that Oz knows very well that he supports dubious claims, but he is now firmly locked into that by audience expectations and he probably has various means of self-justification.

    They might include an awareness that he is operating according to the standards of the CAM sub-culture he is talking to — as most of his audience will also understand when deciding how seriously to take it all.

    It is thus quite normal within CAM to be supportive of claims without being sure in any scientific sense whether they are true or not. A basic legitimacy is acquired from the mere fact that a claim has been made and supported by testimonial or other means. Thereafter, “this is something you can try if you want that outcome”.

  80. nybgrus says:

    You misunderstand. The “soaking up” referred to your apparent absorption of SBM’s sayings about CAM without serious consideration of their accuracy.

    No, I did not misunderstand. That is exactly what I thought you were referring to.

    And no, I did not form my thoughts and ideas about CAM and its history from SBM I merely refined and honed them here. I was already on the journey down this path which is why my friend (oft referenced in my posts) recommended me a single article from here on a topic of interest (acupuncture, as it happened to be). I found the content to be so congruous with my own experience thus far but with a more obective and scientific lens as opposed to what I had been taught and it was that lens that made so much sense to me and it finally “clicked” why all the stuff I had already been doing and saying seemed somewhat “off” to me.

    By small anecdote to relate the grok of it:

    I was having beers with a dear friend of mine and his coworkers in Los Angeles many moons ago (whilst in the latter part of my undergrad days). At this particular event was a professor of marine biology at UCLA. We started chatting and he asked me more about myself and my aspirations. I told him about med school dreams and he lauded them, then asked more. I began explicating my stance on medicine, CAM, and the “integration” thereof. He paused, a bit confused, and I continued to peddle the same BS CAM talking points we are all used to; it was, after all, what I had been learning in my degree! He then asked me if I thought there was legitimacy to homeopathy and I responded in the affirmative. He laughed and called me (politely) an idiot. I gave the same talking points; not the ones you tend to about placebos, making people feel better, etc. No, I defended actual intrinsic efficacy beyond placebo. He asked me where I wanted to go to med school and I said UCSF (having just killed the MCAT, the US version of the GAMSAT). He laughed and said if I even got an interview he would buy me dinner of my choice at any restaurant in LA, money no object.

    I’d had and would continue to have a few such encounters. I was taught, and genuinely believed, that “CAM,” “Western BioMedicine,” etc were legitimate constructs that rigorously defined various aspects of human healthcare; that they had intrinsic efficacy and even very much along the lines of Kaptchuk (though I hadn’t read him in my undergrad, amazingly) that as long as there was internal consistency within the “healing modality” that would suffice in actually treating disease.

    I assume the degree you are referring to is your degree in sociology. Actually the universality and extraordinary variety of medical cultures can tell us a great deal about the influences that sustain CAM

    It was my degree in medical anthropology – the same thing that Moerman is supposedly expert of. But I was not taught about comparative healing modalities from an objective scientific standpoint to examine the influences that engender and sustain CAM. I was taught it credulously.

    In other words, I was not taught the Bible as literature but as fact, if you understand my analogy here.

    And bear in mind that this was at the same university wherein I obtained my Bachelor of Science in Evolutionary Biology where I had professors who taught in buildings bearing their name since they were Nobel Laureates (at the time we had 5 Nobel Laureates in the sciences alone, and a few others in the humanities department).

    Let me stress this again – I was not taught comparative sociological perspectives, I was taught that Western BioMedicine was reductionist evil and that TCM, Ayurveda, etc were valid and intrinsically effective healing modalities which where just as good and often better than so-called evil Western BioMedicine. The only exception being acute care and trauma.

    Funny, how that is still the same rhetoric. So when I came across SBM, I was not soaking in the rhetoric here unquestioningly. I was seeing them describe exactly what I had been taught, what I had felt to be true and correct, and giving extremely good explanations as to why that was false. It did not spur me to mindlessly accept and be content to simply completely flip-flop my entire degree’s worth of knowledge and my own framework of belief on the topic. It spurred me to read more and more, from a variety of sources, to poke and prod, to learn how to dissect and read studies in detail, to learn on my own and find a way to still believe in CAM.

    I couldn’t. And then I became a bit pissed off that my professors had duped me, had taught me quackery and BS were legitimate, had taught me that Western BioMedicine was reductionist and that both concepts were evil. Please understand that I was inspired to enter medical school to change the system, integrate the best aspects of all healing modalities into one ultimate healing modality, to “heal” rather than “treat“. Leaving that belief system was not some passive exercise of swallowing unquestioningly the writings of Drs. Novella, Gorski, Hall, et al. It was an active and at times painful process – one I imagine would be akin in quality if not degree to deconversion from religious belief.

    So no, Peter, I am not just “soaking up” the narrative laid down by SBM. I have researched it independently and read extensively on the topic after having literally experienced it myself.

    There being little place for honest belief, any CAM advocacy becomes “marketing”.

    I can’t even begin to count how many times it has been reiterated here that honest belief is not a significantly mitigating facet of CAM. And how many times it has been noted that honest belief warrants compassionate education, but once educated (or as in the case of Dr. Oz those who should already be better educated) holds almost no sway in the rightful condemnation of such practices.

    Put another way, in the case of the Jihadist who kills you because he honestly believes it is the will of his god to do so “honest belief” really matters very little, doesn’t it?

    This is why it is important that everyone understands what REALLY went on in 70s and 80s, when CAM boomed as the result of its sincere protagonists as much as any commercial interest.

    I see you writing without citation and those whose narratives you condemn writing with plenty. Forgive me if I don’t put much stock on your thoughts of what really happened in the 70′s and 80′s. Besides, at an art opening in Australia called “The New Psychedelia” last year the keynote speaker said, “If you can remember the 70′s you probably weren’t there.” I kid, of course, but my former statement stands.

    Are you saying that intent to defraud is necessary to actually have committed fraud and be a scamster or scamster?

    Yes.

    Does Dr. Oz need to think in his head that he is knowingly spouting bullsh!t in order to be a fraud?

    Yes.

    So I suppose now is when we come to the crux of it.

    You are, in a very technical sense, correct. However the second definition of fraud is:

    A piece of trickery; a trick.

    without mention of intent (as opposed to the 1st which includes intent as operational to the definition).

    So fine, lets call the point moot and find a different word. It doesn’t change the substance of the message or the poignancy of the point.

    And especially Dr. Hall has made it a very clear and innumerably reiterated point that intent is but the smallest facet of the discussion. Intent to deceive makes it worse but it is not the prerequisite for it being bad.

    Your discussion (when we come to such moments of clarity as we currently are in) hinges on this notion that somehow good intent mitigates everything and renders null our point, our goals, and our methods. It does not. And in fact, much of the rhetoric here implicitly and even explicitly acknowledges this – Jann Bellamy speaking of legislation implicitly assumes intent in the argument. For legislation against licensure of CAM is to prevent those who are of genuinely good intent from being duped into and practicing quackery. Those with malicious intent to deceive currently do and always will practice whatever quackery people will pay them to (take John Edwards, the “psychic medium” as an example). But for good intentioned people to see psychic medium-ry or acupuncture or homeopathy or chiropractic as legitimate avenues to pursue their aspirations of helping people, there must be some sort of legitimization in the form of licensing laws and/or teaching it at a university as credulous science.

    Sure, the inception of this was in part hold overs of True Believers (™) from when there was legitimate questions as to the validity of CAM passed down through a couple of generations, but fraudulent schysters who either knew or didn’t care to know of their fraud but wanted to make a buck also played a significant role in the popularization and marketing and then of course those with good intent jumped on the band wagon as well (plus more minor contributions of course; don’t think me stupid enough to assume this isn’t the product of a complex and multifactorial interplay). But without the True Believers (™) and most importantly the fraudsters with the malicious intent, there wouldn’t be anything for these good intentioned folk to do. If acupuncture wasn’t licensed or taught at legitimate universities, do you think that good intentioned folks would still rally to have it included in health cover, claim the benefits of it, and simultaneously malign “Evil Western BioMedicine”?

    So do I think there is some sort of cabal pulling the strings and orchestrating a world takeover of CAM, like some sort of alternative medicine Illuminati? Of course not. I’d be shocked if any of the authorship here did either. But the fact is that it exists as a concept because of marketing not because of any legitimate basis in reality.

    Try an exercise. Have a chat to another medical professional about an actual (but discredited) medical intervention and compare that to a discussion about CAM with an altie. You’ll find the latter to be based purely in marketing terminology, concepts of “turf protection,” and disdain for Western BioMedicine; in other words, like talking to a creationist.

    And lastly, how about this. If you think Dr. Oz isn’t committing fraud because he “genuinely believes” in the BS he is peddling, does that mean we shouldn’t do something about it? And more importantly, how about the fact that he has a professional and ethical onus to use his knowledge and skills to determine best medical practice but is obviously eschewing that for nothing more than monetary gain. Does willful avoidance of knowing the truth (and ignoring the truth) not count as fraud? I mean really, sticking your fingers in your ears and saying “la la la la la!” so you don’t have to hear how what you are peddling for personal gain is bunkum makes it not fraud? That’s just ridiculous

  81. pmoran says:

    I can’t even begin to count how many times it has been reiterated here that honest belief is not a significantly mitigating facet of CAM.

    Is it truthful to class all CAM practitioners and sympathisers as knowing frauds? If it is not quite true, that should be enough in itself for a science-based (“reality-based”, according to some) forum — without going on to ask whether that approach is helpful to any of its ends, which I also question strongly.

    You are correct that it is a prevalent SBM sentiment — hence the nicknames for CAM: “scamsters”, sCAM, and $CAM.

  82. Scott says:

    Not all are KNOWING frauds. Many of them – definitely including Oz – are at a minimum in the category of SHOULD KNOW they are frauds. Meaning that the exercise of the minimal level of due diligence called for by their professional and ethical responsibilities would in fact show that the claims they make are false.

    Suppose Dr. Oz were to see a patient who comes in and says he’s having a heart attack. Without doing any tests to confirm the diagnosis or determine the appropriate treatment, Oz simply performs a bypass operation. The patient dies because the problem was actually something else. Did Oz KNOW that the bypass was the wrong treatment? No, but he SHOULD HAVE KNOWN if he had performed the minimal level of due diligence necessary to the profession.

    Promoting false claims, which he would KNOW are false if he did minimal due diligence, is much the same in this regard. Being grossly ignorant is no excuse if it’s your job to learn the facts before you act.

  83. pmoran says:

    Many of them – definitely including Oz – are at a minimum in the category of SHOULD KNOW they are frauds. Meaning that the exercise of the minimal level of due diligence called for by their professional and ethical responsibilities would in fact show that the claims they make are false.

    There is some truth to that. But there are also many honest CAM practitioners and laymen who offer medical advice. Many don’t get anything out of it, offering advice free on web sites, newsgroups, mailing lists etc.

    They don’t share the same ethical, professional or scientific responsibilities (although I myself try to get even the laymen to see that they do have some basic responsibility for the welfare of those they advise). . So I cannot class them as frauds, yet they are far more influential than anything else in sustaining CAM, precisely because they are obviously sincere. CAM users are nearly as suspicious of commercial manipulations as we are. The most common inquiry on CAM forums is “what do people think of X — is it a scam?”

    But you also need to understand that CAM is a totally different medical sub-culture. Within it, it is taken as read that there is a problem that the mainstream has not resolved, or cannot solve, or is unlikely to resolve satisfactorily. (At least one of those is usually true, too The “not always” is what we have to worry about. ).

    Thus are we instantly removed from the domain of regular, accepted medical science. It is therefore rather silly to expect normal standards of science or ethics to continue to apply. The questions being asked are different, too e.g. “(given certain mutually agreed basic assumptions) what treatment do you know of that might help me?” The door is instantly thrown wide open — testimonial, and anecdote, and “what some scientist found in a lab somewhere”, can all do their thing.

    I am trying to shut up, so I won’t sidetrack myself into how all this helps make some degree of CAM use inevitable.. The best we can do is try to make it safer.

    What to think about Oz? I don’t know. I do suspect that the best approach to him is to treat him as a bit of a joke, a media junky pandering to an already CAM-inclined audience. Appearing to be too alarmed by him may be taking him more seriously than anyone else does. I’d like to think so, but may be wrong.

  84. Scott says:

    Any “CAM practitioner” offering medical advice is practicing medicine, and should be held to the same ethical standards.

    Thus are we instantly removed from the domain of regular, accepted medical science. It is therefore rather silly to expect normal standards of science or ethics to continue to apply.

    I’d call that utter BS, but I don’t want to insult perfectly good manure. If medical science has no good answer, then there is no good answer known and it is in no way “silly” to expect people to not simultaneously present themselves as medical experts AND spout garbage which is known to be completely false!

    I do suspect that the best approach to him is to treat him as a bit of a joke, a media junky pandering to an already CAM-inclined audience.

    The BEST approach to him would be to have his medical license removed and show shut down on public health grounds. I grant it’s unlikely to happen, but there is no possible argument that it isn’t appropriate or anything less than completely justified.

  85. Robb says:

    “If medical science has no good answer, then there is no good answer known and it is in no way “silly” to expect people to not simultaneously present themselves as medical experts AND spout garbage which is known to be completely false!”

    It isn’t as black and white as this though – there’s a variety of things that fall into the “not ready for prime time” “some promising preliminary evidence but needs more research” category that are not yet accepted into mainstream medical practice but are accepted as “worth trying” by a fairly large percentage of the population that are less concerned with waiting decades for larger clinical trials that may or may not happen – especially if their health concerns are pressing and there are either no known conflicts with what mainstream medicine is providing additionally or mainstream medicine is unable to provide much, as the case may be.

  86. Harriet Hall says:

    @Robb,

    I have no problem with people trying something unproven that they perceive as somewhat plausible and that is not known to be unsafe. My objection is only to those who have told them it has already been proven safe and effective. I’m against spreading misinformation, not against informed personal choice.

  87. BillyJoe says:

    The self deluded CAM practitioner is not the same as a knowing fraud practising CAM, however they should be treated the same because the consequences are the same. Otherwise, how are we ever going to make any headway against treatments that do not work.

  88. weing says:

    “It isn’t as black and white as this though – there’s a variety of things that fall into the “not ready for prime time” “some promising preliminary evidence but needs more research” category that are not yet accepted into mainstream medical practice but are accepted as “worth trying” by a fairly large percentage of the population that are less concerned with waiting decades for larger clinical trials that may or may not happen – especially if their health concerns are pressing and there are either no known conflicts with what mainstream medicine is providing additionally or mainstream medicine is unable to provide much, as the case may be.”

    This also has potential for being exploited by the unscrupulous, whether they be CAM artists or pharmaceutical companies. Take the example of midodrine as mentioned by Ben Goldacre in Bad Pharma. It was approved with the promise of further studies. The pharmaceutical company didn’t do them. When the FDA tried to remove it, there was an outcry and it remains on the market. Does it work? Will we ever know?

  89. nybgrus says:

    Is it truthful to class all CAM practitioners and sympathisers as knowing frauds? If it is not quite true, that should be enough in itself for a science-based (“reality-based”, according to some) forum — without going on to ask whether that approach is helpful to any of its ends, which I also question strongly

    First off it is interesting that you completely ignored even commenting in passing about the bulk of my writing. Writing which directly refutes the comments you have been making. Writing which demonstrates in real terms the dangers and problem of quackademia.

    But fine, lets focus on the one little bit you are clinging to.

    Note your own words – “knowing frauds”. You even have to delineate it to make your point. So when I (and others here) just say “fraud” you are reading in your head “knowing fraud” and deciding to argue against that.

    Fine. It merely illustrates the only game you have to play is a semantic one. You didn’t even begin to address the actual substance of my post (nor anyone else here) but focus in on word play in a Bill Clinton-esque “what does “is” actually mean” dodge.

    So fine, I will be more precise in my language and delineate between “knowing” and “unknowing” frauds, to appease you. Not that it matters anyway, since the charges you levy are not even remotely relevant to the topics posted here. Nobody here has ever gone after little old granny who likes her acupuncture and VitB12 shots. It is the famous promoters, the large companies, the licensing bodies, the quackademic professors, the legislators creating wholesale things like the NCCAM and the DSHEA in response to lobbying pressure from those with vested interest that are the targets here. Always and consistently. And those are the people/entites that should be held to the higher standard, should be legislated against to protect the consumer, and should know better much like the Dr. Oz example.

    And yeah, Scott nailed your poorly thought out comment to the wall. If they are offering medical advice, especially if they are licensed by a government body or operating under commerce legislation of course they have a responsibility and ethical onus to be held to the same fracking standard!. That’s why Jann Bellamy is so spot on whith her analysis and commentary on the aptly coined legislative alchemy.

    You are, de facto, espousing a legitimate double standard. We have to operate by our higher standards – and tie our hands and mouths to boot! – but since they claim to be “CAM practitioners” they can do whatever they want and be reasonably held to a lower standard, despite the fact that they are claiming to do exactly the same thing we do! I’m sorry Peter that is absolutely ridiculous.

    Can you imagine if I start a car company and call it an “alternative” car company and thus demand exemption from federal safety and quality assurance laws? And then state that it is reasonable to let me do so because I declared myself to be “alternative” and thus not under the same ethical and professional onus?????????????

    Why the hell should these CAM practitioners get special treatment and free passes for attempting to do the same thing I do but failing?

  90. pmoran says:

    “Within it (CAM), it is taken as read that there is a problem that the mainstream has not resolved, or cannot solve, or is unlikely to resolve satisfactorily. (One of those is usually true, too The “not always” is what we have to worry about. ).

    Thus are we instantly removed from the domain of regular, accepted medical science. It is therefore rather silly to expect normal standards of science or ethics to continue to apply.”

    If medical science has no good answer, then there is no good answer known —

    Oh, I wholeheartedly agree but I am trying to show how that is not relevant to the matters that sustain CAM. (I have restored the full context of the remark you go on to describe as as BS, so that its logic is apparent.)..

    Having been there myself, I also understand how difficult it is to countenance the idea of two vastly different medical systems, having such antithetical standards operating within a modern society. The only way to accommodate it is to accept that it is an established fact, that CAM will wax and wane under influences that we cannot wholly control, just as we more or less have to do with religious beliefs despite their equally irrational aspects and very similar potential for harm.

    We accept “the fact” of CAM within the privacy of our consulting rooms, while roundly condemning the least tolerance of CAM in any other circle. Is that hypocrisy or what? What is the defence of that? We had better have one. But I am not even asking for tolerance of CAM in the any way that goes beyond the extant science.

  91. pmoran says:

    Why should I talk to you Nybgrus, when you just keep restating the same opinions, some of which I don’t disagree with?

    You lost my interest when you presented a completely untrue account of the evolution of CAM, and then stuck to it without offering the least further support when challenged (yes, I was there, practicing medicine since the 60s — ask Wally Sampson if what I had to say about the initial flowering of CAM was true or not and how well documented that period is).

    You also insulted me as not being able to see beyond the end of my nose. You now accuse me of pushing a double standard when I am simply trying to explain to a higher level of sophistication than is usually considered here the conventions under which CAM operates. That does not mean I support them. It simply helps me understand my fellow humans better and more sympathetically.

    In this last piece you are talking around about a very peripheral and uninteresting matter to me of what constitutes fraud, when all I am saying is that is is wrong and unfair for SBM propaganda to imply that anyone who supports CAM is a fraud. You have agreed that this is not so elsewhere but still want to regard them as such and to legislate as such.

    So unless you have something new to contribute, I will not respond further.

  92. elburto says:

    pmoran – WRT intent, ie. the “knowing fraud”, a question for you.

    You’re walking home when a car mounts the pavement you’re walking on. You suffer numerous injuries such as fractures, TBI, soft tissue damage.

    The driver of the car offers one of the following statements as justification:

    “The sun was really low in the sky. As I turned onto that street the glare from the sun temporarily blinded me. I am devastated about this”

    or

    “As I turned onto the street I saw my neighbour, Peter. I don’t like him, I’d had a really awful day at work, and my dog died last week. I just snapped, and decided to run him over. He was in the wrong place at the wrong time”

    If the person that mowed you down is #1, do your bones spontaneously knit back together upon hearing her explanation? Does the extensive bruising resolve, and the catastrophically high ICP return to a safe level when you hear that it was an accident?

    Of course not. Intent is not magical. A chiropractor kills a young woman by causing a massive stroke during neck manipulation. Does the difference between the “honest” chiropractor believing what he was taught, and the guy who trained knowing that chiropracty is bunk alter the outcome?

    Is the dead child of “true believer” homeopaths any less dead because that belief was borne of good intent?

    CAM is, at best, pointless and at worst, actively harmful. That isn’t altered by the sincerity of the practitioner.

    Nybhrus – WRT legislation, an American version of the UK ‘Cancer Act’ would be a good start. It would, at the very least, put a stop to things like Gerson “therapy”, laetrile, Rife, and Burzynski’s bull-dust, being advertised as “cures” for cancer.

    http://en.wikipedia.org/wiki/Cancer_Act_1939

  93. nybgrus says:

    Hey that’s fine Peter. You don’t have to talk with me at all. I’m not offended by it (honestly!).

    But to claim that because you were alive in the 60′s and practicing medicine means you are first hand aware of the entirety of the evolution of CAM is ludicrous. But hey, I’m just telling you what I was actually taught in my medical anthropology classes. It isn’t my narrative – it is what I was taught by the very same people who are the CAM promoters and believers in my university courses. And it is rather well documented both here and at Respectful Insolence.

    But fine, I am also bored with this conversation as well. Do you ever wonder why I (and others here) keep saying the same thing over and over to you? Because you are also a broken record. And a tiring one at that because you consistently dodge and feint, seamlessly transition between meanings of words without delineation, ignore what you don’t want to address, and keep hammering in your points at will… despite the fact that none of us here – not even Dr. Hall – can actually figure out what the hell it is you are actually trying to say.

    And I am sorry you felt insulted by my saying you can’t see past your nose. But if you think education isn’t the single best (not the only) long term solution, then you really can’t see past your nose. I genuinely hope you don’t take it personally, just as I did not take personally your vastly more vicious diatribe (more vicious than anything I have ever laid out to you) about me some time ago.

  94. Scott says:

    So your position is that we can never completely get rid of quacks and frauds, so we should just shut up and let them make whatever false and harmful claims they want.

    No. That is not a position which could ever be accepted by any ethical person. Actively fighting to limit the damage they cause isn’t just reasonable, it is an affirmative obligation of the entire medical field.

  95. nybgrus says:

    @Scott:

    I agree and also read his message the same way. Though I think the bit of nuance he would add is that our “fight” would only serve to entrench CAM more and drive people towards more dangerous complimentary medicines and eschew modern medicine for the “alternative.” It is on these points that I disagree since the evidence I see and experience I have is one of a lack of information and knowledge driving the majority of CAM use, not a deeply entrenched CAM friendly philosophy or a distrust of modern medical science. Yes, those do exist, but I see no evidence that they are the major contributor, especially since – as we can all plainly see – sCAMsters try so hard to sound sciencey and ape the same things we do rather than reject it all outright. Even my woo-iest of friends have told me about truly alternative practitioners so far removed from the trappings of modern medical science that they ran after a single consultation.

    I even had one acquaintance say she went to a naturopath because they are licensed to practice medicine in her state and figured that meant they had some legitimate “alternative” or “complimentary” medical advice to offer her to treat her condition. She had developed idiopathic glomerulonephritis and was under the care of an actual nephrologist. The condition scared her – reasonably so – and so she wanted to explore more options. She found that naturopaths went to school for post-graduate education, were licensed by her state to practice medicine, read about their “integration” into “mainstream” medicine, and decided it was worth a consultation. After one visit she said it was so kooky she never wanted to go back.

    In her case all she lost was some time and money (and gained a laugh about how the ND told her to keep a warm poultice of magical herbs on her flanks to help cure her kidney problem) but this person was not locked into an ideology of woo and had already experienced the tangible benefits (though no cure) of actual medicine and made the rational and easy decision to stick with that. But many could be snookered as we have seen, and fighting legislative alchemy, educating people about why NDs and their ilk are not qualified medical practitioner, etc is thus necessary. But boy is it hard for me to convince someone that an ND is a quack when they point to the fact that similar quackery is taught in legit universities, actual medical doctors practice these quackeries, and there is even a naturopathic oncology group and hospital associated with the Cancer Treatment Centers of America (and that Memorial Sloan-Kettering Cancer Center offers quackery as part of their integrative cancer center).

    That is why it is incumbent for us to fight quackademic medicine and these ridiculous integrative medical centers – the conversation is too long and nuanced for the average person and much easier to simply point out that supposedly legit institutions are embracing this quackery as justification for its validity.

    Oh yeah, and I wrote a brief comment to pmoran but it is in moderation – likely because I used h-e- double-hockey-sticks once in it.

  96. David Gorski says:

    Why should I talk to you Nybgrus, when you just keep restating the same opinions, some of which I don’t disagree with?

    I know I’m going to regret this, but it’s funny you should say that. I concluded the same thing about you a long time ago, which is why I rarely bother with you anymore, the only difference is that these days I disagree with many of your opinions and you seem immune to even considering that you might be way off base.

  97. Scott says:

    @ nybgrus:

    Your naturopath anecdote reminds me of another. I was talking with someone who moved to Massachusetts from Oregon, who was very much in favor of naturopaths being given the same prescribing privileges here that they have there. The reason? NDs in Oregon don’t quibble when you want antibiotics, and just prescribe them without question.

    None of that pesky investigation to find out whether there’s actually a bacterial infection the antibiotics might help. No consideration of how effectively that promotes antibiotic resistance. Attractive only if you don’t understand the larger picture of WHY MDs don’t hand out antibiotics like candy.

    This is precisely what pmoran wants to legitimize. And it illustrates the dangers of that legitimacy. The scientific standard of care exists for a reason. Letting quacks get away with ignoring it is actively harmful, but if they are treated as legitimate providers of medical care, it will be assumed that their standard of care is appropriate!

  98. DavidRLogan says:

    The argument that human life is getting less stressful as time moves forward (is that fair, Dr. Novella?) seems to me in many ways correct but also a bit extreme. I guess I agree with the first poster a more moderate view is in order (moderate because I do think your view is mostly right, Dr. N). Also I agree with that poster’s characterization of significant *modern* stressors not existing in the past.

    If I remember there is some evidence we are pretty bad at estimating our well-being under various counterfactuals (I’m sure somebody way smarter than me-NYB I’m looking to you-knows what it is…but Dan Gilbert has done some work in the area). So while I agree the person who does not think life was brutal in the 19th century is very wrong…it is probably also true we would not be as terribly off in the 19th century as we estimate in 2012 (or rather, the bias works both ways).

    Also I suspect some of the disgust toward previous conditions comes from our exposure to current conditions (some, not all). For instance it does sound bad to have a life-expectancy of 30 or 40 (better start making my will!). But I wonder if it would sound as bad to someone in the 19th century who thinks such a life-expectancy is normal, and cannot easily observe a greater life expectancy. For instance I feel very little (or nothing) about not living to 200 years old, or not having a time machine, or whatever other conveniences the future does or may hold.

    Just my 2cc on that tangential issue. Great post and discussion everyone.

  99. pmoran says:

    Scott: This is precisely what pmoran wants to legitimize

    Gasp!!!!! I have on these very pages and very recently violently opposed naturopaths being recognized as primary care practitioners (PCPs), with similar privileges to doctors. I am less sure about attempts at regulation that would control what they can claim to do or what kind of education they must have.

    At least twice I have pointed out here that the best argument against naturopaths as PCPs is that proper doctors harm a number of patients as it is, through mistakes in diagnosis and prescribing. It therefore makes utterly no sense to allow any reduction in the educational and experience standards for primary care.

    In another scenario the public might be pushing for subsidy of their naturopathic care. In that instance the best argument is that only a small section of the community wants it. It is an optional add-on to normal medical care. Non-users should therefore definitely NOT have to subsidize it.

    May I point out that before I started to think critically about my own understandings of CAM I probably would have missed these points? I would have sputtered on indignantly and at length about how scientifically ridiculous naturopathy was, and if the above points were mentioned they would be buried at the end of a lengthy discourse, to be possibly overlooked given the attention span likely in the average politician. And this despite the fact that everybody already knows that naturopathy is unscientific, or is considered so by doctors and most scientists.

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