M.D. Anderson enters the blogosphere–and goes woo

(* SIGH *) I love my MDACC, I really do, but this kind of stuff makes me cringe. You sure you don’t want to come to work here? Aside from the ocassional crazy, it’s a really, really nice place to work.

-That might only be mildly unethical…-

You mean lying to their patients for money as a trusted organisation dealing in medical care?

So will funds that would have gone to genuine cancer research go to funding woo?

Hmm. I read the “confirmed by neuroscience” bit to be referring to the claims about learning (“the brain continues to develop throughout life and retains the ability to relearn.”); as far as I know, this is perfectly true.

Your attitude toward “can’t hurt, might help, why not” baffles me. When people don’t have appealing explanations for phenomena, there is a vacuum created that woo can fill. If you find a better explanation, it will eventually convince most people- which is why science exists at all. *Using* something doesn’t depend on knowing why it works.

The argument that “it can’t work how you say it works” is not the same as “this doesn’t work”. The emotional way you argue the former distracts from the evidence you present on the later.

It really bothers me that preventative medicine (“shifting the focus from sickness to wellness”) and the concept of holistic medicine (“treating the whole person”) have gotten all hopelessly jumbled up with woo. These are valid concepts, but they have been so mercilessly co-opted by the woo community that it’s hard to have a sensible discussion about it.

That’s entirely intentional on the part of woo-meisters. They intentionally conflate “holistic” with what they do because (1) their dislike of “reductionist” scientific “Western” medicine leads them to actually believe that nonsense and (2) it’s great marketing. I agree that it’s perfectly possible for science-based practitioners to practice “holistic” medicine. Woo is not required. Unfortunately, CAM advocates have been so successful at tying woo to “holistic” that the two appear to be irretrievably linked in the minds of many.

Your attitude toward “can’t hurt, might help, why not” baffles me. When people don’t have appealing explanations for phenomena, there is a vacuum created that woo can fill. If you find a better explanation, it will eventually convince most people- which is why science exists at all.

Would that that were true!

Sadly, it’s not. I’ll give you examples. Germ theory is a powerful explanatory theory for how infectious disease is caused; yet we still have germ theory denialists and a lot of woo based on the concept that it is not the germs that cause disease. We know a lot about how the immune system works and how to prime it with vaccines in order to improve immunity; yet there are still rabid anti-vaccinationists out there pushing not just their “skepticism” of vaccines but dangerous quackery. We know a lot about how cancers form and grow, enough even to be able to cure some cancers, for example, Hodgkin’s lymphoma; yet there are still quacks out there claiming that chemotherapy doesn’t ever cure cancer and convincing credulous boys like Daniel Hauser that “natural” cures will eliminate their cancer.

No, while I would concede that the less sound science there is supporting a treatment or a concept of disease, when a question is answered by science or an effective science-based therapy developed, it in no way fills the vacuum enough to crowd out the woo.

As for the “how it works” bit, in retrospect I now realize that my wording was probably suboptimal. You see, I was letting my mind be too open for a moment and let a little concession in that I perhaps shouldn’t have.

As for your argument that we don’t necessarily have to know how something works in order to use it, well, that’s a massive straw man argument. Sorry, but there’s no other way to put it. I never said anything of the sort, and I’ve dealt with this issue before. What I was referring to is that treatments that are so enormously implausible that, for them to be true, many very well-established laws, theories, and principles of different sciences would have to be radically wrong speaks to the plausibility of a treatment. Drugs whose exact mechanism of action aren’t known can be used because we have strong evidence that they work and the exact mechanism can be worked out later. Moreover, it is plausible that there is a mechanism by which they work, because they are chemicals, drugs, and it is well within the realm of science as it is currently understood that they bind to some protein or other structure and produce their effect. No invocation of fantastical ideas like qi or the “memory of water” is required to explain them, even though we don’t yet know the exact mechanism. In other words, to accept reflexology or acupuncture or whatever as being effective even though we don’t yet know “how they work” requires that someone provide compelling evidence that they do work.

As for “what’s the harm”? Well, one part of the harm of placebo medicine is that it requires physicians to deceive their patients into telling them something will (or even “might”) work when science says it does not. 50 years ago, such behavior was considered more acceptable because medicine was a lot more paternalistic. These days, it’s not.

If acupuncture doesn’t work better than a placebo, then it must be the timing!

Actually, I think the insinuation goes beyond that. It is more of, “When it was successful, it was because they were in the right spots at the right time. When it didn’t work, it was only because they didn’t chose the right spots.”

Coincidentally, though, the amount of times they were in the right spots at the right time matched the success rate of placebo.

Basically, they are trying to credit acupuncture for the placeboic effects, and then dismissing the failures. When you do it that way, acupuncture is 100% effective! When done correctly, of course. So they shift the discussion from “does acupuncture work?” to “what is the correct way to do it?”

I will save my anecdote for the next post.

As far as my research has shown, a modern medical science “cure” for cancer has yet to be developed. With that in mind, I consider “alternative medicine” to be just as big a crap shoot as “modern medicine” when it comes to treating cancer.

I am disconcerted by the fact that modern medical practioners wouldn’t advise their patients to become as aware of their body’s functions as possible. That includes neurological functions, which is the rudimentary basis for certain alternative medicinal practices.

It is unreasonable to accept modern medical practices that are developed in a virtual black box. I think recipients of care are often pressured to accept these accepted measures as the only “right” way.

I appreciate your commentary though, it opens my eyes to alternative views of alternative medicine.

Reflexology in a nutshell: Foot rubs feel really damn good.

Usually, yes. My wife certainly thinks so. However she knows if she gets within a foot of my feet, as it were, she’s in trouble. I had bunion surgery on both toes a few years ago, and have since been diagnosed with peripheral neuropathy in both feet from the mid calf down. I don’t even like touching my own feet, let alone anyone else. I wonder if there is a reflexology point on the hand that helps the feet. My hands, you can touch.

Interestingly, when, after the surgery, I had a lot of pain, my aunt in all seriousness suggested reiki. I said thanks, I’ll look into it, and left it at that.

vbrisley-

I would be genuinely delighted to know how you’ve carried out your research.

“Can’t hurt, might help, why not.” add “Tee time at 2pm; bye.” Lazy, paternalistic a**. How do Dr.’s become “shruggies”?

vbrisley, what research?

“I read a website somewhere that said…” is my guess.

Stephanie W.
Please see article from yesterday’s (8.4.09) NY Times:

http://www.nytimes.com/2009/08/05/health/research/05ghost.html?em

I’ve mentioned it before on this blog, but I’ll say it again: I think that maybe a doctor can be a shruggie and still be ethical, if the “shrug” is properly couched. On the show Breaking Bad, an oncologist responds to a patient’s inquiry about alternative treatments by saying something along the lines of, “Well, there’s no evidence that any of it works… but whatever makes my patients feel better, well, I’m all for it.”

I’m not sure that’s the best approach, but I think it’s at least defensible, because the doctor is being honest about the (lack of) efficacy of alternative treatments.

It also has the advantage that it leaves open the door for the potential positive effects of woo that cervantes mentions, i.e. helping some people to feel more in control. The value of this should not be underestimated.

The big disadvantage is that it also leaves open the door for conmen to get rich exploiting the sick and the frightened. Also, while cervantes is right that most people do the woo in addition to actual effective treatments, that is not always the case, and those who do both (the moderates) inadvertantly provide political cover and encouragement to those who only do the woo (the fundamentalists).

So I dunno what the best solution is. I do think, though, that the “shruggie” position only becomes indefensible when the doctor fails to inform the patient about the lack of evidence, or implicitly suggests that the woo will be effective.

Wow vbrisley, a corperation did something unethical to make money! That so totally disproves the scientific method!

Obviously vbrisley thinks cancer is cancer is cancer; one big encompassing “cancer” cure is what he/she is looking for.

@vbrisley
Cancer is a lot of things. There are a lot of type of cancers, each can come from different tissues. Some are very curable, and others are not. So it is very inaccurate to put all cancers into one category because it is made of many subsets. So when you talk of a “cure” for cancer, you have to consider what the doctors have figured out for all of those different cancers. And as Orac have mentioned above, Hodgkin’s Lymphoma is very curable. You should be able to get some stats on it by googling and finding reliable sites.

Please refer me to research that developed the cure to cancer as I would like to become more informed on this topic.

Cancer is not a single disease. Note what I said:

We know a lot about how cancers form and grow, enough even to be able to cure some cancers, for example, Hodgkin’s lymphoma; yet there are still quacks out there claiming that chemotherapy doesn’t ever cure cancer and convincing credulous boys like Daniel Hauser that “natural” cures will eliminate their cancer.

Your reading comprehension leaves much to be desired. My point was that science-based medicine can cure some cancers (Hodgkin’s disease, for example) with a high probability. Of course, if by “cure” you mean 100% of the time, damned near nothing in medicine can cure anything 100% of the time. Also, we generally don’t like to use the word “cure” because cancer can recur, but after either 5 or 10 years, depending on the cancer, the chance of recurrence becomes so low that for all intents and purposes a successful treatment can be viewed as a cure.

The bottom line is that we can cure several varieties of cancer, such as Hodgkin’s disease, breast cancer that hasn’t metastasized beyond the axillary lymph nodes, colon cancer that hasn’t metastasized to different organs, testicular cancer, various leukemias. True, it’s not 100%. For some cancers it’s 90% and others 40% or even less. Other cancers (pancreatic cancer, esophageal cancer, gastric cancer, various brain tumors, etc.) we don’t do so well against. We can’t cure them, although we can palliate the patients who are unfortunate enough to develop them.

In other words, there is no such thing as a “cure for cancer” and likely never will be. However, there are cures for cancers, and we as clinical researchers hope to add to their number as the years go by.

“Instead she discovers what brings pleasure to that person. ”

Does this discovery take place above or below the waist?

Orac:

Also, we generally don’t like to use the word “cure” because cancer can recur, but after either 5 or 10 years, depending on the cancer, the chance of recurrence becomes so low that for all intents and purposes a successful treatment can be viewed as a cure.

I know a lot of alties like to use this sort of quote as proof that modern medicine doesn’t really cure cancer but instead adjusts the definition of cure to fit the data.

But it’s my understanding that if you get cancer ten years after being “cured” of cancer, there’s really no good way to tell if it’s the same cancer or a new one, and that the purpose of the 5-year or 10-year cutoff is to sort out cases where the cancer survivor has merely been unlucky enough to come down with a new cancer. (After being cured of one cancer, there’s no reason to think you’re somehow invulnerable to cancer; you should be just as susceptible as you were before.)

Am I understanding that correctly, Orac? Because I think this is a point that could do with more explanation so that people can understand what it means and not be swayed by one of the more common altie arguments.

Dear Orac,
You can come work at my CC, the Fred Hutchinson Cancer Research Center. Aside from a few freak days last week it is quite comfortable here in the summer, and aside form last winter, very rarely snows very much. And you can treat people from Alaska! And although the PacNW can be pretty heavy on the woo, we are pretty good at compartmentalizing it (Baystr College of silly).

Respectfully, JustaTech

“A treatment with an unknown causal mechanism might be justified on the basis of very strong empirical data.”

Well, I don’t think the “very strong empirical data” standard is met for some drugs, e.g. SSRIs. However, I still think they might be justified as treatment.
Having a plausible casual mechanism is important (I certainly want them to continue to work on elucidating all the mechanisms behind the SSRIs), but I don’t think lack of a reasonable casual mechanism is sufficient to eliminate a treatment from consideration. Nor do I think some whackaloon putting forth an absurd casual mechanism invalidates a treatment (someone can tell you the invisible pink unicorn purifies mold with it’s horn to make penicillin; it wouldn’t make it a bad idea to take antibiotics for susceptible bacterial infections).

“it’s very difficult to avoid being that way with things like homeopathy which just make no damn sense.”

lol. Point taken. I get the exasperation emotion; I’d probably want to thwap anyone who told me the unicorn story. However, I tend to get annoyed when the exasperation slips into condescending. I realize Orac’s been through it a thousand times. I realize the beliefs he criticizes have actual negative consequences that we all care about. I realize that if I read the blog more I’d probably be able to parse through his language and get his message.
But to a casual visitor, who doesn’t read this blog regularly… well let’s just say it seems rich that he’s worried about advocating CAM because it might be paternalistic…

In other words, to accept reflexology or acupuncture or whatever as being effective even though we don’t yet know “how they work” requires that someone provide compelling evidence that they do work.

I’m with you absolutely on this. Trouble is, to accept a drug or whatever as being valid even though we don’t yet know “how it works” requires someone to provide compelling evidence that it does work. Even if we do know how it works, it’s insufficient.
If you have data on whether a treatment works, it seems to me to be much more efficient to argue based on that, not on the quality (or lack thereof) of the casual explanation.

#7 (Jennifer B. Phillips):

You describe the difference between shills (people in on the scam) and dupes (people who unknowingly further the scam). Either way, the result is the same — an empty wallet and false hope.

Does it really matter if the doctor knows and doesn’t care vs. doesn’t know and doesn’t care?

That’s entirely intentional on the part of woo-meisters.

This is probably true for some, but my impression is that many honestly believe it. They have a mental model for how “allopathic” doctors think and develop their medicine, and it’s just not possible for the doctors in this mental model to have developed preventative and holistic practices, so any such practices must have been copied from alternative medicine. Some even have a mental model that goes so far around the bend that they believe that “allopathic” doctors never practice preventative/holistic medicine. One germ-theory denier I ran into on the misc.health.alternative newsgroup seemed to honestly believe that “allopathic” doctors have always said that diet has no effect on health; when I asked him which doctors said this, and in which venues, he replied “I thought it was common knowledge”.

Even if we do know how it works, it’s insufficient. If you have data on whether a treatment works, it seems to me to be much more efficient to argue based on that, not on the quality (or lack thereof) of the casual explanation.

Well, there’s a couple different scenarios.

There’s the “I just had this amazing treatment idea, I will now go try to get funding for clinical trials of my idea” scenario – that, of course, can’t have data, so it had damn well better have a solid theoretical backing.

There’s also the “I’ve seen this treatment used, and it worked. I want to try to get it given to more people!” scenario. This is where most woo is … and where most actual medical treatments started, too – aspirin derived from willow back, for example. So, here, you won’t have a solid theoretical foot, AND you won’t have solid empirical data – you’ll have anecdotes. So what you should do is examine this proposed treatment to see if there’s plausibility, then run trials. So, herbal medicine – plausible, we can test it – and when we do, some herbs work, and others don’t; we can take the ones that do and discard the ones that don’t. Acupuncture – plausible, we can test it, even if it does fail. Homeopathy – not plausible, we should just ignore it. “Cancer is a fungus” – not plausible, just ignore it. SSRIs – plausible even if theory isn’t up to explaining the mechanism yet, so we tested them and discovered that they really did work.

The problem is that people promoting a treatment won’t stop promoting it if it fails tests, and they certainly won’t stop promoting it if it’s too absurd to bother with (If that was enough to make them stop, they would never have started). They engage in special pleading and whatever other argument they can come up with. Evidence is not enough to convince them, and to someone who doesn’t know how many times some of these things have been studied, they can sound convincing – especially if they can cite the one-in-twenty study with a >95% confidence level of a positive result, even if the other nineteen had a negative result. Sometimes it helps to reveal how absurd the premise is, to help shortcut the evidential “he said she said”.

White Tale- ask a horse owner. You could ask the owners of the best thoroughbred race horses in the world and they will tell you the horses heal better and perform better and with more stamina when acupunture and chiropractic are employed. Why would a horse owner pay $2500 per treatment to have acupunture and spinal manipulation done repeatedly if the evidence was not right in fornt of them. I mean day 1 horse has pain. Day 2 horse has no pain. There has to be an explanation

I understand there is no “science”, but since you are such a doubter do you have an explanation as to why acupunture works on animals? Certainly can’t be the placebo effect, can it? Then what is it?

Acupunture works on horses. Explain the placebo effect, please.

No, it doesn’t.

Next!

White Tale-

How hard is it to copy and paste a name?

ask a horse owner. You could ask the owners of the best thoroughbred race horses in the world and they will tell you the horses heal better and perform better and with more stamina when acupunture and chiropractic are employed.

I can ask 100 mothers who use chiropractic to “cure” their childrens ear infections, and they’ll all say it works too. Yet, they’re still wrong. The science doesn’t back this up.

Why would a horse owner pay $2500 per treatment to have acupunture and spinal manipulation done repeatedly if the evidence was not right in fornt of them.

Because they are too swayed by anecdotal evidence, just like everyone else. Why would someone spend thousands of dollars on “vitamins” for cancer treatments when they’re clearly still dying and have a fungating mass sticking out of their breast? Because they are swayed by anecdotal evidence, and testimonials. Incorrectly swayed.

I mean day 1 horse has pain. Day 2 horse has no pain. There has to be an explanation

…It’s called healing.

I understand there is no “science”, but since you are such a doubter do you have an explanation as to why acupunture works on animals?

Certainly can’t be the placebo effect, can it? Then what is it?

Post hoc ergo propter hoc error. Bad study design. No study design. Recall bias. Plain stupidity. Deceptive practices on the part of the accupuncturist. I’m not even trying and I can come up with a number of explanations.

You aren’t even looking for alternate explanations!

@Ramel

Sorry if this isn’t clear from my comment, by degree I’m an engineer myself, I defected to medicine later. I realise that a majority of us are sane. it’s a silent majority though, with a very vocal minority!

Hey, some of my best friends are engineers!

Oh wait. Not really. I don’t hang out with many (aside from my broth-in-law)

The one thing I can say for engineers is, at least they aren’t lawyers. Lawyers piss me off.

After studying up on Chinese history and culture, I’m astonished to think that people believe any good medicine could come out of Chinese tradition. It’s even worse that the term “ancient Chinese” has become a selling point! Thank you, but when I hear that phrase, I run the other way.

It’s funny how much difference a little cultural context makes. To be fair, the ancient Chinese ‘doctors’ did the best they could with what they had; but what they had was essentially nothing. I’m sure many of them would have jumped at the opportunity to add effective, modern treatments to their repertoires, even if it meant crossing or manipulating common superstition to do it. But to do it the other way around… integrating the ancient Chinese doctors’ desperate, pathetic attempts to make their patients feel better into effective modern medicine… is bass ackwards.

WcT – There *is* something about the mindset of many (note I didn’t say most) who go into engineering disciplines which I think can help lead to woo. I suppose it could be characterized as a kind of self-confidence and self-sufficiency which allows the … unhingedness … to run wild in a way different from the way it does in, say, creationists. (I’ll stop now because I’ve been up all night reading about teh crazies of various sorts and will be unable to engage in continued discussion.)

I’m sorry to say that someone Orac has fisked not too long ago, with an engineering degree from MIT, may well be a classmate of mine, although only really a nod-in-the-hall acquaintance, so I can’t make any personality comparisons.

Me = engineer, so I am loathe to accept the correlation between engineers and cranks, but it does seem to be real. My personal theories as to the causes are that either a) we get enough science in college to use big words and think we know what we are talking about, but not enough to really grok it; or b) engineering is “science-like” in that empirical data and objectivity are paramount, but by its nature engineering disciplines do not require nearly as robust empirical data or careful experimental design as science does. Outside of the research&development realm (which I am lucky to be a part of) the building blocks are already well understood, and you only need to validate that the finished product works as expected — which often ends up being a relatively small number of data points, since the a priori probability is much higher than, say, investigating a new medical treatment. And often, the product then gets handed off to the testing department, and the real validation is done there.

Even in R&D, the demands are nothing like those in medical research. I mean, for example, computers and bridges and the like don’t suffer from the placebo effect, as far as I’m aware. 😀

I must admit, though, I did one time make a classic error of sloppy statistical thinking on the job, one that would be pretty bad in science. I was tracking down the source of a particular software failure, and the first time I ran the test it failed in a particular portion of the data that I thought might be significant. The second time, it failed in a portion of the data that had similar characteristics. I calculated the odds of each one from random chance at 1 in 26, and (stupidly) declared to myself that the odds that this was a fluke were nearly 1 in 700. Please, don’t embarrass my by pointing out all the fallacies in that thinking, it was a long day. 🙂

I proceeded to spend the next couple of hours searching for a way the error could have been triggered by that particular aspect of the location of the failure. After coming up with nothing, I ran the test a 3rd, 4th, and 5th time… and sure enough, the first two runs were just a fluke.

Of course, this still illustrates a way that engineering does not demand as much rigor as science… in that case, either the bug is fixed or it isn’t. Though my hypothesis was based on sloppy reasoning, it was quickly proved wrong in the most unambiguous way possible. Compare this to a scientific research study that attempts to establish a previously unknown correlation, and the sloppy reasoning might not be exposed until others tried to replicate the study. And by that time, the woomeisters already have a published paper they can point at…

Engineers are used to basing answers off a small number of data points, because, except for in a few special cases that are taught in school (e.g. Monte Carlo simulation), that works just fine in our discipline. I think that helps make engineers more susceptible to crankery, because they become convinced by a small data set that in their world would seem incredibly convincing, and from there it’s unshakable.

Of course, what helps perpetuate the crankery is that engineers are, by profession, ad hoc problem solvers. If you give the engineer the task of “Make this crackpot theory plausible,” it is in our nature to search endlessly for some kind of workaround or innovation to do so.

This mindset even backfires in the profession itself. I’ve seen teams get behind their own pet solution and then, when another solution is demonstrated to be better, the response is to scour the data for ways to make their pet solution seem better, or to artificially close the gap, e.g. by appealing to an arbitrary benchmark. Hell, I’ve been guilty of that myself at times…

Stella said

After studying up on Chinese history and culture, I’m astonished to think that people believe any good medicine could come out of Chinese tradition. It’s even worse that the term “ancient Chinese” has become a selling point! Thank you, but when I hear that phrase, I run the other way.

I agree. That’s why I don’t use Calgon for my laundry.

Reflexology is totally real! I have a friend who accidentally shot himself in the foot with a 9mm — he survived but it blew one of his kidneys right out through his back.

Marcus Ranum FTW!

Dr. Wonderful: Here is an extensive blog post discussing the appearance of placebo-like effects in animals.

Quick summary of possible explanations for it:

1) Conditioning — For example, we might imagine that a horse becomes conditioned to associate a visit from the acupuncturist with being in a race the next day, and this could illicit a physiological response that alters the horse’s performance.

2) Human contact — To quote from the blog, “There is a good body of research that demonstrates that human contact has measurable effects on animals. For example, petting by humans reduces heart rates in…horses.” It could just be that some horses benefit from all the extra human attention they get on acupuncture day.

3) Placebo effect in the owners — For example, you mention a reduction in pain… but there is no objective way to measure pain in horses (there’s no objective way to measure it in humans either, for that matter, but we can at least get closer). The amount of pain experienced by the horse has to be judged by the owner. So if the owner knows the horse has received acupuncture, the placebo effect may cause the owner to judge the horse’s pain symptoms as less severe.

Now, that’s all just idle speculation, who knows if that is the real cause… the true causes of placebo and placebo-like efffects are very mysterious and not something we can really say we understand. (There are even people who dispute whether placebo effects exist at all, instead attributing the perception to the Regression Fallacy.) Furthermore, this all assumes that there IS empirical data showing that acupuncture has a placebo-like effect on horses, something you have failed to show.

But I just wanted to address that one specific point: Yes, placebo-like effects are observed in animals. No, we don’t fully understand it, though we can speculate. Deal with it.

James Sweet:

Me = engineer, so I am loathe to accept the correlation between engineers and cranks, but it does seem to be real. My personal theories as to the causes are that either a) we get enough science in college to use big words and think we know what we are talking about, but not enough to really grok it; or b) engineering is “science-like” in that empirical data and objectivity are paramount, but by its nature engineering disciplines do not require nearly as robust empirical data or careful experimental design as science does.

Speaking as another engineer, I think you’ve hit the nail on the head. Engineering is a “sciency” discipline; it isn’t pseudoscientific, but it isn’t scientific either. The focus is on getting it to work, not on conclusively proving why it works. Engineers will gladly use something that seems to work even if they don’t know why. “Cargo cult programming” is a great example of this. Coding practices and even entire code snippets get reproduced by software engineers who don’t know why they work, but believe they do — even when in fact the code does nothing at all. But for some reason they never worked out, a past product always failed when this snippet wasn’t present, or was altered, and so they keep using it, unaware that it has no bearing on the current situation.

Confirmation bias is more common in engineering than engineers would like to admit. Mostly, this is because the demands are simply different. You don’t have time to study it scientifically. If you don’t deliver on time and meeting the requirements, you’re not going to get paid.

DrWonderful:

Just because there is no double blind study on PubMed yet does not mean something does not work. Is it possible some natural phenomenon simply have not been fully understood yet? Have we reached the point where all scientific study has been completed and the book of knowledge is written and closed?

Of course not; the whole point of science is the quest for more knowledge, and the recognition that we cannot trust our own knowledge.

That latter part is what usually escapes pseudoscientists; they have found something that they are sure of, and they do not wish to accept the possibility that they may have been mistaken.

With respect to acupuncture and chiropractic in animals, the anecdotal evidence is small but significant. The scientific evidence is nonexistant, however. There have been some studies showing mild benefit, but the studies were not well controlled, which is typical for a very early study. One should not depend on one of those early studies; one should go on and do more science. Curiously, the world seems to be divided between those who think acupuncture works but are unwilling to test it with any real rigor (because they trust their gut feelings so much), and those who think it doesn’t work and don’t want to waste time studying it.

What can cause a “placebo effect” in animals? Well, classically, the placebo effect shouldn’t exist, but if that’s all you look at, your focus is far too narrow. The animal doesn’t know he’s getting a treatment — but the owner obviously knows, and it’s usually the owner reporting whether symptoms improved. The owner generally wants the horse to feel better; this will color his observations. What’s more, if the animal is very closely bonded with the owner, the owner’s state of mind can have a significant impact on the animal’s behavior. If the owner thinks everything will be okay now, the horse will too. A successful horse owner (male or female) has to fill the role of the lead stallion; the horse will take follow his/her behavior cues implicitly. This is true of most domestic animals, which have been bred for millenia for their ability to read and respond to human behavioral cues.

Bottom line: just because you think it work doesn’t mean it did, and if you are at all scientific, you will acknowledge that there is room for doubt. However, you may be so excited about it appearing to work that you are motivated to study it, quantify it, rule out the errors of human observation, find out why, and see if this new knowledge can be applied anywhere else. Of course, most acupuncturists and chiropractors aren’t interested in that. They do not wish to increase the volume of human knowledge. They think they know everything they need to know. Their minds are closed.

Then they turn around and call scientists closed-minded. I would find the arrogance irritating, but it’s really just sad.

The horse example with acupunture and chiropractic is quite clear. There could not possibly be a placebo effect

That’s absolutely nonsense. Horses are fairly intelligent (about as intelligent as a dog) and humans are incredibly important to them. Horses have lots of time to stand around (literally) and think about what’s going on around them! And they do. My horse, the mighty P-nut, has shown evidence in the past of trying to figure out the significance of things that I do. Horses also periodically undergo medical procedures; they are given mouthfuls of nasty-tasting goo (wormer) and have their feet messed with (hoof trimming) and are sometimes taken out and asked to do mysterious things.

I did the experiment with the mirror with P-nut and for about a month afterward, whenever I came toward him with a new object, he’d come trotting up enthusiastically to examine daddy’s new thing. On one occasion 3 years ago, when he hurt his lip by catching it on a clip, there was a clear association in his mind between waiting for daddy to rescue him and being rescued. I know this because 3 months later when he ripped a hole in his front leg, he ran to me, instead of away, and stood there waiting for me to do something.

My point: horses definitely have a basic notion of causation in injury and make the association between humans and something being done that either helps or hurts. I have seen similar behaviors in my dogs, BTW. Those 2 observations are all you would need to power simple placebo effects.

Put another way: horses are definitely too smart to fall for acupuncture or homeopathy, but they enjoy attention and a good massage.

Oh, yeah, another comment re: horse acupuncture. At the barn where I used to keep P-nut, there was some woo-woo who brought an equine acupuncturist in to help her old horse Cody (who was older than dirt!) feel better about his arthritis. The acupuncturist gave Cody a shot of ACE and then proceeded to do some woo-woo. I kid you not. ACE is a powerful animal painkiller/tranquilizer.

I know that’s an anecdote, and not evidence. But there’s a few important points hidden in that:
1) If you don’t know anything about horses, be careful what you believe about “horses this…” and “horses that…” you need to spend a couple years around the big goofballs before you even have a chance of getting to first base with horse medicine, horse behavior, or horse psychology.
2) Horses don’t just walk up to you and tell you what their doctors do/did. So if I hadn’t noticed that the horse was also given ACE, the acupuncturist would have appeared very credible to his victims.*
3) woo-woos particularly love patients that can’t contradict them in public. Patients that don’t speak are the best.

Since I’m on the tangent about horses, here’s another funny one. The same woo-woo had an “animal communicator” in to the barn. I happened to be just returning from a jog in the woods with P-nut when they were there. The animal communicator looks at the mighty nut and says “OOooh, what a handsome big fellow! what’s his name?” And I just smiled and said, “you tell me.” Priceless.

(* it was this incident: abuse of a poor sweet dumb aging horse, that got me interested in deconstructing acupuncture. I’ve been studying acupuncture con-artists ever since)

Just because there is no double blind study on PubMed yet does not mean something does not work. Is it possible some natural phenomenon simply have not been fully understood yet?

Sure it might work. But that is not what you and the Alt. med people are claiming. You are claiming that it does work. If you are going to make that claim, you better back it up with real studies; not anecdotes similar in quality to those used for years to support things like phrenology, physiognomy, or blood letting.

“I wish I could find the article, but I believe that Traditional Chinese Medicine was invented in the 1940’s or so.”

UPCHUCK (Unabashed Plugging, Craven Hyping of Undisputed, Correct Knowledge):

http://www.sciencebasedmedicine.org/?p=505

Pablo writes:
When I talk to vets (my wife is a vet, so I know a whole lot of them), they always complain that horse owners are the absolute worst, because they think they know more than the vets.

My ex-wife was a farrier and I’ve heard exactly the same from her.

And my horse’s vet would agree. Most horse owners never do “preventive maintenance” and only call when something has gone wrong. It’s only at larger barns, where maintaining herd immunity is important, that the barn owners are able to enforce a “all horses must have their shots” rule.

It’s similar to the Chomsky argument for socialism: yeah, a free market would be nice if it were really free, i.e., all players were ideologically pure. In reality, large corporations game the system to its own ends.

Huh. It seems to me that a purely free market wouldn’t “be nice” even if all the players were “ideologically pure.” Utilities are a simple example. Imagine a pure laissez-faire economy, with a plethora of, say, electric companies all acting benevolently and in the spirit of free competition — and you’ve got a logistical nightmare. Would they all have redundant grids? Would it be divided up regionally? (in which case free market competition breaks down anyway) Would they collaborate to share a single power grid? Well, again, this is not free market either, because now the entity that controls the grid has a monopoly.

It’s not hard to find examples where, even without Evil Corporate Shenanigans, pure laissez-faire is broken.

Of course, that is not an argument in favor of socialism, either, now is it? See also, False Dilemma.

It seems so painfully obvious, to me at least, that the answer needs to be somewhere in between, i.e. harnessing the rapid optimization capability of the free market, within a framework of government regulations that attempt to incentivize the market to optimize for GOOD things. We can argue all day on individual policy choices, but ideological capitalism and ideological socialism both seem hopelessly naive to me.

DrWonderful: “babe Ruth started using a chiro when he was traded the Yankees. he swore, time and time again, it changed his swing and helped create a lot of the power he staretd to generate at exactly that time. The chiro focused on hip/pelvis mobility and was very astute at working with hip flexor/hip extensor issues. From that point all the Yankees greats have chiro’s they have worked with..including today. Not for pain. But for performance.”

A couple of years ago there was a story in the N.Y. Times sports section about the Yankees’ Johnny Damon using a chiropractor and how much he was helping. Shortly after that Damon went into a slump and ended the year nearly 20 points below his lifetime batting average. Haven’t heard much about the chiro influence since then. The chiro also apparently wasn’t able to help Damon’s throwing arm, which remains on the weak side (the joke among Red Sox fans shortly after Damon went to the Yankees (and before his haircut to meet Yankee “standards”) was that Damon “looks like Jesus, acts like Judas, throws like Mary”). 🙂

Whenever I hear some alt med booster going on about “haters and doubters” it demonstrates to me that their evidence is pitifully weak to nonexistent.

@DrWonderful

White Tail- Just because there is no double blind study on PubMed yet does not mean something does not work.

You’re confusing the situation. It isn’t that there is no double blind study. It’s that there are lots of them, and they’re all consistently negative.

Is it possible some natural phenomenon simply have not been fully understood yet? Have we reached the point where all scientific study has been completed and the book of knowledge is written and closed?

Lots of things aren’t understood. But to start “explaining” the efficacy of something like accpuncture, you have to show that there IS efficacy. The studies are consistently negative.

The horse example with acupunture and chiropractic is quite clear.

It’s anything but clear, you have in no way shown that accpuncture works for horses. You’ve asserted that people use it, ergo it works.

There could not possibly be a placebo effect, unless you are assigning human cognitive traits to animals, which certainly in itself cannot be supported scientifically.

I dispute that this is of importance. I don’t need to go to the placebo effect when you can’t show any effect. If it’s as amazing as you’re saying, it should be easy to show benefit, but the evidence shows no such benefit. Check out this article:

Habacher, G., Pittler, M.H., Ernst, E., Effectiveness of acupuncture in veterinary medicine: systematic review. J Vet Int Med May-Jun 2006;20(3):480-8.

To simply say the answer is that this simply does not work because it is not yet found in the literature is sort of foolish.

Whoa, why is this foolish? How hard do we need to look? You treat this as a miraculous cure all/performance enhancer. If it’s that good, the effect should be easy to tease out. Yet people have looked, and found nothing.

The volume of horse trainers, jockeys and owners that will tell you horses heal faster and perform better with acupunture and chiropractic would blow you right off your white pedestal.

The volume of people who will tell you a sugar pill makes them feel better is huge. The volume of people who think what works for them must work for their animals is huge. Most people don’t understand how to gauge these things at all.

Day 1 horse A runs fast. Day 2 horse A runs incredibly faster. Repeat by 30 horses in a stable. Repeat by hundred of stables in the world who cpmpete against each other. There has to be some real scientific explanation, no?

The scientific explanation is that they’re wrong. If it really made horses run faster, you’d have the easiest trial in the world to run, with a clear objective measure. That no such positive study has materialized argues against this being true!

Or have they all been tricked by hundreds of providers who conspired to do the same thing? I’d kinda thing the easiest explanation may be that it works but we do not fulyl understand how yet.

No, the easiest explanation is that people don’t know how to measure what they’re seeing, combined with recall and confirmation bias. Especially when YOU need to explain all of the negative evidence.

Could these owners, trainers, and jockeys who compete so fiercly against each other every day possibly for some reason all conspire to trick you on this one point?

I didn’t say the owners etc are trying to trick me. I said they don’t understand what they’re doing, or what is happening. They don’t rigorously measure any of these things.

Just because the science isn’t understood yet does not mean it does not exist. It may shock you to learn that there are things you do not even know that you do not yet know.

You have consistantly confused the basic point.
You keep argueing against “There is no physiologic explanation of why these things would work, ergo it’s BS.”

But I’m not saying that. I’m saying “There is no effect to have to explain. You assert it’s there. When we measure, it isn’t!”

I don’t have to explain why the unicorn in your garden is eating your carrots. I don’t have to explain that because there is NO unicorn.

Now take that into the super high end athletic world where I spend my work days. Tell an Olympic athlete or Hall of Fame baseball player there is no science behind acupunture and chiropractic and they will tell you on Day 1 they were good, on Day 2 they were better. To be honest, they would not care what you think.

And if I operate, cut open their knee, and do NOTHING, they’ll tell you they feel better afterwards. Sham surgery produces “benefit.” This doesn’t mean that Sham surgery works. It doesn’t! That they don’t care what I think about it has no relevance to the efficacy.

Do you know who the first professional baseball player was to hire a full time chiropractor? Babe Ruth in 1919.

Ah? And why does that matter? This is survivorship error.

How many baseball players hired chiropractors and didn’t get any better at all? Lots, but you didn’t check.

The greatest scientists in the world ask questions about what the observed

We observed. There was nothing there. That’s the point. We observed, and saw no effect. Get it into your head, no effect, no need to explain effect.

instead of arrogantly pre-determining the answer because someone else find it yet. Which is why as a scientist you are complete fraud.

I’m not a scientist. I’m a medical student. I don’t claim to be a scientist. I claim to read what scientists say. They say accpuncture doesn’t work. You arrogantly tell me that your anecdote beats all of science.

You’re the King of Spain that insisted the earth was flat. Harsh, but true.

Not all that harsh. Not all that true. Not all that witty.

@DrB

No, not when the anecdotal support is coming from the veterinary professionals who have nothing to do with/or profit from the acu/chiro themselves.

Ok, my fiance’ is a vet student. I know for a fact that she’s been educated about evidence based medicine. I know she knows about the pyramid of evidence, and the fact that anecdote is at the bottom of the pyramid. So why does the fact that the anecdote comes from a vet change anything?

Evidence shows that human doctors, vets, scientists, we’re all just as capable of being fooled by survivorship, confirmation, post hoc ergo propter hoc, as everyone else. Here, I’ll show you with the rest of your comments.

I am a veterinary surgeon, and I lecture to thousands of veterinarians every year.

Argument from authority.

Most of them that have referred to the specialty would agree with Dr Wonderful that Acupuncture and Chiropractic work.

Argument ad populum. Survivorship bias. Confirmation bias.

Granted, those of us in the universities and specialty practices have had alot more opportunity to see the work done first hand.

Ah, and seeing it first hand means you could have gathered statitsics. Have you? No. Because had you gathered positive data, thatwould have been one hell of a paper, that the media would have picked up on.

But, anecdotal or not, there are 100s(just here)to 1000s of patient records showing improvement in the animals after acupuncture.

Publish it then. It won’t be hard to publish. If you just do a chart review, pick up all the charts of animals that received accpuncture, show how many had legitimate benefit.

Not what the owner noticed, not what the acupuncturist noted, but what the referring veterinarians noted.

Again, why are vets getting special treatment here? Human doctors say that all the time. Then when we run the numbers, we find out they were wrong.

I will continue to refer if it could benefit my patients.

What would change your mind? What would show that accpuncture is NOT valid? How much evidence? What kind of evidence? If the answer is “nothing,” then I don’t care about you’re opinion, it has no value.

First, I would like to say thanks for taking the time to write about Cancerwise. Although I can’t say I agree with all of the points of your post, there are a few that were taken to heart and thanks to your feedback, we are reviewing our practices on citing research within our posts, especially the ones that focus on our integrative medicine programs.

We will continue to write about integrative medicine. Our core audience to this blog is patients, and according to most studies including this one in JCO up to 64% of cancer patients try some type of integrative therapy. http://jco.ascopubs.org/cgi/content/full/23/12/2590 We write about it because it is one of the topics that patients are interested in, in fact, it is some of our most popular content.

The faculty that blog on integrative medicine tell me that, patients are going to do it whether the doctor likes it or not, as a physician it’s important to build that bridge to understanding. If you just dismiss it as “woo”, the patient may not tell you what they are doing, and ultimately that could affect the outcome of their traditional treatment.

I understand that this idea may not impress or have value to many “traditional” physicians or scientists, heck, some of our faculty might sit right up on that fence with you, however here at M. D. Anderson we believe in discovery and innovation, and we invest in whatever it takes to treat the whole patient, mind and body.

In conclusion I must also address the first commenter to this post that said “Its all about supply and demand; that and taking in money.” Perhaps it’s not clear in the articles, but most of the programs and classes in The Place of Wellness at M. D. Anderson are free of charge to patients. http://bit.ly/vxagA

Thanks again, and I encourage you to keep reading and we welcome the feedback, it is the only way we will improve.

Jennifer Texada, Chief Blogger
http://www2.mdanderson.org/cancerwise/

They left out a couple words:

The Integrative Medicine Program at M. D. Anderson is shifting the focus from sickness to wellness, treating the whole person, and providing a forum for evidence-based and anecdotal practices.

Where’s the FTC in all this? Are they the federal agency responsible for investigating false advertising? Because that’s what CAM is, unless it’s carefully worded (This “may” help you as much as any other placebo…)

I’m wondering if there’s any point hooking up amazon’s mechanical turk and a few thousand bucks to spark a massive letter-writing campaign. By definition any advertisement of acupuncture, homeopathy, or chiropractic is deceptive, if it claims to do anything at all.

@DrWonderful
Does this mean you aren’t going to attempt to tackle my fisking of your previous comments?
Fine, I’ll start on your new comment.

Marcus- yuo seem very confused. There is no evidence chiropractic works? It does and ther eis an abundanc eof evidence.

I dispute this assertion. There is SOME, evidence, of varying quality, that chiropractic, MAY not be inferior to conventional treatment for uncomplicated low backpain. This is not validation of chiropractic in general. studies showing chiropractic may help low back pain in no way helps their assertion that they can treat ear infections.

I beleive many of your colleagues here saw the rpesenation from a neurosurgeon at the last RAC conference where he applauded the chiropractic profession for doing outstanding research..to the point where there are more studies confirming the efficacy of spinal manipulation (34) than there are for the treatment of dental caries (7). Your assumption is showing.

Your complete lack of understanding of science is showing. Quality counts, not just quantity. As has been thoroughly analyzed in numerous other blogs, the literature in favor of chiropractic is weak across the board.

Spinal manipulation is also not synonymous with chiropractic. Much of the spinal manipulation research is done related to physical therapist mediated spinal manipulation, and osteopathic manipluation. Niether of these is the same, in theory, or in practice, to chiropractic (although osteopathic has it’s own evidence based medicine problems)

also, when you say “chiropractic” what exactly are you saying? The procedure of a Grade V manipulation which is performed by chiro’s, PT’s, MD’s, Osteopath’s and Naturopaths alike?

This is completely incoherant, I’m not sure what you’re trying to say.

Or are you referring to the profession as a whole consisting of doctorate level, direct access, poral of entry chiropractic physicians who utilize very accepted and solidly evidenced based physical medicine modalities, sound rehab prinicples and pure neuro physiological foundations that are sued by neurologists, medical doctors, physical therapists, etc all over the world?

I dispute that any of this is true. Especially the “solidly evidenced based” part.

Or are you talking abotut eh 2% that prescribe the to the shrinking 2% that adhere to the subluxation theory of old (but who still get people well sort of by accident)?

I dispute that only 2% of chiropractors believe in subluxation theory.

so please do you letter writing campaign and I dare you, I mean really dare you, to call out Doctors of Chiropractic who make claims that are solidly rooted in science. Many have trtied t fgo down that and all have failed when they see what it si they really are attacking. It’s not what you think. So please do it. But you better be sure

Incoherant, but I advise you to read about the BCA, and their problems with Simon Singh.

DrWonderful, you say that we should believe that acupunctur works for horses because “100s or 1000s” of patient records document some improvement after it was used.

First off, these are not terribly impressive numbers really, when you consider how many horses there are, and considering that those are still subject to confirmation bias — those are records kept by veterinarians who referred their patients for acupuncture, which means they already had a preconceived expectation that it would be effective. Not exactly neutral observers, and certainly not blinded. Considering that some patients should improve spontaneously just through the body’s own natural healing processes, you should expect to see some horses improve after acupuncture. It doesn’t mean the acupuncture had anything to do with it.

Secondly, you can find records documenting hundreds of thousands of human patients who improved after bloodletting or vomiting to restore the balance of their humors. Do you suggest that because there are documents recording many cases where people are said to have recovered after bloodletting, that we should use this to treat the same complaints for which it was used two centuries ago?

Or, to put it another way, if everybody jumped off a bridge, would you do it to, or would you want to be sure they actually knew what they were doing first?

Search using “acupuncture” and “equine” yielded 87 results. Looking at the 10 most recent:

Practical applications of acupuncture in equine medicine.
Author(s): May, K. J.
Conference Information: Large animal. Proceedings of the North American Veterinary Conference, Volume 22, Orlando, Florida, USA, 2008.
Source: Large animal. Proceedings of the North American Veterinary Conference, Volume 22, Orlando, Florida, USA, 2008 Pages: 138-140 Published: 2008

Conference presentation. Online abstract presents no real information.

Title: Acupuncture as a treatment of neurological diseases in dogs.
Author(s): Joaquim, J. G. F.; Luna, S. P. L.; Torelli, S. R., et al.
Source: Revista Academica Ciencias Agrarias e Ambientais Volume: 6 Issue: 3 Pages: 327-334 Published: 2008

Full article not available online. Abstracts specifies only 43 subjects that received variable treatment and no controls were included.

Title: The use of acupuncture beads to control exuberant granulation tissue in equine skin wounds: A preliminary study
Author(s): Frauenfelder, H
Source: EQUINE VETERINARY EDUCATION Volume: 20 Issue: 11 Pages: 587-595 Published: 2008

Full article not available online. No real information on methodology or data could be gathered from the abstract.

Title: Acupuncture in equine sarcoid – healing by stimulation.
Author(s): Thoresen, A. S.
Source: Zeitschrift fur Ganzheitliche Tiermedizin Volume: 22 Issue: 3 Pages: 99-102 Published: 2008

Full article not available online. No usable information in the one-line abstract.

Title: Comparison of pharmacopuncture, aquapuncture and acepromazine for sedation of horses
Author(s): Luna, SPL; Angeli, AL; Ferreira, CL, et al.
Source: EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE Volume: 5 Issue: 3 Pages: 267-272 Published: 2008

Full article not available online. From the abstract, this included mixing pharmacologically active materials with acupuncture points. 8 horses were submitted to 4 treatment protocols, meaning 2 per treatment, a statistically very bad choice). Small sample, poor statistics.

Title: Use of acupuncture in equine reproduction
Author(s): Schofield, WA
Source: THERIOGENOLOGY Volume: 70 Issue: 3 Pages: 430-434 Published: 2008

Review article low on data and high on handwaving. The following from the Discussion says it all:

Although the desire in Western medicine is to correlate a direct cause and effect response, this may be more difficult when assessing the therapeutic value of acupuncture. Despite much evidence that acupuncture produces a response from the body, which can be objectively measured in certain instances, an understanding and ability to consistently predict that response can be elusive. As a practitioner who utilizes acupuncture as an adjunct therapy to Western medicine, I would love to see conclusive data that outlines and defines acupuncture’s exact mechanism of action. However, the nature of acupuncture and TCM is more subjective, and fundamentally differs from Western thinking. Therefore, it seems more challenging to design thorough evidence-based Western medicine studies to evaluate the value of acupuncture.

Not very impressive.

Title: Acupuncture treatment for low back pain and lower limb symptoms – The relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow
Author(s): Inoue, M; Kitakoji, H; Yano, T, et al.
Source: EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE Volume: 5 Issue: 2 Pages: 133-143 Published: 2008

Full article not available online. From abstract, a clinical and animal trial. Method details are unclear and I can’t tell if there were controls or blinding. Some results were given as unitless values and some of the treatment references were abbreviations without explanation.

Title: Equine sarcoids – Part 2: current treatment modalities
Author(s): Bogaert, L; Martens, A; Depoorter, P, et al.
Source: VLAAMS DIERGENEESKUNDIG TIJDSCHRIFT Volume: 77 Issue: 2 Pages: 62-67 Published: 2008

Full article not available online. From the abstract, this is a fairly broad review article that describes conventional modalities in a positive light and no mention of acupuncture.

Title: Persistent breeding-induced endometritis
Author(s): Troedsson, MHT; Desvousges, A; Macpherson, ML, et al.
Source: PFERDEHEILKUNDE Volume: 24 Issue: 1 Pages: 56-60 Published: 2008

Full article not available online. Abstract reviews conventional methods giving good results and references acupuncture in passing with other alternatives “have recently been suggested”.

Title: Survival methods for the equine practitioner in equine ophthalmology.
Author(s): Brooks, D. E.; Kallberg, M. E.; Utter, M. E., et al.
Conference Information: Proceedings of the 53rd Annual Convention of the American Association of Equine Practitioners, Orlando, Florida, USA, 1-5 December, 2007.
Source: Proceedings of the 53rd Annual Convention of the American Association of Equine Practitioners, Orlando, Florida, USA, 1-5 December, 2007 Pages: 374-396 Published: 2007

Conference presentation. Abstract does not mention acupuncture.

Again, not much to show. I’ll try to wade through more later after I use the different method I learned to track down abstracts for the chiropractic/equine search.

DrWonderful writes:
Marcus- yuo seem very confused. There is no evidence chiropractic works? It does and ther eis an abundanc eof evidence. I beleive many of your colleagues here saw the rpesenation from a neurosurgeon at the last RAC conference where he applauded the chiropractic profession for doing outstanding research..to the point where there are more studies confirming the efficacy of spinal manipulation (34) than there are for the treatment of dental caries (7). Your assumption is showing.

That’s correct. Chiropractic’s intellectual underpinnings – the presumption that spinal “subluxations” cause a variety of problems – are manifestly incorrect. Indeed, “subluxations” do not appear to exist. Consequently, if chiropractic does actually have any effect, it is purely by accident. That is not to say it has no effect, but that if it does it’s not because of anything to do with the theory behind it. Following from that, we can observe two things:
1) it is hugely unlikely that the wide variety of effects (from curing hypertension to relaxation) claimed would result from the same accidental discovery
2) the explanation most consistent with “do stuff at random, feel better” is the placebo effect
It would therefore fall upon the chiropractors to prove the effectiveness of their method as being greater than a placebo.

You might be tempted to reply, as some acupuncture proponents have, to that argument with reasoning along the lines of:
So what if the intellectual basis for chiropractic/water birth/acupuncture/reiki is bust?! It still works! We just haven’t figured out why, yet!

Don’t fall into that trap. Because, if you do, you’re admitting that people have been performing medical interventions, based on nothing that even they understand, for years, and taking money for doing so – all the while, hoping that maybe someday it’ll be understood. That makes the worst thing that “big pharma” has ever done pale by comparison.

also, when you say “chiropractic” what exactly are you saying? The procedure of a Grade V manipulation which is performed by chiro’s, PT’s, MD’s, Osteopath’s and Naturopaths alike? Or are you referring to the profession as a whole consisting of doctorate level, direct access, poral of entry chiropractic physicians who utilize very accepted and solidly evidenced based physical medicine modalities, sound rehab prinicples and pure neuro physiological foundations that are sued by neurologists, medical doctors, physical therapists, etc all over the world? Or are you talking abotut eh 2% that prescribe the to the shrinking 2% that adhere to the subluxation theory of old (but who still get people well sort of by accident)?

If there are people following a scientific path based on the utter failure of “subluxation theory” why are they still calling themselves “chiropractors”?? Those are the intellectual foundations (if you will) of chiropractic. It sounds like you agree that there are people who have realized that those foundations are rotten, and are desperately trying to come up with new foundations – maybe even based on something that works – in order to keep their cash flow coming. Not to put too fine a point on it, that’s disgusting, immoral, and shameful. What about “we take your money, while we try to figure out something that will help?” is not false advertising?? Wouldn’t you shriek like a bitch if “big pharma” did that?

so please do you letter writing campaign and I dare you, I mean really dare you, to call out Doctors of Chiropractic who make claims that are solidly rooted in science. Many have trtied t fgo down that and all have failed when they see what it si they really are attacking. It’s not what you think. So please do it. But you better be sure.

Thank you. Now that I have your gracious permission, I will do exactly that.

It’s interesting, though – I did a bit of searching and I noticed that many many many chiropractors are careful to say on their websites THAT IT DOESN’T ACTUALLY DO ANYTHING Wow – so, I guess that’s one way of covering against claims of false advertising: advertise that you don’t work, but hope people will come anyway.

From: http://www.leixlipchiro.ie/ourPatients.htm (italics mine)
There is no suggestion that spinal care can cure any of these conditions however for a variety of reasons we find improving spinal joint function affects nerve receptors and does improve the quality of life of the vast majority of our clients. If you click the links there is plausable anecdotal evidence of people being helped. Many people continue to visit the clinic even when treatment has not achieved everything that they had hoped for (…) etc.

I did find a few acupuncturists who claim to help with heart disease, and several chiropractors who appear to claim to – although they also admit that it doesn’t actually work. Which is it? Does it work or not?

If you claim something works, you’re falsely advertising if you know it doesn’t. If you believe it does, you should be able to prove it, right? Why all the weasel words? We both know the answer.

I just noticed I made a serious mis-parse in reading the claims of Bakris’ chiro study. Oops!!!
-More later-

Dear Dr. Orac:

Thank you for taking the time to view and respond to the MD Anderson Cancer Center’s blog, CancerWise, and specifically to the article about the Feldenkrais Method. I am the practitioner who teaches the Awareness Through Movement class at the MD Anderson Place of Wellness, and I was interviewed for the piece. I would like to respond to several of your points.

Firstly, you are correct in observing that the piece in question was short on depth and completeness of information. Since the CancerWise blog publishes concise pieces in a short form, our constraint was around 275 words, and a two-minute video. The purpose of the piece was not to give an exhaustive theoretical or methodological treatise, but to inform people about the opportunity to experience classes in the Feldenkrais Method. Feldenkrais teachers are generally eager to engage with the public, as well as with scientists, researchers, and practitioners in the medical community to speak more fully about our work. Other venues (perhaps your blog, with its extended format?) are available and more appropriate for the type of in-depth examination you are requesting.

Secondly, you speak to the lack of research around the Feldenkrais Method, and this is partly true. I would qualify the statement to say, “the comparative lack of research,” since undeniably there is far less research about the Feldenkrais Method than, say, cancer, calories, or cold medicines. However, a fairly complete listing of research studies about the Feldenkrais Method appears on the website of the International Feldenkrais Federation. http://feldenkrais-method.org/en/biblio. As you know, quality research is costly and time-consuming. Any research study also needs a champion, or a team, to see it through. Research efforts are currently underway in the US, in Australia, and elsewhere. However, lack of funding is certainly an obstacle to obtaining the type of research that would satisfy you. Additionally, when funding is provided to launch a body of research, the objectivity of the study and possibility for conflict of interest is rightly called into question and worthy of consideration. Unfortunately, this is the predicament we find ourselves in: we need funding, interest, and time of qualified and respected researchers if we are to move forward with our research efforts. The Feldenkrais community is actively seeking partners world-wide with whom to collaborate in research, across disciplines including but not restricted to neuroscience, physiology, kinesiology, cognitive science, physical therapy, athletics, and the arts. It will probably take many years to establish a research base and quality longitudinal studies to meet your standard of proof. We are well along the road to establishing a body of research, however, most findings are “preliminary” or “warrant further investigation.” Many of our research studies to date are qualitative, rather than quantitative. We would welcome collaboration with a researcher who could find a way to quantify our results in a way that is meaningful.

Thirdly, you say, “uh, no, it hasn’t” in response to the statement in the article that the findings of Moshe Feldenkrais have been confirmed by neuroscience. Perhaps this sentence was made too simple and concise for the short format of the blog, and the statement is worthy of elaboration. Uh, yes, it has. When Moshe Feldenkrais began his work, the field of neuroscience was in its infancy. He was an early proponent of the idea of neuroplasticity (that the brain undergoes structural changes in response to learning) and neurogenesis (that the brain continues to produce neurons throughout one’s lifespan). These ideas were highly controversial in academia, and in the medical field, until very recently. In fact, researchers interested in these phenomena were slow-tracked, discouraged, and mercilessly criticized/ridiculed when they attempted to publish their findings. We now have fMRI technology to confirm that indeed, neuroplasticity and neurogenesis are actual processes and properties of the human brain. This idea is now widely accepted, when just 10 years ago it was denounced in academic circles. Moshe Feldenkrais died in 1984. While technology and neuroscience research have progressed and have provided information that surpasses or exceeds Feldenkrais’s findings, to date none have been disproved or contradicted.

Medical professionals Karl Pribram, Norman Doidge, Michael Merzenich, and Frank Martin write extensively about neuroplasticity, and all are aware of (and recommend) the Feldenkrais Method. Whether you respect them or their work is for you to decide, and for others to decide on their own. It seems entirely possible and plausible that the Feldenkrais Method stimulates or activates neuroplasticity and neurogenesis. We are eager for researchers to discover the mechanism(s) whereby this might occur.

The Feldenkrais Method has wide applications across disciplines. For example, the Canadian Olympic Ski Team employs the method in its training to improve kinesthetic awareness, essential for elite athletes. As with most emergent ideas and innovations, ideas cross boundaries and disciplines as their wider usefulness is demonstrated. Borrowing ideas from one field (for example, the Feldenkrais Method, athletic performance improvement, cognitive science) and applying them in another (stress reduction, pain relief, injury prevention) does not make the entire enterprise “woo.” Contrary to what you stated in your article, the Feldenkrais Method is NOT based on faith or gullibility, or subscription to any tenets of “woo philosophy.” It is based on the innate potential of each human being to learn, adapt, change, and improve. Feldenkrais teachers are exactly that – teachers – and not gurus or magicians. We teach students or clients, not patients, and our sessions are called lessons, rather than treatments. We facilitate learning, accessing the brain and nervous system though one of its primary sources of informational input: movement.

Lastly, it is inaccurate to portray MD Anderson Cancer Center as generating income from their CAM/IM programming at the Place of Wellness. As was clearly stated in the article, Awareness Through Movement at Place of Wellness is underwritten by the C. G. Jung Educational Center, Houston, through funding by The Houston Endowment. To my knowledge, all programs at the Place of Wellness are provided free of charge to patients, family members, caregivers, and members of the community whose lives have been touched by cancer.

I would invite you to have a direct experience of the Feldenkrais Method with a skilled practitioner. I am certain that you would want to have as much information as possible before drawing a conclusion that would otherwise be uninformed, given your obvious intellectual integrity. We would be happy to have open conversations with you as you are more informed about our work, and not simply reacting to verbiage that activated your “hot buttons.” Perhaps you can help us to translate our work into simple, understandable language that does not set off the “woo alarms.” There is much of value in the Feldenkrais Method, and it is worthy to stand next to any contemporary school of thought as a unique and helpful perspective on the human condition.

Respectfully,
MaryBeth D. Smith, MM, GCFP
Director, the Feldenkrais Center of Houston

I found your post and your logic to be quite bizarre.

You are right to criticize claim that the Feldenkrais Method is “confirmed by neuroscience.” It is largely a meaningless claim. However, as you note there are over 30 studies that have been conducted on the method and they speak to whether or not the work actually can and does help people with specific issues.

But apparently you do not wish to discuss that because it does not fit in with your straw man argument? Or are you simply to lazy to make a thorough evaluation of the research?

The plural of anecdotal evidence is not data, and neither is your hodgepodge of irrelevant personal rantings. Use the scientific method to learn something about the world, not to simply validate your own limited experience of yourself and to keep intact your own emotional commitments.

Ryan Nagy

Annie Gottlieb:

You really should experience it, not merely read words, before you dismiss it.

The “try it” gambit is often used to promote treatments that have no scientific basis (this includes homeopathy, cranialsacral therapy, zappers, and on and on). Unfortunately, because the person who is being told to try it is a case report of one, it falls under the banner of “the plural of anecdote is anecdotes, not data.”

Interesting blog. Respectful insolence indeed! :>

In the spirit of ‘respectful insolence’ then, I would like to rebut some of the claims made by Orac. Specifically –

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But, Feldenkrais concluded the brain continues to develop throughout life and retains the ability to relearn. His findings have been confirmed by research in neuroscience.

Uh, no. No they haven’t.
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Uh, Yeah, they have. Take a look at what Moshe Feldenkris wrote in “Body and Mature Behaviour” (written circa 1945) and other books and then compare it to the below –

On transference and generalization of learning (ie: generalizing motor patterns) –

Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke

http://www.ncbi.nlm.nih.gov/pubmed/18325646

“INTERPRETATION: Preliminary findings suggest that even brief gait training using a treadmill with a restrictive weight placed on the distal extremity of the non-hemiplegic lower limb can improve laboratory measures of gait ability
in a sample of stroke subjects”

On the effects of discrimination and differentiation in reducing chronic pain

Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain.

http://www.ncbi.nlm.nih.gov/pubmed/18054437

“These gains were maintained at three-month follow-up. We conclude that tactile stimulation can decrease pain and increase tactile acuity when patients are required to discriminate between the type and location of tactile stimuli”.

On how training body image helps patients in chronic pain

I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain

http://www.painjournalonline.com/article/s0304-3959(08)00444-2/abstract

“The conscious sense of our body, or body image, is often taken for granted, but it is disrupted in many clinical states including complex regional pain syndrome and phantom limb pain. Is the same true for chronic back pain?

…These preliminary data indicate that body image is disrupted, and tactile acuity is decreased, in the area of usual pain, in patients with chronic back pain. This finding raises the possibility that training body image or
tactile acuity may help patients in chronic spinal pain, as it has been shown to do in patients with complex regional pain syndrome or phantom limb pain”.

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Unfortunately I couldn’t find any evidence that the Feldenkrais method has been “confirmed by by research in neuroscience,” at least not any neuroscience published in the peer-reviewed literature indexed on PubMed
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Interesting… I hit pubmed and found the above, very recent, peer reviewed articles that do just that, in under 20 minutes.

Here’s what another 40 minutes uncovered –

Freda Vrantsidis, Keith D. Hill, Kirsten Moore, Robert Webb, Susan Hunt, Leslie Dowson. Getting Grounded Gracefully: Effectiveness and Acceptability of Feldenkrais in Improving Balance Related Outcomes for Older
People: A Randomised Trial Journal of Ageing and Physical Activity, 2008

Abstract ;The Getting Grounded Gracefully program, based on the Awareness Through Movement lessons of the Feldenkrais Method, was designed to improve balance and function in older people. Fifty five participants (mean age 75, 85%
female) were randomised to the intervention (twice weekly group classes over 8 weeks) or the control group (continued with their usual activity) after being assessed at baseline, then reassessed eight weeks later. Significant
improvement was identified for the intervention group relative to the control group using ANOVA between groups repeated measures analysis for the Modified Falls Efficacy Scale score (p = 0.003) and gait speed (p = 0.028), and a strong trend evident in the Timed Up and Go (p = 0.056). High class attendance (88%) and survey feedback indicate that the program was viewed positively by participants and may therefore be acceptable to other older people. Further
investigation of the Getting Grounded Gracefully program is warranted.

1.Stephens, J., Davidson, J., Derosa, J., Kriz, M., & Saltzman, N. (2006) Lengthening the hamstring muscles without stretching using “awareness through movement”. Physical Therapy, 86(12), 1641-1650.

http://www.hubmed.org/display.cgi?uids=17033041

BACKGROUND AND PURPOSE:
Passive stretching is widely used to increase muscle flexibility, but it has been shown that this process does not produce long-term changes in the viscoelastic properties of muscle as originally thought. The authors tested a method of lengthening hamstring muscles called “Awareness Through Movement” (ATM) that does not use passive stretching. SUBJECTS: Thirty-three subjects who
were randomly assigned to ATM and control groups met the screening criteria and completed the intervention phase of the study. METHODS: The ATM group went through a process of learning complex active movements designed to increase length in the hamstring muscles. Hamstring muscle length was measured before and after intervention using the Active Knee Extension Test. RESULTS: The ATM group gained significantly more hamstring muscle length (+7.04 degrees )
compared with the control group (+1.15 degrees ). DISCUSSION AND CONCLUSION: The results suggest that muscle length can be increased through a process of active movement that does not involve stretching. Further research is needed to investigate this finding

1.Batson, Glenna & Deutsch, Judith E. (2005) Effects of Feldenkrais Awareness Through Movement on balance in adults with chronic neurological deficits following stroke: A preliminary study. Complementary Health Practice
Review, 10 (3), 203-210.

http://chp.sagepub.com/cgi/content/abstract/10/3/203

The Feldenkrais Method is a complementary approach to motor learning that purports to induce change in chronic motor behaviors. This preliminary study describes the effects of a Feldenkrais program on balance and quality of life
in individuals with chronic neurological deficits following stroke. Two male (48 and 53 years old) and 2 female participants (61 and 62 years old), 1 to 2.5 years post-stroke, participated as a group in a 6-week Feldenkrais program. Pretest and posttest evaluations of the Berg Balance Scale (BBS), the Dynamic Gait Index (DGI), and the Stroke Impact Scale (SIS) were administered.

Data were analyzed using aWilcoxon signed-rank test. DGI and BBS scores improved an average of 55.2% (p=.033) and 11% (p=.034), respectively. SIS percentage recovery improved 35%. Findings suggest that gains in functional
mobility are possible for individuals with chronic stroke using Feldenkrais movement therapy in a group setting.

Nair DG, Fuchs A, Burkart S, Steinberg FL, Kelso JA. Assessing recovery in middle cerebral artery stroke using functional MRI. Brain Inj. 2005 Dec;19(13):1165-76.

PRIMARY OBJECTIVE: To understand the temporal evolution of
brain reorganization during recovery from stroke. RESEARCH DESIGN: A patient who suffered left middle cerebral artery stroke 9 months earlier was studied on three occasions, approximately 1 month apart. This patient received
interventions based on Feldenkrais Method twice a week for 8 weeks. METHODS AND PROCEDURES: Brain activation was studied using functional Magnetic Resonance
Imaging (fMRI). During each session, the patient performed a finger-to-thumb opposition task, which involved one bimanual and two unimanual conditions. Each condition consisted of overt movement of fingers and imagery of the same task. RESULTS: With recovery, greater recruitment was observed of the affected primary motor cortex (M1) and a decrease in activation of the unaffected M1 and
supplementary motor area. In addition, the widespread activation of brain areas seen during the initial session changed to a more focused pattern of activation as the patient recovered. Imagery tasks resulted in similar brain activity as overt execution pointing to imagery as a potential tool for rehabilitation

1.Stephens JL, Cates P, Jentes E, Perich A, Silverstein J, Staab E, duShuttle D, Hatcher C, Shmunes J, Slaninka C. Awareness Through Movement Improves Quality of Life in People with Multiple Sclerosis J Neurol Phys Ther.
27(4): 170, 2003.February, 2004

PURPOSE/HYPOTHESIS: To assess quality of life changes associated with a successful balance intervention in a group of people with MS. NUMBER OF SUBJECTS: 12 people with MS mean age 54 yrs, mean Kurtzke EDSS level 4.75 MATERIALS/METHODS: Subjects were randomly assigned to 2 groups: Awareness Through Movement intervention (ATM) and control group (EDU). The ATM group participated in 8 Awareness Through Movement sessions while the EDU group participated in 4 educational sessions over 2 months. Balance and mobility measures were performed before and after the intervention period. These results were published in Neurology Report 2001; 25(2): 39-49. To assess quality of life the MSQLI was administered before and after the intervention. The MSQLI has 10 sub-scales including: Modified Fatigue Impact (MFIS), Pain Effects, Perceived Deficits (PDQ), and Modified Social Support Survey (MSSS).All scales are valid for people with MS with reliability scores ranging from .78 to .97. Data analysis used Kruskal – Walis ANOVA for group comparisons and Spearman rs for correlations. R

RESULTS: There were 3 significant group differences: 1)
increase in pain effects in the ATM group (p< 0.03); 2) decrease in perceived difficulty recalling recent events (PDQ-RM) in the ATM group (p< 0.035); and 3) improvement in perceived availability of others for companionship (MSSS-POS) in the ATM group (p< 0.035). Improvement on the PDQ-RM was highly correlated with decreased Fatigue Impact. Improvement in MSSS-POS was highly correlated with decrease in cognitive fatigue impact and a decrease in total PDQ, retrospective memory and planning and organization subscale scores.
CONCLUSIONS: The larger
picture that emerges is that an intervention that was successful in improving balance and mobility had other spin-off benefits that were physical, psychological and social improving quality of life. ATM is intended to improve people’s awareness and understanding of their bodies and to help individuals create alternative strategies for setting and achieving goals in their life.
This spin-off impact may be present in other kinds of interventions but it has not been measured or documented. CLINICAL RELEVANCE: In an environment where
patients and payers increasingly demand significant functional outcomes and measurable improvements in quality of life, it is important to document not only the physical outcomes but also the outcomes that reflect quality of
life.

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I did, however, find this rather more (I suspect) accurate summation of the Feldenkrais method as being much more akin to faith healing than science. I’m
left to come to the opinion that the Feldenkrais method borders on quackery.
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Well then…in the spirit of Respectful Insolence…I respectfully submit you did a piss poor job of looking. It seems that you based your entire opinion on 30 seconds of very poor internet research and a strong preconcieved bias.

Hardly what one would call impartial scholarship.

Over the years, Feldenkrais work has rapidly helped resolve various pains and injuries for me, from a neck/back problem due to a whiplash injury to a TMJ-related situation. It is clearly NOT placebo. Instead of making judgments based on a limited view of what science can include, why not look at outcomes? The world is much larger than you may think.

Over the years, Feldenkrais work has rapidly helped resolve various pains and injuries for me, from a neck/back problem due to a whiplash injury to a TMJ-related situation. It is clearly NOT placebo. Instead of making judgments based on a limited view of what science can include, why not look at outcomes? The world is much larger than you may think.

And by the way, as a psychologist, I can tell you that cutting edge neuroscience research does indeed show the continued malleability of neural pathways through adulthood. (No, I don’t believe there is any neuroscience research on Feldenkrais perse, but that’s not the point, and that’s not what the website claims).

Next time something hurts you badly, why don’t you treat yourself to a Feldenkrais session and see what it does for you??

You do realize that these are science-free arguments from authority you’ve posted, and personally I don’t consider Andrew Weil much of an authority on anything other than self-promotion.

Michael Merzenich,PhD, Neuroscientist,in conversation with Anat Baniel, trained by Moshe Feldenkrais, D. Sc.
Part 1 :http://www.youtube.com/watch?v=BhxMjkuumEE
Part 2: http://www.youtube.com/watch?v=C-n52dOX6cw

Anat Baniel explains how reduction of effort quickly improves the range and freedom of movement—and several other basic approaches in working with children with learning issues or brain damage—as wells as over-achieving adults. [Oh, dear NEW ideas!]

[Just google!]Michael M. Merzenich is a professor emeritus neuroscientist at the University of California, San Francisco, who earned his PhD at Johns Hopkins University, School of Medicine, Baltimore, MD, 1968. Fellowship in Neurophysiology, University of Wisconsin, Madison, WI, 1968 – 1971.
His contributions to the field are numerous. He took the sensory cortex maps developed by his predecessors like Archie Tunturi, Clinton Woolsey, Vernon Mountcastle, Wade Marshall, and Philip Bard, and refined them using dense micro-electrode mapping techniques. Using this, he definitively showed there to be multiple somatotopic maps of the body in the postcentral sulcus,[4][5] and multiple tonotopic maps of the acoustic inputs in the superior temporal plane.[6] He led the cochlear implant team at UCSF,[3][7] which transferred its technology to Advanced Bionics,[8] and their version is the Clarion cochlear implant.[9] As Co- Director of the Coleman Memorial Laboratory. his research focuses on understanding how the cerebral cortex represents, remembers, controls and employs complex input and action events. Additionally, Dr. Merzenich’s research investigates how brain learning processes contribute to the ontogenesis and expressions of human neurological illnesses.

Oh geez, he is just exuding all kindsa woo-woo–I mean he studies brain learning processes!!! But there is the cochlear implant… And he is interviewing a woman who did this:
Healing Quest: Feldenkrais Achieves What Medicine Could Not
http://www.youtube.com/watch?v=CNVw4ZISLMs

An inspirational story about the body’s ability to teach the brain. A baby born 20 years ago without a third of her cerebellum was given a grim prognosis that she would never be more than a vegetable. In this short video, you can see her as a pretty young woman and successful, college student.

Anat Baniel and other Feldenkrais Practitioners have been working this way for fifty years and are utilized in Physical Therapy clinics worldwide, as well as training many PTs, OTs, RNs and MDs in this approach.

Steve:

You dont’ retain your credibility by not admitting you made a mistake vis a vis Feldenkrais Method.

You would have been better at referencing independent data showing the efficacy of the Feldenkrais Method, rather than an appeal to read his book. Give the actual independent data and skip special pleading and concern trolling.

“Why does acupuncture research often show mixed results?” Dr. Cohen: “Sometimes it’s because of poor study design.”

Amazingly, this very same answer explains why many quack medical treatments are believed to work… until they are later shown by well-designed studies to be no better than placebo. Examples of truly effective medical treatments producing “mixed results” for study after study are far more rare, and almost always imply insufficient understanding of the mechanism behind their effectiveness. Perhaps Dr. Cohen would like to address that?