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Complementary and alternative medicine Medicine Quackery

David Freedman responds to criticism of his CAM apologia

The other day, I expressed my displeasure at an article published in The Atlantic that, boiled down to its essence, was one long apologia for unscientific “complementary and alternative medicine” (CAM) and “integrative medicine” (IM). Yes, I was quite critical, but, I believe, not unfairly so. Not surprisingly, however, the author of the article, David H. Freedman, was quite displeased, so much so that he actually showed up in my comments to take me to task. He didn’t just take me to task, though. He took all of you to task, as well, at least those of you who piled on. Unfortunately, his arguments in his comment were even worse than the arguments he laid down in his actual article. Let’s take a look.

Freedman begins:

As the author of the Atlantic article that has Orac and this crowd so hot and bothered, let me share a few observations and thoughts that I suspect will be completely lost on you. First, it’s interesting that all of you are deeply confident you know so much more than the dozens of highly credentialed, highly regarded physician-researchers I interviewed at several of the world’s most renowned medical centers and academies. (I only quoted a portion of these interviews in my article, due to space limitations.


As Steve Novella points out, “most ‘highly credentialed, mainstream physician-scientists’ don’t have a clue about CAM.

For someone who is so upset about my alleged use of ad hominems, Freedman is pretty free with the ad hominem himself. “Hot and bothered”? That’s clearly nothing more than a ploy designed to make it look as though I (and those of you who chimed in agreeing with me) are basing our criticisms more on emotion than on Freedman’s bad arguments topped off with bad science. It’s also rather amusing that his first gambit, rather than arguing evidence and facts, is to use a classic appeal to authority. Basically, he’s saying that because he interviewed so many “experts” he must be right. Never mind that it’s quite possible that he picked many of the wrong experts (he did), that he discounted the right experts, such as Steve Salzberg and Steve Novella (which he also did), and that he let his own bias lead him astray (which, as I argued, he appears to have done). He’s also implicitly insulting me because he he has disdain for the medical school where I’m faculty. In his view, apparently, because I’m not on the faculty at Harvard, Yale, M.D. Anderson, or Memorial Sloan-Kettering (for example), my opinion is not worth nearly as much as that of those who are. Never mind that the medical school where I’m on the faculty is well-respected and quite large. On the other hand, I could point out that the University of Maryland is not exactly Harvard or Yale either, and Freedman seemed to use Brian Berman at the University of Maryland as the source of many of his arguments. Besides, being a top tier medical school (such as Harvard or Yale) does not inoculate its faculty against falling for quackademic medicine, as I’ve documented time and time again over the last six years.

Freedman then proves himself a pyromaniac in a field of straw men, starting out by building a Burning Man-size straw man, to which he promptly and gleefully aims a flame thrower:

And let me anticipate Orac’s claim that I misquoted or distorted or spun or quoted out of context, as was his claim with my Ioannidis article, by pointing out that such claims reveal a deep ignorance of the fact-checking process that goes on at most well-regarded magazines, and especially at The Atlantic. Every single person quoted had an opportunity to correct the record ahead of time–as did Ioannidis, by the way.)

Except that I made no such claim. Seriously. Go back and read my original post if you don’t believe me. Nor do I give a rodential posterior about the fact-checking process at a magazine like The Atlantic, at least not in the context of Freedman’s article and the arguments it contains. Let’s put it this way: I more or less assumed that every single quote in Freedman’s article was accurate and fairly represented the views of the person being interviewed. That wasn’t the problem. The problem was framing. It’s how Freedman presents his facts and quotes that’s the problem, not the facts and quotes themselves. It’s the overall structure and argument of the article that’s the problem, not the individual quotes and facts marshaled to support that structure and argument. To recap, Freedman essentially admitted that the vast majority of CAM and IM treatments are no better than placebo when tested in randomized clinical trials, perhaps the only statement about which we unequivocally agree. Unfortunately, instead of concluding that this failure in clinical trials means that the vast majority of CAM treatments don’t work (which it does and which would have been the correct conclusion), Freedman instead tries his very hardest to persuade you that it doesn’t matter that CAM doesn’t work, that it’s really the touchy-feely CAM practitioners bringing the human touch by listening to their patients and spending time with them that matters, all to fire up placebo effects. In fact, he does it again in his reply:

These top scientists almost to a person agreed with my four main points: Most mainstream drugs don’t help most patients much with chronic, complex disease; alternative treatments don’t work better than placebo; alternative practitioners do a better job on average than mainstream physicians in investing time and effort with patients to get them to adopt healthier lifestyles and have better attitudes about health; and these lifestyle and attitude changes can significantly reduce the risk of complex, chronic disease as well as relieve the hard-to-treat pain and discomfort of many different disorders. All of these points are backed up by mainstream studies, aren’t even all that controversial, and, as I say, are endorsed by physician-researchers whose credentials and reputations are, well, let’s be charitable and say “at least as solid as,” those of Orac. (I happen to agree that the Nobel Prize or any other credential or affiliation doesn’t confer a monopoly on insight or the truth, but on the other hand it’s genuinely shocking and appalling to me to see the combined word of so many highly regarded people dismissed with a wave of the hand.)

For someone who says he agrees that the Nobel Prize or other credentials or affiliations don’t confer a monopoly on insight, Freedman sure does like his appeals to authority, doesn’t he? He seems to be all about credentials and affiliations. Again, he takes a not-so-subtle dig at me and my qualifications, which serves to amuse me more than anything else. As I’ve said time and time again, one reason I keep the “Orac” pseudonym even though a lot of people know my real name is, besides the fact that I like the pseudonym and am a bit curmudgeonly about ever willingly giving it up, because I want my arguments to stand on their own without having to rely on any “authority” my credentials give me. I’ve said it time and time again going back at least five years. Sure, I’m a doctor. Sure, I’m also a scientist. So what? None of that matters very much when I sit down in front of my laptop to blog. I like to think that my arguments and track record as a skeptical blogger are all that matter in this particular venue.

The other thing that Freedman does is what Steve Novella and I have characterized as the classic “bait and switch.” In other words, he’s completely fallen for the framing of lifestyle changes, such as diet and attitude, as somehow being “alternative.” They are not. They are, and always have been, part of science-based medicine, and no supporter of SBM that I’m aware of, including myself, denies that they can be very effective tools for improving health. However, CAM apologists like Freedman frequently co-opt these modalities as being somehow “alternative.” They then use them as the “foot in the door” to let the real pseudoscience in, woo such as homeopathy, reiki, and the like. Steve prefers the term “bait and switch”; I, on the other hand, prefer the term “Trojan horse.” Basically, diet, exercise, and lifestyle interventions are the Trojan horse pulled into the bastion of science-based medicine. After it’s there, all the quackery, such as homeopathy, acupuncture, reiki, and “energy healing,” leaps out and takes over.

And Freedman uses these rhetorical tricks with the best of them, whether he realizes it or not.

I’m not even convinced of some of Freedman’s facts. For instance, he claims that alternative practitioners “do a better job on average than mainstream physicians in investing time and effort with patients to get them to adopt healthier lifestyles and have better attitudes about health.” Really? Certainly, he presents no evidence, either here or in his Atlantic article, that this is true, that alternative practitioners routinely produce better outcomes in these areas than “conventional” physicians. In fact, if you’ll excuse my French, I call BS on this statement. When you come right down to it, many CAM practitioners have what are most definitely non-science-based views on what constitutes good nutrition and a healthy lifestyle. All too often, the common sense recommendations that some CAM practitioners make are buried under layers of pseudoscience, the hawking of supplements, and interventions based on prescientific, vitalistic ideas about health. Ideas like homeopathy and acupuncture. Indeed, in the Atlantic article, an acupuncturist is reported to tell a patient sticking little needles in his skin would “‘open blocked “energy pathways’ in his body, allowing a more normal flow of energy that would lessen his pain and help restore general health.” Another dubious “fact” presented by Freedman is the bit about how allegedly “most mainstream drugs don’t help most patients much with chronic, complex disease. I can’t help but note that drugs actually do work with chronic disease in many cases, including diabetes, hypertension, and a number of other chronic conditions. I have no idea what Freedman means by “chronic, complex disease.” It seems to be a buzzword he picked up somewhere in his interviews and research.

I have to admit that Freedman actually rather amused me with his finale:

Frankly, the unwillingness of Orac and this crowd to consider for a moment the possibility that there may be some aspect of alternative medicine other than any direct physical action from its core treatments that might be helpful to many patients, especially in light of all the evidence and widespread, highly informed opinion that this is so, perfectly embodies everything that science is supposed to oppose: closed-mindedness, deep bias, hostility to disagreement, reckless disregard for reason and evidence that don’t support a favored conclusion, and a total lack of humility with regard to what one knows for sure. What you are defending here isn’t science, folks–it’s what I call “scienceology,” a quasi-religious faith in a set of closely held beliefs that are dressed up in the trappings of science and kept immune to any counter-evidence or -opinion. When a person genuinely operating in the true spirit of science hears a counter-argument or counter-evidence, he or she thinks, “Hmmm, let me consider this carefully to see if I need to rethink or modify my position”; when a scienceologist hears a counter-argument or counter-evidence, he or she thinks, “Hmmm, what’s the best way to viciously trash this so I can continue to believe in what I absolutely know to be true?” Which one applies to you, would you say?

At the risk of a tu quoque argument, I can’t help but ask: Which one applies to Freedman, I wonder? He’s also got it wrong. I’ve said time and time and time again that I can be convinced by evidence. In fact, I frequently like to use the example of homeopathy (because homeopathy is so inherently ridiculous from a scientific point of view) and quote Tim Minchin’ awesome nine-minute beat poem (NSFW):

Science adjusts its beliefs based on what’s observed
Faith is the denial of observation so that Belief can be preserved.
If you show me
That, say, homeopathy works,
Then I will change my mind
I’ll spin on a fucking dime
I’ll be embarrassed as hell,
But I will run through the streets yelling
It’s a miracle! Take physics and bin it!
Water has memory!
And while it’s memory of a long lost drop of onion juice is Infinite
It somehow forgets all the poo it’s had in it!

You show me that it works and how it works
And when I’ve recovered from the shock
I will take a compass and carve “Fancy That!” on the side of my cock.”

And I will, too; change my mind if the evidence indicates that I should, that is. As for the other part, I most definitely do not like the thought of sharp objects near my most sensitive parts; so I’ll pass on the compass. Be that as it may, I’ve even said on many occasions that if the anti-vaccine movement managed to produce some high quality studies that indicated that vaccination is associated with an increased risk of autism, I’d have to seriously reconsider my position that vaccines don’t cause autism. I’ve yet to see such a study.

As for the charge of “scienceology,” Mr. Freedman really is out of touch with the very CAM movement he appears to find so compelling. As I pointed out in a followup comment, the correct term is “scientism,” which is a favorite charge against skeptics and scientists favored by all manner of cranks, including CAM practitioners, creationists (yes, creationists), HIV/AIDS denialists, and anti-vaccine activists. I’ve seen the term used by all of these varieties of cranks at one time or another. Mr. Freedman should really not be so eager to join these groups by throwing around terms like “scienceology.” Besides, the whole argument that “your science is a religion” that he makes is so tiresome because it is so easy to refute. It’s not for nothing that this canard has been dismissively (and appropriately) referred to as “doggerel.” Science is only a religion to those who do not understand science, and it is clear that Mr. Freedman does not understand science.

You know, before I saw Mr. Freedman’s response to my criticism, wasn’t going to be all that hard on him. He sounds just like any number of journalists I’ve encountered who have become enamored of the glamor of woo. Unfortunately, his response reveals just how deeply he’s drunk the Kool Aid of pseudoscience. The bottom line is that CAM/IM adds absolutely nothing to medicine. Even Freedman admits that nearly all of it is no better than placebo before lamenting that physicians don’t spend enough time with their patients. Unfortunately, he frames this observation as a false dichotomy: Continue with physicians having too little time for their patients or let the quacks in to provide the empathy and “lifestyle” counseling. That’s completely the wrong approach. The answer to the problem of physicians not having adequate time for their patients is not to let quackery invade science-based medicine and quacks take on the role of empathetic healer. Rather, it’s to find a way within the confines of science-based medicine to bring the human touch back and empower science-based practitioners to be the empathetic healers that the vast majority want to be. If, after all his interviews, Freedman realized that, he might have done a valuable service for the readers of The Atlantic. Instead, he revealed himself to have become yet another useful tool for the CAM movement’s endless proselytization.

ADDENDUM: Steve Novella has responded. He’s at least as harsh as I am and makes an excellent analogy between the CAM movement and the creationism/intelligent design movement.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

146 replies on “David Freedman responds to criticism of his CAM apologia”

Great rebuttal.

Sophists are hard to counter, because their method of argument is primary not the essential content of their claims.

-r.c.

Freedman doesn’t even make a decent argument from authority. “I have a PhD from X and studied 5 years under Nobel price winner Y” is good, “I’m a journalist who spent 30 min on the phone with Nobel price winner Y and picked the three sentences that fit best for my article”, not so much.

Truth be told, I like Freedman’s response far less even than his original article. Any time you have to show your credentials or resort to name-dropping to make a point, it’s a sign your argument has no merit. “Believe me, not because the evidence supports my argument, but because I went to Harvard.” Unfortunately, in the real world, that’s often how things work, but it’s not how science SHOULD work, and it’s not persuasive. Evidence means more than the name of your alma mater.

The other really bizarre thing about this Atlantic article (well, ONE of the other really bizarre things about this Atlantic article) is the claim that CAM practitioners spend more time with and are more caring about patients than traditional doctors. That may or may not be true, but either way, it’s NOT an argument in favor of CAM, it’s an argument about our current healthcare system (which doesn’t always permit doctors to spend as much time with each patient as they and/or the patient might like) and the way we train doctors in medical school. A kind and caring quack is still a quack for all that.

What bothers me about all this is the way CAM is infiltrating medicine by way of so-called “integrative medicine”. The more widespread it becomes, the more difficult it is to stop, because people like Freedman are easily bewitched by credentials. Never mind that reiki and homeopathy are completely implausible, never mind that homeopaths are so crazy they actually think you can use “potentized mustard gas” as treatment for mustard gas burns (yes, they’ve actually tried that! I blogged about that recently as part of a post on the history of chemical warfare), no, never mind all that! the University of Maryland Medical Center is doing this stuff now, so it MUST be useful, right?

I have been thinking about David H. Freedman’s article, and agree with Orac when he writes:

many CAM practitioners have what are most definitely non-science-based views on what constitutes good nutrition and a healthy lifestyle.

There is a huge variety of claims about good nutrition in CAM and IM circles. We should eat more starches and less protein (McDougal). We need more protein and fewer starches (Atkins). We need raw and preferably rotting meat (Vonderplanitz – I kid you not). Eat raw fruits and vegetables only (Ann Wigmore and Herbert Shelton). Fruit is poison to the body (Robert O. Young). Fruit is fine, it’s starches that are are poisons to the body (Carol Sinclair). Wheat is a poison (Myhill). Saturated fat is good for you (Ravnskov). It goes on and on.

All these dietary ‘experts’ have a collection of disciples who claim to have beaten life-threatening illnesses using their guru’s diet, and dismiss anyone who disagrees with them as idiots. If you find an expert who says foodstuff X is good for you, try Googling “X is poison” and you will find another expert who says the opposite, and they are nearly all trying to sell you something.

Thank you for the excellent rebuttal of this nonsense and an informative summary of some CAM tactics of which I was previously unaware. Nutrition and lifestyle modification as CAM? They’ve been part of conventional (scientific) medicine, as taught in mainstream medical schools, for decades! I’d be surprised to find primary care physician in the U.S. who doesn’t regard them as critical. To make the mistake of equating diet/lifestyle control with CAM is sloppy thinking but forgivable (except in the case of a journalist supposedly researching an article on the subject). Deliberately conflating the two is shameful.

Good commonsense rebuttal to a very mush-headed and cliché-laden comment.

Mutant Dragon, to add to what you say in your third paragraph: it’s not just about being “bewitched by credentials”. Many if not most homeopathy believers do not actually believe in homeopathy: they just don’t know what it is and accept it on the authoritative veneer of cargo cult science, which is enhanced when real universities and health-care providers allow it to flourish in the dark, dank, damp corners of their homes.

Nutrition and lifestyle modification as CAM? They’ve been part of conventional (scientific) medicine, as taught in mainstream medical schools, for decades!

Hasn’t the doctor saying “Cut down on booze and women” been a punchline for, like, ever?

I’d say that the bit about time is an argument for socialized or at least single-payer medicine: part of why your doctor doesn’t have a lot of time to spend with you is that they are spending time on your behalf arguing with an insurance company (which, remember, has a financial incentive to deny care). There’s a thing called “pre-authorization” which means “after the doctor prescribes a medicine, make him/her fill out a specific insurance company form saying that the patient needs it. Require another copy every twelve months, even if there are no new medicines for this purpose and it is treating a chronic disease.” This serves absolutely no medical purpose: if your doctor thinks you should take medicine X, and is prepared to tell you and your pharmacist that, s/he isn’t suddenly going to decide s/he’s wrong when your insurance company demands a “Simon says.” But the time your doctor is spending on that is time s/he isn’t spending with a patient (or getting some sleep). The time your pharmacist spends chasing down that paperwork from your doctor is time s/he isn’t spending dispensing pills, or checking interactions, or warning you to stay out of the sun while you’re taking this medicine. It’s part of why we spend longer waiting in line.

[more rant about insurance companies deleted as off-topic.]

Freedman says:

“scienceology,” a quasi-religious faith in a set of closely held beliefs that are dressed up in the trappings of science and kept immune to any counter-evidence or -opinion.

Orac replies:

As I pointed out in a followup comment, the correct term is “scientism,” which is a favorite charge against skeptics and scientists favored by all manner of cranks

Hmmm, this isn’t the definition of “scientism” I was accustomed to. I thought “scientism” is “attempts to apply science to areas it doesn’t generally apply to, such as ethical decisions, subjective emotions and personal tastes” (also known as the “Can science prove that a sunset is beautiful (that you love your mother / that Verdi’s music is great / etc.) ?” gambit). Those who (mis)employ the term usually thus defend their faith in certain factual claims against demands for evidence.

What Freedman defines as “scienceology” is either a) best articulated as “being dogmatic” or b) not even a thing.

I’m glad to see so many people calling Freedman out for missing the point that the better solution to how little time some physicians have to spend with patients is to improve the health care reimbursement system, not have sCam fill that roll. I’ll also pile on that sCam is full of weird nutritional advice, that can be harmful if followed (Gluten and dairy free for autism puts kids at risk for malnutrition.)

But, there is another point that hasn’t been addressed. Ethics. Freedman admits that most of the sCam treatments are no better than placebo. However, Freedman thinks it’s fine for patients to be lied to and pay money for treatments that work no better than sugar pills. Typically paid for out of pocket as well because insurance doesn’t cover them. (And if it did, then alt. med practitioners would find themselves in the same economic situation as MDs ending their monopoly on spending time with patients.) Maybe Freedman doesn’t have a problem with being lied to and being asked to spend money on useless treatments, but I find it condescending and morally repugnant.

An uninspired drizzle drips from the mist-enshrouded grey sky and I feel morose. Reading about Freedman didn’t help.

A few things: I wonder if the decision to create a neologism, “scienceology”, when a synonym – “scientism”- already exists, had anything remotely to do with the fact that it sounds like “Scientology”. Let readers unawares associate sceptics with the followers of a despised *cult*. How clever!

If IM and CAM modalities are admittedly no better than placebo, is there really *no* difference? The first one I can think of is obviously monetary: useless treatments waste money whereas cheap or free placebos, although basically useless, are readily available**. I read accounts of charlatans who gross in the 8-figure range USD. CAM and IM are enriching practitioners, manufacturers of supplements, and publishers. For example, ardent followers may now have Mike Adams exclusively streamed for only $24 a month! Woo is a huge business. My late father, when he encountered something hateful or stupid, would derisively remark, “Well, at least it creates jobs.” I must disagree with him in this instance.

Having pseudo-science infiltrate medical schools and national magazines provides additional “street cred” to woo-meisters who are already pumped up on endorphins from their endless workouts as well as braggadocio unimpeded by higher mental functioning. The *lack* of criticism by educated people ( boards of med schools or national magazines) adds to charlatans’ mounting confidence as they spread their wings undertaking new endeavors. It makes them sound safe and acceptable to a general audience.

Another new service: Gary Null now provides free nutritional counselling by phone to customers. It is done by nutritionists and ( supposed) dieticians who advise clients about what supplements to buy. He prefaces this by relating how he has cured “thousands” of serious ills ( cancer, AIDS, CV, ad nauseum) in this manner. Isn’t this “diagnosing and treating” illness without… you know? I suspect that he isn’t the only one.

I hate using the term “enabling” but isn’t that what lack of criticism does?

** here is an ancient placebo: put a charm on a chain and wear it around your neck. You’ll feel better.

As a patient with a “chronic, complex disease” who spent 15 years pursuing relief through CAM, I will agree that most all of the CAM practitioners I saw were caring, compassionate people who spent more time with me than conventional doctors (because I was paying them mightily out of pocket for the privilege.)

I did feel better being cared about in that way – until the inevitable point where it became clear that the “treatments” were not actually working. At that point, I was frequently blamed for “not wanting to get well” despite spending thousands of dollars and following their prescriptions exactly.

After having my bank account drained and my falsely inflated hopes once again dashed, I always ended up feeling much, much worse than when I started. So, yes, Mr. Freedman, what’s the harm?

All that said, Freedman does touch on a good point. Mainstream medicine doesn’t do as well as we might hope with the sympathy, attentiveness, and related issues. (For many reasons, not least time pressure.) And CAM practitioners do better in that limited respect. So to the extent Freedman meant to say that mainstream medicine should ideally do better on that, while dumping the woo, I’d actually agree.

This is hardly a new observation – it’s been discussed here many a time – but it does mean that he’s not completely wrong.

Orac

I think your assessment that Freedman was simply beguiled by woo might be true, though I would love to hear from Freedman why he is so enamored of CAM. I also agree that he doesn’t seem to understand science all that well.

But to be fair to him, and speaking as a reporter who writes about science — sometimes it is hard to find people who are real experts, and to know which ones to go to. I mean, I have written about biochemistry on occasion, and I only know rudimentary chem from high school plus some physics from college. (21 years gone now). So It’s often a struggle for me to find the right people. Once or twice, heck, often, I bet I was completely wrong.

But the thing you do — before you file the story — is try to track down the right people by asking folks who a good person to talk to is and going to the primary literature and looking up the “corresponding author.” They have phone numbers and emails, so it isn’t like tracking down Watergate burglars. But again, it took me a long while to learn the search terms (and I had to ask for a lot of help on one story about brain function).

You can’t be too caught up in the experts you get. Even when they tell you a really cool story. That’s where I think Freedman does less well. Some of it is his take on John Ioannidis’ work. I saw that come up in the primary literature (even pitched the story myself) and the thing is, Ioannidis’ argument has a lot more to do with how studies use statistical math than anything else, and the statistical likelihood that they aren’t completely right (which is rather different from being ‘wrong.’ Also, in any field, there is a large likelihood that what you publish would be refuted — after all, not everyone is going to rewrite the textbooks, as they say.

That doesn’t alter the fact that certain treatments — even for chronic conditions like diabetes — work. ANd when I saw his excerpt that extended the “they are wrong” paradigm to fields such as chemistry and physics I had to laugh a bit. Physics especially has an iron rigor — the stuff works or it does not — that allows for almost no wiggle room. (For example, while there are a lot of things physicists don’t know about dark matter you can constrain quite a bit).

So maybe the apologia he did comes from his book on why experts can be wrong. I don’t know. I’d love to hear him explain it.

@ Recovering Cam User: Thank you for illustrating my point.
A person who follows health regimes like those endorsed by our web woo-meisters could easily blow a couple hundred a month on supplements and a highly restricted diet (vegan, raw, organic)- not to mention so-called treatments- that might be better spent persuing interests and entertainment with family or friends. What’s the harm in a nice dinner out or a movie? It won’t make you *better* although you might *feel* better.However if the money is already spent on CAM ,it isn’t available for enjoyable placebos.

My sister is a GP. One of my brothers is a rich redneck. Rich redneck brother has signed on with what I can only call a “vanity doc” — but this doc provides a very flattering level of care, and is in all honesty probably good for the brother. On his first consultation, apparently they spent half a day going over lifestyle issues, diet, nutrition, possible health problems and what to do to head them off, etc. Of course, redneck brother can actually afford to spend $3,000 on a half-day doctor’s visit, too.

My GP sister works for a state clinic, catering heavily to immigrant, low-income “working poor” and Medicare/Medicaid populations. At the time that redneck brother was just signing on with his doc, she was under pressure to see a minimum of 48 people per day. She often spends time with her notes into the late evening, researching possible diagnoses and doing paperwork that she didn’t have time to do during the day. Due to state budgets being cut, she has now lost two of her colleagues, and has to shoulder as many of their patient load as she can, too.

You could see her sitting and fuming as redneck brother gushed over how much better doctors could be than what sister could do…

The answer to this is not, and has never been, to invite pseudoscientists and medically unqualified or underqualified “alternative therapists” into the field to pick up the burden. It is, as multiple other people have mentioned here, to improve training in real medical schools — not to include the unsupported “alternative therapies”, but to include more about managing communication with patients and dealing sensitively with patients’ “lifestyle issues” — and more to the point, to find ways to relieve the burden on the real docs so that more of them can afford to spend that personal time with their patients.

The simple fact is, yes, people need to feel that the person treating them cares. However, encouraging people to use “alternative therapies” because of this, instead of real ones, actually has the potential to ultimately increase the burden on the real medical system in terms of serious issues which may go ignored or misdiagnosed for too long because of most contact being with medically underqualified woo-meisters. Yes, there are certainly occasions where mainstream doctors ignore or misdiagnose serious conditions, and it is certainly sometimes incompetence, but this is exacerbated by the teeny tiny bit of time with each patient which is enforced by the system, as opposed to being primarily due to ignorance or “alternative ways of thinking.” We should aim at the best of both worlds to tackle this problem — properly medically trained doctors with time to spend.

Now, how could the US do that, given that its medical system teeters on the edge of nonviability anyway….that’s a far more difficult question. But the way that Freedman has pinpointed a real issue and then come up with a completely unhelpful and unsupportable set of answers to enthuse about…this we don’t need.

Freedman says, “…let me share a few observations and thoughts that I suspect will be completely lost on you.” A few responses leap immediately to mind: 1) Then why are you sharing them?; 2) You arrogant prick; 3) You could not have picked better words to shut down any discussion had you gone at it for a week. After reading the rest of Freedman’s reply (in the context of Orac’s post above), I find number 2 to be the most fitting, both in words and number.

…And that just leaves aside the issues of misrepresentation of medicine, with the utter nonsense about how it doesn’t help with “chronic, complex conditions.” That stuff’s just wrong.

I think that whatever improved outcomes, if there actually are any, that come from CAM treatments known to be no more effective than placebo when studied properly can be, at least in part, explained by what I like to call “self-referral bias”.
We have all seen patients who, when told they have early diabetes and need to change their diet and exercise more, do basically nothing. It can be hard to motivate these folks, who usually feel just fine and therefore feel no real compulsion to change.
Those who decide to seek out and pay, out of pocket (usually) to see a CAM provider are signaling, with their time and money, a willingness to change. Hence better outcomes.

[email protected]:

Freedman did in fact go to a couple of the “right people” to get their take on AltMed. See the addendum to Orac’s entry. Sadly, he pretty much disregarded what they had to say.

It appears to me that Freedman approached this assignment with his mind made up. Also, he REALLY doesn’t like Orac or his “friend”. His loss, but, unfortunately, also the reader’s.

clamboy @ 18:

I, too, choose Number 2

@TBruce–
I was thinking more about when Orac said a Nobel Prize in a field doesn’t give you expertise in every field. But point well taken.

And it’s false that CAM is harmless. A friend of mine has recently had five surgeries for herniated vertebral disks after 20 years of twice weekly chiropractic treatments. His orthopedic surgeon told him that he had injuries “consistent with surviving an airplane crash.”

I’m glad things are starting to heat up. What we need to emphasize over and over is that while science-based medicine has its problems that need to be worked out, quackery is never the answer. Hell no to IM!

So what’s this alleged evidence showing that woo practitioners are better at getting patients to adopt lifestyle changes with meaningful impact on health compared to mainstream physicians? (and no, pointing to the popularity of “toxin cleanses” is not an example of “meaningful impact”).

Freedman has not picked up on the fact that Orac’s “crowd” includes numerous health professionals and those in other scientific disciplines, who along with other regular commenters demonstrate the ability to engage in critical thinking and evaluate quality research as opposed to fallacy and anecdote. And as a physician with a previous career in journalism, I’m sorry to see a reporter stack the deck in the way Freedman did in his Atlantic article and handle the issues so poorly, both in the article and his followup.

Not “lost on me” are the typical woo-based tactics Freedman uses to strike back at critics, most regrettably the “Yur science is just religion!” ploy and the appeals to cherry-picked authority.

I also suspect (based in part on the reference to Atlantic’s marvelous fact-checking abilities) that Freedman is ticked off not only that we questioned his authorities and conclusions – it’s also resentment that a (relatively) unpaid blogger and commenters have shot holes in his published oeuvre. How dare we!

Scienceology….

In addition to it being a pointless neologism, and in addition to it sounding suspiciously like Scientology, and in addition to it being a complete misunderstanding of our complaints, doesn’t Freedman know that “scienceology” would, logically, be “the study of science”? And what, honestly, would be wrong with studying science? It might be a bit “meta”, a bit self-referential, but there’s no logical reason why one couldn’t study science, or perhaps the practice of science. That would seem an entirely reasonable thing to do, and quite unlike what he was describing.

That’s why the other neologism, “scientism”, was coined; the “-ism” suffix is more commonly found with religious doctrines (Catholocism, Protestantism, Methodism, etc), aesthetic forms (Modernism, Dadaism, Impressionism, etc), and things like that. Not that we really need that word either; “dogma” is adequate, and also sufficiently pejorative to meet Freedman’s needs.

Another thing that really struck me about his response was the comment that we are being closed-minded. This is a typical response to criticism by cranks; I’m not saying Freedman is a crank, but the fact that the criticism is so frequently leveled by them is illustrative. There is none so blind to their own closed-mindedness than a closed-minded person. And Freedman strikes me as at least somewhat closed-minded — he is closed to the possibility that there is indeed harm in allowing CAM to have a veneer of unearned legitimacy. (I’ve met people far more closed-minded; that Chuck fellow in the last thread who was going on about homeopathy for burns and gout was just about the most closed-minded person I’ve met recently who wasn’t actually nuts. Chuck had decided what worked, and nothing whatsoever, even months of agony from gout, is going to persuade him otherwise. That’s impressive. Pointless, but impressive.)

There are a lot of people who equate “open-minded” with “friendly” and “closed-minded” with “hostile”. And furthermore, they confuse “friendly” with “doesn’t attack my assertions, or at least not too much.” But is it really friendly to let nonsense go unchallenged, at least nonsense with a potential to hurt people? I don’t care what God you do or do not believe in; for the most part, that won’t hurt anybody. You can believe in invisible purple unicorns if that’s what feels right to you. But if you tell me that homeopathy works, and I should try it, then I’m going to rebut that. People have died by using homeopathy instead of actual treatments. (Yes, they seriously have. There’s the harm.)

It’s probably good to be diplomatic when correcting a friend, and you have to choose your moments; it’s not worth alienating a friend over their decision to do cleanses or whatever, as long as they’re not directly threatening their health that way — just as it’s not worth alienating a friend over them spending lots of money on their ceramic unicorn collection of whatever. And when something *is* threatening their health, then you need to talk to them, give them the information, and let them decide what to do with it, respecting whatever they choose — they are your friends, after all.

But articles in the print media are another matter. These are disseminated over a wide audience, and so the potential for harm due to misinformation is much greater. It is the duty of bloggers and journalists alike to respond vociferously to such things, as the opportunity presents itself.

Luna the cat got it, and very eloquently! The point that was so conspicuously missing from Freedman’s snotty and ignorant replies– and Orac unfortunately has neglected — is really crucial. The “talky”, attentive alt med is not a medical system for either a population or for serious diseases. It is a luxury expenditure for those who can afford it, like a “life coach”. As soon as your local homeopathic con man gets paid $12 of someone else’s money to see each each patient, the faster we will will see him drop the fuzzy concern and pass out the vials of magic water in 5 minute appointments. Why is this point so universally missed when people compare real medicine and quackery? Luna’s sister is the heroine, and Freedman’s understanding simply limited.

This entry, and the string of comments that follows, is one of the best things I’ve seen on the internet in quite a while.

Great takedown Orac. I find it ironic that a journalist heavily using arguments from authority is deriding the experience of other experts in the field of medicine (especially people like yourself and Dr. Novella who have actually studied CAM at least as much, and probably more, than the experts he relied on). There’s nothing like a journalist derisively preaching down to physicians about the nature of medicine and how science works, just because he interviewed a couple doctors!

I’ll repost my comment here from NeuroLogica, since maybe Mr. Freedman will see it:

I’d be really interested to know what percentage of internists would agree with Freedman’s first point that “Most mainstream drugs don’t help most patients much with chronic, complex disease.” The point is so vaguely phrased that it is almost useless, but I get the impression that most internists would consider that statement laughably wrong.

Does he mean that a minority of “mainstream” drugs actually do help most patients a lot with chronic, complex disease, but many drugs for chronic conditions aren’t as effective as those few? That would counter his point on the need for CAM. Is he saying that a majority of all the pharmaceuticals available treat acute and not chronic conditions? That may be true, but is trivial. Or is he saying, as I suspect, that scientific medicine is mostly useless to the vast majority of patients with chronic diseases? That last interpretation, the only one that really helps his case, is patently false.

John Smith (or are you the Doctor?):

As soon as your local homeopathic con man gets paid $12 of someone else’s money to see each each patient, the faster we will will see him drop the fuzzy concern and pass out the vials of magic water in 5 minute appointments.

This.

Quacks who are paid for consultations do indeed spend lots of time with their patients. This is because that’s the part they’re paid for. Quacks who are paid for the treatments and not so much for the consultations, however, spend very little time with their patients. Case in point: one of those chelation docs who had killed a patient was found to spend less than five minutes with each patient, then leave the patient unattended while the chelation occurred. I’ve heard the same thing about many docs at various dubious cancer clinics as well. Notably, these are people who are paid primarily for how many treatments are performed, not by the hour (though the chelationist was found to be billing insurers for long consultation sessions despite only spending five minutes, if that, with each patient on many sessions).

So not only is it not an argument that we should use alt med in order for patients to get doctors who spent time with them and show real concern for them, it’s not even true that alt med doctors spend more time with their patients. Some of them do, certainly, but definitely not all. In fact, there are alt med practitioners who are much worse about this than an overworked GP who knows that if he spends an extra five minutes with you, that only means his next patient loses five minutes from their session.

Prior to my stellar career in public health, I worked for a trade magazine…part of a large conglomerate of trade magazines dealing with “the trade” in HVAC, “contract (office) furniture”, electrical, heavy machinery and building supplies.

It was then, and still is now, all about advertising revenue, subscriptions barely covered the costs of editorial staff, printing and mailing costs. And, of course if you could increase your subscription base…corresponding costs to advertise went up as well.

We tried to maintain some semblance of journalistic integrity and a wall between the editorial staff and the advertising sales department…but we were after all…a trade publication.

At the present time all print media is suffering huge losses, with a few notable exceptions including “The Atlantic”. Popular articles that “sell” the magazine such as Mr. Freedman’s increase the subscription base, thus increasing advertising revenue…the infusion of this cash, keeps Atlantic Magazine in business.

Just how would Mr. Freedman’s article add to the magazine’s revenues if he didn’t tout CAM therapies, while trashing science-based medicine?

Advertising Age wrote about the renaissance of the The Atlantic, on their website:

The Atlantic is No. 2 on Ad Age’s Magazine A-List (10-4-2010)

We see examples of this all the time at Huffington Post where they occasionally have some real (science-based) articles along with all the sCAM advertisers popping up at the end of these rare good articles.

Would anyone argue that it is OK for any other professional to tell lies because it makes their client feel better? How would that work with a lawyer, or a car mechanic?

I can only assume that those who defend this practice in medicine are unaware of the dishonesty at the core of most CAM modalities.

Would anyone argue that it is OK for any other professional to tell lies because it makes their client feel better? How would that work with a lawyer, or a car mechanic?

Are you sure you want to use those particular professions as examples? What about adding politicians to that list?

What about adding politicians to that list?

Surely lying to make potential voters feel comfortable voting for them is their profession?

With lawyers I was thinking more along the lines of, “Relax, as long as you wear these lucky socks the jury will definitely acquit”. Or with a mechanic, “No your brakes are fine, as long as you sprinkle this magic water on your car every day…”

The other thing that Freedman does is what Steve Novella and I have characterized as the classic “bait and switch.” In other words, he’s completely fallen for the framing of lifestyle changes, such as diet and attitude, as somehow being “alternative.”

Is it really bait and switch if they actually believe it? I get the impression that many, many CAM advocates genuinely believe that conventional doctors don’t advocate lifestyle changes.

Is it really bait and switch if they actually believe it? I get the impression that many, many CAM advocates genuinely believe that conventional doctors don’t advocate lifestyle changes.

Yes. However, they are applying the technique out of ignorance, instead of intent to deceive.

Why does CAM sell so well? Even talking about it appears to invigorate websites ( Huffington), magazines ( the Atlantic), and TV shows ( Oprah, Oz): if it hurt sales or ad revenue, you wouldn’t see as much of it.

Medical science and technology have accelerated rapidly since the 1980’s: it’s difficult enough for experts to keep up with research, but education in science has not accelerated for *all* people- the general public, alienated by the shockwave of innovation, perhaps experiences *neophobia*. And what a brave new world that has such pharmacopaeia in it!

To some, CAM may represent a welcomed return to the simpler days of personal care by a trusted professional who had all the answers, reassured you, and wasn’t dependent on cold steel MRI machines or multi-page lab reports to help you heal. Some cling to CAM as our ancestors did to their amulets. Obviously, this lovely nostalgia must prove to be a distraction from what technology has wrought: longer life and the management and prevention of serious illnesses.

While the woo-meisters commiserate about how they are maligned or misrepresented by the mainstream, I find myself aghast at how softly the media tread. I hate to say it: woo is going mainstream itself – becoming “acceptable” to the masses.( Please don’t shoot me for saying so). If the educated don’t call out the wasteful, the useless, the dangerous, and fraudulent, who will?

Krebiozen: You nailed it. CAM concepts of nutrition bear more resemblance to religious doctrines than they do to any sort of objective reality. Most of them are based on assigning moral attributes (good or evil) to individual foods or food ingredients; they’re basically systems of taboos and totems.

“Why does CAM sell so well?”

Here’s one example. A friend with severe gall bladder problems was told by her conventional doc that that they could take it out, but there was only a 50-50 chance that would solve the problem.

An acupuncturist, on the other hand, told her that they would be able to completely heal the problem in a limited number of sessions.

I don’t think the acupuncturist was intentionally lying. But for people who are into that sort of thing, there’s just no way the messy reality of real medicine can compete with the fantasy of ignorant certainty.

@ebohlman

they’re basically systems of taboos and totems

I hadn’t taken the idea quite that far, but I think you’re right. If we all had powerful beliefs like that about behavior that really is bad or good for us, I guess we would all be healthier. Perhaps part the trouble is that there are few foods that science tells us are absolutely bad, or good. It’s difficult to get passionate about moderation.

If we all had powerful beliefs like that about behavior that really is bad or good for us, I guess we would all be healthier.

I hope I’m not wide of the mark, but assigning practicality to “taboos and totems” doesn’t work. Kashrut does not prohibit pork because of trichinosis, etc.

I’m just recovering from a kidney stone (had the stent removed to day). For the whole two-week episode, from the pain-level 10 stay in urgent care, through controlling the symptoms with Vicodin, anti-nausea suppositories and anti-inflammatories, and the procedure to zap the stone when it got stuck in the ureter, I kept wondering to myself, “What state would I be in now if I was relying on CAM to get me through this?” Would any transient placebo effect from, say, acupuncture really make a dent in the excruciating agony of the stone making its way down (and what about when it got embedded – a bit of chiropractic to help it on its way?)

Yes, my urologist gave me shorter shrift than I would have liked sometimes, but I have the information about which calcium oxalate foods to avoid now, and he’s doing a urine work-up give him more information for preventive measures.

I think the bottom line is, when it comes to REAL health issues, give me SBM any day, and not a guy with “basically a glass of water in one hand and a huge invoice in the other,” no matter touchy-feely he is.

I think the bottom line is, when it comes to REAL health issues, give me SBM any day, and not a guy with “basically a glass of water in one hand and a huge invoice in the other,” no matter touchy-feely he is.

QFT. Count me as another satisfied SBM customer. I even have a complex, chronic neurological condition, but fortunately one of the most treatable through (actual) medication: ADHD.

Now I’m about 10 years too old to have been diagnosed with it as a child, as today’s elementary school kids are screened for, but I can tell you that I was a very hyperactive and classic ADD kid from a very young age. I got the gene, like 1-2% of the population (equally prevalent in males and females, BTW). If I had been diagnosed as a child, my life would have been far less plagued with anxiety and trouble due to my inability to concentrate on schoolwork I didn’t want to do. Typical ADHD problems, from all the stories I’ve read.

I was lucky and made it through college with a degree and some work experience, but soon I hit a wall in terms of what I could accomplish in my career due to my inability to focus on certain aspects of software development I didn’t want to work on (or rather that my brain was preventing me from being able to focus my train of thought on, despite my deepest desire to be able to do so). Many people with this condition who are older than myself and didn’t know of the existence of this condition, as I was, turn to alcohol, drugs, dangerous lifestyles, and often make complete messes out of their lives due to this neurological difference (in the prefrontal cortex, and science discovers more of the details every year).

So I had to go through a very unfortunate period of clinical depression and anxiety in my 20’s before I finally dragged myself to get diagnosed by a psychiatrist and prescribed the appropriate pills for my particular neurology (personalized medicine! Imagine that!). In my case it was a combo of bupropion (Wellbutrin SR) and methylphenidate (Ritalin). Without them, I wouldn’t be able to live a normal life, in terms of mood and ability to concentrate on the things that matter. With SBM, and a lot of hard work, I have my dream job (programmer at Google) and no side effects from the pills to speak of.

Now there is a mini “big Pharma conspiracy” I could point out, but it’s not the one the woo-ists would like to believe. The problem is that the system is structured such that the drug companies make the most money from advertising drugs that they have patented. The really good ADHD drugs are all off-patent, so you never seem them advertised. The last time I saw a banner ad for adult ADHD it was for some medication specifically for people who can’t take the usual stimulant-based drugs, and not something that was actually more effective. So there’s no real push out there to pull in the vast number (perhaps several million in the U.S. alone) of adults with ADD who would have to, like myself, specifically seek out (and perhaps deal with the stigma of both “mental illness” and “psychiatry” in their worldview) the so-called allopathic medicine that is in fact extremely effective for me, and countless others (not all people with ADD benefit from medication, but many do).

I feel really bad for the folks out there who are missing out on the opportunity to avail themselves of inexpensive and effective medicines and treatments because of their irrational fears of doctors and anti-government paranoia. Like the guy in the previous thread with gout. I wonder what wacky bottles of homeopathic ju-ju he would recommend for my complex / chronic condition.

@Narad

assigning practicality to “taboos and totems” doesn’t work. Kashrut does not prohibit pork because of trichinosis, etc.

It is possible that some religious dietary laws evolved partly through observation (though I suppose that’s blasphemy). Avoiding pork does (or did) help to prevent trichinosis, whether that is the reason for the prohibition or not.

What I meant is that people are capable of lifestyle modification if they strongly believe in it. The dietary fads common in CAM resemble religious taboos and totems, which highly motivate some people. People seem to find it easier to become passionate about avoiding a food or only eating a limited group of foods than about following the science-based dietary guidelines which advocate a balanced diet.

We need to find a way for people to feel passionate about healthy lifestyle modification. We really do.

@ Pete: You’ve just come through one of the most painful experiences, with the great non-invasive medical care that is modern day western medicine. Had you gone to a CAM practitioner who decided to try a variety of alt therapies, you could have suffered through a ruptured ureter, shock and died.

Our noted philosopher Denice Walter has concisely summed it up. Some people remember the good old days fondly, when doctors with little in their arsenal of effective treatments had the time to do some hand-holding, had few tests to pinpoint a diagnosis and targeted treatments. As a consequence, there were no negotiations with insurance companies to justify expensive diagnostic tests and “exploratory” surgeries that patients underwent “might” find a treatable condition…if you didn’t die first from peritonitis.

So easy now to turn on the TV to watch Dr. Oz and his latest woo, espouse “alternatives”, discuss healthy diets along with the latest woo such as Reiki, immune boosting treatments, homeopathy and other nonsense…coupled with big pharma conspiracy and “government interference”…all complicit in the scam to remove patients’ choice. It’s called the dumbing down of medicine for the people.

@ lilady: well, thanks – I’m no philosopher just a liberal arts person who eventually branched out into reality…

The micro-cosm of pseudo-science I observe gives me hints about what the attraction is:
Obviously the touchy-feely stuff. Nostaglia.
Denial of reality/ avoidance of the unpleasant and uncertainty
Desire to be “hip” and on the “cutting-edge”- a “revolutionary”( puzzling- since subcribing to their ideas drags us back centuries, if not millenia).
While consistency is not their strong suit, it’s great material for an ad campaign.

These charlatans present themselves as being harbingers of the future- the “paradigm shift” is upon us! Crappy studies are presented as legit. Articles like the *Atlantic*’s add fuel to the pseudo-scientists’ fire and provide grist for their mills: it’ll be quoted and presented in all of the usual venues. Alt med’s audience doesn’t sift through the background material and takes woo-meisters at their dissembling word. They mis-represent themselves as being humanitarians fighting oppression by… uh, us.

Which is hilarious to me- with my own families’ and personal history- to be considered a representative of the *status quo*.Ha ha ha!

From the Atlantic article: “These top scientists almost to a person agreed…Most mainstream drugs don’t help most patients much with chronic, complex disease”

I thought about these words this morning when reading a Wall St. Journal op-ed piece about the 30th anniversary of the discovery of HIV, the virus that causes AIDS.

The article made the point that 30 years on, we still don’t have an effective HIV vaccine (though significant progress on this difficult problem has been made). What we do have are highly effective anti-retroviral drugs that have turned AIDS from from a short-term death sentence into a long-term manageable chronic illness where people routinely live 20 years or more after diagnosis.

What has woo given us in the fight against HIV? Rank quackery that costs lives.

“…the Society of Homeopaths are holding a conference in London next week featuring the work of Peter Chappell, who also claims he can make an immediate impact on the Aids epidemic using music encoded with his Aids remedies.

“Right now,” he says, “Aids in Africa could be significantly ameliorated by a simple tune played on the radio.” Damningly, contemptibly, not one single person from the homeopathy community has spoken out to criticise this lunacy.

And of course our own rather grand Patrick Holford, Britain’s leading nutritionist, who sells bottles of vitamin pills with his beaming face printed on them, writes, in the “fully revised and updated” 2004 edition of his 500,000 copy best seller “The Optimum Nutrition Bible”, the alarming words: AZT, a drug still routinely used alongside other drugs in Aids treatment, “is proving less effective than vitamin C”…

Peddlers of nonsense treatments – and newspapers – trade in emotive anecdotes. Three million people died last year of Aids, and that figure elicits insufficient emotion, outrage, and coverage, because it is the polar opposite of an emotive anecdote. Nature outguns any man-made weapon, and it remains our greatest challenge. Our greatest impediment is wishful, brutal stupidity.”

– Ben Goldacre

Somebody argued rather plausibly that the taboo against pork could be because pigs are known to scavenge human corpses and dig up graves (and the deterrent would be the cannibalistic “ick” factor, not the danger of disease transmission). This makes more sense to me than thinking that the ancients discovered an epidemiological connection between pork and trichinellosis, which after all does not become symptomatic until at least two days after infection, and often is not symptomatic at all. Besides, visceral repulsion makes for more compelling taboos than rational reflection does.

MESSAGE BEGINS——————————-

Shills and Minions,

I’m sure you’re all wondering, as I was, where your delightful, new drone went. Surely it would have followed the conversation from the previous thread to spout its cheery, “little engine that could” aphorisms. Fret not my marvelous monkeys, the ladies on level 7 have recalled it for some adjustments. I’m sure it will show up sooner or later. On to other business . . .

Shill Walters (DL, Class VII,), your triumph over the treacly postmodernist indoctrination you faced in your tertiary education never ceases to impress us up here at PharmaCOM Orbital. I am suggesting that you receive yet another commendation for your keen intellect and cogent posts. Your insight into the frailties of your species is as helpful to our cause as it is enriching to your bank account.

Your honored place in the history of the Corpus and the records of Terran Subjugation Unit VII is something the other Shills and Minions would do well to emulate.

Stay Vigilant. Stay Evil.

Lord Draconis Zeneca, VC, iH7L
Forward Mavoon of the Great Fleet, Suzerain of V’tar and Pharmaca Magna of Terra
Glaxxon PharmaCOM Orbital HQ 0010101101001

————————MESSAGE ENDS

I find it amusing that Vasha’s comment about the dangers of eating pork is below a comment from Dangerous Bacon.

I agree, pigs eat all sorts of nasty stuff, and that is very probably the reason for the taboo against eating their flesh. I just think that if fear of a supernatural being’s wrath can persuade large numbers of people to avoid certain foods for centuries, science can surely come up with an effective way way to persuade people to eat sensibly.

The really good ADHD drugs are all off-patent, so you never seem them advertised. The last time I saw a banner ad for adult ADHD it was for some medication specifically for people who can’t take the usual stimulant-based drugs, and not something that was actually more effective. So there’s no real push out there to pull in the vast number (perhaps several million in the U.S. alone) of adults with ADD who would have to, like myself, specifically seek out (and perhaps deal with the stigma of both “mental illness” and “psychiatry” in their worldview) the so-called allopathic medicine that is in fact extremely effective for me, and countless others

scienceology, anyone who would mix a latin root with a greek root is beyond the Pale.

@Krebiozen:

If you want people to not eat something, you can spread rumors that it’s made with human flesh (“Did you know that they use fetal tissue to grow GMOs…”) But a positive incentive is harder to come by, and promoting moderation and balance is harder still. And what about the idea that people should make dietary choices based on sound principles rather than their hopes and fears?

Reminds me of a recent column in some magazine, I think it was the Audubon Society. A conservationist wrote about how, paying a visit to Madagascar, he found that someone had been telling villagers that eating sea turtles was deadly, in an apparent attempt to protect endangered species. He didn’t think it was right to lie, and decided to talk to the villagers and tell them instead why he thought they shouldn’t kill turtles. He thought afterward that his talk didn’t get across very well, and one reason for the confusion was that he happened to be wearing a beard in the style of an imam, so people had come expecting him to expound on what the Koran said about sea turtles.

lilady:

You’ve just come through one of the most painful experiences, with the great non-invasive medical care that is modern day western medicine.

Not “western” medicine, just modern-day medicine. It isn’t culture-bound, you know. Let’s try to avoid the genetic fallacy (which seems to be one of the main bases for woo).

Pete! Aieeee! I am glad to hear you are recovering — I’ve never had one of those, and I hope I never will.


“What state would I be in now if I was relying on CAM to get me through this?”

Pretty much like most pre-1900ish (I am not a medical professional) folk:

Writhing in pain for days, and possibly dying. (sorry, can’t quickly find mortality figures

@ ebohlman: I used the terminology “western medicine” because of my extreme distaste of “allopathic” (buzz word used by homeopaths) or “traditional medicine”…as if non-traditional medicine such CAM or intergrative medicine is on the same level as “modern-day medicine”.

I stand corrected and thank you for pointing me toward “modern-day medicine”…much better phraseology.

Lord Draconis states the obvious…shill Walter is superb at cutting through the crap and is deserving of special commendation. I, a newbie novice shill in training, am in awe of her crap cutting prowess.

My dearest Lord Draconis:

Ever since I was a pale- but very pretty- waif, shivering in the miserable drizzle outside the Opera House where I would sell my violets to the fine ladies who were arriving there- oh, they were so lovely in their silken frocks and velvet wraps, swathed in ropes of South Sea pearls, dripping Columbian emeralds from their shell-like ears- I vowed even then: I would be a fine lady too one day- and a dark one- I would wear fine clothes and drip emeralds. *And* I would be the equal of *gentlemen*: in intellect, cunning, and evil- plus, I’d be a lot better looking, so people would like me even more.

Now that I’ve arrived and got the goods wot I wanted and a friggen title on top of it: I must confess that we are basically battling brave maverick wankers- not one of them even got enough wits about themself to figure out what the f–k we’re talking about most of the time. It is so f–king pathetic and lame! We got all the smarties. They’re all on our side. Come on, now! where’s the challenge! It’s like shooting fish in a barrel for cripes’ sake!

I do thank you for making all of this possible, despite my existential dilemma. I shall persevere and continue on my path of inspirational and fashion-conscious evil. Darling, I couldn’t have done it without you!

Most sincerely yours, DW, DL VII

** BTW, I might feel slightly less morose if there were a few more parties.

@Bush Doctor
“In the 19th century, depending on where you were in the world, a lot of cultures of folk had better access to pain medicine than we do in the ‘west’ today.”

From a quick glance at the article: opium and alcohol self-medication, mostly. Both addictive, both with serious side-effects both immediate (risk of death from overdose, increased bleeding…) and long-term.

Morphine – an opium extract – is still used, in carefully controlled doses and carefully controlled circumstances. Alcohol is not recommended as an analgesic/myorelaxant.

Infusions of willow bark are still available in tablet form (aka aspirin); again, dosage must be carefully controlled because of potential side effects.

So, better access? The stuff that works is still used, only with far less risk. This includes remedies used by remote Amazon tribes and Granny Back In The Old Country: part of modern pharmaceutical research involves studying folk remedies, isolating the active ingredient (if it exists, woo isn’t a recent phenomenon), attempting to synthesize the molecule, and testing it for safety and effectiveness.

Modern painkillers are safer, more effective, and more accurately dosed.

So, basically, you’re talking bollocks.

I suspect some sock puppet may have invaded out thread again with cannabis indica extract. They used all sorts of heavy duty drugs like tincture of opium, ether and copious amounts of alcohol before modern pharmacology. I think I would stick to modern drugs that are titrated correctly.

@ Liz Ditz: I too have been lucky, never having suffered with passing kidney (or gall stones which can get caught in the common bile duct). I seen enough patients to understand the excruciating pain that they suffer through as well as a gangrenous gall bladder, necessitating a very long surgery, extended recovery that my brother dealt with.

I would much prefer titrated pain relief for the intra-operative period, so much more reliable.

As long as we`re logically fallacing, I`m going to Ad Hominem and say that this sentence gave me a headache…

Frankly, the unwillingness of Orac and this crowd to consider for a moment the possibility that there may be some aspect of alternative medicine other than any direct physical action from its core treatments that might be helpful to many patients, especially in light of all the evidence and widespread, highly informed opinion that this is so, perfectly embodies everything that science is supposed to oppose: closed-mindedness, deep bias, hostility to disagreement, reckless disregard for reason and evidence that don’t support a favored conclusion, and a total lack of humility with regard to what one knows for sure.

When Freedman makes his opening salvo at Orac and the commenters on Orac’s blog*, the first thing I thought was:

umadbro?

When he starts making up words like “scienceology”, the first thing I thought was:

Troy Maclure: Just ask this Scientician!
{cut to guy in lab coat next to a microscope}
Lab Coat Guy: Uhh…
{cut back to Troy}
Troy Maclure: He’ll tell your that…

Seriously, Mr. Freedman, if that is your real name and if you’re reading this, kindly grow the hell up.

Jesse way back @15:

Are you honestly suggesting that Freedman ought to be given more leeway in responding to his poorly framed articles about science, and his childish responses to critique by other scientists, and his attacks on readers (way to build up those sub numbers for your bosses there, Dave)because “journalism is hard”?

If Freedman wants to write these anti-science science articles and never have to have his worked criticized, he ought to pull a David Kirby and write only for sympathetic alt-woo mags and websites who will fawn over his every word.

Between hard science and patient experience there lies a long bumpy, twisty road that needs to be MUCH more acknowledged.

Why do you think people keep paying for CAM services, even while they have insurance for conventional drug treatments?

I have always felt much better being treated by CAM practitioners, it’s not a new accusation that doctors make you wait, and then spend a short, impersonal time with you; this is an old complaint.

You can blame it on time-consuming insurance requirements, quacks and gullible people all you want. Oh and while it can be dangerous to wait too long to seek conventional treatment, CAM treatments are generally much lighter on dangerous side effects and much less invasive.

CAM treatments are generally much lighter on dangerous side effects and much less invasive.

Even if they don’t work?

Um, yes? Not sure what you’re point is.

I guess my point is some alternative treatments or diets may be worth trying first, before drugs or other intervention becomes necessary. Here’s an example. Say you are in the very early stages of type II diabetes. I don’t have the citation handy, but I have read that for some people even with full blown diabetes six months on Atkins and they can go off their medication permanently. I have actually seen this more than once, and did read the original papers as this concerns my family, but if this is not well-known I will dig up the reference (it’s probably easily googled).

One advantages of this approach over other diet and exercise approaches is that it is easier to follow, as weight loss is less dependent on calorie restriction and constant exercise, and cravings are under control. The more modest diet restrictions most doctors prescribe are actually harder to follow, as every dieter knows.

So it would make sense for every person who presents with early symptoms of stage II diabetes to be placed on a (perfectly healthy) diet of protein, good fats such as nuts and olive oil, berries, and salads and non-starchy vegetables for six months BEFORE trying other forms of therapy (including other dietary changes) and certainly before any drug intervention (unless the stages are advanced enough to warrant it in the short term of course). This could save billions if practiced on a wide scale. And no bad side effects.

But this will never happen. Currently, it seems most doctors recommend lifestyle changes, but don’t really seem to expect them to be followed and are very willing to non-judgmentally prescribe meds when people don’t exercise or lose weight successfully or whatever, so there is much less pressure.

I suspect that many people are like me, and do their own research, use both types of medical services as it feels right. I do think there is something to the charge that most medical practitioners undervalue lifestyle changes, or don’t keep up with the latest nutritional research, so I am sure to especially research those on my own.

Another point I may have brought up before here, so sorry if I am repeating myself, but I recently learned that an estimated 10% of people may be needle phobic, and as any visit to a doctor now requires having blood drawn many people may be avoiding conventional treatment out of a fear that they may be embarrassed to admit to.

Yes, I would imagine that something that does nothing and has no effects would be less invasive with fewer side effects.

Also, isabel, pehaps you haven’t actually read anything written here, but we pretty much acknowledge that CAMies probably do spend more time with patients than actual doctors – because “spend time with patients” is all the CAMies do.

@ Isabel: I review a few alt med websites and radio shows. Followers are actively frightened away from SBM treatments and offered a plethora of supplements as substitutes. Cures for serious illness are offered as a matter of course via articles, shows, e-books, seminars, films, and lectures ( naturalnews.com). The perpetrators of these illusions present themselves as innovative researchers, far ahead of standard medicine, when they are actually *salesmen* hawking nearly useless products which are available untested legally *only* because of a loop-hole called DSHEA.

A few days ago ( @ progressiveradionetwork.com), the guru told how a woman who had used his products was able to discard her meds for high bp. Other tales are spun about easy cures for ills like cancer, HIV/AIDS, Alzheimer’s, diabetes, MS, ASD/LD, SMI, CV- the list is nearly endless. Phone consults with a nutritionist or dietician ( as if they were the same!) are offered free at the sales phone number.( BTW: untreated high bp can lead to many serious complications including heart attack, stroke, damage to vision and kidney fx.)

This has nothing to do with freedom of choice: it is a deliberate mis-information campaign, taking advantage of the public’s natural fears about medical intervention and loss of control at the hands of doctors. They gain the trust of customers through mis-representation.

There’s no such thing as “alternative medicine.” if it works, it’s adopted by the mainstream and so known as Medicine. if it does not work, then it’s not medicine, but an Alternative To Medicine.
The alternative to medicine is going untreated.

“I have always felt much better being treated by CAM practitioners, it’s not a new accusation that doctors make you wait, and then spend a short, impersonal time with you; this is an old complaint.”

Well I’ve had good treatment from both. I’ll admit the chiropractor and the specialist physio both did me some good in terms of mobility of recalcitrant joints. But far and away the best was the specialist anaesthetist who knew more, a great deal more, about dealing with chronic pain than either of them.

We’re about to get some sort of natural health regulatory authority here in New Zealand. The associate health minister claims: “We want to develop a regulatory system that is cost-effective and gives New Zealand consumers the assurance that the natural health products they buy are safe, true to claim and true to label.”

Imagine if this was really to happen. It could be utterly revolutionary and see all the homeopathic remedies on pharmacy shelves tipped down the toilet where they belong and from where, according to the laws of homeopathy, they must have come, but sadly I don’t hold out much hope.The quacks will find a way around it!

These two stories depressed me especially recently. Is there really no end to this nonsense?

http://www.fitnessgoop.com/2011/05/the-homeopathic-treatment-of-autism-olive%E2%80%99s-story/

http://www.thestar.co.uk/news/health/homeopaths_are_honoured_at_commons_1_3416484

I posted a long reply and it is still held up in moderation for some reason.

I am not advocating that people follow gurus, I am simply saying that average patient experience does not necessarily equal the latest, bestest science in action at all times.

And that it is way less stressful going to alternative therapists.

@Isabel: Going to the dogpark is less stressful than going to a medical office, and it doesn’t cost anything. Going to the beach is less stressful than going to a medical office.

You can go anywhere you want, but when the toll must be paid for ignoring symptoms, you’ll end up at the medical offices, or the hospital, usually much worse off than if you had just dealt with the problem up front using science based medicine.

By advocating CAM, you’re saying that people should do the equivalent of nothing. CAM doesn’t do anything for real illness. Do you get that point?

Of course the average isn’t going to be equal to the best, in any field: that’s how comparatives work. The answer is to work to improve things, not throw them away because not all the children are above average.

For that matter, even acknowledging that sCAM artists can spend more time and be more supportive, how exactly does that justify them taking money for treatments which do nothing? If they merely marketed themselves as a sympathetic ear and dropped the woo, I don’t think most people here would have a problem with them.

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