One of the most potent strategies used by promoters of “complementary and alternative medicine” (CAM)–or, as its proponents like to call it these days, “integrative medicine” (IM)–is in essence an argumentum ad populum; i.e., an appeal to popularity. Specifically, they like to use the variant of argumentum ad populum known as the “bandwagon effect,” in which they try to persuade patients and physicians that they should get with the IM program because, in essence, everyone else is doing it and it’s sweeping the nation. Not coincidentally, this is one type of method of persuasion much favored by Madison Avenue when selling cars, clothing, music, movies, food, beer, and nearly every other product. I say “not coincidentally” because what CAM proponents are doing, more than anything else, is selling a lifestyle, a belief system, and, of course, many, many products. In using this appeal to popularity, CAM/IM proponents try to stodgy physicians who insist on plausibility, science, and evidence to support the use of drugs and treatments as hopelessly behind the times, dogmatic, out of touch, and in general no fun to be around at all.
Arguably no single private organization has been more effective at promoting the infiltration of CAM/IM into medical academia (or, as I like to call it, quackademic medicine) than the Bravewell Collaborative. Co-founded by Christy Mack (yes, that Christy Mack), wife of John J. Mack, the former CEO and Chairman of the Board of Morgan Stanley who now serves as a Senior Advisor, and Penny George, the Bravewell Collaborative was formed when Mack and George hit up a bunch of wealthy, woo-friendly donors to form a charitable organization in 2002 to support the “advancement of integrative medicine.” The result has been the proliferation of quackademic departments in medical centers all across North America like so much kudzu choking off science-based medicine. Known as the Consortium of Academic Health Centers for Integrative Medicine, this group of divisions, institutes, and departments of quackademic “integrative medicine” now numbers fifty and includes some of the most famous medical schools in the nation, such as, for example, Duke, Harvard, Stanford, Yale, and, as much as I hate to admit it, my alma mater the University of Michigan.
So successful has the Bravewell Collaborative been in inserting woo right into the heart of medical academia that a couple of years ago it decided to do a project that it called a “nationwide mapping project” whose purpose was: (1) to describe the patient populations and diseases most commonly treated with integrative medicine, (2) to define the core practices and models of integrative care, (3) to determine how integrative care is paid for, and (4) to identify the biggest factors driving successful implementation. Christy Mack wrote a couple of years ago that she hoped the project would be complete by the end of 2010, but apparently there were some glitches along the way, because the project was just released to the Bravewell website as a report entitled Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States (executive summary here). It’s a massive case of putting the cart before the horse in that it is looking at what Bravewell has wrought in terms of promoting quackademic medicine before without paying attention to whether any of this stuff actually works or whether “integrating” this woo into medicine does anything whatsoever to improve the quality of care at the medical centers that have jumped on the “integrative” bandwagon.
Before getting into the meat of the report, it’s worth noting that this is not the first survey of this kind. In fact, Bravewell was beaten to the punch by another major promoter of CAM/IM, the Samueli Institute, and the Health Forum. Together they published a report five months ago entitled 2010 Complementary and Alternative Medicine Survey of Hospitals, which I reviewed in depth. The difference between the Bravewell report and the Samueli report is that the Samueli report focused way more on motivations (i.e., why hospitals decided to start CAM/IM programs), means (how they started up their CAM/IM programs), and finances (how much of do these programs cost and do they make any money?) than the Bravewell report did. The two reports do overlap in trying to survey the specific CAM/IM modalities offered by the hospitals surveyed that reported having CAM/IM programs. Also, the Samueli report had more breadth and less depth in that the investigators sent out a surveys to nearly 6,000 hospitals, while Bravewell focused its attention on 29 hospitals, several of which were Bravewell Consortium members, the rest of which were not. In other words, the differences between the Samueli survey and the Bravewell survey can be summarized as looking at a broad sampling of all hospitals (or at least trying to) and taking a focused look at true believers.
The Bravewell report begins with the same distortions of language to which we’ve become accustomed from CAM/IM apologists:
The Bravewell Collaborative, a philanthropic organization that works to improve healthcare, defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.”
Over the past two decades, there has been documented growth in the number of clinical centers providing integrative medicine, the number of medical schools teaching integrative strategies, the number of researchers studying integrative interventions, and the number of patients seeking integrative care. But whether integrative medicine was being offered in the same, similar, or disparate ways was unknown. In addition, while previous studies focused on the prevalence and use of complementary or alternative medicine (CAM) by patients1, 2 or by practitioners in hospital settings3 by enumerating the use of single CAM therapies, very little information had been collected regarding the actual practice of integrative medicine, which by definition treats the whole person.
That was from the executive summary, but the same sort of language pervades the introduction to the report proper, in which the authors go on and on about how “all factors that influence health, wellness, and disease are taken into consideration,” “care addresses the whole person, including body, mind, and spirit in the context
of community,” and how care is “individualized.” Note the canard of “holism,” in which (or so it is claimed) CAM/IM is supposedly capable of taking care of the “whole patient” in a way that scientific medicine is not. This is, of course, utter nonsense built on a false dichotomy that says that a practitioner has to embrace pseudoscience and prescientific beliefs, such as those behind homeopathy, “energy healing,” and the like, in order to take care of the “whole patient.” It’s been a successful ploy in that quite a few physicians have apparently bought into the lie inherent in the very name “integrative medicine.” If they hadn’t, there wouldn’t be so many CAM/IM programs that have sprung up over the last ten years, to be surveyed now.
The report is fairly easy to read, and it tells us all sorts of things, including that the most common model of CAM/IM care is consultative care, with less than half offering primary care, the latter of which is not as bad as I expected. We also learn tidbits about which I care almost nothing at all, such as that 72% of CAM/IM centers surveyed use electronic medical records and, oddly enough, 72% also offer self-care and wellness programs for their practitioners and staff. One notes that my university offers self-care and wellness programs; so this isn’t particularly impressive to me. I’ll take science-based care over woo any day, and “wellness” is a term that’s been so thoroughly co-opted by CAM/IM that I can’t help but frown whenever I read or hear it. Then, of course, a huge number of these programs say they do research, which makes me wonder what has become of the word. Either way, these little tidbits, while useful, were not particularly novel; basically they were a big snoozefest.
More interesting to me were the specific modalities offered in CAM/IM centers in their order of frequency:
The interventions prescribed most frequently across all conditions, in descending order, are:
- Food/Nutrition
- Supplements
- Yoga
- Meditation
- TCM/Acupuncture
- Massage
- Pharmaceuticals
The authors comment further:
In the treatment of the 20 health conditions (see chart on page 42), 15 or more of the centers report that:
- Food/nutrition is used for all conditions except acute pain.
- Supplements are used for all conditions except pre-operative care.
- Meditation is used for all conditions except ADHD and allergies.
- Yoga is used for all conditions except ADHD, allergies, and post-operative care.
- Relaxation techniques are used for all conditions except ADHD, allergies, and
- immune disorders.
- Herbal and botanical remedies are used for all conditions except ADHD and
- pre- and post-operative care.
- Breathing exercises are used for all conditions except ADHD and allergies.
Notice anything? I do. Look at what the number one most frequently prescribed treatment by these CAM/IM centers. It’s nutrition or food. When I saw that, I had two questions. First, when, exactly, did nutrition or food become somehow “alternative” or “integrative”? Did I miss something somewhere? Nutrition is a science-based field, and the use of nutrition to prevent and alleviate illness is–or at least should be–science-based medicine. Yet, here it is magically “rebranded” as somehow being part of CAM or IM! That’s what we mean when we describe the “bait and switch” of CAM/IM. Plausible, potentially science-based treatments are reborn as CAM/IM and then used as evidence that CAM works. They’re also the Trojan horse that CAM/IM proponents trick the guardians of SBM into bringing into fortress of academia. After these modalities have been accepted as “CAM,” out jumps the real woo, such as “energy healing,” to take over. It’s not so far-fetched, given that my alma mater has a program in Steinerian woo known as anthroposophic medicine. I can’t wait until its botany department starts offering courses in biodynamic farming.
Be that as it may, note that, out of the top seven modalities reportedly used, only one of them is truly “alternative,” namely TCM/acupuncture, while one is borderline (supplements), and the same observation I have about nutrition applies. Massage? Since when is that “alternative,” bad woo-omics studies of it notwithstanding? Pharmaceuticals? You might as well see a real doctor! Yoga? Stripped of its woo, it’s just a form of exercise. Meditation? It’s just a variant of relaxation therapy. Supplements could be woo or non-woo, depending upon how they’re used, but when naturopaths, homepaths, and chiropractors use the they’re almost always woo. And, of course, traditional Chinese medicine and acupuncture are nearly all woo.
Particularly revealing is a section in which the survey asks for what diseases/conditions does IM produce “success.” That is, of course, a question so incredibly vague that, unless the patient dropped dead immediately upon contact with the therapy recommended, centers could claim some level of “success,” and they do. No metrics for “success” are given. Instead centers were asked what conditions they considered to be conditions “among their top five most successfully treated conditions.” This generated the following, utterly useless table:
Cancer was number five, with 52% of institutions claiming it to be in their top five conditions for which they have “success”? What do they mean? Certainly they don’t mean better survival, because I’d sure as heck like to see that data if their claim is that they are successful treating cancer with CAM that way. I do have to admit that I chuckled grimly at this passage:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in Zion, Illinois and The Integrative Medicine Center at MD Anderson Cancer Center in Houston, Texas. These two institutions only treat people with cancer. At CTCA, all treatment teams include a dietician, naturopathic doctor, mind-body therapist, chiropractor, and pain management clinician (including an acupuncturist) as well as a medical oncologist. MD Anderson’s integrative medicine center offers acupuncture, massage therapy, and mind-body-spirit practices such as meditation, guided imagery, yoga, tai chi, and music therapy. Therapies are provided to caregivers as well as patients.
Yes, Bravewell actually lumped together the Cancer Treatment Centers of America and M.D. Anderson Cancer Center. In woo, apparently, they are equals, which is far more an indictment of M.D. Anderson these days than it is praise for CTCA.
Next up, this survey touts the “personalized” care that these CAM/IM centers allegedly give, with 93% of the centers surveyed claiming to offer “individualized care plans” for their patients. This, too, is pure nonense. No, I’m not doubting that these centers come up with care plans designed for each of their patient based on whatever “integration” of science-based medicine and pseudoscience takes their fancy. What irritates the crap out of me is that this CAM/IM apologists claim they are so much better at “individualizing” care than SBM, a claim that is pure nonsense. In breast cancer, I make individualized care plans for each of my patients as well. Nearly all of our breast cancer patients have multidisciplinary plans individualized to each of them involving multiple specialties (usually surgery, medical oncology, and radiation oncology, sometimes with genetic counseling). In other words, this claim is meaningless. The only thing that surprised me was that it wasn’t 100% of centers claiming to offer “individualized care plans.” I’m amazed that two of the 29 didn’t claim to make them. it must have been the evil reductionistic Western scientists who forced them into offering “one-size-fits-all” treatments.
Finally, I found it interesting to look at where the rubber hits the road, so to speak, namely what practitioners these centers are willing to pay to work for them:
Not surprisingly, nearly all of these centers employ MDs. They also nearly all employ massage therapists and acupuncturists. What surprised me is that only 28% of them employ naturopaths, 21% employ osteopaths (maybe they’re all too busy being real doctors), and only 17% employ Ayurvedic practitioners, which is no different than the number employing homeopaths. What didn’t surprise me is that some of these centers employ reflexologists and Rolfers, although I must admit that I have no idea what an “energy psychologist” is. Nor do I really want to know.
So now that we know the “what,” as in what services are offered, what are the outcomes. As it turns out, that is where this survey is unintentionally revealing. Basically, there are no outcomes reported. There are lots of patient satisfaction surveys showing that patients like the woo, but there is little or no discussion of effectiveness other than self-reported effectiveness with no metrics to let us know whether or not the center directors filling out the surveys had any connection with reality when they listed the conditions for which their centers have the most success.
All of this is very thing gruel upon which to base the conclusions of the report, such as:
The number of centers included in this study who expressed to the authors that their patient numbers were growing and/or their roles in their respective healthcare systems were expanding, suggests an increasing acceptance of integrative medicine by the American public and the medical professions.
Remember, there were only 29 centers surveyed. That’s a big conclusion to rest on such a little study, particularly given that the survey used couldn’t measure acceptance of IM by the public anyway.
The authors also conclude that IM really, really needs three things, the first of which is outcomes data. This is, of course, putting the cart before the horse, as outcomes studies are usually indicated only after a treatment has been shown scientifically through a combination of basic science and translational research plus well-designed randomized clinical trials to be efficacious and safe. Until that evidence is there, there really aren’t any good reasons to look at outcomes because there aren’t any scientifically valid reasons to use these therapies to begin with. And if there aren’t any good reasons to be doing outcomes research, then there really aren’t any good reasons to be trying to identify best practices, which is the second recommendation. After all, how does one identify best practices when there is so little sound evidence base to support the practices being examined. But don’t worry! Bravewell will definitely be doing another survey. That is, after all, its third recommended next step.
None of this stops the authors from concluding:
One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with non- conventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community.
The breathtaking inanity of that conclusion took my breath away. (Yes, that was intentional.) My conclusion is different. I conclude that “integrative medicine” integrates pseudoscience with science, quackery with medicine. Where it fails to do that, it rebrands science-based modalities like nutrition as somehow being “alternative,” except, whatever you do, don’t call IM CAM:
As was well articulated by Benjamin Kligler, MD, and Roberta Lee, MD, in the textbook Integrative Medicine: Principles for Practice, “Integrative medicine is not synonymous with CAM.” This survey has shown that integrative medicine centers embrace a group of core values that inform and radiate through their practice and interactions with their patients. Integrative care is, in practice, patient-centered care and is a fundamentally collaborative enterprise fostering cooperation between patients and practitioners, and among the practitioners themselves.
The problem, again is that it is not necessary to “integrate” pseudoscience with science-based medicine in order to practice collaborative patient-centered care. Bravewell keeps selling that false dichotomy. I’m not buying, but unfortunately a lot of doctors and medical centers are.
74 replies on “Surveying the “integrative medicine” landscape (2012 edition)”
Treating “wellness” has one major advantage: most people are well most of the time, so there is always someone to treat.
How long do I have to keep coming in to see you? How long do you want to remain well?
Very nice. I’m wondering:
Say we want patient to exercise more and eat better, and offer them a class and exercise group to join. That may be better than just telling them to do it on their own, since it is just an extra option. In the extreme if we have 9 different such exercise options, each with it’s different flavor of crazy or not-so-crazy spin (Jesus, well-being energy, eastern mystery talk, crunchy plant worshipers, jazz-fusion dance hour, birding, swimming naked) we might get more people to comply. It seems possible that none of them would beat others in randomized head-to-head, but pitting a large choice against a narrower one might give differences. It would seem to be leveraging people’s nuttiness. They presumably do this on their own anyway – I use the famous steelhead-fishing-therapy and killing-autumn-olive land-stewardship therapy to burn calories at this time of year, soon to be followed by gardening on a ridiculously massive scale. Is the problem that 1) there is actually no difference when you measure, or 2) the people will also accumulate false beliefs that do harm (fish worship). What limits should be placed on such pandering?
Maybe the line is: no lying allowed. That kills off a couple of them.
I have no idea what an “energy psychologist” is. Nor do I really want to know.
No, no you don’t. But anyway, it’s basically reiki by another name. Anyone who wants to have a good larf should google “thought field therapy.”
An energy psychologist is….me with too much caffeine or pseudoephedrine?
I think that they mean something like EFT ( tappping non-existent accupuncture points to balance non-existent energies) or the dreaded – and dreadful- poppycock about “energy exchange”. Orac, you missed the last one: writer. I can imagine- if I didn’t have a shred of decency- which -btw- I do have- getting clients by advertising in the monthy woo-pages : *I can balance your energies and show you how writing can help you attain whatever you wish for!* Throw in a little of ‘the Secret’ as well. However, my parents always taught me that taking advantage of people I could outsmart or talk into things was very wrong. I guess not all parents were like mine.
This would include EFT (Emotional Freedom Therapy – tapping on acupuncture points) , Thought Field Therapy and all sorts of other woos that believe that psychological problems are due to messed up energy fields that need to be disentangled, purged etc.
I wonder if in all the paperwork they have you signing, there’s a disclaimer that admits that all this is BS.
What is a ‘Biofeedback Practitioner’?
I have a set of Christmas tree lights I have been unable to disentangle for 2 years. Can I get hold of a thought field therapist do do the needful, come next Xmas?
I misread the title as “Surviving ‘integrative medicine'”, which gives a whole new twist.
Well, I have some time before my services are needed ( no re-balancing fortunately):
I’ve run into a great deal of life energy woo that deals with physical and psychological issues. Generally, it imputes a vitalistic view of human health and illness. There is some sort of life energy ( Qi, Prana, *elan vital*) that circulates and can get all blocked up thus needs work- like a clogged drain does- then you call the woo-eqivalent of a plumber to get things flowing again. A few use a Chakra-based system to label types of problems ( heart Chakra et al) that refer to physical and psychological/emotional correspondences while others use the TCM 5 element system that links up with accupuncture points. Hand-waving *a la* Reiki may be involved as well as meditation or yoga asanas to re-balance. You can easily imagine the relation to Chiropractic allignment.
There is a Life Energy Foundation that researches these so-called therapies. I am familiar with Gary Null’s steal of energy medicine/ psychology from his forays into theories of personality types: unlike Jung, who gave us Introversion/ Extroversion, he postulates 3 types- dynamic( the innovators and revolutionaries), creative ( artists) and adaptives ( followers): guess what he is? The coolest one, of course. People get stuck and exhibit the negative side of their energies and can be naturally adjusted through a dynamic energy exchange with the healer. Thus energies will flow unimpeded as will the crap promulgated by the healers.
Because psychological issues make people vulnerable to charlatans’ prevarication, I find this type of woo especially despicable.
– note: biofeedback may be somewhat reality-based as it measures real things ( like bp, brainwaves, heart rate) the question is about how effacacious it is as a therapy.
Wow, what a bitterly written article. I have no idea why people dismiss those that choose to use a combination of “Eastern” and “Western” medicine. It is clear they have never had a bad reaction to medicine or a chronic or debilitating health condition in which they wanted to see a practioner that wanted to treat the problem, not just the symptoms.
This article is of course, very slanted as I figured. All integrative medicine tries to do is bring two sets of ideas together. Unfortunately it seems to be construed with alternative medicine, which I have no personal experience in and seems to be a lot of B.S. I personally have a family doctor and an integrative doctor, so that both my chronic conditions and acute conditions can be treated. I do feel bad for those that are so closed-minded as to dismiss what actually makes them feel better because there is no definite proof in general. Thanks for the laugh though.
One set of ideas having been carefully tested and backed by science, and the other set being whatever some dude way back when decided to pull out of his nether regions.
Perhaps because it IS exactly the same as alternative medicine, which you correctly identify as a lot of BS. It was to elicit exactly your reaction – that this is somehow new and good – that they changed the name.
You can’t know without the science whether the treatment is what made you feel better, or something else.
On a similar note to this and other articles here in recent weeks, any (informed) opinions on the blood tests offered by Dr. Joachim Fluhrer, a general practitioner based in Sydney Australia, to test cancer patients for CTCs and to “decide” what of a panel of alternative treatments might be offered to the patient – ? (Iâve done a little background on this, but I donât want to clog up the comments expanding on what might be a distraction or nuisance.)
There are plenty of non-medical things one can do to feel better that don’t require paying good money for some woo-meister to diagnose energy blockages or questionable nutrition deficiencies. Some of my personal favourites include having a nice bottle of wine or craft beer, watching a funny movie, reading a trashy novel, going to a new restaurant, making soup….YMMV.
However, all that is kind of beside the point of the blog post, which is about unproven pseudo-scientific treatments being offered in academic medical centres. This is problematic for a number of reasons, the main ones being that it lends superstition-based modalities (reiki or Ayurveda, anyone?) a credibility they don’t deserve and is diverting resources that should be going towards science-based treatment and research instead.
@Orac
Off-topic: Have you seen the “Free to choose medicine” campaign by the Heartland institute? That looks like quack 101, making drugs available before clinical trials are finished.
“Wow, what a bitterly written article. I have no idea why people dismiss those that choose to use a combination of “Eastern” and “Western” medicine.”
-Perhaps if you would define the differences in “Western Medicine” and “Eastern Medicine”…and not pull the race card…we would be inclined to believe what you stated.
“It is clear they have never had a bad reaction to medicine or a chronic or debilitating health condition in which they wanted to see a practioner that wanted to treat the problem, not just the symptoms.”
-Are you including “me”…who has had a bad reaction (allergy to penicillin and ineffectiveness of ACE Inhibitors and ACE blockers) prescribed to treat infections and hypertension)? How would a practioner (sic) treat the “problem”?
“This article is of course, very slanted as I figured.”
-Was your first clue that you chose a science blog to post your drivel?
“All integrative medicine tries to do is bring two sets of ideas together. Unfortunately it seems to be construed with alternative medicine, which I have no personal experience in and seems to be a lot of B.S.”
-Copping out eh, by redefining “integrative” and “alternative” medicine.
“I personally have a family doctor and an integrative doctor, so that both my chronic conditions and acute conditions can be treated.”
-Let me guess. Your family doctor actually treats your acute conditions. Your integrative doctor treats your chronic credulity.
“I do feel bad for those that are so closed-minded as to dismiss what actually makes them feel better because there is no definite proof in general.”
-Wanna translate that in plain English?
“Thanks for the laugh though.”
-The laughs are generated from silly comments.
“It is clear they have never had a bad reaction to medicine or a chronic or debilitating health condition…”
Well, no. I’ve lived with chronic pain for more than a couple of decades, enlivened by the occasional episode of paralysing, throw-up inducing, acute pain. I have to say I was gob-smacked by the listing claiming that chronic pain was their big IM success story, and they even claimed efficacy with acute pain.
Perhaps I use a different dictionary for words like ‘pain’, ‘treatment’, ‘acute’ and ‘successful’. The only time I gained any reliable relief was from evil Big Pharma drugs – until I developed an allergy to them.
Whoops. Just read my post again. Looks like an invitation to the world of whacky to claim that these drugs are no good because you finish up with allergies and you can’t take them any more.
Well, it’s not about the evil of drugs. It’s about the misfortune of having a constitution highly attuned to finding beneficial things to be allergic to. I’m also allergic to most antibiotics – and it’s not ‘sensitivity’. It’s a wonderful opportunity for your doctor’s allergist husband to do some fantastic, exciting analysis to identify anaphylaxis processes as they develop. They were thrilled. Me, not so much.
(But I was grateful she took so much care. I was far too accustomed to low blood pressure to realise that ‘this time it’s different’. She knew better. Lord knows what a woo-meister would have done for me or to me.)
“First, when, exactly, did nutrition or food become somehow “alternative” or “integrative”? Did I miss something somewhere? Nutrition is a science-based field, and the use of nutrition to prevent and alleviate illness is–or at least should be–science-based medicine.” Very much agree with you that food is a science based medicine. However, it’s considered integrative or complementary because it is not taught in medical school in a meaningful way. Physicians rarely talk about food other than to tell patients to eat vegetables. If you want a good view of where nutrition stands in the medical profession stay overnight as a patient in a hospital and eat the food that comes on your tray, courtesy of your medical professionals.
The FDA, IOM, hospitals, ad rag journals, dirty doctors (e.g. “opinion leaders” way in bed with conflicts of interest), etc. are the ones who have made cheap treatments, food, nutrition and supplements “alternative”. I’ve had to drop (fire) a number of doctors because they (w-) couldn’t climb the curve fast enough even when I took precious time to find and print the relevant papers from NEJM, BMJ/C, Lancet, etc, even with trial results p<0.01.
Kathy, have you ever actually talked to a doctor about nutrition? The way you’re talking, it’s like a car manufacturer, when told that their vehicles “safety features” have not been shown to work, responding by insisting that other manufacturers don’t put brakes or steering wheels in their vehicles.
#19 character display failure? should show “…even with trial results, p less than 0.01” (with “<" for "less than")
Shall we analyze exactly who Kathy Merrill is…she is the wife of an integrative medicine doctor who “fancies” herself as an expert in nutrition. Kathy, who has never herself attended medical school, runs a blog about “nutrition” as the be-all and end-all of good health. Kathy needs to look into the ADA website to find real expert advice from Registered Dieticians…not the bullshit that emanates from self-promoting “nutritionists” whose degrees are conferred by diploma mills.
@ prn: Now posting as an expert in “nutrition”, eh? Feel free to fire any or all of your doctors who do not understand your interpretation of articles you have read on “nutrition”; “Big Nutrition Shill”
*Insert obligatory link to Dara O’Briain skit on nutritionists vs. dieticians here*
You are correct, nutrition is in the realm of evidence-based medicine so yes, you did miss something somewhere. Perhaps you are confused by self-styled “nutritionists” who have tried to co-opt the realm of nutrition as alternative.
The only ones it’s considered CAM by are the ones I described above. You are also painting with a very broad brush. More students are demanding more hours of nutrition courses and schools are responding. It also depends upon geographical areas too; many mid-large metro practices employ registered dieticians and have wellness clinics for preventative medicine with absolutely no woo. Hospital food? Again depends upon geography, economics and individual patient needs. Comparing hospital food to a maintenance diet is a bit of a red herring besides.
-I have a post in moderation about so-called psychological applications of energistically abysmal woo-
To re-iterate: people with psychological issues ( including mental illness, substance abuse, learning disabilities, situational stress or emotional turmoil) are especially vulnerable to manipulation by charlatans and con artists: witness, of course, the justly infamous AJW and his work amongst parents of disabled children. Or Scientology. Or any kind of woo that primarily relies upon the provocation of fear prior to rifling through its victims’ pockets.
@ prn: well, well, fancy meeting you here!
@25 Thanks, Denice. Nice to see someone missed me. Several times.
@ Science Mom:
Curiously, there is a war being waged by alt med *against* dieticians – who are SB and tested to standardised requirements- by nutritionists whose training is quite variable based on location and orientation. Any attempts by dieticians to protect their territory from entrenchment by the forces of woo is met with fierce opposition from the likes of Mike Adams and other health freedom-fighters: they profess little love for hospital-based dieticians especially.
Let’s be specific. A dietitian is science based, a nutritionist is more or less a quack. My aunt was able to deal with her diabetes via a skilled nutritionist for a long time.
A, if “eastern medicine” as you like to call it is so fantastic, why is it that people in those countries(Japan, China, Korea) use western medicine unquestioningly? Living in rural china it was incredible how well the vaccination campaign had gone. I don’t think I saw anyone without the jab marks. There they clamor for western medicine, as the folk remedies they relied on for centuries failed them. Those eastern remedies that did work have been folded into SBM for awhile now, leaving those practitioners of “eastern medicine” more or less relegated to side shows in these countries.
Please, don’t think that eastern countries use eastern medicine. They don’t.
No. Spelling failure by commenter.
The < character is spelled < in any HTML context. The < character in HTML means “here is a text markup sequence”, which is why there’s a special way to enter it. If the browser doesn’t recognize the text markup sequence, funny things can happen. In this case, it’s the SB blog engine â if you enter a screwy text markup, it seems to get dropped, along with the rest of the comment. Your markup seems to have been <0.01″ (, perhaps with some spacing added. That’s not acceptable HTML.
The & character is also an HTML funny â it is spelled &.
The SB blog engine may mess up this comment, too. It’s doing a number in preview…
he who knows not and knows not that he know not- is a Fool. –SHUN HIM–
The dieticians are hidebound. There is plenty of medical literature that indicates therapeutic nutritional opportunities unused by the RD. Perhaps some of it is better classified as “experimental” for popular use or governmental fiat, much of it is lab demonstrable in the individual cases.
The recent and forseeable vitamin D application changes are an example of both IOM and RD being behind various curves that are not justifiable to the more scientifically literate with various high risk situations, hobbled by inertia. There exists and has existed a body of knowledge on vitamin D application over the last 10 years where the real risks fell on the followers of IOM and the RDs advice, however incomplete the vitamin D researchers’ formal paperwork and acceptance may be.
I spent way too much time in hospitals in November and December last. The Medical Professionals had me on various diets: NPO (the null diet), clear liquid, and soft, from time to time, sometimes all three on the same day. Each time a Medical Professional changed my diet, a real nutritionist/dietician (not one of the IM fakes) showed up to evaluate me and lead me through the hospital’s food selection process.
Question for the CAM proponents: I presented at the ER with severe hypotension, diarrhÅa, minor abdominal pain and syncope. The CT scan was inconclusive: it seemed to indicate an extra-colonic abscess and something funny in or around the colon. Assume the ambulance had taken me to your CAM facility. What would you do to treat my “wholeness”, in light of my presentation?
The local hospital started me on Normal Saline, for diarrhÅa-induced dehydration, and two or three antibiotics. Then they sent me to the larger, regional hospital, where they sucked the abscess out through a little hole in my side, and sent me back to the med-surg floor for more antibiotics and NS.
After five weeks of antibiotics, I was fit enough for exploratory surgery, where the surgeon found that I had experienced a ruptured appendix: of course, the exploration turned into an appendectomy, to be followed by months of recuperation, still in process.
Nobody told me, until much later, that I had nearly croaked before and during the initial treatment â my wife, a retired nurse, was with me throughout, and had a tough time keeping control of herself, what with her knowledge of the gravity of my condition.
If I had been taken to a CAM facility of any kind, what are the chances I would be telling this story today? Would I have survived, as I did, to celebrate my 70th birthday?
@ prn:
I do seem to recall numerous articles about vitamin D as panacaea (as anti-cancer, used in place of vaccines et al) courtesy of Mercola, NaturalNews, the Progressive Radio Network who *also* proclaim themselves *ahead* of various curves. Are those the references which you also cite ( e.g. Mercola’s Vitamin D Resource Page)?
Denice, I am not following Mercola, although I am somewhat aware of him. He has had products that I consider curious or overpriced, and religious views that I don’t agree. I utilize papers from the established vitamin D researchers at North American medical schools and some of the independents with ca 15-20+ yrs focused interest. Most papers I found through starting searches with several known researchers.
However impressive it is, I don’t consider vitamin D a panacea.
IIRC, the last time “prn” visited here, she had some odd opinions about vitamin D and cancer prevention and cancer treatment…backed up by ancient research papers.
For some reason, “prn” thinks she is “ahead of the curve” when compared to the knowledge of doctors, nurses, Registered Dieticians and others who are educated in the sciences.
FYI, before someone starts in on me, I use “prn” in the latin and medical senses of Pro re nata, “in the circumstances” or “as the circumstance arises” or “as needed” or “as the situation arises.” For reasons perhaps more familiar to long time RI readers.
I looked up the webpage of “Progressive Radio Network” and could only recognize two of the names, Adams and Null, out of a lengthy list. I have no familiarity with that PRN.
I have a background in massage therapy and bodywork, and Iâm currently pursuing a degree as a doctor of physical therapy. Hereâs my take: there is a lot of quackery in alternative therapy, but anyone who writes the whole field off as superstition is guilty of extreme arrogance. Tradition and intuition are inherently flawed as a basis for medical practiceâthe former is difficult to challenge and change, the later canât be taught or standardized; but reason is flawed as well. Any logical conclusion is only as valid as its axioms, and because one cannot feed all available information into a logical construction all conclusions must be wrong in some way. As evidence of this in health sciences, just look at how many FDA approved medicines and procedures are later determined to be ineffective or harmful. Or look back on some of the ridiculous ideas that persisted in science for a long time (such as the existence of phlogiston or radiation being a panacea). Now, this is not to say that I have a problem with modern medicine. No other medical tradition can target a disease for eradication or replace internal organs, after all.
But for all the benefit that the strict focus on the physiology of medicine has been to the detriment of the psychology of medicine. People want to feel important and empowered, and that doesnât happen in most hospitals these days. So if visiting a rolfer or ayur vedic practitioner provides an explanation or structure which helps bring that about then it was well worth the money, with any other benefits being an added bonus. Another aspect to consider is the disconnect between scientific thought and popular thought. Chew on this: the least persuasive scientific argument you can make is the anecdote, but it is amongst the most persuasive rhetorical arguments. Matthew Shepard getting attacked was meaningless from a statistical standpoint, but it put a face on all the violence against gays at the time and changed the nation conversation on the issue. So you canât expect pure evidence based knowledge to meet the psychological needs of all people.
So for those of you who have smugly written off all alternative therapy, I say go take a yoga class and get a massage.
“FYI, before someone starts in on me, I use “prn” in the latin and medical senses of Pro re nata, “in the circumstances” or “as the circumstance arises” or “as needed” or “as the situation arises.” For reasons perhaps more familiar to long time RI readers.”
I thought you are the “prn” that posted here before…the one who dissed doctors (didn’t “trust” a doctor under age 75), nurses and Registered Dieticians. That “prn” touted naturopathic herbs and magical mushroom extracts and advocated on behalf of excessive amounts of Vitamin D 3.
As I recall, that “prn” claimed to be studying “nutrition” textbooks for the past 15-20 years…which provided her with credentials to discuss the immune system and Vitamin D3 cancer therapy.
Gee, we are still waiting for citations from that “prn”.
I have ADHD, so I couldn’t help but notice how many of the “alt” remedies were recommended for everything but ADHD and allergies. I’m somewhat allergic to pollen, and this month is pollen season in the Bay Area, so I’ve been taking generic diphenhydramine (Benadryl) for that. I take two generic meds for my ADHD: methylphenidate (Ritalin) and bupropion (Wellbutrin), which work extremely well for all my symptoms (inability to concentrate on boring tasks, anxiety, depression), and the combo’s been working extremely well for me since I was first prescribed them almost 10 years ago.
I also notice that the “success” rate for the alt therapies is very low for those two conditions: 17% for allergies and only 11% for ADHD. I think the explanation for that is quite simple: neither of those conditions responds to the placebo effect. After all, ADHD is an inability to control one’s brain to focus the attention, and no amount of positive thinking or woo is going to just make it go away. Medication, on the other hand, is often highly effective. Every day I’m grateful for “Western” (LOL) medicine and the relief it gives me from my symptoms.
Ironically, diet and exercise are both very good things for ADHD. Meditation, breathing exercises, and yoga could also be helpful. IOW the very conditions the alt-medsters are not recommending for ADHD are the ones that are probably good advice, but insufficient. Besides medication, good diet, plenty of sleep, and exercise, the thing I’ve found most helpful has been reading books about ADHD and following the lifestyle advice recommended in them: finding ways to work around the limitations of my brain by organizing my life in such a way to work with my wandering attention span instead of against it. But that’s psychology, not alt-med, either.
Anyway, where’s my pharma check? My generics are coming from Mylan and Watson: perhaps I can get some big generic pharma money shilling for them?
Same prn, +1 yr. I quoted substances documented with varied immune benefits, like cimetidine, PSK (a medically prescribed mushroom extract in Japan) and D3. Some here like to just heckle, hoot and holler rather than to analyze, look and exchange.
Vitamin D3 and derivatives *are* being studied in the mainstream for cancer treatment. My personal view is to try to identify cumulative benefits from many low toxicity adjuvants – cancers are hard to eliminate; a body needs a coherent strategy and as many pathways as possible covered. Unfortunately many people die prematurely and miserably at great expense before they understand the limitations of standard care in medical oncology.
I already provided you with more cites than reasonable conversations usually get.
You greatly conflate “trained in often obsolete medical technology and doctrine” with knowing or doing real science. I am not alone in criticizing aspects of current medical practices.
Tony Mach @14 – No doubt some quack has given the Heartland Institute a bunch of cash. However, they are probably currently busy doing damage control after an insider leaked a bunch of documents regarding their AGW misinformation campaign, including a statement that the Heartland Institute is attempting to dissuade teachers from teaching science.*
*They are now claiming this part of the document was altered and are intimidating bloggers with legal threats.
@ 42 Militant Agnostic
Re Heartland. It is a joy to watch.
However the leaked docs show a planned 3 year , $US 1 million per year budget.
Bart Madden the author of the book “Free To Choose Medicine” is listed as ‘partially’ funding the endeavor. He may be wealthy enough to be he major funder. Madden link
@ prn:
The woo-accumulators to which I refer ( aforementioned websites) condense material that I believe is similar to what you espouse. Mercola, for example gives a long list of studies, the others have articles about vitamin D’s effects, citing studies, many un-recognised by SBM. Off the top of my head, I can also recall names like Ng, Cannell, Holick. Similarly, I have heard PSK mentioned by alt med for many years. Cimetidine as well.
Altho’ I understand where you’re coming from-( use several supplements that have shown some slight promise in conjunction and hope they will work synergistically)- here’s the big problem for me: there is no really good data because if there *were* many researchers would have hopped on the bandwagon by now, we’d have a lot more evidence. Another is that perhaps substance1 works the same way physiologically as substance2 does- so using both only increases the dose. Did you ever think that the weak effects may be due to a methodological or statistical problem? Perhaps the reason there isn’t more research is because experts did not see as much promise as you do. I wish simple subsances *did* work.
SBM shows percentages over multiple trials by multiple researchers. You may not like their options ( who *likes* chemo?) but pharma companies are forced into trials.
@ Jake Hamby:
Well, what do you know, an apprentice pharma-shill!**
Seriously, it sounds like you’re doing fine. While I don’t have ADHD, as a student, I always tried to apply what I had learned and found cognitive psych especially advantageous when I had to take data-heavy exams- which were frequent-( my fellow and sister students would seek me out as a tutor: I was usually paid in drinks and dinners). It’s possible to become your own coach.
** the money usually arrives by post on Tuesdays. Don’t get too upset if they miss a payment: they’re testing your loyalty.
http://www.cbc.ca/news/health/story/2012/02/16/mms-sodium-chlorite.html
Supplementary and complimentary to the thread *cough* Health Canada has recalled a “detox” suppliment called MMS for containing toxic levels of sodium chlorite; they have also shuttered the vendor’s web site.
*This* is why we have Health Canada or the FDA, and why I don’t resent paying my taxes.
— Steve
Matt,
Which parts of alternative medicine do you think are not quackery or superstition?
Not very many really. It is only post-marketing surveillance of medicine when used by large numbers of people that allows us to know if treatments are dangerous. Many alternative treatments, like chiropractic neck manipulation, or acupuncture, may be more dangerous than a drug like Vioxx. Neck manipulation can cause stroke, and acupuncture can result in infections, and even punctured lungs. We don’t really know how often this happens because alternative medicine has no well-established mechanisms for assessing this.
People used to believe a lot of what we can now see is nonsense. What really transformed medicine was the development of the randomised, controlled trial. That is the tool that allows us to distinguish between what is truly effective and what is quackery and superstition. It’s not a perfect tool, but when carefully used it is pretty good,
There I agree with you, but I’m not sure that it is the job of a hospital to make people feel important and empowered. If feeling important and empowered had real clinical benefits maybe, but it doesn’t.
Even when that explanation or structure is demonstrably untrue? I am not at all comfortable with practitioners lying to their patients for any reason, and never mind the alleged benefits, what about the proven risks? Rolfing is based on ideas about deep muscle massage that are not supported by the science, and may be dangerous for people with clotting disorders. Ayurveda is based on prescientific ideas about vitalism and humors (compare with medieval European ideas) and people often (I choose the word carefully) end up with lead, mercury or arsenic poisoning.
I disagree. We can use RCTs to establish how to best meet people’s psychological needs without lying to them.
Some yoga teachers and massage therapists do a great job. A bit of gentle stretching and a massage can make you feel great. But then many of them go and spoil it all by talking about imaginary energies, blocking flows and removing imaginary toxins. After years of people trying, no one has been able to identify these energies and toxins, so I don’t think it is smug to object to people still insisting they exist.
Steve…MMS is a miracle substance; good for curing cancers, curing malaria, HIV infections and…ta da for *encouraging* breast growth:
http://www.health-science-spirit.com/MMS.html
Are you a shill for **Big Breast Implants**
Just because I’m Canadian doesn’t mean that I automatically support Pamela Anderson…
— Steve
PS: re: the that link, why do folks keep falling for the snake-oil pitch close to two centuries later?
Thanks, Denice. At some points, your expectations seem too high for even most drugs – single bullet, all weather, every time, any klutzy way any clown does it. The FDA levels of “proof” require means hind dragging 20-30 years, if ever for many molecular (food/generic drug) entities. Some may require personalization to achieve high efficacy.
However many results can be independently observed (e.g. unusual success items in path report) or measured at the individual level, and well correlated with previous research results. If something fails at the individual level, it can be reworked (dose/combo/markers) or written off – next therapeutic personalization trial please.
This unusual correlation with prior research papers was the case both for cimetidine and PSK/PSP (e.g. WBC on while on mild 5FU chemo was raised several points, to > 9). PSK/PSP don’t have massive FDA paperwork is why they are alternative in the (backward) US, not that they are Asian sCAMs, evidence free. PSK is documented and mainstream in Japan.
“Just because I’m Canadian doesn’t mean that I automatically support Pamela Anderson…”
(See Fredericks of Hollywood website for “support”)
“PS: re: that link, why do folks keep falling for the snake-oil pitch close to two centuries later?”
– They don’t know the differences between disinfectants and antiseptics
– Ditto disinfectants versus antibiotics
– Ditto disinfectants versus antimalarials
– Ditto disinfectants versus antivirals, etc., etc., etc
prn – 0.
so-called integrated medicine. the first two aren’t even “alternatives” except when practiced as an alternative to a proper diet. slugging down great chunks of wheatgrass, twigs, vines and other bits of dirt isn’t good for you either.
Proper diet and proper exercise are another thing, and have of course been shown to help with some medical issues. As has massage therapy. (in some studies.)
What is included in “the whole field”?
This I agree with.
The main problem I have with many things that are labeled “alternative medicine” is that they make claims that are either counter to available evidence, or have not been supported by evidence, even though they are testable.
A secondary problem is something that comes up here. Appropriation of some aspects of science based medicine and labeling them as “alternative”.
It is true that scientific knowledge is never presumed to be perfect, is self-correcting, and is always expanding.
That is not a valid reason to charge people money for unsupported interventions, while making no effort to support, or actively resisting investigation of, one’s claims.
This point supports the opposite conclusion from the one you seem to think it does.
Despite an extensive system of clinical trials, unforeseen negative impact can occur. Fortunately, negative drug effects are usually detected and reported by the scientific medical community.
This situation demonstrates the value of the scientific approach.
The FDA was created because it was far worse before there was an FDA. The FDA isn’t perfect by any means, but the better alternative is an even better FDA or similar agency, not a free-for-all of unsupported and untested products sold to the public via unregulated claims.
(For full disclosure the FDA recently made a decision about an obscure class of devices, digital whole slide scanners for use with anatomic pathology slides, that I strongly disagreed with. “Perfect” and “best available” are two different things.)
The self-correcting and constantly improving nature of science is an argument in favor of the scientific method for studying physical reality, not an argument for accepting unsupported, self-serving claims without investigation.
If I read you correctly, you seem to be acknowledging the benefits of science based medicine, but also trying to claim equal status for some things that don’t deserve it.
This overgeneralized claim does have some truth to it, but claiming effectiveness for invalid or untested treatments would not in any way alleviate this condition, if it exists.
In my personal experience, poor people in public hospitals sometimes correctly feel that they are not empowered (although there are many excellent exceptions to this).
Rich people in fancy private hospitals are often made to feel very important and empowered, but paradoxically, this sometimes happens at the expense of best medical practices. This is just my impression.
This statement is illogical. Did the rolfer or ayurvedic practitioner openly come to help the patient feel important and empowered, or did they make unsubstantiated claims? Were there other, less expensive means by which the patient could have felt important and empowered?
If people want to spend their money on such things, and are well informed as to the theory and evidence behind them, I have no problem with that. However, it is a free country, and if practitioners of such techniques make unverified claims, or seek to dissuade patients from using evidence-supported treatments, I will indulge in my right to criticize.
1) This is an argument in favor of teaching people to understand the difference between faulty reasoning and critical reasoning, not an argument in favor of pandering to critical reasoning.
2) Actually, there are different qualities of anecdotes. Some anecdotes are valuable – a well-documented single occurrence can serve as the inspiration for a testable hypothesis. Other “anecdotes” are actually not real anecdotes at all, but urban legends or rumors. Differentiating between an anecdote which can be verified and may be a trigger for further investigation, versus a non-credible rumor lacking in important detail, is part of critical reasoning.
You are confusing an “anecdote” with a “characteristic example” used for instructional purposes. The Matthew Shepard case was an instructional example of gay-bashing. Gay-bashing was certainly not isolated to that case.
Again, you seem to think that the best response to faulty reasoning is to pander to it.
You would be surprised how open regular people, even with limited education, are to logical reasoning.
Invariably, I find that resistance to logical reasoning does not reflect an actual preference for irrational thought (except in cases of untreated mental illness), but rather, isolated defense of a self-serving emotional bias.
However, these activities are beneficial for reasons that have nothing to do with unsubstantiated claims, and are available, at least in the case of yoga, at a reasonable cost.
DLC@52
so-called integrated medicine. the first two aren’t even “alternatives” except when practiced as an alternative to a proper diet.
Here’s a problem I have had with that. Nursing home MD and RD who pride themselves on “conventional” don’t want to listen or budge on carb laden diet and common medications. Blood glucose ca 130, TSH > 3. Dump official medications and diet, do it “alternative way” including *much* lower carb diet with T3 containing animal source, blood glucose < 100, TSH ca 1-. Who’s dangerous?
This example does not contain enough information to evaluate.
However, let’s say that you are claiming that type II diabetes can be managed better when realistic dietary modifications that don’t cause other problems are made. That part of your comment is even intuitively credible. In fact, it’s already conventional.
If the specific change your propose in non-trivially different from what has already been shown, you do a study to demonstrate, to yourself and to skeptical observers, that your dietary intervention helps manage diabetes. You define your patient and control group, how they are being treated and what they are eating, and what outcomes will be measured and when, preferably in a double blind manner. If you are right, and that particular dietary intervention improves management, without causing other major problems, it becomes “medicine”. Alternative medicine that works is called “medicine”. Native American healers used a substance in natural willow bark. That substance has been shown to be valuable in some contexts, so it is “medicine”.
As for thyroid hormone, conventional medicine does not endorse under-dosing hypothyroid patients. I don’t understand your reference to animal foods and “T3”. The role of dietary iodine in thyroid health is extremely well known to medicine, if that is what you are referring to. If it is something else, please give a reference.
You present a false dichotomy. You give an anonymous example of what may be sub-optimal conventional management, and label any other management as “alternative”. However, the existence of sub-optimal conventional management is not a justification for turning to “alternative” management broadly defined, it is an indication for improved conventional management. The ideas that diet can be important in managing diabetes, and that diet is relevant to thyroid health, are themselves conventional.
prn@54 — have you had any interface with nursing homes recently? You’re talking about something that may have been common at one time but not within the past few decades.
I worked (very briefly) for a nursing home after I graduated from school and was still figuring out what I wanted to do with myself. The Director of Nursing, the social worker, and a member of the food service staff attended quarterly meetings with each resident (if they were capable) and their families to discuss possible modifications to diet, exercise and medication. It was part of the continuum of care.
(btw our MD had nothing to do with the food that was offered unless a special diet was mandated for an individual resident).
The establishment that cares for my father does the same. Nursing homes just don’t park residents in chairs and stuff Ensure and meds down them any more…if they ever did.
Thanks Harold. I’ve tried to squeeze in meaningful responses. To me conventional science appears to be frequently disconnected from “conventional medical trials” which may be greatly disconnected from clinical practice and attitudes.
…claiming that type II diabetes can be managed better when realistic dietary modifications that don’t cause other problems are made. That part of your comment is even intuitively credible. In fact, it’s already conventional.
I generally encountered fierce resistence, never resolved, over the concept of 3 low starch vegetables per Lunch or Dinner, cut out the fruit, a la Dr Richard K Berstein. No Medicare nursing home across 125 miles would do the vegetables/lower carb part. I had to become a semipermanent vistor to implement them as best as possible. Things really hit the fan over supplements, despite fast, dramatic changes in three areas.
If the specific change your propose in non-trivially different from what has already been shown, you do a study to demonstrate, to yourself and to skeptical observers, that your dietary intervention helps manage diabetes.
Trials of n=1 don’t have a control population. They’re necessarily based on recordable clinical performance and chemistry changes.
You define your patient and control group, how they are being treated and what they are eating, and what outcomes will be measured and when, preferably in a double blind manner. If you are right, and that particular dietary intervention improves management, without causing other major problems, it becomes “medicine”.
If it were so easy, there would not be nutrition fights worth mentioning.
As for thyroid hormone, conventional medicine does not endorse under-dosing hypothyroid patients. I don’t understand your reference to animal foods and “T3”. The role of dietary iodine in thyroid health…
T3 is triiodothyronine, the active metabolite of T4, thyroxine. A fraction with T3 was commonly available in dessicated thyroid for over a century, in recent times cheaply with little FDA interference until 2009. Many thyroid patients are not satisfied with T4 only scripts and in fact will show varying degrees of low free T3 and/or low metabolism. Most MDs are uncomfortable with dessicated thyroid at several points, from diagnosis, to T3 to source, although recent literature acknowledges T3 benefits more.
You present a false dichotomy. You give an anonymous example of what may be sub-optimal conventional management, and label any other management as “alternative”. However, the existence of sub-optimal conventional management is not a justification for turning to “alternative” management broadly defined, it is an indication for improved conventional management.
Those Medicare paid facilities that insisted on their “conventional” approach, were unable to perform at any remotely acceptable functional level of results – walking, violent shaking, nausea & vomit, blood glucose, body temp, free T3. All fixed with “alternative” nutrition and supplements with much, much fewer meds. Result: extreme hostility, sabotage (disappearing supplements) and finally ejection. I could not find any Medicare facility that could perform conventionally or otherwise.
@Shay
have you had any interface with nursing homes recently? You’re talking about something that may have been common at one time but not within the past few decades.
All too recently. I consider some of the retirement cities entirely corrupt.
The Director of Nursing, the social worker, and a member of the food service staff attended quarterly meetings with each resident (if they were capable) and their families to discuss possible modifications to diet, exercise and medication. It was part of the continuum of care.
A meaningless paper exercise. That’s the reneged or fudged promise anyway.
(btw our MD had nothing to do with the food that was offered unless a special diet was mandated for an individual resident).
Yes, with two physicians signatures. Obstruction city.
…Nursing homes just don’t park residents in chairs and stuff Ensure and meds down them any more…if they ever did.
You may live in an alternate universe.
PRN — bullshit.
I consider some of the retirement cities entirely corrupt. I’m referring to skilled care facilities, not retirement communities. But regardless, evidence would be nice. Can you provide the name of an institution that tosses nutritional guidelines out the window because of staff prejudices?
a meaningless paper exercise. That’s the reneged or fudged promise anyway I worked in a skilled care facility for six months, and have a family member in one now who is visited several times per week by family members including an RN. Our experience contradicts this.
yes with two physician’s signatures. obstruction city what the fuck do these two sentences have to do with what we’re talking about?
You may live in an alternate universe. I live in a universe where I’ve actually spend time at one of the facilities under discussion. Have you?
Shay-
You are a satisfied customer, your family member may not have medical or nutritional needs that required such aggressive care. Great.
I’ve been to places where no nursing home in town could meet my family member’s needs for individual nutritional viability. One size fits all very poorly sometimes.
institution that tosses nutritional guidelines out the window because of staff prejudices… an institution that adheres to medical and nutritional prescriptions that have grossly failed, and continue to repeat said failures in the face of literature, and obvious, profound benefit.
I worked in a skilled care facility for six months… sounds like some ego invested there. Your projected experience has little relevance to mine in another facility. One of the problems was that the staff didn’t listen well and ignored careful, knowledgeable directions. Your attitude here seems symptomatic.
I had medical instructions signed by two doctors that the nursing home ignored at my family member’s discomfort, peril, and despite obvious benefit.
I’ve been to places where no nursing home in town could meet my family member’s needs for individual nutritional viability. One size fits all very poorly sometimes.
I call bullshit again.
Given that the nursing home industry is one of the most highly-regulated and closely-scrutinized in the country (right up there with nuclear power plants), did you go to the state ombudsman and get the situation corrected?
Yes, I did call. Regulated, yes, but not following the literal text when quoted. Overall about as effective as the Soviets.
You and they assume they have all the right answers. They don’t, and can’t even remotely cope when a few better answers slap them right in the face. e.g. Nausea and vomiting for several weeks despite medication. N and V cut off overnight and appetite was restored by some digestive related supplements. One of four such incidents.
Medication has since been black boxed, about 15-20 years late for what I could discern in several weeks.
prn,
I’m going to try reading between the lines, seeing things from the nursing home’s perspective. They are giving their residents a diet recommended by a qualified dietitian, that has been tried and tested, probably for decades. There are a number of problems with formulating a practical diet for elderly people, whose sense of smell and taste may have faded, who may have little appetite and whose ability to chew effectively may be impaired – the best diet in the world is no good if they find it unpalatable or are unable to chew it. Immobility also can make them prone to constipation, leading to a need for additional medication or for unpleasant and undignified procedures, so you need to be aware of this. I am sure the diet given in nursing homes takes all these factors and more into account.
Then you turn up, telling them they are doing it all wrong, and demanding a change in diet for one resident, based on some cherry-picked research you found on the internet. You also demand a change in medication to that prescribed by the resident doctors, waving around recommendations from other doctors of unknown provenance, again based on cherry-picked evidence that goes against expert consensus and, no doubt, their policies.
They probably attribute the improvements in their patient that you describe to their care, based on their considerable experience. But you claim it is due to what they very likely see as the crank diet and treatment you have insisted on. Even assuming that you are right in every respect, I can see how they might see you as the nightmare relative they all dread running into. However, I suspect you are not right, certainly in some respects.
Is it possible that the fall in blood glucose you mention is due to effective malnourishment? Starvation is an excellent way of reducing blood sugar and blood pressure in the short term, but has unfortunate long-term consequences. How do you know the long-term effects of the diet and supplements you imposed? Were the studies you based the change in medication on done on elderly people in nursing homes? Could the improvements you report have been due to the cumulative effects of previous care, and not to your innovations at all? The nausea and vomiting you describe sounds like a self-limiting virus that would usually resolve within a few weeks at most. On what RCTs did you base your prescription of “digestive related supplements” for this condition? You may be fooling yourself into thinking your innovations have been effective when they were not. We are all prone to confirmation bias.
I do have some familiarity with CAM views on thyroid diseases, such as the claims made for dessicated thyroid and T3, as I worked for several years measuring thyroid hormones, and also constructed and managed a database that monitored the effects of treatment on those with thyroid disease, and was used by clinicians to make decisions about changes in dose. From time to time someone with perfectly normal high-sensitivity thyroid function test results would claim that they were subclinically hypothyroid, or someone being treated for hypothyroidism whose results showed their condition was well-controlled would complain that they were still suffering symptoms and demand treatment with dessicated thyroid or T3. I’m afraid these people were not taken very seriously, as their claims are not supported by RCTs. Dessicated thyroid is not sufficiently standardized in dose and is not an effective treatment for hypothyroidism (for example PMID 2701751), which is why it’s use was discontinued, except by cranks (I don’t mean to be rude – but I can’t think of a politer word).
You wrote that “recent literature acknowledges T3 benefits more”; I disagree. The body converts T4 to T3 peripherally as needed, and supplying T3 is not usually considered a wise choice as it bypasses this mechanism. There’s a good review of the current evidence for and against combined T4/T3 therapy here (may require registration). On balance the evidence does not support combination therapy, and the few studies that suggest benefits are likely to have problems with the testing effect, a lack of washout period in crossover studies and a lack of blinding where large placebo effects have been observed. By the way, no inherited deficiency or mutation in human deiodinase genes (for the enzyme that converts T4 to T3) has been reported so far.
If you have come to the conclusion that dessicated thyroid is a better treatment for hypothyroidism than T4, I suspect your assessment of the evidence in other areas is also faulty.
PMID 2701751 [Poland]?!? You’re kidding right? You had to reach back 20+ years to find a post Chernobyl, defective Soviet bloc aflatoxin source in homeopathic doses (0.2-0.6 mg vs 60-200 mg common range). Next you’re going to be selling me Burzynski Polish drinking buddy stories?
Not everyone converts T4 to T3 adequately. Reviewing the TSH “official range” literature, TSH interpretation appears to have more in common with a Ouji board spinner, like 3 – 7.4 (or even higher?) as historical hypothyroid cutoffs change. Endocrinologists’ TSH cutoff still appears headed lower on the TSH test.
Fortunately there are more quantitative thyroid test panels and direct MDs observation to overcome purblind thyroid views. The Medscape article(722086) is an acknowledgement of long term failure to achieve definitive hypothyroid resolutions. The Medscape article acknowledged secondary hypothyroid and other problems in passing as additional complexity, as well as T3 benefits and unknowns. No pig thyroid data was shown, desiccated thyroid has more than just T3 and T4 hormones. The Medscape article basically cites fear and convenience as the bases of T4 monotherapy.
Richard K Bernstein is one well respected author on controlling blood sugar through diet.
I’m sorry prn, but your complaints thematically are painfully familiar to me from surveying alt med:
– doctors don’t know what they’re doing
– dieticians and nursing homes endanger the frail elderly
– nutritional solutions affect serious illness
– medical tests aren’t all they’re cracked up to be
– natural products trump pharmaceuticals
– a person without medical training can accurately critique establishment consensus.
I hate being so blunt but I calls it as I sees it.
There’s another way to look at it: elderly people are fragile and often don’t recover, and people can die of age not poor nutrition and care.
Denice,
– doctors don’t know what they’re doing
Perhaps “they know what they know, and they don’t know what they don’t know” would be a fair summary for some doctors.
– dieticians and nursing homes endanger the frail elderly shhh.It happens.
– nutritional solutions affect serious illness
Yes, “vitamin” technology cleared away the lowest hanging fruit ca 1900-1950. More science literature on specific nutrient molecules exists but is not efficiently translated into uses. But many here apparently don’t read enough science literature to know better. Walking a science line between both “camps” has its difficulties.
– medical tests aren’t all they’re cracked up to be
Sort of true. It often takes more tests to get better, more definitive (or even a hint), more timely information. Finer grained or research type data make a difference to those willing and able to use them carefully.
– natural products trump pharmaceuticals
I am a pragmatist. I am willing to use most tools, prn. FYI, I chose a chemo drug that one head of oncology said would relatively toxic to bone marrow. Turned out their experience and application base was so limited, they hadn’t read the literature and figured out how to use it well for shorter term use, much less for indefinite times with effective uses. platelets>200, WBC>5 for “marrow toxic” chemo after 1+ years straight.
Multilevel bias often prevents “pros” who should know, or perform better, from clearly seeing or acknowledging cases where natural (similar or equivalent) products are useful and effective.
– a person without medical training can accurately critique establishment consensus.
Yes, some people can. Especially consensus science, that’s an oxymoron. Even more, is that sometimes dedicated “amateurs” can outperform the pros on specific medical cases. Time on target, education, experience and intelligence product can even give them a decided advantage against a generalist who only has 5, 15, 30 even 60 minutes for an individual problem every 1-2 months.
prn,
I had to reach back to an obscure Polish paper from 23 years ago because this question was settled in the minds of all reasonable people in the west 40 or 50 years ago, and the peer reviewed research that was based on isn’t well represented on-line. It is only cranks who still insist that dessicated thyroid is more effective than T4. It isn’t, which is why it was abandoned. This is like someone arguing that foxglove tea is a better treatment for congestive cardiac failure than digoxin, or that willow bark is better than aspirin.
By the way, I think you are a bit harsh on Poland, I have known and worked with a number of Polish doctors and scientists who were very capable. Do you have any evidence that Polish dessicated thyroid is contaminated with radioactivity and aflatoxins? Can you direct me to some evidence, such as RCTs that shows that dessicated thyroid is a better treatment for hypothyroidism than T4?
You managed to get hold of the full text and you can read Polish? I am impressed. Or did you get this article mixed up with another one by different authors – PMID 8090652 perhaps? BTW in that study I suspect that they meant 0.2-0.6 mg/kg body weight and this was lost in translation. Just because Poles are from “a defective Soviet bloc” doesn’t mean they are stupid.
True, there may be a very small number of people who don’t convert adequately, and this is being researched. Whether administering T3 will be useful in these people remains to be seen.
Some of these ranges have changed because of changes in methodology. When I first started measuring TSH in the early 80s it was done with radioimmunoassays using crudely labeled antibodies we cooked up ourselves using I125. These days it is mostly enzyme linked antibodies and chemoluminescence. More specific monoclonal antibodies and improved sensitivity of tests have also led to changes in reference ranges. You really don’t want to treat people with T4 unnecessarily, as that can lead to hyperthyroidism which can lead to serious problems, like heart attacks and strokes.
There are international conferences where hundreds of experts spend days discussing these matters and whether reference ranges and diagnostic criteria should be changed. I have been to a couple of these meetings in London where hundreds of clinicians (including professors, consultants and other highly qualified and experienced people) discussed these matters in excruciating detail. You seem to think no one has bothered to think about this apart from a few crank doctors who have found a niche market in people who think they know better than experts who have spent decades studying this stuff.
Which “more quantitative thyroid test panels” are you referring to? I’m interested, seriously. I would love to see you stand up in front of the experts I mentioned and explain to them that they have purblind views.
No it’s not! The treatment of hypothyroidism in at least 99% of patients has been resolved. There remains a tiny minority of people who report symptoms despite being biochemically euthyroid. Many of the symptoms of hypothyroidism are non-specific, such as fatigue, and are highly susceptible to placebo effects. I’m sure there is more to learn, but to describe the current state of affairs as a long term failure is ludicrous.
Secondary hypothyroidism is exceedingly rare, and is due to hypopituitarism. I have only come across a handful of cases in several decades, and they have multiple problems, not just hypothyroidism. The vast majority of hypothyroid patients are rapidly diagnosed, treated and their treatment optimized and monitored long term, with excellent results.
One study showed benefits of combined T4/T3 therapy, and six failed to reproduce the results. There is some interesting work being done on the use of T3 in psychiatric disorders, but this has little bearing on hypothyroidism.
The fact that dessicated thyroid has more than T3 and T4 is a good reason not to use it! Fear and convenience? Nonsense. They base their recommendations on clinical evidence and experience, whereas all you seem to have is anecdote and opinion.
Has he considered the specific difficulties that elderly people have, as I mentioned before? I am sure that diet is a good treatment for type 2 diabetes, but the practicalities, as I discussed above, may result in poor compliance resulting in more problems than it solves.
If anything you have reinforced my impression that you have come to some unorthodox conclusions based on cherry-picking the evidence, and on the work of some crank doctors whose ideas fell out of favor decades ago. I am not surprised that you have had problems persuading nursing home staff to listen to you.
@ prn:
Doctors may spend only a few minutes but their decisions come from years of study, training and experience. They also don’t *stop*( continuing education, journals, professional associations anyone?) because innovations eternally transpire. I wouldn’t trust myself to ceate therapeutic regimens if I had a serious problem DESPITE having background in life sciences prior to graduate degrees in social science. And -btw- I know my way around journals, statistics etc- I also manage lots of money as a sideline which requires data-overload on a daily basis ( right now it’s the *magic time* between NY Open, London close)- I couldn’t do it so I’d relegate it to the apropriate experts. I’ll stick to that for which I was educated and trained.
I think that you’ve been very lucky: I hope you don’t get hurt.
Krebozien
It looks like prn has still not read Ioniddis
Krebozien – Congratulations – you filled in your altie bingo card with your detailed refutation of our current Dunning Kruger champ. Your prize is a box full of the free magazines they give away in health food stores and bottle of homeopathic plutonium.
Ooh goody. The magazines will go into the recycling and I will keep the homeopathic plutonium handy in case of a nuclear holocaust. It will be useful for any dehydration I might suffer in the bunker kindly provided by Lord Draconis.
Krebiozen – before you recycle the magazines you can use them for playing logical fallacy bingo. I think that reading those alt-med for logical fallacies would be a good assignment for an introductory logic course.
Krebiozen:
My “anecdote” is another about doctors who don’t listen even when presented data on blatant failures and measures with multiple medical opinions from more studied doctors. And don’t pay attention when alternate methodology whips around and *measurably* (fT3, basal temps, TSH) succeeds. Hubris seems to be a common medical affliction to cover patterns of failure.
That 99% figure sounds self referential and self congratulatory. The Pub Med article tacitly acknowledged the desiccated thyroid users camp’s complaints many times without hard answers, sotto voce’ “we’re trying” or “we’re studying it”.
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The Soviet bloc was in economic (and political) disintegration and many of the products were defective to greater degrees. Several papers’ results suggest this happened with T Polfa including aflatoxin contamination and lack of potency (several papers). Your presumption of ethnic slur shows lack of attention and unbridled speculation. One of the problems here is the stuffing of words in my mouth to create strawmen and the general assumption of bad faith and incompetence. I did look at several “Related Citations” from Poland of that era (PMID 2641803, simply shows the branded T Polfa material as an ineffective/defective product then; yes, PMID 8090652 “Polfa…doses of 0.2-0.6 mg/daily treatment”)
Available blood tests here can quickly find such an ineffective product on the individual level. Our lab measurements (and observations) were less satisfactory with T4 monotherapy.
people who report symptoms despite being biochemically euthyroid
The ongoing saga of repeatedly changing TSH cutoff for euthyroid, as well as the symptomatic patient self-resolution movement based other measurements, may suggest otherwise. How many times do you get to move the TSH goalposts, while insisting you were right then, again, once more, and now?
The nursing home failed to achieve euthyroid by several measures including mucoid facial lesions that disappeared with desiccated thyroid and not T4. There was divergence between fT4 blood levels (+-replete) and fT3 (low).
The lack of RCT on many generics is an ongoing failure of high spending countries’ medical authorities to deliver the goods for decades.
whereas all you seem to have is anecdote and opinion
I exchange references where needed. The personal observations exemplify the problems patients face no matter what technical resources they bring to the table.
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The bottom line is that I keep having to step into the breach, even armed with technical references, when the paid help fails repeatedly and it annoys me when it persists with the attitude problems. These days, Fail = fired, sooner than later.
Denice, the treatment choice evolved between Japanese and US results with the Japanese results replicated elsewhere several times. The Japanese chemo results for targeted patients with certain prognostic biomarkers are clearly superior, and a number of US trained MDs knew nothing about the Japanese results.
Adding Japanese type chemo, combined with significant necrosis (a localized complete response) that saves the expense of a future HIPEC procedure, at initial surgery following neoadjuvant use of still another set of neoadjuvant inhibitors of very low toxicity, was my independent decision.
The results to date indicate that combined targeted, nontoxic adjuvants carefully selected and added together might be working very well. Otherwise, there should have already been a fatality (per oncologists), or at least gross morbidity from disease (per surgeons), much less normal CRC treatments’ usual damage with platinum plated patient bills and organs. Don’t worry about your stocks Denice, most of this stuff is definitely not approved in the US, even if it is elsewhere. Too cheap, you know.
Replied to Krebiozen earlier, before Denice, stuck in filter.