Boiling “integrative medicine” down to its essence in 34 words

Maybe I missed something in Orac’s “34 words” blog this morning, but I’m not seeing the 34 word definition cited in the title. (Maybe my night of insomnia is clouding my mind). So, please, someone clue me in on these 34 words.

Here you go, kurt:

“If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

Hope that clears it up for you.

kurt:

The 34 words are in the blockquote. It’s not a definition, it’s an analogy, and an appropriate (and amusing) one.

Hope you get some sleep tonight.

A wonderful analogy, Orac. Sorry yesterday was rough. May today be better. More apple, MUCH less cow.

Speaking geneally, those sub-consciously sensing uncomfortable change a-coming, in their more consicous manifestations, tend initially to become still more agressively identified with their ever-weakening position.

Integrative medicine is the beginnings of a movement which has yet but started where doctors themselves are beginning to understand much of what certain quality “CAM” practitioners have been saying for some time. That’s all basically about prevention, quality natural nutrition, stress minimisation and avoidance of toxic patented pharmaceuticals

The CAM label was about “us” and “them” thinking; a denigrating label favoured of course by the orthodoxy.

Folk like you will struggle with this. Your logic reminds me, in another realm, of how those most irate about any sort of criticism of even the most blatantly indefensible aspects of Israeli foreign policy like to brand non-Jewish critics as “anti-Semites” and incredibly, critics who are Jewish as, yes, “self-hating Jews”! Your piece here smells the same. Dr. Weil and his like are “self-hating or self-deluding doctors”, correct?

That’s all basically about prevention, quality natural nutrition, stress minimisation and avoidance of toxic patented pharmaceuticals

Which (aside from the fearmongering “toxic”) is what science-based medicine has been saying since it existed. In no way is any of that the least bit “complementary,” “alternative,” or “integrative.” Completely standard science, harped upon ad nauseum by physicians across the world.

“That’s all basically about prevention, quality natural nutrition, stress minimisation and avoidance of toxic patented pharmaceuticals.”

Conor S., that’s not even word salad you’ve got there. Particularly when CAM often deals with anything but what you describe:

– prevention (cough Wakefield cough, plus anti-pasturisation movements)

– natural nutrition (going off on bizzare food combinations not even remotely reflective of human diets in the past several thousand years)

– stress minimisation (by putting the onus of illness on the sick? yeah, right)

– patented pharamceuticals (when most CAM modalities are nothing but low-cost/high-margin patent medicine with some condescending talk)

CAM is nothing new, and that’s the problem; it harkens back to the bad old days when homeopathy really was competitive with the medicine of the day because at least highly-filtered water won’t harm patients. I’ll stick with modern medicine, myself; I like infant mortality rates in the single-digits-per-100k, keeping my teeth into my golden years, and the absence of epidemic smallpox.

— Steve

Conor: “Integrative medicine is the beginnings of a movement which has yet but started where doctors themselves are beginning to understand much of what certain quality “CAM” practitioners have been saying for some time. That’s all basically about prevention, quality natural nutrition, stress minimisation and avoidance of toxic patented pharmaceuticals”

Let’s see – prevention, good nutrition and stress minimization are all well-established components of mainstream evidence-based medicine, for which CAM falsely claims credit. CAM does promote “avoidance of toxic patented pharmaceuticals” in favor of toxic and/or ineffective “natural” remedies, so I’ll have to grant you that one.

By the way, I don’t think you can “Goodwin” a thread unless you go off on a Nero Wolfe tangent. 🙂

As Conor informs us: we are on the brink of Paradigm Shift, wherein our opponents riding the tsunamic wave of Enlightenment shall righteously overwash the miasmically encrusted Corruption that we have enabled to reign upon our fair Planet and that has enriched us in worldly goods and unnatural Power: it shall be no more!

There will be a new Order arising based upon spirituality and freedom while the present powers evanesce into the gloom of Night: even memory of them shall fade like a bad dream. A new City shall arise from the cleansing floods, sparkling and brilliant in the noonday sun- a beacon of hope to the millions newly freed from the dark slavery of science! And in that new day in that new bastion new wise leaders will rise up to lead the lost children to Truth, Nature, Purity and Goodness. Our Time has passed.

CAM does promote “avoidance of toxic patented pharmaceuticals” in favor of toxic and/or ineffective “natural” remedies, so I’ll have to grant you that one.

I don’t think you do. SBM promotes not using drugs (whether patented or not, and coming from a lab or a plant) unless the benefits outweigh the risks and there are no better alternatives available. I’d say that qualifies as intelligent avoidance.

I love the analogy but then, I love Mark Crislip with a passion!

Well I might like to reply to some of you fine people but my last mail didn’t make it to the site whereas the first one did instantly.

In my experience of web forums (considerable), either moderation is in place or it isn’t. Moderator? Did I foul up or offend or what?

When I thought about how the pies would be labeled–for full and accurate information that is always demanded by alt-med types, I thought that there wouldn’t be legit claims on the alt-pie label.

You know, it didn’t strike me until right now how funny the “label it” donations by Mercola are. He and his minions are harassing a California journalist for complaining about Mercola’s contributions to political activity from out of state, demanding food labels: http://www.sacbee.com/2012/02/25/4289321/gmo-foes-should-rebut-morain-not.html

“Integrative medicine is the beginnings of a movement which has yet but started where doctors themselves are beginning to understand much of what certain quality “CAM” practitioners have been saying for some time.”

I’m curious, Conner: who exactly do you consider representative of those “certain quality “CAM” practitioners”?

Our entire medical system is broken primarily due to 1 fact: Big Pharma only make big dollars from selling patented “new to nature” molecules which substances, de facto, are alien to our systems and thus sooner or later are likely to cause harm to the body. Hence the mounting death toll … Hence the fact that each decade’s blockbuster is the next decade’s class action …

In answer to your question, the practitioners I continue to admire are those who accept as a tenet that “new to nature” molecules are inherently dangerous, de facto. If the moderator hadn’t stopped an earlier post, you’d know already that I hitch my wagon to the Insitute for Functional Medicine as a paradigm with a healthy respect if less knowledge of other ancient systems also, Chinese, Ayurvedic etc

Got any science-based arguments for your comments, Conor…I see your name links to a natural food site.

Oh…are you are “nutritionist”?…that explains it.

@Connor. You seem to think that all drugs are somehow synthetic? When in actuality, quite a bit has been learned from nature, and those drugs are more purified and potent applications of the same natural products.

And god forbid that we would ask for the same types of testing and regulations for so called natural products as we would any pharmaceutical.

Connor, stop lying about what we believe.

And moderation is started by a machine. The computer saw certain words or the number of links or something, thought it was spam, and put it on hold until Orac tells it to allow the post. This happens to me, too, and I’m a regular.

Oh, yeah:

1. You’re being terribly, terribly naive about human nature and “Big Pharma.” Some people join pharma corporations because they believe in the quality of their products and want to help the world. Some do it to make money. Some do it out of sheer curiosity about what the research will reveal. We use regulations, the global scientific community, and watchdog organizations to make sure the products work, and to monitor the risks. Everything is subject to scientific scrutiny from across the globe. Pharma corporations simply don’t have the power to suppress everyone in the information age. The real world is not a black and white cartoon melodrama. Humans have individual desires and motives. You can’t split everything into two “camps.”

2. A lot of drugs come from nature, just refined to purity standards, so that we don’t get the unnecessary or dangerous stuff that might come with the raw form. They can extract the pure active ingredient from the natural source, or to artificially recreate that natural chemical. You can still have a patent on a more efficient purification process, by the way.

3. There are ways to make money without a patent. They still sell aspirin, even though the patent has long ago expired. It’s just a matter of how much it costs to produce, and if you can sell it for more than the cost. Basic economics.

4. You have a very naive, Disneyfied view of nature. Nature does not exist to benefit humans. Nature is not subservient to human desires. Nature can be quite nasty to humans. It often is. Likewise, assuming that artificial chemicals are inherently bad demonstrates fallacious black-and-white thinking. It depends on the chemical’s properties, not how new or old it is, nor how natural or artificial it is. Evolution is probably still churning out “new to nature” novel proteins and other chemicals as we speak, and inside living organisms, possibly to their benefit.

5. Ancient is not inherently good, either. Humans easily fool themselves, no matter the era. Science is about preventing self-deception, and it’s still relatively new to humanity. Why should we assume ancient humans were inherently less prone to self-deception? Also, since I suspect you may very well end up going there: It’s racist to treat “East” and “West” differently. We’re all human, and we’re all at risk of self-deception.

Conor S:

You have made a serious error in your attempt to denigrate the “old medical model”.

The “old model” is the suite of quackeries and practices called CAM: practices justified solely by assertion, or by anecdote, or by faith alone, or by distortions of English and scientific jargon. This “old model” prevailed among humans for a very long time.

Only over the last few centuries has a new model of medicine, based on robust empirical inquiry, emerged and then prevailed, culturally and institutionally. Modern conceptions of this newer model are called ‘evidence-based medicine’ and ‘science-based medicine’ (EBM/SBM).

The recent rise of “CAM” is, IMO, more likely the result of two factors:
(1) The success of “new model” medicine has, ironically, made it seem less succesful, as people forget the scourges of ages past and become more aware of the diseases and disabilities which follow from an enormously larger, older, and more affluent population.
(2) Built-in cognitive biases and heuristics which make rational-empirical thinking difficult and emotional-magical thinking easy – biases & heuristics which serve humans well in some circumstances (especially in the past) but quite badly in others (increasingly so in the present).

Your allusion to the Reformation/Counter-Reformation is correct in one key respect and very wrong in another.

Correct in that it was more a political struggle than a religious one – just as the attempt by apologists for quackery are engaged in a socio-political struggle to bring the patina of scientific legitimacy to baldly unscientific practice more than trying to adequately justify their claims using robust empirical/experimental methods.

Incorrect in that whereas the Reformation and subsequent struggles were between factions of a religion over doctrinal/dogmatic disputes – thus suggesting neither side had any inherently superior position, the CAM/integrative “Reformation” is an attempt to smuggle in obsolete, useless practices in with those which have an empirically-validated history of success.

What advocates of SBM wish for is the same, stringent standard of empirical/experimental validation be applied to all medical practices and products – whether they be the fruits of decades of research and millions of taxpayer or Sanofi-Aventis (or whatever) dollars, or the fruits of Joe Herbalist mixing various plants in his basement, or anything in between – and those practices and products which fail the test be jettisoned.

On this view there is no preference for “Big Pharma” of necessity, save that the size of large pharmaceutical companies makes it easier for them to fund research and development even in the face of high failure rates, easier for them to manufacture products at large scale (e.g. to meet the requirements of mass societies of tens or hundreds of millions of people), and easier for them to be subject to regulatory oversight (while acknowledging that it can be easier for them to try to fight such oversight or subvert it – against which precautions must be taken).

Apologists for CAM, such as yourself (so it appears), apparently, wish for a somewhat lower standard of validation – at least for those practices and products you favour.

lilady@29

Got any science-based arguments for your comments, Conor…I see your name links to a natural food site.

Yes, I noticed that too – it’s promoting “healthy eating” classes for the Dublin/Wicklow area in Ireland. Paleo-type recipes with complementary supplement woo.

There’s also a Facebook page with lots of approving links to articles on the Wretched Hive and other founts of nutrawoo -need I say more?…https://www.facebook.com/SmartEaters

Edith,

It appears you’ve mastered both the art of the hyperlink and reading, although in the latter case, not correctly it seems

Yeah publicity! My plan has worked!

Wretched Hive ?!? In your bonnet perhaps …

Sorry, that couldn’t resist that one !

My hyperlink fail still doesn’t make your nonsense true. You may think what you’re doing is cutting-edge, but it’s actually firmly rooted in the 19th century (and refusing to budge). Here’s another link just for you: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139856/pdf/medhist00063-0063.pdf

And that recipe for spelt soda bread might make a good doorstop, but I can’t imagine anyone eating it voluntarily.

BTW, Wretched Hive is shorthand for “Wretched Hive of Scum and Quackery,” which is what the Huffington Post is called ’round here. It’s like the Weekly World News of health reporting.

Thanks Edith.

Your use of the “’round here”, in-neologisms for sites you dislike etc. confirm my suspicions of an inward looking group, small in a number of ways. Fine. Good luck with that.

Thanks for the site hits y’all

Got some healthy kids to feed now: the world’s first Paleo doorstop bread !!

C

BTW, Wretched Hive is shorthand for “Wretched Hive of Scum and Quackery,” which is what the Huffington Post is called ’round here.

Further, it’s a Star Wars reference: Obi-Wan Kenobi described Mos Eisley Spaceport as “a wretched hive of scum and villainy.” (I’m sorry, but how could you not know that?! It’s probably only one of the most-quoted-online movie lines ever.)

So, not only are you deluded, but you’re uncool, too.

My sympathies to the children.

Also Conor, I find it quite interesting that you’re engaging with my (admittedly) light-weight gibes but not answering any of the far more substantial criticisms from other commenters.

Here’s something you should read very carefully, Connor.

I consider Big Pharma a necessary evil. Despite what slander you’ve likely been taught about us, the average skeptic is not in love with pharmaceutical corporations. They are an ally of convenience, not a part of our identity. I do not approach this as “orthodox” medicine versus “alternative medicine.” Despite your explicit claims to the contrary, you still use the same fallacious rhetoric I’ve heard from people who try to convince me that those are real labels.

What this is really about is science versus individual treatments, and you don’t seem to get that. We want treatments to be judged by certain standards before they’re offered to the public, as well as monitoring standards after they’ve been used, to catch problems that didn’t show up in testing. The real problem is that “alternative medicine” and other labels are consistently used as excuses to avoid scientific scrutiny. It’s a line in the sand, and it keeps changing. I’m interested in the science, not the “alternative” brand name.

If my doctor prescribes me a medication, I’ll take it because I’ve come to trust her judgement. That trust is made based on what I’ve come to understand about medicine and all the mechanisms involved in getting a treatment approved for use, as well as what doctors have to go through to prove their competency in the field of medicine. If I have questions, she’ll answer them. If I question a decision she makes, I’m free to look up my prescription on PubMed and look at the scientific journals.

Where so-called “alternative medicine” and pharmaceutical companies come in is what they’ve done to prove their worth. Which product is better?:

A) A car model that’s gone through extensive, government mandated crash tests with good results, won independent awards for its performance, and built by a company with an established reputation for practicing good customer service as determined by an independent consumer rights group

or

B) Some go-kart hastily slapped together according to the builder’s interpretation of grandpa’s illegible blueprints, never been test driven, and when you ask about a warranty, the builder goes off on an Ayn Rand-inspired rant about how it’s the buyer’s job to evaluate every product they’ll ever buy for themselves, and that the seller is never at fault. And he asks for as much or more money than the “conventional” car.

I know you don’t want to hear this, but that’s what the field looks like: A lot of pharmaceutical products are on the market and succeeding because they’ve been tested by medical researchers who actually care about safety and efficacy tests. Every treatment labeled “alternative,” aside from the bait-and-switch ideas like proper diet and exercise (which the science supports), fails to meet my standards. It doesn’t help that people like you come in and live up to the used car salesman stereotype. Pharma companies have problems, but they’re nowhere near as bad as their competition. Pharma companies at least have to convincingly jump through hoops whenever they release a new product. “Altie” quacks and their supporters argue that I should blindly trust them, and that the hoops are never necessary.

And here’s one thing that might shock you: There are some products I am biased against, that are manufactured by pharmaceutical companies: Vitamin cocktails, herbal supplements, and things like that. Why? Because in America, herbal supplements and such are exempt from a lot of drug regulations because someone drew an arbitrary line in the sand and made it into law. As it stands, just about anyone can grind some not-very-poisonous plants into pill form and sell it without testing to see if it can do what they advertise it for. All they have to do is slap on the Quack Miranda about how it’s (allegedly) not intended to diagnose, treat, or cure anything. Easy profit. And that’s how many self-proclaimed “alternative/complementary/integrative medicine practitioners” do it, too. That way is wrong.

The posts submitted by Conor S. remind me of the rants I see from true-believer chiropractors. Is Conor S. in fact a “doctor” of chiropractic?

Just curious…

No Kurt, I’m suspicious of that whole discipline myself. In that realm, my sympathies lie with osteopathy, Tuina massage and preventatively, yoga. Scary to think I could be confused for one of those boys: I’d have earned about a grand by now surely .. 🙂

In 2009, Prometheus proposed calling alt.med/”integrative medicine” Traditional Victorian Medicine:

I gradually came to realize that many of the “alternative” therapies for autism – and much of “alternative” medicine in general – would be better described as “Traditional Victorian Medicine” (”TVM”, for these fast-paced times). It only seems appropriate to recognize the debt that current “alternative” practitioners owe to the far-sighted healers of that bygone era and acknowledge that so many of today’s “alternative” therapies were, in fact, “mainstream medicine” during the reign of Queen Victoria (1837 – 1901).

Perhaps we should heed him.

Conor S wrote:

Problem is that many of these molecules cause havoc in the body, sooner or later, precisely because of their artificial origin …

[citation needed]

How, exactly, how does artificiality make a molecule inherently bad? I was under the impression that the toxicity of a molecule is related to its chemical properties, and how those properties make it interact with a person or the environment.

If I were to artificially burn some hydrogen gas in an oxygen environment to produce water vapor, condense that vapor into liquid form, would that “artificial” water be more poisonous than “natural” water?

Let’s say I grow a never before seen protein in a lab. At the same time, by coincidence, a bacterium in another part of the world receives a natural mutation caused by a natural ‘malfunction’ in mitosis that causes it to naturally produce that same protein. Is my protein more toxic than the bacterium’s chemically identical protein?

I think it’s time to start defining CAM as competent allopathic medicine. A little bit of google optimization, and any other meaning will disappear down the memory hole.

So, it appears we’re getting places as now the “new to nature” bit is perhaps understood.

Now, studying anything at all bout our Universe, literally any discipline from archaeology to zoology must surely lead to at least some understanding of the delciate balance that exists throughout and how all currently existing quasi-independent organisms exist in a state of fluid and fragile harmony with their environment from where they draw their particular sustenance and to which they return “waste” nutrients etc. Such applies to food and air and some say other finer energies. Who knows?

Intuition would suggest that to suddenly begin only since the last World War, after countless thousands of years of human existence, for humanity to swallow back totally previously unexisting potent bio- and psycho-active chemicals to “fix” us, is a dangerous project to say the least.

But never mind inutition. Where’s the evidence.

It’s here:

http://www.aapcc.org/dnn/NPDSPoisonData/AnnualReports/tabid/125/Default.aspx

over 100,000 deaths in the US every year due to pharmaceutials USED AS PRESCRIBED … Another estimated 36,000 deaths due to overdose …

So inutition AND evidence pointing the same way? And I’m the know geting told what EBM means ?!?

Conor S:

The only individual who tried to call me on matters medical specifically, Steve was it, appears unaware that the body uses 3 primary mechanisms to maintain blood pH within the narrow homeostatic range, one being available calcium from bone if necessary …

I think Steve’s implication was that *you* are unaware that the body regulates blood pH very tightly, so much so that drinking milk will have no measurable effect on it. In fact, as far as I know, calcium is not involved in buffering the blood’s pH. If you have evidence to the contrary, I’d love to hear it.

The body does leach calcium out of bones, but not to alter blood pH; it uses the calcium for something else, something so critical that hypocalcemia can cause rapid death, and not from blood acidification. Do you happen to know what?

A “new to nature” molecule is the expression used in internationl patent law as being the fundamental requirement to secure a patent on a drug and therefore poentially enjoy super-normal profits on sales until the patent expires.

Nylon was the only molecule I could think of off the top of my head that does not and could not occur other than as the result of directed synthesis. But I understand now that new-to-nature is a legal term, not a scientific term, and in fact one that is applied to molecules that are in fact not new to nature (e.g., taxol, rapamycin, tacrolimus, etc.)

Problem is that many of these molecules cause havoc in the body, sooner or later, precisely because of their artificial origin …

As the term is used with respect to patent law it doesn’t denote molecules that are artificial in origin: it simply denotes molecules that have not previously been offered for patent registration.

Further, the potential for ‘havok’–i.e., adverse effect–isn’t a function of a molecules origin, artificial or natural, and that potential is rigorously addressed by estenisve mandatory preclinical and clinical testing which characterize the drug’s saety and efficacy, continuing post-approval surveillance, etc., all of which allows for accurate and continuous evaluation of a drug’s risk versus benefit.

Conor S (#51):

“A ‘new to nature’ molecule is the expression used in internationl [sic] patent law as being the fundamental requirement to secure a patent on a drug and therefore poentially [sic] enjoy super-normal profits on sales until the patent expires.”

If this is the case, how did they ever manage to market Taxol (paclitaxel)? It’s extracted from the bark of the Pacific Yew and isn’t “new to nature” in any sense of the phrase. Perhaps “Conor S” isn’t as well-informed as he thinks.

“Problem is that many of these molecules cause havoc in the body, sooner or later, precisely because of their artificial origin …”

What do the following substances have in common: aconitine, alpha-amanitin, orellanine, gyromitrin? They are all molecules of completely natural origin (the first is a toxin found in wolfsbane; the others are mushroom toxins) that “cause havoc in the body, sooner or later” (some up to weeks after ingestion).

In contrast, there are a number of compounds that are of completely “artificial origin” that are pretty much inert in the human body (e.g. HDPE, nylon 6) or have properties that are indistinguishable from “natural” compounds (e.g. Humulin, rHGH). In short, “Conor S” is grossly overgeneralising when he claims that the artificial origin of a molecule can determine its effect in the human body.

Of course, “Conor S” has been spouting a lot of nonsense about how “alternative” medicine is anything more than the leavings and cast-offs of real medicine. Just because “alternative” medicine is currently popular doesn’t mean anything more than the popularity of Justin Bieber.

Prometheus

Calli,

The carbonate and phosphate salts in bone act as a long term supply of buffer especially during prolonged metabolic acidosis.

The important role of bone buffers is often omitted from discussions of acid-base physiology4.

Bone consists of matrix within which specialised cells are dispersed. The matrix is composed of organic [collagen and other proteins in ground substance] and inorganic [hydroxyapatite crystals: general formula Ca10(PO4)6(OH)2] components. The hydroxyapatite crystals make up two-thirds of the total bone volume but they are extremely small and consequently have a huge total surface area. The crystals contain a large amount of carbonate (CO3-2) as this anion can be substituted for both phosphate and hydroxyl in the apatite crystals. Bone is the major CO2 reservoir in the body and contains carbonate and bicarbonate equivalent to 5 moles of CO2 out of a total body CO2 store of 6 moles. (Compare this with the basal daily CO2 production of 12 moles/day)

CO2 in bone is in two forms: bicarbonate (HCO3-) and carbonate (CO3-2). The bicarbonate makes up a readily exchangeable pool because it is present in the bone water which makes up the ‘hydration shell’ around each of the hydroxyapatite crystals. The carbonate is present in the crystals and its release requires dissolution of the crystals. This is a much slower process but the amounts of buffer involved are much larger.
How does bone act as a buffer?

Two processes are involved:

Ionic exchange
Dissolution of bone crystal

Bone can take up H+ in exchange for Ca++, Na+ and K+ (ionic exchange) or release of HCO3-, CO3- or HPO4-2. In acute metabolic acidosis uptake of H+ by bone in exchange for Na+ and K+ is involved in buffering as this can occur rapidly without any bone breakdown. A part of the so called ‘intracellular buffering’ of acute metabolic disorders may represent some of this acute buffering by bone. In chronic metabolic acidosis, the major buffering mechanism by far is release of calcium carbonate from bone. The mechanism by which this dissolution of bone crystal occurs involves two processes:

direct physicochemical breakdown of crystals in response to [H+]
osteoclastic reabsorption of bone.

Conor,

Osteoporosis and heavy acid load diets is the exception here, which is why this idea is on its way to being mainstream

I disagree, I think it is becoming clear that increased urinary excretion of calcium in those on high protein diets is due to increased calcium absorption, not to calcium leaching from bone. For example this study using calcium isotopes showed that a high protein diet increased absorption of calcium and actually reduced osteoclast activity, though it was not statistically significant, the opposite of what you suggest.

This is also supported by epidemiological evidence that shows lower bone density in vegans and vegetarians (who eat less protein than carnivores) as compared with meat eaters (see for example this meta-analysis).

Krebiozen,

Not at my books here but didn’t Dr T Colin Campbell and son make millions with the “largest ever epidemiolgical study on nutrition and health” or whatever the claim was proving just the opposite? Meat eaters having weaker bones?

About buffering from bone:

Two processes are involved:

Ionic exchange
Dissolution of bone crystal

Bone can take up H+ in exchange for Ca++, Na+ and K+ (ionic exchange) or release of HCO3-, CO3- or HPO4-2. In acute metabolic acidosis uptake of H+ by bone in exchange for Na+ and K+ is involved in buffering as this can occur rapidly without any bone breakdown. A part of the so called ‘intracellular buffering’ of acute metabolic disorders may represent some of this acute buffering by bone. In chronic metabolic acidosis, the major buffering mechanism by far is release of calcium carbonate from bone. The mechanism by which this dissolution of bone crystal occurs involves two processes:

direct physicochemical breakdown of crystals in response to [H+]
osteoclastic reabsorption of bone.

The involvement of these processes in buffering is independent of parathyroid hormone. Intracellular acidosis in osteoclasts results in a decrease in intracellular Ca++ and this stimulates these cells.

I’d rather trust something made by humans, for human needs, tested by humans who care about other humans. Humans can even consider the impacts on other species on their behalf if they care. Not perfect, but nothing is.

Nature, on the other hand, doesn’t care. To nature, we’re all just self-replicating piles of food for other self-replicating piles of food, and it doesn’t matter which transitory types of piles survive.

Heh. Nice one, Jay.

That’s the problem with black-and-white thinkers like Connor. The world is full of grays and colors that need to be judged individually, not according to arbitrary absolutist metaphysical “sides.”

Nylon’s not all that “new to nature” anyway. It’s a polymer formed from a 6-unit amide, the 4- and 5- unit versions of which do occur in nature, and are called “putresceine” and “cadaverine” respectively. If you’ve ever smelled burning nylon, you know why.

I repeated it on Twitter, but had to boil it down to 20:

Mixing fantasy with reality doesn’t instantiate reality. Mixing cow pie with apple pie doesn’t make cow pie better; it makes apple pie shit.

I find the blind faith in so-called evidence-based medicine in this forum and the level of abuse hurled at proponents of natural medicine (e.g. foods, high-dose nutritional supplements, herbal extracts) exasperating and anything but rational.

Here are some more reasonable lines of argumentation that I hope might open the minds of the worst offenders I refer to:

The rigid, so-called EBM model is flawed. A good starting point for getting acquainted with its principles and downsides might be Steve Hickey & Hilary Robert ‘s book: “Tarnished Gold: The Sickness of Evidence-based Medicine.”

These links further explore the concept of evidence based medicine and how it may (not) apply to the various modalities of natural medicine – e.g. how do you control for massage treatment?

Article: Circular instead of hierarchical: methodological principles for the evaluation of complex interventions by Wallach et al, BMC Medical Research Methodology 2006, 6:29
http://www.biomedcentral.com/1471-2288/6/29

Article: Deconstructing the evidence-based discourse in health sciences: truth, power and fascism, by Holmes D. et al
Int J Evid Based Healthc 2006; 4: 180–186
http://dcscience.net/holmes-deconstruction-ebhc-06.pdf

Evidence-based medicine and naturopathy:
http://epubs.scu.edu.au/cgi/viewcontent.cgi?article=1092&context=hahs_pubs&sei-redir=1#search=%22copy+of+article+institutional+corruption+in+medicine+bmj%22

Witch:

You’re using the infamous “microfascism” paper as a reference?

Bwahahahahahahahaha!!!

To nastylittlehorse:

It’s quite possible you didn’t understand the articles provided under the links; it’s absolutely certain that you don’t understand holistic medicine.

And in addition to Conor’s main course, we have the side dishes of Witch: “Natural medicine is better than evidence-based medicine!” “Your disagreement means you don’t understand!” My meal of woo is complete tonight.

Kolga and the other lot: Just so you won’t get indigestion and to end the evening on a hilarious note, here’s something you might like – it’s your favourite topic: Snake oil.

“For many centuries the Chinese used snake oil as a treatment for joint pain, arthritis and bursitis. They brought this folk remedy with them when they arrived in the US in the mid 1800’s to build the Transcontinental Railroad. That was hard work you know. Aspirin, while having been invented, was not a readily available item at that time. When the Chinese workers offered the remedy to Westerners as a palliative it was likely perceived to be a “primitive” form of “quackery” by the medical experts of that time. Hence the origin of the derogatory meaning of the word “snake oil.”

The funny thing about modern “snake oil,” i.e. petrochemically-derived and patented synthetic chemicals – is that they often have considerably less value than a placebo and in certain cases may not even compare in therapeutic value to ACTUAL snake oil. Here are four studies on the potential medicinal value of sea snake and boa constrictor lipids for inflammation and infection……”

http://www.greenmedinfo.com/blog/snake-oil-traditional-and-evidence-based-medicine-converge

How about pertussis vaccine? Tetanus? Diptheria? Measles? Mumps? Rubella? Polio? Or did you just mean flu vaccines don’t work/ Could that be because you don’t understand statistics and herd immunity? How would you prevent these diseases that used to kill hundreds of thousands of people a year? With your wand and some henbane?

@92, Witch

You were educated about how wrong that link on Flu Vaccines is in the last thread you pposted in. Clearly you don’t learn.

And re: post 89 – the links are irrelevant. If you don’t believe that an evidence basis is required for medicine (and anything else) then you’re just peddling magic and magical thinking. You fundamentally operate on a different level of knowledge to other people – you consider your feelings and intuitions to be more important than actual facts.

As I said, that’s fine, but admit it to yourself and stop pretending otherwise.

Note that if the Cochrane Review’s numbers are correct, up to 9 million cases of influenza each year could be prevented, if everyone in the US got a flu shot, though more often it would ‘only’ be 5 million cases prevented. And that’s not including herd protection effects. Ineffective?

@Witch:

…it’s absolutely certain that you don’t understand holistic medicine.

It’s very likely that you don’t understand the word “holistic”.

Roadstergal, thanks for clearing up what I said. You’re correct.

Thank you, Krebiozen, for educating those of us without any post-high-school biology education. 😉 I was only familiar with normal pH buffering, not that found in dire, near-death conditions.

I’m still curious if Conor or Witch knows the *main* reason the body tries to leach calcium out of bones. It doesn’t normally need to do that to maintain pH, but it does need calcium very urgently for something else. I’m curious if they know what it is. (If they want a hint, they can google Abubakar Tariq Nadama, who died of hypocalcemia.)

@ JGC:

Hey, hold on there now, Mr ( Ms)! But *those* SBM studies, *those* mountains of journals filled with research, *those* textbooks are all IN-admissable because they are *tainted* by the contaminating pollution of corruption: sponsored by pharma, conducted in compromised universities by untrustworthy university-educated, establishment-trained and governmentally-approved agents of the orthodoxy and printed in pharma-controlled journals and discussed in paid-for mainstream media. DON’T believe it!
( lord almighty, I’m starting to be able to produce woo-screed without actually thinking!)

#94 Jay Chaplin
Thanks for posting that information.
How many near misses I wonder?
One rather memorable example was Gary Null’s overdose on his own Vit. D supplement.

A controversial alternative health guru is suing after a taste of his own medicine nearly killed him.

A simple version of Mark Crislip’s statement:

Mixing fantasy with reality doesn’t make the fantasy any more real; all it does is make more fantasy. Mixing a bit of shit with chocolate pudding doesn’t turn the shit into chocolate pudding, but it does turn the chocolate pudding into shit.

Prometheus

Does anyone know where the claim “100,000 deaths a year from drugs used AS PRESCRIBED!!!!!!!!!!” comes from? I checked the CDC mortality statistics for 2009 and found drug-induced deaths numbered at 39,147 (here, page 28). As far as I can tell, that is total drug deaths, not just deaths due to properly prescribed drugs.

I also checked the link Conor provided, and couldn’t find it there. It looks like that link is just supposed to show that vitamins don’t kill people. I used RI search to find the 100,000 deaths claim as well. Does anyone have the source for this claim?

Does anyone have the source for this claim?

Usually, it’s Lazarou et al., although I seem to recall Emily the Natural Hygienist eventually producing a slightly earlier cite.

Ben T,
An execrable article by Gary Null titled ‘Death By Medicine’ is a common source of that figure; it quotes Lazarou et al among others. Lazarou’s figures, BTW, were mostly from the 60s and 70s and extrapolated to 1998 IIRC.

JLI: easiest way to think of “instantiate” is as “create an instance of”. dictionary.com provides

to provide an instance of or concrete evidence in support of (a theory, concept, claim, or the like).

But since that is about 5 seconds of Googling away, you’re probably trying to make a point…?

BenT: start your trail of mud on “100000 deaths” here. Even more telling is the first link that comes up when you Google “100000 drug deaths”.

Stu — give the guy a break; English isn’t his native language.

In computer science, it’s a very important word. I don’t encounter it much outside of that. In, for instance, Java, there are all sorts of different kinds of objects defined, and you can create your own definitions of new object types, but they don’t really exist until you *instantiate* them, which causes memory to be allocated to hold them. For instance:

String foo = new String(“bar”);

That declares an object of the String class, names it “foo”, and initializes it with the value of “bar”. “foo” is an instance of the class String.

I just noticed some posts from Conor have emerged from moderation, but they all refer to bone buffering in chronic metabolic acidosis. You don’t suffer chronic metabolic acidosis from eating too much cheese; as I have said before, kidney disease is the most common cause. The article I link to at #104 explains things very clearly.

Conor wrote:

Didn’t Dr T Colin Campbell and son make millions with the “largest ever epidemiolgical study on nutrition and health” or whatever the claim was proving just the opposite? Meat eaters having weaker bones?

If you mean ‘The China Study’ I don’t recall much in there about bone health. Campbell set out with the aim of proving that animal protein is a killer, and cherry-picked his evidence to support that. There’s a good refutation of Campbell here.

Maybe you are referring to Campbell’s article ‘Dietary calcium and bone density among middle-aged and elderly women in China’? It found a strong correlation between dairy intake and stronger bones. It concluded that:

dietary calcium, especially from dairy sources, increased bone mass in middle-aged and elderly women by facilitating optimal peak bone mass earlier in life.

Dairy is a rich source of animal protein and in this study resulted in better bone health.

I have found an article referring to studies done by Campbell looking at urinary calcium excretion and protein intake which made the erroneous assumption that high protein leads to net calcium loss, but I have failed to locate them.

@ Herr Doktor

I believe calcium is needed by the heart to keep functioning.

@ Krebiozen:
@ Ben T:
The excrable *article* is also available in book form and has recently premiered as an *award-winning ‘documentary’*( i.e. the documentation of ridiculous, fear-mongering ideas dreamt up to bilk followers out of their excess cash).
The death-by-drug figures are usually quoted as you say, K, but the ‘money quote’ is the 600K: the sum total of death by drugs, by doctors, by hospitals et al. ( see Gary Null.com/ Progressive Radio Network.com for this and other bilge-water).

Ah, yes, excuse my limited memory of physiology class. I only remembered that fluorine exposure usually kills a person by striping calcium out of their bones and bloodstream and causing a heart attacks.

@Conor:

Problem is that many of these molecules cause havoc in the body, sooner or later, precisely because of their artificial origin …

That’s called the naturalistic fallacy.

Posted by: Mojo | February 29, 2012 7:07 AM

… more like iatrogenesis

Just a few comments on the above posts since yesterday.

Low level, chronic metabolic acidosis does indeed exist on a massive scale in populations on the typical western diet….

Apart from a last resort attempt at buffering acids (in renal failure or in chronic, low-level metabolic acidosis), calcium may also leave bone due to parathyroid disease.

As a closing contribution, here’s an article I’m sure you’ll all enjoy – your favourite topic – snake oil:

Snake Oil: Traditional and Evidence-based Medicine Converge
http://www.greenmedinfo.com/blog/snake-oil-traditional-and-evidence-based-medicine-converge

@Witch #133

“Low level, chronic metabolic acidosis does indeed exist on a massive scale in populations on the typical western diet….”

Perhaps you would be kind enough to provide a citation for your claim.

Jay,

That doesn’t mean that calcium buffers anything – folks ought to learn some basic chemistry.

True, it’s the carbonate and phosphate that does the buffering.

THis is an equilibrium effect and not a “stripping calcium carbonate from the bone to buffer blood pH” effect. Honestly, go back to freshman chemistry class.

Freshman chemistry class won’t help you much with bone biochemistry. Despite dozens of lectures and case presentations, hours of study and exams passed, I still have to go back to the textbooks to be sure I have the roles of PTH, calcitonin, vitamin D, IL-6, osteoblasts, osteoclasts etc right, and that’s just the basics. You can get deeply into cathepsins and metalloproteinases and other esoteric stuff too. It’s not my favorite area of biochemistry.

As a matter of fact it’s not just an equilibrium effect, low pH activates osteoclasts to break down bone, releasing carbonate and phosphate to buffer blood pH.

I am sympathetic to the argument that if a therapy works and is evidenced-based, it should not be called “alternative.”

I am also grateful to the skeptics here for continuing to demand evidence and keep medicine grounded in science, and challenge us to know our sources and use critical thinking.

I am also planning on incorporating elements of yoga – poses, breathing exercises, meditation, etc., into a primary care practice, not in place of allopathic medicine, but alongside it.

Is it wrong to call a practice like this integrative? I am not trying to be difficult, I just want to hear your perspectives.

SC@139–
I think there is fairly good evidence that yoga and its associated components can have beneficial effects on health. I wouldn’t call that alternative; I’d call it patient-centered and progressive. You could call it integrative if you like, but the problem is that the people looking for an “integrative” practice would probably have a different idea about what that term encompasses, and would probably be disappointed that you weren’t also prescribing homeopathy, accupuncture, and other woo-ology.

SC (#139):

“I am also planning on incorporating elements of yoga – poses, breathing exercises, meditation, etc., into a primary care practice, not in place of allopathic medicine, but alongside it. Is it wrong to call a practice like this integrative?”

Why call it anything? As for the term “integrative”, the word has picked up certain connotations that you may or may not want associated with your practice.

If you want people to think that your practice mingles evidence-based and fantasy-based therapies, then “integrative” is an appropriate term. If, on the other hand, you see yoga as a form of low-impact exercise and stretching, a good way to relax and decompress emotionally, then you way want to avoid the term “integrative”.

Words pick up extra layers of meaning from their usage, like the way “allopathic” (originally coined by Hahnemann to describe all non-homeopathic medical therapies) has picked up an taint of insult. The term “integrative” has become yet another “code word” or euphemism for fantasy-based (or magical) pseudoscientific therapies, much the same as the words “alternative” and “complementary” in conjunction with medical practice.

So, if you are an “alternative” practitioner (i.e. you believe in fantasy-based therapies), the term “integrative” would attract the type of patients you seek. If you aren’t an “alternative” type practitioner, some people attracted to the “integrative” label in search of magic cures will be terribly disappointed.

Prometheus

Witch,

Therefore, low pH is one of the reasons for loss of calcium from bone, regardless of the mechanism.

Low pH is not an important reason for the loss of calcium from bone. Look at the risk factors for osteoporosis and you won’t see metabolic acidosis, acid diet or even high protein diet listed there.

You keep referring to material I don’t think you understand – did you notice that bone buffering only occurs “In prolonged metabolic acidosis” according to your link? I have personally measured blood gases (that include pH, CO2 and bicarbonate) on thousands of people, and I can promise you that those with metabolic acidosis sufficient to cause bone loss were not walking around ordering Big Macs. I know there are thousands of websites that claim that we all accumulate acids due to our poor diet and lifestyles, but they are wrong. It is a prevalent and widely believed myth.

If something happens to make our blood more acidic, we ingest some acid-generating food, or we take some vigorous exercise for example, the major buffering systems in our body deal with it. You can see what these are in the link you provided. In the most important, the bicarbonate buffering system, acid combines with bicarbonate to form carbon dioxide and water. The carbon dioxide is exhaled and normal pH is restored. This is why people with metabolic acidosis hyperventilate, as their body rids itself of excess carbon dioxide. It is a very characteristic way of breathing, a sort of deep sighing, that you see in very sick people. It is only when these buffering systems are insufficient to bring blood pH back within the normal range that bone will be broken down.

Metabolic acidosis sufficient to lead to bone loss is rare and is due to underlying disease, not simply due to eating an “acid diet”. As your link says “the body has a HUGE buffering capacity, and this system is essentially IMMEDIATE in effect” (their emphasis). Consider a marathon runner. Running generates a huge amount of metabolic acids, as much as 320 mEq/hour (note this is in addition to the volatile acids that are eliminated as CO2 through respiration). A marathon runner will generate about 1000 mEq of hydrogen ions if they run for 3 hours. This will induce an impressive metabolic acidosis. I have done metabolic profiles on blood samples from marathon runners and if I hadn’t known I would have assumed they has suffered a massive heart attack. However, by the next day their acidosis has vanished. Some people have run marathons on consecutive days over a period of a year or more without succumbing to acidosis.

Compare this to the acids generated by food. The most acid generating food is hard cheese (PMID 7797810) which generates about 30 mEq of acid for every 100g (about 4 ounces) eaten. You would have to eat 7 pounds of hard cheese to produce the same amount of organic acids a marathon runner does.

If marathon runners can easily deal with the 1000 mEq/day of organic acids generated by running multiple marathons without their skeletons dissolving into a calcium soup, why would our bodies be incapable of dealing with the tiny fraction of this that eating acidic foods generates? It doesn’t make sense, and is not supported by experiments or by epidemiological data. Check out PMID 21248199 which concludes, “a high-protein diet has no adverse effects on bone health”.

I see why you mention parathyroid disease, but I think you miss Calli’s point. Maintaining blood calcium levels is essential for life. Low calcium can rapidly lead to fatal cardiac arrhythmias.

How did you all like the Snake Oil link

I appreciate the irony of snake oil turning out to have therapeutic properties. Some folk medicines have proved to be effective. They are tested, the active ingredients isolated, and if they prove to be effective they become science based medicine. The majority of folk remedies that have been tested have been found to be inert, ineffective or dangerous. I don’t see how this supports your assertion that “many disparaged traditional medicines are, in fact, effective medicines”. I think that most aren’t. Does anyone know what percentage of traditional remedies that are tested turn out to be useful in pharmacognosy?

Why is everyone so afraid?

I don’t think anyone is afraid exactly. I just don’t want to see proven science based medicine mixed up with superstitious nonsense. Not only is it ineffective but it encourages people to believe in nonsense, and that can’t be good for anyone.

Why can’t herbalists / nutritionists (naturopaths), yoga teachers, acupuncturists, to name a few, work alongside of conventional doctors as part of an integrative medicine alliance?

Because most of the treatments they use have been proven not to work and they often propagate misinformation about health and disease.

Patients will soon know if a therapy works or not.

Unfortunately that’s not true. Humans are very bad at assessing therapies, which is why dangerous treatments like bloodletting were popular for thousands of years, and doctors were convinced they were helping their patients. It was only when these treatments were subjected to careful scientific study using clinical trials that it was proven they were dangerous.

@141-143

Thanks for your comments. Since over 90% of Americans believe in God, I’m not too worried about allying myself with people who believe in magic. It seems fairly ubiquitous. The trick, it seems, is to balance that belief in magic with a reverence for science and a reliance on evidence. I’d wager that the majority of physicians have some religious affiliation, but it is part of their duty not to let that interfere with evidenced-based medicine. A doctor might recommend prayer to his patients, for example, but he/she would not recommend it in place of medical therapy, but rather, perhaps as a way to help patients manage their illness if faith is part of their background.

It seems from what I’m reading that this is a primary concern with integrative medicine – a fear that belief will overtake evidence, and that this will negatively impact how a physician acts. I think this is a valid concern, and I’m glad there are people on the lookout for this kind of departure from best practices. I do not believe in an external God myself, but I certainly have beliefs that can’t be proven (woo is on a spectrum, after all), so as my practice takes shape, I will be sure to be careful about how my beliefs might be effecting my practice, and whether that is to the potential detriment of my patients. Thanks for reminding me to be aware of that.

How did you all like the Snake Oil link

Anyone who links to the same site three times is a spammer.

TBruce @ #114, thank you, and a virtual Hi5 to your friend the witch! 😀 Tell her I got my flu shot last month!

I would like to report that it gave me superpowers, but so far only super immunity. Which, really, compared to our not-too-distant ancestors IS a superpower, now that I think of it.

You will love this one. There is a cancer article on HuffPo, and I encountered one of the usual luddites. They were saying all cancer treatments are bunk and only alternative medicine will work.

So I wrote.

“Then give an example of an alternative treatment and what it is used for. Cite peer reviewed sources showing its rate of effectiveness vs conventional treatments. Compare the outcome statistically to conventional treatments. Good luck.”

They wrote back….

“Read Suzanne Sommers’ book “Breakthrough.” Chemotherapy does not help most cancers. It does help some but the majority it DOES NOT. Most people, even after treatment, are left with broken bodies that have been poisoned by this treatment. There is no energy. Cells on a cellular level are destroyed. Western medicine only knows chemotherapy/radiation. That’s it. The body is capable of being healed but only with the right protocol. Chemo is not a one size fits all treatment for cancer. Why do you think there is no cure for cancer? It brings in too much revenue for the pharmaceutical companies and oncologists that have absolutely no clue in treatment other than chemo/radiation.”

I am confused. Can you use a Thighmaster for lung cancer?