Over the years that this blog has been in existence, beginning very early on, there has been one overarching theme. That theme is that the best medicine is science-based medicine. Sure, we could quibble about how that was originally defined, and I used to be more of a booster of evidence-based medicine until its blind spot with respect to “complementary and alternative medicine” (CAM) and “integrative medicine” (IM). That blind spot, as I’ve explained time and time again, both here and elsewhere at my not-so-super-secret other blogging location under my real name, that blind spot is prior plausibility. Once I learned about John Ioannidis, Bayesian statistics, and how doing clinical trials with a low prior plausibility is far more likely to produce false positive results than true positive results, I realized that testing modalities with incredibly low prior plausibilities is so unlikely to be fruitful that it’s only something that should be considered when money is no object, and that’s even leaving aside the dubious ethics of doing clinical trials of treatments like that.
And, of course, money is always an object, arguably now more than ever.
The normal sequence of development of a drug or treatment is a progression from preclinical research (basic and translational science that can involve any combination of biochemical studies, cell cultures studies, and animal studies) to early stage pilot clinical trials. If the drug or treatment shows promise in these early studies, then–and only then–are large phase III clinical trials warranted. In an ideal world, basic science considerations determine plausibility, translational preclinical studies solidify the plausibility of a treatment, and then clinical trials confirm whether that plausibility translates into a working therapy that is both efficacious and safe. Similarly, in an ideal world, the first steps of this process are informed by clinical observations that lead to laboratory investigations that progress through the various steps to clinical trials. The paradigm of bedside to bench and back to bedside often works. Indeed, the entire ethics of our current clinical trial system assumes that there is a certain degree of prior plausibility based on preclinical evidence before subjecting human subjects to the potential risks of a clinical trial.
The problem with CAM is that it bypasses that process. With the exception of some herbal medicines (which, of course, could well contain active ingredients that can function as drugs) the vast majority of what passes for CAM lacks prior plausibility. I realize I beat on this example a lot, but homeopathy is the paradigm here. For homeopathy to “work,” huge swaths of physics, biochemistry, and biology would have to be not just wrong, but spectacularly wrong. The same is true for “energy healing.” Acupuncture relies on “meridians” that have no anatomic structure associated with them that anyone has yet been able to find. Chiropractic relies on “subluxations” that, similarly, no one other than chiropractors have been able to find. In other words, their prior plausibility, particularly that of “energy medicine” and homeopathy, is about as close to zero as it is possible to be and not actually be zero. For all practical intents and purposes, homeopathy and energy medicine are impossible.
And the National Center for Complementary and Alternative Medicine (NCCAM) spends about $125 million a year to study CAM, which my good bud Kimball Atwood has quite accurately described thusly as:
A spectrum of implausible beliefs and claims about health and disease. These range from the untestable and absurd to the possible but not very intriguing. In all cases the enthusiasm of advocates vastly exceeds the scientific promise.
As much as I have lamented the infiltration of quackademic medicine into medical academia, it’s not all bad news. Even though an awful lot of woo has found its way into even once-respectable medical journals, every so often there’s something good there by someone who “gets it” with respect to CAM. This very thing happened in yesterday’s issue of the Journal of the American Medical Society (JAMA). I have no idea why, but the editors actually published a commentary by Dr. Paul Offit. While that means that antivaccinationists will automatically dismiss this article as the spawn of Satan, for the rest of us Dr. Offit provides a strong argument that studying much of CAM is a waste of scarce resources in the form of an article entitled Studying Complementary and Alternative Therapies.
After giving a brief history of NCCAM, from its very humble beginnings as the Office of Alternative Medicine back in 1992, a brain child (if you can call it that) of Senator Tom Harkin and Representative Berkley Bedell, to the $125 million a year juggernaut of woo it became, Dr. Offit describes the rationale used by CAM apologists to defend NCCAM:
In support of NCCAM’s mission, proponents argue that one century’s folk medicine can be the next century’s mainstream medicine. For example, Hippocrates used leaves from the willow plant to treat headaches and muscle pains. By the early 1800s, scientists had isolated the active ingredient: aspirin. In the 1600s, a Spanish physician found that bark from the cinchona tree treated malaria. Later, cinchona bark was found to contain quinine, an antimalarial drug. In the late 1700s, William Withering used foxglove to treat heart failure. Later, foxglove was found to contain digitalis, a drug that increases heart contractility. More recently, Artemisia, an herb used by Chinese healers for more than a thousand years, was found to contain artemisinin, another antimalarial drug. Indeed, most drugs on today’s hospital formularies were originally derived from plants.
All of which is true but irrelevant to much of the research that NCCAM funds. It also confuses CAM with pharmacognosy, the latter of which is the study of natural products as potential drugs. Pharmacognosy is an important and respectable branch of pharmacology because, as Dr. Offit mentions, many, if not most, drugs in use today were originally derived from natural products, some of them modified for better pharmacological properties. I’ve asked time and time again why pharmacognosy is in any way “alternative.” it’s a rhetorical question, of course, because pharmacognosy is not “alternative.” But CAM has co-opted pharmacognosy as “alternative” much as it has also co-opted diet, exercise, and lifestyle when the study of such interventions is every bit as much the purview of science-based medicine as the latest drug developed by big pharma. As for the rest, the problem boils down to prior plausibility:
However, unlike studies of drugs derived from plants, many studies funded by NCCAM lack a sound biological underpinning, which should be an important requirement for funding. For example, NCCAM officials have spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390 000 to find that ancient Indian remedies do not control type 2 diabetes; $700 000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406 000 to find that coffee enemas do not cure pancreatic cancer. Additionally, NCCAM has funded studies of acupuncture and therapeutic touch. Using rigorously controlled studies, none of these therapies have been shown to work better than placebo.4â Some complementary and alternative practitioners argue reasonably that although their therapies might not work better than placebos, placebos may still work for some conditions.
I get the feeling here that Dr. Offit is bending over a little too far backwards to be “fair.” While he points out all these highly implausible treatment modalities that NCCAM has wasted money funding, he seems to be buying into the selling of placebo effects as being anything more than subjective improvement without the correction of underlying physiological derangements responsible for disease. CAM is in essence placebo medicine, sometimes to a ridiculous degree. A really ridiculous degree, even, to the degree that it’s not for nothing that I’ve referred to CAM as the new paternalism.
Another point that Dr. Offit makes is that the marketing of CAM, including the supplement industry, is completely divorced from reality and science. Some have argued that NCCAM has done good in funding studies of various CAM modalities that turned out to be negative. In a world where the marketing of CAM treatments is based on solid scientific evidence, that would indeed be a valuable service. We do not live in such a world, and Dr. Offit describes that well:
Several studies have shown that garlic does not lower low-density lipoprotein cholesterol, St John’s wort does not treat depression, ginkgo does not improve memory, chondroitin sulfate and glucosamine do not treat arthritis, saw palmetto does not treat prostatic hypertrophy, milk thistle does not treat hepatitis, and echinacea and megavitamins do not treat colds. Moreover, some studies have found that megavitamins increase the risk of cancer and heart disease. Because the vitamin and supplement industry is not regulated by the US Food and Drug Administration (FDA), negative studies have not precipitated FDA warnings or FDA-mandated changes on labeling; as a consequence, few consumers are aware that many supplements have not delivered on their claims. In 2010, the vitamin and supplement industry grossed $28 billion, up 4.4% from the year before.8â “The thing to do with [these studies] is just ride them out,” said Joseph Fortunato, chief executive of GNC Corp. “We see no impact on our business.”
It’s not just supplements, either. The evidence that homeopathy is nothing more than water is enormous and indisputable; yet that doesn’t keep Boiron from raking it in hand over fist selling homeopathic flu remedies or, sadly, a number of academic medical centers from setting up “integrative medicine” centers that feature all manner of what used to be considered (and should still be considered quackery), such as energy healing. Given that, I agree with Steve Novella and Paul Offit that it is entirely reasonable to ask why taxpayer dollars should be used to fund studies with such a low prior plausibility that the likelihood that they will result in useful information or that they will validate the therapy being tested is incredibly slim and none. Let’s just put it this way, using my favorite example of homeopathy again: When faced with a therapy that violates the currently known laws of physics, which are supported by a few hundred years worth of experimental observations, veritable mountains of evidence, and a messy, bias-prone clinical trial that shows a barely statistically significant apparent effect, which are you going to believe. I know what I will believe. It takes a lot more than an equivocal clinical trial to overthrow hundreds of years of physics and chemistry. To show that homeopathy “works” would require evidence of approximately the same quality and quantity as the evidence that says that homeopathy can’t work. In other words, it takes a lot to prove the impossible to be possible.
That is why I’d quibble a little bit with Dr. Offit when he characterizes CAM therapies as “bordering on mysticism.” Reiki, homeopathy, acupuncture, and “energy healing” don’t border on mysticism. They are mysticism. He is, however, correct when he suggests that NCCAM should stop funding studies of such incredibly implausible modalities. I’m not so sure, however, that I agree with Dr. Offit when he suggests as an alternative that NCCAM might redefine its mission to understanding placebo responses. To some extent, this is already happening, and the results have not been pretty. My vote goes for the third alternative: Dissolve NCCAM and distribute its components to other Institutes and Centers at the NIH. There’s nothing that NCCAM does that can’t be done–and done better–in the rest of the NIH. Keeping the actual plausible modalities claimed by CAM, such as pharmacognosy and nutrition studies, in NCCAM in essence ghettoizes them, and there’s no reason to study the impossible, such as homeopathy.
This is especially true when promising research with a reasonable amount of biological plausibility is going unfunded. NIH paylines right now are abysmal (in the 7th percentile range) and threatening to get worse. My senior colleagues tell me that the NIH funding situation is the worst it’s been in at least 20 years, possibly considerably longer. I remember the early 1990s, and this is at least as bad. Worse, it shows no sign of getting better any time soon. In an environment like this, it’s inexcusable to waste $125 million a year that could go to useful science and useful research.
When it comes to NCCAM I suggest nuking the entire center from orbit. It’s the only way to be sure.
NOTE: For those of you who are humor-challenged (or not fans of the first two Alien movies, I am not seriously suggesting that NCCAM be nuked from orbit. Really. I’m not. It’s a metaphor. Defunding NCCAM and distributing its budget to the rest of the NIH would be just fine. Besides, nuking NCCAM from orbit would also destroy the NIH, in the middle of whose main campus NCCAM rests, and I could never condone that.
101 replies on “NCCAM: I say we take off and nuke the entire center from orbit. It’s the only way to be sure.”
NCCAM: Another example of how a government center, once established, is almost impossible to get rid of.
Inclined to agree, overall. A horrible waste of money, time and talent(?). However, if NCCAM is given any credence by the CAM community (side bar: may we just dispense with the term “CAM”? It’s not medicine. I propose Contemporary Non-Medicine – or CoNMed); if NCCAM carries any weight with quacks, then it gives me some hope that NCCAM statements such as this one may prove an in-road to chipping away at the foundations:
http://nccam.nih.gov/health/homeopathy
The solution is very simple, make NCCAM run a lot more studies on prayer. Publish enough “prayers don’t work” studies, and a certain fraction of politicians will sure as hell (excuse the bad pun) nuke NCCAM’s funding as contrary to their believes.
Genius!
I have to disagree with you on a few of your points above.
Competition for funding is a red herring at risk of becoming an auto-immune response. The solution to shrinking federal research budgets isn’t to go seeking a subspecies that looks enough like your species to threaten your ecological niche, and take them out much as animals do with their closest competitors in the wild. That dynamic can be played iteratively until it’s down to the cancer specialists vs. the infectious disease specialists, fighting each other to the death, while the anti-science brigade cheers from the sidelines as they eagerly look forward to the End Times.
The solution to declining research budgets is to attack it at the source: the combination of a) overweening greed on the part of plutocrats who seek to foist their anarcho-Randian dreams of life-without-government upon us, and b) outrageous diagnosable insanity on the part of religious extremists as they seek to create some kind of theocracy (keyword search “dominionism” or go to talk2action.org and read up).
You want more funding for science? Support the return of a truly progressive income tax, to the levels that existed during the Apollo program. Yes that means taking on some truly nasty evil characters. But think of this: a dozen Goldman Sachs fraudsters’ worth of yearly bonuses are sufficient to undo whatever damage may have been done by paying nitwits to wave their hands over patients and chant mumbo-jumbo. You go after the mumbo-jumbo chanters, while the fraudsters cackle at you from their balconies.
By analogy, James Randi going after crystal-ball gazers while religious fundamentalists are eating the brains of the masses like science fiction alien invaders. Hint: the crystal-ball gazers aren’t the ones trying to force young-Earth creationism into public school classes. Fortunately Randi eventually took on this fight, per (if I recall correctly) an editorial or similar essay on the CSICOP website. Let’s not repeat the same learning curve from scratch.
If money is an object “now more than ever,” the answer is to vote out the Republicans in Congress who toady to the greed-fiends and God-fiends, replace them with progressive Democrats, and reinstate a truly progressive tax system with no loopholes. Then you’ll have all the money you want for doing real science, and the mumbo-jumbo chanters will have all the money they need to fall flat on their faces with empirical results that support the null hypothesis.
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“Prior plausibility” sounds an awful lot like a cross between “a-priori” and “common sense,” and the latter is all too often emotional bias plus rationalization. Bottom line is, there is no substitute for empirical findings. And ruling out whatever-it-is on the grounds that “it must be impossible,” is an open door for all manner of obscurantism and conspiracy theory.
The way to go after “impossible” nonsense is to catch it in the trap of empiricism. A particularly good way to do that is to ask the promoters of the nonsense to operationalize their variables. One of the instances that perennially bugs me is the use of the word “energy” as a black box. So: Operationalize “energy.” What exactly do they mean by that word, and how exactly is it measured?
I’ve actually done this exercise with enough of these people to have finally gotten an answer. “Energy” = “good vibes” = “pleasant emotions.” OK, now we’re making progress! Emotions are communicated through verbal and nonverbal cues, so if you want to “transmit good energy” (convey pleasant emotions) to patients, the question is, how best to do that?
Now you can set up a study in which test group A receives visitations from a mumbo-jumbo hand-waver, and test group B receives visitations from someone who has just spent a half hour hugging their best friend or listening to their favorite music or sniffing nice flowers or otherwise putting themselves in a contagiously happy mood. And of course the control group receives a visitation from someone who has just spent a half hour reading something terribly dull so they’re in a more-or-less flat neutral mood. After the visitations, ask the patients to rate their mood and outlook, using questions that are designed to be, if anything, overly sensitive. What you’ll find is that test group B feels a heck of a lot better than test group A, and test group A feels little better than control. Thereby putting “energy healing” to rest (in a pine box) for once and for all.
Similar routines can be run for a whole range of woo and nonsense, but more often what you’ll find is that simply pressing the woo-meisters to operationalize their variables makes them drop what they’re doing and run in the opposite direction. Problem solved, case closed, and no need to open an “a-priori” door through which obscurantists and other unfriendly ghosts can enter.
Randi did something like this on the homeopathy study that had made it into the pages of _Nature_, and the end result was the paper being retracted. When this stuff is done empirically, the woo-meisters have nothing to complain about. In contrast to the “a-priori” approach, which only gives them conspiracy-fodder about being “suppressed.”
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The word you’re looking for isn’t “mysticism,” it’s “mystification.” Mysticism is the branch of philosophy (usually religious in nature) that is concerned with the direct personal realization of God or the Ground of Being (“ultimate reality” if you will). Fully endorsed, in its atheistic variant, by no less than Einstein. Mystification is the making of mysteries where none truly exist. Any comparative religion student can tell you the same thing.
The Higgs boson is a legitimate mystery in the process of being solved: science treats mysteries as puzzles to solve, and proceeds to do so. Poorly-operationalized procedures that pretend to be forms of “healing” are “mysteries” ginned up by quackadoodles to mystify others, and reinforce their delusions and/or line their pockets.
One can mystify one’s mysticism by sprinkling it with foreign-language terms incorrectly used, or one can de-mystify it by using common language clearly. But in any case they are not the same thing. And belief in a deity is not a precondition for (or result of) the experience of a deeply-felt personal sense of meaning in relation to something larger than self.
You clearly misunderstand the concept of “prior plausibility.” Lack of prior plausibility does not mean “not knowing the mechanism” or “fits perfectly within existing paradigms.” It means not so much at odds with existing science that huge swaths of existing science would have to be overthrown for the treatment being tested to “work.” Gotta run now; I can expound on this more later. I’ve expounded on it a lot in previous posts.
In proof-reading that before I posted it, I left an obvious point of confusion that should have been fixed:
“Anarcho-Randian” >> “Rand” as in “Ayn Rand” Randian, nothing to do with James Randi. Mentioning Rand and Randi in the same posting runs the risk of confusion unless clearly spelled out.
To me one of the indictments of the NCCAM is that the NIH is mostly organized around diseases and functions(National Cancer Institute, National Heart Lung and Blood Institute, etc.). CAM needs its own center because the potential treatments cannot compete for potential impact in these fields. That says there is something wrong with CAM, not the organization of the NIH. Put another way, if NCCAM went away, all of the CAM studies would still be eligible for funding within the existing center that addresses the disease of interest. Having an NCCAM really just gives these researchers a double shot at funding that researchers in fields with a chance of helping do not get.
Thanks for the article Orac…but it’s behind a paywall.
However, I located a JAMA interview with Dr. Offit about this same essay. I just played it:
http://jama.ama-assn.org/content/307/17/1803/suppl/DC1
Think you’ve missing the point, g724: no one has suggested that eliminating NCAM will resolve the problem of insufficient research funding.
What’s being pointed out is simply that while it never makes sense (even when funding is abundant) to spend millions on studies where there can be no expectation of productive outcomes, doing so at a time when funding is limited and studies which do hold out hope of productive outcomes must remain unfunded is idiocy.
Hi Orac, and thanks for taking the time to read & reply to my contrary views.
Yes, I do understand what you meant. As in, a whole swath of physics would have to be wrong in order for homeopathy to be right.
The problem is, that will not convince people who don’t know all the physics that has to be wiped to make way for magical water.
What will, are empirical refutations of magical water. As in, “We gave your homeopath a million bucks for research, and he couldn’t demonstrate an effect.”
Apologies for taking a bunch of long paragraphs to get to the key point, but going after their research funds only encourages them to scream “conspiracy!” and “suppression!” and all that jazz. Give them the rope with which to hang themselves. Once they do that, they are dead and gone for good. They will slink off into the sunset and find some other nonsense to peddle, like New Age pet rocks (crystals).
Ultimately there may be a philosophical difference between you and I about this. When it comes down to it, I’m something of a hard-core empiricist: I want to see the findings, pick apart the operationalizations, and so on. Very often I find truly crappy research methods and on that basis can go after the conclusions in a way that the promoters of nonsense can’t argue.
Though, there are a few specific phenomena that I believe are well supported by findings, that you clearly don’t. (For example certain forms of psi, and I’m not going to digress the discussion to go there, suffice to say I believe that when the mechanisms are found they will be consistent with present physical theories plus or minus a couple of minor adjustments. And yes there’s been plenty of truly crappy research in that field too, about which you and I wouldn’t disagree.)
But I’d rather hang with the hard skeptics than with the True Believers, if for no other reason than a preference for intellectual rigor over the lack thereof. That and we have strong common cause about vaccination and a few other public policy & public health issues.
BTW, in one of my other online identities elsewhere, I’ve been waging a pretty decent battle against certain forms of nonsense, most recently going after someone who was promoting raw milk for all the usual bonehead reasons including “natural bacteria” (to which I replied, “got salmonella?” which seemed more effective than interrogating him about the differences between “natural” bacteria and “supernatural” bacteria:-). One of these days I’m going to post some links but I’ll have to do it as Anonymous in order to maintain compartmentalization of online identities.
What will, are empirical refutations of magical water. As in, “We gave your homeopath a million bucks for research, and he couldn’t demonstrate an effect.”
[citation needed]
As the OP points out, there actually have been several such studies. Granted, there hasn’t been time or money enough to cover all of woo-space, but even within the subset of woo-space that has been so examined I see no evidence that CAM types have abandoned those ideas. They will always find a way around it: point to the handful of apparent successes (the placebo effect is at work) to claim that it is indeed successful; play the “Pharma Shill” card; even in extreme cases resort to “la la I can’t hear you.”
What would work is ridicule of such beliefs, if there were no authority figures clinging to those beliefs. The problem with that approach is that we don’t live in that world, either. A US Senator is, for better or for worse, an authority figure, so having someone like Harkin backing CAM makes it hard to fight off successfully.
This was just overheard from an unidentified official from NCCAM after they finished reading Orac’s latest insolence:
And yet, those empirical refutations have done no such thing. “It is impossible to reason someone out of a position they have not reasoned themself in to.” The proponents of homeopathy (and CAM in general) don’t care about evidence unless it supports their preconceptions.
A purely faith-based system is not amenable to empirical refutation.
Sorry for the double post…
Put another way, people who are not convinced by the current studies either (a) are unaware of them or (b) don’t care. In neither case will doing more studies change anything.
I agree, blast away!**
Offit’s mention of the CEO’s response is important: people want to believe in these products – as self-help, so the companies “ride out” the storm that follows SB research that underlines a supplement’s inefficacy or possible ill effects.
I often peruse offerings at a supplement shop ( there’s a gigantic one at the river near restaurants I like): I entertain my companion by explaining just why these products are not a good investment ( see Dr Offit’s list of specific entries) It seems that in the past few years, the pseudo-pharmacoaeia has grown by leaps and bounds, especially the faux foods ( for lack of a better term)- powders consisting of protein or dried vegetables/ fruits that replace *food* and exotic-foreign-herbals.( For the record: we usually purchase sweet and/or crunchy treats in bar
form- it’s over-priced candy, basically).
I think that research into supplements’ *lack* of effect could eventually take hold of the public’s buying habits. There’s no reason that that research need be done at NCCAM.
** metaphorically, of course.
MESSAGE BEGINS——————————-
RE MISSIVE 395093859903003030: “nuke the center from orbit, it’s the only way to be sure.”
ORAC, my dear and formidable brain-in-a-box, how joyful it is to have received this long awaited message!
But alas, you know how slow things are in a bureaucracy of monkeys, so imagine a bureaucracy of lizards and well, you get the idea. So we must exercise patience as we wait for the required firing codes from the Imperial Department of Blasting and Disintegrating back on Glaxxon Prime. How dreadfully inconvenient. And as for “nuking”, of course we’ll be using our newly upgraded K’vaach & S*poch, 100 yotttawatt matter drivers to do the job (a clean, shiny NCAAM-shaped hole and no radiation), but “nuke” sounds so forceful, if a tad quaint.
The plucky and enthusiastic Miss Flinders will have the honors once we receive the codes, and while she is almost surgical in her precision with the matter drivers, I’d stay out of the Metro D.C. area for the next few days anyway as her penchant for Red Bull can render her rather . . . “enthusiastic.”
Yours in Pure Pharma Eeeeeeeevilâ¢
Lord Draconis Zeneca, V7ihL443
Foreward Mavoon of the Great Fleet, Suzerain of the Terran Subjugation Force, Arbiter of Taste, Pharmaca Magna of Terra, Pusher of Buttons
Glaxxon PharmaCOM Orbital
000101011101010011110010101
——————————————–MESSAGE ENDS
Couple of thoughts I had:
1) Instead of calling for disbanding it, let’s run over it. We always have to find ways to pitch our research to meet the needs of the funding agencies, so take your normal NIH project and throw in a “prayer” component as a complimentary approach. Then after the prayer stuff comes up worthless, you can still talk about the results for the real studies you’ve done.
2) Let’s have the CAMers put up or shut up. Yes, we will use the NCCAM to fund studies of your woo. BUT if the results come up negative, you are subject to FDA regulation and can no longer sell it is a dietary supplement approach. It is failed medicine, and can only be sold as such. None of this “these statements have not been evaluated by the FDA” crap, but “these statements have been evaluated by the FDA and are not true”
@ g724:
Good luck with the raw milk crowd.
While *mystification* is a good description, I might personally go with *deification*- they deify Nature and seek union with Its arcane and numinous essence through ingesting powdered plant material and pulverised and pre-formed minerals and phyto-ceuticals. All eating becomes ritual.
Orac: Also on JAMA’s website, along with the author interview, is an Author Insight interview with Dr. Paul Offit on the News@JAMA blog which is available for free:
http://newsatjama.jama.com/2012/05/01/author-insights-refocus-questionable-us-funded-complementary-and-alternative-therapies-research/
Jann Ingmire
JAMA Media Relations
One of the issues I think comes into play is that “plausibility” may be judged on two standards: A theoretical mechanism, and “results”. Both standards may serve to distract from fundamental demerits. I’d consider homeopathy an archetypal example: It’s generally recognized that in its early days, homeopathy had positive “results”, simply because it did no harm where many or most “orthodox” treatments ot the time were both useless and dangerous. I believe that homeopathy also had a grain of sound theory: There do seem to be circumstances where small doses can have at least as much effect as a larger one.
@g724
“What will, are empirical refutations of magical water. As in, “We gave your homeopath a million bucks for research, and he couldn’t demonstrate an effect.” ”
“Give them the rope with which to hang themselves. Once they do that, they are dead and gone for good. They will slink off into the sunset and find some other nonsense to peddle, like New Age pet rocks (crystals). ”
Really? You must be incredibly new to the discussion as well as this site. Those studies have already been done and your predicted effects have not resulted.
Typical Homeopathy responses:
You see, since my magic works for millions of people and your studies are all negative, your science is obviously incapable of testing it, and there must be other ways of knowing.
Also, my magic is individualized, so it can’t be tested in a randomized, double blinded controlled study.
Plus, I did one hundred studies and two of them showed statistically significant (but not necessarily clinically significant) results for my magic, so I have scientific proof that my magic works.
Additionally, my magic works on children and animals, and they are immune to placebo effects, so that also proves my magic works.
Lastly, the negative results of your studies actually are positive if you look at them through my bias, and even the negative studies prove my magic works.
“Though, there are a few specific phenomena that I believe are well supported by findings, that you clearly don’t. (For example certain forms of psi, and I’m not going to digress the discussion to go there…”
It’s generally consider bad form and poor commenting/argument to make such and undefended and unsupported point. In the absence of support or evidence, all this comment does is frame your bias and willingness to believe in unsupported claims that you personally find credible for the rest of us.
@21 For a pharmacologically active substance a larger dose is going to have a bigger effect (both good and bad) compared to a smaller dose-of the same substance. It’s true that some drugs work in microgram doses, whereas others have to get up into 100’s of milligrams to work, even drugs in the same class. It’s also true that with a # of drugs you can saturate the receptor sites so higher doses don’t give you more benefit (though they generally still give more side effects and/or toxicity). The basic principals of homeopathy “like cures like” and “contamination” (i.e. that having a cure dissolved in water will persist in the water even after you dilute the water until not one molecule of cure remains) are based firmly in magic-not science. The fact that it worked better than some other remedies around when it was invented is a testament to how bad those other remedies were, not how good homeopathy is.
g724, #5 – ” So: Operationalize “energy.” [..] “Energy” = “good vibes” = “pleasant emotions.” OK, now we’re making progress! Emotions are communicated through verbal and nonverbal cues, so if you want to “transmit good energy” (convey pleasant emotions) to patients, the question is, how best to do that?”
I grappled with the meanings of “energy” and energy as defined by physics for a long time. Like many other words used rather indiscriminately, their “street” everyday meanings far removed from any formal definitions and subject to the fads of the day, “energy” actually makes sense to me!
I am able to differentiate between energy and “good vibes” or “transmission of power / feelings / rhythm/ ” between human beings or humans and animals.
Scientifically, we need to look into psychology and ferret out the formal psychological definitions of the various ways to influence people and animals in our proximity. I include animals specially because of the (mostly) non-verbal communication or transmission of “good vibes” or “bad vibes” etc.
Then psych might connect with modern ever-evolving neuroscience, chemical signals and body language studies, which would provide a mechanism for the transmission of “vibes.”
In separating energy (physics) and energy as in “vibes” (psychology) and “energy”(woo) would you and other skeptics, science-oriented people, agree that the “vibes” are real and not woo? (I do not know the proper psych terms, but I am sure research exists)
As devil’s advocate, I will argue that IMO one of reasons so many flee SBM and choose the hypocrisy of woo is because of the times when doctors and hospitals were cold, ugly, loud, dangerous, obnoxious, arrogant places. Today, hospitals and medical offices are much more friendly, clean, the staff pleasant and polite. I do not know how hospitals were in USA in the past, I do know that where I grew up in Europe, hospitals were horrible and doctors, arrogant. (and I had some in the family, not bad people, some excellent specialists, nevertheless, making a patient’s visit pleasant was not on their priority list.)
In my experience, today’s “vibe,” using that term tongue in cheek, is much better in hospital and pre-hospital care, I was an EMT. Staff is trained to be polite and respect patients.
My main complaint is that harried physicians have NO TIME to TALK to patients. Physicians and /or staff have NO TIME to discuss nutrition, lifestyle, have NO TIME to explain a disease or options, and have the minimum of time to partake in those social graces like saying hello, how are you?, minimum time for the social lubricant of chit-chat, etc.
I understand the pressures (and the whole mess) of the financial aspects of health care; I get it that some patients may be “unreasonable” and demand excessive time, refuse to do homework, refuse to follow directions etc etc; nevertheless, on a gut feeling, I think people go to CAM to be scammed because at some point, CAM marketing struck gold and now there is a significant group of people associating CAM with “good things.” It’s wrong, not factual, not rational, … but I cannot even broach the topic with my best friends who “believe.”
And their CAM practitioners take the time to talk to them, when their MD is too busy. I perceive that CAM practioners appear “friendly,” have TIME, chit-chat, promote woo while consciously spreading those “good vibes,” spreading a mix of energy (psychological) and “energy” (woo).
So perhaps the first step to operationalize the concept of energy as used outside of physics is to acknowledge the (psychological?) reality of of the transmission of good or bad “vibes,” then look into communication.
It may be that one of the ways to discourage people from believing in woo and spending money on woo might be to encourage a way for the medical profession to communicate more effectively with patients and the media.
Of course, nothing is “simple” as that and Orac had that post about the hospital survey in which patients’ satisfaction rate was high at “fluffy” improvements, lower when faced with actually rates of healing/improvement.
I guess our ancient reptilian brain stem (or something!) makes us depressingly susceptible to choosing “good vibes” and a bad outcome over a drab, non-fluff but effective process. *sigh*
We can do better than simply defund NCCAM.
Simply add a line to the law that anything they find non plausible or harmful is not allowed to be further studied with taxpayer money, sold, administered, prescribed, or promoted in the US.
Appeals are via the full FDA process, on the charlatans nickel.
It looks like there’s a free link to Offit’s article (no pay wall) in the text of this interview with him
http://newsatjama.jama.com/2012/05/01/author-insights-refocus-questionable-us-funded-complementary-and-alternative-therapies-research/
Click on the hyperlink in the second paragraph.
Certainly, if you’ve either achieved a concentration at which receptors for the drugs are saturated, or if it isn’t necessary to achieve complete saturation of the receptor to acheive a therapeutic effect (for sinstance, if to achieve a therapeutic effect it’s necessary to saturate 30% of available receptors dosages varying by 3-fold might exhibit equivalent efficacy).
I’m aware however of no circumstances where the dose aboslutely no drug substance whatsoever results in ‘at least as much of an effect as a larger one” other than where the drug in question is completely inert.
I’d consider homeopathy an archetypal example: It’s generally recognized that in its early days, homeopathy had positive “results”, simply because it did no harm where many or most “orthodox” treatments ot the time were both useless and dangerous. I believe that homeopathy also had a grain of sound theory: There do seem to be circumstances where small doses can have at least as much effect as a larger one.
I agree with the first of these sentences. Not so with the second one.
It’s true that just about anything is toxic in sufficiently large doses, including many substances which are theraputic in smaller doses. Homeopathy takes this idea to an illogical extreme. There is simply no plausible mechanism by which one can guarantee that a substance diluted by a factor greater than Avogadro’s number will yield a product containing even one molecule of the substance. (In practice, limits to the purity of distilled water kick in several C-dilutions before you reach this stage.) Hanneman developed homeopathy around the time that Avogadro deduced the existence of the number named for him. It might be possible to argue that Hanneman himself wasn’t a crank, but no such excuse applies to anybody who studied chemistry after Avogadro’s number was known.
Mr. Withakay FTW! I’ll have to memorize that list of homeopathic excuses.
@Pareidolius:
Another typical CAM defense, but not applicable to homeopathy is: My magical substance kills X when used in very high concentrations in a petri dish, therefore taking much smaller doses orally cures X.
@ dreamer:
Actually, if you want to understand what contributes to ‘good vibes’ ( as a factor influencing others’ decisions) just watch a woo-meister in action- concern and sympathetic reassurance are communicated either verbally or non-verbally; often, the woo stresses his empathy and how he is a down-to-earth fellow despite his obviously superior knowledge in the health sciences ((cough)).
Psychologists *do* study these interactions: here’s something I just found- Gardner et al (2010)- parents are more accepting of vaccine information from another parent than from governmental sources. Woo-meisters accentuate the idea that professionals have placed themselves upon a pedestal, looking down at their clients: in contrast, they always focus on *equality*, perhaps even telling their audiences that “you know as much about health as any doctor”. Conflating egalitarianism in a political or philosophical sense with equality of knowledge or ability fits into their *empathetic* model of interaction. You’re having a friendly, helpful conversation, not a consult. Odd though, my friends never charge me.
My late father always said that he was successful in business more because of how he looked and sounded than because of his ability- of course, he was joking, but not entirely so. A (former)International Business Man(tm) refers to his “geisha-ness”- he succeeds by getting clients what they want. I’m told I have it in spades.
So woo-meisters sell you by selling themselves as a concerned, sympathetic person who is there primarily to help you and tell you what you want. ‘Con man’ is derived from ‘confidence man’: they first get you to confide in them and trust them, making you feel good about yourself and them. Good vibes.
More wary customers might ask, “What’s in it for them?”
@Orac: Is there anything to this? From everything that I have learned from reading your blog, I am not about to exchange Femara for a glass of baking soda and water.
NCCAM allocated a 2 million dollar grant to the University of Arizona to prove drinking baking soda stops breast cancer from metastasizing. The study only has 18 subjects.
http://medicalxpress.com/news/2012-04-grant-fuel-soda-cancer-therapy.html
“The grant will be used to help refine a new magnetic resonance imaging method for measuring pH, or acid content, of a tumor that has been discovered in a patient but not yet treated.
By measuring the acid content of the tumor, doctors can monitor the effectiveness of personalized treatments such as baking soda on both tumors and healthy tissue, and even predict the effectiveness of chemotherapies before the patient starts the medication.
Drinking baking soda has been proven to reduce or eliminate the spread of breast cancer to the lungs, brain and bone, but too much baking soda can also damage normal organs.
“In other words, this test is designed to lead to personalized medicine for cancer patients, by optimizing the therapy to each individual,” said Mark “Marty” Pagel, UA associate professor of biomedical engineering and lead researcher on the project.”
Here is a link to Mark Pagel discussing the study. He states what method he is using to measure the acidity in the tumor and surronding environment.
He also states that cancer patients should eat an alkaline diet.
http://www.azpm.org/health/story/2012/4/12/1830-can-baking-soda-battle-breast-cancer/
More woo sure to lead to futile research:
Today, Mercola writes about GAPS ( gut and psychology syndrome) and Dr Campbell-McBride: the root vause of anxiety, depression, ADHD, autism, ADD, OCD etc.
It seems that that toxic substances interfere with normal gut flora leading to all manner of psychological devastation!
Probiotics and fermented foods ( including un-pasteurised products and kimchi) do wonders. Or so I’m told.
(I was also told that yoghurt did wonders for HIV in the GI tract. However, they didn’t *eat* the yoghurt)
I take it as a moral certainty that there’s somebody somewhere with a kombucha scobie in their toilet tank.
@ Narad:
Unfortunately, I did know a few woo-entranced people who bought into the kombucha tea ( but I never could figure out why they called it *tea*) rejuvenation claptrap until one got a very interesting GI condition and afterward, the topic was never mentioned again. Oh well.
I’ve been hearing more about fermented food lately from the woo-meisters- even those who fear cheese and wine as being of the devil.
@23, 28,
In addition to the problem of saturation, there’s also the problem of “desensitization”. Between these two problems, on top of side effects,I’d consider it a good rule of thumb that the maximum dose should NOT be treated as the best dose.
As for “like vs. like”, even that could be considered a sound principle, for an ailment caused by a toxin or pathogen. I’d say that it WOULD be correct, except for what it meant to the homeopaths: They thought that “likes” could be recognized purely from symptoms, whereas it should have been evident even in the early 1800s that this approach was “hit or miss” at best. And, of course, any theoretical merits went down the drain (literally?) once Hahneman started watering his solutions down to “placebo” level.
And, I’ll add what I planned to say earlier: PUNCH IT, BISHOP!
“The grant will be used to help refine a new magnetic resonance imaging method for measuring pH, or acid content, of a tumor that has been discovered in a patient but not yet treated.
IMO (disclaimer), this is nobel prize material but do you know of any citations claiming an MRI machine can measure the pH?
I may reveal my ignorance about it and there could be papers on NMR (as used in chemistry) to measure pH but I’d really like to know.
Thanks
A.L.
@Autistic Lurker
I don’t understand it either. The whole study sounds really silly. In the video Dr Pagel has a box of baking soda and a bottle of Ultravist on the desk in front of him. He seems to be insinuating that he is going to measure the PH of a tumor by using this agent with an MRI. How is he going to tell if the tumor is acidic and how is he going to tell if drinking a glass of water and baking soda makes the tumor alkaline with this method?
I can’t find any other information. The 18 subjects are women with early stage breast cancer that havent been treated. The study started in 09 and runs to 2014. Are these women going to go five years with no treatment at all?
It just dosen’t make any sense.
Today, Mercola writes about GAPS ( gut and psychology syndrome) and Dr Campbell-McBride: the root vause of anxiety, depression, ADHD, autism, ADD, OCD etc.
As noted in an earlier GAPS thread, Mercola has long been waging a campaign against glutamate (“This Silent Killer Lurking in Your Kitchen Cabinets”! “How Monosodium Glutamate is Hidden in Vaccines”!!). At the same time he promotes Campbell-McBride’s GAPS diet with its elevated levels of soluble glutamate.
If it’s glutamate now, which neurotransmitter will he oppose next?
@black-cat 38,
currently, we can target oxygen (fMRI) and water (DTI) with an MRI machine at a finite resolution (ranging from a millimeter to two in most human scanners) and I don’t think this would be enough to target the ratio of hydrogen to oxygen at the precision level needed to calculate the pH. You’d have a very gross estimate and I don’t think you could distinguish between tumor tissues and normal tissues.
A.L.
forgot to add: You’d have a very gross estimate and I don’t think you could distinguish between tumor tissues and normal tissues based on the Ph alone.
@Autistic Lurker:
Thanks for the explanation. I did not think an MRI could be used as a diagnostic test for PH.
It’s mind boggling that NCCAM allocated 2 million dollars for that study.
@37 etc,
I’ve noticed some very odd “alt med” claims about acids. It’s something I probably know less about than I should, given that my bachelor’s is in geology and I’ve actually worked with acid in the lab. This MRI business is new to me, and definitely raises more read flags than usual. The big one is, PH is NOT a measure of the concentration of any one chemical. It’s a measure of the ratio of acids and bases. One interesting implication of that: You could mix together an acid and a base, each potent enough by itself to burn a hole in the floor, and get an end product with a PH of 0.
I suppose the “Alien” movies could have contributed to a mystique about acids. Much as I like them, their portrayals of acid is about as wonky as the unabashedly symbolic biology: Where they show one pool of acid burning through one deck after another of a spaceship, I’ve soaked fossils in matrix in HCl repeatedly and still not gotten the limestone off the bones.
And I’ll end with: “We’ve got nukes! We’ve got knives! We’ve got SHARP STICKS!!”
David N. Brown
Mesa, Arizona
@43
“You could mix together an acid and a base, each potent enough by itself to burn a hole in the floor, and get an end product with a PH of 0.”
Err, I’m guessing you mean 7?!
Otherwise yes, this idea that you need to use supplements or special diets to limit the acidity of your body as that is the root of all evil… it’s nuts. I have the feeling it’s often related to the whole idea of negative energies and bad thoughts making you ill. Either way it’s another classic of woo and nonsense.
Isn’t pH the negative log of the concentration of H+ ions (roughly), not a ratio?
Apologies for the second post, but my thought procrss is a little wonky.
If the baking soda study was given 2 million, how much actual evidence for his acid theories is there and they still gave him money? Or did the funding application and the quote above say different things?
@DurhamDave
Yes, pH is the negative log of the concentration of H+ ions.
That being said, I’ve worked with some substances with really low pH but have never seen anything with a pH of 0.
DurhamDave,
Actually, it’s both.
The Elmhurst College Virtual Chembook notes the following:
So, if pH is 7, then pOH is also 7 and the solution is neutral. If pH goes to 6 making the solution acidic, pOH goes to 8 and there are 100 times as many H+ ions (actually H3O+) as OH- ions.
For baking soda to get to cancer cells to have an effect, it first has to go through the highly acidic environment of the stomach, then get absorbed in the intestines. Then, it enters the blood where the body has efficient biochemical mechanisms to adjust the pH to a tight tolerance around 7. If you ingest enough baking soda to overwhelm those mechanisms, your body is going to have a lot more immediate problems than some growing cancer cells.
For more information, I suggest searching this site for “acid base” or Robert O Young.
Here is one link:
https://www.respectfulinsolence.com/2010/04/compared_to_robert_o_young_andrew_weil_l.php
currently, we can target oxygen (fMRI) and water (DTI) with an MRI machine at a finite resolution (ranging from a millimeter to two in most human scanners) and I don’t think this would be enough to target the ratio of hydrogen to oxygen at the precision level needed to calculate the pH.
There is a literature on MR spectroscopy using states of P31 and F19 as proxies of pH in tumours. I have no idea whether anyone’s been able to combine that with imaging.
@44,
Okay, so I’m (even) rustier than I thought. I meant the pH of water, which, yes, would be 7, though it is equivalent to what 0 would be in a positive/ negative value system (I’m sure why I remembered it that way). Something else I had forgotten is that, while you can just as well measure OH- as H+, the former represents pOH, not pH. In summary, I say MY way is better (particularly for an undergrad on meds who has trouble staying awake through an afternoon lab session).
It’s rather curious that, while strong bases like bleach are commonly known to be dangerous, it doesn’t seem to translate into an understanding that acids and bases have a comparable potential for harm unless balanced with each other. One particular bit of nonsense I have run across that clearly reflects this failure to connect is lists of supposedly scary vaccine ingredients that include bleach, which in fact is only used in small quantities for the express purpose of balancing pH.
The national center for folk medicine. Yes, nuke it! Ditto a national center for folk biology – intelligent design. And a national center for folk quantum physics should be nuked too if it should ever come to exist. Folklore should not be integrated with empirical science simply because it’s popular. If it’s folklore and it claims the right to sit at the same table as science nuke it.
Since I’m a chemist I think I have to clear things up a bit concerning acids and bases. The pH is generally defined in water which has an auto-dissociation equilibrium H2O < -> H+ + OH-. Pure water has a concentration of 10^-7 mol per hydroxy- AND hydronium ions in equilibrium, therefore a pH=pOH=7. You can shift that equilibrium towards lower pH by adding acid and vice versa by adding base. But you can never get below pH=0 and above pH=14. That’s called the nivelating effect of water. The ability of a substance to give up protons is measured by the pKa which is also the negative logarithm of a equilibrium constant. Its value can go way below 0 (eg. sulphuric acid = -12) or well over 14 (e.g. methane = 50).
Rich @ 52:
Interestingly enough this is not correct (at least at the low end) and has been demonstrated as occurring at Iron Mountain, CA:
http://www.pnas.org/content/96/7/3455.full
The PNAS paper addresses a special case, however, and notes that reporting negative pH values requires the adoption of a non-standard definition for pH, which is difficult to reconcile with the standard definition which limits the range of measurable pH values from pH 1 to pH 13.
@ 53:
You have to think about the definition of pH that I gave above and remember that the concentration of water in water (~55mol/L) is assumed constant and included in the equilibrium constant. Of course you can measure a pH of -3 but sometimes it makes sense and sometimes it doesn’t. You can also measure negative temperature in a laser and still nobody would argue against the statement that temperatures less than 0K don’t exist.
Rich @ 55:
Well, sure. You can select a definition under which pH is not defined at conditions more extreme than those used to make the definition. It is impossible for a negative number to have a square root, therefore the square root of a negative number is, dare I say it, an imaginary number!
But the fact was that Nordstrom and Munoz discovered in that underground mine a water-based solution in which the hydrogen ion concentration was greater than that permitted under the classical definition of pH. Which means for that particular real-world case, an extended definition (along with unique measurement techniques) was required.
Note that I am not trying in any way shape or form to defend NCCAM or the loons who think that it reveals some magical “truths”. It was just that Iron Mountain presented an interestingly extreme case of a topic I have worked on.
Apologies for being away for a while; busy moving servers and archiving email and dealing with balky software all ’round, on a last-minute basis as our old colo appears to be going ignominiously out of business on a few days’ notice.
—
Eric Lund @ 12: “What would work is ridicule of such beliefs, if there were no authority figures clinging to those beliefs.”
No, no a thousand times, no! Social pressure and appeal to authority are the last resort of those who have no empirical or rational case to make. I refuse to kowtow to that kind of BS. I’ll stick with the empirical case against homoeopathy and crystals etc., and Orac appears to prefer the rational case (“sweep away a huge swath of physics if this was true”), and together those things form a basis for policy.
Pragmatically, using social pressure and appeal to authority is 100% guaranteed to backfire and produce cries of “oppression!” from the woo-meisters and their flocks. It’s simply a bad tactic, an exercise in political Fail.
—
Marry Me Mindy @ 18: “…throw in a prayer component…” Excellent! Out-compete them in their own ecosystem. Adding a homeopathic dose of CAM (heh!) to any legitimate study should be easy and inexpensive. And we can expect to find enough null results as to give them fits when they try to do some kind of meta-analysis to prove their nonsense works.
—
Denise Walter @ 19: I’d differ with you there, but from the perspective of science I’m always going to advocate agnosticism and leave the issue of belief in deities up to individuals to puzzle out for themselves. But my key point about “mystification” wasn’t that it involved inferring the existence of deities where atheists would argue none exist.
My point was that mystification entails “making mysteries generally, where none exist.” The existence of a deity is an empirically untestable assertion. The issue of medical effects of guru-water is highly testable in all the usual ways. The issue of superfluous or downright idiotic “explanatory mechanisms” such as “fine-tuning the vibrational energy of the cellular matrices” can be shot right out of the sky by demanding definitions and operationalizations of the variables. What’s fine-tuning? What are vibrations? What’s energy? Specifically what structures within cells? Start asking those questions, and watch the nitwits grab their bug-out bags and exit as if from a tornado warning.
And the best part is, they can’t digress the issue into arguing the existence or nonexistence of deities.
—
Karl @ 22: I’ve been around this site for a few years and am well-acquainted with the kinds of hand-waving that homeopaths and suchlike do.
“Other ways of knowing” can be readily shot down by invoking Charlie Tart’s proposal for “state-specific sciences” that attempt to render explicit the systems of logic and reasoning that occur within various altered states (e.g. “dream logic”). If done in a rigorous manner, Tart’s approach rapidly corners obfuscation and exposes it for what it is.
“Children and animals” are also susceptible to nonverbal communications cues. Dogs and cats in particular have developed exquisite sensitivity to human emotional and social cues. Mice, not so much:-)
“Bad form … unsupported point.” I disagree. My point was merely to note an area of difference of opinion, by way of illustrating that despite that, I’m generally onboard with the consensus around here. You apparently missed the opening line in the following paragraph, “But I’d rather hang with the hard skeptics than with the True Believers, if for no other reason than a preference for intellectual rigor over the lack thereof.”
I seriously doubt anyone’s worldview around here is so fragile that it’s at risk of being cracked by a difference of opinion on one item out of many. What I do with those types of cases is just accept that as a practical matter, I can agree with someone about W, X, and Y, and differ with them about Z. It’s not as if there’s some kind of objective need for orthodoxy.
—
Dreamer @ 24: OK, it might be useful to allow for a phrase such as “psychological energy,” as another way of saying “emotional motivation.” And we might also recognize colloquialisms such as “I have a lot of energy today” that might even turn out to be “correct” in some neurobiological way (as in, measurable levels of neurochemicals or some other variable). What gets my goat is when people use the word in an obfuscatory manner.
In general if someone is writing philosophy and intends to use a science-word in a manner different to its normal usage in science, that should be spelled out clearly in plain language: “I’m going to use the word ‘energy’ to mean a combination of emotional motivation and its behavioral expression, whereas in the physicals sciences it refers to ‘the capacity to do work’ and that only.”
Further I would say that philosophers and others who are doing this should be open to having their misinterpretations of scientific concepts corrected by those who have the knowledge to do so. This is one of the great things about online publishing: it’s easy to go in and do edits, compared to fixing errors in a book or other published document printed on paper. Further, if philosophy is truly about seeking an accurate worldview and consistent ethical system, one should be open to revising or even chucking out large chunks of it, should they be demonstrated to be based on substantive errors.
—
Robert C @ 25: No, no a thousand times, again. As a principled matter the use of the power of law to shut down even the advocates of idiocy, should only be reserved for instances where there is a clear and foreseeable danger, such as with anti-vaxers and parents who deny their children access to lifesaving SBM.
As a pragmatic matter, that approach only ends up creating an oppositional underground that grows ever stronger in its resolve. Really: the best way to make these pests go away is to give them all the rope they need to hang themselves. That way they have exactly nothing to complain about when they successfully disprove their own nonsense and are obligated to report having done so.
Have all you great science advocates considered the possibility that we, the crown of creation, do not yet know all the science there is to know? Didn’t some eminent science personage at the end of the nineteenth century decree that everything worth discovering had already been discovered? Didn’t the species then summarily put paid to that with the car, the plane, penicillin, the computer, relativity, quantum physics, string theory, the hadron collider, mmicrowave ovens, cell phones etc etc etc? How do you know there isn’t some bit of physics out there that we don’t yet know that will make homeopathy, energy healing, distance prayer (i.e., mind over matter) etc. all make perfect sense? Oh ye of little vision.
Liz,
To borrow an expression, duh!
Supposedly that was said by Charles H. Duell, Commissioner, U.S. patent office, in 1899. However, there’s no strong evidence he said any such thing.
Things don’t usually work that way. But if it does, show me the data and I’ll change my mind (though I won’t write “fancy that” with a compass on my sexual organ). Until you show me the evidence, all the best current data says they don’t work. At all.
Georgetown University Medical School seems to see the value in CAM:
http://www.altmeds.com/complementary-medicine/articles/georgetown-med-school-to-add-cam-courses
Fancy that. (No homeopathy, though. Just acupuncture and chiropractic.)
The part where they “make perfect sense” comes after the one in which they are shown to “do anything.”
Int J Oncol. 2010 Feb;36(2):395-403.
Cytotoxic effects of ultra-diluted remedies on breast cancer cells.
http://www.ncbi.nlm.nih.gov/pubmed/20043074?itool=EntrezSystem2.PEntrez.Pubm
Comprehensive Swiss government report on homeopathy.
http://www.huffingtonpost.com/dana-ullman/homeopathic-medicine-_b_1258607.html
“The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies. When one considers that two of the top five largest drug companies in the world have their headquarters in Switzerland, one might assume that this country would have a heavy interest in and bias toward conventional medicine, but such assumptions would be wrong.
In late 2011, the Swiss government’s report on homeopathic medicine represents the most comprehensive evaluation of homeopathic medicine ever written by a government and was just published in book form in English (Bornhoft and Matthiessen, 2011). This breakthrough report affirmed that homeopathic treatment is both effective and cost-effective and that homeopathic treatment should be reimbursed by Switzerland’s national health insurance program.
The Swiss government’s inquiry into homeopathy and complementary and alternative (CAM) treatments resulted from the high demand and widespread use of alternatives to conventional medicine in Switzerland, not only from consumers but from physicians as well. Approximately half of the Swiss population have used CAM treatments and value them. Further, about half of Swiss physicians consider CAM treatments to be effective. Perhaps most significantly, 85 percent of the Swiss population wants CAM therapies to be a part of their country’s health insurance program.
It is therefore not surprising that more than 50 percent of the Swiss population surveyed prefer a hospital that provides CAM treatments rather to one that is limited to conventional medical care.”
“After assessing pre-clinical basic research and the high quality clinical studies, the Swiss report affirmed that homeopathic high-potencies seem to induce regulatory effects (e.g., balancing or normalizing effects) and specific changes in cells or living organisms. The report also reported that 20 of the 22 systematic reviews of clinical research testing homeopathic medicines detected at least a trend in favor of homeopathy.* (Bornhöft, Wolf, von Ammon, et al, 2006)
The Swiss report found a particularly strong body of evidence to support the homeopathic treatment of Upper Respiratory Tract Infections and Respiratory Allergies. The report cited 29 studies in “Upper Respiratory Tract Infections/AllergicReactions,” of which 24 studies found a positive result in favor of homeopathy. Further, six out of seven controlled studies that compared homeopathic treatment with conventional medical treatment showed that homeopathy to be more effective than conventional medical interventions (the one other trial found homeopathic treatment to be equivalent to conventional medical treatment). All of these results from homeopathic treatment came without the side effects common to conventional drug treatment. In evaluating only the randomized placebo controlled trials, 12 out of 16 studies showed a positive result in favor of homeopathy.”
Oh those crazy, deluded Europeans, the Swiss?
@ Liz: Did you miss something here? From your link…
“Further in-depth studies with additional cell lines and animal models are warranted to explore the clinical applicability of these agents.”
http://en.wikipedia.org/wiki/In_vivo#In_vivo_vs._ex_vivo_research
In vivo veritas! Oh ye of little scientific knowledge…
Liz, on the upper left hand part of this webpage is a search box. Put the name “Dana Ullman” in it and read the results.
Y’all just nix anything that doesn’t happen to support your worldview. What matters is not that Dana Ullman wrote an article about the Swiss government’s homeopathy report; what matters is that the Swiss government’s report, the most extensive ever compiled on homeopathy, endorsed homeopathy for the reasons given above, which Dana Ullman did not dream up. I could have used a direct link to the report itself just as easily. You say give me proof, you’re shown proof, you say “ah, that doesn’t count”. BTW did you know that 80 per cent of medical practice is not supported by science?
“BTW did you know that 80 per cent of medical practice is not supported by science?”
BTW did you know that 100 per cent of what Liz posts is not supported by science?
-FTFY
Here, Liz. Now, given that the “report” is a bound volume for sale, it would be of little utility to link to it, and I rather doubt that you’ve purchased it in any event. Were you referring to the summary that doesn’t quite match up with the assertion of cost-effectiveness or, really, effectiveness of any sort?
what matters is that the Swiss government’s report, the most extensive ever compiled on homeopathy, endorsed homeopathy for the reasons given above, which Dana Ullman did not dream up.
Liz, you haven’t read the report, have you? Because it’s not from the Swiss Government; it’s from a group of homeopaths who were invited by the Swiss government to make the best case they could for continuing to be included in the publicly-funded health system. The Complementary Medicine Complementary Commission — a genuine arm of the Swiss govt — evaluated that report, and congratulated the authors for their enthusiasm, but concluded that they were deluding themselves and money spent on homeopathy was money down the drain.
Executive summary: Dana Ullman is lying.
As always.
Present for Orac!
Gone cold here, but in case anyone’s still reading, re the use of MRI to measure pH mentioned up the thread:
In NMR spectroscopy (not imaging) measuring pH from the chemical shift of a pH-sensitive compound (e.g. inorganic phosphate inside cells) is a long-established trick. Deriving pH from MRI imaging techniques is much newer, and is experimental. However. Pagel has published on it, see e.g. some of the description and refs here. It is extracellular pH that these techniques assess, so the idea is to measure the pH in the tumour but outside (‘around’) the cells, so in what scientists call the extracellular space, or the ‘interstitial’ fluid.
Anyway, the idea of the pH measurements in tumours with MRI is legit science. So if you were being charitable, you could say Pagel was simply using NCCAM (and their enthusiasm for pH-woo) to fund his research program. But of course:
i) there is no reason that research to measure something potentially useful like tumour extracellular pH wouldn’t be eligible for funding by a ‘mainstream’ NIH institute like NCI; and
ii) having it under NCCAM’s banner, and tied up with the bicarbonate-for-cancer nuts, risks offers said wackos wholly undeserved credibility.
So.. I’d say this qualifies as a classic example of the kind of things Orac and others have said about NCCAM in the above post (see the discussion of pharmacognosy) and elsewhere.
Slightly separately, whether Dr Pagel has ‘jumped the shark’ in the way he is promoting the work is something I couldn’t judge without seeing the promo/press stuff, though others may have a view.
No, Liz, I didn’t–and I still don’t, as all you’ve done is assert that this is the case. But as I’m willing to consider your claim might be valid, please show your math: indicate exactly how, and from what starting data set, you’ve calculated the per cent of all medical practice that is not supported by science).
BTW, did you know that 78% of all statistics are made up on the spot? (toggle satire off)
But but but….QUANTUM!!!
Yeah. Quantum something or other gets entangled and things are there and not there at the same time, and therefore anything’s possible!
Checkmate, scientismists!
/snark
No kidding, I’ve just had a discussion where someone claimed that quantum mechanics allow the possibility for the existence of Zeus, Allah, and Santa Claus. And no matter how often I cite physicists who say that’s nonsense, he thinks I’m the one with the problem understanding QM.
Supply & demand.
If enough woo-fans produce a demand, then even top-drawer institutions will see an economic advantage to pleasing them. If they don’t the woo-fans will migrate to someplace were they will be appeased, and there are enough woo-fans to make an economic difference.
@natural cynic
Ain’t economics grand?
@JGC
http://www.businessweek.com/magazine/content/06_22/b3986001.htm
Statistics not made up by yrs. truly but by Dr. David Eddy, a proponent of EBM:
“During his long and controversial career proving that the practice of medicine is more guesswork than science, Eddy has repeatedly punctured cherished physician myths. He showed, for instance, that the annual chest X-ray was worthless, over the objections of doctors who made money off the regular visit. He proved that doctors had little clue about the success rate of procedures such as surgery for enlarged prostates. He traced one common practice — preventing women from giving birth vaginally if they had previously had a cesarean — to the recommendation of one lone doctor. Indeed, when he began taking on medicine’s sacred cows, Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence.
A great many doctors and health-care quality experts have come to endorse Eddy’s critique. And while there has been progress in recent years, most of these physicians say the portion of medicine that has been proven effective is still outrageously low — in the range of 20% to 25%.
…
Coming from a family of four generations of doctors, Eddy went to medical school “because I didn’t know what else to do,” he confesses. As a resident at Stanford Medical Center in the 1970s, he picked cardiac surgery because “it was the biggest hill — the glamour field.”
But he soon became troubled. He began to ask if there was actual evidence to support what doctors were doing. The answer, he was surprised to hear, was no. Doctors decided whether or not to put a patient in intensive care or use a combination of drugs based on their best judgment and on rules and traditions handed down over the years, as opposed to real scientific proof. These rules and judgments weren’t necessarily right. “I concluded that medicine was making decisions with an entirely different method from what we would call rational,” says Eddy.
…
Appointed a full professor at Stanford, then recruited as chairman of the Center for Health Policy Research & Education at Duke University, Eddy proved again and again that the emperor had no clothes. In one study, he ferreted out decades of research evaluating treatment of high pressure in the eyeball, a condition that can lead to glaucoma and blindness. He found about a dozen studies that looked at outcomes with pressure-lowering medications used on millions of people. The studies actually suggested that the 100-year-old treatment was harmful, causing more cases of blindness, not fewer.
Eddy submitted a paper to the Journal of the American Medical Assn. (JAMA), whose editors sent it out to specialists for review. “It was amazing,” Eddy recalls. “The tom-toms sounded among all the ophthalmologists,” who marshaled a counterattack. “I felt like Salman Rushdie.” Stanford ophthalmologist Kuldev Singh says: “Dr. Eddy challenged the community to prove that we actually had evidence. He did a service by stimulating clinical trials,” which showed that the treatment does slow the disease in a minority of patients.
@69 @herr doktor bimler
The link doesn’t work.
I’m sorry, liz, but I don’t see the information I requested (the starting data set used and teh calcualations which establish the percentage of all medical practice that is not supported by science) anywhere in the article you’ve linked to or the excerpt you’ve included in your post.
Care to try again?
@JGC
Ask Doctor Eddy.
The link doesn’t work.
The Scienceblogs sites like to garble embedded links. It’s the first PDF file (“Schlussbericht PEK, April 2005”) linked from this page:
http://www.bag.admin.ch/themen/krankenversicherung/00263/00264/04102/index.html
@80 @herr doktor bimler
Thank you for the link. It does not appear to be a response to the report but something different. However, I was only able to read the English summary, which is very short. It pertains not only to homeopathy but to a grab-bag of CAM responses, including TCM, phytotherapy, and something called neural therapy, which I haven’t heard of. What part of the report suggests to you that it is a response? (I may have missed it, or perhaps it’s in German. If so, please translate.)
Thanks for the link, Herr Doktor; 1/4 of the PDF is in German, 1/4 in Italian, 1/4 in French and 1/4 in English which would explain why it’s 103 pages long. It’s reminding me how my German and French reading fluency has slipped.
I haven’t finished it, just got as far as the paragraph on the project that was the meta-analysis of the efficacy of the five CAMs studied.
As regards the second project, in the view of the authors of the meta-analyses, the available placebo-controlled studies on homeopathy do not demonstrate any clear effect over and above placebo.
Liz,
Dr. Eddy’s claims (made 21 years ago), among others, are addressed in this article, itself 12 years old. Here’s a quote:
I think that even more interventions are based on compelling evidence today, as the concept of evidence-based medicine has become more prevalent over the last few decades. Perhaps of interest in this area is this article about randomized trials that changed medical practice (there are some surprises in there). It’s also 12 years old and I would be interested in seeing a more up to date version as I’m sure there are several other medical practices that have changed due to better evidence since then.
Ask Dr. Eddy
That Business Week Article is more about drumming up investment for his Archimedes app which, while currently still canvas, wire and wood, will soon be making a digital simulated twin good enough to run tests on rather than taking 3400 pills in six months as part of a placebo controlled RCT.
And yet they claim this:
They have access to the computing horsepower to do that? Is there enough hp to do that?
http://en.wikipedia.org/wiki/Supercomputer#Applications_of_supercomputers
there’s a list of the things the fastest ‘puters we have work on and the product in question ain’t one of them
Hmmm, the fastest iron on the planet has simulated 1, uno, a single percent of the human brain
yet these guys are simulating thousands of people holistically, simultaneously and over thirty years
Oh, and in only 30 minutes
iMacs are more powerful than I thought
@Krebiozen
I had a good chuckle over your moniker, given that it is the name of a discredited cancer drug that has gained fame in the annals of placebo literature. Did you choose it for that reason?
Liz @82:
It pertains not only to homeopathy but to a grab-bag of CAM responses, including TCM, phytotherapy, and something called neural therapy
Yep. The Swiss govt. was looking at CAM in general, so it invited all these groups of practitioners to make their cases for continued inclusion in the health-insurance system. Then an international Review Board (appendix 2, page 95) examined their arguments and wrote this Final Report.
The specific report from the homeopathy lobby was “G Bornhöft et al.” (appendix 4, p. 101). If you look further down that “Bundesamt fuer Gesundheit” website (my comment 80), you will find a link to the Bornhöft report; in it, the authors list their affiliations. Bornhöft and Matthiessen later published their report as the book whereof Dana Ullman wrote, as quoted in your comment #63.
To reiterate, when Ullman called that book a “comprehensive evaluation of homeopathic medicine ever written by a government”, it is a lie, straight and simple.
You ask, “What part of the report suggests to you that it is a response [to Bornhoft et al.]?”).
— Entry 11 in Appendix 4.
As regards the second project, in the view of the authors of the meta-analyses, the available placebo-controlled studies on homeopathy do not demonstrate any clear effect over and above placebo.
The meta-analyses in question were by Shang &c (#12 on page 101; also linked on the BfG website).
More of the report can be found in English translation — as well as other documents that explain the background at more length — in an article at Zenosblog, which Narad helpfully provided back at comment #68.
1/4 of the PDF is in German, 1/4 in Italian, 1/4 in French and 1/4 in English which would explain why it’s 103 pages long
— The Summary is translated into four languages but most of the text is in German.
@83 @Krebiozen
If I followed the practice of the commenters on this blog I would now derisively point out that the link you provide is to veterinarywatch.com and ask what that has to do with human medicine. I would also point out that only 37% of practices were supported by RCT, which seems to be the gold standard this forum subscribes to, and I would resoundingly pooh-pooh the notion that 76% of interventions were supported by “compelling evidence” and sneeringly ask what that compelling evidence might be and ask you to produce it.
But I won’t do any of those things. Just tell me how you picked the name @Krebiozan.
If you don’t know *precisely* how the treatment in question affects the human body, how do you program a computer to simulate it? You need at minimum to know what percentage of people will respond and to what degree, and how many will have side effects of what severity — you know, the kind of thing that you learn in a clinical trial.
From the article:
“The remedies used and their dilutions were the same as those prescribed by the [P. Banerji Homeopathic Research Foundation] for the treatment of human breast cancer…”
The two last authors? P. Banerji and P. Banerji. Can you spot anything wrong with this?
Also, the effect they found from the agents was very small and only slightly greater than the vehicle, which for some bizarre reason was alcohol which itself was toxic (I cannot stress how little sense it makes to dilute an already ultra-diluted water solution with alcohol). I’ve performed the same assays that they used. I can tell you those are not convincing results. Although their Western blots look good!
@86 @Krebiozen
The comprehensive article on Zenosblog to which you provide a link is quite thorough and the best exposition on the subject yet. And the Swiss government, like the Georgetown University Medical School, still caved (at least temporarily) to consumer (voter) demand.
Yet your very moniker demonstrates that there is more to healing than meets the eye (or the RCT).
@88
well, Dr. Eddy says he has the algorithms…
and even if his simulated copies take 30 minutes each to run a 3 drug interaction using algorithms good enough to mimic an entire human over 30 years
that’s 6.85 years running 24/7 for 4 thousands of patients
@86 @Krebiozen
Bimler != Krebiozen.
I am relying myself on Zenosblog’s exploration of the topic. Despite the nym, I only read German slowly and painfully… but enough to verify Zenosblog’s extracts & assertions.
I apologise for the rude and challenging tone of my comment #69.
@91
People commenting here seem quite trigger-happy when someone comes on with a dissenting view. But I think it’s quite unnecessary to attack people when they can be persuaded through rational debate.
Just for fun, here is the Krebiozen placebo story, and below it the original reference:
http://books.google.ca/books?id=ZSb3QW-K4kYC&pg=PA89&lpg=PA89&dq=krebiozen+placebo+klopfer&source=bl&ots=MFqzKBmyQ8&sig=KGlFHdMYI1hu92TRdumeUQwq0iI&hl=en&sa=X&
Klopfer, B., “Psychological Variables in Human Cancer”, Journal of Projective Techniques, Vol.21, No.4, (December 1957), pp.331-340. (This paper is also significant because it contains an account of the impact of the treatment of a lymphosarcoma upon Mr. Wright, a patient of one of Klopfer’s colleagues (Dr. Philip West) with a bogus medicine, “Krebiozen'”. Klopfer’s account of Wright’s progress is often referred to in the cancer literature, but the actual reference is seldom cited.)
Can you be persuaded through rational debate, Liz?
@Shay see @90
I wonder if acupuncture might work, not on mysterious oriental meridians vs. elsewhere, but anywhere as counter-irritants or distractions (vs. nowhere). Has that been tested? Most of the tests seem to be on vs. off the traditional targets.
Liz,
Sorry for the delay in replying. Real life intruded.
Partly. 1. It’s a cool-sounding name. 2. It’s a cautionary tale of cancer quackery. 3. It is, as you note, often cited as evidence of placebos having a significant effect on serious objective illnesses (in this case lymphosarcoma), however I think there is less to this tale than meets the eye. It happened in 1950 and it appears to be the only incidence in the literature of anything like this occurring. I suspect the most likely explanation is that the patient’s condition was varying for reasons unconnected with his beliefs. Still, it’s an intriguing tale.
To which I would respond by pointing out that it was originally published in Complementary Therapies in Medicine and in the Scientific Review of Alternative Medicine and that it refers to human not veterinary medicine. I provided the veterinarywatch link as it’s the only place I can find the full text on-line.
I would respond by asking if you had actually read the article in question which discusses why it would be impractical and/or unethical to conduct RCTs on a number of interventions; I quote:
I would also direct you to the 39 references in the article to studies in which estimates have been made of the extent to which a number of different interventions are based on compelling evidence.
In that case you can safely disregard most of my response above 😉
@Monado
In addition to on vs. off the meridians (which set of meridians used is a completely different question), there have been piercing vs. non-piercing, which, like on vs. off meridians studies, have shown no difference in outcomes, meaning that it not only does not matter where you stick someone, it doesn’t even matter if you actually pierce the skin at all.
Now, comparing off-meridian or non-piercing to doing nothing, you’re almost guaranteed to find some subjective benefit from the shamcupunture, since doing something nearly always produces some subjective improvement, just like taking a sugar pill vs. doing nothing.
As an RN, I can’t thank you enough for this post. When I was a nursing student two years ago, I got a lot of flak in class when I complained about the “alternative” treatments (such as therapeutic touch, aromatherapy, and acupuncture) being promoted in nursing texts. I spoke up in class, saying that “if alternative medicine worked, it would just be called ‘medicine’. I got some dark looks from the instructor and several students, who swore that various brands of woo had “worked for them”. Yet, we were all taught that nursing is striving toward an “evidence-based” care standard. One of my clinical advisors told me that we needed to know about this stuff in case some of our patients were using it – which is reasonable – but some nurses whom I’ve met claim to use “healing touch” and swear by certain diets and herbals. It’s depressing. This post says all I’ve been thinking for years, in a nutshell. Thank you!
And I wholeheartedly agree that superstitious woo should not be funded in any way, shape or form.
Sue, RE:post 98. Here, here. You channeled my thoughts. You’re positive energy wave field must be astounding. I’m in Seattle and my only explanation is a wave field emergence between you and me. Errr. NO. I too am an RN and had a similar difficulty in Nursing School. The woo was pretty much limited to eight lecture hours over two years (an AAS program), but I felt I wanted my money back for those hours. We also had two ninety minute guest lecturers extolling midwifery and doulas. I was astonished that the guest lecturers had the temerity to arrive stoned on pot, and during the break get more stoned on pot. I told the sponsoring instructor that this was a disrespect of the school, the instructor, and the students in a professional program. While I have zero problem with marijuana per se, this was like an instructor giving a lecture drunk. It saddens me that Nursing Schools think that they have to present woo as anything but unadulterated crap. I am now a post-op surgical Nurse. And am happy that the hospital where I work dissuades patients from CAM junk.
This center spends thousands of dollars disproving alternative medicine claims?
I understand the struggle for funding, but frankly, this place sounds wonderful.