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Science and the AAAS sell their souls to promote pseudoscience in medicine

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NOTE: There is a follow up to this post.

The holidays are over. Time to start dishing out fresh Insolence, Respectful and, as appropriate, not-so-Respectful for 2015.

I do, however, feel obligated to deal with one painfully inappropriate action by a major science journal left over from 2014. It happened in an issue that came out just before Christmas, and, with all the festivities, being on call last week, and having houseguests; so, unfortunately, I just didn’t get around to addressing it, either here or on my not-so-super-secret other blog (where I might crosspost this later in the week). The journal is Science, which, as most readers know, is one of the two most prominent general science journals out there, the other being Nature. Actually, it’s appropriate that I mention Nature in this discussion because Nature pulled exactly the same bone-headed move three years ago, almost to the day.

Yes, Nature shilled for traditional Chinese medicine (TCM) by publishing an advertising supplement promoting it sponsored by a Japanese supplement manufacturer. Now it’s Science‘s turn to do the same in the form of—you guessed it!—an advertising supplement entitled The Art and Science of Traditional Medicine Part 1: TCM Today — A Case for Integration. Worse, Science appears to be going Nature one better—two better, in fact. This is the first part of what is promised to be a three part series.

Looks like I have blog material for a while.

The overview of the issue is nausea-inducing:

In this first installment of a three part series, “The Art and Science of Traditional Medicine,” we present a series of articles making a case for the integration of traditional Chinese medicine (TCM) into modern medical practice. From the new WHO Traditional Medicine Strategy to the application of systems biology in studying TCM, we aim to highlight the potential for creating an integrated, network-based health care system. The next two issues will cover herbal genomics and highlight the importance of quality control, standardization, regulation, and safety for traditional therapies. An overview of indigenous medicines in Europe, Africa, the Middle East, India, and the Americas will also be provided.

How about the importance of applying actual science to medical treatment, not “rebranding” herbal medicines as somehow “alternative,” and eliminating prescientific superstitious beliefs about disease, such as the concept of qi and the idea that you can map any organ to an area of the tongue using “tongue diagnosis”? Or maybe we should make a case for “integrating” traditional “Western” medicine into science-based medicine. After all, what are the “five elements” in TCM but a different version of the four humors of the humoral theory of disease that was practiced dating back to the time of Hippocrates until less than a couple hundred years ago? Or what about homeopathy, which was invented by a German? Where’s the love for traditional Western medicine (TWM), here, Science?

One has to wonder about the authors here, too. For instance, Josephine Briggs, the director of the National Center for Complementary and Integrative Health (NCCIH, formerly the National Center for Complementary and Alternative Medicine, or NCCAM) is listed as part of the editorial team. Is that kosher? She’s a government official and she’s contributed to the writing of what is, in essence, an advertorial section. Other editors include known boosters of TCM, such as Jan van der Greef, PhD, of the University of Leiden, who actually contributed a particularly awful article to the Nature debacle three years ago. The overall guest project editor is Tai-Ping Fan, PhD, from the University of Cambridge, who looks like a scientist who started out strong studying angiogenesis (one of my favorite topics) but became enamored with the herbal treatments of TCM and is now wasting sophisticated genomics and next generation sequencing methods to study woo.

The introductory articles are painful to read, full of the obfuscations and justifications for the pseudoscience that makes up most of TCM, all wrapped up in calls for more tooth fairy science and completed with a bow of argumentum ad populum. Disappointingly, Margaret Chan, MD, the Director-General of the World Health Organization, begins this parade in an article entitled Supporting the integration and modernization of traditional medicine:

TM [traditional medicine] is often seen as more accessible, more affordable, and more acceptable to people and can therefore also represent a tool to help achieve universal health coverage. It is commonly used in large parts of Africa, Asia, and Latin America. For many millions of people, often living in rural areas within developing countries, herbal medicines, traditional treatments, and traditional practitioners are the main—and sometimes the only—source of health care. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health care costs and widespread austerity.

Calling Dr. Chan. Calling Dr. Chan. The zombie corpse of Chairman Mao Zedong called. He wants his 1950s-era justification for promoting TCM and “integrating” it with “Western” medicine back, not to mention his “barefoot doctors.” Meanwhile, he’s laughing because he did not believe in or use TCM, nor do most educated Chinese, for that matter. Indeed, more than anything else, in China, TCM practitioners are complaining about the infiltration of “Western medicine” into their bailiwick. Of course, using a medical system based on prescientific religious beliefs (e.g., Taoism) to “achieve universal coverage” doesn’t exactly achieve universal coverage with effective medicine, now, does it?

It goes downhill from there:

In wealthy countries, TM meets an additional set of needs. People increasingly seek natural products and want to have more control over their health. They turn to TM to relieve common symptoms, improve their quality of life, and protect against illness and diseases in a holistic, nonspecialized way.

Hey, it’s not just the poor upon whom we can foist our pseudoscience! The rich worried well in “Western countries” like it too! Better yet, they’ll pay big money for it! You know, Dr. Chan mentions the WHO Traditional Medicine Strategy. I might very well have to take a look, if her rationales here in any way resemble what the WHO published. True, she makes the most massive understatement of the year (2014, given that that’s when this was published) when she opines that “to move into mainstream medicine on an equally trusted footing, TM needs a stronger evidence base.” However, she doesn’t seem to consider the question of: What happens if that stronger evidence base just doesn’t exist, as it doesn’t for practices like tongue diagnosis and acupuncture? Never fear, though. The WHO is all about “integrating” quackery with scientific medicine because…well, because:

The two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in beneficial harmony, taking advantage of the best features of each system and compensating for certain weaknesses in each as well. In an ideal world, TM would be an option, a choice, offered by a well-functioning, people-centred health system that balances curative services with preventive care. The challenge is to give TM its appropriate place in an integrated health system, to help all practitioners understand its unique and valuable contribution, and to educate consumers about what it can and cannot do. In other words, we need to modernize this rich resource and cultural heritage, and put it in its proper place in today’s world.

What if its proper place in today’s world doesn’t exist? Strip TCM of its Taoist roots, its balancing of the five elements and attribution of disease to excess “heat,” “dampness,” or other such aspects, and pretty much all you have left is herbal medicine, which needs no special dispensation to become part of science-based medicine. All it needs is for pharmacologists and physicians to study it, identify what’s useful and discard what is not, and then figure out what active ingredients can be used. Then it could become just “medicine,” as the cliche goes. Dr. Chan prominently brags in her article that “nearly a quarter of all modern medicines are derived from natural products, many of which were first used in a traditional medicine context.” Even if so, that doesn’t mean that all of TCM is of value or even that all of the herbal medicines used in TCM have value.

Next up, the CEO of the American Association for the Advancement of Science and Executive Publisher of Science, Alan Leshner, PhD, proclaims A middle way for traditional medicine. Dr. Leshner’s very first paragraph should result in his immediate firing by the AAAS Board of Directors, so horrible is the misunderstanding of the science of medicine reflected in it:

In discussions surrounding traditional healing techniques, a common perception is that those in the West most often take a reductionist approach to medicine, breaking down the body into ever-smaller parts in order to understand its inner workings. In the East, by contrast, medical practitioners are seen to take a more holistic view, regarding the body as a complex, integrated system and treating it as such.

Utter bollocks, Dr. Leshner. This is a stereotype promulgated by quacks who want to attack “Western medicine.” Good science-based primary care medicine is holistic. It takes care of the whole patient. As for “reductionism,” part of the reason why medicine tended to be reductionistic in the past is because it just didn’t have the tools to analyze more than one—or a handful—of genes and enzymes at a time. This, however, has rapidly changed over the last couple of decades, with the advent of cDNA microarrays that can measure the expression of every known gene in the genome at once; next generation sequencing, which, when done finely enough, can measure the levels of every transcript produced, now even getting down to the single cell level; and proteomics, which has provided much more powerful methods of analyzing many proteins at once.

Medicine has become more “systems-oriented” now because it can be. It has the tools now. That medicine and medical research have evolved this way has nothing to do with the attraction of TCM or other TM. Yet, that’s exactly what Leshner seems to be implying in his article, that “Western medicine” is becoming more like TCM because, again implied, TCM was right to be more “holistic.” It’s such utter drivel that I found it hard to finish his article, as brief as it was. That’s even leaving aside the inherent racism in the whole false dichotomy between “Western” and “Eastern” medicine, which implies that the “West” is more analytical and reductionist, while the “East” is more “holistic” and touchy-feely.

Leshner ends appealing to the “middle way” of Buddhism:

In Buddhism, the Middle Way is described as the route to enlightenment—a path found by balancing opposing views, accepting neither extreme, but rather investigating both sides and finding a middle ground. Perhaps a Middle Way can be found for traditional medicine, one that takes the best of East and West and brings them together for the benefit of all.

Can anyone name the logical fallacy here? It’s known by a few names: the fallacy of the golden mean, the appeal to the middle ground, and the argument to moderation. Just because there are two extreme positions does not automatically mean that the truth lies somewhere between the two positions. Think antivaccine pseudoscience. Think evolution denialism. Advocates of such positions love to try to present themselves as being “reasonable” and urging their opponents to “meet them in the middle,” but for some things there is no middle ground, or the truth is so much closer to one pole than the other that, for all practical purposes, there is no middle ground.

You know what? as I write this, I realize that there’s so much material in this advertising supplement, so many fallacies, and so much…plain wrongness that I think I will require at least one more installment to cover it. Indeed, the papers by Briggs and colleagues and discussions of the WHO Traditional Medicine Strategy will likely take at least one more post, if not more.

In the meantime, however, I can quickly and easily cover the last article in the paper, an article by Geoffrey Burnstock entitled Purinergic signaling in acupuncture. I already covered this rather blatant appropriation of acupuncture as a means of making an interesting, but relatively mundane, discovery about pain signaling as somehow being relevant to acupuncture. It isn’t, at least not in any apparently clinically useful way. Let’s just say that trying to shoehorn adenosine and purinergic signaling into acupuncture is very similar to how, for instance, quacks have appropriated the developing science of epigenetics to justify claims that “we control our genome.” It takes quite a contortion to accomplish this.

In the meantime, I can’t help but say to whoever at Science decided that publishing an advertising supplement like this, plus two additional ones to come: What the hell were you thinking? I mean, seriously. Publishing a blatantly purchased supplement promoting TCM is no different than publishing a blatantly purchased supplement paid for by a drug company promoting drug research and its own products. In fact, if you look at the table of contents of this supplement you will find that none of the material in this supplement was peer-reviewed:

The content contained in this special, sponsored section was commissioned, edited, and published by the Science/AAAS Custom Publishing Office. It was not peer-reviewed or assessed by the Editorial staff of the journal Science; however, all manuscripts have been critically evaluated by an international editorial team consisting of experts in traditional medicine research selected by the project editor. The intent of this section is to provide a means for authors from institutions around the world to showcase their state-of-the-art traditional medicine research through review/perspective-type articles that highlight recent progress in this burgeoning area. The editorial team and authors take full responsibility for the accuracy of the scientific content and the facts stated.

Sadly, I can’t help but conclude, Science, like Nature, has sold its soul. Nature, at least, seems to have learned from its mistake. At least it hasn’t done it again in three years. It remains to be seen how low Science will go. After having skimmed the articles that require further discussion, I shudder to go deeper, and I await with trepidation the next two segments in this ad-fest.

For shame, Science. There is no excuse.

By Orac

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

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

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

To contact Orac: [email protected]

633 replies on “Science and the AAAS sell their souls to promote pseudoscience in medicine”

As I read it above and then in the supplement, I couldn’t believe someone who had risen to be CEO of AAAS could have the sheer ignorance and stupidity to state:

In discussions surrounding traditional healing techniques, a common perception is that those in the West most often take a reductionist approach to medicine, breaking down the body into ever-smaller parts in order to understand its inner workings. In the East, by contrast, medical practitioners are seen to take a more holistic view, regarding the body as a complex, integrated system and treating it as such.

I absolutely agree that someone holding his positions in the AAAS and with the journal Science should be summarily fired from both positions for the above paragraph.

Here is something I find interesting. As far as I can tell, one form on ancient Chinese medicine has been modified and adopted by Western medicine, and indeed the world all over- vaccines.

The Chinese practiced variolation, a precursor to vaccination. They did this in India too. I bring that up whenever I see anti-vaxxers gushing about Ancient Chinese Medicine. I love to ask them why they reject this part of it.

http://www.historyofvaccines.org/content/chinese-smallpox-inoculation

Please read Prof. Gotzsche’s “Deadly medicines and Organised Crime”. Very well referenced with published, refereed scientific papers.

I tried to read the supplement. I really did. I got as far as the popularity fallacy and the some of are pharmaceuticals come from nature, so we should embrace quackery fallacy, but I became so nauseous that I could not go farther.

Science and the AAAS should be ashamed of themselves.

Reminds me of when National Geographic had SUV ads while having articles on global warming. They got so much guff from readers that they eventually did not renew those contracts. Cognitive dissonance much?

Chris, I’d say a paragraph like that wouldn’t be out of place in a study on why people use traditional Chinese medicine, probably in an introduction. But it doesn’t have much to do with the merits or lack thereof of TCM.

Here’s the problem:

1. Western, reductionist medicine discovered vitamins and their effects.

2. Western statistical methods determined that taking vitamin supplements, except in rare cases, has no benefit and in some cases may be harmful.

3. Vitamins are still being sold and consumed in vast quantities.

And then there’s gluten-free water…

I guess I can’t really get excited about the fuzzy Chinese stuff or even the anti-vaxers when this kind of snake-oil marketing is a giant industry, no to mention all the FDA-approved prescription medicines for new ‘diseases’ that make me want to kill myself. I mean, if I took any of them– that appears to be a ubiquitous (if ‘rare but serious’) side effect.

BTW, can anyone explain why all these drugs seem to have that effect? That’s a serious scientific question.

If TCM is so helpful in rural areas, how does Dr. Chan reconcile that with the severity of the current ebola outbreak in West Africa? The whole reason the current epidemic is so bad is that there is so little appropriate health care available to the people in rural areas. Gosh, if only Docs Without Borders had some TCM in their medical bags! The stupid just burns a hole right through the universe.

Zebra:

Most of the people who are taking vitamin supplements now don’t need them, because they aren’t sick and don’t have a deficiency. It’s not that most people don’t need vitamins, as you imply: it’s that most people are getting enough from their food.

The problem isn’t with modern medicine: it’s with modern marketing. That people are falsely claiming that we should be taking large amounts of unneeded vitamins is a real problem, yes. That doesn’t somehow make it okay for someone else to falsely claim that you need large amounts of some other worthless or dangerous substance that they’re calling “traditional.” Or for an “alternative” practitioner to promote the same unneeded vitamins.

Vicki,

How did I imply that people don’t need vitamins?

The point, which you obviously didn’t get, is that (relatively) educated people ignore science all the time. That’s good, sound, Western science, like Evolution and Climate Science, as well as medical, particularly when someone can make money by using marketing language to sell stuff.

Now, I think there is an interesting Philosophy of Science discussion that we might have about this topic. But as a practical matter, it just doesn’t rise to the level of concern I see expressed here. Rural Chinese or Africans or anyone aren’t being denied Western medicine because of the traditional practitioners, but because they are poor.

There have certainly been successful efforts to introduce modern good practices in third-world situations using locals– but someone has to put up the money. Let’s improve sanitation before we worry about what may be a form of placebo medicine for those with no options.

Ugh. Just … ugh.

It’s one thing for Science to report the fact that WHO has a new Traditional Medicine Strategy. That’s legitimate news, even if you think (as most posters here believe, and I agree) that it’s a mistake for WHO to have such a strategy. It’s another thing to publish a series of papers endorsing that strategy, or something similar.

At least Mao could claim that the alternative to providing TCM was nothing, and that the former was preferable. One might disagree with that opinion, but the placebo effect is a real thing, so the opinion wasn’t obviously wrong.[1] Pushing TCM or other “traditional”[2] medicine in countries which have adequate access to science-based medicine is clearly the wrong thing for a self-described scientist to do.

[1]Mao’s China didn’t have to deal with anything like Ebola. When you have a hemorrhagic fever outbreak, “traditional” medical clinics might actually be harmful, by allowing additional patients to come in contact with the infected individual.

[2]As regular readers know, some of these so-called “traditional” medical disciplines date all the way back to the twentieth century–reiki is a classic example.

I’m surprised at Nature, since TCM is driving so many endangered animals to extinction.

Alties usually gripe and moan about SB periodicals accepting advertising from pharma ( see AoA about BMJ), perhaps they’ll be happy now: woo-meisters can crow that SBM has ‘seen the light’/

The Fermi Paradox is alive and well…Anti-science nonsense will be the death of what little intelligence we on Earth demonstrate.

zebra, you obviously don’t want to engage in discussions on this blog or any other blog, as evidenced by your statement:

“I guess I can’t really get excited about the fuzzy Chinese stuff or even the anti-vaxers when this kind of snake-oil marketing is a giant industry, no to mention all the FDA-approved prescription medicines for new ‘diseases’ that make me want to kill myself. I mean, if I took any of them– that appears to be a ubiquitous (if ‘rare but serious’) side effect.”

Many of us do comment regularly on Respectful Insolence, the Science Based Medicine blogs and on dozens of other science blogs…as well as mainstream media blogs.

lilady #16

No idea what you are getting at.

Could you explain what “many of us comment regularly” is supposed to convey… ? Is there some exclusive club that you belong to? Sounds mystical, like that TCM stuff.

I’m happy, as I said, to discuss the science aspect of the topic.

I believe that people are misunderstanding zebra’s comments a bit. The gist seems to be that while it is all well and good to complain about the creep of TCM into modern health care, etc., there are larger, more important issues to talk about (e.g., the overly aggressive marketing of products of dubious benefit by large, multi-national companies or improving basic living conditions in developing nations) and that educated people ought to know better than to fall for this marketing.

That’s all well and good, but really quackademic medicine is an important topic to discuss, since it does have an impact on health care overall, not to mention in developing nations. We can have discussions about both things, in my mind.

Todd W #19,

Thanks for actually reading what I wrote.

So, the question would be whether we include vitamin supplements in the quackamedicine category.

So, the question would be whether we include vitamin supplements in the quackamedicine category.

Of course we do, when they’re sold as something they’re not. If you’d type “supplements” into the search box near the top of the page, you’d find that this has been discussed multiple times.

Oh, and this just as it is time for me to renew my membership to AAAS. I have neglected the recent issues over the holidays. But, now I’m faced with a decision – cancel, based on this transgression, or wait to see if they take action and offer an apology and explanation.

#21

“when they’re sold as something they’re not.”

Why don’t you save me the trouble of trying to scroll through previous blog comments and tell me when vitamin supplements are sold as something they “are” as opposed to “are not”?

UGH. As Politicalguineapig said, beyond the obvious, there is also the added ugliness of the fact that many traditional remedies are made from endangered animals. I was watching a documentary the other day and the amount of endangered animal parts for sale was heartbreaking.

If vitamin C supplements are promoted as a cure for scurvy or to make up for a diet deficient in vitamin C (based on current best data), that would be “sold as something they are”. If it is promoted as a way to prevent or cure a cold, that would be “sold as something they are not”. If vitamin D is promoted as something that helps promote calcium absorption, particularly for those who don’t get a lot of exposure to sunlight, that’s “sold as something they are.” If they’re sold as “a happy pill” (which someone once said), that’s “sold as something they are not”. Iron supplements to treat anemia are fine.

Is that a fair start, or did you want more?

From now on, all my research publications will be written holistically:

1. They will all begin “In the beginning, there was nothing”… and continue until they have included a sufficient grounding on the gestalt of existence to proceed to my methods and materials section..

2. All cancer research manuscripts will be written holistically, including quotations from Chaucer, the I Ching, German fairy tales, and a Korean dictionary. After all, it’s important not to be reductionist about including knowledge in authorship. We should borrow equally from all the fields of scholarship equally, as they all have equal merit.

3. The AAAS Board should be dismissed and reformed to include a more integrative approach: I’d suggest at least one televangelist, the Westborough Baptist Church, a South American shaman, Kim-Jong Un, the Easter Bunny and Santa Claus. All of these people, even the fictional ones, have a unique contribution to make to modern science and medicine.

Stacey: It seems odd that Nature would support TCM, since I assume readers of Nature feel strongly about endangered animals and a publication of that caliber should have been aware of all parts of TCM. So were the editors asleep at the switch or what?

#26

Yes, I understand. If you read my original comment, I mention that they are useful in a few cases. But they are not *marketed* (sold) as something that should be used only under certain specific conditions, which are probably not really subject to self-diagnosis.

Do you think me deciding that I need vitamin D supplements is somehow scientifically more valid than some TCM guy telling me to eat liver?

I said originally that there are interesting Philosophy of Science questions in this. That’s one.

@ c0nc0rdance;

I’m disappointed as you left out SO many other ethnicities, religious/ magickal practitioners and personages existing only in folklore or fairy tales.
Please revise your list keeping these considerations in mind
Thanks in advance..

Chris #24,

Thanks. OK, now I know that there was a post ranting about supplements.

Here’s another way of looking at the question I posed to O’Brien.

Which poses a greater threat to people’s well-being: Poor practice of Western medicine, which is right part of the time, or correct practice of Chinese medicine?

@zebra

First, let me rephrase your question: Poor practice of medicine or “correct” practice of TCM?

Now, the answer depends on context. Is it poor practice of medicine as the sole treatment vs. “correct” practice of TCM as the sole treatment? You also need to define “poor practice” as well as the population size to consider.

Of course the fact that a significant proportion of drugs started out as analogues of compounds in herbal medicine is actually a point against TM, as the ones which remain that are not part of medical practice, are the ones that didn’t work.

Todd W,

Let *me* rephrase my earlier question to O’Brien, since that may make my point more clearly:

Which is more likely to help, not harm:

-A TCM practitioner tells a peasant farmer with no access to Western tests or treatments to eat more liver, or eggs, to strengthen bones after a break occurs.

-A poorly educated USA woman takes 10,000IU per day of vitamin D because she wants to avoid osteoporosis, based on what she reads on the internet.

A TCM practitioner tells a peasant farmer with no access to Western tests or treatments to eat more liver, or eggs, to strengthen bones after a break occurs.

How precisely do you arrive at the conclusion that this is the TCM treatment for broken bones?

zebra, what have you been doing to counteract the anti-vaccine groups, the snake oil vendors/supplement sellers and quacks who pander to these groups and the parents of autistic kids who subject their children to painful, dangerous, invasive and unproven “treatments”?

Narad,

I would rather not try to respond to a new individual each time, and Todd W seems to have understood my original comments better than most– perhaps you like many others just don’t read carefully. I didn’t say TCM treated broken bones with liver, I specifically said strengthen bones.

But it really doesn’t matter what actual TCM would suggest; perhaps I should have made a more random choice since liver is based on my Western scientific knowledge– OK, powdered Rhino horn.

The idea is to illustrate the underlying difference in the process by which the ‘treatment’ is arrived at, and potential consequences. Of being right and being wrong.

I would rather not try to respond to a new individual each time

Color me wholly indifferent.

and Todd W seems to have understood my original comments better than most– perhaps you like many others just don’t read carefully.

Or perhaps you’re simply tediously whining that this post should have been about a topic more to your liking and getting obnoxiously snippy about it.

But it really doesn’t matter what actual TCM would suggest; perhaps I should have made a more random choice since liver is based on my Western scientific knowledge– OK, powdered Rhino horn.

Then you’ve answered your own question: Neither is likely to do harm to the individual, and the vitamin D will at least correct any dietary inadequacy.

Narad,

“Neither is likely to do harm to the individual,”

Except if the individual has some underlying condition that would lead to vitamin D toxicity.

As for the post topic– ranting aside, as I’ve said a couple of times, I thought the post raised interesting questions.

How did TCM arrive at [rhino horn], and how did Western medicine decide that people should be allowed to decide their own dosage of vitamin D?

Try reading the original post again.

zebra @38: Only it does matter whether you assume that the TCM practitioner suggests liver or powdered rhino horn.

Western medicine tells us that it’s very hard to overdose on vitamin D.

We also know that the powdered rhino horn is either real or fake. If it’s real, the TCM is directly increasing the risk of extinction of a threatened species. If it’s fake, it could be anything, meaning that the TCM could do nothing at all, or could lead to lead poisoning or, for that matter, vitamin D overdose.

You can’t find a meaningful answer to the question: “What is more likely to cause a problem, an unnecessary vitamin D supplement or whatever is behind door number 3?” without either opening the door, or at least narrowing the question by telling the contestant “behind door number 3 is either liver, sassafras tea, or a year’s supply of Turtle Wax.”

Even the reductive vs. holistic debate is mistaken. Science may be cognitively reductive, but this simply means it first studies small pieces and cognizes the bigger pieces in terms of the smaller ones. How do the holists cognize the body?

Vicki,

If what’s behind door number three were a serious poison, then it would almost certainly not be part of *traditional* medicine. Or do you not believe in Evolution in the cultural context?

We know that in conventional medicine, and particularly in the USA, there are treatments that are used or overused contrary to what science tells us about their efficacy. Perhaps it’s because of the ‘successful’ part of medicine, which allows people to survive such misadventure. And that successful part of medicine also perhaps tends to suppress skepticism.

But perhaps, for people who don’t have quick and easy access to heroic interventions, just having someone with experience and some kind of model to guide them, is the best they can hope for. Do some of those practitioners get things wrong sometimes? Sure, but is sassafras tea more dangerous than acetaminophen, in their respective contexts?

Leshner and the AAAS have form. They promote “constructive dialogue” between science and religion, through the Templeton funded Dialogue on Science, Ethics, and Religion program.

Some scientists are hunky-dory with religion, some are not and some are indifferent. The middle ground here is not accommodation but indifference.

Now Leshner and the AAAS is facilitating the union of medical science with medical woo. This is not the middle ground either.

Shame. Shamanism. Sham. AAAS. Pick your “S”.

zebra: “We know that in conventional medicine, and particularly in the USA, there are treatments that are used or overused contrary to what science tells us about their efficacy.”

So what? Because there are issues with real medicine, that does not mean TCM works. At least there are people who are working to improve outcomes with conventional medicine, not so much with TCM.

Also, I forgot to mention: rhino horn is made of the same stuff as your fingernails. Killing a rhino, sawing off its horn and turning it into a powder is just as effective as chewing your fingernail.

**OT but are lame-brained woo-meisters who purport to have technology that will save millions from starvation and illness ( which doesn’t really work) EVER TRULY OT @ RI?

Mikey’s new 3D printer has failed extruding miserably so saving the world will have to wait for a bit ( Natural News today) : it appears that the Lulzbot ™ ain’t all its writen up to be. AND the material is NOT waterproof either- which can be problematic if you’re designing hydroponic systems,

Natural News: it’s more than an alternative health and news site- it’s a comedy factory.

** if at first you don’t succeed etc.

zebra,

If what’s behind door number three were a serious poison, then it would almost certainly not be part of *traditional* medicine. Or do you not believe in Evolution in the cultural context?

Check out Aristolochia, which is one reason I don’t believe that TCM has happened upon much of use by trial, error and careful observation. If they didn’t notice a substantial proportion of their clientele prescribed Aristolochia dying of kidney failure, I have little faith they would notice anything more subtle.

Regarding your more general point; I don’t think many people here would disagree that there are more important things in the world than woo infiltrating real medicine. That doesn’t mean we can’t be interested and concerned about it.

zebra – I read your original message as saying, “golly, I can’t care much about the spread of TCM because supplements are so badly misused. Why aren’t you talking about supplements?” So I pointed out that we have discussed supplements and if you wanted to know what was said, you could find that.

Now you seem to be saying that TCM is not worthy of concern because it’s not as harmful as badly used conventional medicine.

You are, of course, entitled to your opinion. In my opinion promoting unproven, ineffective, and possibly dangerous treatments of any type is a subject of concern. Today the topic is TCM. On other days we have discussed other treatments.

Questions along the lines of “which is worse, a dose of rhino horn or a poke in the eye with a sharp stick?” seem rather pointless. There’s no reason to want either. If someone were promoting being poked in the eye with a sharp stick, I’m sure that would be a topic for future discussion.

I’ve seen too many people suffer from side effects of modern medicine to assume that its all scientifically sound.
Some supplements have a proven benefit.
Herbal medicines aren’t all just old wives tales. Many of these were studied and tested by generations of physicians.

People have died from placing too much trust in herbal medications that failed to get the job done, but thousands also die each year due to medical malpractice and defective drugs.
Tylenol has destroyed so many livers its ridiculous. Willow bark does the same job and I’ve yet to hear of it causing organ failure.
The Pharmaceutical industry needs to get its own house in order before they start casting stones.

zebra:

Traditional Chinese medicine included, for many centuries, the use of mercury in order to produce longevity. Traditional European medicine included bleeding patients. Both of these practices lasted far longer than your optimistic view of cultural evolution makes room for.

zebra

But it really doesn’t matter what actual TCM would suggest; perhaps I should have made a more random choice since liver is based on my Western scientific knowledge– OK, powdered Rhino horn.

Powdered Rhino horn is definitely harmful for the Rhinoceros.

Leigh Jackson: “Leshner and the AAAS have form. They promote “constructive dialogue” between science and religion, through the Templeton funded Dialogue on Science, Ethics, and Religion program.”

Clearly, Mr. Leshner is an idiot. At least in the US, there’s no such thing as ‘constructive dialogue’ between science and religion. Heck, look how controversial the new Cosmos was. (Although, in my personal opinion, they really shouldn’t have put it on Fox in the first place) Religion will destroy science unless scientists take a stand.

“Religion will destroy science unless scientists take a stand.”
That’s the most ridiculous statement I’ve seen today.

Too much faith in the process of establishing anything as fact through consensus of opinion is undermining science.
Mistaking correlation for causation is another dead end for the road to knowledge.
Trying to kill open discussion while demanding that all toe the line or be censored is the death knell for advancement in any sector.
There seem to be more in the way of pseudo scientists than pseudo science these days.
A closed mind is unlikely to produce anything worth listening to.

pretty much all you have left is herbal medicine, which needs no special dispensation to become part of science-based medicine. All it needs is for pharmacologists and physicians to study it, identify what’s useful and discard what is not, and then figure out what active ingredients can be used. Then it could become just “medicine,” as the cliche goes.

And becoming “medicine” puts a stumbling block in the way of those who need the healing. Often, this really can prevent harm. Often, this really can give a jail term instead of individual-enabled healing. Always, it suddenly takes a fat mastercard.

The Food and Drug Administration (FDA) position is that red yeast rice products that contain monacolin K, i.e., lovastatin, are identical to a drug and, thus, subject to regulation as a drug.

http://en.wikipedia.org/wiki/Red_yeast_rice#Regulatory_restrictions

Is it ‘irony’ or mearly ‘unfortunate’ that integrating TCM with SBM is the shortest route to stamping out the working aspects of TCM??

Questions along the lines of “which is worse, a dose of rhino horn or a poke in the eye with a sharp stick?” seem rather pointless. There’s no reason to want either. If someone were promoting being poked in the eye with a sharp stick, I’m sure that would be a topic for future discussion.

MO’B: for the past year, my retinologist has been poking me in each eye, monthly, with sharp sticks. The Eylea injections from the sharp sticks seems to have resulted in arrest and reversal of my macular degeneration. I would promote such retinologist-ordered poking for anyone else who may benefit.
A dose of rhino horn does not seem to have any benefit, for anyone (especially the rhino). I can see no reason to promote it.

Uncommon Descent gets it, I see.

“Science journals are shilling for the placebo effect.”

UD says about itself:

Materialistic ideology has subverted the study of biological and cosmological origins so that the actual content of these sciences has become corrupted. The problem, therefore, is not merely that science is being used illegitimately to promote a materialistic worldview, but that this worldview is actively undermining scientific inquiry, leading to incorrect and unsupported conclusions about biological and cosmological origins. At the same time, intelligent design (ID) offers a promising scientific alternative to materialistic theories of biological and cosmological evolution — an alternative that is finding increasing theoretical and empirical support. Hence, ID needs to be vigorously developed as a scientific, intellectual, and cultural project.

IOW, science should serve the interest of religious ideology, not show an indifference to ideology of any form. ID can accommodate the placebo effect, just like Science can, it appears.

Squirm Science, squirm.

Except if the individual has some underlying condition that would lead to vitamin D toxicity.

Yah. So, you were relying on obesity predisposing to hypervinosis D and thus chose the regular tolerated upper limit?

Well, that’s fυcking dandy. You’re left with at least two problems, though: The first is that the original question was therefore doubly loaded, although you “played” dumb in #37 with the redaction to rhino horn, leaving a singly “loaded” residue. The second is that you’re stuck with what such specifically constructed scenarios have anything to do with your putative, overarching whining point in terms of representativeness.

Personally I don’t really care about “Western / Chinese” medicine. What matters to me is if the effectiveness of the therapy and its side effects are rigorously documented. (As we saw with the Aristolochia / mercury / bleeding, clinical experience alone is unfortunately not sufficient too often)

The other problems discussed (medical malpractice, incorrectly prescribed medications, marketing of supplements) are not “Western medicine” problems ; they are western health systems / marketing problems. (ex. the poor organization and lack of budget in some hospitals, the very liberal regulation on supplements…)

Orac @46

You seem to be very concerned with rhetorical fallacies. What you are doing here is called “Guilt By Association”.

O’Brian @49

“That’s not what we’re discussing” is a mixture of several fallacies, as is “you’re entitled to your opinion”. I already knew that I’m entitled to my opinion, and my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM. Other than Ipse Dixit, you (and others) make no argument to the contrary.

zebra – You are incorrect. Failings in the practice of conventional medicine do not justify promoting traditional medicine, if that traditional medicine has not been shown to be safe and effective.

I personally am perfectly comfortable with the thought that there are some treatments from traditional medicine that are safe and effective. If you’ve got evidence of any, please share. Likewise, if you have evidence that traditional medicine never provides harmful treatment, please share.

P.S. At no time did I say “that’s not what we’re discussing”. And if you know you’re entitled to your opinion, how can my statement saying so be a fallacy?

zerba- I could just as easily say that the failings of conventional medicine justify the burning of witches. Learn basic logic.

I remember reading years ago that consuming the liver of a Seal killed at a certain time of the year could kill you.
Not something most would have to worry about, other than Inuit.
The seal stored enough vitamin D from foods it consumed during a short season to last for the entire year, the amount of vitamin D in their liver would kill a human.

As for example of an effective herbal remedy I’ve tried recently is use of an expended tea bag to reduce the pain of an abscessed tooth till I could get to a dentist.
After finding this worked better than expected I remembered that bandages soaked in tannic acid were once used to dress third degree burns. They reduced pain but unfortunately increased formation of scars.

Don’t know of much benefit from mercury other than it being an ingredient in some salves.
Arsenic on the other hand did have some effect on certain diseases such as syphilis, and led to development of Erlich’s “Magic Bullet” line of arsenic based toxins that targeted specific disease organisms, and that led to the development of chemo therapy.

The writings of Greek Physicians were preserved and studied by medieval scholars in the Catholic Church and in the Muslim lands.
Galand was a very experienced surgeon , others were experienced in herbal and primitive chemical medications.
A German Nun compiled a encyclopedia of herbal medications.
One of the Popes (don’t remember his title) compiled an extensive medical encyclopedia.
The monastic system preserved knowledge that would otherwise have been lost during the dark ages.

#64 (and 66)

Come on, you have to do better than obvious strawmen– and using the equivocal “promoting” TM; my goodness, it sounds like those supplement commercials.

“my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM”

You still haven’t answered that. Looking at TM in isolation is pointless if we are talking about practice and policy. In fact, the whole basis for Orac’s ranting seems to be the idea of ‘integrating’ the practices.

If TM is a relatively innocuous (medically) form of placebo, then it is certainly fair to compare it to practices like prescribing antibiotics to people with a viral upper respiratory infection. And please, don’t tell me that is a rare event.

If people are convinced that Rhino horn is just as good, I would make that the treatment of choice.

I would also ‘integrate’ by taking all the antibiotics we then don’t prescribe (along with what we feed to cows) and sending them to TM practitioners in remote villages. With a little bit of training, lots of lives could probably be saved.

“my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM”

You still haven’t answered that.

Au contraire. I answered that very specifically with the statement “You are incorrect.” That is my opinion.

In fact, the whole basis for Orac’s ranting seems to be the idea of ‘integrating’ the practices.

Orac certainly discussed the proposal (not his) of integrating the practices of science based and traditional medicine. He sees it as a bad idea.

If TM is a relatively innocuous (medically) form of placebo then it is certainly fair to compare it to practices like prescribing antibiotics to people with a viral upper respiratory infection.

True. However, that would say that we should argue against the practice of prescribing antibiotics to people with viral infections (assuming no secondary bacterial infections). I don’t think you’ll find any dissent here.

If people are convinced that Rhino horn is just as good, I would make that the treatment of choice.

That’s a bad idea because a) it contributes to the extinction of the rhinoceros and b) giving a placebo instead of actual treatment is condescending at best and promotes superstition at worst.

I would also ‘integrate’ by taking all the antibiotics we then don’t prescribe (along with what we feed to cows) and sending them to TM practitioners in remote villages. With a little bit of training, lots of lives could probably be saved.

How about instead of adding a few drugs to unproven practice we were to supply them with better training and information on modern disease theory?

One small addition: while some treatments prescribed by traditional medicine are relatively innocuous placebos, not all are. There is also an entire set of underlying assumptions which are not validated as being helpful to identifying or treating diseases. Teaching those in addition to stuff we think works (based on current best science and clinical practice) provides no improvement to conventional medicine.

@Greg Young

I remember reading years ago that consuming the liver of a Seal killed at a certain time of the year could kill you.
Not something most would have to worry about, other than Inuit.
The seal stored enough vitamin D from foods it consumed during a short season to last for the entire year, the amount of vitamin D in their liver would kill a human.

Not to be pedantic, but I believe you’re thinking of vitamin A.

Just remembered another medieval treatment, blood letting.
Blood letting is the treatment of choice for Hemochromatosis, excessive iron in the blood.
They remove quite a lot of blood, the blood the body manufactures to replace it has less iron until the iron build up again reaches dangerous levels, then they let more blood.
In some cases regular blood donation is enough to control the condition.

I use a commonly available supplement mixture of Chamomile, Melatonin and Valerian. Its been of great help in reducing my need for prescription pain medications and allows me to sleep.

O’Brian:

” I answered that very specifically with the statement “You are incorrect.” That is my opinion.”

You and Orac, from his part two, seem not to be too clear on the concept of rhetorical fallacies. Did you look up Ipse Dixit?

Putting aside the obvious silliness about my metaphorical use of “Rhino horn” (you do know what a metaphor is, right?)…

you’ve nicely made my earlier point when you say that “it would be condescending and promote superstition.”

So when a suburban housewife in the USA thinks she *must* get antibiotics for a head cold, what is the doc who prescribes them doing? How is the housewife’s fantastical woo different from what the peasant farmer believes?

Who’s being condescending here, I wonder?

And as for:

“How about instead of adding a few drugs to unproven practice we were to supply them with better training and information on modern disease theory?”

This is a true no-brainer, again validating an earlier point. Because they don’t have the support system that would allow them to use the information? I know it would be ‘condescending’ in your mind, but it would be far more effective to use the faith the locals have in them to slip them some modern medicines. This is a model that has worked, as I pointed out way back. Doesn’t require medical school; spend the money on a solar powered refrigerator and stuff like that.

@zebra

You have yet to define “poor practice” of medicine in your original question. Also, you might try comparing what a TCM practitioner would actually prescribe, rather than what you think they would (e.g., a combination of herbs vs. the recommendation to eat more liver), versus what a doctor would prescribe for the same thing, not what a company might advertise (which, as others have already stated, is a problem not with medicine, but with marketing).

Let’s take rhino horn, for instance. In TCM, powdered rhino horn is prescribed for male impotence. The medical comparator would be something like Viagra or Cialix. I would argue that the rhino horn, on the whole, is a more detrimental. First, it is not regulated, so, as other have pointed out, while the TCM practitioner may be “responsibly” prescribing it, there is nothing to guarantee the purity of the powder. The purity question makes the side effect a completely unknown factor. It may have no adverse effects, or it may have some manner of lethal contamination (or anything in between). Second, use of powdered rhino horn is leading to the extinction of rhinoceroses. While this is not directly detrimental to the patient, it is still a huge negative factor that must be considered.

There is a similar issue with your bone-strengthening example. The Chinese herbs may have some active ingredients that help, but lot-to-lot variation is likely to be quite high. Every dose will have different potency and purity. There are also a lot of other ingredients in there from the herb itself that may increase the risk of adverse effects. Add to that the lack of regulation regarding purity, and you have an increased risk of contaminants like lead or mercury. Against that, you’re trying to compare an individual self-medicating with a vitamin D supplement, not a physician who has diagnosed and prescribed vitamin D supplementation. So you aren’t even comparing TCM to actual medical practice, even your as yet-to-be-defined “poor practice”.

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