The holidays must truly be over. I say this because, starting around Sunday, the drumbeat of blogging topics that I haven’t covered but that apparently you, my readers, want me to cover has accelerated. However, before I can move on to what might or might not be greener blogging pastures, material-wise, I feel obligated to finish what I started yesterday, namely the deconstruction of an advertising supplement promoting the “integration” of “traditional medicine” (in particular, traditional Chinese medicine, a.k.a. TCM) for which Science and the American Association for the Advancement of Science (AAAS) have sold their collective souls, part one of which is here. One reason is that I don’t like to risk not finishing a series that I have planned. The other reason is that, unfortunately, Science has promised that this is just the first part of a three supplement series, and I didn’t want to risk not getting back to part one before part two of this paean to pseudoscience, quackery, tooth fairy science, and quackademic medicine is published.
The supplement was, as you recall, entitled The Art and Science of Traditional Medicine Part 1: TCM Today — A Case for Integration, and when it comes to tooth fairy science and quackademic medicine, plus, as Kimball Atwood would put it, the weasel words of woo, it’s breathtaking, as I described. Unfortunately, the fun, such as it is, continues in the articles in the supplement that I didn’t get to yesterday. For example, there is an article by Josephine Briggs, director of the National Center for Complementary and Integrative Health (NCCIH, formerly the National Center for Complementary and Alternative Medicine, or NCCAM) and a bunch of other advocates of “integrative” medicine entitled Integrating traditional medicine into modern health care. As you might expect, my first thought upon reading this title was: Shouldn’t we figure out whether anything in TCM has any scientific basis first?
Apparently not, although Brigs and company do at least explain their purpose:
This first issue introduces the WHO Traditional Medicine Strategy (2014– 2023), highlighting the global scientific challenges and showing how a systems biology approach can be applied to diagnosis, leading to integrated network-based medicine. Recent advances in mechanistic studies of acupuncture are also discussed. Some of the exciting areas in TCM research include the therapeutic potential of herbal remedies against influenza, cancer, diabetes, and cardiovascular diseases; the exploration of gut microbiota-targeted dietary interventions against chronic inflammation; and the study of the biological activities of complex polysaccharides present in medicinal plants. Chemogenomics and network pharmacology have been applied to predict molecular targets and decipher the mechanisms of action of pure compounds or phytocomplexes found in combinatorial herbal formulas. A better understanding of the philosophy of synergetic interactions of Jun, Chen, Zuo, and Shi classes of Chinese materia medica used in traditional formulations has led to a simplified Jun-Shi compatibility drug discovery strategy model.
Evaluating the safety of herbal medicines is critical to their wider acceptance as valid therapeutic agents. Integrated toxicological approaches have been successfully applied in this area, for instance to identify antifibrotic and profibrotic substances in certain medicinal plants. As research into the broader application of traditional medicine continues, newer ‘omics technologies and poly-pharmacokinetics will also play an increasing role in bridging the gap between the personalized approach of Chinese medicine theory and modern clinical research methodology.
No one disputes that powerful medicines can be isolated from plants and other natural sources. If that weren’t the case, then natural products pharmacology (or, as it’s also called, pharmacognosy) wouldn’t be such an important part of pharmacology. Of course, using herbal remedies means substituting impure extracts with high lot-to-lot variation in active ingredient(s) for purified, well-characterized pharmaceutical grade active ingredient(s). Perhaps you are wondering what Jun, Chen, Zuo, and Shi classes of Chinese materia medica are. Perhaps this little excerpt from an article on TCM will help you:
The Herbal was put under the name of Shennong or Godly Farmer but it was likely compiled during the Qin/Han dynasties (221 BC – 220 AD). It is the summary of pharmaceutical knowledge during that time. It discusses in detail 365 kinds of drugs, and it also mentioned the basic pharmacological theories which are still being taught in today’s Chinese medical schools. It includes the following: Jun Chen Zuo Shi (monarch, minister, assistant, and guide) indicating the different functions of drugs in a prescription; the Four Qi’s, four properties of drugs; Five Tastes, five kinds of flavours: sour, bitter, sweet, acrid, salty. Long term clinical practice and modern scientific researches have proved that most of the effects of the drugs recorded in this book are true, as with Chinese ephedrine (Herba Ephedrae) used in the treatment of asthma, goldthread root ( Rhizoma Coptidis) prescribed in dysentery, kelp (Sargassum) prescribed in goiter and so on.
If you look closer, you’ll find that Jun (ruler or emperor) corresponds to the principal ingredient directed at the main cause and/or symptoms of the disease, Chen (minister) describes herbs directed at the underlying cause of the disease as well as accompanying symptoms. (You know, Jun and Chen sound very similar to me.) Zuo (assistant) drugs are supposed to help the Jun and Chen drugs do their work by alleviating secondary symptoms of the disease and counteracting adverse effects of other drugs. Finally, shi (enabler or guide) drugs supposedly direct the action of all the others into the right “channels,” thus somehow making sure that the other drugs “do not exceed the patient’s capacity to cope with their actions.” It’s all very complicated and seemingly rationale sounding. Of course, in TCM, the “underlying cause” of diseases invariably involves imbalances in proteries like “dampness” and “heat” or the like, rather than anything with any basis in science. Remember that. These TCM herbs are all designed not based on any scientific understanding of a disease and its symptoms, but rather on a prescientific belief system rooted in religions beliefs (Taoism) very much like humoral theory that ruled in Europe for two millennia.
As I like to ask, where’s the love for traditional “Western” medicine, which postulates imbalances in characteristics not unlike those central to TCM beliefs?
Perhaps the most depressing part of this whole supplement is that the World Health Organization (WHO) is actively promoting the “integration” of traditional medicine, chief among them TCM, into science-based medicine, as indicated in a rather long article entitled The WHO Traditional Medicine Strategy 2014–2023: A perspective, by Zhang Qi and Edward Kelley.
Like other articles in this supplement, the article starts out with the logical fallacy of argumentum ad populum; i.e., an appeal to popularity. Yes, tiresome and predictably, the authors tout how much TCM is used in China. Strike that, they tout how much T&CM (traditional and complementary medicine) is used, bragging about countries in which traditional medicine is completely integrated into health care systems, including China, the Democratic People’s Republic of Korea (North Korea), the Republic of Korea (South Korea), India, and Vietnam. what I can’t figure out from this is why we in the “West” would want to imitate medical systems in North Korea or any of these countries. Yet, according to this article, the WHO’s objectives include more tooth fairy science on traditional medicine, assuring the safety of traditional medicine. Then, the third objective is:
Objective 3: To promote universal health coverage by integrating T&CM services into health care service delivery and self-health care. One of the most significant questions raised about T&CM in recent years is how it might contribute to universal health coverage by improving service delivery in the health system, particularly primary health care. A first step is to capitalize on the potential contribution of T&CM to improve health services and health outcomes. Mindful of the traditions and customs of peoples and communities, member states should consider how T&CM might support disease prevention or treatment as well as health maintenance and health promotion. This process should be consistent with safety, quality, and effectiveness standards and in line with patient choice and expectations. Based on each country’s realities, it is recommended that models for integrating T&CM into national health systems should be explored.
Talk about weasel words of woo. How would “integrating” traditional medicine ito health care delivery services promote universal health coverage? It wouldn’t, at least not unless you define “universal health coverage” as encompassing pseudoscience and quackery or, at the very least, treatments based on prescientific notions of disease whose efficacy and safety are either not established or established, but not in the way the WHO wants. Seriously. you know how much I rail against the infiltration of quackery into medical academia, calling it quackademic medicine? I had no idea that the WHO is actually actively promoting the infiltration of quackery not just into medical academia but into health care systems around the world. It boggles the mind.
Next up is an article by Josephine Briggs. I had hoped to avoid it, because it’s really full of the weasel words of woo, but I can’t. Perhaps the most brain-melting non sequitur I’ve ever seen comes in the second paragraph of her article, entitled A global scientific challenge: Learning the right lessons from ancient healing practices. Make sure you aren’t drinking anything while you read this. Otherwise, I’m not responsible for ruined keyboards:
For many living in developing economies, traditional healers and herbal remedies are the only source of available health care. In contrast, developed economies typically use these approaches as an optional complement to modern medicine, driven by patient preference. However, in both China and India, the ancient medical traditions—traditional Chinese medicine and Ayurvedic medicine—have flourished either in parallel or integrated with advanced modern care. Currently, in North America and Europe certain ancient healing practices—such as acupuncture, traditional Chinese medicine, massage, and meditation—have generated increasing interest and are seen as gentler, “low-tech” complements to conventional care.
The persistence of such traditional practices in these settings suggests we have much to learn from them. Modern scientific methods can offer means to examine traditional practices. In this brief perspective, a few examples of traditional remedies are discussed to illustrate the issues we face in thinking about the intersection between modern medicine and traditional healing practices.
Um, no. It doesn’t. At least, it doesn’t except in the most trivial meaning of the term “learning something.” Think of it this way. Belief in ghosts persists, despite science that shows that ghosts don’t exist. Does this mean that we have “much to learn” from studying ghosts? No. Perhaps we have something to learn from studying believers in ghosts as a means of studying human belief and credulity. No doubt we can do the same with alternative medicine, but that doesn’t mean that we should adopt belief in alternative medicine by “integrating” it wholesale into national health systems any more than we should adopt belief in ghosts as a national policy.
OK, that was a bit of a strained analogy, but you get the point.
Briggs pulls out the standard tropes about how the identification of natural products somehow validates TCM, pointing out that half of the pharmaceuticals approved by the FDA were “either natural products, synthetic derivatives, or had at their core a prototype molecule derived from a natural product.” Certainly, there’s no doubt that natural products and their derivatives are an important source of drugs. That doesn’t mean one has to “integrate” TCM with scientific medicine in order to have the benefit of these compounds. Again, that’s what we have natural products pharmacologists for. Indeed, adopting TCM instead of cherry picking herbs that can be demonstrated to have medicinal benefit would be counterproductive because of all the pseudoscience and mysticism associated with TCM.
Next up, Briggs admits that acupuncture is primarily a placebo intervention but says that we should use it anyway. She cites a paper by Vickers et al that was widely touted as “proving” that acupuncture works for pain but doesn’t prove anything of the sort. Then she writes:
Specifically, when acupuncture was compared to no acupuncture (in effectiveness studies), the benefit appears to be quite sizable, approximately 50% reduction in pain severity. In contrast, when acupuncture is compared to a sham treatment (in efficacy studies), more modest effects are observed (Figure 2). Although statistical significance is achieved, the reduction in pain severity is not as substantial, typically only 20%. Based on this analysis, it seems reasonable to conclude that needling itself may be contributing to acupuncture’s pain-reducing effects, and that the overall benefit is heavily dependent on context—on the reassurance and expectation produced by the acupuncture ritual.
What does this mean for clinical practice? Here, the arguments erupt. Is a contextual effect (some would call it a placebo) that relieves pain and reduces the need for medication an acceptable form of treatment? This is still, for many Western practitioners, a quandary to which there is no simple answer. Building a better biological understanding based on the neuroscience of pain may provide some common ground. As we learn more about the central effects—specific and nonspecific—can also be teased out. pain circuits, the mechanisms underlying acupuncture’s effects—specific and nonspecific—can also be teased out.
Shorter version: The evidence is most consistent with the conclusion that acupuncture is a theatrical placebo (although we really, really hope that the needling actually has pain relief properties), but we should use it anyway, damn the ethical objections to lying to patients. After admitting that “traditional medicine diagnoses” are often not related to science or reality, she then concludes that “clearly, Western medicine does not have all the answers, and systems of care that allow thoughtful integration of healing traditions with modern medicine may offer help to troubled patients.” In other words, let’s fill in the gaps with magic, the same way creationists fill in the gaps in evolution with God.
Last up (for me at least) is a jaw-dropping article by Jan van der Greef and others entitled East is East and West is West, and never the twain shall meet? It begins with a blatant appeal to cultural relativism, saying that “modern Western scientific model” arose in its own cultural context. In comparison, “A different approach to understanding reality and the laws of nature arose in Eastern cultures, such as China. Both models can be considered valid, each with its own model-dependent realism.”
Postmodernism reigns supreme!
Based on postmodernism, van der Greef continues:
One way to bridge the two worldviews is through unification of diagnosis, based on an integration of the collections and arrangements of symptoms and signs. Western biomedical advances offer a plethora of biomarkers that can be detected and measured with advanced equipment, while Chinese medicine contributes knowledge about the dynamic relationships among signs and symptoms. The right side of Figure 2 provides an example of this inter-relationship for rheumatoid arthritis (RA). In Chinese culture, RA is classified as a “Bi Zheng,” a so-called painful obstruction syndrome. In TCM diagnosis every condition is primarily distinguished according to eight basic principles: External-Internal, Heat-Cold, Excess-Deficiency, and Yin-Yang. Figure 2 focuses on the Cold- Heat differentiation.
The signs and symptoms of RA are universally represented across peoples independent of culture, although variations in concepts and emphasis can be seen. In TCM, RA patients can be subdivided based on the predominance of “hot” versus “cold” symptoms. Examples of “hot” symptoms, as illustrated in Figure 2, are thirst, fever, irritability, restlessness, warm feeling, dry mouth, and pain that is relieved by cold, while “cold” symptoms include clear urine, sharp pain, stiff joints, and pain that is relieved by warmth. This systemic approach may help biomedical researchers to distinguish biological subtypes of RA in a manner that could lead to personalization of medical care; firstly, through more personalized lifestyle advice, and in the long term, through the application of modern biomedical technology in studies of RA subtypes. Ultimately, recognizing the particular individualized presentation of RA across different patients based on a systemic approach may improve treatment choices and outcomes.
Arrghh! Not this nonsense about rheumatoid arthritis again! I’ve dealt with it before in detail a mere two months ago, when I discussed a truly credulous Wall Street Journal article about TCM that described exactly this attempt to use systems biology to “prove” that TCM diagnostic criteria and concepts accurately describe the pathologic processes resulting in RA. van der Greef even discusses the same research as justification for his “unification,” complete with this diagram:
Arrrgh!
There’s more in the next article, this time by Leung et al and entitled Integrated network-based medicine: The role of traditional Chinese medicine in developing a new generation of medicine:
According to the philosophy of traditional Chinese medicine (TCM), health is the state of harmony between individual internal physiological networks (IPNs) and external environmental networks (EENs). Aberrant interactions between and within these networks cause complex diseases. TCM is grounded in these holistic principles, integrating philosophies from art and science; it stresses the maintenance of balance, or homeostasis, between the systems of the body and nature.
We believe that this kind of network-based holistic approach to medicine offers a useful counterpoint to today’s biological reductionism-based thinking. We champion integrated network-based medicine (INBM) which takes a systems approach to understanding the individual’s body as a whole, as opposed to relying on discrete components such as gene mutations, in order to explain illness (1). Built on the principles of IPNs and EENs, INBM offers a comprehensive medical system that integrates fundamental theories, diagnostic methods, and therapeutics based on a holistic and dynamic network-based approach.
What does this even mean? Sadly, I know. It means “integrating” TCM with “Western” medicine and then pointlessly applying all sorts of advanced systems biology techniques to give it the sheen of real state-of-the-art science. There’s even another chart:
Do you get the message? See how TCM is in the same circle as personalized medicine and digital medicine surrounded by all sorts of science-y terms and illustrations, with the circle being on the right end of an arrow, the end labeled “future perspective”? That’s right. The message is that the “integration” of TCM with science-based medicine is the future. You pesky reductionist “Western” scientists who dismiss the Five Elements and imbalances of dampness, dryness, heat, and cold (for instance) are the past.
The scary thing is, the authors might actually be right. “Integrating” quackery with medicine does seem to be the future these days, and universities, the NCCIH, the WHO, Science, and the AAAS appear to be doing their very best to make that future a reality.
65 replies on “Science and the AAAS (not to mention the WHO) sell their souls to promote pseudoscience in medicine, part 2”
I’m having a fair amount of trouble figuring out the wavy black line at upper left pointing from the pithy “For example, Metformin or anti-diabetic Chinese herbal medicine” to green spiky things and labeled “Anti-cancer.”
That diagram is horrible, speaking both as a graphic designer and a biology graduate.
OK, kids, it’s time to reverse the HHMI softening of the premed curriculum and roughly triple the amount of hard science prereqs you need to be a doctor.
Well, maybe not, but from the looks of this, a large portion of the medical profession is suffering from what appears to be a kind of dementia. Yikes.
Of course physicians need interpersonal skills. Buf this doesn’t mean they need to check their brain at the door.
I have to wonder, with the patient self-treatment concept, how many unnecessary deaths might result. Our inherent cognitive biases can make self-diagnosis by Google inaccurate, and if patients en masse are encouraged to “own their own health” there is a real possibility that the Mr Woos of this world will die from diabetes complications, stroke, etc.
Kathryn @2 — Whoever did that last diagram probably consulted with the person who does the hilariously awful editorial cartoons for The Onion.
The persistence of such traditional practices in these settings suggests we have much to learn from them.
Namely, that some patients are willing to pay lots of money for sham treatments of this sort. Paging P. T. Barnum….
And I’ll echo the above commenters regarding that second chart. Whoever produced that figure is clearly in Dunning-Kruger territory. Considering how much money they are getting to promote this schlock, you would think they could afford a competent graphic artist. At least my artistically incompetent colleagues (and I’ll admit to knowing far too many) can truthfully say they can’t afford the cost of doing figures right.
The good thing with this TCM story is that it brings evidence that these high impact factor journals sell their souls, whereas, otherwhise, you may suspect it, but not prove it.
Those charts are hilarious. At least they didn’t use a yin-yang sign on the second one settling instead upon a German automobile logo.
And Narad, I think that those “green spikey things” are supposed to represent the much-vaunted ‘natural killer cells’.
The first graphic looks like the posters and calendars biomedical research suppliers send out around the holidays, but with funny collections of random words instead of boring kinases and restriction enzymes. I like the arrow from “Heat” to “Warm Feeling”. Seemed plausible to me, so I just tried it myself with my hand and a glass of hot water (other hand as control) – the hot water hand experienced a warm feeling, validating centuries of TCM!
The second graphic, on the other hand… wow. If all of the words were removed and then replaced at random locations around the spinning, tripartite pie of terror, it is not clear that the meaning of the chart would be altered in any way.
Verdict: first chart has more predictive power.
(Briggs) “Is a contextual effect (some would call it a placebo) that relieves pain and reduces the need for medication an acceptable form of treatment?”
Most studies I’ve read show that patients using acupuncture don’t end up taking less pain meds – they end up taking the same amount as those who (smartly) forgo magic. If I – an ITS Systems Admin knows this, why the hell doesn’t Briggs?! As someone with RA – this drives me nuckin futs. I feel like we’re living in Bizzaro world.
Is a contextual effect (some would call it a placebo) that relieves pain and reduces the need for medication an acceptable form of treatment?
In cases where we know of a more effective and safe treatment, no. We tolerate placebo use in clinical trials because the effectiveness and safety of the medication being used in the trial are what we are trying to establish. I am assuming arguendo that acupuncture does produce a placebo effect in some patients–if it doesn’t even do that, then it is worse then useless, because acupuncture is not risk-free.
And I’m a physicist, not a medical researcher. Briggs should know better.
[…] NOTE: There is a follow up to this post. […]
Oh geez, I hold up AAAS’ consensus on global warming, GMO’s and vaccines as the epitome of good science based on the quality and quantity evidence.
This makes me cranky.
I’m at anger. I may never make it to bargaining.Or skip to depression.
Bargaining may actually be more useful here than it usually is. 🙂
“Of course, using herbal remedies means substituting impure extracts with high lot-to-lot variation in active ingredient(s) for purified, well-characterized pharmaceutical grade active ingredient(s).”
Nope. That means NOT using herbal medicine, but abandoning it for commercial single-molecule drugs. Whether those drugs come from a plant or not is irrelevant to the patient. In some cases, a pharma drug made from a plant is more potent and safer – e.g., digoxin. In others, a plant that has lots of active ingredients – e.g., every food plant – cannot be reduced to a pillful of one molecule without reducing its efficacy and/or safety. If it could, then taking vitamin C, which is certainly an active ingredient in many fruits (being essential to life!) and therefore by the American scientistic paradigm The active ingredient, would entirely substitute for the health benefits of eating fruits. Sadly, it does not.
The already-disproven mantra that every worthy plant would be even better as a prescription-only molecule has another little problem. Most of those imagined molecules don’t exist on the market now. It might be one thing to say to someone, “Yes, Tripterygium – a Chineeeese herb, horrors! – may be better than methotrexate for RA in clinical trials, but by spending your kids’ college fund you can get a pill with one molecule from it that is quite pure and only a bit more toxic. Do that instead.” If the pill doesn’t exist, what you say is “Ignore this and suffer for the rest of your life, if standard American allopathy is not helping you adequately, satisfied with the knowledge that maybe, if the industrial project lasts long enough, your children or grandchildren might be able to benefit from a pill made out of this icky dirty natural plant.” Does this make sense? As usual, it’s a value judgement. I’d rather eat plant foods than gulp pills for nutrition, and I’d rather consume plants than suffer needlessly. Your mileage may vary.
@ Jane — For what it’s worth, ‘dig’ is actually one of the more problematic drugs.
Skeptical Raptor — The various discipline societies and the National Academy of Sciences have a lot more credibility than the AAAS, especially after this.
Though the latest panel convened by APS to look into global warming is really unfortunate. It was composed of more-or-less OK physicists who have ascended to the rank of Professional Know-It-Alls, without any disciplinary credentials. A certain type of physicist is unfortunately subject to what might be called the Shockley Effect.
Orac wrote: “Postmodernism reigns supreme!”
To invoke the relevant meme: “You keep using that word. I do not think it means what you think it means.”
Translation: I know Orac doesn’t have a clue what the word “postmodernism” means.
Orac wrote: “Based on postmodernism, van der Greef continues…”
Schroën et al.* do not use the word “postmodernism” or any variant thereof at any point. The text immediately preceding the passage Orac cites above is an explication of the “unification” diagram, and ends with the sentence…
… a proposition that is INCONSISTENT with postmodernist thought.
The closest Schroën et al. get to something that might be labeled ‘pomo’ is:
I was unaware that Stephan Hawking was a dangerous postmodernist, and on the chance Schroën et al. may be Hawking and Mlodinov, I shall the quote at face value, observe it’s not particularly profound, and a decidedly Modern as opposed to Postmodern notion. C.f. Walter Lippmann, Public Opinion, 1922, ch. 1
Furthermore, what Schroën et al. go on to assert based on this concept does not follow at all. They claim “the modern Western scientific model” and the “different approach to understanding reality” that “arose in Eastern cultures” both “can be considered valid, each with its own model-dependent realism.”
Err, no. The idea “there is no theory-independent concept of reality” doesn’t speak to scientific validity at all, other than perhaps to suggest that validity may be harder to come by than we may imagine. It certainly doesn’t GRANT validity to anything, much less TCM. Nor would any of the serious major ‘postmodern’ thinkers ever make any such claim. They do social/cultural history and theory. They don’t make claims about scientific validity. Some of them make observations and arguments about social or cultural validity conferred on things labeled as “science:, but that’s not the same thing, is it?
Schroën et al. enough of what Orac calls a “target rich environment” on the basis of invalid medical science that there is no call for tossing of unjustifed smack at perfectly valid discourse in the humanities as an aside — especially given the fact this discourse reveals even MORE targets in the BS in question, though I doubt Orac would have much interest in shouldering those particular arms of argument.
The references to “postmodernism” on Respectful Insolance are 100% Dunning-Kruger, and I’m so sick of this sh!te I’m ready to blow virtual chunks. Anyone who presents “postmodernism” as some kind of coherent and consistent perspective — employing anything like “postmodernism says” — has no idea whatsoever what they’re talking about. “Postmodernism” is a corner within the terrain of the larger intellectual project in the humanities now labeled as “Theory”, and that corner is occupied by people who disagree vehemently with one another — when they can even agree what they’re talking about, which varies incommensurably among different cliques hanging out under the street signs. Around that corner, even “some postmodernists argue…” is unacceptably vague, unless closely followed by the proper form, “[author (x)] argues…”
As such, I hereby issue Orac this challenge:
Without resorting to Google, more-or-less correctly state ONE concept put forward by a significant ‘postmodernist’ thinker from the list below, and match it with the corresponding author.
Jean Baudrillard, Donna Haraway, David Harvey, Fredric Jameson, Charles Jencks, Jean-Francois Lyotard… heck I’ll even throw in Jacques Derrida and Michel Foucault, neither of whom is a ‘postmodernist’ but their work has been called ‘postmodern’ with some regularity, so I’ll say ‘close enough.’
……
NOTE: I have not included Deleuze and Guattari on this list because I don’t have a clue what they’re saying, and thus couldn’t verify any response. Re: Gilles and Felix: Having put “postmodernism” in the RI search field, the earliest reference I found was to Orac’s 8/15/06 critique of an essay titled “Deconstructing the evidence-based discourse in health sciences: Truth, power, and fascism” I smelled trouble with the essay from Orac’s quotation of the abstract:
My thoughts were: If these guys think they understand Deleuze and Guattari they’re probably idiots, especially since they seem to think they can employ The Anti-Oedipus in some straightforward critique of evidence-based medicine. I know enough about D&G to know that nothing about their ideas is straightforward, or can be made such without grinding them into hash. I have known a few people who do actually understand Deleuze and Guattari, but when they talk or write about D&G, I don’t understand them either. I read the essay. The authors cited several thinkers, mostly correctly, but then mashed them together in ways that don’t work, and made a bigger mess trying to apply them to something known as The Cochrane Group. (Sorry guys, but you’d need a dissertation chapter to reconcile Foucault and Arendt. You can’t just toss ’em into a Cuisinart.) Apparently this mess-ay caused quite a silly kerfuffle in skeptic-land. (sigh)
_____________
* The authors of the essay are listed as Yan Schroën, Herman A. van Wietmarschen, Mei Wang, Eduard P. van Wijk, Thomas Hankemeier, Guowang Xu, and Jan van der Greef in that order. van der Greef is identified as corresponding author.
http://tinyurl.com/mec34vg
That last article was just horrific. If I were a scientist working on cutting-edge research outside of Europe or North America, I would be offended at the idea that modern medicine is a culturally western concept. The whole characterization of modern science as “Western” (and therefore evil, unlike pure “Eastern” traditional medicine) just kind of strikes me as one of those gross “noble savage” racist tropes.
Oh, goody, histrionics.
Followed by a falsehood, compounded by the fact that standardized extracts are what’s being tested.
Top off with a pair of wholly undefended assertions…
And scurry away with a sneer. If only herbals could be standardized as well as Jane herself.
“damn the ethical objections to lying to patients.”
Well, of course! What the WHO, the AAAS and Science are trying to do is get the laymen to accept and embrace allopathic care by diluting it with woo, even though they know it’s stupid. If they can get the laymen to vaccinate by making them think it’s a homeopathic vaccine, they sure will. If they can get the laymen to obey to their doctors by making sham naturopaths who will tell the laymen to do so, they will as well. Or so it seems. My guess is that they are so some with the laymen rejecting science that they will do anything if it means lesser VPD breakouts, advanced illnesses that could have been treated earlier and other expensive stuff. I’m just speculating, anyways
How can we hope for any improvements in science literacy when we see crap like this clearly showing some very high up scientists being incredibly illiterate?
@ Diego #21
Yes, if ‘lying to patients’ will reduce the number and severity of VPD outbreaks, then by all means damn the ethical objections to lying to patients, because those objections don’t mean squat compared to the moral and ethical obligation to prevent innocent people from this.
But then ‘lying to patients’ is a straw man, as you don’t have to actually lie to employ acupuncture as pain-reduction, just not tell the entire truth. As you say, the typical patient is a lay person, who does not speak ‘Scieneish’. A doctor can say “acupuncture is a theatrical placebo” in a way that makes it sound appealing to patients, but makes no false claims.
After ‘qualifying the customer’ to separate patients who might be offended by any woo-ish reference from patients who might be receptive thereto, the physician could say “A number of our patients have reported reduced pain after undergoing acupuncture. It doesn’t seem to work for everyone, and that might be more of a psychological factor than a physical one. But you can make an appointment here at the clinic if you’d like to try for yourself.”
See. No lie. Not even a recommendation. Just sounds like one. And if a patient asked me follow-up questions that would seem to call for lies — like ‘but do you recommend it?’ — I can dance around that fire all night long and never step into the flames. Mercy, it’s not like hedging is something primary care doctors don’t already do five days a week on all other kinds of questions…
The Oxford dictionary on the word “postmodernism”:
Given that the original use of “postmodern” was in the visual arts and that its use in literary criticism is loosely drawn from it (and that critics spend as much time discussing what postmodern lit is as discussing the literature itself), I can’t see how Orac’s use of the term is any less valid than yours, Sadmar. In particular, stating that two contradictory things are equally valid seems quintessentially po-mo.
Thank the goddess postmodernism is falling out of fashion and lit crit is slowly crawling out of its own hinder.
sadmar #18
Wikipedia on Postmodernism includes :
a reference to a world-view of Postmodernism “which sees truth as socially constructed”
“Postmodernism, the school of ‘thought’ that proclaimed ‘There are no truths, only interpretations'”
Heidegger… ‘rejected the philosophical basis of the concepts of “subjectivity” and “objectivity”‘
That’s easily enough to justify Orac’s take on P-M, and that’s without really trying.
Come back Sokal!
@23 : So, we are making huge effort in the last decade (century ?) to educate people around the world and now you just want to dumb them down ? Really, it’s one of the sadest thing I ever read… Let’s consider the patient too stupid to understand science or medicine, let’s mystify more, and then let’s cry about how people are dumb and know nothing about science !
It’s not just a matter of lying or not, it’s ethical matter, medic are here to help, if they aren’t crystal clear in their method how patient can be confident in modern medicine ?
Don’t forget that alternative ‘medicine’ like acunpunture heal nothing, no vaccine preventable deadly disease, not even a cold, they are useless and not without side-effect between the hand of a bad practionner, there is no reason to recommend this. People who need placebo effect for chronic pain or depression (maybe the 2 condition were the placebo effect is the strongest and with the less effecient pharcological medicine) need human contact and attention, you don’t need treatment to get a placebo effect, even less if it’s a magical mumbo-jumbo treatment. By promotting stupid thing you keep people stupid, and you keep them vulnerable to other quackery.
sadmar has expounded his “what’s the harm” philosophy several times.
One of my problems with it is:
In Europe, healthcare is either paid for everybody from taxation (UK model) or one is compulsorily enrolled in a medical insurance (e.g. Germany). Either way it leads to everyone being forced to carry the cost of hocus-pocus treatments. I think that can only be justified for interventions which have been shown to work, or have a plausible chance of benefit. If placebo effects are defined as benefit, there are enormous problems of drawing the line. There are no natural limits to quackery, and one is as good (in its exponents’ views) as another.
@Peter Dugdale
To anyone who says, “What’s the harm?” Just give them a link to whatstheharm.net.
jane,
That’s a ridiculous argument, even by your usual standards. Food isn’t the same as medicine. We don’t eat fruit merely to prevent scurvy. If we did, and fruit contained other active chemicals that interfered with vitamin C or had adverse effects it would make sense to isolate the vitamin C and take that instead.
Do you have any examples of herbal treatments that are safer and more effective than a standardized extract?
Thunder God Vine again? Apart from the problems with your argument pointed out by Narad, as I pointed out last time you brought it up here, it has such serious adverse effects – “skin rashes, cheilosis, diarrhea, amenorrhoea, hair loss and nausea” – that the reviewers concluded, “serious adverse events associated with the herb mean that this treatment cannot be recommended”. Side effects are the problem, not the fact it is “a Chineeeese herb, horrors!” which sounds vaguely racist.
Are you seriously suggesting that people use Thunder God Vine and suffer serious adverse effects when there are safer and more effective treatments available? Why?
According to Medscape:
MS continues:
DMARDs include but are not limited to methotrexate. Methotrexate itself has some serious side effects, of course, though not so much in the lower doses used in RA as compared to cancer chemotherapy, but I see no evidence that Thunder God Vine is any safer.
I don’t understand why you wrote, “a Chineeeese herb, horrors!” and “icky dirty natural plant”. Is this some sort of weird projection? I’m very happy to drink a herbal tea, sometimes even for minor ailments, like ginger tea to settle nausea, and I find hibiscus tea* is both tasty and mildly sedating. If I had RA I would want something that was effective and had as few serious adverse side effects as possible.
It’s a risk-benefit analysis. I think you are seeing prejudice against herbal treatments where none exist. If someone came up with good evidence that a whole plant was reliably safer and more effective than its drug counterpart, I would support its use, and I’m sure others here would too.
Who wouldn’t? What does this have to do with medicine? Do you imagine that SBM proponents refuse to eat any “icky dirty” plants and live on nothing but burgers, sugar and vitamin pills?
Show me an example of a patient being faced with such a choice and I would agree with you, but you haven’t.
* Known as karkadé in Egypt, which is where I acquired the habit, and sorrel in Jamaica. It seems to have anti-hypertensive effects, though that’s not why I drink it (my blood pressure is too low as it is). I find it has a calming effect, and was warned in Egypt that it has anaphrodisiac effects in men, though I can’t say I’ve noticed.
I asked Orac to identify a concept articulated by a significant postmodern thinker. I did not ask for citations from Wikipedia. Excuse me… ARE YOU F**KING KIDDING ME! Wikipedia? Yes Peter Dugdale you have not even tried, and no you have not justified Orac’s take on pomo one iota. Citation ad populum? Yeah, that works for highly specialized fields grossly distorted in popular publications and the blogosphere.
….
wierdnoise: Well, I Googled to see if there were any handy web resources with an accurate account, found a couple encyclopedia entries, don’t remember if Oxford was one of them, but they all sucked. You’d think a major encyclopedia would do better, I admit, but you’d be wrong.
“Stating that two contradictory things are equally valid seems quintessentially po-mo.” No, it’s called the humanities, and it defines validity differently than science. In science, when two propositions contradict we generally assume that one must be invalid, and some form of empirical test can resolve the question, eventually. But before we get to “eventually” different hypotheses are equally valid for inquiry — is autism more a consequence of genetics or environmental factors? In physics, apparently contradictory general propositions can be valid at different levels, as physicists who actually understand quantum mechanics will assert that any attempt to apply quantum principles outside the sub-atomic realm is just pseudo-religious mumbo-jumbo. The humanities have always been concerned with questions that cannot be resolved empirically. ‘Valid’ does not mean ‘correct’ but ‘remains plausible even in the face of counter-argument.’ On the many points of disagreement between, say, Plato and Aristotle, which do you claim to be invalid? Are the arguments between Platonists and Aristoleans “postmodern”? Did you think before you fired off that remark?
Of course, the only person performing the radical relativism falsely attributed to pomo is you, weirdnoise, with your claim that Orac’s definition of pomo is as good as any other, and need not refer to any empirical reality — in this case the things actual postmodernists have actually written. And (duh) you can’t support Orac’s usage, which attributes some kind of coherent and consistent perspective to ‘pomo’ by asserting there isn’t any kind of coherent and consistent perspective in ‘pomo’.
So, if that was a little trick on your part, nice try, but you lose. If you thought you had a real point there, uff da!
….
Lemme splain sumthin bout ‘cha’ll’s Dunning-Kruger. In some post I can’t now find, Orac was discussing how contemporary science has reached levels of complexity that put successful research beyond the likely reach of investigators lacking field-specific expertise acquired through detailed advanced study. His argument was that, as such, science has become an area in which the pubic must ‘trust the experts’, since non-experts, even those with advanced scientific expertise in other fields, will far too often be unreliable in their findings and conclusions.
According to data compiled by the NSF, the mean time to PhD in the biological sciences is 8 years, with the mean age of completion at 30. In the humanities, the mean time to PhD is 11 years, the mean age of completion 34. And those figures are for comparable levels of financial support.
What do think we’re doing all that time? Some reading maybe? Writing some seminar papers that get grilled so mercilessly 95% of the honors STEM students I’ve ever worked with would run out of the room screaming and never come back? Actually, maybe 90% of us do run out of the room screaming, and only about 60% keep coming back long enough to get the Phud. You might consider that attrition rate works to separate some of the wheat from the chaff.
I started grad school in ’78, got my doctorate in ’92, I was 38 at the time. I had some ‘years off’ in there, except in my field there are no real ‘years off’. Even if you’re not reading, you’re still percolating and processing and re-thinking everything you’ve read before, and since I was in Media Studies, every new TV show, every movie, every news broadcast, every new edition of the newspaper was more raw data that had to be accounted for. So I’d say I had 11 full years of figuring out what I was going to say in my dis, and three getting it all written down in sensible form, work that didn’t really change or add to the content much.
I wrote a 394 page dissertation on postmodernism and popular culture, would have been well over 500 if I’d used the line-printers at the computer center instead of investing 3K in my own Laserwriter II. My chair was a well known Frankfurt School scholar, and one of my committee members was a brilliant guy who’d done his dis with Fred Jameson, so I got away with no BS whatsoever.
I got a got a couple of the dis chapters published, one with a major international journal that was later anthologized. The other appeared in an edited volume and became fairly widely assigned as required reading in courses here and there. 21 years after initial publication, the book long out of print as the press dropped the field when it changed hands, I still get small royalty checks from custom publishing revenue, which is probably the tip of the iceberg of schools putting it on electronic reserve without paying up to the publisher (and good for them!).
I’ve also had 4 other post-dis essays published in edited volumes with good presses, all of them touching on pomo at least a little bit (mainly just a little…) Of course, all of this stuff was given the thumbs up by established experts in the field who were on my external tenure review committee.
So, that’s what I’ve got.* You’ve got a couple encyclopedia entries, flagrant nonsense by Lionel Milgrom and his ilk, and rantings by ‘skeptics’ who admit they don’t understand the stuff, condemn it as meaningless and undecipherable anyway despite the empirical fact that thousands and thousands of people have deciphered it and found it meaningful, and inveigh against a relativism that isn’t there with a crude logical positivism that has long been abandoned in serious philosophy including the American analytic school. Knowing nothing of the ‘culture wars’ debates of the 1980s, they are unaware that their critiques merely recycle the propaganda foisted by political/cultural conservatives attempting to purge lefties out of the academy.
You think some pomo cabal has run the academy since the 70s, and purges never happened? That’s the intellectual version of #gamergate. The MLA has been pretty solidly in the ‘theory’ camp for awhile from what I’ve heard. I wasn’t in Lit, never went to Lit conferences, can’t confirm any details. ‘Theory’ =/= pomo, though pomo(s) are a part of Theory. But as far as the larger battle within the academy is concerned, I Was There, and I guarantee you any legitmacy now held by Theory had to fought for tooth and nail, the Old Guard gave nothing away for free, and there were many casualties among the rank and file.
Alan Sokol? I would so love to tell you all about Alan Sokol. It’s been on my to-do list since I first wandered into RI by accident several years ago after Googling, of all things, a reference to Pee Wee Herman. Sokol hoaxed Social Text, but he committed blatant intellectual fraud in Lingua Franca (or what we would have called ‘lying’ back in primary school). Short** version: Social Text was only “a leading cultural studies journal” in the sense that Andrew Bujalski is a leading mumblecore filmmaker. It was marginal, had little clout in the academy at large, and a Physics professor taking it on was punching down, the act of a bully. There were, in fact, any number of journals of equal or greater stature on which Sokol could have attempted to foist his hoax. But he chose one edited by a colleague at his own University, and if you don’t get the multiple Ethics issues involved in that, you’ll just have to wait for an even longer post. Then he presented the whole thing under the rubric of a “science experiment” in Lingua Franca, and if you don’t get what’s wrong with that, you lose your ‘Skeptic’ card.
And here’s an anecdote that explains something sciencey folks don’t get about the humanities: authorship matters, but authority is not assumed. In one of my grad seminars we came to the pomo part of the syllabus and were assigned an essay by a Big Name author doing a ‘pomo’ thing in Media Studies (no one anyone outside the field would have heard of). So we students are reading this piece, and we’re not Alan Sokol so we figure we should be able to get it, but none of us are. We’re all like, ‘Is it me or is this just silly blather that doesn’t really say anything?’ ‘I dunno, but I had the same reaction fwiw.’ So we get to the class discussion, wondering if our genius (really) professor is going to lead us to see a light at the end of the tunnel. She guides through the discussion, we break the essay down and pick it apart — and we basically come to the conclusion it’s just stupid. That’s our conclusion; the prof. hasn’t given her opinion, just hasn’t shown us an alternative. So we ask her, near the end of class, “Why did you have us read this essay?” She said, “Because you need to know how stupid it is.” Which wouldn’t have made any sense if the author was a nobody in the field.
In the humanities, you learn as much from the stupid parts as the smart parts, because they’re usually mixed together. There’s useful-stupid and there’s useless-stupid, and for the mostest part, the useless doesn’t get published. For a science journal dealing in facts, I can’t see there being a useful-stupid. But, done properly, ‘Theory’ is all critical thinking all the time. What Orac does here is not advanced science, afaik. It’s general science, about how scientific thought works. To that end, the more persuasive to the lay reader the articulation of woo, the more useful the stupid, as it gives Orac the opportunity to demonstrate what valid scientific reasoning looks like, by relief against the false arguments those of us who are not Orac could use some guidance to parse.
Which is why a cutural studies journal could be perfectly justified in publishing an essay by a Physics professor that is both stupid physics and stupid cultural studies, and why if the editors aren’t sure about the physics, they go ahead and publish it anyway.
It’s a cultural studies journal. A certain percentage of the contents are always going to be bullshit. The presumption is that the readers are smart enough to figure out which is which for themselves, on which they’ll disagree, leading to additional productive argument. That’s the dirty secret of ‘pomo’. The process of doing theory is embedded in Enlightenment philosophy about the value of contested ideas, which belie any ‘pomo’ claims to move past Enlightenment thought.
In conclusion, Orac has more than enough to do spraying glyphosate on the weeds his yard of science. When he hops over the fence into my yard of theory, it’s all really tall weeds, and he can only get lost not knowing one species from another, fall down and start sneezing uncontrollably from a host of pollens. I don’t hop over the fence into his yard of PubMed, because I don’t have any glyphosate, and I can’t read the labels to tell which spray container is which. But, I’ve been in my yard for 36 years. I know where the bumps are in the terrain and have developed immunity to the nasty plant sex.
Trust the experts, you say? Please do.
____________
* No, I’m not offering cites, since I’m not comfortable disclosing my IRL identity in open web forums. However, should any of the regular Minions want to correspond privately, shoot Orac a note, as he has all our email addresses, and I authorize him to forward inquiries to me.
** You betcha my bot knows that’s the lulz
I was going to respond to I think is was zebra on the other thread (but didn’t have time to read all of the comments) but jane sums up a lot her his/her points nicely. The problem with using herbal medicine as has been pointed out here many times is that it is an industry which is almost entirely unregulated. If you buy an herbal medicine off the shelf then you are buying some kind of plant material (maybe) in a pill form. Lab test have proven that the amount of the actual herb claimed on the bottle will vary widely between bottles or not be there at all. So you have no clue what you are taking or how much of any active ingredient you are ingesting. You would never walk into a drug store and pick up a bottle of Tylenol without knowing how much acetaminophen is in each tablet or even whether any was present at all. That is your problem with herbal medicine. When an active compound is identified in a plant, purified, and put into a form where dosage can be standardized how is that harming anyone? it is making that drug infinitely safer to take and separating out other compounds that may cause side effects.
On the topic of WHO supporting TCM as primary care, that made me bang my head on my desk. I am lost as to how we can promote stuff we know is ineffective (or downright dangerous) and justify it by saying ‘well they don’t have anything better’. Oh how that shames me that we would abandon people to quackery instead of working toward universal healthcare (with real medicine) for all.
@ Peter D. #27
Yes, universal care makes a difference. No one should be compelled to support someone else’s “hocus-pocus”. But you’ve straw-manned by argument by labeling it “what’s the harm?” My argument is relative harm. Frankly, I don’t see how I could have been more clear about the public health ethics across a broad population in the case of VPDs, vs. some imagined ethics of individual doctor-patient ethics I’ve debunked anyway than I was in #23, so I’ve got no new clues to offer hte clue-deficient on that.
Indeed. I frequently point out that there is a reason doctors don’t prescribe foxglove plant to patients needing a drug like digoxin. The drug has a pretty narrow therapeutic window (the difference between the therapeutic concentration range and the toxic range), and you have to measure its levels.
@ Kiiri
“When an active compound is identified in a plant, purified, and put into a form where dosage can be standardized how is that harming anyone?”
I believe zebra’s claim was that the ingredients in whole plants may have some synergistic curative effect, superior to the purified ‘active compound’ and that this has not been properly addressed by scientific research. Not saying that’s true as I certainly don’t know, just that was what I took the arguement to be.
“The problem with using herbal medicine is that it is an industry which is almost entirely unregulated.”
Why then not regulate that industry to address the issues you raised? That would seem to be a lower hurdle for ‘developing nations’ than implementing universal healthcare (with real medicine) for all
That’s a drastic oversimplification, a strawman take on the WHO position, as presented by Director-General Chan’s Foreward to TCM Today — A Case for Integration anyway. So, please spare your desk.. I mean your head! 🙂
Chan does NOT “promote stuff we know is ineffective or dangerous.”
That would seem to rule out many TM practices for many purposes, via imposing scientific rigor. However what constitutes “evidence-based standards” for legitimating different uses of TM not being specified by Chan, alarm bells will certainly be sounded to regular readers of this blog familiar with the kinds of deeply methodologically flawed ‘research studies’ that have been taken as ‘evidence’ of TM effectiveness for medical issue (x), by people who ought to know better, or so we would hope. The question then would become ‘who decides what constitutes appropriate scientific rigor in terms of setting regulatory standards?’
However, in opening that question, I see much for quacks to worry over in TCM Today — A Case for Integration. Especially given the focus of the “guest editors” on herbal remedies, which would seem the most congenial form of TM to submit to scientific rigor as a Minion might understand it. The WHO is tasked with making progress in health outcomes in, Burkina Faso say, on some realistic schedule. Simply, there are people dying every day all over the world from conditions herbal medicines could address. They live in countries so dirt poor there would be no tax base to support any kind of universal conventional healthcare, even if they underwent some form of socialist revolution, took all the money from the rich people and spent it on health care for the average citizen. (Viva Fidel! Venceremos!)
My question to you, then: Isn’t following upon this Ad Spiel with pressure to be true to its word and institute consensus regulatory standards for herbal medicine going to save more lives in Burkina Faso et al. than rejecting the ‘report’ in its entirety, and insisting on US-standard sbm care for every economy around the globe?
We “justify it by saying ‘well they don’t have anything better’,” because they DON’T have anything better, and unless you see a GLOBAL socialist revolution on the horizon that redistributes wealth across national boundaries, they’re not going to have anything better before uncountable preventable deaths occur. ‘They’ are not abstractions; they are living breathing human beings and they are sick RIGHT NOW!
I mentioned Burkina Faso becuase I spent a couple years working on a no-income media gig with a man who grew up there. He was born in a village like most in his country made up of grass huts. The nearest school of any kind was so far away he had to board there, an elementary school child, sleeping among total strangers on a dirt floor with a bit of grass for bedding. His parents wanted him to get an education so they forced him to go. He couldn’t take being away from his family for an extended period of time, so he ran away and returned home. He was so traumatized, his parents did not have the heart to send him back. The only medicine available in his village was a shaman. Sometime after he returned to the village an older cousin was experiencing prolonged ‘ED’ and my friend participated in an exorcism ritual to restore his cousin’s fertility. I believe various medicinal herbs and the blood of a specific type of rooster were involved, along with plant-based halucinogens. The cousin apparently went on to get married and have children, so post cock propter hoc.
I would ask you to ask him about the WHO programs, but after a ‘miraculous’ series of accidents that brought him to the US, he became a devout evangelical Christian, so I’m not sure how he’d actually respond. He married, has three kids now I think, and works for a large catering company as a day job, so I would guess he’d had good heath coverage through his employer pre-ACA. The rest of his birth family still lives in Burkina Faso, in the same village, which is still only grass huts.
sadmar,
I’m not convinced. Which conditions and which herbal medicines are effective for treating them? I’m not aware of any herbal treatment that can cure the sorts of life-threatening illnesses that afflict people in the developing world. Please correct me if I’m wrong. Maybe artemisia could help with malaria, but if you are going to the trouble of importing the herbal remedy (which doesn’t grow in Africa as far as I know), why not import a pharmaceutical drug?
Citation needed.
Oh, and examples of specific deadly diseases and conditions that herbal medicines could address so well as to save significant numbers of lives, too.
Quite frankly, I call bullshit on this claim.
@34 : ‘Quark contends patients suffering from chronic pain would benefit as much or more from “human contact and attention” as placebo. That is a dubious assertion in that “human contact and attention” may indeed BE placebo, and if not, no pathway to pain reduction is specified. ”
What is acupuncture, homeopathy, or whatever you want of the same kind if not human contact and attention ? Well ? Specific effect ? Wait…. Remember me what is placebo ? I never said that human contact would be better than placebo, just as good, because… It’s a placebo but an ethical placebo and intellectualy good. Study are suggesting that placebo is related to dopaminergic pathway, so it could explain why this effect is strong in parkinson disease and depression. Some human contact indeed can activate this pathway. Obviously if you ‘don’t need an asshole to help you’ it’s like ‘I don’t believe the homeopathy or acupunture bullshit’ so it won’t work. But maybe if you found the good asshole… Social interaction and activity with people you like is a powerful tool to feel better, ask depressive patient. In the same way, interacting with people you don’t like is a good nocebo too.
‘When you come up with science that demonstrates that is superior to placebo in perceived pain reduction AND convince insurance plans to pay for it, then certainly we could wave placebo goodbye.’
How it could be SUPERIOR to placebo… ? Are you sure that you are undestanding well what is placebo effect ?
By the way you are still missing the main point : Manipulation like acupuncture are not without side effect, and are perfectely unethical. My point is that you don’t need mumbo jumbo to affect the placebo effect. About assurance, people already pay for something that is aren’t covered (in my country, France) like acupunturce so I don’t see the problem with a simimal placebo treatement that is not based on deceiving.
It seems that Science has done even worse towards science:
http://ameyer.me/science/2015/01/02/vogel.html
Not really.
http://www.sciencebasedmedicine.org/is-cancer-due-mostly-to-bad-luck/
You should read comments, not only post.
This, however, hasn’t been demonstrated—has it?
Zhang et al (PMID:24733191) found that Tripterygium monotherapy was not inferior to, and in combination with methotrexate performed better than methotrexate alone in controlling disease activity in patients with active RA”, over a treatment period of 24 weeks which isn’t sufficient to allow the conclusion that Triptergium monotherapy is as good or better methotrexate.
As Donald Marcus points out (PMID:24938284)
Known adverse effects of the herb include menstrual irregularities and impaired renal function.
@sadmar:
I’m trying to understand: is your argument that there is no definition of postmodernism, or that it takes years of study to be able to even understand what the definition is?
I did read the comments.
To my eyes, postmodernism is an impenetrable mess of elaborate verbiage that is ultimately meaningless. The standard answer to any critic who is not in the “Club” is: “You don’t get it! I studied it for years and I have (my degree here)!” Unlike any other academic field, there is no attempt to help us ignorant slobs who “don’t get it”.
I say it’s bullshit and I say the hell with it.
Hello, people, you are taking my pseudonym in vain.
This means you Kiri and Sadmar. That was not my topic.
But I have a medical question based on krebiozen’s information from part 1. Are doctors now trained to ask, for example, whether an asthma patient has used acupuncture? This would seem prudent, and generalizing, are they trained to identify symptoms that might have been caused by these herbal compounds and other treatments?
Standard procedure in an encounter with a patient is to ask about all previous or current treatment he or she has experienced. This includes supplements, herbals, alt-med treatments etc. We don’t necessarily know all the symptoms attributable to all of these entities but we can always look them up.
TBruce,
So, with reference to our previous conversation, there must be faculty at the schools teaching these things, and people writing books and manuals where you can do that looking up.
Krebiozen is concerned that once TCM is ‘integrated’, there will be the danger of acupuncture being used on asthmatics, with disastrous consequences. Here’s my problem:
Tenure. And the permanence of books.
You said earlier that ‘newly minted MD’s just follow what authority figures tell them’. Now, I don’t want to go back to my ninja assassin metaphor, but, how exactly are we going to get rid of all the people who know that acupuncture is dangerous in that application, and all the references in the books?
Will there be faculty meetings where it is politely pointed out that “we don’t want to offend the sensibilities of our new Colleagues From The Orient, so certain things are Not To Be Mentioned?”
Perhaps a list of errata glued into paper books, saying “That acupuncture and asthma thing on p147? Well, never mind.”
Do you see where you are not very convincing about the great danger here, and the ranting looks more like a way to avoid dealing with far more consequential underlying problems? Which, if they were addressed globally, would take care of issues with TCM and other less formally constrained practices?
@zebra:
Good lord, you are overcomplicating this issue. Here’s the deal:
Med students are not “automatons”. What they are is overloaded.
Adding bullshite to the curriculum is a ludicrous waste of time.
We don’t need to know the minutiae of every conceivable alt-med treatment. We don’t need to be presented with unproven treatments as if they are on the same level as science-based medicine. We do need to know how to evaluate a scientific study and the value of skepticism and critical thinking.
Medical training is undergoing significant changes, at least where I live. I am glad that my Alma Mater is mostly resisting this alt-med faddism.
And still, you don’t seem to get that you can, in fact, work on more than one problem at the same time. It’s true. Isn’t that amazing?
What this sounds like is a beleif by the authors of this that it’s impossible to provide real modern healthcare to the poorer parts of the world, so let’s just redefine “modern healthcare” to include the local witch or shaman (in the name of inclusivity, of course) and pat ourselves on the back for a job well done. Universal access to medicine solved.
Ding ding ding ding ding! Give that man a stuffed animal!
That’s exactly right. The WHO seems to be advocating exactly the same thing as Chairman Mao did with his “barefoot doctors” program. Because he knew he couldn’t provide adequate science-based health care for all his people, gave them traditional Chinese medicine instead, unless, of course, you were a Party member, in which case you got real medicine.
jts:
“Is your argument that there is no definition of postmodernism?
As a matter of verifiable empirical fact, ‘postmodernism’ cannot be given any global defintion that articulates some consistent coherent position, attitude, set of principles etc. There are, rather, many different ‘postmodernisms’ which could be defined, so there are actually lots of valid definitions of ‘postmodernism’ that describe what different thinkers or groups of thinkers actually think. They’re all just local (in terms of some intellectual map).
There’s an available joke that this fragmentation of meaning, and the resulting lack of any fixable general meaning is itself ‘postmodern’. But it’s an absurdist joke, as the very premise is that the meanings of the term are so diverse, that observation might be true for some of them, but would not be true for others. And there’s nothing new or deep about the proliferation of different uses for any given term. A lot of the differences between incommensurable postmodernisms go back to the fact that there’s never been any consensus on what ‘modernism’ means. There’s no central authority creating taxonomies of these things, and insuring different species are given different names. It’s like a teacher looking over a new class list and seeing over 50% of the boys have been named “Justin” because all their parents were into N’Sync.
The biggest problem with the widely-circulated definition Orac has referenced is it doesn’t apply to any of the major pomos at all. Of course, even if you work within some intellectual project that falls under a rubric that can be given a more or less coherent and accurate definition, nothing prevents ideologues from castigating your peeps with utterly nonsensical and fallacious characterizations, either to counter you influence or use you as a scapegoat for some other agenda.
Ask an evangelical Christian to describe “climate scientists” or ask a warrior mom to describe the CDC or ‘Big Pharma’. Those are more-or-less analogous to the take on ‘pomo’ deployed by skeptics.
“Is your argument that it takes years of study to be able to even understand what the definition is?”
No (obviously, per above). Compared to other schools of thought, most pomos aren’t that difficult, actually. There’s enough of them that would indeed take a very long time to understand all of them, but no one wants to. You pay attention to the ones that deal with things you’re interested in, and the hurdles in most of the local versions aren’t that high.
My argument related to the stupidity of asserting a Wikipedia entry somehow serves as a rebuttal to someone who’s made this stuff their life’s work.
And in the Arrogance of Ignorance department, take the comment from TBruce (please!).
“To my eyes, postmodernism is an impenetrable mess of elaborate verbiage that is ultimately meaningless.”
Well, that settles it then. TBruce Has Spoken. TBruce: would you care to provide cites to any examples of an impenetrable mess of ultimately meaningless elaborate verbiage, you have actually attempted to read?
“The standard answer to any critic who is not in the “Club” is: “You don’t get it! I studied it for years and I have (my degree here)!”
Um, that would be Orac’s answer to critics of vaccine science, to Stephanie Seneff, et al. My answer to the critics here is, “You didn’t even read it,”
“Unlike any other academic field, there is no attempt to help us ignorant slobs who “don’t get it”.
Actually, if ‘ignorant slobs’ actually looked for help they would quite a bit of it. Nobody gets this stuff right away, even the people trying hard. There are all kinds of primers and notes and secondary sources out there. Of course, some are good, some suck, and a noob is likely to get lost w/o a knowledgeable guide. Especially just Googling stuff on the web. But you can get some ideas from reviews and ratings on Amazon for instance, or doing enough research to figure out which secondary sources are most regularly used in schools. This isn’t bad: http://tinyurl.com/luvunxv
The biggest thing the stereotype of pomo gets wrong is the assumption of advocacy. The major thinkers here — Baudrillard, Harvey, Jameson, Lyotard… even Foucault — are trying to think through things they see as historical changes in the real world. “The Postmodern Condition” is to them, an actual thing they are trying to describe/explain/analyze/interpret. That doesn’t mean they like what they see. The Big Guns are big in part because they got there first with useful frameworks for analysis and discussion, and, while perhaps leaning one way or another in valuation, were equivocal enough on that that other folks could take up their ideas for theses that were more laudatory or dubious about cultural changes under consideration.
As an example of a very accessible critique of pomo culture (which would be included in ‘postmodernism’ since it presumes pomo culture is A Thing) see the essay “The Bottom Line on Planet One” by Dick Hebdige in Hiding in the Light (couldn’t find full text online).
And if any of the following works of fiction ‘spoke’ to you, you might be a closet postmodernist:
Adaptation
Barry Gordy Junior’s The Last Dragon
Blade Runner
Crank II
Dark City
The Fifth Element
Gamer
King of Comedy
The Last Action Hero
Natural Born Killers
Neuromancer
Nightcrawler (current, excellent)
Repo Man
Run Lola Run
Snow Crash
To Die For
Total Recall
Videodrome
Wayne’s World II
Quark at #37 wirtes:
“What is acupuncture, homeopathy, or whatever you want of the same kind if not human contact and attention ? ”
Here’s a key point which I think is not enough appreciated in these parts.
Isolate a chiimpanzee and see what happens. (Or don’t, as there’s no further need to torture the animal).
Can someone translate the piece by Dr Emanuel in the NYT today?
It’s almost as if he is implying that that mainstay of SBM, the annual physical, is nothing more than a hocus-pocus, woo-woo, Shamanistic ritual.
It’s as useful as getting your chi checked out once a year, basically?
But that’s just my layperson’s interpretation.
@zebra:
I entirely agree with this article. You will notice that the annual physical has been discouraged in Canada (where I live) since 1979. It’s hardly a “mainstay” of SBM. It is, essentially, a ritual.
In my opinion, its main value would be an opportunity to review what the patient is doing to look after his or her health (including asking about alt-med measures), and to
encourage science-based preventive measures (vaccines, tobacco and alcohol use, activity, diet etc). Of course, that doesn’t require a “complete physical” exam.
I’d written: “Simply, there are people dying every day all over the world from conditions herbal medicines could address.”
Orac asked for cites and called “bullshit”. Kreb replied: “I’m not convinced. Which conditions and which herbal medicines are effective for treating them?”
Fair enough. I don’t have cites. I shouldn’t have written that. I retract it. Fwiw, I was not intending to BS, I hadn’t slept in 48 hours, so I stated the point poorly. But (per semiotics) intent isn’t the issue, so BS is as BS reads. Mea culpa.
Kreb continued:
I don’t know beans about the WHO’s actual strategy for dealing with health issues in poor countries, or what role herbal remedies of any sort may play in that big picture. Maybe they want to grow artemisia in Africa? Maybe importing plant forms of legit medicines is cheaper than acquiring manufactured pharmaceutical drugs with the same active ingredients. Maybe herbals are only a minor part of the program, but still significant enough. IDK.
FWIW, not knowing what people are actually dying from in Africa, I was thinking that with a significant number of people having no access to any sort of health care beyond shamanic incantations and rooster blood, they may be felled by heath problems that seem absurdly triivial and non-fatal to us, some of which could be addressed with planty things we don’t even think of as medicine. I don’t think of an orange as medicine, but 2 million sailors died of scurvy between 1400-1800. Scurvy’s not a big problem in Sub-Saharan Africa, but anything relating to malnutrition is still killing kids there. I did just look up the leading causes of death in Africa: Diarrhea is in fourth place
Will this work for a revised argument?:
Simply, there are people dying every day all over the world from simple conditions the ‘First World’ eradicated centuries ago, If some kinds of herbal remedies might be the most practical means of addressing any of those in terms of cost and availablity in any local setting, I can see why the WHO would want to go that way.
As for Mao, I took from Orac’s earlier posts that the original policy made sense if only in that restoring and maintaining some sort of social order amidst post-war chaos had health benefits, and even TM practitioners might have skills in dealing with minor injuries that could major — e.g. know how to dress a wound or something. I can’t imagine acupuncturists trying to fix broken bones by sticking needles into meridians, but they might have learned how to set fractures somewhere down the line. ??
The problem seems to have been that Mao originally knew that was a stop-gap, but then the follow-through to move toward conventional medicine got waylaid by other concerns, Mao started going around the bend psychologically, and whole new mythology of TCM emerged because the leaders were too busy doing crazy sh!t like the Cultural Revolution to stop it.
So I’d guess Rokujolady’s comment might best be rephrased:
“What this sounds like is the authors know it’s impossible to provide real modern healthcare to the poorer parts of the world, so let’s redefine “healthcare” to include whatever material benefit we might be able to get from ‘traditional healers’ for now, until we can find the money and political will to do something better.”
I see no move to endorse rooster-blood exorcisms, no back-patting, no claim to solutions.
Kreb and Orac: If you know of a pragmatic policy initiative that would deliver adequate science-based health care for ‘all the people’, something that has a reasonable chance of being funded and implemented and actual working in the political, social and cultural realities of poor countries, do tell and I’ll sign up.
To the principle of ‘Trust the Experts’, we might consider the WHO knows a lot more than we do about the cultural dynamics of the local communities they work in, and understands that the trust the afflicted have in their practitioners is a key part of the health outcome equation. Even the most skeptical take on Dr Chan’s Foreward to the TCM ad in Science should recognize it presents a call for moving TM towards the principles of valid medical practice. Among other things, the version of TCM it references appears to focus exclusively on herbal remedies and absolutely minimize acupuncture if not exclude it altogether.
A given community might be far more willing to accept valid medical practice if presented by a trusted TM practitioner as new and better magic than under the rubric of ‘science’. And before anyone has a hissy-fit about the ethics of lying to patients look at this photo from 2001. It’s a row of fresh graves, each about 4 feet in length, dug to accommodate one day’s burials in a children’s graveyard on the outskirts of Nairobi, located in an area Wikipedia identifies as an “affluent suburb”. Then tell me what little white lie you would not tell, if a little white lie could mean digging one less hole.
The Kipling essay – East is East etc – starts out with a pile of guff. A jumble of dislocated words and phrases: reductionistic, phenomenological, holistic, duality, model-dependent realism, theory-independent, systems-based, dynamic correlation network, nodal network, dynamic organisation, Taoist Inner Landscape, archetypal, Vitruvian Man, Taiji, evidence-based, spiritual, eternal universe, fractal, amalgamation, hierarchical, bottom-up, fragmented, top-down, web of life, nexus, unification, integration.
Eventually the authors get to the point. They have some evidence to show that the traditional Chinese diagnostic method correlates with a number of biomarkers. They suggest that this might be useful in directing biomedical research towards more personalised healthcare.
This will be interesting if it ever transpires. On the strength of this essay, it is presently only a conjecture.
Towards the end they talk about integrating Western and Chinese medicine, which would be absurd, on the strength of the evidence they provide, except, as they quite properly say, in the realm of diagnostic medicine. In that realm the two systems may have met, but, to coin a phrase, more research is needed to strengthen and confirm the proposal.
The essay in no way provides any evidence for the use of TCM treatments. Nor does it promote their use.
The authors did themselves no favours by making readers plough through a load of old hogwash before getting to the point.
If one is receiving any sort of specialty care, I’d imagine that a PCP visit at least twice a year is warranted. It’s not as though a routine physical examination takes all that long.
Hell, if one’s primary care is based in a teaching hospital, it’s worth checking in annually just to make sure you know who your PCP is.
Can we (science-based medicine supporters) trust the WHO to behave responsibly on the question of the relationship between traditional and scientific medicine? Not on the basis of recent history.
“In many published placebo-controlled trials, sham acupuncture was carried out by needling at incorrect, theoretically irrelevant sites. Such a control really only offers information about the most effective sites of needling, not about the specific effects of acupuncture. Positive results from such trials, which revealed that genuine acupuncture is superior to sham acupuncture with statistical significance, provide evidence showing the effectiveness of acupuncture treatment. On the other hand, negative results from such trials, in which both the genuine and sham acupuncture showed considerable therapeutic effects with no significant difference between them, can hardly be taken as evidence negating the effectiveness of acupuncture. In the latter case, especially in treatment of pain, most authors could only draw the conclusion that additional control studies were needed. Therefore, these reports are generally not included in this review.”
Is it possible that this statement could emanate from a report commissioned and published by the WHO? Yes, it is posssible. The document is called A
Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. The author was Xiaorui Zhang. It was published in 2003.
It is possibly the most shameful document ever to have emerged from the WHO. (I sincerely hope that there is not a more shameful one.) On the basis of it acupuncturists have been claiming ever since that the WHO recommends acupuncture for over 40 complaints including acute dysentery! This sickness is, of course, a very serious problem in the developing world, for which the only essential treatment is hydration.
The truth is that the WHO does not recommend treatments but leaves that responsibility to national medical authorities and governments – as Zhang’s document itself stated.
The WHO had handed the job of examining the evidence base for acupuncture to a TCM practitioner so biased, that Mike Cummings, Director of the British Medical Acupuncture Society, said he wouldn’t touch the report with a barge pole. Or words to that effect. WHO then tasked the very same person with doing the same for homeopathy. Word leaked out shortly before Zhang was about to publish, that his report was going to be a ringing endorsement of homeopathy. The scientific community scrambled to prevent a second debacle and managed to get the WHO to pull the report. Much to the chagrin of the homeopathic community who must have been rubbing their hands in gleeful anticipation.
Now I will say that Margaret Chan seems to be a far more responsible a person than Zhang but I do not believe it is right for the WHO to promote a world wide policy of integrating traditional and science based medicine. That is way too far for my liking. Way too bossy. Too interfering.
As regards the iNeedle.
An article which begins by referencing a document too soiled to be used as toilet paper “Acupuncture: review and analysis of reports on controlled clinical trials” is down the dunk from the get-go.
“There are numerous challenges to achieving a consensus over the use of acupuncture in a medical environment, including: filling the gap in knowledge about the underlying molecular mechanisms of acupuncture…”
No: the fundamental gap that needs filling is the lack of Gold Standard evidence that acupuncture has any mechanism to speak of.
“…and (re)interpreting traditional categories (such as acupoints, meridians, and qi) and therapeutic indications within an evidencebased medicine framework.”
No: acupuncture has been thoroughly researched and shows no Gold Standard evidence of acting in any other way than as a placebo. Reinterpreting acupoints etc is not difficult – it’s completely pointless.
“Important questions aimed at increasing…”
No. Evidence for the effectiveness of acupuncture for pain relief is minimalistic. There is no need for any more research. Only those who are willfully blind to the absence of Gold Sandard evidence that acupuncture functions as something more than a placebo, despite an immense amount of research having been completed, could possibly argue that any more research into the effectiveness of acupuncture for pain is required.
The jury is not out. The verdict is guilty as charged: Acupuncture is a placebo.
[…] Science and the AAAS (not to mention the WHO) sell their souls to promote pseudoscience in medicine,… The genetic load problem Biochemist questions peer review at UK funding agency: Data show scores given to grant applications by external reviewers don’t correlate with what actually gets funded. Surprise! With $60 Million Genentech Deal, 23andMe Has A Business Plan Is being scooped the flip-side of a pre-print !?! It was for us. […]
There’s of course a lot more money to make in ‘medicine’ that has no true mechanisms of cure, than there is in medicine which is science based. Basically anything non-toxic at prescribed doses will do, which means costs of ingredients can be very low and R&D is mostly unnecessary.
Doesn’t the free market work like a charm?
Leigh Jackson,
That’s depressing.
Next we will be reinterpreting the four humors of medieval European medicine within a evidence-based medicine framework, demonic possession in terms of neurotransmitter imbalances and the use of exorcism in terms of cognitive behavioral therapy.
“which takes a systems approach to understanding the individual’s body as a whole, as opposed to relying on discrete components such as gene mutations”
Ahh! So if I use fundamental theories, diagnostic methods, and therapeutics based on a holistic and dynamic network-based approach I can alter my delta F508 CF mutation to re-integrate a GAA codon back into my DNA. EURIKA!! I’M CURED.
Kreb 🙂
The thing is, acupuncture is so popular as it is.
If there really were a biochemical mechanism concealed behind the cosmic qi , the magic meridians etc, all the spiritual mystique would be removed. I wonder how the punters would feel about such a violent rebranding?
Out goes holistics, in comes reductionism! The Qi reduced to mere molecules! Ouch!
Another thing; if it were really true that there was a molecular mechanism involved, one would inevitably see instances of serious adverse effects. Or else the mechanism would be a truly wondrous one such that negative effects cannot happen. Too good to be true?
Then it’s a placebo.
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