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When traditional medicine doesn’t help, does integrative medicine provide answers?

Sometimes, I think advocates of “integrative” medicine are trolling me. Of course, unlike antivaccine advocates, I realize it (usually) isn’t about me at all and they’re just writing what they believe and have (usually in the vast majority of cases) never encountered me and (usually in the vast majority of cases) aren’t considering me at all. Even so, it’s hard, when coming across an article like The Power of Integrative Medicine When All Else Fails by Emma M. Seppälä over on Psychology Today, not to think that I’m being trolled, so blatant are the alternative medicine propaganda and apologia. As if the title weren’t bad enough, check out the tag line:

When traditional medicine doesn’t help, integrative medicine provides answers.

Regular readers and commenters of this very blog can probably predict Orac’s reaction to this.

It begins, as do so many of these sorts of articles, with an anecdote, a human interest story. In this case, it’s a woman named Stacy Brindise, who, for whatever reason, was having problems with infertility. She and her husband Mike had been trying to conceive for several years and failing. They had what is called “unexplained infertility,” which usually means the man has adequate sperm count and quality, while the woman is ovulating normally. In other words, there doesn’t appear to be a medical explanation, either on the male or female side, for the infertility. Like many couples in this predicament, the Brindises underwent a steady escalation, from hormone treatments for Stacy, to monthly intrauterine insemination, which both failed.

The next step was to be in vitro fertilization (IVF), which starts at $12,000 a round and is usually not covered by medical insurance. This story was the hook, and we’re left with this:

Nothing had worked and it was time, Stacy decided, to change her approach.

“When people have a medical problem, everybody seems to jump right to drugs as the solution,” she says. “I wanted to see if improving my overall health and well-being would increase our chances of getting pregnant naturally.”

I say the story of the Brindises is the hook because the first part of it is told at the beginning, and they are not revisited until the very end of the article. Spoiler alert: We don’t learn about what happened to the Brindises until the end, but these sorts of stories (particularly if they involve infertility) are so utterly predictable that it isn’t really a spoiler at all to reveal right now that Stacy ultimately got pregnant and credits acupuncture. More on that later. First, let’s get to the propaganda between the beginning and end of the Brindises’ story:

Stacy is not alone in her gut feeling that first addressing her overall health and well-being—before investing in more invasive solutions—might be a key element in her health care. High-tech, high-cost approaches clearly have their place, and modern medicine can boast many silver-bullet solutions, but millions of Americans feel that’s not enough. They spend more than $30 billion a year out of their own pockets for alternative treatments, according to data compiled by the National Center for Complementary and Alternative Medicine. Funding for NCCAM—the U.S. government’s “lead agency for scientific research on complementary and alternative medicine”—hit $128 million in 2012, a 156% increase since its inception in 1999.

Even though this article is dated June 30, 2015, one wonders when Dr. Seppälä wrote it. As you all know, it’s no longer called NCCAM—and hasn’t been for more than six months. In December, NCCAM was reborn as the National Center for Complementary and Integrative Health (NCCIH, an acronym that doesn’t flow off the tongue as nice and easy as NCCAM did). Dr. Seppälä needs to get hip with the times. It’s no longer “complementary and alternative medicine” (CAM, another acronym that slides easily off the tongue), but “integrative medicine,” because the nasty word “alternative” has to be banished if the practice of “integrating” quackery into real medicine is to proceed apace. Of course, it remains depressing that the NCCIH budget remains in the $120-130 million range. I suppose the only good thing about the currently stagnant NIH budget is that the NCCIH budget has remained stagnant as well; on the other hand, that’s roughly $125 million that doesn’t go to real research.

In any case, now seems as good a time as any to repeat my rather clear position that NCCIH should be dissolved and its component parts absorbed back into various appropriate NIH centers and institutes. Upon its founding, the reason for its existence was to study alternative or (“unconventional”) medicine, the intent of its primary sponsor, Senator Tom Harkin, being that it “validate” such practices. We’re not just talking about unproven practices that might have some plausibility, such as supplements (which could contain pharmacologically active ingredients) or yoga (which is really just a form of exercise that has been co-opted as somehow “alternative” because it’s, you know, Asian in origin). Indeed, Sen. Harkin became most displeased with NCCAM in 2009, saying that it had “fallen short” because it had failed, as he put it, to validate any alternative medicine. Of course, it never occurred to him that perhaps the reason for this is because there was nothing there to be “validated.” Be that as it may, given that the director of NCCIH, Dr. Josephine Briggs, has promised not to emphasize the sorts of studies that were so widely derided before (such as studies of homeopathy, distant healing, and the like) and, as I like to characterize her view expressed in the 2011-2105 NCCAM strategic plan, do some real science for a change, there really is no reason for NCCIH to exist any more. Its real reason for existence was to provide scientific cover for the more outrageous forms of alternative medicine, and it has failed at that.

Not that that stops Dr. Seppälä from writing:

In 2010, 600 health care professionals assembled in Washington, D.C., for a summit on integrative medicine. It was sponsored by the Institute of Medicine, which defines integrative medicine as “health care that addresses together the mental, emotional, and physical aspects of the healing process for improving the breadth and depth of patient-centered care and promoting the nation’s health.”

The doctors who champion integrative approaches are not simply proposing “alternatives.” They advocate an updated model of health care that integrates mind and body, promotes more interaction and communication in the doctor-patient relationship, puts the patient at the center, and encourages self-care.

First off, the only thing this conference is an indication of is just how entrenched and successful advocates of “integrating” quackery into science-based medicine have been. Second, and more importantly, this is nothing more than the same old trope that you somehow have to embrace quackery in order to “put the patient at the center,” “promote more interaction and communication in the doctor-patient relationship,” and “encourage self-care.” Basically, it’s a false dichotomy that says, in order to become a more “holistic” physician and achieve these three things, you have to embrace woo, including, apparently, mind-body dualism, a concept implied by the frequent use of the term “mind-body” in various “integrative” methods. There’s nothing “updated” about this model of health care, because a good primary care doctor practicing science-based medicine should be a wholistic doctor who does all these things. There is no need to embrace unproven supplements or treatments based on mysticism and prescientific beliefs about medicine, such as acupuncture (or virtually anything other than scientifically validated natural products) from traditional Chinese medicine or “energy medicine,” such as reiki or healing touch, to achieve this. Nor is it necessary to “rebrand” perfectly science-based modalities such as diet and exercise (which is all yoga and Tai Chi, for example, are, forms of exercise) as somehow being “alternative” or “integrative” to achieve this.

Before we get back to the Brindises, though, Dr. Seppälä relates two more anecdotes. The first is a woman named Florence Strang, who is a breast cancer survivor. The treatment of her breast cancer required, as many breast cancers often do, chemotherapy and radiation and credits “mindfulness” with getting through it. Here’s the thing. There’s really nothing particularly “alternative” (back when it was CAM) or “integrative” (now that it’s part of “integrative medicine”) about mindfulness, which is in psychology an approach to reduce cognitive vulnerability to stress and emotional distress. If mindfulness turns out to be a useful psychological strategy to reduce distress, it will be validated by science. Again, it is a false dichotomy to consider it “alternative.” To paraphrase Tim Minchin, there is no such thing as alternative medicine. What do you call alternative medicine that’s been proven to work by science? Medicine! And “alternative” medicine that’s been validated by science will be naturally integrated into medicine, no need for a separate label.

Also, no need for woo-speak:

Strang’s way of coping with her cancer reflects the approach that integrative health care doctors take, according to Dr. Margaret Chesney, director of the Osher Center for Integrative Medicine at the University of California-San Francisco. Chesney emphasizes that the best way to enhance health and heal illness is often a combination of conventional medicine and healing methods that “address the person as a whole, that see where they are in their lives from the point of view of mind, body, spirit, and community.” For a patient at the Osher Center who wants to prevent heart disease, for example, the treatment plan might include an appointment with a cardiologist for appropriate testing but also a stress-management program such as yoga, meditation, or massage.

Once again, you do not need to embrace woo in order to “treat the whole patient.” Wait, you say. Yoga, meditation, and massage are not necessarily woo. I would (mostly agree). Yoga is just a form of exercise, at least when it’s stripped of its mystical practices. Massage is just something that feels good; calling it therapy medicalizes something that doesn’t really need to be medicalized. That’s a complaint that I have about much of “integrative” health practices. Modalities that once were just viewed as supportive services, things to help patients pass the time in the hospital or to take their minds off of things, either in or out of the hospital, have now become “treatments” or “therapy”; i.e., unnecessarily medicalized. I also note that the Osher Center at UCSF offers a lot more than just yoga, meditation, and massage. It offers acupuncture, traditional Chinese Medicine, and Ayurveda, among other unscientific therapies. Funny how supporters of integrative medicine tend not to mention these other things when promoting their centers.

The other anecdote is that of a veteran named Richard Low, who suffered severe post-traumatic stress disorder (PTSD) after 16 months in Iraq as an officer in the 4th Battalion of the 23rd Infantry Regiment. He learned to practice yoga, and apparently it helped him deal with his PTSD. So far, not so bad. Unfortunately, right after that Dr. Seppälä touts pure nonsense:

Shad Meshad, founder of the National Veterans Foundation, was instrumental in bringing attention to post-traumatic stress disorder before it was a clinically acknowledged diagnosis. He is internationally renowned for his work with trauma and was asked by the U.S. government to train critical-incident and trauma teams after the 9/11 attacks. Meshad uses a technique called TFT, in which a practitioner asks the patient to recall a traumatic event, then helps them tap different parts of the body known as meridian points (mostly on the face) in order to release the trauma. This practice is often coupled with breathing practices.

What is TFT, I wondered? Actually, I knew. Odd that Dr. Seppälä didn’t call the treatment what its abbreviation stands for: Thought Field Therapy. TFT is, actually, a form of “energy medicine” based on the traditional Chinese medicine concept of qi. It’s even spawned an offshoot, EFT, or emotional freedom techiques. Basically, Meshad left out a very big part of what TFT really is:

The theory behind TFT is that negative emotions cause energy blockage and if the energy is unblocked then the fears will disappear. Tapping acupressure points is thought to be the means of unblocking the energy. Allegedly, it only takes five to six minutes to elicit a cure. Dr. Callahan claims an 85% success rate. He even does cures over the phone using “Voice Technology” on infants and animals; by analyzing the voice he claims he can determine what points on the body the patient should tap for treatment.

Brandon A. Gaudiano and James D. Herbert wrote an excellent overview of TFT in Skeptical Inquirer 15 years ago:

Despite extraordinary claims to the contrary, TFT is not supported by scientific evidence. The theoretical basis of TFT is grounded in unsupported and discredited concepts including the Chinese philosophy of chi and Applied Kinesiology. Many of the practices of TFT proponents are much more consistent with pseudoscience than science. Controlled studies evaluating the efficacy of TFT will be required for the treatment to be taken seriously by the scientific community.

Nothing has changed regarding the evidence for TFT in 15 years. It’s quackery.

What article like this would be complete without an appeal to “empowering the patient? Yes, it’s there:

The power of integrative medicine doesn’t just lie in techniques. According to Dr. David Spiegel, director of the Center on Stress and Health at Stanford University, part of what’s powerful about any integrative approach is that it helps patients feel more involved, more in control and responsible for their own health care. It also allows for more time with a medical practitioner. “The average doctor,” says Spiegel, “spends seven minutes per patient and the average integrative practitioner spends 30 minutes.”

My common response to this is simple. You don’t have to embrace pseudoscience and quackery like TFT in order to “empower” the patient and make him feel “more involved, more in control and responsible for their own health care.” It’s the false dichotomy at the heart of “integrative medicine.” (More on that tomorrow, when I will discuss another annoying article of this ilk.)

After this detour through steadily increasing levels of quackery, from non-quackery (yoga) to pure quackery (TFT), Seppälä finally makes it back to the Brindises:

It was a friend of Stacy’s who helped the Brindises solve their unexplained infertility. She was a nurse in an obstetrician’s office and she told Stacy that she had met many women who had used acupuncture successfully when they were trying to get pregnant. Despite some misgivings about the little she knew about acupuncture—namely, that it involved a lot of tiny needles—Stacy booked an appointment at the Acupuncture and Chinese Medical Center in Edina, Minnesota.

“My first surprise was that the doctor spent a good hour and a half with me,” Stacy says. “She asked me detailed questions about my eating habits, stress levels, and lifestyle. She took the time to get to know all of my habits so I could make choices that were more conducive to pregnancy. Her assessing my overall well-being made me feel really comfortable and taken care of.”

The acupuncturist advised once-a-week acupuncture sessions and dietary adjustments. Five weeks later, Stacy got her second surprise: She was pregnant. Stacy and Mike welcomed a healthy baby boy into the world in November.

There is no good evidence that acupuncture has anything to do with helping infertile couples conceive or, as it’s often touted to do, improving success rates for IVF or help polycystic ovary syndrome, a common cause of female infertility. Indeed, as happy as one might be for the Brindises having managed to have a child after trying for so long, there is no good evidence that acupuncture improves fertility. (Why should it? There’s no plausible reason why it should, and science bears out that the prediction that it shouldn’t.) Ditto other alternative treatments. Yet, typically anecdotes like the Brindises are presented as slam-dunk examples of the benefits of acupuncture and other “integrative” medicine, when in fact they are examples of tooth fairy science. Acupuncture does not work.

It’s depressing to see an article such as this in Psychology Today. I had never heard of Dr. Seppälä before this; so I took a look at her profile. She is Science Director of the Center for Compassion and Altruism Research and Education at Stanford University. Oddly enough, for holding such a position, she only has three publications listed on PubMed. But she does do this:

In addition to her work at Stanford, she founded Fulfillment Daily (www.fulfillmentdaily.com (link is external)), a magazine on science-based news for a happier life. She is also a popular Psychology Today blogger and contributor to a number of press outlets such as Scientific American Mind, the Huffington Post, Mindful and Spirituality & Health magazines. She often teaches Science of Well-being workshops in university and corporate setting and is a speaker with BrightSight group.

In other words, she appears to be a self-help guru, who mostly publishes in non-peer-reviewed sources and does a lot of talks and workshops. Whatever her role is, Dr. Seppälä has credulously contributed to the spin that promotes integrative medicine as somehow the way to empower patients and provide “holistic care.” It’s a common message that is the primary driver of the growing popularity of integrative medicine. It’s not true that when traditional medicine doesn’t help, integrative medicine provides answers, nor is it necessary to embrace pseudoscience to get those answers.

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]

205 replies on “When traditional medicine doesn’t help, does integrative medicine provide answers?”

Stacy is not alone in her gut feeling that first addressing her overall health and well-being—before investing in more invasive solutions—might be a key element in her health care.

This is the sort of statement that’s difficult to disagree with – and that’s whats so insidious about “integrative” medicine. Science-based medicine has always recognized that lifestyle interventions like diet, exercise, and stress reduction can improve many conditions (especially in the developed world, where so many of our chronic conditions are caused by lifestyle in the first place), and every “allopathic” doctor (or NP) that I’ve ever met recommends trying lifestyle changes first (when appropriate) before proceeding to medication. So-called “integrative” medicine is simply a bait-and-switch scam: they spout a bunch of truisms and common sense about the importance of diet, etc., then once they’ve got you agreeing with them they slip in the acupuncture, homeopathy, etc. What the heck does getting poked with needles or magic water have to do with “over-all health and well-being?”

Yes, an unwillingness to “concede the placebo” keeps people locked into a holding pattern of equal-opportunity credulity based on a subconscious desire to maintain an internal locus of control.

If anyone is interested in how integrative medicine can improve mental health for the elderly watch the film “Alive Inside” by Michael Rossato-Bennett.

It was the most awarded documentary of 2014.

Briefly, it’s about music therapy…it made me cry.

When traditional medicine doesn’t help, integrative medicine provides answers.

I don’t doubt that integrative medicine provides answers. Religious and/or spiritual approaches often do. The problem is that there is no evidence these answers are actually true, and furthermore the people advocating integrative medicine or other religious/spiritual approaches ignore (if not outright deny) the possibility that their answers are not true. To paraphrase Will Rogers: I’m not bothered as much by what these people don’t know, as by what they know for sure that just isn’t so.

The irony of this story is that she didn’t interview anyone who reached the end of the legitimate medical line, tried acupuncture and died anyway. That’s the silent majority’s testimony on alt-med.

Michael, when did music or other expressive psychotherapies become alternative or integrative medicine, rather than simply medicine?

@ JGC:

If you consider the medicine wheel illustrated above, nearly every portion contains SBM/ Psychology.

True, so-called energy medicine and assorted mind-body fol de rol are not as defined SB BUT they may have elements of stress reduction/ counselling tarted up as esoterica when they’re really more mundane approaches. You talk to someone who tells you to relax Or ypu are distracted from your problems for a while. Or you experience the magic of placebo. Then they tell you that your energies have been re-balanced or that your chi has be replenished.

[email protected]:

Michael, when did music or other expressive psychotherapies become alternative or integrative medicine, rather than simply medicine?

As our resident rubber fetishist has elected to pull a most artful dodge (Bravo, sir!), might I offer the probable answer: The moment the quacks realized that with this one simple rebranding trick they could sell suckers exactly the same product as before but at ten times the price.

“Man will never be free until the last postmodernist is strangled with the entrails of the last quack.”

(with apologies to Diderot)

You can say this stuff over and over, but it doesn’t change a simple fact:

1) A good yoga teacher is better at getting certain people to exercise than an MD.

2) A good yoga teacher doesn’t cost the rest of us $500 an hour through insurance or taxes.

Hmm…that Integrative Medicine Wheel is missing the spinner that an ND can flick with their finger to decide which modality to use on any given patient…

It’s depressing</ unsurprising to see an article such as this in Psychology Today.

FTFY Orac

It’s depressing unsurprising to see an article such as this in Psychology Today.

FTFY Orac

When I went to Mikey’s rant against SB227 one comment on it was about a girl who was “killed by vaccines.” A link was shared to a Daily Mail article about a mildly autistic teenager who died of cardiac arrest from constipation because of a fear of bowel movements…

… her doctor said if she had been being treated at the time of her death the outcome might have been different. Her parents argued that she was – homeopathy and a type of distance healing. Poor girl was failed on so many levels.

The theory behind TFT is that negative emotions cause energy blockage and if the energy is unblocked then the fears will disappear. Tapping acupressure points is thought to be the means of unblocking the energy. Allegedly, it only takes five to six minutes to elicit a cure.

Excuse me, but this is being extremely generous with TFT. Say what you will about phlogiston, at least it’s a theory. Phlogiston theory makes specific, testable predictions about the physical and chemical world. Those predictions are wrong, so phlogiston is a falsified theory, but it is a theory. TFT does not even rise to this level: what are the specific, testable predictions of this so-called theory? TFT sounds like something that can only be failed: If it works, great. If it doesn’t, then you didn’t find the right meridian to tap. And that claim about curing people in only five or six minutes is a red flag: if it really were that easy, why isn’t every practitioner on the planet using this technique? I don’t see a pro-TFT answer to that question that doesn’t involve positing a massive conspiracy theory of the sort our host likes to ridicule.

IUI with injectables has the best success rate with respect to IUI treatment, yet it is still not very successful. Perhaps Seppala could have mentioned this in her article. It’s the realm of 15% to start, depending on the age of the female, the patency of her tubes, her response to the drugs, and the sperm count of the male. After about 3 cycles the law of diminishing returns kicks in. 6 cycles is a waste of time and resources, but IVF is a big step both emotionally and financially for many couples, so…

I get the desperation, I really do. I stopped counting the number of strangers who’d seen me naked below the waist when I got into the mid-double digits. Our bank account was pilloried, our marriage alternated between frosty and sad, and after awhile, I began to grasp for an alternative solution.

I saw an acupuncturist. The practitioner, who billed herself as a “fertility specialist”, looked at my temperature charts and said “your eggs have poor energy.” When I asked her “what is the energy of an egg?” she had no reply. My period was three days late. She took my pulse and said, “You’re not pregnant. Make an appointment for next week.” She had me lie down on a table and placed the needles in various parts of my body. Then, she covered my uterine region with what I can only describe as a plastic container to hold strawberries or some other such fruit, and left me there for 20 minutes.

I was indeed pregnant, is the punchline. I never saw her again.

What truly pisses me off about fertility woo is that it wastes the time a woman often does not have. And unlike money, you can’t earn, beg, or borrow more.

@ zebra

1) A good yoga teacher is better at getting certain people to exercise than an MD.

Could be true, but I’m afraid it’s because people looking for a yoga teacher have already decided to do more exercise.

2) A good yoga teacher doesn’t cost the rest of us $500 an hour through insurance or taxes.

And no yoga teacher but learning to do exercises by yourself will cost even less to everybody.
Your point is?

Anyone else spot the flaw in this paragraph, given that the Brindises had already apparently done 6 cycles of IUI/injectables?

“Physicians next suggested that Stacy try in vitro fertilization. It would involve doses of medication, a considerable price tag (starting at $12,000), and increased chances of her having twins—factors that gave the couple considerable pause.”

The theory behind TFT is that negative emotions cause energy blockage

Funny, it doesn’t work that way in boot camp.

I must say that after reading about “Dr” Seppala, I think my father (Stanford ’54) must be rolling in his grave.

Seppala clearly didn’t consult with an actual REI before writing this piece. It would have been beneficial to the reader. Not to Seppala’s agenda, though.

3 Michael J. Dochniak

…, it’s about music therapy…it made me cry.

You were having a problem crying before?

Mea culpa mea culpa.

@Delphine – you have my deepest empathy. My only born child was a surprise after ten years of trying, and a surprise that was never repeated. I am blessed, though, with many children who choose me as mom, and step grandkids who don’t care that I am not their daddy’s mommy. I am grateful that love makes allowances.

Woo is cruel. It is what makes me so angry. They take the most desperate wishes and hopes and sell them to you. How do people not see that?

Thanks, Mrs. Woo. You really sound like a lovely person. I’m glad you got to be a Mum, biologically and otherwise.

When I started treatment, with a doctor whose specialty is AMA women, she bluntly told me that my chances of having a live birth were 1 in 3.

I cycled with 2 other women, all 3 of us were the same age. I saw them for over a year at morning blood draws, ultrasounds, etc. They had both been at this longer than I had. One was a Montessori teacher. The other was a self-described “farm wife” who drove over an hour each way to get to her appointments (which when you are cycling can be daily.)

The Montessori teacher did not get pregnant. I don’t know what became of her. The farm wife had made up her mind, after 4 failed IVF cycles, the 5th was it, done, finito. She was ready to move on. I admired her bravery, because I was not yet there.

At every morning appointment, the farm wife was crocheting or knitting something. When I finally got successfully pregnant and actually stayed pregnant, the clinic called me and said there was a package for me at reception. It was a beautiful yellow and green baby blanket, with a note that said, in part, “I won’t be needing this, and I want you to have it. Congratulations and best of luck to you, love T_____”

1 in 3.

In practical terms I only expect to see more testimonies for “integrated” medicine. It takes logic to realize a doctor who treats you like a text book in a gown, a burden in the day and another entry in an EMR may have the tools to help you. But when you have no clear cut illness or are desperate for emotional support in a chronic debilitating condition the woo type who will listen to you as an individual is very appealing regardless of the BS they are peddling.

My questions are:

Why is it left to these integrative types to promote the dialog of not treating patients like numbers? And I don’t mean the lip service managed care gives with their ridiculous Press Ganey surveys while demanding outrageous volumes of patients.

How can doctors and patients push for bringing back humanity into their encounters?

#19 Helianthus,

I doubt you have scientific evidence about people “already deciding to exercise”.

Some people (not me) are attracted to yoga, and continue to practice, because it has a spiritual (woo if you like) component. Why should we not be happy that they are in better health with exercise just because we do not share that particular motivating belief?

The “point” is that Orac always says we should just pay doctors even more than they earn now to spend time with patients. But he doesn’t say how this will be paid for, and he doesn’t say how the doctor will convince that yoga-oriented person to do exercise if she mistrusts conventional medicine.

I just don’t want pay more or spend more time waiting for a doctor because he is playing psychiatrist or sharing recipes with some fat person. That is why we have yoga teachers and nutritionists or dietitians.

@zebra: if someone distrusts doctors and conventional medicine, then why are they seeing the doctor in the first place?

I just don’t want pay more or spend more time waiting for a doctor because he is playing psychiatrist or sharing recipes with some fat person. That is why we have yoga teachers and nutritionists or dietitians

Do you realize what a hateful person this makes you appear to be? Is it outside of the doctor’s realm to discuss someone’s mental health issues or diet? The alt med types are always screaming that doctors don’t discuss diet, exercise, meditation, whatever. And yes, the doctor could recommend the nutritionist, dietician, or yoga or tai chi or whatever. But that doesn’t mean the patient will (or can afford to) follow through. So a good doctor is bound to discuss diet, exercise, mental health. At least, all the good ones I’ve seen have.

Oh, come now, MI Dawn. It’s not as though mental health issues or obesity are real problems.

@delphine and Mrs Woo

I am so very happy for you both and I mean no malice whatsoever, but I cringe a bit whenever reading about infertility, having always had the exact opposite problem? I was smug for ages thinking it was because I started young and took the babies along with the (relative) poverty and lack of wisdom, but then I had the last at 38, with no effort at all after a ten year gap– then turned up pregnant at (eek!) 46, by which time I had two grandchildren. That was terminated post haste followed by a tubal. You wouldn’t think fertility would be so fickle and unequal with its favors. In spite of the troll, I’m going to tell Delphine that the baby blanket from the farmer’s wife made me cry. I think she possibly took the finality of it better than I. I knitted layettes for each of my four and all six grandkids. So much love goes into that stuff. I cried even more that she wanted you to have it.

#29

” if someone distrusts doctors and conventional medicine, then why are they seeing the doctor in the first place? ”

I thought that’s what I said. If there’s a population that would benefit from practitioners with a different “brand”, why not offer access?

As for being hateful– ok, I guess it’s hateful of me to want the tens of millions of people in the US who have no health coverage to have access to care. (Instead of wasting money paying overly-trained doctors $500/hr to give “annual checkups” to healthy people, and, now, apparently they will also be sharing their favorite recipes.)

If a person has an unhealthy weight, that person needs motivation. What qualifies an MD to provide that?

@darwinslapdog

It probably was (at least in part) because you started young. The most critical factor with respect to the success of ART is the age of the woman, and past fertility is a good sign with respect to future fertility. In the 1 in 3 above, I had been pregnant, and by the same man, before we turned to ART. The other two had not. Because of that, the odds favoured me.

It’s not unusual for women in their 40s have babies. History is rife with women in their mid-forties having their 6th, 8th, 13th child. My paternal great-grandmother had her last of 13 at around 43. Only 8 survived and they were all girls and my great-grandfather needed a son.

The unfortunate thing with this is that because almost everyone can point to someone who had a baby at 43, 44, 45, 46, this turns into “Lots of women have babies in their 40s” as a rationale for delayed childbearing. Conceiving your 6th in your 40s is not the same thing as conceiving your 1st.

One of the things my fertility doc told us was that we had to have an end point in mind. I didn’t have one, which is in hindsight was not good. The other two women did, and I think it helped the farmer’s wife move forward and choose a different life.

“Dr. Seppälä … is Science Director of the Center for Compassion and Altruism Research and Education at Stanford University.”

I get much of my medical care through Stanford, and so far as I have been able to cross-check it’s all been science-based. Stanford also has John Ioannidis, with his ongoing projects to try and make medical research methods better.

But then Stanford goes and condones nonsense like what Seppälä has said. And sometimes worse – like the “poke kids in NICU with needles in random places” bullshit that Clay Jones called them on early this year.

It seems like there are two separate cultures regarding medicine at Stanford – one that promotes evidenced scienced-based care and one that is happy to promote a huge variety of dangerously wrong woo.

Why is it that they always suggest yoga as some form of exercise to do to get better? It’s a good form of exercise… If you are not looking to get gains whatsoever.

Why not encourage people to go to a regular gym and do some weightlifting? Bodybuilding? Powerlifting? Strongman stuff? As long as you do it at your own pace, that’s better for you than yoga, and you actually end up looking good in the process.

My first reaction to Stacy Brindise & her hubby is:

If you can’t get preggers, then adopt a baby or two (or three or four, or more!), rejoice at your built-in “natural” birth control, and “go at it like weasels!”

“But no,” they say, “we want to to be _ours_.” As in, “our genes.”

What part of _their genes_ do they think is so _special_? As if they, along with the rest of us, don’t already share 99% of our genes with chimps and bonobos?

To my mind, the idea that one’s genes are _special_ is nothing more than a subtype of the “my special snowflake” syndrome that motivates anti-vaxers. It’s another form of woo that sets people up to be “naturally” receptive to the marketing messages of quacks.

And getting pregnant five weeks after starting quackupuncture sounds to me like coincidence, pure and simple. She could have saved some money by poking at herself with a pointy object and chanting “Omm,” or maybe “Two four six eight!, getting pregnant would be great!”

I’ve read a fair few ‘acupuncture got me pregnant’ stories (there’s even an acupuncturist I know of who considers herself ‘the baby maker”) and yet, buried deep in the text, there is almost always some throwaway mention of lifestyle modifications they undertook such as diet and exercise. Despite the role excess weight can play in infertility, ’twas all the needles and the positive affirmations.

Quite the scam, really.

@Gray Squirrel,

If you can’t get preggers, then adopt a baby or two (or three or four, or more!), rejoice at your built-in “natural” birth control, and “go at it like weasels!”

That probably comes across as mean and unsympathetic rather than the congratulations and helpful advice you intend. With the global human population rapidly approaching 9 billion people, though …

a Garou:

I think that one of the reasons people – specially young women- do yoga is that it improves their appearance. They use it to tone muscles and strengthen their core which means they look thinner. Believe me, actresses and models use training like this ( and weights as well) for these purposes and they are emulated by fans. That’s why they yoga in overheated studios, not just to eliminate toxins.

@ Gray Squirrel:

You’re so right about the genetic aspect of special snowflakeness

@Gray Squirrel (38)
It worked for us.

My wife and I used birth control for 2 years before trying to have a baby. Then, nothing happened, so we went through several rounds of medication but still nothing happened.
Then, I went back to school at U of M and we stopped worrying about it for a while.
Just before I left my graduate work, we adopted a little girl. About a year later, my wife got pregnant but it turned out to be a miscarriage. The heart never started pumping.
So, a couple years later we adopted twin boys. When they were about a year old, we learned she was pregnant again!
This was delivered and is now a beautiful girl!

No needles, reiki, back cracking or anything else but reasonably good nutrition, time and effort and luck.

@ zebra

I doubt you have scientific evidence about people “already deciding to exercise”.

gah?

OK, let me rephrase my profound, very difficult assertion:

People who decide to go to the doctor are part of a specific population: the population of people who decided they needed to see a doctor to check/fix something health-related (that includes people who really just want to chat).
People who decide to go to a yoga teacher are part of a specific population: the population of people who decided to do some exercise, namely yoga, for a variety of reasons.

My very profound postulate is that these two populations may be very different.
If the lack of success of physicians at convincing members of the first population to do exercise is anything to go by, a large part of this population is not in favor of doing exercise.
On the other hand, the second population is made of people who decided they wanted to see a yoga teacher. One may infer it was not to discuss the socioeconomics of south Tanzania, but rather to do some exercise.

Hence my sparkling conclusion: it’s no wonder yoga teachers are good at making people do exercise, since people looking for them were already entertaining the idea that exercising may be a good thing to do.

If you want, you can poll people at the entrance of a yoga class and ask them what they are coming for. Let me know if the majority answer “crochet” or “pogo-stick”.

And to complete my answer:

If your “yoga-oriented”, physician-mistrusting people end up at the doctor’s place instead of at the yoga place, they must be very confused.

My first reaction to Stacy Brindise & her hubby is:

If you can’t get preggers, then adopt a baby or two (or three or four, or more!), rejoice at your built-in “natural” birth control, and “go at it like weasels!”

“But no,” they say, “we want to to be _ours_.” As in, “our genes.”

What part of _their genes_ do they think is so _special_? As if they, along with the rest of us, don’t already share 99% of our genes with chimps and bonobos?

To my mind, the idea that one’s genes are _special_ is nothing more than a subtype of the “my special snowflake” syndrome that motivates anti-vaxers. It’s another form of woo that sets people up to be “naturally” receptive to the marketing messages of quacks.

The infertile are not responsible for the world’s unwanted children. And if you think adopting is any easier or less expensive than ART, then I invite you to try.

Is it about genes? Yes and no.

My husband is adopted. His parents were a pediatrician and a pediatric nurse. They didn’t marry until late in life. Adoption regulations in the province in which he was born were at that time not as stringent as they are now, so despite their advanced age, they were permitted to adopt.

He had a wonderful childhood. He was deeply loved, and he adored his parents, who were probably among the best people I’ve ever known.

They’ve since passed and my husband has no family other than mine. My husband and I were together for 11 years before we married and we only married because we were trying to adopt. Yet we couldn’t, because we hadn’t been married long enough, and then, we were too old.

But you see, for him, I realised that it was important to have a child that was biologically his. Much more than it was to me. I have siblings, I have a living parent. I can look at photos of my Dad and see his eyes in mine. I can watch the way my sister runs and know that we share the same stride. I hear my own voice in my mother’s laugh, in my brother’s jokes. My husband doesn’t have that, and he wanted it.

People reproduce for all kinds of reasons. Wanting a child who is part of you is not “special”, it’s perfectly goddamned normal.

#44 Helianthus,

You appear to believe that repeating your conclusion “people go to yoga for exercise” counts as an argument supporting your conclusion “people go to yoga for exercise”. We call that circular reasoning.

Many people go to yoga rather than other forms of exercise because of what Orac calls the woo-factor. That is also why they continue. How do I know that? Because woo-factor yoga is successful; it has not been replaced by “secular yoga”. The spiritual or eastern-mystical factor is obviously important to those people.

The question about the doctor makes no sense if you have been following the discussion by Orac. He is complaining that non-secular yoga is advertised as part of the integrated medicine package. I say, if someone gets motivated by woo to start exercising, I am happy for the person, and I would rather pay for the yoga teacher than for the MD to provide gourmet recipes.

You answered my question at #33 very well and scientifically– doctors are not qualified to motivate people to exercise, as we can see from the results.

Doctors are qualified to give people some weight-loss prescription with rare-but-serious-side-effects, as we learn from TV advertising. If you are depressed about your weight, they fix that by giving you something that may make you suicidal. Very clever.

Helianthus,

Hence my sparkling conclusion: it’s no wonder yoga teachers are good at making people do exercise, since people looking for them were already entertaining the idea that exercising may be a good thing to do.

That may be both sparkling and blindingly obvious to most of us, but in zebra’s world people are homogeneous; those who go to their doctor and demand an antibiotic for a persistent sore throat would be quite satisfied with ginger tea instead, remember? However, I would like to see a yoga teacher try to persuade some of the patients my colleague* used to see in her east London lipid clinic to change their lifestyles.

I’m a little confused that s/he is apparently happy for doctors to learn a raft of useless BS about TCM, but is furious they are learning about nutrition and cooking. Curious.

* Indian, but not into yoga, not at all.

I like that zebra holds himself to the same high level of evidence to which he holds other people. Not that I’d expect anything less.

[email protected]

I doubt you have scientific evidence about people “already deciding to exercise”.

[email protected]

Many people go to yoga rather than other forms of exercise because of what Orac calls the woo-factor. That is also why they continue. How do I know that? Because woo-factor yoga is successful; it has not been replaced by “secular yoga”. The spiritual or eastern-mystical factor is obviously important to those people.

#51

?

The market, which in this case is actually free, gives pretty good evidence. What is it that you don’t understand?

My spouse’s oncologist spends not less than an hour with both of us every six months while we monitor his cancer’s progress, treatment plans,etc. We talk about all kinds of things about our lives and are never rushed. It pisses me off to no end to listen to quacks talking about doctors who don’t take time with patients. An anecdote yes, but as valid as any of their crapola.

[email protected]

The market, which in this case is actually free, gives pretty good evidence. What is it that you don’t understand?

All this is evidence of is that there is no significant demand for “secular yoga”. It provides no evidence as to why that is. It could be, as you asserted, that many people go to yoga specifically for the “woo factor”. It could just as easily be that people go in spite of the woo. They may dislike it, but enjoy the exercise part enough to not stop going, hence there is no market demand for something different.

I’m not even certain there is no demand for “secular yoga”, though I’m also not sure where exactly the line is drawn given that is something you made up. The yoga studio my sister attends is surprisingly light on the woo.

I’m not even certain there is no demand for “secular yoga”, though

I don’t recall Lilias, Yoga and You, which basically popularized the whole shebang in the first place, as being anything but “secular.”

I liked that show, too, Narad.
I used to watch it on PBS just as a way to relax after my engineering classes.

I used to watch it on PBS just as a way to relax after my engineering classes.

It was also on in the morning right before Sesame Street, if you get my drift.

The yoga I have encountered (and practiced at times) over the years has been entirely secular, as far as I remember. I don’t recall much in the way of prayer or even visualization.

Incidentally, that’s one reason my mother was so amused when, some decades ago, the vicar of her local C. of E. church told her that by practicing yoga she was “meddling with the occult”, making her unsuitable to sing in his choir (she joined a choir in the neighboring village which had a more sensible vicar).

I’m wondering how many people practice yoga, whether regular or secular, because their doctor persuaded them they should get some exercise….

I’ve taken yoga classes at various times over the years including those offered here at the Healthworks department. Maybe I’ve been just lucky, but all the instructors focused on the bodily/health benefits. Not a whisper of woo involved.

Lilias! I used to do yoga to that show with my Mum when I was tiny.

It was on PBS in the wee small hours when I was in grad school. Very fun to watch stoned.

@ zebra

as we learn from TV advertising

Ah, I see your problem. You believe that the guy in white coat on TV is a real physician.

#55

Yoga, tai chi, karate, and so on, all have a core spiritual component. As practice has expanded, there are obviously more versions being practiced that emphasize that component less, which might make the traditional ones a smaller percentage, but not eliminate them.

So other than avoiding the issue, which is that matching the inclinations of woo-seeking “patients” by providing appropriate options would be more efficient than paying overly-trained and ineffective doctors to provide counseling and dietary advice, what is your point?

So other than avoiding the issue

The irony, it burns.

Many people go to yoga rather than other forms of exercise because of what Orac Z. calls the woo-factor. That is also why they continue. How do I know that? Because woo-factor yoga is successful; it has not been replaced by “secular yoga”.

You pulled this out of your Zorse’s ass. HTH. HAND.

You pulled this out of your Zorse’s ass. HTH. HAND.

It’s also a failure when it comes to definition of terms; what is “woo-factor” supposed to mean? Is a yoga class that focuses on “mindfulness,” which, as Orac suggested in the OP, might have measurable benefits* and is not necessarily “woo” somehow a “woo-factor” yoga class? There’s a studio in town I like because the instructor basically shuts up during class, there’s no crappy music, patter a la Bikram, etc., and it has a focus on paying attention to the breathing and moving that you’re actually doing instead of just “working out.” Is that woo?

*I mean, I do get annoyed at the way “mindfulness” has become such a popular, not-thinking-about-what-it-means buzzword, and the way that avowedly “secular” types tend to pooh-pooh the tradition(s) it comes out of, but so it goes, I guess.

It’s also a failure when it comes to definition of terms; what is “woo-factor” supposed to mean?

I tried to get at that above, but it might not have been the clearest exposition. There are two links in the comment with screwed up link scope, BTW.

^ More to the point, Z. actually only has one comment:

Why am I arguing? Because “someone is saying something wrong on the internet”, and I have a better solution.

This leads to a dreary modus operandi in which he seizes upon things that he either demonstrably lacks or actively disavows any knowledge of, like some sort of desperate tourism bureau for the island kingdom of Sophomoria.

Since when has Karate had a ”core spiritual component”? Sure, there’s the whole clause of ”thou shalt not use it”, but that hardly counts as spiritual. Actually, that’s not spiritual at all, that’s just good advice.

Since when has Karate had a ”core spiritual component”?

David Carradine, man. It’s like when the Germans bombed Pearl Harbor.

So other than avoiding the issue, which is that matching the inclinations of woo-seeking “patients” by providing appropriate options would be more efficient than paying overly-trained and ineffective doctors to provide counseling and dietary advice, what is your point?

What’s stopping “woo-seeking” patients from, well, seeking woo?

And if the woo-seeking patient still go to the doctor to get a list of “appropriate options”, I fail to see where we are saving time. We are back to the triage issue from a previous thread.

Yeah, you can dump the triage on the RN, AP or whoever is manning the front desk. But now you want to make this person responsible for diagnosing and turning away patients with potentially serious health issues. They may be able to do it – they already do it to some extend, as I understand – but the questions of liability may become interesting. And it will certainly not be saving their time, quite the contrary.
And no-one will be paying them for this; the time-man cost will have to come out of the pockets of the “real” patients, like the impatient guy waiting in the queue and complaining about dumb and fatty patients in front of him.

It doesn’t bother you that you want the doctor to act as, basically, a p!mp for providers of unproven or reality-challenged stuff? Keeping the moral high ground is not your forte.

—————————————
I have an idea for a Research project:
Study equidae skin and figure out what makes it so impervious to highly corrosive substances, such as sarcasm. It also seem to have the property to bend the trajectory of heavy things thrown at it, such as facts.
I can already see the applications as a paint for the automobile industry.

These properties will have to be replicated, of course: an automobile coated with horse-skin, once started, would have a tendency to keep going in the same direction, no matter how much you try steering it. Or you may be confident you are driving in some direction, only to suddenly realize the car was heading due north all the time.

Zebra does deserve credit for coining the phrase “secular yoga,” which I haven’t heard elsewhere. My take on yoga is, any exercise is good, and if you like your exercise with a bit of Hindu tradition included, that’s up to you. Though of course it would be nice if secular yoga was equally ubiquitous for those who prefer the specific style of exercise without any religious element. And of course any yoga advocate or instructor who makes specifically medical claims is engaged in quackery and should be avoided.

Mephistopheles O’Brien @ 40: Yes, it was intended as encouragement, sorry if it came off as insensitive. Any discussion of reproduction necessarily brings up the consequences of overpopulation, which are as unavoidable as the consequences of jumping off high places, regardless of whether one “believes in” gravity or not.

Extrapolating from WWF.org figures, Earth can support @ 1 – 2 billion humans at American standard of living, @ 3 – 4 billion at European standard of living, and @ 6 billion at Cuban standard of living (or we can grab all the resources for ourselves and “to hell with everyone else,” gee that’s moral, eh?). The direct result of overpopulation and overconsumption is that we are presently headed for +2 Celsius, with an expected casualty count that will make Hitler and Stalin look like amateurs. Causing a holocaust to occur a century from now is no less morally culpable than doing it in the present.

The biggest crock of dangerous woo today, is the magical belief in growthism. This is not an abstraction, and if it rubs anyone the wrong way, they’re welcome to tell us their magical formula for circumventing the laws of thermodynamics. Otherwise, we are obligated to face reality and deal with it responsibly.

Denise @ 42: Thank you! In the big picture of sustainability, “my” genes and “your” genes are unimportant compared to “our genes” by which I mean the persistence of our species altogether, in a scientifically & technologically capable society. Per numerous other columns here on Scienceblogs, climate change is an _existential threat to our species_ : +5 Celsius and above could lead to human extinction. In the face of that, what’s moral is one child per family by reproduction, and as many by adoption as one wishes to have.

Dephine @ 46: If it was up to me, the same rules would apply to parenthood by either reproduction or by adoption. The idea that adoptive parents have to jump through an excess of hoops while reproductive parents merely have to jump in the proverbial sack, is manifestly unfair to children in both cases. A single standard, equal in the law, should apply to both.

Translated to policy that would start with universal mandatory parenthood classes in secondary school, with passing grades required for graduation. Anyone with an A or B average in those classes would be automatically qualified to adopt. A uniform 9-month waiting period would apply for adoptions (same as with reproduction), plus additional time if someone wanted to wait for a baby who “looked like them.” These policies would solve the adoption backlog and also tend to encourage adoptive parenting generally.

The most important factor in sustainable birth rates is female equality worldwide. The necessary elements are well known: equality under the law, and equal access to education. These also go hand-in-hand with improved health outcomes and longevity, and should be at the center of global policies including trade treaties, with appropriate incentives applied.

In case anyone’s wondering, my paradigm about reproduction is also influenced by R/K selection theory: individuals and societies benefit by having fewer children and devoting more effort to raising each one, rather than by having many and devoting less effort to raising each one. Quality of life for each person in a sustainable world, rather than quantity of lives in an unsustainable world.

@darwinslapdog – I had a coerced abortion at 18 (he said he would suicide if I refused). I never used birth control my adult life, only had the one other pregnancy.

Delphine – wow…

When my granddaughter was stillborn at seven months I frantically crocheted a small afghan to cover her in her homemade coffin (we can do that in rural Missouri, and after participating in a family funeral and burial, I don’t think I want any other kind – it was more peaceful and comforting). I slept less than four hours between the start of my daughter-in-law’s contractions and the funeral, I think. But the baby was buried with something that said we loved her and she was a part of us.

@zebra – I am someone with a rare illness. Believe it or not, I have no trouble with time with regular doctors. It is a matter of communication. If you tell your doctor’s scheduler your visit requires more time for whatever reason (more questions, more than one illness, etc.), they will schedule longer visits with appropriate coding for the visit. When I went to my specialist visit, I was treated with empathy and kindness. Great guy.

They are professionals. I don’t expect them to be my best friends. Don’t expect an hour if I schedule fifteen minutes. Just the way it is.

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