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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.

#72 Helianthus

First, I assume you are not familiar with USA TV pharma advertising, so you did not get my reference.

Second, this “maybe someone has a terrible disease that will be missed” is a nonsense argument, particularly in the USA.

We spend twice as much as any other developed country for equal or worse outcomes. Also we have tens of millions of people with no health coverage and very poor access.

So excuse me if I don’t take this kind of “concern” very seriously.

Third, still nobody answers the point. What qualifies a doctor to be the one trying to get people to change lifestyle?

Gray Squirrel,

“Get your hands out of my goddamned uterus” is my knee-jerk response, however, since you’ve wandered into my actual field with

“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”

I feel as though your reply merits a response I cannot provide due to time constraints. Hopefully later.

What qualifies a doctor? for starters, he or she can tell if my aching knee is caused by excess poundage and encourage me to exercise, or actually examine my knee and diagnose Baker’s Cysts.

And then determine if I can alleviate the problem by losing weight, or refer me to surgery to drain the cysts, whichever is appropriate. This is not something my yoga instructor is qualified to do (nor would I ask her to).

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?

I could ask you the same question? If you’ll recall, what I took issue with was the weasely way you shot down Helianthus for not providing evidence, then proceeded to make an assertion without providing evidence. When I called bull on your “market as evidence” argument instead of providing actual evidence or, god forbid, admitting that someone other than you may have a point, you changed the topic. Again, not that I’d expect anything else given your consistent history of intellectual dishonesty.

#78 shay,

Sometimes people tell me I’m not being clear but this seems to me as clear as it can be:

“What qualifies a doctor to be the one trying to get people to change lifestyle?”

Your answer makes no sense however we parse it. Are you saying that your doctor, before you presented with knee pain, was telling you:

“Good job, Porky, just sit on that couch and consume burgers and sweetened drinks. There’s no downside to having a big pregnant-man belly.”

??

There’s nothing about knowing how to diagnose Baker’s Cysts that would change the ability to persuade someone to change lifestyle. I assume Orac is a good surgeon, but he’s the last person I would pick to create a marketing strategy, or sell cars, or convince patients not to use homeopathy. (Not that being a good surgeon disqualifies you from selling stuff, as Dr Oz demonstrates.)

Is anyone able to answer the question as clearly stated? Or just admit that this is a valid point?

zebra,

“What qualifies a doctor to be the one trying to get people to change lifestyle?” […] Is anyone able to answer the question as clearly stated? Or just admit that this is a valid point?

I may have missed it, but when did persuading patients to change their lifestyle become a doctor’s job? Personally I think a doctor’s responsibility ends at explaining the likely consequences of not making lifestyle changes, and offering a referral to a specialist (dietitian, physiotherapist, yoga teacher or whatever) if appropriate.

Similarly I don’t see the supplement or pharmaceutical industries as a part of medicine as it is practiced, which is what you often appear to be criticizing. You presumably wouldn’t criticize astronomers because astrology is still popular, or blame an F1 race driver for the malfeasance of petrochemical companies. A lot of your complaints appear to me to be straw men based on some rather basic misunderstandings of how things work.

Second, this “maybe someone has a terrible disease that will be missed” is a nonsense argument, particularly in the USA.

That’s ridiculous. Early detection and diagnosis of a number of diseases is a very important part of primary care; people with terrible diseases are missed all the time. To use the example of our host’s specialty, more than 13,000 cases of breast cancer present at stage 4 with metastases, which considerably reduces survival rates.

Also, why, “particularly in the USA”? Are you arguing that because so many people have poor access to health care in the US you should just give up bothering altogether? If not, what?

BTW, I’m pretty sure shay doesn’t have a man-belly of any description, though I’m impressed by your bravery at suggesting she does.

[email protected]

I may have missed it, but when did persuading patients to change their lifestyle become a doctor’s job?

I’m pretty sure zebra is the only one saying that. That said, patient education has always been part of a doctor’s job, and as far as explaining the medical consequences of not making lifestyle changes or the benefits of such changes I don’t think there are many people more qualified than doctors.

This whole thing started because zebra asserted that yoga instructors are better at getting people to exercise than doctors. I say asserted because he, of course, provides no evidence. This, in addition to what Helianthus already said, that even in zebra’s assertion he failed to control for demographics. Yoga is exercise. I would imagine that nearly 100% of people who see a yoga instructor end up exercising.

[email protected]

Sometimes people tell me I’m not being clear but this seems to me as clear as it can be:

People say you are not clear because you make up terms and twist meanings. You set up straw men and shoot down arguments no one has made. You are constantly shifting the target. You ignore things you don’t like.

Or just admit that this is a valid point?

See #79. You first.

#81 krebiozen,

“I may have missed it, but when did persuading patients to change their lifestyle become a doctor’s job? Personally I think a doctor’s responsibility ends at explaining the likely consequences of not making lifestyle changes, and offering a referral to a specialist (dietitian, physiotherapist, yoga teacher or whatever) if appropriate. ”

What is the point of “explaining the likely consequences” if it is not the doctor’s responsibility to persuade the patient to make lifestyle changes?

(As usual, I am trying to deal with one of your several strange statements at a time.)

@Delphine

“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.”

Exactly. I’ve watched and occasionally gently remonstrated with a friend in her early 40s spend a great deal of money on various diet gurus and woo-meisters and their expensive products, together with a great deal of money on IVF treatment. Her long-suffering husband has been put on a number of diets and “wellness” regimes; more than once it’s nearly cost them their marriage

She hasn’t manage to conceive even once, as far as I’m aware. It’s heartbreaking to watch, and I want to personally go and thump every one of the venal quacks who prey on her an women like her.

@Orac

I’ve bookmarked this excellent piece and its headline as a perfect example of Betteridge’s Law.

This whole thing started because zebra asserted that yoga instructors are better at getting people to exercise than doctors.

The irony is this was paired with “a good yoga teacher doesn’t cost the rest of us $500 an hour through insurance or taxes.”

Hey, what did the original post say?

“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.”

Z. goes on:

“The ‘point’ is that Orac always says we should just pay doctors even more than they earn now to spend time with patients.”

Note that this is nowhere stated in the actual post; Z. is simply trying to find a hook for his impotent repetition compulsion.

“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.”

Hey, wait, didn’t the article being commented on say something about this?

“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.'”

It’s as though he didn’t even read it before leaping in. To the extent that his comments have any bearing whatever on the actual post, they’re self-contradictory.

“what qualifies the doctor to be the one…”

Because he or she is the one qualified to tell you that you either (lose weight-stop smoking-stop drinking-whatever the recommended lifestyle change might be) or there are going to be very real medical consequences, and just what those consequences are going to be.

#87 shay,

Huh?

The doctor is qualified because the doctor is qualified?

You’ve heard of circular reasoning, right?

#85

The US spends about twice as much as other developed nations to achieve the same or worse results. If you can demonstrate that all that discrepancy is going somewhere other than to doctors, please do. (I think a good part of it is, but not all.)

Doctors could earn the same amount as they do now and provide better results to more people. That is their choice in the end, since they have great influence on how the system is structured.

The doctor is qualified because the doctor is qualified?

The doctor is qualified because the doctor went to medical school. It’s not that freaking complicated.

[email protected]
Same as it ever was.

The US spends about twice as much as other developed nations to achieve the same or worse results.

You keep saying that, you have yet to provide any evidence though.

If you can demonstrate that all that discrepancy is going somewhere other than to doctors, please do. (I think a good part of it is, but not all.)

Once again, zebra’s word is all the proof he requires but we need absolute evidence of anything. Look, you make the assertion that most of the excess expense goes to paying doctors the onus is on you to provide evidence, not on us to disprove it.

If you can demonstrate that all that discrepancy is going somewhere other than to doctors, please do.

It’s not even hard to do (PDF), Zorse.

One might also note that in the US, unlike in much of the rest of the world, people graduate from medical school with huge amounts of debt that must be paid off, which kind of necessitates paying them enough money to pay off the debt and also live on. I mean, if we want to keep having doctors, anyway.

If you want to make an argument that way too much money in this country gets funneled into the pockets of middle men and usurers, I’m all ears, but that doesn’t seem to be your point, insofar as you even have one.

We’ve been over this before. Average GP salary in the UK is s £92,900 pa, which is about $137,000. In the US a family doctor earns on average $156,000 pa, not such a huge difference. I think other developed countries pay primary care doctors a similar amount. So, I’m not convinced that the problem in the US is overpaid doctors.

You have an enormous health insurance industry, sitting between patient and healthcare provider, siphoning off billions of dollars in profits. The top 5 health insurance companies made profits of $12.2 billion in 2009; bear in mind that the UK’s entire spending on the NHS is somewhere in the region of $200 billion.

[…] When traditional medicine doesn’t help, does integrative medicine provide answers? – 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 … […]

JP’s link is even more convincing. “Is $294.3 billion annually for U.S. health care administration money well spent?” That’s just for administration!

JP wins the thread for use of the word

usurers

And

Zorse

To my compatriots: (or three days late for our neighbors to the north): Enjoy the fireworks!

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.

I don’t even know really where to begin here. There are a couple of issues. Firstly there’s that other F word, fair. My husband’s parents had children because they needed them to work on the farm. Fair? My paternal great-grandparents had children until they had a son who lived, because they needed an heir. My own parents conceived my little sister as an “oh sh!t” at 45 and 55 and she was delivered in a not-so-great area of the world and “welcomed” by siblings more than 10 years her senior who had little interest in her. Fair? Is having children fair at all? It’s all an exercise in narcissism, isn’t it? Yet on a personal level, the past four years since Delphinette had been born have been the best of my whole life. Does she “look like me” and does it matter? Yes, no, maybe, but she’s her own person, her own unique self.

Adoption is not the panacea that you seem to feel it is or should be. If you’re interested in the topic, read Macleod and Macrae’s Adoption Parenting: Creating a Toolbox, Building Connections. There are other worthy books. But that’s a great place to start.

Qualifying a 17 year old to adopt via passing a course is not going to solve the adoption backlog. The demand for infants exceeds the supply. Older children are viewed as being less desirable, and this perception, sadly, is often not without substance. A high school course is not going to equip anyone to deal with the fallout from FASD or RAD. You also don’t mention whether or not you’re in favour of open adoption, which has its own list of pros and cons.

We can debate human overpopulation if you like but I suspect you’ll win that one, simply because a. I chose to try to have a biological child and b. I tend to see things through the lens of SSA, which is my focal point. In any event, you’re right in that it does all start with the woman. Everything, all of it. But the word that matters most — empowerment. Give her the ability to govern her own body, to feed it properly, to access timely, quality care, and you give her agency. It’s as critical as education and equality and sometimes, it doesn’t always follow.

I have more to say but the fruit of my selfish loins needs a bath. 🙂

To my compatriots: (or three days late for our neighbors to the north): Enjoy the fireworks!

I’m fixin’ to go drink beer and blow stuff up in an hour myself, because AMERICA!

JP’s link is even more convincing. “Is $294.3 billion annually for U.S. health care administration money well spent?”

Oh, look, there’s more!

PMIDs 24359713 and 25540104 may be of some interest.

I’m still failing to see what complaint Z. has with the actual post, though.

[email protected]

To my compatriots: (or three days late for our neighbors to the north): Enjoy the fireworks!

My sister is working up in British Colombia and she spent Canada day in the US and Independence day in Canada.

my husband (Canadian, born and raised) is presently watching who isn’t dead of the Dead at Soldier Field. I really don’t care for the Dead, but CHICAGO!!1!!!!1!!! All the jealous, right here.

[email protected]

I’m still failing to see what complaint Z. has with the actual post, though.

It has to do with the post because the real problems in healthcare are direct to consumer advertising, yearly checkups, and doctor’s salaries. And Orac is wasting his time and writing about anything else until we have a solution that fixes those simulataneously and instantly. And zebra knows the solution. It has something to do with yoga and ginger tea. CAN’T YOU SEE simpleton!

Is this really the only point of connection?

[Orac] doesn’t say how the doctor will convince that yoga-oriented person to do exercise if she mistrusts conventional medicine.

WTF does this even mean? Does the “yoga-oriented” woman who “mistrusts conventional medicine” yet is at the doctor also mistrust conventional exercise? It’s not like there’s any shortage of magazines with women sitting in the lotus position in the checkout lanes where I routinely shop.

Or does “the system” somehow prevent physicians from mentioning yoga because of the invented “woo-factor” and imaginary market extinguishment of “secular yoga”?

So, great, one has arrived promptly at the seeming inevitable point at which Z. demonstrates that he’s making pronouncements about things that he has no knowledge of whatever. But I’ve already said this.

Now, since at this point he was at least pretending to argue with the post, it’s difficult to conclude anything other than that he’s in favor of integrated medicine.

OK, so what does this mean? Z. complains that he doesn’t want to “pay more or spend more time waiting for a doctor because he is playing psychiatrist or sharing recipes with some fat person.”

But he’s endorsing integrative medicine by construction. Therefore, these people just need to be shunted off. So what is a university medical center to do? Oh, right, again by construction, devoting resources to building one of these.

And this is the Great Insight? How the fυck is building out a mostly cash-only spa supposed to accomplish dіck about what Z.’s actually bitching about, which is his precious time and putative insurance premiums?

Well, at least I didn’t accidentally have too many children, though it appears I have adopted too many progeny, and they have all been enthusiastically productive (running about two apiece for the ones over twenty).

I think I have to give up attempting to make sense of/with zebra. It seems like the point constantly moves and changes, making it difficult to discuss or debate anything.

I know that I am trying a different medication in my cocktail of pain-management drugs especially for its side effects, and this has made me realize I am as much a walking chemistry experiment as anything else. Mr Woo got another brightly colored advertisement in the mail. It was for a supplement that was supposed to be plant-based stem cells. They were advertised as being able to reset everything in your body to perfect youth and keep it there. Since his conspiracy theory radio shows assure him the rich already have that technology and are using it, he is sure it is out there somewhere, and he just has to find it. So frustrating.

Krebiozen @ 99: $294.3 billion divided by the approx. US population of 350 million = $840 per person per year, including each child. That’s what we’re paying for “administration,” most of which is sheer bloat: the insurance bureaucracy and all the paperwork (or its electronic equivalent) that goes along with. The very idea that doctors should have to spend time _negotiating_ with insurance bureaucrats for the _lives_ of their patients, is a moral obscenity.

The American economy as a whole is groaning under the weight of what I call “the administocracy,” whereby “managers” of all kinds have filled every available niche in the social ecosystem, each of them feeding on the resource-flows through the system. See also “flea anemia.”

Delphine @ 106:

Where, exactly, did I propose to stick my “G.D. hands in (anyone’s) uterus”?

Re. your family’s history going back a century or longer: The state of the world _then_ is not the state of the world _now_, and the key variable is infant mortality. Improvements in public health necessitate changes in culture, as we have seen in the vaccine wars.

If the demand for adoption of infants exceeds the supply, but there are plenty of teenagers waiting to be adopted, then clearly those teenagers were not adopted when they were infants. Increase the demand for infants and fewer of them will grow up to be un-adopted teenagers. Gay married couples have been more willing to adopt special needs babies and children, so I am inclined to believe that nationwide marriage equality per the recent Supreme Court ruling will lead to an increase in adoptions including of older children.

I have a “modest proposal” that should reduce FASD (Fetal Alcohol Spectrum Disorder) markedly, along with drunk driving and active alcoholism:

Alcohol licenses. And relevant education also in secondary school.

A person’s license to drink alcohol would be a routine letter A in a circle on their driver’s license or state ID. Add a circle with an M in it for states with legal recreational marijuana. Everyone gets carded every time they buy. If someone is convicted of DUI, the judge punches out the A (or M as the case may be) on the bench, and any renewed license comes with a red slash-mark through the A (or M) for the duration of the sentence.

DUI is a defining symptom of alcoholism, and keeping the alcoholic away from the alcohol is the first step in treatment. Anyone who provides alcohol to a person whose license is suspended, gets their own license suspended immediately: a built-in incentive to stop people buying it for (or serving it to) their ineligible friends. And while this might not be airtight in fringe or outlaw/underworld subcultures, it’s sufficient to get the ball rolling in the mainstream of society.

Relevant to the present discussion, a diagnosis of pregnancy would automatically require the doctor to take a hole-punch to the driver’s license. This won’t catch flaming alkies who conceal their pregnancies, don’t go to doctors, and have their babies at home, just so they can continue drinking, but it’s a start and can be refined accordingly.

Drinking during pregnancy, would be treated as a form of child abuse. Child abuse in general should be prosecuted vigorously, with loss of parental & custody rights, and mandatory long prison sentences for the worst offenders. Yes we know about the risk of over-zealous prosecution for mild forms of physical punishment, but that can be addressed. And yes I’ve read plenty of sob-stories about crack moms who plead “oppression!” when they are prosecuted. Tough: the laws exist to protect the children, and parents are not entitled to poison their offspring.

I would also reduce the drinking (and pot-smoking) age to 18, as the experiment with increasing it to 21 has been an abject failure that has only unleashed a flood of binge-drinking on college campuses, including ER admissions and acute overdose deaths. Age of 18 enables familial socialization of alcohol (and marijuana) use in a protected environment, reducing the risk of substance abuse once the kids are on their own.

Re. RAD (Reactive Attachment Disorder), more research is needed, but this appears to be related to parental abuse/neglect, strengthening the case for parenthood education in schools.

Yes I’m in favor of open adoption within reason: all children have an inherent and equal right, upon age of majority, to know the facts of their own existence that may affect their health and wellbeing. It may be that genetic testing could provide equivalent information, and if that becomes possible, it would be a reasonable intermediate step.

In the end we agree on the things that are most important:

“In any event, you’re right in that it does all start with the woman. Everything, all of it. But the word that matters most — empowerment. Give her the ability to govern her own body, to feed it properly, to access timely, quality care, and you give her agency. It’s as critical as education and equality and sometimes, it doesn’t always follow.”

As we say on another activist site I frequent, “what you said!” Or to use a religious metaphor, “Amen to that!”

The conditions for women in some parts of the world can only be described as slavery (at best) or, with only slight hyperbole, as a female holocaust (see also Afghanistan, ISIL, etc.). Those countries (and subnational groups) should be treated as international pariahs and subjected to whatever sanctions are necessary, up to and including military action in the worst cases (for which reason I also support strong military action against ISIL, AQ, the Taliban, and Boko Haram). The humanitarian atrocities against women and girls are more than sufficient grounds for international action, even if it wasn’t also the case that female equality translates to sustainable birth rates.

All of these sets of facts, and their implications, are convergent. Female equality, educated parents, increased access to adoption, etc., translate to healthier children, happier families, and meet the ecological existential threats of our era. The implications of climate change are an evolutionary challenge as surely as anything our species has faced in its history. And as with other such challenges, either we will adapt or we will go extinct. Humans have successfully met every evolutionary/existential challenge throughout our history as a species, otherwise we wouldn’t be here right now to discuss this. That’s a good sign, though it’s not a guarantee, and it doesn’t alleviate the degree of hard work needed to succeed.

@ Narad

Does the “yoga-oriented” woman who “mistrusts conventional medicine” yet is at the doctor also mistrust conventional exercise?

As I said, zebra’s virtual patients seem to be mightily confused and unable to find out by themselves the “yoga teaching” ads in the Yellow book..

As far as I can tell, big Z wants the doctor (or someone at the doctor’s office) to send away patients directly to a yoga teacher (or whatever the patient is secretly yearning for).

I can just imagine the doctor saying:

“Since I am very bad at convincing you to go see a sport coach to do more exercise, and you don’t trust me anyway, I will give you the address of a sport coach so you can do more exercise. Trust me, he/she is good.”

[email protected]

As far as I can tell, big Z wants the doctor (or someone at the doctor’s office) to send away patients directly to a yoga teacher (or whatever the patient is secretly yearning for).

With the additional caveat that the doctor does so for free.

@ Gray Squirrel

Drinking during pregnancy, would be treated as a form of child abuse. Child abuse in general should be prosecuted vigorously, with loss of parental & custody rights, and mandatory long prison sentences for the worst offenders. Yes we know about the risk of over-zealous prosecution for mild forms of physical punishment, but that can be addressed. And yes I’ve read plenty of sob-stories about crack moms who plead “oppression!” when they are prosecuted. Tough: the laws exist to protect the children, and parents are not entitled to poison their offspring.

Currently in my country there is some discussion going on about this and there are not many people in favor of this. Even those who are all for mandatory vaccinations think, this is a step to far. Besides they list several practical problems implementing this, like people who are pregnant and drink are not likely to seek help, if this means they end in some form of containment. So you would be dependent of people who are going to tell upon the pregant woman who is drinking. Not something that would do a society much good.

Some thoughts about adoption. Older children who are up for adoption don’t have to be not adopted earlier in their life. It is also possible they lost their parents when they were older.
There is a saying blood is thicker than water.
There is a lot of talk about the right of children, to know their genetical background. Adopting a child is never the same as having a child of your own. And this has nothing to do with special snowflakes.

With the additional caveat that the doctor does so for free.

And with prompt efficiency. This would seem to reduce to a “triage” model that demands inexpensive Betazoids.

These discussions make me appreciate even more President Obama’s understanding of the flock with whose care he has been entrusted. Baby steps for babies.

So, the best response anyone can give as to

“What qualifies a doctor to be the one trying to get people to change lifestyle?”

is “but she went to medical school.”

Because we all know being good at memorizing stuff makes you a real people-person.

And then there’s Krebiozen:

I may have missed it, but when did persuading patients to change their lifestyle become a doctor’s job? Personally I think a doctor’s responsibility ends at explaining the likely consequences of not making lifestyle changes, and offering a referral to a specialist (dietitian, physiotherapist, yoga teacher or whatever) if appropriate.

Still hasn’t explained why the doctor is explaining the consequences if it isn’t to get the patient to change the lifestyle.

The other gem from Krebiozen et al is the response to:

The US spends about twice as much as other developed nations to achieve the same or worse results. If you can demonstrate that all that discrepancy is going somewhere other than to doctors, please do. (I think a good part of it is, but not all.)

Doctors could earn the same amount as they do now and provide better results to more people. That is their choice in the end, since they have great influence on how the system is structured.

So, I said nothing about the relative earnings of PCP in UK. I did say that it is up to the doctors what kind of system they work in. But I guess I was wrong; they are clearly in the same situation as any chattel slave.

“What qualifies a doctor to be the one trying to get people to change lifestyle?”

is “but she went to medical school.”

Because we all know being good at memorizing stuff makes you a real people-person.

Do you have to work at being this stupid, or does it come naturally? The thing that going to medical school qualifies a doctor to do is make diagnoses, numbnuts. To use shay’s example of Baker’s Cysts, I didn’t even know what they were until I looked them up just now. I’m obviously not fit to be a diagnostician*, because I haven’t been to medical school. Possibly the diagnosis will not be Baker’s Cysts, or whatever, and has more to do with lifestyle, but the doctor’s job is to tell the difference.

*Speaking of kicking the can up the line, I was at the very bottom of the line once upon a time, as a CNA (I think that was the term) in Washington State, which was a requirement for a job I had. Basically it entailed learning CPR and first aid, and some really basic medical education. The idea was mainly to know when to call a doctor.

#118 JP,

“The thing that going to medical school qualifies a doctor to do is make diagnoses,”

Yes, we would hope so.

If only I had asked “what does going to medical school qualify a doctor to do”, that would be an appropriate answer.

It’s pretty clear that all the posturing about how I am not clear is just an excuse not to deal with questions that make you uncomfortable.

“What qualifies a doctor to be the one trying to get people to change lifestyle?

Pretty clear.

These discussions make me appreciate even more President Obama’s understanding of the flock with whose care he has been entrusted. Baby steps for babies.

And right on cue, Z. begins to disintegrate. Rather than bothering to respond to observations that his “position” is frankly incoherent, he simply repeats the meaningless Magic Question over and over again, now with stupid insults.

Who’s “uncomfortable”? Let me make this very clear to you, Zorse: someone goes to the doctor, let’s say they’re middle aged, maybe somewhat overweight, as can be the case. They’re having a lot of knee pain. Probably best to get it checked out, they figure, pretty sensibly. The doc takes a look. Maybe he says: “You have Baker’s Cysts, here’s what we’re going to do about it.” Maybe he says: “You probably just need to lose some weight.”

It’s not like the doctor’s going to spend a whole bunch of time cajoling the patient into losing weight or something, so I’m not sure exactly what it is you’re complaining about. It’s up to the patient to actually go about making any lifestyle changes. Maybe they’ll consult a nutritionist or a yoga teacher or something. Maybe not. Most people have a hard time overhauling their lifestyle unless things are dire, and oftentimes even then; it’s not the easiest thing in the world to do.

Tell me again what problem you have with the above-described doctor/patient encounter? Or remind me again of your point?

Or, y’know, just take your marbles and go home already.

It’s pretty clear that all the posturing about how I am not clear is just an excuse not to deal with questions that make you uncomfortable.

And the lava continues to flow from Mount St. Anosognosia.

“What qualifies a doctor to be the one trying to get people to change lifestyle?

Are you in favor of “integrative medicine,” opposed to it, or just randomly whoring for attention with no regard whatever to the content of the post?

Pretty clear.

#121

So, the point of the healthcare system, financed primarily with tax dollars, is to allow people to maintain their fat slob lifestyle as long as possible, at everyone else’s expense. Glad we cleared that up.

If you are overweight and out of shape, but your knee pain is caused by Baker’s Cysts, we aren’t going to worry that you will develop diabetes and heart disease, because then we can spend even more money “treating” those.

Got it.

If you are overweight and out of shape, but your knee pain is caused by Baker’s Cysts, we aren’t going to worry that you will develop diabetes and heart disease, because then we can spend even more money “treating” those.

Wait, so now you do want the medical system to “take responsibility” for people’s general health and lifestyle? Make up your freaking mind already.

FWIW, most doctors will nag you at least briefly about your lifestyle when they see you for pretty much anything.

So, the point of the healthcare system, financed primarily with tax dollars, is to allow people to maintain their fat slob lifestyle as long as possible, at everyone else’s expense. Glad we cleared that up.

Gee, you must have a lot of friends.

#125

“Wait, so now you do want the medical system to “take responsibility” for people’s general health and lifestyle? Make up your freaking mind already.”

No, I want the government (society, in a democratic state) to take responsibility for people’s general health and welfare.

That requires a rationally designed “medical” system, which does not exist in the USA. Such a rationally designed system would use whatever works, and it would minimize things that don’t work, without all the histrionics of the Oracian Minions.

FWIW, most doctors will nag you at least briefly about your lifestyle when they see you for pretty much anything.

I actually prefer my FQHC PCP to seeing a new one every three years at the local teaching hospital; continuity helps. Now, she happens to be of Indian descent and knows that I can cook, which once led to the exclamation “it’s no harder to make lentils and rice than ramen!

The context of the visit was unrelated, but MDD is as MDD does, or something.

This is of course irrelevant to the appropriate response to Z.’s Magic Question, which is why do you ask?

That requires a rationally designed “medical” system, which does not exist in the USA.

See “Betazoid triage.”

The doctors I’ve consulted first suggested lipitor for high cholesterol not lifestyle changes. This was in 1998. I did not want to take it. I went on a diet and maintained an acceptable LDL level. (which by the way was lowered from year to year)
Lately went to dr’s appt at major NYC hospital where they have a special food section in the cafeteria called “comfort food”- ie french fries, fried chicken many unhealthy choices. In the cafe they serve gooey sugary deserts. What message is this sending patients about a healthful diet?

I have to use all my willpower learned from non-traditional sources to resist the temptation of above food.
Oh BTW tofu ain’t so healthy- do the research on fermented foods and MK7-I think it’s alt med.

Lately went to dr’s appt at major NYC hospital where they have a special food section in the cafeteria called “comfort food”- ie french fries, fried chicken many unhealthy choices.

People who are taking their meals in a hospital are often there for deeply unpleasant reasons, ken, like, oh, I dunno, somebody they love is very sick and maybe dying. I suppose they could be limited to undressed salads for the duration of their time there, so that you won’t be tempted to stop off for some fried chicken at your one-time visit.

What was that you were saying about empathy and “emotional intelligence” again?

The doctors I’ve consulted first suggested lipitor for high cholesterol not lifestyle changes. This was in 1998. I did not want to take it. I went on a diet and maintained an acceptable LDL level. (which by the way was lowered from year to year)

*sniff* That must’ve been so hard for you.

JP #132 – Have a great life. Continue being the enabler that you are and watch the results.

““What qualifies a doctor to be the one trying to get people to change lifestyle?”

Because he or she is the one most qualified to diagnose a condition where a lifestyle change will be most useful. All the lifestyle changes in the world, for example, wouldn’t have helped Jim Fixx.

#132 JP they could have made baked chicken and baked fries-
like people who are mourning will notice the difference.

#132 JP they could have made baked chicken and baked fries-
like people who are mourning will notice the difference.

The freaking sign said comfort food, ken. That’s pretty much an admission that it might not be the healthiest food in the world; it’s provided for other reasons.

And actually, if I were in the hospital with a loved one who was dying, and I went downstairs and asked for some strawberry ice cream, and someone told me, “Sorry, we don’t have that because it’s not “healthful,” but here’s some non-fat frozen yogurt!” I’d probably have a hard time not saying something “childishly arrogant” in reply.

The freaking sign said comfort food, ken.

Of course, actually identifying the “major NYC hospital” would greatly simplify an examination of what their dining options in fact are.

#137 Shay-Quote from the article-“Jim Fixx phoned me and criticized the chapter “Run and Die on the American Diet” in my book The Pritikin Promise. In that chapter, I said that many runners on the average American diet have died and will continue to drop dead during or shortly after long-distance events or training sessions. Jim thought the chapter was hysterical in tone and would frighten a lot of runners. I told him that was my intention. I hoped it would frighten them into changing their diets. I explained that I think it is better to be hysterical before someone dies than after. Too many men, I told Jim, had already died because they believed that anyone who could run a marathon in under four hours and who was a nonsmoker had absolute immunity from having a heart attack.”

I’m 72,I have plaque in my carotid artery, have Mitral Valve Prolapse and am facing a possible breast cancer diagnosis. I am sticking to my diet. If and when I need an invasive procedure I will have it and I have faith in SBM. I am in charge of my own health as far as possible.

[email protected]

If you are overweight and out of shape, but your knee pain is caused by Baker’s Cysts, we aren’t going to worry that you will develop diabetes and heart disease, because then we can spend even more money “treating” those.

Woe is the strawman! No one (except you) ever said the two were mutually exclusive. Just because someone is overweight does not mean we should leave them out to dry when, for example, they have Baker’s cysts. Just because we treat someone with Baker’s cysts doesn’t mean we can’t also say, “hey man, you should exercise and eat better.”

Funny thing about how doctors work is that if your chief complaint is knee pain they are going to try to fix your knee pain. Your stance here is similar to the one you take on solving problems with our system: we need to fix only the biggest problem and doing anything else is a waste of time.

I know you don’t put much thought into what you write but I hope you realize that your position now boils down to that we should provide no healthcare beyond counseling lifestyle changes to overweight people as long they remain overweight.

,I have plaque in my carotid artery, have Mitral Valve Prolapse and am facing a possible breast cancer diagnosis.

I’m sorry to hear that, believe it or not.

I am sticking to my diet.

Good.

I will have it and I have faith in SBM.

Also good.

Listen, you come around here accusing people of being groupies and in some sort of cult of personality, generally insulting people, being combative, accusing Orac of COIs or something, being condescending about “emotional intelligence,” leaving random links with cryptic comments, saying really dumb things that maybe you hadn’t thought about much beforehand…

Can you see why that’s obnoxious?

Zebra’s one and only point, that he thinks that doctors get paid too much.

Perhaps, zebra, your time would be better spent in a remedial English literacy class than repeating yourself and seeing how many logical fallacies you can cram into one post.

You know who has to eat in the hospital cafeteria every day? The hospital staff. Editors and bus drivers and cashiers and lawyers get to eat what we like for lunch. I think it’s only fair that the people who are helping us stay alive and healthy get the same choice.

When my sister was in the hospital with cancer, her partner was practically living there as well. I’m glad he was able to choose food based on his own preferences and medical needs, rather than a non-medically-trained stranger’s idea of what would be good for him.

I’m also glad that she got to eat based on what she liked, and still had an appetite for.

I actually prefer my FQHC PCP to seeing a new one every three years at the local teaching hospital; continuity helps. Now, she happens to be of Indian descent and knows that I can cook, which once led to the exclamation “it’s no harder to make lentils and rice than ramen!”

I’d take issue with the idea that it’s no harder to make lentils and rice than ramen, but it is fairly simple. Takes longer, though, and you usually end up with leftovers, which are kind of a pain to reheat if you don’t have a microwave. (I should maybe get one of those one of these days.) Ramen is pretty much single serving, if not super healthy.

Lately I’ve been into open-faced tomato sandwiches, with cream cheese or hummus as the base. It’s just too d*mn hot to do much cooking, and I don’t have AC. This is also the one time of the year when I appreciate celery and crudite in general, with hummus or whatever. (I did get finally get a food processor sometime this year, although, tbh, it’s easier and almost as cheap to just buy hummus, unless we’re talking actually soaking and cooking the chickpeas to make it, which is a pain.)

[email protected]

Lately I’ve been into open-faced tomato sandwiches…

One of my all time favorites. My Grandpa used to make them with tomatoes from his garden. Toast, a thin layer of mayo, and a dash of salt and pepper.

My Grandpa used to make them with tomatoes from his garden.

I bought a quart of tomatoes from a very nice Amish girl at the farmers’ market yesterday; they’re delightful, almost as good as the ones I used to eat straight off the vine as a kid.

Your stance here is similar to the one you take on solving problems with our system: we need to fix only the biggest problem and doing anything else is a waste of time.

Now, now, “the system” exists by virtue of the collective choice of doctors, because they are lining their pockets with “a good part” of “the discrepancy.” (More accurately, substitute the plurals with “Orac.”)

The awkward part is that this immediately collapses under its own imaginary weight, so the only thing left is petulantly demanding that somebody come up with something that will specifically cater to his whims desires, submit it in supplication for the imprimatur of the Great Stripe of the Zorse’s Ass, make it happen, and be G-ddamned sure that it does not inconvenience him in the process, because he will not be bound by the lowly fetters of “addition” and “multiplication.”

#149 Vicki
I love comfort food- ate too much of it when I was younger and also smoked. If I had my choice a meal would include ice cream, cheesecake, pecan pie,muffins, chips as the main course.

Speaking of ice cream and grandpas (or grandpa like figures), one of my favorite uncle-and-aunt teams always made homemade ice cream for birthday celebrations at their place; I’ve never been able to find its equal, especially when it was served with strawberry-rhubarb preserves.

The uncle half of the team has recently branched out into homebrewing, and he is d*mn good at it; I sampled some of his beers when I was out visiting this past winter. The Christmas mint porter was particularly outstanding.

He is a fat old bearded Norwegian man and I like him very much, and he’s not dumb to boot; he’s pretty much a mathematical genius, and I learned a lot from him as a kid, as much as I tend to credit my brains to the other side of the family. He has some sort of a computer engineering job for which he commutes to Portland, although he chooses to live right in our little home not-even-a-town. With my aunt Sue, to whom he credits my hippie-ish leanings, although I’m not entirely sure if I agree with him.

#147 JP Thank you. I will assume we all have good intentions and are diligent in searching for the truth using science as the basis for improving the well-being of all.
Yes, I do go astray; I am human.

I’d take issue with the idea that it’s no harder to make lentils and rice than ramen, but it is fairly simple.

It’s a one-pot dish that contains protein. If one can arse oneself to slice some onions and wait a few more minutes, it’s m’judra. I would not exactly file leftovers, even if cold, as a problem in the context of having a hard time feeding oneself in the first place.

It takes more effort to elevate ramen to something more than frank nutritional garbage – it’s finicky.

It’s a one-pot dish that contains protein. If one can arse oneself to slice some onions and wait a few more minutes, it’s m’judra. I would not exactly file leftovers, even if cold, as a problem in the context of having a hard time feeding oneself in the first place.

True enough; I have a mental recipe for kitcheree for which I typically just substitute red lentils for mung beens, and it’s pretty tasty. I guess the leftovers feel like more of a problem when one is a grad student, or at least, when one is a really busy grad student, and the choice between eating cold leftover rice-and-lentils, or warming them up on the stove, was sitting next to the choice of just getting a sandwich or something. What would usually happen is that the leftovers would get forgotten in the fridge, and then go bad, and become a pain to deal with. Time vs. money thing, I guess.

It takes more effort to elevate ramen to something more than frank nutritional garbage – it’s finicky.

Also true, although at times when I’ve been really broke and taking almost masochistically poor care of myself, I didn’t really care.

The Christmas mint porter was particularly outstanding.

Heaven help us all.

It was a chocolate mint porter, to be specific, and it was amazing.

Do you want to hear something even more blasphemous? I went to a coffee place next to the farmers’ market to get an iced coffee on Saturday, and it was noted that I was staring at the “mint julep” iced coffee abomination, and the lady asked me if I wanted one, and I said yes. And it was amazing.

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…strawberry-rhubarb preserves.

My grandma makes it with strawberries and rhubarb that my grandpa grows. Never tried it on ice cream but I’m sure it’s fantastic; that stuff would make drywall taste delicious.

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It takes more effort to elevate ramen to something more than frank nutritional garbage – it’s finicky.

The eternal struggle. You are really starting from a deficit so with whatever amount of time and effort you put into it could almost certainly have resulted in a better dish from scratch. I just add a splash of Sriracha and accept that I’m eating ramen because it’s cheap and I’m too lazy and don’t care enough to do better.

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I guess the leftovers feel like more of a problem when one is a grad student, or at least, when one is a really busy grad student, and the choice between eating cold leftover rice-and-lentils, or warming them up on the stove, was sitting next to the choice of just getting a sandwich or something.

Oh the simple joy of having a microwave at work. Leftovers become the solution not the problem.

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Do you want to hear something even more blasphemous? I went to a coffee place next to the farmers’ market to get an iced coffee on Saturday, and it was noted that I was staring at the “mint julep” iced coffee abomination, and the lady asked me if I wanted one, and I said yes. And it was amazing.

Some people like plain black coffee, I’m partial to drinks with at least five or six words in the name. Sure I get crap about my “girly” drinks but I say it’s a small way of promoting gender equality.

My grandma makes it with strawberries and rhubarb that my grandpa grows. Never tried it on ice cream but I’m sure it’s fantastic; that stuff would make drywall taste delicious.

Back when I was a kid, my mom used to make strawberry-rhubarb crisp, which was, of course, the best. My dad’s particular favorite was peach crisp, which is pretty much a tie for me; both are great with vanilla ice cream.

I just add a splash of Sriracha and accept that I’m eating ramen because it’s cheap and I’m too lazy and don’t care enough to do better.

Yeah, that has been pretty much my approach as well. I mentioned something about being broke and eating ramen when I was back home visiting and got culinary tips from my brother, of all people; he recommended stirring in an egg, which is actually a nice addition. Also grated vegetables.

Oh the simple joy of having a microwave at work. Leftovers become the solution not the problem.

That is actually a good point; there’s a microwave in the shared Slavic-German kitchen, and I am in the office almost every day at this point. Maybe I’ll invest in some Tupperware-type stuff. Actually, I should have done that a long time ago.

Some people like plain black coffee, I’m partial to drinks with at least five or six words in the name. Sure I get crap about my “girly” drinks but I say it’s a small way of promoting gender equality.

🙂

I like plain black coffee myself, but I just can’t bring myself to make hot coffee in my apartment in the summer, as it is usually hot and sticky, again, not having AC. I end up falling for iced coffee at a coffee shop, and for some reason, I do like sweetener in iced coffee, but never hot coffee. I go back and forth when it comes to half-n-half…

True enough; I have a mental recipe for kitcheree for which I typically just substitute red lentils for mung beens, and it’s pretty tasty.

Minimal kitchari (or pongal) prep is ginger and chilis if one has hing. Then fry the spices, etc., and wonder if there are cauliflower and peas in the freezer. I find onions and m’judra simpler. Sometimes there’s even some uncooked meat that needs to be saved. In with the onions.

(I did however manage to spend four hours Friday night in just the cooking phase of an improvised “saag gobhi gosht.” The one external reviewer seemed enthusiastic.)

I guess the leftovers feel like more of a problem when one is a grad student, or at least, when one is a really busy grad student, and the choice between eating cold leftover rice-and-lentils, or warming them up on the stove, was sitting next to the choice of just getting a sandwich or something.

Yah, I can’t really eat during the day, as it knocks me out cold, so sticking a two-cup ceramic dish in the oven at night isn’t really that much of a problem over here if I made something too bland to be eaten straight from the fridge.

I just add a splash of Sriracha and accept that I’m eating ramen using it because it’s cheap and I’m too lazy and don’t care enough to do better.

I believe that I’ve set out my feelings about this substance in a separate food digression.

I believe that I’ve set out my feelings about this substance in a separate food digression.

Wait, your feelings about Sriracha?

^ I mean, yeah, the rooster sauce is basically a semi-faux SE Asian spicy ketchup-type thing, but I’ve been known to use it liberally.

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

“Integrative medicine” always provides answers, regardless of the question. What it never provides is any evidence that the answer is actually helpful.

I have difficulty conceptualizing a population that is reduced to insisting upon extra-mild mashed potatoes.

I would call your attention to some of my Polish immigrant friends, who are literally terrified of anything “hot” beyond the addition of a little black pepper, and sometimes even then.

I have been known to accidentally give a negative answer to the question “Is it spicy?” with angrily accusatory results.

^ I specifically remember trying to convince my friend Jana to give Indian food a go, after she had denounced it because it was “spicy.” Even the freaking palak paneer was “too spicy,” according to her.

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…he recommended stirring in an egg, which is actually a nice addition. Also grated vegetables.

Egg is good. If you time it properly you can get a nice poached egg.

Maybe I’ll invest in some Tupperware-type stuff. Actually, I should have done that a long time ago.

Hillshire Farm lunch meat comes in these plastic containers with red lids that work very well. They don’t have the microwave symbol on them and honestly seem to get a little melty when nuked but that doesn’t stop me.

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I believe that I’ve set out my feelings about this substance in a separate food digression.

I wouldn’t eat a bologna sandwich without Miracle Whip, I’m not about to eat Top Ramen without Sriracha.

Re. Renata @ 115:

Of course it’s not popular. Alcohol & caffeine are “the 21st Century Cigarettes,” the drugs “everyone” loves and for which “everyone” makes excuses.

But it’s also an incontrovertible fact that alcohol dissolves cell membranes and passes the blood/brain barrier, thus dissolving neurons in brains. That makes it an overt neurotoxin, and this is one place where words beginning with “tox-” aren’t a load of wooey BS. If there was a safe & efficacious medicine to re-grow neurons quickly, that wouldn’t be a problem. But there isn’t, so it is.

Consenting adults should arguably have every right to saturate their brains with their preferred neurotoxins as long as they don’t harm anyone else: but a fetus that one intends to keep qualifies as a “someone else.” If anything, humans need more & better brains, not impaired & damaged brains, especially to face the existential challenges of our times.

If we can reasonably expect women to give up smoking when they become pregnant, we can reasonably expect them to give up alcohol as well. And for the sake of equality, as well as the pragmatics about access to alcohol, their partners (usually male) should do likewise. Punching out the circled A on their drivers’ licenses merely puts teeth in the recommendation. (Social arrangements in general need to be altered such that males have more “skin in the game” when it comes to pregnancies.)

So here’s another “modest proposal,” and partial credit to you for this one: When diagnosed with a pregnancy, the woman has a choice: keep the pregnancy and stop drinking, or keep drinking and abort the pregnancy. If she elects to keep the pregnancy and stop drinking, she has to bring in her partner for a follow-up visit where both of them lose their circled-A for the duration.

And while we’re on the subject of drug policy: I would also make caffeine an “age 18” drug, as it’s the real “gateway drug,” far more powerful than people usually give it credit for, and also physically addictive. Caffeinated sodas for children, and coffee drinks that resemble milkshakes, are like giving candy-flavored cigarettes to kiddies.

I found it interesting that a hospital in the Bay Area that chose to stop making sugary foods & beverages available, still had coffee on tap, freely flowing, and presumably available to children. The sacred cow of caffeine again, and a drug-culture making excuses for itself. Frankly pathetic.

I used to believe that psychedelics & entactogens should be re-classified to Schedule III to foster more research & legitimate clinical uses. But reading Orac’s columns about the activities of quacks, has convinced me that they should instead be re-classified to Schedule II (more restrictive than Schedule III, but better than Schedule I which is scientific Siberian exile), which would also enable legit research & clinical applications but would sharply limit the risk that various quacks would mis-prescribe and over-prescribe them in an abusive manner.

Re. “comfort foods” at hospitals and elsewhere:

Regardless of who said what above, it’s entirely reasonable to provide a diverse menu at hospitals, including “comfort foods” that may happen to be fatty, sweet, calorie-laden, etc. Foods have emotional connotations, and an “austere” diet for those who are visiting loved ones with life-threatening diagnoses, is a gratuitous “cold prickly” where more “warm fuzzies” are clearly called for.

From my experience (and recognizing that anecdotes != data), the strongest influence for eating healthier foods is the context of meals with close friends & family. That context changes the emotional associations of certain foods from “cold” to “warm,” from “austerity” to “loving relationships.” When someone you love says “let’s make XYZ (healthier food), you’ll love it,” it’s hard to say no, and when the emotional context is one of togetherness with loved ones (and of course it helps if you’re hungry so your appetite is up), the attitude toward particular foods changes. By way of which I’ve recently added significantly more salad to my diet and a few meatless meals per week.

(Going metaphysical on that: the fact that emotional states & responses are chemical and therefore deterministic, can be put to good use by freely-willed (nondeterministic) choices to engage those mechanisms.)

But it’s also an incontrovertible fact that alcohol dissolves cell membranes and passes the blood/brain barrier, thus dissolving neurons in brains.

You don’t say.

@ Gray Squirrel
We can expect everything from people, but the question is if we can force them in doing so. Some things, yes, but other things, not so much, unless you want to live in some kind of police-state.
People should have their offspring best interests in mind, but the big question is how much force we can use.
And the option keep drinking and or smoking and have your child aborted, might sound resonable to you, but to me it sounds like a lot of problems, not to mention a slippery slope. Pregnant people can decide to hide their pregnancy and not seeking proper help at all. And I think that would make matters worse.

Some things, yes, but other things, not so much, unless you want to live in some kind of police-state.
People should have their offspring best interests in mind, but the big question is how much force we can use.
And the option keep drinking and or smoking and have your child aborted, might sound resonable to you, but to me it sounds like a lot of problems, not to mention a slippery slope.

Most of Gray Squirrel’s recently opined-upon notions about the ideal society seem pretty much totalitarian to me, but I just haven’t really been able to bring myself to bother replying.

^ Haven’t gotten around to replying largely because they are pure “what if things fit my perfect ideal” kinds of brain-droppings anyway, and not related to any sort of real thing that has a chance of happening in the first place.

#129

While things have been improving (baby steps), probably one of the most significant contributions to US excessive medical spending has been the “hidden” tax subsidy involved in employer-based insurance.

It isn’t really hidden, but not to be mentioned in polite company, I suppose.

“I have difficulty conceptualizing a population that is reduced to insisting upon extra-mild mashed potatoes.”

You need to meet the spousal unit.

(On the other hand, he likes — and grows — rhubarb)

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(On the other hand, he likes — and grows — rhubarb)

Never understood rhubarb. Through some kind of insanity it makes a delicious jam with strawberries but it is an awful, nasty tasty plant. My grandpa will eat it raw straight from his garden though.

But it’s also an incontrovertible fact that alcohol dissolves cell membranes and passes the blood/brain barrier

is it? I know that ethanol dissolves *in* neuron cell membranes… as do xenon, and krypton, and all manner of other anaesthetic agents. Then the extra pressure within the cell membrane facilitates gabanergic pathways, which I for one regard as a good thing because my gabanergic receptors are not doing their job properly by themselves. But “dissolving the cell membranes”?

Your grandpa is weird. Sorry to make a judgment call on a stranger, but still.

Three fruit jam with rhubarb, and rhubarb pie. Oh yum.

But it’s also an incontrovertible fact that alcohol dissolves cell membranes

That explains the hole in my arm where I spilled some gin last night.

capnkrunch,

Never understood rhubarb. Through some kind of insanity it makes a delicious jam with strawberries but it is an awful, nasty tasty plant. My grandpa will eat it raw straight from his garden though.

I used to do that when I was a kid, but stopped when I had a bout of renal colic, which is even less fun than it sounds. It isn’t certain but I strongly suspect the oxalate in the rhubarb was to blame, especially since I have had no problems since, even when I have been quite dehydrated.

I hereby announce that *I* also eat rhubarb raw and like it. However, I sometimes will dip it into a saucer with sugar for extra flavor. And my mom makes an awesome rhubarb pie. (DO NOT speak to me of strawberry-rhubarb pie, which is an abomination.)

What!
Narad doesn’t eat in the daytime either.
If I eat before 4 I feel terrible so I don’t.
Needless to say, this has enabled me to stay relatively thin.

I rarely if ever drink coffee except Cappuccino when it’s cold outside- although I once drank black coffee exclusively- oddly though I was in a study for a restaurant corporation to determine which high end coffee they’d use as their house brand.

I don’t know what to make of Sriracha although I bought some and occasionally throw it into chicken- NOW I can’t because one of my creatures ( two legged) likes to share chicken with another creature ( 4 legged) and the latter has IBS/ IBD.

I’ve decided that all of these trendy sauces/ additions taste wonderful if you mix enough of them together that you can’t taste any one distinctly.

I wouldn’t eat a bologna sandwich without Miracle Whip salad cream

FTFY (~4:50).

The only culinary question regarding bologna is how to address the puffing when it’s fried.

But it’s also an incontrovertible fact that alcohol dissolves cell membranes

At sufficiently high concentration, perhaps, but not it’s not going to “dissolve neurons in brains” at any circulating concentration one could achieve in a still- living organism.

Wow, drinking licenses, rhubarb, Sriracha.

Gray Squirrel, I made the comment about getting your hands out of my goddamned uterus because I saw where this was going. Get your hands out of my goddamned uterus. 🙂

ken, I am sorry you are unwell.

#129

While things have been improving (baby steps), probably one of the most significant contributions to US excessive medical spending has been the “hidden” tax subsidy involved in employer-based insurance.

It isn’t really hidden, but not to be mentioned in polite company, I suppose.

Your nonresponse to the actual comment, noting your usual Fail, is duly noted.

Oh, wait, who could forget that your ultimate cowering position is resorting to the imaginary title of “the master of using cryptic comments to draw people into debate.”

Nobody’s interested in “debating” you, Z.; you’ve long since proved yourself a one-trick zony. The only thing left is idly watching the failure modes.

(DO NOT speak to me of strawberry-rhubarb pie, which is an abomination.)

Amen to that!
Rhubarb pie or strawberry pie (raw berries with a glaze), yes. Mixed, yuk! Besides, by the time the strawberry patch is delivering the goods, the rhubarb is getting a might old and stringy.
My mom used to make a wonderful rhubarb rightside-up cake (it being a tad sloppy for inversion prior to serving).

(DO NOT speak to me of strawberry-rhubarb pie, which is an abomination.)

Amen to that!

I concur. Yamuna Devi did offer a beverage recipe for “chinarcha sharbat,” incorporating rhubarb and pomegranate, that sounds promising in general, but strawberries are merely interlopers in the modern day.

I can only hope that the combination was born from a time of rhubarb privation.

Strawberry rhubarb pie is divine, but ONLY when it’s made with Ontario strawberries. American strawberries are uniformly atrocious.

Rhubarb is best served stewed, then over vanilla ice cream. It’s also really good in a crisp.

@Delphine – my favorite rhubarb pie is rhubarb, orange peel, a little vanilla, sugar and corn starch for the filling. 😉

I just don’t like warm, limp strawberries.

Back before I decided that the Chicago Reader was simply a net loss in terms of recycling effort, I didn’t exactly have a high opinion of Ernie Pook,* but the baloney one was pretty good.

* Don’t even get me started on the sustained idiocy of “Red Meat.”

Back before I decided that the Chicago Reader was simply a net loss in terms of recycling effort, I didn’t exactly have a high opinion of Ernie Pook,* but the baloney one was pretty good.

I’ve been a fan ever since I was gifted a copy of a biggish anthology by a teacher in middle school who said it reminded him of me. I was never sure quite how to take that.

I found particularly resonant the strips from the period when “mom found Jesus and moved us to the Tawny Hill trailer park!”

Why did Kindle autocorrect my nic?

I used to eat rhubarb raw as a child. I cannot anymore. Have been on the prowl for it all spring with no luck. Will plant it next year in the landscaping at the farm (all about edible, mostly perennial, landscaping).

Too bad our esteemed host couldn’t correct my name. My son is highly judgmental of pregnant women who misbehave, be it smoking, drinking, drugs… I try to encourage a little mercy – he is neither male nor has he ever struggled with or tried any addictive substances beyond the occasional soda – but he insists a good parent believes sacrificing for the Health of their child is the only responsible thing to do.

On the original topic. I know a lot of patients who love “other options.” I personally feel insulted when I am offered options with little plausibility – it says, “here is this imaginary cure.” Does that mean my disease is imaginary?

Lately it is hard to be rational. I would love to believe in magic.

I used to eat rhubarb raw as a child. I cannot anymore. Have been on the prowl for it all spring with no luck. Will plant it next year in the landscaping at the farm (all about edible, mostly perennial, landscaping).

We used to have giant bushes of it growing all over the place, and I also used to just take a stem and walk around gnawing on it. I’ve always been a bit weird, though.

It was also fun to play with: elephant ears, ineffective wings, palm fronds for an impromptu Hosanna. The possibilities were endless.

Lately it is hard to be rational. I would love to believe in magic.

Yeah, me too. I have been wishing for a magical pain eraser for pretty much my whole life now, but so far no dice. Various substances have only limited utility.

I did get to meet a friend’s newly adopted greyhound today, and go walking through a forested park, which was nice. (The dog’s name is Lincoln and he is very sweet.)

I also got news that a young person’s asylum case, for which I’ve done a lot of pro bono translation work over the past year, was successful, which was great to hear and had the mild side benefit of making me feel less like a completely worthless and despicable person.

@ORAC
“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.”

Much as I detest the term “alternative” for the very reason you point out, I have to disagree with your statement that validation by science necessarily means that a particular treatment will become part of medicine. In the U.S., at least, no matter the number of randomized double-blind, placebo-controlled trials, unless a treatment is approved by the FDA, it can not be legally integrated in medicine.

Lighthorse: “I have to disagree with your statement that validation by science necessarily means that a particular treatment will become part of medicine.”

What is your verified alternative proof of the treatment? Please do not say “testimonials”, since those are just unverified anecdotes.

Chris: There is no “alternative” proof; a substance is either effective or it is not. My argument is that regardless of well controlled clinical trials (randomized double-blind, placebo-controlled) of a given substance, it may not become integrated in medicine for the treatment of disease due to legal constraints. In the U.S., no matter the number of such well controlled trials, a substance may not be legally prescribed in the treatment of a given condition without approval of the FDA.

There is no “alternative” proof; a substance is either effective or it is not.

This is an awfully naive characterization.

My argument is that regardless of well controlled clinical trials (randomized double-blind, placebo-controlled) of a given substance, it may not become integrated in medicine for the treatment of disease due to legal constraints.

Do you have any specific examples in mind?

In the U.S., no matter the number of such well controlled trials, a substance may not be legally prescribed in the treatment of a given condition without approval of the FDA.

Once again, either naive or sloppy: off-label prescribing is perfectly fine.

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