Respectful Insolence

FAQ: Woo versus non-woo

I don’t think I could have done it much better, if at all.

Dr. R.W. presents, in FAQ-form, a primer on the difference between woo and conventional medicine, even conventional modalities that are weakly grounded in evidence.

A couple of examples:

Many of mainstream medicine’s conventional treatments are not evidence based. Aren’t they a form of woo?

No. Although some conventional methods fail to measure up to best evidence they are at least based on known anatomy and physiology. They have some plausibility in the observable biophysical model in contrast to the “vital forces”, nebulous “energy fields” and “non-local powers of the mind” which are characteristic of woo.

But most importantly, he describes why it’s important to distinguish woo from non-woo:

Then why make a distinction?

Because of important differences in the ways the problems manifest themselves. Mainstream medicine applies a double standard and that’s what I’m trying to expose. People in the mainstream are appropriately critical of conventional deviations from best evidence and are trying to correct the situation. But due to the nature of the problem—a complex interplay of system and cognitive failures—the fix is not easy. In contrast (and here’s where the real hypocrisy comes in) mainstream medicine uncritically embraces woo, applying to it a much easier evidentiary standard and often no standard at all. The remedy for the problem of woo would be much simpler, too. Mainstream medicine could simply say no. Woo, by definition patently implausible, is easy to spot. There’s nothing complicated about it.

He’s referring to the way that woo is creeping into conventional medicine in our hospitals, in our medical students, and in medical schools themselves, even as mandatory classes. And he’s right; we do apply a different and weaker evidentiary standard to woo, primarily because patients want it, and we don’t want to lose them. Hence, woo becomes a marketing tool.

I know some here probably get tired of hearing me say this, but there should be no such thing as “alternative medicine.” There should just be medicine, and the same standards of biological plausibility, scientific evidence, and clinical evidence should be applied to both.

Is that so wrong?

Comments

  1. #1 jba
    December 18, 2006

    “Is that so wrong?”

    In and of itself I would have to say no. Unless what you are saying is that the things that are classified as ‘alternative medicine’ now shouldnt be available to people. I think that would be wrong. If you are saying that every form of medicine should be thoroughly tested scientificly and the risk/gain (if any) explained to every patient before treatment is started, then not only would I say its right, but appalling if they arent doing it already. But if someone thinks that the only cure for them is to drink a silver solution, even after having it explained to them that its stupid and pointless… well its their choice I would say.

  2. #2 Mustafa Mond, FCD
    December 18, 2006

    Down with the Woo!

  3. #3 Koray
    December 18, 2006

    The term “alternative medicine” is troublesome to me. Why, an alternative as a an acceptable (or preferred) substitute? No, I don’t think that’s what they mean. Is there a CAM substitute for aspirin or tylenol?

    I think they mean an alternative approach as the standard (evidence based) approach failed. Is that the only case where we need alternatives?

    CAM sounds like imagining a solution exists when you cannot demonstrate to yourself if/why that solution works.

    Very interesting point regarding patients who want woo. The customer is always right, eh?

  4. #4 Coin
    December 18, 2006

    The term “alternative medicine” is troublesome to me.

    Maybe it’s the alternative to medicine?

  5. #5 Bronze Dog
    December 18, 2006

    I’ve been making a note to avoid using that particular phrase. The closest I come is “alties.” I call it for what it is: “Quackery” or, in the off chance it might actually show promise, experimental medicine (in which case they’d better not drag their feet).

  6. #6 Coin
    December 18, 2006

    Alties just sounds like it ought to be a brand of breath mint.

  7. #7 neil
    December 18, 2006

    I am a final year medical student a firm believer in the scientific method and evidence based medicine. Yet I have encountered classmates all too ready to embrace woo. I have even spoken up in class attacking some of them for it, a move that made me quite unpopular. I think part of the problem is the lack of understanding of the importance of the scientific method and forgetting we should base our views on reason and logic especially when it comes to our patients. Medics have a duty to think scientifically, anything less then we are only subjecting our patients to our own beliefs and nothing more. Its more disturbing than creationist med student this blogged linked too back in April . . . .

  8. #8 Ron Zeno
    December 18, 2006

    “Is that so wrong?”
    But then you leave an untapped market of people willing to spend their money on unproven and disproven treatments ;)

  9. #9 Orac
    December 18, 2006

    Sorry, as tempted as I may have been to indulge these people’s desire for woo, I just can’t bring myself to do it. It goes against everything I stand for.

  10. #10 Suzanne Zane
    December 18, 2006

    As a veterinarian and as a human disease epidemiologist, the woo has always caused me great distress. I will not offer it to my veterinary clients, although if they strongly profess to desire woo from another doctor, I do attempt, if I believe that it may cause harm, to dissuade them politely with facts about their pet’s disease process. Unfortunately, it is up to them to cause their own pocketbook harm the in the situations in which woo would be clinically benign.

    As an epidemiologist with a major federal agency, I feel extremely fortunate to operate within a woo-free scientific, evidence-based environment. I know what a rarity this is, as I live in a severely woo-filled city (Portland, Oregon), which has multiple institutions of “higher” education espousing the woo.

  11. #11 rhubarb
    December 19, 2006

    “Is that so wrong?”

    Not only is it not wrong, it’s all kinds of right. It’s the reason I read your blog, it’s the reason you got all my paltry votes for best medical blog, and I’d like to think it’s the reason you won.

    Your fight against woo has helped this random layperson become more educated and better equipped to rationally discuss my health care with my physician (who’s anti-woo, too).

    The fact that you have a Dalek cookie jar doesn’t hurt, though. ;)

  12. #12 doctorgoo
    December 19, 2006

    This is a great FAQ you and Dr RW gave us. But I have a couple specific examples that I’m not sure if they qualify as woo or not. They both involve, what are in my mind, questionable practices that have become widespread by certain types of healthcare practitioners.

    1. My dentist is one of those who refuse to give people amalgam fillings even though the American Dental Association has repeatedly said it is safe. Is she falling for mercury-based woo?

    2. I used to go to a chiropractor who treated my back pain due to scoliosis (which is a birth defect in my case) in a reasonable manner without woo. Then I moved and had to find a new chiropractor. This new guy was terrible. Not only did he promote the concept of sublaxations, but he had posters in his office that used scare tactics to encourage parents to bring in their kids as young as 4yo to get treatment on everything from preventing earaches to increasing intelligence. And believe me, this was just the tip of the iceberg when it comes to his wooery.

    But even though his woo was completely obvious, I found him through a referral from my insurance company of all places! I thought that it was in the best interests of insurance providers to only provide coverage for EBM, but apparently they have no problem covering woo as well.

    I have 2 questions about chiropractic. First, how much of it is woo and how much is based on EBM?
    In my case, I don’t consider my first chiropractic experience to be woo at all. She relieved my back pain and even taught me some exercises to do on my own to help me even further. I went to her instead of a regular massage therapist because they don’t study anatomy as much and wouldn’t fully appreciate the severity of my peculiar back problems.

    My second question is this: How much has woo, in general, become covered by insurance companies?
    You said that doctors sometimes promote the more benign forms of woo as a marketing tool. And I guess I’m okay with that. If an idiot wants to pay extra on some junk just to get a placebo effect, I have no problem with a doctor giving it to them as long as it doesn’t impact the evidence-based treatments. But I find it totally outrageous and unacceptable that I must pay higher insurance premiums so that these idiots can get their woo for free.

  13. #13 The Loony Bassoony
    December 19, 2006

    The scientific method is the best defense against personal bias when treating patients. While many “alties” are successful in large part because they treat their patients more personally (and the importance of a good bedside manner really cannot be overstated in conventional medicine either), I think the biggest problem facing the proponents of woo is their own personal bias. The fact that they embrace woo is evidence that they do not have a clear understanding of the scientific method, and that means they cannot be entirely trusted to be objective when providing medical care.

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