Respectful Insolence

Dr. R. W. asks (and answers) the question, pointing out in detail how:

  1. Promoters of unscientific claims often reject ordinary scientific standards for experimental design and evidence.
  2. Even government funded CAM research is troubled with serious methodologic flaws.
  3. Research on complementary and alternative methods is conducted without regard to biologic plausibility.
  4. The proponents and funders of alternative medicine research do not accept negative results.
  5. Government oversight is biased in favor of complementary and alternative medicine.

He’s right on all points, although he forgot that medical schools are now uncritically promoting non-evidence-based “alternative medicine,” even adding it to the mandatory medical curriculum. Sadly, from my perspective, it may be too late to stem the tide of woo that’s becoming more and more embedded in the American medical system.

Comments

  1. #1 Dale
    May 17, 2007

    As long as medicine is treated as a business and the goal of business is give the customers what they want, I think CAM will remain a growth industry.

  2. #2 sailor
    May 17, 2007

    Of course CAM can be tested, we are not working entiirely in the spirit world here. A good recent study was the one on acupuncture which showed sticking needles in was effective placebo (It worked as well wherever the needles went). It is true as the negative results come in the CAM crowd run to the next level of defence – “oh double blind does not work” – “it would break the relationship between the patient and the doctor”. None the less a good test showing CAM does not work is very usueful ammunition in dealing with the matter, expecially in the case of funding and insurance. Just because the practicioners rationalize the results is neither here nor there.

    I also find this one interesting: “Research on complementary and alternative methods is conducted without regard to biologic plausibility.” considering some drugs started life treating one diseas and ended up treating another on no other reason than it worked. Sure once we know something works we are pretty good at finding out why – but the relationships are not always obvious initially.

  3. #3 S. Rivlin
    May 17, 2007

    There is a correlation between the increasing strength of the religious right in this country and CAM. As long as the power of this segment of the population grows, there is a very good chance that the supernatural will soon be taught in the basic science class along, of course, with creation (intelligent design).

  4. #4 Roy
    May 17, 2007

    For $1.98 I’ll see you a dowsing rod that tells true woo from foo woo.

    Seriously, as to your title question, the answer is solidly ‘no’. Because you can’t test what you can’t catch, and you can’t catch these pesky critters.

  5. #5 Science Avenger
    May 17, 2007

    Of course it can, and it has. It is not the fault of the scientific method that the supporters of woo refuse to acknowledge the evidence. As long as we are a culture of truthiness, woo will be with us.

  6. #6 Nat
    May 17, 2007

    Good list. You can’t play the game of reality with woo-woos because they will not respect or recognise the rules of the game or reality when presented with them.

    I agree with Sailor that biological plausibility is a bit of a weak criteria. One can invent biological plausibility for just about anything anyway. And it’s not required of an effective intervention that we actually understand how it works in order for it to still be effective (Aspirin).

    Could we perhaps replace biological plausibility with “funders and promotors of CAM are hopelessly financially entangled with conflicts of interest”?

    That might bring one to argue that CAM should be treated exactly the same as all other medicine instead of being treated like a second class retarded cousin who needs special treatment and to be humoured.

  7. #7 Nat
    May 17, 2007

    Good list. You can’t play the game of reality with woo-woos because they will not respect or recognise the rules of the game or reality when presented with them.

    I agree with Sailor that biological plausibility is a bit of a weak criteria. One can invent biological plausibility for just about anything anyway. And it’s not required of an effective intervention that we actually understand how it works in order for it to still be effective (Aspirin).

    Could we perhaps replace biological plausibility with “funders and promotors of CAM are hopelessly financially entangled with conflicts of interest”?

    That might bring one to argue that CAM should be treated exactly the same as all other medicine instead of being treated like a second class retarded cousin who needs special treatment and to be humoured.

  8. #8 Sydney
    May 17, 2007

    The last I heard, RCTs had found no difference between groups that had real accupuncture performed, and those who had sham accupuncture done. They were planning on doing brain imaging as added evidence as well. So what it’s the placebo effect. We all know how effective that is.

  9. #9 wanderingprimate
    May 17, 2007

    Orac-”…although he forgot that medical schools are now uncritically promoting non-evidence-based “alternative medicine,”

    This is becoming a real problem as sCAM weasles its way from fringe “seminars” and general CE courses into the very core of university settings.

    Dale- “As long as medicine is treated as a business and the goal of business is give the customers what they want”

    Also, I wonder if society wants a change from demanding a level of evidence based medicine… so far that has been our charge- do what works. Unfortunately,it seems things are getting muddled.

  10. #10 Chris
    May 17, 2007

    I think you’re underestimating the kind of biological implausibility Orac is talking about. For a drug to have unexpected effects isn’t that implausible. For distilled water to have unexpected effects based on what was in it last week before it was diluted to less than one molecule per dose, *that’s* biologically implausible. Treating people by having them mail you their photographs which you then focus your energy on is biologically implausible.

    Yes, in the ordinary sense of the word chiropractic (for conditions unrelated to the spinal column) and reflexology are “implausible” too – but it’s not (IMO) a complete waste of time and funds to test them. Long-distance healing by chi waves or prayer shouldn’t be getting any public funding for testing (let alone getting into the curricula of accredited medical schools).

  11. #11 Ryan W.
    May 17, 2007

    Sorry this is off topic, but I’m trying to get a question answered, and don’t have a lot of people to discuss it with.

    I’ve been interested for some time in the effect of ascorbate on drug detoxification (via glutathione production) and prevention of tolerance. Maybe you could help me sort something out?

    I know that ascorbate is capable of increasing detoxification and clearance of various drugs. However there’s been at least (__ "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6686637&dopt=Abstract">one study__ suggesting that it may allow certain drugs to be used without danger of dependence or addiction. Is this true, or was the study poorly designed, with the lack of dependance due entirely to more rapid drug clearance?

    Thanks!

    Ryan

    (email: wiserd_at_sign_yahoo _dt_com )

  12. #12 angry doc
    May 17, 2007

    Dr RW may not have mentioned the teaching of woo in medical school in this post, but he is a vocal opponent of that.

    As for acupuncture, there are studies that show that poking needles into people does relief certain types of pain more than not doing anything to them (duh!) or sticking sham-needles (retractable-end needles) into them, even though where in that person you stick them doesn’t really matter. That suggests to me that there might be biologic mechanisms behind dermapuncture, but certainly the qi and meridien bits do not reflect observed reality.

  13. #13 angry doc
    May 17, 2007

    Sydney,

    They’ve already done the brain imaging thing:

    http://archives.cnn.com/1999/HEALTH/12/01/brain.acupuncture/index.html

    http://news.bbc.co.uk/2/hi/health/4493011.stm

    BBC and CNN try to make it sound like “brain imaging proves acupuncture works!”, when in reality it’s just “your brain knows when someone sticks a needle into you!”.

    Uncritical mainstream media is another reason why woo is popular.

  14. #14 Orac
    May 17, 2007

    Dr RW may not have mentioned the teaching of woo in medical school in this post, but he is a vocal opponent of that.

    Believe me, I’m well aware of that. I’ve a regular reader of Dr. R.W.’s blog for many months now, and I’ve cited him many times in my own rants about teaching woo in medical school.

    I was merely giving him a friendly tweak. ;-)

  15. #15 R. W. Donnell
    May 17, 2007

    S. Rivlin:
    “There is a correlation between the increasing strength of the religious right in this country and CAM.”

    I can offer at least one counter example to that. The American Medical Student, a far left leaning group, promotes more woo than any other organization I’m familiar with.

    I think there’s a lunatic fringe on both ends of the political spectrum that promotes woo.

  16. #16 Robert W. Donnell
    May 17, 2007

    Oops! I meant to say the American Medical Student *Association*.

  17. #17 Andrew Dodds
    May 18, 2007

    RW Donnell -

    The loony right fringe dislikes EBM/likes woo where it is promoted by authority figures, and because it isn’t ‘elitist’ like these medical schools with their fancy book-learnin’

    The loony left fringe dislikes EBM/likes woo where it is promoted as ‘natural’, and not done or based on big drug cooporations. Plus the whole ‘touchy-feely’ thing..

    It’s an ironic part of western society that, with modern technology and medicine having given people both long lives and material wealth undrempt-of by kings a few hundred years ago, these things are now so disregarded..
    (Unless you happen to be chinese or indian, of course.)

  18. #18 James
    May 18, 2007

    I agree Andrew, though I think there are more problems than just on the fringe. Psuedoscientists have an adge over actual scientists when dealing with politicians because politics is a very relative business, almost everything is negotiable.

    In science, by contrast, almost nothing is negotiable. In science things are right or they are wrong. This is not an attitude that politicians are used to.

  19. #19 Kelly
    May 18, 2007

    Back when I wrote at my other website (‘Time to Lean’), I wrote about how my nursing school was testing us on the basics of things like reflexology and healing touch. We even had to demonstrate a couple of different Healing Touch techniques to pass one of our lab classes, making sure to keep our hands at a certain distance, etc. This wasn’t done as an exercise in critical thinking, it was done to promote it as good nursing care. We also routinely received brochures from professors which encouraged us to get additional expensive training in these things. Our nursing school, of course, had a CAM research center.

  20. #20 Kelly
    May 18, 2007

    Also, it’s not the “right” that likes woo, it’s usually the new age far leftists. It would be contrary to the beliefs of the religious right to believe in magic. The only complementary medicine that the right believes in is prayer, which, I believe, actually works to assist in healing, if not due to the placebo effect.

  21. #21 vlad
    May 18, 2007

    I think there needs to be a non-biased oversite commity on alternative medicine. I think some of it might actually work (however unlikely), though if it does work it’s a very small amount of it. As far as biological plausability, last I checked there’s all sorts of bio chemical interactions that we do not understand. However the faith healing chi wave transmission stuff is total fraud. Does the nationaly funded center for CAM actually support this research? I though they only looked at herbs, refloxology etc. not wave of the hands and chant based healing. Herbs may have a real effect, some do and if you doubt that take a look as aspirin.
    All CAM sould not be automatically dismissed without evidence.

  22. #22 Orac
    May 18, 2007

    Also, it’s not the “right” that likes woo, it’s usually the new age far leftists.

    I must strongly disagree with you here. Both are into woo. Dan Burton, for example, is anything but a New Age far leftist, yet he’s arguably the Congressional Representative most into woo. Another example, Dr. Lorraine Day is a serious woo-meister, but she’s a fundamentalist Christian (who threatens he critics with hellfire) and Holocaust denier who hangs out in far right-wing circles giving interviews to the likes of right-wing wingnut Holocaust deniers like Daryl Bradford Smith and has been associated with Ernst Zundel. Consider Abraham Cherrix. Support for his fight to choose woo over evidence-based medicine comes from the right.

    Perhaps the best example of this “woo from both sides” is antivaccination woo. New Age types attack vaccination as “unnatural” and a “big pharma conspiracy” while right wing woo-meisters attack it as being a “government conspiracy” to “poison their children” and take away their parental rights.

    Perhaps the ultimate example, at the risk of provoking an attack from the Hitler Zombie, is the Nazis. The Nazis were heavily into woo like naturopathy and promoted it widely once in power.

    No, woo is the gift that both the left and the right like to give, and I haven’t seen much of a difference in the propensity of either side to go for the woo.

  23. #23 Andrew Dodds
    May 18, 2007

    Vlad -

    Problem is, any non-biased, objective criteria are going to find that an awful lot of ‘alternative’ medicine is complete bunk, and even where (for example) herbs have a measurable effect, Pharmaceutacles based on these will be more effective and reliable.

    This will immediately get the oversite community widely criticized as biased and a tool of ‘Big Pharma’.

    Personally, I think that ‘alternative’ medicine already gets a much softer ride than evidence based medicine.

  24. #24 vlad
    May 18, 2007

    Oh, I am in complete agreement with the fact that alternative medicine get way way too soft a ride. When Pharmaceutical companies make a mistake they pay for it, really really pay for it. When alternative medicine makes a mistake they point to the disclaimer that all of them in this country have with the response “We said it isn’t meant to cure anything” or my personal favorite “Well we did say it was not for human use”. We all know who I’m taking about. I looked at the NCCAM website and it looks to me, that this was the initial intention of the group. As far as the Big Pharma argument I still can’t believe that people actually buy it. If any of these therapies worked “Big Pharma” would simply find a way to patent it get insurance to cover it and make even more money. The alties call Pharmaceutical companies greedy but then refuse to acknowledge this simple point. If the government was so controlled by Pharmaceutical companies the companies would simply patent the alties processes and sue them out of existence. How do they not see this as the ultimate outcome of their logic?

  25. #25 vlad
    May 18, 2007

    Oh, I am in complete agreement with the fact that alternative medicine get way way too soft a ride. When Pharmaceutical companies make a mistake they pay for it, really really pay for it. When alternative medicine makes a mistake they point to the disclaimer that all of them in this country have with the response “We said it isn’t meant to cure anything” or my personal favorite “Well we did say it was not for human use”. We all know who I’m taking about. I looked at the NCCAM website and it looks to me, that this was the initial intention of the group. As far as the Big Pharma argument I still can’t believe that people actually buy it. If any of these therapies worked “Big Pharma” would simply find a way to patent it get insurance to cover it and make even more money. The alties call Pharmaceutical companies greedy but then refuse to acknowledge this simple point. If the government was so controlled by Pharmaceutical companies the companies would simply patent the alties processes and sue them out of existence. How do they not see this as the ultimate outcome of their logic?

  26. #26 vlad
    May 18, 2007

    Sorry for the double post I got a server error and tried again apprently both went through.

  27. #27 impatientpatient
    May 19, 2007

    http://www.freepatentsonline.com/5114722.html

    This link is a patent on a homeopathic remedy made from Peyer’s Patches. Found purely by accident. And it is unbelievable. It would make a good FDOW story, but also highlights the lack of science and the preference towards anecdotes that is so prevalent with woo.

    My answer is no- not if it is left in the hands of people who are heavily invested in the result being positive.