Respectful Insolence

Some readers have been sending me links to this article on CNN.com entitled 5 Alternative Medicine Treatments That Work. Unfortunately, Your Friday Dose of Woo took up the time that normally would have gone into given this article the lovingly Respectfully Insolentâ„¢ treatment that this utterly credulous article so richly deserves and that you, my faithful readers, demand. Fortunately Mark over at denialism.com has taken the time to fisk this one in detail. Does that mean Orac has nothing more to say on this article?

You know the answer to that one. Mark just made it so that I can restrain my usual logorrheic tendencies and be succinct (or at least as succinct as I can be).

Just a look at the first paragraph should tell you all you need to know about the level of scientific reasoning this article demonstrates:

ATLANTA, Georgia (CNN) — Dr. Andrew Weil wasn’t sure exactly how he hurt his knee; all he knew was that it was painful. But instead of turning to cortisone shots or heavy doses of pain medication, Weil turned to the ancient Chinese medicine practice of acupuncture. “It worked — my knee felt much better,” says Weil.

Americans spend billions of dollars each year on alternative medicine, everything from chiropractic care to hypnosis.

Weil says alternative medicine can work wonders — acupuncture, certain herbs, guided imagery.

Any article that approvingly cites celebrity alternative medicine advocate Dr. Weil as an authority in this area without some skepticism is going to be depressingly credulous, and this one is no exception. I’m not going to go down the list of the five that supposedly work, except to mention that for all but one of them the evidence is extremely weak and mixed, as I’ve pointed out for acupuncture. Mark has discussed this well. My only question about this is: Who on earth is this “panel of experts” that the article keeps citing? The ones who are named appear to be all directors of centers of “integrative medicine” (translation: centers for diluting evidence-based medicine with non-evidence-based medicine) or to hold similar positions. Not a skeptical, scientific faculty member is to be found.

The part of the article that I’m going to focus like a laser beam on is this:

So how do you know what works and what doesn’t when it comes to alternative medicine? Just a decade ago, there weren’t many well-done, independent studies on herbs, acupuncture, massage or hypnosis, so patients didn’t have many facts to guide them.

But in 1999, eight academic medical centers, including Harvard, Duke and Stanford, banded together with the purpose of encouraging research and education on alternative medicine. Eight years later, the Consortium of Academic Health Centers for Integrative Medicine has 38 member universities, and has gathered evidence about what practices have solid science behind them.

Here, from experts at five of those universities, are five alternative medicine practices that are among the most promising because they have solid science behind them.

I’ve lamented time and time again the infiltration of woo into medical school curriculae (1, 2, 3, 4, 5, 6, 7). Indeed, it’s even showing up in the mandatory medical curriculum in at least one medical school, in the major medical student association (which credulously and actively promotes woo), and in the NIH, even to the point where some schools are credulously teaching about homeopathy.

Articles like the CNN.com article are one consequence of this infiltration of woo into academic medicine. Although these departments and institutes dedicated to “complementary and alternative medicine” (a.k.a. CAM) or “integrative medicine” (a.k.a. combining woo with non-woo) all claim to champion an “evidence-based” approach to CAM, in reality this claim does not really stand up to scrutiny. For example, four out of the five CAM boosters quoted in this article vastly oversold the benefits of the therapy discussed based on the evidence. Indeed, the number one modality stated in the article to have a solid evidence base behind it (acupuncture) and was represented as being highly effective against pain and nausea, when it is not at all clear that acupuncture is that effective against either, as I’ve pointed out before.

The bottom line is that the infiltration of woo into academic medicine is a threat to evidence-based medicine because it lends the prestige of scientific medicine to modalities that are not evidence-based, thereby promoting the belief that they are on an equal footing, even though the vast majority of them are not. In so doing, it blurs the line between science and non-science, between scientifically supported treatments and quackery. Moreover, the faculty of the institutes, divisions, and departments dedicated to CAM in medical schools are, by and large, not made up of skeptics, but of true believers, be they M.D.s or not, who apply a veneer of skepticism and science to their studies and curriculae and then give interviews to credulous reporters like Elizabeth Cohen to publish on CNN.com. Remember, there really is no such thing as “alternative medicine.” There is evidence-based medicine, and there is non-evidence-based medicine, the latter of which describes the vast majority of so-called “alternative medicine” modalities. When “alternative” medicine passes scientific muster through basic and translational experimentation and clinical trials, it is no longer “alternative.” It is just medicine.

Comments

  1. #1 mark
    October 5, 2007

    Magical, herbal, and spiritual healing has been around for thousands of years. I am an alternative healer. I practice scientific medicine. Scientific medicine is the alternative to the stuff that’s been around since the dawn of humanity and did not work particularly well.
    BTW, I’m about Dr. Weil’s age and sometimes my knee hurts without any obvious cause. I find an infusion of Humulus lupulus very useful especially on Friday afternoons.

  2. #2 peter
    October 5, 2007

    out of curiosity, what are your feelings towards corticosteroids. I hear about cortisone and prednisone quite a bit, but the reasons for their administration seems to vary widely. and I have seen what appear to be devastating side-effects from their use. (see last paragraph of “Uses” here.)

    I have almost come to think of them as the “drug-you-give-someone-when-you-don’t-know-what-else-to-do” and an alternative treatment in their own right. I have not yet been prescribed any, and I have a long list of weird side effects to common over the counter drugs that make me a bit suspicious about things I don’t know enough about.

    can you expand a bit there? I’m asking this here as the quote you referred to indicates that the guy in the article was looking for an alternative to cortisone. I don’t have any real regard for the alternative medicines that you are combatting, (a chiropractor seems to me a slightly more violent and rushed physical therapist. been to both, prefer the latter…) but there are times when I look at the history of some medications, (which I admittedly only have a cursory knowledge of,) and wonder at things like this.

    do you ever find yourself having a “wait a minute” moment about things like this? the sort of less obvious ‘woo’?

  3. #3 anon1234
    October 5, 2007

    I am reminded of a classic numerical analysis book called “Numerical Methods that Work”; that title is stamped in silver on the spine and cover, and printed on the title page, but if you look closely at the cover, you see “Usually” blind-stamped between “that” and “work”. Maybe CNN should adopt some device like this.

  4. #4 Brian
    October 5, 2007

    As long as it’s not before noon, Mark, I think you’re in the clear. I also find that little flower to be particularly helpful.

  5. #5 Onkel Bob
    October 5, 2007

    The problem I have with homeopathy isn’t so much that it works or doesn’t work, it’s that people don’t understand or investigate why it works. We have receptors for all sorts of chemicals that occur naturally, doesn’t mean that these chemicals are “good” or better than the “artificial” versions. I dislike homeopathy because it seems to rely heavily on anecdotal evidence instead of empirical evidence. Gee, that mushroom I ate tasted good, let’s eat the ones that look like it. Every year about this time, dozens of Mexican immigrants go into the emergency room for Amanita Phalloides poisoning because it resembles one found in the home country.
    Same holds true with homeopathy, it’s a roulette wheel.

  6. #6 Pi Guy
    October 5, 2007

    “I also find that little flower to be particularly helpful.”

    The sad thing is that that little flower has been shown to have therapeutic value. And yet, it’s perfectly legal for somebody who took a 90-day course in the back room of a massage parlor to stick needles into your body to stimulate your brain into ignoring your pain.

    I think that that’s rather inconsistent but, then again, I think that water is wet so what do I know?

  7. #7 geekinacyclotron
    October 5, 2007

    “But in 1999, eight academic medical centers, including Harvard, Duke and Stanford, banded together with the purpose of encouraging research and education on alternative medicine. Eight years later, the Consortium of Academic Health Centers for Integrative Medicine has 38 member universities, and has gathered evidence about what practices have solid science behind them.”

    This is one of those times I’m particularly thankful my school (UC Berkeley) doesn’t have a medical school. One trip to the local, independent “pharmacy” and a quick glance at the herbal remedies counter and you can see that this town is big into woo. The pharmacy is always crowded–clearly there are enough students all too ready to board the psudoscience train to CAM town.

  8. #8 Flex
    October 5, 2007

    Onkel Bob wrote, “The problem I have with homeopathy isn’t so much that it works or doesn’t work, it’s that people don’t understand or investigate why it works. We have receptors for all sorts of chemicals that occur naturally, doesn’t mean that these chemicals are “good” or better than the “artificial” versions.”

    Umm.

    Maybe because in a homeopathic preparation there ARE no chemicals left of the original substance? It’s not a matter of “good” or “artificial” chemicals, it’s a matter of there being no chemicals there are all.

    It’s a roulette wheel without a marble.

  9. #9 IanR
    October 5, 2007

    Of course faith healing “works”. When I take an aspirin for a headache, it works immediately. No need to wait for it to get into my bloodstream (or even all the way down my oesophagus). It even works for caffeine withdrawal – for about 15 minutes, and then my body wises up and my head starts hurting again. If I take something else, like ibuprofen, I have to wait for it have an effect chemically. I happily endorse aspirin as a very effective “alternative medicine” for pain. :)

  10. #10 Sastra
    October 5, 2007

    Eight years later, the Consortium of Academic Health Centers for Integrative Medicine has 38 member universities, and has gathered evidence about what practices have solid science behind them.

    I would also be very interested in seeing the Consortium of Academic Health Centers for Integrative Medicine’s list of the alternative practices which do not have solid science behind them, and should therefore be abandoned. Since every altie I meet hastens to assure me that there are worthless quack remedies out there (see, they’re skeptics, too), given 8 years this list must be quite long.

  11. #11 Orac
    October 5, 2007

    Ah, but that’s the point. Alternative medicine believers never abandon therapies that science shows not to work. Heck, over 20 years after clinical trials showed that Laetrile doesn’t do diddly-squat against cancer, there are still alternative practitioners in Mexico prescribing Laetrile.

    I had hoped that academic centers would be better, but in reality they are not. Oh, they play down the really wacky alternative therapies, like homeopathy and reiki, but they almost never flat out say anything like “homeopathy is not supported by scientific evidence” or “reiki is implausible at best and there is no evidence that ‘healers’ can manipulate ‘life energy fields.’”

    At least, I’ve yet to see any major medical center release a statement like that about any alternative medicine. Yet studies come out all the time that show that various conventional medicines don’t work as well as expected or even do harm (hormone replacement therapy, anyone?) or that experimental drugs just plain don’t work (AIDS vaccine, anyone?). The day I see one of these “integrative medical centers” publish as part of their literature a list of alternative therapies that science has definitely shown to be ineffective is the day I might start to soften my stance.

  12. #12 kevinj
    October 5, 2007

    the exeter medical school in the UK has an alternative medicine section who really arent on the alt medicine bods christmas card list.

    their most recent attempt is covered here

    http://www.guardian.co.uk/medicine/story/0,,2183054,00.html

    The rapidly growing dislike for this research unit from the alt med bods is also quite amusing, i think they had high hopes for it supporting their views.

    incidentally on the plus side at least one of the uk homeopathic hospitals is in trouble

    http://dcscience.net/?p=167

  13. #13 DaJoKr
    October 6, 2007

    The Exeter folks, led by Drs Edzard Ernst and Max Pittler, do a really nice job with their journal, Focus on Alternative and Complementary Therapies, or FACT. Ernst has solicited international researchers in areas related to CAM to serve on their editorial board – the idea is that they review CAM studies and then provide commentary on each paper, discussing the strengths and shortcomings, etc. The original authors can then comment on the critique. The journal provides a very sober assessment of CAM research across the board; unfortunately, PubMed doesn’t list it because they consider it an “abstract” journal but I find it to be a great resource (disclosure: I’m on the intl advisory board but subscribed to it before I joined.).

    The bottom line is that Ernst is committed to the truth based on evidience, not advocacy. That is what science and medicine are all about.

  14. #14 Laser Potato
    October 8, 2007

    “Magical, herbal, and spiritual healing has been around for thousands of years.”
    The very same argument can be made in favor of slavery. Try again.