Respectful Insolence

Perusing the skeptical medical blogosphere, I came across some rather amusing, but nonetheless informative, videos from the 1950s about medical quackery. There are a number of aspects of these videos that are a bit unsettling to modern viewers, such as the “doctor knows best” paternalism, naïve faith in the AMA and other medical organizations, the utter seriousness, the cheesy reading of lines, and a rah-rah cheerleading for science and technology über alles. On the other hand, as Steve Novella points out, there was a refreshing directness about how the government viewed dubious medical practices. The FDA was not afraid to call a quack a quack, as demonstrated in this PSA from 1959 (hat tip: Quackometer):

Besides showing that some forms of quackery are at least decades old (Z-rays, “healing music” therapy), it also shows a willingness to be direct in saying that there area no such thing as Q-rays and this device doesn’t work. Today, the National Center for Complementary and Alternative Medicine (NCCAM) would probably fund several grants to determine whether or not there are in fact Z-rays (seemingly renamed to Q-rays these days) and whether or not tape-recorded music could in fact cure cancer.

The other video is also a snapshot of a simpler time:

And here’s part II:

Yes, the acting is pretty atrocious, as is the dialogue, but this educational short actually does explain several important principles of why unscientific remedies seem to be effective, including regression to the mean, the placebo effect, and confirmation bias. The social mores and attitudes in these videos may seem conservative and silly, and the paternalism of the physicians and unquestioning acquiescence to the experts of the characters is not a model that empowers patients or to which we should go back. However, the videos themselves suggest that, at least in terms of critical thinking about “alternative” medicine, we probably haven’t made much progress in the last 50 years. In fact, we’ve arguably gone backwards, with more tolerance than ever for unsupported, unscientific nostrums than at any time since the time when non-science-based remedies were conventional medicine.

Think I’m exaggerating? Well, let’s go back to NCCAM for a moment, shall we? Even in these tight budgetary times, we taxpayers are still funding it to the tune of $121.6 million in FY 2008. With that money, it’s funding multiple trials in acupuncture, naturopathy, reiki therapy, therapeutic touch, chiropractic, the Kelly/Gonzalez regimen, homeopathy, and even energy healing. Meanwhile, it funds and actively encourages programs at medical schools to teach non-evidence-based and nonscientific woo to the next generation of medical students and residents and infiltrating even the bastion of scientific medicine in the U.S. at the NIH, the NIH Clinical Center. Is it any wonder that there are now at least 40 academic medical centers with active “integrative” medicine programs that teach nonscientific modalities alongside scientific medicine? (It’s a list that I keep promising to update but haven’t gotten around to it because contemplating it depresses me so.)

I agree with Steve that I wouldn’t want to go back to the 1950s in terms of the doctor-patient relationship. The model then was too paternalistic and authoritarian in a way that was sometimes abused. The cooperative model of empowering patients to help their doctor forge a therapeutic plan as partners is in general a good thing. However, it should not necessitate acquiescing to pseudoscience to the point of “integrating” it into scientific medicine. In that aspect, despite all the good that’s come of shedding the paternalistic doctor-patient relationship, we need to find a way to keep the good from that from being overshadowed by the increasing willingness of medicine, apparently largely in response to “giving the patient what he wants,” to accept non-evidence-based and even extremely scientifically implausible therapies into our armamentarium as though they had passed the same gauntlet of basic scientific and clinical studies that the latest cancer treatments have. After all, as I have said so many times before, there is no such thing as “alternative” medicine. There is scientific and evidence-based medicine; there are scientifically plausible but as yet unproven medicine; and there is non-evidence-based and unproven medicine. We should be using the former; the middle should only be used in the context of clinical trials; and the latter should be relegated to museums of medical history.

Comments

  1. #1 Jackie
    January 15, 2008

    I think we should be careful about lumping all “non-traditional” treatments together under quackery – just because a treatment wasn’t discovered in a molecular biology/chemistry/microbiology lab does not mean that the medical principles underlying it aren’t sound. For example, there’s quite a bit of evidence that some Chinese herbal remedies do work due to active compounds in the plants that have anti-inflammatory properties, etc. It’s ridiculous to think that we know everything there is to know about medicine and the human body, and I think we risk missing out on real phenomena if we just dismiss it out of hand.

    On the funding issue – how do you propose sorting the wheat from the chaff if not by testing them in scientific trials? I’m sure there are a lot of studies that don’t necessarily meet the standards of intellectual rigor, but that’s a separate problem and also affects trials of regular old drugs…

  2. #2 Jim
    January 15, 2008

    Jackie:
    Could you provide a bit more detail? Which herbs, what active compounds and where is the evidence presented?

  3. #3 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  4. #4 bsci
    January 15, 2008

    How much of the NCCAM’s $121million budget goes to studying quackery? How much goes to scientists that might use that money to definitively disprove some of that quackery? Are there therapies that NCCAM looks at that you think might have potential and are worth funding?
    Compared to $121million in taxpayer dollars how much money are people paying to chiropractors each year? I think a well designed study that compares the healing effects of an hour with a chiropractor to an hour with a massage therapist is well worth taxpayer dollars. (Of course that’s only true if the study is followed up by someone trying to shut the profession down or at least have more truth in advertising)

  5. #5 PalMD
    January 15, 2008

    Unfortunately, as has been discussed at this space and at mine, very rarely is woo ever abandoned, no matter how much evidence is accumulated against it.

  6. #6 Jackie
    January 15, 2008

    The one I am thinking of (an ethnobotanist at my university studies it) is a moss, Rhodobryum giganteum… it’s used culturally to treat arrhythmias, as far as I can tell the active component is still unknown but apparently has been shown to increase blood flow in the hearts of pigs and a couple other mammalian models. All the papers I can find on it are in Chinese, unfortunately (e.g.: http://scholar.ilib.cn/A-zxyjh200410018.html), so I can’t evaluate the data myself, sadly – and cardiovascular health is not my area of specialty anyway. But the larger point I was trying to make is that it would hardly be shocking if some plants had interesting/useful properties that had been discovered by people before the last century or so. Another prime example would be artemisinin, which has been a pretty successful anti-malarial, and was used in herbal medicine for many years. (I hate to cite wikipedia, but it has a pretty good compilation of links on the topic: http://en.wikipedia.org/wiki/Artemisinin)

    I don’t mean to argue that we should continue to validate woo once it’s been disproved, of course (that’s funding they could be giving me!) I just disagree that we shouldn’t ever investigate non-traditional therapies – they sometimes DO have a valid underlying mechanism!

  7. #7 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  8. #8 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  9. #9 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  10. #10 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  11. #11 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  12. #12 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  13. #13 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  14. #14 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  15. #15 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  16. #16 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  17. #17 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  18. #18 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  19. #19 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  20. #20 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  21. #21 Jason L. Harris, PT, DPT
    January 15, 2008

    Great videos. I don’t know about anyone else, but the second embedded video (Part II) is not working. Here is the direct URL I found for it: http://www.youtube.com/watch?v=noT3LxKB2KI

  22. #22 CanadianChick
    January 15, 2008

    Jackie, if you read the last line of the blogpost, you’ll see that Orac is not advocating that all avenues of inquiry be shut down – I believe that investigation of many plant-based compounds would fall under the second category (plausible but unproven).

  23. #23 Heathen Dan
    January 16, 2008

    I really like the no-nonsense debunking in the first video:

    “There are some as phony as a three dollar bill…”

    “This fake device claim to cure cancer with tape recorded music. [Turns on the music player.] The practitioner who used it was as big a phony as his device.”

    LOL!

  24. #24 Andrew Dodds
    January 16, 2008

    Heathen Dan -

    Just thinking, it could even make good TV, perhaps as a regular news slot – ‘This week’s charlatan..’. These woo-merchants might not be defeated by calm, rational argument, but a few guys pointing, laughing and making the whole thing a joke could well do. New clothes and all..

  25. #25 has
    January 16, 2008

    I wouldn’t want to go back to the 1950s in terms of the doctor-patient relationship. The model then was too paternalistic and authoritarian in a way that was sometimes abused.

    I wonder how much alt-med consumption is driven by a need for omniscient authority figures? With mainstream medicine [quite rightly] abandoning this role, perhaps this is another reason why alt-med, with its quasi-religious nature, appeals to some people?

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