Respectful Insolence

A few days ago, I was amused by a term coined by Dr. R.W. The term, “quackademic medicine,” was meant to describe the unholy fusion of non-science- and non-evidence-based woo that has infiltrated academic medicine to a disturbing extent over the last decade or two. There was a lot of reaction, mainly positive, to the new term, and I even got an e-mail from a certain skeptical podcaster vowing to use the term every opportunity that he got. One reader, Jim Benton, made a comment that got me to thinking. Here’s the comment:

My ‘crusade of the year’ this year (other than getting a Democratic Congress that will deBushify the country) is to get Skeptics (and especially SkepDocs) to stop using the term ‘CAM’ or ‘Alternative medicine.’

‘Medicine’ is what you do, Orac, and Dr. R.W. and Flea and my own doctor. It is NOT what quacks, homeopaths, and woomeisters do!

I would suggest/beg at least the skeptical community to stop using ‘CAM’ and, if you HAVE to have a ‘polite’ name, to start calling their methods either

ATP (for Alternative Therapy procedures) or

ATM (for Alternative Therapy Methods or Modalities).

After spending much of my life watching the ‘good guys’ (scientific, political, etc.) cede the ‘linguistic high ground’ in various ways, I think this is one we can start stopping.

Ask yourself, would you allow Creationists to call their work “Alternative Geology” (or Biology) or Holocaust Deniers call their books “Complementary History”?

No?

Then WHY LET QUACKS GET AWAY WITH THE SAME THING?

It’s a thought-provoking concept, but would it help?


Certainly, language has power. It can frame an issue in a way that is advantageous or disadvantageous to one side or another. There are numerous examples of the use renaming or appropriating to try to change the public’s perception of an issue or to serve a purpose. Sometimes such attempts misfire badly (the ill-conceived idea of renaming secularists, agnostics, and atheists as a term as ludicrous as the “Brights” comes to mind), but often the change in language can be quite useful.

Advocates of CAM (for lack of a better term) know the power of language very well. Years ago, CAM nostrums were called by a variety of names because they encompass a wide variety of unrelated modalities. Such names included “folk medicine,” traditional Chinese medicine, herbalism, naturopathy, homeopathy, or even snake oil or quackery. The next term in the evolution of CAM was “alternative” medicine. The term “alternative medicine” unified these disparate and even contradictory therapeutic modalities under the rubric of a single term that encompassed pretty much all medicine that wasn’t encompassed by modern, science-based medicine. The term, although it served a purpose, had a fatal flaw, though. It implied that these modalities were somehow an “alternative” to modern medicine, even though there was a paucity of evidence that they were efficacious and, in a few cases, good evidence that they were harmful. Moreover, to the average person, the term connoted inferiority. This led to statements by critics of alternative medicine:

  • “…since many alternative remedies have recently found their way into the medical mainstream [there] cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.” (Marcia Angell, former Editor-in-Chief of the New England Journal of Medicine.)
  • “There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is ‘Eastern’ or ‘Western,’ is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues–namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy.” (George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA.)

I’ve said similar things frequently on this blog myself.

One thing you’ll note is that these articles date back to the 1990s, which was around the time that advocates of alternative medicine were trying to rename it. This was largely done in response to the realization that the vast majority of this “medicine” was completely unproven; consequently, it was reasoned, using it as an “alternative” to “conventional” medicine was a bad idea. Instead, it was said, it should be “complementary” to conventional medicine. Of course, for something to be complementary it needs to bring something to the table, add something to the treatment, so to speak, but this was about language, not fact

The evolution of the term “complementary and alternative” medicine (CAM) can actually be studied by examining the history of the federal agency, a branch of the NIH, whose charge is to study CAM, namely the National Center for Complementary and Alternative Medicine (NCCAM for short). In 1991, at the behest of a couple of powerful woo-friendly legislators, NCCAM was born in an embryonic form known as the Office of Alternative Medicine. By 1998, it had become a center and obtained its current name.

By the early 2000’s, however, it was clear that “complementary and alternative” medicine just wasn’t a simple enough. True, it had a catchy abbreviation (CAM), but it still had the word “alternative” in it, which still connoted inferiority to “conventional” medicine. Thus was born a new term for a new millennium: “integrative medicine.” It’s powerful. It’s concise. The word “integrative” is hip. It’s happening. It implies “integration” of the best of all modalities (both woo and non-woo). But, best of all, it got rid of the word “alternative.” So we now have a multitude of “Departments of Integrative Medicine” and a dwindling number of “CAM” programs, most of which are seemingly being renamed. Of course, from my perspective, I fail to see any advantage of “integrating” non-evidence-based woo with medicine that works, but that doesn’t take away from the power of reinventing CAM as “integrative medicine.”

So should we try to “rename” CAM or integrative medicine, at least when we are applying skepticism?

I’m of two minds on this. On the one hand, the terms “CAM” and “integrative medicine” are widely known among the public. They’re also ripe for parody. On the other hand, as Jim points out, it is ceding the linguistic high ground to let such terms stand unchallenged. Obviously, the term “quackademic medicine,” although amusing for use in particularly sarcastic takedowns of particularly egregious misadventures in “integrating” woo into academic medicine, is too harsh and snarky as a candidate for terms by which to identify CAM or integrative medicine routinely. Too much scorn will backfire. Personally, I’ve favored terms like “non-evidence-based medicine” (which is too long to be punchy) or “nonscientific medicine” or “nonscientific treatments” (both of which are better), but I readily concede that there must be a better term. For one thing, both of my favored terms contain the word “medicine,” and, as we have learned lately, it is not appropriate to refer to many of the practices that fall under CAM as “medicine,” given that they are based on religious beliefs from prescientific societies.

I’m not sure that I’m entirely convinced by Jim’s argument. On the one hand, I fully believe that, based on the available evidence, the vast majority of CAM therapies are not worthy of being called medicine. Certainly, following the analogy of creationism, we would never let creationists call their religion-inspired drivel “alternative biology” or to call “intelligent design” creationism “alternative evolution.” On the other hand, a poorly chosen moniker could risk being too obvious (like the “Brights”) and bringing much-deserved derision. That being said, I rather like the terms “alternative therapy modalities” or “non-science-based therapy.”

The reason I posted this is not so much to propose a term but to get feedback on this issue, as well as potential terms to use instead of CAM or integrative medicine. Remember, the reason “quackademic medicine” won’t do is because it’s too snarky except for the most blatant woo. Ditto “supplements and complementary and alternative medicine” (SCAM). I’m looking for at term that is serious and that does not contain the word “medicine.” It would be better if it could be turned into a memorable acronym as easy to remember as “CAM.” I’m also interested in learning whether readers even think that it is worthwhile to try to take the linguistic high ground back from the purveyors of woo who now seemingly hold it. However, if we’re going to try to do that, we need a term that does not use the word “medicine” and is not so derogatory that it backfires.

Comments

  1. #1 MartinM
    January 30, 2008

    However, if we’re going to try to do that, we need a term that does not use the word “medicine” and is not so derogatory that it backfires.

    Unfortunately, any term which accurately describes CAM could be considered derogatory. Non-evidence-based? Non-scientific? When it comes to medicine, these are derogatory, and so they should be.

  2. #2 PalMD
    January 30, 2008

    I vote for “modern shamanism”. The sCAMers might like it, and I love it.

  3. #3 Caledonian
    January 30, 2008

    Why not unproven?

    This can apply both to ‘alternative’ techniques and the occasional examples of conventional medical techniques that haven’t been rigorously examined. (Yes, they do exist. And they’re usually gotten rid of when they’re recognized. Usually.)

    And don’t call the ‘alternatives’ medicine. ‘Medicine’ should be reserved for the proven stuff.

    Unproven therapies?

  4. #4 Caledonian
    January 30, 2008

    Additional:

    What about calling it ‘cargo-cult medicine’? As in crude attempts to imitate the appearance of medical practice without the substance?

  5. #5 Orac
    January 30, 2008

    Unfortunately, any term which accurately describes CAM could be considered derogatory.

    Would “alternative therapy modalities” be considered derogatory?

  6. #6 David D.G.
    January 30, 2008

    …as we have learned lately, it is not appropriate to refer to many of the practices that fall under CAM as “medicine,” given that they are based on religious beliefs from prescientific societies.

    This is the money quote, Orac — the heart of the issue. Any term that contains the word “medicine” (or, in my opininon, even such medically loaded words as “therapy”) should be avoided in referring to such practices.

    Frankly, while there’s no great need to pursue snarkiness, I see no reason why snarkiness should be avoided with any great effort either. It is earned! “Snake oil” is quite appropriate for describing these methods, as is “Voodoo.” There’s also SAOF — “Superstition and/or Fraud.” “Quackademia” should apply to those who push its inclusion in medical schools, or to the schools that include it, but I would avoid the use of the word “medicine” with it even then.

    But, since you honestly want some term less insolent (an odd break from your blog’s stated modus operandi), my suggestion would be the term “Nonmedical Practices.” This way, we can at least be clear that what they are doing is NOT medicine — not alternative, not complementary, and most importantly NOT medicine of any kind. True, this term has the disadvantage of incorporating every activity that isn’t medicine, from drinking herbal tea to skydiving — but I think it’s much more accurate than CAM, and it clearly demarcates things so that the practices of CAM are clearly outside of medicine, thus explicitly denying it any validity in the field.

    ~David D.G.

  7. #7 Steven Novella
    January 30, 2008

    I agree that we should not accept the self-labeling of CAM or integrative medicine. This has a specific purpose – to carve out a double standard for non science-based practices. We need to point this out and oppose it at every turn.

    My strategy has been multifarious. First, I avoid CAM and integrative whenever possible. Rather, I refer to science-based medicine or evidence-based medicine in the positive (rather than it’s opposite in the negative).

    Second, when referring to practices that are not science based that is what I call them. “Unproven” or “not evidence-based” is not sufficient for those modalities that defy basic science, like homeopathy.

    I also (especially recently) have started using Wally Sampson’s term of “sectarian health practices.” This hits the nail on the head and avoids misleading labels like “alternative” or “medicine.”

    But at times I just have to refer to CAM when talking about it as a cultural/social/political phenomenon. When I do I will typically say – so-called “complementary and alternative medicine.” I use “so-called” to distance myself from the term and use scare quotes for added displeasure.

    Finally I have written, and we all should continue to write (and speak when being interviewed) about this exact issue – that terms like CAM and integrative were invented as a deception and a con, to distract the public from the only real issue – do the treatments work and are they safe. These are false terms crafted to dodge the standard of care, and nothing else.

  8. #8 Margaret Romao Toigo
    January 30, 2008

    Language is indeed powerful. Remember how the estate tax was renamed the “death tax?” Regardless of which side of that issue one falls, it was a very effective meme.

    Homeopathy is not the same thing as acupuncture, and neither of those can be described as herbalism or folk medicine, which is completely different from chelation, hyperbaric oxygen, enemas, saunas, mud baths, etc.

    Ambiguity is a very effective marketing technique as it allows for natural diversification — if the supplements don’t work, there are plenty of other products and services that fall under the same banners of “alternative,” “complementary,” and/or “integrative.”

    One broad, all-encompassing term would only add to the confusion, which is the larger point of the semantic blurring of what used to be a bright line between medicine and quackery. One name implies organization, and organization implies authority.

    Unifying terms can either validate (“CAM”) or demonize (quackery), so unless one wishes to be critical and use derogatory language, I say atomize the category altogether and just call specific things what they specifically are. Divide and conquer.

  9. #9 isles
    January 30, 2008

    I like “modern shamanism” too. But if that won’t fly, how about “prescientific treatments”?

    I think a term that includes “therapy” is a little too generous. And “prescientific,” like “unproven,” isn’t necessarily derogatory, while conveying that there’s no evidentiary basis for these treatments.

  10. #10 Badger3k
    January 30, 2008

    I like Mark Crislips’ (Quackcast) – “Supplements, Complementary and Alternative Medicine” – SCAMs. It fits in every sense of the word.

    Speaking of the SCAMs, I heard from Brian Dunning of the Skeptoid podcast that a judge upheld the fine on the makers of the Q-ray bracelet (a sum of around $90 million). Score one.

  11. #11 One Brow
    January 30, 2008

    Therapeutic Unproven Treatments (TUTs)? When you use tow of them, you have a tut-tut.

  12. #12 Joe
    January 30, 2008

    As it happens, ‘complementary history’ isn’t a million miles removed from how a lot of pseudohistorical kooks of various stripes regard their gibberish, from Sitchin to Zundel. The usual claim is that the ‘real truth’ has been suppressed by ‘elites’, but *they* (and by extension anyone idiot enough to believe them) are perceptive, free-thinking visionaries.

  13. #13 StuV
    January 30, 2008

    Faith-based treatment?

  14. #14 Judith
    January 30, 2008

    Unless we pay some attention to therapies which are not Western medicine, we won’t be able to separate the effective from the superstition. I’d suggest “Alternative Healing Practices” as a term that gives respect to practices that may turn out to have a germ of truth, but which still distinguishes them from Western medicine. I remember watching the Western trained doctors in India battle ineffectively against staph infections. The local indigenous population had a simple remedy that worked quickly and painlessly, without antibiotics. The doctors sneered at it. But I used it often. Quackery to some, but – certainly a healing practice.

  15. #15 Rod Clark
    January 30, 2008

    I’m also a big fan of SCAM. Supplements, Complementary and Alternative Medicine.

  16. #16 Joseph Hertzlinger
    January 30, 2008

    Can we call counterfeit money “Alternative Payment”?

  17. #17 MartinM
    January 30, 2008

    Would “alternative therapy modalities” be considered derogatory?

    Well, no, but as descriptions go, it’s about as useful as describing Hitler as ‘some guy with a bad moustache.’

    Any term which doesn’t make it clear that CAM is less respectable than real medicine is missing the point – but pseudoscience is essentially all about demanding undue respect.

  18. #18 Troika21
    January 30, 2008

    You don’t necessarily have to have a catchy acronym, just a phrase that could be used as a wedge to open up the conversation, for example it could be called ‘Irresponsible Medicine’.

    A woo can’t let this pass without opening themselves up to a discussion on evidence and ethics, but leaving the word medicine in there could placate them. Also I give the public enough credit to know that some treatments out there are just quackery, but dont know what – this could get them interested in finding out.

  19. #19 Prup aka Jim Benton
    January 30, 2008

    Let me expand on some of the reasons why I made this suggestion.

    In the first place, it is simple honesty, sticking to the facts linguistically as we — as skeptics — are supposed to do in our arguments. ATMs are not medicine, it is conceding the linguistic high ground.

    Furthermore, if we agree on a term and start using it, there is a good chance that, somewhere down the line, it might just create publicity for our point of view. Can’t you imagine a reporter, a talk show host, starting an interview with “Now, Dr. Novella, I notice you refuse to use the term CAM, but refer to ATMs.”
    “Yes, Larry, and let me explain why…”

    Just by answering this question, we put the quacks on the defensive — something we need to do more often. Think about almost every television segment on any kind of woo. It’s almost always structured so that the proponent gets in the first shot, and from there on we are on the defensive, trying to disprove what he has claimed. By focusing on a consistent insistence on not using the CAM term, we get the first shot in. Thy have to try to defend calling themselves ‘medicine.’

    Finally, we in the Skeptical community have many reasons for writing our articles, but one major one is, or should be, concern for the people who sincerely get fooled. They aren’t necessarily stupid, just ignorant, and we are trying to fight that ignorance.

    And this is even more important, I would think, in the medical skeptics. For the most part, belief in UFOs, theism, Uri Geller, Deepak or Keely’s Wonderful Machine only costs a person money, time, and pleasures. Belief in quackery much more directly costs lives.

    People’s decisions often rest on small things. If the change in terminology was the feather that came down on the side and made the difference for half a dozen people, wouldn’t that be worth it? Or is there a downside that I’m just not seeing?

  20. #20 Lorne
    January 30, 2008

    I vote for Quackology practiced by Quackologists trained by Quackademists at Quackademimies.

  21. #21 Skeptical Cat
    January 30, 2008

    How about just “pseudo medicine”? It still uses “medicine”, but I think the meaning will be perfectly clear.

    It’s also perfectly accurate, and captures the way “CAM” can often appear to be legitimate medicine to the naive observer.

  22. #22 Luna_the_cat
    January 30, 2008

    OT, Orac, check this out: Pure Pedantry’s got a live one!

  23. #23 Wallace Sampson
    January 30, 2008

    Orac called my attention to this set of posts. The language problem has a longer and more complex history than commonly known.

    I have a book chapter on it as part of Post-modern Medicine, (in: Gross and Levitt, Flight from Science and reason, 1997, Johns Hopkins U Press.) One paper on postmodern medicine in Sci Rev Altern Med (SRAM.org;) plus two papers submitted in the past several months – one a survey of major journal editors (with K. Smith, U. Abertay, UK) about editors’ interest and antention to the problem, and the other a history of the language problem.

    The first to call attention to my knowledge was NCAHF president, William Jarvis at a Calif. Med. Assn. meeting on quackery in 1982. We had recognized it during the 1970s “Holistic Medicine” craze, which morphed into “Alternative.” We had to deal with definitions in our Stanford course in 1979-80s. Bill Jarvis pointed out what a real alternative is.

    We have evidence that the sCAMmers invented the terms “Alt” and “Compl” with specific intent of…gaining acceptance, to put it nicely. They wrote about it in journal articles.

    When I gave a talk at the Western Psychological Assoc. some time in the 1980s, Prof. Ray Hyman suggested using the term, “anomalous medicine.” Which I did. I still have sections on this in the courses and talks with all the “Alt” terms I know of listed with their dictionary meanings and their propaganda meanings – this is all propaganda, BTW. (This is also in the pending papers.)

    When we named our journal, the publisher would not accept the other terms I suggested – “anomalous, aberrant,” because he wanted listing in data bases under “alternative.” In 2002 I successfully inserted “aberrant” into the subtitle. A few complained that it was politically incorrect and counterproductive. I said BS.

    Both the NCCAM and the NIH, and four other orgs have their individual definitions of “CAM” which are frightening in their propagandistic and postmodern qualities. NCCAM (2002)and Office of Technology Assessment (1989-92) had special meetings or sessions on word usage and definitions (“Unorthodox, “Unconventional, etc…)

    I thought of “sectarian” a few years ago, forgetting that Prof. Norman Gevitz had used it in his book title. (The George Harrison/Norwegian Woods syndrome) so give credit to Dr. Gevitz. Someone pointed that out on the sciencebasedmedicine blog. Thanks for that.

    Point of allthis: many have been aware of the problem. I share blame for not having broadcast it earlier and farther. I like some of the other suggestions here. We can use many of them depending on content and the point we are trying to make. English is a “rich” language. Let us use it also. Thanks

    WSampson

  24. #24 N.B.
    January 30, 2008

    I like StuV’s suggestion–“faith-based treatment”–about as much as I like PalMD’s “shamanism” moniker.

    My significant other and I have spent a lot of time talking about science, belief, evidence, and culture (she’s an anthropologist). She often plays devil’s advocate, partly because doing so is (to some extent) her job when we’re talking about things that are “beliefs” or “part of cultural identity.” In the interests of personal freedom, she doesn’t object to people using CAM modalities, as they are essentially a religious belief; but she does object to fraud, and she also objects to them being called medicine when they aren’t. Calling CAM medicine disguises a religious practice or ritual (such as using a homeopathic remedy) as scientifically-tested and validated.

    “Faith-based treatment,” or FBT, has my vote. It’s succinct and describes CAM accurately–therapies that the user is accepting are effective in absence of evidence.

  25. #25 Anna M.
    January 30, 2008

    The key is choose a term that is close enough to respectful that it can eventually infiltrate their own way of speaking about themselves. This is exactly what was done with terms like “death tax” and “politically correct” by the right wing.

    ATM actually has a chance of being adopted in that way, but terms that make obvious derogatory implications do not. If you want to alter the linguistic playing field, it has to be done subtly enough that it seeps into the language rather than attacks it.

    You also risk driving more patients into their arms when they feel their doctors are not helping them and do not care. (They take those derogatory terms as simply more evidence that Western medicine is afraid of ATM.) This is one of the key points of ATMs: some level of personal connection with the practitioner and a belief that they do care. Simple, blatant attacks are not the way to get those people back or make them understand the difference.

  26. #26 txjak
    January 30, 2008

    I like the term “non-science alternative,” it’s almost like saying “nonsense alternative.”

    It may also be time to resurrect the term “Witch Doctor” for those who promote practices that “are based on religious beliefs from prescientific societies.” :-)

  27. #27 Runolfr
    January 30, 2008

    Actually, I think you came pretty close with “nonscientific treatments”. I would be inclined to use a term like “unscientific treatment” or “unscientific therapy”, giving you a nice abbreviation like UT (although I daresay the University of Tennessee would be none-too-pleased by that).

  28. #28 inkadu
    January 30, 2008

    Hm. Nobody mentioned “Placebo,” yet as a good blanket summary of woo. It’s polite, won’t offend those who honestly feel better because of it, and specifically limits its effectiveness. Plus, everyone has an idea what placebo is.

    Here’s an interesting exercise: Try to imagine a federally-funded national institute with your new name for the Woo field:

    The National Institute of Placebo Study has a nicely ridiculous ring to it, as does, National Institute for the Study of Treatments That Fail to Show Any Evidence of Working At All.

    If you can win the name game, it’ll be a lot harder to fund that agency.

  29. #29 vhurtig
    January 30, 2008

    I think skeptical cat has a good idea. Modify it slightly to “pseudomedical practices”.

  30. #30 marcia
    January 30, 2008

    I can’t say that I like using the word “therapy.” It connotes treatment or curative power. I might say that antimicrobial therapy is the treatment of infectious disease, but I can’t say that homeopathy might also be therapeutic.

    Proof is important for people: proof that a stain is lifted from the carpet by a product, proof that Toyota makes a quality automobile, proof that a food is not tainted, proof that bypass reduces angina.

    We love Consumer Reports.

    Therefore, I prefer making use of the word “proof,” and in this case, my suggestion: “unproven regimen.”

    I may well hold on to my wallet if you tell me your regimen is unproven.

  31. #31 The Crack Emcee
    January 30, 2008

    I like “Faith-Based Treatments” (FBTs) but “Supplements, Complementary and Alternative Modalities” (still SCAM) works better for me because of the acronym.

    I’d go with FBTs, because now I’m hung up on “complimentary” being in there, which it shouldn’t.

  32. #32 chancelikely
    January 30, 2008

    Stick a ‘to’ in between ‘alternative’ and ‘medicine’.

    Alternative to medicine. Doesn’t mislabel it at all.

  33. #33 Ahistoricality
    January 30, 2008

    I like ‘pseudo-medicine” suggested above. It isn’t likely to seep into the usage of practitioners, though.

    “Mind-numbing pablum” isn’t going to work, either, but it does avoid the use of “medicine” or “therapy”…

  34. #34 Owen
    January 30, 2008

    I like “Placebo Therapy” – particularly for homeopathy or reiki. Unfortunately it doesn’t work for stuff like chelation, which I think is more accurately labeled “Pending Malpractice Suit”.

  35. #35 Dr Aust
    January 30, 2008

    For a snappy abbreviation, how about “BBQ” for “Belief-Based Quackery?”

    I tend to call it “self-styled “Alternative Therapy”” and refer to its practitioners as “self-styled “therapists””.

    In the specific case of the burgeoning army of “nutritionists”, some of the UK bloggers have taken to calling them “Nutritionistas”. We thought this alluded nicely to their vanity, vacuousness, and general place as a sort of lifestyle affectation of the over-moneyed.

    PS Saw Wallace Sampson posting above. If he is still around, can he update us on what is going on with SRAM? The “current issue” on the website is from 2004-5.

  36. #36 Flex
    January 30, 2008

    Like a couple above commentors, I use a term which provokes additional questions. So when I get into a discussion about some quackery, I will say, politely, that, “I trust EBM a lot more than (insert quack practice here).” Or possibly, “You realize that (quackery) is not EBM.”

    Usually someone asks what ‘EBM’ is, and I can explain that ‘EBM’ is medicine based on testing to determine that it actually works. On occasion I’ll throw in a few adjectives like ‘rigorous’ or ‘scientific’. Interestingly enough, while ‘rigorous’ doesn’t usually raise any hackles from the quack-proponent, ‘scientific’ does.

    However, I agree that CAM is a poor term to describe non-EBM. In regard to the suggestions above, while they are all good, I suspect terms like ‘pseudomedicine’ or ‘unscientific’ used to describe CAM would be met with resistance. While we know that CAM practices are without medical value, the true believers won’t adopt a term which implies to them that these CAM modalites are without value.

    So while ATM may catch on as not being obviously derogatory, ‘unproven’, ‘pseudo-x’, ‘unscientific’, ‘nonmedical’, and even ‘FBT’ will not be generally accepted. Remember, many CAM believers strongly believe they have evidence and proof to back up their beliefs. (Which is where my own strategy with politely dealing with woo also breaks down.)

    I have to confess that I like ‘cargo-cult medicine’, but I don’t think that most people would get the (black) humor of it as a reflection of the post-modernist thinkers rampant in our society. Further, those that do get the humor would never use it to describe their own beliefs.

    So, after critiqing (respectfully I hope) the suggestions of others, do I have one to make myself. Well, have some offerings, and a suggestion.

    My offerings are:
    Metaphoric medicine; which is subject to the same criticisms as above and probably should be applied to the more concentrated woo, like homeopathy, which has no discernable causal path to operate. The positives are that the post-modernists will love it.

    Sycophantic therapies; which has a nice sympathetic ring to it, but if anyone actually looks up the word it wouldn’t last long.

    (Which of course suggests Parasitic practices; while probably a good description for most CAM, should really been reserved for those items like the Q-ray braclets. I doubt it would catch on among the CAM practicioners.)

    Or, we could call them all ‘Pre-treatments.’ Which could suggest, should the question arise, that people who frequent quacks are simply at a stop on the way to the ER.

    My suggestion though, is that we try to use a variety of the options submitted thus far in this thread. Who knows, throw enough mud against the wall and some of it might stick. The richer the language of derision grows, the more it will be used.

  37. #37 Joan
    January 30, 2008

    naturalistic therapy, treatment, or modality

  38. #38 Coin
    January 30, 2008

    I think the idea of trying to find an alternate term to refer to CAM by is definitely appealing. It’s clear that alternative medicine benefits from the “alternative” framing (although it’s never really struck me as particularly complimentary phrasing… so we’re saying it’s the alternative to medicine?).

    However you have to be careful. The point is to come up with a term which sticks. Anything that’s clearly just an insult, will remain just an insult. And “quackademic medicine” just sounds silly. I am not even sure I know how to pronounce it. You don’t want to wind up like Bill O’Reilly, calling all your enemies “secular progressives” and finding your audience has fallen asleep by the third syllable.

    “Non-scientific medicine” or “Non-medicine” or “Nonmedical therapies” sound actually kind of workable though. I’m not sure.

  39. #39 Mojo
    January 30, 2008

    Badger3K wrote, “I like Mark Crislips’ (Quackcast) – “Supplements, Complementary and Alternative Medicine” – SCAMs. It fits in every sense of the word.”

    Already in use:

    http://www.thecliftonpractice.co.uk/

    “supplementary, complementary and alternative medicine”.

  40. #40 Chris Noble
    January 30, 2008

    Ignorance Based Medicine (IBM)

    You forgot to mention “holistic” in the list of inaccurate descriptors for non-evidence based medicine. How can ignoring modern science be “holistic”?

    I think Steve is on the right track. Practioners of non-evidence based medicine choose positive descriptions for what they do such as holistic. By implication real medicine is supposed to be non-holistic or reductionistic which is meant to be negative.

    Sticking to a positive descriptor such as EBM makes it patently clear that non-EBM lacks something that EBM has – evidence.

  41. #41 The Crack Emcee
    January 30, 2008

    I also like the “to” idea:

    “supplementary, complementary and alternative to medicine”.

    SCAM.

  42. #42 Joan
    January 30, 2008

    naturalistic therapy, treatment, method, modality

  43. #43 Patrick
    January 30, 2008

    UTP/Universal Treatment Protocol (sounds respectable enough for the meister’s?) though we would all know the alternative (ouch) meaning of it was Unproven Treatment Protocol, I’m leaning on the universal so it can encompass all woo’s, not just the quantum folks, or the pinheads, but be inclusive!

  44. #44 Ed S.
    January 30, 2008

    N-P-T – Non-Proven Treatment. Say the letters fast to indicate there’s nothing there.

  45. #45 Joe
    January 30, 2008

    First, without prejudice- I am not the “Joe” who posted, above.

    I really appreciate Dr. Sampson’s response. Unfortunately, I have to agree with his publisher that (C)AM is the common reference/search term/phrase. I don’t think we can beat it.

    As for CAM in popular use, if you are going to replace it, you will have to explain your new term every time (unless it catches-on like wildfire) including why it is better than CAM. It seems easier to explain why “CAM” is misleading (every time) and leave it at that; without introducing a new term that confuses the public. Not using that term (CAM) at all is adequate (as I think Dr. Novella suggested). However, in a recorded/published context it can result in your remarks not showing up in a database search.

    I like “quackademics” used in the right context- to rub their noses in it.

  46. #46 MonkeyT
    January 30, 2008

    Naturalistic Unproven Therapeutic Supplements?

  47. #47 Joe
    January 30, 2008

    First, without prejudice- I am not the “Joe” who posted, above.

    I really appreciate Dr. Sampson’s response. Unfortunately, I have to agree with his publisher that (C)AM is the common reference/search term/phrase. I don’t think we can beat it.

    As for CAM in popular use, if you are going to replace it, you will have to explain your new term every time (unless it catches-on like wildfire) including why it is better than CAM. It seems easier to explain why “CAM” is misleading (every time) and leave it at that; without introducing a new term that confuses the public. Not using that term (CAM) at all is adequate (as I think Dr. Novella suggested). However, in a recorded/published context it can result in your remarks not showing up in a database search.

    I like “quackademics” used in the right context- to rub their noses in it.

  48. #48 David D.G.
    January 30, 2008

    Quantum Universal Alternative Complements Keeping Everyone Really Youthful — Q.U.A.C.K.E.R.Y.

    All right, seriously, I get it now about trying to use something subtle, something that might even catch on for general use. I still balk at calling a spade a “gardening implement,” but I now grasp the intended point.

    “Pseudomedicine” just might catch on for general use, but it would surely be fought vehemently by the practitioners and true believers themselves, so I doubt it. I also like NPT, “nonproven treatment,” but it likewise would never be accepted by those who support the stuff; the gullible folk support it precisely because, on THEIR terms, it IS proven.

    “Prescientific Treatment,” unfortunately, just sounds as if it is a perfectly acceptable lead-up to a treatment that is scientific — and, unfortunately, the irony of this would be lost on nearly everyone. Pity. “Witch-Doctoring” would be the clearer version of this, and it’s too bad that we can’t use it.

    “Nonscientific treatment” would seem to be a possibility — it is absolutely accurate, often even by the purveyors’ own words (consider how many of them deride science while touting their “other ways of knowing”), so you might even get some of them to accept this nomenclature proudly. So this is the one that gets my vote, at least secondary to my own suggestion of “Nonmedical Practices.”

    ~David D.G.

  49. #49 Marcus Ranum
    January 30, 2008

    “quack medicine” is an old, accurate, and perfectly good term for it. Maybe we could update it by trademarking it or something.

    The initials “QM” imply perhaps a dose of quantum-woo… It’s a rocket!

  50. #50 Martin P
    January 30, 2008

    If it could be dissociated from its other fine uses, I propose NEBBish – Non-Evidence-Based-Beliefs in supportive healthcare.

  51. #51 Roy Niles
    January 30, 2008

    I suggest use of the following:

    QAP – Questionable Alternative Practices – aka: Qappery.

    Rhymes with one descriptive word and evokes another.

  52. #52 Michael Suttkus, II
    January 30, 2008

    I’ve used “Alternative To Medicine” for years. Also NBM (Nonsense Based Medicine) and YHIM (You Hope It’s Medicine, pronounced “why him”)!

    But, let’s see about getting less snarky.

    Broken down to basics, “medicine” implies something it isn’t. That argument also removes most of the suggested alternatives. “Treatment”, “healing”, and “therapy” are also all things that YHIM just isn’t. Ditto “complementary”, “supplemental”, “integrate” and varients. What does that leave us with?

    Well, having decided that these quacks aren’t making people healthier, the only words to describe what they are doing are prejudicial (“quackery”) or horribly generic.

    In short, we’re stuck with modifying “activity”, “modality” or “technique”. Our problem here is that anything that attaches to those words to narrow their meaning back into the field, again, has to be either prejudicial or attach them to positive words we’re avoiding.

    Examples:

    * Alternate Modalities: Nonprejudicial, not related to healing, but what is it? That could describe anything from programming to car repair! Also, avoid “modalities” as it’s not a familiar word to the public.

    * Alternate Therapy Methods: Calling them therapy is as bad as medicine.

    * Alternate Treatment Methods: Better, because “treatment” is less “successful” in denotation, but still too close.

    * Alternate therapy-like methods: Gone back to prejudicial.

    Treatment is probably as good core word as you’re going to get.

    So, how to modify it? “non-proven” doesn’t appeal to me. It implies it might be proven later. Homeopathy is, by any reasonable standard, disproven and will NOT be proven at any point in the future. Unevidenced has the same problem. Again, you’re stuck between accurate-but-prejudicial and insufficiently-accurate-but-open-minded. Hmm, that’s the problem. Anything that implies open mindedness fails to properly cover homeopathy and the like, for which close-minded rejection is the only rational position.

    Unscientific? Well, some of the YHIMers will wear it proudly!

    Hope-based treatment? Hey, it has hope in it, that’s positive, right?

  53. #53 DLC
    January 30, 2008

    Quackery works for me.
    Quack Therapy, Non-Evidence Based Treatment, Non-Functional Practice.
    SCAM also works, but sounds too much like CAM.
    I’ve got a cousin Cam out there… somehow I don’t think he’s practicing medicine.

  54. #54 PalMD
    January 30, 2008

    For reasons discussed at Sciencebasedmedicine.org and other places, “placebo” can’t really work here, as that implies an intention to harness the placebo effect (among other problems), which is quite slippery.

  55. #55 Bill Silverhectare
    January 30, 2008

    The quacks like to include the high prestige word “medicine”, so how about simply “Not Medicine”?

  56. #56 Caledonian
    January 30, 2008

    I think Quackery works perfectly well.

  57. #57 RadgeHavers
    January 30, 2008

    If you don’t mind a lay opinion, I’d like to suggest that Flex’s comment about ‘metaphor’ is on the right track

    When you start peeling away at what makes ‘alternative’ medicine, you come down to the issue of comfort. While this gets wrapped up in a lot of religious sounding language, basically I think we’re talking about creating a place or zone where one can feel secure. By shifting the thinking to a more prosaic category, you can also create a space for your MBA types to tack on fees without necessarily cutting into the practice of medicine. Here are some suggestions:

    Medical Decorating
    Special Effects Medicine
    Medical Condiments
    Medicinal-like Metaproducts
    Medical Ambiance Aides…
    Really when you get on this track, the list is almost endless.

    An extra $100 for the blue-themed room. $5 for a funny hat on the nurse. $20 for readings from the Sufis. $10 dandelion eye of newt mocha latte. Personally I want my surgeon to enter the OR with a fog machine and music from “20001 A Space Odyssey.”

  58. #58 Jonathan
    January 30, 2008

    Why don’t we be honest and call it “nonsense”. This trend is actually scary. I searched the NIH’s RFA page for “alternative medicine”:

    http://grants.nih.gov/grants/guide/search_results.htm?scope=rfa&scope=pa&year=active&text_curr=alternative+medicine

    I found things like:

    “CAM Approaches in the Management of HIV Disease and Its Complications (R01)”

    They are taking away real money from actual science, and attempting to fund crappy projects. I think they should leave the NIH alone, and I think all “CAM” and “integrative medicine” programs at medical schools should be immediately shut down.

    If there are legitimate researchers interested in studying “CAM”, then “legitimate CAM” is basically the effects of diet and exercise (e.g. yoga, supplementation, etc). The rest of “legitimate CAM” could be epidemiology studies of the effects of “actual CAM” that patients are seeking out on their own (e.g. herbs, rituals, chelation, homeopathy, etc). At this point there is nothing “alternative” about it, and it’s the NCCAM that needs to be renamed.

  59. #59 cm
    January 30, 2008

    Although I agree that “quackery” is already the word that best matches these things, if you want one that would stand a snowball’s chance of actually being used, the best you might hope for is the subtle change to “alternative treatments”–I resist “alternative therapy” because therapy seems to imply effectiveness.

  60. #60 tonyl
    January 30, 2008

    Well, given that these various practices generally have no oversight or government regulation: Unregulated Treatments (UTs) or Non-regulated treatments (NRT’s).

  61. #61 isles
    January 31, 2008

    Oh! I like that last one (NRT = Non-Regulated Treatments), with its built-in warning that nobody is supervising the quacks who hawk them.

  62. #62 Chris Noble
    January 31, 2008

    Well, given that these various practices generally have no oversight or government regulation: Unregulated Treatments (UTs) or Non-regulated treatments (NRT’s).

    That could feed into the “if it’s regulated it must be real” mentality.

    Not everything that is regulated works or is evidence based.

  63. #63 fullerenedream
    January 31, 2008

    “Nonmedical treatments” sounds good to me.

  64. #64 fullerenedream
    January 31, 2008

    People looking for alternatives to “western medicine” will be happy to hear that these supposed alternatives are not regulated by The Man. I think “unregulated treatments” might backfire for that reason.

  65. #65 cm
    January 31, 2008

    fullerenedream said: “Nonmedical treatments” sounds good to me.

    I like it. Simple, true, not insulting.

  66. #66 Sigmund
    January 31, 2008

    While ‘quack’ is indeed an accurate term for it I doubt that it will be taken up by the media, at least, because of fear of offense to their customers, as it does sound like a direct insult (although not exactly undeserved).
    I tend to agree with some of the earlier commenters here that using the term ‘placebo’ is a much better way of approaching this issue as its most likely the only way these treatments have any efficacy.
    How about ‘Placebo Based Therapies’? It will sound perfectly innocuous to the public and media until they realize what placebo means.

  67. #67 Dr Aust
    January 31, 2008

    For some of them one could describe then as “Ritual-based”, as in “ritual-based healing practises”. This strikes me as an accurate description of many of them where they are based solely on “culturally-encoded ritual practises” – homeopathy and Reiki being particular examples

  68. #68 Flex
    January 31, 2008

    Tonyl suggests, “Non-Regulated Treatments”.

    Oh, yes!

    I like that one! While I think Chris Noble has a point that not everything that is regulated is backed by evidence, I suspect there would be an effort by some woo-meisters to enter the mainstream medical practices by submitting themselves to regulation.

    Once they have submitted to regulation, only a few lawsuits would be necessary to create public pressure to increase the regulatory oversight in order to ‘protect the children’.

    It won’t stop the more inane woo, like the magnetic foot-massagers, but it might be a lever to fight some of the more plausable woo, like dietary suppliments.

    On the other hand, there is the negative example of chiropractic. But maybe with that example in front of us the evidence-based community may be willing, and able, to fight for stronger regulations for the yet unregulated woo.

  69. #69 Oldfart
    January 31, 2008

    Vietnam War Hero: When I went to war in Vietnam I was convinced of the necessity of that war. But I came back convinced of its fraud and failure…..
    Right Wing Drunkard: See, he’s a flip-flopper. How can you elect a person who flip-flops?
    Result: Right Wing Drunkard is President for 8 years and never changes his mind about anything despite massive failures.

    It’s all word magic and framing and it is very important.
    How about extra-medicinal practices? (as in extra-sensory perception)…..

  70. #70 Prup aka Jim Benton
    January 31, 2008

    It seems like, of all the comments here, Oldfart and Anna came close to getting my point. I was NOT looking for a ‘snark contest.’ I was not calling on each of you to declare their disbelief in this sort of nonsense. (It might surprise you, but I knew that already.)

    What I was looking for, again, very simply, was a term we in the Skeptical Community — and particularly medical Skeptics — could begin to use with the idea that it would spread to the general public at large, effectively a neutral term, but one which would help us reclaim the term ‘medicine’ for ourselves.

    Also, because some of you are ‘important’ enough to be called before Congressional or Legislative comittees, or to get interviewed during a news program, I wanted a term that would raise questions. (When you answer the questions, THEN you lower the boom on the quackery, but a term with a built-in negative won’t get the same response.)

    Some of you have questioned use of the term ‘therapy,’ but I think, in the eyes of the general public, it is a neutral term. Anything can be therapy. And again, it doesn’t turn off the people we should be caring about.

    Can we actually start using one of these? (I’ve come to prefer “ATP” because the other abbreviation is taken, but either would work.) Or should be totally cede the ‘framing’ of the debate to the quacks, and leave us eternally on the defensive, explaining why they are wrong, instead of forcing them to start by defending their indefensible ideas.

  71. #71 David D.G.
    January 31, 2008

    Prup aka Jim Benton wrote:

    Some of you have questioned use of the term ‘therapy,’ but I think, in the eyes of the general public, it is a neutral term. Anything can be therapy. And again, it doesn’t turn off the people we should be caring about.

    I emphatically disagree about “therapy” being a “neutral term.” Massage, for example, is a neutral term. Massage therapy is NOT. It implies that the massage is merely a method, and that the application of this method is designed to have the effect of improving health in some fashion — in other words, that the massage should have a therapeutic effect.

    If you don’t believe me, believe The American Heritage Dictionary, which reflects standard usage of words:

    * therapy: 1. The treatment of illness or disability. 2. Healing power or quality.

    * therapeutic: 1. Having healing or curative powers; gradually or methodically ameliorative. 2. Of or pertaining to therapeutics.

    * therapeutics: The medical treatment of disease.

    Note that last one especially. “Therapy” is inherently understood by the general public to be medical treatment, not just ANY “neutral” practice.

    ~David D.G.

  72. #72 #1 Dinosaur
    January 31, 2008

    I like “Faith Based Treatment” so much I’m not even going to wait for a consensus on this comment trail to begin using it.

    It’s accurate, both in the sense of “faith that it works” and the derivation from religious practices of pre-scientific societies. It’s not snarky; I’d be comfortable using it in front of a congressional committee; best of all, it puts all the modalities (and their practitioners) squarely in their place, right alongside other religious-type interventions. It also puts an end to the unwinnable arguments; I have no trouble respecting a faith-based position as a simple difference of opinion that has nothing to do with tangible facts.

    I really like this. Methinks I feel a blog post coming on.

  73. #73 Anna M
    February 1, 2008

    Perhaps this is one to try to get people to repost everywhere? It seems like the problem is that everyone already agrees on the nonsense, so there is no one to critique the terms. If the key is to find one that will catch on, find a way to post the need for a new term on a borderline-woo blog/website (you must know someone…).

    As always, the responses you get from those that disagree with you will give you more information than a thousand people with the same opinion. Maybe you can get the term to catch on as well. Otherwise known as guerilla marketing.

  74. #74 Harriet Hall
    February 2, 2008

    How about “So-called Alternative Medicine”? Everyone will understand what you’re talking about and yet realize you don’t accept it.

    I don’t think it’s wise to distinguish between faith-based and evidence-based treatments, because SCAM advocates will insist they have evidence and will not understand why we think their evidence is unconvincing. And it’s possible that some of their treatments will turn out to work. (I didn’t say probable.)

  75. #75 Skeptico
    February 3, 2008

    I could be wrong here, but aren’t these renaming exercises usually performed by proponents of something, not the opponents? Thus homosexuals renamed themselves “gays”, proponents of the war in Iraq talk about the “War On Terror” or “The Surge”, the political left in America renamed themselves “Progressives”, blacks are now “African Americans”. There are exceptions – the “Death Tax” for example. But it seems to me you’ll be more successful renaming what you stand for, rather than what the other guy stands for.

    So to reclaim the linguistic high ground we need always to refer to real medicine as Evidence Based Medicine (EBM). That states clearly and simply what it is and therefore it’s clear what the bad guys lack.

    The alternative stuff should then always be referred to as Non-EBM.

    I realize that’s not the snappy acronym you were looking for, but I don’t really see any of the other suggestions so far catching on. Just an opinion though.

  76. #76 David D.G.
    February 7, 2008

    Skeptico, that’s an excellent point. By emphasizing actual medicine as being “evidence-based,” it then becomes the default to refer to “alternatives” as being “non-evidence-based.” That’s less blatant than calling it “faith-based,” so it might get in under the radar of those who would want to protect it, yet it would convey the proper meaning. Agreed, it’s not “snappy,” but it may yet do the job right.

    ~David D.G.

  77. #77 Kimball Atwood
    March 14, 2008

    I wish I had noticed this post sooner. If I had, I would have linked to it from my blog on Science-Based Medicine: http://www.sciencebasedmedicine.org/?p=62

    Regarding an accurate, matter-of-fact designation for “CAM” (which itself should always be enclosed in quotation marks to indicate that you, the author, are aware that it is a misnomer):

    Implausible Health Claims (IHC) or Implausible Medical Claims (IMC).

    Notes:

    “Implausible” is the hallmark of “CAM.” It’s why we roll our eyes whenever we hear of another “CAM” claim. It invokes the concepts of established knowledge and prior probabilities, whose absence from EBM “evidence” schemes is an important reason that “CAM” has managed to sneak in the back door of the medical academy. Discussed at:

    http://www.sciencebasedmedicine.org/?p=42 and

    http://www.sciencebasedmedicine.org/?p=48

    “Unproven” is strictly correct but too broad. It’s also true, for example, of (plausible) new drugs that haven’t yet been subjected to clinical trials. It doesn’t convey what’s distinctive about “CAM.”

    “Therapy” implies a method that works. Better to use “treatment,” “method,” or “practice,” for example, when looking for an honest noun that isn’t inherently pejorative. Don’t use “modality,” although that technically works, because it fails the literary taste test. That’s changing the subject, I know, but you want your writing to be pleasing. Don’t use “utilize” for the same reason. (Try this little game with yourself: every time you’re tempted to utilize “utilize,” use “use” instead. I guarantee that after a bit of getting utilized to it, you’ll utilize “use” exclusively. “Utility” still has some use, but it’s not very utilityful).

    It’s unnecessary and perhaps counter-productive to use any form of the word “science” in a term that means “CAM,” as counter-intuitive as that may sound. The reasons: some readers view the “science” of medicine as synonomous with EBM. It is not, so don’t even throw that bone. The science that most pertains to Implausible Medical Claims (IMC) is the group of firmly-established theories, eg, the physical laws, electromagnetic theory, gravitational theory and planetary motions, plate tectonics and the “old” earth, evolution by variation and natural selection, established genetics, microbiology, cellular and molecular biology, etc. These are better called “facts” or, if you’ll excuse the slightly pompous redundancy, “established knowledge” (see the p=42 link above). Those terms are entirely justified and portray the part of science that exposes the implausible nature of most “CAM” claims.

    “Science” is ambiguous because it has at least 3 meanings: the scientific method; the body of knowledge that has resulted from that method; and the collective “culture” of the scientific pursuit, including the institutions and people who are part of it. Science in the second sense is what mainly disqualifies “CAM,” but you can count on sCAMsters and well-meaning but misguided EBMers to get stuck on numbers 3 and 1, respectively.

    I agree that “pseudomedicine” is an accurate and pleasing term for IMC when there is not a reason to be scrupulously polite. “Implausible,” by the way, is not a term that we should relinquish to the “manners” police. It is not pejorative; it is subjective to an extent, but an educated, “good faith” extent, exactly as is the case for responsible prior probability estimates in Bayesian analyses. If we can’t say that something that violates the 2nd law of thermodynamics is implausible, we might as well stop teaching chemistry.

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