Respectful Insolence

A few months ago, I wrote a post lamenting how science- and evidence-based medicine has lost the linguistic high ground to the woo peddlers, those who have “rebranded” quackery first into “alternative” medicine, then into “complementary and alternative medicine” (CAM), and more recently into “integrative” medicine (as though “integrating” antiscience and pseudoscience into effective, science-based medicine somehow adds anything of value to medicine) and discussing strategies for reclaiming it.

Now, I’ve found out how CAM promoters pulled it off. Dr. Wallace Sampson has the scoop and dishes it out for your education in Why would medical schools associate with quackery? Or: How we did it. He shows how changing the language was the first step for the pseudoscience that is the vast majority of CAM to first gain a foothold and then achieve seeming “respectability.” The only thing he’s left out, I think, is that one other tactic that’s used by the woo-boosters is to intentionally conflate criticizing ideas with criticizing the person espousing them or the cultural tradition from which the ideas come. Consequently, if one criticizes what someone boosting traditional Chinese medicine says, for instance, not only is one being mean to that person but one may even be a racist. It’s a Chinese cultural tradition, after all!

All of this leaves me with two questions for you, my readers (after you’ve read Dr. Sampson’s post, of course):

  1. Is it too late? Have the postmodern forces backing CAM won?
  2. If your answer to #1 is “no,” then how can scientific medicine reclaim the linguistic high ground?

Please discuss.

Comments

  1. #1 Zeno
    June 26, 2008

    Maybe we should make a point of calling it “folk medicine” and avoiding “integrative” or even “alternative”. “Folk medicine” is not as overtly derogatory as “pseudoscience”, but still tends to make the point that it’s not scientifically founded.

  2. #2 Interrobang
    June 26, 2008

    Zeno’s on the money (as usual). Don’t use their terms at all. I don’t even like coinages like “SCAM” (So-Called Alternative Medicine) for the purposes of out-group communication, because even by subverting their terms, you’re still reinforcing them. “Folk medicine” is good, another term that doesn’t use the word “medicine” would be better. (If I think of something, I’ll let you know.) Be loud. Insist that your term be used when communicating with the public. (Someone with some paper clout should write to the large media outlets who maintain style guides and see what you can do about getting “CAM” out of newspapers, for instance.)

    Part of the problem is that you’re fighting large cultural forces, one of the major ones being anti-intellectualism. There’s always been a deep strain of that in American culture, and sometimes it ascends for a while. A longer-term comprehensive strategy to make science cool again would probably help there, but that’s not a “what can we do this minute” type of thing.

    I’m a little nonplussed by your referring to the con artists as “postmodern,” since they’re nothing of the sort. Postmodernism is an analytical tool for studies in the humanities and social science, and as near as I can tell, the woomeisters don’t actually analyse anything, except for figuring angles.

    Having a mental tool that lets you shift your frame of reference “on demand,” so to speak, is a great way of getting culture and other bias out of an analysis when looking at certain questions. Anybody who’s using it to justify chicanery is, well, DOIN IT RONG.

  3. #3 bsci
    June 26, 2008

    “Folk” can fall into the same trap of being called racist since it’s making a judgement on other people’s cultural remedies.
    “Historical treatments” might be better. That both makes clear that these aren’t done anymore, but it does it with respect because we really can learn from history. Historical leech treatments were terrible, but by studying the use of leeches we’ve discovered their anti-coagulatory benefits and can apply them to some transplant surgeries. Historical medicinal beverages aren’t valid science any more, but we can study them to figure out if and why some worked so we can isolate the beneficial molecules. Homeopathy and phrenology are historical treatments that ended up being wrong turns.

  4. #4 CRM-114
    June 26, 2008

    You’re on the right track gang. How about denying them the use of ‘medicine’ entirely. Call it black magic, hocus pocus, snake oil, or woo.

  5. #5 Sam C
    June 26, 2008

    “Folk healing” perhaps?

    That avoids abusing the word “medicine” and retains Zeno’s excellent suggestion of a term that does not flatter quackery but avoids being overtly offensive. I have no sympathy at all with woo and quackery, but insults alienate people who might listen more to what sounds to them like reasonable debate.

    The hijacking of “integrative” by the quacks is really disgusting, as most quackery is anything but integrative; each quack proposes exactly one variety of snake oil for curing all ills.

  6. #6 Liesl
    June 26, 2008

    It can’t be too late. Things do have a way of constantly changing, and I suspect this will someday be subjected to change. Unfortunately, it’s going to take a large number of people being harmed by the lack of medicine in CAM for it to change. We only care about these things when we are forced to care about them, and being harmed forces that caring. I refuse to believe we are stuck with this crap.

  7. #7 mike stanton
    June 26, 2008

    The quacks working their woo in the autism community claim to be following a biomedical approach. We call them biomeddlers. Can we extend that to chiropranksters and ho-ho-homeopaths?

  8. #8 dsidhe
    June 26, 2008

    With regard to appropriating science’s language for pseudoscience, I remember an interesting article by Richard Weaver to that effect. I can’t remember the title offhand, but the word he coined for that kind of appropriation is “scientism.” It isn’t 100% applicable because he’s criticizing sociology rather than “alternative medicine” but the tactic is similar.

  9. #9 wfjag
    June 26, 2008

    As my Psycholinguistics Prof. liked to say “Naming the game is the name of the game. The side that decides which names are used, wins.” Dr. Sampson is completely correct.

    However, don’t overlook the fact that CAM has pressed its agenda by litigation and legislation for decades. Legislation and litigation is all about word usage and the “names” used. I suggest a number of responses:

    1. Anyone providing health care services who is not a MD or DO is referred to as “Mr.” or “Ms.” Ph.Ds and D.Psy s, etc., who have degrees from accredited programs requiring going to class on a campus (i.e., not including “graduates” from mail order schools like the now defunct Columbia Pacific Univ. — read the Men Are From Mars series for an example) are referred to as “Professor”, if in a teaching position, and addressed as “Mr. ___, Ph.D.”, “Ms. ___, D.Psy.”, etc. There are a lot of academic doctorates who do not use the title “Doctor” as a type of common address. A “J.D.” is a doctorate level degree, but an attorney is formally addressed as “Mr. ___, Esq.” or Ms. ___, Esq.” Start referring to D.C.s, N.D.s, etc., in the same way — and insist the peer reviewed professional publications do it that way, too. (I’ve used this tactic very effectively at trial — a D.C. refers to him/herself as “doctor” and I ask “Where did you get your medical degree from?” They always fall for the trap and talk about their “chiropractic medical training”. And so I ask, very innocently, “So, you’re not a REAL Doctor, right?” That prompts an argument that D.C.’s are real doctors, to which I respond “I’ve got a Juris Doctorate, and no one calls lawyers ‘doctor'”. After some quibbling, I get the court to rule that I can refer to the D.C. as “Mr. Chiropractor” (and sometimes get the court to require the other side to do so, too, on the grounds of avoiding jury confusion), and the result is that it is clear to the jury that a D.C. isn’t a M.D., D.O., Ph.D. or other profession commonly called “Doctor.” People don’t like learning they have been fooled).

    2. Insist on the adoption uniform, national standards for all persons practicing health care. The standards for the practice of medicine, nursing, dentistry, podiatry, etc., are uniform nationally. For D.C.’s, what is allowed by state law varies incredibly from state to state. For example, check Missouri, and you’ll find that a D.C. can do pretty much whatever he/she wants. However, last time I checked, in Ohio the law prohibited a D.C. from calling him/herself a “Doctor.” Insist that terms like “CAM” be abolished — it’s “chiropractic” or whatever so-called discipline is being employed. Insist on precision in the use of language. “Ineffective” is an accurate description when a “treatment” or “procedure” is ineffective.

    3. In insist on enforcement on the limitations established by law. In Kentucky the statutes authorizing the practice of chiropractic limited it to pretty much straight chiropractic. The state chiropractic board tried promulgating fairly expansive regulations. This was challenged and the KY Sup Ct held that the regulations were invalid as exceeding what was authorized by statute. However, even in states with fairly strict laws, those aren’t enforced because there isn’t public pressure to do so. I suggest obtaining a copy of the report of the Louisiana Dept. of Health and Hospitals (about 1990) on Cancer Mortality in Louisiana. The LaDHH found that while cancer incidence in Louisiana, except of lung cancer related to smoking, was at or below national averages, cancer mortality was well above national averages. One of the main reasons for this was the common practice of going to “non-traditional” care providers so that by the time the cancer was diagnosed, it had progressed too far. Note the growing body of evidence relating chiropractic manipulation of the cervical spine and strokes. Insist that medical schools teaching CAM also teach its risks and the risks of delaying appropriate medical treatment. CAM is not a harmless waste of resources. Rather, CAM kills. That’s a message to repeat and demonstrate often, and gather and cite studies showing that.

    4. Insist that all health care providers be covered by professional liability insurance as a requirement of licensing. D.C.s like to assert as proof of the effectiveness of their treatments that D.C.s are seldom sued for malpractice. This isn’t the reason. The reason D.C.s are seldom sued is that they seldom have malpractice insurance. Since they are effectively judgment proof, it’s a waste of time to sue them, no matter how bad the outcome.

    5. For CAM practitioners who are on staff at a hospital, insist that the hospital risk management committee establish standards of care on the procedures and services they are allowed to provide, and enforce those standards.

    6. Report false or deceptive claims to the FTC and states attorneys general. Insist that action be taken to stop such.

    7. Challenge the use of “homeopathic” and other remedies, and seek to require FDA review and approval. This will require federal legislation.

    8. Analyze the contents of homeopathic, etc., remedies and file complaints to appropriate authorities. My ex gave my sons some concoction to “calm them.” I had it checked. It was about 80% ethyl alcohol by volume. I’m sure it calmed them – so would a shot of Bourbon. However, from any source other than a Rx by a D.C., I would have filed charges for contributing to the delinquency of a minor.

    9. Work with state bar associations for “fair and equal” time and treatment when Continuing Legal Education courses have CAM practitioners making presentations to attorneys. D.C.s love to give presentations to attorneys and judges to assert their “theories.” A good presentation (including slides and citations to studies) by a doctor, which reviews the science and medicine would counter such. CAM practitioners are excellent at bloviating – Latinizing common words to make them sound important. However, it’s still a common word or concept – explain that.

    10. Get involved in political campaigns, and contribute to candidates who will insist that scientific and evidence based medical standards are required. Most state court judges are elected. D.C.s and trial attorneys contribute heavily to campaigns. A trial judge is unlikely to hold the opinions of a contributor are not admissible. The National Chamber of Commerce has, for the past few years, been working hard in this area. Your state medical associations need to become involved. As I noted at the beginning, for the past several decades, CAM practitioners have used legislation and litigation. If you believe they are winning the fight, then organize and start fighting back. If not, then don’t complain. CAM practitioners haven’t “taken” the linguistic high ground. Physicians and scientists have ceded it. If you want it back, you’ll have to fight for it.

  10. #10 MikeB
    June 26, 2008

    Unfortunately, the woo-artists are winning on this one, and its difficult to see how we can fight it. Even if we follow CRM-114’s advice (which I totally agree with), the alt-bunch will say that they are being insulted rather than debated and will claim the high ground. On the other hand, if we try to debate them, they can argue that their views are equally valid!

    I have lost count of the times that I’m subjected to meaningless waffle from some quack on the BBC’s ‘Today’ programme, defending alternative therapies, etc. Unfortunately, arguing with them is a bit like trying to nail jelly to a wall, and the often inexpert questioning of the interviewer gives them plenty of wriggle room.

    Perhaps we need to change both the language, and how the media handles the subject. At the very least we should never allow them to set the terms of the debate, and pull up any journalist who uses language like ‘integrative’ – if the media uses such a word, that gives it authority, so lets stop them doing it.

  11. #11 daedalus2u
    June 26, 2008

    There is a perfectly good term, nostrum remedium. I think calling it a ‘folk nostrum’ would be a better than calling it ‘folk medicine.’ ‘Folk remedy’ is ok too.

  12. #12 Arren Frank
    June 26, 2008

    @ wfjag

    Thank you for taking the time to write your comment.
    I found it incisive and (perhaps surprisingly) encouraging.

    *****

    With regard to the semantic discussion on what to call sCAM, I think wfjag nailed that as well, in that each so-called discipline within that overarching sCAM classification (read: non-empirical) should be referred to specifically (e.g. “chiropractic”).

    Personally, I like daedalus2u’s nostrum remedium, but Latin has a way of precluding widespread adoption, no?

    As far as the suggested “folk _” alternatives: let’s steer clear of words with positive connotations (such as “medicine”, “remedy”, “healing”, “cure”, etc.)

    Upon further consideration, “folk” itself might be, in the first place, undesirable as part of a linguistic construction to be used out-group. I think coupled with the tone of voice used to refer to it (at least in my case), people just might hear “folk” as pejorative.

    Hmm….. it would be best to instead develop a construction that takes pains to present equanimity (as opposed to scorn).

    If your humble narrator actually comes up with a construction that satisfies that aspiration, I’ll return and post it….. no promises.

  13. #13 Brian
    June 26, 2008

    I’m starting to think it may be too late. Here at my community hospital, we’ve just started considering Therapeutic Touch as a service offered in the PACU. Apparently, it’s been done for some time now up on the floors. I have to assume that if it’s infiltrating small-fry hospitals already, the end-times must be near.

  14. #14 pastbyer
    June 26, 2008

    I’d just like to say, on behalf of all Chinese people, that we’re not insulted if you criticise traditional Chinese medicine, since we do that too, all the time. :)

    All of the Chinese people I know personally (which admittedly is a very small part of the very large population) would like TCM, acupuncture, chiropractory, etc, to be studied scientifically to find out whether they actually work, how they work, and more importantly, precisely where and on whom these treatments are better or worse than Western medicine. Chinese people (that I know of) are quite pragmatic, and generally like to have things that work, rather than holding onto something solely because it’s traditional. You’ll probably notice this if you go to China and see the increasing adoption of and research contributing to Western medicine there.

    That said, I don’t think that TCM treatments are necessarily bonkers. I mean, the qi spiritualism in acupuncture and the yin-yang system are pretty silly, but that’s not enough to immediately say that maybe some of those treatments or innumerable herbs do something, right? Could it be somewhat possible that the woo-woo-ism was simply a way to pass along knowledge in a society lacking in rigorous science and soaked in general mysticism? Does it matter? You don’t have to adopt the whole woo (in fact I’d rather you didn’t), just the parts that work. We can’t be sure that it doesn’t work until we test them scientifically, just like we can’t be sure that they do work.

    And lastly, a message to non-Chinese woo-supporters (who are generally well-off white people): Please stop assuming that Chinese people will immediately take offence if people make legitimate criticisms of their culture or medical traditions, there is such a thing as humility in our culture, which is highly valued (in the appropriate place and time, of course). Assuming to know what we think and getting it wrong, is much more insulting and belittling. Just because something is from a culture you’re not familiar with or think more highly of than your own culture does not make it automatically better than what SCIENCE came up with. To any racist people out there (though I doubt they’ll be reading this blog, since you all seem to be reasonable people): it does not make it automatically worse either. To both: Get over your insecurities and learn to judge goodness based on actual value, rather than where it came from.

  15. #15 Dr. T
    June 26, 2008

    The quacks won the battle easily for two reasons: 1. The public loves woo and the magical thinking behind it. 2. The media knows that woo stories draw more readers or viewers than straight science stories, so the media gladly used the altered terminology of the woo-meisters. The result is that woo belief has increased over the past 50 years. (So much for improved science education.)

    We will never reclaim the vocabulary or win the minds of the public. Logic, reason, critical thinking, the scientific method, etc. are just too much work for most people, even those of above average intelligence. Hell, I know scientists (well, people with science degrees and science jobs who think of themselves as scientists) who believe in woo! In my pathology course, I had physician assistant and doctor of pharmacy students who could not be convinced that woo was quackery.

    If we want a woo-free society, we need to form a deep sea or space colony that prevents magical thinkers from joining.

  16. #16 Marty
    June 26, 2008

    Why all the hand-wringing? This is very easy:

    Evidence-based medicine is pretty darn good — except it kills 225,000 patients/year in US. Source: Starfield, Jama (2000)

    Woo-based medicine (ie, “integrative” medicine) kills far fewer, but doesn’t work much. However, since probably 50% of evidence-based medicine is placebo effect anyhow, now the wooers get the placebo effect from their woo.

    Perhaps, if doctors and hospitals would stop killing people, woo would be less popular.

  17. #17 sailor
    June 26, 2008

    It is not the language, it is the money. Hospitals are interested in the bottom line. If they can sell crap and make a buck they will. It is true that if it was called “witch doctor” they would have a harder time with their staff. Same with the big pharmacies, they are all selling this crap because they make a buck, even if the actual pharmacist thinks its nuts. You don’t get rich giving people what is good for them, you give them what they want.
    I think when we had a generation that was willing to pay millions of dollars annually to drink water (available out of the tap virtally free) out of a plastic bottle for a high price, the conditions became perfect for snake oil salesmen. Now these guys have always been around, but now they have an environment in which they can flourish.

  18. #18 NM
    June 26, 2008

    Actually Marty we don’t know how many people are killed by SCAM each year. Why? Because unlike real medicine SCAMmers don’t bother with things like counting. Failure to provide care that is known to be (cost) effective is still killing people as much classic scalpel slips or therapeutic drug overdoses.

  19. #19 Harry Eagar
    June 26, 2008

    ‘Patent medicine’ is still a good, dismissive term that should be used more often than it is.

  20. #20 HCN
    June 26, 2008

    Marty, your “argument” would hold more weight if your link did actually go to the PubMed index or JAMA, but not to some silly website that was a reprint of a COMMENTARY.

    Look at this:
    http://www.disastercenter.com/cdc/111riskf.html

    About 235000 deaths of people between the ages of 45 and 65 are from cancer and heart disease. There is no listing for “iatrogenic”.

    If you go back in that website you’ll find that up to age 45 the leading cause of death are accidents, mostly motor vehicle accidents. And if you add up the motor vehicle accidents for ages 0 to 65 and over you get:
    834
    2,002
    10,624
    14,528
    7,659
    7,539
    Total = 43086 deaths from vehicles

    Is it time to ban travel by anything other than walking?

    so what are all those iatrogenic causes really from? How are they counted? Do they include people not taking their prescribed medication properly? (like continuing to drink grapefruit juice while taking statins?) Or from last minute attempts to save folks from heart attacks and vehicular accidents?

    Tell us exactly how those “iatrogenic” deaths relate to recent news that American life expentancy is at an all time high:
    http://www.medicalnewstoday.com/articles/111113.php

  21. #21 HCN
    June 27, 2008

    In the last link I posted was this report:
    http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf

    Please tell me where it lists “iatrogenic”.

  22. #22 HCN
    June 27, 2008

    pastbyer said “I’d just like to say, on behalf of all Chinese people, that we’re not insulted if you criticise traditional Chinese medicine, since we do that too, all the time. :)”

    Well, recently I had an argument with a relative on how “Western” medicine did not … whatever. Except she was defending homeopathy, which is from Germany! She looked confused when I asked her (since she was born and lived there) how Germany was not “western”.

    Some folks just can’t get their compass postings in the right place with their pet theories.

    I have recently learned that something I really wished my kids had was developed in Japan: the varicella vaccine. I personally am taking medication for high cholesterol developed in Japan, and today underwent a procedure developed by this guy: http://en.wikipedia.org/wiki/Hiromi_Shinya … so am I being helped by Eastern or Western Medication?

  23. #23 DLC
    June 27, 2008

    I’d say “Damn the PC-Torpedoes, full speed ahead!”
    This isn’t a fight you win by giving in.

    As for the Iatregenic deaths canard:
    how many people die annually because their woo-based-medicine failed ? We don’t know, because no pseudoscientific crank keeps accurate records. How many people die because they went to their quack therapist for “Energy Work” or some other ineffectual useless junk-impersonating-medicine and so died because their otherwise treatable illness went undiagnosed until it was too late to do anything about it ?

  24. #24 a
    June 27, 2008

    my goodness, I can’t even read the article, and I’m horribly interested. I got about six lines in and gave up.

    Isn’t this our problem?

    I’m not being snarky. I believe the author has good points, but OMFG were they hard to get to. We can do better.

  25. #25 Hyperion
    June 27, 2008

    wfjag’s comment about non-MD/DO practitioners made me think:

    Why not just go with simplicity and call woo “non-medical treatment”? The term is certainly both apt and accurate, but I also think that it may have a chance of succeeding by playing to the general distaste that woo types have for “mainstream medicine.” By using a term that they might, at first glance, be willing to adopt for themselves (because it distinguishes them from “mainstream medicine”), and appears at first glance to be non-pejorative, it might work. “non-mainstream treatment” might work as well.

    I know that some readers will argue that these terms are too mild, but the point is to choose terms that are seemingly moderate and unobjectionable so as to gain acceptance. By simply choosing names that refer to the lack of widespread mainstream acceptance of these treatments within the medical community, it underscores the fact that it’s quackery and snake oil in a discreet manner, without being confrontational.

    If terms like these gained wider acceptance, their every utterance would serve as a subtle reminder that evidence-based medicine is “mainstream” because it can be demonstrated to work, whereas woo is and should be left by the wayside until such a time as its practitioners can provide evidence of efficacy.

  26. #26 Ms. Clark
    June 27, 2008

    Mike Stanton mentioned, “biomeddlers” I also like “biomuddled”. I think “chiroquackters” is already in use. “Antivax wingnuts” sounds right to me, but I guess if you are aiming for something more neutral sounding… I guess, “placebo based pseudo-medicine” might be good.

    or maybe
    “Yahoo!-Group Based Medicine”
    “Crackpot Based Medicine”
    “Delusion Based Medicine”

    Or

    “Profit Based Medicine” aka “Opulence Based Medicine”
    “Propaganda Based Medicine”
    “Arrogance Based Medicine”
    “Narrative Based Medicine”
    http://www.bmj.com/cgi/content/full/319/7225/1618

  27. #27 raiseya
    June 27, 2008

    This is a lost cause under the current conditions. As much as I think government is far too involved in our day to day lives in the U.S., legislation is the only answer. Strong laws must be put in place to stop health related claims without reproducible evidence of such, with the immediate shut down/confiscation of bogus claimers …. and penalties for news outlets that publish these things without FDA/NIH clearances. Force this junk into the nooks and crannies of the internet where it is hard to see the light of day by ordinary people.

    I’ve played poker with a chiropractor; I wouldn’t let him remove my hangnail. He has money to burn at the poker table though. I know several people (a police detective, a teacher) that have been to the chiropractor and they WILL NOT hear negative stuff about it or him.

    One of my best friends is a nurse anesthetist. He swears by a homeopathic remedy for colds and told me it was recommended to him by a surgeon he works with. When I told him it was water his ears (mind) closed up as tight as a clam.

    You cannot overcome this stuff by talking….I’ve tried.

    But I respect all of you who are trying to enlighten against long odds.

  28. #28 D. C. Sessions
    June 27, 2008

    May I suggest “ritual healing?”

  29. #29 angry doc
    June 27, 2008

    Actually, pastbyer, I would say that the Chinese people and the Chinese government do seem to take criticism of TCM rather personally:

    http://angrydr.blogspot.com/2006/10/how-not-to-argue-for-alternative.html

    If you can read Chinese, follow the link to Professor Zhang’s blog and read some of the comments there. Many of the posters there consider his proposal to remove TCM from the national healthcare system treason (and this being China, being a traitor to your country equates with being a traitor to your race and culture).

    I sense the same sentiment in proponents of TCM in my country too, although I am not sure if they are using TCM to boost their racial pride, or using racial pride to boost TCM.

    I too find that the term “alterntaive medicine” gives woo too much credit, so I sometimes use the term “unproven therapy”, which to me sounds neutral (OK, let’s face it, PC) and is factual.

  30. #30 Joe
    June 27, 2008

    I fear the forces of sCAM have, irretrievably, won the popular vote.

    What I don’t understand is how they have been so successful at medical schools and hospitals (the professional vote). Yes, it brings in money the administrators crave; but this is the tail wagging the dog. The faculty should be bolstered by AMA accreditation requirements. Why isn’t this happening?

  31. #31 Tsu Dho Nimh
    June 27, 2008

    wfjag … I like your suggestions!

  32. #32 Dr. Val
    June 27, 2008

    I don’t think the war has been lost. I think that the majority of physicians are not aware of the war and its implications. Many of our peers don’t know much about CAM and figure it’s harmless enough, so they ignore it. What we need to do is awaken our peers to the threat – and rally them around preserving the sanctity of rational thought and the scientific method. Blogs are one way to do so – another is to create CME programs for physicians, with annotated and accurate information about the risks associated with unproven therapies. It would also be great if someone created a website to organize scientists’ efforts to lobby/educate our political leaders, with very specific and actionable tasks offered: e.g. “click here to send a message to your congressman/woman regarding your concern about [fill in issue].”

    “Theory based practices” or TBP might be a reasonable name for CAM, since it’s not derogatory but makes it clear that the practices are based on theories (which, in common language, suggests the absence of scientific rigor). I know that “hypothesis based practices” is more accurate terminology – but it lacks the immediate consumer appeal that “theory based practices” has.

    Thoughts?

  33. #33 DAJ
    June 27, 2008

    from James Randi’s site:

    THE UNSINKABLE WEIL

    From reader Linda Rosa:
    Weil

    Andrew Weil’s infamous CAM [Complimentary Alternative Medicine] program at the University of Arizona has been named a “Center of Excellence” by the regents. This center claims to be introducing its “required” residency program in CAM to eight medical schools this year. See tinyurl.com/46xw28.

    I find this incredible, though it’s understandable that the university is embarrassed – as it certainly should be – over Dr. Weil’s strange declarations and his embrace of mysticism, it’s difficult to understand how the entire board of regents could decide to endorse the granting of such a distinction. It may be a way of simply protecting the academic body, but to the public it must appear to be a week-kneed method of escaping their real responsibilities, which would seem to include a need to inform the public of the true nature of education and the intrusion of pseudoscience onto their campus.

    The U of A can take some comfort in knowing that they are not alone in their acceptance of quackery. A course in “Structural Acupuncture for Physicians” (???) is now being offered by Harvard University at the price of $6,500. Reader Richard Schultz, learning of this, wrote:

    It makes me want to return my degree (AB 1985) from what was once one of America’s premiere institutions of higher learning.

    Understood, Richard…

  34. #34 pastbyer
    June 27, 2008

    HCN said “… so am I being helped by Eastern or Western Medication?”

    Good point, I called it “Western” medicine to denote the fact that it originated in “Western” countries. But I think that calling it scientifically-tested, evidence-based medicine is a much better global term, since “Eastern” countries are doing more and more research these days. There’s still a tendency in China to differentiate the two as Chinese medicine vs Western medicine though (but that’s really a language issue, I think).

  35. #35 HCN
    June 27, 2008

    pastbyer said: There’s still a tendency in China to differentiate the two as Chinese medicine vs Western medicine though (but that’s really a language issue, I think).”

    And Japan is east of China! Though both are west of me!

  36. #36 HCN
    June 27, 2008

    Sorry… I am just being silly.

    (though it was truly fun to play the geography game with my homeopathy loving niece!)

  37. #37 Linda Rosa
    June 28, 2008

    Big problem: We have long lacked an organization for effective activism against quackery.

  38. #38 Joe
    June 28, 2008

    Dr. Val,

    Inre “theory-based-medicine” in science a theory is a well-established idea. However, I like your approach in that the public thinks a theory is a, mere, hunch. My best suggestion, along that line, is “notional diagnosis and treatment.” I avoid the words “medicine” and “therapy” since they suggest efficacy.

  39. #39 Kimball C Atwood
    June 28, 2008

    “Implausible health claims” (IHC) or “implausible medical claims” (IMC), for reasons explained here: http://scienceblogs.com/insolence/2008/01/renaming_complementary_and_alternative_m.php#comment-787671

  40. #40 North of 49
    June 29, 2008

    Lots of great ideas so far. Riffing off some of those, I like “placebo medicine”, “fake medicine”, and “magic”.

    For another approach, how about a little ju-jitsu? Use their own claims and frames against them.

    For example, though all these practitioners claim to be “holistic”, they are in fact more silo-ed than real medicine. When, if ever, would one go to, say, a chiropractor for an ailment and be told “I can’t really help you much, you’d be better off seeing a physiotherapist” — or even an acupuncturist? In my experience this never happens, since every woo insists it can cure every ailment (or darned near). So I’d suggest we begin referring to each of these, ah, fields, as “just another ‘universal’ cure.” When the number of “universal” cures becomes apparent to the public, they may begin to wonder if they can all be true, or indeed if any are true. (Or not. The religious right, for example, questions the truth of nearly identical religions all the time, without ever applying the questions to their own.) Worth a try, though, I think.

    Another avenue of attack might be the money angle. Sure as shootin’, if you go into an acupuncturist, chiropractor, naturopath or homeopath, they’ll find something to sell you. It’s how they make their living. In contrast, when your GP writes you a prescription, it’s not coming off their shelf, is it? They have no financial interest in that prescription, whereas the woo-practitioner most definitely does have an interest in selling you some remedy or service that only they provide. So I’m thinking something along the lines of “money-pit therapy”, or “market-based therapy”, or “retail medicine” (though I don’t like the word medicine).

    That’s all for now. Off to watch Russia v Spain in the Euro cup final.

  41. #41 Wallace Sampson
    June 30, 2008

    First, thanks to Orac for referring to my Sciencebasedmedicine.com post. Orac himself has recognized and commented incisively on the problem.
    Second, one’s knowledge and pleasure are not complete until one has reviewed Kim Atwood’s series on Weasel Words of Woo, a literate and entertaining challenge, also on SBM.
    If any are stll reading here, a few comments on comments:

    wfjag: Excellent suggestions. Couldn’t have done better…

    But I did develop in 1987 a (10-20?) page handbook for county and state medical societies for dealing with public mis-education through positive educational methods, that included most of the suggestions made here excepting the language problem.
    We started to develop the language idea as recorded in a chapter on PM Medicine in Gross and Levitt’s 1997 Flight from Science and Reason. That was before I even had a good understanding of the “transforming” influences postmodernism has had on the educational system and the elite who run it.
    Understanding increased with two Stanford courses – one on PM literature (Richard Rorty) and one on medical anthropology with a disciple of the Harvard group. The courses were more than eye-opening. They exploded my brain. I had no idea how pervasive and revolutionary were and are the forces of re-education and language manipulation in our colleges. I second those here who recognize the depth to which belief can take the human mind.
    Back to the pamphlet, the Calif. Med. Assoc. attorneys had them destroyed from fears of lawsuits from chiros and others. I kept one copy.
    I have a series of Power Point lectures on the history of “CAM,” the conflicts with Evidencebasedmedicine, the weaknesses and susceptibility of science and medicine, traditional Chinese medicine, and brief sections on several methods, ethics, the inability to find ineffectivenes. I lectured at 16 venues in Canada 1999-2000 to mixed reviews, and came away unhappy and discouraged by the questions and comments. Lots of believers.
    In 2006 I gave 8 talks to 7 northern California hospital staffs to a better reception 70-90 percent gave the talks a 1 or a 2 on 1-5 scale. This despite the fact that a spade was called a spade, especially in the language sections.
    My offer to educate the Stanford medical staff was sidetracked several times. I got as far as two talks to department of medicine residents. My course for med students gets “out classed” by the student run, quack-dominated non-credit course (that my course was formed to replace by the then faculty,) forcing cancellation the last 2 outings. In US med schools There were 5 science-based “altmed” med school courses out of 53 in 1996, but only one or two remain.
    Joe: Postgraduate Continuing Ed courses? Steve Barrett and I were consultants to the ACCME for a year or two, but they do not call any more, worse, they don’t return calls. Junk medicine crops up here and there.
    Astounding development, Linda Rosa – thanks. Follow the money?
    Hyperion: We (I) named our journal with a subtitle of “…and Aberrant Medical Practices.” Could have been “Anomalous Medical Practices.” Intentionally low-key provocative. Like resectful insolence.
    I like your suggestion of using “non-medical” (systems, practices, methods…) It says it all, and “why didn’t I think of that?”
    Great discussion, quite an impressive brain collection here.
    Wallace Sampson

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