Respectful Insolence

I’ve been on a bit of a tear criticizing the National Center for Complementary and Alternative Medicine (CAM). One of the reasons is because, as I’ve said time and time again, there is no logical organizational or scientific reason why the potpourri of disparate, often unrelated, and often mutually contradictory therapies that fall under the rubric of CAM should have its own Center at the National Institutes of Health.

Yesterday, blog bud Abel Pharmboy posted a very good explanation on why. Money quote:

CAM is a terrible term. It is NOT medicine. Modalities proven to work are medicine. Modalities that don’t work are not medicine. There is no complement to medicine. Medicine is medicine. There is no integrative medicine, either. Medicine already takes advantage of all modalities: surgical, pharmacological, radiological, physical, psychological, nutritional – if a clear benefit can be offered to a patient that outweighs the risk.

So-called integrative medicine gurus have adopted proven, preventive medicine techniques – diet, exercise, meditation, yoga – and have used them 1) to justify that “CAM” works and 2) that the efficacy of these approaches justifies study and implementation of approaches that have absolutely no scientific basis.

Exactly what I’ve been saying all along.

Comments

  1. #1 Rogue Medic
    March 20, 2009

    Very well put.

    It takes the focus off of claims of fairness. As if it is fair to patients to mistreat them just to give these ineffective treatments equal time, or some other unfair abuse of patients.

    It takes the focus of of the charisma of the pusher proponent of this holistic pseudo-medicine. A proponent, who focuses on using that charisma to put a hole in the patient’s wallet.

    It takes the focus off of claims of being misunderstood geniuses. As if a true genius, such as Galileo, would have to wait for money from NCCAM to rigorously test his ideas.

  2. #2 DLC
    March 20, 2009

    I consider the key to be: “. . . a clear benefit can be offered to a patient that outweighs the risk. ”

    A Clear benefit that outweighs the risk.
    I couldn’t say it enough.
    Every so-called “Alternative therapy” either has no clear benefit (no positive effect above that of the placebo) or is not worth the risk. All too often Alternative therapy is the alternative to getting well.

  3. #3 Magpie
    March 20, 2009

    Weeeelllll….

    The problem with ethical medicine is that is loses some potential placebo effect. You can’t lie. But if you can come along and “supplement” real medicine and, um, also supplement the truth with a harmless placebo, and – to get the full effect – lie and say “this placeb- ahem, err, this new treatment is tremendously effective in many cases as a complement to your existing therapy, though does nothing without the mainline treatment” – well, you would expect patients to have better outcomes, right? You can’t lie about active treatments because they require informed consent – they can have serious side effects – but properly researched CAM (that is, researched to prove it does NOTHING at all), and most of all properly branded CAM, could be useful, surely? You can lie because the lie itself is the fully researched and effective treatment. Anything that gives legitimacy to the truly ineffectual treatments also improves its benefit, right?

    Shorter: “…if a clear benefit can be offered to a patient that outweighs the risk.” Lying satisfies this criteria. Maximum placebo, minimal side effects.

    Not that I think these bozos should get actual MONEY, and “alternative” therapies should be bloody banned, but… I’m torn over the “complimentary”. If my boy was in hospital with something potentially fatal, I would honestly prefer the docs to lie to him and me, even if it garners only a tiny fractional increase in his chances. And we know that complicated impressive bulshytt works better than simple bulshytt with no Centre to call its own.

    So maybe this is all some vast experiment to upgun the placebo effect…

    /only half joking: of course confidence in the medical profession is the best placebo of all. Lying could damage that – unless you had some kind of government body whose job it was to obscure the science…

    (Bulshytt: http://www.nealstephenson.com/anathem/dict.htm)

  4. #4 FishNChimps
    March 20, 2009

    Hang on a minute – yoga is a “proven, preventive medicine technique” ?

  5. #5 techskeptic
    March 20, 2009

    Magpie, I don’t think you have that right.

    All medicine has placebo. You can not give medicine without inflicting placebo on people. When you give a drug or try a procedure, you are giving placebo.

    The good part of EBM whether it be a pill or a procedure is that it gives placebo and added benefit.

    The only thing that EBM could benefit from is they way that healthcare is delivered. I don’t know what to do about it, but I think the average time a doctor spends with a patient is like 7 minutes… a reiki practitioner or homeopath is like an hour.

    The talking, the comfortable quiet setting and empathy is something that would benefit all those people who seek CAM, but would allow them to get treated with EBM.

    I have no idea, with our current system, how doctors can make money that way…. but i’m just sayin… you don’t need to give a magic sugar pill with every prescription to get placebo action.

  6. #6 D. C. Sessions
    March 20, 2009

    Hang on a minute – yoga is a “proven, preventive medicine technique” ?

    Sure. Low-impact exercise with an emphasis on stretching and range of motion? Forty years of that and a lot of the aches and pains I’ve acquired over the years would be seriously reduced.

  7. #7 davidp
    March 22, 2009

    Yoga: Anecdotally, I got lots of leg cramps overnight related to my bicycle commute home from work. After six weeks of weekly yoga sessions last year, I have had hardly any (and cant remember any) since.

    Of course ‘these positions release toxins’ was rubbish, but the exercise, stretching, and relaxation was real, and the exercise and stretching were measurable.

    Earlier recomended techniques – a couple of supplements – didn’t do much, if anything.

  8. #8 Abel Pharmboy
    March 24, 2009

    Hey, thanks Bro. I’ve not been making the blog rounds the last couple of days so I really appreciate the endorsement.

  9. #9 Jacob
    June 6, 2011

    The lymph system removes ‘toxins’.

    Yoga gives the lymph a good ‘push’

    Ujayyi breath creates heat, making sweat which is also purifying in it’s own way.

    FACT: Yogis can stop and restart their own hearts at will.

  10. #10 Antaeus Feldspar
    June 6, 2011

    Not “fact”, just a claim, and a dubious claim at that.