Respectful Insolence

In which I echo PalMD…

Blog bud PalMD was asked this most difficult question:

A colleague of mine asked a great question: if you have one question to ask a booster of so-called alternative medicine in a public forum, what should it be?

To which he responded:

My answer: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

I tend to agree. If there’s one difference between so-called “alternative” medicine and science- and evidence-based medicine, it’s that ineffective therapies in general are abandoned. Now, I don’t claim that it always happens as fast as it should. All too often it does not. Sometimes, in extreme cases, it takes the older generation of doctors retiring and dying off and the newer generation taking over. Nor do I claim that the process isn’t messy. Scientific and clinical studies often take years to shake out, and in the meantime there can be a great deal of confusion. But make no mistake. Ineffective therapies do disappear in science-based medicine. The examples are legion.

Now contrast that to “alternative medicine,” where “ancient wisdom” is prized and faith-based “cures” are the rule. Is there any “alternative medicine” that CAM practitioners have ever stopped using because the evidence showed it not to work? I can’t think of any. Homeopathy and reiki, for example, have time and time again been shown to be nothing more than water and faith healing, respectively. Yet they are as popular as ever among CAM practitioners. That’s why this is an excellent question.

But there must be others. What other questions directed at a CAM believer could limn the essential difference, the faith-based nature of CAM, for a general audience? For me, the question would be this:

“What specific evidence would it take to convince you that homeopathy {or whatever woo the CAM practitioner believes in} is ineffective medicine?” Then I would press for specific examples.

The comments are now open for your ideas.

Comments

  1. #2 wybory sondaze demokracja
    April 21, 2009

    We can’t say that something is bad just because it was not proven with the newest technology. The gretest powers are in human’s mind, so if reiki, homeopathy and another red ribbon and mirrow work – why not try. They even have quite nice name – placebo. And as far as I remember, it IS proven that placebo works. How we say it: man proposes, God disposes.

    By the way – isn’t it funny that what we call ‘alternative medicine’ was used by our ancestors decades and even centuries ago?

  2. #3 Andy Lewis
    April 21, 2009

    These two questions are pretty key. They highlight the essential closed mindedness of CAM and refusal to acknowledge potential error.

    An interesting and related question for me is this: “Within your discipline of [say, homeopathy] how do you resolve differences of opinion about best practice between different schools of thought?”

    This sort of combines the two questions. Firstly, within homeopathy and other CAMS different traditions may emerge (one pill or many pills, remedy machine manufacturing, delivery through non-traditional means, e.g MP3 files (not kidding)).

    Although there may well be disagreement, there is never a push to resolve the issue by reaching a concensus based on reason and evidence. Different schools of thought just shout loudly at each other, and then pretend to listen respectfully to each other. To reach consensus would mean a) abandoning disproven modes of operation and b) developing methods of proving one way or another what works and what doesn’t. Alternative medicine is incapable of doing either.

  3. #4 Christopher
    April 21, 2009

    It seems that people do switch from “TCM” to “Western” medicine when the result is not only proven, but immediately obvious – as with viagra…
    http://www.news-medical.net/?id=13664

  4. #5 ababa
    April 21, 2009

    (we’ll call him “bob”) said: “why not try.”

    As long as there is no harm, (other than false hope), sure. But alternative medicine practitioners tend to charge a nice sized fee for their services. A homeopath that gives their water away for free would “only” be dishonest, and not a con.

  5. #6 Bilbo Baggins
    April 21, 2009

    What have I got in my pocket?

  6. #7 Antaeus Feldspar
    April 21, 2009

    “We can’t say that something is bad just because it was not proven with the newest technology.”

    We can’t make a final, absolute, for-all-time determination that way — that much is correct. That is in fact (part of) Jake Crosby of AoA’s problem — even if he was reading and responding to the best scientific data available now, which he isn’t, that would be no justification for announcing that no data that comes up in the future will ever change his conclusion.

    However, we can and must make our decisions for the current time based on the best information available at the current time. Sorry, Polish bob, when something is costing time, money and attention and neither the “newest technology” nor any other form of legitimate scientific evaluation shows that it’s actually doing anything, yes we can say it’s bad.

    Is it possible that new data will come in later showing it’s good? Yeah, that’s possible. And it’s also possible that new data will come in later showing it’s even worse than we thought. We can’t make our decisions based on data that we don’t have.

  7. #8 Michael
    April 21, 2009

    I would like 2 questions answered:

    1) What evidence (and how would it be obtained) would convince you that a particular treatment is not effective?

    2) What treatments have been discarded because of evidence that they are ineffective (and what was the evidence)?

    I rather suspect that the answers would be a lot of hand waving and hot air.

  8. #9 Dr Benway
    April 21, 2009

    Dr. CAM, where do you draw the line between plausible and implausible treatment ideas?

    Example:

    We learn of a treatment for shingles from a native American tribe which involves standing under a full moon for one night. Plausible or implausible, and why?

  9. #10 BB
    April 21, 2009

    “By the way – isn’t it funny that what we call ‘alternative medicine’ was used by our ancestors decades and even centuries ago?”

    Hey Wybory, how healthy were they?

  10. #11 Cogito
    April 21, 2009

    I think a more pertinent question, as far as patient safety goes, is “what treatments are you aware of that have been discarded by “mainstream” medicine, on account of ineffectiveness or actual harm done? (Hints: how about the 10’s of thousands injured by Viox, for starters? And when was the last time you actually looked at the actual evidence for effect of NSAIDs on the actual natural history of arthritis. Little if any; but plenty of evidence to suggest that some NSAIDs may actually accelerate joint damage by inhibiting synthesis of cartilage.)

    In other words, I suggest MD’s attend to the logs in their own eyes (and in the eyes of the extortionate pharmaceutical industry to which they are enslaved) rather than the specks in CAM.

  11. #12 The Perky Skeptic
    April 21, 2009

    The reason we know so much about iatrogenic injuries and deaths is that medicine STUDIES them in order to LEARN from their mistakes. Does CAM do this? It is shown time and time again that they can’t even follow their patients well enough to record outcomes beyond “patient felt better, then lost contact.” Did they die? Did they get, oh, REAL medical treatment from an MD? We. Don’t. Know. Because CAM doesn’t want to examine their own eyes for motes or logs, as Cogito so eloquently metaphored.

    Science is self-correcting. What is CAM? Is there ANY evidence that CAM practitioners refine their practice and learn from their mistakes?

    Well, the first step would be to get them to stop finger-pointing and name-calling at “mainstream medicine” and actually take a good, hard look at their own untidy house. Because the fact is that science-based medicine is CONSTANTLY on the lookout for stuff within its own practice to clean out.

  12. #13 Hap
    April 21, 2009

    Well, you can count medical deaths, but only if you also count the lives medicine has saved. (Life expectancy probably cinches that as a net positive.) Is there a CAM modality that actually has worked (by which one means “works better than placebo or nothing”)? If so, how many lives has it (and CAM overall) saved? If CAM works/worked so well (by so well, meaning “has actually saved any lives”), why has it been so rapidly displaced by medicine as a method for treatment of disease? (And why has live expectancy increased dramatically while doing so? – while at least part of the increase is both better food and a cleaner environment, those weren’t exactly improvements that were advocated by CAM but were by medicine).

    I don’t think you need to worry about the logs in your own eyes though – even if you could somehow remove them, it would not help. None so blind as those who won’t see, and all that.

  13. #14 Calli Arcale
    April 21, 2009

    Cogito, Vioxx is actually an example of a treatment discarded because it caused harm. So it really does not support your argument. Why was Vioxx such a scandal? Because mainstream medicine was outraged to have been duped by the manufacturer. You see, MDs actually care about truth, so when they learn they’ve been lied to, they get quite upset.

    But why is there not similar outrage over those who lost their hearing due to ear candling? Why do the proponents of Ayurvedic medicine not acknowledge that many of their remedies contain high levels of lead? Why do chelationists keep trying to treat atherosclerosis and autism despite the fact that, even by their own proposed mechanism, it cannot work, and has killed several people already? I can only conclude it is because alternative medical practitioners, by and large, are not so concerned about truth. Indeed, many see truth as a flexible entity. It matters more how you *feel* about something. Intuition is more important than evidence. A climate like that makes it nearly impossible for the multi-billion-dollar alternative health industry to self-correct. Practitioners will not notice when they are duped, and indeed, may not even care, because to them, evidence is not important. Show them evidence that a treatment is harmful and they do not discard it. They merely say that they are too careful to screw up like that, and it’s never hurt anyone in their practice, and they just *know* it works. In alternative medicine, evidence is neither needed nor wanted.

    In a perfect world, there would be no dichotomy between alternative and mainstream medicine. All of it would be regulated so that the unscrupulous and the sloppy could not get away with pushing fake therapies on us and sweeping side effects under the rug. Out of concerns that mainstream medicine had too many risks, people started to push for “choices”, and lo and behold, DSHEA was passed. But this did not improve matters. On the contrary, it opened up a huge new avenue for fraud. If the manufacturers of Vioxx had not attempted to sell it as a pharmaceutical, but instead as a dietary supplement, they would never have been caught. Indeed, they wouldn’t even have been required to do the studies that ultimately demonstrated the dangers the drug posed.

    If you want Big Pharma reigned in, the answer is not to give them a big huge new playground of marginally-regulated drugs. I do not understand why people think that Big Pharma is corrupt but Big Vitamin isn’t. The truth is that they’re both corrupt, so we as a society need to appoint watchdogs to keep them honest.

  14. #15 wackyvorlon
    April 21, 2009

    I have an even more chilling question. Can you name a single alternative medicine practitioner who was sanctioned by his fellow alt med practitioners for malpractice? Can you name a single homeopath who was sanctioned by the British SoH? Can you name a single naturopath who was sanctioned by his fellow naturopaths for malpractice?

    Alternative medicine has no concept of malpractice. They have no concept of inappropriate treatment. That should scare the hell out of people.

  15. #16 Phoenix Woman
    April 21, 2009

    Quick O/T — More deaths and disease that can be laid at Andrew Wakefield’s and Jenny McCarthy’s feet:

    Measles Cases in D.C. Area Prompt Awareness Campaign

    [...]

    World health authorities have said measles deaths have dropped significantly world-wide. But federal health officials say the disease has been resurgent in the U.S., with nearly half of those involving children whose parents refuse vaccination.

    Recent cases in California, Pennsylvania, Iowa and now the Washington region show that as long as measles exists somewhere in the world, it’s still a threat, said Athalia Christie, senior technical adviser with the American Red Cross and member of the Measles Initiative, a global group.

    [...]

  16. #17 hmd
    April 21, 2009

    How can you tell which alternative methods are valid, wrong, or just plain fraudulent?

    Which alternative methods do you think are just bunk? How do you tell?

    (This has the potential to pit various different types of alternative practices against each other, which would be amusing if not particularly edifying.)

  17. #18 Orac
    April 21, 2009

    Check this PLos ONE paper out: From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious

    A friend speaks:

    http://www.sciencebasedmedicine.org/?p=462

  18. #19 Scote
    April 21, 2009

    I always ask a variation of the same question in the OP, which is are all alternative medicine techniques equally valuable? How do you tell which works better? Is iridology as good as acupuncture? It is a process question, where I can invoke an alternative medicine technique that even most CAM advocates reject and ask them about their epistemology and explain the value of science based studies. It it’s just meant to get them thinking about science, not change their mind immediately. I have no idea if it works, but it is a way to start a dialogue.

  19. #20 Michael
    April 21, 2009

    I have a third question provoked by wybory’s remark that “isn’t it funny that what we call ‘alternative medicine’ was used by our ancestors decades and even centuries ago?”

    3) What progress has alternative medicine made in the past few centuries?

  20. #21 wackyvorlon
    April 21, 2009

    I can tell you this much, my ancestors never did reiki or acupuncture. They did blood letting and leeches.

  21. #22 Calli Arcale
    April 21, 2009

    Yes, that’s the other problem with the “argument from antiquity” idea — most of these supposedly traditional remedies aren’t traditional at all but are merely sold as traditional for marketing reasons.

  22. #23 Sastra
    April 21, 2009

    What I hear sometimes is “what works for one person may not work for another.” People who are into alternative medicine seem quite comfortable with this idea: everyone is different (i.e. special), and you have to find what’s right for you. Reiki works for some, homeopathy works for some, megavitamins work for some — and not others. It’s all very supportive of the importance of being an individual, and trying things out for yourself, the old-fashioned way.

    Since this method of case-by-case evaluation leaves then with no possible way to tell the difference between someone who got better because the medicine “worked,” and someone who just got better for any other unrelated reason, they get their intermittent positive reinforcement — and nothing is ever discarded because it doesn’t work. It does work — but it wasn’t “right” for you.

  23. #24 Hap
    April 21, 2009

    How do they know what’s right for anyone, or (in a restatement of the original question) what’s wrong for someone? Do they just try everything until something works? That sounds like an expensive way (both in money and lives) of treating anything. One would figure a field whose alleged point is to help make people better would want to know when a given treatment might work. Under what conditions would you not want such data?

    Care that recognizes me as an individual is only useful if it actually helps me – if I don’t survive, my ability to resolve questions about or change myself is zero, while if I survive, I can at least have a chance to explore myself (or the rest of my world). Why is knowing that a brand of care is effective considered irrelevant (or not considered) by the people who buy such care?

  24. #25 Diane
    April 21, 2009

    I always wonder how a standard of care can be created if everyone is so unique that you have to invent a new protocol every time.

  25. #26 Antaeus Feldspar
    April 21, 2009

    “I think a more pertinent question, as far as patient safety goes, is “what treatments are you aware of that have been discarded by “mainstream” medicine, on account of ineffectiveness or actual harm done? (Hints: how about the 10’s of thousands injured by Viox, for starters?)”

    To hold this up as evidence that CAM has the better answer is to show that you don’t even understand the question. It’s like saying “How many suspects that were arrested by the police were found at trial to be innocent?? Obviously the much better system is the one in Communistan, where all suspects are executed without trial; you never hear of someone that the Communistanis arrested proving their innocence!”

  26. #27 Scott
    April 21, 2009

    Actually, AF, the question (though not the inference) is not unreasonable. The difference (indeed, what seems to be PalMD and Orac’s main point) is that mainstream medicine *can* give such examples – bloodletting and leeches, to name two (I’m sure Orac could cite more recent examples, and I’d actually be interested to know what he would mention). sCAM can’t.

  27. #28 Marcus Ranum
    April 21, 2009

    I always enjoy asking them “since your CAM cure appears to be capable of doing anything, can you use it to kill me or make me high?”

    I actually did have one acupuncture woo woo say he probably could if he wanted to but he backed out when I started trying to schedule it and did a lot of hand-waving about how it was a violation of his doctor’s “hippocritic oath” to injure a patient even if they asked for it.

  28. #29 Marcus Ranum
    April 21, 2009

    Yes, that’s the other problem with the “argument from antiquity” idea — most of these supposedly traditional remedies aren’t traditional at all but are merely sold as traditional for marketing reasons.

    Otherwise, they’re damned by their thousands of years of ineffectiveness. For sure, if acupuncture (for example) had worked for thousands of years, we’d have seen a long-term difference in life-spans in China. Instead, life-spans were about the same worldwide until Pasteur, at which point they started to climb. Promoting woo woo as ancient woo actually damns it as a pretty ineffective long-term study.

  29. #30 Miutchael
    April 21, 2009

    I would like to develop Dr Benway’s question:

    “Dr. CAM, where do you draw the line between plausible and implausible treatment ideas?

    Example:

    We learn of a treatment for shingles from a native American tribe which involves standing under a full moon for one night. Plausible or implausible, and why?”

    One of the stock CAM defence-attacks is “You need to keep your mind open”. And the stock response is “Agreed. But, not so open that your mind falls out.”

    This is funny, and true. But it may not be obvious why it is true. The problem is that there are an infinite number of remedies (like exposure to moon beams) that someone will think is plausible. However, we do not have enough time to investigate every claim. Therefore we must rely on some filter to screen out most of the rubbish claims, and leave only those that have a high expected value (probability of being true times value of the therapy should it work).

    CAMs which have no evidence to support any of their therapies and no evidence to support any of their theories (i.e. are biologically implausible) fall through the filter.

    That’s how I draw the line between plausible and implausible treatment ideas. But, I would like to know how CAMs draw the line. With invisible ink on water under a full moon?

  30. #31 Koray
    April 21, 2009

    The question about moon beam treatment being feasible or not is similar to what’s known as AB/X testing. Add 19 more quack treatments (some existing, some your own invention of the moment) to this list and present it to a group of quacks.

    Not only will all their answers be wrong, but they’re also be quite inconsistent with each other because unlike real medicine they don’t have a fixed set of consistent scientific theories to reason with. They’ll start pulling answers from magic hats, or try to handwave by saying that whether or not bacon cures cancer depends on the individual, etc.

  31. #32 Mandos
    April 21, 2009

    What?? Bacon cures cancer???

  32. #33 Karl
    April 21, 2009

    I’d like to change our point-of-view and make another question: Why, although clear and good evidences favoring the use of determined procedures and medications, the doctors insist on not using them? What is, actually, another question:

    What more it is necessary so that the doctors believe a behavior, since the scientific method does not seem to be enough?

  33. #34 Michael Suttkus, II
    April 21, 2009

    I eat bacon several times a day and I have never had cancer. That PROVES bacon cures cancer.

    I have had dozens of medical problems, like obesity, diabetes, hypogonadism, etc., but I’m sure bacon was unrelated to all of those. Those were caused by toxins in my over-vaccination and by exposure to EMF.

  34. #35 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  35. #36 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  36. #37 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  37. #38 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  38. #39 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  39. #40 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  40. #41 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  41. #42 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  42. #43 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  43. #44 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  44. #45 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  45. #46 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  46. #47 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  47. #48 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  48. #49 Ron Sullivan
    April 21, 2009

    Mandos, Mandos, Mandos. Of course it does, by the Second Corollary of The law of Similia. Because Bacon is already cured itself, see? Makes perfect sense.

    Srsly, like a man with a good car, bacon doesn’t need to be justified.

  49. #50 Dr Benway
    April 21, 2009

    Bacon cures cancer because…

    Bacon is already cured itself, see?

    Ha! Genius!

  50. #51 MikeMa
    April 21, 2009

    Scott,
    I think I’ve seen recent stories where leeches are making a comeback of sorts but I accept your point:-)

    My ex-wife spent a lot of time and a (thankfully) fairly small amount of money keeping logs and estimating bowel function and the like in order to help the homeopath give her a sugar pill with a vanishingly small amount of poison in it to correct for left curling or floating stools or some other nonsense. In her case it seemed altogether harmless because there was nothing wrong with her physically.

    The deflection of truly suffering patients into this crap avoiding scientific care is unforgivable. I like the “what protocols have you dropped as ineffective” query. The “how would you test to determine the efficacy or failure of a treatment” issue is easier for the homeopaths I’ve met: Poison A didn’t fix the ailment. We must have missed something in the history or logs. We’ll try poison B. And so on.

  51. #52 sydneycarton
    April 21, 2009

    Hmmmm. Because I’m feeling antagonistic even though I am generally against alternative medicine…
    How about phrenology? Or does that count as a mainstream thing that was jettisoned when it was found to not work? Or maybe drinking Radium water? Or drinking ground up rubies to cure your bubonic plague? On a side note there, can’t fads in scientific medicine be just as dangerous and misguided as alternative medicine?
    How about drawing a symbol on your tongue and reciting verse 17 of the book of the dead to make yourself immortal? I feel that magic spells in general have been phased out even by most of the alties.

  52. #53 Dr Benway
    April 21, 2009

    On a side note there, can’t fads in scientific medicine be just as dangerous and misguided as alternative medicine?A “fad” basis would not be a scientific basis.

    It’s possible a scientific community might become corrupted and follow after some fad rather than the evidence. But we can’t lay that crime at the feet of science anymore than we can lay it at the feet of algebra.

  53. #54 Antaeus Feldspar
    April 21, 2009

    “Actually, AF, the question (though not the inference) is not unreasonable. The difference (indeed, what seems to be PalMD and Orac’s main point) is that mainstream medicine *can* give such examples – bloodletting and leeches, to name two (I’m sure Orac could cite more recent examples, and I’d actually be interested to know what he would mention). sCAM can’t.”

    Exactly. Cogito is apparently under the impression that a system which says “whoa, we thought this treatment was safe and effective but now we’ve got evidence that it’s not; we’d better stop using it” is inferior to the system that says “we think this treatment is safe and effective, and if we receive any evidence to the contrary, well, obviously that’s just people not having sufficiently open minds, or the evidence is all cooked up by Big Pharma — there’s all sorts of possibilities but the possibility that our treatment isn’t actually helpful will be ignored.”

    Which indicates that Cogito didn’t get the point.

  54. #55 antipodean
    April 21, 2009

    Bacon doesn’t cure cancer.

    Kevin Bacon cures cancer.

  55. #56 Skemono
    April 22, 2009

    I actually did have one acupuncture woo woo say he probably could if he wanted to but he backed out when I started trying to schedule it and did a lot of hand-waving about how it was a violation of his doctor’s “hippocritic oath” to injure a patient even if they asked for it.

    You’re a braver person than I. I don’t think I would dare someone to kill me who has demonstrated a willingness to stab people with needles for money.

  56. #57 daedalus2u
    April 22, 2009

    Perky, it isn’t

    “patient felt better, then lost contact.”

    It is:

    ”patient felt better, paid bill, then lost contact”.

    It is the nitrite in bacon that prevents cancer.

  57. #58 skeptyk
    April 22, 2009

    daedalus2u: It is the nitrite in bacon that prevents cancer.

    HeeHee. Longtime fans are giggling with you, deaddy.

  58. #59 gaiainc
    April 22, 2009

    My understanding is that leeches are making a comeback in limb reattachment surgeries as the leeches help decrease vascular congestion in the reattached limb and promote bloodflow. That’s my very basic understanding. However that’s fundamentally different than what the leeches were used back in the 18th century when the leeches were just another form of blood-letting.

    As to Karl’s question, I don’t know the answer. I try to keep up with what’s going on in my field and it helps that I’m faculty at a residency program. Still, it does get challenging. Doctors are human. “I did it this way, so I’m going to keep doing it this way” can get pretty entrenched. I’m not saying that’s right, I’m just saying this is not unusual. Practice does change, but some practices take a REALLY long time to change.

  59. #60 Cath the Canberra Cook
    April 22, 2009

    It’s pretty unlikely that anyone’s ancestors used reiki or acupuncture, unless you count such close ones as grandparents.

    Reiki was invented in the 20th century. Acupuncture as we know it today was resurrected after a lapse of several centuries, modified to use teeny weeny needles instead of the honking big things you find in genuine Chinese antiques, and spread widely by Chairman Mao. China was very short of doctors at the time.

  60. #61 Perky Skeptic
    April 22, 2009

    sydneycarton wrote:
    “How about drawing a symbol on your tongue and reciting verse 17 of the book of the dead to make yourself immortal? I feel that magic spells in general have been phased out even by most of the alties.”

    Sadly, you’d be wrong. “Magical thinking” is quite literal for far, far too many people on this planet, and many of them are my friends and relatives.

    @daedalus2u– ROFLOL! You’re right, how silly of me. The bill-paying stage of the treatment is all-important!

  61. #62 Dianne
    April 23, 2009

    My understanding is that leeches are making a comeback in limb reattachment surgeries as the leeches help decrease vascular congestion in the reattached limb and promote bloodflow.

    I don’t know that application well enough to comment, but a drug derived from leeches, hirudin, is used semi-regularly in hematology. It’s quite useful in cases of heparin induced thrombocytopenia among other things.

    I suppose one might ask a naturopath to explain why one might use hirudin (or lepirudin) rather than leeches for anti-coagulation. No doubt they would mention big pharma, leading to the following follow-up questions:
    1. Lepirudin is given in very tightly controlled, standardized doses for a particular goal level of anti-coagulation which has the best chance of preventing clot without causing bleeding. How do you standardize a leech (or leech extract)?
    2. Lepirudin is produced recombinantly in yeast. No leeches need be harmed or exploited to produce it. How is it superior to use a method that depends on the unnecessary exploitation and/or death of an animal?
    3. In the event of a bad reaction, side effect, or overdose, an IV can be stopped immediately. A hungry leech will tend to be difficult to remove. Which is safer for the patient?
    4. (Or maybe 3a). Which would the average patient rather have close to him or her: an IV needle or a hungry leech? (Admittedly, the proper answer to this is probably “neither one”.)

  62. #63 Alex Reynolds
    April 25, 2009

    Do you deny the efficacy of certain alternative medications such as Saw Palmetto (for BPH) and St John’s Wort (for mild to moderate depression)? The efficacy of both has been proven through double blind clinical trials that have been published in scientific literature. As a matter of fact, I know of quite a few doctors who employ herbal medicine alongside conventional treatments. And I know of many doctors who speak out against corruption in the pharmaceutical industry (to be specific, most recently, I was talking to a cardiologist who complained about how AstraZeneca was marketing Crestor– he said they were actually trying to bribe doctors to prescribe their product!)

    I understand your concerns about many aspects of alternative medicine which have proven to be not effective, but dont stereotype and make a blanket statement that all forms are ineffective– because in certain areas, such as herbal medicine, there are certain treatments which do rise up to the level of prescription medicine in terms of effectiveness and with far fewer side effects.

  63. #64 Chris
    April 25, 2009

    Alex Reynolds said “Do you deny the efficacy of certain alternative medications such as Saw Palmetto (for BPH) and St John’s Wort (for mild to moderate depression)? The efficacy of both has been proven through double blind clinical trials that have been published in scientific literature.”

    Then post the cites.

  64. #65 a-l-e-x
    April 25, 2009

    Go look it up yourself (its on Medline). I know of several doctors who dispense either or both and the studies outlined also show which active ingredients produce the intended effect. In the case of St John’s Wort, for example, hyperforin is an SSRI. The Chinese have been investigating huperzine (a cholinestrase inhibitor) for its role in treating Alzheimer’s. Just because some supplements dont work, doesnt mean none of them work… dont be so simplistic.

  65. #66 Alex Reynolds
    April 25, 2009

    http://en.wikipedia.org/wiki/Hyperforin

    Pharmacology

    Hyperforin is a prenylated phloroglucinol believed to be the main active constituent responsible for the antidepressant effects of extracts of St John’s wort.[3] Hyperforin has been shown to inhibit the uptake of the neurotransmitters serotonin, dopamine, noradrenaline, GABA and glutamate.[4] It was identified as a specific activator of the ion channel TRPC6 which is involved in neuronal axonal sprouting. The activation of TRPC6 causes entry of sodium and calcium ions in neuronal cells which can explain the inhibition of neurotransmitter uptake.[5]
    Hyperforin is also thought to be responsible for the induction of the cytochrome P450 enzymes CYP3A4 and CYP2C9 by binding to the Pregnane X Receptor (PXR).[6]

    http://en.wikipedia.org/wiki/Huperzine

    Huperzine A has also attracted the attention of Western medical science. It is currently being investigated as a possible treatment for diseases characterized by neurodegeneration – particularly Alzheimer’s disease.[2][3] It has been found to be an inhibitor of the enzyme acetylcholinesterase.[4] This is the same mechanism of action of pharmaceutical drugs such as galantamine and donepezil used to treat Alzheimer’s disease. Huperzine A is also a NMDA receptor antagonist[citation needed] which protects the brain against glutamate induced damage, and it increases nerve growth factor levels.[citation needed]

    Clinical trials in China have shown that huperzine A is comparably effective to the drugs currently on the market, and may even be a bit safer in terms of side effects.[citation needed] Currently, the National Institute on Aging is conducting a Phase II clinical trial to evaluate the safety and efficiency of huperzine A in the treatment of Alzheimer’s disease in a randomized controlled trial of its effect on cognitive function.[citation needed] Recently, it has been investigated for its effectiveness against epilepsy in an initial 20-person clinical study by Harvard University neuroscientists examining its worth and side effects in those who are not satisfactorily treated by existing pharmaceuticals.[citation needed]

  66. #67 snerd
    April 25, 2009

    How do you standardize a leech

    You compare it against the platinum-iridium leech they keep in a vault in Paris?

  67. #68 Alex Reynolds
    April 25, 2009

    So there are two examples right there. Its interesting that you guys do so much hand wringing over nutraceuticals and yet are silent about the atrocities committed by large corporations like Monsanto, which is basically Gestapo-esque, if not fascist in the way it destroys the environment and attempts to use threats to silence anyone who oppose them.

    http://en.wikipedia.org/wiki/Monsanto

  68. #69 LW
    April 25, 2009

    Yes, many herbs do have pharmacological effects, and pre-scientific individuals have discovered some of them. But they also came up with many herbs that don’t have the claimed effect or have undesirable side-effects.

    If an alternative medicine practitioner claims that St John’s Wort cures asthma, arthritis, and cancer, is he right? How would you know? If a randomized double-blind test showed that St John’s Wort isn’t effective for those illnesses, would you expect him to stop making those claims? Would you criticize him if he continued to make those claims?

    That is, I believe, the point of this challenge: that in fact alternative medicine practitioners go on making their claims whether or not there is any scientific evidence for them, or even if there is scientific evidence against them.

  69. #70 Scott
    April 25, 2009

    Do you deny the efficacy of certain alternative medications such as Saw Palmetto (for BPH) and St John’s Wort (for mild to moderate depression)? The efficacy of both has been proven through double blind clinical trials that have been published in scientific literature.

    Strawman. Once herbal remedies are demonstrated to be safe and effective, they are adopted by mainstream medicine – usually in a purified and standardized form which is therefore safer and more effective than the actual plant.

    There is absolutely nothing whatsoever alternative about pharmacology. Where it becomes alternative is, as LW points out, when quacks promote herbs for conditions where they have NOT been demonstrated to be safe and effective.

  70. #71 Chris
    April 25, 2009

    Alex replied “Go look it up yourself (its on Medline)”

    It does not work that way. If you make the claim, you have to provide the evidence. Telling the person to look up the evidence for your claim is a way of admitting that you are just making it up and have no evidence to back it up. Try again.

  71. #72 Antaeus Feldspar
    April 25, 2009

    “Just because some supplements dont work, doesnt mean none of them work… dont be so simplistic.”

    Alex, did you miss the entire point of the post? Apparently you did. The point is not “no alternative remedies work,” the point is “those who tout alternative remedies don’t distinguish those that work from those that don’t.”

  72. #73 snerd
    April 25, 2009

    large corporations like Monsanto, which is basically Gestapo-esque

    .. the fark? Black-leather clad men come around, beat you senseless, then drag you away for a few weeks of torture then off to the concentration camps?

    Dude – I love hyperbole as much as the next galactus but please attempt to get a grip.

  73. #74 Alex Reynolds
    April 25, 2009

    About Monsanto– I provided you a link about numerous times them having been sued and lost (in America as well as other countries) for dumping PCB’s (notable examples, Anniston, AL, UK, India) and how theyve threatened networks (FOX) when reporters were exposing them. If you had bothered to read the link, you would have seen the documented proof.

    About the other stuff– Ive posted links and references to the pharmacologically active ingredients in two natural supplements. Yes, many (maybe most) natural supplements dont work, but my argument was that doesnt mean you can characterize them all that way. And I did post the evidence, along with references– I was being belligerent, because most of this can easily be gotten online in a few seconds searching the medical journal of your choice. At any rate, doctors have been recommending both of these supplements, so they wouldnt be doing that unless they had something to back it up right?

    I actually have a medical background, so I dont usually listen to alternative medicine practitioners, I do my own research through various channels, so if AMPs are making claims about supplements outside of that which their ingredients can logically produce than theyre being fallacious. My main point, as I resulted above, is that there are SOME that do work, if the active ingredient is standardized and taken in the right amount.

    Also, Im not sure what you mean by “mainstream medicine” but the reason Ive been told that neither Hyperforin or Huperzine (let’s just use the names of the chemicals instead of the plant itself) havent been patented by large pharmaceutical companies is that natural substances arent patentable and they cant turn a profit on them? At any rate, Ive noted that many pharmacies carry both OTC, in the standardized amount (SJW 450 mg 3% hyperforin, Huperzine 50mcg) and the amount quoted in the studies is 900mg per day at that standardization level for SJW and 50-100mcg per day of Huperzine A.

    Also, Ive noticed doctors questioning the motivations of large pharmaceutical companies– one example is Crestor and AstraZeneca. Do you remember when the FDA told AZ to pull the false and misleading Crestor ads (where they were saying that Crestor was found to be safe) when the FDA said no such thing? About a month ago, I read a cardiologist’s blog where he claimed AZ was trying to bribe doctors into prescribing Crestor and that this was standard fare for the pharmaceutical industry. And then we have the class action lawsuit going on in Australia, concerning Merck (already infamous for Vioxx), where they were trying to coerce doctors to prescribe their meds. Also, we have the Celebrex scandal (and yet theyre still allowed to air TV commercials? I notice a double standard here!) Honestly, how much do you trust pharmaceutical companies? I brought Monsanto into this as well, since theyve been trying to push hormonized milk and meat on us (which is now going off the market, thanks to consumer pressure and the fact that major retailers wont sell it) and the fact that numerous studies have shown that its linked to numerous ailments was enough for the Canadian Ministry of Health, WHO and other health organizations to ban it– but the FDA was the lone voice insisting on its “safety.” So, honestly, I know that the natural supplement industry hasnt been straight with us– but lets not let large pharmaceutical companies or Monsanto off the hook either. If the WHO and various ministries of health condemn a company, Id believe them before I’d believe the FDA.. after all, the FDA has undergone PLENTY of scandals and links between the FDA and major drug companies are too close for comfort (going back to Crestor, do you remember the scandal that ensued when the FDA comissioner resigned and admitted that Crestor had nto been recommended for approval, and yet it was “pushed through at the last moment” in spite of various studies going against it? The grass isnt much greener on the other side either.

    BTW, here’s a link to the class action lawsuit against Merck

    http://www.news.com.au/business/story/0,27753,25273468-462,00.html

    If you have any more questions or comments let me know, I’m here until 4PM EDT and then will be back later on tonight.

  74. #75 LW
    April 25, 2009

    “About Monsanto– I provided you a link about numerous times them having been sued and lost…”

    Strangely, I don’t seem to recall any cases wherein the Gestapo were sued and especially not any where they lost. Monsanto is subject to the law, even if sometimes they may not obey it. The Gestapo were not. Maybe that’s why people like snerd don’t really appreciate your trivializing the Holocaust by likening a drug company to the Gestapo.

    Most of the rest of your message is bashing doctors and pharmaceutical companies. Yawn.

    Did you have anything to say in answer to the question, “if you have one question to ask a booster of so-called alternative medicine in a public forum, what should it be?”

  75. #76 blf
    April 26, 2009

    Whilst it’s fun to speculate on one or two questions to ask a quack, it seems to me there’s a (possibly major) flaw here: Presuming the quack answers the question asked, there’s no reason to think it will tell the truth.

    For instance, to PalMD’s and Orac’s question, a quack might answer “goolipathoically”. And to your reasonable objections that you’ve never heard of, and cannot find out anything about, goolipathoically, the reply is simple: “It doesn’t work. It’s been known not to work for so long now knowledge of it has essentially vanished. It’s an excellent example of a treatment which was rejected precisely because it didn’t work.”

    Quacks are professional liars and can probably construct a better chain of lies than my own feeble attempt/example above.

  76. #77 Alex Reynolds
    April 27, 2009

    Really LW? The Gestapo has nothing to with this discussion, so Im not sure why youre vainly attempting to divert the attention. Did you read the article? Yes, Monsanto is subject to the law, but even so, theyve tried to subvert justice, even when the courts decided against them. This of course, caused even more law suits and even more fines. BTW, since you brought it up, the Gestapo was subject to justice, even if only after the Nazi Regime was brought down (although, it seems that certain members escaped justice, and settled down in the US and other countries to help us further our own war efforts– but that’s besides the point.) Bashing doctors? Did you merely skim over what I wrote? I specifically stated that Ive met several doctors (or read their blogs), many of whom bash pharmaceutical companies for trying to prescribe medications which they, THE DOCTORS, dont want to prescribe. I also posted a link to a class action lawsuit in Australia concerning Merck, which proves my point.

    And, why do you use the descriptor “so-called” in front of the term “alternative medicine.” Dont bother answering, it was a rhetorical question (you seem to clearly be incapable of understanding or being able to debate me on the points which I raised, so I will save you the effort.) I will, however, answer YOUR question. Before I answer it, I have a bone to pick with you. Some alternative medicine is clearly quackery, while other types have science on their side (for example, the use of some medicinal herbs.) To lump everything together is to show clear bias at best, and extreme ignorance at worst. Now, in answer to your question: I’d ask them if they trust these treatments enough to give them to someone they really care about– i.e., close family, best friends, etc. In the case of those who practice alternative medicine with a firm foothold in science, Id also ask if they feel liberated by being able to practice medicine altruistically, without the taint of greed placed by big business, which has corrupted conventional medicine– as stated by doctors themselves.

  77. #78 Alex Reynolds
    April 27, 2009

    Before you start nitpicking, let me correct an omission in the above post:

    I specifically stated that Ive met several doctors (or read their blogs), many of whom bash pharmaceutical companies for trying to push them to prescribe medications which they, THE DOCTORS, dont want to prescribe. I also posted a link to a class action lawsuit in Australia concerning Merck, which proves my point.

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