Respectful Insolence

Did you know that acupuncture is very much related to astrology?

No, it’s not just because both of woo. Rather, it’s likely true that the whole concept of “meridians,” those invisible “channels” through which our life energy (a.k.a. qi) allegedly flow were indirectly based on astrological signs, which had been used to guide points used by ancient healers for bloodletting. Indeed, far from being “ancient wisdom,” by the middle of the second century, needling had been mostly abandoned and even banned by the Imperial Medical Academy in China and prohibited in Japan, only to be resurrected by Chairman Mao in the “barefoot doctor” campaign in the 1960s as a method of providing care to the masses without actually investing in–you know–modern medicine. In other words, whether it “works” or not (and, make no mistake, the totality of the evidence is most consistent with no effect greater than a placebo), the history and mythology that have grown around acupuncture bear little resemblance to its actual history.

I was thinking of this as I perused a relatively new blog about which I had been unaware until recently, namely Cancerwise, the official blog of the M.D. Anderson Cancer Center in Houston. This blog appears to have been in existence around five months or so, and it was pointed out to me by a reader a couple of days ago. Last night, curiosity led me to take a look. After all, M.D. Anderson is one of the two most renowned cancer centers in the U.S., if not the world. Whenever one thinks cancer, two names come to mind: M.D. Anderson Cancer Center or Memorial Sloan-Kettering Cancer Center. These two cancer centers are without a doubt the Big Kahunas of cancer centers, academic powerhouses towards which all other cancer centers strive. And, no, I’m not just sucking up. Personally, I’d love to work at M.D. Anderson if it weren’t in Houston and I weren’t terminally allergic to hot, hot heat and super high humidity. What that means, I guess, is that I doubt I ever could work there (even if the administration there had any interest in hiring me) and, after this post, it may well be that I will destroy any chance I might ever have had of working there.

The reason?

Quackademic medicine. Lots of it. Worse, as it typical in these cases the dubious “complementary and alternative medicine” CAM (also known as “integrative medicine, or IM) is interspersed with good, solid science-based information (for instance, this story about the acceleration of the start of phase I clinical trials) and personal interest stories relevant to cancer patients. In many ways, I consider the mixing of science-based modalities with pure woo by a source as authoritative as M.D. Anderson to be a profound threat to science-based cancer care, because this blurring of the line between science and the highly implausible leaves it impossible for the typical lay person (and even many physicians) to distinguish between science-based medicine and woo. In any case, I perused the Wellness category, and, well, unfortunately, all I can say is: The woo it is strong there.

For example, the most recent post in this category involves the Feldenkrais Method of Somatic Education, otherwise known as “therapeutic movement.” This is what:

The Feldenkrais Method was conceived by Moshe Feldenkrais (1904-1984), a physicist and martial artist, mainly to recover from his own sports-related knee injury in the 1920s. He learned to decrease pain and improve performance when he paid attention to how his body moved.

Prior to his findings, most people believed it was difficult to retrain the body to do an already-learned activity once a person reached a certain age. But, Feldenkrais concluded the brain continues to develop throughout life and retains the ability to relearn. His findings have been confirmed by research in neuroscience.

Uh, no. No they haven’t. More on that later. In the meantime, here is the woo-ful language straight from the Feldenkrais website itself:

The Feldenkrais Method is named after its originator, Dr. Moshe Feldenkrais, D.Sc. (1904-1984) [about], a Russian born physicist, judo expert, mechanical engineer and educator.

The Feldenkrais Method is a form of somatic education that uses gentle movement and directed attention to improve movement and enhance human functioning. Through this Method, you can increase your ease and range of motion, improve your flexibility and coordination, and rediscover your innate capacity for graceful, efficient movement. These improvements will often generalize to enhance functioning in other aspects of your life.

The Feldenkrais Method is based on principles of physics, biomechanics and an empirical understanding of learning and human development. By expanding the self-image through movement sequences that bring attention to the parts of the self that are out of awareness, the Method enables you to include more of yourself in your functioning movements. Students become more aware of their habitual neuromuscular patterns and rigidities and expand options for new ways of moving. By increasing sensitivity the Feldenkrais Method assists you to live your life more fully, efficiently and comfortably.

“Include more of yourself in your functioning movements”? What the hell does that mean? Maybe the experts at M.D. Anderson can tell me. Or not:

Maybe this will help:

When she works with a student, Smith says, she doesn’t dwell on what hurts or what obstacles are in the way. Instead she discovers what brings pleasure to that person. Through being aware of movement, the student learns to perform everyday actions (for instance, gardening, singing or just being comfortable) using a new pattern that works better with current life circumstances.

Nope. No help there.

Now, I don’t know about those fancy-pants high-powered docs at M.D. Anderson, but I’m just a simple surgeon with a lab from the Midwest working at a strong, but not super-duper top two cancer center like M.D. Anderson. Dumb surgeon or not, though, I recognize woo-speak when I see it, and this is some of the finest vintage. Does M.D. Anderson present any evidence that this Feldenkrais method is anything more than glorified yoga? Nope. It simply tells us that Feldenkrais’ findings have been “confirmed by neuroscience,” whatever that means. So I looked at that bane of woo-meister claims, PubMed. Unfortunately I couldn’t find any evidence that the Feldenkrais method has been “confirmed by by research in neuroscience,” at least not any neuroscience published in the peer-reviewed literature indexed on PubMed. True, I did find 34 references, but a lot of them were in the CAM literature, and none of them were in any neuroscience journals that I could find. I did, however, find this rather more (I suspect) accurate summation of the Feldenkrais method as being much more akin to faith healing than science. I’m left to come to the opinion that the Feldenkrais method borders on quackery.

Quack one!

Next up is reflexology. Yes, you read me right. Reflexology. No, I’m not kidding you. Really, I’m not. I couldn’t believe it myself. There it was, right there on the official blog of the world-renowned M.D. Anderson Cancer Center reflexology:

The eyes have been called the windows to the soul, but the hands and feet are often the first parts of the body to experience something, perhaps the softness of a blanket or hot sand on a beach.

The importance of hands and feet make them the focal point of reflexology, a healing art historians believe was used first in China more than 5,000 years ago. It focuses on pressure points of the hands and feet and can be used by anyone, but it may be especially beneficial to cancer patients…

Reflexology therapists use their hands – usually their thumbs or forefingers – to apply pressure to areas of the hands and feet that they believe are connected to specific zones of the body. Stretching and movement techniques also may be used. They may open or close the session with a gentle hand or foot rub.

I may get in trouble for pointing this out, but I don’t know how else to put my opinion based on having studied the literature and examined the tenets of reflexology. Reflexology is quackery. It just is. Reflexology postulates a connection between regions of the feet and hands and ten zones of the body and that massaging and manipulating specific areas of the hands and feet can manipulate the flow of life energy, blood, nutrients, and nervous impulses to the corresponding zone of the body and thereby can relieve symptoms or ailments in that zone. There is no evidence to support the contention that these pathways exist or that there is any connection between specific areas of the feet and hands and specific “zones” of the body. There is no anatomic structure or physiology that supports such a connection. In other words, it’s bunk, and M.D. Anderson is not only offering it, but promoting it. It would be one thing if MDA were simply offering foot massages as a means of making its patients feel better. Few are those who don’t like a good foot massage. But reflexology is not merely foot and hand massage. It is an entire modality built on pseudoscience and mystical concepts that have no basis in evidence or science–and it’s right there on the official blog of one of the top two cancer centers in the U.S., if not the world, complete with a credulous, evidence-free, glowing review by a practitioner.

Quack two!

Finally we come full circle. Admittedly, this is was the one form of CAM that I used consider to be among the most plausible of the mish-mash of unrelated and often mutually contradictory treatments that have been lumped together under the rubric of CAM, because I imagined that there might actually be a physiological mechanism to explain how it might actually work. As such, I used to consider it nowhere near as quacktastically quackademic as reflexology. Now I consider it placebo medicine. I’m referring, of course, to acupuncture, and the M.D. Anderson Cancerwise Blog has a very credulous and promotional post on acupuncture. (Surprise, surprise!) It’s by Lorenzo Cohen, Ph.D., the director of M. D. Anderson’s Integrative Medicine Program and entitled The 3 Most Common Questions People Ask About Acupuncture. I’m going to address them out of order. For instance, question two is “Is it safe?” Well, yes, acupuncture is pretty safe, but it’s not entirely without risk. There have been cases of pneumothorax after acupuncture, infection, and bleeding. True, such complications are uncommon, but their incidence is not zero.

Let’s move on to the more problematic questions. Question one is “What should I use acupuncture for?” The answer is disturbing:

Acupuncture has been shown to be effective for nausea/vomiting and some types of pain. There also is a growing body of evidence for xerostomia (dry mouth) and hot flashes. Although it may help for other symptoms such as constipation, loss of appetite, fatigue, insomnia, anxiety, depression, peripheral neuropathy and delayed wound healing, not enough rigorous clinical trials have been conducted to draw meaningful conclusions. That being said, as a safe, inexpensive treatment, there’s no reason not to try it if you’re interested.

Uh, no. It hasn’t. As I’ve documented here and friends have documented elsewhere, there is no evidence for an effect of acupuncture above and beyond that of placebo or “noise” from random chance that produces the occasional apparently positive study. It disturbs me mightily to see what should be a bastion of science-based medicine advocating in essence anecdote-based medicine:

As a clinician, I often see a synergistic effect when acupuncture is added to a patient’s treatment plan. For example, adding it to a comprehensive pain management regimen often allows patients to reduce the amount of medications they’re taking and thereby reduce unpleasant or debilitating side effects. Dr. Moshe Frenkel, medical director of our Integrative Medicine Program, always says, “Can’t hurt, might help, why not!”

I was in pain when I read that last sentence. Trepanation. Can’t hurt, might help, why not? OK, that was a bad example. How about this instead: Homeopathy. Can’t hurt, might help, why not? Never mind that homeopathy is based on magical thinking and ideas that would require for them to be true that huge swaths of exceedingly well-established science in physics, chemistry, and biology to be not just wrong, but fantastically wrong.

Why not?

True, acupuncture is not quite as wildly implausible as homeopathy, but it’s still pretty darned implausible from a scientific point of view. For it to “work,” a lot of what we know about physiology would have to be wrong. Again, I’m willing to consider that possibility if evidence supporting the efficacy of acupuncture were presented in a quantity and quality as compelling as the scientific evidence that it can’t possibly work the way it’s claimed, but no such strong evidence exists. This brings us to what’s most depressing about this post, namely the answer given to this question, “Why does acupuncture research often show mixed results?” Of course, I’d question the very premise of this question in that the research testing acupuncture is not really mixed, at least not if you look at it closely. Not to Dr. Cohen:

I think there are many reasons. Sometimes it’s because of poor study design. Sometimes researchers ask the wrong questions, and sometimes it’s because we don’t have a clear understanding of how acupuncture works. Recent data from Germany show that although acupuncture points are indeed areas on the skin with reduced bioelectric resistance, this characteristic varies over time; thus, timing of the treatment may be key to its effectiveness. To date, very little research has evaluated this aspect of acupuncture, even though it’s an important concept in traditional Chinese medicine theory.

I’d be very interested in seeing this research, given that I can’t find it on PubMed. Of course, I only have so much time to devote to literature searches. It is rather convenient, though. If acupuncture doesn’t work better than a placebo, then it must be the timing! Even if that were true, it adds one more layer to the whole edifice of woo that makes acupuncture so much of a logistic pain in the rear that I ask: Why bother? Think about it. If it’s not enough just to stick acupuncture needles in special places (I know, I know, it doesn’t matter where the needles are placed; sham acupuncture with toothpicks is indistinguishable from “real” acupuncture–sometimes even better!) but you have to do it only at certain times, then one starts to wonder what the attraction is. It’s difficult, and, even under the kindest interpretation of current studies, is equal to or perhaps only slightly better than a placebo. So, again, why bother? It’s a long run for a short slide.

What I find more disturbing, though, is this passage:

Putative mechanisms of acupuncture are multiple, and although there’s certainly a large placebo effect, fMRI and animal studies clearly indicate there’s a physiologic response above and beyond placebo. Let’s face it, if it works on lab rats, there’s something more than the “power of suggestion” at work. In terms of pain, for example, animal studies have shown the effects of acupuncture are reversed with Naloxone, a powerful opioid antagonist. For other symptoms such as xerostomia, mechanisms are a little harder to explain, but studies are under way to explore these questions.

Ugh. Dr. Cohen clearly doesn’t understand the placebo effect if he dismisses it as just the “power of suggestion.” In any case, the five animal studies cited are hardly convincing evidence. Two of these studies (1, 2) were of electroacupuncture, which is not acupuncture. It’s a frequent bait-and-switch to study electroacupuncture, which is in reality nothing more than the science-based treatment method of transcutaneous electrical nerve stimulation rebranded. Other articles (3, 4) appeared in Chinese in Chinese journals of traditional Chinese medicine, which make them very difficult to evaluate. Only one study looking at acupuncture without electrical stimulation is cited, and it’s 13 years old; it also only looked a surrogate marker of immune system activation and concluded that acupuncture was associated with better immune function. This is all very thin gruel indeed to feed any scientific interest in acupuncture. Suffice it to say, I’m not impressed. Even worse, I’m profoundly disappointed that M.D. Anderson would lend its hallowed name to this sort of dubious science.

Quack three! You’re outta there!

Sadly, there’s even more than just what I’ve described at Cancerwise. There’s a full-on buy-in to the concept of “integrative” care as being anything more than “integrating” nonsense with science:

I recently watched the Feb. 26, 2009, hearing before the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee: Principles of Integrative Health: A Path to Health Reform. I was pleased to hear Sen. Tom Harkin (D-IA) support the role of integrative medicine in the national health care plan: “It is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative “… “Today, we are not just talking about alternative practices but also the integration between conventional and alternative therapies in order to achieve truly integrative health.”

The Integrative Medicine Program at M. D. Anderson is shifting the focus from sickness to wellness, treating the whole person, and providing a forum for all evidence-based practices. The program’s goal is to integrate the best of complementary and conventional treatments using a multidisciplinary approach.

As regular readers of this blog would guess, integrating pseudoscience with science-based medicine does not impress me. Indeed, I’ve written extensively about Senator Tom Harkin’s promotion of pseudoscience and quackery, the use of his power to create NCCAM, and, most recently, to try to hijack President Obama’s health care reform initiative in order to force the government to pay for “alternative” medicine. To see one of the two premier cancer centers in this country declaring solidarity with Tom Harkin on its official blog is truly depressing.

In closing, I’d like you to think once again about how acupuncture is, in essence, astrology with needles. Then think how an academic cancer center as high-powered and revered as M.D. Anderson has apparently embraced such pre-scientific magical thinking in toto. It’s the ultimate triumph of quackademic medicine, to be mixed in with science-based medical treatments in what would normally be considered one of the most authoritative sources for cancer information out there, with nothing to distinguish science from pseudoscience, the science-based from the woo. Indeed, I can’t help but think: If M.D. Anderson doesn’t have the wherewithal to resist the infiltration of woo and to refuse to sully its name by association with this sort of nonsense, what hope do the rest of us have?

Comments

  1. #1 Court the Snort
    August 5, 2009

    Its all about supply and demand; that and taking in money. The world is in a sad sad state with many (if not most) people believing in woo, so MDA is just doing what any smart business would do and cashing in on that. It is despicable that a place that should be a bastion for science has turned to this just to bring in a few more dollars!

  2. #2 Noodle
    August 5, 2009

    (* SIGH *) I love my MDACC, I really do, but this kind of stuff makes me cringe. You sure you don’t want to come to work here? Aside from the ocassional crazy, it’s a really, really nice place to work.

  3. #3 cervantes
    August 5, 2009

    I think this is essentially a marketing strategy. A lot of customers will like this stuff and be inclined to get treatment at MDA. And they probably figure they’re co-opting the competition, at least the people will get the real stuff too.

    I had a friend who got a job as medical director at an “integrative medicine” facility called the Marino clinic in Cambridge, Mass. The outfit made big bucks. Some real doctoring went on there but they gave you the mystic arts along with it. That might only be mildly unethical except they took the insurance for the medical treatment, and made the people pay out of their cookie jar for the rest of it.

  4. #4 Richard Eis
    August 5, 2009

    -That might only be mildly unethical…-

    You mean lying to their patients for money as a trusted organisation dealing in medical care?

  5. #5 James Sweet
    August 5, 2009

    Reflexology in a nutshell: Foot rubs feel really damn good.

  6. #6 Alex
    August 5, 2009

    So will funds that would have gone to genuine cancer research go to funding woo?

  7. #7 Jennifer B. Phillips
    August 5, 2009

    You mean lying to their patients for money as a trusted organisation dealing in medical care?

    This would indeed be despicable, but it’s not at all clear to me that this (or any other ‘integrative’ medical centers) is a case of wholly skeptical doctors/HCPs passing off treatments they know to be quackery just for the sake of making a buck. I’ve heard so many stories from skeptical docs about their ‘shruggie’ colleagues–the ‘can’t hurt, might help, why not?’ sentiment quoted in this post is a case in point. I think a lot of them just truly don’t know, and don’t care enough to investigate. As such, ‘shruggies’ have plausible deniability in these cases, and while that may be equally despicable (frankly it does dismay me to know that so many MDs are so damned incurious), it’s probably inaccurate to call it ‘lying’. Not that there’s anything wrong with that–assuming you’re beyond the reach of the long arm of British Libel Law :)

  8. #8 becca
    August 5, 2009

    Hmm. I read the “confirmed by neuroscience” bit to be referring to the claims about learning (“the brain continues to develop throughout life and retains the ability to relearn.”); as far as I know, this is perfectly true.

    Your attitude toward “can’t hurt, might help, why not” baffles me. When people don’t have appealing explanations for phenomena, there is a vacuum created that woo can fill. If you find a better explanation, it will eventually convince most people- which is why science exists at all. *Using* something doesn’t depend on knowing why it works.

    The argument that “it can’t work how you say it works” is not the same as “this doesn’t work”. The emotional way you argue the former distracts from the evidence you present on the later.

  9. #9 James Sweet
    August 5, 2009

    The Integrative Medicine Program at M. D. Anderson is shifting the focus from sickness to wellness, treating the whole person, and providing a forum for all evidence-based practices.

    It really bothers me that preventative medicine (“shifting the focus from sickness to wellness”) and the concept of holistic medicine (“treating the whole person”) have gotten all hopelessly jumbled up with woo. These are valid concepts, but they have been so mercilessly co-opted by the woo community that it’s hard to have a sensible discussion about it.

    I really believe in the value of “holistic medicine” in the literal sense, i.e. the idea that health is about quality of life rather than merely the absence of disease, and that ideally doctors, as well as public and employer-provided health programs, would consciously work towards thus end. However, as soon as somebody says the word “holistic,” my bullshit detector goes into high gear, because what comes next is almost always woo.

    Why does it have to be like that? grumble grumble…

  10. #10 Orac
    August 5, 2009

    It really bothers me that preventative medicine (“shifting the focus from sickness to wellness”) and the concept of holistic medicine (“treating the whole person”) have gotten all hopelessly jumbled up with woo. These are valid concepts, but they have been so mercilessly co-opted by the woo community that it’s hard to have a sensible discussion about it.

    That’s entirely intentional on the part of woo-meisters. They intentionally conflate “holistic” with what they do because (1) their dislike of “reductionist” scientific “Western” medicine leads them to actually believe that nonsense and (2) it’s great marketing. I agree that it’s perfectly possible for science-based practitioners to practice “holistic” medicine. Woo is not required. Unfortunately, CAM advocates have been so successful at tying woo to “holistic” that the two appear to be irretrievably linked in the minds of many.

  11. #11 James Sweet
    August 5, 2009

    The argument that “it can’t work how you say it works” is not the same as “this doesn’t work”. The emotional way you argue the former distracts from the evidence you present on the later.

    Hmmm, I think I disagree. “It can’t work how you say it works,” or more specifically, “You have not provided a valid mechanism for how this works,” relates directly to the Fallacy of Limited Depth, i.e. rather than appealing to a causal mechanism, the argument appeals to the superficial fact that “people use it” as a medical treatment.

    A treatment with an unknown causal mechanism might be justified on the basis of very strong empirical data. On the other hand, a potential treatment with a strong theoretical causal mechanism might be justifiable on weaker correlative data, or at the least it might justify a more thorough search to try and identify a correlation. So the lack of a causal mechanism is important.

    Regarding the “emotional way” that Orac and others approach it… well, I half-agree with you that this probably is not hugely productive (though it’s definitely entertaining), but it’s very difficult to avoid being that way with things like homeopathy which just make no damn sense. Things like acupuncture, herbal remedies that are unproven or are proven no better than placebo, etc., I don’t tend to get too irate over that, because at least I can see how it might work, and someone unaware of the data could be easily forgiven for a bit of misplaced credulity. Homeopathy, on the other hand, I just don’t see how anybody could fall for it, whether they are aware of the data disproving it or not. It’s hard not to get emotional about something so blatantly stupid…

  12. #12 Orac
    August 5, 2009

    Your attitude toward “can’t hurt, might help, why not” baffles me. When people don’t have appealing explanations for phenomena, there is a vacuum created that woo can fill. If you find a better explanation, it will eventually convince most people- which is why science exists at all.

    Would that that were true!

    Sadly, it’s not. I’ll give you examples. Germ theory is a powerful explanatory theory for how infectious disease is caused; yet we still have germ theory denialists and a lot of woo based on the concept that it is not the germs that cause disease. We know a lot about how the immune system works and how to prime it with vaccines in order to improve immunity; yet there are still rabid anti-vaccinationists out there pushing not just their “skepticism” of vaccines but dangerous quackery. We know a lot about how cancers form and grow, enough even to be able to cure some cancers, for example, Hodgkin’s lymphoma; yet there are still quacks out there claiming that chemotherapy doesn’t ever cure cancer and convincing credulous boys like Daniel Hauser that “natural” cures will eliminate their cancer.

    No, while I would concede that the less sound science there is supporting a treatment or a concept of disease, when a question is answered by science or an effective science-based therapy developed, it in no way fills the vacuum enough to crowd out the woo.

    As for the “how it works” bit, in retrospect I now realize that my wording was probably suboptimal. You see, I was letting my mind be too open for a moment and let a little concession in that I perhaps shouldn’t have.

    As for your argument that we don’t necessarily have to know how something works in order to use it, well, that’s a massive straw man argument. Sorry, but there’s no other way to put it. I never said anything of the sort, and I’ve dealt with this issue before. What I was referring to is that treatments that are so enormously implausible that, for them to be true, many very well-established laws, theories, and principles of different sciences would have to be radically wrong speaks to the plausibility of a treatment. Drugs whose exact mechanism of action aren’t known can be used because we have strong evidence that they work and the exact mechanism can be worked out later. Moreover, it is plausible that there is a mechanism by which they work, because they are chemicals, drugs, and it is well within the realm of science as it is currently understood that they bind to some protein or other structure and produce their effect. No invocation of fantastical ideas like qi or the “memory of water” is required to explain them, even though we don’t yet know the exact mechanism. In other words, to accept reflexology or acupuncture or whatever as being effective even though we don’t yet know “how they work” requires that someone provide compelling evidence that they do work.

    As for “what’s the harm”? Well, one part of the harm of placebo medicine is that it requires physicians to deceive their patients into telling them something will (or even “might”) work when science says it does not. 50 years ago, such behavior was considered more acceptable because medicine was a lot more paternalistic. These days, it’s not.

  13. #13 James Sweet
    August 5, 2009

    Unfortunately, CAM advocates have been so successful at tying woo to “holistic” that the two appear to be irretrievably linked in the minds of many.

    Indeed. I remember a commenter on this blog a few weeks ago who got all indignant about one of your homeopathy articles, said “Now I don’t know much about homeopathic medicine, but from what I understand…” and proceeded to describe holistic medicine, and ask what was so bad about that — to which several people replied, absolutely nothing is wrong with that, but it’s not homeopathy.

    I don’t mean to pick on the guy; I understand 100% where he was coming from. The woomeisters have managed in the minds of the public to make homeopathy more of a brand than a theory… which is a terrific strategy on their part, because if people were told the theory up front, before they became true believers — well, there’s a reason Scientologists don’t start their pitch by asking if what you think of Lord Xenu…

  14. #14 Pablo
    August 5, 2009

    If acupuncture doesn’t work better than a placebo, then it must be the timing!

    Actually, I think the insinuation goes beyond that. It is more of, “When it was successful, it was because they were in the right spots at the right time. When it didn’t work, it was only because they didn’t chose the right spots.”

    Coincidentally, though, the amount of times they were in the right spots at the right time matched the success rate of placebo.

    Basically, they are trying to credit acupuncture for the placeboic effects, and then dismissing the failures. When you do it that way, acupuncture is 100% effective! When done correctly, of course. So they shift the discussion from “does acupuncture work?” to “what is the correct way to do it?”

    I will save my anecdote for the next post.

  15. #15 vbrisley
    August 5, 2009

    As far as my research has shown, a modern medical science “cure” for cancer has yet to be developed. With that in mind, I consider “alternative medicine” to be just as big a crap shoot as “modern medicine” when it comes to treating cancer.

    I think its disconcerting that medical practioners wouldn’t advise their patients to become as aware of their body’s functions as possible. That includes neurological functions, which is the rudimentary basis for certain alternative medicinal practices. I also think it is unreasonable that accepted modern medical practices work in a virtual black box that which recipients of care are often pressured to accept as the only “right” way.

    I appreciate your commentary though, it opens my eyes to alternative views of alternative medicine.

  16. #16 vbrisley
    August 5, 2009

    As far as my research has shown, a modern medical science “cure” for cancer has yet to be developed. With that in mind, I consider “alternative medicine” to be just as big a crap shoot as “modern medicine” when it comes to treating cancer.

    I am disconcerted by the fact that modern medical practioners wouldn’t advise their patients to become as aware of their body’s functions as possible. That includes neurological functions, which is the rudimentary basis for certain alternative medicinal practices.

    It is unreasonable to accept modern medical practices that are developed in a virtual black box. I think recipients of care are often pressured to accept these accepted measures as the only “right” way.

    I appreciate your commentary though, it opens my eyes to alternative views of alternative medicine.

  17. #17 evinfuilt
    August 5, 2009

    Don’t ever surrender to temptation and move to Houston. Our heat index has been over 100 pretty much every day since June. Its oppressive, and it forces you to spend most of the time indoors.

    Also, I’m sad to see this Woo at MDA; the Library I work for got its name due to their donations. I thought it was cool to not be thought of as a corporate shill but a name that had an excellent reputation (unlike our Baseball Stadiums past names.)

  18. #18 chris
    August 5, 2009

    Reflexology in a nutshell: Foot rubs feel really damn good.

    Usually, yes. My wife certainly thinks so. However she knows if she gets within a foot of my feet, as it were, she’s in trouble. I had bunion surgery on both toes a few years ago, and have since been diagnosed with peripheral neuropathy in both feet from the mid calf down. I don’t even like touching my own feet, let alone anyone else. I wonder if there is a reflexology point on the hand that helps the feet. My hands, you can touch.

    Interestingly, when, after the surgery, I had a lot of pain, my aunt in all seriousness suggested reiki. I said thanks, I’ll look into it, and left it at that.

  19. #19 Pablo
    August 5, 2009

    Acupuncture anecdote:

    I have a veterinarian friend who is getting into acupuncture. She is setting up a “mobile rehabilitation” practice, where she does house calls to do physical therapy on animals. I fear a large chunk of it is going to be acupuncture. She even did an “acupuncture” training. More on that later.

    A few things that she said rang bells in my head

    1) She was asked about how effective it is to do acupuncture at someone’s home. Her response? “It is more effective that way, to do it in their natural environment.” Serious bells should go off on that one, but apparently they don’t for acupuncturists. It seems to me that this type of results SCREAMS of a placebo effect. All you are doing by doing it “in their own home” is making the patient (and, more importantly with animals, the owners) more comfortable. That has nothing to do with acupuncture at all! The question that would need to be answered is, how would normal physical therapy be if it were carried out in the home? I predict that it would ALSO be more effective. The only difference is that it is tough to haul around a treadmill and a doggie swimming pool in the back of your truck, and easy to carry needles. So the effectiveness of acupuncture in this case comes from the fact that it doesn’t require anything and therefore can be used in cases where placebo is more effective.

    IOW, it’s like giving friggin sugar pill, when the actual medical treatment requires an IV.

    2) As I mentioned, she went to acupuncture school. An interesting comment she made about that: there are apparently two “schools” of accupuncture. There is apparently the “scientific approach” where people (vet faculty) are investigating approaches and mechanisms. Presumably, these are the ones that end up getting into the electroacupuncture and stuff like that in desperate attempts to find things that work. Then there is the “traditional Chinese” approach. Again, bells flew in my head. All I could think was, if the “traditional Chinese” approach worked, then why couldn’t it be studied scientifically? The mere fact that they make the distinction between “scientific” and “traditional Chinese” versions pretty much tells you that the “traditional Chinese” version has no scientific basis. Of course, this is the whole Chi crap.

    It was not the time to challenge or make an issue, but I found the discussion curious, to say the least.

  20. #20 Stephanie W.
    August 5, 2009

    vbrisley-

    I would be genuinely delighted to know how you’ve carried out your research.

  21. #21 Kismet
    August 5, 2009

    vbrisley, what research? Elaborate please, as your post did not say anything else than “I distrust ‘western’ medicine”, but you gave no reasons. Why?
    The problem is that only “modern medical science” has the chance of ever yielding a cure for any of the different cancers and in fact is able to cure some at this very moment (e.g. Hodgin’s Lympha as ORAC just pointed out).

  22. #22 Bodach
    August 5, 2009

    “Can’t hurt, might help, why not.” add “Tee time at 2pm; bye.” Lazy, paternalistic a**. How do Dr.’s become “shruggies”?

  23. #23 Marilyn Mann
    August 5, 2009

    Cancerwise also has a post promoting Acai berries or supplements based on Acai berries. There are a lot of companies scamming people to sign up for shipments of Acai berry supplements based on all kinds of wild, unsubstantiated claims. Many of these companies have been reported to the Better Business Bureau for billing people on their credit cards for supplements that don’t arrive and/or continuing to bill people after they cancel.

    Not to mention that so far as I know there is no proof that Acai berries are better for you than any other kind of fruit.

  24. #24 Pablo
    August 5, 2009

    vbrisley, what research?

    “I read a website somewhere that said…” is my guess.

  25. #25 cervantes
    August 5, 2009

    Regarding “shruggies,” many doctors feel, and it certainly seems defensible to me, that as long as whatever their patients are doing really can’t hurt them, and it isn’t stopping them from doing what the doctor thinks can help them, why argue? It just gets in the way of the Dr/Pt relationship and may even drive the people away.

    They also feel, if it does help the patient feel better, feel more in control, feel more optimistic, etc., it could even be doing some good. Hence the shrug.

    And research does show that for most people, that’s basically what happens. They don’t do the reflexology or Reiki or healing crystals instead of taking the FDA approved pills (not always a good idea either, BTW), they do it in addition. Which you may think of as a waste of time and money but then again, so is television and Disneyland.

    Not that all the bullshit in the world isn’t annoying, I’m just saying it isn’t necessarily all that harmful either. Although it certainly can be, especially if it results in a substantial monetary rip-off or persuades people not to get their kids vaccinated.

  26. #26 vbrisley
    August 5, 2009

    Stephanie W.
    Please see article from yesterday’s (8.4.09) NY Times:

    http://www.nytimes.com/2009/08/05/health/research/05ghost.html?em

  27. #27 vbrisley
    August 5, 2009

    “As far as my research has shown, a modern medical science “cure” for cancer has yet to be developed.”

    Please refer me to research that developed the cure to cancer as I would like to become more informed on this topic.

  28. #28 James Sweet
    August 5, 2009

    I’ve mentioned it before on this blog, but I’ll say it again: I think that maybe a doctor can be a shruggie and still be ethical, if the “shrug” is properly couched. On the show Breaking Bad, an oncologist responds to a patient’s inquiry about alternative treatments by saying something along the lines of, “Well, there’s no evidence that any of it works… but whatever makes my patients feel better, well, I’m all for it.”

    I’m not sure that’s the best approach, but I think it’s at least defensible, because the doctor is being honest about the (lack of) efficacy of alternative treatments.

    It also has the advantage that it leaves open the door for the potential positive effects of woo that cervantes mentions, i.e. helping some people to feel more in control. The value of this should not be underestimated.

    The big disadvantage is that it also leaves open the door for conmen to get rich exploiting the sick and the frightened. Also, while cervantes is right that most people do the woo in addition to actual effective treatments, that is not always the case, and those who do both (the moderates) inadvertantly provide political cover and encouragement to those who only do the woo (the fundamentalists).

    So I dunno what the best solution is. I do think, though, that the “shruggie” position only becomes indefensible when the doctor fails to inform the patient about the lack of evidence, or implicitly suggests that the woo will be effective.

  29. #29 IBY
    August 5, 2009

    @cervantes
    But there is also the problem that people are thinking that those kind of woo medicines are legitimate. While it feels good, it is certainly no substitute, and some people are taking it as substitute. That is the worry. The fact that some people take some of these stuffs seriously.

  30. #30 Ramel
    August 5, 2009

    Wow vbrisley, a corperation did something unethical to make money! That so totally disproves the scientific method!

  31. #31 James Sweet
    August 5, 2009

    Please refer me to research that developed the cure to cancer as I would like to become more informed on this topic.

    Heh, vbrisley, I hate to pick on you, because I know this blog and I can tell you that you are about to get very picked on… but let me point out here that your logic is basically:

    1) While Western medicine has developed treatments that are proven to increase the lifespan of cancer patients and in a few cases even cause the cancer to go into permanent remission, Western medicine has not developed a “cure” that consistently defeats all types of cancer.
    2) Alternative medicine has not developed a “cure” that consistently defeats all types of cancer.
    3) Therefore, Western medicine and alternative medicine are equally ineffective when it comes to cancer.

    As far as the “research” that justifies my assertion that Western medicine has developed treatments proven to extend the lifespan of cancer patients, well here ya go:

    http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=DetailsSearch&term=cancer+treatment&log$=activity

  32. #32 E.V.
    August 5, 2009

    Obviously vbrisley thinks cancer is cancer is cancer; one big encompassing “cancer” cure is what he/she is looking for.

  33. #33 James Sweet
    August 5, 2009

    Wow vbrisley, a corperation did something unethical to make money! That so totally disproves the scientific method!

    In other news, the recent revelations about Blackwater prove conclusively that evolution is a lie.

  34. #34 IBY
    August 5, 2009

    @vbrisley
    Cancer is a lot of things. There are a lot of type of cancers, each can come from different tissues. Some are very curable, and others are not. So it is very inaccurate to put all cancers into one category because it is made of many subsets. So when you talk of a “cure” for cancer, you have to consider what the doctors have figured out for all of those different cancers. And as Orac have mentioned above, Hodgkin’s Lymphoma is very curable. You should be able to get some stats on it by googling and finding reliable sites.

  35. #35 Pablo
    August 5, 2009

    Obviously vbrisley thinks cancer is cancer is cancer; one big encompassing “cancer” cure is what he/she is looking for.

    Actually, I was thinking it was more of a false dichotomy. “Cured” or “not cured.” Or maybe the “Fallacy of the Excluded Middle.” As James Sweet notes, “medical treatment has not given a complete cure for all forms of cancer” and “alternative treatments have not given a complete cure for all forms of cancer” and therefore medical treatment = alternative methods.

    However, that completely ignores the fact that medicine can indeed cure some cancers, and even if it doesn’t, it does things like make patients live much, much longer than they would if they didn’t have treatment, which is not something that can be said for alternatives. So no, they are not “just as much of a crap shoot.”

  36. #36 Orac
    August 5, 2009

    Please refer me to research that developed the cure to cancer as I would like to become more informed on this topic.

    Cancer is not a single disease. Note what I said:

    We know a lot about how cancers form and grow, enough even to be able to cure some cancers, for example, Hodgkin’s lymphoma; yet there are still quacks out there claiming that chemotherapy doesn’t ever cure cancer and convincing credulous boys like Daniel Hauser that “natural” cures will eliminate their cancer.

    Your reading comprehension leaves much to be desired. My point was that science-based medicine can cure some cancers (Hodgkin’s disease, for example) with a high probability. Of course, if by “cure” you mean 100% of the time, damned near nothing in medicine can cure anything 100% of the time. Also, we generally don’t like to use the word “cure” because cancer can recur, but after either 5 or 10 years, depending on the cancer, the chance of recurrence becomes so low that for all intents and purposes a successful treatment can be viewed as a cure.

    The bottom line is that we can cure several varieties of cancer, such as Hodgkin’s disease, breast cancer that hasn’t metastasized beyond the axillary lymph nodes, colon cancer that hasn’t metastasized to different organs, testicular cancer, various leukemias. True, it’s not 100%. For some cancers it’s 90% and others 40% or even less. Other cancers (pancreatic cancer, esophageal cancer, gastric cancer, various brain tumors, etc.) we don’t do so well against. We can’t cure them, although we can palliate the patients who are unfortunate enough to develop them.

    In other words, there is no such thing as a “cure for cancer” and likely never will be. However, there are cures for cancers, and we as clinical researchers hope to add to their number as the years go by.

  37. #37 Pablo
    August 5, 2009

    Of course, we generally don’t like to use the word “cure” because cancer can recur, but after either 5 or 10 years, depending on the cancer, the chance of recurrence becomes so low that for all intents and purposes a successful treatment can be viewed as a cure.

    I realize that this is a good functional approach, but I always figured that to be truly “cured” of cancer would mean that the likelyhood of your cancer returning would be the same as the occurence in the full population. It’s a little more convoluted, I agree, but I think that’s what “cure” means.

  38. #38 NoAstronomer
    August 5, 2009

    “Instead she discovers what brings pleasure to that person. ”

    Does this discovery take place above or below the waist?

  39. #39 Stephanie W.
    August 5, 2009

    vbrisley-
    Thanks for responding. So you abruptly came to your conclusions yesterday based on that article? Or did it confirm a pre-existing belief that all “Western” medicine (presumably also that Western medicine performed in non-Western countries) was the product of fraud? If so, do you recall when/how you developed this opinion? Did you ever hold a different view?

    That in mind, I have a question for everyone (inspired by your black box comment, actually). Is there any altie research into mechanisms? Is there an altie-Behe alleging that he’s discerned biological structures corresponding to meridians or what have you? Is there an altie-ID movement dedicated to rewriting physics to account for the physiological effects of their crystals? How do they convince themselves they aren’t knocking on wood?

  40. #40 Calli Arcale
    August 5, 2009

    Orac:

    Also, we generally don’t like to use the word “cure” because cancer can recur, but after either 5 or 10 years, depending on the cancer, the chance of recurrence becomes so low that for all intents and purposes a successful treatment can be viewed as a cure.

    I know a lot of alties like to use this sort of quote as proof that modern medicine doesn’t really cure cancer but instead adjusts the definition of cure to fit the data.

    But it’s my understanding that if you get cancer ten years after being “cured” of cancer, there’s really no good way to tell if it’s the same cancer or a new one, and that the purpose of the 5-year or 10-year cutoff is to sort out cases where the cancer survivor has merely been unlucky enough to come down with a new cancer. (After being cured of one cancer, there’s no reason to think you’re somehow invulnerable to cancer; you should be just as susceptible as you were before.)

    Am I understanding that correctly, Orac? Because I think this is a point that could do with more explanation so that people can understand what it means and not be swayed by one of the more common altie arguments.

  41. #41 SteveF
    August 5, 2009

    Is there any altie research into mechanisms? Is there an altie-Behe alleging that he’s discerned biological structures corresponding to meridians or what have you? Is there an altie-ID movement dedicated to rewriting physics to account for the physiological effects of their crystals?

    Actually, in homeopathy there kind of is. A kook by the name of Lionel Milgrom

  42. #42 JustaTech
    August 5, 2009

    Dear Orac,
    You can come work at my CC, the Fred Hutchinson Cancer Research Center. Aside from a few freak days last week it is quite comfortable here in the summer, and aside form last winter, very rarely snows very much. And you can treat people from Alaska! And although the PacNW can be pretty heavy on the woo, we are pretty good at compartmentalizing it (Baystr College of silly).

    Respectfully, JustaTech

  43. #43 Stephanie W.
    August 5, 2009

    SteveF-
    Why am I not surprised he calls on quantum entanglement? I swear half the time people say “quantum” to mean “a wizard did it.”

  44. #44 becca
    August 5, 2009

    “A treatment with an unknown causal mechanism might be justified on the basis of very strong empirical data.”

    Well, I don’t think the “very strong empirical data” standard is met for some drugs, e.g. SSRIs. However, I still think they might be justified as treatment.
    Having a plausible casual mechanism is important (I certainly want them to continue to work on elucidating all the mechanisms behind the SSRIs), but I don’t think lack of a reasonable casual mechanism is sufficient to eliminate a treatment from consideration. Nor do I think some whackaloon putting forth an absurd casual mechanism invalidates a treatment (someone can tell you the invisible pink unicorn purifies mold with it’s horn to make penicillin; it wouldn’t make it a bad idea to take antibiotics for susceptible bacterial infections).

    “it’s very difficult to avoid being that way with things like homeopathy which just make no damn sense.”

    lol. Point taken. I get the exasperation emotion; I’d probably want to thwap anyone who told me the unicorn story. However, I tend to get annoyed when the exasperation slips into condescending. I realize Orac’s been through it a thousand times. I realize the beliefs he criticizes have actual negative consequences that we all care about. I realize that if I read the blog more I’d probably be able to parse through his language and get his message.
    But to a casual visitor, who doesn’t read this blog regularly… well let’s just say it seems rich that he’s worried about advocating CAM because it might be paternalistic…

    In other words, to accept reflexology or acupuncture or whatever as being effective even though we don’t yet know “how they work” requires that someone provide compelling evidence that they do work.

    I’m with you absolutely on this. Trouble is, to accept a drug or whatever as being valid even though we don’t yet know “how it works” requires someone to provide compelling evidence that it does work. Even if we do know how it works, it’s insufficient.
    If you have data on whether a treatment works, it seems to me to be much more efficient to argue based on that, not on the quality (or lack thereof) of the casual explanation.

  45. #45 Prometheus
    August 5, 2009

    Becca comments:

    When people don’t have appealing explanations for phenomena, there is a vacuum created that woo can fill.

    This is the most succinct explanation I have seen for the existence of magical thinking and other forms of fantasy-based medicine. People would rather believe a pleasant lie than an unpleasant truth – even when they know it is a lie.

    Imagine that your real doctor tells you that you have colon cancer and that you need surgery, radiation and maybe even chemotherapy and even after all that you still have a less than 20% chance of living five more years. You then go to your “holistic healer” who tells you that your cancer is caused by liver flukes and all you need is a few sessions with a “zapper” to be “cured”

    Who are you going to believe? Who do you want to believe? I think the fact that most cancer patients face reality and go with the reality-based medical therapy is a testimonial to their courage and their doctors’ skill.

    Beccas continues:

    If you find a better explanation, it will eventually convince most people- which is why science exists at all.

    As it often is, the devil is in the details – “better” is a very subjective word. If by “a better explanation” you mean “an explanation that is supported by and explains the available data”, then we are complete agreement.

    If, on the other hand, you mean “an explanation that the general public likes better”, then you are back to the vacuum of woo. Anybody can make up some “Just So Story” about cancer, or lupus or whatever that is based on nothing more than what happened to pop into their head while they were eating their corn flakes. The ability to create such a “better” explanation does not make it valid.

    Becca goes on to say:

    *Using* something doesn’t depend on knowing why it works.

    Very true. I have no idea how my car’s automatic transmission works, yet I use it several times a week. Of course, I don’t try to argue that my ability to use an automatic transmission makes me an expert car mechanic, unlike some of the “alternative” practitioners.

    Becca also states:

    The argument that “it can’t work how you say it works” is not the same as “this doesn’t work”. The emotional way you argue the former distracts from the evidence you present on the later.

    I have to disagree with Becca on this one – if the “mechanism” for a treatment contradicts well-supported physiology (or anatomy), then it is unlikely that it will work. If someone tells me that they have a device that magnetically aligns the gasoline molecules in their fuel line to give them 50% great mileage, I can confidently say that “this doesn’t work”.

    I can say this because I know that their device consists of a magnet and because I know that no magnet that could fit in an automobile has the strength to “align” the gasoline molecules AND because I know that the “aligning” the gasoline molecules will decrease their entropy (increase their order) and thereby decrease the amount of energy that combustion will yield.

    To use a sports analogy (another field where I am woefully uninformed), if a person is speaking of “home runs” when discussing a football game, you already know they aren’t a sports expert. You don’t need to listen to their entire spiel “with an open mind”.

    Another issue is that the woo-mongers who so readily spout their contra-physiological (and often contra-physics) “mechanisms” don’t have any data showing that their “treatment” even works. Homeopathy, acupuncture, aromatherapy, crystals, “energy medicine” and chiropractic (except for minor muscular back pain) have all got the cart before the horse – they offer up complex “mechanisms” without first showing that their “treatments” work.

    The first thing these woo-mongers need to do is show that their “treatment” works. After that, researchers will fall all over themselves trying to find out how it works.

    Prometheus

  46. #46 spudbeach
    August 5, 2009

    #7 (Jennifer B. Phillips):

    You describe the difference between shills (people in on the scam) and dupes (people who unknowingly further the scam). Either way, the result is the same — an empty wallet and false hope.

    Does it really matter if the doctor knows and doesn’t care vs. doesn’t know and doesn’t care?

  47. #47 Brian
    August 5, 2009

    Ah… the “cure for cancer”. In my mind, that’s on the same level as a “cure for death”. Like Calli said, curing Hodgkin’s lymphoma doesn’t mean you’re somehow now invulnerable from pancreatic cancer. And that’s because time is on cancer’s side – it’s basically evolution in action. Your cells don’t “know” what’s best for your body – if they get around the blocks the body has set up to prevent them from dividing all over the place, you have cancer. And a drug is just another block. It’s actually pretty impressive that we can cure *any* cancers. Given that they’re made up of millions, if not billions of cells, any drug that is 99.9% effective will still leave thousands or millions of resistant cancer cells that can repopulate the tumor.

  48. #48 Matthew Cline
    August 5, 2009

    That’s entirely intentional on the part of woo-meisters.

    This is probably true for some, but my impression is that many honestly believe it. They have a mental model for how “allopathic” doctors think and develop their medicine, and it’s just not possible for the doctors in this mental model to have developed preventative and holistic practices, so any such practices must have been copied from alternative medicine. Some even have a mental model that goes so far around the bend that they believe that “allopathic” doctors never practice preventative/holistic medicine. One germ-theory denier I ran into on the misc.health.alternative newsgroup seemed to honestly believe that “allopathic” doctors have always said that diet has no effect on health; when I asked him which doctors said this, and in which venues, he replied “I thought it was common knowledge”.

  49. #49 DrWonderful
    August 5, 2009

    Acupunture works on horses. Explain the placebo effect, please. Just because no scientific explanation has been worked out does not mean one does not exist, does it?

    I think many of you have severe psychological problems and live very narrow angry lives. Does that have any effect on your health? Your immune system? Blood sugars? Clotting factors? Heart disease? Not too much research around to say it does…but I do know we accept that as fact, no?

  50. #50 Michael Ralston
    August 5, 2009

    Even if we do know how it works, it’s insufficient. If you have data on whether a treatment works, it seems to me to be much more efficient to argue based on that, not on the quality (or lack thereof) of the casual explanation.

    Well, there’s a couple different scenarios.

    There’s the “I just had this amazing treatment idea, I will now go try to get funding for clinical trials of my idea” scenario – that, of course, can’t have data, so it had damn well better have a solid theoretical backing.

    There’s also the “I’ve seen this treatment used, and it worked. I want to try to get it given to more people!” scenario. This is where most woo is … and where most actual medical treatments started, too – aspirin derived from willow back, for example. So, here, you won’t have a solid theoretical foot, AND you won’t have solid empirical data – you’ll have anecdotes. So what you should do is examine this proposed treatment to see if there’s plausibility, then run trials. So, herbal medicine – plausible, we can test it – and when we do, some herbs work, and others don’t; we can take the ones that do and discard the ones that don’t. Acupuncture – plausible, we can test it, even if it does fail. Homeopathy – not plausible, we should just ignore it. “Cancer is a fungus” – not plausible, just ignore it. SSRIs – plausible even if theory isn’t up to explaining the mechanism yet, so we tested them and discovered that they really did work.

    The problem is that people promoting a treatment won’t stop promoting it if it fails tests, and they certainly won’t stop promoting it if it’s too absurd to bother with (If that was enough to make them stop, they would never have started). They engage in special pleading and whatever other argument they can come up with. Evidence is not enough to convince them, and to someone who doesn’t know how many times some of these things have been studied, they can sound convincing – especially if they can cite the one-in-twenty study with a >95% confidence level of a positive result, even if the other nineteen had a negative result. Sometimes it helps to reveal how absurd the premise is, to help shortcut the evidential “he said she said”.

  51. #51 Whitecoat Tales
    August 5, 2009

    …mechanical engineer and educator.

    Engineer? Why is it always engineers? Damn Salem hypothesis is making my bachelors degree look like crap!

    Acupunture works on horses.

    I dispute this assertion. The evidence disagrees with you. The balance of evidence is that acupuncture doesn’t work on anything.

    I suspect that if you gave me a citation, it would be to a study that isn’t blinded. Without good experimental design, you can make up whatever result you want, and “prove” it.

  52. #52 DrWonderful
    August 5, 2009

    White Tale- ask a horse owner. You could ask the owners of the best thoroughbred race horses in the world and they will tell you the horses heal better and perform better and with more stamina when acupunture and chiropractic are employed. Why would a horse owner pay $2500 per treatment to have acupunture and spinal manipulation done repeatedly if the evidence was not right in fornt of them. I mean day 1 horse has pain. Day 2 horse has no pain. There has to be an explanation

    I understand there is no “science”, but since you are such a doubter do you have an explanation as to why acupunture works on animals? Certainly can’t be the placebo effect, can it? Then what is it?

  53. #53 Tally Ho
    August 5, 2009

    Orac says Feldenkrais is “Quakademic medicine” because he is unable to understand it? You know what “Quackademic medicine really is? It is guys like Orac lying about the effectiveness of western medicine.

    Today a news article came out that says people like Orac perform surgery on the backs of patients for 100,000’s of dollars, and that surgery is worthless. That surgery really truly is Quackery.

    ” In the past decade, a low-risk technique for repairing fractured bones in the spine has surged in popularity, to an estimated 100,000 operations last year in the U.S.

    But in the first two studies to rigorously examine the effect of the procedure, known as vertebroplasty, researchers found no detectable benefit when compared with a placebo group of patients who received a sham procedure that only mimicked the real thing.”

    To me it looks like Orac’s buddies in Western Medicine are the Quacks. Their own studies prove it.
    ————–

    Let’s move Orac’s ignorance displayed in this blog entry. Orac says.

    “Reflexology is quackery. It just is.”

    Reflexology is not quackery Orac. You do not have the education nor the familiarity with your own body to make the statements that you do. The lack is in you Orac, not Reflexology.

    Orac – ” Reflexology postulates a connection between regions of the feet and hands and ten zones of the body….There is no anatomic structure or physiology that supports such a connection. In other words, it’s bunk,”

    This is your problem Orac. If you cannot cut into a human being and find an object you can hold in your hand, it does not exist.

    Orac? You must be smart if you are a doctor. Let me ask you a question. If I told you to find a current in a body of water, could you do it? I want to say of course you could because you are smart. But then I think, “you can’t hold a current of water in your hand. So maybe even if Orac can see the effects of the current on the body of water, maybe if he can’t hold the current of water in his hand he ignores the evidence of his eyes and says there is no such thing as a current in a body of water?”.

    Do you see what I am getting at Orac? You cannot find the connections talked about by Reflexology because they are ephemeral. The connection is there, but you cannot grab it with your hand. Why not? For the same reason you cannot grab a current of water or a current of electricity. Those things exist but you cannot grab them with your hand.

    The connections within a human body talked about by Reflexology do exist, but you and your fellows will never find them with a knife. The only way to find them is through years of physical practice like Chinese Kung Fu, Pilates, Or Feldenkrais.

    You still have time Orac. Start practicing those physical exercises now and before you die you should be able to find what I, Chinese Medicine, and the Reflexology people are talking about.

  54. #54 Orac
    August 5, 2009

    Acupunture works on horses. Explain the placebo effect, please.

    No, it doesn’t.

    Next!

  55. #55 Ramel
    August 5, 2009

    @DrWonderful: “I mean day 1 horse has pain. Day 2 horse has no pain. There has to be an explanation” erm, regression to mean? Subjective evaluation of the horse’s pain by a human? The placebo effect does not need to work on horses, just the horse’s ass, I mean owner.

    @Whitecoat Tales: Please don’t dispair at every one in engineering, most of us are quite sensible.

  56. #56 Whitecoat Tales
    August 5, 2009

    White Tale-

    How hard is it to copy and paste a name?

    ask a horse owner. You could ask the owners of the best thoroughbred race horses in the world and they will tell you the horses heal better and perform better and with more stamina when acupunture and chiropractic are employed.

    I can ask 100 mothers who use chiropractic to “cure” their childrens ear infections, and they’ll all say it works too. Yet, they’re still wrong. The science doesn’t back this up.

    Why would a horse owner pay $2500 per treatment to have acupunture and spinal manipulation done repeatedly if the evidence was not right in fornt of them.

    Because they are too swayed by anecdotal evidence, just like everyone else. Why would someone spend thousands of dollars on “vitamins” for cancer treatments when they’re clearly still dying and have a fungating mass sticking out of their breast? Because they are swayed by anecdotal evidence, and testimonials. Incorrectly swayed.

    I mean day 1 horse has pain. Day 2 horse has no pain. There has to be an explanation

    …It’s called healing.

    I understand there is no “science”, but since you are such a doubter do you have an explanation as to why acupunture works on animals?

    Certainly can’t be the placebo effect, can it? Then what is it?

    Post hoc ergo propter hoc error. Bad study design. No study design. Recall bias. Plain stupidity. Deceptive practices on the part of the accupuncturist. I’m not even trying and I can come up with a number of explanations.

    You aren’t even looking for alternate explanations!

  57. #57 Orac
    August 5, 2009

    Today a news article came out that says people like Orac perform surgery on the backs of patients for 100,000’s of dollars, and that surgery is worthless. That surgery really truly is Quackery.

    Oh, goody. This should be fun.

    Note how “Tally Ho” can’t present a single positive scientific argument, but can only present attacks. Also note that it was science that demonstrated this surgery not to be as efficacious as thought, not woo-meisters like Tally Ho. Science-based medicine is self-correcting, unlike CAM. It may be messy, but correction does ultimately occur. Contrast that with CAM, where negative study after negative study fail to sway true believers like Tally Ho that there’s no there there.

    Orac? You must be smart if you are a doctor. Let me ask you a question. If I told you to find a current in a body of water, could you do it? I want to say of course you could because you are smart. But then I think, “you can’t hold a current of water in your hand. So maybe even if Orac can see the effects of the current on the body of water, maybe if he can’t hold the current of water in his hand he ignores the evidence of his eyes and says there is no such thing as a current in a body of water?”.

    Do you see what I am getting at Orac? You cannot find the connections talked about by Reflexology because they are ephemeral. The connection is there, but you cannot grab it with your hand. Why not? For the same reason you cannot grab a current of water or a current of electricity. Those things exist but you cannot grab them with your hand.

    The connections within a human body talked about by Reflexology do exist, but you and your fellows will never find them with a knife. The only way to find them is through years of physical practice like Chinese Kung Fu, Pilates, Or Feldenkrais.

    Quite frankly, that’s the dumbest argument I’ve ever heard for reflexology ever. Can’t detect it? It can only be detected after years of training? You’re basically postulating a non-physical, non-material force or flow of “energy.” Remember, we can detect nerve impulses, chemical gradients, and all manner of energy and forces down to an incredibly low level. Yet, somehow reflexologists can detect something that science can’t?

    What you’re talking is religion, not science. You can believe what you like. As they say, you’re entitled to your opinion. However, you are not entitled to your own facts. Show me the science.

  58. #58 Whitecoat Tales
    August 5, 2009

    @Ramel

    Sorry if this isn’t clear from my comment, by degree I’m an engineer myself, I defected to medicine later. I realise that a majority of us are sane. it’s a silent majority though, with a very vocal minority!

  59. #59 Ramel
    August 5, 2009

    It’s ok, engineering does seem to attract more than it’s fair share of cranks.

  60. #60 Pablo
    August 5, 2009

    Hey, some of my best friends are engineers!

    Oh wait. Not really. I don’t hang out with many (aside from my broth-in-law)

    The one thing I can say for engineers is, at least they aren’t lawyers. Lawyers piss me off.

  61. #61 Marcus Ranum
    August 5, 2009

    Reflexology is totally real! I have a friend who accidentally shot himself in the foot with a 9mm — he survived but it blew one of his kidneys right out through his back.

  62. #62 Stella
    August 6, 2009

    After studying up on Chinese history and culture, I’m astonished to think that people believe any good medicine could come out of Chinese tradition. It’s even worse that the term “ancient Chinese” has become a selling point! Thank you, but when I hear that phrase, I run the other way.

    It’s funny how much difference a little cultural context makes. To be fair, the ancient Chinese ‘doctors’ did the best they could with what they had; but what they had was essentially nothing. I’m sure many of them would have jumped at the opportunity to add effective, modern treatments to their repertoires, even if it meant crossing or manipulating common superstition to do it. But to do it the other way around… integrating the ancient Chinese doctors’ desperate, pathetic attempts to make their patients feel better into effective modern medicine… is bass ackwards.

  63. #63 Michael Simpson
    August 6, 2009

    @Stella. I wish I could find the article, but I believe that Traditional Chinese Medicine was invented in the 1940’s or so. Hardly Traditional. Anyways, I agree. People seem to think things were better 2000 years ago. Maybe somewhere they were, but in general the lifespan was about 30-40 years, and aside from the super powerful and rich, those were miserable lives.

  64. #64 Uncle Glenny
    August 6, 2009

    WcT – There *is* something about the mindset of many (note I didn’t say most) who go into engineering disciplines which I think can help lead to woo. I suppose it could be characterized as a kind of self-confidence and self-sufficiency which allows the … unhingedness … to run wild in a way different from the way it does in, say, creationists. (I’ll stop now because I’ve been up all night reading about teh crazies of various sorts and will be unable to engage in continued discussion.)

    I’m sorry to say that someone Orac has fisked not too long ago, with an engineering degree from MIT, may well be a classmate of mine, although only really a nod-in-the-hall acquaintance, so I can’t make any personality comparisons.

  65. #65 James Sweet
    August 6, 2009

    @becca:

    Well, I don’t think the “very strong empirical data” standard is met for some drugs, e.g. SSRIs. However, I still think they might be justified as treatment. Having a plausible casual mechanism is important (I certainly want them to continue to work on elucidating all the mechanisms behind the SSRIs), but I don’t think lack of a reasonable casual mechanism is sufficient to eliminate a treatment from consideration

    Heh, as it turns out, in the original comment I made that you are responding to, I almost mentioned SSRIs and other mild antidepressants as an example of a treatment with a plausible causal mechanism but weak empirical support. Yes, I think it’s a good example. A treatment with a measured efficacy comparable to SSRIs, but relying on a completely implausible causal mechanism (like homeopathy), would probably not be a particularly promising research avenue.

    While it’s true that a plausible mechanism without empirical evidence is insufficient, and empirical evidence without a plausible mechanism is sufficient, I still think it’s true that the lack of a plausible mechanism significantly raises the bar on the empirical evidence required to justify widespread acceptance.

  66. #66 James Sweet
    August 6, 2009

    Me = engineer, so I am loathe to accept the correlation between engineers and cranks, but it does seem to be real. My personal theories as to the causes are that either a) we get enough science in college to use big words and think we know what we are talking about, but not enough to really grok it; or b) engineering is “science-like” in that empirical data and objectivity are paramount, but by its nature engineering disciplines do not require nearly as robust empirical data or careful experimental design as science does. Outside of the research&development realm (which I am lucky to be a part of) the building blocks are already well understood, and you only need to validate that the finished product works as expected — which often ends up being a relatively small number of data points, since the a priori probability is much higher than, say, investigating a new medical treatment. And often, the product then gets handed off to the testing department, and the real validation is done there.

    Even in R&D, the demands are nothing like those in medical research. I mean, for example, computers and bridges and the like don’t suffer from the placebo effect, as far as I’m aware. :D

    I must admit, though, I did one time make a classic error of sloppy statistical thinking on the job, one that would be pretty bad in science. I was tracking down the source of a particular software failure, and the first time I ran the test it failed in a particular portion of the data that I thought might be significant. The second time, it failed in a portion of the data that had similar characteristics. I calculated the odds of each one from random chance at 1 in 26, and (stupidly) declared to myself that the odds that this was a fluke were nearly 1 in 700. Please, don’t embarrass my by pointing out all the fallacies in that thinking, it was a long day. :)

    I proceeded to spend the next couple of hours searching for a way the error could have been triggered by that particular aspect of the location of the failure. After coming up with nothing, I ran the test a 3rd, 4th, and 5th time… and sure enough, the first two runs were just a fluke.

    Of course, this still illustrates a way that engineering does not demand as much rigor as science… in that case, either the bug is fixed or it isn’t. Though my hypothesis was based on sloppy reasoning, it was quickly proved wrong in the most unambiguous way possible. Compare this to a scientific research study that attempts to establish a previously unknown correlation, and the sloppy reasoning might not be exposed until others tried to replicate the study. And by that time, the woomeisters already have a published paper they can point at…

    Engineers are used to basing answers off a small number of data points, because, except for in a few special cases that are taught in school (e.g. Monte Carlo simulation), that works just fine in our discipline. I think that helps make engineers more susceptible to crankery, because they become convinced by a small data set that in their world would seem incredibly convincing, and from there it’s unshakable.

    Of course, what helps perpetuate the crankery is that engineers are, by profession, ad hoc problem solvers. If you give the engineer the task of “Make this crackpot theory plausible,” it is in our nature to search endlessly for some kind of workaround or innovation to do so.

    This mindset even backfires in the profession itself. I’ve seen teams get behind their own pet solution and then, when another solution is demonstrated to be better, the response is to scour the data for ways to make their pet solution seem better, or to artificially close the gap, e.g. by appealing to an arbitrary benchmark. Hell, I’ve been guilty of that myself at times…

  67. #67 DrWonderful
    August 6, 2009

    White Tail- Just because there is no double blind study on PubMed yet does not mean something does not work. Is it possible some natural phenomenon simply have not been fully understood yet? Have we reached the point where all scientific study has been completed and the book of knowledge is written and closed?

    The horse example with acupunture and chiropractic is quite clear. There could not possibly be a placebo effect, unless you are assigning human cognitive traits to animals, which certainly in itself cannot be supported scientifically.

    To simply say the answer is that this simply does not work because it is not yet found in the literature is sort of foolish. The volume of horse trainers, jockeys and owners that will tell you horses heal faster and perform better with acupunture and chiropractic would blow you right off your white pedestal. Day 1 horse A runs fast. Day 2 horse A runs incredibly faster. Repeat by 30 horses in a stable. Repeat by hundred of stables in the world who cpmpete against each other. There has to be some real scientific explanation, no? Or have they all been tricked by hundreds of providers who conspired to do the same thing? I’d kinda thing the easiest explanation may be that it works but we do not fulyl understand how yet.

    Could these owners, trainers, and jockeys who compete so fiercly against each other every day possibly for some reason all conspire to trick you on this one point? Just because the science isn’t understood yet does not mean it does not exist. It may shock you to learn that there are things you do not even know that you do not yet know.

    Now take that into the super high end athletic world where I spend my work days. Tell an Olympic athlete or Hall of Fame baseball player there is no science behind acupunture and chiropractic and they will tell you on Day 1 they were good, on Day 2 they were better. To be honest, they would not care what you think.

    Do you know who the first professional baseball player was to hire a full time chiropractor? Babe Ruth in 1919.

    The greatest scientists in the world ask questions about what the observed instead of arrogantly pre-determining the answer because someone else find it yet. Which is why as a scientist you are complete fraud. You’re the King of Spain that insisted the earth was flat. Harsh, but true.

  68. #68 Pablo
    August 6, 2009

    Stella said

    After studying up on Chinese history and culture, I’m astonished to think that people believe any good medicine could come out of Chinese tradition. It’s even worse that the term “ancient Chinese” has become a selling point! Thank you, but when I hear that phrase, I run the other way.

    I agree. That’s why I don’t use Calgon for my laundry.

  69. #69 Pablo
    August 6, 2009

    Do you know who the first professional baseball player was to hire a full time chiropractor? Babe Ruth in 1919.

    He also drank a lot and ate a lot of hot dogs.

    I don’t think he should be considered a great health expert.

    The horse example with acupunture and chiropractic is quite clear. There could not possibly be a placebo effect

    While I agree that the horse cannot be lead to think it is feeling better after a sham treatment, we are, unfortunately, not dealing with the horse’s opinion.

    How do we know that a horse feels better after treatment? Someone has to make a pain determination. Who makes that determination? The horse? No, a person. And the person’s interpretation can be affected by the knowledge of whether they got a treatment or not.

    Owners, in particular, are completely ill-equipped to make such an assessment, and are going to give very unreliable result. Veterinarians have training in pain assessment in animals, so can be more objective, but still are not perfect.

  70. #70 Bob O'H
    August 6, 2009

    Reflexology is totally real! I have a friend who accidentally shot himself in the foot with a 9mm — he survived but it blew one of his kidneys right out through his back.

    Marcus Ranum FTW!

  71. #71 Marcus Ranum
    August 6, 2009

    DrWonderful writes:
    Is it possible some natural phenomenon simply have not been fully understood yet? Have we reached the point where all scientific study has been completed and the book of knowledge is written and closed?

    Physics is complete at this time, through the electromagnetic spectrum and outside of the atomic nucleus. The underlying reason for quantum mechanics is not understood, what happened before the singularity is not understood, and the inner structure of the nucleus is not understood (i.e.: there is no equivalent of quantum electrodynamics – perhaps we might call it quantum nucleodynamics). Other than that, yes, it’s understood to the point where it makes extremely accurate predictions that are constant use (think: computers, lasers, GPS, wireless communications, etc)

    More importantly, our understanding of those things is so solid that it should be counted as extremely, extremely improbable that they will be overturned by new knowledge. Perhaps if you recall how relativity “overturned” Newton’s laws of motion – it would be more accurate to say that it “completed and modified them for very small or very fast things” but Newtonian physics remained, basically, correct. If someone came along tomorrow with a quantum nucleodynamics, the chances it would change our understanding of quantum electrodynamics approach zero – it might complete it (i.e.: explain more) but it’s not all going into the garbage can.

    At this point, outside the nucleus and below gamma radiation and cosmic rays, the chance that something new is going to come along and throw it all over is about the same as the chance that someone will discover a new continent the size of Australia, in the Atlantic, that we somehow overlooked.

  72. #72 James Sweet
    August 6, 2009

    Dr. Wonderful: Here is an extensive blog post discussing the appearance of placebo-like effects in animals.

    Quick summary of possible explanations for it:

    1) Conditioning — For example, we might imagine that a horse becomes conditioned to associate a visit from the acupuncturist with being in a race the next day, and this could illicit a physiological response that alters the horse’s performance.

    2) Human contact — To quote from the blog, “There is a good body of research that demonstrates that human contact has measurable effects on animals. For example, petting by humans reduces heart rates in…horses.” It could just be that some horses benefit from all the extra human attention they get on acupuncture day.

    3) Placebo effect in the owners — For example, you mention a reduction in pain… but there is no objective way to measure pain in horses (there’s no objective way to measure it in humans either, for that matter, but we can at least get closer). The amount of pain experienced by the horse has to be judged by the owner. So if the owner knows the horse has received acupuncture, the placebo effect may cause the owner to judge the horse’s pain symptoms as less severe.

    Now, that’s all just idle speculation, who knows if that is the real cause… the true causes of placebo and placebo-like efffects are very mysterious and not something we can really say we understand. (There are even people who dispute whether placebo effects exist at all, instead attributing the perception to the Regression Fallacy.) Furthermore, this all assumes that there IS empirical data showing that acupuncture has a placebo-like effect on horses, something you have failed to show.

    But I just wanted to address that one specific point: Yes, placebo-like effects are observed in animals. No, we don’t fully understand it, though we can speculate. Deal with it.

  73. #73 James Sweet
    August 6, 2009

    I’ve got a post held-up in moderation right now because it had too many external links, so let me just give a link to a blog post discussing placebo-like effects in animals and the possible causes:

    http://www.sciencebasedmedicine.org/?p=263

  74. #74 Calli Arcale
    August 6, 2009

    James Sweet:

    Me = engineer, so I am loathe to accept the correlation between engineers and cranks, but it does seem to be real. My personal theories as to the causes are that either a) we get enough science in college to use big words and think we know what we are talking about, but not enough to really grok it; or b) engineering is “science-like” in that empirical data and objectivity are paramount, but by its nature engineering disciplines do not require nearly as robust empirical data or careful experimental design as science does.

    Speaking as another engineer, I think you’ve hit the nail on the head. Engineering is a “sciency” discipline; it isn’t pseudoscientific, but it isn’t scientific either. The focus is on getting it to work, not on conclusively proving why it works. Engineers will gladly use something that seems to work even if they don’t know why. “Cargo cult programming” is a great example of this. Coding practices and even entire code snippets get reproduced by software engineers who don’t know why they work, but believe they do — even when in fact the code does nothing at all. But for some reason they never worked out, a past product always failed when this snippet wasn’t present, or was altered, and so they keep using it, unaware that it has no bearing on the current situation.

    Confirmation bias is more common in engineering than engineers would like to admit. Mostly, this is because the demands are simply different. You don’t have time to study it scientifically. If you don’t deliver on time and meeting the requirements, you’re not going to get paid.

    DrWonderful:

    Just because there is no double blind study on PubMed yet does not mean something does not work. Is it possible some natural phenomenon simply have not been fully understood yet? Have we reached the point where all scientific study has been completed and the book of knowledge is written and closed?

    Of course not; the whole point of science is the quest for more knowledge, and the recognition that we cannot trust our own knowledge.

    That latter part is what usually escapes pseudoscientists; they have found something that they are sure of, and they do not wish to accept the possibility that they may have been mistaken.

    With respect to acupuncture and chiropractic in animals, the anecdotal evidence is small but significant. The scientific evidence is nonexistant, however. There have been some studies showing mild benefit, but the studies were not well controlled, which is typical for a very early study. One should not depend on one of those early studies; one should go on and do more science. Curiously, the world seems to be divided between those who think acupuncture works but are unwilling to test it with any real rigor (because they trust their gut feelings so much), and those who think it doesn’t work and don’t want to waste time studying it.

    What can cause a “placebo effect” in animals? Well, classically, the placebo effect shouldn’t exist, but if that’s all you look at, your focus is far too narrow. The animal doesn’t know he’s getting a treatment — but the owner obviously knows, and it’s usually the owner reporting whether symptoms improved. The owner generally wants the horse to feel better; this will color his observations. What’s more, if the animal is very closely bonded with the owner, the owner’s state of mind can have a significant impact on the animal’s behavior. If the owner thinks everything will be okay now, the horse will too. A successful horse owner (male or female) has to fill the role of the lead stallion; the horse will take follow his/her behavior cues implicitly. This is true of most domestic animals, which have been bred for millenia for their ability to read and respond to human behavioral cues.

    Bottom line: just because you think it work doesn’t mean it did, and if you are at all scientific, you will acknowledge that there is room for doubt. However, you may be so excited about it appearing to work that you are motivated to study it, quantify it, rule out the errors of human observation, find out why, and see if this new knowledge can be applied anywhere else. Of course, most acupuncturists and chiropractors aren’t interested in that. They do not wish to increase the volume of human knowledge. They think they know everything they need to know. Their minds are closed.

    Then they turn around and call scientists closed-minded. I would find the arrogance irritating, but it’s really just sad.

  75. #75 DrWonderful
    August 6, 2009

    Pablo- You seem to be relying on pain as the only indicator of health. Not so. Does high blood pressure hurt? The issue with acupuncture and horse is quite clear. The vets are the ones typically applying the acupuncture and working with the animal chiropractors. In the big stables the vets run the entire show and they are using acu and chiro services en masse. Not sure why you’d assume a chiro who has the same level of training is not qualified to make the aseesment but that is a different issue, I guess.

    babe Ruth started using a chiro when he was traded the Yankees. he swore, time and time again, it changed his swing and helped create a lot of the power he staretd to generate at exactly that time. The chiro focused on hip/pelvis mobility and was very astute at working with hip flexor/hip extensor issues. From that point all the Yankees greats have chiro’s they have worked with..including today. Not for pain. But for performance. If you were trained in physical performance measures you’d know they are completely objective…as is batting average, power, running speed, strength, agility, visual acuity, proproception, etc. For horses and human athletes alike.

    You doubters and haters think you are sooo progressive but you’re decades behind what is really happening in the field…and in performance labs such as the Olympic training centers around the world. Sort of sad.

  76. #76 Marcus Ranum
    August 6, 2009

    The horse example with acupunture and chiropractic is quite clear. There could not possibly be a placebo effect

    That’s absolutely nonsense. Horses are fairly intelligent (about as intelligent as a dog) and humans are incredibly important to them. Horses have lots of time to stand around (literally) and think about what’s going on around them! And they do. My horse, the mighty P-nut, has shown evidence in the past of trying to figure out the significance of things that I do. Horses also periodically undergo medical procedures; they are given mouthfuls of nasty-tasting goo (wormer) and have their feet messed with (hoof trimming) and are sometimes taken out and asked to do mysterious things.

    I did the experiment with the mirror with P-nut and for about a month afterward, whenever I came toward him with a new object, he’d come trotting up enthusiastically to examine daddy’s new thing. On one occasion 3 years ago, when he hurt his lip by catching it on a clip, there was a clear association in his mind between waiting for daddy to rescue him and being rescued. I know this because 3 months later when he ripped a hole in his front leg, he ran to me, instead of away, and stood there waiting for me to do something.

    My point: horses definitely have a basic notion of causation in injury and make the association between humans and something being done that either helps or hurts. I have seen similar behaviors in my dogs, BTW. Those 2 observations are all you would need to power simple placebo effects.

    Put another way: horses are definitely too smart to fall for acupuncture or homeopathy, but they enjoy attention and a good massage.

  77. #77 James Sweet
    August 6, 2009

    Confirmation bias is more common in engineering than engineers would like to admit. Mostly, this is because the demands are simply different. You don’t have time to study it scientifically. If you don’t deliver on time and meeting the requirements, you’re not going to get paid.

    In fact, I’d even argue that allowing oneself to fall victim to confirmation bias a little bit here and there can be a positive thing for an engineer with a good knack for it. I gave an example earlier where I wasted a couple of hours barking up the wrong tree because I had let my confirmation bias intrude on data with a sample size of 2 — but for every time that happened, there’s another five or ten times my gut was right, or at least led me somewhere productive even if my initial premise was wrong.

    I’m going to sound all egotistical now… but I’ve been able to come in and solve some really difficult problems that other people had been working on for a week to no avail, because I have a real intuitive knack for software and for abstract systems in general.

    I think the best scientists employ intuition in a similar way… BUT, in science, once your intuition leads you somewhere, you need to employ a rigorous process to validate your gut feeling, which is not necessary in engineering. Or to put it succinctly:

    In engineering, intuitive leap + plausible hypothesis + demonstrable causal mechanism = problem solved.
    In science, intuitive leap + plausible hypothesis + demonstrable causal mechanism = you might be able to get a research grant. If you’re lucky.

  78. #78 Marcus Ranum
    August 6, 2009

    Oh, yeah, another comment re: horse acupuncture. At the barn where I used to keep P-nut, there was some woo-woo who brought an equine acupuncturist in to help her old horse Cody (who was older than dirt!) feel better about his arthritis. The acupuncturist gave Cody a shot of ACE and then proceeded to do some woo-woo. I kid you not. ACE is a powerful animal painkiller/tranquilizer.

    I know that’s an anecdote, and not evidence. But there’s a few important points hidden in that:
    1) If you don’t know anything about horses, be careful what you believe about “horses this…” and “horses that…” you need to spend a couple years around the big goofballs before you even have a chance of getting to first base with horse medicine, horse behavior, or horse psychology.
    2) Horses don’t just walk up to you and tell you what their doctors do/did. So if I hadn’t noticed that the horse was also given ACE, the acupuncturist would have appeared very credible to his victims.*
    3) woo-woos particularly love patients that can’t contradict them in public. Patients that don’t speak are the best.

    Since I’m on the tangent about horses, here’s another funny one. The same woo-woo had an “animal communicator” in to the barn. I happened to be just returning from a jog in the woods with P-nut when they were there. The animal communicator looks at the mighty nut and says “OOooh, what a handsome big fellow! what’s his name?” And I just smiled and said, “you tell me.” Priceless.

    (* it was this incident: abuse of a poor sweet dumb aging horse, that got me interested in deconstructing acupuncture. I’ve been studying acupuncture con-artists ever since)

  79. #79 James Sweet
    August 6, 2009

    @DrWonderful:

    Every single shred of evidence you have supplied is anecdotal. You don’t see a problem with this?

    On a side note, it is not at all inconceivable that Babe Ruth could have received some benefit in pelvic mobility from spinal manipulation (i.e. chiro). I don’t think there’s good evidence to support this, but there’s not any evidence to contradict it either. Who knows?

    What I do know is that evidence-based medicine has shown that chiro can be effective for lower back issues, and I can easily imagine a reduction in lower back pain/stiffness resulting in a practical benefit to pelvic mobility. So absent any other evidence, I am agnostic as to whether Babe Ruth may have benefited from chiro.

    Now, if he said that chiro had cured him of flu symptoms or something…

  80. #80 tl
    August 6, 2009

    Just because there is no double blind study on PubMed yet does not mean something does not work. Is it possible some natural phenomenon simply have not been fully understood yet?

    Sure it might work. But that is not what you and the Alt. med people are claiming. You are claiming that it does work. If you are going to make that claim, you better back it up with real studies; not anecdotes similar in quality to those used for years to support things like phrenology, physiognomy, or blood letting.

  81. #81 Marcus Ranum
    August 6, 2009

    Babe Ruth also really liked the loose women. It’s possible that the additional pelvic mobility he experienced was from the blowjobs. Ever think of that, woo-tards?

  82. #82 Kimball Atwood
    August 6, 2009

    “I wish I could find the article, but I believe that Traditional Chinese Medicine was invented in the 1940’s or so.”

    UPCHUCK (Unabashed Plugging, Craven Hyping of Undisputed, Correct Knowledge):

    http://www.sciencebasedmedicine.org/?p=505

  83. #83 Pablo
    August 6, 2009

    In the big stables the vets run the entire show

    Funny you should say this. When I talk to vets (my wife is a vet, so I know a whole lot of them), they always complain that horse owners are the absolute worst, because they think they know more than the vets. In fact, vets DON’T run the show with horse owners, in general.

    So if there is a barn full of acupuncture and chiropractic, it tells you a lot about horse owners. It says nothing about the effectiveness of those treatments.

  84. #84 Marcus Ranum
    August 6, 2009

    Pablo writes:
    When I talk to vets (my wife is a vet, so I know a whole lot of them), they always complain that horse owners are the absolute worst, because they think they know more than the vets.

    My ex-wife was a farrier and I’ve heard exactly the same from her.

    And my horse’s vet would agree. Most horse owners never do “preventive maintenance” and only call when something has gone wrong. It’s only at larger barns, where maintaining herd immunity is important, that the barn owners are able to enforce a “all horses must have their shots” rule.

  85. #85 Jeff Read
    August 6, 2009

    Wow vbrisley, a corperation did something unethical to make money! That so totally disproves the scientific method!

    It’s similar to the Chomsky argument for socialism: yeah, a free market would be nice if it were really free, i.e., all players were ideologically pure. In reality, large corporations game the system to its own ends.

    To the woo-meisters there is no “scientific” medicine, and the stated efficacy of allopathic treatments is determined by whomever pays for the research.

    I’m not saying it’s true, but that’s the line.

  86. #86 James Sweet
    August 6, 2009

    It’s similar to the Chomsky argument for socialism: yeah, a free market would be nice if it were really free, i.e., all players were ideologically pure. In reality, large corporations game the system to its own ends.

    Huh. It seems to me that a purely free market wouldn’t “be nice” even if all the players were “ideologically pure.” Utilities are a simple example. Imagine a pure laissez-faire economy, with a plethora of, say, electric companies all acting benevolently and in the spirit of free competition — and you’ve got a logistical nightmare. Would they all have redundant grids? Would it be divided up regionally? (in which case free market competition breaks down anyway) Would they collaborate to share a single power grid? Well, again, this is not free market either, because now the entity that controls the grid has a monopoly.

    It’s not hard to find examples where, even without Evil Corporate Shenanigans, pure laissez-faire is broken.

    Of course, that is not an argument in favor of socialism, either, now is it? See also, False Dilemma.

    It seems so painfully obvious, to me at least, that the answer needs to be somewhere in between, i.e. harnessing the rapid optimization capability of the free market, within a framework of government regulations that attempt to incentivize the market to optimize for GOOD things. We can argue all day on individual policy choices, but ideological capitalism and ideological socialism both seem hopelessly naive to me.

  87. #87 Dr B.
    August 6, 2009

    @78 ” Every single shred of evidence you have supplied is anecdotal. You don’t see a problem with this?”

    No, not when the anecdotal support is coming from the veterinary professionals who have nothing to do with/or profit from the acu/chiro themselves.

    I am a veterinary surgeon, and I lecture to thousands of veterinarians every year. Most of them that have referred to the specialty would agree with Dr Wonderful that Acupuncture and Chiropractic work. Granted, those of us in the universities and specialty practices have had alot more opportunity to see the work done first hand. Most pet horse owners cannot afford to fly in acupuncture specialists for their animals, and yes, alot of them do their own preventive care. But, anecdotal or not, there are 100s(just here)to 1000s of patient records showing improvement in the animals after acupuncture. Not what the owner noticed, not what the acupuncturist noted, but what the referring veterinarians noted. I will continue to refer if it could benefit my patients.

  88. #88 Dangerous Bacon
    August 6, 2009

    DrWonderful: “babe Ruth started using a chiro when he was traded the Yankees. he swore, time and time again, it changed his swing and helped create a lot of the power he staretd to generate at exactly that time. The chiro focused on hip/pelvis mobility and was very astute at working with hip flexor/hip extensor issues. From that point all the Yankees greats have chiro’s they have worked with..including today. Not for pain. But for performance.”

    A couple of years ago there was a story in the N.Y. Times sports section about the Yankees’ Johnny Damon using a chiropractor and how much he was helping. Shortly after that Damon went into a slump and ended the year nearly 20 points below his lifetime batting average. Haven’t heard much about the chiro influence since then. The chiro also apparently wasn’t able to help Damon’s throwing arm, which remains on the weak side (the joke among Red Sox fans shortly after Damon went to the Yankees (and before his haircut to meet Yankee “standards”) was that Damon “looks like Jesus, acts like Judas, throws like Mary”). :)

    Whenever I hear some alt med booster going on about “haters and doubters” it demonstrates to me that their evidence is pitifully weak to nonexistent.

  89. #89 DrWonderful
    August 6, 2009

    Pablo- I am talking about the stables where multi million dollar throughbred are trained. These are the horses that run in the Triple Crown races. The entire program is managed by vets and at this point every single horse that races receives acupunture and chiropractic as part of it’s training program. I repeat, training, not just symptom relief. The same is to be said regarding chiropractic for every single American Olympic and professional athlete. The studies you read are focused on pain and insurance data. The perormance training data we use is hosued in teh Olympic training program and is not in peer reviewed lit. We’re talking about optimal functional performance not pain relief. This is a blend of the work derived fomr research by Janda, Lewitt, Leahy, Liebenson, et al.

    You people are so far out of touch with what is really, actually, truly happening in the field and how remarkbaly evidenced based it is. Are you even familar with this type of stuff or are you all stuck on PubMed as if it were Biblical? This is basic neurophysio and strucural science applied to the human frame.

  90. #90 Whitecoat Tales
    August 6, 2009

    @DrWonderful

    White Tail- Just because there is no double blind study on PubMed yet does not mean something does not work.

    You’re confusing the situation. It isn’t that there is no double blind study. It’s that there are lots of them, and they’re all consistently negative.

    Is it possible some natural phenomenon simply have not been fully understood yet? Have we reached the point where all scientific study has been completed and the book of knowledge is written and closed?

    Lots of things aren’t understood. But to start “explaining” the efficacy of something like accpuncture, you have to show that there IS efficacy. The studies are consistently negative.

    The horse example with acupunture and chiropractic is quite clear.

    It’s anything but clear, you have in no way shown that accpuncture works for horses. You’ve asserted that people use it, ergo it works.

    There could not possibly be a placebo effect, unless you are assigning human cognitive traits to animals, which certainly in itself cannot be supported scientifically.

    I dispute that this is of importance. I don’t need to go to the placebo effect when you can’t show any effect. If it’s as amazing as you’re saying, it should be easy to show benefit, but the evidence shows no such benefit. Check out this article:

    Habacher, G., Pittler, M.H., Ernst, E., Effectiveness of acupuncture in veterinary medicine: systematic review. J Vet Int Med May-Jun 2006;20(3):480-8.

    To simply say the answer is that this simply does not work because it is not yet found in the literature is sort of foolish.

    Whoa, why is this foolish? How hard do we need to look? You treat this as a miraculous cure all/performance enhancer. If it’s that good, the effect should be easy to tease out. Yet people have looked, and found nothing.

    The volume of horse trainers, jockeys and owners that will tell you horses heal faster and perform better with acupunture and chiropractic would blow you right off your white pedestal.

    The volume of people who will tell you a sugar pill makes them feel better is huge. The volume of people who think what works for them must work for their animals is huge. Most people don’t understand how to gauge these things at all.

    Day 1 horse A runs fast. Day 2 horse A runs incredibly faster. Repeat by 30 horses in a stable. Repeat by hundred of stables in the world who cpmpete against each other. There has to be some real scientific explanation, no?

    The scientific explanation is that they’re wrong. If it really made horses run faster, you’d have the easiest trial in the world to run, with a clear objective measure. That no such positive study has materialized argues against this being true!

    Or have they all been tricked by hundreds of providers who conspired to do the same thing? I’d kinda thing the easiest explanation may be that it works but we do not fulyl understand how yet.

    No, the easiest explanation is that people don’t know how to measure what they’re seeing, combined with recall and confirmation bias. Especially when YOU need to explain all of the negative evidence.

    Could these owners, trainers, and jockeys who compete so fiercly against each other every day possibly for some reason all conspire to trick you on this one point?

    I didn’t say the owners etc are trying to trick me. I said they don’t understand what they’re doing, or what is happening. They don’t rigorously measure any of these things.

    Just because the science isn’t understood yet does not mean it does not exist. It may shock you to learn that there are things you do not even know that you do not yet know.

    You have consistantly confused the basic point.
    You keep argueing against “There is no physiologic explanation of why these things would work, ergo it’s BS.”

    But I’m not saying that. I’m saying “There is no effect to have to explain. You assert it’s there. When we measure, it isn’t!”

    I don’t have to explain why the unicorn in your garden is eating your carrots. I don’t have to explain that because there is NO unicorn.

    Now take that into the super high end athletic world where I spend my work days. Tell an Olympic athlete or Hall of Fame baseball player there is no science behind acupunture and chiropractic and they will tell you on Day 1 they were good, on Day 2 they were better. To be honest, they would not care what you think.

    And if I operate, cut open their knee, and do NOTHING, they’ll tell you they feel better afterwards. Sham surgery produces “benefit.” This doesn’t mean that Sham surgery works. It doesn’t! That they don’t care what I think about it has no relevance to the efficacy.

    Do you know who the first professional baseball player was to hire a full time chiropractor? Babe Ruth in 1919.

    Ah? And why does that matter? This is survivorship error.

    How many baseball players hired chiropractors and didn’t get any better at all? Lots, but you didn’t check.

    The greatest scientists in the world ask questions about what the observed

    We observed. There was nothing there. That’s the point. We observed, and saw no effect. Get it into your head, no effect, no need to explain effect.

    instead of arrogantly pre-determining the answer because someone else find it yet. Which is why as a scientist you are complete fraud.

    I’m not a scientist. I’m a medical student. I don’t claim to be a scientist. I claim to read what scientists say. They say accpuncture doesn’t work. You arrogantly tell me that your anecdote beats all of science.

    You’re the King of Spain that insisted the earth was flat. Harsh, but true.

    Not all that harsh. Not all that true. Not all that witty.

    @DrB

    No, not when the anecdotal support is coming from the veterinary professionals who have nothing to do with/or profit from the acu/chiro themselves.

    Ok, my fiance’ is a vet student. I know for a fact that she’s been educated about evidence based medicine. I know she knows about the pyramid of evidence, and the fact that anecdote is at the bottom of the pyramid. So why does the fact that the anecdote comes from a vet change anything?

    Evidence shows that human doctors, vets, scientists, we’re all just as capable of being fooled by survivorship, confirmation, post hoc ergo propter hoc, as everyone else. Here, I’ll show you with the rest of your comments.

    I am a veterinary surgeon, and I lecture to thousands of veterinarians every year.

    Argument from authority.

    Most of them that have referred to the specialty would agree with Dr Wonderful that Acupuncture and Chiropractic work.

    Argument ad populum. Survivorship bias. Confirmation bias.

    Granted, those of us in the universities and specialty practices have had alot more opportunity to see the work done first hand.

    Ah, and seeing it first hand means you could have gathered statitsics. Have you? No. Because had you gathered positive data, thatwould have been one hell of a paper, that the media would have picked up on.

    But, anecdotal or not, there are 100s(just here)to 1000s of patient records showing improvement in the animals after acupuncture.

    Publish it then. It won’t be hard to publish. If you just do a chart review, pick up all the charts of animals that received accpuncture, show how many had legitimate benefit.

    Not what the owner noticed, not what the acupuncturist noted, but what the referring veterinarians noted.

    Again, why are vets getting special treatment here? Human doctors say that all the time. Then when we run the numbers, we find out they were wrong.

    I will continue to refer if it could benefit my patients.

    What would change your mind? What would show that accpuncture is NOT valid? How much evidence? What kind of evidence? If the answer is “nothing,” then I don’t care about you’re opinion, it has no value.

  91. #91 Arnold T Pants
    August 6, 2009

    Dr. B,

    But, anecdotal or not, there are 100s(just here)to 1000s of patient records showing improvement in the animals after acupuncture. Not what the owner noticed, not what the acupuncturist noted, but what the referring veterinarians noted.

    So have you published this? Have you or anybody done a case-control analysis? If you have such a wealth of good data, it should be easy for you to produce an article for us.

  92. #92 Jennifer Texada
    August 6, 2009

    First, I would like to say thanks for taking the time to write about Cancerwise. Although I can’t say I agree with all of the points of your post, there are a few that were taken to heart and thanks to your feedback, we are reviewing our practices on citing research within our posts, especially the ones that focus on our integrative medicine programs.

    We will continue to write about integrative medicine. Our core audience to this blog is patients, and according to most studies including this one in JCO up to 64% of cancer patients try some type of integrative therapy. http://jco.ascopubs.org/cgi/content/full/23/12/2590 We write about it because it is one of the topics that patients are interested in, in fact, it is some of our most popular content.

    The faculty that blog on integrative medicine tell me that, patients are going to do it whether the doctor likes it or not, as a physician it’s important to build that bridge to understanding. If you just dismiss it as “woo”, the patient may not tell you what they are doing, and ultimately that could affect the outcome of their traditional treatment.

    I understand that this idea may not impress or have value to many “traditional” physicians or scientists, heck, some of our faculty might sit right up on that fence with you, however here at M. D. Anderson we believe in discovery and innovation, and we invest in whatever it takes to treat the whole patient, mind and body.

    In conclusion I must also address the first commenter to this post that said “Its all about supply and demand; that and taking in money.” Perhaps it’s not clear in the articles, but most of the programs and classes in The Place of Wellness at M. D. Anderson are free of charge to patients. http://bit.ly/vxagA

    Thanks again, and I encourage you to keep reading and we welcome the feedback, it is the only way we will improve.

    Jennifer Texada, Chief Blogger
    http://www2.mdanderson.org/cancerwise/

  93. #93 Bronze Dog
    August 6, 2009

    The founding principle of science is quite simple: People make mistakes. If we were gods with perfect perception of the world, there’d be no need for science. Science is all about taking out or minimizing the impact of the observer’s cognitive biases on the results, as well as eliminating known alternative explanations.

    Woos who rely on anecdotes, on the other hand, assume that observers are infallible gods, incapable of being mistaken. Asking for more details or positing simpler alternative explanations is blasphemy. I often wonder how many elephants died in order to build that ivory tower of theirs.

  94. #94 k
    August 6, 2009

    They left out a couple words:

    The Integrative Medicine Program at M. D. Anderson is shifting the focus from sickness to wellness, treating the whole person, and providing a forum for evidence-based and anecdotal practices.

  95. #95 Scientizzle
    August 6, 2009

    Jennifer Texada, thanks for your feedback.

    The faculty that blog on integrative medicine tell me that, patients are going to do it whether the doctor likes it or not, as a physician it’s important to build that bridge to understanding. If you just dismiss it as “woo”, the patient may not tell you what they are doing, and ultimately that could affect the outcome of their traditional treatment.

    (emphasis mine)
    This stance conflates pragmatism and defeatism, in my opinion. A treating physician should certainly not be dismissive to a patient, and should be able to explain why any treatment has or has not been demonstrated to have clear safety and efficacy relevant to that patient’s needs.

    However, your comment doesn’t address the obvious question: if the patients will seek out ineffectual treatments anyway, why does M. D. Anderson have to be the place to provide them? I will concede that offering those treatments may bring in a wider patient base (there’s a potential money angle, even if you offer these particular services for free) which may lead to better outcomes generally given your successes as a treatment center. But doesn’t that also give credibility by association to a category of treatments that haven’t earned that credibility? (Look! M. D. Anderson offers acupuncture, so acupuncture must work!)

    Would you do this for a pharmaceutical that hadn’t been shown to work in clinical trials? (Hint: the answer should be a resounding “no”.)

    Don’t you see the self-fulfilling prophecy here? You lend acupuncture, reflexology, etc. credibility it hasn’t yet earned thorugh proper scientific study; this causes people to think these modalities have earned credibility and will thus demand it in greater numbers.

    I am curious: do the informed consent rules dictate in any way that an accurate representation of the scientific literature of these CAM modlities be presented prior to a patient’s participation?

  96. #96 Marcus Ranum
    August 6, 2009

    Where’s the FTC in all this? Are they the federal agency responsible for investigating false advertising? Because that’s what CAM is, unless it’s carefully worded (This “may” help you as much as any other placebo…)

    I’m wondering if there’s any point hooking up amazon’s mechanical turk and a few thousand bucks to spark a massive letter-writing campaign. By definition any advertisement of acupuncture, homeopathy, or chiropractic is deceptive, if it claims to do anything at all.

  97. #97 DrWonderful
    August 6, 2009

    Marcus- yuo seem very confused. There is no evidence chiropractic works? It does and ther eis an abundanc eof evidence. I beleive many of your colleagues here saw the rpesenation from a neurosurgeon at the last RAC conference where he applauded the chiropractic profession for doing outstanding research..to the point where there are more studies confirming the efficacy of spinal manipulation (34) than there are for the treatment of dental caries (7). Your assumption is showing.

    also, when you say “chiropractic” what exactly are you saying? The procedure of a Grade V manipulation which is performed by chiro’s, PT’s, MD’s, Osteopath’s and Naturopaths alike? Or are you referring to the profession as a whole consisting of doctorate level, direct access, poral of entry chiropractic physicians who utilize very accepted and solidly evidenced based physical medicine modalities, sound rehab prinicples and pure neuro physiological foundations that are sued by neurologists, medical doctors, physical therapists, etc all over the world? Or are you talking abotut eh 2% that prescribe the to the shrinking 2% that adhere to the subluxation theory of old (but who still get people well sort of by accident)?

    so please do you letter writing campaign and I dare you, I mean really dare you, to call out Doctors of Chiropractic who make claims that are solidly rooted in science. Many have trtied t fgo down that and all have failed when they see what it si they really are attacking. It’s not what you think. So please do it. But you better be sure.

  98. #98 Whitecoat Tales
    August 6, 2009

    @DrWonderful
    Does this mean you aren’t going to attempt to tackle my fisking of your previous comments?
    Fine, I’ll start on your new comment.

    Marcus- yuo seem very confused. There is no evidence chiropractic works? It does and ther eis an abundanc eof evidence.

    I dispute this assertion. There is SOME, evidence, of varying quality, that chiropractic, MAY not be inferior to conventional treatment for uncomplicated low backpain. This is not validation of chiropractic in general. studies showing chiropractic may help low back pain in no way helps their assertion that they can treat ear infections.

    I beleive many of your colleagues here saw the rpesenation from a neurosurgeon at the last RAC conference where he applauded the chiropractic profession for doing outstanding research..to the point where there are more studies confirming the efficacy of spinal manipulation (34) than there are for the treatment of dental caries (7). Your assumption is showing.

    Your complete lack of understanding of science is showing. Quality counts, not just quantity. As has been thoroughly analyzed in numerous other blogs, the literature in favor of chiropractic is weak across the board.

    Spinal manipulation is also not synonymous with chiropractic. Much of the spinal manipulation research is done related to physical therapist mediated spinal manipulation, and osteopathic manipluation. Niether of these is the same, in theory, or in practice, to chiropractic (although osteopathic has it’s own evidence based medicine problems)

    also, when you say “chiropractic” what exactly are you saying? The procedure of a Grade V manipulation which is performed by chiro’s, PT’s, MD’s, Osteopath’s and Naturopaths alike?

    This is completely incoherant, I’m not sure what you’re trying to say.

    Or are you referring to the profession as a whole consisting of doctorate level, direct access, poral of entry chiropractic physicians who utilize very accepted and solidly evidenced based physical medicine modalities, sound rehab prinicples and pure neuro physiological foundations that are sued by neurologists, medical doctors, physical therapists, etc all over the world?

    I dispute that any of this is true. Especially the “solidly evidenced based” part.

    Or are you talking abotut eh 2% that prescribe the to the shrinking 2% that adhere to the subluxation theory of old (but who still get people well sort of by accident)?

    I dispute that only 2% of chiropractors believe in subluxation theory.

    so please do you letter writing campaign and I dare you, I mean really dare you, to call out Doctors of Chiropractic who make claims that are solidly rooted in science. Many have trtied t fgo down that and all have failed when they see what it si they really are attacking. It’s not what you think. So please do it. But you better be sure

    Incoherant, but I advise you to read about the BCA, and their problems with Simon Singh.

  99. #99 Michael Ralston
    August 6, 2009

    That’s right, if you try to attack Chiropracty, he’ll get you. Probably by sicking the ever-so-bogus Judge Eady on you.

  100. #100 Calli Arcale
    August 6, 2009

    DrWonderful, you say that we should believe that acupunctur works for horses because “100s or 1000s” of patient records document some improvement after it was used.

    First off, these are not terribly impressive numbers really, when you consider how many horses there are, and considering that those are still subject to confirmation bias — those are records kept by veterinarians who referred their patients for acupuncture, which means they already had a preconceived expectation that it would be effective. Not exactly neutral observers, and certainly not blinded. Considering that some patients should improve spontaneously just through the body’s own natural healing processes, you should expect to see some horses improve after acupuncture. It doesn’t mean the acupuncture had anything to do with it.

    Secondly, you can find records documenting hundreds of thousands of human patients who improved after bloodletting or vomiting to restore the balance of their humors. Do you suggest that because there are documents recording many cases where people are said to have recovered after bloodletting, that we should use this to treat the same complaints for which it was used two centuries ago?

    Or, to put it another way, if everybody jumped off a bridge, would you do it to, or would you want to be sure they actually knew what they were doing first?

  101. #101 the bug guy
    August 7, 2009

    A search of ISI’s Web of Science full database found eight (8) articles for the keywords chiropractic and equine. Online access through the library system of a major university that includes a large veterinary school.

    Effect of chiropractic manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems.
    Author(s): Gomez Alvarez, C B; L’ami, J J; Moffat, D, et al.
    Source: Equine Vet J Volume: 40 Issue: 2 Pages: 153-9 Published: 2008 Mar

    Sample size of only 10 horses selected from animals presented to a “a 3-person veterinary
    practice located in Northern Germany that specialises in and
    performs only equine chiropractic manipulations”. No control group was included in the experimental protocol.

    Diagnosis and treatment of equine musculo-skeletal pain. The role of the complementary modalities: acupuncture and chiropractic.
    Author(s): Ridgway, K. J.
    Conference Information: Proceedings of the 51st Annual Convention of the American Association of Equine Practitioners, Seattle, Washington, USA, 3-7 December, 2005.
    Source: Proceedings of the 51st Annual Convention of the American Association of Equine Practitioners, Seattle, Washington, USA, 3-7 December, 2005 Pages: 403-408 Published: 2005

    Conference paper, abstract not available online.

    Author(s): Moffatt, S
    Source: PRAKTISCHE TIERARZT Volume: 85 Issue: 2 Pages: 104-107 Published: FEB 1 2004

    Not available online.

    Use of complementary veterinary medicine in the geriatric horse
    Author(s): Boldt, E
    Source: VETERINARY CLINICS OF NORTH AMERICA-EQUINE PRACTICE Volume: 18 Issue: 3 Pages: 631-+ Published: DEC 2002

    Review article lacking data.

    Chiropractic evaluation and management
    Author(s): Haussler, KK
    Source: VETERINARY CLINICS OF NORTH AMERICA-EQUINE PRACTICE Volume: 15 Issue: 1 Pages: 195-+ Published: APR 1999

    Not available online.

    Dispelling the myths concerning equine chiropractic
    Author(s): Harman, JC
    Source: EQUINE PRACTICE Volume: 18 Issue: 9 Pages: 36-38 Published: OCT 1996

    Not available online.

    Equine chiropractic care.
    Author(s): Willoughby, S. L.
    Conference Information: Proceedings of the Thirty-Ninth Annual Convention of the American Association of Equine Practitioners, San Antonio, Texas, USA, December 5-8, 1993.
    Source: Proceedings of the Thirty-Ninth Annual Convention of the American Association of Equine Practitioners, San Antonio, Texas, USA, December 5-8, 1993. Pages: 31-32 Published: 1993

    Conference paper. Abstract not available online

    NATURAL RIGIDITY OF THE HORSES BACKBONE
    Author(s): JEFFCOTT, LB; DALIN, G
    Source: EQUINE VETERINARY JOURNAL Volume: 12 Issue: 3 Pages: 101-108 Published: 1980

    Not available online.

    The review article above included a SCOPUS link to another article:

    K. Haussler, Back problems. Chiropractic evaluation and management. Vet Clin North Am Equine Pract 15 1 (1999), pp. 195–209.

    Only abstract available online. A review article that calls for more research.

    Overall, little published research on the subject and the one article I could closely was deficient in scope and experimental design.

  102. #102 the bug guy
    August 7, 2009

    Search using “acupuncture” and “equine” yielded 87 results. Looking at the 10 most recent:

    Practical applications of acupuncture in equine medicine.
    Author(s): May, K. J.
    Conference Information: Large animal. Proceedings of the North American Veterinary Conference, Volume 22, Orlando, Florida, USA, 2008.
    Source: Large animal. Proceedings of the North American Veterinary Conference, Volume 22, Orlando, Florida, USA, 2008 Pages: 138-140 Published: 2008

    Conference presentation. Online abstract presents no real information.

    Title: Acupuncture as a treatment of neurological diseases in dogs.
    Author(s): Joaquim, J. G. F.; Luna, S. P. L.; Torelli, S. R., et al.
    Source: Revista Academica Ciencias Agrarias e Ambientais Volume: 6 Issue: 3 Pages: 327-334 Published: 2008

    Full article not available online. Abstracts specifies only 43 subjects that received variable treatment and no controls were included.

    Title: The use of acupuncture beads to control exuberant granulation tissue in equine skin wounds: A preliminary study
    Author(s): Frauenfelder, H
    Source: EQUINE VETERINARY EDUCATION Volume: 20 Issue: 11 Pages: 587-595 Published: 2008

    Full article not available online. No real information on methodology or data could be gathered from the abstract.

    Title: Acupuncture in equine sarcoid – healing by stimulation.
    Author(s): Thoresen, A. S.
    Source: Zeitschrift fur Ganzheitliche Tiermedizin Volume: 22 Issue: 3 Pages: 99-102 Published: 2008

    Full article not available online. No usable information in the one-line abstract.

    Title: Comparison of pharmacopuncture, aquapuncture and acepromazine for sedation of horses
    Author(s): Luna, SPL; Angeli, AL; Ferreira, CL, et al.
    Source: EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE Volume: 5 Issue: 3 Pages: 267-272 Published: 2008

    Full article not available online. From the abstract, this included mixing pharmacologically active materials with acupuncture points. 8 horses were submitted to 4 treatment protocols, meaning 2 per treatment, a statistically very bad choice). Small sample, poor statistics.

    Title: Use of acupuncture in equine reproduction
    Author(s): Schofield, WA
    Source: THERIOGENOLOGY Volume: 70 Issue: 3 Pages: 430-434 Published: 2008

    Review article low on data and high on handwaving. The following from the Discussion says it all:

    Although the desire in Western medicine is to correlate a direct cause and effect response, this may be more difficult when assessing the therapeutic value of acupuncture. Despite much evidence that acupuncture produces a response from the body, which can be objectively measured in certain instances, an understanding and ability to consistently predict that response can be elusive. As a practitioner who utilizes acupuncture as an adjunct therapy to Western medicine, I would love to see conclusive data that outlines and defines acupuncture’s exact mechanism of action. However, the nature of acupuncture and TCM is more subjective, and fundamentally differs from Western thinking. Therefore, it seems more challenging to design thorough evidence-based Western medicine studies to evaluate the value of acupuncture.

    Not very impressive.

    Title: Acupuncture treatment for low back pain and lower limb symptoms – The relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow
    Author(s): Inoue, M; Kitakoji, H; Yano, T, et al.
    Source: EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE Volume: 5 Issue: 2 Pages: 133-143 Published: 2008

    Full article not available online. From abstract, a clinical and animal trial. Method details are unclear and I can’t tell if there were controls or blinding. Some results were given as unitless values and some of the treatment references were abbreviations without explanation.

    Title: Equine sarcoids – Part 2: current treatment modalities
    Author(s): Bogaert, L; Martens, A; Depoorter, P, et al.
    Source: VLAAMS DIERGENEESKUNDIG TIJDSCHRIFT Volume: 77 Issue: 2 Pages: 62-67 Published: 2008

    Full article not available online. From the abstract, this is a fairly broad review article that describes conventional modalities in a positive light and no mention of acupuncture.

    Title: Persistent breeding-induced endometritis
    Author(s): Troedsson, MHT; Desvousges, A; Macpherson, ML, et al.
    Source: PFERDEHEILKUNDE Volume: 24 Issue: 1 Pages: 56-60 Published: 2008

    Full article not available online. Abstract reviews conventional methods giving good results and references acupuncture in passing with other alternatives “have recently been suggested”.

    Title: Survival methods for the equine practitioner in equine ophthalmology.
    Author(s): Brooks, D. E.; Kallberg, M. E.; Utter, M. E., et al.
    Conference Information: Proceedings of the 53rd Annual Convention of the American Association of Equine Practitioners, Orlando, Florida, USA, 1-5 December, 2007.
    Source: Proceedings of the 53rd Annual Convention of the American Association of Equine Practitioners, Orlando, Florida, USA, 1-5 December, 2007 Pages: 374-396 Published: 2007

    Conference presentation. Abstract does not mention acupuncture.

    Again, not much to show. I’ll try to wade through more later after I use the different method I learned to track down abstracts for the chiropractic/equine search.

  103. #103 the bug guy
    August 7, 2009

    Retrieving abstracts for the chiro/equine search:

    Ridgeway: Still no abstract found.

    Moffatt 2004: Looks to be a review, no data or experimental information given.

    Hausseler 1999: Looks to be another review with no experimental data in the abstract. Important quote from the extract – “However, limited research is currently available on equine chiropractic in veterinary medicine.”

    Harmon 1996: No abstract found.

    Willoughby 1993: No abstract found.

    Jeffcott & Dalin 1980: No abstract found.

  104. #104 Marcus Ranum
    August 7, 2009

    DrWonderful writes:
    Marcus- yuo seem very confused. There is no evidence chiropractic works? It does and ther eis an abundanc eof evidence. I beleive many of your colleagues here saw the rpesenation from a neurosurgeon at the last RAC conference where he applauded the chiropractic profession for doing outstanding research..to the point where there are more studies confirming the efficacy of spinal manipulation (34) than there are for the treatment of dental caries (7). Your assumption is showing.

    That’s correct. Chiropractic’s intellectual underpinnings – the presumption that spinal “subluxations” cause a variety of problems – are manifestly incorrect. Indeed, “subluxations” do not appear to exist. Consequently, if chiropractic does actually have any effect, it is purely by accident. That is not to say it has no effect, but that if it does it’s not because of anything to do with the theory behind it. Following from that, we can observe two things:
    1) it is hugely unlikely that the wide variety of effects (from curing hypertension to relaxation) claimed would result from the same accidental discovery
    2) the explanation most consistent with “do stuff at random, feel better” is the placebo effect
    It would therefore fall upon the chiropractors to prove the effectiveness of their method as being greater than a placebo.

    You might be tempted to reply, as some acupuncture proponents have, to that argument with reasoning along the lines of:
    So what if the intellectual basis for chiropractic/water birth/acupuncture/reiki is bust?! It still works! We just haven’t figured out why, yet!

    Don’t fall into that trap. Because, if you do, you’re admitting that people have been performing medical interventions, based on nothing that even they understand, for years, and taking money for doing so – all the while, hoping that maybe someday it’ll be understood. That makes the worst thing that “big pharma” has ever done pale by comparison.

    also, when you say “chiropractic” what exactly are you saying? The procedure of a Grade V manipulation which is performed by chiro’s, PT’s, MD’s, Osteopath’s and Naturopaths alike? Or are you referring to the profession as a whole consisting of doctorate level, direct access, poral of entry chiropractic physicians who utilize very accepted and solidly evidenced based physical medicine modalities, sound rehab prinicples and pure neuro physiological foundations that are sued by neurologists, medical doctors, physical therapists, etc all over the world? Or are you talking abotut eh 2% that prescribe the to the shrinking 2% that adhere to the subluxation theory of old (but who still get people well sort of by accident)?

    If there are people following a scientific path based on the utter failure of “subluxation theory” why are they still calling themselves “chiropractors”?? Those are the intellectual foundations (if you will) of chiropractic. It sounds like you agree that there are people who have realized that those foundations are rotten, and are desperately trying to come up with new foundations – maybe even based on something that works – in order to keep their cash flow coming. Not to put too fine a point on it, that’s disgusting, immoral, and shameful. What about “we take your money, while we try to figure out something that will help?” is not false advertising?? Wouldn’t you shriek like a bitch if “big pharma” did that?

    so please do you letter writing campaign and I dare you, I mean really dare you, to call out Doctors of Chiropractic who make claims that are solidly rooted in science. Many have trtied t fgo down that and all have failed when they see what it si they really are attacking. It’s not what you think. So please do it. But you better be sure.

    Thank you. Now that I have your gracious permission, I will do exactly that.

    It’s interesting, though – I did a bit of searching and I noticed that many many many chiropractors are careful to say on their websites THAT IT DOESN’T ACTUALLY DO ANYTHING Wow – so, I guess that’s one way of covering against claims of false advertising: advertise that you don’t work, but hope people will come anyway.

    From: http://www.leixlipchiro.ie/ourPatients.htm (italics mine)
    There is no suggestion that spinal care can cure any of these conditions however for a variety of reasons we find improving spinal joint function affects nerve receptors and does improve the quality of life of the vast majority of our clients. If you click the links there is plausable anecdotal evidence of people being helped. Many people continue to visit the clinic even when treatment has not achieved everything that they had hoped for (…) etc.

    I did find a few acupuncturists who claim to help with heart disease, and several chiropractors who appear to claim to – although they also admit that it doesn’t actually work. Which is it? Does it work or not?

    If you claim something works, you’re falsely advertising if you know it doesn’t. If you believe it does, you should be able to prove it, right? Why all the weasel words? We both know the answer.

  105. #105 Marcus Ranum
    August 7, 2009

    Michael Ralston writes:
    That’s right, if you try to attack Chiropracty, he’ll get you. Probably by sicking the ever-so-bogus Judge Eady on you.

    I’m in the US, so UK libel laws are a bit less of an issue for me.

    Also, I’m not sure what’s libelous about asking our government agencies that are responsible for truth in advertising to hold people accountable for deceptive marketing.

    Go do some googling for stuff like:
    chiropractic center hypertension
    and it’ll make your head explode. These wankers are implying that getting a backrub will help your heart condition?! I suppose they don’t care if you die anyway.

    Look at the kind of crap these lying bastards are pushing:
    Fifty participants with diagnosed high blood pressure participated in the study; 25 received specific adjustments to the first vertebra of the spine, known as the atlas. The other 25 received “sham” adjustments (placebo). Immediately after, the 25 who received the “real” adjustments experienced a significant decrease in blood pressure, while those who received the sham adjustments showed no change. The results remained the same eight weeks later.

    It is also notable that although participants took no blood pressure medication during the eight-week study, the “real” atlas correction had the effect of two blood pressure medications taken in combination.
    (http://www.drgoffe.com/printformat.asp?chiropractor=10138S)

    Got that? Blood pressure medication plus chiropractic works better than nothing. No shit!

    The same study is mentioned here (http://www.atlaschiropracticofcary.com/article/Atlas_Chiropractic_Adjustments_to_Reduce_Hypertension) but they left out the part about the blood pressure medication.

    Lying fucking douchebag woo woos. They make the worst “big pharma shills” look like candidates for sainthood by comparison.

  106. #106 Marcus Ranum
    August 7, 2009

    I just noticed I made a serious mis-parse in reading the claims of Bakris’ chiro study. Oops!!!
    -More later-

  107. #107 Marcus Ranum
    August 9, 2009

    OK, so I misread the comments on the study – namely that the atlas manipulation “has the effect of 2 blood pressure reducers” The rest of the study looks unimpressive, but certainly the claims were nowhere near as egregious as I thought. That’ll teach me to drink beer while I review woo-woo.

    My bad. I was mistaken.

  108. #108 MaryBeth Smith
    August 9, 2009

    Dear Dr. Orac:

    Thank you for taking the time to view and respond to the MD Anderson Cancer Center’s blog, CancerWise, and specifically to the article about the Feldenkrais Method. I am the practitioner who teaches the Awareness Through Movement class at the MD Anderson Place of Wellness, and I was interviewed for the piece. I would like to respond to several of your points.

    Firstly, you are correct in observing that the piece in question was short on depth and completeness of information. Since the CancerWise blog publishes concise pieces in a short form, our constraint was around 275 words, and a two-minute video. The purpose of the piece was not to give an exhaustive theoretical or methodological treatise, but to inform people about the opportunity to experience classes in the Feldenkrais Method. Feldenkrais teachers are generally eager to engage with the public, as well as with scientists, researchers, and practitioners in the medical community to speak more fully about our work. Other venues (perhaps your blog, with its extended format?) are available and more appropriate for the type of in-depth examination you are requesting.

    Secondly, you speak to the lack of research around the Feldenkrais Method, and this is partly true. I would qualify the statement to say, “the comparative lack of research,” since undeniably there is far less research about the Feldenkrais Method than, say, cancer, calories, or cold medicines. However, a fairly complete listing of research studies about the Feldenkrais Method appears on the website of the International Feldenkrais Federation. http://feldenkrais-method.org/en/biblio. As you know, quality research is costly and time-consuming. Any research study also needs a champion, or a team, to see it through. Research efforts are currently underway in the US, in Australia, and elsewhere. However, lack of funding is certainly an obstacle to obtaining the type of research that would satisfy you. Additionally, when funding is provided to launch a body of research, the objectivity of the study and possibility for conflict of interest is rightly called into question and worthy of consideration. Unfortunately, this is the predicament we find ourselves in: we need funding, interest, and time of qualified and respected researchers if we are to move forward with our research efforts. The Feldenkrais community is actively seeking partners world-wide with whom to collaborate in research, across disciplines including but not restricted to neuroscience, physiology, kinesiology, cognitive science, physical therapy, athletics, and the arts. It will probably take many years to establish a research base and quality longitudinal studies to meet your standard of proof. We are well along the road to establishing a body of research, however, most findings are “preliminary” or “warrant further investigation.” Many of our research studies to date are qualitative, rather than quantitative. We would welcome collaboration with a researcher who could find a way to quantify our results in a way that is meaningful.

    Thirdly, you say, “uh, no, it hasn’t” in response to the statement in the article that the findings of Moshe Feldenkrais have been confirmed by neuroscience. Perhaps this sentence was made too simple and concise for the short format of the blog, and the statement is worthy of elaboration. Uh, yes, it has. When Moshe Feldenkrais began his work, the field of neuroscience was in its infancy. He was an early proponent of the idea of neuroplasticity (that the brain undergoes structural changes in response to learning) and neurogenesis (that the brain continues to produce neurons throughout one’s lifespan). These ideas were highly controversial in academia, and in the medical field, until very recently. In fact, researchers interested in these phenomena were slow-tracked, discouraged, and mercilessly criticized/ridiculed when they attempted to publish their findings. We now have fMRI technology to confirm that indeed, neuroplasticity and neurogenesis are actual processes and properties of the human brain. This idea is now widely accepted, when just 10 years ago it was denounced in academic circles. Moshe Feldenkrais died in 1984. While technology and neuroscience research have progressed and have provided information that surpasses or exceeds Feldenkrais’s findings, to date none have been disproved or contradicted.

    Medical professionals Karl Pribram, Norman Doidge, Michael Merzenich, and Frank Martin write extensively about neuroplasticity, and all are aware of (and recommend) the Feldenkrais Method. Whether you respect them or their work is for you to decide, and for others to decide on their own. It seems entirely possible and plausible that the Feldenkrais Method stimulates or activates neuroplasticity and neurogenesis. We are eager for researchers to discover the mechanism(s) whereby this might occur.

    The Feldenkrais Method has wide applications across disciplines. For example, the Canadian Olympic Ski Team employs the method in its training to improve kinesthetic awareness, essential for elite athletes. As with most emergent ideas and innovations, ideas cross boundaries and disciplines as their wider usefulness is demonstrated. Borrowing ideas from one field (for example, the Feldenkrais Method, athletic performance improvement, cognitive science) and applying them in another (stress reduction, pain relief, injury prevention) does not make the entire enterprise “woo.” Contrary to what you stated in your article, the Feldenkrais Method is NOT based on faith or gullibility, or subscription to any tenets of “woo philosophy.” It is based on the innate potential of each human being to learn, adapt, change, and improve. Feldenkrais teachers are exactly that – teachers – and not gurus or magicians. We teach students or clients, not patients, and our sessions are called lessons, rather than treatments. We facilitate learning, accessing the brain and nervous system though one of its primary sources of informational input: movement.

    Lastly, it is inaccurate to portray MD Anderson Cancer Center as generating income from their CAM/IM programming at the Place of Wellness. As was clearly stated in the article, Awareness Through Movement at Place of Wellness is underwritten by the C. G. Jung Educational Center, Houston, through funding by The Houston Endowment. To my knowledge, all programs at the Place of Wellness are provided free of charge to patients, family members, caregivers, and members of the community whose lives have been touched by cancer.

    I would invite you to have a direct experience of the Feldenkrais Method with a skilled practitioner. I am certain that you would want to have as much information as possible before drawing a conclusion that would otherwise be uninformed, given your obvious intellectual integrity. We would be happy to have open conversations with you as you are more informed about our work, and not simply reacting to verbiage that activated your “hot buttons.” Perhaps you can help us to translate our work into simple, understandable language that does not set off the “woo alarms.” There is much of value in the Feldenkrais Method, and it is worthy to stand next to any contemporary school of thought as a unique and helpful perspective on the human condition.

    Respectfully,
    MaryBeth D. Smith, MM, GCFP
    Director, the Feldenkrais Center of Houston

  109. #109 Orac
    August 9, 2009

    I find your rebuttal unconvincing for a number of reasons, but they would take a full post to elaborate. Maybe later this week, as I’ve already finished Monday’s post. Briefly, the study of neuroplasticity does not validate that the Feldenkrais method works. Uh, no, it doesn’t.

    But you can prove me wrong. You’ve spoken in generalities. Show me specifics. Tell me predictions specifically made by Feldenkrais that have been specifically validated by neuroscience. I did a simple thing. I searched PubMed for papers on the Feldenkrais method. Why didn’t I find any neuroscience papers about it? Answer me that.

  110. #110 Ryan Nagy
    August 10, 2009

    I found your post and your logic to be quite bizarre.

    You are right to criticize claim that the Feldenkrais Method is “confirmed by neuroscience.” It is largely a meaningless claim. However, as you note there are over 30 studies that have been conducted on the method and they speak to whether or not the work actually can and does help people with specific issues.

    But apparently you do not wish to discuss that because it does not fit in with your straw man argument? Or are you simply to lazy to make a thorough evaluation of the research?

    The plural of anecdotal evidence is not data, and neither is your hodgepodge of irrelevant personal rantings. Use the scientific method to learn something about the world, not to simply validate your own limited experience of yourself and to keep intact your own emotional commitments.

    Ryan Nagy

  111. #111 Annie Gottlieb
    August 10, 2009

    I’m a science editor and blogger. I first encountered the Feldenkrais Method by chance in the 1980s, when interviewing a practitioner’s wife on another subject. He offered to introduce me to the method. I didn’t know what it was and had no expectations. He asked me if I had any physical pains or complaints, and I said I’d been having low back pain for about a year, ever since breaking a toe in karate class. After being guided through some gentle motions on the table, some of which brought my attention to the way force (such as gravity) is transmitted from the feet through the skeleton, I got up and within a day, my back pain had concentrated in one spot, popped like a bubble and disappeared, not to return. This was so striking and so clearly not imaginary that I remained interested, and starting in 2002 began a Feldenkrais practitioner training in New York City, which I had to discontinue halfway through as my husband was becoming disabled and could not be left alone.

    Feldenkrais’s discoveries have, in fact, been validated by modern neuroscience in the form of the well-accepted concept of lifelong neuroplasticity (e.g. Norman Doidge, The Brain that Changes Itself and Jeffrey M. Schwartz and Sharon Begley, The Mind and the Brain. What Feldenkrais realized (partly by studying early development in the patients of his pediatrician wife) is that movement is the brain’s first language, the way it develops itself, and that there is a distinct, evolved, survival-related intelligence in the way the body orients itself through the senses and moves in gravity — a demonstrable relationship between the central nervous system (including, significantly, the eyes) and the dynamic structure of the skeleton. We all establish habits of movement that exclude many possibilities and are not always optimally efficient, much as we select the syllables of one human language from a vast variety of babbled sounds. Feldenkrais discovered that other possibilities of movement are still available to us, so that we can come to have a choice rather than just one habit, and may choose an easier, more efficient and pleasurable pathway. In fact, when shown such a pathway, the brain has the ability to recognize and prefer it very quickly. I have experienced this, and it’s what makes the Feldenkrais Method at times so startlingly much more effective than physical therapy that concentrates on the strength and flexibility of muscles. This method “speaks” directly to the central nervous system through its first language, movement.

    You really should experience it, not merely read words, before you dismiss it. If Feldenkrais strikes you as “woo-woo,” it’s partly because of the inadequacy of words and partly because at the time when the method “came up,” there was a lot of that going around. Because it was new and not immediately classifiable, it was the Esalen types, in part, who were open to it. Some practitioners of that generation may indeed have a tendency (unfortunate in my view) to merge the method with their own countercultural mysticism. Feldenkrais would not have been very happy with that fate. He was tough-minded and scientifically inclined. And his method has objective validity. Look up neuroscientist Esther Thelen; Google “Esther Thelen Feldenkrais.” Further research is a high priority for the community, though it is difficult to design because difficult to quantify. I recommend you experience it for yourself.

  112. #112 Chris
    August 10, 2009

    Annie Gottlieb:

    You really should experience it, not merely read words, before you dismiss it.

    The “try it” gambit is often used to promote treatments that have no scientific basis (this includes homeopathy, cranialsacral therapy, zappers, and on and on). Unfortunately, because the person who is being told to try it is a case report of one, it falls under the banner of “the plural of anecdote is anecdotes, not data.”

  113. #113 antipodean
    August 10, 2009

    Annie

    I think you’re missing the point.

    A Philosophy of treatment, an anecdote about a auto-remitting condition remiting (lower back pain), and the conflating of human movement with human language are not science. At least as science is applied to healthcare modalities.

    Clinical trials should be no more difficult to design than any other physical therapy or device-based trials and outcomes are not that difficult to quantify.

  114. #114 kbits
    August 26, 2009

    Interesting blog. Respectful insolence indeed! :>

    In the spirit of ‘respectful insolence’ then, I would like to rebut some of the claims made by Orac. Specifically –

    *********************************************************
    But, Feldenkrais concluded the brain continues to develop throughout life and retains the ability to relearn. His findings have been confirmed by research in neuroscience.

    Uh, no. No they haven’t.
    *********************************************************

    Uh, Yeah, they have. Take a look at what Moshe Feldenkris wrote in “Body and Mature Behaviour” (written circa 1945) and other books and then compare it to the below –

    On transference and generalization of learning (ie: generalizing motor patterns) –

    Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke

    http://www.ncbi.nlm.nih.gov/pubmed/18325646

    “INTERPRETATION: Preliminary findings suggest that even brief gait training using a treadmill with a restrictive weight placed on the distal extremity of the non-hemiplegic lower limb can improve laboratory measures of gait ability
    in a sample of stroke subjects”

    On the effects of discrimination and differentiation in reducing chronic pain

    Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain.

    http://www.ncbi.nlm.nih.gov/pubmed/18054437

    “These gains were maintained at three-month follow-up. We conclude that tactile stimulation can decrease pain and increase tactile acuity when patients are required to discriminate between the type and location of tactile stimuli”.

    On how training body image helps patients in chronic pain

    I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain


    http://www.painjournalonline.com/article/s0304-3959(08)00444-2/abstract

    “The conscious sense of our body, or body image, is often taken for granted, but it is disrupted in many clinical states including complex regional pain syndrome and phantom limb pain. Is the same true for chronic back pain?

    …These preliminary data indicate that body image is disrupted, and tactile acuity is decreased, in the area of usual pain, in patients with chronic back pain. This finding raises the possibility that training body image or
    tactile acuity may help patients in chronic spinal pain, as it has been shown to do in patients with complex regional pain syndrome or phantom limb pain”
    .

    *********************************************
    Unfortunately I couldn’t find any evidence that the Feldenkrais method has been “confirmed by by research in neuroscience,” at least not any neuroscience published in the peer-reviewed literature indexed on PubMed
    ****************************************************

    Interesting… I hit pubmed and found the above, very recent, peer reviewed articles that do just that, in under 20 minutes.

    Here’s what another 40 minutes uncovered –

    Freda Vrantsidis, Keith D. Hill, Kirsten Moore, Robert Webb, Susan Hunt, Leslie Dowson. Getting Grounded Gracefully: Effectiveness and Acceptability of Feldenkrais in Improving Balance Related Outcomes for Older
    People: A Randomised Trial Journal of Ageing and Physical Activity, 2008

    Abstract ;The Getting Grounded Gracefully program, based on the Awareness Through Movement lessons of the Feldenkrais Method, was designed to improve balance and function in older people. Fifty five participants (mean age 75, 85%
    female) were randomised to the intervention (twice weekly group classes over 8 weeks) or the control group (continued with their usual activity) after being assessed at baseline, then reassessed eight weeks later. Significant
    improvement was identified for the intervention group relative to the control group using ANOVA between groups repeated measures analysis for the Modified Falls Efficacy Scale score (p = 0.003) and gait speed (p = 0.028), and a strong trend evident in the Timed Up and Go (p = 0.056). High class attendance (88%) and survey feedback indicate that the program was viewed positively by participants and may therefore be acceptable to other older people. Further
    investigation of the Getting Grounded Gracefully program is warranted.

    1.Stephens, J., Davidson, J., Derosa, J., Kriz, M., & Saltzman, N. (2006) Lengthening the hamstring muscles without stretching using “awareness through movement”. Physical Therapy, 86(12), 1641-1650.

    http://www.hubmed.org/display.cgi?uids=17033041

    BACKGROUND AND PURPOSE:
    Passive stretching is widely used to increase muscle flexibility, but it has been shown that this process does not produce long-term changes in the viscoelastic properties of muscle as originally thought. The authors tested a method of lengthening hamstring muscles called “Awareness Through Movement” (ATM) that does not use passive stretching. SUBJECTS: Thirty-three subjects who
    were randomly assigned to ATM and control groups met the screening criteria and completed the intervention phase of the study. METHODS: The ATM group went through a process of learning complex active movements designed to increase length in the hamstring muscles. Hamstring muscle length was measured before and after intervention using the Active Knee Extension Test. RESULTS: The ATM group gained significantly more hamstring muscle length (+7.04 degrees )
    compared with the control group (+1.15 degrees )
    . DISCUSSION AND CONCLUSION: The results suggest that muscle length can be increased through a process of active movement that does not involve stretching. Further research is needed to investigate this finding

    1.Batson, Glenna & Deutsch, Judith E. (2005) Effects of Feldenkrais Awareness Through Movement on balance in adults with chronic neurological deficits following stroke: A preliminary study. Complementary Health Practice
    Review, 10 (3), 203-210.

    http://chp.sagepub.com/cgi/content/abstract/10/3/203

    The Feldenkrais Method is a complementary approach to motor learning that purports to induce change in chronic motor behaviors. This preliminary study describes the effects of a Feldenkrais program on balance and quality of life
    in individuals with chronic neurological deficits following stroke. Two male (48 and 53 years old) and 2 female participants (61 and 62 years old), 1 to 2.5 years post-stroke, participated as a group in a 6-week Feldenkrais program. Pretest and posttest evaluations of the Berg Balance Scale (BBS), the Dynamic Gait Index (DGI), and the Stroke Impact Scale (SIS) were administered.

    Data were analyzed using aWilcoxon signed-rank test. DGI and BBS scores improved an average of 55.2% (p=.033) and 11% (p=.034), respectively. SIS percentage recovery improved 35%. Findings suggest that gains in functional
    mobility are possible for individuals with chronic stroke using Feldenkrais movement therapy in a group setting.

    Nair DG, Fuchs A, Burkart S, Steinberg FL, Kelso JA. Assessing recovery in middle cerebral artery stroke using functional MRI. Brain Inj. 2005 Dec;19(13):1165-76.

    PRIMARY OBJECTIVE: To understand the temporal evolution of
    brain reorganization during recovery from stroke. RESEARCH DESIGN: A patient who suffered left middle cerebral artery stroke 9 months earlier was studied on three occasions, approximately 1 month apart. This patient received
    interventions based on Feldenkrais Method twice a week for 8 weeks. METHODS AND PROCEDURES: Brain activation was studied using functional Magnetic Resonance
    Imaging (fMRI). During each session, the patient performed a finger-to-thumb opposition task, which involved one bimanual and two unimanual conditions. Each condition consisted of overt movement of fingers and imagery of the same task. RESULTS: With recovery, greater recruitment was observed of the affected primary motor cortex (M1) and a decrease in activation of the unaffected M1 and
    supplementary motor area. In addition, the widespread activation of brain areas seen during the initial session changed to a more focused pattern of activation as the patient recovered. Imagery tasks resulted in similar brain activity as overt execution pointing to imagery as a potential tool for rehabilitation

    1.Stephens JL, Cates P, Jentes E, Perich A, Silverstein J, Staab E, duShuttle D, Hatcher C, Shmunes J, Slaninka C. Awareness Through Movement Improves Quality of Life in People with Multiple Sclerosis J Neurol Phys Ther.
    27(4): 170, 2003.February, 2004

    PURPOSE/HYPOTHESIS: To assess quality of life changes associated with a successful balance intervention in a group of people with MS. NUMBER OF SUBJECTS: 12 people with MS mean age 54 yrs, mean Kurtzke EDSS level 4.75 MATERIALS/METHODS: Subjects were randomly assigned to 2 groups: Awareness Through Movement intervention (ATM) and control group (EDU). The ATM group participated in 8 Awareness Through Movement sessions while the EDU group participated in 4 educational sessions over 2 months. Balance and mobility measures were performed before and after the intervention period. These results were published in Neurology Report 2001; 25(2): 39-49. To assess quality of life the MSQLI was administered before and after the intervention. The MSQLI has 10 sub-scales including: Modified Fatigue Impact (MFIS), Pain Effects, Perceived Deficits (PDQ), and Modified Social Support Survey (MSSS).All scales are valid for people with MS with reliability scores ranging from .78 to .97. Data analysis used Kruskal – Walis ANOVA for group comparisons and Spearman rs for correlations. R

    RESULTS: There were 3 significant group differences: 1)
    increase in pain effects in the ATM group (p< 0.03); 2) decrease in perceived difficulty recalling recent events (PDQ-RM) in the ATM group (p< 0.035); and 3)
    improvement in perceived availability of others for companionship (MSSS-POS) in the ATM group (p< 0.035). Improvement on the PDQ-RM was highly correlated with
    decreased Fatigue Impact. Improvement in MSSS-POS was highly correlated with decrease in cognitive fatigue impact and a decrease in total PDQ, retrospective
    memory and planning and organization subscale scores.

    CONCLUSIONS: The larger
    picture that emerges is that an intervention that was successful in improving balance and mobility had other spin-off benefits that were physical, psychological and social improving quality of life. ATM is intended to improve people’s awareness and understanding of their bodies and to help individuals create alternative strategies for setting and achieving goals in their life.
    This spin-off impact may be present in other kinds of interventions but it has not been measured or documented. CLINICAL RELEVANCE: In an environment where
    patients and payers increasingly demand significant functional outcomes and measurable improvements in quality of life, it is important to document not only the physical outcomes but also the outcomes that reflect quality of
    life.

    *-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-
    I did, however, find this rather more (I suspect) accurate summation of the Feldenkrais method as being much more akin to faith healing than science. I’m
    left to come to the opinion that the Feldenkrais method borders on quackery.

    *-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*

    Well then…in the spirit of Respectful Insolence…I respectfully submit you did a piss poor job of looking. It seems that you based your entire opinion on 30 seconds of very poor internet research and a strong preconcieved bias.

    Hardly what one would call impartial scholarship.

  115. #115 Felicia N. Trujillo
    August 27, 2009

    As for FELDENKRAIS being woo…I was born with spina bifida occulta and was unable to walk about 25% of the time, the other 75% was just in agonizing pain. The FELDENKRAIS METHOD, and work from its founder, Moshe’ Feldenkrais, made me able-bodied enough to study dance. Three years later,at 28, after an auto accident left me with with hairline fractures of all my anomalies and the prognosis that I would have to have surgery AND STILL BE IN A WHEELCHAIR the rest of my life, I sought his help again and have been mobile ever since.

    The url above is about a girl born with 1/3 of her cerebellum missing, a horrible prognosis (not speaking, walking) and how FELDENKRAIS brought her not only to speaking and walking, but being a successful college student. Do you also believe that Obama is not a US citizen, by any chance? Sigh.

  116. #116 Karen K. Milstein, PhD
    August 28, 2009

    Over the years, Feldenkrais work has rapidly helped resolve various pains and injuries for me, from a neck/back problem due to a whiplash injury to a TMJ-related situation. It is clearly NOT placebo. Instead of making judgments based on a limited view of what science can include, why not look at outcomes? The world is much larger than you may think.

  117. #117 Felicia N. Trujillo
    August 28, 2009

    The url re: the girl born with 1/3 of her cerebellum missing,was not posted with my comment: Healing Quest: Feldenkrais Achieves What Medicine Could Not
    http://www.youtube.com/watch?v=CNVw4ZISLMs

    And…uh yes…not very scholarly research on your part.

  118. #118 Karen K. Milstein, PhD
    August 28, 2009

    Over the years, Feldenkrais work has rapidly helped resolve various pains and injuries for me, from a neck/back problem due to a whiplash injury to a TMJ-related situation. It is clearly NOT placebo. Instead of making judgments based on a limited view of what science can include, why not look at outcomes? The world is much larger than you may think.

    And by the way, as a psychologist, I can tell you that cutting edge neuroscience research does indeed show the continued malleability of neural pathways through adulthood. (No, I don’t believe there is any neuroscience research on Feldenkrais perse, but that’s not the point, and that’s not what the website claims).

    Next time something hurts you badly, why don’t you treat yourself to a Feldenkrais session and see what it does for you??

  119. #119 Felicia N. Trujillo
    August 28, 2009

    Oh, two more articles–of course, these are just doctors:

    For Dr. Weil’s article on Feldenkrais, see: http://www.feldenkraiscentre.com/Weil%20article2.pdf

    Author of neuroscience best seller: The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (James H. Silberman Books) Norman Doidge, MD has used Feldenkrais for over fifteen years.

    Dr. Norman Doidge on The Feldenkrais Method:
    http://www.feldenkraiscentre.com/Doidge%20article.pdf

    Felicia N. Trujillo

  120. #120 Orac
    August 28, 2009

    You do realize that these are science-free arguments from authority you’ve posted, and personally I don’t consider Andrew Weil much of an authority on anything other than self-promotion.

  121. #121 Janet Carter
    August 28, 2009

    Sheesh. I continue to be amazed at the arrogance of sectors of allopathic medicine. Frankly I think it’s out of fear and defensiveness that their bailiwicks might be threatened. I suffered a near catastrophic riding accident 5 years ago and sustained 7 major fractures to the left hemi-pelvis. The catastrophe I avoided was death, as I had many medical professionals express amazement that I didn’t die that day on the mesa. However I did encounter staggering medical incompetence in response including so-called physical therapy, which was utterly useless. After 3 months of inappropriate treatment I found an expert trauma surgeon who repaired the fractures and they healed. Again, physical therapy failed miserably as I encountered the so-called protocols that predicted among other things that I was headed for a hip replacement. I found a Feldenkrais practitioner and was given treatment and tools that not only mitigated the chronic pain, but taught me how to walk and sit appropriately again. I have worked with an Egoscue practitioner also and found essential tools to keep me functional. Without these so-called non-science based practices that I use daily, I’d be up shit creek headed for a hip replacement, using a cane and god knows what else. Thank you Moshe Feldenkrais, and sir, you might want to do some “field” research before you take pot shots.

  122. #122 Felicia N. Trujillo
    August 28, 2009

    Michael Merzenich,PhD, Neuroscientist,in conversation with Anat Baniel, trained by Moshe Feldenkrais, D. Sc.
    Part 1 :http://www.youtube.com/watch?v=BhxMjkuumEE
    Part 2: http://www.youtube.com/watch?v=C-n52dOX6cw

    Anat Baniel explains how reduction of effort quickly improves the range and freedom of movement—and several other basic approaches in working with children with learning issues or brain damage—as wells as over-achieving adults. [Oh, dear NEW ideas!]

    [Just google!]Michael M. Merzenich is a professor emeritus neuroscientist at the University of California, San Francisco, who earned his PhD at Johns Hopkins University, School of Medicine, Baltimore, MD, 1968. Fellowship in Neurophysiology, University of Wisconsin, Madison, WI, 1968 – 1971.
    His contributions to the field are numerous. He took the sensory cortex maps developed by his predecessors like Archie Tunturi, Clinton Woolsey, Vernon Mountcastle, Wade Marshall, and Philip Bard, and refined them using dense micro-electrode mapping techniques. Using this, he definitively showed there to be multiple somatotopic maps of the body in the postcentral sulcus,[4][5] and multiple tonotopic maps of the acoustic inputs in the superior temporal plane.[6] He led the cochlear implant team at UCSF,[3][7] which transferred its technology to Advanced Bionics,[8] and their version is the Clarion cochlear implant.[9] As Co- Director of the Coleman Memorial Laboratory. his research focuses on understanding how the cerebral cortex represents, remembers, controls and employs complex input and action events. Additionally, Dr. Merzenich’s research investigates how brain learning processes contribute to the ontogenesis and expressions of human neurological illnesses.

    Oh geez, he is just exuding all kindsa woo-woo–I mean he studies brain learning processes!!! But there is the cochlear implant… And he is interviewing a woman who did this:
    Healing Quest: Feldenkrais Achieves What Medicine Could Not
    http://www.youtube.com/watch?v=CNVw4ZISLMs

    An inspirational story about the body’s ability to teach the brain. A baby born 20 years ago without a third of her cerebellum was given a grim prognosis that she would never be more than a vegetable. In this short video, you can see her as a pretty young woman and successful, college student.

    Anat Baniel and other Feldenkrais Practitioners have been working this way for fifty years and are utilized in Physical Therapy clinics worldwide, as well as training many PTs, OTs, RNs and MDs in this approach.

  123. #123 Steve
    October 6, 2009

    Orac,

    Part of putting yourself out there and creating a blog and having people comment, is that sometimes you are forced to deal with your own mistakes. You dont’ retain your credibility by not admitting you made a mistake vis a vis Feldenkrais Method. The man could have sqaushed you with his pinky, intellectually speaking. Read his books, take a Feldenkrais class. There is a strong sense of logic and well-thought out reason for most of his movement exercises.

    It would greatly increase my respect for you and your blog if you would take the time to investigate whether or not you should retract your assumptions about Feldenkrais.

    Be honest with yourself about the fact that you may have made the wrong call on this one, or don’t. It’s your integrity and your concience and your blog.

    -Steve

  124. #124 Chris
    October 6, 2009

    Steve:

    You dont’ retain your credibility by not admitting you made a mistake vis a vis Feldenkrais Method.

    You would have been better at referencing independent data showing the efficacy of the Feldenkrais Method, rather than an appeal to read his book. Give the actual independent data and skip special pleading and concern trolling.

  125. #125 Pxztwy
    November 23, 2009

    Orac,

    http://clinicaltrials.gov/ct2/show/NCT00891618

    This should send you over the edge.

    Pxztwy

  126. #126 https://me.yahoo.com/a/kfv354lkm.JxzZc0cyRXo4qL4A--#0c188
    March 23, 2011

    “Why does acupuncture research often show mixed results?” Dr. Cohen: “Sometimes it’s because of poor study design.”

    Amazingly, this very same answer explains why many quack medical treatments are believed to work… until they are later shown by well-designed studies to be no better than placebo. Examples of truly effective medical treatments producing “mixed results” for study after study are far more rare, and almost always imply insufficient understanding of the mechanism behind their effectiveness. Perhaps Dr. Cohen would like to address that?

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