Respectful Insolence

It’s been a while since I wrote about this topic, but I fear for the future of medicine.

Regular readers know what I’m talking about. The infiltration of various unscientific, pseudoscientific, and even anti-scientific “complementary and alternative medicine” (CAM) modalities into academic medicine seems increasingly to be endangering science-based medicine. Worse, this infiltration of quackery seems at least as bad, if not worse, in academic medicine, so much so that Dr. R.W. coined a most exquisite term for the increasing prevalence of pseudoscience in medical academia: Quackademic medicine. Whether it is the American Medical Student Association promoting quackery, the National Center for Complementary and Alternative Medicine (NCCAM) funding studies of homeopathy, medical schools adopting pseudoscience wholesale in their medical curriculum, or hospitals using it to attract woo-friendly paying patients, there is ample reason to fear for the scientific basis of medicine. It’s not just the U.S., either. All you have to do is to peruse David Colquhoun’s DC’s Improbable Science to know that this is a phenomenon that transcends national boundaries and has made its way into virtually every industrialized nation, particularly in the U.K. and Europe.

The result, it would appear, is a generation of medical students with far too many students like Jonny Martell. Jonny Martell is a third year medical student at Kings College London, and he has apparently found sufficient time away from his studies to write paeans to woo like The magic of alternative medicine. Sadly, he doesn’t see the irony of his chosen title. Alternative medicine is magic, all right. For what is homeopathy, if not magic? What is the idea that a healer can manipulate some sort of “life force” that is undetectable by modern scientific instruments in order to heal people but magic? What are psychics but people who either lie about being able to do magic or have deluded themselves into thinking they can do it? Yet, Mr. Martell feels inadquate around psychics:

I was working next to a world renowned psychic and spiritual healer in the healing sanctuary of a music festival. This made me nervous: my own training in complementary medicine before medical school gave me no such special powers. Many of the people I treated had the customary battle wounds of a sedentary office bound existence. Others came in just to feel better. These people were clearly treating themselves. Who else uses complementary and alternative medicine (CAM) and why?

Why indeed? I’ll give Mr. Martell credit for a modicum–but just a modicum–of awareness about CAM. He does realize that many patients seek it out for chronic conditions for which science-based medicine doesn’t have a lot of good treatments, although I would point out that I’ve come across my share of patients who have conditions that are perfectly treatable for potential cure using modern scientific medicine. Martell’s answer appears to be that if symptoms aren’t explained well through scientific medicine, then we should try magic to treat it.

And people wonder why I fear for the future of medicine.

Martell gives me even more reason to fear. Although he shows an admirable concern for patients with chronic diseases, his answer is anything but a service to them, as he launches into an essay that shows no sign of recognizing what is and is not science. Worse, he even seems to equate what CAM practitioners do with what the “best” science-based practitioners do:

Several approaches in CAM employ language and metaphors redolent of Eastern concepts of balance and energy flow. These are strikingly at odds with the reductionist technical lexicon of allopathic orthodoxy. This perhaps appeals to patients interested more in the “why” as opposed to the “what.” If stripped of its more esoteric overtures, this is of course no different to the best practice offered by general practitioners. A crucial difference, however, is the luxury of time.

Here’s a hint: Whenever you see someone refer to science-based medicine as “allopathic” medicine, you know you’re dealing with a historically ignorant git. The term “allopath” was invented by the creator of homeopathy, Samuel Hahnemann, ot describe anyone who was not a homeopath. In essence, it was used to describe the physicians of the era, who used harsh treatments like toxic metals, purgatives, and bleeding based on the ancient Greek idea of imbalances in the four humors being the cause of disease. Basically, allopathy is the opposite of homeopathy in that it isn’t like curing like, but the opposite curing opposite. The bottom line is that “allopath” is an intentionally derisive term that misrepresents what modern, science-based medicine is, and, in fact, science-based physicians do not practice “allopathy. In fact, the term is rarely, if ever, used by anyone other than practitioners of “alternative” medicine practices rooted in vitalism, like naturopathy, homeopathy, or chiropractic. I weep to see a medical student in his clinical rotations referring to his future profession as “allopathy” because it betrays an ignorance of and contempt for his own future professoin that is breathtaking to behold. Remember, “allopath” is virtually always intended as a derogatory term. Using “allopath” to describe a science-based MD is just like using the term “Darwinist” to describe an evolutionary biologist or a modern-day defender of evolutionary theory. As evolution has progressed far beyond Darwin, “allopathy” has progressed far beyond what it was in Hahnemann’s day.

Proving himself irony-proof, Martell continues by pointing out that the doctor-patient relationship in many instances has become too impersonal. He points out a deficiency of touch. Of course, too much touch puts a physician at risk for being accused of improprieties; so I’d be careful there. Unfortunately, Martell describes placebo medicine perfectly but seems utterly oblivious to the fact that that is what he is describing:

Working at the festival brought home to me how the tensions that exist between CAM and allopathic medicine can illuminate each other’s blind spots. Where primary care’s 10 minute consultation, spot of reassurance, and some tablets fail to hit the spot, I suspect that in some cases the holistic principles underpinning some CAM approaches are as instrumental in making the patient feel better as the intervention itself.

In other words, it’s placebo medicine. Most CAM modalities don’t do anything active against a disease process, but they do involve showing a lot of attention to the patient, which is perfect to maximize placebo effects. Unfortunately, poor Jonny gets it wrong when he concludes from this that in such instances “the therapy is unlikely to perform too well in randomised controlled trials, focusing as they do on an illusory magic bullet.”

Or maybe the reason why such therapies fail to do well in randomized controlled trials is because they are placebos and therefore perform roughly equal to placebos.

If I weeped for the future of medicine before over seeing a medical student deride his own future profession as nothing more than “allopathy,” I weep even more at the concluding paragraph of this revealing little post:

A willingness to develop an understanding of the appeal of CAM, despite its shortcomings, might be more likely among doctors if they had a better understanding of the fallible foundations on which their own pedestal of evidence based medicine is built. At the very least, it might make for a bit more humility and less flippant mockery when confronted with the popularity of the clairvoyant shop next door.

It’s truly depressing to think that a young man who will soon be a physician apparently thinks that the foundation of evidence-based medicine is so fallable that it is comparable to the “magic” and “mystery” that is alternative medicine and rationalizes the failures of CAM to measure up in randomized clinical trials to its allegedly “holistic principles.” By doing so, he profoundly devalues his own future profession. For instnace, if he were to become a primary care physician, he could be a holistic doctor without the need for scare quotation marks. He could be, as PalMD might put it, a real holistic doctor, wielding only the most kick-ass science-based medicine. As for who is the most arrogant, it is not necessarily science-based practioners mocking quackery. Rather, it is the pseudoexperts who think that they can bypass the hard work of showing that their therapies actually work through science and clinical trials in favor of testimonials and magical thinking.

Of Jonny Martell, I’m afraid that I have to conclude by saying that the woo is strong in this one. Sadly, because of the infiltration of quackademic medicine into medical academia, there are more and more Jonny Martell’s out there, and they will be taking care of you and me as we age and inevitably begin to suffer the diseases of aging.

It’s a thought that scares me.

Comments

  1. #1 Christophe Thill
    March 18, 2010

    “A willingness to develop an understanding of the appeal of CAM, despite its shortcomings”…

    … is actually a very good attitude.

    For a sociologist, I mean.

  2. #2 mekei
    March 18, 2010

    Not to infuse the health care debate, but I did cringe yesterday when Dennis Kucinich mentioned alternative medicine and his plant-based diet in his “yes” speech. I fear, only b/c we don’t really know what’s in the bill, that CAM will be supported to save $$ over conventional medicine.

  3. #3 Dr Benway
    March 18, 2010

    NIH didn’t want NCCAM. And back in my day, my med school wouldn’t have wanted a department of Infiltrative Integrative Medicine. This crap was wedged into medicine by outsiders.

    Entering med school is like joining a cult, complete with caste system, servitude, sleep deprivation, indoctrination, and scripted roles. It works as an intensive way to learn a huge amount of information, provided that instructors subordinate their own personal authority to the authority of evidence. CAM, in its subversion of basic rules of evidence, is a mindf*ck for students.

    Believing six impossible things before breakfast dulls one’s sensitivity to contradiction. It can take years to undo that sort of damage.

    I hope we can boot the quacks from our teaching hospitals and government oversight organizations before they drown us in pseudo-peer reviewed crap publications.

    Problem is, quackery pulls in serious money.

  4. #4 rork
    March 18, 2010

    “his own future profession” and several similar phrases made me smile.

    (Please write about your cancer center’s attitude more sometime – what you do, what we can do. Mine is scaring me, and I’m not sure I understand the dynamic.)

  5. #5 tsig0
    March 18, 2010

    Orac. it’s not just medicine. The entire science based culture is being eaten away by those who cannot or will not understand it.

    Science is hard and non-intuitive, woo is easy and makes ‘common-sense”.

    I admire you and others who are fighting the good fight but you may be struggling against the force of human nature.

  6. #6 English Rose
    March 18, 2010

    @ Christophe
    Funnily enough, that’s what I was thinking, too. Although I was thinking in terms of a psychological study into lay health beliefs. But it’s an eye opener when a future doctor is endorsing lay health beliefs.

  7. #7 Jacksonskepticalsociety
    March 18, 2010

    So, if science-based medicine gets taken over by woo-land practitioners, then the CAM modalities won’t be alternative anymore.

    Then science based docs will set up fly-by-night clinics in strip malls, your friends will come in and say “oh those rieki guys are evil reductionists and killing you – visit my friend who prescribed me this crazy antibiotic!”

    Though it always cracks me up when alt-medders refer to real doctors as “reductionists,” when I’ve never seen a real doctor peddle something as a cure-all.

  8. #8 Dangerous Bacon
    March 18, 2010

    C’mon, there’ve got to be new quacks coming along to take up the torch of flaming stupid from the old generation.

    I foresee Jonny Martell as possibly becoming the next Joe Mercola. They even have the same number of letters in their last names, as the sages of the East predicted.

    A few years from now and the guy could be pushing his own line of supplements and gadgets.

    Wonder what he thinks of vaccines?

  9. #9 Dr. T
    March 18, 2010

    I taught medical students and residents for twenty years. I served on a medical school’s admissions committee in the early 1990s. I believe that the primary cause of the increasing acceptance of woo and quackery among physicians is the acceptance into medical school of persons who do not understand science.

    Despite a long and praiseworthy series of improvements in medical sciences and medical education that began in the late 1800s, there remain far too many medical educators who avoid scientific thought and promote illogical and magical thinking. That would not be a serious problem if all medical students were strongly grounded in scientific thought. But, sadly, many medical students never learned about science. Instead, they treated their required science courses as hurdles to leap over (and forget) instead of as building blocks for a foundation of scientific knowledge.

    Our admissions committee continually argued about selection criteria. Applications were fewer each year since the mid-1980s, and most applicants did not meet what some of us believed were minimal standards. The non-scientist physicians on our admissions committee (and at most others in the USA) won their battles for weakening admission standards. Each year since the mid-1980s a smaller proportion of new physicians knows how to be skeptical and science-minded.

    I do not believe there is a near-term solution to this problem: most medical professionals and a large proportion of medical faculty are unconcerned with science and rarely exhibit skepticism. There is no widespread desire within society or within our profession to revamp the medical education system and to reeducate (or revoke the licenses of) physicians who advocate woo. Perhaps an epidemic of woo-related mortality and morbidity will spur needed changes, but I doubt it.

  10. #10 Harbo
    March 18, 2010

    I share orac’s despair; in the ICU tea room one evening recently, I watched a resident, eat a cold meal of leftovers, and asked why they did not use the microwave to heat their meal.
    They replied (without a hint of irony or humour) “I don’t hold with irradiating my food.”
    I suggested they eat in the dark, and received a quizzical look.
    I know “medical physics” is dumbed down. But how dumb can we get?

  11. #11 Jojo
    March 18, 2010

    Orac, if you think it’s scary for you, imagine what it must be like for those of us who don’t have the medical knowledge and background that you have. It’s hard enough for those of us without medical backgrounds to weed out the quacks when they call themselves CAM practitioners. Now we have to be able to distinguish if our MDs have crossed over to the woo-side as well, and that’s really hard to do when half of what he/she is saying is medicine and half is magic. How are we supposed to tell? I know some doctors say they are just trying to respect everyone’s opinions, but as a patient, it feels like a betrayal of trust. I expect my factory trained mechanic to follow manufacturer’s guidelines in repairing my car, I expect my CPA to do my taxes in accordance with tax law, and I expect my doctors to provide the standard of care for their field. I think they are all reasonable expectations.

    Sorry for the rant. I’m just a little raw from a trip to the pharmacy last night looking for something to help my 3 year old with a lingering cough. The pharmacy has completely reorganized the cold and allergy section to integrate all of the sCAM products in with the real products. Zicam and Airborne are displayed at eye level right next to Mucinex and Benadryl. The children’s section was filled with crap like Oscillococcinum and Cold Calm. Granted, there’s not much available for a three year old with a cough, but that doesn’t make it ok to target parents who are desperate for their child to feel better (and for some sleep). It sucks to watch your kid suffer, but it’s even worse to pay money for crap and then watch your kid suffer.

  12. #12 Harbo
    March 18, 2010

    PS it reminds me of a great joke…. which is now sadly redundant.

    The woo student puts their hand up in the back of the medical physics class and asks’
    “why do we have to study all this complicated physics stuff?”
    The sad professor replies
    “to keep the stupid people out of medicine!”

  13. #13 John Wills Lloyd
    March 18, 2010

    Meanwhile, over on the education ranch, we’re not hoping to keep the woo out, but to get the science into the profession. I suspect that increasing the proportion of primary, elementary, and secondary education devoted to teaching systematic and rational analysis would help mitigate the problem of finding woosters in MD schools.

  14. #14 Michael
    March 18, 2010

    He could come be a US Navy medical practitioner. They all seem to think 800 MG of Motrin is the cure for everything up to and including broken bones…

  15. #15 Michael
    March 18, 2010

    He could come be a US Navy medical practitioner. They all seem to think 800 MG of Motrin is the cure for everything up to and including broken bones…

  16. #16 OleanderTea
    March 18, 2010

    Woo is the kudzu of science.

    I was disturbed to see that my pain care clinic has added acupuncture to its list of “treatments”. What will they offer next? Reflexology? Chakra alignment? Aromatherapy?

    It’s enough to make me beat my head against a wall, but since my head is what hurts, it could be counterproductive. Then again, it could be a “homeopathic cure”.

  17. #17 DayOwl
    March 18, 2010

    Related Article (Orac, take aim!):

    http://www.realclearpolitics.com/articles/2010/03/17/reform_threatens_alternative_medicine_104797.html

    Nicely worded to imply all kinds of research support.

  18. #18 sophia8
    March 18, 2010

    I was working next to a world renowned psychic and spiritual healer in the healing sanctuary of a music festival.
    Sounds like it was the Healing Field at the Glastonbury Festival. Why didn’t he choose instead to volunteer at one of the first aid posts staffed by real doctors and paramedics? It would have been an invaluable boost to his medical education.

  19. #19 English Rose
    March 18, 2010

    @Jojo, I don’t know if you get any parenting magazines, but recently I’ve noticed a lot of adverts for ‘safe, natural, drug free remedies’ similar to the ones you mention. The advertising suggests they are gentle medications that your experienced older sister would recommend. I looked up one of the cold/sore throat remedies and it is basically sugar and vitamin C. You’d be as well off with the hot lemon and honey drink my mom used to make.

    @Harbo: I had a major falling out with a mom in my mom group who held to the whole evil microwave plot. Even when I pointed out that her whole basis for believing it was a random email she’d received from a supposed doctor at some organization that wasn’t clearly identified (and when I googled the acronym there wasn’t one answer that would appear a valid source for the scare mongering). I put together an organized list of actual evidence to back it up, but basically her line was ‘I don’t understand microwaves so I can’t believe they’re not bad’. I managed to persuade (I hope) another mom to remove the homemade ‘safety additions’ she had made to her microwave.

  20. #20 Chris
    March 18, 2010

    As a future doctor, I’m incredibly concerned about these things. Especially with the upcoming universal care. Many countries cover nonsense medicine.

    I’m also concerned because I’m going to an osteopathic school, and I’m afraid the woo will be strong there, even if it’s not the school’s fault. That degree tends to attract the woo woos in full force.

  21. #21 Luna_the_cat
    March 18, 2010

    I had a homemade cough medicine recipe from my grandmother that I have had considerable success with — basically, boil half a strong white onion in two cups of honey until the onion is transparent, then strain the honey into a jar to be taken a tablespoon at a time as your cough medicine.

    I do believe it works on the basis that the honey soothes your throat, and you will conquer even involuntary reflexes in order to not have to taste any more of that stuff.

    …More on topic, I have to say, I think this stems from several cultural trends. First is the dropping academic standards in the 80s, which I also got to see 1st hand — somehow, much of that generation seemed to develop a serious case of entitlement and aversion to the hard work of a real education (related to the whole “warm fuzzies” and “make your child feel good about him/herself” movement which got started then, too), and these people are now passing that ethic and ignorance on to their own kids. The second is the rise of the internet, where people sure of their own opinions and ignorant of facts were able to find each other much more easily and set up self-reinforcing communities which affirmed their “knowledge.” This played right into the already-existing American distrust of “intellectual elites” which has been so widely noted (personally, I think that got started around the time of President Andrew Jackson).

    I think science and scientific thinking enjoyed a surge of popularity and support in the 50s and early 60s because of the incredibly visible successes that new knowledge gave ordinary daily life after WWII, and then the challenge and nationalistic drive provided by the technological aspect of the Cold War. But the technological challenge by other nations faded and the incredible change in life quality after WWII is a victim of its own success in that now few people remember what it used to be like — so that is fading, and conspiracy theories which are fed by distrust of government corruption are taking over, which also feeds into the distrust of expertise and authority.

    Woo and magical thinking and a distrust of intellectual achievement and official authority has been around for a long, long time and has always been sort of an undercurrent to the culture. By being supported in mainstream institutions and the media, now, I agree, we risk it taking over. But I don’t know what to do about it, precisely, except to keep kicking against it — we desperately need a dozen or so more Carl Sagans, in a whole bunch of different fields.

  22. #22 Vilding
    March 18, 2010

    I am concerned about magic thinking even in evidence-based medicine. You see for instance beta blockers bandied about almost as some sort of cardiovascular panacea (many other examples). Medicine which has certain documented effects used in cases where evidence isn’t really in yet.

    This is the a type of quackery not mentioned enough, IMO, where medicine with a proven effect on one ailment is used on related contitions based on intuition rather than evidence.

    It is easy to have a giggle at homeopaths or nutritionists, and forget that even the medical profession hand out remedies for conditions that the drug hasn’t been proven effective for. This is the most serious undermining of EBM, IMO, because while it is easy for a lay person to investigate the science behind homeopathy (not much), keeping up to date on novel uses of old drugs is virtually impossible.

  23. #23 Jeff Read
    March 18, 2010

    As a supporter of science-based medicine, I have a huge problem with acupuncture: it works.

    It works via placebo effect, sure, but for certain classes of pain it’s an affordable and easy alternative to painkilling medication.

    I have an issue with being dishonest to people but let’s face it: if seeing an acupuncturist makes a patient happy, makes their pain go away, and does not cause them harm nor preclude them from getting real treatment they need, why the hell not? You’re never going to be able to get rid of CAM therapies that pass the “let’s hurl this at the wall and see if it sticks” test for minor noncritical pain or illness.

  24. #24 browngrl
    March 18, 2010

    I’ve been a doctor for over 20 years – first as a family doctor and now as a subspecialized radiologist. I agree fully that medicine should be evidence based but let me tell you – that is not the type of medicine I see practiced – even by science oriented doctors. I see “fear based medicine” as in : “I am afraid of being sued so I will order many many imaging tests”. What is the big difference between someone who asks for test after test without ever thinking about the validity/sensitivity/specifity etc and someone who waves crystals over the patient? Not much, in my opinion. I too am pessimistic about medicine – especially in countries where medicine is run by companies who have a greater interest in the profit generated by doing tests than in proving the tests have any scientific backing. As doctors we should not waste time worrying about alternative medicine – we have enough to clean up in our own backyard.

  25. #25 Rahul
    March 18, 2010

    Frankly, Orac, I think attitudes like yours are the reason why crackpottery is gaining ground. You didn’t even read Martell’s entire article, but quit at the first paragraph. “In other words, it’s placebo medicine”, you say. Yes, of course it is. Martell would agree, I’m fairly sure. The point is, it’s providing people something that they do not find in mainstream medicine: comfort. The other point is, mental comfort is a huge factor in healing — that’s why placebos work as often as they do. I know mainstream doctors who prescribe vitamin pills for the same reason — to reassure the patient and give them the impression that things are under control (which they often are, but the patient is not reassured by saying “there’s nothing wrong with you”).

    The key quote from Martell’s article is not what you quoted, but this: “A crucial difference, however, is the luxury of time. Another commodity sparingly used in modern medicine is touch. Whereas the doctor-patient relationship is ever more impersonal, with the growing battery of diagnostic technology, many CAM therapies thrive on a greater intimacy. Perhaps part of CAM’s appeal is that touch offers patients something magical and mysterious. It is also for many, the purveyor of the natural, free from the market hungry wolf of big bad pharma and the side effects of its drugs.”

    Many of your posts give the impression of denying that big pharma is bad — but it is, and has been repeatedly caught in the most egregious acts. It is also true, though you may not believe it, that the majority of doctors get their information on new therapies from big pharma, not from the literature. While I fully agree on the crackpot nature of homoeopathy and the limitations of herbal medicine, it is not because of the merits of those systems that people are being drawn to them. Nor is it their own irrationality. It is the limitations and, worse, the corruption in mainstream medicine — corruption from medical research (ghostwritten, paid-for papers) to practice (pharma companies pushing unnecessary drugs). We need to fix those problems and not fret so much about pseudoscience.

    Martell is absolutely right in saying that “Where primary care’s 10 minute consultation, spot of reassurance, and some tablets fail to hit the spot, I suspect that in some cases the holistic principles underpinning some CAM approaches are as instrumental in making the patient feel better as the intervention itself…. A willingness to develop an understanding of the appeal of CAM, despite its shortcomings, might be more likely among doctors if they had a better understanding of the fallible foundations on which their own pedestal of evidence based medicine is built.” (An example of the fallible foundations is the dreadful statistics that underpins much of the biomedical literature. A couple of years ago a Canadian team showed that, using standard biomedical statistics, astrological signs were highly correlated with particular diseases. Using proper statistics, the correlations vanished.)

    Of course CAM has its shortcomings — much of it is quackery and the rest is of limited applicability. But mainstream medicine has shortcomings too. To scientists, CAM is not validated. To the common public, mainstream doctors are terse, uncaring, arrogant and often corrupt. There may be many ways to fix this public perception, but I don’t think blogposts like yours are helpful.

  26. #26 Andreas Johansson
    March 18, 2010

    English Rose wrote:

    @Jojo, I don’t know if you get any parenting magazines, but recently I’ve noticed a lot of adverts for ‘safe, natural, drug free remedies’ similar to the ones you mention. The advertising suggests they are gentle medications that your experienced older sister would recommend. I looked up one of the cold/sore throat remedies and it is basically sugar and vitamin C. You’d be as well off with the hot lemon and honey drink my mom used to make.

    I guess this is as good a place to ask as any – is there any basis for treating the common cold with vitamin C?

    Back when I was a teenager my mother once bought me vitamin C pills in the hope it’d help alleviate my (very frequent) colds; if it helped any the difference wasn’t big enough for me to notice. When the batch of pills ran out my mother had a bright idea and bought orange juice instead – didn’t seem to help either, but at least it tastes good …

  27. #27 Denice Walter
    March 18, 2010

    Oh,the wave of anti-elitism sweeping across America:don’t trust experts!Doctors are in bed with Big Pharma:they’re only there for profit!Heal yourself with nutrition or homeopathy!The government is *entirely* corrupt:replace all of Congress with inexperienced newcomers!Wall Street and the banks are *totally* evil!Keep your money in your mattress!Pure mistrust of education and the educated:it’s a minority who espouse these views but a very vocal minority.Result? What will happen with new school texts coming from Texas.

  28. #28 Freemage
    March 18, 2010

    Rahul posted much of what I was going to say–the reason that so many of the woo-meisters have an audience at all is the corporatist nature of modern medicine. Particularly when dealing with issues like pain relief, which are exceptionally susceptible to the placebo effect, the woo-pitchers produce just enough superficially plausible results to be able to seem preferable to a modern medical practice that has become increasingly frustrating for the average patient to deal with.

    Patent abuse by Big Pharma (which entails jiggering the system so that the patent remains valid for longer, thereby extending the period in which a drug can be kept from being offered as a cheap generic), for instance, makes claims that they’re also peddling “toxins” in their vaccines seem more plausible–sure, it’s essentially a form of ad hominem attack (if he’ll do one evil thing, he’ll do another), but that argument has a lot of emotional appeal.

  29. #29 Jojo
    March 18, 2010

    @ English Rose. I let all of my parenting magazine subscriptions lapse. I couldn’t handle all of the “you should do this” articles that all contradicted themselves. I will say that I am not in the least bit surprised that the alternative treatments are being marketed for small children. The recall of all cold medicines for children under 4 (6 for some) has left a lot of people looking for anything to make their sick kids feel better. Listening to your child cough for an hour straight makes you feel pretty helpless.

    @ Luna_the_cat. I can’t even trick/bribe/beg/force my kid into taking bubble gum flavored Motrin. There is no way he would even consider onion honey cough medicine. just thinking about it makes me gag.

    @ Rahul – I’d suggest you scan through some of Orac’s posts where he goes after Big Pharma and Big Publishing the same way he goes after woo. No one is spared.

    While I often hear stories about how rude, abrupt and corrupt doctors are, I’ve never seen any evidence of this. Can you site evidence to support that claim? If all you have are anecdotes, I’ll chose to use my own, which is that the vast majority of doctors I have seen have been caring, patient, thoughtful, and willing to take the time to explain things when I ask questions. (And I ask a lot of questions).

    Even if you are correct and doctors are scumbags, how does allowing for the incorporation of pseudoscience into science based or evidence based medicine improve matters?

  30. #30 Michael Simpson
    March 18, 2010

    @ Rahu

    Many of your posts give the impression of denying that big pharma is bad — but it is, and has been repeatedly caught in the most egregious acts. It is also true, though you may not believe it, that the majority of doctors get their information on new therapies from big pharma, not from the literature. While I fully agree on the crackpot nature of homoeopathy and the limitations of herbal medicine, it is not because of the merits of those systems that people are being drawn to them. Nor is it their own irrationality. It is the limitations and, worse, the corruption in mainstream medicine — corruption from medical research (ghostwritten, paid-for papers) to practice (pharma companies pushing unnecessary drugs). We need to fix those problems and not fret so much about pseudoscience.

    There is nothing worse in a debate than illogical “appeals to conspiracy” and broad condemnation of a group of people. Big Pharma is bad? Corruption of medicine? (And like the use of “allopathic”, when someone uses “mainstream medicine”, I know the point of view of the user.)

    Many medicines are good and give patients healthier lives. You state that a physician can spend maybe 10 minutes with a patient (yes, many primary care physicians have that much time or less). When will he or she be able to read about new medicines? Maybe pharmaceutical companies provide a service and fill a need. If the physician doesn’t use critical thinking skills, then whose to blame?

    The health care system in the US plainly sucks. But to condemn an industry based on the lack of ethics of a few is unfair, unjust and unacceptable. Do I think the medical products industry is purely altruistic? Of course not. It makes profits. But nearly everyone involved in the industry is proud that every morning they do their best to help people live longer healthier lives. I can’t say that about those employees in Big Herba. Or Toyota. Or Louis Vuitton.

  31. #31 rob
    March 18, 2010

    @Harbo: lol at both posts.

  32. #32 Scott Cunningham
    March 18, 2010

    Luna_the_cat @20 is absolutely right.

    Having grown up in the warm-fuzzy educational environment, which started shortly before I started school, logic and facts were seldom there, memorization never necessary, and it only got worse as time went on. I don’t think I saw any logic or memmory work between the end of Grade 6 and when I changed my undergrad major to Biology. Everything was about writing journals about personal feelings, and regurgitating heart-felt political talking points.

    Even in math! The first time I took a grade 12 Calculus course to get into biology, in a distance ed. program partnered with the Ontario government, there was a journal I had to fill with emotional reflection graded on equal terms to my solutions! I stopped and took the math at another university instead.

    I didn’t realize what my education was missing until I was in University, and even then only because I had abusive armchair radical English profs weilding Foucault as a weapon.

    We need more math, history, science and logic in elementary school, and none of the social engineering, emotional reflection and platitudes. Giving kids constant crutches and no real work or challenges cripples them.

  33. #33 Rahul
    March 18, 2010

    Michael Simpson: if you know my point of view from a single phrase I used and not from what I actually wrote, I suppose I need say nothing more.

  34. #34 Rahul
    March 18, 2010

    Jojo: Incorporating pseudoscience into mainstream medicine does not improve matters. But nor does ignoring what drives people to pseudoscience in the first place. Meanwhile, not everything in CAM is pseudoscience. Some of it — yoga, meditation, diet etc — can be excellent advice for healthy people, and for people suffering from certain “lifestyle diseases”. I think you’ll find that such people are the major users of CAM. Cancer patients are a minority. And CAM practitioners who claim to cure cancer are a minority, too.

  35. #35 Ian
    March 18, 2010

    I don’t think anyone is arguing for the status quo of modern medicine. I can’t imagine anyone denying that there are serious issues with the practice of medicine, the influence of pharma interests being a large issue. The point of the post, as I interpreted it, was that we shouldn’t address the problems with magic. Doing so throws the baby out with the bath water, to borrow a phrase.

    Rahul is right, in a way. Jumping on those who criticize pharmaceutical companies and labeling them as conspiracy-mongering twits are likely to forget something important: pharmaceutical companies DO conspire. Just as any other lobby group does (although significantly more powerful than most), pharmaceutical companies are interested in obeying the rules so long as the risks outweigh the benefits. Just like any industry, they will circumvent regulation whenever possible to make profit. The solution is increased transparency and more stringent lobbying regulation. But let’s not pretend that the pharma firms are saving lives out of the goodness of their hearts; they’re doing it because it’s profitable – JUST LIKE ANY BUSINESS.

  36. #36 Mojo
    March 18, 2010

    Whenever you see someone refer to science-based medicine as “allopathic” medicine, you know you’re dealing with a historically ignorant git. The term “allopath” was invented by the creator of homeopathy, Samuel Hahnemann, ot describe anyone who was not a homeopath. In essence, it was used to describe the physicians of the era, who used harsh treatments like toxic metals, purgatives, and bleeding based on the ancient Greek idea of imbalances in the four humors being the cause of disease.

    I’ve just finished reading Bad Medicine by David Wootton (highly recommended, BTW). One of the things that most struck me was the similarities between the way homoeopaths think and the way 18th century “allopaths” thought. The whole “it works for me” thing, for example, was precisely the reason they thought that bleeding worked.

    The continued use of the term “allopathy” to describe medicine is particularly ironic in that the only medical systems that can still accurately be described as “allopathic” are considered to be part of CAM. In particular in India, where the use of the term appears to be particularly prevalent, Ayurveda is based on humours (although they only have three of them and call them “doshas”) and Unani is a variation on the humour-based system that originated with Hippocrates and Galen.

  37. #37 Edwardson
    March 18, 2010

    I too am concerned with the escalating infiltration of quackery in the medical profession. I just fired off a response to a doctor-acupuncturist who happens to have studied in the same high school as I did. He is adamant there is evidence for TCM including acupuncture. I’m sure he has cherries to show.

    Then there is this orthopedic surgeon who couldn’t stop recommending acupuncture for the pain my mom was experiencing, over and above the medication he prescribed. He had only praises for needling. He said he can’t explain how all that jabbing could, but that it’s a “higher science.” Sigh.

    It’s worrisome.

  38. #38 Scientizzle
    March 18, 2010

    @ Andreas Johansson

    I guess this is as good a place to ask as any – is there any basis for treating the common cold with vitamin C?

    Download Quackcast #28: Vitamin C and the Common Cold to get a good overview…

  39. #39 Jojo
    March 18, 2010

    Rahul

    Meanwhile, not everything in CAM is pseudoscience. Some of it — yoga, meditation, diet etc — can be excellent advice for healthy people, and for people suffering from certain “lifestyle diseases”.

    If it’s science, not pseudoscience than it’s not CAM, it’s simply medicine. Yes, the CAM practitioners address diet and exercise, but so do doctors. Every time someone implies that doctors don’t address these topics it makes me wonder why the first thing I do at every doctor’s appointment is step on a scale. Maybe I’m imagining all of those discussions about diet and exercise I’ve had with my GP, OB/GYN and my endocrinologist? I’m sure not all doctors address diet and exercise like they should, but to say that they don’t or that people need to go to CAM practitioners for such care is absurd.

    I do agree with you that there are problems with the economics of our current health care system that make it difficult for doctors to spend appropriate time with patients. I think doctors would like that to change as much as patients would. I differ from you on two points though. 1) That instead of fixing the problem, we should just let CAM take care of the touchy feely stuff, and 2) That there is no value in attacking pseudoscience as long as there are other problems to deal with.

  40. #40 Anthro
    March 18, 2010

    I am glad to see Orac writing about this again as it’s a big concern of mine as I have posted many times. I personally know two physicians who have quit what they seriously refer to as “allopathic” medicine (one is an anesthesiologist–what is the woo for anesthesia?) in favor of becoming a CAM practitioner. The anesthesiologist has become an Ayurvedic and the internist is now involved with everything from acupuncture to bee pollen. I know a number of well-educated women who use “bio-identical” HRT and many get it from their MD’s. I completely agree with Dr. T, Luna, and others who link this to the dumbing down of education. I had no idea, however, that this had gone as far as the weakening of med school standards. I think I will start looking for docs over 40.

    To the parents concerned about coughing children. I have raised four children who were pretty healthy and none were ever seriously ill, but all had colds from time to time. I have never, ever purchased any OTC remedy. Once a year I would ask our family doc for an rx for a small bottle of cough syrup with codeine. This would be used through the cold season for the whole family and only given for a persistent cough. It worked, of course, by putting the kid to sleep as well as suppressing the cough reflex. A good night’s rest always seemed to stop the cough once and for all. Nobody became a drug addict. For lesser coughs we just used a tsp of honey or a hot toddy minus the whiskey.

  41. #41 Andreas Johansson
    March 18, 2010

    Scientizzle wrote:

    Download Quackcast #28: Vitamin C and the Common Cold to get a good overview…

    Unfortunately the link appears to be broken, and I can’t seem to find the article it should point to on some googling.

  42. #42 Jojo
    March 18, 2010

    Andreas, Google Quackcast, click the first link and then select the podcast list tab. That should get you to the list and you can just scroll down to find # 28. You can also find it on iTunes by searching for Quackcast.

  43. #43 MS1
    March 18, 2010

    1. The thoughts of this medical student in Britain are not reflective of most medical students… at least not of my peers or at my medical school.

    2. We are not taught CAM at my school. We are trained to determine the validity of scientific articles using the principles of EBM and we enjoy reading your insolence regarding those who refuse.

    3. @Dr T. While med school applications did bottom out in the late 80s, they are currently at their highest level (http://www.aamc.org/data/facts/charts1982to2010.pdf) and matriculant GPA and MCAT scores have been steadily increasing over the past decade.(http://www.aamc.org/data/facts/applicantmatriculant/table17-fact2009mcatgpa98-09-web.pdf)

  44. #44 Everyday Atheist
    March 18, 2010

    The infiltration of woo into medicine gets even scarier when you consider the number of people receiving primary care from nurse practitioners, whose required level of scientific training is far less than that of an MD. That’s not to say NP’s can’t do great work and be science-minded, but if the acceptance of woo inversely correlates to degree of science literacy, it should be cause for concern.

    My sister-in-law is a NP who recently announced that she cured my niece’s chronic ear infections with … wait for it … a visit to the chiropractor!

  45. #45 Rene Najera
    March 18, 2010

    @43, The Everyday Atheist
    True, there are people like that who are supposed to know better. One nurse I know doesn’t vaccinate her children because she home-schools them so, “they never come into contact with anyone carrying a disease.” Except her, all the people at Wal-Mart and the other kids at camp.
    And then there is this one nurse who is on Facebook. She’s applied to a whole bunch of funding to study “women’s issues”, yet she keeps hammering me about me “eventually” developing dystonia from the vaccines I take, just like Desiree Jennings.
    I can’t say anything about Physician Assistants, though. I’m marrying one, and she’s the brightest star in my constellation.
    I guess there are loons in every corner of the known universe. And that right there scares the crap out of me.

  46. #46 cervantes
    March 18, 2010

    I have to take issue with your discussion of the term “allopathy.” Many words in common use today have etymological roots very different from the way they are used today, and could be re-interpreted as pejorative if we suddenly decided they must actually have their archaic meaning after all. That’s an illogical exercise. What matters is how people understand the word today, not it’s forgotten origin.

    In fact, it is not only promoters of quackery who use the term “allopathic medicine.” It’s used by social scientists who need a way of talking about the specific institution that includes licensed physicians trained in certified medical schools who hold MD, DO, DMD and other mutually recognized degrees. To refer to this as “scientific” medicine is to assume a consequent. Whether or not this institutions has a monopoly on “science,” the whole point of your post is that it includes a lot that is not science – and in fact every medical sociologist knows that full well. Physicians rely on tradition, intuition, heuristics of various kinds at least as much if not more than they rely on science.

    Therefore we need a term to call this thing in which you are employed, and we choose allopathic medicine not for etymological but for historic reasons. It is the practitioners once derided as allopaths who went on to create the Harvard Medical School we know today.

    The term is not value laden, not pejorative, and perfectly useful.

  47. #47 Andreas Johansson
    March 18, 2010

    @Jojowrote:

    Andreas, Google Quackcast, click the first link and then select the podcast list tab. That should get you to the list and you can just scroll down to find # 28.

    Thank you. The podcast turns out to be pretty hard on the ol’ attention span, but I’ll be tracking down the references.

  48. #48 young skeptic
    March 18, 2010

    I loathe having a perfectly reasonable discussion where all the facts point in one direction and consensus is not far off (how could it be when all reliable information points to a single cause or culprit?) and someone decides to disagree with you, not because any information you provide is faulty or because there is some flaw in your reasoning. No. They disagree because you aren’t sensitive enough.

    If you are a person of intellectual integrity (or integrity period) you must base your judgment of a position on the merits of the position NOT the feeling you get from whoever is presenting those facts. Questions of integrity are very black and white and if you lack the impartiality, bow out of the conversation.

  49. #49 Orac
    March 18, 2010

    I have to take issue with your discussion of the term “allopathy.” Many words in common use today have etymological roots very different from the way they are used today, and could be re-interpreted as pejorative if we suddenly decided they must actually have their archaic meaning after all. That’s an illogical exercise. What matters is how people understand the word today, not it’s forgotten origin.

    And how people understand the term now is as a pejorative, given that CAMsters have so frequently used it as such. Its negative connotations go far beyond its origin with Hahnemann. Years and years of woo-meisters saying it with a sneer and spitting have tainted the word beyond recovery.

  50. #50 Kim
    March 18, 2010

    I have seen “allopathic” used quite a bit in a completely non-pejorative context to distinguish schools that confer an MD degree from schools that confer a DO degree (which is a perfectly legitimate medical degree last time I checked).

  51. #51 Raging Bee
    March 18, 2010

    IT’s easy for us to take it for granted that science-based medicine is the ONLY effective remedy for our ills, if we and everyone we know have good jobs, good money, good coverage, and access to good doctors. Unfortunately, most people are much poorer than us, don’t have the education to make sensible decisions, don’t have decent insurance, and live in areas where there isn’t enough money to attract even decent practitioners. Those communities are stuck with mediocre, probably uncaring doctors who couldn’t get work in wealthier areas and end up making mistakes that make science-based medicine look a LOT less credible or trustworthy than it looks to us. It’s hard to tell someone she needs back surgery, not a chiropractor, when her last back surgery wasn’t done right and the chiropractor is nicer to her than the GP at the free clinic.

    There are competent and incompetent doctors; and for the uneducated poor, the incompetent ones are the face of science-based medicine. To them, science-based medicine really is not that clearly superior to quackery.

    The best way to combat quackery, is to make decent medicine more available to the poor. Another way, of course, is to make education more availble to the poor.

    Most CAM modalities don’t do anything active against a disease process, but they do involve showing a lot of attention to the patient, which is perfect to maximize placebo effects.

    News flash: for most people, a trip to the hospital is a HORRIBLY stressful experience, made worse by the inconsistent attention given by fast-moving, overburdened doctors and nurses, who are constantly shuttling from one short-term crisis to the next, and are often unable to focus coherently on a patient when other emergencies keep popping up at unpredictable intervals. And stress is bad for the health and the healing process. So anything that helps to relieve patient stress, without dangerous practices or outright fraud, is therefore a useful complement to the actual medical treatments. Even the placebo effect is beneficial if it reduces stress, because stress interferes with healing.

  52. #52 Mojo
    March 18, 2010

    @Anthro

    I personally know two physicians who have quit what they seriously refer to as “allopathic” medicine (one is an anesthesiologist–what is the woo for anesthesia?) in favor of becoming a CAM practitioner. The anesthesiologist has become an Ayurvedic…

    Taking up a system based on humours is not quitting allopathic medicine. Quite the opposite.

  53. #53 Mojo
    March 18, 2010

    @Raging Bee

    Yes, some doctors are not very good, and some people don’t have access to good medical treatment. But that doesn’t make CAM work.

  54. #54 Bastion Of Sass
    March 18, 2010

    Today’s Baltimore Sun has an article that promotes the use of homeopathy for treating allergies. The homeopath quoted in the article is an assistant professor of family and community medicine with the University of Maryland School of Medicine’s Center for Integrative Medicine.

    So disgusting. The school should be ashamed in promoting woo like this.

    http://www.baltimoresun.com/health/bal-gl.hs.allergies18mar18,0,7691960.story

    The on-line version of the article permits comments if you’re so inclined.

  55. #55 Hank Roberts
    March 18, 2010

    Oh yes. Same thing for pharmacy.
    My formerly independent drugstore, with an absolutely solid pharmacist owner, got bought out a while ago by this chain that’s into selling wacky woo crap:
    http://www.pharmaca.com/integrative_medicine/p/integrative-medicine

    I have to stand surrounded by homeopathic stuff and listen to their salespeople describing how great it is to customers while in line to see the real pharmacist. Product placement.

    I asked them how come they were selling B12 in 2-gram capsules (recommending one a day, twice the recommended maximum daily dose of B12 advised on their own damned computerized information kiosk) and all they could say is, that’s what the chain puts on the shelves so we sell it.

    I keep expecting to see the old classic 1800s weight loss remedy showing up again on the shelves. You ever hear of that? It was a nice big sugar pill, containing a tapeworm egg sack. Worked, too.

  56. #56 Adam_Y
    March 18, 2010

    Many of your posts give the impression of denying that big pharma is bad — but it is, and has been repeatedly caught in the most egregious acts. It is also true, though you may not believe it, that the majority of doctors get their information on new therapies from big pharma, not from the literature. While I fully agree on the crackpot nature of homoeopathy and the limitations of herbal medicine, it is not because of the merits of those systems that people are being drawn to them. Nor is it their own irrationality. It is the limitations and, worse, the corruption in mainstream medicine — corruption from medical research (ghostwritten, paid-for papers) to practice (pharma companies pushing unnecessary drugs). We need to fix those problems and not fret so much about pseudoscience.

    Talk about ignorance. Would you stop idiotically comparing the entire field of medicine with the pharmaceutical industry? The field of medicine combines all of the science and engineering fields.

  57. #57 Adam_Y
    March 18, 2010

    Today’s Baltimore Sun has an article that promotes the use of homeopathy for treating allergies. The homeopath quoted in the article is an assistant professor of family and community medicine with the University of Maryland School of Medicine’s Center for Integrative Medicine.

    So disgusting. The school should be ashamed in promoting woo like this.

    http://www.baltimoresun.com/health/bal-gl.hs.allergies18mar18,0,7691960.story

    The on-line version of the article permits comments if you’re so inclined.

    If you go to Science Based Medicine Neti Pots were covered as working. Nasal sprays also do work. Though I wonder why they didn’t just cover using a freaking allergy shot. Homeopaths like to trot that out like its a form of homeopathy when it isn;t.

  58. #58 Maryn
    March 18, 2010

    On the UK show Argumental John Sargeant said – I prefer alternative therapies. Like that one with the needles. What’s it called? Oh yes, Heroin.

  59. #59 Mu
    March 18, 2010

    Cervantes, I like how you give value to “allopathic medicine” by adding social scientists to the promoters of quackery on the list of user of the expression. So fitting.

  60. #60 Scientizzle
    March 18, 2010

    @ Andreas Johansson

    I’m not sure what borked up my link, but if you click on my name in the same post, that link works and takes you to a list of Quackcast pods.

  61. #61 Prolix
    March 18, 2010

    Someone should tell the National Cancer Institute that they’re ignorant gits. Though Hahnemann coined the term allopathy, that does not make the term disreputable, any more than the fact that Karl Marx coined the term capitalism makes that term disreputable. In both cases a useful distinction was drawn. You have to stand outside a house to see what it looks like.

  62. #62 Dangerous Bacon
    March 18, 2010

    Virtually nobody involved in the day-to-day practice of medicine uses the word “allopathic”. Apart from a specialized academic use, the term is employed virtually exclusively by alties, who like to pretend that they’re getting at the root causes of disease, while physicians only treat symptoms using nasty harsh drugs and surgery.

    Even then, alties seldom comprehend that the opposite of allopathy is homeopathy, something those who are less than stark raving loons would generally prefer not to be associated with.

    No big deal – actually, hearing people use the word “allopathy” is a useful indicator that one is dealing with a woo disciple, much like “dis-ease”, “cut-burn-poison” and other catchphrases of the altie universe.

  63. #63 Katharine
    March 18, 2010

    “The point is, it’s providing people something that they do not find in mainstream medicine: comfort.”

    At the cost of their health. Too many people want ‘comfort’ that ends up hurting them in the end. Which only adds a certain amount of patheticness to the fact that they’re approaching a lot of this without much information.

    It’s like psychological dependence on a substance.

    Everything else wrong with your post has already been said.

    I think this is partially a problem of the sorry state of pre-tertiary science education in the United States.

  64. #64 Katharine
    March 18, 2010

    The trouble with these stupid people is that stupid people are also often rather ruthless and unfair. Look at PeTA. Look at the antivaxxers. Look at Kevin Trudeau. Heck, look at the Republicans! You can’t do much about their double standards, and they’ll shrug off any attack on them while they whine when you do it.

    We need to mount a bigger offensive.

  65. #65 Harbo
    March 18, 2010

    To Rahul @25
    Just because we criticize the anti-scientific doesn’t mean we; don’t care, don’t touch and don’t make use of the placebo effect.
    Yes many of us are often terse and arrogant BUT not often uncaring AND never corrupt.
    Yes corporate medicine and big pharma have the “bottom line” as the top motivation, and much of the published medicine is drivel, but this just makes critical thinking MORE important.
    I found your post offensive, and full of the generalisations you accuse others of.

    Much of the touching/caring I see from the CAM world borders on the creepy, and CAM practitioners rarely complete their therapy once the hooks are in.
    (How many chiropractors have ever said “you are cured now… Goodbye”?)

  66. #66 AnthonyK
    March 19, 2010

    Another commodity sparingly used in modern medicine is touch.

    It is used, however, when I’m being manually examined for prostrate enlargement, thank goodness! In fact it always makes me smirk, should I regard the doctor as in any way arrogant, to think that part of his living is earned by inserting a gloved finger up another man’s rectum.

    But you’re certainly correct: this article is pure nonsense, by a soon-to-be medic seduced by a pyschic at a music festival.

    The plain fact is that doctors don’t have all the answers, and so don’t give them: “alternative” medical practitioners always have the answers, and always give them – at a price. The advice my doctor gives me is simple and general: don’t smoke, don’t drink too much, take exercise and eat a balanaced diet (but of course these things can be difficult to do – easier to just pop a pill). And I’ve always found that the doctors do give me time, do treat me as an individual, and rely very much on my previous medical history to inform their diagnosis, as far as they can – if they need to, they will refer me to a specialist.

    And, since this it the UK all this treatment is completely free.

    In practice however, no doubt this doctor, when he qualifies, will at least be aware of how to treat the serious conditions he come across, and only refer the neurotic well, those who are “feeling a little bit hurty” to the woo merchants, where the placebo effect, at a price, can do its bit.

    However I suspect that in the long run there is simply so much, real, hard work to be done on a medical course that woo/bullshit will only ever be a tiny component, sort of like compartive religion in a secular education.

  67. #67 MikeMa
    March 19, 2010

    Yikes,
    I just woke up from a sound sleep with screechy Joy Bahar complaining that while WND was interviewing Obama about stuff and my sugar was still falling, (58, 53, 40) I just ate a little applesauce and hope you (Rahul) will call a doctor rather than a woo-meister when sick.
    Cheers.

  68. #68 Dr Benway
    March 19, 2010

    The point is, it’s providing people something that they do not find in mainstream medicine: comfort.
    Lies can be comforting but they’re still lies.

    In the US last year CAM gave liars 60 billion dollars. Those liars will use a part of those profits to further corrupt science.

    MS1, does your school have a department of Integrative Medicine?

  69. #69 Dr Benway
    March 19, 2010

    But let’s not pretend that the pharma firms are saving lives out of the goodness of their hearts; they’re doing it because it’s profitable – JUST LIKE ANY BUSINESS.

    BigPharma is happy to press unregulated heavy-metal contaminated grass clippings from China into pill or capsule-like shapes, to be sold by LittlePharma, a wholly or partially owned subsidiary.

    Regulation. It’s a good thing. Repeal DSHEA.

  70. #70 Dr Benway
    March 19, 2010

    Orac, your spam trap makes me sad.

    I now hate BigSpam as much as the chiropractors hate BigPharma.

  71. #71 skeptifem
    March 19, 2010

    I think the problem is that many people become doctors for money or to get some kind of prestige, rather than because they genuinely like anything related to medical science or patients. This is why I hear so many pre med students complain non stop about having to get a biology degree before applying to med school. This is why there are creationist doctors and dentists; they aren’t in it for the science. They don’t think it is important to know how anything actually works, they just want to be doctors. This isn’t all doctors of course, but that breed of MD is severely annoying and kinda common.

    When people like that become doctors their egotism gets worse. I have had a lot of them try to cut ahead in line for getting their blood drawn and other ridiculous demands (“Why won’t you take this presciprtion I wrote for myself??”), giving no reason other than “I’m a doctor”. These are the same people that make it hard to correct medical mistakes, because they express anger at your unwillingness to treat them as infallable. I am so not suprised at CAM catching on with that sort of environment. The problem of wanting to work in the medical field without caring at all for the process that made the industry possible in the first place is absolutely rampant. It isn’t just doctors, its everywhere. I have heard plenty of woo get passed back and forth in hospitals, even anti vaccine woo. The lack of science education here is shameful. There is a special math class for nurse programs, so they don’t have to learn the hard math that enables them to actually understand their biology and chemistry courses. Its a shame.

  72. #72 Chris
    March 19, 2010

    skeptifem:

    his is why I hear so many pre med students complain non stop about having to get a biology degree before applying to med school.

    I don’t know where you talk to pre-med students, but having a biology degree is not a prerequisite to medical school. ScienceBasedMedicine’s Dr. Mark Crislip’s undergraduate degree is in physics (and yet he still has issues with statistics!… he also does a Quackcast, plus a PusCast), and Dr. Harriet Hall’s is in Spanish.

    A pre-med student just has to satisfy certain undergraduate class requirements before applying to medical school. Dr. Hall laughs when she describes her adviser’s reaction to her signing up for biochemistry classes.

    According to her autobiography she majored in Spanish in order to spend a year studying in Spain. Her major turned into a big advantage after she joined the Air Force when she was stationed in… wait for it… Spain!

  73. #73 Pareidolius
    March 19, 2010

    My 85 year-old mom’s cardiologist holds her hand when he talks with her and always hugs her when we leave. He’s deeply caring, especially when he talks to her cardiac issues. And you should hear him talk about Pharmaceutical reps. To quote him “they’re ghastly hybrids, part used-car salesmen, part runway model. I chase them out before they can give crap away.” And this has been my (albeit limited) personal experience with medical providers for most of my 50 years on the planet, with the exception of one jackass of a dermatologist. But my life wasn’t in danger, he was just an asshole, not a quack.

  74. #74 Bastion Of Sass
    March 19, 2010

    If you go to Science Based Medicine Neti Pots were covered as working. Nasal sprays also do work. Though I wonder why they didn’t just cover using a freaking allergy shot. Homeopaths like to trot that out like its a form of homeopathy when it isn;t.

    I didn’t mean to imply that all the interventions mentioned in the article were woo.

    As I noted in my blog post about The Sun‘s article, I too have no objection to neti pots, saline nasal sprays, vaporizers, or humidifiers. It was the promotion of homeopathy to treat allergies, by someone who holds a position at a medical school no less, and the uncritical reporting that I was objecting to.

    I too wondered why the article didn’t even mention immunotherapy. I felt omitting it made the article even more misleading.

  75. #75 RxnMan
    March 19, 2010

    Don’t worry too much, Orac. There will be at least *one* EM department (location TBD) where woo will have no hold.

  76. #76 marcia
    March 19, 2010

    We really don’t realize how damn healthy we really are, do we?
    Only one out of 25 Americans made it to age 60 in 1900, before western medicine blossomed. Now look at us.

    Is it any wonder that the poor love it when we help them when the shamans can’t?

    Western medicine infiltrating woo:
    http://www.cnn.com/2010/HEALTH/03/18/cnnheroes.webster.peru/

  77. #77 cervantes
    March 19, 2010

    Mu@59 — social scientists are not “promoters of quackery” nor does anything I wrote imply anything of the kind. What on earth do you mean by that? I just said that they use the term in “allopathy” non-pejoratively.

    Orac — Obviously, people who don’t like allopathic medicine mean the term pejoratively when they use it. People who don’t like gay people use the term gay pejoratively; people who don’t like Jews use the term Jew pejoratively; etc. That is not a reflection on the term, but on the person using it.

    Get over it.

  78. #78 physicsmum
    March 19, 2010

    Anthro: I wouldn’t count on doctors over 40 – I know doctors and nurses over 60 who have gone over to the other side :-(

    Also, as a physics tutor I have certainly encountered “pre-med” students who were disgusted to have to waste their time learning any real science. Not very encouraging……

  79. #79 alastair yarrow
    March 19, 2010

    What i see in the anti-energy medicine lobbyh are peole fearful of the future. let me explain. They were all educated in the old style where Newtonian ideas ruled the waves; where these people ruled supreme in regurgitationg the socially accepted facts and figures for the examinations. The higher the grades the more perfect, and socially approved, the thinking capabilities must be; their current and future credability stands upon there being no change; the acceptance of idea of ‘energy medicine’ and that it works means change which then destroys their frame of reference…and the pillars upon which their fame has been based. How, not so long ago, the ‘academics and intelligencia’ tried to destroy Copernicus then later Galileo for daring to say the world rotated round the sun. Because, for the same reasons their power stood in maintaining the ancient belief system.

  80. #80 Todd W.
    March 19, 2010

    And we have the Galileo gambit!

  81. And we have the Galileo gambit!

    Yup, with some refreshing almost-honesty mixed in. Aside from name-checking Copernicus, there’s no attempt to sugarcoat the woo with something sciencey-sounding.

  82. #82 ebohlman
    March 19, 2010

    alastair: Care to share with us the name and URL for the Markov chain text-generation software you’re using? Yours does better than most.

  83. #83 Jonny Martel
    March 20, 2010

    Dear Orac,

    I am sorry my piece has upset you and given you further cause to ‘fear for the future of medicine.’ It is a shame this has happened because it is entirely unnecessary. This, I suspect, is for two reasons. One, you have singularly failed to detect the streak of irony running through the piece, from the title (not my choice) to the concluding sentence. Second, you have made erroneous deductions from what I have actually written as to what my beliefs are about medicine, CAM and science. I suspect many people have replied to your misrepresentative blog in the belief that what you have written is correct, without making their own mind up about it. Through this you have neatly illustrated a mechanism by which one can legitimately describe the foundations of evidence-based medicine ‘fallible’- I recommend Greenberg’s ‘How citation distortions create unfounded authority- an analysis of a citation network,’ (BMJ 2009;339:b2680)

    I will help you through your erroneous interpretations and faulty deductions-

    I do not feel inadequate around psychics. Irony, Orac.

    I do not suggest we try magic to treat symptoms that aren’t well explained by scientific medicine, I merely suggest it is unsurprising people turn to it.

    I do not equate what CAM practitioners do with what the best science based practitioners do; all I am saying is that best practice by GPs is to explain why a given disease process is taking place as opposed to merely stating what it is.

    I was indeed historically ignorant as to the root meaning of the word allopathy until you enlightened me and will use it with greater caution next time. In the same vein, you might take greater care with the use of the word ‘git’- to the best of my knowledge I am not a bastard child.

    I am not -as you assert- making the point that the doctor-patient relationship has ‘become too impersonal.’ I am merely stating an observation of a difference between CAM and ‘scientific’ medicine as you call it.

    I am aware that much of what I am describing is the placebo, but chose to avoid its use as its mere mention invariably tends to stifle exploration of what it is and how it might operate.

    In terms of some CAM modalities performing poorly in RCTs, you have a sound point, except I would say that it is precisely because the non-specific elements of CAM treatments tend to be watered down in RCTs, that they perform less well. Much of CAM works on the basis of the super-placebo, as we both seem to agree on.

    I hope that you and your fan base Orac, have not become overly depressed at the thought of the likes of myself entering the medical profession. Any sadness would be based on your inability to pick up on what I thought was barn-door irony (even for Americans) and your failure to actually read what I wrote.

    Kind regards,

    Jonny Martell

  84. #84 Mrs. Ward
    March 20, 2010

    Isn’t it better to go to an acupuncturist who is also a medical doctor than one who is not? If you have decided to do acupuncture, isn’t it better that a real doctor do it so that he doesn’t cause damage to the nerves?

  85. #85 Harbo
    March 20, 2010

    Dear Mr Jonny,
    All intelligent healers USE the placebo effect.
    If An RCT “waters down” a treatment s that homeopathy? or just uselessness?

    I am an anaesthetist / intensivist In a provincial hospital and I take I very personally when someone says I don’t care , I don’t touch and I am a tool of corporate medicine.
    I Love my job and after 30 years I feel I am reasonably good at it, I try to keep up with the true progress in my profession without falling into fashion, which plagues us all …..or poor science…… (a term you should research).
    I have cried with parents/spouses/friends at the hopelessness of trauma/infection/tumour; and how dare some pumped up uneducated STAR tell those parents/spouses/friends at the lowest point in their lives that immunisation/medicine/science will poison their child/spouse/friend……..because they “feel it in their water”(an old Australian term for unjustifiable bullshit from a old aunt)
    I don’t use the term EVIL because it requires BELIEF !

    You don’t “enter” my profession you pollute it.

  86. #86 Jonny Martell
    March 20, 2010

    Dear Mr. Harbo,

    may I suggest you re-read my piece (if indeed you bothered to read it in the first place) and my response to Orac lest you make the same mistakes. Nowhere do I suggest that you don’t care, don’t touch or that you are a tool of corporate medicine. I am pleased you love your job and am sure you are reasonably good at it. I have never told (nor do I foresee myself telling) vulnerable people that ‘immunisation/medicine/science will poison’ their loved ones.

    Kind regards,
    Jonny

  87. #87 Dangerous Bacon
    March 20, 2010

    “Gee, I didn’t really mean what I said.”

    Jonny Martell: “Several approaches in CAM employ language and metaphors redolent of Eastern concepts of balance and energy flow. These are strikingly at odds with the reductionist technical lexicon of allopathic orthodoxy.”

    I guess I missed the subtle irony in that statement. The latter sounds rather condemnatory, but I suppose I’m only looking at it in a reductionist way.

    “In terms of some CAM modalities performing poorly in RCTs, you have a sound point, except I would say that it is precisely because the non-specific elements of CAM treatments tend to be watered down in RCTs, that they perform less well.”

    This is just another way of saying “Your science can’t hope to properly measure our woo.” It’s the typical dodge used by alties when their treatments don’t measure up, and I’m sorry (but not entirely surprised) to see Mr. Martell falling back on the same line.

    ” Much of CAM works on the basis of the super-placebo, as we both seem to agree on.”

    Except for the extensive parts that don’t work at all.

    I still foresee a big future for Dr. Martell’s Center of Holistic Excellence and Supplement Shoppe.

  88. #88 freemage.geo#b98e9
    March 22, 2010

    Okay, here’s a proposal–at medium-sized and larger practices, where you have multiple doctors working together, hire a couple of professional ‘handholders’, who would provide all the emotional support and human connection given by woo-meisters–but without the woo. Instead, they could even work on establishing a personal rapport in support of good science, talking with the patient before the diagnosis (to elicit more information, which could be passed along to the physician), and after (in order to explain why this particular procedure is ‘best practice’).

    They could also serve to establish a bulkhead against woo by explaining patiently the flaws of any particular CAM the patient may have heard about.

  89. #89 very_important_person
    March 23, 2010

    i love jonny martell

  90. #90 RIchard
    April 6, 2010

    This sight is truly amazing. And truly ignorant. There are evidence based scientific studies showing the benefits of massage, plant oils, touch for health, hypnosis and a host of other CAM treatments for specific conditions. Not everything needs to be treated with a pill or surgery. Of course, the belief that CAM can cure anything anytime (as some practitioners would have us believe) is as ludicrous as to think that modern western medicine can cure anything. And to suggest that when a CAM treatment shows scientifically to be effective that it somehow stops being CAM is again ridiculous. If you can show that an herb used in TCM (Traditional Chinese Medicine for those who cannot even think outside of their training) is effective (as has been done) does not stop the herb from being TCM. Boy does this site prove the point Jonny Martell was trying to make (whether or not you think he did or could make it well).

  91. #91 Travis
    April 6, 2010

    If an herb from Chinese medicine is found to work it is medicine. The herb working does not mean any of the explanation given by the practitioners is correct. So if they invoke a bunch of woo to explain why it works, they are wrong, and the traditional medicine can be wrong. Just because it worked does not mean the explanation given was correct.

    For someone who claims to have evidence you have provided very little. Are we supposed to take your word for it? Especially when some of these are very dubious. Touch for health (therapeutic touch?) is especially discredited. Some of those might be useful though. I have no idea why you think no one thinks massage is valid in some cases. The problem with many of the treatments like that is that people take a kernel of truth about the validity and extend it where there is no evidence at all. Also CAM practitioners do not seem to invoke science based methods to determine the validity of any of these things. They rely on testimonials, or explanations that invoke mysterious energies etc. Even when some testing is done it is often very poor, as has been seen on this site many times in the past.

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