The "integration" of pseudoscience into medicine continues apace

Ignorance.

If you really had done any research on CAM, especially the way it is taught at Bastyr and the University of Washington, by the way, you would know that they use hard science to evaluate the effectiveness of CAM procedures, including randomized controlled trials.

Ignorance.

If you really had done any research on CAM, especially the way it is taught at Bastyr and the University of Washington, by the way, you would know that they use hard science to evaluate the effectiveness of CAM procedures, including double-blind, placebo-controlled, randomized controlled trials.

This post is almost a perfect narrative of a discussion I had with our med school dean. The dean met with our department (a basic research department) to discuss the plan for changes to the medical school. One thing noted as being critical is a curriculum for med students in evidence based medicine. I then asked the dean to explain why we have an institute devoted to pseudoscience and spirituality in the medical school where students can learn about homeopathy reiki and any other feel-good-quick-fix-magic-approach to health. I got the reasonable "need to know about these things to avoid adverse interactions" defense (well it wasn't reasonable because we were dealing with the homeopathy issue at the time and I am unaware of adverse effects between evidence based treatments and water, although Im not a doctor). I pointed out that the institute sponors talks by quacks like Deepak Chopra and offered classes to teach these approaches, which is not what the dean just stated were the goals of the institute. I then received the rebuttal that NCAAM exists therefore it must be real type response. I responded that if that were true, there should be some evidence that we could teach, but I was unaware of any and if the dean was unaware of any (which based on the dean's initial defense seems likely), brought us back to square one.

It made for an uncomfortable few minutes in the department meeting, but several colleagues were very happy with me afterwards. Oh and for the record vive-le-tenure, because I certainly wouldn't confront the dean in this economic reality without it.

Ignorance.

If you had really researched the way CAM is studied at Bastyr AND the University of Washington, by the way, you would know that they use rigorous scientific processes to evaluate the effectiveness of CAM, including double-blind, placebo-controlled, randomized controlled trials.

@Lori

You mean like this unethical trial?

http://scienceblogs.com/insolence/2007/03/studying_homeopathy_in_third_…

I apologize for the multiple posts.

I have been struggling with these same issues for a while. I have a case in point: a GI physician I know very well - Studied and trained in the United States, Board-certified gastroenterologist, very successful, well-known and well-respected in the field, Chief of the Division at the prestigious hospital ranked No. 1 in the US for, like, 16 consecutive years.

And yet, this doctor also heads the Integrative Medicine division in the same hospital. And the office of this doctor offers acupuncture and mind-body therapy (apart from regular GI consultations), and openly stocks various so-called homeopathic remedies including oscillococcinum.

The doctor, knowing my dislike for alternative medicine, never brings it up during our conversations. But there must be other patients whom this doctor's "integrative medicine" office caters to. The massive degree of cognitive dissonance (if not downright dishonesty) that is involved here frankly boggles my mind.

Orac - I believe this has nothing to do with the legitimacy of CAM and everything to do with giving doctors the ability to make a greater profit in their practices.

Right now, doctors are hamstrung by the rates the insurance industry allows them to charge for legitimate medical procedures. All one has to do is look at your regular statements to see what the medical professional (or hospital) charges & what the insurance will actually pay.

By incorporating Reiki, homeopathy, etc - doctors and medical organizations can charge whatever they like & because there are no expensive tests, rigorous certifications, etc. this becomes an almost 100% profit center for a medical practice. And since insurance won't cover these types of treatments, doctors will be more than happy to accept cash payments from those woo-minded individuals and laugh all the way to the bank.

I'm sorry to be so cynical - but I do believe it is all about the Benjamins here.

Sure, that's unethical. Are you suggesting conventional medicine has NEVER done anything corrupt or unethical?
Of course it has. Um, syphilis testing on African Americans? The recent apolgogy the US made to the Guatemalan government for testing on their people?

Just because corruption exists in one area of something doesn't disregard that subject entirely.

Lori,

After Bastyr applies these throughly rigorous, randomized, double-blind, placebo-controlled scientific study protocols to the modalities of naturopathy, what modalities are left to teach under the "naturopathy" program? Are there any beyond taking a person interest in the patient? Why even create a separate program then when one "professional" has no scientific data behind it?

Every time I have seen good studies that have data displaying a complete lack of efficacy for a modality, the CAM-influenced authors generally either argue that more research is needed or because the placebo worked, the modalities inherently works.

Look on the bright side:

1) Any medical student with half a functioning brain is going to ask hard questions: What's this "energy"? How can it be measured? What are its physical properties? And upon getting vague and vacuous answers, students will tend to become vaccinated against further exposures to blatant nonsense.

2) Earth is presently overpopulated by about 50% and heading toward a climate catastrophe. Voluntary self-darwinization of imbeciles and morons is second only to voluntary use of contraception as a humane means of bringing down the population to a sustainable level.

Lori,

After Bastyr applies these throughly rigorous, randomized, double-blind, placebo-controlled scientific study protocols to the modalities of naturopathy, what modalities are left to teach under the "naturopathy" program? Are there any beyond taking a person interest in the patient? Why even create a separate program then when one "professional" has no scientific data behind it?

Every time I have seen good studies that have data displaying a complete lack of efficacy for a modality, the CAM-influenced authors generally either argue that more research is needed or because the placebo worked, the modalities inherently works.

I second Lawrence. Now that Oprah and others have convinced mainstream upper middle class America that the world around us is "toxic" and all you have to do is drink memory water and lie on a table while someone waves a tuning fork over you to reverse the damage... I see easy $$$$$

I mean, how many people bought the shake weight or a bottle of 'Extenze' last year?

@Lori

Just because there may be ethical lapses in medical science does not mean that alternative medicine is somehow "correct" or that their ethical lapses are okay.

The way to show that something like reiki, homeopathy, etc. work is to provide evidence. You can rail against medicine all you want, but it still won't support a claim that alt-med works.

I'm not saying there isn't nonsense in some of this stuff. But it can't all be disregarded when there is solid scientific evidence showing that some of this stuff actually works, evidence revealed using the same rigorous scientific testing used in conventional medicine. And if you deny that it's out there, go educate yourself. Have access to pubmed?

Just because corruption exists in one area of something doesn't disregard that subject entirely.

Nice straw man, ya got there. The point in mentioning the Honduras homeopathy study was to point out that this "rigorous" CAM research you tout as coming from Washington is in general not so rigorous.

Please provide me the names of the specific modality and the specific scientific evidence you feel is compelling.

You are making this wild and unsubstantiated claim here, and the burden of proof is on you to provide the evidence. If you are willing to break the fundamental laws of biology, chemistry and physics- I want to at least see a meta analysis.

The question is Lori - do you?

Please feel free to post away on any studies that show solid evidence for Reiki or homeopathy.

@Lori

So, present some of this evidence. Herbal medicine has some basis in reality, as Orac noted about the field of pharmacognosy. However, not all herbal medicines work for what they claim, and some are actually quite dangerous.

As for reiki and TT, there's no evidence that it actually works beyond placebo effects and wishful thinking. (Feel free to prove me wrong with evidence, though.)

Acupuncture has some scant evidence suggesting that it might work for some types of pain or nausea, but even then it doesn't matter where the needles are placed or if they even break the skin. In short, again, most likely placebo.

Homeopathy is in the same realm as reiki and TT.

Chiropractic is good for some musculoskeletal problems, but not any better, really, than most physical therapy programs. As far as it being used to treat asthma, allergies, bed wetting, hearing loss, etc., it's utter crap. And dangerous crap at that.

As I said, if you feel that there is some alternative medicine that has some basis in reality and actually works, provide the evidence.

But it can't all be disregarded when there is solid scientific evidence showing that some of this stuff actually works, evidence revealed using the same rigorous scientific testing used in conventional medicine.

Citations needed. PMIDs will suffice.

And if you deny that it's out there, go educate yourself. Have access to pubmed?

You'll find that all regular posters here are well familiar with pubmed. But you don't get to make us do your homework; if you wish to claim that there is "solid scientific evidence" demonstrating that these modalities are anything other than quackery, it is YOUR obligation to present it.

Agent Smith,

Medical studies practically ALWAYS conclude with "more research is needed". This doesn't just happen in CAM.

As I work with premature babies, one example I can provide is the extensive and growing evidence supporting the technique known as "kangaroo care" for mothers and infants. All it involves is laying a baby wearing nothing but a diaper on the bare chest of his or her mother. This could be considered a type of "therapeutic touch" that would seem like nonsense. Yet rigorous controlled trials have demonstrated decreased nosocomial infections, increased early weight gains, reduced length of hospital stay, and high levels of maternal satisfaction.

you would know that they use hard science to evaluate the effectiveness of CAM procedures, including double-blind, placebo-controlled, randomized controlled trials.

Apologies for the double post, but I just figured out how to express the real problem with this statement. It reminds me of a math department promoting their rigorous mathematical inquiry of applications of the fact that 1+1=3. Namely, that if one ACTUALLY does such things rigorously, one can only conclude that they're bogus (word choice intentional), yet said rigor is claimed alongside uncritical acceptance.

Lori - it sounds like this is something that will, if all of the studies pan out, become part of standard medical care. This isn't CAM - if this is supported by actual evidence, it is conventional medicine.

As I work with premature babies, one example I can provide is the extensive and growing evidence supporting the technique known as "kangaroo care" for mothers and infants.

[citation needed]

@Lori

This could be considered a type of "therapeutic touch"

You may want to educate yourself on what Therapeutic Touch (capital Ts) actually is. What you are describing has absolutely no connection to TT. In fact, TT doesn't even involve touching the patient. You may also be interested in the research into TT done by Emily Rosa.

Orac,

My point was that ONE CAM study was being pointed out purely BECAUSE it was unethical. I'm not saying it's right. But that's like me saying that because the US tested syphilis on African Americans years ago that all of medical science should be disregarded. Your argument is a straw man.

You guys should educate yourself about CAM because your patients will be asking you about it. If you purely disregard all their concerns, they will not trust you anymore. Especially if they read all the studies in support of CAM therapies or know someone that those therapies have worked for and your response suggests you think they are crazy because it is all bunk.

I'm not into reiki or even homeopathy for that matter. So, I'm not saying that there is science behind that. I haven't studied that area. But conventional medicine has a lot to learn about preventing illness and maintaining health. Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Indeed, Todd hit the nail on the head on this one.

The problem with the "kangaroo care is good" claim is not whether it works or not, but in this attempt to call it "therapeutic touch."

It's like when people take some natural supplement and call it homeopathy, regardless of the dilution, or where sCAMmers try to jump on the results of studies of the electrical stimulation of nerve endings all call it acupuncture.

Laying the naked newborn skin-to-skin, regardless of whether it has positive outcomes or not, is not TT. Not even close, and any attempt to falsely equate them is either dishonest or ignorant.

All it involves is laying a baby wearing nothing but a diaper on the bare chest of his or her mother. This could be considered a type of "therapeutic touch"...

Not really, because it involves actual contact.

@Lori

I would venture that, if you really get down to the nitty gritty, the folks here in general probably know much more about the various popular alt-med treatments than the average patient or doctor, for that matter.

Pablo and Lawrence,

Tiffany Field has done a lot of studies on therapeutic touch. And yes, you are right, it's not the actual Therapeutic Touch that involves holding the hands a little above the patient's skin. My point is that Pablo and Lawrence are going to claim this as "conventional medicine", but I would bet not everyone else would agree with that, despite scientific research for its support, just because of its nature.

This is the kind of CAM I am talking about that is taught at Bastyr and University of Washington, not reiki or crystals or that bed-wetting can be cured by acupuncture.

wine (science) + mud (naturopathy) = junk thought

Lori - you offer a false comparison here. When a treatment is proven, it is no longer CAM. So, you reject Reiki & Homeopathy - well, that's a start at least.

So, what else is left?

My point was that ONE CAM study was being pointed out purely BECAUSE it was unethical.

Then again, Lori, it's the only actual study that has been mentioned so far. You mention all these supposedly wonderful double-blinded, placebo controlled studies, but apparently we are all unaware, and the only example we have is an unethical study.

You talk about us getting educated, so why don't you help. Direct us to all that great work coming out of Bastyr so that we can learn about it. Just saying, "It's being done, you need to learn up on it" doesn't teach us anything.

And keep in mind, you aren't talking to dummies here. We are very familiar with using the medical literature, so we will need more than "search the literature." We've done that.

So if you want us to learn, you could help. Instead of complaining that the one paper we have is not fair, why not bring out your own examples of stuff that IS good?

I would be all for CAM if it worked. But by definition it is NOT alternative medicine if it works-once something has been proven as a successful medical treatment it becomes part of science based medicine.
It saddens me to see medical insurance covering some of the more dubious therapies. It is bad enough that our laws are not keeping on top of these schemes to pray on persons with serious diseases.

@Lori: yes, "kangaroo care" works and has several good peer-reviewed studies to show that it does do so. It has become a standard of care in many NICU areas when possible to do so. However, it is NOT the same as TT. Kangaroo care works because the mother's breathing stimulates the baby to breath, her body temperature keeps the baby's temp stable, and her heartbeat and body noises are familiar to the baby. They grow better, gain weight faster, and have fewer apnic spells.

As pointed out by others, TT involves waving your hands over a body, "wiping the aura clean". It does not involve touching the body at all. Please do not confuse actual medically accepted care with quackery. I learned about the theory of TT in nursing school (and have had it "practiced" on me once, as part of a medical massage! Never saw that massage therapist again.) so am well aware what it is.

MI Dawn

But conventional medicine has a lot to learn about preventing illness and maintaining health.

Examples of what CAM can offer in terms of "preventing illness and maintaining health" are needed, with citations to demonstrate efficacy.

Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Pure straw man. Lifestyle interventions are a core and universally accepted part of mainstream medicine. MDs harp incessantly on stopping smoking, getting more exercise, eating better, losing weight, etc.

The only sense in which mainstream medicine denies such is the sense of not blindly accepting "[insert fad food du jour] cures all medical problems!" in the absence of evidence demonstrating such.

I've found that, when someone makes a statement like yours quoted above, it pretty much always is connected to blind and uncritical acceptance of claims that, for instance, megadoses of vitamin C will cure cancer. I'd be happy to be shown that you're not in that category, but it doesn't look good.

People are turning away from rigid, positivistic science because it continues to fail to address aspects of reality that people consider important, such as people's inner lives. The alternative to the rise of unrestrained superstition (whether as alternative medicine or creationism or the like) is integration of scientific and non/pre-scientific ways of thinking. The shape of this next world view is a work in progress and can of course evolve in an irresponsible, anti-scientific manner, but this possibility is not an argument against such integration.

Hence there is no going back: science will either have to evolve to be able to encapsulate all of reality (explanatorily rather than dismissively), or it will sadly atrophy as people turn back to superstition. The most fruitful approach is not to resist this trend but to make the best of it, recognizing that reductionist science has inadequacies that cannot be overcome at its own level of complexity.

Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Well, I guess that rules out homoeopathy, then.

@David:

"People are turning away from rigid, positivistic science because" they want to believe stuff that ain't so.

My point is that Pablo and Lawrence are going to claim this as "conventional medicine", but I would bet not everyone else would agree with that, despite scientific research for its support, just because of its nature.

What nature is that?

In the end, if it is shown to help, then of course it is medicine. We may not currently know the mechanism, but that is an issue of time, and, for something like this, I can imagine there are many possible, reasonable mechanisms that could be explored.

As opposed to something like TT or homeopathy or acupuncture, which are claimed to work by processes that make no sense at all to explain non-existent effects.

Surprizingly, a great deal of magical thinking surrounds an area of CAM that *has* value from the perspective of SBM(actually, it *is* SB): dietary change and exercise**. Most of the woo I survey invokes "lifestyle change" as panacaea: where would our web woo-meisters be if they could not scold lesser beings(i.e their audience, SBM advocates, rational people) about their miserable American diets and lack of exercise and then substitute their professed extreme measures : veganism, organic raw food, ultra low fat, one hour of aerobic activity every day, marathons, ad nauseum.

Magical thinking(about a realistic subject) involves the spurious claims and exaggerations about *how much* these measures can affect outcomes- cures and prevention of CV disease and cancer are commonplace claims. If there is a study that shows, let's say, that a certain type of cancer occurs in people that ingest- on the average- higher amounts of fat, telling people to cut out *all* fat ( or cut back to 10%) to _prevent_ that type of cancer is not warranted. Magical foods (green juices) also provide magical cures. Acai,mangosteen, anyone?

Magical thinking goes downright mythological when woo-meisters "counsel" their marks about dietary change and exercise programs. After the scolding, the sinner is shown the error of his or her ways and told exactly how to emulate the master's "proper" method. Eat this way, exercise this way, and buy these supplements. The magic and myth creep in because the guru does not account for the real world and how difficult it is to implement _any_ change, never mind the drastic measures recommended. Of course, any failure rests solely on the penitent not on the method or its perpetrator.

For a sampling of these regimes, consult any ultra low dietary fat plan ( e.g. Ornish), raw food bible, or if you're feeling adventuresome, the HealthRanger.com or Gary Null.com, for dietary and exercise "wisdom".

** Several family members have used reasonable dietary measures and exercise to control illness successfully. I exercise, play tennis, and eat relatively low fat, no red meat, little salt, not much processed food, very little alcohol, etc.

Kangaroo care works because the mother's breathing stimulates the baby to breath, her body temperature keeps the baby's temp stable, and her heartbeat and body noises are familiar to the baby.

Hmmm, Dawn, you actually said this without resorting to claims of the healing energy of the mother's aura, or anything like that.

So much for being just like TT....

@ David:

You display a grossly wrongheaded view of science. There are things that it makes no attempt to explain precisely because they are not susceptible to empirical investigation. Trying to demand that science "evolve" to explain such is as ludicrous as demanding that the Bible evolve to provide blueprints for the Space Shuttle.

Yes Pablo - it is amazing when someone can actually explain the benefits of a particular treatment or regimen without referring to "auras" and "magic touching."

And I have no idea what David is smoking, but it is probably a bit more than weed. Why on earth would we want to "dumb down" science?

Lori: You imply that you accept the well-demonstrated facts that homeopethy and reiki are nonsense. So, should we trust a "University" that teaches them as fact (i.e. Bastyr)? I think not.

The problem we all have with CAM is that no concept can ever be proved wrong in the minds of CAM proponents. In real medicine, we continue to discover that things don't always work the way we thought. We throw those things out and move on. It's called progress.

Triskelthecat/MI Dawn @34

Kangaroo care works because the mother's breathing stimulates the baby to breath, her body temperature keeps the baby's temp stable, and her heartbeat and body noises are familiar to the baby. They grow better, gain weight faster, and have fewer apnic spells.

All very good but wouldn't the leaping about cause brain or spinal injury? :)

Orac, with all the writings you've done on various "alternative" treatments, why don't you summarize them into a textbook for a class on SBM and CAM. It would give academics a nice source to teach an elective to expose medical students to the "alternatives".

Lori, about twenty years ago I literally lived down the street from Bastyr, when they were renting a building from the school district (before they moved to the former seminary across the lake). I remember they put out a big press release saying they were going to do a definitive study on homeopathy. That is where I first learned exactly what homeopathy consisted of.

Since then I never heard anything else about it. I cannot find any papers, or anything on their website. I could understand if the study was not positive how it could have succumbed to the file drawer effect, but not why they still have it as part of their curriculum. That does not sound very honest, does it?

Now flash forward fifteen years and a relative of mine was released from the county psyche ward. After several years she is feeling healthier than she had been, since she was finally diagnosed and on real meds. So she goes back to her Bastyr trained ND (also known as Not a Doctor) who tells her that the psychiatrist is an idiot and to stop taking the real meds, but instead take her special expensive homoepathic remedies.

My relative actually left the ND because the homoepathy did not work. But unfortunately, all of the work of the real psychiatrist was gone and she spiraled down again (and ended up in the psyche ward of another county).

Ten months ago she committed suicide.

Tell me exactly which CAM is a better treatment for bi-polar disorder than real medicine. Do provide some real references.

As I work with premature babies

Good lord that is terrifying.

...the technique known as "kangaroo care" for mothers and infants. All it involves is laying a baby wearing nothing but a diaper on the bare chest of his or her mother. This could be considered a type of "therapeutic touch"

This has nothing to do with the therapeutic touch discussed in this post. That's simple human contact, totally unrelated to the existence of undetectable energy. There are probable mechanisms through which this could work (reduced stress, hormones, pheromones, even simple warmth) that don't invoke energies that violate the laws of physics.

...high levels of maternal satisfaction.

Being satisfied with something isn't the same thing as that "something" actually working. I'm sure patients were "satisfied" with bloodletting, enemas and purging for centuries, that doesn't make it less dangerous or more effective.

You guys should educate yourself about CAM because your patients will be asking you about it. If you purely disregard all their concerns, they will not trust you anymore. Especially if they read all the studies in support of CAM therapies or know someone that those therapies have worked for and your response suggests you think they are crazy because it is all bunk.

Not all of us are doctors, and by reading this blog we are educating ourselves. And I would argue that we would be disregarding their best interest (both in terms of health and finances) by not pointing out the shoddy evidence base and even worse theoretical base for most of these treatments. A consistent point on this blog is that the evidence base is usually quite bad, with poorly-designed studies being the only ones showing consistent positive effect, and better designed studies showing no effect. Orac, and most readers, wouldn't think patients were crazy for wanting CAM, we would probably think they are poorly informed and unaware of the many cognitive biases that exist and are responsible for many ostensibly "positive" results.

But conventional medicine has a lot to learn about preventing illness and maintaining health. Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Is there any doctor out there that doesn't recommend diet and exercise to sedentary patients? These interventions are not CAM, they are standard lifestyle advice that are incredibly mainstream, to the point that considerable research money is poured into figuring out the best ways to make people eat better and exercise. Holy strawman. Not to mention vaccination, the best way to prevent infectious diseases. If patients actually followed the evidence-based instructions for health - that would be good diet, adequate exercise, up-to-date vaccinations, proper sanitation, adequate sleep and positive relations with other human beings - then yes most nations would be more healthy. The problem is, most people do not. Prevention isn't magic, it's just hard.

Have you ever read this blog before? Orac has made these very points many times. In fact, it appears that if you sat down and exchanged actual definitions and operational terminology, you'd probably agree. You're not saying anything Orac hasn't said before, but you're sure working hard at making it seem like you're talking about different things.

Lori said: "If you really had done any research on CAM, especially the way it is taught at Bastyr and the University of Washington, by the way, you would know that they use hard science to evaluate the effectiveness of CAM procedures, including randomized controlled trials."

From the Bastyr website:

"In November 2010 the (Bastyr) Center for Spirituality, Science and Medicine hosted "Earthanima" with kinesthetic poet and contemplative juggler Thomas Arthur."

So, how exactly did they do randomized controlled trials of "contemplative juggling"? Were ordinary jugglers recruited into the placebo arm of the studies? (One thing for sure - not only do I want no part of "therapeutic touch" when I'm in the hospital, contemplative jugglers get the same reception as mimes - out the door, fast).

I'm also interested to see when and how "kangaroo care" was ever a CAM innovation, derided and dismissed by contemptuous mainstream doctors ("they LAUGHED!") only to be adopted once the courageous CAMsters did their rigorous studies. This claim sounds like attempts by alt med proponents to claim credit for nutrition advice or any accepted medical modality that doesn't involve drugs or surgery.

MI Dawn beat me to the punch. Her assessment of kangaroo care is spot-on, and exactly as the NICU nurses described it to my husband and I - in purely scientific terms. (We had a 27 weeker and did lots of kangaroo care; on top of the reported benefits, it was awesome to snuggle with our wee one and give her some parent time out of the incubator).

"Alternative medicine" that works is no longer "alternative." It's just medicine

That's not quite how cheap herbal, or some foreign therapies seem to be applied in the US by my observations.

Medicine with 1-2 active principals that are extensively documented, lots of lawyers etc, and FDA approved eventually become expensive medicine, perhaps only slightly better than nothing (placebo). The rest have to be alt med supplements, or disappear. The FDA czars seem incapable of dealing with mixed molecular entities like herbal extracts registered in countries with more advanced development.

Before anyone jumps me, consider this: I just got the CBC results that show a cheap supplement, an American clone of a long registered asian medicine, an extract for oral use, that allowed higher chemotherapeutic dosage while substantially *increasing* depressed WBC, RBC and platelets on treatment. Pretty much like the asian literature describes, and apparently they can do this for years on continuous chemo. Better than anything FDA registered in the US, for ca $2/day.

The regular therapeutic alternatives on a given chemo treatment with a shot CBC: temporarily stop the chemo when WBC, RBC or platelets erode (drop) too low, or, permanently stop because the chemo is ineffective at the tolerable dose; AND/OR use expensive, $$$$/month, sometimes painful daily shots of multiple RBC/WBC/platelet stimulators during resistance building chemo stoppage(s). Drugs that may be less effective, or may even stimulate cancer growth(e.g. VEGF for RBCs).

If it's all "just medicine", how come I can't get this extract prescribed by an average, or even a "size" 38R, American MD? Whereas, more likely, the lowly ND would suggest or support it.

Scientists create the findings their sponsors want and delay the results of research which is "negative."

http://www.newsweek.com/2011/01/23/why-almost-everything-you-hear-about…

Best,

Jay

The problem we all have with CAM is that no concept can ever be proved wrong in the minds of CAM proponents.

CAM proponents don't even have a problem with mutually contradictory modalities such as Reiki versus Therapeutic Touch. Although they are similar, they can not both be right since a Reiki practitioner must be "attuned" by a Reiki master and be given special symbols in order to project the healing "energy".

Lawrence @8

It is all about the Benjamins in Canada as well be integrating woo, doctors have the security of practicing within the provincial health care system while adding what the market will bear, cash up front CAM treatments.

(We had a 27 weeker and did lots of kangaroo care; on top of the reported benefits, it was awesome to snuggle with our wee one and give her some parent time out of the incubator).

I love the feel of my baby's skin against mine. Baby skin is so soft, it feels awesome. I do this "kangaroo care" regardless of any medical benefit (and I'm a guy).

I had a great comment about this in an earlier post, but I deleted it. I likened it to a claim that having lots of sex makes you live longer. I mean, how great would that be? Irrespective of whether it actually helps you live longer, you get to have lots of sex! Man, what a great modality!

@Dr. Jay

As I pointed out before, Sharon Begley i three months late and a dollar short:

http://www.sciencebasedmedicine.org/?p=7734

In fact, she's much later than that. Try searching for "Ioannidis" in my search box, and you will find that I have written about his work many times in mostly flattering tones.

Try again.

As for your comments about "corporate masters," all I can say is that I'm grateful you didn't parrot your tired old "tobacco science" cliche. Seriously, can you actually criticize the details of the science you don't like, citing actual peer-reviewed research? Just saying science is "biased" as a reason to dismiss it is intellectually lazy and convinces no one who knows the issues.

@Lori
RE: 'Ignorance" & "You guys should educate yourself about CAM because your patients will be asking you about it. "

Before you throw out a word like ignorance, you should be certain of whom it is best applied to. It seems obvious you are new to this blog and have failed to do any cursory browsing of the previous content on this site before commenting. The bloggers here are highly educated on "CAM". They have spent large amounts of time investigating and researching "CAM" and have read and analyzed a seemingly endless plethora of CAM studies and papers. You may disagree with their positions, but you are in error to claim they are uneducated on CAM. They are arguably far more educated on CAM than many practitioners of such.

But please, make your logically supported case. Present your evidence, reference the specific studies you claim are of quality that support your position on CAM. Perhaps you should first clarify which "CAM" modalities you are speaking of since the term "CAM" is a catch all term for a broad range of various practices, some of which (homeopathy, reiki) you have already admitted are bunk.

Orac says: Just saying science is "biased" as a reason to dismiss it is intellectually lazy and convinces no one who knows the issues.

Just saying that this is "intellectually lazy" without proof of that laziness is really lazy, David.

Best,

Jay

To quote Dara O'Briain on the subject of herbal medicines: "They tested it, and the stuff that worked became...MEDICINE. The rest is just a nice cup of tea and some potpourri."

As for the rest: "Get in the feckin' sack."

@Militant Agnostic: If it doesn't hurt a kangaroo's joey, it doesn't hurt a human baby. (LOL...my coworkers are all wondering why, in this lousy weather and crazy work day, I am laughing my head off.)

OT story: I worked in a Level II nursery so we would transport really "premie" babies to another hospital but they would often be sent back to us to "feed and grow" before they could go home. One set of parents was very afraid to touch/handle their now healthy baby. The pediatrician picked up the baby by (sex deleted) arm and leg and very gently swung the baby back and forth then laid the baby back down, looked at the parents and said: "See? XX won't break". (Mom nearly fainted - we had to sit her down FAST! But that's how this pediatrician - and father of 6 children - was. No coddling of the babies in HIS practice!)

@Jay

Uh, Orac did show why it was lazy. It is because you do not provide substantive criticism. You simply drive in, say "Science is biased!" and drive off. You don't say how it is biased. But even then, you're making a blanket statement, rather than specific criticism of specific studies.

It would be similar to simply saying that Jay Gordon, MD, FAAP is biased, without actually saying why.

Now, do you have something of substance to contribute, or are you just going to whine?

@Jay Gordon #53,

That's rich Jay, considering that CAM researchers craft studies biased towards a positive result, and when they get a negative result, they claim a positive result because their control works too.

http://www.sciencebasedmedicine.org/?p=492

-Karl Withakay

Orac says: "Try searching for "Ioannidis" in my search box, and you will find that I have written about his work many times in mostly flattering tones"

That's great! But his work is just beginning to come to the attention of the lay press in a big way.

"Science" as a monolithic deity to be worshipped at all costs is an outdated concept. Have you followed the controversy about The Lancet--one of the world's most prestigious journals--publishing an article some years ago about vaccines and autism which contained only 12 subjects?! If you've missed this controversy, I suggest you have a look.

This sort of publication/confirmation bias happens every day.

Have a wonderful day!

Jay

@Jay Gordon #63,
I've said it before, and I'll say it again, it's always amusing when someone uses an example of how the process of science ultimately works as an example of how science doesn't work.

-Karl Withakay

http://www.newsweek.com/2011/01/23/why-almost-everything-you-hear-about…

Thanks Jay. Your perspective is always much appreciated.

Lori, I suggest that you learn about naturopathy at www.naturowatch.org

Also, while you correctly describe that people can find supporting literature on CAM- what you (and they) miss is that such "literature" is junk. If one does not know how to interpret the research, one is easily misled (and yes, PubMed indexes junk literature).

You may enjoy reading "Suckers" by Rose Shapiro. Also, look at www.ebm-first.com www.skepdic.com and www.quackwatch.org and its subsidiaries.

Very well written article. I have checked various university affiliated hospitals in New York City and other large metropolitan areas and the majority of them do have "centers for complementary and alternative medicine" BTW, Sanjay Gupta is affiliated with such a "center" in NYC.

There is an interesting article in the New York Times (Sunday,January 23, 2011 "National Section"). It is available on line...if you key in the exact headline "A New Federal Center Will Help Develop Medicines".

An interesting paragraph in the article "For the plan to go into effect by October, the administration must by law get rid of of one on the 27 centers already in existence at the NIH-something that has never been done before. So the administration plans to downgrade the National Center for Research Resources, in part by giving some of its resources to the new drug center".

As expected, those who work at the National Center for Research Resources have inundate a complaint blog about the the coming change. I don't want to open a debate here about bureaucracies and private institutions and companies which seek to consolidate divisions for financial reasons...or because their function may be redundant and resources would be more effectively used elsewhere. It is the only one of the twenty-seven Centers in the NIH that has be "targeted".

I'm wondering why other Centers in the NIH, such as the NCCAM (National Center for Complementary and Alternative Medicine) haven't been considered for downsizing/elimination as well?

Just musing.....

Lori:

Tiffany Field has done a lot of studies on therapeutic touch. And yes, you are right, it's not the actual Therapeutic Touch that involves holding the hands a little above the patient's skin. My point is that Pablo and Lawrence are going to claim this as "conventional medicine", but I would bet not everyone else would agree with that, despite scientific research for its support, just because of its nature.

So you *already know* that kangaroo care has absolutely zip-doodle to do with Therapeutic Touch, and yet you still offered it up as a reason to think there might be something to TT, as some sort of defense of alternative medicine? And you want us to think you're not being disingenuous here?

It's true that many laypeople have become confused about what medicine will support, but I would argue this is mostly because of the totally unnecessary creation of a false dichotomy between "medicine" and "alternative medicine". If the goal is to find modalities that work, why do we need a special category for ones that some people think are sorta hippy or new agey? (Note: I don't use the word "hippy" as a pejorative, just a descriptive.) If teaching hospitals use the "CAM" term, they are deliberately choosing to constrain their medical practice by barring it from receiving anything out of the CAM arena. What could they possibly gain from that? Well, medicine doesn't gain anything from that, but CAM does. The hospital suddenly gets to use therapies which aren't medicine, which haven't been shown to work, and which may in fact be total bunk, and this is profitable.

It's all about money. It is not about health freedom. That's the marketing divisions talking. They want freedom to make money; the only freedom they want the consumer to have is the freedom to hear their advertising.

All medicine should be held to the same standard. No free rides just because a modality is fashionable in certain circles, or excitingly novel. That applies whether it's natural-orifice surgery, a new pharmaceutical, or distance healing or iridology.

@ Jay Gordon

Scientists create the findings their sponsors want and delay the results of research which is "negative."

Are you talking about Wakefield?

Jay Gordon: Scientists create the findings their sponsors want and delay the results of research which is "negative."

Then how do you explain the fact that most new drugs fail preliminary studies?

That's great! But his work is just beginning to come to the attention of the lay press in a big way.

Perhaps you would care to explain how the lay press' attention to Ionnidis has anything whatsoever to do with quackery and fraud becoming part of medical school?

"Science" as a monolithic deity to be worshipped at all costs is an outdated concept.

And a straw man. What exactly makes you think anybody here thinks (or thought) that way? And again, what relevance does it have to the topic of the post?

Exactly Karl - I don't see why this kind of corrective action is a problem? There is plenty of stuff we still don't know, but scientists don't seem to have a problem filling in the gaps or changing theories over time as new information is made available.

Science also doesn't turn on a dime - it takes time to either confirm results/information or find flaws that may result in changes being necessary. This applies to every scientific field, from astronomy and physics, to geology and medicine (and everything in-between).

Again, I don't understand how this process is "bad."

Lori:

I live in Seattle and am well aware of what Bastyr is and what "research" it does. I suggest before you try and defend Bastyr as anything but a source of pseudoscience and magical thinking (to quote a frequently used term), I suggest you go and look at the classes offered there ... including reiki and homeopathy, which even you seem to agree are utter nonsense.

As those before me have said in many different ways, if you have examples of these well done, "double blinded, placebo controlled trial" that show CAM to be effective.

As to "kangaroo care", I believe that was first started in an NICU, by a neonatologist ... not, as you will note, by a reiki master or specialist in touch therapy.

I apologize for my ignorance on the subject, but what the hell is Bastyr? Is it like the ITT Tech of medical schools? Or is just a naturopathic degree-mill that loads students full of nondischaragable debt that they will never be able to pay back w/ meaningful employment?

There was a guy (a failed attorney) that was talking about going to one of those naturopathic schools on jdunderground. Apparently the requirements were like 2 basic, lower-division science classes and that was the extent of it. School cost like 50k a year, ouch!

Just a speculation, but Lori's attitude about Bastyr may be the result of their expertise at public relations. My wife, for example, has no use for nonsense like homeopathy, but tends to take umbrage at negative references to Bastyr. This is because both she and I have had great experiences dealing with them on things having nothing to do with CAM practices.

Bastyr is (or has been in the past) generous with the use of their facilities. They have a lovely chapel on their campus which has been made available for musical and other events, and they tend to be supportive of the community. Of course, this has nothing to do with what they teach.

It is the same sort of successful PR that is used by churches - if people feel good about the institution, they tend to think that what the institution does must be okay too, without digging too deeply into it. I think that explains my wife's attitude, and I'd bet it has something to do with Lori's, too.

Myself, I'm just dour old skeptic who thinks they are full of bull but good at promoting themselves.

@48 Chris
Sorry, for your loss. Non-biological, non-chemical treatment of such a problem is tragic.

A somewhat similar starting bipolar story - a fast cycler on a high gluten, high carb, junk food diet. An insomniac that can go delusional. Of course, resistant to any and all medications once out of confinement until fast cycle strongly asserts itself.

In desperation, the family gets one cocktail with perhaps a year supply of some vitamins, inhibitory amino acids, EPA-DHA, some minerals, and some other high potency nutrients, down the hatch.

Wham, lights out for over 12 hours, like tranked. Upon awakening, seems pretty normal. But will not touch another cocktail, afraid maybe it's spiked.

Stressors reduced, not removed. The gluten content was reduced some, reduced but still high-carbs, with frequent fish and some vegetable and fruit content. No more cycles, no more meds, still needs improvements for holding a professional job. Family is considering how to ethically get more nutrient cocktails down, and maintain thrust.

Jay Gordon:

Just saying that this is "intellectually lazy" without proof of that laziness is really lazy, David.

Just saying that Orac is just saying that this is "intellectually lazy" without proof of that laziness is really lazy without proof that Orac is saying this without proof that this is lazy is really, really lazy.

After all, "alternative" medicine is nothing more than medicine that either hasn't been shown to work or has been shown not to work. "Alternative medicine" that works is no longer "alternative." It's just medicine.

This. If they can't prove it scientifically, then it is not worth anyone's time. This shouldn't be impossible for alternate health advocates unless what their touting is nonsense. And there is absolutely no reason to integrate nonsense into healthcare.

@74 Agent Smith

Bastyr is an accredited university in Seattle teaching naturopathy and Chinese herbal medicine. They used to teach homeopathy, too, but I just looked and it seems to have fallen off of their curriculum.

Interestingly, under "research" the big emphasis is on the grants they have received. They list their activities, including an Oncology center. There is currently an "outcomes" study with them and the Fred Hutchinson Cancer Research Center, looking at whether there are significant differences in outcomes for cancer patients between standard and CAM treatments. No indication when that will be complete.

They also list many completed research studies, but link to few where you can see results, and most of those do not relate to actual therapies and/or are not published in mainstream journals. (E.g., "Types of alternative medicine used by breast, colon, and prostate cancer patients: predictors, motives, and costs", Patterson R E, Neuhouser N M, Hedderson MM, Schwartz SM, Standish LJ, et.al. J Alt & Comp Med, 8(4): 477-485, 2002; and "Safety and reliability of lactobacillus supplements in Seattle, Washington (A Pilot Study)", Berman, S, D Spicer. Internet Journal of Alternative Medicine, 1(2), 2003.)

My favorite linked study is: "Why alternative medicine cannot be evidence-based." Tonelli M, and TC Callahan. Academic Medicine, 76(12): 1213-20, 2001.

Say what?!

@Jay Gordon

You get your scientific information from Newsweek rather than peer-reviewed scientific journals? I have even less respect for you than I did before. May I ask, what do you think of "biostatistician Steven Goodman of Johns Hopkins"'s thoughts on the subject? He is the sole representative of what is doubtless an extensive debate in the actual scientific community. Newsweek is hardly giving a nuanced discussion here, this is the flat earth news version of scientific reporting - inaccurate, slanted, biased, one-sided and completely, utterly ignorant of the actual, substantive debate. The lay press is a horrible, horrible source of information on nearly any scientific issue because they have their own biases of news cycles, headlines, advertising dollars, etc. and are themselves not strongly motivated to really investigate and understand the issues.

And dismissing evidence as "baised" without substantially engaging with it is lazy. For instance, I could have said "Don't listen to Dr. Jay Gordon, he's biased by the credulous adulation of antiscientific antivaccination zealots." Instead, I criticized your information source. That took time. You, on the other hand, dropped a popular press article on the page, called Orac (who posts tens of thousands of words on this blog alone every week) lazy, incorrectly invoked Wakefield as if it supported your point (science is self-correcting when based on data; Wakefield faked his data and violated the trust and honesty that science requires in order to function) and left. And you'll probably ignore most of the comments addressing your comments. Fail.

But that's OK, we're not really concerned what you think. You've already drank the kool-aid. We're aiming for the fence-sitters who think you might have a point.

For all those sitting on a fence - Jay Gordon is a dull pencil. He has no point.

WLU

"Sharp" answer. No, I haven't relied on Newsweek. Dr. Ioannidis has published and spoken extensively. Laudatory comments have come from some fine scientific minds:
http://scienceblogs.com/insolence/2007/09/the_cranks_pile_on_john_ioann…

Holding up scientific studies as immutable proof is just plain . . . unscientific. Again, I call your attention not just to the studies mentioned in Newsweek and elsewhere but to a recent controversy regarding The Lancet's article about a possible connection between vaccines, intestinal issues and autism. Even the most prestigious journals and peer reviewers conclusions can be overturned.

Best,

Jay

Lori,

Still waiting on those PubMed references. Thanks!

This. If they can't prove it scientifically, then it is not worth anyone's time. This shouldn't be impossible for alternate health advocates unless what their touting is nonsense. And there is absolutely no reason to integrate nonsense into healthcare.

@Jay

Still not posting anything of substance, and still off topic from the original post.

Even the most prestigious journals and peer reviewers conclusions can be overturned.

Yep, through science. And, in the case of your coy Lancet reference, through uncovering fraud committed by your hero Andrew Wakefield.

Now, what the hell does any of that have to do with alt med at Georgetown and Bastyr?

"Sharp" answer. No, I haven't relied on Newsweek.

It's the citation you chose to support your point. That's relying on it.

Holding up scientific studies as immutable proof is just plain . . . unscientific.

Please provide evidence of anyone here doing such a thing.

lol, Nibi.

So, we have someone (Lori) who supports supports SBM and rejects CAM but is slightly confused about what actually falls into those categories.

Then, we have someone (Jay) who is confused about everything.

@Dr. Gordon,

"Scientists create the findings their sponsors want and delay the results of research which is "negative.""

I used to think you were probably a decent person who, despite the medical degree, had a blind spot for anti-vaccine woo.

This just opened my eyes to the fact that you are a stupid asshole. How many scientists do you even know? How many scientists comment here? Since you periodically tone-troll, why the hell do you think making a stupid insulting comment like that is acceptable?

I tell ya what, I'll give you a chance at proving your point. I can point you at my list of publications and the agency that funded me for each study, and you can make suggestions as to how I altered my data to agree with their agenda. How does that sound?

Stupid asshole.

John V says: "Stupid asshole." and further comments: "Stupid asshole."

I find myself at a loss for a comeback to those remarks. I believe that the First Amendment gives you the right to say those things but I'll search for something in Robert's Rules of Order which explains why you shouldn't.

Here's my point more succinctly: Research is often biased. Wakefield's was and there's no disputing that. He found what he wanted to find and no study that small should have been regarded as highly as The Lancet or anyone else regarded it. Other medical research will come and go and be held up as scientific proof only to be disproved later. The heated debate about certain aspects of complementary medicine becomes more difficult when RCTs suddenly show positive results but I don't think that these, or any other, results are etched in stone. I believe that the National Children's Study will help clarify vaccine issues as we accumulate--accidentally--a prospective look at vaccinated and unvaccinated babies and children. I'll wait and tone my rhetoric appropriately in the mean time.

Best,

Jay

Jay, with your collection of straw men it's amazing your local fire department hasn't yet cited you for creating a flammable hazard.

You earlier suggested that criticism of woo has to mean that the critics are doing the bidding of Big Pharma. Now we have this tripe about "Holding up scientific studies as immutable proof"

Even a drive-by troll like you (for that's what you've become, sad to say) knows that supporters of evidence-based medicine do not hold published studies as immutable proof of anything. We go with the best available evidence, and if it is superseded by new findings, we don't bury our heads in the sand, but accomodate to the new evidence. Speaking of ostrichism (and irony-meter redlining):

Jay "Again, I call your attention not just to the studies mentioned in Newsweek and elsewhere but to a recent controversy regarding The Lancet's article about a possible connection between vaccines, intestinal issues and autism. Even the most prestigious journals and peer reviewers conclusions can be overturned."

Does this mean you're considering editing that embarassing suck-up to Andrew Wakefield that appears on your website, where you proclaim that all doubts you had about him were removed by seeing him in person at a conference?

@Jay

Research is often biased. Wakefield's was and there's no disputing that.

You don't seem to understand what "bias" means. Looking at results and interpreting them according to preconceptions is bias. Looking at results and changing them to fit preconceptions is fraud. Accurately reporting data, but spinning it to fit a certain message might be bias. Consciously changing and inaccurately reporting data to fit a certain message is fraud.

I hope I cleared that up for you, Jay. Now, back on topic, what does all this have to do with Georgetown and Bastyr?

@87

Dr. Gordon, I have been paying attention to your comments. While you do make passing responses to name calling ("stupid asshole"), you don't seem to respond to the substantive claims and questions people are posing. I do think that this is what generates the exasperation and frustration in others. Thoughts?

I also don't quite understand the way you keep refering to the Wakefield article (as though it isn't notorious around here and the subject of thousands of words)...is this some kind of inside joke I'm not getting?

"Dr" Jay seems to think that Wakefield's fraud somehow reflects more badly upon science than upon his ardent sycophants. (Where he unquestionably is among the latter.) WHY he thinks that I have no idea, but logic has never been his strong suit.

Having the gall and arrogance to claim his personal experience trumps not only careful science, but the collective personal experiences of the entire rest of the medical profession is.

Careful, JohnV... the humble (but Right Honourable) anus may take exception to you likening Dr. Jay to it...

@Jay Gordon,
"Research is often biased."

More so are personal observations and anecdotes.

-Karl Withakay

"Dr. Jay" retorts (#80) with:

"Holding up scientific studies as immutable proof is just plain . . . unscientific. ... Even the most prestigious journals and peer reviewers conclusions can be overturned."

Ah, yes, the "science has been wrong before" gambit.

All too true, "Dr. Jay", but that still doesn't mean that you can simply make up stuff and claim that it is just as valid as hypotheses supported by data. A hypothesis supported by just one study is infinitely more likely to be true than one supported by no data (e.g. homeopathy, vaccines-cause-autism, etc.).

As usual, "Dr. Jay" is trying to claim (indirectly and oh, so subtly) that making up "Just So Stories" (or, if you prefer, "My Professional Experience") about medicine is equal to real research.

Research can occasionally be wrong, it is true, but "making stuff up" is only right by accident.

Prometheus

@74 Agent Smith

Bastyr is an accredited university in Seattle teaching naturopathy and Chinese herbal medicine. They used to teach homeopathy, too, but I just looked and it seems to have fallen off of their curriculum.

Interestingly, under "research" the big emphasis is on the grants they have received. They list their activities, including an Oncology center. There is currently an "outcomes" study with them and the Fred Hutchinson Cancer Research Center, looking at whether there are significant differences in outcomes for cancer patients between standard and CAM treatments. No indication when that will be complete.

They also list many completed research studies, but link to few where you can see results, and most of those do not relate to actual therapies and/or are not published in mainstream journals. (E.g., "Types of alternative medicine used by breast, colon, and prostate cancer patients: predictors, motives, and costs", Patterson R E, Neuhouser N M, Hedderson MM, Schwartz SM, Standish LJ, et.al. J Alt & Comp Med, 8(4): 477-485, 2002; and "Safety and reliability of lactobacillus supplements in Seattle, Washington (A Pilot Study)", Berman, S, D Spicer. Internet Journal of Alternative Medicine, 1(2), 2003.)

My favorite linked study is: "Why alternative medicine cannot be evidence-based." Tonelli M, and TC Callahan. Academic Medicine, 76(12): 1213-20, 2001.

Say what?!

Well, I tried posting some info on Bastyr, but the post has been flagged for moderation. Rather than double post I'll just mention this - an example of "completed studies" done by Bastyr research is the following title:

"Why alternative medicine cannot be evidence-based." Tonelli M, and TC Callahan. Academic Medicine, 76(12): 1213-20, 2001.

That may say all that needs be said.

Really, Orac? You're going to throw "straw man" claims at Bastyr and UW when you used a straw man claim against Lori? That's sloppy thinking, man.

You say "integrating Bastyr & Georgetown is bad". Lori says "Bastyr and UW have a reputation for good science". You say "oh like this study on homeopathy and the 3rd world?!" Lori replies "so, allopathic medicine has never ever taken advantage of the 3rd world" and you bust out straw man? Not quite. Lori made a statement that you tried to derail by pulling up an article that's going to have less than stellar scientific merit, given, ya know, it's homeopathy. This does not invalidate the fact that Bastyr has done quite a bit of solid, peer-reviewed, double-blind, placebo-controlled trials (both with and without the UW), especially in areas of acupuncture and Chinese herbal medicine.

Just like Lori's question about allopathic and rampant ethical abuses in the Developing World - of which we have so many examples, just hit any medicine/ethics journal - do not invalidate the fact that EBM has purpose and validity. (Although wasshisname at Stanford certainly is tackling the idea of validity in EBM, given how much of it is funded by pharma companies and thus only publish positive studies. Neither here nor there, tho.)

Bastyr has a good reputation. Do they embrace woo there? Sure, but they also don't force it on anyone, and they embrace the scientific method in their research and teaching.

Lumping in naturopathy along with homeopathy, reiki, and so forth, just makes you look ignorant in the end. And that's a shame, especially since so much of medicine is moving forward to acknowledge that reductionism in medicine (and pharma, thanksomuch) is a bad thing.

Lumping in naturopathy along with homeopathy, reiki, and so forth, just makes you look ignorant in the end.

Clearly, you do not know much about naturopathy if you think it doesn't embrace reiki and homeopathy. It does, especially homeopathy, which is part and parcel of the curriculum in schools of naturopathy. Let's just look at Bastyr's website. Here it is on homeopathy:

http://bastyrcenter.org/content/category/4/147/161/

I particularly like this question in the FAQ:

Q. Do all naturopathic physicians use homeopathy?

A. All naturopathic physicians are trained in the use of homeopathy, but not every naturopathic physician will use it as part of their treatment.

Let's repeat that: All naturopathic physicians are trained in the use of homeopathy.

And, oh, look: Bastyr has a teaching clinic that has a Department of Homeopathy, chaired by Richard Mann, ND, a naturopath!

And, oh, look again: Bastyr's standard four year naturopath track requires three full terms (a whole year: fall, winter, and spring terms) of homeopathy.

Then check this out. The website for the Center for Naturopathic Health and Medicine says:

Once youâve finished all course prerequisites, you must complete a minimum of a four- to six-year course of study in naturopathy to acquire one of the careers in naturopathic medicine. The four-year curriculum entails comprehensive studies in biochemistry, human physiology, histology, embryology, traditional Chinese medicine (TCM) principles, hydrotherapy, botanical medicine, macronutrients, homeopathy, and more.

And:

Students enrolled in accredited Canadian naturopathy programs acquire a wealth of knowledge. For instance, typical naturopathy programs entail course-intensive curricula in naturopathic philosophies and fundamentals, Asian medicine, anatomy, biochemistry, immunology, microbiology, physiology, botanical medicine, homeopathic medicine, massage therapy, hydrotherapy, clinical nutrition, naturopathic manipulation, radiology, and many other related studies.

Note that every naturopathic school whose curriculum I've ever looked at includes a heapin' helpin' of homeopathy classes. In fact, the NPLEX (Naturopathic Physicians Licensing Examinations), which is required for naturopaths to be licensed in the 16 states in the U.S. and 5 provinces in Canada that license naturopathic physicians tests naturopaths on homeopathy:

The current examination, based on these original blueprints, forms the Core Clinical Science Examination now required by every state and province that regulates the practice of naturopathic medicine. The Core Clinical Science Examination is a case-based examination that covers the following topics: diagnosis physical, clinical, lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, emergency medicine, medical procedures, public health, pharmacology, and research. Two additional treatment examinations (Minor Surgery and Acupuncture) may also be required for eligibility to become licensed to practice as a naturopathic physician in some jurisdictions.

Another passage:

The NPLEX Part II - Core Clinical Science Examination is designed to test your knowledge of: diagnosis (physical, clinical, and lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, medical procedures, emergency medicine, public health, pharmacology, and research. The examination is comprised of a series of clinical summaries followed by several questions pertaining to each patient's case. For example, you might be asked to provide a differential diagnosis, to select appropriate lab tests, to prescribe therapies which safely address the patient's condition, and to respond to acute care emergencies.

I could start listing a whole bunch of naturopaths who offer homeopathy and reiki as their services if you like. Or I could point out the many articles on homeopathy and reiki you can find on the official blog of the American Association of Naturopathic Physicians. For instance, here the AANP poo-poos the various 1023 days designed to show the ridiculousness of homeopathy:

Do these âskepticsâ really think the public cares about Avogadroâs number when homeopathy has just significantly improved their toddlerâs autism or offered help with any of a vast range of diseases which respond so well to homeopathic (and often not to conventional) treatment?

This is just another tantrum by the clueless wing of the scientific/medical community that canât understand why the people donât praise them for their ideological purity and courage, even when the fruits of their scientific labors rot like a brown banana. Note to protestors: maybe theyâre just not that into you.

No, homeopathy is part and parcel of naturopathy, and it's not I who say so. Naturopathic schools say so. The various accrediting boards for naturopathy say so. The AANP says so.

Kelly @98

. Do they embrace woo there? Sure, but they also don't force it on anyone

I am sure Bernie Madoff never forced his Ponzi scheme on anyone either. Felderoff and Walsh never forced anyone to buy Bre-X (biggest core salting mining scam in history) stock.

@Dr. Gordon,

Are you trying to prove me right? You just made a blanket statement about scientists' lack of integrity (and unless you're andrew wakefield, a scientist's integrity is extremely important and a lack of it can mean a career change is in order) and yet you tone troll me for calling you a stupid asshole.

Why exactly do you get a free pass to behave in an incivil manner?

You also failed to respond to my challenge, why is that?

Lori and Kelly I suggest that you learn about naturopathy at www.naturowatch.org

Also, while you correctly describe that people can find supporting literature on CAM- what you (and they) miss is that such "literature" is junk. If one does not know how to interpret the research, one is easily misled (and yes, PubMed indexes junk literature).

You may enjoy reading "Suckers" by Rose Shapiro. Also, look at www.ebm-first.com www.skepdic.com and www.quackwatch.org and its subsidiaries.

Holding up scientific studies as immutable proof is just plain . . . unscientific. Again, I call your attention not just to the studies mentioned in Newsweek and elsewhere but to a recent controversy regarding The Lancet's article about a possible connection between vaccines, intestinal issues and autism. Even the most prestigious journals and peer reviewers conclusions can be overturned.

Yawn. The old "science was wrong before" trope. I do find it hilarious, Dr. Jay, that you cite Andrew Wakefield's fraud as "evidence" that science is corrupt. After all, wasn't it just the other day that you were saying you don't trust Brian Deer, that you think he was biased, that you don't believe that Wakefield committed fraud?

Why, yes. Yes it was.

You're so transparent. I might take you a wee bit more seriously if you were to name Wakefield and explicitly renounce his fraud (as opposed to your fawning bit a while back about how you believed him after having met him). Right now, you're dancing around the issue, treating him like He Who Must Not Be Named or You-Know-Who. It's disingenuousness at its most obvious.

Yowch, Orac, that was a major smackdown of kelly. I anxiously await her response, although I suspect that it will be difficult for her as she is left drooling and blibbering.

"I apologize for the multiple posts."

You'll find that the more diluted your posts are on this site the more powerful they will be.

One issue in discussing CAM is that the term is very broad and vague (deliberately so) and can extend to mean many different things. I'm sure someone has done a whole nomenclature; here's mine.

CAM of the first order is the stuff that not only has no good evidence behind it, but is built on theories (e.g. water memory, cancer is fungus) that are inconsistent with chemistry, physics, and biology. In some cases, proponents may argue that it is not subject to scientific proof. Reiki, Therapeutic Touch, and Homeopathy are CAM of the first order.

CAM of the second order is the stuff that has some basis in fact and stretches it out beyond what can be proved. Many alternative nutritional "therapies" (e.g. claims that extreme diets will cure AIDS or cance), for example, fall into this group.

CAM of the third order is emerging and experimental treatments. There isn't sufficient evidence to say it definitely works yet, but there are hopeful signs and the theory makes sense.

I think there is also a CAM of the fourth order which is activities that actually help (based on evidence) but which are not for one reason or another considered medicine.

Unfortunately, many categories of "CAM" may span the categories, depending on the particular circumstances. Chiropractic has (I'm told) proven results in certain areas and as such may be considered medicine; Chiropractors that claim to cure viral or bacterial diseases would be CAM-1. People who advocate good diet and nutrition as a way to maintain weight, prevent high blood pressure, reduce the risk of heart attack, and so on may be science-based; nutritional claims that may be true but have no compelling evidence may be CAM-3.

Jay says: "Here's my point more succinctly: Research is often biased. Wakefield's was and there's no disputing that."

Orac says: " . . . I might take you a wee bit more seriously if you were to name Wakefield. Right now, you're dancing around the issue, treating him like He Who Must Not Be Named or You-Know-Who. It's disingenuousness at its most obvious."

F. Scott Fitzgerald says: "The test of a first-rate intelligence is the ability to hold two opposing ideas in mind at the same time and still retain the ability to function."

I did name Wakefield! I respect Andrew Wakefield for calling attention to the possible connection between vaccines and autism and for standing up to severe criticism and much more. I think that both he and The Lancet erred in encouraging the public to view this as a landmark conclusive study. Again, I fault The Lancet and their peer review process more than Dr. Wakefield.

@JohnV: You're not entitled to an answer. I deal with children all day who call me a poopoohead. I just don't expect that from adults.

@Bacon and others: My experience might be wrong and filled with confirmation and observational bias. I hold it up only as experience and evidence and not proof.

If you assembled scientists and others used your obvious and considerable experience, intellect and education to present facts instead of thinking up new insults for me and for one another this would be a better place. In the meantime, I will adhere to my right to remain cordial and civil.

Best,

Jay

@106 M.O.B.
I thought CAM of the third order was when you tried regular medical advice or methods (doctors orders) twice, failed or made inadequate measured progress, and being an experimentalist, tried something that sounded plausible and could be measured, rather than just being dumped, dead, duped or doped. :)

@Dr. Jay:

I fault The Lancet and their peer review process [for failing to spot Wakefield's fraud] more than [ex-]Dr. Wakefield [for committing the fraud in the first place].

Fixed that for you. No need to thank me, consider it a public service.

Let me get this straight. You value Wakefield for essentially making stuff up *at the same time* you're blaming *science* for him making stuff up?

Can you make a comment here that doesn't contradict itself?

Jay Gordon

I respect Andrew Wakefield for calling attention to the possible connection between vaccines and autism and for standing up to severe criticism and much more.

WTF You respect a man who commits fraud because he stands up to his critics who call him on it. Wow - just Wow. Thanks for showing us your ethical bankruptcy.

Andrew Wakefield did not ""make stuff up." He studied a small number of children, gathered his observations and published them. I don't know his motives beyond what he's stated. Those of you who unequivocally accept Brian Deer's set of observations and conclusions don't necessarily deserve plaudits for rigorous peer reviewing.

As for calling me a "troll," I must protest that I've been sliced and diced on this blog almost since it's inception. (Great movie!) Some nights I feel like I live here.

Best,

Jay

Andrew Wakefield did not ""make stuff up."

Then why did the GMC conclude otherwise?

because the GMC used "evidence" and "corroborated fact" and "independently verified data" which, as we all know (especially Jay Gordon) those things are never to be trusted above someone's word. Because only the person in question knows what is truly going on in their own head and nobody ever lies. Well, at least Wakefield didn't, and Jay is damned sure about that after having met the man.

Andrew Wakefield did not ""make stuff up." He studied a small number of children, gathered his observations and published them. I don't know his motives beyond what he's stated. Those of you who unequivocally accept Brian Deer's set of observations and conclusions don't necessarily deserve plaudits for rigorous peer reviewing.

Since you don't bother at all with peer review and scientific consensus Dr. Jay, I could see why you would say that. Brian Deer's 'raw data' are available on the GMC transcripts and anyone can compare those with the Lancet paper. But don't let that get in the way with your fanboy obsession with Wakefield, you met him after all. How could someone you have met with the posh accent and charismatic demeanour possibly be a fraud? Go ahead and pull the other one Jay.

because the GMC used "evidence" and "corroborated fact" and "independently verified data" which, as we all know (especially Jay Gordon) those things are never to be trusted above someone's word. Because only the person in question knows what is truly going on in their own head and nobody ever lies. Well, at least Wakefield didn't, and Jay is damned sure about that after having met the man.

because the GMC used "evidence" and "corroborated fact" and "independently verified data" which, as we all know (especially Jay Gordon) those things are never to be trusted above someone's word. Because only the person in question knows what is truly going on in their own head and nobody ever lies. Well, at least Wakefield didn't, and Jay is damned sure about that after having met the man.

I deal with children all day who call me a poopoohead.

Well, children can be very perceptive.

sorry about the multiple posts... I am on a bluetooth tethered internet connection in brisbane that is patchy (err... dodgy)

Wakefield is off topic here. He's been chewed up, castigated and cast out, as discussed in Orac's previous posts, recently, and still open for comment. No one is threatening to integrate Wakefield into medicine now, are they?

Wakefield is off topic here. He's been chewed up, castigated and cast out, as discussed in Orac's previous posts, recently, and still open for comment. No one is threatening to integrate Wakefield into medicine now, are they?

@han Good one.

J

Jay,

"I respect Andrew Wakefield for calling attention to the possible connection between vaccines and autism and for standing up to severe criticism and much more.

But he did it for a lawyer in order to provide evidence to sue vaccine manufacturers. He also didn't disclose his other financial conflicts of interest (like his own single vaccine version). If he had done it because there was a valid reason to suspect that MMR was responsible for autism, I'd say "go investigate it". But that wasn't the case. So yeah, it wasn't really "calling attention to the possible connection between vaccines and autism" so much as being paid to make up data for a lawsuit. I don't see how anyone can have respect for someone like that.

@ han

As we say in my country, "truth comes out of children's mouths".

@ Jay Gordon

No, seriously, Dr Gordon, Wakefield did a poor study, by your own admission (let's not even talk fraud), but it's "mostly" the Lancet fault?

So, if a pickpocket crashes a private party and steals everyone's wallet, it's "mostly" the fault of the rent-a-cop at the entrance? The pickpocket should just be send on his way out?

I dunno about you, but my mom taught me that blaming someone else for your mistakes is bad childlike behavior.

Which evidence considered in the GMC's case against Wakefield that led to him being "struck off" the medical register do you dispute, Jay? And why?

What findings published by the British Medical Journal do you find "biased" and presumably incorrect, Jay? And how do you reach your conclusions?

What part of Brian Deer's reporting can you factually dispute, Jay?

Provide forthright answers to these questions and I'll withdraw my characterization of you as a drive-by troll (who no longer makes even token attempts to justify his views, but plops into threads to render third-rate snark and idiotic insinuations, while patting himself on the back for his "civility").

Wakefield is off topic here. He's been chewed up, castigated and cast out, as discussed in Orac's previous posts, recently, and still open for comment. No one is threatening to integrate Wakefield into medicine now, are they?

Blame Dr. Jay for derailing the comment thread by bringing up Wakefield first as "evidence" that science is corrupt--without, of course, actually mentioning Wakefield's name until after he was prodded. It began here:

http://scienceblogs.com/insolence/2011/01/the_integration_of_pseudoscie…

Bacon, your name makes me hungry!

I did name Wakefield! I respect Andrew Wakefield for calling attention to the possible connection between vaccines and autism and for standing up to severe criticism and much more. I think that both he and The Lancet erred in encouraging the public to view this as a landmark conclusive study. Again, I fault The Lancet and their peer review process more than Dr. Wakefield.

Thank you for demonstrating my point. You still won't admit that Wakefield committed fraud and you still say you admire him. And you wonder why I don't take anything you say about vaccines seriously anymore.

"Science" as a monolithic deity to be worshipped at all costs is an outdated concept.

Is Dr. Gordon a creationist? I have never observed a non-creationist to come up with the "science as religion" drivel before. Of course, those of you who risk your braincells on CAM websites might have seen it.

But if Dr. Gordon is a creationist ... well, that explains a lot.

@Jay Gordon:

Again, I fault The Lancet and their peer review process more than Dr. Wakefield.

So if a researcher does sloppy research, which then gets accepted by a peer-reviewed journal, then the peer review is more at fault than the researcher's sloppiness?

Andrew Wakefield did not ""make stuff up."

Changing the dates of autism diagnosis to match up with vaccination dates is not "making stuff up"?

Saying children were diagnosed with autism when they weren't is not "making stuff up"?

Also, Wakefield was given the opportunity to replicate his study with a larger sample size and he refused to do so. Why would he do this is he was not "making stuff up".

Many years ago we had some dealings with an insurance agent from the small Mennonite town of Linden Alberta. A couple of years later Linden became infamous as the source of a Ponzi Scheme which also took hold in the Mormon town of Cardston. The suckers would get a couple of interest payments and then nothing. A couple of years later I heard a radio interview of an RCMP fraud squad detective and our former insurance agent. A bank in California had managed to snag some of the stolen funds as it passed through through their hands but must of the money was gone. The Mountie expressed his frustration at the lack of cooperation he was getting from the victims. Many of the victims believed that the com man was in the USA trying to recover the money. The insurance agent said he had tried to warn people that the whole thing was a scam and had lost many friends as a result. It is amazing what lengths gullible people will go to defend a con man rather than admit they have been fooled.

Loosely related to the original thread topic, the Lawyer that paid Wakefield to create his fake data is a director of the British Society of Homeopaths as has been mentioned on another thread.

Now who does Jay Gordon choose to believe, a respected investigative journalist with a long track record in a country where the libel laws are stacked against him or a smooth talker who had every motive to commit fraud and whose actions afterwords (failure to followup with a larger study) showed that he had something to hide? Someone who went to a career of taking advantage of desperate parents by offering phony cures for autism.

""Science" as a monolithic deity to be worshipped at all costs is an outdated concept. Have you followed the controversy about The Lancet--one of the world's most prestigious journals--publishing an article some years ago about vaccines and autism which contained only 12 subjects?! If you've missed this controversy, I suggest you have a look. This sort of publication/confirmation bias happens every day."

It is worth noting that in the case of Wakefield's fraudulent paper, most scientists realized something was not right with it. It was the media and woo-meisters that that ran with it.

W: failed vaccine developer, failed apostate. Boring.

@Dr. Gordon

Well I don't deal with anyone, child or adult, in real life who would make the accusations about scientists that you laid upon us here. And yet here I am with a "professional", a "doctor" with "over 30 years of experience" doing that very thing.

I've also given you the opportunity to prove your statement true, at least with me. And yet you continue to hide like a coward behind your tone trolling. Which is hilarious since the impetus for my comment was your egregious incivility.

Anyhow, continue to focus on tone and pretending to be cordial and civil. You're really pulling the wool over our eyes.

I hate that stuff.

Quack healing:
â "It doesn't work."

â "But it makes you feel better."

â "But it doesn't work!"

Anti-vaccine quackery:
â "It works."

â "But aren't you scared of teh toxins?"

â "But it works!"

@MilitantAgnostic Re. Richard Barr, the MMR class action suit lawyer in the UK, we were talking about him in a thread about three or four back on "British Science Accused..." which dealt with Brian Deer's final BMJ piece.

Getting back to the present thread, I was particularly impressed by Orac's de-cloaking (in the long comment somewhere up the thread) of what the naturopaths actually say about homeopathy (as opposed to what the CAM-sympathetic would like to believe they say).

Here in the UK our Government is currently trying to break up our single-provider attempted-value-for-money healthcare system and open it up to private providers (including the big managed care US HealthCos who are rumoured to be keen to get into a new market). Any bets on whether this, and our Govt's cosy mantra about "Patient Choice", are used to Trojan Horse in a shedload of CAM? After all - patients like it. And if you fix the rates right, everyone can make money off it - except the taxpayer who will be footing the bill for Auntie's visits to the osteopath.

@Jay Gordon

"Sharp" answer.

Thanks!

No, I haven't relied on Newsweek. Dr. Ioannidis has published and spoken extensively. Laudatory comments have come from some fine scientific minds:
http://scienceblogs.com/insolence/2007/09/the_cranks_pile_on_john_ioann…

So I criticized you for relying on an article in a popular news magazine, and your rebuttal is to link to a...blog post? Really? Now I'm having a hard time not simply insulting you. I would like to know what you think of the actual debate in peer-reviewed journals. Not blogs. Blogs are interesting and popular, but that's not what I am asking about. If you want a substantive discussion rather than rhetorical points, then you need to provide evidence, in this case actual publications by scientists rather than journalists who do not bother understanding the debate. Rhetoric is only convincing to people who are ignorant, uninformed, not paying attention or just plain stupid. The use of rhetoric rather than evidence suggests a complete inability to muster actual evidence.

Holding up scientific studies as immutable proof is just plain . . . unscientific.

Jesus Christ, what do you call ignoring scientific studies in favour of a pre-existing conclusion, the only ostensibly scientific "proof" of which was rejected by the journal that published it after the primary instigator was found to have actively committed fraud? Scientists took the autism-vaccine hypothesis seriously, tested it several times using tens of thousands of subjects, and it was found completely unsubstantiated. Are you pranking us? We're not defending a tested and failed hypothesis - you are. That's the pot calling the refrigerator seven. Orac isnât holding up studies as immutable proof â in this article he is pointing out that many of the therapies being âintegratedâ into medicine lack an evidence base. Past posts have acknowledged Ioannidisâ work and provided substantive, nuanced analysis of where Orac thinks he has a point, and where Ioannidis overreaches. And an ongoing theme is the shoddy job CAM researchers tend to do in conducting their research â either producing studies that are so badly designed they are uninterpretable, or advance conclusions that do not follow from the actual results (or fly in the face of our knowledge of anatomy, chemistry, biology and physics). Thatâs an active, critical scrutiny involving a substantive engagement with large volumes of the scientific literature. Thatâs the very opposite of âholding up studies as immutable proofâ.

Again, I call your attention not just to the studies mentioned in Newsweek and elsewhere but to a recent controversy regarding The Lancet's article about a possible connection between vaccines, intestinal issues and autism. Even the most prestigious journals and peer reviewers conclusions can be overturned.

Yeah, Andrew Wakefield. He faked his data, was attempting to produce a competing vaccine, was fed patients by a group of lawyers attempting to sue on the basis of vaccine injury, didnât disclose any of this to his institution, coauthors or editors at The Lancet, and this proves what? When people lie, they can fool people for a short period of time but eventually further evidence clarifies the truth. Hooray. Seriously, I donât see your point â it is widely acknowledged that science is imperfect and studies can have biases. We know this. Ioannidisâ contribution to the debate is welcome and taken seriously within scientific circles. There are ongoing efforts to improve on this in the form of meta-analyses and this is the entire point of the Cochrane Collaboration.

I respect Andrew Wakefield for calling attention to the possible connection between vaccines and autism and for standing up to severe criticism and much more.

â¦and the fact that he faked his data and has continued to push his theory despite a complete lack of compelling evidence? The fact that he planned on developing a competing vaccine and told no-one? The fact that he was funnelled children by a law firm looking to launch a class-action lawsuit? The fact that no-one has been able to replicate his results? You respect him? Why? For his persistence? May I suggest you transfer your respect to the hard-working researchers who persist in the time-consuming and tedious work of doing actual research? How about you respect his persistence while rejecting his conclusions? That seems more sensible.

I think that both he and The Lancet erred in encouraging the public to view this as a landmark conclusive study. Again, I fault The Lancet and their peer review process more than Dr. Wakefield.

The Lancet thought they had a compelling public health issue, based on the statement of someone who they did not know was an active fraud. Science is terrible at detecting fraud, it is predicated on the honesty of its practitioners.

If you assembled scientists and others used your obvious and considerable experience, intellect and education to present facts instead of thinking up new insults for me and for one another this would be a better place. In the meantime, I will adhere to my right to remain cordial and civil.

Itâs hard to remain cordial when youâre making so many egregiously unsubstantiated points, particularly given the hypocrisy with which you make them. Accusing pharmaceutical companies of bias while admiring a known research fraud? Those are two ideas that shouldnât be in the same head.

For those keeping score, Jay Gordon is at -q and while JohnV and han are tied neck-and-neck at three points apiece. Dr. Gordon, you should really read Mistakes were made (but not by me) by Carol Tavris and Elliot Aronson. I think you are simply digging yourself a deeper hole because you donât want to admit youâve been wrong for years now. I urge you, for the sake of your present and future patients, to read the book and strongly consider how it applies to you. Continuing to believe the same thing in the face of contradictory evidence will just cause further harm and waste more time. All people are wrong many, many times in their lives, and the world is a better place when we admit it. Please, admit even the possibility that you might be wrong, and take a long, hard look at the evidence rather than the conclusion you are defending. Being cordial and civil doesn't mean you are right, it simply means you are nice about being wrong. But you're still wrong.

Wait WLU, is 3 points good or bad?

I respect Andrew Wakefield for calling attention to the possible connection between vaccines and autism and for standing up to severe criticism and much more.

If any additional proof were needed that "Dr" Jay cares not a whit about the truth, is sublimely indifferent to potentially killing off his own patients by the gross, and would have his level of intelligence improved by a double hemispherectomy, here it is.

Lying and making stuff up for profit is now "calling attention to the possible connection between vaccines and autism [which never actually existed, he just made it up for the $$$]."

After Wakefield's fraudulent study of hand-picked cases, real scientists in several countries did one large-scale studies of entire populations of schoolchildren without finding any link between vaccination and autism; and that's without limiting their search to any postulated mechanism. They started in 1999 and continued to at least 2007, with about one a year. A simple search will find them.

@JohnV

When your opponent has a score of -q? Clearly the only answer is "it depends".

When your opponent is Jay Gordon the score doesn't matter because you're both playing different games and it's really about the cheerleaders.

Dr. Jay likes this stuff because:
1) he makes money from gullible parents
2) since he doesn't really have to treat kids, just pretend,
his margins are higher

"Itâs hard to remain cordial when youâre making so many egregiously unsubstantiated points"

Really?? That's the criterion for behaving civilly??

Makes no sense.

Jay

@Jay

Umm, so are you going to, y'know, post something about the actual topic of the thread? Or are you going to continue to post irrelevant complaints?

Speaking of making sense, Jay said:

"If you assembled scientists and others used your obvious and considerable experience, intellect and education to present facts instead of thinking up new insults for me and for one another this would be a better place."

Please do present facts, Jay.

As I asked you yesterday:

Which evidence considered in the GMC's case against Wakefield that led to him being "struck off" the medical register do you dispute, Jay? And why?

What findings published by the British Medical Journal do you find "biased" and presumably incorrect, Jay? And how do you reach your conclusions?

What part of Brian Deer's reporting can you factually dispute, Jay?

Facts, Jay. Evidence. Got any?

Jay:

Really?? That's the criterion for behaving civilly?? Makes no sense.

Placing a premium on civility, above substance makes no sense. It may appear civil, but ultimately it wastes time. And considering we all die in a geological eyeblink, wasting time is probably the least civil thing you can do. Civility should be offerred and expected but part of that implied bargain is fair dealing - laying out your assumptions, prejudices, biases and evidence. Being polite to someone while you steal their wallet (or in your case, endanger their children and everyone else their children come in contact with) places a premium on the veneer of civility while doing far more harm than any simple rudeness ever could. By opposing rational, evidence-based vaccination as you do endangers lives. It's also extraordinarily uncivil to pretend to be scientific while actually ignoring the main criteria for science - the steady accumulation of empirical evidence and testing hypotheses against evidence. You sir, are a well-disguised parasite that attempts to claim the credibility of the scientific process while actively working against it for what appears to be your own self-aggrandizement. And part of your camouflage is your deceitful politeness, as if you were the reasonable one rather than an obfuscating, dishonest, hypocritical promoter of pseudoscience. In a choice between talking to a superficially polite, mendacious fool who knows they are right and a foul-mouthed, abrupt, caustic jackass who is interested in finding out if they are right, I will happily choose the latter. So take your Victorian histrionics and shove them up your supercilious ass until you reach your brainstem. If on the way they produce a reference thatâs not a popular news story or blog posting, please let us know. Once again, you have demonstrated your utter, utter inability to produce any statement supporting your beliefs and instead resorted to rhetoric to score cheap points. That may work with Jenny McCarthy but here itâs transparently obvious you are bluffing. Don't give me bullshit about being civil, you have the manners of Hans Landa.

Hitler used rhetoric you know. Do you want to be like Hitler?

Twice in one post? Somewhere out there, Mike Godwin is probably looking annoyed.

WLU, your comment is a thing of beauty. [polite golf clap]
Martini, sir?

@Jay: "Really?? That's the criterion for behaving civilly??
Makes no sense.
Jay"

If that's the limit of the kind of thing you're going to post, and I've been reading here long enough to know that it never gets much more on-point, insightful or responsive from you, I really question why you even bother. Don't you have better things to do with your time?

WLU's post has inspired me to butcher a quote. It's quite appropriate to Jay.

Ok, I've just about had my FILL of concern trolling, evidence manufacturing, insult throwing, child killing, fact ignoring, fear mongering, smart arsed doctors, frauds, and models that continually test my will, mettle, strength, intelligence, and most of all, patience! If you've got a straight answer ANYWHERE in that bent little head of yours, I want to hear it pretty damn quick or I'm going to take a large blunt object roughly the size of Abraham Lincoln AND his hat, and stuff it lengthwise into a crevice of your being so seldom seen that even the denizens of AoA themselves wouldn't touch it with a twenty-foot rusty syringe! Have I MADE myself perfectly CLEAR?!

Thanks, but all the credit must go to Dr. Jay Gordon. I just let him play out the rope until his neck tripped over it.

For anyone who doesn't know who Hans Landa is - look it up. Totally worth it. Possibly the best comparison I've ever made.

WLU - I am currently in hot water in a parenting forum for being mean and uncivil. Admittedly, I have been responding very harshly to various, supposedly innocuous and innocent comments ("just stating their opinion.") Comments such as how they believe in old-fashioned sex roles (their terminology), and they are going to have their sons grow up to be real men. They aren't going to let the children's mothers turn them into girly men by dressing them up in pink and letting them play with dolls (and one guy keeps harping on "wearing dresses;" apparently this is a major concern). They don't want their boys to grow up sexually confused.

(I didn't make any of this up; these are the comments that have been made)

Now, why would anyone object to such an innocent opinion? I mean, what did they say that would justify them being attacked? They are only talking about their views on parenting.

Sure, it's sexist and homophobic bigotry, but hey, they weren't being uncivil to anyone. No need to be mean to them...

I got a nasty note from the moderator. I let her know quite clearly that I am not going to sit back and let this type of bigotry go unchecked, and that insulting me and my family (who have no intention of conforming to old-fashioned sex roles) by insinuating that we are not "real men" is not going be accepted, no matter how flowerly it is stated, nor will I stand by and condone homophobia.

But I'm the uncivil one.

Jay Gordon:

In the meantime, I will adhere to my right to remain cordial and civil.

Very interesting notion of "civility" you have. It's possible that some of the scientists and doctors you routinely tar with your dainty little brush might find your huffiness over namecalling a wee bit hypocritical.

There's a bit more to civility than "politely" calling your ideological enemies corrupt and incompetent. A truly civil person would hold off on such accusations until provided with solid evidence. By that measure, you are almost as far from being civil or cordial as you are from being logically coherent.

@Jay Gordon:

You could just ignore the insulting comments and respond to the non-insulting ones. The fact that you often prefer to chastise insulting commenters over engaging with non-insulting ones is rather aggravating.

Matthew, I answer the questions to the best of my ability.

And, yes, Phila, I think it's well-documented that the "business" of medicine and "science" in general is corrupt. One need look no further than this excellent website:

http://www.propublica.org/article/drug-companies-retain-tight-control-o…

It has a series of articles about very corrupt doctors, researchers and pharmaceutical entanglements.

Tell me what you think, please.

Best,

Jay

More interesting reading about doctors and the industry.

http://www.propublica.org/article/medical-schools-policies-on-faculty-a…

@Jay Gordon:

Matthew, I answer the questions to the best of my ability.

So "why the Lancet peer reviewers are more at fault than Wakefield" is a question you're unable to answer? Or did you simply not see it?

Matthew: Maybe they're not. Maybe the authors and the peer reviewers share equal responsibility for all of this.

Jay

@Jay Gordon:

"Maybe" as in you changed you mind as to how blame should be apportioned, and now have no idea? Or "maybe" as in you still think that the peer reviewers hold the majority of the blame, but you're open to the possibility of being wrong? If the later, you still have answered why you believe that.

@Jay Gordon:

"Maybe" as in you changed you mind as to how blame should be apportioned, and now have no idea? Or "maybe" as in you still think that the peer reviewers hold the majority of the blame, but you're open to the possibility of being wrong? If the later, you still have answered why you believe that.

@Dr. Gordon,

Matthew, I answer the questions to the best of my ability.

The implications of this statement absolutely terrifies me.

My word, you mean money can influence people towards a viewpoint? Good thing we have been discussing that fact on this very blog for years now. Good thing Ioannidis has published a series of articles examining that fact as part of his overall thesis. Good thing journals have put in place conflict of interest disclosure agreements. Good thing more emphasis is placed on large-scale studies with randomized control groups to test compounds. Good thing the Cochrane Collaboration exists. Good thing scientific conferences have enacted policies to reduce the number of booths and the sponsorship by pharmaceutical companies. Good thing there is extensive discussion about this topic in the scientific literature. Good thing Brian Deer spent so much time investigating and reporting on the conflict of interest present in Andrew Wakefield's work, which again was accepted for publication by peer reviewers under the assumption that the data was not blatantly fraudulent and further biased by two undisclosed financial conflicts of interest.

And again, the peer reviewers do not deserve blame equal to Wakefield. Peer review is based on the assumption that the author is not falsifying their data. The job of a peer reviewer is to evaluate methods, interpretation and discussion, not question whether the author is lying. So no, though the peer reviewers may have made errors in the rigour of their interpretation, the publishers may have gone to the public far too early, the press may have reported the matter far too credulously, overall it is Andrew Wakefield who bears the majority of the burden for faking his data in the first place.

Also, do you not see the irony in making the statement that "science and medicine are generally corrupt" when linking to an article discussing efforts to reduce that corruption? And in the context of this post by Orac, do you realize the answer to corruption and bias is better data rather than integrating nonsense with actual medicine? Or in the larger context, giving up on science or embracing a known fraudster because you like the answer he arrived at with his fraudulent data? If the question is "how do we reduce bias and produce better science for decision making", how can your answer be "start with an assumption and never, ever let it go no matter how many studies contradict it"? Your approach compounds an existing set of problems, claiming "all science is biased" then picking the results you want certainly doesn't help. What should we return to, divine revelation? Because that's the approach you seem to be advocating for. Please, tell us how your system will let us know who to believe. Is there a pope? Can there be heresies? Will there be a college of cardinals to adjudicate disputes?

Jay said: "Matthew, I answer the questions to the best of my ability."

Well, that must explain why Jay has not answered my questions about what evidence he uses to dismiss the findings of the GMC and the British Medical Journal (as well as the investigative reporting of Brian Deer) regarding the gross malfeasances of Andrew Wakefield. He wasn't ignoring me (that would be rude and lacking in cordiality and civility).

That leaves the obvious conclusion that Jay lacks the ability to provide any facts in support of his views. Instead Jay goes off into further hijacks about how medicine is corrupt.

So, failing to provide any evidence as the basis for his opinions, Jay falls back on insinuating that physicians as a group can't be trusted (earlier he dismissed Deer's reporting with the claim that he's "biased").

This however falls well outside the bounds of acceptable behavior of which Jay professes to be a shining example. Insinuating institutional corruption and lack of professionalism on the part of Wakefield's critics without providing any evidence of same is extremely uncivil, not to mention being the antithesis of cordiality. Far worse than simple name-calling, most would agree.

Sadly, we will need to look beyond Jay to other models of decorum. :(

Jay Gordon:

Tell me what you think, please.

I think it's a legitimate problem about which you have nothing intelligent to say, and for which you have no solutions. I also think you're opportunistically trying to use issues like these in support of beliefs, attitudes and methodologies that have equally serious problems, and far fewer benefits.

People being what they are, anyone can find easily examples of "scientific" wrongdoing, or any other kind. It doesn't make you right. Or honest.

"You guys should educate yourself about CAM because your patients will be asking you about it. If you purely disregard all their concerns, they will not trust you anymore."

Don't worry, patients don't trust doctors anymore. Why do you think this blog exists? They can't get patient's trust back so really all that is left to do is to try and make patients trust naturopaths even less than allopaths.

Here's another question that Jay Gordon, MD, FAAP has not answered: what do any of your posts have to do with Orac's article? Do try to stay on topic; it's the civil thing to do.

"They can't get patient's trust back so really all that is left to do is to try and make patients trust naturopaths even less than allopaths."

Nah, the thing to do since we can't beat 'em is join 'em, like our formerly major universities which are showing the way.

I am personally in training to be America's first homeopathic pathologist. I will have a special microtome to cut tissue for slides into such small pieces that there is not a single molecule of the original biopsy left. That will make my diagnoses immensely powerful.

I am personally in training to be America's first homeopathic pathologist. I will have a special microtome to cut tissue for slides into such small pieces that there is not a single molecule of the original biopsy left. That will make my diagnoses immensely powerful.

Forensic Homeopathologist offers Police âalternativeâ evidence, suspects:

When Detective Inspector Craig King hits a dead-end with conventional investigative police-work, he knows where to turn. Forensic homeopathologist Simon Yates.

@166 LOL!