Respectful Insolence

As a cancer surgeon, one aspect of the infiltration of quackademic medicine into academic medical centers that bothers me more than most others is how willingly academia has been to “integrate” quackery with science-based oncology to form the bastard stepchild known as “integrative oncology” that has metastasized to numerous cancer centers that should know better. Metastatic deposits of quackademia have infiltrated the University of Texas-M.D. Anderson Cancer Center, UCSF, Memorial Sloan-Kettering, and many others. It’s quackademic medicine victorious out there; or at least so it seems.

Yet, sometimes we forget that, for all the progress that “integrative” medicine has made into respectable medical institutions, things are not entirely as bad as they seem. It may seem that “integrative medicine” (IM) reins supreme, but thus far it’s still a fairly small proportion of medicine, at least compared to science-based medicine. Moreover, reliable data are hard to come by; so it’s not even clear how fast it’s growing as a segment of the medical business. However, there are many indications that it is growing, including the story I blogged about just the other day, where “alternative medicine” has become such a lucrative segment of the local business in Asheville that the city leadership is working to promote its growth. Couple this with the undeniable infiltration of what used to be considered quackery into medical schools and academic medical centers up to and including fellowships in woo and the very existence of the National Center for Complementary and Alternative Medicine (NCCAM), the picture is definitely far more consistent with increasing use of “integrative” medicine, rather than decreasing use.

Still, advocates of IM feel an almost–dare I say it?–evangelical need to proselytize, and one of their favorite techniques is to repeat constantly just how popular IM is, unleashing a relentless stream of argumentum ad populum to make it sound as though only close-minded curmudgeonly skeptics who don’t want anyone to feel better, so dogmatically tied to a completely narrow view of science are we. (I wonder how long it will take that sentence to be quote-mined.) This leads to articles like the one I saw yesterday in–where else?–that wretched hive of scum and quackery, The Huffington Post. We’ve met the blogger before, “Dr.” Nalini Chilkov, an acupuncturist and practitioner of traditional Chinese medicine whom we’ve met before who promoted a testimonial by Hollie Quinn, who was convinced that she had cured herself of breast cancer. Chilkov posted a paean to IM entitled Why 80 Percent of Cancer Patients Use Integrative Medicine.

Before I get into the article, let’s be reminded who Chilkov is again:

Dr. Nalini Chilkov, L.Ac.O.M.D. combines her diverse training in Traditional Oriental Medicine, Modern Biomedicine and Cell Biology with 30 years in private practice.

Dr. Chilkov primarily serves patients with cancer and complex, chronic
illnesses alongside her Optimal Health and Wellness practice.

She is a respected expert in Collaborative Integrative Cancer Care known both for her meticulous attention to detail and individualized treatment plans as well as her warmth and compassion.

Dr. Chilkov is a seasoned clinician and an innovator building bridges between modern and traditional healing paradigms, partnering with physicians to provide best outcomes for patients. She has been a lecturer at the School of Medicine at UCLA and UC Irvine in California as well as many schools of Traditional Oriental and Naturopathic Medicine over her long career.

Oh, goody. The scary thing is, Chilkov not only cares for cancer patients; she “specializes” in cancer, offering all manner of woo to cancer patients, including traditional Chinese medicine and acupuncture, as well as “integrative functional medicine,” a truly frightening concept based on “functional medicine.” And, boy, is she anxious to convince you that “everybody’s doing it”:

Approximately 83 percent of people with cancer use at least one complementary and alternative medicine (CAM) modality (11).

It even has a reference! So I looked it up. As you might imagine, it’s pretty thin gruel. Basically, it’s a followup to an oft-cited study from 2000 of IM usage among cancer patients. This study suffers from the same problems that many studies of IM usage suffer from, including selection bias (people who agree to take place in the survey are more likely to be IM users) and the inclusion of “spirituality” and psychological support therapies (the latter of which is not–or at least should not be–anything other than science-based) as being part of “alternative” medicine. Another problem is that “complementary and alternative medicine” CAM is a political/ideological entity, not a scientific one. It’s a category of unproven, questionable, unscientific, pseudoscientific, or even downright fraudulent health practices lumped together more because they are outside of science rather than because they have any good evidence or science supporting them. These modalities are often then mixed together with what should be perfectly respectable, science-based modalities, like diet and exercise, co-opting them in order to provide a patina of plausibility. As I’ve said many times before, diet and exercise, among other things associated with CAM, are the Trojan horse. Out of their belly leaps the quackery, such as naturopathy, homeopathy, reiki, and many others. A further advantage to CAMsters of this approach is that it inflates the apparent numbers of CAM users, making CAM seem a lot more popular.

Be that as it may, CAM usage is probably considerably lower than reported in this study, although admittedly distressingly high, even excluding prayer and spiritual modalities. For instance, just last month Paisley et al reported that 82% of pediatric patients whose tumors had relapsed used CAM. However, looking at the numbers, I see that this was a small study (only 54 patients) and that CAM usage was by far dominated by prayer/spiritual healing (83%), supplements (31%), and diet (19%). If you look at the more “out there” bits of woo, acupuncture, “detoxification,” aromatherapy, and mind-body treatments all hovered around 6-8%.

Back to Chilkov. The rest of her post is a mish-mash of familiar CAM/IM tropes, mixed in with irresponsible health advice for cancer patients. For example, we get all the usual rhetoric about “empowerment” of the patient. Patient empowerment is, of course, not woo, but it is often equated with choosing CAM/IM, the implication being that CAM/IM use “empowers” patients somehow in a way that scientific medicine does not. Of course, if choosing to shoot coffee up my butt multiple times a day is “empowerment,” I think I’ll choose enslavement. Jests aside, “empowerment” is not really empowering if you are not provided with truly informed consent, which means a realistic assessment of risks and benefits based on science and evidence, not wishful thinking and prescientific beliefs. Yet, here we go with the rhetoric equating CAM with “taking control”:

Using my experience as a health and wellness expert, I have compiled a list of what cancer patients say about the choices they make regarding cancer treatment:

To be proactive, to take control, to take charge of decisions that affect my care, my health, my experience, my results and outcomes.

To participate in my own care and my own decisions rather than giving power to make all decisions away to my care providers.

To feel a sense of empowerment rather than be disenfranchised and disempowered.

To decrease and manage my fear, stress and anxiety and to support, increase and improve my peace of mind.

To ask my care providers to work with me as a team and to show respect for my values, my feelings and my choices in all decisions.

Once again, the use of “conventional” science-based medicine does not preclude any of these things, but Chilkov feeds the myth that they do, because it allows her to paint her favored woo as “breaking the shackles.” Not coincidentally, it feeds the self-image of CAM users as being “smarter,” “more independent,” and less of a “sheeple” than the rest of us drones who actually listen to our doctors. It also feeds their self-image that they are special, different, and, above all, “unique”:

I choose to reject an approach based solely on a ‘war on cancer’ that only targets my cancer tumor cells and neglects the whole person and the environment.

I choose a comprehensive care approach using a wide range of therapies, tools and resources from many traditions and many points of view.

I choose individualized and targeted care which views me and my cancer as unique and in which decisions and choices are based on a careful analysis of the traits and characteristics of my cancer cells and my unique physiology, genetics and risk factors rather than a generic one size fits all approach.

Uh, Nalini, baby. We practitioners of science-based medicine already do “individualize” and “target” our care, and we do a lot of research to try to figure out the best way to do it. (For just one example, there’s this study.) The difference between us and woo-meisters like you is that we tailor our treatments for our patients based on actual science and evidence. Unlike woo-meisters like “Dr.” Chilkov, we do not “make it up as we go along, which is basically what practitioners like Chilkov really mean when they refer to “personalized” care or “tailoring” their therapy to their patients’ uniqueness. In reality, the appeal to the individualization of therapies is nothing more than intellectual laziness. Chilkov no more knows what it means than she knows anything about science. All she knows is that it sounds good and it appeals to her natural customer base. It’s what they want to hear.

Comments

  1. #1 Krebiozen
    March 24, 2011

    I’m sure many of the CAM modalities do make patients feel better. I think that’s why humans seem to like rituals so much; they distract us, and make us feel as if we are doing something useful when we feel we have lost control. The danger is that we will conflate feeling better with actually being better, and will attribute our improvement to an imaginary supernatural power, or entity.

    What also concerns me about integrative medicine is that when conventional therapies work, it is the CAM component that is often thought to be responsible by the patient, and sadly sometimes the doctor. Almost any testimonial for a CAM cancer cure you look at closely demonstrates this process:

    Get conventional treatment, add in some CAM treatment during or after the conventional treatment, improve, claim the CAM did it, get an “I cured my cancer naturally” website, write book, market range of natural products that cured your cancer.

    Then some unfortunate person with cancer reads these glowing testimonials and decides to do without the real treatment altogether…

  2. #2 longsmith
    March 24, 2011

    I have a friend whose mother has pancreatic cancer. While they are treating it conventionally, they also participate in some program that includes herbal therapy, yoga and “traditional” medicine. At $1,000.00/week! I am sad for I love this woman, who is in deep denial anyway, but the waste of money is mind boggling. And yet these “practitioners” also rail against big pharma only wanting money. Pot meet kettle.

  3. #3 Dangerous Bacon
    March 24, 2011

    I take “supplements” (a multivitamin) and am trying to eat more fruits and vegetables (dietary intervention).

    Obviously I am heavily into CAM.

    Orac should try Dr. Chilkov’s individualized approach instead of the typical cut-burn-poison tell-patients-they-have-two-months-to-live and send-them-home-to-die oncology paradigm that everyone seems to use except Cancer Treatment Centers of America and integrative docs like Dr. Chilkov.

    Science is cold and uncaring, integrative is warm and fuzzy. Marketing, baby.

  4. #4 squirrelelite
    March 24, 2011

    @Dangerous Bacon,

    I remember that same ad for M.D. Anderson. I was immediately doubtful that the doctor really told them that.

    But, it does make good ad copy.

  5. #5 squirrelelite
    March 24, 2011

    I am also curious how she measures whatever it is that she “optimizes” with her Optimal Health Care?

  6. #6 Militant Agnostic
    March 24, 2011

    squirrelelite

    I am also curious how she measures whatever it is that she “optimizes” with her Optimal Health Care?

    I think her accountant does the measuring of what she optimizes.

  7. #7 squirrelelite
    March 24, 2011

    Quite likely!

    It reminds me of the original defense of why practitioners of chiropractic weren’t supposed to need to be licensed as medical doctors. They weren’t really practicing medicine, they were just businessmen selling a service. (or something to that effect)

  8. #8 prn
    March 24, 2011

    CAM is…[long denunciation, uniformly negative] Yes, there are frauds and superstitions, that perhaps abound. There are also obscured opportunities, some that reflect the history, and future of effective, biologically based medicine, some that offer here and now advantages. The uniformly negative stridency, extended by categorization to areas with some technical literature, is misplaced.

    We practitioners of science-based medicine already do “individualize” and “target” our care
    I am sure the expectations are different. The options offered, as a professional discipline, are much more narrow than the literature, including that co-opted by some CAM providers.

    My limited experience, as well as other “civilians” that I’ve talked with, has been that individual doctors offer more focused selections, that often seem to focus even more narrowly on certain procedures or companies that can be correlated with income premiums, rather than individual optimization of patients’ results.

    CAM supplements, foreign medicines, off label generics, and herbs often appear to fill physiological needs at low cost for problems poorly served, overlooked or unaddressed by conventional providers and conventional treatment recommendations.

  9. #9 Dangerous Bacon
    March 24, 2011

    prn: “CAM supplements, foreign medicines, off label generics, and herbs often appear to…focus even more narrowly on certain procedures or companies that can be correlated with income premiums, rather than individual optimization of patients’ results.”

    Fixed that for you.

  10. #10 Composer99
    March 24, 2011

    prn @8:

    What makes an off-label generic drug CAM, exactly?

  11. #11 Todd W.
    March 24, 2011

    @prn

    CAM supplements, foreign medicines, off label generics, and herbs often appear to fill physiological needs at low cost for problems poorly served, overlooked or unaddressed by conventional providers and conventional treatment recommendations. [emphasis added]

    That “appear” is the problem. They may seem to fill patients’ physical needs, but the reality is that, more often than not, they don’t. And even the low cost can be a bit of a mirage. Most sCAM options are not covered by insurance, which means the patient ends up personally paying a lot more for their care than they might otherwise.

  12. #12 Denice Walter
    March 24, 2011

    I suspect that the much of the public’s so-called desire for IM is simply creative marketting produced by our ever prolifically vile woo-meisters.

    If you peruse any of the popular woo sites I follow, you’ll discover articles, special reports, “white papers”, films, as nauseum, focused on cancer and the “inadequacy” and “fraud” of SBM. Indeed, Mikey has taken on Carolyn Dean as a featured writer. Interesting background, hers: MD, lost certification in Canada, moved to the US, went ND, wrote a book with Null & cronies,”Death by Medicine”( see Quackwatch/ Other Individuals).

    It appears that there is a small coterie of doctors ( real, disgraced, or imagined) whose pearls of “medical wisdom” are thrown about like fertilizer by those (not so) “young dudes who carry” the woo **. Dean, Tenpenny, Blalock, Brezinski, Gonzalez, et al, show up incestuously over woo-ful sites. Not pretty at all.

    You can present a convincing case if you make up data and studies to support your idiosyncratic ideas . It’s called *fiction*.

    ** my apologies to Mr. Bowie.

  13. #13 palindrom
    March 24, 2011

    I particularly liked the point that she made about using “safe, non-toxic” treatments. She didn’t say anything about such treatments actually being efficacious, though.

    It’s occurred to me that the seeming obsession with ‘health’ among the New Agers is an odd form of narcissism. Obviously, cancer is a hugely big deal, but the amount of nattering from the New Agers about therapies for minor ailments and optimizing their ‘health’ strikes me as, well, unhealthy. Just get on with it.

  14. #14 Scott Cunningham
    March 24, 2011

    Whenever I see the CAM appologetics start here, I rember a Far Side joke.

    For what was to be a short-lived experience, a chicken, tied to a red balloon, drifted into a samauri bar.

    Prn writes:

    Yes, there are frauds and superstitions… There are also obscured opportunities

    And how do we know which are which? Come on Prn, you know this one. Scientific evidence.

    And what do you call alternative medicine that actually has some demonstrable effect? Medicine.

    When you say

    The options offered… are much more narrow than the literature

    You’re right. Because not all studies are created equal, and those that can’t be reproduced, run contrary to basic highschool level scientific knowledge or are routinely supported by emotional pleas and politics and sheltered against contrary evidence by their supporters don’t belong in medical practice.

    You write:

    CAM supplements, foreign medicines, off label generics, and herbs often appear to fill physiological needs at low cost for problems poorly served, overlooked or unaddressed by conventional providers

    In my neighbourhood we’ve got two CAM providers who advertise herbs and other CAM for sins in past lives, Morgellon’s disease and auricular blockages. You’re damn right CAM offers treatment for problems not addressed by conventional doctors. They’re not addressed because nobody’s ever demonstrated that the problems are real.

    There’s one tiny niggling detail I have to disagree about though. Low cost. CAM can fetch a very large bill. Especially if you consider all the return visits for more Reiki, angel therapy and past-life regression because the ailments have no symptoms and the treatment no objective end point.

  15. #15 Denice Walter
    March 24, 2011

    @ palindrom: Sure. Looking at the intricate regimes of “pure food” and “perfect exercise” promulgated by woo- aficionados, I’d concur: it’s a form of self-worship and perfectionism hinged on orthorexia and divorced from reality-based health information.

    Funny thing: I was just “handed a brochure”(figuratively)about a spa in NY state ( the New Age Spa @ Neversink/ it has website ). You can spend a day or two immersed in luxe contemplation, exercise, treaments, and pure food, i.e. infuriatingly precious nonsense at high cost. Needless to say, I’ll pass. ( I am a narcisscist, but a sane one).

  16. #16 Beth
    March 24, 2011

    “Once again, the use of “conventional” science-based medicine does not preclude any of these things”

    I agree, but neither is it required. Sadly, too many doctors fail to do these things and leave patients to seek out others – usually CAM providers – to provide them with the empowerment and respect they aren’t getting from their science-based medical providers.

    Does medical training include classes to help people become doctors who will do so?

  17. #17 sadmar
    March 24, 2011

    that wretched hive of scum and quackery, The Huffington Post.

    Yep, it’s another of my ‘the argument is stronger if you don’t over-reach posts.’ Would it hurt Orac to say “that wretched hive of scum and quackery, the Health section of The Huffington Post” so as not to PO all the folks who read the other sections and never even look at the woo stuff?

    Me, I don’t like HuffPo because it’s got a wretched layout and most of the stories and comments are superficial. And, of course, Arianna Huffington scares the shit out of me, since I remember the days when she was pimping for Newt Gingrich (I mean that figuratively, but with those two, who knows), and trying to get her Chauncy Gardner hubby into the Senate to boost her own influence, and no doubt advance the programs of Rajneesh and/or John-Roger.

    Nevertheless, HuffPo is a massive content aggregator, presenting the work of many fine journalists (along with many not-so). It’s just not, well, accurate to paint the whole thing with a broad bush, and that inaccuracy is going to alienate many readers who don’t yet have a stake in the CAM-wars, thus putting off potential allies in the fight against woo.

    It remains to be seen how the AOL buyout of HuffPo will affect Ms. Huffington fame/power/balling. Will John-Roger be pulling the strings at AOL, or HuffPo become more ‘mainstream’ wile Arianna takes her newfound billions off to do something else.
    And, yeah, the whole Michael Huffington thing is completely consistent with (if not utterly predicted by) Jameson and Baudrillard, for yet another instance of PoMo corresponding to actual empirical facts, and laying a theoretical basis for a critique of the rise of woo.

  18. #18 Pablo
    March 24, 2011

    Sadly, too many doctors fail to do these things and leave patients to seek out others – usually CAM providers – to provide them with the empowerment and respect they aren’t getting from their science-based medical providers.

    IOW, those mean old doctors won’t lie to patients and blow fluff up their skirts.

    But the CAM people will.

    (then again, maybe I should get some clarification. Exactly what “empowerment” are CAM practicers giving patients that doctors are not?)

  19. #19 Beth
    March 24, 2011

    “Once again, the use of “conventional” science-based medicine does not preclude any of these things”

    I agree, but neither is it required. Sadly, too many doctors fail to do these things and leave patients to seek out others – usually CAM providers – to provide them with the empowerment and respect they aren’t getting from their science-based medical providers.

    Does medical training include classes to help people become doctors who will do so?

  20. #20 sadmar
    March 24, 2011

    Hi Beth:
    I think there have been historical changes in medical practice that have resulted in physicians becoming more distant and emotionally disconnected from patients, and thus leaving an opening for woo. Training might help, but I don’t think that’s the root issue.
    I’m 57, and in my youth I didn’t know anyone who did not have a good relationship with their family doctor. It WAS very Marcus Welby then. And if you went into the hospital, the nursing staff was usually very nice and supportive as well as skilled.
    Of course, since then medicine has been corporatized, physicians proletarianized, and the insurance companies run everything. Internists come out of med school with massive debt from student loans, and go to work for HMOs or large medical centers where they are given an overload of patients and are forced to turn and burn all appointments to stay on schedule. I.e., primary care has become Taylorized, and there’s no time for bedside manner even if the Doc wants to have one.
    Hospitals are worse, as the insurance companies force them to operate with maximum capacities and minimum staffs. I was taken to the ER 11 months ago for stroke-like symptoms. They didn’t have an MD there who did that, so they put me in front of a videoconference thing that looked like something out of 12 Monkeys. I could see the Dr. (who was 60 miles away) and he looked utterly bored, exhausted, and annoyed.
    They got me past the crisis stage, but decided I needed to be admitted. I was there on the gurney in the ER, alone, for 11 hours before a bed opened up. Not that the hospital was actually full, but because they have to close down any wings that aren’t full due to how the insurance works.
    I was there 3 days, I never saw the same medical provider twice. The Dr-ish guy (I don’t know if he was a resident, an intern, a med-student, a PA…) who admitted me misdiagnosed me, (ignoring the key element of of my medical history I had provided him.) As my condition declined under the exactly-wrong treatment they were giving me, I rang for the nurse several times. An aide would come, and say she would go look for a nurse, who then might or might not appear in the next hour or two. When I asked to see a Dr., they told me ‘the Medical Specialist will be by on her rounds at lunch-time tomorrow.”
    Totally anecdotal evidence, of course. It would have helped if Doc-ish had actually listened to me and not been so arrogantly confident, but the problems seem way more systemic than any kind of sensitivity training in med schools could address. (Though “it wouldn’t hurt.”)

  21. #21 Beth
    March 24, 2011

    Sorry about the double post.
    Pable said:

    (then again, maybe I should get some clarification. Exactly
    what “empowerment” are CAM practicers giving patients that doctors are not?)

    I don’t know since I don’t visit CAM practicers. I can only state that my experience with doctors/hospitals is they basically have ignored my requests regarding any deviations from their normal procedures. This relates specifically to requests during birth/newborn care as that is my main experience with hospitals. I did not feel empowered or my choices respected. In fairness, my youngest is 11, so it’s been a while.

    I am mostly healthy and my main interaction with doctors is seeing my physician for yearly physicals. One reason she’s my physician is I feel she does empower me by giving me options and choices and respecting my decisions. As I said I agree that conventional medicine/doctors are certainly capable of doing so.

  22. #22 Yojimbo
    March 24, 2011

    @17 Pablo
    I’m not sure the “empowerment and respect” beth mentions are real factors – the key is what’s often called “nurturing”, i.e., hand-holding and warmth and time spent with the patient. The problem is economics – most standard care facilities have to diagnose, treat and move on to the next patient, and don’t have the manpower to have doctors spend time cheerleading.

    If people really want some “mother love” to go with their medicine they can get it from the sCAM people. Sadly, that’s about all they do get. But if our system had the wherewithall to have doctors do intensive nurturing along with the actual care, it would go a long way to undermining “alternative medicine”.

  23. #23 sadmar
    March 24, 2011

    those mean old doctors won’t lie to patients and blow fluff up their skirts.

    So ‘truth’ is enough justification for those who treat patients like meat or, worse, like shit?

    Exactly what “empowerment” are CAM practicers giving patients that doctors are not?

    I believe, in the non-scientific world, that would be referred to as empathy, compassion, respect etc. (or the illusions thereof). That this seems to be enough to get large numbers of people past the tipping point where they turn to quackery ought to be a sign that ‘Houston, we have a problem.”

  24. #24 Pablo
    March 24, 2011

    I believe, in the non-scientific world, that would be referred to as empathy, compassion, respect etc.

    How is any of that “empowerment”?

  25. #25 Blasphemous_Kansan
    March 24, 2011

    It seems to me that rather than providing “empathy, compassion, respect etc. (or the illusions thereof)” and calling this empowerment, CAM providers actually are quite adept at selling the illusion of empowerment.

    And regarding Sadmar’s ridiculous false dichotomy about ‘truth’; the ‘truth’ is justification enough for those interested in tried and tested, real world, solutions to real health problems, but not justification for the actions he speaks of. It’s justification for wanting to effectively help someone as quickly and efficiently as possible so that the next person can get their help. The delivery of the ‘truth’ and the treatment of people like meat seem wholly unrelated, outside of his anecdote, which, while definately unfortunate, seems to have embittered him, somewhat.

    I’m reminded of the Futurama episode when Fry desperately tries to find Bender with the help of a robotic fortune teller:

    Fortune teller: What? Don’t you want any false hope?
    Fry: Well, only if you don’t have any real hope!

    BTW long-time reader and first time commenter here! Hi Orac! Keep up the good work!

  26. #26 Scott Cunningham
    March 24, 2011

    How does CAM empower its patients?

    From what I’ve seen of CAM promotional magazines, CAM storefronts and CAM websites, they do it by saying they “empower the patient!” or let them “take charge of their own health!” over and over again.

    It’s kind of like how politicians are pro-growth and pro-business.

    Politician: “I’m pro-growth and pro-business!”

    Journalist: “Do you have any substantive plans in mind?”

    Politician: “Yes, I’m going to keep shouting that I’m pro-growth and pro-business!”

    CAM empowers its patients. I’m siding with the angels. God save the Queen. The Maple Leaf Forever.

    It’s basically patriotic white noise.

  27. #27 Finn
    March 24, 2011

    It’s worse than that; “empowerment” is merely a euphemism for “manipulation.” I don’t understand how passively waiting for a doctor to offer options and choices amounts to “empowerment,” any more than choosing a CAM “treatment” lacking evidence of its effectiveness does. Anyone who feels “empowered” by these has just been manipulated into the false feeling that they’ve taken charge.

  28. #28 mende
    March 24, 2011

    But, I thought tumors could “literally disappear” by “destabilizing solidifying imbalance” to “restore balance.” It’s “mysterious” but, it is a “demonstrable effect.”

    (And it can be had by being in my presence for $240 an hour. I won’t talk to you for that hour, but you can feel the blessing of energy from my Chinese medicine and plant spirit knowledge.)

    http://www.vimeo.com/20656585 (1 min. 30 sec. into video)

  29. #29 sadmar
    March 24, 2011

    Blasphemous:
    You seem to have completely misunderstood my point. Look closely at the language. I make no dichotomy whatsoever. Observing that solid science does not excuse poor behavior does not draw a dichotomy between the two, but asserts exactly the opposite: that there is no necessary dichotomy between them.
    And did you not see the words “illusions thereof” in my post? Time to visit the optometrist maybe?
    I happen to find the term ‘empowerment’ an extremely annoying buzzword, because it refers exactly to how in-control-of-their-lives people FEEL, without reference to how in-control they ARE. One can, as CAM suckers no doubt are, be utterly powerless, and ‘empowered’ at the same time.
    (Perhaps you didn’t know that, and made the reasonable assumption the term referred to actual power. Nope. BTW, this actually did float out to the mainstream from some of the bullshit branches of American Cultural Studies, sorry to say [the Brits would never be so squishy]…)
    And I have to ask, “What’s the matter with Kansas!” as yet again another self-identified champion of science and reason utterly stereotypes me and makes totally unsupported assumptions about my thoughts and intentions.
    And, to point out what should be obvious, what empathy compassion and respect have to do with ‘empowerment’ is that they address the patient as a subject, not an object. You cannot be anything but disempowered (in every sense) if you feel like an object, and you can’t even entertain illusions of self-control unless you feel like a subject. (If you don’t know what ‘subject’ and ‘object’ mean in philosophy, go look it up.)
    And if you think the hospital was just being ‘efficient’ you have GOT to stop putting hallucinagens in your Kool-Aid. Like I said, I’m 57. I’ve been taken to the hospital quite a few times. I’ve been triaged, waited long times to be seen while the Docs tended to more urgent matters. I totally get that, accept that, and that’s not what I’m talking about. I should have noted, I guess, that my recent experience was not idiosyncratic. All the other patients in the ER who were to be admitted faced ridiculously long waits for beds to open, and I discovered the connection of this to insurance policy by talking to the staff, who told me that this goes on all the time, every day.
    So yes, I’m pissed-off about that experience. Embittered about medicine in any general sense? No. You could talk to my internist, my gastric surgeon, my cardiologist, my ottorhinolaryngologist, my orthopedist… all of whom find me a charming and cooperative patient.
    I would think that if science taught people anything, it would tend to dissuade them from simplistic black-and-white takes on human affairs, and enable them to see more gray areas. But there’s so much irrational absolutism here: “if you’re not with our Skeptic Program 100%, you must be one of THEM!” Please, get a grip.

  30. #30 Yakamoz
    March 24, 2011

    @Sadmar,
    I have had very similar experiences. Once I was in the hospital for 3 days because I was in extreme pain and lost function in my arms. They thought I had meningitis, then slipped disc in my back. After a spinal tap and an MRI did not confirm their guesses, they decided it must just be an anxiety disorder and discharged me.

    This left me disabled for 2 years until an otolaryngologist finally put the pieces together and diagnosed a rare bone malformation that they could have diagnosed from the MRI, if they’d spent 2 minutes thinking outside the box.

    And that was only after I’d studied enough anatomy to say, “My medial-pharyngeal muscles are not contracting efficiently, and my hyoglossus muscle is constantly spasming without meds.”

    Oh and the bill for their 3 days of bumbling doctors giving me one 5 minute misdiagnosis after another? $31,000 fucking dollars. Thank god for my union insurance. Two years later, this same hospital misdiagnosed an endometrioma as appendicitis. Without insurance, that would have given me a $51,000 debt. For their fuck-up.

    I love science based medicine. Insurance-based medicine, not so much.

  31. #31 Blasphemous_Kansan
    March 24, 2011

    sadmar:

    I’m completely open to the possibility that I missed the point of your post. Perhaps because the first part of it had no point, other than to underscore your bitterness, and in the second part you supplied your working definition of ‘empowerment’. Did I get it this time? In your post, I did not see language that said “good science does not excuse bad behavior”. This I agree with, and I resent your strawman implication to the contrary. What I saw was an implication that a doctor who would not hold a patient’s hand in every conceivable emotional way was treating that patient like meat or waste. If you did not intend to make this implication, it could have easily been avoided for someone as well-versed in communication as you.

    Regarding ‘illusions’: yes, I noticed this, and this was why I chose my phrasing. To highlight that CAM practitioners are often in the business of selling therapy for the mind, and not the body (as their paying clientele would believe). As such, I was agreeing with and adding to your point. I thought this was obvious, but if it wasn’t I apologize.

    Regarding empowerment: I think you could have let on what definition of empowerment you were using at the beginning, and saved me the misunderstanding. However, I don’t believe that the two instinces of empowerment you cite are necessarily mutually exclusing (perhaps you didn’t know that?). You say my assumption was reasonable, yet spend the last 3/4 of your post doing your darndest to insult me for making it (and failing, as that was not the assumption that I made. See mutual exclusivity above).

    “What’s the matter with Kansas?” Lots. Just like everywhere. I would love to see where I championed myself as anything, or stereotyped or labelled you as anything, other than raising the possibility that you are bitter (this was done by use of the qualifier ‘seems’ in my comment. This opens the possibility that you are not angry or bitter!! Given this, it doesn’t really seem like I labelled you as anything.). Since the rest of your post goes on to elaborate on your rage, I’m not sure if you can foul me on that one.

    To your philosophical bloviations, I have no comment as this goes back to your selective use of ‘empowerment’, which you chose not to make clear until 28.

    I obviously also cannot comment on the specifics of your experience, or as to what a charming patient you no doubt are, so I’m not sure why you chose to include it. Your experience is still very unfortunate, and very anecdotal.

    At the end of the day it really seems like we agree on more than we disagree on, but you’ve chosen to harp on this because I wasn’t using your pet definition of ‘empowerment’. Of this I’m guilty. As guilty as you are of not specifying it in the first place. Looking through past threads, it seems that other readers have noticed the frustration that you exhibit when someone fails to understand the subtleties in one of your arguments (subtleties which are not at all clear at the onset).

    Also, do you not think it is in the least bit hypocritical to rail people for alleged stereotyping and labeling in a post where you say this at the end:

    ‘But there’s so much irrational absolutism here: “if you’re not with our Skeptic Program 100%, you must be one of THEM!” ‘. Honestly I couldn’t find a bigger strawman in all of Kansas!

    I humbly request that you, please, get a grip.
    (And I humbly request that someone could demonstrage block quoting)

    Have a good one.

  32. #32 BKsea
    March 24, 2011

    The integrative medicine centers are all about trying to bring in patients – i.e. marketing. To me, the key is to market science-based centers in a way that appeals to patients. If being “integrative” starts to cause your medical center to lose patients, the “integrative” part will be dropped like a hot rock.

    Some buzzwords that come to mind to describe science-based centers: “honesty”, “respect for the patients’ intelligence”, “respect for the patients’ time and money”, “transparency”

  33. #33 Blasphemous_Kansan
    March 24, 2011

    BKsea: I suggest also adding ‘accountability’ to the list.
    One more key difference between SBM and CAM. If you get sick, seek CAM, and stay sick, all too often it’s your fault for not having the right ‘positive vibes’. Kind of like how reiki practitioners are told that the process simply won’t work if they have even a little bit of skepticism! CAM requires patients to close their eyes and ears as a basic operating premise!

  34. #34 prn
    March 24, 2011

    Re rancid bacon bits@9
    CAM supplements, foreign medicines, off label generics, and herbs often appear to…focus even more narrowly on certain procedures or companies that can be correlated with income premiums, rather than individual optimization of patients’ results… Fixed that for you.i
    Mixed bag. I’ve seen bigger examples “mainstream”.

    @10
    What makes an off-label generic drug CAM, exactly?
    Better funded competitors’ marketing and lack of regulatory co-option, as well as lack of funds for testing?

    Todd W@11
    CAM supplements, foreign medicines, off label generics, and herbs often appear to fill physiological needs at low cost for problems poorly served, overlooked or unaddressed by conventional providers and conventional treatment recommendations. [emphasis added]
    That “appear” is the problem. They may seem to fill patients’ physical needs, but the reality is that, more often than not, they don’t. And even the low cost can be a bit of a mirage. Most sCAM options are not covered by insurance, which means the patient ends up personally paying a lot more for their care than they might otherwise.

    Consumerism may be a better approach to deal with both price and effectiveness issues. I wouldn’t know, I don’t pay a lot for most things and I am pretty serious about looking for literature and metrics.

  35. #35 Vicki, Chief Assistant to the Assistant Chief
    March 24, 2011

    prn: The hard part is identifying appropriate metrics.

    Price is not always the best metric, but if it is, you need to find out what you’re really paying, which is not the amount on the paper that Cigna sends me telling me how much I “saved” because of their contract with my doctor (when what I actually pay is a flat $25/visit copay, plus my share of the premiums).

    More to the point, is bedside manner the best metric for a doctor or other medical practitioner? I don’t want a sympathetic but ignorant person at my bedside: I want someone who knows as much as possible about the medical issue and ways of dealing with it, including possible side effects. (I have family to sit there and hold my hand.)

  36. #36 sadmar
    March 24, 2011

    Blasphemous:
    To make a block quote use the tag ^blockquote^ at the beginning, and ^/blockquote^ at the end (except mark the tags with ‘less than’ and ‘greater than’ instead of accent marks.) If you have paragraph breaks in the quote, that can turn the tag off. If so, separate the paragraphs in the quote with break tags: ^br^. I recommend using the ‘Preview’ button below the comments box to check the formatting before you post. I always make lots of typing errors I don’t catch until I see the text in that form.

    If you see an example of something you want to emulate in one of the comments, open a ‘Page Source’ window in your browser, and use Find to look for a relatively unique word in the example, to get past all the scripting language used in the generic page features.
    For example, try searching for this block quote in source view by doing a find for “emulate.”

    Thank you for taking the time to venture a substantive reply to my post. I shall attempt a snark-free rejoinder later.
    BTW, is there any way on this board to send a PM to other posters?

  37. #37 Dangerous Bacon
    March 24, 2011

    “Empowerment” should not mean “I will entertain all sorts of modalities for your treatment, whether or not they are indicated, have any demonstrable value or conflict with the standard of care and avoid criticizing any of them, because I don’t want to be judgmental and it’s more important to me to be seen as your buddy than as the responsible person trained to be your health care provider” (why I am reminded of a certain Brave Maverick Pediatrician?).

    As to who benefits financially from providing cancer care to patients, my earlier post was intended to show that there are business aspects across the spectrum from evidence-based care to CAM. What matters (or should) to patients is deriving a tangible benefit from care. When (as in the case of the “integrative” CAM-rich models I’ve seen) there is little to nothing of proven value and what does work is within the classic purview of mainstream medicine, it is wise to be wary of putting one’s trust in the bearers of woo. Health care dollars are precious enough without blowing them on useless and sometimes dangerous fluff.

    Sorry to see prn venting her hostility by belittling other posters’ usernames. It’s a typical ploy used when one can’t or won’t provide factual rejoinders of value to a discussion.

  38. #38 lilady
    March 24, 2011

    @ Dangerous Bacon: The Brave Maverick Pediatrician “practices” in Santa Monica, California…just down the road from “Dr.” Nalini Chilkov. I cannot figure out where Nalini received her education as her C.V. on the Ho-Po doesn’t state where she received undergrad or graduate diplomas. Hell, I cannot figure out what the “alphabet”..L.Ac.O.M.D… after her name…stands for.

    I visited Hollie Quinn’s websit and viewed her short video which did not locate the particular body part where her cancer was diagnosed. As I went through the blogs on that site she states that she was diagnosed with Stage II breast cancer, it was excised with a a lumpectomy and (sentinel?) lymph node dissection. She also states she had “zero percent” of surviving if she refused chemotherapy because all the “prognosticators” (whatever that means) were abysmal without the chemotherapy. Sorta fudging with that statement. She also fudges with the facts when she doesn’t mention if she received radiation treatment before the lumpectomy.

    Miracle cure with non-traditional “treatments”, I don’t think so. She underwent excision of the breast cancer, may have had radiation before or after the lumpectomy and we don’t even know what the nebulous “prognosticators” were.

    More woo from Hollie; she doesn’t believe in mammography but opts for full body “thermography”.

  39. #39 sadmar
    March 24, 2011

    Hi Dangerous Bacon:

    Just to clarify, MY earlier query about the derivation of your username was not meant to be sneering in any way. I think it’s a funny name in a good way, and I just wondered what the joke might be.

    Now, I have repeatedly made fun of other people’s usernames, and FWIW, I want to say I do mean it (mainly anyway) as fun. My tongue is frequently in my cheek, and I mean no genuine hostility. My writing, especially in the extemporaneous mode of web forum comments, is characterized by shifts between various levels of irony. This is extremely hard for people who don’t know me to pick up from written text, and it’s still an issue when I compose things through a few drafts.
    It’s my fault. MY communication problem. I write similar to the way I would speak, and if you could hear me, you would probably be able to pick up the verbal cues that indicate the shifts in tone and the various theatrical form of ‘literary voice’ being employed. No amount of emoticons can make up for that. I realize that for this audience especially I should try to be more straight-forward, but it’s just so much a part of who I am that it’s hard, especially given the difficulty I have writing non-extemporaneous pieces due to my health problems.
    So consider this both an apology for my lack of clarity, and a guide for interpreting my tone, which is certain to return to its usual humour sooner or later. I am NOT a troll; I wouldn’t be posting here if I didn’t respect the discussion.
    sincerely,
    sadmar

  40. #40 Denice Walter
    March 24, 2011

    @ lilady : the alphabet soup probably signifies some variant of- “licensed accupuncturist, Oriental Medicine Doctor” ( alt med speak for “twit”)

  41. #41 DW
    March 24, 2011

    Sorry for that double

  42. #42 Narad
    March 24, 2011

    You could talk to my internist, my gastric surgeon, my cardiologist, my ottorhinolaryngologist, my orthopedist… all of whom find me a charming and cooperative patient.

    You have access to the contents of other people’s heads?

  43. #43 sadmar
    March 24, 2011

    I wrote this this morning, and the post didn’t go through. So it’s in the wrong time frame for the flow of the thread. It’s also irony-free, in intent anyway, except for the Gingrich joke…

    that wretched hive of scum and quackery, The Huffington Post.

    Yep, it’s another of my ‘the argument is stronger if you don’t over-reach’ posts. Would it hurt Orac to say “that wretched hive of scum and quackery, the Health section of The Huffington Post” so as not to PO all the folks who read the other sections and never even look at the woo stuff?
    Me, I don’t like HuffPo because it’s got a wretched layout and most of the stories and comments are superficial. And, of course, Arianna Huffington scares the shit out of me, since I remember the days when she was pimping for Newt Gingrich (I mean that figuratively, but with those two, who knows), and trying to get her Chauncy Gardner hubby into the Senate to boost her own influence, and no doubt advance the programs of Rajneesh and/or John-Roger.
    Nevertheless, HuffPo is a massive content aggregator, presenting the work of many fine journalists (along with many not-so). It’s just not, well, accurate to paint the whole thing with a broad bush, and that inaccuracy is going to alienate many readers who don’t yet have a stake in the CAM-wars, thus putting off potential allies in the fight against woo.
    It remains to be seen how the AOL buyout of HuffPo will affect Ms. Huffington’s fame/power/balling. Will John-Roger be pulling the strings at AOL, or HuffPo become more ‘mainstream’ wile Arianna takes her newfound billions off to do something else?
    And, yeah, the whole Michael Huffington campaign thing is completely consistent with (if not utterly predicted by) Jameson and Baudrillard, for yet another instance of PoMo corresponding to actual empirical facts, and laying a theoretical basis for a critique of the rise of woo.

  44. #44 DW
    March 24, 2011

    @ Dangerous Bacon: Instant translation- whenever a woo entrepreneur refers to “empowerment”, he’s referring to his own ability to buy stuff, not to his audience’s mastery-orientation or coping skills.

  45. #45 sadmar
    March 24, 2011

    Narad queried:

    You have access to the contents of other people’s heads?

    No. But I left the TV on the last time I went on a trip, and apparently my cat watched a lot of Oprah shows, because she’s psychic now. When I scratch behind her ears she transmits vibes into my nervous system about her thoughts and those of other people as well. It’s amazing! Not only does she adore me, but so do my physicians, the mailman, and Richard Blumenthal (and I’ve never even met him!). I’ve got to watch out for the Yorkie down the block though. He’s REALLY got it in for me.

  46. #46 Narad
    March 24, 2011

    I’ve got to watch out for the Yorkie down the block though. He’s REALLY got it in for me.

    You had a Berkeley gag within reach there.

  47. #47 rob
    March 25, 2011

    integrative functional medicine is shit.

    you need to incorporate quantum and biomedical:

    quantum biomedical integrative functional medicine

    now, THAT is the shit. QBIFM can 100% cure the following:

    measles,mumps
    gashes, rashes, purple bumps
    wet mouth, dry throat
    going blind in the right eye
    tonsils big as rocks
    sixteen…no seventeen chicken pox
    green faces, cut legs
    intamatic flu
    coughs, sneezes, gasps and choking
    broken legs
    hurt hips and chins
    belly button cave ins
    wrenched backs, sprained ankles
    ‘pendix pains coinciding with rain
    cold noses, numb toes
    slivers in your thumb
    stiff necks, weak voices
    enlarged tongues
    receding hair
    bent elbows and crooked spines
    temperatures less than one-o-nine
    shrunken brains, deafness
    holes in your ear
    hangnails

  48. #48 Cameron Peters
    March 26, 2011

    longsmith: Well I’m sure you know where the building this charlton operates from is. Why not make sure they can’t continue to steal from those in need of real medical help, by lobbying your local city council or mayor or something like that?

  49. #49 David N. Andrews M. Ed., C. P. S. E.
    March 26, 2011

    DW: “( alt med speak for “twit”)”

    Typo italicised for clarity.

  50. #50 DW
    March 26, 2011

    @ David N. Andrews, M.Ed. C.P.S.E.

    No, no, my love, it isn’t a typo: I was raised to be a proper lady and would never utilise that…(( shudder))*expression*, but would instead, go directly to “f#cking waste of friggin’ ox-y-gen”.

    And good morning to you !

  51. #51 David N. Andrews M. Ed., C. P. S. E.
    March 26, 2011

    You too, DW!

    Lovely to see you again…

    Loving your responses to my responses to your comments!

  52. #52 prn
    March 27, 2011

    I’ve been getting “page errors” for several days, so a lot has been lost.

    Scott@14
    what do you call alternative medicine that actually has some demonstrable effect?
    In my recent experience, treatments with better literature, “too cheap for boat payments.”

    You’re right. Because not all studies are created equal, and those that can’t be reproduced, run contrary to basic high school level scientific knowledge or are routinely supported by emotional pleas and politics and sheltered against contrary evidence by their supporters don’t belong in medical practice.
    Although they have not been through the FDA process, PSK (Coriolus mushroom extract) and targeted cimetidine in colon cancer appear to me to rise well above that charge. I’ve interviewed a number of oncologists, some who were very shocked when I finally started dropping some of the cimetidine papers on them, still with no real support. I finally got more support out of the surgeon cum oncologist, who seemed a little at odds with the “regular” oncologists’ programs, so I worked on him longer. However, this approach loses precious time and focus.

    You’re damn right CAM offers treatment for problems not addressed by conventional doctors. They’re not…demonstrated …real.
    The problem at RI is that the common voices here tend to condemn ALL non-mainstream treatments. Including those for real problems, with even superior treatments trialed and described in historical literature.

    I…disagree about…Low cost. CAM can fetch a very large bill.
    My experience is radically different, probably completely opposite. Of course, (m)any fearful fools can be parted with large sums of money by over ambitious providers, both conventional and less conventional. I’ll start with the 12 month cost of cimetidine vs Avastin (per AVANT, C-08) for a stage IIIc CC. Life Extension Foundation has apparently been pushing this one for 20+ years.

    sadmar@29
    But there’s so much irrational absolutism here: “if you’re not with our Skeptic Program 100%, you must be one of THEM!” Please, get a grip.
    I concur.

  53. #53 prn
    March 27, 2011

    Vicki@35
    My metrics all about useful lab measurements and observation. Low price preference simply weeds out much potential scam activity, conventional or less conventional. However, I still pay for advanced technology, PRN.

  54. #54 prn
    March 27, 2011

    DB@37
    I’ll only address one error.
    venting…by belittling other posters’ usernames
    “rancid bacon bits” is plural and a lighthearted play on words for your contribution that I considered trolling. Or did I miss an extension beyond the “royal We”?

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.