Respectful Insolence

I and others have often written about how “complementary and alternative medicine” (CAM) and “integrative medicine” (IM) represent a “bait and switch.” The basic concept is that CAM/IM has co-opted several ostensibly science-based modalities, such as diet, exercise, relaxation, and the like. These are used as the bait by representing them as being somehow “alternative” and outside of the mainstream of medicine. The switch occurs when CAM/IM advocates use the known efficacy of modalities like this to argue that other woo works. They do this through a “big tent” policy, where diet, exercise, and the like are put in the same CAM/IM big tent with reiki, homeopathy, acupuncture and other traditional Chinese medicine, energy healing, and many others.

One of my favorite examples of this bait and switch technique is the concept of herbal medicine. There’s no doubt that herbs and plants can be medicine because many of them contain medicinal compounds that have pharmacological activity. The differences between herbs and pharmaceutical are potency, purity, and consistency. Basically, herbal medicine represents unpurified natural product that can have widely varying amounts of active ingredient from lot to lot; pharmaceuticals, on the other hand, contain the active ingredient in pure form with its purity and potency stable from lot to lot, allowing for more reliable treatment. As with diet and exercise, for herbal medicine the fact that there are pharmacologically active compounds in many herbs and plants is the “bait,” which gives it plausibility. The switch comes with the philosophy that tends to cloak herbal medicine, concepts including that because it’s natural it must be better, that somehow there is “synergy” between the various compounds in an herbal remedy (something that is almost never actually the case), and even a touch of vitalism, wherein “living” plants are better than those cold, sterile, pharmaceutical company-manufactured pills. Then herbal medicines are lumped in with the other parts of the bait, such as diet and exercise, because they can be science-based. Of course, science-based medicine has used herbal medicines as the basis for medicine for a long time. There’s even a scientific branch of pharmacology devoted to the study of natural products as drugs: pharmacognosy. Bait and switch indeed.

The latest in a long line of CAM/IM bait and switch appeared earlier this week in the form of another study that got a fair amount of media play. For example, there’s this news report:

More than a third of Americans use some form of complementary and alternative medicine (CAM) and that number continues to rise attributed mostly to increases in the use of mind-body therapies (MBT) like yoga, meditation and deep breathing exercises.

Prior research suggests that MBT, while used by millions of patients, is still on the fringe of mainstream medical care in America. New research suggests that attitudes are changing.

In a study from Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, researchers found that one in 30 Americans using MBT has been referred by a medical provider.

Notice the classic bait and switch, which is reinforced in another news report:

In 2007, 38 percent of Americans used complementary and alternative medicine (referred to by researchers as CAM). Mind-body therapies, which include things like yoga and tai chi, are a type of CAM. Use of CAM in the United States has increased since 2002, with mind-body therapies comprising 75 percent of the rise, the researchers say.

According to the study itself, “mind-body therapies” (MBTs) were defined quite broadly and included yoga, tai chi, qi gong, meditation, guided imagery, progressive muscle relaxation, and deep-breathing exercises. Why tai chi, yoga, and qi gong should fall under the rubric of a category known as “mind-body” therapy, I don’t know; they’re all basically forms of physical activity and exercise. As for guided imagery, relaxation, and deep-breathing, I suppose these could be called MBTs, but in reality the whole term “mind-body therapy” is more a marketing buzz word that sounds all nice, fuzzy, and “holistic,” rather than any sort of useful descriptive term. It’s a wastebasket into which is thrown any therapy that involves some combination of relaxation, thinking, or gentle exercise that can be infused with some form of “spirituality” or gentle woo. There’s no reason why relaxation or deep breathing therapies can’t be science-based or why they should be considered “alternative.” The same is true for exercises like yoga, tai chi, or qi gong. The switch comes in when yoga, tai chi, and qi gong assert various “spiritual” and vitalistic aspects, such as the existence of what is in essence a magical, mystical life energy (the qi in qi gong, for example).

Also, it should be pointed out that this study that sparked all these news stories a few days ago is not really a full study at all. It’s a “research letter,” the shortest form of research. It consists of exactly one table of data that looks at correlations between the use of physician-prescribed and self-prescribed MBTs based on data from the 2007 National Health Interview Survey (NHIS). Despite my dislike for the bait and switch inherent in the study, I’ll admit that there were a few interesting findings. For instance, the authors found that the use of physician-prescribed MBTs (P-MBT) was correlated with greater health care use and illness:

Respondents with more chronic conditions, quantified by a Charlson score of 4 or higher and composing 11.3% of all P-MBT users, were more likely to use P-MBT. Of our 16 comorbid conditions, only chronic obstructive pulmonary disease [COPD] and anxiety were associated with P-MBT use. Greater health care use was associated with a greater use of P-MBT. We observed a “dose-response” relationship with the number of office visits and the use of P-MBT: as the number of office visits increased over a 12-month period, so did the likelihood of using P-MBT. Use of P-MBT was associated with an encounter with a mental health professional over the past 12 months. Finally, respondents with heavy alcohol use were less likely to use P-MBT.

Although a lot of this is much ado about nothing (note how there were only correlations between two conditions and P-MBT use, one of which was a psychiatric disorder), there are at least a couple of observations worth considering. First, it seems that doctors with chronically ill patients are more willing to refer for MBT. This points to a commonly noted problem with our health care system in which we have a tendency not to do nearly as well with patients with chronic diseases as we do with more acute illnesses. Many of these common illnesses and conditions, such as hypertension, type II diabetes, and COPD are associated with lifestyle and can be mitigated by lifestyle interventions, such as diet, exercise, and smoking cessation. To the extent that CAM/IM can blur the line between science-based and woo-based lifestyle interventions, such as calling a form of exercise and concentration “qi gong” and branding it as somehow being “alternative,” it wins. The science-based modalities co-opted by the CAM/IM label serve as a propaganda tool that makes CAM/IM look like a bigger phenomenon than it is and as “wedge” strategy to slip in the real woo behind it.

Another aspect of the study is that it promotes the same sort of framing that Dr. Oz promotes on his show when he paints CAM/IM as the wave of the future and paints physicians who don’t get on the bandwagon as “holdouts” against the inevitable. The study is being presented in a similar manner, as in this report, which states:

Prior research suggests that MBT, while used by millions of patients, is still on the fringe of mainstream medical care in America. New research suggests that attitudes are changing.

That’s right, you skeptics out there, you’re all holdouts!

Except that perhaps you’re not. The real number was that only 3% of respondents had used MBTs because a physician had referred them. Because we have no number to compare this to, we have no idea whether or not this represents an increase, a decrease, or no change. Lacking that, we’re left with CAM apologists marveling at how huge the number is:

“There’s good evidence to support using mind-body therapies clinically,” said lead author Aditi Nerurkar, MD, Integrative Medicine Fellow, Harvard Medical School and BIDMC. “Still, we didn’t expect to see provider referral rates that were quite so high.”

And drawing exactly the wrong conclusion from their data:

“What we learned suggests that providers are referring their patients for mind-body therapies as a last resort once conventional therapeutic options have failed,” Nerurkar said. “It makes us wonder whether referring patients for these therapies earlier in the treatment process could lead to less use of the health care system, and possibly, better outcomes for these patients,” she said.

Or maybe it means that there is a dedicated cadre of a small percentage of doctors out there who do a lot of referring of their patients for woo-ish modalities, and the vast majority are science-based and don’t refer their patients for modalities that are unproven.

Or maybe it’s just background noise, a not-unexpected low background rate of referrals, whether due to desperation or repeated patient requests to the point where the clinician refers them just to get them off his or her back.

Or maybe it means that “conventional” doctors need to think more critically and resist the temptation to buy into the CAM/IM marketing machine and recommend “alternative” therapies as a last resort.

I rather suspect that it might well be all three or other explanations that I haven’t thought of. The data presented in this study neither support nor refute the CAMsters’ claim that it’s all because CAM/IM is becoming more “mainstream” and popular, but they sure are doing their best to use this study as an argumentum ad populum to make it seem as though it is.

Comments

  1. #1 JayK
    May 13, 2011

    They didn’t investigate the insurance angle, either. With a physician referral, insurance might be more likely to cover some or all of the visits over a period of time. So could recent changes to insurance policies be a confounding variable? Did they also take into account rapid changes in economic conditions that would encourage people to avoid costly physician costs and seek alternatives, something that has been discussed (and well cited) here in the past?

    The prelim study is at least interesting from a lot of different perspectives. If this is followed up to see if the alternatives are providing benefits above what physicians were able to provide, then it could be an indication of a real change, otherwise it is probably just another swing of the pendulum.

  2. #2 Jolo5309
    May 13, 2011

    There is a doctor in Red Deer or Lethbridge, Alberta, Canada that uses acupuncture, probiotics, green tea (for acne) and peppermint oil (for IBS). He insists what he is doing is correct, and does use other “CAM” such as diet, exercise, and Tai Chi.

    I call him a quack

  3. #3 CholeraJoe
    May 13, 2011

    “the vast majority are science-based and don’t refer their patients for modalities that are unproven.”

    I was cheering for you until I read this. Many of my physician colleagues claim to be science-based yet they over-prescribe antibiotics and steroids. The standard of care for acute low back pain in my community is a steroid dosepack and an order for an MRI, neither of which has any scientific validity. If you ask them when they prescribe antibiotics for bronchitis or sinusitis, the answer usually has something to do with green or yellow sputum or snot, not with scientific validity.

    I recently saw a middle-aged woman with tender cervical adenopathy referred by a primary care who told her she probably had lymphoma, ordered a CBC and CT scans of her head, neck, chest and abdomen and referred her to me to finish the workup. Fortunately, I was able to stop the madness before the massive dose of radiation.

    Our profession still has a ways to go before the majority are practicing science-based medicine and not using unproven methods of treatment.

  4. #4 squirrelelite
    May 13, 2011

    @CholeraJoe,

    Would you rather that be only a slim majority or even a minority?

    Also, there is an important difference between prescribing therapies like reiki, homeopathy, acupuncture, etc. for which there is little or no evidence that they are effective for treating any medical condition, which is what this article is about, and misprescribing or overprescribing medications that have been scientifically demonstrated to be effective for treating some medical conditions.

    The latter is certainly a problem, but it is a different problem and needs to be dealt with by different methods.

  5. #5 Scott Cunningham
    May 13, 2011

    Dr. Adidi Nerurkar

    “There’s good evidence to support using mind-body therapies clinically,”

    Statements to this effect are offered all the time in defense of CAM, without ever presenting any such evidence. At this point, those words sound like “there’s abundant evidence of past alien influence on ancient cultures,” “there’s plenty of evidence that Saddam Hussein has WMDs” or “the Emperor has marvelous clothes.”
    Citation needed.

  6. #6 Heliantus
    May 13, 2011

    There’s no doubt that herbs and plants can be medicine because many of them contain medicinal compounds that have pharmacological activity.

    And as a result, a good number of modern drugs are indeed of natural origin. This article lists quite a lot of them, from insulin to anticancer drugs:
    “Natural products as sources of new drugs over the last 25 years.” Newman DJ, Cragg GM.
    J. Nat. Prod., 2007, 70 (3), pp 461–477
    PMID: 17309302

    (not sure if it’s free for non-academic readers)

    So much for the meme “Big pharma is against herbals, because a natural product cannot be patented”. Apparently it can and it was.

  7. #7 Moderation
    May 13, 2011

    I wonder how much this takes into account “active” vs “passive” referral. I have on many occasions told a patient that chiropractic, accupuncture or homeopathy from their naturopath are not backed by science, but if they wish to persue these modalities, these are the safety precautions I would give. Now, I don’t know if a patient might report this to the CAM provider or a researcher as a referral by me. I certainly would not consider it one. And there was certainly no paperwork submitted. I have however “actively” referred my patients on many occasions to a dietician … which certainly would not be considered a “CAM” referral in my book.

  8. #8 prn
    May 13, 2011

    They do this through a “big tent” policy, where diet, exercise, and the like are put in the same CAM/IM big tent
    This is a reversal of sequence. Someone with a shiny new insight or therapy for some long suffering group that violates the mindset, profitability, or control of a more established group that has overpaid psychopa…er, gatekeepers, is all too often set out the door, and – or into the “big tent”. Rather than helped, or allowed, to develop and publish higher levels of evidence.

    concept of herbal medicine was survival. Today often a dramatically cheaper, here-and-now source of relief and molecules than the glass towers that guard our medical campuses. I count the PSK mushroom extract in the herbal supplement category, and silymarin, too. Why wait for Pharma to figure out how to make a bastardized copy at 1000x your cost 50 years from now, if it can be grown in the living room or backyard?

    “Mainstream”, you mean “bait and bash with switch to a name brand”?

    concepts including that because it’s natural it must be better… This has been historically true in a number of cases, but should be considered an implicit challenge by the biochemists, formulators [and their sr management] to noticeably outperform on efficacy AND price. Not noise level and harassment.

    that somehow there is “synergy” between the various compounds in an herbal remedy (something that is almost never actually the case)

    even a touch of vitalism, wherein “living” plants are better than those cold, sterile, pharmaceutical company-manufactured pills.
    Partly depends on how “patently defective” the new pills are. The other part should be considered a reflection on [lack of] efficacy in our public education.

    The science-based modalities co-opted by the CAM/IM label …
    The embarrassing number of science-based modalities forced or banished into the CAM/IM label by obtuse, biased, corrupt review processes threaten to start a revolution of non-participating (im)patients. I suggest that such errors and omissions are now so great, that unless doctors find a way to deliver more cost effective medicine in short order, often ridiculed therapies, self education (defense), computerization and networking will allow disintermediation many providers or marketing structures of today. Not just for huge cost differences.

    I suspect that many providers and patients didn’t want to be in the “big CAM tent”, rather they were forced into it, or were drugged and left there to die. Obviously their abilities to succeed might reflect 6-8 standard deviations of a skewed ability curve, perhaps even bimodal. -4 or -3 sigma, perhaps possible Darwin awardees, +3 or +4 sigma – includes trampled genius. With some ruthless (pathological) opportunists in between, like lots in the “regular” medical industry.

    “conventional” doctors need to think more critically… and sometimes pull their head out of their as…,uh, pharmaceutically influenced feed troughs, strokers, and even introductory medical texts. The large gap in medical reality glazed with a large dose of systemic corruptions is becoming increasingly apparent to outside observers.

    I suspect that if mainstream medicine itself does not make more successful efforts to quickly identify the big diamonds in the rough – therapies/providers previously isolated, castigated, attacked and effectively destroyed, “regular medicine” is going to get ground up by them.

  9. #9 JayK
    May 13, 2011

    Friday the 13th and Zombie Billy Mays seems to have a new low price on the word salad shooter.

  10. #10 Composer99
    May 14, 2011

    prn… I can’t help but notice something in your long series of assertions.

    I can’t quite place it… something missing…

    Ah, yes, I have it now! Evidence to support them.

  11. #11 prn
    May 14, 2011

    So, Orac gets a free pass on his rhetorical flourishes?

    If you want to pick at a point, perhaps I can help you out. I can’t make up for all the bias, educational shortfalls and open controversies here.

    Try make a counterpoint. I am willing to discuss, and where I see the need, provide references, that I can get through the link blocker in a timely manner. But I am not even going to try to reference every phrase or sentence.

  12. #12 lilady
    May 14, 2011

    Scrolling down the comments, perusing #8…I knew who was posting halfway through the first paragraph…our old friend “prn”.

    prn is even more incoherent than usual..must be doubling up on the hallucinegenic mushrooms or growing some super “weed” in the backyard.

    @ Moderation: We have never said that a licensed dietician is a CAM/Alt practitioner. The Registered Dieticians that I am acquainted with are not “nutritionists”, do not hawk supplements; they work with a patient by providing information about good dietary practices, balancing their food intake, deceasing sodium intake, food preparation and weight control.

    Nutritionists are another story. They push vitamins and supplements and they work in tandem with naturopaths and homeopaths, who as well, are totally unqualified to prescribe or treat any patient…or to assist the patient to achieve maximum health.

  13. #13 Moderation
    May 14, 2011

    @12 lilady

    I was using the reference to the science based practice of dieticians as an example of the co-opting habits of CAM/IM practioners. I am aware of the difference between dieticians and nutritionist. For some interesting reading on it check out the blog posting series on nutritionist and dieticians in Canada at skepticsnorth.com.

  14. #14 lilady
    May 14, 2011

    @ Moderation: I re-read your posting and (confess) I misinterpreted it…sorry.

    You provided me with a great site and I have bookmarked it for future reference. I did look into some of the articles on “nutritionists”. One in particular was a hoot. The credentialing of the “nutritionists” in Canada are through a board of credentialing that was set up to legitimize only one school’s graduates.

    A close friend in Toronto always forwards emails that she has received with obvious pseudo medical advice. Now in addition to sites from the USA I will also send her the terrific articles from skepticsnorth.com…Thanks.

  15. #15 The Analyst
    May 14, 2011

    This points to a commonly noted problem with our health care system in which we have a tendency not to do nearly as well with patients with chronic diseases as we do with more acute illnesses.

    Holy crap! David actually shows some reason in the midst of a rant.

  16. #16 Narad
    May 14, 2011

    *plonk*

  17. #17 Krebiozen
    May 14, 2011

    @prn

    The embarrassing number of science-based modalities forced or banished into the CAM/IM label by obtuse, biased, corrupt review processes

    Could you please give some examples of these “obtuse, biased, corrupt review processes”, and evidence that they are “obtuse, biased and corrupt”?

  18. #18 WMDKitty
    May 14, 2011

    Dude. What’s prn been smoking?

    I mean, come on, I’m freakin’ stoned and that still made absolutely zero sense!

  19. #19 rw23
    May 14, 2011

    @WMDKitty #18

    Damn. We were hoping you could translate for us!

  20. #20 prn
    May 14, 2011

    I’ve had some recent experience with a surgically assigned stage III and then a year later, a retrospectively acknowledged stage IV colon cancer diagnosis.

    One of the thing that strikes me in the face, hard, is how US based medical oncology handles chemotherapy technology beyond the expensive, favored few approved chemos rich with side effects.

    I’ve looked at some of the Asian papers, and noticed how different their answers can be from “ours”, and on reading “our” current literature, how “our oncology” resists much more favorable results from Asia including Japan, or even ignored, obvious to me on the first paper, (likely continued) failings like Avastin for stage III. “biased”; “Obtuse”

    Fortunately [and amazingly only 1-2 yrs late] the FDA backed my position up over the next 8 months.

    Trying to find more informed, or broader, minded oncologists [6th opinions??], I’ve even had a chance to personally witness [and interact with] part of their group doings, leadership and [supposed to be] outside influence when their presence strayed into territory that I had a more frequent physical presence. Non-oncology doctors affirmed my summary of specific personalities. “corrupt”

    I can understand that med oncology [-ists] might prefer to offer a limited subset of treatments. I am amazed at the ignorance of, and outright resistance to, other countries’ treatments when the published, experimentally based results can be starkly better for clearly identifiable, large patient fractions, when [tech] customer initiated. When presented with papers and a specfic plan for specific facts and uncertainties that clearly favor the less advertised, “foreign” solution, they apparently cling to much small percentage success when larger whole fractions of long term success with far fewer side effects are readily available.

    Despite some pratfalls like the III-IV kerfule, I’ve had somewhat better luck with some surgeons over oncology issues. I’ve posted some before on the UFT-cemetidine-biomarkers, and PSK. Reviewer on Matsumoto (2002, PMID 11870500), “remarkable”. Almost 10 yrs later, with many more academic answers and papers, still no US-UK movement or trials on cimetidine for the commonly biomarked damned [or lucky, if in Japan]. Deadly.

  21. #21 Denice Walter
    May 14, 2011

    @ prn: What I don’t get is how you can discard an SBM *tested* treatment with a modicum of a chance of extending life for a substance with a hint of a glimmer of a hope for development in the future. I’ve heard about these mushroom substances for years ( Healthy Healing: An Alternative Healing Reference; Linda Rector-Page, 1992; articles in NaturalNews, Gary Null.com)

    In the early 1990′s, my 80+ year old father was diagnosed with CHF- a few natural health enthusiasts scolded him ( and me) for taking pharma poisons ( i.e . diltiazem, nitro, later Altace ) when the wondrous CoQ10 and other marvels would soon *be* the cure. He managed to live for nearly 10 years on those horrible drugs. He’s gone now nearly 10 years: has CoQ10 or *any* of the other natural substances panned out ? These promises are part of a sales agenda to sell folks on supplements and simultaneously discourage hope in SBM.

    You only have one life : stage 3 or 4 is serious business not a time to argue the politics of medicine. Come on, now. You should seek out your best options based on data and reason. The people here who support SBM aren’t the enemy. Neither am I. Best of luck to you.

  22. #22 DrWonderful
    May 14, 2011

    I am a chiropractic physician and nearly half of my new patients are direct referrals from MD’s. Mostly from ortho’s but a few primary care docs, pediatricians, and neurologists send patients to our office somewhat regularly. So, I’d say “yes” MD’s are without question referring for non-medical therapies on a regular basis now.

  23. #23 lilady
    May 14, 2011

    @ prn: How about provided some more recent citations (less than 10 years old) about Cimetidine and its use in colorectal
    cancer?

    I, on the other hand have the American Cancer Society and the National Cancer Institute and it seems that Cimetidine is not approved as an anti-cancer treatment and there are no studies being conducted..anywhere..on Cimetidine.

    prn, I found some other Cimetidine “studies” for you as well:

    Life Extension Magazine, July, 2002 issue “The Lethal Information Gap”

    Knock yourself out, prn.

    @ Dr. Wonderful: Really? I’ve been to all types of medical doctors and specialists for myself and family members and nary a one ever suggested or made a referral to a chiropractor. All members of my family and extended family, at various times have been referred to physical therapists for rehab following orthopedic surgery and for treatment of pinched nerves…never, ever to a chiropractor.

  24. #24 DrWonderful
    May 14, 2011

    Yes lilady, it’s true. MD’s do refer to chiropractors nowadays with increasing frequency. As a matter fact, the medical director of the US Olympic Committee medical staff is a chiropractor. I heard (but cannot confirm right now) the number 3 guy will be a DC too. Nearly every VA hospital in the country has chiropractors on staff. The medical services unit on Capitol Hill has chiropractors treating our Representatives and Senators right in the facility along side with the MD’s.

    Bethesda Hospital has an outstanding chiropractic staff who the medical and PT interns rave about and request to work with. Actually, increasingly, chiropractors are gaining staff privileges at hospitals and outstanding medical centers around the world. Private orthopedic practices are now slowly beginning to either integrate or replace their more expensive and less effective physical therapy practices with staff chiropractic physicians. At this point every single professional sports team and major college athletic program have staff chiropractors. I am one of them.

    For the treatment of musculoskeletal conditions chiropractors have a proven record of efficacy, cost effectiveness and safety. Truth be told, many innovations in physical medicine have come from chiropractors who historically have been performing and developing physiotherapy modalities and rehabilitation techniques for decades before PT’s even existed.

    I know Orac, who I like and respect, was not really heading in this direction but it is true. There is a whole side of chiropractic that for some reason is never discussed on blogs and web sites like this. It’s almost as if the audience is too biased and discriminatory to hear it.

  25. #25 Ariel
    May 14, 2011

    “Why tai chi, yoga, and qi gong should fall under the rubric of a category known as “mind-body” therapy, I don’t know; they’re all basically forms of physical activity and exercise.”

    I’ve only practiced Yoga and I wouldn’t label it as therapy, unless you have an anger-management problem, but it is more than just a “physical activity”. A large component of it is focus; training your mind to be aware of extraneous stimuli but not focusing on it or being distracted by it whatsoever, unless it’s coming at your head.

    Do I agree that it can be turned to woo with extravagant claims, as well the silly nodes, sure.

  26. #26 lilady
    May 14, 2011

    @ DrWonderful: I never stated that some medical doctors may refer their patients to chiropractors…merely stating my experience with physicians who have treated my family and me.

    I’ve also had my son treated by a number of neurologists and physiatrists on staff at several university-affiliated teaching hospitals; he received physical therapy by a pediatric RPT 5 X weekly following 10 weeks in a hip spica cast due to a supracondylar femur fracture at age nine. He continued with physical therapy provided by RPTs twice weekly until his death at age 28. None of these physicians ever recommended a chiropractor…if they had I would have changed physicians.

    Most of the care that our family receives is provided by physicians/specialists who are affiliated with one university-affiliated teaching hospital; it doesn’t have a CAM Department and has no chiropractors who have affiliations with the hospital.

    Our friends at Quackwatch (ChiroBase) have provided us with a lot of information about the practice of chiropractics. I myself have done a lot of research and there is no science behind the practice. A (scant) few of many scientific studies of chiropractics “treatments” and “manipulations” have acknowledged, that in a minimum of cases studies, chiropractors may have alleviated some lower back pain…as long as they don’t employ sublexation/cracking of the vertebrae. And, neck manipulation has resulted in many deaths. All of the other many studies have been unable to identify any other orthopedic condition that has been treated successfully by a chiropractor…no less non-orthopedic diseases/conditions that have been treated successfully by chiropractic “treatments”.

    A newer report from the International Journal of
    Clinical Practice reviews published cases of deaths attributed to chiropractic treatment:

    “Deaths after chiropractic; a review of published cases”

    I don’t think you want me to delve further into the practice of chiropractics and their stance against immunizations, theories of nutrition and the hawking of supplements, theories of disease processes and other junk science theories.

  27. #27 DrWonderful
    May 14, 2011

    @lilady- you can delve away all you want, wouldn’t bother me one bit. You’d actually only prove my point that this network of individuals, blogs and websites you refer to only myopically cherry-picks the worst of the worst to justify their/your pre-drawn conclusions and then literally shuts everything else out. There is another side to the profession you have either ignored or have been shielded from by your biased sources.

    I’ll give you a hint. When searching pub-med do not use the term “chiropractic.” That is the name of a profession and not the name of a technique or procedure. You’ll find the terminology used in credible chiropractic research is the same as used throughout all of physical medicine, orthopedics, physical therapy and neurology.

    When searching a scientific lit database do you use the term “oncologist” or “pediatrician” to find the efficacy of a particular procedure? Of course not, then why would you selectively do the same for “chiropractic”? Look at Grade 3,4 and 5 joint mobilization, proprioceptive re-education, myofacial release, mechanoreceptor modulation, basic neuromuscular rehabiliation, etc. That’s actually what we do and it falls under the umbrella of the science of physical medicine. Y’all should know better than that, if you weren’t biased and truly science based that is.

    You’ve drawn many rational conclusions about chiropractic, the problem is that nearly all of your premises are false or incomplete or too narrow or baited with falsehoods and distortions. As a result you miss the target by a long shot and look silly when talking about chiropractic with such authority. I guess simply put, I don’t discuss breast cancer because I know nothing about it. Unless you have a background in musculoskeletal health you wouldn’t even know where to start when truly learning about chiropractic. I’ve read Barrett’s junk on Quackwatch and I find it lacks any real credibility. Same with Ernst’s biased, incomplete and agenda driven junk pieces like the one you cited above. In the end that crap makes chiro’s look good because it is so lacking in credibility the chiro actually gets elevated when the truth comes out and the rebuttals are written. So please spare me the authoritarian posturing.

    For the most part, chiropractic is basic structural musculoskeletal medicine with some outlier exceptions. Even when the dorks in the profession think they are treating a “subluxation” all they are doing is applying various physical medicine modalities to reduce a musculoskeletal distortion.

    So, anyway, yes MD’s are referring to chiropractors with increasing regularity (and all of the other points and examples I raised earlier but you ignored).

  28. #28 prn
    May 14, 2011

    @21 Thanks for your concerns, Denice.

    What I don’t get is how you can discard an SBM *tested* treatment with a modicum of a chance of extending life for a substance with a hint of a glimmer of a hope for development in the future.
    Various Japanese research groups have been grinding away on SB cimetidine related cancer research for almost 25 years, after being first reported but largely ignored in America. Unrecognized by most here, CSLEX and CA19-9 are major clinical and research tools in Japanese diagnositics and therapy for colorectal cancer, identifying biomarked patients that cimetidine targets.

    A number of austral-asian cimetidine(+chemo) papers all have characteristic overall survival curves. About 30 years of papers analyze CSLEX and-or CA19-9 with adenocarcinomas. Matsumoto, et al additionally analyzed their double blind RCT results for CSLEX, CA19-9 and several other biomarkers over several publications. For the highest CSLEX biomarker group, as well as for the highest CA19-9 biomarker group, 100% of the controls were dead at six years. 100% of cimetidine treated patients were still alive six year later. Patients who have elevated CA19-9 and unusual, “mysteriously” strong responses should stop taking cimetidine??

    stage 3 or 4 is serious business not a time to argue the politics of medicine.
    Such is not the time to be waylaid by the politics of medicine. But many are.

    Come on, now. You should seek out your best options based on data and reason.
    I have sought, you have no idea. Probably similar to several groups of researchers and MD-PhDs, I studiously consider the austral-asian cimetidine data far superior to anything else that I’ve found for stopping metastatic spread in CA19-9/CSLEX biomarked colon cancer patients. Cimetidine with low dose fluoropyramidine [it was designed for stage III as (mis)staged after first surgery] is not quite as effective on large nodes. So cold steel to platinum plating as part of definitive treatment for an enlarged residual stage IV met became preferable to 4 highly experienced surgeons – one MDA trained, two heads of surgery in the highest rated hospitals in their respective cities, and a radiologist in a major US cancer complex. All the “regular” oncologists, of course disagreed, and had their own recommendations.

    The cimetidine+fluoro+other inhibitors++++ seem to have prevented gross metastasis where everyone (me, too) worried about, or expected outright, both more distant mets AND widespread peritoneal seed sprouts from the previous extracolonic invasion at first surgery but had fully necrosed with cimetidine and other FDA unapproved adjuvants of asian origin. Those sneaky Japanese :) [ref, WWII era jingoism]. My plan has been longer immunomodulated chemo, incorporating Japanese science based medicine, not harder chemo with resistance promoting cycles followed by a bungee jump on a kite string without any adjuvants at all. Interestingly, two of the surgeons were supportive about continuance of such “FDA unapproved treatments” even through surgery, after they saw all the case data [lots].

    The people here who support SBM…
    I am not medical. Here, I’ve recognized some less advertised science and technology advances in other countries.

    … aren’t the enemy. Neither am I.
    Wow. Denice, I’m so sorry if there is a misunderstanding here. I am probably more likely to answer you, in long detail, because I don’t think you are being oppositional.

  29. #29 Gopiballava
    May 15, 2011

    Dr.Wonderful: What problems do you think subluxations can cause, and do you think that different chiropractors can reliably identify subluxations in the same patient?

  30. #30 lilady
    May 15, 2011

    @ DrWonderful: You are a massage therapist, with a DC after your name. I am unimpressed with the treatments you describe and the curriculum of courses provided in chiropractic programs and the theory of chiropractics. There is so much more to maintaining health than doing adjustments on the spine, Rolfing, cracking joints and hawking supplements.

    I have a BS-Nursing Degree and have way more education in the sciences and contemporary medicine than chiropractors do. Nursing Education and Medicine education are evolving health care fields. We do not practice based on the theory of spinal manipulation as the be-all and end-all to maintain homeostatis…developed at the turn of the last century. Contemporary nursing and contemporary medicine has become specialized because of the advances made by solid research, innovative treatments and pharmacology. Furthermore, we do rotations and internships in hospitals (where people are really sick) and physicians have three year residencies and post-doctoral fellowships in specialties. Are there now sub-specialties in cervical, thoracic and lumbar spine manipulation/massage in a chiropractic practice

    There was a bill (HB 127) in the New Mexico legislation to allow certain “advance practice chiropractors” to prescribe and administer certain pharmaceuticals (vitamins, minerals, enzymes, glandular products (?), gerovital (?), amino acids, bio-identical hormones, vapocoolants (?), etc.)

    Chiropractors could become certified as “Advance Practice Chiropractors” upon completion of a minimum 90 hour course in pharmacognosy, administration and toxicology.

    The ICA (International Chiropractic Association) apparently doesn’t claim that chiropractors “practice medicine”. They were strongly against enactment of the legislation and they sent a strongly worded letter to the Legislature. On their website they state:

    “The legislation sought to re-define the chiropractic practice as a ‘medical’ practice and significantly expand the scope of chiropractic practice into the realm of medical practice, by including the prescription and administration of pharmaceuticals…..” (I concur with their statement)

    The bill was defeated in March.

    I guess in New Mexico, the practice of chiropractics remains an expensive, medical insurance reimburseable service of spinal manipulation and massage.

  31. #31 DrWonderful
    May 15, 2011

    @lilady- yes, I am familiar with the bill in new Mexico. Most legislation takes time and many attempts to pass and this one will too eventually.

    You and Gopiballava seem to be missing the pink elephant that is standing on your toes. I have already established that around the world chiropractors are working hand in hand with medical physicians at Bethesda, nearly every VA Hospital, several other prestigious medical facilities, on Capitol Hill, with every professional and major college sports team, and now at the very top of the US Olympics medical staff. This is not by coincidence or trickery. It is not because we are massage therapists. Marginalize us all you want, it isn’t working…obviously. (It’s actually helping).

    Do you really think these DC’s are treating subluxations? Let alone subluxations that cause visceral disease and/or doing all sorts of “quackery”? By the way y’all sound so foolish when you use that word. It’s a bit over, you know. Anyway, do you really think the VA, Bethesda, Capitol Hill health services unit, every professional and major college sports program, numerous medical facilities, and the Olympics have suddenly bought into the subluxation theory? Does that even make sense? Or are most chiropractors actually something other than what you believe? Is your ridiculous and dated premise totally askewed? Is it possible the ICA represents approximately 5% of chiro’s who act like the fundamentalist Taliban? (yet we continue to advance without them. The ICA has only 2,000 members worldwide. That is half the number of members in the Florida State association alone. Did you know that? But because the ICA says what you want them to say, you put them up as the glowing example of the profession.

    When faced with the mounting evidence does your position, as etched in stone by your own fundamentalists Stephen Barrett et al 40 years ago, still hold water? It really doesn’t. The crap has been draining out of this profession for decades and many great organizations and starting to see the clearly the best of the best that chiropractic has to offer. And it is unique, separate and distinct.

    So, now we have many thousands of chiropractors working directly with medical physicians across the world and many of those in very prestigious environments. That fact is undeniable. You can ignore it, but it remains undeniable. And we have, hopefully, established these DC’s are not what you portray us to be. Are they just an isolated few (thousands) or is there actually more to the profession than you believe? Is there actually an entire side of the profession you refuse to acknowledge but instead myopically focus on the 5-10% that suit your pre-determined conclusions? For such awesome critical thinkers, it’s disappointing you are so biased and you seem to be unable to see the whole picture.

    What exactly are the DC’s at Bethesda, Capitol Hill health service unit, many hospitals and medical facilities across the world, every professional and major college sports team, most VA hospitals and the Olympics doing? Why are they there? do you know? Do you care? Or have you already made up your mind?

  32. #32 lilady
    May 15, 2011

    Yes I care that chiropractors have invaded the medical field and are now reimbursed for massages and spinal manipulations. See, unlike you I have a defined profession and don’t practice “medicine”. Nursing practice entails working next to medical doctors and providing care after a medical doctor has made a medical diagnosis. We actually know how to medicate patients with real medications, know what interactions can occur and know the potential dangers of supplements on other systems of the body…not just the spine. You would be totally flummoxed in an Emergency Room, in CCUs and ICUs and totally inept to practice in an acute care setting, a clinic or in a nursing home. Nurses also have a pathway to become certified in a specialty, by actually becoming proficient in all the specialties that medical doctors are. We never claim to be medical doctors.

    Registered nurses also have a pathway to become Nurse-Practitioners through intensive post-grad courses and sitting for licensing boards for Nurse-Practitioner licensing. They become specialists and many of them have set up their own autonomous practices. They can and do
    make diagnoses and can and do prescribe treatments and real medications. And, we have never labeled state, national or international nursing boards as “acting as the Taliban”.

    Even NCCAM set up in the National Institutes of Health is unable to find any disease process…that chiropractics provide curative care for. The only condition that chiropractors have provided relief for is lower back pain.

    The 90 hour class proposed by New Mexico to certify chiropractors as “Advance Care Chiropractors” is a joke. During my first semester in college I took classes in pharmacology, dosage and administration that exceeded the 90 hours proposed classes. In all my years in nursing practice I took hundreds of hours of CNE classes and they weren’t in glandular products, live cell products (?), protomorphogens (?) or vapocoolants (?).

    Sorry “doctor” you haven’t convinced this Registered Nurse who is educated in the sciences…I’ll stick with medical doctors and physical therapists…not any wannabes.

  33. #33 DrWonderful
    May 15, 2011

    @lilady- excellent response. Blind fundamental adherence to a pre-determined and biased precept based totally on a false premise despite compelling evidence to the contrary. Thanks again, you have been more than helpful in proving my point. The issue here actually is fundamentalism, not science or reasoning.

  34. #34 Gopiballava
    May 15, 2011

    Dr.Wonderful: A lot of text, but no direct answer to my question. Are you willing to give a straightforward answer?

  35. #35 lilady
    May 15, 2011

    Thanks for re-posting repeatedly…

    Yes, I am biased toward science-based medicine that you label a “false premise despite compelling evidence to the contrary”.

    Please provide citations that back up your “compelling evidence”.

  36. #36 Denice Walter
    May 15, 2011

    @ lilady: Is being biased toward SBM is a *bias*? Wait. Isn’t that the point? Science and stat are supposed to lessen our biases. Followed by *regulation* I hope.

    I suppose our critics would prefer a bias toward believing whatever first pops into our heads, whatever tickles our fancy, whichever words are evoked randomly when we partake of our chosen intoxicant, what causes an increase in our personal revenue, what appeals to our vanity, or what’s written about by some dude with a website, an axe to grind, and supplements to sell. Thanks for informing me. I needed that!

  37. #37 lilady
    May 15, 2011

    @ Gopiballava: Don’t expect an answer from Wonderful about subluxations…it is defined differently by various D.C.s and their associations…dependent on various regulations from State insurance departments and Medicare. Also, a moving target to get insurance reimbursement for spinal manipulation and massage.

    Gee, I’ve been wasting my time, energy and money on real medical doctors, real licensed physical therapists and real medicine…when subluxation massage would cure all my ills…dumb.

  38. #38 DrWonderful
    May 15, 2011

    @Gopiballava- I didn’t think your question needed to be answered, to be honest with you. It was irrelevant to the discussion. Especially since I already stated, in essence, that the credible portion of the profession has already abandoned the concept….90 years ago. This represents many, many thousands of chiropractors, not just an isolated few. The examples I’ve cited several times here are not of those who practice subluxation chiropractic…so, uh, what’s your point? The DC’s at Bethesda, the VA or the Olympics are not practicing subluxation based chiropractic…so what are they doing? Do you care? Or are you completely sure you already know?

    Actually, if you’ve been paying attention, my point here has been that you’ve assumed all chiropractic = subluxation theory…and that is a totally false premise. But I assume you can’t/won’t hear this because it doesn’t follow the narrative that already plays in your head.

    So, honestly, are you accusing Bethesda, professional and major college sports programs, the VA, Capitol Hill health services, the Olympics, numerous hospitals and medical facilities etc all of committing heinous crimes of woo? Or is there something else these chiro’s are doing there? Something very good and powerful and effective?

    I know where you were going with your silly question and you might be surprised to learn I already agree with you. I graduated from chiropractic school a long time ago and never once during my 4 years there ever heard the word “subluxation” in a classroom. Also, I have have never used the word in practice with patients. To me the term is irrelevant and at the end of the day no one cares. Really, no one cares. No one except a few fundamentalist chiropractors and the few fundamentalist skeptics who are hunting them. Other than those few people, literally no one cares about this hissy-fit over semantics.

    I will say the profession in practicality is no longer truly defined by the use of the term, except by you, and it hasn’t been for a long time. The seeds against the subluxation theory within the profession itself were planted as far back as the 1920′s. Those seeds bloomed after WWII and were in full effect by the 60′s and 70′s and continue to prosper today stronger than ever. The outstanding side of the profession has been in development for 90+ years but you’d never know it reading Barret and Ernst etc.

    Today the term subluxation appears in a few state scopes of practice and Medicare and the terminology is used at some schools but it continues to slowly drain out of the profession. The majority of the chiro’s do not use it in their daily speak amongst colleagues. It appears in some treatment documentation because it is still a requirement of some states scopes and Medicare.

    I understand you need us to continue to adhere to it, and continue to be defined by it, so that your false premise may be realized, but I’m sorry that is not the case.

    I will say the essential core related to the term subluxation is still useful. It basically describes a musculoskeletal lesion where joint fixation, proprioceptive and mechanoreceptor abberations, muscle tension, inflammation, asymmetry, etc have lead to musculoskeletal discomfort and dysfunction. The origin of of the lesion or lesions (kinetic chain distortion have multiple lesions) is typically either traumatic, repetitive stress, or lifestyle in nature. Basic physical medicine.

    The term subluxation in the medical world means something slightly different so many of us have realized it is not an appropriate way to describe what we treat. Mostly just so we can communicate better. Most chiropractors who still use the term do so as a way to describe a musculoskeletal lesion that causes pain and dysfunction, and which follows Medicare guidelines.

    95% of all initial chiropractic encounters are for the treatment of musculoskeletal based discomfort and dysfunction and is totally legit, and has been cutting edge for a century. You can focus on the other 5% where they believe anecdotally that correcting said musculoskeletal lesion affects disease process’ but as a critical thinker aren’t you supposed to study the whole thing without pre-conceived bias?

    Anyway, I blew off your question because I personally couldn’t be bothered with the subluxation discussion, that’s between you and the other fundamentalists. Me? I’m more interested in how my baseball players are healing, feeling and performing this weekend. And that’s all they care about too…

  39. #39 Gopiballava
    May 15, 2011

    Dr.Wonderful: Would an accurate summary then be,
    “I don’t accept subluxation theory as the cause of diseases, and only a very small minority of chiropractors do”?

    Do you have any sources you can cite for the prevalence of your viewpoint?

  40. #40 lilady
    May 15, 2011

    Wonderful has been asked about subluxation theory citations repeatedly when he posts on this blog…his posted reply is always the same…he doesn’t believe in it and doesn’t incorporate it into his “practice”. Most chiropractors now have discarded that theory, according to him…except those who want to follow Medicare Guidelines.

    I am so impressed with Wonderful’s use of sciency terminology to describe his massage practice and so unimpressed with his lack of basic science education.

  41. #41 Donna B.
    May 15, 2011

    Dr. Wonderful – you have stated that nearly every VA hospital has chiropractors on staff.

    That is not true.

    There have been several bills that would require chiropractic services be available (not necessarily by a staff chiropractor) in 40 or 75 or all of the 150+ VA hospitals, but none of them have passed both houses. Currently, chiropractic care is offered at fewer than 30 VA hospitals.

  42. #42 DrWonderful
    May 15, 2011

    @Gopiballava- I would say that statement does apply to me and an increasing number of chiropractors. I cannot say “only a very small minority” of chiropractors agree. I did say earlier that overwhelmingly most of the initial and follow-up chiropractic encounters are for treatment of musculoskeletal based complaints but that does not speak to the actual belief system of the actual practitioners. Consumers have recognized our proficiency at treating musculoskeletal disorders and fill our offices for that reason.

    Estimates in our discussions are that 40-50% of practicing DC’s do believe the structure of the body can and likely will affect it’s overall function. That’s not horribly unreasonable but I’m personally not bringing it into a discussion with a patient unless I can back it up even a little. Many, many, many fewer, however, believe the old “subluxation = misaligned spinal joint causes nerve pressure causes diease” model.

    Those numbers have shifted steadily over the past 3 decades.
    I will say that speaking out against the old subluxation concept is now a regular occurrence and is not met with fierce opposition except from the fundamentalists, who look more and more like the crazy minority every time the act up. Chiropractors have changed much more than our critics have acknowledged.

    I unfortunately do not have any references to support this viewpoint as it really is a simple cultural observationfrom a nice perch in the profession. I’m not so sure has ever been studied appropriately but I bring you more than my own opinion as it does reflect a trend that is quite apparent to all inside the profession. But no, I do not have an appropriate study. I don’t think it actually matters to enough people, to be honest.

    Let me boil it down even further…what makes more sense? The first test of reasonable thought.

    1.) The VA, Olympics, many hospital and medical facilities, Bethesda, every single major profession and college sports program, the Capitol Hill health services unit, etc, etc, etc have all at once lost their compass and are blindly committing heinous acts of woo because of some magical spell chiropractors placed over them? The DC’s who reached these high points are isolated exceptions who somehow just appeared in these positions without the support of the profession.

    or

    2.) the chiropractors in these integrated settings are actually not practicing woo at all, have risen from the much broader ranks of outstanding chiro’s, and have the support of the profession.

    (It’s #2)

  43. #43 lilady
    May 15, 2011

    or-

    3.) the chiropractors in these integrated settings are practicing woo, aided and abetted by a gullible public who pay a minimum or no insurance co-payment for a massage, and have no support of the (medical and nursing) profession.

    (It’s #3)

  44. #44 Moderation
    May 15, 2011

    Dr. Wonderful, repeat after me, “Subluxation as supported and taught by every chiropractic school in the US is not supported by existing research or understanding of human physiology.”. If you truly believe that the massive majority of chiropractors don’t believe in subluxation, I challenge you to present them. I have had many encounters with chiropractors and they claim to be able to treat everything from constipation to allergies to asthma to ADHD to autism with spinal manipulation. Just go look in the yellow pages or read the homepages for chiropractors. Current research supports chiropractic manipulation for low back pain as equal to PT, and perhaps mid to upper back pain, nothing else.

  45. #45 DrWonderful
    May 15, 2011

    @lilady- sorry, you again show our bias and well, um, ignorance I guess. In the settings of the Capitol Hill health services unit, US Olympics, VA hospital, professional and major college athletic programs there are no insurance co-pays whatsoever and we enjoy extraordinary support among our medical colleagues in those arenas. In each of these setting patients have multiple choices but typically choose their chiropractors. In the private insurance market the co-pays make up a majority of the reimbursement and people still choose chiropractic over PT in droves. Thanks again for proving my other points to be true.

    Did a chiropractor poke you in the eye when you were a child or something? Why can’t you just accept there are thousands of very good chiropractors who practice at the highest levels of physical medicine that do not practice woo? Isn’t that good news? Why is that so hard to handle, unless it conflicts with a fundamentalist belief, of course? You really don’t know what to do with this do you? (PS… I have a lot of nurses as patients and they refer a lot of patients to me too. Oh my gosh, the scandal)

    @Moderation- maybe you need to read the thread above as written, I’m not re-plowing the ground for you.

  46. #46 technically impartial
    May 15, 2011

    DrWonderful, appeal to common practice isn’t an argument; I don’t care how many chiropractors are treating the rich and powerful and famous.

    Frankly, I’m not convinced chiropracty is a real medical practice suitable for treating anything other than lower back pain, and that is because you haven’t convinced me.

    Do better next time, and with something real; Donna B has set fire to one of your claims about widespread practice (“Currently, chiropractic care is offered at fewer than 30 VA hospitals.” – refer post 41). I’m rather sceptical about the remainder.

  47. #47 lilady
    May 15, 2011

    No one poked me in the eye when I was little. I find your postings totally based on woo without any documentation/citations…blabber with sciency words to impress your massage clients.

    Aren’t you coming up to a deadline for publishing of your pamphlet/flyer that you put in the racks at supermarkets…be sure to enclose the coupon “for new patients” and the discount for supplements that you “recommend”.

  48. #48 Gopiballava
    May 16, 2011

    Dr.Wonderful:

    Of the organizations you listed, do you know how many offer reiki, therapeutic touch, or other non-evidence based treatments?

    Have you been following Orac long enough to realize how many supposedly reputable places have accepted things with zero reliable evidence and zero plausibility?

    Your repeated insistence that these groups can’t be *that* wrong is quite tedious. You have made vague claims about what chiropractors as a group may believe. Do you have evidence for this? Personal anecdotes don’t count.

    Is the spinal manipulation that you do limited to chiropractors, or do other medical professions perform comparable manipulations? Surely you understand that choosing to associate yourself with a profession founded without evidence and with a significant number of practitioners who believe ridiculous BS makes you look suspect? You keep complaining about what skeptics think, yet you choose to label yourself with a label that stands for woo when there are other options available.

  49. #49 lilady
    May 16, 2011

    @ Gopiballava: Guess which president signed the law to make Chiropracty available to all veterans…and their dependents?

    (hint) It wasn’t President Clinton or President Obama.

    (another hint) It was the same president who signed the bill for the fiscally unsound and inefficient Medicare Part D.

  50. #50 prn
    May 16, 2011

    Orac: skeptics…all holdouts…[CAM claims]…CAM/IM is becoming more “mainstream”
    In therapeutic nutrition this is a simple fact. More and more what was derided before, by the least able, but scientifically discovered mainstream ages ago, is very slowly being (re)established as medically accepted, scientific fact for even the very slowest in the class.

    Some problems that I have with such slow change include deadly delays and expensive demands for an EBM monopoly as payoff, even 70 to 120 years after initial scientific disovery, general acceptance, and commercialization. For things that benefit patients and society by their ready availability. Where EBM is a huge bait and switch from what the EBM founders and advocates stated about using best available evidence, to what is now waved about as absolute “rules” for not seeing any level of evidence outside the expensive monopoly zone.

    Fundamentally Orac should not disagree with me here, if he believes in SBM. However his skeptic mentors have many biases, errors and omissions that have been allowed to fester for some decades now and he doesn’t see through them.

    Come into the light, Orac.

  51. #51 technically impartial
    May 16, 2011

    You know prn, you didn’t offer a single shred of evidence for your claims… so yeah; I’m not convinced of anything you said there.

    Specific examples and links, or it didn’t happen.

  52. #52 Militant Agnostic
    May 16, 2011

    prn – Have you read John Ioannidis paper Why Most Published Research Findings Are False?

    You can find it here:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/?tool=pmcentrez

    You might realize why it is unwise to realize on unreplicated studies. Not that you even provide links to those.

  53. #53 lilady
    May 16, 2011

    @ prn: Militant Agnostic has provided you with an excellent paper about not pinning your hopes and not quoting small studies on any of your postings here. Try and read it and stop the inane rambling postings….it is so tiresome and boring to read about your theories and accusations.

  54. #54 Militant Agnostic
    May 16, 2011

    @52 realize should be rely

  55. #55 Denice Walter
    May 16, 2011

    @ Militant Agnostic:

    I swear, I tried so hard (see my #21 above). If those substances prn advocates held promise- wouldn’t US/UK/European researchers have jumped on the chance to subtantiate or replicate them? Or Pharma itself? Over *how* many years? Come on.

  56. #56 prn
    May 16, 2011

    Tech imp@51you didn’t offer a single shred of evidence for your claims
    look again @20, on Matsumoto (2002, PMID 11870500), and the review linked at “remarkable”.

    Militant Aggie@52: In some times and places, it’s more true than others. I look for corroborating studies of independent types (over 20 related studies on CSLEX, CA19-9 and cimetidne) and performance measures for the specific instance at hand. I mentioned @ that there were multiple cimetidine papers from “austral-asian” sources with “characteristic curves” – the longest and most detailed being Matsumoto, et al’s series (1995, 1998, 2002). In this case, I also have several forms of individual path data that are consistent with various papers.

    Denice@55
    If those substances prn advocates held promise- wouldn’t US/UK/European researchers have jumped on the chance to subtantiate or replicate them? Or Pharma itself?

    The pharmas have jumped in, with expensive biomarker-targeted therapeutics of inferior coverage, inferior biological strategy, inferior survival, and more side effects. Understand, in corporate marketing and competition, targeted cimetidine is a hated cheap competitor to be unspoken, ignored, heckled, punished, destroyed and extinguished. SOP. Don’t forget to wipe the knife. Damnatio memoriae, if possible.

    That’s some of the corporate real politik that many people are complaining about.

  57. #57 DrWonderful
    May 16, 2011

    @lilady- my oh my, you are selective, aren’t you? Yes, President Bush signed the law that authorized the VA to staff their hospitals with chiropractic physicians.

    However, did you know it was President Clinton who signed similar laws authorizing DOD to staff their active military hospitals and bases with chiropractic physicians? Did you know the studies (real actual studies oh my!) that came out of DOD demonstration projects showed military personnel were extremely satisfied with the care they received, the military MD’s generally were happy to work with the DC’s, military readiness improved due to fewer lost work days because we better managed musculoskeletal ailments, and money was saved system-wide when chiropractors were utilized to their fullest? It’s true. That is why the VA thing happened so easily. President Clinton also authorized the addition of chiropractic physicians to the Capitol Hill health services unit where Member of Congress and their staff receive medical services right on the Hill.

    Did you know President Obama specifically asked that chiropractors be included in the PPACA in an effort to help close the primary care gap? It’s true.

    Did you know all three of these Presidents are long time and very happy chiropractic patients? Yup, it’s true.

    Not that it means anything as far as “evidence” is concerned (other than the numerous DOD and VA studies, of course) but even in politics you, again, should be fair and give the total picture instead of just small biased slices. Clinton may actually go down as the strongest supporter ever, at least since Kennedy that is.

  58. #58 technically impartial
    May 16, 2011

    My apologies prn; I was referring specifically to your post at 50, where there’s a lot of unfounded tripe, but no actual verifiable claims.

    So my point stands.

    Oh, and DrWonderful, I understand the common practice here is to point out that we only have your word for it on those presidents’ actions (speaking of which, a politician’s endorsement is not helping your cause at all).

  59. #59 lilady
    May 16, 2011

    @ Wonderful: Got to you, eh. I notice that your postings only serve to advance chiropractic “theories” and you NEVER post anything on Orac’s blogs that adds to the discussion when we delve into science-based studies/science-based medicine. Heck, you are unable to provide peer-reviewed citations to refute our observations that chiropractics has been found minimally effective for temporary relief of lower back pain/discomfort.

    This blog is where the big boys/big girls post…you know the ones who have a science background…not a crappy doctorate awarded from a chiropractic schoool.

    See ya….

  60. #60 Blasphemous_Kansan
    May 16, 2011

    I’ve found the implications of prn’s posts to be profound, far-reaching, and overall incredible.

    Now imagine if any of them had citations to support them. Wow!!

  61. #61 lilady
    May 16, 2011

    @ technically impartial: Notice how I reference the president who added chiropractic care to veteranss and dependents of veterans…Bush II…and notice that Wonderful mentions President Clinton as having signed into law similar legislation?…total b.s.

    President Clinton signed into law an act that provided chiropractic care to active duty personnel…a much smaller group than “veterans and their dependents”.

    President Obama did not specifically address chiropractic care in the PPACA, but did request the formation of a “Patient-Centered Research Institute” and funding for that group. Funding is provided for that group which will evaluate outcomes for patient treatment modalities.

    Utter crap about the Presidents’ use of chiropractic massages. Still a crappy doctorate from an even crappier school of chiropracty.

  62. #62 prn
    May 16, 2011

    Ti@58 ….unfounded tripe
    No, it would be a ["boring"] rehash of complaints on previous RI threads about govt interference with pyridoxamine (vit B6), vitamin D3, natural T3-T4, L5MTHF (active, reduced vit B9), pancrelipase, etc, including some references.

    BK
    …implications of prn’s posts to be profound, far-reaching, and overall incredible… :) I know you really don’t mean it, but you happen to agree with the surgeons.

  63. #63 lilady
    May 16, 2011

    @ prn
    @ Wonderful

    Citations Please!

  64. #64 technically impartial
    May 16, 2011

    @lilady: yes, I did. Seeing as I’ve seen you, many a time, reference and back up what you say, I’m happy to accept what you’ve put forward. So that’s another stike against DrWonderful’s claims.

    @prn: No. What is at #50 is tripe. Opinionated, vague, unreferenced tripe presented as gospel truth, if you want me to be specific. And your attempted justification at #62 is more of the same. To echo lilady; citations, or it didn’t happen. No, I’m not inclined to go looking it up myself; I’m a very busy person.

  65. #65 prn
    May 16, 2011

    Here’s some light bedtime reading with nice color pictures.

    This paper reviews scientific progress on CA19-9 and some implications for cancer.

    Reiji Kannagi. Carbohydrate Antigen Sialyl Lewis a – Its Pathophysiological Significance and Induction Mechanism in Cancer Progression. Chang Gung Med J Vol. 30 No. 3. May-June 2007.

  66. #66 prn
    May 17, 2011

    Another citation, stuck in the RI reference link blocker.

    Yes, many “skeptics” are too lazy to be informed. I try to balance repetition, especially with the RI link blocker delaying linked references so badly. LL already complained today about the repetition.

    To echo lilady… very often, you’ll want to change your moniker to “technically incompetent”. I am already beginning to turn a deaf ear to LL. She likes to pretend I don’t ever have refs when she’s already seen quite a few and throw this scat every subthread or so. I see you’re “new in town” and she snagged you with it. It makes “skeptics” look like lazy, biased ignoramuses. Sorry, “gnorons” might be more pc.

  67. #67 prn
    May 17, 2011

    Blocked comment after LL@63, delinked:
    Here’s some light bedtime reading with nice color pictures.

    This paper reviews scientific progress on CA19-9 and some implications for cancer.
    [http:|| memo.cgu.edu.tw/cgmj/3003/300301.pdf]

    Reiji Kannagi. Carbohydrate Antigen Sialyl Lewis a – Its Pathophysiological Significance and Induction Mechanism in Cancer Progression. Chang Gung Med J Vol. 30 No. 3. May-June 2007.

  68. #68 lilady
    May 17, 2011

    @ prn: Now you’re simply lying about citations. You posted a rant a while back on B6 supplementation…similar to your conspiracy (“government interference…..”) rant at # 62 above. Several posters asked you for citations to back up your extraordinary claims about Vitamin B 6 over dosage (hypervitaminosis). You refused to provide any citations, as usual.

    I provided you with the web site of the NIH-Office of Dietary Supplements to get science based information on Vitamin B6 and all the other supplements that you are an “expert” on and that you continually promote on your postings. Here it is again for you:

    ods.od.nih.gov/fact sheets/vitamin B 6

    Note at the bottom of this informative fact sheet there are real citations…37 of them…based on scientific studies. Also note the downright rarity, in the United States, of people who have Vitamin B 6 deficiencies and the small amount of B 6 that is prescribed for those deficiencies…not the mega-doses that you speak of. It seems you haven’t a clue about what mega-doses can do to the human body.

    I also told you that in my experience as a public health nurse, working in public health clinics that I only saw physicians prescribe Vitamin B 6 to patients with active non-multi-drug-resistant tuberculosis. Standard drug treatment for these patients is a long course of Isoniazid, Rifampin, Ethambutal and Vitamin B 6. The vitamin is prescribed because long-term Isoniazid tends to deplete the body’s natural stores of the vitamin.

    Yet again, I ask for citations and, please try to write some cogent sentences instead of the sciency word salads.

  69. #69 lilady
    May 17, 2011

    @ prn…you finally posted (rather old) research papers on the cancer marker Sialyl lewis a.; otherwise known as cancer antigen 19-9. What does this have to do with the discussion on this blog about CAM? And, what meaning does it have aside from your set belief system that Big Pharm, “traditional” (science-based) medicine and Big Government conspire to not research alternative medicine, supplements, vitamins…..

    I suggest you go to the ASCO (American Society of Cancer Oncologists) website to see more recent research about testing for Sialyl lewis a/cancer antigen 19-9 cancer markers.

  70. #70 technically impartial
    May 17, 2011

    @prn, #65; I’m sorry you took offence when I asked for a citation to actually be provided, instead of accepting what you said as if it were the word of God. Now, you’ve posted an actual paper! There, was that so hard?

    And it’s a paper on sialyl Lewis a, a cancer marker? How on Earth is this relevant? It does not demonstrate that “EBM” (I assume it means “evidence-based medicine”) is a “huge bait and switch” centred on shifting from basing medicine on evidence to adherence to some mindless adherence to orthodox rules you fail to specify the nature of. First of all, this is a singular study. One source is simply not good enough when attempting to establish the veracity of a chain of events, especially one as long-standing and controversial as what you claim. Especially when the source in question doesn’t actually support your argument (that’s my second point). The study itself is wholly concerned with the use of sialyl Lewis a. It doesn’t deal with the matter at hand at all; a bad or irrelevant source is, frankly, worse than no source at all. No source just makes you look lazy; a bad or irrelevant one casts doubts on your intellectual honesty.

    Nor does the paper address whatever it is you’re trying to say at #64.

    Now, if I may turn to the personal remarks (“technically incompetant” – are you really making fun of my ‘nym now? My, I haven’t encountered that tactic since I was ten); my dear prn, please, don’t do that. It really brings out feelings of contempt. Ones that only grow when you try to deflect my attention from your shortcomings by accusing others of having the same.

    Your accusations in post 50 are unreferenced, unfounded, and, until sound supporting evidence comes to light, can be dismissed as nothing more than a rude fiction.

    (@lilady; sorry, but did I turn uncivil there?)

  71. #71 OleanderTea
    May 17, 2011

    Are more physicians really prescribing CAM?

    Mine certainly try.

    First, it seems that doctors with chronically ill patients are more willing to refer for MBT.

    Yeah, some of the docs at the pain care center I visit keep trying to get me to try acupuncture and/or The Graston Technique. The others have already heard my views on those subjects.

  72. #72 Krebiozen
    May 17, 2011

    @prn I used to measure serum CA-199 levels in a UK clinical biochemistry laboratory. It’s a tumor marker, and is elevated in some but not all cancers of the GI tract. It is interesting to read that there are ways of improving its sensitivity, but it doesn’t seem to have any relevance at all to what you have posted about effective cancer treatments being suppressed by “obtuse, biased, corrupt review processes”.

  73. #73 lilady
    May 17, 2011

    @ technically impartial: Sometimes, outrageous rants demand a bit (or more) uncivil responses. I wasted a lot of time reading that old (2006) pdf document provided and quickly located updated (2010) information on testing for Sialyl lewis a cancer markers at the ASCO site.

    @ Oleander Tea: The Graston Technique was analyzed by Harriet Hall on her Science Based Medicine blog “The Graston Technique-Inducing Microtrauma With Instruments (12-29-2009).

    You can become proficient in the Graston Technique…just take a 12 hour course offered by Graston Technique “practitioners”…offered during their traveling road show…at various hotels/motels meeting rooms. “Advanced” certification is offered during a 7 hour course…same Motel 6 University Certification. I suspect you would be able to finance the cost ($ 3,000) of the specialized instruments (stainless steel bars with anatomically correct bends).

    I always look forward to posters here who add to the discussion of science-based medicine and who dissect claims made by CAM practitioners.

  74. #74 lilady
    May 17, 2011

    @ technically impartial: I did post a reply to you about your uncivility…it was held by Orac…I probably messed up again, due to lack of computer tech skills.

    (Short version of my posting)

    Sometimes outrageous aimless rants against science and loaded with blatant conspiracy theories warrant a little respectful insolence or uncivility.

    Some posters here like to brag about their research skills…but lean toward remote old studies; as long as those studies are from Asia.

    Now I don’t lay claim to being a cancer or nutrition researcher and I have acknowledged that my computer skills are somewhat deficient, but I do know b.s. when I encounter it. I also know how to go to the sources of top-notch science research, hence my referral to the NIH Office of Dietary Supplements and to the ASCO websites. B 6 supplementation along with three antibiotics for treatment of active non-multi-drug-resistant tuberculosis I know from my experiences in public health clinics and intensive case management of TB cases at the health department-division of infectious disease control.

  75. #75 prn
    May 17, 2011

    LL@68
    Yes, I’ve discussed FDA’s hijacking of pyridoxamine for an FDA approved megavitamin use as a new drug, at length before. This safer B6 vitamin, marketed for decades in vitamin formulas, was disappeared recently to make way for overpriced B6, now as a prescription drug. It is not practical to redo multiple discussions, you’re just throwing mud pies.

    World reknown Bruce Ames disusses high dose vitamins in Ames,et al. “High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms” Am J Clin Nutr April 2002 vol. 75 no. 4 616-658 www .ajcn.org/content/75/4/616.full

    I also told you that in my experience as a public health nurse, working in public health clinics that I only saw physicians prescribe Vitamin B 6 to patients with active non-multi-drug-resistant tuberculosis.

    Ancient history. B6 for diabetes and glycation treatment, PMID 19681870, 17823506.
    250 mg/d B6, Cardioprotective in bypass grafting PMID 18371465, 17532963

    Biostratum is going for FDA registration on renal failure, I think mention 50-250 mg/d.

  76. #76 prn
    May 17, 2011

    Krebiozen @72
    @prn I used to measure serum CA-199 levels in a UK clinical biochemistry laboratory. It’s a tumor marker, and is elevated in some but not all cancers of the GI tract. It is interesting to read that there are ways of improving its sensitivity, but it doesn’t seem to have any relevance at all to what you have posted about effective cancer treatments being suppressed by “obtuse, biased, corrupt review processes”.

    Thanks. In the UK, UFT is available, not so in the US. The FDA made a strange, protested decision against approving UFT ~10 years ago that foreclosed treatments with the unique aspects of some UFT treatments. Cheaply. Here I apply “obtuse, biased, corrupt review processes” to FDA regarding UFT in light of CRC stage III results with Avastin, and the marginal benefit of Erbitux.

    The Japanese and others have demonstrated that CA19-9, elevated in surgerical tumor tissue, forbodes a much worse prognosis, highly treatable with cimetidine, Matsumoto (2002). In a 1998 filing Matsumoto showed chemo test results with high CA19-9 stains in stage II and III CRC patients, controls: 100% dead in six years; cimetidine treated, 100% alive at six years. Genetic variation and non cancer sources complicate CA19-9 serum test results. The Japanese have developed analyses to distinguish cases, increasing sensitivity AND specificivity. This is the importance of the Kannagi (1997) paper that I mentioned in #65 above.

    Japanese results suggest that CIM-UFT-LV-PSK ($200-300/mo) for high CA19-9 patients should equal or outperform FOLFOX-avastin (ca $20,000-25,000/mo) in some stage IV CRC cases. Having just paid cash for a curative resection (now “official”) on a stage IV CRC case following CIM-UFT-LV-PSK treatments, I’m biased :), and given several positive particulars, the surgeons were amazed no more mets anywhere for the node and peritoneal exposure time.

    Of course CIM, UFT and PSK extract for CRC are not FDA approved, and so are just altie CAM craziness….

    LL@69 ASCO (American Society of Cancer Oncologists) website to see more recent research about testing for Sialyl lewis a/cancer antigen 19-9 cancer markers.
    A society of cancer oncologists’ meeting that I saw, the Avastin sales manager had the oncologists doing better than the trained seal act for breast cancer, even after the negative news release. With over half a dozen more young and shapely sales associates waiting in the wings for any more medical stragglers.

    If you think that ASCO’s opinion is relevant in any way to CA19-9 as described by the Japanese, and with targeted cimetidine, you simply do not understand Kannagi (2007), Matsumoto (2002) or the other targeted cimetidine papers I’ve cited before, at all.

    technically impartial @70: this is a singular study…
    Perhaps about a singular country but it is not a singular study. Kannagi (2007) is a review article, covering about 25 years of Japanese technology on CA 19-9 (along with CSLEX and cimetidine) and adenocarcimonas that reflects a prime thrust of Japanese cancer medicine research.

  77. #77 technically impartial
    May 17, 2011

    @lilady; thanks. I was after a cue from an Orac regular on whether I’d gone overboard there; being served a steaming pile of tosh by someone trying to pull the wool over my eyes annoys me.

    @prn, how about we don’t quibble over the semantics because I used the wrong word, and say we did – it will save time and my blood pressure. The incorrect terminology on the part of yours truly doesn’t change this fact; it’s a single, irrelevant, source. To repeat myself: it does not demonstrate that “EBM” is a “huge bait and switch” centred on shifting from basing medicine on evidence to adherence to some mindless adherence to orthodox rules you fail to specify the nature of.

    It shows a direction of Japanese cancer research; it does *not* establish that this is direction is the result of this “huge bait and switch” operation you allude to, or furnish any evidence to support that notion.

    I’ve asked you three times for that evidence, and three times you’ve offered up irrelevancies. Therefore I am forced to conclude you were wrong, and move on.

    We’re done here.

  78. #78 augustine
    May 17, 2011

    Liladay

    This blog is where the big boys/big girls post…you know the ones who have a science background…

    Gimme a freaking break. You’re a former county nurse, with just a bachelor’s degree from the 60′s. And two years of that is general studies. Your perch isn’t so high to talk down to others from.

    Maybe you talked down to LPNs and techs like that because doctors were always condescending to you and bossing you around. You have some self esteem issues. Should’ve went to med school.

  79. #79 lilady
    May 17, 2011

    Ugh Troll, my Bachelor Science-Nursing degree is at least 4 more years of education than you ever had.

    How did that work out for you with your employment? Did you apply at McDonalds for burger flipper trainee. It might be a career path for you and you could matriculated into Hamburger U.

    Did you have that discussion with your mommy…about your lack of education, your laziness and lack of employment and income derived solely from the dole? Is mommy still adamant that all your “problems” are a result of vaccine injury?….she lied and continues to lie to her sonny boy.

  80. #80 prn
    May 18, 2011

    Technically inc & impatient@:

    What am I? yo’ mama? because you need me to hold it every time for you, Right Now?

    Jumping to such a conclusion simply makes you a shallow, impatient, and especially incompetent pseudoskeptic.

    I didn’t want Denice (@21, 55) worrying that some misguided soul is going to expire broke and unbrutalized before their appointed time (estimated MBTF was Aug 30, 2011 with benefit of Folfox+Avastin, and presumably Folfiri+Erbitux, according to the first oncologist, who has the most awards and publications, and prima trained seal at the SCO meeting), pursuing expensive, poorly thought out quack remedies, unsupported by any literature.

    Lilady was first in line tapping her foot and hollering, impatiently waiting for mundane B6 references (since April?)…and I realized that I could better address Denice’s earlier concerns with my timely answer@75 for the queries of Kerboztian@72 and LL@69.

    You’re “busy”??? I’m up to my a-h- with alligators here demanding remedial education in their own professional interests, and real life problems inadequately addressed by “standard medicine”. It takes a while to develop points and address everyone here in the middle of figuring out more effective answers IRL.

    My reply pointing out your mistake (@70), or misrepresentation, deprecating an English language review almost like the Rosetta stone as …a singular study had priority to not go unchallenged. Criticism of EBM’s historical hijacking is a long term discussion by many as even the MDs figure out that they’re being screwed. Finding a particular quote in the internet haystack is a low priority, sisyphean task.

    Thanks again, for not waiting and not listening. Gotta keep up pseudoskeptic standards.

  81. #81 augustine
    May 18, 2011

    Ugh Troll, my Bachelor Science-Nursing degree is at least 4 more years of education than you ever had.

    LPN’s today get more science than you had in your two years in the 1960′s.

    Obsolete education does not a scientist make. You were just a vaccine tech. Stop making yourself out to be more than that.

    If you’re going to dish out condescension then you better be willing to take it. Maybe you should go back to school, become a librarian, or a google researcher.

    See ya..

  82. Gimme a freaking break. You’re a former county nurse, with just a bachelor’s degree from the 60′s. And two years of that is general studies. Your perch isn’t so high to talk down to others from.

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