Respectful Insolence

The other day, I expressed my displeasure at an article published in The Atlantic that, boiled down to its essence, was one long apologia for unscientific “complementary and alternative medicine” (CAM) and “integrative medicine” (IM). Yes, I was quite critical, but, I believe, not unfairly so. Not surprisingly, however, the author of the article, David H. Freedman, was quite displeased, so much so that he actually showed up in my comments to take me to task. He didn’t just take me to task, though. He took all of you to task, as well, at least those of you who piled on. Unfortunately, his arguments in his comment were even worse than the arguments he laid down in his actual article. Let’s take a look.

Freedman begins:

As the author of the Atlantic article that has Orac and this crowd so hot and bothered, let me share a few observations and thoughts that I suspect will be completely lost on you. First, it’s interesting that all of you are deeply confident you know so much more than the dozens of highly credentialed, highly regarded physician-researchers I interviewed at several of the world’s most renowned medical centers and academies. (I only quoted a portion of these interviews in my article, due to space limitations.


As Steve Novella points out, “most ‘highly credentialed, mainstream physician-scientists’ don’t have a clue about CAM.

For someone who is so upset about my alleged use of ad hominems, Freedman is pretty free with the ad hominem himself. “Hot and bothered”? That’s clearly nothing more than a ploy designed to make it look as though I (and those of you who chimed in agreeing with me) are basing our criticisms more on emotion than on Freedman’s bad arguments topped off with bad science. It’s also rather amusing that his first gambit, rather than arguing evidence and facts, is to use a classic appeal to authority. Basically, he’s saying that because he interviewed so many “experts” he must be right. Never mind that it’s quite possible that he picked many of the wrong experts (he did), that he discounted the right experts, such as Steve Salzberg and Steve Novella (which he also did), and that he let his own bias lead him astray (which, as I argued, he appears to have done). He’s also implicitly insulting me because he he has disdain for the medical school where I’m faculty. In his view, apparently, because I’m not on the faculty at Harvard, Yale, M.D. Anderson, or Memorial Sloan-Kettering (for example), my opinion is not worth nearly as much as that of those who are. Never mind that the medical school where I’m on the faculty is well-respected and quite large. On the other hand, I could point out that the University of Maryland is not exactly Harvard or Yale either, and Freedman seemed to use Brian Berman at the University of Maryland as the source of many of his arguments. Besides, being a top tier medical school (such as Harvard or Yale) does not inoculate its faculty against falling for quackademic medicine, as I’ve documented time and time again over the last six years.

Freedman then proves himself a pyromaniac in a field of straw men, starting out by building a Burning Man-size straw man, to which he promptly and gleefully aims a flame thrower:

And let me anticipate Orac’s claim that I misquoted or distorted or spun or quoted out of context, as was his claim with my Ioannidis article, by pointing out that such claims reveal a deep ignorance of the fact-checking process that goes on at most well-regarded magazines, and especially at The Atlantic. Every single person quoted had an opportunity to correct the record ahead of time–as did Ioannidis, by the way.)

Except that I made no such claim. Seriously. Go back and read my original post if you don’t believe me. Nor do I give a rodential posterior about the fact-checking process at a magazine like The Atlantic, at least not in the context of Freedman’s article and the arguments it contains. Let’s put it this way: I more or less assumed that every single quote in Freedman’s article was accurate and fairly represented the views of the person being interviewed. That wasn’t the problem. The problem was framing. It’s how Freedman presents his facts and quotes that’s the problem, not the facts and quotes themselves. It’s the overall structure and argument of the article that’s the problem, not the individual quotes and facts marshaled to support that structure and argument. To recap, Freedman essentially admitted that the vast majority of CAM and IM treatments are no better than placebo when tested in randomized clinical trials, perhaps the only statement about which we unequivocally agree. Unfortunately, instead of concluding that this failure in clinical trials means that the vast majority of CAM treatments don’t work (which it does and which would have been the correct conclusion), Freedman instead tries his very hardest to persuade you that it doesn’t matter that CAM doesn’t work, that it’s really the touchy-feely CAM practitioners bringing the human touch by listening to their patients and spending time with them that matters, all to fire up placebo effects. In fact, he does it again in his reply:

These top scientists almost to a person agreed with my four main points: Most mainstream drugs don’t help most patients much with chronic, complex disease; alternative treatments don’t work better than placebo; alternative practitioners do a better job on average than mainstream physicians in investing time and effort with patients to get them to adopt healthier lifestyles and have better attitudes about health; and these lifestyle and attitude changes can significantly reduce the risk of complex, chronic disease as well as relieve the hard-to-treat pain and discomfort of many different disorders. All of these points are backed up by mainstream studies, aren’t even all that controversial, and, as I say, are endorsed by physician-researchers whose credentials and reputations are, well, let’s be charitable and say “at least as solid as,” those of Orac. (I happen to agree that the Nobel Prize or any other credential or affiliation doesn’t confer a monopoly on insight or the truth, but on the other hand it’s genuinely shocking and appalling to me to see the combined word of so many highly regarded people dismissed with a wave of the hand.)

For someone who says he agrees that the Nobel Prize or other credentials or affiliations don’t confer a monopoly on insight, Freedman sure does like his appeals to authority, doesn’t he? He seems to be all about credentials and affiliations. Again, he takes a not-so-subtle dig at me and my qualifications, which serves to amuse me more than anything else. As I’ve said time and time again, one reason I keep the “Orac” pseudonym even though a lot of people know my real name is, besides the fact that I like the pseudonym and am a bit curmudgeonly about ever willingly giving it up, because I want my arguments to stand on their own without having to rely on any “authority” my credentials give me. I’ve said it time and time again going back at least five years. Sure, I’m a doctor. Sure, I’m also a scientist. So what? None of that matters very much when I sit down in front of my laptop to blog. I like to think that my arguments and track record as a skeptical blogger are all that matter in this particular venue.

The other thing that Freedman does is what Steve Novella and I have characterized as the classic “bait and switch.” In other words, he’s completely fallen for the framing of lifestyle changes, such as diet and attitude, as somehow being “alternative.” They are not. They are, and always have been, part of science-based medicine, and no supporter of SBM that I’m aware of, including myself, denies that they can be very effective tools for improving health. However, CAM apologists like Freedman frequently co-opt these modalities as being somehow “alternative.” They then use them as the “foot in the door” to let the real pseudoscience in, woo such as homeopathy, reiki, and the like. Steve prefers the term “bait and switch”; I, on the other hand, prefer the term “Trojan horse.” Basically, diet, exercise, and lifestyle interventions are the Trojan horse pulled into the bastion of science-based medicine. After it’s there, all the quackery, such as homeopathy, acupuncture, reiki, and “energy healing,” leaps out and takes over.

And Freedman uses these rhetorical tricks with the best of them, whether he realizes it or not.

I’m not even convinced of some of Freedman’s facts. For instance, he claims that alternative practitioners “do a better job on average than mainstream physicians in investing time and effort with patients to get them to adopt healthier lifestyles and have better attitudes about health.” Really? Certainly, he presents no evidence, either here or in his Atlantic article, that this is true, that alternative practitioners routinely produce better outcomes in these areas than “conventional” physicians. In fact, if you’ll excuse my French, I call BS on this statement. When you come right down to it, many CAM practitioners have what are most definitely non-science-based views on what constitutes good nutrition and a healthy lifestyle. All too often, the common sense recommendations that some CAM practitioners make are buried under layers of pseudoscience, the hawking of supplements, and interventions based on prescientific, vitalistic ideas about health. Ideas like homeopathy and acupuncture. Indeed, in the Atlantic article, an acupuncturist is reported to tell a patient sticking little needles in his skin would “‘open blocked “energy pathways’ in his body, allowing a more normal flow of energy that would lessen his pain and help restore general health.” Another dubious “fact” presented by Freedman is the bit about how allegedly “most mainstream drugs don’t help most patients much with chronic, complex disease. I can’t help but note that drugs actually do work with chronic disease in many cases, including diabetes, hypertension, and a number of other chronic conditions. I have no idea what Freedman means by “chronic, complex disease.” It seems to be a buzzword he picked up somewhere in his interviews and research.

I have to admit that Freedman actually rather amused me with his finale:

Frankly, the unwillingness of Orac and this crowd to consider for a moment the possibility that there may be some aspect of alternative medicine other than any direct physical action from its core treatments that might be helpful to many patients, especially in light of all the evidence and widespread, highly informed opinion that this is so, perfectly embodies everything that science is supposed to oppose: closed-mindedness, deep bias, hostility to disagreement, reckless disregard for reason and evidence that don’t support a favored conclusion, and a total lack of humility with regard to what one knows for sure. What you are defending here isn’t science, folks–it’s what I call “scienceology,” a quasi-religious faith in a set of closely held beliefs that are dressed up in the trappings of science and kept immune to any counter-evidence or -opinion. When a person genuinely operating in the true spirit of science hears a counter-argument or counter-evidence, he or she thinks, “Hmmm, let me consider this carefully to see if I need to rethink or modify my position”; when a scienceologist hears a counter-argument or counter-evidence, he or she thinks, “Hmmm, what’s the best way to viciously trash this so I can continue to believe in what I absolutely know to be true?” Which one applies to you, would you say?

At the risk of a tu quoque argument, I can’t help but ask: Which one applies to Freedman, I wonder? He’s also got it wrong. I’ve said time and time and time again that I can be convinced by evidence. In fact, I frequently like to use the example of homeopathy (because homeopathy is so inherently ridiculous from a scientific point of view) and quote Tim Minchin’ awesome nine-minute beat poem (NSFW):

Science adjusts its beliefs based on what’s observed
Faith is the denial of observation so that Belief can be preserved.
If you show me
That, say, homeopathy works,
Then I will change my mind
I’ll spin on a fucking dime
I’ll be embarrassed as hell,
But I will run through the streets yelling
It’s a miracle! Take physics and bin it!
Water has memory!
And while it’s memory of a long lost drop of onion juice is Infinite
It somehow forgets all the poo it’s had in it!

You show me that it works and how it works
And when I’ve recovered from the shock
I will take a compass and carve “Fancy That!” on the side of my cock.”

And I will, too; change my mind if the evidence indicates that I should, that is. As for the other part, I most definitely do not like the thought of sharp objects near my most sensitive parts; so I’ll pass on the compass. Be that as it may, I’ve even said on many occasions that if the anti-vaccine movement managed to produce some high quality studies that indicated that vaccination is associated with an increased risk of autism, I’d have to seriously reconsider my position that vaccines don’t cause autism. I’ve yet to see such a study.

As for the charge of “scienceology,” Mr. Freedman really is out of touch with the very CAM movement he appears to find so compelling. As I pointed out in a followup comment, the correct term is “scientism,” which is a favorite charge against skeptics and scientists favored by all manner of cranks, including CAM practitioners, creationists (yes, creationists), HIV/AIDS denialists, and anti-vaccine activists. I’ve seen the term used by all of these varieties of cranks at one time or another. Mr. Freedman should really not be so eager to join these groups by throwing around terms like “scienceology.” Besides, the whole argument that “your science is a religion” that he makes is so tiresome because it is so easy to refute. It’s not for nothing that this canard has been dismissively (and appropriately) referred to as “doggerel.” Science is only a religion to those who do not understand science, and it is clear that Mr. Freedman does not understand science.

You know, before I saw Mr. Freedman’s response to my criticism, wasn’t going to be all that hard on him. He sounds just like any number of journalists I’ve encountered who have become enamored of the glamor of woo. Unfortunately, his response reveals just how deeply he’s drunk the Kool Aid of pseudoscience. The bottom line is that CAM/IM adds absolutely nothing to medicine. Even Freedman admits that nearly all of it is no better than placebo before lamenting that physicians don’t spend enough time with their patients. Unfortunately, he frames this observation as a false dichotomy: Continue with physicians having too little time for their patients or let the quacks in to provide the empathy and “lifestyle” counseling. That’s completely the wrong approach. The answer to the problem of physicians not having adequate time for their patients is not to let quackery invade science-based medicine and quacks take on the role of empathetic healer. Rather, it’s to find a way within the confines of science-based medicine to bring the human touch back and empower science-based practitioners to be the empathetic healers that the vast majority want to be. If, after all his interviews, Freedman realized that, he might have done a valuable service for the readers of The Atlantic. Instead, he revealed himself to have become yet another useful tool for the CAM movement’s endless proselytization.

ADDENDUM: Steve Novella has responded. He’s at least as harsh as I am and makes an excellent analogy between the CAM movement and the creationism/intelligent design movement.

Comments

  1. #1 daijiyobu
    June 17, 2011

    Great rebuttal.

    Sophists are hard to counter, because their method of argument is primary not the essential content of their claims.

    -r.c.

  2. #2 DPSisler
    June 17, 2011

    @Orac: Ouch…that’s gonna leave a mark

  3. #3 Mu
    June 17, 2011

    Freedman doesn’t even make a decent argument from authority. “I have a PhD from X and studied 5 years under Nobel price winner Y” is good, “I’m a journalist who spent 30 min on the phone with Nobel price winner Y and picked the three sentences that fit best for my article”, not so much.

  4. #4 Mutant Dragon
    June 17, 2011

    Truth be told, I like Freedman’s response far less even than his original article. Any time you have to show your credentials or resort to name-dropping to make a point, it’s a sign your argument has no merit. “Believe me, not because the evidence supports my argument, but because I went to Harvard.” Unfortunately, in the real world, that’s often how things work, but it’s not how science SHOULD work, and it’s not persuasive. Evidence means more than the name of your alma mater.

    The other really bizarre thing about this Atlantic article (well, ONE of the other really bizarre things about this Atlantic article) is the claim that CAM practitioners spend more time with and are more caring about patients than traditional doctors. That may or may not be true, but either way, it’s NOT an argument in favor of CAM, it’s an argument about our current healthcare system (which doesn’t always permit doctors to spend as much time with each patient as they and/or the patient might like) and the way we train doctors in medical school. A kind and caring quack is still a quack for all that.

    What bothers me about all this is the way CAM is infiltrating medicine by way of so-called “integrative medicine”. The more widespread it becomes, the more difficult it is to stop, because people like Freedman are easily bewitched by credentials. Never mind that reiki and homeopathy are completely implausible, never mind that homeopaths are so crazy they actually think you can use “potentized mustard gas” as treatment for mustard gas burns (yes, they’ve actually tried that! I blogged about that recently as part of a post on the history of chemical warfare), no, never mind all that! the University of Maryland Medical Center is doing this stuff now, so it MUST be useful, right?

  5. #5 Krebiozen
    June 17, 2011

    I have been thinking about David H. Freedman’s article, and agree with Orac when he writes:

    many CAM practitioners have what are most definitely non-science-based views on what constitutes good nutrition and a healthy lifestyle.

    There is a huge variety of claims about good nutrition in CAM and IM circles. We should eat more starches and less protein (McDougal). We need more protein and fewer starches (Atkins). We need raw and preferably rotting meat (Vonderplanitz – I kid you not). Eat raw fruits and vegetables only (Ann Wigmore and Herbert Shelton). Fruit is poison to the body (Robert O. Young). Fruit is fine, it’s starches that are are poisons to the body (Carol Sinclair). Wheat is a poison (Myhill). Saturated fat is good for you (Ravnskov). It goes on and on.

    All these dietary ‘experts’ have a collection of disciples who claim to have beaten life-threatening illnesses using their guru’s diet, and dismiss anyone who disagrees with them as idiots. If you find an expert who says foodstuff X is good for you, try Googling “X is poison” and you will find another expert who says the opposite, and they are nearly all trying to sell you something.

  6. #6 M Roberts
    June 17, 2011

    Thank you for the excellent rebuttal of this nonsense and an informative summary of some CAM tactics of which I was previously unaware. Nutrition and lifestyle modification as CAM? They’ve been part of conventional (scientific) medicine, as taught in mainstream medical schools, for decades! I’d be surprised to find primary care physician in the U.S. who doesn’t regard them as critical. To make the mistake of equating diet/lifestyle control with CAM is sloppy thinking but forgivable (except in the case of a journalist supposedly researching an article on the subject). Deliberately conflating the two is shameful.

  7. #7 Forbidden Snowflake
    June 17, 2011

    Good commonsense rebuttal to a very mush-headed and cliché-laden comment.

    Mutant Dragon, to add to what you say in your third paragraph: it’s not just about being “bewitched by credentials”. Many if not most homeopathy believers do not actually believe in homeopathy: they just don’t know what it is and accept it on the authoritative veneer of cargo cult science, which is enhanced when real universities and health-care providers allow it to flourish in the dark, dank, damp corners of their homes.

  8. #8 Marry Me, Mindy
    June 17, 2011

    Nutrition and lifestyle modification as CAM? They’ve been part of conventional (scientific) medicine, as taught in mainstream medical schools, for decades!

    Hasn’t the doctor saying “Cut down on booze and women” been a punchline for, like, ever?

  9. #9 Vicki
    June 17, 2011

    I’d say that the bit about time is an argument for socialized or at least single-payer medicine: part of why your doctor doesn’t have a lot of time to spend with you is that they are spending time on your behalf arguing with an insurance company (which, remember, has a financial incentive to deny care). There’s a thing called “pre-authorization” which means “after the doctor prescribes a medicine, make him/her fill out a specific insurance company form saying that the patient needs it. Require another copy every twelve months, even if there are no new medicines for this purpose and it is treating a chronic disease.” This serves absolutely no medical purpose: if your doctor thinks you should take medicine X, and is prepared to tell you and your pharmacist that, s/he isn’t suddenly going to decide s/he’s wrong when your insurance company demands a “Simon says.” But the time your doctor is spending on that is time s/he isn’t spending with a patient (or getting some sleep). The time your pharmacist spends chasing down that paperwork from your doctor is time s/he isn’t spending dispensing pills, or checking interactions, or warning you to stay out of the sun while you’re taking this medicine. It’s part of why we spend longer waiting in line.

    [more rant about insurance companies deleted as off-topic.]

  10. #10 Forbidden Snowflake
    June 17, 2011

    Freedman says:

    “scienceology,” a quasi-religious faith in a set of closely held beliefs that are dressed up in the trappings of science and kept immune to any counter-evidence or -opinion.

    Orac replies:

    As I pointed out in a followup comment, the correct term is “scientism,” which is a favorite charge against skeptics and scientists favored by all manner of cranks

    Hmmm, this isn’t the definition of “scientism” I was accustomed to. I thought “scientism” is “attempts to apply science to areas it doesn’t generally apply to, such as ethical decisions, subjective emotions and personal tastes” (also known as the “Can science prove that a sunset is beautiful (that you love your mother / that Verdi’s music is great / etc.) ?” gambit). Those who (mis)employ the term usually thus defend their faith in certain factual claims against demands for evidence.

    What Freedman defines as “scienceology” is either a) best articulated as “being dogmatic” or b) not even a thing.

  11. #11 Jojo
    June 17, 2011

    I’m glad to see so many people calling Freedman out for missing the point that the better solution to how little time some physicians have to spend with patients is to improve the health care reimbursement system, not have sCam fill that roll. I’ll also pile on that sCam is full of weird nutritional advice, that can be harmful if followed (Gluten and dairy free for autism puts kids at risk for malnutrition.)

    But, there is another point that hasn’t been addressed. Ethics. Freedman admits that most of the sCam treatments are no better than placebo. However, Freedman thinks it’s fine for patients to be lied to and pay money for treatments that work no better than sugar pills. Typically paid for out of pocket as well because insurance doesn’t cover them. (And if it did, then alt. med practitioners would find themselves in the same economic situation as MDs ending their monopoly on spending time with patients.) Maybe Freedman doesn’t have a problem with being lied to and being asked to spend money on useless treatments, but I find it condescending and morally repugnant.

  12. #12 Denice Walter
    June 17, 2011

    An uninspired drizzle drips from the mist-enshrouded grey sky and I feel morose. Reading about Freedman didn’t help.

    A few things: I wonder if the decision to create a neologism, “scienceology”, when a synonym – “scientism”- already exists, had anything remotely to do with the fact that it sounds like “Scientology”. Let readers unawares associate sceptics with the followers of a despised *cult*. How clever!

    If IM and CAM modalities are admittedly no better than placebo, is there really *no* difference? The first one I can think of is obviously monetary: useless treatments waste money whereas cheap or free placebos, although basically useless, are readily available**. I read accounts of charlatans who gross in the 8-figure range USD. CAM and IM are enriching practitioners, manufacturers of supplements, and publishers. For example, ardent followers may now have Mike Adams exclusively streamed for only $24 a month! Woo is a huge business. My late father, when he encountered something hateful or stupid, would derisively remark, “Well, at least it creates jobs.” I must disagree with him in this instance.

    Having pseudo-science infiltrate medical schools and national magazines provides additional “street cred” to woo-meisters who are already pumped up on endorphins from their endless workouts as well as braggadocio unimpeded by higher mental functioning. The *lack* of criticism by educated people ( boards of med schools or national magazines) adds to charlatans’ mounting confidence as they spread their wings undertaking new endeavors. It makes them sound safe and acceptable to a general audience.

    Another new service: Gary Null now provides free nutritional counselling by phone to customers. It is done by nutritionists and ( supposed) dieticians who advise clients about what supplements to buy. He prefaces this by relating how he has cured “thousands” of serious ills ( cancer, AIDS, CV, ad nauseum) in this manner. Isn’t this “diagnosing and treating” illness without… you know? I suspect that he isn’t the only one.

    I hate using the term “enabling” but isn’t that what lack of criticism does?

    ** here is an ancient placebo: put a charm on a chain and wear it around your neck. You’ll feel better.

  13. #13 Recovering Cam User
    June 17, 2011

    As a patient with a “chronic, complex disease” who spent 15 years pursuing relief through CAM, I will agree that most all of the CAM practitioners I saw were caring, compassionate people who spent more time with me than conventional doctors (because I was paying them mightily out of pocket for the privilege.)

    I did feel better being cared about in that way – until the inevitable point where it became clear that the “treatments” were not actually working. At that point, I was frequently blamed for “not wanting to get well” despite spending thousands of dollars and following their prescriptions exactly.

    After having my bank account drained and my falsely inflated hopes once again dashed, I always ended up feeling much, much worse than when I started. So, yes, Mr. Freedman, what’s the harm?

  14. #14 Beamup
    June 17, 2011

    All that said, Freedman does touch on a good point. Mainstream medicine doesn’t do as well as we might hope with the sympathy, attentiveness, and related issues. (For many reasons, not least time pressure.) And CAM practitioners do better in that limited respect. So to the extent Freedman meant to say that mainstream medicine should ideally do better on that, while dumping the woo, I’d actually agree.

    This is hardly a new observation – it’s been discussed here many a time – but it does mean that he’s not completely wrong.

  15. #15 Jesse
    June 17, 2011

    Orac

    I think your assessment that Freedman was simply beguiled by woo might be true, though I would love to hear from Freedman why he is so enamored of CAM. I also agree that he doesn’t seem to understand science all that well.

    But to be fair to him, and speaking as a reporter who writes about science — sometimes it is hard to find people who are real experts, and to know which ones to go to. I mean, I have written about biochemistry on occasion, and I only know rudimentary chem from high school plus some physics from college. (21 years gone now). So It’s often a struggle for me to find the right people. Once or twice, heck, often, I bet I was completely wrong.

    But the thing you do — before you file the story — is try to track down the right people by asking folks who a good person to talk to is and going to the primary literature and looking up the “corresponding author.” They have phone numbers and emails, so it isn’t like tracking down Watergate burglars. But again, it took me a long while to learn the search terms (and I had to ask for a lot of help on one story about brain function).

    You can’t be too caught up in the experts you get. Even when they tell you a really cool story. That’s where I think Freedman does less well. Some of it is his take on John Ioannidis’ work. I saw that come up in the primary literature (even pitched the story myself) and the thing is, Ioannidis’ argument has a lot more to do with how studies use statistical math than anything else, and the statistical likelihood that they aren’t completely right (which is rather different from being ‘wrong.’ Also, in any field, there is a large likelihood that what you publish would be refuted — after all, not everyone is going to rewrite the textbooks, as they say.

    That doesn’t alter the fact that certain treatments — even for chronic conditions like diabetes — work. ANd when I saw his excerpt that extended the “they are wrong” paradigm to fields such as chemistry and physics I had to laugh a bit. Physics especially has an iron rigor — the stuff works or it does not — that allows for almost no wiggle room. (For example, while there are a lot of things physicists don’t know about dark matter you can constrain quite a bit).

    So maybe the apologia he did comes from his book on why experts can be wrong. I don’t know. I’d love to hear him explain it.

  16. #16 Denice Walter
    June 17, 2011

    @ Recovering Cam User: Thank you for illustrating my point.
    A person who follows health regimes like those endorsed by our web woo-meisters could easily blow a couple hundred a month on supplements and a highly restricted diet (vegan, raw, organic)- not to mention so-called treatments- that might be better spent persuing interests and entertainment with family or friends. What’s the harm in a nice dinner out or a movie? It won’t make you *better* although you might *feel* better.However if the money is already spent on CAM ,it isn’t available for enjoyable placebos.

  17. #17 Luna_the_cat
    June 17, 2011

    My sister is a GP. One of my brothers is a rich redneck. Rich redneck brother has signed on with what I can only call a “vanity doc” — but this doc provides a very flattering level of care, and is in all honesty probably good for the brother. On his first consultation, apparently they spent half a day going over lifestyle issues, diet, nutrition, possible health problems and what to do to head them off, etc. Of course, redneck brother can actually afford to spend $3,000 on a half-day doctor’s visit, too.

    My GP sister works for a state clinic, catering heavily to immigrant, low-income “working poor” and Medicare/Medicaid populations. At the time that redneck brother was just signing on with his doc, she was under pressure to see a minimum of 48 people per day. She often spends time with her notes into the late evening, researching possible diagnoses and doing paperwork that she didn’t have time to do during the day. Due to state budgets being cut, she has now lost two of her colleagues, and has to shoulder as many of their patient load as she can, too.

    You could see her sitting and fuming as redneck brother gushed over how much better doctors could be than what sister could do…

    The answer to this is not, and has never been, to invite pseudoscientists and medically unqualified or underqualified “alternative therapists” into the field to pick up the burden. It is, as multiple other people have mentioned here, to improve training in real medical schools — not to include the unsupported “alternative therapies”, but to include more about managing communication with patients and dealing sensitively with patients’ “lifestyle issues” — and more to the point, to find ways to relieve the burden on the real docs so that more of them can afford to spend that personal time with their patients.

    The simple fact is, yes, people need to feel that the person treating them cares. However, encouraging people to use “alternative therapies” because of this, instead of real ones, actually has the potential to ultimately increase the burden on the real medical system in terms of serious issues which may go ignored or misdiagnosed for too long because of most contact being with medically underqualified woo-meisters. Yes, there are certainly occasions where mainstream doctors ignore or misdiagnose serious conditions, and it is certainly sometimes incompetence, but this is exacerbated by the teeny tiny bit of time with each patient which is enforced by the system, as opposed to being primarily due to ignorance or “alternative ways of thinking.” We should aim at the best of both worlds to tackle this problem — properly medically trained doctors with time to spend.

    Now, how could the US do that, given that its medical system teeters on the edge of nonviability anyway….that’s a far more difficult question. But the way that Freedman has pinpointed a real issue and then come up with a completely unhelpful and unsupportable set of answers to enthuse about…this we don’t need.

  18. #18 clamboy
    June 17, 2011

    Freedman says, “…let me share a few observations and thoughts that I suspect will be completely lost on you.” A few responses leap immediately to mind: 1) Then why are you sharing them?; 2) You arrogant prick; 3) You could not have picked better words to shut down any discussion had you gone at it for a week. After reading the rest of Freedman’s reply (in the context of Orac’s post above), I find number 2 to be the most fitting, both in words and number.

  19. #19 Luna_the_cat
    June 17, 2011

    …And that just leaves aside the issues of misrepresentation of medicine, with the utter nonsense about how it doesn’t help with “chronic, complex conditions.” That stuff’s just wrong.

  20. #20 Dr. Steve
    June 17, 2011

    I think that whatever improved outcomes, if there actually are any, that come from CAM treatments known to be no more effective than placebo when studied properly can be, at least in part, explained by what I like to call “self-referral bias”.
    We have all seen patients who, when told they have early diabetes and need to change their diet and exercise more, do basically nothing. It can be hard to motivate these folks, who usually feel just fine and therefore feel no real compulsion to change.
    Those who decide to seek out and pay, out of pocket (usually) to see a CAM provider are signaling, with their time and money, a willingness to change. Hence better outcomes.

  21. #21 TBruce
    June 17, 2011

    Jessie@15:

    Freedman did in fact go to a couple of the “right people” to get their take on AltMed. See the addendum to Orac’s entry. Sadly, he pretty much disregarded what they had to say.

    It appears to me that Freedman approached this assignment with his mind made up. Also, he REALLY doesn’t like Orac or his “friend”. His loss, but, unfortunately, also the reader’s.

    clamboy @ 18:

    I, too, choose Number 2

  22. #22 Jesse
    June 17, 2011

    @TBruce–
    I was thinking more about when Orac said a Nobel Prize in a field doesn’t give you expertise in every field. But point well taken.

  23. #23 RobNYN1957
    June 17, 2011

    And it’s false that CAM is harmless. A friend of mine has recently had five surgeries for herniated vertebral disks after 20 years of twice weekly chiropractic treatments. His orthopedic surgeon told him that he had injuries “consistent with surviving an airplane crash.”

  24. #24 Richard
    June 17, 2011

    I’m glad things are starting to heat up. What we need to emphasize over and over is that while science-based medicine has its problems that need to be worked out, quackery is never the answer. Hell no to IM!

  25. #25 Dangerous Bacon
    June 17, 2011

    So what’s this alleged evidence showing that woo practitioners are better at getting patients to adopt lifestyle changes with meaningful impact on health compared to mainstream physicians? (and no, pointing to the popularity of “toxin cleanses” is not an example of “meaningful impact”).

    Freedman has not picked up on the fact that Orac’s “crowd” includes numerous health professionals and those in other scientific disciplines, who along with other regular commenters demonstrate the ability to engage in critical thinking and evaluate quality research as opposed to fallacy and anecdote. And as a physician with a previous career in journalism, I’m sorry to see a reporter stack the deck in the way Freedman did in his Atlantic article and handle the issues so poorly, both in the article and his followup.

    Not “lost on me” are the typical woo-based tactics Freedman uses to strike back at critics, most regrettably the “Yur science is just religion!” ploy and the appeals to cherry-picked authority.

    I also suspect (based in part on the reference to Atlantic’s marvelous fact-checking abilities) that Freedman is ticked off not only that we questioned his authorities and conclusions – it’s also resentment that a (relatively) unpaid blogger and commenters have shot holes in his published oeuvre. How dare we!

  26. #26 Calli Arcale
    June 17, 2011

    Scienceology….

    In addition to it being a pointless neologism, and in addition to it sounding suspiciously like Scientology, and in addition to it being a complete misunderstanding of our complaints, doesn’t Freedman know that “scienceology” would, logically, be “the study of science”? And what, honestly, would be wrong with studying science? It might be a bit “meta”, a bit self-referential, but there’s no logical reason why one couldn’t study science, or perhaps the practice of science. That would seem an entirely reasonable thing to do, and quite unlike what he was describing.

    That’s why the other neologism, “scientism”, was coined; the “-ism” suffix is more commonly found with religious doctrines (Catholocism, Protestantism, Methodism, etc), aesthetic forms (Modernism, Dadaism, Impressionism, etc), and things like that. Not that we really need that word either; “dogma” is adequate, and also sufficiently pejorative to meet Freedman’s needs.

    Another thing that really struck me about his response was the comment that we are being closed-minded. This is a typical response to criticism by cranks; I’m not saying Freedman is a crank, but the fact that the criticism is so frequently leveled by them is illustrative. There is none so blind to their own closed-mindedness than a closed-minded person. And Freedman strikes me as at least somewhat closed-minded — he is closed to the possibility that there is indeed harm in allowing CAM to have a veneer of unearned legitimacy. (I’ve met people far more closed-minded; that Chuck fellow in the last thread who was going on about homeopathy for burns and gout was just about the most closed-minded person I’ve met recently who wasn’t actually nuts. Chuck had decided what worked, and nothing whatsoever, even months of agony from gout, is going to persuade him otherwise. That’s impressive. Pointless, but impressive.)

    There are a lot of people who equate “open-minded” with “friendly” and “closed-minded” with “hostile”. And furthermore, they confuse “friendly” with “doesn’t attack my assertions, or at least not too much.” But is it really friendly to let nonsense go unchallenged, at least nonsense with a potential to hurt people? I don’t care what God you do or do not believe in; for the most part, that won’t hurt anybody. You can believe in invisible purple unicorns if that’s what feels right to you. But if you tell me that homeopathy works, and I should try it, then I’m going to rebut that. People have died by using homeopathy instead of actual treatments. (Yes, they seriously have. There’s the harm.)

    It’s probably good to be diplomatic when correcting a friend, and you have to choose your moments; it’s not worth alienating a friend over their decision to do cleanses or whatever, as long as they’re not directly threatening their health that way — just as it’s not worth alienating a friend over them spending lots of money on their ceramic unicorn collection of whatever. And when something *is* threatening their health, then you need to talk to them, give them the information, and let them decide what to do with it, respecting whatever they choose — they are your friends, after all.

    But articles in the print media are another matter. These are disseminated over a wide audience, and so the potential for harm due to misinformation is much greater. It is the duty of bloggers and journalists alike to respond vociferously to such things, as the opportunity presents itself.

  27. #27 john smith
    June 17, 2011

    Luna the cat got it, and very eloquently! The point that was so conspicuously missing from Freedman’s snotty and ignorant replies– and Orac unfortunately has neglected — is really crucial. The “talky”, attentive alt med is not a medical system for either a population or for serious diseases. It is a luxury expenditure for those who can afford it, like a “life coach”. As soon as your local homeopathic con man gets paid $12 of someone else’s money to see each each patient, the faster we will will see him drop the fuzzy concern and pass out the vials of magic water in 5 minute appointments. Why is this point so universally missed when people compare real medicine and quackery? Luna’s sister is the heroine, and Freedman’s understanding simply limited.

  28. #28 palindrom
    June 17, 2011

    This entry, and the string of comments that follows, is one of the best things I’ve seen on the internet in quite a while.

  29. #29 Dan
    June 17, 2011

    Great takedown Orac. I find it ironic that a journalist heavily using arguments from authority is deriding the experience of other experts in the field of medicine (especially people like yourself and Dr. Novella who have actually studied CAM at least as much, and probably more, than the experts he relied on). There’s nothing like a journalist derisively preaching down to physicians about the nature of medicine and how science works, just because he interviewed a couple doctors!

    I’ll repost my comment here from NeuroLogica, since maybe Mr. Freedman will see it:

    I’d be really interested to know what percentage of internists would agree with Freedman’s first point that “Most mainstream drugs don’t help most patients much with chronic, complex disease.” The point is so vaguely phrased that it is almost useless, but I get the impression that most internists would consider that statement laughably wrong.

    Does he mean that a minority of “mainstream” drugs actually do help most patients a lot with chronic, complex disease, but many drugs for chronic conditions aren’t as effective as those few? That would counter his point on the need for CAM. Is he saying that a majority of all the pharmaceuticals available treat acute and not chronic conditions? That may be true, but is trivial. Or is he saying, as I suspect, that scientific medicine is mostly useless to the vast majority of patients with chronic diseases? That last interpretation, the only one that really helps his case, is patently false.

  30. #30 Calli Arcale
    June 17, 2011

    John Smith (or are you the Doctor?):

    As soon as your local homeopathic con man gets paid $12 of someone else’s money to see each each patient, the faster we will will see him drop the fuzzy concern and pass out the vials of magic water in 5 minute appointments.

    This.

    Quacks who are paid for consultations do indeed spend lots of time with their patients. This is because that’s the part they’re paid for. Quacks who are paid for the treatments and not so much for the consultations, however, spend very little time with their patients. Case in point: one of those chelation docs who had killed a patient was found to spend less than five minutes with each patient, then leave the patient unattended while the chelation occurred. I’ve heard the same thing about many docs at various dubious cancer clinics as well. Notably, these are people who are paid primarily for how many treatments are performed, not by the hour (though the chelationist was found to be billing insurers for long consultation sessions despite only spending five minutes, if that, with each patient on many sessions).

    So not only is it not an argument that we should use alt med in order for patients to get doctors who spent time with them and show real concern for them, it’s not even true that alt med doctors spend more time with their patients. Some of them do, certainly, but definitely not all. In fact, there are alt med practitioners who are much worse about this than an overworked GP who knows that if he spends an extra five minutes with you, that only means his next patient loses five minutes from their session.

  31. #31 lilady
    June 17, 2011

    Prior to my stellar career in public health, I worked for a trade magazine…part of a large conglomerate of trade magazines dealing with “the trade” in HVAC, “contract (office) furniture”, electrical, heavy machinery and building supplies.

    It was then, and still is now, all about advertising revenue, subscriptions barely covered the costs of editorial staff, printing and mailing costs. And, of course if you could increase your subscription base…corresponding costs to advertise went up as well.

    We tried to maintain some semblance of journalistic integrity and a wall between the editorial staff and the advertising sales department…but we were after all…a trade publication.

    At the present time all print media is suffering huge losses, with a few notable exceptions including “The Atlantic”. Popular articles that “sell” the magazine such as Mr. Freedman’s increase the subscription base, thus increasing advertising revenue…the infusion of this cash, keeps Atlantic Magazine in business.

    Just how would Mr. Freedman’s article add to the magazine’s revenues if he didn’t tout CAM therapies, while trashing science-based medicine?

    Advertising Age wrote about the renaissance of the The Atlantic, on their website:

    The Atlantic is No. 2 on Ad Age’s Magazine A-List (10-4-2010)

    We see examples of this all the time at Huffington Post where they occasionally have some real (science-based) articles along with all the sCAM advertisers popping up at the end of these rare good articles.

  32. #32 Krebiozen
    June 17, 2011

    Would anyone argue that it is OK for any other professional to tell lies because it makes their client feel better? How would that work with a lawyer, or a car mechanic?

    I can only assume that those who defend this practice in medicine are unaware of the dishonesty at the core of most CAM modalities.

  33. #33 Mephistopheles O'Brien
    June 17, 2011

    Would anyone argue that it is OK for any other professional to tell lies because it makes their client feel better? How would that work with a lawyer, or a car mechanic?

    Are you sure you want to use those particular professions as examples? What about adding politicians to that list?

  34. #34 Krebiozen
    June 17, 2011

    What about adding politicians to that list?

    Surely lying to make potential voters feel comfortable voting for them is their profession?

    With lawyers I was thinking more along the lines of, “Relax, as long as you wear these lucky socks the jury will definitely acquit”. Or with a mechanic, “No your brakes are fine, as long as you sprinkle this magic water on your car every day…”

  35. #35 Matthew Cline
    June 17, 2011

    The other thing that Freedman does is what Steve Novella and I have characterized as the classic “bait and switch.” In other words, he’s completely fallen for the framing of lifestyle changes, such as diet and attitude, as somehow being “alternative.”

    Is it really bait and switch if they actually believe it? I get the impression that many, many CAM advocates genuinely believe that conventional doctors don’t advocate lifestyle changes.

  36. #36 Jarred C
    June 17, 2011

    Is it really bait and switch if they actually believe it? I get the impression that many, many CAM advocates genuinely believe that conventional doctors don’t advocate lifestyle changes.

    Yes. However, they are applying the technique out of ignorance, instead of intent to deceive.

  37. #37 Denice Walter
    June 17, 2011

    Why does CAM sell so well? Even talking about it appears to invigorate websites ( Huffington), magazines ( the Atlantic), and TV shows ( Oprah, Oz): if it hurt sales or ad revenue, you wouldn’t see as much of it.

    Medical science and technology have accelerated rapidly since the 1980′s: it’s difficult enough for experts to keep up with research, but education in science has not accelerated for *all* people- the general public, alienated by the shockwave of innovation, perhaps experiences *neophobia*. And what a brave new world that has such pharmacopaeia in it!

    To some, CAM may represent a welcomed return to the simpler days of personal care by a trusted professional who had all the answers, reassured you, and wasn’t dependent on cold steel MRI machines or multi-page lab reports to help you heal. Some cling to CAM as our ancestors did to their amulets. Obviously, this lovely nostalgia must prove to be a distraction from what technology has wrought: longer life and the management and prevention of serious illnesses.

    While the woo-meisters commiserate about how they are maligned or misrepresented by the mainstream, I find myself aghast at how softly the media tread. I hate to say it: woo is going mainstream itself – becoming “acceptable” to the masses.( Please don’t shoot me for saying so). If the educated don’t call out the wasteful, the useless, the dangerous, and fraudulent, who will?

  38. #38 ebohlman
    June 17, 2011

    Krebiozen: You nailed it. CAM concepts of nutrition bear more resemblance to religious doctrines than they do to any sort of objective reality. Most of them are based on assigning moral attributes (good or evil) to individual foods or food ingredients; they’re basically systems of taboos and totems.

  39. #39 Recovering Cam User
    June 17, 2011

    “Why does CAM sell so well?”

    Here’s one example. A friend with severe gall bladder problems was told by her conventional doc that that they could take it out, but there was only a 50-50 chance that would solve the problem.

    An acupuncturist, on the other hand, told her that they would be able to completely heal the problem in a limited number of sessions.

    I don’t think the acupuncturist was intentionally lying. But for people who are into that sort of thing, there’s just no way the messy reality of real medicine can compete with the fantasy of ignorant certainty.

  40. #40 Krebiozen
    June 17, 2011

    @ebohlman

    they’re basically systems of taboos and totems

    I hadn’t taken the idea quite that far, but I think you’re right. If we all had powerful beliefs like that about behavior that really is bad or good for us, I guess we would all be healthier. Perhaps part the trouble is that there are few foods that science tells us are absolutely bad, or good. It’s difficult to get passionate about moderation.

  41. #41 Narad
    June 18, 2011

    If we all had powerful beliefs like that about behavior that really is bad or good for us, I guess we would all be healthier.

    I hope I’m not wide of the mark, but assigning practicality to “taboos and totems” doesn’t work. Kashrut does not prohibit pork because of trichinosis, etc.

  42. #42 Pete
    June 18, 2011

    I’m just recovering from a kidney stone (had the stent removed to day). For the whole two-week episode, from the pain-level 10 stay in urgent care, through controlling the symptoms with Vicodin, anti-nausea suppositories and anti-inflammatories, and the procedure to zap the stone when it got stuck in the ureter, I kept wondering to myself, “What state would I be in now if I was relying on CAM to get me through this?” Would any transient placebo effect from, say, acupuncture really make a dent in the excruciating agony of the stone making its way down (and what about when it got embedded – a bit of chiropractic to help it on its way?)

    Yes, my urologist gave me shorter shrift than I would have liked sometimes, but I have the information about which calcium oxalate foods to avoid now, and he’s doing a urine work-up give him more information for preventive measures.

    I think the bottom line is, when it comes to REAL health issues, give me SBM any day, and not a guy with “basically a glass of water in one hand and a huge invoice in the other,” no matter touchy-feely he is.

  43. #43 Chris
    June 18, 2011

    Oh, come on! Why not let the people choose?

  44. #44 Jake Hamby
    June 18, 2011

    I think the bottom line is, when it comes to REAL health issues, give me SBM any day, and not a guy with “basically a glass of water in one hand and a huge invoice in the other,” no matter touchy-feely he is.

    QFT. Count me as another satisfied SBM customer. I even have a complex, chronic neurological condition, but fortunately one of the most treatable through (actual) medication: ADHD.

    Now I’m about 10 years too old to have been diagnosed with it as a child, as today’s elementary school kids are screened for, but I can tell you that I was a very hyperactive and classic ADD kid from a very young age. I got the gene, like 1-2% of the population (equally prevalent in males and females, BTW). If I had been diagnosed as a child, my life would have been far less plagued with anxiety and trouble due to my inability to concentrate on schoolwork I didn’t want to do. Typical ADHD problems, from all the stories I’ve read.

    I was lucky and made it through college with a degree and some work experience, but soon I hit a wall in terms of what I could accomplish in my career due to my inability to focus on certain aspects of software development I didn’t want to work on (or rather that my brain was preventing me from being able to focus my train of thought on, despite my deepest desire to be able to do so). Many people with this condition who are older than myself and didn’t know of the existence of this condition, as I was, turn to alcohol, drugs, dangerous lifestyles, and often make complete messes out of their lives due to this neurological difference (in the prefrontal cortex, and science discovers more of the details every year).

    So I had to go through a very unfortunate period of clinical depression and anxiety in my 20′s before I finally dragged myself to get diagnosed by a psychiatrist and prescribed the appropriate pills for my particular neurology (personalized medicine! Imagine that!). In my case it was a combo of bupropion (Wellbutrin SR) and methylphenidate (Ritalin). Without them, I wouldn’t be able to live a normal life, in terms of mood and ability to concentrate on the things that matter. With SBM, and a lot of hard work, I have my dream job (programmer at Google) and no side effects from the pills to speak of.

    Now there is a mini “big Pharma conspiracy” I could point out, but it’s not the one the woo-ists would like to believe. The problem is that the system is structured such that the drug companies make the most money from advertising drugs that they have patented. The really good ADHD drugs are all off-patent, so you never seem them advertised. The last time I saw a banner ad for adult ADHD it was for some medication specifically for people who can’t take the usual stimulant-based drugs, and not something that was actually more effective. So there’s no real push out there to pull in the vast number (perhaps several million in the U.S. alone) of adults with ADD who would have to, like myself, specifically seek out (and perhaps deal with the stigma of both “mental illness” and “psychiatry” in their worldview) the so-called allopathic medicine that is in fact extremely effective for me, and countless others (not all people with ADD benefit from medication, but many do).

    I feel really bad for the folks out there who are missing out on the opportunity to avail themselves of inexpensive and effective medicines and treatments because of their irrational fears of doctors and anti-government paranoia. Like the guy in the previous thread with gout. I wonder what wacky bottles of homeopathic ju-ju he would recommend for my complex / chronic condition.

  45. #45 Krebiozen
    June 18, 2011

    @Narad

    assigning practicality to “taboos and totems” doesn’t work. Kashrut does not prohibit pork because of trichinosis, etc.

    It is possible that some religious dietary laws evolved partly through observation (though I suppose that’s blasphemy). Avoiding pork does (or did) help to prevent trichinosis, whether that is the reason for the prohibition or not.

    What I meant is that people are capable of lifestyle modification if they strongly believe in it. The dietary fads common in CAM resemble religious taboos and totems, which highly motivate some people. People seem to find it easier to become passionate about avoiding a food or only eating a limited group of foods than about following the science-based dietary guidelines which advocate a balanced diet.

    We need to find a way for people to feel passionate about healthy lifestyle modification. We really do.

  46. #46 lilady
    June 18, 2011

    @ Pete: You’ve just come through one of the most painful experiences, with the great non-invasive medical care that is modern day western medicine. Had you gone to a CAM practitioner who decided to try a variety of alt therapies, you could have suffered through a ruptured ureter, shock and died.

    Our noted philosopher Denice Walter has concisely summed it up. Some people remember the good old days fondly, when doctors with little in their arsenal of effective treatments had the time to do some hand-holding, had few tests to pinpoint a diagnosis and targeted treatments. As a consequence, there were no negotiations with insurance companies to justify expensive diagnostic tests and “exploratory” surgeries that patients underwent “might” find a treatable condition…if you didn’t die first from peritonitis.

    So easy now to turn on the TV to watch Dr. Oz and his latest woo, espouse “alternatives”, discuss healthy diets along with the latest woo such as Reiki, immune boosting treatments, homeopathy and other nonsense…coupled with big pharma conspiracy and “government interference”…all complicit in the scam to remove patients’ choice. It’s called the dumbing down of medicine for the people.

  47. #47 Denice Walter
    June 18, 2011

    @ lilady: well, thanks – I’m no philosopher just a liberal arts person who eventually branched out into reality…

    The micro-cosm of pseudo-science I observe gives me hints about what the attraction is:
    Obviously the touchy-feely stuff. Nostaglia.
    Denial of reality/ avoidance of the unpleasant and uncertainty
    Desire to be “hip” and on the “cutting-edge”- a “revolutionary”( puzzling- since subcribing to their ideas drags us back centuries, if not millenia).
    While consistency is not their strong suit, it’s great material for an ad campaign.

    These charlatans present themselves as being harbingers of the future- the “paradigm shift” is upon us! Crappy studies are presented as legit. Articles like the *Atlantic*’s add fuel to the pseudo-scientists’ fire and provide grist for their mills: it’ll be quoted and presented in all of the usual venues. Alt med’s audience doesn’t sift through the background material and takes woo-meisters at their dissembling word. They mis-represent themselves as being humanitarians fighting oppression by… uh, us.

    Which is hilarious to me- with my own families’ and personal history- to be considered a representative of the *status quo*.Ha ha ha!

  48. #48 Dangerous Bacon
    June 18, 2011

    From the Atlantic article: “These top scientists almost to a person agreed…Most mainstream drugs don’t help most patients much with chronic, complex disease”

    I thought about these words this morning when reading a Wall St. Journal op-ed piece about the 30th anniversary of the discovery of HIV, the virus that causes AIDS.

    The article made the point that 30 years on, we still don’t have an effective HIV vaccine (though significant progress on this difficult problem has been made). What we do have are highly effective anti-retroviral drugs that have turned AIDS from from a short-term death sentence into a long-term manageable chronic illness where people routinely live 20 years or more after diagnosis.

    What has woo given us in the fight against HIV? Rank quackery that costs lives.

    “…the Society of Homeopaths are holding a conference in London next week featuring the work of Peter Chappell, who also claims he can make an immediate impact on the Aids epidemic using music encoded with his Aids remedies.

    “Right now,” he says, “Aids in Africa could be significantly ameliorated by a simple tune played on the radio.” Damningly, contemptibly, not one single person from the homeopathy community has spoken out to criticise this lunacy.

    And of course our own rather grand Patrick Holford, Britain’s leading nutritionist, who sells bottles of vitamin pills with his beaming face printed on them, writes, in the “fully revised and updated” 2004 edition of his 500,000 copy best seller “The Optimum Nutrition Bible”, the alarming words: AZT, a drug still routinely used alongside other drugs in Aids treatment, “is proving less effective than vitamin C”…

    Peddlers of nonsense treatments – and newspapers – trade in emotive anecdotes. Three million people died last year of Aids, and that figure elicits insufficient emotion, outrage, and coverage, because it is the polar opposite of an emotive anecdote. Nature outguns any man-made weapon, and it remains our greatest challenge. Our greatest impediment is wishful, brutal stupidity.”

    - Ben Goldacre

  49. #49 Vasha
    June 18, 2011

    Somebody argued rather plausibly that the taboo against pork could be because pigs are known to scavenge human corpses and dig up graves (and the deterrent would be the cannibalistic “ick” factor, not the danger of disease transmission). This makes more sense to me than thinking that the ancients discovered an epidemiological connection between pork and trichinellosis, which after all does not become symptomatic until at least two days after infection, and often is not symptomatic at all. Besides, visceral repulsion makes for more compelling taboos than rational reflection does.

  50. #50 Pareidolius
    June 18, 2011

    MESSAGE BEGINS——————————-

    Shills and Minions,

    I’m sure you’re all wondering, as I was, where your delightful, new drone went. Surely it would have followed the conversation from the previous thread to spout its cheery, “little engine that could” aphorisms. Fret not my marvelous monkeys, the ladies on level 7 have recalled it for some adjustments. I’m sure it will show up sooner or later. On to other business . . .

    Shill Walters (DL, Class VII,), your triumph over the treacly postmodernist indoctrination you faced in your tertiary education never ceases to impress us up here at PharmaCOM Orbital. I am suggesting that you receive yet another commendation for your keen intellect and cogent posts. Your insight into the frailties of your species is as helpful to our cause as it is enriching to your bank account.

    Your honored place in the history of the Corpus and the records of Terran Subjugation Unit VII is something the other Shills and Minions would do well to emulate.

    Stay Vigilant. Stay Evil.

    Lord Draconis Zeneca, VC, iH7L
    Forward Mavoon of the Great Fleet, Suzerain of V’tar and Pharmaca Magna of Terra
    Glaxxon PharmaCOM Orbital HQ 0010101101001

    ————————MESSAGE ENDS

  51. #51 Krebiozen
    June 18, 2011

    I find it amusing that Vasha’s comment about the dangers of eating pork is below a comment from Dangerous Bacon.

    I agree, pigs eat all sorts of nasty stuff, and that is very probably the reason for the taboo against eating their flesh. I just think that if fear of a supernatural being’s wrath can persuade large numbers of people to avoid certain foods for centuries, science can surely come up with an effective way way to persuade people to eat sensibly.

  52. The really good ADHD drugs are all off-patent, so you never seem them advertised. The last time I saw a banner ad for adult ADHD it was for some medication specifically for people who can’t take the usual stimulant-based drugs, and not something that was actually more effective. So there’s no real push out there to pull in the vast number (perhaps several million in the U.S. alone) of adults with ADD who would have to, like myself, specifically seek out (and perhaps deal with the stigma of both “mental illness” and “psychiatry” in their worldview) the so-called allopathic medicine that is in fact extremely effective for me, and countless others

  53. #53 Old Ari
    June 18, 2011

    scienceology, anyone who would mix a latin root with a greek root is beyond the Pale.

  54. #54 Vasha
    June 18, 2011

    @Krebiozen:

    If you want people to not eat something, you can spread rumors that it’s made with human flesh (“Did you know that they use fetal tissue to grow GMOs…”) But a positive incentive is harder to come by, and promoting moderation and balance is harder still. And what about the idea that people should make dietary choices based on sound principles rather than their hopes and fears?

    Reminds me of a recent column in some magazine, I think it was the Audubon Society. A conservationist wrote about how, paying a visit to Madagascar, he found that someone had been telling villagers that eating sea turtles was deadly, in an apparent attempt to protect endangered species. He didn’t think it was right to lie, and decided to talk to the villagers and tell them instead why he thought they shouldn’t kill turtles. He thought afterward that his talk didn’t get across very well, and one reason for the confusion was that he happened to be wearing a beard in the style of an imam, so people had come expecting him to expound on what the Koran said about sea turtles.

  55. #55 ebohlman
    June 18, 2011

    lilady:

    You’ve just come through one of the most painful experiences, with the great non-invasive medical care that is modern day western medicine.

    Not “western” medicine, just modern-day medicine. It isn’t culture-bound, you know. Let’s try to avoid the genetic fallacy (which seems to be one of the main bases for woo).

  56. #56 Liz Ditz
    June 18, 2011

    Pete! Aieeee! I am glad to hear you are recovering — I’ve never had one of those, and I hope I never will.


    “What state would I be in now if I was relying on CAM to get me through this?”

    Pretty much like most pre-1900ish (I am not a medical professional) folk:

    Writhing in pain for days, and possibly dying. (sorry, can’t quickly find mortality figures

  57. #57 lilady
    June 18, 2011

    @ ebohlman: I used the terminology “western medicine” because of my extreme distaste of “allopathic” (buzz word used by homeopaths) or “traditional medicine”…as if non-traditional medicine such CAM or intergrative medicine is on the same level as “modern-day medicine”.

    I stand corrected and thank you for pointing me toward “modern-day medicine”…much better phraseology.

    Lord Draconis states the obvious…shill Walter is superb at cutting through the crap and is deserving of special commendation. I, a newbie novice shill in training, am in awe of her crap cutting prowess.

  58. #58 DW
    June 18, 2011

    My dearest Lord Draconis:

    Ever since I was a pale- but very pretty- waif, shivering in the miserable drizzle outside the Opera House where I would sell my violets to the fine ladies who were arriving there- oh, they were so lovely in their silken frocks and velvet wraps, swathed in ropes of South Sea pearls, dripping Columbian emeralds from their shell-like ears- I vowed even then: I would be a fine lady too one day- and a dark one- I would wear fine clothes and drip emeralds. *And* I would be the equal of *gentlemen*: in intellect, cunning, and evil- plus, I’d be a lot better looking, so people would like me even more.

    Now that I’ve arrived and got the goods wot I wanted and a friggen title on top of it: I must confess that we are basically battling brave maverick wankers- not one of them even got enough wits about themself to figure out what the f–k we’re talking about most of the time. It is so f–king pathetic and lame! We got all the smarties. They’re all on our side. Come on, now! where’s the challenge! It’s like shooting fish in a barrel for cripes’ sake!

    I do thank you for making all of this possible, despite my existential dilemma. I shall persevere and continue on my path of inspirational and fashion-conscious evil. Darling, I couldn’t have done it without you!

    Most sincerely yours, DW, DL VII

    ** BTW, I might feel slightly less morose if there were a few more parties.

  59. #59 anarchic teapot
    June 19, 2011

    @Bush Doctor
    “In the 19th century, depending on where you were in the world, a lot of cultures of folk had better access to pain medicine than we do in the ‘west’ today.”

    From a quick glance at the article: opium and alcohol self-medication, mostly. Both addictive, both with serious side-effects both immediate (risk of death from overdose, increased bleeding…) and long-term.

    Morphine – an opium extract – is still used, in carefully controlled doses and carefully controlled circumstances. Alcohol is not recommended as an analgesic/myorelaxant.

    Infusions of willow bark are still available in tablet form (aka aspirin); again, dosage must be carefully controlled because of potential side effects.

    So, better access? The stuff that works is still used, only with far less risk. This includes remedies used by remote Amazon tribes and Granny Back In The Old Country: part of modern pharmaceutical research involves studying folk remedies, isolating the active ingredient (if it exists, woo isn’t a recent phenomenon), attempting to synthesize the molecule, and testing it for safety and effectiveness.

    Modern painkillers are safer, more effective, and more accurately dosed.

    So, basically, you’re talking bollocks.

  60. #60 lilady
    June 19, 2011

    I suspect some sock puppet may have invaded out thread again with cannabis indica extract. They used all sorts of heavy duty drugs like tincture of opium, ether and copious amounts of alcohol before modern pharmacology. I think I would stick to modern drugs that are titrated correctly.

    @ Liz Ditz: I too have been lucky, never having suffered with passing kidney (or gall stones which can get caught in the common bile duct). I seen enough patients to understand the excruciating pain that they suffer through as well as a gangrenous gall bladder, necessitating a very long surgery, extended recovery that my brother dealt with.

    I would much prefer titrated pain relief for the intra-operative period, so much more reliable.

  61. #61 Imogen
    June 19, 2011

    As long as we`re logically fallacing, I`m going to Ad Hominem and say that this sentence gave me a headache…

    Frankly, the unwillingness of Orac and this crowd to consider for a moment the possibility that there may be some aspect of alternative medicine other than any direct physical action from its core treatments that might be helpful to many patients, especially in light of all the evidence and widespread, highly informed opinion that this is so, perfectly embodies everything that science is supposed to oppose: closed-mindedness, deep bias, hostility to disagreement, reckless disregard for reason and evidence that don’t support a favored conclusion, and a total lack of humility with regard to what one knows for sure.

  62. #62 Doc Rocketscience
    June 19, 2011

    When Freedman makes his opening salvo at Orac and the commenters on Orac’s blog*, the first thing I thought was:

    umadbro?

    When he starts making up words like “scienceology”, the first thing I thought was:

    Troy Maclure: Just ask this Scientician!
    {cut to guy in lab coat next to a microscope}
    Lab Coat Guy: Uhh…
    {cut back to Troy}
    Troy Maclure: He’ll tell your that…

    Seriously, Mr. Freedman, if that is your real name and if you’re reading this, kindly grow the hell up.

  63. #63 Doc Rocketscience
    June 19, 2011

    Jesse way back @15:

    Are you honestly suggesting that Freedman ought to be given more leeway in responding to his poorly framed articles about science, and his childish responses to critique by other scientists, and his attacks on readers (way to build up those sub numbers for your bosses there, Dave)because “journalism is hard”?

    If Freedman wants to write these anti-science science articles and never have to have his worked criticized, he ought to pull a David Kirby and write only for sympathetic alt-woo mags and websites who will fawn over his every word.

  64. #64 Isabel
    June 19, 2011

    Between hard science and patient experience there lies a long bumpy, twisty road that needs to be MUCH more acknowledged.

    Why do you think people keep paying for CAM services, even while they have insurance for conventional drug treatments?

    I have always felt much better being treated by CAM practitioners, it’s not a new accusation that doctors make you wait, and then spend a short, impersonal time with you; this is an old complaint.

    You can blame it on time-consuming insurance requirements, quacks and gullible people all you want. Oh and while it can be dangerous to wait too long to seek conventional treatment, CAM treatments are generally much lighter on dangerous side effects and much less invasive.

  65. #65 Chris
    June 19, 2011

    CAM treatments are generally much lighter on dangerous side effects and much less invasive.

    Even if they don’t work?

  66. #66 Isabel
    June 19, 2011

    Um, yes? Not sure what you’re point is.

    I guess my point is some alternative treatments or diets may be worth trying first, before drugs or other intervention becomes necessary. Here’s an example. Say you are in the very early stages of type II diabetes. I don’t have the citation handy, but I have read that for some people even with full blown diabetes six months on Atkins and they can go off their medication permanently. I have actually seen this more than once, and did read the original papers as this concerns my family, but if this is not well-known I will dig up the reference (it’s probably easily googled).

    One advantages of this approach over other diet and exercise approaches is that it is easier to follow, as weight loss is less dependent on calorie restriction and constant exercise, and cravings are under control. The more modest diet restrictions most doctors prescribe are actually harder to follow, as every dieter knows.

    So it would make sense for every person who presents with early symptoms of stage II diabetes to be placed on a (perfectly healthy) diet of protein, good fats such as nuts and olive oil, berries, and salads and non-starchy vegetables for six months BEFORE trying other forms of therapy (including other dietary changes) and certainly before any drug intervention (unless the stages are advanced enough to warrant it in the short term of course). This could save billions if practiced on a wide scale. And no bad side effects.

    But this will never happen. Currently, it seems most doctors recommend lifestyle changes, but don’t really seem to expect them to be followed and are very willing to non-judgmentally prescribe meds when people don’t exercise or lose weight successfully or whatever, so there is much less pressure.

    I suspect that many people are like me, and do their own research, use both types of medical services as it feels right. I do think there is something to the charge that most medical practitioners undervalue lifestyle changes, or don’t keep up with the latest nutritional research, so I am sure to especially research those on my own.

    Another point I may have brought up before here, so sorry if I am repeating myself, but I recently learned that an estimated 10% of people may be needle phobic, and as any visit to a doctor now requires having blood drawn many people may be avoiding conventional treatment out of a fear that they may be embarrassed to admit to.

  67. #67 Doc Rocketscience
    June 19, 2011

    Yes, I would imagine that something that does nothing and has no effects would be less invasive with fewer side effects.

    Also, isabel, pehaps you haven’t actually read anything written here, but we pretty much acknowledge that CAMies probably do spend more time with patients than actual doctors – because “spend time with patients” is all the CAMies do.

  68. #68 Denice Walter
    June 19, 2011

    @ Isabel: I review a few alt med websites and radio shows. Followers are actively frightened away from SBM treatments and offered a plethora of supplements as substitutes. Cures for serious illness are offered as a matter of course via articles, shows, e-books, seminars, films, and lectures ( naturalnews.com). The perpetrators of these illusions present themselves as innovative researchers, far ahead of standard medicine, when they are actually *salesmen* hawking nearly useless products which are available untested legally *only* because of a loop-hole called DSHEA.

    A few days ago ( @ progressiveradionetwork.com), the guru told how a woman who had used his products was able to discard her meds for high bp. Other tales are spun about easy cures for ills like cancer, HIV/AIDS, Alzheimer’s, diabetes, MS, ASD/LD, SMI, CV- the list is nearly endless. Phone consults with a nutritionist or dietician ( as if they were the same!) are offered free at the sales phone number.( BTW: untreated high bp can lead to many serious complications including heart attack, stroke, damage to vision and kidney fx.)

    This has nothing to do with freedom of choice: it is a deliberate mis-information campaign, taking advantage of the public’s natural fears about medical intervention and loss of control at the hands of doctors. They gain the trust of customers through mis-representation.

  69. #69 DLC
    June 19, 2011

    There’s no such thing as “alternative medicine.” if it works, it’s adopted by the mainstream and so known as Medicine. if it does not work, then it’s not medicine, but an Alternative To Medicine.
    The alternative to medicine is going untreated.

  70. #70 adelady
    June 20, 2011

    “I have always felt much better being treated by CAM practitioners, it’s not a new accusation that doctors make you wait, and then spend a short, impersonal time with you; this is an old complaint.”

    Well I’ve had good treatment from both. I’ll admit the chiropractor and the specialist physio both did me some good in terms of mobility of recalcitrant joints. But far and away the best was the specialist anaesthetist who knew more, a great deal more, about dealing with chronic pain than either of them.

  71. #71 NZ Sceptic
    June 20, 2011

    We’re about to get some sort of natural health regulatory authority here in New Zealand. The associate health minister claims: “We want to develop a regulatory system that is cost-effective and gives New Zealand consumers the assurance that the natural health products they buy are safe, true to claim and true to label.”

    Imagine if this was really to happen. It could be utterly revolutionary and see all the homeopathic remedies on pharmacy shelves tipped down the toilet where they belong and from where, according to the laws of homeopathy, they must have come, but sadly I don’t hold out much hope.The quacks will find a way around it!

    These two stories depressed me especially recently. Is there really no end to this nonsense?

    http://www.fitnessgoop.com/2011/05/the-homeopathic-treatment-of-autism-olive%E2%80%99s-story/

    http://www.thestar.co.uk/news/health/homeopaths_are_honoured_at_commons_1_3416484

  72. #72 Isabel
    June 20, 2011

    I posted a long reply and it is still held up in moderation for some reason.

    I am not advocating that people follow gurus, I am simply saying that average patient experience does not necessarily equal the latest, bestest science in action at all times.

    And that it is way less stressful going to alternative therapists.

  73. #73 JayK
    June 20, 2011

    @Isabel: Going to the dogpark is less stressful than going to a medical office, and it doesn’t cost anything. Going to the beach is less stressful than going to a medical office.

    You can go anywhere you want, but when the toll must be paid for ignoring symptoms, you’ll end up at the medical offices, or the hospital, usually much worse off than if you had just dealt with the problem up front using science based medicine.

    By advocating CAM, you’re saying that people should do the equivalent of nothing. CAM doesn’t do anything for real illness. Do you get that point?

  74. #74 Vicki
    June 20, 2011

    Of course the average isn’t going to be equal to the best, in any field: that’s how comparatives work. The answer is to work to improve things, not throw them away because not all the children are above average.

  75. #75 Beamup
    June 20, 2011

    For that matter, even acknowledging that sCAM artists can spend more time and be more supportive, how exactly does that justify them taking money for treatments which do nothing? If they merely marketed themselves as a sympathetic ear and dropped the woo, I don’t think most people here would have a problem with them.

  76. #76 Edith Prickly
    June 20, 2011

    For that matter, even acknowledging that sCAM artists can spend more time and be more supportive, how exactly does that justify them taking money for treatments which do nothing?

    EXACTLY. This is the point Mr. Freedman can’t seem to grasp. He keeps trying to claim that since some conventional treatments can induce a placebo effect in the patient, that means any alternative treatment that also works as a placebo is just as good. It’s not, for all the reasons that have been exhaustively documented here in all the posts about his article.

    As for Freedman’s notion that alt-med practitioners do a better job than doctors at providing things like nutritional counselling – maybe he should have a chat with Gary Null about that. (Cheap shot, I know, but perfect example…) If someone’s been trained in a completely unscientific treatment system *cough* Homeopathy! *cough*, how could you possibly trust their advice about any other health issues? Based on completely anecdotal reports from relatives and friends, the nutritional counselling often consists of being immediately diagnosed with food allergies (without any reliable testing being done, of course) – milk, pork, wheat, or whatever food group they’re blaming for everything that week – and a recommendation to take supplements that just happen to be sold right in your friendly neighbourhood naturopath’s office!

  77. #77 Edith Prickly
    June 20, 2011

    Total Gary Null hyperlink fail, will have to make due with old-school cut and paste:
    http://scienceblogs.com/insolence/2010/04/too_deliciously_ironic_for_words_gary_nu.php

  78. #78 Isabel
    June 20, 2011

    “By advocating CAM, you’re saying that people should do the equivalent of nothing.”

    I just said I am not advocating it.

    ” CAM doesn’t do anything for real illness.”

    Sometimes it does. Some of the diets mentioned do work for some conditions. I don’t know what happened to my long reply. A message said it was going into moderation but it never appeared. Unfortunately I didn’t save it.

    “Do you get that point?”

    Yes, I have been here before and I understand about the self-correction of science.

    “usually much worse off than if you had just dealt with the problem up front using science based medicine. ”

    I haven’t seen a lot of evidence for this, just anecdotal evidence usually referring to serious cases. In many cases people just get better on their own. In some cases an alternative diet might work and save them having to take dangerous meds.

    My main point was that there are many factors affecting treatment options. I disagree with your conclusion that my best option in all cases is to go to the health clinic that my grad student insurance covers and follow their recommendations.

  79. #79 JayK
    June 20, 2011

    @Isabel: The cost of ignoring chronic illness is growing, and as US healthcare costs grow out of the reach of those in lower economic classes, we see more and more costs involved in illnesses that cannot be ignored past a certain point.

    doi:10.1016/S0140-6736(10)61414-6

    Nutrition and diet isn’t CAM. sCAM docs may act like they have some sort of insight (which they don’t), but most of the time they just have a supplement to sell you.

    I’m glad you like to have your hand held by someone to whom you’ve granted an unearned authority, but when you decide to grow up you might want to look at the science behind the magic they try to sell you.

  80. #80 Chris
    June 20, 2011

    Isabel, if you read today’s article by Orac you will learn he is in the midst of some heavy duty work demands (trying to get grants, I have posts that are still in moderation so they may have been lost — not a big deal). If you have evidence that CAM does anything worthwhile then post the journal, title, date and authors of the papers that support your opinion.

    And, I shall also repeat that special diets are not CAM, but part of conventional medicine. You should play around this website: http://whatstheharm.net/alternativemedicine.html

    Because what do we call CAM modalities that work? Real medicine.

  81. #81 Isabel
    June 20, 2011

    “I’m glad you like to have your hand held by someone to whom you’ve granted an unearned authority, but when you decide to grow up you might want to look at the science behind the magic they try to sell you.”

    I haven’t granted ANYONE authority over my body.

    The treatment at my university health clinic may or may not be (probably won’t be) the latest greatest science. The person treating me might not have read the latest research and might tell me to avoid eating coconut oil because it is saturated, or some other such nonsense, when actually it might be a healthy substitution for me. The experience will probably be very alienating, impersonal, and uncomfortable and they will undoubtedly order blood work and I am one of the 10% of people who are needle-phobic, so it’s yet another reason to avoid going if possible.

    One thing I mentioned in my other post is that I don’t believe most doctors emphasize lifestyle changes enough, and they criticize (my health care provider recently did) diets like Atkins which can be really helpful, and are perfectly healthy, and don’t take enough of an organized stand about unhealthy aspects of our diets. I have a 40-year-old relative who weighs 350 lbs and is on 3 blood pressure meds among many others. When does a doctor become an enabler, driving up health care costs for everyone?

    These are just some of the very reasonable concerns about the current system that could drive a person to at least experiment with alternatives, is all I’m saying.

  82. #82 Chris
    June 20, 2011

    Isabel:

    I have a 40-year-old relative who weighs 350 lbs and is on 3 blood pressure meds among many others.

    So you have accompanied this relative to the his/her doctor’s appointment and noted that no lifestyle information was provided. You have personally discussed this lack of information with his/her doctor.

    Now, since your long comment is taking a long time to get moderated, perhaps you can tell us what the journal, title, date and authors of those papers that support your opinion.

  83. #83 JayK
    June 20, 2011

    @Isabel: I guess you wouldn’t expect someone to know that the Atkins diet is actually a bunch of crap that endangers people with undetected diabetes or causes ketosis in a substantial numbers of those practicing it without the review of a medical doctor. I’m sure a CAM doc would do a proper evaluation of diabetes without bloodwork before recommending Atkins, right? Oh, wait, they don’t do bloodwork.

    You haven’t come up with one suitable reason for anyone to use CAM, but you sure have made a lot of excuses for your poor choice(s).

  84. #84 Chris
    June 20, 2011

    Speaking of blood pressure medications: I have a child who has been on them since he was fourteen years old. He has a genetic heart condition called hypertrophic cardiomyopathy with obstruction. The heart muscle has grown abnormally and his mitral valve has been damaged due to the increased pressure.

    This brings up two things:

    1) Do you really know everything about your relative’s diagnosis?

    2) What CAM treatment do you think would be effective for my son’s diagnosis, which occurs in about one in a thousand people? Be sure to provide the journal, title, date and author of the paper that supports you statements.

  85. #85 Krebiozen
    June 20, 2011

    Isabel,
    I have lost count of the number of times I have seen CAM proponents claim that coconut oil and palm oil are healthy oils. However, there seems to be very little evidence that this is true. Both are saturated fats, and reputable authorities on nutrition advise against excessive consumption. Which recent research are you referring to?

  86. #86 lilady
    June 20, 2011

    Um, Isabel…I suggest you also check the internet for Atkin’s diet and the formation of renal calculi and also kidney failure…before you tout the Atkin’s diet for weight loss.

    @ Chris: A very long road ahead of you to preserve your child’s health and, I know you are on top of the latest research.

  87. #87 Chris
    June 20, 2011

    lilady, unfortunately the HCM forums are very very depressing. But he does go to the cardiologist this week.

  88. #88 Isabel
    June 20, 2011

    “bunch of crap that endangers people with undetected diabetes”

    Do you have a citation for that?

    This is what I am talking about. So now a person is afraid to tell their doctor because the doctor thinks it is a bunch of crap. I should be able to tell my doctor I would like to go on the diet, and get tested for whatever the doctor thinks is relevant first. Your hostile attitude makes the situation worse.

    Basically I am ignoring the controversial and brief “induction phase” of Atkins which is optional anyway, so I am referring to cutting back dramatically on processed foods, bread and starches, and adding no special supplements (also optional even if you are following it ‘strictly’). Not going overboard on meat or dairy (another myth), and eating lots of fish, non-starchy vegetables, salads, berries, nuts, nut flours, eggs, avocados, small servings of beans and sweet potatoes. How is not adding starches or sugars or processed grains to one’s diet ‘dangerous’ when these are not even foods (bread, pasta) one is likely to come across in nature?

    This can be a useful diet for people who are at risk of developing diabetes, as an alternative to other diets, or who need to lose weight to lower blood pressure, and especially those who are wheat or gluten intolerant. It is also easy to follow because cravings are lessened. It may not be suitable for everyone, but “crap”?

  89. #89 JayK
    June 20, 2011

    @Isabel: Oh, did you call for a citation and never actually provide any to back up your assertions?

    Sassa, M., Hosokawa, M., Fukuda, K., Fujimoto, S., Toyoda, K., Tsukiyama, K., Inagaki, N., … Seino, Y. (August 01, 2008). Glycemic instability in type 1 diabetic patients: Possible role of ketosis or ketoacidosis at onset of diabetes. Diabetes Research and Clinical Practice, 81, 2, 190-195.

    or

    Choukem, S.-P., Sobngwi, E., Fetita, L.-S., Vexiau, P., Gautier, J.-F., Calvo, F., Boudou, P., … Mauvais-Jarvis, F. (December 01, 2008). Multitissue insulin resistance despite near-normoglycemic remission in Africans with ketosis-prone diabetes. Diabetes Care, 31, 12, 2332-2337.

    As for sugars not being in a “natural” diet, I would challenge that, extensively. You provide no citation and the sheer amounts of complex and simple carbohydrates in human diets isn’t something we just came upon. As well, can you please cite the difference between a “processed” grain and a “natural” grain. Or perhaps you can indicate why humans have been using starches in diets for at least ten thousand years (Piperno & Dillehay, 2008). You’re using standard CAM lies to indicate that human’s have to radically alter their diet to remain healthy without providing proof of such.

    Piperno, D. R., & Dillehay, T. D. (December 16, 2008). Starch grains on human teeth reveal early broad crop diet in northern Peru. Proceedings of the National Academy of Sciences of the United States of America, 105, 50, 19622-19627.

  90. #90 Chris
    June 20, 2011

    Isabel:

    This can be a useful diet for people who are at risk of developing diabetes, as an alternative to other diets, or who need to lose weight to lower blood pressure, and especially those who are wheat or gluten intolerant.

    Except nothing you wrote was really CAM, that is what real medicine does. As noted, the stuff that works and is documented as working is real medicine. It is not CAM, and diets like that were researched in by real medicine before sCAMsters decided to steal the ideas.

    Except it is known to be effective for Type 2 diabetes! Have you the documentation that it works for Type 1 diabetes?

    And as for high blood pressure, how effective is it for genetic forms? Or the type of heart condition my son has?

    Also, what percentage of the population is gluten intolerant? And how does it work for those with tree nut allergies?

    And what berries and fruit do not contain sugars like fructose?

  91. #91 Gilgamesh
    June 21, 2011

    “Never mind that it’s quite possible that he picked many of the wrong experts (he did), that he discounted the right experts, such as Steve Salzberg and Steve Novella (which he also did), and that he let his own bias lead him astray (which, as I argued, he appears to have done).”

    It’s not so much as the appeals to authority are bad, just the way he selected his testimonies. (As far as I can tell from this post)

    http://www.appealtoauthority.info

    You must remember these criteria to selecting your testimonials:

    1. Selectivity
    2. Personal interest
    3. Omitted information
    4. The human factor

  92. #92 Edith Prickly
    June 21, 2011

    The experience will probably be very alienating, impersonal, and uncomfortable and they will undoubtedly order blood work and I am one of the 10% of people who are needle-phobic, so it’s yet another reason to avoid going if possible

    Oh, for Hippocrates’ sake! I’m “needle-phobic” too, but I suck it up because I know how important blood tests are as a diagnostic tool. At my last physical my doctor noted that my blood test showed I have low iron (something I never would have figured out on my own) and recommended…iron supplements, taken with vitamin C to enhance absorption! And a Google search turned up a set of instructions for increasing iron-rich food in your diet on the website of a completely mainstream hospital.

    One thing I mentioned in my other post is that I don’t believe most doctors emphasize lifestyle changes enough, and they criticize (my health care provider recently did) diets like Atkins which can be really helpful, and are perfectly healthy, and don’t take enough of an organized stand about unhealthy aspects of our diets.

    This is nonsense. My doctor always asks about diet and exercise habits when I see her for checkups, and when I started having blood pressure issues the FIRST recommendation I got was to try the DASH diet and increase my physical activity. I did still need medication in addition to lifestyle changes and my blood pressure is now under control.

    And the reason a doctor wouldn’t recommend the Atkins diet is that there are valid concerns about the long-term health impacts (e.g. increased risk of heart disease, impaired kidney function, osteoporosis, colon cancer…) The CAM canard that conventional medicine doesn’t recognize the benefits of diet and lifestyle changes is completely baseless.

  93. #93 JayK
    June 21, 2011

    Oh magic 8-ball, will David Freedman still be oblivious to his own CAM apologetics after he earned all this chastisement?

    *Magic 8-ball* Signs point to hell yes!

    //no, it wasn’t written by Freedman, but it might as well have been. The Atlantic shows no signs that it won’t enable the alt-med woosters in their magazine.

  94. #94 Isabel
    June 22, 2011

    “@Isabel: Oh, did you call for a citation and never actually provide any to back up your assertions?”

    Because people are demanding I provide citations, and then not providing them themselves (as you did).

    “Oh, for Hippocrates’ sake! I’m “needle-phobic” too, but I suck it up”

    Ah, yes, obviously anyone who does take your approach is morally deficient, so the hell with them. A very compassionate, realistic approach.

    “concerns about the long-term health impacts (e.g. increased risk of heart disease, impaired kidney function, osteoporosis, colon cancer…) ”

    Citations please?

    “Except it is known to be effective for Type 2 diabetes! Have you the documentation that it works for Type 1 diabetes? ”

    I said Type 2 in my earlier comment, just forgot to add it. Of course I did not mean Type 1, calm down.

    “And what berries and fruit do not contain sugars like fructose?”

    All contain fructose, but berries have a lot more fiber.

    “As for sugars not being in a “natural” diet,”

    I said “adding” sugars, and earlier specifically referred to processed sugars. Of course sugars are part of a natural diet. Honestly, I am trying to write a cohesive comment on a blog post, not writing and checking and rechecking a scientific article.

    “why humans have been using starches in diets for at least ten thousand years ”

    some have, certainly not all populations. And probably few to the extent that we do today in industrialized countries.

    It’s funny reading some posts at SBM, I am struck by the attitude that supplements such as herbs and various teas are not harmless just because they are natural, vs the idea that food is food, just avoid fatty meats and eat fruits and vegetables and eat a reasonably balanced diet and you’ll be fine, everything else is bunk. All “food” is fine, just watch out for those “herbs”.

  95. #95 Chris
    June 22, 2011

    Again, what CAM treatment is recommended for the high blood pressure due to anatomical changes due to this genetic heart condition?

    Why do you consider diet and exercise as CAM, when it clearly is part of mainstream medicine?

  96. #96 Chris
    June 22, 2011
  97. #97 Isabel
    June 22, 2011

    Haha that was the post I already *read* and the comments were the ones I was talking about!

    “Again, what CAM treatment is recommended for the high blood pressure due to anatomical changes due to this genetic heart condition?”

    Please argue rationally! I am not saying people should even follow CAM so kindly fuck off, I’m getting tired of this.

    “Why do you consider diet and exercise as CAM, when it clearly is part of mainstream medicine?”

    Specific diets thought to have specific health benefits are certainly regarded as CAM by my health professionals as I have already pointed out. How can we have a conversation if you are not even reading my comments?

    Also, my SBM professional thinks coconut oil is harmful and I should avoid it. How many people have been harmed by giving up coconut oil and using margarine instead on the advice of health professionals?

  98. #98 Taylor
    June 22, 2011

    I can’t believe I’m stepping onto this, but…. Someone once said that “CAM is like climate change,” in other words, a point of cultural and ideological divisiveness.

    Freedman offers the assessments of many MDs at the Mayo Clinic. Many hundreds of others are at work every day applying and evaluating the approaches and therapies called “integrative medicine” in medical schools and hospitals. The Institute of Medicine is the center of reputable, credible medical knowledge in this country. It hosted a national Summit on Integrative Medicine and the Health of the Public in 2009. The American Academy of Pediatrics has had for three years a section on Complementary and Integrative Medicine. It is hard to understand the objections here, to say nothing of the hostility.

    Although it may be infuriating to hear for participants here, integrative medicine has long since passed the tipping point of acceptance and credibility. This is due to the widespread acceptance by the public over 30-plus years (paying out of pocket) and the very deliberate examination and research on its approaches and therapies conducted over 20-plus years. Forget 3,000 years of acupuncture in Asia.

    I am anything but a practitioner or even user of any alternative therapies, but as I’ve looked at this phenomenon it seems to me that it reflects attitudes that we admire deeply in America: thinking and acting “outside the box;” and creating more tools that provide use and effectiveness. We love these attributes elsewhere.

    I encourage everyone to reconsider the importance of inquiry, examination and trial all across our health and medical landscape, including that which is experienced in real-world settings, not only within Random Controlled Trials. There will be much, much more integrative practice and thinking in the years ahead, in particular as its preventive qualities become more widely known.

  99. #99 Chris
    June 23, 2011

    Isabel:

    Also, my SBM professional thinks coconut oil is harmful and I should avoid it. How many people have been harmed by giving up coconut oil and using margarine instead on the advice of health professionals?

    What evidence do you have that coconut oil is good? How could a person with high cholesterol benefit from it?

    All you said is that you have been told it was harmful. It you have evidence to the contrary, then present it.

  100. #100 lilady
    June 23, 2011

    @ Chris: Coconut oil must be good…Joe Mercola sells it on his website as does Whole Foods (clever daughter refers to the emporium as Whole Paycheck).

    I personally like the coconut, pineapple juice and rum in a pina colada.

    Isabel, why not “Google” coconut oil and look at the Wikipedia site for information on coconut oil…and why not look at margarine labels at the grocery…there are some excellent, non hydrogenated margarines made with olive oil. Better yet, look up some recipes for olive oil dips…simply yummy with crusty baguettes or sour dough breads.

  101. #101 Isabel
    June 23, 2011

    “What evidence do you have that coconut oil is good? How could a person with high cholesterol benefit from it?”

    Who said anything about a person with high cholesterol?

    Anyway, coconut oil is saturated and solid at room temperature. However, unlike other animal based saturated fats or hydrogenated plant fats it is not harmful. As coconut oil has a long history of being a staple and not considered harmful, I think the onus is on those claiming it is harmful to show some evidence for that assertion.

  102. #102 Chris
    June 23, 2011

    Isabel, I have high cholesterol due to genetics. Through diet and exercise I pushed the numbers down to normal. Then the numbers went up, even though I was still swimming 2000 yards and eating very little fat. My liver decided my levels were too low, so it pumped up its production of squalene and cholesterol. I am not allowed coconut oil, and am a big fan of olive oil, but not a fan of margerine. Hence, my question.

    Now, I asked for actual evidence that it is not harmful. Especially since I have been given a reason for not using it. You provided only an unsupported statement. If you claim it is “a staple and not considered harmful” for people like me, or anyone else it is up to you to provide that evidence.

    In the future, when you start making claims: be prepared to back them up. Don’t get prissy when we ask for evidence. It would help you if you actually provided the cites first.

    Absolutely nothing you advocated for other than the coconut oil is CAM. And what is interesting, in the realm of specialty diets you skipped ketogenic diets for intractable epilepsy. But while it can help with seizures, it causes other problems.

    Because, whether you like it or not: it is a bit more complicated than than you think.

    Taylor, you seem to be new here. I suggest you investigate this blog a bit more. Especially the “argument from antiquity” on acupuncture. Do yourself a favor and use the handy little search box on the upper left of this page.

  103. #103 lilady
    June 23, 2011

    @ Chris: I have been hearing of “re-visiting” the ketogenic diet for intractable seizures. There are a few large medical centers where some pediatric neurologists are admitting youngsters to the hospital to start them on ketogenic diet control.

    Children with West Syndrome (infantile spasms) and Lennox Gastaut Syndrome seizures have responded to the ketogenic diet…induced ONLY in the hospital and very strictly monitored…it is somewhat less drastic then putting them under general anesthesia or brain surgery to cut the corpus callosum.

  104. #104 JayK
    June 23, 2011

    @Isabel:

    However, unlike other animal based saturated fats or hydrogenated plant fats it is not harmful.

    [Citation Needed]

    As if I had to add that :)

    Oh the other hand, the risks of saturated fats and cardiovascular disease are documented. Here is just one link, it’s citations include pathways to hundreds of other experiments and reviews that agree.

    Jakobsen, MU; O’Reilly, EJ; Heitmann, BL; Pereira, MA; Bälter, K; Fraser, GE; Goldbourt, U; Hallmans, G et al. (2009). “Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies”. The American journal of clinical nutrition 89 (5): 1425–32. doi:10.3945/ajcn.2008.27124. PMC 2676998. PMID 19211817

    But Isabel won’t give a citation, because she can’t. It would screw up her confirmation bias that she so carefully tends like a little black hearted garden.

  105. #105 Isabel
    June 23, 2011

    “I am not allowed coconut oil…Especially since I have been given a reason for not using it”

    What reason? This is an example of a myth, spread by SBM practitioners. There is no evidence for this.

    It is possible you might benefit from eating it. Oh, well.

  106. #106 Gray Falcon
    June 23, 2011

    Isabel, please provide some evidence for your statements. We aren’t just going to take the word of somebody we met on the Internet.

  107. #107 Chris
    June 23, 2011

    Isabel:

    It is possible you might benefit from eating it. Oh, well.

    [Citation Needed]

    Until you provide something more substantial in the way of evidence, it will be assumed everything you write was pulled out of thin air.

  108. #108 Peapoh
    June 23, 2011

    “It is possible you might benefit from eating it. Oh, well.”

    You know, repeating yourself is not evidence. It’s quite simple…cite your claims and the conversation will move forward.

  109. #109 Calli Arcale
    June 23, 2011

    Isabel — honestly, if my doctor, who was managing some difficult chronic conditions for me, advised me to stay away from Food Substance A, and some random person I’ve never met tells me that it’s possible I might benefit from eating it, I’m honestly going to go with my doctor. For all you know, he’s allergic to coconut. (I used to be, but I outgrew the allergy. Was also allergic to tree nuts and peanuts. I’m very glad to have outgrown those, but alas, have traded them for a citrus allergy. And I always loved lemonade. *pouts*)

    It is true that coconut has been a staple food for a very long time. That doesn’t mean it’s harmless, or that we should eat huge amounts of it; what it is is an argument from antiquity. The Inuit have been eating whale blubber for centuries, and pemmican is a major staple of their diet; does that mean high-animal-fat, high-protein diets are not harmful? Of course not. The bottom line is that no single food item is a magic bullet. You can eat yourself sick on almost anything, and for most people, moderation and variety are probably enough to be worrying about.

    BTW, I like olive oil better than coconut oil — in part, *because* olive oil is liquid at room temperature, which makes it easier to use in certain applications. I do not use palm oil in my own cooking, but this is for ecological/agricultural concerns which aren’t really relevant to this discussion.

  110. #110 Isabel
    June 23, 2011

    But coconut oil is and long has been a common food, a staple even, of populations that do not appear damaged by it. There is no evidence that it is harmful, so why would I need to prove that it is safe?

    “But Isabel won’t give a citation, because she can’t.”

    JayK, the paper you cite makes no distinction between the long chain saturated fats typically found in animal products and the medium chain saturated fats that coconut oil is almost entirely composed of.

    Here’s a couple of references from the same journal, one of which also deals with nuts and eggs, two other extremely nutritious foods that have been foolishly banned by the medical establishment.

    Frank B. Hu, JoAnn E. Manson, and Walter C. Willett
    Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review J Am Coll Nutr February 2001 20:5-19

    Marie-Pierre St-Onge,Aubrey Bosarge,Laura Lee T. Goree, and Betty Darnell. Medium Chain Triglyceride Oil Consumption as Part of a Weight Loss Diet Does Not Lead to an Adverse Metabolic Profile When Compared to Olive Oil J Am Coll Nutr October 2008 27:547-552

  111. #111 Isabel
    June 23, 2011

    But coconut oil is and long has been a common food, a staple even, of populations that do not appear damaged by it. There is no evidence that it is harmful, so why would I need to prove that it is safe?

    “But Isabel won’t give a citation, because she can’t.”

    JayK, the paper you cite makes no distinction between the long chain saturated fats typically found in animal products and the medium chain saturated fats that coconut oil is almost entirely composed of.

    Here’s a couple of references from the same journal, one of which also deals with nuts and eggs, two other extremely nutritious foods that have been foolishly banned by the medical establishment.

    Frank B. Hu, JoAnn E. Manson, and Walter C. Willett
    Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review J Am Coll Nutr February 2001 20:5-19

    Marie-Pierre St-Onge,Aubrey Bosarge,Laura Lee T. Goree, and Betty Darnell. Medium Chain Triglyceride Oil Consumption as Part of a Weight Loss Diet Does Not Lead to an Adverse Metabolic Profile When Compared to Olive Oil J Am Coll Nutr October 2008 27:547-552

  112. #112 Isabel
    June 23, 2011

    Orac, it would be really nice to know why my posts are being frequently moderated (or lost/censored in one case). I could then modify my posting behavior accordingly, rather than face this unpredictable moderating. I can’t find anything specific on your about page, I did look there. I don’t think I am posting excessively considering the amount of replies to my posts, and my comments are not often long and haven’t contained links. Thanks.

  113. #113 JohnV
    June 23, 2011

    The f bomb gets posts, mine at least, sent to the moderation file.

    Also the use of several names will do the same, I believe as a result of the way they were banned: he who shall not be named, ben’s parents and possible our most recent stoner idiot.

    I’ve had comments with a single link in them also end up in the moderation bin/spam bucket, but that at least isn’t the case for you.

  114. #114 Chris
    June 23, 2011

    JohnV:

    I’ve had comments with a single link in them also end up in the moderation bin/spam bucket, but that at least isn’t the case for you.

    I have had posts without links or profanity put into moderation. Sometimes the system here is just flaky.

  115. #115 JayK
    June 23, 2011

    Did your moderated posts finally contain some citations, Isabel? Somehow, I doubt it.

  116. #116 Isabel
    June 23, 2011

    Yes, two citations.

  117. #117 Chris
    June 24, 2011

    There are ways to get around the moderation:

    1) Simply post the journal, title, date and authors of the paper you are referencing.

    2) Post the PubMed Identification Number. All we need to find paper is to put in the search window at http://www.PubMed.gov.

  118. #118 Isabel
    June 27, 2011

    That’s it? No response after all that nagging to post references?

    It would be better if the moderated posts posted at the end of the thread.

  119. #119 Chris
    June 29, 2011

    Some of us have actual lives. I just spent the day helping to clean my twenty year old son’s apartment before he moves on Thursday.

    I looked at Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review, which said absolutely nothing about coconut oil. This was your main point, so it is interesting that you did not find the papers that really supported your view. The emphasis on coconut was interesting to me because I just bought one, it had a semi-clear fluid and a some nice crunchy flesh. Neither of which was particularly oily. It must take lots of processing to get both the thick coconut “milk” and oil.

    So that one article specified a variety of fat sources like “vegetable oils, fish, nuts and legumes for saturated and trans fatty acids.” Nothing about the result of processing coconut flesh for oil.

    I didn’t have time to read “Medium Chain Triglyceride Oil Consumption as Part of a Weight Loss Diet Does Not Lead to an Adverse Metabolic Profile When Compared to Olive Oil”, but I got the full paper and did a text search for “coco” and did not come up with anything.

    I still don’t see how any of this shows any evidence that “CAM” works better than real medicine.

  120. #120 Chris
    June 29, 2011

    I did post a response last night, but it is in moderation. Since Orac is really busy I’ll give you the short answer:

    Your studies do not support what you say. You have presented no real evidence that “CAM” is worthwhile. Plus after actually buying a real coconut, I can say that the coconut water is nothing like coconut “milk”, and the flesh is not at all oily (but very yummy). So all I can figure out is that “coconut oil” is a highly processed product that uses many coconuts for just one jar. Personally I prefer my foods to be less processed and much less concentrated.

  121. #121 lilady
    June 29, 2011

    Perhaps Isabel would care to look at the Wikipedia-Coconut Oil website for information about its processing, content of saturated fat and citations.

    @ Chris: I remember traveling through the El Yunque rain forest in the middle of Puerto Rico 45 years ago, when indigenous people had their own small villages. The inhabitants had some vegetable stands set up on the side of rutted dirt roads. For less than a dollar, we purchased the large green entire coconut that the villagers would whack the top off with a large machete and fashion the top into a scoop. After drinking the coconut juice, we used the scoop to get at the gelatinous white meat…The brown coconuts available at most groceries are nothing compared to the green fresh-from-the-tree coconuts that we savored in El Yunque.

  122. #122 Isabel
    June 30, 2011

    What an ignorant response. Clearly I won this argument and you are flailing. The primary literature paper certainly does discuss coconut oil. The other paper showed how the idea that eggs or nuts need to be limited or avoided is also bunk, in fact all three sources of fats are healthy.

    I have no idea how I am supposed to respond to your anecdote about buying a coconut.

    I am not trying to show evidence that CAM works. I am calling into question the dichotomy put forth in these discussion between “CAM” and “SBM”. I am calling into question the idea that AMA approved care = the latest science. It often doesn’t, as I have easily demonstrated.

    How many lives were lost because people were told for decades to use hydrogenated oils instead of coconut oil? Or because people avoided nuts (proven heart-healthy) and instead ate more trans fats?

  123. #123 Isabel
    June 30, 2011

    “Perhaps Isabel would care to look at the Wikipedia-Coconut Oil website for information about its processing, content of saturated fat and citations.”

    Perhaps you would care to explain why I would want to do such a thing? I have thoroughly researched coconut oil. Are you implying it is dangerous? That is ridiculous. You are spreading dangerous lies.

  124. #124 Chris
    June 30, 2011

    Isabel, you really are making no sense. You were recommending coconut oil for all sorts of things, but show no evidence that it is safe or even helpful.

  125. #125 Chris
    June 30, 2011

    Where in dub dub dub jacn dot org/content/20/1/5.long is coconut mentioned? It is not in the section titled “NUT CONSUMPTION AND RISK OF CHD.” Which section?

    Remember if CAM works its name gets changed to real medicine.

  126. #126 lilady
    June 30, 2011

    Isabel I have been following this debate/what your statements are about coconut oil…by the way sans any citations from peer-reviewed journal or from the American Dietitic society about the value of coconut oil…pubmed citations will do…but sites from “nutritionists”, naturapaths, internet purveyors of coconuts are unacceptable.

    Are your strong convictions about the benefits due to something that you read somewhere, or your intuition or some other unacceptable “resource”…then be a big girl and state:

    I don’t remember where I heard about coconut oil’s nutritional value or,

    I read about coconut oil at an alernative medical site totally lacking in any studies or,

    I myself market the stuff on the internet or,

    I am just a silly uneducated troll.

  127. #127 Krebiozen
    June 30, 2011

    Personally I like virgin coconut oil, I think it’s delicious, and it doesn’t go rancid like unsaturated fats. However I don’t see any reason to think it is “good for you”. It may be a little less damaging than other saturated fats as it contains predominantly lauric and myristic acids which elevate LDL cholesterol less than the palmitic acid that predominates in animal fats. That’s according to one of the studies cited by Isabel (Fig 2).

  128. #128 Isabel
    June 30, 2011

    “You were recommending coconut oil for all sorts of things”

    wtf????????? I never did this at all!

    “but show no evidence that it is safe or even helpful.”

    wtf? I just showed that it was not dangerous, as other popular saturated fats are. So it can substitute for those harmful fats!! Therefore it is helpful.

    “..by the way sans any citations from peer-reviewed journal or from the American Dietitic society about the value of coconut oil…”

    Are you MAD???? I purposely used the same journal that was used as evidence against coconut oil (supposedly, but not in reality) right here on this thread. Are you saying you are now not happy with this journal selection?

    “..but sites from “nutritionists”, naturapaths, internet purveyors of coconuts are unacceptable. ”

    Again I used the same journal used on this thread. There are tons of coconut oil articles out there. Tons. Do your own research.

    “I am just a silly uneducated troll.”

    What on earth are you talking about?

    “It may be a little less damaging than other saturated fats as it contains predominantly lauric and myristic acids which elevate LDL cholesterol less than the palmitic acid that predominates in animal fats’

    Right. And “not going rancid” is not bad either. right?

  129. #129 Krebiozen
    June 30, 2011

    Isabel,
    I disagree. Being a little less damaging isn’t the same as doing you good. Too much coconut oil will make you fat, and will elevate your LDL cholesterol. Polyunsaturated fats reduce LDL cholesterol.

  130. #130 Isabel
    June 30, 2011

    “I disagree. Being a little less damaging isn’t the same as doing you good.”

    No harm has been shown. So it is not “a little less damaging”. If someone substituted coconut oil for animal fats in baking for example, or coconut milk as a sauce base (as many southeast asian culturess do all the time in curry sauces etc) it would be beneficial if they have a medical need to avoid long-chain saturated fats. I never made any claims other than that, although there do appear to be other benefits. In one of the papers I cited it mentions weight loss, you might want to check that paper for references if you are interested.

    “coconut oil will make you fat, and will elevate your LDL cholesterol.”

    Citation? And you seem to be talking about over-eating, which is an entirely different subject. I was suggesting substitution so how do you get *more* weight gain, and whatever else? That sounds like nonsense to me.

  131. #131 Chris
    June 30, 2011

    And so what? Diets and food choices are not CAM.

  132. #132 Isabel
    June 30, 2011

    “And so what? Diets and food choices are not CAM. ”

    That is not my point. My point is that woo comes from AMA and FDA approved sources as well as “CAM”.

    And it is equally harmful. Possibly even more so, on a larger scale in any case, the wide-scale attempts to get people to eat less (or totally eliminate) common, nutritious (and in the case of eggs and coconut, very affordable) foods.

    In reference to my research into low-carb diets that I mentioned earlier in the thread, that my medical provider disapproved of, I just came across this interesting article in the LA Times, Dec. 20, 2010, called A Reversal on Carbs:

    “Fat is not the problem,” says Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health. “If Americans could eliminate sugary beverages, potatoes, white bread, pasta, white rice and sugary snacks, we would wipe out almost all the problems we have with weight and diabetes and other metabolic diseases.”

    In a 12-week study published in 2008, Phinney and his colleagues put 40 overweight or obese men and women with metabolic syndrome on a 1,500-calorie diet. Half went on a low-fat, high-carb diet. The others went on a low-carb, high-fat diet. The low-fat group consumed 12 grams of saturated fat a day out of a total of 40 grams of fat, while the low-carb group ate 36 grams of saturated fat a day — three times more — out of a total of 100 grams of fat.

    Despite all the extra saturated fat the low-carb group was getting, at the end of the 12 weeks, levels of triglycerides (which are risk factors for heart disease) had dropped by 50% in this group. Levels of good HDL cholesterol increased by 15%.

    In the low-fat, high-carb group, triglycerides dropped only 20% and there was no change in HDL.

    The take-home message from this study and others like it is that — contrary to what many expect — dietary fat intake is not directly related to blood fat. Rather, the amount of carbohydrates in the diet appears to be a potent contributor.

  133. #133 lilady
    June 30, 2011

    @ Krebiozen-# 127 and #129: The rather long Journal referred to in your posting that you commented on is from February, 2001.

    Here’s another more recent (2007) “position paper” that I believe is more complete:

    Position of the American Dietetic Association and Dieticians of Canada: Dietary Fatty Acids

    I think it confirms what my dietary oil choices are…olive oil for salads and for the occasional (sinful) garlic bread and for dipping sauces…as well as rather low temperature sauteing; canola oil for somewhat higher temperature sauteing or frying.

    Of course, I trying to stay away from “white” foods…with the possible exception of some pasta for my magnificent made-from-scratch tomato sauce with fresh herbs; cauliflower in season…sauteed with a splash of olive oil, garlic and fresh ground red pepper…yummy.

    Knock yourselves out…reading this report.

  134. #134 Isabel
    July 1, 2011

    “Position of the American Dietetic Association and Dieticians of Canada: Dietary Fatty Acids”

    Sounds like an appeal to authority to me. Where did they even get that figure? They trash coconut oil in the table, but there is no citation, and o explanation in the text. This is very typical. Coconut oil has been completely cleared of wrongdoing, but these lies keep being repeated.

    What is the source of the table in this “position paper”, and on the statements in the table about lauric acid and the other MCFA’s found in coconut oil?

  135. #135 Krebiozen
    July 3, 2011

    I had neglected this thread but just noticed Isabel on another thread crowing that she won the argument about coconut oil! Really? That’s not what it looks like to me.

    “coconut oil will make you fat, and will elevate your LDL cholesterol.” Citation? And you seem to be talking about over-eating, which is an entirely different subject. I was suggesting substitution so how do you get *more* weight gain, and whatever else? That sounds like nonsense to me.

    You seem to be claiming here that coconut oil is good for you and consuming it has no adverse health effects at all.

    unlike other animal based saturated fats or hydrogenated plant fats it is not harmful.

    That is clearly nonsense as shown by one of the papers you cited, and confirmed by lilady’s citation which is an overview of the current information available. Look at figure 2 in this paper you cited and you will see that lauric and myristic acids (which constitute 66% of coconut oil) elevate LDL cholesterol – that’s bad cholesterol in case you don’t know.

    Unsaturated or monsaturated fatty acids found in other vegetable oils (oleic and linoleic acids in the table) lower LDL cholesterol. It would be far better to eat polyunsaturated fats instead of saturated fats like coconut oil, the exact opposite of people being damaged by eating margarine instead of coconut oil as you claimed above. I don’t know about the USA but in the UK most margarines are made with polyunsaturates, and none contain partially hydrogenated fats.

    As for the weight gain, I was pointing out that any fats in excess lead to weight gain. Some fats are healthier than others, but excessive consumption of any are not wise. I have seen claims that coconut oil is immune from this, but this is not true. Numerous studies have shown that if calories consumed exceed calories used then weight gain occurs. I agree that eating too much carbohydrate is also bad, but I wonder why there is no mention of either LDL or total cholesterol in the study you cite (which is a calorie-restricted diet), only triglycerides and HDL cholesterol. Since fructose is converted to triglycerides in the liver, it is not surprising that a high carb diet increases triglycerides. Willett also does not mention cardiovascular disease, just “diabetes and other metabolic diseases” which is very misleading as cardiovascular disease is by far the biggest killer in the developed world.

    Coconut oil has been completely cleared of wrongdoing, but these lies keep being repeated.

    Where was it “completely cleared of wrongdoing?” Just repeating the same thing over and over does not make it true.

  136. #136 Denice Walter
    July 3, 2011

    @ Krebiozen: re “appeals to authority”

    Ah yes! Alt med doesn’t hang with dieticians’ associations in the US, UK, or Canada. A recommendation is often the “kiss of death” for them if it comes from the “Man” ( or is it the “Woman” in charge?). In fact, the woo-meisters/ nutritionists I track appear to have declared open war on those “fascists” carrying meal charts. I guess that “registered” part (RD)-and the”MS”- gets to them. I wonder why?

    Coconut oil is clearly one of their faves: Mercola even believes it may have an impact against Alzheimer’s amongst its many wonders( Mercola.com 1/18/11; Orac, here; 1/19/11). Others tout its boiling point or suchlike- which contributes to my boiling point.

    ( returns to holiday/ vacation)

  137. #137 Krebiozen
    July 3, 2011

    Denice,
    I’ve spent too much time arguing with people on CAM forums about this. They claim that there is no evidence that saturated fats are bad for us, and that heart disease was unknown in the good old days when everyone ate nothing but eggs and lard. They cite people like Ravnskov, who cherry picks data like no one else, Mary Enig and Weston Price, and other unreliable sources. The other claim is that statins often cause hideous side-effects but that this is covered up by Big Pharma. That’s the CAM litany, but like so many others it doesn’t stand up to scrutiny, at all.

    I would be interested in seeing more research on coconut oil, but it seems very unlikely it will live up to the claims I have seen for it. Not just Alzheimer’s, but systemic fungal infections and even AIDS are allegedly curable by coconut oil (I was told, “Aids is easy to cure. Just don’t tell anybody that. Eat lots of coconut oil and it will get rid of it.”).

    None of these claims have much to support them. They mostly seem to be based on the effects of medium chain fatty acids, but coconut oil contains only 15% fatty acids that are C6,C8 or C10. The medium chain fatty acids used clinically are 98-99% C6, C8 or C10 (PMID:6814231). It is not reasonable to assume that coconut oil will have the same effects as medium chain fatty acids.

    Nor is it reasonable to assume that coconut oil will have the same effect as individual fatty acids. Lauric acid can kill some microorganisms in vitro (PMID:11600381), and this seems to be the source of the claim that coconut oil can cure AIDS and other infections.

    There are also claims that coconut oil helps people lose weight, as I mentioned above. This seems to be based on a study on rats which gained less weight when overfed medium chain fatty acids than long chain fatty acids, due to an increased metabolic rate (PMID: 7072620). Of course humans are not rats, coconut oil is not the same as medium chain fatty acids, and less weight gain is not weight loss. Curiously, coconut oil is also claimed to be useful for helping underweight people gain weight.

    Enjoy your vacation!

  138. #138 Krebiozen
    July 3, 2011

    Isabel,
    I came across more from Walter C. Willett, M.D. of Harvard, not about carbohydrates this time, but regarding coconut oil. He says, among other things:
    “But, for now, I’d use coconut oil sparingly. Most of the research so far has consisted of short-term studies to examine its effect on cholesterol levels. We don’t really know how coconut oil affects heart disease. And I don’t think coconut oil is as healthful as vegetable oils like olive oil and soybean oil, which are mainly unsaturated fat and therefore both lower LDL and increase HDL. Coconut oil’s special HDL-boosting effect may make it “less bad” than the high saturated fat content would indicate, but it’s still probably not the best choice among the many available oils to reduce the risk of heart disease.”

  139. #139 Isabel
    July 3, 2011

    “I would be interested in seeing more research on coconut oil, but it seems very unlikely it will live up to the claims I have seen for it.”

    I agree of course. And I am also not suggesting that people eat excessive amounts fats, or that they should get them all from the same source. My personal consumption consists of at least half olive oil and various nuts including peanuts; followed by coconut oil; then meat (all kinds but mainly chicken and fish often with fat removed), eggs (every day) and cheese as a frequent garnish on foods; and occasionally other dairy (mainly half-and-half in my coffee).

    We may not have long term studies, but it is true that coconut is used as a staple in many countries. The “woo” books claim these regions have low rates of heart disease, and are surprisingly able to withstand water-bourne infections in areas without clean water supplies but I haven’t researched it. They do seem to have less of an obesity problem. But again, *I am not making any such claims* as I haven’t looked in to them sufficiently.

    “but coconut oil contains only 15% fatty acids that are C6,C8 or C10. The medium chain fatty acids used clinically are 98-99% C6, C8 or C10 (PMID:6814231)”

    Um, I believe the figure is more like 60% MCFA. Lauric acid is C12.

    “Nor is it reasonable to assume that coconut oil will have the same effect as individual fatty acids.”

    totally agreed. Why can’t we discuss the claims that have been made right here on this thread, rather than claims you heard someone make one time? This is how internet discussions become so quickly garbled.

    “It is not reasonable to assume that coconut oil will have the same effects as medium chain fatty acids. ”

    It is because of the high MCFA concentration (when you include, as all the studies I’ve seen do, lauric acid) that the benefits are assumed to occur, and the study I cited above used coconut oil itself and found it was as protective as olive oil (but yes, I agree a longer term study would be better).

    “Of course humans are not rats,”

    Yes, what a crazy woo-like thing to assume, that experiments with rats might tell us anything about human physiology.

    “coconut oil is not the same as medium chain fatty acids”

    again you seemed confused about this part- it has a high concentration of MCFAs which include lauric acid.

    “and less weight gain is not weight loss. Curiously, coconut oil is also claimed to be useful for helping underweight people gain weight.”

    So, rather than seeing these as contrasting claims and shaking our heads at the “woo-meisters”, we can instead observe that there are a number of apparent effects that are all related to maintaining a healthy weight. Yes, it is intriguing and certainly warrants further study.

  140. #140 Isabel
    July 3, 2011

    “may make it “less bad” than the high saturated fat content would indicate, but it’s still probably not the best choice among the many available oils to reduce the risk of heart disease.”"

    Where is the evidence that MCFAs have the same effect as LCFA-rich animal fats? The only citations I have seen on this thread, and correct me if I am wrong, assume the MCFAs are dangerous because they are saturated, like the LCFAs in animal fats.

    Anyway I originally quoted him because he practically described a low-carb diet as the most healthy. His position statement on coconut oil seems very vague and opinionated. And I like how he admits you’ll need to use it if you are making Thai food. I guess the Thai people are doomed!

  141. #141 Krebiozen
    July 3, 2011

    Isabel,

    The “woo” books claim these regions have low rates of heart disease, and are surprisingly able to withstand water-bourne infections in areas without clean water supplies but I haven’t researched it.

    I don’t think that’s surprising, as heart disease is a a disease of excess, which is why it occurs primarily in developed countries. To assume it has anything to do with coconut oil is pure speculation, as is any resistance to water-borne infections.

    again you seemed confused about this part

    Perhaps you should read what I wrote and the citation I gave before accusing me of being confused. I wrote:
    “coconut oil contains only 15% fatty acids that are C6,C8 or C10. The medium chain fatty acids used clinically are 98-99% C6, C8 or C10 (PMID:6814231)”

    The citation I gave, titled ‘Medium-chain triglycerides:an update’ says:
    “Medium chain triglycerides are made up of a mixture of C6:0 (1 to 2%), C8:0 (65 to 75%), Cl0:0 (25 to 35%), and C12:0 (1 to 2%) medium-chain fatty acids (MCFAs) obtained by the hydrolysis of coconut oil followed by the fractionation of the fatty acids”. Research studies done on medium chain fatty acids have mostly, possibly all, used this mixture that only contains 1 to 2% lauric acid.

    It is because of the high MCFA concentration (when you include, as all the studies I’ve seen do, lauric acid) that the benefits are assumed to occur

    Can you name a study looking at MCFAs that includes lauric acid in more than a tiny amount? If you look closely they all seem to use C6, C8 and C10 which only constitute 15% of coconut oil. Maybe 15% is enough to have an effect, but the studies don’t tell us that.

    I never suggested that you were making the claims about coconut oil and Alzheimer’s AIDS etc. My apologies if I gave the impression I was. Every other person I have come across who claims that coconut oil is “good for you” does make such claims, which is why I mentioned it. It’s a very common claim in CAM circles and goes hand in hand with claims that coconut oil doesn’t really count as a saturated fat (in fact it is 90% saturated as compared with lard which is only 40% saturated).

    Yes, what a crazy woo-like thing to assume, that experiments with rats might tell us anything about human physiology.

    Despite your sarcasm, you can never make assumptions about anything in humans based on what happens in animals. Animal experiments can be interesting, and may suggest what might be going on in humans, but to come to any conclusions about human health and nutrition based on rats would be foolish.

    Where is the evidence that MCFAs have the same effect as LCFA-rich animal fats? The only citations I have seen on this thread, and correct me if I am wrong, assume the MCFAs are dangerous because they are saturated, like the LCFAs in animal fats.

    Here’s a well-referenced paper that looks at the effects of individual fatty acids, and at the effects of saturated versus unsaturated fats. Over 70% of coconut oil is lauric, myristic and palmitic acids. The study compared these to stearic acid (C18:0), the predominant fatty acid in animal fat, or oleic acid (18:1) and found:
    Lauric acid 12:0 “compared with 18:1, 12:0 was hypercholesterolemic, raising both total and LDL-cholesterol concentrations (by 11 and 12%) but had no significant effect on HDL-cholesterol concentrations”.
    Myristic acid 14:0 “14:0 significantly increased both total and LDL-cholesterol concentrations, showing a much greater cholesterol-raising effect when substituted for 18:1 than for 16:0″.
    Palmitic acid 16:0 “The cholesterol-raising effects of 16:0 compared with 18:0 are marked (14-28% increase in total cholesterol, 28-36% increase in LDL-cholesterol, and 6-15% increase in HDL-cholesterol concentrations)”.

    If you accept that cholesterol and in particular LDL-cholesterol are risk factors for cardiovascular disease, it looks to me as if coconut oil is not much better than animal fat. For other conditions, like metabolic syndrome, there may be a positive effect from coconut oil. As I wrote before, I would like to see further research. Until then, I’m treating coconut oil as I do other saturated fats, as a treat to be consumed in moderation.

  142. #142 Isabel
    July 3, 2011

    “I don’t think that’s surprising, as heart disease is a a disease of excess, which is why it occurs primarily in developed countries. To assume it has anything to do with coconut oil is pure speculation”

    Yet you *are* assuming that it does, which is why you said:

    “Until then, I’m treating coconut oil as I do other saturated fats, as a treat to be consumed in moderation.”

    The paper you link to is from 14 years old and referencing a single, earlier study of only 14 patients.

    Why not just use it, but not in excess? I see no reason to limit my usage. Demonization of foods is a bad road to head down.

  143. #143 Krebiozen
    July 4, 2011

    Let me explain what I mean more clearly. Assuming that a lower rate of heart disease in developing countries where they eat a lot of coconut oil is due to the coconut oil is pure speculation. There could be many other reasons.

    I am assuming that coconut oil will have the same cardiovascular effects as the large majority of the fatty acids that constitute it, as demonstrated in several human studies. That assumption may be wrong, as the C6, C8 and C10 medium chain fatty acids that make up about 15% of coconut oil may have other effects that change the overall effects of coconut oil, though that seems unlikely. There has been little human research in this area so we simply don’t yet know for sure.

    The paper you link to is from 14 years old and referencing a single, earlier study of only 14 patients.

    I think you are nitpicking a little here – where are your studies showing that coconut oil has been “completely cleared of all wrongdoing”? Anyway, I don’t think much has changed in the way individual fatty acids affect cholesterol in the past 14 years. It is only the effects of lauric acid that are based on a single study of 14 subjects (to be pedantic there were 2 studies and 28 subjects as the same subjects were used to compare lauric acid to 16:0 and then to 18:1), and the results for total cholesterol and LDL are statistically significant. The effects of the other fatty acids are based on more studies, using more than 300 subjects in total, and all the studies confirm the predictive algorithms constructed using mixed fatty acid diets.

    Here’s a more recent study that confirms these effects, though it also looks at TC:HDL ratio which lauric acid lowers (when it replaces carbohydrate in the diet), because it increases HDL (good) cholesterol as well as increasing LDL (bad) cholesterol, as Dr. Willett mentioned.

    Why not just use it, but not in excess? I see no reason to limit my usage. Demonization of foods is a bad road to head down.

    What do you think I mean by “moderation”? I don’t think I’m demonizing foods by suggesting that coconut oil should be consumed in moderation. You were the one claiming that:

    unlike other animal based saturated fats or hydrogenated plant fats it is not harmful… Coconut oil has been completely cleared of wrongdoing, but these lies keep being repeated.

    I still don’t see any good evidence supporting that, and plenty of evidence that the fatty acids in coconut oil will increase LDL cholesterol which is a major risk factor for cardiovascular disease.

  144. #144 Krebiozen
    July 4, 2011

    Comment in moderation, only one link, hardly any profanities, not especially long. SB spam filter is baffling.

  145. #145 Isabel
    July 4, 2011

    “I think you are nitpicking a little here – where are your studies showing that coconut oil has been “completely cleared of all wrongdoing”?”

    Okay fair enough. But there are many positive studies. There was one study (I’ll have to find the link again) where they looked at a region in India that did have higher rates of heart disease, and they suspected coconut, but when they compared healthy to sick populations usage did not vary.

    “It is only the effects of lauric acid that are based on a single study of 14 subjects”

    But isn’t that important, as it is the main ingredient under discussion and up to 50% of the oil?

    “I don’t think I’m demonizing foods by suggesting that coconut oil should be consumed in moderation”

    I guess we have different definitions of “moderation” – you said “as a treat” as if it was equivalent to an occasional piece of cake. I mean incorporating it into my diet (in smoothies, Thai dishes) but having it not be my main source of fats (which is olive oil/nuts). In sauces and smoothies it can also substitute for dairy. How is that approach bad? It is useful in baking also.

    The reason I brought up the coconut oil was not to promote its usage, but to point out that the advice not to eat it from my doctor was not the best, or most scientific in my opinion.

    “and plenty of evidence that the fatty ”

    I don’t agree that there is plenty of evidence.

    “SB spam filter is baffling.”

    agreed

  146. #146 Krebiozen
    July 5, 2011

    I don’t think I have much more to add to this discussion. I’ll just add an apposite quote from Ben Goldacre:

    The most important take-home message with diet and health is that anyone who ever expresses anything with certainty is basically wrong, because the evidence for cause and effect in this area is almost always weak and circumstantial…