Respectful Insolence

The infiltration of quackademic medicine continues apace, except that it’s not just quackademic medicine. Now, it goes way, way beyond that to encompass not just academic medical centers but community hospitals, hospitals of all sizes, large private hospitals, and health care institutions of all shapes and sizes. Frequently, proponents of quackademic medicine try to portray those of us who oppose the infiltration of pseudoscience into medicine as being behind the times, as futilely resisting the wave of the future. They portray so-called “complementary and alternative medicine” (CAM) as the future and proponents of science-based medicine (SBM) as the past, as Luddites who resist the tsunami of CAM not because of science but because of ideology. It’s a neat switch, given that in reality support of CAM has far less to do with science than it does with human cognitive frailties and either religion or ideology, while the reason we who support SBM object to CAM is because we don’t like the double standard it demands. Rather, we insist on one scientific standard for all medicine, such that “alternative” medicine that is shown to work becomes simply “medicine.”

I must admit, though, that sometimes I feel as though the characterization of us SBM supporters as holdouts against CAM sometimes hits too close to home when I see articles like this one that I just saw in Crain’s Business:

Most hospital systems in Southeast Michigan created integrated medicine clinics in the late 1990s to provide alternative health care.

They include Beaumont Health System, Crittenton Hospital Medical Center, Henry Ford Health System, University of Michigan Health System, Botsford Hospital and St. John Providence Health System.

Yes, my alma mater the University of Michigan, is on the list. I graduated from medical school there and have been persistently disappointed to see what used to be a hard-ass, science-based institution embrace quackademic medicine, giving it a big, sloppy wet kiss on the lips. At least, certain departments at U. of M. have done so. As far as I can tell, the university as a whole has not. Be that as it may, U. of M.’s even gone so far as to “integrate” mystical nonsense like anthroposophic medicine into its medical offerings. It makes me feel like Sylvester’s son putting a paper bag over his head, and lamenting, “Oh! The shame of it all!” At least, that’s how I feel when I read about things like U. of M. embracing anthroposophic medicine. Even if it is just a small division and not indicative of the scientific basis of the school as a whole, the very presence of quackademic medicine at my alma mater risks tainting everything.

Sadly, U.of M. is not alone. It turns out that most of the major health systems in my hometown (with at least one notable exception, which reassures me) are heavily into the woo. What I normally consider to be very good or even excellent health care systems are joining the University of Michigan in this race to “integrate” quackery with real medicine. It’s truly depressing to behold, and I wish there were a way to shake the executives at these hospitals and make them see how embracing non-science-based medicine can’t do anything good for their patients or reputations.

There is a problem noted that might slow down the infiltration of quackademic medicine, however:

“Ten years ago, a number of hospitals went into alternative medicine and set up clinics, but it has not taken off because of a lack of insurance” coverage, said Paul LaCasse, D.O., CEO of Botsford Health Care in Farmington Hills.

On the other hand, I’d wonder why health care systems keep setting up these “integrative” medicine clinics if they don’t expect to realize some profit from them. After all, the lack of insurance coverage might prevent large numbers of people from using these clinics, but that very lack of insurance coverage for “integrative medicine” services, but that very same lack means that these services are all cash (or credit card) on the barrelhead. There’s no mucking about with insurance company paperwork, co-pays, or preapprovals. Just deliver the woo and get paid. What more could a business ask for? It almost makes me wonder why CAMsters are lobbying so fiercely to have insurance coverage for their services, given the huge paperwork burden and the loss of freedom of action that would ensue if insurance companies began paying for these services. Actually, no it doesn’t. Cash on the barrelhead might well be profitable, but it’s a small market compared to the potential market that would become available if insurance companies covered IM services. The increase in potential market is more than enough to be worth the increased hassle and loss of freedom.

In any case, my heart sank when I read this:

“At our clinic, we have three family practice physicians and an integrative medicine fellow who are all training in conventional medicine and holistic and alternative medicine,” she said. “We all come from different points of view. I spent 14 years studying with a Native American healer for spiritual healing, nutrition and herbal medicine.”

Other physicians at UM focus on acupuncture, massage, Rolfing and guided imagery, Warber said.

Let’s see. Acupuncture? Not good, but it’s so common that I tend to look at it as one of the gateway woos of quackademic medicine. It’s so common that I’ve become numb to seeing it almost anywhere. Massage? I’ve never had a problem with massage. It makes people feel good. The problem is that all too often it’s covered with layer upon layer of vitalistic, mystical woo about “qi” and “energy flows.” If it’s offered as just “massage,” I have no problem with it, but when it gets rolled into “massage therapy,” chances are high that the woo quotient will be intolerable. In any case, why is massage therapy considered “alternative” anyway? It’s more of the successful rebranding and “bait and switch” of alternative medicine.

And then there’s Rolfing.

Rolfing?

Holy crap! U. of M., my medical alma mater, is offering Rolfing? Seriously? Rolfing is a close cousin to chiropractic, except that Rolfers don’t think that just the spine needs to be aligned, as chiropractors do. Rather, everything has to be “balanced’ or “aligned”. If your body parts are properly aligned, then, according to Dr. Rolf, “Rolfers make a life study of relating bodies and their fields to the earth and its gravity field, and we so organize the body that the gravity field can reinforce the body’s energy field.” You know, I’ve been meaning to do a post on Rolfing for the longest time now, and, after nearly seven years of blogging, I find it hard to believe that somehow Rolfing has escaped anything but an off-hand mention or a mild taste of not-so-Respectful Insolence. Oh, well. Add it to the folder of potential topics. In the meantime, I’ll just mention that I’ve seen a breast cancer patient whose alternative medicine practitioner tried to Rolf the tumor away by deep massage of the breast in which the tumor arose. It didn’t work. Big surprise.

Elsewhere, the St. John Providence Health System goes one woo beyond that:

St. John Providence Health System in Warren operates several alternative medicine clinics through its oncology program, said Elena Weismann, director of the Providence Healing Arts Center. The Providence center has offices in Southfield and Novi.

To help cancer patients, St. John offers massage, Reiki, yoga, cooking classes, meditation, reflexology, hypnosis and guided imagery and nutritional counseling.

How many times do I need to repeat it? Reiki is faith healing substituting Eastern mystical beliefs for Christianity. Instead of God, reiki appeals to the “universal source” of energy, which is claimed to be channeled through the “healer” into the patient. Unfortunately, reiki has sprung up like a weed among reputable hospitals all over the U.S., sometimes even in the most surprising places (like one of the hospitals where I did my trauma training as a resident) and found its way into all manner of “integrative” medical clinics in hospitals big and small, private and academic. Personally, I view reiki as more akin to religion than anything medical. I’d have no objection to reiki practitioners being treated by hospitals the same way as priests, rabbis, imams, and chaplains, but that’s not what hospitals are doing with reiki. Instead, they’re offering the magic words, gestures, and (sometimes) touch as though they were real medicine.

As for reflexology, that’s only marginally less magical. Well, not really. Basically, reflexology postulates that pretty much every organ and function in the body maps to the feet or the hands and that reflexologists can diagnose and treat many illnesses by looking at the hands and feet and, in essence, massaging the right points on them. Now, there’s no doubt that foot massages and hand massages feel good, but reflexology is extremity massage with delusions of grandeur. For instance, it’s quite true that there are a lot of things you can tell about a patient by looking at his feet and hands. Clubbing of the nails can tell you that the patient has chronic respiratory or cardiac disease, and pedal edema can indicate heart failure, for example, but reflexology is not about that in that it maps organs to parts of the feet or hands where there is no known (or even plausible) physiologic or anatomic connection. In other words, reflexology is another medical modality based on prescientific thinking and vitalism, just like acupuncture.

And it’s in our hospitals alongside real, scientific medicine, as though it had the same validity.

In fact, apparently even insurance companies are starting to fund this stuff:

Earlier this year, Blue Cross Blue Shield of Michigan provided $400,000 to the Center for Integrative Wellness to conduct wellness services and research to 600 Blue Cross members who have pain and stress-related problems.

While offering conventional medicine and wellness programs, the Blues’ wellness project also incorporates alternative medicine techniques such as somatic movement and guided relaxation.

Yes, it’s times like these that I wonder why I keep doing what I do. Maybe the CAMsters are right. Maybe this is a tsunami, and docs like myself relics about to get swept away. Expecting evidence of efficacy based on science and well-designed clinical trials before introducing a therapy and believing that medicine had moved beyond prescientific vitalism seem so old-fashioned these days.

Comments

  1. #1 MATT
    August 11, 2011

    Two major health systems in SE Michigan. I don’t see the trinity/St Joe’s name on there either.

  2. #2 Calli Arcale
    August 11, 2011

    Rolfers make a life study of relating bodies and their fields to the earth and its gravity field, and we so organize the body that the gravity field can reinforce the body’s energy field.

    OMG. I now totally want the Bad Astronomer (Phil Plait) to do a post on this. He’s taken astrologers to task for their claims that gravity fields have something to do with how planets affect our lives (those astrologers having skipped the step of first finding out whether planets affect our lives in the first place), so I’d love to hear what he’d make of gravitational alignment for reinforcement of the body’s energy field. :-D

    I wonder — do Rolfers account for the presence of nearby massive objects? Blocks of metal, passing trucks, mountains? Do they account for elevation and latitude, as well as the Earth’s lumpy geoid? Does your body need to be aligned differently if you live in New Guinea rather than Sri Lanka? (The gravitational difference is significant, if you look at the GOCE data.) Have they considered the gravity gradient? Would your alignment need to be different if your job has you standing all day or sitting? What does this mean for astronauts, who sit a little higher in the gravity well for months at a time, and adopt arbitrary attitudes relative to the Earth’s barycenter? How does the Moon play into this, if at all?

    Oooh, and could we achieve maximum health if we built a big space station and put it at a Lagrange point? If we can get them to believe that, can we get them to triple NASA’s funding for human spaceflight, pretty please? :-D :-D :-D

  3. #3 C.L.
    August 11, 2011

    My insurance wouldn’t pay for a hearing test to help diagnose my hyperacusis (which, by the way, was clearly shown in the test I ended up paying hundreds for) but as of 2010 they will gladly pay the equivalent to some quack for “balancing” your spine. Hooray for alternative medicine!

  4. #4 Denice Walter
    August 11, 2011

    What I fear is that economic constraints will somehow shuffle people off ( perhaps through misguided self-selection) towards cheaper alt med options which could conceivably be good for the institutional bottom line despite deleterious effects on health.These options are given an aura of respectibility and efficacy purely by their presence at universiities and hospitals. Hospitals, insurance companies, and perhaps eventually Medicare/ Medicaid might opt in to save bucks through a two-tiered system of SBM/sCAM. I realise that this is a rather jaded view: however we live in the era of creative financial instruments and artistic accounting.

    The US will soon be caught up in cost-cutting mania ( so will Europe) concerning entitlements.High tech medicine- including tests and treatments- involves high costs, now imagine if, under the guise of “personal choice” ( beloved darling of the Tea Partiers and Conservatives as well as alt med advocates), costs could be drastically cut by offering alternative “solutions”. I imagine that it is quite inexpensive to educate and train ( if we can call it that) and re-imburse a reiki practictioner or a “life coach” vs experts in SBM. Herbs and supplements might replace expensive ( and frightening) chemotherapeutic drugs if the patient should so choose. Costs of testing (MRI’s) would be greatly reduced since alt med often touts their own arcane sensitivities to changes in energy patterns or suchlike.

    Thus, I can envision a brave, new horrible world that would be Nirvana for woo-meisters : imagine if you will a nutritionist versed in mega-vitamin dosage consulting a cardiac patient. The severely depressed new mother will speak to a life coach who will treat her through journal writing and deep breathing exercises. And cancer patients will be liberated from cutting, burning, and poisoning and given a choice of either Burzynski’s or Gonzalez’ ground-breaking therapies- or may try the Secret. Wakefield’s project will be resurrected and expanded to include GI connections to other developmental and psychological disabilities. Mike Adams and Gary Null will be lauded and applauded as harbingers of the New Reality of Paradigm Shift: there are whispers about a joint Nobel in the air. Ornish and Weill vie for the position of Surgeon General under President Paul ( I’m not sure which Paul- *pere ou fils*). Yes, I see all of these wonders in my mind’s eye. And I don’t like them. My vision should serve only as a warning to us all- no one sees the future only what is likely given the set of variables we now consider and can test.

    Orac is not a relic but a true Representaive of Reality as revealed unto us by Research. Oh Praise it! Even if we *were* out-numbered ( and I don’t think that we are-except in PR) we would still be right and they would still be deluded charlatans chasing after airy-faery illusions that happen to increase their income bracket.

  5. #5 Raging Bee
    August 11, 2011

    While I share your disdain for woo — and, more importantly, your anger over incidences of innocent people being defrauded or given treatments that don’t work — I’d like to offer some conditional justification for CAM.

    (Full disclosure: my fiancee is a reiki practitioner, who has sometimes been paid for her services; but I have yet to hear her making or supporting any outrageous claims regarding the efectiveness of her practice. No, she’d never tell you that reiki could, say, kill a tumor.)

    You wrote:

    And it’s in our hospitals alongside real, scientific medicine, as though it had the same validity.

    Is it really offered “alongside” SBM? Or is it offered as a sideline for people who want it, in addition to the SBM treatments the doctors ordered? There is an important diference here. If a doctor allows reiki to be used in place of surgery for, say, tumor removal or resetting a broken bone, then yes, that’s just evil. But if CAM treatments are offered in addition to the standard SBM, on a voluntary basis, with no misrepresentation of its effectiveness, then that could, at least, constitute a helpful dose of psychosomatic medicine to reduce stress in some patients.

    And reducing stress IS important to SBM. Let’s be honest: a trip to a doctor’s office can be very stressful, and a trip to the hospital is EXTREMELY stressful; and stress is well known to have negative effects on physical health — in this case, the health of patients who are already ill or injured. So if someone in a hospital wants some bit of woo treatment, be it reiki, meditation, the local shaman, aromatherapy or whatever, then allowing such treatment might reduce that patient’s stress, and thus improve his/her overall health, at least in the short run.

    The biggest issues here are: is the treatment offered on a voluntary basis, with no pressure of any kind? Is there a potential for harm in this or that CAM treatment? And, is the patient being given an honest picture of what works and what doesn’t?

  6. #6 Beamup
    August 11, 2011

    (Full disclosure: my fiancee is a reiki practitioner, who has sometimes been paid for her services; but I have yet to hear her making or supporting any outrageous claims regarding the efectiveness of her practice. No, she’d never tell you that reiki could, say, kill a tumor.)

    I’m curious. What claims DOES she make? Because there really isn’t any claim of effectiveness for reiki that isn’t outrageous.

    But if CAM treatments are offered in addition to the standard SBM, on a voluntary basis, with no misrepresentation of its effectiveness, then that could, at least, constitute a helpful dose of psychosomatic medicine to reduce stress in some patients.

    Unless the statement is “there is no evidence suggesting that this actually does anything at all, and a lot of evidence saying that it does nothing” then it’s misrepresentation.

    There’s also the ethical issue of taking money from people for something known not to work. Which is fraud if the “practitioner” knows it doesn’t work, and gross ignorance if they don’t.

  7. #7 Beamup
    August 11, 2011

    Oh yes, and specific to reiki, the disclosures (in order to be honest) would have to expressly include “the energy I claim to be manipulating does not exist.”

  8. #8 rob
    August 11, 2011

    great. CAM crap is invading everywhere. how long will it be until your local fast food place stops asking “would you like fries with that?” and instead asks “would you like a homepathic remedy with that? or perhaps a nice coffee enema?”

  9. #9 Heavens to Marketroid
    August 11, 2011

    I think the real reason we’ve been seeing CAM coverage on the insurance front is that the consumer demands it. The flip side of Tim Minchin’s “Storm” would be a 30-second advertising spot in which Storm says something like “What? Your insurer doesn’t cover (woo-du-jour)? Why not switch carriers and get one day a year at the health spa ‘for free’!”

    From the insurance company’s POV, providing woo-coverage gains them a premium-paying client, and if that client *does* develop cancer, covering a few months of quackery between the time-of-diagnosis and death is (up to a point) likely to be a lot cheaper than the cost of attempting to treat the disease.

    Rolfing: Wait, you mean there are people actually advocating deep tissue massage for breast cancer? Disclaimer: I’m no doctor, but off the top of my head, that sounds like a pretty good way to break off a few clumps of cells and efficiently transport them from lymph node to lymph node. (I suppose one could design a study to demonstrate whether or not my handwaving idea stands up to experiment, but I feel somewhat unethical for pondering just *how* unethical such a study would have to be: “Let’s do a properly-randomized study to see which CAM ‘treatment’ is most effective in *decreasing* overall survival relative to the placebo group!”)

  10. #10 Richard
    August 11, 2011

    I don’t think we are really outnumbered. Americans are uninformed, not hostile, to science-based medicine. We have to educate them.

  11. #11 lilady
    August 11, 2011

    @ Calli Arcale: All these problems of location can be rectified by Rolfer “practitioners” by the use of a global position systems…to customize the Rolfing “treatment”…available at a small additional charge. See, Rolfing really is “complementary medicine” which uses the latest technology.

    Wow Denice, brilliant analysis of the budget crisis, national debt, burgeoning health insurance costs and the rise of the Libertarians. President Michele Bachmann will appoint Junior Rand Paul as Surgeon General…Ron Paul will stay in Congress to work on the abolishing of Social Security and Medicare (“it’s unconstitutional”)…high on his “priority list” after the abolishing of the Federal Reserve. I would be the first one to “nominate” Mike Adams and Gary Null for the Nobel…if and when the Nobel Committee opens a new category of “Pseudoscience Medicine”.

    @ Raging Bee: See Denice Walters posting above, and, why should pseudoscience “practitioners” be a part of the science of healing in a hospital? If a patient finds that other resources in a hospital such as pastoral services and social services are inadequate, they have the option of contacting their own “practitioner” to come to the hospital for “treatment”.

  12. #12 zarza
    August 11, 2011

    I survived a miserable 5 years of misdiagnosis…being ill, and helpless, and frustrated and , well you know how it goes. Eventually , doctors managed to figure it out, and I had surgery , and I am healthy and happy and so grateful. I do not blame the doctors for failing to solve my rubik’s cube fast enough, stuff happens…no one was ‘incompetent’. During this period, friends , family, virtual strangers kept pushing me hard to ‘alternate medicine’. I was vulnerable and desperate, but horrified at the thought of going anywhere near these quacks. In my desperation, I went looking for MDs with PHDs, thinking a double doctor might be the ticket….my point (hang in there, I will get to it) is this is not just about a gullible public making ill informed choices, it is of critical importance that vulnerable, ill people are protected and cared for by the very institutions that exist, or should exist, for that purpose.

  13. #13 Raging Bee
    August 11, 2011

    Beamup: her claims basically amount to “this might make you feel better” in some unspecified way. And to the extent that her clients are people she’s already friendly with, in friendly settings such as “shares” or Pagan gatherings, the claim is probably valid in a purely subjective way. She’s done reiki on people with minor medical complaints, but never with any claim that this is the only treatment needed.

    As for your other points, they’re all valid, of course. My defense applied mostly to CAM practitioners going into hospitals on a volunteer basis, offering free “services” to whoever is conscious and says they want them. (I’ve never observed such people charging money, interfering with any conventionsl medical treatment, or lying about the effectiveness of SBM treatment; either of which would be, to put it mildly, unethical.) It’s basically like having visitors, chaplains offering to pray with you, or people offering to put flowers in your room: you get to say yes to whatever makes you feel better, which reduces stress, which has a real medical benefit.

  14. #14 blog.anarchic-teapot.net
    August 11, 2011

    @Calli Arcale

    do Rolfers account for the presence of nearby massive objects?

    Well, I do know a guy called Rolf and he is pretty massive. Haven’t seen any passing trucks flying off the road and sticking to him though.

  15. #15 Vicki, Chief Assistant to the Assistant Chief
    August 11, 2011

    Raging Bee–

    Orac did say he had no objection to the reiki practitioner being in the hospital on the same basis as a chaplain: the problem is that they’re being brought in as if they were medical professionals, like the surgeon, nurse, or dietician.

  16. #16 Jojo
    August 11, 2011

    I’d be interested to see how much CAM is really going on at many of these institutions. When my received her breast cancer diagnosis and we were looking for a treatment center, every local hospital/system had some kind of CAM available to their cancer patients (Fox Chase may be the one exception). Her treatments ended up crossing several different health systems, all that talk about CAM on their websites, but nothing was ever actually brought up at any of her visits and no information on any CAM was provided to her in the huge piles of info she did receive.

    If, this is typical, it would be interesting to do a study on how much interrogative services at hospitals are really being utilized. CAM uses this infiltration as validation of CAM, but if the services aren’t being used, that would be a nice bit of data to present to counter their claims.

  17. #17 marcia
    August 11, 2011

    Last sentence in Crain’s

    “Blue Cross funds some of our research, but insurers haven’t stepped up to pay for these services. We hope to have more research to prove its value.”

    Hope ain’t gonna work.
    Inevitable bad research ain’t gonna work, either.
    And, of course, higher out of pocket costs for that acupuncture treatment may doom it.

    But, then again, you have fools like this who aren’t tamped down:

    http://www.startribune.com/politics/statelocal/126740718.html

  18. #18 augustine
    August 11, 2011

    Non-skeptic based therapy and lifestyles exists in direct proportion to science based medicine’s failures and inadequacies. If science based medicine worked, there would be no market for what they call CAM. All of science based medicines customers would already be healthy.

    Science based medicine is responsible for an epidemic of diagnoses and sickness. Where ever they are more people are sick.

  19. #19 Gray Falcon
    August 11, 2011

    Tell me, augustine, how would you feel if you heard someone say this: “If Christianity worked, there wouldn’t be any atheists. All of the Christians would be free of pain and suffering.” Don’t demand from science what you don’t expect from God.

  20. #20 Anton P. Nym
    August 11, 2011

    If science based medicine worked, there would be no market for what they call CAM.

    Of course, the inverse argument (that if CAM worked the market for SBM would never have arisen) is equally valid. Therefor the assertion is worthless as-stated and, at a minimum, needs to be recast in order to be meaningful.

    — Steve

  21. #21 Raging Bee
    August 11, 2011

    Science based medicine is responsible for an epidemic of diagnoses and sickness. Where ever they are more people are sick.

    That paragraph is a perfect thumbnail example of augie’s hateful, stupid, uncaring childishness.

  22. #22 marcia
    August 11, 2011

    augustine:

    “If science based medicine worked, there would be no market for what they call CAM.”

    You’ve got it backwards there, Sparky. If the traditional, ancient, shamanic science of CAM worked, you wouldn’t have had science-based medicine.

    One out of 25 people made it to age 60 in 1900 with the average age of death around 45. Back in the 1700s, the average age of death was low 20s.

    This craps hangs on, but is losing big time to the real.

    Those ancient ways were and are so effective, huh?

  23. #23 lilady
    August 11, 2011

    @ Gray Falcon: I kinda liken the postings from us *Christians here who are science based clinicians as doing the Lord’s work:

    And Jesus went into the temple of God, and cast out all them that sold and bought in the temple, and overthrew the tables of the moneychangers, and the seats of them that sold doves. (Matthew 21:12, King James Bible)

    * That would be us Christians who don’t have a narrow minded (misanthropic, xenophobic, ignorant) view of the world like Ugh Troll.

  24. #24 rork
    August 11, 2011

    I can’t see the article at Crain’s, but wondered if Dr. Warber plugged her latest paper: PMID: 21724155.

  25. #25 cervantes
    August 11, 2011

    Well, Augie is a wacko, but there is of course a legitimate issue of overdiagnosis. I’d like to see Orac address the issue of “diagnosis creep,” where the threshold for labeling someone with say, diabetes or hypertension is adjusted downward over time, so that more and more people get a disease label and one or more prescriptions, with no real evidence that this constitutes cost-effective prevention and indeed, some evidence to the contrary. There is legitimate controversy over this. Drug companies push diagnoses at people over the teevee to sell pills, and primary care docs hand out antidepressants to people who have no diagnosis of depression, and so on.

    Not that this has anything to do with the validity of quackery, but people feeling overmedicated and losing trust in the medical profession is part of what helps the woomeisters generate appeal.

  26. #26 Composer99
    August 11, 2011

    Clueless troll’s drivel is clueless drivel by a troll.

  27. #27 augustine
    August 11, 2011

    Lilady

    @ Gray Falcon: I kinda liken the postings from us *Christians here who are science based clinicians as doing the Lord’s work:

    Science based Medicine Atheists (95% of SBM) collectively roll their eyes.

  28. #28 lilady
    August 11, 2011

    @ marcia: Gee, I’m surprised that a practicing chiropractor/powerful state legislator would “step over the line” to push an agenda of increased coverage for chiropractic care.

  29. #29 Anton P. Nym
    August 11, 2011

    As an aside, for the longest time I thought “Rolfing” was the term for the percussive massage used to loosen phlegm in cystic fibrosis patients’ lungs. Dunno why… and, come to think of it, I never have Googled to see what that technique is actually called.

    — Steve

  30. #30 kd
    August 11, 2011

    If science based medicine worked, there would be no market for what they call CAM. All of science based medicines customers would already be healthy.

    As usual, Augie’s definition of “working” medicine arbitrarily excludes any intervention with less than a 100% effectiveness rate. Therefore one can expect no treatment modality whatsoever to qualify as “working” according to Augie.

    Based on his previous posts, he also recommends against the utilization of any intervention with less than a 100% effectiveness rate (i.e. everything). So we should follow his and Thingy’s combined advice and wrap our homes in thick plastic and duct tape and never emerge (yet somehow continue to eat, drink, and breathe).

    But someone’s quarantine tent might not be properly sealed, so … not 100% effective, guess that option is out, too!

    Regarding measles vaccines, he would have us risk a several-thousand-fold greater chance of infection and tenfold greater chance of death simply because the vaccine isn’t 100% effective. That’s right, folks, if you can’t have 100%, 0% is the preferable alternative to 99% in Augie World.

    The “100% Effectiveness Standard” fails hard. No modality is 100% effective. Any “healing art” that claims to be 100% effective almost certainly isn’t, and is probably some type of woo. Science-based modalities aren’t afraid to admit that they aren’t perfect. And unlike those methods which claim to be so (without any proof, of course), however, science-based methods are willing to prove that they do something legitimately beneficial.

  31. #31 D. C. Sessions
    August 11, 2011

    Yes, it’s times like these that I wonder why I keep doing what I do. Maybe the CAMsters are right. Maybe this is a tsunami, and docs like myself relics about to get swept away. Expecting evidence of efficacy based on science and well-designed clinical trials before introducing a therapy and believing that medicine had moved beyond prescientific vitalism seem so old-fashioned these days.

    Bear in mind that I live in Arizona. A lot of the MDs around here attended the UofA after Andrew Weil got established there, so I’m well ahead of you on the “can I trust these people” anxiety front.

    I seriously wish there were a certificate that practitioners could display to the effect of “I only practice scientific medicine, if you want woo it’s three doors down on the left.”

    If worse comes to worst, give it a thought — there are enough of us out here to support more than a few practices.

  32. #32 lilady
    August 11, 2011

    “As an aside, for the longest time I thought “Rolfing” was the term for the percussive massage used to loosen phlegm in cystic fibrosis patients’ lungs. Dunno why… and, come to think of it, I never have Googled to see what that technique is actually called.

    – Steve

    Well, you don’t have to “Google” to find out how chest percussions and postural drainage help a child with cystic fibrosis. From the Cystic Fibrosis website:

    Cystic fibrosis causes mucus to become thick and sticky, which can clog the lungs and cause serious problems. You can help your child maintain lung function and avoid complications from mucus buildup and blockage by performing an airway clearance technique (ACT). Postural drainage and chest percussion (PD & P) is one of several airway clearance techniques that help clear mucus from your child’s lungs.

    And, the NY Times has an article about Rolfing on its website:

    Rolfing, Excruciatingly Helpful, (October 6, 2010)

    Dr. Rolf developed a theory that the body’s aches and pains arose from basic imbalances in posture and alignment, which were created and reinforced over time by gravity and learned responses among muscles and fascia — the sheath-like connective tissue that surrounds and binds muscles together. Rolfing developed as a way to “restructure” muscles and fascia.

    The focus on manipulating fascia is part of what distinguishes it from chiropractics, which deals with bones, and from therapeutic massages, which works on muscles.

    That also explains why Rolfing has a reputation for being aggressive, even painful at times. Fascia is stubborn material, particularly if it is marked by knots and scar tissue. Rolfers gouge with knuckles and knead with fists, contort limbs and lean into elbows to loosen tendons and ligaments. Patients, meanwhile, need the fortitude to relax and take it during the hourlong sessions.

    I learned how to do chest percussions and postural drainage from a respiratory therapist. (You do tend to increase your skill set when you have a child who is immune suppressed with severe scoliosis/kyphosis and frequent episodes of aspiration pneumonia).

  33. #33 Emil Karlsson
    August 11, 2011

    I am astonished by the fact that I continue to be astonished over things like this. Just when you think it cannot get any worse…

    Scientific skepticism and philosophy of science should be part of all good science educations.

  34. #34 TBruce
    August 11, 2011

    D.C. Sessions:

    Never fear, if the bulk of the population turns to altmed, the science-based practitioners will still be around because there will be a market – the patients who turn to us when the aCAM teatments fail. Unfortunately, we will see diseases at a later stage than we do now – fungating metastatic tumors, diabetic ketoacidosis, myxedema comas etc., not to mention epidemics of vaccine-preventable diseases.

    Hey, it’ll be just like the good old days!

  35. #35 Grace
    August 12, 2011

    I am a licensed massage therapist and there is a lot of new agey woo that you have to learn in addition to anatomy/physiology/massage techniques, which has been extremely frustrating. For my continuing ed credits, the classes I have to choose from are becoming more and more about “energy work” and less about actually learning new ways of effective physical massage.

    Structural Integration (the nontrademark term for Rolfing) was actually a great class. It’s basically very deep tissue massage, working with muscle and fascia, with the goal of improving things like postural problems or chronic holding patterns. The alignment is about postural alignment and stretching the muscle tissue/fascia to improve any problems, so I’m not sure how that could be classified as woo. It seemed like one of the less woo-ey classes I took.

    So I’m not exactly clear on what issues you take with SI/Rolfing, if you could elaborate a bit more I would appreciate it. I know Ida Rolf had some metaphysical ideas that she added to the basic philosophy behind the system, but everything I was trained in was based on physical manipulation and anatomy.

    (And a cancerous tumor would be *completely* contraindicated for massage of any kind, so whoever tried to Rolf away a tumor has no basic knowledge of massage therapy and should get his head examined and his license revoked!)

  36. #36 BadDragon
    August 12, 2011

    Well… in the end, it is all just good old natural selection. Pardon my cynicism.

  37. #37 Vicki
    August 12, 2011

    BadDragon: I sincerely hope none of your relatives die because they don’t have whatever traits would enable them to tell which doctor with a degree from Cornell on the wall is competent, and which is a woo-meister who won’t treat their real disease properly.

    Civilization is a long, complicated, and often successful effort to protect each other from nature cruel in tooth and claw. One aspect of that effort is pointing out risks to each other.

  38. #38 davep
    August 12, 2011

    Raging Bee@5 “Is it really offered “alongside” SBM? Or is it offered as a sideline for people who want it, in addition to the SBM treatments the doctors ordered? There is an important diference here….And reducing stress IS important to SBM. Let’s be honest: a trip to a doctor’s office can be very stressful,”

    Sounds like a BJ would be more effective. Maybe, hospitals should provide that service too.

  39. #39 davep
    August 12, 2011

    Augustine@18 “Science based medicine is responsible for an epidemic of diagnoses and sickness. Where ever they are more people are sick.”

    Utter fail! No more leeches for you!

    SBM is really only about 150 years old. “Ancient” alternative “medicine” still can’t even bothered to prove that it does anything!

  40. #40 The Crack Emcee
    August 12, 2011

    You can be so funny. Don’t despair, Orac – we’re right and they’re wrong – we’re just waiting for our O.J. moment.

    Don’t worry about it – it’s coming. Here, cheer up, you big loser – I still love you:

    http://www.themachoresponse.com/crackMC/wordpress/?p=4393

  41. #41 Delurked lurker
    August 12, 2011

    Boring moderated troll is till boring and hopefully still moderated.

  42. #42 titmouse
    August 12, 2011

    If a doctor allows reiki to be used in place of surgery for, say, tumor removal or resetting a broken bone, then yes, that’s just evil. But if CAM treatments are offered in addition to the standard SBM, on a voluntary basis, with no misrepresentation of its effectiveness, then that could, at least, constitute a helpful dose of psychosomatic medicine to reduce stress in some patients.

    No. When you “integrate” CAM with medicine, the medicine gets soft around the edges. Your allegedly science-based doctor will begin prescribing sciency diagnostic procedures or treatments involving drugs, surgery, or high tech imaging, justified by the same quality of evidence as we now have for acupuncture.

    Lower standards mean lower standards generally.

  43. #43 Militant Agnostic
    August 13, 2011

    @42 The use of CAM treatments in hospitals also gives these treatments undeserved credibility. My wife is a Reiki master and uses the “they use it in hospitals” argument from authority all the time. If CAM is available in the hospital even if it is from unpaid volunteers, the general public will assume there must be something to it. When woo is used alongside real treatments, the woo often gets the credit when the patient is cured. This can lead to someone else using the woo exclusivity with disastrous results.

    Raging Bee – does your fiancee believe some of the more preposterous claims of Reiki such as it working over the phone and at a distance?

  44. #44 DLC
    August 13, 2011

    One of the problems I have with the sCAM stuff is that people allow it into their hospitals and treatment based on “Well, it does no harm.” but, the problem is.. when people are going to those fake treatments they all too often eschew real treatments that might actually “diagnose, treat cure or prevent ” their illness — a claim which the sCAM products cannot make.

  45. #45 Denice Walter
    August 13, 2011

    *And* woo-meisters ardently insist that pseudo-science in hospitals is evidence of “paradigm shift”- that the “tide is turning”** their way and soon SBM will realise the error of its ways and come on over to the realm of light and twinkling stars. They use the instances Orac cites of quackedemic medicine as PR and ad copy for their own brand of nonsense.

    What I can’t fathom is how they try to portray alt med as “hip” or “the new thing”: it’s neither. How can being dense, simplistic, and easily hood-winked by charlatans *ever* be hip? And none of this crap is new: anti-vax goes back to Jenner’s days and I can quote you many alt med tropes beloved by Mike Adams that were faves of J.I. Rodale, c. 1960 : there is nothing new under the sun or in the collected works of Gary Null or Joe Mercola. Chopra and Oz are re-plays of the 1970′s fascination with ” Orientalism” which had precedents in the 19th century.

    ** Right. And bringing in tons of flotsam, jetsam, and organic detritus in its wake.

  46. #46 Rogo5
    August 14, 2011

    I seriously thought that “Rolfing” was a synonym for “ROFLing” when I first heard it. But, hey, ROLFing fits, doesn’t it?

  47. #47 No Homeopathy with my Taxes!
    August 14, 2011

    Hi UK people please sign this petition against homeopathy on the NHS

    http://epetitions.direct.gov.uk/petitions/2159

  48. #48 lilady
    August 14, 2011

    @ Rogo5: I thought it may be the shortened version of ROTFLMAO.

    In any case I don’t want anyone mauling me and loosening/releasing/adjusting my fascia.

    @ No homeopathy…Good luck with your petition.

  49. #49 Bronze Dog
    August 14, 2011

    Do Rolfers use a ROFLcopter to airlift emergency patients?

  50. #50 lilady
    August 14, 2011

    @ Bronze Dog: Perhaps Rolfers will use the ROFLcopter for humanitarian purposes, if they balance the U.S. Budget by keeping the tax breaks for the wealthy (the job creators) and lower the defense budget and remove the Rofl’ing guns.

    Rofl’ing Gun

    t3h second most mcPWNAGE weapon in the universe, after the noobclear bomb. Fires a hailstorm of ROFL rounds at 5000 rounds per minute and can sustain the fire for ten minutes and may be reloaded while firing.
    “man someone take out that Rofl’ing gun when it needs a reload!”

    “it probably just got reloaded!”

    “OH NOES!”

  51. #51 BadDragon
    August 14, 2011

    @Vicki I surely hope the same.

    On one hand, here where I am answering to you from the woo-meisters have a lot of reasons for success. Not because they are wright or because they are effective but because the SBM is in coma (a patient has to bring his own aspirin, bandages and syringes because the hospital has none. Plus some money to bribe incompetent doctors, nurses and whoever else works around there and you need their help).

    And, although you keep telling them that neither bribery nor CAM is the answer but a healthy reboot of the whole system, they keep being stupid enough to support the existing system by bribing the doctors and visiting fortune tellers and curse breakers.

    A nice ground for at least a moderate cynicism.

    On the other hand, I fully agree with you, we should (and I do that) help each other, we should inform the ones less informed. And we should open our eyes when others inform us we are in danger.

    (the place is somewhere in South-East Europe, no Cornell doctor in my vicinity)

  52. #52 Rogo5
    August 14, 2011

    @ lilady

    Yes, ROFLing is good for the soul. It is a basic human requirement to undergo a ROFLing procedure.

  53. #53 BadDragon
    August 14, 2011

    Ups, sorry for a missing comma and a “wright=right” in the first paragraph. It was late in the night when I wrote it.

  54. #54 Thomas Pickwick
    August 15, 2011

    Hmm. My younger brother spent several months in the U of Michigan’s Mott Children’s Hospital a few years back, for a traumatic brain injury. For the most part his care was absolutely everything we could have hoped for, undertaken by the most attentive and knowledgeable nurses and doctors imaginable, who also had strong group cohesion and made sure to keep us informed at every stage. Working against tremendous odds, they saved his life and helped him recover most of his faculties.

    Then, there was the Touch Therapist and the shaman. I wish I were joking.

    I wasn’t at the hospital when either of those individuals plied their trade, but the idea of TT gave me pause, since my brother doesn’t much like to be touched. But as I’ve read more recently on RI, TT doesn’t actually involve touch, so it probably didn’t cause any direct harm.

    Then the shaman came through, most probably clad in feathers and sporting a bone stuck at a jaunty angle through her nose, though I didn’t hear that part. She wanted to surround my brother’s hospital bed with objects that “held his essence,” such as reeds he’d used to play his wind instrument; the doctors apparently objected to those on the wholly reasonable–and, you would think, *totally fucking obvious*–grounds that such unsanitary objects have no place in the ICU or PICU.

    Now, I don’t believe that the two quacks had any connection to the hospital; one of my parents was into various sorts of pseudomedicine and probably contacted them both. And I’m sure that, had the quacks posed significant threats to his recovery, the real medical professionals would have thrown them out of my brother’s ward. But even minimally-invasive quacks have no place in the ICU/PICU, even to comfort the parents. At best, they were distractions from the real business of healing–a nurse had to watch the TT and shaman to make sure they didn’t cause any harm, and that was time and attention she could have been using to record data or monitor vital signs or do any number of useful things. It didn’t cause any discernible damage in my brother’s case, but there’s just no reason they should have been allowed in, and every bit of news about the metastasizing of quackery into medicine makes me worry that a few years down the line, these people might be invited in by the medical system itself. And patients will suffer for it.

    Thanks, Orac, and everybody who’s pushing back against IM/CAM. And thanks to everybody in the real medical profession, too.

    –Thomas Pickwick–

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