Respectful Insolence

Medical therapies should be based upon science. That is a recurrent theme, indeed, the major theme, of this blog. Based on that simple thesis, I’ve spent the last decade examining “unconventional” treatments and evaluating the scientific basis (or, much more usually, the lack of a scientific basis) for various treatments. Yes, I’ve looked at other issues, including general skeptical issues, the occasional political rant, Holocaust denial, and, of course the odd self-indulgent bit of twaddle that every blogger engages in every now and then, but I always come back to the question of the scientific basis of medicine and the lack thereof exhibited by so-called “complementary and alternative medicine (CAM) or “integrative medicine.” Whether it be antivaccine pseudoscience, cancer quackery, or other medical topics, I always come home to my niche.

Unfortunately, as part of that discussion, I’ve been forced to confront time and time again the infiltration of outright quackery into medical venues that should know better. Whether it’s utter nonsense like acupuncture, “energy healing,” or other forms of woo infiltrating academic medical centers (a phenomenon that I frequently refer to as “quackademic medicine”) or changes in the law that legitimize quackery, such as the licensing of naturopaths. So it was yesterday that I was depressed to read two stories that speak to both of these points—and not in a good way.

I’ve mentioned before that I did my surgery residency in Cleveland. I didn’t do it at Cleveland’s more famous institution, the Cleveland Clinic, but I did do it at what used to be the bitter rival of the Clinic, University Hospitals of Cleveland (UH). Actually, it was the Case Western Reserve University combined surgical residency, and we rotated at multiple hospitals, including UH, MetroHealth Medical Center (where we got most of our trauma and critical care experience), the Cleveland Wade Park VA, and Mt. Sinai, the last of which no longer exists. However, we did spend a lot of time at UH, and that’s why I’m very saddened to have seen this story, University Hospitals integrating alternative therapies into patient care.

Truly, it is sad to see the great institution that trained me fall so low. I’ll show you what I mean:

CLEVELAND, Ohio — Dr. Roy Buchinsky had a male patient in his 50s with chronic pain in his right ankle and pain in many of his joints. Anti-inflammatories and narcotics had not helped.

So Buchinsky, an internal medicine physician, recommended something else.

Acupuncture.

“You wouldn’t think it’s the kind of thing a middle-aged guy would do,” said Buchinsky, who works for University Hospitals Case Medical Center. “And normally, this fellow wouldn’t have, but he said, ‘At this point, I’ve tried everything else, what can I lose?’”

Six weeks later, his patient was no longer taking pain medication. “Now he’s a believer,” said Buchinsky.

He’s joined by hundreds of other patients who, since last fall, have received reiki, acupuncture, reflexology and massage at University Hospitals, often based on a doctor’s referral.

Reflexology? Seriously? At my surgical alma mater? Are they kidding me? They might as well offer “detox” foot baths or Kinoki “detox” foot pads while they’re at it? Why not? Detox foot baths and foot pads are no more ridiculous, from a scientific standpoint, than reiki or reflexology. By offering reiki, they’re offering a modality that is nothing more than magical thinking, faith healing that substitutes Eastern mysticism for Christianity as it belief system. Reiki masters claim to be able to channel the “energy of the universal source” to heal patients, while faith healers claim to channel the healing power of God. What’s the difference? It’s all basically the same thing; only the names have changed. As for reflexology, that’s just about as bad. True, almost everyone enjoys a good foot massage, but that foot massage passes into the magical thinking that is reflexology when reflexologists claim to be able to affect specific organs by linking them to where they are “mapped” on the soles of the feet and palms of the hands. And, yes, this magical mystical modality is being offered by UH. What a depressing thought. First it was my medical school alma mater starting a program in anthroposophic medicine, now this. No academic institution appears to be safe from the scourge of quackademic medicine.

Even more annoying, the way this article is written makes it basically a press release for the new “integrative medicine” center at UH, the Connor Integrative Medicine Network, whose home base is the University Hospitals Ahuja Medical Center. There, apparently, you can get many forms of what used to be justifiably called quackery, including reiki and reflexology. Let’s just let that sink in for a moment That means that at UH you can see a practitioner who claims to be able to channel mystical, magical “energy” into you to fix what tails you. Or you can see a practitioner who thinks that you can diagnose specific organ abnormalities by feeling the hands or the feet. Through it all, instead of science, anecdotes are the order of the day:

He’s joined by hundreds of other patients who, since last fall, have received reiki, acupuncture, reflexology and massage at University Hospitals, often based on a doctor’s referral.

That’s a huge shift, said Buchinsky, who has been practicing for 17 years.

“In the past, doctors would never have considered making such referrals,” he said. “But as science continues to confirm what we think we know, this will happen more and more.” The alternative therapies he recommends most often to patients are acupuncture, reiki and massage therapy.

University Hospitals is one of a growing group of hospitals around the country that are integrating such therapies into patient care. Many of the UH patients availing themselves of such alternative treatments are trying them because they have been recommended by their doctors — physicians who not so many years ago would have considered these treatments fringe, if not outright quackery.

No longer. As Dr. Francoise Adan, medical director of UH’s new Connor Integrative Medicine Network, explained, “We are an academic center, so these are evidence-based therapies.”

“Evidence-based.” You keep using that word. I do not think it means what you think it means. Let’s just put it this way: It doesn’t mean “a crappy study or two whose results could easily been due to bias, placebo effects, and other confounders suggested that it might work.” It also doesn’t mean, “ridiculously implausible therapies with no basis in science that are based on prescientific and/or religious ideas about how disease occurs.” I shouldn’t have to point this out, but apparently I do, again and again. As for acupuncture, that is, as I have said before, the “gateway woo,” that leads to so much other nonsense. Of course, as I’ve pointed out time and time again, it doesn’t matter where you put the needles in or even if you put the needles in; acupuncture still “works,” even if it consists of twirling a toothpick against the skin.

No, Dr. Adan, neither acupuncture, reflexology, and reiki is “evidence-based,” unless your standards of evidence are risibly low. Don’t believe me? Take a look at the Connor Integrative Medicine Network’s pages on reflexology, reiki, and acupuncture. There you will find no clear references to specific clinical trials, meta-analyses, or Cochrane reviews (although there are vague references to “studies” with no citations to allow one to look up the study). Instead, what you will find are many mentions of “natural energy,” “removing energy blocks,” “restoring balance and flow in the body,” “universal energy,” the body’s “innate healing power,” and “reviving energy flow.” These are not scientific terms. They do not belong anywhere near a website of a facility claiming to provide only “evidence-based” therapies. They belong on websites like Whale.to, NaturalNews.com, Mercola.com, and other quack websites, which is, not surprisingly, where such terms are usually found.

So how did the Connor Integrative Medicine Network come to be? As is often the case, a wealthy donor is responsible for inflicting this bit of quackademic medicine on the academic medical world:

That’s one of the reasons Chris and Sara Connor of Chagrin Falls funded the program at UH last year with a $1 million gift — knowing that people would be more open to such therapies if they were offered through a medical center. (Chris Connor, chairman and CEO of the Sherwin-Williams Co., has been a board member at UH for more than 10 years.)

The integrative medicine program is technically based at the UH Ahuja Medical Center in Beachwood, and Adan has a small office there. By fall, the practitioners of treatments such as acupuncture and reiki will be setting up appointments throughout the system. On some days, classes or appointments will be offered at the Westlake campus, for example, or at other suburban UH locations.

Lovely. Just what UH needs. In fact, the woo is metastasizing. Later in the article, I learn that more than 1,500 employees of UH have been treated with “integrative medicine,” but, worse, 356 of them have undergone reiki 1 training. True, they’re not reiki masters because of that (it is, after all, the most “basic” level of training), but it’s disturbing that so many employees of what should be a science-based hospital are being educated in mysticism and having it called medicine. I will give the Connors credit, however, for their honesty. The very reason quackademic medicine exists is because promoters of pseudoscientific treatment modalities know that being associated with an academic medical center gives their favored pseudoscience the imprimatur of great medical centers like UH, the Cleveland Clinic, Yale, Harvard, and the like.

Which brings us to the second story. I won’t spend as much verbiage on it, but I will tell you: If you live in Alberta, Canada be careful. Be very, very careful with your health care. Why do I say that? Because the government of Alberta just set the province’s naturopaths loose:

Alberta has beefed up the powers of its naturopathic doctors, giving them full status as medical professionals but stopping short of funding treatment.

The move – chiefly, the creation of a College of Naturopathic Doctors of Alberta – allows the profession to self-regulate and weed out those who don’t meet certain standards.

It will likely mean more private health plans will cover naturopathic treatment, Alberta Health Minister Fred Horne said, and will allow patients to claim receipts as medical expenses on tax returns.

Naturopaths are celebrating this, claiming that it will allow them to regulate their own and to “weed out” naturopaths who don’t practice up to the standard of care. Of course, I have no idea what this means with respect to naturopathy, given that naturopathy itself is a collection of virtually every woo known to humans, up to and including homeopathy, which is an integral part of naturopathy. How, specifically, do naturopaths determine if a naturopath is practicing up to the standard of care? What is the standard of naturopathic care? No one’s been able to define it, as far as I’m aware. For instance, when is it correct to choose homeopathy? The correct answer should be that it’s never correct to choose homeopathy, but naturopaths love homeopathy. The same question can be asked of traditional Chinese medicine, chelation therapy, and the rest of the cornucopia of woo that makes up naturopathy. The bottom line is that there is no science-based naturopathic standard of care. Actually, as far as I can tell, there is no naturopathic standard of care, period, science-based or otherwise. Perhaps a naturopath could tell me what sort of treatment or diagnostic naturopathic misadventures would be considered severe enough to warrant taking away a naturopath’s license to practice. We in medicine can rattle off all sorts of examples of the sorts of actions that would fall so far below the standard of care that they should result in sanctions up to and including stripping a doctor of his license. I have yet to see a naturopath state concrete violations of the naturopathic standard of care that warrant such penalties.

Perhaps it’s because there is no naturopathic standard of care, as I have just said.

I must admit that, after seeing those two articles, I can’t help but feel a little depressed. The “integration” of quackery into real medicine continues apace.

Comments

  1. [...] Orac at Respectful Insolence has the sad story of a similar situation in the US. Share this:TwitterFacebookEmailPrintLike [...]

  2. #2 Marion Delgado
    July 26, 2012

    Also, it’s really helpful when the journal of complementary and alternative medicine articles are accessed through the NIH website for people to point me to and go See?? See??

    Also, ditto on homeopathy. That’s the line in the sand for a LOT of people. One German quack bullshiting? It doesn’t even have the imprimatur of folk medicine or ancient wisdom or culture or what have you. It’s New Age Holy Water used in medicine that comes out of a d&d handbook, and it’s not even a tradition?

  3. #3 Anj
    July 26, 2012

    “The move – chiefly, the creation of a College of Naturopathic Doctors of Alberta – allows the profession to self-regulate and weed out those who don’t meet certain standards.”

    Self regulation by peer review boards is how much of the oversight of lay midwives in the United States is currently done. The results are not encouraging. In theory, lay midwives have a defined scope of practice and standards in care. In practice, many midwives ignore both.

    When this habit results in loss of life and serious injury, the punishments are often light, and in this case not even enforced.

    “Final order issued regarding death of infant and total hysterectomy for mother in a failed VBAC in 2008. Violation for maternal antepartum non-absolute risk criteria & assessment, transport plan, fetal heart tone evalution. Suspension of one month, during which Rose continued to practice.”
    http://oregonmidwifeinfo.com/adele-rose/

    Self regulation rarely works well.

    [Midwife care is intended to be evidence based, and generally is under NHS programs with good results. Without enforced standards and oversight, care can easily evolve into whatever its practitioners want it to be.]

  4. #4 Ender
    July 26, 2012

    Look, if self regulation didn’t work, why would we let all the big banks self regulate??

  5. #5 Ender
    July 26, 2012

    p.s. I just started the International Consortium of Homeopaths. The only rules are that there AREN’T ANY… molecules of the active substance anywhere near your dilutions.

  6. #6 BrentRN
    New London, PA USA
    July 26, 2012

    As a nurse I run into a lot of nurses gaga over woo. I am sympathetic to the placebo effect of CAM, which is why it persists despite lack of evidence. Patients know so little about their own biology they are credulous to any claim that sounds good. The two issues in CAM for me are the ethics of providing a known placebo, and the ethics of providing a placebo the practitioner thinks is real. The former has been long debated. The latter is malpractice in my opinion.

    Sadly, too many nurses into woo are supported by physicians and hospitals that should know better. My local children’s hospital is sponsoring therapeutic touch treatments and pay a nurse to wave her hands over kids. I am appalled but everyone I speak to there says “there are studies” to support it. Of course they can never show me the studies from anything other than a poorly done report in a holistic nursing journal.

  7. #7 Mrs Woo
    July 26, 2012

    So – if a naturopath chooses to recommend evidence-based treatment, is that a reason to be censured by their group?

    I mean, that’s about the only thing I can think of that would be outside their standards of care….

  8. #8 Dave Ruddell
    July 26, 2012

    I’d sat that the most important thing in the Alberta example, as in my home province of Ontario is this:

    but stopping short of funding treatment.“.

    Of course, I’d rather that the government not recognize naturopaths at all, but at least they’re not getting any OHIP money.

  9. #9 palindrom
    July 26, 2012

    anj @727 — What a horror story.

    Just for the record, lay midwives should not be confused with Certified Nurse-Midwives, who are RNs who undergo 2 years of post-grad training.

    Our local academic medical center has a CNM group which operates in close and amicable cooperation with the OB-GYNs. All their care is in-hospital, with the whole apparatus of modern medicine available immediately if needed. Their safety record over several decades has been excellent.

  10. #10 Orac
    July 26, 2012

    @Dave Ruddell

    It’s only a matter of time before they pay for naturopaths if they’re a licensed health care professional. That’s the next phase in the naturopaths’ political push.

  11. #11 JGC
    July 26, 2012

    Maybe it can become a two-edged sword.

    As duly recognized medical practitioners, aren’t Alberta’s naturopaths now liable should they fail to refer their clients to appropriate speciailists to treat their preseenting illnesses, just as would be a physician if I presented with appendicitis and he didn’t refer me to a surgeon for appendectomy, instead electing to treat it himself with antibiotics and bed rest?

  12. #12 Denice Walter
    July 26, 2012

    @ BrentRN:

    “Pay a nurse to wave her hands over kids”

    Just amazing! You would think in an era of fiscal austerity, someone would step up and say, “Isn’t this a waste of time, money and the effort of an educated person who could instead be trained to do something that actually helps a person?” I would actually prefer that nurses be trained in reading stories to sick kids.

    About nurses and woo:
    one of the alt med idiots I survey has an RN enabler who works with him. And she has a website:
    metropolitanwellness.com

    SB RNs might like to have a peek at this.

  13. #13 Mark Thorson
    July 26, 2012

    The Dental Board of California is supporting an upcoming quack convention with continuing education credits, as can be seen here:

    http://www.cancercontrolsociety.com/meeting2012-html.html

  14. #14 Anj
    July 26, 2012

    @palindrom,

    Yes, it’s a horror story. Yes, CNMs in the US are close the midwives who work in NHSystems complete with direct supervision and active oversight.

    The lay midwives span the range from ethical and responsible to maximum woo – and there’s no way to tell the difference. The kicker to me is that a midwife whose negligence caused one preventable death and could have caused the woman’s death got nothing more than a single month’s suspension that the midwife flouted.

    Self regulation works when those in charge are interested more in the public good than protecting their own personal and professional assets. Human nature tells us that we make protecting ourselves and those close to us a priority. Self regulation usually means collective CYA and self enrichment than anything else.

  15. #15 BKsea
    July 26, 2012

    “Connor, chairman and CEO of the Sherwin-Williams Co”

    In an odd twist, I have just opened an integrative paint center at the local hardware store. We use aura and chakra projection instead of that nasty allopathic paint.

  16. #16 Militant Agnostic
    July 26, 2012

    Chris and Sara Connor of Chagrin Falls funded the program

    How appropriate

    @orac

    Even more annoying, the way this article is written makes it basically a press release for the new “integrative medicine” center at UH

    It probably is the press release.

    Long before the era of copy pasta, I worked for a large Canadian oil company (Dome Petroleum) that floundered on the verge of bankruptcy for years and was often in the news as a result. They would post there press releases on the office bulletin boards and I would read the same words mostly verbatim (without quotation marks or “A Dome spokesman said”) in the Calgary Herald the next day.

    If you want freed advertising in a newspaper, just write the article for the reporter and they will copy paste and put their name on it.

  17. #17 Denice Walter
    July 26, 2012

    To combat Orac’s depression about the NDs:

    There is a similar political effort by woo-meisters to STOP governmental moves to curtail the activities of nutritionists, who run amok in health food stores, yoga studios, workout parlours and woo-tinged medical offices. They often prescribe food/ supplements as remedies for serious illnesses and developmental conditions like autism. The so-called profession may include ‘graduates’ of extremely dodgy ‘universities’ ( woo-niversities) whose ‘science’ has a slipshod grasp upon reality.

    Nutritionists are as common in woo-dom as is sand on a beach. Mike Adams is a nutritionist; many believe that nutrition causes and cures most illnesses: “Toss away those meds!”

    What the woo-meisters fear is that eventually laws might restrict giving advice about diet to registered dieticians. They would then find themselves up the proverbial creek without a paddle.

    Wouldn’t that be lovely?

  18. #18 Militant Agnostic
    July 26, 2012

    @Denice Walter
    Wasn’t Ben Goldacre’s cat a nutritionist?

    @me
    there press releases should be their press releases or maybe them there press releases.

  19. #19 Denice Walter
    July 26, 2012

    @ Militant Agnostic:

    Yes. The dead one.

  20. #20 Denice Walter
    July 26, 2012

    And as we all know:

    “even a dead cat will bounce if it falls from a great height”
    and
    “in the long run, we’re all dead”

    Now, I’ll go lie down.

  21. #21 Anj
    July 26, 2012

    @Militant Agnostic

    Locals call Chagrin Fall “the bubble” in terms of being cut off from The Real World.

    ;)

  22. #22 Narad
    July 26, 2012

    “Connor, chairman and CEO of the Sherwin-Williams Co”

    In an odd twist, I have just opened an integrative paint center at the local hardware store. We use aura and chakra projection instead of that nasty allopathic paint.

    In an even odder twist, I have rather close connections in the Cleveland paint world.

  23. #23 FilipinoMDstudent
    July 26, 2012

    One of the major private hospitals where our school does clinical rotations offers acupuncture in its “Wellness Center”. To be fair, though, I don’t think we are required to rotate in that department (at least I hope we don’t have to). I agree, it’s depressing to see this nonsense “metastasizing” into institutions that are supposed to promote evidence-based therapies.

  24. #24 palindrom
    July 26, 2012

    Anj @1043 — Just so I’m not misunderstood, I wasn’t being at all ironic when I characterized your lay midwife example as “a horror story”. It really IS awful.

    I know one of the local CNMs about as well as I could, if you get my drift, and when I think of how she and her colleagues work their tails off to deliver sensitive, meticulous, expert care to their patients … and compare that to how any old new-ager can claim to be a “midwife”, no matter how slapdash and dangerous she is, well … it does tend to get me a bit riled up.

  25. #25 lilady
    July 26, 2012

    @ anj @ palindrom: Here’s an excellent blog about lay midwifes in Oregon and how they are *monitored* by their *professional association*:

    http://10centimeters.com/ohla-direct-entry-midwifery-board-is-a-joke-and-a-hazard-to-your-health/

    Who the hell is providing malpractice insurance for them?

  26. #26 Krebiozen
    July 26, 2012

    Mark Thorson,

    The Dental Board of California is supporting an upcoming quack convention

    So Dara O’Briain’s joke about certified toothiologists may come true?

    As for Oregon lay midwives who apparently get to attend higher and higher births until something goes terribly wrong, I’m lost for words.

  27. #27 Krebiozen
    July 26, 2012

    higher and higher risk births

  28. #28 Mrs Woo
    July 26, 2012

    Orac is right – this is a sequential, and very planned thing – first they get governing approval and licensing, then since they are licensed medical providers, they lobby to get insurance coverage since, after all, they are now licensed medical practitioners and “indistinguishable” from any other licensed provider.

    Then you end up with messes like 2001 in Washington state when a little girl died of an asthmatic attack when she was taken to their family’s primary care provider, a naturopath. The family honestly said that they believed that if their insurance covered the provider they believed the provider had to be qualified to provide basic medical care.

  29. #29 Renate
    July 26, 2012

    @ Denise Walter
    Metropolitan Wellness also had the Quack Miranda Warning, which is one of the things to recognize a quack-site.

  30. #30 SandyT
    July 26, 2012

    As an often ashamed resident of Alberta, I apologize to scientists and rational thinkers everywhere about the naturopathic idiocy.
    But don’t worry about them getting government funding any time soon. Our provincial government has been looking for ways to privatize more and more services for years.
    And on the plus side, they delisted chiropractic in 2009! That’s got to count as a small entry in our favour.

  31. #31 Morgan
    July 26, 2012

    What is the overall consensus when it comes to massage therapy?

    I believe it works to reduce pain and stress levels, but it is always lumped into the “pseudoscience” category. Obviously acupuncture, reflexology, and reiki don’t work, but imo massage actually does?

    What do you guys think? I’m just curious to see others opinions.

  32. #32 jrkrideau
    July 26, 2012

    @ Militant Agnostic
    If you want freed advertising in a newspaper, just write the article for the reporter and they will copy paste and put their name on it.</b?

    You've been reading Margaret Wente recently?

    @ orac and others

    As part of the deal, which comes after 14 years of negotiation, the province’s 144 naturopaths have agreed to a list of services they’re not authorized to provide.

    Mr. Horne said it’s the government’s priority to protect the public by regulating each profession, not pick sides.
    “We’re not here to endorse any particular philosophy or form of treatment,” Mr. Horne said, noting there are two dozen health professions, including acupuncture and massage therapy, with the same status.
    Mr. Horne balked, though, when asked whether the province would now consider funding treatment.
    “Well, not in the immediate term,” he said.

    It looks a lot like the Govt is trying to a least contain the critters. I believe naturapath was an uncontrolled namebefore so a) anyone could call themselves that and b) do anything.

    This way there seems to be some hope of controlling the worst excesses but the self-regulating is scary.

    I suppose some private insurance companies may fund treatment but I doubt it would be popular with them and clearly the main govt funder is not. So at a guess 70-80 percent or more of Alberta residents won’t have coverage.

  33. #33 jrkrideau
    July 26, 2012

    @ Militant Agnostic
    If you want freed advertising in a newspaper, just write the article for the reporter and they will copy paste and put their name on it.?

    You’ve been reading Margaret Wente recently?

    @ orac and others

    As part of the deal, which comes after 14 years of negotiation, the province’s 144 naturopaths have agreed to a list of services they’re not authorized to provide.

    Mr. Horne said it’s the government’s priority to protect the public by regulating each profession, not pick sides.
    “We’re not here to endorse any particular philosophy or form of treatment,” Mr. Horne said, noting there are two dozen health professions, including acupuncture and massage therapy, with the same status.
    Mr. Horne balked, though, when asked whether the province would now consider funding treatment.
    “Well, not in the immediate term,” he said.

    It looks a lot like the Govt is trying to a least contain the critters. I believe naturapath was an uncontrolled namebefore so a) anyone could call themselves that and b) do anything.

    This way there seems to be some hope of controlling the worst excesses but the self-regulating is scary.

    I suppose some private insurance companies may fund treatment but I doubt it would be popular with them and clearly the main govt funder is not. So at a guess 70-80 percent or more of Alberta residents won’t have coverage.

  34. #34 jrkrideau
    July 26, 2012

    @ Orac
    re: @Dave Ruddell
    @Dave Ruddell
    It’s only a matter of time before they pay for naturopaths if they’re a licensed health care professional. That’s the next phase in the naturopaths’ political push

    Possibly but it’s not that easy to get onto the provincial plan.
    Massage thearapy, (RMT -which is licenced in Ontaro) has be licenced for twenty years here and while it may be on a private plan the major insurer is OHIP and it does not look like it’s anywhere near being funded.

  35. #35 Karl Withakay
    http://blog.cordialdeconstruction.com
    July 26, 2012

    “It looks a lot like the Govt is trying to a least contain the critters.”

    You don’t contain a dangerous incursion by letting it get a foot hold on the beach.

    So let’s say that 5 years down the road, the province’s Naturopaths argue that since they are legitimate, licensed & regulated medical professionals, they should be allowed to do some of those services they previously agreed they were not authorized to provide, especially any they were previously doing before the agreement.

    What’s more likely to happen, the government stands their ground and doesn’t budge an inch, the government rescinds the Naturopaths legal recognition as medical professionals, or another round of negotiation where the Naturopaths win additional concessions (such as the right to prescribe drugs) and are allowed to expand the scope of their practices?

    Keep in mind the people in charge in government at that time may not be the same people that are there today, and they may not understand the reason for recognition of naturopaths might have been for containment. They may think some of the limitations are absurd to impose on legally recognized, legitimate, trained medical professionals.

    A fence is of limited use if everyone doesn’t know why it’s there. I may think you put up that fence in the common grounds to keep me from walking within sight of your backyard on my shortcut to the lake, while you may have actually put it there because there is a series of uncover well holes that a person could fall in to.

  36. #36 Karl Withakay
    http://blog.cordialdeconstruction.com
    July 26, 2012

    Mr. Horne notes that acupuncture currently has the same status, to which I say:

    Just because you’re currently doing something stupid doesn’t mean that it’s a good idea to add an additional face palm to your resume.

  37. #37 Greengirl
    July 26, 2012

    Ok… Where is my comment ?

  38. #38 Militant Agnostic
    July 26, 2012

    @jkrideau

    You’ve been reading Margaret Wente recently?

    No, I don’t read the Grope and Fail – what has she been blathering about recently that has raised your ire.

  39. #39 Denice Walter
    July 26, 2012

    OT- but is anti-vaccinationist lunacy ever truly OT @ RI?

    Today @ AoA ( Anne Dachel’s post on BLF); Jake Crosby comments that:
    ” I think our best bet is to simply shelve the vaccination program and just regulate vaccines as we do all other drugs. Then leave the promotion of vaccines to the big, private, pharma-funded medical societies that are not funded by taxpayers’ money- AAP, AAFP and AMA”.

    Yes. He really wrote that.

  40. #40 Infuriatingly Moderate
    Hoping the Depo Medrol shot works for my cat
    July 26, 2012

    @Mrs Woo – I’m embarrassed to admit I just got around to digging through WA state insurance law. As a buyer of individual health insurance here it’s now more clear why even my crummy cheap catastrophic policy covers CAM providers (and the new policy I’m thinking of switching to includes naturopaths in the 3 annual “office visits” that waive the deductible).

    http://www.insurance.wa.gov/consumers/health/every-category-law.shtml

    Dug up a study on PubMed that I haven’t fully digested yet (and am not qualified to critique anyway), but my takeaway was that even if CAM reimbursements are only a tiny fraction of total claims, on a per-person/per claim basis it’s far cheaper than conventional care:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513668/?tool=pubmed

  41. #41 bad poet
    July 26, 2012

    The best use for many barn cats is in aerodynamic experiments to determine whether or not they always land on all four feet. After all, there are infinite numbers of them, thus they are disposable. Kind of like naturopaths, homeopaths, chiropractors, alt med enthusiasts, etc.

  42. #42 Mrs Woo
    tired of running back and forth checking on alarmed guinea fowl
    July 26, 2012

    @Infuriatingly Moderate – “one of the articles I looked at earlier today” when I remembered the death in Washington of a teenager from an asthma attack said that one argument by naturopaths that their type of practice is safer is their much lower malpractice insurance rates vs. traditional medical doctors.

    It is very likely that one of the reasons the office visits are cheaper are reduced insurance rates, reduced overhead (if they can’t afford a peak flow meter, they probably aren’t exactly bothering with a lot of things that would be considered common in a regular medical practice), etc.

    As someone who spent a few years uninsured, I can tell you that an uninsured patient that can afford payment is actually a significant savings to a medical practice vs. an insured patient because of the amount of time and staff needed to obtain the insurance reimbursements.

    The system here in the US is a real mess. I was very frustrated when they kept insurance companies in the loop for the universal coverage vs. allowing them to market extra coverage. There’s an immediate increase in cost just because you’ll have to support all the insurance companies and their management, etc. Granted, we would need to have people to process claims for the government, but I believe the savings would have been substantial. You can’t have someone in the middle making a profit over this and not have it cost more than a government system where they are paying the cost of processing and coverage only.

    What’s wrong with your cat?

  43. #43 Mrs Woo
    July 26, 2012

    @bad poet – I hope you are joking! Any cat is infinitely more valuable than a naturopath/chiropractor/alt med practitioner/etc. – ask one and it will tell you! ;-)

  44. #44 Denice Walter
    July 26, 2012

    Disclaimer:

    The dead cats to which I referred previously were a metaphor for *stocks*, not real cats.

  45. #45 Infuriatingly Moderate
    July 26, 2012

    Naturally I had a brain fade and neglected to dig through SBM – Kimball Atwood’s and Jann Bellamy’s posts on health care legislation already covered most of it, including the possible impact of the Affordable Care Act. D’oh!

    Maybe Bad Poet’s been reading too many Pharyngula Anti-Caturday posts. Pfft.

    Cat clinically diagnosed with eosinophilic granuloma – essentially an immune-mediated skin disorder. In her case recurring raised lesions on her belly. Blood tests all clear for systemic disease, so the steroid will hopefully give her some relief. Then we try and sort out if it’s an allergy or idiopathic – could be food, bugs, litter…. And the vet recommended postponing her vaccines too. HAH!

    I still swear, next time I get sick I’d rather go to the vet. At least they give itemized estimates.

  46. #46 Mrs Woo
    July 26, 2012

    @Infuriatingly Moderate – sorry she’s not feeling well. Glad she’s owns such a good human (I’m unfortunately owned by four cats). Hopefully things will be easy to sort out after this.

    Yes, veterinarians can be great. When it was the awareness month for my illness I posted a diagnostic image as my profile picture (my own). A vet immediately recognized it and was probably much kinder to me about it than any medical professional, except maybe my primary care doctor. I’ve also been very lucky – most vets in farm country don’t “do” chickens. The local vet here also trained in exotics, etc., and has been a real resource for me when I’ve had a few emergencies. Since vets aren’t common for chickens I do a lot of things myself as well, but a few things, like realizing more than 24 hours later a rooster had fought off a fox personally, wouldn’t have gone nearly as well without his help.

    Also fascinating how they can tell you usually how much it will cost without running up an itemized bill and get the ballpark within $20 bucks or so. ;-)

  47. #47 Ian King
    the Left Coast
    July 27, 2012

    Disappointed but not too surprised at the news in Alberta; there’s a strong libertarian current in the province. That doesn’t necessarily lead to the government paying for naturopath visits, though. Here in British Columbia, naturopaths have been licensed since the 1930s but haven’t had more than limited government coverage. For some years, BCers could get 12 visits a year partially paid but that was axed in 2001, along with massage, chiropractors and physio. This was more about cost savings than any scientific merit; the same government gave them prescribing powers eight years later! (groan)

  48. #48 nastylittlehorse
    Clinging, remora-like, to the underside of the planet
    July 27, 2012

    Can we hope that the Alberta thing is a step towards regulating them and allowing them to be sued for malpractice when (not if) the screw up?

  49. #49 Skeptigal
    July 27, 2012

    Does massage therapy help w/ disease management? Of course, who doesn’t feel better after a massage? How would one test for efficacy? It could conceivably be prescribed for almost any condition. That is the sticky wicket for massage as CAM. Employing the same logic would mean beer and weed are CAM for mental stress Plus, it would bankrupt the insurance industry. Dang.

  50. #50 jrkrideau
    July 27, 2012

    nastylittlehorse
    Can we hope that the Alberta thing is a step towards regulating them and allowing them to be sued for malpractice when (not if) the screw up?

    That would be kinda my guess. Unlicenced they can do anything and probably not have any comeback. Who is that guy selling bleach? Before the licencing law he could just claim to be a naturalpath with not problem. This way, at least advertizing gets a bit more difficult.

    I’d bet that this was one reason the bureaucrats may have gone along.

    With MPPs who knows what goes on in their (insert adjective here) minds.
    As something of a frightening aside, I was looking for some other kinds of information and tripped over this from Dr. Carries wiki site.:

    Dr Colin Carrie D.C., MP
    In November 2008, Carrie was appointed Parliamentary Secretary to the Minister of Health by Prime Minister Stephen Harper.[5]

    During the 40th Parliament Carrie resumed his membership on the House of Commons Standing Committee on Health

    Oh well, we’ve lost a Census but gained a chiropracter.

  51. #51 bad poet
    July 27, 2012

    In the jurassic era, my late father performed the aforementioned aerodynamic experiments. We all thought it was hilarious, especially since there was always a superfluity of barn cats on our uncles’ and other relatives’ farms. We never did it – it was much more fun to throw old, hard corn cobs at the pigs. When you hit one, it squealed, and the others fought over the cob. It’s lame, but there’s not a whole lot for a bunch of little city slickers to do i they’re not allowed to drive each other around on the little tractor.

  52. #52 Mrs Woo
    July 27, 2012

    @bad poet – it’s too bad – your rural relatives should have introduced you to the joy of “farm chores” during your visits. I’m sure that with a little ahead of time planning they could have had plenty of weeding, animal care, etc., ready for you to do. Then there’s always the lovely “mucking out” – barns, stalls, you name it. At least there’s also the farm pond for fishing and swimming….

  53. #53 THS
    A cool morning. Fog/mist on surroundung hills
    July 28, 2012

    “We are an academic center, so these are evidence-based therapies.”
    There are plenty of academic centers. English departments, etc. Evidence can subjective?

  54. #54 Denice Walter
    July 28, 2012

    THS spots the trend that has become sickeningly prevalent amongst the woo-meisters:
    they claim that their methods are evidence-based- they have research, they have data, ad nauseum. They will then trot out a long list of studies- many of which are not studies at all but testimonials or ad copy from another woo. They decorate their fictions in linguistic window-dressing by tossing in words like ‘academia’, ‘research fellow’ and ‘clinical trials’.

    Usually, this spiel is presented in tandem with accusations that what we call ‘research’: RCTs, peer review, journals, consensus et al is *compromised*: it is a product of pharma-funded research, ghost-written by industry reps; universities and their employees are bought and paid for ; journals do their advertisers’ will; media is owned by corporations with their own vested interests that determine content; governmental overseers are in similar straits- on the take. They demand “independent” research.

    Because they present these faery tales as exposes and as investigative reportage, the less suspicious audience members may take them at their word: they have prepared the ground by citing many past industrial, governmental and media scandals and errors- the audience then thinks they are getting early insight into a new one that hasn’t broken widely as news yet.

    The entire reality shambles is carefully constructed over time as audiences incrementally absorb the messages designed to create doubt about SBM and just about every other informational source that isn’t their own. And yes, at least two I survey are venturing into the news business: their services are no longer limited to health issues but any topic in the wide world is fair game.

  55. #55 Mrs Woo
    July 28, 2012

    @Denice – I’ve seen that since first developing any awareness of alternative medicine (mostly since Mr Woo). Do you think the same thing existed before the internet, or that it became a convenient and effective marketing tool once the internet was ubiquitous and people began looking to it (the internet) as a means of self-education?

  56. #56 bad poet
    July 28, 2012

    @Mrs Woo – Rock picking and manure gathering weren’t done in winter in Minnesota. Both were frozen solids under multiple inches of what used to be iced over snow. Maybe it’s just rainy up there now during that time period due to manmade global warming. All the uncles are dead and the other relatives sold off their farms. There’s no money in dairy, livestock, or crops unless your name is Cargill or Archer Daniels Midland.

  57. #57 Mrs Woo
    July 28, 2012

    @bad poet – my bad – I assumed it was summer. I think you still get some good snows up there.

    It is very hard to make a living in farming. Mr Woo’s family still does alright with cattle.

  58. #58 THS
    Nightfall; cool & clear again
    July 29, 2012

    Thanks, DW & I agree. Also I mean no disrespect to English Depts. where there still can be genuine, thoughtful scholarship. (Let us set aside post-modern claptrap crowd.) But “academic” can mean a lot of things. We see a lot of folks yearning to be addressed as “doctor”. We see plenty of grasping at will-o-wisps for meaning & significance. I’ve been there, in my own way.
    My earlier post was dashed off one-handed with a 4-yr old (calls me Grampa) on my lap, helping. High-energy healthy quirky kid leaves me thankful for his educated parents and careful health professionals. It’s been a creek-walking weekend. Fortunate, for now, in Western Oregon.

  59. #59 Skeptigal
    July 29, 2012

    CAM seems inevitable. A suggestion (tho’ not a new one I imagine): Media streaming/DVD websites allow the insertion of reason. One can rate titles that espouse quack therapies and psuedo-science. I try to be respectful and provide sources for information. It can be stomach churning to see all the high ratings, but every little bit helps.

  60. #60 Denice Walter
    July 29, 2012

    @ Mrs Woo:

    Dr Barrett has tales of the history of snake-oil salesmen @ Quackwatch ( see ” Toadstool Millionaires” etc). One of my profs taught us about how a popular magazine’s efforts led to the regulation of patent medicines. The internet has made things MUCH easier for these creatures.

    Here’s my own take:
    a few days ago, my tennis coach said something brilliant-
    ” We’re good at tennis because we’re *hunters*”. He’s absolutely right! Human beings are forever scoping out the opposition and trying to figure our how to make a killing.
    I would add that we’re also story-tellers who like to share our experiences around the campfire: winning friends and influencing people. Fortunately, I have devoted my own powers for good.

    Woo-meisters seek out vulnerable people through a finely- honed sales pitch ( the bait), casting out their nets for those dis-satisfied with medical services, without much education in life sciences, with a difficult to treat problem, wary of professionals and the establishment or merely frightened about death and illness. Then, they lure them in with unrealistic tales of cures while exhibiting their shared derision for the aforementioned *betes noires*.

    Like a predator, they seek out the weakest and easiest prey.
    A cancer patient, someone just diagnosed HIV+, a parent with a child who has an ASD or an SMI AND the worried well who simply fear illnesses that they might have seen family members suffer. Unlike a lion, when *they* stalk it is not based upon physical hunger that they or their pride suffers.

    The internet enables them to have wider coverage of possible targets- like a hunter riding in a helicopter rather than walking or driving. And like disreputable hunters they like to poach others’ territory. Rather than showing the heads of their quarry in their dens, they boast high sales figures/ book sales, high rankings on the ‘net / facebook and display luxurious estates ( all for your viewing pleasure) as they regale you with tales of victory.

    Be that as it may, even a hunter may be someone else’s
    quarry. Welcome to Orac’s Virtual Safari.

  61. #61 Mrs Woo
    July 29, 2012

    So – the internet and search engine optimization has made the more effective at finding their “targets,” so to speak. Yup…

    It absolutely drives me crazy. I see so many patients with my own illnesses (or the others that are comorbid with it – the more you get diagnosed with the more frantic you get, I think – I refuse to be bothered with other symptoms and chasing down their labels anymore at this point) who are desperately trying everything, discussing “everything” on message boards, etc. We are lucky to have two fairly science-based well known support websites. They do have areas that are labeled “alternative” and a lot of warnings on all forums, including science-based that no one should be dispensing medical advice, etc., etc. They also regularly debunk some of the sillier claims and warn patients away, thank goodness. I like that kind of advocacy!

    Still, I have watched patients find a “cure” and start it, then start websites about their journey and start web radio shows, etc., to share the good news of the cure…

    Usually it hasn’t even cured them yet – but they’re so hopeful and so sure they’re doing everything in their power to proselytize the whole patient population it isn’t funny.

    And that’s another thing – many of the patient anecdotes on a lot of this stuff is within the first few months – “hey it made me feel better and I’m letting you know.” Well, welcome to placebo effect… ~sigh~

  62. #62 Mrs Woo
    July 29, 2012

    That was terribly bad grammar at the end there.

    And that’s another thing – many patient anecdotes on a lot of this stuff are written within the first few months. “Hey, it made me feel better and I’m letting you know!” Well, welcome to the placebo effect…

    ~sigh~

    That’s better.

  63. #63 Daily Medical Examiner
    July 29, 2012

    Interesting article. I have nothing against non-traditional things (i.e. massage, acupuncture, even bunnies) that make people feel better as they deal with an illness. I think that much of the challenge with alternative therapies comes from trying to decide what we are willing to deem “medical” in nature. Attaching the word “medical” to a therapy implies a level of research and support which I’m afraid can’t yet be offered to may non-traditional treatments. (Unfortunately, “medical” support has long been thrown around for a few mainstream therapies that also don’t have that great a body of evidence…)
    -the Daily Medical Examiner

  64. #64 Jeff Rubinoff
    July 30, 2012

    @.Marion Delgado, 0727 at whatever hour
    Hey, no fair comparing homeopathy to D&D medicine. D&D spells all have material components!

  65. #65 Kathryn
    Valley of the Heart's Delight
    July 31, 2012

    Over on Science-Based Medicine, Harriet Hall wrote about a military hospital hiring acupuncturists, complete with a lengthy list of job duties that are incompatible with acupuncture.

    http://www.sciencebasedmedicine.org/index.php/therapy-or-injury-your-tax-dollars-at-work/

    I’ve used it as the basis of a petition to Congress here:

    http://www.change.org/petitions/the-u-s-senate-protect-our-troops-from-fake-medical-procedures

    It would be lovely if some of the Americans on this board could sign the petition.

    Thanks!

  66. #66 J. Goebz - Retired Air Force Captain
    Ohio
    August 3, 2012

    You conventional medicine people crack me up.
    Chinese homeopatic medicine has been around for centuries and it works.
    Not one single pill from big pharma states that it can cure you, and then you have the side affects of the pills.
    I take herbs, get massage and acupuncture, and it has cured me of my PTSD, anxiety, depression, and every other medical problem I have had since becoming a disabled veteran and I will never see a conventional doctor unless I need emergency surgery.
    If you want to know if natural cures work, ask those who choose the homeopathic treatment over pills.
    You can take those pills and their side effects and shove them way up your but.

  67. #67 herr doktor bimler
    August 3, 2012

    Chinese homeopatic medicine
    Thank you, that made my day.

  68. #68 lilady
    August 3, 2012

    @ Kathryn…I already signed that petition. Thanks.

    How does that Chinese homeopathic medicine work? How do you know which herbs you are ingesting?

  69. #69 Krebiozen
    August 3, 2012

    Captain Goebz,

    If you want to know if natural cures work, ask those who choose the homeopathic treatment over pills.

    I have asked many, and I have never come across anyone who has been cured by homeopathy of anything that doesn’t go away on its own eventually. I have also looked at numerous clinical trials of homeopathic treatment that overwhelmingly suggest that it doesn’t work any better than a placebo, which is not surprising as there is no plausible mechanism by which it could possibly work (water doesn’t have memory that persists for more than a few nanoseconds, and even if it did, how could it possibly transfer that to a sugar pill?).

    I hope I’m wrong but I suspect that sooner or later you will find yourself with a condition that doesn’t respond to alternative medicine, and you will then be grateful that there are medical treatments that have real effects (including, unfortunately, side-effects) as opposed to alternative treatments that mostly do nothing at all. It’s interesting that all the conditions you mentioned are psychological disorders that often respond well to placebos.

  70. #70 Cynical Pediatrician
    August 3, 2012

    “Not one single pill from big pharma states that it can cure you”
    –Allow me to introduce you to this novel class of pharmaceuticals called “antibiotics.”

    “You can take those pills and their side effects and shove them way up your but.”
    –Ah…I think the reason you feel prescription medicines don’t work is because you’re doing it wrong.

  71. #71 Darwy
    Røde grøde med fløde
    August 3, 2012

    Captain Goebz

    I know that math ability is required to be a member of the Air Force as I have a close friend who is a retired Lt. Colonel. The fact that you can profess to believe in homeopathy does you a disservice. It’s water. Perhaps with a bit of sugar or flavoring – but there is no medicine present.

  72. #72 Mu
    August 3, 2012

    Must be morbid curiosity, but when I saw someone with “retired air force captain” as moniker in the recent post list, I just had to click. I was expecting some right-wing christian lunatic like the one that used to haunt Ed Brandon’s blog, but “Chinese homeopathy” beats that for entertainment value.

  73. #73 Shay
    August 3, 2012

    And I’m wondering why would anyone brag that they had retired as an 03?

  74. #74 herr doktor bimler
    August 3, 2012

    but “Chinese homeopathy” beats that for entertainment value.
    Centuries-old Chinese homeopathy, remember!!
    If only the ex-captain could squeeze ‘Ayurvedic’ in there as well…

  75. #75 Scottynuke
    August 4, 2012

    *shaking-head-sadly-@-so-called-ex-Cpt.-as-I-reinstall-cookies-for-proper-blog-performance*

  76. #76 Militant Agnostic
    August 4, 2012

    @Herr Doktor Bimmler, Mu and others regarding Chinese homeopathy

    Han Ah Minh is a Chinese name isn’t it?

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