Respectful Insolence

It’s hard to believe that it’s been nearly two years since I first noticed that a board certification in quackery was in the works and appeared to be nearly ready to go. I’m referring, of course, to Andrew Weil’s effort to create a board certification in so-called “integrative medicine,” better known to those of us on the science-based side of medicine as integrating quackery and pseudoscience with real medicine. Since it’s been so long since I last addressed this issue, it’s probably worth a brief recap. Basically, back in 2011, Andrew Weil and his Arizona Center for Integrative Medicine (ACIM) at the University of Arizona announced that they were going to lead the creation of a formal specialty for medical doctors in integrative medicine. ACIM, founded by Andrew Weil, MD and directed by Victoria Maizes, MD, was in dialogue with the American Board of Physician Specialties (ABPS) toward establishing an American Board of Integrative Medicine in collaboration with the American Board of Integrative and Holistic Medicine (ABIHM). In that time, the plan has gone forward and over the last few months has come to fruition. Now there is indeed a board certification process for “integrative medicine,” and I can’t help but take a look at it.

As I noted at the time, the choice of the ABPS instead of the more established and respected American Board of Medical Specialties (ABMS) as the board responsible for certification in “integrative medicine” virtually guaranteed second-class status for this budding specialty because in most states the ABMS is the only board that matters for MDs. There is a board that certifies DOs, the American Osteopathic Association Bureau of Osteopathic Specialists, that also counts, but for purposes of this discussion, it’s the ABMS that rules. For instance, the board that certified me as a surgeon, the American Board of Surgery, is part of the ABMS. It’s the board that certifies surgeons in General Surgery, Vascular Surgery, Pediatric Surgery, Surgical Critical Care, Hand Surgery, and other surgical specialties. In addition, the ABMS certifies 23 other specialties, including Anesthesiology, Emergency Medicine, Internal Medicine, Pathology, Pediatrics, and many others. These boards set up minimum standards for knowledge and skills and devise tests and documentation necessary to be “certified.” Generally, board certification requires an MD or DO degree, completion of an accredited residency in the relevant specialty, and the passing of written and oral examinations. Some specialties require documentation of practice results.

Before I look at the examination process for integrative medicine, I can’t help but recap a brief video from the ABPS that describes its board certification:

As I pointed out at the time, take a look at the arguments. “Who’s got your back?” Fight against unfair “discrimination against deserving physicians.” The ABPS has a “big tent approach to medicine.” “You’re not a mere number” with ABPS. I don’t know about you, but I know that I don’t want a “big tent” approach to medicine. A “big tent” approach is a major reason why quackademic medicine has gotten as far as it has. Fortunately, relatively few hospitals recognize ABPS board certifications. And no wonder! take a look at the “integrative medicine” certification process. Take a look at the eligibility requirements to sit for the board examination in this “specialty.” Basically, all that’s required of applicants is that they be physicians in the US or Canada with an unrestricted license to practice, be board-certified in some specialty (and those specialties can be ABPS-boarded specialties); and then either:

a. Have completed an ABOIM approved Fellowship in Integrative Medicine OR

b. Have graduated from an accredited 4-year naturopathic college OR

c. Have graduated from an accredited National Certification Commission on Acupuncture and Oriental Medicine (NCCAOM) college OR

d. Have graduated from an accredited Council on Chiropractic Education (CCE) college OR

Oh, yes, there is more after the “OR” at the end of item “d.” I’ll get to that in a minute. First, let’s look at the fellowships in quackery “integrative medicine” quackery. It’s a depressing list to behold, and academic medical centers that really should know better have such pseudo-fellowships, including the Albert Einstein College of Medicine, Harvard, George Washington University, and The Ohio State University. Having gotten my M.D. from the University of Michigan, I can’t help but gloat a bit over that, at least until I remember that my alma mater is currently steeped in woo itself and offers its own quackery fellowship as well). Sadly, OSU and U. of M. are by no means alone.

However, apparently the outcry of “integrative medicine” practitioners who were unhappy with the thought of being locked out of a potentially lucrative certification that would elevate them over the run-of-the-mill naturopaths, acupuncturists, and homeopaths had an effect. At the time, I found it rather amusing, because the “integrative medicine” practitioners reacted pretty much the same way that many medical practitioners react to a proposed new specialty. They complained about being excluded. They wanted a mechanism whereby they could be somehow either grandfathered in or be eligible to take the test without having to take a whole new fellowship training program. (I still simultaneously chuckle and cry when I think about training programs incorporating homeopath and other quackery.) And apparently they got it, as this section of the ABPS eligibility requirements for integrative medicine shows:

Applicants submitting completed applications no later than December 1, 2016 may qualify under the following eligibility requirement (7e). This option is being offered for a limited time to allow current practitioners and leadership in integrative medicine to obtain Board Certification. As more fellowships and instruction in integrative medicine become available, this option will be phased out.

e. The board acknowledges that many MDs and DOs have become proficient in integrative medicine through extensive training from CME, self-study and clinical experience. The board will consider physicians with a minimum of 500 points of documented training and experience in integrative medicine subject areas, as demonstrated by alignment with domains listed in the exam description. See “Notes on the Limited Time Option” at the bottom of this page for more details on the documentation required.

  • For each year of clinical practice in Integrative Medicine, up to five years, 50 points will be awarded.
  • For active Diplomates of the American Board of Integrative Holistic Medicine (www.abihm.org) 200 points will be awarded. Active status is defined as having a current, unexpired certificate and will be confirmed using ABIHM’s online search.
  • For successful completion of category 1 AMA CME in Integrative Medicine, 1 point will be awarded for each documented hour of CME.
  • For successful completion of category 2 AMA CME in Integrative Medicine, 1 point will be awarded for each documented hour of CME (max 150 hours).

Hurry! This offer is only good until December 1, 2016! I expect that this scheme will be a boon to organizations offering CME in integrative medicine!

But what about the examination itself? Take a gander at this description. The examination is made up of nine sections:

  • Nutrition
  • Dietary supplements, botanicals and other natural products
  • Mind-body medicine and spirituality
  • Complementary and alternative therapies
  • Whole medical systems
  • Lifestyle, prevention, and health promotion
  • Integrative approaches (including conventional medicine)
  • Foundations of integrative medicine
  • Professional practice of integrative medicine

As I’ve said before, I’d love to get a copy of the exam, but that’s highly unlikely. Boards guard their examinations with a zealousness so great that even Edward Snowden probably wouldn’t have been able to get a copy if he had worked for the ABPS. In any case, it’s hard not to note that there’s a lot of quackery on this examination. We’re talking homeopathy, traditional Chinese medicine, Ayurveda, shamanism, “energy medicine” (reiki, therapeutic touch, and the like), and manipulative therapies (osteopathic, cranial-sacral, chiropractic, and the like). At this point, I have a hard time not making my usual observation about examinations like this, and that’s basically this: How on earth do you construct questions about such quackery that have answers that all the quacks can all more or less agree on? I’ve been involved in making examinations on science-based surgery. There are nuances, and the wording of a question can make an enormous difference in interpretation, and even in science-based questions it’s easy to be ambiguous. Now imagine questions about when to use homeopathy versus when to use acupuncture versus when to use Ayurveda. How do you choose one over the other? What is the evidence base? The answer, of course, is obvious: There is no evidence base. It’s basically whatever the practitioner wants to use. But how do you put that in an examination, and how on earth do you justify the answer? It’s hard enough to justify some answers when there’s science to do it, but in the case of an examination like this it’s a horrible conundrum. I almost feel sorry for the writers trying to put together multiple choice questions on this nonsense. I’m half tempted to try to write a few sample questions myself.

In the end, to me it’s quite obvious what the purpose of this certification is. It’s to provide legitimacy to pseudoscience and quackery. After all, if there’s a “board certification” in something, it must be legitimate, right?

Wrong.

Comments

  1. #1 Composer99
    https://composer99.blogspot.ca
    July 24, 2013

    Well, we have cargo cult science and cargo cult medicine: why not cargo cult board certification?

    The problem, as made plain in the closing remarks of the OP, is the undeserved legitimacy that such process will give to quacks, cranks, and charlatans.

  2. #2 Dangerous Bacon
    July 24, 2013

    It’s a double-edged sword though.

    Pseudoscience practitioners crave the respectability of titles and professional certification. But the more they drape themselves in Establishment trappings, the more they’ll be viewed with suspicion by their clients, who’ll smell a sellout.

    Outlaw status can buy you a very snazzy lifestyle. Just ask Joe Mercola.

  3. #3 Alison Cummins
    Montreal
    July 24, 2013

    Do you mean this, or do you mean that you don’t want it?

    “I don’t know about you, but I know that I want a “big tent” approach to medicine. A “big tent” approach is a major reason why quackademic medicine has gotten as far as it has.”

    I know that you despise nitpicking and apologize in advance if I fritz a circuit, but a missing “do not” changes the meaning completely.

  4. #4 Orac
    July 24, 2013

    I know that you despise nitpicking

    But you nitpick anyway.

  5. #5 Christine (the public servant Christine)
    July 24, 2013

    You’re right DB, the more they “sell out to The Man” the more they’ll lose their current client base.

    But the trouble is, there are a lot of people out there who see the titles and think, hey, doctor, must be trustworthy and know what they’re talking about. And this pool of people is A LOT bigger than the pool of die-hard natural only obsessives, hence much more profitable. Which is why the cranks are so desperate for the trappings.

    God I get cynical when the insomnia hits (it’s currently 23:10 where I’m sitting and I can’t get to sleep.)

  6. #6 Denice Walter
    July 24, 2013

    Dr Maizes was recently the guest of Gary Null. They seemed to ‘get along’ rather well. I’ll find the date.

  7. #7 Denice Walter
    July 24, 2013

    It was exactly a week ago. She appears a little past the half point IIRC so if anyone wants to hear her they won’t have to wade through the entire hour of malarkey.

  8. #8 JGC
    July 24, 2013

    Now imagine questions about when to use homeopathy versus when to use acupuncture versus when to use Ayurveda. How do you choose one over the other?

    That’s an easy one–you choose whichever one transfers the greatest amount of money from your mark’s wallet to your own.

  9. #9 Denice Walter
    July 24, 2013

    Because I aim to please ALWAYS:

    she appears at about 37 minutes in until 55 minutes**- it appears that she was in a debate with Dr Offit recently which can be found at npr :
    transcript “Is Alternative Medicine Really ‘Medicine;?” – hosted by Ira Flatow see npr.org> Science Fridays for July 05, 2013. There must also be a tape somewhere.

    ** when the over-the- air station signs off : the rest of his rants are only for his private PRN listeners.

  10. #10 Krebiozen
    July 24, 2013

    I find these developments horrible and fascinating in equal measure. Just where is this going? Will we see an increase in poor outcomes among clinicians who take an integrative approach? Or will it consist of good quality care with a sprinkling of unicorn droppings on top, in which case the die-hard woo supporters will be unhappy. Either way, I will be interested to see where those who support this dysfunctional cocktail take it.

  11. #11 Shay
    July 24, 2013

    Just what medical care in this country (the US) needs; board-certified quacks.

    (I’m waiting for one of their defenders to show up here and point out that natural cures are so much cheaper than science-based medicine).

  12. #12 lilady
    July 24, 2013

    “The ABPS offers the only Board certification in Disaster Medicine”…

    Like this?

    http://www.youtube.com/watch?v=WIFVeAttaC8

  13. #13 WLU
    July 24, 2013

    Does “Whole medical systems” mean anything, is it code for German New Medicine or something?

    Because I see that and think “wouldn’t that just be biology”?

  14. #14 jane
    July 24, 2013

    Shay – Yep, modalities that are not under the total control of a Learned Intermediary very often are cheaper. It so happens I have found an allopath who (perhaps because she is foreign-born) does not spew in rage or tell me how defective I must be if she hears that I would rather use elderberry than Tamiflu. But finding her took some doing. As a consumer, I would like to able to look up a list of MDs who have been educated regarding the science that supports some traditional medicine.

  15. #15 Shay
    July 24, 2013

    Except that there is no science supporting traditional medicine. If there is, then it’s science-based medicine.

    And you are defective if you’d rather use elderberries than Tamiflu for anything but a pie.

  16. #16 Eric Lund
    July 24, 2013

    Does “Whole medical systems” mean anything

    Yes. It’s a key phrase which tells people who prefer SBM to run, not walk, to another provider. Woo-providers have generally co-opted the concept of holistic medicine, such that any science-based uses of the term have been drowned out in woo-noise.

    Of the nine sections on the proposed board exam, I’d say at least seven are guaranteed to have (if not be dominated by) some form of woo, and the other two (Nutrition and Lifestyle) have at least a 90% chance of being woo-infested. It’s possible to do nutrition and lifestyle within an SBM framework, but again, the ratio of SBM signal to woo-noise is distressingly low. “Whole medical systems” and the other six sections involve words or phrases which are reliable woo signifiers.

  17. #17 Eric Lund
    July 24, 2013

    how defective I must be if she hears that I would rather use elderberry than Tamiflu

    I’m trying very hard to resist the temptation to use a certain Monty Python quote in response.

  18. #18 palindrom
    July 24, 2013

    Eric @17 — Great minds run in the same path.

  19. #19 Calli Arcale
    July 24, 2013

    Shay,
    Well, Tamiflu only works if taken quite early in the disease (which unfortunately makes it a problem because most people prefer not to bother their doctor until it’s clearly not just a run-of-the-mill cold), and it does have some rather freaky side effects. Personally, I might actually decline Tamiflu myself, depending on the situation, although if I took elderberries at the same time, it would be likely in fermented form and, ah, not precisely medicinal. ;-)

    As far as board certification in quackery, oh lord. Moliere’s “La malade imaginaire” once again. I have difficulty believing their certification process will be any better than that depicted in Moliere’s last farce.

  20. #20 JGC
    July 24, 2013

    Yep, modalities [for which there is no actual evidence of efficacy] very often are cheaper.

    FTFY.

  21. #21 JGC
    July 24, 2013

    As a consumer, I would like to able to look up a list of MDs who have been educated regarding the science that supports some traditional medicine.

    But if there’s scientific evidence supporting efficacy it isn’t ‘traditional’ or alternative medicine–it’s just medicine.

  22. #22 Shay
    July 24, 2013

    Calli — I grant you elderberries would probably be as effective as Tamiflu in such an instance.

    Eric, I wasn’t going to bring that up.

  23. #23 Chris Hickie
    July 24, 2013

    I’m trying very hard to resist the temptation to use a certain Monty Python quote in response.

    Now I know why my father smelt like that in the pre-oseltamivir days…

  24. #24 Chris Hickie
    July 24, 2013

    Can’t wait to see what the MOC requirements would be for this “specialization” such as modules in:

    1. acupuncture and its relationship to pneumothoraces
    2. touch therapy and IM-acquired MRSA
    3. self-hypnosis so you can do quackery like a duck when you snap your fingers

  25. #25 Rich Woods
    July 24, 2013

    @Chris #24:

    Don’t be so daft. All that is just bolloc..*snap*…QUACK!

  26. #26 Derek
    July 24, 2013

    Forget the fellowship and “grandfathering”, just look at (b) through (d) – would you want to deal with a physician whose claim to fame is that he/she had also graduated from naturopathy/acupuncture/chiropractic school? I’ll take my non-integrative physicians anytime.

  27. #27 JKW
    Danville, Tri-state area
    July 24, 2013

    If you dilute pseudoscience with enough real medicine the magic only gets stronger.

  28. #28 Christine (the public servant Christine)
    July 24, 2013

    @Eric Lund: I took a quick peek at the Nutrition section, and here’s what they say the exam will cover:
    Nutrition
    Macro/Micro nutrients (including nutrient deficiencies)
    Therapeutic Diets (e.g. Gluten-free, Mediterranean)
    Elimination Diets
    Social/Cultural Influence on Diet
    Environmental Factors (e.g. pesticides, mercury, local and/or organic sourcing)
    Functional Foods

    OK, so they mention nutrient deficiencies; but there is nothing in that list that says anything about food chemistry, nor is there anything about altermative delivery methods (such as intravenous feeding). In Australia, to be an accredited Dietitian you have to have knowledge of both these things.

    And seeing as they mention “nutrient deficiency” in terms of micro/macro diets (this screams “macrobiotics” to me) and class a GF diet as a “theraputic diet” along with a “Mediterranean diet” my suspicion is their “Nutrition” competency is more along the lines of superfoods and superdiets rather than properly medically managing patient nutrition.

  29. #29 Shay
    July 24, 2013

    Derek@26:

    One of the things I regret about no longer being on active duty is that I’ll never have the opportunity to tell someone who offers me battlefield acupuncture to put it where the sun don’t shine.

  30. #30 Andy
    July 24, 2013

    I would have thought any answer would be the right answer so long as it’s written with a positive frame of mind.

  31. #31 Khani
    July 24, 2013

    #27 Only if you shake it first, JKW. Don’t forget that step, it’s very important!

  32. #32 Pareidolius
    July 25, 2013

    She doesn’t spew rage because she’s polite. She tolerates the worried well because it’s very good for her wallet. Waiting for the flounce . . .

  33. #33 prn
    July 25, 2013

    Of course it’s more of a mutual defense league rather than a defined, -able specialization. I would rather the individuals define themselves in ways that identify their school of training or treatment philosophy and areas of focus rather than hide in the big tent.

    @28…micro/macro diets (this screams “macrobiotics” to me
    Macronutrients are fats, carbs and proteins or their elemental components, not some 60s derived “macrobiotic” diet. A lot of alternative nutrition involves discarding injurious foods tolerated by conventional doctors and dietitians like the current glycemic carb loads, unhealthy fats and various additives.

    I will say this again. Patients typically turn to CAM after repeatedly striking out with “regular medicine” and a lot of it concerns nutrition and digestion. I’ve seen both doctor and dietitian strikeout on missing simple digestive problems, one shoveling Reglan, the other more carbs on top of blood sugar over 130.

    No telling how much damage the AMA could do to chiropractors on muscle and bones pains with bottles of 2000-5000 iu vitamin D caps and other nutrients.

  34. #34 Narad
    July 26, 2013

    “This examination is based on the Principals of Integrative Medicine”

    Nice to see that they really hoked up the operation. Seriously, who edited this mess?

  35. #35 Dr. Nancy Malik
    Gurgaon, India
    July 26, 2013

    Evidence in support of homeopathy is published in 111 Homeopathy Journals such as Homeopathy (Elsevier), Homoeopathic Links, etc, 13 CAM Journals such as Alternative Medicine Review, Alternative Therapies in Health and Medicine, etc and surprisingly 95 integrative journals such as lancet, BMJ, Nature, Paediatrics, etc.

    Hospitals in India to integrate homeopathy,ayurveda & naturopathy for diabetes, hypertension, obesity, HIV, cancer and infertility.
    http://timesofindia.indiatimes.com/city/bangalore/Karnataka-govt-to-start-integrated-medicine-and-music-therapy-in-hospitals/articleshow/15104439.cms

  36. #36 Dr. Nancy Malik
    Gurgaon, India
    July 26, 2013

    Evidence in support of homeopathy is published in 11 Homeopathy Journals such as Homeopathy (Elsevier), Homoeopathic Links, etc, 13 CAM Journals such as Alternative Medicine Review, Alternative Therapies in Health and Medicine, etc and surprisingly 95 integrative journals such as lancet, BMJ, Nature, Paediatrics, etc.

    Hospitals in India to integrate homeopathy,ayurveda & naturopathy for diabetes, hypertension, obesity, HIV, cancer and infertility.
    http://timesofindia.indiatimes.com/city/bangalore/Karnataka-govt-to-start-integrated-medicine-and-music-therapy-in-hospitals/articleshow/15104439.cms

  37. #37 Todd W.
    http://www.harpocratesspeaks.com
    July 26, 2013

    @Nancy Malik

    Again, I’ll ask, what methods can you use to distinguish a normal vial of water from a homeopathic preparation? Or a lactose pill from a homeopathic pill? Inquiring minds want to know.

  38. #38 Krebiozen
    July 26, 2013

    prn,
    I really don’t mean to pick on you. I would respond to such sweeping statements without a jot of evidence to support them, whoever made them.

    A lot of alternative nutrition involves discarding injurious foods tolerated by conventional doctors and dietitians like the current glycemic carb loads, unhealthy fats and various additives.

    Examples? Evidence? Which conventional doctors and dietitians suggest “glycemic carb loads, unhealthy fats and various additives”? My doctor tells me to keep my weight down, eat plenty of fruits and vegetables and take moderate exercise, all of which I do.

    Which fats and additives do conventional doctors and dietitians “tolerate” that you consider are unhealthy? What evidence do you have for this?

    You would gain a lot more credibility here if you supported your claims with some citations.

    I will say this again. Patients typically turn to CAM after repeatedly striking out with “regular medicine” and a lot of it concerns nutrition and digestion.

    Even if that is true, that isn’t evidence that CAM is any better at treating digestive problems, or anything else, than “regular medicine”. I’m sure that a large amount of the nutritional advice given by CAM proponents is nonsense, particularly in the arena of raw foods and juices, none of them seem to agree with each other about much, and some of their recommended diets can be dangerous.

    I’ve seen both doctor and dietitian strikeout on missing simple digestive problems, one shoveling Reglan, the other more carbs on top of blood sugar over 130.

    Some doctors are lousy, I know, but I don’t understand what you mean, unless you are accepting CAMsters nonsense about intestinal candidiasis or colonic dysbiosis that they claim is exacerbated by carbohydrates which are in fact absorbed in the duodenum and never reach the colon, and which they treat using prebiotics like inulin which do get to the the colon undigested and do feed microbes there.

    What simple digestive problems are you suggesting are made worse by carbohydrates? What evidence is there for low carbohydrates having a beneficial effect on any digestive disorders? Why would a doctor be concerned about a normal blood glucose? Why would even a modestly elevated glucose indicate a digestive disorder?

    The evidence for risks and benefits of low carbohydrate diets is far from clear.

    Digestive disorders very often have a large emotional/psychological component and are extremely susceptible to suggestion and placebo-type effects. Fertile ground for woo.

    No telling how much damage the AMA could do to chiropractors on muscle and bones pains with bottles of 2000-5000 iu vitamin D caps and other nutrients.

    Do you have any evidence for efficacy of vitamin D on muscle and bone pains except in patients with osteomalacia due to vitamin D deficiency? Cochrane reports they found 4 studies on vitamin D and chronic pain and:

    Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain.

  39. #39 JGC
    July 26, 2013

    Evidence in support of homeopathy is published in 111 Homeopathy Journals such as Homeopathy (Elsevier), Homoeopathic Links, etc, 13 CAM Journals such as Alternative Medicine Review, Alternative Therapies in Health and Medicine, etc and surprisingly 95 integrative journals such as lancet, BMJ, Nature, Paediatrics, etc.

    Can you provide actual citations to well designed, appropriately blinded studies demonstrating homeopathy effective at treating non-self-limiting illnesses or injuries?

    You must realize you aren’t making a case for homeopathy’s efficacy by asserting “There’s evidence out there–go find it yourself”

  40. #40 JGC
    July 26, 2013

    Evidence in support of homeopathy is published in 111 Homeopathy Journals such as Homeopathy (Elsevier), Homoeopathic Links, etc, 13 CAM Journals such as Alternative Medicine Review, Alternative Therapies in Health and Medicine, etc and surprisingly 95 integrative journals such as lancet, BMJ, Nature, Paediatrics, etc.

    Can you provide actual citations to well designed, appropriately blinded studies demonstrating homeopathy effective at treating non-self-limiting illnesses or injuries?

    You must realize you aren’t making a case for homeopathy’s efficacy by asserting “There’s evidence out there–go find it yourself”

  41. #41 JGC
    July 26, 2013

    sorry for the double post…

  42. #42 Politicalguineapig
    July 26, 2013

    Calli: Personally, I might actually decline Tamiflu myself, depending on the situation, although if I took elderberries at the same time, it would be likely in fermented form and, ah, not precisely medicinal.

    In 1918, there was a doctor in Italy who prescribed alcohol for all of his patients. Almost all his patients lived, so he must’ve been on to something.

  43. #43 Denice Walter
    July 26, 2013

    prn repeats what I often hear from alt media:
    SBM knows nothing about nutrition, standard dietary requirements are all wrong, dieticians are un-informed, the government supports this travesty etc.

    Because they scoff at pharmaceuticals and must, at heart, believe in life energy or an arcane force which can be encouraged as well as the mysterious healing powers of the plant world, they can ONLY offer these solutions. What else is there? The bounty of Nature or the twisted and perverted products of science.

    By chance, I just re-read some material from the Weston Price Foundation and seriously, it is rather incredible. Take a look: a blue print for woo-meistery.

  44. #44 Alain
    July 26, 2013

    SBM knows nothing about nutrition, standard dietary requirements are all wrong, dieticians are un-informed, the government supports this travesty etc.

    I wonder what that makes out of my primary care doctor because, doctors are required by law here to provide Science Based Medicine and she does tell me to eat well, exercises and take measure of my weight and general health condition. Does that make her an outlaw?

    Alain

  45. #45 Alain
    July 26, 2013

    Correction: and take == and she take…

    Alain

  46. #46 Krebiozen
    July 26, 2013

    If you wade through the tons of literature you find that within the realms of ‘normality’ bounded by deficiency at one extreme and obesity at the other, there is little unequivocal evidence for any large effects of either including or avoiding any specific foods or food groups, apart from trans and saturated fats, and some people even argue about these.

    I’m with Michael Pollan and his much-quoted maxim: “Eat food, not too much, mostly plants.” I think it was Ben Goldacre who suggested that most nutritional advice that goes beyond this is hyperbole.

  47. #47 Alain
    July 26, 2013

    @ Krebiozen,

    That does tell much the difference between SBM’s telling the facts in less than 5 minutes and woo’s telling an hour long story to say potentially harmful advices in certain cases.

    Alain

  48. #48 Dr. Nancy Malik
    Gurgaon, India
    July 27, 2013

    @Todd #37

    5 techniques to distinguish homeopathic medicine from the solvent/control

    1. Bio-Electro-graphy: Dynamic Electrophotonic Capture: Gas Discharge Visualisation (2003)
    Gas Discharge Visualization Evaluation of Ultramolecular Doses of Homeopathic Medicines (2003)

    2. Fourier Transform Infra Red spectroscopy (2005)
    Variation in Fourier transform infrared spectra of homeopathic potencies (2005)

    3. High Voltage Plasma (2008)
    Distinguishing Natrum Mur 30 from water by High voltage plasma (2008) // electrical impedance of Natrum Mur 30 c differ from water

    4. Transmission Electron Microscopy (2010)
    Presence of nanoparticles in homeopathic medicines as detected by TEM while there won’t be any nanoparticles detected in solvent/control bcoz its a placebo

    5. Ultra-Violet Spectroscopy (2011)
    Cuprum Sulphuricum 11-30c differs from placebo (2011)

  49. #49 Grant
    http://sciblogs.co.nz/code-for-life/
    July 27, 2013

    Nancy Malik,

    To repeat from an earlier thread:

    Why present yourself as if you have a medical degree when, as best as I understand, your highest qualification is not be recognised as a medical degree in most parts of the world?

    A BHMS (Bachelor of Homoeopathic Medicine and Surgery) may well be recognised in India, but it is not recognised in most countries — with good reason. If you must credential yourself (best not to really, but…), refer to yourself as ‘Nancy Malik, BHMS’.

    (I believe you should also correct your LinkedIn profile. I’d like to think that they take implication of credentials that person doesn’t have seriously.)

  50. #50 Lawrence
    July 27, 2013

    Great, another thing to worry about, but might explain the “roid-rage” by some of the quacks out there:

    http://www.cnn.com/2013/07/27/health/fda-steroid-warning/index.html?hpt=hp_t2

  51. #51 Krebiozen
    July 27, 2013

    Nancy Malik,
    If you can reliably distinguish a 30C belladonna pill from a 30C common salt pill (or “Natrum Mur” as I believe you homeopaths prefer to call it, which must be amusing at the dinner table), or any other remedies at true homeopathic dilutions (i.e. 1 mole diluted more than 1 in Avogadro’s number), whether by using chemical means or by giving them to people, you could win the Randi million dollars.

  52. #52 Krebiozen
    July 27, 2013

    Lawrence,
    That’s terrible. It’s absolutely unacceptable that products for human consumption can be contaminated like this, it is the sort of story I expect to hear about China, not the USA (no bigotry intended). Mistakes can always be made, but it boggles my mind that there clearly aren’t effective quality assurance schemes in place that will pick them up to pick them up.

  53. #53 Dr. Nancy Malik
    Gurgaon, India
    July 27, 2013

    @Krebiozen #51

    4 techniques for Identification of homeopathic medicines

    A. Spectroscopy
    1. Raman Laser Spectroscopy (1976)
    2. New Magnetic Resonance method by K. Lenger (2006)
    3. Ultra-Violet–Visible spectroscopy (2007)
    4. Nuclear Magnetic Resonance spectroscopy (2008)
    5. Electromagnetic Signatures (2009)

    B. Thermo-luminescence (2003)
    C. Dielectric Dispersion (2010)
    D. Physiological variability in human body (2008)

  54. #54 Chris,
    July 27, 2013

    (not a doctor) Nancy Malik, I sincerely doubt you even know what a Fourier Transform does.

    If you do please tell me, with references, the primary frequency of 30C Nat Mur versus 30C Vomica, both in a lactose base. You might also point us to graphs of the power spectral density for both of them.

    Because if you can do a spectral density measurement on two different bottles of homeopathic pills and tell the difference with consistency… you can claim a million dollars from the James Randi Education Foundation.

  55. #55 palindrom
    July 27, 2013

    Reading Dr. Malik’s stuff about how various high-tech tests have supposedly seen a difference between homepathic preparations and others reminds me of how easy it is to fool youself using high-tech equipment without a clear understanding of the physical principals involved, and without adequate controls. This may be relevant:

    http://blogs.scientificamerican.com/scicurious-brain/2012/09/25/ignobel-prize-in-neuroscience-the-dead-salmon-study/

  56. #56 Grant
    July 27, 2013

    Nancy,

    Why are you avoiding the question? You are misrepresenting your qualifications. You have neither a medical degree recognised by other nations nor a Ph.D.

    You haven’t actually given citations, preventing anyone from checking if what you’re offered is even relevant, let alone not just junk. As such, you’ve offered nothing more than hand-waving.

    palindrom,

    Without proper controls pretty much any recordings involving small fractions is pretty much a waste of time.

  57. #57 Alain
    July 28, 2013

    Tonight’s a slow night so I took the occasion to update the blog:

    http://www.securivm.ca/2013/07/pubmed-tetrahydroisoquinolines-and.html

    small part of it was written yesterday and most of it, tonight.

    Alain

  58. #58 Alain
    July 28, 2013

    Nancy Malik,

    What you post here is laughable and even underwhelming. Can you do better?

    Alain

  59. #59 Narad
    July 28, 2013

    You haven’t actually given citations, preventing anyone from checking if what you’re offered is even relevant, let alone not just junk.

    She at least tipped the Lenger one. It’s the “magnetic photons” classic.

  60. #60 Dr. Nancy Malik
    Gurgaon, India
    July 28, 2013

    @Chris #54

    Variation in Fourier transform infrared spectra of homeopathic potencies (2005)
    http://www.homeopathy.org/wp-content/uploads/downloads/2012/05/acm-2005-11_11.pdf
    FTIR spectra of Nux Vomica 30c, Lycopodium 30c, Santonin 30c, Cina 30c distinguishes from solvent, sugar globule soaked in homeopathic medicine retains its specific spectral absorption properties

  61. #61 Dr. Nancy Malik
    Gurgaon, India
    July 28, 2013

    @grant #56

    citations in support as requested by you

    New Magnetic Resonance method by K. Lenger (2006)
    http://hpathy.com/scientific-research/homeopathic-potencies-identified-by-a-new-magnetic-resonance-method-homeopathy-an-energetic-medicine/

    Nuclear Magnetic Resonance spectroscopy
    http://www.homeopathyeurope.org/media/news/Demangeat_JML_2009.pdf/at_download/file

    Electromagnetic Signatures (2009)
    http://www.homeopathyeurope.org/media/news/MontagnierElectromadneticSignals.pdf

    If you wish I can provide citations for each and every method.

  62. #62 Narad
    July 28, 2013

    citations in support as requested by you

    New Magnetic Resonance method by K. Lenger (2006)

    Nancy, if magnetic photons existed, they wouldn’t couple to electrons. Get back to me when you figure out why this is a problem for this paper.

  63. #63 Krebiozen
    July 28, 2013

    Nancy Malik,
    With regard to reading the paper about Fournier IR absorption spectroscopy you refer to, I don’t believe you can tell truly homeopathic remedies apart using these methods. I would like to see some independent confirmation of these results, with hard evidence that it is possible to consistently and replicably produce the same results. The IR spectra look suspiciously like noise to me, and there is no discussion of how much variability was observed between the 5 pellets produced for each control and for the dliluted remedies. The speculation that, “Because all KBr pellets were prepared under similar conditions, it is quite unlikely that they have different amounts of water in them” is not acceptable. They should have designed the experiment to unequivocally demonstrate that. I’m not familiar with the Fourier IR spectrometer used, but I do know that insufficient purging of the chamber can lead to erroneous and/or noisy results.

    By the way, you wrote, “sugar globule soaked in homeopathic medicine retains its specific spectral absorption properties”, but in fact potassium bromide pellets were used, for reasons that are not clear, just a statement that they, “simulate sucrose globules soaked with a potency”. Presumably this is because KBr is transparent to IR and lactose is not, but they should really state this.

  64. #64 Chris,
    July 28, 2013

    Ms. Malik, I asked for the primary frequency. I did not see any, just noise. The primary wave numbers do not vary enough to definitively separate the samples. It looks just like variation due to contaminates.

  65. #65 prn
    K@38, My kind of nutritionist....
    July 30, 2013

    Richard K Bernstein is an incisive systems thinker that has wielded n=1 answers to surpass 99+% of type 1 diabetics for longevity and scaled up to change and challenge how diabetes can be cared for. His digestive disfunction analysis point in his book, Dr Bernstein’s Diabetes Solution, gastroparesis and carb levels.

    Of course he was just a middle aged chemical engineer, slighted and ignored by doctors, dietitians, and ADA, so he enrolled in medical school at Albert Einstein near its peak… He’s eating their lunch on results…

    K: Which fats and additives do conventional doctors and dietitians “tolerate” that you consider are unhealthy? What evidence do you have for this?
    Let’s not rewrite my quote so much. I said … current glycemic carb loads, unhealthy fats
    … current glycemic carb loads See RK Bernstein’s “Diabetes Solution”. It considers carb loads at length that affect current and future type II’s similar to many CAM advisories. “dietitians”
    unhealthy fats CAM often selects certain fats as desirable but rejects others contrary to conventional wisdom or tolerance. Bernstein specifically prefers coconut oil and rejects Olestra. Olestra is FDA approved. At this point doctors and dietiticians have conceded (several years ago) on trans fats, about 15 yrs later than CAM nutritionists became alarmed.

    .additives FDA approved, medical/dietitian tolerated: bromine compounds, aspartame, propyl gallate, foods with nitrate

    I will say this again. Patients typically turn to CAM after repeatedly striking out with “regular medicine” and a lot of it concerns nutrition and digestion.

    K: What simple digestive problems are you suggesting are made worse by carbohydrates?
    gastroparesis would be one see RK Bernstein’s book “Diabetes Solution”
    prn: I’ve seen both doctor and dietitian strikeout on missing simple digestive problems, one shoveling Reglan, the other more carbs on top of blood sugar over 130.
    K: ….but I don’t understand what you mean…
    In the US, blood glucose units are mg/dl with a fasting b.g. of 126 representing diabetic levels. A dietitian piling carbs up on untreated hyperglycemia may be exacerbating b.g. issues and gastroparesis, among others.

  66. #66 Whyaskmeifyouknoweverything
    U.S.
    August 9, 2013

    You probably don’t believe in God either?

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