Respectful Insolence

While I’ve been all tied up paying attention to the developments in the Stanislaw Burzynski case, it figures that President Obama would go and do something like nominating the next Surgeon General. Normally, this is not such a big deal, because there really hasn’t been a Surgeon General who has really been particularly well-known or had much of an impact since Dr. C. Everett Koop, although back when President Obama first took office Dr. Sanjay Gupta’s name was floated as a possibility for the position. Obviously, he didn’t get it. (I’m guessing that being a neurosurgeon and CNN’s chief medical correspondent probably pays much better than being surgeon general.) To be honest, I didn’t even know that the Surgeon General had stepped down, but apparently she did in July.

Yesterday, we learned whom President Obama nominated to be her successor, Dr. Vivek Murthy, a faculty member at the Harvard Medical School:

President Obama will nominate Dr. Vivek Murthy of Harvard Medical School and Brigham and Women’s Hospital as surgeon general of the United States, the White House announced Thursday night.

Murthy is a hospitalist at the Brigham and is co-founder and president of Doctors for America, a Washington, D.C.-based group of 16,000 physicians and medical students that advocates for access to affordable, high quality health care and has been a strong supporter of the Affordable Care Act.

If he’s confirmed by the Senate, Murthy would replace acting surgeon general Boris Lushniak. The surgeon general serves a four-year term and the post is essentially a bully pulpit to speak out on public health issues.


The official White House biography of Dr. Murthy reads:

Dr. Vivek Hallegere Murthy is the Co-Founder and President of Doctors for America, a position he has held since 2009. Dr. Murthy is also a Hospitalist Attending Physician and Instructor in Medicine at Brigham and Women’s Hospital at Harvard Medical School, a position he has held since 2006. In 2011, Dr. Murthy was appointed to serve as a Member of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. Dr. Murthy has been the Co-Founder and Chairman of the Board of TrialNetworks, formerly known as Epernicus, since 2007. Dr. Murthy co-founded VISIONS Worldwide in 1995, a non-profit organization focused on HIV/AIDS education in India and the United States, where he served as President from 1995 to 2000 and Chairman of the Board from 2000 to 2003. Dr. Murthy received a B.A. from Harvard University, an M.B.A. from Yale School of Management, and an M.D. from Yale School of Medicine.

So far, at least on the surface, there doesn’t appear to be anything particularly alarming about Dr. Murthy. He’s very accomplished for his age, which is only 36. The group he leads, Doctors for America, seems to have fairly conventional moderate-to-left views and has lobbied for Medicaid expansion, to protect Medicare, and to support the Affordable Care Act. In general, it supports expanding access to health care coverage to the entire population. Of course, no one would expect President Obama to nominate a doctor for Surgeon General who doesn’t support the ACA, and, since it’s the law of the land now, one would expect the Surgeon General to support it.

Although opponents of the ACA might not like Dr. Murthy’s staunch advocacy for the ACA, that’s not a problem for me. If anything, it’s a point in his favor. What worries me about Dr. Murthy is his connection to so-called “complementary and alternative medicine” (CAM), otherwise known these days as “integrative medicine.” My skeptical antennae started twitching when I saw that Dr. Murthy has been serving on the U.S. Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health since 2011, along with Dr. Dean Ornish. (Come to think of it, it’s disturbing that President Obama would have appointed Ornish to such a committee.) Also on the council is Janet R. Kahn, PhD, who is described as a having been a “Faculty Preceptor in the Fellowship Program in Complementary, Alternative, and General Medicine at Harvard Medical School” since 2000 and having served on the National Advisory Council for Complementary and Alternative Medicine at the National Institutes of Health since 2009. You know who also serves on that particular advisory council? Brian Berman. There’s also an acupuncturist, Charlotte Kerr, on the U.S. Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health.

OK, OK, none of this proves anything about whether or not Dr. Murthy has far too much credulity towards quackademic medicine. After all, there are also perfectly respectable science-based health care practitioners on that council, although it is truly disquieting to see an acupuncturist there, even more so than the fact that Dean Ornish is there. Ornish, after all, has managed to make himself seem scientific to the point where he many physicians don’t realize how far down the row of woo he has traveled. In contrast, there’s no excuse for an acupuncturist to be on a President’s health care council—any President. Annoyingly, the advisory council has issued reports that cite the problematic section 2706 of the ACA that mandates nondiscrimination of health plans to urge consistency between state and federal law. Translation: The council wants the ACA to be interpreted to guarantee that any quacks that states license (like chiropractors and naturopaths) count as valid health care providers whose services should be reimbursed by insurance companies selling policies through the government exchange. Meanwhile, the 2011 National Prevention Strategy, which Dr. Murthy contributed to, emphasizes “evidence-based” CAM, an oxymoron if ever there was one.

More concerning is what Dr. Murthy said in this article, published in Harvard Magazine in 2003:

Murthy’s combined expertise in medicine and business (and he still might pursue an advanced degree in public health) makes him well qualified to follow through with one of his dreams: to develop a system that provides proven, affordable, integrated (traditional and alternative) healthcare in a standardized fashion.

His interest in alternative medicine stems from his own cultural background—both his parents emigrated from India. Although he grew up in Miami, Murthy’s frequent visits to his parents’ homeland allowed him to witness that country’s ancient art of healing, Ayurveda (Sanskrit for “the science of life”). “I have tried various alternative medical therapies myself,” he reports, “and I have found that many alternative modalities are based in principles that make sense, and seem to frequently be effective with patients.” Research in recent years has made important strides in investigating alternative medicine in the United States, Murthy says, but much more needs to be done, and he would like to be a part of that process.

Oh, dear. “Based on principles that make sense?” That’s the sort of thing no physician whose practice is science-based should ever utter about Ayurveda or other “alternative medicine.” He also seems to have been prone to the same sorts of deficits in reasoning that lead all too many people to confuse correlation with causation or placebo effects for real effects.

In fairness, I realize that this is a ten year old interview, and Dr. Murthy was very young at the time, but it’s concerning nonetheless, although elsewhere, in a book entitled The Yale Guide to Careers in Medicine and the Health Professions, Dr. Murthy was quoted as a fourth year medical student as being interested in integrative medicine. Has Dr. Murthy followed through with his youthful interest in “integrative medicine,” or, as I like to call it, integrating quackery with real medicine? Is he practicing and/or supporting CAM or integrative medicine? It’s hard to tell. There’s not much that can be found about him with regards to this question on the Harvard Medical School or Brigham Women’s and Children’s Hospital websites. I’ve also been Googling my little brain and fingers off, and I haven’t been able to find any “smoking gun” that indicates that Dr. Murthy is still as enamored of quackademic medicine as he was 10 to 15 years ago, although there are niggling little indications. But who knows? Maybe he’s reformed himself.

In my perfect world, if I were a Senator asking Dr. Murthy questions, I wouldn’t ask so much about Medicaid, Medicare, the ACA, or other health policy. Well, I would, but that wouldn’t be my primary line of questioning. I figure that Dr. Murthy has political views compatible with those of President Obama; otherwise President Obama wouldn’t have appointed him. Presidents rarely appoint people with highly incompatible views to theirs to positions that are very public, like that of the Surgeon General. What concerns me more is that the Surgeon General be a voice of science-based medicine, even if it means bucking the prevailing views, existing government policies, the pharmaceutical companies, whatever. Think the Surgeon General in 1964 warning that cigarettes cause cancer, even though cigarettes were popular (not to mention extremely profitable) and the tobacco companies were doing everything they could to bury or counter the developing body of evidence linking smoking tobacco to lung cancer and heart disease. What we don’t need is a Surgeon General who will be a voice in favor of the ongoing pollution of science-based medicine with quackery.

If Dr. Murthy is that kind of doctor—and there are far too many of these doctors around—then then to me he’s disqualified from being the Surgeon General.

Comments

  1. #1 Pamela
    November 19, 2013

    Wow, you are so quick to dismiss alternative therapies! Many if not all have been around a lot longer than conventional medicine of today. Maybe you should do some research and actually learn about Ayurvedic medicine and how it works and how healing that system can be to a person. Just don’t assume that conventional medicine is the end all, be all… It is shoved down our throats because of big money backing it up.

  2. #2 TBruce
    November 19, 2013

    Many if not all have been around a lot longer than conventional medicine of today.

    And this is important because…?

  3. #3 Lawrence
    November 19, 2013

    @Pamela – sure, bloodletting has been around for ages….so it must be better than modern medicine, right?

  4. #4 AnObservingParty
    November 19, 2013

    @ Pamela,

    Many if not all have been around a lot longer than conventional medicine of today

    Please, sources on how health/mortality/life expectancy was better in the past than it is now? Just because something was done forever doesn’t mean it has worth.

    Just don’t assume that conventional medicine is the end all, be all… It is shoved down our throats because of big money backing it up.

    A wise person once said, “you know what they call alternative medicine that works? *beat* Medicine.” .

    The majority of CAM is not yoga or relaxation techniques. It’s Reiki, homeopathy, heavy-metal toxicity, faith-healing, acupuncture, etc. We’re dismissive of things that have no supporting evidence and/or have shown to be actually damaging. Thanks, BTW, for accusing all of us who support SBM to be in it because money is holding it up. And we’re dismissive of you?

    Also, in conclusion, [citations needed]

  5. #5 DB
    November 19, 2013

    Pamela -

    “Maybe you should do some research and actually learn about Ayurvedic medicine and how it works”

    While you’re telling us what not to assume, how about we tell you to do the same – don’t just assume Ayurvedic works. Look for the evidence. It is pointless to try to understand “how it works” before you actually know IF it works.

  6. #6 Narad
    November 19, 2013

    Maybe you should do some research and actually learn about Ayurvedic medicine and how it works

    At least the Occident had four humours.

  7. #7 SpaceTrout
    Revvin' up like a douche.
    November 19, 2013

    Wow, you are so quick to dismiss alternative therapies!

    Nope. People have been dismissing alternative therapies for many, many years.

    Many if not all have been around a lot longer than conventional medicine of today.

    The argument of antiquity has been around for quite a while too. That doesn’t mean that it becomes more valid over time.

    Maybe you should do some research and actually learn about Ayurvedic medicine and how it works and how healing that system can be to a person.

    Research has been done and there is no scientific proof of plausibility or efficacy of Ayurvedic (and I shudder to say) “medicine”. Also a recent study found that one in five Ayurvedic “medicines” available on the interwebs contain harmful amounts of toxic substances (lead, mercury, arsenic), If I’m going to take a placebo, I don’t want an added bonus of lead poisoning.

    Just don’t assume that conventional medicine is the end all, be all…

    Personally, I’ll continue to use conventional medicine. I like knowing that what I put in my body has been studied many times over for safety and efficacy and comes from a relatively reliable, quality-controlled source. If there comes a time when an “alternative” therapy is proven to work safely, it will become a conventional medicine and I’d be comfortable taking it.

    It is shoved down our throats because of big money backing it up.

    Oh, that’s right… Alternative medicine is all grassroots mom and pop business driven solely by honest people who only have our health and well being in mind. Yeah, that’s the ticket!

    Is there any way to nominate Orac for Surgeon General? I’d pay attention then.

  8. #8 Calli Arcale
    http://fractalwonder.wordpress.com
    November 19, 2013

    Ayurvedic medicine — um, yeah. That’s the system that still thinks lead is an effective treatment for stuff. I wouldn’t touch an Ayurvedic treatment if it was the only option around. Seriously. It’s a system of treatment that has openly resisted adopting any scientific discoveries. Like the fact that lead is poisonous.

  9. #9 Eric Lund
    November 19, 2013

    If I’m going to take a placebo, I don’t want an added bonus of lead poisoning.

    Seconded. For all the deserved ribbing homeopathy gets on this blog, at least its practitioners follow the principle of “first, do no harm.” If I’m going to take something with a heavy metal allegedly in it, I’d actually prefer a 40C dilution (12C would be enough, but I’m not going to be fussy).

  10. #10 Mephistopheles O'Brien
    November 19, 2013

    @Pamela,

    If you could provide replicated high quality peer reviewed studies that show that Ayurvedic medicine (or the treatment of your choice) has at least as good a clinical outcome as today’s science-based medicine, that would be very helpful. Thanks!

  11. #11 Denice Walter
    November 19, 2013

    @ Space Trout:

    Alt med is “mom and pop grassroots business”…

    Exactly. It is a highly profitable enterprise which enables its down-to-earth, humanistic practitioners to live in frigging palatial estates. see Brian Deer.com for Casa Wakefield and paradisegardensnaplesfl.com for Null’s ( estates of Mercola and Burzynski are easy to find).

  12. #12 Lawrence
    November 19, 2013

    @Denise – not to mention the “multi-billion dollar” supplement trade…all run by “Mom & Pop” businesses, I guess.

  13. #13 Politicalguineapig
    November 19, 2013

    I wouldn’t worry too much. By the time Congress glaciates toward Murthy’s nomination hearing, Obama’s term will be up.

  14. #14 JustNuts
    November 19, 2013

    Is “Pamela” a real person? It’s almost like someone decided to poke the regulars here with just about every lame altie trope possible just for fun!

  15. #15 Delysid
    November 19, 2013

    We might be getting Janet Yellen to further destroy the monetary system with her quackenomics. We have Michele Leonhart, with zero education in pharmacology, at the head of the DEA. Barack Obama is Commander and Chief and has never served in the military (or had a real job outside of academia or government.)

    Bring on Murthy!

    The government is GOD!

  16. #16 palindrom
    November 19, 2013

    Heh heh. Poor Pamela @1 had no idea that she was addressing an audience that’s been dealing with this stuff for years and years. I laughed out loud when I got to the “do some research” trope. Jeeze Louise!

  17. #17 Bronze Dog
    November 19, 2013

    Pamela, I think you should know that I consider defining treatments as “alternative,” “integrative,” “complementary,” or whatever label they’re going to dream up next is purposeless at best and deceitful at worst. I suspect you’re loyally parroting the idea because it’s a seductive oversimplification into “Us versus The Other.” I flatly reject framing the issue in those terms. I don’t like package deals that are based in ideology and cultural identity when they should be based in science.

    Age has nothing to do with quality. Tradition and popularity mean nothing to me when it comes to questions of science. History has taught us it’s easy for generations of human beings to fool themselves. Humankind came up with scientific methodology because we acknowledged our irrational tendencies and can work to counteract them.

    If you’re so confident that Ayurvedic medicine works, give us the best evidence you’ve found instead of simply asserting it’s out there if we’d only look. A number of us have rejected it because we’ve done some research and find it’s supported by typical quack propaganda tactics and logical fallacies. I can’t recall encountering an Ayurvedic supporter do anything but spout fallacies and rehearse prejudiced scripts. If you don’t at least try to guide where we look, you’re not taking on the responsibility involved in making a claim.

  18. #18 bill smith
    florida
    November 19, 2013

    I believe this may be Pamela (Neitenbach). https://www.facebook.com/theneitenbachfarm
    She is a real person.

  19. #19 Krebiozen
    November 19, 2013

    Pamela,

    Wow, you are so quick to dismiss alternative therapies!

    I think you took a wrong turn somewhere; this is a science-based medicine blog. Any therapies without reliable scientific evidence to support them get short thrift around here.

  20. #20 The Smith of Lie
    November 19, 2013

    I have nor academic background, my scientific literacy is pretty low, but there’s always been one thing that made me curious about the traditional modalities, like Ayuvredic medicine, and their claims that they are good cause they’ve been around for centuries.

    I never heard about groundbreaking new research in those. In my country we have a saying that goes “better is enemy of good”. We constantly get new “western medicine” inventions. Old therapies and drugs are replaced with new, more safe or more effective all the time. People and companies try to improve on what they have. Even without any education in the field I know enough to see that medicine today and medicine 60 years ago are divided by huge progress.

    And yet whenever I see someone praising the virtues of Ayuvreda or TCM all I see is “it has thousand years of backstory”. Wow that’s great! What great improvements happened withing those thousand years? No one ever tells me that. I want to hear about cutting egdge ayuvredic medicne!

  21. #21 Carl
    November 19, 2013

    So Orac expects appointees to support the ACA because it is “the law”, but when it comes to section 2706 of the ACA, which is also “the law”, he expects appointees to be rebellious.

  22. #22 JGC
    November 19, 2013

    “Wow, you are so quick to dismiss alternative therapies!”

    Could you explain exactly what you are referring to here when you use the term “alternative therpaies”? I’m guessing that you’re referring to the usual collection of modalities (reiki, acupuncture, homeopathy) for which there’s either a complete absence of evidence demonstrating efficacy or there is instead evidence demonstrating a lack of efficacy.

    “Many if not all have been around a lot longer than conventional medicine of today.”

    Some of them, perhaps, not all: acupuncture as used today dates from China’s cultural revolution circa 1966 and reiki was invented by Japanese monk Mikao Usui in1922. That said–did you have a point? The fact that something is of relative or great antiquity doesn’t argue that it’s either safe or effective, much less that it’s comparable or superior to modern competitors.

    “Maybe you should do some research and actually learn about Ayurvedic medicine and how it works and how healing that system can be to a person.”

    I have, but I’m always ready to consider new evidence. Tell you what, why don’t you provide a citation to the single most credible and compelling piece of evidence supporting the efficacy of Ayurvedic medicine in treating non-self limiting illness or injury? One must hope that evidence will take the form of a well designed, blinded and adequately controlled clinical trial, with outcomes assessed using one or more quantifiable metrics.

  23. #23 AdamG
    November 19, 2013

    Carl, is it really that hard to believe that someone could support the law in general but have criticisms of certain sections?

  24. #24 Chris HIckie
    November 19, 2013

    I always gave ayurveda about the same level of respect as In-A-Gadda-Da-Vida.

  25. #25 Renate
    November 19, 2013

    I prefer In-A-Gadda-Da-Vida over ayurveda.

  26. #26 palindrom
    November 19, 2013

    “Wait a minute! That sounds like rock and/or roll!”

    – Pastor Lovejoy, after Bart Simpson and Milhouse have tricked the church organist into playing “In the Garden of Eden, by I. Ron Butterfly”.

  27. #27 AnObservingParty
    November 19, 2013

    @ palindrom

    “Hey Marge, remember when we used to make out to this hymn?” ~Homer

  28. #28 Narad
    November 19, 2013

    So Orac expects appointees to support the ACA because it is “the law”, but when it comes to section 2706 of the ACA, which is also “the law”, he expects appointees to be rebellious.

    Did you miss the “consistent with reasonable medical management techniques” and “this provision does not require plans or issuers to accept all types of providers into a network” bits?

  29. #29 Carl
    November 19, 2013

    “AdamG
    November 19, 2013
    Carl, is it really that hard to believe that someone
    could support the law in general but have criticisms
    of certain sections?”

    No, but that’s not what he said. Orac didn’t just say he supports the law, he said that it should be supported simply BECAUSE it is the law:

    “since it’s the law of the land now, one would
    expect the Surgeon General to support it.”

    Nothing in that sentence differentiates between an entire bill vs. its subsections. By Orac’s own logic, the Surgeon General should be EXPECTED to accept quackery given that the law accepts quackery.

  30. #30 Carl
    November 19, 2013

    > “Narad
    > November 19, 2013
    > Did you miss the “consistent with reasonable
    > medical management techniques” and “this
    > provision does not require plans or issuers
    > to accept all types of providers into a network” bits?

    I didn’t “miss” it because that is not part of the law. That is merely a suggestion by HHS, and is preceded by “until any further guidance is issued”.

    While the qualifiers (in the actual law) may be unclear, what is clear is that the law intends to prevent discrimination against,

    > any health care provider who is acting within
    > the scope of that provider’s license

    …and your heroes at HHS, between the two lines your cut out, agree that,

    > a plan or issuer shall not discriminate based
    > on a provider’s license or certification, to the
    > extent the provider is acting within the scope of
    > the provider’s license

  31. #31 herr doktor bimler
    November 19, 2013

    “Based on principles that make sense?” That’s the sort of thing no physician whose practice is science-based should ever utter about Ayurveda or other “alternative medicine.”

    Does Ayurveda have any principles, on which the grifters practitioners can all agree? As far I can tell, it’s all about TRADITION!! packed into tablets along with arsenic compounds and cheap generic v1agr4 from some factory down the road… any rationale is made up on the spot.
    Evidently TCM is too mainstream now, it has lost that sense of Eastern Wisdom exoticism, so all the hip alt-medders moved on to Ayurveda.

  32. #32 herr doktor bimler
    November 19, 2013

    I had forgotten that Ayurveda brings us back to Choprafraud.

  33. #33 Barnesm
    November 19, 2013

    “there’s no excuse for an acupuncturist to be on a President’s health care council” well unless they are there to take minutes and they are a really good minute taker. Certainly not to provide any medical advice. maybe to provide comedy relief during the breaks though for that I’d recommend a homeopath as that system is more hilarious.

  34. #34 Krebiozen
    November 19, 2013

    HDB,

    I had forgotten that Ayurveda brings us back to Choprafraud.

    It is also yet another scam modality that divides people into a number of different groups that determine what diet/occupation/medicine/whatever is best for them. I have dim memories of trying (and failing hopelessly) to decide what dosha I was: vata, pitta or kapha. It seems obvious to me now it was an entirely pointless exercise (no offense intended to the literally millions of people who swear by ayurvedic medicine).

    It reminds me of homeopathy, and its attempts to identify what remedy is best for each person depending on how dry their skin is and if they dreamed of giraffes last Thursday. It’s another desperate attempt to control the uncontrollable; if I know what dosha I am, or understand my astrological chart or how my blood type determines my diet, I will know what diet and lifestyle to adopt and I will be healthy forever. Hurrah!

  35. #35 Narad
    November 19, 2013

    I didn’t “miss” it because that is not part of the law. That is merely a suggestion by HHS, and is preceded by “until any further guidance is issued”.

    This is akin to saying that IRS Publication 526 is “merely a suggestion” about valuing donated property and “is not part of the law.” HHS is the implementing and rulemaking body, and as things stand, their take is that Section 2706(a) is completely in the hands of the insurers.

    While the qualifiers (in the actual law) may be unclear, what is clear is that the law intends to prevent discrimination against,

    > any health care provider who is acting within
    > the scope of that provider’s license

    It has nothing to do with “discrimination” in the sense that you seem to be trying to invoke. PPACA as implemented doesn’t require coverage for podiatry,* much less craniosacral nitwits. How the Falardeau–Daly axis apparently convinced themselves that the plain wording of a subsection captioned “Providers” actually meant “Categories of Providers” is anybody’s guess.

    …and your heroes at HHS,

    Do me a favor and don’t try to tell me who my “heroes” are, thanks.

    between the two lines your cut out, agree that,

    > a plan or issuer shall not discriminate based
    > on a provider’s license or certification, to the
    > extent the provider is acting within the scope of
    > the provider’s license

    If you’re going to whine about things being “cut out,” let’s have the beginning as well, shall we?

    “Until any further guidance is issued, group health plans and health insurance issuers offering group or individual coverage are expected to implement the requirements of PHS Act section 2706(a) using a good faith, reasonable interpretation of the law. For this purpose, to the extent an item or service is a covered benefit under the plan or coverage, and consistent with reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service, a plan or issuer shall not discriminate based on a provider’s license or certification, to the extent the provider is acting within the scope of the provider’s license or certification under applicable state law. This provision does not require plans or issuers to accept all types of providers into a network.”

    Oops. Furthermore, let’s get to the supposed meat of your claim, which is that it would be hypocritical to suggest that the Surgeon General be expected to support PPACA but not your “interpretation” of Section 2706(a), which necessarily includes chiropractors and naturopaths, the specific examples given above. Why? PPACA is a federal law. Where is the moral imperative to blindly support random state licensing choices?

    * “Podiatric physicians” in my state, to be precise, who are otherwise uniquely granted one noteworthy privilege under law that sets them apart from all other health-care providers.

  36. #36 Denice Walter
    November 19, 2013

    Reading through a spa catalogue I discovered that there is an Ayurvedic therapy which involves ( I swear that this is true) dripping oil on the subject’s forehead – it’s called “Shirodhara” and it’s supposed to be calming, help with headaches and sinus trouble etc.

    Now who would want someone dripping oil- perhaps herbal oil-on them- running all over their face, into their hair making them all greasy and slick? And you have to pay for the pleasure of this service yet.

    The Journal of Altrnative and Complementary Medicine even has an article about its psychoneuroimmunological effects ( Uebaba et al, 15, 10, 2008).

  37. #37 Dan
    November 20, 2013

    I found some info on the new surgeon general nominee a few days ago that indicates he may still be into alternative medicine. Here is a link to a blog written in his name: http://www.vivekmurthy.com/ . If you click on his about me section it looks like he followed some alternative medicine websites, including one on Ayurveda and another by a doctor who incorporates CAM into her practice. He blogged in 2011, and joined blogger in 2007, so it looks like he’s had an interested in alternative medicine since getting out of residency.

  38. #38 herr doktor bimler
    November 20, 2013

    What is Deepak Chopra’s current position vis-a-vis Ayurveda? Does he talk much about that part of his career, riding on the coat-tails of Maharishi Mahesh Yoga and his more egregious scams,* or does he try to play it down? It strikes me that there is not a comfortable fit between Chopra’s current shtick of vague Higher Obscurities — Global Quantum Consciousness and such as — and the crabbed, finicky, literally Medieval particularities of body types.

    * Unusually long for Medical News & Perspectives, the expose on the marketing of Maharishi Ayur-Veda documents a widespread pattern of misinformation, deception, and manipulation of lay and scientific news media. This campaign appears to be aimed at earning at least the look of scientific respectability for the TM movement, while boosting the sales of their extremely lucrative products and services. (One example is the herbal elixir known as Maharishi Amrish Kalash, which costs $1000 for a year’s supply.

    Chopra says everyone should take the cure/prevent-all twice a day. Chopra claims their health care is far more cost-effective than conventional medicine. However, the annual cost of just this one Maharishi Ayur-Veda product is equivalent to 40% of the average per-capita expenditure on all health care in the United States in 1989. The other products and services he recommends just to maintain health would cost thousands of dollars more each year. However, this pales compared with the cost of Maharishi Ayur-Veda treatments in case of actual illness, which can exceed $10,000 for the performance of a ceremony to appease the gods or or for the purchase of Jyotish gems to restore their health.

  39. #39 Narad
    November 20, 2013

    However, this pales compared with the cost of Maharishi Ayur-Veda treatments in case of actual illness, which can exceed $10,000 for the performance of a ceremony to appease the gods….

    I actually just wanted to say “buttering the lingam at both ends,” but I’m too tired to do it properly. Somebody have Carl get back to me with a 2706(a) analysis, pronto.

    “When traveling in India, I stayed at an Ayurvedic hospital, where each patient is given an astrological reading before treatment begins. I was told by the medical astrologer after reading my chart, that I should perform an Abhishekam once a week as a remedy. She gave me instructions to break a tender coconut, and pour the fresh coconut juice over a Shiva lingam every Monday. She said that this would help to appease Lord Shiva, and he in turn would bless me with a more calm, collected, and peaceful mind. This reaffirmed for me that Ayurveda is a spiritual science of healing, concerned with all aspects of the body, mind, and emotions.”

  40. #40 herr doktor bimler
    November 20, 2013

    I stayed at an Ayurvedic hospital, where each patient is given an astrological reading before treatment begins.

    Conspicuously absent there: any mention of illness. Evidently the “spiritual science of healing” works best in the absence of disease.

  41. #41 herr doktor bimler
    November 20, 2013

    no offense intended to the literally millions of people who swear by ayurvedic medicine

    Part of me thinks “Why *not* offend them?” and part of me redoubles the efforts to follow Krebiozen’s example.

  42. #42 Krebiozen
    November 20, 2013

    HDB,

    Part of me thinks “Why *not* offend them?” and part of me redoubles the efforts to follow Krebiozen’s example.

    There’s nothing saintly about it I assure you. I was once in a bus that was stoned by an angry mob of Hindus, and only escaped with my life* thanks to the quick-thinking driver’s ability to reverse at speed down a muddy flooded road. Don’t be fooled by all that smiling, chanting and incense. They may look gentle and unthreatening, but an angry Hindu is a force to be reckoned with.

    * Or so it seemed at the time. I had made the mistake of traveling on the day of a General Strike, which a number of locals objected to quite strenuously (the traveling, not the General Strike). This was all because I misunderstood the Indian head jiggle when I asked the Brahmin man who owned the hotel I was staying in if it was safe to travel. Also, I got on the wrong bus, and asked someone, “Does this bus go to Pushkar?”. Useful tip: avoid yes/no questions when in South Asia, as many people are too polite to say “no”.

  43. #43 Krebiozen
    November 20, 2013

    HDB,

    Evidently the “spiritual science of healing” works best in the absence of disease.

    .
    I’m reminded of the claim that in ancient China doctors were paid as long as their patients remained well. If there is any basis to this I suspect it is because in the days before scientific medicine so many diseases were untreatable that relying on placebo effects like regression to the mean (as quacks do today) wouldn’t cut it, since so many self-limiting diseases were limited by death.

    Claiming to be able to keep a person healthy might have been a better scam approach, since dissatisfied customers were unlikely to be able to complain, those that did could be accused of not following the instructions properly, and satisfied ones could provide testimonials.

  44. #44 Krebiozen
    November 20, 2013

    Also, regular income from those that, by happenstance, didn’t get sick.

    Of course now I remember that the server migration may eat my words at any moment. Luckily I kept copies.

  45. #45 TBruce
    November 20, 2013

    I’m reminded of the claim that in ancient China doctors were paid as long as their patients remained well.

    This was debunked a long time ago in a book called Chinese Looking Glass by Dennis Bloodworth. He states that a very wealthy family would have a personal doctor on retainer and pay him as such, but there was no such thing as paying the doctor to keep you well and withdrawing payment if you got sick. In his view (and he was very convincing about this), the idea stemmed from the prejudicial myth of China being a “topsy-turvy land” where customs were opposite to those in “civilized” Europe.

  46. #46 TBruce
    November 20, 2013

    Bleaugh…

    My comment didn’t get et, but it did get Italicized. Of course, it may have just been my own screw-up.

  47. #47 Carl
    November 20, 2013

    “Narad
    November 19, 2013 ”

    Once again Norad, THAT IS NOT THE LAW, and yet the HHS and the actual law both agree that the type of license is not a reason to reject a provider. HHS even talks about their own statements as “guidance”, so your attempt to equate their FAQ with the law is ridiculous.

  48. #48 Carl
    November 20, 2013

    And if the Surgeon General is expected to support anything which is “the law of the land”, shouldn’t HHS support is as well, instead of trying to add qualifications to dilute it?

  49. #49 Narad
    November 20, 2013

    Thank you, Textarea Cache plugin:

    Once again Norad, THAT IS NOT THE LAW, and yet the HHS and the actual law both agree that the type of license is not a reason to reject a provider.

    Please identify where Section 2706(a) says anything regarding “type of license.” Or don’t, as you lose again.

    HHS even talks about their own statements as “guidance”, so your attempt to equate their FAQ with the law is ridiculous.

    Uh-huh. I imagine you were quite perplexed by all the fuss over coverage for contraception in that case. After all, it’s “merely a suggestion.”

    And if the Surgeon General is expected to support anything which is “the law of the land”, shouldn’t HHS support is as well, instead of trying to add qualifications to dilute it?

    Were you planning on responding to the part on where the contradiction lies between supporting a federal law and thinking that individual states have made stupid decisions about what fields they’re willing to license? Or the fact that there’s no requirement to cover services that don’t cut the mustard with the USPSTF? You did make it to Section 2713, right?

  50. #50 Delphine
    Washing Diapers, CA
    November 21, 2013

    *lurker in*

    I just have to say, I was a fertility patient for quite some time. Do any of you know what it’s like to be a woman pushing 40 and running out of time? It’s a scratching, desperate feeling, that longing…coupled with the knowledge that while we can fix bunged up tubes, surgically extract sperm, ablate/excise endo…we can’t get time back. Ever.

    Anyhoo, during our joyless quest for Just One Live Baby Please, I saw an acupuncturist. She was recommended by my RE — in fact, there were lots of lovely brochures handed out to patients on the joys of acupuncture.

    I took my 13 months worth of fertility charts (temperature, cervical fluid, fun s#x turned to grim, get ‘er done s#x) to said acupuncturist. She was a “specialist” in acu and TCM. She looked at my charts and said, “your eggs have poor energy.”

    To which I replied, “what is the energy of an egg?”

    She didn’t answer. She took my pulse and looked at my tongue. I was in the latter half of my cycle, which she knew from looking at my charts. “You are not pregnant” she said, her fingers on my wrist.

    Gotta go…my 2.5 year old is smearing snot on the dog. :)

  51. #51 Narad
    November 21, 2013

    Do any of you know what it’s like to be a woman pushing 40 and running out of time?

    Not me, but I’ve been getting pretty detailed IVF accounts from a 43-year-old lately.

  52. #52 jane
    November 22, 2013

    What’s with the hostility toward anyone who will enter the same room as Dr. Dean Ornish? Is Ornish’s true sin simply believing that lifestyle modifications can affect disease, or is it scientifically testing them and getting better results than any drug or procedure conventional cardiology has to offer? If you believe that his approach, being patient-controlled, must be Quackery, yet you also believe that published research should be the sole basis for our beliefs, then the positive results of scientific studies of his program can’t help but induce cognitive dissonance and hence anger. The same sort of response can be seen with regard to the results of positive studies of non-Western botanical medicines, or acupuncture for that matter, but it’s harder to see what cultural underpinnings put Ornish so far beyond the pale that his daring to do science is automatically un-Scientific.

  53. #53 Narad
    November 22, 2013

    If you believe that his approach, being patient-controlled, must be Quackery, yet you also believe that published research should be the sole basis for our beliefs, then the positive results of scientific studies of his program can’t help but induce cognitive dissonance and hence anger. *plonk*

    Ahhhhh.

  54. #54 TBruce
    November 22, 2013

    What’s with the hostility toward anyone who will enter the same room as Dr. Dean Ornish? Is Ornish’s true sin simply believing that lifestyle modifications can affect disease, or is it scientifically testing them and getting better results than any drug or procedure conventional cardiology has to offer?

    Well, for one thing, he’s on the advisory board of the loathsome Physicians for Responsible Medicine. That’s enough for me.

    For another, here’s some material for you to catch up on:
    http://scienceblogs.com/insolence/2009/03/05/dr-dean-ornish-turn-away-from-the-dark-s/
    http://scienceblogs.com/insolence/2009/03/03/senator-tom-harkin/

  55. #55 TBruce
    November 22, 2013

    Sorry, that was Physicians Committee for Responsible Medicine. An even more pompous and insufferable title.

  56. #56 Jake Hamby
    United States
    November 28, 2013

    There is one Ayurvedic therapy that works great for sinus problems and has even been scientifically proven to work (Harriet Hall posted on SBM about it in 2009): saline irrigation with a Neti pot. If you can stand pouring warm water up your nose into your sinuses (some people say it feels like they’re waterboarding themselves, but I don’t get that feeling), it flushes out dust and allergens quite nicely.

    Personally, I like the NeilMed version with the blue plastic teapot and the premeasured salt + sodium bicarb packets. No drugs, no Big Pharma, but this might be the *only* aspect of Ayurvedic medicine that qualifies as “medicine” (because it works and has a science-based explanation) instead of the SCAMmy kind.

  57. #57 lilady
    November 28, 2013

    I’d been skittish about using Neti pots and guaranteeing that the solution you sniff into your nasal passages is absolutely sterile.

    http://www.infectioncontroltoday.com/news/2013/09/fda-advises-using-neti-pots-carefully-to-avoid-infection.aspx

    I’m more in favor of “house brand” sterile saline nasal spray for congestion.

  58. #58 Krebiozen
    November 29, 2013

    Ayurveda seems to have some odd ideas about cleaning various bits of the body. Whenever I see a reference to neti pots I always remember the book on yoga therapy I have in my library of nutty medical books. I’m sure I have mentioned here before that as well as nasal irrigation, it recommends swallowing a length of cloth, keeping hold of one end, leaving it for a little while and then pulling it out, which cleans the stomach out, obviously.

    They warn that you shouldn’t leave it too long or it will pass through the pyloric sphincter and you will have trouble pulling it out. I always wondered if you could allow a long enough piece of cloth to travel right through, keeping hold of the end hanging out of your mouth, so you could floss the entire GI tract. That would really give it a good clean.

    There are also instructions in this book on teaching yourself to suck salt water up your anus, so you can give yourself an enema without any tubes. Very handy for Gerson advocates, no doubt, simply squat in a large bowlful of warm coffee…

  59. #59 Renate
    November 29, 2013

    @ Krebiozen
    You could try to pull the piece of cloth out on the other end of the GI tract.

  60. #60 Johnny
    127.0.0.1
    November 29, 2013

    You could try to pull the piece of cloth out on the other end of the GI tract.

    It’s been considered
    http://www.straightdope.com/columns/read/44/can-yogas-swallow-a-cloth-and-have-it-come-out-the-urk-other-end

  61. #61 Krebiozen
    November 29, 2013

    Johnny,
    I should have guessed someone else had pondered this mystery…

  62. #62 Denice Walter
    November 29, 2013

    Oh yeah I’ve read about that crap too.
    Plus the oil drip therapy. AND other nonsense that I can’t recall now…
    And how about using gems and metals to heal?

  63. #63 Denice Walter
    November 29, 2013

    And- btw- don’t cats often swallow string/cord and it comes out the other end?

  64. #64 Renate
    November 29, 2013

    @ Denice
    My parents had a Siamese cat that loved gnawing holes in socks, but I never saw a string coming out the other end.

  65. #65 sheepmilker
    November 29, 2013

    Denice, I can personally confirm the cats eating string and it “re-appearing”. It was especially festive at this time of the year as the cat in question loved to swallow tinsel from the tree!

  66. #66 Bronze Dog
    November 29, 2013

    I think my brother has mentioned his cat eating string and getting it out the other end.

  67. #67 Denice Walter
    November 29, 2013

    @ all:

    I had a cat like that: the notorious string-eater, Sam.
    However, if string does come out the back end, you should never pull on it because that can damage their intestines- as can natural periastalic motion- it sort of saws away at the intestines!

    Despite these problematic habits, the cat survived until age 14.

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