Respectful Insolence

The vast majority of what is known as “alternative medicine” is quackery. Let’s just get that right out front right from the very beginning of this post. That’s where I’m coming from, and where I’m coming from is a science- and evidence-based viewpoint. To quote a cliche that is true and modified to my own view of medicine, there is no such thing as “alternative medicine.” There is medicine that has been scientifically demonstrated to work. There is medicine that has been scientifically demonstrated not to work. And there is medicine that has not been shown to work. What makes up “alternative” medicine consists of the latter two, because once a medicine is shown scientifically to work it ceases to be “alternative.”

What, then, is the value of “integrative” medicine? Recall that “integrative” medicine is simply the latest iteration of the name of what was once, as recently as 30 or 40 years ago, referred to widely as quackery, but became instead “unconventional” or “alternative medicine,” to evolve later into “complementary and alternative medicine” (CAM), the idea being that the “alternative” medicine somehow “complements” real, science-based medicine. However, that wasn’t enough for the advocates of pseudoscientific medicine because “complementary” implies a subsidiary position, a position not equal to that of scientific medicine. Thus was born out of quackademic medicine (the infiltration of quackery into academic medicine) a term, “integrative” medicine, intended to paint a picture in the mind of the “integration” of a co-equal set of modalities with science-based medicine, to produce what its advocates bill as the “best of both worlds.” The problem, of course, is that, as my good bud Mark Crislip put it, “integrating” cowpie with apple pie doesn’t make the cowpie better; it makes the apple pie worse. Similarly, “integrating” pseudoscience and quackery with science-based medicine doesn’t make the quackery more credible; it dilutes real medicine with nonsense.

So it was with amusement that I read an article I came across on the Alliance for Natural Health USA (ANH-USA) website entitled War on Integrative Medicine, Part One: Eliminate the Integrative Doctors. My first thought was, “Gee, you say that as though it were a bad thing!” My second thought was that it would be a very good thing indeed if the specialty of “integrative medicine” was utterly ripped from body of medicine like the tumor it is, because, again, “integrating” nonsense with sense, pseudoscience with science, quackery with real medicine adds nothing to medicine that couldn’t be added without such “integration.” The ANH-USA, as you might remember, is a group dedicated to “health freedom,” which in practice means freedom from pesky science- and evidence-based standards of care, oversight by state medical boards, or regulations of supplements and quack medicine by the FDA and medical advertising by the FTC. Most recently, the ANH-USA has been supporting Stanislaw Burzynski in his never-ending war against the FDA to get his unproven and almost certainly ineffective cancer chemotherapy known as antineoplastons approved.

Particularly amusing is the way that ANH-USA paints it all as a grand conspiracy between the American Medical Association (AMA), which is basically a medical trade/professional association; the Federation of State Medical Boards (FSMB), an umbrella organization overseeing and coordinating state medical boards; and the American Board of Medical Specialties (ABMS), the umbrella organization to which medical specialty boards belong, the boards that administer the tests that result in physicians being board-certified. Of course, quacks frequently attack the AMA as though it were this overarching supervillain like Ernst Stavro Blofeld to “natural healers'” James Bond, but it’s really more like Dr. Evil to Austin Powers. However, although once powerful, the AMA has been in decline for at least a decade, with its membership having fallen from 278,000 in 2002 to 217,490 in 2011. In the early 1950s, 75% of U.S. physicians were members of the AMA; by 2011, around 15% of practicing physicians are full, dues-paying members of the AMA. Personally, I’m not a member of the AMA because, like a lot of doctors, I don’t see much benefit to me in it. To hear the ANH-USA tell it, though, the AMA is like the Empire in Star Wars, the Lannisters in Game of Thrones, and Sauron in The Lord of the Rings all rolled up into one, with a dash of the computer empire in The Matrix movies thrown in for good measure. Its sole purpose? To team up with its evil allies in the FSMB and ABMS to crush integrative medicine:

The three organizations described above work so closely together that they seem to us to be virtually one entity led by the AMA. The AMA and FSMB openly collaborate on projects and initiatives, while the FSMB is officially affiliated with ABMS.

Until now, doctors who are board-certified by the AMBS must be recertified every ten years. That gives the organization considerable control over doctors, though the control is loose. But, starting this year, the AMBS is requiring that doctors go through “mini” recertification every two to five years. This would make it much easier to keep tabs on and rein in anyone daring to dissent from standard orthodoxy.

Would it were so!

Don’t get me wrong. Personally, I find the new recertification requirements to be rather onerous, as I just completed one of these “mini-recertifications,” although I’m not due to do the full recertification until 2018 (2017, actually, given that you really should try to recertify at least a year before your certification expires, just in case you don’t pass the test on the first try and need to take it again, which is all too easy when you’re hyperspecialized like I am and in essence have to learn huge swaths of general surgery, complete with changes since I trained, in order to pass the test. However, it’s not a bad thing to have to check in more often to be certified. Basically, for surgery, what this consists of is verifying CME credits more often, taking CME courses that require a post-test, and keeping track of your cases in a database in order to track your complications and develop plans for quality improvement for your practice.

Amusingly, the ANH-USA complains about how the AMBS refuses to work with integrative medical doctors as a specialty. Again, the ANH-USA says this as though it were a bad thing. It’s not, as I explained when I discussed the birth of an “integrative medicine” board certification through a rival board, the American Board of Physician Specialties (ABPS), which has little cachet, to the point where few hospitals accept its board certifications as acceptable to fulfill their requirements to acquire admitting privileges. Amusingly, when Andrew Weil’s plan to set up a board certification process for “integrative medicine” was first revealed more than two years ago, the reaction of the “natural practitioners” championed by the ANH-USA was highly mixed, with many of them viewing it as a naked power grab designed to shut out non-physician “holistic” practitioners as blatant as anything the ANH-USA accuses the AMA and ABMS of doing. All is not well in woo-ville, contrary to the picture the ANH-USA wants to paint.

Besides, the ANH-USA paints a dire picture for its “natural healing” specialties that is quite at odds with reality. In fact, the doyens of quackademic medicine, have had astounding success over the last 30 years in inserting quackery into medical schools and academic medical centers while co-opting various modalities that are science-based (like nutrition and exercise) to “rebrand” them as somehow “alternative” and naturally part of “integrative medicine.” The AMA, FSMB, and ASMB have been quite powerless to stop this infiltration of quackademic medicine and “integrative” medicine into scientific medicine. In fact, arguably, they haven’t even really tried that hard and today are not even trying at all. Naturopathy is considered a valid specialty in the 17 states that license it, plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, no matter how full of quackery it is. Chiropractors are licensed in every state of the union, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. (Indeed, chiropractors even have their own equivalent to the FSBM, the Federation of Chiropractic Licensing Boards.) Acupuncturists can be licensed in 43 states and the District of Columbia. This is an astonishing accomplishment on the part of advocates of quackery, the equivalent of setting up a Ministry of Magic in each of the states that license such specialties rooted in prescientific vitalism and magical thinking. The only difference is that in the world of Harry Potter, magic works.

If there’s a war against integrative medicine, contrary to the self-serving whining of the ANH-USA, it is not the AMA, FSMB, and ABMS who are winning.

Comments

  1. #1 Dangerous Bacon
    February 18, 2014

    I agree, it’s comical to see the AMA’s influence so vastly overrated by alties.

    “Of course, quacks frequently attack the AMA as though it were this overarching supervillain like Ernst Stavro Blofeld to “natural healers’” James Bond”

    Historically, the most Blofeldian figure in the AMA seems to have been Morris Fishbein, onetime editor of the AMA Journal who was active against quackery in the early to mid 20th century. Even now, if you Google his name you’ll find a huge assortment of quacks and quackery enablers (from Rife machine enthusiasts to Mike Adams and his kin) seething with anger over Fishbein’s activities.

    I had never heard of the guy until recently, but anyone capable of riling up the alt med loon base to that extent deserves posthumous attention and respect.

    http://jama.jamanetwork.com/article.aspx?articleid=181891

  2. #2 Denice Walter
    February 18, 2014

    ” the Empire… the Lannisters…and Sauron.. all rolled into one”
    Actually, it sounds more like the sceptics.
    Take a bow, people!

    @ Dangerous Bacon:

    Fishbein has often been identified as the *ne plus ultra* of evil ™ by alties: recently Gary Null** has been delineating the many atrocities SBM ( and its predecessors) committed against “natural medicine” such as ( lots of this stuff buried in his archives as articles) :
    -using money supplied by Rockefellar, Morgan and Carnegie to fund SB ( pharma-based) universities
    -creating a War on Magi… I mean “Natural remedies” via governmental controls over meds
    – opposing Chiropractic, leading to an historic court case
    – opposing herbalism, homeopathy, energy healing et al.
    – controlling what is acceptable for mainstream media programming ( a/k/a censoring woo)

    ** he battling with the Pacifica network and has apparently been tossed from their airwaves- he was supposed to explain all in detail last night @ PRN –
    I was away so I couldn’t listen live but I venture that most is already scrubbed from the archives as is often the case with his other rants.

    I imagine that his ire for SBM is also fuelled by his current situation which is characterised by his increasingly limited access to the radio and television airwaves

  3. #3 jane
    February 18, 2014

    Depends upon what “shown scientifically” means. There is a disconnect between evidence-based medicine and Science-based medicine: some botanical medicines that are officially Woo and Quackery to the latter have positive clinical trials totalling thousands of patients to their credit, so to the former, are evidence-based. You are free to reject those scientific studies out of hand, just as you are free to reject positive studies for acupuncture out of hand – but you do so as a value judgement; there is no possible way you can “scientifically prove” that it is right for me to do so too. Therefore I should retain legal access to those modalities.

  4. #4 Helianthus
    February 18, 2014

    @ Denice / Orac

    OT / SoIaF tangent

    ” the Empire… the Lannisters…and Sauron.. all rolled into one”

    I protest. Putting the Lannisters next to the other two is evidence of seeing the world only in black and white. Most Lannisters are complex characters in many shades of grey.
    Although I would admit they tend toward the darker shades.
    If only someone had taught the twins about the wonders of subtlety and diplomacy.

    Game of Throne is actually a nice study of why hereditary regimes are just disasters waiting to happen. The number of times the story took a turn for the worse because a spoiled brat (a.k.a. an immature heir) was in charge…

    Back on topic:

    the ANH-USA paints a dire picture for its “natural healing” specialties that is quite at odds with reality.

    Same observation due North, in Canada. Naturopaths and chiropractors are at home in the universities in Toronto.

  5. #5 Denice Walter
    February 18, 2014

    @ Helianthus:

    We just mean the bad Lannisters not the semi-bad ones.

    Actuallly, I was reading the first book yesterday on the train. There ARE complex characters and the author seems capable of creating subtle hints about their personalities without hitting you over the head- MOST of the time anyway.
    They also have a ‘Walder’ .

    I need densely packed books for plane and train trips- I used to read 19th century novels exclusively on planes for the thrill of anachronism – Hardy or Wharton @ 30 000 ft.

  6. #6 LovleAnjel
    February 18, 2014

    @Helianthus & Denice

    You could make similar arguments for the small council (Baelish and Varys). Trying to make out the machinations behind events turns you into a bit of a conspiracy theorist.

    A lot of the story turnings involve the people who are not at all on the throne at the time, acting as personal agents rather than rulers or future rulers. I actually rather like Sersei, since the crux of her character is the injustice of institutionalized and cultural patriarchy.

  7. #7 kruuth
    February 18, 2014

    One thing I think should be noted. “Integrative Doctor” is an oxymoron.
    Medical doctor=GP/Oncologist/Neurologist, etc.
    Integrative doctor=quack

  8. #8 Denice Walter
    February 18, 2014

    @ LovleAnjel:

    Actually, I’m not too far into the books altho’ I have seen tapes of more recent episodes.

    I think that writers- like many of us- have to attempt to figure out what proportion of how people behave is due to personality and how much is purely situational- and of course, how much blends the two seamlessly?
    E.g. if a person acts a certain way is it -always, usually, now- and-then or rarely? When people behave similarly across divers situations, we tend to label that personality- interestingly, we often label our own actions as situational whereas we may see others’ as personality.

  9. #9 Krebiozen
    February 18, 2014

    jane,

    Depends upon what “shown scientifically” means.

    I think that’s pretty clear; replicated high quality clinical trials showing clinically significant results.

    There is a disconnect between evidence-based medicine and Science-based medicine:

    Not really, the basic difference is SBM takes prior scientific plausibility of an intervention into account and EBM doesn’t. SBM is intended to avoid the occasional false positive results that inevitably show up in clinical trials of ineffective treatments being misinterpreted as being clinically significant. I think this is how EBM has led us to this ridiculous and shameful situation, where acupuncture and other woo is taught at respectable medical schools.

    some botanical medicines that are officially Woo and Quackery to the latter have positive clinical trials totalling thousands of patients to their credit, so to the former, are evidence-based.

    This is where systematic reviews and metaanalyses come in. You need to look at the evidence as a whole as well as prior plausibility to avoid being deceived by noise and biases. Which botanical medicines did you have in mind by the way?

    You are free to reject those scientific studies out of hand, just as you are free to reject positive studies for acupuncture out of hand –

    I don’t see anyone dismissing anything “out of hand”, I see people looking very hard at the available evidence and coming to unavoidable conclusions. To be fair, I agree with you that some conventional treatments have a poor evidence base and prior plausibility too. That doesn’t mean CAM should get a free pass.

    but you do so as a value judgement; there is no possible way you can “scientifically prove” that it is right for me to do so too.

    I suppose the criteria used to assess the quality of evidence are part of a value judgment, but it does seem the best way we have of doing so. If you choose to believe in false positives in a sea of negative trials and noise, that’s up to you, but I think you are deceiving yourself.

    Therefore I should retain legal access to those modalities.

    Legal access? Who is suggesting that anyone be denied access to acupuncture* or any other CAM unless it is dangerous? I just want people to stop claiming it is medicine, and an end to public money paying for it or paying for more research into it.

    * Since sham acupuncture is apparently as effective as real acupuncture, is there any rational argument for puncturing the skin? Isn’t that risk without benefit?

  10. #10 Dorothy
    Oz
    February 18, 2014

    Ahhh, Jane—we await your citations for the efficacy of acupuncture.

    Also, if you look around in the archives here or at sciencebasedmedicine.org blog, you will find that credit is given to properly tested botanicals (pharmacognosy), and that that makes those demonstrated to have value medicine, NOT “alternative” medicine.

    You keep giving us the “choice” argument, but it’s like asking me to respect the “choice” of the Flat Earth Society. Yeah, they can choose to believe whatever they want, but I don’t have to have such an open mind that my brains fall out.

  11. #11 Denice Walter
    February 18, 2014

    Correction to my ** above:

    We are sorry to report that Null has been re-instated @ Pacifica radio : I clicked on the ‘listen live’ button ( WBAI) on their website and sure enough – the wankery persists.
    I understand his art(ifice) over the airwaves is not compensated but he is re-imbursed for the listener “premiums” he supplies ” at cost”.

  12. #12 Leigh Jackson
    February 18, 2014

    Jane,
    You are a true believer in acupuncture. I am a true sceptic. I am so because as well as sounding highly implausible and there’s plenty of high quality evidence to show that it works no better than placebo.

    Science has scepticism has one of its trademarks. It’s to do with not wanting to make a fool of oneself by fooling oneself unwittingly. True believers have no such fear.

  13. #13 Leigh Jackson
    February 18, 2014

    O dear, I rally must start proof reading myself. So far so good.

  14. #14 Leigh Jackson
    February 18, 2014

    I don’t believe that!

  15. #15 jane
    February 18, 2014

    Krebiozen – Your religion is showing. You assume that for any complementary or traditional treatment for which I might point out multiple positive trials, there just must be a “sea of negative trials” outweighing them. If I accept the majority evidence for any such treatment whatsoever, those are “occasional false positives” and I’m “deceiving myself.” Like the radiologists going berserk over the Canadian mammography study, you feel that if published data don’t support your beliefs, the published data must be wrong.

    Dorothy – Can you perhaps list five clinically tested botanicals whose use SBM approves of, then? Last time I saw anything from them, it was the same line of “If these have any real value, [it must be due to only one molecule and] one of these decades a real pharma drug will [because the myth of progress tells me so] be made from it; meanwhile, go ahead and abandon the icky old traditional use.”

    As for acupuncture, the body of evidence is made more problematic by the fact that many studies of sham acupuncture have presumed that they know exactly how acupuncture works, which they clearly do not. There are a lot of researchers and scholars out there who do not assume that studies showing acupuncture to be better than conventional treatments – or, sometimes, sham acupuncture – in both animals and humans must be automatically rejected. Evidence-based medicine would say: “We still don’t know exactly what is going on, but there may be some real effect”, while Science-based medicine says: “All those studies are no good and anyone who doesn’t reject them out of hand is stoopid.” I like the former attitude a lot better.

    And yes, there are those who would like to deny legal access to acupuncture; what else does it mean when Orac rages against licensure? Does he want unlicensed acupuncture to be legalized in all those states, perhaps, in the hope that total incompetents will start practicing and jack up the now upsettingly minuscule rate of complications? Or does he want to see all those offices closed down by state health departments after the practitioners are delicensed?

  16. #16 RobRN
    February 18, 2014

    #15 Jane sez:

    “As for acupuncture, the body of evidence is made more problematic by the fact that many studies of sham acupuncture have presumed that they know exactly how acupuncture works, which they clearly do not.”

    Please, Jane, do tell us EXACTLY how acupuncture ‘works”!

  17. #17 Denice Walter
    February 18, 2014

    As far as I know, Krebiozen doesn’t have a ‘religion’.

    SBM is more than a mere accumulation of trials that show the results you want or negatives that show the reverse- it is the cumulative results that signify underlying mechanisms that fit together into the BODY of evidence that already exists and is a vast interlocking network of results which has transpired and grown over decades. The whole set fits into what we already know about medicine, physiology, pharmacology, psychology, biology, chemistry and physics- as well as many other facts.

    Woo-meisters may point out a study that says what they like or list a series of studies but they often are of low power, are poorly controlled,not intrinsically related to the question at hand or point to unlikely mechanisms. Homeopaths can show volumes of studies that show ‘effects ‘ and so can acupuncturists- doesn’t mean that they’re worth anything. Anti-vaccinationists have *tons* of data to support their ideas- doesn’t mean it’s true.

    It isn’t just data, it’s also methodology and analysis- people who study science have to understand statistical analysis and research design. Amateurs often create shockingly glaring errors that scream out for mercy to anyone who has even an inkling of what is involved.

    None of this stuff is secret or hidden knowledge- you can look it up.
    Warning: don’t expect it to be comprehensible in an hour or a week or a year. Especially without expert guidance- a/k/a an instructor.

    I hear about proposed/ actual alt med research that is nothing but laughable:
    the most famous example being that of comparing vaccinated vs unvaccinated children- besides being unethica, it probably assumes that the two groups are not different in other ways as well as the main one.
    Other studies rely primarily on self-report or expect compliance with complicated regimes. There are tons of bad studies fromthe 1970s that link emotional responses with illness- and they’re not worth much.

    When I first read about Wakefield’s case series, I suspected something amiss because it didn’t make sense and fit into what I already knew about neurodevleopment. It contradicted other research.
    It also had only 12 subjects. More experimenters than subjects- that should be a tipoff.

  18. #18 Science Mom
    http://justthevax.blogspot.com/
    February 18, 2014

    Another citation-less whinge from jane. Shocking.

  19. #19 lilady
    February 18, 2014

    @ Science Mom: I just ignore any comments posted by jane, who posted her “friend’s” anecdotal story about needling as treatment for restoring normal sinus rhythm:

    http://scienceblogs.com/insolence/2013/11/25/a-rather-clueless-defense-of-cam-from-across-the-pond/

  20. #20 Krebiozen
    February 18, 2014

    jane,

    Krebiozen – Your religion is showing. You assume that for any complementary or traditional treatment for which I might point out multiple positive trials, there just must be a “sea of negative trials” outweighing them.

    I assume nothing, I am describing what I see in the literature. I have been interested in alternative medicine of all varieties for the past 30 years or more, and the more I have read the less confidence I have had in any of it. It’s at a nadir right now, from feeling decidedly hopeful about a number of modalities, including acupuncture, a few decades ago.

    Browse through the Cochrane Reviews that mention acupuncture, and you will see condition after condition for which the evidence is underwhelming or non-existent. I just don’t understand how anyone can look at this with a skeptical eye and come out of it believing there is something interesting, much less useful there.

  21. #21 Dangerous Bacon
    February 18, 2014

    Jane, I have trouble coming up with five “botanicals whose use SBM approves of”. Even the handful that have a reasonable amount of evidentiary backing (such as St. John’s wort, kava and horse chestnut seed extract) are problematic because products on the market are undependable as regards amount of active ingredient/contamination/adulteration. This is not an SBM problem but one affecting the supplement industry.

    “And yes, there are those who would like to deny legal access to acupuncture; what else does it mean when Orac rages against licensure? Does he want unlicensed acupuncture to be legalized in all those states, perhaps, in the hope that total incompetents will start practicing ”

    Since there is no demonstrated difference in clinical outcomes between trained and untrained acupuncturists (except possibly in terms of risk of transmission of hepatitis and other infectious diseases), one wonders what purpose licensure would have, other than to legitimize a dubious practice in the eyes of the public.

  22. #22 Krebiozen
    February 18, 2014

    Missed a bit:

    If I accept the majority evidence for any such treatment whatsoever, those are “occasional false positives” and I’m “deceiving myself.”

    Where is this majority evidence for any such treatment you claim to accept? I have been searching for this for decades, and I can’t find it.

    Like the radiologists going berserk over the Canadian mammography study, you feel that if published data don’t support your beliefs, the published data must be wrong.

    This is getting very bizarre. You keep complaining that we reject the published data, but you don’t tell us where we can find this convincing published data?

    Where is this data that I am rejecting because of my “religion”? Please, show me a systematic review or a metaanalysis that shows an unequivocal and clinically significant effect of acupuncture over placebo.

    I just picked an acupuncture systematic review at random, and found myself with irritable bowel syndrome (not literally, thankfully). That reminded me of Ted Kaptchuk’s open-label placebo study of irritable bowel. The percentage of untreated and treated patients who improved in both these studies were 34% and 63%. In other words acupuncture performed just as well as a sugar pill the patients were told would, “produce significant improvement in IBS symptoms through mind-body self-healing processes”.

    Cochrane concludes:

    Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control for IBS symptom severity or IBS-related quality of life.

    If there is something worthy of further study here apart from perhaps looking at (being as charitable as I can) suggestion or perhaps hypnosis, I can’t see it.

    Incidentally, last night’s BBC Horizon on placebos included one of Kaptchuk’s IBS patients, who symptoms were completely controlled by the placebo, but returned after the end of the trial. Sadly she was unable to buy a placebo anywhere, even at her local health food store (they should perhaps have suggested a homeopathic remedy). One wonders why antispasmodic drugs don’t work for her, as surely they provoke a placebo response just as a sugar pill does.

  23. #23 Sastra
    February 18, 2014

    To quote a cliche that is true and modified to my own view of medicine, there is no such thing as “alternative medicine.” There is medicine that has been scientifically demonstrated to work. There is medicine that has been scientifically demonstrated not to work. And there is medicine that has not been shown to work. What makes up “alternative” medicine consists of the latter two, because once a medicine is shown scientifically to work it ceases to be “alternative.”

    I’ll agree and disagree.

    Yes, the classification of “alternative medicine” exists only in order to give certain types of medicine a lower standard of evidence to meet. Since all medicine should be judged by the same standard, this classification is worthless. I agree.

    But consider this — there’s something significantly different about most alternative medicine modalities. It’s a mixed bag and that confuses things. As you point out, the category includes claims which are not obviously scientifically implausible per se — like herbal remedies or prolotherapy. They’re not extraordinary, but either unproven or have failed to live up to expectations and should be dropped. And, if things change and scientists discover they do work, it’s unproblematic to incorporate them into the rest of “medicine.” They cease to be “alternative.”

    And of course there’s things like nutrition and exercise which should never have been included in the first place.

    But what about the rest? The vast majority of what’s called “alternative medicine” seems to be working in an alternative reality. The claims are extraordinary. As you’ve pointed out many times, things like homeopathy and reiki pull their ideas from spiritual or quasi-religious systems of sympathetic magic and vitalism. The mind/body connection is mystical substance duality.

    Frankly, if it were to turn out that some of these alternative medicines really DO work for the reasons they say they work, I would have no problem continuing to classify them as ‘alternative.’ We’ve got spiritual realms alongside the material realm. They’re so different from what’s in science-based medicine that they may well merit their own system, their own special classification. And we would admit we were wrong.

    We’d be able to admit we were wrong. If we’re doing science, then that’s important.

    It’s like the supernatural/natural problem. If scientists discovered that ghosts, souls, or something else labeled “supernatural” really exists, do we simply re-label it “natural” and continue to insist that the supernatural can’t exist? Naturalism is true by definition. Or would we be forced to concede that we were wrong and the supernatural exists after all?

    It’s not an obvious answer.

  24. #24 Antaeus Feldspar
    February 18, 2014

    You assume that for any complementary or traditional treatment for which I might point out multiple positive trials, there just must be a “sea of negative trials” outweighing them.

    Can’t speak for Krebiozen, but if you declare, as you have so many times before, that this alternative treatment or that one is supported by just bucketloads of evidence, but that you’d never know it because the meaniehead skeptics absolutely refuse to look at it, then yeah, I’m going to assume until shown differently that the real state of affairs is that the treatment isn’t supported by a lot of evidence, and what there is, is outweighed by evidence that you refuse to look at.

    It has nothing to do with my religion and everything to do with my knowledge of you.

  25. #25 Bend
    February 18, 2014

    Sastra, “If scientists discovered that ghosts, souls, or something else labeled “supernatural” really exists, do we simply re-label it “natural” and continue to insist that the supernatural can’t exist?”
    Yup, that’s exactly what we’d do. It’s what we’ve done. What were once mythical sea monsters are now giant squid and oarfish. Troy was a made up city nation until archeology showed that it wasn’t. There is no supernatural. There is only the natural which has yet to be explained.
    If chi is discovered, it will be by science and its association with alternative medicine will be nothing but an astonishing coincidence.

  26. #26 Sastra
    February 18, 2014

    Bend #25 wrote:

    Yup, that’s exactly what we’d do. It’s what we’ve done. What were once mythical sea monsters are now giant squid and oarfish.

    But ah — what if they HAD turned out to be mystical sea monsters? I think you’re taking the fact that the supernatural has always turned out wrong and confusing that with it being inherently impossible.

    Naturalism wins on the merits, not by definition or else it’s unfalsifiable. The term becomes meaningless. Likewise, it means nothing to say that “there is no alternative medicine” if the issue is at bottom a semantic quibble instead of a scientific conclusion.

    We can legitimately argue against any double standard for evidence. Absolutely. But I’m not so sure that we should dismiss ‘alternative medicine’ in one swoop by definition. It avoids the issue and looks suspiciously like stacking the deck in our favor — when we don’t have to do that. We’ve got the science!

    Yes, if chi is discovered it will be by science. Why not say then that science proved the truth of an alternative medicine?

  27. #27 Jenn H
    February 18, 2014

    @Jane

    “Can you perhaps list five clinically tested botanicals whose use SBM approves of, then?”

    Tea, coffee and chocolate are 3 that are commonly used for, well, almost everything. Opium derivatives are standard use in SBM. Low THC cannabis may be beneficial as pain relief and as an appetite stimulant for some patients. Digitalis was used to treat heart problems before a much safer synthetic alternative was created.

    I could keep naming more. SBM doesn’t reject the use of herbal remedies off hand, it’s just that many don’t show evidence that they work, or don’t work as well as other treatments, or have side effects which outweigh the benefit, or the dose is too hard to safely control if derived from natural sources.

  28. #28 Denice Walter
    February 18, 2014

    If there WERE mystical sea monsters, after their discovery, someone would catalogue their population, distribution and seasonal migrations. In addition, we would have physiognomic variation ( length, weight, fin span, tooth positioning etc), analysis of swimming patterns as well as dietary factors, genetics, mating preferences, gestation and child rearing. Sea monster cognition would become a speciality and so would study of their social groupings. They would be photographed and filmed and their scales or skin would be compared to various other sea life; possibly, subspecies would be identified.

    In short, they wouldn’t be mystical anymore.

  29. #29 Sastra
    February 18, 2014

    Denice Walter #27 wrote:

    In short, they wouldn’t be mystical anymore.

    Depends on your definition of “mystical.” If the sea monsters were manifestations of the ‘direct consciousness of the presence of God,’ then maybe we’re learning more about mysticism. Hmmm?

    Bah — forget it. The “mythical sea monsters” example Bend used was just not a good example of a supernatural claim in the first place, and my sly attempt to turn “mythical” into “mystical” in order to illustrate my point wasn’t a good idea. Bottom line, stuff like sea monsters and Big Foot and space aliens in UFOs are weird claims, but not in themselves ‘supernatural’ — unless someone starts granting them magical or paranormal powers and connecting them to spiritual beliefs.

    Ghost sea monsters. Maybe. Habits known and analyzed by the Ghostbusters. Conceivable.

  30. #30 Denice Walter
    February 18, 2014

    I would guess that we *transform* creatures and events into ‘supernatural’ entities whilst we know little of them and thus, giving free reign to fantasy, we imbue/ imagine them with ultra-natural powers and qualities. So the briefly glimpsed 30 ft whale a mile off becomes an 80 ft Leviathan hell-bent on destruction of ships and their crews.

    Limits imposed on imaginative actvities by experience and negotiaton with reality damp down the supernaturalising tendency.
    Early man may have seen gods/ mana in every blade of grass and every chirping bird.-nature itself emanating numenosity.

  31. #31 Sastra
    February 18, 2014

    Early man may have seen gods/ mana in every blade of grass and every chirping bird.-nature itself emanating numenosity.

    Yeah. Nowadays you have to sign up for a “spiritual development” course and sit around in a circle seeking numenosity for what seems like forever.

  32. #32 Denice Walter
    February 18, 2014

    An earlier 20th century writer ( Jung? Kohler?) wrote that when we are alone in the wilderness experiencing extreme weather and traversing rough ground we become as “primitive humans” imagining malevolent forces and powers of the earth and air personified very quickly.

    Fortunately, I don’t spend much time out in the elements myself.

  33. #33 Narad
    February 19, 2014

    An earlier 20th century writer ( Jung? Kohler?) wrote that when we are alone in the wilderness experiencing extreme weather and traversing rough ground we become as “primitive humans” imagining malevolent forces and powers of the earth and air personified very quickly.

    I’m reminded, and have no other likely place to mention it hereabouts, that Richard Noll, who has already been jacked around by Princeton University Press at the behest of the Jung family check-cashers, has also recently suffered a baroque retraction escapade at the hands of the Psychiatric Times.

  34. #34 herr doktor bimler
    February 19, 2014

    a baroque retraction escapade at the hands of the Psychiatric Times.

    Retractionwatch follows up that story in the ‘Weekend Reads’, linking to a recent essay by a psychiatrist on the Satanic Ritual Abuse Salem reenactment witch-hunt:
    http://www.huffingtonpost.com/allen-frances/righting-wrongs-setting-t_b_4718989.html

    The reference to ‘a handful of rogue practitioners [who] hijacked psychiatry in the name of “satanic ritual abuse”‘ seem a tad disingenuous, but when you are trying to convince an entire profession to accept collective responsibility, it is possibly easier to describe the culprits as a few rotten apples than to admit that they were right in the mainstream.

    Re Noll’s disappearing article, it’s indicative of the non-rogue, non-minority status of the pro-SRA psychiatrists. After the SRA episode, they continued to follow influential careers, and are now important enough that they can threaten legal action and un-publish essays which detailed the episode.

  35. #35 Antaeus Feldspar
    February 19, 2014

    The thing I find blackly humorous about the SRA aftermath is that it’s perhaps psychiatry’s darkest hour since the days of the lobotomy, and as such it should be a huge and for once LEGITIMATE talking point for everyone’s “favorite” anti-psychiatry group, the CCHR.

    But the CCHR is in fact pretty quiet on the issue. Gee, think it could be because the discredited “recovered memory” techniques that elicited all those fantasies of Satanic abuse rings actually pale next to the techniques Scientologists still use to “recover” memories of prenatal traumas and past lives?

  36. #36 lurker
    February 19, 2014

    ‘All the Woos down in Wooville liked Quackmed a lot
    But the Grinch, who lived just north of Wooville, did not!’

    (Sorry, couldn’t resist.)

    I’m an unabashed frequentist, so colour me sceptical about Bayesian statistics and ‘prior plausibility.’

    The best thing you can do to promote quackmed is to call for cutting off its research funding. That throws petrol on the fire of conspiracy theorising, puts the true believers into self-defence warfare mode, and plays right into the hands of their narratives.

    Instead, call for *more* research, insist on proper methodologies, and challenge the alties to come up with private-sector funding for it. If Google can hire Ray Kurzweil, who takes 120 supplement pills a day and whose doctor believes in immortality, surely they can hire a team or two to test some ‘cutting edge frontier medicine.’

    Re. de-certifying acupuncturists, acutoothpickpokers, homeoquacks, etc.: They will only form new professional organisations. Or they will form churches and claim freedom of worship. After all, needles are hardly as dangerous as handling snakes, and as with praying away snakebite, if it doesn’t work one can always claim that the patient was ‘called home by God.’

  37. #37 JCL
    right here
    February 19, 2014

    @lurker
    ‘I’m an unabashed frequentist, so colour me sceptical about Bayesian statistics and ‘prior plausibility.’ ‘

    Well, some might say that ‘frequentist’ are the woo of mathematical science.
    IIRC (its been some years) the difference between Baysian and frequentist stats is basically one can be derived from
    axioms in a deductive system and the other was made up by Bool et al so that social scientists didn’t have to learn maths
    and then most of the rest was ‘intuited’ by Fisher – his intuition was pretty good by and large probably he was a bit of a genius – but he was
    also a b**turd who surpressed Baysian methodologies and their practioners.
    Again, IIRC, any valid frequentist approach has an equivalent Baysian formulation, but frequentist stats has several
    inconsistencies and problems where it simply doesn’t offer a solution.

    The ‘prior probability’ is in fact pretty important in my view for correct reasoning.
    Correct application of a prior for instance in the Wakefield case might have lead quicker to a conclusion of ‘dodgy dealings’
    rather than ‘breakthrough science’. If someone demonstrated to me time after time their (apparent) ability to predict the next
    random card it would drive me more and more to conclude they had a really clever scam rather than they were psychic.
    It also offers a psychological reason why various proponents of woo see more data as evidence of more conspiracy rather than
    being wrong!

    If you want a reference (and a seminal read) try ET Jaynes ‘Probability Theory’ – which I’m now going to have to go blow the dust off of!

  38. #38 JCL
    February 19, 2014

    doh on the misspelling of ‘Bayesian’ – kinda robs the post of any authority at all it might have aspired to! :)

  39. #39 JerryA
    February 19, 2014

    Regarding “herbal remedies”, willow bark tea was widely used up to the mid-1800s, with the active ingredient salicylic acid, but had nasty side effects like stomach ulcers. “Herbal” and “natural” doesn’t mean “safe”. From SA, chemists made acetylsalicylic acid (aspirin), then developed acetaminophen/APA (Tylenol), then ibuprofen and other NSAID pain reliever and antiinflammatory drugs. Science-based chemistry and medicine does not ignore herbals, it incorporates and improves them in a testable manner. Quackery just takes on the trappings of modern technology (new, improved sharper sterile acupuncture needles) without going to the bother of showing *how* it works or even *if* it works. I don’t let an MD stick me with anything sharp until after I’m convinced it’s both necessary and effective. Quackery/CAM/integrative whatever fails at both.

  40. #40 rs
    February 19, 2014

    Bayesian? Frequentist? As usual, xkcd describes it well.
    http://xkcd.com/1132/

    This discussion of statistics abuse brings back memories from early in my career. Too often I witnessed firsthand social scientists and economists building models and then crunching data with their ill-conceived SPSS programs. They were so pleased with themselves and their self-learned skills using tools such as those. Their results were used in developing public policies, or at least recommendations to their political bosses. They often reminded me of drunken teenagers going for a joy ride in daddy’s car. It’s all great fun until…

    As to E. T. Jaynes opus, it is one of the more expensive items on my bookshelf. It is worth every dollar.

  41. #41 rork
    February 19, 2014

    lurker: “I’m an unabashed frequentist,”
    My comment is like rs’s – gambling on real-world phenomena may convert you. Medical decision making is such gambling.

    Example: I have a coin I just tossed once and it came up heads. Please offer me odds for betting on the next toss? Let’s repeat that game a few times until you grow sick of it.

  42. #42 Leigh Jackson
    February 19, 2014

    Krebiozen 22
    I see that there was no significant difference between acupuncture and psychotherapy in the Cochrane Review of acupuncture for IBS.

    I have long been of the opinion that acupuncture is psychotherapy by another name. I also saw the BBC blurb for placebo-power. The case of Kaptchuk’s patient who became psychologically dependent on her placebo might be considered to be an adverse effect of her brain-washing (being as uncharitable as I can).

  43. […] All of which brings me back to yet another manifestation of the pernicious influence that is the “health freedom” movement, or, as I like to call it, the freedom of quacks to prey on desperate individuals unhindered by pesky things like consumer protection laws. (I need to think of a catchier phrase to boil that concept down to a term as pithy as “health freedom.”) In any case, this brings us back to the Compassionate Freedom of Choice Act of 2014, a bill championed by the Alliance for Natural Health USA, a “health freedom” group that has yet to see a pro-quackery bill it doesn’t like and that has defended Burzynski vigorously before, as well as attacked any attempt to regulate “alternative” therapies. […]

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