Respectful Insolence

A finger in the dike isn’t enough

Every so often I wonder what the status is regarding the infiltration of pseudoscience into medicine. It’s something I’ve been writing about on a regular basis for nine years now, a phenomenon known as “quackademic medicine.” It’s simultaneously a depressing and energizing topic, energizing because it’s something I’m passionate about, but depressing because at times it seems like an unwinnable battle.

Times like now.

What depressed me this time was article that popped up in my feed on Medscape entitled, Do Clinicians Base CAM Recommendations to Patients on Evidence of Efficacy? Since “complementary and alternative medicine” (CAM) is, by and large, mostly made up of a collection of modalities either based on prescientific thinking and possessing little, if any, plausibility on a scientific basis, my first reaction was to note that health care practitioners do recommend CAM to some patients, meaning that the answer must be, “No,” and then to move on. However, I wanted to see what Dr. Désirée A. Lie, the author, said and to see what the reasons are for whatever answer she came up with. So I read on.

The article starts with a case study:

A 50-year-old man with a body mass index in the normal range presents to your office stating that he would like to be more active in outdoor sports, but he is unable to participate because of chronic low back pain. Vertebral disc prolapse had been excluded by earlier imaging, which was notable for mild osteoarthritis of the lumbar spine. In the past, physical therapy has been of limited help, although he continues to do back stretches daily. He spends 2-4 hours commuting by car to work each day and runs or walks 2-3 times a week, 30-40 minutes at a time.

The patient is asking for your recommendation for a complementary or alternative medicine (CAM) option that would improve his functioning and ability to participate in more vigorous physical activity. He does not wish to take anti-inflammatory agents because of reflux esophagitis.

Notice how the question is framed. The patient is asking for CAM. That puts a physician in a tough spot. The patient wants something magical to make his low back pain go away, and, unfortunately, for low back pain there is nothing magical. My first recommendation would be that the man find a way not to have to drive so much, because if there’ one thing that’s hard on a person with low back pain, it’s driving hours every day in a car. If that’s impossible, I’d ask the man if he could find a way to have better lumbar support and plenty of room. Or, I might suggest a few things but then tell the patient what he doesn’t want to hear, namely that if those interventions don’t work his desire to be more active in outdoor sports might not be feasible. Be that as it may, though, many docs would probably recommend some sort of “CAM” to this patient, although I would note that recommending more or different exercises or other lifestyle modalities represent what should be science-based medicine, not CAM. CAM has appropriated many of these modalities, such as lifestyle interventions or nutrition, as somehow being “alternative” when they are not.

Be that as it may, there are two questions in a survey form:

  1. Which of the following healthcare professionals is likely to recommend CAM for the patient’s low back pain?
  2. What modalities are healthcare professionals most likely to recommend?

The choices for the first question included physicians, nurses, and pharmacists—and, of course, “all of the above.” The choices for the second question included osteopathic or chiropractic manipulation, acupuncture, massage, and, again, “all of the above.” Disappointingly, by far the most common answer given for the second question was “all of the above” (61%), while for the first question the most common answer was “a nurse” (45%), followed by “they are all likely to recommend CAM” (40%). “All of the above” was listed as the “correct answer” for both questions, based on this explanation:

Since the 1990s, national survey data in the United States have reported a prevalence of CAM use that has risen from 1 in 3 patients to nearly one half of all patients.[1-4] A recent review of the 2007 National Health Interview Survey examined self-reported CAM use by healthcare workers (categorized as providers, such as physicians and nurses; technicians, such as sonographers and laboratory technicians; and support workers, such as nursing aides) using the National Center for Complementary and Alternative Medicine taxonomy (alternative medical systems, biologically based therapies, manipulative body therapies, mind/body therapies, and energy-healing therapies).[5]

The authors found a higher prevalence of use in the past year among all healthcare workers compared with the general population (41% vs 30%). As well, 76% of all healthcare workers reported using at least 1 modality in the prior year. Those working in the ambulatory setting were more likely than hospital workers to use CAM. Healthcare providers (such as physicians, nurses, and pharmacists) had a 2.2 times increased odds of seeking practitioner-based CAM modalities (such as acupuncture and manipulation) and 2.7 times increased odds of self-treated CAM modalities (such as botanicals or supplements) compared with support workers.

The most common reason given for CAM use by healthcare workers was “general wellness,” and the most commonly treated condition was anxiety in this study. There was also a significant increase since 2002 in use of the following modalities by healthcare workers: acupuncture, deep breathing exercise, massage therapy, meditation, naturopathy, and yoga.

I can’t help but note that the very first sentence promulgates a common myth about CAM, namely that anywhere from one-third to one-half of patients use it; i.e, that its so popular that it should be considered mainstream. As bloggers here at SBM, such as Steve Novella, Brennen MacKenzie, and myself, have explained, this is indeed an exaggeration, but it’s a useful exaggeration, given how it feeds CAM media myths. As Steve Novella has pointed out, for instance, that, contrary to a picture of increasing CAM use, CAM use for all categories except massage are all either static or only slightly increased. More importantly, as all of us have been pointing out again and again, these CAM numbers are inflated by including items that shouldn’t necessarily be considered outside of mainstream medicine, such as massage, biofeedback, and yoga—which, let’s not forget, is merely exercise and stretching. It’s only when pseudoscientific claims are made (as is not infrequently the case for nutrition and exercise modalities like Tai Chi and yoga) that these modalities fall outside of the mainstream and become “alternative.” Also, manipulative therapy is included. As I like to say, I have little problem with chiropractic as long as chiropractors use only manipulative therapies similar to those used by physical therapists, which is science-based medicine. I only have a problem with chiropractors when they go beyond that—which, unfortunately, all too many of them do—and become what I like to call physical therapists with delusions of grandeur, claiming to be able to treat allergies, asthma, and all manner of disease not based on the spine or the musculoskeletal system. In any case, chiropractic and osteopathic manipulation together add up to around 21%, and yoga adds nearly 10% to that.

Yes, Dr. Lie fell into that trap. She also cites a study published in 2012 claiming that CAM use is more prevalent in health care workers and providers (41% compared to 30% in the last year). If you look at the study in a bit more detail, though, you’ll soon find that it has the same issues as the 2007 NHIS had, and if you look at the numbers for individual modalities (which you can, as the study’s available at PubMed Commons for free), particularly in Table 2, you’ll see that, once again, they are dominated by manipulative therapies, 21.7% reporting having used chiropractic or osteopathic manipulation. If you look at biologically based therapies, which includes any diet-based therapy, such as vegetarian diet, macrobiotic diet, Atkins diet, Pritikin diet, Ornish diet, Zone diet, South Beach diet, as well as any use of dietary supplements, you’ll notice that 68.9% report some form of self-treatment, but only 0.3% doing “practitioner-based” therapy. One wonders whether anyone who put himself on a diet to lose weight without having a practitioner supervise it would count as having used CAM by this definition. One notes a similar issue with “mind-body” therapies. While 30.8% of health care practitioners reported using them as “self-treatment,” only 0.9% reported practitioner-based use of these therapies. One notes that yoga and Tai Chi are listed as falling under this category (supplemental information); so it’s not at all surprising that one in three people might have tried yoga or Tai Chi at some time in their lives. My wife’s done yoga. My uncle used to do yoga before it was cool to do it. I’ve thought of trying it myself to get into better shape. It’s exercise, people!

The rest of the modalities listed in Table 2 show single digit percentages for everything else, such as energy therapies, which would included reiki, therapeutic touch, and various other forms of “energy healing” (1.5%), and alternative medical systems, which would include homeopathy and ayurveda (3.0% self-treatment, 2.6% practitioner-based treatment). Next, if you look at the odds ratios in Table 4, you’ll see that, disappointingly, health care providers have an odds ratio of having used CAM in the last year of 2.6 (95% confidence interval 1.7-4.2), leading the authors to conclude:

Even with these limitations, our results are suggestive of why CAM therapies are increasingly integrated into health care. There is evidence that personal use of CAM by health care workers is related to the provision of, referral for, or general openness to the integration of CAM therapies in health care practices. For example, Tracy et al. (2005) reported a strong correlation between personal use of specific CAM therapies among critical care nurses and the use of those same CAM therapies in practice. Thus, personal use of CAM by health care workers may be a principal determinant in the movement toward “integrative care”—the mainstreaming of CAM with allopathic medicine (Mann, Gaylord, and Norton 2004; Winnick 2005). In addition, in the context of recent federal health reform changes, in 2014 when the health insurance exchanges begin, states may be more ready to license practitioners of various CAM therapies and thus require insurance coverage for CAM.

In other words, more health care providers are using CAM, at least if you believe this study and Dr. Lie’s article. The implication (and apparent hope) among CAM advocates is that this means that CAM will increasingly become more tightly “integrated” with real medicine. True, we are left with the proverbial “chicken or egg” problem in that it’s not clear whether the reason health care practitioners are apparently using more CAM, however defined, is because of the propaganda promoting its use or whether CAM is becoming more “integrated” with medicine because more and more physicians are embracing it. It could well be a vicious cycle, in which increasing “mainstreaming” of CAM through its infiltration into academic medical centers and the medical school curriculum feeds greater acceptance among physicians and therefore greater usage. While it is true, if Dr. Lie’s article is correct, that CAM use is highest among nurses, followed by pharmacists, and then by physicians. It’s noted, however, that although the average of reported usage by physicians is the lowest, geographic variability in usage among physicians is the highest, ranging from only 24% of physicians in Denver having reported ever using CAM (I really didn’t see that one coming, given Colorado’s well-known predilection for embracing quackery) to 49% of physicians in Kentucky and up to 83% of primary care physicians at a medical school (it was the Morehouse School of Medicine, for anyone who’s interested).

It all makes me wonder whether medicine has reached a tipping point, if the CAM genie is out of the bottle and can’t be put back in. A while back, I wrote about how Andrew Weil was spearheading a plan for a board certification in “integrative medicine,” which I dubbed the “ultimate triumph of quackery,” because of how it was the next step in the legitimization of “integrating” quackery with scientific medicine? Even though CAM practitioners were very cool to the idea because of turf issues (namely, only physicians could have a board certification in “integrative medicine”), physicians are apparently flocking to this new certification, so much so that the first ever integrative medicine board exam has been postponed, as announced on the American Board of Physician Specialties website:

Since announced in mid-2013, interest in the new American Board of Integrative Medicine (ABOIM) has been overwhelmingly positive. An unprecedented number of applications were received by the December 1st deadline for the first exam administration, originally scheduled for May 2014, and this tremendous demand affected our projected timelines. In an effort to ensure the highest level of customer service to both current and future applicants, we have postponed the first administration of the examination until November 2014.

It’s times like these that I wonder whether the forces of pseudoscience have already won. But then I reassure myself by pointing out that, if you exclude exercise, diet, and manipulative therapies, vanishingly small numbers of physicians and other health care providers use anything that could in any way be considered “CAM.” Most physicians don’t use CAM themselves or prescribe it for their patients. From my anecdotal experience, most physicians appear dismissive of CAM. Unfortunately, they also don’t stand up for science-based medicine (or even evidence-based medicine) enough, either. Rather they are “shruggies,” whom Val Jones defined as “fairly inert,” unwilling to “argue the merits (or lack thereof) of complementary and alternative medicine (CAM) or pseudoscience in general,” because they just “aren’t all that interested in the discussion, and are somewhat puzzled by those who are.” That leaves it to us, the ones who are interested, to sway them and hold our fingers in the dike protecting SBM from the ever-pummeling waves of quackademic medicine that have been pounding against it for the last 30 years ago. Stories like these remind me that we need to do more than just hold our fingers in the dike.

Comments

  1. #1 Shank
    March 10, 2014

    Quick question about this quote:

    “Unfortunately, they also don’t stand up for science-based medicine (or even evidence-based medicine) enough, either.”

    What’s the difference between science-based medicine and evidence-based medicine? I always thought they were synonymous. Cheers.

  2. #2 Neurokeen
    March 10, 2014

    Shank:

    This piece is one of his earlier ones where he talks about the difference in greater detail:

    http://scienceblogs.com/insolence/2012/05/14/plausibility-bias-try-reality-bias-when/

    Basically, EBM tends to overemphasize the randomized controlled trial (RCT) and adopt a stance of total indifference on a therapy before it goes through an RCT. SBM, on the other hand, tends to weigh observational studies and basic science into the equation.

    The flavor of the difference is very much tied in to the emphasis many fields place on a single study’s null hypothesis significance test.

  3. #3 Dorit
    March 10, 2014

    Question – I really don’t know: does the patient need the doctor’s recommendation or involvement in any way in getting access to CAM? Are there, for example, insurance implications if the doctor is on board? Or is the concern about the doctor’s acceptance because of the doctor’s (real enough, if the relationship is good) moral authority and expertise which can seem to put a sign of approval on the practice?

  4. #4 imr90
    Springfield, Mass
    March 10, 2014

    Science-based means there is a plausible scientific rationale for why it should work. Just because a putative scientific basis exists does not mean it will actually work in practice. Evidence-based means that clinical trials have shown it to be effective. Sometimes evidence can precede a scientific explanation, as with early aspirin use. However, scientific basis is stronger since there are weak degrees of evidence that may fail closer scrutiny.

  5. #5 jane
    March 10, 2014

    Well, just having a Mechanism may not qualify a method as scientific if it is traditional or alternative and has thereby been decreed to be pre-Scientific – take many herbal medicines whose bioactivities are being elucidated at the molecular level for an example.

    Our host here has been entertainingly mocked in another forum for descibing yoga as “just stretching” by people who would have found it even more risible if they had known that he elsewhere describes tai chi as “just stretching.” Yes, these are both modes of exercise, but they are not identical with one another nor with the sorts of exercise that have been recently invented by degreed western Experts. I can report from my own experience that a year and a half of tai chi improved my flexibility and physical function in a way that reductionist stretching never did, despite many efforts over years. There is a double attack on clinical trials of yoga and the like: as recently portrayed for the scientism crowd at Slate, they are all Worthless because the participants know they are doing yoga, and on the other hand, if you accept their results, you should take them instead as evidence that Western-style exercises would be as good or better yet, better. Both are ideological positions not supported by any form of science-as-process.

  6. #6 Calli Arcale
    http://fractalwonder.wordpress.com
    March 10, 2014

    I can’t help but note that the very first sentence promulgates a common myth about CAM, namely that anywhere from one-third to one-half of patients use it; i.e, that its so popular that it should be considered mainstream

    One thing that maybe should be asked when we see claims that it’s becoming “mainstream” is “mainstream what?” There isn’t just one mainstream, after all, and there’s a difference between “mainstream medicine” and “mainstream culture”. I would contend that CAM is becoming the latter, but not the former, and purveyors are counting on the public not to realize the difference — or do not even recognize that difference themselves.

  7. #7 JerryA
    March 10, 2014

    Are physicians flocking to Integrative Medicine(tm) because they believe in the woo, or because it’s easy to get Board certified in prescribing diet, exercise and vitamins? (Not that vitamins will do any good in most cases, excluding real deficiencies, but at least there is little chance of harm at RDA levels.) I think a lot pf physicians are practical folks. So, belief in “healing energy” or a chance to attract a broader set of patients, and the ability to bill as “integrative therapy” for previously ignored common sense advice they’ve been giving already?

  8. #8 Narad
    March 10, 2014

    Yes, these are both modes of exercise, but they are not identical with one another nor with the sorts of exercise that have been recently invented by degreed western Experts.

    Given that asana yoga is a fairly modern amalgam of Primitive Gymnastics and vyayamasala exercises, it’s Mysterious Eastern bona fides aren’t the greatest.

    I can report from my own experience that a year and a half of tai chi improved my flexibility and physical function in a way that reductionist stretching never did, despite many efforts over years.

    There’s something you don’t hear every day.

  9. #9 palindrom
    March 10, 2014

    shank @1, imr90 @3 — To expand on this a bit, “evidence based medicine”, as I understand it, tends to privilege the clinical trial as a form of evidence, while “science-based medicine” adopts what might be called a Bayesian approach — assigning low prior probabilities to modalities which, in order to be effective, would require a wholesale reworking of well-tested laws of physics and chemistry.

    Here’s a hypothetical example. Suppose you had a study of homeopathy which showed an effect which would only be explained by random chance 1/1000 of the time. Adherents to pure “evidence-based” medicine might see this as persuasive. However, if otherwise extremely reliable laws of physics and chemistry are correct, then homeopathy has to be bunk; adherents of science-based medicine would have no problem disregarding such a study, because in their eyes the prior likelihood of homeopathy being anything but a placebo is very close to zero.

    Remember this example is hypothetical — I don’t follow this stuff very closely, so I can’t discuss the pros and cons of the actual clinical trials. I do get the impression that the signal is nowhere near compelling, and absolutely not strong enough to overcome the minuscule a priori probability of there being a real effect beyond placebo.

  10. #10 Narad
    March 10, 2014

    With respect to “reductionist stretching,” it occurs to me that it’s probably worth noting explicitly that the ‘Chi’ in “Tai Chi” doesn’t refer to qi.

  11. #11 squirrelelite
    March 10, 2014

    @palindrom, good point.

    I was going to suggest reading the first postings on the Science Based Medicine blog, but they don’t seem to be available since the switch to a different platform. The earliest I saw was January 2008, and a quick search didn’t reveal any articles that specifically or primarily discussed this point.

    Perhaps, Orac could provide a link to a good one.

    On yoga as exercise, I would note that while yoga has an ancient tradition in India, it was used as a cover during the late 19th and early 20th centuries to provide physical training for Indian men to prepare for possible fighting as soldiers against the British. These methods used physical fitness training techniques developed in Sweden during the 19th century.

    Also, Russian rhythmic gymnasts like Yulia Barsukova and figure skaters like Julia Lipnitskaia manage to achieve extraordinary flexibility in a “Western” exercise discipline. (I don’t know if they do some yoga-style stretching exercises.)

    It might be fair, if perhaps confusing, to characterize yoga and tai chi as boundary methodologies. The core techniques of what is actually done have some good evidence to support them, but the discipline as a whole has a significant quantity of extraordinary claims that lack such supporting evidence.

  12. #12 Orac
    March 10, 2014

    I was going to suggest reading the first postings on the Science Based Medicine blog, but they don’t seem to be available since the switch to a different platform. The earliest I saw was January 2008, and a quick search didn’t reveal any articles that specifically or primarily discussed this point.

    SBM went live on January 1, 2008; so it is not surprising that you didn’t find any posts earlier than this. :-)

    Kimball Atwood’s earliest posts are the ones that best explain it, though.

  13. #14 Chadwick Jones
    March 10, 2014

    Reminds me of the ad I heard on NPR this morning from the Cancer Treatment Centers of America, with an emphasis on their integrative oncology services. :(

    http://www.cancercenter.com/ctca-difference/integrative-cancer-treatment/

    Apparently they can boost your immune system. 0_o

  14. #15 Narad
    March 10, 2014

    On yoga as exercise, I would note that while yoga has an ancient tradition in India

    Let’s not confuse the yoga of Patanjali with the hatha yoga that emerged much later. The last time I checked, the Hatha Yoga Pradipika has no standing asanas and arguably provides the postures as aids to meditation. We’re talking the late 17th century when these start to be documented.

  15. #16 Narad
    March 10, 2014

    ^ (“these” being standing postures)

  16. #17 palindrom
    March 10, 2014

    The Yogi I follow most religiously is Berra.

    Attributed:

    Questioner: “What time is it, Yogi?”

    Yogi Berra: “Do you mean, right now?”

  17. #18 squirrelelite
    March 10, 2014

    Thanks, Orac.

    I think I was fooled by seeing the newest (end of the month) postings first.
    Here is the one I remember reading:
    http://www.sciencebasedmedicine.org/hello-world/#more-1

    And, for those interested, after a 5 part take down on homeopathy, Kimball Atwood does a detailed explanation of SBM vs EBM starting here:
    http://www.sciencebasedmedicine.org/prior-probability-the-dirty-little-secret-of-evidence-based-alternative-medicine-2/

  18. #19 squirrelelite
    March 10, 2014

    You’re right Narad.
    I was mainly responding to jane @5, where she states:

    Yes, these are both modes of exercise, but they are not identical with one another nor with the sorts of exercise that have been recently invented by degreed western Experts.

    Because of the cross-fertilization of exercise techniques I mentioned, one would need to go back to pre-1800′s published descriptions of yoga exercises to confidently assert that a specific exercise was developed in India and not in the west.
    But, I should try to read more about the details.

  19. #20 Old Rockin' Dave
    On the expressway to your heart...
    March 10, 2014

    (A divergence from the topics here.)
    It occurs to me that when S-CAM promoters talk about nutrition that they never seem to talk about is the most important nutritional change that anyone can make, and that is to lose weight. The only time they mention weight loss is to promote some more or less obscure substance, usually one that they just happen to be able to sell to you.
    We all know this and pass comment on it regularly, put I don’t recall anyone using this as a counterargument.

  20. #21 squirrelelite
    March 10, 2014

    Also, Narad, that was where I remember reading about this in the first place. The Wikipedia entry pretty much ignores this.
    But, your links in that comment seem to be broken now :(

  21. #22 Mark Thorson
    March 10, 2014

    Watch what you say about quackademic medicine! You might need a new source of income soon.

    http://news.sciencemag.org/funding/2014/03/1000-nih-investigators-dropped-out-last-year

    Perhaps you should consider selling supplements on your blog. Or crystals. Detoxing is big. “Cancer Doc Says You Should Be Eating These Berries!”

  22. #23 Denice Walter
    March 10, 2014

    @ Old Rockin’ Dave:

    *Au contraire, mon ami*
    I think that I’ve mentioned that some orthorectic woo-meisters appear to be obsessed with weight and use the promise of losing weight (although possibly disguised) as a way to promote veganism and raw food fads. Similarly juicing and fasting.
    Perhaps “healthy” is a code word for “thin”.

  23. #24 Sastra
    March 10, 2014

    It’s times like these that I wonder whether the forces of pseudoscience have already won. But then I reassure myself by pointing out that, if you exclude exercise, diet, and manipulative therapies, vanishingly small numbers of physicians and other health care providers use anything that could in any way be considered “CAM.”

    Here’s a question I find interesting. Assume that a tipping point is reached and CAM has actually become mainstream. Which strategy would be wisest?

    An accomodationist one, where SBM proponents smile hard and agree that CAM works, but argue that it ought to be limited to well-proven exercise, diet, and manipulative therapies, as well as any herbal remedies which are tested and shown to work?

    Keep firm and insist that no, the parts that work are not CAM and no, the whole category of CAM should be thrown out no matter how popular it is because the core definition involves pseudoscience.

    Might the tactic depend on the level of CAM acceptance?

  24. #25 Krebiozen
    March 10, 2014

    jane,
    Here we go again ;-)

    Well, just having a Mechanism may not qualify a method as scientific if it is traditional or alternative and has thereby been decreed to be pre-Scientific –

    Just having a mechanism won’t cut it for any treatment, it has to be effective and have an acceptable safety profile too. Can you give a single example of a method with prior scientific plausibility and positive clinical trial results that has been rejected merely because it is “traditional or alternative”? Why would NCCAM and OCCAM have spent billions of dollars researching traditional or alternative treatments if they could never, a priori, be accepted into conventional medicine?

    take many herbal medicines whose bioactivities are being elucidated at the molecular level for an example.

    Again, do you have any specific examples of this? I can think of herbal remedies like St John’s Wort, kava kava, ginkgo biloba and valerian which are all used for subjectively assessed disorders like anxiety, depression and insomnia, and which have variable evidence for a small effect (St John’s Wort was never used traditionally for depression, by the way, this is a modern idea). Then there are phytochemicals like curcumin, which may eventually be formulated into a useful drug. I can’t think of any herbal medicine that hasn’t been subject to at least some research to evaluate efficacy.

    Many conventional drugs based on traditional treatments, such as opiates, cocaine, aspirin, digoxin, quinine, physostigmine, pilocarpine, d-tubocurarine, and ephedrine, for example; I could go on. There is still an entire scientific field, pharmacognosy, that is based on looking for useful drugs in plants, and traditional uses of herbs are a part of this.

    Our host here has been entertainingly mocked in another forum for descibing yoga as “just stretching” by people who would have found it even more risible if they had known that he elsewhere describes tai chi as “just stretching.”

    Please, do explain how specifically yoga and tai chi are more than stretching. I fail to see what else is involved, apart from mild to moderate exercise and some visualization of imaginary energies. More than this, there are a bewildering number of different forms of both, especially tai chi, all of which claim to be the One True Tai Chi.

    Yes, these are both modes of exercise, but they are not identical with one another nor with the sorts of exercise that have been recently invented by degreed western Experts.

    Are you really expecting us to believe that the specific movements in tai chi have been carefully refined, correlating changes in technique with short to long term health outcomes since the 13th century when they were supposedly developed (more likely 17th to 19th centuries)? Do they really contain distilled oriental wisdom that those degreed western experts cannot rival despite their superior understanding of physiology and biology generally? Did someone say “risible”?

    We rightly consider European understanding of health in the 17th century to have been primitive, so why do some elevate Chinese medicine from the same period, based on a similar level of ignorance of physiology, biochemistry, cell biology etc etc. as somehow containing ancient wisdom? Look at the dismal state of health and life expectancy in China since the 13th century, until the introduction of modern scientific medicine.

    I can report from my own experience that a year and a half of tai chi improved my flexibility and physical function in a way that reductionist stretching never did, despite many efforts over years.

    You will have trouble convincing me that tai chi is superior to an exercise regime put together by a physiotherapist. Which “reductionist stretching” was this?

    There is a double attack on clinical trials of yoga and the like: as recently portrayed for the scientism crowd at Slate, they are all Worthless because the participants know they are doing yoga, and on the other hand, if you accept their results, you should take them instead as evidence that Western-style exercises would be as good or better yet, better. Both are ideological positions not supported by any form of science-as-process.

    Shouldn’t we start from the null hypothesis, which is that there is no difference in the efficacy of different exercise regimes, and only abandon that null hypothesis if we have good evidence to support this? From a science-based medicine position I struggle to see any rational mechanism for yoga or tai chi being significantly superior to physiotherapy.

  25. #26 Iorek
    Australia
    March 10, 2014

    Here in sunny Oz, when you buy private health insurance it is difficult to avoid paying for the opportunity to get money back for going to the naturopath, osteopath, homeopath…you get the idea. I wonder if people, feeling rotten and not being ‘cured’ by actual doctors, feel these things must be mainstream-why else would the insurer be offering them-and so go along and give it a try. The insurers also support ‘lifestyle’ interventions-the cost of my husband’s pilates classes, run by a physiotherapist, is fully covered by the health insurer.

    Re yoga, I’ve been going for eight years, and am way more flexible etc than I was when I started. I go twice a week, about 45 weeks a year, for about two hours each time. Pretty much anything done that regularly for that long would have some effect-desirable in the case of yoga, perhaps less so if the activity was, for example, drinking beer.

  26. #27 Nathanael
    March 10, 2014

    ” The patient wants something magical to make his low back pain go away, and, unfortunately, for low back pain there is nothing magical. My first recommendation would be that the man find a way not to have to drive so much, because if there’ one thing that’s hard on a person with low back pain, it’s driving hours every day in a car.”

    Well, yeah. But if you look at actual scientific evidence from the studies which have been done, you’ll find that trigger point massage is going to help him. Also Alexander technique for posture.

    Conventional physical therapy is mostly woo. There’s no evidence behind a lot of it, unfortunately.

    One of the problems with “conventional doctors” is that they assume that there’s actual evidence behind “conventional” physical therapy. There isn’t. If you look at the German studies, a bunch of the so-called “alternative” therapies simply work better than conventional physical therapy.

    Don’t assume that the people who designed yoga and tai chi routines were stupid. They weren’t. They examined muscles — easy enough to study, and the anatomical diagrams are ancient in both China and India — and they did spend centuries refining their techniques.

    Are traditional calisthenic techniques such as Tai Chi and yoga gonna do much for anything other than muscles, or the things connected to them? No. Are they gonna be better than Western calisthenics which have had a *lot* less history and testing? *Of course they’re going to be better*. Why wouldn’t they be? You’d actually *expect* them to be better — more testing.

    Just like “organic” agriculture. The reason it’s safer is that *the techniques have been tested longer*, for hundreds or thousands of years rather than a mere couple of decades, and as a result we *know* all the downsides. With modern chemical agriculture, we *don’t know how ignorant we are* — we are dealing with *unknown unknowns*, to use Rumsfeld’s phrase. With ancient techniques, you can be sure that all the downsides have been recorded over the hundreds of years they’ve been used.

    ” Can you give a single example of a method with prior scientific plausibility and positive clinical trial results that has been rejected merely because it is “traditional or alternative”?”

    Pretty damn near any branch of massage. I’m not saying *every* doctor or scientist rejects massage — but far too many do, just from out-of-hand bias. I’m glad you don’t, but remember that this is what gets rejected when doctors are hostile to “alternative medicine”. When the massage isn’t covered by insurance, but the crappy traditional 1950s PT exercises are….

    “More importantly, as all of us have been pointing out again and again, these CAM numbers are inflated by including items that shouldn’t necessarily be considered outside of mainstream medicine, such as massage, biofeedback, and yoga— which, let’s not forget, is merely exercise and stretching.”

    Yoga’s actually not merely exercise and stretching. It’s one part exercise and stretching and one part meditation. (And yes, meditation of any number of varieties has been proven to be effective for a bunch of stress-related stuff, as well as for concentration and learning, in controlled studies.) Having met some actual yogis, I can tell you that advanced yoga is basically a practice for attaining the same kind of mental control over the body attained with biofeedback. People often attach weird religious stuff to it, but leaving that aside, it seems to work comparably to biofeedback for the same goals… but with less equipment.

    “It’s only when pseudoscientific claims are made (as is not infrequently the case for nutrition and exercise modalities like Tai Chi and yoga) that these modalities fall outside of the mainstream and become “alternative.””
    You can *say* this, and I wish you were right, but it doesn’t affect the insurance codes or what gets published in the American medical journals, which still consider them all “alternative”.

    The basic way most doctors think is, bluntly, this: If it doesn’t involve surgery or drugs, it’s “alternative”. This is a crap way of thinking, but in practice this is what you see among most doctors in the “wild”.

    So these perfectly-good modalities *do* get considered “alternative*, and I’d like to know what you’re doing to fix *THAT*, because if you fix that, you’ll see fewer people chasing after ridiculous stuff. And that would be a hell of a lot more valuable to everyone than crusades against the nonsense.

    Again, when studies have actually been done (mostly not in the US) comparing traditional yoga practices to western exercises, the yoga practices are often better. (There are dozens of different “traditional yoga practices”, so you have to pick your category.) But scientism is alive and well, as we see from thoughtless, ignorant comments such as “Krebiozen”‘s.

  27. #28 Nathanael
    March 10, 2014

    ” I reassure myself by pointing out that, if you exclude exercise, diet, and manipulative therapies, ”

    Well, if you add meditation into the list, you’ve got all four of the categories where “traditional medicine” often gives better advice than “Western medicine”.

    So, if you exclude the alternative medicine which works, then nobody uses alternative medicine!

    There’s something funny about this discussion. It seems semantic. When you get down to nuts and bolts, what are you talking about?

    When most people are talking about “alternative medicine”, they’re talking about getting insurance approval for massage, yoga, meditation, tai chi, unusual diets, etc. Bluntly speaking. Get that approval and the debate over “alternative medicine” will go away.

  28. #29 Nathanael
    March 10, 2014

    BTW, I don’t want to get started discussing the screwball crap which goes by the name of “yoga” these days. When the British arrived in India in the 1690s, the yogis were happy to discuss their practices with the British in the spirit of shared knowledge; and their medical practices were often better.

    By the 1920s in the US, there was a concerted effort being made to share the empircal knowledge of techniques and methods which had been acquired in different cultures at different times, with different theories, and to integrate it into a single scientific paradigm.

    This kind of evaporated in the 1930s and most of the bigoted Western establishment decided to simply ignore the hard-won knowledge of other cultures, rather than trying to integrate it. Much of what you see now is backlash against that particular form of ignorant arrogance.

    This (1930s-1950s) was the period when the Western medical establishment routinely gave penicillin for everything, not just bacterial infections, and even when people were allergic to penicillin — it was a deeply anti-scientific period in medicine.

  29. #30 Krebiozen
    March 10, 2014

    Nathanael,
    I don’t think much of what you have claimed in your comments is true.

    Conventional physical therapy is mostly woo. There’s no evidence behind a lot of it, unfortunately.

    Such as? My impression from talking to physiotherapists and having had physiotherapy myself is that it has a strong evidential base, and that physiotherapists are very aware of the importance of this. I’m in the UK, but I very much doubt it is very different elsewhere.

    One of the problems with “conventional doctors” is that they assume that there’s actual evidence behind “conventional” physical therapy. There isn’t.

    There are 600 systematic reviews with the phrases “physiotherapy” or “physical therapy” in their title on PubMed, which seems like quite a lot of evidence to me. A quick look at the role of physiotherapy in treating shoulder impingement syndrome, which I have recently had, and which was successful, finds evidence that it is at least as effective as surgery. In short, I don’t believe you.

    If you look at the German studies, a bunch of the so-called “alternative” therapies simply work better than conventional physical therapy.

    Which German studies are these? I’m not familiar with them. Citation?

    Don’t assume that the people who designed yoga and tai chi routines were stupid. They weren’t.

    I’m not suggesting they were stupid, but they lacked any real understanding of physiology. The ancient Chinese had a horror of mutilating the human body, and dissection of corpses was prohibited until the 20th century. How could they possibly have developed an understanding of the human body more advanced than we have now?

    They examined muscles — easy enough to study, and the anatomical diagrams are ancient in both China and India — and they did spend centuries refining their techniques.

    With completely inaccurate ideas about how the human body works based on superstition and magic ( yin-yang and the five phases for example) and without any understanding of randomized clinical trials I don’t believe they could have refined their techniques the way modern treatments are refined and tested. If they did refine them, how is it that we find so many different versions of yoga and tai chi? Why was the health of the ancient Chinese and their life expectancy the same as, or even worse than it was in Europe at the time?

    One last thing I can’t ignore:

    This (1930s-1950s) was the period when the Western medical establishment routinely gave penicillin for everything, not just bacterial infections, and even when people were allergic to penicillin — it was a deeply anti-scientific period in medicine.

    Deeply antiscientific? Utter nonsense. This era was the dawn of scientific medicine, when doctors at last had effective treatments for bacterial infections (even TB and syphilis), for diabetes, for vitamin deficiency diseases, for malaria and when clinical trials first came into common use. DNA was discovered, steroids were first used, viruses were first isolated, chemotherapy was invented, new vaccines were developed… The 1950s saw an explosion of new effective medical treatments and by 1960 life expectancy was higher than ever before in human history. How anyone can describe this extraordinary period in human history as unscientific I do not understand.

  30. #31 reader
    March 10, 2014

    If you knew anyone getting penecillin before 1942, it was probably from moldy food…..

  31. #32 Chris,
    March 10, 2014

    Nathanial: “They examined muscles — easy enough to study, and the anatomical diagrams are ancient in both China and India — and they did spend centuries refining their techniques.”

    How? Especially in China where human dissection was prohibited.

  32. #33 Calli Arcale
    March 10, 2014

    One only needs to look at the most detailed anatomical drawings in regions and time periods where dissection was forbidden to see clearly how badly this hampered medical training. Oh, I’m sure they had a good idea of what muscles looked like from the outside, but their opportunities to look under the hood were few and far between given strong taboos on desecration of the dead. (At the very least, you’d lose the patronage you depended upon for your entire ability to study.) There are some particularly quaint depictions of pregnant women.

  33. #34 herr doktor bimler
    March 10, 2014

    This (1930s-1950s) was the period when the Western medical establishment routinely gave penicillin for everything, not just bacterial infections

    Nathanael, you do realise (I hope) that penicillin was not even available in oral form until nearly the end of your 30-year window.

  34. #35 Chris,
    March 11, 2014

    I love it when folks like Nathanial and others come here to edumacate us, and totally get basic history wrong, wrong, wrongety wrong.

    It is so amusing.

  35. #36 AnnB
    March 11, 2014

    I wouldn’t be so quick to write off Asian study of the outside form. They did give us martial arts and multiple ways of killing a human. Not that I am saying it is scientific, just that it is.

  36. #37 Chris,
    March 11, 2014

    “Not that I am saying it is scientific, just that it is.”

    A scene from Raiders of the Lost Ark comes to mind.

  37. #38 Chris Hickie
    March 11, 2014

    Will any large medical groups truly stand up to quackery?
    A: no.
    Here’s a relatively recent article from the Journal Pediatrics highlighting how a chiropractor didn’t think that continued and worsening back pain in a teen despite chiroquacktic treatment might be something else….like testicular cancer (http://pediatrics.aappublications.org/content/128/Supplement_4/S200.full) . Do the authors of this article use this an an opportunity to say chiropractors should not see children. Of course not. Instead they stupidly say chiropractor and their “colleges” need to learn and teach more pediatric-based curriculum.

    Just great.

  38. #39 Narad
    March 11, 2014

    (St John’s Wort was never used traditionally for depression, by the way, this is a modern idea)

    I’m not aware of any indigenous use of kava other than as a frank intoxicant.

  39. #40 Narad
    March 11, 2014

    When the British arrived in India in the 1690s, the yogis were happy to discuss their practices with the British in the spirit of shared knowledge; and their medical practices were often better.

    “Like a house protecting one from the heat of the sun, Haṭha Yoga protects its practiser from the burning heat of the three Tâpas; and, similarly, it is the supporting tortoise, as it were, for those who are constantly devoted to the practice of Yoga.

    “A Yogî desirous of success should keep the knowledge of Haṭha Yoga secret; for it becomes potent by concealing, and impotent by exposing….

    “Placing the right ankle on the left side and the left ankle on the right side, makes Gomukha-âsana, having the appearance of a cow….

    “Having placed the right foot at the root of the left thigh, let the toe be grasped with the right hand passing over the back, and having placed the left foot on the right thigh at its root, let it be grasped with the left hand passing behind the back. This is the âsana, as explained by Śri Matsyanâtha. It increases appetite and is an instrument for destroying the group of the most deadly diseases. Its practice awakens the Kundalinî, stops the nectar shedding from the moon in people….

    “Having stretched the feet on the ground, like a stick, and having grasped the toes of both the feet with both the hands, when one sits with his forehead resting on the thighs, it is called Paśchima Tâna.

    “This Paśchima Tâna carries the air from the front to the back part of the body (i.e., to the suṣumna). It kindles gastric fire, reduces obesity and cures all diseases of men.

    “Place the palms of both the hands on the ground, and place the navel on both the elbows and balancing thus, the body should be stretched backward like a stick. This is called Mayûra-âsana.

    “This Âsana soon destroys all diseases, and removes abdominal disorders, and also those arising from irregularities of phlegm, bile and wind, digests unwholesome food taken in excess, increases appetite and destroys the most deadly poison….

    “Press firmly the heel of the left foot against the perineum, and the right heel above the male organ. With the chin pressing on the chest, one should sit calmly, having restrained the senses, and gaze steadily the space between the eyebrows. This is called the Siddha Âsana, the opener of the door of salvation….

    “Some call this Siddhâsana, some Vajrâsana. Others call it Mukta Âsana or Gupta Âsana….

    “Out of the 84 Âsanas Siddhâsana should always be practised, because it cleanses the impurities of 72,000 nâḍîs.

    “By contemplating on oneself, by eating sparingly, and by practising Siddhâsana for 12 years, the Yogî obtains success.”

  40. #41 Narad
    March 11, 2014

    This kind of evaporated in the 1930s and most of the bigoted Western establishment decided to simply ignore the hard-won knowledge of other cultures

    After Krishnamurthi torched the Order of the Star?

  41. #42 herr doktor bimler
    March 11, 2014

    I’m not aware of any indigenous use of kava other than as a frank intoxicant.

    That is all very well for Frank, and I am pleased for him, but what about the rest of us?
    Kawa-kawa — the New Zealand version of kava — had its pre-European uses in poultices and such. These days it’s being used by our more innovative brewers, as a flavouring element in beer (with the side effect of turning one’s face numb).

  42. #43 The Smith of Lie
    March 11, 2014

    I know it is juvenile, but I can’t skip over the strange synchronicity, of the medscape article author having name, that sounds like “desire a lie”. The coincidence is too much.

  43. #44 Krebiozen
    March 11, 2014

    I know it is juvenile, but I can’t skip over the strange synchronicity, of the medscape article author having name, that sounds like “desire a lie”. The coincidence is too much.

    Now that really is an ad homonym attack on Dr. Lie.

  44. #45 AnnB
    March 11, 2014

    Chris A scene from Raiders of the Lost Ark comes to mind

    Well, that is all very well and good – until you run out of bullets. See Temple of Doom.

    My apologies, I couldn’t find a youtube video of the scene. Apparently it is all about Legos these days.

    OT: Are you all on the east side of the Atlantic? It seems like some here never sleep and I am being to question whether you are human.

  45. #46 AnnB
    March 11, 2014

    ….I mean beginning to question whether you are human.

    As you can see I am human and very prone to the effects of sleep deprivation unfortunately.

  46. #47 Chris
    March 11, 2014

    I’m on the east side of a bigger ocean.

  47. #48 Krebiozen
    March 11, 2014

    Between us I think we have most time zones covered.

  48. #49 Shank
    March 11, 2014

    @neurokeen and palindrom: Good explanations. Thanks!

  49. #50 Denice Walter
    March 11, 2014

    Actually, I’m an android.
    I throw in references to alcohol, curry, fashion, sexuality and vernacular coarse speech in order to convince readers that I’m a real person.

  50. #51 Lurker
    March 11, 2014

    Jane @ 5 coined a splendid meme: ‘reductionist stretching.’

    Methinks someone in SBM should trademark it (with capital letters: Reductionist Stretching) and offer it as ‘the All Natural alternative to Supernatural Stretching’! All Natural Science with no Supernatural ingredients!

    Thank you, Jane, though you knew not what you did!

    Though, there is probably a mechanism for Jane’s and others’ reports of benefits from supernatural ingredients: placebo + belief >> endorphins >> sense of comfort and wellbeing.

    Re. ‘energy healing,’ or perhaps that should be, ‘Energy Healing’:

    Next time someone starts talking about ‘energy,’ ask them, how many milliwatts per square metre, and how do they measure it?

    Palindrom @ 9: I’m an unabashed frequentist and a sceptic of Bayesian stats and ‘prior plausibility.’ The latter in particular comes across as inherently qualitative and subjective. ‘It can’t exist, therefore it doesn’t exist,’ is questionable at best (and I’m also an unabashed empiricist, so there!;-).

    Why not just quantify it by setting a higher significance threshold for the hypothesis? For example add a decimal place: for the social sciences, instead of a threshold of p < .05, use p < .005.

    Your hypothetical example of homeopathy showing results at p < .001 makes my case: If any such result actually obtained, IMHO it would be pretty damn strong in favor of homeopathy: time to stop debating 'does it exist?' and start looking for a mechanism (or an animism, as it were;-). But the plain ordinary mundane fact is, there are no such strong results for homeopathy, only wishy-washy clinical studies that show placebo effects at best, plus the one in the major journal (was it Nature?) that James Randi debunked and got retracted. We haven't that to worry about.

    On the other hand, why use different standards of evidence at all? That just lets shoddy research get by, if it happens to agree with our biases. Imagine how much less rubbish would be published if the social sciences in general insisted on p < .005 or even p < .01. Do likewise for medical science, and all the quackadoodle stuff will go swirling down the drain where it belongs.

  51. #52 Mephistopheles O'Brien
    March 11, 2014

    I’m unsure about the fuss about yoga or t’ai chi, when I suspect everyone can agree that:
    - exercise and stretching have known health benefits.
    - yoga and t’ai chi are a form of exercise and stretching.
    - not all methods to stretch and exercise are equally effective.

    So it is certainly possible that these forms of exercise could have health benefits and could be better for various reasons than other forms of exercise to achieve some results. Like other exercises, they may help reduce stress and improve sleep.

    As long as the claims made for these don’t exceed what is provable, then the question is both how well these exercises stack up compared to others, and whether people are more likely to stick with them than with other exercises.

  52. #53 JGC
    March 11, 2014

    So, if you exclude the alternative medicine which works, then nobody uses alternative medicine!

    Self evident, because ‘alternative’ medicine that’s proven to work isn’t alternative: it’s just medicine.

  53. #54 AnnB
    March 11, 2014

    All the time zones make much more sense than androids. Although, I am positive that I have met the Stepford wives in corporate America, and they come in both sexes.

    My comment was driven by the observation that the threads here move at hyper-speed compared to other blogs where it takes so long to get a reply or to learn something new it is like watching paint dry. That’s a compliment by the way. I confess I find it difficult to keep up with you all though and with the Daylight Savings time change, it has been particularly challenging.

    But, back to the main topic. I have sleeping disorders and am cursed with excessive daytime sleepiness and/or fatigue. My GP of nine years was not interested in a differential diagnosis, it was straight to antidepressants within two 10 minutes visits and a few (really a few) normal labs, so I decided to visit a nautropath. [Note, I was also being treated at a sleep clinic at the time. Their meds didn't really work and I found if your spontaneous arousal is not tied to a respiratory event or RLS then they are pretty much clueless too.]

    There are not too many choices in upstate NY for naturopaths, but I was able to get an appointment with a fairly young graduate of Bastyr Univerity. She meant well and spent an hour with me per visit, but nautropaths are not allowed to order tests in this state so I gained no traction there. To summarize the three visits, I was advised to order a whole bunch of supplements, most I tried and not a darn one worked, since my fatigue was a mystery she dwelt on my high blood pressure (just like my GP) for a majority of the time instead, and when she advised that I just keep upping my melatonin dose until it improved my sleep, I pretty much ran away from that office. The upsides to the visits, I felt like someone listened to me, I have no illusions about natural medicine anymore and I know that I have covered that base in trying to find out what is wrong with me.

  54. #55 palindrom
    March 11, 2014

    Mephistopheles — I find that the best exercise is to go over to the philosophy department, find a few reductionists. and attempt to stretch them.

    They do tend to get annoyed, though.

  55. #56 anon
    March 11, 2014

    @AnnB
    I empathize with your sleep disorder. It’s a long hard road to wellness. I have been diagnosed with PTSD, depression, hyperesthia, mitral valve prolapse, 3 herniated discs. But it’s also an individual one and I’ve spent years researching. I’m OK now but I would continue the search. Because I am biased in my individual case to psychological well-being, I choose diet and supplements. I did not do well on Paxil. I had awful side effects. One (i can’t remember the name of)
    gave me facial spasms.
    Obviously I may need surgery for the mitral valve and herniated discs but so far I can still do yoga. There is no easy answer, we are all unique individuals. I am lucky in the gene area as I went through college on coffee and cigarettes.
    Good luck in your search and never, ever give up.

  56. #57 anon
    March 11, 2014

    Also high cholesterol, was prescribed Lipitor ( didn’t take it) but with careful dieting and exercise got it down to an acceptable range according to my cardiologist.

  57. #58 AnnB
    March 11, 2014

    @anon – Thanks for the sentiment. You have (had) a lot going on and I am glad you are OK now.

    I sound like I am a very ill individual, but for most of life I didn’t visit doctors for more than strep throat or an upper respiratory infection. It is in only the past three years that my health has gone south. I have made progress after the nautropath. My new GP referred me to a gastroenterologist and an endoscopy determined Grade C esophagitis. I have pretty much deduced that is silent reflux causing my poor sleep and now I “self-medicate” with diet and exercise. So, “mainstream” medicine to the rescue, but i am glad I didn’t the first cure they offered me.

  58. #59 Mephistopheles O'Brien
    March 11, 2014

    So, if you exclude the alternative medicine which works, then nobody uses alternative medicine!

    Not entirely true. People do use things that don’t work, or aren’t shown to provide the benefit claimed. Diet and exercise as a way to reduce cholesterol and strengthen your heart – that’s fine. Diet and exercise to cure cancer – not quite so fine. Chiropractic to relieve lower back pain – fine. Chiropractic to cure allergies – not quite so fine. Massage to help you relax and ease soreness – fine. Massage to, well, pretty much anything else – not so fine. Chelation to cure acute heavy metal poisoning – fine. Chelation to cure autism – not fine at all.

    Of course there are those things like acupuncture, MMS, homeopathy, reiki, or therapeutic touch where much more evidence is needed before saying “fine” in pretty much any context.

  59. #60 Krebiozen
    March 11, 2014

    AnnB,
    I’ve been pondering this on and off today:

    I wouldn’t be so quick to write off Asian study of the outside form. They did give us martial arts and multiple ways of killing a human. Not that I am saying it is scientific, just that it is.

    You can learn a lot about large short-term effects, such as death, through trial and error, but there are limits. To detect subtle and/or medium to long-term effects you need a randomized clinical trial, or something resembling one, in order to detect a signal amongst all the noise of human health, and the multiple variables that affect it. Not least, that requires a knowledge of statistics that I don’t believe was available in ancient or medieval China.

    When this or similar claims of ancient wisdom arise I always remember aristolochia, a medicinal herb recommended in TCM but which causes renal failure, cancer and death. If traditional Chinese doctors were unable to detect this rather large long-term effect from this herb, I don’t believe they would have detected smaller medium to long-term effects. The same could be said for other damaging treatments used and in ayurvedic medicine, which arises from the same traditions as yoga. I also think the same applies to the tai chi masters; I see no reason to think they were any better at this than doctors at that time. However wise the ancients might have been, they didn’t have access to the same quality of data and means of analyzing it that we do today.

    Look at what was required to unequivocally demonstrate that smoking cigarettes causes lung cancer i.e. a 50 year prospective study of 40,701 doctors, and even then many people didn’t really believe it. If it took this many subjects over such a long period to prove that smoking decreases life span up to 10 years, and that more than 50% of all smokers die of a disease known to be smoking-related, could Chinese tai chi masters or Indian yogis have detected much smaller effects than this due to different movements or postures? I don’t think so, but this and other even more hyperbolic claims are made for tai chi and to a lesser extent yoga.

  60. #61 anon
    March 11, 2014

    #60 Thank you, Krebiozen. A true voice of reason.

  61. #62 Nick K
    Chengdu
    March 11, 2014

    For those who still think there is some validity in Traditional Chinese Medicine, this link may be enlightening: http://scienceblogs.com/insolence/2013/10/25/chairman-mao-inventor-of-traditional-chinese-medicine/

    Of course, the Great Helmsman never used TCM himself, instead entrusting his own health to Western medicine. He lived to 83, despite being a heavy smoker.

  62. #63 anon
    March 11, 2014

    #60 So glad I quit smoking 46 years ago. I am amazed when I
    see people still smoking. I started with prenatal vitamins around that time. My Ob/Gyn prescribed them and I have been taking them even since.

  63. #64 AnnB
    NY
    March 12, 2014

    Hi Krebiozen,

    You always have well reasoned, informative answers. I do apologize though, I wish I hadn’t been as cryptic in my comment as I was; I would have saved you some time.

    When I spoke of Asians developing martial arts and how to kill people, I was only speaking of their knowledge of body form such as muscles, ligaments, bones, weak points, etc. I had been reading comments here about yoga and Tai Chi vs our modern physical therapy and was responding to that. Not thinking of anything else practitioners claim it heals.

    From seeing the knowledge they were able to gain in perfecting martial arts moves, I don’t know why they could not have developed the knowledge necessary for treating the majority of common physical therapy issues we see today. I grant that scientific method was not used, but there has been a lot of knowledge developed outside of the scientific method. For example, bows and arrows. Look how much progress was made through trial and error, and the more important piece, generational transfer of knowledge in the development of them. And, even though they never had compound bows, what they had served their needs or didn’t and then they died not to pass on their mistakes to the rest of the clan.

    I don’t know if I will ever find an investigation of physical therapy treatments from yoga and Tai Chi on the net, but there was something I can reference that I find more fascinating and that is the way monks can manipulate their body temperature. http://news.harvard.edu/gazette/2002/04.18/09-tummo.html I don’t go as far as the researchers in speculating what raising your body temp like this will treat as I don’t think its investigation is far enough along yet. I am simply intrigued that it is possible to do and that it is verifiable.

  64. #65 Politicalguineapig
    March 12, 2014

    Anon: My Ob/Gyn prescribed them and I have been taking them even since.

    Even when you weren’t pregnant? And why would you go to any doctor given that you distrust them?

  65. #66 Narad
    March 12, 2014

    there was something I can reference that I find more fascinating and that is the way monks can manipulate their body temperature

    As reported by the Harvard Gazette, which makes embarrassing generalizations about “Buddhists” in the process. Impressively, “it was not long before steam began rising from the sheets.” Perhaps they could have heated up some po cha instead of doing the laundry.

    Backing up for a second,

    “In a monastery in northern India, thinly clad Tibetan monks sat quietly in a room where the temperature was a chilly 40 degrees Fahrenheit. Using a yoga technique known as g Tum-mo, they entered a state of deep meditation. Other monks soaked 3-by-6-foot sheets in cold water (49 degrees) and placed them over the meditators’ shoulders. For untrained people, such frigid wrappings would produce uncontrolled shivering.”

    OK, we’ll warm you up and then you’ll start shivering.

    This appears to have been mainly Benson’s idée fixe, but never fear, Maria Kozhevnikov has taken over, and PLOS One is on the job: Everybody can heat up their armpits, but Lamaists can do it longer. Because brain waves. More specifically, “In the case of FB meditation, one of the possible mechanisms preventing heat loss could be the mental imagery of flames and heat.”

  66. […] Read more here: A finger in the dike isn't enough – Respectful Insolence – ScienceBlogs […]

  67. #68 Helianthus
    March 12, 2014

    @ AnnB

    I grant that scientific method was not used, but there has been a lot of knowledge developed outside of the scientific method. For example, bows and arrows. Look how much progress was made through trial and error,

    I tend to regard “trial and error” as part of the scientific method. A crude one, maybe, more prone to error biases than more sophisticated methods, but it’s part of science nonetheless.

    There are also three aspects, or phases, to discovery: innovation (finding something new), research (finding out what to do with this new thing) and development (optimizing the use of the new thing). Each phase varies slightly in its challenges and pitfalls: by example, it’s easier to take a wrong direction when innovating by proposing a new model (e.g. humor-based medicine and its stereotypical remedies, bloodletting and enemas), than when developing something for which the basic concept is already established (like bows and arrows).

    Finally, engineering/mechanical sciences tend to be very straightforward in causes and effects – to take your example, a bow shoots an arrow farther away than another, or doesn’t.
    I’m not saying that these sciences are easier, but that the outcome could be easier to assess compared to other sciences, like biological sciences, in which the outcomes could be very muddy. (full disclosure – I’m a biologist)

    tl;dr: please don’t fall for the alties mainstream/alternative dichotomic worldview. Whenever you are experimenting with the world, you are doing science. There is no “outside way” of doing things. There is that is working, and there is that is not.
    My 2 cents of scientism…

  68. #69 dingo199
    March 12, 2014

    Bows and arrows – scientific method of development:

    Observation:
    My friend Ug can throw spear far. Gets more kills than me.

    Hypothesis:
    If I make thing to throw my spear farther than Ug, I make more kills than him.

    Experiment:
    I try many things to help me throw spear. I try lighter spear. I try heavier spear. I try whirly rope with spear. I try stick with springy rope to launch spear. I try many things many times in many places.

    Conclusion: Using other stick with springy rope work best. Many kills.

  69. #70 herr doktor bimler
    March 12, 2014

    there was something I can reference that I find more fascinating and that is the way monks can manipulate their body temperature

    IIRC, Alexandra David-Neel was quite cynical about the gTummo techniques, or at least unimpressed with them… in her account, the important part is the control of respiration, while the visualisations are just flim-flam (or a tool for ignoring the discomfort so the breathing exercises can be conducted undistracted).
    Me, I am happy to accept the possibility that manipulating one’s breathing can have physiological effects. If it works, then well done those Tibetans for finding out.

    The Whackyweedia (as well as Narad) mention a 2013 addition to the wet-blanket-drying literature from Kozhevnikov &c.

  70. #71 AnnB
    March 12, 2014

    @Nick K

    Apparently Western Medicine, but not Western dental care. More here: http://www.people.com/people/archive/article/0,,20104202,00.html

    I know, I know. It is People Ragazine, yet I don’t have time to find anything peer-reviewed at the moment.

  71. #72 AnnB
    March 12, 2014

    Helianthus – thanks for the scientific method 101 summary.

    Narad – As reported by the Harvard Gazette, which makes embarrassing generalizations about “Buddhists” in the process.

    Yes, that article was full of woo sounding things. Maybe, proves Orac’s point about it bleeding into Western thought.

    herr doktor bimler – Me, I am happy to accept the possibility that manipulating one’s breathing can have physiological effects. If it works, then well done those Tibetans for finding out.

    This about sums up what I am thinking. In the larger sense, I am very intrigued by the possibility of controlling aspects of our autonomic nervous system. I don’t care if it is by the janitor in my office (Flowers for Algernon anyone?) or one of the monks or whether it is done through breathing, mediating or via popsicle sticks. Vetted through the scientific method of course.

    I can barely control things assigned to by nature to my motor cortex, but I am able to control the endings to about 95% the dreams I recall. [btw, I didn't know there was a whole cult out there chasing lucid dreaming, to include taking drugs until I started studying sleep disorders and came across their ideas on the net.]

    I have found sometimes my mind messes with itself. After I was taught that most people dream in black and white in AP Psychology (later disproved), I attempted to dream in black and white for the next three nights. I had only dreamt in color until then, so it was like a challenge to me; I also found it odd that everyone around me had such dull dreams. I never was able to force my mind to dream in B&W, but about two weeks later I had a dream all in B&W. I think my mind did that just to spite me.

  72. #73 herr doktor bimler
    March 12, 2014

    Yes, that article was full of woo sounding things.

    Which brings us back to Nathanael’s cheerful assertion that most of the bigoted Western establishment decided to simply ignore the hard-won knowledge of other cultures, rather than trying to integrate it. To the contrary, it seems to me that Western intellectuals have been fascinated with the claims of Himalayan yoga, at least since the 1903/1904 Younghusband invasion expedition. ‘Mystic heat’ features in Iris Murdoch’s “The Sea, the sea”, from back in [googles frantically] 1978.

  73. #74 Denice Walter
    March 12, 2014

    @ herr doktor bimler:

    For some reason, I suspected that I wasn’t the only regular @ RI to have read David-Neel.

  74. #75 herr doktor bimler
    March 12, 2014

    to have read David-Neel.
    It is interesting to contrast her reports — delivered in the style of an amused skeptical onlooker, and carefully distinguishing between what *she* saw and what *other people* told her — from how the stories were distorted, exaggerated, or simply misunderstood in second- and third-hand retellings.

    Case in point: the description of Mystic Heat has become quite standardised over the years, like a bed-time story, with “clouds of steam evaporating from blankets” as an integral element (the Harvard Gazette report is careful to touch that base). Kozhevnikov’s paper — linked upthread — credits David-Neel for this part:

    Eyewitness accounts describe g-tummo practitioners as being able to generate sufficient heat to dry wet sheets wrapped around their naked bodies, producing a visible amount of steam, while sitting or walking in the freezing cold of the Himalayas [4,5]

    .
    Sadly, her book says nothing about steam.

  75. #76 Krebiozen
    March 12, 2014

    I have a copy of Magic and Mystery in Tibet somewhere. I seem to recall some very unlikely tales in addition to tumo: monks in trance running across the snow, holes opening in the top of monks’ heads after chanting… Of course there’s also her tale of the monk she visualized so strongly that it then materialized as a tulpa which she lost control of and it went rogue and started terrorizing the camp.

  76. #77 Krebiozen
    March 12, 2014

    BTW, my very favorite in the Tibetan travelers’ tales genre is ‘Sungods in Exile’ which turned out to be a hoax. I have a copy of that somewhere too.

  77. #78 Krebiozen
    March 12, 2014

    The link I meant to add to that last comment is this.

  78. #79 ann
    March 12, 2014

    This about sums up what I am thinking. In the larger sense, I am very intrigued by the possibility of controlling aspects of our autonomic nervous system.

    I’ve always thought psychosocial/pychogenic dwarfism was an impressive example of that.

    It’s not conscious control, though.

  79. #80 Denice Walter
    March 12, 2014

    Pro-tip-

    If you want your wooly tale of Tibetan magic to be taken seriously you shouldn’t refer to the artifacts of interest as “dropa stones’.

  80. #81 AnnB
    March 12, 2014

    Opinions on this person’s ideas, por favor?

    http://www.bulletproofexec.com/hack-stress/

    I wrote him off after reading his work on modafinil, yet I am curious to know what you more intelligent* folks think. Huge money making scam hidden under business-speak? Does he really have all that time to invest in monitoring every part of his being? How does he get doctors to order every test under sun? Inquiring minds would like to know.

    *There is no dig here; I truly mean more intelligent. Having an IQ of 115 only means that I am smart enough to know how truly ignorant I am.

  81. #82 Denice Walter
    March 12, 2014

    @ AnnB:

    A quick look – because his website behaved badly for me- shows multiple Woo Warnings ™:
    he has a shop AND a store
    he uses the ™ sign
    he mentions *glutathione*
    he’s available to make presentations
    he has a recipe for coffee with friggin’ butter in it
    - oh, did I forget to mention, he *sells* stuff?

  82. #83 herr doktor bimler
    March 12, 2014

    Opinions on this person’s ideas, por favor?

    The blogger is evidently a huckster authorised affiliate for HealthMinds, and one purpose of his website is to pimp their products. That doesn’t mean that none of the claims he makes for them (mixed in among anecdotes about his general awesomeness) are true. Just that he has no special reason *not* to bullsh!t.

    It all gives me bad flashbacks to the 1970s and the golden age of biofeedback woo.

  83. #84 AnnB
    March 12, 2014

    @Krebiozen – Those stories are really far-fetched. Did you read ‘Sungods in Exile’ and others in the series out of morbid curiosity? I paid little to no attention to crop circles when they were the rage, but I did spend sometime reading on those explained how they made them.

    @ann – I vaguely recall the aspect of stunted growth from reading about lack of language development in feral children. The body saving itself at the expense of growth, perhaps.

    @Denice Walter – LOVE the Woo Warnings ™

    @herr doktor bimler – yes, it is a shame that tidbits of true, helpful information can be lost in the pursuit of deceit for profit. I give him props for spinning his marketing to one of the few demographics with any money though.

  84. #85 herr doktor bimler
    March 12, 2014

    I have a copy of Magic and Mystery in Tibet somewhere.
    The Wayback Machine has an e-copy:
    http://web.archive.org/web/20050307162540/http://www.algonet.se/~johnnyfg/books/mmtibet/

    Of course there’s also her tale of the monk she visualized so strongly that it then materialized as a tulpa which she lost control of and it went rogue and started terrorizing the camp.
    I have sometimes resorted to a similar excuse, when confronted with accusations of alcohol-related bad behaviour. “It was not me, it was my psychic double! Mea Tulpa!”

  85. #86 ann
    March 12, 2014

    @ann – I vaguely recall the aspect of stunted growth from reading about lack of language development in feral children. The body saving itself at the expense of growth, perhaps.

    I associate it with JM Barrie, the author of “Peter Pan,” who’s been said — maybe apocryphally — to have been affected by it.

    But it’s this anecdote…

    One case was a child who was admitted to a hospital with an extremely low weight. One nurse took over his care and he began to rapidly gain weight and his growth hormone levels increased during this time. The child was so dependent on the nurse emotionally that when she left, his levels returned to what they had been when he was admitted to the hospital, and once she returned, they stabilized once more.

    …from wiki that captured my attention. Just that love could make the endrocine system stop and start, I guess.

    I idly researched one of the stress-reducers on that Bulletproof site once, Heart Math. IIRC, it was ridiculously overpriced and didn’t do what it was said to, but — on the upside — kinda-sorta almost not nonsense.

    The details are a little fuzzy.

    But I’m not that smart.

  86. #87 lurker
    March 12, 2014

    Mephistopheles O’Brien @ 59 is spot-on: ‘…Massage to help you relax and ease soreness – fine. Massage to, well, pretty much [implied: diagnose or treat] anything else – not so fine….’ etc. That’s exactly right and it draws the line in the right places: Yoga & Tai Chi for exercise, good; for treating diseases, not-good, etc., and some things (homeopathy), not-good at all, full stop.

    Tibetan monks: Under the right conditions of temperature, humidity (low), and lighting (from behind), a cold wet cloth placed on a normally-warm person might be seen to give off ‘steam’. Add suggestion and a belief system (not to mention the desire to please one’s hosts), and the effect may seem to have an anomalous cause (which it does not). Buddhism generally frowns on any preoccupation with ‘makyo’ (unusual phenomena) as side-effects of meditation. The goals of practice are compassion and enlightenment; all else is distraction at best.

    Ann @ 72: A cult based on lucid dreaming? Say more, I’m curious.

    The existence of lucid dreaming is soundly established, per LaBerge at Stanford, numerous peer-reviewed publications. IMHO LaBerge’s methodology was brilliant: he instructed Ss in a sleep lab, ‘whilst having a lucid dream, look over to the right twice in a row, and repeat.’ The EEG picks up emergent stage 1 sleep (reliable correlate of dreaming), and the EMG picks up the deliberate eye movements to the right, and there you have it: objective correlates of a subjective state. Nice and neat, unambiguous, and repeatable.

    Herr doktor bimler @ 83: As far as I know, biofeedback (EEG, EMG, GSR, skin temperature) is viable as an aid to relaxation and meditation, but I haven’t seen it come up in the discussions of quackery here. Was it touted as an alt med treatment in the 70s?

    Lastly, as I mentioned elsewhere, a spot of good news today: Herbalife is being investigated by USA authorities as a pyramid scheme. There’s an article about it on the Beeb, and more sordid details about Herbalife on Wikipedia. I wouldn’t mind seeing some insolent takedown of Herbalife in more detail, in these pages.

  87. #88 AnnB
    March 13, 2014

    Hi lurker,

    I am aware that lucid dreaming exists.The “cult” part of my statement …I didn’t know there was a whole cult out there chasing lucid dreaming… relates to the “chasing” part. Maybe because I’ve been a semi-lucid dreamer since my teenage years, I just take it for granted, and I don’t understand this burning passion to accomplish it like displayed here http://www.world-of-lucid-dreaming.com/ But, it is fine if you are trying to achieve it. To each their own.

    Thanks for the science behind it. I didn’t know they did studies like you quoted.

  88. #89 Narad
    March 13, 2014

    I have a copy of Magic and Mystery in Tibet somewhere. I seem to recall some very unlikely tales in addition to tumo: monks in trance running across the snow, holes opening in the top of monks’ heads after chanting…

    The trick here is that these are really lousy siddhis by any stretch of the imagination. I’ll concede that my opinion about diving for some sort of Stuckey’s gift shop–level materialist novelty in Lamaism is conditioned by closing in on the end of this and the tanking of Ch’an at the end of the Sung dynasty by virtue of, basically, endorsement of sitting around like a lump “meditating” on isolated words in straightforward observations.

    As for “lucid dreaming,” I’ve already mentioned my take on this plonking siddhi.

  89. #90 Denice Walter
    March 13, 2014

    ” Mea tulpa” !!!!!!
    dr bimler: there’s only one and we got him.**

    and whilst we’re on the topic of eastern spiritual concepts-

    it seems that Mark and Jennifer’s eternally re-incarnating social-&-travel club.. ooops! Sorry, *autism advocacy organisation* in its latest incarnation concerns “health freedom”: and is named appropriately;
    and ace junior ‘prentice cub reporter, Jake, is right on their case. ( @ autism investigated today)

    Perhaps reporting on autism advocacy groups will the subject of his AutismOne autism advocacy presentation given to autism advocacy groups and sponsored by autism advocacy groups for the benefit of autism advocacy groups.

    Oh wait, shouldn’t they already know about themselves?
    Seems a bit redundant to me.

    ** it just dawned on me that if we were Germans, we could call our esteemed and magnanimous host, ” Dr Dr”.
    Right?

  90. #91 Antionette
    uk
    March 15, 2014

    I would love to, but I am transferring to UC Santa Cruz in September. Once I get settled in I will look into the possibilities of organizing a local hackathon in Santa Cruz!

  91. #92 AnnB
    March 16, 2014

    A finger in the dike isn’t enough, yet I see a larger issue of what passes for science drowning out the real thing.

    It was entertaining and educational dabbling here with you skeptics, but I haven’t been able to shake the subtle, subjective concern I’ve had ever since the whole h pylori kerfuffle* years ago that the harder task is wading through the polluted water of scientific studies to find the truth. The recent discussion of the birthing at home kerfuffle* seems to support my concern. What specifically prompted my comment today was I just finished reading this post http://brodyhooked.blogspot.com/2014/03/over-enthusiasm-in-research-results-how.html?m=1

    It appears my concerns are getting less subjective by the day.

    If science cannot redeem its roots as the search for truth, but is increasingly tainted by business, politics and personalities, I’d say you can expect more alt medicine wacko followers to influence it, but even worse, reasonable people will begin to abandon it as we trust it less and less as real science and see it more as the hype that it is. I can accept all the studies based on evidence cited here are the best we have at the moment, but to me, bad science is worse than no science.

    I still have hope though. This young man, and the researchers that helped him, shine as an example of what true science can do, yet I think of it more as the exception than the rule. This isn’t to diminish the work that most of you toil at everyday; rather it is just that I grew up and realized that the world isn’t what I thought it would be nor is the pursuit of science.

    *Score! I was able to use the word kerfuffle three times in 310 words. Note: this isn’t meant as a dig for either the word police or Orac; it is just me messing with you both.

  92. #93 Mephistopheles O'Brien
    March 16, 2014

    AnnB – I’m having difficulty with what your actual subtle subjective concern is. Is it that individuals who do and publish science can, from time to time, be influenced by factors other than the observations? Or is there something else.

    Thanks.

  93. #94 squirrelelite
    March 16, 2014

    I would suggest that a big part of the problem is that there is this incestuous feedback mechanism between the media, which are continually looking for the newest and greatest thing and researchers who want to be the first to get credit for a new discovery.
    This leads to marginal and very preliminary results being repeatedly touted as a major breakthrough.
    The actual process of science, which relies on confirmation and consensus, is much too slow for the media because by the time consensus is reached it is old news.

  94. #95 AnnB
    March 16, 2014

    MB – Thanks for asking.

    Your guess is half right, and why I mentioned the teenager. I think of that story as the scientific ideal. I would speculate that most all researchers start out like him. However, in actual practice things get complicated with co-founding factors. I accept that it can be just “human nature” although I would fight vigorously to remove these impacts and I would expect the same from the researchers. However, knowing it is going to happen and that it needs to be mitigated, is where the skeptics come in, and it brings me to my second concern, and why I included the link to the Hooked article.

    The author there said it well when he wrote:

    “If good scientists like this can publish results that are so little supported by their data, and a supposedly excellent journal lets them get away with it– then what happens when to the natural enthusiasm of the research team, we add the incentives as well as the incredible monetary resources of the drug industry? You start to get a sense of how much misleading information can appear on the pages of the “best” medical journals, and how long it could take us to sort through it all and decide what’s really best for patients.”

    And having just read his reply to my comment, I’ll include it here as he expounded on this:

    “In the real world two things are the case– first, scientists don’t just report their results, they also offer recommendations; and in this case the scientists recommended using the lower blood pressure target. That would mean more patients taking more drugs and being at risk for more adverse reactions, in order to obtain a benefit that might not exist and that if it did exist seems very small. The second real-world problem is that physicians are very busy and if they read journals at all, they tend to skim and try to pick up the highlights, and so don’t critically evaluate the validity of recommendations like this one but are inclined simply to believe them.”

    The people who are getting paid to be skeptical about the research before it is published appear to be failing in a big way, and I don’t just mean this particular study. There is a kerfuffle (I couldn’t resist) raging right now regarding the manufacturer sponsored drugs trials and medical journals. I used to think that published research was the Gold standard, but now it appears to be more like a bronze standard if that.

    I am just positing that although it is hard work to debunk the crap in the alt med world, it is much harder with the stuff coming from the scientific world. Most of us do not have the intelligence or time to parse every research study when those paid to do so fail. However, we are often expected to behave as if the results of these studies are infallible. I am not asked to do this with the woo stuff yet and hopefully never will be.

    It’s just that I think that the great big opening being exploited by the alt med crap is the bigger problem because it ls letting in the crap science as well.

  95. #96 Krebiozen
    March 16, 2014

    AnnB,
    As others have noted, if science understood everything it would stop. It’s not perfect, and there are some serious problems, not least where large companies are concerned. That said it is my impression that the vast majority of scientists are honest and do their best to overcome their biases, and that dishonesty and fraud are very rare.

    Science is messy, sometimes gets things wrong, occasionally makes serious errors, but generally it is self-correcting and moves us toward the truth.

    I used to think that published research was the Gold standard, but now it appears to be more like a bronze standard if that.

    The gold standard in medical research is the systematic review or the metaanalysis, which assesses the quality of the evidence using internationally agreed criteria and comes to a conclusion based on that. No health policies are based on a single study, it requires committees of experts examining all the evidence to do that. The Institute of Medicine report on vaccine safety comes to mind.

    I looked at the Hooked article you referred to, and at the study it was about. I was surprised to see Dr. Hoffman’s claim that:

    Since no results were statistically significant, that means the study failed to show any real benefit from the lower blood pressure target in these patients.

    Looking at the abstract for the study I see most outcomes were not statistically significant, though the main ones were very close to it: relative risk for all strokes was 0.81 (95% confidence limits 0.64-1.03), for ischemic stroke 0.84 (0.66-1.09). There was a statistically significant 63% reduction in the incidence of intracerebral hemorrhage in the lower blood pressure group, so the Hooked article is wrong.

    The article also states:

    If you are going to look at slight, nonsignificant trends, how about the slightly higher overall mortality rate in the lower blood pressure target arm of the study? Funny how the authors get so excited about “trends” that confirm their hypothesis, and yet ignore similar “trends” that go the wrong way.

    Yet the relative risk for overall mortality in the low blood pressure group was nowhere near statistical significance at 1.03 (0.79-1.35), and the risk of death from vascular causes was 0.86 (0.55-1.35). That is not a trend.

    Does the author not understand that lower risk of all stroke, ischemic stroke, intracranial hemorrhage, disabling stroke, myocardial infarction and major vascular death together constitute a trend? That you cannot compare a reduction in risk of stroke with p=0.08 to an increase in overall risk of death with p=0.82?

    I think the Hooked article is extremely disingenuous, inaccurate in places and that it twists the truth to support its premise. That’s ironic really, since it is similar behavior that it condemns in others.

  96. #97 Narad
    March 16, 2014

    This young man, and the researchers that helped him, shine as an example of what true science can do

    You apparently missed the fact that Andraka has yet to publish a damn thing, despite claiming that it’s coming Real Soon Now. (In the meantime, his parents incorporated a company for him to market the vaporware.)

  97. #98 AnnB
    March 16, 2014

    Narad – Ok, I deserve the smack-down you gave me. Even though your reply was harsh-sounding, it would have been harsher still to leave me in my ignorance.

    So – I was remiss and hadn’t looked at the Andraka story since last Fall. At that time the article stated the name of a company that was looking at marketing the product, so I thought that it was much farther along in the process. I can’t find a reference to the company now, only that when I looked into it, it appeared to be an established company and made me think of him selling out at young age. I just decided that someone had to manufacturer it, so he would need to work with a business regardless.

    This evening, after reading your response, I really had to search hard for an honest report on the status of this test. The only easy find that wasn’t a puff piece was a reference to patent negotiations with John Hopkins, but that had no date. The harder find, and stranger still, was that the article with the most substance was at a business site here. Live and learn. Thanks for pointing this out.

    Krebiozen – you are a true gem! Thanks so much for stepping through this with me and the science 101 lesson.

    Per the study you critiqued, the site that linked to it is hosted by a psychiatrist. Still an MD, yet those in this field aren’t renowned for their math skills. Nor am I. Anyway, I always read the beginning and the end of published research papers because i really don’t understand the middle (I admit it). I did this with the Lancet article when I first reached the Hooked site.

    After reading this in the Introduction (emphasis mine):

    Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial.

    and this in the conclusion (emphasis mine):

    As our study cohort comprised patients with recent lacunar strokes due mainly to cerebral small-vessel disease, whether our findings are applicable to patients with strokes from other mechanisms warrants additional research.

    I thought that Dr. Jerry Hoffman’s critique was correct. Instead, boo!

    This kind of proves my point though. There is a whole lot of (mis)information flowing around and even when you think you are getting accurate scientific review, you aren’t. I understand why researchers would obfuscate or spin their research, yet I frankly don’t understand why anyone would rip a good, valid study apart for no reason. Wouldn’t that be highly obvious to other scientists like you have demonstrated here?

    I guess I will just go on and be even more skeptical of everything I read. For news, history or politics, I always try to find at least three different sources, preferably on both central ends of the political spectrum, to see if they agree on the factual data. Since I can’t carry a Krebiozen in my pocket, I guess I am screwed at the present moment when it comes to scientific data. I think I will start being a lurker here for awhile and try to learn some things from you all before my fingers hit the keyboard.

    Btw, I really do believe that most scientists are honest and looking for the truth, yet having worked in Corporate America for a decade, I do not trust business one bit. Watch, now you’ll tell me that you work for a pharmaceutical company. Oh, heck, I don’t care…your company may be evil, but you are still my hero!

    I hope that your are feeling well and that you’ve received good answers on your health from your immunologist.

  98. #99 Krebiozen
    March 16, 2014

    AnnB,
    Ah, a psychiatrist, that makes sense ;-) A small correction to what I wrote before, I read the whole study, not just the abstract. If you stick around here and continue reading in this area you will soon pick up the basics of looking at studies like this. It’s worth the effort, I think.

    My wife reads the UK Times every day, and always lets me know if there is an article on medical matters that might interest me. I often make a point of tracking down the study and press release that prompted the article, and quite often there is more (or less) to the story than the article tells us, and it’s nice to have the skills to figure this out.

    Often I think it is either the person who wrote the press release and/or the journalist who wrote the article that are to blame for giving the wrong impression, not the scientists who carried out the research and wrote the paper. Surprisingly often it isn’t even a published paper that triggers an article like this, but a poster presentation, or a preliminary finding that shouldn’t really get anyone too excited.

    Drug companies (I don’t work for one, though I have been wined and dined by them in the past) certainly do sometimes spin their studies to make their products look as good as possible, but mostly this is limited to exaggerating efficacy and minimizing side effects, or not publishing negative results. A lot of the fuss about Vioxx, for example, was based on when a study officially ended and whether a couple of deaths should have been included or not. The difference, when extrapolated to the millions who took the drug, could mean thousands of excess deaths. Or not.

    I, and many other skeptics, want to improve the way all this works. Dr. Ben Goldacre, for example, is campaigning for rules to make drug companies register all trials in advance and force them to publish them regardless of the results, so we get the full picture, and not just the bits the drug company wants us to see. Others are working on improving the peer review process. Things are slowly getting better, I think.

    I hope that your are feeling well and that you’ve received good answers on your health from your immunologist.

    Thanks. I’m on a course of antibiotics for yet another flare up of my continual sinus/ear infections at present, so I’m not feeling at my best. Interestingly the immunology consultant I saw last week (at an HIV clinic, which was a little odd) prescribed a couple of vaccines, meningitis C and pneumococcus, one in each deltoid, that are normally given to children.

    The idea is to see how my immune system responds to each. He said that I should be immune to both already at my advanced age, and to expect local pain and inflammation, and possibly a fever. I didn’t have any reaction at all to either, so it will be interesting to see what my antibody titers are in a few weeks, along with the results of the battery of tests he ordered.

  99. #100 Denice Walter
    March 16, 2014

    @ AnnB:

    Interestingly enough, only today, while surveying woo, I managed to read/ hear two separate accounts concerning ‘corporatism engulfing science’ and why we really shouldn’t trust anything that is reported ( Natural News/ PRN, Talkback). Pharma sponsors research that benefits its bottom line; drugs that are ineffective are promoted; dangers are dismissed. Can no one be trusted? Is there any “pure” science?

    I always ask myself -what is the purpose of this article? To create a splash? To make a name for its author? OR, in the case of most of what I canvas: to cast doubt upon consensus science ( SBM) and open up a new market for alternative views and products. For example, portraying vaccines as ineffective or even dangerous makes perfect sense IF you sell alt med products like supplements or dietary powders that “boost” “natural”immunity.

    If I read an article about mental health, I would consider *where* it appeared: a journal of counselling or clinical psychology or a more standard news magazine. If it were on a website, I would be very wary of any that are not linked to academic or institutional sources. Or any that made disparaging references to the standard sources.

    ANYBODY can write anything- it doesn’t mean that it’s worth your time. When you spend time wading through the swampy morass that is alt med you’ll find that the same names and websites keeping appearing as well as the same memes.

    Oddly, tearing down SBM is usually accompanied by a trumpetting of an alternative system or individual, often being the person doing the hatchet job.

  100. #101 Denice Walter
    March 16, 2014

    @ Kreb:

    Hey, take care.
    You need to really reduce stress in your life since we all know that it can have such detrimental effects on immunity. Perhaps meditate a little every day, talk a walk in natural surroundings like a park, listen to relaxing music and have a glass or two of….

    You know that I’m joking of course.
    At any rate, feel better!

  101. #102 Narad
    March 17, 2014

    The harder find, and stranger still, was that the article with the most substance was at a business site here.

    Yah, that was the most recent thing I had seen as well. The wankers industry apologists* at “The Scholarly Kitchen” ran what I consider to be a truly deplorable, grasping smear piece on him in January,** which is why it was fairly fresh in my mind.

    * And AoA-grade PMC haters; if it’s ever occurred to them that the usual PMC interface is vastly superior to the cruft-bombs that their nominal constituency deploys, I haven’t seen it.

    ** Continuing with the AoA similarity, they followed up with a rant about Wikipedia “bullying,” which kind of boils down to two self-promotional entries being taken down after the first article: “While getting an entry on Wikipedia was at one time desirable because the theory was all about social media, search engine optimization, traffic, and legitimacy, my take-away is that any gains in these areas are probably meager….” This John Stone–esque tantrum is linked at the end of the original post.

  102. #103 AnnB
    March 17, 2014

    Ok, I’ll break my lurker status to comment on something I know; my history.

    Denice – This is good advice, yet it wasn’t the Woo community, however much they poke at SBM, that taught me to be skeptical, it was a PharmD.

    In my occupation (I don’t think of pharmacy technician as a career), I worked with about 100 pharmacists and got to know about a third of them really well. Of that third, I only know of two that were not burned out in their profession. A PharmD was one of them. He had such a passion for medicine; he was always reading medical journals and interacting with physicians.

    I worked with him for about 12 years and watched him go back to school to become a PharmD, implement a clinical pharmacy program in a small town hospital, and after we parted jobs he became the a Director of Pharmacy at a regional, rural hospital group that although small is very well respected.

    Fairly early on in working with him, he told me “There is no such thing as a good drug.” Of course, I was surprised; I would have thought he would have been the poster boy for medicine is All That and More! He waited for me to ask him about his statement and I ended up blurting out “You mean because of the side effects?” He sort of nodded and answered back, interestingly without ever using the word side-effects, something like “Every drug has unintended impacts and you need to weigh them against the benefits for what you are using them for” (sorry my memory is a little vague on his exact words). I know he also used to grill the pharmacy sales reps on their sales pitches. I never got to see that in person as I worked evenings (only worked with him when he rotated through them) but I did hear stories. And once, he told me that he couldn’t believe what the sales reps told doctors.

    So, I think Woo is the least of my worries; they are easy enough to discount. I just have a healthy skepticism that runs a little wild based on my ignorance and my experience working in Banking; a truly soulless business. But, I’ll keep in mind what you wrote and be on the look out for the repeat offenders in the Woo world.

  103. #104 AnnB
    March 17, 2014

    Krebiozen – I hope you take this part of the advice from Denice:

    “reduce stress in your life…take a walk in natural surroundings like a park, listen to relaxing music and have a glass or two of….”

    I don’t know of anything it’ll cure, yet it is how life is enjoyed.

  104. #105 AnnB
    March 17, 2014

    Narad – Thanks for the follow-up. I wasn’t aware of “The Scholarly Kitchen” site or anything they were writing about. Nor that anyone was questioning PubMed as a source. Interesting.

  105. #106 ann
    March 17, 2014

    If science cannot redeem its roots as the search for truth, but is increasingly tainted by business, politics and personalities, I’d say you can expect more alt medicine wacko followers to influence it, but even worse, reasonable people will begin to abandon it as we trust it less and less as real science and see it more as the hype that it is.

    Honestly, I don’t think it’s worse now than it’s ever been. Or that it’s worsening. (Or improving.) It’s a human endeavor. It comes with all the pros and cons that usually entails fully en suite.

  106. #107 Narad
    March 18, 2014

    Nor that anyone was questioning PubMed as a source. Interesting.

    They’re not. Their bête noire is PubMed Central, the National Library of Medicine’s platform for delivering open-access papers. (Being indexed in PubMed itself isn’t much of an imprimatur; I think searching by MeSH terms restricts results to the MEDLINE filter, but I’m too pooped to make sure at the moment.)

  107. #108 Krebiozen
    March 18, 2014

    Denice and AnnB,

    Thanks for your kind words. I’m OK, and currently enjoying some unexpected sunshine in London at present.

  108. #109 Krebiozen
    March 18, 2014

    AnnB,
    I meant to address something you wrote above:

    It was entertaining and educational dabbling here with you skeptics, but I haven’t been able to shake the subtle, subjective concern I’ve had ever since the whole h pylori kerfuffle* years ago that the harder task is wading through the polluted water of scientific studies to find the truth.

    The “h pylori kerfuffle” is an interesting topic, as there has been some hyperbole and inaccurate information tossed about in the past.

    The CAM narrative is that conventional medicine is so entrenched in its dogma that it took decades to accept the idea that peptic ulcer disease was caused by a bacterial infection. Even when a brave maverick researcher infected himself with H. pylori, developed peptic ulcers and then cured himself they still wouldn’t listen.

    Marshall, the ‘brave maverick vindicated’, encouraged this image of him and, I suspect, embellished his account a little. I don’t blame him; it’s a great tale that appeals to us all emotionally, but when you look a little closer it isn’t exactly what it seems.

    Warren and Marshall first published their findings as a letter to the Lancet in June 1983 and by 1990 antibiotics and bismuth became an accepted treatment for peptic ulcer disease (PUD), with a paper published in the Lancet independently confirmed Warren and Marshall’s results, declaring:

    H pylori eradication, without altering acid output, will become the mainstay of duodenal ulcer treatment because it cures the disease.

    When you consider there was a whole industry based on the stress-acid-ulcer idea (from vagotomy to antacids to stress reduction classes), I don’t think 7 years from a letter published in a medical journal to acceptance by the medical community is too bad, and it certainly didn’t take the ‘decades’ I have often seen claimed. Of course there were those that were slow to accept the evidence, but generally I think the scientific community did a good job. It is quite right to be sceptical of all claims, and insist on solid evidence and independent replication.

    Other aspects of the story aren’t quite what the narrative claims either. Warren did infect himself with H. pylori, but after a period of gastritis he developed no further symptoms, certainly not PUD, and he treated himself with antibiotics because of halitosis, not PUD symptoms.

    Another doctor, Arthur J Morris, also infected himself with H. pylori, which made him ill, and despite initial treatment with antibiotics and bismuth it took 3 years of different treatments to eradicate. Also, H. pylori is found in 40% of people, yet doesn’t cause disease in all of them, and a 1983 clinical trial comparing bismuth treatment with cimetidine was inconclusive, so the evidence wasn’t quite as compelling as some would have you believe.

    By the way, Marshall and Warren were not the first to come up with this idea. A bacterial cause for peptic ulcers had been suspected as far back as 1868, the stress-acid hypothesis had been questioned and several other researchers had suspected H pylori but hadn’t managed to produce convincing evidence. Some had even successfully used bismuth as a treatment for PUD without realizing it has antibacterial properties. One unfortunate Greek doctor, Lykoudis, was fined for treating his PUD patients with antibiotics.

    It was only when Warren and Marshall more or less accidentally found a way to culture H. pylori that their work became replicable and they had a way to convince the sceptics.

  109. #110 Denice Walter
    March 18, 2014

    @ AnnB:

    I see no reason why sceptics should restrict their inquiries to alt med alone: pharmaceutical products and their marketting are fair game as well.

    re “there is no good drug”:
    I don’t think that it’s a question or good and bad at all: it involves- like all life decisions- weighing the contributions vs the problems with any particular product. Looking at “good vs bad” limits choices to dichotomies- although in the final analysis, we may decide whether to accept or reject.- only two choices.

    We can set criteria based upon the seriousness of the health issue: I might be willing to accept more difficult side effects if I have a life-threatening condition but would not if I am taking meds for an intermittent, minor condition. People may vary in their own tolerance of side effects also.

    And I think that there are “good drugs”: those which control a physiological condition which could lead to serious or deadly consequences with relatively few side effects. For a true real life example: an elderly person has a signiificant arrhythmia and high bp and takes a med which controls those problems well and only has the side effect of slight cough
    ( diltiazem) allowing the person to live relatively symptom-free * for nearly a decade* and reach a quite advanced age…

    Although I don’t presently counsel people who take meds, alt med usually has a field day with meds for psychological conditions, always accentuating the negative side effects and quickly glossing over the benefits- which may greatly improve quality of life and day-to-day abilities to function more independently. There is often a trade-off which is acceptable to patients.
    In the end, it should be their own decision.

  110. #111 Denice Walter
    March 18, 2014

    @ Krebiozen:

    I’m glad you’re OK.

    And THE SUN! Really, the other way we went down to the bay and just sat there enraptured for more than an hour because there was ACTUAL SUNLIGHT on the waters!
    People were so happy as they left their cars and walked around. The restaurants were filled. I guess the equinox is upon on. Time for a festival.

  111. #112 Denice Walter
    March 18, 2014

    the other DAY

  112. #113 AnnB
    March 19, 2014

    Narad – Thanks for the information. I’ll look into searching by MeSH terms. Yes, I had mistakenly thought that PubMed and PubMed Central housed the same information with the exception that PM Central was a subset of papers offered without a subscription. And, yes, I thought all of the papers in either location were as rigorously scientific as a layman was ever was going to be able to access.

  113. #114 AnnB
    March 19, 2014

    @ Denice Walter

    I agree and I think the PharmD would too with the exception of ever using the word “good”. I think it bothered him that the word was banded about the hospital so much. That medications did good, I think he always saw that and is one of the reason he loved his profession so much.

  114. #115 AnnB
    March 19, 2014

    Krebiozen,

    You’re a gentleman and a scholar. Thank you for filling me in on the H. pylori story. After getting burnt on the “teenage scientist” hype, I looked into this story again using vastly more resources than were available to me at the time I first heard it. I didn’t find anything near as sensational as I remember. Probably just the media being exactly like squirrelelite described, in addition to me being young and impressionable.

    Yes, it is looking like the process of science is working as well as any human endeavor, like ann aptly referred to it, can. The good news is that is looking like I can drop my cynicism for science and just keep the skepticism. :)

    Take care and enjoy your time in the sun.

    AnnB

  115. #116 herr doktor bimler
    March 19, 2014

    currently enjoying some unexpected sunshine in London at present.

    You don’t want to miss an opportunity like that.

  116. #117 Krebiozen
    March 19, 2014

    You don’t want to miss an opportunity like that.

    Sadly I blinked.

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