Oh, no, Nature. Not you. Not again.

It wasn’t enough that you were busted shilling for traditional Chinese medicine with a big, glossy advertising supplement a few years ago. I thought you had learned your lesson after that, as you didn’t do it again. Maybe I was wrong. Granted, your offense this time is not quite as bad as accepting cash from Saishunkan Pharmaceutical Co., ltd. and the Kitasato University Oriental Medicine Research Center to put together what was in essence pure propaganda for quackery, but, on the other hand, I do have to be worried that you might be thinking of backsliding, of moving that way again. What else am I supposed to think when I see a defense of quackery as credulously execrable as Jo Marchant’s op-ed entitled Consider all the evidence on alternative therapies, especially when it’s subtitled Investigate and incorporate the mechanisms of complementary medicine instead of rejecting it outright, says Jo Marchant?

It is rare that I see an article so full of fallacious reasoning, outright misunderstandings of science and placebo effects, and utter ridiculousness in a scientific journal. That the editor of Nature saw fit to publish this rubbish, thus sullying the pages of that respectable journal, is a travesty. That Jo Marchant, an otherwise respectable freelance journalist specializing in science and history, would make such appallingly bad arguments, was at first to me unexpected. Then I did some Googling and discovered that she’s written a book coming out in January entitled Cure: A Journey into the Science of Mind Over Body. If the blurb about the book is any indication, her article in Nature is a warm up for a whole lot of quackery:

Yet while we accept that stress or anxiety can damage our health, the idea of “healing thoughts” was long ago hijacked by New Age gurus and spiritual healers. Recently, however, serious scientists from a range of fields have been uncovering evidence that our thoughts, emotions, and beliefs can ease pain, heal wounds, fend off infection and heart disease, even slow the progression of AIDS and some cancers.

In Cure, award-winning science writer Jo Marchant travels the world to meet the physicians, patients, and researchers on the cutting edge of this new world of medicine. We learn how meditation protects against depression and dementia, how social connections increase life expectancy, and how patients who feel cared for recover from surgery faster. We meet Iraq war veterans who are using a virtual arctic world to treat their burns and children whose ADHD is kept under control with half the normal dose of medication. We watch as a transplant patient uses the smell of lavender to calm his hostile immune system and an Olympic runner shaves vital seconds off his time through mind-power alone.

Drawing on the very latest research, Marchant explores the vast potential of the mind’s ability to heal, acknowledges its limitations, and explains how we can make use of the findings in our own lives.

Calling Harriet Hall! I have a book for you to review early next year! Apparently Marchant believes that mind-body dualism is a thing and that you can think yourself healthy, at least to some extent. (After all, she does “acknowledge its limitations,” whatever those are. Perhaps she admits that you can’t cure cancer with your mind, although she does seem to think that meditation can actually slow aging, citing Elizabeth Blackburn’s work.) In any case, as you will see Marchant’s article is a sterling example of what you do when you advocate therapies that don’t have any specific therapeutic effects above and beyond that of placeboes. You embrace placeboes as real medicine, and claim your quackery exerts its therapeutic effect through placebo.

Yes, it’s amazing how a little Googling can let me know where a writer is coming from, for instance, as Marchant declares in her Nature article:

“Insane”, “a joke”, and “exactly the sort of thing the NHS should not be doing!” are a few of the Twitter responses to last week’s news that Britain’s Princess Alexandra Hospital NHS Trust wants to hire a reiki therapist for a hospital in Epping. On a salary of up to £22,236 (US$34,000) a year, the appointed person “will provide Reiki/Spiritual healing to patients to enable them to cope with the emotional, physical and spiritual issues of dealing with their cancer journey”.

Critics of the advert — and there are many — advocate instead what they call “evidence-based” approaches to health care. These critics should look again at the evidence — because it shows that to dismiss the benefits of alternative therapies is simplistic and misguided.

Um, no. Just no. It’s not “simplistic,” although that’s a frequent simplistic trope used by fans of quackery to dismiss criticisms of said quackery based on science. Oh, they will say. You silly English kniggits reductionistic Western scientist, you! I fart in your general direction! You do not understand the deep complexities and interrelatedness of our woo. Now, go away, or I shall taunt you a second time!

You silly English knight

I exaggerate, of course, but not by much.

Actually, British skeptics and advocates of science-based medicine have every right not to want their precious taxpayer funds, funds that could and should be used to pay for treatments shown to be effective based on science, rather than for rank quackery like reiki. It’s particularly irritating to me that this specific ad is looking for a reiki practitioner to ply his quackery on cancer patients, particularly breast cancer patients.

Now, I know the British seem to have a soft spot for homeopathy. After all, there was an NHS-funded homeopathy hospital known as the Royal London Homeopathic Hospital, until a few years ago when the people who run it realized that (1) homeopathy is too easy to attack because it’s so obviously not based in science and (2) they needed to diversify their quackery and get hip to the latest lingo, which is to “integrate” quackery with science-based medicine, the better to give it the appearance of scientific validity. That’s why a few years ago theRoyal London Homeopathic Hospital was reborn as the Royal London Hospital for Integrated Medicice. The other thing that Marchant seems utterly unconcerned about is that reiki is among the quackiest of quackeries. Indeed, whenever I would contemplate a ranking of quackery, I used to call homeopathy “The One Quackery to Rule Them All.” (It’s true, just search this blog for that phrase.) Lately, however, I’ve been wondering if that’s true. After all, reiki is basically faith healing that substitutes Eastern mystical claims that its practitioners can channel healing energy from “the universal source” through the practitioner into the patient. Substitute the word “God” for “universal source,” and you’ll see why I refer to reiki as faith healing.

So what’s quackier? Faith healing, or a treatment that claims that water “remembers” the healing substance that it’s been in contact with (conveniently forgetting all the nasty stuff it’s also been in contact with, like urine) and that diluting a substance makes it stronger. I don’t know, to be honest. It’s kind of like asking what stinks more, a sewer or a cesspit. I do know that, when you add all the other nonsense that goes along with reiki, like distance healing, and reiki does indeed given homeopathy a run for its money as far as quackery goes.

Of course, Marchant is quick to point out after this that she doesn’t believe in all that mystical mumbo-jumbo. Oh, no. She’s into science, ma-an. Rather, she believes in what I like to call the power of the magical placebo:

Let’s be clear, I don’t buy into the pseudoscientific claims of reiki and spiritual healers. There is no evidence that they can tap into and manipulate human ‘energy fields’ to clear blockages and heal the body. Like many alternative therapies, these practices perform no better than placebos in clinical trials.

Well, that’s a relief. I can hear the “but…” coming, and so it does:

But that does not mean that such treatments have no distinct therapeutic value. To dismiss people’s complex psychological and physiological reactions to serious illness — and how it is treated — as mere placebo effects is not helpful.

Neuroscience studies show that placebo effects can trigger significant physiological responses that are often identical to those created by drugs, ranging from the release of dopamine in the brains of people with Parkinson’s disease to a rush of endorphins for those in pain.

And there you have it. Marchant buys wholeheartedly placebo myth. Sure, she doesn’t go off the deep end, the way that Robert Schiffman did when he cited placebo effects as proof that God exists, but she does buy into the myth. Indeed, she sounds very much like a homeopath, whose similar nonsense I once took on. Anyone remember Heidi Stevenson? Actually, on second thought, maybe not. Heidi Stevenson stated flat out that placebo effects cannot cure, as part of arguing that alternative medicine is more than placebo, while Marchant argues, in essence, that placebo effects can cure. Well, not exactly, but close:

The standard ‘evidence-based’ argument is that this is irrelevant. Even if alternative therapies induce a biological response, sceptics argue, patients are still better off receiving trial-proven conventional treatments, because then they benefit from both a placebo effect and the active effect of the drug.

This logic misunderstands the nature of placebo effects. Not all placebos are the same, and alternative therapies can sometimes trigger larger responses than conventional ones do. For example, in one trial, fake acupuncture relieved pain more effectively than a fake pill (T. J. Kaptchuk et al. Br. Med. J. 332, 391–397; 2006); in another, it relieved symptoms of irritable bowel syndrome with fewer side effects than available drugs (T. J. Kaptchuk et al. Br. Med. J. 336, 999–1007; 2008). It is true that if a therapy cannot beat a fake version of itself in trials, it is not working as the therapist claims. But if it triggers a big enough placebo effect, it might still be the best treatment available.

Marchant is actually missing a part of the skeptic argument, which is that placebo effects do not affect “hard” outcomes. For instance, placebo effects have never been shown to increase survival in patients with cancer, (Yes, death is the “hardest” endpoint of all, as it’s rather indisputable whether a patient is dead or alive.) That is why placebo controls are rarely used in cancer clinical trials any more. Instead, we tend to compare experimental treatment versus standard-of-care or compare adding experimental treatments to the standard of care to the standard of care alone. In addition, placebo effects do not generally affect the physiology behind the disease process. A great example of this is a study of sham acupuncture versus albuterol inhaler in patients with asthma. The results showed that, yes, patients did feel better. They did feel less short of breath. However, the “hard outcome” as measured by spirometry showed absolutely no effect on lung function. So, basically patients felt better but weren’t actually better. In the case of asthma, this could lead to death, as a patient could have the false assurance that, because he doesn’t feel as short of breath, he must be doing better when he could be very close to full decompensation.

So what about the studies cited by Marchant? The first one was only a single-blinded study examining acupuncture and amitriptyline for arm pain versus their respective placebos from repetitive stress injury. The acupuncturists were not blinded to whether they were providing “real” or “sham” acupuncture. It also has an utterly unsurprising result: More invasive placebos, like sham acupuncture, have long to produce more placebo effect than less invasive placebos, like pills. This study in no way shows that “alternative therapies can “sometimes trigger larger responses than conventional ones do.” It just provides one more bit of evidence supporting the unremarkable conclusion that invasive interventions produce more placebo effects than non-invasive measures.

The second study was no better. It, too was single blind, with practitioners not blinded to assignment. It, too, does not show what Marchant thinks it showss. In fact, the study abstract looked very, very familiar. So I searched the archives, and guess what? I blogged about this very study when it came out in 2008, and you can read the details here. The CliffsNotes version is that what this study really showed is the importance of practitioner-patient interaction in enhancing placebo effects. I mean, seriously. Did Marchant even read the same study I did? I went back, read the study again, and read my blog post about it again. I didn’t recognize the conclusion.

So, having demonstrated that she has been thoroughly taken in by alt-med propaganda, Marchant happily goes all in advocating placebo medicine. Pointing out that people tend to look at alternative medicine for problems that don’t have a good treatment available in conventional medicine, she advocates this:

The benefits of therapies such as reiki and acupuncture go beyond what we normally think of as placebo effects, however. Alternative therapists do not get results just because they are particularly good at fooling people into thinking that they will get better. Many elements of the care they provide — from talking to touch — seem to have the power to relieve symptoms and even influence physical outcomes. These elements do not show up when therapies are compared against sham treatments, because they are present in both arms of a trial.

Such benefits can be indirect. For example, tackling patients’ anxiety during invasive procedures such as keyhole surgery can reduce the risk of dangerous fluctuations in heart rate. This results not only from the direct effects on physiology, but also probably from patients needing lower doses of sedatives and painkillers.

Conventional medicine, with its squeezed appointment times and overworked staff, often struggles to provide such human aspects of care. One answer is to hire alternative therapists.

No, no, no, no, a thousand times no! To expand on Ben Goldacre’s famous quip about how problems in the airline industry do not mean that flying carpets work, just because there are problems in medicine does not mean that we should hire quacks like reiki practitioners to fill in the gaps. If physicians and nurses do not have the time or training to provide the “human touch,” then the answer is to change the system so that they do have that time (hiring more science-based practitioners would be a start) and to train them so that they are better at it. The reason is simple, and it’s all the pseudoscientific baggage that comes along with alternative medical practice. It’s a problem that Marchant acknowledges as a “legitimate concern” only to dismiss that same concern thusly:

Critics say that this is dangerous quackery. Endorsing therapies that incorporate unscientific principles such as auras and energy fields encourages magical thinking, they argue, and undermines faith in conventional drugs and vaccines. That is a legitimate concern, but dismissing alternative approaches is not evidence-based either, and leaves patients in need.

Instead of rejecting such approaches wholesale, let’s learn from them. That means going beyond the simplistic practice of jettisoning anything that cannot beat placebo. We must tease out the real active ingredients of these therapies — things such as ritual, mental imagery, empathy, care and hope — so that we can learn how they work and find ways to incorporate them into patient care.

Marchant is actually attacking a rather massive straw man here. Yes, endorsing treatments incorporating unscientific principles does encourage magical thinking. That is true. However, the reason we oppose “integrating” such nonsensical therapies goes beyond just that. Such therapies are rejected because they don’t work. Yes, the criteria used to evaluate them is that horribly “simplistic” standard of doing better than placebo. It’s a single, science-based standard that we advocate, one the applies to potential medicines and treatments, wherever they come from, “conventional” drug development pathways or “alternative” medical traditions. There are only three kinds of medicine: Medicine that has been shown to work scientifically, medicine that hasn’t been shown to work scientifically, and medicine that has been shown not to work. Guess which two categories apply to the vast majority of alternative medicine, if not all of it? Yes, the latter two. Of course, alternative medicine that is shown scientifically to work ceases to be “alternative” and becomes just medicine. Unfortunately, the concept of “integrative medicine” is special pleading, a transparent attempt to bypass the step of scientific validation in going from “alternative” medicine to medicine.

Marchant appears to misunderstand the reasons why advocates of science-based medicine are alarmed by the “integration” of pseudoscience and mystical thinking into medicine in the form of “integrative” medicine. She seems to think it’s just because we don’t like them, While it’s true that we have a distaste for the utter nonsense behind alternative medicine like homeopathy and reiki, our objection goes beyond mere disgust at what we perceive (correctly) as quackery. There is also the issue of prior plausibility and Bayesian thinking, in which the posterior plausibility that a “positive” result of a clinical trial is really indicative of an effect depends on the prior plausibility. To put it very simply, the lower the prior plausibility, the more likely seemingly “positive” results are real effects are “false positive” results. That is the key difference between evidence-based medicine and science-based medicine: SBM incorporates prior plausibility based on basic science considerations into its assessment of treatments. EBM, in essence, does not, which is why quackery like acupuncture, homeopathy, and even reiki can be touted by some as “evidence-based.”

Finally, we already do “tease out the real active ingredients” of placebo effects. One of the papers cited is an effort to do just that. However, as virtually all proponents of “integrative medicine” do, whether they realize it or not, Marchant is advocating a classic false dichotomy: Embrace quackery or abandon patients. It’s a false dichotomy because we don’t have to abandon science and reason to avoid abandoning patients, and problems with the “human touch” in medicine can be don’t require embracing magic to solve.

It’s not as though we haven’t been making these same points again and again and again for as long as I can remember. The problem is that advocates of “integrating” quackery into medicine keep making the same fallacious arguments. Now Jo Marchant is doing the same thing. These same old pseudoscientific arguments regurgitated by her are no more compelling or impressive than they’ve ever been. It’s just sad that the editor of Nature didn’t see that or didn’t care. As a result, there is now a defense of spending precious NHS resources to offer quackery to cancer patients.

Contrary to her view, it is not unscientific to reject alternative medicine, nor do critics do so because of their lack of sophistication leading them to embrace “simplistic” ideas. We understand alternative medicine all too well, clearly better than Jo Marchant, who could really use to read this article on integrative oncology. We also understand that, as study after study fails to find effects of various alternative medicine treatments above placebo effects, the narrative about “integrative medicine” is morphing to embrace placebo medicine. It’s what you do when what you have doesn’t have any specific therapeutic effects. You treat placebo effects as though they are some sort of magic, Secret-like way of “healing yourself.”

Comments

  1. #1 herr doktor bimler
    October 15, 2015

    I thought you had learned your lesson after that, as you didn’t do it again.

    In 2012 ‘Nature’ put their name on an advertising supplement sponsored by the Saisei Mirai cancer ghouls:
    http://web.archive.org/web/20150218052643/http://www.nature.com/nature/outlook/breast_cancer/sponsor.html

    — with 5 pages of advertorial offering

    Various treatments such as immunotherapy with GcMAF, Hyper T NK cells, gene therapy, cancer vaccines, Coley vaccine, and intravenous high dose vitamin C or alpha-lipoic acid are routinely used as complementary therapies. And, the thermotherapy with hyperthermia, a unique equipment developed originally was also performed. The thermotherapy activates a patient’s immunological competence in combination with the above mentioned medical treatment.

    — which is to say, Saisei Mirai are the griftiest of the grifters.

    The other day they put out a supplement boosting cosmetic surgery and skin-care scamming:
    http://www.nature.com/nature/outlook/beauty/index.html

    Before that was the Medicinal-Cannabis advertising supplement:
    ht_tp://www.nature.com/nature/outlook/cannabis/index.html

    They may have 99 problems but “Excess integrity” is not one of them.

  2. #2 David Colquhoun
    United Kingdom
    October 15, 2015

    I did an interview about the Reiki for NHS hospitals thing.
    http://www.dcscience.net/in-memoriam/the-diary-june-2015-may-2016/#121015

  3. #3 Orac
    October 15, 2015

    In 2012 ‘Nature’ put their name on an advertising supplement sponsored by the Saisei Mirai cancer ghouls:
    http://web.archive.org/web/20150218052643/http://www.nature.com/nature/outlook/breast_cancer/sponsor.html

    — with 5 pages of advertorial offering

    Holy crap. How did I miss that when it first appeared? That’s some serious quackery.

    Perhaps it was because the actual content of the advertorial doesn’t look particularly quacky. I perused the table of contents. Still, bad idea to let a quack clinic sponsor anything.

  4. #4 Kaplan
    October 15, 2015

    I too am hugely wary of alternative medicine and pseudoscientific babble that accompanies it, but in many places I think you are misrepresenting Marchant’s point, and present several strawman arguments of your own.

    “Apparently Marchant believes that mind-body dualism is a thing and that you can think yourself healthy, at least to some extent.”

    I can make my mouth water by thinking about food, and my heart rate increase by picturing myself giving a seminar to 300 students. It seems unequivocal to me that what I think about can affect my physiology. Would you disagree? Does this make me a mind-body dualist?

    “Marchant buys wholeheartedly placebo myth.”

    It is unclear what you mean by this. Do you doubt the existence of a placebo effect?

    “Marchant is actually missing a part of the skeptic argument, which is that placebo effects do not affect “hard” outcomes.”

    Whether this is generally the case or not, so what? Are placebo effects not still useful for soft outcomes? Your argument is akin to dismissing a painkiller as useless because it doesn’t cure cancer.

  5. #5 Orac
    October 15, 2015

    I do not doubt the existence of placebo effects. What I doubt is that they are as powerful as Marchant represents them, as they are mostly an artifact of the clinical trial process more than real, usable “mind-body” medicine. As for what I mean by placebo myth, click on the link in the text. That’s what it’s there for, as the rest of the links are there for providing background for people who are interested.

    At least you seem to accept that placebo effects do not change hard outcomes.

  6. #6 Dangerous Bacon
    October 15, 2015

    Kaplan: “I can make my mouth water by thinking about food, and my heart rate increase by picturing myself giving a seminar to 300 students.”

    What health outcomes are improved in the process? Does having your heart rate increase by stressing about giving a seminar have the same benefit as increasing your heart rate through regular exercise?

    Marchant: “Not all placebos are the same, and alternative therapies can sometimes trigger larger responses than conventional ones do. For example, in one trial, fake acupuncture relieved pain more effectively than a fake pill”

    This suggests a major cost-saving measure for health care facilities. Since fake woo has been shown to work better than “real” woo, why bother hiring alternative therapists? Use unaccredited minimum wage hires to simulate acupuncture/reiki/whatever. Why not, if you can achieve the same or better outcomes?

  7. #7 Orac
    October 15, 2015

    Not to mention that what Marchant showed is not that alternative medicine works better as a placebo but reinforced an old and very well-established observation that more invasive interventions produce larger placebo effects.

  8. #8 Eric Lund
    October 15, 2015

    Consider all the evidence on alternative therapies

    OK, I’ll consider all the evidence.

    There isn’t any that shows it to be significantly better than placebos.

    Done. That was easy!

    Too bad Nature has been susceptible to woo for a long time. IIRC they published some of Benveniste’s work on the memory of water. Benveniste, of course, is the first and so far only person to have won two Ig Nobel Prizes.

  9. #9 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2
    October 15, 2015

    If it is in Nature, it cannot be bullshit. Because, you know, Nature has a high impact factor, so they cannot publish bullshit.
    Papers in Nature are selected by editors who were wannabe scientists in their youth and chose the more prestigious career of journalist. Decision on the manuscripts are difficult for maintaining the high IF, but choosing the authors with high H-index and hot topics with predictable rapid citations helps a lot. Complementary medicine is a hot topic in the mainstream press, and the author had already a lot of papers in Nature, so why wouldn’t they publish the paper?
    On the other hand, this paper, with an unknown topic, from an author with a low H-index has not been published in Nature, for the sake of its impact factor: http://www.ncbi.nlm.nih.gov/pubmed/24156014

  10. #10 Murmur
    UK-ia
    October 15, 2015
  11. #11 Murmur
    UK-ia
    October 15, 2015

    Prof Colquhoun @2

    This isn’t, as I’m sure you know, the only NHS trust employing reiki “therapists”.

    Not long back I came across one in Lincolnshire employing a reiki “therapist” as part of their eating disorder service, which, as a former CAMHS person who spent a lot of time working with bairns with eating disorders, annoyed me hugely.

    Employment of these people goes further than what you suggest about the uselessness of HR…HR just rubber stamp what management tell them to. This is more about the inability of managers (see some of my other comments about MBAs) to assess evidence or even to know what evidence is.

  12. #12 Kaplan
    October 15, 2015

    Dangerous Bacon: “What health outcomes are improved in the process?”

    That wasn’t my point. I was merely saying that statements like “Apparently Marchant believes that mind-body dualism is a thing” are unhelpful and suggestive of quackery, when her position only seems to require acceptance that thoughts can affect physiology. Let me ask again: if I believe this then does this make me a mind-body dualist too?

    (To address your question anyway, it seems very conceivable to me that, e.g., relaxation/meditation can maintain lower blood pressure and this could have further positive health outcomes, but I am just speculating)

    Dangerous Bacon: “Use unaccredited minimum wage hires to simulate acupuncture/reiki/whatever. Why not, if you can achieve the same or better outcomes?” Indeed. If this were trialled and evidence pointed to it working then would you have any objections?

    Orac: “As for what I mean by placebo myth, click on the link in the text. That’s what it’s there for” Fine (I guess I missed this, or my reader didn’t show the link)

    Orac: “At least you seem to accept that placebo effects do not change hard outcomes.” I’m not sufficiently familiar with the literature to know, though I’m willing to believe you. You didn’t address my question though: if outcomes (whether soft or hard) are positive with a cost-effective placebo then why dismiss it?

  13. #13 Kaplan
    October 15, 2015

    Dangerous Bacon: I should have written “To address your questions anyway, probably “none” and “no”, though it seems …”

  14. #14 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2
    October 15, 2015

    Eric Lund:
    When they published Benveniste’s paper they did not support quackery, quite the opposite. John Maddox was the editor in chief, and Nature was another journal.

  15. #15 Denice Walter
    October 15, 2015

    ” Anyone remember Heidi Stevenson?”

    I believe I read that she died.

  16. #16 darwinslapdog
    The Beagle
    October 15, 2015

    @Kaplan, #11

    I’m ok with offering things that touch many people’s need for spirituality, but whether or not practitioners are “qualified”, no one should charge for these things. There are chapels in many hospitals in the US to address these needs and clergy visit patients, but these things are FREE and available to all. I don’t care if a patient wants Reiki as long as s(he)’s clearly told that it’s a “spiritual” treatment and offered by volunteers. In short: No Evidence, No Payment.

  17. #17 Denice Walter
    October 15, 2015

    I found it!
    There’s a facebook page ” We honor Heidi Stevenson of Gaia Health”.
    She is no more. Only her writings remain.

  18. #18 Common Sense
    October 15, 2015

    re: “It is rare that I see an article so full of fallacious reasoning, outright misunderstandings of science and placebo effects, and utter ridiculousness in a scientific journal.”

    It is unfortunate when when true believers get their footholds into a field and its publications and hold things they wish to believe to a lower standard of evidence. Then the public can be told “scientists” or a “scientific journal” makes a claim and those who don’t know better will fall for it. Unfortunately it isn’t quite as rare as you’d think. This is an area you are familiar with and so you spot the problems. I’m sure there are many in the public that know little about medicine and see some journal on “naturopathy” and mindlessly trust claims since it is a “journal” since they don’t grasp that it has low standards. I have no doubt that there are ads claiming that “X% of homeopaths say this works” which the clueless don’t realize means little since critical outsiders realize the low (or non-existent) standard of evidence.

    . Outside your niche you don’t and you grant credibility to articles appearing in journals since you don’t know any better. The quality of work in the real of climate is at best only a slight bit better than the work on alternative medicine, but unfortunately too many people dogmatically defend what they don’t truly understand since the people pushing climate research claim to be “scientists”. Unfortunately there are many “skeptics” that don’t know much about physics and computer modeling that leave their skepticism aside since “journals” published articles making certain claims. In that case it is a complicated realm where it is easy for people to be snowed by lots of data and claims which obfuscate simple realities like models not matching reality in the way they need to in the realm of real science. To many a world where alternative medicine types have taken over Nature, Science, and other publications is what we see now in the realm of climate research.

  19. #19 Quark
    October 15, 2015

    “You didn’t address my question though: if outcomes (whether soft or hard) are positive with a cost-effective placebo then why dismiss it?”

    Heard about ethic ? When someone got disease, you tell him you will help him and maybe heal him, then you do nothing and give fake treatement (and charge it). Do you see the problem here ?

    What alties do not get is that most of standard care USE placebo effect + a specific physiologic effect (the drug, etc…), because science based medicine efficacy is tested against placebo alone. So, WHY give just the placebo ? (And charge for it). There is case when there is no real treatement for a condition (some chronic pain for exemple), then what you need is general care and friend, this will give you the same (and free) placebo effect as paying for some fancy energy healing or whatever. + it’s etheically ok (you are not lying to the patient).

  20. #20 Dr. Chim Richalds
    October 15, 2015

    The only “evidence” that I see Marchant presenting re: alt therapies is the appeal to its popularity: “Hey, if it helps a lot of people, we shouldn’t worry too much about well-designed studies to support its use.” It’s similar to the idea that we should consider different “kinds” of evidence when evaluating alternative therapies, like anecdotes and testimonials. It’s nonsense, and it’s another attempt to add a patina of science to woo. As the saying goes, you can’t polish a turd.

  21. #21 Dr. Chim Richalds
    October 15, 2015

    This is what I was referring to regarding a different standard of evidence for woo, btw: http://scienceblogs.com/insolence/2008/05/19/integrative-medicine-at-yale-a-more-flui/

  22. #22 has
    October 15, 2015

    Common Sense@18: Poor thing. Did you get lost on your way to trolling William Connolley?

    Orac: Perhaps Prof Myers could score himself an easy Nobel with a paper on convergent Larmarckian evolution, as Nature is obviously turning itself into the WSJ.

  23. #23 capnkrunch
    October 15, 2015

    Kaplan@4

    Whether this is generally the case or not, so what? Are placebo effects not still useful for soft outcomes? Your argument is akin to dismissing a painkiller as useless because it doesn’t cure cancer.

    Two problems, one is what darwinslapdog said in #16. It’s pretty well documented that acupuncture et al varies in effectiveness with belief. It is unethical to condone such a scam.

    Second is that you seem to be the one misrepresenting Marchant.

    Recently, however, serious scientists from a range of fields have been uncovering evidence that our thoughts, emotions, and beliefs can ease pain, heal wounds, fend off infection and heart disease, even slow the progression of AIDS and some cancers. [emphasis mine]

    The rest of these are objective outcomes and there is scant evidence that happy thoughts have any effect on them.

    Also, both you and Marchant seem to have some misunderstandings about how placebo actually works. It’s not the magic cure-all she makes it out to be.

  24. #24 Alan Henness
    United Kingdom
    October 15, 2015

    Denice Walter #17

    Stevenson died of cancer in 2014.

  25. #25 sadmar
    October 15, 2015

    I find Marchant’s piece in Nature quite limited and reasonable, and well within the domain of things a science journal might publish as opinion. To me, the possible red flag here is Marchant’s forthcoming book. It’s hard for me to imagine how this subject could be presented in a book-length treatment for a general audience without supporting over-reaching claims, at least implicitly. Essays published prior to a book release often present a more narrow and cautious take on one piece of the larger topic – as the author and publisher want to gain attention, but save the ‘big idea’ for the book buyers. Her language in the op-ed is sometimes a bit slippery – again perhaps to leave room for more extreme claims in the book – but the thrust of this piece is hardly outrageous.

    There is, however, one glaring falsehood/omission in her piece which IMHO, ought to be the focus of criticism from sbm advocates. I’ll get to that after noting the ‘good’ elements of the essay.

    1. She places the potential utility of placebo effects as treatment “for subjective, stress-related conditions such as chronic pain, depression, nausea and fatigue.” This is hardly a radical articulation of some broad mind-cures-body principle. Having suffered from chronic panic attacks, I know psychological states do have physiological effects.

    2. She makes no claim here that CAM can ameliorate underlying physiological conditions. Her suggestion that it might be useful for cancer patients has nothing to do with the actual cancer, but with those “subjective, stress related” conditions that tend to be co-morbid for patients with devastating illnesses undergoing painful treatments like chemo.

    3. She suggests that any increase in survival rates for patients with physiological condition X who use CAM result not from addressing the disease itself, but by ameliorating those co-morbidities: “tackling patients’ anxiety during invasive procedures such as keyhole surgery can reduce the risk of dangerous fluctuations in heart rate.” And: “If [acupuncture] helps patients to complete a conventional treatment by making [chemo side-effects] bearable… it might improve survival rates,” Not only do we have the qualifying “If”, but a rebuttal to any BS arguments that ‘positive results’ from CAM provide any prove that CAM does what it claims to do in alleviating physiological illnesses.

    4. She makes the essential point that where conventional medicine falls short is not a ‘science’ problem, but an ‘administration’ problem. “with its squeezed appointment times and overworked staff, [it] often struggles to provide… human aspects of care.”

    5. While we might argue her language allows readers to take her as endorsing current “integrative medicine” practice, taken at her words, she does not actually do so. “One answer is to hire alternative therapists” is a proposition of fact, not policy, and is essentially true. By beginning with “One”, she indicates there are other ‘answers’, and that those ‘answers’ might indeed be better.

    6. She indicates that ‘integrative medicine’ is superior to free- flowing CAM, as the placebo therapy can be regulated, and the MDs can direct patients to “also get the conventional treatment they need.”

    BUT, it’s in phrasing this last point that she goes off the rails…

    She writes that IM “ensures” that such therapies are regulated and patients get the conventional treatment they need (my emphasis). Sadly, while this could and should be the outcome of IM, Orac’s previous posts on ‘quackademia’ indicate that’s not necessarily the case. The descriptions of CAM units in major health care institutions do not outline a clear “chain of command” for patient care, in which CAM therapies are indeed overseen and “regulated” by ‘real’ non-wooey doctors. The alties may have too much autonomy (I can’t say they do, but it’s worrisome enough that I can’t say they don’t). Worse, too many of the authorities running the IM show appear to believe CAM can actually address underlying physiological conditions. There was an absolutely mind-blowing statement to that effect from Mark Hyman in an RI post I read not to long ago, though I can’t find it now (it might have been an older entry I got to following a link)…

    Still, Marchant’s conclusion – her proposition of policy – strikes me as sound. She calls for us to learn more about how placebo therapies work in addressing subjective psychological conditions that manifest in the form of physical discomfort and/or dangerous behaviors (such as failing to complete a course of conventional treatment). She posits that ‘active ingredients’ for treating subjective conditions may be present inside the wrappings of pseudoscientific nonsense like the ‘energy power’ of reiki, and calls for us to ‘tease them out’ – “so that we can learn how they work and find ways to incorporate them into patient care.” I cannot see anything but a dismissal of CAM ‘modalities’ as-is in that proposition; cannot read it as saying anything but that ONLY if those “active ingredients” can be isolated, reframed within true evidence-based practices, and the pseudo-science shells discarded, would they be acceptable to incorporate into a proper ongoing standard of care. That is, she’s not saying it’s OK to just blithely send patients off to an acupuncturist or reiki master.

    I’d guess Orac’s counterargument would be something like ‘But quackademia never makes that separation. It doesn’t ensure that placebo treatments are quarantined into adressing subjective maladies subjectively. It actually endorses and re-inforces the pseudo-scientific physiological-cure claims of mere quacks!’ To which I would reply: even if that’s true now, that does not have to be so. It wouldn’t be easy to overcome the obstacles, but it’s conceivable we could do what Marchant suggests here. And that could be a good thing.

    I actually take Marchant as being in agreement with Orac’s argument that “we don’t have to abandon science and reason to avoid abandoning patients, and problems with the ‘human touch’ in medicine don’t require embracing magic to solve.” But she might have a problem with Orac’s assertion, “we already do ‘tease out the real active ingredients’ of placebo effects.” That is, she might note the literal meaning of that assertion is trivial, considering any teasing being done at present grossly inadequate. (Like Mickey D’s saying ‘we already do promote a healthy diet’ because they’ve put one salad on the menu…)

    Differences between what is and what could be are at the heart of the issue here. I certainly agree with Orac that “we don’t have to abandon science and reason to avoid abandoning patients” and also aver that “problems with the ‘human touch’ in medicine” don’t require embracing quackery to solve. But these are ‘what could be’ points, and Marchant’s essay points to several ‘facts on the ground’ that complicate the issue.
    • Conventional medicine IS too often delivered in squeezed appointment times by overworked staff.
    • As such, if often DOES struggles to provide the psychological support that has been labeled “the human aspects of care.”
    • Many patients DO turn to one form of quackery or another in search of those “human aspects of care”, and apparently a good number of them do indeed find something of the sort there.

    It’s not just that quacks have a leg up because they have no hesitance to employ placebo measures. IMHO, the big differences here are time and context. We have created an administrative structure for health care that is grossly unfair to patients by shackling conscientious sbm physicians and enabling quacks. The quacks get the time to help patients with their psychological needs, and operate in a context that supports that sort of interaction, rather than sterile exam rooms and professional routines geared to treating a person as a sort of biological machine.

    While it may not fit your definition of ‘medicine’, patients are getting something from quacks. I’m convinced that’s essentially ‘psychological support’ for dealing with those ‘subjective’ conditions that come with physiological effects or consequences. You can rail against the scientific wrong-ness of pseudo-science until you have a mental burn-out, but that won’t keep patients from going to quacks if that’s the easiest path available to addressing their needs/desires. Thus, I submit the best way for sbm to whack the quacks is to find ways to meet those patient needs/desires at least as effectively, and at lower cost.

    A method of doing that shouldn’t be hard to design. I’d guess quacks are overpaid for what benefits they actually deliver – framing themselves as ‘doctors’ and all – and they’re dealing with patients one at a time. It seems to me group sessions under the purview of qualified psych therapists would not only be cheaper, but get even better results with if framed with ‘the right approach’ (whatever that is…).

    The problem would be implementation. Systemic dysfunctions are awfully hard to remedy, as there are so many moving parts with their own entrenched inertias. There are obviously massive obstacles to putting a better sbm-compatible system for ‘treating the whole person’ into practice. Since such a system is a “could be”, any means of getting form here to there are also ‘could be’s. And it just might be that the most pragmatic of those – however many flaws may accompany it – falls along the lines Marchant has sketched: bringing a select group of CAM practitioners into the tent; keeping them strictly regulated and under the watchful eye of MDs who limit the CAM practice to those ‘subjective’ issues, and must approve any and all prescriptions; studying their practice to better ‘tease out’ the ‘active ingredients’ of “ritual, mental imagery, empathy, care and hope”, and gradually weaning those away from their pseudo-science wrappers into rational adjunctive therapy.

    But, then again, that might NOT be a workable strategy, given the facts-on-the-ground. “Quackademia’ appears to be all too content to pull woo-meisters into its clinics with little or no oversight, granting them way too much autonomy, and with program of transformative woo-stripping. Getting TPTB at those institutions to change could well be a bridge too far, making some other strategy a better bet. But what? Maybe we should trying to come up with workable light sources, instead of just cursing the darkness…

  26. #26 herr doktor bimler
    October 15, 2015

    Jo Marchant, an otherwise respectable freelance journalist

    Jo Marchant is also hooked into the whole “Mind control over telomeres” grift.
    http://mosaicscience.com/story/can-meditation-really-slow-ageing

  27. #27 Dr. Chim Richalds
    October 15, 2015

    Regarding the failings of allopathic medicine to address the psychosocial aspects of stressful therapies, such as chemotherapy, don’t we already have a pathway for managing these? Can’t involving a psychiatrist, psychologist, and/or social worker address these issues? Why not put the psychological and social aspects of health care into the hands of providers that are specifically equipped to deal with them, without resorting to pseudoscience and woo? This seems like a better way of “integrating” care, and in fact, many cancer centers, for example, do just this.

  28. #28 JP
    October 15, 2015

    can-meditation-really-slow-ageing

    A quick look at any of the meditation teachers I have had suggests that not, it does not. Nor is it expected to, though, and nor is it the point, which is why I find the whole article weird.

    It’s also a crappy article. I had to start skimming once I got to this little piece of idiotic blobular thinking:

    They are engaged in serious studies hinting that meditation might – as Eastern traditions have long claimed – slow ageing and lengthen life.

    What? Which Eastern traditions? Like, maybe there are some old Taoists notions out there like this, but that’s about all I can think of. I mean, the general lifestyle of Buddhist monks might very well mean that they live longer than average, but that is for purely “physical” reasons. Which reminds me:

    Blackburn isn’t tempted to embrace the spiritual approach herself. “I’m rooted in the physical world,” she says.

    Clearly neither Marchant nor the people about whom she is writing have the foggiest idea of what it is they’re talking about.

  29. #29 herr doktor bimler
    October 15, 2015

    Clearly neither Marchant nor the people about whom she is writing have the foggiest idea of what it is they’re talking about.

    A lot of it stems from Dr Blackburn, Nobel Laureate for telomere work, who is going emeritus on the topic and has coauthored a series of absolute junk-science papers about telomeres and fizzy drinks, telomeres and Mindfulness*, et cetera. Marchant has interviewed Dr Blackburn several times and is invested in her claims.

    Harriet Hall surveyed the topic over at SBM.
    * “Many ancient contemplative traditions believe presence of mind promotes greater longevity” [citation missing].

  30. #30 JustaTech
    October 15, 2015

    That Nature article really struck a nerve with me.
    Here is my issue with the way she presents mind-body dualism: she talks about people treating their depression with meditation, and children with ADHD doing something (unspecified) and using less medication. And that’s great, that some people can treat their conditions this way.

    But if you have ADHD or depression, and you can’t control your symptoms with your thoughts, then you have failed. And since both of these conditions are often seen by (contemporary American) society as failures already, then you have created a vicious spiral for the patient. You are already ‘not normal’ and now you’ve failed to have the willpower to fix yourself.

    And that is the horrifyingly negative outlook that can destroy people’s lives. The idea that you didn’t get better (cure your cancer, get over your depression) because you didn’t *want* to. Or you didn’t want, or pray, or believe hard enough.

    In SBM, sometimes the treatment doesn’t work. But we don’t say that it didn’t work because the patient didn’t believe.

  31. #31 capnkrunch
    October 15, 2015

    sadmar@25

    2. She makes no claim here that CAM can ameliorate underlying physiological conditions.

    This is a good point. The more egregious claims are from the blurb about her book. A distinction I missed the first time around.

    …limit the CAM practice to those ‘subjective’ issues…

    But even for subjective issues there’s a difference between a treatment having a physiological effect itself and having one mediated by a psychological effect. Morphine works independent of whether or not you believe in it, acupuncture doesn’t. People won’t necessarily come looking for CAM and knowing what they are getting (elaborate placebo). They just want pain management and selling placebo as effective treatment seems unethical.

  32. #32 Leigh Jackson
    United Kingdom
    October 15, 2015

    Marchant has travelled this road before in the vehicle of New Scientist.
    https://www.newscientist.com/article/mg21128271-600-heal-thyself-the-power-of-mind-over-body/

    She had another article this month in Nature News.
    http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511

    This is a strange article based on a study by Tuttle et al. still in print.
    http://www.ncbi.nlm.nih.gov/pubmed/26307858

    This study claims that placebo effect in the US is rising – meaning that it is getting stronger. Yet the evidence in the abstract does not exactly fit with that. It says that longer trials show the placebo response continues to rise after treatment response reaches a plateau.

    Looks like yet another fishy sales promotion of the placebo effect. As for Marchant, re critical thinking: Fail big time.

  33. #33 JP
    October 15, 2015

    Here is my issue with the way she presents mind-body dualism: she talks about people treating their depression with meditation, and children with ADHD doing something (unspecified) and using less medication. And that’s great, that some people can treat their conditions this way.

    Yeah, it’s the assumption that one method is better than the other, and that only inferior people would choose the “inferior” method. I’ve heard even people who have struggled with, say, a mental illness themselves and found meditation to be helpful sort of trumpeting it about and saying that people should always turn to it and other “natural” methods before medication. (See this episode of Mental Illness Happy Hour, for instance.)

    I don’t think I would have started doing meditation really regularly again if I hadn’t also gone (back) on medication. I’m certainly doing better now, and I guess I could ask which piece is the bigger piece, but I don’t really care. I mean, I’ve also been drinking a lot less and getting more exercise and whatnot, so there are those threads as well: but again, I don’t know that I would have been able to stick with those things either if it weren’t for the meds.

    I actually do agree that SSRIs, for instance, are often over-prescribed in situations that don’t really call for them, but I don’t go around talking about it that much, since I know that constantly hearing that kind of “skepticism” regarding can sound like an accusation of weakness to people who do need them, or that it can make perfectionist types, say, feel like they should be able to manage without the meds.

  34. #34 sadmar
    October 15, 2015

    Don’t we already have a pathway for managing the psychosocial needs of patient?
    In theory, yes. In practice, not so much.
    Can’t involving a psychiatrist, psychologist, and/or social worker address these issues?
    Absolutely! But just try getting that to happen.
    Why not put the psychological and social aspects of health care into the hands of providers that are specifically equipped to deal with them, without resorting to pseudoscience and woo?
    Because the asshole insurance companies won’t pay for it, and too few conventional physicians are proactive in demanding it.
    Many cancer centers, for example, do just this.
    I know there’s ‘holistic’ sbm, including psych support, because I got that from the program that did my bariatric surgery. It stood out for me, though, because it was so different from what I’ve experienced as the norm.

    If cancer centers are doing this well sans woo, we ought to campaign to expand that. As I said, sbm wins by proving it can beat woo at its own game, and that’s not a matter of health science as much as health policy and health economics.

  35. #35 sadmar
    October 15, 2015

    JustaTech:

    As I’ve had ‘issues’ with depression/anxiety and still struggle with a kind of ADD, I hear ya’, but I don’t see Marchant’s essay as going down the road of victim-blaming. (Again, however, the book could be truly cringeworthy.) The thing is, we already have the “you have failed if you can’t control your symptoms with your thoughts,” problem within ‘mainstream’ psych therapy in the form of CBT/DBT. I have actually been told all the sh!t you mentioned at one time or another (albeit ‘nicely’) by the professional therapists who were supposed to be helping me: I don’t want to get better; I have no willpower; if i only believed and followed the program, CBT/DBT would work for me, so it’s my fault I’m still screwed up.

    So, since the CBT/DBT folks do claim to be ‘science-based’ (humbug!), I’d limit your claim to ‘if its physiological prescriptions don’t work, sbm doesn’t say it’s because the patient didn’t believe.’

    But basically, I’m with JP on this. Meditation, ‘mindfullness’ exercises, etc. etc. do seem to help people, and whatever ‘works’ to help anyone out of the trench or away from the edge, I don’t much care. It also makes sense to me that meds help folks do the mental/behavorial stuff, and the mental behavorial stuff helps the meds work, if only by reducing some of the stigma of being on them.

    My take is that all forms of treatment for mental health issues are a crap-shoot for any specific individual. Whatever works for you may not work for me, and vice versa. (This being true even among the different formulae of SSRIs.) As such, nobody has any business telling anyone that any treatment should work for them, whether that’s delivered in accusatory tones or not. If depressives take med ‘X’ and don’t improve, they can spiral down because they feel fate has doomed them to a ‘body beyond the scope of help’, and that can be just as bad as feeling a failed will. I went through over a half-dozen scrips for depression-meds (on and off-label) over a period of several years before finally hitting one that correlated to improvement. Was that just a ‘self-limiting’ waning of the depression enough to let that med have a placebo effect the others didn’t? Do I care? The point is the people supervising my meds didn’t toss me onto the trash pile when something didn’t work. They said, ‘OK, since that didn’t help, let’s try this. And if that doesn’t help either, we’ll try something else.’ Any high-mindedness about one treatment being ‘better’ than another as JP described just gets in the way of helping patients, whose responses to any of them will vary all over the map from one person to the next.

  36. #36 Orac
    October 15, 2015

    I was going to spend more time replying to sadmar, but then I thought about it and realized I don’t have that much time tonight not if I want to get a new post ready by tomorrow morning. I’m rather disappointed that, after all this time on RI and SBM, he appears unable to recognize alt-med woo “dog whistles,” which are similar in concept to antivaccine dog whistles that I wrote about before. Of course a Nature article will be constrained in how much she can let her woo freak flag fly, but there’s so much code in her article that it’s not surprising that he needs a woo-Enigma machine to decode it all.

    Early posts on one of my favorite blogs (SBM) spent considerable time discussing how language, both scientific language and other, is appropriated by CAM advocates to serve the purposes of promoting the “integration” of quackery into conventional medicine (e.g. Misleading Language: the Common Currency of “CAM” Characterizations, Part I and Part II). Indeed, Kimball Atwood made a game of it called The Weekly Waluation of the Weasel Words of Woo. The funny thing about the weasel words of woo is that CAM proponents don’t use them to deceive; they really believe them and seem to fall into a pattern of using them once they become sufficiently invested in quackery.

    In any case, Marchant’s post is a classic in that, on the one hand she strongly implies, if not outright says, that the mind can have powerful physiologic effects, the implication being that it can heal (clearly she believes this based on the blurb for her forthcoming book). On the other hand, she admits that alt-med effects are no greater than placebo and falls back on the classic CAM fallback position of invoking the “power of placebo” as the magical all-purpose reason why CAM supposedly “works.” That, in my experience, is a pretty darned reliable sign of a true believer, particularly when coupled with a pre-emptive defense that the believer is really all about the science and doesn’t believe in that mystical mumbo-jumbo.

  37. #37 emily goodall
    October 15, 2015

    Mainstream medicine IS quackery, pure & simple. Until they begin archiving the perhaps millions of iatrogenic incidences that occur each year, we will never know just how big the Big Med scam really is.

  38. #38 Daniel.Corcos
    France
    October 16, 2015

    Usually, literature published in Nature is good and original. But the part that is good is not original and the part that is original is not good. This one is exception, so one may wonder why it has been published. I propose this explanation: placebo is used in nearly half of the clinical trials, it’s really a blockbuster in terms of impact factor. That’s why journals and institutions must promote placebo if they want to have followers and likes.

  39. #39 perodatrent
    October 16, 2015

    Oftentimes it is difficult to draw a line between epistemical rationality (as defended by Orac) and practical rationality (as illustrated by Marchant). Science minded physicians (as I am) are more inclined towards the first, many practical physicians use the last.
    This is not to say that practitioners have to believe everything: it is only to say that if many of their patients live in a culture that influences then heavily, then physicians are compelled to use elements of that culture.
    Or, as GB Shaw said in The Doctor’s Dilemma: “They are not trained in the use of evidence, nor in biometrics, nor in the psychology of human credulity… Further more, they must believe, on the whole, what their patients believe… When the patient has a prejudice the doctor must either keep it in countenance or lose his patient.”

    On the other side, what Marchant misses was told centuries ago by French physician and writer F Rabelais:
    “There is also a passage in our father Hippocrates, in the book I have named, which causes some to sweat, dispute, and labour; not indeed to know whether the physician’s frowning, discontented, and morose Catonian look render the patient sad, and his joyful, serene, and pleasing countenance rejoice him; for experience teaches us that this is most certain; but whether such sensations of grief or pleasure are produced by the apprehension of the patient observing his motions and qualities in his physician, and drawing from thence conjectures of the end and catastrophe of his disease; as, by his pleasing look, joyful and desirable events, and by his sorrowful and unpleasing air, sad and dismal consequences; or whether those sensations be produced by a transfusion of the serene or gloomy, aerial or terrestrial, joyful or melancholic spirits of the physician into the person of the patient, as is the opinion of Plato, Averroes, and others”.
    (Gargantua, Book IV The Author’s Epistle Dedicatory).

  40. #40 Murmur
    UK-ia
    October 16, 2015

    Several things: it is entirely possible, indeed normal, for some with ADHD to manage without medication (UK guidelines say that meds should only be used AFTER trying behavioural management techniques, parenting courses and the like), so nothing new there, indeed it would be standard UK practice.

    Re Sadmar’s comment on CBT/DBT: anyone who has read any significant portion of the supporting literature with a halfway objective eye will know that some of that literature isn’t great, with some iffy methodology and dubious assumptions (hint – the cognitive model does NOT describe everyone’s experience of depression). In practice many of us were of the pragmatic view that CBT, as with most other psychological therapies, will work for some people some of the time and were deeply suspicious of the claims for curing everything for everybody and alarmed by any hint of victim blaming.

  41. #41 herr doktor bimler
    October 16, 2015

    [Bacon]Campaign for my real friends and real pain for my CAM friends! [/Bacon]

  42. #42 Eric Lund
    October 16, 2015

    Daniel@38: There’s a saying in this business: Just because it’s in Nature doesn’t mean it’s wrong. The journal has a habit of going for flashy papers with high immediate impact, and the reason people want to publish in that journal is because they reasonably expect such papers to be highly cited. But often those results don’t hold. Sometimes that’s just preliminary results that don’t hold up under further statistical scrutiny, sometimes it’s honest error, and sometimes the paper turns out to be fraudulent (e.g., Nature bit particularly hard on Jan-Hendrik Schön’s alleged research).

    This is an opinion piece, so it isn’t subject to the same degree of peer review as a research paper, but getting it published involved someone (probably several someones) in an editorial capacity thinking this was a good idea. Here’s where the two missions of the journal, to promote good science and publish high-impact papers, come into conflict. I’m sure plenty of alt-med types will cite this opinion piece. But the author is pointing out research that has been done, which has consistently found alt-med to be bunk, and she insists that the treatments are doing some good, even if only at placebo level. The point is that placebos are non-treatment. It’s one thing to give somebody a placebo in a clinical trial where the patient is informed that they may be getting a placebo. It’s another thing to apply a known placebo treatment without telling the patient that it’s been shown to be a placebo. Most people with a smidgen of moral sense would call the latter unethical. The editors who allowed that piece to be published seem not to have that moral sense. That reflects badly on Nature.

  43. #43 Daniel Corcos
    France
    October 16, 2015

    @ Eric
    I am quite convinced that Jo Marchant really believes what she has written. The same for the editors who allowed this piece to be published. So, from my point of view, there is no ethical problem related to them. The ethical problems stem from the fact that intelligent scientists still push to evaluate science by the impact when they know it is bad.
    https://www.researchgate.net/post/Is_modern_research_becoming_more_and_more_publication_oriented

  44. #44 Clare Wilson
    London
    October 16, 2015

    If I can make a point in defence of Jo (a friend, btw), she hardly attempted to hide the fact she has a book coming out on this subject. It was stated in her author affiliation. (Although for the record, I don’t believe NHS hospitals should provide Reiki therapy or any other form of alt med.)

  45. #45 sadmar
    October 16, 2015

    Hi Orac:

    I wanted to take Marchant’s essay at face value, as I care less about her than about the arguments she’s making. I did note a suspicion that the Nature essay was an attempt to pimp a more outre book with a more rational bit of argument, and other posts that followed confirmed that for me. “Meditiation slows ageing!”? Gaack!

    So, it’s not that I missed the dog whistles, or need a magic decoder ring. You know I’m ‘on your side’, but I do kind of act as ‘devil’s advocate’ from time to time. I could critique your OP for missing the ‘dog whistles’ in the other direction. I have been here and at SBM long enough to know what “a full-throated defense of integrating quackery into medicine” looks like, and the Nature essay ain’t it. I’d argue a more accurate critique of the essay would go something like: ‘well, this all seems pretty reasonable, but look at all the dog-whistles between-the-lines!’ That is, the woo-promoting elements may be more insidious because they’re subtle and well-hidden.

    Whatever her motivation, the essay made some interesting points. If Marchant was utterly disingenuous in offering them, and building a hidden agenda, that doesn’t make those component parts wrong, or justify sweeping them off the table.

    By yesterday afternoon, I was actually kinda ‘depressed’ about the ‘Marchant situation’. Dial back the bubbly enthusiasm just a bit from that essay, and you’d have a pretty good statement of a ‘moderated’ position that’s worth consideration. Maybe sbm can learn some things by studying some of the more concrete thinks quacks wrap inside their promises of magic. But I realized from the get-go nobody’s going to publish a book about that. What we’ll get is simplistic gee-whiz Panglossian optimism, that is the promise that magic solutions to all our problems are just around the corner. That sells books. Remember all those best-sellers about how the Internet was going to create a new sort of utopian democracy? What we got was Ben Carson and Donald Trump…

    So, I’m bummed then that the Nature essay isn’t straight up, is just shilling for some forthcoming ‘your mind CAN cure your body!” hogwash. Because I think the debate needs voices that would say similar stuff without using it as bait for over-reaching Big-Promise crapola.

    I thought about making a comment about my bummitude yesterday, but decided I’d taken enough bandwidth already… and besides, I need to fix my kitchen sink so I can use the faucet w/o getting water all over the floor.

    But, in response to your #36, I’ll put on my ‘scholar of propaganda’ hat and observe: the reason “spin” is now a synonym for propaganda is that between 1915-1925 (roughly) professional propagandists discovered their messages were more persuasive the more truth they contained. The trick was to minimize outright lies, and spin the truth to your desired ends. Which means that effective BS is going to contain a lot of valid component parts. ‘Dog whistles’ may, in fact, be truths deployed to unscrupulous ends. And from time to time, some of those valid parts your ‘enemy’ disseminates can be things you haven’t thought of, and can actually be ‘good ideas’… IF you can spin them back to the righteous cause.

    I stand by the following conclusions I drew in #25:
    * “Integrative medicine” as outlined by the likes of Mark Hyman is indeed bad sh!t.
    * CAM has grown in large part where the administration of conventional medicine has failed to address patients’ psychological needs.
    * The best way to push back against CAM is to best it at ‘it own game’, not what it claims to do, but what ‘health consumers’ actually get from it — i.e. do better with the psych component of the ‘whole person’.
    * We actually know how to do that via sbm-compatible means, it’s just that TPTB either don’t want to pay for it, and/or wrongly dismiss it as foo-foo.
    * Building an alternative truly sbm-compatible ‘integretive medicine’ system – essentially expanding the approach of the cancer centers Dr. Chim mentioned and my bariatric doc – might face long odds, but it’s probably a better bet than trying to get ‘quackademia’ to rein in and de-woo their alties.
    ________

    ‘Language, both scientific and other, is appropriated by CAM advocates to serve the purposes of promoting quackery.’

    You’re preaching to the choir, Doc. They’ll mangle anything, and they’re skillful enough that if you’re not in the field they’re twisting, they’ll sound knowledgeable enough you’ll think that’s what the discourse they’ve appropriated actually says. I become so angry at the way they misuse contemporary theory, I get Stalinist fantasies of just putting a total censoriship ban on their garbage and sending them off to a work camp in Alaska. But, OK, I guess we can’t eliminate free speech… But as A. J. Leibling observed, “Freedom of the press is guaranteed only to those who own one.” So if somebody broke that SOB Lionel Milgram’s press, that would be really cool by me.

  46. #46 Old Rockin' Dave
    Looking for a really really good placebo...
    October 16, 2015

    I have nothing against the placebo effect. I sometimes exploited it as a practitioner, and as patient I have sometimes fallen for it in spite of myself.
    Personally, if a hospital wants to do something that will let my brain decide to say “Relax, it’s not that bad”, I would prefer a massage therapist. Or a nice person to come and cradle my head. Or a prostitute. Or all three, possibly all in one person, as long as none of this is actively contraindicated. All of these are material interventions that have known and usually desirable effects, and don’t require me to believe in woo.

  47. #47 jrkrideau
    At the bottom of the lake (the bottom end that is)
    October 16, 2015

    So what’s quackier? Faith healing, or a treatment that claims that water “remembers” the healing substance

    Homeopathy, of course. It actually pretends to do something in the physical world. Faith healing has a long and distinguished history (The King’s Touch?)

  48. #48 jrkrideau
    At the bottom of the lake (the bottom end that is)
    October 16, 2015

    #2 David Colquhoun

    I got as far in the interview as a bit like a TV aeriel and gave up.

    However does the UK still have TV licences? If so, does the patient require a licence before being treated?

  49. #49 Kate
    October 16, 2015

    @herr doktor bimler, #28, the headline on that piece is a great example of Betteridge’s Law, which states that any headline that poses a question can be answered with “no”.

  50. #50 JustaTech
    October 16, 2015

    emily goodall @37: If modern medicine is a scam, how then would you treat any of the following:
    Compound fracture of the femur
    Breech birth
    Heart attack

    Sure, modern medicine isn’t perfect. But it’s a hell of a lot better than the alternatives.

  51. #51 Chris
    October 16, 2015

    Ms. Goodall: “Big Med scam really is”

    So what should I have done when my toddler had a grand mal seizure? Was I wrong in calling 911 and letting them take him by ambulance to the hospital?

  52. #52 capnkrunch
    October 16, 2015

    Chris@51

    So what should I have done when my toddler had a grand mal seizure? Was I wrong in calling 911 and letting them take him by ambulance to the hospital?

    I’m told reiki works for seizures so you probably should have called a reiki practioner and got some happy thoughts over the air. That would’ve solved the root cause unlike SBM that’s only concerned about fixing symptoms and getting kids hooked on benzos.

    Actually, I think the typical alt med response is something like “conventional medicine is good for stuff like broken bones but we address the patient’s overall health.”

  53. #53 Chris
    October 16, 2015

    “That would’ve solved the root cause unlike SBM that’s only concerned about fixing symptoms and getting kids hooked on benzos.”

    Actually the root cause of dehydration due to a rotavirus infection. He got a saline drip hydration and an appointment to the neurologist for an EEG. The same neurologist that took him off of phenobarbital that he had been on since he had neonatal seizures.

    Perhaps I should have asked about the neonatal seizures? Which started off as a “shutter”, and then became longer, stronger and more frequent as his second day of live progressed.

    Should I have asked Ms. Goodall about his obstructive hypertrophic cardiomyopathy?

  54. #54 Chris
    October 16, 2015

    Don’t drink and type: “Actually the root cause was dehydration due to a rotavirus infection.”

  55. #55 Daniel.Corcos
    France
    October 17, 2015

    @ Chris
    Drink to avoid dehydration.

  56. #56 shay
    October 17, 2015

    JustaTech and Chris — Other than my annual physical, I’ve seen a healthcare practitioner four times this year.

    Broken bone in right hand
    Dislocated left thumb (I’m an equal opportunity klutz)
    Sinus infection
    Pleurisy

    I’m not sure what the consequences of NOT seeing the APN would have been but I’m happy that I didn’t have to find out.

  57. #57 shay
    October 17, 2015

    I must add that I don’t count my flu or shingles vaccine as visits because I got them at work.

  58. #58 Old Rockin' Dave
    No massage therapist, no one to cradle my head...well, at least I'm one for three (see my previous),,,
    October 17, 2015

    @jrkrideau: Your mention of the Royal Touch got me wondering. How long do you think it will be until we see someone advertising as a medical thaumaturge? It sounds so much more mysticomagical than “alternative health practitioner.” Mage is another one I expect to see make a comeback.
    Incidentally, I had a patient with scrofula, the disease supposedly healed by the Royal Touch, and I was seriously tempted to write down his diagnosis as the King’s Evil.

  59. #60 Lynn Eggers
    United States
    October 19, 2015

    Off-topic, but I need to vent a bit … and it’s sort of related.

    At dinner with a friend the other night, a fellow guest — a very limber, flexible man of 65 who rides his bike everywhere — mentioned that he had ankylosing spondylitis, which he had been treating for years with low-dose ibuprofen and homeopathy.

    Even aside from the homeopathy, what are the odds that a man that age with AS would be able to sit cross-legged for an extended period of time, often reaching forward to get his wine glass, and then rise easily?

  60. […] you are of this opinion, please read the excellent article David Gorski recently published on this issue. Here I want to re-visit my question from above: WHAT DO WE KNOW ABOUT THE RISKS […]

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