With the Christmas holiday over, I thought it would be a good time to revisit a topic that I’ve discussed before from time to time over the last several years. Part of the reason is that I saw something that irritated me before the holidays. Another part of the reason is that Christmas was so busy that some of you might recognize parts of this post. Fear not, more original Insolence will be forthcoming, likely tomorrow.

In any event, given that I’m not a fan of naturopathy, it probably comes as no surprise to our readers that I’m even less of a fan of the emerging “specialty” of naturopathic oncology. As I and other bloggers here have described time and time again, naturopathy is a cornucopia of quackery that encompasses modalities as diverse as acupuncture and traditional Chinese medicine (TCM), applied kinesiology, chelation therapy, UV blood irradiation, organ repositioning, and, yes, The One Quackery To Rule Them All, homeopathy. Indeed, as I’ve pointed out many times, you can’t have naturopathy without homeopathy because homeopathy is an integral part of naturopath training, so much so that it is part of the NPLEX, the examination naturopaths take for licensing purposes. (And, as I say every time I mention the NPLEX, I would really, really love to see some questions from the exam.) While it’s true that naturopaths also emphasize diet, exercise, and lifestyle interventions, whatever legitimacy they have as a specialty is completely undermined by the massive amounts of quackery they “integrate” with such advice, which often goes far beyond what the evidence supports anyway. We’ve frequently asked whether there is a naturopathic standard of care and come to the conclusion time and time again that there is not. Basically, naturopaths don’t know their limitations, and naturopathic oncology is quackery, plain and simple.

So, just because naturopaths have decided to produce a “specialty” that they’ve dubbed “naturopathic oncology” does not in any way legitimize naturopathy, although clearly by taking on the trappings of conventional medicine and its specialties naturopaths hope that they seem more like a real medical specialty. Unfortunately, in the ultimate failure to heed the warning that it’s good to be open-minded but not so open-minded that your brains fall out, the Society of Integrative Oncology not only admits naturopaths as members but includes them as authors in their attempts to legitimize the integration of pseudoscience into medicine with the publication of dubious clinical guidelines for breast cancer and other cancers.

To give you an idea what I mean about how clueless physicians practicing “integrative oncology” are regarding naturopathy, I like to repeat an anecdote from time to time. Back when I published my review article, “Integrative oncology: Really the best of both worlds?” in Nature Reviews Medicine two years ago, the SIO immediately criticized me for spending so much of it discussing homeopathy. Of course, the amusing thing was that homeopathy was a far smaller part of the first draft, but reviewers made me add more. Even more amusing (or disappointing—or both) was that it was clear that the SIO had no clue how integral homeopathy is to naturopathy, forcing me to point out that naturopathy schools include many hours of homeopathy in their curricula and that naturopaths are tested on homeopathy in the NPLEX. I also couldn’t resist twisting the knife a little bit by pointing out that one of the authors of the SIO clinical guidelines for breast cancer was a naturopath who had an open clinical trial of homeopathy listed on ClinicalTrials.gov.

The bottom line is that naturopathic oncologists, as they like to call themselves, can form their own society (Oncology Association of Naturopathic Physicians, or OncANP) and append “FABNO” after their name as much as they’d like. None of this makes them actually oncologists or any less quacks than regular naturopaths. That doesn’t stop them from trying, though. Jann Bellamy sent me an example of them doing just that again in the form of an article published this year in Integrative Cancer Therapies by naturopaths from a variety of clinics.

Applying the Delphi method to nonsense: Prelude

The article I’m referring to is by Hill et al and entitled “Naturopathic Oncology Modified Delphi Panel.” I had heard of the Delphi method before. As described in the introduction of the paper, it’s a structured communication method developed by the RAND Corporation in the 1950s, which describes it thusly:

RAND developed the Delphi method in the 1950s, originally to forecast the impact of technology on warfare. The method entails a group of experts who anonymously reply to questionnaires and subsequently receive feedback in the form of a statistical representation of the “group response,” after which the process repeats itself. The goal is to reduce the range of responses and arrive at something closer to expert consensus. The Delphi Method has been widely adopted and is still in use today.

Now, it might sound weird that a group communication process to achieve a convergence of opinion from experts in a specific field regarding a specific question that was designed during the Cold War to forecast the impact of technology in warfare, but the system has evolved since then and has been applied to many other areas. If you search PubMed for “Delphi method” or “Delphi consensus,” you’ll find thousands of articles on topics ranging from developing consensus on the diagnosis and treatment of personality disorders, identifying language impairments in children, founding multidisciplinary units for treating psoriatic arthritis, and even the treatment of chronic constipation. (To be honest, I couldn’t help but think of chronic constipation as I read Hill et al attempt to do a Delphi panel on key issues in naturopathic oncology.)

So what is the Delphi method? Basically, it is a process that is based on the idea that forecasts or decisions from structured groups of individuals will be more reliable than those from unstructured groups. A panel of experts is chosen and then serially queried. The experts answer questionnaires, after which a facilitator provides an anonymous summary of the experts’ answers, forecasts, and recommendations from the previous round, as well as reasons provided for the answers given, after which the experts are queried again and can change their answers in light of each round of answers shared among the panel. Thus, the Delphi method is supposed to result in a convergence of opinion from the experts towards the “correct” forecast or answer. The process is in general stopped after pre-defined stopping criteria are reached, such as number of rounds of questioning, achievement of consensus, or stability of answers). The method can be illustrated thusly:

delphi-method-flowchart

Obviously, this is the simplest outline of the Delphi method. There are now many variations. There are also several key characteristics that should be briefly mentioned:

  • Anonymity: Usually the participants remain anonymous in order to prevent prestige and authority or force of personality from skewing the results too much. Anonymity is generally maintained even after the final report is published. I note that this general feature of Delphi panels was not followed in this study, as the members of the panel were named in the methods section and listed as co-authors of this paper. In fact, there was no anonymity at all among the panelists, as far as I could tell.
  • Structured information flow: Initial contributions are collected in the form of answers to questionnaires and panel members’ comments about these questions and why they answered the way they did. This prevents the negative effects of interpersonal interaction by minimizing problems of group dynamics.
  • Regular feedback: Participants comment on their own answers, on other participants’ answers, and on the emerging consensus.
  • Facilitator: The facilitator sends out the questionnaires, collects and analyzes the responses, and prepares the summary for each iteration of questioning.

As you can imagine, though, there are a lot of complexities here, and everything depends on the definition of the problem and how the questions related to the problem are phrased. Let’s take a look at how this Delphi panel went.

Applying the Delphi method to nonsense: And so it begins

There were eight experts participating in the panel. They were chosen by a rather involved process, beginning with the requirement that any panel member must:

  1. Hold a degree of Doctorate of Naturopathic Medicine from a 4-year accredited medical school
  2. Attend the third annual OncANP conference during the date and time of the modified Delphi panel
  3. Have a minimum of 7 years of experience with a majority (>50%) of patients seeking cancer treatment or support
  4. Sign a consent form providing permission to use the participant’s name, biography, and any recorded dialogue in the final publication

So you can see right there that all the advantages with respect to anonymity of responses was thrown right out the window. The eight panel members met at the third annual OncANP conference in person. It should also be noted that their discussion was recorded, although it was structured this way:

fabnoflowsheet

This, of course, demonstrates that this “modified Delphi panel” also doesn’t do anything that the Delphi method was intended to do to minimize group dynamics, influence due to personality, and the like. This is basically no different from a typical roundtable or panel discussion that you can see at any professional meeting, only a bit more structured, with time limits for each panelist to make a statement and conclusion and for the open discussion.

Be that as it may, how were the panelists selected? Here is the methodology:

A summary of the Delphi study and protocol was distributed on the OncANP online forum. The members of the OncANP were encouraged to select and nominate 8 physicians to represent the field of naturopathic oncology and sit on the Delphi panel to discuss and debate questions regarding ethics, philosophy, and research development. The members were encouraged to self-nominate if they desired to be considered for selection to the panel of experts. The OncANP members were asked to share the e-mail, study summary, and nomination request with any colleague in the field of naturopathic oncology. This request was made in an attempt to allow naturopathic oncologists who are not members of OncANP to nominate themselves or their desired representatives. A total of 389 members subscribed to the forum at the time the study summary was posted, and 39 physicians received nominations from their colleagues in the field of naturopathic oncology.

In addition to nominating other physicians in the field, the OncANP members were encouraged to self-nominate, indicating that they were interested in participating in the study, able to attend the panel at the designated time and location, and met all the criteria and qualifications required to participate.

This large group was then winnowed down thusly. Nominees had to provide more information, including:

  1. Personal statement of philosophy to naturopathic oncology
  2. Years of clinical experience
  3. Type of clinical work (hospital/private practice, licensed/unlicensed state or province)
  4. Research and publications
  5. Additional related information

And then:

This additional required information and total number of nominations was organized into a rubric format used to compare the physicians. The rubric assisted in selecting panel members with a combination of the following: (1) the most years of clinical and/or research experience, (2) varied philosophical approaches to naturopathic oncology, (3) relevant additional oncology experience pertinent to the topic of ethics, philosophy, and/or research development, and (4) a higher number of colleague nominations. A total of 15 physicians provided self-nominations and the required additional information for consideration for panel selection. Two physicians were removed from consideration because they had less than 7 years of clinical experience. The research team unanimously selected the physicians who satisfied the rubric categories for panel qualification to the greatest degree.

This resulted in the following panel:

  • Tim Birdsall, ND, FABNO
  • Daniel Rubin, ND, FABNO
  • Gurdev Parmar, ND, FABNO
  • Neil McKinney, NDa
  • Davis Lamson, ND, MSa
  • Lise Alschuler, ND, FABNO
  • Dugald Seely ND, MS, FABNO
  • Shauna Birdsall, ND, FABNO

We’ve met Dugald Seely before. He runs the Ottawa Integrative Cancer Centre and somehow has managed to score two rather rich grants from an anonymous benefactor to run clinical studies of naturopathy in cancer patients, one for $4 million and then another for $3 million. He was also the naturopath co-author of the SIO guidelines that I meant when I mentioned how naturopathy and homeopathy can’t be separated.

We’ve also met Tim Birdsall before. He was the Vice President of Integrative Medicine at the Cancer Treatment Centers of America from 2002 to 2012 and has been voted physician of the year by the American Association of Naturopathic Physicians. In 2013 he was promoted by CTCA and now serves as Senior Vice President of Information Services, Chief Medical Information Officer & Naturopathic Physician Western Regional Medical Center. (He’s also quite adept at spinning negative studies of supplements to look not quite so negative.) Shauna Birdsall also works for CTCA and is the Medical Director of Naturopathic Medicine and Integrative Oncology at Western Regional Medical Center. Now, I’m clearly no expert in the Delphi method, but it appears to me that it would not be a good thing for avoiding the “bandwagon effect” or minimizing bias to have two members of the panel working at the same medical center, much less for them to be related to each other. It just goes to show that, whenever naturopaths try to undertake science or other structured, evidence-based undertakings, they just can’t seem to follow the protocol expected.

But what about the questions? Here’s the method used to formulate the six questions:

A request for question suggestions for the panel discussion was distributed on the OncANP online forum. OncANP members were encouraged to share the question submission request with any colleague in the field of naturopathic oncology. OncANP members were encouraged to develop questions that (1) discuss the main topics of the panel, which are ethics, philosophy, and research development of naturopathic oncology; (2) integrate these main topics with a subset of topics relevant to the field of naturopathic oncology, including, but not limited to, clinical approach, research, and future goals of the field; (3) are open-ended, possibly multifaceted, controversial, and able to initiate thorough debate among the physicians on the panel. A total of 45 questions were submitted for consideration for question selection. Questions were categorized to assist in selecting topics of interest as identified by the physicians in the field of naturopathic oncology. The research team indicated their preferred questions and topics, and the principal investigator for the study selected and formatted the top 6 questions that were used in the discussion.

So basically, they polled the OncAMP membership. That’s probably an OK method, but note how the research team “indicated their preferred questions and topics.” No chance of bias there, is there?

Applying the Delphi method to nonsense: The naturopathic panel speaks

Here are the questions that this convoluted process ultimately yielded for the panel to answer:

  • What are 3 topics in naturopathic oncology that generate consensus among practicing physicians? What are 3 issues in naturopathic oncology that generate the most controversy?
  • How do you approach research evidence that contradicts other research when making a clinical decision? How do you approach research evidence (or lack of evidence) that contradicts your clinical experience and/or personal philosophy to the practice of naturopathic oncology?
  • What ethical responsibility does a naturopathic oncologist have when a patient’s wishes are contrary to evidence or contrary to the physician’s philosophy? Please provide a real or hypothetical example of how this situation should be managed.
  • What research evidence will make the most difference to the clinical practice of naturopathic oncology? What type of research is needed to benefit the field of naturopathic oncology? Explain how and why.
  • What criteria should determine the priorities for the development of “best practice” guidelines with respect to naturopathic oncology?
  • What symptoms or diagnoses should naturopathic doctors who have no additional oncology training be able to treat? For example, is it ethical for primary care NDs to treat side-effects of chemotherapy and/or directly treat the cancer?

These questions are, as far as panel questions go, reasonable enough, even somewhat uninteresting. What interested me more were the answers. For instance, for the first part of question #1, answers number one and two were, by far, supporting “quality of life” and “focusing on the whole person.” Of course, as I’ve said many times before, the whole issue of “focusing on the whole person” is a common trope used in “integrative medicine.” It’s a false dichotomy, where it’s implied (or even outright claimed) that you have to embrace the “unconventional” modalities (translation: the quackery) in order to be able to take care of the whole patient. I know several science-based family practice doctors and internists who would beg to differ on that.

There was also quite a bit of mention that naturopathic oncology should be “integrative” in that it should work within the standard of care and not be an alternative to the standard of care. For example, panelist 6 said:

I think most in naturopathic oncology would agree that naturopathic oncology is typically integrative and not alternative to the standard of care.

And panelist 4 added:

I agree that one of the consensus is that naturopathic oncology is inherently integrative and that our role is to play within the system to help support people going through that, and not as a source of alternative care.

Clearly, the naturopathic definition of “standard of care” is very different from a physician’s science-based definition of standard of care. By this standard then, other than diet and exercise, naturopathic oncologists have nothing to offer patients, and there’s no reason a dietician and a science-based supportive and palliative care physician couldn’t do that. After all, everything else naturopaths offer ranges from the unproven (such as most supplements) to pure quackery like homeopathy, energy medicine, “detoxification,” UV blood irradiation, applied kinesiology, and the like. If naturopathic oncologists—heck, if naturopaths—practiced according to this standard, they’d have to get rid of the vast majority of what they’ve been taught in naturopathy school. The “specialty” would have no purpose. (OK, from my perspective, it already has no purpose.)

A couple of the answers to question 2 stood out to me. For instance, panelist 7 said:

That actually is one of my pet peeves, is naturopathic doctors not reading the primary source of the research, the full article, themselves, and relying on somebody’s analysis that immediately dismisses the evidence because they don’t like it, and finds all the faults of the study. I think that it needs to be weighed much more carefully.

One wonders if he’s referring to the many studies that show that modalities favored by naturopaths have no effect detectable other than placebo effects or to crappy studies that purport to show a benefit that “evil” skeptics like those of us here at SBM deconstruct and show not to have sufficient evidence to support the conclusions made. Inquiring minds want to know.

Then panelist 4 says:

I think while within the context of limited evidence, and it’s being framed, I think we really have to rely also on the art of the practice of naturopathic medicine, and be guided by clinical experience, because there is a limit to what we can derive from the information

In other words, rely on anecdotal evidence and “clinical experience,” both of which can be profoundly misleading, as I’ve explained many times before.

That ties in to question 4, which is about research evidence and naturopathy, specifically what research evidence will make the most difference to the clinical practice of naturopathic oncology and what type of research is needed to benefit the field of naturopathic oncology. I found these to be very odd questions. I can’t picture any other medical specialty even asking these questions, at least not this way. In oncology, for instance, we might ask what the most pressing unanswered questions are in the diagnosis and treatment of various cancers, but I can’t picture anyone asking what would make the most difference, and especially asking what sort of research is needed to benefit the field of oncology. We’d ask what research is needed to benefit our patients with cancer, not the field. Not surprisingly, strange questions provoked strange answers. For instance, panelist 6 said:

In my opinion, the research that’s needed most, that will make the most difference in the practice and I think general acceptance of naturopathic oncology, is a systems approach. Naturopathic medicine teaches us to treat the whole person, to address their main health determinants such as diet, lifestyle, exercise, stress management, with a multitude of modalities that we have that are at our disposal. I think a study of one vitamin, or amino acid, or herb at a time, although critical and essential, it does not represent the practice of naturopathic oncologists and I think we need to be doing systems approach studies.

This is what I like to refer to as woo babble, which is like technobabble from Star Trek, but with woo. It also represents the predictable whine about “reductionistic” techniques of research that science-based physicians supposedly do. Unfortunately, naturopaths and other quacks have latched on to “systems biology” in the way that Deepak Chopra latched onto “quantum,” as an all-purpose term to make what they do sound scientific and plausible to people who have little science background.

Here’s the one, though, that best encapsulated why naturopaths shouldn’t be considered physicians under any circumstances and will never be science-based. Behold the answer from panelist #3:

I propose 4 projects that we can do now that will take us far. One is the publication of case studies by individual naturopathic oncologists should be highly fostered. These can document for the rest of us what may have helped or did not, and that’s the best kind of data at present to help us reach consistency consensus in treatment

No, no, no, no. Case studies and case reports are among the lowest forms of clinical evidence. They are useful to generate hypotheses to test by more rigorous methodology up to and including randomized, double-blind controlled clinical trials, but to develop treatment consensus guidelines? Absolutely not, with the possible exception of very uncommon or rare diseases for which it is just not possible to do rigorous clinical trials because there are too few patients. Panelist 3, whoever it was, just distilled the essence of what is different between naturopathy and science-based medicine into a brief paragraph.

Naturopathic oncology: They still don’t get it

Leaving aside the way that this “modified Delphi panel” used by the naturopaths doing this study was so modified from what a Delphi panel normally is that it’s unclear why they bothered to use the name and didn’t just refer to their discussion as a structured panel or roundtable discussion, the results of this discussion were quite informative, just not in the way naturopaths hoped. There was one thing lacking that would have likely been a key question in such a panel discussion in any other medical specialty, and that would be the most pressing areas where evidence is lacking. For instance, in a breast cancer panel, one would expect someone to bring up the lack of targeted therapies for triple negative breast cancer, as that’s a perennial problem that we haven’t solved yet. In a naturopathic panel, I was shocked to see no specific clinical problems mentioned or specific kinds of evidence lacking. And, no, the handwaving about “systems biology” doesn’t count, because it’s too vague to be meaningful. Systems biology with respect to what condition, what clinical problem, what disease? The naturopaths don’t say, or, if they did, the study coordinators chose not to cite those quotes. Instead they cited more than one panelist advocating for anecdotal evidence and not even mentioning clinical trials.

That is one key reason why naturopathic oncology, like all of naturopathy, is a fake medical specialty and will remain so until it embraces science and evidence. Of course, that will never happen, because if naturopaths ever embraced science and evidence, their specialty would disappear.

Comments

  1. #1 BadlyShavedMonkey
    December 27, 2016

    That whole process sounds like children playing doctors and nurses. They can wear little white coats and hang plastic stethoscopes around their necks to look like grown-ups but they have no idea how the grown-up world actually works.

  2. #2 jrkrideau
    At the bottom of the lake (the bottom end that is)
    December 27, 2016

    # 1 BadlyShavedMonkey

    + 1

    However we should not discount the Cargo Cult explanation either.

  3. #3 Anonymous Pseudonym
    In Your Head
    December 27, 2016

    So they are so incompetent, they cannot even use the correct terminology for what they are attempting to do. If they screw up something as simple as an analytical technique, why in the name of all that is true and proper would anyone trust them with their lives? Magical non-thinking is going to be the downfall of western civilization.

  4. #4 BadlyShavedMonkey
    December 27, 2016

    The last 15-20 years of Web 2.0 has equalised access to information but not equalised comprehension. We are paying the price for this in politics, science and medicine.

  5. #5 Chris Hickie
    December 27, 2016

    Delphi method?
    Sounds more like the dillweed method in a GIGO setup.

  6. #6 Zach
    US
    December 27, 2016

    #4 Indeed. People too often show disdain for experts with years of study and work in a field as being “elitist.” Instead, too many people want to believe they are capable of googling anything and being the master of that domain in a day. It’s an ego thing.

  7. #7 Lawrence
    December 27, 2016

    Yes, people are now assuming that because they have access to all of this information, that they also have the ability to comprehend it as well…..when one can easily “Google” the answer to any question, why should they try to comprehend the information they are receiving?

    At the end of the day, we’ve done ourselves a huge disservice by not requiring knowledge of the “context.” History is nothing without context, for instance.

    The history of medicine is also easily misunderstood, without context….for example – antivaxers love to talk about how “measles” was no big deal, just look at episodes of the Flintstones or the Brady Bunch!

    The two points they fail to recognize, over and over again, is that no TV executive in their right mind would show the true effects of disease on TV (especially not in a comedy)….and they also fail to grasp that parents did not see these diseases as “benign,” instead, they saw them as inevitable.

    The inevitability of these diseases was such that parents had to hope and pray (and do whatever little they could) in the hope that their kids would not be one of the unfortunate ones who died, or went blind or deaf, or suffered any one of the other severe complications of these diseases.

    The very inability of anti-vaxers to understand the context of history – how things were viewed 100 years ago vs. today, along with all of the other host of quacks out there, is a symptom of this disease of contextual ignorance.

  8. #8 sadmar
    December 27, 2016

    Reading this leads me to think again that there’s such a broad spectrum of ‘not-sbm’ practice it’s useful to observe the differences, and not tar all of it with the same brush (though tarred it still may be). In this case, naturopaths calling themselves ‘oncologists’ strikes me as far more troubling than the sort of ‘Integrative Oncology’ now practiced at a number of well-respected clinics, which offer acupuncture, or rieki or other woos as pain management therapies but only that, and only under the guidance of real oncologist MDs. I know Orac detests this ‘quackademia’ but I looked at a website description for one IM-Oncology program recently, and while it had a variety of CAM ‘modalitie’ on offer, I actually found something comforting in the way they were described. The vibe (if you will) wasn’t curative, and certainly wasn’t at all ‘instead-of’ conventional standard of care, but rather stuff-to-do in addition to that to the end of coping with the often devastating physical and psychological effects of chemo, radiation, surgery etc. etc. I found myself asking whether, in good conscience, I could feel good about denying patients what was being described, and I concluded that in all honesty my answer had to be ‘No.’

    At the same time, I felt this reaction was specific to the description I had read, and thought I might have reacted quite differently, and far more negatively, to a different framing of the CAM stuff.

    While it seems that some of the ” integrative and not alternative” language from the naturopaths is gesturing in this direction, I don’t at all trust naturos to do this well. For one thing, that would include sincerity, humility, and understanding their own limitations (or, rather, flaws), and I don’t see much of that in naturos. For another, the whole ‘natural remedies’ schtick of herbals/supplements/homeopathy has no use I can see in terms of the sort of ‘supportive care’ effects of those other ‘modalties’, which basically derive from patients spending time with sympathetic people who have skills in getting their minds off the awfulness of their situation.

    As such, I have the suspicion OncANP is just a sleazy attempt to ride the coattails of approaches that have far more limited and legitimate (humanistically, anyway) ends into a wider acceptance and increased authority for naturopathy in general. And I do think that is very, very bad.

  9. #9 herr doktor bimler
    December 27, 2016

    It may be that I spend too much time reading ‘ScholarlyOA’, but the OncANP logo looks far too much like that those of mockademic-publishing scams.
    The scammers seem to have settled on blue-and-green or blue-and-beige colour schemes as a hallmark of mendacity.

    https://web.archive.org/web/20161217174603/http://ayancreatives.com/portfolio-item/juniper-publishers/
    https://scholarlyoa.com/2016/12/20/another-dangerous-medical-publisher-smgroup/
    ht_tps://scholarlyoa.com/2016/12/08/amateurish-new-open-access-publisher-launches-with-64-journals/
    ht_tps://scholarlyoa.files.wordpress.com/2016/10/scientific-literature.jpg
    ht_tps://scholarlyoa.files.wordpress.com/2016/05/main-picture.jpg
    ht_tps://scholarlyoa.files.wordpress.com/2015/10/open-access-text.jpg

  10. #10 sadmar
    December 27, 2016

    @ Lawrence

    I really appreciate seeing someone stand up for historical context on RI. Bravo! You also make an excellent point in noting that sitcoms rarely if ever show the true nature of anything.

    I’m not really into the genealogy thing, but in a moment of curiosity I looked up the census data on my paternal grandmother’s family. She had never mentioned having any siblings, and I’d kind of imagined her as an only child. But it turns out she had (iirc) 3 brothers and sisters who didn’t make it to adulthood…

  11. #11 Michael Kelsey
    SLAC National Accelerator Laboratory
    December 27, 2016

    @Orac, I fully understand our general disdain for “Google expertise,” but it does come in handy occasionally. You wrote, “as I say every time I mention the NPLEX, I would really, really love to see some questions from the exam.”

    Searching “NPLEX sample questions” was fairly helpful. The first two hits were from BoardVitals, with sample questions for both Part I (https://www.boardvitals.com/blog/nplex-1-sample-questions/) and Part II (https://www.boardvitals.com/nplex-part-2-naturopathic-exam).

    The Wikipedia article on the NPLEX (also a first-page hit) include a statement that some sample questions were entered into the Colorado legislative record (in 2014) with a link to the relevant PDF file (http://www.leg.state.co.us/CLICS/CLICS2015A/commsumm.nsf/58e6d054c29cbe1287256e5f00670a70/cc2547974fd82e0d87257dff00796715/$FILE/150305%20AttachF.5.pdf). This one may be the most interesting, as it also shows the “correct” (shudder) answers.

    There’s also a commentated set of questions on MedWisely (http://www.medwisely.com/nplex-sample-question-croup-infanticide/). Holy crap. Apparently “standard of care” must be meaningless word salad to these effing nutcases.

  12. #12 Panacea
    December 27, 2016

    Michael beat me to it 🙂 I looked up the same sources for the same reason.

    I also looked at the question structure using Bloom’s Taxonomy, which is what nurse educators apply when writing NCLEX-RN style questions for nursing exams.

    Most of the questions in the review sample are at the Knowledge and Comprehension level, which means rote memorization. A few are at the Application level (use of good clinical judgement in handling a common patient care situation). None were of the Analysis and Synthesis level, which involves coming to the correct conclusion from breaking down information or putting it together to come to a correct plan of care.

    Equally interesting, a website I found that offers a practice test bank for the NPLEX noted that the most difficult section of the exam was section 1, which includes the anatomy and physiology sections of the examination. Small wonder; these are the concepts that are actually science based, and include some very difficult concepts. An article on the Arizona Naturopathy Boards exam showed the state wanted them to address the fact that their pass rate was 100% after “adjusting” scores of applicants, the reasons for which were opaque. One student had 90 questions “adjusted.”

    The review sample on a patient with acute coronary syndrome was as equally frightening as the questions on the kid with croup that Orac dissected not too long ago.

    I would really love to see an item analysis of the actual test. I simply can’t see how it measures any kind of competency for anything.

  13. #13 Julian Frost
    Gauteng North
    December 28, 2016

    To add to what Lawrence said @7…
    We see things as they are now, and forget that even 50 years ago, things were very different. My parents were born in the 40s before mass vaccination. They knew about childhood diseases. I was born in 1976. I may have misremembered, but I don’t recall anyone I knew at school getting Measles, Mumps or Rubella.
    We see things as they are now, and incorrectly assume that that is how they always were.

  14. #14 Daniel Corcos
    December 28, 2016

    @ Panacea
    “I would really love to see an item analysis of the actual test. I simply can’t see how it measures any kind of competency for anything.”
    Simple: if you prescribe Rhamnus purshiana and Podophylum peltatum instead of Ricinis Communis, it’s eliminatory.

  15. #15 Julian Frost
    Gauteng North
    December 28, 2016

    For BadlyShavedMonkey & Zach:

    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge’.

    – Isaac Asimov

  16. #16 Daniel Corcos
    December 28, 2016

    @ Julian Frost
    Here it’s not a question of knowledge, but of understanding : they “know” that Rhamnus purshiana is better than Ricinus communis for some disease.

  17. #17 Johnny
    127.0.0.1
    December 28, 2016

    My parents were born in the 40s before mass vaccination. They knew about childhood diseases. I was born in 1976. I may have misremembered, but I don’t recall anyone I knew at school getting Measles, Mumps or Rubella.

    In one episode of the Quackcast, Mark Crislip (the world needs more Mark Crislip), an infectious disease doctor, reports that he’s never seen a case of Mumps.

    My mom, an ordinary stay at home housewife, treated 3 cases that I know of – my cousin (who moved in with us for a week or so for just this reason), my sister, and myself.

  18. #18 Learner
    December 28, 2016

    I had excellent, evidence based naturopathic treatment for stage 3 uterine cancer in concert with surgery and chemotherapy and am cancer free

    Fortunately, I live in Seattle, where we have excellent integrative naturopathic oncology and extensive research bringvdone. My MD oncologist wisely recognized the value of my naturopathic treatment and encouraged me to seek help from my naturopathic doctors on several occasions, even modifying my chemo regimen based on the naturopathic doctor’s recommendations.

    I’ve seen dozens devastated by conventional cancer treatment, and many die. I’ve seen great success with naturopathic treatment when conventional treatment failed.

    Cancer patients deserve the opportunity to evaluate and combine treatment options that will give them the best chance of success. We are not widgets and therefore few perfect answers for cancer yet.

  19. #19 Chris
    December 28, 2016

    Learner, Washington State law only allows someone to visit a naturopath for cancer only if they are working with a real oncologist. We need to know that little fact when evaluating unsupported anecdotes.

  20. #21 Robert L Bell
    December 28, 2016

    Sigh. About five years ago the local paper had an interview with a local heiress who had recently been diagnosed with cancer. She spoke with great enthusiasm about Natural Medicine and how – with the blessing of her oncologist – she had great hopes for getting through this even stronger than ever.

    My disgust with that article moved me to construct a little slogan, which goes something like “So-called Natural Medicine is an elaborate set of rituals for managing anxiety while hoping to get lucky and experience spontaneous remission.”

    Nothing that I have seen or read since then has convinced me to modify that opinion.

  21. #22 Narad
    December 28, 2016

    My disgust with that article moved me to construct a little slogan

    That’s pretty honking big for a slogan.

  22. #23 Melody
    Canada
    December 28, 2016

    While you’re busy spewing insult and your biased view, I find your perspective small minded and likely a big pharma-paid fear monger. Let’s be fair and point out the fact that conventional oncology has a very limited scope, applying merely poisonous big pharma profit strategies and doing their patients a disservice by slagging anything naturopathic or homeopathic. I know far more cancer patients with successful outcomes who are still alive thanks to their naturopathic practitioners, approaching their cancer integrative and not. Those patients who didn’t have the privilege, courage or knowledge to pursue other means of getting their bodies healthy haven’t fared as well, if at all.

  23. #24 shay simmons
    December 28, 2016

    In one episode of the Quackcast, Mark Crislip (the world needs more Mark Crislip), an infectious disease doctor, reports that he’s never seen a case of Mumps.

    I was sitting in on a conference call during a mumps outbreak in our county (2015) listening to an APRN thank the county health department’s CD department for sending out clinical information about the disease. She’s head of a local prompt care and she’d never seen the mumps. Nor had any of her medical staff.

    Made me feel old.

  24. #25 Panacea
    December 28, 2016

    @shay #24: I’ve been a nurse for 30 years. I’ve never seen measles or mumps . . . thank God! I’ve seen a few cases of pertussis, and each scared me to death. I’ve seen chickenpox in an adult (who got septic); it scared me to death.

    I hope to God I never see the so called childhood diseases come back. That’s an experience I can do without.

    @ Learner #18: how do you know the naturopathy had any effect on your disease since you also chose science based medicine, including surgery?

    @ Melody #23: Don’t forget that SBM includes surgery for many types of cancers (solid tumor cancers). Yes, cancer treatments are quite toxic. But they work.

    Homeopathy, as Orac has discussed multiple times, is simply water. Water does not have memory. There is nothing of the original molecule of the supposed medication in it. There is just no possible way it can work, and this has been demonstrated on multiple occasions.

    I pray I never get cancer. But if I do, I’ll take the real medicine over fake medicine any day of the week and twice on Sunday. Because I’ve never seen a case where fake medicine had any positive effect on a patient outcome, not in my 30 years as a nurse. And sadly, I’ve seen plenty of fake medicine in the hands of patients that has done nothing for them but empty their wallets.

  25. #26 Chris
    December 28, 2016

    Melody: “…likely a big pharma-paid fear monger.”

    How boring, it is the old stale worthless Pharma Shill Gambit.

    Perhaps you should try with something new and exciting: providing actual evidence for your claims. You can start with the PubMed indexed case reports of naturopathy curing cancer without any surgery, radiation nor medications. There are many stories of those who did not do so well with homeopathy here:
    http://whatstheharm.net/homeopathy.html

  26. #27 prn
    December 29, 2016

    I view all cancer care providers MD, ND, RN, etc, as fractional contributors, at best. So I buy a la carte for general and specialized services, as needed, from the those willing and able.

    Case histories actually become more useful for comparison with superior data for stratification and comparison, as limited patient numbers accumulate and begin to cognitively cluster common problems and better non-standard resolutions. In the limit, improved data would allow better direct design and personalization of treatment.

    My greatest concern is transparency – what services or therapies are offered, how they are priced and what the basis of treatment is in terms of literature and local local clinical results. I don’t expect magic bullets, I settle positive measurechanges, often modest sometimes dramatic, with the power in the accumulation of improvements.

  27. #28 Lawrence
    December 29, 2016

    @melody – yet Cancer survival rates continue to improve. Certain cancers can be cured quite regularly and we now have vaccines which prevent Cancer…..

    Which of those were the responsibility of naturopaths?

  28. #29 prn
    browser problems
    December 29, 2016

    My greatest concern is transparency – what services or therapies are offered, how they are priced and what the basis of treatment is in terms of literature and local clinical results. I don’t expect magic bullets, I settle for positive measured or observed changes, often modest sometimes dramatic, with the power in the accumulation of improvements.

    Some results are so different that any benefit is notable to the patient. Even if ignored by std medicine, again.

  29. #30 prn
    December 29, 2016

    “Some results are so different that any benefit is notable to the patient. Even if ignored by std medicine, again.”

    You what? Think you need to calm down on the big words and settle for clarity.

  30. #31 Panacea
    December 29, 2016

    Case histories are a very weak form of evidence. You can compare them with superior data all you want, but by themselves they only serve to drive interest and create the research question. The superior data from stronger forms of research is how to prove safety and efficacy.

    I don’t care how transparent the pricing of quackery is. Without firm evidence of safety and efficacy, you’re still getting your pocket picked. Your whole argument is a sham.

  31. #32 prn
    unknown author@30 I'm not sure who addressed me (prn)@30
    December 30, 2016

    With alt med / integrative medicine, sometimes one can achieve effects or conditions simply not possible with conventional medicine for these situations. Situations where doctors might say less than 1 in 100 or 1K or 100k patients (actually their reaction tends to I’ve never seen (20-30 yrs), or some form of sudden denial of original problem).

    Pancea@31
    Most CAM components are previously recognized as safe.
    Your rather fixed ideas about proof of efficacy are about communication and administration, rather than the

    Case histories are a very weak form of evidence. for “proof” (or general acceptance) …because of inadequate stratification, diagnosis and description.

    I don’t need proof on a treatment, I need (multiple) methods to yield adequate minimum results, what is for me a one-off problem.

    As predictive diagnostics improve, individual cases become more analyzable, comparable. There are many kinds of analysis and misc data a good experimentalist can use to improve the odds of success, sometimes dramatically, especially with multiple processes.

    You can compare them with superior data all you want, but by themselves they only serve to drive interest and create the research question. The superior data from stronger forms of research is how to prove safety and efficacy.

    I don’t care how transparent the pricing of quackery is. Without firm evidence of ….efficacy, you’re still getting your pocket picked.
    You seem to conflate proof of efficacy in unstratified heterogeneous groups as a requirement for to achieve any efficacy in very specific circumstances. Mission critical, one time solutions for a specific, time critical case often aren’t worked that way.

    Also I daresay my pocket leaks about 100x less than the more conventionally tx’d patients billed at $25k – $80k per month, where they died-out in ~3 years, OS<1% and this was not a case of zero or one wimpy, bottom 10% marker that shows up as the last survivor.

  32. #33 prn
    premature launch
    December 30, 2016

    Panacea@31
    Most CAM components are previously recognized as safe.
    Your rather fixed ideas about proof of efficacy are about communication and administration across groups, rather than the methodical achievement of a success for one type in the broader group.

    Case histories are a very weak form of evidence for “proof” (or general acceptance) …because of inadequate stratification, diagnosis and description in std medicine.

    I don’t require proof on one treatment, I need (multiple) methods to yield adequate minimum results, what is for me a one-off problem with multiple roots.

    As predictive diagnostics improve, individual cases become more analyzable, comparable and stratified. There are many kinds of analysis and misc data a good experimentalist can use to improve the odds of success. Sometimes dramatically, especially with multiple processes.

    I don’t care how transparent the pricing of quackery is. Without firm evidence of ….efficacy, you’re still getting your pocket picked.
    You seem to conflate proof of efficacy in unstratified heterogeneous groups as an absolute requirement to achieve any efficacy in very specific circumstances.

    Mission critical, one time solutions for a specific, time critical case often aren’t worked that way.

    Also I daresay my pocket leaks about 100x less than the more conventionally tx’d patients billed at $25k – $80k per month, where they died-out in ~3 years, OS<1% and this was not a case of zero or one wimpy, bottom 10% marker that shows up as the last survivor.

  33. #34 dingo199
    December 30, 2016

    I was interested to see that when signing up for the practice NPLEX exam, that for a fee, one can get a “pass guaranteed”.
    https://www.boardvitals.com/nplex-part-1-naturopathic-exam?utm_source=socialmedia&utm_medium=blog&utm_campaign=nplex1freetrial

  34. #35 dingo199
    December 30, 2016

    @Learner#18

    I had excellent, evidence based naturopathic treatment for stage 3 uterine cancer in concert with surgery and chemotherapy and am cancer free.

    This claim is the equivalent of someone saying:
    “I had an excellent, evidence based prayer results during my recent moonshot (in concert with NASA technology). Isn’t prayer a wonderfully effective mechanism for flights to outer space?”

  35. #36 Dangerous Bacon
    December 30, 2016

    Melody: “Those patients who didn’t have the privilege, courage or knowledge to pursue other means of getting their bodies healthy haven’t fared as well, if at all.”

    Some of them haven’t fared at all? How odd.

    Must be due to their lack of “courage”. See, this gratuitous insulting of cancer patients is a major roadblock to my accepting alt med as a gentler and more holistic form of therapy. 🙁

    Now it’s off to start celebrating the end of 2016. You are all treated to a round of expensive cocktails, courtesy of my giant roll of $hill Buck$.

  36. #37 Panacea
    December 30, 2016

    @prn

    Wow. Great example of argumentum ad nauseum.

    When you cut through the bullshit what you’re really saying is, “if one person gets a benefit from quackery that should be good enough.”

    And that just isn’t true.

  37. #38 Tonster
    January 1, 2017

    When the time comes, you will be diagnosed with something awful that causes you to realize you actually are only made of live tissue that needs to be looked after. At which point your doctor will sit you down and give you the list of options they have at their disposal to treat you. You will take all the drugs they tell you too, then you will take the drugs they recommend to fix the side effects caused by their drugs. You will get sicker and weaker from their drugs, then eventually you will die within the time frame they gave you. You became another sad victim of a terrible disease, the doctors pat themselves on the back saying we did everything we could. And the pharmaceutical company gets paid for all the drugs the doctors used to treat/kill you. Personally i think attitudes like yours exist because people don’t want to admit their lifestyles and personal habits are the cause of their illnesses. You shouldn’t rubbish things until you have looked at them with an open mind. It is true that pharmaceutical companies are only interested in their bottom line, its in their best interests to rubbish therapies they can’t make money off.

  38. #39 titmouse
    January 2, 2017

    prn: “I don’t require proof on one treatment, I need (multiple) methods to yield adequate minimum results, what is for me a one-off problem with multiple roots.”

    If I am sick and I get to pick between
    1. prn’s opinions
    2. peer reviewed evidence

    I think I will go with #2.

  39. #40 titmouse
    January 2, 2017

    Tonster: “And the pharmaceutical company gets paid for all the drugs the doctors used to treat/kill you. ”

    Pharmaceutical companies own the supplement companies so they get paid when they do science and when they do not bother. The science bit is the important part regardless.

    • #41 Tonster
      January 2, 2017

      The man with the biggest cheque book owns the science results.

  40. #42 Lawrence
    January 2, 2017

    Yet mortality rates for almost every disease on the planet, including Cancers, have dropped dramatically over the past 100 years….care to explain?

  41. #43 Johnny
    127.0.0.1
    January 2, 2017

    And the pharmaceutical company gets paid for all the drugs the doctors used to treat/kill you.

    I don’t know much about medicine, but I do know a little about business, and I can tell you that killing your customers is a time proven strategy that leads to glory and riches.

    /sarcasm

  42. #44 Renate
    January 2, 2017

    @ Johnny
    Still cancerquacks are able to get away with it, but they always come with the same excuses. It’s the patients fault, the regular treatment is to blame, the patient didn’t come in time, or whatever, but it’s never, never the quack-treatment that has failed the patient.

  43. #45 Opus
    Just north of the buckle on the Bible Belt
    January 2, 2017

    Tonster @ #38:

    My wife recently died of multiple myeloma. She had three separate genetic events during the course of the disease:
    1. Alteration of the MYC oncogene, followed by
    2. Alteration of the RAS oncogene.
    At some point during this process there was also a mutation involving deletion of the P53 gene.

    Given your expertise in this subject I am certain that you can easily identify WHICH lifestyle decisions of hers led to each of these discrete events and how long it took for such lifestyle decisions to impact her plasma chromosomes. Please do be specific – it will help set my mind at ease as I work my way through the grieving process.

  44. #46 Dangerous Bacon
    January 2, 2017

    “You will get sicker and weaker from their drugs, then eventually you will die within the time frame they gave you”

    Well, you don’t want docs to lose Medicare reimbursement because their patients lived longer than the time they were given.

  45. #47 titmouse
    January 2, 2017

    Tonster: “The man with the biggest cheque book owns the science results.”

    Explain how rich people can game results with a double-blinded placebo controlled trial.

  46. #48 Daniel Corcos
    January 2, 2017

    @ titmouse
    “Explain how rich people can game results with a double-blinded placebo controlled trial.”
    1) Perform 20 double-blinded placebo controlled trials, with different medical teams and various indications.
    2) Get a p < 0.05 in one of the indications by chance.
    3) Subdivide your cohort in order to have a subset with a p<0.01
    Pay experts to explain why later studies are not successful.

    • #49 Tonster
      January 2, 2017

      Im not a doctor im speaking from my own personal experience, which is 10 yrs ago i found i had cancer, I did all the treatments the doctors told me to do, the chemo nearly killed me it took my body 2 years to recover enough for me to go back to work. The whole time a voice in my head was telling me this doesn’t make sense, cancer is is my own body cells behaving badly, so if i could fix what is causing them to mutate then my bodys immune system may be able to attack the cancer and prevent it from returning. I tryed to speak to the doctors about this and they were completely uninterested. They told me to go home enjoy my life and hopefully it wouldn’t return. Well of course it returned, because a side effect of chemotherapy is cancer. But this time is worse because it has become metastatic. This time the doctors have said the treatment available will make the tumors go away for a while but they will return and eventually kill me. I went home confused and terrified, but this time was able to do alot more research about other options available. I realized if i fix my body by changing my environment, eating habits and mental attitude i have a chance of surviving this disease. So that’s what I have done and so far the tumors are shrinking and I feel the best i ever have, i have not taken any of their medication this time. I am now happily working with the so called quacks, everything in my life and the lives of my family has improved, we are all alot more self aware and healthier. Whether it works long term or not im not sure, but I do know if im going to die, at least iv learned a huge amount about myself and my last years will be filled with health and balance not sickness in the form of doctors medicine. I have learned that doctors don’t promote health they just medicate on top of medicating and the drug companies make $$$ out of it. And yes regardless of what you think the person with the biggest cheque book does own the results. The attitudes of you people is slowly becoming antiquated thank god!

  47. #50 sadmar
    January 2, 2017

    To be fair, there’s no shortage of real world examples of ‘killing customers as a strategy that leads to riches’ – tobacco companies, gun manufacturers, Ford Pintos, Love Canal, TRIS… heck, you could make an Orac length comment form the list.

    It’s also true that the pharmas do a lot of bad sh** that falls short of customer-homicide, and that “the biggest cheque book owns the science results.”

    None of which actually supports Tonster’s theses that conventional medicine kills most of it patients, or more to the point, that alternative treatments are somehow superior.
    You know, just because airplanes may not be maintained properly, and have to land and take off at too-short runways full of potholes, guided by non-union undertrained air traffic controllers who come to work hungover or tweeked – that not only don’t mean magic carpets fly, it also don’t mean getting dragged over a field of rocks on a magic carpet is without peril, either. Maybe even greater chances of peril than getting on the plane, which is hard to justify since the magic carpet isn’t really going to get you get you anywhere…

    Let’s see…
    Killing customers as a strategy that leads to riches:
    Exhibit A: The Hippocrates Health Institute
    ______

    Tonster is singing a familiar CT song: Natural remedies work and if people only knew the truth they’d embrace these effective and relatively cheap methods, which would put pharma profits into the sh**hole, and therefore the pharmas employ shills to “rubbish” their ‘competition’. The problem is, the pharmas aren’t exactly SPECTRE, they’re too big and too public to conceal all the facts about how they actually make money, and how they actually spend money in efforts to boost or protect the bottom lines that are their primary priorities – including their funding of people who actually are ‘pharma shills’. So you can find out a lot about who these people are, and what they do that gets the pharma overlords to keep sending them checks.

    And if you actually check, you know, facts you discover those actual well-funded pharma shills don’t rubbish CAM at all. There are two primary categories of pharma shilling. The first is directed at promoting high profit meds to physicians and institutions in competition with similar products from other pharma manufacturers. Alt med never enters the equation in the day to day efforts of the sales reps who do this shilling. The second is directed at influencing government policy toward directions the pharmas find favorable. In this – even if it may seem counter-intuitive to some – the pharmas are all in free market ideology and de-regulation. Which basically makes them political allies of Big Cam. And sure enough many if not most of the pharma shills in politics also shill for the supplement industry.

    Working back through the CT narrative, we’d find that the pharmas are making money from all signicant market sectors of health care – including OTC remedies of dubious benefit, supplements (if not directly making and marketing them, but in providing raw materials and facilities), etc. etc. ‘Naturopathic oncologists’ may be a potential economic threat to sbm oncologists, but to the pharmas, they’re just another target market.

    And the reason the pharmas have a few toes in the less outre varieties of CAM is that CAM is not cheap, and there is, in fact, a lot of profit to be had there. If the profit motive sometimes leads to bad behavior on the part of Big Pharmas, that happens far less often there than it does in Big CAM. And, and their worst, the pharmas can’t touch the evil of Big CAM outfits like Truehope.

    It’s misleading to frame the bottom-line thinking of the pharmas as only an interest in the bottom line. Which is to say that a lot of things go into the bottom line, there are very different strategies for maximizing profit that in contest both within large firms and between them, and so bottom-line interests become translated into all sorts of other interests. And for the pharmas, a lot of those interests are highly pro-social. The pharmas are evil sometimes. They’re also good more of the time. And more often than both the clearly evil and clearly good put together, they’re some mixture of both. In this, they’re not that different from other massive multinational corporations. The bad stuff they do represents a fairly small percentage of their activities, and considering all the failings endemic to our species, a not particularly surprising percent at that. It’s just that they are so massive and do so much that the bad stuff numbers still look ‘big’ to our everyday-life scales of evaluation.

    Finally, the notion that ‘Big Pharma’ is sitting on cures to preserve long-term profit from treatment fits neither the facts of where the profit comes from, or the nature of corporate behavior. First and foremost, pharmaceutical companies not only compete tooth and nail with one another in the marketplace for pharma products, but with other capitalist firms in stock markets where shares are traded daily. Those relatively rare occasions where the profit motive leads to sketchy activities by a pharmaceutical company, that’s generally a response to competitve pressures from other pharmaceutical companies. And the reasons these firms will go forward with tactics that are potentially risky to them is that when corporate executives and managers aren’t focused on the bottom of the next fiscal quarter, they’re most likely looking at stock prices in an even shorter time window. The strongest imperative is always to get the money in the till now. If a pharma could market a cure for any common disease, they would be on that like white on rice full-bore as windfall profits would surely abound. All the major players would get big promotions and bonuses such that they could retire into the lap of obscene luxury well before any long-term consequences of lost income from mere-treatments-not-sold would show up in the company’s ledger. Not there actually would be profit-lowering losses. The pharmas are smart enough to know that every product has an economic life-cycle, and they have plenty of new products and new types of products in the R&D pipeline to fill the profit holes left by sometimes unpredictable obsolescence. Never mind that people who get cured of one disease and have their lives extended as a result will still develop other medical problems and have other health maintenance needs. Finding a cure for some nasty thing would not only bring short term riches, but expand the market of older medical-product consumers capable of buying all that new stuff the pharmas will be putting out to help them fend off hair-loss, wrinkles, wimpy weinies and all the ravages of Father Time…

  48. #51 Gilbert
    January 2, 2017

    My condolences.

    1. Alteration of the MYC oncogene, followed by
    2. Alteration of the RAS oncogene.

    The herbicide atrazine — do you live near a corn field or where one leaks into your water supply?

  49. #52 Opus
    Just north of the buckle on the Bible Belt
    January 2, 2017

    Tonster @#49

    I asked a question at #45.

    Your response had nothing of substance aside from your little personal narrative, one which demonstrates that ‘conventional’ oncology kept you alive for years and you haven’t the cerebral horsepower to figure that out.

    I am struck, however, by the revelation that cancer is merely a product of cells “behaving badly.” What a magnificent breakthrough for science!! I await the next chapter in this scintillating scientific thriller!

    Will it be The Cancer Whisperer, who returns misbehaving cells to normal behavior by instilling the ‘pack rules’ that govern normal cells?

    Will it be Skinnerites, who use operant conditioning to modify the cells’ behavior so they no longer misbehave?

    Or will it the disciples of Dr Phil, who use a highly rated television show and promises of a two-week stay at an inpatient facility to bring the recalcitrant cells back to the straight and narrow?

    Wait – maybe an old-fashioned fire-and-brimstone preacher could best let them see the error of their ways, to bring them back to the straight and narrow!

    But what if the cells are Calvinist, and are predestined to ‘misbehave’ and nothing we can do will change them!!!

    I can’t wait to see which of these approaches is best to convince those recidivist cells to return to the straight and narrow. Only time will tell!!!

    • #53 Tonster
      January 2, 2017

      You can throw in all the big words and terminology you want, just because you can use a thesaurus doesn’t make you intelligent. At the end of the day cancer is your own bodys cells behaving in a way that is non conducive to your health. something has caused this to happen, the holistic approach trys to figure out why and gives your body the tools to try to reverse the damage. I don’t give a damn about your opinion, i only stumbled on this blog and was quite shocked at the closed minded attitudes of the people contributing. I now realize that people like me don’t even bother with people like you, thats why all the posts are so narrow minded and predictable.

  50. #54 Opus
    Just north of the buckle on the Bible Belt
    January 2, 2017

    Forgot to close the sarcasm tag 🙁

  51. #55 Dangerous Bacon
    January 2, 2017

    “You can throw in all the big words and terminology you want, just because you can use a thesaurus doesn’t make you intelligent.”

    Yes, I’m also tired of doctors throwing around those big words and pretending they know more than I do. The arrogance is appalling.

    https://www.facebook.com/photo.php?fbid=10154626617131558&set=gm.877065509100097&type=3&theater

  52. #56 Opus
    Just north of the buckle on the Bible Belt
    January 2, 2017

    Tonster @ #53:
    I don’t give a damn about your opinion.

    Don’t be modest: Your disdain for facts FAR outweighs your lack of respect for my opinion.

    PS: You forgot to tell me how cuddling with a hyperdiploid plasma cell and talking about its childhood could repair chromosome damage. Please enlighten me!

  53. #57 Chris
    January 2, 2017

    Tonster: “ou can throw in all the big words and terminology you want, just because you can use a thesaurus doesn’t make you intelligent.”

    I suspect that Opus is taking the terminology directly from the medical reports from his late wife’s doctors. I have several reports from doctors with lots of interesting terminology from the neurologist who my saw saw trying to figure why the child had seizures and could not take (by the “tonic clonic” apparently means “grand mal seizure”, and “static encephalopathy” means something is wrong with the brain, we don’t know what but it is not changing), and with the several cardiologists he saw for his obstructive hypertrophic cardiomyopathy, which was helped by a septal myectomy (I’ll let you look them up).

    “I don’t give a damn about your opinion,..”

    And why should we care about yours? Perhaps you should try providing us some actual verifiable documentation to support your assertions.

    “…and was quite shocked at the closed minded attitudes of the people contributing.”

    Oh, the irony! You could have changed our minds if you had actually answered Opus’s questions with actual verifiable evidence of what “lifestyle” that would have prevented those genetic events. Perhaps you can tell me what “lifestyle” would have prevented my son’s neonatal seizures, genetic abnormal heart anatomy and his autism.

    By the way, make sure your reply includes the PubMed indexed studies by reputable qualified researchers… not just your life story.

    • #58 Tonster
      January 2, 2017

      Nothing i can say would change your attitude. I don’t have scientific evidence i have my own experience and common sense. Iv been in the farming industry my whole life so i know the chemicals that are pumped onto the fruits vegetables and animals that we eat. Then there’s the chemicals in all the washing powders, cleaners, foods drinks. Everywhere we turn we are surrounded by chemicals our bodys are unable to process, eventually they have an effect. lifestyle changes need to be avoid anything processed as much as possible, grow and eat your own vegetables dont eat processed foods, use organic cleaners all these things can help. For some people its too late their body’s are too broken to fix. I’m not a scientist i can’t help you with your sons problems im sorry.

  54. #59 Chris
    January 2, 2017

    Tonster: “Nothing i can say would change your attitude.”

    I told what could change my opinion: actual factual verifiable evidence that has been studied and shown to work.

    What would change my attitude is if you would actual read what we are saying and stop grandstanding. Right now I get the feeling you are telling me that my son is the way he is because what I ate before I got pregnant? Even though I have been growing food in my garden organically several years before he was born. That is your explanation for a possible de novo mutation is that it is all my fault. Seriously?

    Why should we believe you?

    By the way, my family were fruit growers in the US west for over a century, and I grew up eating good food, very little processed stuff, though I did help with fall canning. Food growers are not fools, and have been using science and technology to reduce harmful chemicals and get better crops (WSU Cougers may have lost their football game, but the agricultural research is awesome!)…

    …. so why do you folks make such sweeping generalizations?

    • #60 Tonster
      January 2, 2017

      Wow i originaly posted because i came across the original post and was surprised at the narrow mindedness of what was written. How did it somehow turn into me having a go at your life choices ???? I know nothing about your childs unfortunate illness and i have no interest in it either. I have experience with both conventional and alternative medicine of my illness, I was simply pointing out that the alternative holistic approach isn’t rubbish. of course there is a lack of scientific evidence around this because sadly pharmaceutical companies control the information.

  55. #61 Chris
    January 2, 2017

    Tonster: ” I know nothing …”

    Exactly.

    “I was simply pointing out that the alternative holistic approach isn’t rubbish.”

    With classic worthless “argument by blatant assertion.” Unfortunately that does not work around here. We need evidence, not stories and not insults about having a close mind. Real evidence that it has been proven to work. And again, if you bring up evidence then you will be taken seriously.

    And not silly evidence free statements like: “… of course there is a lack of scientific evidence around this because sadly pharmaceutical companies control the information.”

    Um, yeah. That is the reason. I am sure all the Aggie schools in this country from Alaska to Florida make sure the pharmaceutical companies control their research.

  56. #62 Dangerous Bacon
    January 2, 2017

    “Iv been in the farming industry my whole life so i know the chemicals that are pumped onto the fruits vegetables and animals that we eat.”

    Farmers do not appreciate the claim that they are poisoning the world (and themselves):

    https://petersonfarmblog.wordpress.com/2016/12/30/17-myths-about-agriculture-in-2017/

    • #63 Tonster
      January 2, 2017

      Well they should stop doing it then. Yes of course there are some that are environmentally conscious and more so these days, its slowly changing thank god! It still happens tho alot. Look we will not agree, iv had an attitude like some of these people but gladly i have seen the light. You guys like to wank on about scientific this and that, the fact is when i read the posts in this blog the impression i got was a bunch of people believing the rubbish you are fed. May i point out to you that Holistic medicine is based on the whole body being healed, when the patient is totally focused and making all the changes needed, thats when the medicine works properly. its alot harder to measure than giving a patient a pill and collating the results.

  57. #64 Opus
    Just north of the buckle on the Bible Belt
    January 3, 2017

    Tonster @ #63: “May i point out to you that Holistic medicine is based on the whole body being healed, when the patient is totally focused and making all the changes needed, thats when the medicine works properly. its alot harder to measure than giving a patient a pill and collating the results.”

    Actually, it’s not all that hard to measure at all.

    You had cancer ten years ago. If you had been treated holistically you would be dead now. You are a walking, talking example of the success of conventional oncological treatments.

    The fact that you live to spout nonsense about whole body treatment, your very existence, highlights the emptiness of your arguments.

    It’s a classic case of spitting in the face of the people who saved your life. Your willingness to do so says all I need to know about your honesty, your courage and your integrity.

    ~~~~~~~~~~~~~~~~~~~

    Hey, this argument by assertion is neat stuff! No need to worry about facts, research or anything! In under five minutes I was able to analyze your situation, assess your character and intelligence and adjudge you to be a worthless, ungrateful dumbass.

    NOTE
    Any parallels between the above comment and your approach to the issues and commenters on this post is purely coincidental.

  58. #65 Chris
    January 3, 2017

    DB: “Farmers do not appreciate the claim that they are poisoning the world (and themselves):”

    Thank you. They are not robots, they are very intelligent people working in a very competitive business, and they do try to do their best with available information. That is why the aggie universities extensions exist.

    Opus, my very sincere sympathies to the loss of your wife. I cannot imagine what that is like. Thank you for having better wit than I could conjure up.

  59. #66 Chris
    January 3, 2017

    Tonster: “May i point out to you that Holistic medicine is based on the whole body being healed, when the patient is totally focused and making all the changes needed, thats when the medicine works properly.”

    Citation needed. Essentially prove it, but with some actual data… otherwise it more worthless “argument by blatant assertion.

    Which is really boring, and useless.

  60. #67 titmouse
    January 3, 2017

    @ titmouse
    “Explain how rich people can game results with a double-blinded placebo controlled trial.”
    1) Perform 20 double-blinded placebo controlled trials, with different medical teams and various indications.
    2) Get a p < 0.05 in one of the indications by chance.
    3) Subdivide your cohort in order to have a subset with a p<0.01
    Pay experts to explain why later studies are not successful.

    So we insist that clinical trials be registered to guard against the file-drawer effect. How do the rich people game things then?

    I think for every problem there is a way to tighten up the way research is done to minimize fraud.

    I notice that new treatments that look promising in preclinical studies usually fail clinical trials. This means that funders do not get what they want most of the time. So the fraud cannot be too big a problem for phase 3 trials.

  61. #68 Opus
    Just north of the buckle on the Bible Belt
    January 3, 2017

    Chris @ 65

    Thank you for the kind words. It’s only been six weeks, so the magnitude of my loss is still becoming apparent. However, I have often drawn comfort from this:

  62. #69 Opus
    January 3, 2017

    Well I didn’t mean to do that!

  63. #70 Narad
    January 3, 2017

    May i point out to you that Holistic medicine is based on the whole body being healed, when the patient is totally focused and making all the changes needed, thats when the medicine works properly.

    You may, but that doesn’t make the statement anything more than low-rent, blobovian occultism.

  64. #71 Chris
    January 3, 2017

    Opus: “Thank you for the kind words.”

    You are very welcome. I lost my mother when I was eleven years old because of an aircraft accident. I know what it is to suddenly lose a bit of your being. I cannot imagine the pain of that being extended. Though this may be because I have dealt with my oldest child’s multiple hospital experiences (which once included open heart surgery). Which is just an added bit of torture (though my kid is still with us).

  65. #72 Chris
    January 3, 2017

    By the way I really truly appreciate the people who work at the various hospitals that my kid has been from the emergency departments to the wards. I actually have a way too long list of the amenities of our local hospitals where he has been taken to by ambulance or just for cardiac rehab.

    I just wish that was not part of my life. Which is why one thing that makes me very angry at anti-vaccers is that they think it is “better” to treat vaccine-preventable diseases than vaccinate. I pretty much know none of these parents have ever had a child hooked up to a respirator. Yep, my kid has… along with an IV and a few other fun machines that go “beep!” and “boop!”

  66. #73 Daniel Corcos
    January 3, 2017

    @ Titmouse
    Clinical trials are registered: treatment A has failed to show significant effect in 19 indications. p is <0.05 in one indication. How can you use the failures of treatment A in other indications to show that p <0.05 occurred by chance, when the company will say that this is proof of specificity?
    Other example: 5 vaccines against HIV show total lack of efficiency. Another one, which does not differ fundamentally from the previous ones at the conceptual level, shows a borderline significance, which can be stretched to 0.05 by carefully selecting the data and the period of follow-up. The main conclusion should be that the putative protective effect is so low that the vaccine cannot be used. However, the results were published in a high impact journal as a proof of concept, with headlines in the media, and this has led to increase the funding of HIV vaccine research.
    Seven years later, there is still no HIV vaccine, but many people have got money from governments.
    For those who want to make money, there is always a way, even with failures.
    https://en.wikipedia.org/wiki/The_Producers_(1968_film)

  67. #74 MI Dawn
    January 3, 2017

    @Opus: my sincere condolences. I’ve been a very lucky person and have lost very few loved ones (grandparents, some HS friends). I can only say that I hope your memories of your time with your beloved wife give you comfort as time passes.

  68. #75 prn
    January 3, 2017

    Panacea@37
    prn… argumentum ad nauseum.
    When you cut through the bullshit what you’re really saying is, “if one person gets a benefit from quackery that should be good enough.”

    I say when intelligent people cut through the bullshit of both conventional medicine and CAM, that they can get a better set of combined answers, more likely to multiply their remaining lifespan.

    Titmouse@39
    If I am sick and I get to pick between 1. prn’s opinions 2. peer reviewed evidence. I think I will go with #2.
    Tittmouse, you’re recasting my comment.
    I do utilize peer reviewed papers, however, I am somewhat independent on their interpretation and utilization.

    I’m sharing part of my experiences. Apparently I trust my opinion and methods, more than you trust your own opinion. So I understand and accept your choices without condemnation, for yourself. Good luck.

  69. #76 prn
    January 3, 2017

    my replys and comments in the real #75,” are awaiting moderation”

  70. #77 Politicalguineapig
    January 3, 2017

    Opus: My condolences. Be kind to yourself.

  71. #78 Dangerous Bacon
    January 3, 2017

    Tonster: “May i point out to you that Holistic medicine is based on the whole body being healed, when the patient is totally focused and making all the changes needed, thats when the medicine works properly.”

    And when the “Holistic medicine” doesn’t work, it’s gotta be the patient’s fault for not being “totally focused”.

    Blaming patients for not being cured is such a predictably obnoxious trait of woo-promoters.

    As always, I prefer medicine that works regardless of whether I’m mentally “focused” on the treatment, and whether I believe in it or not.

  72. #79 Lawrence
    January 3, 2017

    Quackery is known for its “heads I win, tails you lose” philosophy.

  73. #80 Dangerous Bacon
    January 3, 2017

    I might have to bone up on the subject matter a bit, but the company that e-mails me come-ons for primary care medicine jobs has come up with a real doozy.

    Job Title: Family Medicine/Alternative Medicine Physician – Oregon Metro Job Summary: Greater Portland, Oregon Family Medicine 4.5-Day Work Week – 1 Year to Partner No Sales Tax – Tort Reform State Practice: Enjoy an outpatient only practice with a 4.5-day work week Base salary with partnership track of 1 year Work alongside 3 OB/GYNs, Family Nurse Practitioner and a Naturopathic physician Average patient load is about 16 to 18 per day-30 to 45-minute patient visits Have the ability to incorporate acupuncture or Osteopathic Manipulation Therapy into your practice-optional! Work with a team that combines conventional and alternative medicine to treat chronic diseases In-house lab, EKG and medical spa-ability to perform procedures once ramped up Be a part of a practice that believes in patient centered health care Hip, Urban and Affordable | No Sales Tax | Tort Reform Bedroom community to Portland”

    Wow – hip, urban, affordable and less likely to be able to sue you into oblivion when the homeopathy backfires! Count me in!*

    *on second thought, if you’re seeing that many patients for up to 45 minutes each, you could wind up working 13 1/2 hour days and needing naturopathic stress relief. 🙁

  74. #81 Ben
    January 3, 2017

    @73

    You’re describing pharmaceutical research in motion. If one HIV vaccine candidate out of five shows significance of effect, that does call for more research, doesn’t it? Hence, the increased funding to HIV vaccine research?

    Let’s also not forget that it’s never one clinical trial that gets a drug or vaccine approved. If there’s a Type I error in one trial, usually that will be confirmed or disconfirmed with another trial.

  75. #82 Denice Walter
    January 3, 2017

    @ Opus:

    I’m very sorry to hear of your loss.

    Six weeks is an awful time in the roller coaster of an emotional schedule you’re currently riding..

    HOWEVER it may be better than three weeks. I hope it is.

    I wish you can find something intriguing/ important/ meaningful/ not totally horrible with which to occupy yourself over the next few weeks.

    Perhaps DJT and company with oblige with some hilarity and, at the very least, NOT a new war or a nuclear attack.

    I will make note of Melania’s / Ivanka’s outfits.
    I need something to look forward to
    ( although, personally, I doubt I would ever wear anything like what they usually choose)

  76. #83 Murmur
    UK-ia
    January 3, 2017

    “May i point out to you that Holistic medicine is based on the whole body being healed, when the patient is totally focused and making all the changes needed, thats when the medicine works properly. its alot harder to measure than giving a patient a pill and collating the results.”

    And may I point out that “holistic” was a huuuuuge buzz word in UK-ian nurse training back in the ’80s: it was pretty meaningless then and remains so now…

    And may I also point out that pretty much ALL “conventional” medicine is rather more than pill pushing?

  77. #84 Daniel Corcos
    January 3, 2017

    @ Ben
    For a drug, I think that one clinical trial may lead to approval. The example of the vaccine was to show that you don’t need efficiency to make money. What you need is to convince governments to support basic research with a goal that politicians can understand. Then, if something emerge, make money until the drug is shown to be useless. Many anti-cancer drugs were successful in clinical trials without any effect in clinical practice.

  78. #85 Chemmomo
    Catching up on comments
    January 4, 2017

    Opus #45 I am sorry to hear about your wife.

    Opus #52 I need to tell you I’m still laughing. (paraphrasing) What if they’re Calvinist ?

    In the morning (I am PST) I’m going to play Rush’s Free Will in honor of your wife’s battle with recalcitrant cells. If you would prefer a different song, let me know and I will dedicate that to her instead.

New comments have been temporarily disabled. Please check back soon.