White Coat Underground

It’s true that words matter, and that we who practice real medicine have often let cult medicine practitioners get the linguistic high ground. We’ve let them get away with calling non-science-based practices “alternative” and “complementary”, without really asking, “alternative to what?” or “does it really “complement, or just distract?” We’ve often ignored language, and when we don’t, we are accused of being pedantic, of focusing on “rhetoric” rather than “real” issues. Language is powerful. There is no such thing as “it’s just a word”.

Language is even more important in the fight against pseudo-science in medicine. Since evidence consistently fails to show benefit of practices such as homeopathy and acupuncture, language is all their adherents have left. What can you do when your favorite cult practice just isn’t showing promise? Call your legislator! Maybe he or she will pass a law making your hobby sound better.

And that’s just what is happening right now in Washington state. Let’s look at some of the language of the bill.

Sec. 1. INTENT. The legislature intends this act to
8 recognize that acupuncturists licensed by the state of Washington are
9 practicing a system of medicine, and that changing the name of their
10 title to “Oriental medicine practitioners” more appropriately captures
11 the nature and scope of their work. It is further the intent that
12 references in federal law to “acupuncturists” apply to persons licensed
13 under this act as “Oriental medicine practitioners.”

So much wrong in such a short piece of writing. First, “acupuncturists…are practicing a system of medicine…” is rather deceiving. What “system of medicine”? Is there more than one “medicine”? As far as I know, there is medicine that works, and is taught in medical schools and practiced throughout the world, and that which does not. Harriet Hall has a nice piece on the history of this so-called ancient bit of wisdom. It’s not what you think.

“Oriental medicine practitioners” more appropriately captures
11 the nature and scope of their work.

Really? Why? What is “the Orient”? Are they referring to Edward Said’s writings? Are they talking about Camboida? Turkey? Azerbaijan? And what kind of medicine is practiced in “the East”? Do they do things much differently than here? (Answer: They practice the same medicine we do here, to their ability to pay for it.)

The Bill is fascinating, and refers to such time-honored idiocy as “laserpuncture” (originated by Lao Tze as we know that the first laser was developed in the ancient Far East), moxibustion, and cupping. Lovely.

It’s been (famously) said that that you can put lipstick on a pig, but it’s still a pig. Unfortunately, it’s not that simple. Dress a pig pretty enough, and someone’s going to ask it to dance. When a quasi-medical practice can’t gain legitimacy through science, and it turns to the government for a stamp of approval, it really can become legitimized. It can gain funding and acceptance, despite it’s lack of efficacy. Government’s should be a little more cautious before throwing their weight behind fringe practitioners of quackery.

That is all.

Comments

#1 Danio
January 26, 2009

This is typical of the overall woo-legitimization festering in the Pacific Northwest. By way of example, there are a number of Chiros, Acupuncturists and Naturopaths listed as providers (many of them ‘preferred’!) on my health insurance plan (provided to all state of Oregon employees). It’s an alarming trend, to say the least.
#2 Rogue Epidemiologist
January 26, 2009

Nice citation of Edward Said. It aptly points out how condescending it is to lump a bunch of alti-med practices into “Oriental medicine.” Make it look as exotic as possible, so we can’t possibly question its efficacy, and at the same time, imply that medical practices in Asia are all backwards.

FWIW, my father is a GP from the Old Country (gung hei fat choy, everyone!), and aside from rejecting TCM on grounds of it NOT WORKING, his attitude towards these practices is that it *is* backwards and against modern progress.
#3 PalMD
January 26, 2009

Happy New Year to you too!
#4 The Perky Skeptic
January 26, 2009

OMG… Calling themselves “Oriental medicine practitioners” would make it sound racist to call them on their quackery!

Oh wait… that’s probably half the point.

Funny how those who cannot show good science to support their position always want to be rendered magically above criticism.
#5 DrBadger
January 26, 2009

OMG… Calling themselves “Oriental medicine practitioners” would make it sound racist to call them on their quackery!

Actually, I think that some real scientist from east (i.e. Rogue’s father) can easily sue the state for being racist by calling fake medicine “oriental” medicine.
#6 abb3w
January 27, 2009

When a quasi-medical practice can’t gain legitimacy through science, and it turns to the government for a stamp of approval, it really can become legitimized.

This would appear to be a defect of both said society and the government of such society.

Until the underlying problem of social tolerance of “woo” is addressed, I think the best to be hoped for is to require that “alternative” practitioners keep records consistent with FDA experimental protocol trials, listing diagnosis, treatment, side effects, and efficacy (if any), providing patient-anonymized annual reports to the state. I doubt there’d be anything to learn from them, but someone might find a use as a large-scale placebo effect study or something.
#7 Dana Ullman
January 28, 2009

You’re so right. When you consider that the World Health Organization estimates that 80% of the world’s population relies upon “traditional medicines” (NOT conventional drugs) as their primary mode of care, it is conventional medicine that should be considered “alternative” care.

As for medicine taught in medical schools today, ALL of the leading medical schools in the US have added courses in “alternative and complementary medicines” into their curriculum.

When you consider what we in America pay for health care and our truly miserable morbidity and mortality statistics, I hope that we can realize that we are relying too much on a failed medical reductionistic paradigm that provides real benefits in a minority of situations but tends to give the short-term benefit and serious side effects as a way of life. Like the green revolution of the former century, it may be time to explore organic agriculture and a NEW green medicine.
#8 James Pannozzi
January 28, 2009

PalMD, I don’t believe you will deny that our current health system in America stands in ruins, invaded by rapacious health care “provders” who seem to want to require YOU to make calls to some outsourced country with the proper “treatment codes” in order for you to beg to be allowed to give treatment to your patients. I suspect, no matter what your opposition to alternative medicine, you would agree that some urgent reforms to our current pharmaceutical based system would be necessary which puts YOU, the Doctor, and other medical professionals back in control.

On your criticisms of Complementary and Alternative medicine, I believe you mean well but you’re ignorance of, for example, Acupuncture is overwhelmingly obvious. May I suggest the book:
“Acupuncture Case Histories from China” compiled and edited by Chen Jirui M.D., and Nissi Wang M. Sc. (Eastland Press) these case histories are for typical western type ailments for which both standard medicine and herbs did not help and often the patient came to the Acupuncturist out of desperation. Certain types of Parkinson’s, glaucoma, breast masses, skin numbness, cerebrovascular accident sequelae, Meniere’s syndrome, rectal prolapse, gallstones, and many other diseases and conditions are analyzed and the course of treatment described and they are from actual case histories.

As you know, these kinds of case histories are exactly what constitues the body of knowledge behind western medicine and Homeopathy too – and NOT some double blinded placebo controlled studies, falsely claimed to constitute “evidence” based medicine. There are NO such controlled studies for heart surgeries, chemotherapies, knee replacements on human patients… etc. and rightly so for ethical reasons. To claim otherwise is only to misrepresent your own system of medicine with false justification – something I’m sure you do not want nor need to do.

You should pay attention to Dana Ullman’s excellent comments as well, hopefully you will learn something to correct your current provincial and uninformed attitudes.

Those using the “quack” and “woo” words should cause you grave misgivings as these usages can easily backfire on your own system of medicine for equally flawed reasons when one examines the success rates and cancer recurrence rates for chemo “therapy”, for example.

That you have had the guts to allow opposing opinions, such as the ones by Dana Ullman is good.
#9 PalMD
January 28, 2009

PalMD, I don’t believe you will deny that our current health system in America stands in ruins, invaded by rapacious health care “provders” who seem to want to require YOU to make calls to some outsourced country with the proper “treatment codes” in order for you to beg to be allowed to give treatment to your patients.

I think you have some basic misunderstandings. “Providers” require no such thing (the word usually applies to clinicians). Insurers often set requirements, but it is not a matter of calling Bangalore to get some sort of code.
#10 James Pannozzi
January 28, 2009

@PalMD – Ya, that is exactly the sort of useage for the word “provider” that I would agree with but, correct me if wrong, I’ve read of numerous health “insurance” companies calling themselves health care “providers”. Look up some of the exclusionary criteria of these outfits any time you don’t feel like watching a horror movie but want to quake with fright. Likewise their provisions about “unusual” diseases and their termination criteria for “chronic” diseases.

The bottom line is that the profit motive and helping sick people are two sometimes mutually exclusive goals – something the 45 million people with no health care coverage at all in this country have already found out. With the coming of the current recession, many more will too, unfortunately.
#11 marty
January 29, 2009

@James Pannozzi

The bottom line is that the profit motive and helping sick people are two sometimes mutually exclusive goals

I always find it amusing that those supporting the “Alternative” side often come up with assertations about the profit motive within real medicine, and yet never mention the expensive (and sometimes deadly) consequences of using the alternatives. Acupuncture is free, is it?
Same with accusations against “Big Pharma”, when some of the same companies also sell supplements, herbal remedies and the like.
#12 James Pannozzi
January 30, 2009

I always find it amusing when those supporting “standard” medicine often come up with assertions about the profit motive within alternative medicine, and yet never mention the expensive (and sometimes deadly) consequences of using the “standard”.

Same with accusations against “Big Pharma”. when those same companies also sell, mainly, standard remedies, and the like.