White Coat Underground

Dana Ullman is an idiot. Or maybe insane. I’m not sure which, but his latest article at the Huffington Post reveals such a severe defect in rational thought that it must be one or the other (charitably speaking). He calls it “Lies, Damn Lies (sic), and Medical Research,” and the point of it is quite clear: Ullman calls himself an “expert in homeopathic medicine” (which is akin to being a unicorn veterinarian) and since he has never been able to show that his particular health religion has any validity, he lashes out futilely at reality.

His entire argument boils down to a profound ignorance of medical science and a series of rhetorical/logical fallacies. His first straw man is a typical argument of alternative medicine gurus: that modern medicine only treats symptoms and not their causes. His first claim in this regard is that clinical studies define efficacy wrong because we consider symptom relief to be “efficacy”. This is simply wrong. End points of studies depend on what is being studied. If, for example, we wish to know if a pain medication works, then pain relief is a reasonable end point. If we want to know if a particular drug prevents heart attacks, then heart attack is a reasonable end point. Ullman is either intentionally raising a straw man, or simply too ignorant to understand the barest basics of medical science:

The bottom line to scientific research is that a scientist can set up a study that shows the guise of efficacy. In other words, a drug may be effective for a very limited period of time and then cause various serious symptoms. For example, a very popular anti-anxiety drug called Xanax was shown to reduce panic attacks during a two-month experiment, but when individuals reduce or stop the medication, panic attacks can increase 300-400 percent (Consumer Reports, 1993). Would many patients take this drug if they knew this fact, and based on what standard can anyone honestly say that this drug is “effective”?

The “bottom line” is that anyone can create a crappy study, but that the method we use approach prevention and treatment of disease depends on data. In the case of alprazolam (Xanax), this drug is not generally used for the long-term treatment of anxiety. For example, the package insert for Xanax XR states that:

XANAX XR Tablets are indicated for the treatment of panic disorder, with or without agoraphobia…The longer-term efficacy of XANAX XR has not been systematically evaluated. Thus, the physician who elects to use this drug for periods longer than 8 weeks should periodically reassess the usefulness of the drug for the individual patient.

See, the data don’t give us much guidance beyond short term usage. There is, of course, no guarantee that a doctor will use this data, but that’s what education is for. Drugs such as alprazolam can be life-savers. Alleviating symptoms of an illness is one of the most important things we do and in the case of panic and anxiety disorders, symptoms are often all we have to work with. We don’t know enough about these protean disorders to separate out “cause” from “symptom”.

His next burning heap of stupid regards his understanding (sic) of how medicine works. He claims that drugs are inherently dangerous, and that doctors just don’t get this.

These problems are evidence of the limitations of a model of medicine that over-emphasizes a biochemical, biomechanical pharmacological approach to healing that ultimately seeks to “attack” disease, “combat” illness, and wage “war on cancer” or on the human body itself (Ullman, 2009) This paradigm can be invaluable in emergency medicine and help us survive certain infectious diseases, but for the large majority of people facing day-to-day chronic illnesses, it provides short-term results, serious side-effects, and stratospherically high costs.

Which “day-to-day chronic illnesses” does he think are inherently not amenable to a “biochemical, biomechanical pharmalogical approach?” Is there some other way to approach human biology besides, you know, human biology? Where is all this expensive inefficacy? For example, our current medical regimens for coronary heart disease, including life-style modification, prevent hundreds of thousands of heart attacks and deaths every year, with safe medications that cost a few dollars per month. Reality is indifferent to Ullman’s lack of interest and knowledge.

Ullman goes on to defend homeopathy as a legitimate alternative to real medicine. Right after railing against clinical trials, he defends homeopathy’s failure in clinical trials:

The deniers of homeopathy love to say that homeopaths “cherry-pick” the positive studies and ignore the negative ones. They then incredulously assert that we should ignore ALL of the positive trials. Such statements and viewpoints are profoundly misguided and simply daft. Will these same people say that Thomas Edison “cherry-picked” his positive study and ignored all of his “negative” studies in his efforts to invent electric lights? The (il)logic of the deniers is that they would recommend ignoring Edison’s discovery because the vast majority of his studies were not positive.

This isn’t even a clever use of the Galileo Gambit. The fact is, when you turn on an intact and properly functioning light bulb, it illuminates. Every. Single. Time. The magic potions of homeopathy do not even come close to this sort of success. Ullman’s tenacious support of magic does not make him a brave maverick—it makes him a pitiable unicorn cowboy, riding his fantasy into a unsung oblivion.

Comments

#1 Glendon Mellow
April 30, 2010

Homeopathic medicine akin to unicorn vetrinarian.

That is pure verbal gold.
#2 Diane
April 30, 2010

I love when homeopaths say that science-based medicine only treats the symptoms. isn’t that precisely what homeopathy claims to do? isn’t the whole idea to have a person list all their symptoms and then give them the sugar pill?
#3 Electric Landlady
April 30, 2010

I… guess by this logic you could say medical science only treats the symptoms of my asthma. The argument would be more convincing if I’d only been prescribed Ventolin, but it is quite true that medical science has not cured my asthma. If I stop taking my inhaled steroids, my airways will get inflamed again. I cannot argue against this. (Medical science hasn’t found a cure for type 1 diabetes either! Useless medical science!)

But you know, I’m pretty much good with the treatment I’ve got. And I don’t think homeopathy has anything that will reliably compete. Unicorn veterinarians are welcome to try and convince me otherwise, of course.
#4 Mu
April 30, 2010

If Ullman ever gets a RCT of homeopathy shine as brightly as Edison’s light bulb (without holding a match to a printout), I will stop thinking of him as the unicorn rider, I promise.
#5 daijiyobu
April 30, 2010

What have unicorns done to be closely associated with Dullman?

Unicorns rock; he sucks.

-r.c.
#6 Pascale
April 30, 2010

Preaching to the choir, again, Pal. I just hope someone will read your post (and other like it) and be convinced of the fantasy that is homeopathy.
Unicorn veterinarian (snort); is unicorn snot pink or lavendar? Or does that depend on what color of fairy is riding it at the time?
#7 Dr Aust
April 30, 2010

I contine to be amazed anyone gives DUllman a platform.

Or maybe not. Pal and Orac may find this interesting.
#8 Kwombles
April 30, 2010

“pitiable unicorn cowboy, riding his fantasy into a unsung oblivion.”

Lovely turn of phrase and excellent depiction of Ullman, who barely, and I mean just barely, escapes being as completely offbase as Lanza.
#9 daijiyobu
April 30, 2010

Also, I’m reminded of that great William Shatner song…

“Has Been.”

-r.c.
#10 Jake
April 30, 2010

I suffer from panic attacks and have been on Xanax, and gone off of them as well.

First, I say these pills are very addictive. As you body gets used to them you build of a tolerance, and withdraw can be difficult.

When stopping taking this medication, I noticed more panic attacks, but I would not go as far as saying they increased 300%, but I wasn’t keeping track either. Very interesting to say the least. This topic interests me. Some say the only way to stop them is through mediation and breathing exercise. Pills do help though at least while you keep taking them.

Next time I’m at the doctor I just may bring this up. Thanks.
#11 Badger3k
April 30, 2010

Will I be showing my age if I say I can hear Glen Campbell singing “Unicorn Cowboy”?
#12 daijiyobu
April 30, 2010

“Like a rhinestone…unicorn cowboy.”

-r.c.
#13 _Arthur
April 30, 2010

Uh, even if for the sake of argument, Xanax withdrawal do causes panic attacks, it doesn’t logically follows that *ALL* drugs have severe side-effects.
#14 leigh
April 30, 2010

dude cited consumer reports as a valid source of medical information?! come ON.

benzodiazepines are not meant to be used in the long term because of the rapid tolerance that develops to them (and several other reasons). the withdrawal, being that whole part where the body readapts and often goes through the *opposite* of the drug’s initial effect, can be minimized if the treatment regimen is properly managed.

until we can do things like re-wire the brain, we are stuck with the obviously useless option of treating the symptoms. i guess we are not the least bit fortunate to have advanced that far.
#15 gaiainc
May 1, 2010

Consumer Reports likes to think that it gives out good medical information and for the most part it does. However, their bias is definitely from the consumer’s perspective and some of what they recommend and/or advocate for kind of drives me up the wall. So it goes.

If drugs didn’t have side effects (or potential side effects), then they wouldn’t be doing anything. A drug can’t cause an effect on the body without having side effects. Gah!
#16 James Pannozzi
May 2, 2010

PalMD !!! Boo-Hoo ing about Ullman, eh?

Understandable.

And that utterly absurd Homeopathy – nonsense, eh?

Well, I’ve been trying little experiments, when the need arises.

A few weeks ago I got one of my favorites – an occipital headache from the overhead fan – not a migraine, but good enough to make life miserable for the rest of the evening. I’ve gotten this type of headache many times in similar situations – draft from air conditioner, fans etc. Typically it will stay all night and diminish in the following morning. Another characteristic is that it gets much worse when lying down, so after going to bed, I usually sit up all night and sleep that way. Asprin is worthless for this beast, does nothing but makes me a wee bit nauseous, nor will I touch Ibuprofen,ever, for anything.

OK, time to try “crazy” Homeopathy – I go to Robin Murphy’s Homeopathic Repertory and look up Headache – occipital. Next I look for “worse when lying down”. It takes me a moment to find it but there it is and the indicated remedy in big black letters is Cina (high dilution of bark from a Peruvian tree, I think).

Do I know what I’m doing? No. Do I think this craziness will cure this type of headache? No. I have a stash of nice Boiron Homeopathic remedies in the medicine cabinet for just such an “experiment” and there’s the “Cina” so I take the 5 little pellets, under my tongue, being careful to pour them from the cap and not touch them with my fingers. I’ve had nothing to eat or drink for over a half hour before taking them, nor for a half hour afterwards. The dose is 30C.

I go back to the computer to do a few chores and wait, fully expecting absolutely nothing to happen. However, after about 10 minutes, something amazing happens. It’s like someone flipped a switch and the headache just stopped. Not diminished, I mean STOPPED. Gone.

Now I’ve tried various remedies in the past for this same type of problem – there is a Chinese herbal formula called Yan Hu Suo which will typically knock out about 90% of the headache leaving a tiny bit behind but not enough to bother me. Takes about 20 minutes to 30 minutes to work. I’ve also tried using the BLadder 60 point of Acupuncture (Kun Lun)and that has worked in the past too. (Ouch! sometimes get a sore ankle from that one, the point is located behind the ankle).

But this was simply magical, the entire headache was gone and did not re-occur. It was no temporary amelioration, it was GONE.

So I don’t really care if this was, as some are going to claim, erroneously I believe, that it was “placebo” (how could it be, I was convinced it would NOT work) or rays from a Man in the Moon Marigold plant, or if it really was the principles of Homeopathy operating.

Feel free to think anything you like about Homeopathy PalMD, and if you think Ullman an “idiot” may I suggest your opinion is very much wrong.

As for me, I shall continue reading Homeopathy and learning more because when all is said and done ……. it works.

(Images of PalMD foaming at the mouth and legions of anti-alternative medicine fanatics ready to assert my craziness, that I was dreaming, am a self deluded fool, made the whole thing up, can’t “prove” it was the Homeopathic remedy etc. etc.)

Thanks for posting your opinion PalMD, could you excuse me now, there’s a blog at the Huffington post I’d like to read by….
(uh I have omitted his name for fear of antagonizing an already rather distraught PalMD).
#17 PalMD
May 2, 2010

Sorry, I lost you after I realized you were simply sharing an anecdote of yours rather than anything illuminating.
#18 TWood
May 2, 2010

Dana Ullman is not an idiot.

He’s a very talented snake oil salesman. He knows exactly how dishonest his sales pitch is and he just doesn’t care. There’s a lot of money to be made off the gullible, and if they are that stupid then they deserve to be taken.

Apparently everybody in the supply chain of the industry feels the same way. And, I guess society as a whole has reached the same conclusion. So, to make sure nobody gets sued, everybody colludes on selling sugar pills and water as ‘medicine’ because it’s at least safe in and of itself. If people take homeopathic junk instead of real medicines and suffer for it, well that’s just Darwin Award stuff.

The only reason homeopathy can survive is because too many people are making too much money on it. Otherwise the FDA could have shut this fraud off a long time ago.
#19 Ian
May 2, 2010

I am amazed at the lack of insight expressed by some believers in alternative medicine. They take their personal experience as proof of effect, never stopping to think that this means everything works. You can’t name a purported treatment that doesn’t have anecdotal reports of success.
The one thing I can’t help but notice is that these alternative treatments generally make dramatic claims for the effectiveness of their treatment unlike medical treatments that always come with a reasonable qualifier. Even more glaring is that their reported successes seem related to conditions where success is based on self-reported improvement. What do they have to offer for illnesses where there is objective evidence of effect. What is their success in treating bacterial pneumonia, pulmonary embolus, cardiac arrest, heart attack, heart failure, reversing stroke, septic shock, etc? It’s amazing to me that believers don’t see this inconsistency.
#20 BB
May 3, 2010

quote: I… guess by this logic you could say medical science only treats the symptoms of my asthma
@Electric Landlady: Medical science now treats some underlying causes of asthma (depending upon how you look at it from avoidance of triggers/allergens to newer drugs such as Accolate and Singulair). Cure? No. Manageability? Yes.
#21 fodderfile
May 3, 2010

I agree with you, PalMD, although your vehemently tactless assault, I fear, has clouded your reading.

TRUE: Homeopathy is scientifically groundless.
TRUE: Allopathic medicine is made better by evidence-based practice.
TRUE: The scientific method is our strongest tool for investigating biology, medicine etc.
TRUE: Dana Ullman is a unicorn cowboy.

However, don’t be so quick to relegate Ullman’s column as complete tosh. I feel like his overall theme is valid: science is not perfect. We should all have a bit of humility and agree with him, if only on this point (please only on this point, and no further!).

In incredibly illuminating piece by Mita Giacomini from McMaster Medical Centre in Hamilton, Canada, attests to this. I would certainly encourage you to give it a read. It uses the example of remote intercessory prayer to illustrate the importance of re-evaluating the validity of RCTs as the be-all and end-all of acceptable evidence for EBM, and reminds us to make sure that the experimental method fits the theory when testing treatment strategies.

Science does not accomodate testing of homeopathic, religious or some naturopathic treatments for health. We need some humility when coming up against them. But I understand, PalMD, that you need to write in a fundamentalist way to appease your readership.

http://www.ncbi.nlm.nih.gov/pubmed/19395822

fod. – http://www.fodderfile.com
#22 PalMD
May 3, 2010

What is with the profusion of concern trolls lately?
#23 Prolix
May 3, 2010

The fact is, when you turn on an intact and properly functioning light bulb, it illuminates. Every. Single. Time. The magic potions of homeopathy do not even come close to this sort of success.

You’re setting a bar that is so high that no form of medicine can pass over it.
#24 PalMD
May 3, 2010

I’m not the one who came up with the light bulb analogy.
#25 JohnV
May 3, 2010

“I feel like his overall theme is valid: science is not perfect.”

Other in depth analyses to look forward to:

Water is wet
Grass is green
Strawmen are strawmanny.
#26 PalMD
May 3, 2010

“Strawmen are stawmanny”

LOL!
#27 James Sweet
May 3, 2010

Well, of course if you are trying to promote homeopathy, you don’t want to define your success criteria as “patient no longer experiences symptoms of the disease”. Researchers using that criterion for evaluating the efficacy of homeopathy have found it to be no better than a placebo! So obviously that’s the wrong approach.

Re: The concern trolling, let me quote PalMD in regards to the lack of efficacy-studies on long-term use of Xanax to treat anxiety:

There is, of course, no guarantee that a doctor will use this data, but that’s what education is for.

To build on that theme, the more I learn, the more frighteningly non-evidence-based a lot of mainstream medicine seems to be. Unfortunately, for some reason, folks like Ullman take the observation that mainstream medicine often fails to adhere to high standards of evidence and scientific rigor, and from there go on to “deduce” that therefore the preferred alternative is “medicine” that doesn’t even attempt to be evidence-based. Harumph!
#28 k8
May 3, 2010

Thanks!
#29 James Sweet
May 3, 2010

And BTW, I’m very confused by fodderfile’s comment… everything he/she says is eminently reasonable, except the apparent implied notion that Ullman’s article has anything of value to say on the topic, and this left-field accusation of “fundamentalism” against PalMD.

Seems to me that recognizing the difficulty of the struggle to maintain high standards of evidence in medicine ought to inspire us to be even more dismissive of Ullman and his ilk. For one, it shows the stakes are high. And for another, if MSM all too often fails to take an evidence-based, what does that say about alternative medicine in comparison!!!

Really bizarre that fodderfile seems to have come to the opposite conclusion, despite recognizing all of the factual points leading up to it…
#30 Toxicology Kat
May 4, 2010

James Sweet @29: Fodderfile is spam selling something, I think.
#31 fodderfile
May 4, 2010

Yowzah, that got a response, eh?
Nope, not selling anything, @ToxKat.
Listen… I agree with PalMD on many of his points, and I enjoy reading his column because he brings an interesting perspective to the issue.
I’m not asking for, nor would I encourage, a welcome home party for “Ullman and his ilk” (I might be the first to lock the door). My point was that although Ullman pushes a homeopathic agenda (which is scientifically baseless), he raised some interesting points about some of the limitations of science. That’s it. Don’t make it more than it was, @JamesSweet.
-fod
#32 Calli Arcale
May 4, 2010

I’d believe you, fodderfile, except that you went on to say that “Science does not accomodate testing of homeopathic, religious or some naturopathic treatments for health. We need some humility when coming up against them. But I understand, PalMD, that you need to write in a fundamentalist way to appease your readership.”

First off, “write in a fundamentalist way” is pretty damn insulting, and makes it quite a backhanded compliment. Which is pretty hypocritical after saying you didn’t like the way he put it.

But more importantly, what makes you think science does not accommodate testing of homeopathic, naturopathic, or religious treatments for health? It does. It’s true that such tests generally fail, but to argue this is because science can’t test them is a logical fallacy called special pleading — you want us to make different rules for alternative medicine so that it will pass the tests. It’s true that science won’t allow that. But it shouldn’t; the whole point of science is that nobody gets a free pass.

You can use the scientific method to test a great many homeopathic, naturopathic, and religious claims. Now, some claims are too vague to be tested, but that’s not science’s fault. That’s the claimant’s fault, for refusing to make a claim that can be tested, and it is usually done specifically to avoid disproof. Fortunetellers and astrologers are especially good at it.

But these claims are not vague. Homeopaths make specific claims. Mr Pannozzi above makes a specific claim. He states that he took 5 pellets of a remedy called “Cina”, prepared at 30C dilution, from the manufacturer Boiron. (They are a very prominent homeopathic manufacturer.) He asserts that within 10 minutes, his severe headache was gone, and attributes this to the 5 pellets of 30C Cina placed under his tongue and allowed to dissolve in his saliva.

Now, we cannot test whether his headache went away; it happened in the past, we were not present, it’s an anecdote. We can take his word for it, though. More pertinent is his claim that the Cina remedy is responsible. This also cannot be tested, as it occurred in the past, but that does not mean science is helpless. We can test whether or not 5 pellets of 30C Cina, manufactured by Boiron and used as directed in patients not taking any other remedies, outperforms placebo. Or, we can test how long it takes for a large group of people’s headaches to go away versus how long it takes a similarly large group of people’s headaches to go away if they use this remedy, controlling for as many variables as possible. (For instance, we want them all to have the same kind of headaches.)

This is not easy, but it is also not impossible. Why do you assert that it is?

Likewise, naturopaths and religions most certainly do make claims which are testable. (Disclosure time: I am a Christian; there are holy cows of mine that may get roasted in the process. But I prefer my beef cooked anyway.) If a naturopath claims that adding a particular herb to my diet will improve my asthma, I can test that. Get a bunch of asthmatics. Test their lung function. Give some of them the herb. Test their lung function again. Do this again over time, watching for markers such as lung function and also use of rescue medications (e.g. albuterol). If the herb group does better, the naturopath may be on to something. If not, time to move on.

Religious claims. You can’t test whether there is an invisible pink unicorn living on Titan. But you *can* test whether or not intecessory prayer is effective at healing when the recipient is unaware of the prayer. Indeed, this has been tested several times, to varying results. Generally, the results are unimpressive. Sometimes they are flat-out negative. That doesn’t mean prayer can’t be tested scientifically. It means that praying for someone’s healing probably isn’t magic. Tellingly, studies where the recipients were aware of the prayers were far more positive, though even there, the results were mainly in subjective areas. This is exactly what you would expect of a placebo. People like knowing that someone cares; beyond that, prayer doesn’t appear to have much effect in the physical world.

If it has an effect outside of the physical world, science can’t test that. But if it has such an effect, then it is irrelevant to this one, and science is only concerned with this one. You can’t base claims of miraculous healing on things which have no effect in this world, since miraculous healing would be an effect in this world.

Do you understand now why you’ve put people off?
#33 red rabbit
May 5, 2010

Yeah, McMaster.

*sigh*

I was the token skeptic in my postgrad medical small group. They don’t do anatomy or physiology in medical school there. They don’t understand statistics *at all* because it isn’t required that they study stats. They have a course which is a nod to evidence-based-medicine, but really, it’s a joke.

My group included a guy whose brother was a chiropractor and therefore wouldn’t hear any criticism of them; a chick whose electives included one of those “retreats” they do in Arizona, you know, those fake ashrams. She came back spouting all manner of nonsense.

Open minded? You betcha. So much so, their brains have been known to spill all over the floor.

It is the biggest repository of quackademic medicine (who coined that? I love you!) in Canada.
#34 fodderfile
May 6, 2010

All excellent points, Calli. Thanks for taking the time to respond – yes I see why some people may be put off. I wholeheartedly agree with you: claims for health, whoever is putting them forward, should be submitted to scientific scrutiny.

I am not requesting or suggesting that homeopathic, naturopathic or religious “treatments” that purport to be healthful, should be subjected to a different type of science. Nay, where possible the scientific method and randomized, double-blind, placebo-controlled trials (RCTs; the gold standard) should be employed to distinguish the bogus from the true, and the unicorn cowboys from the Butch Cassidy’s. You have eloquently described a few situations (i.e. James Panozzi’s Cina anecdote above, naturopathic herbs) where this is possible.

I may have been too rash as to say, “Science does not accommodate testing of homeopathic, religious or some naturopathic treatments for health.” You have gracefully shown otherwise. I will try to elaborate on some scenarios that become problematic when testing with the gold standard of RCTs, and to which I was unsuccessfully referring above.

Consumption of long-chain omega-3 fatty acids from marine origins in capsule form have been shown to be of benefit in patients at very high risk of cardiovascular events (Meta-analysis: PMID:19609891, Large intervention: PMID:11997274, Systematic review: PMID:19106137). When exploring dietary approaches (often employed by naturopaths), how do you blind fatty fish consumption? What serves as placebo? These are methodological problems faced by nutritional scientists when trying to explore evidence-based solutions to promoting positive health outcomes. Similar problems present themselves with meditation. Also with surgery!

Here’s a quote I really like, which comes from the paper I referenced in my first comment (PMID:19395822):
“The ferment of new knowledge – where new ideas are generated, tested and flourish or decay – occurs at the surface of a vast ocean of tacit assumptions about the nature of things.”

We test these assumptions with the best tools we’ve got. In the case of prayer that you brought up Calli, our assumptions about the nature of things create a disconnect between scientific theory and accepted scientific methodology.

“Remote intercessory prayer refers to people praying to God for the healing of others, without the others’ knowledge, and with no interaction between those praying and those prayed for.”

We test this in RCTs like you described Calli (PMID:11761499; 16569567; 19370557; 10547166). Mixed results. The hockey score certainly won’t take Prayer to the playoffs. But again, it is problematic. This is based on the ontological assumption that God (if He/She/It exists) will act to answer the prayer with a positive result of “healing” because He/She/It is beneficent. But in traditional Judeo-Christian belief (and the religious group mostly involved in these RCTs) God is autonomous, active, intervenes at will and on His own imperatives. Ah ha! The disconnect. How can we use “healing” as the outcome of “prayers working” when God may just as well be answering the prayer by intervening to put someone out of their misery, as God’s will pleases? Our assumption is false, and the method we use to test the outcome does not yield meaningfully interpretable results. (for a fuller analysis, see PMID:19395822)

But as you say: “That doesn’t mean prayer can’t be tested scientifically.” You’re right… but is it meaningful? I think it is worthwhile to continue testing, but I don’t think we will ever get to the point where we can definitively say “prayer does or doesn’t work”. This is a debate that will continue far into the future, but I’m sure PalMD would appreciate it if it didn’t occur here!

I can’t provide a decent argument for why some homeopathic remedies should face complications in scientific methodology besides the above. Nor do I want to, nor will I attempt to! Treatments like those described by Cina fit the bill: it can be blinded, controlled, the theory works, the assumptions are there and valid. From my perspective, it can be submitted to scientific scrutiny (you’ve illustrated this Calli), and I was wrong to heap it together with the above.

These are some complex limitations in our employment of science and certainly not “special pleading.” These *singular* examples do not discredit the whole method of science and does not mean we should give up on it. To the contrary, it illustrates that we should continue to examine difficult topics as it will help to make science stronger. But humility is needed.

Books have been written about this. Atul Gawande, a surgeon at the Brigham and Women’s Hospital in Boston, (equally as qualified to speak on the issue as PalMD) writes in his book ‘Complications’:
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, inuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”

Ullman was not humble in his self-righteous tirade against EBM, so you might argue that he must be labeled as an “idiot” or “insane.” I disagree. Although Ullman is incorrect in his analysis, the medical profession has the opportunity to practice tolerance, respect and tact in the filleting process. But the filleting should take place. I’ll probably take some heat for this “moralistic” bent, but I’m trying to walk the line of moderation.

If that qualifies as “concern trolling”, then I’m guilty as charged.

p.s. my apologies for the length… This shall be my last attempt at reply, so I don’t take up more space on your comment board, PalMD.
#35 davep
May 6, 2010

fodderfile@34 “Ullman was not humble in his self-righteous tirade against EBM, so you might argue that he must be labeled as an “idiot” or “insane”.

Ullman’s basic failure isn’t his criticisms of science. It’s the odd implication that homeopathy is not subject to the same sorts of problems.

He also undermines his “authority” as a critic of science because he is an “expert” in homeopathy, which, as far as anybody can tell, is just water. Accepting the “theories” of homeopathy requires having to dump a great deal of established basic science.

What would motivate any rational person to go mucking around in what he writes for rare bits of truth?
#36 Wizard
May 8, 2010

Wow…the fact that you’re choosing to attack Dana Ullman personally must mean that he is successfully reaching you and others. The fact that you’ve chosen to call him an “idiot” shows something about YOU more than him. If you and the people here are supposed to represent “sound, rational medicine,” I do not want any of that point of view.

Are you suggesting that polypharmacy, which Ullman rails against, is evidence based medicine? Are you suggesting that polypharmacy for infants and children and seniors is evidence based medicine? Are you even suggesting that surgery, which has virtually no placebo controlled trials, is evidence based medicine? I could not help but notice that you didn’t choose to attack any of Ullman’s substantative assertions.

I just googled Ullman and found his newest article here:
http://www.altmedrev.com (article #6). Are you suggesting that the four trials by Reilly (2 in the BMJ and 1 in the Lancet) were invalid? Are you now so cynical that you only think that randomized double-blind placebo controlled trials are only valid when they show a negative result to homeopathy? There IS a difference between cherry-picking and looking at high quality research that is a fair and accurate test of the homeopathic system.

Who is the real idiot here?
#37 Chris
May 8, 2010

You are. Mostly because you cannot recognize Ullman’s use of cherry picking.

Here, you might enjoy reading about the Dull-Man Law.

I first encountered Mr. Ullman many years ago when I was posting on Usenet. Some poor guy from India had received a degree in homeopathic medicine and was wondering if could practice as a doctor in the USA. I sent him the websites on the the medical boards. He came back fuming that he was sure homeopaths could practice as doctors in the USA, only to find out the website was telling him a lie.

It turned out that website was Dana Ullman’s homeopathy site. It has since been changed.