John Weeks has long been an activist for alternative medicine—excuse me, “complementary and alternative medicine” (CAM) or, as it’s more commonly referred to these days, “integrative medicine.” Despite his having zero background in scientific research or the design and execution of experiments and clinical trials, for some bizarre reason in May he was appointed editor of the Journal of Alternative and Complementary Medicine (JACM). It didn’t take him long at all to use his new post to launch a nasty broadside against CAM critics in general (such as yours truly) and those who criticized a sloppily done systematic review article by high ranking members of the National Center for Complementary and Integrative Health (NCCIH) in particular (such as Edzard Ernst, Steve Novella, Michael Vagg, and, of course, yours truly), in which he compared critics of the NCCIH review to Donald Trump. This was, of course, before the election.
I hadn’t planned on mentioning Donald Trump again for a while, given that my last two posts were about him and his antivaccine views, but apparently, Mr. Weeks is still nursing a grudge, because he’s still unhappy and still comparing critics of CAM and “integrative medicine” to Donald Trump. So into the fray I leap once more! Only this time it’s not in his journal, but rather in the pages of the left-leaning Huffington Post (or, as I like to refer to it, that wretched hive of scum and quackery) in an article entitled Trumpism and the Bigotry of the Antagonists to Integrative Medicine and Health, where, no doubt, a comparison to Donald Trump is more toxic than just about anywhere else shy of AlterNet. This time around, it’s because of an article in JAMA by Jennifer Abbasi entitled As Opioid Epidemic Rages, Complementary Health Approaches to Pain Gain Traction. The article reported, mostly approvingly and with little input from critics, about the NCCIH systematic review published in September. Worse, as I pointed out in my discussion of the JAMA article a little more than a week ago, Abbasi seemed to buy totally into a favorite CAM trope, namely the idea that somehow CAM can ease the opioid addiction epidemic through “nonpharmacological approaches” to the management of chronic pain.
I wasn’t the only one unhappy about JAMA’s article, either. For instance, Juliana LeMieux of the American Council on Science and Health (ACSH) referred to JAMA as the “journal of medical atrocities” in response to Abbasi’s article. Regular readers know that I’m not generally a big fan of the ACSH. I view it as too sympathetic to industry interests, particularly pesticide manufacturers, as evidenced in part by its buying into right wing smears against Rachel Carson and remarks by its founder and former president Elizabeth Whelan dismissing concerns about potentially toxic chemicals, especially pesticides, as “chemophobia,” which she characterized as an “emotional, psychiatric problem.” That’s why I thought its attack on Dr. Oz last year was a very bad idea. Be that as it may, as much as I tend to distrust ACSH, I do have to admit that it’s gotten somewhat less blatant in supporting corporate interests since Hank Campbell took over, which is perhaps why it irritates me a lot less than before. This time around, Dr. LeMieux and I are pretty much in agreement, for example.
Indeed, it seems to be LeMieux at whom Weeks’ anger and rant are mostly directed. Let’s take a look at Weeks’ framing first. After discussing Donald Trump and his penchant for name calling, the first thing Weeks does is—you guessed it—poison the well by comparing his opponents to Donald Trump and labeling their tactics “Trumpian.” He then describes the reaction to the JAMA article as an example:
An example came across my desk yesterday. It was in response to a news piece at JAMA Network entitled “As Opioid Epidemic Rages, Complementary Health Approaches to Pain Gain Traction highlighted a paper published in Mayo Clinic Proceeding.”
Stage-setter #1: JAMA is of course a well-known, historic advocate for complementary and integrative health approaches. Not.
Stage-setter #2: The focus of JAMA Network was an article published through the Mayo Clinic. Mayo of course has a long history of quickly adopting new approaches without consideration for science. Not.
Stage-setter #3: The subject of the Mayo article considered in JAMA was a review from a team of five authors each of whom are scientists at the USA National Institutes of Health. This of course is another institution with a long-time disregard for science. Not.
Stage-setter #4: The subject of the paper, “Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States,” was based on an examination of 105 USA-based randomized controlled trials (RCTs). RCTs are of course rank near case reports at the bottom of the evidence hierarchy. Not.
So we have aligned JAMA, Mayo Clinic, NIH and RCTs. Now that’s a line-up from which one can expect shoddy science. That is the assertion in the name-calling article in response to the work of this triumvirate+ entitled “JAMA: Journal of Alternative Medicine Atrocities.” Atrocities. The approach of the NIH researchers is denigrated as “ridiculous.” The author asserts, on the basis of her personal experience, that despite positive outcomes in multiple studies, that yoga cannot possibly have real value for chronic pain but only for “mild discomfort.”
Let’s unpack them one by one. Stage-setter #1 is, of course, irrelevant. It’s a straw man. No one claimed JAMA is a “well-known, historic advocate” for CAM. No one. In fact, it was because JAMA has historically been considered a top tier journal that I and others who criticized the JAMA article were so irritated. Indeed, in the past JAMA has published editorials advocating against the NIH funding of CAM research, a study showing that saw palmetto doesn’t work against urinary tract symptoms, and an article criticizing the supplement industry, while JAMA Oncology has published a study showing that CAM use is associated with patients declining chemotherapy. And, no, JAMA didn’t recommend chiropractic care first for low back pain.
Stage-setter #2 is just silly. In actuality, Weeks is wrong. The Mayo Clinic has jumped whole-heartedly on the CAM bandwagon and recommends a number of interventions that are not science-based, such as traditional Chinese medicine and even cupping. Yes, the Mayo Clinic used to be a bastion of science-based medicine, and in many ways it still is. However, it does now have a lengthening history of quickly adopting CAM approaches without consideration for science. That is, unfortunately, just a fact.
Stage-setter #3 is even sillier. Yes, the NIH is a bastion of science-based medicine, but NCCIH is not. Notice how Weeks said “NIH,” not “NCCIH.” This remark is just another example of how CAM advocates co-opt the reputation of the NIH as a mantle to cover the pseudoscience of NCCIH. NCCIH studies are frequently represented as coming from the NIH or funded by the NIH. It’s an intentional tactic. While true, characterizing such a review as coming from the “NIH” doesn’t tell the whole story, which is that there is a center within the NIH that was foisted upon it in the 1990s by a woo-loving Senator and his allies that has a long history of pseudoscience and bad science. That is where this review came from.
Stage-setter #4 is a another straw man and red herring. No one—and I mean no one—who criticized the NCCIH systematic review claimed that it was using anything but RCTs as its basis. Our complaints were, quite clearly, that the RCTs used were either small, of poor quality, or misinterpreted. For example, I pointed out how in reality this systematic review produced a negative result for acupuncture for back pain. To summarize what I said then, the only clearly “positive” results were found in studies that compared acupuncture versus usual care or no treatment and only one study comparing “verum” acupuncture to sham showed a positive result, that result being “slight but significant.” To me, “slight but significant” means small and statistically significant but almost certainly not clinically significant. This sort of result is very common in studies of treatments that are no better than placebo controls, and the proper way to report this would have been that there is no good evidence that acupuncture does better than sham/placebo for low back pain. Worse, nowhere in the review is there any rigorous formal assessment of the quality of the studies that were used to do the review. This is hardly the dismissal of the review because the studies used in it were less than RCTs.
All this leads Mr. Weeks to a truly mind-blowingly stupid statement. (Note to Mr. Weeks: I said the statement was stupid, not you. This is not an ad hominem or “Trumpism.” Sometimes smart people make stupid statements.) Here it is:
So we have aligned JAMA, Mayo Clinic, NIH and RCTs. Now that’s a line-up from which one can expect shoddy science. That is the assertion in the name-calling article in response to the work of this triumvirate+ entitled “JAMA: Journal of Alternative Medicine Atrocities.” Atrocities. The approach of the NIH researchers is denigrated as “ridiculous.” The author asserts, on the basis of her personal experience, that despite positive outcomes in multiple studies, that yoga cannot possibly have real value for chronic pain but only for “mild discomfort.”
No, Mr. Weeks. Just no. Yes, Dr. LeMieux did mention her personal experience, but only after discussing Tables 3 and 4 from the systematic review and pointing out, in essence, what I pointed out: That the studies were actually mostly negative. Oh, and while we’re working on logical fallacies, Mr. Weeks is using a whopper of one, an appeal to authority (authorities, actually), while attacking Dr. LeMieux’s weakest argument and ignoring her strongest. And, again, this is not an ad hominem, Mr. Weeks. It is a description of your argument.
I’ll say one thing about Mr. Weeks. When he picks a logical fallacy to accuse his critics of, he doesn’t let go:
The group, from Australia, USA and Great Britain - the 3 last two named...[Orac] and Ernst - each used Trumpian tactics. One pre-emptively names the report as “one of the most blatant examples of quackacademic confabulation I have seen in ages.” Another’s label is “tooth fairy science.” Like the Florida judge deemed mistrustful to Trump by his heritage, the study is questioned based on the professional background of two members of the team: “If you want to know why NCCIH supports so much pseudoscience, look no further than it having chiropractors and naturopaths in high ranking positions.” Never mind that each of these NIH employees has a separate research doctorate along with a clinical doctorate.
I’ve already dealt with Mr. Weeks’ complaints about these criticisms in detail. So I will spare you the same arguments again; that’s what hyperlinks are for. Instead, I will point out that describing a report as “quackademic confabulation” is not “Trumpian” (for one thing, Trump rarely uses language that complex or flowery) or an ad hominem. It is a description of the science of the review. Second, it is not illegitimate to question the source of a review article. Indeed, when some of the authors belong to “professions” (and I do use the word loosely) based on pseudoscience, it is not only legitimate to point that out, but mandatory. As for their having PhDs in addition to their quack degrees, who cares? They’re still chiropractors and naturopaths, and they still advocate for chiropractic and naturopathy.
Edzard Ernst nailed Mr. Weeks’ methods perfectly:
The principle is adorably simple and effective:
- you are faced with some criticism,
- you find it hard to argue against it,
- therefore you elect to attack your critic personally,
- you claim that the criticism is insulting,
- you re-name any criticism ‘TRUMPISM’,
- and all is forgiven!
Weeks is not even original; others have used this method before him. In fact, advocates of alternative medicine thrive on ad hominem attacks, and without them they would go nowhere.
Exactly. This is the second time Mr. Weeks has done exactly that.
Here’s the funny thing. Whenever a critic of CAM does do what Mr. Weeks claims he wants, and tries to remain respectful, sticking to just the science and facts, does Mr. Weeks respond any differently? Not that I can recall, but it’s possible confirmation bias is clouding my memory. Maybe a prospective experiment is in order. Perhaps I’ll keep an eye out for Mr. Weeks’ next attack on science and then intentionally write a perfectly measured, reasonable response with no snark, sarcasm, or hyperbole whatsoever. Compared to my usual writing it’ll be as boring as hell to read and will probably result in record low traffic for a post, but it would make an interesting experiment. We’ll see.
In the meantime, I have a friendly suggestion for Mr. Weeks. Given his constituency among CAM practitioners and believers, whom he represents in the media frequently, he might not want to use Donald Trump’s name as an insult so freely or frequently. After all, a lot of believers in alt-med love Donald Trump. Love him. I’m serious. For example, Mr. Weeks might want to wander over to Mike Adams’ NaturalNews.com, where Mikey is beside himself with glee at Trump’s victory in the election. Advocates of “autism biomed” are equally elated. Maybe it’s because Donald Trump is just like them, full of conspiracy theories and antivaccine to the core. He even ran a pyramid scheme multi-level marketing scam selling supplements. As Ernst also pointed out, Donald Trump is one of their own.
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"He even ran a pyramid scheme multi-level marketing scam selling supplements. As Ernst also pointed out, Donald Trump is one of their own." In as much as Weeks is distributing bull on multiple levels, his new position might be called Fertilizer-in-Chief. Of course, these days, it doesn't take much to qualify.
I know you want to punish John Weeks, but this is inhumane.
Far be it for me to suggest you could have saved yourself some words, but a perfectly valid response to Weeks' rant would be to state that none of the things he mentioned really matters. What matters is the quality of the research base, and in the case of this paper it is lacking.
I don't know Weeks, of course, but on the basis of Orac's previous post about his complaint in JACM, I took him to be an overly-sensitive soul, responding rather hyperbolically out of butt-hurt feelings from both the substance and trademark 'insolence' of Orac's critique. That is, he seemed to be whining sincerely.
But, the level of spinning in those 'stage-setters' just strikes me as calculatedly bogus, purposely manipulative... The cynical opportunism of a salesman looking for any angle that might might fool the rubes. That is, me now thinks Mr. Weeks is lying,just pulling sh!te out his butt. Maybe he's not as nasty as Orac can get sometimes, but the Trump analogy is really beginning to stress the irony meter. Or, in the language of the times, "No Trumpian! No Trumpian! You're the Trumpian!"
Too bad, actually, since unlike our host, I think an 'Integrative Medicine' that includes supported 'non-pharmacological pain management' in the form of not-implausible really-physical-therapy-or-exercise 'modalities' like Yoga and Tai Chi as coping methods could be a good thing... beyond just handing out the pain meds and sending the patients on their way. But with 'friends' like Weeks, that idea doesn't need enemies.
Not that he is a friend. I'm getting the feeling he actually hates defending the Mayo survey, exactly because it mainly finds promise in those 'non-Rx approaches' that aren't really CAM, and he sooo wants those 'classic' Alt Med methods to be taken seriously (and paid for).
Another thing: If HuffPo actually had print/journalism-type editors vetting the feed, having this appear after the election - so trivializing a genuine dangerous fascist - would be a fail beyond the pale. But, It's the web, so anything,anything that comes into the server goes back out with no real scrutiny. New corollary to Godwin's Law. First Trump analogy loses the argument.
Weak, Weeks,,, very weak..
You've clearly not been paying attention if you think my opinion is in opppsition to this. What I object to is the co-opting of things like diet and exercise as somehow "alternative" or "integrative" and the selling of these "nonpharmacologic" methods of pain management based on weak or nonexistent evidence. Also, I don't like how "integrative medicine" specialists bring perfectly science-based modalities like exercise under the "integrative" tent in order for them to provide seeming plausibility to the woo that's also under that tent.
"...unlike our host, I think an ‘Integrative Medicine’ that includes supported ‘non-pharmacological pain management’ in the form of not-implausible really-physical-therapy-or-exercise ‘modalities’ like Yoga and Tai Chi as coping methods could be a good thing… beyond just handing out the pain meds and sending the patients on their way."
What a classically bogus wooist retort this is.
Clearly sadmar has no idea how physicians deal with chronic pain issues (especially now that there's considerable scrutiny and pressure to avoid "handing out the pain meds" and instead promote exercise, physical therapy etc.).
It's bizarre how alties like Weeks rail against the medical establishment, only to embrace it wholeheartedly the instant it is seen as endorsing their views, ignoring that fact that a "news piece at JAMA Network" is not the journal as a whole, nor is a paper published in Mayo Clinic Proceedings "the Mayo Clinic". (I've run into this "the Mayo Clinic says" nonsense from alties before; curiously, it doesn't have any impact on them when you cite other Mayo Clinic website articles that contradict what the piece they're citing says).
I'm in a bad mood about quackademic medicine this morning, having tuned in to Doctor Radio (run by NYU Langone Med Center) on Sirius on the drive into work. Their internist host, Ira Breite was fawning over a supplement industry microbiologist on the subject of probiotics. You see, his company is unlike all those others, it does research! It would've been nice to find out what percentage of sales gets plowed back into meaningful clinical research (compared to what Big Pharma does), but I guess that would've been rude to ask.
Orac writes,
John Weeks has long been an activist for alternative medicine.
MJD says,
Alternative medicine is like the absence of the hole in a donut hole, it doesn't make sense but it leaves a good taste in your mouth. :-)
Sadmar, I don’t know what doctors you are referring to, but mine (many over the many years) always--always, refer me to physical therapy/exercise for anything but the most acute pain, say, post surgery. It’s true that I don’t suffer long-term, chronic pain (or I don’t complain to the doc about it because I don’t want pills for it to begin with), but I do have continual pain from the ravages of aging and gentle exercise is exactly what the docs have recommended. They suggest walking and stretching as a base and then adding what I am motivated and comfortable doing. I don’t do yoga because I am not a Hindu and find its contortions silly, but I do walk, run a bit when I can, and stretch religiously.
Whenever I have been prescribed a serious painkiller, it is no more than a 30-day supply, and usually less. I really wonder who these docs are who write these long-term prescriptions? I know a man who has a genetic back problem that causes horriffic pain and he has had to go through incessant machinations to get any relief at all. He certainly is not physically capable of doing yoga or anything else. He can barely walk. Should he be thrown to the alties?
No doc I have ever seen for chronic pain has just "handed out the pills." Ever. I have a friend who seems to be able to find them, though. This trope of every doc passing out pills like candy fits their alternative universe very well, though. For once I'd like to see them cite some hard numbers on actual prescribing practices.
Seconded.
I'm sure there are a few Dr. Feelgood types out there, but doctors have an incentive to avoid that route: many opioids are controlled substances, and there are people who check when doctors write more than a few such prescriptions. The ones who are caught inappropriately prescribing controlled substances risk losing their license.
I wanted to emphasize that Weeks is totally turning off even someone a bit sympathetic to some version of 'IM', i.e. me -- that you don't have to have an absolutist 'Never IM!' view to find this guy to be bad news. To be honest, I've yet to read about any 'IM" proponent with the kind of approach I'd like to see. They're all too quacky. But whatever we'd call any kind of change to how things like pain management are approached, the point is we can agree Weeks is going in the wrong direction, and has to cheat to do so, without having to agree on everything else.
Trying to put that 'not totally against the broader concept' into a brief bit of prose, I certainly couldn't be nuanced, so while I can say you've read things into my comment I didn't mean, I'm not really surprised or upset.
I'm not saying MDs generally "hand out pills" carelessly, too many, too often, for too many who may not need them etc. Someone's getting controlled Rx meds into street sales, and I've known a few folks who've developed addictions to Rx meds. There is a problem with a few Dr. Feelgoods*, as there always has been, but that's not what I'm talking about.
I don't want to throw anyone to the alties. I had a looonger version of the comment where I framed these 'non-pharmalogical' methods as genuinely 'complementary' patient support and 'coping' aids, and noted they should never be substituted for Rx meds for people who really need them. As it happens, I have a friend with severe lymphedema (among other things) who has serious constant chronic pain, and can barely walk down the stairs, much less do yoga or tai chi, and has constant trouble getting her health plan to renew the scrips for the pain meds she relies on (Celebrex, IIRC).
I'm on the same page with darwinslapdog on this as far as the docs are concerned. The problem, as I see it, is the insurance companies. To the extent docs wind up doing little more than prescribing pills (however stingily), it's because that's what the larger system channels them into. Oh sure, they'll advise you to walk and stretch, but just saying, "And get some exercise, OK?" just doesn't cut it. 'Promoting' isn't enough. We should be talking about 'providing'.
If darwinslapdog's docs do 'always refer to physical therapy' then the Beagle has a better health plan than I've ever been on. Oh, my PCPs recommended PT for my ruptured L2 and my too-painful-to-move-my-arm arthritic left shoulder. It was just that getting the insurance to go along was like pulling teeth. They'd make the docs and the PT jump through a whole series of hoops, and then approve, like, a week of treatment. I'd barely get started, and then fall through the cracks as my providers had to go through the whole rigamarole again.
And these hurdles were in the way of treatment that promised to actually improve my physical health. I submit we need to go beyond this to the psychological benefit to suffering patients in just getting out of the house, doing something generally healthy, getting their minds off the pain, recouping some of the quality of life that has suffered serious degradation from the physical illness. I'm talking about 'support' and 'coping', and I think they're damn important...
"The longest journey... blah blah blah..." we have to start somewhere, and if insurers began providing yoga, tai chi relaxation/massage for pain sufferers who could indeed benefit from them, that would be a start but only that. At least then maybe we'd have some acknowledgement that 'support and coping therapy is good', important enough to pay for, and then we can both widen the available supported approaches, and weed out the weak or ineffective. I'll admit to naked self-interest there, since I'm no more inclined or able than darwinslapdog to do yoga... ;-) \Nor, for that matter, can my knees and feet handle enough walking to benefit me... we'll need a variety of therapies suitable to a wide range of varying patient conditions and situations, not just trendy new-agey exercise classes.
I understand Orac's concern about "science-based modalities like exercise" being co-opted by 'quackademics' in an attempt to generate bogus plausibility for "the woo that's also under the 'integrative' tent. I guess I just don't think that BS will continue to fly in the long run. If 'heathcare leaders' are actually concerned with bringing patients into the tent to help them, I think the more useful stuff will come to dominate the tent as the more useless stuff gets tossed out. Or at least, that could happen if we worked for it, in part by calling out clowns like Weeks. co-optation works both ways. we can co-opt the buzz (and NCCIH research money) now associated mostly with true altie woo to get more support for the science-based 'non-pharmacological modalities', including some actual coverage.
...BTW, great point by DB on the hypocrisy of Week's cherry-picking anything from 'the establishment' that can be twisted to support his positions, and rejecting everything else that doesn't. We could use some folks asking honest questions about this stuff, but Weeks is just another snake-oil salesman with a ready-made 'answer' to promote regardless of the truth. I wish DB hadn't mentioned that radio thing, though. That stuff makes me want to puke, so I try to avoid it as best I can, and he just reminded me how retching wretched that puffery is.
I hope the thread can get off my case now,and back to criticizing Weeks and his thoroughly regressive take on 'Integrative medicine'. Whatever insolence I may be due, they're a lot more worthy... and I don't have an audience outside of here and Weeks, alas, does.
I have chronic migraines. While injectable Imytryx or it's generic works very well for me, I was cautioned that overuse (i.e., don't take it every time you have a headache) can lessen it's effectiveness and/or cause side effects. It's my last resort medication. Usually, I take a couple of codeine or vicodin and hope that that will take care of it. It is like pulling teeth to get that codeine prescription refilled by my M.D.s. It has always been a "no refills without authorization" prescription. I WISH I could find a doctor that just hands it out! LOL
Mr. Delphine had rotator cuff surgery recently. For pain management he was prescribed 800 mgs of ibuprofen.
I have seen Mr. Delphine cry three times. One was when he Dad died. Two was when Delphinette was born. Three was waking up the day he got home from the hospital, when his 800 mgs of ibuprofen just weren't cutting it.
Hospital wouldn't prescribe anything stronger. Nor would the walk-in clinic we visited. Our family doctor saved him the following day. Blissful sleep ensued.
The pendulum, it has certainly swung in the other direction.
Don't know if the opiates for migraine is sarcasm, but I flip my sh*t every time I treat a recurring headache that previously got an opiod script for migraine.
Sandra@11: Your doctor is right to caution you about overusing these drugs can lessen their effectiveness. One of the major downsides of opioids, whether used for legitimate pain control or for illicit recreation, is that the body can build up a tolerance, meaning that you would have to take a larger dose for the drug to have the effect it once did. Such tolerance can build to the point where the line between an effective dose and a fatal overdose becomes so thin as to be easily crossed. Far too many opioid users, legitimate or otherwise, have met their demise in this fashion.
It hasn't been mentioned yet, but as most regular RI readers are presumably aware, one should never combine opioids and alcohol. These two in combination enhance each other's effects, again with lethal results in far too many cases.
There is an herb for pain that is allowing many people to side-step the prescription wall and do away with addiction altogether:
https://www.regulations.gov/docketBrowser?rpp=25&so=DESC&sb=postedDate&…
Kratom!?! Are you flipping kidding? Drug policy experts are saying now that this could be the next horrifying street drug, although DEA backed off on putting it on the schedule a few weeks ago.
The basic problem is a reckless and poorly enacted policy of responding to the opioid problem. Now we have good docs scared of losing their licenses and so possibly underprescribing needed pain relief, thus driving people in chronic pain to marvellous street drugs such as heroin and Chinese designer drugs cut with unknown quantities and qualities of Fentanyl, among other things. Promoting unknowns such as kratom sounds like one of those nifty solutions that will kill many people before there's a morsel of sanity introduced into this situation and the regulators realize that more sane prescription policies are the core solution.
No doc I have ever seen for chronic pain has just “handed out the pills.”
Cripes, when I broke my leg the goddamned Navy wouldn't even give me morphine.
sullenbode @15: Hemlock? (Sorry, you and that other guy are a total broken record and I don't believe it.)
My FIL's regular doc (or hopefully his *former* doc) is one of those "pills for anything" and it's a nightmare. That doctor is a quack in the "idiot who should never have graduated" mode, not the alt-med mode. He doesn't seem to know the first thing about mixing medications and I'm always afraid that he's going to prescribe stuff with dangerous interactions.
I presumed that Mitzi Gilbertimmeh had simply changed pseudonyms again.
Meanwhile in England:
Three people arrested after diabetic grandmother dies following Chinese 'slap treatment'
Narad @18: Sully and Gil have been on at the same time talking to each other in a way that made me think they're not the same person, but I can always be wrong.
I've found the opioids are effective for migraine, but they don't "get rid of it" as does Imytryx/generics. It just makes me not care/able to sleep. Usually, I awake with the migraine gone. However, I guess I just don't have an addictive personality. I use the codeine in limited amounts and have never, despite my flip remark above, wanted an unlimited prescription. It just occasionally gets inconvenient/miserable if I run out on say, a Friday, and am facing a migraine weekend w. no drugs. That's when I go straight to the Imytryx.
My (main) shrink in the psych ward was like that.* I was on about 10 different things by the time I got out; I don't remember what they all were for, but I was on at least two anti-psychotics. (Geodon and Risperdal.) Thankfully once I was an outpatient and seeing someone else it was cut down to two. He did eventually add an antidepressant though, bringing the total up to three.
They also had me doped up on Ambien every night I was there, which did at least grant me a few hours of sleep most nights.
*This was the same doc who wanted to send everybody to the Eastern State Hospital, for some reason. Even my attorney didn't like him.
What rubbish
"what rubbish"
Wow, Chris Preston; an N=1 smear study writeup. The addiction is about on par with coffee which is not surprizing as it is in the coffee family (Rubiaceae). It doesn't have respiratory depression which is the hallmark of deaths from prescription opiates and, in many ways, is superior to the prescription stuff.
So...I guess that's why this harmless substance attracted attention from the DEA for inclusion in the schedule of controlled substances? They can be a joke, but they don't invest their resources in proposing regulation of something that truly is on the level of coffee. Evidence, please, for the consistency and safety of kratom. Not woo-level anecdotal garbage. The real thing.
It's more likely that I am, as the Plonk-O-Matic was invoked promptly. Selah.
I'm the same way with cat bites and antibiotics. I should probably buy some Fish Mox.
Please stop with the "addictive personality" stuff. That was discredited long ago but persists in bad journalistic coverage of addictions. It's not personality, it's physiology--and largely neurophysiology--and behavioral conditioning. To simply very grossly.....
Sorry, correction. Why some people are vulnerable to addictions and others aren't is unfortunately very complex and just beginning to be well understood, but the notion of an "addictive personality" type is not useful and was rejected a while ago. I wish qualified professionals would stop using that term.
I'm surprised that tramadol isn't more widely employed for acute injuries. It has basically zero abuse potential, in my experience. I think Nurse K.'s blog is moribund, but "allergy" to it was a bright line for ED drug seekers, IIRC.
Response to Narad's comment about tramadol because I am a blog virgin and can't figure out how to respond to individual messages here.....
We use tramadol a lot on animals sometimes in conjunction with buprenorphine (Buprenex) for long-term chronic pain. Its response varies a lot by species and condition.
I'm not really convinced of tramadol's safety or efficacy yet in actual use, but other people report good responses and no real concerns about long-term safety.
We are also using Fentanyl patches with great results on animals. There are far fewer concerns about addiction in small animals. I'm not sure how well this translates to human clinical practice.
Tramadol has proven to be a good new option for pain control in animals, and those who are using it also report that it seems to be very safe. I don't have enough experience with it yet to say that myself.
Fentanyl transdermal patches are a great solution, I think. I'm much less inclined to use buprenorphine now that we have this new option.
Weird thing about buprenorphine is that it is modulated--can't get nerdy about it because I don't fully understand some of how that works--and poses little threat of overdose. Overdose in small animals is unlikely, though, so I have no knowledgeable comment about how this may relate to human pain control.
Other people tell me tramadol is great stuff being used for a variety of chronic pain problems in animals with few nasty side effects.
Meanwhile in England:
Three people arrested after diabetic grandmother dies following Chinese ‘slap treatment’
Ah, that lovable loon Hongchi Xiao has taken his scam to kill people in a different country!
Heaven knows why the UK tabloid press are calling his invention "Chinese slap therapy" when there is nothing specifically Chinese about it, other than the nationality of the grifter.
Oy.
http://lajinpaidadeutschland.blogspot.com/2016/10/freedom-from-diseases…
To illustrate the vast variability in human beings I have seldom needed more than ibuprofen for any of my recent bone breaks. This includes a severely fractured ankle (which was actually heard by a couple of nearby police officers, my kids got to ride home in a cop car after they put me in an ambulance) and last year's Colles fracture that involved both arm bones.
Which is fortunate since narcotic medication makes me literally sick to my stomach. While cleaning out a cupboard I found the unopened bottle of Ondansetron prescribed by the emergency room doctor so I could tolerate the pain meds he gave me (I used two... one that night, and the other after the surgery that attached my arm bones back to my hand, only because I was told to).
There is also a bad side to me and pain... I get injured without knowing it. Often my dear hubby sees me get out of the shower and asks me about the bruise somewhere on my body. I have no idea why they are there.
I have actually had people come up to me and tell me I am bleeding. I had no idea I had scraped myself. I was once repairing the white wool part of the marching band's drum major uniform when I noticed I was bleeding on it because I had stabbed myself with a pin! I am very good at getting out blood stains.
It is not stoicism, bravery or any of that other nonsense. It is just a very stupid dull nerve network that is just another reason that shows nature does not care about us.
By the way, trust me... I sympathize with your pain. I am not that much of a genetic freak that I don't actually experience pain (they do exist, and what they go through is not pretty, especially through childhood). I have felt immense pain during certain illnesses (mumps, dengue and a couple of influenza bouts come to mind), sinus headaches, menstrual and birth contractions to name a few. At those times I am the worst person to be around.
Long story short: pain varies between people, and it is very difficult to find a pain management system that works for anyone.
PS: it does not help that I am from a family with weird sleep disorders, we are literally sleep walkers/talkers with many weird stories. Since my intestines are not good travelers I used Imodium daily on a summer road trip. It is a very low dose narcotic, and it mostly worked.
When we got back home I stopped using it, and that seemed to be okay. Except for the night dear hubby came to bed and saw me in the bathroom in a fetal position complaining loudly about the pain. Apparently once he spoke to me, I got up, said I was better because he was there and went to bed.
I have absolutely no memory of this.
I will now limit my use of Imodium from now on. I hate narcotics, even in small bits.
Myself: "I found the unopened bottle of Ondansetron"
So I decided to Google this and it is "Zofran"
This has apparently gotten some praise on this blog:
http://scienceblogs.com/insolence/2016/10/25/licensing-naturopathic-qua…
I had no clue. But it makes me happy that there has been serious research in dealing with those of us who cannot tolerate narcotics. Which is about one in ten of the total population, a fairly significant population.
Though I suspect the sleep disorders are a wee bit less common. I am still going to avoid the narcotics.
Growing poppies is actually illegal, but hardly ever enforced. Thousands of old ladies are breaking the law right now!
But you would be fine really. The only people that get arrested for this are known drug dealers.
I was thinking about growing a few poppies one of these days for fun. I don't think a bit of poppy tea is going to do any harm, especially if you have to wait 6 months for each growing cycle.
I would be careful around the concentrated opiates! Plastic bottles full of pills kinda take the magic out of opium. They are really gorgeous flowers and fun to look at.
I was going to say something bad about Trump, but you people said it better.
"During the course of the following 20 years I tried every kind of alternative therapy, including a seven day fruit fast, Chinese herbal remedies, acupuncture, aryuvedic dieting, acupressure, and a very costly stem cell transplant in Germany. This last one consisted in taking stem cells out of the bone marrow and implanting them into the pancreas."
When someone is determined to make a career of giving money to conmen, there is no clue-stick large enough to knock sense into them.
Here's another of Hongchi Xiao's websites where he promotes Danielle Carr Gomm as a triumphant cure achieved by self-slappery.
Link is to Google Cache version because the murderous mercenary little sh1tweasel scrubbed the original after her death.
@Sarah
"Promoting unknowns such as banning kratom sounds like one of those nifty solutions that will kill many people"
http://www.al.com/news/birmingham/index.ssf/2016/07/jeffco_sees_25_hero…
That's just one county; Alabama banned kratom on May 10, 2016
@sadmar
Hey, I get what you’re trying to say, but it’s a tricky thing to discuss around here or at SBM--I’ve tried to some extent. No matter how much you say: “I hate woo, but I DO think docs could do better at offering support for their advice--not just a handout written for someone who never heard of a calorie or knows what a physical therapist is”, you will be interpreted as being on the dark side. I can also sympathize with your insurance issues. I’m just lucky that I’m finally on Medicare with a good Advantage Plan that gets me broad coverage. That doesn’t mean I am not angry about all the years I spent with crappy or NO coverage.
Still, to be clear, I have never had a doc who I perceived to be blithely handing out pills, and it’s a charicature that doesn’t seem accurate or fair to me. Nor should wanting docs to get better at being supportive or more involved in the implementation of their recommendations be interpreted as “alternative” in any way. It’s just improving the practice of medicine. It would help, though, I think if docs like Orac and his friends would discuss it more and make concrete suggestions for improvement. Many people could be spared a brush (or worse) with quacks if this issue could get some traction.
@ Jessika:
" kinda take the magic out of opium"
And make no mistake about it, it IS magic.
Which is reason enough to stay away.
@ Sarah #26
You know what else is completely safe and relieves pain that is also just happens to be schedule 1? Cannabis.
The appeal to 'authority' of the DEA is rather sickening on your part.
Sullenbode--You obviously have some big bones to pick with the DEA. I hope you get over that and over any undiscriminating promotion of cannabis for anything and everything. I get a bit tired of that. There is nothing sickening about my comments involving DEA. Don't pick fights here just because you feel like trolling someone. I will not be trolled. Nor will many other people here.
darwinslapdog said:
No matter how much you say: “I hate woo, but I DO think docs could do better at offering support for their advice–not just a handout written for someone who never heard of a calorie or knows what a physical therapist is”, you will be interpreted as being on the dark side.
This sort of thing is said all the time by both Orac and by many regulars, so not likely that you would be interpreted as being on the dark side.
Perhaps perceptual inaccuracy owing to attitude problem. There seem to be some commentators very invested in perceiving themselves as contributing much more than actually they do.
Semoticians - can't live with them, can't live without them.
sullenbode @42: First, any inhaled burnt material is not "completely safe". In fact, I'm having a hard time coming up with any substance that is "completely safe".
Second, the placement of cannabis on the DEA controlled substances list has a long and unpleasant history of racism, class-ism, nativist sentiment and puritanical morality. Far more than any sort of medical or scientific reason. But just because the reasons it is on the list are BS doesn't mean it's a panacea with no down sides. I'd like to see it studied properly so we can have some data behind any decisions about where it goes in the controlled substances pile.
@sara
""I’m not really convinced of tramadol’s safety or efficacy
""We are also using Fentanyl patches
""Other people tell me tramadol is great stuff being used for a variety of chronic pain
Did you know, sara, that the recorded 'kratom' related deaths all involved other substances which were FDA approved such as fentanyl and tramadol? It is interesting that you mention tramadol in this context as, from Chris Preston's link above,
"Despite his having zero background in scientific research..."
Perhaps that is why he was appointed.
@ darwinslapdog
Yay! We're on the same page. But let me stress the important thing here is to get the discussion away from the MDs and onto the insurance companies and health groups, since the docs have long ago been proletarianized and they 'just work here' rather than running the joint. Whether docs hand out pills 'blithely' or not, whether they they have a supportive disposition or not, we have to frame the reliance on pills and the fact the docs don't deliver support beyond handouts within 'what the he!! else is the doc going to do within an enforced 12-minute limit on office visits?"
One thing I will say about PCPs: I suspect they're getting worse on the patient support front with each new generation, and most of the commenters here never see that becuase they're older and have had their PCPs for awhile, so the docs are not only older too, but have more rapport with them. My path through life and academia led me to move to new cities over ten times, meaning I was always having to find a new PCP practice, and as a new patient usually I wound up with the younger members of the group. Over the decades, I've found the fresh-faced young-uns ever less adept at the 'whole person' aspect of the job. It makes sense, actually. As primary care become ever more assembly-line, it becomes ever more filled with practitioners who function well in that system. Indeed, the one just-out-of-med-school PCP I had in CT who I thought had promise in developing the ability to deal with me as a human being not just a meat machine quit less than a year after starting to go back to med school for a specialization where he'd get the time to do medicine the way he thought it ought to be done. It's not the young PCP docs are rude or anything. There's not a McCoy stereotype grouch in the lot. They're all smiles and hand shakes, but they rush you through the visit and they.do.not.LISTEN. Eventually, after many years of frustration, I got so alienated I decided to to ditch the friendly-robot PCP I fell to after doc #1 headec back to med school, and I waited like 9 months for a doc recommended by a co-worker for her compassion and communication to have an opening for a new patient. She was, in fact, awesome, but always well behind her appointment schedule as a result of giving patients the time warranted by their complaints, and constantly at odds with her stop-watch-and-bean-counter admins. After a few years the succeeded in driving her out, and she moved over to a tiny upstairs office with a previously 1-MD independent practice serving mostly low-income patients from the 'sketchier' parts of town...
Anyway, if I'm taken as somehow supporting 'the dark side', I'll try to clarify, but I'm not going to censor myself to keep the waters calm. I've tried to be a straight shooter in all things, and in all sorts of contexts that has made waves, so I'm used to it. If I ever had a go-along-to-get-along, it broke a long time ago. Fwiw, most of my not-going-along involved expecting my colleagues and superiors to be honest and open, respect and follow their stated principles and written rules, and asking for rational cases for their positions from folks who couldn't be bothered justifying whatever-it-was-they-wanted and could just go ahead and do by virtue of institutional power and influence. So I'd like to think keeping quiet here would be antithetical and damaging to the principles of 'skepticism; (which I've actually read, and, you know, mostly agree with a lot). And I'd invite any other regular who fears offering a logic-and-evidence based point that goes against the prevailing grain just enough to get mistaken for 'going over to the dark side' to privilege priciple over politesse and fire away with whatever respectful insolence might be on their minds...
Of course, my path led me to winding up in a mental hospital outpatient program for depression fueled largely by the Sisyphusian rock rolling back onto my head, and leaving my job due to total system burnout. Not that I have second thoughts or regrets. I just want to include a 'Facts Label' on the potential side effects of the prescription for honesty and intellectual integrity. :-)
Myself: “I found the unopened bottle of Ondansetron”
So I decided to Google this and it is “Zofran”
Now that shit is MAGIC in bottle, I swear to the Almighty. It's the only reason I was able to maintain gainful employment during pregnancy.
You know what else is completely safe and relieves pain that is also just happens to be schedule 1? Cannabis.
You know what drug I first tried and really really liked before I became a heroin addict? Cannabis.
@ Narad
You're "missing the relevance of semiotics per se here" because there isn't any. RJ just doesn't like me, and is trying to lat down some snide ellliptical know-nothing shade in my direction. Brush up against naive and arrogant logical positivism at the first principles it can't defend on your way to anywhere -- even trying to find common cause with their pragmatic concerns -- and that's what you get.
I do have to say, though, that I'm missing the relevance of spelling here. :-)
Well, at least Carson isn't interested.
@ Delphine
I'm hoping you were dropping irony on sullenbode's logical fallacy in his(?) assertion that the fact the FDA has placed pot in a 'dangerous drug' category out of politics has any relevance as to whether or not 'kratom' (whatever the heck that is) is actually "completely safe". That your example of 'pot --> smack' is meant to throw some equally bogus argument back in his face.
Gotta say, though, that I didn't catch any irony at first read, and thought you were going all Nancy Reagan on him with a logical fallacy you actually think has some argumentative purchase. Lest any naive reader think 'good point!' straight up:
You know what sullenbode first tried and really, really liked before becoming a pothead? Milk. McDonald's french fries. And, no doubt, beer. Shame on the FDA for caving to Big Milwaukee, putting it's head in the sand on the true roots of addiction to dangerous mind-altering drugs, and refusing to call for the reinstatement of the Volstad Act.
And, oh yeah, we have to get any trace of chemistry out of the public school curriculum. Because Walter White, (and Owsley, for those who remember what was going into the Dead's heads).
Not only is Carson out, but Rick Scott who had previously been touted for HHS if Carson didn't get it seems to have fallen out of the hot-take speculation. This leaves the likely new HHS secy du jour as Rep. Tom Price, a former orthopedic surgeon and Obamacare hating, AAPS pimping, anti-regulation of anything except abortion (just ban that), climate change denying, PATRIOT act loving, NRA approved advocate of More Guns!
If not Price, it might be Mike Huckabee. Price has no public statements on vaccine policy I can find, and Huckabee's actually pro-vax. Why am I not reassured?
Yes, it was meant as irony. Should have used the irony font.
Whether I like sadmar is of course irrelevant to anything I say. My personal feelings towards him or anyone as an individual is not at issue (and I have no such feelings). Let's just put it this way: he does not represent the humanities. He does not represent me.
Sadmar is not actively offensive and clearly he has as much right to have his say as anybody else. There are those, however, who seem to assume that he is some sort of 'humanities' representative; that his views somehow represent the humanities; that his views express professional expertise. They don't and they don't.
There are many of us in the humanities that are deeply unimpressed by the sources sadmar claims as authorities. I personally see Jameson as far more like Ayn Rand than like John Rawls or some other real scholar. I am not impressed by Derrida; not impressed by Foucault. I see them largely in the same pile as Glenn Beck, not in a pile with scholarship.
I realize this is a side issue, to put it mildly, to the subject matter of the blog here. I'm not here to police the humanities or to flame an individual. But notice that sadmar, like the pomo logophobes generally, resorts very quickly to the 'you just don't get it' response.
Yes, I read Hegal, I read Heidegger, I've read most of the famous authors generally lionized by the pomo logophobes. Deeply, deeply unimpressed, along with many other people I respect.
Here's the upshot(s) again: like his ideas or not, sadmar does not in any way represent the humanities. And, when a pomo type tries to deflect your criticism with a claim that 'you just don't get it', don't believe them. They do not represent a discipline, like mathematics, physics, or biology, that has consensus results tested over time. In other words: no disciplinary expertise.
If a physics professor writes from a disciplinary perspective, citing scholarly consensus, I view that as a strong prima facie reason to accept what they say. I have no such intellectual-prudential obligation to accept anything said by a person that think Fredric Jameson is a serious scholar. Nor does anyone else.
So if that particular commentator seems to you to be saying, "No Orac; you should see it my way because sign event context", your seeming is accurate as far as I'm concerned. And he does it a lot.
sadmar @50: Anecdote alert: my new PCP (previous one moved away) did a great job of listening and having a SBM conversation with me. She was also training an intern who was adorably awkward trying to take my history.
Then again the doc I saw for exactly half an appointment was incredibly unhelpful and refused to continue my prescription because she didn't prescribe "opiates and barbiturates", which is fine and all, but this is neither and there was no call to act like I was some kind of drug seeker. (Still angry about that.)
So basically opposite anecdote that I've always found young PCPs to be good listeners.
http://www.huffingtonpost.com/allen-frances/the-dea-has-the-wrong-pri_b…
JustaTech, it sounds like you could have used some kratom. People taking it are doing away with the need for the dangerous prescriptions while still achieving relief from pain, depression, and anxiety -- Just don't get it from the gas station or headshops (which are often aldulterated with caffiene and worse) when a kilogram of fine ground leaf runs around a hundred bucks or so. And no, you don't 'smoke' it. Yes, it can be addictive.
The beef in Alabama was that people may take it when they can't get their usual fix -- Alabama is a strong 'abstinence only' state which does not countenance harm reduction.
@ JustaTech
Ouch! and been-there-got-that on that 'drug seeker' thing. Mine was a psychiatrist.At the time, i was wondering whether my increasing debilitating symtoms of what I callled 'The Nerves' (as opposed to 'axiety attacks') might be related to my long-term use of clonazepam. A friend had alerted me to a paper by a benzo expert MD that listed something like that as a risk with benzos, and detailed a protocol she'd developed to successfully wean patients off benzos that involved first transitioning them from whatever else they might be taking to diazepam, which, having both a 'softer' and longer effect curve is easier to dial down w/o side effects. So I try to ask my shrink about this, and hand him a printed copy of this long detailed paper, and he doesn't even look at it, just says, as if offended; "I do NOT prescribe Valium!" Taken aback I meekly ask 'why' and he thunders back with clear 'What ARE you, some kind of JUNKIE' subtext, "It is an abused drug!' Mind you, I'm already on Klonopin, which is stronger than Valium, and I'm trying to ask him if he thinks it might help me to get off benzos altogether...
As for your good young PCP... I guess we're stuck with anecdotes, and I'll just say that having been an academic vagabond [wink} I have more than you have![/wink]. Anyway, my larger point is still that it's not about the doctors, but the systems they work in. If your PCP actually has the time to listen to you before the next sick body comes down the line, count yourself lucky that either your condition is straightforward enough to be accurately described quickly and clearly, and/or the medical group hasn't fully Taylorized its services. Yet.
Thanks herr doktor bimler and Narad, have left search terms pointing to the first article, in the comments.
Sullenbode @59: Why the heck would I take a plant with an unknown concentration of a compound that hasn't been adequately studied that even you have not suggested would address the condition I have?
I wasn't asking for anything even remotely similar to any kind of pain killer, opioid, or any other suppressant. I was asking for a continuation of a well understood, totally normal treatment for a generally-uncontroversial condition. It would be like if you walked into a cafe and ordered a coffee and had the barista scream that they don't sell weed. Like, duh, and that's not what I asked for.
Also, sullenbode, are you capable of making any posts not about your plant? Monomania is tiresome.
sadmar @60: Hilariously, the reason I generally have time to get to know my doctors is because I do have a straightforward condition, but US drug laws require that I physically show up to renew my prescription. So we often spend about 5 minutes chatting about stuff and then I go so she has more time for other patients.
I seem to have trouble hanging on to scripts for hydroxyzine even though it is non-narcotic, non-scheduled, and available over the counter in most of the rest of the world.
If pot don't cure what ales you, hydroxyzine probably does. It's great stuff for sleep, anxiety, as an antihistamine, and tremors. Somewhere along the line, somebody claimed it "treats" rather than it "helps with" so it is unfairly stuffed behind a hard-to-surmount prescription wall.