Woo: The future of American medicine? (revisited)

Sure hope whoever gets that nutrition part right, in the future, this time. Or a least better. It sure as heck wasn't right last time I visited the nursing home or hospital, last year.

The in-house nursing home food is so poisonously sugar-starchy-(trans?)-PUFA now, people are just dying to get out. Almost gives people chest pains just to look at the stuff. Seemed like the ambulance always came about 20-40 minutes after dinner, 5-6 days of the week in the nursing home. Suicide by state approved dietitian?

The hospital was more efficient. The "food" served there could scramble rescue staff in about 30 minutes with one small dish.

Ah, perhaps AMSA has read the handwriting on the wall- or NaturalNews!** The Health Ranger, after first publishing his Health Freedom Manifesto ( 12/30/10), informs us that people are abandoning "Orthodox medicine" in *droves* ( in droves, I tell you!) (1/1/11; 1/2/11; 1/3/11) for the untainted, corruption-and-toxin-free ministrations of natural health practitioners in the purity and pharma-and-GMO-free independence of health freedom: a natural health/ health freedom revolution /renaissance is on its way! I'm sure that he ( and other woo-meisters) would opine that "greedy" med students are either looking for a "piece of the action" or are truly "enlightened", and after seeing the error of their ways, are signing up for woo - in droves.

A long time ago, when I was in grad school and doing training in therapy/counselling: a funny guy I knew, Joe, said I should start doing New Agey "lectures" to women about airy-fairy psycho-babble, and *then* when I actually counselled them, use the *real* methods I was learning. And *help* them, despite themselves.( "A spoonful of whimsy helps the medicine go down"?) He would be my manager/PR guy (@ 10%): we would become rich and I would get to wear really cool clothes- flowy things in muted colors. I thought that to be totally unethical. Sometimes I wonder if some people trained in real medicine think like Joe did.

Re: Dr. Maker-Clark- Geeta? *comme* "Gita"? A WASP-ish last name, Indian-based first name? Like a yoga teacher? Wait, if I went woo, I kinda like the sound of "Lakshmi" Walter.**

** I'm only joking. Although, in the first instance, I *wish* I were *totally* joking.

here is a cartoon i think you will all enjoy.

(be sure to click the red button at the end too)

I like Denice's idea of using woo to market science. That is the only way the AMSA activities make sense.

A very sad commentary about (formerly)respected hospitals plugging into alternative medicine. I foresee lobbyists working their magic to enact legislation to force insurance companies, including Medicare, to pay for this alternative woo; they did it for chiropractors.

Meanwhile, Congress will be debating repeal of the Health Care Reform Act and Americans are still without health care insurance coverage for "traditional" medicine.

Sad, sad state of affairs.

What a very interesting thread indeed.

Your readers might find interesting the work of Dr. John Ioannidis, one of the world's foremost experts on the credibility of medical research. His work was recently summarized in The Atlantic magazine - one of America's oldest and most respected publications.

The article is called "Lies, Damned Lies, and Medical Science" and cites that "80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials." Check it out yourself.
http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-an…

Some of Dr. Ioannidis' work has been published in JAMA - the "gold standard" of the American Medical Association.

I'm not an apologist for whatever "woo" medicine is (don't really know what you're referring to), but I find the blog post and reader comments absolutely astonishing in their righteousness about "science-based medicine" that is increasingly being found to be riddled with fraud, bias, and deception for the sake of profit.

Pot calling the kettle black?

@laddshack:

If you use the search, you'll find that Dr. Ionnidis is often cited with approval here. What you're missing is that the number of published findings which turn out to be wrong does not represent "fraud, bias, and deception." It is a natural and inevitable consequence of the uncertainty inherent in the scientific process. You would benefit from reading his work more closely.

Also keep in mind that the way we find out which published results are wrong is by doing the careful science to confirm or refute them.

laddshack:

Been there, done that.

@laddshack

Way ahead of you:

http://scienceblogs.com/insolence/2007/09/the_cranks_pile_on_john_ioann…

Also, my "good buddy" is way ahead of you as well:

http://www.sciencebasedmedicine.org/?p=7734

Of course, there is the distinct prospect that woo will become the future of medicine, and not only in the USA. Between the "worried well" and the spiraling cost of real medicine, it's quite possible that the payors will decide to steer patients to woo. It's cheaper to deliver and, for a large class of conditions, cheaper to pay for because the patients either recover on their own or die rather than require extensive care.

integrating different global medical systems

Would that include such "different global medical systems" as:

Killing albinos for their body parts

Accusing people of witchcraft and either killing or ostracizing them

Using body parts of endangered species

Bleeding and cupping

Consuming lead and other heavy metals in significant quantities

Treating mental illness by exorcism

and so on

D. C. Sessions @10 - the flip side of you argument (especially in countries like Canada with socialized medicine) is that "integrative medicine" is very lucrative for the doctor. They can charge whatever the market will bear instead of accepting what the provincial health care plan will pay and treat imaginary ailments that are not covered. In addition they can supplement their income with sales of supplements and devices that they recommend.

Perhaps we can counter woo by simply BEING LOUDER

@ Militant Agnostic -( while I *do* realize that you jest when referring to mental illness treated by exorcism-) Mike Adams, in his new ranting** revelations, predicts that psychiatry will be tossed aside and supplanted by the methods favored by the C.C.H.R.( i.e. Scientology)- that include the exorcism of long-dead aliens' ghosts or somesuch and volcanic hoo doo.

** and barking mad.

When you get places like Columbia University Medical Center that have things such as "Integrative Therapies Program for Children with Cancer" http://integrativetherapies.columbia.edu/Reiki.html that have been going on for years and have names like Dr Oz out there in public promoting this stuff it is no wonder that we see more and more. According to this article http://tinyurl.com/2vcw5ra this person goes into the OR with cancer patients and stays there.

Woo is everywhere. As a patient I can assure you that was brought home to me nearly 3 years ago. I'm not embarrassed to admit that it scared the hell out of me when I had my first consult with a highly-regarded neurosurgeon, immediately after my melanoma diagnosis (out of the blue at stage 4, courtesy of brain mets)
The most well-known neurosurgeon in this country attempted to browbeat and harangue me, then finally deigned to agree to operate to remove my two 4cm tumours IF I agreed to the following conditions:
I was NOT to undergo any radiation or chemo, ever.
I was not to take steroids under any circumstances (Sorry, mate- I was already on 24mg/d by that stage!)
I was to take up meditation.
I was to drink copious amounts of water (even going so far as to suggest that the water and meditation had previously cured people of advanced melanoma)
After swearing at me because I wasn't willing to meekly accept his conditions, I told him I didn't want him to treat my melanoma, I wanted him merely as a surgeon to cut out my tumours, and then demanded a referral to another neuro.
Then I proceeded with my own brand of 'complementary therapy'- a neurosurgeon and a RadOnc who complement each other, and have managed to keep me functioning independently despite 20+ brain mets, 7 craniotomies, and several SRS.
Deliberately misleading, or genuinely misguided, makes no difference to me- I feel the urge to slap woo proponents, regardless.

The behavioral sciences have been credited with a major role in shaping both the specialty of family practice and family medicine's identity as an academic discipline. Beyond the primary contribution to residency education, the behavioral sciences have contributed significantly in the areas of faculty development, primary care research, clinical service, and in the development of collaborative practice models. For over three decades, behavioral science teachers and consultants have helped prepare family physicians to balance care of the person with the demands for technical competence in the treatment of disease.

@witless

Thanks for your story. I, too, had a run in with a woo-prone neurologist, although happily, for a far less life-threatening situation. The one I saw recommended some kind of supplement and when I asked for some kind of published evidence, he seemed shocked and insulted. I called the office to follow up on the request and was sent a newspaper clipping from a column written by a layperson, in a community newspaper, that briefly (and lamely) "discussed" the use of said supplement--that is recommended it wholeheartedly with the full support of a couple of anecdotes and the usual "emerging evidence" gambit.

The thing is, this guy's waiting room was full of older women (on that day, anyway), who were all talking glowingly of the good doctor and how his "compassionate" methods had helped them so much more than those "other" cranky doctors. I don't know what this means, but the doc in question is Indian (as in recent immigrant) and seems to function as a guru. I'm sure many docs of all ethnic persuasions do this stuff, but many Indian doctors that I've seen (my primary care doc is Indian and ALL his referrals are to other Indians), dance around the edges of Ayuervedic (sp?) woo. My primary care doc does NOT do this, happily.

Hey...the point is that we are looking for a change..our current system is failing, miserably.

After 20 years of practice in Traditional Vhinese Medicine, I am proud to report that I have not killed anyone, yet. Please note the following study with referrals from the AMA and Institute of Medicine

Table Of Iatrogenic Deaths In The United States
(Deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures)
Condition Deaths Cost
Adverse Drug Reactions 106,000 $12 billion Lazarou (1) Suh (49)
Medical error 98,000 $2 billion IOM (6)
Bedsores 115,000 $55 billion Xakellis (7) Barczak (8)
Infection 88,000 $5 billion Weinstein (9) MMWR (10)
Malnutrition 108,800 â Nurses Coalition (11)
Outpatients 199,000 $77 billion Starfield ( 12) Weingart (1, 12)
Unnecessary Procedures 37,136 $122 billion HCUP(3, 13)
Surgery-Related 32,000 $9 billion AHRQ(85)
TOTAL 783,936 $282 billion

OK, this, like all studies has a lot of WOO (Please note the article by Dr. John Ioannidis cited above) Cut it in half, hell cut it by 80%! It is still a huge amount of Iatrogenic Deaths and a lot of money spent to make them happen...

Acupuncture has been around for close to 3000 years.
Would you call that a significant clinical trial? (Now there are 1000's of modern ones)

The point is, there is more to healing than reductionist based science. If any of you have ever tended to patients, in any capacity, then you will know what I am speaking of.

Science has brought the average mortality rate from 40 to 80 in the west over the past 200 years, which is astounding. It has also brought other calamaties that we are all aware of.

Let's not throw out what can help us because we don't understand it, Galileo would have appreciated that approach

Kirk Moulton, L.Ac

@Kirk

OK, this, like all studies has a lot of WOO (Please note the article by Dr. John Ioannidis cited above) Cut it in half, hell cut it by 80%! It is still a huge amount of Iatrogenic Deaths and a lot of money spent to make them happen...

The mistakes made by science-based individuals do not validate non-science-based hogwash.

Acupuncture has been around for close to 3000 years.
Would you call that a significant clinical trial? (Now there are 1000's of modern ones)

First off, modern acupuncture has only been around since, oh, about Chairman Mao's days. Look up your history.

Second, even if it had been around for thousands of years, no, it would not be a significant clinical trial, as there were no controls, no blinding. The stories are not worth much at all as to whether it a) works and b) is safe.

Science has brought the average mortality rate from 40 to 80 in the west over the past 200 years, which is astounding.

Far better results than non-science-based "treatments".

Let's not throw out what can help us because we don't understand it, Galileo would have appreciated that approach

Oh, but we do understand a fair bit about alternative therapies like acupuncture. We know, for example, that acupuncture is nothing more than a placebo. To whit: it doesn't matter where you stick the needles, nor whether the needles actually break the skin. Given that, acupuncture, as currently practiced, is unethical, in that it introduces extra risk (infection) without any added benefit.

Oh, and if you want to play the Galileo bit, you have to remember one thing: you need to be correct.

As far as the whole reductionist thing, that's a bunch of nonsense, too. Your precious practices can be tested with science. If they work, then a scientific approach will show that they work. If they don't, then a scientific approach will show that they don't work. Just because they fail under properly conducted studies doesn't mean that the science it broken; it means your practice is likely bunk.

@Kirk #20

Acupuncture, as you know it, has only been around for 60 years,* since Mao was unable to provide his people with real medicine (which he subscribed to for himself). Acupuncturists have killed and maimed people; but the numbers are small because you mostly provide un-needed service to the wealthy, worried well. When was the last time an ambulance brought you a seriously sick or injured person and asked you to save someone's life. You don't need to answer, I know- it has never happened.

Real illness, and real treatment have their drawbacks (as does your quackery); but real healthcare providers strive to understand and eliminate the dangers. And real healthcare provides results that acupuncturists cannot provide.

Forget Galileo- he was persecuted by the Church, not fellow scientists. It is not that scientists don't understand acupuncture, we do. It is not accepted by credible scientists because it fails every adequate test.

*Traditionally, "acupuncture" was akin to bloodletting that was abandoned by medicine as it became more scientific.

Medicine is a tricky thing. The placebo effect is real and large. Presently drug companies are complaining that the placebo effect is getting bigger and wiping out the apparent good effects of some of their drugs. (Of course the placebo effect isn't getting bigger, but the double-blind studies to measure the efficacy of drugs are getting better designed and the data analysis more sophisticated so that random chance does not promote a drug as effective when it isn't).
Before I was born, Congress banned snake oil remedies and then about 20 years ago renigged and allowed "natural remedies". Shame on them!
It is hard do do a double-blind study on acupuncture. Accupuncture is unlikely to cure anything, but it is plausible that it might relieve pain, which could be a good thing. However that placebo effect thing has me wondering. Of course if accupuncture or a placebo relieves pain who cares? Well, it reduces pain, but fails to address an underlying, treatable illness that worsens to becoming untreatable, we all should.

Medicine is a tricky thing. The placebo effect is real and large. Presently drug companies are complaining that the placebo effect is getting bigger and wiping out the apparent good effects of some of their drugs. (Of course the placebo effect isn't getting bigger, but the double-blind studies to measure the efficacy of drugs are getting better designed and the data analysis more sophisticated so that random chance does not promote a drug as being effective when it isn't).
Before I was born, Congress banned snake oil remedies and then about 20 years ago renigged and allowed "natural remedies". Shame on them!
It is hard do do a double-blind study on acupuncture. Accupuncture is unlikely to cure anything, but it is plausible that it might relieve pain, which could be a good thing. However that placebo effect thing has me wondering.
Of course if accupuncture or even a placebo relieves pain what is wrong with that? Well, if it reduces pain, but fails to address an underlying, treatable illness that worsens to becoming untreatable, we all should care.

I remember seeing far too much of this in my (recent) medical school days. However, I think the problem is minor. I'll never forget the day that my classmates showed that most of them would become good SBM practitioners:

One of our profs had ill-advisedly invited a naturopath to give us an overview of "CAM" modalities - ostensibly to prepare us to deal with patients who use "CAM". The naturopath, unsurprisingly, wanted to convince us that his woo worked and came with a bunch of bad studies that he felt supported the efficacy of everything from salves to homeopathy. The class immediately jumped on him, finding obvious holes in his arguments. Those with laptops found the much larger and well-designed studies that refuted his crap. The man won no converts.

Although there are a minority of misguided medical students who love nothing more than a good woo, I think the vast majority still have a strong respect for science. It's not doomsday yet.

It is hard do do a double-blind study on acupuncture.

Actually not. These days there are retractable needles in sheaths; neither the acupuncturist nor the "patient" can tell the difference.

Acupuncturists would just rather they didn't exist, since it makes the case so much more strongly that they're scam artists...

Some people just can't accept the future of healing and you are certainly one. You are holding yourself back from what healing is all about---a combination of alleopathic medicine and the whole rhelm of wholistic healing!! I bet you've never even taken a vitamin C tablet in your life!! Until you work with patients and know what supplements, healing touch, and meditation can do, you'll never understand the healing qualities that they have. You are putting up a block on yourself for the sake of arguement!!

Kathie, a couple of things you need to embrace:

1) An understanding of reality.

2) The idea of spell check.

So in your future you should probably head on down to a bookstore and get some books: basic books on science and a dictionary.

You didn't actually assume that I may resist weighing in on this well being care debacle, did you? With my 35-plus year background in the insurance enterprise, I believe I can carry some distinctive perspective to the table.

I do not know for certain what is within the bill. Nobody does. However from what I read all over the Web, there are a few options that need early discussion.
Effectively, let's use the low finish of the estimates, 32 million. I am only using that as a result of the federal government at all times lies, and the true number is probably lots lower. And for example that the annual premium for the very best health insurance coverage you can buy is $5,000 per year per individual regardless of age. Then do the math. 32 million uninsured people instances a $5,000 annual premium per particular person is barely $a hundred and sixty Billion. visit here

@29

Great, an unintelligible spammer.

From the horrid post you put up, I doubt you have that background you claim, and how in the world does that relate to the blog post above?

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." ~ Arthur Schopenhauer

I am pleased to see that holistic/integrative medicine has passed from the first into the second stage. Truth normally takes a complete generation to progress through all three stages.

What are the 3 stages of stupidity? I'm not sure, but I get the feeling I'll be able to define them after a bit more time spent on this blog.
@19- speak for yourself. I like/trust scalpels, stereotactic headframes and crusty doctors with little bedside manner, yet wicked senses of humour :) I just sent my primary care doc an sms @ 9pm, and had an sms and appointment time for the following day within 5 mins, so I certainly don't feel like I'm being failed by conventional medicine. MAYBE patients should be a little more discerning with who they choose as a medico, and take some responsibility (rather than labeling them all as evil bastards and blindly embracing the woo and allowing dodgy bastards to blow smoke up their collective arses)?
*apologies, but I've got a filthy headache and mood to match! I am in no mood for eloquence or niceties.

AMSA is a large organization with significant influence on med school course development, and gets a lot of money from the woosters. I think it is one of the main drivers of quackademic medicine. I elaborated with a post of my own today.

http://doctorrw.blogspot.com/2011/01/time-to-take-american-medical-stud…

AMSA is a large organization with significant influence on med school course development, and gets a lot of money from the woosters. I think it is one of the main drivers of quackademic medicine. I elaborated with a post of my own today.

http://doctorrw.blogspot.com/2011/01/time-to-take-american-medical-stud…

"Unfortunately, all these truly important points are trapped within the authors' generally anti-capitalist view. The authors mire their arguments in the simplistic assumption that business is inherently evil and that the solution to these problems lies in a utopian state that ignores human nature and indeed all of evolution.

The Terrible Gift does not examineâexcept as a necessary evilâthe possibility that a for-profit system can also be responsible for most of the headway in recent therapeutic medicine.

The US biotech industry is the largest in the world by far. Despite the authors' claims that other industrialized nations consider ""our developmental frenzy excessive,"" other countries, especially in Europe, are desperate to catch up, offering tax breaks and research funding to entrepreneurs brave enough to try to start companies. The reason for this success in the U.S. is the promise of profits from a huge market. The public should be equally aware of this truth if it wants to benefit from biotech.

Some of Carlson and Stimeling's statements will mislead uniformed readers. They write for example that ""private sector-funded research on humans completely lacks the peer reviews and test-subject safeguards required in federally funded work."" While institutions such as the US National Institutes of Health in Bethesda, Maryland, have their own set of requirements that may not apply to privately funded clinical trials, companies must apply to the US Food and Drug Administration with adequate preliminary data to conduct any human studies.

In discussing the evils of patenting genes, which is legal, the authors suggest that soon the entire human genome will be privately owned. In fact, it is not legally possible to patent an entire organism under current US law; nor is it possible to patent the entire human genome, which, for all practical purposes, is already in the public domain. The patent system, we should remember, exchanges limited exclusivity for innovation and is a core reason for the rapid progress of genetic medicine. Also, the patent system is a place where policy adjustments can be made. The authors themselves suggest that use-patents or patents on procedures replace patents on genesâa view that is widely shared by many researchers in the field.

Carlson and Stimeling propose some specific changes to laws and policies, though most of the proposals, they admit, are unrealistic at best. Among them is the establishment of an international authority to enforce a moratorium on specific research."

Orac, you've got spamming necromancy here.