Perhaps the biggest bÃªte noire for me is the infiltration of quackademic medicine into academic medical centers; so whenever I see particularly egregious examples, it gets my fingers twitching over the keyboard, ready to lay down some not-so-Respectful Insolence. So it was last Friday when I happened across an article published nearly two years ago in The Hospitalist entitled Growth Spurt: Complementary and alternative medicine use doubles, which began with this anecdote:
Despite intravenous medication, a young boy in status epilepticus had the pediatric ICU team at the University of Wisconsin School of Medicine and Public Health in Madison stumped. The team called for a consult with the Integrative Medicine Program, which works with licensed acupuncturists and has been affiliated with the department of family medicine since 2001. Acupuncture's efficacy in this setting has not been validated, but it has been shown to ease chemotherapy-induced nausea and vomiting, as well as radiation-induced xerostomia.
Following several treatments by a licensed acupuncturist and continued conventional care, the boy's seizures subsided and he was transitioned to the medical floor. Did the acupuncture contribute to bringing the seizures under control? "I can't say that it was the acupuncture -- it was probably a function of all the therapies working together," says David P. Rakel, MD, assistant professor and director of UW's Integrative Medicine Program.
The UW case illustrates both current trends and the constant conundrum that surrounds hospital-based complementary medicine: Complementary and alternative medicine's use is increasing in some U.S. hospitals, yet the existing research evidence for the efficacy of its multiple modalities is decidedly mixed.
My jaw dropped in horror when I read this story. Acupuncture for a child in status epilepticus? There's no evidence that acupuncture works to alleviate this condition and no scientific plausibility suggesting that it might work. More importantly, what does the questionable research suggesting that acupuncture might ease chemotherapy-induced nausea and vomiting or radiation-induced xerostomia (which, if you look more closely at the studies, it almost certainly does not, but that's another post for another time) have to do with this case, anyway? Nothing. Worse, Dr. Rakel fell for the classic post hoc ergo propter hoc fallacy; i.e., despite his disclaimer, he appears to be implying that, because the child recovered, acupuncture must have contributed somehow to his recovery. He also repeats the classic fallacy that I've written about time and time again in the context of cancer therapy, namely that if a patient is using quackery as well as science-based medicine, then either it was the quackery that cured him or the quackery somehow made the conventional medical care work better.
I expect better from an academic medical center like the University of Wisconsin. Unfortunately, increasingly I'm not getting it. Quackademic medicine is infiltrating such medical centers like kudzu.
Surveying the landscape of "integrative medicine"
One of the most frequently used arguments by promoters of "complementary and alternative medicine" (CAM) or, as it's more frequently called these days, "integrative medicine" (IM) has nothing to do with science at all. Actually, few of the arguments put forth for "complementing" or "integrating" quackery (which, let's face it, is all the vast majority of IM really is) with science-based medicine actually have anything to do with science, favoring vague and fuzzy appeals to "holistic" medicine and the "whole patient," as though it's not possible to be holistic without adding a heapin' helpin' of magical thinking to medicine. It's the classic false dichotomy: Either we inject a generous dose of woo into our medicine, or medicine remains "non-holistic" or, even worse, reductionistic, and we all know how evil "Western" reductionistic science is, right?
No, one of the favorite tactics used to market CAM/IM comes straight out of the Madison Avenue playbook. Indeed, I can imagine Don Draper of Mad Men cooking it up. It's a classic argumentum ad populum, whereby CAM/IM advocates try to represent their "product" as being very popular and gaining in popularity every day. These sorts of appeals on the part of CAM/IM frequently emphasize the various subcategories of argumentum ad populum, such as the "bandwagon fallacy," in which it is argued that, because most people believe something (or because large numbers of people; i.e., a sizable majority) you should believe it too, or at least consider it more seriously. Regular readers should be able to see the problem inherent in that approach. After all, many people believe in ghosts or astrology; the fact that such beliefs are popular does not make them true. The second form of argumentum ad populum is known as "snob appeal," in which CAM proponents try to persuade you of a conclusion by appealing to what an elite or a select few (but not necessarily an authority) in a society thinks or believes. Of course, I view this variety of argumentum ad populum as more an appeal to authority than anything else, and, as I point out from time to time, an appeal to authority is not always a fallacy, which is why legitimate authorities need to be careful and responsible in what they say. They are, after all, legitimate authorities. What they say matters to non-experts.
We in medicine have apparently been failing in this respect utterly with respect to CAM/IM.
This failure is demonstrated yet again is a recent survey that's being flogged in the CAM/IM blogosphere that reports to have found that CAM/IM programs are becoming more common in hospitals and medical centers. My first reaction was almost shruggie-like in that I just wanted to shrug my shoulders and agree with my good blog buddy Steve Novella that pseudoscience sells. But then I decided to take a closer look.
What I'm referring to is the 2010 Complementary and Alternative Medicine Survey of Hospitals, a survey that was carried out by the Samueli Institute in collaboration with Health Forum, which is listed as an American Hospital Association Company." Oddly enough, this survey was not funded by the National Center for Complementary and Alternative Medicine (NCCAM), but rather by the US Army Medical Research and Materiel Command under Award No. W81XWH-10-1-0938. With two wars going on, one would think that the Army would have better things to spend taxpayer dollars on. Apparently you'd be wrong.
For those of you who don't remember the Samueli Institute, it's one of the major forces, along with the Bravewell Collaborative, promoting the infiltration of quackademic medicine into academic medical centers. It even describes itself thusly on the cover page of its survey report:
Samueli Institute is a non-profit research organization investigating the safety, effectiveness and integration of healing-oriented practices and environments. We convene and support expert teams to conduct research on natural products; nutrition and lifestyle; mind-body practices; complementary and traditional approaches such as acupuncture, manipulation and yoga; and the placebo (meaning) effect. We support a knowledge network that assists in integrating evidence-based information about healing into mainstream health care and community settings and in creating Optimal Healing Environments.
The "meaning" effect"? Holy Dan Moerman, Batman!
Professor Moerman aside, in a couple of talks I've given, I've used the Samueli Center for Integrative Medicine at UC-Irvine as an example of just how egregious quackademic medicine can get. Indeed, right there on the SCIM website you can see a homeopath, along with acupuncturists and naturopaths. Some of these might well recommend something called FirstLine Therapy, which is basically a program marketed by Metagenics. Not surprisingly, dietary supplements are part of the program, as is "Ultrameal," which is billed as "medical food" and takes the form of expensive drink mixes and bars. Yum.
But I digress. (Dubious supplement programs have that effect on me.) What about the survey itself? Let's go to the Samueli Institute's press release first:
Hospitals across the nation are responding to patient demand and integrating complementary and alternative medicine (CAM) services with the conventional services they normally provide, according to the results of a new survey released today by Health Forum, a subsidiary of the American Hospital Association (AHA) and Samueli Institute, a non-profit research organization that investigates healing oriented practices. The survey shows that more than 42 percent of responding hospitals indicated they offer one or more CAM therapies, up from 37 percent in 2007.
Note how this is a clever combination of the bandwagon appeal and an appeal to authority. After all, there is "patient demand," and the authorities (i.e., hospitals) are responding. The unspoken subtext is the assumption that hospitals wouldn't respond to such a demand if there weren't something to it. They are, after all, health care institutions made up of health care professionals, right? Well, yes, but hospitals are also businesses, and many of these health care professionals have either bought into the myth that "holism" and improving the doctor-patient relationship requires woo, or they are shruggies.
Meanwhile, CAM/IM apologists and supporters are jumping all over this survey as "evidence" that they are winning. John Weeks of the Integrator Blog, for instance, crows:
The most significant data point here is that 74% say that "clinical effectiveness" is a top reason for inclusion. This growth took place in a down economy and despite the lack of good payment models for CAM. These findings will be interesting to view after new incentive structures that might support CAM inclusion kick in with the growth of accountable care organizations (ACOs).
"Clinical effectiveness"? Based on what? Certainly not science in the vast majority of cases.
In any case, the story has gotten some traction in the mainstream media, such as the L.A. Times, which, tellingly, chose to report on the survey on its Money & Company blog under the title Alternative medical services growing at U.S. hospitals, quoting widely from the joint press release of the AHA and Samueli Institute.
But does the survey actually show what it claims to show? Let's go to the report itself. The first thing I noticed when I read the report was that it's full of the typical "bait and switch" language of CAM designed to inflate the numbers of people who apparently use "CAM modalities." For instance, diet, exercise, and the like are represented deceptively as being somehow "alternative" when their utility not only can be studied by science but has been studied by science. None of this is surprising, but it is harmful in that it applies a layer of "mystery" and "danger" to modalities that physicians have been prescribing their patients for a long time, such as better nutrition and more exercise. These modalities are, in effect, "woo-ified." Then, they are lumped together with the real woo, such as acupuncture, homeopathy, and "energy healing," in order to provide legitimacy by association. For instance, if you look at Figure 2, you'll see that natural products are the most commonly reported CAM modality, which tells me that the supplement industry's marketing hype has been effective. More tellingly, other than chiropractic, all of the top nine modalities are nothing that couldn't be considered SBM. True, homeopathy just barely squeaks into the top ten at number ten, but only 1.8% of adults in the U.S. have reported using it. (I suspect the number would be higher in Europe.) Where's traditional Chinese medicine? Where's acupuncture? Where's "energy healing"? Apparently none of them made the top ten. For instance, if you go to the 2007 National Health Interview Survey Report, you'll find that only 1.4% reported using acupuncture; 0.4% reported using naturopathy; 0.1% reported using Ayurveda; and 0.5% reported using reiki.
No wonder the "bait and switch" is necessary, at least if CAM practitioners want to represent the popularity of their methods as being higher than single digit percents (or, in the cases of some woo, higher than 1%).
Here's how the survey was done:
The 2010 Complementary and Alternative Medicine Survey of Hospitals, a 42-question instrument, was mailed to 5,858 hospitals from American Hospital Association's inventory of opened and operating member and nonmember hospitals in March 2010. Respondents had the option to either complete the survey online or mail back a hard copy. A total of 714 responses were received for a response rate of 12%. Of responding hospitals, 299 (42%) stated that they offered one or more CAM therapies in the hospital--which could be either in the form of services provided to patients or employees.
Does anyone see the problem here? It's fairly obvious, namely the response rate. It's pretty hard to say much of anything based on a 12% response rate. Basically, all we can say is that 42% of the 12% of health care institutions that bothered to send a response have a CAM program of some sort or another, but we have no idea whether that 12% of respondents is a representative sample. Indeed, it almost certainly is not; there is probably major selection bias going on here, with respondents more likely to be the ones who have some sort of CAM program. Indeed, the author of the survey basically admits as much in verbiage buried in the report, where it is pointed out that "most of the hospitals responding to this survey would be considered 'early adopters'" who are, apparently, adopting CAM "because they believe it's the right thing to do or because it's important to respond to the needs of their communities and patients." Clearly, this is not a representative sample. Be that as it may, it can still be informative to examine this non-representative sample. For example, the "bait and switch" continues here, with the top six outpatient modalities being:
- Massage therapy
- Guided imagery
And the top six inpatient modalities being:
- Pet therapy
- Massage Therapy
- Music/art therapy
- Guided imagery
- Relaxation training
- Reiki and therapeutic touch
The authors of the survey report conclude with amusing understatement:
Looking at the top modalities offered in hospitals it is clear that hospitals are "playing it safe" and starting with fairly conservative and non-invasive therapies to appeal to the broadest range of patients and consumers in the their community. Pet therapy has been growing in popularity. Massage therapy is provided predominantly for pain and stress management and for cancer patients, according to the American Massage Therapy Association's 2007 Survey of Massage Therapy Utilization in Hospitals.
Other key findings include:
- Majority of respondents offer wellness services for patients and staff, including nutritional counseling, smoking cessation, fitness training and pastoral care;
- Massage therapy is in the top two services provided in both outpatient and inpatient settings;
- The majority of hospitals that offered CAM were urban hospitals (72 percent); and
- Seventy-five percent cited budgetary constraints as the biggest obstacle for implementation of CAM programs.
It is rather instructive, though, to look at the differences between inpatient and outpatient. First of all, who decided that "pet therapy" was in any way alternative? It's not really "therapy," either: it's a great way to raise spirits among hospitalized patients, but lumping it in as a "CAM" therapy seems a major stretch to me. If pet therapy is an "alternative" or "integrative" therapy, then sending patients flowers to lift their spirits must also be alternative or integrative therapy. Secondly, it is interesting how reiki and therapeutic touch are major offerings in the inpatient realm but not in the outpatient realm. Very likely this is due to the decades-long infiltration of therapeutic touch in the nursing profession, leading too many nurses to come to believe that they can somehow realign a patient's energy field to healing effect by waving their hands around. Reiki fits right into that, particularly given that reiki practitioners have been making a concerted effort to get into hospitals and offer their "services" to patients.
Money, money, money
It's even more instructive to look at the reasons given for starting up a CAM program. Inevitably, financial considerations, plus popularity and a perceived demand among patients, are among the handful of factors that predominate:
Look at what comes in as number one: patient demand at 85%. None of this is surprising, given that in the introduction it is stated:
The American public is also demanding that their hospitals offer more than conventional allopathic health care and begin to integrate CAM therapies into the care they receive in the hospital. In response, hospitals have been looking to meet the needs of their communities. The demand for CAM services is significant, even though insurers may not cover all services or products, with the American public spending approximately $12-19 billion on CAM providers and a total of $36-47 billion on all services and products combined.
Which at first suggested to me that it's almost all about the business. There's a lot of money to be made in CAM, and it's paid for out of pocket. No muss, no fuss messing around with those nasty insurance companies, their policies, and their unending demands for more and more documentation. It's also instructive to look at the reasons given for choosing the CAM modalities offered:
There are, however, a couple of anomalies here. Most prominent, given that only 27% admit that market research drove their decision to offer CAM, one wonders how all the others who didn't do any market research (78%) knew that there was enough patient demand to justify spending the money to offer specific CAM services. In any case, I consider it also telling that the survey reports that 85% will use patient satisfaction as a metric to evaluate the CAM program while only 42% plan on evaluating health outcomes and 31% will evaluate quality. Don't get me wrong, patient satisfaction is important, and we measure it for science-based medicine. However, there's something wrong when twice as many hospitals with CAM programs will be looking at patient satisfaction as will be looking at health outcomes.
Perhaps the most interesting part of this study suggests that it may actually not be all about the money, despite the listing of how lucrative CAM can be. For example, only 57% of facilities will be using volume as a criterion for evaluating their CAM program. Is there a clinical program on earth (or at least in the U.S.) that doesn't use volume as part of its criteria for evaluating it? It may be one of many, and it might not even be one of the more important criteria, but it's usually a significant criterion. Adding to this, only 39% will use revenue; 20% will use profit; and 8% will use market share. To me these suggest that perhaps CAM is indeed more ideological than financial, particularly when coupled with the finding that 75% of hospitals reported that budgetary constraints are the biggest obstacle to implementing a CAM program, even though such programs can cost as little as $200,000 to start up. (One notes, in contrast, that only 43% reported that a "lack of evidence-based studies" was a major obstacle.) No wonder quackademic medicine is trying so hard to entice third party payers to reimburse for their services; if that were to happen, no doubt many CAM programs that are currently not financially viable will become viable. Perhaps, for as unrepresentative a sample as was surveyed, this survey serves the inadvertent purpose in providing evidence to suggest that the infiltration of quackademic medicine is not driven primarily by money, as skeptics and supporters of SBM (myself included) have on occasion speculated.
Maybe it really is about the ideology. As mixed a bag as it is, this survey suggests as much.
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this is some great information, thank you so much!
I have a feeling the overarching point of this 'great information' is lost on a homeopath like yourself, Dr. Linda.
There are, however, a couple of anomalies here. Most prominent, given that only 27% admit that market research drove their decision to offer CAM, one wonders how all the others who didn't do any market research (78%) knew that there was enough patient demand to justify spending the money to offer specific CAM services.
I think ORACâs qbits must have been disrupted by a subspace anomaly. As that particular set of figures exceded 100% the question base canât have been exclusive i.e the respondents could tick more than one box, therefore all respondents could have carried out market research (how else would 78% know that there was patient demand ?), but only 27% of respondents are fessing up to using market research as their guiding principle. In reality âpatient demandâ and âmarket researchâ are the same thing, although arguably "patient demand" could be a specific survey cohort comprised of âexisting customersâ, with âmarket researchâ defining a âpotential customerâ cohort. But outside of any marketing strategy, the distinction between the two categories has no substance.
Ah. Health care consumers - or are they customers - demanding silly things from the health system.
I think that if American healthcare were taxpayer funded, people might be more careful where their tax dollars go.
Universal health care. Just adopt it already! It solves so many problems.
Moerman was wrong in suggesting that Meaning has any effect on the patients' medical conditions. But he was right that it's always there. And one thing it might well have an effect on is whether the patients even set foot in the hospital in the first place. Once again, I'll insist that the architecture, haberdashery, etc. of hospitals has nothing to do with how scientific they are. The only concern is how to advertise the hospital at minimum cost and without disrupting the medical procedures.
I think the ideology at work here is that the legitimate symbols of advertising are mistaken for part of the hospital's medical practice. The disparity from the patients' actual perception of the hospital's advertising prowess is made up for by what passes for adding other symbols. But the ideology makes a second mistake, this time in the opposite direction, because these additions are far more than just symbols. They are actual procedures on the patient that have no medical effect and take resources away from the real medicine.
These useless practices are sometimes referred to as "traditional medicine", but that phrase is an insult to all the world's traditions. Every long-standing culture has a concept of having been wrong and trying new ideas that might be better. It's only their modern knock-offs that put faith in things that have been proven wrong.
In order to attain the international significance that medicine must have, it must be assumed that every traditional society can understand the benefit of science-based medicine, if presented to them according to the international standards for scientific education. And those standards do not include white coats.
The "clinically effective" #s really surprise me, I have to say. There IS no solid evidence to show that CAM-junk like reiki and acupuncture is clinically effective!!! It's a little sad that mainstream hospitals & healthcare organizations, in a time of skyrocketing medical costs, are buying into this voodoo on the grounds it is "clinically effective". I have to say I'm baffled.
Oh, the "aura favoris popularis"! Often used as an excuse for the justification or implementation of one's own choices without solid reasons. "My music *must* be great: the artist sold X million copies/ downloads are huge!"
On the other hand: the top oupatient and inpatient modalities ( even the most woo-ful, i.e. accupuncture, Reiki) might be viewed as ways to deal with stress- which, if you're inpatient especially, is probably present.** Woo may serve as a substitute for hand-holding and spiritualised self-esteem boosting for many patients. Woo subverts itself into a function that usually is the province of close relations and SB counselling services.
If money is not the prime consideration, whose ideology has seeped into the decision making process? Is it a belief that people generally like this so it will eventually be more profittable as more folks come aboard the woo-luxury liner? Funny, but this sounds a lot like the "paradigm shift" argument often espoused by woo-meisters. "The tide is turning our way". Looks like circular justification to me. "It's trending that way so let's follow the trend!" An appeal to Fashion ? Do those who make these decisions forecast a future that fits hand-in-glove with the propaganda from entrenched woo entrepreneurs?
(Just an errant thought, I remember PALMD writing about how patients are more seriously ill if they are actually inpatient - probably due to cuts in payments by Medicare and insurance. Are hospitals trying to recoup losses from these trends as well? If more services are outpatient perhaps it might be a form of business expansion).
** my father's many sojourns in the CCU were often complemented by WSJ/NYT financial page therapy ( or in a standard room by Bloomberg TV). Patient demand,you see.
The comments by Dr. David Rakel regarding acupuncture and treatment of status epilepticus are totally without merit. I checked into Dr. Rakel's "credentials" and expertise in neurology and find that he is seriously deficient, indeed they are non-existent:
"Dr. Rakel is board certified in family medicine, sports medicine and holistic medicine. He also is certified in interactive guided imagery. He was one of the first graduates of a two-year fellowship in Integrative Medicine at the University of Arizona. He then came to the University of Wisconsin to start the Integrative Medicine program in 2001. He is editor of one of the main texts in the field, entitled Integrative Medicine. He has been awarded a number of teaching awards including the Baldwin E. Lloyd clinical teacher award, the UW Department of Family Medicine faculty excellence award, the Marc Hansen lecture award and the resident teacher-of-the-year award. His interests include learning how the body self-heals, mind- body health influences, sports medicine, nutrition and incorporating health and healing curriculum into medical school education, a project for which he has NIH funding." (University of Wisconsin Medical Center-Integrative Medicine website)
It's been a number of years since I was at the bedside of my son and the bedside of another child who were in status epilepticus...so I checked into the treatment protocol for status epilepticus and the treatment remains the same...IV push bolus lorazapam and/or phenytoin while monitoring/supporting airway clearance, respiration and breathing. There is nada, zilch, zero mention in the treatment protocol for status epilepticus for any "complementary/alternative treatments".
Orac stated, "Very likely this is due to the decades-long infiltration of therapeutic touch in the nursing profession, leading too many nurses to come to believe that they can somehow realign a patient's energy field to healing effect by waving their hands around."
Perhaps I've had limited exposure to these "holistic nursing practices"...but every nurse I ever came across only practices science-based nursing. I've checked the course study at the university where I received my degree and a few other universities nearby and I don't see any alternative/complementary courses being offered. Perhaps you are confusing the AHNA (American Holistic Nursing Association) with the ANA (American Nursing Association)?
My personal belief about "holistic nursing" is that it is blot on my science-based nursing profession...i.e. a crock.
Yeah, so, this one time, at band camp, I had a cold sore and this girl did, like, acupuncture on me and shit, and the cold sore went away in, like, a few days.
What a bunch of bull.
You just made me wonder something. If I attempted to bring a new woo modality to market, and called it simply "Regression to the Mean," do you think the woo consumers would buy into it despite the obvious joke?
"Try new, ALL NATURAL, Regression to the Mean Therapy (RMT), guaranteed to cure what ails you*!"
(*in 6 to 8 days.)
Let's talk back pain for a minute. I support SBM as necessary for effective care. Is it sufficient though? Is a clinician that recommends yoga a quack?
As a cure for cancer, yes - a quack.
As a cure for cancer, agreed - a quack.
Physical therapy and/or exercise regimens are recognized SBM modalities. If yoga is being recommended as an option for that purpose, that is within SBM, though there is still the question of how well it does in comparison to other exercise programs. Take the exercise, ignore the woo frosting, and make sure to discuss with your doctor whether there are certain motions you should avoid or include.
Here in Seattle, the buzzword for CAM/integrative medicine is "Wellness". What is driving hospitals to open "Wellness Centers" is the perception that upscale consumers want their hospital to at least have an appearance of openness to alternative medicine. It's all about competitive marketing to the desired demographic (yes, Don Draper would be totally on board) and it's not really about money, ideology, or science. A hospital where I used to work opened their Wellness Center over the objections of many of the medical staff; the doctors were told to look the other way if they were unhappy. Bastyr University brought the woo in the form of student practitioners. They weren't able to develop a sustainable business model where patients would pay actual money for student-level woo. After the woo failure, the hospital moved their regular healthy eating and exercise classes into the Wellness Center and remarketed them as integrative medicine.
Whoa there, let's not flush relaxation, meditation, and biofeedback down the drain along with the wooful junk. Numerous studies in the 1970s demonstrated real effects and real benefits for all three. Provided of course that in any clinical context, they are offered within the framework of SBM rather than with a hefty dose of nonsense.
The fact that people don't know how to relax without being taught, or can't observe their internal states without high tech amplifiers (biofeedback), speaks volumes about our culture.
Meditation, stripped down to its empirically-supportable essentials, is nothing more than a structured method for observing and directing one's attention. Frankly that ought to be taught in elementary school; it would probably improve educational outcomes.
@ g724 :
While there may be real benefits to relaxation techniques/ stress reduction we also shouldn't forget that often the woo-persuaded unrealistically attribute causation of many conditions to stress ( e.g. cancer and nearly every other illness) and similarly believe that stress reduction/ relaxation is part of the cure, not purely a coping technique. Thus their advocacy for these techniques is linked to their holistic mind/body/spirit model unsupported by research or common sense. And which benefits- real or spurious- do you think are getting the PR by alt med proselytisers?
Now tell us how quantum physics doesn't make it "evidence-based" ;-}
"Despite the importance of energetic aspects to human physiology, we limit research on functional mechanisms and treatment modalities to particulate matter. This is not consistent with quantum theory and makes the primary theoretical framework of biomedicine more than ninety years out of date...... Are we using the right paradigm? Given the experimentally verified validity of quantum mechanics, I believe itâs time to seriously consider the implications for biomedical research."
"New research indicates, not just that the placebo effect is real, but that "Placebo effect works even if patients know they're getting a sham". "
Is everything interconnected?
Does observing something change it?
Are science and religion converging?
"There's a Seeker born every minute" (Firesign Theater LP)
Thomas Kuhn nailed it....
The Structure of Scientific Revolutions
by Thomas S. Kuhn
Outline and Study Guide
prepared by Professor Frank Pajares
"The Structure of Scientific Revolutions (1962), by Thomas Kuhn, is an analysis of the history of science. Its publication was a landmark event in the history, philosophy, and sociology of scientific knowledge and it triggered an ongoing worldwide assessment and reaction in â and beyond â those scholarly communities. In this work, Kuhn challenged the then prevailing view of progress in "normal science." Scientific progress had been seen primarily as a continuous increase in a set of accepted facts and theories. Kuhn argued for an episodic model in which periods of such conceptual continuity in normal science were interrupted by periods of revolutionary science. During revolutions in science the discovery of anomalies leads to a whole new paradigm that changes the rules of the game and the "map" directing new research, asks new questions of old data, and moves beyond the puzzle-solving of normal science"
"Despite the importance of energetic aspects to human physiology, we limit research on functional mechanisms and treatment modalities to particulate matter. This is not consistent with quantum theory and makes the primary theoretical framework of biomedicine more than ninety years out of date."
Growth Spurt: Complementary and alternative medicine use doubles
This is nothing to be proud of. Hitler and Saddam Hussein used doubles too.
Re. Denice at #15: I *did* say *within* the framework of SBM, not otherwise.
There are plenty of robust findings demonstrating that stress has numerous ill health effects, and that reduction of stress improves health in measurable ways. Of course that doesn't translate to curing cancer, any more than using hyperbole translates to winning a debating point.
As for body/mind/spirit, "souls" aren't measurable so we can reasonably leave them to the domain of religion. But certain aspects of the "body/mind" part are also robustly supported, the placebo effect being one prime example, biofeedback being another. (And the fact that woomeisters spin more nonsense around both of those, doesn't diminish the actual peer-reviewed findings, any more than quantum woo diminishes physics.)
The way it appears to the general public, the rational minority included, is that knee-jerk reactions against relaxation and meditation across the board, cost you credibility. Word to the wise: if you want to fight quackery successfully, don't do it by taking up obviously ideological stances against things that, so long as they are not promoted as treatments for diseases, are harmless at worst.
But speaking of quackery, has anyone here heard about the "Christian Science" "hospitals"? Some of these have pediatric patients who are in for treatable life-threatening illnesses, and who are not even given basic pain medication, but who are told that if they moan or scream they are going to hell. If you want to go after a truly egregious form of quackery that includes the most flagrant and disgusting types of child abuse up to the point of murder (too bad for "freedom of religion" but withholding lifesaving medical treatment from a child is murder), go after those places and get them shut down and their executives sentenced to prison.
Really: the chief enemies of science and reason today aren't the people who teach meditation to hospital patients who are also getting the very best treatments that SBM has to offer. The chief enemies of science and reason are running for elected office on religious platforms, and funding them, and promoting their frankly psychotic garbage (keyword search "seven mountains") as being somehow politically respectable. Now roll up your sleeves and get to work, elections have real consequences.
"Despite intravenous medication, a young boy in status epilepticus had the pediatric ICU team at the University of Wisconsin School of Medicine and Public Health in Madison stumped. The team called for a consult with the Integrative Medicine Program, which works with licensed acupuncturists and has been affiliated with the department of family medicine since 2001"
That makes no sense. The way it's written states that while the boy was in status epilepticus, the health care team had time to scratch their heads and consult with the CAM team. Status epiilipticus is a true medical emergency and there is no way in hell that the team working on the child would have consulted the CAM section of the hospital. It's hard enough to get a line and diazepam on board in status epilepticus and there certainly is no time to stand back and ponder CAM.
@ Black-cat: I suspect that the story of the little boy in status epilepticus receiving acupuncture is made up (bullshit) by this sports medicine jock doc.
In China, half the hospitals are solely dedicated to western biomedicine and the other half to an integrated traditional chinese medicine-western approach. As a chinese medicine practitioner and acupuncturist myself I have practiced in chinese hospitals and seen integrative medicine at it's core provide greater patient outcomes compared to a non-integrative approach. Sure there is a lack of scientific evidence supporting the use of many non-conventional healthcare approaches, but science is not an absolute truth and even gets it wrong. Take for example that only recently scientists have started questing the entire structure of the universe following revelations that even Einstein was wrong.
"On Thursday, the worldâs biggest physics lab unveiled a shocking finding: that one type of subatomic particle was clocked going faster than the speed of light. If true â a big if, even the scientists there concede â it could undercut Einsteinâs theories"
So it just goes to demonstrate that science is not an absolute truth but really only one way to explain phenomena according to the "current" level of knowledge of that time. I think it is science that is behind and needs to catch up to the integrative medicine model. Don't deny people health because of your ignorance.
the story of the little boy in status epilepticus receiving acupuncture
For family reasons into which I shall not go, we have been provided with a whopping great diazepam suppository in case of emergencies.
Have not been provided with an emergency set of acupuncture needles.
@RJD - Before you go crowing about how "even Einstein" was wrong, please note the words you quoted, "if true". This is one result from one experimental team. If true, it would indeed lead to substantial re-thinking of some of the laws of physics. It might, of course, not be true - there might be some experimental or calculation error, or some other confounding factor. But if true, then the job of science will be to examine the new results and integrate it to form a better picture of the way things work.Likewise, if there were good, solid evidence that acupuncture and "chinese medicine" had an actual benefit, then the job of science would be to examine that and determine how it works.So where's your good, solid evidence that acupuncture and "chinese medicine" provide any benefit above placebo response? How do you explain the studies that show no difference between using real needles, placebo needles, or toothpicks? How do you explain the studies that show no difference between using commonly defined acupuncture points and random points on the skin not associated with acupuncture?
@lilady: Yes, it's definately fabricated. Sadly 95% of the populatin would not know this and could buy into the story.
However, I would love to put this theory to good use on the druggies that fake status epilepticus in the hopes of getting a valium buzz. The ones that contol their tonic clonic movements and that are always alert and talking throughout the seizure. Maybe CAM does have a place in emergency medicine.
Re. Mephisto at #24:
Bad operationalization. Better to draw the lines really conservatively: operationalize acupuncture as any intervention involving point-contact with the skin surface. Then you have three groups: a) acupuncture per traditional methods, b) 1st control: toothpicks at random points on the skin, c) any type of intervention that does not involve point-contact with the skin, for example giving the subjects placebo pills.
What you should expect is no difference between the three groups.
If groups A and B each show significant difference to group C, something is going on here that needs to be investigated further.
But using B as a control to A and then claiming that no difference demonstrates that A is worthless: sorry folks, that's sloppy science.
The right way to do it is to use C as the control to both A and B. If anything, that design is biased in favor of acupuncture and "acupuncture-like" treatments, so a failure to get a significant difference between either of A or B vs. C, is a more robust finding against acupuncture.
Otherwise, you're going to find quacks with toothpicks claiming that their "treatment" is as effective as acupuncture. Didn't anticipate that one, eh?
g724 - That would make all the people who spend so much time learning where the vital flows of Qi are supposed to be and how to redirect them using needles feel pretty foolish, wouldn't it?
We could rename it randotapping, just to be more accurate. Now if only someone had good evidcnce taht randotapping really provides a noticeable benefit.
"Otherwise, you're going to find quacks with toothpicks claiming that their "treatment" is as effective as acupuncture. Didn't anticipate that one, eh?"
I anticipated it the first time I read about the toothpick trial. It sounded like an excellent idea to me. "Our treatment is as effective as acupuncture *and* is more sanitary! When you leave our clinic, you needn't worry about bloodstains on your clothes!" The "therapists" needn't bother learning "ancient Chinese acupuncture points" though they might hang a chart for window dressing; any location is as good as any other. And toothpicks are way cheaper than needles, so we could just toss them as they're used. No worries about transmitting disease from one patient to the next.
"Ethical acupuncture" -- that's going to be the tagline of my new clinic.
g724, the trouble with your suggestion is that it is known (i.e., demonstrated by carefully designed tests) that different placeboes vary in effectiveness for reasons that have nothing to do with their actual effects. More expensive sugar pills are more effective than the same pills at a lower price, for instance. With regard to acupuncture, people have cultural expectations of its effectiveness. Their expectations of pills may be different, so the placebo effect may differ just for that reason.Â
The placebo effect of pills would be far greater than that of acupuncture for me, just as an example, since I'd be thinking it's stupid and painful to stick needles in me and furthermore I'd be wondering just how careful you'd been about sterilizing them. Someone else might find acupuncture a better placebo because they consider pills to be the symbol of reductionistic Western medicine.
I started to suggest that placebo needles would be the right control to use in your suggestion, but even they have some contact with the skin, at least enough to push the needle back into the holder, so I suppose the fact that placebo needles have the same effect as real needles and toothpicks wouldn't disprove your hypothesis.Â
The point of trials with real vs. sham acupuncture is that the expectations are the same: both groups think they're getting the same treatment. Since the effect is the same in both groups, what this really shows, as Mephistopheles pointed out, is that the supposed justification for acupuncture *cannot* be correctÂ -- even if acupuncture works for some purposes -- because sticking needles in on the meridians is no more effective than sticking them in off the meridians, and poking the skin with toothpicks or a placebo needle is as effective as sticking in needles (and a lot more sanitary).Â Â
Someone who pushes woo's scientific street cred whilst saying at the same time that science is way behind the curve clearly has a cognitive problem.
Ideological dissonance, shall we say?
Re. LW and Mephistopheles: Excellent critiques! And yes I'd neglected the fact that placebo effects vary according to expectations (expensive pills vs. inexpensive pills) and that culture also plays a roles (we'd respond to pills, someone else would respond to needles).
So now we would have to insert a carefully designed questionnaire into the protocol, to ascertain patients' beliefs about various types of treatments, and assign patients to groups accordingly. That increases the N to the point where the whole thing might be just a wee bit cumbersome, to put it mildly.
Here's a clinical quandary: You have a cancer patient on chemo, and you teach them to do whatever psychological procedure for reducing stress. In the midst of all this, the chemo works, they go into remission, and they attribute that result to their psychological state rather than the chemo. What to do about that? IMHO the way to proceed is to tell them that they did _everything_ they were supposed to do and got better, and in the future, if they have a recurrence, they should do likewise. The point being to at least be sure to reinforce that they should get back to the doc and take another course of chemo if that's indicated. If a spoonful of psychological sugar helps the real medicine go down, that's OK.
That said, I strenuously object when people call chemo "poison" that "poisons you so it can kill the tumor." When I've dealt with friends undergoing cancer treatments, the language I've used is "it takes a _strong person_ to take _strong medicine_, and stand up to the side-effects." The point being to create a set of positive associations and ego-reinforcements that support continuing the treatments despite whatever nausea etc. may occur. Seems to me that it's entirely legit to use psychological techniques to support the patient in following a medically prescribed course of action.
Re. "randotapping," don't give the woomeisters a possible brand name there! BTW, have you heard of "acupressure" that allegedly "works" by some means having to do with pressure on certain locations? As in, poke your fingers here and here, and get better. Hey, at least it's potentially more sanitary than needles, plus or minus where the fingers are poked:-)
@22. Thanks, RJD. Finally a real summary of a foreign system!
In America, some hospitals have chapels. If you hire a pastor to visit and pray with you in the chapel, nobody calls it medicine. In China, some hospitals have acupuncture. Perhaps we are looking at China all wrong. Perhaps acupuncture to the Chinese serves the same function as pastoral care to us. That would mean that there is no "integrative" medicine in China, because the only non-science-based practice is acupuncture, and perhaps they don't consider it medical either. That would leave all the medicine science-based, and then the designation "Western" can be dropped.
I suspect much fewer Americans would seek acupuncture if they thought it was worshipping a Chinese deity.
As to the claim that the mind can heal the body, it doesn't matter. Because if it can, it's something your own brain is doing, and it doesn't need any ritual, any potion, or any assistance from anyone else. In other words, it doesn't need anything than can be bought or sold. Therefore anyone peddling it is a liar by economics alone, and no further analysis is necessary. Even clergypeople aren't necessary, although they're tolerable because they can be kept on reservation.
I have had great success with my acupuncturist and am a fan of CAM in general. It's interesting to read opposing views. I have worked with people with deep roots that go back generations outside of western medicine. There is a quote here from a famous western inventor that is quite profetic and gives some creed and intuition to what was coming. http://www.momemineral.com/ . When someone with a highly scientific mindset saw what was coming with the advent of CAM and preventative measures I think this speak volumes.
Perhaps, Ms. Rosin, your statements would be better if you presented the actual scientific evidence instead of spamming a pseudoscience supplement sales site.
Ms. Rosin, you are just a spamming supplement shill.