It wasn't so long ago (less than a week, actually), that I noticed what I referred to as a paean to the quackery known as naturopathy. It appeared—where else?—on that wretched hive of scum and quackery known at The Huffington Post. It was even entitled My Love Affair with Naturopathy. Not unexpectedly, this very article revealed just what quacks naturopaths are, as it told the story of a woman with vague symptoms, "messed up menstrual cycles," and other complaints who went to a naturopath and was blown away by the "personalized" attention and even more happy that this particular naturopath actually gave her a diagnosis to tie all of her problems together. Never mind that the diagnosis ("adrenal fatigue") is a bogus diagnosis with no support in science. It was a diagnosis, and she loved it.
Well, just yesterday I became aware of another paean to naturopathy on the same wretched hive of scum and quackery, only this time it wasn't from the patient's perspective. Rather, it was from the naturopath's perspective. It's a post by a naturopath named Michael Stancliff entitled You're What Kind of Doctor? My answer to that question, of course, would be something along the lines of saying that naturopaths are:
- Fake doctors
- Not a doctor (which is what "ND" really stands for in my mind)
- Pretending to be a doctor
The list goes on, and I'm sure you'll be happy to add to it.
If there's one thing that naturopaths crave, it's respectability, to be considered to be equals with real doctors. To achieve this, they will do almost anything—anything, that is, except learning real science and giving up the pseudoscience and quackery that make up so much of naturopathic treatment. But first, like all good naturopaths, Stancliff has to distance himself from what he views as quacks. I'm not like those people, he says in essence, I'm a real doctor:
What we do probably wouldn't make for a popular TV show like House or Grey's Anatomy. Preventing heart disease and cancer through diet or helping someone break the pattern of insomnia is not nearly as exciting as rare diagnoses or ethically questionable emergency transplant surgeries. In fact, when some "alternative" health approach is portrayed on one of these shows, you can be fairly certain it's why the patient is so ill. Ironic, considering the now-famous JAMA article reporting "medical treatment" as a leading cause of death in the United States.
Oh, goody. Stancliff not only thinks he's better than quacks, but he seems to think that he's better than doctors. Of course, the article he cites is the infamous article by Barbara Starfield that I deconstructed a couple of years ago. Let's just put it this way. Starfield's conclusions don't really pass the "smell test." Starfield estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes or physician error, making this number three in the leading causes of death for all Americans. To recap briefly my previous criticism, this figure has actually always bothered me. The reason is simple math. Each and every year in the U.S., approximately 2.5 million people die. If Dr. Starfield is to be believed, approximately 10% of all deaths are from iatrogenic causes, which would make iatrogenic death the third leading cause of deaths in the U.S. after heart disease and cancer. There's a bit of a plausibility problem there. I suppose it's possible that doctors kill more patients than strokes, but it seems highly unlikely for a number of reasons.
So why do I doubt the Starfield paper? Patients in hospitals tend to be sick and more prone to complications. For one thing, Starfield counts 80,000 deaths from nosocomial infections in hospitals. Nosocomial infections (hospital-acquired infections) are a big problem, no doubt, but lumping them in with medical error and iatrogenic causes is rather questionable. Many nosocomial infections can’t be prevented easily and are not the fault of the physicians treating the patient. Moreover, nearly all of these numbers were derived from hospital studies. Similar considerations apply to non-error adverse reactions, which are said to claim 100,000 deaths a year. Remember, these were not medicines given in error. To compare this number honestly, you have to look at it in comparison to the number of lives saved every year by these medications. In other words, one has to compare the risks versus the benefits, and the vast majority of these studies don't even try to do this.
But I digress. Mentioning that paper has a tendency to irritate the crap out of me.
Stancliff then introduces what he's trying to get across by claiming that most people, when they hear the word "naturopath," think of "magic wands, potions, and Kramer's holistic healer friend on Seinfeld," clearly trying to set himself up in contrast to such wackiness and obvious quackery before trying to convince you that he's a real, honest-to-goodness doctor, dammit! Stancliff brags about having taken biochemistry, anatomy, and pathology, and claims that he learned how to use the same diagnostic tests, physical examinations, and medical imaging. As I said, he's practically screaming, "We're real doctors! Really, truly we are!"
But he's not, and naturopaths are not. Unfortunately, too many states are licensing naturopaths:
Depending on the state, our naturopathic medical license covers everything from dietary advice to pharmaceuticals and suturing wounds. For instance, in California my license is nearly identical to that of a nurse practitioner or physician's assistant. In Washington and Oregon, the license covers a greater scope of practices and ND care is covered by nearly every insurance provider.
Naturopaths' scope of practice is like that of nurse practitioners or physicians assistants? That's a burn on NPs and Pas, isn't it? There is one glaring difference that I can think of, though. I greatly respect NPs and PAs. I work with them on my clinical days. Naturopaths, on the other hand, are doctor wannabes whom I do not respect, and Stancliff doesn't take long to justify my disrespect, for all his protestations that, honestly, really, and truly he takes the same classes as doctors and should be treated as a real doctor. Naturopathic practice can never be truly science-based. The reason is simple:
Homeopathy means to give a medicine in a very small dose. Scientifically, we don't know why it works, because the doses are so small. Naturopathic medicine is not how medicine is given specifically, but based on our six principles. Naturopathic medicine refers to an approach to treating people, and tends to favor natural and low-force interventions. Our treatments with patients might include dietary changes, supplementary nutrients, exercise, herbal medicine, pharmaceuticals or homeopathy. So homeopathy can be part of an ND's treatment plan, but it's not the only tool in the shed. That said, other medical providers may use homeopathy as well, and it doesn't make them naturopathic doctors.
No, homeopathy means giving medicine in a nonexistent dose, the original component having been diluted to the point that nothing is left. In any case, given that homeopathy is nothing more than magical thinking, no naturopath can be considered scientific or to be practicing medicine that is science- or evidence-based. Of course, naturopathy does mix the plausible with the utterly implausible, such as dietary changes and exercise, but it mixes it with pure nonsense like homeopathy, most of traditional Chinese medicine, and the irrational, non-evidence-based use of various supplements. Unfortunately, even when using ostensibly "evidence-based" modalities, naturopaths somehow manage to "woo-ify" them.
Stancliff is also very protective of the term "doctor," way more so than most real doctors are. For example, he really, really doesn't like it when he's called a "naturopath," dismissing people with "questionable training" who "call themselves 'naturopaths,'" even bragging how he's reported people advertising themselves as having the ND degree but do not to state medical authorities. Of course, in reality, mental masturbation over the difference between a "naturopath" and a "naturopathic doctor" serves no one but naturopathic doctors protecting their turf as ruthlessly as they accuse MDs of protecting their turf. It doesn't matter that licensing pseudoscience and quackery does nothing other than to legitimize pseudoscience and quackery. It dos not make the pseudoscience and quackery any less pseudoscientific or quacky.
Nor does petitioning the government to allow naturopaths to be treated as primary care physicians, as this recent petition to the Obama Administration to be considered for purposes of "Obamacare" to be primary care docs:
Licensed naturopathic physicians should play an integral part in patient access to alternative medicine within the Federal Healthcare Law (Obamacare) as they serve as primary care physicians within the complementary health care field.
With Americans spending over $34 billion dollars spent annually on alternative medicine, the inclusion of licensed Naturopathic physicians would offer patients the option of seeking alternative medicine care covered by insurance AND provide access for those currently unable to afford care.
Licensed Naturopathic physicians are able to diagnose and treat both acute and chronic disease and are experts in nutrition, herbs, and other holistic therapies.
I'm not sure why naturopaths are petitioning the federal government, given that the vast majority of regulation of the medical profession occurs at the state level, but this is just the latest in a long line of gambits by naturopaths to try to claim legitimacy for thmselves that their discipline hasn't earned through science and clinical practice. Whether it is a single naturopath like Stancliff or organized naturopathy acting in the interests of single naturopaths like Stancliff, naturopaths crave respectability and want to be treated as equal. Too bad they don't seem to understand that being treated like a doctor means behaving like a doctor and treating patients like a doctor.
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Off topic, I know, but it had me wondering where Ron "Risk Analyist" Law had got to.
Sometime, I always get to wonder why someone would choose to be a naturopath vs a physician assistant....hell, I already the prerequisite needed to be a PA and if I had the chance, would love to take the training to be one.
Alain
I think the nautronuts saw that Obamacare covers preventive medicine and they got excited .They stopped reading and didn't notice that preventive care means flu shots.
Alain, it's because they get to say 'Doctor' rather than 'physician assistant', and the degree is (allegedly) doctoral rather than being a master's (PAs are trained to master's level).
Some people value at the sufrace things (name of degree) more than the content.
@ David Andrew,
Yeah, but then, the last naturopath I've seen (& chatted with) was a woman in her 600$/month appartment (downstair of a friend Aspie); doesn't bode well for a doctor.
Alain (who should really get to sleep).
Went over to HP and put in a few whacks in the comments. This column has already been mentioned there.
Here's a question: The HP "Healthy Living" section looks to be designed to appeal almost exclusively to women, and my impression is that, in general, women seem to be more interested in health news than men ("Men's Health" notwithstanding. My own 6-pack abs mostly reflect the consumption of 6-packs, by the way).
Do other people share that impression? If so, what is is about men and women and their roles in contemporary society that makes women fret so much about "healthy living"? Discuss.
@Palindrom
I think it's designed to appeal to women more because (traditionally) we're the ones that 'make the home'.
You know, we buy the food, make the dinner, etc. We're the ones that choose the soaps, detergents, etc that are used in the home.
It could also be a reflection of the 'beauty' pressure. Men can get away with adding a love handle moreso than women. If a woman (after 20 years of marriage) still can't squeeze into those size 3 jeans she wore in high school (or before kids), then she's "let herself go" or somesuch. If a guy's six pack is more budweiser than beef, it's just because he deserves to relax on his days off.
There could also be a bit of 'competition' going on amongst women. The "we do X, Y and Z better than the neighbors" - and from what I've seen in the rabid AP, BF, AV camps - there's a definite sense of superiority for their 'healthy' living choices over what others do.
Women, we be crazy.
The contrast between the Huffington Post climate science pages & their health/medicine pages really hammers home how much people let their worldview inform their acceptance of evidence, rather than letting evidence inform their worldview.
Otherwise, we would be at a loss to explain how HuffPo can get the science on climate more-or-less correct yet be so off-base on medical science as to have boosters of naturopathy writing for it.
"Women, we be crazy."
At least some women! I'm sure there are binders full of 'em who aren't.
Composer99 -- That's an astute observation about HP. Unfortunately, there are VERY few journalists working today who have the background needed to evaluate scientific claims on their merits. We chide global warming denialists for using political tribalism in place of scientific judgment, but that's pretty much standard operating procedure in the media.
It very easy for the anti global warming propaganda machine to hoodwink journalists, and with them a large fraction of the population. All they have to do is trot out their captive experts -- who are, pretty much without exception, ideologues, has-beens, sellouts, incompetents, or compulsive contrarians -- and journalists seeking "balance" will think there's still a controversy. Hence the excellent new word, "manufactoversy".
To follow up on Darwy:
To make matters worse, folkloric beliefs about sex roles and 'natural' abilities might not encourage women- especially those born in the last century- to persue education in science and mathematics: which might feed unrealistic leanings and allow them to develop into slants away from data.
What I find fascinating amongst the web woo-meisters is a quasi- feminised message about how SBM 'talks down' to them and how medical procedures ( Caesarean sections; HRT; cancer therapies) and attitudes interfere with their individuality and freedom. Or suchlike. Yep, these guys are feminists. SB physicians are misogynists. ( Does that include the growing number of FEMALE doctors I wonder?)
Oddly enough, the charlatans then go on to lecture women about appropriate health and lifestyle choices displaying their own authority in no certain terms. Remember that doctors might instruct patients BUT they actually KNOW something, usually having worked hard in formal studies and training. Woo-meisters however have acquired their "knowledge" on their own: it is selected and synthesised according to their own self-aggrandising tendencies. There are more subtle strokes of self-regard aimed at women that I won't go into: let's just say that like AJW, they're working the matinee idol angle even when their own appearance doesn't warrant it .
Often the goal of woo-treatment includes appearance: do what I say and you'll look younger, thinner and more attractive. PRN's head honcho often cites a long list that focuses upon the signs of aging in women. Further more, he discusses how these changes might compromise your lifestyle. There's something perverse about a 65+ year old unattractive man telling (much) younger women about how they are 'losing their looks' and becoming 'disposable' in order to sell them a load of supplements and books at high profit. There is a cumulative effect of hearing the same garbage over time: you're being labelled as fat, old and past your prime. The overweight / exercise issue is heavily ingrained in woo lore ( see Mercola; Adams also)
Another annoying trend I've observed is amongst the vaccine-autism crowd wherein the women/ mothers play up the 'just us girls' attitude making them appear adolescent and inconsequential even when they discuss serious issues about their children. Perhaps they think that this will help sell their books ( Kim Stagliano has two) and the Thinking Moms have just launched their first.
It's very hard for me to decide which set - meister wankers or shrinking moms- I dislike more. Both of them apparently don't think much of their audiences since they pander to the lowest possible common denominators and stereotypes.
OT- but are woo-meisters venturing into new areas of in-expertise ever REALLY OT @ RI?
Today Mike Adams discusses why his state should secede from the US. His budding political awareness has blossomed into a flowering of stupid unsurpassed by his previous efforts.
Well I was busy posting on the Ho-Po about Jenny McCarthy and her new job as a columnist/blogger at a Chicago media outlet...that thread just ended.
I also took a whack at Dr. Margaret Cuomo (again) for recommending "taking Vitamin D" for cancer prevention. (I managed to pass "moderation" with snide remarks about Joe Mercola and Mike Adams, as well.
http://www.huffingtonpost.com/margaret-i-cuomo-md/cancer-prevention_b_2…
How did you miss this article Orac, written by the same N.D.? I just posted there about antibiotics and his care of patients undergoing treatments for psychological/psychiatric problems and his care of cancer patients, as well.
http://www.huffingtonpost.com/michael-stanclift-nd/naturopathic-doctors…
That's from Lazarou 1998, 'Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies' PMID: 9555760. Lazarou extrapolated from 78 ADR deaths in papers mostly from the 60s and 70s to the 33,125,492 total US hospital admissions in 1994 to come up with the estimate of 106,000 deaths due to adverse drug events. Not a very reliable estimate, IMHO.
@ Krebiozen:
Although that cite is abysmal, it could have been worse: i.e. the infamous 600K from "Death by Medicine" which is sub-abysmal. Is that a word?
@ lilady:
I think that Stanclift ( in the post you link) very sneakily and stealthily suggests that by making yourself 'generally' more healthy, via his minstrationsI suppose, perhaps you'll not ever need real doctors. That's one of the hidden messages in woo. Maybe one of their major selling points.
Why don't we ever see a paean to Urology?
Denice,
That 106,000 is part of Gary Null's 600k, which also includes a proportion of all patients with bedsores who die from any cause, and duplicates several hundreds of thousands of deaths from various causes. It was when I realized this I gave up on my deconstruction of it.
If not, it should be. It sounds like it should refer to Dante, which prompted me to look up his circles of Hell, only to find someone has helpfully made Lego models of them. I think the 8th Circle of Hell, Fraud, is probably most appropriately sub-abysmal.
Denice:
Re: 600K iatrogenic deaths from 'Death by Medicine'
It's abysmally abysmal!
Re: alt-med proponent's so-called 'feminism'
That kind of behaviour is aggravating. Essentially, the quackmeisters (Adams, Mercola, et al) are engaging in precisely the paternalist talking-down to women that they accuse real doctors of engaging in - they are projecting. And the likes of the Thinking Moms, reinforcing the false stereotype that Science Is For the Menz... suffice to say that with 'friends' like those, science-loving women (feminists or no) have their work cut out for them.
palindrom:
+1 for the binders reference.
Krebiozen:
It's probably too much to expect those to become official Lego sets. *sigh*
:headdesk:
"With Americans spending over $34 billion dollars spent annually on alternative medicine, the inclusion of licensed Naturopathic physicians would offer patients the option of seeking alternative medicine care covered by insurance AND provide access for those currently unable to afford care.
Licensed Naturopathic physicians are able to diagnose and treat both acute and chronic disease and are experts in nutrition, herbs, and other holistic therapies. "
GIVE US THE MONEY!
The part about being able to diagnose and treat is what prompted the :headdesk:
OT - I had a very nice conversation with my local Jehovah's Witness representative this week. We talked about cancer: my sister, the younger's JH aunt, the elder JH sister(RIP) and herself, a twenty year survivor of breast cancer.
The Divine was never brought up during the conversation. Neither was alt med. Most people are quite pragmatic about these things.
As a side note, Lego is the combination of two Danish words:
Lege (to play)
god (good or well)
/nerd off
When it comes to woo, I've seen my share of something I've heard called "difference feminism" which seems largely about how women are naturally intuitive, sensitive, and nurturing because that's what the gender stereotypes say they are. It sounds pretty damn Orwellian to me.
Naturally, a lot of female woos use this idea to wave around their femaleness as evidence that their intuitions are correct, that they know what's best for children, and so forth instead of doing the science and math.
@Dangerous Bacon
They tried, once, but the comments just got too pissy.
Sorry, as abyss is defined as a bottomless pit, sub-abysmal is physically impossible. Nice try so.
@ Bronze Dog:
Those esoteric and arcane qualities are certainly trumpetted as well as the Mother Warrior, Mother Bear, Great Mother of the G-ds or whatever the h3ll other archtypal fantasies they toss about like confetti. They augment their Mutterechtische entitlement with "research" ( i.e. googling woo) that obviously is superior to that which SBM promotes- for their own is infused with MamaWisdom and LovePower! Can't go wrong.
Some of us RI ladies- especially those who are childless by choice and those who are interested chiefly in DATA rather than emotional grandstanding - are probably a category which they might have trouble comprehending or even recognising as existing. They hold these beliefs to make themselves feel better about themselves. And that works well if you limit your communication with most of the cognisant world.
@ Mu:
Sub-abysmal fits woo because it is also physically impossible.
@ Bronze Dog
Yes, the woo version of feminism drives me berserk for exactly that reason. It blows my mind that they think they're so cutting edge and progressive, yet subscribe to a completely reactionary ideology that portrays women as puppets controlled entirely by their biological functions. Grrrr.
I just got finished posting at the Ho-Po...still "in moderation".
There are 128 comments there and many of them are disparaging of naturopathy medicine. Michael Stancliff has posted back at some of those disparaging posters...not too successfully, I might add.
@Dangerous Bacon:
Just be careful how you pronounce "paean."
I don't think we know for sure that there are more women than men that are smitten with woo. In the two wootowns I lived in (both heavily infested) the men were there right beside their "wise women". We need data my skeptical friends! All of the ND's I've run into are male, but most of the aromatherapists were women. Acupuncture seems evenly split as are its adherents. I see just as many men as women perusing the supplements at Costco, although women are more often earnestly reading the ones that promise weight loss via magic rather than by eating less.
Happily, I knew a woo couple who got divorced when the husband decided to go to medical school--to be a real doctor, not a dr, Weill
@ Femimommy: Some people have all the fun...
I don't ever recall actually meeting a N.D. or an acupuncturist, although there are some medical doctors that I had contact with, when I worked in public health, who were LLMDs (Lyme Literate Medical Doctors). I've followed their career trajectories and many of them are DAN! doctors now.
I guess my telephone conversations with delicensed MD, Rebecca Carley...now a N.D. sorta makes up for my non-contact with other woo practitioners.
And...I will now be cruising the aisles at Costco...to check out who is buying the vitamins, supplements and other nostrums.
@lilady
"Some people have all the fun"
Lol. I have come to think of it as more of a curse. It plagues me wherever I go--including websites of newspapers and magazines. Just now the NY Times Neediest Cases column reports the case of a man mugged so badly that he lost his sight for some years. Lo and behold, though, his mother sent him to an herbalist in Colombia and after "a tingling at the back of his brain" began, his sight began to improve. While still legally blind, he does have some vision. No other explanation or info is offered.
I have a huge file of photos I take at box stores and drug stores and grocery stores that sell every kind of woo. I began doing this in lieu of complaining, only to be told that a) well, that's your opinion; b) people request this product; c) people can decide that themselves.
Sometimes I come upon a pharmacist who commiserates with me and reports being embarrassed to have homeopathic crap in the store and even more so when s/he is forced to display it right at the checkout. It really is a travesty to force educated people to work under such circumstances.
Costco is one of the worst. They send monthly coupon flyers that have large, slick, and colorful ads promoting all kinds of supplements. I click the iPhone, and complain about no evidence, cite the latest evidence to the contrary and receive silly replies. Sometimes while I take the pics, people inquire, and maybe I'm honing my skills, because sometimes they put them back on the shelf. Too bad we can't post pics--I have some hilarious ones.
So basically their petition is an appeal to popularity...
@Chris P
Looks like the Meryl Dorey's of NZ got the same treatment as she did!
I've been commenting on these threads now for some time. It is I think, pissing against the wind. Perhaps we should just regarded as evolution in action. You can engage with these people until you go mad, but it's almost impossible to budge them. And I'm afraid eventually my comments become more and more impatient until I lose them completely.
I tend to recommend these in pure self defence. Worth a laugh if nothing else.
http://www.youtube.com/watch?v=YMvMb90hem8
http://www.youtube.com/watch?v=HMGIbOGu8q0
There is no wrong or bad in wanting to be healthy and helping folks in a healthy way.
There is something very wrong with this kind of arrogance ... 'paean' ?? ...and coming from one who doe sn't look healthy, no wonder the nastiness! Go be in nature for a bit and rid yourself of the crap attitude. It just makes you appear envious and feeling threatened.
Suzy - I'm confused. What do you think the word paean means and why do you think the use of such a word is arrogant and nasty?
Yeah!! There's absolutely nothing wrong with pretending to knowledge one doesn't actually have, and encouraging people to make literal life-and-death decisions based on one's own wannabe fantasies of --
Oh wait. There's everything wrong with that.
Why do I have the feeling you don't understand what that word means?
I see from the "Integrative Health Institute" blog that cranberries are now alkaline, as well as lemons.
Narad,
All the crackpot proponents of "alkalinizing for health" claim the same thing: it's not the actual acidity of the fruit, but rather some mumbo-jumbo about the "ash" that remains in the body after the food is consumed.
I read some idiotic attempt to explain this phenomon on one of the quack websites advocating an alkaline diet. It really is too stupid to even begin to debate with those people.
Here's one example out there claiming how lemons turn the body "alkaline":
http://phbalance.wikispaces.com/Lemons+Alkaline%3F
@ Femimommy: I have Costco membership. I kinda like the idea that they are making all the money on vitamins and supplements...it keeps the costs down on the other products they sell.
(anecdotal) About twenty-five years ago, a close friend who is a pharmacist was refurbishing his store. My daughter and I and his other friends assisted him after hours, to rearrange his display shelves. I wanted to move the display of vitamins and supplements to the back of the store. He quickly informed me that it was the biggest money-maker because of the health spa located in the same strip mall. The devotees purchased their vitamins and supplements in bulk, after their evening workouts.
@ suzy: What does *nature* have to offer a woman with an abnormal mammography? Does *nature* give a good G-d damn if you die from metastatic breast cancer?
@ Marc Stephens Is Insane:
Zowie...look at that blogger's biographical information!!!
http://phbalance.wikispaces.com/x.+About+Aminahcc
Krebiozen has addressed this more than once here. With lemon juice, what is seen is a lowering of urine pH with a net depletion of bicarbonate. I have no idea what this particular smoothie recipe is about other than slapping the "alkalinizing" label on it for no specified reason and despite the fact that your body isn't going to cooperate in the effort anyway.
Wow--I really hit the jackpot on that one. I just picked it at random after a Google search for "lemons alkaline." Every single website spouts the exact same nonsense.
I first learned of this "concept" when rustichealthy claimed apple cider vinegar had an alkalizing effect on the body (this was on Orac's "friend's" other blog). I presume everybody here is familiar with rustichealthy--if not, catch up on some of her creative writing for the laughs. It's a wonder she has yet to discover this blog to further spread her misinformation and lies. In a way she's exactly like Marge from the reiki threads, or Sharon Hanson (?) the gadolinium lady from the Huff Po.
And why do they all insist on using Random capital letters When they Post on these Blogs? Is that a side effect from taking supplements?
MSII,
There's a very popular and very weird pre-scientific idea on planet CAM that your urine (and saliva*) reflects the state of your body, so if your urine is alkaline, so is your body and all is well. The truth is that your body will excrete excess alkalis or acids, partly in your urine, and your blood pH will remain resolutely at 7.4 unless you run a marathon, hyperventilate, ingest vast amounts of acid or alkalis, or something goes dramatically wrong.
Lemons contain citric acid which is neutralized by bicarbonates in your blood and excreted as mostly sodium and potassium citrates which are weakly basic so your urine becomes mildly alkaline.
I did have a discussion once with a naturopath who claimed that urine is identical to blood. I agreed, except to point out that normal urine doesn't contain red or white blood cells, protein or glucose and has very different concentrations of everything including hydrogen ions. Apart from that it is very similar ;-)
CAM people don't seem to be aware that our kidneys don't only filter our blood, they actively excrete and reabsorb specific constituents. In fact CAM people seem to be completely unaware of most homeostatic mechanisms.
*Saliva pH may actually have some correlation with health, because the main determinant of salivary pH is the amount of bacteria present, which produce acids.
Rustic Healthy a.k.a. "Rusty" has infested the SBM blog.
http://www.sciencebasedmedicine.org/index.php/scaremongering-to-sell-wa…
IIRC, she first showed up there, before the Presidential election, spreading her moronic libertarian science-illiterate views about "Obamacare".
The *adults* on that blog had to educate her about history (Nazi-Communist-Socialist plots), tax codes and a boatload of other crap that she posted. She *claimed* that she was going to take her sorry a$$ and her children to another country, if Barack Obama won another term. (Even her own State (Virginia), went "blue" for the President).
Well she hasn't relocated to another country...and she's still posting on the SBM blog...for our enjoyment.
Kreb,
Thanks for that information. Regardless of whether lemons or vinegar are acidic or alkaline, the second and more important part of the take-home message to CAM believers is that food or a normal diet does not affect the blood pH, as you state (within reason, of course, in healthy humans). No matter how many times they're told that the body regulates its own pH, they insist on making a correlation between diet and body pH. There's even a book called "Alkalize Or Die":
http://www.amazon.com/Alkalize-Die-Superior-Through-Alkaline-Acid/dp/09…
The "doctor" who wrote this book is an ND, a PhD and a chiropractor. Here's an early dose of respectful insolence from our host on the subject, from way back in 2006:
http://scienceblogs.com/insolence/2006/09/15/your-friday-dose-of-woo-ac…
I will also mention that our favorite naturopath Robert O. Young sells alkalizing kits that contains "pHour Salts" (bicarbonates of one sort or another) and pH strips, plus some other bits and pieces, all for only $200.
It's a simple scam - the mark sticks a pH stick in their urine and probably finds, to their horror, it is slightly acidic since normal urine pH ranges between 4.6 and 8.0. The mark then ingests the magic alkalizing powders, their kidneys excrete the excess bicarbonate and when they next check their urine pH it is more alkaline. It's a miracle!
suzy,
I assume you are going by the photo of Orac at the left of the title at the top of the page. He doesn't look so great there, but I believe he was in a recharging maintenance cycle at the time.
Kreb,
Not to mention the Kangen water and other water-alkalizing machines out there. I think Mikey Adams hosts a few ads for those things. "Look! They're approved in Japan!" Yeah Mikey, they're approved as electrical devices, like UL or CSA approves all consumer electrical products.
For a long time there was a banner ad here at RI for alkaline water equipment. But then again, there was also a banner ad for MMS during that discussion a few months ago.
MSII,
My pleasure - I get particularly pissed off by pH woo as I used to do blood gases, back in the days when a hospital lab had the only blood gas analyzer in the hospital - these days they mostly don't have one at all, each critical care department has one instead.
Usually a junior doctor would be sent down with the sample on ice and they would wait until the result was ready, so I got a chance to chat about the patient, what the diagnosis was and what treatment they were using. I also had the chance to keep an eye on the patient and see how they did over the following hours and days. I measured blood pH on people varying from the clinically dead who didn't survive, sick people with diabetic ketoacidosis, salicylate overdoses, renal failure patients, respiratory failure and others, marathon runners with impressive but temporary acidoses, and also healthy colleagues, so I got a pretty good idea of how this works over the years.
As you have observed there is a truly staggering amount of completely inaccurate information about acid base homeostasis out there. Since it seems a lot of people judge the accuracy of stuff they see on the internet by how common it is, this is a very bad thing. I try to do my little bit to combat that ocean of nonsense.
Lilady,
Rusty has polluted several threads on SBM, including her recent suggestion that molasses might help with tinnitus. She pipes in on any conversation involving health, food or health politics and freedom. Like Marge the reiki saleswoman, she is proud of the fact that she refuses to learn and insists anything that is "her experience" is valid and true, regardless of what science has proven. And worst of all, she spreads this misinformation via her website and her frequent postings.
I first encountered Rusty during a thread a few months ago on SBM involving a cancer patient who opted for Robert O. Young's baking soda scam. Rusty chimed in with "how dare you tell her what to do, it's her health and her choice to go natural..." yada yada. She then posted YouTube videos about the flax and cottage cheese cancer cure guy and keeps posting meaningless statistics about conventional medicine and how vitamins, supplements and organic food can prevent or cure everything.
I don't believe it! I settle down to watch a bit of harmless escapist entertainment ('Person of Interest') and a character asks, "Did you know, according to the AMA 98,000 people a year die from medical error?" There's no getting away from this stuff!
I did have a discussion once with a naturopath who claimed that urine is identical to blood.
The naturopath is welcome to opt for a piss transfusion in the event of surgery, and leave the limited resource of blood transfusions for people who prefer the red stuff.
On the other hand, I watched a recent episode of "American Dad" that skewered "alternative healers." And both "Family Guy" and Seth McFarlane's other shows have been vicious toward scientology and Christian Science. And of course "South Park" has taken on psychics (The Biggest Douche in the Universe!), scientology, Mormonism and faith healing.
OR...you could always watch Penn & Teller's "Bullshit" that has no tolerance for woo or pseudo-science. I wish they were on mainstream TV so they could reach a wider audience. They preach much the same message we do here.
“Did you know, according to the AMA 98,000 people a year die from medical error?” There’s no getting away from this stuff!
Of course we all know the real number is 106,000. That's what alties keep spouting--no idea where that figure came from but it's out there on the internetz so it must be true.
Krebiozen,
On the other hand last night’s (re-run) episode of Doc Martin featured the doctor remonstrating his partner, saying of her joining a parent's group something to the effect* that the internet was full parents advocating nonsense that they didn't understand.
---
* I forget the exact wording now.
@ Marc Stephens Is Insane: I lost contact with that thread, because I was in Europe (Rome, Umbria and Germany), after I posted at Danielle and her husband Brad, who opted for Robert O. Young's *therapy*:
http://www.sciencebasedmedicine.org/index.php/another-cancer-tragedy-in…
When is *Rustic Health* a.k.a. *Rusty* going to relocate to a foreign country, now that our President has been reelected?
(America's gain is a foreign country's loss)
Johanna Budvig wasn't a dude. And I can tell you with certainty that you're no more going to successfully pulverize flaxseed with a coffee grinder than you will poppy seeds for kolacky.
^ "Budwig"
Narad,
The video was of some guy who used the Budwig protocol supposedly to cure himself. He showed how he mixes the flax with the cottage cheese, etc. He's well-known in alternative circles and is often cited as a success story in the natural cure world.
I got confused in my old age: it was a Robert O. Young follower, not a Budwig follower in the video. His name is Vernon Johnston and he claims he used the baking soda/molasses concoction to "alkalize" his body and cure his prostate cancer. He also has a pH website where he spews the baking soda lies. Young and his fans use this guy as a shining light. I wonder how he's doing today.
http://www.youtube.com/watch?v=Yl8Y8I_TsjI
@ Marc Stephens Is Insane: Vernon Johnston is still alive. He took baking soda and molasses for eight days before his 3rd bone scan which showed no metastases to his pelvis. His PSA also dropped dramatically (below "1'). Alkalinity cures cancer !!!
This twit is blogging about alkaline cancer cures....you can also sign a petition online to secede from the Union.
http://unitedtruthseekers.com/profiles/blogs/combating-cancer-with-an-e…
Here's a comment about Johnston from an astute reader of another skeptic blog:
If you look more closely at this case you will find that, contrary to what is claimed in the Natural News article, this man was given conventional drugs for his prostate cancer. His website is here http://www.phkillscancer.com and he quotes from his oncologist’s report in March 2008:
“Pre-treatment PSA was 22 but has decreased to 5.88 after institution of Finasteride and Casodex.”
Finasteride and Casodex are androgen blocking drugs used to shrink prostate tumors. His PSA had dropped from 22 to 5.88 before he started taking sodium bicarbonate in June 2008. It looks to me like he is one of the lucky men whose prostate cancer and bone metastases respond well to androgen blockers.
Here's the website's very rational rebuttal of Mikey Adams article about Johnston's baking soda cure:
http://depletedcranium.com/natural-news-takes-idiotic-to-the-next-level/
Johnston has his own article on whale.to. Need I say more?
Here's the first paragraph:
Well I am just delighted to share with you that I just got off the phone with Vernon Johnston, the gentleman that reached out to me when I was finishing my Sodium Bicarbonate book. He was the fellow who had been diagnosed with prostate cancer with metastasis to the bones. This was over 15 months ago and I wrote up his story and shared his treatment diary in my Rich Man’s Poor Man’s Cancer Treatment bicarbonate book. He was going to do a cesium chloride treatment but because his order got lost in the mail ended up doing sodium bicarbonate (baking soda) orally, managed to get his urinary pH up to 8.5 for five days and then within two weeks was back at his oncologists office for a test, which showed his bones being cleared of his cancer.
So he only tried the baking soda (BS? Very appropriate abbreviation) because what he really wanted got lost in the mail. What effin' luck.
Pardon the link to whale.to, but here's the source:
http://www.whale.to/cancer/cure3.html
MSII:
So does Orac. Though for him, it is a mark of honor that he annoyed John Scudamore to deserve the bits and time. Just like the latest screed from Clifford Miller and John Stone in their ironically named "childhealthsafety" blog.
@ Chris:
How about this from your link?
"Relative to the overall population of internet users, Science Blogs’ audience tends to be Caucasian; it also appeals more to childless men aged under 25 and 55–65 browsing from school and home. Got the picture?"
I haven't seen John Stone(d) posting here or at any of the science blogs that I post on, lately. When he did his hit-and- run posts, he just "disappeared", when confronted. He is a prolific blogger on AoA, where the "Caucasian women browse from home and office". Got the picture?
@ ChrisP,
re, "it had me wondering where…"
Haven't heard much from him for while, bar one attempt to sockpuppet on my blog. Didn't surface on the Darcy’s post about IAS losing it’s charity status.
@ flip:
"Looks like the Meryl Dorey’s of NZ got the same treatment as she did!"
I'm under the impression that AVN was hit harder (but then I haven't followed that story particularly well). The ruling on IAS is a bit gutless in many respects; I suspect as a practical matter it won't really change that much other than them not getting a tax credit. They're still claiming they're a charity, even.
Not part of the Miller/Stone demographic who posts on Science Blogs
Neighter do I. That's one of the major thing I stumbled in the blog post but I have to wonder if it's (the post) worth responding to.
Alain
@ Alain:
It's just my opinion...I would not post at that Child Health Safety blog. The two cranks are looking for *engagement* and for traffic to be driven over to their blog.
@ Alain, lilady -
Toyed with writing myself, but decided it's too obviously a troll set-up. (Have posted on Erwin's Alber's new my child's vaccine reaction FB page instead! Couldn't not after seeing that one of them is clearly lactose intolerance.)
Should add - best not to "bomb" that FB page, Erwin will just lock it down. It'd be good to encourage him to let the explanation comments stand.
@Grant
Not really. Last I heard, Dorey succeeded in having getting it reinstated, due to a legal technicality. (Prosecuted under an incorrect clause or some such)
@ lilady,
Your opinion is valid, this blog don't need attention.
Alain
MSII,
That was me using a different 'nym - I emailed Johnston asking if he was still on those drugs, but he never replied.
By the way, I have to ask this: How was it discovered that the ChildHealthSafety blog is the work of Miller and Stone?
Alain:
I also do not *trust* Miller and Stone with anyone's identity. Don't forget they are part of that totally incestuous group at AoA, Generation Rescue and a slew of other sites.
They have a history of going after people, who are not in lockstep with their philosophy, at their places of employment. That crowd is a nasty bunch of people.
I just browsed that poor excuse for a safety blog, and no surprise the usual suspects are responding there. I also noticed this gem:
Art Langford, on November 17, 2012 at 12:11 pm said:
Great stuff! I worked with Gorski for about a year. The best thing I can [say?] about him is that he is a scientifically xxxxxxxxxx xxxxxole.
@ Chris:
And i am aware that a few other defenders of SBM also have their own pages as well- even though they might be under another 'nym.
Take a bow.
@ lilady:
Actually, John Stone was lovely to me- I have absolutely no idea why- I think that he didn't realise I was telling him that he didn't make sense because I said it in a very polite way. Maybe he thought I was someone else.
About AoA ( and TMR and other anti-vacciniana on the web):
while I don't have stats, I imagine that their audience is predominantly white, middle-class women age 30-50+ from their ( low) cultural references and how they use language. The Mommy Warrior meme shows up frequently ( see TMR today) and there is an infuriatingly cloying 'just us girls' attiftude that is positively sickening, to me at least. They are forever griping - and simultaneously- bragging about the harsh hand that SBM has dealt them ( see AoA's Jameson today). I suspect that having a child with an ASD is not the only issue in these family units.
But then, what do I know? I don't have children! I suppose this is the new post-modern, post-feminist feminism wherein focusing on and trumpetting traditional roles to the exclusion of all others is *de rigeur* and often illustrates that yes, sometimes vicious stereotypes about groups of people can, unfortunately, be true. I think that they sound like 12 year old girls- I should re-phrase that- like SUPERFICIAL, under-educated, clique-forming 12 year olds. I wouldn't want to insult 12 year old girls- perish the thought!
Random thought:
they have 'silent Sunday" @ TMR: good idea!
I am reminded of the ( fictional?) inn called "The Quiet Woman" bearing an illustrative sign featuring a headless woman. Sometimes wishing that stupid people would be silent is not an indication of prejudice against women.
Antaeus Feldspar:
It has been known for quite a while. One of them must have mentioned it either online or in real life. Though at one point Miller does admit he is behind on a LeftBrainRightBrain comment.
Becky has them dead to rights about their lies here, where she also mentions "Gus." It looks like much of that is derived from the JABS forum, which used to be very active but the last I looked was full of spam.
Denice,
You reminded me of this possibly offensive but very funny offering from the late Jake Thackray.
@ Kreb
Well, he was absolutely right about some women: it would be prejudicial to say that there are NO women like that; similarly, you have to admit that there are also MEN like that- although the topics they ramble on about vary. Obviously it takes social skills: person perception, recursive thought, reading emotion to discern when others are dis-interested.
I know a certain business man- actually two - who can carry on for hours about the intricacies of an office, boss or product./ service: it gets worse when 2 or more from the same space- and alcohol- are present.
Then of course, we have the so-called "little professor" syndrome characteristic of Asperger's/ other conditions wherein ( mostly males) will drone on and on about their own private little niche topic, irresponsive to the disinterest signalled by the the un-entranced audience. We have also sport/ game trivia/arcanae as well as choice of professions ( Baron-Cohen) again, more males..
Believe me there are dissertation topics lurking in this.
I could go on but I won't.
Of course, it's not an exclusively female problem by any means. I generally find a male bore considerably more tedious than a female one - sports and cars don't interest me, which doesn't help. It can often be a symptom of social anxiety; the dread of an awkward silence.
:-)
Wow, I have a comment in moderation and I can't see why?
Then again, it's a quote from another blog with (what I'm assuming is) profanity edited out with x's.
I guess it's the last part which is x's followed by ole that's doing it?
I was online earlier today at the "Shot of Prevention" blog...we hooked a "live one" there:
Take a look at Heather's links, heh, heh.
http://shotofprevention.com/2012/01/17/responsible-nurses-and-then-ther…
@ lilady:
Don't feel bad: various vaccine-autism websites number psychologists ( and psychiatrists and social workers- see Stott, Taylor, TMR) amongst their elite. Orac has mentioned that woo doth flow even amongst the rareified upper echelons of surgeons. People can go off the deep end ( wouldn't 'shallow end' really be more apropro?): it's human nature that some will follow the beat of a new and different drummer even if everyone else hears quite a lot of missed beats there.
@Denice Walter: It took "Canadian Nurse" and "Autismum" to take down the Patriot Nurse. See Patriot Nurse Part II
http://shotofprevention.com/2012/01/25/vaccination-ethics-come-to-quest…
Now "Heather" shows up to revive this moribund thread with her utter nonsense and claiming her child has been diagnosed with "heavy metal toxicity" and is part of a *study* conducted by the CDC. She also *claims* that she is in "a PA school". Sheer unadulterated bullsh!t from a crank anti-vaccine bullsh!t artist.
Where do alt-med idiots insist that "allopathic" doctors ignore diet and exercise in managing health care? When my mother was being treated for endometrial cancer 2 years ago, part of her treatment was a twice-weekly session with a dietitian to ensure her diet was optimised for her general well-being, and she also participated in thrice-weekly exercise, again overseen by the cancer treatment team.
Next week I have an appointment with a dietitian so we can tailor my diet a little more to aid in the management of my Crohn's Disease... I got the referral from my gastroenterologist.
And my friend who's a cardiologist? Probably knows more about how diet and exercise can improve heart health than most of these bozos. She waxes lyrical about the benefits of diet all the time, including fish oil.
I often wonder if it's because SBM rejects or downplays alt-med's embracing of "superfoods" and supplements.
I don't know that I'd call it 'post-feminist'. Mothering began in 1976, the same year as Mother Jones and three years after Country Women. The back-to-the-land movement seems to have had a flavor of political radicalism through apostasy. A declaration of competence, if you will. Then, however, insularity sets in, and everything repeats in miniature. I think I'm with Spencer Tunick on this one.
Notice that I call it " post-feminist feminism" because it represents an odd mixtureof both.
-btw- back-to-the-land is alive-and-well @ Natural News and PRN: it'll help to become self-sufficient when the final economic crash/ electrical grid failure/ revolution/ secession occurs "within the next 2 years" or so I'm told.
First, MIkey went back-to-the-land in Ecuador then he took his act on the road to Arizona, then Austin.
Need a cookie, nowt else.
Gotta get a cookie, Firefox lost them all.
"Iatrogenic" does NOT refer solely to physician error.
Iatrogenic = resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. from Dorland's Medical Dictionary.
See also the Wikipedia article http://en.wikipedia.org/wiki/Iatrogenesis which clearly states that iatrogenesis involves other causes besides physician error.
Of course physicians also do a lot for people's health. When evaluating the usefulness of medical treatment, one would subtract the "iatrogenic" harm from the benefits.
And evaluating the usefulness of naturopaths would involve the same process, subtracting THEIR "iatrogenic" harm from their benefits.
Laura,
Of course it doesn't. Where has anyone here suggested that it does?
Since most naturopathic treatments have no benefits, that's a powerful argument against naturopathy.
... which has a new browser, so I need a cookie.
PS Also, calling Dr. Starfield's paper "notorious" is unfair.
I looked at the first page of it online, and she does not equate "iatrogenic" with physician error.
I didn't find criticism of the paper's conclusions in a quick google search online.
Dr. Starfield's paper has been widely cited by alt-med people to criticize mainstream medicine. However this doesn't reflect unfavorably on the paper itself.
Orac :
And Orac is criticizing this figure mainly on the basis that most of those deaths aren't due to physician error.
If true, this is a shocking number of deaths from iatrogenic causes, even though most of them aren't caused by doctors' errors.
Laura, just because you can't find criticism of Starfield's paper on a quick Google search doesn't mean there's no criticism or that it isn't valid. I'm not going to try to untangle what you think the exact boundaries of "iatrogenic" and "physician error" are or should be, but Starfield's paper comes in for criticism because it makes the simplistic assumption that if the choice "physician treatment" was taken and the result was N hundred thousand deaths, under some other course none of those deaths would have occurred.
All you have to do to see why that assumption doesn't hold up is consider insulin. How many diabetics would die without their insulin injections? Out of those who require insulin to live, there will surely be a small percentage who end up dying because they get the wrong dosage of insulin at some point. Under Starfield's methods of counting, physicians are responsible for every diabetic who dies because of insulin, because taking insulin is of course an iatrogenic intervention - but they don't receive any credit for the much larger number of patients who live because of insulin. See the problem?
Laura,
Orac wrote:
Which I took to mean either/or.
It is shocking until you consider in what context the vast majority of these deaths occur. If you look at studies that have looked closely at these deaths you find that nearly all of them are in very sick people with multiple illnesses who are very likely to die anyway. Doctors are likely to try high risk procedures, and use drugs that may kill the patient in an attempt to save their life. If the patient dies, it wasn't an error, as the drug or procedure was used as it should have been, it was part of a high risk strategy that didn't pay off in this patient, but may well have in others.
Even when it is a medical error, I think it is sometimes understandable that a doctor makes a mistake with a patient who has kidney failure, fractures, osteoporosis, cancer, congestive heart failure and neuropsychiatric problems. Trying to juggle the drug interactions alone is mind-boggling. This is not an unusual scenario either, this sort of comorbidity (to use the medical jargon) is increasingly common as people live longer and the population ages. I know it isn't much of a consolation when a loved one is the victim of this, and I have experienced this myself, but I do understand how it can happen. When you consider the millions of medical procedures that are carried out every year you realize that this is inevitable to some extent.
As another example (though Antaeus's example of insulin is also a good one), look at anticoagulant drugs, which undoubtedly save hundreds of thousands of lives every year. Without these drugs patients with clotting disorders are very likely to suffer embolisms that will make them very ill or kill them. However, anticoagulant drugs are also responsible for more deaths than any other. They kill thousands of people every year. This is because the therapeutic dose is very close to a lethal dose. Too much of the drug and they will suffer internal bleeding, too little they may have a stroke, a heart attack or a pulmonary embolism, if they die either way it will be counted as iatrogenic.
That's why these patients have to be closely monitored, as various factors can also affect how they respond to these drugs. This is also why scientists have been working hard to produce safer versions of these drugs, which are now coming into use.
Just to add to that, it isn't just lives saved that need to be taken into account. NSAIDs and other painkillers drugs also kill large numbers of people, but they don't save any lives. What they do do is dramatically improve people's quality of life. I'm sure most of us know someone with musculo-skeletal disorders who could not function without either anti-inflammatory drugs or stronger painkillers. I have often had reason to be very grateful for the existence of these drugs myself, yet NSAIDs cause GI bleeds (that's what killed my grandmother), and may increase the risk of cardiovascular disease, while opiates are addictive and acetaminophen is deadly in overdose. How many people made mobile by NSAIDs do you need to justify one fatal GI bleed?
None of this is easy, and perhaps we need to discuss it more than we do. Throwing up our hands in horror at iatrogenic death and disease isn't very helpful, since the alternative to medicine is even less alluring.
Laura
And when you consider the iatrogenic harm caused by naturopaths, you must include the fact that their patients may be skipping treatments that are effective for their condition in favor of what ever the naturopath is offering.
Have you actually read Dr. Starfield's paper? I don't see any place that she makes the stupid assumption that you describe. The full text is available free online at http://silver.neep.wisc.edu/~lakes/iatrogenic.pdf
Dr. Starfield asks in her paper why public health in the U.S. is so much worse than in other developed countries, and she cited the high iatrogenic death rate as a possible problem with the health care system here. She was not using the iatrogenic death rate as an argument for alt-med, as the many alt-med people who cited her paper did.
Orac's and your comments are more appropriate as a reaction to what the alternative Dr. Dossey wrote at http://www.huffingtonpost.com/dr-larry-dossey/the-mythology-of-science_…
Dr. Dossey did say
This is a serious misrepresentation of Dr. Starfield's paper. It seems Dr. Dossey believes that "iatrogenic" = physician error! He is the one who is lumping things like adverse effects from medications with "physician error".
A reader of Huff. Post complained, and Dr. Dossey responded:
ha-ha. That really is an atrocious line of bull.
Dr. Starfield was part of the internal self-criticism of the medical profession. I have been looking on Medline among papers that cite her paper, and I've found nothing so far criticizing her paper. Other papers that cite hers ask the same question, how could health care in the U.S. be improved.
Orac makes one criticism that is somewhat relevant, that is that people who are sick are more likely to get infections. Thus, that hospital-acquired infections are partly the result of the original sickness.
However, one would hope that hospitals would actually be safe places to be. People get dangerous antibiotic-resistant infections in hospitals, and one wonders about the preventability of those deaths - how many are due to inadequate air purification, people being careless about sterilizing instruments, etc? If a sick person is especially vulnerable to infections, shouldn't their environment be especially free of dangerous germs?
Of course medical care has risks. This does not imply that iatrogenic deaths being the third leading cause of death, is fine, or that the health care system in the U.S. couldn't be improved.
It sound like Orac thought that Dr. Starfield lumped things like hospital-acquired infections into "physician error". She did no such thing, and I wonder whether he even read her paper.
Laura,
The main problems are direct contact with other people, both healthcare workers and visitors, and overuse of antibiotics leading to the development of resistant strains of bacteria. I don't think air or instrument contamination are significant causes of noscomial infections. There have been trials of strictly enforced handwashing, changes in the use of antibiotics and screening of patients on admission that have greatly reduced nosocomial infection.
I entirely agree (though I question Starfield's figures, see below). I'm in the UK and things need to be improved here too. I have heard two appalling stories of medical screwups within the last couple of weeks. I do hope that things are changing for the better here and in the US, I know that measures are being taken to minimize the number of errors, and that safer drugs are being introduced.
Actually Starfield wrote of "the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error", combining these separate categories into one. When Dr. Dossey wrote "between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes or physician error" I understood this to also mean this number of deaths is caused iatrogenic causes and physician error together. It's ambiguous really, but I suspect you are right and he was conflating the two. I'm quite confident that Orac knows the difference, from his writings on the subject over the years.
Incidentally, I was annoyed to notice that Dr. Dossey trots out the BMJ Clinical Evidence figures about which medical treatments are evidence based and, as alternative health advocates always do, he writes as if these are figures for conventional medicine alone when they actually include "many treatments that come under the description of complementary medicine".
Anyway, I'm not at all convinced that Starfield's figures are accurate. To repeat what I wrote above, I have looked closely at one of the papers Starfield refers to; Lazarou 1998 'Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies' PMID: 9555760. Lazarou extrapolated from 78 ADR deaths in papers mostly from the 1960s and 1970s to the 33,125,492 total US hospital admissions in 1994 to come up with the estimate of 106,000 deaths due to adverse drug events. Have the drugs used in hospitals really not changed for the better in the past 40-50 years? Can we have have any faith at all in this figure? Can we have any more faith in the total number of deaths suggested by Starfield?
Isn't Larry Dossey the guy who advocates PRAYER to assist patients?
-btw- alt med folk like to extrapolate from studies that like : see James Laidler on 'chaining' numbers re "Death By Medicine".
So, Laura, last year my son complained of a rapid heart beat and then a pain down one of his arm. Then his speech became unintelligible.
We called 911, and he ended up in the hospital with a possible stroke.
What would you have done? Just tell the person to stop complaining, and to go back to bed because in your would someone who is suffering symptoms like that is better off not in the hospital.
Tell us truthfully, what would you do if a loved one showed signs of stroke?
@Palindrome Just harking back to your impression that women show a greater interest in health 'news' (we're using that term really loosely, right?) and 'fret' more about healthy living... That is my impression too. But femimommy says we don't know for sure if women are more smitten with woo than men, so I offer this, from the Australian Bureau of Statistics
http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter5202008 (Australian Social Trends - Complementary Therapies - 2008)
And I'd say, sadly, yes, women are a bit more smitten. I think the CDC has US statistics, and IIRC there was a gender difference there too but I believe the social-demographics were quite different, with more lower income users than here in Oz, presumably because of the differences in our health care systems.
As to the why, I think Darwy's answers had some truth. The marketing/purchasing angle has been hammering women for a good long while. The same kind of solve-all-ills/protect your family/be beautiful editorials can be found in our newspapers from the 19th century. They're just 'green' now and the ills include saving the planet. The 'beauty' pressure is a big element and very rarely, in my experience, is 'health' anything but a dog-whistle slyly meaning thinner and more attractive, both in the 'news' and in sCAM practitioners' literature. But I think these things are more answers to 'how' because people aren't /just/ puppets whose strings get pulled.
For the 'why', I think there's some hints at answers in research from several disciplines about religiosity, where there is also a gender difference. (I'd say the decline in religious affiliation has some correlation with the rise in CAM and postulate that it is largely the same social dynamic in different clothes.)
I also think there are hints to be found in psych research about the gender split in stress levels, maladaptive perfectionism, 'belief in a just world' as a coping mechanism. In there, you get the placebo effect, risk aversion, disparities in mental illness like depression and anxiety and also that competitiveness Darwy mentioned and the rigid judgement 'bitchiness' that women are so often accused of, unfortunately not always unfairly.
So, I would assert that women's lower status in our societies is clear. And I'd assert that (middle-class) women's 'fretting' over ridiculous things plays a divisive and diversionary role in maintaining that status. (Diversionary in that focus on it buries actual threats to women's well-being like, say, the higher rates of poverty in old age or VAW. It also obscures the social realities for those further down in the hierarchy, such as Indigenous women.) And I think that there would be reasonable grounds to hypothesise at least part of the 'why' is because the certainty of woo (or religion, or being thin, or mothering /exactly/ the right way, or having the/'right/ amount of pubic hair) has a greater appeal, on a statistical level, because of the insecurities and pressures associated with that lower status.
Which is in no way an excuse for an unnecessarily stupid individual to be stupid, of course. :)
Dr. Starfield does list caveats:
Maybe she had difficulty getting data on iatrogenic deaths. She does write:
This might be an area where the medical profession tends to protect itself by making it difficult to gather data.
Dr. Starfield didn't claim in her paper that the iatrogenic death rate in the U.S. is way too high. She only mentioned the medical system in the U.S. as a possible contribution to the poor health of people here, relative to other developed countries. She mentioned other possible causes.
I haven't delved into the source of her statistics or the IOM report, but Orac doesn't seem to have, either. He's simply said he thinks that 200-300,000 iatrogenic deaths/year in the U.S. is too high a number, without telling us why.
I don't know that it's too high. A lot of the iatrogenic deaths are probably people who are already dangerously ill - that's why they're getting dangerous treatments.
For example, Christopher Hitchens apparently died from iatrogenic causes. His widow Carol Blue said
But Christopher Hitchens' death would have been counted as a death from cancer, when calculating the death rate from cancer.
I have the impression this is common, that someone is very sick from cancer (or maybe heart disease or stroke), but something iatrogenic is the actual "proximate cause" of death.
So a lot of the iatrogenic deaths are probably actually contained in the death rates from other causes.
So, I don't know why Orac thinks Starfield's figures are so unbelievable.
The billion-dollar question is of course, how much these deaths could have been avoided? How many people do hospitals and doctors generally kill, who would not otherwise have died? Dr. Starfield didn't try to answer that question in her paper, I don't know the answer and it's a difficult question.
Orac hasn't in any way justified the pejoratives (infamous, notorious) he's thrown at Starfield's paper. Her venturing that the U.S. medical system might contribute to poor health via iatrogenic harm, was used by many people to make mainstream medicine look bad. But she didn't say that, and blaming her seems to be guilt by association.
I looked on Medline through the 35 papers that cite Starfield's paper. I didn't find any rebuttal paper. Maybe in JAMA there were letters to the editor rebutting it that didn't cite her paper. I haven't looked in the following issues of JAMA.
So where is Orac's evidence? There might be evidence, but he hasn't given it.
Dr. Starfield actually wrote "in noninstitutional settings". (pdf of paper is protected so I had to copy that by hand.)
So, Laura, you would not make sure a person is showing signs of stroke gets medical help.
Do you also ignore the medical needs of someone who has signs of a heart attack, seizure and broken bones? Do tell how you would treat them. Drag them into a naturopath's office?
Okay, Laura, it seems you don't like my scenarios. Perhaps you think that they are lifestyle issues. My son is in a demographic more prone to a stroke because he has a genetic heart condition because one of the walls in the heart grew abnormally to about three times its normal size, and in a shape that partially blocks the blood leaving the heart. I have grumbled at the insurance company's nurses who call him about preventative care, at one time I wondered (very out loud) that I wished I knew how to prevent the creation of that genetic sequence in him when I was pregnant.
But that is neither here nor there, you have questions to answer. How does naturapathy address the tachycardia and blood pressure drop from that kind of condition, obstructive hypertrophic cardiomyopathy? Come on, tell us you would treat it without real medicine. Remember it is the biggest cause of sudden cardiac death in young people, so you really need to be on point with your answer.
Or perhaps you don't like those silly genetic diseases. Who cares about HCM, Type 1 diabetes or cystic fibrosis. They don't happen to good people who live a healthful lifestyle.
But here is something that does happen to folks who gather foods growing natural in the wild, like a lovely white carrot. Except that it was hemlock root, and very poisonous. You do know that the stuff that killed Socrates looks very much like a carrot plant, right? The difference is that hemlock has purplish leaves. A couple of years ago there was a hemlock death and near death near here, the guy who survived actually got to the hospital.
So, Laura, how would you treat hemlock poisoning?
More than ten days later and Laura has no answers on how to deal with real medical issues. This is obvious confirmation that "ND" stands for "Not a Doctor."
Thank you Laura. Your non-conviction has shown us exactly how naturopathy is shallow and ineffective.