Tooth Fairy science about traditional Chinese medicine, promoted in the Wall Street Journal

chinese_medicine_five_elements

They are winning.

I’ve spent nearly ten years on this blog and nearly seven years at my not-so-super secret other blog (where I will likely crosspost this over the weekend) discussing the infiltration of quackery into medicine, both in academic medical centers and, increasingly, even in community medical centers. There’s a term that I wish I had coined but do frequently use to describe this infiltration: Quackademic medicine. Over the last 30 years or so, what was once quackery, rightly dismissed in a famous 1983 editorial in the New England Journal of Medicine as a “pabulum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason” has become mainstream, evolving from quackery to “alternative medicine” to “complementary and alternative medicine” (CAM) and finally to “integrative medicine.”

At each stage, the idea was to rebrand medicine based on pseudoscientific, mystical, and/or prescientific beliefs as somehow being co-equal with “Western” or “scientific” medicine through the clever use of language, whose latest term, “integrative” medicine is a near perfect Orwellian twisting of language meant to imply that what is happening is the “integration” of what advocates of integrative medicine like to call the “best of both worlds.” Of course, as I and others have pointed out time and time again, when you “integrate” quackery with science-based medicine, as is becoming so common in quackademic medical centers, you don’t instantiate the quackery, nor do you make medicine better. Let’s just put it this way. When you “integrate” modalities like “energy healing,” of which reiki, for example, is nothing more than faith healing and intercessory prayer (distant healing), substituting Eastern mystical beliefs for Christianity as its basis, can it honestly be said that medicine is improved? Does mixing magical thinking with science help patients?

If you want to see just how successful quackademic medicine has been at not only infiltrating itself into what should be bastions of science-based medicine but at changing the very terms and language under which it is considered, just look at this article that appeared in the Wall Street Journal yesterday by Shirley S. Wang entitled A Push to Back Traditional Chinese Medicine With More Data: Researchers Marry Modern Analytical Techniques to Centuries-Old Theories on What Makes People Sick:

Traditional Chinese medicine teaches that some people have hot constitutions, making them prone to fever and inflammation in parts of the body, while others tend to have cold body parts and get chills.

Such Eastern-rooted ideas have been developed over thousands of years of experience with patients. But they aren’t backed up by much scientific data.

Now researchers in some the most highly respected universities in China, and increasingly in Europe and the U.S., are wedding Western techniques for analyzing complex biological systems to the Chinese notion of seeing the body as a networked whole. The idea is to study how genes or proteins interact throughout the body as a disease develops, rather than to examine single genes or molecules.

“Traditional Chinese medicine views disease as complete a pattern as possible,” says Jennifer Wan, a professor in the school of biological sciences at the University of Hong Kong who studies traditional Chinese medicine, or TCM. “Western medicine tends to view events or individuals as discrete particles.” But one gene or biological marker alone typically doesn’t yield comprehensive understanding of disease, she says.

As if to drive home the "integrative medicine" narrative that TCM is equivalent to “Western” medicine, there’s even a truly infuriating illustration of a stylized human body, half of which is TCM and half is “Western medicine,” with “Western medicine” ascribing the cause of the example, rheumatoid arthritis, to autoimmune disease, with treatments listed as being nonsteroidal antiinflammatory drugs, steroids, disease-modifying antirheumatic drugs to slow disease progression. On the other side, TCM postulates as the cause of rheumatoid arthritis the “blockage in flow of qi and blood in the energy pathways of the body; wind, cold, and damp penetrate the body and get into muscles, joints; there are different forms of arthritis depending on if wind, cold, damp, or heat predominate.” I kid you not. And the treatment? Acupuncture, tai chi, and herb thunder god vine. I’m saving this poster for use in future talks to illustrate just what I’m talking about, so emblematic is it of the false equivalence “integrative medicine” lends to prescientific, unscientific, and pseudoscientific ideas. The overall idea communicated by the illustration? That TCM's magic-based description of the pathophysiology and treatment of rheumatoid arthritis is worthy of being considered along with the science-based knowledge, gathered over decades, of what causes rheumatoid arthritis and how to treat it.

This narrative has become so depressingly common that it ought to have a name. “They thought it was quackery but now it’s science”? Too long, but that’s the false message of every one of these stories, which is that they thought us mad, mad, I tell you! But now we’re showing those nasty, close-minded, reductionistic “Western” doctors! Except that they aren’t, and this story inadvertently shows why they aren’t. Still, a punchier name for the trope would be useful. “They thought us quacks,” maybe? The “we’re really, really science, maaaan” trope, perhaps? Perhaps you can help me out. I’ll leave thinking of a pithy, punchy name for this trope as an exercise for the reader in the comments.

In the meantime, let’s take a closer look at the article. It’s based entirely on the very hubris behind “integrative medicine,” namely that medicine based on prescientific and religious beliefs, like traditional Chinese medicine, is at least nearly co-equal with medicine based on science and rigorous clinical trials. Or, at least, it would be equal to scientific medicine if there were actually some evidence for it, which these brave maverick doctors and scientists are furiously searching for, no matter how much they have to torture modern systems biology and molecular biology techniques to shoehorn TCM's fantasy-based "networks" into networks of gene activity being increasingly understood by modern molecular biology. Look at the passage above. Wan claims that TCM views disease as “complete a pattern as possible.” Really? Would she say the same thing about ancient “Western” medicine? After all, ancient “Western” medicine believed that imbalances in the four humors (phlegm, blood, yellow bile, and black bile) caused disease. TCM postulates that ascribes illness to six pernicious influences, which include wind, cold, heat, dampness, dryness and summer heat, which are, like totally not like the four humors. (There are, after all, six pernicious influences.) TCM also has the “five elements” (fire, wood, earth, water, and metal), which are associated with different organs. So maybe TCM is on to something because its prescientific beliefs were more complicated than Western prescientific beliefs. That means they must be better, right?

I know, I know. Regular readers are wondering why I'm using the term "Western" medicine given that I find the whole “East-West” dichotomy favored by advocates of TCM and “integrative medicine” to be borderline, if not outright, racist. After all, the unspoken assumption behind this dichotomy, whether those using it realize it or not, is that the “West” is cold, reductionistic, and scientific while the “East” is “wholistic” and connected to the human. It’s all pernicious nonsense, of course, insulting to Chinese and other Asian scientists. Science is science, and those in the “East” can do science as well as we “Western” scientists can. What counts are evidence, experiments, and reason, none of which knows “East,” “West,” "North," or "South."

Another trope is plain in the passage above. Where “Western” medicine is presented as “reductionistic.” Note the bit about viewing events or individuals as “discrete particles” and how “one gene or biological marker alone typically doesn’t yield comprehensive understanding of disease. We hear this time and time and time again, but no one can tell me how viewing organs as related to “five elements” (which are not actually elements, of course) and disease as being caused by six pernicious influences is in any way “wholistic” or more “wholistic” than viewing disease as being due to imbalances in four humors. Moreover, although in metabolism science has always looked at whole networks (e.g., glycolysis, the Krebs cycle, oxidative phosporylation, and all the metabolic networks that feed into these pathways), part of the reason why science focused on single genes for so long is because it was limited by the technology. It wasn’t until about 15 years ago that the tools were developed to start looking at, yes, “wholistic” changes in gene expression using whole genome expression profiling, which allows the detection of changes in the expression of every known gene in the genome. Since then, we’ve only become better at this. Using next generation sequencing techniques, it’s possible to examine changes in expression of every transcript in the genome, coding and noncoding, simultaneously, and the technology has gotten to the point where it is now becoming possible to examine the changes in gene expression of the whole genome of single cells.

Much of the second half of the article deals with what TCM refers to as “hot” or “cold” syndrome. I swear, when I saw this next passage I couldn’t believe an otherwise intelligent journalist could write something so ridiculous with a straight face:

One promising area of TCM research several independent groups of scientists are investigating is the notion of hot and cold syndromes. The work is still in its early stages. But it could result in a new direction for TCM research by using the systems biology approach and integrating it with experience gleaned from TCM patient care, says Yale’s Dr. Cheng, who also serves as chairman of the Consortium for the Globalization of Chinese Medicine.

In a series of studies, Tsinghua’s Dr. Li and his colleagues examined people with hot and cold syndromes and whether they exhibited different signs of illness, including gastritis, a common digestive disorder in which the lining of the stomach becomes inflamed or irritated.

To gauge whether gastritis patients had cold or hot syndromes, researchers asked questions like whether individuals had chilly body parts or exhibited a preference for hot beverages or a susceptibility to catching colds. Doctors dug into their subjects’ emotional states, asking whether they experienced so-called cold feelings like apathy. The scientists also measured proteins linked to gastritis and took measurements of the bacteria in the gut and imaged the bacteria in the tongue’s coating.

They found some variations depending on whether patients were identified as hot or cold. They also found differences in the bacteria of patients’ tongues that corresponded with tongue coating color and whether patients had been diagnosed with hot or cold syndrome.

One might as well run systems biology experiments on patients subjected to magical incantations, because that’s basically what is happening here! As I've said before, if the treatments and diagnostic modalities being tested are prescientific or pseudoscientific, using all the flashy new science in the world won't make the experiment science. If there’s one thing I see in common with experiments examining whether “hot” or “cold” diagnoses correlate with changes in biomarkers and other laboratory values is that they tend to be small studies, prone to false positives, and to be massive fishing expeditions, with large numbers of comparisons. In this they remind me of some homeopathy studies.

Consider what it is that TCM means by “hot” and “cold” diagnoses. The root of the “hot-cold” dichotomy is not based on any science. Rather, it’s based in Taoist religion, the “Yin Yang theory” of disease. As described here, TCM states:

The root of many of the ideas within Chinese medicine lies in the concept of Yin and Yang. Yin and Yang are emblems of the fundamental duality in the universe, a duality that is ultimately unified. Yin and Yang are complementary, and not contradictory. Nor is one regarded as 'good' and the other 'bad'. People will often state that, “I am Yin”, or “I am Yang”, but this would be inaccurate; they may have a Yin-Yang imbalance or tendancies, but everyone has both qualities.

Harmony is sought between these Yin and Yang qualities and any imbalance avoided when approaching the body as a holistic union. Yin is matter like Blood, fluids and tissue in the body. Yang is the action potential, Qi, and heat in the body. Chinese medicine balances Yin and Yang and can also build these qualities in the body when they are deficient. No one person is completely Yin or Yang; rather, one would look for tendencies and patterns, and weigh them out; one organ system may have Yang excess while another organ system in the same body can have Yang Deficiency.

From the same source, we learn that “yang excess” or “yin deficient” signs include things like constipation, thirst, dark yellow urine, red tongue, dryness, heavy loud respiration, burning bowel movement, and strong body odor. (I suppose the last two probably go together.) We also learn that signs of “true heat” include blood in the nose, stool, or urine; yellow green mucus; fever; and sticky, thick excretions. These are the sorts of things that TCM practitioners look for and ask about. I suppose it’s possible that certain biomarkers might be different in people with true heat or yang excess or yin deficiency, but whether those have anything to do with a disease like rheumatoid arthritis due to anything other than coincidence is unlikely.

It’s all utter nonsense, of course. It’s as perfect example of what Harriet Hall likes to refer to as Tooth Fairy science as I’ve ever seen. Basically, Tooth Fairy science involves applying the scientific method to phenomena that don’t exist. As Harriet’s pointed out many times (and I’ve echoed), we can study the amount of money left by the Tooth Fairy in different settings, but since we havent’ determined that there really is a Tooth Fairy, any conclusions we reach will be falsely attributed to a magical being, rather than to the real cause. The prescientific beliefs behind TCM are are a lot like the Tooth Fairy. It’s not for nothing that a Chinese physician has issued a TCM challenge, not unlike James Randi’s million dollar challenge to TCM practitioners to prove their methods.

Lots and lots of research money is being wasted studying prescientific superstition such as qi, yin and yang, and “hot” and “cold” applied to human disease, and universities are embracing such twaddle with both arms. Just this year, for instance, the Cleveland Clinic opened an herbal medicine clinic run by a naturopath practicing largely TCM (mentioned in the article). Dozens of academic medical centers offer this sort of quackery to their patients, in the name of supposedly wanting to study it, but if they don’t know it works how can they offer it as anything other than experimental therapy? Instead, they offer it as though it were validated medicine. Meanwhile, TCM advocates try to sell this prescientific form of medicine as though it were somewhere on the same planet, evidence-wise, as scientific medicine when it is not. Let's just put it this way. You can make up all the complex "networks" and "systems" that claim to describe human physiology and disease as you want, but if they aren't grounded in reality and evidence they're nothing more than fantasy. Indeed, fantasy is what is being "integrated" with scientific medicine, fantasy like TCM.

It should anger you. It should anger anyone who cares about science and medicine. Sadly, the reaction of the vast majority of physicians is a shrug.

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Thanks for this Orac.

Has there been much protest from doctors at these institutions or any public challenge by the SBM doctors?

Also, in my travels, I noticed that the National Eye Institute at the NIH has granted $225k to Dr. Ava Bittner (of Johns Hopkins) and Andy Rosenfarb, N.D., L.Ac to try to answer the question "Is Acupuncture a Beneficial Treatment for Retinitis Pigmentosa?"

Of course, the study is on so-called electro-acupuncture. It's quite the effective way to throw away money.

Does it even matter what the results of the study are? I wonder if they stick the needles in the eye...

That's a pretty sad diagram as far as these things go.

"Now researchers in some the most highly respected universities in China, and increasingly in Europe and the U.S., are wedding Western techniques for analyzing complex biological systems to the Chinese notion of seeing the body as a networked whole. The idea is to study how genes or proteins interact throughout the body as a disease develops, rather than to examine single genes or molecules."

Blablabla, I hate this ! Come on, molecular biology is studyng body as a "network whole" from years ago, new technology in sequencing allow to look gene expression from thousand gene together. If it's not REAL 'hollistic" approach what is it then ?
When biology do that kind of thing no one give a damn, when some magician claim do to the same (and they are not) everyone is like "oh my, that's a marvellous, fabulous, fantastic, amazing new revolutionnary... Why dumb and closed minded western scientist don"t think the same ?" What if I told you : They are ! But they use real method, not some new metamumbo-jumbo.

"It should anger you. It should anger anyone who cares about science and medicine."

This bother me but I don't see what to do at my scale. When I hear stupid things (like "ho hey I'm going to see a magnet healer') I try to explain to the concerned person that is thievery but i don't think it's very efficient. And more I try, more It's seems that im' the bad of the story.

Yep. If you criticize quackery, you're the baddie. You're "close-minded," hate patients, and in the thrall of big pharma. At least, that's how you'll be painted. Embrace it.

For your slogan, I think you should go with an "Emperor's New Lab Coat," theme -- woven of qi, yin, yang and herbal essences -- can only be seen by the pure of heart -- repels science -- allows you to cure anything -- yours for 6 easy installments of $19.99

Unfortunately, the word emperor sounds too much like blaming all nonsense on East Asia, so maybe the "scientist's" new lab coat?

I tell my students its not science based medicine, its
faith based practices.
...am I wrong?

By nutritionprof (not verified) on 04 Nov 2014 #permalink

Oh, for crying out loud! I'd love to know how practitioners of TCM utilize "Hot" and "Cold" diagnoses for say, Reactive Arthritis. On the one hand you have a "hot" array of symptoms (fevers, infections* etc.) then you have your "cold" symptomology in the arthritis. Maybe the REAL story is that it's a "Metallic" or "Wood" related problem? I guess it doesn't really matter when you are reliant primarily upon argumentum ad populum.

How much money do you suppose goes into making sure this nonsense infiltrates universities and business journals etc?

*Assuming the practitioner in question isn't into Germ Denial to boot ;)

By AntipodeanChic (not verified) on 04 Nov 2014 #permalink

@nutritionprof: With respect to reiki, you're right on, given that it's faith healing substituting Eastern religious beliefs for Christian beliefs. Think about "distance healing" or sending reiki energy over distances. What is that but an "Eastern" version of intercessory prayer, just as "hands-on" reiki is very much like Christian faith healing involving the laying on of hands?

As a Yale physician and scientist, I am again frustrated to see our involvement in the integrative nonsense. Despite having been here for five years, I have to admit being unaware of the Integrative Medicine Center until the Quackademic Medicine in Connecticut post a few weeks ago - although we are all familiar with Katz. I still retain some hope that our integrative initiative is mostly a shell program to capture donor and (sadly) grant dollars. There are signs that this may be the case to some degree, or maybe this is wishful thinking on my part. The home page for the Center is little more than a "donate" link a schedule of 5-6 talks a year that range from 'meditation to manage stress' talks to acupuncture. So while the Trojan Horse has been within our walls for about six years now, we are lucky that not too many Trojans have jumped out just yet.
The case of Dr Yung-Chi Cheng mentioned here brings up a challenging point about how to deal with such "academics". He has puttered along for decades as a professor of pharmacology doing legitimate science on chemotherapeutics and HIV. Now he lends his name and credentials to the Consortium for the Globalization of Chinese Medicine. So how does a university deal with people like this? How, in practical terms, should the academic community push the tenured members of the Trojan invaders out? Suppose, hypothetically, that an Ivy League cardiothoracic surgeon started peddling anything and everything on a popular TV show? We can weed out the crap in the literature via peer review, but it's harder to prevent the damage that is done by these people lending their name - and institution's name - to making this research seem legitimate.
What's perhaps worse, is that as they approach a critical mass, they care start to push each other's work through study sections. This is the only possible explanation for how stuff like the acupuncture/retinitis pigmentosa study mentioned by a comment above is getting money in the present funding environment.

By CTGeneGuy (not verified) on 04 Nov 2014 #permalink

It was about 40 years ago that Richard Feynman gave his commencement speech on the subject of what he called cargo cult science. Being a physicist, he took most of his examples from physics, but he included some mentions of alternative medicine. The term "cargo cult science" is an analogy to the cargo cults that developed on several South Pacific islands after World War II, where the believers went to great lengths to recreate the conditions which, a few years earlier, were correlated with the arrival of airplanes (mostly American but some Australian) with lots of cargo. What the cargo cult adherents didn't understand, at least at first, was that the cargo on those planes was supporting the Allied war effort in the Pacific theatre, and once the war was over, there was no longer any need to supply the region with cargo.

Very little has changed since Feynman gave this address, and most of what has changed has changed for the worse. It doesn't help that far fewer people today know what a cargo cult is (the cargo cults died out because their fundamental belief, that performing these rituals would attract planes full of cargo, was decisively falsified). The suggestion by ruthq@5 of "The Emperor's New Lab Coat" is a good one, because most Westerners are familiar with the story of "The Emperor's New Clothes" (I don't actually know which culture originated this story), and this is the audience Orac is trying to reach.

By Eric Lund (not verified) on 04 Nov 2014 #permalink

And WE'RE the bad ones!

Seriously, I read / hear so much absolute garbage like this that they would instill in the public's mind-
that sometimes I just want to scream**.

I often wonder how we could enlighten people about the loads of money being wasted on woo which enriches the prevaricators who sell it -
- one way is to show the f@cking palaces in which they live
- another is looking at their earnings
- also, figuring out much profit is made if one sells supplements/ foods/ videos/ books at huge markups

-btw- the TMs are now firmly entrenched in the woo business as they sell ( @ 40 USD) e-conferences about food ( anti-GMO, GFCFSF etc), energy healing ( ultra pure woo) and newest of all, homeopathy ( aka 'water'). For this amount, a person can listen or watch ( I forget which) the string of woo-slingers' presentations live and then, have access to its 'wisdom' for an entire year- so I suppose that it could be shown to others and memorised perfectly then applied, transforming the viewer into a practitioner of sorts.

** Aiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii!

By Denice Walter (not verified) on 04 Nov 2014 #permalink

Pfizer made a lot of money from pills fur curing insufficient wood. Just sayin

By Militant Agnostic (not verified) on 04 Nov 2014 #permalink

CTGeneGuy --

Suppose, hypothetically, that an Ivy League cardiothoracic surgeon started peddling anything and everything on a popular TV show.

That has to be a hypothetical, since nothing whatsoever of that kind has ever happened. /sarc

Are you sure that that fellow is in pharmacology? Could it be "farm ecology", a la Donald Knuth? (Narad and Eric Lund may get this one).

Lastly, mention of Feynman's wonderful essay prompts me to express how disgusted I am at global warming deniers who invoke Feynman's healthy skepticism when defending their own bone-ignorant claptrap. It's real bad for my blood pressure.

By palindrom (not verified) on 04 Nov 2014 #permalink

You sneer against Chinese treatments for rheumatoid arthritis, but these are increasingly being proven in clinical trials. An herbal remedy containing thunder god vine just recently beat methotrexate in a head-to-head comparison. It's getting harder and harder for anointed experts from one small group of countries to tell the increasingly diverse population of trained scientists worldwide to research only those things that the former culture already believes in. Clinical trials whose results you don't like still really are science ... maaaaaaan.

@brook:

I seem to recall that water-buffalo horn has been supplanting rhinoceros.

@ jane:

[citation needed]

By Sarah Auclair (not verified) on 04 Nov 2014 #permalink

An herbal remedy containing thunder god vine just recently beat methotrexate in a head-to-head comparison.

I see that jane's citation habits haven't improved.

Could it be “farm ecology”, a la Donald Knuth?

I hadn't seen that one before. I'll still never forgive him for that calligraphic font, though.

I have had an academic colleague (from social sciences) say that my attitudes were part of treating science as a “privileged way of knowing”. On the contrary, one of the best features of science as a way of knowing is that the knowledge gained thereby is explicitly not privileged. Science works because when properly applied no knowledge is sacred. Everything has to stand on the evidence or it falls. “Data talks, bullsh*t walks.” The respect for science is because no other way of knowing has the success rate of science. Most other ways produce results that are no better than random chance.

@ Narad:

Clearly, citations are for cultural imperialists - argument by assertion is just another way of knowing and is every bit as valid as actually presenting empirical evidence to support your claims.

Seriously, though, plenty of pharmaceuticals are isolated from plants or synthesized versions of something that was originaly isolated from plants; that doesn't validate the various metaphysical paradigms that have been used throughout histoy in different cultures to try and predict which plants would treat which diseases. I'm sure jane and others who champion TCM would laugh at the ancient European idea that "like cures like" (i.e., a fungus that looks like an ear must cure ear infections, a root that looks like a penis must be an aphrodesiac, etc.) But ascribe a similarly nonsensical prescientific idea to some romanticized "mysterious Orient" and they lap it up. They think they're being "multicultural" but its just a more subtle form of racism, just like the whole "Mommy instinct is better than science" thing is a subtle form of sexism.

*Orac, you can delete the comment that's in moderation: I think it got tagged as a sock puppet filter b/c autofill filled in the name field

in a country where half the people believe there is an invisible man in the sky watching them is it any surprise that they might believe in other kinds of bunk?

By freethinker (not verified) on 04 Nov 2014 #permalink

@jane: Show me research to the effect that a specific compound present in thunder god vine can alleviate arthritis pain by some plausible mechanism, and I would be in favor of the research. I am not a fan of fishing expeditions, whether figurative or literal, and like Orac, I don't see any evidence that research into TCM is anywhere beyond that stage. While I agree with Paul Simon that "these are the days of miracle and wonder", I don't agree with his claim that "medicine is magical"--there are reasons why the body reacts (or doesn't) to herbal supplements, even if we don't know what they are.

@palindrom: "Farm ecology" is a new one to me as well. I rarely have need for the calligraphic font Narad mentioned, so I find TeX a nice tool for writing--in fact, I recently was forced to write a paper in MS Word (which has become standard in the book publishing industry) and found myself wondering why anybody would want to use Word for scientific writing--it's every bit as clunky as TeX on a bad day, the output (especially the mathematics) isn't as pretty, and you don't even get the fine control of the output that TeX allows you.

By Eric Lund (not verified) on 04 Nov 2014 #permalink

This is the "everything old is new again" trope that with each new investigative modality we have to apply it to these same tired magical ideas and disproven nonsense. and maybe this time devil beet buttplugs or whatever will cure constipation to p of less than 0.05, or maybe they're just looking for some magic in big data because if it is good for anything it is good for generating false positives. Then it gets to appear on Dr Oz with some handwaving BS correlation between it and some highly questionable healthy state. Next we'll hear about how it improves our microbiome.

I guess they figure each new big thing in science is just another opportunity to rip people off. And it's true, it will work for a time, and add a patina of legitimacy to the same old quack BS until the fad wears off.

More on that thunder god vine study, from Arthritis Today (a popularized report, but one I'll bet a lot of people have read in their rheumatologist's lobby) (http://www.arthritistoday.org/news/thunder-god-vine-good-for-ra-342.php), "The dosage of methotrexate used in the study was lower than what’s typically used in the United States, which means the herb could be less effective compared to the doses of methotrexate used here." Meaning that the "wasn't inferior to" can easily turn into "was inferior to" when you increase the dosage of methotrexate to the standard level. That's some endorsement.

By Joe Ellison (not verified) on 04 Nov 2014 #permalink

Narad -- See the TeXbook, page 404.

It's an example of a formatted letter, which is supposed to be from a "Professor of Farm Ecology" at 'The University of St. Anford", to a colleague. It reads:

I understand that you are having difficulties with Alka-Seltzer tablets. Since there are 25 pills per bottle, while the manufacturer's directions recommend "plop, plop, fizz, fizz", my colleagues tell me you have accumulated a substantial number of bottles in which there is one tablet left.

At present I am engaged in research on the potential applications of isolated analgesics. If you could be so kind as to donate your Alka Seltzer collection to our project, I would be more than happy to send you preprints of any progress reports that we may publish concerning this critical problem.

By palindrom (not verified) on 04 Nov 2014 #permalink

On the contrary, one of the best features of science as a way of knowing is that the knowledge gained thereby is explicitly not privileged.

And what if gaining that 'knowledge' is explicitly forbidden?? I wonder how that happens in this day and age of such 'enlightenment'...

But is there any peer reviewed, randomized, placebo-controlled clinical evidence supporting the use of cannabis to treat children with seizures, such as children with Davet syndrome or Lennox-Gastaut syndrome?

To date, the data is limited and anecdotal. But that will soon change. And it will change using a drug in which the psychoactive part of cannabis – THC – has been removed. GW Pharmaceuticals recently obtained orphan drug designation for Epidiolex®, an oral liquid formulation that contains plant-derived cannabidiol for the treatment of children with Dravet syndrome or Lennox-Gastaut syndrome

http://www.ajmc.com/articles/Drug-from-Cannabis-Dravet-Lennox-Gastaut-S…

And while the moneyed interests that control the entirety of targeted pharmaceutical medicines drags their feet, meanwhile funding groups like Project SAM to oppose whole-plant access to cannabis in every state that tries. All so they can justify the cost of synthesizing a substance that is easily derived from a non-toxic plant almost anyone can grow in their backyard. That plant’s extract was part of almost every doctor’s medical kit up until 1937, used to treat a multitude of ailments *effectively*. Doctors had no idea that the evil “marihuana” plant demonized in the papers was the same as the cannabis plant they used as medicine.

http://www.thedailychronic.net/2014/37977/texas-childrens-hospital-part…

I rarely have need for the calligraphic font Narad mentioned

You can swap that (not yellow) pig out for a proper script font, although font management in modern LaTeX distributions is frankly nightmarish.

I recently was forced to write a paper in MS Word (which has become standard in the book publishing industry) and found myself wondering why anybody would want to use Word for scientific writing–it’s every bit as clunky as TeX on a bad day

Impressively, the switch to OLE objects has made things even worse at the interface level. I had reason over the weekend to look at interconverting the formats; it seems to be quite possible. Word's ubiquity in the book racket, I think, is mainly just a reflection of technological primitivism – change tracking is no excuse, as Arbortext Editor can handle this just fine.

But...

the output (especially the mathematics) isn’t as pretty, and you don’t even get the fine control of the output that TeX allows you.

Unless one is really dealing with preparing "camera ready" copy, it's best to assume that what's submitted is only guidance for the typesetter. Now, in the modern day, that very well may just be some guy loading files into a hopper and pressing the "typeset" button, but it's always been the case that fine control really belongs in the proof stage.

This is a complete freaking pain in the ass to offload to authors, but the scrupulous typesetters and editors with loupes were thrown overboard a long time ago.

So much for 'ancient Chinese wisdom'. Even I know the five elements are Earth, Air, Fire, Water, and Milla Jovovich. How do they get by without Air? Do they breathe Metal? Colloidal Silver perhaps. Have they been so inundated with clarinets they've conflated wood and wind? Did they not learn The Way of the World from Earth Wind and Fire?

Wood is not an element. It has to be Air. Apple's never going to make a Macbook Wood. I could see adding Metal as a fifth element if we were talking Earth, Air, Fire, Water, and Motorhead.

But this motley crue of tooth trolls is certainly out to undermine and displace Christianity. Do not be fooled by the bright colors, sheeple. That graphic is a Pentagram! Somebody notify James Dobson and Paul Broun about this Satanic conspiracy, stat!

Speaking of conspiracies, what conspiracy theorist in his right (wing) mind wouldn't be freaked out by the concept of 'The Consortium for the Globalization of Chinese Medicine'? (check the link)

Seriously, if anyone wanted to dip into the Dark Side to push back against TCM's legitimation, there would be ways. Anti-science AND anti-Christian? Might Rush Holt and Paul Broun actually co-sponsor a piece of legislation? The more Libertarian Republicans might be pro-woo as laissez faire, but I could see the Religious Right taking a stand here if somebody gave them the proper wake up call...

In the original Greek version the elements were Earth, Water, Fire and Air, but Empedocles later replaced the last of these with Wood anf Paper, after Democritus pointed out that you can have Earthworks, Waterworks, Fireworks, Paperwork and Woodwork, but ot Airwork.

By herr doktor bimler (not verified) on 04 Nov 2014 #permalink

what conspiracy theorist in his right (wing) mind wouldn’t be freaked out by the concept of ‘The Consortium for the Globalization of Chinese Medicine‘?

I confess, I wondered whether they are anything like the Confucius Institute(s) -- funded by the Chinese Government. Although the Consortium for Globalisation seems to be raking in enough research money to not need an overseas source.
http://medicine.yale.edu/cancer/news/article.aspx?id=805

By herr doktor bimler (not verified) on 04 Nov 2014 #permalink

On the contrary, one of the best features of science as a way of knowing is that the knowledge gained thereby is explicitly not privileged.

And what if gaining that 'knowledge' is explicitly forbidden?? I wonder how that happens in this day and age of such 'enlightenment'...

But is there any peer reviewed, randomized, placebo-controlled clinical evidence supporting the use of cannabis to treat children with seizures, such as children with Davet syndrome or Lennox-Gastaut syndrome?

To date, the data is limited and anecdotal. But that will soon change. And it will change using a drug in which the psychoactive part of cannabis – THC – has been removed. GW Pharmaceuticals recently obtained orphan drug designation for Epidiolex®, an oral liquid formulation that contains plant-derived cannabidiol for the treatment of children with Dravet syndrome or Lennox-Gastaut syndrome

http://www.ajmc.com/articles/Drug-from-Cannabis-Dravet-Lennox-Gastaut-S…

And while the moneyed interests that control the entirety of targeted pharmaceutical medicines drags their feet, meanwhile funding groups like Project SAM to oppose whole-plant access to cannabis in every state that tries. All so they can justify the cost of synthesizing a substance that is easily derived from a non-toxic plant almost anyone can grow in their backyard. That plant’s extract was part of almost every doctor’s medical kit up until 1937, used to treat a multitude of ailments *effectively*. Doctors had no idea that the evil “marihuana” plant demonized in the papers was the same as the cannabis plant they used as medicine.

http://www.thedailychronic.net/2014/37977/texas-childrens-hospital-part…

@ Orac #30

Did Pastor Garman's complaint get beyond The Poconos? Have any major figures in the Religious Right had anything to say about CAM one way or the other? Is CAM commonplace in the Southern strongholds of Evangelicals, or shunned?

From your old post, one commenter replied under the story about Garman:

I am a Reiki Master Teacher. I have studied, practiced and experimented with Reiki for a long time so that I know without a doubt what it is I am working with. I am also a Christian (Episcopalian)... Reiki energy is DIVINE life force energy from God channelled through the practitioner for the purpose of healing.

Now I can guarantee that Evangelicals do not consider Episcopalians to be Christians. Paul Broun has said publicly that pastors of mainstream denoninations are "going to send their people to hell because they don't know Jesus personally as Lord and Savior. You've got to know him PERSONALLY!"

So unless the stigmata show up on the Reiki Master's palms during the hand-waving, I think Broun would not approve. (He is — facepalm — a licensed MD.)

First indented paragraph is quote, last two are mine.

Perhaps you should get over your own hype and do some actual research into the value and validity of alternative medicine. You present a rather smug, uninformed, western- centric ( possibly Big Pharma funded) biased, closeminded viewpoint. There is a plethora of evidence to support medical modalities other than the present drug cult of Western medicine.

An herbal remedy containing thunder god vine just recently beat methotrexate in a head-to-head comparison.

That would be this clinical trial. This was an open label trial, meaning no patient blinding, there was no placebo group and the criteria for assessing improvement included several subjective measures:

The ACR Core Data Set includes 7 measures – swollen joint count, tender joint count, patient assessment of global status, an acute phase reactant [erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)], health professional assessment of global status, physical function, and pain; the first four of these measures are included on the DAS. Improvement criteria for the ACR Core Data Set are based on improvement of at least 20% in both tender and swollen joint counts, and three of the five additional measures (ACR 20), and corresponding “ACR 50,” and “ACR 70.”

I would be more impressed by a double-blind study, and it would be interesting to see if there were objective differences between the methotrexate and thunder god vine groups e.g. CRP, ESR, rheumatoid factor or x-rays of joints (I don't have access to the full study, sadly).

Also worth noting is that one systematic review and meta-analysis of thunder god vine in RA (PMID: 16487688) concluded:

However, the literature indicates that T. wilfordii is associated with serious adverse events which make the risk-benefit analysis for this herb unfavourable. Therefore, we cannot recommend its use.

Those adverse events include diarrhea, indigestion, nausea, upper respiratory tract infections, hair loss, headache, menstrual changes, skin rash, decrease in bone mineral density in women who take the herb for 5 years or longer and possible decreased male fertility. Still, they are natural adverse events so I suppose that's OK.

By Krebiozen (not verified) on 04 Nov 2014 #permalink

anointed experts from one small group of countries

We definitely need a double-blind RCT to test whether Chrism confers expertise.

Is Pedro @34 the usual pot troll or a new one?

By herr doktor bimler (not verified) on 04 Nov 2014 #permalink

Still, a punchier name for the trope would be useful. “They thought us quacks,” maybe? The “we’re really, really science, maaaan” trope, perhaps? Perhaps you can help me out. I’ll leave thinking of a pithy, punch

This is probably not pithy or punchy enough, but the first phrase which occurred to me is the old standby "No Right; No Wrong; Just Different."

It seems to me that proponents of quackery are making an analogy to different styles of food, of dance, or maybe just different lifestyles or cultures. In this case, we're dealing with different styles of science. Different sorts of medicine. And gosh, no one way is going to suit everyone. Let's put it all on the smorgasbord and let the patients choose!

The skeptics are of course automatically the bad guys in this scenario because if we're dealing in NRNWJD territory disputes and debates turn you into a bigot. You're trying to tell people YOUR way is the ONLY way. And need I point out that this tipetoing nary-a-negative-word respect is the hallmark of the ecumenical approach to religion (Many paths to the Truth?) The worst thing you can do is be judgmental.

9 times out of 10, "holistic" means they're including your feelings, the spiritual world, or both.

Perhaps you should get over your own hype and do some actual research into the value and validity of alternative medicine. You present a rather smug, uninformed, western- centric ( possibly Big Pharma funded) biased, closeminded viewpoint.

VMDPHD's comment depressingly reminds me that Wisconsin Public Radio still gives this person a monthly 90-minute slot, even though they have another one for someone from the UW veterinary school.

Scientificalization?

You can find the thunder god vine study here http://ard.bmj.com/content/early/2014/03/18/annrheumdis-2013-204807.full

Open label, with subjects in the methotrexate or TwHF monotherapy groups switched to the combined methotrexate plus twHF group at 12 weeks if they reported no improvement in symptoms.

Efficacy determinationwas heavily informed by patient self-assessment:

The primary efficacy point was the proportion of patients achieving an ACR50 (the American College of Rheumatology criteria) response at week 24. To meet the criteria, patients had to have ≥50% improvement in both tender and swollen joints (28 tender and 28 swollen joints were assessed) and ≥50% improvement in three or more of the following: the evaluator's or patient's assessment of global health status, the patient's assessment of pain on a visual analogue scale, the patient's assessment of function using the Health Assessment Questionnaire (HAQ) and the ESR or serum CRP level.

is this really the best evidence in support of traditional Chinese medicine Jane has to offer?

There is a plethora of evidence to support medical modalities other than the present drug cult of Western medicine.

I'd love to see that evidence, VMDPHD. Where can I find published articles documenting well designed, appropriately blinded and controlled studies which support the safety and efficacy of these alternative medical modalities in first or second-tier peer-reviewed scientific journals?

medical modalities other than the present drug cult of Western medicine

That's a rather broad catchment, encompassing mainstream non-pharmaceutical medicine -- surgery, exercise / dietary recommendations -- as well as tribal drugs from around the world. But I hope no-one would cite the evidence supporting the former as a reason to take the latter seriously!

By herr doktor bimler (not verified) on 05 Nov 2014 #permalink

@herr doktor bimler - no, no! If any treatment besides a drug made by a major pharmaceutical company is effective for any condition, then any non-drug treatment is necessarily effective for all conditions. Thus spake Zarathustra!

By Mephistopheles… (not verified) on 05 Nov 2014 #permalink

Since selected CAM is now being integrated into real medicine perhaps we should recognize these selected practices with the acronym SCAM

Overview Confronting skeptics and arguing that Western physicians cannot afford to ignore over 5000 years of Chinese medical tradition, Dr. Daniel Keown challenges the popular belief that acupuncture cannot be part of truly scientific medicine. With a radical new approach which ties together Western medicine and the Chinese energetic system, The Spark in the Machine will take you on a journey over billions of years to the outer realms of medical science... http://www.barnesandnoble.com/w/the-spark-in-the-machine-dr-daniel-keow….

By Karin Six (not verified) on 06 Nov 2014 #permalink

Overview Confronting skeptics and arguing that Western physicians

Your impressively sloppy spam is noted.

Are you the chemtrails "Karin Six," by any chance?

"By definition," I begin
"Alternative Medicine", I continue
"Has either not been proved to work,
Or been proved not to work.
You know what they call 'alternative medicine'
That's been proved to work?
Medicine."
- Storm, Tim Minchin

Dr. Daniel Keown challenges the popular belief that acupuncture cannot be part of truly scientific medicine.

All he has to do is prove that it has a significant clinical benefit in a substantial replicated double-blind, placebo controlled trial. Repeat for each condition where someone wants to use acupuncture as a treatment - after all, an effective treatment for, say, pain cannot be assumed to be effective for, say, gout.

If he could do that, then it certainly could be part of truly scientific medicine.

By Mephistopheles… (not verified) on 08 Nov 2014 #permalink

It's almost as if he would rather sell books.

By herr doktor bimler (not verified) on 08 Nov 2014 #permalink

Agreed, Chinese Medicine is not a science. But regardless, is the goal of medicine to simply to help people feel better? Most people would agree. So if these "woo woo" therapies work, if they help people feel better, then why does it matter whether the underlying mechanisms are completely understood...
Perhaps it would serve us well to stop spending money researching chinese medicine and similar therapies; and instead allow clinical & therapeutic outcomes to be the proof.

Adam: "So if these “woo woo” therapies work, if they help people feel better, then why does it matter whether the underlying mechanisms are completely understood…"

And if they don't work? What about those who pay good money for something that is worthless and carries some risk?

Perhaps it would serve us well to stop spending money researching chinese medicine and similar therapies; and instead allow clinical & therapeutic outcomes to be the proof.

So riddle me this - how do we evaluate those clinical & therapeutic outcomes without spending money on research?

By Mephistopheles… (not verified) on 10 Nov 2014 #permalink

But regardless, is the goal of medicine to simply to help people feel better? Most people would agree.

Most people would be wrong then, wouldn't they? The goal insn't just to make them 'feel better' while their illness runs its course unimpeded but to actually address whatever illness or injury they suffer from.

If the goal was simply to help them feel bertter while doing nothing to halt their illnesses progression we could simply prescribe opiates for damn near everything, as in fact was common in the not too distant past when laudanum was available over-the-counter).

Perhaps it would serve us well to stop spending money researching chinese medicine and similar therapies; and instead allow clinical & therapeutic outcomes to be the proof.

How are we to determine what thses clinical and therpaeutic outcomes are without spending money on research?

is the goal of medicine to simply to help people feel better? Most people would agree.
What fresh stupidity is this? Most things that "help me feel better" are emphatically not medicine, are not available on prescription, and may not even be legal.

By herr doktor bimler (not verified) on 10 Nov 2014 #permalink

There is an old Chinese remedy that does help people feel better - the prepared exudate of the seed capsule of Papaver somniferum. A large enough dose will put an end the course of any disease. It's natural, so it must be perfectly safe and without side effects.

As is the goal of Chinese medicine, treating the cause is always a priority to treating symptoms.
Furthermore, an important question to consider is not how acupuncture compares to placebo, but how it compares to standard medical treatments.
This meta-analysis speaks to clinical outcomes of acupuncture treatments relative to standard of care treatment for migraines, it is but one example of many: http://www.ncbi.nlm.nih.gov/pubmed/19160193.
Additionally, a RCT evidence review by the BMJ concludes that at least 50% of all treatments (including both conventional and alternative therapies) are of "unknown effectiveness." So in the spirit of most effective clinical outcomes, perhaps we need to keep in mind that "conventional" treatments need to be scrutinized with the same critical eye as "alternative" therapies.
BMJ reference: http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisatio…

As is the goal of Chinese medicine, treating the cause is always a priority to treating symptoms.

This hardly seems to be the case with aconite "remedies":

"Being pungent and warm with the actions of dispersing and smoothing, it has a marked action of dispersing cold to alleviate pain, and commonly indicated for pain due to cold congealing and obstruction of meridians."

That seems awfully symptomatic.

^ I mean, what's the deal with all the topical stuff? (PDF) Smearing yourself with stuff isn't going to "get to the cause" of a fracture.

Adam - both questions are important. If acupuncture is no better than placebo and acupuncture is at least as good as a conventional therapy, then by the transitive property the conventional therapy may be no better than placebo. This would certainly be a signal that it's time to re-evaluate the effectiveness of the conventional treatment.

As to using a critical eye when evaluating any therapy, I can only agree. Special pleadings are no more appropriate for conventional treatments than for alternative ones.

By Mephistopheles… (not verified) on 25 Nov 2014 #permalink

Adam:

So in the spirit of most effective clinical outcomes, perhaps we need to keep in mind that “conventional” treatments need to be scrutinized with the same critical eye as “alternative” therapies.

Goodness, I don't want to degrade the scrutiny of conventional treatments to the low standard widely applied to alternative therapies! All therapies should receive the same critical eye, and I don't think anybody here would disagree with that (except maybe some of the alt-med proponents who claim it can't be tested).

It is unfortunately true that there are no good, widely effective treatments for migraine. I suffer migraines, and I've tried a bunch of things, and have the nagging suspicion that nothing actually works; some things just get tried when the migraine is about to resolve anyway. But that's not an argument in favor of acupuncture. When nothing works particularly well, I don't take that an endorsement of any of the things that don't work particularly well and it puzzles me that anyone would.

By Calli Arcale (not verified) on 25 Nov 2014 #permalink