Science and the AAAS sell their souls to promote pseudoscience in medicine

ScienceTCMsupp

NOTE: There is a follow up to this post.

The holidays are over. Time to start dishing out fresh Insolence, Respectful and, as appropriate, not-so-Respectful for 2015.

I do, however, feel obligated to deal with one painfully inappropriate action by a major science journal left over from 2014. It happened in an issue that came out just before Christmas, and, with all the festivities, being on call last week, and having houseguests; so, unfortunately, I just didn't get around to addressing it, either here or on my not-so-super-secret other blog (where I might crosspost this later in the week). The journal is Science, which, as most readers know, is one of the two most prominent general science journals out there, the other being Nature. Actually, it's appropriate that I mention Nature in this discussion because Nature pulled exactly the same bone-headed move three years ago, almost to the day.

Yes, Nature shilled for traditional Chinese medicine (TCM) by publishing an advertising supplement promoting it sponsored by a Japanese supplement manufacturer. Now it's Science's turn to do the same in the form of—you guessed it!—an advertising supplement entitled The Art and Science of Traditional Medicine Part 1: TCM Today — A Case for Integration. Worse, Science appears to be going Nature one better—two better, in fact. This is the first part of what is promised to be a three part series.

Looks like I have blog material for a while.

The overview of the issue is nausea-inducing:

In this first installment of a three part series, "The Art and Science of Traditional Medicine," we present a series of articles making a case for the integration of traditional Chinese medicine (TCM) into modern medical practice. From the new WHO Traditional Medicine Strategy to the application of systems biology in studying TCM, we aim to highlight the potential for creating an integrated, network-based health care system. The next two issues will cover herbal genomics and highlight the importance of quality control, standardization, regulation, and safety for traditional therapies. An overview of indigenous medicines in Europe, Africa, the Middle East, India, and the Americas will also be provided.

How about the importance of applying actual science to medical treatment, not "rebranding" herbal medicines as somehow "alternative," and eliminating prescientific superstitious beliefs about disease, such as the concept of qi and the idea that you can map any organ to an area of the tongue using "tongue diagnosis"? Or maybe we should make a case for "integrating" traditional "Western" medicine into science-based medicine. After all, what are the "five elements" in TCM but a different version of the four humors of the humoral theory of disease that was practiced dating back to the time of Hippocrates until less than a couple hundred years ago? Or what about homeopathy, which was invented by a German? Where's the love for traditional Western medicine (TWM), here, Science?

One has to wonder about the authors here, too. For instance, Josephine Briggs, the director of the National Center for Complementary and Integrative Health (NCCIH, formerly the National Center for Complementary and Alternative Medicine, or NCCAM) is listed as part of the editorial team. Is that kosher? She's a government official and she's contributed to the writing of what is, in essence, an advertorial section. Other editors include known boosters of TCM, such as Jan van der Greef, PhD, of the University of Leiden, who actually contributed a particularly awful article to the Nature debacle three years ago. The overall guest project editor is Tai-Ping Fan, PhD, from the University of Cambridge, who looks like a scientist who started out strong studying angiogenesis (one of my favorite topics) but became enamored with the herbal treatments of TCM and is now wasting sophisticated genomics and next generation sequencing methods to study woo.

The introductory articles are painful to read, full of the obfuscations and justifications for the pseudoscience that makes up most of TCM, all wrapped up in calls for more tooth fairy science and completed with a bow of argumentum ad populum. Disappointingly, Margaret Chan, MD, the Director-General of the World Health Organization, begins this parade in an article entitled Supporting the integration and modernization of traditional medicine:

TM [traditional medicine] is often seen as more accessible, more affordable, and more acceptable to people and can therefore also represent a tool to help achieve universal health coverage. It is commonly used in large parts of Africa, Asia, and Latin America. For many millions of people, often living in rural areas within developing countries, herbal medicines, traditional treatments, and traditional practitioners are the main—and sometimes the only—source of health care. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health care costs and widespread austerity.

Calling Dr. Chan. Calling Dr. Chan. The zombie corpse of Chairman Mao Zedong called. He wants his 1950s-era justification for promoting TCM and "integrating" it with "Western" medicine back, not to mention his "barefoot doctors." Meanwhile, he's laughing because he did not believe in or use TCM, nor do most educated Chinese, for that matter.Indeed, more than anything else, in China, TCM practitioners are complaining about the infiltration of "Western medicine" into their bailiwick. Of course, using a medical system based on prescientific religious beliefs (e.g., Taoism) to "achieve universal coverage" doesn't exactly achieve universal coverage with effective medicine, now, does it?

It goes downhill from there:

In wealthy countries, TM meets an additional set of needs. People increasingly seek natural products and want to have more control over their health. They turn to TM to relieve common symptoms, improve their quality of life, and protect against illness and diseases in a holistic, nonspecialized way.

Hey, it's not just the poor upon whom we can foist our pseudoscience! The rich worried well in "Western countries" like it too! Better yet, they'll pay big money for it! You know, Dr. Chan mentions the WHO Traditional Medicine Strategy. I might very well have to take a look, if her rationales here in any way resemble what the WHO published. True, she makes the most massive understatement of the year (2014, given that that's when this was published) when she opines that "to move into mainstream medicine on an equally trusted footing, TM needs a stronger evidence base." However, she doesn't seem to consider the question of: What happens if that stronger evidence base just doesn't exist, as it doesn't for practices like tongue diagnosis and acupuncture? Never fear, though. The WHO is all about "integrating" quackery with scientific medicine because...well, because:

The two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in beneficial harmony, taking advantage of the best features of each system and compensating for certain weaknesses in each as well. In an ideal world, TM would be an option, a choice, offered by a well-functioning, people-centred health system that balances curative services with preventive care. The challenge is to give TM its appropriate place in an integrated health system, to help all practitioners understand its unique and valuable contribution, and to educate consumers about what it can and cannot do. In other words, we need to modernize this rich resource and cultural heritage, and put it in its proper place in today’s world.

What if its proper place in today's world doesn't exist? Strip TCM of its Taoist roots, its balancing of the five elements and attribution of disease to excess "heat," "dampness," or other such aspects, and pretty much all you have left is herbal medicine, which needs no special dispensation to become part of science-based medicine. All it needs is for pharmacologists and physicians to study it, identify what's useful and discard what is not, and then figure out what active ingredients can be used. Then it could become just "medicine," as the cliche goes. Dr. Chan prominently brags in her article that "nearly a quarter of all modern medicines are derived from natural products, many of which were first used in a traditional medicine context." Even if so, that doesn't mean that all of TCM is of value or even that all of the herbal medicines used in TCM have value.

Next up, the CEO of the American Association for the Advancement of Science and Executive Publisher of Science, Alan Leshner, PhD, proclaims A middle way for traditional medicine. Dr. Leshner's very first paragraph should result in his immediate firing by the AAAS Board of Directors, so horrible is the misunderstanding of the science of medicine reflected in it:

In discussions surrounding traditional healing techniques, a common perception is that those in the West most often take a reductionist approach to medicine, breaking down the body into ever-smaller parts in order to understand its inner workings. In the East, by contrast, medical practitioners are seen to take a more holistic view, regarding the body as a complex, integrated system and treating it as such.

Utter bollocks, Dr. Leshner. This is a stereotype promulgated by quacks who want to attack "Western medicine." Good science-based primary care medicine is holistic. It takes care of the whole patient. As for "reductionism," part of the reason why medicine tended to be reductionistic in the past is because it just didn't have the tools to analyze more than one—or a handful—of genes and enzymes at a time. This, however, has rapidly changed over the last couple of decades, with the advent of cDNA microarrays that can measure the expression of every known gene in the genome at once; next generation sequencing, which, when done finely enough, can measure the levels of every transcript produced, now even getting down to the single cell level; and proteomics, which has provided much more powerful methods of analyzing many proteins at once.

Medicine has become more "systems-oriented" now because it can be. It has the tools now. That medicine and medical research have evolved this way has nothing to do with the attraction of TCM or other TM. Yet, that's exactly what Leshner seems to be implying in his article, that "Western medicine" is becoming more like TCM because, again implied, TCM was right to be more "holistic." It's such utter drivel that I found it hard to finish his article, as brief as it was. That's even leaving aside the inherent racism in the whole false dichotomy between "Western" and "Eastern" medicine, which implies that the "West" is more analytical and reductionist, while the "East" is more "holistic" and touchy-feely.

Leshner ends appealing to the "middle way" of Buddhism:

In Buddhism, the Middle Way is described as the route to enlightenment—a path found by balancing opposing views, accepting neither extreme, but rather investigating both sides and finding a middle ground. Perhaps a Middle Way can be found for traditional medicine, one that takes the best of East and West and brings them together for the benefit of all.

Can anyone name the logical fallacy here? It's known by a few names: the fallacy of the golden mean, the appeal to the middle ground, and the argument to moderation. Just because there are two extreme positions does not automatically mean that the truth lies somewhere between the two positions. Think antivaccine pseudoscience. Think evolution denialism. Advocates of such positions love to try to present themselves as being "reasonable" and urging their opponents to "meet them in the middle," but for some things there is no middle ground, or the truth is so much closer to one pole than the other that, for all practical purposes, there is no middle ground.

You know what? as I write this, I realize that there's so much material in this advertising supplement, so many fallacies, and so much...plain wrongness that I think I will require at least one more installment to cover it. Indeed, the papers by Briggs and colleagues and discussions of the WHO Traditional Medicine Strategy will likely take at least one more post, if not more.

In the meantime, however, I can quickly and easily cover the last article in the paper, an article by Geoffrey Burnstock entitled Purinergic signaling in acupuncture. I already covered this rather blatant appropriation of acupuncture as a means of making an interesting, but relatively mundane, discovery about pain signaling as somehow being relevant to acupuncture. It isn't, at least not in any apparently clinically useful way. Let's just say that trying to shoehorn adenosine and purinergic signaling into acupuncture is very similar to how, for instance, quacks have appropriated the developing science of epigenetics to justify claims that "we control our genome." It takes quite a contortion to accomplish this.

In the meantime, I can't help but say to whoever at Science decided that publishing an advertising supplement like this, plus two additional ones to come: What the hell were you thinking? I mean, seriously. Publishing a blatantly purchased supplement promoting TCM is no different than publishing a blatantly purchased supplement paid for by a drug company promoting drug research and its own products. In fact, if you look at the table of contents of this supplement you will find that none of the material in this supplement was peer-reviewed:

The content contained in this special, sponsored section was commissioned, edited, and published by the Science/AAAS Custom Publishing Office. It was not peer-reviewed or assessed by the Editorial staff of the journal Science; however, all manuscripts have been critically evaluated by an international editorial team consisting of experts in traditional medicine research selected by the project editor. The intent of this section is to provide a means for authors from institutions around the world to showcase their state-of-the-art traditional medicine research through review/perspective-type articles that highlight recent progress in this burgeoning area. The editorial team and authors take full responsibility for the accuracy of the scientific content and the facts stated.

Sadly, I can't help but conclude, Science, like Nature, has sold its soul. Nature, at least, seems to have learned from its mistake. At least it hasn't done it again in three years. It remains to be seen how low Science will go. After having skimmed the articles that require further discussion, I shudder to go deeper, and I await with trepidation the next two segments in this ad-fest.

For shame, Science. There is no excuse.

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As I read it above and then in the supplement, I couldn't believe someone who had risen to be CEO of AAAS could have the sheer ignorance and stupidity to state:

In discussions surrounding traditional healing techniques, a common perception is that those in the West most often take a reductionist approach to medicine, breaking down the body into ever-smaller parts in order to understand its inner workings. In the East, by contrast, medical practitioners are seen to take a more holistic view, regarding the body as a complex, integrated system and treating it as such.

I absolutely agree that someone holding his positions in the AAAS and with the journal Science should be summarily fired from both positions for the above paragraph.

By Chris Hickie (not verified) on 05 Jan 2015 #permalink

Here is something I find interesting. As far as I can tell, one form on ancient Chinese medicine has been modified and adopted by Western medicine, and indeed the world all over- vaccines.

The Chinese practiced variolation, a precursor to vaccination. They did this in India too. I bring that up whenever I see anti-vaxxers gushing about Ancient Chinese Medicine. I love to ask them why they reject this part of it.

http://www.historyofvaccines.org/content/chinese-smallpox-inoculation

Please read Prof. Gotzsche's "Deadly medicines and Organised Crime". Very well referenced with published, refereed scientific papers.

I tried to read the supplement. I really did. I got as far as the popularity fallacy and the some of are pharmaceuticals come from nature, so we should embrace quackery fallacy, but I became so nauseous that I could not go farther.

Science and the AAAS should be ashamed of themselves.

By Michael Finfer, MD (not verified) on 05 Jan 2015 #permalink

Reminds me of when National Geographic had SUV ads while having articles on global warming. They got so much guff from readers that they eventually did not renew those contracts. Cognitive dissonance much?

By e canfield (not verified) on 05 Jan 2015 #permalink

Chris, I'd say a paragraph like that wouldn't be out of place in a study on why people use traditional Chinese medicine, probably in an introduction. But it doesn't have much to do with the merits or lack thereof of TCM.

By Becca Stareyes (not verified) on 05 Jan 2015 #permalink

Here's the problem:

1. Western, reductionist medicine discovered vitamins and their effects.

2. Western statistical methods determined that taking vitamin supplements, except in rare cases, has no benefit and in some cases may be harmful.

3. Vitamins are still being sold and consumed in vast quantities.

And then there's gluten-free water...

I guess I can't really get excited about the fuzzy Chinese stuff or even the anti-vaxers when this kind of snake-oil marketing is a giant industry, no to mention all the FDA-approved prescription medicines for new 'diseases' that make me want to kill myself. I mean, if I took any of them-- that appears to be a ubiquitous (if 'rare but serious') side effect.

BTW, can anyone explain why all these drugs seem to have that effect? That's a serious scientific question.

If TCM is so helpful in rural areas, how does Dr. Chan reconcile that with the severity of the current ebola outbreak in West Africa? The whole reason the current epidemic is so bad is that there is so little appropriate health care available to the people in rural areas. Gosh, if only Docs Without Borders had some TCM in their medical bags! The stupid just burns a hole right through the universe.

Zebra:

Most of the people who are taking vitamin supplements now don't need them, because they aren't sick and don't have a deficiency. It's not that most people don't need vitamins, as you imply: it's that most people are getting enough from their food.

The problem isn't with modern medicine: it's with modern marketing. That people are falsely claiming that we should be taking large amounts of unneeded vitamins is a real problem, yes. That doesn't somehow make it okay for someone else to falsely claim that you need large amounts of some other worthless or dangerous substance that they're calling "traditional." Or for an "alternative" practitioner to promote the same unneeded vitamins.

Vicki,

How did I imply that people don't need vitamins?

The point, which you obviously didn't get, is that (relatively) educated people ignore science all the time. That's good, sound, Western science, like Evolution and Climate Science, as well as medical, particularly when someone can make money by using marketing language to sell stuff.

Now, I think there is an interesting Philosophy of Science discussion that we might have about this topic. But as a practical matter, it just doesn't rise to the level of concern I see expressed here. Rural Chinese or Africans or anyone aren't being denied Western medicine because of the traditional practitioners, but because they are poor.

There have certainly been successful efforts to introduce modern good practices in third-world situations using locals-- but someone has to put up the money. Let's improve sanitation before we worry about what may be a form of placebo medicine for those with no options.

Ugh. Just ... ugh.

It's one thing for Science to report the fact that WHO has a new Traditional Medicine Strategy. That's legitimate news, even if you think (as most posters here believe, and I agree) that it's a mistake for WHO to have such a strategy. It's another thing to publish a series of papers endorsing that strategy, or something similar.

At least Mao could claim that the alternative to providing TCM was nothing, and that the former was preferable. One might disagree with that opinion, but the placebo effect is a real thing, so the opinion wasn't obviously wrong.[1] Pushing TCM or other "traditional"[2] medicine in countries which have adequate access to science-based medicine is clearly the wrong thing for a self-described scientist to do.

[1]Mao's China didn't have to deal with anything like Ebola. When you have a hemorrhagic fever outbreak, "traditional" medical clinics might actually be harmful, by allowing additional patients to come in contact with the infected individual.

[2]As regular readers know, some of these so-called "traditional" medical disciplines date all the way back to the twentieth century--reiki is a classic example.

By Eric Lund (not verified) on 05 Jan 2015 #permalink

I'm surprised at Nature, since TCM is driving so many endangered animals to extinction.

By Politicalguineapig (not verified) on 05 Jan 2015 #permalink

Alties usually gripe and moan about SB periodicals accepting advertising from pharma ( see AoA about BMJ), perhaps they'll be happy now: woo-meisters can crow that SBM has 'seen the light'/

By Denice Walter (not verified) on 05 Jan 2015 #permalink

The Fermi Paradox is alive and well...Anti-science nonsense will be the death of what little intelligence we on Earth demonstrate.

zebra, you obviously don't want to engage in discussions on this blog or any other blog, as evidenced by your statement:

"I guess I can’t really get excited about the fuzzy Chinese stuff or even the anti-vaxers when this kind of snake-oil marketing is a giant industry, no to mention all the FDA-approved prescription medicines for new ‘diseases’ that make me want to kill myself. I mean, if I took any of them– that appears to be a ubiquitous (if ‘rare but serious’) side effect."

Many of us do comment regularly on Respectful Insolence, the Science Based Medicine blogs and on dozens of other science blogs...as well as mainstream media blogs.

lilady #16

No idea what you are getting at.

Could you explain what "many of us comment regularly" is supposed to convey... ? Is there some exclusive club that you belong to? Sounds mystical, like that TCM stuff.

I'm happy, as I said, to discuss the science aspect of the topic.

Where's Kent Anderson when you need him?

I believe that people are misunderstanding zebra's comments a bit. The gist seems to be that while it is all well and good to complain about the creep of TCM into modern health care, etc., there are larger, more important issues to talk about (e.g., the overly aggressive marketing of products of dubious benefit by large, multi-national companies or improving basic living conditions in developing nations) and that educated people ought to know better than to fall for this marketing.

That's all well and good, but really quackademic medicine is an important topic to discuss, since it does have an impact on health care overall, not to mention in developing nations. We can have discussions about both things, in my mind.

Todd W #19,

Thanks for actually reading what I wrote.

So, the question would be whether we include vitamin supplements in the quackamedicine category.

So, the question would be whether we include vitamin supplements in the quackamedicine category.

Of course we do, when they're sold as something they're not. If you'd type "supplements" into the search box near the top of the page, you'd find that this has been discussed multiple times.

By Mephistopheles… (not verified) on 05 Jan 2015 #permalink

Oh, and this just as it is time for me to renew my membership to AAAS. I have neglected the recent issues over the holidays. But, now I'm faced with a decision - cancel, based on this transgression, or wait to see if they take action and offer an apology and explanation.

By Ian D'Souza (not verified) on 05 Jan 2015 #permalink

#21

"when they're sold as something they're not."

Why don't you save me the trouble of trying to scroll through previous blog comments and tell me when vitamin supplements are sold as something they "are" as opposed to "are not"?

UGH. As Politicalguineapig said, beyond the obvious, there is also the added ugliness of the fact that many traditional remedies are made from endangered animals. I was watching a documentary the other day and the amount of endangered animal parts for sale was heartbreaking.

By Stacey C. (not verified) on 05 Jan 2015 #permalink

If vitamin C supplements are promoted as a cure for scurvy or to make up for a diet deficient in vitamin C (based on current best data), that would be "sold as something they are". If it is promoted as a way to prevent or cure a cold, that would be "sold as something they are not". If vitamin D is promoted as something that helps promote calcium absorption, particularly for those who don't get a lot of exposure to sunlight, that's "sold as something they are." If they're sold as "a happy pill" (which someone once said), that's "sold as something they are not". Iron supplements to treat anemia are fine.

Is that a fair start, or did you want more?

By Mephistopheles… (not verified) on 05 Jan 2015 #permalink

From now on, all my research publications will be written holistically:

1. They will all begin "In the beginning, there was nothing"... and continue until they have included a sufficient grounding on the gestalt of existence to proceed to my methods and materials section..

2. All cancer research manuscripts will be written holistically, including quotations from Chaucer, the I Ching, German fairy tales, and a Korean dictionary. After all, it's important not to be reductionist about including knowledge in authorship. We should borrow equally from all the fields of scholarship equally, as they all have equal merit.

3. The AAAS Board should be dismissed and reformed to include a more integrative approach: I'd suggest at least one televangelist, the Westborough Baptist Church, a South American shaman, Kim-Jong Un, the Easter Bunny and Santa Claus. All of these people, even the fictional ones, have a unique contribution to make to modern science and medicine.

By c0nc0rdance (not verified) on 05 Jan 2015 #permalink

Stacey: It seems odd that Nature would support TCM, since I assume readers of Nature feel strongly about endangered animals and a publication of that caliber should have been aware of all parts of TCM. So were the editors asleep at the switch or what?

By Politicalguineapig (not verified) on 05 Jan 2015 #permalink

#26

Yes, I understand. If you read my original comment, I mention that they are useful in a few cases. But they are not *marketed* (sold) as something that should be used only under certain specific conditions, which are probably not really subject to self-diagnosis.

Do you think me deciding that I need vitamin D supplements is somehow scientifically more valid than some TCM guy telling me to eat liver?

I said originally that there are interesting Philosophy of Science questions in this. That's one.

@ c0nc0rdance;

I'm disappointed as you left out SO many other ethnicities, religious/ magickal practitioners and personages existing only in folklore or fairy tales.
Please revise your list keeping these considerations in mind
Thanks in advance..

By Denice Walter (not verified) on 05 Jan 2015 #permalink

Chris #24,

Thanks. OK, now I know that there was a post ranting about supplements.

Here's another way of looking at the question I posed to O'Brien.

Which poses a greater threat to people's well-being: Poor practice of Western medicine, which is right part of the time, or correct practice of Chinese medicine?

@zebra

First, let me rephrase your question: Poor practice of medicine or "correct" practice of TCM?

Now, the answer depends on context. Is it poor practice of medicine as the sole treatment vs. "correct" practice of TCM as the sole treatment? You also need to define "poor practice" as well as the population size to consider.

Of course the fact that a significant proportion of drugs started out as analogues of compounds in herbal medicine is actually a point against TM, as the ones which remain that are not part of medical practice, are the ones that didn't work.

By Guy Chapman (not verified) on 05 Jan 2015 #permalink

Todd W,

Let *me* rephrase my earlier question to O'Brien, since that may make my point more clearly:

Which is more likely to help, not harm:

-A TCM practitioner tells a peasant farmer with no access to Western tests or treatments to eat more liver, or eggs, to strengthen bones after a break occurs.

-A poorly educated USA woman takes 10,000IU per day of vitamin D because she wants to avoid osteoporosis, based on what she reads on the internet.

A TCM practitioner tells a peasant farmer with no access to Western tests or treatments to eat more liver, or eggs, to strengthen bones after a break occurs.

How precisely do you arrive at the conclusion that this is the TCM treatment for broken bones?

zebra, what have you been doing to counteract the anti-vaccine groups, the snake oil vendors/supplement sellers and quacks who pander to these groups and the parents of autistic kids who subject their children to painful, dangerous, invasive and unproven "treatments"?

Narad,

I would rather not try to respond to a new individual each time, and Todd W seems to have understood my original comments better than most-- perhaps you like many others just don't read carefully. I didn't say TCM treated broken bones with liver, I specifically said strengthen bones.

But it really doesn't matter what actual TCM would suggest; perhaps I should have made a more random choice since liver is based on my Western scientific knowledge-- OK, powdered Rhino horn.

The idea is to illustrate the underlying difference in the process by which the 'treatment' is arrived at, and potential consequences. Of being right and being wrong.

I would rather not try to respond to a new individual each time

Color me wholly indifferent.

and Todd W seems to have understood my original comments better than most– perhaps you like many others just don’t read carefully.

Or perhaps you're simply tediously whining that this post should have been about a topic more to your liking and getting obnoxiously snippy about it.

But it really doesn’t matter what actual TCM would suggest; perhaps I should have made a more random choice since liver is based on my Western scientific knowledge– OK, powdered Rhino horn.

Then you've answered your own question: Neither is likely to do harm to the individual, and the vitamin D will at least correct any dietary inadequacy.

Narad,

"Neither is likely to do harm to the individual,"

Except if the individual has some underlying condition that would lead to vitamin D toxicity.

As for the post topic-- ranting aside, as I've said a couple of times, I thought the post raised interesting questions.

How did TCM arrive at [rhino horn], and how did Western medicine decide that people should be allowed to decide their own dosage of vitamin D?

Try reading the original post again.

zebra @38: Only it does matter whether you assume that the TCM practitioner suggests liver or powdered rhino horn.

Western medicine tells us that it's very hard to overdose on vitamin D.

We also know that the powdered rhino horn is either real or fake. If it's real, the TCM is directly increasing the risk of extinction of a threatened species. If it's fake, it could be anything, meaning that the TCM could do nothing at all, or could lead to lead poisoning or, for that matter, vitamin D overdose.

You can't find a meaningful answer to the question: "What is more likely to cause a problem, an unnecessary vitamin D supplement or whatever is behind door number 3?" without either opening the door, or at least narrowing the question by telling the contestant "behind door number 3 is either liver, sassafras tea, or a year's supply of Turtle Wax."

Even the reductive vs. holistic debate is mistaken. Science may be cognitively reductive, but this simply means it first studies small pieces and cognizes the bigger pieces in terms of the smaller ones. How do the holists cognize the body?

By Colin Day (not verified) on 05 Jan 2015 #permalink

Vicki,

If what's behind door number three were a serious poison, then it would almost certainly not be part of *traditional* medicine. Or do you not believe in Evolution in the cultural context?

We know that in conventional medicine, and particularly in the USA, there are treatments that are used or overused contrary to what science tells us about their efficacy. Perhaps it's because of the 'successful' part of medicine, which allows people to survive such misadventure. And that successful part of medicine also perhaps tends to suppress skepticism.

But perhaps, for people who don't have quick and easy access to heroic interventions, just having someone with experience and some kind of model to guide them, is the best they can hope for. Do some of those practitioners get things wrong sometimes? Sure, but is sassafras tea more dangerous than acetaminophen, in their respective contexts?

Leshner and the AAAS have form. They promote "constructive dialogue" between science and religion, through the Templeton funded Dialogue on Science, Ethics, and Religion program.

Some scientists are hunky-dory with religion, some are not and some are indifferent. The middle ground here is not accommodation but indifference.

Now Leshner and the AAAS is facilitating the union of medical science with medical woo. This is not the middle ground either.

Shame. Shamanism. Sham. AAAS. Pick your "S".

By Leigh Jackson (not verified) on 05 Jan 2015 #permalink

zebra: "We know that in conventional medicine, and particularly in the USA, there are treatments that are used or overused contrary to what science tells us about their efficacy."

So what? Because there are issues with real medicine, that does not mean TCM works. At least there are people who are working to improve outcomes with conventional medicine, not so much with TCM.

Also, I forgot to mention: rhino horn is made of the same stuff as your fingernails. Killing a rhino, sawing off its horn and turning it into a powder is just as effective as chewing your fingernail.

**OT but are lame-brained woo-meisters who purport to have technology that will save millions from starvation and illness ( which doesn't really work) EVER TRULY OT @ RI?

Mikey's new 3D printer has failed extruding miserably so saving the world will have to wait for a bit ( Natural News today) : it appears that the Lulzbot (tm) ain't all its writen up to be. AND the material is NOT waterproof either- which can be problematic if you're designing hydroponic systems,

Natural News: it's more than an alternative health and news site- it's a comedy factory.

** if at first you don't succeed etc.

By Denice Walter (not verified) on 05 Jan 2015 #permalink

zebra,

If what’s behind door number three were a serious poison, then it would almost certainly not be part of *traditional* medicine. Or do you not believe in Evolution in the cultural context?

Check out Aristolochia, which is one reason I don't believe that TCM has happened upon much of use by trial, error and careful observation. If they didn't notice a substantial proportion of their clientele prescribed Aristolochia dying of kidney failure, I have little faith they would notice anything more subtle.

Regarding your more general point; I don't think many people here would disagree that there are more important things in the world than woo infiltrating real medicine. That doesn't mean we can't be interested and concerned about it.

By Krebiozen (not verified) on 05 Jan 2015 #permalink

zebra - I read your original message as saying, "golly, I can't care much about the spread of TCM because supplements are so badly misused. Why aren't you talking about supplements?" So I pointed out that we have discussed supplements and if you wanted to know what was said, you could find that.

Now you seem to be saying that TCM is not worthy of concern because it's not as harmful as badly used conventional medicine.

You are, of course, entitled to your opinion. In my opinion promoting unproven, ineffective, and possibly dangerous treatments of any type is a subject of concern. Today the topic is TCM. On other days we have discussed other treatments.

Questions along the lines of "which is worse, a dose of rhino horn or a poke in the eye with a sharp stick?" seem rather pointless. There's no reason to want either. If someone were promoting being poked in the eye with a sharp stick, I'm sure that would be a topic for future discussion.

By Mephistopheles… (not verified) on 05 Jan 2015 #permalink

I've seen too many people suffer from side effects of modern medicine to assume that its all scientifically sound.
Some supplements have a proven benefit.
Herbal medicines aren't all just old wives tales. Many of these were studied and tested by generations of physicians.

People have died from placing too much trust in herbal medications that failed to get the job done, but thousands also die each year due to medical malpractice and defective drugs.
Tylenol has destroyed so many livers its ridiculous. Willow bark does the same job and I've yet to hear of it causing organ failure.
The Pharmaceutical industry needs to get its own house in order before they start casting stones.

By Greg Young (not verified) on 05 Jan 2015 #permalink

zebra:

Traditional Chinese medicine included, for many centuries, the use of mercury in order to produce longevity. Traditional European medicine included bleeding patients. Both of these practices lasted far longer than your optimistic view of cultural evolution makes room for.

zebra

But it really doesn’t matter what actual TCM would suggest; perhaps I should have made a more random choice since liver is based on my Western scientific knowledge– OK, powdered Rhino horn.

Powdered Rhino horn is definitely harmful for the Rhinoceros.

By Militant Agnostic (not verified) on 05 Jan 2015 #permalink

Leigh Jackson: "Leshner and the AAAS have form. They promote “constructive dialogue” between science and religion, through the Templeton funded Dialogue on Science, Ethics, and Religion program."

Clearly, Mr. Leshner is an idiot. At least in the US, there's no such thing as 'constructive dialogue' between science and religion. Heck, look how controversial the new Cosmos was. (Although, in my personal opinion, they really shouldn't have put it on Fox in the first place) Religion will destroy science unless scientists take a stand.

By Politicalguineapig (not verified) on 05 Jan 2015 #permalink

"Religion will destroy science unless scientists take a stand."
That's the most ridiculous statement I've seen today.

Too much faith in the process of establishing anything as fact through consensus of opinion is undermining science.
Mistaking correlation for causation is another dead end for the road to knowledge.
Trying to kill open discussion while demanding that all toe the line or be censored is the death knell for advancement in any sector.
There seem to be more in the way of pseudo scientists than pseudo science these days.
A closed mind is unlikely to produce anything worth listening to.

By Gerg Young (not verified) on 05 Jan 2015 #permalink

pretty much all you have left is herbal medicine, which needs no special dispensation to become part of science-based medicine. All it needs is for pharmacologists and physicians to study it, identify what’s useful and discard what is not, and then figure out what active ingredients can be used. Then it could become just “medicine,” as the cliche goes.

And becoming "medicine" puts a stumbling block in the way of those who need the healing. Often, this really can prevent harm. Often, this really can give a jail term instead of individual-enabled healing. Always, it suddenly takes a fat mastercard.

The Food and Drug Administration (FDA) position is that red yeast rice products that contain monacolin K, i.e., lovastatin, are identical to a drug and, thus, subject to regulation as a drug.

http://en.wikipedia.org/wiki/Red_yeast_rice#Regulatory_restrictions

Is it 'irony' or mearly 'unfortunate' that integrating TCM with SBM is the shortest route to stamping out the working aspects of TCM??

Questions along the lines of “which is worse, a dose of rhino horn or a poke in the eye with a sharp stick?” seem rather pointless. There’s no reason to want either. If someone were promoting being poked in the eye with a sharp stick, I’m sure that would be a topic for future discussion.

MO'B: for the past year, my retinologist has been poking me in each eye, monthly, with sharp sticks. The Eylea injections from the sharp sticks seems to have resulted in arrest and reversal of my macular degeneration. I would promote such retinologist-ordered poking for anyone else who may benefit.
A dose of rhino horn does not seem to have any benefit, for anyone (especially the rhino). I can see no reason to promote it.

By Bill Price (not verified) on 05 Jan 2015 #permalink

Uncommon Descent gets it, I see.

"Science journals are shilling for the placebo effect."

UD says about itself:

Materialistic ideology has subverted the study of biological and cosmological origins so that the actual content of these sciences has become corrupted. The problem, therefore, is not merely that science is being used illegitimately to promote a materialistic worldview, but that this worldview is actively undermining scientific inquiry, leading to incorrect and unsupported conclusions about biological and cosmological origins. At the same time, intelligent design (ID) offers a promising scientific alternative to materialistic theories of biological and cosmological evolution — an alternative that is finding increasing theoretical and empirical support. Hence, ID needs to be vigorously developed as a scientific, intellectual, and cultural project.

IOW, science should serve the interest of religious ideology, not show an indifference to ideology of any form. ID can accommodate the placebo effect, just like Science can, it appears.

Squirm Science, squirm.

By Leigh Jackson (not verified) on 05 Jan 2015 #permalink

Except if the individual has some underlying condition that would lead to vitamin D toxicity.

Yah. So, you were relying on obesity predisposing to hypervinosis D and thus chose the regular tolerated upper limit?

Well, that's fυcking dandy. You're left with at least two problems, though: The first is that the original question was therefore doubly loaded, although you "played" dumb in #37 with the redaction to rhino horn, leaving a singly "loaded" residue. The second is that you're stuck with what such specifically constructed scenarios have anything to do with your putative, overarching whining point in terms of representativeness.

^ "hypervitaminosis"

Funny how this happened after Bruce Alberts left the AAAS...

Personally I don't really care about "Western / Chinese" medicine. What matters to me is if the effectiveness of the therapy and its side effects are rigorously documented. (As we saw with the Aristolochia / mercury / bleeding, clinical experience alone is unfortunately not sufficient too often)

The other problems discussed (medical malpractice, incorrectly prescribed medications, marketing of supplements) are not "Western medicine" problems ; they are western health systems / marketing problems. (ex. the poor organization and lack of budget in some hospitals, the very liberal regulation on supplements...)

Orac @46

You seem to be very concerned with rhetorical fallacies. What you are doing here is called "Guilt By Association".

O'Brian @49

"That's not what we're discussing" is a mixture of several fallacies, as is "you're entitled to your opinion". I already knew that I'm entitled to my opinion, and my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM. Other than Ipse Dixit, you (and others) make no argument to the contrary.

zebra - You are incorrect. Failings in the practice of conventional medicine do not justify promoting traditional medicine, if that traditional medicine has not been shown to be safe and effective.

I personally am perfectly comfortable with the thought that there are some treatments from traditional medicine that are safe and effective. If you've got evidence of any, please share. Likewise, if you have evidence that traditional medicine never provides harmful treatment, please share.

P.S. At no time did I say "that's not what we're discussing". And if you know you're entitled to your opinion, how can my statement saying so be a fallacy?

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

@Bill Price - point taken.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

zerba- I could just as easily say that the failings of conventional medicine justify the burning of witches. Learn basic logic.

By Gray Falcon (not verified) on 06 Jan 2015 #permalink

I remember reading years ago that consuming the liver of a Seal killed at a certain time of the year could kill you.
Not something most would have to worry about, other than Inuit.
The seal stored enough vitamin D from foods it consumed during a short season to last for the entire year, the amount of vitamin D in their liver would kill a human.

As for example of an effective herbal remedy I've tried recently is use of an expended tea bag to reduce the pain of an abscessed tooth till I could get to a dentist.
After finding this worked better than expected I remembered that bandages soaked in tannic acid were once used to dress third degree burns. They reduced pain but unfortunately increased formation of scars.

Don't know of much benefit from mercury other than it being an ingredient in some salves.
Arsenic on the other hand did have some effect on certain diseases such as syphilis, and led to development of Erlich's "Magic Bullet" line of arsenic based toxins that targeted specific disease organisms, and that led to the development of chemo therapy.

The writings of Greek Physicians were preserved and studied by medieval scholars in the Catholic Church and in the Muslim lands.
Galand was a very experienced surgeon , others were experienced in herbal and primitive chemical medications.
A German Nun compiled a encyclopedia of herbal medications.
One of the Popes (don't remember his title) compiled an extensive medical encyclopedia.
The monastic system preserved knowledge that would otherwise have been lost during the dark ages.

By Greg Young (not verified) on 06 Jan 2015 #permalink

#64 (and 66)

Come on, you have to do better than obvious strawmen-- and using the equivocal "promoting" TM; my goodness, it sounds like those supplement commercials.

"my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM"

You still haven't answered that. Looking at TM in isolation is pointless if we are talking about practice and policy. In fact, the whole basis for Orac's ranting seems to be the idea of 'integrating' the practices.

If TM is a relatively innocuous (medically) form of placebo, then it is certainly fair to compare it to practices like prescribing antibiotics to people with a viral upper respiratory infection. And please, don't tell me that is a rare event.

If people are convinced that Rhino horn is just as good, I would make that the treatment of choice.

I would also 'integrate' by taking all the antibiotics we then don't prescribe (along with what we feed to cows) and sending them to TM practitioners in remote villages. With a little bit of training, lots of lives could probably be saved.

“my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM”

You still haven’t answered that.

Au contraire. I answered that very specifically with the statement "You are incorrect." That is my opinion.

In fact, the whole basis for Orac’s ranting seems to be the idea of ‘integrating’ the practices.

Orac certainly discussed the proposal (not his) of integrating the practices of science based and traditional medicine. He sees it as a bad idea.

If TM is a relatively innocuous (medically) form of placebo then it is certainly fair to compare it to practices like prescribing antibiotics to people with a viral upper respiratory infection.

True. However, that would say that we should argue against the practice of prescribing antibiotics to people with viral infections (assuming no secondary bacterial infections). I don't think you'll find any dissent here.

If people are convinced that Rhino horn is just as good, I would make that the treatment of choice.

That's a bad idea because a) it contributes to the extinction of the rhinoceros and b) giving a placebo instead of actual treatment is condescending at best and promotes superstition at worst.

I would also ‘integrate’ by taking all the antibiotics we then don’t prescribe (along with what we feed to cows) and sending them to TM practitioners in remote villages. With a little bit of training, lots of lives could probably be saved.

How about instead of adding a few drugs to unproven practice we were to supply them with better training and information on modern disease theory?

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

One small addition: while some treatments prescribed by traditional medicine are relatively innocuous placebos, not all are. There is also an entire set of underlying assumptions which are not validated as being helpful to identifying or treating diseases. Teaching those in addition to stuff we think works (based on current best science and clinical practice) provides no improvement to conventional medicine.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

@Greg Young

I remember reading years ago that consuming the liver of a Seal killed at a certain time of the year could kill you.
Not something most would have to worry about, other than Inuit.
The seal stored enough vitamin D from foods it consumed during a short season to last for the entire year, the amount of vitamin D in their liver would kill a human.

Not to be pedantic, but I believe you're thinking of vitamin A.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

Just remembered another medieval treatment, blood letting.
Blood letting is the treatment of choice for Hemochromatosis, excessive iron in the blood.
They remove quite a lot of blood, the blood the body manufactures to replace it has less iron until the iron build up again reaches dangerous levels, then they let more blood.
In some cases regular blood donation is enough to control the condition.

I use a commonly available supplement mixture of Chamomile, Melatonin and Valerian. Its been of great help in reducing my need for prescription pain medications and allows me to sleep.

By Greg Young (not verified) on 06 Jan 2015 #permalink

O'Brian:

" I answered that very specifically with the statement “You are incorrect.” That is my opinion."

You and Orac, from his part two, seem not to be too clear on the concept of rhetorical fallacies. Did you look up Ipse Dixit?

Putting aside the obvious silliness about my metaphorical use of "Rhino horn" (you do know what a metaphor is, right?)...

you've nicely made my earlier point when you say that "it would be condescending and promote superstition."

So when a suburban housewife in the USA thinks she *must* get antibiotics for a head cold, what is the doc who prescribes them doing? How is the housewife's fantastical woo different from what the peasant farmer believes?

Who's being condescending here, I wonder?

And as for:

"How about instead of adding a few drugs to unproven practice we were to supply them with better training and information on modern disease theory?"

This is a true no-brainer, again validating an earlier point. Because they don't have the support system that would allow them to use the information? I know it would be 'condescending' in your mind, but it would be far more effective to use the faith the locals have in them to slip them some modern medicines. This is a model that has worked, as I pointed out way back. Doesn't require medical school; spend the money on a solar powered refrigerator and stuff like that.

MO'B

@Bill Price – point taken.

I see that you did there.

By Militant Agnostic (not verified) on 06 Jan 2015 #permalink

@zebra

You have yet to define "poor practice" of medicine in your original question. Also, you might try comparing what a TCM practitioner would actually prescribe, rather than what you think they would (e.g., a combination of herbs vs. the recommendation to eat more liver), versus what a doctor would prescribe for the same thing, not what a company might advertise (which, as others have already stated, is a problem not with medicine, but with marketing).

Let's take rhino horn, for instance. In TCM, powdered rhino horn is prescribed for male impotence. The medical comparator would be something like Viagra or Cialix. I would argue that the rhino horn, on the whole, is a more detrimental. First, it is not regulated, so, as other have pointed out, while the TCM practitioner may be "responsibly" prescribing it, there is nothing to guarantee the purity of the powder. The purity question makes the side effect a completely unknown factor. It may have no adverse effects, or it may have some manner of lethal contamination (or anything in between). Second, use of powdered rhino horn is leading to the extinction of rhinoceroses. While this is not directly detrimental to the patient, it is still a huge negative factor that must be considered.

There is a similar issue with your bone-strengthening example. The Chinese herbs may have some active ingredients that help, but lot-to-lot variation is likely to be quite high. Every dose will have different potency and purity. There are also a lot of other ingredients in there from the herb itself that may increase the risk of adverse effects. Add to that the lack of regulation regarding purity, and you have an increased risk of contaminants like lead or mercury. Against that, you're trying to compare an individual self-medicating with a vitamin D supplement, not a physician who has diagnosed and prescribed vitamin D supplementation. So you aren't even comparing TCM to actual medical practice, even your as yet-to-be-defined "poor practice".

"Not to be pedantic, but I believe you’re thinking of vitamin A."
..........................................................................................
No problem. I'd read of this around 40 years ago so the details are a bit hazy.
The vitamin A overload reacts with vitamin D in the body to increase the toxic effect.
.....................................................................................
"Altered fat-soluble vitamin metabolism

Vitamin A is fat-soluble and high levels have been reported affect metabolism of the other fat-soluble vitamins D,[23] E and K.

The toxic effects of Vitamin A might be related to altered Vitamin D metabolism, concurrent ingestion of substantial amounts of Vitamin D or binding of Vitamin A to receptor heterodimers. There have been reported antagonistic and synergistic interactions between these 2 vitamins as they relate to skeletal health."

By Greg Young (not verified) on 06 Jan 2015 #permalink

@zebra

Can I ask you which is worse: correct practice of medicine (which can have negative side effects at times) or "poor" practice of TCM?

If we are to consider your question, then we must also consider the converse. And really, both questions are pretty poor ones, in that they assume unrealistic ideals/extremes. The reality is in between, since there will always be both good and bad practitioners of both medicine and TCM.

Todd W,

I think that to avoid composition errors, we would both have to agree on what constitutes TM *and* CM, and the potential for poor or correct practice of each. That's in general, not just trading instances.

I look at it as a range of practices for which the system must be held accountable-- so, we go from excessive use of stents, to prescribing antibiotics for head colds, to pretty irrational scheduling of drugs, to allowing excessive marketing...and even including that CM allows supplements whose composition are just as unregulated and chancy as any in TM, except that they come in shiny plastic bottles and uniform capsules. Those are examples of broad categories which I expect you can readily understand.

I suggest you also read my #73. I just haven't seen any argument that TM, even if we can cite some specific somewhat dangerous compounds, has the potential for harm that CM does-- both in terms of outcomes, and costs, including opportunity costs for other treatments. This shouldn't even be debatable, and we can do a simple reductio argument using homeopathy-- ranting about its dangers while pointing out that the stuff can't possibly have any effect is kind of absurd, isn't it?

Leigh Jackson: "At the same time, intelligent design (ID) offers a promising scientific alternative to materialistic theories of biological and cosmological evolution — an alternative that is finding increasing theoretical and empirical support. Hence, ID needs to be vigorously developed as a scientific, intellectual, and cultural project.

IOW, science should serve the interest of religious ideology, not show an indifference to ideology of any form. ID can accommodate the placebo effect, just like Science can, it appears."

I can't tell if you're quoting or if those are your own words. Intelligent Design isn't scientific. It is a Trojan Horse, undermining science at every level. If someone doesn't understand the theory of evolution- at the most basic level, they are hobbled for life in their understanding of biological sciences. It's like someone studying physics who has never heard of gravity. God and science have nothing to do with each other, and never have. If someone wants to be a scientist or a doctor, or even a nurse, they need to learn that worship is only for Sundays (or Saturdays or Fridays depending on the person.) But if the main understanding of the world is constantly filtered through a religious viewpoint, patients will suffer, since they won't get effective treatment (if the patient happens to be the wrong skin color, in the wrong profession, or has the wrong orientation, they'd be lucky to get ANY treatment, let alone the wrong one.)

Placebos are okay for non-life-threatening conditions Heck, I've been consuming lots of cloves to try to improve my teeth. But the problem with TCM is not only that it's advertised for ALL conditions, it's that it's actively impacting the environment, which sugar water and harvesting herbs generally do not do. I happen to like rhinos, though I guess Tim, Mr. Young, Zebra and Leigh Jackson don't.

By Politicalguineapig (not verified) on 06 Jan 2015 #permalink

zebra

I just haven’t seen any argument that TM, even if we can cite some specific somewhat dangerous compounds, has the potential for harm that CM does– both in terms of outcomes, and costs, including opportunity costs for other treatments

PGP - where did Leigh Jackson say they were fine with powdered Rhino horn?

Apparently driving the Rhinoceros to extinction and tormenting bears doesn't count as harm in your world.

By Militant Agnostic (not verified) on 06 Jan 2015 #permalink

@zebra

It seems like you are arguing that, in your view, since the potential harm from real medicine practiced poorly (still undefined) is greater than the potential harm from TCM practiced "correctly" (also undefined), we should not bother arguing against TCM and instead argue against poorly practiced real medicine? Or that we should support TCM use that brings some elements of real medicine into TCM with some minimal level of training? If the former, then you are engaging in a false dichotomy. In the latter, it's a sort of tu quoque (i.e., "since real medicine has the potential for harm, we should therefore support superstition-based treatments").

I don't see why we cannot argue against medical pseudoscience regardless of whether it is so-called "traditional medicine" or misapplication of science-based medicine (e.g., overuse of antibiotics for viral infections).

@Leigh Jackson - I had to re-read your comment to make sure you weren't supporting ID, which it appears you were merely quoting something else, correct?

@zebra

We also need to bear in mind that unrefined herbal medicines are essentially adulterated drugs.

My impression is that Leigh was quoting/paraphrasing Uncommon Descent, with a bit of sarcasm tossed in at the end. I did not read it as supporting UD's viewpoint, esp. considering Leigh's past commenting history at RI.

zebra: "If people are convinced that Rhino horn is just as good, I would make that the treatment of choice."

Obviously you did not click on either SBM link I provided. Do you not understand that consuming rhino horn is the same as chewing your fingernails?

zebra: Let's say someone was convinced that their neighbor was placing a curse on them, and that burning their neighbor at the stake would cure them. Would you make that the treatment of choice?

By Gray Falcon (not verified) on 06 Jan 2015 #permalink

Todd,

I thought I gave a pretty good definition. There are broad categories each of which may contain levels of risks-- unnecessary surgeries, medication, and so on, down to the supplements we allow to be sold without regulation.

You are clearly misunderstanding what I think is very clearly articulated. We can argue against individual dangerous practices in both, but Orac is arguing against integrating TM with CM simply because of ideology. There may be wrong things in TM, but they are not wrong because practitioners use funny language.

Consider again the suburban USA housewife with a head cold. Then consider the peasant farmer, with an infected cut. If the TM practitioner could give antibiotics, while calling them Uga-Bugah-Chi-Adjustment, why would you deny that life-saving intervention? It doesn't matter *why* the patient thinks something is going to help them, it only matters if it helps and doesn't hurt them.

This is neither false dichotomy nor tu quoque. It is simple pragmatism.

Did you look up Ipse Dixit?

I've known what ipse dixit (or proof by assertion) means for decades now. You do realize that you did the same when you said “my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM”? My opinion (rejecting yours)has at least as much basis as yours. If you'd care to justify exactly why your opinion (which, in effect, sets up a false dichotomy, is a tu quoque argument, and misses the point of Orac's post) is justified, I've missed it.

Putting aside the obvious silliness about my metaphorical use of “Rhino horn” (you do know what a metaphor is, right?)

Yes, I know what metaphor is. I also know that physical rhino horn is used by various traditional medicines. I also know that even metaphorical rhino horn may mean parts of creatures which are being hunted towards extinction in order to collect parts that are essentially worthless for treatment. Thus my use of "rhino horn" and "rhinoceros" was metaphorical as well and one could easily substitute in tiger testicles, bear gall bladders, and so on. But lest you be confused on the topic, I never once was specifically discussing rhino horn except as an example.

So when a suburban housewife in the USA thinks she *must* get antibiotics for a head cold, what is the doc who prescribes them doing? How is the housewife’s fantastical woo different from what the peasant farmer believes?

Who’s being condescending here, I wonder?

If you'll note my statements above, I have already conceded this one. Yes, doctors over prescribe antibiotics. Yes, they often do that when they have no effect in order to get the patient out of their hair. Yes, this is wrong. Yes, if a doctor prescribes this saying that it will do something when s/he knows full well it won't, that's condescending.

I presume your use of the term "housewife" is also metaphorical and not indicate that you believe that women who are not in the paid workforce are more susceptible to magical thinking than other people.

it would be far more effective to use the faith the locals have in them to slip them some modern medicines.

It sounds as though you've read "The Little Black Bag" by Cyril M. Kornbluth. Yes, that might be a way to gradually modernize medicine in these areas. However, ho do you justify the introduction of TCM into medical schools and practices in countries that have an advanced medical system (which is, after all, what the post above is about)?

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

Sorry, Leigh. Intelligent Design is one of those things that really gets on my nerves, so I responded hastily.

Todd W: I presume your use of the term “housewife” is also metaphorical and not indicate that you believe that women who are not in the paid workforce are more susceptible to magical thinking than other people.

Mm, as we've seen with TMR and AOA, homemaking does tend to lead to magical thinking, but most of them wouldn't touch anti-biotics with a ten-foot pole. Well, I suppose most of them haven't seen any live humans that they aren't related to in years, therefore they'll agree to anything for the sake of human contact.

By Politicalguineapig (not verified) on 06 Jan 2015 #permalink

@Politicalguineapig -

1. Please don't insult Todd W by attributing things I typed to him.

2. You often tar with way too broad a brush. In my opinion, this is one of those occasions.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

zebra,

my opinion is that the relative merits of TM v poor (or non-existent) CM are germane to how we view TM

Science based medicine done properly is either safe and effective, or is working towards safety and efficacy. Traditional medicine done properly is sometimes unsafe, rarely effective and never changes; toxic species of Aristolochia are still listed in the Pharmacopoeia of the People's Republic of China. The time-hallowed nature of traditional medicine is a selling point, a feature not a bug.

I would like to see safe and effective treatments for people, which means the treatments supported by the best available evidence i.e. SBM. That may not be happening as well as it might at present, but I think it's where we should be heading. In that context traditional medicine is at best a distraction and at worst an obstacle.

I would like to see over-prescription of antibiotics stopped and I think people are better off with SBM than with TCM.

By Krebiozen (not verified) on 06 Jan 2015 #permalink

Obrien 88:

" However, ho do you justify the introduction of TCM into medical schools and practices in countries that have an advanced medical system (which is, after all, what the post above is about)?"

Sorry, I must have missed the part where they were going to teach about the efficacy of [Rhino horn] in medical school. And require 'practices' to dispense it.

When you can show me some concrete threat to real science, I will pay attention and join in the battle. Otherwise, this is just ideological ranting and posturing. Postmodernism! ID! yadda yadda. Who knew they've been plotting with the Chinese for hundreds and hundreds of years, planting all those hippie concepts to burst forth now and destroy modern medicine. Who knew science was so weak that it could not deal with these silly challenges.

For a long time now, Physics has accommodated different modes of thinking about problems. We don't find it all that problematic to teach Newtonian mechanics even though Relativistic mechanics is based on a completely different and profoundly contradictory worldview. Oh yeah, and then there's QM. Spooky stuff.

What we do is see what works and doesn't for particular applications. That's what is going to happen in this context as well.

@zebra

We can argue against individual dangerous practices in both, but Orac is arguing against integrating TM with CM simply because of ideology. There may be wrong things in TM, but they are not wrong because practitioners use funny language.

I see where your misunderstanding lays. No, he is not arguing against TM because of ideology. He is arguing against TM (as it is promoted) because it is not shown to be safe and/or effective. Those elements of TM that do end up being shown, through rigorous science, to be safe/effective become part of medicine, and there's no need to class them under the heading of "TM". It has nothing to do with "funny names".

Consider again the suburban USA housewife with a head cold. Then consider the peasant farmer, with an infected cut. If the TM practitioner could give antibiotics, while calling them Uga-Bugah-Chi-Adjustment, why would you deny that life-saving intervention? It doesn’t matter *why* the patient thinks something is going to help them, it only matters if it helps and doesn’t hurt them.

Your example isn't an argument in favor of TM; it's an argument in favor of real medicine.

"Traditional medicine" is not simply using a bunch of funny words in place of the actual medical terminology. Traditional medicine is pre-scientific misunderstanding of how the body works combined with a grab bag of adulterated drugs (herbs) and magic (acupuncture, tongue diagnosis, etc.). And as promoted, it is the fitting of facts to the ideas, rather than fitting the ideas to the facts.

Your argument above is that we should integrate SBM into TCM. That says absolutely nothing about the problem of integrating TCM into SBM, which is, actually, a big problem.

M'OB: Ah, I read too quickly again.

By Politicalguineapig (not verified) on 06 Jan 2015 #permalink

This is quite mind blowing frankly. I am reminded of the Peter Principle when I consider how on earth the editorial staff could publish such nonsense.

By KillCurve (not verified) on 06 Jan 2015 #permalink

To clarify my comments regarding Intelligent Design.

See #46 for William Demski's support for Science's support for placebo medicine. I was quoting his "About" page and then summarising his position. Which is the position of ID.

The Intelligent Design movement is all about religious ideology, not science.

I deplore all ideologies that seek to distort science to suit a predetermined worldview. There are many of them.

Dembski is spot on about what Science is doing in supporting the integration of TCM with scientific medicine. They are supporting placebo medicine. Dembski approves. How glad Science must be about that.

By Leigh Jackson (not verified) on 06 Jan 2015 #permalink

Sorry, I must have missed the part where they were going to teach about the efficacy of [Rhino horn] in medical school. And require ‘practices’ to dispense it.

I presume you were busy developing your metaphors, but if I may quote from the overview from the Science supplement Orac is discussing (emphasis mine):

In this first installment of a three part series, “The Art and Science of Traditional Medicine,” we present a series of articles making a case for the integration of traditional Chinese medicine (TCM) into modern medical practice.

To be clear - they're not talking about how to add science to TCM - they're talking about how wonderful it would be to use TCM in modern medical practice. Now, if TCM provided a more useful framework for diagnosis and treatment, or if it had a well documented set of treatments that were unequivocally shown to be superior to what modern medicine provides, I'd be all over that. Orac's point above - it doesn't.

We don’t find it all that problematic to teach Newtonian mechanics even though Relativistic mechanics is based on a completely different and profoundly contradictory worldview. Oh yeah, and then there’s QM. Spooky stuff.

Actually, not so much. Relativity merely tweaks Newtonian mechanics by a) eliminating an "at rest" reference plane (which is clearly not required by Newtonian mechanics), b) extending the concept of reference frames to include accelerating reference frames, c) showing that acceleration and gravity act identically in previously unexpected ways, and d) accounting for the observation (unknown in Newton's day) that the speed of light is invariant regardless of reference frame to the limits of measurement. Not to talk down Einstein, but saying that relativity comes from a wildly different world view is an overstatement.

I will grant you, though, that it's tough to reconcile quantum mechanics and relativity since they produce different results.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

It sounds as though, whenever we point out what's wrong with zebra's examples, they fall back on "it's a metaphor" or "you should have known I didn't mean that one literally."

It's not our job to guess at what zebra might actually be trying to say, with multiple rounds of answering what they have actually written and being told that no, that's not it. If I was to guess, at this point it would be "Orac is being rude to TCM and Science, and there must be something of value in TCM that justifies 'integrating' it with actual medical science, even if nobody has identified what that valuable thing is," and proof by blatant assertion.

Todd:

"That says absolutely nothing about the problem of integrating TCM into SBM, which is, actually, a big problem."

Pretty much the same as OBrian.

What exactly does "integrating TCM into SBM" entail, and why is it a "big problem"?

Are you saying that someone in medical school is going to tell the students that Rhino horn is an effective treatment for something? If not, what is this mysterious threat?

@zebra

What exactly does “integrating TCM into SBM” entail

As MO'B notes, and as I wrote in my previous comment, it means integrating pre-scientific, untested and ineffective nonsense into science-based medical practice.

Are you saying that someone in medical school is going to tell the students that Rhino horn is an effective treatment for something?

That is, in essence, what this Science supplement is arguing for, yes. It is basically saying, "Let's take all this stuff that is labeled "Traditional (Chinese) Medicine" and tell our medical students and insurance companies that these are safe and effective treatments." This in spite of the fact that there is often no evidence that those treatments are safe and effective, and sometimes (c.f. aristolochia) those that are downright ineffective and harmful.

Did you even read Orac's post?

Not long ago a study was done on an interesting U S Civil War phenomena.
In one battle the dirt embedded wounds of some soldiers were found to glow in the dark. The wounded whose injuries glowed were far more likely to survive than those whose wounds were clean and did not glow.
It was found that micro organisms in the soil of that battle field were natural antibiotics.
Recently I'd run across articles on ancient methods of treating wounds. In Russia they sometimes packed dirt into a wound, and perhaps if the dirt were host to similar micro organism this may have been beneficial.
Human urine has a strong antifungal effect. Spider webs promote rapid clotting when packed into a deep wound. Maggots placed in a deep wound eat away necrotic flesh while leaving live tissue alone, something that has been revived in treatment of some types of wounds and bed sores.
They now breed sterile maggots for this purpose.

Many of the old home remedies and legendary methods of treating injuries have turned out to be very effective and less invasive than surgery.
With the growing problem of antibiotic resistant infections some of these older methods may become the only viable alternative.

By Greg Young (not verified) on 06 Jan 2015 #permalink

Vicki,

I would have a position on the value of "integrating" TCM if one of you would explain what that involves in the real world.

What Orac is doing is kind of at the level of WHO Black Helicopters landing at all the medical schools with kung-fu ninjas and then indoctrinating all the nice students into mindless Traditional Medicine Zombies.

Because they really want people to get useless and dangerous treatments, and that's the only way it will happen.

Seriously people, get a grip. You are apparently in denial about the fact that in the USA we *already have* the dispensation of unregulated, untested for either efficacy or purity of content, herbal and other supplements. What's the difference?

Are you saying that someone in medical school is going to tell the students that Rhino horn is an effective treatment for something?

To chime in with Todd W. - yes. They are suggesting that medical schools should teach about balancing humours. They are suggesting that medical schools should teach the channels by which chi flows through the body and techniques to unblock its flow. They are suggesting medical schools teach which herbs are good for excess external heat or rising damp.

You may believe that this is far fetched - it is not. There are already modern medical schools that teach this sort of thing not in comparative anthropology, not in history, not as "here's something some people believe", but as valid medicine. You might read David Colquhoun's blog where he has, from time to time, published slides and curricula from such classes in the UK. You might also review some of Orac's posts where he discusses "quackademic medicine" and how TCM (as well as homeopathy) are being not only examined but taught.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

@zebra

What Orac is doing is kind of at the level of WHO Black Helicopters landing at all the medical schools with kung-fu ninjas and then indoctrinating all the nice students into mindless Traditional Medicine Zombies.

Nice strawman ya got there.

You are apparently in denial about the fact that in the USA we *already have* the dispensation of unregulated, untested for either efficacy or purity of content, herbal and other supplements. What’s the difference?

Two strawmen in one post? Trying to build an army?

If you bothered to ask, you'd find that the majority of commenters here would also be against unregulated and untested herbal and other supplements in the U.S. You would find many who think that DSHEA is a ridiculous act that has resulted in a big problem in the U.S. and should be repealed. You would further discover that the promotion of herbal supplements and similar things for which there is no scientific support is not considered part of "science-based medicine".

Todd,

See 102.

You (and others) are getting awfully close to the kind of paranoia we see in the actual anti-science crowd.

@zebra

You might want to peruse some of the other posts here at RI for some examples of exactly what we are describing. Major, well-respected cancer centers have established, for example, "integrative medicine" centers, which promote such things as acupuncture and reiki (I know of at least one big hospital that has offered CME credits for reiki). There are medical schools which have established curricula in TCM and other alt-med practices.

If you feel that this is not happening, please feel free to provide evidence to support your position.

What Orac is doing is kind of at the level of WHO Black Helicopters landing at all the medical schools with kung-fu ninjas and then indoctrinating all the nice students into mindless Traditional Medicine Zombies.

Nice image, but no. This is a tremendous distortion of what Orac or anyone else said.

Because they really want people to get useless and dangerous treatments, and that’s the only way it will happen.

Once again, no. There are people (even doctors) who seriously believe that this stuff works. All they need to do is find the proof. They are not dissuaded by the fact that the best studies to date don't show these systems and techniques are safe and effective.

Seriously people, get a grip. You are apparently in denial about the fact that in the USA we *already have* the dispensation of unregulated, untested for either efficacy or purity of content, herbal and other supplements. What’s the difference?

Once again - no. I think all regular readers know that there are major problems with how "nutritional supplements" are manufactured, marketed, and sold in various countries. We've all read the story of how a promoter of these supplements poisoned himself on his own badly manufactured formula. We've all read how someone tried to sell an industrial chelation chemical as a supplement and how someone else sells bleach as a supplement. I suspect most around here would agree that more regulation of supplements is needed (a statement that has gotten more than one person's panties in a bunch).

How, exactly, does that justify ignoring that a major scientific journal is using its name to give the appearance of respectability to another unproven system?

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

zebra,

You are apparently in denial about the fact that in the USA we *already have* the dispensation of unregulated, untested for either efficacy or purity of content, herbal and other supplements. What’s the difference?

Aren't we discussing how medicine is practiced? Very few conventional doctors prescribe supplements, except in cases of proven vitamin deficiency, or herbal medicines, ever.

You (and others) are getting awfully close to the kind of paranoia we see in the actual anti-science crowd.

How is it paranoid when a reputable journal like Science is promoting the use of acupuncture and unproven herbal remedies? When the once-respected Cleveland Clinic offers acupuncture, claiming it is "used to balance the flow of Qi and stimulate our body’s natural ability to heal"?

Would you take the same casual attitude if your local university opened an astrology department? Or American Airways offered magic carpet flights?

By Krebiozen (not verified) on 06 Jan 2015 #permalink

I work in tiger conservation and so have had cause to read up on Chinese medicine (use of endangered species parts is a major factor in driving some taxa, including tigers, to extinction). TCM is not even self-consistent, read the history, particularly of what Mao did to use it a a social control tool (he didn't believe in it himself). It is nonsense from start to finish and belongs in the dustbin alongside homeopathy and astrology. I am appalled that Science should touch it with a forty-foot pole.

Or American Airways offered magic carpet flights?

Actually, that might be kind of cool, but I'd be afraid of getting airsick.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

So, zebra, why are you not willing to hold TCM to the same standard that you want to hold SBM to?

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

@zebra

Question for you: what do you call so-called "traditional medicine" that has been proven to work through rigorous scientific study?

From the WHO Traditional Medicine Strategy:

The knowledge and qualification of practitioners have a direct bearing on patient safety. The ways in which T&CM practitioners obtain their knowledge and skills vary between countries. In some countries, some T&CM practices have become established and practitioners are required to complete an official education/training programme. For instance, in many European countries and in North America, chiropractic, naturopathic, herbal and osteopathy practitioners must be educated in university-level programmes.

Look! More evidence that TM is in medical schools.

About those flying carpets...

altho' I'm sure they might be aesthetically pleasing -
I'm really a good flyer but EVEN *I* occasionally need something solid to hang onto when there's turbulence.

By Denice Walter (not verified) on 06 Jan 2015 #permalink

I’m really a good flyer but EVEN *I* occasionally need something solid to hang onto when there’s turbulence

I'm assuming that safety belts would be woven in, as mandated by the FCA (Flying Carpet Administration). I'd also hope that since they're a) unheated, b) unpressurized, c) unenclosed and d) without supplemental oxygen that flights would be at a relatively low altitude and airspeed. You might also want to wear a face shield and eye protection.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

@Greg Young, #67

William: Do you find many circumstances in which you apply... arsenic, brother Severinus?

Herbalist: Yes, indeed. It is a most effective remedy for nervous disorders; If taken as a compound, in small doses.

https://www.youtube.com/watch?v=vEi7XL0wrG4

I have a vision of an enormous magic carpet and dozens of true believers sitting on it in formation, waiting in vain for it to take off. None of them would want to be the first to point out that they hadn't actually traveled anywhere, and had been ripped off by the travel company.

Perhaps they would have a discussion about what a fantastic flight they just had, and pretend they had traveled as hoped to their destination. Some would, no doubt, berate any science-based meanies who insisted they were still in Los Angeles as being closed-minded sheeple in the pay of Big Aerodynamics.

By Krebiozen (not verified) on 06 Jan 2015 #permalink

@Greg Young

Tylenol has destroyed so many livers its ridiculous. Willow bark does the same job and I’ve yet to hear of it causing organ failure.

I guess you've never heard of Reye's Syndrome, which is caused by the active ingredient in willow bark.

By justthestats (not verified) on 06 Jan 2015 #permalink

Tylenol has destroyed so many livers its ridiculous. Willow bark does the same job and I’ve yet to hear of it causing organ failure.

By the way, do you have any data to show that willow bark is as effective as aspirin, acetaminophen, or ibuprofen? Thanks.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

Gangsters have long used iron weapons to whip or kneecap people. It turns out that iron is a necessary nutrient and required to effectively transport oxygen from the lungs to the cells of the body.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

I have a vision of an enormous magic carpet and dozens of true believers sitting on it in formation, waiting in vain for it to take off.

My daughter had that experience flying through Atlanta the other week.

By Mephistopheles… (not verified) on 06 Jan 2015 #permalink

To all:

It still isn't clear to me what would be different.

At the risk of triggering another embarrassing DK lecture from Mr Obrien about relativity, I will repeat what I said about Physics. We test stuff and see if it works. We jump around between disparate conceptual models, depending on what works for the task we're on. One year I might be thinking in terms of action-at-a-distance, and the next about conforming to the space-time continuum. Which one is chi?

Now doctors, to listen to them talk, are way smarter than physicists. They believe in making their own decisions for each patient in each situation.

So, if some doctor decides to treat me based on some weird chi stuff, and I go along, and it works, cool. If it doesn't I (or my widow) will sue.

How is that different from the way things work now? Is everything taught in med school immutably correct? Aren't there corrections every few years as new data is established?

And haven't we all agreed that doctors trained in traditional supposedly SBM often ignore the science? Why wouldn't they ignore the TCM if they felt it didn't work?

And to get back to the supplements-- look, somehow the medical establishment has managed to get all kinds of regulations established about drugs. You can't argue that it is not also responsible for those TCM-equivalent products we have on the market in the USA. If y'all are so concerned about TCM compounds, get the mote out of your own eye first. Just sayin.

''I guess you’ve never heard of Reye’s Syndrome, which is caused by the active ingredient in willow bark."

Just much Willow Bark would you have to consume to damage your liver?
The active ingredient in willow bark is salicylic acid, but aspirin is an acetyl derivative of salicylic acid, a refined or manufactured derivative chemically close but not quite the same.
I've heard of Reyes syndrome ( a two-phase illness almost always associated with a previous viral infection with underlying genetic metabolic disorders found in most victims), but never in relation to use of willow bark . Some swelling of the liver is a long way from total shutdown.
Brain edema in children can cause permanent damage but adults usually recover completely without lasting damage to brain or liver.
Hippocrates, the father of modern medicine made great use of powdered Willow bark and leaves. If he ever witnessed a negative reaction to it I'm sure he'd have written of it.

By Greg Young (not verified) on 06 Jan 2015 #permalink

I use a commonly available supplement mixture of Chamomile, Melatonin and Valerian. Its been of great help in reducing my need for prescription pain medications and allows me to sleep.

I hope you're not under the impression that the melatonin you're going to find in a "supplement" is anything other than a synthetic hormone.

The active ingredient in willow bark is salicylic acid

To be specific, it's salicin, which is

metabolized

to (active) salicylic acid.

but aspirin is an acetyl derivative of salicylic acid, a refined or manufactured derivative chemically close but not quite the same

Actetylsalicylic acid is metabolized into salicylic acid and acetic acid. From an analgesic standpoint, it seems reasonable to assume broadly similar toxicological profiles.

I’ve heard of Reyes syndrome ( a two-phase illness almost always associated with a previous viral infection with underlying genetic metabolic disorders found in most victims), but never in relation to use of willow bark .

Has it ever occurred to you that this might have to do with the relative frequency of the use of the two substances?

Hippocrates, the father of modern medicine made great use of powdered Willow bark and leaves. If he ever witnessed a negative reaction to it I’m sure he’d have written of it.

Yah. See, you have a problem here: the Hippocratic Corpus wasn't written by a single person to whom you can fancifully attribute writing habits as a way of asserting that salicin in the form of ground willow bark is magically without toxicity.

^ Let me try that again:

"salicin, which is metabolized to (active) salicylic acid."

"I hope you’re not under the impression that the melatonin you’re going to find in a “supplement” is anything other than a synthetic hormone."
I should hope so, mad cow disease forced them to find another source other than the brains of cattle.
When I first began using melatonin they were still harvesting it from cow brains.
Gabapentin is the prescription alternative and no safer or more effective that I can see.
Regardless there was no reason not to mention it as an ingredient in the supplement I use.

"From an analgesic standpoint, it seems reasonable to assume broadly similar toxicological profiles."
Coca leaves contain similar ingredients to cocaine, how many times have you heard of a coca leaf over dose?

" the Hippocratic Corpus wasn’t written by a single person to whom you can fancifully attribute writing habits "
Separating Hippocrates personal contributions to this body of work might be difficult, but fact remains that he did test and record findings which would be found in this work if anywhere.
Being one of a number of contributors does not negate his individuality or his contributions to that work.
Are you claiming that Hippocrates never wrote anything down?

If you can calculate just how much powdered willow bark it would take to trigger a Reyes syndrome effect please do.
Also since the percentage of those who might be vulnerable if a series of uncommon factors converged is so small and the number of actual victims of Reyes syndrome is miniscule compared to the number of victims of Tylenol related liver failures, plus the fact that Reyes syndrome causes only temporary swelling of the liver with little or no likelihood of permanent liver damage I still consider Willow bark to be entirely safe for the liver, and aspirin to have very minimal health risks compared to Tylenol, which has also been implicated in Reyes syndrome.
NSAIDs formulated to offset the occasional stomach upset side effect of Aspirin have been found to cause Stevens-Johnson Syndrome which is a horrific and often deadly skin necrotizing condition.
I think I'll stick with aspirin.

By Greg Young (not verified) on 06 Jan 2015 #permalink

Greg Young,

If you can calculate just how much powdered willow bark it would take to trigger a Reyes syndrome effect please do.

Why would the therapeutic index of willow bark be any different to that of aspirin? If you take enough to be effective you have taken enough to cause side effects.

Also since the percentage of those who might be vulnerable if a series of uncommon factors converged is so small and the number of actual victims of Reyes syndrome is miniscule compared to the number of victims of Tylenol related liver failures,

Acetaminophen is a very safe drug if taken according to directions, it is only dangerous in overdose or in people with existing liver damage, whereas salicylate even in therapeutic doses can cause GI bleeding and Reye's especially in children. If all the children who currently take Tylenol were given willow bark instead we could expect to see a rise in cases of Reye's.

Reyes syndrome causes only temporary swelling of the liver with little or no likelihood of permanent liver damage

What? It has a 30% fatality rate. I was involved with several liver transplants for children with Reye's back in the 80s.

By Krebiozen (not verified) on 06 Jan 2015 #permalink

zebra,

At the risk of triggering another embarrassing DK lecture from Mr Obrien about relativity, I will repeat what I said about Physics.

Embarrassing why? Didn't you understand it?

We test stuff and see if it works. We jump around between disparate conceptual models, depending on what works for the task we’re on. One year I might be thinking in terms of action-at-a-distance, and the next about conforming to the space-time continuum. Which one is chi?

Neither is chi; chi doesn't exist. Medicine also tests stuff to see if it works. TCM and other TM has been tested and it mostly doesn't work. The bits of it that do work get incorporated into SBM, and the rest is used by people who come up with increasingly desperate excuses for its failure in RCTs.

You can't draw parallels between medicine and physics like this. Disparate models are useful in physics, but I can't think of any field of physics that is based on an outmoded medieval model that clearly doesn't work but still has proponents and supporters determined to make it part of the mainstream.

Medicine is almost entirely concerned with the macro world, where Newtonian physics still reigns. Newtonian physics is essentially the same as quantum physics if Planck's constant was zero, IIRC.

Now doctors, to listen to them talk, are way smarter than physicists. They believe in making their own decisions for each patient in each situation.

Not really. There are accepted diagnostic and treatment pathways for most conditions, certainly common ones. Most doctors don't make it up as they go along, thankfully.

So, if some doctor decides to treat me based on some weird chi stuff, and I go along, and it works, cool. If it doesn’t I (or my widow) will sue.

You might be happy with that, but I would prefer to be treated with something that has been proven to work. Trial and error is best left to researchers, who have the resources to eliminate cognitive biases, not to doctors who do not.

How is that different from the way things work now? Is everything taught in med school immutably correct? Aren’t there corrections every few years as new data is established?

Better treatments are developed, sometimes they take longer to be accepted than would be ideal. Occasionally we find that a treatment that has been in use for years has more risks than benefits, but that doesn't happen very often these days now RCTs have been in common use for several decades. In general I think the recommended CM treatments are the best we have based on the evidence we have. I don't think anyone is going to discover that chi and meridians really do exist, that reiki healing at a distance is actually quantum physics in action or that epilepsy is caused by demonic possession.

And haven’t we all agreed that doctors trained in traditional supposedly SBM often ignore the science?

Often? I have seen estimates that at least 80% of conventional medical interventions are based on some sort of compelling evidence. If you are referring to over-prescription of antibiotics, it's a known problem, and may be due to patient demand and busy doctors simply giving in because if they refuse, patients "head straight over to an urgent care center and obtain their antibiotics there instead." The existence of problems doesn't give us license to throw up our hands and accept witchcraft in lieu of SBM. We need more and better SBM.

Why wouldn’t they ignore the TCM if they felt it didn’t work?

They apparently ignore antibiotics for viral infections, even though they don't work, as the vast majority of viral infections are self-limiting and the patient gets better. Acupuncture is a powerful placebo. There may or may not be an argument for prescribing placebos, but I don't think leading patients to believe in imaginary energy and meridians is very responsible.

There are also dangers in prescribing placebos; I don't know if you are aware of the recent study that found asthma patients given a placebo felt better even though their lung function didn't improve. That is extremely dangerous, as even mild symptoms can rapidly progress to a serious asthma attack.

And to get back to the supplements– look, somehow the medical establishment has managed to get all kinds of regulations established about drugs. You can’t argue that it is not also responsible for those TCM-equivalent products we have on the market in the USA. If y’all are so concerned about TCM compounds, get the mote out of your own eye first. Just sayin.

I'm not American, but as I understand it the US medical establishment is not responsible for regulating supplements and herbal medicines in the US, the federal government is, through the FDA and specifically the DSHEA. Regulation of supplements and herbal medicines has a complex history in America, with widespread support for continued availability of supplements, opposed by the medical establishment, leading to the current situation.

By Krebiozen (not verified) on 06 Jan 2015 #permalink

@zebra

And to get back to the supplements– look, somehow the medical establishment has managed to get all kinds of regulations established about drugs. You can’t argue that it is not also responsible for those TCM-equivalent products we have on the market in the USA.

First of all, who's arguing any such thing? Stop it with the strawman arguments. Also, you seem to be using rather broad, undefined terms again. What exactly do you mean by the "medical establishment"? Doctors? Medical researchers? Med. schools? Manufacturers? Patients? Legislators? Some laws have been passed due to patient/patient group efforts. Some by manufacturer lobbying. Some by the efforts of physicians. But mostly, drug laws have been established due to events that led to serious harm due to corporate malfeasance.

On the flip side, you have quacks to thank for the legislation around things like homeopathy and supplements. Those are pretty clear examples of lobbying dictating law, rather than law being informed by science.

I think we can all agree that aspects of drug law have ample room for improvement, but that has nothing to do with whether a treatment has a sound basis in science or is magical nonsense.

If y’all are so concerned about TCM compounds, get the mote out of your own eye first.

You need to work on your reading comprehension. We aren't giving bad conventional medicine a pass while only criticizing TCM. It just happens that the topic of this particular post of Orac's is focused on TCM, therefore, that's what the focus of the comments have been. You may as well harangue us for not posting comments in this thread critical of the premeditated murder of autistics.

Frankly, I would advise you to go back and read Orac's post a few more times, and then re-read the comments, focusing on comprehension. At the very least, you can put your shovel down for a bit, 'cause that hole you're in is getting pretty deep.

"Why would the therapeutic index of willow bark be any different to that of aspirin? If you take enough to be effective you have taken enough to cause side effects."
Because willow bark is more effective than aspirin and requires doses with less Salicin (or its metabolized form Salicitic acid) than a dose of aspirin that achieves the same effect. Exactly why its a more effective drug at lower doses has not been established but willow bark contains other chemicals that apparently do much or most of the work.

"What? It has a 30% fatality rate."
That would be due to swelling of the brain not the liver.
Haven't heard of liver transplants being done, and sources I read have said the swelling of the liver was temporary.
Also Reyes Syndrome is dependent on preexisting factors that affect aprox 1.1 out of 1,000,000 children in the affected age group. It would be difficult to calculate the actual risk to any individual if those factors were not known to be present, the risk factor is almost but not quite non existent.
Acetaminophen is found in so many OTC drugs and prescription drugs that hundreds of people OD on it accidentally every year. Acetaminophen has been described as the cause of most liver failures in the U S, and even in recommended doses it produces elevated rates of the waste products associated with liver failure. That can't be good.
Tylenol also causes intestinal bleeding.

A recent study suggests that an aspirin a day reduces the risk of developing cancer, previous studies have indicated that one aspirin per day reduces the risk of heart attack. We've also been told that if one suffers the symptoms of a heart attack that you should take an aspirin because it will increase the probability of survival and reduce possible damage.
I haven't heard of similar claims being made for Tylenol.

"They apparently ignore antibiotics for viral infections, even though they don’t work, as the vast majority of viral infections are self-limiting and the patient gets better. Acupuncture is a powerful placebo. There may or may not be an argument for prescribing placebos, but I don’t think leading patients to believe in imaginary energy and meridians is very responsible. "
Anti-Viral drugs are entirely different from the conventional antibiotics, Effective Anti-Viral drugs were only developed in recent years, largely through AIDS research.
The basics of Acupuncture may have a basis in fact. I noticed years ago that when rubbing the space between my fourth and fifth toes I felt a sharp sensation very close to midway up the spine. I found a few other spots like that were pressure caused a pin prick like sensation along the spine.
There's a skein of nerve tissue that leads directly from the brain bypassing the spinal column this skein is what transmits sensation of pain in the various organs that otherwise have little or no nerve tissue. This network passes by or through certain structures such as the hypogastric plexus and solar plexus. Only reason I looked into this was because I'd been taught that these are good targets in hand to hand combat.
Pressure at certain spots can drop blood pressure or cause temporary paralysis, or block all sensation.
Really the whole subject is a bit beyond me, but I picked up enough to know that pressure on nerves far removed from organs can have an effect on those organs.

By Greg Young (not verified) on 06 Jan 2015 #permalink

@Greg Young

A recent study suggests that an aspirin a day reduces the risk of developing cancer, previous studies have indicated that one aspirin per day reduces the risk of heart attack.

You left out "in high risk patient". For the average person, an aspiring a day can be risky.

The basics of Acupuncture may have a basis in fact. I noticed years ago that when rubbing the space between my fourth and fifth toes I felt a sharp sensation very close to midway up the spine. I found a few other spots like that were pressure caused a pin prick like sensation along the spine.

And your control was...?

BTW:

Hippocrates, the father of modern medicine made great use of powdered Willow bark and leaves.

Leaving aside the fact that you're also speculating on the imaginary persona's habits (unless you'd like to define "make great use of"), I'd like an actual freaking attestation for this bit.

[W]illow bark is more effective than aspirin and requires doses with less Salicin (or its metabolized form Salicitic acid) than a dose of aspirin that achieves the same effect.

I strongly suggest that you familarize yourself with the concept of documenting your claims, also known as "not making other people do your homework for you."

You are making two assertions: (1) Salicylates are safer than APAP, because acute liver failure. (2) Ground-up willow bark is superior to aspirin, apparently because it magically has no toxicity whatever. Try to treat them separately.

Greg Young, @128

"Gabapentin is the prescription alternative (to melatonin) and no safer or more effective that I can see."

Melatonin. "Pineal gland hormone. Short-term monotherapy in primary insomnia with poor sleep quality in patients > 55 years." Manufactured by Healthcare Logistics.

Gabapentin. "GABA analogue, anticonvulsant. treatment of partial seizures +/- secondarily generalised tonic-clonic seizures in patients> 3 years inadequately controlled with other antiepileptics; neuropathic pain." Manufactured by Pfizer and Mylan.

Both quoted from MIMS New Ethicals, the prescription formulary for New Zealand.

Both are prescription medicines in New Zealand, and neither is an alternative to the other. Do you want to reconsider your statement?

About willow bark and Reyes syndrome: the amount of salicylate in willow bark will vary depending on the growing location, the season harvested and the methods used for purification and/or dehydration. There are many other pharmacoactive substances in willow bark as well as the salicylate; I have no idea how many of them are hepatotoxic, nephrotoxic or even neurotoxic simply because I've never seen any decent research on the subject.

I'd much rather have the purified, exact dose of acetylsalicylate, as delivered by an aspirin tablet, than trust to the uncertain dose, delivered with other unknown but potentially toxic pharmacoactive substances, that is willow bark.

Both are prescription medicines in New Zealand, and neither is an alternative to the other. Do you want to reconsider your statement?

I think he meant that gabapentin was his other option.

Kreb: You need to test that out with a very large carpet and a video camera. Y'know, for science. Or it'd make a great theater sketch.

By Politicalguineapig (not verified) on 06 Jan 2015 #permalink

Todd W

For the average person, an aspiring a day can be risky.

I think whether or not is risky depends on what they aspire to. My aspirations to being a blues guitarist may be annoying to those within earshot but they are not dangerous.

By Militant Agnostic (not verified) on 06 Jan 2015 #permalink

If you can calculate just how much powdered willow bark it would take to trigger a Reyes syndrome effect please do.

A 240 mg dose of salicin appears to correspond to approximately 87 mg of aspirin. A look at Table 4 of Pinsky et al. (PDF) straightforwardly reveals that 11 mg/kg/day of salicin is more than enough.

“What? It has a 30% fatality rate.”
That would be due to swelling of the brain not the liver.

You know how the crack between your fouth and fifth toes is, ah, "connected" to someplace in your spine? Yah, it's like that.

The problem is that you can't keep your objections straight: APAP bad! Liver or bust!

Narad,

I would certainly hope that no-one else would consider them to be alternatives!

There are so magic (auto-undulating, active draft counter-conformal nanoweave) flying carpets. That's why everybody is taking their shoes off before getting aboard.

@zebra #92,

Relativistic and Newtonian mechanics converge in the limit v << c. Of course, YMMV (literally) depending on how converged one needs to be when using timing signals -- This concerning relativity and GPS is interesting:
http://www.astronomy.ohio-state.edu/~pogge/Ast162/Unit5/gps.html

As acceleration vs gravitation seem 'equivalent' -- Perhaps Mephistopheles O'Brien could chime in on if it is correct thinking to consider time dilation due to proximity to mass and time dilation due to velocity similar analogs due to velocity implying 'energy' and also warping spacetime (mass-energy equivalence).

Anyway, triangulating the references from these guys seems to be less of a pain in the ass than resetting their cookies when the lure goes all SINED SEELED DELIVERED UR MINE (cf. "12808," which is PMID 11599656, which is my comment 141).

Krebiozen,

I appreciate that you gave a thorough and well-written reply, but I am still missing a concrete threat to anything.

First: "Embarrassing why? Didn’t you understand it?"

I did understand it. It's just that I know enough about the subject to both know my own limitations and be able to recognize common misconceptions. Even on the internet, I don't pretend to be a cosmologist; my life has been humbly Newtonian and pragmatic. OBrian clearly overstepped and displayed ignorance. Einstein indeed!

That said, the metaphor/analogy is useful, and you are not addressing the question I've been asking of all my interlocutors. Thinking in terms of action-at-a-distance does not make my calculation of the path of a projectile invalid; it is a convenient fiction, perhaps. Other than our sensibilities being offended, what terrible outcome is supposed to happen because people are thinking in terms of chi or humours or whatever? That, in itself, does not threaten medical care except by (to me extreme) slippery-slope thinking. If it does, *then there is a serious flaw in the system*, which is what we should be worried about fixing.

The only concrete issues I have understood go something like this:

"There's this Chinese book with a list of herbs, one of which is known to be toxic, and they're going to teach about it in medical school. Eeek!"

"Acupuncture and reiki (whatever that is) are probably placebos. Eeek!"

Now Todd will probably claim Strawman, but he nor anyone has provided a rational causal path by which these things will impact my medical care. Are we seriously worried that doctors will now prescribe a toxic substance that has no effect other than toxicity? What, are drug reps going to be showing up with Aristolochia plants for the office?

These fears seem irrational to me because, again, there's this long slippery slope to fall down before you hit bottom, and the supplement issue plays into this very strongly-- if I can already get these compounds on the internet or by growing some plants, what do doctors have to do with it? Are we going to legalize pot and make the growing of sassafras a felony? And then allow doctors to prescribe it?

It may sound flip the way I am putting this, but I'm seriously asking. When I say you guys are sounding like the true anti-science guys, it's because you are failing to make the connection-- I think that's what reiki is like, right?

zebra said

We don’t find it all that problematic to teach Newtonian mechanics even though Relativistic mechanics is based on a completely different and profoundly contradictory worldview.

My response, in essence, is that relativistic mechanics is not based on a completely different and profoundly contradictory worldview (by worldview, I mean underlying assumptions and postulates). It was based on a very similar worldview as Newtonian mechanics, with the benefits of additional facts not available to Newton.

No one would question that they can produce very different predictions, and you'd never find things like time/space dilation or mass-energy equivalence in Newtonian mechanics. In that sense, they produce very different worlds. However, for a range of conditions they produce very similar results.

This is what makes your metaphor a poor one. While relativity can be seen as a superset of Newtonian mechanics, this is untrue of various traditional medicines. This extends to the causes of disease, the basis for treatment, and even (it appears) the standards for proof.

By Mephistopheles… (not verified) on 07 Jan 2015 #permalink

To echo M O'B: It's a wild misunderstanding to think that "Relativistic mechanics is based on a completely different and profoundly contradictory worldview."

Relativistic mechanics is the same as Newtonian Mechanics with one addition (unknown to Newton): The observed fact that the speed of light is the same for all observers regardless of their relative motion. That plus the assumption that there are no preferred frames of reference (AKA Galilean Relativity—also acknowledged by Newtonian mechanics) equals Special Relativity.

By The Very Rever… (not verified) on 07 Jan 2015 #permalink

what terrible outcome is supposed to happen because people are thinking in terms of chi or humours or whatever?

The practitioner thinking in terms of "whatever" and relying on traditional remedies is more likely to:
- provide invalid or harmful treatment
- have worse clinical outcomes
- waste the patient's time and money

The patient who went to a doctor convinced that traditional medicine was valid would at least delay getting more effective treatment, if not avoiding that effective treatment entirely. While this would not matter in the case of a mild respiratory infection, it would be a bigger issue with some curable, life threatening disease.

The school that teaches such things would:
- spend scarce research money on pointless activities
- waste the scarce time of their students on unproven, vitalistic systems
- produce doctors who learned more myth and less science
- based on what has been reported elsewhere, distort the entire concept of scientific proof, at least when it comes to this form of medicine.

Thinking in terms of non-existent visualizations like magnetic field lines or resonance structures can have some value. This does not apply in the case of, say, Reiki - where the energy claimed to exist cannot be found and the effects claimed to be created cannot be measured. If chi provided a useful visualization that helped someone understand a disease process, it might be useful. It's my understanding that it does not do any such thing, and taken literally it would mislead someone into providing ineffective treatments.

Now, if there were evidence that TCM provided particularly good clinical outcomes, or if the surrealism of the underlying metaphors provided a better way to diagnose and treat than conventional medicine, it would be worth study.

By Mephistopheles… (not verified) on 07 Jan 2015 #permalink

Obrian,

I have to go do some useful tasks, but let me briefly address your 149 and I'll get back in a while.

I stipulated somewhere back around the Big Bang, perhaps in a perfunctory way since it seems obvious, that if a patient has a realistic chance of benefiting from conventional medicine, it is probably a Bad Idea to forgo that in favor of herbs and hand-waving. But other than that, you're the one doing the hand-waving with your points.

How about you afford me the same rigor that you claim to demand from TCM and offer some SBP-- Science Based Policy analysis.

I don't even mean empirically; tell me how, without those WHO ninjas indoctrinating the medical students (using the very same Arcane and Mysterious Oriental Arts), this is all supposed to happen.

"CONCLUSION:

Willow bark extract in the current therapeutic dose leads to much lower serum salicylate levels than observed after analgesic doses of synthetic salicylates. The formation of salicylic acid alone is therefore unlikely to explain analgesic or anti-rheumatic effects of willow bark."

So unless you are a beaver building a dam from willow trees you aren't likely to consume a toxic amount of willow bark.

"Both are prescription medicines in New Zealand, and neither is an alternative to the other. Do you want to reconsider your statement?"
I don't live in New Zealand.
Perhaps if Melatonin were a prescription drug in the U S doctors would prescribe it instead of prescribing Gabapentin to produce the a similar effect.
Here they try to shoehorn the patient's symptoms to fit the meds they push.

The more I read on Reyes Syndrome the less seems to be certain about its causes.
The main problem seems to have been that so many OTC drugs at that time contained massive amounts of aspirin that consuming any more pushed things beyond the limit.
I've never met anyone who had a child affected by this syndrome, which is now all but extinct.
I'm a half century older than the age group affected, so chances of developing Reyes Syndrome are less than my being elected Pope.

I think there's evidence that Acupressure and acupuncture do work to some extent.
The Vagus nerve skein running through the torso is likely involved in the effect.
There's too much recent literature on the subject to summarize here.

By Greg Young (not verified) on 07 Jan 2015 #permalink

I can’t help but conclude, Science has sold its soul. It remains to be seen how low Science will go. For shame, Science. There is no excuse.

'Science' has a soul? I thought it just had a Method. Magazines have souls available for sale? I thought they were in the business of selling something else. Yeah, right: advertising.

I can’t help but say to whoever at Science decided [to publish] an advertising supplement like this, plus two additional ones to come: What the hell were you thinking?

A rhetorical question, obviously, as Orac used "say to" rather than "ask", but I'll answer it anyway. They were thinking, "Whoo boy, we got us a whale!" Those ad supplements ain't cheap, and a big chunk of change just got transferred from The Beijing University of Chinese Medicine and The Baptist University of Hong Kong into the coffers of the AAAS. And not just the very considerable fee for publishing the insert and binding into the magazine — selling space as it would to any other advertiser — the sponsors paid the AAAS Custom Publishing shop to create the thing. I.e. AAAS got all the ad agency fees as well as the media buy. Thus providing work for AAAS employees Editor Sean Sanders, Ph.D; Asst. Editor Tianna Hicklin, Ph.D; Proofreader/Copyeditor Yuse Lajiminmuhip; Designer Amy Hardcastle; Custom Publishing Global Director Bill Moran; and Custom Publishing Associate Director, Asia Ruolei Wu. The job market is tough for PhDs these days, so have a heart!

What "there is no excuse" for, is discussing a sponsored advertising supplement without identifying the sponsors!

See, whoever at Science decided to publish an advertising supplement like this has nothing to do with the editorial contents of Science. Orac noted the disclaimer about the supplement material not being peer reviewed. Hello! The disclaimer also says the editorial staff didn't even look at it! "The content contained in this special, sponsored section was not assessed by the Editorial staff of the journal Science." Translation: 'Hello, Editorial? This is the Business Office. Just wanted you to know there'll be a 28 page insert on TCM in the December 19th issue whether you like it or not. Happy Holidays!"

So, if you have a beef here with some institution from which you expect better, it's not Science, but the AAAS. And that beef would be that this non-profit organization is funding itself in part by operating a 'Custom Publishing Division' that will create and distribute content for anyone willing to pay for it — which is to say that 'Custom Publishing Division' is PR speak for and advertising and PR agency for hire.

Chris Hickie wrote: " I couldn’t believe someone who had risen to be CEO of AAAS could have the sheer ignorance and stupidity to state [snip] I absolutely agree that someone holding his positions in the AAAS and with the journal Science should be summarily fired from both positions for the above paragraph." Rest assured, Chris, your belief meter ain't broken. The CEO has no voice in AAAS position or policy, Alan I. Leshner is not a scientist, nobody at AAAS thinks he is, his 'position' with Science is just a figurehead designation on the business side of the journal operation,

Leshner's the head admin of the whole business wing of AAAS, the big boss of operations. Custom Publishing is but a sub-division of one of 5+ major divisions that report to the CEO — HR, IT, Development, Finance and Legal among them. The folks two levels below him in the hierarchy aren't making decisions he doesn't want them to make.

If Leshner's gonna get fired, it's not going to be over the innocuous little Foreward he contributed, It's because his peeps "decided [to publish] an advertising supplement like this, plus two additional ones to come." But my bet is they didn't 'decide' to publish it, they went after it. They were whale hunting. And nobody's gonna get fired. They're all going to get raises. They were all doing their jobs, which consist most importantly of keeping AAAS supplied with baleen, oil and blubber.

And any kind of desire to promote TCM had nothing to do with it, anymore than as Treasurer of SfSBM Harriet Hall has any desire to promote the supplement vendors whose illustrated clickbait links appear on SBM. In fact, Alan I. Leshner would probably prefer not to touch TCM with a ten-foot pole as medical science. (Orac has read Leshner's forward to the supplement very, very badly.)

But Alan I Leshner ain't in the medical science biz. His job description from the AAAS bylaws: manage the affairs of the Association, be custodian of the operating funds, enter into contracts. He doesn't have a vote on the Board. He has a seat there so he can answer questions and record the minutes. The CEO is is appointed by the Board for whatever term they like. Leshner's been there since 2001. He didn't rise within AAAS. AAAS hired him away from the National Institute on Drug Abuse for his administrative skills.

Still, nobody's likely to have lasted 14 years in an appointed position if they're foolish enough to torpedo their bosses policy positions, so Leshner's Foreward to the TCM supplement should tell us something about how AAAS views TCM. And to start, 'the West takes a reductionist approach to medicine, while the East, by contrast, takes a more holistic view' is NOT AT ALL A CLAIM BEING ADVANCED BY ALAN I. LESHNER. It's called "attribution", and he goes on to deny that polarity in the next paragraph. In fact, Leshner actually agrees with Orac that 'Western medicine' has been gettin' holist all by itself. His paradigm of holistic medicine is NOT TCM, but "systems biology" (don't know what that is, but it don't sound like qi).

Orac's reading of Leshner's Foreward as 'implying Western medicine is becoming more like TCM because TCM was right to be more “holistic".is simply not supported by the text. What the text is, I submit, is a carefully worded hedge that actually says nothing at all, while appearing to say — well whatever you confirmation bias expects it to say. It can be just as easily read as giving lip-service to a vague holistic philosophy as cover for an attempt to spread standards of "quality control of medicinal products"; "reproducibility of results"; and "verifiable scientific evidence" in China. Not that I'm guessing that's Leshner's agenda, but it might be AAAS's.

I would bet that Leshner's agenda is framed by his job description. I would bet he knows full well that China has nothing America needs in terms of medicine — "systems biology" will do for the holistic paradigm, thank you very much. I would bet the American Association for the Advancement of Science has stationed it's Associate Director of Custom Publishing and Advertising in China to tap something the Chinese have America that does need: not Traditional Chinese Medicine, but New Chinese Money.

I have a lot more to say about the TCM supplement, and what it does and doesn't say about AAAS in general, and AAAS and TCM in specific, but I'd better hang this for now.

Nothing I've said or will say necessarily makes the TCM supplement 'OK', or absolves Alan I. Leshner or the AAAS of all responsibility for any extent to which it's not-OK. But the attack in the OP misses the target by a light year.

"Abstract

OBJECTIVES:

To compare the effect of melatonin and gabapentin on anxiety, pain, sedation scores, and satisfaction of surgeon in patients of cataract surgery.

MATERIALS AND METHODS:

One hundred thirty patients aged between 35 and 85 years scheduled for cataract surgery were randomly allocated to three study groups to receive melatonin (6 mg), gabapentin (600 mg) or placebo 90 min before arrival in the operating room. Pain, anxiety, and sedation scores during block and surgery as well as the surgeon's satisfaction with the surgery were assessed.
"
http://www.ncbi.nlm.nih.gov/pubmed/24347765

By Greg Young (not verified) on 07 Jan 2015 #permalink

But the attack in the OP misses the target by a light year.

Bullshit.

You appear to be going out of your way to absolve Leshner of cluelessness. You are, quite simply, wrong. In his intro article, Leshner demonstrates a complete misunderstanding of how medical science works, claims "Western" medicine coming to resemble "Eastern" medicine by itself, but the implication is clearly there that because "Western" medicine is allegedly becoming more like "Eastern" medicine "all by itself" is because "Eastern" medicine was on to something, "ahead of the curve," even. It's utter nonsense that "Western medicine" is becoming more like "Eastern" medicine because TCM is on to something, but the implication is nonetheless clearly there, because in the very same supplement are articles likening systems biology to TCM and applying systems biology, all tooth fairy science-like, to TCM. You can't separate Leshner's foreword from the context of the whole supplement.

You know, that very same "attribution" error you describe seems to apply clearly to you, as you seem to be bending over backwards to claim that Leshner is not implying what he is pretty clearly implying by divorcing Leshner's commentary from the content of the rest of the supplement, at least two articles of which echo what he is saying by explicitly linking the evolution of systems biology as being like TCM and a superior way to understand human disease, like RA. Further, van der Greef is known for his belief that TCM "systems" can be validated through systems biology, as I described in an old post I linked to above.

Please don't grace us with one of your Orac-length responses repeating your same arguments at even greater length and telling me how wrong I am. If you haven't persuaded me with your first volley of verbiage, a second volley won't succeed either. Besides, when you do that your comments become exceedingly tiresome exceedingly quickly.

Since Willow Bark has been in use by Native Americans for over 1200 years, and is believed to have been used in the middle east for as long as 6000 years without any indication of toxic effects, I figure it has a much better track record that Tylenol.
While one of the active ingredients has been associated with an extremely rare syndrome, there zero evidence of willow bark itself having ever produced a similar effect.
Any possibility that it might pose a risk is based on extrapolation rather than direct evidence of any such harm having been observed.

To sum up what me previous posts were getting at.
Many medications and treatments once considered old wives tales have been proven to be effective in treatment of some disorders.
While the level of knowledge of the human body is at its highest point in human history, there is still much to be learned.
Ignoring the lessons of the past hampers advancement.

A side note would be the supposed energy fields and their effect on health.
Magnetic fields are used to promote healing of broken or shattered bone including injuries where large sections of bone are completely missing.
Electrical stimulation of the vagus nerves is a common treatment.
There are several areas in this state where very powerful magnetic fields can be found. Those who visit these places can feel a strong sensation.
Experiments on the totally blind have shown that microscopic deposits of iron in the nose and face can allow them to sense the presence of objects they can't see.
Birds appear to navigate using the same phenomena.

Call them by any name you chose, magnetic fields and electric charges are a part of how our bodies work.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Mephistopheles O'Brien #98, #147 sez

... accounting for the observation (unknown in Newton’s day) that the speed of light is invariant regardless of reference frame to the limits of measurement.

...with the benefits of additional facts not available to Newton

And The Very Reverend Battlaxe of Knowledge #148 sez

...with one addition (unknown to Newton): The observed fact that the speed of light is the same for all observers regardless of their relative motion.

Just a small matter of (semantics??) here; The invariance of the speed of light, c, was not an accepted 'fact' at that time. What was observed with Michelson–Morley was still used to attempt to futher Aether Theory (frame-dragging and whatnot).

I could be mistaken but Einstein discounting aether theory and choosing as his 'absolute frame of reference' to be the speed of light was one of two crucial postulates {is the other called 'space invariance'? -- that the laws are the same regardless of frame/position}. It was, at the time, unique to Einstein. He pulled it out his U-know, it's what makes him extra special.

I guess facts are facts regardless of documented status or recognition; Many still attempt to disprove this invariance or find fault with its' absolute value**; All seem to have failed.

**A most recent example may be the 60 ns descrepency in clocked arrival time of neutrinos back at Cern, 2011. All kinds of hair-brain was flying around to account for it -- (as a novice, the most romantic and most favored by myself was the one where they were getting breifly knocked out of our space-time altogether so that, being outside the Fabric, the limit did not apply.... The correct answer?? A loose cable on a clock.
http://en.wikipedia.org/wiki/Faster-than-light_neutrino_anomaly

Greg Young,

Because willow bark is more effective than aspirin and requires doses with less Salicin (or its metabolized form Salicitic acid) than a dose of aspirin that achieves the same effect. Exactly why its a more effective drug at lower doses has not been established but willow bark contains other chemicals that apparently do much or most of the work.

So it contains other unidentified chemicals that have some beneficial effects, but we don't have the faintest idea what adverse effects they might have? How can you claim that willow bark is safer than anything when the truth is you simply do not know?

So unless you are a beaver building a dam from willow trees you aren’t likely to consume a toxic amount of willow bark.

How can you make such a statement when you have no idea how toxic willow bark is? Perhaps the unknown active causes heart disease or cancer. We don't know. Assuming something is safe just because no one has done any safety studies is a potentially dangerous mistake.

Regarding Reye's syndrome:

“What? It has a 30% fatality rate.”
That would be due to swelling of the brain not the liver. Haven’t heard of liver transplants being done, and sources I read have said the swelling of the liver was temporary.

Your sources are wrong. The neurological problems are partly due to liver dysfunction, leading to elevated ammonia levels which cause encephalitis. I have met a child who had liver failure and subsequently a liver transplant due to Reye's Syndrome, and her parents, so I find your casual dismissal of its seriousness somewhat offensive.

Acetaminophen is found in so many OTC drugs and prescription drugs that hundreds of people OD on it accidentally every year.

There are only about a hundred deaths each year due to accidental overdose despite hundreds of millions of doses taken. These deaths could be prevented by adding an antidote to the pills, but this would increase the cost and make them smell strange (NAC and methionine have a sulfurous odor), which apparently puts people off. Who pays more for a headache pill so it doesn't poison them if they take too much? Most people don't plan to overdose accidentally. Anyway, I would like to see fewer overdoses, of course, but exaggerating the problem isn't helpful.

Acetaminophen has been described as the cause of most liver failures in the U S,

Not true, most liver failure is caused by alcohol. Acetaminophen is the major cause of acute liver failure, which is very different. To put in into perspective, tens of thousands of people die due to alcoholic liver disease in the US every year.

and even in recommended doses it produces elevated rates of the waste products associated with liver failure. That can’t be good.

Citation needed. As I understand it the liver metabolizes the drug safely unless its detoxification mechanisms are overwhelmed by an overdose, so toxic waste products are not produced except in overdose.

Tylenol also causes intestinal bleeding.

All drugs have side effects, even herbal ones.

Anti-Viral drugs are entirely different from the conventional antibiotics, Effective Anti-Viral drugs were only developed in recent years, largely through AIDS research.

Yes, I'm aware of the existence of antiviral drugs. What possible relevance does this have to doctors prescribing unnecessary antibiotics for viral infections?

The basics of Acupuncture may have a basis in fact.

Since the best-designed studies find no effects, I disagree.

Perhaps if Melatonin were a prescription drug in the U S doctors would prescribe it instead of prescribing Gabapentin to produce the a similar effect.

Anecdotally I don't find any effect at all from melatonin ((which is a prescription drug in the UK, by the way) for insomnia, recovery from shift work or jet lag, and the evidence is equivocal.

I’ve never met anyone who had a child affected by this syndrome, which is now all but extinct.

It must be reassuring to know that only illnesses have personal experience of exist.

I’m a half century older than the age group affected, so chances of developing Reyes Syndrome are less than my being elected Pope.

The point is that it is entirely possible that willow bark could cause Reye's Syndrome, contrary to your claim that it has no side effects. You don't know what other side effects it might have on you because there are no safety studies. If a drug company marketed a drug without any large safety studies it would be illegal and people would rightly be outraged. Why is it that you are happy to take a drug like willow bark when you have no idea what it might do long term?

By Krebiozen (not verified) on 07 Jan 2015 #permalink

^ Oops. Only "acute" should be in bold.

By Krebiozen (not verified) on 07 Jan 2015 #permalink

"The point is that it is entirely possible that willow bark could cause Reye’s Syndrome, "
Yet it never has.
"contrary to your claim that it has no side effects"
Did I in fact make such a statement?
Care to show me even one case where liver failure has been attributed to use of Willow Bark?

As for supposed testing of effectiveness of acupuncture, how much observer bias was present?
Some trials showed positive results, others showed no measurable result.
The procedure may be more effective or less effective according to the practitioner.
In any case I was pointing out that the theory behind such treatments may have a basis in fact.
I provided some examples of how pressure in one area can affect other areas of the body and how stimulation of the vagus nerve can affect the operation of the internal organs.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Greg Young,

Since Willow Bark has been in use by Native Americans for over 1200 years, and is believed to have been used in the middle east for as long as 6000 years without any indication of toxic effects, I figure it has a much better track record that Tylenol.

Where can I find the records of toxic effects during that period? How is it that Aristolochia was also in use for hundreds of years without any indication of toxic effects, yet it was causing 10% of all kidney failure in Taiwan? I have no faith at all that any adverse effects of willow bark would have been noticed.

While one of the active ingredients has been associated with an extremely rare syndrome, there zero evidence of willow bark itself having ever produced a similar effect.

Any possibility that it might pose a risk is based on extrapolation rather than direct evidence of any such harm having been observed.

True, but that's may well be only because no one has bothered to gather any such evidence before marketing the stuff. The only safety study I have seen involved 39 patients.

Many medications and treatments once considered old wives tales have been proven to be effective in treatment of some disorders.

Many? Just how many exactly, and how many proved to be unsafe or ineffective? You might want to brows the NCCAM website to see just how few herbal remedies are actually useful. Some have some very nasty side effects, like aloe vera preventing wound healing, for example.

While the level of knowledge of the human body is at its highest point in human history, there is still much to be learned. Ignoring the lessons of the past hampers advancement.

Yet ignoring these lessons seems to be precisely what you are advocating. Promoting use of willow bark without adequate safety studies is an example.

A side note would be the supposed energy fields and their effect on health.

Really? Why is it that studies of these supposed energy fields fail to find any evidence that they exist, much less have any effects on health.

Call them by any name you chose, magnetic fields and electric charges are a part of how our bodies work.

If you are familiar with the literature you would know that the energy fields and energies claimed by therapeutic touch and reiki practitioners are not electrical or magnetic. How can a magnetic field act at a distance of hundreds of miles as reiki practitioners claim? What electrical or magnetic field does a therapeutic touch practitioner's hands emit, and how does it heal the patient? This is a rhetorical question, since large studies demonstrate without any doubt that these things do not work. For healing of wounds, for example, results are as you would expect from chance. Speculating about the mechanism by which non-existent effects occur is the very definition of a waste of energy.

By Krebiozen (not verified) on 07 Jan 2015 #permalink

"Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported."
http://www.medpagetoday.com/Psychiatry/Depression/2233

"While acetaminophen has few side effects when used in therapeutic doses, recent reports suggest that its standard use can result in severe hypersensitivity reactions including Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Both of these syndromes can be life-threatening and both may be accompanied by evidence of liver injury. However, the hepatic involvement is usually mild and marked only by asymptomatic mild-to-moderate elevations in serum aminotransferase levels. "
http://livertox.nih.gov/Acetaminophen.htm
"In a study of 145 healthy subjects who were randomized to receive placebo or 4 grams of Tylenol daily for two weeks, subjects in the placebo group experienced no elevations of ALT, a liver enzyme, but 33%-44% of the subjects in the Tylenol group had ALT elevations greater than three times the upper limits of normal. The highest ALT elevation was greater than 500 which is approximately 10 times the upper limit of normal. All enzyme elevations returned to normal after stopping Tylenol. Thus, recommended doses of Tylenol given to healthy subjects for two weeks can cause mild to moderate reversible liver injury."
http://www.medicinenet.com/tylenol_liver_damage/page2.htm

By Greg Young (not verified) on 07 Jan 2015 #permalink

" For healing of wounds, for example, results are as you would expect from chance."
I gave examples of actual uses of Magnetic fields and Electricity, treatments with proven results, not the mumbo jumbo you are speaking of.

"In a study of 145 healthy subjects who were randomized to receive placebo or 4 grams of Tylenol daily for two weeks, subjects in the placebo group experienced no elevations of ALT, a liver enzyme, but 33%-44% of the subjects in the Tylenol group had ALT elevations greater than three times the upper limits of normal. The highest ALT elevation was greater than 500 which is approximately 10 times the upper limit of normal. All enzyme elevations returned to normal after stopping Tylenol. Thus, recommended doses of Tylenol given to healthy subjects for two weeks can cause mild to moderate reversible liver injury."
http://www.medicinenet.com/tylenol_liver_damage/page2.htm

https://www.google.com/url?q=http://livertox.nih.gov/Acetaminophen.htm&…

https://www.google.com/url?q=http://www.medpagetoday.com/Psychiatry/Dep…

"Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported."
http://www.medpagetoday.com/Psychiatry/Depression/2233

Somehow my giving examples of the beneficial effects of some types of herbal medications and treatments has ballooned in your mind as a blanket endorsement of all alternative medicines.
I'm speaking of studying these old cures and finding out if there's anything to them and looking into possible basis in fact for some of what has been handed down.

I find it very interesting that use of maggots as a less destructive method to debride wounds has made a comeback.
The research into finding new anti-biotics in soil samples is also very interesting.
So many "old wives tales" have proven to have a basis in fact that to ignore all traditional medicine is throwing the baby out with the bath water.

Physics seems to be on some poster's minds. What do you make of the modern theories on Dark Matter/Dark Energy?
These seem to have answered questions Einstein could not.
The "Missing Matter" that stymied Einstein?

By Greg Young (not verified) on 07 Jan 2015 #permalink

@Tim

Just a small matter of (semantics??) here; The invariance of the speed of light, c, was not an accepted ‘fact’ at that time.

You are quite correct that it was not universally accepted. Einstein's decided to believe the observations rather than to try to further bend the aether out of shape.

By Mephistopheles… (not verified) on 07 Jan 2015 #permalink

Please forgive my editing mistake - Einstein's was meant to be Einstein.

By Mephistopheles… (not verified) on 07 Jan 2015 #permalink

“The point is that it is entirely possible that willow bark could cause Reye’s Syndrome, ”
Yet it never has.

How often has it been used in situations where the risk of Reye's Syndrome exists (e.g., during/following varicella or influenza infection)? Since Reye's Syndrome was only identified in 1956, how much unpurified willow bark has been used over the past 58 years in children?

How can a magnetic field act at a distance of hundreds of miles as reiki practitioners claim?

I'd settle to hear how an electric or magnetic field supposedly generated by a reiki practitioner's hand is strong enough to penetrate tissue and effect therapeutic changes when their hand is only a centimeter or so away. And how such field cannot be detected.

"How can a magnetic field act at a distance of hundreds of miles "
"Spooky action at a distance"?
How does gravity actually do what it does?
The effects of gravity are well explained but theories about gravitons and such don't appear to have been proven.

Galileo accused Kepler of dealing in the occult for suggesting that the moon exerted a force that affected the tides.
Kepler's mama was an herb doctor of some note, and was once accused of witchcraft. I wonder how much she encouraged her son to think outside the box.
The last few posts never showed up. I wonder if this one will stick.

By Greg Young (not verified) on 07 Jan 2015 #permalink

" In a study of 145 healthy subjects who were randomized to receive placebo or 4 grams of Tylenol daily for two weeks, subjects in the placebo group experienced no elevations of ALT, a liver enzyme, but 33%-44% of the subjects in the Tylenol group had ALT elevations greater than three times the upper limits of normal. The highest ALT elevation was greater than 500 which is approximately 10 times the upper limit of normal. All enzyme elevations returned to normal after stopping Tylenol. Thus, recommended doses of Tylenol given to healthy subjects for two weeks can cause mild to moderate reversible liver injury."

" Tylenol, like all other medications should be used cautiously under a doctor's supervision with monitoring of liver enzyme levels."
http://www.medicinenet.com/tylenol_liver_damage/page2.htm

So they are basically saying use of Tylenol should be monitored as if it were a prescription drug.

"SEATTLE, Nov. 30 - Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported. "
SEATTLE, Nov. 30 - Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported.

PS
Saying that we should study the traditional treatments and that there's a basis in fact for some of these is not a blanket endorsement of mumbo jumbo.

By Greg Young (not verified) on 07 Jan 2015 #permalink

@ Greg Young

That paper suggests gabapentin and melatonin may have similar sedating effects only during a single type of cataract surgery, but not during other types of cataract surgery.

Bear in mind that cataract surgery can only occur twice, once for each eye, so that situation can only occur twice in someone's lifetime.

How do you justify your stance, by both statement and implication, that gabapentin and melatonin are alternatives in long term use?

Greg Young,

“How can a magnetic field act at a distance of hundreds of miles ”
“Spooky action at a distance”?

Are you seriously invoking quantum physics as an explanation for distant healing as claimed by reiki masters?

How does gravity actually do what it does? The effects of gravity are well explained but theories about gravitons and such don’t appear to have been proven

You are missing an important step. Gravity does what it is claimed to do, anyone can immediately verify that for themselves. Distant healing does not do what it is claimed to do, rendering speculation about how it works redundant. How do unicorn droppings cure rabies? It's a mystery.

Galileo accused Kepler of dealing in the occult for suggesting that the moon exerted a force that affected the tides.

Again this is about explanations for measurable effects, Tides exist, unexplained healings of people by reiki masters do not.

Kepler’s mama was an herb doctor of some note, and was once accused of witchcraft. I wonder how much she encouraged her son to think outside the box.

How was herbal medicine in the 16th and 17th centuries in any way "thinking outside the box"?

By Krebiozen (not verified) on 07 Jan 2015 #permalink

My response, in essence, is that relativistic mechanics is not based on a completely different and profoundly contradictory worldview (by worldview, I mean underlying assumptions and postulates). It was based on a very similar worldview as Newtonian mechanics, with the benefits of additional facts not available to Newton.

I'd argue that QFT, on the other hand, is a completely different worldview from Newtonian physics, and the fact that they make the same predictions in almost all cases when they seem like they are profoundly contradictory is pretty amazing.

I don't conceptually find the idea that there could be multiple different useful ways of looking at medicine in analogy to relativity vs. quantum to be problematic, but there is the issue that no one has found that other paradigm for medicine. It would have to suggest treatments that reliably work when you test them, which seems to be a weakness of currently proposed candidates for that other paradigm.

By justthestats (not verified) on 07 Jan 2015 #permalink
Kepler’s mama was an herb doctor of some note, and was once accused of witchcraft. I wonder how much she encouraged her son to think outside the box.

How was herbal medicine in the 16th and 17th centuries in any way “thinking outside the box”?

Witchcraft was.

By justthestats (not verified) on 07 Jan 2015 #permalink

"How do you justify your stance, by both statement and implication, that gabapentin and melatonin are alternatives in long term use?"
Because I was prescribed Gabapentin and found Melatonin to work far better.

I posted an example of Gabapentin and Melatonin being tested side by side for the same purpose, I never said that Gabapentin was not prescribed for purposes other than relieving anxiety and associated sleep deprivation.
I'm sure it has other uses that Melatonin would not be suited to.
Near as I can tell neither is considered to be for long term use. Three months is the recommended limit for Melatonin.
If you had noticed the effective dosage of Gabapentin in that test was also many times greater than the effective dose of Melatonin, suggesting that Melatonin is effective in much smaller doses.
Being a substance found naturally in the body its also unlikely to be a problem for the body to handle just as it would the Melatonin produced in the body.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Kerbiozen,

I see that you have not followed up on my 146. However, in your interchange with Greg Young, you are doing a pretty good job of backing yourself into a corner with respect to my issues.

What exactly is the danger of 'integrating' again? Here you are telling us in great detail that willow bark is just too chancy a material to be tamed, and Greg is telling us that he would happily use aspirin (or willow bark extract) even without consulting a licensed MD/[TCM charlatan]. There is no intersection.

For willow bark (or Rhino horn or whatever) to be a prescription drug, it would have to be standardized and approved by the FDA. If that can't happen (according to you), then it can't be prescribed by MD/TCM. What would be the point of teaching about it in medical school?

What exactly are these students going to be taught that worries everyone so much? What is a possible scenario where one of these doctors is going to say: "I want you to take this stuff that you buy on the internet and the composition of which is indeterminate."? Or, "go find a willow tree and chew the bark." ? What would the malpractice insurance cost?

It really sounds more and more like a paranoid conspiratorial fantasy, with some dark alien forces (or maybe just hippies and French philosophers) controlling what scientifically oriented individuals at every level of education and experience are thinking. And yes, I know about Dr Oz-- Dr Oz is on television; he isn't dispensing wacky stuff from his office.

Being a substance found naturally in the body its also unlikely to be a problem for the body to handle just as it would the Melatonin produced in the body.

Within reason. Formaldehyde, salt, and water are also substances you'll find in every body, and yet ingesting too much of any of them will kill you.

You also run into the issue that the body often uses the same substance for more than one thing, and if you raise the level of that substance present in the body, it affects every process that uses that substance.

By justthestats (not verified) on 07 Jan 2015 #permalink

Ignoring the lessons of the past hampers advancement.

Making up the past out of whole cloth isn't very helpful, either. I'm still waiting for the answer to this.

Shorter zebra: "Lalala, I can't hear you!"

While one of the active ingredients has been associated with an extremely rare syndrome, there zero evidence of willow bark itself having ever produced a similar effect.

Let's cut to the chase: Are you recommending willow bark over APAP for children and adolescents suffering from febrile/viral illnesses?

"Within reason."
Exactly.
I can't see anyone harvesting willow bark by the bushel then sitting down and chewing their way into oblivion.
Even a determined suicide would be unlikely to be able to hold enough chewed bark down to absorb a fatal dose.

I've used Melatonin on its own off and on for at least ten years with zero ill effects and gotten some very beneficial effects from its use.
I don't take it everyday, I don't need to, the benefits last for some time.
The increased effectiveness of prescription pain medications for several days after every good nights sleep allowed by the Melatonin is reason enough.
The pain relieving effect of the Valerian root and the calming effect of the Chamomile are good enough reasons to continue using the mixture I use now regardless of the extra benefits of the Melatonin.

I'm a bit surprised at the extent of aspirin bashing and Tylenol cheerleading I've seen here. Must be some new fad, or perhaps its just the contrarianism of a few posters.

Suggesting that there's some basis for at least some traditional remedies is not a blanket endorsement for any and all such treatments.
I do believe that more things pass twixt heaven and earth than are dreamed of in our philosophy.
Modern theory on Dark Matter/Dark Energy would suggest that.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Where can I find the records of toxic effects during that period? How is it that Aristolochia was also in use for hundreds of years without any indication of toxic effects, yet it was causing 10% of all kidney failure in Taiwan?

Speaking of American Indians, one might note that the hepatotoxicity of chaparral wasn't exactly picked up on. Then again, not having a written tradition complicates things when hand-waving about their habits 1200 years ago.

Sadmar 152,

Very interesting. With great humility, I would offer my suggestion that your reasoning extends to the Cleveland Clinic and schools that are offering some classes in these areas; it's about the money as well.

I would call it chi-washing.

Nobody is giving up their big machines and sharp knives and potent meds; there's no harm in adapting one's image to make all those boomers doing yoga and getting fancy massages feel at home. Low cost and low risk marketing.

"Let’s cut to the chase: Are you recommending willow bark over APAP for children and adolescents suffering from febrile/viral illnesses?"
I'm not a doctor and I don't even play one on TV, so I don't prescribe medicines for anyone.
I'm still waiting for any evidence that willow bark has ever caused a case of Reyes syndrome.
Surely with your vast knowledge of history you can find a single citation.

I'd make more of an effort to ignore your various strawman arguments, but that would leave almost no content in your posts.

As for Hippocrates
http://inventors.about.com/library/inventors/blaspirin.htm
"The father of modern medicine was Hippocrates, who lived sometime between 460 B.C and 377 B.C. Hippocrates was left historical records of pain relief treatments, including the use of powder made from the bark and leaves of the willow tree to help heal headaches, pains and fevers."

https://www.google.com/url?q=http://www.medpagetoday.com/Psychiatry/Dep…

https://www.google.com/url?q=http://www.medicinenet.com/tylenol_liver_d…

Too many posts aren't coming through. No sense wasting a lot of time typing,

By Greg Young (not verified) on 07 Jan 2015 #permalink

Todd W:

"We aren’t giving bad conventional medicine a pass while only criticizing TCM. "

Sure you are. If you fix bad conventional medicine, you don't have to worry about TCM. If you lock out TCM, you do nothing about bad conventional medicine.

If you could explain why TCM is a threat, given what I have pointed out, you would be more credible. If TCM were 'integrated', it would simply be equivalent to the lowest-level type of 'bad conventional medicine', which is the supplements that already exist. It would change nothing.

Final physics lesson from zebra (and Wikipedia):

In modern physics, the laws of conservation of momentum, energy, and angular momentum are of more general validity than Newton's laws, since they apply to both light and matter, and to both classical and non-classical physics.

This can be stated simply, "Momentum, energy and angular momentum cannot be created or destroyed."

Because force is the time derivative of momentum, the concept of force is redundant and subordinate to the conservation of momentum, and is not used in fundamental theories (e.g., quantum mechanics, quantum electrodynamics, general relativity, etc.). The standard model explains in detail how the three fundamental forces known as gauge forces originate out of exchange by virtual particles. Other forces such as gravity and fermionic degeneracy pressure also arise from the momentum conservation. Indeed, the conservation of 4-momentum in inertial motion via curved space-time results in what we call gravitational force in general relativity theory. Application of space derivative (which is a momentum operator in quantum mechanics) to overlapping wave functions of pair of fermions (particles with half-integer spin) results in shifts of maxima of compound wavefunction away from each other, which is observable as "repulsion" of fermions.

Newton stated the third law within a world-view that assumed instantaneous action at a distance between material particles. However, he was prepared for philosophical criticism of this action at a distance, and it was in this context that he stated the famous phrase "I feign no hypotheses". In modern physics, action at a distance has been completely eliminated, except for subtle effects involving quantum entanglement.[citation needed] However in modern engineering in all practical applications involving the motion of vehicles and satellites, the concept of action at a distance is used extensively.

(Just sayin')

Kreb asserts:
1. Patients should be treated with something that has been proven to work.
2. A scientific study shows patients given a placebo feel better
3. Treatment with placebo is dangerous if perceived pain reduction masks symptoms of an underlying physical illness treatable by conventional medicine.

Therefore:
A. A placebo treatment should not be prescribed by a practitioner w/o sbm diagnostic training, e.g. an acupuncturist.
B. An sbm practitioner who has ruled out an underlying physical illness treatable by conventional medicine as cause of a patients pain symptoms, and prescribes a placebo treatment for the reduction of those symptoms, is treating patients with something known to work that is not dangerous.
C. zebra's statement "It doesn’t matter _why_ the patient thinks something is going to help them, it only matters if it helps and doesn’t hurt them" is valid only in the context of supervision by a qualified sbm practitioner.
D. Any placebo treatment, being potentially valid only if it helps and doesn't hurt, must, in fact, work for the individual patient to whom it prescribed. By defintion of "placebo" a placebo treatment can only work as pain reduction when the patient believes it can work.
E. A placebo treatment presrcibed by a practitioner skilled in up-to-date sbm diagnostic procedures, for reduction of pain due to an underlying condition that cannot be treated effectively with conventional medicine, to a patient who believes it can work, is, in fact, science-based medicine.
F. So-called "Traditional Medicine" treatments are valid if and only if the conditions of E. apply.
G. Kreb has established the basis for an argument to include TM as a "complementary" practice in medicine, but one which comes with an attendant set of restrictive rules.
H. To the extent different perspectives in TCM Today — A Case for Integration are consistent and/or inconsistent with the above, they may be considered a step in the right direction, or if taken without additional modification, a prescription for potentially poor practice. E.g. WHO Director-General Chan's comments [edited]...

TM needs rigorous, scientific data to demonstrate its efficacy. It also needs evidence-based standards for quality and safety evaluation to support its appropriate regulation.... to move into mainstream medicine on an equally trusted footing, TM needs a stronger evidence base. The need for stronger regulatory control covers not only the products, but also extends across the practice and practitioners. The challenge is to give TM its appropriate place in an integrated health system, to help all practitioners understand its unique and valuable contribution, and to educate consumers about what it can and cannot do.

... would seem to rule out many TM practices for many purposes, via imposing scientific rigor. However the claim that TM has a "unique" contribution to offer has hardly been demonstrated, and what constitutes "evidence-based standards" for legitimating different uses of TM being not specified, alarm bells will certainly be sounded to regular readers of this blog familiar with the kinds of deeply methodologically flawed 'research studies' that have been taken as 'evidence' of TM effectiveness for medical issue (x), by people who ought to know better, or so we would hope. The question 'who decides what constitutes appropriate scientific rigor in terms of setting regulatory standards?' cannot be escaped.
I. The misgivings expressed by Meph and Todd in the comments above apply to TCM as administered and prescribed by essentially unregulated TCM practitioners, and thus are not necessarily relevant to positions taken in TCM Today — A Case for Integration and are irrelevant to the argument outlined in A.- G.

… would seem to rule out many TM practices for many purposes, via imposing scientific rigor.

Except that it never does, as I have documented ad nauseam both here and on my not-so-super-secret other blog. We have a TCM clinic at the Cleveland Clinic now, TCM at various universities, even the most magical of the magical remedies, like acupuncture, tongue diagnosis, and the diagnosis of RA as being due to an excess in "heat," complete with attempts to apply state-of-the-art genomics to, in essence, magic. There's plenty of science to rule out much of TCM now, no need for "more research," yet we see neither the AAAS nor WHO nor universities simply stating this. In reality, the only thing of potential value in TCM right now is herbal medicine, and, let's be frank, that's just substituting adulterated drugs for pure drugs.

I can’t see anyone harvesting willow bark by the bushel then sitting down and chewing their way into oblivion.
Even a determined suicide would be unlikely to be able to hold enough chewed bark down to absorb a fatal dose.

No, sorry, put down the goalposts. You're advocating commercial willow bark products. Botanic Health brand white willow bark extract contains 8 grams of bark in 2 milliliters, or at least 1200 mg salicin,* which – based solely on Schmid et al. – is equivalent to 435 mg of aspirin. Unless I've made a stupid arithmetic error, 1/4 cup of that is 400 mg/kg for a 150 lb person.

* If the magic extra components are simply other salicin-like glycosides, there may be more salicylate to be had over time, and chronic poisoning occurs at lower plasma levels.

Final physics lesson from zebra (and Wikipedia)

*plonk*

“Let’s cut to the chase: Are you recommending willow bark over APAP for children and adolescents suffering from febrile/viral illnesses?”
I’m not a doctor and I don’t even play one on TV, so I don’t prescribe medicines for anyone.

Your pathetic evasiveness is duly noted.

As for Hippocrates

I hate to break this to you, but about-dot-com is not an attestation.

To zebra:

You are an exceptionally good example of an apologists for TCM. Please tell us why your arguments are different than those in support treatments that come out of. witchcraft. After all, many of them are probably just placebo, and made with the consent of the patients.

If you do not feel comfortable supporting withcraft-founded treatments, please feel free to ammend most of your arguments. .

"IS CHAPARRAL SAFE TO USE ?

In 1992, the FDA issued a warning regarding the use of chaparral
tablets and capsules saying it was possibly linked to five cases of
hepatitis (liver inflammation).

Other organizations including the World Health Organization(WHO),
the National Cancer Institute and researchers at the University of
Illinois at Chicago have determined there are no hepatotoxicity (toxic
to the liver) properties in Chaparral.

In 2005, Health Canada (The Canadian equivalent to the FDA in the
United States) warned consumers to not ingest any products that
contained Chaparral and banned importation of the herb after
receiving ONE report of acute hepatitis associated with chaparral
ingestion.

Given the widespread use of chaparral and its documented
historical use by indigenous tribes for centuries, it appears to be
quite safe.

Chaparral sensitivity symptoms include, nausea, vomiting, dark urine
and/or abdominal pain. If your eyes or skin become jaundiced
(turn yellow), stop using chaparral immediately, this is a sign of liver
toxicity.

We encourage you to do your own research and make educated
choices regarding your health care. Choose doctors knowledgeable
in the use of herbs and nutrition and those who will take time to
answer your questions"

http://www.t-a-d-a.com/Chaparral.html

By Greg Young (not verified) on 07 Jan 2015 #permalink

zebra,
I'll have a longer reply tomorrow, but in the meantime, in short, This could happen.

By Krebiozen (not verified) on 07 Jan 2015 #permalink

Apparently the Native American of our far west used Chaparral mainly in topical applications and weak teas.
Since studies have shown that Chaparral can shrink tumours for up to twenty months its use may have extended the lives of some who used it.

The worst case of liver damage associated with Chaparral reported in the U S was a woman who upped her dosage to six times normal for several weeks. The other three cases were not nearly so severe.
There don't seem to be any problems in using chaparral in the traditional manner. Only when the drug is packed in a capsule can a human ingest a toxic dose. Its taste is so bitter that taking any large amount orally would be practically impossible.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Since studies have shown that Chaparral can shrink tumours for up to twenty months its use may have extended the lives of some who used it.

From:
http://www.cancer.org/treatment/treatmentsandsideeffects/complementarya…

"Available scientific evidence does not support the idea that chaparral can prevent or slow the growth of cancer in humans, nor does it support chaparral as effective in treating other medical conditions."

Other organizations including the World Health Organization(WHO), the National Cancer Institute and researchers at the University of Illinois at Chicago have determined there are no hepatotoxicity (toxic to the liver) properties in Chaparral.

I can have links to the relevant studies plz?

Given the widespread use of chaparral and its documented historical use by indigenous tribes for centuries, it appears to be quite safe.

Yes, I can see why an Interweb site selling chaparral products would simply wave away several dozen case studies of severe liver damage (sometimes requiring a replacement liver), with the airy words "appears to be quite safe".

By herr doktor bimler (not verified) on 07 Jan 2015 #permalink

Since studies have shown that Chaparral can shrink tumours for up to twenty months its use may have extended the lives of some who used it.

In one comment you repeated the claim that the NCI determined chaparral was not hepatotoxic (a citation-free claim, made by someone whose living depends on selling chaparral).
When the NCI reports finding no therapeutic value, you ignore it.

You are also moving the goalposts back and forth between the positions that "Chaparral is not dangerous when taken in small quantities in the traditional manner", and "Chaparral might be therapeutic if taken in sufficiently large quantities".

Please make up your mind.

By herr doktor bimler (not verified) on 07 Jan 2015 #permalink

"You are also moving the goalposts back and forth between the positions that “Chaparral is not dangerous when taken in small quantities in the traditional manner”, and “Chaparral might be therapeutic if taken in sufficiently large quantities”.

Please make up your mind."
If you bothered to read more than one or two pages on that subject you'd find that there's been more than one trial of its effectiveness.
Chaparral reduced the size of tumors for up to twenty months but then the tumors began to grow again at an accelerated rate, That's why its not considered an effective long term treatment for cancer.
There's some evidence that it increased the effectiveness of some chemo therapy drugs when both were used.
Other studies showed it is effective on tumors in animal tissues.
I'm not recommending it for anything, I'm just reporting what I was able to find out about it.
Its not available here so I'm not likely to ever encounter it.
I was going to post a link to a study on this but the site was unavailable due to an internal server error.
I'll get back to that later.

As for records of use of herbal medicines by Native Americans this should be interesting reading.
https://archive.org/details/cherokeephysicia00fore

I've barely scratched the surface of this book. He writes of herbs I've never heard of and some are apparently Cherokee names.
I can remember some of these remedies still in use when I was a child.
He appears to be an educated physician trained in conventional medicine as well as Native American medicine.

His book reminds me of the writings attributed to Hippocrates,
which are also available on the Internet Archive in both the original language and in translation with comments by Galen.

The Cherokee were known as the Civilized tribes, and parts of the U S Constitution are based on the Cherokee constitution.
Many Cherokee were known for superior intelligence and earned the respect of their peers in white society.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Greg Young

I think you are confused. That paper had a moderate dose of gabapentin (I've prescribed both less and more) versus three times the maximum recommended dose of melatonin.

IS CHAPARRAL SAFE TO USE ?

You left out this:

Chaparral boosts the immune system and helps keep the body in an alkaline state

I mean, seriously, you're offering the say-so of these clowns as a fυcking reference? And you have the balls to say mind-bogglingly stupid shіt like this?

I’d make more of an effort to ignore your various strawman arguments, but that would leave almost no content in your posts.

Here. See also, e.g., PMID 22831551:

"Cases of herbal hepatotoxicity are normally presented as case reports, which do not allow characterization of general herbal hepatotoxicity for the herbal product used. However, accidental re‐exposure and/or thorough causality assessment methods have provided clear evidence for hepatotoxic properties of some herbal products, in addition to [greater celandine] [4,5]. Among these are Ayurvedic herbs [b38], Chaparral [b12], Chinese herbal mixture [10,13,68], germander [b9,b15], few Herbalife products [b21,b22], Ho Shou Wu [b69], Jin Bu Huan [b11,b70], Kava [b71], Ma Huang [b72], mistletoe [7], senna [8] and Syo Saiko To [b14]."

What I'd like to see is (a fuller version of) PMID 1977040, which I'm only getting scraps of along the lines of "analysis of laboratory results from 395 patients found higher ALT levels among 53 patients taking herbals [55 U/L] than among those who did not [12 U/L]" and "liver function tests normalized in 52 of 53 patients when herb use was stopped for 6 weeks."

Greg Young

I note that once you are in a corner (eg aspirin vs willow bark) you change the subject (eg to chaparall).

This is known as changing the goal posts.

With aspirin/willow bark/salicylates of sufficient dose to have therapeutic effects, there will be some cases of both GI hemorrhage and Reyes syndrome. That's what others here are saying.

You say that willow bark does not have the same adverse effects as other salicylates; it's up to you to prove it.

His book reminds me of the writings attributed to Hippocrates,
which are also available on the Internet Archive in both the original language and in translation with comments by Galen.

Then I imagine you'll get right the fυck down to finding that attestation.

"
Stuartg

January 7, 2015

Greg Young

I think you are confused. That paper had a moderate dose of gabapentin (I’ve prescribed both less and more) versus three times the maximum recommended dose of melatonin.
"

"One hundred thirty patients aged between 35 and 85 years scheduled for cataract surgery were randomly allocated to three study groups to receive melatonin (6 mg), gabapentin (600 mg) or placebo"

How is one hundred times as great a dose in any way safer?

My script for Gabapentin was one 300 mg pill once a day.
Sounds to me like you are over prescribing.

My supplement mix contains 200 mcg of Melatonin. You don't need any more than that to get the job done.

How would a drug that requires 100 times as much to do the same job be considered to be more suitable?

I had side effects from gabapentin and have had no side effects from use of Melatonin.

I did notice a UK based gabapentin support forum. There seem to be a lot of patients in the UK that are having problems with those massive doses.
Perhaps you should rethink your policy. You could start by asking your patients if they are having any side effects.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Here’s a story on the more recent trials.

A news story from 2004. But strangely there is nothing in the scientific literature about this trial.

I wonder why?

Correction 300mg of Gabapentin is more than one thousand times higher dose than 200mcg.

"RESULTS:

Systemic M4N treatment suppressed the in vivo growth of xenografts in each of the five human tumor types. Four of the five tumor models were particularly sensitive to M4N with tumor growth inhibitions (T/C values) of < or = 42%, whereas the fifth, HT-29, responded to a lesser extent (48.3%). Growth arrest and apoptosis in both the xenograft tumors and in the tumor cells grown in culture were accompanied by reductions in both Cdc2 and tumor-specific survivin gene expression. Pharmacokinetic analysis following oral and i.v. administration to ICR mice indicated an absolute bioavailability for oral M4N of approximately 88%. Minimal drug-related toxicity was observed.

CONCLUSION:

These preclinical studies establish that when given systemically, M4N can safely and effectively inhibit the growth of human tumors in nude mice."
http://www.ncbi.nlm.nih.gov/pubmed/15958646

You weren't using the right key word. try M4N.

This study mentions the 2004 human trials obliquely. Some necrosis was observed in human test subjects.
https://www.google.com/url?q=http://www.pnas.org/content/101/36/13239.f…

From Cancer Research UK
"There is also an extract from the chaparral shrub called M4N. An American study in 2004 showed that M4N may be safe to use. Researchers injected it into the tumours of 8 people with advanced head and neck cancer. These cancers had not responded to other types of treatment. Nobody on the trial had the serious liver damage that has been shown in studies with chaparral. The study found that M4N appeared to shrink some tumours. A 2006 study showed that M4N might help to stop cancers from becoming resistant to certain types of chemotherapy. But we need more research to see if M4N will help cancer treatments to work better."
http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatme…

The previous study was done in the 1970's, so the 2004 study is much more recent.

By Greg Young (not verified) on 07 Jan 2015 #permalink

@ Greg Young:

Here's a Quack Miranda Warning from your friends at t.a.d.a.com:

We are not medical experts and encourage you to continue
your own research on any topic found on this website.

One of our recommended sites is: www.drmercola.com

No further comment is necessary.

With aspirin/willow bark/salicylates of sufficient dose to have therapeutic effects, there will be some cases of both GI hemorrhage and Reyes syndrome.

There are two core assertions: (1) the conversion of the prodrugs to salicylic acid occurs in the liver, sparing the GI tract, and (2) there is reduced antiplatelet action (or it's completely impossible, whatever; cf. goo-dot-gl/EB3WDc and see also PMID 17622365 for the assertion that the acetyl makes the antithrombotic).

The evidence for the latter

^ Scratch that leftover sentence fragment at the end if you would.

Correction 300mg of Gabapentin is more than one thousand times higher dose than 200mcg.

"RESULTS:

Systemic M4N treatment suppressed the in vivo growth of xenografts in each of the five human tumor types. Four of the five tumor models were particularly sensitive to M4N with tumor growth inhibitions (T/C values) of < or = 42%, whereas the fifth, HT-29, responded to a lesser extent (48.3%). Growth arrest and apoptosis in both the xenograft tumors and in the tumor cells grown in culture were accompanied by reductions in both Cdc2 and tumor-specific survivin gene expression. Pharmacokinetic analysis following oral and i.v. administration to ICR mice indicated an absolute bioavailability for oral M4N of approximately 88%. Minimal drug-related toxicity was observed.

CONCLUSION:

These preclinical studies establish that when given systemically, M4N can safely and effectively inhibit the growth of human tumors in nude mice."
http://www.ncbi.nlm.nih.gov/pubmed/15958646

You weren't using the right key word. try M4N.

This study mentions the 2004 human trials obliquely. Some necrosis was observed in human test subjects.
https://www.google.com/url?q=http://www.pnas.org/content/101/36/13239.f…

From Cancer Research UK
"There is also an extract from the chaparral shrub called M4N. An American study in 2004 showed that M4N may be safe to use. Researchers injected it into the tumours of 8 people with advanced head and neck cancer. These cancers had not responded to other types of treatment. Nobody on the trial had the serious liver damage that has been shown in studies with chaparral. The study found that M4N appeared to shrink some tumours. A 2006 study showed that M4N might help to stop cancers from becoming resistant to certain types of chemotherapy. But we need more research to see if M4N will help cancer treatments to work better."
http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatme…

The previous study was done in the 1970's, so the 2004 study is much more recent.

PS
I had not noticed that Melatonin is supposed to have anti aging qualities. That would explain why people have been remarking on my youthful appearance in recent years.
Other than my grey hair I show little sign of my true age, With a hat on I could pass for late thirties.
After looking into this I can now understand why.

Since chronic vitamin D deficiency is a factor in Reyes syndrome that could be why its still a problem in the UK, you don't get enough sun.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Posts keep appearing and disappearing, that's why the double post.

By Greg Young (not verified) on 07 Jan 2015 #permalink

Perhaps you should rethink your policy. You could start by asking your patients if they are having any side effects.

Perhaps you should find a new fυcking hobby.

A news story from 2004. But strangely there is nothing in the scientific literature about this trial.

Ding!

Here we go on the literature front. But, hey, be warned:

The active ingredient in willow bark is salicylic acid, but aspirin is an acetyl derivative of salicylic acid, a refined or manufactured derivative chemically close but not quite the same.

"
Stuartg

January 8, 2015

Greg Young

I note that once you are in a corner (eg aspirin vs willow bark) you change the subject (eg to chaparall).

This is known as changing the goal posts.

With aspirin/willow bark/salicylates of sufficient dose to have therapeutic effects, there will be some cases of both GI hemorrhage and Reyes syndrome. That’s what others here are saying.

You say that willow bark does not have the same adverse effects as other salicylates; it’s up to you to prove it."
I'm not the one who brought up Chaparral, Look back over posts made before I mentioned it.

I said there's no evidence of a case of Reyes Syndrome being brought on by Willow Bark, can you prove that there has been?

Tylenol is implicated in hundreds of liver failures and tens of thousands of emergency room visits. Can you say the same for Willow Bark.
For that matter Chaparral has been implicated in very few cases of liver failure, and none of these involved it being used in the traditional manner.

I know for a fact that Melatonin in the miniscule doses I use is safe and effective. I have my suspicions about how safe Gabapentin would be in the massive doses you prescribe.

Its 141 AM here so I'm going to bed.
If you find a single known case of Reyes syndrome associated with use of Willow Bark let me know.
Same goes for liver failures caused by use of Chaparral as an ointment or in a traditional tea.

You should read the book on Cherokee medicine I linked to, you might at least find it of interest.

By Greg Young (not verified) on 07 Jan 2015 #permalink

I'm really going to try to avoid wasting more time on this tonight, but I'm starting to get the strong feeling that tetra-O-methyl NDGA isn't in any way, shape, or form what Mr. Young imagines a "refined extract" to be.

I’m not the one who brought up Chaparral, Look back over posts made before I mentioned it.

No, but you are the one who seized upon an idle comment I made on one of Krebiozen's and started running as fast as you could with it, to the point of rhapsodizing about "the Civilized tribes" and the Constitution and your new reading discovery at archive-dot-org.

You might understand how this might look an awful lot like a distractionary maneuver.

Tylenol is implicated in hundreds of liver failures and tens of thousands of emergency room visits. Can you say the same for Willow Bark.
For that matter Chaparral has been implicated in very few cases of liver failure, and none of these involved it being used in the traditional manner.

Does that mean that willow bark should only be used in the traditional manner? Oh, wait, you don't prescribe answer questions like that.

You've already tried this routine, remember?

So much for willpower:

Tetra-O-methyl NDGA (M4N) is a semi-synthetic derivative of NDGA also known as terameprocol (TMP).

"No, but you are the one who seized upon an idle comment I made on one of Krebiozen’s and started running as fast as you could with it,"
This has been a discussion on traditional medicines has it not?
Questions were asked about records of use of herbal medications by Native Americans. I answered those with available sources.

Be careful stroking your own inflated ego so vigorously, the static electricity generated might ignite your army of strawmen.
Good night.

By Greg Young (not verified) on 07 Jan 2015 #permalink

This has been a discussion on traditional medicines has it not?

No, it has been a bizarre spectacle of your raving incoherently about the default superiority of willow bark preparations over APAP.

Questions were asked about records of use of herbal medications by Native Americans. I answered those with available sources.

Aimless blabbering, not to mention somehow managing to shoot yourself squarely in the foot with M4N, is not "answering" anything. It especially does not help out your flat assertion that "Willow Bark has been in use by" American Indians – who, you may recall, had no written tradition – "for over 1200 years" in the slightest, nor does it help your frankly deranged attempts to claim that the adverse-event "record" of antiquity is sufficient to make claims regarding the actual toxicity of random botanicals.

Orac:

"There’s plenty of science to rule out much of TCM now, no need for “more research,”

As I pointed out earlier, for someone who accuses others of rhetorical fallacy, your arguments are full of them.

This would be "error of composition".

Jeff 188:

"You are an exceptionally good example of an apologists for TCM. Please tell us why your arguments are different than those in support treatments that come out of. witchcraft. After all, many of them are probably just placebo, and made with the consent of the patients."

See Sadmar at 183; I don't believe I have anywhere suggested anything contrary to his interpretation of my quote.

So yes, I have no problem with witchcraft as long as there is no harm done. Could you explain why you do? Is it a religious position or what?

And I'm not apologizing for anything, I'm just pointing out poor reasoning on the part of Orac and a number of others, who are making alarmist predictions, but can't offer any rational causal narrative to justify their hysteria.

Can you provide a scenario where a normative licensed MD would provide sub-standard care as a result of having been exposed to the concepts of TCM (or witchcraft?) Or of having read that terrifying Chinese pharmacopia? Is she going to prescribe non-prescription adulterated drugs? Why?

zebra,

I appreciate that you gave a thorough and well-written reply, but I am still missing a concrete threat to anything.

Do you sincerely believe that medical schools teaching pre-scientific nonsense, and doctors prescribing treatments that have been shown to be useless, are not threats to the quality of patient care?

That said, the metaphor/analogy is useful, and you are not addressing the question I’ve been asking of all my interlocutors. Thinking in terms of action-at-a-distance does not make my calculation of the path of a projectile invalid; it is a convenient fiction, perhaps.

So what convenient fiction is useful in medical science? If conventional medicine is Newtonian physics in your metaphor, what is quantum physics? TCM? Homeopathy?

Thinking of photons as waves in one context and particles in another helps us to make sense of experimental observations. Thinking of rheumatoid arthritis as an imbalance of liver and kidney energies (or whatever TM model you prefer) is just not as useful as thinking of it as an autoimmune disease. It's not a convenient fiction at all, it's an inconvenient obfuscating fiction that helps nothing but the bank account of the practitioner.

Other than our sensibilities being offended, what terrible outcome is supposed to happen because people are thinking in terms of chi or humours or whatever?

You could make that argument about a million things that present no immediate "concrete threat". What concrete threat does teaching intelligent design in schools present? What about racist ideas, misogyny, geocentrism, germ theory, holocaust or climate change denial pose? It's a cheap debating trick to demand evidence of immediate harm and to cite the slippery slope fallacy as a response.

I'm passionate about education, especially in science. I think it's a good thing, and pseudoscience is a bad thing. It's an aesthetic judgement really: I prefer truth and honesty to ignorance and deceit, however convenient they may be. I think misinformation is a bad thing.

That, in itself, does not threaten medical care except by (to me extreme) slippery-slope thinking. If it does, *then there is a serious flaw in the system*, which is what we should be worried about fixing.

You seriously don't see a problem with this? You are happy for doctors to be trained in the use of acupuncture, or whatever, and to be told that it works because it stimulates the flow of a non-existent energy through non-existent meridians? You seem to be arguing that no doctor would be stupid enough to take this seriously so it's OK, or have I misunderstood you?

“There’s this Chinese book with a list of herbs, one of which is known to be toxic, and they’re going to teach about it in medical school. Eeek!” “Acupuncture and reiki (whatever that is) are probably placebos. Eeek!”

I believe that medical school should be teaching doctors how to serve their patients best. I don't see how teaching them things that are not true is helpful. If your child came home from school and told you she had been learning about Narnia in her geography classes, would you be happy? Would you shrug and think it wouldn't do any harm? Or would your response be, "Eeek!".

Now Todd will probably claim Strawman, but he nor anyone has provided a rational causal path by which these things will impact my medical care. Are we seriously worried that doctors will now prescribe a toxic substance that has no effect other than toxicity? What, are drug reps going to be showing up with Aristolochia plants for the office?

Firstly, I object to this development on principle, because as I've said, I don't think we should be teaching medical students nonsense, and I don't think we (humanity as a whole) should encourage people to believe nonsense.

Secondly, I can imagine several scenarios in which this could be dangerous for patient care. I already gave the example of placebo treatment of asthma potentially leading to disaster.

These fears seem irrational to me because, again, there’s this long slippery slope to fall down before you hit bottom,

The newly qualified doctor who remembers being taught that acupuncture can relieve the symptoms of asthma, and prescribes it for his patient instead of a bronchodilator is right at the bottom of your hypothetical slippery slope already, with status asthmaticus and death as very real possible consequences.

and the supplement issue plays into this very strongly– if I can already get these compounds on the internet or by growing some plants, what do doctors have to do with it? Are we going to legalize pot and make the growing of sassafras a felony? And then allow doctors to prescribe it?

Indeed, what does this have to do with doctors? You seem to want to drag this into the equation when really the issue is what doctors are being taught in their training. I don't care what people grow, or what supplements or herbs they take, though I would like them to be informed of the risks.
If I see a doctor I want him/her to be well-versed in the best that scientific medicine can offer. If I want traditional medicine I'll go to one of the many alternative health clinics that seem to exist absolutely everywhere.

It may sound flip the way I am putting this, but I’m seriously asking. When I say you guys are sounding like the true anti-science guys, it’s because you are failing to make the connection– I think that’s what reiki is like, right?

What connection? I have failed to find anything resembling a point in your comments, other than some sort of claim that it doesn't really matter if we teach doctors nonsense because it probably won't do too much harm, no doctor is going to actually use any of the nonsense they are taught in practice, they prescribe too many antibiotics anyway and patients can take supplements and herbal remedies without a prescription so who cares? That just seems, well, rather lazy to me.

I see that you have not followed up on my 146.

I have now.

However, in your interchange with Greg Young, you are doing a pretty good job of backing yourself into a corner with respect to my issues.

Oh really?

What exactly is the danger of ‘integrating’ again?

Doctors being taught nonsense and practicing it on patients.

Here you are telling us in great detail that willow bark is just too chancy a material to be tamed,

No, just pointing out that his claim that it has no side effects is incorrect, and exploring a few side roads such as Reye's Syndrome on the way.

and Greg is telling us that he would happily use aspirin (or willow bark extract) even without consulting a licensed MD/[TCM charlatan]. There is no intersection.

That is his right, and I would not wish to take it away from him. I still reserve the right to call BS when he claims it has no side effects. It isn't true that herbal medicines are always harmless, they do vary in potency in an unpredictable manner, and if doctors are going to prescribe a treatment I think it should be as reliable as possible i.e. a standardized extract at the very least, or preferably a drug that has been formulated to be safer and more effective, like artemisin derivatives that are more bioavailable than the natural substance.

For willow bark (or Rhino horn or whatever) to be a prescription drug, it would have to be standardized and approved by the FDA. If that can’t happen (according to you),

I didn't say it couldn't happen. I pointed out that no one has done any of the large long term studies on willow bark that would be required for a drug to be marketed.

Anyway, it has been standardized and approved by the FDA - the result was aspirin. However it seems there may be other active substances in willow bark that could also be isolated and standardized and approved by the FDA.

then it can’t be prescribed by MD/TCM. What would be the point of teaching about it in medical school?

Huh? Do you really believe that doctors are not allowed to prescribe (in the looser sense) anything but prescription medicines? If it isn't a prescription drug then they don't have to prescribe it (in the stricter sense of writing an actual prescription), they can just tell them to buy some at their local health food store (or more likely from Sharon at reception - kerrching).

What exactly are these students going to be taught that worries everyone so much?

See above.

What is a possible scenario where one of these doctors is going to say: “I want you to take this stuff that you buy on the internet and the composition of which is indeterminate.”? Or, “go find a willow tree and chew the bark.” ? What would the malpractice insurance cost?

That is precisely how naturopaths and some (but not all) chiropractors practice, and they seem to manage. Malpractice is when "treatment provided falls below the accepted standard of practice in the medical community" (from Wikipedia), so if prescribing willow bark becomes part of that accepted standard it isn't malpractice.

It really sounds more and more like a paranoid conspiratorial fantasy, with some dark alien forces (or maybe just hippies and French philosophers) controlling what scientifically oriented individuals at every level of education and experience are thinking.

Except it isn't a paranoid fantasy, it is actually happening. Some of us are, or have been, involved in medical education, so it isn't just some abstract thing to us, it's an important issue. Did you read the supplement? I honestly find this worrying. We know how easy it is to fall prey to our cognitive biases and start believing in BS. When BS starts being taught as fact in our educational institutions I think we have to take a stand on principle, however hypothetical the risks. When a problem is clearly getting worse, invoking the slippery slope fallacy as an excuse for not doing something about it seems pretty lame to me.

And yes, I know about Dr Oz– Dr Oz is on television; he isn’t dispensing wacky stuff from his office.

You know this how? It wouldn't surprise me if he was, suggesting it if not dispensing it. I wonder which psychic healer he recommends, except no doctor could be stupid enough to suggest that, could they? Or maybe he only gives "medical advice with no scientific grounding" on his TV show, and not to patients in person, which must confuse them no end.

By Krebiozen (not verified) on 08 Jan 2015 #permalink

I think I've figured out a couple of the flaws in zebra's reasoning.

First, he seems to think that the original post is arguing against taking SBM and gussying it up in some new clothes, harnessing the names and rituals of so-called traditional medicine in order to get SBM to places without high quality modern healthcare. But that's not what is being argued. The problem is that AAS/Science and the WHO are trying to get things like "acupuncture", relatively unregulated herbal medicine and homeopathy integrated into SBM as acceptable treatments, when they are either useless or harmful.

Second, zebra is engaging in argument from incredulity. He seems to believe that no trained MD would knowingly prescribe something that is useless or harmful to their patients. He also seems to think that the education being called for in the supplement and in the WHO's plan would include teaching med students that these TM/TCM treatments are merely placebos that may or may not make the patient feel better, or that herb X can have these negative side effects and vary greatly in potency. It is a rather idealistic and naive view. One need only look at existing educational programs (some of which have already been pointed out) to see that these ideas and notions are not being presented from a scientific standpoint, but rather credulously telling students, "Yep, this works!"

zebra also seems to be laboring under some misunderstandings of definitions. For example:

Sure you are. If you fix bad conventional medicine, you don’t have to worry about TCM. If you lock out TCM, you do nothing about bad conventional medicine.

If you could explain why TCM is a threat, given what I have pointed out, you would be more credible. If TCM were ‘integrated’, it would simply be equivalent to the lowest-level type of ‘bad conventional medicine’, which is the supplements that already exist. It would change nothing.

When we are talking about science-based medicine, we're talking about ensuring that the treatments that patients receive have a sound scientific basis. Prescribing antibiotics for viral infections or telling someone that taking a bunch of vitamin supplements will prevent the flu does not fall under "SBM". We do not give what you are calling "bad conventional medicine" a pass. Those things should be fixed, and we're just as critical of MDs prescribing abx for a cold as we are of them prescribing therapeutic touch or some concoction of poorly characterized herbs to balance chi.

If you agree that those things are bad and should be fixed, then why do you think it's okay to integrate even more unscientific nonsense into the mix? It's like walking into your room, seeing a pile of sh*t on your floor and saying, "Well, it won't change anything if I dump another couple buckets of sh*t on the floor."

You're basically saying to bring in more sh*t, while we're arguing, "Nope, we've already got a bit of a mess here to clean up. We don't need even more. Just take that sh*t to the compost pile where it belongs."

We aren't saying that this is going to happen overnight and suddenly there will be MDs everywhere killing their patients through negligence, though that seems to be what you think we're saying. Rather, pseudoscientific nonsense will creep in slowly (heck, it already is; see above). The impact won't be immediate or huge. We won't suddenly see people dying left and right. We will, however, see a decrease in health improvement. Most people will probably be fine, since the most common reasons people seek medical treatment is for self-limiting things. But some people will have conditions that will go on longer than they ought to because they received woo instead of SBM. Some will have conditions that worsen for similar reasons. And it won't be every doctor or nurse. But the percentage of the whole will increase, particularly if TM/TCM becomes more normative and rigorous standards of research are relaxed (as TM/TCM advocates are currently trying to do).

As I advised before, I would encourage you, zebra, to do some more reading on this blog, David Colquhoun's blog, and just generally educate yourself a bit more about medical pseudoscience and its effects. You might also peruse What's the Harm? to see examples of things that may become more frequent should nonsense be "integrated" with real medicine.

@Krebiozen

You know this how? It wouldn’t surprise me if he was, suggesting it if not dispensing it. I wonder which psychic healer he recommends, except no doctor could be stupid enough to suggest that, could they? Or maybe he only gives “medical advice with no scientific grounding” on his TV show, and not to patients in person, which must confuse them no end.

Well, I do recall something about him having reiki practitioners in his operating suite.

Krebiozen,

A long and not very focused response.

"I have failed to find anything resembling a point in your comments, other than some sort of claim that it doesn’t really matter if we teach doctors nonsense because it probably won’t do too much harm, no doctor is going to actually use any of the nonsense they are taught in practice, they prescribe too many antibiotics anyway and patients can take supplements and herbal remedies without a prescription so who cares? That just seems, well, rather lazy to me. "

Actually, I would call it parsimonious. As I said to Todd earlier, if you fix the problems in medicine, then TCM is not a problem. But ranting about TCM is a way of denying the problems and simply engaging in posturing about virtue.

You tell me about an MD selling supplements out of her office. Isn't that a problem of ethics education and regulatory laxity? And isn't Dr Oz a (previously) highly regarded product of exactly the system you are so eager to protect from change?

"I think we have to take a stand on principle, however hypothetical the risks."

But your "risks" are not hypothetical, they are as wacky as reiki. They are not just factually questionable; they fail the simplest tests of logic and reason.

How does "willow bark become a standard of care" if the material isn't standard--ized? Is the FDA going to be magically staffed with those naturopaths, and all you guys aren't going to notice?

And the thing about acupuncture and asthma is even more delusional. We are obviously quite capable of relieving the symptoms of any number of potentially fatal conditions without treating the underlying problem. Are you suggesting

1) Such practice will become the standard of care in *all* cases

or

2) Just those doctors accepting the utility of acupuncture are going to become psychotic? Sounds like a case for "Criminal Minds"...

Really, you guys are trying to stretch some very virtually trivial points to create an argument. We obviously should not forgo regular medicine where there is a realistic expectation that it will benefit the patient. But unless you can demonstrate that something is happening other than chi-washing (#179), I would say this is a tempest in a pot of hibiscus tea.

Fix the FDA. Fix the US medical system. There's tons of work to be done that will deal with your fears as a byproduct.

zebra- Allow me to simplify it for you. We have a simple standard for medicine:
1) Things that work.
2) Things that don't work.
Much of TCM is of the second.

By Gray Falcon (not verified) on 08 Jan 2015 #permalink

zebra,

A long and not very focused response.

Sorry, but I responded to each of your comments in turn, in the order you presented them. The length and lack of focus are a direct reflection of what you wrote.

Actually, I would call it parsimonious.

I don't see how any of your arguments could be described as in any way parsimonious. Quite the opposite if anything.

As I said to Todd earlier, if you fix the problems in medicine, then TCM is not a problem. But ranting about TCM is a way of denying the problems and simply engaging in posturing about virtue.

TCM is one of the problems in medicine. How does stopping excessive prescription of antibiotics stop the infiltration of quackery into conventional medicine? Who is denying any problems? You seem very confused about this.

You tell me about an MD selling supplements out of her office. Isn’t that a problem of ethics education and regulatory laxity?

If willow bark becomes a part of conventional medicine, then it could be sold out of a doctor's office. Naturopaths already supply their patients with supplements and herbal medicines.

And isn’t Dr Oz a (previously) highly regarded product of exactly the system you are so eager to protect from change?

How does Oz's decent into quackery justify teaching quackery in medical school? I don't follow.

“I think we have to take a stand on principle, however hypothetical the risks.”
But your “risks” are not hypothetical, they are as wacky as reiki. They are not just factually questionable; they fail the simplest tests of logic and reason.

How so? How does the scenario of a patient being prescribed acupuncture for asthma and having an acute asthma attack "fail the simplest tests of logic and reason"?

How does “willow bark become a standard of care” if the material isn’t standard–ized?

I don't believe you are dumb enough to be sincere in asking these silly questions. Doctors make all sorts of recommendations that are not standardized; diet and exercise for example.

Is the FDA going to be magically staffed with those naturopaths, and all you guys aren’t going to notice?

What does the FDA have to do with this? If doctors have been taught that acupuncture or homeopathy are effective treatments, either they are going to use them, in which case teaching them this is harmful, or they won't use them in which case teaching this is a waste of time and resources. Either way it is a bad thing.

And the thing about acupuncture and asthma is even more delusional. We are obviously quite capable of relieving the symptoms of any number of potentially fatal conditions without treating the underlying problem.

You fail to understand my point. The study I was referring to found that asthma patients given a placebo reported a subjective improvement in their symptoms, but objective measures of lung function found no improvement. This means that asthmatic patients given an placebo like acupuncture are in real danger of an acute asthma attack, without any warning signs. Thousands of people die due to asthma every year, this is not a delusion.

Are you suggesting
1) Such practice will become the standard of care in *all* cases

Of course not.

or
2) Just those doctors accepting the utility of acupuncture are going to become psychotic? Sounds like a case for “Criminal Minds”…

What psychotic behavior are you referring to? Prescribing acupuncture to an asthmatic patient may lead to a subjective decrease in symptoms that leads them to stop their conventional medication, assuming they have been prescribed one.

Really, you guys are trying to stretch some very virtually trivial points to create an argument.

It seems to me you are hand-waving away a very real threat to science based medicine with some juvenile debating tricks.

We obviously should not forgo regular medicine where there is a realistic expectation that it will benefit the patient.

Then why teach doctors to do just that?

But unless you can demonstrate that something is happening other than chi-washing (#179), I would say this is a tempest in a pot of hibiscus tea.

Did you even bother to read the supplement in question? This isn't about pandering to the worried well, it is about putting TCM on an equal footing with SBM, using TCM philosophy to develop new drugs and monitor drug side effects.

Why shouldn't schools teach intelligent design or that the earth was created in 4004 BC? What harm can it do? Why not teach about Narnia in geography classes? Your objections are as puerile as these questions.

Fix the FDA. Fix the US medical system. There’s tons of work to be done that will deal with your fears as a byproduct.

You seem to be unable to conceive of the possibility of dealing with more than one problem at once. Curious.

By Krebiozen (not verified) on 08 Jan 2015 #permalink

I guess stopping an epileptic seizure by stimulating the vagus nerve must rank right up there with ground dragon's teeth.
Many years ago I was told of a method used by life guards to handle a panicked drowning man. It involved pressure on the lymp nodes under the arm pits. Near as I can reminder the pressure tricked the body into not trying to breathe. The victim quickly stopped struggling and took no more water into their lungs. If not done a drowning man could easily take the life guard down with him.

When I was a boy scout our scout master was old enough to have been one of the original Lord Baden Powell scouts.
He had earned the Martial Arts merit badge awarded in those days, which included use of weapons of various sorts and hand to hand combat techniques adapted and further developed by British troops in far flung regions of the world.

We were also taught quite a bit about wound care where no modern medicines could be found.

If anyone here were injured in a plane crash deep in some mountain range in the arm pit of the world, you'd be far better off if one of the survivors had studied those ancient methods of wound treatment.

By Greg Young (not verified) on 08 Jan 2015 #permalink

HEALTH; Healing Treatment, 4,000 Years Old, Is Revived

By ELISABETH ROSENTHAL

Published: April 5, 1990
http://www.nytimes.com/1990/04/05/us/health-healing-treatment-4000-year…

"Other Remedies From History

Until a century ago, doctors applied leeches for almost every illness in the mistaken belief that they would draw out ''bad blood.'' Today they are used after microsurgery that reattaches fingers, toes and other body parts. An operation can fail because tiny blood vessels become clogged. But when a small European leech, Hirudo medicinalis, is attached, it sucks out an ounce or two of blood from the clogged vessels. The leech's saliva containes an anticoagulant and an antiseptic.

Maggots, fly larvae, once allowed to clean festering battlefield wounds, have been used to save the legs of a 17-year-old girl who developed a blood infection that caused clotting in her legs. Oral antibiotics could not reach the sores, so physicians at Children's Hospital in Washington D.C., applied 1,500 maggots. They ate away dead skin while allowing healthy skin to thrive.

Scientists have also validated a folk remedy for cuts used by Arab fishermen. The Arabian saltwater catfish, Arius bilineatis, secretes a slimy, gellike substance that contains proteins that coagulate blood to stop bleeding and enzymes that speed the growth of new tissue. "

Anti Biotic from dirt
http://www.nytimes.com/2015/01/08/health/from-a-pile-of-dirt-hope-for-a…

By Greg Young (not verified) on 08 Jan 2015 #permalink

@Greg Young (in #227)

Congratulations, you provided examples of treatments which were studied scientifically and applied according to the science. That is part of conventional therapy. It does not, however, justify using TM/TCM willy-nilly, much of which is more along the lines of leeches for every malady under the sun to get rid of "bad humours".

We have no problem studying plausible treatments and incorporating what actually works. We're not arguing against that. It's when things are used without having been studied or where study has shown them to be usless/harmful that we object to.

To go back to Gray Falcon's post, there is:

1) That which has been shown to work (medicine).
2) That which has been shown not to work (quackery).
3) That which has not yet been shown to work or not work (may be medicine, may be quackery).

Mr Young's standard appears to be that if something traditional works, everything traditional probably works too. Which is, frankly, bonkers. Bloodletting was traditional too, and the traditional uses of leeches (basically, a somewhat tidier form of bloodletting to balance humors) were quite different from their modern uses (to restore blood flood to surgically reattached tissues, which isn't something that had much application a century ago when the surgical response to an accidental amputation was to cut off a bit more so your stump is at least clean).

By Calli Arcale (not verified) on 08 Jan 2015 #permalink

Greg @201:

That one drug is measured in micrograms and another in milligrams doesn't make the microgram-dose one a better choice. Caffeine and LSD are both stimulants, and LSD doses can be in the 100-microgram range. Even if it was legal, I wouldn't start dropping acid in the morning instead of having a mug of black tea.

Todd W: Thanks, I forgot category 3.

By Gray Falcon (not verified) on 08 Jan 2015 #permalink

Greg Young

You compare apples with oranges when you compare gabapentin with melatonin. I gave the indications for both in my first comment. The only place where they are in any way alternatives to each other is within your own mind.

Perhaps you should read the indications and doses for both gabapentin and melatonin before you put your foot further in it with more obviously unknowledgeable comments.

@zebra:

You seem to have a touching faith in the ability of newly minted MDs to recognize SBM and consistently reject unproven treatments. Medical school is a barrage of information that has to be assimilated in a very short time. There is little time for contemplation of whether something presented by an authority figure is real or BS. There are too many MDs who buy into to such notions as acupuncture, homeopathy, energy medicine, antivaccination and so forth. "Integrating" this stuff into the med school curriculum will just make things worse. Far better would be courses in skepticism and critical thinking.

Greg Young,

The dose varies between medications for many reasons, hence the need for the science of pharmacology.

If you don't have the background education to understand the basic reasons why melatonin is prescribed in single milligram doses daily, compared with gabapentin in hundreds of milligram doses several times a day, for different reasons, there is no point in trying to educate you further.

"@Greg Young (in #227)

Congratulations, you provided examples of treatments which were studied scientifically and applied according to the science. "
Which has been my intention all along. You'd understand that better if you read my posts rather than accepting strawman arguments made by others without thinking.
" It does not, however, justify using TM/TCM willy-nilly, much of which is more along the lines of leeches for every malady under the sun to get rid of “bad humours”.
When did I make any such suggestion?"

When the German Nun Saint Hildegard von Bingen
wrote of humors and black bile she was describing what we now know to be symptoms of liver dis-function.
Doctors in Germany have studied her methods and still use some of them today.

"January 8, 2015

Greg @201:

That one drug is measured in micrograms and another in milligrams doesn’t make the microgram-dose one a better choice. "
It does when the drug commonly prescribed in such massive doses and not metabolized but excreted directly in urine is responsible for a very long list of other even more dangerous side effects.
http://www.drugs.com/sfx/gabapentin-side-effects.html
While taking Gabapentinin my urine turned dark as tea, then black then bloody.
Tell me you would continue using a drug that caused that side effect.
My vision was also seriously impaired. I couldn't carry my car keys in my pocket without huge black bruises forming on my thigh.
I was weak as a kitten with irregular heart beat.
And that from what's considered a minimal dosage and over a very short period of use.

When I stopped using that drug the side effects went away.

The false sense of well being that has led to serious abuse of Gabapentin by drug addicts in the UK may prevent patients from reporting these side effects till its too late.
There seems to be some serious withdrawal problems with this drug as well.

Gabapentin though not metabolized by the liver has still been implicated in several cases of liver damage.

Melatonin is metabolized in the liver and has been proven in clinical trials to improve liver function in those with previous liver damage.
The dose I use is a mere fraction of the maximum allowable dose.
In maximum doses the body can tolerate this drug for up to two years of regular use though to be on the safe side they recommend no more than two months use at that high level.

Prescribing Gabapentin as a sleep aid is a common but "off label" use. More care should be taken in dispensing this drug, the side effects are often extremely serious.

I choose to use a minimal dose of a drug known to improve liver function, what's so strange about that?
I choose not to use huge doses of a drug with known and proven side effects that adversely affected my own health and was prescribed "off label". What's so strange about that?

By Greg Young (not verified) on 08 Jan 2015 #permalink

Greg Young @195

You are also moving the goalposts back and forth between the positions that “Chaparral is not dangerous when taken in small quantities in the traditional manner”, and “Chaparral might be therapeutic if taken in sufficiently large quantities”.
Please make up your mind.”

If you bothered to read more than one or two pages on that subject you’d find that there’s been more than one trial of its effectiveness.

I am pointing out a contradiction in your own statements, where studies of effectiveness are irrelevant. You are claiming that
(1) Chaparral is non-toxic if taken in small traditional doses; and
(2) Chaparral may be therapeutic if taken in large enough non-traditional doses.
But your claim for non-toxicity does not apply to the allegedly therapeutic use, and vice versa. Choose one or the other.

By herr doktor bimler (not verified) on 08 Jan 2015 #permalink

Melatonin is metabolized in the liver and has been proven in clinical trials to improve liver function in those with previous liver damage.

You really just can't control yourself from deranged exaggerations, can you?

Many years ago I was told of a method used by life guards to handle a panicked drowning man. It involved pressure on the lymp nodes under the arm pits. Near as I can reminder the pressure tricked the body into not trying to breathe. The victim quickly stopped struggling and took no more water into their lungs. If not done a drowning man could easily take the life guard down with him.

Speaking as a former lifeguard and lifesaving instructor, I can honestly say that I have never heard of that method, and that, on its face, it sounds like an incredibly dangerous way to approach a panicked drowning person. Even assuming it would work, in order to do it, you would have to get right in close to this panicked drowning person and fumble under their arms for the proper pressure point, all while they are thrashing around trying to climb up on top of you. Sounds like a pretty good way to get dragged down to me.

The standard method we were taught (and made to practice over and over and over and over) to keep a panicking non-swimmer from dragging you down with them was to approach and carry from below.

By delta-orion (not verified) on 08 Jan 2015 #permalink

While taking Gabapentinin my urine turned dark as tea, then black then bloody.

How could you tell it was bloody after it had turned black?

you are not addressing the question I’ve been asking of all my interlocutors

My prescriptivist side finds this usage extremely amusing.

Perhaps you mean the Master-at-Arms badge for “skill in any two of Singlestick, Fencing, Boxing, Quarterstaff, Ju Jitsu, Wrestling, or Gymnastics“.

https://www.youtube.com/watch?v=piWCBOsJr-w

What about self defense against fruit (or a pointed stick)?

Tbruce 233:

"You seem to have a touching faith in the ability of newly minted MDs to recognize SBM and consistently reject unproven treatments. Medical school is a barrage of information that has to be assimilated in a very short time. There is little time for contemplation of whether something presented by an authority figure is real or BS. There are too many MDs who buy into to such notions as acupuncture, homeopathy, energy medicine, antivaccination and so forth. “Integrating” this stuff into the med school curriculum will just make things worse. Far better would be courses in skepticism and critical thinking."

You mean doctors aren't trained in skepticism and critical thinking? It's worse than I thought! You mean they are little algorithmic automatons?

See, this is what makes all these arguments ridiculous. Yes, I do have a touching faith in normative doctors, since I have friends and family in that category, and not one of them would prescribe acupuncture for asthma, or anything else, without doing their homework looking for dangers.

You, krebiozen, todd, et al may be projecting from your own need to feel relevant or something, I don't know. Maybe you're just a bunch of old farts doing the "what is the world coming to" thing. (Speaking as an old fart myself.)

But if you are correct that these kids are so mindless, again:

Fix It!

They will then prescribe *neither* willow bark *nor* antibiotics, nor unnecessary tests and procedures, when not warranted. See how easy it is? One universal cure. Holistic thinking, right? No drug interactions.

By the way, I thought of a factual question. Are doctors now taught to ask asthma patients if they have had acupuncture? That would be prudent, wouldn't it?

What about self defense against fruit (or a pointed stick)?

Haig: My god, yes. You saved my damn life that day, Blacky. If it weren't for you, that pygmy woman with the sharpened mango could have seriously...

By herr doktor bimler (not verified) on 08 Jan 2015 #permalink

Fix It!

Rejecting this alt med BS would be a good start. Note the word "start".

"I am pointing out a contradiction in your own statements, where studies of effectiveness are irrelevant. You are claiming that
(1) Chaparral is non-toxic if taken in small traditional doses; and
(2) Chaparral may be therapeutic if taken in large enough non-traditional doses."
Please quote in its entirety any post where I made such statements.

I quoted passages that revealed that the actual number of cases of liver damage due to ingestion of Chaparral was small. The victim of the worst case having upped her dose to six times greater than normal.
I quoted or linked to information on studies of the use of refined extracts of Chaparral in treating some forms of cancer. These refined extracts would not have been available to Native American Shamans.
I described how the Native Americans used this herb as topical applications and weak teas. This would be an answer to the following.
"
Narad

Speaking of American Indians, one might note that the hepatotoxicity of chaparral wasn’t exactly picked up on."
The American Indian didn't pick up on the hepatotoxicity of chaparral because they didn't ingest large concentrations. Its unlikely that when used as they used it that any toxic effect would present itself.

Then there's this question about information on Native American remedies in general and willow bark specifically.

"Where can I find the records of toxic effects during that period?"
So I posted the Link to "the Cherokee Doctor".

The Cherokee did have writing of a sort but mainly depended on oral tradition.
There's a good study on oral tradition and oral history on a U S Army website.
A Cherokee later developed a proper written language.
Without paper of any sort writing was not a viable method of keeping records, though petroglyphs from those days still exist.
Testing of pottery from those periods have revealed presence of willow bark.

Either toxicity was not a problem when the Indians and Greeks etc were using for thousands of years or they left no record of any observed toxic effect and those better educated members of their society in later generations who went to medical schools and practiced both European medicine and traditional medicines don't seem to have left any such records either.
I'm not going to waste my time looking for something that apparently doesn't exist.
If someone can find a single case of anyone suffering liver damage or Reyes Syndrome from ingestion of Willow Bark I'll be happy to look into it.

By Greg Young (not verified) on 08 Jan 2015 #permalink

Krebiozan,

Help! I have a serious medical question that Tbruce couldn't answer:

Are doctors trained to ask asthma patients if they have had acupuncture? It would seem prudent given what you have told me.

acetaminophen sux.
aspartame sux.
Rumsfeld sux.

"
TBruce

January 8, 2015

Perhaps you mean the Master-at-Arms badge for “skill in any two of Singlestick, Fencing, Boxing, Quarterstaff, Ju Jitsu, Wrestling, or Gymnastics“.

https://www.youtube.com/watch?v=piWCBOsJr-w

What about self defense against fruit (or a pointed stick)?
"
I learned how to kill a man with a potato, no bull.
Also how to kill with a rolled up newspaper.
Some really weird sounding but actually very simple techniques.

"Master at Arms" is the correct term.
In his day that included rifle marksmanship and archery as well as the martial arts.
Technically use of weaponry is a martial art.
We were instructed in marksmanship using .22 rifles and air guns. I made my own long bow.

Our troop was disbanded and absorbed by another before I got more than one merit camping badge. They said I could build a campfire from wet rocks.
I didn't care for the new troop so I dropped out.

By Greg Young (not verified) on 08 Jan 2015 #permalink

zebra,

You, krebiozen, todd, et al may be projecting from your own need to feel relevant or something, I don’t know. Maybe you’re just a bunch of old farts doing the “what is the world coming to” thing. (Speaking as an old fart myself.)

Are you as obnoxious in real life as you are in these comments? How is concern about the quality of medical attention an expression of a need to feel relevant? Do you really not care at all if the quality of medical education goes down the pan?

Presumably you have nothing to do with medical education. I am increasingly getting the impression that you are just speculating on something you clearly know little about for your own amusement, with the intention of annoying people who do care about the subject.

But if you are correct that these kids are so mindless, again:
Fix It!

How precisely do you propose to do that? Oncologists are starting to see untreated advanced cancer that they had previously only seen in historical text books. This is because people are listening to alternative health practitioners who tell them they can cure them with quackery. When publications like Science bring out a supplement like this it helps to validate dangerous nonsense that really does lead to serious problems, despite your disbelief.

They will then prescribe *neither* willow bark *nor* antibiotics, nor unnecessary tests and procedures, when not warranted. See how easy it is? One universal cure. Holistic thinking, right? No drug interactions.

It's very easy declaring change by fiat with absolutely no explanation of how this would be achieved in practical terms. How would you deal with the TM proponents who have infiltrated academic medicine? What are you doing to change things if it is as easy as you claim?

By the way, I thought of a factual question. Are doctors now taught to ask asthma patients if they have had acupuncture? That would be prudent, wouldn’t it?

I doubt it. I think doctors managing asthmatics expect them to use a peak flow meter and manage their own condition, as I do. I doubt that many are aware that placebos can lead to a dangerous false sense of well-being in asthmatic.

Why don't you ask your friends and family who are doctors? While you are at it, why don't you ask them what they think about this Science supplement and the introduction of 'integrative medicine' into academia. Are they as complacent about it as you are?

By Krebiozen (not verified) on 08 Jan 2015 #permalink

"Speaking as a former lifeguard and lifesaving instructor, I can honestly say that I have never heard of that method, and that, on its face, it sounds like an incredibly dangerous way to approach a panicked drowning person. Even assuming it would work, in order to do it, you would have to get right in close to this panicked drowning person and fumble under their arms for the proper pressure point, "
This was in the days before Baywatch, when a life guard had only swim trunks and a whistle.
Pulling the victim along from behind with hands under the armpits is a common method. Pressure was applied with balled fists, the area was not so small that you'd have to search for it.
The method was also taught to women as a self defense technique when pinned down by a rapist.

I suspect fear of liability if the victim didn't resume breathing once out of the water has caused the method to be dropped.

By Greg Young (not verified) on 08 Jan 2015 #permalink

Krebiozan,

I don't get into this kind of discussion with friends and family because if you think I'm 'obnoxious', you would turn into jelly if they got after you. I'm the polite wimp in that circle. More to the point, they are not closely accessible and I don't do the facebook and constant contact stuff.

But, yes, I don't know about the subject that much. I do know about issues with reasoning and expertise though, and the progression of scientific thought.

If you say there are these TM proponents 'infiltrating' medical education, then I have to assume that someone hired them. What's up with that? Who hired them and why? Was this over the objections of the existing faculty? Did they fire people who knew about the problems with acupuncture and asthma despite tenure? How does that work-- it isn't something I have experience with. Usually, when people with new concepts are hired, it is for a reason.

The thing is, I'm willing to learn if you give me actual information; you and others seem only willing to repeat the same simple assertions and expect never to be challenged.

As for how do you fix things-- you have to not dodge the real underlying problems by attacking silly and inconsequential ones. Give doctors some more spine. That's the problem with prescribing *both* antibiotics and acupuncture.

I am amazed that you don't understand that.

"Abstract

The present study represents the follow-up of our initial observations designed to investigate whether in patients with nonalcoholic steatohepatitis (NASH) the beneficial effect of 12-week course of melatonin (MT) on liver enzymes could be maintained with prolonged period of treatment and to analyze whether biochemical treatment responses could be sustainable after melatonin discontinuation. Forty two patients with histologically proven NASH (30 treated with melatonin 2x5 mg daily, 12 controls receiving placebo) enrolled to our previous 3-month study agreed to take part of subsequent 12 weeks treatment followed by 12-week follow-up period. Enrolled patients had biochemical determinations every six weeks during the melatonin treatment period and again after 12 weeks of follow-up. Significant reduction in median alanine aminotransferase (ALT) levels between baseline and week 18, week 24 and follow-up was observed in both MT-treated and control group: 43% and 31%, 42% and 33%, 32% and 31%. Aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) levels decrease significantly only in MT-treated group. In MT-treated group mean percentage change in AST level below baseline at week 18, at week 24 and at follow-up was 45%, 33% (p<0.05) and 8% (ns), respectively. The evolution of GGT levels was as follows: the mean percentage reduction in GGT below baseline level at week 18, 24 and follow-up was: 48%, 52% and 38% (p<0.05), respectively. In both MT-treated and control group plasma cholesterol, triglicerydes and glucose concentrations as well as plasma alkaline phosphatase persisted within normal values during the prolonged study period. Plasma concentration of melatonin (pg/ml) in MT-treated group averaged 7.5±3.5 at baseline and increased to 52.5±17.5 at 24th week. The results of our study demonstrating beneficial effect of melatonin on liver enzymes in patients with NASH would seem to encourage further controlled trials of melatonin given over a longer period of time with liver histology as end point."

"The results of our study demonstrating beneficial effect of melatonin on liver enzymes in patients with NASH "
So that part is proven by clinical trial.

Saying they would like a longer trial to study the long term effect does not mean that the results of the short term trial should be ignored.

http://www.ncbi.nlm.nih.gov/pubmed/22460459

By Greg Young (not verified) on 08 Jan 2015 #permalink

"
Stuartg

January 8, 2015

Greg Young,

The dose varies between medications for many reasons, hence the need for the science of pharmacology.

If you don’t have the background education to understand the basic reasons why melatonin is prescribed in single milligram doses daily, compared with gabapentin in hundreds of milligram doses several times a day, for different reasons, there is no point in trying to educate you further."

I've pointed out just why a drug that passes unchanged through the kidneys and is prescribed at such high doses can cause serious side effects.
Or perhaps you like having a black discharge and blood in your urine.

"
Stuartg

January 8, 2015

Greg Young

You compare apples with oranges when you compare gabapentin with melatonin. I gave the indications for both in my first comment. The only place where they are in any way alternatives to each other is within your own mind.

Perhaps you should read the indications and doses for both gabapentin and melatonin before you put your foot further in it with more obviously unknowledgeable comments."

I'm not the one who prescribed the Gabapentin as a sleep aid. The idiot Dr who did prescribe it is the one who seemed to believe these were interchangeable.

"Gabapentin documents raise concerns about off-label promotion and prescribing

Melissa Sweet, Health and Medical Writer, Sweet Communication, Sydney

Summary

Anticonvulsant medications have been widely used for off-label indications. Court documents recently released in the USA suggest that some of the off-label use of the anticonvulsant gabapentin was driven by deceptive and illegal marketing practices. Reliable evidence is not available to support many of the off-label uses of gabapentin. Off-label use of medications can be beneficial, but clinicians and patients should be aware of the quality of evidence available to support such usage."
http://www.australianprescriber.com/magazine/26/1/18/9

If you are supporting the practice of off label prescription then say so.
If you are intent on ignoring serious side effects of Gabapentin then say so.

If you prescribe Gabapentin only as intended then more power to you. If you closely monitor its use then more power to your.
If you were to ignore side effects of this drug on your patients be prepared to face the music when the time comes.

By Greg Young (not verified) on 08 Jan 2015 #permalink

Greg Young,

You weren't using the right key word. try M4N.

How on Earth is a paper on use of M4N in mice from John Hopkins University the same as a small-scale human clinical trial from Medical University of South Carolina?

This just highlights your Gish Gallop activities.

GY: "This was in the days before Baywatch, when a life guard had only swim trunks and a whistle."

You haven't been to the beach since you were a kid, obviously. The ones at the beaches I frequent have basically the same equipment.The only things that are different are that they now have phones and a bullhorn-oh, and better training.

Zebra: You still haven't mentioned what you've got against rhinos. Part of the concern over TCM is that the trade in endangered species is such a big part in it. Obviously if TCM spreads in the US, the current trade in rare and endangered species will rise. So that's another reason that it shouldn't be imported here.

By Politicalguineapig (not verified) on 08 Jan 2015 #permalink

How on Earth is a paper on use of M4N in mice from John Hopkins University the same as a small-scale human clinical trial from Medical University of South Carolina?How on Earth is a paper on use of M4N in mice from John Hopkins University the same as a small-scale human clinical trial from Medical University of South Carolina?

I posted related study that mentioned results of the 2004 study. So it does appear in the literature if you look hard enough.
If you aren't interested in answers don't ask questions.

By Greg Young (not verified) on 08 Jan 2015 #permalink

"Abstract
Terameprocol (meso-tetra-O-methyl nordihydroguaiaretic acid, formerly known as EM-1421 and M4N) is a semi-synthetic small molecule with antitumor activity occurring via selective targeting of Sp1-regulated proteins, including survivin and cdc2 that control cell cycle and apoptosis. Terameprocol is in clinical development as a site-specific transcription inhibitor in solid refractory tumors. The present studies were designed to investigate the in-vitro and in-vivo anticancer activity of terameprocol in a novel hydroxypropyl β-cyclodextrin and polyethylene glycol solvent formulation (designated CPE) designed for safe parenteral administration. Terameprocol powder was dissolved in CPE (20% hydroxypropyl β-cyclodextrin and 50% polyethylene glycol 300 or 30% hydroxypropyl β-cyclodextrin and 25% polyethylene glycol 300) or dimethyl sulfoxide and used for in-vitro cell proliferation assays, and in human carcinoma xenograft studies using female athymic nude mice injected with SW-780 human bladder cells. Terameprocol (50 and 100 mg/kg), paclitaxel (5 mg/kg), terameprocol and paclitaxel or vehicle was administered intraperitoneally daily for 21 days. Stock solutions of the CPE formulation were stable for up to 12 months. Terameprocol CPE formulation showed concentration-dependent inhibition of HeLa and C33A cell proliferation, and was less toxic than terameprocol dimethyl sulfoxide formulation. The terameprocol CPE formulation showed no overt toxicities in tumor-bearing mice. Terameprocol alone reduced the rate of tumor growth, and a combination of terameprocol/paclitaxel reduced both the rate and extent of tumor growth. These preclinical results confirm the tumoricidal activity of terameprocol formulated in a solvent suitable for parenteral administration and suggest that terameprocol has improved efficacy when coadministered with paclitaxel."
http://journals.lww.com/anti-cancerdrugs/Abstract/2007/09000/The_antica…

By Greg Young (not verified) on 08 Jan 2015 #permalink

"

Australia
January 8, 2015

Here’s a story on the more recent trials.

A news story from 2004. But strangely there is nothing in the scientific literature about this trial.

I wonder why?"
I guess you just didn't look hard enough.

Since the name used for these extracts is not the same in every article that mentions this trial its not easy to find the right ones.
An example would be someone being asked about Gabapentin and being shown an article on Neurontin . They are the same drug, just different names for the same drug.

By Greg Young (not verified) on 08 Jan 2015 #permalink

"

January 8, 2015

So much for willpower:

Tetra-O-methyl NDGA (M4N) is a semi-synthetic derivative of NDGA also known as terameprocol (TMP)."

Did you somehow fail to notice that the article you linked to confirmed what I'd said about Chaparral not showing toxic effects when used in the traditional applications.

If you had bothered to read some of the articles you have posted links to you wouldn't have to ask these silly questions, but then you'd have no opportunity to mischaracterize the answers. No fun in that I suppose.

By Greg Young (not verified) on 08 Jan 2015 #permalink

What exactly does the term "Semi Synthetic" mean to you?
Not entirely synthetic?
Derivative could mean extracted from.

Since you can't even glean any useful information from the articles you yourself post links to how could I be expected to force you to accept what you yourself have proven to be true without ever realizing it.

Besides which you are so immature and arrogant no body is going to take you seriously, I certainly don't. Grow up.

One thing about Melatonin that had had never suspected, turns out it protects living cells from damage from Gamma ray exposure. That's so out of left field that I don't know what to think about it.
I wonder why they even thought of testing it for that purpose.

By Greg Young (not verified) on 08 Jan 2015 #permalink

When the German Nun Saint Hildegard von Bingen
wrote of humors and black bile she was describing what we now know to be symptoms of liver dis-function.
Doctors in Germany have studied her methods and still use some of them today.

My immediate reaction was to be skeptical about the interpretation of any 12th-century descriptions of physiology, and to be concerned that you have stared so long into the Abbess that the Abbess stared into you. But I don't know enough about Hildegaard's oeuvre to agree or disagree (being more familiar with her music, and with Sacks' theory that she was a migraineuse, i.e. One of Us).

Do you have any sources for this claim, for my education and possible disagreement?

By herr doktor bimler (not verified) on 08 Jan 2015 #permalink

What exactly does the term “Semi Synthetic” mean to you?
Not entirely synthetic?
Derivative could mean extracted from.

It means that the NDGA came from the crude material and then somebody in a lab had to swap out the hydroxyls for methyls.

It's "the chaparral version of aspirin," if that helps.

^ Yah, methoxyls.

One thing about Melatonin that had had never suspected, turns out it protects living cells from damage from Gamma ray exposure. That’s so out of left field that I don’t know what to think about it.

If only Paul Zindel had known.

I guess you just didn’t look hard enough.

Well, you sure the fυck didn't "look hard" at all, which is why I wasted my time on comments 213 and 214, which you are now apparently just barfing back up in copy–paste format.

You weren’t using the right key word. try M4N

No, this is a recipe for failure.

zebra,

I don’t get into this kind of discussion with friends and family because if you think I’m ‘obnoxious’, you would turn into jelly if they got after you. I’m the polite wimp in that circle.

Your style doesn't bother me, I'm just puzzled by it. I spent several years working with colleagues to make the area of medicine I was involved with more science and evidence based, with some modest success, and I was involved in medical education for a while too. That's one reason this is important to me.

More to the point, they are not closely accessible and I don’t do the facebook and constant contact stuff.

Next time you are in contact, ask them what they think about the subject, unless you are too much of a wimp, of course ;-).

But, yes, I don’t know about the subject that much. I do know about issues with reasoning and expertise though, and the progression of scientific thought.

Yet you seem to have no problem with nonsense being taught in medical schools. How does that work?

If you say there are these TM proponents ‘infiltrating’ medical education, then I have to assume that someone hired them. What’s up with that? Who hired them and why? Was this over the objections of the existing faculty? Did they fire people who knew about the problems with acupuncture and asthma despite tenure? How does that work– it isn’t something I have experience with. Usually, when people with new concepts are hired, it is for a reason.

I'm in the UK so I'm not too familiar with how things work in the US. I don't think any new people have been hired, so perhaps I should have been more precise in my language. This isn't a new thing, this goes right back to the formation of the Office of Alternative Medicine quarter of a century ago, and before that to the battles against homeopathy by the AMA. Altmed proponents have been working to get it accepted by the mainstream for a long time, and they appear to be succeeding in some areas.

The thing is, I’m willing to learn if you give me actual information; you and others seem only willing to repeat the same simple assertions and expect never to be challenged.

The assertions we have made about the infiltration of woo into mainstream medicine are undeniably true. The issue is that you apparently don't understand why some of us are concerned about it.

As for how do you fix things– you have to not dodge the real underlying problems by attacking silly and inconsequential ones. Give doctors some more spine. That’s the problem with prescribing *both* antibiotics and acupuncture.

I had no idea it was so simple, silly me. Now how specifically do we go about giving doctors "more spine"? I would have thought ceasing to teach them that BS is true at medical school would be a start, but it seems you disagree.

I spent years trying different ways of persuading doctors to order fewer unnecessary blood tests, and trying to educate them in the use of near patient testing technology with limited success. Doctors are humans like the rest of us, and suffer from the usual human foibles. Ordering them to get some "more spine" works about as well with doctors as it does with anyone else.

To take an example we have used before, doctors know that prescribing antibiotics for viral infections is wrong, but they still do it. How do you propose to force them to get some more spine and stop this practice?

I am amazed that you don’t understand that.

I am amazed that you think that teaching medical students that alternative medicine works is "silly and inconsequential".

By Krebiozen (not verified) on 09 Jan 2015 #permalink

"
Narad

January 9, 2015

One thing about Melatonin that had had never suspected, turns out it protects living cells from damage from Gamma ray exposure. That’s so out of left field that I don’t know what to think about it.

If only Paul Zindel had known."

I'll be content with walking the earth looking thirty years younger with my DNA intact while you are slithering through the sewers catching rats with your tentacles and arguing with your second evil head.

By Greg Young (not verified) on 09 Jan 2015 #permalink

"While most people today view Hildegard’s medicine as folkloric, a few take her theories seriously. Dr. Gottfried Hertzka of Germany has practiced “Hildegard medicine” for thirty years, using Causae et Curae as his guide. In the 1980s, he was joined by Dr. Wighard Strehlow, a research chemist, at the St. Hildegard Center on Richenau Island in Lake Constance. In 1993, he moved his practice to the Hildegard House in Allensbach, a small town in southern Germany. Diet, diagnosis, and herbal remedies based on Hildegard’s writings are available there.

The International Society for Hildegard von Bingen Studies, headquartered in Cambridge, Massachusetts, brings together scholars and other people interested in Hildegard and her place in history. The August 1994 issue of its newsletter, Qualelibet, is devoted to Hildegard’s medical works and her relevance to holistic medicine. For further information, contact Professor Pozzi Escot, 24 Avon Hill, Cambridge, MA 02140."

Read more: http://www.motherearthliving.com/health-and-wellness/hildegard-of-binge…

By Greg Young (not verified) on 09 Jan 2015 #permalink

I think you need to step back and listen to your own arguments.

*You* are telling me that teaching students that something (antibiotic prescription for viral infections, excessive testing) is BS....

Doesn't Work!

My diagnosis, like it or not, is that because you can't deal with this (admittedly very difficult) problem, you are campaigning against an easier foe, and inflating his importance.

And by any logic, it simply isn't anywhere near as important.

If it came to pass that powdered ginger root rather than antibiotics was what patients demanded when they had a head cold, that would be enormous progress, wouldn't it? I see no downside at all in that.

I think I've made this as clear as I can, so unless you can demonstrate that you have read carefully, and speak specifically to my point, I'll leave it at that.

Sorry, my comment 280 is addressed to Kerbiozen.

minor point re: those glowing wounds from Shiloh battlefield: to the best I can establish It was found that micro organisms that both glow (more precisely, luminesce) which also produced natural antibiotics were not isolated from that battlefield's soil of that battle field were natural antibiotics. Instead, following speculation that the glow could have been due to luminescent bacteria the luminescent bacteria P. Luminescens (an insect pathogen) isolated from a different source was examined to determine if it produced antibiotic compounds.

The idea that the glow associated with the wounds was caused by 1) bacteria at all, 2) a bavcteria like P. Luminescens that both glowed and produced one or more natural antibiotics and 3) that bacterial infection of the wounds would produce sufficient natural antibitics to affect wound healing, oprevent infection or improve chances of survival remains wholly speculaltive.

I'll note also that this glowing bacteria has been isolated from human lesions following insect bites, where despite the production of potential natural antibiotics it's hardly been found to be beneficial (for example, see PMID:10523568).

Interestingly when I noticed that St Hildegard used "Oil of Poppy" for her head aches. I at first thought it was an opiod, but it isn't, theres no opium in this oil which comes from the seeds,
Though ingestion of poppy seeds in baked foods can cause a false positive for opiods in drug tests.
On looking into Oil of Poppy I found it has been used in modern medicine to selectively embolize tumors without effecting healthy tissue.

Could be Hildegard had a brain tumor which stimulated her mind to unconventional thinking.

Also Hildegard was not an Abbess, though usually referred to as such, she was a "magistra".

By Greg Young (not verified) on 09 Jan 2015 #permalink

One problem with the incorporation of woo into medical school curricula, hopsital/clinical practices, etc., that hasn't been pointed out yet is that doing so it creates a the impression of a false equivalence between science/evidence based medicine and what may quite accurately be characterized as quackery.

Acupuncture and reiki, for example, simply do not work as claimed by traditional medical practicioners: when appropriately designed and controlled clinical trials find their performance to be indistinguishable from placebo controls or sham treatments. Including either of these 'traditional' treatment modalities in medical school curricula or offering them in clinical practices vest them with a false veneer of respectability.

"Acupuncture and reiki, for example, simply do not work as claimed by traditional medical practicioners: when appropriately designed and controlled clinical trials find their performance to be indistinguishable from placebo controls or sham treatments"

I can agree with that. I haven't endorsed this sort of treatment.
There may be a basis in fact for Accupuncture, or Accupressure at least. Stimulation of the vagus nerve at specific pressure points does have proven effects on body processes, both bad and good.
The use of electrical stimulation on this and other nerves suggests that the theory of magnetic or electrical fields affecting health deserves further study.

The only reason I'd even mention these ancient methods in a school setting would be to give the students something to think about that they might later build on for more viable theories on non invasive treatments.

When looking into St Hildegard I found she used what we now call the "scientific method" of observation and experiment.
Back in those days they practiced "natural philosophy".

By Greg Young (not verified) on 09 Jan 2015 #permalink

@Greg Young

There may be a basis in fact for Accupuncture, or Accupressure at least.

Only for stress relief and potential relief of subjective symptoms, but there's no evidence for objective relief of symptoms/signs.

@JGC #284,
That's what I was alluding to at #255 when I wrote, "When publications like Science bring out a supplement like this it helps to validate dangerous nonsense".

By Krebiozen (not verified) on 09 Jan 2015 #permalink

zebra,

I think you need to step back and listen to your own arguments.

I have been thinking about this for years, thanks.

*You* are telling me that teaching students that something (antibiotic prescription for viral infections, excessive testing) is BS….
Doesn’t Work!

So it's OK to teach medical students any old crap because they won't listen anyway? Really?

My diagnosis, like it or not, is that because you can’t deal with this (admittedly very difficult) problem, you are campaigning against an easier foe, and inflating his importance.
And by any logic, it simply isn’t anywhere near as important.

This is sometimes known as the "Don't you have more important things to worry about?" fallacy, and is a rather immature (IMO) debating trick.

Who says 'we' aren't campaigning against over-prescription of antibiotics? Again you seem to think that it is only possible to deal with one problem at once. I'm also concerned about publication bias and lack of oversight in the pharmaceutical industry and many other issues in medicine, as well as environmental issues such as ocean acidification and endangered animals. Do I have to give up these interests and only deal with one at a time?

By your 'logic' people concerned about rape shouldn't be wasting their time, they should be worrying about murder,or genocide. In fact the only 'logical' way of dealing with any problem would be to to start with the most important and work our way down the list one issue at a time.

If it came to pass that powdered ginger root rather than antibiotics was what patients demanded when they had a head cold, that would be enormous progress, wouldn’t it? I see no downside at all in that.

Me neither, though I have no clue how that would be achievable. Patients demand antibiotics because they know they work for bacterial infections, and believe that's what they have when they actually have a cold. I don't see how teaching doctors about herbal medicine isn't going to change that. I also still don't see how we can persuade doctors not to give in to patient demand without a spine transplant that isn't yet available.

I think I’ve made this as clear as I can, so unless you can demonstrate that you have read carefully, and speak specifically to my point, I’ll leave it at that.

I think you are dancing around the issues, avoiding making any firm statements about anything. This might be a good way of winning a debate, but not a good way of getting to the truth of a matter or deciding the best way forward with a thorny issue.

It's OK to teach medical students BS because if you tell them the truth they won't believe it anyway? Sheesh.

By Krebiozen (not verified) on 09 Jan 2015 #permalink

Krebo: "Patients demand antibiotics because they know they work for bacterial infections, and believe that’s what they have when they actually have a cold."

How do people not know the difference between a bacterial infection and a cold? I've had strep a couple of times and get a half-dozen colds every winter, and believe me, they feel very different. And, yes, I do rely on home remedies for colds, but that's more for placebo effect- and because I know that whatever I do, it'll be gone in a week.

Zebra; You still haven't explained why you dislike rhinos.

By Politicalguineapig (not verified) on 09 Jan 2015 #permalink

^ I don’t see how teaching doctors about herbal medicine is going to change that.

By Krebiozen (not verified) on 09 Jan 2015 #permalink

I think I'll add to the points I made at #224 (which zebra seems to have ignored) and say that zebra seems to have this idealized vision that doctors are somehow superhuman beings that are immune to the foibles to which all humans are prone, and that if only we would teach them properly, every problem associated with the practice of medicine (whether conventional or "traditional" or other) would just disappear.

Who says ‘we’ aren’t campaigning against over-prescription of antibiotics? Again you seem to think that it is only possible to deal with one problem at once. I’m also concerned about publication bias and lack of oversight in the pharmaceutical industry and many other issues in medicine, as well as environmental issues such as ocean acidification and endangered animals. Do I have to give up these interests and only deal with one at a time?

Perhaps in zebra's mind, if only you'd work toward the magic bullet of properly educating physicians, all of that would just go away. I love panaceas totally divorced from reality; don't you?

PGP,

How do people not know the difference between a bacterial infection and a cold? I’ve had strep a couple of times and get a half-dozen colds every winter, and believe me, they feel very different.

I think some people assume that if a cold drags on for a long time it must be bacterial. IANAD but I don't think it's always so easy to tell. I have read various dubious claims about mucus colors, and you can tell by the way a fever spikes IIRC. By the time a culture comes back it has usually gone anyway.

One of the few advantages of getting older seems to be fewer colds, at least that has been my experience. Presumably we develop a resistance to more and more rhinoviruses year after year.

By Krebiozen (not verified) on 09 Jan 2015 #permalink

This was in the days before Baywatch, when a life guard had only swim trunks and a whistle.

I sincerely hope you don't think Baywatch was anything like an accurate representation of real lifeguarding. Time was, it was a convenient shorthand metaphor for bad pop-cultural representations of real jobs. (My biochemist roommate for instance used to declare that "CSI is the Baywatch of forensics!" as she ranted about sloppy lab technique.)

Pulling the victim along from behind with hands under the armpits is a common method.

I only ever certified for pool lifeguarding, where distance is not a factor, but I did do some waterfront training on the side as part of a competitve guard team (yes, that's a thing, and it's AWESOME), and pulling someone along from behind with both hands under the armpits was not in either condition considered good technique. You wanted to hold the victim around the waist and against your hip, if possible, with one arm, leaving the other arm free to help you swim. To the extent that the distance you had to swim made it possible, you wanted to actually keep yourself underwater so that the person would not instinctively try to climb up on top of you to get clear of the water. At a waterfront especially, with the distance an issue, you would bring out some sort of a floatation device like a torpedo buoy (at a pool it was usually a flutterboard or a ring buoy, and you would throw it at the person before diving in) so that they were holding onto something before you approached, again to make it less likely that they would try to climb up on you. If the victim's size, the distance you had to swim, or some other factor made it necessary, you might grab them under the shoulders -- but a two-handed carry was generally only done once you reached shallow water and no longer needed your free arm for swimming (or if you were trying to immobilize their head because of a suspected spinal injury, but that's a whole different set of techniques).

Unless of course you were a character on Baywatch! (A good underwater carry looks really unsexy on camera. Can't see the lifeguard in her impractical but very pretty swimsuit at all.)

Pressure was applied with balled fists, the area was not so small that you’d have to search for it.
The method was also taught to women as a self defense technique when pinned down by a rapist.

I have questions about this. Are you're telling me that if I jam my balled fists indiscriminately into someone's armpits, they will stop breathing? For how long? Why would a panicked non-swimmer stop panicking upon suddenly being unable to breathe at all? Or are you also paralyzing them temporarily? I won't deny the possibility that this is simply a (pretty cool) thing I have never heard of, but without a proper citation I'm going to remain skeptical...

I suspect fear of liability if the victim didn’t resume breathing once out of the water has caused the method to be dropped.

I suspect the fact that it's a really dangerous way to approach a panicked non-swimmer is the reason it was dropped, if in fact it was ever used at all. Floatation device + underwater approach = safer. (Still not perfectly safe, though, which is why we also had to learn release and escape techniques, none of which involved armpits as far as I can recall.)

By delta-orion (not verified) on 09 Jan 2015 #permalink

@PGP

How do people not know the difference between a bacterial infection and a cold?

Because most people are not versed in immunology, microbiology or similarly related fields. Bacteria and viruses are abstract concepts. They get a sore throat and a cough and are prescribed antibiotics for the causal bacterial infection. Next time, they get sick with similar symptoms, they ask for the same treatment, not knowing the differences in symptoms well enough to figure out that it's a viral infection. Or they have an infection that produces nonspecific symptoms that could have either a bacterial or viral origin, but only a lab test can distinguish.

There may be a basis in fact for Accupuncture, or Accupressure at least. Stimulation of the vagus nerve at specific pressure points does have proven effects on body processes, both bad and good.

Unless the vagus nerve is an acupuncture meridian and not the 10th cranial nerve phsyically innervating target organs, and pressure upon can be demonstrated to alter the movement or flow of 'chi' energy within the body, I can't see how this can be interpreted as supporting a basis in fact for acupuncture. Quite the contrary, it sould seem to me to argue that what acuuncturists believe to be the fundamental mechanism of actio of their 'therapy' has another, entirely scienced based, explanation.

Greg Young: "The method was also taught to women as a self defense technique when pinned down by a rapist."

Speaking as someone who's done self-defense training, I was never taught this. If pinned, with one's back to the attacker, a strike to the solar plexus with elbows is much more effective. Alternatively, you could thrust your head up underneath the attacker's chin.

Todd W.: "Because most people are not versed in immunology, microbiology or similarly related fields. Bacteria and viruses are abstract concepts."

Todd, I'm a layperson myself. The sum total of my knowledge is two biology courses in college, high school science (we spent one semester banding birds and another playing with the Bunsen burners) and whatever I've picked up via reading or via family. What I know is stuff *anyone* could know. And yet, despite not having been near a microscope, lab or textbook in years, my first response to a cold isn't dosing myself with anti-biotics or calling the doctor.

By Politicalguineapig (not verified) on 09 Jan 2015 #permalink

@PGP

So, since you know the difference, everyone else must, too? You really need to work on your tendency to over-generalize.

Ginger tea has been shown to be as effective as antibiotics in treating a viral head cold. And better tolerated, as the docs say.

So, teaching that bit of herbal medicine to medical students, which would 'legitimize' it in the public's perception, might be an effective way to reduce the development of antibiotic resistance.

There is absolutely no difference in validity between thinking antibiotics will cure the common cold and thinking rhino horn will cure impotence. It's just part of a different magical paradigm:

"Sciency stuff that costs a lot and requires a prescription to get must work-- they wouldn't charge so much and make it a controlled substance otherwise, right?"

Different cultures, different delusions. Maybe integrating the two would even save some Rhinos.

Ginger tea has been shown to be as effective as antibiotics in treating a viral head cold.

If, for the sake of argument I'm willing to assume that this is accurate, the only appropriate response I can envision is: Did you have a point? Antibiotics do not exhibit anti-viral activity.

that being the case, the list of things known to be just as effective (that is, not effective at all) at treating viral head colds as antibiotics is all but limitless. Some examples:

wood carving
Zydeco music
juggling live goldfish
wearing your undewear on the outside of your clothes

"Greg Young: “The method was also taught to women as a self defense technique when pinned down by a rapist.”

Speaking as someone who’s done self-defense training, I was never taught this. If pinned, with one’s back to the attacker, a strike to the solar plexus with elbows is much more effective. Alternatively, you could thrust your head up underneath the attacker’s chin."
It was taught to be used when the woman was pinned down on her back facing the rapist. Perhaps I should have made that clear.

How would you be able to place both fists under the arm pits of an attacker who was behind you?
I would have thought you could have visualized what I meant without being told.
The area is the axilla, more or less, there are nerves near the surface.
From what I was told pressure on the lymph nodes there sent a scrambled signal to the autonomic system telling it there was no need to breath. The attacker in a rape situation would continue his strenuous activity for a few moments using up the oxygen in his blood then simply black out without realizing he had stopped breathing.
A woman pressing on the arm pits in that position would not even seem to be a defensive move. It might even be mistaken for responding to his advances.

In a situation where a drowning victim was in a blind panic, thrashing about and taking more and more water into their lungs and trying to climb on top of his rescuer he could drag the life guard down with him.
The rescuer would have no choice but to render the victim unconscious for his own good.

Since the pressure point is described in martial arts its use by life guards in those days may have come from underwater fighting techniques used by WW2 frogmen.
A family friend was a Korean War era frogman (UTD) and he taught me a number of very effective fighting techniques.
Since trying to throw a punch underwater is unlikely to have any effect use of these pressure points sounds like it would be the only sure method of getting the job done.

Since the vagus nerve carries signals from organs and glands directly to the brain bypassing the spinal cord altogether I would expect that it is involved in the effect.

By Greg Young (not verified) on 09 Jan 2015 #permalink

"Different cultures, different delusions. Maybe integrating the two would even save some Rhinos."
Or maybe it would drive them into extinction. Alternative medicine is not about living in harmony with nature, it is about exploiting nature's resources.

By Gray Falcon (not verified) on 09 Jan 2015 #permalink

Greg Young:" t was taught to be used when the woman was pinned down on her back facing the rapist. Perhaps I should have made that clear.

How would you be able to place both fists under the arm pits of an attacker who was behind you?
I would have thought you could have visualized what I meant without being told."

Well excuuuuse me for not being a very visual person. From a pinned position, best chance would actually be to raise the legs and employ the knees. The assailant will not be lying flat, so there's a bit of space to work with.
Also, American self-defense before World War 2 was in a pretty sorry state. Maybe a few people knew ju-jitsu, but karate, kung-fu, tae kwon do and many other styles were totally unknown to most Westerners.
We've come a long way since then, mostly because a lot of servicemen took lessons in martial arts and brought those home with them. And for your information, bub, I'm a black belt, so I think I know a bit more than you about self-defense.

Todd W: My point is that I work off information that is commonly available, including what my own nerves tell me. And that I spent two semesters in high school that did little science and I still wound up knowing more than the average bear. (Did make a pretty sweet pet cage and learned that chickadees are bastards, so it wasn't wasted.)
This is not rocket science, brain surgery, or rocket surgery. It's common sense!

By Politicalguineapig (not verified) on 09 Jan 2015 #permalink

You might look into this book by Dr. Wighard Strehlow, Gottfried Hertzka
Thanks.

By herr doktor bimler (not verified) on 09 Jan 2015 #permalink

@PGP

And my point is that you cannot use your own experience as applicable to the population at large. One thing that you do that I'd wager a lot of people don't is you hang out on blogs such as this one, where the topic of antibiotics and viruses is not unheard of.

It may seem like common sense to anyone who knows the differences between bacteria and viruses and the very basics of how antibiotics work, but those people are working from a state of knowledge that they take for granted. I'm sure there are probably things that you are ignorant about that someone else may consider common sense.

Again, try to put aside your tendency to over-generalize things. It's a common habit of yours, and one that is frequently pointed out to you on this blog.

"Also, American self-defense before World War 2 was in a pretty sorry state. Maybe a few people knew ju-jitsu, but karate, kung-fu, tae kwon do and many other styles were totally unknown to most Westerners."
I think you seriously underestimate the level of knowledge of the day.

Training for the average grunt was not that extensive but training for Commandos and UDT was often very advanced. Training for Naval frogmen was the basis for modern SEAL training.

Here's something on therapeutic uses of pressure in the same general area.
http://www.yogamag.net/archives/2011/joct11/swara2.shtml
Note the effect on breathing, in this case meant to improve breathing.

"Well excuuuuse me for not being a very visual person. From a pinned position, best chance would actually be to raise the legs and employ the knees. The assailant will not be lying flat, so there’s a bit of space to work with."
Have you ever had sex in the "missionary position"?
If not find a illustration and then rethink what you've said.
Also do you know what a roll up is?

By Greg Young (not verified) on 09 Jan 2015 #permalink

JGC 299,

Did you just stop reading after the first sentence?

"When I hit nineteen, I joined the Marine Corps and served for ten and a half years. When I joined in 1934, the Marines were teaching hand-to-hand combat, bayonet fighting and jiu-jitsu - all of which I absorbed. I trained with other Marine and F.B.I. agents under Colonel Biddle. I also met a Sergeant Kelly, who had been attached to the International Police in Shanghai, China in the 30's. He was looking for someone to practice with and I had the qualifications. This is how I came to learn a unique fighting method that no one else in the U.S. teaches.
This method is based on Mongolian wrestling techniques intended to maim or cripple. Combined with other methods that I studied through out the years, these techniques form a complete system. My method combines boxing, jiu-jitsu, karate, principles of Tai-Chi and Aikido, and dirty fighting. Keeping only what is useful and practical for self defense, there is not a wasteful technique. Over the years I have had many students with black belts in other martial arts come to me; all were amazed at how little they knew about real self-defense, despite years of training. They felt my method had rounded out their knowledge of self-defense. Many black belts and other so-called experts in the martial arts have been killed or injured in street fights because their skills didn't work outside the dojo."
http://www.urbancombatives.com/charlienelson.htm

There were other instructors with many years of experience fighting Chinese rebels and the private armies of war lords.
The USN had fought Korean warrior priests in close combat before WW1.
Biddlle was an international master of the sword, a boxer and a student of several forms of martial arts.

Jujitsu was developed from techniques of "Wrestling in Armor" and was uniquely suited to underwater combat where kicks and blows from the fist were so slow as to be ineffective.

By Greg Young (not verified) on 09 Jan 2015 #permalink

No, zebra. Given the equvialent eficacy, we should benefit just as well teaching medical students "Outside underwear has been shown to be just as good as antibiotics" as we should teaching them "Ginger tea has been shown to be as effective as antibiotics", shouldn't we? We've no rational reason whatsoever to preferentially teach them the latter rather than the former.

We simply need to be teaching them "Antibiotics aren't effective treatments for viral head colds: don't prescribe them for this indication."

"Unless the vagus nerve is an acupuncture meridian "
The vagus nerve runs through out the torso, find a diagram and check for were it comes close to the acupressure points.

" Floatation device + underwater approach = safer. "
Like I said "Baywatch".
Ever see those old ring type life savers. How quickly could you swim pushing one of those in front of you.
" The person is turned on their back with a secure grip used to tow from behind. If the person is cooperative they may be towed in a similar fashion held at the armpits. If the person is unconscious they may be pulled in a similar fashion held at the chin and cheeks, ensuring that the mouth and nose are well above the water."
Once they are unconscious and no longer struggling you could tow them by holding them under the arm pits.

By Greg Young (not verified) on 09 Jan 2015 #permalink

Result of a hard blow under the armpit rather than use of firm pressure.
"Armpit: A large nerve lies close to the skin in each armpit. A blow to this nerve causes severe pain and partial paralysis. A knife inserted into the armpit is fatal as it severs a major artery leading from the heart."
http://www.asiakravmaga.com/vitaltargets.html

By Greg Young (not verified) on 09 Jan 2015 #permalink

JGC

Still think you stopped reading.

It has been well documented by experts commenting here that it doesn't matter what you teach doctors, they will still prescribe antibiotics if the patient insists, and perhaps even if the patient doesn't insist.

So, ginger tea would definitely be more effective at minimizing antibiotic abuse because it would offer a believable alternative for the patient. The reasons are obvious.

More and more, I think the group of commenters here, doctors or not, would have benefited from a more comprehensive education. Reasoning skills are decidedly lacking.

If I were in a position of authority over a lifeguard who deliberately stopped someone's breathing, said lifeguard would be fired on the spot. I would take measures to try to have their certification permanently revoked, and I would be looking into having criminal charges laid. It is dangerous and unbelievably stupid. I would also be going after anyone I thought might have put the idea in their head.
And I couldn't care less what some aged chop-sugo idiot has to say about it.

"In a situation where a drowning victim was in a blind panic, thrashing about and taking more and more water into their lungs and trying to climb on top of his rescuer he could drag the life guard down with him.
The rescuer would have no choice but to render the victim unconscious for his own good."

"If I were in a position of authority over a lifeguard "

You would be perfectly happy to see both victim and life guard drown rather than risk a lawsuit.

By Greg Young (not verified) on 09 Jan 2015 #permalink

In a situation where a drowning victim was in a blind panic, thrashing about and taking more and more water into their lungs and trying to climb on top of his rescuer he could drag the life guard down with him.
The rescuer would have no choice but to render the victim unconscious for his own good.

No choice? Pfft. We were taught lots of defensive techniques, none of which required us to render anyone unconscious, none of which involved attempting to throw a punch underwater, and most of which would have been much more likely to be successful than trying to hit a couple of pressure points when someone's already climbing on top of you. It doesn't sound nearly as impressive and martial-artsy as pressure points, but the most basic one was simply: swim down. Down is the one place the panicking non-swimmer is trying desperately, mindlessly, not to go. If that didn't work, there were a variety of release techniques to use depending on the situation.

Like I said “Baywatch”.

If you think Baywatch demonstrated authentic lifeguarding techniques, you really are demonstrating how little you know about real-world lifesaving.

Ever see those old ring type life savers. How quickly could you swim pushing one of those in front of you.

Which is why, as I mentioned, they're used at pools (and other settings where throwing the life preserver is a reasonable option -- target practice with ring buoy and flutterboard are part of pool lifeguard training), and beaches tend to have torpedo buoys (which are often towed behind, rather than pushed in front).

” The person is turned on their back with a secure grip used to tow from behind. If the person is cooperative they may be towed in a similar fashion held at the armpits. If the person is unconscious they may be pulled in a similar fashion held at the chin and cheeks, ensuring that the mouth and nose are well above the water.”

You seem to be quoting something here, but what? Regardless, what is being described here, as far as I can tell, is a one-arm tow, which can be done at waist or chest or armpits depending on the situation. I note that it says that they can be towed by the armpits *if they are cooperative.* As I recall, holding them so that they were more or less sitting on your hip was the easiest (and safest) way to carry.

You seem to be trying to use some apocryphal story someone told you once about lifeguards to prove something-or-other. When reasons are pointed out why that story is probably not true, you start speculating about how it *might* have worked and why it *might* have been done rather than provide any evidence that it *did* work or *was* done. Which is not a pattern unfamiliar to people used to debating alternative medicine, incidentally.

By delta-orion (not verified) on 09 Jan 2015 #permalink

Is life saving technique an Alternative medicine?

What I was pointing out is that pressure points do have effects both good and bad depending on how the pressure is applied and for what reasons.

"Breaking a stranglehold had been a lifesaving technique since such training first began in the late 19th century. In fact, turn-of-the century rescuers were taught to break a victim's "death grip" by knocking the person unconscious. However, delivering a knockout punch in deep water with no foothold was difficult to impossible, and eventually slightly milder tactics were taught."
The article
http://scoutingmagazine.org/issues/0305/d-wwas.html

Tells of various self defense methods once taught for the purpose of avoiding being dragged down by a drowning man, and demonstrates the hysterical strength of a drowning man.
The conclusions of the article do pretty much agree that there are better methods, though the method I mentioned is not among those mentioned in the article so I don't know whether it could have been one of those "slightly milder tactics" that were taught either before or after the time frame he wrote of.

What I was interested in was how such a method might involve the Vagus nerve, and whether the vagus nerve was also the mechanism by which respiration was altered by traditional practices like Accupressure.

Since no one here ever heard of this method no one could offer any answers to my questions.
The method may have been one adapted from Jujitsu, it certainly sounds like one that may have been taught for "wrestling in armor".
The U S Navy used fighting techniques adopted from enemies they had fought in asia and the Philipines, all those enemies had distinctive fighting styles. Finding out where this technique came from is begining to be a mission for me. I'll continue my search without expecting any useful input from those here who never heard of it.

By Greg Young (not verified) on 09 Jan 2015 #permalink

zebra,

More and more, I think the group of commenters here, doctors or not, would have benefited from a more comprehensive education. Reasoning skills are decidedly lacking.

I have been lucky enough to have had an excellent education, in both natural and social sciences. You, however, appear to be more than a little lacking in reasoning skills yourself.

You offer an laughably impractical solution to a complex problem - simply make doctors grow a spine - and express amazement that no one else has though of that.

You make the ridiculous claim that because some doctors prescribe antibiotics for viral infections it doesn't matter what you teach them.

You argue that "ginger tea would definitely be more effective at minimizing antibiotic abuse because it would offer a believable alternative for the patient", when the entire point is that patients very likely have experience of the efficacy of antibiotics.

When your blunders are pointed out to you you accuse others of lacking reasoning skills - is that some form of projection? Or just the Dunning Kruger effect?

By Krebiozen (not verified) on 09 Jan 2015 #permalink

JGC wrote:

The incorporation of woo into medical school curricula, hopsital/clinical practices, etc., creates the impression of a false equivalence between science/evidence based medicine and what may quite accurately be characterized as quackery. Acupuncture and reiki, for example, simply do not work as claimed by traditional medical practitioners. Including these ‘traditional’ treatment modalities in medical school curricula or offering them in clinical practices vest them with a false veneer of respectability.

And Kreb decried, "teaching medical students that alternative medicine works."

I think there's too much assumption here. I have no idea what or how much any actual med school may teach about any TM practice, but I can certainly imagine a curriculum that touches on those practices without endorsing that they "work" as "claimed by traditional medical practitioners." As I've noted any number of times, placebo treatments are valid for certain patients under certain conditions. No false equivalence is implied when orthopedic surgeons and physical therapists are housed under the same roof.

Of course, admitting TM practitioners into 'real medicine' education or practice on their own terms would be horrible. It's not clear to me to what extent that occurs in "quackademia", and to any extent it does occur I would argue that need not be the case.

IMHO, as I tried to frame in #186, the real issue is the diagnostic competency of the practitioner in charge of a patient's primary care. As long as a sbm doc remains in charge, I see no problem with a patient seeing some form of woo-ist for chronic pain — on the presumption said wooist does not attempt to sell the patient on the power of reiki to cure cancer.

So let me note what scares the bejeebers out of me: state licensing and insurance recognition of any of these bozos for primary care. That is, giving the diagnostic call to anything less than a well-trained conventional practitioner. Which is exactly what naturopaths are trying to get in Maryland, and SfSBM is trying to fight.

Reiki masters don't scare me. All things considered, I land at 'if you're dumb enough to think folks claiming hand waving cures leukemia are credible, we really can't help you.' Naturopaths scare me, because they've work the 'intergretive' angle well enough to gain fairly wide credibility with typical medical consumers. They dispense enough valid medicine that their woo comes under an umbrella embodying both in a single "authoritative' voice that may actually (shudder) be granted some legitimacy by policy-makers.

One of the sopkesfolks for the Maryland naturos is currently employed in the 'Intergrative Med' wing of a legit health practice — The sort of thing I'd guess Orac would include in "quackademia". Her conditions of employment specifically rein her in to non-dangerous stuff, and give her little if any diagnostic authority. Her beef is that her education and expertise are thus being unfairly limited and underutilized. She and her gang want ore authority. A lot more.

So, I'm wondering if Kreb, JGC, Todd and maybe even zebra might agree with me that this woman's present practice is no big whoop compared to what she wants, and might actually get, and that the first order business for sbm advocates is to do what we can to prevent her from getting it.

Now, even if you think the path from her present to her desired future is a slippery slope (I don't btw) the question would be, "what can we use to de-grease the hill?" yes? And the hill in question is politics, decisions that will made by state officials in Maryland — and many states to follow.

Now, put on your politics hat, and take another look at TCM Today — A Case for Integration. Is there anything there you could pull out an apply as a degreasing agent?

TM needs rigorous, scientific data to demonstrate its efficacy. It also needs evidence-based standards for quality and safety evaluation to support its appropriate regulation…. The need for stronger regulatory control covers not only the products, but also extends across the practice and practitioners.

I submit if you can't use that, you're not thinking very clearly.

A small print note on the first page of TCM Today — A Case for Integration reminds us that it is but part 1 of a series titled The Art and Science of Traditional Medicine and "The next two issues will... highlight the importance of quality control, standardization, regulation, and safety for traditional therapies." I wonder how they'll tackle that — what sort of elaboration they'll offer on what constitutes "rigorous, scientific data"; and "evidence-based standards" for "appropriate regulation" of not just "products" but "practice and practitioners" as well.

I'd expect there to be some fudging, but I'd expect the nature of the promise will keep the fudging within a certain boundary that gives some ground a Maryland naturopath, say, might not want to give. Or at least be used as such in the political arena by SfSBM and other sbm advocates. Time will tell, as the next installments appear.

In the meantime, your thoughts?

Todd W: I knew the difference between bacterial infections and viral infections before I ever stumbled on this blog. I also knew what anti-biotics do to viruses (nothing) before I even went to college.

Greg Young: No, you're the one that doesn't understand. A tuck and roll maneuver could be used, or there are several other methods.
Korean Warrior Priests, really?
I'm sure they're in a comic book, but the US wasn't in Korea until World War 2. Korea spent most of the first half of the 20th century as a Japanese colony. I have nothing against comic books, but you want a history book. They're the ones without pictures, you know.

GY: "Ever see those old ring type life savers. How quickly could you swim pushing one of those in front of you."

You don't push them in front of you, dimbulb. You tow them behind you.

By Politicalguineapig (not verified) on 09 Jan 2015 #permalink

Greg Young is full of something.

Useful information it is not.

sadmar 317

Clearly articulated as almost always.

But politics is the art of compromise, and the players here are either not trained or psychologically disinclined in that area-- it's almost as if they fit the stereotype of old-school doctors. (Exacerbated by old-fart-what's-the-world-coming-to syndrome in some cases perhaps.)

You and I are very much on the same page with respect to the probable utility of these TM structures for people with minimal access if any to modern medical technology. I suggested at the very beginning of this often silly discussion that we ship some of our overused (in people and cows) antibiotics to third-world village practitioners, who with a bit of training could save some lives while adjusting chi and driving out witch-spirits. No takers.

I referenced [in part two] the op-ed yesterday by Dr Emanuel in the NYT, making the case that annual physicals are a waste of time, equivalent to Shamanistic ritual. (This is a controversial idea in the USA at least.)

So. What's the value of this 'integration'? It's that the process will shine light on the lack of scientific rigor, and poor delivery design, in both camps. The US medical establishment at least needs some major shaking up.

Maybe (another silly metaphorical suggestion) you see your local naturopath once a year, who takes your BP and some blood (data processed by some app, sent to some MD if needed), and tells you to quit smoking, lose some weight, and get some exercise. And treats your head cold with ginger tea. And that's the extent of the license.

I have to admit that, participating in this kind of discussion-- whether it's about medicine, or energy technology, or education-- I am truly puzzled (as an old fart myself) why people are so frightened of change. We should be contributing by *guiding* the inevitable changes, not fanatically resisting them.

“A decrease in liver enzymes has been noted in persons with fatty liver given melatonin supplementation, although not to a remarkable degree”

Why in G-d's name you're barfing up stuff from examine-dot-com, whatever the hell that is, when I handed you #241 defies my comprehension. Did it even occur to you to look at what was there? Or to wonder why the word "steatohepatitis" was in the link?

[PMID 24696836]

Melatonin shown to help in un blocking bile ducts

I'm not offhand seeing anything about biliary obstruction in that review. Since you've no doubt read it carefully before trotting it out, it should no trouble for you to point out the relevant section.

and reduce damage of Tylenol toxiticity.

You didn't read the reference for that, did you?

Also protects from other sorts of damage.
There’s quite a list of beneficial effects on the liver.

No, it's an example of your demonstrating that you can't understand a review paper for no discernible reason. This was your original comment:

Melatonin is metabolized in the liver and has been proven [sic] in clinical trials to improve liver function in those with previous liver damage.

So, where are they? I'm sure not finding anything over here.

sadmar,

I think there’s too much assumption here. I have no idea what or how much any actual med school may teach about any TM practice, but I can certainly imagine a curriculum that touches on those practices without endorsing that they “work” as “claimed by traditional medical practitioners.”

Why not check what is actually being taught to medical students, instead of imagining it? The following refers to the curriculum for integrative medicine at the Loyola University Stritch School of Medicine in Chicago:

The course also provides an overview of acupuncture, phytopharmaceuticals, mind-body medicine, homeopathy, and other manual CAM modalities. The overview of acupuncture includes the concept of Qi and Meridians, different forms of Qi, and the blockage of Qi and its consequences. [...]
In addition, the concept of Qi and Meridians and the mechanism behind the physical properties of an acupuncture needle are discussed. [...]
The methodology in these workshops is to give students an opportunity to experience first-hand the modalities, feel the flow of Qi, and learn the location of a few major acupuncture points along their Meridian systems. [...]
The physical examination includes some Eastern techniques involving tongue and pulse diagnoses and the evaluation of the relative temperatures of the Triple Energizer system. Some concepts and theories on Traditional Chinese Medicine such as the 4 vital substances, the origin of Qi, the 8 diagnostic principles, and the classification of Chinese herbs according to their energy and effects are discussed.

It certainly seems to me that they are teaching medical students that the TCM model is valid, that Qi and meridians exist and that pulse diagnosis is valid.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

zebra,

But politics is the art of compromise, and the players here are either not trained or psychologically disinclined in that area– it’s almost as if they fit the stereotype of old-school doctors. (Exacerbated by old-fart-what’s-the-world-coming-to syndrome in some cases perhaps.)

Nonsense. Medical students are being taught that Qi and meridians are real, and that pulse diagnosis is useful - see above. How is objecting to this appalling development, "old-fart-what’s-the-world-coming-to syndrome"? Arguing for compromise in this context is the golden mean fallacy.

You and I are very much on the same page with respect to the probable utility of these TM structures for people with minimal access if any to modern medical technology.

If these TM structures are at best useless and at worst dangerous, as we know from extensive research, how are they going to help people in the developing world? Placebos may be helpful for the worried well in the developed world, but in areas with high rates of contagious diseases, dysentery and malaria they are just going to make things worse.

I suggested at the very beginning of this often silly discussion that we ship some of our overused (in people and cows) antibiotics to third-world village practitioners, who with a bit of training could save some lives while adjusting chi and driving out witch-spirits. No takers.

The only silliness I have seen here has come from you, and this is another example. Why not just ship some antibiotics out there and train some locals in SBM? Why do we have to integrate this with traditional medicine at all? I don't believe there are too many places in the world where people are dying because they reject SBM. I have studied medical anthropology and done field work looking at the use of traditional and conventional medicine in Egypt, and while many people still believe in traditional medicine, they seek conventional medical help when this fails.

People from the developing world are certainly capable of understanding and learning how to practice SBM - I have worked with many excellent healthcare professionals from these countries. Isn't a bit patronizing, paternalistic and perhaps even racist to assume that they have to be taught these things in a way that fits in with traditional belief systems?

I referenced [in part two] the op-ed yesterday by Dr Emanuel in the NYT, making the case that annual physicals are a waste of time, equivalent to Shamanistic ritual. (This is a controversial idea in the USA at least.)

I still struggle to see how the existence of one part of medicine that is not scientifically supported justifies adding a whole raft of more nonsense. Perhaps this is some sort of reasoning skill my education neglected.

So. What’s the value of this ‘integration’? It’s that the process will shine light on the lack of scientific rigor, and poor delivery design, in both camps. The US medical establishment at least needs some major shaking up.

Medical students in the US are being taught the following: acupuncture, phytopharmaceuticals, mind-body medicine, homeopathy, the concept of Qi and Meridians, different forms of Qi, and the blockage of Qi and its consequences, the mechanism behind the physical properties of an acupuncture needle, how to feel the flow of Qi, and learn the location of a few major acupuncture points along their Meridian systems, tongue and pulse diagnoses, the evaluation of the relative temperatures of the Triple Energizer system, the 4 vital substances, the origin of Qi, the 8 diagnostic principles, and the classification of Chinese herbs according to their energy and effects. How does any of this, "shine light on the lack of scientific rigor, and poor delivery design"? Please explain, since my poor education hasn't equipped me to understand this.

Maybe (another silly metaphorical suggestion) you see your local naturopath once a year, who takes your BP and some blood (data processed by some app, sent to some MD if needed), and tells you to quit smoking, lose some weight, and get some exercise. And treats your head cold with ginger tea. And that’s the extent of the license.

Except naturopaths don't just do that already, they prescribe supplements, homeopathy, acupuncture, chelation therapy, IV vitamin C and a host of other dubious and sometimes dangerous treatments, as well as conventional drugs, in some US states. This blog and the SBM blog regularly addresses this problem.

I have to admit that, participating in this kind of discussion– whether it’s about medicine, or energy technology, or education– I am truly puzzled (as an old fart myself) why people are so frightened of change. We should be contributing by *guiding* the inevitable changes, not fanatically resisting them.

Yet another strawman - who has suggested here that anyone is afraid of change? There are many changes in medicine I am very happy about, and many more things I would like to see changing in the future. What puzzles me is why you think change is inevitably a good thing when in the area we are discussing it most certainly is not? How is it inevitable that medicine embraces pre-scientific nonsense about humors and meridians?

Please, read the paper I linked to in my comment to sadmar above and tell me whether you honestly believe it is a good thing that medical students are being taught this.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

322

Or, the less cherry-picked version:

" Every year, there
is a marked increase in the number of consumers using com-
plementary and herbal medicine without consulting their pri-
mary care physicians.

As this number grows, more ad-
verse effects may arise from unchecked interaction between
conventional treatment and natural/herbal medicine. Con-
sumers feel even more confused when they try to discuss
complementary modalities with their physicians and find
them unsympathetic and often less informed than the pa-
tients about these alternative therapies.

It is not just the patients and consumers pressing the med-
ical establishment to become more versed in CAM; a recent
survey showed that physicians in practice also want to learn
more about CAM so that they can better advise their pa-
tients on the efficacy, safety, and best complementary use
of these modalities.

In response to this growing patient
demand and rising interest from physicians, 64% of US med-
ical schools surveyed in 1998 offered CAM training either
as an elective or required course.

The courses taught in
medical schools commonly include acupuncture, homeopa-
thy, herbal therapies, mind-body medicine, and chiropractic
manipulative therapy.

Loyola University Stritch School of Medicine (Chicago,
IL) developed and launched a model curriculum of integra-
tive medicine for the medical students. This curriculum
weaves CAM topics into the traditional curriculum at ap-
propriate junctures and is carefully designed to....

avoid any disruption to the existing training in Western medicine. "

Classic case of someone providing a reference that refutes his argument. Reading the entire paper is enlightening; apart from a little "course-description-puffery", it all sounds pretty innocuous (and rational).

Of course some students are going to "feel the Chi"--

Hellooooooo.....placebo effect anyone?

It's not a unidirectional phenomenon.

zebra,

Classic case of someone providing a reference that refutes his argument. Reading the entire paper is enlightening; apart from a little “course-description-puffery”, it all sounds pretty innocuous (and rational).

That “course-description-puffery” is what medical students are actually being taught. How does that in any way refute my argument?

By Krebiozen (not verified) on 10 Jan 2015 #permalink

Krebiozen,

Maybe you're just not a very good teacher.

If I were a 'believer' teaching that course, I would say to the student:

"Feel the chi? So, do you think it is just a placebo effect, or is it real?"

If I believed that it is pure BS, I would say to the student:

"Feel the chi? So, do you think it is just a placebo effect, or is it real?"

I've been told that I'm a good teacher by both students and colleagues. And that it's because of that approach. But YMMV.

And what do you tell the student when s/he replies "I think it's all in my mind"?

By Mephistopheles… (not verified) on 10 Jan 2015 #permalink

Obrien,

"OK. But now you have experienced what others-- some of whom may be your patients-- have experienced. They may have reached a different conclusion, and you will have to deal with that.

And I hope you will remember that I have always taught you to keep an open mind, and to recognize that every problem is not a nail.

And, whatever you think of all this, the material will be on the test"

zebra - after your "black helicopters" comments, I'm surprised to see something so reasonable.

By Mephistopheles… (not verified) on 10 Jan 2015 #permalink

zebra,

Maybe you’re just not a very good teacher.

Another personal dig, the last refuge of those with no evidence to support their arguments.

I don't have any experience teaching people nonsense. I don't believe a good teacher would waste precious time and resources teaching students stuff that isn't true.

If I were a ‘believer’ teaching that course, I would say to the student: [...]

What makes you think that believers in SBM are teaching this course in integrative medicine? Where does it say in that paper that the medical students are told that the diagnostic techniques and treatment modalities they are spending hours learning and being examined on are useless? I see nothing to suggest that medical students are being taught about nonsense, everything in that paper suggests to me that they are being taught that Qi and meridians are real.

I think you are assuming facts very much not in evidence. For example, of students who, "wish to have in-depth experience in CAM or who plan to prominently incorporate some CAM modalities into their future practices" we are told:

Each student is assigned 2 actual patients. In addition to conventional Western medical approaches, students are expected to integrate CAM techniques into their history-taking and physical examinations. The Twelve Principal Meridians and Six Energy Axes are discussed in more detail. The Back Shu and Front Mu subsystem, concept of the Triple Energizer system, and the Five Phases paradigm are introduced at this juncture.

Does this suggest that students are being taught a skeptical approach to TCM? What possible use is there in learning "The Back Shu and Front Mu subsystem, concept of the Triple Energizer system, and the Five Phases paradigm" unless they plan to use this in clinical practice?

The physical examination includes some Eastern techniques involving tongue and pulse diagnoses and the evaluation of the relative temperatures of the Triple Energizer system.

How would you explain what was going on when you were teaching them tongue and pulse diagnosis, which are bogus diagnostic techniques? How would you address those students who were planning to "prominently incorporate some CAM modalities into their future practices"?

Your argument appears to be "it's OK to teach BS because if I were teaching it I would explain that it is BS". That's special pleading of an extraordinary caliber.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

Obrien,

I've also been told by my colleagues that I am an exceptionally patient person... with students. ;-)

Much of the misunderstandings about Alchemy come from the methods the practitioner used to protect their formulas.
"Baby Boy Fat" for example was a code word for Lanolin extracted from the fleece of a sheep.
This sort of subterfuge came back to bite them on the hind quarters if someone discovered their notes and called in the authorities.

By Greg Young (not verified) on 10 Jan 2015 #permalink

zebra,

You tell us possess superior reasoning skills, political acumen, patience, and teaching skills.

Would you be kind enough to explain to me how teaching medical students tongue and pulse diagnosis, the evaluation of the relative temperatures of the Triple Energizer system, the 4 vital substances, the origin of Qi etc. all with the express intention of equipping them to incorporate CAM modalities into their future practices will, “shine light on the lack of scientific rigor, and poor delivery design” in medicine. Thanks in advance.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

Greg Young,

“Baby Boy Fat” for example was a code word for Lanolin extracted from the fleece of a sheep.

I don't think that was alchemists, it was witches' flying ointments.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

Interesting discussion on non-swimmers...

As a has-been static apneist, I whole-heartedly just *know* there is a great deal of physiological affect through mental and vagus nerve (the timescale resolution may be quite dramatic, smallwise, as a response to slight variations in temperature and sensible current during the exersize) manipulation -- It makes it very unreliable to take my own 'vitals' when in an already agitated state of fear when trying to do self-diagnosis.

I think you do not read carefully, either my comments or the referenced paper.

Please read my 327 and 330 replying to 328 again, objectively.

And, the program design described in the paper seems to do exactly what it says in the introduction I quoted. Different techniques are juxtaposed, and experiments are done. That's how we learn-- whatever method is used to get a diagnosis, there will be a result, and the result will be discussed. The more that happens, the more critical thinking skills are developed. Why would you object?

It might even help people understand why ginger tea is so superior to antibiotics for treating head colds.

"Politicalguineapig
"Greg Young: No, you’re the one that doesn’t understand. A tuck and roll maneuver could be used, or there are several other methods.
Korean Warrior Priests, really?
I’m sure they’re in a comic book, but the US wasn’t in Korea until World War 2. Korea spent most of the first half of the 20th century as a Japanese colony. I have nothing against comic books, but you want a history book. They’re the ones without pictures, you know."
Maybe you should find a history book.
The U S Navy had to go into Korea in the 19th century to destroy the bases of Korean pirates who were raiding shipping of many nations.
One of the biggest battles involved reducing an ancient fortress that commanded the river mouths used by the pirates.
A naval Lieutenant was decorated posthumously for leading a raiding party that spiked the guns of the fortress. They were attacked on the way out by Korean warrior priests wielding swords.
You apparently have no knowledge of Korean history.

"Greg Young: No, you’re the one that doesn’t understand. A tuck and roll maneuver could be used, or there are several other methods."
If you don't know what a "Roll Up" is I suspect you actually have zero martial arts training and your black belt must only serve to hold up your pants.
The roll up is the common method for dealing with exactly the kind of advice you gave about a supine victim raising her knees to the attackers chest.
The roll up leaves the victim completely helpless when extreme pressure on the neck.
The roll up is part of modern hand to hand combat training, so you obviously have no knowledge of that subject either.
You just got the victim killed.

"GY: “Ever see those old ring type life savers. How quickly could you swim pushing one of those in front of you.”

You don’t push them in front of you, dimbulb. You tow them behind you"
Congratulations you just discovered the "Sea Anchor" and ended up slowing the swimmer down and using up all his energy before he got anywhere near the victim.
The ring type live saver was entirely unsuited to being dragged along tethered to a swimmer that's why they developed the streamlined floats.

Geez are you twelve years old?

By Greg Young (not verified) on 10 Jan 2015 #permalink

@ Kreb #323

Yes, that language seems very not-cool. However, looking at the paper, I see some cause to view it with a grain of salt. Written by acupuncturists and published in an acupuncture journal, it may distort what Loyola is actually doing for propaganda purposes. I definitely got a vibe of cherry-picking and puffery from the article.

In my experience, if you have strong language available, you use it, rather than hedge.The conclusion of the paper is "integration of acupuncture into the curriculum appeared to help future physicians feel more prepared to discuss acupuncture with their patients." Discuss? Not recommend, employ, prescribe etc. etc? Discuss how?

These aren't whole classes. It looks like the Med students get 10 hours of material on CAM. Not 10 credit hours, 10 clock hours. Then there's a one month elective available for "Do You Want to Know More?"

We're talking about a Jesuit University here, and one at which I was employed for an overall unpleasant if brief period of time as it happens. The top administrative positions can only be held by priests who have worked their up through the Society of Jesus. They're rather opaque in matters of policy, and not into disclosure at all. I cannot imagine them endorsing a belief in Qi without risking the fires of hell from their Catholic constituencies, if not the Trinity themselves. That said, the Jesuit method allows a fairly wide-ranging examination of certain topics. A theology grad student will learn about Islam and Buddhism, but those religions will not be presented at possible True Faiths.

So forgive me if I'm skeptical a couple needle-stckers from LaGrange constitute a valid source of what is actually being taught to medical students at Stritch, or rather the how, why and for what purpose CAM may being given a little corner in the curriculum. And if it certainly seems to you they are teaching med students the TCM model is valid, Qi and meridians exist, and pulse diagnosis is valid, you might want to be a little less certain, instead of just imagining Medical Acupuncture is giving you the straight dope about anything.
-------
FWIW, by 'imagine' I did not mean 'this is what I guess school/clinic (x) is doing'. I meant 'this is what I imagine some school/clinic might do somewhere sometime that would be theoretically OK'.
-------------
I'm not sure in what way any accredited Medical School could incorporate actual endorsement of Qi, meridians, pulse diagnosis, etc, in education for MDs, and encourage MDs to themselves treat patients with those principles. I can see how certain so-called TMs might be 'complementary' to sbm as practices, but not as intellectual systems for understanding the human body. How could you train a student to order labs for diagnostics AND just check shit through pulse or examining a tongue? How could anyone embracing such incompatible schema ever get hired by a legit hospital or medical group? I get how a clinic might be 'integrative', not how a physician could be.
-----------
So my concern remains naturopathy, which DOES have a philosophy that picks and chooses and is able to 'blend' accordingly.
-----------
Regardless of how quackery may be deployed alongside sbm — be it within a single practitioner under one rubric or another, or folks with quite different philosophies who happen to have offices in the same building, the question is still the same: what are the skills of the practitioner making the diagnoses and supervising the care — an the validity of the courses of action that practitioner prescribes.

And, again, my point is that TCM Today — A Case for Integration offers some very useful tools for a political effort to keep the above within bounds.

Any halfway-decent politician is always looking to hoist opponents by their own petards.

"1871 -- Korea -- June 10 to 12. A U.S. naval force attacked and captured five forts to punish natives for depredations on Americans, particularly for murdering the crew of the General Sherman and burning the schooner, and for later firing on other American small boats taking soundings up the Salee River."

"1888 -- Korea -- June. A naval force was sent ashore to protect American residents in Seoul during unsettled political conditions, when an outbreak of the populace was expected."

"1904-05 -- Korea -- January 5, 1904, to November 11, 1905. A Marine guard was sent to protect the American legation in Seoul during the Russo-Japanese War."

By Greg Young (not verified) on 10 Jan 2015 #permalink

http://www.history.army.mil/moh/korean1871.html

My error Lt McKee was not the man who received the medal of honor it was one of the Marines who tried to save him after he was wounded.
The fighting was fierce and many Congressional Medals of honor were awarded to the Marines and Naval personel involved in these actions.
If you'll notice some of those wounded were struck by swords.
From what I remember reading of this action an order of warrior monks occupied one or more of these fortresses and these were the swordsmen who fatally wounded Lt McKee.
They rushed again and again trying to capture the wounded McKee but his men fought them off.

By Greg Young (not verified) on 10 Jan 2015 #permalink

zebra,

I think you do not read carefully, either my comments or the referenced paper.

I read both carefully. My point in citing that paper was to draw your attention to what is on the syllabus for medical students in one medical school.

You seem to have been distracted by the paper itself which was looking at how effective this course was in teaching students about TCM. I'm not particularly interested in how effective a course is at teaching medical students diagnostic and therapeutic techniques that have been shown not to work. It sounds like Tooth Fairy science to me.

Incidentally, I wonder how a student who answered a question about the effects of Qi in blocked meridians by stating that Qi and meridians don't exist. Fail or extra points?

Please read my 327 and 330 replying to 328 again, objectively.

I just did. What bearing does the way you personally would teach the course have on anything? You are not teaching this course, as far as I know. At least one of the people who is teaching this course, Dr. Kit C. Lee, is a practicing acupuncturist; she has also authored a paper on acupressure for pruritus and lichenification. Does she sound like a TCM skeptic to you?

And, the program design described in the paper seems to do exactly what it says in the introduction I quoted. Different techniques are juxtaposed, and experiments are done. That’s how we learn– whatever method is used to get a diagnosis, there will be a result, and the result will be discussed. The more that happens, the more critical thinking skills are developed. Why would you object?

You think they are teaching all that nonsense about pulse diagnosis, the evaluation of the relative temperatures of the Triple Energizer system, the 4 vital substances, the origin of Qi etc. just so they can demonstrate experimentally to the students that they are all pre-scientific nonsense? They clearly are not, the paper explicitly states that they are teaching students this so that can use these techniques and concepts in their clinical practice. Why are trying to deny this?

It might even help people understand why ginger tea is so superior to antibiotics for treating head colds.

It isn't. As I wrote before, people have had the experience of having a bacterial infection cured by antibiotics, which is why they think it will be similarly effective for a subsequent sore throat, earache or whatever. They aren't going to be satisfied with ginger tea.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

Guess which moves are the roll up moves.

https://www.youtube.com/watch?v=wfGC8EOWABI

In these demonstrations they have to make an effort not to seriously injure each other.
In another file a very experienced female is able to execute a reversal from a roll up position, though her opponent says he was trying to avoid hurting her. I can believe the male opponent, From the looks of it she could not have made a successful reversal from that position if the attacker were intent on doing her harm. I'm surprised she didn't break her own neck.

The tactic is common in MMA bouts. When the roll up is complete they cup the head with one hand and pull it towards their chest, Getting out of a completed roll up is nearly impossible for even the strongest fighters.

The roll up maneuver is dependent on getting the victims knees in front of the attackers chest, so the advice given by our resident Jackie Chan would have done 3/4 of the rapist work for him.

Interestingly the roll up maneuver is described in detail in an old Arab text that suggests the best way to rape a female captive.
The resemblance to rough sex moves is pretty obvious. Probably the origin of the move.

By Greg Young (not verified) on 10 Jan 2015 #permalink

"
Krebiozen

January 10, 2015

Greg Young,

“Baby Boy Fat” for example was a code word for Lanolin extracted from the fleece of a sheep.

I don’t think that was alchemists, it was witches’ flying ointments."
The difference between being a tolerated if eccentric Alchemist and being burned as a witch was whether or not you were denounced and tortured into a confession.
You don't honestly believe that there actually was a flying potion do you?
Most denounced as witches were herb doctors like Kepler's mother, but anyone who dealt with anything the common folk didn't understand were at risk.

By Greg Young (not verified) on 10 Jan 2015 #permalink

A fairly good source on the history of Alchemy and how it evolved into modern chemistry.
http://www.alchemywebsite.com/islam.html

https://www.google.com/url?q=http://scribol.com/anthropology-and-histor…

https://www.google.com/url?q=http://www.alchemywebsite.com/bookshop/rea…

"Alchemists heavily coded their work in symbols and metaphors to both prevent backlash from the church and to keep the uninitiated from penetrating their secrets. Animals, humans, plants, colors, and celestial bodies were used to indicate different substances, processes, and the desired result of those processes. While there were no fixed rules in the use of symbolism (different symbols were often used to represent the same thing), there are a few common themes. Seven base elements—gold, silver, iron, mercury, tin, copper, and lead —for example, were associated with particular planets and zodiac signs. The products of chemical processes were represented by colors. Kings and queens represent gold and silver, respectively."

http://www.pbs.org/wgbh/nova/education/activities/3217_newton.html

By Greg Young (not verified) on 10 Jan 2015 #permalink

Is life saving technique an Alternative medicine?

In no way meant to imply that it was. Just that the argument style was similar. When presented with reasons why something is probably not true, by someone who is in a position to know a thing or two more than you do about the subject, you respond with lots of handwaving and no actual evidence -- and this despite the fact that you don't even seem to remember where you heard about it in the first place!

If you posted anything demonstrating that indiscriminate pressure applied to the armpits would even work to render a person unconscious, I must have missed it, because all I saw was something about striking and/or stabbing someone in the armpit -- not something a lifeguard would be doing.

The conclusions of the article do pretty much agree that there are better methods, though the method I mentioned is not among those mentioned in the article so I don’t know whether it could have been one of those “slightly milder tactics” that were taught either before or after the time frame he wrote of.

In other words, you still haven't found any evidence that the technique you describe ever existed or was ever taught at all, to any lifeguard, ever, but you're going to keep on handwaving about it.

I could tell you what some of those "slightly milder methods" might have been, since releases were still being taught as part of lifeguard training as recently as the late 90s (and afaik still are). My speculations would be just that, speculations, but given that I actually *was* a lifeguard, I'm going to go ahead and say that my speculations are more likely to be close to the mark than yours.

Finding out where this technique came from is begining to be a mission for me. I’ll continue my search without expecting any useful input from those here who never heard of it.

Why don't you start by finding whether it even existed, before you speculate any further about what martial art it might have been adapted from? If you can find a real manual used by some agency involved in lifeguarding or drowning prevention or first aid or search-and-rescue or anything of the sort that recommends your technique, I will happily concede the point.

In the meantime, I won't hold my breath.

By delta-orion (not verified) on 10 Jan 2015 #permalink

@ 348:

OK, this is just completely wrong. The Universities, since their founding, had taught Aristotelean science and Galenic medicine. Only herbal remedies were accepted as having any medicinal value.

The Church was so invested in the standard curriculum that anyone who questioned either Aristotle or Galen was ripe for charges of heresy. Paracelsus, for example, who touted the value of mineral medicines such as mercury*, had to keep moving from town to town to escape prosecution.

*Let's remember mercury was the only real treatment for syphilis for close to 400 years

By The Very Rever… (not verified) on 10 Jan 2015 #permalink

""If you posted anything demonstrating that indiscriminate pressure applied to the armpits would even work to render a person unconscious, I must have missed it, because all I saw was something about striking and/or stabbing someone in the armpit — not something a lifeguard would be doing."
Did I ever at any point say I knew exactly how this method was supposed to work?
I only said I had heard of it many years ago.
I was looking for information on how it may have worked.
As the article I posted has proven life guards were at one time taught to render a hysterical drowning victim unconsious.
As I had said earlier throwing a punch in water is unlikely to be effective, and they reached the same conclusions. Whatever "milder tactic" they later taught isn't identified.
All these arguments you people are putting up are based soley on your own personal ignorance.
I don't know how it was done either but I don't pretend to know everything there is to know on the subject.

Some things are very obvious, the first is that some here have little idea how things work in the real world, suggesting dragging a ring type life saver behind you when trying to swim as fast as possible is one example.
Anyone who's done any sailing knows how a sea anchor works . Now I expect some yahoo will claim they are a ships captain and they never heard of a sea anchor.

If anyone has information on the technique I mentioned they can post it. Those with no idea what I was speaking of are wasting magnetic ink by continuing to yammer on about how much they don't know.

As I did find the pressure point I spoke of can be triggered by a blow from the fist. Also that a pressure point in that general area can be stimulated to aide respiration.
How much pressure it would take to trigger the result by pressing hard rather than throwing a punch is something I'd like to find out.

I do remember that the use of this pressure point in self defense courses for women was mentioned in an article on the subject around 1970. The person interviewed was a woman who taught self defense in california, San Francisco IIRC.
Now no doubt someone will claim they know everything about self defense classes taught in San francisco in 1970 and they never heard of it.
Apparently the standard here is if you never heard of something it can't possibly have ever existed. If theres no web page on the subject it never existed.
If you don't believe the technique ever existed why involve yourself in the discussion at all?

I'm satisfied that no one here has any knowledge on the subject. The subject is dropped so far as I'm concerned.

I still can't believe how limited history classes must have been for some of the people here.
No U S involvement in Korea before WW2? What a joke.

By Greg Young (not verified) on 10 Jan 2015 #permalink

Greg Young,

The difference between being a tolerated if eccentric Alchemist and being burned as a witch was whether or not you were denounced and tortured into a confession.

I beg to differ. Alchemists were precursors of chemists who were trying to turn base metals into gold and/or to find the elixir of life. Witches were either practitioners of a pre-Christian pagan religion, or more likely mostly eccentric old people (mostly women except in some areas) who perhaps used herbal remedies, or hysterical younger people with mental health problems who fell foul of Christian fundamentalist psychopaths. They were not the same thing at all.

You don’t honestly believe that there actually was a flying potion do you?

I don't believe there were potions that could make people literally fly, of course, but some have made a moderately convincing case for there being ointments that contained plant alkaloids that could induce hallucinations of flying - belladonna, aconite and others. It has been claimed that these were applied to the vaginal mucosa via a broomstick, hence the legends, though this seems a bit far-fetched to me.

Most denounced as witches were herb doctors like Kepler’s mother, but anyone who dealt with anything the common folk didn’t understand were at risk.

There we agree. It doesn't mean that alchemists were witches though.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

On the subject of vagal nerve stimulation, my brother used to suffer from tachycardia when he was a child, back in the 1950s. My mother was taught to slow his heartbeat by pressing on his eyeballs, hard, which she said was immensely distressing for both of them but it worked.

By Krebiozen (not verified) on 10 Jan 2015 #permalink

"
Krebiozen

January 10, 2015

Greg Young,

The difference between being a tolerated if eccentric Alchemist and being burned as a witch was whether or not you were denounced and tortured into a confession.

I beg to differ. Alchemists were precursors of chemists who were trying to turn base metals into gold and/or to find the elixir of life. "
Theres the most common error, believing that alchemists were only interested in those two subjects.
You could look up the illustrations in some Alchemy texts, most are of various herbs or animals.

" It doesn’t mean that alchemists were witches though."
Neither were the vast majority of those denounced and burned as witches.

"
Krebiozen

January 10, 2015

On the subject of vagal nerve stimulation, my brother used to suffer from tachycardia when he was a child, back in the 1950s. My mother was taught to slow his heartbeat by pressing on his eyeballs, hard, which she said was immensely distressing for both of them but it worked."
Thank you, that is very helpful.
I did find a site with instructions on calming children using pressure points.

By Greg Young (not verified) on 10 Jan 2015 #permalink

PS
I forgot to mention I found a site where a guy gives advice on dealing with savage dogs. He mentioned using pressure under the dogs "armpits" to stop an attack.
The same area is compressed by one type of "no-pull harness" for dogs. Pressure there causes the dog some distress so he stops trying to fight the harness.

By Greg Young (not verified) on 10 Jan 2015 #permalink

Greggles: The equivalent of Korean samurai are not priests, and you yourself admitted they used swords. Therefore it doesn't count in discussing the state of unarmed combat before WW2.
Thing about being down on the ground? If you are, from that point on, being killed is the best case scenario. And most of my training tends to deal with avoiding being on the ground. Plus the neck is such a small area that attackers usually won't go for it.
Y' know, in oceans and rivers they have these things called currents. If you do it just right, the current'll push the rescuer and rescuee onto the shore.
Finally, at twelve I was vastly more intelligent and mature than you ever will be if you live to be 100, douche. I'd like to see you survive a blackbelt test, but I bet you're strictly an armchair warrior. Why don't you run along and let the grownups talk now?

By Politicalguineapig (not verified) on 10 Jan 2015 #permalink

Sorry, that should be the Korean equivalent of samurai...

By Politicalguineapig (not verified) on 10 Jan 2015 #permalink

"
Politicalguineapig

January 10, 2015

Greggles: The equivalent of Korean samurai are not priests, and you yourself admitted they used swords. Therefore it doesn’t count in discussing the state of unarmed combat before WW2."
Preist or monks, not much difference in that sort of religion.
The monks were warrior monks highly trained in ever form of combat.
The fortresses were built by the warrior monks centuries earlier to guard against incursions by the Japanese, the first or most famous was built by warrior monk named Uiam manning these forts was a religious duty.
The U S Navy and the navies of every other nation on earth still depended on close quarters combat much of the time, both boarding parties and shore parties, My dad was in the Navy during WW2 and I still have his Blue Jacket's Manual.
The USN fought every sort of enemy on the high seas and on land all over the planet. They picked up techniques from every place they were sent.
While the average man on the street may not have known much about martial arts the USN most certainly did.
If you will look up sword fighting tactics of the day you'll find these often included martial arts moves as well, and all warrior societies had some form of unarmed combat.
One martial art that was very useful during the days of fighting sail was Savate, the French taught all their sailors savate, and still do. The kick fighting techniques used in some Asian martial arts like Kung Fu were adapted from savate taught to the peasants by Jesuit Priests who traveled through Asia. Bruce Lee learned Savate before he became a noted nartial artist.

Everything else you have to say is lost in bluster.
I had my first knife fight at twelve, against a thug six years older and fifty pounds heavier. I never got a scratch but he ended up in intensive care for two weeks.
I've had four other knife fights since then, and never got a scratch.
I've had more real life knock down drag out fights than you've had hot meals. Very seldom where these fights against a single opponent unless they were armed. I've never had the least bit of compunction about using deadly force.
Thats the kind of town I grew up in.
You often had to kill or be killed.

So make your bones before you start talking trash.

If you think its impossible for some one to bring you down and therefore theres no reason to learn reversals, you are in for a big surprise.

By Greg Young (not verified) on 10 Jan 2015 #permalink

Did I ever at any point say I knew exactly how this method was supposed to work?
I only said I had heard of it many years ago.
I was looking for information on how it may have worked.

I never said that you said you knew exactly how it worked. Just the opposite. What you're claiming is that you know for sure *that* it worked. That's the part I'm skeptical of.

You can't even say where or from whom you heard it, but you assume it must be true, based on... what exactly? You can't point to a single piece of evidence that this was ever a technique used by lifeguards; the best you can do is something about punching people in the armpits to knock them out, and an article saying that people were at one point taught that trying to knock out a drowning person by hitting them in the face was a good idea.

I'm not arguing from ignorance here. I'm arguing from my own experience as a former lifeguard. Your story seems wildly implausible on its face based on what I know about lifeguarding and lifesaving, which doesn't necessarily mean that it's not true; but it does mean that I'm not just going to take your word for it. This is critical thinking 101, here.

Now I expect some yahoo will claim they are a ships captain and they never heard of a sea anchor.

I take this to mean that you think I'm lying about having been a lifeguard? Fine, that's your prerogative. I am, after all, anonymous on the internet. But whether or not I was ever a real lifeguard, the cross-chest carry and the Pia Carry are still real, easily-verifiable things, unlike your pressure-point technique for which the only evidence you've presented is the fact that you remember someone telling you about it many years ago.

Apparently the standard here is if you never heard of something it can’t possibly have ever existed. If theres no web page on the subject it never existed.

Apparently your standard is that if you have some vague memory of someone, somewhere, having told you that something existed, then it must have existed, no matter how implausible, even if no evidence can be found.

If you don’t believe the technique ever existed why involve yourself in the discussion at all?

I realize that lifeguarding is pretty tangential to this thread. But when I see what appears to be misinformation that I can correct, I'm inclined to do it. I'm mostly a lurker here on RI, but every now and then the topic drifts into an area I know something about, and it's fun at that point to chime in. If people are tired of the tangent, I'm happy to move on.

By delta-orion (not verified) on 10 Jan 2015 #permalink

"which doesn’t necessarily mean that it’s not true; "
And I couldn't care less about whether you believe it or not.

Nothing in your experiance would have led you to believe that knocking the victim unconcious had at one time been the standard procedure for life guards.

Get over yourself.
If you had anything to add as useful information you would have done so.

By Greg Young (not verified) on 10 Jan 2015 #permalink

The following refers to the curriculum for integrative medicine at the Loyola University Stritch School of Medicine in Chicago

Which does not include Chuck Dumont, BTW (see also "toldja).

Mr. Young,

I would like to ask what, precisely, the fυck you think is going on here.

Your first comment was #49,

I’ve seen too many people suffer from side effects of modern medicine to assume that its all scientifically sound. [...] Herbal medicines aren’t all just old wives tales. [...] Tylenol has destroyed so many livers its ridiculous. Willow bark does the same job and I’ve yet to hear of it causing organ failure.[...]

After a seeming eternity of digression, you ponied up this at #239:

Congratulations, you provided examples of treatments which were studied scientifically and applied according to the science. ”
Which has been my intention all along. You’d understand that better if you read my posts rather than accepting strawman arguments made by others without thinking.

Now, I'm engaged for a while in a separate task,* at #359, I find you raving that

I’ve had more real life knock down drag out fights than you’ve had hot meals.

I take it that this freakout is a result of your being called out on something in terms that you can actually understand, as opposed to, say, being told that the whole melatonin-clinical-trials routine sure the hell looks like boisterousness on your part.

The problem in that case seems to boil down to your not knowing and not really caring what the words "clinical trial" mean in the first place. They're part of some weird cloud of linguistic intensifiers or something.

You've had plenty of tools offered up to you, but you didn't recognize them for what they were, and it apparently never occurred to you to ask how to use them rather than blundering around pulling up shіt from about-dot-com and so forth.

Nobody gives a rat's ass about your insane fantasy that one can induce temporary respiratory arrest or unconsciousness or something by virtue of punching somebody in the armpit with a "balled fist" because of the "skein of nerve tissue" that you eventually managed to connect to the vagus nerve [sic]. A few hints:

This isn't West Side Story.

This isn't Berlin Alexanderplatz.

This isn't Grease.

So, again, tell me: What, precisely, the fυck do you think is going on here?

* If I finally manage to glue together these PPC JVMs – and it's close – it would be the first documented example, assuming that I document it.

Greg Young just makes it up as he goes along.

Don't expect any reasoning to work with Greg.

Krebiozen,

You are embarrassing yourself.

You say you read my comments and then you ask me the same question I answered for Obrien.

The other comment you apparently misunderstood-- the one about patience, was a little joke. The point was that my colleagues said I was patient with students, implying that it was *contrary* to how I acted with them. Too subtle for you I guess.

At this point, my patience is exhausted.

If someone else wants to (seriously) discuss the ginger tea question, which is a valid science/medicine/policy concept, I will continue.

zebra,

You are embarrassing yourself.

Not at all. I think some of your contortions, however, have been more than a little cringe-inducing. You denied there was a problem, and mocked Orac for even suggesting there might be:

I would have a position on the value of “integrating” TCM if one of you would explain what that involves in the real world.
What Orac is doing is kind of at the level of WHO Black Helicopters landing at all the medical schools with kung-fu ninjas and then indoctrinating all the nice students into mindless Traditional Medicine Zombies.

Then when presented with incontrovertible evidence that medical students are indeed being indoctrinated into TCM, you claimed that it's OK to teach nonsense in medical school because if you taught it you would explain that it is nonsense. That's priceless.

You say you read my comments and then you ask me the same question I answered for Obrien.

M.O'B. asked:

And what do you tell the student when s/he replies “I think it’s all in my mind”?

Where did I ask the same question? I asked:

What makes you think that believers in SBM are teaching this course in integrative medicine? Where does it say in that paper that the medical students are told that the diagnostic techniques and treatment modalities they are spending hours learning and being examined on are useless?

You still haven't answered this.

The other comment you apparently misunderstood– the one about patience, was a little joke. The point was that my colleagues said I was patient with students, implying that it was *contrary* to how I acted with them. Too subtle for you I guess.

What makes you think I misunderstood it?

At this point, my patience is exhausted.

Your failure to answer most of the questions put to you is noted.

If someone else wants to (seriously) discuss the ginger tea question, which is a valid science/medicine/policy concept, I will continue.

Valid science/medicine/policy concept my ass.

By Krebiozen (not verified) on 11 Jan 2015 #permalink

Regarding the "ginger tea question".

Premise: doctors who practice conventional medicine sometimes prescribe ineffective treatments even when they know (or should know) that these treatments are ineffective (example: prescribing antibiotics for an upper respiratory viral infection with no sign of a bacterial infection such as strep). People working from different medical or folk medical practices might prescribe something in these cases which is no less effective than what the conventional practitioner prescribed.

Proposed conclusion: unless all doctors who practice conventional medicine always prescribe something that is more effective than one practitioner of some other medical system would, then the two systems are fundamentally equal. People who practice or consume conventional medicine have no justification for commenting on the specific practices, underlying principles, or absence of evidence for phenomena predicted by traditional medicine.

Call to action: People who practice or advocate for conventional medicine should get the motes out of their own eyes before messing about with traditional medicine's beams. Until then, everything is equal.

Discussion: When dealing with any disease, the entire universe can be split into two sets: the set of things that have been shown to have some effect in curing the disease and the set of things that haven't. In the example case, antibiotics fall into the set of things that are not known to cure the disease, as does ginger tea (to the best of my knowledge), water, hot tea with lemon and honey, orange juice, various vitamins, milk sugar, homeopathic duck liver (but then, I repeat my self), air, sunlight, plutonium, and so on. Thus any system that would prescribe any of those treatments would be at least as good as conventional medicine.

By Mephistopheles… (not verified) on 11 Jan 2015 #permalink

"
Narad

January 11, 2015

Mr. Young,

I would like to ask what, precisely, the fυck you think is going on here.

Your first comment was #49,

I’ve seen too many people suffer from side effects of modern medicine to assume that its all scientifically sound. […] Herbal medicines aren’t all just old wives tales. […] Tylenol has destroyed so many livers its ridiculous. Willow bark does the same job and I’ve yet to hear of it causing organ failure.[…]"

Show me a single known case of liver failure due to ingestion of willow bark in its natural form .

Thats simple enough.

As for the "freak out", listening to some internet "black belt" yammer on about how much they know about hand to hand combat training and the history of Asian martial arts how America had no involvement in Korea before WW2 was vexing enough.
A life time of dealing with violence on a scale most here can't imagine outside of their favorite video games has had an adverse affect. I wouldn't even be interested in alternative pain medications and reducing dependence on prescription meds if not for the injuries I've received over the course of more than half a century. Winning a real fight doesn't mean you aren't going to be injured, especially when the opponents were more often than not high on amphetamines and trained in hand to hand combat. Worst fight I had was with a paratrooper wanted for desertion and armed robbery, he got the worst of that encounter but I didn't get off easy either.

They say people who use non linear thinking often have problems in communicating, thats true enough, but linear thinking limits those like yourself on a more basic level, I might as well be discussing Shakespeare with a beagle.

Einstein used both linear and non linear thinking, he seems to have handled it very nicely.

A couple of those here understood at least part of what I was saying.
You seem to be spinning your tracks in a circle and waving your arms saying "danger danger Will Robinson, it does not compute".

If you are saying my thought patterns are chaotic you're not telling me anything that my doctors haven't already told me, and at least they had theories as to why. The growth they removed may be the cause, I'm certainly much better now than before the surgery and have very slowly regained the ability to read and write and to piece together my memories of times before the injury.
Even after the last surgery I was contacted by MENSA. Like several other members of my family I had an IQ they said was higher than 165 though I never found out how high, now I test at 135 so I lost something along the way.
Two of my nephews and one niece are Black Belts, and one of the nephews was a university wrestling coach. If they were still around I could ask them about some of these things.

Anyway finding answers for some is just academic, for others its because they have a real need to find answers.

By Greg Young (not verified) on 11 Jan 2015 #permalink

Obrien,

No.

I never knew this was such an issue, so I am probably repeating stuff that has been done, but here's where I would begin. (Pencil and paper please.)

Let's set up three perpendicular axes as follows:

x, as usual, called "harm"
y, going up, called "help"
z, coming out of the page, called "demand"

So, harm is negative physical effects, help would be reducing pathology/relieving symptoms, and demand would be actively seeking of or likely "compliance" with interventions. Away from the origin means "more".

It seems trivially obvious to me that we can locate our metaphorical examples with good qualitative precision: Ginger tea makes your throat feel better and perhaps provides hydration, antibiotics have no positive effect and serious negative ones.

The question you people are dodging is what the goals are, and how would programs like what is described in the acupuncture paper affect the distribution of patient-practitioner interactions as they are mapped into the space constrained by the three planes.

Me, I do not reject the possibility that some stuff could be moved towards the yz plane. Which would be my goal.

Care to try again now?

Chicken soup also makes your throat feel better. How would you determine which is better?

By Mephistopheles… (not verified) on 11 Jan 2015 #permalink

The question you people are dodging is what the goals are, and how would programs like what is described in the acupuncture paper affect the distribution of patient-practitioner interactions as they are mapped into the space constrained by the three planes.

Me, I do not reject the possibility that some stuff could be moved towards the yz plane. Which would be my goal.

I don't think anyone has dodged discussing what the goals are. Based on the quote above

he two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in beneficial harmony, taking advantage of the best features of each system and compensating for certain weaknesses in each as well. In an ideal world, TM would be an option, a choice, offered by a well-functioning, people-centred health system that balances curative services with preventive care. The challenge is to give TM its appropriate place in an integrated health system, to help all practitioners understand its unique and valuable contribution, and to educate consumers about what it can and cannot do.

it certainly appears that the goal of at least some is to teach TM as a valid form of medicine. However, as Orac also mentions above

Strip TCM of its Taoist roots, its balancing of the five elements and attribution of disease to excess “heat,” “dampness,” or other such aspects, and pretty much all you have left is herbal medicine, which needs no special dispensation to become part of science-based medicine. All it needs is for pharmacologists and physicians to study it, identify what’s useful and discard what is not, and then figure out what active ingredients can be used. Then it could become just “medicine,” as the cliche goes.

Thus my goal would be to introduce those treatments & practices shown by good science to be of actual benefit.

In the "ginger tea" case, that would be to avoid prescribing antibiotics or vitamins for viral infections (as they're shown to be ineffective, and there are serious issues that come from overuse of antibiotics) and to encourage people to drink arm beverages to make their throats feel better and improve hydration. If you want to say that ginger tea, specifically, is better than warm beverages as a class, please provide the evidence to show that.

By Mephistopheles… (not verified) on 11 Jan 2015 #permalink

Obrien,

You're having trouble with the metaphor thing again, trying to change the subject to silly little details.

Everyone agrees, AFAIK, that most things for which people see doctors (or practitioners) would resolve with no intervention. That means a whole bunch of points populating my space that can be moved towards the desirable part of the yz plane.

This:

"Thus my goal would be to introduce those treatments & practices shown by good science to be of actual benefit."

is evasive and question-begging. "We shouldn't keep the concept of TM because we shouldn't keep the concept of TM."

I can get that kind of nonsense from Fundamentalists and Creationists and their like. Show me how the points move.

sadmar,

Written by acupuncturists and published in an acupuncture journal, it may distort what Loyola is actually doing for propaganda purposes.

One author, Dr. Tony V. Lu, MD, is an acupuncturist who is also board certified in internal medicine at Loyola University Hospital, which I assume is affiliated with the university. The other author is a university professor with an interest in program evaluation. I see no reason to think they have lied about what is taught in this course, and presumably Loyola would have objected if they did.

The conclusion of the paper is “integration of acupuncture into the curriculum appeared to help future physicians feel more prepared to discuss acupuncture with their patients.” Discuss? Not recommend, employ, prescribe etc. etc? Discuss how?

I think that's because the stated aim of the paper was, "To determine if discussion of acupuncture into the medical school curriculum helps future physicians feel more prepared to discuss acupuncture with their patients." [sic]. How you discuss something into a curriculum I'm not entirely sure.

Anyway, I'm not particularly interested in the conclusions of the paper, I'm interested in what it tells us about precisely what is taught in integrative medicine courses.

These aren’t whole classes. It looks like the Med students get 10 hours of material on CAM. Not 10 credit hours, 10 clock hours. Then there’s a one month elective available for “Do You Want to Know More?”

I'm not sure how you determined that. They state that:

Additionally, throughout the year, other CAM topics are woven into other parts of the Pharmacology and Therapeutics curriculum. For example, 2 hours are devoted to topics in nutraceuticals, herbal medicine (including a few single Chinese herbs), and herb/drug interactions.

There could be many more hours, for all I know. Still, that's at least ten hours that could have been spent teaching something more useful, and from what I recall, ten hours in the classroom is more like forty hours of study, reading and learning material. The fact that the one month course is elective doesn't reassure me much either.

I cannot imagine them endorsing a belief in Qi without risking the fires of hell from their Catholic constituencies, if not the Trinity themselves.

The university itself states that in the four week elective course:

During the rotation, students will be exposed to various disciplines and modalities of complementary/alternative medicine through lectures, observations, and participation. The lecture and didactic sessions cover the principles and techniques of acupuncture, mind-body medicine, pediatric CAM, massage therapy, homeopathy, herbal medicine, and nutrition.

I find it hard to imagine anyone teaching all this with a skeptical approach. I did like the statement that:

The student will learn how to treat "the whole person"

Don't all doctors already do this? Or should do.

So forgive me if I’m skeptical a couple needle-stckers from LaGrange constitute a valid source of what is actually being taught to medical students at Stritch,

As I mentioned, the principal author is an internist at Loyola University Hospital, so I would hope he knows what is going on there. You and zebra really don't want to believe what is being taught on these course, do you?

And if it certainly seems to you they are teaching med students the TCM model is valid, Qi and meridians exist, and pulse diagnosis is valid, you might want to be a little less certain, instead of just imagining Medical Acupuncture is giving you the straight dope about anything.

Why should I ignore what an internist who works at the university hospital that teaches this integrative medicine course tells us about what is on the syllabus? It seems perfectly clear, given some of the portions I have posted from the paper's description of the course.

Why would they teach tongue and pulse diagnosis if they didn't believe they are valid diagnostic techniques?
Why, when students get an "overview of acupuncture, phyto-pharmaceuticals, mind-body medicine, homeopathy, and other manual CAM modalities" in the first year, do they require another four hours including another introduction to homeopathy in the fourth year? I could tell someone all they need to know about homeopathy in half an hour.

Why teach about The Twelve Principal Meridians and Six Energy Axes, The Back Shu and Front Mu subsystem, concept of the Triple Energizer system, and the Five Phases paradigm? Isn't this a little more than is necessary to teach students when the best evidence strongly suggests that acupuncture is merely an elaborate placebo, and it doesn't matter where you place the needles?

FWIW, by ‘imagine’ I did not mean ‘this is what I guess school/clinic (x) is doing’. I meant ‘this is what I imagine some school/clinic might do somewhere sometime that would be theoretically OK’.

You wrote:

I have no idea what or how much any actual med school may teach about any TM practice, but I can certainly imagine a curriculum that touches on those practices without endorsing that they “work” as “claimed by traditional medical practitioners.”

I too can imagine a curriculum like that, but that isn't what happens in practice, as I hope I have demonstrated. It isn't what we imagine that is important, sadly, but what happens in reality.

I’m not sure in what way any accredited Medical School could incorporate actual endorsement of Qi, meridians, pulse diagnosis, etc, in education for MDs, and encourage MDs to themselves treat patients with those principles. I can see how certain so-called TMs might be ‘complementary’ to sbm as practices, but not as intellectual systems for understanding the human body. How could you train a student to order labs for diagnostics AND just check shit through pulse or examining a tongue? How could anyone embracing such incompatible schema ever get hired by a legit hospital or medical group? I get how a clinic might be ‘integrative’, not how a physician could be.

That is a concern for many of us. Steven Salzberg, a professor at the University of Maryland College Park, part of the same system as the University of Maryland Medicine which is teaching an “integrative medicine” program, that includes acupuncture, homeopathy, reflexology, reiki and qi gong, writes:

That’s right: homeopathic treatments are just water. Or rather, water dropped onto a sugar pill, [...] And offered up as medicine by the University of Maryland’s Center for Integrative Medicine through their clinical services. (Why isn’t this malpractice? I haven’t figured that out yet.)

My example of Loyola teaching nonsense is just that, an example. The majority of medical schools in the US are now teaching integrative medicine courses. I wish they were teaching it from a skeptical perspective, but it really doesn't look like that to me.

By Krebiozen (not verified) on 11 Jan 2015 #permalink

zebra - you keep ignoring the fact that this cannot be discussed strictly as metaphor, because details are important.

I will agree that a substantial number of conditions people in developed countries get are self limiting, Often the right answers** for those are to get rest, keep warm, get adequate liquids and nutrition, restrict exposure to other people, take something to reduce discomfort, and seek medical attention if symptoms worsen or new symptoms appear. Of course, it's important that the doctor saying this knows the difference between diseases that start off with similar symptoms - it's one thing to have influenza, it's another completely to have one of the many much more serious diseases with flu-like symptoms. A sore throat is one thing, scarlet fever something else altogether.

It appears you are arguing that as long as the doctor can tell the serious from the self-limiting, it doesn't matter how the doctor diagnoses the condition or describes it. So it wouldn't be important whether it's described in terms of qi, imbalances in the humours, or germs - it's all the same thing, right?

The answer, of course, is that it does matter because different philosophies of the cause of disease and functions of the body will, almost by definition, likely lead to different treatments. Perhaps they will be equally effective or ineffective - without discussing the specifics, it is impossible to know how they compare.

I am perfectly willing to accept that there may be some things in traditional medicine which provide a substantial benefit over conventional medicine. There are things, though, we know don't match up with observation. The items that may have benefit should be studied; things that are untrue should be discarded.

** I am not a doctor and this is not intended as medical advice.

By Mephistopheles… (not verified) on 11 Jan 2015 #permalink

They say people who use non linear thinking often have problems in communicating, thats true enough, but linear thinking limits those like yourself on a more basic level, I might as well be discussing Shakespeare with a beagle.

At least a beagle would be more likely to not notice your gross errors and subject-changing when called out on them.

Even after the last surgery I was contacted by MENSA.

Or ECCO posing as MENSA.

"Or ECCO posing as MENSA."
Nope the Mensa Society.
I also scored in the top 2% on SAT and turned in the only percent score they had seen at that time on the U S Army apptitude test, 97 out of a possible 97.

My thought processes may seem chaotic to you, but to me you seem like a mud turtle trying to hump a river rock.

Keep on digging your hole somewhere else by digging your hole deeper. Thats the major drawback of the verticle phase of linear thinking.
Being stuck in your particular type of rut is the only reason you are even disscussing this with me now. Repeating the same tactic over and over while expecting a different result each time.

By Greg Young (not verified) on 11 Jan 2015 #permalink

Correction
The only "perfect" score on the Army aptitude test, 97 out of a possible 97.

How the heck can I modify my posts using this sort of comment box?
Can I just ask a moderator to make a correction?

By Greg Young (not verified) on 11 Jan 2015 #permalink

The only “perfect” score on the Army aptitude test, 97 out of a possible 97.

How the heck can I modify my posts using this sort of comment box?

If you're so smart, you figure it out.

Yeah, a cheap shot, but obligatory.

"Yeah, a cheap shot, but obligatory."
And not at all unexpected.
With all the egg bonces on this site one might expect a simple answer to a simple question.

By Greg Young (not verified) on 11 Jan 2015 #permalink

I also scored in the top 2% on SAT and turned in the only percent score they had seen at that time on the U S Army apptitude test, 97 out of a possible 97.

It's not often that one sees MENSA followed up with bragging about an ASVAB score.

Especially when that's not how it's scored.

Repeating the same tactic over and over while expecting a different result each time.

Not actually an Einstein quote, for future reference.

Kreb #374
Thanks for the measured response.

By "distort" I did not mean Dr. Lu lied. I don't know what the actual nature of the Stritch curriculum might be. I suspect, though, that Lu is 'spinning' to make TCM in general and acupuncture in particular to be given more emphasis than they actually are. Given that he is affiliated with Loyola Hospital, we can assume the hospital is not antithetical to acupuncture. However, we can not know what status he holds within the institution, how his practice might be framed or limited there.

Universities are very politicized environments. Folks with a variety of perspectives will be allowed to enter the tent. Once inside they may find themselves marginalized and undermined at every turn. There are constant internal struggles for degrees of influence, legitimacy, control. At Jesuit schools (I've worked at two, and know many people in my field with their own experiences at such schools) these conflicts are somewhat more rancorous, and much more hidden than at other schools. Pretty much any publicly released document will be about something that is not manifestly apparent on the surface, even to members of the institution outside the specific conflict at hand. I shall spare you the detailed examples I could relate. They're very complicated, and would require 1000s of words to sketch out.

You wrote, "There could be many more [than 10 clock hours of instruction], for all I know." Well, those the key words: you don't know. As for how I concluded Lu was referring to in-cll time not credit hours:

In the third year, there is a 4-hour symposium devoted entirely to CAM. This symposium takes place during the week that the students return from their rotations and the entire class is assembled.

They're not getting 4 credits for a week of class, that sounds like it includes other things going on as well.

Lu is not going to lie, but he is going to present his position in the best light possible. If the wording is vague, you can make an excellent guess it's intended to be misleading. If he actually had the goods, he'd be crowing about them.

Most specifically, this applies to not just describing what it taught but how and why. If, indeed, Stritch was in any way "teaching medical students the TCM model is valid, Qi and meridians, and pulse diagnosis is valid" Tony Lu would be 100% clear on that, and be whacking the readers' heads with that at multiple points through the paper.

"You don’t want to believe what is being taught on these course, do you?" No, I don't believe you know what's going on in these courses. And the reason I don't is after a 30+ year career in the academy I know ho these things work.

Course descriptions, BTW, are worthless. If you don't have a current syllabus from the actual faculty member teaching a course at any given time, you have no clue what they're actually doing. This 'works both ways'. "Students will be exposed," could be neutral, or skeptical, or a full-on endorsement. And where it lands on that scale could vary from term-to-term if different faculty are assigned to the course.

So, it is indeed Lu's paper that offers the best clue to what's actually happening, and what that is is most evidenced by the absences in the paper: the lack of anything more specific than general course descriptions and hour counts. If there was A There there, he'd have more significant and telling statements by the instructors of record, and indicators of their status within the institution (which also would be spun for best impression).

Again, the one clear fact is that the Stritch school has people who discuss CAM from one point or another inside it's tent. Fwiw, I doubt they approach it skeptically. I would guess the presentation is as neutral as one could imagine. The question you may ask, then, is 'why have they been let into the tent in the first place?' This is a no-brainer for me, having been in the tent for not-too-long before being ushered out. But I guess I can understand why the could-be-obvious answer has not crossed your mind.

It's the money. S.J.s aren't exactly rolling in dough. Most of the Jesuit schools are what we call in the biz "tuition-driven." The yearly budgets are dependent on (x) number of students enrolling at full tuition. Elements will be added to the curriculum and instructors hired to meet what is perceived as 'student demand'. If you enter the tent under such conditions, you will be universally despised by colleagues who consider your field bogus fluff only being tolerated as a sop to stupid students. They would rather be rid of you. The administration wants you there in name only. They want to SAY they do this-or-that; they don't care if it's done well, won't provide proper resources, won't allocate you any status in the de facto power structure. You are ADVERTISING, and no more.

Again, that is not conjecture, that is been-there done-that myself more-than-once, and seen it done a few dozen other times. Do I know that's how it is with CAM at Stritch? No. The proper skeptic question: Do you know it isn't? You are talking about an institution governed by Jesuit priests — and I do mean governed. They are not figureheads. They run the joint. My guess on this is better than yours because Orac is absolutely right about the ideologies of CAM. Pseudo-science has nothing to do with it. Qi IS Eastern religious mysticism. Reiki IS faith healing. And there's no way a Jesuit priest doesn't know that. The Jesuits have their own opposing brand of mumbo-jumbo to promote, and doing so is their life's work. They have been politicking inside the Catholic Church for four and a half centuries. They know how to pursue their agenda effectively, while hiding their goals and tactics from potential foes.

If what you've got is Tony Lu's paper and a course description, what you've got is nothing. Of course, there may be other 'quackdemic' programs elsewhere that are quire different situations. I maintain certification of natuorpaths for primary care is a deadly serious matter, far outweighing 'quackademia' and most certainly 'quackademia' at Loyola University.

sadmar,
OK, I'll take your word for it about Loyola, though my wife was educated at a Jesuit seminary, and speaks very highly of them; she says they were very broad-minded. Anyone who has starved and flagellated themselves into hallucinating that they are actually Christ crucified on the cross* must have somewhat flexible view of reality, I imagine.

I still think even ten hours a week is a lot of time to spend explaining to medical students that the majority of alternative medicine is bunk, that some of it can interfere with conventional medicine, and that most patients will get the same benefits from a massage or a walk in the sunshine as they do from altmed.

It's the fact that they have made their way into the tent in the first place that bothers me, and what they are going to do now they are in there.

What about the University of Maryland Medicine, which not only teaches homeopathy, among other quackery, but offers it through their clinical services? It's going to be a hard sell convincing me that they are only dispensing magic water because they believe it's a placebo.

I maintain certification of natuorpaths for primary care is a deadly serious matter, far outweighing ‘quackademia’ and most certainly ‘quackademia’ at Loyola University.

There I entirely agree.

* This is what I have read about the process of becoming a Jesuit, but I have no idea if it is accurate, or if it is if it is still practised, to be fair.

By Krebiozen (not verified) on 11 Jan 2015 #permalink

For some reason, I find this talk of tests and scores fascinating- hilarious- but fascinating.

It's not as if scores were Holy Writ**, written in stone or suchlike: societies like Mensa ( and the others) fetishise
numbers, concretising a concept which wouldn't be at all what I'd expect from those endowed so stratospherically intellectually- I'd think they'd be somewhat more aetherial, traipsing about contemplating abstractions all the livelong day.

And right, I studied this stuff.

I am always surprised just how many people have admitted having perfect scores on this test or that and IQs in the highest 1%- either they pad results or I've been exceedingly fortunate to have met so many.

** not that there is such a thing.

By Denice Walter (not verified) on 11 Jan 2015 #permalink

With all the egg bonces on this site

Jesus, that's just painful.

Delta Orion: " Your story seems wildly implausible on its face based on what I know about lifeguarding and lifesaving, which doesn’t necessarily mean that it’s not true; but it does mean that I’m not just going to take your word for it. "

Almost all of his stories are implausible, including the one about kung fu being derived from French fighting techniques. I think a few techniques might've been learned, but kung fu predates *anything* the Europeans were doing.

To be fair, it seems he doesn't listen to people he thinks don't know what they are talking about, even if they act calm and reasonable. You must be remarkably patient. This guy might be a candidate for the troll hall of fame.

Greg Young: I can't believe you're accusing me of bluster, windbag. Europeans had no martial arts, except for boxing and stave fighting. Hand-to-hand combat was typically regarded as low class and weapons were far more easily available. Therefore, while sword-fighting and dueling thrived, bare hand styles weren't encouraged or developed. Since America was obsessed with Europe, we followed the same pattern they did. And no, priests and nuns wouldn't learn self-defense.

If I need to learn reversals, I'll ask someone who knows what they're doing- and you don't fall under that category. I'd also like to point out that legitimate martial artists avoid fights. If you'd ever bothered to visit a dojo, you'd already know this.
Humans are like cats, they won't pick a fight they know they can't win.

By Politicalguineapig (not verified) on 11 Jan 2015 #permalink

"My wife was educated at a Jesuit seminary, and speaks very highly of them; she says they were very broad-minded."

Don't get me wrong. They are broad-minded. Even with financial incentive in play, they wouldn't open the tent to as many things and different kinds of people as they do if they were closed minded. The concept of "a Jesuit education" is very well respected outside the faith in large part because of this.

On a day-to-day basis, inside the tent, this broad-mindedness prevails most of the time. These days, there are fewer Jesuits on the faculty, and in academic administration because there just aren't that many Jesuits and they operate a lot of schools.* But the senior administrators have to be S.J.'s. The thing is, as I said, they're a pretty secretive and mysterious group, so on the few occasions where they assert their authority for one reason or another (perhaps doctrinal, perhaps political within their own hierarchy), it's like a bolt out of the blue, you'd never see coming.

Everything turns upside-down in a snap, the matter gets settled in fairly short order, then everything's back to normal as if nothing happened — unless you're talking a really close inventory of the tent. Should some innocent recent hire say "Hey, what happened to..." they'll be stopped short by the subtle head-shakes of wiser, more veteran colleagues. There's no point in asking anyway, as you'll never get a straight answer (if any reply at all).

* There are 30 Catholic universities in the U.S. that I'd gauge any non-Catholics outside of their local communities have ever heard of. 16 of those are operated by the Jesuits. The most affiliated with any other order is 3. Only, four Catholic universities have med schools, all of them Jesuit. (Creighton, Georgetown, Loyola Chicago, Saint Louis U.)

DW

I am always surprised just how many people have admitted having perfect scores on this test or that and IQs in the highest 1%- either they pad results or I’ve been exceedingly fortunate to have met so many.

If your experience with such people is like mine these people seem to have achieved much less in terms of education or other accomplishments the people who have not scored so high. I have come to assume anyone who tells me they are MENSA member is more likely than not to be a complete idiot.

By Militant Agnostic (not verified) on 11 Jan 2015 #permalink

I suspect that people who go on and on about how well they did on standardized tests as a kid are for the most part desperately trying to divert attention from how little they've accomplished since then.

By palindrom (not verified) on 11 Jan 2015 #permalink

Kreb: I'm glad we agree on naturopathy. It's nice to have an agreement on RI :-)

It’s the fact that they have made their way into the tent in the first place that bothers me, and what they are going to do now they are in there.

Moral of the above story: It's not who's in the tent, it's who runs the tent, and how. What anybody in any tent gets to do is constrained by the folks who own not just the tent, but the land it sits on, the concessions for food/water/heat/bug-spray etc.

What about the U of MD which not only teaches homeopathy but offers it through their clinical services? It’s going to be a hard sell convincing me that they are only dispensing magic water because they believe it’s a placebo.

About MD, I know naught. But just applying general institutional knowledge: whether or how much this is a problem depends on, 1st) who the 'they' are in authorizing and doing the dispensing, 2nd) what patients take away as the 'why' thereof, and only 3rd) the 'why' in the minds of the various 'them'. In the end, it all comes down to whose diagnoses go where on the patients' charts, who holds the Rx pad, who's the key decision-maker in primary care. As far as that goes, I think we're on the same page. Woo should NEVER get to make a key call.

"Even ten hours a week is a lot of time to spend explaining to medical students that the majority of alternative medicine is bunk..."
First, again, all I can verify from Lu's paper is 10 required hours of class time over 3 years. But say it was somewhat more. I'd still not necessarily agree "that’s at least (x) hours that could have been spent teaching something more useful."
Knowledge is power. Even if Stritch grads go on to work in totally CAM-averse clinics, their patients will include a fair number of folks who at least wonder if this woo or that could help them. On SBM, when Mark Crislip noted that 25% of HCW don't get flu shots, I commented about an HCW worker I'd met who (while I'm sure she vaxes) was doing the paleo diet, and generally buys in to the Natural Food-as-vague-health-issue-prevention — not for any specific inapplicable condition, and not as a cure — but it's a tad woo-ey still.

Patients have web connections, and know how to Google. They're going to come to their PCPs with questions about acupuncture, chiro, homeopathy, supplements (especially the supplements), herbals and various other cures. What's the PCP supposed to say? "They didn't cover that in Med school, and if they didn't it must be bunk."? That's not going to work.

I've never brought up any of my won thoughts with a PCP as best I can recall. But I certainly have with specialists and with psych practitioners. These haven't been woo-ish, as I'm not inclined in that way, but if I'm having some persistent issue that the doc seems not to be addressing well (to my layman's experience of the thing) I'll Google and then ask questions, 'Well, what about this? Or what about that?" When I get good explanations, my faith in the doc goes up. When I don't it goes down.

Perhaps to echo one of zebra's points in a different voice: I don't guess anyone bright enough to get into a real med school is likely to be a sheeple. Realizing the limits of projecting from my won experience, I think back to the required course I had to take s undergrad that I would have preferred to skip. Some of them I considered wastes of time, as they had no relevance i could see to my studies. Others were actually annoying, as they had a discernible minimal relevance but were presented with some form of implicit intellectual or quasi-political agenda students were expected to accept to show the 'got' the material.

The harder the curriculum pushed, the harder I fought back in my mind (and sometimes during class...) The result, natch, was that I learned some things but mainly got smarter by working my mind. Part of Knowledge as Power is 'Know Your Enemy' (though 'enemy' is far too strong a word for the cases at hand... you get the general picture).

So, if I were designing a curriculum for PCPs, not only would I include more than 10 hours in 3 years of info on medi-woo, I would insist that it NOT be presented within a frame of 'skepticism.' I wouldn't want indoctrination, either, of course. I'd offer it up close to 'neutral' — maybe with a subtle positive lean. Then I'd make sure the students had access to the relevant sbm perspectives that would go the other way — maybe a short review essay on principles of sound science they should know from other classes. And the end of the unit would be a guided discussion where they got to hash everything out for themselves, with the instructor acting to highlight the internal weaknesses of arguments that might be offered in any direction.

That's how we do it in the Humanities (when we do it right). We put stuff out on the table only with the warrant that it's interesting in some way — and not necessarily intrinsically, but sometimes just for how people take it. As film art Star Wars Ep. 4 is barely mediocre. As culture, it's obviously pretty significant.

So, perhaps the best way to imagine CAM in Med Schools. It's not essential education in the facts of medical science. It's essential education in medical sociology, the application of scientific thought, and connecting the two — which can't be dictated, but must be a 'learn-by-doing.' The doing in this case not being doing CAM, but doing the thinking for yourself about what CAM claims for itself.

Denice wrote: "societies like MENSA fetishise
numbers— I’d think they’d be somewhat more aetherial, traipsing about contemplating abstractions all the livelong day."

For the longest time I had a stereotype of MENSAs as folks who were puffing out their chests rather foolishly, trying to claim some superiority they didn't have. But a couple years ago, I fell into a social group composed mostly of East Bay MENSA members, and found they weren't like that. For the most part, they were aware that MENSA has that kind of rep, and weren't particularly forward about being in the club. (I.e., I only learned the group was MENSA connected after a couple months of knowing them.) To plot the mean of a diverse lot, they're pretty nice folks, definitely on the immature side, wicked sharp with abstract thought, only so-so on book knowledge, and way behind the curve on street smarts. No one has ever mentioned their score on any kind of test. My conclusion is it's a club where 'nerds' lacking in typical social skills can hang out with one another, feel comfortable instead of awkward, and do the stuff they like to do — which seems to consist mainly of playing different kinds of strategic board games.

That's my contact with the folks I know. I met them at a pub quiz, and they were very congenial and invited me to join their game club that meets bi-weekly. (I've stopped going only because I live too far away, and it means crossing the Bay Bridge in rush hour...) But aetherial contemplating of abstractions is not what they do. Quick and complex processing of abstractions is the scene. (Numbers and letter-forms being abstractions, of course.)

This game club meets over dinner in a casual restaurant, 6-10 people show up. One or two folks bring a few games, and after a bit of socializing, a game is selected by general consensus and good-natured mildly competitive play begins. Trivial-Pursuit-style knowledge-based games are never chosen when I'm there because I skunk the field every time. On everything else, I'm lucky to stay out of last place.

A.N. plays Scrabble and does crosswords in competitive tournaments, so find-word-pattern games are mostly out, too, as he just crushes everyone (though most of the group are closer to his level at such skills than to mine.) A.L. has a running gag about how no one will accept his challenge to play Boggle for money — knowing A.N. declines because it would too easy for him to take A.L.'s shirt.

The few times we've played anything along those lines, I've been simply staggered by the to-my-mind savant-like ability of the group overall to pluck multiple words out of a hash of seemingly random letters.

In short, being MENSA-smart doesn't necessarily translate into the real-world reasoning skills as (ahem) some may claim An,d as in most things, the people most qualified to brag about (x) almost never do, because 1) it's usually self-evident, 2) they consider themselves 'normal,' ('if I can do it, it's not that hard') and 3) life has made them aware that 'gifts' tend to balance, and there's something else they're not so good at, so modesty remains the order of the day.

None of this applies to surgeons, of course. ;-)
(And no, that's a not a reference to Orac, but to the folks who've wielded literal scalpels on me...)

"It’s not often that one sees MENSA followed up with bragging about an ASVAB score.

Especially when that’s not how it’s scored."

The test I took was in 1968 at the induction center.
If you knew much about the history of some of these tests you'd know that the scorings systems evolved over the years.

I finished the test in 1/5 the alotted time and made not a single error.
They went wild with offers of waiving the physical requirements and sending me straight to OCS with rank of LT on completion and a postion in Military Intelligence.

All I was interested in was going into UDT, despite some medical problems I was a very powerful swimmer and excelled at free diving to depth. I could stay at 25 feet for a full five minutes before coming up for air, the more recent records are over eight minutes.
I had not passed the physical due to limited mobility in my left arm. Not long after that they had the Draft Lottery which put me out of the first two categories so I was never in danger of being drafted. When I tried to enlist later on the limited mobility problem made me ineligible .
Contary to popular belief the physical requirements for military service during that time frame were very high.

The I Q testing was done at my school, with examiners coming to the schools administering the tests.
In those days a student was never told the exact score they had made. The only reason I know mine was over 165 was because they got all excited about it and told me that much.
My sisters score was over 180, again how much over 180 they would not say. She has great communication skills and retired after more than 50 yrs as a journalist and news paper editor.
My grand niece when tested was so far above the limits of the test that they were talking about specialized tests for people of her caliber. She is Steven Hawkins smart at 18.
My younger brother was a math prodigy, doing college level calculus at 14. Unfortunately he died young in a traffic accident.
Plenty of smart folks in my family.

My point , which you continue to miss, is that intelligence alone isn't always the deciding factor. Communication skills are not a matter of intelligence.
There are a great many people out there with highly developed communication skills that really have nothing to say that makes sense. Often they know what they are saying is wrong. They use their skills to make themself seem smarter by pulling the wool over the eyes of the gullible.

By Greg Young (not verified) on 11 Jan 2015 #permalink

"
Politicalguineapig

January 11, 2015

"To be fair, it seems he doesn’t listen to people he thinks don’t know what they are talking about, even if they act calm and reasonable. "
When someone like yourself proves that they don't know what they are talking about while trying to come off as an authority I'll listen then call them on it.

"Greg Young: I can’t believe you’re accusing me of bluster, windbag." Europeans had no martial arts, except for boxing and stave fighting. Hand-to-hand combat was typically regarded as low class and weapons were far more easily available. Therefore, while sword-fighting and dueling thrived, bare hand styles weren’t encouraged or developed. Since America was obsessed with Europe, we followed the same pattern they did. And no, priests and nuns wouldn’t learn self-defense".
I find it difficult to believe that you would know so little about the history of martial arts.

"If I need to learn reversals, I’ll ask someone who knows what they’re doing-"
By which time you'd already be dead or in intensive care with spinal cord damage, too late to ask then.

"
I’d also like to point out that legitimate martial artists avoid fights. If you’d ever bothered to visit a dojo, you’d already know this."
Unlike you I never fancied myself a martial artist, but I have visited dojos and know a few real martial artists.
In real life there are a great many situations where fights can not be avoided, and these don't start off with people bowing and squaring off. Real world self defense situations start off with some hopped up goon trying to stab you in the back or sucker punch you for no apparent reason. Punks like this seldom travel without the back up of several pack mates.

"
Humans are like cats, they won’t pick a fight they know they can’t win."
Reasonable people don't, but if you think street gangs and meth heads are reasonable people you don't know much about human nature.
Also just where do you get the idea that humans will just knuckle under even if they did know they had no chance of winning.
Your complete lack of knowledge when it comes to world history, and recent events for that matter is showing once more.

Why don't you look up the evolution of kung fu from chinese boxing. Look up the early expeditions by Jesuit priests into Japan and China.
Priest learned and developed un armed combat techniques because they were forbidden to draw human blood. Even during the crusades the few fighting priests that engaged in battle used only a mace not edged weapons. Some priest carried cast lead crosses that they could use like a hammer.

European Martial arts haven't been the subject of popular studies for quite awhile. Norse martial arts were called "War Magic" in the eddas, which leads to some confusion.

Most European martial arts were based on what the Romans taught their legionaires fort dealing with civilian populations in occupied lands, much like modern police riot techniques and compliance holds and unarmed self defense when attacked by infiltrators before you could reach a weapon. The present art of Krav Maga is based on these same techniques.
Just having a sword doesn't always mean you'll get a chance to use it, and in a mellee weapons could be broken or lost.

None of this information is unavailable, and you seem to be avoiding common sense in your statements as much as possible.

By Greg Young (not verified) on 12 Jan 2015 #permalink

Obrien 375

Not many, most.

And we are using examples (metaphors) to represent broad categories. For which we *actually know things*-- it is not speculation.

I'm guessing you didn't draw my axes and play around with placing things in the space? Lets. So, if we count placebo as symptomatic relief:

reiki = (0, >0, >0)
homeopathy = (0, >0, >0)

Most back pain resolves itself. Most medical treatments (interventions beyond advice) for back pain would be

(>>0, >0, >0)

And we don't really have a way to distinguish much of the reported relief attributed to such interventions from placebo.

I forget the rough numbers, but back pain affects a big chunk of the population. We could move a large number of points if the standard of care for back pain began with reiki, rather than potentially harmful drugs.

You are still begging the question because you do not make a case for not trying the approach described in the paper to achieve that goal.

ps: I forgot to include cost in my "harm" category.

zebra,
Let's take a look at the 'ginger tea' issue using your own frame of reference.

Let’s set up three perpendicular axes as follows:
x, as usual, called “harm”
y, going up, called “help”
z, coming out of the page, called “demand”
So, harm is negative physical effects, help would be reducing pathology/relieving symptoms, and demand would be actively seeking of or likely “compliance” with interventions. Away from the origin means “more”.

Usually we talk about risk and benefit, but I see what you mean, though I don't really see how plotting these on a coordinate system like this is very useful, since I doubt we will determine a direct relationship between any of the variables, which is the usual purpose of a system like this.

Still, ginger tea as a treatment for a cold is of low benefit and low risk, but also low demand. Antibiotics are even lower benefit, higher risk, but also higher demand.

What we want to do is to reduce the risk to patients by reducing the unnecessary prescription of antibiotics, yes?

Is this best achieved by increasing the demand for ginger tea? Even if it is, which is doubtful in my mind, I'm not sure how you would go about doing this, unless you lie and tell people it is more effective than it really is. Many doctors have a problem with lying to patients, which is why placebos have gone out of fashion.

Also, I suspect that the patients that might be amenable to using ginger tea as a cold treatment would already be taking vitamin C, zinc or echinacea, and that those demanding antibiotics would be less amenable.

Would simply teaching patients about the use of antibiotics to reduce their demand be more effective? It seems to me that educating patients is far more likely to reduce demand for antibiotics than promoting what is essentially a placebo. Doctors already tell patients with a bad cold to stay at home, keep warm and drink plenty of fluids. I don't really see how adding a recomendation to drink ginger tea (or whatever other traditional medicine you have in mind) to this would help.

A few days ago I visited my local pharmacy and noticed a poster telling patients that antibiotics are ineffective in 80% of sore throats because they don't work for viral infections. It is part of an NHS campaign to reduce overuse of antibiotics. Similar posters appear in GP's surgeries and in hospital clinics.

I don't know how effective this will be, but it seems a more logical approach than promoting alternative medicine or teaching medical students homeopathy or acupuncture.

It seems trivially obvious to me that we can locate our metaphorical examples with good qualitative precision: Ginger tea makes your throat feel better and perhaps provides hydration, antibiotics have no positive effect and serious negative ones.

I agree that ginger tea is a better treatment for a cold, in terms of risk and benefits, than antibiotics, but it isn't a simple choice between the two as I explained above.

The question you people are dodging is what the goals are, and how would programs like what is described in the acupuncture paper affect the distribution of patient-practitioner interactions as they are mapped into the space constrained by the three planes.

I don't think anyone has been dodging anything, I still don't think teaching nonsense to medical students will increase the demand for higher benefit lower risk treatments. As for "distribution of patient-practitioner interactions as they are mapped into the space constrained by the three planes", personally I find it easier to simply think of risk, benefit and demand as three independent variables, and see little utility on mapping them in a coordinate system like this.

Me, I do not reject the possibility that some stuff could be moved towards the yz plane. Which would be my goal.

In plain English that means increasing demand for beneficial treatments. That's where SBM comes in and, I believe, is precisely what Mephistopheles O'Brien was referring to when he said he wanted to "introduce those treatments & practices shown by good science to be of actual benefit.”, which you described as "evasive and question-begging".

By Krebiozen (not verified) on 12 Jan 2015 #permalink

Sadmar,

I would only add one thought to your excellent and valuable exposition 390: It isn't just the humanities.

There's room for what you describe in math, physics, and engineering, and it certainly happens as people move along in their education.

About naturopaths:

As I've said, I have given this topic little thought prior to encountering it here, so I had no idea about what goes on with naturopaths. But it appears to be a problem with local regulation, allowing them to practice beyond their training. I would be concerned that "guilt by association" creeps in here as an argument against the CAM education for doctors. Herbalists can't prescribe oxycontin.

Not many, most.

Discounting periodic checkups and wellness visits, I won't concede that without statistics.

And we don’t really have a way to distinguish much of the reported relief attributed to such interventions from placebo.

Of course we do. They're called "trials".

You are still begging the question because you do not make a case for not trying the approach described in the paper to achieve that goal.

You've made no effort to propose any action; I fail to see why I should argue against it first.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

One note on placebos - they do not relieve symptoms in any significant way. They can reduce the perceived severity of symptoms, which is not the same thing.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

"Steven Hawkins"? Yeah, you're a real genius, there, Gomer!

By The Very Rever… (not verified) on 12 Jan 2015 #permalink

Is Steven Hawkins related to Jim Hawkins?

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

An example of war magic
"A third [rune] I know, if great is my need / Of fetters to hold my foe. / Blunt do I make mine enemy's blade, / Nor bites his sword or staff. (...) A fifth I know, if I see from afar / An arrow fly 'gainst the folk, / It flies not so swift that I stop it not / If ever my eyes behold it."

In Egil's Saga Egil Skalgrimson takes up a "lawsuit" in which unscrupulous land grabbers sent in their hired killer to challenge old or infirm men to trial by combat in order to sieze their lands.
Egil's foe was a practioner of war magic. In this instance it was a system of turning and spining to prevent the opponents blade from making any solid contact. Its been compared to Akido. The man was such a master that the sharpest sword had never cut his flesh.
This is very helpful in a knife fight.
Egil was also a master of Runic magic, which was basically a learning tool.
He knew he wasn't fast enough to take the man out in a straight up sword fight, so he undid the safety cord that held his sword to his wrist and flinging his sword as a distraction he leapt on the man and ripped out his throat with his teeth.

This illustrates that if you don't use your head only for a hat rack you can overcome a preceived superiority of an opponent.

War magic was taught to select young warriors and besides the martial arts it included herbal medicine and field surgery as well as state of the art engineering. Many of the instructors were women.

By Greg Young (not verified) on 12 Jan 2015 #permalink

BTW
I figured out why some words I type don't appear as typed.
I'd noticed that several times whatever spell check correction system this site uses will sometimes add letters to a word or rearrange letters. Apparently it sometimes makes mistakes, turning the word "aspirin" into "aspiring" or "for" into "fort".
Somehow it turned "perfect" into "percent".

I've seen a few similar buggy programs like this, but never had this sort of problem with them before.
It might also be some conflict with a spell check built into my browser, but I don't think its been turned on.

By Greg Young (not verified) on 12 Jan 2015 #permalink

To reflect off of what sadmar and Militant Agnostic wrote:

You're right and that's why psychologists study *social* cognition in addition to studying whatever it is that IQ tests study. This area and the study of its development explain many of the phenomena under discussion here- the amount of research since the 1980s is indeed staggering.
Some topics include:
person perception, attribution theory, recursive thought, reciprocity, taking the role of the other, executive functioning.

By Denice Walter (not verified) on 12 Jan 2015 #permalink

sadmar,

That’s how we do it in the Humanities (when we do it right). We put stuff out on the table only with the warrant that it’s interesting in some way — and not necessarily intrinsically, but sometimes just for how people take it. As film art Star Wars Ep. 4 is barely mediocre. As culture, it’s obviously pretty significant.

I am unusual in that I have training in both natural and social sciences. I trained and qualified as a biomedical scientist and worked in a hospital pathology department that was closely associated with a university research department for several years. Later I studied social anthropology (my college motto was 'knowledge is power') and found them to be very, very different.

The former demanded that I know everything I was expected to know and to be able to regurgitate it on demand, no extra points for independent thinking. If they had tried to teach us live blood analysis with a mildly positive slant, and had hoped that we might realize that is was bogus, I think we might have objected. I don't see how it would have helped at all.

The latter was extremely tolerant of students wandering off the syllabus and exploring their own areas of interest.
Both were useful, but the former provided me with a good basis for doing a job well, the latter was more of a rite of passage that I believe improved my reading, writing and thinking skills and my life in other unexpected ways.

I also have relatives and friends who have trained as doctors, so I know the enormous amount of information they are supposed to learn and retain. I really don't think the kind of learning experiences you suggest - essentially playing devil's advocate and hoping that they kick back and learn something useful - has any place in a doctor's education. They are too busy learning every branch of every major nerve system, drug interactions and vast amounts of other important practical material.

So, I consider most of the material on that Loyola curriculum as only being of any use if they intend to use CAM in their practice, and I consider that to be a bad thing.

So, perhaps the best way to imagine CAM in Med Schools. It’s not essential education in the facts of medical science. It’s essential education in medical sociology, the application of scientific thought, and connecting the two — which can’t be dictated, but must be a ‘learn-by-doing.’ The doing in this case not being doing CAM, but doing the thinking for yourself about what CAM claims for itself.

I disagree. I don't think it's essential education for a doctor at all. You may expect your doctor to know about the The Back Shu and Front Mu subsystem but I don't. I want him or her to know the best way of diagnosing and treating whatever ails me. Teaching medicals students BS like this in the hope that they will recognize it as such just seems ridiculous to me.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

This site doesn't use any "spell check correction system", goober. How would that even work? Your Spell-Check isn't going to catch imbecilities like that either. "Steven" is a name. "Hawkins" is a name. Spell-Check can't protect you from your marrow-deep ignorance.

By The Very Rever… (not verified) on 12 Jan 2015 #permalink

And whilst there is NO one like Krebiozen, a few of us here also studied natural and social sciences as well as arts.

By Denice Walter (not verified) on 12 Jan 2015 #permalink

Axe @405 --

From the wiki article on the Simpsons "Treehouse of Horror VI" Halloween episode:

In "Homer3", as he is about to fall in the black hole Homer says, "There's so much I don't know about astrophysics. I wish I'd read that book by that wheelchair guy."

By palindrom (not verified) on 12 Jan 2015 #permalink

It has been well documented by experts commenting here that it doesn’t matter what you teach doctors, they will still prescribe antibiotics if the patient insists, and perhaps even if the patient doesn’t insist.

Which argues that we work harder to educate doctors, not that we encourage them to lie to their patients.

So, ginger tea would definitely be more effective at minimizing antibiotic abuse because it would offer a believable alternative for the patient.

We don't know this, however. if we can't teach them "Stop offering your patients antibiotics to treat viral infection" what reason is there to believe we can teach them "Start offering your patients ginger tea to treat infection?"

Sorry if this duplicates:

Your comment is awaiting moderation.

It has been well documented by experts commenting here that it doesn’t matter what you teach doctors, they will still prescribe antibiotics if the patient insists, and perhaps even if the patient doesn’t insist.

Which argues that we work harder to educate doctors, not that we encourage them to lie to their patients.

So, ginger tea would definitely be more effective at minimizing antibiotic abuse because it would offer a believable alternative for the patient.

We don’t know this, however. if we can’t teach doctors “Stop offering your patients antibiotics to treat viral infection” what reason is there to believe we can teach them “Start offering your patients ginger tea to treat viral infection?”

zebra,

Herbalists can’t prescribe oxycontin.

Naturopaths in Oregon can prescribe fentanyl and morphine, as well as an alarming range of other drugs, and naturopaths are lobbying for more prescribing privileges in other states.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

Krebiozen @404 -- As a science professor I tend to think memorization is overrated and that some time should be carved out of the medical curriculum to ensure that doctors have a broad understanding both of science and the role they play in society. Obviously, if a surgeon is opening me up he or she had better know exactly what they're doing, but that's only the minimum requirement for a good physician.

I've learned recently that in Australia at least, medical training starts at 18; in the US, they start much later, after a 4-year college curriculum in which some of this broader education can be assimilated. Very interesting stuff.

By palindrom (not verified) on 12 Jan 2015 #permalink

"And, whatever you think of all this, the material will be on the test”

Why? What benefit would be realized by requiring medical students demonstrate they've mastered this material?

Obrien,

"You’ve made no effort to propose any action; I fail to see why I should argue against it first."

Dude, we've all been discussing the Loyola paper, which I quoted, as an example of integrating CAM within conventional medical education.

I've said it sounds reasonable, and sadmar does a very nice discussion of his/her take on it at 390.

Why don't you deal directly with why incorporating CAM can't help move the points. It might just start moving people away from Kreb's auto mechanic model...

As to excluding annual physicals and screening tests-- absolutely not; that's where much of the damage originates. I would expect some of our experts here to refute my claim if they could, but I doubt they can. Think about all those doctor visits for colds, aches and pains, and so on.

(About placebo effect in back pain-- I know some blind studies have been done with fake surgery but I'm pretty sure they are limited to minimally invasive procedures. And sure, I will stipulate that oxycontin will make people mind the symptom of acute pain less, better than a sugar pill. Is that all you've got? So will a couple of glasses of alcohol or smoking pot.)

JGC,

" What benefit would be realized by requiring medical students demonstrate they’ve mastered this material?"

What benefit is realized by requiring Creationists to correctly describe principles of Evolution on the test?

I'll tell you: If you are going to reject something, you should correctly know what it is that your are rejecting.

"Which argues that we work harder to educate doctors,"

Exactly what I am suggesting. Doing the same thing over and over and expecting different results is the definition of insanity, right?

(Please read sadmar at 390 for a much more articulate explanation.)

Dude, we’ve all been discussing the Loyola paper, which I quoted, as an example of integrating CAM within conventional medical education.

Could've fooled me. I thought we were discussing the advertising supplement for traditional medicine in Science, or perhaps how to graph relative harms/benefits in Cartesian coordinates, or whether you need to teach alternative medicine in order to channel which ineffective medicines a doctor prescribes (you keep changing what you consider to be "the question"). If you and Sadmar are having some other conversation, that's your concern.

As to excluding annual physicals and screening tests– absolutely not; that’s where much of the damage originates.

So you don't believe in preventive maintenance?

(About placebo effect in back pain– I know some blind studies have been done with fake surgery but I’m pretty sure they are limited to minimally invasive procedures. And sure, I will stipulate that oxycontin will make people mind the symptom of acute pain less, better than a sugar pill. Is that all you’ve got? So will a couple of glasses of alcohol or smoking pot.)

But which of them provides the best pain relief at the least harm? While any of them might reduce the perceived pain (and, I'd argue, that some actually eliminate the pain temporarily), so might a quick knee to the groin. Given the substantial number of things that will reduce either perceived or actual pain, how would YOU select between them?

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

” What benefit would be realized by requiring medical students demonstrate they’ve mastered this material?”

What benefit is realized by requiring Creationists to correctly describe principles of Evolution on the test?

It would read better if you reversed the two. The reason you teach a creationist the principles of evolution is to try to show him/her what the current best theory underpinning much of modern biology is all about. That would also be the reason you'd teach, say, a germ theory denialist germ theory.

The reasons you'd teach someone creationism would be either:
- you want them to understand the principles involved so they can compare them with observations.
- you truly believe that species were created by a creator and want to convince them of this truth.
- you are teaching religion and this is incidental to that.
- it's on the test.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

I’ll tell you: If you are going to reject something, you should correctly know what it is that your are rejecting.

Which doesn't require training in the practical application of or detailed understanding of the postulated theoretical principles of acupuncture, homeopathy, reiki, etc.-does it? All that's necessary is communicate that these alternative treatments have either been shown not to work or lack any evidence even suggesting they might work.

Or do you really believe we should benefit by requiring medical students to master 'traditional' blood-letting, before they are encouraged to reject it as a valid therapy for multiple indications?

Exactly what I am suggesting.

No, you're not. Recall that here we'respeaking narrowly of educating doctors not to prescribe antibiotics for viral infection--and that is my suggestion. Your suggestion is that we encourage doctors to lie to their patients and suggest that ginger tea could be of benefit.

Doing the same thing over and over and expecting different results is the definition of insanity, right?

But no one is suggesting that we simply do the same thing over and over again, instead we're suggesting we commit more resources, expend more effort and develop more effective educational strategies to communicate the same message.

The Very Reverend Battleaxe of Knowledge

January 12, 2015

"This site doesn’t use any “spell check correction system”, goober. How would that even work? Your Spell-Check isn’t going to catch imbecilities like that either. “Steven” is a name. “Hawkins” is a name. Spell-Check can’t protect you from your marrow-deep ignorance."

Well "Blunt manure fork of imbecility" the blasted thing has come on several times while posting here and only here, never on any other board.
A wavy red line shows up under a word, then before you can finish typing the letters shift to form a different but similar word.
I checked and my browser spell check is off and has never been enabled, so it has to be something associated with this site.

The arogance and narcissism you display is reflected in your user name.

By Greg Young (not verified) on 12 Jan 2015 #permalink

A wavy red line shows up under a word, then before you can finish typing the letters shift to form a different but similar word.
I checked and my browser spell check is off and has never been enabled, so it has to be something associated with this site.

Perhaps so - I have not noticed any such behavior in Chrome.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

zebra still seems not to have addressed the issues with his reasoning that I pointed out in posts #225 and #292.

That aside, let's take a look at this ginger tea bit. Patient with a viral illness goes into the doctor and asks for antibiotics. Doctor says that abx will not work, but why not try some ginger tea. Patient asks why. Doctor explains it is better than abx because it does not have the negative side effects and will help their throat feel better. Patient takes away, "ginger tea is better than antibiotics". The next time patient is sick, they remember that ginger tea is better than antibiotics (thanks to problems with human memory), so they drink some tea and don't actually go to the doctor to get checked out. It turns out they do actually have a bacterial illness this time, and by the time they do seek real treatment, their illness is much more severe and either requires more intervention than if they'd gone to the doctor in the first place, or it has already done irreparable damage.

When calculating the "harm" of a CAM treatment, you also need to consider the likelihood that the patient will delay real treatment in favor of trying a placebo that they think actually works, since their doctor prescribed it in a similar (to them) situation in the past.

@Greg Young

The comment software here does not autocorrect anything. So any typos are more than likely your own.

Apparently this site has a server side spell check program
something like this.
http://spellerpages.sourceforge.net/

I looked up another site with message board that gives a run down on how this works and they stated that theirs works with Firefox and Chrome but caused problems with Internet Explorer browsers.

If possible I'd like for a site admin to answer a few questions about why this spell check program alters lettering of words that aren't misspelt (or misspelled as the case may be).
I have noticed some UK sites profanity filters have mistaken the name of author Michael Moorcock for profanity. I got a real laugh out of that one.
Alternative spellings can also be a problem.
I once noticed an eastern european university site had the word college spelled colledge throughout the site.

I've read that there are five forms (or dialects) of the english language in use on the net.

By Greg Young (not verified) on 12 Jan 2015 #permalink

Got a couple posts in moderation because I typoed my email, so apologies if these double-post:

zebra still seems not to have addressed the issues with his reasoning that I pointed out in posts #225 and #292.

That aside, let’s take a look at this ginger tea bit. Patient with a viral illness goes into the doctor and asks for antibiotics. Doctor says that abx will not work, but why not try some ginger tea. Patient asks why. Doctor explains it is better than abx because it does not have the negative side effects and will help their throat feel better. Patient takes away, “ginger tea is better than antibiotics”. The next time patient is sick, they remember that ginger tea is better than antibiotics (thanks to problems with human memory), so they drink some tea and don’t actually go to the doctor to get checked out. It turns out they do actually have a bacterial illness this time, and by the time they do seek real treatment, their illness is much more severe and either requires more intervention than if they’d gone to the doctor in the first place, or it has already done irreparable damage.

When calculating the “harm” of a CAM treatment, you also need to consider the likelihood that the patient will delay real treatment in favor of trying a placebo that they think actually works, since their doctor prescribed it in a similar (to them) situation in the past.

@Greg Young

The comment software here does not autocorrect anything. So any typos are more than likely your own.

Ugh, I give up. I have some posts in moderation for typoed email address. Orac, sorry for clogging your moderated comments!

One comment is for zebra, but too long to risk pasting in a third time. The other is for Greg Young: this site does not autocorrect anything, as far as I'm aware. Any typos are most likely your own.

I left one possibility off from my list of why one might teach creationism - one is teaching current affairs and this is a current issue before a school board.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

zebra,

Dude, we’ve all been discussing the Loyola paper, which I quoted, as an example of integrating CAM within conventional medical education.

I brought up the Loyola paper as evidence that medical schools really are teaching this BS to refute your and sadmar's disbelief that this is indeed the case.
zebra #92

Sorry, I must have missed the part where they were going to teach about the efficacy of [Rhino horn] in medical school. And require ‘practices’ to dispense it.

I think we have established that rhino horn is a metaphor (or "metaphorical example") for CAM.

sadmar #318

And Kreb decried, “teaching medical students that alternative medicine works.”
I think there’s too much assumption here. I have no idea what or how much any actual med school may teach about any TM practice, but I can certainly imagine a curriculum that touches on those practices without endorsing that they “work” as “claimed by traditional medical practitioners.”

I'm amused that both of still apparently don't accept this even after I provided evidence that U of Maryland not only teaches medical students about magic water, it actually prescribes it to patients. Perhaps this is some kind of elaborate experiential teaching aid I don't understand, but it seems unethical to me, at best.

Why don’t you deal directly with why incorporating CAM can’t help move the points.

Why don't you explain first how incorporating CAM, a collection of ineffective, non-zero risk diagnostic techniques and treatments, would result in more people getting, or wanting, more effective, lower risk treatments, to translate your helpful coordinate system into plain English.

It might just start moving people away from Kreb’s auto mechanic model…

I wasn't aware I had an auto mechanic model, but if I did I might point out that I don't expect the person fixing my car to study reiki and crystal healing (yes some people really do use these on cars) with the intent of them figuring out why it doesn't help fix a blown gasket.

BTW, perhaps you and sadmar could explain to me where we draw the line with educating medical students about CAM. Surely if they need to know about the Back Shu and Front Mu subsystem, how to perform tongue and pulse diagnosis and how to do a homeopathic interview, they should also know about other CAM therapies and diagnostic treatments.

Why not teach them how to perform live blood analysis, reflexology, iridology, chelator-provoked heavy metal urine analysis, astrological, tarot, runic, psychic diagnosis, the various bogus radiology machines that go "beep", and all the other varied bogus diagnostic techniques?

Why not educate them in the use of 'miracle mineral supplement', chelation and other biomedical treatments for autism, every single one of the many mutually contradictory fad diets, alkalization, all the many claims for megavitamin therapies, prayer, therapeutic touch, reiki, magnetic therapies, electrical therapies including zappers, ozone therapy, hyperbaric oxygen therapy, intravenous hydrogen peroxide, fasting, herbalism, homeopathy, quack stem cell therapies, sun-gazing, the many detox systems, colonic irrigration, coffee enemas, Gerson therapy and all the other varieties of quackery that are just as valid as homeopathy and acupuncture?
After all, one of their patients might ask them about these, and they wouldn't want their patients to lose confidence in them if they didn't know all about them, would they?

Of course they wouldn't have the time or energy left to learn any actual medicine, but you can't have everything.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

JGC,

"But no one is suggesting that we simply do the same thing over and over again, instead we’re suggesting we commit more resources, expend more effort and develop more effective educational strategies to communicate the same message."

"commit more resources, expend more effort" = same thing over and over

"develop more effective educational strategies" = vaporware BS

I'm suggesting an *actual* "more effective educational strategy."

If you believe in science you should be willing to give it a chance to demonstrate results. It's just anecdotal, but let's see-- I, sadmar, and palindrome I think, would attest to its potential efficacy.

Please read carefully before you give a Kreb-like kneejerk response.

I meant 'bogus radionics machines that go “beep”'
There may be bogus radiology machines for all I know. Very little would surprise me in this area any more.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

re auto-spelling corrections:
I doubt that it's part of RI because I switched computers 6-8 weeks ago and never had an event until then.
The new one is absolutely maddening BUT its evil work can be easily circumvented.**
If I write:
'Quelle stupit loaad deh trashebin blarnie'
each and every word will be underlined

** but bright folks can figure that only for themselves.

By Denice Walter (not verified) on 12 Jan 2015 #permalink

That should be-
figure that OUT for themselves

By Denice Walter (not verified) on 12 Jan 2015 #permalink

palindrom,

As a science professor I tend to think memorization is overrated

I agree, but unless things have changed a lot in the past decade or so, a large chunk of medical training is about memorizing things. I don't expect my doctor to have to do a Google search to figure out what medication to prescribe me, or how to do a prostate examination or whatever. Some stuff doctors do have to remember. Making them learn useless stuff in addition just doesn't seem very effective to me.

and that some time should be carved out of the medical curriculum to ensure that doctors have a broad understanding both of science and the role they play in society.

I would have hoped that they would have acquired this at undergraduate level if not before.

I’ve learned recently that in Australia at least, medical training starts at 18; in the US, they start much later, after a 4-year college curriculum in which some of this broader education can be assimilated. Very interesting stuff.

If medical students have not had this broader education I'm all in favor of giving it to them. I still don't see how the sort of education in CAM that Loyola and Maryland are giving their medical students in this area will be very helpful in this regard.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

"
Todd W.

http://www.harpocratesspeaks.com
January 12, 2015

Ugh, I give up. I have some posts in moderation for typoed email address. Orac, sorry for clogging your moderated comments!

One comment is for zebra, but too long to risk pasting in a third time. The other is for Greg Young: this site does not autocorrect anything, as far as I’m aware. Any typos are most likely your own."

Then explain to me why that wavy red line was appearing under words, then the lettering shifts or extra letters appeared before I pressed the submit button, then other words were changed to similar words when I did submit.

If these things are built into servers there may be a server between here and there that is running this program.

I checked my browser spell check and not only was it not enabled, I'd never downloaded the component necessary to enable it.

I misspell a word now and then, otherwise I'd have not had the opportunity to observe the spellcheck at work, but I know the difference between "perfect" and "percent" and "for" rather than "fort".

I don't make a habit of pointing out when someone else has misspelled a word, but I have noticed a few odd misspellings and typos in other visitor's posts. I'm fairly sure the guy who posted "aspiring" actually typed in "aspirin".

The red line hasn't showed up in the last few posts. Maybe it turned itself off. It did show up until I posted about this glitch, which is obvious from here but apparently doesn't show up to those on that end.

By Greg Young (not verified) on 12 Jan 2015 #permalink

417:

Well, it's not, you imbecilic cretin. How in the fuçking hell could there be any spell-check here? It's your OS's spell-check. It woks whether your browser's spell-check is enabled or not.

Figures you wouldn't know the context of my username, but I wouldn't talk about "arogance" (sic) and narcissism if I were you.

By The Very Rever… (not verified) on 12 Jan 2015 #permalink

I may have this figured out.
I normally use Flashpeak Slimbrowser, that browser did not have the spellcheck enabled.
When I used history to return to this site it came up in IE which is still the default browser.
the spellcheck and auto correct in IE is enabled and apparently is enabled by default. I'd never noticed it was even there because I almost never use IE anymore.
That's the program that has been messing with my posts.

Looks like lots of people are having this sort of problem.

If anyone else is having this problem here's a tutorial on how to disable spell check and auto correct in IE.
http://www.askvg.com/how-to-disable-built-in-spell-checker-feature-in-i…

By Greg Young (not verified) on 12 Jan 2015 #permalink

When someone like yourself proves that they don’t know what they are talking about while trying to come off as an authority I’ll listen then call them on it.

*spit-take*

Pots and kettles.

By delta-orion (not verified) on 12 Jan 2015 #permalink

@Greg Young

Glad you finally figured out what it was on your end that was causing your issues, however:

I misspell a word now and then, otherwise I’d have not had the opportunity to observe the spellcheck at work, but I know the difference between “perfect” and “percent” and “for” rather than “fort”.

Spell check will not change "for" to "fort" or "perfect" to "percent", since those are all legitimate words. Maybe you have some manner of grammar checker or autocomplete turned on.

And as the person who wrote "aspiring" instead of "aspirin", I can assure you that it was my own typo, not any nefarious software shenanigans.

There must be some technological corollary to Hanlon's razor.

I’m suggesting an *actual* “more effective educational strategy.”

No, zebra: you're not.

Instead you're sugesting we encourage physicians to lie to their patients (by suggesting ginger tea might be an effective treatment for viral infections, when you've characterized such treatment as wholly ineffective yourself) and have only asserted, without evidence, this must prove to be effective.

Nosing about to see if I could find any studies of the effects of teaching integrative medicine I came across this paper about the teaching of complementary and alternative medicine in U.S. Medical Schools which observes:

Most of the courses (78.1%) were taught by individuals identified as being CAM practitioners or prescribers of CAM therapies. Few of the courses (17.8%) emphasized a scientific approach to the evaluation of CAM effectiveness.

And concludes:

A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.

I'm now even less convinced that these courses are equipping future doctors with a science-based understanding of CAM, as some here appear to want to believe. Maybe things have improved since 2002, but I doubt it.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

I may have missed it, but I don't think zebra has acknowledged the problems with his reasoning that I raised in posts #225 and #292.

But that aside, let's assume, for a moment, that we have a viral illness/ginger tea scenario. Patient Y (we'll call him Bob) comes down with a viral illness and goes to Dr. X (no relation to Frank N. Furter) and demands antibiotics. Dr. X (rightfully) tells Bob that abx won't work for a viral infection, but Bob is persistent. Dr. X then suggests that Bob try drinking some ginger tea, describing it as just as effective as abx (i.e., not effective) but it will soothe his throat, with fewer side effects. Bob accepts this prescription and goes home to try some ginger tea. Lo! and behold, it soothes his throat and makes him feel better even though it has no significant impact on the objective symptoms Bob is suffering.

Fast forward to Bob's next infection. This time it is a bacterial infection that starts out, as far as Bob is concerned, with the same symptoms as before. He feels like crap, but he remembers Dr. X telling him that ginger tea is just as effective as antibiotics (human memory being the fallible thing it is), so he drinks some ginger tea. His throat is soothed by the warm liquid, but the underlying bacterial infection continues unabated. After his condition overall worsens, he finally decides to go in to see Dr. X. Dr. X prescribes a course of antibiotics, but also schedules some additional tests because, by this point, Bob waited too long and the infection is now systemic. Additional treatments are prescribed, as well, but there has already been some permanent minor damage to Bob's (lungs/ears/eyes/take your pick for this hypothetical). In the end, Bob delayed what would have been an inexpensive, 10-day course of antibiotics that would have cleared up his infection without any lasting problems. In the end, he spent more money and more time on treatments with an overall worse outcome.

Now, this may be a slightly extreme example, but it's a perfectly plausible one and is meant to illustrate that when considering how "harmful" some TM/TCM/CAM treatment is, you need to consider what the patient will take away from it. There is more than just the one-time patient interaction.

Here's another interesting survey, this time from 2011 looking at the effect of medical education on the knowledge and attitudes to CAM of UCLA medical school students. This is perhaps a little more encouraging , with third year students generally showing less confidence in and likelihood to prescribe CAM.

However, I was struck by the finding that their education had little effect on whether they would prescribe homeopathy or therapeutic touch - 13.6% and 10.1% would respectively, and almost a third of third year students said they would prescribe herbal remedies or TCM. Sadly they didn't ask if they would prescribe ginger tea or antibiotics for a cold.

By Krebiozen (not verified) on 12 Jan 2015 #permalink

Spell check will not change “for” to “fort” or “perfect” to “percent”, since those are all legitimate words.

No, but Grammar Check might. More common is for a typo to be autocorrected to a different word than the intended one.

Then again, I have this problem with some of the documents I maintain at work using MS Word, where for no reason anyone can fathom, it sometimes decides a swath of the document is actually in some other language and so marks a huge number of words as misspelled. One document believes that it is a combination of English, Français, and Bokmål Norsk, and I have utterly failed to persuade it otherwise -- it keeps reverting back when I'm not looking.

By Calli Arcale (not verified) on 12 Jan 2015 #permalink

Of course, once I finally decide to report my comment to zebra, the previous versions get out of moderation. Once again, Orac, my apologies.

Todd W,

I can't remember if I replied directly to earlier comments, but reading them again I would say they just aren't useful arguments.

This is a discussion about policy-- 'global' policy; it's about the population of medical students, and the population of people who may be patients, and all the factors that may be involved.

Your last example ignores all that. It is the same argument that says we should do screening tests on the entire population, at whatever cost, and whatever direct risk, and whatever risk and expense of treating false positives, because one person might be saved.

Anyway, Bob could just as easily die from an allergic reaction to wrongly prescribed antibiotics. You claim to believe in "science", but it doesn't sound like you understand statistics and relative risk.

If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.

How do you recognize the value of vaccination and not recognize this?

Krebiozen,

I was very interested in the abstract where it said that the negative views towards CAM in third year students "may reflect the increased curricular emphasis on evidenced-based medicine, and subsequent student dependence on randomized clinical trials to influence and guide practice. This will need to be addressed in curricular efforts to incorporate Integrative Medicine." (emphasis mine)

This and the discussion suggest that the goal of such changes to the curriculum would be to encourage new doctors to prescribe various alternative techniques including Meditation/Yoga/Relaxation/Imagery, Massage, Spirituality, Herbals, Chiropractic, Traditional oriental medicine, T’ai Chi, Homeopathy, and others. It further says that the institution in question has already implemented such changes, which is why (in the author's view) the third year students - who started with the old, science based curriculum - were less positive towards these treatments.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

JGC, 437

Ummm... you didn't follow my advice.

An educational strategy is not a medical intervention. What does the efficacy of ginger tea have to do with the ground truth goal of education:

The student is not the same after taking your class.

?

So, yes, if I can get some portion of the students to lie about ginger tea instead of lying about antibiotics, I've done something that conventional medical **education** has consistently failed at.

I wonder, seriously, what does one say when one is writing that prescription:

"This antibiotic doesn't work, and it may give you really unpleasant side effects, or actually harm you, but I don't care enough about your well-being to refuse your idiotic request."

?

@zebra

A modicum of verbiage that doesn't actually answer the issues I raised, opting instead to hand-wave them aside as irrelevant. I suppose that's one way to deal with inconvenient questions.

Your last example ignores all that. It is the same argument that says we should do screening tests on the entire population, at whatever cost, and whatever direct risk, and whatever risk and expense of treating false positives, because one person might be saved.

In what way is pointing out the problems of a person delaying treatment because of belief in nonsense the same as advocating that every person be screened for X disease/disorder no matter the cost? False comparison, there.

Anyway, Bob could just as easily die from an allergic reaction to wrongly prescribed antibiotics.

Oh, I'm sorry. I was using your infallible doctor who prescribes both medicine and nonsense honestly and doesn't make mistakes because of their superhuman awesomeness. I suppose I ought to have included that info in the scenario, though I took it as a granted, since it's your scenario.

If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.

Prove it. Run the numbers and show your work. If, overall, real medicine decreased while nonsense increased, what would the actual numbers be. Give us the concrete answer. I'm certain you must have it, since you're so sure of the answer that you've ignored and casually dismissed all of the issues that the rest of us have brought up. No dodging this, by bloviating about how our logical skills are wanting. Concrete numbers based on real data showing that the overall population would benefit by decreased real medicine and increased woo. Your calculations should include effects on patient perception (e.g., Bob's belief that ginger tea is just as good or better than real antibiotics).

So, yes, if I can get some portion of the students to lie about ginger tea instead of lying about antibiotics, I’ve done something that conventional medical **education** has consistently failed at.

This would only be true if no graduates of traditional medical education had ever recommended "ginger tea" (or as I prefer, rest and warm beverages) over antibiotics. To date, you've provided no evidence that this is so.

Teaching someone to lie - even if it's a little white lie - doesn't sound like something to brag about.

By Mephistopheles… (not verified) on 12 Jan 2015 #permalink

This is a discussion about policy– ‘global’ policy; it’s about the population of medical students, and the population of people who may be patients, and all the factors that may be involved.

Then I suggest that as a matter of 'global' policy it's a bad idea to waste both time and resources teaching mdeical students details of CAM therapies which are known not to represent effective medical interventions--apparently for no reason other than allowing them to understand them better when choosing to reject them--or to encourage doctors to deliberately mislead their patient's about the benefits of ginger tea instead of encouraging them to educate their patients about the reaons why it's inapporpriate to treat viral infections with antibiotics.

So, yes, if I can get some portion of the students to lie about ginger tea instead of lying about antibiotics, I’ve done something that conventional medical **education** has consistently failed at.

But you're instead advocating we get students to lie to theri patients about ginger tea rather than tell the truth about antibiotics (that they're no good for viral infections.

You really don't see the ethical problem with med schools encouraging theri graduates to lie--knowingly and deliberately--to the patients in their care?