Alright, alright already! I get the message.
Over the course of the day yesterday I was bombarded by e-mails with a link to a New York Times article that shows a rather shocking lack of understanding of the science—more specifically, the lack of science—behind alternative medicine. Whenever something like this happens and I get so many requests to address a specific article, I'm always torn between my natural contrariness, which tempted me not to touch this article with the proverbial ten foot cattle prod (although something about this needs a cattle prod applied to it) and my desire to give the people what they want. In this case, the latter won because the the article is by someone whom I've actually cited on this blog before, someone who "gets it," or so I thought. I'm referring to Aaron Carroll, a.k.a. The Incidental Economist, whose to whom I've referred in discussions of why cancer care is not worse in Europe than in the US and lead time bias.
It's always a shock when someone who seemed to "get it" turns out not to. Actually, that's not the way to put it. Clearly Carroll "gets it" when it comes to screening and cancer overtreatment. He also "gets it" about a lot of other things. However, when it comes to alternative medicine, he clearly doesn't and demonstrates it in an article entitled Labels Like ‘Alternative Medicine’ Don’t Matter. The Science Does. (It's reprinted here at Carroll's blog, but unfortunately the comments are closed.) Now, reading the title, you might wonder why I'm even bothering. The title, after all, says nothing that I haven't said myself many times, albeit not in quite that way. Indeed, one of my favorite sayings, cribbed from skeptics as varied as Richard Dawkins and Tim Minchin is that there is no such thing as alternative medicine. Alternative medicine that has been shown to work ceases to be "alternative" and becomes just "medicine." Personally, I use a version that goes something like this: There is no such thing as alternative medicine. There is medicine that has been shown to work scientifically; there is medicine that hasn't been shown to work; and there is medicine that has been shown not to work. So-called "alternative" medicine is made up almost exclusively of the latter two categories. Otherwise it wouldn't be "alternative."
You get the idea.
What apparently inspired Carroll's article were the recent news stories about a course in alternative medicine being taught by an antivaccine homeopath, who thought that appropriate curricular material included writings by Andrew Wakefield and other luminaries of the antivaccine movement, you know, the one that I complained so bitterly about. This leads Carroll to write:
The dichotomy, however, between alternative and traditional medicine, or between Eastern and Western medicine, is a false one. We would be much better off if we could reframe the issue.
People often think of Eastern or alternative medicine as more “natural.” Many feel that Western medicine is built around technology and products produced in a lab. They’re not entirely wrong. Many of the gains that have been made in traditional medicine have been the result of innovation in laboratories.
But that doesn’t mean that everything doctors are taught in medical school involves a drug or device. I talk to patients all the time about diet and exercise. I don’t do this because there’s a company making money off it. I do it because both of these things have been proven to be important for health.
OK, so far, so good. There's not much to disagree with here. Carroll just says what I've been saying in a different way, although I do take issue with his referring to "Eastern" or "alternative" medicine as somehow being more "natural." That is, in actuality, nonsense. Is it any more "natural" to grind up animal parts, as, for example, traditional Chinese medicine does, than it is to isolate purified components from plants, as modern pharmacology not infrequently does? Is it more "natural" to rely on a vitalistic system divorced from science and reality in which "imbalances" between the five elements (very much like the four humors in "Western" medicine) than it is to rely on natural science, as science-based medicine does? Only if your definition of "natural" is a bit constrained and artificial in which the laboratory is somehow "unnatural or artificial" while everything else is "natural."
That being said, Carroll is correct and makes a point that I've made many times about how diet and exercise are science-based medicine. Somehow, "alternative medicine," then "complementary and alternative medicine," and then "integrative medicine" have claimed these modalities as somehow "alternative" or outside of "mainstream medicine." They do this because these are modalities that can have value for many conditions. Lumping them in with the hard core quackery, like homeopathy, "energy medicine" (healing touch and reiki, for example), and acupuncture gives credence to the quackery by association.
Speaking of acupuncture, this is where Carroll goes off the rails. If only he stopped with what he wrote above. But he doesn't. First, he mentions that "not all medications get cooked up in a lab," mentioning folic acid for pregnant women to reduce the risk of major birth defects, vitamin C for the prevention of scurvy, and vitamin D for the prevention of rickets. Of course, the wag in me can't resist getting snarky and pointing out that most of these things actually are "cooked up in a lab," at least when administered as a supplement. There's nothing more "natural" about them than there is about Lipitor.
Unfortunately, acupuncture begins Carroll's downfall in this article:
There are many other forms of nontechnological medicine that have the weight of scrutiny behind them. In a meta-analysis published just a few years ago, researchers looked at all the accumulated randomized controlled trials examining how acupuncture fared in treating people with chronic pain. They found that not only did acupuncture work better than no-acupuncture control groups, but there were also significant differences between acupuncture and sham acupuncture. This suggests that not all of the benefits are placebo effects.
No, no, no, no, no, no! How can someone who is usually so spot-on most of the time get something like this so spectacularly wrong. Before I explain why, let me ask you a question. (Longtime regular readers have a good chance of knowing the answer to this one.) What is the study to which Carroll's link goes? Here's a hint: It's in the JAMA Archives of Internal Medicine. Give up? It's the meta-analysis by Andrew Vickers, a meta-analysis that was widely touted in the press as slam-dunk evidence that acupuncture "works," when in fact it showed nothing of the sort. I myself discussed why that is, particularly the part about how the purported effect size is well below the minimum clinically important detectable difference (MCID). In other words, Vickers' meta-analysis, despite the play it got in the press, did not show that acupuncture works better than placebo for chronic pain. Quite the contrary as Steve Novella, Mark Crislip, and I argued. To go into detail is beyond the scope of this post; so I leave the links for interested readers to peruse, along with the one article where, in the context of critiquing "integrative oncology," I also discussed how existing evidence does not support the efficacy of acupuncture for pretty much anything in the peer-reviewed medical literature in a high impact journal. The bottom line is that when you look at the totality of evidence for acupuncture, there is no convincing evidence that it is more than an elaborate placebo. How Carroll missed that, I don't know. One wonders if he even read the paper.
On the other hand, a lot of doctors were fooled by Vickers' meta-analysis. You really have to dive into the weeds of the exact methods to see its problems, and even then it's not easy.
On some level, Carroll and I seem to be saying the same thing. Elsewhere in his article, he points out how many drugs used by "conventional" medicine derive from natural products. Digitalis, for instance, comes from foxglove; quinine from cinchona bark; penicillin from bread mold; and aspirin from willow tree bark. This is nothing more than pharmacognosy, the branch of pharmacology that studies natural products for potential pharmacologic activity. Indeed, in the case of aspirin, it's not the substance isolated from the raw willow tree bark that is used, but rather a chemically modified version of it, acetylsalicylic, derived from the salicylic acid in the bark. He does this as a prelude to discussing all the herbs and plants used as "natural" alternative medicine.
There's a big problem, though. He's comparing apples and oranges. Carroll concedes that the reason that all the drugs mentioned above are so effective is because "conventional medicine may have improved our ability to purify these substances" (there's no "may have" about it), but then plunges into a false equivalence between modern natural product-derived pharmaceuticals, purified, standardized, packaged, and reliable, compared to a variety of natural medications
Butterbur, a plant extract, has been found in medical studies to be as effective as antihistamines in treating allergic rhinitis, without the sedating side effects conventional drugs often have. Horse chestnut seed extract appears to be safe and effective in the short-term treatment of chronic venous insufficiency. Peppermint oil can be used to relieve the symptoms of irritable bowel syndrome. I know of few physicians who promote these therapies as often as they do prescription or over-the-counter drugs. Granted, that could be because it’s potentially hard to be sure of supplements you’re buying, but there are ways to overcome those problems.
None of these studies are particularly impressive. The butterbur study, for instance, was a non-inferiority study comparing butterbur to Zyrtec (cetirizine) that concluded that butterbur was equivalent to Zyrtec. However, it's not as clear as that. For instance, a more recent randomized study, which, unlike the study referenced by Carroll, had a valid placebo control to compare to butterbur, found no difference between placebo and butterbur on allergic rhinitis symptoms. Another found a difference. Summing it all up, a systemic review from 2007 concluded that butterbur had some promise, but "independent replication is required before a firm conclusion can be drawn because of the financial support from the manufacturer of P hybridus extract to the 3 large trials." Carroll also forgot to mention that butterbur can cause severe liver toxicity. Indeed, in 2012 in the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) urged British herbal shops to remove products containing butterbur from their shelves. Oops! There' goes the "non-toxic" claim. Repeat after me: If an herbal medicine has actual, measurable effects on a symptom or disease, it is a drug, and if it is a drug it can cause toxicity along with its therapeutic effects.
Of course, the reason that butterbur has an effect on allergic rhinitis is because it contains substances that block the production of leukotrienes, key molecules modulating inflammation. Given that, one wonders why an extract of the plant would be better than isolating these molecules. The same is true of horse chestnut extract, whose evidence supporting its use in chronic venous insufficiency is stronger. Ditto peppermint oil. Ironically enough, the very problem with supplements recognized by Carroll are the same problems each of these "natural remedies" have. The way to overcome that problem? Apparently Carroll thinks that state attorney generals going after sellers of adulterated or mislabeled supplements is a model to overcome the problems with using herbal medicines like the ones described above.
Carroll quite correctly recognizes that the evidence for homeopathy is resoundingly negative. He also correctly recognizes that evidence doesn't matter to its proponents. Disappointingly, this leads Carroll to a painful-to-read false equivalence:
Those who favor conventional medicine, though, can be just as blinded. Too often, when confronted with evidence that advanced technology might not be providing benefits, the medical community refuses to change its behavior. My Upshot articles are littered with examples of this, including potentially too-widespread mammography screening, advanced life support and many surgical procedures. Supporters of Western medicine are often blind to their own prejudices.
As I've conceded more times than I can remember, yes, physicians can be frustratingly slow to change in the face of new evidence. Indeed, from time to time I've repeated a joke I first heard from faculty in medical school that outmoded treatments never truly go away until the physicians who learned them during their training either retire or die off. That's a bit of an exaggeration, of course. As a counterpoint, I can point to my own specialty of breast cancer surgery and note that the way I approach breast cancer surgery now is strikingly different from the way I learned to approach it during my residency and fellowship in the 1990s. Practice has changed enormously since then based on science and clinical trials. I'm sure other physicians in other specialties can report the same thing. In other words, in medicine, change is the rule, not the exception. It is true that there are holdouts that resist evidence (such as vertebroplasty for osteoporotic compression fractures of the spine). Some even lash out at those who produce evidence that goes against their orthodoxy.
Here's the difference, though. In science-based medicine, science and evidence eventually win out. Practice changes in response. The process might be messier than we like, meet more resistance than might be reasonable, and take longer than one would like, but in time practice does change. It really does. Contrast that to homeopaths and other alternative medicine practitioners, who are completely impervious to evidence. Yes, we practitioners of science-based medicine do all too often resist new evidence, but eventually we are forced to capitulate because science and reality compel us. That's because our practice is rooted in science. Therefore, we speak and think in scientific terms. We justify our treatments with science. If science turns against a treatment we cannot resist indefinitely. Contrast this to alternative medicine practitioners, whose practices are rooted in magic, fantasy, and prescientific vitalism. Let's just put it this way. When your entire practice is rooted in pseudoscience and unreality, science and reality have a hard time breaking through.
It's a shame that Carroll doesn't seem to understand that.
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On a herbalism forum I frequent, I used to suggest that allergic rhinitis patients check out butterbur. Not any more.
Like you say, he got some things correct, but plenty wrong. Apparently, the NY Times no longer has a budget for fact-checkers. For chipping at the proverbial 'Berlin wall' erected in the concept of "alternative medicine", he deserves applause, but then it goes horribly astray.
In telling readers that aspirin comes from willow bark and penicillin from moldy bread, IMO, he gets failing marks. Perhaps he thought it too technical to point out that salicylic acid derived from willow bark was subjected to acetylation to produce aspirin, or that the production of penicillin as a medicine required the isolation of suitable strains of fungi, none of which were obtained as molds growing on bread.
But what really burned my beets is that he so much as cited the investigation of the NY Attorney General's office. Not as entertaining as Inspector Clouseau, but attempting to find matching plant DNA in herbal products manufactured by extraction with alcohol still has some scratching their heads. As useful as DNA-matching can be in confirming the identity of raw materials, none of the herbal products failed when checked by routine means of identification, such as HPLC, or when the raw materials used in their manufacture were examined for matching DNA.
In bringing the conversation to the mainstream via the NY Times, he may well become extensively cited, which is another of saying the fusterclucking from quacks is bound to grow loud. If herbal products are de facto medicines – no 'alt' about it – they must be drugs.
Re. hospitals etc. branding diet & exercise as alt med:
The going hypothesis here is that this is being done to give alt med an aura (heh) of respectability, thereby luring uninformed patients into the quagmire of quackery.
But what about this: Could it be (instead of, or also) the reverse? Luring patients who are favorable to alt med, to get them into a place where they can be convinced to use science-based medicine. Is there any evidence to indicate that this is going on? And/or, is there any way to know which is the case for any given institution?
People often think of Eastern or alternative medicine as more “natural.” Many feel that Western medicine is built around technology and products produced in a lab.
TBF, Carroll is accurately reporting popular perceptions of Eastern/alternative vs. Western medicine, but there is no basis in fact for those perceptions. Consider what it would take to manufacture homeopathic remedies. You need an ample supply of distilled water. Either you are buying it from a more or less reputable lab supply company, or you are making it yourself, and the latter requires a setup at least as good as what the makers of [insert your favorite >50 proof beverage here] use. Then you use that distilled water to subject your alleged active ingredient to serial 10- or 100-fold dilutions. You couldn't do that with the sort of kiddie chemistry sets they sold when we were kids, let alone the vastly scaled back versions of them that are sold today. OK, you don't have to regulate the process as tightly as manufacturers of Western pharmaceuticals do, but you still need something a bit more sophisticated than a typical meth lab, and you may have to persuade (likely with the help of a lawyer) the local constabulary that you aren't producing the latter.
@Gray Squirrel #3
I recall conversations to that effect from the late 1990s. Back then, it was more a germ of an idea. One day, if the popularity of alternative medicine continued to grow, offering courses in the subject would attract students who, in turn, could be brought to realize the lack of evidence in support of alt med; however, the same conversation was going on at the opposite pole: if the popularity of alt med continued to grow, it might lead to greater acceptance among practitioners of "conventional medicine", thereby increasing the market share. I think that what we have today is more about the mainstream popularity and translating that into profits, whether from enrolling students or offering alt med in hospitals.
Regardless its need for clean water and lactose, homeopathy is a Western tradition, just as herbalism in the European tradition. By allowing the public to assume that so-called alt med can be boiled down to West versus East, he only muddies the already murky perceptions of the general public as to what it's all about.
Excellent point. I always like to say that homeopathy is "Western medicine" because it was invented in Germany. I also like to point out, as I did in the post, the similarities between the "five elements" in TCM and the four humors in what I like to call "ancient Western medicine." :-)
The potential toxicity of herbal remedies vs. purified compounds is excellently illustrated with butterbur. The antiinflammatory sesquiterpenes in butterbur have very little hepatotoxicity at the commonly used dosages. But as the plant is part of the Tussilago/Senecio-assembly of the composite flowers, the herb also contain rather substantial amounts of pyrrolizidines - wellknown as potential initiators of hepatic cancers and inflammation. I think there is still an antiallergy pill containing sesquiterpenes from butterbur in Japan - produced by extraction, purification, measuring and equal dosing in each tablet just as a drug should...
In my experience, the people around me who are prefer natural vs artificial don't see labs as alien to the planet, it's that their paradigm is similar to what is taught nutritionally about things such as white bread and white rice.
We have a plant with nutrients that have been stripped out for commercial reasons. However, after stripping out everything we lost the vitamins and have to put them back in. But, we also don't know exactly what else was lost in addition to these few vitamins so it is best to eat whole grains and brown rice.
They believe, rightly or wrongly, that the whole plant synergistically (natural) is better than the one chemical extracted (artificial) from it. Of course, they don't have a lot to say when I mention that in extracting the one chemical this allows the dose to be standardized and in some cases it removes poisons or allergens.
Yes, what you said; we cross-posted. I only wanted to add that many people have a very hard time seeing anything of the earth as poisonous outside of a few mushrooms, and in some cases, I am not even sure of that.
It reminds me of a conversation with a friend when he told me that wherever people live, the environment provides what they need to survive; there is no need for processed anything. The conversation stopped when I asked him where he planned to find Vit C in the wintertime (which isn't even the best example but I'm not well-versed on geographically malnourished populations).
in extracting the one chemical
Or synthesizing it. Chemistry only cares what the molecule is; the provenance is irrelevant.
The difference between processing a grain to produce a commercially desired food product and processing a plant to produce a pharmaceutically active substance is that in the first case, the manufacturers either don't know or don't care what they are throwing away. (Probably the latter, since whole grains and brown rice are known to be much higher in fiber content than processed grains and white rice.) In the latter case, they have good reasons for discarding what isn't the desired product: some of it is toxic. For that matter, some foods can be toxic if not handled properly. There is a reason sushi chefs in Japan must have a special license to prepare fugu.
Or vitamin D in northern latitudes, especially for the less pale among us. I'd rather take capsules than swallow fish oil every day, to be honest.
^ Sorry, cod liver oil more specifically, I think. "Fish oil" was a literal translation from the Russian.
The conversation stopped when I asked him where he planned to find Vit C in the wintertime
Many cultures (among them the Inuit, Sami, and Yakut) have solved that problem in various ways. (Vegetables, even canned, would have been scarce or even nonexistent in the days before the Twin Otter.) The real issue is that many of the natural sources don't scale up to modern population sizes. You need to have storage and preservation techniques, or else you can't support a town the size of the one I live in (1X,XXX), let alone a megacity like Tokyo or São Paulo. Of course there is a legitimate question as to whether it is desirable to have a world human population in excess of seven billion, but I don't want to get into that here.
Science, or engineering, which is what the practice of medicine really is, requires us to be able to think qualitatively or "approximately" before we start talking about very specific numbers. Here's a quote from one of Orac's posts Orac references:
Consider two groups of patients.
One group receives stents as described.
The other group receives "integrated" treatment, using medical management with a correctly constituted homeopathic supplement.
Which approach has the greatest potential for physical and economic harm? I don't think we need no stinkin' study to answer that.
So, when Orac says
...what question is he answering?
This is an almost childish, petulant response to Carroll's well-articulated and not very controversial proposition. "We may keep doing harm for a long time, but eventually we change, unlike those other people who don't do much harm at all, but, but, but..... woo." There it is again.
And why not leave out the homeopathy entirely?
"What is a significant difference between science based medicine and many 'alternative' medicines?" In the case of your homeopathic treatment, the homeopaths will with great seriousness talk about how well it works (and therefore, why they should be paid) without regard for actual effectiveness.
Maybe facts are of no interest to you.
THANK YOU for talking about this, Orac! I thought I was going crazy reading the article, which is why I had to send it to you. Dr. Carrol produces so much good content, when he lays out a stinker like this it annoys me even more. He's also one to buy into the new herbalism of cannabis as miracle cure.
Did you notice the quick reference to moxibustion being effective for reducing breech birth? The link provided finds that the reduction AT BIRTH barely approaches significance (p=0.02 in an unblinded trial), with a 95% confidence interval from [1.02--1.43]. If burning dried mugwort next to your small toe has to be considered as a viable treatment for breech birth, I think I'm done with this whole science and research profession.
Overall, it wasn't just the content of the article that bothered me, nor was it the unexamined presentation of low-quality evidence in support of alt-med, it was the really, really poor quality of the writing and constant references to informal fallacies like the appeal to antiquity and appeal to nature.
Yes, he's answering that question with what I said:
“We may keep doing harm for a long time, but eventually we change, unlike those other people who don’t do much harm at all, but, but, but….. woo.”
In both cases, the practitioners will tell you how valuable and superior their approach is, and defend their practice. Yes, the "significant difference" is that one approach is dangerous and expensive, and the other is cheap and harmless even if silly.
Yeah, I noticed it. It was probably exhaustion last night that kept me from mentioning it, particularly after I had discussed the butterbur and how Carroll completely neglected to mention the liver toxicity issue, as well as how he had been completely taken in by the Vickers meta-analysis. I probably should have thrown a sentence or two in there. Maybe I'll add them later.
The other group receives “integrated” treatment, using medical management with a correctly constituted homeopathic supplement.
If it is water, why does it need to be correctly constituted?
How is the fact that if the stents weren't tested rigorously enough or that time was needed to confirm outcomes have anything to do with homeopathic supplement.s that have been tested for hundreds of years and found lacking? Mephistopheles has is correct, why bother.
Science/medicine makes mistakes but I don't t know why you keep wanting to introduce a known mistake into the equation.
And, to add to Carroll's misapplied herbal treatments. Peppermint is an irritant of the upper digestive tract when taken in clinically significant amounts at clinically significant frequency. It is also broken down to a degree in the stomach and small intestine - which is why clinical formulations for the treatment of IBS are set in a semi resistent shell that delays break down to maximise release close to its point of greatest effect - the lower end of the digestive tract.
One thing about this blog is that it helps put things in perspective.
I've been worried by all the news reports about spreading opioid addiction, and consequent heroin use, and overdosing, but now I see that this is being hyped as part of the Homeopathic Lifestyle Agenda.
What I really need to panic over is The Scourge Of Butterbur Toxicity, not to mention Peppermint Pattie Consumption Syndrome. Yep, that's what's eating up healthcare dollars and clogging the ER. Without this stuff-- and the horse-chestnuts and all-- we would certainly be getting much better care.
Really zebra, human kind should only be concerned about one thing at a time and all others not part of the one true problem that is the only one anyone may discuss shall be completely ignored and allowed to do as they will until such time as they finally make it to the top of the list ? (or top three or whatever arbitrary cut off works for the striped)
Doesn't matter where your passion is, what your preferences are, where your talent lies, only this problem, or these three problems are your theme for every single utterance of any kind?
Sure there are other problems, but these people get a pass to do whatever damage they want since well there is that over there effecting those people.
Maybe there's a homeopathic cure for addiction we should be trying? Of course, that homeopathic cure for addiction might itself be addictive! Pretty soon, we'd have people strung out in the alleys, begging passers by for enough change to buy some Dasani.
I'm hoping there's a homeopathic cure for being a jerk. If like cures like.... Hey, on an unrelated note, can I have one of your eyelashes?
I have a question for you. What would it take to change your mind?
In some webcomic (cannot remember which one), one character is wisely pointing that, because you are helping cleaning a toxic chemical dump next to your city, you don't stop cleaning the litter around your home.
(I believe this webcomic was published no long after the "dear muslima" letter's antics).
That, or unbeknownst to us and our host, there is a bevy of opium addicts reading Respectful Insolence between two chemically-induced trips, and thus Orac has the moral obligation to make a post entitled "Drugs: Just say No."
If Z is so concerned about drug abuse, maybe Orac is not the doctor Z should be yelling at.
The conversation stopped when I asked him where he planned to find Vit C in the wintertime
It has the added benefit of reducing the spread of disease by cutting down on person to person contact.
If the active component of butterbur is a leukotriene receptor antagonist, this has its own potential for side effects even if purified from the hepatotoxic plant constituents. A subset of the population reacts to leukotriene receptor antagonists, such as montelukast, with severe depression.
This has been documented since 2008.
tl;dr version: Some people react to drugs similar to butterbur with severe depression. If butterbur or its extract aren't labeled properly, people sensitive to the other drugs may assume the herbal preparations are safe for them.
Speaking of sustenance from what can be produced locally, Mr Woo is sure we can "grow our own" as far as 99% of fruits and vegetables starting next spring. Once again the tin foil hat brigade is sounding the alarm of economic cataclysm next month and All Will Be Lost. Someone needs to teach me how to insert a little TM symbol. I got lazy a decade or more ago when word processors would turn (TM) into it...
I am grateful that Orac always acknowledges that medicine can drag its feet when confronted by scientific evidence it isn't totally happy with. One of my favorite things about his Insolence is that he tries very hard to be balanced and honest.
Well, we have an extensive vegetable garden, but I would hate to limit my diet to only what we could grow. For starters I'd hate to do without coffee, sugar, citrus fruits and wheat.
Did they test whether burning mugwort next to the big toe had the effect? The elbow? The ear? I'm trying to imagine how they think this works. The fumes have some physiological effect, in which case why burn the stuff next to the toe instead of the nose? The woman pulls her foot away before her little toesies get burned, and that disturbs the fetus enough to make it shape up and turn the right way? Or is it just plain magic?
the people around me who are prefer natural vs artificial don’t see labs as alien to the planet
Labs? Those big goofy brown dogs? The ones I've met certainly don't act like natives, always bouncing around going Gosh! Look at that!
Oh my gosh, a ball, my favorite thing! Oh, oh, a walk, oh, my favorite thing! Oh my gosh, oh my gosh, you came home, I thought you left me forever, this is my favorite thing!
A squirrel! We don't have those on my home planet!
I was dogsitting a greyhound over the weekend, and will be doing so all next week, or the week after, I don't remember. The "chasing things" instinct is strong in those dogs, let me tell you. The spotting of any small mammal invariably results in a tug of war of "come ON, already, I'm not letting you get the squirrel," repeated several times, with eventual sulky acquiescence.
What an outstanding example of Synergy, the complementary interaction of different substances from the same plant that the quacks are always babbling about. I'm going to remember that one.
We used to have a running gag about the Homeopathic Bar: fill the stadium with drunks on less than a pint of cheap hooch.
Mr Woo is sure we can “grow our own” as far as 99% of fruits and vegetables starting next spring.
There are good reasons for preferring locally produced foods, but it's not as easy as it looks. I planted several blueberry bushes in my yard a few years ago, the yield from which has been underwhelming. I've thought of trying to put in a vegetable garden next spring, but I don't know how that will turn out--it might be a bust or it might work too well. In the meantime, I patronize the weekly farmers' market in my town, and occasionally partake of some of our local wines. The wines are varietals you've probably never heard of--most if not all of the common varietals can't take Zone 5 winters--but there are some decent whites out there (the reds are more hit and miss).
As for your other question: ™ gives you ™. Here is a list of HTML entities which also includes accented Latin characters (East European as well as West European), Greek, Cyrillic, and an extensive collection of mathematical symbols.
Re.Mephistopheles O'Brien @ 16: (paraphrase) "Why not just leave out the (magic water) entirely?" Yeah, I had the same question.
One might argue that some patients would be more likely to take their real medicine if they're told they're "special" and they're getting some "special" homeopathy to go along with their medicine.
Problem with that is, some of those patients might think that the magic water is the real deal, and stop taking their pills. For a while they might feel just fine, and not make the connection when they have heart symptoms later.
One can go down the psychology trail about how to motivate patients, but in the end, second-guessing their beliefs has serious risks, so the conclusion is convergent: Leave out the cr@p entirely, and spend the time explaining to the patient how their real medicine works, so they understand why they should be taking it as directed.
The spotting of any small mammal invariably results in a tug of war of “come ON, already, I’m not letting you get the squirrel,”
At least it's not a German shepherd (or even two German shepherds in conjunction with a very fat and obnoxious Persian that used to live across the street, which resulted in me being pulled completely off my feet and dragged down the sidewalk. That cat had it in for me, I swear).
I think the chipmunks had it in for us. Mom would let little bred to hunt vermin dog out once in awhile to chase the squirrels but she liked the chipmunk.
I swear the chipmunk would sit at the patio window just to watch the little dog completely lose it. Little vermin hunting dogs are quite yappy when letting you know there is some vermin about that is not scared at all of the noise on the other side of the glass that will never be released.
I swear the chipmunk kept egging little vermin hunting dog on. Rabid animals have more composure than that dog had when the chipmunk didn't care.
My sleep-deprived brain somehow read that as "Homeopathic Bra" - the less fabric the more modesty I guess?
My doxie is just recovering from three weeks of pain killers, muscle relaxants and steroids, having aggravated her disc disease by doing her best to dig in very dry, hard soil for ground squirrels (aka chipmunks). I have buckets with planks for them to walk. Several so far.
When I young we had a black Lab as a family pet. I don't see them around much anymore. I don't know if they've been leaving the planet or are all becoming Labradoodles,
Come to think of it, I don't see squirrels around much anymore either. It must be a conspiracy.
Heh. One of the first things my now eldest cat (whom I bottle-raised) did upon moving in with my then ladyfriend in Iowa was to snag a chipmunk and let it escape to under the fridge.
Let's just say that they're too big to simply dry out post mortem.
Well that is one way to cover up any old scents left behind with new scents.
Brings back memories of trying to figure out why there was some deterioration of the foam padding and a horrendous stench coming from one of our equipment boxes we used for field studies the first time we came back with that box from the field. Turns out fields have field mice and one came back with us only to become dearly departed in the box.
There is one condition, and one only, that acupuncture can treat (though not cure): belonophilia. I doubt, however, that there can possibly be enough patients to make it a paying proposition for so many acupuncturists.
KayMarie -- that brings back memories of when we had our basement redone. We rented a portable storage unit to put our stuff in while the basement was worked on. When we pulled stuff back out, we found that a mouse had gotten into one of the boxes. Trapped in the storage container in the hot summer sun, it had not only died, it had mummifed.
I have learned a new word from Old Rockin' Dave.
Ack. So I had to look it up too. I've also learned a new word, and kind of wish I hadn't....
Would it actually treat that condition, though, or encourage it? :-P
If the needles are inserted by a *therapist* they are axiomatically *treatment*. The fact that the patient keeps coming back for more treatment proves that the treatment is keeping the patient healthy.
*cringe* You're making me think like an altie, and it hurts!
In a good way or a bad way? Will you be seeking out the good doktor's services again?
TMI, no? They should be keeping that between themselves.
I have learned a new word from Old Rockin’ Dave.
Me too, and I wish I hadn't.
Woo treatments not just for humans...
Thank you so much for this article-- it is the first of yours that I have read, and it will not be the last. I can't tell you how difficult it is (though you probably already know) to find an article written by someone who has done thorough research.
I don't mind reading about alternative medicines and other such things. I like to know the ideas that are out there, of course. However, I also love questioning things.
As a layman, it takes a lot of effort for me to do my due diligence when it comes to such articles. It is difficult for me to analyze data properly, so when such an article cites a scientific study, I can't always tell if the study actually supports the claims.
I really can't tell you how much I appreciate the work you're doing so that, basically, I don't have to. It's awesome.