I didn't think I'd be writing about acupuncture again so soon after deconstructing another "bait and switch" acupuncture study less than a week ago. True, the quackery that is acupuncture and the seemingly unending varieties of low quality studies published to make it seem as though there is anything more than nonspecific placebo effects invoked by sticking needles into the skin against an even more unending variety of diseases, conditions, and complaints. Basically, according to its adherents, acupuncture can treat almost anything. Particularly galling to me as a cancer surgeon is the emerging specialty of "integrative" oncology, which gleefully "integrates" many forms of quackery with science-based oncology, so much so that major cancer meetings feature it and there is even a Society of Integrative Oncology, which promulgates allegedly "evidence-based" guidelines for breast cancer "complementary" treatment. It's not for nothing that I published a critique of this growing "integration" of pseudoscience with science-based medicine.
All of this explains why I was particularly irritated when, while watching local Detroit news, I saw this story:
Yes, it's a human interest story about a woman named Jennifer Tesler with breast cancer and how she used acupuncture to help with the symptoms associated with chemotherapy. It might as well be a commercial for the "holistic health center" where Ms. Tesler received her acupuncture treatment. There was another odd thing about this story. Normally, when I see commercials for woo masquerading as news reports, they are usually for local quacks. And so this seemed to be at first, as though Ms. Tesler was a Detroit area woman. However, as the story proceeds, we learned that Ms. Tesler must live in the Atlanta area, as she sought out acupuncture at the Atlanta Center for Holistic and Integrative Medicine from a physician named Dr. Taz Bhatia, who is advertised on her website as a "Physician, Best-Selling Author, International Lecturer, Acupuncturist, Certified Nutritionist, Prevention/Wellness Expert, Mom and Wife." Before we get to "Dr. Taz," let's go back to the news report that looked like a local news report but wasn't. Indeed, if I hadn't been paying attention, I might very well have missed that Dr. Taz is based in Atlanta, not Detroit.
First, we meet Ms. Tasler relating the story of how sick she felt after her chemotherapy, so much so that there were times when she felt that she couldn't even get up. I know what she's talking about. I've heard stories from my own patients. Some women seem able to fly through chemotherapy with relatively few side effects, but some women react very badly, suffering severe side effects from breast cancer chemotherapy, including nausea, hair loss, peripheral neuropathy, and more. Although anti-emetics (anti-nausea) medication has improved considerably since my career started, for some women they are not enough. Not surprisingly, acupuncturists claim they can help these symptoms, despite a paucity of evidence that I've documented both here and in my Nature Reviews Cancer paper. In any case, after suffering extreme nausea, she believes acupuncture helped her:
TESLER: “I was really sick. My children spent many nights sleeping on the bathroom floor with me the whole night because I just couldn’t get up.”
NARRATOR: She found doing acupuncture before each chemo treatment was the key to relieving the symptoms that made it unbearable.
Enter Dr. Taz:
DR. BHATIA: “We don’t want to throw away all the beauty of conventional medicine. But at the same time, we don’t need to throw away thousands of years of older systems of medicine that had techniques and strategies that helped make people better. So, a marriage of the two is perfect and it really makes for great care.”
NARRATOR: Doctor Taz breaks healing into three phases:
In phase one, acupuncture helps to manage side-effects during chemotherapy, like the nausea. Then it helps balance the nervous system and reduce the pain and issues that arise post-treatment. In phase three, acupuncture minimizes stress and inflammation to keep cancer at bay.
This is, of course, utter nonsense. There is no evidence whatsoever of even mildly reasonable quality that acupuncture can do anything to keep cancer at bay. The reason, of course, is that that's a hard outcome. Either the cancer has recurred or it hasn't. Given that acupuncture is a theatrical placebo, It's not at all surprising that it has no effect on outcomes like cancer recurrence and survival.
I also noted that while Dr. Bhatia was talking the images shown were of her looking at graphs on a computer screen, the implication being that she's looking at some sort of modern, scientific test and discussing it with a patient. The message, of course, is that Dr. Bhatia is no quack. Oh, no! She's a doctor using the very best of modern, science-based medicine, but she combines it with "thousands of years of older systems of medicine." Of course, I cannot help but point out yet again, as I do whenever I see acupuncturists using the fallacy known as the appeal to antiquity that implies that because something is ancient and has been used a long time there must be something to it, that acupuncture as we know it is not ancient. In reality, it evolved from primitive bloodletting, not unlike the bloodletting practiced in the West. Think about it this way. Advocates frequently claim that acupuncture is thousands of years old, but the technology to make such exceedingly thin needles didn't exist. In fact, the entire history of acupuncture, including its supposedly ancient origins, was retconned by no less a figure than Chairman Mao Zedong himself after World War II. Indeed, arguably Mao was the very first advocate of "integrative medicine," having proposed the "integration" of traditional Chinese medicine with "Western medicine" decades before our own homegrown doctors enamored of pseudoscience thought of it.
But who is Dr. Taz Bhatia, and how did this minute and a half infomercial for her "holistic" practice in Atlanta come to be? I can't answer the second question, but I can make educated guesses. A quick Googling of Jennifer Tesler, along with breast cancer and acupuncture, quickly revealed the source of this story: CNN, with Martha Shade reporting. The story appears to have been distributed for use by local news stations that have time to fill. It makes sense in that light that Ms. Tesler apparently lives in the Atlanta area. It makes even more sense in light of this:
With an established agenda of improving women’s and children’s health, Dr. Taz expanded her reach through media in 2003. Since then, she has served as a medical expert for CNN Headline News, a Dr. Oz Sharecare expert, columnist and contributing editor for Prevention Magazine and been featured on numerous media outlets, including TODAY, Access Hollywood, Good Morning America, The Weather Channel, EXTRA!, Live with Kelly and Michael and the Meredith Vieira Show. As an associate professor at Emory University and former spokeswoman for the American Academy of Pediatrics, Dr. Taz MD continues to bring attention to the frequently ignored health issues of women and children.
So she's a quackademic and a Dr. Oz wannabe every bit as steeped in pseudoscience as the Master who periodically freelances for CNN. I wonder who pitched the story idea to Ms. Shade. Be that as it may, she comes to the job with a "conversion" story that reminds me, more than anything else, of those of The Food Babe and Mike Adams, both of whom related a story of being chronically ill at a young age and both of whom claim to have reversed it by a radical lifestyle change, chock full of woo, of course:
So what services does Dr. Bhatia offer to bring her patients to "whole health"? It's a veritable cornucopia of quackery. Homeopathy? Check. Acupuncture? Check. (Obviously.) IV vitamin therapy? Check. Oh, and of course Dr. Bhatia offers thermograms. She even offers mobile thermograms. Never mind that thermography remains an unvalidated test for the early detection of breast cancer, much less for all the other conditions for which Dr. Bhatia recommends it, such as arthritis, fibromyalgia, back injuries, digestive disorders, "and more..."
I also think I know what those graphs on the computer screen that Dr. Bhatia was explaining to her patient was in the news story, Biopulsar-Ayurvedic Bioenergetic Screening:
Real time energetic information throughout the body can be measured through the Biopulsar system. The Biopulsar scan is non-invasive, and measures the pulse frequency of your organ systems via reflex zones (similar to acupuncture points).
These measurements help us visually see each organ’s vitality or life force on a screen. Biopulsar measures the vitality of 49 organs and glands, including the complete brain. The technology incorporates the sciences of thermography, EEG, EKG, neuroscience, reflex zone therapy and pulse diagnostics. This is a revolutionary energy diagnostic system that gives us a snapshot of a patient’s present condition combined with his or her history.
The Biopulsar also gives us the ability to look at the organ systems and apply concepts from multiple systems of medicine, including conventional, Ayurvedic, Chinese, and naturopathic medicine. We use this tool to provide you with an Ayurvedic diagnosis. Repeated scans can be used for biofeedback to determine the effectiveness of medications, dietary interventions, or supplements.
Hmmm. This reminds me very much of Bill Nelson's EPFX/Quantum Xrroid Consciousness Interface (EPFX/QXCI). It really, really does. If you don't believe me, go back and read for yourself what this interface involves. True, the computer interface of Dr. Bhatia's software doesn't look as eye-meltingly psychedelically painful as that of the EPFX/QXCI. (Maybe new programmers worked on the application.) It's also under a different name. In any case, whether it's a competing product or an "evolution" of the EPFX/QXCI, the Biopulsar-Ayurvedic Bioenergetic Screening sure does strongly remind me of the EPFX/QXCI.
Quacks sure do love their bioresonance, don't they?
The depressing thing about this story goes beyond the sheer credulousness of a CNN reporter and the local news team at WDIV Detroit. What's depressing is that Dr. Bhatia is not only apparently a respected physician but an advisor to CNN and multiple media outlets. For every Dr. Oz who is nationally syndicated and can reach several million viewers a day, there are all sorts of Dr. Bhatias out there, spreading the same message.
Since then, she has served as a medical expert for CNN Headline News, a Dr. Oz Sharecare expert, columnist and contributing editor for Prevention Magazine and been featured on numerous media outlets....
"Having your taste criticized by Dorothy Kilgallen is like having your clothes criticized by Emmett Kelly."
This post makes me look at some "biopulsar" commercial. Well, that was funny. The most funny part was the price.
(French commercial) stated price spreading from 45 euros to 87 euros (you may want to add magnet therapy to this, helping diagnosis for a hefty 30 euros).
I liked the disclaimer in the commercial : this is not a diagnosis, only a MD are able to give you a diagnosis BUT whatever, energetic dignosis sounds cool.
In a nutshell : This surely wont help you at all, but your money will surely help us.
those graphs on the computer screen that Dr. Bhatia was explaining to her patient
I am SHOCKED to find clouds of hi-tech bafflegab coming from a needle grifter.
I am waiting for the next paper presenting curietherapie with needles as acupuncture.
Yup- it's perfectly fine to mislead a patient if you're trying to relieve symptoms of cancer, rather than cure their cancer- as Dr. Mark Crislip was informed by the staff of Memorial Sloan Kettering last week: https://www.mskcc.org/blog/truth-behind-three-natural-cures
"Biopulsar"? I don't think you want to get anywhere near a real pulsar. Although a hundred-million Tesla magnetic field would make for hella resolution in an MRI, the gravity 10 biliion times as large as earth would be, uh, problematic. Oh, and the gamma rays, too. Wouldn't want those.
And HDB, thanks for reminding me of the wonderful word "bafflegab". I should use it more often.
She's also anti-vaccine, too: http://doctortaz.com/pediatric-wellness/dr-taz-md-wellness-solutions-ba… . She is board-certified, but not in oncology or internal medicine. She is board-certified in pediatrics
Bhatia is probably one of the worst results yet of Andrew Weil's "fellowship program" at the University of Arizona. She's equally offensive to you, Orac for doing things in oncology she has no reason to be doing and she clearly stinks up pediatrics as well, raising my hackles. She has two other physicians with her--one is internal medicine and has already done Weil's "program" while the other is a family physician who is doing the fellowship online. It is deeply worrisome if physicians can now do Weil's fellowship without at least having to move to Tucson for a few years. WTH kind of fellowship is that?
I despise this lot of MD quacks wholeheartedly. They get a foot in the door so they can shove a boat load of manure into their "practice" and coat if with the veneer of their "training".
My medical tricorder doesn't have an acupuncture setting, I think it's broken.
WTH kind of fellowship is that?
Indeed. If it doesn't involve a trek through dangerous territory to throw a ring into Mount Doom in the company of sturdy - but flawed - comrades while avoiding Nazgûl at every turn, then what kind of fellowship is it?
@palindrom: As you know better than I, lots of wannabe doctors can't handle physics. So it's not exactly surprising that some snake oil salesman with a medical degree and a case of physics envy would not think her analogies through.
The Biopulsar also gives us the ability to look at the organ systems and apply concepts from multiple systems of medicine, including conventional, Ayurvedic, Chinese, and naturopathic medicine.
And now we are getting into Ron Popeil territory here. I'm half expecting somebody to tell me that this "Biopulsar" slices! Dices! Even does a ripple cut!
Eric @10 -- Actually, many of the premeds I see these days aren't too bad with physics. And when I see a particularly good doctor and tell them what I do, they often perk up and say they really liked physics back in college. And fortunately, our local med school/teaching hospital seems to have avoided all traces of quackademia and woo -- so far (knock on Formica).
Curiously, Ron Popeil's half-sister is the highly respected vocalist and voice coach Lisa Popeil. Showmanship runs in the family, though -- according to Wiki, she performed in her underwear in a Frank Zappa show doing the sprechstimme piece "The Dangerous Kitchen" and a song called "Teenage Prostitute" in full-on operatic style.
We now return you to your regularly scheduled programming.
Hickie #7: WTF is up with anti-vaccine pediatricians? I wish I believed in a hell with a special place for them, really.
And it's nice to know that someone anti-vaccine is dealing with immunosuppressed cancer patients.
The Biopulsar sounds like a Listen Device with a fresh coat of paint.
And now we are getting into Ron Popeil territory here. I’m half expecting somebody to tell me that this “Biopulsar” slices! Dices! Even does a ripple cut!
With the exception that Popeil's gimmicks did more or less what he claimed they did.
I vague;y remember some other TV news item on woo-things linked here or SBM turned out to also be from a unidentified syndicated feed — making it look like the reporter and subject were local when they weren't. These pieces are created for this purpose, otherwise they'd have some local identifiers ("a Detroit woman..."). IIRC the other one I recall was about dog acupuncture (??).
For some time, newspapers have been cutting local staff, and pulling as these can off various wire and syndication services, so it's no surprise local TV news would do the same with human interest features. What is odd is woo being among the apparent go-to topics. It's possible some PTB has a woo-genda, but I doubt it. More likely, some news consultant has focus-group-tested a wide variety of topics and 'tropes' for these 'human-interest' fillers, and discovered that these stories are among the most effective methods of drawing a key demographic to the news broadcasts. 'Hard news' is pretty gendered, so I'd guess these stories have been chosen to appeal to a largely female audience: the folks who've watched Oprah, Oz, Dr. Phil etc. during the day. TV is very corporate, and news shows are big revenue producers for local stations, since they get to sell all the ad time. The ad rates are all based on the latest book, so the stations are highly competitive for ratings and demographics and they'd run anything that was cost effective in pulling numbers and demographics (i.e. this is actually on the lower end of the embarassment scale...)
My guess then is it's not that Martha Shade, or the news director at WDIV who pulled this piece from the available pool of syndicated stuff are genuinely credulous — they just couldn't care less about this material beyond its marketability.
The person who pitched this piece to CNN is probably Bhatia herself. She doesn't seem to have appeared on CNN or HLN much lately, so I'd guess they're not trying to promote her into the next Oz, or ringing her up with 'what do you have for us?' queries. SHE may want to be the next Oz, but I don't think she's found a big-time backer yet.
She does have some fine natural food woo going on her site though, and a book for sale:
The 21-Day Belly Fix
Fix Your Belly, Find Your Health
...a groundbreaking 21-day eating plan to shed pounds, accelerate metabolism, balance your digestive system, improve gut function, and feel better every day – without dieting.
Tasneem Bhatia does not show up in the Emory faculty directory, nor does Emory appear to even have a program in "Preventive/Integrative Medicine". The med school department is called 'Family and Preventive Medicine." A couple faculty there do identify themselves as expert in "integrative medicine", but the only hits Google returns for 'Taz Tasneem Bhatia + Emory' are pages with her bio. Emory is not listed as a current or former employer on her Linked-In page, which does list Orac's old pal Dr. David Katz as an "influencer".
As for the acupuncture-for-chemo, I've certainly seen worse. "Minimizes stress and inflammation to keep cancer at bay," is BS, of course, and "balance the nervous system" is questionable (awfully vague, so not necessarily a full-on qi thing), but I've got no problem per se with doctors prescribing needling to patients who imagine it might help "manage side-effects during chemotherapy, like the nausea" or "reduce the pain and issues that arise post-treatment". Over on SBM, even Dr. Novella noted the placebo effects of acupuncture for such uses appear to be stronger than other placebos — "the more invasive the procedure the larger the placebo effect".
And no, placebo effects do not depend on doctors lying to patients. They depend on the patients' beliefs that they are being treated with something that might work, which is why any medical treatment being evaluated by subjective patient reports has to be controlled against placebo. Patients can and will believe what they believe without physicians making specific claims, and even in the face of physicians telling them "science says this doesn't do anything but trick your mind..."
Which is not at all to endorse "Dr. Taz". Looking at her web stuff, including the fairly recent dates of her woo 'certifications', my guess is that she wants to be the next big 'holsitic health' celebrity/entrepreneur, that she's in it for the fame and fandom (even more than the $$), and I wouldn't bet the rent money that her medical discretion won't become even more compromised in pursuit of her goals...
@ Chris Hickie #7
I'm not sure it's fair to call her anti-vax, though. The first bold point on the page you linked is "Vaccines are not bad or the cause of autism." She supports a delayed schedule for "children (and adults) that have defective systems of detoxification," but there's no indication on the page she'd enable total non-vaxers a la Dr.s Bob and Jay. That ship's sinking, anyway, and my guess would be she's too smart to go there, lest it damage her cred.
Did you ever try Popeil's spray-on hair? :-)
And no, placebo effects do not depend on doctors lying to patients.
Wrong, wrong, wrong, wrong. Every attempt I've seen to demonstrate that there can be placebo effects without deception has failed, most notably:
It's not as though this topic hasn't been explained in depth, both here and on my not-so-super-secret other blog, multiple times.
Well, there's always the possibility of using ignorance, as when Dr. Hibbard addresses a crowd of miserable people suffering from the Osaka Flu on The Simpsons :
Hibbard: The flu is a viral disease! Anything I give you would be a placebo!
Man (desparate) : Where can we get some of these placebos?
A carton of bees falls off a passing truck, causing pandemonium ...
Man: Ow!! Ow!! Ow!! -- I mean, I'm cured!
And no, placebo effects do not depend on doctors lying to patients.
I have to side with Orac here. It may be true, particularly if the study is properly designed, that the doctors administering the placebo treatment aren't lying, because they themselves don't know that Patient #1742 is getting the placebo and not the real medication that is being studied in the trial. The attending physicians aren't supposed to know who is in which group. But somebody up the chain of command does have access to the list of which patients are in which group, and this person is lying to Patient #1742 by claiming that (s)he is getting the experimental treatment. The point is that somebody, somewhere, knows that Patient #1742 is getting the placebo, and allowing the patient to believe otherwise.
Last time I took my cat to the vet there was a brochure for pet acupuncture. I had to take a photo of the pet torture advertisement.
I think any vet offering pet acupuncture should have the same performed on them...by a cat.
I think any vet offering pet acupuncture should have the same performed on them…by a cat.
All vets I know already have.
Patient #1742 would have been told that he (or she) might get a placebo when he (or she) enrolled in the study, right? If so, I see no lie being told by anyone.
But somebody up the chain of command does have access to the list of which patients are in which group, and this person is lying to Patient #1742 by claiming that (s)he is getting the experimental treatment. The point is that somebody, somewhere, knows that Patient #1742 is getting the placebo, and allowing the patient to believe otherwise.
In the IRB approved clinical trials I have been associated they must reveal to the patient that they are being randomized and they will not know if they are getting a placebo or a medication until the end of their participation in the trial, often at the complete end of the trial. Although sometimes for some things compassionate use may cause that pt to be unblinded once their participation ends even if the trial is not over.
Ideally no one who ever talks to the patient knows which arm they are in. However there usually is at least some level of deception in that the placebo is made to look like that the kinda drug that would have that effect (which they do for the actual drug, if people expect a whatever to be blue they make it blue)
My understanding is that in trials where the patient does knows for a fact it is the placebo that you don't see the same results as when they know they believe they might be taking the real drug.
"My understanding is that in trials where the patient does knows for a fact it is the placebo that you don’t see the same results as when they know they believe they might be taking the real drug."
It also depends on the endpoint(s). In a recent trial (properly blinded), the clinical group worked hard to make the endpoints so un-subjective that we had no placebo remission. It was pretty good work, IMO.
Did you ever try Popeil’s spray-on hair? :-)
I don't need it. I go to Donald Trump's barber.
It appears as though Dr. Bhatia is an adjunct assistant professor at Emory School of Family Medicine and there is no Preventive/Integrative department there as sadmar noted.
My medical tricorder doesn’t have an acupuncture setting
I wish I'd said that
(I probably will).
OK, I need to clarify that I'm arguing about placebo effects because I think it's BAD STRATEGY against dangerous woos to critique them on the basis of generating placebo effects... which I'll explain following the 2nd break below (should you care to skip the further discussion of placebo, and get on to why I think it matters...).
Every attempt I’ve seen to demonstrate that there can be placebo effects without deception has failed.
Wrong, wrong, wrong, wrong. :-)
First: chicken soup.
Second: I'll bet you've seen umpteen hundred placebo controlled clinical trials of new meds scored with some sort of subjective patient report similar to the IBS-GIS. The reason for the placebo control is to establish a baseline of subjective improvement which the med must exceed to be considered effective. Otherwise, the patients receiving the 'real' med — who have not been deceived by the researchers — may report improvement simply because they expect to feel better after taking something, anything they think is 'medicinal', and those physchological effects will be conflated with the physiological effects of the remedy being tested.
Yes, the Kaptchuk study screwed-the-pooch by priming the test subjects with the statement "shown in rigorous clinical testing to produce significant mind-body self-healing processes," (my emphasis) since no "healing" is involved, just subjective symptomatic relief. But if they had said "significant mind-body processes of symptomatic relief", do you think it would have made that much difference? (Not really rhetorical... I mean, I'd guess it wouldn't, but it might.)
My problem with that study – a concern I do share with you – is the reliance on subjective reports of subjective relief. Placebo effects wouldn't be worth much if all they do is create a different grade of answers on questionaires. IMHO, what a study like this needs is 'objective' measures of 'feeling better'. I'm not sure I'd expect number of bowel movements to change (or matter), or medication requirements necessarily. But "time lost from work" seems valid, and maybe other time measures as well — time in enjoyable activities gained, maybe. Though it would be hard to collect the 'data', there ought to be 'objectively' observable changes in patients' moods and actions as they go about everyday life if they are indeed 'feeling better'.
The self-selection of study respondents is a feature, not a bug. Any individual real or hypothetical placebo treatment would not be an 'it works for most patients' proposition. If you truly believe it won't offer any relief, it won't be placebo. So, if placebo treatments can indeed help patients with chronic 'subjective' conditions achieve a better quality-of-life, only a select group of them will ever likely get a valuable subjective benefit from any given placebo 'modality'.
A key point here is we keep focusing on 'deception' by the prescribing medical professional. However, patients do not live in glass bubbles where their physicians are the only source of opinion and information. Nor do most patients – however much they trust their doctors – imagine their physicians are infallible. If the doc says "I can have you do/take (X) but science says it won't make you feel better in any way," the patient might think "well, maybe the doc's wrong about that" and get a placebo effect by doing or taking (X) anyway, as long as some other factor leads them to think it might have medicinal value. If your mom always gave you chicken soup when you had a cold, you just might believe chicken soup will make you feel better enough that it WILL make you feel better, no matter what anyone else says. And how many cold sufferers get chicken soup, just on their own volition, without even talking to any medical 'authority' much less being fibbed to by a physician? Who's running the great matzo ball deception, Linda Richman? (Say it's not so; I'm getting verklempt!)
If your hypothesis is "placebo effects don't even provide substantive symptomatic relief", well, that would be subject to scientific verification, yes? If you ran a variant of the Kaptchuk study, using test subjects who at least thought the placebo treatment they received might help symptomatically, against a control group who stated they were convinced it wouldn't do anything at all, AND used some of those 'objective' quality-of-life measures rather than just questionaire-based self-reports — AND if there was no significant difference between the 'objective' measures of 'improvement' between the two groups, THEN you'd have strong evidence that placebos are all but worthless... Lacking that, I'm not convinced.
[A valuable variation of such a study would seek to measure the difference, if any, in placebo effects of treatment (X) between patients who believed only that might/would offer symptomatic relief, and patients who believed it would offer actual physiological healing. That is, how much does any psychological benefit depend on a totally false belief in a cure?]
OK: to the anti-woo strategy. Regardless of how many sbm advocates consider placebo effects 'worthless', the question remains open to debate, and more importantly, a lot of the population we'd like to keep away from the clutches of quacks will take any kind of relief from chronic maladies they can get, even if merely psychological. When sbm advocates declare flatly 'acupuncture doesn't work', too many in the intended audience will reject the message because they 'know' the treatment does work, as they define 'work'. Which also happens to be how the American Heritage Dictionary defines 'work': "to cause or effect, bring about". Thus, a 'placebo effect' is essentially synonymous with 'placebo work'. (If that bothers anyone, I suggest you take it up with the lexicographers)
I will assume the first-order goal of sbm advocates is to get patients in need of real physiological medical treatment to forego using woo as a substitute. To that end, getting into the murky waters of condemning placebos carte blanche is absolutely unnecessary and deflecting. The point is the woo 'modalities' make promises for cures that are utterly false, and dangerous. That's all you need to establish, and all you SHOULD attempt to establish for the target audience. One of the first rules of advertising (and media communication in general, as opposed to face-to-face persuasion) is 'limit each message to one and only one central idea'. (Among the many ad gurus who've made that point is David Ogilvy, creator of the iconic "At 60 miles an hour, the loudest noise in this new Rolls-Royce comes from the electric clock" ad you cited yesterday, which is a perfect exemplar of the concept.) Even multiple entirely-positive points (the various different benefits a salesperson might pitch in person, for example) dilute one another and become noise in a mediated environment where the message competes for attention time and importance. You sure as hell don't want to toss in anything that could generate "well, I don't know about that!".
There's more than enough smack to dump on the curative claims of the wooists. You don't need to open the 'placebos are worthless' suitcase. You don't have to endorse placebo effects, just don't go to the question in the abstract at all. It wouldn't kill sbm advocates to say '[acupuncture] doesn't work beyond placebo effects!' instead of saying '[acupuncture] doesn't work!' (substitute other woos as desired). If people feel better, there's no problem if they JUST feel better. The problem is their underlying condition is NOT going to get better if an acupoint prod, a 30C dilution, a subluxation alignment, hand waving, an 'all-natural' supplement enhanced diet, coffee enemas, yada yada yada replaces physiologically effective conventional therapy. Let those suffering sbm-meds-inescapable pain deal in whatever way 'works' for them — qi alignment, CBT, meditation, prayer, whatever The last person I want to see if I have a serious illness is any kind of preacher, but I wouldn't kick the chaplins out of the hospitals. OTOH, faith healers like Ted Shuttlesworth who help convince patients like Makayla Sault to forego chemo for Jesus, I would put in jail.
It's not the nature of the woo, it's the damage done with it. There are plenty of legitimate meds that can be abused, and fatally so. But we don't ban Oxycontin, Adderal, or Klonopin. We fight the abuse, try to head off the damage. Compared to Rx drugs, the line with woo is a lot easier to draw. It's all there on the quacks' webpages. They WILL claim they can cure almost anything. There are homeopaths telling you your cancer will disappear if you use your laptop to listen to .mp3s alleged to be infused with some 'energy wave' (which, if you know how .mp3s are compressed and how audio is reproduced by tiny little speakers, is a 30C dilution of the probability 30C dilutions do anything beyond placebo...). And like every alt-cancer-scam, the message is, you don't need that nasty, expensive, uglifying chemo and radiation!
Personally, I'll admit that what "Dr. Taz" is hawking doesn't bother me much. But if it did, if I was just as galled by acupuncture as much as Mark Crislip is, I'd like to think that if I was running an anti-woo PR campaign, I'd be professional enough to put my own hot-buttons aside, assess where I could direct my limited resources to doing the most good – in this case by minimizing the greatest harms – and laser-focus my messages on the most effective strategies to reach the people at risk in the most powerful way.
[After years of telling teenagers that smoking causes cancer and lung disease, with little effect, the agency doing anti-smoking spots changed strategy. They had an attractive young actress face the camera and say, "Kissing a smoker is like licking an ashtray... Smokers are losers." I'll bet it hurt the medical advisers NOT to mention the health risks. But it was the right move...]
OK: to the anti-woo strategy. Regardless of how many sbm advocates consider placebo effects ‘worthless’,
Who ever said they were "worthless"? Go on. I challenge you to find somewhere where I said placebo effects are "worthless" (although, to be honest, there is considerable evidence out there that there really is no such thing as the placebo effect, at least not as it's advertised, if you care to find it). That's a complete straw man. The only person I know who borders on arguing that placebos are worthless is Mark Crislip.
What we do argue is that placebos don't produce any objective measurable impact on hard outcomes. They don't stop cancers from growing, for instance, which is why we don't even really do placebo-controlled trials much any more in oncology. Instead, we compare standard of care to either standard of care + new drug or to new drug. The classic example of this is the asthma/albuterol study:
Time and time again, I (and Steve Novella elsewhere and other medical skeptics) point out that placebo effects can be invoked without telling patients that magic works by simply being encouraging and having a good relationship with. You also have a very profound misunderstanding of how wooists are using placebo effects to justify their quackery. Placebo, like epigenetics, is the new quantum with respect to pseudoscience. It can do anything!
Placebo effects are described as "powerful self-healing" and the ability of the body to heal itself. Come to think of it, epigenetics is being fused with placebo plus mind-body dualism to tell patients that they can heal themselves if only they will it enough. I've written about this many times, e.g.:
And, most amusingly (or disturbingly) of all:
Note that I wrote those well over three years ago.
Seriously, dude. You're way behind the times. I and others have been all over this for years, and your remarks betray some big holes in your knowledge of how placebo effects have been coopted for magic. They also betray an ignorance of what most medical skeptics actually argue about placebo effects.
As far as chaplains in hospitals I don't know that they ever claim to be performing any kind of treatment, and if they do, they need to be kicked out.
The problem with alt med practices and proponents is they conflate everything from placebo effects to bashing real medicine to time spent with patients (not just cures) with medical treatments. This is how they make in-roads. If they were confined to the "this will make you feel better" only mantra they would be competing with things like a fifth of gin, video games, massage, fine food, whores, drugs, etc. - all things that may make you feel better when you're not ill. And they were losing to these handily until people started being told there was actually something medicinal about their rot.
Side note: I used to see doctor's orders for beer/liquor from time to time because a patient insisted on having it while in the hospital. Prior to the order the doctors counseled patients on it and often asked their families about it. If no contraindication the patients had to make their own arrangements to have it brought in. We in the pharmacy were never tasked with obtaining, monitoring it (outside of med interactions) and no one pretended it was a placebo treatment or an actual treatment. And, more importantly, the administration of the hospital wasn't marketing it and building bars on campus.
I'm fine with people believing in whatever and doing whatever (ethically) they want to make themselves feel better when ill but keep the make-believe, feel good, pretend medicine far away from the practice of real medicine, please.
I used to see doctor’s orders for beer/liquor from time to time
^ Have one on me then, Alter.
It figures there would be a brewery such as this, and here I thought the "whores" line would bring out the jokes.
there is considerable evidence out there that there really is no such thing as the placebo effect
I understand that a study that compared a placebo to a sugar pill found no difference.
"Biopulsar-Ayurvedic Bioenergetic Screening" eh? That gets the "Teenage Mutant Ninja Turtles" award for three adjectives before the noun. It also gets...
...to the tune of Supercalifragilisticexpialidocious:
Biopulsar Ayurvedic Energetic Screening
String some words together that have very little meaning!
Hopefully the FDA will soon be intervening
Biopulsar Ayuvedic Energetic Screening!
Why are MDs in the U.S. allowed to administer and prescribe treatments of unproven benefit to the endpoint of resolving disease without the repercussion of having their license pulled? Does MD come with some sort of 007 clause?
@Gray Squirrel: You just made my day. Dare I add, 'Um diddle diddle, diddle um, diddle lies. . . '
Alice didn't know what (the word) meant but it sounded like a very grand thing to say. (Alice Through The Looking- Glass). Quantum.Pulsar.etc ad nauseam. And what is an organ system, as distinct from an organ? Is this a real term? "if you wish to discourse with me ,you must define your terms." (Voltaire). Not the terms of it but the terms you use in it. Coming soon to a planet near you : Using the Higgs field to cure everything.
@Gray Squirrel - Brilliant. :-) You may also like this, Paracetamoxyfrusebendroneomycin:
Lighthorse @ 38: Excellent! Game ON, stay tuned...!;-)
Rich @ 40: Super! (some of the accompanying pictures aren't for the faint of heart).
First we look up the canonical lyrics, here:
and the performance thereof, here:
And then (hey Orac, check this out!).....
Back when I was afraid to squeak, much less to quack out loud
My alt-med business winning-streak was hardly well-endowed
But then I learned to grow a beak and quack up strong and proud
My waiting room began to bloom with patients by the crowd, oh:
Biopulsar Ayurvedic Energetic Screening
String some words together that have very little meaning
Hopefully the FDA will not be intervening
Biopulsar Ayurvedic Energetic Screening!
Um diddle diddle diddle, um, diddle LIES! (x4)
At conferences and seminars I learned to sell and schmooze
And patients who were TV stars would spread the happy news
It works! It's real! It helped me heal! said all the Yelp reviews
My bank accounts had huge amounts from multiplying woos, oh!
Biopulsar Ayurvedic Energetic Screening
String some words together that have very little meaning
Hopefully the FDA will not be intervening
Biopulsar Ayurvedic Energetic Screening!
Um diddle diddle diddle, um, diddle LIES! (x2)
(spoken) Now you can say it backwards, which is Screening Energetic Auyrvedic Biopulsar! But that's going a bit far, don't you think? No!
One day a man came in and said he had fatal case
In six months he might well be dead but I'm his saving grace
I switched on my machine and put some sensors on his chest...
(spoken) What happened? Cured?
An then the guy said "FBI!" and "You're under arrest!"
Biopulsar Ayurvedic Energetic Screening
First the judge repeated it, then said "your quack machine thing"
Now my job in prison is to do the daily cleaning
Biopulsar Ayurvedic Energetic Screening
Biopulsar Ayurvedic Energetic Screening!
(Copyleft, spread it freely, with attribution.)
That's utterly brilliant. Sharing now. :-)
Grey Squirrel -- That deserves way more than a golf clap! More like the Met crowd after the tenor knocks an aria out past the nosebleed seats. Bravo!
@ MOB #9: The whole thing is a scam compared to *real* fellowships: file:///C:/Users/Dr%20Hickie/Downloads/Fellowship%20expenses_0714.pdf . You have to pay about $35,000 to "do" this "fellowship". You apparently only spend a week in Tucson kissing Weil's ass.
If I were to do a pediatric infectious disease fellowship (3 yrs), I would be *paid* a stipend of ~ $59 K for my many hours of clinical work (https://gme.wustl.edu/About_the_GME_Consortium/Policy/Pages/Stipends.as…) actually caring for patients using SBM and not the crap of "integrative medicine".
Sorry, link to costs of 35k to become an IM shoveler of horsepoop is here: http://integrativemedicine.arizona.edu/education/fellowship/tuition.html.
I wonder if Weil lives in a mansion as big as Mercola?
Rich @ 43 and Palindrome @ 44: Thanks!;-) I do that sort of thing for fun, and I've also planted a number of memes in the culture.
If we can find one man and one woman with good singing voices, and a good pianist, in the San Francisco Bay Area, and someone to underwrite the cost of two days in a recording studio, I can produce this at professional quality (I have studio production experience). That plus a volunteer videographer (I don't know squat about doing video), gets us a YouTube video as well as a downloadable audio file, and I guarantee it'll go viral. I can come up with a video script for the visuals as well, though it might be necessary to pay for some stock photos.
There's no copyright problem: satire is fair use, per US Supreme Court decisions.
_And then_ we send a copy to the woomeister who is the subject of this column. And watch her poo in her pants and change the name of her "treatment." (I've gotten another group of nasties to change their name after I demolished the one they started with, so this isn't an idle boast.)
Question is, who shall be the next target for this treatment? How'bout Mikey the Health Ranger?
I was at the veterinary oncology clinic yesterday waiting to pick up my black Lab (she is having a course of chemo for lymphoma). While at the front desk I noticed a rack of professional cards for the staff (this is a large multi-specialty vet center that has DVMs doing surgery, oncology, radiology/radiation oncology and various facets of internal medicine, along with physical therapy and other things). They also have a veterinary chiropractor and a DVM whose practice is limited to acupuncture. I didn't see any cards for homeopaths but I bet if I'd asked, that service would've been available too.
Now, my dogs's regular vet there seems quite evidence-based and no one has proposed woo treatments to me. It's still discouraging that this stuff has penetrated the veterinary medical world and being inflicted on animals who have no choice in the matter.
@ Gray Squirrel:
In fact, we do have a creative fellow in the Bay area who might know how to hook up the people you need altho' he is often very busy in his sideline occupation of conquering the known universe for Pharma.COM.
Mikey would be a good target for your efforts but I'm afraid it's too sophisticated for his tastes/ abilities. You might need to toss in some zombies or cannibals to reach him.
I'm sorry to hear about your dog: I hope the treatment helps her.
@ DB #48--A naturopath called my clinic last month wanting to know if I had space to rent and was interested in a collaborative effort. I only wished I owned the garbage dumpster....
Denice @ 49:
Great, let's follow up on this, for real. The email address I enter when I post here is a complete fiction that doesn't exist in reality, so I'll have to set up a temporary real one I can post here for purposes of getting in touch (I'll let y'all know when that's done and I'll post it).
The minimum we need is a male and female vocalist and a pianist. I could go into more details here about parts and track maps and so on, but that's all routine studio production stuff.
Hey if this goes viral, start a band that can do occasional performances such as at skeptic conferences. Call it The Naturopaths or something;-) Tom Lehrer style, stick to piano and two vocalists (look up his videos on YouTube). And/or a group of four or five people who can do Pythonesque comedy on live stage, also for skeptic confs and suchlike, and possibly for simple videos. My only self-interest in this is as occasional songwriter & studio producer, because I'm also very busy in my main occupation which is in the tech infrastructure industries. And I'll probably have to keep my "real" name out of it for various reasons, not the least of which is that some of my clients might catch wind of this and think I'm nuts;-)
There's definitely a place in the overall scheme of things for facing down the anti-vaxers and quacks and wooskis with humorous ridicule. Heh, I can envision a couple of Python skits even as I'm typing this. Hmm...!
@ Gray Squirrel:
Whilst I cannot speak for his Saurian Majesty, I can merely suggest that you wait patiently for his response, if there is one.. So hold your horses for a bit.
-btw- he also has a band, Baby Seal Club, which performs professionally.
I am not the Source but merely an intermediary of this beneficence.
Denice @ 53: Aha!, OK, horses held;-) Meanwhile I've got to scoot for the day, be back tonight. Cheers!
Gray Squirrel -- you're a genius.
I will have to dig out the anti-vax parody I wrote to the tune of "Ain't Mis-behavin" during H1N1 and send it to the two of you after you've gotten his Lordship's permission.
@Dangerous Bacon #48:
They also have a veterinary chiropractor
Next time you're in there, please ask what s/he charges for treating a stick insect with the sniffles.
DB@48: Sadly, veterinary chiropractors are not a new thing, even on this blog. Yes, that linked post really is talking about a chiroquacktic. Yes, I still find the idea to be absolutely quackers, two years after Orac posted that.
Thanks for the support. So far she's responded extremely well, with nodes shrinking to undetectable size by physical exam and no side effects except a lowered white blood cell count.
Lymphoma treatment for dogs is nowhere near as advanced as for humans, either in diagnosis or treatment. They are upfront about letting you know that with dogs you are basically buying time and not to expect a cure.
Woo and animals.
Accupuncture, homeopathy and herbalism are very big in organic livestock production. Even some of the bigger milk companies hire wootastic vets to have on staff. It is sickening.
I live in the Bay Area. I used to teach film/video production, have made several docos for public TV, have tons of video gear. I also do audio production: mainly audio for moving pictures, but I can do basic multi-tracking for music. I have all the software, a decent mixer, a few good-enough microphones. For a YT vid, I'm sure we could improvise someplace to record w/o an actual studio.
I also write and perform song parodies myself, btw. I put a couple in my dropbox
(NOTE: "smallboneS" is NSFW.)
My basic method is to find a midi track of the instrumental, and completely re-orchestrate it in GarageBand. You can hear how that works in the samples. I've already found a .midi for 'Supercalafragalistic...' so we wouldn't even need instruments or players.
I've done some guerrilla theater in the past, written comedy sketches, worked with guys from Duck's Breath Mystery Theater and SFMT.
Are you on the web elsewhere where I can PM you with contact info?
Shay @ 55: Cool, looking forward to hearing it. With enough of these we could compile an album or a YouTube channel or something.
Sadmar @ 60: Excellent, which means we could get to video right away. We still need two decent vocalists, male and female. If I can retrieve that item in your Dropbox account, I might be able to leave you a quick .TXT doc with my contact info including a phone number. Or if not, then I'll set up a temporary email address and post it here. (Pardon all the spy-vs-spy but I've dealt with a stalker before and I don't want to pick up another one from the flock of loons who occasionally drop in here.) Once we're in touch the rest is "easy";-) Stay tuned...
@ Gray Squirrel:
Being cautious is certainly appropriate because- believe it or not-
there are readers of RI who are not madly in love with Orac and his minions. In fact, some of us have endured retribution from alties at work - including our most esteemed host and EpiRen.
Other sceptics have been sued for writing truthfully ( Todd, Lee) at their own blogs.
I know that there are some who would love to have my home address but so far my smokescreen has held up quite well and I don't get any disturbing mail or visits from the woo-entranced a-knocking at my door.
and -btw- alties, I'm not the DW in Tasmania. She's nice.
Denice @ 62: Yes, I've read of those cases where badguys and badgals have tried to harass people here. Always protect your home address, very smart.
Sadmar: I just wrapped up my night stack, and I'll have time to set up a public email address later today (Thursday), at which point I'll post it here and then post a brief "check the other column" message in whatever new column Orac might post today.
This ought to be fun, heh heh...
Hi! I'm actually Jennifer Tesler and Yes, I do live in Atlanta. I find your comments hugely offensive and without merrit. Yes, I was recommended by Dr. Taz Bhatia to CNN to give my opinion on my experience with implementing holistic measures into my treatment plan during and after cancer treatment. I was asked to participate as I have had great personal success with the avenues I have chosen to pursue and Dr Taz knew I have a strong desire to share my story and help other women on their journey's. I am a Vanderbilt graduate and a very intelligent women so I too have done my own extensive research on accupuncture and other holistic measures. For me, these have served me best in my ongoing quest to regain my life after a very long hard journey as I strive daily to lead a pain free and cancer free life. This was in no way an "info commercial" on accupuncture nor an advertisement for Dr Bhatia's practice. It was a sincere and open and honest sharing of stories of the success that I experienced. Hopefully by sharing it will bring encouragement and hope on many levels to others on this path. I don't think anyone would argue that we have all seen way to many wives, mother's, sister's and friends battling breast cancer every day. My most sincere wishes that you too will find peace and happiness and health down whatever cancer free path you feel heals you physically, mentally and spiritually. For me, it was accupuncture.
For the record, I thought you should know it was Dr Eric Minninberg, my oncologyst with Piedmont Cancer Institute that suggested I try accupuncture. Dr Minnenberg attended Dartmouth, Univ of VA, and was a fellow at MD Anderson. Not really a "woo" program. Piedmont Hospital offers accupuncture on-site on the cancer floor because of science behind accupuncture. I did not start seeing Dr Taz Bhatia until after completing 6 rounds of HCT, a year of Herceptin and a double masectomy. It was not until afterwards when I was suffering from severe nuerapthy, fibromyalsia, severe fatigue, autoimmune issues, thyroid and hormone issues, severe anemia, celiac and issues from mthfr that I started to see Dr. Taz. If you go back through my medical records you will see I was continually anemic, had chronic severe low vit D, high inflammation marks from chronic back pain and in general, thyroid problems, reynauds and had suffered a huge loss of my late husband from acute AML on our ten year anniversary. I was a walking time bomb for Breast Cancer and yet not a SINGLE traditional Dr ever told me that I needed to get my inflamation under control, get my vit D up and get control over my high estrogen numbers and thyroid. Whose job was it? No ones... For every Dr just focused on their individual specialty and no one treated me as a whole.. And my story sadly is not unique. I have never claimed accupuncture alone would cure or prevent cancer. I have had Dr's throw every single drug possible to help with my severe side effects to no avail other than destroying my eyes ( i have implants in both eyes from steroidal cataracts) and destroying my stomach to the point I could not eat and for six months I could not even leave my bed to even get to the couch my symptoms were so severe. It was another six months I spent with my only move being to the couch then back to bed. Traditional medicine offered no cure only treatment of the different symptoms with more and more drugs-- to the point my body was reacting adversely to every RX. My body was just spent. Then Dr Taz took the time to treat my whole body and helped me come up with a plan that did not include throwing more drugs and toxins into my body. We worked on my gut and diet, on getting my vitamin d up, balancing my thyroid, getting my hormones balanced (i can not tolerate tamoxifen and was tripple positive--i can not walk if I am on it) explaining methylation as well as help with identifying the triggers that send me back to bed during autoimmune flare ups... I have symptoms that fall inbetween ms, lupus and schleraderma.... I have been blessed to have always had access to amazing Dr's who are at the top of their field, here in Atlanta, Dallas and Nashville...yet it was Dr Taz, who took 6 hours with me on my initial visit and then additional time in going back through my years of records, that has helped me in reclaiming my life. Before cancer, I was an active and healthy Mom of three children, I was a competitive athlete, enjoyed tennis, horses, volunteered and worked full time as an event planner... So to be not able to walk from my bed to the couch was a complete 360 to life I had. Though accupuncture and keeping inflammation down may not cure cancer - that was never my claim nor Dr Taz's. Keeping all in balance, including balanced hormones, a diet free of sugar and items that are known to feed cancer along with keeping my inflammation, pain and flare ups under control.... That does allow my body to be the best it can so I can have a body that does not allow cells to divide and cancer to grow and I have a body that can now fight as well. For these gifts of "woo woo", I am so greatful and I would not trade Dr Bhatia and the holistic lifestyle measures I incorporate in my life, including accupunctire, for the world. I am surviving and thriving as I approach my four year cancer free mark in December and that is a story worth sharing! So for me..bring on the "woo"! Sincerely, jennifer
"For the record, I thought you should know it was Dr Eric Minninberg, my oncologyst with Piedmont Cancer Institute that suggested I try accupuncture."
I am sorry, but this is as far as I got. Did he also instruct you that paragraphs were useless and a "wall of text" was an effective means of communication?
Please try again with more coherence. You have plenty of time, Orac is on vacation is not going to be back for a few days. Though I would suggest you provide something more compelling than an "argument from anecdote and blatant assertion" by including some actual peer reviewed citations form PubMed indexed journals by reputable qualified researchers.
I can't recall whether it was Piedmont or Georgia Baptist hospital that perforated my mother's esophagus doing a routine scoping for hiatal hernia. They did keep her without charge, for the months it took her esophagus to heal.