BMC Complementary and Alternative Medicine

The RAND Corporation: Supporting the "integration" of quackery with real medicine since 2008

oracknows — Thu, 05 May 2016 01:00:51 +0000

The RAND Corporation: Supporting the "integration" of quackery with real medicine since 2008

As regular readers of this blog and related blogs know, over the last two or three decades there has been a successful effort to legitimize quackery in the form of what is now called “integrative medicine.” Three decades ago, modalities like homeopathy, acupuncture, much of traditional Chinese medicine, reflexology, chiropractic, and many other modalities based on vitalism, prescientific mysticism, and pseudoscience were rightly referred to as quackery. Then in the 1990s came “complementary and alternative medicine” (CAM), a term that sought to sand the rough edges of quackery off of the, well, quackery.

It wasn’t enough, though. After all the word “complementary” implies a subsidiary status for the woo. It implies that science-based medicine is the real medicine and all that other stuff, such as acupuncture, naturopathy, and the like, were just “icing on the cake.” In other words, it implies that they can be discarded, that they aren’t, strictly speaking, necessary. Of course, these modalities aren’t necessary because they aren’t real medicine, but that didn’t stop CAM advocates from coining a term that implies that quackery is co-equal with real medicine. Thus was born the term “integrative medicine.”

I’ve bemoaned for years the way that academic medical centers, seemingly under thrall of an ideology that has convinced too many otherwise sensible doctors that to be more “humanistic” or “holistic,” one must embrace nonsenses. I’ve frequently criticized examples of “quackademic medicine,” such as anthroposophic medicine at my old alma mater and traditional Chinese medicine and “functional” medicine at once fully science-based institutions. Unfortunately, in some institutions this degradation of scientific medicine has paid off.

What I hadn’t realized before so much is that it’s not just medical academia, at least in the traditional sense of medical schools and their affiliated academic medical centers. Seemingly respectable other institutions, such as think tanks, have embraced “integrative medicine” as well. For example, get a load of this essay by Doug Irving published on the RAND Corporation web site, entitled Science and the Healing Arts. It’s a perfect distillation of the sorts of dubious arguments made for pseudoscience that we’ve seen in academia and elsewhere. It’s as disappointing to see them coming from the RAND Corporation as it is from medical academia.

The RAND Corporation is a nonprofit global policy think tank originally formed by Douglas Aircraft Company to offer research and analysis to the United States Armed Forces. Since then, the RAND Corporation has expanded its purview and now does research and provides policy recommendations to many other areas, including (according to Wikipedia): child policy, civil and criminal justice, education, health, international policy, labor markets, national security, infrastructure, energy, environment, corporate governance, economic development, intelligence policy, long-range planning, crisis management and disaster preparation, population and regional studies, science and technology, social welfare, terrorism, arts policy, and transportation. On its website, the mission of the RAND Corporation is described thusly:

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

For more than six decades, RAND has used rigorous, fact-based research and analysis to help individuals, families, and communities throughout the world be safer and more secure, healthier and more prosperous. Our research spans the issues that matter most, such as energy, education, health, justice, the environment, and international and military affairs.

However, health care is one area where the RAND Corporation has distinguished itself in health care policy. Indeed, I’ve cited the RAND Corporation’s work on vaccine safety (once again showing that vaccines don’t cause autism) and critically examined one of its not-so-awesome studies before. What I hadn’t realized before is just how deep into integrative medicine the RAND Corporation has dived. I should have. After all, I’ve critiqued at least one really bad CAM paper on “energy chelation” whose co-investigators included investigators working for the RAND Corporation.

Now I realize that the RAND Corporation has in essence teamed up with the woo-promoting Samueli Institute. In fact, in 2008, the two organizations formed the RAND/Samueli Institute Chair in Policy for Integrative Medicine.. Ian D. Coulter was appointed the first chair and remains the chair today. The article that caught my attention basically summarizes the RAND Corporation’s views, approach, and “achievements” in the world of “integrative medicine.” It begins with a trope that’s become so old in the world of CAM that I really should think of a name for it. I know. It’s what I like to call the false dichotomy of the future:

Modern medicine has a problem. It can fix a damaged heart, battle cancer into remission, and operate on the deepest recesses of the human brain. Yet it continues to struggle with the everyday anguish of an aching back.

Americans now spend billions of their own dollars seeking relief from such chronic conditions in alternative schools of health, such as acupuncture or chiropractic. RAND researchers have started to examine what it would take—and what it would mean—to more fully integrate such practices into the medical mainstream.

The obstacles are forbidding; the insurance questions alone might require an actual act of Congress to solve. But the benefits could transform health care as we know it, expanding its scope from sickness and trauma to whole-body wellness.

Unconventional medicine, once dismissed as quackery by the medical establishment, might be the missing piece of modern health care.

“How do we take two parallel systems and bring them together?” asks Ian Coulter, a senior health policy researcher who holds the RAND/Samueli Institute Chair in Policy for Integrative Medicine. “That,” he added, “is the future.”

Let’s just put it this way. Even if every premise stated above were true, it would not follow that “integrative medicine” is the future. Also notice what I like to call the “they called it quackery” trope, wherein the advocate claims that all that quackery is no longer quackery because it’s being validated by science ma-an. After a quick anecdote ment to illustrate the favorite alternative medicine propaganda point that modern medicine is good at dealing with acute disease (true) but not as good at dealing with chronic disease (easily questionable), the article elaborates on the “they called it quackery” trope, complete with a historical example:

To get a sense of why those different models of medicine remain a step outside the mainstream, start with a mild October day in 1893, when medical students lined the streets of Philadelphia to jeer at a parade of homeopaths. “Sugar pill, sugar pill,” they chanted, “never cured, and never will.”

The medical establishment spent decades deriding most other practitioners as dangerous charlatans—“unconscionable quacks,” according to a pivotal paper in 1910 that set the tone for generations of doctors. The American Medical Association tried to run chiropractors out of business until 1980, dismissing their practice as an “unscientific cult”; a federal judge later ruled its boycott amounted to an illegal conspiracy.

“We've come a long way,” said John Scaringe, a professional chiropractor and the president of Southern California University of Health Sciences. Its students of Eastern medicine and chiropractic will soon share their classrooms with future physician assistants, a pioneering attempt to integrate even the training of health care professionals.

“We're not looking at it as holistic versus traditional health care, but contemporary health care,” Scaringe said. “We're hoping that in the future, we don't have those distinctions.”

Funny to see how in 1893, medical students seem to know more than the learned scholars of the RAND Corporation do today. After all, one of the most commonly used “whole medical system” alternative medicine is naturopathy, of which homeopathy is an essential part. I also can’t help that the article complains about the derision of chiropractors and other alternative medicine practitioners as “unconscionable quacks” as though it were a bad thing. Of course, what chiropractic advocates forget to note is that although, yes, the AMA lost that lawsuit, nothing in the court decision validates chiropractic. The decision was made on a very narrow basis (restraint of trade) and said nothing that supported chiropractic as a profession. Even if it had, law is not science; indeed, it frequently gets science wrong.

More disturbing is that Irving portrays having students of Eastern medicine and chiropractic in the same classrooms with physician’s assistants as a good thing. Why on earth would anyone want to “integrate” pseudoscientific medical systems that basically posit that disease is caused by either imbalances in a mystical “life energy” (tradiational Chinese medicine) or a nonexistent anatomical alteration (subluxations) causing an alteration in the flow of a nonexistent mystical life energy (chiropractic and “innate intelligence”)?

As for “distinctions,” notice the rhetorical ploy here. It’s one that I often use, but for a different purpose. Specifically, I deny a distinction between “alternative” medicine and science-based medicine. When I use it, it generally takes the form of a statement something like, “There is no such thing as ‘alternative medicine.’ There is medicine that has been scientifically proven to be safe and effective; there is medicine that has not; and there is medicine that has been scientifically shown not to be safe and effective. Almost all of so-called ‘alternative medicine’ consists of one of the latter two categories.” Of course, that’s not what Scaringe means. He means, although he probably doesn’t realize it and would strenuously deny it if called out, that we should eliminate the distinction between quackery and medicine.

Indeed, Irving describes the barriers to the implementation of policies facilitating that “integration,” which he risibly called “fully integrated health care”:

Yet the road from here to fully integrated health care, uniting the best of modern medicine and its alternatives, remains a long one, full of barriers, RAND researchers have found.

Some states, for example, still forbid medical doctors from partnering with complementary health providers; naturopathy is entirely outlawed in South Carolina and Tennessee. Many states license CAM practitioners but limit the scope of their practice and don't treat them as primary health care providers.

Then there's the tangle of insurance regulations. No insurance codes even exist for some CAM specialties. Government-sponsored health plans, including Medicare, also don't include most CAM providers, a situation that in some cases only Congress can change.

I never thought I’d approve of something about the politics of South Carolina and Tennessee. I also know that advocates of pseudoscientific medicine have been lobbying Congress to try to get it to change those laws. Fortunately, as yet this effort has not been as successful as it has been in promoting federal funding of research into quackery through the National Center for Complementary and Integrative Health.

Still, the bad analogies don’t end here:

The result has been what one RAND paper called “siloed chaos,” with mainstream and complementary medicine practicing independently of—and sometimes wholly unaware of—each other. It also has built a double standard into America's health care system, with the full suite of treatment options available only to those who can afford to pay out of pocket for them.

Apparently to the RAND Corporation, the cure for this “double standard” is to use a double standard with respect to scientific evidence in order to facilitate the “integration” of quackery into medicine. If you don’t believe me, just go back again and look at how risibly bad one such study designed to do just that co-authored by RAND Corporation investigators. Seriously, it tested a form of faith healing called energy chelation.

Also, seemingly if someone is willing to pay for a treatment it must be good:

What those patients want to know, RAND's Coulter says, is not so much how a specific spinal realignment performed in a clinical trial, but whether it's safe to go to a chiropractor in the first place—and whether the visit will help that aching back.

“We know that patients appreciate CAM, we know they give it very good satisfaction scores, we know they're willing to pay for it,” he says. “We should start paying attention to this. This is worthy of attention.”

I could say the same thing about psychics: We know people appreciate psychic readings, we know they give them very good satisfaction scores, we know they’re willing to pay for it. We should start paying attention to this. This is worthy of attention.

No, it isn’t. Just because people are willing to pay for something and like it doesn’t mean that something has value. Scientology e-meters also come to mind. It’s sad to see a think tank like the RAND Corporation use such non sequiturs to support policy positions.

oracknows Wed, 05/04/2016 - 21:00

Categories

Education

You forgot the reverse vampires. We're through the looking glass here people.
https://www.youtube.com/watch?v=ut3I6gFmlls

All this has reminded me, I really have to call my doctor in the morning. I've been getting odd muscle spasms that suggest an old bulging disc might have let go onto a nerve root or something otherwise significant is going on bilaterally. Previously, all symptoms were unilateral, so this is quite concerning.
If doctor suggests any of the above quackery, doctor will be fired and an evidence based physician will be found. As I've yet to see any non-evidence based medicine practiced at this practice, I suspect doctor's "job" is safe. :)
The closest thing to CAM I'm interested in might be having two forms of diagnostic imaging used and perhaps another electromyogram. The latter study being about as much fun to receive as masturbating with a cheese grater, but necessary to ascertain the level of nerve damage present.*

*Once, I had three electromyogram studies of my hands, with the pain management physician not liking anyone doing the test, save him, as he complained "they're too easy on the patient to give accurate results". When he was giving me static about a fourth test, not liking his practice partner's results, I offered a compromise; "Fine, first you do me, then I do the test to you".
Interestingly, he accepted his partner's results.
Oh well, regardless, it's nothing that a full body transplant wouldn't fix. Pity that all of the GSV's are hanging out in Andromeda... :/

For being a scientist and probably thinkinking your an intellectual (author)

This is such an uninformed and narrow view point that shows you have no knowledge of what you are talking about

You should read some scientific journals that prove the efficacy of certain alternative treatments or cam

@Courtnay, ah, the evidence free gambit!
So be it!
Our kids interacted with a goat that performed quantum mechanics. It expressed itself via goat butts.
No peer review is required, goats rule the universe or something.
After all, goats are either wonderful magic or wonderful meat.
I'm big on the latter....

So, the RAND Corporation has found yet another piñata to beat for funding. Maybe they can find some government willing to pay them for a study on homeopathy.

Some states, for example, still forbid medical doctors from partnering with complementary health providers; naturopathy is entirely outlawed in South Carolina and Tennessee.
I think So Carolina and Tennessee are likely to resist integrative medicine quite a while. I'm old enough to remember when they first tried to integrate the schools and heaven help you if they caught a doctor partnering too enthusiatically with the wrong kind of provider. ...

@prn, in this case, "the wrong kind of provider" is, in this instance, entirely appropriate.
Previously, not so, but now, entirely correctly. Evidence based medicine in favor of woo, handwaving and magic.

I'll have zero woo in my or my family's medical treatment, evidence based medicine only, thank you.
My father was convinced by a relative, while I was deployed, to go to a chiropractor for "manipulation" of his neck after a car accident, but while awaiting carotid artery stripping.
The chiropractor happily proceeded, the risk of stroke be damned. After mentioning that to his primary physician, he desisted with the chiropractor and fully recovered from his wrenched neck. His carotid artery stripping was uneventful and he enjoyed a decade of life further.

@Courtnay
Exactly which journals do you believe 'prove the efficacy of certain alternative treatments or cam'? "Do your own research" is neither helpful nor is it very convincing.

Courtnay @3 -- Thanks for providing this morning's laugh. I guess you haven't read the last 8 years or so of Orac's columns, in which he explores the evidence base of alternative medicine in exceptional detail -- and with remarkable fair-mindedness -- and finds it badly lacking. Believe me, he's almost certainly looked at every one of the journal articles you allude to, and carefully teased out the logical and methodological errors that render them, well, worthless.

It's always rather funny when folks show up and accuse him of not knowing what he's talking about.

Also, seemingly if someone is willing to pay for a treatment it must be good

I'm reminded of Dave Barry's remark that astrology is based on a proven scientific principle: if you know the exact positions of the sun and planets when someone was born, you can get this person to give you money.

There are lots of things people pay money for. Some of them are actually useful, some of them are mere ego boosters, and some (such as alcohol or drugs if you are an addict) are actually harmful.

For being a scientist and probably thinkinking your an intellectual (author)

Does anyone else see the irony of this?

On topic, sCAM is going to continue infiltrating medicine in part because they are well-organised and well-funded. Another part of sCAM's successful infiltration of medicine is the deficit of the healthcare model. Fix that (generally speaking), don't just slap on a shiny, new image that consists entirely of magic.

@ Secret Cisco

Courtnay might refer to this one:
https://bmccomplementalternmed.biomedcentral.com

We must pay close attention to the fact that science must rely on the intelligence of the scientists, and not on procedures, journals, impact factors, editors, authority, journalists, administrators, lobbies, politicians, and so on..

@ Daniel Corcos, what about your citation is so compelling as to support sCAM?

@ Science Mom
By citation, do you mean the link to BMCCAM?

@Science Mom,
Yup, English grammar and spelling, how does that work?

@ Daniel Corcos
So do you mean to say that you believe that intelligence is, above all else, the most important factor in judging scientific work? How do we judge a scientist's intellect anyways? It seems to me that such things as the quality of the data and proper procedures should be of greater importance than just how smart you think the author is.

Amongst the woo-meisters I survey ( prn, NN), there's an admission that 'emergency medicine' is indeed excellent- after all, who can argue with the ability to re-attach severed limbs or re-start stopped hearts- but the REST of medical care is deficient even dangerous.

First, how can you separate medicine into halves?

The same physiology, anatomy, biochemistry and pharmacology- and education and training- underlies each area. People with long-standing chronic conditions like diabetes/ CVD are often the recipients of startling, live-saving interventions. An emergency that is aided by intervention may turn into a chronic problem, You can't neatly draw a line.

Secondly, everyday problems are often aggravated or ameliorated by the patient's life style choices. Woo makes much of 'healthy' choices, diets and exercise and conveniently forgets that legitimate doctors do as well. HOWEVER it doesn't mean that people follow up on the advice: this factor is something that woo-meisters manipulate- the person may be responsible for some of his or her own problems- it's not all the doctor's fault. What can they do? Monitor everyone 24 hours a day for life?
Whereas in their own system they blame the patient if the woo fails.

Lastly, woo-meisters have to admire emergency care because it is simply something that they can't do** AT ALL. Herbal teas and supplements don't go very far when surgery, electrical interventions or intubation is necessary.

in other words, woo is sufficient in conditions which can probably be managed at home, by the patient or an untrained caregiver. That's why I call much of woo, spa medicine or grandmother/ parent medicine. There are many useful comfort measures that anyone can undertake- tea if you have a cold, RICE for a simple injury, skin care for minor problems, cleaning small wounds etc.

** unfortunately, I've been hearing about naturally 'reversing' gangrene in 10 days ( at prn) via supplements and various ointments/ herbs. So far I haven't looked at the photos at the websites. I don't think that I want to. Such a liar!

Yes Daniel, what was your point linking to those articles?

?? Perhaps Daniel provided the link to a journal that might be said to ‘prove the efficacy of certain alternative treatments or cam’ because if we examined the articles there, they would be revealed as methodological garbage that proves nothing of the kind.??

That is, if Secret Cisco was implying, 'there are no journals that support CAM', Daniel might be replying, 'yes there are, they're just bad.'... ??

I think Daniel @12 is referring to the existence of at least one journal devoted to complementary and alternative medicine (I didn't follow his link, but that's what the URL suggests).

Publishing in scientific journals is a system, and like any system, it can be gamed. Orac has ranted on several instances of this phenomenon in the past. To people who practice what Richard Feynman so aptly called "cargo cult science", it is important to follow the forms of science by publishing in journals that are supposedly peer reviewed (and in many cases technically are, but the pool of peer reviewers is disproportionately predisposed to believe in what you are doing). Alt med practitioners are very much into cargo cult science: they have their journals, and they publish peer-reviewed papers there. But despite their faithful simulation of what they see as the forms of science, they fail to attract actual scientific interest, any more than the original cargo cultists attracted planes full of cargo to their simulated airfields.

@ sadmar,
Thank you for translating, it is what I meant to say. But I wanted to say more than that: quackademic medicine makes me happy, because it shows what is wrong in academic medicine. It is not necessary to accumulate observations and data if we cannot interpret them. And, yes, scientist must have the ability and the will to interpret the data, even if it does not bring them grants.

@ Science Mom
"How do we judge a scientist’s intellect anyways?"
How do you do that? As for me, I read what he or she has written, if this is in my field, and if it is bullshit, even if published in a high IF journal, I make my own opinion. For getting one Einstein published, you need one Planck.
You may say that it is subjective, but what we must avoid is conflict of interest, not subjectivity.
A major problem with high impact factor journals is the peer review process. Most of the papers submitted to these journals are rejected by editorial decision, and are not peer reviewed, and those that are peer reviewed rarely stand the test of time.

Thanks for the response but that wasn't me who asked that question.

@ Science Mom
Oops sorry, the response was for Secret Cisco
Anyway, I think that Sadmar, Eric and I have answered your question. But I go further than Eric: I think that the term "cargo cult science" could be applied to many practices of biomedical science.

@palindrom #9:

It’s always rather funny when folks show up and accuse him of not knowing what he’s talking about.

Graduates of the University of Google truly enjoy creating their own reality.

A major problem with high impact factor journals is the peer review process. Most of the papers submitted to these journals are rejected by editorial decision, and are not peer reviewed, and those that are peer reviewed rarely stand the test of time.

This is a separate issue of gaming the system. In this case certain journals (particularly Nature and Science; I can't speak to other biomedical journals because I am not in the field) act in ways that are intended to maximize their impact factor, because the bean counters who control university library budgets look at that number when deciding which journal subscriptions to renew. So these journals tend to go for controversial papers on the cutting edge that are likely to draw multiple citations within two years of publication.

Not surprisingly, many of these controversial papers, because they are on the cutting edge, don't hold up. Some of that is honest error: preliminary findings that don't hold up, and such. The bigger issue is that scientists committing actual research fraud are likely to be writing controversial, cutting edge papers. The peer review system is not designed to detect fraud--reviewers don't have time or resources to duplicate results, so they have to assume (and at least 99.9% of the time this assumption is correct) that the authors of the paper did the described research and obtained the described results, and the reviewers are asked whether the methodology is sound and the data support the conclusions drawn. This is how, to name two examples, Woo-Suk Hwang's cloning work and Jan-Hendrik Schön's work on organic LCDs got published in Science, even though the work was not actually done.

I have no evidence that the proportion of fraud among authors who publish in alt-med journals is significantly different from authors in more mainstream journals. The peer review issues there are more often reviewers ignoring (whether willfully or by simply not knowing better) things like methodological issues and conclusions that happen to flatter the reviewer's viewpoint but aren't supported by the data.

@ Eric
When fraud is involved, editors cannot be blamed. But there are many examples like this one:
http://www.ncbi.nlm.nih.gov/pubmed/25554788
where there is nothing fraudulent but conclusions cannot resist at close examination and obviously there is a peer review problem.
In addition, do you think that editors of high IF journals are really good at knowing what will be important or not? For example the discovery of the adaptive immune system of bacteria by Mojjica has been serial rejected for 2 years by these journals.

@ Eric Lund:

Organic LCDs?
Are you serious?

Denice Walter
from:
http://www.science20.com/science_20/jan_hendrik_schön_world_class_physi…
"As book author Gary Taubes, no stranger to ferreting out bad science, said in in an interview here:
I used to joke with my friends in the physics community that if you want to cleanse your discipline of the worst scientists in it, every three or four years, you should have someone publish a bogus paper claiming to make some remarkable new discovery — infinite free energy or ESP, or something suitably cosmic like that. Then you have it published in a legitimate journal ; it shows up on the front page of the New York Times, and within two months, every bad scientist in the field will be working on it."

I am pretty sure that the cleansing method would not work in biology or medicine.

@Denice: I may be misremembering exactly what Schön claimed to be working on (I've read the book about that case, but it was some years ago and I don't have it handy), but it was something along those lines. He worked at Bell Labs, and if his research had been genuine it would have been potentially quite profitable.

@Daniel: The editors are of course guessing at what will be important, and I expect they aren't significantly better at it than a team of trained monkeys.

One of the ways peer review is routinely gamed is that corresponding authors are typically asked to suggest up to five potential reviewers for papers. (At least that's true of the journals I am familiar with.) Of course the corresponding author will tend to list reviewers who are likely to be friendly, so a good editor will choose at most one reviewer from that list and at least one reviewer who is not on the list, to minimize if not counter the effects of the author trying to game the review. For specialty journals, at least in my field, editors are likely to have a good idea who's who in the field, so the system works reasonably well. But for journals with broader scope, the editor is less likely to know potential reviewers with expertise in the field, so a lazy editor might succumb to the temptation to pick both reviewers from the author-supplied list. Or in other cases the corresponding author submits to an editor known to have a friendly viewpoint (almost certainly the case for CAM-focused journals), and the editor obliges by choosing reviewers with a friendly viewpoint, even if they weren't on the author-suggested list.

In this case certain journals (particularly Nature and Science; I can’t speak to other biomedical journals because I am not in the field) act in ways that are intended to maximize their impact factor, because the bean counters who control university library budgets look at that number when deciding which journal subscriptions to renew.

I tend to doubt that either Science or Nature is going to fall off of anybody's acquisitions list any time soon. Moreover, libraries are locked into package deals with the likes of Elsevier and Springer. For what's left, I suspect that actual utilization data are more compelling than IF.

Ahh, the good old days. It's unfair, really - I've spent 7 years at university, 4 of them at medical school, a total of 17 years in the medical field and never have I had the opportunity to jeer at a passing parade of homeopaths.

No fears, forgotten one, your chance shall come, as the woo movement buys their way into our practices and institutions.
IV vitamin C all around, for no physiologically apparent reason!

@ Narad
IF counts even for Science and Nature because the activity of editors can be easily evaluated by those who pay them.
And the easiest way to have a big IF is to publish papers in a HOT topic, i.e. not conceptually new. So the basic recipe for these journals is "papers on at HOT topic", for the IF + papers by reputable teams with a lot of data, for seriousness + papers able to make the headlines of newspapers, for the sales".

@Cuortnay the

You should read some scientific journals that prove the efficacy of certain alternative treatments or cam

gambit is usually played by those who haven't a clue what they are talking about. Care to share some of these Journals and I assume you do mean peer reviewed journals and not journals created by quacks for quacks.

@ John Phillips
Quacks are quacks peers.

Quackers, :)

Also, seemingly if someone is willing to pay for a treatment it must be good

The same could be said for about everything on the market. This includes:
- GMOs
- things at the dollar-bargain shops (the ones surprisingly sturdy enough and the ones breaking after 2 days)
- ersatz-cola (enter your lest favorite brand and flavor here)
- animal extremities (ears, feet...) and internal organs
- Californian camembert
- Australian champagne
- lutefisk

Actually, almost nothing on this list is inherently bad*; their marketing appeal mostly boils down to matters of preferences and tastes.
Now, as for being good for your health... I dare say some other metric other than them being on the market must be measured.

I will also dare anyone believing in the quoted sentence to approve and buy/eat everything I named here, and then some.

* the exception is Californian camembert

Indeed, I happen to love fresh pork hocks for my pasta cause and as my local region doesn't have that as part of its cuisine, I have to substitute pork necks.
Something that both are somewhat unhealthy on a regular basis, but innocuous on an occasional basis.

As for dyslexia, it comes in multiple flavors. I'm dyslexic, but heavily trained to compensate and it usually only creeps up when I'm fatigued. My wife, her dyslexia was never detected and training initiated until our marriage, so her compensation is less effective.
Our eldest is also dyslexic, but trained and compensated well enough for her to acquire her RN degree.

*least favorite", not lest

Dyslexia? I did "opposite to best" --> "start with a 'l' --> "lest"
Or was it "better --> best", "lesser --> lest" ?

Need coffee.

Honest question ( seriously, not jaqing off), sCAM deals with a bunch of things medicine can't [(chronic pain, self limiting conditions like seasonal depression, and side effects of proper treatment like chemo, etc) there are pharmaceutical ways, but dependency and negatives are the reason we don't]. Most of those "studies" do show an improvement, albeit a placebo equivalent, but above non treatment. The question is, is it beneficial to give a nod nod wink wink to the quacks that don't promise the moon to increase quality of life, or tell the patient the best they are going to get is dumping insane amounts of money to feel like they are doing something?

@But I Play One on T.V,

This has been discussed here many times, and different people have different opinions.

In order to recommend a placebo treatment, you
- have to lie to the patient, which some consider unethical;
- endorse treatments which have no actual therapeutic effect; and
- potentially put the patents at further risk.

An example on that last one. Some time back Orac commented on a study that showed that people with asthma reported an improvements in asthma attacks after placebo treatment, but that objective measurements showed no actual improvement.

Here is that study:
http://scienceblogs.com/insolence/2011/07/18/dangerous-placebo-medicine…

Let's see, we're to question the Rand Corporation's integrity, Right? But more than that, integrative medicine's validity or right to exist kind of thing. I have a dear, dear relative in the traditional medicine business, plus several relatives have been nurses, and others strove to find key answers regarding illness, and they are: What's the cause; what's the cure? Is it only modern medicine that is symptomatic essentially? No. Nearly all medicine, be it alternative, allopathic, Chinese, alternative, etc., in fact, all medical applications use various methods of relieving symptoms. Okay, I get it, but some want to find a cure, too. Does modern medicine seek to do that and if so why do they stay stuck in the same methods that don't generally work? One of the greatest and most effective ways to reverse heart disease is rest, diet and light exercise. Instead, modern medicine and many alternative medical solutions try to reverse heart disease with drugs, bypass, etc. Essentially, it's an evolutionary mess but may be getting better. Why? Because so called quacks are busy trying to find answers to health problems traditional medicine is failing at. Are they, the quack contingency simply another example of snake oil salesmen (it's almost always a male doing it), or is the term, quack a misnomer? In many cases a misnomer. These folks want to get rich, they want to be heroes, they want to save people and get the strokes that may be heaped upon them along with more wealth. There's a huge incentive to find cures, for one thing it can be fun, yes, fun! How? For example, a young girl is being diagnosed by a "quack," the girl's mother heard good things about. Mainstream medicine had her, briefly on Retinol, but it as disastrous and the mother, desperate sought the quack not a quack, more to the point, an explorer/innovator and a little neurotic but very intelligent, after all, with a society like ours how can anyone be normal if they have a tad more intelligence than normal? The girl, let's call her Gilliam, couldn't sit still, she was disruptive in class, and even her mental health was in question. The, let's call him The Innovator/quack, talked to the mother but keeping his eye on Gilliam, and then he said to her, Gilliam, that is, "Gilliam, you're mom and I are going to step out of the room for a little while." As he was leaving he turned the radio on to a music station. When the mother and he got out of the room and closed the door, he said, "Mrs. Lynn, watch your daughter.," who was up and dancing to the music, "Gilliam doesn't have a mental problem, she's a dancer, enroll her in a dance class." Problem solved. It's also a true story, quote from Wikipedia:
Dame Gillian Barbara Lynne, DBE (née Pyrke; born 20 February 1926) is a British ballerina, dancer, choreographer, actress, and theatre/television director, noted for her popular theatre choreography associated with the longest running show in Broadway history, Cats and The Phantom of the Opera. At age 87, she was made a DBE (Dame Commander of the Order of the British Empire) in the 2014 New Year Honours List.
In this day and age, traditional medicine would have put her on a drug to calm her down, call her ADD/ADHD or something and she would never have become what she became. You can talk all day about how holistic medicine, Chinese herbs, homeopaths, etc., are quack, but remember the vipers/ghoul who did away with homeopaths, Rockefeller and Carnegie with only one thought in their greedy like minds, profit and they couldn't make it on natural remedies, but natural remedies are nearly always the only remedies that can cure unnatural chemical causes disease. Consequently things that seem too far out are used, like fasting, exercise, chiropractic (I had a horrible back pain for three years in my upper back and saw a chiropractor in Aberdeen, WA, who did an X-ray and found my neck was out of line, in one manipulation he cured my problem and I've never had it come back. Cost: 25.00. I went to a regular doctor and he recommended Tylenol, and nearly everybody recommended an OTC alternative. Maybe Rand C. may seem self-serving, and maybe they are but there are many of us who help and are chagrined if we fail but try harder next time. There's a thing called brain-storming, the Internet is a written form of brain storming and the best ideas come from the freedom to say something, anything, that may sound stupid, crazy, brilliant, etc., and what can happen is, a solution will nearly always be found or there is none.

The fallacy of moderation at BMC Complementary and Alternative Medicine

oracknows — Tue, 17 Sep 2013 01:00:25 +0000

The fallacy of moderation at BMC Complementary and Alternative Medicine

One of the fun things about blogging is that I can often follow how various issues develop and, more importantly, insert my opinion into the issue. As bizarre as it seems to me even almost nine years after starting this blog that anyone keeps reading what I have to lay down (and it still does seem bizarre that anyone cares much what I have to say every day, but several thousand of you apparently do), that's what I continue to be here for. Last month, I wrote about an editorial by the director of the National Center for Complementary and Alternative Medicine (NCCAM) in which she called for a "nuanced conversation" about "complementary and alternative medicine" (CAM, or as it's now called these days, "integrative medicine"). As you might imagine, I wasn't impressed. Indeed, what I lay down here day in and day out is a nuanced conversation about CAM, at least as nuanced as it deserves on a scientific basis. Not long after that, there was an article in The American Journal of Medicine about the "future of integrative medicine." Personally, I was unhappy that the "future is now" when it comes to integrating quackery into real medicine.

Barbarian that I apparently am when it comes to CAM and "integrative medicine," I couldn't help but be amused when you, my readers, sent me a link to a post on the BMC Series Blog by Tom Rowles entitled Striving to bring balance to the complementary medicine debate, which uses Brigg's editorial and the article about the future of CAM as a jumping off point. It occurs to me: Whenever I see the word "balance" coupled with the word "debate" and the term CAM (or any related term), I know I'm in for a whole lot of the logical fallacy known as the fallacy of false balance, also known as the fallacy of the golden mean or the fallacy of moderation, and the author of this post, Tom Rowles, doesn't disappoint. While not-so-subtly denigrating skeptics and supporters of science-based medicine who criticize the pseudoscience and quackery that are at the heart of so much so-called CAM or "integrative medicine." When faced with a science-based medicine versus the pseudoscience and quackery of so much CAM, Rowles touts how the BMC takes a "balanced" approach, which basically means in most cases, splitting the difference, proclaiming in the very first paragraph:

Is a balanced outlook on complementary medicine research even possible? BMC Complementary and Alternative Medicine would like to think so, and would like your help to achieve this.

I'd be more than happy to help the BMC out, but I doubt they'd like my version of a "balanced" solution, because my balance would require completely eliminating balance. There is no need for it; either a treatment is science-based, or it is not. Yes, I know there are gray areas, but in most cases with CAM we aren't talking about gray areas. For example, homeopathy is not a "gray area." It is pseudoscience. Similarly, even areas of CAM that are presented as "science-based" are, more than anything else, a triumph of "rebranding" science-based modalities (diet, nutrition, and exercise, for example) as being somehow "alternative." Either that, or CAM "woo-ifies" science-based modalities like nutrition by insisting that you need all sorts of supplements that you do not, in fact, actually need, or layers all sorts of mysticism onto exercise, as in yoga and Tai Chi.

Next up, Rowles then, seemingly intentionally, trivializes the criticism of CAM as being just another disagreement. Just like Marmite, you either love it or hate it:

Whatever your stance on Complementary and Alternative Medicine (CAM), whether you feel that it is an important part of healthcare that should be taken more seriously, or whether you denounce it as ‘quackery’, I think we can all agree that it is a subject that generates strong opinions. To use a comparison that I’m afraid will probably only work for our British readers, it is the Marmite of the medical and scientific world: You either love it or you hate it.

It kind of makes CAM and science-based medicine seem like different foods, styles, or other things that individual tastes determine whether a person likes them or not. Maybe this season CAM will be in style and next season SBM will be the taste du jour. Don't like SBM? Hey, try CAM! Or vice-versa! So when Rowles notes that both of the above articles "negative reactions from the anti-CAM ‘blogosphere’ and much debate in comments sections," I can't help but wonder if in part they're referring to me, given that it's really only been at most a handful of bloggers who wrote about the article. Or maybe it's just my massive ego. Who knows? Who really cares? (Well, actually, given my massive ego, I do.)

In any case, Rowles touts the utter superiority of BMC Complementary and Alternative Medicine (BMC CAM) based on what he proclaims as its scrupulous effort to "remain neutral." But, what, exactly, does that mean? What is "neutral" with respect to SBM versus CAM? Rowles is no help:

We fervently believe that research into alternative therapies is important and necessary, with regards to both positive and negative results (see this previous blog for more on our position on negative studies). We feel that it is only with this balance that any truly beneficial CAM therapies will make their way into common practice. However, to do this requires a circus-worthy tightrope walk between open-mindedness and scepticism which can sometimes be difficult to maintain.

This is typical nonsensical CAM-speak. Rowles claims that BMC CAM is neutral in such a way that requires walking a tightrope between open-mindedness and skepticism, but admits that it "fervently believes"—not just "believes," but "fervently believes"—that research into alternative therapies is "important and necessary." Moreover, they justify this fervent belief by appealing to such research as the only way that "truly beneficial CAM therapies" will enter into common medical practice. Here's my fundamental disagreement, and it's a simple one. I reject the entire category of CAM as a false category and the division between SBM and CAM as a false dichotomy. To me, any medicine or treatment, regardless of where it comes from, should have a valid scientific rationale rooted in good basic science, and it must have valid evidence from well-designed clinical trials to support its efficacy and safety. If an "alternative therapy" can achieve that, then I have no problem adopting it as "medicine." As the oft-repeated cliche goes, attributed to skeptics as diverse as Richard Dawkins and Tim Minchin, by definition, alternative medicine is either proven not to work or unproven. Medicine that is proven to work scientifically ceases to be "alternative" and becomes just "medicine."

Rowles does do an interesting thing, though, for a CAM apologist (and, make no mistake, he comes across as a CAM apologist in this blog). Sure, he appeals to science, as most CAM apologists do, and claims to be extra super rigorously scientific (or, in this case, that BMC CAM is extra super rigorously scientific) in addition to being totally neutral, but he also echoes the arguments of supporters of SBM like me and insists that BMC CAM is not only extra super rigorously scientific but that it also insists on a plausible scientific mechanism by which a CAM treatment can work before publishing studies on it in the journal. Unfortunately, he misses something. Can you tell what it is? Here's the paragraph:

We do this by always keeping in mind that we are, before everything else, a scientific journal. This is why we are generally unwilling to consider any manuscript on therapies that do not have a clear underlying scientific rationale. It is also the reason that you will very rarely see any studies dealing with energy therapies or homeopathy within the pages of BMC Complementary and Alternative Medicine.

That's right, maaaan! It's science! Well, except for those pesky energy therapies and homeopathy, which we ~~never~~ only rarely publish. When it comes to pseudoscience and quackery, it is apparently possible to be a little bit quacky, just like it's possible to be a little bit pregnant. Wait, strike that.

Out of curiosity, I searched the journal for "homeopathy" and found quite a few articles. Most were more general articles about CAM that must have mentioned homeopathy, but there were several studies of homeopathy, including a protocol for the homeopathic treatment of irritable bowel syndrome, a model for homeopathic effects based on nanoparticles (one of the favorite explanations that aren't for this particular quackery these days), homeopathy for mental fatigue, and even in vitro studies of homeopathy. It's even a study that I blogged about! There's also the odd study on various energy therapies here and there.

Unfortunately, its claims for scientific rigor not withstanding, BMC CAM seems willing to publish about most forms of CAM, although admittedly my perusal of the tables of contents of the journal revealed a preponderance of articles on herbs and natural products. Regular readers can probably predict what I'll say about that: Studying natural products is not "alternative" or "complementary." It is the very old, very science-based subdiscipline of pharmacology known as pharmacognosy, a.k.a. natural products pharmacology. It does not need its own "alternative" journal; there are plenty of pharmacology journals that publish lots of pharmacognosy studies. Segregating studies like this in CAM journal and mixing them in with studies of homeopathy does nothing for the credibility of herbalism or herbal remedies.

I'll finish by reiterating a one of the key themes of this blog since its inception in 2004, and that's SBM doesn't distinguish between "alternative" and "conventional." There should be one science-based standard applied equally to all medicine. The problem, of course, is that the vast majority of CAM fails that standard from the standpoint of scientific plausibility, basic science, and clinical trials. Rare it is that a CAM therapy can meet that standard—incredibly rare. Indeed, the vast majority of CAM is no better than an elaborate placebo justified by misguided claims of "neutrality" and and rigorous therapy that is no more than what Harriet Hall refers to as "tooth fairy science."

oracknows Mon, 09/16/2013 - 21:00