The stupid truly burns brightly in this one. Dana Ullman, known to readers of Respectful Insolence, Science-based Medicine, and this blog as Hahnemann's cognitively impaired bulldog, has started blogging at the Huffington Post. It's certainly an appropriate venue for his brand of cult medicine belief, but that doesn't make it any less painful. His inaugural piece, entitled The Wisdom of Symptoms: Respecting the Body's Intelligence betrays a stunning level of ignorance of basic human biology.
I have good and bad news about the human body: it is neither wise nor foolish, good nor evil, nor is it simple in any way. It is a complex system where few simplistic explanations suffice. It would be nice to believe in "feed a cold, starve a fever" and other simplistic pablum, but things are rarely so simple. This is why there is a science to medicine---our instincts and hunches often betray us, and only by studying the body systematically can we form valid conclusions.
Or, if you're lazy or deceitful, you can just make shit up.
Which brings us to Dana Ullman who has come up with the shattering
observation that, "just because a drug is effective in getting rid
of a symptom does not necessarily mean that this treatment is truly
curative (or even helpful)."
Really? I never would have
guessed that---which is why I read the literature, which is pretty
damned clear that sweeping generalizations such as this are
meaningless. Take the symptom of chest pain---if you don't know the
likely causes of a case of chest pain, you won't know how to work it up
or treat it properly. Giving someone nitroglycerin may make a patient
feel better, but may indicate a cardiac etiology or an esophageal
etiology. If you simply treat the pain with nitroglycerin without
treating the underlying cause you may cause someone to die. That would
be a bad thing. His "revelation" simply reveals how ignorant he is
about current concepts of human medicine.
His ignorance, rather
than giving him pause, leads to more senseless expostulations. He goes
on to write about the "wisdom" of the body, whatever the hell that
means.
Our human body has survived these thousands of years because of its
incredible adaptive capabilities, and one of the ways that it adapts is
through the creation of symptoms. Whether it be through fever and
inflammation, cough and expectoration, nausea and vomiting, fainting
and comatose states, and even the variety of emotional and mental
states, each symptom represents the best efforts of the bodymind to
fight infection and/or adapt to physical and psychological stresses.
What an ignorant load of horse shit. First of all, "the human body"
has not "survived these thousands of years". As a distinct species we
are a couple of million years old, more or less. We have survived
because we have survived. If we hadn't survived, we wouldn't be having
this discussion. Human beings have been generally able to reproduce at
a faster rate than we die. Our bodies work very much like other
mammals (and other vertebrates for that matter). While vomiting may be
"beneficial" when it is caused by a toxic ingestion, it is not so
beneficial when it is caused by increased intracranial pressure.
Although symptoms may be the best effort of the organism to defend
itself at that time, it is not usually effective to simply let the body
try to heal itself. Most often, some treatment must be provided to help
nurture, nourish, and augment the body's own wisdom. The challenge to
physicians, healers, and patients is to determine when to help aid this
inner wisdom of the body and when to intervene to make certain that the
body does not harm itself.
One can view the human body in one of two fundamental ways: as a
typical biological organism that is subject to the usual laws of
physics, chemistry, and biology, and therefore understandable through
systematic investigation; or as some sort of mystical thing infused
with an elan vital,
subject to the whims of the supernatural and fundamentally mysterious.
It's pretty easy to verify which is a better model of reality, and
which is a fundamentally arbitrary fantasy.
What Ullman is
leading to is a fetishization of symptoms. He elevates the subjective
experience of illness to a magical force for good. I have bad news for
you, Dana: symptoms are a biological phenomenon which are neither
inherently good or bad.
Nesse and Williams show how our symptoms and seemingly normal body functions work as important defenses:
- Fever is an important, even vital, defense against infection.
- Tears help wash and cleanse the eyes.
- The respiratory system is bathed in antibody and enzyme-rich
secretions that are propelled up and down the throat and bronchial tree
so that invaders are killed.
- The ears secrete an antibacterial wax which helps to fight infection.
- The frequent washing of the mouth with saliva kills
some pathogens and dislodges others so that the stomach's acid and
enzymes can destroy them.Without having to tell the bodymind what to do, our innate survival
instinct has developed sophisticated responses to both old and new
infections and stresses.
No,
no, no! I'm wondering if this guy is even educable. Fever is not some
magical defense against infection. Fever is (usually) caused by the
release of certain cytokines as a reaction to many different stimuli,
especially infection. There is no evidence that suppression of fever
prevents healing. The "discovery" that tears help cleanse the eyes his
hardly groundbreaking. None of these support his assertions about our
"innate survival instinct". Now, if Ullman had actually bothered to
learn some immunology, he'd be blown away by the beautiful truth. Our
bodies have evolved very sophisticated defenses against malignancy and
infectious disease. The truth is much more complicated and interesting
than Ullman's oversimplification.
This type of teleologic
thinking is child-like. Confounding a reaction with a purposeful,
beneficial response is idiotic. For example, hypertension can cause
compensatory thickening of the heart muscle, analogous to a biceps that
grows with weight-lifting. Unlike a biceps muscle, this thickening is
not beneficial. While it temporarily keeps the cardiac output up, it
leads to accelerated heart damage, and eventually heart failure.
Having
established his fundamental misunderstanding of biology, Ullman tops it
off with praise for his pet medical cult, homeopathy.
The implications of recognizing that symptoms are efforts of the body
to defend itself are significant. Because some conventional drugs work
by suppressing symptoms, these drugs tend to provide helpful
temporarily relief but tend to lead other new and more serious problems
by inhibiting the body's defense and immune processes. Such drugs
should be avoided except in dire situations or in extreme pain or
discomfort when safer treatments are not working fast or adequately
enough.
In
other words, based on his own fantasy about how the body works, doctors
have it all wrong, but thankfully, he has all the real answers without
having to perform all that pesky science.
Because symptoms are adaptations of the body in its efforts to defend
and heal itself, it makes sense to use treatments that mimic this
wisdom of the body. Ultimately, homeopathic medicine is a well-known
therapeutic modality that honors this wisdom of the body. Homeopathy is
a type of "medical biomimicry" that uses various plant, mineral, and
animal substances based upon their ability to cause in overdose the
similar symptoms that the sick person is experiencing.
This only "makes sense" if you buy into the false assumptions about human biology.
There
is no way to state this forcefully enough: Dana Ullman is an ignorant
twit who leads a fringe medical cult which promulgates dangerous
falsehoods.
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Maybe I'm just too immersed in rational and reasoned thought, but I simply can't understand how anyone who actually knows the claims of homeopathy can possibly believe that crap. It doesn't make any sense.
But he's an "expert in homeopathic medicine"...
Seriously, the HuffPo continues its downward spiral around the toilet bowl.
I guessed correctly. Reading through his sorry writing, I figured out that his woo was homeopathy. His "bodymind" sounds like older ideas given a cutsey name, but it's still a load of horsepuckey. Given his preference for letting our body heal itself, do you supposed he'd just have a lie down if he got a vein punctured, or got infected with ebola, or do you think he'd be going to a doctor faster than you can say "idjit?"
unreal shit. I honestly don't understand how homeopaths sleep at night, unless they're amoral con artists.
oh wait! they are!
Why didn't I think of that? How silly of me to not recognize that altered mental status, rapid thready pulse, and falling diastolic BP are good for us, and are indeed what the patient needs to cope with an imbalance in vital forces.
Congratulate the family and send them on their way, obviously, since the body has the innate wisdom to apply these symptoms in a way that will restore perfect balance. Or thermodynamic equilibrium, anyway.
"thermodynamic equilibrium"
Spit take!
Thank you, Doctor. I seem to be on a roll. Yesterday it was "Estrogen-Americans."
I confess that the "homeopaths accusing Real Medicine (tm) of being all about symptoms" schtick is one of my favorites. The joke is arguably too good to spoil for those who don't know homeopathic dogma.
Still, "symptoms are your body's wisdom doing what you need" reminds me immediately of closed-head injuries and compartment syndrome.
Not only was the article horrible, but the only comments that made it through are all in praise of him and homeopathy. I can't believe how gullible some people are.
It was 25 years ago that a co-worker (at a job where neither of us had much to do) gave me a book on homeopathy to read. I read it. And I wondered what happened to the basic chemistry I was taught in high school if anything in it were to be true.
Were I to state that I'm not the brightest bulb in the chandelier, I'm sure I'd get some "amens" from the commenters here... but damn, I ain't that dumb. Homeopathy has got to be the biggest crock of you know what out there.
Ick. I'm reminded of the stories of Catherine of Siena drinking her patients' pus and vomit, and Angela of Foligno drinking the dirty bathwater of lepers.
Remind me next time I'm nursing a child in febrile convulsions (a couple of particularly bad teenage experiences of mine), waiting for the ambulance, that cold-sponging and putting her under a fan is impeding her natural response to infection. [expletives deleted]
Something about the "word" bodymind sets my teeth on edge.
Argh, quote fail.
Here's another new low: Intigrative physician Dr. Frank Lipman urging patients not to vaccinate against pandemic H1N1, and instead recommending homeopathic oscillococcinum to boost the immune system.
http://www.huffingtonpost.com/dr-frank-lipman/swine-flu-what-to-do_b_28…
I'm not so into alternative treatment (aside from inconsistent omega 3-6 use) but I don't understand your point about fevers. For instance a fever in children is not usually a sign of some life threatening illness leading to seizures, in traditional medicine many pediatricians encouraged leaving a low end fever alone.
http://www.mayoclinic.com/health/fever/DS00077
"Usually a fever goes away within a few days. A number of over-the-counter medications lower a fever, but sometimes it's better left untreated. Fever seems to play a key role in helping your body fight off a number of infections."
My rule of thumb as a mom is if it's under 101 and my kid seem comfortable I leave it alone. If it's over OR there's discomfort I use tylenol. If the fever goes on over 3 to 5 days (depending upon week-end) I call the doctor for appt. If the fever is high and not responding to tylenol I go to ER (it's never happened, but that's my plan ;)
I'm sure from an expert level you are seeing subtles that are lost to me as a layman. From a laymen's perspective you just seem a little nitpicky. If you are trying to convince patients (which I know is not your audience here) then it doesn't hurt to used some of the warm friendly terminology like "mind/body". Do you know what mind/body means to most people? If you try to do some things to relax and gain a broader perspective, maybe do some exercise like yoga or taking a walk you might feel better. Is that so controversial?
I believe people use things like homeopathy and herbals for that little everyday malaise that doctors are no good at anyways. When they get truly sick they turn to traditional medicine.
Do you disagree?
It is not clear what you are asking.
@Avi:
I suspect that some of them aren't entirely serious.
Gosh, it seemed reasonably lucid when I typed it. But that happens to me. I guess I have two or three questions.
Do you find that a good percentage of sick people with diseases that can be helped by modern medicine are using homeopathy instead? (let us assume that the people commenting on the HuffPo article are not a good selection)?
2) Do you think if doctors used terminology like "body/mind connection or the body's natural defenses" but suggested the same treatments they would be more convincing to some patients?
3)I've always heard from reading sites like mayoclinic.com and talking to our Pediatrician that a low end fever (under 102F)is good for fighting the infection. To give medicine when the fever is higher or for discomfort. ( Which sounds kinda like "Fever is an important, even vital, defense against infection.") Is that not true?
So, no offense, but whenever I go to my doctor (not our pediatrician), they seem kinda impatient with my minor problems. In fact so am I. But then all these docs on this site seem very offended that people are looking for other options. I don't get it.
No. The actual use of what most of us would agree is alternative medicine is quite low in this country. if you exclude the various vitamins that my patients take but may or may not need, very few of them use altmed to a significant degree.
I think any good physician knows how to communicate to an individual effectively without distorting reality beyond its breaking point. Creating a palatable message is part of the art of medicine.
There is little reason to treat a moderate fever unless it is causing discomfort, but neither is there evidence that a fever has significant benefit.
PalMD "No. The actual use of what most of us would agree is alternative medicine is quite low in this country. if you exclude the various vitamins that my patients take but may or may not need, very few of them use altmed to a significant degree. "
I don't get it then. Why does it bug you so much?
micheleinmichigan: Why doesn't it bug you? People like Dana Ullman are directly promoting sickness and disease. Are you saying we shouldn't worry about it, because they haven't been that successful (yet)?
@Micheleinmichigan:
Because:
1) Consider an analogy. The number of people taken in by Ponzi schemes is also quite low. Doesn't mean Ponzi schemes don't bug me.
2) There is a small number of people that adopts alternative treatments for life-threatening conditions. They die because they go to an alternative physician instead of taking the medicines they actually need.
To give an example of the latter: A friend of mine works in a pediatric hospital. She's been confronted multiple times with kids who she treated, gave a medicine, and subsequently had to treat again in a much worse state because the mother decided to try alternative medicine instead of the treatment she prescribed.
There is as much art to medicine too. For example, a couple years back I started getting serious vertigo and severe hearing loss in the left ear.
Saw my doctor, he referred me to an ENT. The ENT ran tests galore, including a head MRI, etc. and nothing.
Here's the interesting part. It was my allergist who I've been seeing for 30 years who figured it out. I happened to be at his office for my annual allergy review and he asked how things were going and I told him about the ear thing.
He took a look and told me yes, the eardrum was retracting. He reminded me of the ear infections I had as a kid and explained that those leave lots of scar tissue and that generally once you hit your 40's is when the fun starts.
Oh joy! Here's the thing that gets me, the head MRI, they were looking for brain tumor but if they'd scanned a few cm down they would have seen the retracting eardrum and the scar tissue.
Doh!
Congrats to Dana on his new column! I'm looking forward to more squawks of outrage on this and other blogs!
Thank you so much for answering my posts. I was checking out the scienceblogs/medicine looking for information genetic counseling for my son. I did not find that, but the medicine blogs seemed to be filled with this avid criticism of alternative medicine. Which I have always viewed as the sort of harmless crazy aunt of medicine. I guess I took it as picking on old aunt Florence.
Most of my experience with folks who try alternative treatments are friends who have a problems that their doctor hasn't been able to help. acupuncture for migraines, massage for muscle pain, supplements or eliminating wheat or gluten, etc. People who are more extreme, I've always considered to be more willfully ignorant like people who refuse to try to quite smoking.
Having read your comments and having surfed through your and some other blogs, I do see where you are coming from, now. As a parent, I just didn't imagine another mom treating a sick child with an alternative remedy when you have prescribed medication available. It is just outside my scope of experience and it makes me very sad.
Thanks again for taking your time to answer.
I found this blog by typing into google "why does Huffington Post allow quacks to write columns?" I have complained to their editors several times, which is not easy since their contact information does not really envision that people will have any questions about the editorial content.
Some of what I have seen promoted on there strikes me as merely stupid, and some of it as profoundly dangerous. The fact that these crazy, harmful beliefs are on a website with news content makes it infinitely worse: a mother with a newly diagnosed autistic child has a real danger of getting on the net and having the anti-vax movement be the first thing that she finds. And to the extent that you can scientifically prove a negative, the link between vaccinations and causation of autism has been scientifically disproven. Tonight I read an article about how giving antipsychotics or stimulants to children is chemical lobotomy. Encouraging the public to end the psychiatric abuse of children. It deforms their brains!
I am not sure why they are doing this, but I'm wondering what the reality-based community can do to stop it. Woo is getting so pervasive as to be a force of its own, spreading through the networks with the help of places like HP. Reality is a good deal more complex and it takes effort to understand the science behind imperfect understanding of some things. How are we ever going to attract people to embrace the gray of what is genuine, when these charletains can milk them for millions promoting things that are shiny and empty?