I realize that I've been very, very remiss in attending to a task that I've been meaning to get to since late January. There are several reasons, albeit not excuses, for why I have failed to do this task. Perhaps the most powerful impediment to my overcoming my inertia and just diving in and doing what needs to be done is that it depresses me to no end to contemplate what needs to be contemplated to complete this task. Moreover, although I have completed a great deal, I sense that I have barely even scratched the surface of what needs to be done to complete the task, which also continuously expands.
I'm talking, of course, about my long-promised update to my famous (or, depending on your point of view, infamous) Academic Woo Aggregator.
Yes, the last time my poor Woo Aggregator was updated, there was snow on the ground, given that it was late January. It didn't take me long afterward to find out that there were some academic hospitals that had missed my loving attention and publicity, but I decided that I would wait until I had gathered several more and then do a mass update. The problem, of course, is that as several more accumulated I became more depressed at contemplating the task. Remember, before I place an institution in the Woo Aggregator, I have to delve deeply into its "integrative medicine" website and see just what "alternative" medicine it offers, as well as figure out just how credulous I think its attitude is towards unscientific medicine. Meanwhile, I dithered on whether I should start listing woo-friendly academic medical centers outside of North America in order to make the list more comprehensive. All in all, it was a recipe for inertia.
So, to my shame, I just things lapse. Weeks turned into months, and now here we are almost at Memorial Day. The weather has turned warm, and the foliage in our backyard is in bloom. I even need to cut the lawn! And still I haven't updated the list.
Then David Colquhoun of DC's Improbable Science posted a report of his recent visit to Yale University, where discussed a recent conference that had been held there in April entitled the 1st Annual Integrative Medicine Scientific Symposium. I had heard about this symposium around the time it occurred when I came across this post, but couldn't find out enough about it to figure out whether it justified a new post or not. It soon slipped my mind.
And then I read Colquhoun's account of his talk there, and, more importantly, I perused some of the nearly three hours of video from the conference that is now available on YouTube, the three parts of which I am appending to this post for those who are interested in seeing for themselves. I didn't have time to watch all of it, but what I watched was disturbing and enough to conclude that the situation at Yale was far worse than I had imagined. Quackademic medicine was invading! Bigtime! This called for a STAT brief update to the Aggregator to add Yale to it at the very least.
Why?
David L. Katz, MD, MPH, FACPM, FACP, is founder and director of the Integrative Medicine Center (IMC) at Griffin Hospital in Derby, Connecticut. He is also an associate professor, adjunct, of Public Health and director of the Prevention Research Center (PRC) at the Yale University School of Medicine in New Haven, Connecticut.That sounds pretty respectable. But he is into not just good nutrition, exercise, relaxation and massage, but also utterly barmy and disproved things like homeopathy and 'therapeutic touch'.
Homeopathy? At Yale? Say it ain't so. Homeopathy is the one of the most utterly pseudoscientific systems of "medicine" there is, and the Director of the Integrative Medicine Service is into homeopathy? This is really, really bad. Although no mention of homeopathy appears on the poster, mentions of chiropractic manipulation, qi gong, and reiki do. Worse, after the Dean of the Yale School of Medicine embarrassed himself in the introduction by saying he's proud of how far this nonsense has come, Dr. Katz takes the stage and demonstrates the sort of hostile attitude towards science that, if allowed to take root will be the death of scientific medicine in any meaningful form at U.S. medical schools, in a talk apparently entitled Evidence-based Medicine and CAM: How Opposites Attract (at about 11:46 into the first part). It starts out very badly, as Dr. Katz asks:
Which of these two would we be more inclined to renounce, our dedication to science or devotion to the needs of our patients? And if there's a constant tension between, it seems to me that we are obligated to reconcile it rather than attempt to make a choice.
I wanted to vomit right there upon hearing that. Fortunately, I managed to restrain myself. In any case, Dr. Katz's statement is a mind-numbingly obvious false dichotomy. "We" physicians are not "obligated" to "choose" either CAM or scientific medicine, nor is it incumbent upon us to somehow "reconcile" the two. Medicine is medicine. It is either effective to varying degrees, or it is not, and the scientific method is how we discover which medicines and treatments are or are not efficacious. Dr. Katz's statement is also highly offensive to me, being nothing more than the usual "CAM" nonsense that implies that using scientific medicine alone is not enough to show adequate devotion to the needs of patients. Frankly, I was pissed off royally when I heard him say this. Dr. Katz then goes on to spout the usual CAM cliches about how we are somehow not "meeting the full needs of our patients." Even if it is true that we in the evidence-based medicine (EBM) community are not "meeting the full needs of our patients," his seeming implication that we must embrace pseudoscience and magical thinking to achieve that end is not. Dr. Katz even parrots the mindless alt-med cliche beloved of cranks and pseudoscientists everywhere that "absence of evidence is not evidence of absence," in other words, the classic argument from ignorance. Yes, well there is no evidence that there is an undetectable teapot orbiting the earth either; does that mean we must accept the contention of CAM believers that there is? At one point Dr. Katz asks:
So again, the conundrum we face as we commit ourselves to what clearly is one of the prevailing mantras in American medical education, evidence-based practice, the conundrum is, what do we do when the evidence we have learned, or perhaps if we care to be more provocative, with which we have been indoctrinated, does not fully meet the needs of our patients? What do we do then?
Ah, yes. Dr. Katz apparently views EBM as "indoctrination." Why am I not surprised? It's yet another classic "alt-med" trope. Perhaps the most over-the-top version of this oldie moldy was a hilariously overwrought article from a couple of years ago that referred to evidence-based medicine as "microfascism." Apparently Dr. Katz either concurs or is at least sympathetic to that view. After all, what is one of the major features of fascism (or even "microfascism")?
Indoctrination, of course!
This likening of evidence-base medicine to "indoctrination," not surprisingly, leads this brave maverick physician, who, true to the inflated self-image held by all too many in the CAM world, is clearly not "indoctrinated" like the rest of us sheep, to an amazing conclusion. After discussing several randomized controlled clinical trials (RCTs) that failed to find an effect attributable of CAM interventions over and above that of placebo, he says:
I think we have to look beyond the results of RCTs in order to address patient needs today, and to do that I've arrived at the concept of a more fluid form of evidence than many of us have imbibed from our medical educations...[Referring to a patient anecdote, Dr. Katz went on.] Now, we don't want you on narcotics anymore than you want to be on narcotics. We initicated a course of acupuncture and over the next two to three months weaned him off narcotics. He was pain-free on acupuncture and subsequently transitioned into homeopathy. Now, I don't care to get into a discussion of how or even whether homeopathy even works, but this guy had tried everything.
[...]
And the anecdotal evidence that homeopathy might be effective was brought up by the naturopaths. We tried it. It worked.
In other words, for Dr. Katz, anecdotal evidence trumps solid evidence from randomized clinical trials. Dr. Colquhoun describes this attitude perfectly:
This is not science. It isn't even common sense. It is a retreat to the dark ages of medicine when a physician felt free to guess the answer. In fact it's worse. In the old days there was no evidence to assess. Now there is a fair amount of evidence, but Dr Katz feels free to ignore it and guess anyway. He refers to teaching about evidence as 'indoctrination', a pretty graphic illustration of his deeply anti-scientific approach to knowledge. And he makes a joke about having diverted a $1m grant from CDC, for much needed systematic reviews, into something that fits his aims better.
Exactly.
To CAM aficionados, the problem with science- and evidence-based medicine is that it actually provides reasonably objective evidence suggesting to us as physicians what therapies do and do not work. Indeed, it doesn't even necessarily require all RCT evidence, as long as it's consistent evidence from well-controlled trials from multiple lines and sources of high quality evidence obtained in a scientifically valid manner. Even with all the uncertainties in EBM, though, it's still too constraining for "integrative" physicians like Dr. Katz because the expectation of EBM is that physicians will not use therapies for which there is no compelling clinical or scientific evidence--except as a last resort and even then only when the proposed course of treatment is at the very least scientifically plausible or justifiable. It also demands of us as physicians that we honestly inform patients when we are offering them something that has little or no evidence of efficacy, telling them to the best of our knowledge what the risks are in pursuing such a therapy. Of course, these are the problems with EBM for "integrative" physicians. Virtually all of the therapies that fall under the rubric of "CAM" or "integrative" medicine fail the most basic tests of EBM. Not only are they often completely scientifically implausible (think: homeopathy or reiki), but they reliably show no efficacy in randomized clinical trials better than placebo. Moreover, if CAM practitioners honestly told patients that, then most patients would, quite correctly, tell them, "Thanks, but no thanks." In any case, "integrating" unscientific, ineffective remedies with effective scientific medicine makes no sense, but that is what we are being asked to do by physicians like Dr. Katz: Accept the "integration" of woo with scientific medicine.
I've always wondered what's driving this move to woo in academia. For a while now, I've maintained that it's money. NCCAM, with its grants to study woo, no matter how implausible, and its grants designed to promote the acceptance of CAM through "education" and CAM practitioner fellowship training programs, is clearly one major force tempting institutions into this sort of pseudoscientific dreck. Dr. Colquhoun mentions the Bravewell Consortium, whose explicit goal is to fast-track integrative medicine into the mainstream and which, run by Christy Mack, is backed up by the incredible wealth of her husband John Mack. Also, Dr. Katz himself describes the economic forces that drive the movement to CAM:
For billing, whenever possible we are reimbursed by insurance, but if a patient doesn't have insurance or if insurance doesn't cover a procedure then there is an out of pocket expense. As far as the business structure goes, we use midlevel providers--so while I'm overseeing the clinic, a nurse practitioner does much of the hands-on care for the patients. And similarly, on the naturopathic side, Dr Ali is the director, but we also have a naturopathic resident. The hiring of a resident offers an array of benefits. To be blunt about it, doctors in training are inexpensive labor. You spend a lot less money on a naturopathic resident than you would on an experienced practitioner.
I've always said that it's cash on the barrelhead for CAM, along with simple, relatively inexpensive nostrums that can be marked up at quite a profit and mid-level practitioners to administer them and little or none of that pesky insurance claims paperwork to deal with. Combine that with NCCAM support and promotion and grant support from rich benefactors like the Macks, who encourage academic medical centers to set up programs like the one at Yale by showering money on them, and in this time of tight NIH budgets, rising expenses, and ever-tightening third party payer reimbursements, it's hard for science-based medicine to say no. Finally, most doctors, even those dedicated to science-based medicine, are simply too busy or unconcerned. Most correctly dismiss the more extreme forms of woo as ridiculous, but they do not recognize the threat to scientific medicine that the infiltration of pseudoscience into academic medicine represents. Moreover, in accepting more "plausible" forms of woo like acupuncture, they let the tip of the wedge to woo like homeopathy be driven in; the strategy of CAM advocates promoting woo in medical schools is not unlike that of creationists and their Wedge Strategy.
But what is the real significance of this infiltration? I think Dr. R. W. nailed it perfectly when he wrote that we are now entering the era of post-scientific medicine, with powerhouse medical institutions like Yale, Harvard, and Stanford leading the way. I fear that he may be exactly correct in his characterization. After many decades of work on the part of physicians dedicated to bettering the treatments we have to make medicine more and more based on science and objective evidence rather than dogma, tradition ("we've always treated disease X this way"), and authority, the move to "integrative" medicine is poised to reverse all that and send us headling back to the days when physicians practiced based as much on tradition, dogma, and personal preference as on any sound scientific evidence. That's what Dr. Katz, whether he knows it or not or would ever acknowledge it or not, meant when he referred to a "more fluid concept of evidence." That's what he and Dr. Weill, whether they would ever realize it or admit it or not, are pushing when they advocate a "more fluid concept of evidence."
In other words, I guess it's back to the future. In the meantime, I need to get my tail in gear and update the Woo Aggregator for real.
YouTube videos of the Yale conference:
"Fluid" concept of evidence? It seems like Yale will be a prime target for Water Wooers, like our friend Dr. Emoto
I agree that money is a big motivation for this. But self-aggrandizement seems to me to play a large role as well.
"Look at me! I'm a special doctor. I understand your problems in ways those indoctrinated "establishment" doctors can't. I can treat your whole body and indeed your spirit, not just your symptoms. I can apply the wisdom of the ancients."
These people are contemptible.
Once upon a time a degree from Yale meant something.
If this goes on, that YouTube CAM-ER segment someone shot
may become more real than anyone thought possible.
Another one for the list of shame!
Unfortunately the disease is spreading; this week's edition of Der Spiegel (Germany's only readable news magazine!) has a report on the fact that the Berlin Charité (Berlin's leading university hospital) has just inaugurated Germany's first professorship for complimentary medicine (that's woo in polite academic speech!). The only think that can be said in defence of this piece of inanity is the fact that the chair is financed by a private foundation.
Not to argue or disagree with any of you, but do you think that this is a step in trying to get "Alternative" medicine under the mainstream medicine umbrella? Just curious.
That's what I was thinking:
EBM makes a physician a practitioner of a skill; woo makes him/her a sage.
Brooke:
Yes they want into the tent, they just don't want to put up with the usual entrance requirements (reasonable evidence of effectiveness).
as someone who depends very directly on EBM to be able to function and work, this makes me feel somewhat nauseated - and I don't think it's the side effects of my "traditional" medicine...
I can't wait to se the following from Yale:
- The teaching of "integrative" approaches at the business school, for example by including methods developed by the cosa nostra.
- A more "fluid" approach to engineering, say, bridges: if it looks nice and feels good, go ahead and build it!
- "Holistic football tactics", in which all Yale fans are allowed on the field when the team plays defense. Sure, the rules say something else, but excluding them wouldn't be very open minded, now would it?
I believe we should transition to a more fluid concept of embarassing the hell out of foolish, fatuous, ignorance-promoting medical educators like Dr. Katz.
Orac's article is a good start.
Dr. Katz's talents would better fit another type of academic institution - the kind that offers mail-order naturopath degrees.
"Look at us"...we're defending medicine's claim to being reasonably effective and/or scientific...please...with humans , double blind long-term studies on safety and effectiveness are not done...that's why pharmaceuticals and surgical procedures keep getting "updated" or replaced so quickly- as you experiment on a larger group of "volunteers" you get closer to what could be called a science experiment.... medicine claiming science is what is contemptible!
As I recall, Colquhoun (it will be a miracle if I spelled that correctly) ends by observing that University faculty at Florida State rallied against adding a chiro school. It really makes one wonder why medical faculty can't do the same.
I know battles like that can be really acrimonious. However, surely the most senior faculty realize the seriousness of the problem, and their voices must count. What are they doing?
Another thought, but wouldn't this kind of be a good thing to put the "Alternative Medicines" under the mainstream umbrella? I agree whole-heartedly about the lack of evidence that supports their effectiveness, but hear me out, please:
The IOM, the FDA and the CDC would be able to regulate and monitor "Alternative Medicines." They would also have better control over possible drug/herbal "remedy" mixes. They could even prove or disprove their effectiveness, even eventually phase them out altogether.
Again, like I said, just a thought, and I welcome your feedback.
"Look at us"...we're defending medicine's claim to being reasonably effective and/or scientific...please...with humans , double blind long-term studies on safety and effectiveness are not done...that's why pharmaceuticals and surgical procedures keep getting "updated" or replaced so quickly- as you experiment on a larger group of "volunteers" you get closer to what could be called a science experiment.... medicine claiming science is what is contemptible!
You gotta claim to be scientific and you got to do things that seem reasonable...but if the acceptable # of dead each year in the US from pharmaceutical drugs (not OD"...) is about 100,000 and then you got your 96,000 dead from avoidable errors and 26% of people in hospital because of something that happened in the science healing center....Com'on ..hard science...not when you're talkin medicine!
Ok - I need to post this somewhere:
http://www.sciencedaily.com/releases/2008/05/080513101614.htm
My question:
Is the Journal of Complementary and Alternative Medicine a peer-reviewed journal and, if so, are the peers scientists or sCAMmers?
OMG! Are they really defending Harry Hoxey at Yale? I was watching a bit of the first video and I am actually stunned. This guy "invented" a cancer "cure" by collecting some herbs in a field that a horse with a "cancerous tumor" on his leg was eating when he miraculously "became cured". You may remember the 16 year old kid whose parents were sued for taking him to Tijuana to get Hoxey's treatment for Hodgkin's disease, the most treatable cancer there is (but not with herbs). I am surprised that people didn't just walk out. I am applying to medical school currently, and if I ever found myself in a lecture or program such as this, I would have to just leave the room.
Hodgkin's disease has successful medical protocols based on...come on you can guess it..name the plant..Where did medicine get any of it's safe and effective drugs? The starting point has often been a plant...everyone knows Hoxey is not for Hodgkins....it's one of the only cancers medicine has a decent record with...peer review as a gold standard?...yesterday's peer review is
often a nice try ,but wrong...
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
..remember risk to benefit ratio....medicine with it's cloak of science is risky... 1000's of unnecessary deaths and injuries...daily...alternatives often effective and very safe...scientific evidence or not....We want good medical practices for when we really, really need to risk using medicine....but a preventative lifestyle does more to promote health than Merck can...
Oldfart observed "Is the Journal of Complementary and Alternative Medicine a peer-reviewed journal and, if so, are the peers scientists or sCAMmers?"
JCAM is a quack magazine. When one is a quack, one's peer reviewers are, too.
Brooke said: "Another thought, but wouldn't this kind of be a good thing to put the "Alternative Medicines" under the mainstream umbrella? I agree whole-heartedly about the lack of evidence that supports their effectiveness, but hear me out, please:
The IOM, the FDA and the CDC would be able to regulate and monitor "Alternative Medicines." They would also have better control over possible drug/herbal "remedy" mixes. They could even prove or disprove their effectiveness, even eventually phase them out altogether."
This is exactly what alt med proponents do _not_ want. Attempts at virtually any regulation to protect Americans are typically met with dire pronouncements from practitioners and supplement manufacturers about how their products and treatments will be denied to consumers, accompanied by the usual paranoid rantings by the "Big Pharma" conspiracy devotees. And for most of the people who go in for this stuff, having it co-opted by mainstream medicine would ruin its appeal. Of course, substantial reform at the federal level will continue to be thwarted as long as politicians like Senators Orrin Hatch and Tom Harkin continue to protect the supplement industry (Hatch and his family have received substantial financial benefits from this stance).
The activities of Doc Katz and his kind (to "mainstream") alternative medicine) are as much anathema to diehard alties as they are to advocates of evidence-based medicine.
Joe said---
As I recall, Colquhoun (it will be a miracle if I spelled that correctly) ends by observing that University faculty at Florida State rallied against adding a chiro school. It really makes one wonder why medical faculty can't do the same.
I know battles like that can be really acrimonious. However, surely the most senior faculty realize the seriousness of the problem, and their voices must count. What are they doing?
Unfortunately, for reasons that escape me, academics have a history of remaining silent about woo, even when they see it going on at their own institutions. I wouldn't expect the people at Yale to do anything. In my own post on this subject I asked where the Association of American Medical Colleges (AAMC)is in all this. Although they're supposed to be the guardians of professionalism and scientific integrity in medical education they've been strangely silent on the issue of woo. They have recently proposed restrictions on Pharma reps and gifts at med school campuses. Why not a similar AAMC proposal to ban woo? Maybe we should organize a petition to AAMC.
I've been meaning to find some way of figuring out the tones of the words in "qi gong". I've been learning mandarin chinese, and the phrase that corresponds to the english "stuff" is "gong xi". (Q and X are similar sounds, and some transliterations switch them.)
It would be strangely appropriate if it were to turn out that this random nonsense woo had a name that was a random permutation of the phrase for unspecified stuff.
I am unsurprised that Yale, long a bastion of fuzzy thinking and dumb ideas, has become heavily immersed in Woo. Here's a story of a different type of idiocy at Yale:
In the 1970s, after medical students protested that learning should not involve grubbing for grades, the medical school eliminated examinations. Students would study diligently in a manner that would prepare them for the real world of medicine, not some silly multiple guess exams! The first class that 'benefited' from this policy experienced (unsurprisingly) the highest failure rate on Part 1 of the National Board Examination in Yale's history. I'm certain that crop of Yalies did not learn from this, and that they've added to their repertoire of medical school stupidities by shunning science and adopting woo. After all, why should medical students waste time on scientific concepts and evidence-based medicine, when they can learn woo 'concepts' in just minutes?
John,
Um...I really have no idea what you're talking about. I suppose the take home message is...why fly to Tijuana to get a US banned treatment that involves herbs and potions someone rubbed on a horses leg when you have a disease that has a 95% cure rate by conventional means but can otherwise be debilitating and even fatal? One would be forced to question your ability to reason.
Starchild Abraham Cherrix obviously thought Hoxsey was for Hodgkins (google it). I'd appreciate it if you'd clarify your views on peer review, plant based pharmaceuticals, and what exactly Hoxsey is supposed to be for...besides ripping off the sick and desperate.
Robert W. Donnell,
I am currently in the medical school application process, and have recently graduated from university. You wrote about faculty influences, here is a student perspective. Student pre-med clubs are all the rage (I never joined). Most of these pre-med clubs are affiliates of AMSA, which masquerades as a student organization, but whose sole purpose in life is to create government run health care. As you can imagine, they are also heavily into CAM. (Government run health care will mean more CAM since then the quacks won't have to appeal to scientists, but only lobby and bribe politicians.) AMSA organizes a retreat for med students every year that centers around CAM.
http://www.amsa.org/humed/retreat03.cfm
(take special note of the purple wizard ceremony)
Most pre-med clubs are AMSA fronts, they use the Ronald MacDonald technique of indoctrinating them while they are young. Pre-meds join in the (false) hopes that it will improve their resume, go to the silly meetings where they watch Michael Moore and Al Gore movies and talk about integrated medicine. The result is that many fresh med students are very CAM friendly and lack basic critical thinking skills (because they are encouraged not to think by AMSA). Many of these people are the doctors of the future. In other words, the CAM epidemic is coming. As Dr. Stephen Barrett has said, it is open season on the sick and desperate.
Joe,
There is one journal that objectively examines alternative medicine. It's called The Scientific Review of Alternative Medicine.
http://www.sram.org/
A lot of the papers they publish are also published in a general audience manner in the Skeptical Inquirer.
John wrote: ..remember risk to benefit ratio....medicine with it's cloak of science is risky... 1000's of unnecessary deaths and injuries...daily...alternatives often effective and very safe...scientific evidence or not....We want good medical practices for when we really, really need to risk using medicine....but a preventative lifestyle does more to promote health than Merck can...
I wanted to ask what an increasingly common result of herbal remedies is? Could it be...acute kidney failure? Seems your "safe" alternatives are not so safe after all.
OT: sorry to do an OT but I'm a simple soldier on the front line in my community and I'm being hit the the Kennedy Rollingstone article. Is there a 'go to' response to this. I swear this lady thinks that this article confirms that mercury was in mmr shots. arrrrrggggg. Anything you can throw my way would be helpful.
Glad to oblige:
From the vaults: RFK, Jr. gets his first ever taste of Respectful Insolence
Robert F. Kennedy Junior's completely dishonest thimerosal article
Lies, damn lies, and quote mining
Oh, and mercury was never in the MMR shot because it's a live attenuated virus vaccine and preservatives kill the virus.
MBA wrote "Joe, There is one journal that objectively examines alternative medicine. It's called The Scientific Review of Alternative Medicine.
http://www.sram.org/ {snip}"
I know, I have a subscription.
With regard to the plant based medicine for Hodgikins - It comes from the Madagascar Perwinkle. It was a serindipitous discovery. The plant was being investigated because it was a West Indian folk remedy for diabetes - it turned out to be useless for it's traditional purpose. It was scientific medicine, not traditional folk medicine that discovered it was an effective chemotherapy agent for Hodgkins.
What about *studying* alternative medicine instead of just passing it on to students? For example, rigorous double-blind testing of herbal meds to find out which are woo and which are like aspirin (I heard that one was originally found in some tree species' bark and is now syntesized in labs to offer more reliable doses)?
OT again. Sorry everyone.
1) Has Kennedy ever recanted or adjusted his position after the 2005 article?
2) if you dare (today's version of Winona anti-vax)
When I was at Yale we had a little inside joke: "You can spot the Yale speakers at a conference; they're the ones with the black and white slides," meaning that the Yale science was so good it would survive even a flat, unpolished presentation by a dull speaker.
I rather liked that meme. *sniff*
Here, I've got some other woo for ya. You're not going to like it though, when you see whose ox is getting gored:
1) Bed rest to prevent the development or the progression of pre-ecclampsia. (More accurate would be to call it "semi bed rest" though. Because there is never any problem with the pregnant woman on "bed rest" driving to the OB's office, hiking from parking lot to office building, standing in line at the desk, sitting in the chair in the outer waiting room for a half hour, walking to the lab, walking to the inner waiting room, sitting in the chair in the inner waiting room for two or three hours, walking to the exam room, walking to the desk to check out, hiking back to the car, and driving home. It's "semi bed rest" in that it's bed rest until it's inconvenient for the doctor or his staff.)
2) Antibiotics for viral infections. (One time I got a sore throat soon after moving to a new town. My old doctor had me really well trained -- if I had a sore throat that lasted too long, or seemed to get better and then worse, or I just felt really, really crappy compared to previous sore throats, I would come in for a throat culture. This would happen about once a year or so, and over the five years all of the cultures were negative, but I would still feel a little better just because I didn't have to worry that I had strep. Ok, so now it's a new town, new doctor. I'm sitting in the exam room feeling crappy and slightly feverish even after the tylenol, looking around, and I notice a small poster on the wall, obviously a pharma rep tchochke, that says, "Your doctor cares about you too much to prescribe an antibiotic you don't need." So then the doc comes in, looks down my throat and says, "Ouch! that looks like it hurts." Then she sits down, under the sign, says, "It's our policy to treat all sore throats," and writes out a prescription for an antibiotic.)
3) Every Friday at 6am induction of labor to "effeciently" put all of a doctor's patients who are due the same week into the L&D unit the same day. Followed up by c-sections for anybody who hasn't produced a baby within 12 hours. (It does make it very unlikely that the doctor would have to deliver a baby on a weekend that way, and by making all office appointments on Monday through Thursday, also makes it a lot less likely that an inconvenient baby arrival will mess up the office schedule.)
4) C-section to prevent cerebral palsey.
5) Hysterectomy because no woman over 40 needs a uterus.
6) Surgical adhesiolysis. (Often comes after that unnecessary c-section or hysterectomy. Imagine the coincidence.)
7) Scolding ulcer patients for making themselves sick by thinking bad thoughts. (Ok, so that one is something that most mainstream practitioners have finally given up. For ulcers, anyway. But they still believe that bad thoughts cause all sorts of symptoms, and that condescending lectures are a safe and effective treatment for them.)
8) Starvation as the all-purpose preventative for all pregnancy complications, and condescending lectures as the enforcement mechanism. (One time I was at a moms-and-tots group when one of our members, about 8 months pregnant with her second child, said from her position of newly-swollen ankles propped on chair that she was going to cancel her OB appointment for that afternoon. Because she had gained 15 pounds since the day before, and she didn't want to endure the snotty lecture she was going to get for being a fat disgusting pig, especially since she had this killer headache that the tylenol didn't even touch. She said that if she could just go a couple of days of not eating to take off some of the weight then she could reschedule the appointment -- and hopefully the headache would be gone by then, too. Yes, don't worry, we took her to the ER.)
9) 95% episiotomy rates. (Giving birth in a position which makes episiotomy unnecessary but is inconvenient or undignified for the doctor just won't do, you know. And the nosocomial MRSA infection in a most unfortunate spot is just some random piece of bad luck -- ignore that antibiotic-writer behind the curtain -- that couldn't have been forseen or prevented. Heck, just be glad it wasn't flesh-eating bacteria!)
10) The pediatrician who convinces the mom that formula is better than human milk because the mother who breatfeeds can't tell him how many ounces the baby drinks, and human milk constantly changes composition and caloric density, while formula has a guaranteed nutritional analysis on the side of the can. (Of course if that baby dies of SIDS or is hospitalized with RSV or has 15 ear infections before reaching age 1 that had nothing to do with the formula in this particular child. Because breastfed babies sometimes die of SIDS or get RSV or get ear infections, too.)
You may want to claim that when "evidence-based" (yeah right) doctors practice this stuff it's not woo and it doesn't matter, but I've seen enough to believe otherwords. A close friend had a due date the Friday before a holiday weekend, and the midwife and her backup doctor both had plans, so she had a c-section. Then 8 months later the baby was snotty, cranky, and tugging on his ears, so mom took him to the pediatrician. The ped looked in the kid's ear and wrote out a prescription for an antibiotic. After he broke out in hives and wheezing with the first antibiotic dose a couple of hours later, the doctor in the ER looked in his ears and said that there was no sign of an ear infection. Within a few months, she had fallen in with the whole anti-vax "vaccines damage your immune system" crowd. She basically believed the anti-vax story that doctors just make things up or out-and-out lie for their convenience or financial gain or because their inflated egos won't allow them to admit that they "just don't know" things. I am utterly convinced, from our many conversations where I tried (mostly unsuccessfully) to convince her otherwise, that a huge factor in making her open to the argument was that she, personally, did experience doctors who lied to her or made stuff up.
Another "Joe" wrote "What about *studying* alternative medicine instead of just passing it on to students? For example, rigorous double-blind testing of herbal meds to find out which are woo and which are like aspirin (I heard that one was originally found in some tree species' bark and is now syntesized in labs to offer more reliable doses)?"
Studying AM is legit if, and only if, one can write a research proposal that demonstrates the plausibility of the study. Most AM is implausible.
Herbs are likely sources of new drugs; but, unless one identifies the "active ingredient" they cannot be properly studied. For example, an antimalarial drug is found in some Artemisia plants, depending on the conditions under which they grow. If you pick the wrong plant, you don't get the drug.
Another barrier to use of herbs, in many cases, is the inability to "screen" for efficacy. If one needs a clinical trial to identify activity, that would entail 100 patients for each prospective therapy. If a dozen herbs are candidates, the expense is prohibitive.
BTW, it is a common misconception that aspirin is found in willow-tree bark. As far as I know, it is not found in nature. Willow bark has Salicin, which confers a similar benefit if you take enough of it. Salicylic acid is found in Meadowsweet; its chemical derivative (acetyl salicylic acid) is aspirin.
Is this journal still being produced?
The "current issue" dates to 2005.
In fact, studying herbs and actually succeeding at getting pharmaceuticals out of them is a major prong of pharmaceutical activity. The difference is that the stuff is rigorously tested, and only the stuff that makes the cut gets FDA approval.
Now there is a different but related problem which could definitely use some better solutions. The way that we finance the discovery and engineering of new drugs is through the patent process. (A patent is a government license to have a monopoly on the drug for a limited time.) The problem is what to do about herbals and folk medicines which just might be turned into pharmaceuticals. They are in the public domain, so you can't get a patant on them, and can't get paid for any research and engineering that you do on them, so that doesn't get done. (There is a similar problem with treatments for so-called "orphan diseases" where a patent on an effective treatment isn't worth hardly any money.)
We've kind of addressed this problem through government grants. But that does mean that we've got government grant money going to things that look like they might be woo-zy. So you've actually got to due some due diligence there to separate out something which is evidence-based in the process of gathering evidence, and something which is just nonsense. And, of course, real woo likes to hide behind the looks-like-woo-but-isn't work. Which brings up a different problem, which is to avoid the trap of sweeping the real woo and looks-like-woo together and giving the real woo credibility.
@DT Sad to say, SRAM may be defunct; I don't know.
@Cathyf I think you are right about the legal/regulatory problems. My experience is in basic science, I entirely avoided such considerations. Re-writing patent law to address those problems may be a step in the right direction. As a practical matter, I don't see that happening since the problem was identified decades ago, and the pharmaceutical industry has not really gone after it. On the other hand, expanded patent protection could also mean decreased access to (cheaper) generic products.
"Studying AM is legit if, and only if, one can write a research proposal that demonstrates the plausibility of the study. Most AM is implausible."
Yeah, plausibility and falsifiability's required for every study, right?
"Herbs are likely sources of new drugs; but, unless one identifies the 'active ingredient' they cannot be properly studied. For example, an antimalarial drug is found in some Artemisia plants, depending on the conditions under which they grow. If you pick the wrong plant, you don't get the drug."
Now I wonder how one might look for the "active ingredient." Also, thanks for clearing up the misconception about aspirin!
Sounds like cathyf should be writing a blog. Thanks for the info on JCAM, Joe. Been reading stuff from Science Daily for a long time. Didn't realize they were now into woo headlines.
@Joe "Now I wonder how one might look for the "active ingredient.""
That is usually the biggest problem- finding a simple test to identify a drug. If you are looking for an antibiotic, growing bacteria is cheap. As I recall, the antimalarial drug (arteminisin) was found by treating infected mice, a HUGE jump in cost; and they checked over 100 traditional herbs to find one active ingredient. If the only model for the disease is humans, you simply cannot screen herbs for active ingredients. And, as someone observed inre periwinkle, traditional uses may not be a good guide for which herbs to test.
If you have a good screening method, there are ways to separate the chemicals in an herb and track down the activity to one, or more, of those compounds.
Oh my dear Ammy. Another ellipses-crazed woo.
1. EBM is about risk-benefit ratio. Alties very frequently go under the very dangerous refrain of "What's the harm?" and simply assume everything they do is safe.
2. Malpractice is an entirely different sort of problem. That's like saying automobiles don't work because there are reckless drivers out there. Just because some doctors make dangerous slip-ups doesn't mean that the treatment doesn't work.
3. Whenever I see an altie being charged with misconduct, one item always comes up: Failure to keep records. You can't say quackery is safer if you don't bother recording its success-failure rate.
4. A LOT of quackery out there is equivalent to inaction. Are you seriously suggesting that inaction against life-threatening diseases is preferable to treatments that have been shown to work under rigorous protocols?
5. How can you know if a quackery treatment is effective without scientific evidence? It's that ivory tower "I know everything just because I say so!" attitude that really infuriates me.
6. It's our scientific medical knowledge that allows us to prevent disease, not the hubris of quacks. Quackery-inspired lifestyles are not preventative, no matter how much they say they are. They need to provide good evidence, not arrogance as justification.
It appears to me that most of the so-called MD's now days are too full of themselves. I do research in biomedical engineering, and I have come to realize that medicine is far from getting close to understanding what goes on with us. But even greater is what it seems to be a lack of HUMANITY from the doctors, who consistently treat other people as non-people. The homeopathy movement may have a point, do not forget that what you call "real medicine" comes from nature... people, some time ago, that's what humans had. Then we went into discovering which particular compound from these natural products was the most effective. Then we went on to isolating them, and even producing synthetic materials. But along the way, we neglected other things that were present in the original product that nature gave us. So, pharmaceutical companies started producing some very useless products that need constant "updates" because they simply don't work. But they have told us that that is what works, and we bought it... Makes me wonder how intelligent this so-called MD's are
Jose said "The homeopathy movement may have a point,"
Well it certainly does not have any active ingredients!
For those willing to subscribe to a fluid interpretation of medicine I have a cure for all kinds of cancer available for a nominal price. Terms and conditions apply.
And, of course, Jose resorts to lying.
1. The stuff the pharmaceutical companies produce has to be proven to work under rigorous study conditions for them to sell it. The 'updates' are stuff that work better, with fewer side effects, or other benefits. Quacks are given free passes. They get to be taken at their word that their crap works. That's why they scream bloody murder every time we try to level the playing field. "Consumer protection" is one of the things quacks are most afraid of. Interferes with their caveat emptor business model.
2. Witch doctors who practice good bedside manner are still quacks. EBM could use more doctors with more time to do that sort of thing, but that's an infrastructure thing. At least real doctors individualize treatments as much as possible. Homeopaths and such only pretend to individualize their water and sugar pills. If you want there to be more time for doctors to spend at your bedside, get all the quacks into a real medical school, where they can learn to do something useful besides lend a sympathetic ear.
3. Lots of quacks forget about the humanity of their patients all the time. They proscribe useless but highly profitable "cures" and let the patient suffer and worsen while making a profit. Only when it's clear that they won't be recovering do they hand 'em over to EBM: After it's too late.
Interferes with their caveat emptor business model.
I like the caveat emptor business model. I get it anyways with pharmaceuticals. Anyone who puts all his faith in any particular medical professional, company, model or institution is a fool. How is it that Searle didn't realize the role that COX I played in inflammation after all the testing they did to approve Celebrex? They must be either stupid or deliberately dishonest. When I was in school I had a Searle rep lecture me on how COX I was totally irrelevant to adults, how it only played a role in fetal development and so forth. Apparently it also plays a role in adult inflammation, which is exactly what Searle should have been studying and apparently wasn't or did and ignored. Yes, we find out these things eventually and I'm glad for that. But I don't see FDA approval, by itself, as enough to suggest safety.
There are chemicals in all the foods I eat. What matters to me most is that they've had a long history of use, ideally with corresponding clinical studies. It's secondary that some possibly biased or misleading studies have been done on them.
Another nice thing about herbs is that I don't have to set up a doctor's appointment whenever I want any kind of medicine. I'd rather be able to just drop off a urine sample somewhere after work and get results back, but the doctor is stuck on a certain routine that must be performed 9-5 sometime during the business week.
Also, most doctors don't seem, from my perspective, to use the best available evidence. Saw palmetto extract inhibits two isoforms of 5Alpha-Reductase. Finesteride inhibits one type. Finesteride is more expensive and has more side effects (I say this from personal experience, having tried both, and also because beta-sitosterol experimentally is shown not to inhibit the cellular capacity to produce PSA.) So I'll take the Saw Palmetto. Thanks.
Same with Gaba-ergic drugs. Valium may have the most efficacy, but the strong Gaba-ergic drugs are more addictive and problematic. Theanine is much weaker, but a little theanine and melatonin lets my girlfriend get to sleep when she couldn't otherwise. They may be tolerance forming, but they're not addictive, and they can be periodically cycled off. And they're safer than valium.
Mainstream medicine is decent on efficacy (I'm talking about clinicians here, not medical researchers), but not so good on reducing side effects. And it seems a legit point to ask; what if there isn't a single "active ingredient" in an herbal preparation? It doesn't seem like most researchers even ask that question, it's just an assumption. Though if I'm wrong there, please point me to the studies. If a secondary metabolite co-evolved alongside some other secondary metabolite it seems reasonable to think that they may have some sort of combined action.
The nice thing about herbal medicine; I don't see it as a terrible risk to take most drugs which have been used traditionally (even if it might have some minor side effects) to test and see if they help me. (Yes, there are some exceptions like rotenone in Mullein, hallucinogenic drugs, etc.) It's hard to do that with traditional doctors, since the basic premise of prescriptions is that patients are children who shouldn't be allowed to have control of their own health or be allowed to calculate their own risks.
I don't want a doctor to be a guru telling me what to do. I want a medical consultant who sees himself as being in my employ. I want to understand my condition so I can research it better than most GPs can, looking at the latest research. Possibly a doctor could tell me what has worked for his other patients (but how many actually care enough to follow up and gain that crucial knowledge? Most just seem to assume if the patient doesn't come back then the drug worked). What I want from the medical community, more than anything, is a proper diagnosis. Help with drug conflicts is also helpful. But unless we're talking about surgery, I can research the rest myself.
The thing is, most mainstream doctors don't see things this way. They focus very little on nutrition. Naturopathic medicine, properly practiced, is quite "evidence based."
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.
How is it that people can accumulate numerous degrees without ever being exposed to the basics of thinking? Self delusion is easy - science a bit harder. When you do a bit of both they make you head Woomeister. Just remember to hang your brain at the door along with your hat.
It would be amusing if these clowns didn't actually hurt real people (or monkeys). A visit to www.whatstheharm.net would be a useful reminder of why it is important to challange this nonsense whenever possible.