There's a website out there that calls itself Opposing Views. I haven't visited it in a while, but its very reason for existence and philosophy seems to be built on the "tell both sides" fallacy that so irritates me. In other words, Opposing Views appears to be built from the ground up to provide "balance" in all things. Sometimes, as in areas of politics, balance is not a bad thing. When it comes to science, not so much. The reason is that the "balance" in science shown by Opposing views is the sort that thinks there are two equally valid views in manufactroversies like the "debate" over whether vaccines cause autism (hint: the best available data currently existing does not support this notion); whether animal research is useful in making discoveries that improve our understanding and treatment of human disease (it does, the dubious arguments of Ray Greek notwithstanding), or whether alternative medicine (like Stanislaw Burzynski) is worthy of being "integrated" into science-based medicine (hint: it's not).
Oddly enough, a while back I was actually invited to join Opposing Views (OV) as one of its "experts." Even though I am a legitimate expert in some topics and a bit of a self-taught lower tier expert in others, I was highly reluctant to join for the same reasons that I'm reluctant to do public "debates" with creationists, HIV/AIDS deniers, anti-vaccine loons, or other cranks. It elevates the crank's views by putting them on an equal footing with scientific views. None of this, however, means I can't call BS when I see it on OV. So it was when I saw an article by someone named Alice Shabecoff entitled Pediatricians Beginning to Embrace Alternative Medicine for Kids, and the article wasn't a lament that this is true but rather a celebration of the infliction of quackery on children.
One thing you should know is where Shabecoff is coming from; she's the co-author of a fear mongering book entitled Poisoned for Profit: How Toxins Are Making Our Children Chronically Ill. One thing I can't help but notice right off the bat is that Shabecoff apparently doesn't know what the word "toxin" means. As I've pointed out before, "toxin" has a specific meaning in science, and she appears to be using it to mean "chemical." Given this background, I find it utterly unsurprising that Shabecoff would be into alternative medicine for children:
In the 1970s, when visits to his office cost $4 and he would come to your home for $5, pediatrician Warren Levin began to practice alternative medicine, figuring it out a bit at a time. After a few years, his practice grew into New York City's first full-blown holistic health center. But the mainstream medical world objected. Alternative pediatricians were called quacks back then. For prescribing vitamin supplements and a healthier way of eating for patients with severe allergies, Dr. Warren was hauled before the state's Office of Professional Medical Conduct. In the end, he was exonerated.
Today, holistic, mind-body pediatrics has come of age. It seems very appropriate for a generation of parents looking for foods without pesticides and cosmetics without solvents.
"Conventional Western medicine is about fixing disease, mainly acute illnesses. It's oriented around disease labeling and treatment," says Dr. Lawrence Rosen, a young New Jersey-based pediatrician who is one of today's leading holistic practitioners.
Ah, yes. Two (at least) of the most popular alt-med canards right there in the introduction. First, there's the usual annoying and exaggerated claim that "Western" medicine is only about taking care of acute illnesses. Yawn. Second, there's the bait and switch, wherein the prescribing of healthy diets and/or exercise is co-opted and labeled as being somehow "alternative," "complementary," or "integrative," when diet-based interventions are part of science-based medicine. Then the fact that a healthy diet does lead to better health is used to imply that the rest of the woo that comes along with it as "alternative" is also just as valid. Notice how Shabecoff talks about "healthier eating" in one breath and then in the next breath mentions prescribing vitamins and supplements for patients with severe food allergies. No wonder Dr. Warren was hauled before the state's Office of Professional Medical Conduct. Fat lot of good it apparently did; Dr. Warren is still in business, and his practice appears to be a veritable cornucopia of woo, leavened with more than a touch of self-aggrandizement:
Dr. Warren M. Levin is recognized as the "East Coast Dean of Alternative Medicine." He has been a visionary in reporting the interconnections among many intractable syndromes with the Standard American Diet--which he calls SAD, the heavy metals in our environment, and other factors in the modern lifestyle and drug-oriented conventional medicine.
Whenever you see a practitioner rant about "drug-oriented conventional medicine," the odds are pretty good that you're dealing with someone for whom science is not a big motivator. Just an observation. In any case, Dr. Warren takes credit for a number of amazing things, including being:
- One of the first to document the connection of Candida (Yeast) infections with Fibromyalgia, Chronic Fatigue Syndrome, Autistic Spectrum Disorders, Multiple Chemical Sensitivities and most recently with refractory Lyme disease
- An early pioneer in treating Autism, Asperger's, ADD/ADHD, and Learning Disabilities with avoidance of allergenic foods, environments, and toxins, as well as via correcting metabolic imbalances and infections.
- The first to recognize and report Lyme-Induced Autism.
- Among the first to offer IV Chelation Therapy for heart Disease.
- One of the first to warn about the dangers of vaccine, especially Hep B for newborns, cervical cancer vaccine for young girls, and as a contributing factor to Mercury overload in infants
- A pioneer in providing Bio-Identical Hormone Replacement for weight loss and anti-aging.
See what I mean? It truly is a veritable cornucopia of woo. Dr. Warren's into it all, including blaming yeast for disease for which there's no good evidence it's involved, "detoxification" to treat autism, Lyme-induced autism (a nonexistent entity), anti-vaccine nonsense, and even bioidentical hormone therapy.
Given that Dr. Levin is such a pioneer in so many areas, I did a PubMed search for his name. All I could find were two articles, both letters to the editor to medical journals. He also appears to have a publication from 1972 in which he is in the middle of the pack of authors; my guess is that he was probably in medical school then and did a research project as a part of that. Whatever the case, it's not exactly what one would call an impressive publication record. Whatever "visionary" discoveries Dr. Levin might have made, he apparently never saw fit to publish his discoveries in the peer-reviewed medical literature and thus bestow them upon his scientific peers.
No apologia for alternative medicine would be complete without a broadside against "conventional" science-based medicine, and Shabecoff doesn't disappoint:
In contrast to the conventional approach, holistic medical care works to keep children well by instilling a long-life pattern of healthy living and by treating simple problems such as earaches without resorting to the overuse of drugs. It particularly lends itself to caring for children with chronic illnesses, including cancer, juvenile arthritis, obesity, asthma and developmental disorders like autism and ADHD, where conventional medicine hasn't a great track record of cures. In fact, there's been a major increase in the number of prescription medications used to treat symptoms of childhood chronic illnesses, despite the absence of data that they are effective in curing the underlying problems.
If the incidence of chronic childhood illnesses continues the upward climb it has taken over the past two decades, and as more families understand the link between prevention and treatment, integrative pediatrics may very well become the standard practice of the future.
First off, even if the incidence of chronic childhood illnesses is climbing, it's a non sequitur to conclude from that increase that "integrative pediatrics" is likely to become the standard practice in the future. Shabecoff also repeats a claim that I hear again and again and again from "integrative" practitioners. Unfortunately, I never see any actual--oh, you know--evidence presented to back up. That claim is that somehow "integrative" medicine or pediatrics is better at encouraging a healthy diet and lifestyle than "conventional" medicine or that health outcomes are better when integrative medicine is used. Seriously, I've looked, and I have yet to see any integrative practitioner cite any rigorous research on this issue; rather, they seem to expect us to take their word on faith or based on patient anecdotes. Couple that with an invocation of areas where current medicine might not do as well as we would like, and--voilà !--you have standard CAM or "integrative medicine" boilerplate.
Arguments like Shabecoff's are an insult to the intelligence of skeptics and critical thinkers.
But that's not all. Implicit in Shabecoff's arguments are the standard CAM apologia that we've all come to know and not exactly love. For instance, there's the appeal to popularity, in which Shabecoff paints "integrative pediatrics" as the "wave of the future." Indeed, her entire article is based on the logical fallacy of argumentum ad populum. How many times does it need to be repeated that just because something is popular doesn't mean it's scientific, worthwhile, right, or whatever you want to call it? Apparently ad nauseam. Also implicit in Shabecoff's argument is the claim that "integrative pediatrics" is already so accepted and popular that it's already mainstream. Here's a hint: I am not impressed to learn that Dr. Andrew Weil has edited the "first textbook on integrative medicine," although I am disappointed to learn that the American Academy of Pediatrics has formed a practitioners' section. The AAP really should know better.
Also nauseating is the fluffy, New Age vibe that Shabecoff give her article. She refers to the health of children being inextricably linked to the health of the planet, after which she argues for providing the "context--the ecology--in which the whole child's health and wellness can thrive." Here's what this means:
In the first months of a child's life, the doctor focuses on frequent well-baby care. As part of that conversation, doctor and parents together design individualized schedules for vaccinations and treat problems that may arise, such as colic. These conversations with parents and patient continue as the child grows. What could be more different from the usual harried, cookie-cutter 15-minute consultation!
Once again, I have to ask: How many times does it have to be repeated that the way to fix the systemic problem of physicians not being able to spend as much time as they should with patients due to how they are reimbursed is not to throw out science and let the quacks take care of all the touchy-feely stuff. It's to find a way to alter the system so that it is possible--nay, encouraged--to spend time with patients. I would argue that a practitioner who spends a lot of time with patients and their parents in order to peddle "individualized" vaccine schedules that leave children vulnerable to infectious disease are doing far more harm than physicians who practice according to science-based guidelines but can't spend that much time with patients. More is not better when that "more" is crap. When that's true, all that "more" gets you is deeper in a pile of crap. Yet that's what "integrative pediatrics" offers. Not surprisingly, Shabecoff herself appears to buy into common anti-vaccine myths wholesale, to the point that she actually recommends the Barbara Loe Fisher's National Vaccine Information Center as a source of "sensible and reliable information," even going so far as to recommend its ridiculous Vaccine Ingredients Calculator.
Oh, and Shabecoff recommends the rabidly anti-vaccine group Generation Rescue as a good source for "alternative vaccination schedules," and Generation Rescue's propaganda blog Age of Autism loves her back.
Shabecoff ends by quoting Dr. Tieraona Low Dog, director of education at the Arizona Center for Integrative Medicine:
Her prescription for a healthy child: "Unplug. Go for a walk in nature and find your voice again. Never leave the house without telling your children you love them." When was the last time you heard a "conventional" pediatrician say something so wise?
Uh, last week?
Again, the bait and switch rears its ugly head. Again, pediatricians are perfectly capable of suggesting to the parents of their patients that perhaps they should take their children for nature walks and have the child unplug from technology from time to time. Pediatricians are perfectly capable of advising parents to let their children know how much they love them. Physicians don't have to abandon science for quackery in order to do this, but Shabecoff and other integrative medicine apologists portray a false dichotomy in which the ony answer to the impersonalized, rushed primary care visit is to embrace woo.
Unfortunately, for some reason this argument is dangerously attractive.
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Yes, indeed, the argument is dangerously attractive. I have a friend who often looks at this type of thing when her children are sick. Fortunately for her them, I have been able to keep her out of the woo-meds.
My favorite thing to tell her is a quote I once heard, but can't remember who said it.
"Do you know what we call Alternative Medicine that actually works? Medicine."
I sense a fair amount of restraint, especially regarding this little gem:
The first 6 words of that sentence make it a flat lie.
"My favorite thing to tell her is a quote I once heard, but can't remember who said it. 'Do you know what we call Alternative Medicine that actually works? Medicine.'"
That's a quote from Tim Minchin.
Oh, the quote is much older than that. Richard Dawkins used it a few years ago, and I saw it on various skeptical blogs and in at least one book years before that.
Well, if we got chronic-Lyme induced autism, the morgellon-autism hypothesis can't be far behind.
If only they knew. Cosmetics isn't exactly where they should be worried about solvents. Don't they realize that every single thing they eat or drink is contaminated with solvents? Virtually all of them contain easily detectable amounts of the "universal solvent" used in myriad industrial processes! These parents should ensure that they eliminate all solvents from their diet as a very first step. Quite soon, solvents in cosmetics will cease to be a concern.
I invented that saying. I also invented the saying, "Delusions of grandeur"
"When was the last time you heard a "conventional" pediatrician say something so wise?"
Well, it's not a pediatrician saying it, but the "unplug your kids" advice is currently plastered on a billboard paid for by Blue Cross/Blue Shield of Minnesota that I drive by every morning.
Lovely. Alt med, amongst its many (dis)services to humanity, efficaciously sets up quandaries and conflicts for patients and caretakers: "in contrast to the conventional approach" implies that a *better* way is available. I am assuming that the standard issue decision maker is *not* armed with the ability to understand medical research easily and thus can hit the journals independently. Here is the dilemma set up by alt med apologists, providers, or proselytisers ( which I know only too well):
"Conventional Medicine" presents treatments based upon research, uses high tech diagnosis, and pharmaceutical treatment: this is characterised as cold, unfeeling science. It carries the weight of approval by professional associations, governmental agencies, universities, and corporate science.
vs
Alt med presents the "kinder, gentler" approach steeped in naturalism like a fine herbal tea. "You'll be 'taken care of'"- both figuratively and literally. It's both traditional *and* the wave of the future.
Additionally, the methods and results of SBM research are called into question: "You can't trust research funded by pharma"."Many of those treatments" -( chemotherapy, pharmaceuticals)-"cause more harm than good".
People in distress and seeking relief are especially susceptible to scare tactics and find easy promises attractive. Then, there is always the problem of executive function: some people are just not great at "delaying gratification", dealing with complex - perhaps paradoxical- information, comprehending probability, and seeing risk/benefit easily: this makes them targets for the alt med "old school try".
I notice that AoA has been focusing on the "rise" of chronic illness in children, as have our web woo-meisters, implying that SBM is responsible- whereas the link between childhood obesity and a sedentary, cyber-based lifestyle or between asthma and poverty seems appararent to me- "Doctors just don't focus on diet and exercise"- although they *do*, patients - and parents- don't necessarily follow up.
Like many who write about alt med, Shabecoff probably doesn't have much of a background in science or math ( like many liberal arts people)- and wouldn't recognise a statistical test if it hit her upside the head. This disability can certainly affect your view of medicine.
I guess I am confused as to what's wrong with the first year wellness checks. With our first, ours were extremely productive. The doctor provided some good general advice about things we should be thinking about at the various times, and then answered questions that we brought up.
They were scheduled for 30 minutes, but ranged everywhere from maybe 20 minutes to 45, depending on how many questions we had. If we had more questions, he kept answering them. If we didn't have any more questions, he left.
What else should he have done? Sat around shooting the shit for an hour? I mean, he is our neighbor and we could talk about how his family is doing, and everyone's vacation plans, but we do that when we see him out in the neighborhood.
With our second, the appts are even shorter, because we have heard a lot of it before and don't have near as many questions.
What are we missing in our 15 minute consultations that we would get in a 1 hour appt?
I thought someone might have recognized Dr. Lawrence Rosen. He appeared as a speaker at the "Vaccine Safety Conference" blogged on earlier this year by Orac (http://vaccinesafetyconference.com/speakers.html). He shared the stage with Barbara Loe Fisher and Andrew Wakefield. More disturbing yet, he is the chairman of an official section of the AAP, the SOCIM (Section on Complementary and Integrative Medicine).
I also invented the saying, "Delusions of grandeur"
My personal favorite, and applicable to many alt-med types, is 'delusions of adequacy.'
The alt-med apologist's binary contrast between real medicine and sCAM is prefigured in such things as Norman Mailer's hip/square dichotomy.
sCAM comes clearly on the side of 'hip'.
Treat pediatric cancer with woo. My God.
Blanket statements like "medicine doesn't do so well with cancer" will cause deaths. Does this idiot know about the change in survival rates of many childhood leukemias?
Survivals were about 10% decades ago, then improved when evidence-based medicine came up with better treatments, to about 90% survival today. Of course, she might know all about that, but just ignores it, since hey, it's not all that important that parents know how well medicine might treat their child's leukemia.
It's more important that the kids lead a holistic lifestyle uncontaminated by toxins. Because then they won't get leukemia.
I just came from my 9-month appt with my first baby, and it was similar to what Marry Me, Mindy @#10 described. The doctor sat and talked with us for about 15 minutes while observing our baby about her sleeping/eating habits, physical growth and physical/mental/behavioral development. (It didn't take long because our baby is healthy and normal. When she was sick, early on, we spoke for MUCH longer about how to solve the issues.) His examination took another 15 minutes. We brought up our concerns and he gave us his advice. We talked about toys and activities. He also discussed her vaccinations, what she was getting now and why.
Then the nurse came in and shot her up. That took 3 minutes. (it also took about 3 minutes for the nurse to weigh and measure her at the start of the appt.)
If people have problems with the attention their doctors are paying them, get new doctors. Don't get quacks. It is CERTAINLY possible to have lovely, attentive, science-based doctors. You don't have to throw the baby (and the life-saving vaccines) out with the bathwater.
Brilliant point Allie. Like you, my check ups and appointments with my baby's doctor have always covered a range of issues including lifestyle, diet and my own wellbeing. My doctor only prescribes medication when it is needed and offers lifestyle advice instead of (or as well as) medication when appropriate. She has often given me wise advice such as to ensure I tell my children I love they regularly and to enjoy their childhoods. It's already been said, I know, but the answer to the problem of short consultations and doctor with poor interpersonal skills isn't to ditch sbm altogether and replace it with disproven nonsense. Although it must be said that when it comes to my children's health, I'd take a brisk sbm doctor over a tea-and-sympathy woo master any day.
Yeah. I can remember my children's well-baby checks taking variable amounts of time (more with the first, less with the second) depending on issues. The physical exam/vaccines were a very short part of the visit; more time was spent on discussing child development and growth. Not that information on the exam and vaccines was ignored but I am sure that, as a nurse with a good education (who, btw, worked with the peds in the hospital so they knew me well), they figured they didn't need to nuts-and-bolts the information for me. However, the few vaccine questions I DID have were answered fully and with literature.
MI Dawn
Allie wrote:
No it's not. Along with diet and exercise, loveliness and attentiveness are alternative practices. Your physician was obviously an integrative pediatrician.
Science tells us to leave the house without telling our children we love them, but fortunately there are more and more brave maverick parents out there who refuse to obey.
@Sastra: I LOL'd. But you probably should have put an /sarcasm tag on that for those who don't know you...
MI Dawn
Congrats, Allie. I have a 9 mo old myself. He needs to get in for his 9 mo checkup. He doesn't need any shots this time, I don't think, and we might not be able to get him in until almost 11 mos, so we might skip this one.
I don't know how much people realize that a lot of babywellness checks is observing baby activity. The doctor may be talking to you, but his eyes are on the baby activities.
In fact, in contrast to the loon assertions, I think this is actually mostly the norm. I always hear claims about how "western doctors don't spend any time with their patients," and this is not the first time I've heard it about pediatricians. Yet, whenever I talk to people about their experiences at the doctor, they all sound very similar to what Allie and I have described, and I ask, what should they have done differently?
I put this crap about pediatricians in the same category as those claims that doctors never discuss diet or exercise. My response is, have you ever BEEN to the doctor? Jeez, that's what mine spends most of the time talking about when I go in for a physical, and everyone who chimes in with their own experiences says the same thing. I seriously do wonder if people who make claims like that have ever actually been to a doctor. These claims are always made as generalities - we almost never hear of people who say "I went to the doctor, and she did not spend enough time with me." Or when we do, and you ask what should they have done instead, it is met with yammering about nothing.
@sastra My god, are you serious?! I'm gobsmacked that anybody could think dietary and lifestyle advice are 'alternative'. They're only alternative if they're disproven or unproven. There is plenty of good, scientific evidence to support a healthy diet and exercise! And I think my doctor would certainly object to being called an alternative practitioner on the grounds of her niceness!
@sastra oops, you had me going for a minute there! Nobody could possibly believe anything so ridiculous...oh wait.
I had to laugh at Dr. Warren Levin's snipe at "drug-oriented conventional medicine" after seeing his list of alt-med "breakthroughs":
- Candidiasis, treated with antifungal DRUGS.
- Lyme-induced autism, treated with months of antibiotic
DRUGS.
- Chelation therapy, which is IV adminitration of Chelating
DRUGS.
- Bio-Identical Hormones, which happen to be DRUGS.
@Sastra (re Kate) told ya so! /snark. Sorry. I really do love you, you know.
@TBruce - but, but, but...this is all ALT-MED! Obviously, the fact he is using those meds means he did some magic so they didn't come from TEH EBIL PHARMA and they have, like Galahad, "the strength of 10 because [the meds] are pure."
And, of course, he only gives those meds out of the kindness of his heart. He can't be making any evil profit from them...
I forgot to mention that these drugs are all being misused.
I guess that means they don't count.
TBruce - they aren't drugs, they are nutritional supplements.
My sister is a pediatrician, and had a patient with serious muscle pain at the base of her thumbs. Turns out she was an ultra- heavy texter.
Her father wanted pain meds. My sister's cold, hurried, unkind treatment consisted of two words: "Quit texting."
This family came to her because these science-based doctors all prescribe narcotics, and she turned integrative on them. How very unloving.
So, the good doctor was EXPERIMENTING on children until 'he got it right'?? WTF? Did the parents sign a consent for the experiment. Did he file the appropriate paperwork to the FDA for the 'experiments'? WHY does he STILL have a license to practice medicine???
Oh noez!!!11!! Don't tell them about dihydrogen monoxide, the universal solvent! It's everywhere!! OMG whatever will happen if they ingest it or get any on themselves???????
"Conventional Western medicine is about fixing disease"
As said before, why do we take our children for the first 2 yrs of their life to the doctor 10 times (not counting any sicknesses) if it's about treating disease? Pretty sure there's some preventative medicine going on their (but I guess in the anti-vax world, that's creating diseases). And agreed, we love our pediatrician who stays as long as we have questions, takes her time; I've never felt rushed (I did with our first, and changed docs).
Have to disagree on the love thing, I really don't want, or need, our pedi telling me to tell my child I love her. I'd go to a psychiatrist for emotional issues, and if that's what a pedi infers from our well visits, that's who they should recommend.
Has anyone pointed out to the alt-med proponents that their claim of increased incidence of chronic childhood disease corresponds to the documented increase in use of CAM?
Apart from there being no documentation of increased incidence of chronic childhood disease, I'd love to see the squirming.
As a pediatrician (and internist), I want to thank all of you for defending your pediatricians. I do spend a lot of time discussing a myriad of topics with parents during well visits and the list of necessary topics seems to be getting longer every day--don't get me started!
As far as giving all this woo to kids, your kids! I just don't get that. Why are all doctors characterized as always to eager to give meds. In the 15 years I have been practicing, my prescribing of meds to kids has drastically decreased, not that there was a lot in the first place. Have a cold? Suck it up or take some honey - oh, no, that might be "alternative". Fortunately, most of the parents I see just want reassurance and information.
DD - and its important to note that reassurance means more than "everything will be ok." We make a lot of trips to the ped, and very often it is nothing we do anything about. The problem is that we don't know that until we've had it checked.
So the reassurance we are looking for is to confirm their is nothing to do. Maybe its viral - probably. But let's make sure its not strep. ok, it's not strep so we'll just deal.
If there is something that can be done we want you to do it. But if you say there's nothing to do, we don't need anything. Our son responds well to ibuprofin so that can often suffice.
MMM, thanks for clarifying my somewhat vague statement. That is what I meant by reassurance. Evaluation, then explanation of the process going on and what to expect going forward.