Once upon a time, there was quackery. It was the term used to refer to medical practices that were not supported by evidence and were ineffective and potentially harmful. Physicians understood that modalities such as homeopathy, reflexology, and various "energy healing" (i.e., faith healing) methodologies were based either on prescientific vitalism, magical thinking, and/or on science that was at best incorrect or grossly distorted. More importantly, they weren't afraid to say so.
Quacks did not think this good.
Then, sometime a few decades ago, supporters of quackery decided that they would never get anywhere selling their products, outside of a small minority of people, if they allowed practitioners of evidence-based medicine to define their favorite quackery as being...well, quackery. As a consequence, "quackery" somehow morphed into "alternative medicine." Alternative medicine was (and, when the term is used, still is) medicine that does not fit into the current scientific paradigm, a term used to describe medical practices that were not supported by evidence, were ineffective and potentially harmful, and were used instead of effective therapies. Physicians understood that modalities such as homeopathy, reflexology and various "energy healing" (i.e., faith healing) methodologies were based either on prescientific vitalism, magical thinking, and/or on science that was at best incorrect or grossly distorted. More importantly, they weren't afraid to say so.
Practitioners of alternative medicine did not think this good, either.
That's why, sometime lost in the mists of time (back in the 1990s), alternative medicine practitioners (i.e., quacks) decided that they would never get anywhere selling their products, outside of a small minority of people, if they themselves defined their own products as being outside the mainstream of medicine by calling them alternative. Thus was born "complementary and alternative medicine," which had the nice, pithy abbreviation of "CAM." CAM was (and is) medicine that does not fit into the current scientific paradigm, including treatments that are not supported by evidence, are ineffective and/or potentially harmful, and are used in addition to real medicine. Over time, the name change had its intended effect. No longer did most physicians automatically view modalities that were once considered quackery, later considered "alternative," and now considered "CAM" as quackery. Modalities such as homeopathy, reiki, various energy healing methods, and even reflexology were no longer dismissed. Somehow, despite several of them (especially homeopathy and the various energy healing modalities) violating known laws of physics and requiring that our understanding of physics be not just wrong, but spectacularly wrong, for them to work, somehow methodolatrists preaching "evidence-based medicine," valuing randomized, double-blind, placebo-controlled trials above all else even when physics, chemistry, and common sense should tell them that a treatment (such as homeopathy) cannot work, allowed the noise and occasional false positive clinical trial to convince them that there might be something to these modalities. Also, by using their former quackery in addition (i.e., as complementary) to real medicine, CAM practitioners (mostly) neutered the biggest complaint about alternative medicine, namely the concern that patients forego effective therapy in order to pursue alternative medicine. The stage was set for the widespread adoption of CAM by medical schools.
And CAM practitioners did declare that this was indeed good--but not good enough.
That's why CAM practitioners, even though they had made huge inroads introducing quackademic medicine into medical schools and academic medical centers, bolstered by the influence of the National Center for Complementary and Alternative Medicine (NCCAM) and the Bravewell Collaborative, an organization founded by Christy Mack, the wife of a wealthy investment banker, for the express purpose of promoting the study and use of CAM in medical academia, decided that even this was not good enough. A new term was needed. Thus was born in recent years a new term. CAM practitioners (formerly alternative medicine practitioners, formerly quacks) hit upon the perfect term for their treatments. It is a term so media-friendly, so seemingly reasonable that it is a wonder that no one had thought of it before.
"Integrative medicine."
Yes, no longer were CAM practitioners content to have their favorite quackery be "complementary" to real medicine. After all, "complementary" implied a subsidiary position. Medicine was the cake, and their wares were just the icing. That wasn't good enough. They craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine. The term "integrative medicine" (IM) served their purpose perfectly. No longer were their treatments merely "complementary," they were "integrating" their treatments with those of science- and evidence-based medicine! The implication, the very, very intentional implication, was that alternative medicine was co-equal to EBM, an equal partner in the "integrating."
And to IM practitioners, it was very good indeed, so much so that they are proclaiming that CAM is dead:
Over the past 25 years, practitioners integrating the best of Western, Eastern and other evidence-based models of medicine into their practices have endured a series of catch-all titles that describe their model of care. Not long ago, all medicine not tacking closely to conventional allopathic care was termed "alternative". Then about 15 years ago the term complementary and alternative medicine (CAM) began to seep into the medical vernacular. NIH's National Center for Cancer and Alternative Medicine (NCCAM) became a full-fledged center in 1991. Although most of the major hospitals and cancer centers did not introduce their integrative centers until a decade later, NCCAM's "CAM" acronym stuck, and had an influence on new private clinics and centers across the country.
I'll say one thing about the guy who wrote this, Glenn Sabin. He doesn't know the history of NCCAM. In 1991, NCCAM was indeed born, except that it was not a full-fledged center. Rather, thanks to woo-friendly Senator Tom Harkin (D-IA) and $2 million of discretionary funding, NCCAM started its life as the Office of Unconventional Medicine, which was soon renamed the Office of Alternative Medicine (OAM). It was not until October 1998 that NCCAM received its current name and was elevated to a full center. Mostly, this was a big "screw you" from Tom Harkin to the then director of the NIH, Harold Varmus, who, responding to objections to the OAM from the scientific academic community, moved to place the OAM under tighter NIH control. The result? Tom Harkin introduced and passed legislation that elevated the OAM to an independent center within the NIH. Soon after, appropriations skyrocketed to over $100 million a year. NCCAM's current budget hovers in the $125 million range.
One wonders what else Sabin gets wrong.
Whatever he might get wrong or right on a factual basis, Sabin does reveal the mindset of promoters of non-science-based medical treatments in the very next paragraph:
Today several integrative centers across the country still contain the words CAM in their name. This is both confusing to health consumers and damaging for these centers' brand. Most clinics and centers launched during the last decade have evolved with their branding to include today's more appropriate terminology of "integrative medicine", "integrative services" or "integrative therapies".
(Bold not mine.)
I will give Sabin credit. Whether he realizes it or not, he's basically just admitted that the move to rename CAM as IM is all about the marketing of quackery. Yes, I know that he would never, ever admit that's what he just did. After all, he liberally sprinkles his post with terms like "evidence-based integrative medicine," which makes me wonder why IM aficionados haven't renamed IM to "EBIM." Perhaps that's coming later.
But I digress.
Getting back on track, I note that Mr. Sabin does a wonderful job of expressing the confusion at the heart of so-called "evidence-based integrative medicine," almost certainly without realizing that he is doing so. See if you can figure out what I mean before I explain it:
Alternative medicine is often pushed in lieu of proven conventional care. Alternative medicine does not have an adequate science base behind it and is not practiced in clinics within an academic setting. Integrative medicine integrates proven therapies into conventional medicine. True, not all methods of mindfulness-based stress reduction techniques like, say, Reiki have a solid evidence base behind it, but in this case, many clinicians that offer services like Reiki do so because their clinical observations tell them that it helps many of their patients relax and may lessen the need of certain pain meds.
So, let me get this straight. IM is better than "alternative medicine" because alternative medicine is "often pushed in lieu of proven conventional care" while in contrast (allegedly) IM "integrates proven therapies into conventional medicine." Then, right after that, Sabin admits that "not all" IM methods have a solid evidence based behind them but that clinicians use them because of anecdotal observations. Here's a hint: Anecdotal observations are not the same thing as being "proven." Far from it! Anecdotal observations can be profoundly misleading, thanks to well-known phenomenon that confound "clinical observations," such as regression to the mean, confirmation bias, and placebo responses. That's why "conventional" medical researchers long ago realized that well-designed clinical trials, preferably randomized and well-controlled, are necessary to minimize these biases and to correct for placebo responses. Mr. Sabin comes across as profoundly confused about the science in that he doesn't seem to realize that the vast majority of "alternative medicine" modalities that he wants to see "integrated" with conventional medicine are not "proven" by any stretch of the imagination. "Evidence-based." You keep using that word, Mr. Sabin. I do not think it means what you think it means.
Not that any of this stops Sabin from proclaiming, even as he tries to misrepresent CAM as "personalized" medicine when it is anything but:
CAM is dead. The evolution of evidence-based, personalized integrative medicine, and its implementation in clinic, lives on.
Of course, CAM is dead. CAM advocates themselves killed it because they sensed a better marketing opportunity if they could come up with a term that didn't have the connotation that their treatments were inferior to those of conventional medicine. The killing of CAM was deliberate and calculated, but it is not complete yet. Rather, it is ongoing. But don't worry. Marketers like Glenn Sabin will make sure that before too long the corpse is well and truly dead, cold, and buried. In its place is rising the zombie that is "integrative medicine."
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More like this
"Integrative medicine" further evolves into "evidence-based complementary medicine." Nothing changes
This is not the story of the evolution of CAM,
It's not even a sock-puppet on the waggy tail of last year's quack's dog's 3 year old owner's birthday card pretending to be the story of the evolution of CAM.
If I wasn't so high on yoga I'd be cursing you instead of laughing at you.
A vain and pale attempt to fill the holes in the disintegrating grounds you laid down in your last few posts.
Exactly which year did CAM begin to evolve ORAC?
Was it before or after we first learnt to eat elephants?
CAM, or just medicine as it was known back then, can be defined as follows:
"Conscious practice of medicine is any attempt by a sentient being to pass on any health restoring procedure other than general food acquisition and preparation to another sentient being at a time when the procedure is not needed for real."
We are not talking about baby animals copying which plants mummy uses. We are talking about mummy telling baby which plants to use should a certain situation arise.
Certainly it starts to happen in writing a few thousand years ago. It began earlier than 1990 and before you were born, that is for sure.
The question it, how did we come to have the duality of 'Alternative' and 'Orthodox' medicine? Conspiracy? Or is that just the way folk like to mill it up?
Ancient people were not simpletons and the kings' advisors did not really believe that witches or even jesus could perform miracles any more than we do.
With the advent of 'civilisation' came the split.
You can't get away with charging money for medicines that everyone can produce, so you ban the production or use of such medicines unless they come from the king's official doctors.
Anyone who cannot afford doctors are encouraged to pray. After all, it worked for jesus, right? Religion serves two purposes. It offers prayer in lieu of medicine and it offers morality so that the public become brainwashed into policing each other's medicine (If you mess up and fail this part, like China, you can always install a citizen spy network later).
Read The Prince and stop being so simple minded and trusting.
I've lost count of the number of straw men there, sorry guys.
Walnuts. Legal as food, not legal to sell as a health product.
Note that Orac has publicly defamed my woo-free stretching-free yoga.
Behave or you go court. (Quote: lilady)
Blog safely.
Yes Orac, and even silly men are allowed to have facts.
How ever serious you try to be, you cannot dispose of 'facts', however much you'd like to.
It is when these 'facts' become relevant to the masses that your attempts to dispose of facts will look mean to the average person (assuming people always take screenshots before and after posting).
What is done cannot be undone. All you can do now Orac is continue to redeem yourself like you did briefly the other day.
Sorry AL,
Everyone, please call me á¹£á¹an or, if you prefer, yogacharya
Or Alji.
Or if you need to call me a troll, let's go with rakshasa ;)
@Mad the swine.
I did wonder about that, so I relied on google auto-fill to guide me and guess what comes up?
Unless something else comes up in the first few pages there is only one thing it cures* and that's the big C, which I find rather hard to believe.
*according to some but I'm out of my depth anyway, Orac is an oncologist so I don't want to tread on his webbed toes. (lizard people joke not defamation).
May I suggest you use Orac's specification for 'yoga' as the dummy placebo.
You can use my specification for Mysore style ashtanga vinyasa yoga meditation as the real thing.
Just stretching and breathing in an unspecified manner (90 mins) vs Moving and ujjayi breathing with bandha and drishti, yoga chikitsa, 5 x A, 3 x B, standing sequence, warrior sequence, primary series, full finishing sequence. (90 mins) Totally unambiguous.
Hope you're getting all this down?
btw i've been at a friend's house for the last few hours, no posts in the last 5 hours from me. Nothing slows a forum down like paranoia. Get some grips!
I don't know about you guys but I was pretty ignorant about the politics of autism until I watched this last night. Shocking!
http://thautcast.com/drupal5/content/watch-michael-john-carly-comictrag…
liliady you appear to be trying to discourage the readers from clicking on the link. You obviously didn't.
it is not an article, simply an embedded presentation, 1 1/2 hours long! Really great speaker, the guy who runs 'GRASP'.
He said he could have done 5 hours and I believe him. Extremely on the ball and it covered so much ground.
He explains the changing diagnosis rates really well and that seems to be one of the sticking points for the anti-vax people.
I'm (perhaps incorrectly) beginning to form the opinion that you are something other than mean, you're manipulative but your motives are not clear. Have you taken a Turing test recently? Prove that you are human?
I don't know where you get your sense of PC?
In the UK we don't say 'call a spade a spade', it is considered to be slightly racist.
Hyperlexic folk sometimes like to call a hoe a digging implement.
Integration! Is it inclusion or is it Imperialism? or is in invasion...
Interesting. Calling a spade a spade is calling on a mistranslation of 'calling a bowl a bowl'!
Origin of 'Hoe' is cool. Comes from *Kau meaning 'to strike'.
*Kau is pronounced 'Cow', to which the word 'vaccine' is related. Wow.
Hey, I implied racism was wrong, I didn't say it isn't funny!
On the Evolution of Stupidity
Once upon a time was an oncologist, who, somehow, despite all his important work, had time to write lots of blogs, hundreds of them...
But, to have read one of these blogs was pretty much to have read them all.
Busy important oncologist should have better things to do but then perhaps ....
Alexander #1
I can think of few better ways for an academic or medic to spend their free time than giving it over to writing on a free open access basis about their work and giving their educated opinion.
I have my doubts as to whether your own time is spent as productively as Orac.
Great post, might I suggest that the next move will be to follow the current marketing trend for names that do not relate in any way to the product. Perhaps they could use the noise a duck makes...
I read a newspaper report that said half of Australians use some form of quack remedies but the problem here is that a lot of those remedies get a government subsidy. The incredible thing is that there are qualified doctors who defend those remedies. Also concerning is that qualified pharmacists who have been scientifically trained sell a lot of those remedies.
I just popped over here from PZ's blog and... wow. What a fabulous write-up. This is truly a beautiful piece.
It truly is frightening how all this quackery continues, and evolves to fit a changing environment in order to survive (Ahh, I love you, Darwin...), but I think what's more frightening is that these people who are making these changes, these artificial selections, are -aware- of what they're doing. I wonder about that. I wonder if they're aware that they're manipulating the truth about their practices, yet unaware of the fact that they're hurting people.
Thanks, Orac. This is a really informative piece and I appreciate you posting it. It reminds me quite a bit of the evolution, ironically enough, of the creationist movement.
Persistent pseudoscience is crafty.
Evolution of Stupidity? Alexander, that doesn't even make sense. Are you perhaps referring to your own comment to this blog - is it meant to be ironic? To say an oncologist shouldn't bother giving his opinion on matters of science, medicine, quackery and the like because he ought to be busying himself with his *day* job is absurd. Who do you deem worthy of such a blog, who *should* take the time?
based either on prescientific vitalism or on science that was at best incorrect or grossly distorted
I think you left out "magical thinking" and "sympathetic magic".
Yes I donât know how you do it Orac finding the time to right all the posts, I for one have no free time, my boss makes me work 24 hours a day I havenât been able to do any of those things that people enjoy doing in their spare time like say playing with their children, playing sports, going for a long walk, riding a bike, reading a book, going to the beach or maybe even i donât now ahem writing a blog.
Alexander you Putz try thinking before you type
I hadnât thought of it that way before, the morphing from alternative to IM but it goes back to what the silly troll AL was on about yesterday (not very successfully) â they desperately want an air of respectability and being integrated gives them that in the same way that their bogus regulation does, but you may as well integrate and regulate the use of fairydust.
Write all the posts, obviously
Mau5 obviously doesn't understand what he just read. The act of calling it "Alternative" or "CAM" is what this is about. It's always been quackery, it just wasn't always recognized as such, and in the olden days, it didn't have a whole lot of useful medicine to compete against.
Besides, "Orthodox" is part of the same marketing attempt, to try to set up a false dichotomy and falsely cast one as dogmatic, when it's anything but.
"Integrative" is just the latest rebranding of the same lie.
Youâre right itâs not itâs on the evolution of quackery
When was back then?
Simple orthodox works alternative doesnât
M5 - you are completely incoherent.
Yep I've read and re-read Mau5 several times and I'm still not sure what he's on about.
Can you give us an example it might help clarify things
I think he's implying that SBM only functions by banning the woo which actually works? And that it's essentially a religion?
When the trolls are merely spewing drivel and word salad, it's probably a waste to engage them.
Can't alla youse pharma shills see what he's gettin' at? It's an outrage I had to pay $2.99 for this bottle of 300 aspirin tablets when I could just chew on willow bark fer nuthin'.
(I don't know how much gas I'd have to burn up driving around looking for willow trees to strip the bark off of, or how much the fine would be when I got caught, but I'm sure it's all a plot!)
Read The Prince
I wasn't aware that Sr. Machiavelli was board-certified in internal medicine, or even a practicisng physikian or chiurgeon at his time.
The things one can learn on the Internet...
-- Steve
Guessing from how Mau5 is talking about making your own "medicine," I'm willing to bet he's the cannabis troll.
@Anton P. Nym
Perhaps Mau5 means this prince.
You're wrong twice over. "Ancient people" (and what culture are we talking about exactly?) believed in witches and magic and miracles. In Greek and Hebrew, the word for 'witch' is related to the word for 'poisoner' or 'herbalist' - because, without a scientific understanding of biology, how could they know whether the healing effect of some drug was the result of 'magic' or 'nature'? This is not a result of a lack of intelligence. We only see further than, say, the ancient Greeks, because we have 2500 more years of research and study to stand on.
By the way, ordinary people today also believe in witches (in Africa and Asia), magic (horoscopes in the newspapers, "New Age" spirituality, etc), and miracles (ask any Catholic and most Protestant churches). 'Scientific' reasoning processes, even in 2011, even in the United States, are utilized by a relatively small minority.
Except everyone can't produce those medicines. Even if we're talking about basic herbalism, it takes time and effort to learn how to recognize various plants, where they grow (or how to grow them), what parts of them are useful, what doses are effective for what gender, age, and body type, how to avoid poisoning people... Even in the simplest hunting-gathering societies, the shaman/healer is more or less a specialist in his art.
(And before anyone mentions medical marijuana: marijuana doesn't cure anything. It creates an altered state of consciousness that temporarily alleviates the symptoms of various illnesses. I'm in favor of legalization, but talking about 'medical' marijuana is about as useful as talking about 'medical' beer.)
Can't accuse anyone of making straw men when you didn't present anything vaguely coherent or recognizable as an argument to begin with. All we CAN do is try to speculate what you might possibly have meant.
If you have something to say, SAY IT.
@Mau5
Marketing them as a health product would involve making claims of health benefits. Do you have good evidence of benefits beyond what might be expected of a foodstuff?
Going by the fact that there isn't a single blocked AL comment in the thread but a new incoherent blubberer, I think we have us a sockpuppet.
On the subject, I'm still hoping that once IM gets fully integrated it will die due to the constant competition with real treatments. If you can review 1000 patient files in a normal hospital setting and determine that the magic water/handwaving/distance healing doesn't statistically make any difference insurances will quickly use that as a reason to cancel coverage for a proven ineffective treatment.
Note that Mau5 appears to be a sockpuppet for Ashtanga London
And before anyone mentions medical marijuana: marijuana doesn't cure anything. It creates an altered state of consciousness that temporarily alleviates the symptoms of various illnesses. I'm in favor of legalization, but talking about 'medical' marijuana is about as useful as talking about 'medical' beer.
Okay, but you can say the exact same thing about anti-depressants, analgesics, anti-nausea drugs -- anything that relieves symptoms but doesn't cure.
I'm still not convinece that AL isn't a sock-puppet for Jacob as well. There are just too many similarities in writing style and focus on one particular topic.
Ashtanga,
Use a sockpuppet again, and you're banned. This is your final warning.
In news from the front:
As quackery continues evolving, making subtle advantageous adaptions to its environment to increase profits as well as promoting its own pseudo-respectibility, my own lens reveals the following:
Not content to encroach upon the MDs' ecological niche, quackery is promoting its own brand of "professionals"- ( no, not ad men and pr people ) but NDs and nutritionists. How often I hear a woo-meister/ supplement-provider ask his followers to consult only NDs ( see health ranger.com). Similarly, dieticians (RDs)are to be shunned- they're downright dangerous: "Look at all the patients they kill regularly through their rxs of junk foods at hospitals" ( paraphrase: "Death by Medicine", Gary Null et al). Indeed supplement purveyers (like the aforementioned author) staff their own health food/supplement shops and telephone ordering lines with nutritionists (to whom he sometimes refers to as "dieticians"). Other vitamin sellers do the same ( e.g. Invite Health shops and mailorder).
To alt med, where nutrition is the be-all and end-all in addressing serious and minor illness both physical and mental, nutritionists reign supreme, towering over mere doctors and nurses. Some woo-meisters advocate implicating nurses into their system, thus is born the "natural nurse", i.e. real nurses who cross over to the Dark Side** and study nutrition, reiki, TCM, etc. They also have their eye on dentists ( see mercury amalgam fillings) and psychologists ( EFT, life coaches, ad nauseum).
Thus as quackery itself evolves, it will breed a plethora of highly specialised organisms to sustain its own survival. Oh what a brave new world that has such creatures in it!
** I think I slipped there, *we're* supposed to be the Dark Side.Somehow though that sounds about right to me.
You're a very silly man.
I still like the name "infiltrative medicine."
Totally agree, Orac.
Nonetheless, despite my own distaste for "quackedemic medicine," I can see one potentially useful role for it: reaching the folks who've drunk the woo Kool-Aid and are too deep in denial to be reached by SBM.
For example, I have a friend who works as a trainer in a very woo-oriented gym outside of Washington DC. In addition to basic gym services, they push "detox" foot baths, ALCAT testing, cleansing programs, special supplements... the works. While my friend is skeptical of this stuff, she has to conceal this to fit in, since the other trainers/staff are very hardcore CAM enthusiasts.
A little over a week ago, she forwarded an e-mail exchange to me. Apparently, one of her clients canceled a workout because of back pain (a recurring problem, apparently), and asked her for advice on treatment. My friend then contacted one of the other trainers for a recommendation to a doctor... his response was unequivocal: NO DOCTORS! Instead, he recommended chiropractic, + some of the gym's other services (massage, pilates, etc.).
I told her that this was terrible advice, from both a health and legal perspective... my first rule for non-medical-professionals giving medical advice is: don't! Instead, I advised her to encourage her client to see a doctor first, if for no other reason than to eliminate any treatable medical conditions that could be causing her pain. Beyond that, unless she could make a recommendation within her area of expertise (such as foam roller exercises), she should gracefully decline any more invitations to direct her client's decisions about how to deal with her pain.
My point (a weak one, I'll admit), is that hardliners (like the trainer my friend consulted) would be more accepting of a doc with training in "integrative medicine" vs. SBM. As such, the folks who turn to them for guidance would have a better chance of being directed to a (hopefully) better-trained and more responsible provider, than - say - an acupuncturist or Reiki master. Andrew Weil, Mehmet Oz and their ilk may flirt with the "dark side," but at least they aren't totally bats**t.
Yes Ashtanga, sockpuppetry is just one of the totally honest ways of spreading the "truth."
Makes complete sense.
Totally agree, Orac.
Nonetheless, despite my own distaste for "quackedemic medicine," I can see one potentially useful role for it: reaching the folks who've drunk the woo Kool-Aid and are too deep in denial to be reached by SBM.
For example, I have a friend who works as a trainer in a very woo-oriented gym outside of Washington DC. In addition to basic gym services, they push "detox" foot baths, ALCAT testing, cleansing programs, special supplements... the works. While my friend is skeptical of this stuff, she has to conceal this to fit in, since the other trainers/staff are very hardcore CAM enthusiasts.
A little over a week ago, she forwarded an e-mail exchange to me. Apparently, one of her clients canceled a workout because of back pain (a recurring problem, apparently), and asked her for advice on treatment. My friend then contacted one of the other trainers for a recommendation to a doctor... his response was unequivocal: NO DOCTORS! Instead, he recommended chiropractic, + some of the gym's other services (massage, pilates, etc.).
I told her that this was terrible advice, from both a health and legal perspective... my first rule for non-medical-professionals giving medical advice is: don't! Instead, I advised her to encourage her client to see a doctor first, if for no other reason than to eliminate any treatable medical conditions that could be causing her pain. Beyond that, unless she could make a recommendation within her area of expertise (such as foam roller exercises), she should gracefully decline any more invitations to direct her client's decisions about how to deal with her pain.
My point (a weak one, I'll admit), is that hardliners (like the trainer my friend consulted) would be more accepting of a doc with training in "integrative medicine" vs. SBM. As such, the folks who turn to them for guidance would have a better chance of being directed to a (hopefully) better-trained and more responsible provider, than - say - an acupuncturist or Reiki master. Andrew Weil, Mehmet Oz and their ilk may flirt with the "dark side," but at least they aren't totally bats**t.
You're a very silly man.
I like that. Now I have the image of Graham Chapman stepping in whenever AL posts and proclaiming:
http://www.youtube.com/watch?v=Iu7vySQbgXI
Sorry for the double post, btw... from my end, it wasn't clear that it posted at all. :-(
For the love of Hippocrates...Yogatroll is starting to make me miss that Air Force guy who was obsessed with homepathic burn cream.
A few threads ago, I was wondering why the people here looked pissed off after me but instead, I find out that my pseudonym's initial are used by a troll....
perhaps I should comment under my real name.
pissed off A.L.
Unfortunately, a rather large distinction between the evolution of quackery and the evolution of biological organisms is that species of quackery do not seem to go extinct.
It would be nice if, say, homeopathy went the way of the dimetrodon.
We need to arrange a cage match between Ashtanga and Chuck PeltoâTony the postmodernist could referee.
(At least Tony and Chuckles never seemed to figure out what a blog isâthat there's more than one thread to it.)
Quacks did not think this good.
When I first read this (the second paragraph), I wanted to correct it to "Quacks did not think this well", but I then realized that "good" was an adjective referring to critical thinking, rather than an adverb referring to quacks' critical thinking skills. But actually it works good both ways.
Orac,
Nice detailed rewind on CAM. I'm a fan and semi-regular reader but one of the things I don't see discussed here (at your blog) is the role culture plays in the rise and spread of alternative medicine. Alternative medicine runs parallel to the rise and mainstreaming of the New Age movement, which is largely a cultural phenomenon.
For example, just yesterday I happened to highlight (at my site) a mass market magazine profile of a young rising star in the New Age movement. (Yes, we media are culpable.)
But before I wrote about this person, I briefly noted the New Age progression, how the "the free spirited, social change-minded Age of Aquarius [in the 1960s] was giving way to the self-absorbed, inwardly focused era of crystal healing and personal gurus [of the 1980s and 1990s]. The New Age movement soon became a mainstream, commercial success, brilliantly marketed by the likes of Deepak Chopra and Marianne Williamson, among other charismatic types."
http://www.collide-a-scape.com/2011/07/27/the-world-of-fortune-cookie-w…
This is a topic I've been meaning to write more on, but suffice to say, the cultural zeitgeist (think Oprah, think the kinds of commercial magazines such as the one I mention in my post) has been just as big an influence on the evolution of CAM as anything.
All this seems to stem from the political correctness movement. We as the general public are so worried about offending someone because of what they believe that we have been essentially forced to accept what they believe, even if we don't personally believe it. We aren't allowed to say anything against it or we are labeled a bigot and potentially able to be sued for libel or defamation of character or something else just as trivial. There are some very sensitive people in the world and God forbid they get offended. I mean, we don't want to hurt anyone's precious little feeler bugs, do we?
How fair is that? There is a difference between being unoffensive and someone else manipulating a situation to force their own belief system into acceptance. This of course is quite different from actual bigotry when it comes to race or religion, but it's been put into the same family somehow. Quack 'medicine' isn't a race, it isn't a religious creed in most cases. When it is, it's even more dangerous I think (magical/energy healing concepts are scary to me). These quacks so cleverly weaseled their preferred brand of woo into mainstream medicine that it went nearly unnoticed by most people. Even if it's pointed out to many people now and laid out as Orac has done so beautifully in this post (loved "The Princess Bride" reference by the way) there are people who still will choose not to see it for what it really is. Denial and self deception are much easier then admitting you've been wrong about many things for many years. It's a sad commentary on our society that so many people are so easily swayed and lack the ability to sort out reason and fact from fantasy and fallacy. They would rather continue believing what they believe and practicing what they practice then be told they are wrong. Is it so bad to be wrong? I'd rather find out I've been wrong so I can correct things then continue doing, speaking and believing wrong and potentially hurt myself or others. But hey, I'm weird like that.
While quacks and their enablers "evolve" different terms for their woo as a p.r. and marketing strategy, they're still stuck in a rut when it comes to name-calling directed at evidence-bsed medicine.
"Allopathic" doctors, "Pharma shills"...come on fellas, let's have insults that show a bit of originality and imagination.
Venna
Ohh, goody. I knew you wouldn't disappoint. See if you can answer this straightforward question that Chris and Lilady refuse to acknowledge because of political correctness. It's a simple exercise in logic.
Can a non-ambiguously sex person logically be born in the wrong body?. Is this a psychiatric disorder or is this a real physical possibility? In other words, is sex reassignment for obvious females or males good science based medicine practice. Is the acceptance of it grounded in science or political correctness.
If you believe that it is a psychiatric disorder, can you tell me the mechanism of how mutilating the sexual organs fixes the psychiatric condition?
Also, what if one believes they are a kitty cat born into a human's body? Is this actually true or is this a psychiatric disorder. Is feline reassignment surgery evidence based?
Boring troll - you first, answer the question that has been directed to you time and time again - what is your educational and vocational background? And what are your core beliefs on vaccines, autism & the such?
@Denice #33:
Back around 2001 and 2002 I was temping at a law firm. One of their clients produced "nutriceuticals". I thought to myself, "What the hell is that?" But I guess that's what attracts people -- they see "nutri" as in nutrition and "ceutical" as in pharmaceuticals and think wow, this must be powerful stuff! Of course now we get to hear the term ad nauseam.
(Unfortunately, it was nothing about a lawsuit or trouble with the FDA. Just regular old business correspondence.)
@Porky Pig, Evidence Based Name calling is stuck in a rut.
"Quacks" , "Woo", "snake oil saleman", charlatan"...come on fellas, let's have insults that show a bit of originality and imagination.
"Nutriceuticals" is a silly word, and it always makes me think of this similarly-named silly product.
@Lawrence
Why?
This is the part where I wish we could easily embed photographs in posts here, because there is a glaring need for an Obvious Troll is Obvious picture now.
Or maybe off-topic troll is off-topic.
@augustine
You are deliberately baiting me. I have no medical or psychiatric training, therefore I can't answer this with any kind of professional knowledge.
From what I could find, Gender Identity Disorder can be either physical or psychological, depending on different factors. But in actuality this question can't be answered with any certainty because, like autism, nobody knows what really does cause it, it is simply speculation at this point.
It appears a prenatal hormone imbalance can predispose a person to this and problems in family interactions and dynamics can also have a causal impact. This being the case it appears to be both physical and psychological in origin. Would one have an issue if they didn't have both the prenatal hormone imbalance and the messed up family dynamic?
I have also heard of people who switched genders and they had a medical condition (E.g. extra Y or extra X chromosome) and even in some cases had outer genitals for one gender (vulva/vagina) but inwardly organs for the other gender (testes and prostate, etc). In that situation I think it's clearly physical, their organs are producing hormones for one gender while outwardly they appear to be the other gender. So what would you recommend for these people?
Yeah, that's what I thought.
@little augie: just because you are so unintelligent, I'll try to use small words.
Yes, it is considered medically possible, (oops..too many big words?) for a human being with unambiguous genitalia to feel they have been born into the wrong body. There is a medical diagnosis, Gender Identity Disorder (aka transsexualism) and a step-wise approach to treatment is usually considered appropriate. (oops again. More big words.)
From a health insurance directive: Due to the far-reaching and irreversible results of hormonal and/or surgical transformational measures, a step-wise approach to therapy for GID, including accurate diagnosis and long-term treatment by a multidisciplinary team including behavioral, medical and surgical specialists, is vital to the patient's best interest.
More big words. Hope you can deal with it.
So. There you have it. It may be considered a psychiatric disorder, but the treatment, to allow the person to acquire the body they believe they were meant to have, helps them live a happier life. It may be covered by health insurance, and is an accepted treatment in many places in the world.
Now, shut up. You know NOTHING about medicine, diagnosis of either medical or psychiatric disorders, or appropriate prophylaxis or treatment. Try learning before opening your mouth. Your prejudice and lack of compassion are showing.
@52 au-(dis)gustin(g)-e
Ah augie, I knew you wouldn't dissapoint. Back again trumpeting your ignorance, your fetishes and your bigotry all in one short post.
@52 augustine
I think it is important to note that there are those, such as our own ugh troll, who will use the cover of being against 'political correctness' as a smokescreen to hide genuine bigotry and hatefulness and to spew unsubstantiated nonsense.
Well, to address this tired issue, there have been numerous cases of children born with partial genitalia & the doctors forced to make a decision on whether or not the child was supposed to be a boy or a girl - especially in the 1940s, 50s & 60s, this was usually followed by instructions to the parents never to mention the procedure to the children in question.
If the wrong decision was made (boy/girl, girl/boy) then the child could and did end up with gender identification disorder, among other psychological issues - only rectified when the individual underwent gender re-assignment (and in this case, correct gender assignment surgery).
So there boring troll - now what is your educational background again? Vocation? And core beliefs please.
Venna
I specifically stated "unambiguous" to purposefully exclude "ambiguously" (ie hermaphrodites) sexed persons. You described ambiguously gendered persons.
@ Trisket a Trasket
Your non science political correctness bias is showing.
I didn't ask you what is possible for a person to FEEL is wrong. I asked what is true. Obviously one can FEEL they are a kitty cat trapped in a human body. Is this objectively true?
Yeh, uh that's pretty objective "science" right there. I guess in your world kitty cats can be trapped in the wrong bodies. SBM veterinarians should get in on this ruse. Talk to the kitty cats and find out what's ailing them.
Woo is covered by health insurance. And consensus is not a reliable way to determine if something is true.
Trisket, you're a regular here. Your logic, critical thinking, and objectivity should be a little crisper than that.
Just so you know, what more or less started that discussion was that Chris told augustine she was an engineer and a woman, and augustine decided she had to be a transgendered man based on this. Don't bother engaging him on it, he's just trying to make himself look moral, and doing a bad job of it.
Augustine, question. Which was more moral: That some people suffered side effects from the smallpox vaccine in the process of eradicating the disease, or that millions died from smallpox, and without the vaccines, millions more would have died each year. If you're going to beat us over the head with your morality, I'd like to know where you stand on relevant issues.
@ Venna: See the troll is transferring his weird mommy animus complex to you as well. According to troll's warped misogynistic thinking processes, any woman is a target; his sub specialties are women posters who have disabled children...truly an odious creature.
Notice how it gets its "jollies" by bringing up sex topics to satisfy its needs. (Troll, you will go blind doing that)
Just another sicko posting from the pious hypocritical christian. I skeeve sexual deviants who are pious hypocritical christians.
@66 Gay Falcon
He's trying to make himself look moral by being a bigoted asshole? Sounds about par for the course for augie. Up is down, vaccines are bad 'cause they save lives, blah blah blah.
I had forgotten that particular animous towards Chris - yeah, the whole transgendered thing came up when it found out she was an engineer.
@Gray Falcon: I know. Augie did that from the first. He just really annoys me, since he is such an unintelligent being. I know several transgendered people, some who are just living as the correct (as they feel) gender without hormones or surgery and others who are on various steps of treatment. The insults to my friends get to me sometimes.
And Augie: show me any sane person who believes they are another species. Transgendered persons don't believe they are another species, they are not insane.
Back on topic:
I have seen (and actually gone through) periods of belief in quackery. Fortunately, I always had a scientific mind and refused to believe without research and testing. I have seen over the years the increase of quackery and the increase in insurances that cover it. It's a shame, but unless society becomes more scientifically educated, woo will increase.
It psorta pseems one psilly psoul has issues with its own psexual identity. I psorta predict it will pstill use it to avoid psupplying pstraight answers.
OK, Augie: It's unscientific to try to give someone the body they feel they should have. Fine. What about CAIS? Let's assume for a moment that the rumors about Jamie Lee Curtis are true (I have no idea, but just to put a face to itâthe syndrome does exist). Obviously you would advocate forcible surgical "correction" to match her genetic sex...right? Being so scientifimacalacious and all.
come on fellas, let's have insults that show a bit of originality and imagination
Augustine, Augustine, Augustine... Please regale the audience with your most recent efforts on the orignality and imagination front. Perhaps you switched from regular mayonnaise to Miracle Whip in your regular endeavor of pretending that your date hand is someone who Made You Mad and rehearsing your lines on it while trying to create a family of half-human, half-Kleenex hybrids?
@ Narad: LOL. When you first put down the Ugh Troll, I just assumed you were using some clever remarks in response to its vicious postings. Then I really started to analyze the raving loony's postings and came to the conclusion that Ugh Troll has many sexual issues...big time.
I suppose the broke ass troll can't afford phone sex and this blog is his freebie outlet...pathetic.
The evolution of evidence-based, personalized integrative medicine
Going back to the original post, this part of Sabin's article is worth emphasising. The key word is "personalized" -- meaning "a mix-&-match combination of different forms of woo, customised so closely to the client as to rule out any tests of efficacy". He is preemptively appealing to the familiar homeopathy argument that "Treated / untreated comparisons are not possible because no two clients receive the same treatment".
Having ruled out objective tests of the clients, the therapists are still happy to accept their subjective reports of well-being... that's the "Evidence-based" part.
@ augustine
As far as I am aware, these are the only times when gender confusion (I.E. Gender Identity Disorder) would be diagnosed. Any other time, it isn't this but personal choice that comes into play. I am not going to get into a philosophical debate with you regarding people's sexual preferences because it is off topic and none of your business what I personally feel about this issue. On that note, I have dropped it, if you continue, it's obvious you have issues.
Most patients and physicians are unaware that many common Allopathic practices have minimal to no evidence based rational. Most elective surgeries have never been evaluated with double blind placebo studies. So called evidence for many potentially harmful medical treatments that we think are supported by scientific studies are often skewed by pharmaceutical companies deliberate suppression of data that does not support their products safety and or efficacy.
There have been lots of studies showing the benefits of meditation techniques like MBSR, yoga, acupuncture, massage.
Dr. Small, you must be new here. You tipped your bias by using the pejorative term "allopathic."
[citation needed]
Also, see the little search box on the upper left of this page. Put in one of those words, especially "acupuncture", and see what pops up.
Protip, Maureen: Anybody who uses the term "Allopathic" outs themselves as a complete maroon. "Allopathy", if you accept the Homeopaths' made-up definition of it, died out 200 years ago. If you don't take the Homeopaths' word for it, then it never existed. Either way, you sound like an idiot.
Uh-oh, Woo Alert: we have a poster sneering at "Allopathic" medicine. Could Dr. Small be this devotee of yoga and "holistic" medicine? (maybe we should be leery of trifling with a medical ninja).
Dr. Small is probably blissfully unaware that 1) pro-evidence-based views that take in all health care practices, not just "alt med" are promoted here, and 2) the existence of medical procedures/treatments that lack an "evidence based rational" does not justify the overwhelming majority of woo procedures/treatments that are non-evidence based.
"There have been lots of studies showing the benefits of meditation techniques like MBSR, yoga, acupuncture, massage."
Extremely few good ones that deal with any serious medical conditions, unfortunately - and none that support using the woo you mention to the exclusion of proven mainstream treatment.
Sorry, Chrisâslow typing fingers.
@Dr Small:
How, pray tell, would you evaluate a surgical procedure by a double blind placebo study? Have the meditation and yoga techniques been evaluated by the same double blind placebo studies?
Let's also note that the (admitted and regrettable) evidentiary shortcomings of real medicine do not justify quackery.
@ Queen Khentkawes:
Woo-meisters perpetrate the idea of specific nutrients as curative of illness: this portmanteau term suits their purpose well ( *nutri*ents as substitutes for pharma- *ceuticals*). If a modicum of vitamin C can prevent scurvy, perhaps a load of it can prevent illnesses and (jumping to even further conclusions) even cure them! In his dotage, Linus Pauling ( often cited by woos as the double Nobel Prize winner) advocated huge dosages of C; his followers today persist in this delusional thinking.
Today co-incidentally- a well-known woo-meister( via the progressiveradionetwork.com -see Archives)- advised 2000 mg every 2 hours : total 10,000 mg per day for healthy folk** and increasing the amount for prevention- up to 200,000 mg per day intravenously for *curing* AIDS and cancer.
Other especial faves include antho- and pro-anthocyanadins , resveratrol, CoQ10, various amino acids, vitamin D, B complex,EGCG ( green tea) etc. Basically, they isolate chemicals found in healthy foods and prescribe them in place of pharmaceutcals. Needless to say, much of the "research" cited as evidence is spurious or unrelated. It must *sound* good to those already taught to fear and detest pharamceutical companies' evil products.
Interestingly enough, cosmetics manufacturers ( "natural" and standard) have latched onto the nutriceutical label as well. Oh right, proper nutrition you smear on your face.
** who will probably spend more time in the bathroom.
@ Dr. Small: We are anxious to hear about your alternative medicine techniques and an answer to the question posed by TBruce about double blind placebo elective surgery studies...you are spot on with your remark that such studies have never been done. How would you set up such a study? Be specific here...because this is scientific community.
(I need a sock puppet scorecard to determine who is who)
Oy! Nia - movement woo with belts. I accept as a given that exercise is good, but it is certainly ironic to have the trappings of combat training tacked onto a "healing" system.
Hmmm! Got enough qualifiers in there? In any case, if we think these treatments are supported by scientific studies, it should be easy enough to confirm that they actually are.
You of course have evidence? Since it happens often there should be lots of evidence. Or have these same pharmaceutical companies suppressed that evidence, too? Which brings up the question of why pharmaceutical companies would skew and suppress data on any medical treatments that were not directly pharmaceutical. What does it have to do with elective surgery?
Ah yes, the old Unsupported Assertion ploy...
This last comment stinks of socks...
@64 Lawrence:
Well that would be ambiguous, wouldn't it?
@gray
Well, you remembered wrong. I was ribbing her about her masculine name and her alpha male qualities and then she got defensive saying something about females can be engineers. I guess it's a complex or stigma she has because I never mentioned it.
The question about the transgender operation came up later because I had a hunch she would be sensitive about the politically correct nature of the subject even though it's not logical or scientific. It posed a dilemma for her.
@71 TRisket
Well they would be ambiguous wouldn't they? Not applicable here. Don't be so sensitive. See you can't think straight when you let your emotions cloud logic and facts. Now if one of your friends with Chaz Bono then you can abandon logic for tolerance and get defensive about the subject.
The point of the whole question is to show that you science bloggers aren't always logically consistent. And this is an instance where your own political correctness supercedes your need to be logical. Pick and choose to your fancy.
augustine:
So, now you admit to deliberately changing the subject to obfuscate issues. Thank you for being arrogant enough to reveal your true nature.
I loves me some killfile - no more Ashtanga, no more Augie (unless I choose to read the comments). Just the interesting talk of people who see different sides of the story. Though I'm not too sure about Dr Maureen Small. However, she appears, at least at this time, to be a post and run type.
Ugh Troll: I left a message for you/Thingy about herpes zoster infection.
BTW, Are you read to answer our questions?
Where did you get your education?
Where are you gainfully employed?
We are really interested because of your unique germ theories and your unique analytical skills.
A foolish consistency is the hobgoblin of little minds.
- Ralph Waldo Emerson
hdb@76: You made me realize that those "personalized" treatments are analogous to a sort of job posting that we've all seen: a position that requires a bizarre and very specific combination of unrelated skills and experience. The reason, of course, is that the employer already has a specific candidate in mind but for policy reasons has to pretend to offer the position widely. Thus the posting is written so that only the pre-chosen candidate can possibly qualify; in other words, the purpose is to eliminate any meaningful competition. Similarly, the "personalized" treatment is cobbled up to make it difficult or impossible to ask "wouldn't (insert name of something else) work better in this case?".
ISSUES!!
gray
You don't even know what you're talking about. In order for you to know you would have to go back and read the original posts and context. You haven't. You don't know what you're talking about.
Speaking of Quackery. Science Based Medicine is rock solid real life hard core science.
http://pipeline.corante.com/archives/2011/07/28/massive_piles_of_faked_…
"Massive Piles of Faked Data"
Where's the ORAC outrage? Too busy bashing vaccine compliance issues instead of dealing with reality of 200,000 iatrogenic deaths. Ohhh, the vitamins, they're so dangerous!Lol.
How many died from measles in 1960? 450.
How many died last year because they listened to their doctor? 200,000
This is how you control quackery. Control the guideline and policy makers. Pharma knows how it works. Control the masses. Make more money. Do it again.
http://www.cchrint.org/2011/07/28/drug-firms-paid-independent-experts/?…
Augustine, as far as I can tell, your only purpose of your actions was to attempt to make us look "illogical", which did absolutely nothing to change the facts and reality, just made you look a twit. Likewise, bringing up corruption in medicine is only showing that corruption exists, not that it is happening in the area of vaccines. And if your argument was valid, why wouldn't it apply to all medicine, and all science? Finally, you still haven't answered my questions: Which would be more moral: Letting people die or saving them?
Gray
What would be more moral? Killing more people or killing less?
Seriously, some of your questions are retarded.
ugh troll only reinforces Orac's complaint against the ongoing infiltration of quackery into medical schools.
After all, would not pharmaceutical companies also benefit if freshly minted MDs have had their critical thinking skills diluted by "integrative medicine"?
Also, ugh troll needs to provide a credible source for his ever-shifting iatrogenic mortality figure. Unless the troll enjoys being viewed as a spiteful liar.
Good post Orac. If anybody needed further proofs of these insidious practices, they need look no further than the likes of Dr Small and Mau5
That is neither what I asked nor what vaccines do. A more accurate comparison is four hundred and fifty a year dead and thousands more with permanent damage versus maybe fifty a year with problems from the vaccine. Which is more moral? And don't answer with "Nobody getting killed", unless you have a realistic way of doing that.
Giving people complete informed consent(BTW those pink and purple sheets VIS are not informed consent) and giving them the choice without fearmongering or coercion. That's moral. Telling someone they have to get the shot to go to school while simultaneously taking zero responsibility for that medical decision if it goes wrong is immoral.
I thought people had been compensated for vaccine injuries. And you did admit that hundreds of people died each year of measles. How many died from the vaccine?
Call a spade a spade. No matter what term is used, there is might not be any sound basis for what is known as 'alternative medicine'. Through the centuries, people have been healed using these methods, but, the option of going to a licensed physician is one that should not be ignored, as it could mean the difference between life or death. Thank you for this revealing article. There are quacks everywhere, and many people should be aware of these issues.
In certain situations, like public health which affects everyone, there cannot be an option to 'agree to disagree' because the decision in some situations can threaten other's besides yourself.
In the case of IM and real medicine, I don't want it integrated, I want to know the doctor I go is going to give me good, solid, proven medical advice and treatment, not magic water.
The newest quack-
http://online.wsj.com/article/SB100014240531119048883045764745625087011…
Stupid Yoga spammer is still stupendously stupid.
And larry is afraid of shrink wrap. Seriously, dude?
And on sites that do not require a subscription to read, it was the FDA that noticed it last April. Note that this was the same newspaper that claimed a blond Norwegian was probably a Muslim about a week ago.
Richard @36
"Infiltrative Medicine!" Many thanks for the description. It's certainly infiltrative, even if it isn't medicine.
Before anything gets integrated into medicine, it needs to demonstrate that it is indeed medicine.
ISSUES!!
Entire collected volumes.
herr dockter bimler:
On Little Augie's obsession with gender identity and total lack of logic?
I remember when I first found this blog, I really enjoyed reading the comments section. Smart people with good information, discussing science.
I miss that.
@ Boring and Pathetic Troll:
Citations Needed. Specifically, citations that show that 200,000 people died while under Medical Care, and citations that show that those people wouldn't have died anyway.
Boring off topic obvious troll is annoyed at transgender ops because he prefers his trannys with dicks that bring tears to his eyes.
Love the term "infiltrative medicine"....
Venna:
Absolutely. Many argue (and with justification) that the free market ought to prevail and that people should be free to choose whatever they like. But the problem is that in practice, they are not really free in a laissez-faire situation; the manufacturers and providers have a huge advantage over them, and without regulation, no incentive besides their good will to be honest. And even if they have good will, they themselves may be deceived and pass on that deception.
Another problem is that the general public tends not to understand what's really going on, especially in the Big C -- cancer. Appropriately, then, today's XKCD addresses that, with the final panel apparently built using actual breast cancer survival statistics. It illustrates the problem of defining cancer "survival", and why the word "cure" maybe isn't what we tend to think it is. It's nothing surprising to regulars here, and certainly not to Orac, but it's a good illustration.
http://xkcd.com/931/
Ugh Troll: The VIS are white and are not consent sheets. If you ever really read one, you would know that there is no "signature line" for the patient to sign. There is however, a "signature" line for the patient/guardian to sign on another sheet of paper...at the bottom...after a clinician has questioned the patient/guardian about any contraindications for each vaccine to be administered.
BTW, if you had "real" children, your "real" child's personal physician would have you sign a consent form for other procedures such as drawing blood for annual check-ups.
So what do we have here? A boring Ugh Troll who cannot or will not read the VIS, who has never signed an (imaginary) consent sheet for troll's "imaginary" children and is anti-vax through and through. Of course, as other posters have pointed, out the anti-vax stand is based on limited intellect and inability to read any scientific paper with its rudimentary skill set.
Yogi is going to read up on the "politics of autism" and within a half hour be posing and posting as the expert on the "politics of autism".
Around the middle of the 19th century, when basic principles of physiology and cell biology were first elucidated and was developed procedures that worked. Since then, if something works, it is referred to as medicine.
@116 Christopher Wing
Yes - those were good times.
We could return to those times if we ignored the spammers and trolls. Though sometimes they are just too easy to mock.
Looks more like a sock to me.
Personally, I often call a spade a club. Makes my bridge partners quite cross.
In the UK, making a job ad that says that only honest and reliable people should apply also is considered offensive. So what do you want to tell us? We can also say a duck is a duck is a duck [...].
You forgot to mention another advantage of the term Integrative Medicine. Skeptics are now "against integration."
Doesn't it somehow just sound better if you say you're in favor of integration?
Any way they can.
If they're going to be in favor of integration, can't we differentiate ourselves somehow?
Sorry, I can never resist making bad puns...
Vets like to call a neutered cat a spayed.
There are many people who erroneously assume that this is an idiom of racist origin, and that "spade" as used in the idiom refers to slang for an African-American person. It is not difficult to do the research to find out that the idiom dates back to Plutarch and predates the English language, let alone any slang that has crept in over the years.
In the UK we don't say 'call a spade a spade'
Oscar Wilde says otherwise.
augie- if GRS would make you happy, then pursue it. We'd support you. It's obvious that your gender dysphoria is making you terribly unhappy.