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Skeptical Battlegrounds: Part III – Alternative Medicine

by Steven Novella, Dec 15 2008

Being both a skeptic and a physician I have focused a great deal of my skeptical efforts towards science and medicine. While I endeavor to be a full-service skeptic, pseudoscience in medicine is definitely my specialty. It is therefore especially painful for me to admit that in this arena, more than any other, we are getting our butts kicked. We are almost at the point of being routed, with the defenders of scientific medicine being relegated to the role of insurgency. How did this happen?

What is Alternative Medicine?

I think the biggest victory scored by the promoters of complementary and alternative medicine (CAM) was the name itself. Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery. The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all – a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberate blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.

The goal of CAM proponents is nothing less than the elimination of the standard of care in medicine in exchange for an anything goes approach. Key to their strategy was the language game – getting people to talk about fraud and pseudoscience in medicine as if it were a legitimate “alternative”, that pseudoscience can “complement” science or be “integrated” with it. Scientific medicine was rebranded with derogatory labels such as “Western” and “allopathic.” Anyone defending the scientific standard of medicine was attacked as closed-minded, and accused of protectionism.

The very fact that there is a category of medicine such as CAM, whatever you call it, is a significant defeat for scientific medicine. CAM as a category includes an extremely diverse collection of claims and modalities that do not share a common theme or philosophy, including some that are mutually exclusive. The only thing they have in common is that they do not meet the scientific standards of mainstream medicine. The only purpose of the CAM category is to create a space in which substandard or unscientific modalities can exist. It exists to create a double standard.

A Perfect Storm of Anti-Science

Wallace Sampson, writing for Science-Based Medicine, gives an excellent overview of the last forty years of medicine and what went wrong. He points to several cultural trends that conspired together to allow the anti-scientific revolution to occur. These include political correctness – which has had the effect of rendering appropriate scientific criticism as impolite. The post-modernist influence in academia also played a major role, one aspect of which is the portrayal of science as just another narrative without any special relationship to the truth. In fact science, according to some post-modernists, is just a way for one group (in this case Western white males) to impose their power over minorities and the oppressed.

Add to this a general anti-establishment movement beginning in the 1960s. CAM proponents were successful in portraying scientific medicine as the Establishment – something that needed to be taken down. This evolved into the “health care freedom” movement, the ostensible purpose of which was to earn freedom for the public to access whatever health care they wanted. In reality the health care freedom movement is about earning freedom for practitioners to do whatever they want, free from any regulation meant to protect the public. I find it one of the greatest ironies of the CAM phenomenon that they have been able to pass laws that are overtly anti-consumer, in that they remove protection from fraud or incompetence, in the name of consumer freedom. Why hasn’t Ralph Nader noticed this? What if the auto industry promoted “automobile freedom” laws so that consumers could buy any vehicles they wanted, free from any government quality or safety regulation?

This brings up the political dimension of CAM. Proponents have been successful at working both sides of the aisle, appealing to anti-regulation sentiment on the right and anti-corporate/anti-establishment sentiment on the left. Unfortunately, science has no political party.

And of course all of this is happening in a generally scientifically illiterate society. In my experience most of the public does not understand why homeopathy cannot possibly work (it’s just water), why scientists are confident that there is no mysterious life force at work in the body, why chiropractic subluxations make no sense, and why megadosing vitamins or the latest fad tropical fruit juice cannot cure everything.

And yes, of course, there are legitimate criticisms of mainstream medicine. The system is under great financial strain. Technology, while extremely effective, is very expensive and may render some medical encounters very unpleasant and frightening. The ethical model in medicine has also shifted from a paternalistic model, where doctors just did what they thought was best, to a cooperative model that focuses on informed consent. This is a good thing, but it means that physicians are ethically obliged to tell patients the whole and unpleasant truth. We do not have the luxury of lying to patients to make them feel better. Charlatans have no such constraints.

Tactical Defeats

The specific tactical defeats of scientific medicine include, first and foremost, the cultural non-judgmental acceptance of an “alternative” category of medicine. But in addition to this, there is the NCCAM (National Center for CAM), which was created specifically to fund CAM research. These funds, however, are generally spent doing studies designed to promote CAM, not answer the only question that really matters – does it safely work. More than a decade and hundreds of millions of dollars later, there has not been a single CAM modality that has been proven by research to the point that is has gained general acceptance, nor has any modality been rejected as disproven. Sorting what works from what does not work is the primary purpose of medical research, so in that regard the NCCAM is an unmitigated failure. But, it has lent incredible legitimacy to CAM.

Healthcare freedom laws have been passed in almost 20 states – eliminating the ability of states to act against practitioners simply because what they are doing is substandard (as long as they self-label what they do “alternative”). That’s right – eliminating the standard of care.

The Dietary Supplement Health and Education Act of 1994 removed “supplements” from the control of the FDA, and redefined supplements to include herbs used as drugs, and pretty much anything else that is not already a drug. It also created a separate category of health claims, so-called structure function claims, that are beyond regulation. This led to an explosion of the supplement industry. This allows snake oil peddlers to decry the excesses of the highly regulated pharmaceutical industry, while making billions in the largely unregulated supplement industry. To further increase the irony, in many cases the two industries are one and the same.

A reasonable person might think that medical academia would be the last line of defense for scientific medicine. Surely trained medical scientists can see anti-scientific propaganda for what it is and will defend the scientific integrity of their profession. Unfortunately, this is largely not the case. Academics have been cowed by calls for “freedom” and political correctness. Promoters have learned to speak the language of academics to further subdue their skepticism – using pleasant terms like “holistic”, and “patient-centered” practice. Like most deceptions, there is always a kernel of truth to such ideas. But in the end it all amounts to a sweet-sounding justification for outright pseudoscientific quackery in medicine.

This happens, however, because the academics who should know better are largely asleep at the switch. They have mostly put CAM into the hands of proponents, because they are the ones who are interested. Most physicians and scientists are “shruggies” when it comes to CAM – they just don’t think about it and don’t want to think about it. So proponents have been able to become the gatekeepers of their own claims. CAM proponents are appointed to committees on CAM, are able to make CAM curricula for students, and decide what CAM journals should be registered with the International Library of Medicine (which means they can keep out critics). The foxes are in charge of the hen house.

What this also means is that those few of us who are trying to point out that the Emperor has no clothes (to use a tired metaphor), and defend science-based medicine are made to seem like ideological, closed-minded fanatics. Defending science in medicine is no longer politically correct – at least not within the alternate reality of CAM.

Evidence-Based Medicine

More irony. Over the last couple of decades there has been a growing movement within mainstream medicine called evidence-based medicine (EBM). One might think that EBM would have worked to retard the advance of CAM but the opposite was true. It is an unfortunate happenstance of history that the minds behind EBM inadvertently played into the hands of CAM proponents.

The concept behind EBM is that medical modalities should be judged primarily by the empirical evidence, not by their plausibility. The reason for this was the perception that too many practices were being widely used because they made sense – they were plausible – despite a lack of evidence that they actually worked. Therefore EBM was constructed to eliminate the advantage of plausibility. Medical claims require evidence no matter how plausible they are.

But by eliminating plausibility (or prior probability) from consideration EBM also leveled the field for highly implausible claims, even though this was never the intent. EBM is not unreasonable in a world where it is assumed that treatments and claims make basic scientific sense, but it is not equipped to deal with a world in which highly implausible claims are being promoted. This had the effect of almost eliminating basic science from consideration. Under EBM claims that are highly implausible are treated the same as claims that are highly plausible. This approach exists no where else in science.

Therefore, CAM proponents just adopted the language of EBM. It did not take long for CAM modalities to have the EBM label slapped on them, whether or not they earned it even by the flawed methods of EBM. I see “evidence-based homeopathy” or “evidence-based acupuncture” promoted all the time, even though these terms are oxymorons. Even without consideration of prior plausibility CAM modalities do not fair well under EBM examination, so proponents simply lie. They claim their methods are EBM even when no formal EBM evaluation has validated them. They behave as if their personal assessment of the evidence is sufficient to support a claim of EBM, when in fact there are formal methods of systematic review that are required.

But the EBM infrastructure is vulnerable. They already fail to put CAM modalities in their proper scientific perspective by considering prior probability. And now they too are putting the foxes in charge of the hen house – allowing CAM proponents to perform and publish biased EBM reviews.

A Ray of Hope

I recently wrote about the National Health Statistics on use of CAM by Americans. The stats have been misrepresented by proponents to argue that CAM is increasingly popular, followed by the argument ad populi that therefore they should be supported. A closer look at the data, however, shows that the hard-core CAM modalities are still marginal, and not significantly increasing. In the last year only 1.4% of Americans used acupuncture, 1.7% homeopathy, and 0.5% energy healing (by self report). These numbers are not significantly different than 20 years ago.

Use of these modalities remains marginal. I am not sure exactly how to interpret this. The best-case interpretation is that most of the public still regards the magical claims of homeopathy and acupuncture with skepticism. The most pessimistic interpretation is that the public accepts these modalities in greater numbers, but the infrastructure has not yet expanded to meet demand.

I also find some comfort in the fact that most of my colleagues have not drunk the Koolaid of CAM. They regard it as quackery – and yet frustratingly think it’s not their responsibility to do anything about it. But perhaps there is a growing backlash against the nonsense. I think as CAM’s profile increases, the sham at its core is more apparent. Maybe.

Conclusion

The situation is grim. A generation of health care providers is being indoctrinated into unscientific acceptance of dubious claims and methods. The public has largely bought the framework of CAM. Even among skeptics I find that CAM is a frequent blind spot. The propaganda has simply been extremely effective.

Most disheartening is that academia has largely failed to recognize and confront this attack on science. They now understand well the threat of creationism/intelligent design. They get it. They do not understand how CAM erodes the scientific basis of medicine and the standard of care.

Those of us who are opposing the infiltration of pseudoscience into medicine have an uphill battle, and no apparent allies. We have been marginalized. We are also a couple of steps behind the CAM proponents in understanding how the language and the laws are being manipulated. We’re catching on, but we are already far behind.

The situation is not hopeless, but it is desperate. I think in the long run science always has the advantage that it actually works. But history has shown us that cultural inertia can be immense. As CAM becomes infused in the culture and in the institutions of health care it is becoming entrenched and will be difficult to remove. It will likely continue to be a drain 0n the effectiveness and efficiency of health care for decades to come.

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126 Responses to “Skeptical Battlegrounds: Part III – Alternative Medicine”

  1. teacherninja says:

    Sigh.

    Thanks for continuing the good fight.

  2. Cambias says:

    I’ve also noticed that there’s a “fifth column” within medicine itself. RNs, midwives, and other non-MD “health professionals” seem to have a weak spot for quackery. It was nurses who fell for and promoted the whole “therapeutic touch” nonsense. And as a personal note, there was a pretty obvious anti-physician tone to a lot of the presentations in the childbirth class my wife and I took back in the 1990s — a strong strain of “what’s natural is better.” The high point was a 15-minute video of Peruvian women delivering babies in the squatting position, accompanied by Andean flute music.

  3. Hear, hear. Standing O.

    A few years ago I presented at the NC School of Substance Abuse Counseling, held that year in Wilmington NC, the NC cert board’s bi-annual week-long program of education and training providing credits towards various SA counseling and supervision credentials. The theme that year was ‘Evidence-Based Best Practices’, which I found heartening given the foothold woo has in this field. Alas, alongside my presentation on the intersect between substance abuse treatment and the judicial system were found presentations on acupuncture, no less than three variants of religion-based treatment (praying for wellness, faith = wellness, etc.), Myers Briggs-type profiling as assessment tools and similar nonsense, as well as 2-3 unresearched and unproven counseling approach theories, all of which disappeared in just a couple years. That’s the last time I presented, informing the cert board that where entertainment value and popularity overrules efficacy and evidence, they may count me out.

  4. Julian says:

    Cambias -

    That’s especially true amongst left-leaners, at least in my experiences. I’m willing to let child-birth slide (very personal and whatnot) but then it starts leaking into everything else. Gets to be a real pain when you try to explain to them why ‘A doctor told me I needed [insert treatment] and it would cost a lot but after [insert crap] I was all better and still am’ isn’t a valid argument and they say ‘I don’t care. It made me feel better so I’m recommending it to everyone.’

  5. LovleAnjel says:

    The whole childbirth thing scares me. A good friend of mine had her first child under high risk conditions (pre-eclampsia, six weeks premature), and after getting into attachment parenting (which has good points, I’ll grant), she decided that because the doctors deprived her six-week premature child which might have had non-working lungs from the first hour of flesh-on-flesh post-birth contact with her mother (I’m sorry, but if the nurse thought it sounded like the baby couldn’t breath, I would not have been upset if they took her away to help her– my friend thinks that since the baby turned out to be okay they should never have touched her in the first place because “SHE WAS FINE!!”) she wants NOTHING to do with doctors or hospitals for her second child– she has a midwife and doula and I’m pretty sure she’s trying to have it at the midwife’s place. This honestly scares the crap out of me.

    She says she wants the “lowest risk high-risk birth possible”. Isn’t that what EVERY parent wants?!

  6. Dave says:

    “RNs, midwives, and other non-MD ‘health professionals’”

    There is a huge difference between a Registered Nurse and just a nurse, at least there is in Canada.

    An RN is a health professional.

    My mother was one for 30 years before she retired. As a registered nurse she supervised many ‘normal’ nurses who had much less training.

    (not to say that there aren’t RNs who are crazy…just that there is a distinction between RN and nurse)

  7. Max says:

    There’s money in CAM and in Pharma, but there’s no money in being against CAM.

  8. Doctor Melkor says:

    It’s amazing to me just how much micromanagement and regulation takes place with regard to real medicine–things that have been proven, tested and about which many if not all of the potential effects and side-effects are at least known if not understood–while CAM can say pretty much ANYTHING about some ground up seed or root as long as they put a little label on it that says, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

    I’m reminded of the Monty Python Crunchy Frog Sketch: “I’d think it more appropriate if the box bore a large red label, ‘WARNING: LARK’S VOMIT!’”

    And of course, the reply in Python carries part of the answer to the CAM problem: “But our sales would plummet!”

    I think this is a large part of why the (S)CAM push has been so successful: There’s a lot of immediate money to be made here. Not everyone is interested in UFO’s, not everyone is religious to the point where they give VERY much money to the representatives of mythology, and so on, but everone gets sick sometimes, and we’re all afraid of being sick or in pain and we’re (most of us) afraid of dying. Unfortunately, though medical science is IMMENSELY POWERFUL and our understanding of the human body and health is steadily improving…it’s probably the most complex individual system in the known universe. We can do amazing things, but people just take that for granted and sue us when we can’t do EVERYTHING (and as you point out, we consider it ethically important to tell our patients so). So people run to the “ancient practices and arts” of acupuncture and herbology, which at least CLAIM to do magical things.

    Even in my own family people tell me that as soon as they start feeling a cold come on they start taking their (megadose vitamin C, echinacea, mandrake, baboon’s blood, whatever)and they’re certain that–though they do get sick–the colds don’t last as long and aren’t as bad. I point out the confirmation bias involved in those statments but that only goes so far when people have their lucky charms protecting them. And of course one problem is that there may be SOME herbs out there that have some benefit though how many is hard to say. But why would they pay to test a product and let it either be brought into the fold of EBM or thrown out as not effective when they can market it already, making two-faced claims and avoiding the pitfalls of side-effects because they already admit it hasn’t been tested?

    I am on the verge of giving up medical practice altogether. The only reason I haven’t is that I regularly dose myself with exposure to sites like these which remind me that there are lots of thinking people out there too.

  9. Max says:

    Should CAM be outlawed or what? Should vitamins be regulated like drugs? Throw accupuncturists in jail?

  10. Steven — Excellent post. CAM is unquestionably one of skepticism’s largest failures. As I’ve written elsewhere (PDF),

    this explosive success necessarily means we skeptics screwed up. An organized paranormal lobby, a magical marketing machine, utterly kicked our collective asses.

    One other wrinkle that has to be mentioned: skeptics as a subculture have a critical vulnerability to the “health freedom” argument. It’s a strange quirk of history, but skepticism has inherited ideological baggage from previous movements that makes many skeptics deeply predisposed to “let the market decide.”

    It’s true that market forces can be focussed as a part of the solution for many problems, but in the CAM arena laissez-faire sentiments are a disaster with a steep human cost. Skeptics need to face the reality of this. The market solution to CAM is, “Use any means to sell lots and lots of fake medicine to unsuspecting sick people.”

    That can’t be acceptable.

    Whatever your politics, the health freedom argument is flat out unethical. It assumes that all patients are competent to personally evaluate medical research, when in fact this is not so. Most patients are not doctors or scientists. We take it for granted that extensive training is required to qualify someone to make decisions about, say, aircraft maintainance. Biology is orders of magnitude more complicated, so it is not surprising that training and expertise is required to evaluate medical evidence. (When I tell people that homeopathic preparations are “just water” or “just sugar,” they are invariably very surprised. Why shouldn’t they be? One needs specific background in these topics to even consider such preposterous possibilities.)

    Just as it’s unethical to sell unsafe boilers, experimental seatbelts, or fake insurance policies, it’s unethical to sell fake, unsafe, or experimental drugs. Where such dangerous products are sold, it is unethical for authorities (or skeptics!) to stand by and do nothing.

    It’s wrong to blame the victim. If someone deliberately persuades your grandmother to buy bogus medicine (or, for that matter, a new car transmission she doesn’t need), that doesn’t make her an idiot.

    It suits the interest of fraudulent practitioners to make “buyer beware” arguments, but this callous attitude is rarely in the best interests of anyone else. Promoting that sentiment helps frauds, harms patients — and undermines the goals of the skeptical enterprise.

  11. BB Wolfe says:

    “it’s unethical to sell fake, unsafe, or experimental drugs.” I wonder what the avowed Skeptics think of the medical profession’s favorite cancer “treatment” – chemotherapy. If you want an example of quack science, this is it. Why do I get a funny “intuitive” feeling that to even doubt the merits or ethics of officially sanctioned cancer treatment (as opposed to, say, treatment with laetrile/vitamin B17) will lead to howls of derision from the self-styled Rationalists here?

  12. Julian says:

    How much does everyone here want to bet BB Wolfe doesn’t know what chemotherapy is and any answer he/she/it/whatever gives will be mostly cut and paste from a wiki article?

  13. Max says:

    I’ll bet the cut/paste won’t be from Wikipedia.

  14. Max says:

    But how do you like the finding that half of doctors routinely prescribe placebos?
    http://www.nytimes.com/2008/10/24/health/24placebo.html

  15. Julian says:

    My thoughts are along the lines of Dr. Browdy.

    “Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston, said the popularity of alternative medical treatments had led many doctors to embrace placebos as a potentially useful tool.”

    At least I think that’s contributing to it. Another major problem I see are the patients themselves. I’m not a doctor but I’ve had to listen to more then one friend complain about a doctor telling them ‘Nothing’s wrong with you. Go home and have a long rest.’ And it didn’t surprise me when a few of these friends went on to abandon said doctor for ‘holistic’ treatment citing ‘He never believed me when I said I was sick. He always thought he knew better then me’ as their primary reason.

    Personally I’m of the opinion everyone in the medical field should be completely honest with their patients. It is troubling to hear that doctors are compromising themselves in anyway mostly because it’s such a personal relationship. When you ask someone to take care of you they should no matter how much grief you give them.

  16. Max says:

    Yeah, stupid patients with their imaginary “illnesses”. Wait, maybe this attitude is the problem. Maybe doctors should spend more than ten minutes figuring out the patient’s problem instead of pigeonholing him, prescribing a pill for his symptoms — if not a placebo — and shoving him out the door. That seems to be the standard of care today.

  17. Julian says:

    And it seems to be the standard response from any patient to demonize their doctor no matter what happens. I don’t understand why people get like Max. How have doctors wronged you and is this indicative of the larger population? Are the conditions patients find themselves in poor because of the doctors who treat them? Your disdain seems a little irrational to me.

  18. Julian says:

    Max I hope you realize encouraging doctors to make patients ‘feel better’ might be one of the contributing factors to prescribing placebos.

  19. Julian says:

    OMG I love the story of the 400 lb chick who was upset her diet (haven’t people figured out weight loss is a long term commitment?) wasn’t causing as much weight loss as before. The doctor was right on telling her off. People like her get no sympathy from me.

  20. Max says:

    Oh I have experience with dismissive, arrogant, unapologetic doctors. Clearly, it’s prevalent enough to warrant a front page NY Times story, which I recommend reading.

  21. Julian says:

    Max Wrote

    “Oh I have experience with dismissive, arrogant, unapologetic doctors. Clearly, it’s prevalent enough to warrant a front page NY Times story, which I recommend reading.”

    Max, your hate is still doesn’t make sense to me. Dismissive, arrogant these are all human characteristics. To demand that no doctor have them is absurd. So long as a doctor is doing his job (treating your illnesses, encouraging a healthier lifestyle) I don’t see a problem. The first article you linked to seemed much more relevant then the second. Come back with more studies showing negligence ect. But stories about patients being flipped the bird just don’t strike me as reflecting negatively on medicine.

  22. Max says:

    If the doctor doesn’t take the time to listen and do the necessary tests to figure out the real problem, then the doctor will not treat the problem. For example, if the patient has neck pain, it’s much faster to prescribe pain relievers than to figure out that he needs better glasses.

  23. Julian says:

    Max -

    Is this widespread? If your answer is ‘yes’, how do you know?

  24. Julian says:

    Disclaimer – I’m not defending doctors who are irresponsible or saying that doctors who are don’t exist. I don’t object to oversight for anyone in a position of power but I do object to labeling an entire group ‘bad’ on entirely anecdotal evidence.

    And I’d also like to point our little argument, Max, really doesn’t have much to do with Dr. Novella’s blogpost.

  25. Max says:

    Julian, you said yourself, “It didn’t surprise me when a few of these friends went on to abandon said doctor for ‘holistic’ treatment…”

    I’d wager that much of the appeal of “holistic” treatment is not just the treatment but a healer who knows how to listen. Meanwhile, doctors have to be taught to say “Uh huh” (NYT story P3). Yale Medical Group had to form a subcommittee to figure out that patients want to know why they have to wait.
    http://www.yalemedicalgroup.org/physician/pg_pedi.html
    Has medical practice been taken over by robots?

  26. Julian says:

    I wasn’t asking about patients leaving their doctors or their motives for doing so. I was asking about doctors not doing follow ups on their patients.

    Don’t think I’m entirely unsympathetic (unless you’re the 400 lb chick from the second article you linked to) I get how scary these things can be. I get how sometimes it can feel you’re just not getting across. Like I said before this is very personal. You are literally putting your life in these people’s hands and trusting them to do what’s best for you. But I don’t see doctors as the enemy.

  27. CreidS says:

    It’s about care — that is mostly what people are looking for when they turn to CAM. If some skeptics and MDs (present blog excluded) didn’t have their head up their ass, they might realize that attending to the human condition is as important as tending the disease.

    Since Western Medicine switched to a cooperative model, which forces patients to know the whole truth, many people have flocked to CAM’s paternalistic model. CAM often gives the impressions of hope, and of being cared for. There is a great deal of theater in “energy healing;” it can feel really nice.

    For example, when I was in a bad place, I dated a girl that was quite granola; she was a practicing energy healer. When she laid hands on me, even as a patient, I felt accepted, loved, and cared for. I felt like my human condition was perfectly acceptable, and that we both had in mind a healthier me. That alone did a great deal for me, but it wasn’t some mystical energy. It was simple gentleness of spirit and caring. WesMed is so full of prodding and sterilization; there is practically nothing human left to it, at least the way most doctors practice. Thats the gap in the door that allows the rest of the hoo-haw through. They treat you like family, not like professionals.

  28. SeanJJordan says:

    Steven,

    Another wonderful post. Thank you!

    What concerns me most is the mistrust of science. Someone I know recently purchased about $150 worth of junk for a week-long “detox diet” that involved consuming nothing but special milkshakes for a week. As she explained the claims of the product to me, it was apparent that she’d been suckered by someone else caught up in a multi-level-marketing scheme who was trying to unload product. I tried to persuade her that the diet was going to make her miserable, but she refused to be dissuaded, and even insisted that, when I saw it working, I’d want to try it myself.

    She put herself through an agonizing week of not being able to eat the foods she enjoyed, and fortunately, she seems to have realized the folly of the program. But since her attitude is often that of “science doesn’t know everything!”, I’m sure she’ll get suckered in on another product down the road.

    This sort of attitude is deeply troubling. Yes, science doesn’t purport a knowledge of everything. But does that mean that one should accept alternative claims on the basis that they’re _not_ science? That’s exactly why people will buy into alternative medicine, “ancient” wisdom and “natural” cures — because these things all claim to be something other than science, and therefore, are somehow supposed to be viable alternatives.

    In the field of consumer behavior, we often talk about the “consideration set” – the items that a consumer might evaluate when making a purchase decision. Often, this set is only really examined upon the first purchase, and if the product seems to work out, the purchase becomes routinized. So, the problem seems to be that consumers are weighing “science” and “not science” items as equal alternatives in their consideration set instead of automatically placing “not science” items in their “inept set.” And, if they make a “not science” purchase and it seems to work, they’ll continue to choose that alternative until it ceases to meet their needs.

    Sadly, the only way to combat this is with education during the postpurchase evaluation phase, when people realize they’ve been suckered and are looking for explanations as to why. Consumers really need to come to an understanding that products based in true science are based in reality, while products that are based on pseudoscience or “ancient” wisdom are just junk. They should never considered together as equal alternatives. And yet that mistrust of science will always bring them back.

  29. Morvis13 says:

    If every person reading this blog fought the good fight to close down one local Naturopathic shop then word would spread. I want to be a solder in this fight but lack the knowledge and training required. This certainly helps but are there any other useful tips and tricks you could pass along?

  30. Julian says:

    CreidS –

    *sigh* I was going to type out a long response but I just bring myself to care. It’s your life put it in the hands of who ever has the fluffiest mittens.

  31. Ian Mason says:

    Quack medicine is a canard.

  32. Beowulff says:

    People think the CAM practitioners take better care of them, because CAMers can always find a diagnosis (like having your energy out of alignment or whatever), and they can always find something they can treat you with (like re-balancing your energy flow), risk-free.

    Real doctors, on the other hand, sometimes have to admit that they don’t have a clear diagnosis for some vague complaints, or that whatever they could subscribe would not likely help you, or have unnecessary risk attached, and that it might even be harmful.

    It’s not difficult to imagine the preferred choice of a patient who thinks that both antibiotics and acupuncture are equally magical, or who simply trusts that anybody licensed to treat patients knows what they are doing.

  33. bob says:

    BB Wolfe: “Why do I get a funny “intuitive” feeling …” No, BB, the relevant question is, why do you trust these intuitive feelings over evidence and science?

  34. IMMD says:

    I am a primary care physician working in an academic medical center (which does have a section of integrative medicine, which I am not part of); this posting was forwarded to me by one of my patients. I agree with the author that CAM therapies are, by and large, either unproven or disproven. When patients bring up CAM-related issues, I try to give them factual information when it exists; otherwise I tell people that I know of no evidence in the medical literature either for or against whatever it is they are using. I regard dealing with CAM practices as similar to dealing with patients’ spiritual or religious beliefs; it is important for me to be sensitive to them and in particular how they might affect the person’s attitudes towards conventional medical treatment, but I am not required to buy into their beliefs myself.

    I also feel it is important to have at least a passing familiarity with whatever data exists on common practices, or else a knowledge of where to go to find (reliable) information. That is the one legitimate reason I can think of for establishing areas for study of CAM in academic medical centers.

  35. Mike says:

    A First Blast of the Trumpet Against The Monstrous Regiment of Quacks!

    (With apologies to John Knox)

    Excellent post Steven and as a practising physician I am alwys quick to point out to patients what is science and non science.

    I spend a lot of my time listening to patients, trying to understand what they want to know and delivering it – whilst Max may well have met arrogant and incompetent Drs (a minority I am sure) most try to do their best for their patients and at least do no harm. Part of that is to make sure patients know when something is unlikely to work.

    I am less pessimistic than Steven (maybe a UK perspective) but when the chips are down and patients have serious health problems they rarely choose CAM – those who do use CAM will often do so for minor self limiting illnesses which I tell them to self treat anyway. most people with a cancer for example just want the diagnosis as quick as possible and start the treatment as quick as possible. I cannot recall any patient of mine using CAM to treat a breast lump.

    I regard it now as part of my job to tell patients about pseudo-science and quackery in medicine and willing defend scientific medicine to the hilt!

  36. Max says:

    Beowulff, real doctors won’t admit that they don’t have a clear diagnosis. They’ll just call it a “syndrome”, or they’ll say, “There’s nothing wrong with you” or “It’s all in your head, try a low-dose anti-depressant.” Maybe it’s how they cope with feeling powerless to help, but you won’t hear, “I don’t know. Let’s figure it out.”

  37. Mike says:

    On the contrary Max I often tell my patients that I don’t know what is wrong – Quite often I can tell them what they don’t have rather than what they do and if I can’t diagnose or treat them so be it.

    Modern medicine does not claim to have a ‘pill for every ill’.If you find a Dr who is always right then I would contend that they will often be wrong (and a dangerous Dr to boot) Once again it is far better to admit your ignorance and do no harm.

  38. Theo says:

    @ 37 Max said: Beowulff, real doctors won’t admit that they don’t have a clear diagnosis. They’ll just call it a “syndrome”, or they’ll say, “There’s nothing wrong with you” or “It’s all in your head, try a low-dose anti-depressant.” Maybe it’s how they cope with feeling powerless to help, but you won’t hear, “I don’t know. Let’s figure it out.”

    Well, yes, that can be frustrating. That’s why CAM is so awesome – they know for sure, what’s wrong with you, no matter what it is! And moreover, they know exactly how to treat it! No uncertainty and all your wishes as a patient are fulfilled!

    Admittedly anecdotal, possibly a generalisation, but I’ve never come across a chiropractor or homeopath (for example- and I’ve met a few) who says: “You know what, I’m really not sure what’s wrong with you and I don’t know how to treat it.” Or, “There’s nothing I can do for you.” Uncertainty and living in a knowledge vacuum is something that does not compute for these people…

  39. If you want to contrast medical doctors with CAM-artists, compare stats on consultations and referrals. CAM-sters largely do not consult and do not refer. This implies support for the charge they know it all and can cure anything.

  40. CAM may also be a backlash. Since my forced retirement (injury), I have been most disappointed to discover the actual “evidence” about my profession (American medicine): American medical spending has zero net marginal effect. If you, like me, are not familiar with the jargon of economists, the “margin” is the point at which spending more money gets no increase in returns, an important concept for businesses. In American medicine, that point occurs at the 50% boundary of spending: the “second half” of spending does more harm than good. Ironically, this is truly “evidence-based”.

    Economists deal with the overall picture, not individual cases. As one informed me when I objected to this negative view of my life’s work: “I don’t think you understand what statistics mean. They are not a sort of weak extra argument that you weigh in addition to your much more reliable personal experience; statistics are a stronger, more reliable way of looking at the world that summarizes far more evidence than your personal experience, even though it just looks like a little number on paper while all that other experience weighs so heavy in your mind.”

    For doubters (as I was), begin your investigation at . The first sentence of the post is a combination of multiple links that outline the evidence.

    I always thought I was part of the solution. “Evidence” neither confirms that nor consoles me.

  41. sproutlore says:

    I think the growth of the homeopathic movement is directly related to the corporatization of the medical profession. The feeling that it’s all about profit – especially “big pharma” – has left patients looking for two emotional components that many feel is missing with modern medical practice – caring and trust. Where better to find that care and trust than with a den mother who drinks herbal tea. You can trust the den mother who, with her ancient wisdom, isn’t going to give you a bunch of yellow, blue and purple pills just to get your money. The heart warming rotes about connection, completion and chakras while being sold organic seaweed marinated in bat urine to unblock your colon, proves that she cares. With horrific insurance companies, financial destitution from medical bills and over medication it isn’t a wonder that people are looking for and finding alternative sources of comfort.

  42. Paula says:

    While I hole-heartedly agree that there is a scientific illiteracy problem in this nation, your article completely ignores the attractiveness of “alternative medicine.” I think more than scientific illiteracy and propoganda, it is a widespread discontent with our healthcare system or for many, a lack of access to healthcare that creates a demand for alternatives.

    I have stuggled with back pain for years with no help from my many doctors. When the only choice given to me from my doctors was painfully invasive treatment with odds of little to no improvement or a worsening of the condition, I chose to seek alternatives.

    My mother is treating a virtually incurable disease with change in diet, chinese herbs, vitamins, and massage with great results. Not a single person she knows with the same condition has gotten rid of their M.A.C. with the traditional treatment of massive doses of powerful antibiotics for months on end, in fact many have gone blind, ruined their kidneys, etc. in the process. When her choice was to take poisonous pharmaceuticals with odds of no improvement and damage to her vital organs vs. massage, herbs, vitamins, etc., my mother gladly chose the latter.

    My advocacy for alternative medicine is simply from the lack of choices, lack of creativity, lack of compassion, lack of access, and a generally reactive (vs. proactive) approach to “scientific medicine.” “Scientific medicine” doesn’t have all the answers. Do not underestimate peoples’ desperation for a cure.

  43. Julian says:

    Paula wrote,

    ““Scientific medicine” doesn’t have all the answers.”

    If we skeptics needed any evidence that this is going to be a long (probably fruitless) war just take a look at this. Maybe we can adapt some of the arguments against creationism to match this?

  44. TimBC says:

    I agree with everything you said. In my small community, I was one of the few staff physicians who protested an initiative to bring “Healing Touch” into our local hospital. The proposal was made by another doctor, a nurse, and an occupational therapist all of whom worked in the hospital.
    I waged essentially a one man campaign to keep them out, largely by challenging their claims with the actual evidence. The debate got quite heated at times and I felt little support from other colleagues. They would come up to me privately and agree it was “woo”, but didn’t want to challenge their friends and co-workers who believed in it.
    It’s a small victory, as there is a small coven of nurses who practice it on patients on the sly, its’ just not officially recognized as a service available. However, “energy field disturbance” remains an official nursing diagnosis according to NANDA (North American Nursing Diagnosis Association)
    I am heartened by your ray of hope of the actual numbers of believers in nonsense.

  45. My heart’s with you, TimBC. I fought the same battle against Therapeutic Touch at a county-level OP mental health center in the early 1990s. Won too, but not without a lot of grief.

  46. Paula says:

    Julian says:

    “Paula wrote,

    ““Scientific medicine” doesn’t have all the answers.”

    If we skeptics needed any evidence that this is going to be a long (probably fruitless) war just take a look at this. Maybe we can adapt some of the arguments against creationism to match this?”

    I may not be an expert debater, but Mike the Dr. (above) even admits “Modern medicine does not claim to have a ‘pill for every ill’”

    It’s not SCIENCE that I have anything against. Defend science all you want and I will back you on it, the HEALTHCARE INDUSTRY is another matter.

  47. James Severin says:

    I no longer believe in Alternative medicine (having my mind changed by evidence and research)but I still don’t trust doctors. They get kickbacks from Big pharma to prescribe pills I don’t need. My Mother had a great primary care physician but when it came time to remove her gall bladder the jackass surgeon accidently put her in a wheelchair. Last year a doctor made Time’s “100 most influential persons” list, he made the list because he instituted checklists at his hospital so doctors and nurses wouldn’t forget the proper proceure. Are you kidding me? Thousands are affected each year by being prescribed the wrong medicine because of a doctor’s poor handwriting. On top of that there is the “white” code of silence where a doctor won’t rat on another doctor no matter how much they screwed up. So while I don’t want to be doctor bashing I think that disregarding the general publics very real distrust of medical doctors would be a mistake when attacking the “woo”. I don’t think people can really understand that unless they or their family have been victims of malpractice.

  48. The attraction to alt-med and CAM nostrums is based on the very human desire to seek the simplest, easiest way to the solution of a problem. Cancer: surgery, chemo, radiation… or herbal supplements, meditation, and healing touch?

  49. T. Hughes says:

    I think skepticism where health freedom is concerned is a little more grey than some of you are considering…

    The problem with EBM is it takes too long and doesn’t take the human cost of its long delays, or the format of its trials, into account. Because of this, EBM has earned, at least in part, its current position of distrust. If what you have doesn’t work for you (and a drug in a 10 year pipeline isn’t going to help you if you are going to die next year or can’t get into the trial) then you turn to other sources. Yes they may not be proven, but the alternative is to lay down and die… most people just aren’t going to do that for scientific progress (nor should they).

    The current regulatory setup is incredibly slow and somewhat unethical. Its unethical to give dying people placebos in trials, yet its what has to be done right now. You would think by now we’d know how much of an effect could be attributed to placebo, at least enough to avoid using such things in life and death situations. Or, there could be more ethical ways of doing placebos in life and death situations… such as tracking the wellbeing of people who aren’t enrolled in the trial by choice and are on traditional treatments. Yes, life could get a little bit less certain that way, but people aren’t lab rats. I’m not sure we even have a right to give dying people placebos. (I am aware that trials that show a huge effect are sometimes stopped early… there’s some hope on the horizon).

    Seriously, you apparently don’t even have the right to access in-trial medications in some western countries *if you are going to die anyways*. Hows that for protecting you from yourself? =) I suspect that was done to force people into trials where they may be on placebos, otherwise the whole placebo thing may have died out. Thats just not ethical. Of course people are going to turn to CAM.

    There are regulatory improvements that could speed the delivery of new life saving medications to the public. Better knowledge of how the placebo effect works could reduce the size requirements and placebo requirements in trials. Better sharing of regulatory/trial information between western nations could reduce the amount of trials done and ensure you don’t have to leave your country to try new life saving medications. People could have a constitutional right to access drugs in the pipeline if they are dying anyway. Things like that.

    Until this is done, I doubt the situation will improve. In fact, the situation is the biggest argument for health freedom: CAM will force EBM to confront and hopefully improve its regulatory systems, in order to compete. And EBM can compete, no doubt about that, because it delivers things that work. EBM can win entirely. It just needs to try. Its a good thing IMO that EBM is being called to account for some of its less efficient practices.

    And yes, lots of CAM is silly stuff that has nothing to do with these life and death situations.

    - Tracy

  50. Julian says:

    Paula -

    Re-read your comments and compare them to those of creationist if you want to see why I’m being dismissive.

    James Severin -

    Hey, I’m totally with you on the protocol reform thing. I think the entire system should be electronic (as in all information is entered and shared electronically. Not robots… which would be pretty cool. See Star Trek: Voyager for more details.) but whenever the idea gets pitched you wouldn’t believe how many people freak out.

  51. Beowulff says:

    Sproutlore said:
    “think the growth of the homeopathic movement is directly related to the corporatization of the medical profession. The feeling that it’s all about profit – especially “big pharma” – has left patients looking for two emotional components that many feel is missing with modern medical practice – caring and trust.”
    and
    “With horrific insurance companies, financial destitution from medical bills and over medication it isn’t a wonder that people are looking for and finding alternative sources of comfort.”

    Don’t forget that the big corporations are perfectly willing to make a buck on CAM as well. Here in the Netherlands, many health insurance companies cover homeopathy and/or acupuncture. Many pharmaceutical companies sell dietary supplements, or own companies who do. Make no mistake, CAM is big business too.

  52. Beowulff says:

    Paula said:
    My advocacy for alternative medicine is simply from the lack of choices, lack of creativity, lack of compassion, lack of access, and a generally reactive (vs. proactive) approach to “scientific medicine.” “Scientific medicine” doesn’t have all the answers. Do not underestimate peoples’ desperation for a cure.

    Such a string of unfounded rants can only have one type of response:
    snark.

    Lack of choices: Yes, scientific medicine can’t cure everything, while CAM has many “one cure for all ailments” treatments to choose from.

    Lack of creativity: Yes, too bad doctors can’t just make stuff up. I’m sure they’d love to though, and probably many would be quite good at it, too.

    Lack of compassion: Doctors are people. Most will have plenty of compassion, some won’t. And some will just be too swamped in work to be able to show all the compassion they’d like to show. (Okay, so I failed with the snarkiness on this one. I suppose this accusation you’re making here is too serious to joke about.)

    Lack of access: CAM isn’t free either. It’s still cheaper than scientific medicine, of course. Not having to do trials for safety and efficacy for every new treatment helps to keep the costs down.

    Reactive Vs. Proactive: Never mind all those advices on getting exercise and eating healthily. After all, that means you have to work, instead of them making you feel better, those lazy bastard doctors.

    Paula wrote as well:
    I may not be an expert debater, but Mike the Dr. (above) even admits “Modern medicine does not claim to have a ‘pill for every ill’”
    Admitting that science doesn’t have all the answers doesn’t mean CAM does. It doesn’t even mean that CAM has some answers in any area where science doesn’t. Basic logic.

    It’s not SCIENCE that I have anything against. Defend science all you want and I will back you on it, the HEALTHCARE INDUSTRY is another matter.
    So how would you propose to improve the health care industry? By adding CAM? CAM almost by definition are unscientific treatments, so adding CAM dilutes the science in health care. How is this defending science? And adding CAM to health care industry is only increasing their area of influence, not decreasing it. How is this fixing the health care industry?

  53. sproutlore says:

    It’s not that doctors aren’t compassionate, it’s just that the “holistic healers” do a better job selling “compassion and communication” because it’s part of the spiel.

  54. Paula says:

    Beowulff, thank you for taking time to snarkily dissect my comments.
    The message I tried, and apparently failed, to convey is that the author glosses over legitimate criticisms of mainstream medicine and the healthcare industry. When people do not have satisfactory solutions to their ailments from traditional medicine, what would you skeptics propose they do? Just sit around and die? Can you fault people for trying to find alternate solutions when medical experts give them little to no hope? Ever given thought to who these people are that seek alternative treatments, besides questioning their IQ scores?

    You asked, “So how would you propose to improve the health care industry?”

    I do not claim to have an answer to our healthcare problems, I just wanted to point out a giant hole in this argument. Perhaps legitimate limitations of mainstream medicine and the healthcare industry have a little more to do with market demand for alternatives than just scientific illiteracy and propaganda. Is there no social, economic, or psychological component to the issue?

    You said, “Admitting that science doesn’t have all the answers doesn’t mean CAM does. It doesn’t even mean that CAM has some answers in any area where science doesn’t. Basic logic.”

    I didn’t imply alternatives (CAM) have all the answers, just commenting that there is a place in the market for alternative treatments when science, or better the health industry, isn’t able to supply people with satisfactory solutions.

    My “lack of” rant was based on personal negative experiences. I will spare you the anecdotes, but I will say that I have sought and received satisfactory solutions to some of my medical issues outside traditional medicine, simpler solutions than “have this surgery, take these pills for the rest of your life” and certainly simpler than drinking bear bile, burning incense, poking needles into my back, while clicking my heels together. I have honestly received more information about general wellness, diet & exercise from alternative sources than I have from any GP (a.k.a. “lazy bastard doctors”)

    It shouldn’t be presumed that all alternatives to our traditional healthcare are equal and at odds with scientific medicine. I certainly would not advocate anything that claims to have “one cure for all ailments” treatments. Nor do I advocate adding “CAM” to traditional healthcare for that matter. If “CAM” indeed threatens the integrity of medical care, I agree it should go, but it will not get rid of a demand for alternatives outside the realm of traditional healthcare.

    By the way, I think my dentist does some sort of creepy “healing touch.” I’m not a big fan of it. If anyone can suggest any sources, I am open to reading any research debunking any alternative medicines.

  55. Christopher Grell says:

    The real culprate is not so much CAM, but what allowed CAM and the dietary supplement industry to exist, and prosper. The Dietary Supplement Health and Education Act of 1994. (DSHEA)
    As a result of this federal law, products sold as dietary supplements, unlike food products or drugs, can and are being sold to the public without ever being subject to any FDA or other government review as to eith safety or efficacy.
    Under DSHEA, ingredients that are banned from use in foods and drugs, can and are being used in dietary supplements.
    Up until recently, dietary supplements and adverse events associated with the use of these products did not have to be reported to any government agency, (unlike foods and drugs).
    Under DSHEA, the company that actually maufactures the dietary supplement is often unknown, since only the distributor’s name need be identified on the label. For example, Herbalife does not manufacture any of the dozens of dietary supplements it hundreds of thousands of distributors sell and use. Instead, Herbalife has unknown third party maufacturers, using ingredients supplied by unknown suppliers, making their products.
    Under DSHEA, anyone can start a Dietary Supplement Company whether or not they know the difference between a weed and a herb. In fact, under DSHEA, there is little to stop a company from marketing a weed as a dietary supplement.
    Under DHEA, cancer causing ingredients, which are banned from foods, are routinely found in dietary/herbal/nutritional products.
    In short, until Congress restores order in an uncontroled industry, CAM, and every other dietary supplement organization will continue to promote the use of these untested products that can and have caused countless injuries and deaths, often overlooked because the medical profession do not ask their patients about there history of using these types of products or, if they do, the medical profgession all too often assumes, like many individuals, that if it is natural is is safe.
    In short, until the same safety and efficacy laws applicable to foods and drugs are applied to dietary supplements, the public will continue to be at risk.

  56. Julian says:

    “I will spare you the anecdotes, but I will say that I have sought and received satisfactory solutions to some of my medical issues outside traditional medicine, simpler solutions than “have this surgery, take these pills for the rest of your life” and certainly simpler than drinking bear bile, burning incense, poking needles into my back, while clicking my heels together.”

    Please share. Especially all the details relating to the tests the doctors performed, what their recommendations were, the ‘treatment’ you took in place of the doctor’s suggestion and the advice given by the homeopath (or whatever it was). Something about how doctors were dismissive about your complaints ect. would also be appreciated as well as explaining how that gives credibility to CAM actually, you know, being able to cure diseases.

  57. Max says:

    Since “holistic healers” don’t actually heal patients, they have to rely on their charisma and communication skills to stand out from the competition.
    And they don’t always offer the easiest solutions to problems. They can scare healthy people into removing their amalgam fillings and having unnecessary colonics and chiropractic tune-ups.

  58. Max says:

    retired urologist, have you seen this?

    “Why Most Published Research Findings Are False”
    by John P. A Ioannidis

    Response:
    “Most Published Research Findings Are False—But a Little Replication Goes a Long Way”

    “For example, a survey of 600 positive associations between gene variants and common diseases showed that out of 166 reported associations studied three or more times, only six were replicated consistently. Lack of replication results from a number of factors such as publication bias, selection bias, Type I errors, population stratification (the mixture of individuals from heterogeneous genetic backgrounds), and lack of statistical power.”

    Also:
    “Why Current Publication Practices May Distort Science”

    P.S. When I posted the links to the PLoS publications, the post didn’t show up, so I didn’t include links this time.

  59. Max says:

    Let’s see if this link shows up:

    “Why Most Published Research Findings Are False”
    by John P. A Ioannidis
    http://medicine.plosjournals.org/archive/1549-1676/2/8/pdf/10.1371_journal.pmed.0020124-S.pdf

  60. Mike says:

    I think that Paula’s criticisms of the Health Care Industry are well made – there is plenty of evidence that it can harm you. Drug companies releasing new products and lying about the safety data (Vioxx) or not releasing research trial data that shows no effect of their new drugs (SSRIs). But CAM does not submit itself to research and trials – and where it does it fails dismally, so imperfect as it is the scientific medicine route is the best we have.

    Another point we forget is that an incurable disease is not necessarily an untreatable one – you patient needs hope and compassion especially when dealing with serious life threatening illnesses and if they use CAM to try and cope – so be it – you can advise against but only an arrogant fool would not continue to treat them.

  61. Max says:

    Came across this Ayn Randist “grass-roots” organization that wants to eliminate or cripple the FDA.
    http://www.afcm.org/freedomfromfda.html

    “The FDA adds billions to the development cost and price of new drugs. The FDA delays the availability of new drugs for years.”

    No kidding. Why not skip the whole approval process.

    “The first steps in reform should be to direct the FDA to focus entirely on safety and allow physicians and their patients to determine efficacy.”

    They’re shooting themselves in the foot here, since efficacy is what justifies the risks. Without knowing efficacy, everything is unsafe, except placebos like homeopathy and healing touch.

  62. @60: retired urologist, have you seen this? (“Why Most Published Research Findings Are False”)

    I’m not certain whether you are referring to the possible inaccuracy of the studies that show the zero net marginal value of American medicine, or to the the myriad of inaccurate findings that American doctors must use in the conduct of their practices, having no reliable way to verify their legitimacy. The latter is apparently a main cause of the former. Thanks for the reference.

  63. Beowulff says:

    Paula, sorry to hear you’ve had bad experiences with medical professionals, but you’ll agree that doesn’t make it right to paint all health care professionals with the same brush.

    Paula said:

    Can you fault people for trying to find alternate solutions when medical experts give them little to no hope?

    No, not really, which (I assume) is why Steve Novella focused on those that take advantage of these desperate, credulous people by selling unproven treatments, and on those that lobby to make it easer to sell them.

    I do not claim to have an answer to our healthcare problems, I just wanted to point out a giant hole in this argument.

    Well, yeah, others (me included) had already added that there is a attractiveness of CAM over traditional health care for many patients, that is an important component of the “success” of CAM. It was also pointed out that part of its attraction is because it’s not weighed down by the constraints of scientific medicine, like actually having to prove it works.

    But you weren’t “just pointing out a giant hole”, you were advocating for alternative medicine, by your own admission: “My advocacy for alternative medicine is simply from …” Remember?

    I didn’t imply alternatives (CAM) have all the answers, just commenting that there is a place in the market for alternative treatments when science, or better the health industry, isn’t able to supply people with satisfactory solutions.

    Nobody would argue that treatments developed by others than the big health care corporations shouldn’t be allowed on the market – as long as those treatments adhere to the same level of rigor as regular medicine: they must be shown to work, and to be safe. Anything less is not a viable alternative, and not my idea of a satisfactory solution either.

    Paula said:

    It shouldn’t be presumed that all alternatives to our traditional healthcare are equal and at odds with scientific medicine.

    Indeed, some are less implausible than others, but like I said, almost by definition, they all are at odds with science. After all, if science could show that they worked, and especially how they worked, they wouldn’t be “alternative” anymore, would they? They’d be part of science-based medicine.

    I do hope you and your mother recover from whatever medical misfortune you’re having.

  64. Max says:

    It refers more to medical research that finds false correlations. For example, 80% of epidemiological studies fail to replicate, and genetic associations are even more dismal.

    The reasons are summarized here.
    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1808481

    “These findings suggest that there is a tendency among epidemiology researchers to highlight statistically significant findings and to avoid highlighting nonsignificant findings in their research papers. This behavior may be a problem, because many of these significant findings could in future turn out to be false positives.”

  65. I’ve had nothing but good experiences with health care providers over the years.

    Does my positive anecdotal report cancel any negative anecdotal report?

  66. Max says:

    Like births cancel deaths.

  67. I’ll see your single negative personal anecdote and raise you two positive personal anecdotes……. lol.

  68. John Draeger says:

    Yet another excellent article on CAM by Dr. Novella. For those who don’t already know, you can read more on this topic on the Science-based Medicine blog or the NeuroLogica blog. The good doctor must have the typing skills of Flash Gordon and not require much sleep.

    Paula (44): Anecdotal evidence does not count in science. It can lead to an hypothesis, but one shouldn’t make a recommendation to another person on anecdotal evidence alone, especially if the proposed treatment could possibly do harm or cost a lot of money. If, however, a doctor hears of a handful of people having the same unreported side effect, she should report it to the FDA so they can investigate further. Consider this bit of psychology: Most people falsely trust personal stories over statistics, probably because not so long ago in our evolutionary history humans did not use writing or numbers—our brains are set up to listen carefully to stories and remember them.

    But you’ve invited some criticism by stating what helped was Chinese herbs, vitamins, massage. Why are Chinese herbs any different than other herbs—do all the good ones grow in China? If you think so, the argument from antiquity fallacy might be involved. Only people who cannot eat a sufficient variety of foods may benefit from a single daily multivitamin/mineral tablet. Also, some people who can’t consume dairy products or don’t get enough sunlight in winter may benefit from some extra calcium or vitamin D supplementation, but all other vitamins & minerals taken in amounts greater than the standard medical recommendations have been shown to do more harm than good. Antioxidants had some promise in the 90’s, but studies have subsequently proven they don’t help—some increased cancer rates. Massage does help people relax muscles, and most people do feel better when touched by other people, but you can get that effect from exercise and stretching (some need a physical therapist) and a cooperative spouse/boyfriend/girlfriend.

    Tracy (51): So you think careful (slow) trials are unethical? How about fast and sloppy? Medicines often take time to produce full effects, and surgical interventions require years of follow-up to determine the final outcome and all complications. The standard significance level for medical studies is p <= 0.05. Some epidemiologists consider this to be too large. In physics it might have to be 0.001 to be considered significant enough to make important decisions based on the results. The p-value is high in medical studies specifically so that treatments which show some potential for reducing suffering can be made available to people who need them. Let me remind you that some medicines can have deadly effects even in end-stage trials. There was an Alzheimer’s disease vaccine in the past couple years that looked like it was going to work great (worked fine in rodents), but caused meningitis in some human participants so the trial had to be halted. Sometimes not enough synergistic effects are known even with current protocols that you apparently consider too slow. Remember the fen-phen combination that caused heart damage? Yes, doctors are human and do therefore make mistakes, but a large percentage of the population of developed countries would not live to be senior citizens were it not for modern medicines and modern surgery. Don’t forget that if you were born before about 1900 CE most medical treatments would have done about as much harm as good. That was before placebo-controlled double-blinded medical trials were the norm.

    And evidence-based doctors shouldn’t need to give you a course in nutrition or tell you to exercise. The U.S. FDA has something called “My Food Guide Pyramid” on the web that will tell you if you’re eating right—probably something there for exercise too. If you eat healthy food in the right amounts, exercise, sleep enough, and have a sense of humor you’re going to have that “general wellness” you claim the alternative medicine practitioner provided. But the fact is most people don’t follow through on the advice their doctor gives them anyway. Self-deception is involved—things one only learns by practicing skepticism as Dr. Novella has so eloquently defined it. Taking an audio recorder to your doctor appointments might be helpful. It’s possible an overworked evidence-based doctor didn’t spend enough time explaining what you wanted to know because she was required to see too many patients in a given day. That may be a problem ultimately stemming from a healthcare system that rewards health insurance companies. A single payer national healthcare system would do a lot to provide better evidence-based treatment at a lower cost IMO. I think even the libertarian-leaning Dr. Shermer would agree with that.

    Julian (52): This is off-topic, but others might be interested to know that robots are already being used to do surgery on people. Being done in Madison, WI at UW Hospital where I worked for 4 years. No doubt they’re in use all over the place. The one I saw resembles a human—has 2 arms, a blocky “head”, a trunk—creepy-looking, but very cool. They can get into small holes that human hands cannot, and they don’t get shaky after working a long time like people. They’re taking organs out (directed by human surgeons) like prostate glands, uteruses, etc.

  69. paula says:

    (70) John Draeger said: “But you’ve invited some criticism by stating what helped was Chinese herbs, vitamins, massage. Why are Chinese herbs any different than other herbs—do all the good ones grow in China?… but all other vitamins & minerals taken in amounts greater than the standard medical recommendations have been shown to do more harm than good…Massage does help people relax muscles, and most people do feel better when touched by other people, but you can get that effect from exercise and stretching (some need a physical therapist) and a cooperative spouse/boyfriend/girlfriend.”

    1) I called them Chinese herbs because they are herbs prescribed by a Traditional Chinese “Dr, for lack of a better term. I wasn’t indicating they were grown in China. 2) Glad I stay within the standard medical recommendations for vitamins, then. 3) At least we can agree that there is some benefit to massage. Unfortunately not everyone has a cooperative spouse though. Thank “GOD” you all don’t expect me to get a Dr.’s referral for a massage, or do you?

    “And evidence-based doctors shouldn’t need to give you a course in nutrition or tell you to exercise. The U.S. FDA has something called “My Food Guide Pyramid” on the web that will tell you if you’re eating right—probably something there for exercise too.

    I didn’t know I was expected to use the FDA’s website as my comprehensive tool for a healthy body. No wonder I’m so out of touch! What we were we expected to do before the internet? That old food pyramid was a joke! The website does looks like pretty cool though, if indeed it actually works (I’m confident its effectiveness must have been thoroughly tested.) But, I wonder how many people really know about it. I would wager that the majority don’t. It’s also too bad not everyone has access to the internet. Also, who could possibly want advice from an actual human when you can get it via a computer?

    “But the fact is most people don’t follow through on the advice their doctor gives them anyway.”

    If this really is a fact, then perhaps the advice given via directing one to a website, just isn’t comprehensive enough for “most people.”

    “It’s possible an overworked evidence-based doctor didn’t spend enough time explaining what you wanted to know because she was required to see too many patients in a given day. That may be a problem ultimately stemming from a healthcare system that rewards health insurance companies.”

    I totally agree. Highly likely on both counts.

    (67-69) Devil’s Advocate & Max, I’m glad you can make jokes about negative personal medical anecdotes and life and death. The two DO sometimes go hand in hand.

    (58) Julian,
    You asked for the anecdotes. I’ll bite, reluctantly.

    Anecdote #1) I was a dancer and was diagnosed with Spondylolysis, after complaining of chronic pain and inflammation in my low back, pain in my buttocks around hips, and inflammation in the front of my hips (hipflexor area.) It was a major problem for a number of years and was still bothering me after a year of resting (Dr. Recommended.) I had xrays and mri to confirm the condition. Dr. prescribed physical therapy and anti-inflamatories. Went through one, maybe two rounds of PT. PT prescribed a routine of crunches, pelvic tilts, cat/dog back arching business (whatever you call it) – a knee-jerk response treatment of basic exercises that I’ve already done a million times in my life on a regular basis. After unsuccessful PT, my Dr. did a bone scan to determine if there was movement in the bones with the Spondy. There wasn’t but he suggested if the pain gets worse over time we may want to consider fusing my bones. He also suggested that my condition might be psychosomatic, especially considering that Spondylolysis is usually asymptomatic. I’m sure that was probably a logical conclusion for him, after all back pain is difficult to diagnose and successfully treat. It often gets the “it must be in your head” reaction.

    With that, though I wasn’t really depressed (but possibly now on the road to depression), I paid out of pocket to see a psychologist for about 6 months. It was very expensive and didn’t help my back pain at all (her couch WAS comfortable though.) The only good thing I got out of it was her suggestion to get occupational therapy to help manage my discomfort.

    I was referred by a friend and went to a chiropractor for about 18 visits. She used ultrasound and TENS, tools a prior PT once used to help me quickly recover from a pulled hamstring (but not offered to me the more recent PT.) These treatments seemed to give me temporary relief from pain and inflammation. She also offered occupation therapy (not offered to me by my GP nor Osteopathic Dr) which helped me the most, long term. In particular, I had not noticed prior to having it pointed out to me, how the car I was driving was contributing to my pain. I initially got back support for my driving seat, which helped, but eventually got rid of the car after driving a rental car for a week confirmed just how much it was contributing to my problem. The chiropractor later referred me to a good gym in my area and particular trainers she knew that patiently helped me get back into working out. Did my chiropractor help cure a disease? No. I don’t think I ever stated alternative sources could. And I still have the condition, whatever it is. But seeing her helped me manage my pain and I believe she did use some techniques that are not out of the realm of what’s acceptable in scientific medicine.

    Anecdote #2) I don’t care to tell all the details of her condition and treatment, but my mother has advanced Mycobacterium avium Complex and has chosen not to take medications at this time. There is only a slight possibility that MAC may be cured, but the cure rate is greater than 90% if sputum cultures are negative for 12 months. Because MAC is commonly associated with dry coughing, she originally wasn’t able to produce sputum for testing. Within hours of taking a tea prescribed by her Traditional Chinese “Dr” she is able to have productive coughs and is now able to get her sputum tested. So far she has had 2 negative tests.

    (65) Beowulff said, ” I do hope you and your mother recover from whatever medical misfortune you’re having.” – Thank you, I sincerely appreciate it.

    (62) Mike – Thank you. I agree, Scientific Medicine IS the best we have, despite its imperfections. “But CAM does not submit itself to research and trials – and where it does it fails dismally.” Can you or anyone direct me to research that has been done? I’m not able to find much.

  70. paula says:

    PS, my mother also reports about 10% improvement with her fatigue. Those who know her notice and appreciate the improvement.

  71. Mike says:

    (71) Paula – The UK has a Professor of Alternative Medicine at Exeter University who is doing a good job of bringing some rigour to the analysis of CAM. These are 2 links to interviews he has given – the New Scientist one is fuller.

    http://www.guardian.co.uk/society/2005/dec/18/health.medicineandhealth1

    http://www.newscientist.com/article/mg19826531.400-interview-the-complementary-medicine-detective.html

    if you want more scientific data then the Cochrane Collaboration is a fantastic place to find systematic reviews on everything CAM and Scientific Medicine: -

    http://www.cochrane.org/

  72. Julian says:

    Paula -

    And how many doctors did you see for your chronic back pain?

    Mike -

    from the interview
    “Other evidence-based treatments include hypnosis for pain, music therapy for anxiety, and relaxation for insomnia.”

    These do not count as successes. All props to the man but seriously. You can’t expect me to take CAM seriously when these are put down in the win column.

  73. Paula says:

    (75) Julian

    Not including my GPs, I saw two different orthopedic Drs, and an internist. When I had a PPO, I took myself to one of the top sports doctors in my area. He was the first to diagnose the spondy and recommended rest. The second was a referral made by my GP, under my HMO. After the second orthopedic dr, my GP referred me to an internist. I cannot remember what, if any treatments he gave me. I tried to get he or my GP to refer me to a different PT, since I had success with it for other injuries in the past. But because of my insurance I think I could only go to the same place.

  74. BB Wolfe says:

    Well done, Julian (and let’s not forget Max) ! Your remarkably rude “riposte” to my crystal-clear question was even dumber than I could have imagined. So this “attitude” is what you gum-chewing twats think skepticism demands? No wonder you’re often despised — and not just by the dribbling untermensch with their greasy tin-foil hats and dirty keyboards, which is – I imagine – how true believers like you picture all those who burst your bubbles of smug flatulence. “Cut and paste” indeed!

  75. Max says:

    Paula’s anecdote #1 validates my point that instead of knee-jerk “algorithmic” treatment of symptoms, a little investigation can reveal the actual problems specific to the patient. In Paula’s case, her car contributed to her back pain. In post #23, I gave the example that a bad eyeglass prescription can cause a patient’s neck pain (by making him lean toward a computer monitor). It can also cause migraines. In another thread, someone said her candida infections were caused by tomato intolerance. A doctor needs to be a detective, not just a drug dispenser.

  76. Julian says:

    BB -

    Blow me.

    Paula -

    wow sounds like you really did get boned but, hey, it’s going to happen to someone. How do you think I liked landing a doctor who barely spoke English and could only communicate his diagnoses through elementary Spanish?

    I’m sorry for dragging this out but I’m finding your support of CAM somewhat confusing. If your dislike of medicine stems from procedural errors shouldn’t your efforts be spent on trying to reform instead of push forward an alternative that is at least 10x worst?

  77. commenter says:

    The medical establishment brought this upon themselves by being BAD at their job. So boo hoo.

  78. Karen Eliot says:

    When you argue against healthcare freedom, you are basically stating — implicitly — that our bodies belong to the governments we live under.

    It is quite possible to disagree with the medical establishment on many issues. Medicine is not a strictly scientific affair, there are profits at stake, and the pharmaceutic industry isn’t run by altruists. When untold billions of dollars are involved, there WILL be subterfuge, deceit, and impropriety.

    That I should give the government the last word over what I do with my body, just because you feel the need to protect me from myself, is a dangerous and violent argument.

    If you feel you have the right to impose your ideas on me about what I can do with my body, then what’s to stop me from imposing my views over what you can do with your body?

    What it comes down to is that you want to use government coercion to force me into behaving in ways that make you happy. If that’s the case, let me tell you what I advocate.

    I advocate that people like you — people who want to boss others around in order to “protect” them — only receive the kind of “medical” treatment that absolutely hate. How about crystal healing and orgone therapy?

    Don’t like it? Tough. Your opinion doesn’t matter because your body is government property.

    You don’t have the freedom to decide.

    You’ll do whatever we tell you is good for you.

    And you’ll like it.

  79. Tarun says:

    I agree, but medicine has failed in a lot of places and EBM has only exposed those weaknesses- e.g. the fact that dietary recommendations are based on politics and special interests and are often shown to have tenuous connections, at best, to morbidity and mortality – can only serve to increase the distrust.

    Medicine needs to clean its own house. Meaning cutting ties to interested pharma entities, to stop kowtowing to special interests, and to rigorously prove unfounded assumptions.

    @Karen Eliot- no, we are arguing for the scientific community to adopt rigorous standards and cast out the charlatans for what they are. And to require actual proof for the claims they make… If truth is too much of a light to handle, well… maybe you should question whether it is “the man” keeping you down, or pure idiocy.

  80. Herbalist in Agreement says:

    So I have a strong interest in herbalism and certain aspects of holistic and alternative medicine.

    However, I have always thought that homeopathy, aromatherapy, faith healing and many other things that get lumped under the “alternative” label were total crap, and still do. Until the very end of your article I thought you were including in your damnation the sensible use of herbs and other well-established practices, and was simultaneously relieved but more than a little upset that you weren’t more clear about just what it was you were shaking your finger at from the beginning.

    There are literally hundreds of herbs with scientifically demonstrated, medically significant effects, supported by thousands of peer-reviewed studies, not to mention anecdotal evidence that in many cases spans nearly to the dawn of civilization itself (or earlier). Many of the pharmaceutical drugs used today have herbal origins (penicillin, anyone?). Even non-human animals seek out specific plants when suffering from disease and use them for their medicinal effects, a behavior likely induced by evolutionary selection.

    I would ask you to please make the minor revisions to your article necessary to enhance the clarity of your argument, which I agree with, or at the very least refrain in the future from confusing such quackery with other, proven forms of alternative medicine which frankly save lives and improve the health and well-being of literally billions of people.

    I appreciate your critical thinking and the nobility of your goals, but don’t throw out the baby with the bathwater.

  81. One HUGE difference that nobody has mentioned (and I’ve read every post) is the third party payor system. When a primary care doc has to wade through mountains of paperwork and has to wait 120 days to collect 30 cents on the dollar from Medicare or insurance, the advantage falls squarely to the CAM practitioner. This is the reason your doctor can only spend 10 minutes with you and can’t go out to the parking lot to inspect your car seat. If patients paid cash, like they do to their naturopath, doctors would have a lot more time to spend with you and could give you more of the attention that you deserve. I don’t know of a single colleague who doesn’t want the ability to spend more time with each patient. Unfortunately it is economically impossible.

  82. Alson says:

    “What if the auto industry promoted “automobile freedom” laws so that consumers could buy any vehicles they wanted, free from any government quality or safety regulation?”

    Then I’d be able to buy one of those little German cars which gets 60 mpg, and which is safer than many of the cars on our roads now, but kept out merely because their manufacturers don’t want to spend the money for testing (because I don’t represent a big profit center like the SUV).

    You can legally drive a 1967 Ford Mustang here but not a 1997 Audi A3, and you think motor vehicle laws in this country are based on *safety*? :-)

    I’m all in favor of better medicine but this particular argument isn’t exactly a strong one. I think it speaks volumes that physicians think motor vehicle laws in this country are an example of successful government intervention. I suppose it’s natural for everybody to assume that other industries are immune to the politicking that your own is victim to, but it’s simply not the case.

  83. Gene says:

    Why wouldn’t people grasp at alternative straws? Mainstream medicine is a de-facto monopoly, but not subject to fiscal regulation. The price has become impossibly high for individuals, indeed for society. Furthermore, supposedly impartial and scientific oversight by the FDA is increasingly questionable as it appears influenced by corruption. The promotion of patented drugs to the profession seems to be more hyped than responsible. The list goes on…

  84. William Volterman says:

    Karen the statement isn’t that CAM shouldn’t be accessible, but that they shouldn’t be able to parade themselves as something they are not.

  85. Richard says:

    You say “More than a decade and hundreds of millions of dollars later, there has not been a single CAM modality that has been proven by research to the point that is has gained general acceptance…”

    Off the top of my head: hyperbaric chambers – rejected by medicine 50 years ago, but now a useful therapy; Atkins diet – rejected for many years but now MD’s agree with its low-glycemic guidance.

  86. Max says:

    Grant,

    Health insurance really sets the doctors’ incentives. HMO doctors tend to see way too many patients, so their job is to first determine that the patient isn’t dying, and second to prescribe the most obvious treatment for the patient’s symptoms. British doctors typically spend 8 minutes per patient visit.

    On the other hand, there’s a growing “network” of doctors who don’t accept insurance, but PPO plans still cover them at the out-of-network rate. It’s more expensive, but they spend much more time on patients. The ones I’ve met have good credentials and seem more open-minded about CAM. But they can be sleazy, trying to sell you things you don’t need and making deals with drug companies to push certain drugs.

  87. signalfire says:

    I’m confused… tell me again which group gave us Thalidomide?

  88. Simon says:

    There are no arguments here convincing to any mindset beside the prejudice behind them. But you wonder why all these social forces are arrayed against you.

    Keep preaching hellfire and damnation to the choir, like they did in the crusade agaisnt Gallileo. Now you know what it feels like to be dogmatic orthodoxy slowly strangling.

    Your comments on homeopathy prove a philosophical hamfistedness that you probably consider a virtue, in the grand tradition of bigotry.

  89. garf says:

    In principle I agree with you, but how would you classify the medical societys response to Peter Duesberg complaints in ‘Inventing the AIDS virus’? Here we have medical researchers ignoring Kochs postulates. I use doctors for diagnosis, but always consider alternatives when it comes to prescriptions. The system is too heavily influenced by the pharmaceuticals. (BTW, the alternatives I look at are the ones suggested by MD’s that are somewhat counterculture & publishing, not anything like homeopathy which is simply ridiculous)

  90. Tarik says:

    83) You probably make the most salient point on this page. CAM is a response to the abject failure of modern Western medicine to maintain the health and well-being of patients. Western medicine, in fact, is focused on keeping the patient alive and paying (or establishing a bedrock of debt to ruin their remaining life) and little beyond this.

    The rationalization many doctors give themselves, as participants in this process, is that their *patients* are the ones making the error by choosing CAM therapy over rigorously tested scientific methods. When you think about the economic costs and compromises that must be made over a medical diagnoses vs. the legal choices and freedom available to a person who avoids medical counsel completely, you might begin to fathom where quality of life, which is the essence of health and well-being, is improved for the patient. You don’t need to be a psychologist or an empath or a faith healer to see this. When the medical field is more concerned with preventing the dollars that mark the end of your life and your procession towards death from being put into the pockets of ‘somebody else’ than reflecting on the reasons why you might choose to deny them the chance to ‘cure’ you, it’s obvious to me that a mistrust of doctors and modern medicine has been wholly earned and hard-fought for by doctors against patients.

    As a healthy person, you pay into insurance in the hope that the insurance company will do nothing (and you will be healthy). Then when you are sick, you go to the professional who informs you that you are, indeed, sick. The professional outlines a treatment plan and informs you that after some processing on their side, you will receive a cure and your out-of-pocket cost will be only X. Your insurance provider will pay Y, for a total of Z. You pay X in good faith and undergo a few tests and an impersonal referral to a person you don’t know who opens your body up and does something to your insides while making little/no effort to make the process any less painful for you than it already is. After recovering from this pain (and the loss of X), your insurance company sends you a letter informing you that, due to a clause you probably didn’t read, or at least didn’t consult with a lawyer about, one of their professional claims auditors (collecting a commission?) has discovered that you really do NOT qualify for the procedure and Y will not be paid as part of Z to your care providers. As a matter of fact, due to a genetic history of ABBA in your family, no insurance company will cover you anymore, so tough toodles. Naturally, when the honest practitioners who did the work to cure you start asking for part Y of the amount you agreed on and the insurance company denies that they ever knew you, bills begin showing up on your doorstep. This isn’t a worst-case scenario and it is only enabled by ignoring the symptoms and treating the *pain* (CAMs) as if it will cure the problem.

    -Doctors need to re-establish a code of honor and decency as part of their professional rigor. Elective surgery and other aspects of modern medicine have blurred this line and people need to see the perspective of a doctor who doesn’t treat them like a walking meatsuit. When patients *believe* doctors will not do them harm by saddling them with life-long and anxiety-inducing debt, then patients can rest assured that it is better than alternative CAM therapies which are costly and aren’t proven effective.
    -Doctors should know, for a fact, that they will be compensated for their services at the end of the day and that they have sufficient protection from frivolous malpractice suits that they can *help people* without second-guessing policy.
    -Doctors should never profit from prescribing more drugs, ordering more tests and procedures, or performing more surgeries.
    -Patients should know, for a fact, that a doctor is honestly concerned about helping them and that their ability to pay for treatment is not even an ancillary concern for the doctor during a diagnosis.
    -Patients should reward caregivers for making them feel better, not for identifying a biological malady or malfunction and removing it from their bodies. People should be allowed to own their maladies as much as their good health – they should have a right to die in peace.

    As far as I see it, these should be the immutable truths of medicine, but as developed by the best experts, they are not so I can only guess that I am missing something else. If doctors who ultimately “own” this process cannot change it (back) by agreeing among themselves, then I don’t really see how licensed and legitimate medical practitioners, as we define them, are more useful than a Wall Street hack who pretends to be an investment expert that can help you plan for retirement. Since HMOs and insurance entered the scene and doctors stopped making house calls, doctors have followed a different honor code and, from what I see, it doesn’t include social responsibility. If that is how it’s going to be, let’s dispense with the empty promises of care so we can relegate these forms of “assistance” to the scrap-heap of history.

    Without doctors and nurses to actually *provide care* for patients, the gigantic conglomerates that support these vestigial organs of exploitative medicine, and also fund research for patented drug profits, are just associations of bit-twiddlers and beetle-shell pushers that carry a veneer of legitimacy. If you are good at what you do, the patients will show up whether you are informed on the latest drugs or not. Doctors and nurses need to restore meaning to the oath “Do no harm” beyond the treatment of illness. They are the only ones with the leverage to achieve this and I believe they should feel a social responsibility to look beyond the cost-profit model of economics and the limitations of political interests to solve this problem because economists have already established in the past few months that they are morally/ethically incapable of processing math above a fourth-grade level or containing more than seven digits per number. And the politicians…well let’s not even begin with them. You are smarter than these guys…this should be cake.

    While I’m at it, I guess I’ll just state that doctors should also stop drug companies from using television ads to suggest patients should perceive a particular feeling as something they might want to treat with Drug X. This harms you and your patients, I would think, and I do not understand how this practice can, in good conscience, be allowed to continue.

    Happy Christmas to all and to all a good night.

  91. andomar says:

    Heavy government regulation (include the FDA and patents) puts an almost full stop on non-trivial invention.

    Ask yourself when the main advances in medicine where made.

  92. Memet says:

    I could not agree more with Tarik.

    You reap what you sow. Maybe you haven’t sown this yourselves literally, but your predecessors have. In fact, science as an endeavour in the last century is slowly failing because of this. And I say this despite having been in love with Science since as long as I can remember.

    There was recently a very beautifully produced radio show on CBC.ca called “How to think about science”. The final episode of the series was an interview with a philosopher called Nicholas Maxwell. I highly recommend anyone interested in listening to what he has to say (which is almost an hour long). (You can find the podcast on their site)

    There is no point in my rehashing what was said in that interview or transcribing his books onto this blog, however I would like to add a point to what Tarik says. Many of the topics Tarik talks about are related to the US health care system, which is almost entirely based on the bottom line. This doesn’t change the fact that the malaise that leads to CAM being accepted worldwide is a malaise in the culture of science itself.

    The point is that Science believes it is objective and impartial, but in reality it is quite subjective in what it chooses to study. For instance: a theory that is considered simple somehow has more value in science, whereas one which is based on exceptions is considered weak. The question “why” or “is it right to be so” is not so much important as the realization that, indeed, there is a subjective pursuit in science. All of our discoveries *are* a result of human subjective values. If our subjective values preferred complicated, rule based theories, we would not be searching for a grand unified theory.

    It is true that the post-modern thought college entirely subverted this and turned it into a “science is a patriarchal value imposition system” mumbo-jumbo. But they were only crystalizing something out of the zeitgeist of the 20th century.

    To use Maxwell’s words, Science has become psychotic. It refuses to accept that it’s got feelings (subjective values), and in doing so, refuses to see that there *can* be a discriminating way to approach research. Science for the sake of science does not exist.

    To the topic at hand: how much of modern medicine is based on increasing the quality of life? I would say that outside of trauma medicine (snake bites, car crashes, aneurysms), most of science including Cancer care is only palliative, and sometimes not even that. Sometimes it is but a study in the god complex of men. In the history of things, it could be considered that the millions of terminally ill cancer patients of this century who got bombarded with radiation to the point of being ghosts of their former selves in their last days on this earth will have been the stepping stone towards a true “cure” to cancer. But in the meantime, doctors *must* recognize the dehumanizing aspect of it. Today, cancer’s stigma is more about the therapy itself than the death that ensues. Anyone who’s had a relative suffer cancer knows this.

    In all of this, I haven’t even begun talking about CAM, and I don’t need to either. CAM is the anti-particle of current Medicine. It is the mere projected ghost of all of the modern medical failures. Why do people get casts when their arms are broken, glasses when their eyesight fails, and yet choose to get CAM when they have pains in their stomach or headaches that won’t go away? Because the treatments for the former two forms of illness have a net value in increasing human well-being, whereas the later doesn’t. The later is a drug company dollar fest.

    You can’t not recognize your own problems and go on a hunt of CAM. You are hunting your own ghost, your own shadow.

  93. John Davis says:

    Wow dude makes perfect sense to me.

    http://www.Privacy-Center.net

  94. burned out md says:

    You people are self-professed skeptics, and so are inclined to view the rise of CAM through a skeptical lens (meaning, primarily, as a failure of science education). Looked at that way, CAM has the potential to be the perfect storm you’re so concerned about, but your skeptical outlook is blinding you to the real reasons CAM is so popular in this country.

    The rise of CAM has everything to do with the failings of the USA’s real medical system, the use of which has become an expensive, unpleasant, and frequently humiliating experience for the end-users.

    CAM is popular for three — and only three — reasons: loss of trust in the regulatory complex, CAM is easier to get, and CAM offers treatments for conditions Western Medicine doesn’t.

    Point One: loss of trust in the regulatory complex.

    Contrary to your apparent intuitions about what normal men-off-the-street tend to think, even normal men-off-the-street understand and accept the scientific method…but you have to be careful to ask them about it in the form of a hypothetical, like “if you did such-and-such with such-and-such people over such-and-such time and found such-and-such results, would you be justified in concluding such-and-such efficacy?”.

    People get that that works.

    What people no longer accept is the proposition that “if some drug company X shepherds some drug through the FDA’s approval process, it’s reasonable for me to assume that the drug is actually safe and efficacious”, because that’s in many cases not a proposition it’s wise to accept.

    Some of the lack of trust is a result of widely publicized incidents like, most recently, vioxx.

    Some of the lack of trust is the result of crazy television advertising with the fast-talking voices at the end listing all kinds of side effects.

    Some of the lack of trust is from experience — either personal, or on the part of some family member or friend — who wound up suffering tons of side effects on something and/or taking something that never really worked.

    Some of the lack of trust is from seeing all the drug-company-supplied-schwag in doctors’ offices, which really eats away at a doctors’ credibility over time (we’re not that far from a time when hospital scrubs will look like nascar uniforms…really trust-inspiring).

    Some of the lack of trust is just a halo effect from losses of trust in other major societal institutions (the media, the politicians, the financial system, take your pick).

    This is not really a loss of faith in the scientific method — it’s a growing skepticism about what they read and hear, and the CAM-buying population’s subsequent actions are very understandable: they try stuff until they find something that they think is working (which, due to the placebo effect, shouldn’t take long, especially if their problem isn’t that serious to begin with).

    And, once you’ve found something you think works, why wouldn’t you stick with it?

    Point Two: CAM is easier to get. This is true at every possible level:

    * CAM is logistically much simpler to obtain: you just buy your supplements, or call, schedule an appointment, and pay a flat fee when you’re done.

    No need to bother with referrals, or the particulars of a health insurance plan, or get in to see some super-overworked, rarely-available specialist, or worry about denied claims.

    * CAM practitioners will give you their full, undivided attention for the duration of your appointment. Your appointment is often 30 minutes or more (an hour+ is not uncommon). It’s very hard to see a real doctor for more than 10-15 minutes, and while you’re there they are usually visually preoccupied and probably thinking about anything other than you.

    * CAM doesn’t need prescriptions: if you think you need something, you can get it, you don’t have to go begging until you find some practitioner willing to write a prescription.

    * CAM usually don’t keep medical records that can be used to, later, document pre-existing conditions (that might deny you coverage for such-and-such problem for some period in the future), and doesn’t keep medical records that might interfere with your working some particular job or engaging in some particular activity.

    Compare with medicine, wherein you leave a much larger paper trail, much of which has the potential to work against the patient’s future interests.

    * CAM doesn’t lard up your bill with all kinds of random crap. You might be buying some expensive Chakra-RAaligning Procedure (CRAP), but if they tell you your CRAP is going to cost $1000 it’s going to cost $1000 when it’s done; you won’t get a bill in the mail two months later for $2500 on account of random stuff like $100 aspirins and $150 blood-draws (which, say, were necessary for whatever procedure you thought you were billing for).

    If you’re of limited financial means, a predictable expense is much preferable to an unpredictable expense, and you only have to be burned once yourself — or have heard, once, about someone getting burned — to know to prefer the predictable expense.

    * CAM practitioner facilities are generally no less pleasant than real facilities, and often substantially more pleasant: better interior design, more comfortable waiting rooms, fewer agitated people mulling about, etc…

    I could go on, I think it’s clear that — aside from issues of efficacy — the CAM-system beats the real medical system on most issues of patient experience.

    Point Three: CAM offers treatments for conditions western medicine doesn’t recognize.

    Western medicine conceives of health mainly in terms of homeostasis: there’s some “healthy” state to be in, and when you have a medical problem you have gotten stuck in some inferior state; the point of a medical treatment is to return you to that “healthy” state via some kind of intervention, and then if no such original-healthy-restoring intervention is possible then perhaps some mix of symptom-patching interventions will, by their combined effect, bring the patient closer to that original state of health.

    Nowhere in western medicine (at least officially) do you see any real interest in scientifically improving the health or wellbeing of the already-healthy patient (making them better-than-well, as it were).

    If I’m an old fart feeling a little slow and foggy, I can go to my doctor and complain “hey, I’m feeling old and foggy”, but if the doctor doesn’t find anything wrong with me that’s the end of it…whereas, if I go to some CAM practitioner, there’s at least something on offer for that like some rare herbal root or some meditation or whatever; efficacy is not important here, just that one party will try and work with you and the other will tell you to suck it up and go home.

    It’s not just old people that want to be better than well, there’s also serious athletes, and some thriving subcultures of people who, say, think for a living and thus find it worthwhile to experiment with stuff that might help them out.

    So if you want to be better than well — or just have a vague sense that something about you could be better — your choices are either being told to go home and get over it, or hey this might work…no surprise which side wins this one.

    Conclusions:

    CAM is popular b/c

    * the loss of trust in the medical-regulatory-system means that the populace is less trusting of the claims of efficacy that system delivers

    * CAM provides a hands-down superior customer experience to real medicine

    * CAM at least has offerings to make you better-than-well in various ways, western medicine is only officially about treating problems post-facto

    If you want to reduce the popularity of CAM, you’re going to have to start with fixing the problems of the medical system. A better medical system would have:

    * more, better-mannered, less busy, more-affordable doctors

    * predictable costs of treatment and fewer downsides to “officially” seeking treatment (like a paper trail leading to future denials of coverage or whatever)

    * more patient autonomy: ie, needing a doctor’s prescription for insurance to cover a procedure or product, but never needing a prescription just to purchase it

    * a more consultative doctor-patient relationship. instead of assuming the doctor not only knows best but also knows what the patient should want, instead let the patient describe what they’re trying to do and let the doctor advise the patient on how best to do that.

    CAM is less about a mass rejection of science and more about trying to find ways around an incredibly broken system.

  95. Max says:

    Doesn’t insurance coverage favor conventional medicine over CAM, since it’s cheaper for the patient?

  96. David Paterson says:

    And I am waiting for Steven Novella to comment on the appalling number of deaths and injuries his profession direcly causes. An witch doctor would leave more patients living at the end of treatment.

  97. Max says:

    David, compare to the number of successful treatments.

  98. Fred says:

    I read as much of this self-pitying article as I could before commenting. Novella is not completely wrong in that CAM is largely based on unscientific principles and procedures. Certainly there have been grave abuses in homeopathy, chiropractic medicine, reflexology, and the health-food and supplement industry. Very few people would dispute that. Nor would many people dispute the assertion that the practice of CAM alone (without recourse to the advantages of allopathic medicine) often leads to inadequate diagnoses, inadequate care, and early death.

    Novella is wrong is in his assertion that CAM is, in its totality, equivalent to quackery, fraud, and the schemes of con-men. That’s ridiculous. The naturopathic industry does regulate itself. We are no longer living in the nineteenth century, where all that existed in CAM were the tiny herbal shops and the eccentric proprietors with their sheds full of potions. Naturopathic physicians do have to complete rigid, elaborate, course curricula required for certification. So do chiropractors, reflexologists, nutritionists, and most other CAM professionals.

    Novella is also wrong in his assertion that care which is based only on trial-and-error and case studies (rather than applied science) is automatically ineffective. That’s not true. A practice which is based on anecdotal evidence and case studies can certainly prove proficient in the treatment of many ailments. Furthermore, CAM specialists focus much more on prophylaxis than medical doctors do, so they are meeting a need that traditional medicine most emphatically does not. M.Ds treat sick patients. They do not specialize in preventing illness. That single fact is why the natural health industry and CAM gained a foothold in the first place. Conscientious people want to lessen their chances of developing a serious illness in the first place. They don’t want to wait until they are already diagnosable with a serious condition before they focus on health. CAM consistently meets that need.

    Novella’s greatest error in the article is his refusal to see a complementary role between allopathic medicine and CAM. It is a common error which many MDs have succumbed to. Ideally, CAM should not eliminate the need for the services of scientific medicine, and vice versa. Trust in MDs does not eliminate the need for alternative therapies when finances, personal preference, or a focus on prophylaxis make hospitals less of an effective option. The existence of more options in life is almost always a good thing. Scientific medicine plus the availability of CAM is a better scenario than scientific medicine alone. Any rational person who is objective about this should be able to see it. The two disciplines do not have to be competitive to the detriment of patients. They can be complementary and even inclusive—-meeting the needs of patients in a more comprehensive way.

  99. Memet says:

    I’m still waiting for a response or even simply an acknowledgement by Novella to the many very well written and well thought out responses.

  100. ImperfectlyInformed says:

    A 2006 US National Research Council report referenced surveys of Cochrane systematic reviews for conventional and alternative medicine which revealed that a comparable proportion have evidence indicating similar efficacy.

    http://en.wikipedia.org/wiki/Alternative_medicine#Testing_of_efficacy

    Obvious examples I’ve discovered: kava for anxiety (the root doesn’t cause liver damage), 5-HTP or SAMe for depression (similar efficacy as trycylics, no sexual dysfunction, increased suicide risk, or various other problems), devil’s root (http://en.wikipedia.org/wiki/Harpagophytum) for athritis or back pain (comparable to Vioxx). The ones that everyone has heard of, St. John’s Wort and echinacea, are also fairly well-supported by evidence.

    There are plenty of other examples, but these have all generally received positive reviews from mainstream scientists to varying degrees.
    Look at the Wikipedia articles to see the basic evidence in favor of these, although there are some MDs editing Wikipedia who will try to play down the results and exaggerate the toxicity that they don’t understand. However, in the US (as opposed to Germany) none of these are regulated, so there is a real risk from lack of purity.

    In some cases, like 5-HTP, the only double-blind RCT was performed in the 70s, and there have been many “open” (non-blinded) or crossover (interchange placebo and treatment) studies since which suggest efficacy. It’s an example of mainstream medicine dropping the ball. Tryptophan is similar. SAMe has more evidence, but is still relatively ignored.

    Overall, there is something to be said for the argument that mainstream medicine doesn’t pursue natural alternatives which are safer and as effective because they aren’t lucrative. That, and the blind generalizing ideology which one can see in this blog post.

  101. John Appleseed says:

    The author of this article, Steven Novella, stated:

    “While I endeavor to be a full-service skeptic, pseudoscience in medicine is definitely my specialty. It is therefore especially painful for me to admit that in this arena, more than any other, we are getting our butts kicked. We are almost at the point of being routed, with the defenders of scientific medicine being relegated to the role of insurgency. How did this happen?”

    Here, in a non pseudoscience study, published in the Journal of the American Medical Association, is your answer.

    From the article “Incidence of Adverse Drug Reactions in Hospitalized Patients”, we find the following:

    “We estimated that in 1994 overall 2216000 hospitalized patients had serious ADRs and 106000 had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.”

    The full article is here:
    http://jama.ama-assn.org/cgi/content/abstract/279/15/1200

    .

    Note carefully, that these deaths are directly caused by doctors. If you write the prescription and the patient dies, its your fault, plain and simple. (However I am sure that more than a few doctors will have long winded explanations to try to remove both blame and liability.)

    .

    Here from The National Academies is another report:

    “Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says.”
    http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11623

    .

    So doctors kill over 100,000 people a year and injure another 1.5 million, just from the drugs they prescribe. And these figures do not take into account any other medical malpractise.

    Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health concludes that in total, doctors kill 225,000 people every year. You can read a summary of her report here:

    http://www.ratemds.com/social/?q=node/12415

    Or pay to read the full article here

    http://jama.ama-assn.org/cgi/content/extract/284/4/483

    .

    225,000 deaths per year would make doctors the third leading cause of death in the US, following heart disease and cancer.

    Outside of heart disease and cancer, it is more dangerous to be treated by a doctor than to suffer from the illness and seek out alternative care. When the treatment modality itself is the 3rd leading cause of death, it is no wonder people seek out alternatives.

    I am waiting for Steven Novella to comment on the appalling number of deaths and injuries his profession direcly causes. A witch doctor would leave more patients living at the end of treatment.

  102. CreidS says:

    Horribly, terribly belated response . . . But I wasn’t advocating for CAM. I’m just illustrating how they get their foot in the door; and perhaps an area for improvement. I worked in a hospital for a few years. I trust Western Medicine. But Doctors themselves are often the weakest link. I’ve watched plenty treat their patients like meat, or just simply treat the patient like an idiot. None of that helps.

    The idea that caring for the whole patient is somehow fluffy is how we are losing this thing. Acting like the CAM people are fools and quacks might make you feel smart, but they clearly have something figured out that many doctors do not: human psychology.

  103. Max says:

    Can someone explain why a car mechanic and a software developer can spend more time diagnosing and repairing a problem than a doctor? Whose challenge is more complex?

  104. Winston Smith says:

    “Can someone explain why a car mechanic and a software developer can spend more time diagnosing and repairing a problem than a doctor?”

    No rocket science here. A car mechanic doesn’t get paid unless the vehicle is fixed and running. Same with software. It has to work or people won’t buy it.

    Medicine on the other hand can treat the same ailment for years, without necessarily showing any results in terms of a cure. People with migraines often get pain medication for the remainder of their life, without any real cure. Same with back problems and all sorts of other ailments. And the doctor always gets paid.

    For a long time, peptic ulcers were believed by western medicine men to be caused by stress. Only when the real cause, Helicobacter pylori, was found was there a real cure. However, herbalists have been prescribing Mastic Gum for a long time.

    Recently, we have this from the New England Journal of Medicine:

    “Even low doses of mastic gum — 1 mg per day for two weeks — can cure peptic ulcers very rapidly, but the mechanism responsible has not been clear. We have found that mastic is active against Helicobacter pylori, which could explain its therapeutic effect in patients with peptic ulcers.”
    http://content.nejm.org/cgi/content/extract/339/26/1946

    Western medicine men have so profoundly bought into two treatments, pharmaceutical drugs and surgery, that for the most part, as Steven Novella has shown, they are quite biased against any other type of treatment, even though their own methods makes doctors the third leading cause of death.

    None of this is surprising, given the enormous profits and lobbying power of the pharmaceutical industry. What it comes down to is that outside of prescribing drugs (usually with a long list of side effects) doctors are only allowed to perform surgery. Anything else, no matter how well it works, is “pseudoscience”.

    Both procedures are quite clearly so risky that they kill almost a quarter million people a year.

    But the doctor always gets paid.

    The sad part of all this is that only the internet provides reliable information on any treatment outside of drugs and surgery.

    Because of the enormous advertising budget and lobbying power of the pharmaceutical industry, these issues are never reported, not even once, on TV or in mainstream newspapers.

  105. Shahar Lubin says:

    Winston Smith, if mastic gum works than it is a drug. It has an active ingredient and was found to work as medicine by scientific method. That’s how “western/tradional/EB” medicine works. The next step is finding out what is the active ingredient and how it works. Then we can isolate it, improve it and control the dosages. Realize whether it has side effects and whether or not there could be problems using it with other drugs. That is medicine and science.
    Pseudoscience is what doesn’t work. What isn’t based on evidence but on philosaphy and wishful thinking, all the while confusing population with nonsensical “explanations” with no backing of logic and reasoning. Astrology is a pseudoscience.

  106. Winston Smith says:

    Shahar Lubin,

    Your comments, while accurate in some ways, indicate the bias inherent in western medicine. Mastic gum isn’t a drug, it is a plant. Why would you bother to spend millions of dollars studying, analyzing and isolating its “active ingredient”, when it already works, and has been proven to work by independent studies?

    For one thing, where is the proof, implicit in your argument, that any of its parts would work on their own, without the whole?

    You state that pseudoscience “doesn’t work”, and is based on wishful thinking.

    Isn’t a treatment modality that is itself the third leading cause of death, not only pseudoscience, but worse than pseudoscience?

    Talk about wishful thinking. Go to a doctor with any ailment other than cancer and heart disease, and statistically, you are more likely to die from the treatment than the ailment.

    Pseudoscience indeed.

  107. Max says:

    Winston, Shahar gave reasons for finding the active ingredient. Same reason we take aspirin instead of chewing willow bark, and penicillin instead of eating mold excrement.

    The Wikipedia article shows why studying mastic gum is important.

    “Some in vivo studies have shown that mastic gum has NO effect on H. pylori when taken for short periods of time. However a recent and more extensive study showed that mastic gum reduced H. pylori populations after an insoluble and sticky polymer (poly-β-myrcene) constituent of mastic gum was removed and taken for a longer period of time. Further analysis showed the acid fraction was the most active antibacterial extract, and the most active pure compound was isomasticadienolic acid.”

    So this may lead to a new type of general-purpose antibiotic.

  108. Winston Smith says:

    The Wikipedia article also states:

    “People in the Mediterranean region have used mastic as a medicine for gastrointestinal ailments for several thousand years.”

    There is nothing wrong with studying something that has been proven to work for millenia. However, this train of thought highlights the problems inherent in western medicine.

    The real reason the pharmaceutical industry would spend millions of dollars trying to isolate and replicate the active ingredient is to patent it. Unfortunately, patents run out in 20 years, so they are then on a new quest for another drug they can profit from.

    Unfortunately, many, perhaps most inventions of the pharmaceutical industry have a long list of side effects. However to keep the game going, they have to push the newest inventions over the expired patents, regardless of toxicity or efficacy.

    And natural substances are to be avoided at all costs. Not a penny to be made off of any herb, plant extract or vitamin.

    Steven Novella stated:

    “Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery. The promoters of dubious health claims were charlatans, quacks, and con artists.”

    I would ask Steven Novella directly, have you ever heard of mastic gum? If so have you ever prescribed it for ulcers or other bacterial related stomach problems such as bloating?

    And as a doctor, are you even allowed to prescribe a simple herb or plant extract with known efficacy over several thousand years?

    I suspect that Mr Novella would lump mastic gum in with snake oil, fraud, folk medicine, and quackery, then write a prescription for something the pharmaceutical industry can profit from.

    It is because of the internet that many people are becoming skeptical of the pharmaceutical industry, and their representatives, the doctors. It is a profit driven model that kills over 200,000 people a year.

  109. Max says:

    And CAM is not a profit driven model?

  110. Winston Smith says:

    “And CAM is not a profit driven model?”

    Complementary and alternative medicine is certainly profit driven to a degree. However there are many websites set up by people who have suffered from a disease that try to provide accurate information about alternative treatments.

    Using the internet, I have found excellent treatments for severe bloating caused by bacteria (mastic gum, which works very rapidly), gum infections (brush with baking soda and a little 3% hydrogen peroxide), severe back problems diagnosed as arthritis, to mention a few.

    If you look at the history of western medicine, Penicillin was discovered in 1928. The first vaccines were created around the same time.

    This was clearly a turning point in many ways. Both products worked, and saved many many lives. More relevant to our present situation, they could be mass produced and marketed.

    Nothing wrong with that at all. However, this has led to a frantic, profit driven search to find a pill for every ailment. Penicillin was a natural substance with few side effects for most people. The same cannot be said for the billions of dollars worth of pills doctors prescribe each year.

    Take Tylenol (paracetamol or acetaminophen). It is extremely toxic to the liver.

    “Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.
    A 2008 study indicates that Paracetamol given to infants may also be linked to an increased risk of developing asthma in children.”
    http://en.wikipedia.org/wiki/Paracetamol

    Look closely at the side effects of many, if not most, drugs prescribed by doctors and you will find a long list of side effects.

    With a total US population of about 300 million and 225,000 deaths caused directly by doctors each year, we get the startling fact that doctors kill 0.075% of the population every year.

  111. SIV says:

    If “science based” medicine wasn’t the province of whiny rent-seekers you might have better luck competing in a free market.

  112. Dear Steve,

    You wrote: “The only thing they have in common is that they do not meet the scientific standards of mainstream medicine. “

    This is not true. What they have in common is their metaphysical element: what you call “CAM proponents” are in reality “NewAgers” – which is the true umbrella term for a wide variety of spiritual cultists. I have been documenting their movement (in my own way) on my blog, The Macho Response. I think to disregard the metaphysical aspect of these groups is to miss the point of who they are, what they’re doing, and why they won’t stop, but, despite their successes, few are still willing to do so.

    You are fighting a group with a structure like Al Qaeda. Their leaders are, both, well known and obscure. Because they aren’t taken seriously, as NewAgers, they have the perfect cover for their efforts – which aren’t limited to science and medicine. Until they are focused on (as others focus on the beliefs and efforts of Right-Wing Christians, Catholic Priests, or Radical Islamists) they will be free to continue to destroy the fabric of reality. These are cults, and they must be addressed as such.

    I encourage you and your readers to investigate my site (not just glance at it and assume anything) but, if it isn’t to your taste (which wouldn’t surprise me) write me and I’ll gladly point you to more scholarly researchers, papers, and statements by people you respect.

    Keep in mind, I’m “just a guy,” and I’m not attempting to be more than that. I also know I’m right:

    I used to be married to one of these people, have had an opportunity to see this phenomena at close range, and my ex-wife killed her mother-in-law and two others.

    I repeat: to miss the cult aspect of this is to miss the point.

    –CMC

  113. Cambias,

    “It was nurses who fell for and promoted the whole “therapeutic touch” nonsense.”

    It was the late Jef Raskin (designer of the original Macintosh computer) who first identified therapeutic touch as a cult. Here’s his paper: http://jef.raskincenter.org/published/NursingTheoryForSite.html

    Julian,

    “Gets to be a real pain when you try to explain to them why ‘A doctor told me I needed [insert treatment] and it would cost a lot but after [insert crap] I was all better and still am’ isn’t a valid argument and they say ‘I don’t care.’”

    This is how cultists react to things they don’t agree with – like the Borg – think of followers of David Koresh, The People’s Temple, or Heaven’s Gate: do you think merely reasoning with them could talk them out of their beliefs?

    Max,

    “Should CAM be outlawed or what? Should vitamins be regulated like drugs? Throw accupuncturists in jail?”

    Yes, yes, and yes – that is The Macho Response.

    Daniel Loxton,

    “Just as it’s unethical to sell unsafe boilers, experimental seatbelts, or fake insurance policies, it’s unethical to sell fake, unsafe, or experimental drugs. Where such dangerous products are sold, it is unethical for authorities (or skeptics!) to stand by and do nothing.

    It’s wrong to blame the victim. If someone deliberately persuades your grandmother to buy bogus medicine (or, for that matter, a new car transmission she doesn’t need), that doesn’t make her an idiot.”

    You are, both, right and wrong here: this is unethical, from top to bottom, for all involved. But, though (you’re right) this isn’t an intelligence test, that doesn’t eliminate the ethical violation – even for the supposed “victims.”

    Everyone – listen to BB Wolfe:

    “I wonder what the avowed Skeptics think of the medical profession’s favorite cancer “treatment” – chemotherapy.”

    BB Wolfe is a person to be shunned and hounded out of existence. I feel the same way as Dr. Browdy. This is war, and it’s you guys or them. Take a lesson from Israel: dig them out of their tunnels and don’t finish until you’re sure the job is complete.

    Max,

    “Yeah, stupid patients with their imaginary “illnesses”. Wait, maybe this attitude is the problem.”

    No, it isn’t. I am a back patient who, recently, had to insist my doctor give me an MRI against his wishes. But I knew more about my long-standing injury than he did: it wasn’t some mysterious self-limiting pain, which is what “alternative” medical practitioners deal with. Don’t stop being doctors, y’all. That’s your strength. There’s no excuse for what these parasites do and you owe no one any excuses for what doctors do.

  114. sonic says:

    What if acupunture actually worked?

    http://www.mayoclinic.org/news2006-rst/3495.html
    “The results of the study convince me there is something more than the placebo effect to acupuncture,” says David Martin, M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist. “It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients.”

    http://www.sciencedaily.com/releases/2004/11/041123212055.htm
    “Acupuncture, as a complementary therapy to drug treatment for osteoarthritis of the knee, is more effective than drug treatment alone, find researchers from Spain in this week’s BMJ.”

    http://www.medscape.com/viewarticle/547251
    “Patients with chronic pain due to OA of the knee or the hip who were treated with acupuncture in addition to routine care showed significant improvements in symptoms and quality of life compared with patients who received routine care alone,” the authors state.

    Would it be OK with you?

  115. Hilary McCrae says:

    The comments on the side effects of modern drugs are spot on.

    Take a closer look at the Prozac family of “antidepressants”, which are widely prescribed by doctors. They were invented, at least in part, to replace the previous generation of antidepressants whose patents have expired.

    Technically they are called SSRIs, or Selective serotonin reuptake inhibitors. They include:

    * citalopram (Celexa, Cipramil, Dalsan, Recital, Emocal, Sepram, Seropram, Citox)
    * escitalopram (Lexapro, Cipralex, Esertia)
    * fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin, Fluox, Depress, Lovan)
    * fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
    * paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Rexetin, Xetanor, Paroxat)
    * sertraline (Zoloft, Lustral, Serlain)
    * zimelidine (Zelmid, Normud)

    SSRIs act by inhibiting the re-uptake of serotonin, a key brain neurotransmitter.

    ___________

    The list of side effects for these new inventions are long and nasty. Way too many to list here. Wikipedia lists most of them:
    http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Adverse_effects

    SSRIs also have a long list of adverse drug interactions:
    http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Contraindications_and_drug_interaction

    ————-

    Given that Steven Novella has painted alternative medicine as “snake oil, fraud, folk medicine, and quackery”, perhaps it would be intersting to look at a snippet of research into these drugs:

    “A 2004 Food and Drug Administration (FDA) analysis of clinical trials on children with major depressive disorder found statistically significant increases of the risks of “possible suicidal ideation and suicidal behavior” by about 80%, and of agitation and hostility by about 130%. An additional analysis by the FDA also indicated 1.5-fold increase of suicidality in the 18–24 age group.”
    http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Suicidality_and_aggression

    An “antidepressant” that increases agitation and hostility by 130% and with a 1.5-fold increase of suicidality….???

    AND

    “A study in the New England Journal of Medicine on a possible publication bias regarding the efficacy of SSRI medications in the treatment of depression suggests that their effectiveness and risk-benefit ratios may be greatly exaggerated. Of 74 studies registered with the United States FDA, 37 with positive results were published in academic journals, while 22 studies with negative results were not published and 11 with negative results were published in a way that conveyed a positive outcome. Overall, 94% of studies actually published were positive outcomes; when published and unpublished studies were included for analysis, the percentage of positive outcomes was 51%.”
    http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Criticism

    —————————

    So with a positive outcome of 51%, that means there is a negative outcome of 49%.

    Basically any doctor prescribing these drugs is flipping a coin. Even ignoring all the nasty side effects, they only work half the time, and the other half of the time the patient gets worse.

    Clearly, we have an elaborate corporate created, doctor supported, government approved case of “snake oil, fraud, and quackery”.

    Then we have this:

    “Dr. Malcolm Bowers of Yale University states that eight percent of all psychiatric hospital admissions in 1994 were due to SSRI induced psychosis.”
    http://www.drugawareness.org/ssris-under-fire.html

    It goes on and on, and in fact appears to be one of the biggest hoaxes foisted onto the unsuspecting public in a long long time, with doctors on the front line pushing this stuff onto people with legitimate problems.

    —————————–

    It is no wonder that the public seeks out alternative medicine. And it is no wonder that doctors feel increasingly threatened, when this is what they have to offer the public.

    —————————–

    If you have read this far, you might be interested to read the information as it written on the label insert for Prozac in 1988:

    Body as a Whole—Frequent: chills; Infrequent: chills and fever, face edema, intentional overdose, malaise, pelvic pain, suicide attempt: Rare: abdominal syndrome acute, hypothermia: intentional injury, neuroleptic malignant syndrome, photosensitivity reaction.

    Cardiovascular System —Frequent: hemorrhage, hypertension: Infrequent: angina pectoris, arrhythmia, congestive heart failure, hypotension, migraine, myocardial infarct, postural hypotension, syncope, tachycardia, vascular headache: Rare: atrial fibrillation, bradycardia, cerebral embolism, cerebral ischemia, cerebrovascular accident, extrasystoles, heart arrest, heart block, pallor, peripheral vascular disorder, phlebitis, shock, thrombophlebitis, thrombosis, vasospasm, ventricular arrhythmia, ventricular extrasystoles, ventricular fibrillation.

    Digestive System—Frequent: increased appetite, nausea and vomiting: Infrequent: aphthous stomatitis, cholelithiasis, colitis, dysphagia, eructation, esophagitis, gastritis, gastroenteritis, glossitis, gum hemorrhage, hyperchlorhydia, increased salivation, liver function tests abnormal, melena, mouth ulceration, nausea/vomiting/diarrhea, stomach ulcer, stomatitis, thirst: Rare: biliary pain, bloody diarrhea, cholecystitis, duodenal ulcer, enteritis, esophageal ulcer, fecal incontinence, gastrointestinal hemorrhage, hematemesis, hemorrhage of colon, hepatitis, intestinal obstruction, liver fatty deposit, pancreatitis, peptic ulcer, rectal hemorrhage, salivary gland enlargement, stomach ulcer hemorrhage, tongue edema.

    Endocrine System—Infrequent: hypothyroidism: Rare: diabetic acidosis, diabetes mellitus.

    Hemic and Lymphatic system—Infrequent: anemia and ecchytmosis: Rare: blood dyscrasia, hypochromic anemia, leukopenia, lymphedema, lymphocytosis, petechia, purpura, thrombocythemia, thrombocytopenia.

    Metabolic and Nutritional—Frequent: weight gain; Infrequent: dehydration, generalized edema, gout, hypercholesteremia, hyperlipemia, hypokalemia, peripheral edema; Rare: alcohol intolerance, alkaline phosphatase increased, BUN increased, creatine phosphokinase increased, hyperkaltemia, hyperuricemia, hypocalcemia, iron deficiency anemia, SGPT increased.

    Musculoskeletal System—Infrequent: arthritis, bone pain, bursitis, leg cramps, tenosynovitis: Rare: arthrosis, chondrodystrophy, myasthenia, myopathy, myositis, osteomyelitis, osteoporosis, rheumatoid arthritis.

    Nervous System—Frequent: agitation, amnesia, confusion, emotional lability, sleep disorder; Infrequent: abnormal gait; acute brain syndrome, akathisia, apathy, ataxia, buccoglossal syndrome, CNS depression, CNS stimulation, depersonalization, euphoria, hallucinations, hostility, hyperkinesia, hypertonia, hypesthesia, incoordination, libido increased, myoclonus, neuralgia, neuropathy, neurosis, paranoid reaction, personality disorder*, psychosis, vertigo; Rare: abnormal electroencephalogram, antisocial reaction, circumoral paresthesia, coma, delusion, dysarthria, dystonia, extrapyramidal syndrome, foot drop, hyperesthesia, neuritis, paralysis, reflexes decreased, reflexes increased, stupor.

    Respiratory System—Infrequent: asthma, epistaxis, hiccup hyperventilation: Rare: apnea, atelectasis, cough decreased, emphysema, hemoptysis, hypoventilation, hypoxia, larynx edema, lung edema, pneumothorax, stridor.

    Skin and Appendages—Infrequent: acne, alopecia, contact dermatitis, eczema, maculopapular rash, skin discoloration, skin ulcer, vesiculobullous rash; Rare: furunculosis, herpes zoster, hirsutism, petechial rash, psoriasis, purpuric rash, pustular rash, seborrhea.

    Special Senses—Frequent: ear pain, taste perversion, tinnitus; Infrequent: conjunctivitis, dry eyes, hydriasis, photophobia; Rare: blepharitis, deafness, diplopia, exophthalmos, eye homorrhage, glaucoma, hyperacusis, iritis, parosmia, scleritis, strabismus, taste loss, visual field defect.

    Urogenital System–Frequency: urinary frequency; Infrequent: abortion, albuminuria, amenorrhea, anorgasmia, breast enlargement, breast pain, cystitis, dysuria, female lactation, fibrocystic breast, hematuria, leukorrhea, menorrhagia, metorrhagia, nocturia, polyuria, urinary incontinence, urinary retention, urinaryurgency, vaginal hemmorrhagia, Rare: breast engorgement, glycosuria, hypomenorrhea, kidney pain, oliguria, priapism, uterine hemmorrhage, uterine fibroids enlarged.

    The above from: http://www.drugawareness.org/adverse-ssri-reactions.html

  116. Max says:

    Ok Macho Man, where do you draw the line between vitamins and orange juice fortified with vitamin C? Or between medicinal herbs and culinary spices?

  117. Amanita Verna says:

    I think Skeptics had an opportunity to turn the CAM tide back in the late 1980s, but blew it because they failed to adhere to their own principles.

    At that time there was legitimate research being done on several CAM-type topics, including the effects of taking vitamin supplements. Rather than wait for the outcome of this research, outspoken Skeptics were often quick to denounce such notions as quackery. As it turned out, the Skeptics were largely right, even about (most) vitamins. But the strident tone, the name calling, and the eagerness to denounce hypotheses that were still under investigation by legitimate researchers undermined Skeptics’ claim to be a source of objective information.

    In my opinion, this impression was reinforced by articles that appeared in some Skeptics’ publications of the time. All too often, prominent Skeptics were allowed to write about their own exploits in glowing terms, with no apparent attempt to ensure accuracy or fairness. Articles didn’t necessarily offer evidence to support statements of “fact” and “facts” were often mixed up with opinion, with no attempt made to distinguish one from the other. “Logical” arguments sometimes were based on obvious logical fallacies. All in all, the impression created was that Skeptics are not interested in presenting information objectively.

    At least, this is how it seemed to me at the time. If I’m right, tragically Skepticism threw away an opportunity to seize the high ground. We could have demonstrated that we are interested in the pursuit of truth no matter where it leads. And some Skeptics tried to do exactly that! But their efforts were drowned out by more strident, angry voices within the movement, and Skepticism lost credibility with the public. As a result, as the author of this post has noted, the high ground was ceded to the proponents of CAM. Through clever marketing, THEY became the public representatives of open-minded inquiry, a position they hold to this day.

    I considered myself a Skeptic 20 years ago (and still do), but I ended up disassociating myself from Skepticism as a movement because I concluded that Skeptics were not applying the same standards of evidence and objectivity to their own pronouncements that they were applying to others. I’m not a fan of irrationalism, but hypocrisy bothers me even more.

    I apologize if this seems harsh, but I am simply trying to record why someone who was biased toward Skepticism at that time essentially turned away from it. I’ve started reading about Skepticism again because, a., a lot of time has passed and I’m hoping the movement has matured and, b., I am very concerned about the spread of CAM and of scientific illiteracy, both of which seem to be growing exponentially, at least among the people I meet.

    I do hope that Skepticism has matured into a movement that earn credibility with the public. But it’s not going to be easy. I believe that it would take, among other things, a willingness for Skeptics to criticize their own if self-designated Skeptics make statements that cannot be supported by evidence. It would also take an effort to abide by commonly accepted standards for what constitutes civil discourse. It means adhering to the highest standards of evidence and logic. If we do that, and do it consistently, we might have a chance to win back the allegiance of at least some of those who have gone over to CAM. If we don’t, it’s time for us all to become practicing “shruggies”.

  118. Justin says:

    This was a great article and I thank you for highlighting this problem in our society.

    However I felt that you left out one of the major reasons that “alternative medicine” has been gaining ground in the United States. It is those headline articles that come out every so often describing a specific drug as dangerous or ineffective. For those who aren’t doctors, it can seem like these drugs only do more harm than good. Also the side effect of some of these potent drugs can make those suffering more vulnerable to advertisements of no side effect alternative medicine.

  119. David Paterson says:

    Steven Novella and the Skeptics have won!

    Perhaps they just don’t yet realize it yet. Or they don’t like the implications over issues they personally support

    By promoting skepticism, all issues come under scrutiny, not just the obviously wacky ones. Doctors themselves are the easiest of targets. Studies by prominent people in prominent journals document that they kill close to a quarter million people a year.

    Of course doctors also help people, and in many ways the whole medical system is overburdened, with doctors on the front line. However, they are also perceived as front men for the big drug cartels, pushing a pill on most patients for every ailment from depression from a relationship breakup to “restless leg syndrome” that is so well documented in drug adds on TV.

    And the latest depression medications appear to be quite deadly indeed.

    I applaud Mr Novella and the other creators of this website for promoting healthy skepticism. Along with the vast internet access to information untainted in many cases by large financial interests, the public, perhaps for the first time in history, is in a position to make informed decisions about a large number of issues that were previously the exclusive domain of professionals and large financial interests.

    I don’t think Mr Novella likes where this going in terms of the battle between doctors and alternative medicine. Nonetheless, I applaud him for his efforts

  120. Barb RN,BC says:

    Sigh- I am an RN who is a great advocate of Skepticism and I shudder when I read passages like this-

    “I’ve also noticed that there’s a “fifth column” within medicine itself. RNs, midwives, and other non-MD “health professionals” seem to have a weak spot for quackery. It was nurses who fell for and promoted the whole “therapeutic touch” nonsense. And as a personal note, there was a pretty obvious anti-physician tone to a lot of the presentations in the childbirth class my wife and I took back in the 1990s — a strong strain of “what’s natural is better.” The high point was a 15-minute video of Peruvian women delivering babies in the squatting position, accompanied by Andean flute music.

    Comment by Cambias — December 15, 2008 @ 8:19 am ”

    I can’t deny that I have noted a large number of nurses in my hospital who practiced or promoted Therapeutic Touch, Reiki and other CAM. Indeed they was promoted by our hospital a few years ago but appear to have fallen by the wayside more recently. We still have a large percentage of staff that believe in and promote herbal medicine, and cold remedies invented by second grade school teachers ??!! I have offered my opinion and my coworkers know where I stand but am always outnumbered so I say less lest I be thought of as a “Quack” Their arguments being- “herbs have been used in Europe and China for hundreds of years!” My thought being that they didn’t have anything else – it was a “cure em or kill em” and who was keeping records or doing resaerch back then anyway? I don’t disagree that there might be some CAM that is helpful but advocate caution and research. As for Theraputic Touch- I believe that was handed down to nurses a few years ago when Nursing Educators started including that in classes that nurses could take for credit and Nursing Administators were promoting it and everyone was jumping on the CAM bandwagon. (Except most of our Doctors ,bless them ) Even today you will find full page ads in newspapers advertising a Major Hospials’ Health Fair with classes (for a fee) for Massage and Reika,Aromotherapy and Meditation listed right along side classes for “Diabetics,monitoring your Blood Sugar” and “Controlling Hypertension” Makes me want to pull my hair out. How can the public believe Health Care about from health professionals on Diabetes and Heart Disease et al-when we are also promoting “woo woo” On a further note on TT see this-

    “Therapeutic Touch is also heavily funded. In 1992, $200,000 was granted to the D’Youville Nursing Center in Buffalo, New York, by the Division of Nursing, US Department of Health and Human Services, to treat patients and train students in the technique. In 1994, a Department of Defense grant of $355,000 was given to a team of nurses at the University of Alabama, Birmingham, to study the effects of Therapeutic Touch on burn patients.

    In the practice of Therapeutic Touch, no actual physical touch occurs. Therapeutic Touch is based on the assumption that the physical body is surrounded by an aura (energy not visible to normal vision) and is penetrated and kept alive by a universal energy called prana (a Sanskrit word meaning vital force) that flows through the body and is transformed by chakras or nonphysical vortices. Energy imbalance supposedly results in illness, which can be intuitively assessed in a form of psychic diagnosis, and then treated by means of the hands (The Personal Aura, pp. 32-55).”

    Actually I left my postion a few months ago as I was moving to another area and as I was leaving a Nursing Tech (Nursing Aide) was showing another Tech a chart on Refexology which she pracised outside of the hospital. “Why” she moaned to me-”Don’t Doctors give this a chance?” I just prayed she didn’t start going around telling the patients about it. Years ago I walked in on a RN giving a group (this is a mental health unit) on energy fields and holding her hands over a patients body to demonsrate. This was a group on Coping Skills ?! Please please keep up the good work on Skepicblog. Although I was at another Skepticsite today where an article was virually dismissing all psychiatric illnesses and meds and promoting Behavioral Analysis (sigh)

    Addendum- In my 28 years of Psych Nursing I have seen some pretty strange/cruel behavior from a *few* Drs. as well. Would you believe I wittnessed a Dr. proceed to tell a pt. he “knew things about her such as she owned a small dog”,etc. He was holing her chart in his hand with the chart closed and his hand on top of it telling her “he was psychic” ha! Another Dr. used to steal the patients cigarettes from the drawer at the nursing station, give orders in foreign languages at night or garble when called or order meds that the nurses would refuse to give as we feared it would kill the pt. Then there was the Dr. who gave every new admit he had a spinal tap then made them walk to their room and refused to let the nurses take them to their room on a cart-though wee begged. They always had a massive headace that lasted 5 days. On the fifth day when they reported they “felt better” he used this as grounds to discharge them! All 3 of these docs were ran out on a rail after a period of time and evidence. We had some truely great great docs as well. My point being-there are incredibly bad examples in every profession. In some of these cases almost every single one of the nurses was working hard helping to supply evidence to give these particular Dr’s the boot and refusing to carry out orders that would harm pts-as is our pledge. Whew! There- I feel better.

  121. John says:

    Steven Novella=Stupid Fool

  122. Jeb Nobe says:

    “Being both a skeptic and a physician…” Says a lot doesn’t it… This is just a big med / big pharma site for ambiguously deceptive charlatan shills that attempt to dispense disinformation to lure the populace into the clutches of the profiteering mainstream sick care industrial complex — not that there is anything complex about, only simple drugged-up fools fall for your lies. You all must be on antidepressants and sleeping pills to be able to cope with devastation that you knowingly inflict on the dumbed-down morons that buy into your disgusting bulloney.

  123. Steven says:

    wow. This thread is almost like a right/left political blog.
    Lot of issues discussed here but I like to keep it simple and concise.
    I’d like to address this statement:
    “We are almost at the point of being routed, with the defenders of scientific medicine being relegated to the role of insurgency. How did this happen?”
    As the voice of the generic patient to the professional here I would say:
    Thanks! Science and innovation has saved my life AND gave me a hip that works pain free. I think that’s pretty great.
    Not so great was that doctors (both good and bad) don’t have a method to treat me as a whole person instead of a problem to be solved.
    Quacks appeal to me as either a quick fix or if I feel they are actually SEEING me and CARE about my situation honestly or more likely not. But if I’m ill and desperate don’t demonize me for wanting and/or believing in crazy sounding options.
    If my science based Dr. can’t diagnose me or relieve chronic pain why wouldn’t I try anything? My quality of life is at stake.
    I won’t bash the bad doctors I’ve had I’ll just say there is a disconnect in treating mental issues in relation to physical ailments.
    We want to feel better you guys want to feel good about what you do.
    I don’t know how we can do that but unless we can do something about it there will be a market for cures that are suspect.

  124. Jason says:

    Maybe Medicine has done just as much false advertising with its drugs and research and that has caused a shift towards more natural health instead of being pumped full of poisons.