Seven or eight years ago, the news broke that Steve Jobs had been diagnosed with pancreatic cancer, but considering it a private matter, he delayed in informing Apple’s board, and Apple’s board delayed in informing the shareholders. So what. The only delay that really mattered was that Steve, it turned out, had been treating his pancreatic cancer with a special diet [UPDATE] prescribed by the alternative medicine promoter Dr. Dean Ornish.

Most pancreatic cancers are aggressive and always terminal, but Steve was lucky (if you can call it that) and had a rare form called an islet cell neuroendocrine tumor, which is actually quite treatable with excellent survival rates — if caught soon enough. The median survival is about a decade, but it depends on how soon it’s removed surgically. Steve caught his very early, and should have expected to survive much longer than a decade. Unfortunately Steve relied on a diet instead of early surgery. There is no evidence that diet has any effect on islet cell carcinoma. As he dieted for nine months, the tumor progressed, and took him from the high end to the low end of the survival rate.

Why did he do this? Well, outsiders like us can’t know; but many who avoid medical treatment in favor of unproven alternatives do so because they’ve been given bad information, without the tools or expertise to discriminate good from bad. Steve was exposed to such bad information, as are we all.

Eventually it became clear to all involved that his alternative therapy wasn’t working, and from then on, by all accounts, Steve aggressively threw money at the best that medical science could offer. But it was too late. He had a Whipple procedure. He had a liver transplant. And then he died, all too young.

My whole family loves Apple devices. Steve made our lives better, and I think I can say that pragmatically and without any Apple heroin in my veins. Not only that, he created my profession.

His lifelong friend Bill Gates tweeted:

For those of us lucky enough to get to work with Steve, it’s been an insanely great honor. I will miss Steve immensely. b-gat.es/qHXDsU

I saw another tweet today from @DamonLindelof that I thought was beautifully worded:

Steve Jobs. On behalf of every dreamer sitting in his or her garage who is crazy enough to try to change the world, you will be missed.

We can’t say for sure that Steve would still be alive and making lives better were it not for the alternative therapy, but the statistics suggest it very strongly. If you insist on unproven therapies, fine; but also try the proven ones while you’re at it. Nobody likes to either write or read a post such as this one.

For a more expert response to this post, see Dr. David Gorski’s critique at Science Based Medicine.

For many years now there has been considerable debate between so-called complementary and alternative medicine (CAM) and mainstream science-based medicine. In reality there is no debate because there is only science-based medicine and everything else that has yet to be tested. Most of CAM falls into this latter category. This does not automatically mean that all CAM claims are false; only that most of them have yet to be tested through the rigorous methods of science, which begins with the null hypothesis that holds that the hypothesis under investigation is not true (null) until proven otherwise. A null hypothesis states that X does not cause Y. If you think X does cause Y then the burden of proof is on you to provide convincing experimental data to reject the null hypothesis.

The statistical standards of proof needed to reject the null hypothesis are substantial. Ideally, in a controlled experiment, we would like to be at least 95–99 percent confident that the results were not due to chance before we offer our provisional assent that the effect may be real. Everyone is familiar with the process already through news stories about the FDA approving a new drug after extensive clinical trials. The trials to which they refer involve sophisticated methods to test the claim that Drug X (say a statin drug) improves outcomes in Disease Y (say cholesterol-related atherosclerosis). The null hypothesis states that statins do not lower cholesterol and thus have no effect on atherosclerosis. Rejecting the null hypothesis means that there was a statistically significant difference between the experimental group receiving the statins and the control group that did not.

In most cases CAM hypotheses do not pass these simple criteria. They have either failed to reject the null hypothesis, or they haven’t even been rigorously tested to know whether or not they could reject the null hypothesis.

What, then, is the pull of CAM for so many people? According to a 2002 survey of U.S. adults conducted by the National Center for Health Statistics and the National Center for Complementary and Alternative Medicine: 74.6% had used some form of complementary and alternative medicine, 14.8% “sought care from a licensed or certified” practitioner, suggesting that “most individuals who use CAM self-prescribe and/or self- medicate,”¹ and that the most common CAM therapies used were prayer (45.2%), herbalism (18.9%), breathing methods (11.6%), meditation (7.6%), chiropractic (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%), and visualization (2.1%).²

A 2004 survey of 1,400 U.S. hospitals found that over 25% offered such alternative and complementary therapies as acupuncture, homeopathy, and massage therapy. According to researchers Sita Ananth of Health Forum, an affiliate of the American Hospital Association, and William Martin, PsyD, of the College of Commerce at DePaul University in Chicago, in a news release: “More and more, patients are requesting care beyond what most consider to be traditional health services. And hospitals are responding to the needs of the communities they serve by offering these therapies.”³

Herein lies one answer to understanding why CAM sells. There is a market demand for it. Why? One possibility is that people are turning to alternative medicine because their needs are not being met by traditional medicine. As the late medical historian Roy Porter was fond of pointing out, before the 20th century this certainly was the case.⁴ Medical historians, in fact, are in agreement that until well into the 20th century it was safer not to go to a doctor, thus leading to the success of such nonsense as homeopathy—a totally worthless nostrum that did no harm, thus allowing the body to heal itself. Since humans are pattern-seeking animals we credit as the vector of healing whatever it was we did just before getting well. This is also known as superstition, or magical thinking.

Another explanation may be found in examining what CAMers are offering that mainstream physicians are not: TLC. By this I do not just mean a hand squeeze or a hug, but an open and honest relationship with patients and their families that provides a realistic assessment of the medical condition and prospects. People are going alternative because in too many instances physicians have become highly skilled technicians—cogs in the cold machinery and massive bureaucracy of modern HMO medicine.

I witnessed the effect directly over the course of a decade during my mother’s recurring and malignant meningioma brain tumors. She finally succumbed, but in the process I gained a deeper understanding of why people turn to alternative medicine. Don’t get me wrong—my mother’s doctors were brilliant, her care the very best available, and we have no regrets about what might have been. And that’s the point. Even under such ideal conditions I found the whole experience frustrating and unfulfilling: it was nearly impossible to get honest and accurate information about my mom’s condition; neither my father nor I could get doctors to return our calls; misinformation and (usually) no information was the norm; and despite my best efforts, the relationship with her physicians (with one exception—her oncologist whom I befriended), could not have been more detached.

I found it rather telling, for example, that when I identified myself as “Dr. Shermer” I got faster results at the hospital than when I was merely “Mr. Shermer” (a lie of omission, not commission, since I do have a Ph.D.), but I still found it difficult to get calls returned. Even worse, when my mom’s oncologist (one of the country’s best-known and well-respected in his field) called her surgeons, he too heard too many dial tones. If physicians show such a remarkable lack of professional courtesy with their own colleagues, what are the rest of us to expect?

More than anything patients want information. They want to know what is really going on. They don’t want jargon. They don’t want false hope or unnecessary pessimism. Studies show that patients do better when they know in detail all the steps they will have to take in their recovery process—probably because it allows them to anticipate, plan, and pace themselves. Knowledge is power, and physicians are modern-day shamans. Patients want the power that knowledge brings, and that empowerment cannot be given in the 8.5 minutes the average doctor spends per patient per visit. Patients want a relationship with their primary caretaker that allows them to ask the important questions and expect honest answers.

Physicians tend to have monologues when they should be having dialogues. The reasoning process of diagnosis, prognosis, and treatment goes on inside their heads, and what comes out is a glossed telegram of truncated lingo. The physician-patient connection is a one-way street, an authority-flunky relationship top heavy in arrogance and off-putting to anyone with a modicum of self-esteem and social awareness. If I could reduce all this into a single request, it is this: Talk to patients as if they are thoughtful, intelligent people capable of understanding and deeply curious about their condition.

So…we should turn to CAM then, right? Wrong. An even deeper problem is that CAMers lack much medical knowledge and (especially) scientific reasoning, making them dangerous. The 2002 study referenced above found that 54.9% used CAM in conjunction with conventional medicine but did not always tell their primary care physician, thus leading to possibly deadly mixtures of drugs and herbs.¹ It is not a matter of everything to gain and nothing to lose by going CAM (even if your doc offers no hope), because quack medicines cost money, cause harm, and, most importantly, take away valuable time that could and should be spent with loved ones in this already too-short of a stay we have with each other.

Besides TLC, the cognitive pull of CAM is anecdotal thinking. Since humans are pattern-seeking animals, we credit whatever we did just before getting well as the vector of healing. If A appears to be connected to B, we assume that it is unless proven otherwise. This is the very antithesis of the science-based system of the null hypothesis. The recent medical controversy over whether vaccinations cause autism reveals the power of anecdotal thinking. On the one side are scientists who have been unable to find any causal link between the symptoms of autism and the vaccine preservative thimerosal, which breaks down into ethylmercury, the culprit du jour for autism’s cause. On the other side are parents who noticed that shortly after having their children vaccinated autistic symptoms began to appear. These anecdotal associations are so powerful that it causes people to ignore contrary evidence: ethylmercury is expelled from the body quickly (unlike its chemical cousin methylmercury) and therefore cannot accumulate in the brain long enough to cause damage, and rates of autism diagnoses did not decline in children born after thimerosal was removed from vaccines.

The anecdotal thinking upon which CAMers rely—even if unconsciously and with the best of intentions—can be particularly dangerous in the hands of those whose intentions are less than ethical. Thus it is that any medical huckster promising that A will cure B has only to advertise a handful of successful anecdotes in the form of testimonials, and the human brain will do the rest. By way of example from the annals of medical quackery, witness the case of John R. Brinkley, one of the greatest medical quacks of the first half of the twentieth century, and his nemesis Morris Fishbein, the quackbusting editor of the Journal of the American Medical Association. Their decades-long struggle that criss-crossed the American heartland throughout the 1920s and 1930s, represents this tension between folk and scientific medicine, well summarized in Pope Brock’s 2008 book Charlatan: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam.⁵

What Brinkley was selling was what all men want—sexual vitality—and he developed a surgical technique that offered the type of firm results that his male clientele so desperately sought: goat testis sewn right into the patient’s scrotum, which he likened to “embedding a marble in an apple.” Come one, come all. And they did, to the tune of $750 per surgery, advertised widely in newspapers (an AMA study revealed that over half of all newspaper advertising at the time was for patent medicines) and the new fangled technology—radio—which Brinkley took to like an evangelist to television. The ads featured testimonials from happy men who proclaimed their restored manhood, and these anecdotes made Brinkley a rich man as it drove customers to his practice. But as his business grew he got careless, performing operations both before and after happy hour, and fobbing off work to assistants whose medical credentials were even shadier than his own (Brinkley graduated from the unaccredited and improbably named Eclectic Medical University of Kansas City). The result was dozens of dead patients.⁵

This got the attention of the ambitious Morris Fishbein, whose career coincided with the rise of the AMA’s attempt to rein in flimflammery through accrediting medical colleges and licensing practitioners. Fishbein made his public mark in 1923 when the Chicago Daily News sent him to investigate the “Hot Girl of Escanaba” (Michigan), a woman who suffered from a temperature of 115 degrees for two weeks. Fishbein exposed her as a “hysterical malingerer” when he discovered that a flesh colored hot water bottle was employed to elevate rectal thermometer readings. For the next two decades Fishbein pursued the country’s “most daring and dangerous” swindler, as he called Brinkley, until he finally brought him down in a decisive courtroom confrontation.⁵

Fishbein’s promotion of science-based medicine was heroic in his day, but medical flapdoodle flourishes today on the Internet so every medical association and journal needs a quackbusting Fishbein on its staff, for without such eternal vigilance folk medicine will trump scientific medicine in the minds of patients. And thus it is that skepticism should be our default rule of thumb when it comes to CAM claims.

Chilkov tells her readers how Hollie was diagnosed with breast cancer while pregnant at age 27. After telling us over and over again how intelligent, educated, and well-informed Hollie and her husband are, we are informed that Hollie decided to treat her breast cancer entirely with alternative cancer treatments. And now, 8 years later, she is perfectly healthy and has two wonderful children.

First, let me say that I am very happy for Hollie and Patrick and I sincerely wish that Hollie has nothing but the best of health. This story is actually somewhat personal for me as my wife was diagnosed with breast cancer earlier this year, and now she is doing very well after standard treatment. So I understand, not just as a physician but as a husband, how difficult it is to face this diagnosis and the treatment options.

But the purpose of Hollie Quinn’s book, and Chilkov’s promotion of it, is to promote a decision to forgo science-based cancer treatment in favor of a dangerous fantasy. Chilkov’s article is dripping throughout with desperation for acceptance and scientific legitimacy – but in my opinion it is all a con.

While reading the article my first question was this – did Hollie undergo any surgery for her breast cancer? This is a critical question to evaluating her story – and Chilkov does not inform her readers either way. That information is conspicuously absent. But it only took me a moment with Google to find the answer – she had stage 2 breast cancer and underwent lumpectomy and sentinel node biopsy. Curious that Chilkov did not think it necessary to mention that, especially since that procedure alone is sufficient in about 70% of cases (depending on stage, type, etc.) to cure the cancer.

So Hollie did not forgo standard therapy for CAM therapy. She underwent standard surgical treatment, which is curative in most cases, and then did not undergo adjunctive therapy which is meant to decrease the risk of recurrence.

So all we really have in Hollie’s story is yet another patient who underwent surgical treatment of breast cancer and is in the 70% who will not have a recurrence. There is no reason to suspect that the alternative treatments she subjected herself to had any effect – but she gives it full credit.

Chilkov does make this comment:

“Therefore, because this book is the story of just one woman, no generalizations or assumptions can be made about other women facing breast cancer.”

I wonder if the Huff Po lawyers had anything to do with this disclaimer, or if adding such disclaimers is just a reflex for Chilkov now. This is almost a Simpsonsesque disclaimer – “don’t believe any of the things I just told you.” Chilkov spends many paragraphs fawning over Hollie Quinn’s story, telling us that it has profound implications for the treatment of cancer, but then – Oh, we cannot generalize.

The disclaimer is truer than she likely knows. Not only is it anecdotal, and further worthless as evidence of anything since Hollie did, in fact, undergo surgical treatment, but we must also consider that all the women who forgo proven therapy for alluring nonsense and die horribly are not around to write books about their experiences. There is also a huge psychological factor at work. People feel the need to justify their decisions, especially controversial ones. The very title of the book: “You Did What?” is screaming “risk justification.”

At the same time people will tend to hide their bad decisions. Con artists largely depend upon the fact that those conned will be so embarrassed by their perceived stupidity that they will just crawl under a rock and not go after the con artist. (This is not to say they are truly stupid, just that they will feel that way.)

So we have a situation in which those who make the controversial decision to choose CAM and do well are motivated to shout it from the rooftops, while those who do not do well are either dead or are too ashamed of their decision to make it public.

That is precisely why anecdotal stories, even if written in book length and promoted in an anti-scientific rag like the Huff Po, are worse than worthless. They are biased and misleading.

Chilkov also seems intent on destroying her readers’ irony meters – saying over and over that alternative cancer treatments are rational, evidence-based, and scientific. However, the only feature that defines a treatment as alternative is that it is not evidence-based. Science-based medicine will use rational evidence-based treatments, no matter what they are. Everything else is “alternative”.

She specifically mentions acupuncture as an alternative cancer treatment. She does not reference any science to show that acupuncture is useful for cancer – that may have something to do with the fact that there is no evidence (nor any plausibility) for any beneficial effect from acupuncture on breast cancer.

Here is another example of the propaganda worth dissecting:

Because our understanding of cancer genetics is advancing, Oncologists are beginning to acknowledge that Cancer Care can now become more individualized and that lifestyle and diet, nutrients and botanicals and acupuncture have a place in a complete treatment approach for cancer patients.

Yes – our understanding of cancer genetics is advancing due to science-based medicine, not any alternative superstition. Notice how she says, “Oncologists are beginning to acknowledge.” She makes it sound almost reluctant, as if they are being dragged into the light. Science-based oncologists are doing the research and following the results. As our knowledge base increases, our ability to individualize treatment is increasing. This is science-based medicine, but CAM proponents like Chilkov are frequently trying to take credit for it.

Then, of course, she equates science-based “individualized” care with diet and nutrition – these components are perhaps the least individualized. Good nutrition is mostly standardized, not individualized. The only individualization would come through blood testing for specific deficiencies, or those who may benefit from weight loss or a diabetic diet – all standard components of science-based medicine.

Then she shifts seamlessly into “botanicals and acupuncture” – in that one sentence she is demonstrating the CAM strategy of blurring the lines between science and nonsense, starting with proven therapies, then sliding into those areas that are science-based but sold as alternative (diet and nutrition), and then finally into hard core superstition like acupuncture – as if it’s all part of the same spectrum.

Conclusion

Chilkov’s article is a masterwork of pro CAM propaganda, but scratching beneath the surface reveals her intellectual shenanigans – most notably her omission of the fact that Hollie Quinn underwent surgery to treat her cancer.

More and more it is becoming apparent that reading the Huffington Post can be hazardous to your health.

Skeptoid has a long-standing tradition of making every 50th episode a lavish musical production. This tradition began last year at episode 150, which established the lavish musical employing a host of talented professionals; and crumbled all to hell this week at episode 200, when I applied my own unassisted imbecility toward the construction of a musical piece. The result is a parody of marketing efforts from purveyors of pseudoscience in the form of a song entitled Buy It!

–>> Click here to listen now (3 minutes) <<–

Being an experienced non-musician, and quite impressively talented on no musical instruments, I elected to make this piece an a cappella. This allowed me to leverage my deep gifts for not singing. Critics have already praised the performance as one of the great voices made for blogging.

My background in not composing music helped to cunningly construct chord progressions as provocative and complex as those from The Wiggles.

And so armed with the needed talents, I proceeded. Among those talents are not the abilities to count beats, keep rhythm, or hold a note, so I had to cheat a bit. Contrary to suppositions I’ve already heard, no sampling or pitch correction was used in Buy It! But there is a lot of looping. This meant I had to record each loop, usually 4 measures long, in the correct pitch and timing. So I played each vocal part separately on a keyboard into Garageband, each on its own track. I listened to each track solo, as a guide, as I sang each line. There are thirteen separate vocal tracks, plus ten handclap tracks and one finger snap track. Put them all together, mute out the keyboard guide tracks, and presto, we have a multitrack vocal performance that’s actually in sync and reasonably close to being on key. Pretty good, I thought, for someone who has no clue and little hope of ever obtaining a clue.

Yes, I know there is some clipping in a couple parts. The clipping provoked much colorful language. It’s not in the original recordings, so perhaps some future engineering will get rid of it.

The crowd-shouted “Buy it!” line caused a lot of headaches. Richard Saunders gathered a crew together in Australia and did some takes. I thought it would be fun to make this a bi-continental piece, but unfortunately I ended up being unable to use that clip; it just didn’t sound right when I mixed it in. I also gathered my family around the mic and we all shouted it too, but it came out unintelligible. So I ended up reverting to my original concept of a Village People style chorus: a combination of basses and falsettos. I doubt any listeners were able to divine that inspiration, but that’s what I was going for. Regardless, it was the only one of my three options that worked.

Anyway, I hope you enjoy it. It was fun to make, and I think its message is a worthy addition to the Skeptoid body of work.

http://www.accessdata.fda.gov/scripts/email/oc/buyonline/buyonlineform.cfm

Selling crap online, and claiming that it has medical value, is illegal. This is just and proper, because it’s wrong to con sick people out of money. Yet it’s so profitable to do so that it remains a flourishing business. And those sellers who may genuinely believe their product helps people also deserve to be turned in and prosecuted. They’ve heard the research already, they’ve just chosen to ignore it. Well, they may find it a little harder to ignore a warning letter from the Food & Drug Administration.

This online form can be filled out to report online sales of fraudulent products that make specific health claims. If you claim that your product diagnoses, treats, prevents, or cures any disease, then your product is classified as a drug; and it’s illegal to sell unapproved drugs in the United States. Therefore, any web site that sells any form of alternative medicine, or  non-FDA approved gadgets or contraptions, and makeS specific medical claims about it, are breaking the law, and are fair game for this form to be used.

The form is short. Just be sure to state your complaint specifically and succinctly. An unapproved product must be offered for sale over the Internet, and a specific health claim must be made about it.

Bookmark it. Use it. Protect your neighbors from con artists and vultures.

From: The Real Food Channel <newsletter@therealfoodchannel.com>
Subject: The shocking truth about dairy
Date: Thursday, October 1, 2009, 11:59 AM

John McDougall MD routinely reverses and cures serious diseases like diabetes and heart disease simply by helping his patients change their diets.

Well there’s certainly no news in the fact that poor dietary habits can contribute to obesity, diabetes, and some forms of heart disease. No doctor would dispute basic health information like that. But “routinely reverses and cures serious diseases”? Red flags begin waving.

In his experience, the most important thing to remove from your diet is dairy foods.

Really? And is there any correlation between dairy and heart disease? Dairy and diabetes? Sounds like this author paints Dr. McDougall as being a little blinded by his own luminance.

I realize that a lot of people are not going to want to hear this, but the science is overwhelming.

Got to love “A lot of people are not going to want to hear this.” He’s being suppressed for bucking the official establishment. Too bad this kind of rhetoric is so effective on unsuspecting readers.

And the science is overwhelming! Well, if this guy says so, it must be true. But I wonder how he has come to this conclusion, since McDougall has not managed to convince any meaningful percentage of the medical community that outrageous claims are anything other than quackery. This total failure constitutes “overwhelming science”?

The scary thing is that advertising dollars from the milk and cheese industry keeps this simple information from getting to the public.

Ahhh, so it’s all a conspiracy. That puts it into a whole new light of plausibility. I know that my doctor receives his share of Big Milk dollars every month, and he’s always telling my kids and I to drink it. The bastard.

If you want a simple thing you can do to significantly improve your health, take the time to watch this important video.
Details:
http://www.therealfoodchannel.com/page/29.html

Ken McCartthy
Founder, The Real Food Network

P.S. Please share Real Food Channel videos with your friends, family and colleagues. That’s how we grow. Thanks.

Amacord, Inc.
14 North Road,
Tivoli, NY 12583,  USA

I wouldn’t post an email like this unless it was obviously bunk. I searched the literature, and found that the preponderance of research supports…ummm… exactly the opposite of what McCartthy is attributing to Dr. McDougall. Here’s from a 2005 study published in the Archives of Internal Medicine:

Each serving-per-day increase in total dairy intake was associated with a 9% lower risk for type 2 diabetes… CONCLUSION: Dietary patterns characterized by higher dairy intake, especially low-fat dairy intake, may lower the risk of type 2 diabetes in men.

McCartthy’s “overwhelming science” – 0; real science – 1. I could go on, but there are useful things to do in life.

So what is this “The Real Food Channel” anyway? No, it’s not a food channel, surprisingly enough. It’s a nearly blank web site slathered in advertising links, and its only content is videos promoting quackery with titles such as Make Yourself Heart Attack Proof. As far as I can tell, these videos appear to all be pirated from other sources, not created by McCartthy himself. Click any of the links, and you’re sent off to some site selling quack health products: Supplements, books, superfruits, you name it; all promising to endow you with some kind of magical super-health. In short, it’s an affiliate marketing site, making money off of tricking you into buying worthless woo. Always be skeptical…

“For 23 years, my show has presented thousands of topics that reflect the human experience, including doctors’ medical advice and personal health stories that have prompted conversations between our audience members and their health care providers. I trust the viewers, and I know that they are smart and discerning enough to seek out medical opinions to determine what may be best for them.”

Sorry, Oprah – wrong. She may indeed trust her viewers to be smart but her celebrity status, amplified by her frequent celebrity guests,  blinds many of them from making rational decisions about their health and well-being.  Our celebrity-obsessed culture influences many to accept all the medical quackery she promotes on her show, aided and abetted by way-past-their-prime celebrities and New Age cultist physicians. From ex-Playboy Centerfold Jenny McCarthy and her anti-vaccination campaign to 1970′s blonde bombshell Suzanne Somer’s promotion of “bioidenticals hormone” therapy and the regular appearance of “quantum fantasist” Deepak Chopra, Oprah has done more to misinform our fellow citizens about science, damage respect for science and science-based knowledge than all the Young Earth Creationist propagandists combined. Does Oprah not know how much damage she can do and hurt she can bring when she let someone so completely ignorant of chemistry and physiology as Suzanne Somers to come on to her show to promote her nonsense and exploit the scientific ignorance of her viewers. Ms Somers claims that in addition to taking over 60 vitamin pills a day she also injects her vagina herself with “natural” estrogen synthesized from plants. Ms Somers harped on the claim that estrogen synthesized from plants is natural (because it’s sold by “alternative” medicine websites?) but estrogen prescribed by board certified M.D.’s are not (because it’s sold by Big-Pharma?) So, female readers, – please do not inject anything into your vagina unless it’s done by a board certified gynecologist! And more importantly, please, please do not take medical advice about your reproductive system from anyone (including Oprah) who cannot even use the correct terminology to describe one of your most important reproductive organs. (It’s called the vagina – it’s not a bad word and it’s not V-jayjay!  Pul-leeeez!  Adult women sitting around giggling about their reproductive organs using made-up baby-talk or middle-school slang is not funny and promotes and celebrates ignorance.)

After Newsweek’s take down of the woo-mistress, who did you expect would come to her defense? No other lesser woo-miester than Dr Deepak Chopra who is a frequent guest on Oprah’s show. In a Huffingpost column, Dr. Chopra wrote in her defense: “And the fact that she has celebrity guests who have causes and crusades in the area of health, such as Jenny McCarthy or Suzanne Somers, is not the same as Oprah herself endorsing what they say.” No sh*t Sherlock! What kind of logic is that? For an audience of science-phobic and scientifically ignorant but celebrity-obsessed TV addicts who don’t know their vagina from their vulva; who think that “chi” is real; and who take Jenny McCarthy’s “keep toxins away from my child, don’t vaccinate” mantra to heart, (but ignore the fact that she injects herself at frequent intervals with botulism toxin!) having celebrity guests on her show to push ignorant superstitious nonsense is dangerous and detrimental to the general health and well-being of our population. Is it a wonder at all that areas with the lowest childhood vaccination rates are in suburbs where upper middle-class stay-at-home moms have the luxury to spend time watching the Oprah Show and have their minds poisoned by Ms McCarthy’s anti-vaccination message? (The most recent California Department of Health statistics listed Marin County – one of the richest counties in the country – with kindergartners non-medical immunization exemption rate at 6.3% while neighboring Solano county with blue-collar towns like Vallejo has an exemption rate of only 0.9%)

While the likes of Suzanne Somers and Jenny McCarthy, due to their lack of formal science education may be just ignorant blabber mouths, Dr. Deepak Chopra does not have that excuse. He has a real medical degree from a highly respectable university but yet he chose to ignore everything he learned in medical school and instead makes his millions giving medical advice conspicuous by the absence of science. Dr Chopra endorses, promotes and defends every form of alternative medicine as long as it is based on some ancient Eastern-Mystical tradition. (When he writes or talks, he sprinkles words like “quantum” and “energy field” liberally in meaningless context just to add an air of scientific authority.)  Consider this defense of acupuncture where Dr. Chopra writes in Huffington Post citing this latest study of acupuncture as “evidence” that the modality works: “In Seattle a recent study of 638 patients with chronic lower back pain were given either some sort of acupuncture or standard treatment with anti-inflammatory drugs and massage. On average, the acupuncture patients received twice as much benefit as those on standard treatment. The kicker is that some of the patients received fake acupuncture — they were pricked superficially with toothpicks — and received the same relief.” No, Deepak, are you really so dense as to not understand what the study showed about acupuncture? The study clearly demonstrated that “fake” or “sham” acupuncture, done with toothpicks or needles poked randomly without regards to locations of the mystical “chi” meridian lines works just as well as “real” acupuncture. Goofy charade with sharp objects (toothpicks?) poked randomly at body parts is not acupuncture by even the most lax definition of what acupuncture is and if it works just as well as acupuncture with real needles inserted at proper “chi” meridian line locations, can we not learn something – that perhaps “real” and “sham” acupuncture are the same thing? If there is no difference between “real” acupuncture and sham/fake acupuncture, where is the evidence that there is anything to support acupuncture other than the fact that it’s just a placebo? The awful truth about this acupuncture study is that it’s either the first nor the only, but one of many such studies done, which confirmed the same placebo effect outcome. There is no shame, and it’s not a crime to be ignorant, but it is stupid to continue to be ignorant when information and knowledge is handed to you or shoved in your face. It is highly irresponsible for someone with credentialed authority (like an M.D. and with license to practice medicine) to knowingly and deliberately disseminate wrong information about proven ineffective treatments and to actively promote ignorance and stupidity. Dr. Deepak Chopra seem to have an endless supply of drivel and never miss an opportunity to preach his nonsense when given an audience – which lately seem to be provided by Oprah and PBS pledge weeks.

One night we were out for drinks and were discussing a few Skeptoid episodes where I’d discussed various non-scientific alternatives to healthcare. Soon, he’d had enough. And he told a story that went about like this:

“In my village there is an old man who cures people. He’s well known throughout the region, and people come from all over just to see him. And they do it because it works. All day, every day, he has a long line of people waiting outside his door. They bring their elderly, their children, their sick. No matter what their problem is, he heals them by the laying on of his hands. He’s poor and doesn’t do it for money. He doesn’t want fame or thanks. He only wants to help people. What do you say about that, Mr. Skeptic?”

And, I should mention, my friend was quite passionate about it. He’s also 6’5″ and had a couple beers in him. Not someone you want to contradict when his blood is up.

But I had no desire to contradict him or argue with him anyway. However, nothing would please me more than to see his loyalties move away from folk medicine and toward modern medicine. In his profession he gets injured sometimes, and avoids treating his injuries; thus they persist, to the detriment of his career. His other friends and I have urged him to see a doctor, but one characteristic of many immigrants is that they often have a large circle of fellow countrymen; so he always has as much, or more, support from his folk medicine friends as he’ll ever hear from us.

Now it’s one thing to sit in the comfort of your office, research materials close at hand, and contemplatively write a well-framed argument to make a point. It’s quite another to have something sprung on you by surprise in a social situation. Everyone was expecting me to take him on, but I didn’t have my ducks in a row, and I really didn’t want to offend my buddy. I was concerned about coming off as a blabbering, hateful, closed-minded skeptic. Frankly, my usual preference would have been to change the subject and move on. I think that’s usually best in such a situation.

But he wouldn’t have it. He really wanted to know what my problem was with the old man. (He rightly assumed that I’d be skeptical of the old man, in fact I hadn’t even said anything yet.) So I was dragged into battle. There are a number of ways I could have gone:

1. Be the nice, positive skeptic. Say that the prospect of such a thing is very exciting, and that I eagerly await its being tested and proven and certified and made available to the rest of the world.
2. A more cynical and confrontational approach. If he can do these miracles, why hasn’t he won Randi’s million dollars? Why has he jealously kept this power to himself and not given it to the rest of the world; is he an asshole?
3. Apply the scientific method. I can’t comment on this guy specifically because I don’t know anything about him; but many other claimants to such powers have come forward and failed to perform once controls were applied. So despite your personal experience with the old man, I would need to see him perform under controlled conditions in order to be convinced.

#1 is probably the best choice in such a situation where friendships are on the line. It shows open mindedness, it expresses a positive attitude about the old man, and it even hints at the need for testing. But it doesn’t encourage my friend to think more critically in a way that’s likely to lead him to seek useful treatment for his own injuries.

#2 is rarely successful. It’s like the dark side of The Force. It’s easy and seductive. Anyone can be confrontational. While it’s intended to raise alarm about the old man’s motives, it doesn’t have that effect. Instead it builds barricades, it draws lines in the sand. It encourages disagreement and fighting. And that’s the wrong path to take when the goal is enlightenment and knowledge.

#3 is kind of a compromise. It lacks the argumentative edge of #2, but it also lacks the positive tone of #1. It’s a good way to put the debate to rest quickly, because it’s not really something that can be argued against. It’s intended to plant the seeds of skepticism, and help my friend to conclude “Hey, maybe I should also demand a higher standard of evidence.” In this case, I doubt that it would have that result. My friend knew friends of friends who had been cured by the old man, and that’s a profound experience in his mind. In his mind, the old man has already passed all the tests he needs, with flying colors. A great way to follow up #3 is to cite other examples of controlled tests from other sciences. Most people love to hear about exciting science, and if it’s clear that it’s going to be hard to plant the seed you want, you can always make some progress planting a similar seed.

The best thing to do would have been to start with #1 to set the right tone, and to let my friend see that I’m on his side, and that our goals are the same: To bring better treatments to the world. This establishment of shared motivations is essential. And then, in discussion, gradually move into #3. I’d probably avoid saying something as specific as this old man has not passed any controlled tests. That would be too confrontational, and anyway my friend has not tried to argue that the man has passed any controlled tests. Move the conversation away from the sore point, and talk about other exciting areas of science where tests have been applied. What could have become a debate turns into a shared adventure through science, and it instills proper appreciation for good science.

What I ended up doing, however, was not the right thing. I tried to open with #3, but I did so as a preamble to a great, raging tirade on #2. Essentially, I made the worst argument possible. I did offend my friend; I did not in the slightest encourage him to reconsider his own mistrust of evidence based medicine; and I made myself look like a jackass whose opinion is not likely to be sought again. Such failures are how we gain experience. The important point is to be able to learn from such experience, and to do a better job next time. I’ve done that to some degree, but there is always room for improvement. Helping people to understand the way the world works, and to be able to make good life decisions based on good information, is important work; and we can all do a better job of it.

Doctors are bad

Many of the comments made the basic point that the popularity of CAM is the fault of evil, uncaring, incompetent or dangerous doctors. These comments took one of two forms – using negative claims about doctors and medicine to explain why CAM is popular, and using them to justify CAM. These are similar but distinct claims. The latter claim, that CAM is legitimate because scientific medicine “doesn’t have all the answers” or is uncaring or corrupt, is a non sequitur. The position of CAM critics like myself is that CAM treatments are unscientific, not proven, and often already proven to be unsafe or ineffective. There should be a single science-based standard of care for all medicine – not a double standard where fraud and unscientific claims can flourish. If we are currently not doing an adequate job enforcing the standard of care that is not a justification for abandoning it – it just means we need to figure out how to do a better job.

The claim that people are attracted to CAM because of the failings of scientific medicine seems to be the default assumption on the part of CAM apologists, but there is little evidence to support this claim. In fact what few surveys that have been done show that dissatisfaction with scientific medicine is a minor factor in using CAM. Users site the desire to feel as if they have control over their health care and philosophical reasons for their choice of CAM. Also, 85% of CAM users continue to use scientific medicine and use CAM only to “complement” their health care. They are not choosing CAM instead of mainstream medicine – they just want to explore all their options.

So motivations for CAM use are more complex than the simple-minded propaganda of  “doctors are bad.” But there is a kernel of truth to this claim. It is true that the experience of mainstream medicine can often be cold and complex. The current ethical standards of informed consent mean that doctors are obligated to tell patients the unpleasant truth. Tests are often unpleasant to endure also.

Further, managed care has put tremendous pressure on the health care system and as a result office visits are generaly shorter than they have been in the past. The bottom line is this – the system is paying for less medicine (especially for E&M – evaluation and management), so patients are getting less medicine. Many older physicians in the 1990′s simply retired, because they literally could not afford to keep their practice open. For medical practice not based on procedures revenue is down by about 60% over the last 20 years.

Of course, if patients are willing to pay out-of-pocket then they can get as much time as they want with their physicians. This is the model of so-called boutique clinics, or some spciality clinics. It is also the model of most CAM providers, not by coincidence.

My point is that the answer to the challenges of the overwhelming costs and subsequent compromises of modern medicine is not to abandon the scientific standard of care. Again – that is a dangerous non sequitur. In fact, CAM just worsens the problem by diverting funds away from standard medicine.

Also, I acknowledge that CAM practitioners have largely mastered the psychological aspects of a positive therapeutic relationship. Those are the selective pressures they have been under – to tell their clients what they want to hear. They are not constrained by science, by informed consent – in short, by the truth. They are free to give a simple explanation for every client that walks through their door, to claim that they have the answer for everything, and to design their treatments to be pleasant rather than effective. Being disconnected from science and ethics can be very liberating.

There were also some specific claims made that I want to address. Tracy wrote:

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.

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.

This is both misleading and a logical fallacy. It is another form of the argument from final consequences – people need treatments, therefore they should get them. But what if no such treatment exists? Does that mean it is ethical to make up a fake treatment?

The statements are also false. The delay of doing clinical trials is definitely taken into account. It is even possible to get experimental treatments on a compassionate basis for terminal illnesses. Researchers and ethicists have actually spent decades being quite thoughtful on all these issues. Also – it is unethical to withold a proven treatment from someone to put them in a trial – so no one gets a placebo instead of a proven treatment. Preliminary open (no placebo) trials are often done before placebo-controlled trials, and if a treatment were dramatically effective it would be fast-tracked. When possible the placebo arm is limited to 1/3 of study patients so that the chance of getting a placebo is minimzed. Also, trials are monitored so that if a treatment is proven adequately to work before the trial is scheduled to conclude it can e stopped early so that that the treatment can be made available right away. In other words – every effort is made to get effective treatments to dying or suffering patients as quickly as possible.

But Tracy’s type of comments are common – people who don’t have any actual experience in medicine or clinical research base their conclusions on assumptions and second-hand information, or perhaps what they see on tv. But they have no relationship to the actual ethical standard in medicine.

Paula made a similar point when she wrote:

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?

Of course not. Take any reasonable action. The more desperate one’s situation, the greater the justification for speculative and risky treatments. But this is already incorporated into the ethics and practice of scientific medicine. There is a line, however – do not abandon all science and reason.

There is also a hidden assumption in Paula’s point – that short of a cure there is nothing to do but go home and die. This is almost never the case. When a terminal disease cannot be cured there is often a great deal we can still do to maximize the duration and quality of life. It is far better to focus your efforts on that – get the most out of the time you have left -then to spend your remaining days spending your family’s money searching for a cure that does not exist. I have seen patients spend tens of thousands of dollars on unsafe and unpleasant treatments outside the country, grasping for a sliver of hope that turned out to be a false hope. They typically greatly regret the experience. It is like hitting a drowning man over the head with a sledgehammer.

Some blamed the popularity of CAM on the for-profit nature of “corporate” medicine. This is certainly part of the anti-medicine propaganda. Also, as is commonly the case, there is a kernel of truth. Conflicts of interest are a problem – but they are recognized and are largely being delt with. Contrary to one commenters claims – doctors do not get “kickbacks” from pharmaceutical companies. Kickbacks are illegal. Large gifts from pharmaceutical reps for listening to their sales pitches have mostly already been weeded out. Small gifts are on the wane also – mainly due to internal criticism by doctors who feel it taints our reputation with the appearance of conflict. They probably have a point. But, to be clear, medical decision making is largely driven by the standard of care – not financial conflicts of interest. Actually, the biggest conflict probably comes from managed care, which provided a huge incentive not to treat.

This is a tangential issue – but it is impossible to design an incentive-neutral system. Whoever pays for health care will be motivated to minimize it, and whoever profits will be motivated to maximize it. You can shift the incentives around, but you cannot eliminate them.

And, let’s remember that the whole argument is the fallacy of inconsistency. CAM is largely a for-profit cottage industry. They are just good at attacking their competition.

Doctors kill patients

Several commenters brought up the fact that many patients die from either medical mistakes or adverse drug reactions. David Paterson specifically concludes that patients would have a better outcome going to a witch doctor than a medical doctor.

This argument, however, is based entirely on a fallacy – considering only the risks and not the benefits. Dr. Harriet Hall wrote an excellent recent post on one of the studies David cited, making that same basic point. First, the numbers cited are likely greatly exagerated, but that is a side point I don’t have time to go into today. Even if we take them at face value – the point is that medical decision-making is all about risk vs benefit. In order for any treatment to be considered ethical and part of the standard of care it must demonstrate benefit in excess of risk. Standard of care also includes giving informed consent regarding the calculation of risk vs benefit.

Clinical trials are designed to look at the net effects of a treatment – if the only variable is the use of a specific treatment vs a placebo, what are the final outcomes for the patients?

In fact, my primary criticism of CAM is that they generally have not gone through this analysis. Most CAM modalities (I know I am lumping here, but remember I am against the CAM category – every treatment needs to be considered individually, but I am responding to the CAM proponents) have no proven benefit or have not demonstrated benefit in excess of risk.

It is therefore absurd to criticize scientific medicine in favor of CAM over the issue of risk.

The issue of risk management is medicine is a legitimate and serious issue. But there already exists mechanisms within mainstream medicine to address the problem of mistakes and failures to meet the standard of care. A great deal of progress has already been made, but we do need to do much better still. The answer largely is in putting into place redundant systems that minimize error. This is increasingly necessary as the practice of medicine becomes more complex.

Of course, if all you are doing is waving your hands over a patient there is not much that can go wrong – but there isn’t much that can go right, either.

CAM is preventive

Some of the commenters made the point that CAM focuses more on prevention. This is simply not true. All of the real effective preventive health measures, like diet and exercise, were discovered (and continue to progress) through scientific medicine. Primary care doctors routinely advise patients to quit smoking, lose weight, eat a healthier diet, etc. Blood pressure is often managed by reducing salt, high cholesterol by dietary changes, and diabetes by going on a diabetic diet and exercising regularly. Aspirin is routinely prescribed to prevent heart attacks and strokes. In my own practice I advice withdrawal of dietary triggers (like caffeine) or hydration to manage migraines, change in “sleep hygiene” to manage sleep problems, and stretching, exercise, gentle massage and moist heat to manage back pain. I routinely check certain vitamin levels and prescribe supplements as needed. The list goes on.

It is simply absurd to argue that doctors do not emphasize life-style changes or prevention. These have already been built into the standard of care. Such interventions are also often the low-hanging fruit – that’s where we start because it is easy and low risk. Medical management is used when the lifestyle changes are not enough, and invasive options, like surgery, are a last resort.

More importantly – we question what we do, we conduct research to find out what the best options are, and we change what we do based upon that evidence. CAM practitioners do not change what they do in response to scientific evidence. They certainly have never abandoned a worthless modality.

Can we do better? Of course. That will always be true. But we are doing better. Simply taking a snap shot of the current state of medicine and arguing that any deficiencies warrant abandoning science as the standard of medicine is absurd.

Conclusion

I know I did not get to every point. I could have written a dozen articles this length addressing every side point raised in the comments. But I hit the highlights – the points that are most commonly raised. I don’t expect this entry will end any debate. This is too complex and emotional an issue.

I do want to emphasize my central theme. Most of the comments were distractions from the central issue – the public is best served by medical practices that are safe and effective. The best way to maximize safety and effectiveness of medicine is through a standard of care based upon the best science available. Magic and false hope are no substitute.

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.