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An Online CAM Poll

by Steven Novella, Feb 13 2012

Online surveys are worthless. That is, they are worthless as a source of information about popular belief and opinions. Yet many people still find them compelling, and so they can be useful as a way of driving traffic to your website. I guess that’s why they persist.

A recent poll about teaching complementary and alternative medicine (CAM) in Australian universities has become a matter of unnecessary controversy. Asher Moses wrote an article complaining about the fact that the survey seems to have been “gamed”, in an article: Vote on alternative medicine falls victim to dark arts of the internet. In the article he seems to miss the two real points about the poll – surveys are not reliable, and it’s fallacious to use them as an argument from popularity anyway. He writes:

Voting progressed steadily at first but on Tuesday votes began rising from about 125,000 to more than 877,000 by the time voting closed on Thursday. The end result was 70 per cent no, 30 per cent yes. The number of votes in the poll was about eight times more than the number of online readers of the story, a clear indicator that the poll had been gamed.

Moses talks in the article about how easy it is to “game” an online survey, but that is not the real issue. Most surveys are probably not hacked, as indicated above it is easy to detect such manipulation. Rather, there is a problem inherent with polls and surveys. The only reference to this issue in the article is acknowledgement that the survey was not “scientific” – but what does that mean, exactly?

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Science, Medicine, and Academia

by Steven Novella, Jan 23 2012

Proponents of so-called complementary and alternative medicine (CAM) are forcing us to answer a question no one has explicitly asked – should there be a scientific basis to medicine? Proponents are generally very coy about this topic, and in most venues want to pretend that they are being scientific, while really promoting “other” forms of evidence and “other” ways of knowing. They promote health care freedom laws designed to weaken the scientific standards of medicine, while simultaneously infiltrating academia with assurances that they are science-based.

Unfortunately most academics and health care professionals are simply naive to the situation (so-called “shruggies”) and too easily accept these assurances without checking out the facts themselves. Their initial reaction to those of us who are calmly but insistently pointing out that the CAM emperor has no clothes is to assume that we must be overreacting, because CAM can’t truly be as bad as we say. Homeopathy can’t really be made of nothing, can it? But it’s a large industry, with entire hospitals in the UK. How can it be as nonsensical as the skeptics are saying?

This naivete extends, unfortunately, to many university administrators, who are used to being egalitarian and accommodating. Proponents of CAM are sincere, and know how to play the game, so they put their best academic foot forward (often lubricated with grants from ideologically dedicated organizations like the Bravewell collaboration) and work their way into academia. They are persistent, and good at dismissing their critics as closed-minded, unfair, or having an axe to grind.

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Fighting CAM – In Australia

by Steven Novella, Dec 12 2011

One thing that I notice when the issue of so-called complementary and alternative medicine (CAM, although some of my colleagues add the “s” from “so-called” to make is SCAM) is brought up in the media is that many misconceptions will be cited as fact, often by both sides, although far more by the pro-CAM side. CAM advocates seem to rely almost entirely on misconceptions and factual errors.

In Australia recently an ABC program aired that was highly critical of CAM, and now CAM advocates are firing back. The latest exchange was initiated by a group of 34 Australian physicians who are campaigning against pseudoscience in medicine. This is something that should not be controversial, but amazingly there is a large number of practitioners (although a minority) that stand  up to defend pseudoscience in medicine. They report:

Emeritus Professor of Medicine at the University of New South Wales John Dwyer says some courses previously offered at Southern Cross were more “magic” than science.
“We were off to a bad start with Southern Cross University when their founding Professor of Health and Nursing was teaching for years Healing Touch therapy; quite extraordinary nonsense.”

Good for him and his colleagues – we need more professionals who are not afraid to point out that the CAM emperor has no clothes.

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Folk-Wisdom Medicine
versus Science-Based Medicine

by Michael Shermer, Aug 16 2011

This article first appeared as an alternative medicine opinion editorial for the American Medical Associations’s Virtual Mentor Journal, Volume 13, Number 6: 389–393, June 2011.

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. Continue reading…

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Young Scientists Condemn CAM in the Third World

by Steven Novella, Jun 01 2009

As much as unscientific medicine is a problem in relatively wealthy Western nations, it is even more so in developing and third world countries. In the US so-called CAM (complementary and alternative medicine) is largely consumed by the “worried well” – people with disposable income who use it to treat common everyday ailments or symptoms. CAM does also infiltrate the treatment of serious diseases, but to a much smaller degree.

In the third world, however, unscientific treatments for serious public health threats is a real problem. Malaria, HIV, TB, influenza, and childhood diarrhea are all epidemic in Africa and other locations, all exacerbated by the lack of adequate health care resources. The impact of this lack of resources is worsened by reliance on ineffective pseudoscience treatments, and sometimes (as with HIV) the denial of scientific treatments.

The World Health Organization (WHO) whose very purpose is to serve the public health worldwide, especially in developing and struggling nations, has failed to adequately address the problem of unscientific medicine. The WHO, unfortunately, is an imperfect political organization and as such is vulnerable to sectarian interests. It has a poor record on combating unscientific medicine, and in fact promotes it.

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Medical Neglect

by Steven Novella, May 18 2009

Daniel Hauser is a 13 year old boy suffering from a form of blood cancer called Hodgkins lymphoma. His oncologist is recommending a standard course of chemotherapy. I do not know the clinical details of this case, but overall, with current treatments, the 5 year survival for childhood Hodgkins lymphoma is 78%.  Without treatment, Daniel’s chance of survival drops to 5%.

Despite this Daniel is refusing chemotherapy, and his family is supporting his decision. If Daniel were an adult that would be the end of the story – competent adults have the right to refuse any intervention for whatever reason they choose. But Daniel is a minor, so the state has a duty to protect him, even from his own parents and himself.

Daniel’s family are members of the Nemenhah religion, a Native American religious tradition that preaches that the journey from sick to healthy is a spiritual journey. They only use “natural” remedies and refuse modern medical intervention.  Dan Zwakman, a member of the Nemenhah religious group, is arguing that this is a case of religious freedom, saying that “our religion is our medicine.”

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