Mar 31 2014

Acupuncture – Science as Promotion

Almost weekly I see a new press release about an acupuncture study claiming benefits. While I have written extensively about acupuncture previously, and will continue to cover the topic, I can’t cover every little study that comes out. Most of the studies are utterly useless – they contain no control group, they are effectively pilot studies, they are of “electroacupuncture” (which is really just transdermal electrical nerve stimulation pretending to be acupuncture), or they are looking at some dubious biomarker rather than objective clinical outcomes.

Occasionally, however, an acupuncture study deserves a mention, in this case because it is particularly abusive.

Rachael Dunlop, my skeptical colleague from down under, sent me a report of an acupuncture study performed in Melbourne. News outlets are reporting the study at face value, in typical gushing terms, stating that “acupuncture is just as effective as drugs in treating back pain and migraine.”

It seems to me that this is the actual purpose of such studies – to produce positive news coverage. They are not designed to actually answer the question of efficacy.

In this case I can’t delve deeply into the methods and results, because the study has not yet been peer-reviewed and published. That’s right, the authors pulled a Pons and Fleischmann and announced the results of their study prior to publication.  This lends further to the appearance that the purpose of the study was the press release, not the data.

This is inappropriate for obvious reasons. The media now has to essentially take the authors words for what was in the study. It is difficult for them to interview experts not involved in the study on what it shows, because those experts don’t have access to the study. Who knows if the study will even be published.

Further, we already have a problem with the media sensationally reporting every preliminary finding as if it is a breakthrough. This is only worsened when we extends the press releases to unpublished results.

What we do know about the study is that it contained three arms: 1) standard medical treatment of pain, 2) acupuncture alone, 3) medical treatment plus acupuncture. The study was conducted in four emergency departments in Melbourne.  The authors are claiming that in their study acupuncture was as effective as drugs for back pain, sprained ankles, and migraine.

I, of course, have lots of questions about the protocol. For example, did the “acupuncture alone” migraine patients also get IV hydration? Perhaps this wasn’t considered a significant intervention, but hydration alone has the potential to significantly improve many ER migraine cases. It would be unethical to withhold something as basic as IV fluids for a dehydrated patient.

There are many potential problems with the study. How many outcomes did they measure, for example. Were there any objective outcome measures, or only subjective pain?

While such questions are important, the are mostly trumped by the one thing we do know about this study – there was no acupuncture control group. The study was unblinded, so everyone in the study knew if they were getting acupuncture or not. An unblinded study for a subjective outcome like pain is virtually guaranteed to generate a false positive. It cannot possibly decide the question of efficacy.

This brings me back to my original question. After thousands of acupuncture studies have been published, including many well-controlled studies with sham or placebo acupuncture, why would anyone want to go back to doing a preliminary unblinded acupuncture study that could not possibly settle any scientific questions about acupuncture?

Imagine if you will a pharmaceutical company doing an unblinded study of one of their drugs with a subjective outcome and then announcing  in a press release how wonderfully effective their drug was, before the study was even published. What if the same drug had already been shown to be ineffective in better studies that were blinded and controlled?

Conclusion

The current acupuncture study, even with the little information we are given, seems completely worthless. It may have been a reasonable pilot study thirty years ago, but there is simply no place for such a study at this time, after thousands of studies on acupuncture have already been published.

The only possible purpose of the study is to generate false positive results and then use those results as propaganda to promote acupuncture. Such a conclusion would be obvious if this were a pharmaceutical company doing something similar for one of their drugs.

I also think the press is irresponsible for even reporting this study. They should have waited until it was published and independent experts had a chance to peer-review the study.

Share

164 responses so far

164 Responses to “Acupuncture – Science as Promotion”

  1. DrRachieon 31 Mar 2014 at 10:05 am

    Steve, thank you for blogging this. I have spent a lot of time today and yesterday trying to explain to journos why this is not actually a “study”. Also, why the shit did RMIT agree to release this when the results are apparently not even analysed?! what?! I asked the editor of the relevant section of the news paper where they got the “results” and they have yet to answer me. This is the worst piece of shit “research” I’ve seen for some time, and I’m always looking.

    bah http://scepticsbook.com/2014/03/30/announcing-scientific-results-in-the-press-before-peer-review-bad-science/

    Cheers R

  2. Ori Vandewalleon 31 Mar 2014 at 12:39 pm

    The press reports the news. This study is news, but the press is getting the story wrong. The story isn’t that a study showed positive results for acupuncture; the story is that some acupuncture proponents ran a poorly controlled study on acupuncture. The problem is that news organizations only tell stories like that when they’re running SPECIAL REPORT EXPOSES, rather than telling such stories whenever they appear.

  3. Steven Novellaon 31 Mar 2014 at 12:54 pm

    Ori, I agree with your second statement, but not the first. It is not as simple as saying the press reports the news. They cannot report all the news. They decide which news to report – where is the threshold for newsworthiness, is the story properly sourced, etc.

    I think you can make a reasonable argument that unpublished preliminary study results are not newsworthy.

    You are correct in that the other question is – what is the real story here? I agree that the real story here is that of proponents using poor and unpublished data to promote their special interest.

  4. Enzoon 31 Mar 2014 at 3:35 pm

    “…why would anyone want to go back to doing a preliminary unblinded acupuncture study that could not possibly settle any scientific questions about acupuncture?”

    I can’t help but feel these awful trials/studies keep popping up because each new researcher interested in acupuncture decides they are going to conclusively demonstrate the practice works — because they believe in their own integrity and capability. I doubt they are even appropriately familiar with the pre-existing literature let alone its criticisms; they just have this vague sense that they can produce a more conclusive study.

    It’s like that “How Standards Proliferate” xkcd comic. Every acupuncture researcher thinks they can be the one to deliver the best evidence. And we just end up with one more of the same crappy study.

    https://xkcd.com/927/

  5. jt512on 31 Mar 2014 at 3:48 pm

    The study was conducted in four emergency departments in Melbourne.

    Oh, great. Emergency acupuncture.

    911 Operator: What is the nature of your emergency?

    Caller: I think my husband is having a heart attack.

    911 Operator: Stay calm, maam. Do you have a sewing kit? Good. I need you to go and get some needles.

  6. zorrobanditoon 31 Mar 2014 at 8:21 pm

    “How many outcomes did they measure, for example. Were there any objective outcome measures, or only subjective pain?”

    Pain IS subjective. It is impossible to get any objective measures for pain relief. I realize this drives all you hard science people crazy, but if you are genuinely interested in science you should be willing to accept reality:

    Pain is what the patient says it is.

    If I’m in pain and sticking needles in me or killing chickens on my coffee table or scattering holy water about or chiropracty or whatever relieves that pain, unless you can show me that it does a greater harm in some other way, I’m for it.

    As I said before in an earlier thread, suffering unnecessary pain in the interest of Truth went out with the Empire.

  7. rezistnzisfutlon 31 Mar 2014 at 9:16 pm

    I believe the reason these kinds of studies pop up so often is so that practitioners can then claim that there is evidence supporting their practice, and can point to a long list of bad studies to the uninitiated who don’t know any better in order to give them an unwarranted air of legitimacy.

    Of course, all it truly highlights is the difference between evidence-based medicine and science-based medicine. One relies on quantity, while the other relies both on quantity and quality.

  8. Ori Vandewalleon 31 Mar 2014 at 9:59 pm

    zorrobandito:

    Pain is subjective, yes, but…

    I often get headaches. Sometimes I take ibuprofen for them if they’re particularly bad, but most of the time I don’t. Yet treatment or no treatment, every headache I’ve ever had has gone away. Or to put it another way, I’ve cured every headache I’ve ever had. I wonder what it is I’m doing that cures headaches? Maybe it’s the way I’m breathing oxygen, or all that Mountain Dew I drink, or possibly something genetic. Whatever it is, I should certainly sell it.

  9. grabulaon 01 Apr 2014 at 5:15 am

    @Bandito

    “If I’m in pain and sticking needles in me or killing chickens on my coffee table or scattering holy water about or chiropracty or whatever relieves that pain, unless you can show me that it does a greater harm in some other way, I’m for it.”

    You and DrJoe both agree it’s ok to snowjob the patient as long as he thinks he might be getting some relief. It’s ok to charge them hundreds, sometimes thousands of dollars, probably repeatedly for something that absolutely does not work, probably because they are desperate and will try anything. The thing you aren’t willing to accept is that sometimes they don’t know whether they are receiving pain relief or not. These options definitely don’t cure anything in the case of issues that might be cured. Not to mention the slippery slope both in woo and financial indebtedness telling patients or people it’s ok to seek out things that do not work.

  10. Bruceon 01 Apr 2014 at 5:16 am

    Zorro:

    “Pain IS subjective.”

    This might be true but often there are underlying causes and while there are certainly cases where we do not understand them, simply treating the pain symptom with woo does not really go far in actually curing the patient of those underlying cause.

    Either we understand the pain and the cause and therefore can treat it properly, or we don’t understand it and we should look to science to try to understand it. Plastering what we don’t know with woo will not go any way towards helping our understanding of it.

    You also conveniently miss the point that came right after what you quoted, there was no control group so we have no way of measuring the reduction in pain against any number of placebo effects. Further to that there was NO blinding, which is even more important in a subjective outcome.

    “hard science people”

    What exaclty is the difference between a Hard Science Person and a Not-Hard (perhaps Soft?) Science Person?

  11. BillyJoe7on 01 Apr 2014 at 7:24 am

    zorrobandito,

    “Pain IS subjective”
    Yes, but you are denying that there are objective means of evaluating patient reports of pain.

    “It is impossible to get any objective measures for pain relief”
    But functional improvement is a pretty good surrogate.

    “Pain is what the patient says it is”
    Nope. Patients lie. Patients misperceive. Patients are decieved. Patients deceive themselves.

    “If I’m in pain and sticking needles in me or killing chickens on my coffee table or scattering holy water about or chiropracty or whatever relieves that pain, unless you can show me that it does a greater harm in some other way, I’m for it.”
    And I’m for using TREATMENTS THAT WORK along with placebo effects.

    “As I said before in an earlier thread…”
    You have not learned anything from that thread.

    “…suffering unnecessary pain in the interest of Truth went out with the Empire”
    You’re just telling stories that exaggerate placebo effects to justify using treatments that do not work.

  12. Christopher_NWon 01 Apr 2014 at 7:25 am

    As soon as I heard Australia and Acupuncture, I thought RMIT. Might just be my snobbishness since I’m from Uni of Melbourne, but they do have woomeister supreme Charlie Xue, who sucks up tax payer dollars in nonsense research. It is sad to say that there does seem to be a big rise in pseudoscience here.

  13. Steven Novellaon 01 Apr 2014 at 7:55 am

    zorro – there are objective measures that can be used to augment the subjective pain ratings. These include – use of pain medication, disability, time spent in the ER, even autonomic measures, like blood pressure.

    If a patient tells me their headaches are better with a new treatment, but they use the same amount of pain medication they were previously, and visit the ER as often as they did, or miss work as often as they did – is the treatment really working?

  14. SteveAon 01 Apr 2014 at 7:57 am

    zorrobanditoon: “If I’m in pain and sticking needles in me or killing chickens on my coffee table or scattering holy water about or chiropracty or whatever relieves that pain, unless you can show me that it does a greater harm in some other way, I’m for it.”

    Prodding people with needles temporarily distracts people from their discomfort. Big deal. If I bash my thumb with a hammer and sit in a chair, my perception of pain will be very different to the scenario in which I bash my thumb, sit in a chair, then have a naked supermodel drop in my lap.

    The issue is that acupuncture is being promoted as some kind of orthodox (if mysterious) treatment that is tapping into unknown energy fields and whatnot. Whereas, what it really is, is prodding people with needles, a technique that belongs in the same box as every other ‘distraction’ you can think of: chicken killing, water sprinkling, head patting, Irish jigging, finger painting, holding your breath, dunking your face in cold water, endurance yodelling…I could go on and on and on….

  15. sonicon 01 Apr 2014 at 8:56 am

    Here is a different story with more details-
    http://www.smh.com.au/national/health/acupuncture-as-effective-as-drugs-in-treating-pain-trial-shows-20140329-35qec.html

    “While data from the study is still being analysed and finalised for publication in a medical journal, one of the researchers, Dr Michael Ben-Meir, said it showed acupuncture offered the same level of pain relief as analgesic drugs when patients rated their pain one hour after treatment.”

    “He said study participants treated with acupuncture also tended to leave hospital earlier, suggesting it sped up emergency department care.”

    So it is one of the researchers ‘leaking’ the results and it appears there are objective measures (length of stay) involved.

  16. Bruceon 01 Apr 2014 at 9:10 am

    “While data from the study is still being analysed and finalised for publication in a medical journal
    one of the researchers, Dr Michael Ben-Meir, said it showed acupuncture offered the same level of pain relief as analgesic drugs when patients rated their pain one hour after treatment.”

    I am sorry, but there is no detail there, just some pre-analysis observation by one of the researchers.

  17. steve12on 01 Apr 2014 at 11:16 am

    “So it is one of the researchers ‘leaking’ the results and it appears there are objective measures (length of stay) involved.”

    Not how it works. Any time your results find their way to the popular media before peer review has taken place, you’ve done the wrong thing. And he’s not mentioning that he has some preliminary data while being interviewed about some other work – this whole article sells acupuncture on work that has not gone through peer review.

    Irresponsible.

  18. DrJoeinCAon 01 Apr 2014 at 12:56 pm

    Zorro: Don’t you see that you cannot win this? You are deceived, deceiving yourself, lying, distracted, “have not learned anything,” spend “thousands” of dollars on “woo,” unobjective, unscientific, etc.

    All the time you think your pain is better, but it cannot be. You just can’t convince the geniuses on this blog that you actually do feel better because they know better than you how you feel, and if you claim otherwise, you are just…see above.

  19. Steven Novellaon 01 Apr 2014 at 1:13 pm

    DrJoe – Thanks for the clear evidence that you have not made any attempt to understand our position, you have not learned a thing from our exchange, and have not genuinely engaged with the discussion. Right back to square one – no nuance at all.

  20. steve12on 01 Apr 2014 at 1:21 pm

    DrJoe , you don’t seem to grasp some very basic concepts of science, which is very dismaying

    So now you’re saying that even when we ARE doing science (not the clinical work you’ve talked so much about), we shouldn’t try to parse the different components contributing to our data? We should just put a needle in a few folks’ arms and if they say they feel better, we’re done? What should we do about reasonable alternative explanations in our findings? Just say “aw the hell with it!”?

    We don’t say “good enough” re: our understanding in science. And ya know what the payoff is? The modern world. Space shuttles and smart phones and vaccines didn’t come from “going with our guts” and ancient Chinese medicine. They came from the method that you seem to think is unnecessary.

  21. DrJoeinCAon 01 Apr 2014 at 1:57 pm

    StevenNovella: Just quoting what others said to Zorro. Am I wrong, or were all those adjectives — and more — not used to describe a patient response to acupuncture?

    I fully understand your position. You have concluded that acupuncture does not work. And when you see still another study (yawn) that attempts to show that it does work, and this study is released prematurely and appears to not be a rigid placebo-controlled study, and when this study appears to show some benefit, you bridle at it. It offends your scientific sensibilities. I get that.

    You dismiss Zorro with, what if a patient tells you it’s better, but other signs point to it not being better. You ask “is the treatment working?” Why don’t you answer that question yourself? If the patient is requiring the same amount of treatment, then presumably the original treatment is not working. But what if the patient (Zorro) tells you it’s better, refuses further treatment, walks out of the ER with a smile on his face, and is back to work? Is the treatment, even if it’s something you think cannot possibly work, working? Or is this self-deception, lying, regression to the mean, etc?

  22. Ori Vandewalleon 01 Apr 2014 at 2:20 pm

    DrJoe:

    There are a variety of reasons why a patient’s assessment that a treatment was successful is not necessarily reliable. The example I attempted to point out is that there are a whole host of conditions with which humans can be afflicted that are inherently self-limiting.

    Pain is an extremely common example of this. Except in rare circumstances, pain goes away. Thus, having pain, getting treatment for the pain, and the pain going away is not, despite outward appearances, an indication that the treatment made the pain go away.

    This is just one of many, many possible ways in which what appears to be true about via anecdotal evidence turns out not to be via rigorous science.

  23. Steven Novellaon 01 Apr 2014 at 2:36 pm

    Let’s make this simple. 20 consecutive patients walk into the ER with an acute migraine. Everyone gets IV fluid. 10 of the patients get drug X and 10 get placebo. In each group, three patients find relief after one hour, 6 get relief only after 3 hours and more aggressive medications, and 1 has to be admitted for in patient headache management (I’m just making these numbers up to illustrate a point).

    Now – did drug X make any difference? What about the three patients who took drug X and had good relief in 1 hour. Did drug X work for them? They had headache, they took drug X, their headache got better. Should I prescribe them drug X? If not, does that mean I think they are lying or deceived?

    I think it’s pretty obvious here that drug X is worthless – even in the three cases where the headache improved in 1 hour.

    There are other variables to consider. How many people will have their headache get better spontaneously. How much is the IV fluid playing a role, or just perhaps leaving whatever stressful situation you were in and now lying down on a bed in an ER?

    When acupuncture is the variable controlled for, acupuncture does not work. There is no statistical benefit for patients. It is just like drug X.

  24. BillyJoe7on 01 Apr 2014 at 2:41 pm

    DrJoe,

    “But what if the patient (Zorro) tells you it’s better, refuses further treatment, walks out of the ER with a smile on his face, and is back to work? Is the treatment, even if it’s something you think cannot possibly work, working? Or is this self-deception, lying, regression to the mean, etc?”

    You cannot make up a story that fits your conclusion and think that you’ve proven anything.
    This is now the third time I’ve bought this illegitimate strategy to your attention.

  25. zorrobanditoon 01 Apr 2014 at 2:47 pm

    “If the patient is requiring the same amount of treatment, then presumably the original treatment is not working. But what if the patient (Zorro) tells you it’s better, refuses further treatment, walks out of the ER with a smile on his face, and is back to work? Is the treatment, even if it’s something you think cannot possibly work, working? Or is this self-deception, lying, regression to the mean, etc?”

    I can see why this would matter to the medical professionals. They’re not really trying to make me feel better, laudable as that would be, they’re trying to find treatments which will reliably work for a large population.

    Because I am not a physician or a scientist, my goals are somewhat different. If I am in pain, I want to not be in pain. Just me. OK? And if the ritual killing of a chicken in my living room relieves my pain, causes me to decline further conventional treatment, and allows me to continue my life without discomfort, I’m for it. I have nothing to gain by lying about this, and if I am now “deceived” into living and sleeping without pain, well, bring it on.

    Of course if there is an underlying condition which should be addressed, that isn’t enough. However, we were talking, I thought, about pain per se.

    If I am supposed to learn that when a physician says I am in pain, even though I feel fine, he’s right and I’m wrong, I am afraid I’m proving resistant.

  26. DrJoeinCAon 01 Apr 2014 at 2:51 pm

    BillyJoe: Pay attention. These were questions — not conclusions — to Steven based on the news reports of the Australian ER study and based on his statement that there are objective measurements of pain. There’s no getting around your jumping to conclusions, is there?

  27. DrJoeinCAon 01 Apr 2014 at 3:01 pm

    StevenNovella: The answer is that you cannot tell; there are too many variables. If some patients get better spontaneously and some by walking in the door and lying down, you would have to set up another arm to withhold treatment from a certain group of patients.

    Your simplified example is unlike the ER study that was done. As I understand it, they compared standard treatment with acupuncture and found similar results. There was no placebo arm and no non-treated group.

    I bounce the question back to you. If they found standard treatment and acupuncture provided the same results, what would you conclude from that?

  28. BillyJoe7on 01 Apr 2014 at 3:10 pm

    zorrobandito,

    “And if the ritual killing of a chicken in my living room relieves my pain, causes me to decline further conventional treatment, and allows me to continue my life without discomfort, I’m for it. I have nothing to gain by lying about this, and if I am now “deceived” into living and sleeping without pain, well, bring it on”

    You’re doing it as well.
    Anecdotes are the poorest form of evidence – useful only for forming hypotheses
    Made up anecdotes are less than useless.

  29. BillyJoe7on 01 Apr 2014 at 3:18 pm

    DrJoe,

    So why should Steven answer a question based on a made up anecdote?

    “If they found standard treatment and acupuncture provided the same results, what would you conclude from that?”

    Apparently they did find that.

    (I say apparently, because we have only the word of the reseachers. We do not yet have the details of the study and we do not yet have peer review.)
    But, from what we know about the study, nothing can be concluded from it. From what we know of the study, it is useless. As are all studies without a control. As are all studies without double blinding. As are all studies without random allocation.

    As are your made up anecdotes.

  30. Hosson 01 Apr 2014 at 3:18 pm

    “Made up anecdotes are less than useless.”
    Unless you’re a philosopher, then it is referred as “work”. lol

  31. steve12on 01 Apr 2014 at 3:24 pm

    ” The answer is that you cannot tell; there are too many variables. If some patients get better spontaneously and some by walking in the door and lying down, you would have to set up another arm to withhold treatment from a certain group of patients.”

    What???

    I think DrJoe is putting us on. YOu can’t get an MD and be this clueless about basic experimental design, can you? Please say no!

  32. BillyJoe7on 01 Apr 2014 at 3:27 pm

    zorrobandito,

    “I can see why this would matter to the medical professionals. They’re not really trying to make me feel better, laudable as that would be, they’re trying to find treatments which will reliably work for a large population. Because I am not a physician or a scientist, my goals are somewhat different. If I am in pain, I want to not be in pain. Just me. OK?”

    You misunderstand.
    Replicated methodologically sound trials can show that a particular treatment does not work.
    This translates into: this treatment will not work for you.
    If you do report that you feel better after a treatment that has been shown not to work, then there are other reasons why you report that you feel better. And we have been through those reasons a thousand times so I won’t repeat them here.

  33. DrJoeinCAon 01 Apr 2014 at 4:40 pm

    BillyJoe: I keep asking you to pay attention. “So why should Steven answer a question based on a made up anecdote?” Because he’s the one that made up the anecdote finding similar results.

    Really? All studies without controls, blinding and random allocation are useless? I wonder where you get that from.

    Zorro: See what I mean? “If you do report that you feel better after a treatment that has been shown not to work, then there are other reasons why you report that you feel better.” Not that you actually DO feel better ’cause we all know that’s impossible and incidentally you’d be a fool to think otherwise, but delusional reasons why “you report” feeling better.

    Steve12: Steven says there are unknown variables and I suggest that maybe those variables have to be tested for and that somehow irritates you?

  34. steve12on 01 Apr 2014 at 5:06 pm

    ” Steven says there are unknown variables and I suggest that maybe those variables have to be tested for and that somehow irritates you?”

    Those other variables not controlled for are mitigated by random assignment – the variable controlled for is drug X. That’s why it’s interpretable – drug X is ineffective in the toy experiment.

    YOu either don’t understand what he wrote or you don’t understand the logic behind basic experimental design. I really hope it’s the former considering all the arguing you’re doing. But I’m starting to see that it’s the latter.

  35. DrJoeinCAon 01 Apr 2014 at 5:26 pm

    Steve12: Seriously? How would you ever know that people might have got better without treatment if you treat everyone?

    If they only treated people with either A (standard treatment) or B (acupuncture), and the results are equivalent, what can you conclude from this?

    Steven’s example was comparing unknown drug with placebo which is not what the Aussie study was.

  36. Mr Qwertyon 01 Apr 2014 at 5:29 pm

    BillyJoe7:
    “So why should Steven answer a question based on a made up anecdote?”

    Just wait a few more posts of people deconstructing his nonsense, and he’ll also start hiding behind his made up implied degree – that seems to be the pattern for him these days!

  37. steve12on 01 Apr 2014 at 5:48 pm

    “Seriously? How would you ever know that people might have got better without treatment if you treat everyone?”

    Not sure I believe you’re an MD. You’ve never read a paper where standard of care was given to 2 groups, but one was given placebo and the other was given an experimental treatment? Pretty basic shit.

    Everything was held constant save for what was manipulated (drug administration). No difference between groups – no evidence for an effect of drug X. Very simple, undergrad example of a study.

    “Steven’s example was comparing unknown drug with placebo which is not what the Aussie study was.”

    We’re dealing with his toy experiment testing drug X. Don’t try to confuse the issue now that you got caught with your pants down. You said his toy experiment was not interpretable becasue of “other variables” and the common treatment (IV), but that’s BS

    Cue the DrJoe shuffle….

  38. Hosson 01 Apr 2014 at 5:56 pm

    JoeinCA
    “If they only treated people with either A (standard treatment) or B (acupuncture), and the results are equivalent, what can you conclude from this?”

    I conclude that you are bad at science. The framing of the question is devious. There is a large body of research demonstrating that acupuncture is useless. Why should this particular unpublished study be analyzed outside of the previous research? Ohhhh, that’s right, to claim efficacy for a treatment that doesn’t work. You’re bad at science.

  39. steve12on 01 Apr 2014 at 6:06 pm

    Hoss, just so you realize – he’s not even summarizing the design corectly

    “If they only treated people with either A (standard treatment) or B (acupuncture), and the results are equivalent, what can you conclude from this?”

    Everyone gets water. 20 people presenting with migraine get water. Then, 10 people get placebo and 10 get drug X. He doesn’t seem to know that in real medical research, you often cannot withhold a standard of care treatment, so everyone will get that. Then additional treatments or placebo will be given in addition to that.

    He can’t possibly read much medical literature and think that completely withholding treatment (common in simplified examples) is the way you would always conduct these studies. No way.

  40. DrJoeinCAon 01 Apr 2014 at 6:22 pm

    Steve12: As Steven opined, this Aussie study is preliminarily a worthless study because there are only two arms, treat with A or treat with B. There are other variables which were not controlled for, such as IV solution in all patients and the fact that some people get better spontaneously without treatment.

    So, I ask you again as I asked Steven, when you treat a patient with standard treatment and compare it only to one other treatment, is it then reasonable to compare the outcomes? Please say yes.

    You are correct that his toy experiment did not use the standard of care drug versus placebo, but instead used an unknown drug versus placebo. And as he said there are other variables not controlled for that could muddy the conclusions. Therefore, the anecdotal experiment proved nothing other than that X=placebo, but we don’t know whether ANY treatment is better than no treatment unless we test the no-treatment option. “How would you ever know that people might have got better WITHOUT treatment if you treat everyone?” Which is what I asked.

    This is again not what we started with — and this is why these threads drag on so long — which is a comparison of standard of care with acupuncture.

  41. DrJoeinCAon 01 Apr 2014 at 6:30 pm

    Hoss: Oh, the science is settled on this one so no need to discuss a particular study that goes against your conclusions, huh?

    Steve12: Muddying it up again, huh? Look at what they did with the Aussie study or what we know of it. They gave some people the standard therapy and some acupuncture and some both. There was not a placebo and a drug X. That was not the study.

    “He doesn’t seem to know that in real medical research, you often cannot withhold a standard of care treatment, so everyone will get that. Then additional treatments or placebo will be given in addition to that.” You simply do not know what you’re talking about.

  42. sonicon 01 Apr 2014 at 7:00 pm

    It seems clear why these studies continue– it has to do with the scientific consensus on this subject–

    http://consensus.nih.gov/1997/1997Acupuncture107html.htm
    “Assessing the usefulness of a medical intervention in practice differs from assessing formal efficacy. In conventional practice, clinicians make decisions based on the characteristics of the patient, clinical experience, potential for harm, and information from colleagues and the medical literature. In addition, when more than one treatment is possible, the clinician may make the choice taking into account the patient’s preferences. While it is often thought that there is substantial research evidence to support conventional medical practices, this is frequently not the case. This does not mean that these treatments are ineffective. The data in support of acupuncture are as strong as those for many accepted Western medical therapies.”

    This document is from 1997, so much has been done since.
    I couldn’t find any info that would make me think this consensus has changed, however.
    I did find this from WHO 2004

    http://www.who.int/mediacentre/news/releases/2004/pr44/en/
    Empirical and scientific evidence exists to support the benefits of acupuncture, manual therapies and several medicinal plants for chronic or mild conditions. For instance, the effectiveness of acupuncture, a popular treatment for relieving pain, has been demonstrated both through numerous clinical trials and laboratory experiments. As a result, 90% of pain clinics in the United Kingdom and 70% in Germany include acupuncture as a form of treatment.

    More recently (June 2013)–

    http://www.ncbi.nlm.nih.gov/pubmed/24024341
    CONCLUSION: We found problems in conclusions based on results of controlled clinical trials of sham acupuncture in Germany. Therefore, there is still not enough evidence to support the statements that “acupuncture and sham acupuncture have no difference in treatment effect” and “acupuncture is just a placebo effect.”

    So it seems a researcher might do a study to find if the intervention is useful in a particular setting (emergency room) as it appears the consensus is that acupuncture is a useful intervention in other settings.

    Right?

  43. steve12on 01 Apr 2014 at 7:39 pm

    “And as he said there are other variables not controlled for that could muddy the conclusions.”

    No. You don’t understand what he said. Random assignment takes care of those other variables. Drug treatment is what’s manipulated! IOW, that’s all that differs between the groups given random assignment (low N not withstanding).

    “Therefore, the anecdotal experiment proved nothing other than that X=placebo, but we don’t know whether ANY treatment is better than no treatment unless we test the no-treatment option.”

    Anecdotal experiment? Things are unraveling for you…

    Any treatment is better than no treatment? We’re testing whether Drug X works. And this is solid evidence that it does not.

    “How would you ever know that people might have got better WITHOUT treatment if you treat everyone?”

    WTF??? You didn’t treat everyone with drug X!!!! That’s what we’re testing! Are you for real dude?

  44. steve12on 01 Apr 2014 at 7:42 pm

    “Steve12: Muddying it up again, huh? Look at what they did with the Aussie study or what we know of it. ”

    My bad. I’m only talking about Steve’s toy experiment, not the Aussie study.

    I have no idea what they did. If they publish a paper, maybe I’ll read it. They can tell a journalist that Leprachauns administered the acupuncture.

  45. grabulaon 02 Apr 2014 at 1:38 am

    DrJoeinCa is a chiropractor, he’s made that pretty clear. He hasn’t come out and said it yet but his defense of alt med and his rejection of science I think tell.

    “Oh, the science is settled on this one so no need to discuss a particular study that goes against your conclusions, huh?”

    Two things here. The consensus is moving firmly in the direction of useless. The second thing is the assumption that acupuncture is based on anything but hokum. There’s no science to even support the claims on acupuncture, much less it’s origins. I think most of us were confident that acupuncture wouldn’t hold up long before the studies started to show it doesn’t work. There’s no surprise there to anyone. On the side of science and the rational, it was pretty obvious it’s just woo. On the Woo and irrational side they’d already made up their minds regardless of what the science shows.

    The problem with guys like you DrJoe are that you want to attempt to argue subtleties without even understanding the basics. That’s a common theme amongst woo embracers on sites like these. They tend to gloss over really trying to understand the science enough to give it a nice spin. They come in swinging with slightly misdirected arguments that completely miss the important points. The fact that you guys keep coming back for more abuse is Einsteins definition of insanity.

  46. Bill Openthalton 02 Apr 2014 at 6:29 am

    As long as people continue to believe what goes against established scientific knowledge (i.e. acupuncture meridians, subluxations, homeopathic succussion, vital energy, magical force fields that are effective but not measurable, etc.), people will try and prove the unprovable.

    I think we have to accept the fragmented nature of human intelligence – people can study medicine and get a degree, and still believe in acupuncture and homeopathy. They will give more scientific sounding reasons (like “acupuncture releases endorphins”, or “water memory”), but what really matters is their belief.

    Belief trumps knowledge any time, anywhere.

  47. BillyJoe7on 02 Apr 2014 at 6:55 am

    DrJoe,

    “BillyJoe: I keep asking you to pay attention. “So why should Steven answer a question based on a made up anecdote?” Because he’s the one that made up the anecdote finding similar results”

    You’ve simply lost track!

    Here is the trail:

    DrJoe to Steven Novella:
    ” But what if the patient (Zorro) tells you it’s better, refuses further treatment, walks out of the ER with a smile on his face, and is back to work? Is the treatment, even if it’s something you think cannot possibly work, working?”

    BillyJoe to DrJoe:
    “So why should Steven answer a question based on a made up anecdote?”

    —————————————

    “Really? All studies without controls, blinding and random allocation are useless? I wonder where you get that from”

    Thanks for substituting “clinical trials” with “all studies” to make it look like you have collected a cookie.

  48. Hosson 02 Apr 2014 at 10:41 am

    “Oh, the science is settled on this one so no need to discuss a particular study that goes against your conclusions, huh?”

    I never suggested that discussion on any study should be squashed. Where the hell did you get that from? My referencing of the medical literature was to put the study into context.

    You’re dodging my question. Why should this study be analyzed outside of previous knowledge(the medical literature)? Also, there is nothing to be properly analyzed since the study has yet to be published.

    Just because I’m curious, but are you a practitioner of alternative medicine?

  49. etatroon 02 Apr 2014 at 12:12 pm

    I’m going to state the obvious and mention that none of the practitioners in the video were wearing gloves when they performed the procedure. I didn’t see any cleaning of the puncture site either. I wonder if their IRB knows the level of safety and risk-reduction from infection they’re (not) implementing in their research.

  50. Steven Novellaon 02 Apr 2014 at 12:54 pm

    Dr.Joe – My toy experiment was not meant to be an analog of the acupuncture study. It was meant to demonstrate a very simple principle to see if we can proceed from basic common ground. You seem to still think that I don’t believe patients when they tell me they feel better. That so thoroughly misses the point I wanted to settle some basics, but this still seems to be elusive.

    The only point I was making is that, even with a treatment that is demonstrably worthless, and in fact even with a treatment that causes harm, there will be some patients who get better. They will feel the treatment helped them, but I can know that it almost certainly didn’t.

    Saying the treatment did not work is NOT the same thing as saying the patient does not really feel better. We are trying to determine why they feel better, and specifically if the treatment contributed to them feeling better.

    Otherwise your just a rainmaker – keep doing your rain dance until it rains, then take credit.

    My criticism of the acupuncture study is not that they are studying acupuncture, but that they are doing a preliminary design in a field that already has matured to much more rigorous studies. What’s the point? Their study can answer nothing. Then to use it to promote acupuncture before even publishing the results is very dubious behavior.

    Sonic – regarding acupuncture, there are many biased reviews because of the documented extreme cultural bias with acupuncture. But if you look at all available systematic reviews, none of them demonstrate that acupuncture works for any indication. The quote about not proving it doesn’t work is misleading, and also is shifting the burden of proof. We have decades of research and thousands of studies, and they have yet to demonstrate that acupuncture works for anything. http://www.sciencebasedmedicine.org/acupuncture-doesnt-work/

  51. DrJoeinCAon 02 Apr 2014 at 1:37 pm

    StevenNovella: “Saying the treatment did not work is NOT the same thing as saying the patient does not really feel better. We are trying to determine why they feel better, and specifically if the treatment contributed to them feeling better.”

    This is the point. The patient feels better after the CAM treatment, and you agree with that. The patient had no other intervention in the half hour between when they had pain and when the pain went away. Your conclusion that CAM could not possibly have worked then leads you to “know” that there must have been something else that caused the relief of pain. Am I right so far?

    You propose there are other causes of this pain going away in half an hour such as regression to the mean, desire to please the CAM practitioner, self-deception, placebo effect, etc., all of which had to occur within the half hour of treatment but had not occurred beforehand. Often, as you know, patients use CAM as a last resort after having failed conventional treatment. So you propose that in the long period of conventional treatment they were undergoing beforehand, none of “other causes” that popped up during the CAM treatment appeared. Just so I understand.

    CAM treatment garners very high patient satisfaction, and this satisfaction is a result of several factors. The patient feels relief of symptoms, and the treatment is comfortable without any side effects. Hospitals and healthcare organizations are adopting CAM as a complement to standard medical treatment, and the reason they adopt it is overwhelmingly patient request. Patients request it because after treatment they feel better, and their symptoms are relieved. Organizations of medical professionals are suggesting that CAM can be used as an adjunct treatment when other treatments have not proven efficacious. CAM is being taught in some medical schools, and it is not being taught as something to be shunned.

    I’m not suggesting that CAM be used to treat disease, but it can be used effectively to alleviate patient symptoms. It is a harmless treatment modality that patients find makes them feel better. And that’s the bottom line. Patients come to you for relief of their symptoms and some of them get that relief following CAM treatment whether the studies show it or not.

  52. Bruceon 02 Apr 2014 at 1:59 pm

    And there we have it. The placebo gambit.

  53. steve12on 02 Apr 2014 at 2:08 pm

    I just want to hear DrJoe’s take on the toy experiment more. That was entertaining at least….

  54. sonicon 02 Apr 2014 at 2:10 pm

    Dr. N.-
    I agree that disclosing results before they can be verified is a bad idea… but it seems fairly common.

    It seems when I look for the consensus on this there is one– acupuncture is an effective tool for pain.
    If one assumes the practice is useful in many settings, then this study is just saying it is also effective in an emergency room setting– nothing really earthshaking when you consider the practice is successful just down the hall in the doctor’s office.
    I’m thinking this result is like saying that ‘ice melts when the temp. is exactly 41.023 degrees F’– not that anyone would doubt it, just never been specifically tested.
    For people who think acupuncture doesn’t work, this result is absurd and the study will be found full of holes and wanting in design and so forth.

    It seems a matter of what one thinks before this came out– not something about this study in particular.

  55. Bruceon 02 Apr 2014 at 2:51 pm

    “acupuncture is an effective tool for pain.”

    As much as a placebo is, yes.

  56. Steven Novellaon 02 Apr 2014 at 3:37 pm

    Sonic – I disagree with your assessment of the consensus. I think you are listening to proponents. If you read evaluations of the literature, it clearly shows that acupuncture does not work. Proponents have to say ridiculous things, like placebo acupuncture also works. They basically claim acupuncture works, then cite literature showing it doesn’t work.

    Dr. Joe – you are contriving a particular scenario that favors your assumptions. The thing is – if CAM modalities worked as you suggest, why do these miraculous results vanish when proper blinding is applied?

    Effects that vanish under properly blinded and controlled observation are not real effects, they are illusions. That is a pretty good rule of thumb, anyway.

    You are also making assumptions about CAM satisfaction and the reasons for it – assumptions that serve your position. Patient satisfaction tracks better with bedside manner than actual outcomes. But we don’t want to just schmooze the patients, we want to actually make them better.

    You further falsely conflate the position that evidence shows a treatment does not work vs the a-prior assumption that it cannot possibly work. These are two different things. I only reject acupuncture because the research overwhelmingly shows it does not work. Homeopathy, on the other hand, cannot possibly work, and the clinical evidence shows that it doesn’t work.

    So – if a patient feels better after taking homeopathy, this was not an effect of the homeopathy. It may be difficult to figure out exactly why an individual patient feels better, but I can say it was not the homeopathic treatment.

  57. BillyJoe7on 02 Apr 2014 at 4:10 pm

    Well he’s still at it – spinning made up stories and using them as evidence for his claims!

    In the example above, we have a patient who has tried everything evidence based medicine can offer who finally tries a treatment (that has been shown not to work) and having his pain completely and permanently relieved within half an hour after a single session of this treatment.

    I’ve spun it a bit further, but that’s essentially what he’s saying.
    He’s made up a story about an imaginary patient and is using it to justify sending patients for treatments that have been shown not to work.

    How can we argue against that!

  58. steve12on 02 Apr 2014 at 4:15 pm

    I have no idea what goes on in medical school, but some MDs I’ve met seem not to have had training in basic experimental methods /logic. Other MDs I work with (albeit in research) are brilliant scientists. Seems very uneven.

    Is training in basic research methods something that most med schools do?

  59. BillyJoe7on 02 Apr 2014 at 4:20 pm

    SN: “They will feel the treatment helped them, but I can know that it almost certainly didn’t”
    DrJoe: “The patient feels better after the CAM treatment, and you agree with that”

    Nope.
    The patient feels better after the CAM treatment but we can know that it almost certainly didn’t.
    Let that point sink in.

  60. BillyJoe7on 02 Apr 2014 at 4:29 pm

    SN: “Proponents have to say ridiculous things, like placebo acupuncture also works”

    There’s a famous migraine study in which the authors conclude that true and sham acupuncture work equally well. They declare that the question of whether or not acupuncture works has been settled and that sham acupuncture trials are no longer necessary (because it works just a well as true acupuncture) and that future trials should centre on defining which protocols work best!

    Welcome to the world of CAM!

  61. BillyJoe7on 02 Apr 2014 at 4:43 pm

    “For people who think acupuncture doesn’t work…”

    Acupuncture doesn’t work:

    No Chi.
    No meridians.
    Nothing special about acupuncture points.

    Doesn’t matter where yopu stick the needles in.
    Doesn’t matter how far you stick the needles in.
    Doesn’t matter if you don’t stick them in.

    “…this result is absurd and the study will be found full of holes and wanting in design and so forth.”

    It’s already been shown to be worthless:

    No random allocation.
    No blinding.
    No control.

  62. Karl Withakayon 02 Apr 2014 at 5:06 pm

    It’s worth pointing out that many proponents of acupuncture are now left trying to defend non-specific &/or subjective claims for a modality that was not supposed to be limited to such non-specific &/or subjective claims.

    In well controlled, properly blinded studies, acupuncture has been consistently shown not to work for objective claims. (Frankly, the same holds true for subjective claims as well.)

    It’s also been shown that acupuncture is indistinguishable form sham acupuncture (poking with toothpicks), and that the location of needling/poking is irrelevant to any claimed effects.

    From the original claim(s) that penetrative needling at specific, non-local points (chi points) can achieve all sorts of (unrelated) significant, specific, objective, physiologic, therapeutic effects, we are left with the thin gruel that acupuncture has subjective effects (for things like pain, nausea, etc) indistinguishable from placebo, which quite often aren’t even clinically significant in scale.

    Why are we still talking about this again? The emperor’s nude; let’s move on.

    Also, occasionally, as with the asthma study, proponents will argue that subjective effects (if indeed really present) are important when they’re really not. For asthma (among many other conditions), the objective measures are the ones that really matter. In fact, improving someone’s subjective assessment of their condition with zero improvement of the objective measures can be detrimental. It’s not entirely unlikely that someone who felt their asthma (or blood pressure, blood sugar, etc) was effectively managed by acupuncture/homeopathy, etc might be more likely to leave their actual medication at home.

  63. DrJoeinCAon 02 Apr 2014 at 5:57 pm

    StevenNovella: “You are also making assumptions about CAM satisfaction and the reasons for it – assumptions that serve your position. Patient satisfaction tracks better with bedside manner than actual outcomes.” CAM is not concerned with influencing the “actual outcomes” of the treatment of disease but only with symptom alleviation. Traditional medicine treats disease. CAM does not. You are right. I am assuming that patients who undergo CAM and express satisfaction with it would likely be satisfied with the outcome of the CAM treatment.

    “Effects that vanish under properly blinded and controlled observation are not real effects, they are illusions. That is a pretty good rule of thumb, anyway.” Again, there’s this argument that the patient is experiencing something that is not real, that is an illusion.

    The problem I have with this is that there is such a large gap between what the studies show and what clearly is a high level of patient satisfaction with the treatment and increasing adoption of CAM by the medical establishment. (You and others assume that acupuncturists and chiropractors and others have better bedside manner and this contributes to better satisfaction. I’m not so sure about that. Why would that be and shame on physicians if that’s so.)

    This is a problem that needs reconciliation. You are convinced that acupuncture does not work, and yet I’m sure you and your colleagues have seen patients who claim to have benefitted from it when traditional means of treatment have failed. The level of satisfaction is high, the risk is negligible, the cost is low, hospitals are adopting it, medical schools are teaching about it, physician societies are recommending it as an option for treatment. How do you reconcile the fact that this is something that is so obvious to you and not so obvious to patients, hospitals, medical schools, and physician societies?

  64. steve12on 02 Apr 2014 at 6:08 pm

    DrJoe:

    How do YOU interpret placebo controlled studies that show CAM treatments are no better than placebo?

    We know what you think clinically, but what is your interpretation of this result?

  65. Ekkoon 02 Apr 2014 at 7:17 pm

    @DrJoeinCA,

    “CAM is not concerned with influencing the “actual outcomes” of the treatment of disease but only with symptom alleviation.”
    Wat? This is the complete opposite of what most CAM practitioners claim. They claim that mainstream medicine is all about symptom alleviation and that CAM is more holistic and deals with root causes, etc.

    “I am assuming that patients who undergo CAM and express satisfaction with it would likely be satisfied with the outcome of the CAM treatment.”
    So in other words, satisfied patients are satisfied?

    “Again, there’s this argument that the patient is experiencing something that is not real, that is an illusion.”
    Yes, correct. And the illusion of feeling better does not last based on placebo effects alone.

    The rest of your post is mostly an argument based on popularity and I shouldn’t have to explain why this alone is fairly vacuous in terms of effectiveness. Also this part “the cost is low” I would question. What is the average cost of an acupuncture treatment session? How many sessions are required before a “cure” is effected? What is the opportunity cost to the person if and when no results are effected?

    I also shouldn’t have to explain that falling back on “patient satisfaction” alone as a selling feature for a treatment is pretty weak. Surveys of satisfaction are notoriously rife with self-selection biases and other biases like the Hawthorne effect.

  66. grabulaon 03 Apr 2014 at 12:47 am

    @Hoss

    “Just because I’m curious, but are you a practitioner of alternative medicine?”

    DrJoe answers here:

    “CAM treatment garners very high patient satisfaction, and this satisfaction is a result of several factors.

  67. grabulaon 03 Apr 2014 at 5:25 am

    @”Dr”Joe

    your true colors are starting to show Joe, be careful:

    “This is a problem that needs reconciliation. You are convinced that acupuncture does not work, and yet I’m sure you and your colleagues have seen patients who claim to have benefitted from it when traditional means of treatment have failed.”

    This statement shows you’ve totally missed the point. Whether they believe it or not doesn’t matter. CAM doesn’t work, what they think works is irrelevant to how they should be treated.

    “The level of satisfaction is high”

    So? I’m not a doctor but I’ve never heard one talk about satisfaction of the patience being a necessity for proper treatment.

    “the risk is negligible, the cost is low”

    You’ve already been told and been given resources to links showing the dangers of certain fakemed. The risk is not negligible and the cost can be extremely high. Especially when all you’re paying for is to have someone lie to you.

    “hospitals are adopting it”

    Ah yes, hospitals need to make money and they can charge…what was the word again a ‘negligible’ cost for fake treatments?

    “medical schools are teaching about it”

    The school you got your “dr” at possibly, no credible medical school is teaching CAM. Oh I understand some small schools have been infiltrated by fakemed practitioners but most of those had already stepped off the deep end, and some places will do anything – like fakemed practitioners – for a buck.

    “physician societies are recommending it as an option for treatment.”

    Dr. Oz’s book club doesn’t count. People of your ilk throw around words like ‘physician’ and ‘doctor’ as if calling certain people that makes them those things. Finally, physicians are human and also make mistakes. Some of them have been led astray, whether by the lure of money or credulous thinking. I personally know an individual pursuing a doctorate in Geology who literally believes the earth is 6000yrs old…

    “How do you reconcile the fact that this is something that is so obvious to you and not so obvious to patients, hospitals, medical schools, and physician societies?”

    Taking all of those into account that buy into the fakemed you do, they still only represent a very tiny slice of the populous who have been misled.

    You’ve been refuted on every point joe, you’ve been provided resources and evidence to lead you to the truth. You’ve had a real doctor try to explain to you how ethical and science based medicine works. I imagine the incense and aroma therapy candles around your computer are making your eyes water and confusing you so much you’re having a hard time following the trail of breadcrumbs.

    Even the one guy here who agrees with you, only agrees with you on certain points lol.

  68. Bruceon 03 Apr 2014 at 7:21 am

    @DrJoeinCA,

    “CAM is not concerned with influencing the “actual outcomes” of the treatment of disease but only with symptom alleviation.”

    Aside from what Ekko has already said, what he is saying is that CAM just wants to make you feel better, it doesn’t want to actually make you better. There is a massive false dichotomy here in that he is implying it is either make you feel better or make you better. As far as I know medicine is about both… CAM is about the feels only.

    His response will be along the lines of “If you feel better then you are better” and we will go into yet another round of this wonderful circular argument he has created.

    My advice to all here is to not engage in responding to something he says that has been addressed many many times before.

  69. BillyJoe7on 03 Apr 2014 at 7:25 am

    DrJoe has put everything that demolishes his claims into a black box to be hidden away and ignored.

    Into the black box goes the evidence that the treatment does not work.
    Into the black box goes the evidence that patients can misreport their subjective experience.
    Into the black box goes the objective tests of subjective reports.

    The only thing left outside the black box is the patient’s report.

    DrJoe believes without question the patient’s report and he can do so only by hiding away and ignoring:

    - the evidence that the treatment does not work.
    - the evidence that patients can misreport.
    - the objective tests of subjective reports.

    But I repeat myself.

  70. BillyJoe7on 03 Apr 2014 at 7:29 am

    …sorry Bruce, I didn’t see your post.
    Yes, we should stop kicking the rotting corpse of a dead horse.

  71. DrJoeinCAon 03 Apr 2014 at 1:58 pm

    Choir: Missed it again, huh? The horse is not dead. You are kicking a spot where the horse was. The horse, in fact, has left the barn. The ship has sailed. The bird has flown.

    Patients are using CAM, doctors are prescribing it, hospitals are using it, medical schools are teaching about it, healthcare organizations are using it, insurance companies are paying for it, physician organizations are recommending it as complementary care, care guidelines are recommending it as complementary care. All the entities that matter are increasingly adopting CAM because patients like the results of CAM. This is what is known in the real world as “settled.”

    So I would say those of you who piss and moan about the reality of the situation — which, in case you are not paying attention, is that CAM is now part of American medicine — that you are behind the curve, grasping at straws, whistling in the dark, peeing up a rope, whatever you find is more soothing.

    All together now: “But, but, but…”

    Maybe you can find another topic you can actually do something about like, I dunno, climate change. Oh, wait, you can’t do anything about that. How about the existence of God? Oops, nothing there either. How about chiropractic? Nope, that’s part of CAM. Gee, maybe there’s nothing. Well, I guess there’s always Bingo. There’s enough members of the choir here to make a good game.

    I will wait for StevenNovella to answer my last question about reconciliation.

  72. steve12on 03 Apr 2014 at 2:03 pm

    “atients are using CAM, doctors are prescribing it, hospitals are using it, medical schools are teaching about it, healthcare organizations are using it, insurance companies are paying for it, physician organizations are recommending it as complementary care, care guidelines are recommending it as complementary care. All the entities that matter are increasingly adopting CAM because patients like the results of CAM. This is what is known in the real world as “settled.””

    Appeal to popularity? Really?

    But you can’t answer this simple question?:
    How do YOU interpret placebo controlled studies that show CAM treatments are no better than placebo?
    We know what you think clinically, but what is your interpretation of this result?

  73. Hosson 03 Apr 2014 at 2:55 pm

    JoeinCA
    “How do you reconcile the fact that this is something that is so obvious to you and not so obvious to patients, hospitals, medical schools, and physician societies?”

    Since when is the truth necessary to move people or groups into action?

    http://en.wikipedia.org/wiki/Argumentum_ad_populum

    Can you see the fallacy you’re making now? Its already been pointed out, which was more than adequate, but I thought I’d drive the point home.

    Feel free to continue to ignore sound arguments against your already discredited beliefs. You know there is a phrase for what you’re doing(you’re doing a lot, but I’ll focus on this one). I’ll give you a hint – it is a type of bias.

  74. Draalon 03 Apr 2014 at 2:57 pm

    “Maybe you can find another topic you can actually do something about like, I dunno, climate change. Oh, wait, you can’t do anything about that. How about the existence of God? Oops, nothing there either. How about chiropractic? Nope, that’s part of CAM. Gee, maybe there’s nothing. ”

    Is there something akin to a voter’s fallacy? That an individual’s vote will change the outcome so why bother.

    There are many things that can be done as an individual do but more can be done as a group. Congrats on missing that point.

    DrJoe, there many examples in American history where grass root movements have changed this country. If you cannot see that activism can affect the status quo, you have blinders on.

    - DrJoe in MI

    (what are you a doctor of anyways?)

  75. Hosson 03 Apr 2014 at 3:00 pm

    Whoops. I guess I shouldn’t use “” since it made some of my text disappear.

    “This fallacy is sometimes committed while trying to convince a person that a widely popular thought is true.
    Nine out of ten of my constituents oppose the bill, therefore it is a bad idea.
    Fifty million Elvis fans can’t be wrong.
    Everyone’s doing it.
    In a court of law, the jury vote by majority; therefore they will always make the correct decision.
    Many people buy extended warranties, therefore it is wise to buy them.
    Millions of people believe in God.
    The majority of this country voted for this President, therefore this president can’t be wrong
    [Patients are using CAM, doctors are prescribing it, hospitals are using it, medical schools are teaching about it, healthcare organizations are using it, insurance companies are paying for it, physician organizations are recommending it as complementary care, care guidelines are recommending it as complementary care. All the entities that matter are increasingly adopting CAM because patients like the results of CAM. This is what is known in the real world as “settled.”]”
    http://en.wikipedia.org/wiki/Argumentum_ad_populum

  76. Ekkoon 03 Apr 2014 at 3:17 pm

    “So I would say those of you who piss and moan about the reality of the situation — which, in case you are not paying attention, is that CAM is now part of American medicine — that you are behind the curve, grasping at straws, whistling in the dark, peeing up a rope, whatever you find is more soothing.”

    Apparently a lot of young people like Justin Bieber’s music. It is very popular with a certain demographic. But eventually they will outgrow it. It just won’t sound pleasant anymore the way it once did. Placebo effects and the mystique of certain ineffective CAMs are much the same way. People are often willing to try anything for a little while. A lot of people who try chiropractic or homeopathic treatments really understand very little about it and are too trusting of the claims being made. That is where education and the role of skeptics and science helps. There are certain aspects to CAM, or things that have been co-opted under the umbrella of CAM, that actually have real effects and positive health benefits and hopefully those will stay. But eventually, even if something is temporarily enjoying an upswing in popularity as a fad, things that just don’t work get discarded. Placebo effects do not have any kind of lasting impact. Repeat customers will dwindle. Fads will fade away.

    There is also a large and growing upswing of increased appreciation and emphasis on scientific evidence, logic, rational thought, etc. in the general public as a response to the machinations of climate change deniers, conspiracy theorists, anti-vaccinationists, creationists, and various snake oil salesmen of ineffective therapies and products. People are increasingly asking for and placing value on scientific evidence for therapies. They don’t want something that simply gives them a placebo effect. I know it can be hard to relinquish cherished beliefs in the face of mounting evidence, but it’s really the only way forward for personal growth and to not live in a fog of cognitive dissonance.

  77. BillyJoe7on 03 Apr 2014 at 3:42 pm

    DrJoe,

    “So I would say those of you who piss and moan about the reality of the situation…that you are behind the curve, grasping at straws, whistling in the dark, peeing up a rope, whatever you find is more soothing.”

    Say that to:

    Slaves.
    Blacks.
    Women.
    Gays.
    Atheists.

    Some people believe that what is right actually matters.

  78. DrJoeinCAon 03 Apr 2014 at 3:49 pm

    Choir: The “people who matter” include the providers of healthcare, the organizations of providers of healthcare, the patients, the insurance companies. The first two are the ones who set the standards for medical practice. Who else would you consult to determine what the standard for medical practice is? A software engineer? That is neither an argument of “popularity” nor a “widely popular thought.” The third are the ones who benefit from the practice. The fourth are the ones who pay for it. And don’t forget the medical students who are being taught about it. So you got the ones who set the standards, the ones who benefit from it, the ones who pay for it, and the providers who will shortly be in practice. I think that probably about takes care of everyone who matters.

    Re “grass roots movements” changing the country, this IS the grass roots movement that is changing the country. It certainly is changing the way medicine is practiced. Re “fads,” could be a fad, but the fad has not run its course yet.

    As Snoopy said regarding theology, “Has it ever occurred to you that you might be wrong?”

  79. steve12on 03 Apr 2014 at 4:24 pm

    “Has it ever occurred to you that you might be wrong?”

    How do you figure out who’s wrong? Evidence and debate. YOu refuse to engage in a good faith way (because you were RIGHT!) and then say this? Did you ever consider that you’re wrong? (answer:no)

    What an absurd thing to say.

    Money talks, BS walks: when we got down to the nitty gritty of experiment interpretation, you bailed after showing that you don’t understand the very experiments that actually CAN answer the question of who’s wrong.

    Your witchcraft anti-science views will always be around in some form, but the modern world s based on science and technology.

  80. BillyJoe7on 03 Apr 2014 at 4:24 pm

    DrJoe,

    Bloodletting used to be standard medical practice.

    Also, as a chiropractor, do you also prescribe homoeopathy?
    If not, why not?
    (After all, it’s popular!)
    If so, why?
    (Do you think it works?)

    “As Snoopy said regarding theology, “Has it ever occurred to you that you might be wrong?””

    Yes.
    Up till the age of sixteen, I was a devout theist.
    Then it occurred to me that I might be wrong.

  81. steve12on 03 Apr 2014 at 4:26 pm

    I mean, you’re dodging an open ended question. YOu can aways stop the nonsense and answer:

    “How do YOU interpret placebo controlled studies that show CAM treatments are no better than placebo?
    We know what you think clinically, but what is your interpretation of this result?”

    THIS is where correct and incorrect are settled. Not by appeals to pop and insults that we thing in lockstep.

  82. sonicon 03 Apr 2014 at 4:58 pm

    Dr. N.-
    I’m not a big advocate of believing the consensus is correct- but it does seem that when I look at this area what I find is that their is large agreement that acupuncture is useful– perhaps effective is too strong.
    I gave the NIH evaluation and the WHO in support.

    You might be right about what the current actual consensus is, but I wouldn’t be surprised if these researchers and a reporter might see it differently- and referencing yourself would probably not be overly convincing.

    Of course this has little to do with whether or not it is actually useful.

  83. Hosson 03 Apr 2014 at 5:12 pm

    Joe(I don’t understand logic)inCA
    The premises you are presenting are irrelevant to your conclusion. You’re doing nothing more than presenting red hearings in the form of arguments of popularity and of authority. Explaining why you chose a particular authority and populace for you argument does not make your argument valid.

    “As Snoopy said regarding theology, “Has it ever occurred to you that you might be wrong?””

    Let me reread your arguments and the counterarguments against you.
    You’re definitely grasping at straws trying to justify using CAM treatments.

    My impression of you.
    I know CAM has no efficacy as demonstrated by clinical trials….but…but….patient satisfaction….and everyones doing it too. Sooooooooo why not? *Puts fingers in ears.* LALALA I’m not listening. LALALA

  84. DrJoeinCAon 03 Apr 2014 at 6:26 pm

    Hoss and the Choir: “The…providers of healthcare [and] the organizations of providers of healthcare…are the ones who set the standards for medical practice.” It is not necessary or productive to litigate every study upon which the standards are based. The presumption is that his colleagues have looked at the studies and formed a conclusion based on them. A provider either accepts the standards or he doesn’t.

    Sometimes it doesn’t matter. In the treatment of disease, it does matter. Physicians treating diabetes and heart disease and cancer, for example, should have a very good reason for not following the standards of care determined by his peers.

    In the treatment of symptoms such as pain, it doesn’t matter. In some cases, though the peer groups have “ok’d” the use of CAM for certain conditions, the physician may choose not to use/recommend/advise CAM for symptom relief. That’s individual physician preference.

    However, if a provider IS practicing in the recommended way and those recommendations include the use of CAM, then he IS practicing according to standards and cannot be faulted for doing so. Except of course by non-physicians who wouldn’t know good patient care if they tripped over it.

  85. RickKon 03 Apr 2014 at 8:06 pm

    CAM standards?

    You’ve made it clear that medicinal efficacy is whatever you can convince the patient to believe.

    So aren’t CAM standards whatever some group of CAM elites can get their practitioners to believe?

    The FDA should drop efficacy requirements and let the pharma companies spend that money on developing more convincing theater.

  86. BillyJoe7on 04 Apr 2014 at 5:47 am

    Rick: “You’ve made it clear that medicinal efficacy is whatever you can convince the patient to believe”

    I think you meant: whatever the patient can convince their practitioners to believe.

  87. grabulaon 04 Apr 2014 at 6:08 am

    I’ve grown bored. “Dr”Joe has been called out so many times on his BS he has no idea how to answer anymore. He’s on the defensive, dehumanizing his enemy the “Choir”, desperately claiming a few Doctors make a consensus and that CAM has standards and works while at the same time admitting all it does it make people think they feel better. It’s become embarrassing but how could the endgame have possibly ended for an irrational person trying desperately to vindicate his irrational belief system to a rational populace? There seems to still be some confusion as to where Joe is coming from so let’s lay it all down.

    1 – Joe is not an MD, he’s a chiropractor or some other fakemed practitioner who’s claiming a degree I’m guessing wouldn’t be recognized in a real medical facility.

    2 – He’s into the woo. Chiropracty, homeopathy and science denial.

    3 – His faith is unassailable. While constantly being given evidence showing his stance is wrong he’s continued to bark like a dog on a chain.

    I think we can move on, right now much like Will N, I think he’s just here to entertain himself and for any serious discourse (obviously).

  88. BillyJoe7on 04 Apr 2014 at 6:30 am

    The Australian Medical Association has this position statement regarding CAM.

    https://ama.com.au/position-statement/complementary-medicine-2012

    Here are some excerpts:

    “there is limited efficacy evidence regarding most complementary medicine. Unproven complementary medicines and therapies can pose a risk to patient health either directly through misuse or indirectly if a patient defers seeking medical advice”

    “There is a substantial gap between the use of complementary medicine and the evidence to support that use”

    “Evidence-based, scientific research in the form of randomised controlled trials is required to validate complementary medicines and therapies for efficacy, safety, quality, and cost effectiveness so that practitioners and consumers can evaluate the potential benefits and any adverse effects”

    “Third party funding should only provide benefits for complementary therapies if they are supported by good quality scientific evidence of safety and efficacy”

    “Medical practitioners should have access to education about complementary medicine in their undergraduate, vocational and further education to provide advice to patients. They should be informed of the level of scientific evidence for both benefits and adverse reactions”

    “Medical practitioners should be able to explain the level of evidence for all medicines and therapies they utilise to help patients make an informed choice”

    “Consumers should have access to accurate information and education about the level of evidence for complementary medicines and therapies in order to make well-informed choices. This should include the risks and opportunity costs of delaying conventional treatment”

    “The majority of complementary medicines do not meet the same standards of safety, quality and efficacy as mainstream medicines as they are not as rigorously tested. Information about the level of testing and evidence should be easily accessible by medical practitioners, consumers and complementary medicine practitioners”

    “Government agencies…and educational bodies…should ensure information on the safety, quality, efficacy and cost effectiveness of complementary medicines is readily available to consumers and health practitioners”

    Sounds like a pretty good standard for medical practitioners in Australia to follow.
    I can’t imagine it would be different in the USA.
    Certainly a better standard than “just give the patient what they want”

  89. grabulaon 04 Apr 2014 at 6:46 am

    @billjoe7

    You’d be surprised. Financial pressure as well as popular pressure can amount to a lot in many of our systems here in the US. When cornered on why they allow fakemed into occasional hospitals and schools it often boils down to money, or the misled attitude that if the patients want it and it “does no harm” why not since they can charge for it. Unfortunately we’re behind the curve here in the US and I think we’re going to have to rely on other countries who are making better headway to lead the charge on this. I’m confident it won’t become as prevalent as fakemed practitioners claim or think it is now but the fact that it’s infiltrated the way it has now is embarrassing.

    I think it’s a weakness of our capitalist society. Since we charge for medicine, the medical sector feels a lot of pressure to bring in money to support programs, or just to keep the places running.

    Also keep in mind that our society is easily deceived by those claiming to know what’s going on. Just look where a lot of these guys and gals come from…Jenny McCarthy, Dr. Oz, Oprah the list goes on.

  90. DrJoeinCAon 04 Apr 2014 at 12:26 pm

    BillyJoe: “The purposes of CAM education should be:
    a. To emphasise the provision of appropriate, non-judgemental medical care;
    b. To equip students with sufficient knowledge of CAM to be able to analyse and evaluate individual therapies on their scientific merits;
    c. To provide an awareness of the types of treatments many patients are using;
    d. TO DISTINGUISH BETWEEN APPROPRIATE AND POTENTIALLY HARMFUL CAM PRACTICES; which will allow students to guide patients safely and accurately in their use of CAM;
    e. Educate for harm minimisation e.g. teaching about potentially harmful interactions with concurrent usage of enzyme inducing herbs such as St John’s Wort [8];
    f. TO ENSURE UNDERSTANDING OF THE INTERACTION BETWEEN CONVENTIONAL MEDICINE AND CAM IN THE DELIVERY OF HOLISTIC AND INTEGRATED HEALTHCARE”

    Source: Australian Medical Students Association. My caps.

  91. DrJoeinCAon 04 Apr 2014 at 12:36 pm

    Grabula: “desperately claiming a few Doctors make a consensus”

    Maybe we should let the non-doctors determine what the standard of care is. Maybe software engineers or professional skeptics or other people who have no idea at all about patient care.

    I seriously doubt that you would be able to find ANY society of medical professionals that says that CAM should NEVER be used.

    But, but, but, it doesn’t work! It’s a scam, a farce, a con, woo! Chiropractic is the same as bloodletting and killing chickens and witch doctors! Really, the louder you say that the more people will listen.

  92. Hosson 04 Apr 2014 at 12:54 pm

    “Dr”JoeinCA
    “Maybe we should let the non-doctors determine what the standard of care is. Maybe software engineers or professional skeptics or other people who have no idea at all about patient care.”

    Not a single person here said nor implied that. You’re arguing with your own straw man.

  93. steve12on 04 Apr 2014 at 1:11 pm

    “Maybe we should let the non-doctors determine what the standard of care is. Maybe software engineers or professional skeptics or other people who have no idea at all about patient care.”

    Straw man. We’re proposing scientists familiar with appropriate experimental techniques nterpret results, not software engineers or whatever.

    YOu still refuse to discuss the experiments.

    The scenario Steve gave you is interpretable, and mirrors many results. YOU don’t understand that, ergo YOU are not in any position to adjudicate the effectiveness of CAM.

    This is why you’re dodging experimental interprtation – you don’t understand it.

  94. DrJoeinCAon 04 Apr 2014 at 2:09 pm

    Steve12, Hoss: “We’re proposing scientists familiar with appropriate experimental techniques nterpret results, not software engineers or whatever.” And don’t forget Grabula: “desperately claiming a few Doctors make a consensus” and “physicians are human and also make mistakes. Some of them have been led astray.”

    And I’m proposing that medical doctors interpret results and determine the standard of care. See the difference? Medical doctors, not “scientists.”

    Maybe that’s what the choir does not get, the difference between “scientists” and “doctors.” That would explain a lot.

  95. steve12on 04 Apr 2014 at 2:23 pm

    dodge,dodge,dodge

    TALK ABOUT THE WORK!!!!

    It’s all that can adjudicate the question

  96. DrJoeinCAon 04 Apr 2014 at 2:50 pm

    Steve12: “The…providers of healthcare [and] the organizations of providers of healthcare…are the ones who set the standards for medical practice.” It is not necessary or productive to litigate every study upon which the standards are based. The presumption is that his colleagues have looked at the studies and formed a conclusion based on them. A provider either accepts the standards or he doesn’t.”

    It’s not about the individual studies; it’s about the medical standards of care. StevenNovella has looked at the studies and formed HIS conclusion that CAM does not work and shouldn’t be used. But others (hospitals, healthcare organizations, physician organizations, Aussie medical students, etc.) have looked at the same data and concluded that there IS a role for CAM as a complement to standard medical care.

    So the practitioner makes his decision from the available information he has.

  97. Hosson 04 Apr 2014 at 2:53 pm

    “Dr”JoeinCA
    “And I’m proposing that medical doctors interpret results and determine the standard of care. See the difference? Medical doctors, not “scientists.”
    Maybe that’s what the choir does not get, the difference between “scientists” and “doctors.” That would explain a lot.”

    You do understand that medical doctors and scientist are not mutually exclusive, right? Clinical research is science. I’m not familiar with the best methods for establishing or revising medical standards, but I would think that medical scientist would have a major role in the discussion about standards.

    You’re also misunderstanding Grabula’s point.

  98. steve12on 04 Apr 2014 at 3:13 pm

    Sandy Koufax should have been as good a Dodger.

  99. Hosson 04 Apr 2014 at 3:26 pm

    I wish my dodging skills in Dark Souls 2 were as L33T as DrJoe’s logic dodging skills.

    Oh no….I semi-talked to someone other than DrJoe. Now we are going to hear more about the choir.

  100. steve12on 04 Apr 2014 at 3:28 pm

    I have to say, I know my Koufax and Drysdale better than my Dark Souls!

    Dr. Joe would have made that rotation a 3 headed monster! Greatest ever!

  101. BillyJoe7on 04 Apr 2014 at 4:59 pm

    DrJoe,

    I would have difficulty accepting the position statement of medical students above that of qualified medical practitioners if their respective position statements were different.
    But you could at least have quoted them in full:

    http://media.amsa.org.au/policy/2014/201403_CAM_in_Medical_Education_Policy.pdf

    AMSA supports the evidence-based education of CAM by qualified clinicians in medical programs across Australia insofar as it is important for students to understand commonly used CAM practices to ensure a holistic approach to patient management and wellbeing.

    AMSA believes that:
    1. Evidence-based methodology should be the cornerstone of medical practice;

    2. Medical education in Australia should incorporate an awareness of the underlying principles
    and practices behind the most frequently used Complementary and Alternative Medicines in
    Australia;

    3. CAM education may be incorporated with the view to facilitate greater discussion between
    patient and doctor regarding the appropriate use of CAM;

    4. The purposes of CAM education should be:
    a. To emphasise the provision of appropriate, non-judgemental medical care;
    b. To equip students with sufficient knowledge of CAM to be able to analyse and evaluate individual therapies on their scientific merits;
    c. To provide an awareness of the types of treatments many patients are using;
    d. To distinguish between appropriate and potentially harmful CAM practices; which will allow students to guide patients safely and accurately in their use of CAM;
    e. Educate for harm minimisation e.g. teaching about potentially harmful interactions with concurrent usage of enzyme inducing herbs such as St John’s Wort;
    f. To ensure understanding of the interaction between conventional medicine and CAM
    in the delivery of holistic and integrated healthcare;

    5.CAM education should be taught by:
    a. Health practitioners who have knowledge and experience of utilising CAM in practice, and who teach within an evidence based framework with a view to provide better awareness about CAM

    This provides no support for your motto: “give patients what they want”
    Thank you for playing.

  102. BillyJoe7on 04 Apr 2014 at 5:06 pm

    However, I disagree with their use of the phrase “integrated care”.
    It should be “science-based care” or “evidence-based care” which would be more in tune with the rest of their position statement.

  103. DrJoeinCAon 04 Apr 2014 at 5:17 pm

    BillyJoe: And you probably disagree with “appropriate” and “allow student to guide patients safely and accurately in their use of CAM” and “interaction between conventional medicine and CAM” and “taught by health practitioners who have knowledge and experience of utilizing CAM in practice” too. No matter.

    Their position that there is a role for CAM is pretty clear. Thanks for sharing that with the choir. This is the real grass roots movement referred to previously.

  104. DrJoeinCAon 04 Apr 2014 at 5:24 pm

    Hoss: “I’m not familiar with the best methods for establishing or revising medical standards, but I would think that medical scientist would have a major role in the discussion about standards.” Medical standards are determined by physicians. Period. The non-doctor scientists do not determine medical standards. Period.

    Otherwise — ah you know already, don’t you? — we would have non-doctors telling doctors how to practice. And that does not happen.

  105. Draalon 04 Apr 2014 at 5:41 pm

    “This is the real grass roots movement referred to previously.”
    I said grass roots movement, and I was referring to them in general, not your specific ‘real’ movement. So, no. uh uh. bad parrot.

    Medical stds are crafted by many parties including congress folk. If you can not see how what should be a medical system is influenced by those without medical training, prehaps you will consider the following:
    K-12 education standards are influenced by those who are not educators. Teaching of creationism along side of evolution (google Steve’s blog for examples). So Dr Joe in CA, do you agree or disagree that creationism should be taught in schools and the curriculum should not be shaped by non-educators? One is scientifically based, the other is not. Yet creationism is accepted by many. You see how standards can be influenced by those who are not experts? Same applies to medical standards.

  106. DrJoeinCAon 04 Apr 2014 at 5:47 pm

    Choir: And lest you think that American medical students are behind the curve:

    “AMSA’s working position statement on Integrative Medicine

    “AMSA believes that students and physicians can best serve their patients by recognizing and acknowledging the availability of integrative medicine in their communities. By pursuing education in complementary and alternative medical (CAM) treatments, medical students and physicians can better facilitate the appropriate education, treatment and counseling of patients and consumers.

    “AMSA believes that an empowered patient can serve as a powerful and central actor in their own healing.
    Appropriate education in CAM treatments uses scientific and ethnographic methods, including quantitative and qualitative outcomes research of efficacy and effectiveness. Although it is informed by evidence, it considers explanatory models and cultural.
    AMSA supports students who wish to work within the healthcare system to create an environment which is supportive of the whole patient.
    AMSA believes that medical students and other health care professionals need to be restored and whole in order to be empowering and healing for their patients.”

    Sorta touchy feely, huh?

  107. DrJoeinCAon 04 Apr 2014 at 5:58 pm

    Draal: Medical STANDARDS OF CARE are not “crafted” by non-medical folks. That’s just simply false. Doctors determine their own standards of care since they are the ones with knowledge, training, and experience in caring for patients. Whereas, others do not have such qualifications.

    Yeah, this is the real grass roots movement I referred to earlier. That was in response to someone (you?) who said the grass roots movement is away from stuff like CAM. In fact, it is the opposite.

  108. Draalon 04 Apr 2014 at 6:28 pm

    So then… you are a Creationist? Figures.

    At a very minimum, statisticians influence medical standards ’cause their the guys telling the docs what they are doing is working or not. Another example, medical standards are influenced by the companies that pay for the medical bills, aka insurance companies. They often do not pay for ‘experimental’ procedures, sometimes in the form of CAM (my insurance does not cover acupuncture or herbal supplements). Access to insurance influences healthcare stds because the costs of our health system will prohibit the use of some procedures, tests and equipment.

  109. DrJoeinCAon 04 Apr 2014 at 8:41 pm

    Draal: I’m a creationist? Sigh. Congratulations, you are now a member of the I’m-not-paying-attention-to-what-has-been-said-or-not-said-and-it’s-irrelevant-anyway choir.

    Oh, so we go from “crafted” to “influenced.” Of course, statisticians help to interpret the original studies. That doesn’t mean they write or “craft” the standards that sometime reflect the results of those studies. Insurance companies do not pay for experimental procedures, but mine pays for acupuncture and chiropractic. I guess because they consider those modalities effective. Maybe you went with Obamacare….

    The medical standards of care drive what the insurance companies pay for. If something becomes the standard of care, the insurance companies pay for it. Mine does anyway. It doesn’t work the other way around.

  110. sonicon 04 Apr 2014 at 8:41 pm

    I notice Kaiser offers various CAM treatments.
    From the website I get the impression this is because the doctors and patients (perhaps the administrators too ) have found them to be useful.

  111. DrJoeinCAon 04 Apr 2014 at 9:44 pm

    And then there’s Aetna:
    “Aetna considers needle acupuncture (manual or electroacupuncture) medically necessary for any of the following indications:

    Chronic low back pain. (Maintenance treatment, where the patient’s symptoms are neither regressing or improving, is considered not medically necessary. If no clinical benefit is appreciated after 4 weeks, then the treatment plan should be re-evaluated); or
    Migraine headache; or
    Nausea of pregnancy; or
    Pain from osteoarthritis of the knee or hip (adjunctive therapy; if no clinical benefit is appreciated after 4 weeks, then the treatment plan should be reevaluated); or
    Post-operative and chemotherapy-induced nausea and vomiting; or
    Post-operative dental pain; or
    Temporomandibular disorders (TMD)”

    Blue Shield of California, Anthem Blue Cross.

  112. Hosson 04 Apr 2014 at 9:53 pm

    DrJoeinCA
    “Medical standards are determined by physicians. Period. The non-doctor scientists do not determine medical standards. Period.”
    “Otherwise — ah you know already, don’t you? — we would have non-doctors telling doctors how to practice. And that does not happen.”

    There are non-doctors telling doctors how to practice. Are you not familiar with medical laws? And do I really need to fully argue how everyone has a voice when it comes to the law.

    There is a slight problem down here in Texas involving ideologues influencing medical care, but the same is true all around the world. Essentially you’re promoting ideological based medicine. And quite frankly, I find ideological based medicine that ignores/denies science, evidence, and reason disgusting.

    If you want to engage in a service to make people happy or feel good, then go ahead and do it. But do not call it medicine, and do not lie or mislead people about that service, which you, and the many like you, seem unable to do.

  113. Hosson 04 Apr 2014 at 10:00 pm

    JoeinCA
    “And then there’s Aetna:
    “Aetna considers needle acupuncture (manual or electroacupuncture) medically necessary for any of the following indications:…”"

    Thanks for proving that medical insurers will pay for treatments based on “patient satisfaction” and not evidence.

  114. DrJoeinCAon 04 Apr 2014 at 10:52 pm

    Hoss: “There are non-doctors telling doctors how to practice. Are you not familiar with medical laws? And do I really need to fully argue how everyone has a voice when it comes to the law.” Oh, now we’re talking about “medical laws”? I thought we were talking about standards of care. Bounce bounce.

    “Ideological based medicine.” Ah, a new term without any relevance to the discussion.

    “Thanks for proving that medical insurers will pay for treatments based on “patient satisfaction” and not evidence.” Patient satisfaction based on results of treatment. But, but….

    And yes, I want physicians and practitioners to make patients happy and feel good.

  115. grabulaon 05 Apr 2014 at 12:44 am

    @ChiroJoeinCa

    There’s a website that addresses all of your concerns and provides some insight you could probably find helpful in understanding science and evidence and how it fits into mainstream science and fakemed.

    http://www.sciencebasedmedicine.org/

  116. DrJoeinCAon 05 Apr 2014 at 1:01 am

    Grabula: Thanks, but I have no concerns and no trouble understanding science and role it plays in medicine. Nice pics of Jennifer Aniston’s back though. That was worth the look.

  117. BillyJoe7on 05 Apr 2014 at 1:35 am

    DrJoe,

    “BillyJoe: And you probably disagree with “appropriate””

    Nope.
    Because “appropriate” means “evidence based” not “whatever the patient wants”.

    “and “allow student to guide patients safely and accurately in their use of CAM””

    Nope.
    Because “safely” implies an “evidence base” not “whatever the patient wants”

    “and “interaction between conventional medicine and CAM” ”

    What on Earth is your point here?
    Of course medical practitioners would need to know about the interactions between treatments the patient is taking, be they evidence based treatments or not evidence based treatments (most of CAM – see AMA position statement).

    “and “taught by health practitioners who have knowledge and experience of utilizing CAM in practice” ”

    Did you deliberately exclude the remainder of the quote: “…AND WHO TEACH WITH AN EVIDENCE BASED FRAMEWORK”

    “Their position that there is a role for CAM is pretty clear”

    False.
    Their position is that there is a role for CAM TREATMENTS THAT ARE EVIDENCE BASED.
    As I said before they should be distinguishing evidence-based treatments from non evidence-based treatments, not conventional treatments from CAM treatments
    But their whole framing is around the two words EVIDENCE BASED.

  118. grabulaon 05 Apr 2014 at 2:19 am

    @ChiroJoeinCa

    ” Thanks, but I have no concerns with and can’t be troubled understanding science and the role it plays in medicine. Nice pics of Jennifer Aniston’s back though. That was worth the look.”

    I thought so.

  119. BillyJoe7on 05 Apr 2014 at 3:25 am

    DrJoe,

    “AMSA believes that students and physicians can best serve their patients by recognizing and acknowledging the availability of integrative medicine in their communities”

    Fair enough, it’s out there. No problem recognising that fact.

    “By pursuing education in complementary and alternative medical (CAM) treatments, medical students and physicians can better facilitate the appropriate education, treatment and counseling of patients and consumers”

    Fair enough, they need to know about non evidence-based (CAM) treatments to apropriately educate treat and counsel patients about those treatments.

    “AMSA believes that an empowered patient can serve as a powerful and central actor in their own healing”

    Yep, patients will decide in the end what treatments they will accept. All the more important to educate them about the evidence base of the treatments available.

    “Appropriate education in CAM treatments uses scientific and ethnographic methods, including quantitative and qualitative outcomes research of efficacy and effectiveness. Although it is informed by evidence, it considers explanatory models and cultural”

    Scientific research. Did you gloss over that bit, Joe?
    For my part, I’m going to interpret “explanatory models” and “cultural aspects” in the best possible light.

    “AMSA supports students who wish to work within the healthcare system to create an environment which is supportive of the whole patient”

    Who could argue?

    “AMSA believes that medical students and other health care professionals need to be restored and whole in order to be empowering and healing for their patients.”

    Well, they could have dispensed with smaltzy language, but hey, whatever floats your boat.

    So where, pray tell Joe, is the advice to “give the patients what they want”?

  120. BillyJoe7on 05 Apr 2014 at 3:28 am

    You could also do us the courtesy if providing the link.

  121. grabulaon 05 Apr 2014 at 3:52 am

    “You could also do us the courtesy if providing the link.”

    what? and allow you to peruse the whole thing instead of his cherry picked bits?!

  122. BillyJoe7on 05 Apr 2014 at 10:49 am

    I can’t find DrJoe’s reference, but this one is interesting:

    http://www.amsa.org/AMSA/Libraries/Misc_Docs/2013_PPP.sflb.ashx
    Page 128

    To quote in full:

    The American Medical Student Association:
    1. RECOGNIZES the potential inherent to non-western systems of medicine and forms of health care and prevention currently available outside of accepted biomedical practice.
    a. The term “Integrative, Complementary and Alternative Medicine” shall be understood so as to correspond with definitions used by the National Institutes of Health Center for Complementary and Alternative Medicines. “Complementary medicine” shall be understood to mean the use of alternative medicine secondary, or as an adjunct, to unconventional therapies alongside conventional biomedicine with the approval of a licensed physician. The term “alternative medicine” shall be understood to mean the use of unconventional therapies in place of conventional biomedicine. The term “integrative medicine” shall be understood to mean medical practice combining conventional treatments and CAM therapies where there is some quality scientific evidence of safety and effectiveness. The term “Holistic Medicine” shall be understood to correspond with the American Holistic Medical Association’s principles, which refer to a practice of medicine that reaffirms the importance of relationship between practitioner and patient, emphasizes prevention, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches to achieve optimal health and healing. (2006)
    b. ENCOURAGES evidence- based, peer- reviewed research and investigation regarding integrative, alternative and complementary medicines (icam) within ethical, legal, professional guidelines. (2013)
    c. ENCOURAGES medical students and residents to seek and take advantage of educational opportunities in integrative, alternative and complementary medicine. When unavailable, medical students and residents are encouraged to propose the addition of such opportunities to the curricula or practices of their respective institutions. (2005)
    d. ENCOURAGES medical administrators and faculty to meet the demands of their students and the patient population by developing and implementing appropriate training in evidence-based integrative, complementary, and alternative medicines. Training should include general information about the variety of treatment alternatives available to the general public, especially those that have been proven to be effective. (2013)
    e. Conscientious and effective health care shall include the use of integrative, complementary and alternative medicine when such remedies or modalities have been clearly demonstrated to positively affect patient outcomes. In cases where efficacy is undetermined but strongly suspected, ICAM may be used with the same precautions and indications for other experimental therapies. (2005)
    f. Physicians and physicians-in-training have an obligation to respect the patient’s prerogative to self-treat with over-the-counter alternatives, visit a practitioner in the field of ICAM, and otherwise choose nonbiomedical means of health care and maintenance. (2005)
    g. ENCOURAGES medical schools to incorporate educators, researchers, and practitioners of evidence-based alternative, complementary, and integrative medicine into the curricula as part of medical education. (2013)

    Note the repeated uses of phrases such as “scientific evidence”, “evidence based”, “proven to be effective”, in relation to CAM, and the caution to use plausible but unproven CAM treatments “with the same precautions and indications for other experimental therapies”

    Nowhere…NOWHERE…do they suggest medical practitioners “give patients what they want”.

  123. DrJoeinCAon 05 Apr 2014 at 12:08 pm

    BillyJoe: So now do you admit that some CAM works, is “appropriate,” is “evidence-based”? I thought you were convinced that no CAM worked at all. Perhaps you have evidence that some CAM works that you would like to share with the choir.

    “Physicians and physicians-in-training have an obligation to respect the patient’s prerogative to self-treat with over-the-counter alternatives, visit a practitioner in the field of ICAM, and otherwise choose nonbiomedical means of health care and maintenance.” Yep. The patient can choose self-treatment, CAM, and non biomedical means of treatment.

    Notice, if you will, that nowhere in any of these documents does it say that (a) CAM does not work or (b) CAM should not be used or (c) CAM should not be taught. This is yet another group of medical professionals (to-be) that recognizes that CAM should be integrated into traditional medicine and that it has a place in patient treatment. This is unlike the choir here which uses terms like woo and magic and “fakemed” to describe all CAM. Funny how the professionals know what works and what can be used and the choir keeps saying but, but….

    Grabula: Nice job. In America, however, when we use quotation marks, it’s actually supposed to be — a quotation. But this is more “evidence” of where you’re coming from in terms of accuracy.

  124. DrJoeinCAon 05 Apr 2014 at 12:12 pm

    BillyJoe: “Because “safely” implies an “evidence base” not “whatever the patient wants.”

    Uh, no. “Safely” means not likely to lead to harm or injury. Has nothing to do with “evidence.”

  125. BillyJoe7on 05 Apr 2014 at 5:48 pm

    DrJoe,

    “BillyJoe: So now do you admit that some CAM works, is “appropriate,” is “evidence-based”?”

    I don’t even recognise the category!
    That is my sole criticism of the position statements of the organisations I have quoted.
    They continue to categorise treatments as either conventional or alternative/complementary/integrative.
    There is only evidence-based treatments and non evidence-based treatments.
    I don’t care if they come originally from conventional or alternative medicine, as long as there is an evidence base.

    “I thought you were convinced that no CAM worked at all”

    Unfortunately, almost no treatments that are classified as CAM work.
    Most have been shown not to work, some have not yet been shown to either work or not work, a small minority work.
    Of course, the small minority of CAM that works is called evidence-based medicine.
    Similarly, conventional medicine that works is called evidence-based medicine.
    …because it is the EVIDENCE that determines if something WORKS.

    ” Perhaps you have evidence that some CAM works that you would like to share with the choir”

    I think, Joe, that that is your job.
    And you’re not having much success.

    ““Physicians and physicians-in-training have an obligation to respect the patient’s prerogative to self-treat with over-the-counter alternatives, visit a practitioner in the field of ICAM, and otherwise choose nonbiomedical means of health care and maintenance.”

    I would have used better wording.
    Instead of “have an obligation to respect”, I would have said “should accept”.
    I would treat the person with respect, but I would not respect choices not based on evidence.
    And I’m not talking just about medicine.
    Now, let me turn it back on you, because you have studiously avoided the elephant in the room:
    Would you have used the following wording:

    “scientific evidence”
    “evidence based”
    “proven to be effective”
    “with the same precautions and indications for other experimental therapies”

  126. DrJoeinCAon 05 Apr 2014 at 6:12 pm

    BillyJoe: So you do or don’t agree with the statement that you posted? You think that there is such a thing as “a small minority of CAM that does work”? That’s huge growth for you, BJ.

    The professional and other healthcare groups who are involved with treating patients + the patients themselves recognize the value of CAM.

    Yes, I agree with the statement. The statement recognizes that CAM is a part of the total treatment of the patient, encourages the practitioners of CAM to teach in medical schools, allows the patient and physician to choose to use CAM and other non biomedical means of health care, allows for the use of CAM when its efficacy is “strongly suspected”, and still respects that medical care should be evidence based.

    This tells me that they would not use homeopathy but would use chiropractic or acupuncture or yoga or meditation or massage all of which have shown benefit. Unlike the choir, they can differentiate between what works and what doesn’t.

    Obviously, this group and the other professional organizations recognize that there is a place for both CAM and traditional medicine in the treatment of patients, unlike the choir which sees no role. Remember woo and witch doctors and all that? Again I call to your attention that they did not say CAM does not work and shouldn’t be used and should not be taught and is “settled science.” Unlike the choir.

  127. BillyJoe7on 05 Apr 2014 at 6:13 pm

    DrJoe,

    “Notice, if you will, that nowhere in any of these documents does it say that (a) CAM does not work or (b) CAM should not be used or (c) CAM should not be taught.”

    And nowhere does it say that CAM works.
    And nowhere does it say that CAM should be used – UNLESS THERE IS EVIDENCE THAT IT WORKS!
    And of course it should be taught in medical school because doctors need to….
    - be familiar with the evidence base of CAM treatments.
    - be familiar with the side effects of CAM treatments their patients may be using.
    - be familiar with the interactions between CAM treatments and prescription medication.
    - know enough about CAM in order to advise patients making informed choices about CAM.

    “This is yet another group of medical professionals (to-be) that recognizes that CAM should be integrated into traditional medicine and that it has a place in patient treatment”

    Please quote where it says this.
    They are at pains to emphasise that the treatments must have “scientific evidence”, be “evidence based”, be “proven to be effective”, and, in the case of plausible but unproven CAM treatments, to use them “with the same precautions and indications for other experimental therapies”.
    It’s all about the EVIDENCE.
    Please understand this.

    (And you still haven’t provided your link)

  128. BillyJoe7on 05 Apr 2014 at 6:21 pm

    Well, Joe, you have come a long way from suggesting doctors treat patients with treatments that don’t work merely because they say they feel better.
    Now all you need to do is become familiar with the evidence base of these treatments.

    I can recommend http://www.sciencebasedmedicine.org
    There you can find all you need to know about the evidence base for homoeopathy, chiropractic, and acupuncture.

  129. DrJoeinCAon 05 Apr 2014 at 7:02 pm

    BillyJoe: How you could misinterpret the statement that you quoted is beyond me. Well, not really. The fact that the students want to be taught CAM by its practitioners, say that it’s ok for patients to choose CAM on their own, etc., tells me that they think it has a place in treatment.

    Otherwise, they would just invite you or StevenNovella to present the results of the studies in one lecture and be done with CAM for the duration of medical school. Which they do not do. Why do you think they don’t do that? Something that is so obviously magical and woo and “fake” to you that you ridicule its practitioners and adherents is actually taught in medical school. Go figure. Maybe they didn’t consult you when they made the curriculum.

    Oh, there are “side effects” and “interactions between CAM treatments — which are after all only placebos — and prescription medication”?

  130. BillyJoe7on 05 Apr 2014 at 9:18 pm

    DrJoe,

    How you can misinterpret these quotes is beyond comprehension:

    “The term “integrative medicine” shall be understood to mean medical practice combining conventional treatments and CAM therapies where there is some quality scientific evidence of safety and effectiveness

    “The term “Holistic Medicine” shall be understood to correspond with the American Holistic Medical Association’s principles, which refer to a practice of medicine that…is informed by evidence

    “Encourages evidence-based, peer-reviewed research and investigation regarding integrative, alternative and complementary medicines

    “Encourages medical administrators and faculty to meet the demands of their students and the patient population by developing and implementing appropriate training in evidence-basef integrative, complementary, and alternative medicines

    “Training should include general information about the variety of treatment alternatives available to the general public, especially those that have been proven to be effective

    “Conscientious and effective health care shall include the use of integrative, complementary and alternative medicine when such remedies or modalities have been clearly demonstrated to positively affect patient outcomes

    “In cases where efficacy is undetermined but strongly suspected, ICAM may be used with the same precautions and indications for other experimental therapies

    “Encourages medical schools to incorporate educators, researchers, and practitioners of evidence-based alternative, complementary, and integrative medicine into the curricula as part of medical education”

    You have to be wilfully ignorant not to see what is staring you right in the face.

    Well, not really. The fact that the students want to be taught CAM by its practitioners, say that it’s ok for patients to choose CAM on their own, etc., tells me that they think it has a place in treatment.
    Otherwise, they would just invite you or StevenNovella to present the results of the studies in one lecture and be done with CAM for the duration of medical school. Which they do not do. Why do you think they don’t do that? Something that is so obviously magical and woo and “fake” to you that you ridicule its practitioners and adherents is actually taught in medical school. Go figure. Maybe they didn’t consult you when they made the curriculum.
    Oh, there are “side effects” and “interactions between CAM treatments — which are after all only placebos — and prescription medication”?

    Still no link for your quotes from AMSA.

    Still no quote from either link that supports your motto “give the patient what they want”.

    Still no response to this:
    Note the repeated uses of phrases such as “scientific evidence”, “evidence based”, “proven to be effective”, in relation to CAM, and the caution to use plausible but unproven CAM treatments “with the same precautions and indications for other experimental therapies”

  131. BillyJoe7on 05 Apr 2014 at 9:25 pm

    How you can misinterpret these quotes is beyond comprehension:

    “The term “integrative medicine” shall be understood to mean medical practice combining conventional treatments and CAM therapies where there is some quality scientific evidence of safety and effectiveness

    “The term “Holistic Medicine” shall be understood to correspond with the American Holistic Medical Association’s principles, which refer to a practice of medicine that…is informed by evidence

    “Encourages evidence-based, peer-reviewed research and investigation regarding integrative, alternative and complementary medicines

    “Encourages medical administrators and faculty to meet the demands of their students and the patient population by developing and implementing appropriate training in evidence-based integrative, complementary, and alternative medicines

    “Training should include general information about the variety of treatment alternatives available to the general public, especially those that have been proven to be effective

    “Conscientious and effective health care shall include the use of integrative, complementary and alternative medicine when such remedies or modalities have been clearly demonstrated to positively affect patient outcomes

    “In cases where efficacy is undetermined but strongly suspected, ICAM may be used with the same precautions and indications for other experimental therapies

    “Encourages medical schools to incorporate educators, researchers, and practitioners of evidence-based alternative, complementary, and integrative medicine into the curricula as part of medical education”

    You have to be wilfully ignorant not to see what is staring you right in the face.

  132. BillyJoe7on 05 Apr 2014 at 9:39 pm

    “The fact that the students want to be taught CAM by its practitioners…”

    They want to be taught the science-base, the evidence-base, and the peer-review aspects of CAM so that they can properly inform patients about the these treatments.

    “say that it’s ok for patients to choose CAM on their own”

    Please quote them where they say that.

    “Otherwise, they would just invite you or StevenNovella to present the results of the studies in one lecture and be done with CAM for the duration of medical school”

    You have forgotten about interactions and side effects.
    This will have relevance to almost every lecture.

    “Something that is so obviously magical and woo and “fake” to you that you ridicule its practitioners and adherents”

    Please quote me where I have done this.

    “Oh, there are “side effects” and “interactions between CAM treatments — which are after all only placebos — and prescription medication”?”

    Quote me where I said all CAM is placebo.
    Ever heard of herbal treatments?

    Oh, and…
    Still no link for your quotes from AMSA.
    Still no quote from either link that supports your motto “give the patient what they want”.
    Still no response to this:
    Note the repeated uses of phrases such as “scientific evidence”, “evidence based”, “proven to be effective”, in relation to CAM, and the caution to use plausible but unproven CAM treatments “with the same precautions and indications for other experimental therapies”

  133. BillyJoe7on 05 Apr 2014 at 9:40 pm

    …sorry about the errant post upstream. Not sure how that happened.

  134. DrJoeinCAon 05 Apr 2014 at 10:26 pm

    BillyJoe: “Quote me where I said all CAM is placebo.” Well, excuse me. I thought you knew that CAM was placebo. You mean that you think that it actually has some physiological effect that might relieve symptoms? You mean that, after all this, we are discussing something that actually has measurable physiological effects and which might be used as, uh, treatment? You mean that a patient could actually respond to CAM with symptom relief and you wouldn’t credit that to self-deception or regression to the mean or lying? I weep in joy that we have reached this point.

    So if we have non-placebo treatments that have physiologic and pain-relieving effects and no side effects, hmm, might a patient not want to try one of those harmless treatments rather than a treatment that might increase blood pressure or cause an ulcer to bleed or something worse? Might a patient actually want to weigh side effects vs NO side effects in the choice of treatment if the treatment acts physiologically to relieve symptoms?

    The students want to be taught CAM by its practitioners. Do you have a list of CAM that they might teach and not teach? Some science-based CAM vs non-science-based CAM?

    But seriously, StevenNovella could bring the choir and you all could just go to the med schools and in an hour or two debunk all the non-science, destroy acupuncture and chiropractic at its roots and have the students proceed blissfully into the science-based curriculum they deserve.

    “respect the patient’s prerogative to self-treat with over-the-counter alternatives, visit a practitioner in the field of ICAM, and otherwise choose nonbiomedical means of health care and maintenance.” In other words, let the patient choose the means of healthcare and maintenance. The patient has the prerogative to choose their means of treatment, including “non biomedical” means.

  135. BillyJoe7on 06 Apr 2014 at 1:34 am

    DrJoe,

    “Well, excuse me. I thought you knew that CAM was placebo”

    You left out the “all”.
    I’ve never said ALL OF CAM is placebo.
    Have you really never heard of herbal therapy? – even after I mentioned in my last post!
    Herbs contain active ingredients such as digoxin and salicylate.
    Some are even contaminated with heavy metals and pharmaceuticals!
    They have well recognised effects on the body.

    “You mean that you think that it actually has some physiological effect”

    Do you even realise what you’re asking?
    Even the placebo effect is a physiological effect – even if only on the brain!
    The patient comes into your office feeling miserable. You smile and confidently say you can help her. Her brow flatten and his lips curl into a smile. That’s a physiological effect. That’s a placebo effect.

    “that might relieve symptoms? ”

    Well now, that’s where the science-based, evidence-based, peer-reviewed medicine comes in that the AMA and the AMSA (American and Australian) are at pains to keep repeating in their position statements.

    “So if we have non-placebo treatments that have physiologic and pain-relieving effects and no side effects…”

    To repeat, even placebo treatments have physiological effects including pain-relieving effects!
    You have a toothache. A gun goes off outside. You forget all about your toothache…it is gone…and run outside. This is a placebo effect. This is a placebo effect that has had a physiological effect that has relieved your pain. Temporarily. Because as soon as you realise it was a car backfiring, your damn toothache is back!
    On the other hand, If you are claiming more than placebo…well now you need replicated methodologically sound clinical trial.

    “Do you have a list of CAM that they might teach and not teach? Some science-based CAM vs non-science-based CAM?”

    I don’t need a list. Teach it all. And, as all these organisations are at pains to keep repeating, teach the science-base and the evidence-base for these treatments, so that doctors can inform patients of the science-base and the evidence-base of various treatment options so the patients can make an informed choice.

    “StevenNovella…could just go to the med schools and in an hour or two debunk all the non-science, destroy acupuncture and chiropractic at its roots and have the students proceed blissfully into the science-based curriculum they deserve”

    Good idea!
    In the mean time, there is a “Great Courses” series of twenty-four half-hour lectures titled “Your Deceptive Mind: A scientific guide to critical thinking skills”, plus a series of twenty-four half-hour lectures titled “Medical Myths, Lies, and Half-truths: What we think we know may be hurting us”, all written and spoken by your host, Stephen Novella.

    “In other words, let the patient choose the means of healthcare and maintenance”

    You forgot the “informed” bit.
    Ensure that the patient makes an INFORMED choice about the means of healthcare and maintenance.
    That information comes from replicated, methodologically sound, clinical trails.
    Please avail yourself of this wealth of information so that you can impart it to your patients.
    It’s a bit harder and more time consuming than a quick referral, but hey…your patients get real treatment!

  136. steve12on 06 Apr 2014 at 11:31 am

    You mean Joe still won’t discuss the only thing that can dispositively settle the question of CAM efficacy – experiments? If only you could see the shock on my face!

    This is, of course, because Joe doesn’t understand basic experimental design. As he demonstrated above he couldn’t even interpret an idealized toy experiment, but I’m supposed to respect his opinion on the actual literature.

  137. steve12on 06 Apr 2014 at 11:33 am

    I’m thinking at this point that Joe is a doctor of chiropractic or naturopath or some such.

    Sort of hard to believe he’s an MD

  138. DrJoeinCAon 06 Apr 2014 at 12:46 pm

    BillyJoe: Let’s leave out the gunfire outside for a second since it is not “treatment.” Nor is a kind word and smiling face “treatment.”

    Follow me here. The premise now is that CAM has physiological properties which include pain relief. And we know that it has no significant side effects. And we agree that it is not a placebo.

    If the CAM has physiological pain-relieving effects with no side effects and a patient chooses to use the CAM for its pain-relieving properties and lack of side effects, you are ok with that. So far so good? All we are discussing then is whether one treatment is more effective than another in A PARTICULAR PATIENT. Not in all patients, but in some patients. Got that? The studies may show that most people will respond more to A than to B, but there is still a group that will respond to B. And there are those who would choose the “weaker” modality over the “stronger” one just because they don’t want all the attendant side effects that come with the “stronger” one.

    So if a particular patient finds relief in CAM where they did not find it with Oxycontin, that’s ok too. Agree? You are aware that some people find relief with aspirin whereas others need narcotics, right? And there are probably some people who find relief with CAM who don’t find as much relief with ibuprofen. And also some people who just don’t trust traditional medicine and are more comfortable with CAM.

    If the patient makes a choice between using CAM (acupuncture, chiropractic) with NO side effects and with physiological pain-relieving effects and using narcotics or ibuprofen with notable life-threatening side effects and physiological pain-relieving effects, would you fault them for doing that? Would you say they are using magic and woo and “fakemed” and self-deception and lying when they decide to use one physiological modality over another?

    You said “teach it all.” Do you think there is some CAM that is “science-based” and some that is not?

    Steve12: See above. “Experiments” are not patient care, as any patient care provider can tell you.

  139. steve12on 06 Apr 2014 at 1:19 pm

    “Steve12: See above. “Experiments” are not patient care, as any patient care provider can tell you.”

    They are the only way to adjudicate the question at hand

    THE ONLY WAY.

    Are you an MD Joe? Because I will completely leave the discussion if you’re a chiro, naturopath, etc.

  140. DrJoeinCAon 06 Apr 2014 at 1:47 pm

    Steve12: The question at hand is whether patients may use CAM to relieve their symptoms without being accused of self-deception, lying, magical thinking, etc. “Experiments” do not adjudicate that question, because, as we know, “experiments” may show CAM does not work, whereas…. Aw, come on, you know. Even as a non-provider of patient care you know.

  141. steve12on 06 Apr 2014 at 3:29 pm

    “The question at hand is whether patients may use CAM to relieve their symptoms without being accused of self-deception, lying, magical thinking, etc. ”

    Not the Q.

    “Experiments” do not adjudicate that question, because, as we know, “experiments” may show CAM does not work, whereas…. ”

    Experiment tell us whether they work. Put up or shut up, $ talks BS walks, cards on the table. It’s a standard that bullshit artists of all stripes fear, including you.

    BTW, congrats on concern trolling us for a bit and misleading us about your credentials. That was super.

  142. DrJoeinCAon 06 Apr 2014 at 4:09 pm

    Steve12: Hahahaha! You mean it’s necessary to have “credentials” to post on this blog? Who knew? I thought one just had to have lots of time with nothing else to do.

    Uh, yes, it is the question, now that we know that CAM has actual physiological effects which could have an effect on patient symptoms such as pain. It’s patient’s choice of which modality with physiological effects they want to use.

    See how easy that was? We went from woo and bullshit and “fakemed” and magic and “doesn’t work” to the patient makes the choice about how they want to get treatment, and the doc respects that choice. Embrace that.

  143. steve12on 06 Apr 2014 at 4:22 pm

    “Steve12: Hahahaha! You mean it’s necessary to have “credentials” to post on this blog? Who knew? I thought one just had to have lots of time with nothing else to do.”

    Straw man (once again)…never said this. You’re claiming credentials and then being evasive about what they are – that’s on you. So wanna set the record straight and tell us what yours are?

    Uninterested in the rest of your stupid shit – I don’t do bullshit & magic. Just wanna point out that you
    a. Are too scientifically illiterate to understand what experiments say about CAM
    and
    b. Lied about your credentials.

  144. BillyJoe7on 06 Apr 2014 at 5:20 pm

    DrJoe,

    I will use two of the most obvious examples of CAM to make it easier for you to understand your error:

    Homoeopathy does not work.
    There is no possible mechanism of action and clinical trials have shown no effect beyond placebo.
    This means that homoeopathy does not work.
    Okay?

    Some Herbal medicines do work.
    There are plausible mechanisms and clinical trials have shown that some herbal medicines have an effect beyond placebo.
    This means some herbal treatments work.
    Okay?

    Are you with me Joe?
    So when I say that homoeopathy does not work, I’m not saying ALL OF CAM does not work.
    And when I say that some of herbal medicine works, I’m not saying that ALL OF CAM works.
    Okay?

    Okay, let’s move on…
    The following statements from your last post are therefore false:

    “The premise now is that CAM has physiological properties”

    Can you now see the falsity of that statement now?
    Let’s spell it out shall we:
    Homoeopathy has no physiological effects.
    Some herbal treatments have physiological effects.
    Are you following me?

    ” And we know that it has no significant side effects”

    Yes, false again.
    I’m sure it’s obvious by now why that statement is false, but let’s just write it down shall we:
    Homoeopathy has no side effects.
    Some herbal treatments have significant side effects.
    Okay?

    “And we agree that it is not a placebo”

    Well I’m sure you could do this yourself at this stage but, again, let’s nail it:
    Homoeopathy is a placebo.
    Some herbal treatments have both physiological effects and placebo effects.
    There, you’ve got it!
    Right?

  145. DrJoeinCAon 06 Apr 2014 at 5:41 pm

    BillyJoe: OK, that took care of two modalities of CAM. Homeopathy does not work. “Some herbal treatments work.” Of course, we had already disposed of and agreed upon homeopathy long ago, but I question your conclusion that herbal treatments “work”. So I’m zero for two on your choice of examples. I don’t think either of them works.

    Be that as it may, what about acupuncture and chiropractic which is what we have been talking about? You didn’t address those in your response.

    Are you saying that these two modalities are placebos? Or do they exert physiological effects which can cause pain relief?

  146. DrJoeinCAon 06 Apr 2014 at 5:46 pm

    Steve12: I lied about my credentials? What credentials did I lie about or “claim”? Are you really that bored that you have nothing to talk about but silliness like that? Why don’t you just assume that I am a chiropractor or acupuncturist or bloodletter and relax instead of arguing with yourself?

  147. steve12on 06 Apr 2014 at 6:33 pm

    Steve12: I lied about my credentials? What credentials did I lie about or “claim”? Are you really that bored that you have nothing to talk about but silliness like that? Why don’t you just assume that I am a chiropractor or acupuncturist or bloodletter and relax instead of arguing with yourself?

    More BS. You are a bullshitter. I mean, you put your goddamn credentials in your name, now you can’t even say what you are?

    Keep BSing. No one’s buying it.

  148. DrJoeinCAon 06 Apr 2014 at 6:53 pm

    Steve12: Seriously. Arguing with yourself.

  149. steve12on 06 Apr 2014 at 7:53 pm

    So childish.

    Trust me – for the amount of time you’ve spent arguing for your BS here, I’m not arguing with myself. And I love the gun-shy lying. You could just lie and say you have an MD for chrissakes. You’re at least the 3rd person who’s been caught lying about their degree here. So silly.

    Good luck “Dr”Joe! Get your patients that eye of newt they need – STAT!!!!!!!

  150. BillyJoe7on 07 Apr 2014 at 12:42 am

    DrJoe,

    Stop switching and changing.
    The point of my last post, which was in response to your last reponse, can be summarised as follows:
    (I’ve deleted reference to the examples I used before because it seems they are only confusing you)

    When I say that one form of CAM does not work, I’m not saying ALL OF CAM does not work.
    And when I say one form of CAM works, I’m not saying that ALL OF CAM works.

    That was your confusion in your reply to me that I was attempting to correct.
    But you’ve shot right past that to argue about my examples!

    They were examples!
    Do you understand what an example is?

    Now please acknowledge that you have understood my generic statement above.
    I have highlighted it above just so there’s no mistake.

  151. DrJoeinCAon 07 Apr 2014 at 11:46 am

    BillyJoe: Oh, come on. Now you’re acting like Steve12.

    I commented on your examples. And what I’m asking you is,

    1. Which “small minority” of CAM works and which does not?
    2. Which CAM is “evidence-based” and which is not?

    We’re making progress here. Don’t blow it.

  152. steve12on 07 Apr 2014 at 2:32 pm

    If you’re gonna con people, you gotta commit to the bit. Get gunshy, and everyone knows.

  153. BillyJoe7on 07 Apr 2014 at 3:39 pm

    DrJoe,

    “I commented on your examples”

    That point was NOT to comment on the examples.
    They’re just examples!
    That is why I have now used the generic statements highlighted above:

    When I say that one form of CAM does not work, I’m not saying ALL OF CAM does not work.
    And when I say one form of CAM works, I’m not saying that ALL OF CAM works.

    Are you going to acknowledge that you have understood this generic statement?

  154. BillyJoe7on 07 Apr 2014 at 3:42 pm

    And your questions are irrelevant.
    Apart from which they have been answered in general.
    Just go back a few posts.
    I have, of course, not made an exhaustive list because that too would be even more irrelevant.

  155. BillyJoe7on 07 Apr 2014 at 3:47 pm

    Finally, it’s time we dropped the labels mainstream, traditional, conventional, complementary, alternative, and integrative.
    All we need are “science-based medicine” and “non science-based medicine”.

  156. BillyJoe7on 07 Apr 2014 at 5:21 pm

    DrJoe,

    “Which CAM is “evidence-based” and which is not?”

    Since this subject is too exhaustive for a short comment, perhaps I’ll at least do you the favour of a couple of references where you can discover for yourself the answer to this question.

    http://www.amazon.com/Trick-Treatment-Undeniable-Alternative-Medicine/dp/0393337782

    http://www.thegreatcourses.com.au/tgc/courses/course_detail.aspx?cid=1924

    http://www.sciencebasedmedicine.org/

    http://theness.com/neurologicablog/

    You really do need to educate yourself about science-based medicine so that you can help your patients make informed choices about which treatments to use.

  157. BillyJoe7on 07 Apr 2014 at 5:22 pm

    …oops, one too many links in my last post.
    Nevermind, it will come out of moderation eventually.

  158. DrJoeinCAon 07 Apr 2014 at 5:50 pm

    BillyJoe: OK, so you don’t want to say which CAM modalities should be taught (the “evidence-based” CAM) or used. And you cannot identify which CAM is “evidence-based” and which is not. And you don’t want to say which CAM works and which CAM doesn’t.

    I guess you got nothing other than a generic statement such as I like some colors and I don’t like others. Tough for those medical students to know what they should be thinking and advising their patients when their adviser-”scientists” cannot commit.

  159. BillyJoe7on 07 Apr 2014 at 6:33 pm

    The point is, Joe, use science based treatments on your patients.
    Give patients what they need not want they want.
    Otherwise you are less than useless to them.
    You are a professional. Right? Please act like one.

  160. Bruceon 08 Apr 2014 at 4:23 am

    Against my better judgement I am wading in here:

    Complimentary or Alternative Medicine is by definition not Science based. The parts that are science based are medicine and are included in one way or another in medicine.

    Dr Joe is arguing here that just because some modalities sometimes include treatments that are sometimes science based that CAM is viable as a whole.

  161. BillyJoe7on 08 Apr 2014 at 7:27 am

    Bruce,

    “Complimentary or Alternative Medicine is by definition not Science based”

    It sort of depends on what you include as CAM.
    That is why it is best to classify treatments as either science-based or non science-based.

    “The parts that are science based are medicine and are included in one way or another in medicine”

    But, if you include a herb in “conventional medicine” because of evidence of effectiveness, then CAM practitioners claim victory, not just for that particular herbal treatment, but for all of CAM, as you say below…

    “Dr Joe is arguing here that just because some modalities sometimes include treatments that are sometimes science based that CAM is viable as a whole”

    Yes, that seems to be Joe’s ploy.
    Not only that, but he assumed that I was doing the same, which is why I have had to correct him several times…

    When I say that one form of CAM does not work, I’m not saying ALL OF CAM does not work.
    And when I say one form of CAM works, I’m not saying that ALL OF CAM works.

  162. Bruceon 08 Apr 2014 at 7:43 am

    “It sort of depends on what you include as CAM.”

    Well, this is the rub. The best definition of CAM is really quite vague at best.

    From the NCCAM website itself:

    ““Complementary and alternative medicine,” “complementary medicine,” “alternative medicine,” “integrative medicine”—we have all seen these terms on the Internet and in marketing, but what do they really mean? While the terms are often used to mean the array of health care approaches with a history of use or origins outside of mainstream medicine, they are actually hard to define and may mean different things to different people.”

    The key for me is “use or origins outside of mainstream medicine” which comes up a lot in any definition you look up.

  163. steve12on 08 Apr 2014 at 10:11 am

    “I guess you got nothing other than a generic statement such as I like some colors and I don’t like others. ”

    HAHAHA!!!!

    “Oh, Mr. Kettle! How very black you are!” said Mr. Pot.

    So what’s the story? You an MD or what? YOU are the one with “Dr” in your friggin name – let’s here it already. What are you a doctor of?

  164. BillyJoe7on 08 Apr 2014 at 5:50 pm

    Bruce,

    “The key for me is “use or origins outside of mainstream medicine” which comes up a lot in any definition you look up”

    That would make digitalis and salicylic acid CAM.
    They originate from foxglove and willow tree respectively.

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.