Jun 16 2011

Alt Med Apologetics at the Atlantic

A few weeks ago I was interviewed by journalist David Freedman for an article on so-called complementary and alternative medicine (CAM) he was writing for the Atlantic. I get many such requests, and I’m happy to provide the science-based medicine (SBM) perspective – but I always have to worry about how such articles or documentaries will turn out. Journalists (regardless of medium) often have a story in mind and can build the facts around that story. So I wonder – how much of an influence am I having on the story, or am I just providing sound bites that will ultimately serve whatever agenda the journalist has going in?

The article has now come out in the Atlantic, and the title pretty much says it all – “The Triumph of New-Age Medicine.” Ugh.

Freedman does try to be fair – he quotes me at length, as well as Steven Salzberg, who is also skeptical of CAM. But in such an article framing is everything. If you consistently give one side the final word, you can use the words of the other side just to set them up to be knocked down. You give the superficial sense of balance, but the agenda comes through loud and clear. That is essentially what Freedman did with his article. Also – clearly he is now steeped in CAM apologetics, and can rattle off the standard rationalizations they have to offer.

Here is his premise in a nutshell: Mainstream medicine has “lost that loving feeling”, the “touchy feely” side of medicine. Meanwhile, now that we have conquered many life-threatening illnesses, the population is aging, and health care is shifting to more chronic illness. He quotes Elizabeth Blackburn to make this point:

But medicine’s triumph over infectious disease brought to the fore the so-called chronic, complex diseases—heart disease, cancer, diabetes, Alzheimer’s, and other illnesses without a clear causal agent. Now that we live longer, these typically late-developing diseases have become by far our biggest killers. Heart disease, prostate cancer, breast cancer, diabetes, obesity, and other chronic diseases now account for three-quarters of our health-care spending. “We face an entirely different set of big medical challenges today,” says Blackburn. “But we haven’t rethought the way we fight illness.” That is, the medical establishment still waits for us to develop some sign of one of these illnesses, then seeks to treat us with drugs and surgery.

Standard straw man argument against SBM. This is largely a false premise. First, the medical system has had decades to slowly adapt to the slowly changing face of health care – and we have. Of course it has not been fast enough, and there are many flaws in the system (just like every complex human system). But our resources have shifted to managing these chronic illnesses.

And it is completely a false charge to say that mainstream medicine waits for illness to happen (the “preventive medicine” gambit of CAM). Preventive care is a core part of primary care and many other specialties as well. There is tons of research looking into ways to reduce risks of heart attack, stroke, cancer, and other diseases. Further, physical-therapy type interventions, lifestyle changes, as well as legitimate (not pseudoscientific) nutritional interventions are part of mainstream medicine. The “drugs and surgery” claim is patently false.

But now that Freedman has set up his cartoon version of mainstream medicine, he then follows with how wonderful CAM is – because they care about their patients, and spend time with them. This is an utter false dichotomy, of course. But there is a kernel of truth here – in that CAM practitioners do often spend more time with their patients. But Freedman entirely misses the real reason (even though I told him) – it has everything to do with resources and reimbursement.

The system is currently set up to minimize physician time with patients. It is not well reimbursed. There is a saying that applies in many contexts – don’t tell me what you value, show me your budget. What the system pays for is what it values – and face time with a physician is not adequately valued in the system. CAM practitioners, on the other hand, often charge cash and (since they don’t have any real medicine to offer) give their time and attention in exchange. They don’t have insurance companies looking over their shoulders. And, a fact that is often missed, denied, or glossed over – their income is often comparable to that of physicians. The average chiropractor salary in the US is 129k. The median salary for an internist is 160k (but it’s only 80k for a solo practitioner). (Many specialists make more, but we are talking about managing chronic illness – which is the purview of the internist.)

I acknowledge that the current demand requires a system that can provide more time with patients than the current system allows. There are ways to fix this – proposals that have already been made and to some extent incorporated. One mechanism is increased use of physician extenders – APRNs, LPNs, etc. Therefore you get the best of both worlds – the physician’s time (and therefore expense) is used efficiently, while the bulk of the time with the patient spent by a trained practitioners who specializes in patient education, preventive management, nutrition, and lifestyle risk factors. This can be (and increasingly is) all done within a scientific framework. In addition we need to adjust the reimbursement scheme so that this kind of time with patients is sufficiently reimbursed. If you pay for it, it will happen.

The solution absolutely is not discarding all of the principles of science in medicine (even common sense) and wrapping some kind of practitioner attention and maybe some basic common sense lifestyle advice around an elaborate pseudoscientific ritual. But that is exactly what Freedman concludes.

To make this case he makes all of the standard CAM apologetic deceptive and logically flawed arguments. He argues that science cannot test the practitioner effect on patient outcomes. This is wrong – this has been measured in controlled trials (Orac points this out also in his nice take down of the Freedman article). If it has an effect – it can be measured.

What the research shows is that the time and kind attention paid by the CAM practitioners is the entire effect. Patients respond to hope, they respond to attention. The ritual of nonsense that is acupuncture, homeopathy, therapeutic touch, or any similar magic-based system is entirely irrelevant. It adds nothing to the interaction, or to the patient outcome. All the elaborate philosophies of human energy or “like cures like,” all the training about acupuncture points – is all entirely worthless. We now have a large and growing literature of research that clearly leads to this conclusion.

But Freedman and others would endorse all of this demonstrably absurd and false nonsense, which adds nothing to patient care, because of the non-specific effects that come with the practitioner interaction.

This, he argues, is a better solution than just increasing the practitioner interaction of SBM, which has proven real effects also.

Freedman also completely ignores the potential harm of CAM (other than a quote from Salzburg which doesn’t really capture the full phenomenon). What is the harm that comes from instilling patients with magical thinking when it comes to health and illness? What is the harm from indoctrinating patients against SBM? They may think they feel better from their chronic aches and pains, but then when they get a serious illness they are likely to trust the Guru that made them feel better instead of the science-based medicine that actually has a chance of helping. Just browse What’s the Harm? for some examples.

The closer we look at CAM the less impressive it becomes. The core claims have never been plausible and have utterly collapsed under scientific investigation. The magnitude of the much-praised placebo effect is actually not that impressive, and no greater for CAM practitioners. And there is much more harm and risk than is claimed – once you actually start to keep track, rather than just relying on anecdotes and propaganda.

Conclusion

Freedman seems to have been overwhelmed by the finely crafted propaganda of the CAM industry. The “triumph of new-age medicine” is not in patient outcomes, or in filling any perceived gap in science-based medicine. The triumph is in pulling off a massive con. They have managed to put together a very slick package of logical fallacies, misdirections, misconceptions, and outright deception that is very effective. They have an excuse for every failure, and have managed to successfully attack their critics – even science itself.

Sowing confusion is easier than careful explanation, however. And it is remarkably easy to sell people something that they want. The appealing lie will always be hard to counter with harsh reality.

A journalists job, however, is to tell the harsh reality. Freedman failed in this regard. Despite his intentions, in the end his article was just another advertisement for an industry of pseudoscience.

 

Note: A written debate about the article is being hosted by the Atlantic. You can read Steve Salzberg’s entry, and others, here.

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27 responses so far

27 Responses to “Alt Med Apologetics at the Atlantic”

  1. Carbonon 16 Jun 2011 at 9:06 am

    Inspired by Steve,

    Both sides of the controversy point to biases or errors in the data that falsely make it look as if the alternative medicine is or is not working.

    I am not suggesting equivalency here – just that the fight is largely taking place in the arena of horrifically complex sets of massive amounts of data. For the record, I find the argument for conventional medicine to be compelling. I would not say that it is certain, …

  2. maerison 16 Jun 2011 at 9:25 am

    More upsetting is when this thought pattern pervades into the thinking of physicians. I’m starting medical school (at a large Canadian university, not some backwater hovel) in August, and was poking around into what sort of activities there are for med students to be active in the community. First of all, there is a CAM club. I have no idea what it entails, but I plan on joining so I can a) increase my awareness of the lunacy that’s out there and b) demand evidence and be the voice of reason.

    However, more frighteningly, I was looking into helping at the student-run clinic. The physician in charge of it proudly states in her biography that she is interested in “holistic and integrated medicine” and practices homeopathy and “mind-body techniques.” Although I really would love to help by providing care to the homeless and people in need, I don’t want to have CAM shoved down my throat and think it’s massively unethical to give placebos people who desperately need health care. On the other hand, I worry about seeming arrogant and dismissive to my peers and professors (in spite of the fact that my graduate research has been on dietary interventions for atherosclerosis).

    Do you have any advice for challenging CAM as a student?

  3. Steven Novellaon 16 Jun 2011 at 10:04 am

    Carbon,

    Nice try – but false analogy. First, “conventional medicine” is a field, not one specific claim like AGW. If you said the same thing about 100 different controversies within mainstream medicine, your language would be right on.

    For each individual claim, you have to decide where the evidence is and what the level of certainty is.

    And, as I said with AGW – there is a massive asymmetry between CAM and SBM. That asymmetry, however, stems largely from the fact that CAM is systematically incorrect about its basic premises and methods. We are not just dickering about complex sets of data. I prefer to dicker about the data – because that is what SBM is all about. The problem with CAM is not ONLY that they distort the data with cherry picking, etc. but their basic premises are demonstrably fallacious or wrong.

  4. ccbowerson 16 Jun 2011 at 10:58 am

    Carbon is making the same mistake as the guest on the SGU did from months ago who was arguing against animal testing. On that program he was lumping all of animal testing together and attempting to evualate it as a whole… which makes no sense because you have to test specific claims. If you mix good interventions with bad ones you may not be able to see the good.

  5. locutusbrgon 16 Jun 2011 at 2:01 pm

    I agree with the topic and discussion. However I would like to point out that an LPN and a APRN are completely different professions. An LPN stands for Licensed Practical Nurse( in some states Vocational Practical Nurse), while APRN Stands for Advanced Practice Registered Nurse.
    They are not related except in use of the word nurse. I will not go over my issue with the term “Physician Extender”, however APRN is most closely related to a Physician’s Assistant from a doctor’s point of view.

    1. LPN is mostly associate degree, and has very limited scope of practice. In most circumstances operates under the supervision of a registered nurse, simple dressings, medication administration, and in most states they are not allowed to give IV medication.
    2. APRN for a short time was a board designation, but it has mostly been dropped due to this type of confusion. It is representative of a post graduate degree(mostly masters some doctoral) plus additional training and clinical experience. APRN involves several different specialties and differing training/education. This includes Nurse Practitioners, CRNA’s, Nurse Midwives, and Clinical nurse specialists.

    Despite your lack of precision related to titles, you are correct overall. I feel it is my role to spend time with my patients and focus on education.

    Although I often feel there is far too much woo involved in my field. I do my best to fight it. Cam is very attractive to mid level providers, patients love it and makes you stand out from a physician. In my opinion, it helps contribute to the perception that nurses are somehow failed doctors as well as the other unethical aspects of CAM treatment.

  6. Steven Novellaon 16 Jun 2011 at 2:27 pm

    locutus – thanks. I actually meant nurse practitioner, not LPN.

    I did not invent the term “physician extender” – that is how they are regulated in many states. But I can see how this would have a negative connotation.

    I see a huge role for health care professionals (whatever the title) whose focus is on patient education, routine prevention, and dealing with the many ancillary issues of chronic health problems. The fact is – many of these patients present to physicians to deal with their issues, but an office visit with a physician is simply not the ideal venue for this.

    These patients need a once over by a physician for diagnostic purposes, but most of the management can be handled by another practitioner who does not have to have an MD – and in fact could focus their training so that they are better at this than your average MD.

    And yet this can all be science-based and reasonable – no need for woo.

    And, as you say – they are already out there. The issue is resource allocation.

  7. dhfreedmanon 16 Jun 2011 at 3:23 pm

    As the author of the Atlantic piece, I’d like to point out a few things. It’s true that the author of an article can score points by framing things a certain way, and no doubt I did that in my piece. But let’s look at how this post is framed. Apparently, according to the post, the point of view in my piece is that of the CAM apologist, while the (true) opposing point of view is that of mainstream medicine, as represented by Steven Novella. In fact, mainstream medicine is becoming increasingly open-minded about the benefits of alternative medicine for some patients, even as it becomes more painfully aware of its own limitations. The many highly credentialed, mainstream physician-scientists I interviewed for the article express fairly typical views. I assure you they weren’t carefully selected to meet any criteria. (Nor did I manipulate or carefully select their quotes, as I also did not do with Steven Novella’s quotes, as he was gracious enough to acknowledge.) Indeed, I went to the trouble of seeking out and interviewing the two people I felt are the most highly credentialed, articulate, passionate opponents of alternative medicine in the country, namely Steven Novella and Steven Salzberg. (I don’t consider David Gorski to be article and thoughtful on the subject, he’s just rabid, and I was sorry to see Dr. Novella compliment his venomous comments.) Those two people were carefully selected to powerfully represent the anti-
    CAM point of view–I had no idea how the others I interviewed felt about alternative medicine, they just turned out to be very open-minded to it. (As did many others I interviewed, but didn’t have space to include in the article). So I’d suggest a more honest framing of this post might have positioned me as highlighting the views of much of mainstream medicine, opposed by an increasingly small minority of hard-core, won’t-give-an-inch opponents of all aspects of alternative approaches. The growing interest in the benefits of some aspects of alternative medicine (while we can all agree the physical treatments themselves work only through the placebo effect) isn’t about CAM apologism or journalistic manipulation, it’s about a strong trend within mainstream medicine, and one which is leaving Steven Novella and other intensely anti-CAM voices increasingly marginalized.

  8. mufion 16 Jun 2011 at 3:29 pm

    I acknowledge that the current demand requires a system that can provide more time with patients than the current system allows.

    I’ve been listening to a CD version of the book Social Intelligence by Daniel Goleman during my morning commutes, and just yesterday I heard a chapter on this very topic. He cited similar studies re: the potential medical benefits of lengthening time per patient, improving caregivers’ bedside manner, etc.

    Not to diminish the importance of debunking alt-med claims w/science-based facts, but I would like to see more emphasis on recognizing and solving this institutional problem.

    Thanks for spending some time on it.

  9. locutusbrgon 16 Jun 2011 at 3:57 pm

    Thank you Steve I cannot really argue with anything you are saying.
    My problem with Physician extender is related to billing/third party issues and public perception. Federal legislative restrictions, health care reimbursement problems and state legislation which have utilized that particular terminology to illuminate NP’s negatively. Some have used that term to indicate NP’s and CRNA’s are a bait and switch type scam that physicians use to defraud medicare, patients, and/or insurers. It is lawmaker use of the term and it’s lay person connotation that is at issue.
    My personal opinion is that APRN’s are fractured and a poorly organized group, we have done a poor job of presenting ourselves to the public at large. In addition even a fair fraction of medical doctors have no idea about training and education. Physician extenders, although accurate, in most cases is a poor identifier. For all intents and purposes a medical assistant and registered nurses have all assumed roles, that physicians used to do. IE: injections. That is kind of big bucket to be lumped into, especially when you are trying to justify your usefulness to an lay public.

    Terminology is always touchy, APRN’s are not substandard physicians, neither are they equivalent to physicians in training or education. Physician Extender does not accurately identify that dichotomy, in my opinion.

  10. elmer mccurdyon 16 Jun 2011 at 4:40 pm

    http://bostonreview.net/BR35.3/gordon.php

    “Today nurses no longer have to beg to get noticed. Like medical conferences, nursing conferences are now heavily supported by pharmaceutical and medical-equipment companies, which, like the corporations advertising on public television and radio, demand more and more of the spotlight. Nurses, like physicians, are flown to exotic spots and showered with so-called educational presentations. When I mentioned this phenomenon to a very respected nurse-academic, I expected her to share my concern. Her response: “It’s about time we got ours.” “

  11. Kimball Atwoodon 16 Jun 2011 at 4:48 pm

    @maeris:

    Right you are. This is a growing problem in medical schools. It isn’t easy to be a student faced with this stuff; if it had happened when I was in medical school in the 1970s, I’d have wondered if I’d fallen down the rabbit hole. Here’re some places to start:

    A just-published article by yours truly:

    “CAM” Education in Medical Schools—A Critical Opportunity Missed

    http://virtualmentor.ama-assn.org/2011/06/ccas2-1106.html

    Articles by Tim Kreider (written while he was a medical student) at SBM:

    http://www.sciencebasedmedicine.org/index.php/contributors/timothy-kreider/

    Many other articles on SBM about “CAM” presentations in medical schools.

    KA

  12. elmer mccurdyon 16 Jun 2011 at 5:18 pm

    Anyway, I should think that any serious chronic pain specialist who finds himself with a lot of patients with chronic muscle pain might want to educate himself about Feldenkrais, taijiquan (known in the west as “tai chi,” which I think gets certain people thinking it has something to do with “chi”), yoga, muscle energy technique etc. along with psych approaches like cognitive behavioral therapy, (I’d also throw in trigger point therapy, with which I self-treat to manage my pain, but that’s tricky because of the very small number of trained practitioners), take into account any obstacles to research, any risks to giving them a whirl, and make up their minds about whether they’re worth trying before they load their patients up on drugs.

    I’ll also throw in a thought about chiropractic. Now, I think most people accept that manipulation is helpful for back pain, and I happen to think some of the other things they do can probably be helpful for other kinds of chronic pain, regardless of the paucity of controlled studies. Anyway, I’ve noticed there’s a tendency on these (very selectively) “skeptical” sites to say that people should see PTs rather than chiros for manipulation, because some of them are trained for it. My reaction to that is that personally I haven’t met one who is, and I’ve seen quite a few PTs. The truth is that, in practice, PTs are trained to focus on acute problems, and to deal with pain, if at all, as a symptom of an acute physical disability rather than as a problem in itself. This is the reason they typically are not interested in chronic pain. So I’m all in favor of reforming this aspect of physical therapy, but until that happens, chiros are going to necessary in order to fill that gap.

    Here’s a good paper that discusses the problem.
    http://www.bethesdaphysiocare.com/professionals/pdf/painpractitioner_pt_domm04.pdf

  13. DBonez5150on 16 Jun 2011 at 5:31 pm

    There is an area of medicine already established AND reimbursed by insurance companies: Psychotherapy. Instead of promoting CAM and all its ludicrous claims, it seems to me Freedman, and others lambasting SBM for its lack of touchy/feely, warm-and-fuzzy connections to the patients, should look to forms of therapy. I have been seeing a therapist (childhood trauma) for years with fantastic, life improving results. I go to my physician for sound, practical medical treatments, and good interaction too, but don’t expect him to sit with me for 45 minutes listening to me explore the history of my pains and fears. So between my physician and psychotherapist, I have worked out a great course of antidepressants and found a good solution to chronic back pain. Some may argue that psychotherapy is also a pseudoscience, and there may be valid arguments both ways, but I trust my therapist’s education and Ph.D. over a naturopathic’s “doctorate” or some street-trained person jabbing needles into people.

    My health insurance isn’t the best and they still cover 80% of up to 30 therapist office visits. I still have to make my deductible and my co-pay is at a specialist’s rate ($35/visit), but I get 45 to 60 minutes of quality interaction with professional feedback. There are also many free state-run therapy clinics out there, but I have never, ever, despite numerous calls, been able to get into one. I have also had physical therapy for my back pain which is also a covered benefit and somewhat helpful – albeit briefly. Physicians should really consider offering those options (real alternatives!) to patients when the patient is still left wanting more, but there’s nothing medically indicated. Perhaps this too would take time to permeate into standard medicine, and several negative stigmas about seeing a shrink would need to be tackled, but it could add so much without the woo.

  14. lizditzon 16 Jun 2011 at 5:32 pm

    Oh dear. David Freedman has shown up at Respectful Insolence, , with argument from authority (“top scientists”) and then proceeds to miss the point of objections to the marketing of CAM as efficacious:

    Frankly, the unwillingness of Orac and this crowd to consider for a moment the possibility that there may be some aspect of alternative medicine other than any direct physical action from its core treatments that might be helpful to many patients, especially in light of all the evidence and widespread, highly informed opinion that this is so, perfectly embodies everything that science is supposed to oppose: closed-mindedness, deep bias, hostility to disagreement, reckless disregard for reason and evidence that don’t support a favored conclusion, and a total lack of humility with regard to what one knows for sure. What you are defending here isn’t science, folks–it’s what I call “scienceology,” a quasi-religious faith in a set of closely held beliefs that are dressed up in the trappings of science and kept immune to any counter-evidence or -opinion.

    The rest of the comment stream is an infestation from a known pro-homeopathy troll, “Chuck Pelto”, except for a few comments, including a closing insult from Freedman

  15. elmer mccurdyon 16 Jun 2011 at 6:14 pm

    http://www.sciencebasedmedicine.org/index.php/national-health-interview-survey-2007-cam-use-by-adults/

    “As we can see – most hard-core CAM modalities are used by a very small percentage of the population. Most are less than five percent. Only massage and manipulation are greater than 10 percent. These numbers are also not significantly different from 10 or 20 years ago – belying the claim that CAM use is increasing.

    Also, if you look through the specific indications for which these modalities are being used, most are for back pain, with arthritis and other pains next most common. Very few are being used for medical indications.”

  16. sonicon 16 Jun 2011 at 7:09 pm

    From the article–

    “The beneficial effects of alternative therapies on Mayo Clinic patients, he says, have been observable in shorter hospital stays, in lower levels of self-administered painkillers, and in reduced tissue inflammation, which is a general indicator that the immune system is better holding its own.”
    This is a quote from the dean of Mayo Clinic’s medical school Keith Lindor.

    It seems the use of the therapies is getting results Lindor wants.

    Is Lindor wrong?

  17. PTsickof BSon 16 Jun 2011 at 8:57 pm

    @ Elmer

    As a PT who has been educated in Feldenkrais, and trigger point therapy, and is trained in manips, and comes from a country where we use Tai Chi as a government funded falls prevention strategy. Let me point out a few things -

    Feldenkrais is just motor relearning – not mysterious.

    Trigger point therapy is just manual therapy – not mysterious.

    Tai Chi is just slow controlled exercise – not mysterious.

    Manipulation is no more effective than mobilisation of a specific vertebral segment – which all PTs are trained in.

    As pointed out by Steve many times – If you strip off the woo and BS that underlies some of these interventions, they are very normal, standard, “Western medicine” approaches.

    “…PTs are trained to focus on acute problems, and to deal with pain, if at all, as a symptom of an acute physical disability rather than as a problem in itself. This is the reason they typically are not interested in chronic pain. So I’m all in favor of reforming this aspect of physical therapy, but until that happens, chiros are going to necessary in order to fill that gap.”

    What on earth makes you believe chiros are more equiped / better trained to deal with chronic pain??? (manipulation / mobilisation has only shown to be effective in acute pain – not chronic pain).

    As pointed out I am trained in a number of the modalities you mention, however I don’t style myself a Chronic pain specialist. I don’t pretend to know it all, or be able to fix it all.
    I (hope) I am professional enough to know where my expertise ends and a referral to our local pain clinic is indicated, I am not sure that the chiro theory of Life the Universe and Everything allows them the freedom to say – “I dunno, but I’m going to send you to someone who will know”.

  18. Khym Chanuron 16 Jun 2011 at 9:29 pm

    I acknowledge that the current demand requires a system that can provide more time with patients than the current system allows. There are ways to fix this – proposals that have already been made and to some extent incorporated. One mechanism is increased use of physician extenders – APRNs, LPNs, etc. Therefore you get the best of both worlds – the physician’s time (and therefore expense) is used efficiently, while the bulk of the time with the patient spent by a trained practitioners who specializes in patient education, preventive management, nutrition, and lifestyle risk factors.

    But what if what a lot of patients want is to have more time with the person doing the diagnosis and prescribing the therapies? The impression I get is that what a lot of people want.

  19. sonicon 17 Jun 2011 at 5:30 am

    Dr. N–
    Sorry about that last. It’s just that the guy from the Mayo clinic comes across pragmatic and you came across dogmatic.
    This is problematic from the communications stand point. (And that’s axiomatic. ;-) )

    Freedman claims he would pick you for his physician. A plug!

    It seems that different people would respond to different placebos. If I were going to give you a placebo I’d go with an injection that caused mild discomfort. Am I right?
    Some would do with a pill, others encouragement.
    A mother’s kiss seems universal, but it’s not just any mother.

    The factors that would determine what placebo was good for what person might include their education, profession, genetics, philosophy, sex, sexual orientation, religion,birthplace, age…
    I’m not sure it would make sense to try to change any of those to make a placebo work. It seems one could just use the placebo that fit the situation– Some people would probably respond to touch better than pill- and vice-versa, for example.
    Some people will respond to statements like “You are doing so well,” others might prefer, “We are healing the body,” others might respond to “Mumbo jumbo wombo tombo,”
    I’m not sure the studies have been completed on this.
    In the meantime, it seems pragmatic to go with what is seen to be working best, right?

    I think that is what Freedman is trying to say here.

  20. Steven Novellaon 17 Jun 2011 at 7:09 am

    Sonic – I guess pragmatic vs dogmatic is in the eye of the beholder. What did I say that is dogmatic? I am advocating one standard of science for all of medicine. CAM proponents are proposing a special double standard for their ideologically preferred modalities.

    Yes – Lindor is wrong in his interpretation of the literature. That is largely what this whole controversy is about. We write about this exhaustively at SBM – proponents are trying to change the rules, they are cherry picking evidence, and they are misinterpreting the significance of research. But they have an appealing marketing strategy – it just doesn’t hold up to close scientific scrutiny. We do that – and then we get dismissed as closed minded and dogmatic. But that’s just part of the marketing strategy – and it unfortunately works. Freedman bought it.

  21. Oracon 17 Jun 2011 at 8:04 am

    Depressingly disappointing. Freedman claims I “do away with all pretenses of objectivity, civility, or respect for evidence and reason”:

    http://www.theatlantic.com/life/archive/2011/06/evidence-not-anecdotes/240588/

    This is, of course, utter nonsense. Mr. Freedman was completely unable to refute a single point I made. Instead, he posted a long, rambling, nearly incoherent angry comment, chock full of ad hominems and logical fallacies.

  22. SimonWon 17 Jun 2011 at 8:32 am

    I presume Gertz is a regular apologist since he seems to be comparing off label prescribing with lack of evidence? I’m guessing he isn’t one of the doctors who finished top of his class with that sort of logic.

    Besides failed clinical trials are not “lack of evidence” but “evidence against”, and there are plenty of failed clinical trials for a whole host of common snake oil medicine.

  23. elmer mccurdyon 20 Jun 2011 at 9:05 pm

    @PTsickof BS

    Sorry to be too slow getting back, I’ve been working on other things, and don’t like being sucked into debates. The reason I mentioned those protocols is because when I searched the archives of this blog for them, the only mention was disparaging – it appear that Dr. Novella considers them woo.

    I personally have not had manipulation done, but based on comments I’ve read by chronic pain sufferers, manipulation gives them temporary relief – that’s called “pain management.”

    I think it’s wonderful that you know those protocols you’ve mentioned, but the truth is they’re rare for PTs, (see the link I provided – written by a PT, I might add), and much more common for chiros.

    My experience with PTs has been generally that their approach to everything revolves around weightlifting – which did make me a little stronger, but aggravated my symptoms. Ultimately I found I had to to do my own reading, experiment and self-treat.

    I should note that I’d forgotten about one PT I saw who did manage to give me some relief, using an unusual technique involving arm manipulation as I held air in my lungs. This was a U.S.-educated PT I saw briefly in Taiwan, though unfortunately no other PT I described the technique to had any idea what it was, and by the time I managed to contact him again, it had been so many years that he himself couldn’t identify it… however, it strikes me as similar to a description of muscle energy technique as described in another article by the same PT who wrote the link I provided above. As it happens the only L.A. area PT I’m aware of who knows this technique is way the hell over in Beverly Hills; although there is a chiro who knows it fairly close to me. By this point I’m no longer interested in seeing any practitioner, though. I find the library more helpful.

  24. elmer mccurdyon 20 Jun 2011 at 9:07 pm

    Wow, I should have proofread that before submitting. Oh, well.

  25. elmer mccurdyon 20 Jun 2011 at 10:22 pm

    Actually, I suspect the only way to get the relevant text read is to quote it here. Note again that the following is written by a PT. I hope blockquotes work….

    Although there appears to be consensus that pysical therapy is an integral component of pain management centers, few physical therapists have received adequate training in clinical pain mechanisms and pain management strategies, which is somewhat remarkable considering that the chronic pain prevalence is estimated to range from 10% to 55%. The International Associaton for the Study of Pain (IASP) has developed a specific pain curriculum for occupational and physical therapy education (http://www.iasp-pain.org/ot-pt_toc.html), yet there is no evidence that htis or similar curricula are commonly taught in physical therapy academic programs. It should then come as no surprise that many phsyical therapists lack knowledge on pain managment and may not be all that interested in working with persons with chronic pain.

    According to Wolff and colleages, 96% of orthopedic physical therapists prefer to work with patients who are not likely to have chronic pain. A search of the membership directory of the Orthopedic Section of the American Physical Therapy Association (APTA) suggests that its Pain Management Special Interest Group has less than 400 physical therapy members out of a total APTA membership of about 64,000, which equates to approximately 0.6 percent (from “members only” section of http://www.orthopt.org, accessed October 30, 2004). A similar search of the membership directory of the American Academy of Pain management suggests that there are less than 100 identifiable physical therapy members out of a total of approximately 6,000 members (less than 1.7 percent)(http://www.aapainmanage.org/search/MemberSearch.php, accessed October 30, 2004). The apparent lack of professional interest and insufficient education and knowledge in pain mechanisms and pain management strategies can create multiple challenges for physical therapiests to become effective pain management clinicians.

    As for my impression that what I consider suitable protocols (i.e. “manual therapy” and “movement therapies” in the words of the above author) are much more common among chiros, it comes from searching for practitioners of any sort who had those skills, both in google searches and databases, and from noting the backgrounds of the authors of the articles I’ve read. It is an impression, but I believe it’s correct.

  26. elmer mccurdyon 20 Jun 2011 at 10:23 pm

    btw, I couldn’t seem to copy and paste that, so any typos are mine.

  27. ftouhiion 24 Nov 2014 at 8:47 pm

    Carbon is making the same mistake as the guest on the SGU did from months ago who was arguing against animal testing. On that program he was lumping all of animal testing together and attempting to evualate it as a whole… which makes no sense because you have to test specific claims. If you mix good interventions with bad ones you may not be able to see the good.

    https://www.youtube.com/watch?v=ZApjypY0kQU

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