http://www.youtube.com/watch?v=l3EdUk8QXzc

if this guy says “qi” (chi) is real, are YOU gonna argue with him?

I would like to address one point though:

@ism:

My question is: to what degree are practicing MDs (non research) trained to recognize good or bad science?

I must preface this by saying it is my opinion and based purely on anecdote and my own experience, but in short, the answer is “not very much.”

We have EBM classes and are examined on the material. But the reality is that most people don’t take it very seriously. They learn enough to get by (which isn’t much since you could do quite poorly on it and still get decent grades overall) and are generally happy with a cursory examination.

I learned most of my EBM and study interpretation through reading SBM, RI, and this blog, as well as my background in post-grad research. But I just recently had some classmates beg me for a tutorial in EBM for our finals which we just had and it was clear there was not a deep understanding of it.

Now this is quite fine, assuming that studies and consensus views are intellectually honest. If Cochrane actually said, “Studies on homeopathy are equivocal, with some showing minor benefits, but it is still total BS because we’d have to live in bizarroworld for it to possibly do anything” then I’d say the level of understanding your average medical student gets through the curriculum would be quite sufficient.

Of course, many students go on and learn on their own and truly think about such things – those students tend to be my best friends over here at med school. But I also have good friends representative of the other side of the spectrum – those for which their science background is not quite as extensive and are having a hard enough time just keeping up with the flow of material and expected amount of knowledge learned to bother themselves with thinking in depth about such matters. One in particular comes from a very “new-agey” background and is hard pressed to give up some of her slightly woo-ish notions, but at least she listens when presented with evidence and changes her opinion accordingly.

But many are blown away when I show them evidence about our CAM professor – I’d been lambasting him for some time and finally one of them looked him up and gasped; everything I’d been saying was spot on and suddenly the room was abuzz. These are the same students that had been to his lectures and listened to what he had to say and took it in (or ignored it) without much thought. But when I actually showed them the depth of his quackery and discussed some specifics and actually demonstrated his sleight-of-hand tactics they were shocked – so I would very much second Dr. Novella’s statement that most well credentialed physicians aren’t aware of what CAM actually is. This is because many intelligent and otherwise concientious med students also don’t know. Heck, most can’t even tell me what homeopathy or chiropractics actually are. They think they are “natural” (aka “wholesome” or “holistic”) or just physical therapy. They know nothing of the Law of Similars or the Theory of Subluxation. When I tell them, they are once again aghast.

So yeah. Take med students who are busy trying to learn the real stuff, add in ignorance on the specifics of the modalities, sprinkle in some lack of rigor with the EBM modules, add a few years time and you get a credentialed physician who is a shruggie and doesn’t think (s)he needs to care much about homeopathy or acupuncture.

This reasoning is not circular-
Premise- The guy at Mayo knows how to adjudicate what is gettng good results-
Premise- The reporter is accurately reporting ‘good results’
Conclusion- They are getting good results
Corallary- Studies that would conclude otherwise are flawed.

It is possible the guy at Mayo is wrong. Or it could be they are seeing good results for reasons other than he claims. But either way, the fault is in the premise, not the logic.

It seems that any benefit from some therapies would come from patient attention and/or relaxation.
If that is true, what techniques should be approved?

Sorry, I didn’t mean that you meant it that way, only that it is the sort of thing CAM proponents say to have their unproven treatments given alongside science based medicine.

But my question still remains: how do know you’ve benefitted from “woo medicine”? The point is that you don’t know.
This is the whole point of science based medicine, that anecdotes are unreliable, and that you need clinical trials to sort the wheat from the chaff.

“as someone who has benefited from SBM and what some will call “woo” medicine”

Some call it “woo” medicine because there is no possible mechanism of action and because there is no clinical evidence from RCTs of effectiveness. In which case, how do you kow you benefited? What you have is an N=1 clincal trial which is close to useless.

“I look forward to the day medical care gives the best of everything to all the people”

I hope you mean only treatments which are plausible and have clinical evidence of effectiveness. (The above sounds like it came out of the mouth of CAM)