Oct 29 2012

Integrative Medicine Propaganda

While I am at home preparing for the “perfect storm” – an Autumn hurricane that is barreling down on the northeast –  I found the following letter in my e-mail:

I am appalled at what I am reading. How is integrative medicine quackery? Have you ever visited a Naturopathic Doctor, or an integrative Doctor or practitioner? I bet you know not one thing concerning not only their practice or about what they do to treat diseases. They understand that sometimes pharmaceutical drugs and surgery are necessary, but understand that sometimes they can cause more harm than good.

For some people, not having their nutrients at optimal levels can cause a series of symptoms to exhibit their “deficiency”. For some people toxins do cause problems and therefore need to detoxify. For instance, a cancer patient went to see a naturopathic doctor and found that she was being exposed to large amounts of copper which not only lead to her cancer but also to its persistence. Some people do have food sensitivities that can cause to lymph related cancers.

You may say that nothing that they do is scientific but how can you prove that?

Naturopathic Doctors have always treated people with “Adrenal Fatigue”. You may say that this is not a disease, and that the Adrenals can deal with bountiful amounts of stress. But if Adrenal Fatigue is not a scientifically sound nor is it a disease, then please tell me why has The Journal of Psychosomatic Medicine found that patients with CFS, have an altered Cortisol and DHEA diurnal rhythm? And why has McGill University, a prestigious academic institution, found the same results, as people who suffer from fatigue have altered or varied Cortisol and DHEA diurnal rhythm.

These studies are new studies, but Naturopathic Doctors have been treating them for thirty years or more?

If a Medical Doctor says in their Hippocratic oath that they are to first do no harm, why do they sometimes prescribe medications which at the end causes more harm.

A statin drug was recently taken of the market because although it was approved, they found that it now causes bladder cancer.

Hippocrates said, “Let thy food be thy medicine, and thy medicine be thy food”

If an apple a day keeps the Doctor away, then why don’t we suggest nutrition.

Naturopathic Doctors are unscientific. If the statement be then they would not use blood test and other means to measure biochemical substances and use what they can to treat it.

There is a lot of Journals and Papers published on Orthomolecular Medicine, and CAM. Are these journals not scientific.

The Tripedia Vaccine for Pertussis has been taken off the market. It was noted to the FDA that multiple adverse effects included autism, and SIDS.

If certain drugs can cause carcinogenicities, liver failure, and other nasty side affects why should we take them when there are safer alternatives which can perform the task?

Before you open your traps on making statements that CAM and IM as being  pseudoscientific, go see someone who has treated the ROOT cause of ailments and pathologies.

If you want scientific research I can give them to you!

Sincerely,

This e-mail is very typical. I get some version of it every week or so – the points are not just typical, but positively cookie-cutter. They are popular alt-med memes, what I would call propaganda, that I see over and over again, using almost exactly the same language.  Let’s take the points one by one

“I bet you know not one thing concerning not only their practice or about what they do to treat diseases.”

As a general rule I would avoid making sweeping assumptions about someone or some group with whom you disagree, especially when those assumptions are self-serving. It is perhaps more effective to search for common ground, and to be charitable to the “other side.” If you can effectively argue against the best version of an opposing argument, then your position is likely solid. Otherwise you risk being a straw-man warrior. Regarding this particular assumption, the e-mailer claims to be appalled by what they read (I don’t know if they mean here, at Science-Based Medicine, or both), but they must not have read much. The many articles I and my colleagues have written over several years about so-called “integrative” medicine are pretty overwhelming evidence that we have a detailed knowledge of the philosophy, claims, and methods of all sorts of such practices and practitioners, including the relevant scientific literature.

This particular e-mailer did not play the “pharma-shill” card, but that is also a common assumption on the part of SBM critics. Making such casual and self-serving assumptions dramatically weakens one’s position and argument.

Next:

“They understand that sometimes pharmaceutical drugs and surgery are necessary, but understand that sometimes they can cause more harm than good.”

This is a vague statement, so vague that you can probably say this about most practitioners, except the most extreme (those who disavow all drugs and/or all surgery).  It is true of every physician I personally know, and certainly conventional wisdom within medicine. There is, in fact, a great deal of medical research and reviews directly addressing this question – risks vs benefits of specific interventions. This is the centerpiece of clinical decision-making. Saying that naturopaths understand this and implying that mainstream physicians do not is an absurd straw man.

The real question is – how do the respective professions, and individual professionals, apply the evidence to risk vs benefit decisions. My colleagues and I have documented exhaustively that, on the whole, naturopaths apply the evidence in an ideologically and highly biased way, one that abhors evidence-based practice (even while at times claiming they are evidence-based).  (More on this below.)

For some people, not having their nutrients at optimal levels can cause a series of symptoms to exhibit their “deficiency”. For some people toxins do cause problems and therefore need to detoxify. For instance, a cancer patient went to see a naturopathic doctor and found that she was being exposed to large amounts of copper which not only lead to her cancer but also to its persistence. Some people do have food sensitivities that can cause to lymph related cancers.

“Not having their nutrients at optimal levels” is an odd way to state this, and why the scare quotes around “deficiency?” Perhaps it has something to do with the fact that naturopaths and other dubious “natural” practitioners overdiagnose nutritional issues, because that’s what they treat. To some practitioners all health issues are about nutrition and toxins, because that is their philosophy. The standard medical paradigm, however, recognizes nutritional and toxic diseases, but also infectious, auto-immune, degenerative, anatomical, genetic, developmental, metabolic, psychological, and physiological causes of illness. We recognize and study the influence of diet and lifestyle on health and disease. It is yet another strawman (a demonstrably wrong and unfair one) to claim that mainstream medicine is all about drugs and surgery and for some reason ignores certain disease etiologies. Just read any standard medical textbook, or browse the medical literature, and you will see that this is true.

Naturopaths, however, focus unreasonably, and against the evidence, on nutrition and vague toxins, and then prescribe diet changes and supplements for conditions that are not significantly modifiable with these modalities, or they give “detoxifying” treatments for imagined toxins.

The point about the patient with copper toxicity is just an anecdote. In reality the relationship between copper and cancer is a complex one. Both low and toxic levels of copper can be associated with certain kinds of cancer, but the relationship is not definitively established. Further, lowering copper levels is being researched as a strategy of starving cancers by limiting blood vessel formation. This treatment, however, has been linked with low blood counts and fatigue in cancer patients. In short researchers are looking at every possible angle of copper and cancer and looking at the risks vs benefits of specific interventions. Naturopathy, rather, make assumptions based upon preliminary or cherry picked evidence – whatever supports a nutritional intervention.

Further, non-science-based practitioners will often latch onto preliminary evidence and then run with it, while science-based practitioners recognize that most new treatments or ideas in medicine turn out to be wrong and there is a certain threshold of evidence that should guide practice. Occasionally the preliminary evidence may turn out to be true, and the early adopters can claim to be “ahead of their time” when in fact they were practicing without adequate evidence.

“You may say that nothing that they do is scientific but how can you prove that?”

I actually never claimed that nothing they do is scientific, just that they do not properly use science as a guide to their claims and practice. They may happen to incorporate some science-based treatments, but they certainly do not do so systematically, nor do they exclude treatments that are blatantly unscientific. Naturopaths, for example, use homeopathy – a completely unscientific treatment that is not only as implausible as a treatment can get, but the clinical evidence shows that it does not work. Kimball Atwood has reviewed naturopathy and found:

‘An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices.”

Naturopathic Doctors have always treated people with “Adrenal Fatigue”. You may say that this is not a disease, and that the Adrenals can deal with bountiful amounts of stress. But if Adrenal Fatigue is not a scientifically sound nor is it a disease, then please tell me why has The Journal of Psychosomatic Medicine found that patients with CFS, have an altered Cortisol and DHEA diurnal rhythm? And why has McGill University, a prestigious academic institution, found the same results, as people who suffer from fatigue have altered or varied Cortisol and DHEA diurnal rhythm.

These studies are new studies, but Naturopathic Doctors have been treating them for thirty years or more?

If naturopathic doctors have “always” treated adrenal fatigue, and yet current evidence is just showing that it is legitimate – how did naturopaths know about it? Do they have some magical access to knowledge we should know about? The truth is, there is no convincing evidence that adrenal fatigue really exists. It’s easy to make up a fake illness, then simply proclaim your fake illness to be real and declare victory, while criticizing the mainstream for not recognizing your fake illness. The cherry picked evidence the e-mailer offers does not establish adrenal fatigue as real – not even close. This is, ironically, just another example of how naturopaths are ideological and not evidence-based. If convincing evidence emerges that something like adrenal fatigue exists, science-based practitioners will happily incorporate that into their treatment. If evidence shows that it is not real (as it seems the case to be), will naturopaths drop this idea from their list of things to treat? History suggests no.

If a Medical Doctor says in their Hippocratic oath that they are to first do no harm, why do they sometimes prescribe medications which at the end causes more harm.

Because medical knowledge is imperfect. All interventions have risks, and those risks are statistical. No one can promise (not a naturopath, a homeopath, an acupuncturist – no one) that their interventions will not cause any harm. Even the opportunity cost of seeing one practitioner can potentially cause harm. Again – what matters is risk vs benefit. What we can promise is to use the best currently available scientific evidence to provide the optimal probability of benefit while minimizing risk. Sometimes there is still a bad outcome. Is the e-mailer claiming that the interventions of naturopaths never cause harm? What magic must they have at their disposal?

“Naturopathic Doctors are unscientific. If the statement be then they would not use blood test and other means to measure biochemical substances and use what they can to treat it.

There is a lot of Journals and Papers published on Orthomolecular Medicine, and CAM. Are these journals not scientific.”

Because they are pseudoscientific. Using the trappings of science, like blood tests, does not make a practitioner scientific. Following scientific evidence and methods make one scientific, and as a whole the naturopathic profession is not science-based in their practice. Having a journal is just another trapping of science. If the editorial policy of the journal is not adequately science-based, then no, that does not make them scientific.

The Tripedia Vaccine for Pertussis has been taken off the market. It was noted to the FDA that multiple adverse effects included autism, and SIDS.

The Tripedia vaccine is no longer produced, but it was not pulled from the market. Also, the FDA does not recognize that the Tripedia vaccine caused autism or SIDS. That is just made up propaganda by the anti-vaccine movement. The whole-cell pertussis vaccine was replaced by an acellular pertussis vaccine in the 1990s because of the controversial (still) concern of neurological side effects from the vaccine. In retrospect the evidence is not convincing that the whole cell pertussis vaccine caused any problems, but the newer vaccine was considered safer and so replaced the older vaccine. This is an example of the medical community erring on the side of safety, to minimize risk wherever possible. You can see how the e-mailer make a highly inaccurate reference to this issue as nothing more than scaremongering.

Before you open your traps on making statements that CAM and IM as being  pseudoscientific, go see someone who has treated the ROOT cause of ailments and pathologies.

This is a common CAM meme – that CAM practitioners treat the “root” or real causes of disease, while mainstream doctors only treat symptoms. Treatment modalities used by naturopaths and CAM practitioners and not by mainstream science-based practitioners do not treat real causes of disease. They treat fantasies with magic and fairy dust. They base their claim on their own made-up causes of disease. Naturopathic treatments, like homeopathy and acupuncture, are vitalistic practices that are based on ancient superstitious notions of an imaginary life energy – not on real “root” causes of illness.

Conclusion

The above claims are depressingly common among CAM believers. They are demonstrably wrong and most of them do not even make logical sense. They collapse under any level of scrutiny.

It is important to recognize that the SBM criticism of CAM is based upon their own claims and writing. They can make their best case for their position – it is simply not based on a fair and reasonable assessment of the scientific evidence, and it frequently involves blatant abuses of scientific methods.

Meanwhile the anti-science and mainstream medicine propaganda from the CAM side is a demonstrably false and unfair strawman. I suggest the e-mailer take their own advice and find out what mainstream medicine is all about from primary sources, rather than secondary hostile sources with a marketing agenda.

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17 responses so far

17 Responses to “Integrative Medicine Propaganda”

  1. BillyJoe7on 29 Oct 2012 at 2:37 pm

    Steve,

    Did you email a link to this article back to the emailer?
    It would be interesting to see the response.

  2. Davdoodleson 30 Oct 2012 at 12:33 am

    “It would be interesting to see the response”

    I doubt a response will fairly (if at all) traverse anything Dr Novella actually wrote, and instead will simply be a regurgutation of other, un-related, anti-science memes.

    Hopefully, I’ll be proved wrong.
    .

  3. ConspicuousCarlon 30 Oct 2012 at 12:53 pm

    It was noted to the FDA that [...]

    I’ve seen this odd phrasing before, applied to unrelated issues. They want to appeal to authority, but they don’t even have an authority on their side, so they instead frame it as what some authority has been told by some unspecified entity.

    Naturopathic Doctors have always treated people with “Adrenal Fatigue”.

    This reminds me of the time that one of the chiropractors commenting on a post at SBM tried to exalt himself (I think he used the word “prophetic”) by claiming that things he said 5 years ago now have scientific evidence, and also offered a prediction that the same would happen with his current claims. So he was basically admitting that he was saying things which lacked evidence, but he thought it made him sound like a genius.

  4. Bronze Dogon 30 Oct 2012 at 3:49 pm

    This reminds me of the time that one of the chiropractors commenting on a post at SBM tried to exalt himself (I think he used the word “prophetic”) by claiming that things he said 5 years ago now have scientific evidence, and also offered a prediction that the same would happen with his current claims. So he was basically admitting that he was saying things which lacked evidence, but he thought it made him sound like a genius.

    That’s one thing that annoys me, ‘appeal to the future.’ There are a lot of Cassandra and Galileo wannabes out there who so confidently predict what will be discovered in X years and do so without justifying their confidence. It’s a retreat into ego-boosting ‘I told you so!’ daydreams. It doesn’t help that a great number of trolls seem to do it for that purpose instead of genuine concern for correcting our alleged mistakes.

    People who know how science works scale their confidence in a prediction to the available evidence and prior plausibility. We also know that we might turn out to be wrong, and that being wrong isn’t a character flaw in itself, and being right isn’t a virtue if you got there by dumb luck alone.

  5. ccbowerson 30 Oct 2012 at 4:30 pm

    If only these attitudes were confined to the fringe. Many of these are just extreme versions of unchallenged assertions and errors in thinking that are too common in the general public. The application and promotion of critical thinking is needed to help keep these beliefs and attitudes in check- and in their proper place as fringe beliefs and attitudes unsupported by any evidence.

  6. BKseaon 30 Oct 2012 at 4:55 pm

    This was a test, right? So far, I have found the logical fallacy in every sentence except the opening: “I am appalled at what I am reading.”

    Can you give us a hint on that one?

  7. Davdoodleson 30 Oct 2012 at 7:37 pm

    ““I am appalled at what I am reading.”

    Argument from consequences :)
    .

  8. BobbyGon 30 Oct 2012 at 11:19 pm

    “If a Medical Doctor says in their Hippocratic oath that they are to first do no harm”
    ___

    Urban myth. Not in the Oath, farm & fuzzy as it may otherwise be.

  9. gervasiumon 31 Oct 2012 at 8:18 am

    The original Hippocratic oath had “abstain from doing harm”. It might not have had the exact wording “first, do no harm”, but the intention is there.

  10. nybgruson 31 Oct 2012 at 11:10 am

    I think the concept is antiquated. At least the black and white version alties like to bandy about.

    In nearly every single instance, we do harm with every intervention we do. The question is, is the harm worth the benefit?

    Of course I am preaching to the choir here

  11. ccbowerson 31 Oct 2012 at 12:14 pm

    “I think the concept is antiquated.”

    Since it has been over 2000 years since the original oath was written, it is not surprising that the concepts are antiquated (there is a line in it about not having sexual relations with men or women in a patient’s home – still true, but odd that this had to be spelled out). Also 2000+ years ago I imagine that doing nothing was often a person’s best option for good outcome

    “In nearly every single instance, we do harm with every intervention we do. The question is, is the harm worth the benefit?”

    Not only that, but we are usually thinking (or should be) probabilistically: is the potential harm (aka risk) worth the potential benefits for a given patient. We attempt to make an educated judgement about that from the evidence available (SBM) given what we know about the individual. Two thosand years ago there was no such thing as evidence or science based medicine

  12. Dmitrion 31 Oct 2012 at 1:43 pm

    I think one important piece of circumstantial evidence against CAM is that insurance companies are reluctant to cover it.

    If CAM really treated the “root” of the problem while mainstream doctors only treated symptoms then insurance companies would have an enormous financial incentive to direct people to CAM practitioners.

    If you could treat cancer, for instance, by making adjustments to patient’s diet rather than expensive surgery and medications insurance companies would have been all over it.

    You can’t accuse insurance companies of being in the pocket of Big Pharma.

  13. ConspicuousCarlon 31 Oct 2012 at 2:13 pm

    The first part of a medical oath should be what Sam Harris suggested as an improvement to the Ten Commandments: Do not pretend to know things you do not know.

  14. Bronze Dogon 31 Oct 2012 at 2:42 pm

    There’s a good point in bringing up insurance companies. To them, people are a source of regular income with some risk of losses if they have to pay out. If I buy car insurance and never get in an accident, I’m essentially paying them every month to do nothing. If a person buys medical insurance, the insurance company wants him to lead a long, healthy life with no expensive medications.

    People who are sick can end up costing the company money. Useless regular drugs and underachieving palliatives would cost the insurance company money, discouraging them from covering them since they don’t contribute to the well being of the insured. In contrast, a cheap treatment that eliminates the core problem would be a blessing for them, since it means one less lingering cost.

    Of course, insurance companies are run by people, so they can and do make mistakes as well. They’re also profit-motivated, so they might cover quackery if they think it’ll convince more people to sign up with them and if those additional people will offset the losses associated with paying for useless treatments.

    Not that most alties will appreciate the complex web of conflicting motives between different groups. They’re typically stuck in the tribalist cartoon where anyone who’s not with them must be collectively allied against them.

  15. daedalus2uon 31 Oct 2012 at 8:13 pm

    The idea that some treatments may cause harm if misused reminds me of the joke: A man asks his GF what she wants for her birthday. She says “something expensive that don’t need”, so he gets her radiation treatments.

  16. thequiet1on 31 Oct 2012 at 8:51 pm

    “They’re also profit-motivated, so they might cover quackery if they think it’ll convince more people to sign up with them and if those additional people will offset the losses associated with paying for useless treatments.”

    Uh-huh, big time. The TV ads for many health insurance companies here in Australia tout their coverage of woo-woo very proudly. Some of them sound like a roll-call of every BS treatment in existence.

  17. norrisLon 01 Nov 2012 at 4:03 am

    Hey, Quiet1

    The TV ad you’re referring to must be the AHM ad with 17 different forms of quackery. And WTF is Rolfing????????
    There is only one health insurance in Australia that does not pay out on quackery. It is called something like Doctors Own Health Insurance.

    Have a good one.

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