Jul 01 2011

More CAM Debate in the Atlantic

I have stayed only peripherally involved in the debate going on over at the Atlantic over alternative medicine, spawned by an article by David Freedman. I first wrote about the article here, with a follow up here. Orac has written a series of articles about it as well, and we covered it on Science-Based Medicine.

The Atlantic has also hosted an ongoing debate on the topic. Apparently at the Atlantic they feel that a fair debate is to have six prominent advocates on one side, along with the original author of the article, against a lone token skeptic on the other side (Steve Salzberg). Well, at least they are not revealing any bias. At the urging of Salzberg they did add a second token skeptic, David Colquhoun.

The debate, such as it is, at least reveals the current rhetorical tactics of the CAM proponents. They can be summarized largely as – we know that CAM modalities don’t work, but we’re nice and they will give you a good placebo effect. Plus science-based medicine isn’t perfect (shocker), so (false dichotomy) we offer an alternative. CAM proponents further try to take as much credit as they can for just good medical practice and some science based modalities, like nutrition, exercise, and good communication skills.

This latter strategy is all about the bait and switch – come for the good communication, stay for the abject pseudoscience. Or (here’s a radical idea) we could just continue our efforts to improve the practice of medicine without ejecting all science and reason in the process.

All of this is standard CAM fair, and no surprise. But perhaps the most disappointing aspect of the whole debate has been the reaction of the original author, David Freedman. He appears to have been stung by the (quite reasonable) criticism of his piece, and now gives every indication of circling the wagons. He is trying a number of logically-flawed gambits, all familiar to skeptics.

His latest rebuttal it titled: What’s Eating the Small, Loud Band of Alt-Med Critics? The article is an attempt to defend his position, which he does while ignoring most of our actual criticism. He also does his best to dismiss us out of hand – starting right with the framing in the headline (which, even if he did not write it, accurately reflects the article itself).

Here is a paraphrase of his article – “Don’t bother listening to these guys. There’s like four of them, and they are just angry and closed minded.”  Freedman would have you believe that he marshaled all of his journalistic skills to track down the only four CAM critics in the world. First, I have already dealt with this false impression in my second article on this debate – and Freedman has chosen to ignore my refutation. (He can’t pretend not to know my blog exists, as he left a comment on the first article.)

But most importantly – this is a gross misrepresentation. Really, Freedman should be ashamed of that assertion. Just checking the various authors on the SBM website comes up with many other names. Or, he could have gone to the Institute for Science in Medicine website and looked at our list of Fellows – we are up to 54 (mostly, but not all, MDs). These are all professionals who are as dedicated to the defense of science in medicine against the forces of pseudoscience as the four that Freedman recognizes. If Freedman could not find the ISM himself, he could have asked me for references while interviewing me for the article. Clearly he wasn’t interested.

And there are many others, such as Ben Goldacre, who Freedman likely knows about as Ben was suggested as a possible second token skeptic for the Atlantic “debate.” Ben is internationally known for his criticism of CAM and other pseudoscience. Some of his fellow journalists get it too – like Simon Singh.

Freedman also ignored the arguments I put forward to put these numbers into context. Namely that most physicians do not understand the nature of CAM. They buy into the bait and switch deception, because they never cared enough to look into more deeply. When they are made aware – they are as outraged as the rest of us at the infiltration of pseudoscience into medicine.

Freedman also tries to frame our position as hating CAM, as if we are protectionist and irrational. Rather, our stated position is that we are pro-science-based medicine. We advocate the application of a single science-based standard in health care, and we are concerned by the deception, illogic, and abuse of science that CAM promoters use to insinuate their practices into mainstream medicine. They are trying to establish a double standard for their preferred modalities – and that’s what we oppose.

All of this is just an elaborate argument from authority, which Freedman acknowledges. It reveals, however, his rhetorical tactics – portray his critics as on the outside and closed-minded. In a comment to Orac’s most recent blog post he even takes this gambit one step further. He writes in part:

I characterize religion-like thinking as being absolutely certain that one has hit on pure truth, that the evidence supporting it is perfectly solid, that the evidence that might be held to refute it is weak or flawed, that anyone who disagrees simply doesn’t get it or is highly biased, and that any arguments or evidence presented to counter one’s beliefs must be (supposedly) demolished or ignored so that no trace remains that might prompt reconsideration in the least of any aspect of one’s beliefs.

Obviously determining who should be labeled a scienceologist is a subjective affair, but here’s one little field test that I find helpful: When a proponent of one particular view or theory in a presumably scientific debate consistently fails to yield any ground on any points, or concede any possible truths to any aspect of the opponent’s views, I fear I’m dealing with scienceology. After all, we live in a complex world, and the chances that one is right about all aspects of any non-trivial issue are minute. Only religion-like faith invites and sustains belief that one has it completely right in every way, or so I would argue. Succumbing to scienceology doesn’t necessarily mean one is wrong, but in my opinion it means if one is right, one is just lucky, because one has closed one’s mind to all routes to discovery of being wrong.

I most definitely do not feel you folks are engaging in scientism in criticizing my article. I heartily agree with you that science should, at least in principle, be able to settle the question of whether there are measurable patient benefits to alternative medicine when compared to mainstream medicine, even if the core treatments of alternative medicine work no better than placebo.

Freedman is arguing that we are all guilty of “scienceology” – holding to our position with religious-like zeal. This is a strategy that should be familiar to most skeptics. PZ Myers, who is not a physician but who is a good skeptic, picked it up right away. In his review he wrote:

The way it did this was devious, and reminded me so much of creationist tactics. First, it declares that “mainstream medicine itself is failing”; it doesn’t really have any evidence of this, it just declares that modern medicine is built around the infectious disease model, and that it hasn’t solved all health problems. Familiar stuff, hey?

The creationist analogy is sound. Freedman is taking the false balance approach above – the truth must be somewhere in the middle of these two sides. But this is not always the case. Pair any creationist against a mainstream evolutionary biologist and you will find that the biologist is unyielding, unwilling to concede any points to the creationist. The reason – creationism is ideological BS. It is sophisticated nonsense, but it is pseudoscience down to the core. However, this allows creationists to portray defenders of evolution as being closed-minded, intellectual thugs, and opposed to academic freedom and open debate.  In short Freedman’s rule of thumb utterly fails when applied to pseudoscience.

We see this over and over again. Pseudoscientists make outrageously unscientific claims, and then when defenders of science are outraged they are portrayed as extremists for their outrage. Journalists often fall for this (when balance becomes false balance), and Freedman is no exception.

Further, we collectively have written thousands of articles explaining in great detail why the claims of the CAM crowd are simply wrong. We are not being dismissive or closed – we are carefully articulating a persuasive position. Freedman has clearly not availed himself of this.  (I am not saying he should have read it all, but a sampling would be nice. Or at least recognize that our body of work exists, and perhaps be a bit more humble in your conclusions, if you are not willing to delve deeply into our arguments.)

Freedman is still not listening. He keeps repeating his basic premises, as if we have not dealt with them already, and pretending like we haven’t. Yes, we agree that CAM works no better than placebos. Yes, we agree that there are limitations to mainstream medicine. But no, we do not agree that CAM practitioners are better at instilling good lifestyle choices than MDs. There is no compelling evidence for this. And no, we do not agree that placebo effects are worth it.

Freedman also acts as if these are the only points relevant to the discussion. The problem with Freedman’s reporting is what he did not discuss. The harm that is done by unscientific practices is being increasingly documented. I think we have made (many times) a cogent argument that using pseudoscience to get a placebo effect, and sometimes wrapping it in some common sense advice that you can get from any competent practitioner, is a huge net negative, not a net positive as Freedman argues.

But Freedman continues to insist that his position is rock solid and unassailed. He should go back and read his definition of “scienceology” again.

Finally – what exactly is Freedman proposing? He has come to the dubious conclusion that CAM is worthwhile, even if just for the placebo effect. And therefore what? Does he think we should prescribe homeopathic potions to patients, even though they are just water? Does he think we should stick needles into non-existent acupuncture points, even though the evidence shows poking the skin with toothpicks is just as effective? Should insurance pay to have nurses wave their hands over patients prior to going into surgery in order to fluff up their “human energy field?”

What, exactly, does he imagine should be happening? And what should we tell patients? Should we tell them that these interventions are just placebos? Or should we instill in them a belief in magic and pseudoscience, in order to maximize the placebo effect (although the evidence does not support this conclusion). How would we regulate CAM? If scientific evidence is no longer the standard, then anything goes – we already have ample evidence for this in the CAM and supplement industries. How do we keep out the cranks and exploiters? Paul Krugman put it very succinctly when he wrote (in the context of economics, but it still applies), “When the public believes in magic, it’s springtime for charlatans.”

Unless Freedman and others who support his position can articulate exactly what kind of medical system they envision that incorporates CAM, I see no reason to take their position seriously. It’s easy to criticize an existing system, like mainstream medicine. It’s more difficult to propose workable improvements. One might say that we should take advantage of the alleged benefits of CAM (lifestyle improvements) while fixing the pseudoscience. But I submit it would be far easier to fix the problems in mainstream medicine, than to try to fix the rotten-to-the-core pseudoscience problems in CAM. Freedman’s cure is far worse than the apparent disease.

Mainstream medicine at least has a built-in system for self-correction (science). Show us a better way with reliable evidence, and we will change our practice. CAM proponents, on the other hand, display a clear history of trying to fit the evidence to their practice, rather than their practice to the evidence. When the evidence does not fit – they dismiss it, and then try desperately to change the rules of evidence. They seek the evidence that is most likely to support what they already want to believe – like their current advocacy for using pragmatic studies (unblinded studies) instead of double-blind efficacy trials to assess outcomes.

The bottom line is that Freedman got his bottom line wrong. He appears to have engaged in a process of confirmation bias – before he interviewed me he had a clear idea of the article he was going to write. The article was framed by the questions he asked and the people he spoke to, but even more by the questions he didn’t ask and the people he didn’t speak to. In my opinion, it was a journalistic fail.

All that would be forgivable – it’s a complex topic shrouded with sophisticated deception on the part of proponents. Freedman fell for the smoke and mirrors. What matters most, however, is what you do after the article is out there in the public. Christopher Hitchens told me in an interview that after he publishes an article on a topic, then all the people that he should have interviewed in the first place come out of the wood work. The most productive research is done after the first article is published and the ideas are out there.

Freedman should consider the publication of his Atlantic article the beginning of his journey to truly understand this topic, not the conclusion. We in the science-based medicine community are trying to engage with his ideas (if he can look past the occasional snarkiness). Our style is unrestrained criticism (much like how science itself works). We don’t pull our punches. But Freedman seems like a big boy. I would like to see him try to actually answer my criticisms, rather than continue to hide behind his original premises.

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123 responses so far

123 Responses to “More CAM Debate in the Atlantic”

  1. SteveAon 01 Jul 2011 at 9:16 am

    “Namely that most physicians do not understand the nature of CAM. They buy into the bait and switch deception, because they never cared enough to look into more deeply. When they are made aware – they are as outraged as the rest of us at the infiltration of pseudoscience into medicine.”

    Is there any way to increase awareness of CAM and its manifest limitations within the medical community? Letters to the editor, papers etc to relevant publications. Perhaps some easy-on-the-eye pdf literature that could be emailed to relevant bodies (doctors are always giving me leaflets; they seem to like them).

    I consider myself well-educated, but for many years I was agnostic on the subject of CAM. I had this big mental file where I stuffed all these ‘alternative modalities’, and because I included herbal medicine in the file, and I knew good reasons why some herbal remedies might actually work, I figured I’d be big-hearted and opened minded and give it all the benefit of the doubt.

    And then…

    And then you actually read up on some of this garbage and your jaw hits the floor (my favourites are the ‘ologies’ . Ewwwww!)

    It seems it’s not just a question of educating the patients. The educators, docs and researchers need some love too.

    Any ideas?

  2. doubting skepticon 01 Jul 2011 at 9:36 am

    Excuse me Dr. Novella, can you please calm down? You are extremely harsh in your criticism and you resort to attacking people’s intelligence. You and you pal PZ Meyers do that in almost every blog post.
    May i ask you a question, you claim that alternative medicine works similarly to a placebo, please back that up with good evidence?
    Do you ever ask yourself ‘WHAT IF I AM WRONG’?
    You said : The article is an attempt to defend his position, which he does while ignoring most of our actual criticism.

    Don’t you also do that?
    My favorite part is when you compare anyone that angers you to creationists?

    Please get real, if you are a skeptic i would like to see you being skeptical about your own positions to.
    What would convince you that Alternative medicine is valid?

  3. banyanon 01 Jul 2011 at 9:50 am

    The “closed-minded” argument is fascinating, isn’t it?

    There are a small number of true believers and a small number of skeptics and then millions of people who don’t think it’s worth their time to think about or argue. Of those three, which one actually looks at the evidence and argues that we should follow wherever that evidence takes us?

    Of course, I’m not being quite fair. The “true believer” camp as I understand it generally falls into two groups: (1) those who have looked at the evidence but lack the training–or will–to evaluate it properly and (2) those who think that evidence is the wrong standard.

    The former camp believe skeptics are closed-minded because they keep saying the evidence only points one way, when they have plenty of “evidence” pointing the other. The latter camp believe skeptics are closed-minded because they reject any conclusions not supported by their chosen method of evaluation. And of course they’re not mutually exclusive. I mean, logically they are, but not psychologically.

    Absent rigorous training in critical thinking, what can you do?

  4. taustinon 01 Jul 2011 at 10:37 am

    I have to agree about the numbers being unfair. At only six to one, the CAM proponents don’t stand a chance.

  5. Skepticoon 01 Jul 2011 at 10:51 am

    I characterize religion-like thinking as being absolutely certain that one has hit on pure truth, that the evidence supporting it is perfectly solid, that the evidence that might be held to refute it is weak or flawed, that anyone who disagrees simply doesn’t get it or is highly biased, and that any arguments or evidence presented to counter one’s beliefs must be (supposedly) demolished or ignored so that no trace remains that might prompt reconsideration in the least of any aspect of one’s beliefs.

    I’ve said this before, but isn’t Freedman describing himself here?

  6. Rikki-Tikki-Tavion 01 Jul 2011 at 11:03 am

    @Skeptico,
    I don’t think so. In his mind he gave both sides a say. He even took a step towards SMB by saying, that CAM has only placebo effects. He now believes he is entitled to the skeptics’ community taking a step towards his side. It’s a very human thing to think. Price negotiations (even in large scale contracts) work that way.
    What he, understandably, doesn’t realize is, that this is reality. And scientific truth is not a matter of negotiation.

    With regard to the open mindedness statement, I’d like to quote James Randi, but I think I you the quote I mean. :)

  7. tmac57on 01 Jul 2011 at 11:34 am

    Namely that most physicians do not understand the nature of CAM. They buy into the bait and switch deception, because they never cared enough to look into more deeply. When they are made aware – they are as outraged as the rest of us at the infiltration of pseudoscience into medicine.

    This is troubling to me,because if most physicians are not up to the challenge of sorting out the nonsense of various CAM modalities,then are they up to the challenge of sorting out medical nonsense in general? I would like to think that my doctor can act as a firewall against harmful and worthless therapies of any sort.

  8. Karl Withakayon 01 Jul 2011 at 11:35 am

    Rikki-Tikki-Tavi, but that is Freedman’s inflexible position, and he has refused to concede any ground from his position stated in the original article; therefore his term scienceology, as defined by him, applies to him.

    Of course, his defined term presents a derivation of Zeno’s paradox:

    As soon as one concedes ground on their position to avoid scienceology, they must then concede ground on their new position to avoid sciencology. Both sides must continually do this in the avoidance of scienceology as they asymptotically approach the likely false middle ground.

    Obviously, to end up with the advantage, one must start with the most exaggerated, extreme position possible such that the final middle ground is as close to your real position as possible.

  9. steve12on 01 Jul 2011 at 12:35 pm

    If Freedman’s argument is…

    “I know that CAM doesn’t work, but it’s worth having for the placebo effect”

    …then isn’t talking about CAM’s lack of efficacy a misplaced debate? The point’s been granted.

    The only thing that matters now is whether the inclusion of CAM in practicing medicine will be

    (A) a net gain, i.e., placebo effect

    or

    (B) a net loss – lower standards of evidence will be accepted generally in medicine, CAM practitioners will want greater say in medical descisions, the public will become confused in making medical choices because they don’t understand that CAM is all placebo, etc

    So in it’s best form, the argument is whether A is worth B, or whether we can have A w/o B. I contend the answers are no and no, but I think this is more the heart of the argument, with Freedman anyway.

  10. dhfreedmanon 01 Jul 2011 at 1:00 pm

    Sorry to be ignoring you, Dr. Novella, it wasn’t intentional. I just don’t have time to respond to all the largely repetitive and, to me, not very insightful or thoughtful, criticism that I’ve been getting from a small cast of characters.

    You are, of course, mostly ignorant of my and the Atlantic’s efforts to bring a good balance to the debate. You and Dr. Salzberg were given prominent voice in the article itself. If the article omitted any of the significant points that you made to me in our longish interview, please do say so. Dr. Salzberg was given an opportunity to elaborate in the post-article debate. Sadly, he chose to focus on the (by his own estimate, as per his second spot on Minnesota Public Radio) one in one million chance that a chiropractor will do harm, an issue my article dealt with frankly. Dr. Gorski beat us to the punch with his own very long criticism that got quite a lot of attention. Ben Goldacre was asked to submit a response, and declined. Dr. Colquhoun was asked, and submitted a response that merely echoed the standard vitriol. I stand by my claim that I and the Atlantic worked pretty damned hard to give the world’s most prominent, respected, outspoken critics of alternative medicine their full say. Can you claim the same balance? Sorry if the numbers didn’t work out to provide an exactly equal number of responses from both sides. Personally, I didn’t think the fairness of the debate was going to be decided on the basis of a head count. If I had known that, you’re right, I could have worked harder to even up the score.

    Given that, like your fellow critics, you continue to try to conflate what I argue with pseudoscience (and, inevitably, creationism), let me try to clarify the issues here. Let’s say that alternative medicine has three components. Component A is pseudoscience. Component B is a non-pseudoscientific placebo effect. Component C is a non-pseudoscientific focus on getting patients to adopt healthy attitudes and behaviors. I argue that alternative medicine does a better job on average with non-pseudoscientific components B and C than does mainstream medicine, and many patients thereby significantly benefit. I couldn’t care less whether you feel, in your personal judgment, that the existence of component A within alternative medicine is so abhorrent that it outweighs or taints whatever claims can be made for components B or C. I couldn’t care less that you think alternative medicine practitioners use components B and C as a bait-and-switch tactic to get patients involved in Component A. That’s your opinion, you’re welcome to it, and everyone else can decide for themselves. How about addressing my actual argument? Again, my argument is this: Alternative medicine does a better job on average with non-pseudoscientific components B and C than does mainstream medicine, and many patients thereby significantly benefit.

    I hope you can do better than, “Oh yeah? Prove it.” I hope you can do better than, “Hey, how about that component A? It sure is pseudoscience.” I hope you can do better than, “How dare someone who offers component A try to offer component B and C?” By the evidence I’ve seen so far, though, I doubt you will. You’re stuck on the pseudoscience, and rely on the weak argument that there is no good randomized-study evidence that alternative medicine provides patients with benefits via components B and C, even though everyone else in medicine seems pretty sure that’s true from what patients tell them. Please go ahead and prove me wrong, and offer a thoughtful response to my argument that doesn’t depend on your holding all of alternative medicine to be tainted by its pseudoscience component, or on an absence of good formal study data. I’d be delighted.

  11. steve12on 01 Jul 2011 at 1:09 pm

    “Again, my argument is this: Alternative medicine does a better job on average with non-pseudoscientific components B and C than does mainstream medicine, and many patients thereby significantly benefit.”

    But you’re ignoring that accepting B & C is not without cost. Inviting charlatans into science because of some tangential practical benefit weakens the field as a whole (see my other post above for why), and B & C can be accomplished w/o A, so why not argue for that?

  12. robmon 01 Jul 2011 at 1:27 pm

    Component B is irrelevant because creating the illusion that treatment is taking place might give people the impression that treatment is taking place, but says nothing about the actual effects that help the patient. Hint in a placebo there are no effects that actually treat the patients condition.

    Component C isn’t separated from Component A by the vast majority of CAM practitioners. IF CAM does a better job at convincing patients to adopt healthier lifestyle practices (and that’s a big if), then their pseudoscience definitely plays a role, should doctors frighten their patients with lies about toxins, toxins, toxins, not to mention phony food allergies to change their behavior?

  13. Karl Withakayon 01 Jul 2011 at 2:02 pm

    @dhfreedman

    >>>I hope you can do better than, “Oh yeah? Prove it.”

    I hope you can do better than “I said so first so I don’t have to prove it.”

    You have made a claim and failed to support it and then pushed the burden of disproving your claim to your opponents. You must be new to logical argument.

    You also seem to be new to the topic of medical ethics and seem to have no idea why using placebos in medicine (outside of research) is completely unethical.

    Again and again you demonstrate that you have done little to no objective research on the topic of which you speak, including the history of the past debate, argument and discussion. You constantly trot out questions, arguments, and positions (repeating numerous logical fallacies) which have been repeatedly and tirelessly answered, debunked, disproved, and deconstructed.

    “I stand by my claim that I and the Atlantic worked pretty damned hard to give the world’s most prominent, respected, outspoken critics of alternative medicine their full say. Can you claim the same balance?”

    It wasn’t just a matter of the numbers on each side you presented, you framed the matter as the dissenters being a small, insignificant minority that refused to concede ground because they were stubborn rather than no evidence had been presented worthy of conceding points to.

    Also, if you maintain that Dr. Novella and his colleges have not represented the oppositions positions or given their opponents fair chance to represent their positions themselves, you again demonstrate how little research you have done on this and other blogs. Dr Novella and others at SBM frequently cite, link to and quote at length the postings and publishing of those they are critiquing, and they have a open comment system (generally un-moderated except for spam filtering) that you yourself have been using. That fact that Dr. Novella et al have given the CAM world every opportunity to provide quality, convincing support for their positions and found those attempts unconvincing is not your sciencology, it is simple science.

    Even if I were to accept your B & C positions, the argument that it means we should just embrace CAM and not worry about A rather than see what real medicine could learn from CAM’s success at B & C (if they even are true) is astounding. It is also astounding that you seem to never have considered the possibility that if C were true that it could be due to the type of people that seek out CAM rather than a general success of CAM itself. You’re applying what you think to be a success with a select non-random sample to the general population. Look up epidemiology in the dictionary if you don’t know why that’s wrong.

  14. Oracon 01 Jul 2011 at 2:10 pm

    Let’s say that alternative medicine has three components. Component A is pseudoscience. Component B is a non-pseudoscientific placebo effect. Component C is a non-pseudoscientific focus on getting patients to adopt healthy attitudes and behaviors. I argue that alternative medicine does a better job on average with non-pseudoscientific components B and C than does mainstream medicine, and many patients thereby significantly benefit…Again, my argument is this: Alternative medicine does a better job on average with non-pseudoscientific components B and C than does mainstream medicine, and many patients thereby significantly benefit.

    Yes you do argue that. Ad nauseam. I remain unimpressed by your argument.

    The problem, as I (and others) have pointed out multiple times now, is that you provide zero evidence that this is actually so in order to support your arguments. Every time you are challenged to provide evidence to support your assertion above, the best you can come up with is to appeal to authority by saying that “virtually every doctor” you interviewed agrees with you. In one of your blog entries you referred to “hundreds” of studies that allegedly support your point of view without actually being able—oh, you know—to provide a few examples of these “hundreds” of studies that show that CAM practitioners can use placebo and do a better job of “getting patients to adopt healthy attitudes and behaviors” than conventional physicians.

    All of this is leaving aside whether component C (the allegedly healthy attitudes and lifestyles that CAM practitioners promote in their patients) are, in fact, actually healthy. Large swaths of lifestyle and diet advice promoted by CAM practitioners are in fact pseudoscience; so even if you were correct that CAM practitioners do a better job of C, that would actually not be a good thing.

    Finally, you say you want an “open” debate, but what do you do? You try your damnedest to dismiss skeptics as “close-minded,” “angry,” and “few,” painting us as a marginalized group who are dogmatic (your comparison to religion with your extremely ill-chosen word “science-ology”). This is exactly what pseudoscientists do (particularly creationists and anti-vaccine activists, in my experience). If you don’t want to be tarred with the brush of being a defender of pseudoscience akin to a creationist, then stop using the tactics that defenders of pseudoscience like creationists use. Your lapse could perhaps have been forgiven initially; perhaps you honestly didn’t know that’s what you were doing. Now you do. It’s been explained to you multiple times since your article was published, and not just by me.

    By the evidence I’ve seen so far, though, I doubt you will. You’re stuck on the pseudoscience, and rely on the weak argument that there is no good randomized-study evidence that alternative medicine provides patients with benefits via components B and C, even though everyone else in medicine seems pretty sure that’s true from what patients tell them.

    Straw man argument, at least with respect to me. I don’t argue that there is no good RCT evidence that alt-med provides patients with benefits via B and C (although I strongly suspect that this is so). I’m arguing that you have not been able to provide ANY evidence to support your position other than a truly lame “everyone else in medicine seems pretty sure that’s true.” Do you realize just how weak that argument is? It’s pathetic. There’s no other way I can think of to put it. And you have the nerve to call our arguments “weak”?

    Believe it or not, I (and Steve, and every other skeptic here) can be persuaded. But it takes hard evidence to persuade, not anecdotes. Anecdotes are often misleading. As Richard Feyneman so famously put it, “The first principle is that you must not fool yourself and you are the easiest person to fool.” That goes for you, Steve, me, and every single physician and patient you interviewed. Regression to the mean, confirmation bias, confusing correlation with causation, and any number of other cognitive biases lead us as human beings to come to mistaken conclusions based on our own observations. Science is nothing more than a means of trying to minimize those biases and thereby minimize our chances of being fooled. Science is also hard because it goes against every one of those biases that lead us astray, and every one of those biases are a result of how our brains function.

    In fact, as I’ve found out, physicians are often among the easiest to fool because they tend to have far more confidence in their own observational abilities and skepticism than is justified. That’s why three of the most dangerous words in medicine are, “In my experience…” Your entire Atlantic piece and your subsequent defense of that piece boil down to an invocation by your sources of those three words.

  15. Steven Novellaon 01 Jul 2011 at 2:29 pm

    David – I am disappointed that yet again you have repeated your premises and you have not responded to my points above. Your characterization of this post is completely inaccurate.

    I made very salient points that go beyond just saying that CAM is pseudoscience. Specifically, that the harm of knowingly prescribing placebos and supporting nonsensical notions in medicine has significant harm. Saying “I don’t care” is hardly a response. That harm vastly outweighs the alleged claims of placebo effects and lifestyle changes.

    Further- I have argued that the placebo effects of CAM are no greater than from mainstream medicine, and they are mostly illusory effects, and not real effects that are worth pursuing (except with pain, which is no better from CAM). I have already written about this extensively. There is even a recent study (I will dig up the reference when I have time) that the magnitude of the placebo effect is the same for homeopathic and mainstream practitioners.

    I also maintain there is no evidence that CAM practitioners are better at improving lifestyle than mainstream physicians. I know they claim this – but that does not make it true. Since this is the central of your thesis, I would think some evidence is in order.

    In fact, there is vast evidence that CAM practitioners mix any good advice they give with a lot of bad and magical advice.

    You also failed to address the ethical issues raised. And – you failed to address my question about how, exactly, should CAM be practiced to get the alleged effects you want.

    I actually don’t want to keep going around about the original article. As I stated above – what is more important is the continuing conversation. That seems to be stuck on the same points, when, in fact, there is a lot to engage about, if you will actually engage with the points I am making.

  16. Karl Withakayon 01 Jul 2011 at 2:52 pm

    D Freedman:

    Let’s assume that for a moment that CAM practitioners are better at getting their customers at adopting diet and lifestyle changes than medical doctors are with their patients, though so far, it is pure assertion and anecdote on your part.

    You are assuming those changes are necessarily healthy, beneficial changes, but due to the dominance of pseudoscience in CAM , that is not necessarily true. The diet and lifestyle recommendations are based on the CAM practitioner’s pesudoscience. (and let’s be clear here, though you apparently acknowledge that CAM is just placebo, the vast majority of the practitioners do not, and they actually believe in the underlying understanding of what they do, which is a source of danger) You assume the beneficial recommendations won’t be mixed in with harmful ones, which is not reasonable.

    As a side, it is reasonable to hypothesize that if CAM became as widespread and generally accepted as actual medicine that the novelty might wear off, practitioner’s time with patients could diminish, and and much of the apparent power of CAM’s perceived effectiveness might decline to background noise.

  17. Oracon 01 Jul 2011 at 3:07 pm

    David – I am disappointed that yet again you have repeated your premises and you have not responded to my points above.

    Sadly, after a few go-arounds with Mr. Freedman, I’ve reluctantly come to conclude that this is a pattern with him, his M.O., if you will. Every time he is asked for evidence to support his points, his responses boil down to one of three lines of argumentation:

    1. Skeptics are a “tiny band” of “angry,” “dogmatic,” “close-minded” people. Of course, this is nothing more than a naked ad hominem attack.

    2. All the doctors I interviewed agree that CAM practitioners do a better job of being empathetic and promoting “healthy lifestyles.” This is nothing more than an appeal to popularity, and, I strongly suspect, an appeal based on a highly unrepresentative sample asked the question unwittingly framed as a false dichotomy.

    3. Conventional medicine has “failed” and a lot of it is just as much placebo as “alternative medicine.” Even if this were true (and it’s so exaggerated as to be a highly dubious assertion), this would not be a valid reason to adopt pseudoscience, as the harms of doing so outweigh even the debatable or illusory “benefits” of doing so.

  18. titmouseon 01 Jul 2011 at 3:32 pm

    Oh lord “not even wrong” with the CAM components thingy.

    Off topic blogging material for Dr. Novella:

    http://www.facebook.com/NeuroLogic

    What do you think about chiropractors claiming to specialize in neurology? Can the ABPN do anything about this?

  19. Steven Novellaon 01 Jul 2011 at 4:02 pm

    doubting skeptic wrote:
    “Excuse me Dr. Novella, can you please calm down?”

    - Please explain how you inferred my state of agitation.

    “You are extremely harsh in your criticism and you resort to attacking people’s intelligence. You and you pal PZ Meyers do that in almost every blog post.”

    - Please show me where I insulted anyone’s intelligence in this post, let alone almost every post.

    “May i ask you a question, you claim that alternative medicine works similarly to a placebo, please back that up with good evidence?”

    - Please read the appropriate articles on this site and science-based medicine. You will hundreds of articles that painstakingly review copious amounts of evidence to support this conclusion. This is also not even at issue in the current debate – all sides acknowledge this.

    “Do you ever ask yourself ‘WHAT IF I AM WRONG’?”

    - Every day

    “You said : The article is an attempt to defend his position, which he does while ignoring most of our actual criticism.

    Don’t you also do that?”

    - No. I addressed his specific points in detail multiple times.

    “My favorite part is when you compare anyone that angers you to creationists?”

    - I am not angry (you haven’t seen me angry). And what I did was compare some of his tactics to the tactics of creationists. I am not the only one to see the parallel – and I explained exactly what it is.

    “Please get real, if you are a skeptic i would like to see you being skeptical about your own positions to.
    What would convince you that Alternative medicine is valid?”

    - Um, evidence? You imply that you are familiar with this blog, but such a question seems to contradict this.

  20. MarkLon 01 Jul 2011 at 4:47 pm

    I have been placed in the undesirable position of allowing the start of chemotherapy treatment of an individual who became incapacitated during a routine biopsy.

    It has been explained to me by CAM proponents that I ordered unnecessary and harsh “toxins” pumped into someone. Oh, I got nutritional advice. I got lambasted for following the nutritional advice of the physicians when I returned home with a severely underweight cancer patient.

    One day all of those “toxins” may complicate her future, but I can assure you that if I had adopted the approach of the CAM proponents I would have 8 anniversaries visiting a grave.

    Mr. Freedman your suggestion to adopt “Component A” to realize better outcomes elsewhere is unethical, negligent, dangerous and personally abhorrent. The dirty secret about many CAM proponents is that they completely reject “Western Medicine” (their term). They peddle bad advice to others and potentially delay or discourage the seeking of proper medical treatment.

    Encouraging the use of psuedoscience encourages people to adopt dangerous thinking. Yes I take it personally. Potentially endangering people’s lives when there is a better solution is unacceptable.

    Dr. Novella, I deeply appreciate your work. Keep up the good fight!

  21. mrgon 01 Jul 2011 at 4:48 pm

    One of the issues that makes it difficult to sympathize with CAM is that it leads straight down the road to antivaxers and HIV denialists.

    I don’t want to imply that all CAM advocates endorse such extreme positions, I would hope not, but both are dependent on CAM. Indeed, with HIV denialism the term CAM becomes misleading: they’re not talking “complementary” or “alternative”, they’re saying mainstream medicine will kill you, we can save you, and (trust us) we have no doubt you’ll be alright Jack if you listen to us.

    I’m mostly into the battles over evo science, and I would have to agree that in a contest between creationists and CAM advocates, there’s not much to choose between them except for a different paint job. However, at least CAM advocates don’t cite scriptures at you.

  22. Nikolaon 01 Jul 2011 at 5:25 pm

    I have to say I have found great enjoyment in following this debate from the start. I hadn’t expected that it would deteriorate into such corrosive fallacies by Mr Freedman (or at least I’d hoped it wouldn’t), but I suppose the odds were against my hopes – taking into account the authors premise.

    I’m sure, Mr Freedman, you would claim I’m engaged in scientism and characterize me as dogmatic if I appear not to budge or concede a point when it comes to most CAM practitioners. What you fail to take into account is the actual (lack of) coherence of the opposing argument, as well as the fact that science isn’t like politics. There is no room for compromise regarding scientific truths – your claims are either well-substantiated or they are simply lacking and out of place. You may do well at a dinner party with your arguments, but not in a scientific environment.
    I know that, with a good foundation, you will be able to understand this. Read a couple of dozen of the articles here and on SBM (very basic research), learn why studies are what matters in medicine, not anecdotes. Learn not to drag yourself down with simple logical fallacies. I promise you, it will all become clear.
    I know this because it’s become really clear to me from reading those same fine texts over the years – and I’m no singular genius.
    I am a 25 years old high-school drop-out and I understand most of what these fine folks are talking about, and I’m sure you can best me with effort.
    Best of luck.

  23. nybgruson 01 Jul 2011 at 7:11 pm

    @Freedman:

    I can only echo the scientific and skeptical points made by the other commenters here. Everyone here, particularly Drs. Novella and Gorski, have made painstaking efforts to carefully, thoughtfully, and carefully address your points. In his first riposte he even stated the whole time that he was giving you the benefit of the doubt that you were uninformed deeply enough to give a proper analysis. He stated that your quotes and your statements were correct but that your conlcusion and the way your framed the piece was off-base.

    You consistently come back with calls for evidence and discussion, calling us all here closed-minded. Yet you have clearly refused to actually read what has been written between here and SBM. Why must the authors here generate new content to re-hash what has already been discussed just for you? You don’t care to do the in-depth research and reading and demand everything be spoon-fed to you anew. And you call yourself a journalist?

    Yes, doing the background reading and parsing through the literally hundreds (if not thousands) of articles between here, SBM, and RI is hard work. It is much easier to just make your stance and say “Prove me wrong.” (Hint: You’ve already been proven wrong, you just need to go read it). But that is the point, Mr. Freedman – intellectual honesty, appropriate in depth research, and avoiding logical/cognitive fallacies is hard work. But if you want to be respected in this community and have people like me willing to call you an excellent journalist instead of a pandering pulp author, then you need to do that hard work.

    Your initial piece was your foray into a world that is not your expertise and that you clearly had little knowledge of or experience in. You fumbled and were given the benefit of the doubt and invited by the skeptical community to see your error and explore the reasons for our staunchness (if you claimed the sky was red and were were steadfast in calling you wrong, would we be labeled as “scienceologists” and ultimately have to decide the sky is purple to meet your “fair and balanced” demands?). But your response is one of wounded pride. You felt good about your piece, you put work into it, and when it was roundly denounced, you did the human thing – you became prideful and hurt and lashed out. Everyone here knows that feeling – I experience it regularly, and I can guarantee you Drs. Novella and Gorski have not only had their fair share of it, but still experience it to this day. The difference is that we feel the sting and shove it down in order to truly see if the criticism is valid. Painful as it is, we admit when we are wrong.

    You are the one throwing a tantrum because actual experts have said your piece was no good.

  24. doubting skepticon 01 Jul 2011 at 7:54 pm

    WOW this is unbelievable, are all of you so dogmatically against alternative medicine because of your Atheism?
    Either it works or it doesn’t work. It seems to me that Dr. Novella and his angry buddy Orac hate the idea of Alternative medicine, they equate it with creationism and a lack of critical thinking.
    I am sorry but Science doesn’t work that way, we have to go where the evidence takes us.
    Is there any evidence that alternative medicine is harmful?
    Mainstream medicine is not at all perfect, my grandfather died of cancer, and the cold heated doctors could care less. He was diagnosed in 2007, they said it was serious, 4 months later the doctors said he is ok, the cancer is gone, he is healthy again. And then when he went for his check up 6 months later they said he is serious with very little time left.
    The chemotherapy destroyed my grandfather. Why should a 85 year old man be subjected to such brutal treatment.
    If there is anything that can help people like my grandfather we should investigate it thoroughly.
    By the way most alternative medical practicioners make it clear that we must, must follow our MD’s advice.
    I feel anxious everytime i come to this blog because i know anything that annoys all of you will be categorized as Creationism.

  25. robmon 01 Jul 2011 at 8:15 pm

    @doubting skeptic

    Alternative medicine has been and continues to be studied, has been shown to have no effect when compared to placebo. Thats where the evidence takes us. Since people spent time, money, and hope on ineffective treatment, that is the harm.

    What makes alt med like creationism is they both throw out weak evidence, ignore strong evidence, and constantly claim persecution at the hands of real scientists, that’s how they are similar. What’s annoying is people like you playing the victim because you don’t get way, at least not until you prove your case.

  26. Oracon 01 Jul 2011 at 8:24 pm

    WOW this is unbelievable, are all of you so dogmatically against alternative medicine because of your Atheism?

    Uh, no. Atheism has nothing to do with it. Evidence (namely the lack thereof for the efficacy of alternative medicine) has everything to do with it.

    One notes that there are plenty of Christian physicians who understand the importance of evidence and do not accept alt-med either.

  27. doubting skepticon 01 Jul 2011 at 8:56 pm

    @ robm, i am not playing the victim, i don’t see any strong evidence against alternative medicine.
    @ Orac, i care for the evidence to. The evidence is clear that, you are a doctor and so is Dr. Novella, i understand your need to defend Drug companies and to fight, fight, fight against alternative treatment.
    I have evidence too, read this:
    Drug companies don’t have our interest in mind, if you are really practicing Science i expect you to go where the evidence leads you, you seem to be only reading things that confirm your biased view, READ THIS IF YOU HAVE THE COURAGE:

    How drug companies’ PR tactics skew the presentation of medical research

    Elliot Ross reveals the secret ‘army of hidden scribes’ paid by the drug companies to influence doctors

    When doctors are deciding which drug to prescribe a patient, the idea behind evidence-based medicine is that they inform their thinking by consulting scientific literature. To a great extent, this means relying on medical journals.

    The trouble is that pharmaceutical companies, who stand to win or lose large amounts of money depending on the content of journal articles, have taken a firm grip on what gets written about their drugs. That grip was strong way back in 2004, when The Lancet’s chief editor Richard Horton lamented that “journals have devolved into information laundering operations for the pharmaceutical industry.” It may be even tighter now.

    Drug companies exert this hold on knowledge through publication planning agencies, an obscure subsection of the pharmaceutical industry that has ballooned in size in recent years, and is now a key lever in the commercial machinery that gets drugs sold.

    The planning companies are paid to implement high-impact publication strategies for specific drugs. They target the most influential academics to act as authors, draft the articles, and ensure that these include clearly-defined branding messages and appear in the most prestigious journals.

    Over the past few months I’ve tried to find out as much about these companies as possible. I wanted to know how big this industry is, exactly how it operates, and how people in the business think about their work. It’s a nervous, opaque industry, but I did find answers to some of my questions.

    There are now at least 250 different companies engaged in the business of planning clinical publications for the pharmaceutical industry, according to the International Society for Medical Publication Professionals, which said it has over 1000 individual members.

    Many firms are based in the UK and the east coast of the United States in traditional “pharma” centres like Pennsylvania and New Jersey.

    Precise figures are hard to pin down because publication planning is widely dispersed and is only beginning to be recognized as something like a discrete profession. These numbers are higher than any previous estimate, yet in truth the industry is likely to be bigger still.

    In selling their services to drug companies, the agencies’ explain their work in frank language. Current Medical Directions, a medical communications company based in New York, promises to create “scientific content in support of our clients’ messages”. A rival firm from Macclesfield, Complete HealthVizion, describes what it does as “a fusion of evidence and inspiration.”

    Having talked to over a dozen publication planners I found that the standard approach to article preparation is for planners to work hand-in-glove with drug companies to create a first draft. “Key messages” laid out by the drug companies are accommodated to the extent that they can be supported by available data.

    Planners combine scientific information about a drug with two kinds of message that help create a “drug narrative”. “Environmental” messages are intended to forge the sense of a gap in available medicine within a specific clinical field, while “product” messages show how the new drug meets this need.

    But the issue that dominates industry discussions is authorship.

    In a flow-chart drawn up by Eric Crown, publications manager at Merck (the company that sold the controversial painkiller Vioxx), the determination of authorship appears as the fourth stage of the article preparation procedure. That is, only after company employees have presented clinical study data, discussed the findings, finalised “tactical plans” and identified where the article should be published.

    Perhaps surprisingly to the casual observer, under guidelines tightened up in recent years by the International Committee of Journal Editors (ICMJE), Crown’s approach, typical among pharmaceutical companies, does not constitute ghostwriting.

    What publication planners understand by the term is precise but it is also quite distinct from the popular interpretation.

    “We’ve never done ghostwriting, per se, as I’d define it”, says John Romankiewicz, president of Scientific Therapeutics Information, the New Jersey firm that helped Merck promote Vioxx with a series of positive articles in medical journals. “We may have written a paper, but the people we work with have to have some input and approve it.”

    The industry has grown despite its prominent involvement in a succession of medical ghostwriting scandals.

    In the early 2000s, court documents released through litigation over controversial drugs – such as Vioxx and the hormone replacement therapy Prempro – showed pharmaceutical companies frequently hiring medical communication agencies to ghostwrite articles and place them in influential medical journals under the “authorship” of well-known academics paid thousands of pounds for their endorsement.

    The ICMJE tweaks, plus a new willingness to disclose their involvement in the preparation of articles, has fostered a remarkable confidence among industry proponents.

    “I feel that we’re doing something good for mankind in the long-run,” said Kimberly Goldin, head of the International Society for Medical Publication Professionals (ISMPP). “We want to influence healthcare in a very positive, scientifically sound way.”

    “The profession grew out of a marketing umbrella, but has moved under the science umbrella,” she said.

    But without the window of court documents to show how publication planning is being carried out today, the public simply cannot know if reforms the industry says it has made are genuine.

    Dr Leemon McHenry, a medical ethicist at California State University, says nothing has changed. “They’ve just found more clever ways of concealing their activities. There’s a whole army of hidden scribes. It’s an epistemological morass where you can’t trust anything.”

    Alastair Matheson is a British medical writer who has worked extensively for medical communication agencies. He dismisses the planners’ claims to having reformed as “bullshit”.

    “The new guidelines work very nicely to permit the current system to continue as it has been”, he said. “The whole thing is a big lie. They are promoting a product.”

    Matheson expects an article he wrote about a new cancer treatment to appear in print later this year, with an oncologist considered a “key opinion leader” (KOL) by planners listed as the author in his stead. “You’d do the same thing if you were selling cornflakes,” Matheson told me. “It’s no different.”

    And with the industry business model that is all about facilitating the influence of business over science thriving as it is, it’s hard to see when, if ever, we will again see the thick line one likes to imagine there once was between the sale of cornflakes and the analysis of medicine. It has all become rather blurry.

  28. nybgruson 01 Jul 2011 at 9:21 pm

    i am not playing the victim, i don’t see any strong evidence against alternative medicine.

    Simply put, because you are blind. There are mountains of evidence – the fact that you don’t “see it” is yet another creationist tactic. Much like when Wendy Wright told Richard Dawkins she has simply “never seen” transitional fossils. He said, “Sure – just go to the Smithsonian, they are there.” Her response, “I’ve been there, they aren’t there.”

    What does one say to that? Your active denial doesn’t change our message. We aren’t staunch because of ideology – you are. We present the evidence, explain it carefully, and frame it in the context of reality. You are simply a denialist.

    You even pull out the “Pharma Shill gambit” – unbelievable.
    And the lone maverick – “READ IF YOU HAVE THE COURAGE”

  29. mrgon 01 Jul 2011 at 9:31 pm

    @doubting_skeptic: mainstream medicine is indeed unavoidably stuck with a tension between responsibility and profitability, and as the establishment it is similarly unavoidably stuck with a degree of bureaucracy as well. No matter how good it was in practice, these two things would be realities.

    However, the business of CAM runs to literally tens of billions of dollars per year, and profitability is by no means an irrelevant concept to sellers of megavitamin therapies and homeopathic medicines. In fact, given the negligible cost of materials for homeopathic medicines, the profit margins are impressive.

    Where the two differ is in regulation. Everybody, mainstream medicine included, acknowledges that regulation is necessary, that sellers of medicines and treatments must be able to justify the safety and effectiveness of their products. CAM, however, screams very loudly when confronted with any need to similarly justify their own claims except on their own terms. Indeed, they call it perscution.

    Modern medical practice reminds of what Churchill said about democracy: the worst system there is, except for all the others.

    “Live Long & Prosper” — MrG.

  30. robmon 01 Jul 2011 at 9:44 pm

    A great deal of research on alternative medicine is funded through the National Institutes of Health, so Big Pharma is much less of an issue in discrediting alternative medicine.

    Having had the courage to read the rest of your post, I actually found most of it informative. It’s been pretty clear for a while now that drug companies do have skewered ways of pursuing profits, including not publishing alot of research they do. There is a good case for being cautious about the newest drugs, but it doesn’t make everything put out by the pharmacutical industry ineffective or dangerous. I also fail to see how one group of people being dishonest makes alt med true, it doesn’t work like that.

    There is little in the way of good positive evidence for alt med and quite a bit against it. FYI I think cars are a good mode of transportation but I’m not in the pockets of Detroit.

  31. titmouseon 01 Jul 2011 at 9:55 pm

    If some alt med treatment is proven to work it’s no longer alt med. It’s medicine.

  32. mrgon 01 Jul 2011 at 10:01 pm

    “FYI I think cars are a good mode of transportation but I’m not in the pockets of Detroit.”

    I would feel a little exasperated to be called a “Big Pharma Shill”. After all, if they’re paying out money to maintain the “Conspiracy”, why am I not getting any of it? Who do I talk to to get my payoff?

    “Get the money.” — Henny Youngman

  33. robmon 01 Jul 2011 at 10:07 pm

    Oh, sorry about the misunderstanding, I should mention I schill for toyota. As part of that conspiracy I get cool japanese gadgets and connections to the yakuza.

  34. doubting skepticon 01 Jul 2011 at 10:16 pm

    Typical of you skeptics, now you accuse me of being a conspiracy theorist.
    I strongly suggest others to not be afraid of Dr.Novellas and James Randi’s constant yelling at Alternative Medicine.
    Learn, Explore, don’t just rely on Authority figures. Here is a lovely interview Dr. OZ had with the amazing Dr. Andrew Weil: http://www.doctoroz.com/videos/dr-andrew-weil-future-medicine-pt-1

    Don’t be afraid to challenge conventional wisdom my friends.
    Without criticism, progress is impossible. To be content is to cease to advance.

    I would like to see a detailed criticism by Dr.Novella on modern medicine, why isn’t there progress with cancer or hear disease or anything?
    Dr.Oz and others care for our health not our money.
    This is your life and health, take a more proactive role.

  35. titmouseon 01 Jul 2011 at 10:20 pm

    I have a little dyslexia so at first I was like, “why is David Freedman calling us all Scientologists?”

    I lol’d at my misread. Then I Googled “David Freedman” at the Scientology completions web site, to see if I might find an explanation for the motivated reasoning.

    BTW, the differential for missing the blindingly obvious:
    1. Ignorant
    2. Brain damaged
    3. Motivated reasoning

    At least one “David Freedman” liked the rush he got from the purif mega-doses of niacin so much that he came back for seconds. He must have a kick-ass liver.

    Of course, no way to know if it is the same guy or not.

    So of course I had to

  36. titmouseon 01 Jul 2011 at 10:22 pm

    Oh link fail. Try again here.

  37. robmon 01 Jul 2011 at 10:31 pm

    doubting skeptic I whole heatedly agree we can’t be content that will stop progress. That is why we can’t give in to alt med, magical thinking will lull us into a false sense of health and well being and should be criticized as long as it is prevalent.

    Oh wait your actually meant the opposite, that we should adopt magical thinking because we are discontented with reality.

    Historically we have made huge progress in treating just about every disease. Just because cancer treatment doesn’t progress as rapidly as smart phones doesn’t mean it’s at a stand still. The fields of oncology and cardiology are actually are progressing, however don’t see that because you don’t have any expertise in those areas or medicine in general.

  38. steve12on 01 Jul 2011 at 10:43 pm

    “WOW this is unbelievable, are all of you so dogmatically against alternative medicine because of your Atheism?”

    Just what this discussion needs – poor reasoning due to religio-politcal affiliation.

    That said, I’m sorry to hear about your grandfather.

  39. steve12on 01 Jul 2011 at 10:50 pm

    I spoke too soon – I had no idea conspiracy theories were to come. I don’t generally think of the religios as being conspiracy people as well. Doubting Skeptic is the real deal.

    “Typical of you skeptics, now you accuse me of being a conspiracy theorist.”

    Well, you are. It’s just a matter of whether the conspiracy is true or not, right?

  40. titmouseon 01 Jul 2011 at 10:56 pm

    Dr. Oz is married to a Reiki practitioner. And he’s on the Harpo productions payroll. So his motivated reasoning is easy to sort.

    Andrew Weil has become a celebrity based upon his pandering to the aging boomers who want to believe in magic and eternal life. Sorted.

    “I would like to see a detailed criticism by Dr.Novella on modern medicine, why isn’t there progress with cancer or hear disease or anything?”

    There’s lots of progress in medicine. Just a few examples:

    - When I was a kid childhood leukemia was a death sentence. Now it’s nearly always curable.
    - HIV was a certain early death in the 1980s; now people can live for decades on anti retrovirals.
    - Average life expectancy is about 80 now compared to 40 something a hundred years ago.

    Medicine is a human enterprise and thus prone to the politics and corruption of all human efforts. But the scientific method helps to minimize the distorting influence of human desire upon our perception of the world.

    The SBM team is relatively small. Most doctors are busy and apolitical. They’re “shruggies,” as I once was. It takes a gross offense against human decency to arouse one’s understanding of the nature of “alt med.” But once aroused, there is no turning back.

    So the SBM as a movement is bound to grow. It is the conscience of medicine. It is the righteous fury of the human heart against the charlatans who take advantage of the weak.

  41. nybgruson 02 Jul 2011 at 12:12 am

    Learn, Explore, don’t just rely on Authority figures. Here is a lovely interview Dr. OZ had with the amazing Dr. Andrew Weil:

    I vomited alittle in my mouth.

    FAIL.

  42. rafalon 02 Jul 2011 at 12:38 am

    Let me get this straight:

    So author advocates alternative medicine and its practitioners along with the pseudoscience that comes with it for its supposed benefits,
    as opposed to advocating medical practitioners simply promoting an increased focus on getting patients to adopt healthy attitudes and behaviours?

    That’s not reasonable at all.
    And that’s assuming that all of the implied premises are true.

  43. rafalon 02 Jul 2011 at 12:49 am

    EDIT for clarity:

    Let me get this straight:

    So the author advocates alternative medicine and its practitioners along with the pseudoscience that comes with it, for its supposed benefits
    as opposed to simply advocating for medical practitioners to increase focus on getting patients to adopt healthy attitudes and behaviours?

    That’s not reasonable at all.
    And that’s assuming that all of the implied premises are true.

  44. steve12on 02 Jul 2011 at 12:51 am

    rafal has pretty much condensed the whole issue perfectly. all this back and forth, and yet that’s the whole deal.

  45. nybgruson 02 Jul 2011 at 1:02 am

    I agree, steve12. And somehow my comment about “doubftul” skeptic appealing to authority in the same breath as condemning appeals to authority disappeared.

  46. steve12on 02 Jul 2011 at 1:10 am

    “And somehow my comment about “doubftul” skeptic appealing to authority in the same breath as condemning appeals to authority disappeared.”

    I’m slow – I just thought your comment was just about the Dr. Oz ref, but yeah, it’s pretty hillarious: Don’t trust authority figures – except this one!

  47. nybgruson 02 Jul 2011 at 1:13 am

    yeah, it was – and part of it included the appeal to authority comment, but I used bad html and it disappeared.

  48. doubting skepticon 02 Jul 2011 at 1:22 am

    WOW i am clearly not wanted here, nybgrus for you to associate Dr.Oz with vomit is just mean spirited.
    Fine i will go, all i wanted to do was to show all of you that there might be other options for our health.
    Go on, keep insulting others and keep living under the illusion that everyone else is stupid but all of you the great Skeptics are the smart highly educated ones.
    Goodbye.

  49. nybgruson 02 Jul 2011 at 1:30 am

    Dr. Oz is known as “The Lizard of Oz” around here for good reason. You didn’t come here to show us “another perspective” you came here to prosyletize. And just as you may be offended that I would associate Oz with vomit, I can assure you we are more offended that you would think we here haven’t read or listened to them.

    The difference between me and you is that I listened to Oz (and his ilk), read the “evidence” he put forth, and evaluated it myself and found it lacking. You, on the other hand, assume we haven’t looked and preach purely from authority. You listen to Weil, Oz, Chopra and decide they are right and that is it. We looked at the evidence. We know the science. They are wrong and unlike most new-age hippie types would like to think, there is actually such a thing as simply being wrong. We won’t budge because we looked at the evidence and decided it was wrong. Period.

    We are actually highly educated. So are Oz and Weil. We just have intellectual honesty.

  50. doubting skepticon 02 Jul 2011 at 1:57 am

    That’s it, i am not going to sit down silently while you degrade Dr.Chopra, you are a mean spirited, unfriendly, cold, uncaring and a bully typical of Atheists writing blogs, just look at PZ Meyers and the whole lot on the JREF forum.
    Dr. Chopra cares for our health, tell me what the hell is wrong with this:

    http://www.huffingtonpost.com/deepak-chopra/prostate-cancer-screening_b_874838.html

  51. steve12on 02 Jul 2011 at 2:21 am

    “you are a mean spirited, unfriendly, cold, uncaring ”

    All of which is entirely beside the point. Where’s the evidence? For many of their claims, Chopra, Oz et al. have no evidence.

    I’m sure they’re all quite nice, seriously – they’re just wrong. It happens.

  52. elmer mccurdyon 02 Jul 2011 at 3:22 am

    As usual I’d like to hijack the thread to ask about something that interests me. For a while I’ve had the feeling that the way doctors diagnose and treat “tendonitis” seemed awfully unscientific. So a moment ago I did a quick google scholar search, and the 1st couple results I got seemed to confirm this impression. Now, aside from lacking scientific expertise, I don’t have access to the full text of the first article, but I know there are a lot of regular commenters who have both, so if any of them would be willing to comment on this, they’ll have earned my precious gratitude.

    http://journals.lww.com/acsm-msse/Abstract/1998/08000/Etiology,_diagnosis,_and_treatment_of_tendonitis_.1.aspx

    http://www.bmj.com/content/324/7338/626.extract

  53. roadfoodon 02 Jul 2011 at 4:20 am

    “Dr.Oz and others care for our health not our money.”

    Wow, I’m not sure how to respond to someone who apparently believes that Dr. Oz doesn’t have money as any component of his motivation. He may not make money from you directly, but he sure does make money from the advertisers that support his show, and those advertisers are willing to pay because you’re watching. So Dr. Oz is most certainly making money because of you.

    Anyway, I wanted to address Mr. Freedman’s component C, that CAM is better at “getting patients to adopt healthy attitudes and behaviors”. He seems to be ignoring some important specifics here.

    As Dr. Novella has said many times, CAM practitioners have an advantage on that point in that they generally get to spend more time (than MDs) with their patients because their patients spend more money to buy that time. I have seen Dr. Novella completely agree that traditional medicine would be better if MDs could spend more time with each patient.

    And since CAM advocates are fond of anecdotes, here’s one to support that point:

    I am 54 years old, I’ve been fairly sedentary for many years, a chronic snacker, and around fifty pounds overweight for many years. In the last six months, I’ve cut way down on sugary snacks, gone up on eating fruits and vegetables, I’m exercising at least four days a week, and I’ve lost twenty pounds. Why, after so many years of bad behavior, did I turn myself around and adopt more healthy behavior?

    Because my MD spent twenty minutes with me, talking to me and explaining things, using science and evidence (not woo). My most recent blood test showed that I was pre-diabetic. My doctor explained what that meant, explained what insulin is, how it works, how ingesting large amounts of sugary snacks over a long period of time can “wear down” the body’s ability to keep producing enough insulin. My blood pressure has been getting into the pre-hypertensive range. Again, my doctor spent time to explain what that means. He talked about how studies have shown that being overweight is one of the biggest risk factors for heart problems, and that regular exercise is one of the best overall preventative measures.

    My doctor did not, as so many CAM advocates like to charge, immediately prescribe drugs for me. He also did not tell me about “toxins”, or “bad energy”, or any other alternative woo. But he was, clearly, treating the patient, not the disease, and was advocating preventative measures.

    I’ve changed my lifestyle (not drastically, mind you) and am on the road to generally better health because my doctor explained the reality, and talked about the science and the medical studies.

    So, for whatever one anecdote is worth, this one shows that an MD, by spending some time with a patient and making the case in a science-based and evidence-based manner, can be at least as good at “getting patients to adopt healthy attitudes and behaviors” as any CAM practitioner.

  54. Nikolaon 02 Jul 2011 at 6:04 am

    @doubting skeptic:
    “keep living under the illusion that everyone else is stupid but all of you the great Skeptics are the smart highly educated ones.”

    I think I pointed out earlier that I am a high-school drop-out – there goes education! As for smarts…. Well, I understand logical fallacies, cognitive biases and the need for controlled studies. Do you? If you’d read and understood some texts on SBM, perhaps you wouldn’t keep repeating easily refutable claims and non sequiturs. My earlier comment to Mr Freedman may as well be aimed at you.

  55. doubting skepticon 02 Jul 2011 at 7:24 am

    Ok now i am disturbed, sorry for going of topic but this article claims that Darwin is wrong: http://www.afa.net/Blogs/BlogPost.aspx?id=2147497773
    Can someone please point out the errors in this article, i am serious here, there are 10 points please read them all.

  56. tmac57on 02 Jul 2011 at 10:47 am

    doubting skeptic- I doubt that you really want answers to those 10 points,but if you really want to know then go here:

    http://talkorigins.org/

    I won’t be holding my breath however.

  57. mrgon 02 Jul 2011 at 10:48 am

    “Typical of you skeptics, now you accuse me of being a conspiracy theorist.”

    You claim that Big Pharma is orchestrating the criticisms against CAM, and then complain when people think you’re a conspiracy theorist? “Life is tuff. Wear a hat.”

    “Can someone please point out the errors in this article, i am serious here, there are 10 points please read them all.”

    I doubt very much that you’re serious, since they’re all “Creationism 101″, and if you were honestly interested you would be inclined to actually do a little homework and figure it out for yourself. I have never run across a creationist argument, at least one I hadn’t heard a hundred times before, that didn’t end up in the trashcan after a few minutes of checking around.

    So what you’re actually doing is sitting there with your arms crossed and daring people to give you a clue, which I would judge a losing game on the face of it. But I will give you a slight benefit of the doubt.

    Obviously, getting to the bottom of all these questions would take doing some homework (oh that nashty word again!) but fortunately their Number 10 SUPER_KILLER argument, “Creationist Information Theory”, was the subject of an article I wrote myself:

    http://www.vectorsite.net/taifevo.html

    And if you actually do like it, I’ve got LOTS MORE materials I’ve written to educate people!
    However, I doubt that you’ll bother to read it, and even if you do, all you’ll do it pick through it for things to complain about — but maybe you’ll surprise me.
    There is hope.

    At least you have established that a linkage between CAM and creationism is by no means unrealistic.

  58. Rikki-Tikki-Tavion 02 Jul 2011 at 10:54 am

    @doubting skeptic:
    Will you please go?

    You can say that we don’t want you here, because we are closed-minded. It’s not the case, but you can say so if you wish. I think I speak for most here, when I say we don’t want you here, because you do not adhere to our standards of discussion.
    Not everyone here is flawless in this respect – the vomit thing was uncalled for – but you take it to another level. You post whole newspaper articles in the comments, when you could have easily just posted a link. You kept insulting members here much more than anyone else. You did not respect the basic principles of evidence on which this community is founded. So please think about all that and come back when you can support your claims with evidence, and be more objective about others than others are about you.

    So as a present to you, in hopes that you will learn good lessons from it, I take the time to dissect all of the 10 Points in this article you sent in.

    1. Various quotes, mostly taken out of context. The fact of the matter is, that evolution did happen (as proven by various independent lines of evidence), and that hence we can deduct, that it must have started somewhere.

    Although I will not deny that Pasteur was an early critic, but at his time, the evidence for evolution was much weaker. They had only a hand full of fossils at the time, and no DNA, and no models of how, in a multiple billion year process amino acids could have randomly recombined until they hit upon the jackpot of life. Most of us would have been skeptical of evolution at the time, after all it was the first theory to make the outrageous claim, that the earth was billions of years old, instead of thousands.
    Suggested reading: http://en.wikipedia.org/wiki/Abiogenesis

    2. A simple matter of argument from ignorance. I cannot imagine, therefore it cannot be. That is not a valid argument. Certainly, the burden of proof lies with biologists to prove evolution, but they have done this many times over. If you would like to suggest a different explanation, you would have to prove that explanation, and not disprove evolution.

    3. The word explosion in “Cambrian Explosion” is in no way implying that is happed in a week, but rather over the span of millions of years. The fact of the matter is, that evolution can be extraordinarily fast, if the conditions are right. Such has been proven in observation (got flu?) and mathematical models (see “The Ancestors Tale”, I think it was in the Tarsier’s tale).

    4. Oh yes, the origin of species is great for misquoting, because it is written in a very humble language. This is in fact the opening to a a large explanation of why evolution predicts the fossil record to look as it does indeed look.
    For more info: http://embryology.med.unsw.edu.au/pdf/Origin_of_Species.pdf page 130 onwards

    5. A strawman. First of all, Biologists do not say that we descended from “living fossils”, in fact “living fossils” are just as modern animals as we are, they just happened to find a niche that stayed open for some of them to keep their overall shape. In fact biologists love to talk about living fossils. They are perfectly in line with what evolution predicts.

    Another argument from ignorance here: I do not know how coelacanth-like fish could have survived for a very long time, while also brancing into other species, so it couldn’t have happened. Here’s just one explanation (of many) how it might have been: A small group of fish got separated from the rest of their species, by a freak current or geological event. The main group can live on in the same shape, but wherever the other group landed, there is an evolutionary pressure to change, like for example an overabundance of predators, not enough food, or unsuitable breeding conditions. There you go.

    6. Yes, conventional wisdom says that during fossilization complex matter gets broken down. But there are two canards here: First of all, this does not take into account the many fossils that have been dug up containing absolutely no such material up until the few lucky hits, that where conserved in a very special and rare way that prevented life to take it’s full course with them.
    The second canard is that they supposedly found hemoglobin, a very large, very very complex molecule. This is a simple falsehood. They found heme, a tiny much less complex part of hemoglobin. As for the other stuff they supposedly found, I don’t see any evidence.

    7. Oh my Darwin, that’s a crazy one, I don’t even know where to begin, so I’ll make you a list:
    A. Mitocondrial Eve and Y-Chromosome Adam where not contemporaries according to recent data (“The Ancestor’s Tale” page 54) Eve lived 140,000 years ago, Adam a mere 60,000 years ago. The quoted Science article is discussing an (apparently now dismissed) paper that cast doubt on the mutation dating system. The original results could not, as far as I can tell be replicated.

    B. Of course evolution predicts we are all decedent from one woman and one man! Let me take the opposite assumption Ad Absurdum for you: If it where not the case, then you could go back a very long time in evolution and find two male shrew like animals with the same farther. One brother’s decedents would have evolved to be your ancestors, and the other one’s would have independently evolved to be my ancestors, without any interbreeding between the two strains. That’s obviously implausible. Hence there must have been two humans, one of whom fathered your ancestors and his (half-) brother fathered mine. If the two of us are the most distantly related humans on the planet (by male ancestry), then that person would have been Adam.

    C. The same thing goes for Eve, but since Men can farther much more children than women can give birth to, Adam lived much later than Eve, and was probably some tribal warlord with a very large harem (not containing Eve).

    D. You can find Eves and Adams for all living species of animal, not just humans.

    8. This is getting very time consuming… I hope it’s worth it:

    A. “If all came from twenty goats, then it could actually prove that Noah’s Ark was just a fairy tale.”
    That’s an easy one, because the same would have to go for all land living animals, and you will find that wolves have a much broader ancestry than 20 animals, in recent evolutionary history.

    B. No definition of a “Gene Pool” is given, but I don’t think it means what the author thinks it means. Is certainly doesn’t mean, that at one time only four women lived in the world. As a matter of fact, all humans will after a large number of generations, in a non-isolated population, say in Africa, be either universal ancestors or ancestors of none. Hence there might have been 200 individuals, only 4 of whom passed their mtDNA on to us (assuming the number is correct).

    C. If point A is not enough of a disproof of Noah, then think about Occam’s Razor: We have on one side of the razor a global flood, for which there is no evidence (even though there would be if it where true). On the other side we have a simple drought or some other environmental effect, that caused a severe choke in human population, which sounds more plausible to you?

    9. A simple falsehood. The copying mechanism of DNA is much better than the author gives it credit. Also, according to evolution, harmful mutations where always sorted out. According to one hypothesis, that’s what our brains where originally for:
    As about 50% of our genes play a role to form the brain, if there is something wrong with someones genes, there is likely something wrong with his brain. That is why being witty is attractive to women and men alike.

    10. Finally.
    A. The author gives no reason for even introducing DNA. We knew the information was stored somewhere in the cells, way before we found the molecule responsible. I suspect this to be an attempted argumentum verbosium.
    B. The structure of the DNA is very unlike anything a designer would come up with. It’s often needlessly complex, containing many parts that are no longer needed (says a man with an extra vertebra). Many parts of DNA influence countless parts of the body. DNA is utterly unlike a blueprint of the body, it’s more like a recipe.
    C. “It is against all of the known principles of information science that these instructions might have happened all by themselves, and by accident.”
    A simple falsehood, backed up by a clever combination of two utterly unrelated quotes. There is no law of information science violated by evolution.

    Now, can you please come back, when you have understood the principles of this community?

  59. doubting skepticon 02 Jul 2011 at 11:09 am

    Thank you Rikki-Tikki -Tavi for taking the time and effort to reply, i promise i really wanted the answers, i am new at this, i am just learning about what evolution really is after reading Richard Dawkins wonderful book ‘The Ancestors Tale’ i felt so inspired reading our connection with every living thing on this planet. But i hate, hate, hate ‘ The God Delusion’. I also hate how Creationists are hijacking Science. I don’t know how to respond to them, some of their arguments seem good, and i just wanted a proper scientific response to their silly claims.
    Thank you once again, you will not hear from me again. Sorry for being offensive.
    Take Care:)

  60. daedalus2uon 02 Jul 2011 at 1:01 pm

    Mr Friedman, I am a long term commenter on SBM, and there is probably no one else here who thinks that the placebo effect is stronger and more effective than I do (I probably think it is stronger than you do).

    In spite of that am completely 100% opposed to the use of CAM to treat patients without trials showing clinical efficacy greater than placebo, and although I may disagree with the other posters on the physiology of the placebo effect, I am in complete agreement with them that deceiving patients has no legitimate role in medicine and that CAM has no legitimate role in medicine and that administering placebos has no legitimate role in medicine (other than in the context of research where informed consent protections are included).

    The major arguments against CAM come from science. Science is not like politics, or fashion, or music, or sports. People’s opinions about science do not matter the slightest bit. Science is all about facts, the data and the logic tying that data together. If you don’t know and understand the facts, then your opinion about a scientific matter is of zero value. This can difficult for non-scientists to appreciate that their opinions are of zero value. This statement is not meant to be pejorative, it is an accurate statement. It is unlike your characterization of the SBM MDs as a “Small, Loud Band of Alt-Med Critics” which was meant to be pejorative and dismissive.

    What you are proposing is in effect changing the “rules” of medicine to allow CAM a free-pass on efficacy whenever you can’t think of obvious adverse effects and even when adverse effects are pointed out to you by MDs who treat actual patients you simply dismiss them.

  61. Jeremiahon 02 Jul 2011 at 3:15 pm

    @doubting skeptic
    “It is against all of the known principles of information science that these instructions might have happened all by themselves, and by accident. That is impossible. That is illogical. This is perhaps the most scientifically important proof of all of the Top Ten that—Darwin is wrong.”

    Darwin wasn’t wrong because he didn’t say or argue that. He felt initially that all nature’s forms followed learned behavioral instructions gained from past experiences on earth. Darwin didn’t know where those instructions were stored but he was smart enough to know they weren’t stored in an imaginary creature in the sky that the forms had no access to except through paying homage through acting out the experiences that their gods already knew they’d have to have.

  62. Nikolaon 02 Jul 2011 at 4:03 pm

    @doubting skeptic

    You see, the choice other than buggering off is to open your mind and accept the value and necessity of the scientific approach. This will make you reconsider your stance and standard of discussion in this forum. It’s no crime being new to any field, in fact it’s very exciting, however your tone is often far from neutral and simply sounds antagonistic. I’m sure that, as far as most of us are concerned, you’re welcome to stay – especially if you moderate your attitude somewhat.

  63. nybgruson 02 Jul 2011 at 6:27 pm

    doubting skeptic is making me think he is a Poe. The pseudonym alone is good start for that. But then randomly jumping in with an evolutionary trope? On a completely unrelated thread (yes, Dr. Novella made the comparison in tactics but the subject matter that has been the ongoing theme of these posts is CAM – not evolution)?

    I will also second RTT and Nikola’s sentiment. Offer something genuine, take the time to ask a reasoned question or a referenced assertion. But do not just jump in, say we are all mean, and then drop links or copy-paste entire articles for us to read. We can all read (and we have). The premise here is that we have read those articles and decided they were incorrect. Offer your own analysis and synthesis of the data and what you think it means. Reference it. Then someone here will either agree and change their viewpoint or counter with an explanation.

    Simply coming in and claiming we haven’t listened to the arguments of Weil and Oz and then dropping a link makes me… well, want to vomit. That is not engaging in an intellectual endevour – that is claiming we appeal to authority while doing exactly that yourself.

    So yes, come back and write some more – make an effort to actually do your own critical thinking (or if you have, at least make the effort to let it show in your posts). You will be welcomed for it, I assure you. Being wrong is not a bad thing. Continuing to be wrong after being shown why is.

    And one last thing about “tone” – many trot out PZ Myers as the epitome of bad tone. I agree – he is pretty nasty at times. But there is nothing wrong with that. Everyone has a different personality. IT is the content of what is written, not the tone that is important. I believe it was Dr. Crislip who wrote that if someone denies the sky is blue and insists it is red, responding with “Actually, dear sir, it is blue” vs “It’s obviously blue your frackin’ idiot!” doesn’t change the content or the validity of the argument. One certainly may be more effective than the other, depending on the circumstance, but if the only thing you can pick apart is the tone, you’ve already missed the point and lost.

    The example I can give is with the commenter here whose ‘nym is Sonic. I started up a somewhat nasty tone with him when he began questioning evolution (yes, I’m prickly about that). He sliced through the tone, actually asked questions relevant to content, and lo and behold, my tone changed. We had an honest and interesting discourse and his view has changed a bit on the topic.

    So, doubting skeptic, if you really aren’t a Poe and you really are interested in learning something in a foreign field in a new forum for you, then I genuinely encourage you to do so. If you make a sincere effort, I will keep my snark to a minimum and I think the remainder of the commenters here will offer their insights as well.

  64. Rikki-Tikki-Tavion 02 Jul 2011 at 6:30 pm

    I also want to stress, d. skeptic, that you are very welcome to stay, if you accept the rules of evidence we have here, and how we try to keep our human nature in check to have a discussion based on that evidence.

    In your last post I thought you made a huge step towards that goal. If you can keep that attitude, I personally, would like to read more from you.

  65. Rikki-Tikki-Tavion 02 Jul 2011 at 6:43 pm

    Erratum:
    [quote]B. Of course evolution predicts we are all decedent from one woman and one man! Let me take the opposite assumption Ad Absurdum for you: If it where not the case, then you could go back a very long time in evolution and find two male shrew like animals with the same farther. One brother’s decedents would have evolved to be your ancestors, and the other one’s would have independently evolved to be my ancestors, without any interbreeding between the two strains. That’s obviously implausible. Hence there must have been two humans, one of whom fathered your ancestors and his (half-) brother fathered mine. If the two of us are the most distantly related humans on the planet (by male ancestry), then that person would have been Adam.[/quote]
    The father of these two humans would have been Adam, of course.

  66. banyanon 02 Jul 2011 at 7:08 pm

    I’m starting to think that Doubting Skeptic is trolling…

  67. doubting skepticon 02 Jul 2011 at 7:56 pm

    Thank you Rikki-Tikki-Tavi, i look forward learning about Science and Evolution from you, thanks again for your kindness.

  68. Mlemaon 02 Jul 2011 at 8:53 pm

    Doubting Skeptic:
    you might be interested in reading things by Kenneth Miller
    http://en.wikipedia.org/wiki/Kenneth_R._Miller

    there are links to a couple of his books on the wikip page
    ps, I don’t think this blog is the best place to learn about evolution (if that’s what you’re trying to do)
    just my opinion as a Jesus freak

  69. Mlemaon 02 Jul 2011 at 9:01 pm

    I do want to say, though, that I thought it was pretty nice of Rikki-Tikki-Tavi to do write such a thorough answer to your questions. :-)

  70. neverknowon 02 Jul 2011 at 9:15 pm

    “The debate, such as it is, at least reveals the current rhetorical tactics of the CAM proponents. They can be summarized largely as – we know that CAM modalities don’t work, but we’re nice and they will give you a good placebo effect”

    They are not all saying that. For example:

    “Evidence is growing, based on carefully controlled studies, that certain non-pharmacological complementary interventions may be useful adjuncts to conventional care.”

    They are saying there is scientific evidence, and you are saying they admit there is no evidence. So which is true?

  71. doubting skepticon 02 Jul 2011 at 10:05 pm

    Thank you Mlema, very kind of you, yes Rikki-Tikki-Tavi is one of the nicest skeptics that i have ever come across.
    Also about Kenneth Miller he is obviously a great scientist, but i feel like my spiritual pathway is more into the teachings of people like Deepak Chopra and Eckhart Tolle. I respect Christianity but i find it difficult to believe in a god in the sky that cares only for one species of primates.
    I am more comfortable with the teachings of Deepak Chopra about love and consciousness beyond death and that we are all one. Furthermore following Deepak Chopra doesn’t make me anxious learning about evolution, but being a Christian its harder to learn about evolution because first of all your Christian family and friends will actually think you have embraced Stanism by learning about evolution. Furthermore i don’t know why do they feel anxious about evolution, even Richard Dawkins has said we can believe in God and evolution.
    This is just my experience coming from a Christian background, but i have left that and i am more at ease with Deepak Chopra.
    Thank you for those links Mlema

  72. Jeremiahon 02 Jul 2011 at 10:57 pm

    I hear Deepak’s God’s take special care with Dolphins, having allowed them to evolve a tool maker’s intelligence without needing tools.

  73. Mlemaon 02 Jul 2011 at 11:07 pm

    doubting skeptic,
    I don’t see any big change in leaving Christianity for Chopraism. But if it appeases your anxiety, that’s great!
    You might be interested in the writings of Meister Eckhart, from whom Eckhart Tolle adopted his first name.
    good luck to you!

  74. Mlemaon 02 Jul 2011 at 11:11 pm

    doubting skeptic: sorry, that first bit sounded a little condescending. I truly hope you find what you’re looking for. Thing is, it’s a life-long pursuit. :-)

  75. nybgruson 03 Jul 2011 at 12:48 am

    but i feel like my spiritual pathway is more into the teachings of people like Deepak Chopra and Eckhart Tolle.

    I actually can’t comment on Tolle, but Chopra is a woo-meister to the extreme. If you prefer to follow his “teachings” you will certainly meet some opposition here. There has been many a post dissecting his writings and ideas and the authors here and myself included have decided he has it wrong. The fundamental error you may find yourself getting into is using Chopra-isms as a counterpoint to some of the things said here. The problem with that is we do not accept his “teachings” as valid, so if you do so you will run into that resistance I spoke of.

    I suggest you get down to the basics and try and find out why Chopra is a scheister (whether he believes his own quantum woo or not, the result is the same). You can begin by looking up articles on him here on this very site. In fact the most recent SBM post deals with Chopra’s latest musings.

  76. doubting skepticon 03 Jul 2011 at 1:10 am

    Mlema thank you so much very kind of you, nybgrus, i don’t like what you are doing at all. Deepak Chopra is not Sylvia Browne, i am very well aware Deepak Chopra is deeply hated by Atheists and skeptics and i think you anger is misplaced, Deepak Chopra does not threaten Science, Deepak Chopra doesn’t encourage hatred and division.
    I find comfort in his teachings after the death of my grandfather, i have hope that we will meet again.
    Deepak’s meditation has been helpful.
    Your deep seated hatred for Deepak Chopra is almost racial, sorry to say that but there are far more dangerous cranks out there, the Christian Right is just mad compared to Deepak Chopra and Eckhart Tolle.
    I first became interested in Evolution after reading Deepak Chopras book why is God laughing.
    So please don’t hate Deepak Chopra.
    Thank you again Mlema

  77. doubting skepticon 03 Jul 2011 at 1:30 am

    I can’t find the latest hatred against Deepak Chopra on the SBU site, please someone send it to me, i feel anxious everytime i come to skeptical blogs because i know someone will have something bad to say about Deepak Chopra, please let me read that latest article that nybgrus mentioned.
    Also the core of Dr. Chopras teaching is this:
    (1) You belong in the scheme of the universe. There’s nothing to be afraid of. You are safe.
    (2) There is always a reason to be grateful
    (3)Your Soul Cherishes Every Aspect of your life
    (4) Death is not the end, our separation from our loved ones is not forever
    (5) This is an intelligent universe

    There is nothing wrong with Dr. Chopras teachings, i believe if all the creationists and fundamentalists were to learn from him, they would be more open to Science.
    You are not taking this away from me nybgrus

  78. nybgruson 03 Jul 2011 at 1:41 am

    @DS:

    I actually took care to ensure there was no malice in my last post. In fact, I don’t “hate” Chopra. I just think he is utterly wrong. I think he is a scheister, and I certainly don’t like the fact that he takes people’s money in return for his nonsense. He is the epitome of the modern snake-oil salesman.

    I truly am sorry for your loss and I am glad you managed to find some sort of solace. Around here though, we are all about reality, and will unashamedly point out that Chopra is fundamentally wrong.

    Your own argumentation for Chopra is actually rooted in feeling, emotion, and anecdote. I can tell this because you immediately become extremely defensive and invoke atheism as some sort of reason why I am against Chopra. Metaphysics aside, he is demonstrably wrong on many levels and that has nothing to do with my atheism or any philosophy I may espouse.

    Furthermore, how on earth did you go from my calmly written post explaining the issues you may run into here vis-a-vis Chopra and get that I not only hated him, but that it was racially motivated? That is purely an emotional lash-out. I never mentioned his race, nor do I care one tiny whit what his race is. Wrong is wrong, no matter how you slice it.

    Next, you go on to say there are “far more dangerous cranks” – I absolutely agree. But just because Chopra may not be “as bad” or “as wrong” as someone else, doesn’t mean I have to accept his piffle wholesale. I don’t focus my skepticism on the worst of the world, I am an equal opportunity skeptic and have no issues saying when I believe someone to be wrong. When it comes to Chopra, I am in good stead.

    And lastly, I’ll once again re-iterate – I do not “hate Deepak Chopra.” I have read what he has to say and found it wrong on a fundamental level. He in fact seems like a very pleasant man, but that doesn’t mean he isn’t wrong and that doesn’t mean he gets a free pass for it. He could honestly and genuinely believe each and every bit of what he says and could be honestly doing it out of genuine concern and care for humanity. I wouldn’t be surprised if that actually was the case. But that doesn’t make him any less wrong. He may have done some good in your life, as he seems to, but once again, that doesn’t make him any less wrong. It is not all or none. Take the good parts and eschew the rest. The problem is Chopra is mostly wrong, and the things he is right about are fairly mundane and obvious so I am quite content to write him off completely.

    So please, don’t bring emotion into this by claiming I am the one hating on someone else. I’m not. I just happen to know enough science to know Chopra is fundamentally wrong and I will continue to say so.

    My admonition to you was that if you try and use Chopra as a reference to prove a point you are making, that will be met rather negatively here. Take that as you will. However, if you don’t bring up Chopra and he isn’t relevant to the topic, I would have no cause to bring him up either.

  79. nybgruson 03 Jul 2011 at 1:45 am

    @DS: I was the SBM site – link here

    Also, no need to discuss Chopra. He isn’t relevant to this thread, and I have no desire to “take him away from you” so I am quite happy to drop it. If you continue it over at SBM though, prepare to hear why he (and you) are wrong on the topic.

    Also, please stop framing it as an “atheist” outlook or “hatred of Chopra” or other such nonsense. Atheism has nothing to do with this and we don’t have hatred for Chopra. We believe he is wrong, he have science and evidence on our side, and we are happy to explain why. Read the post and try and understand. But I can already tell by how touchy you are on the matter that you will be very closed-minded and cling to your adoration of Chopra no matter what. I hope you prove me wrong.

  80. doubting skepticon 03 Jul 2011 at 1:49 am

    Thank you for saying Deepak Chopra is a pleasant man, but please don’t confuse him with the SECRET and WHAT THE BLEEP DO WE KNOW.
    Dr. Chopra is not saying that we manifest reality, all he is saying that you might not like is that Consciousness is divine and one with God.
    Yes he does talk about attracting wealth and good things into our life’s but he does not tell us to just sit down and think positively, he tells us to engage our selves in the world spreading love and kindness.
    And when he talks about Quantum Physics he makes it clear he is speculating. And he is not in anyway hijacking Quantum Physics he makes it clear he is just giving his own intepratation for the existence of God and the Soul.
    By the way in his books he even encouraged us to read Stephen Hawkings Brief History of time.
    So yes i know all of you hate it when he invokes Quantum Physics but please be assured that Dr. Chopra makes it clear in his books that he is speculating and that these things are not discussed and are not even of interest to mainstream scientists.
    Thank you for your response. Sorry for saying your anger against him is racially motivated.

  81. doubting skepticon 03 Jul 2011 at 8:26 am

    I am loosing the will to live, i just finished reading all of Dr. Novellas criticism of Dr. Deepak Chopra, i am really loosing the will to live, its too depressing, I shouldn’t have come here, i shouldn’t have joined this blog.
    I really wish a truck knocks me down.

  82. Steven Novellaon 03 Jul 2011 at 10:17 am

    Neverknow wrote: “They are saying there is scientific evidence, and you are saying they admit there is no evidence. So which is true?”

    Both are true. When they are being held to standards of evidence, such as in the published literature, they often have to admit a lack of evidence and then move on to plan B – but the placebo effect is worth it.

    But they also claim elsewhere (other proponents at other times) that the evidence supports their position. They are wrong in this, and largely cherry pick to make their case.

    They are also good at tailoring their message to their audience. And there are many mutually-exclusive beliefs within the big tent of CAM.

  83. titmouseon 03 Jul 2011 at 10:57 am

    doubting skeptic,

    Would you agree that the universe is what it is, regardless of how you feel about it? Or do you believe that your feelings are a reliable guide in figuring out what is true?

    I notice that you consult your feelings often.

  84. hippiehunteron 03 Jul 2011 at 9:59 pm

    doubting skeptic are you channelling skeptical atheist ?

  85. robmon 03 Jul 2011 at 10:21 pm

    hippiehunter,

    that’s my thoughts on doubting skeptic’s sudden change of tone from anger to concern.

  86. doubting skepticon 03 Jul 2011 at 11:22 pm

    LOL, who is this Skeptical Atheist that you talk about :)
    My purpose of coming to this blog is to help heal the anger deep within all you angry Atheist, i also want to assure all of you that Death is not the end my dear friends, Death is merely a movement, a movement from on plane to another where we will be embraced by the loving light and meet all our loved ones again.
    Love and Light is all there is, Consciousness is eternal and divine. You will not disappear at death as Stephen Hawking and Steven Novella and Steven Pinker will want you to believe.
    Smile, be happy, you will not die.
    Love and Peace :)

  87. doubting skepticon 03 Jul 2011 at 11:36 pm

    Oh God help, Dan Dennet says here that there is no Life After Death, please, someone please tell me he is wrong, why, why do i keep finding these things:

    http://www.youtube.com/watch?v=hio4ZtVVLhY

    Oh God Susan Blackmore say’s there is no Life After Death, someone please help me, i am really dying here, why, why is this happening to me: http://www.youtube.com/watch?v=sX5JEOyum2M

    Oh God, Sir Jonathan Miller says that there is no Life After Death, please someone please help me: http://www.youtube.com/watch?v=BhUoeKoBJ7w

    I give up. I really give up.
    I am just waiting, waiting to be run over by a truck.

  88. pious fraudon 03 Jul 2011 at 11:45 pm

    # doubting skeptic on
    “Love and Light is all there is, Consciousness is eternal and divine. You will not disappear at death as Stephen Hawking and Steven Novella and Steven Pinker will want you to believe.
    Smile, be happy, you will not die.
    Love and Peace ”

    Oh no, please no, not this crap again. Somebody ban this motherfarker.

  89. sonicon 03 Jul 2011 at 11:52 pm

    Apparently the use of placebo by medical doctors is not unusual or considered unethical by most.
    http://www.bmj.com/content/337/bmj.a1938.short

    Freedman visited the Mayo Clinic to see a situation where the doctors are using the treatments he is suggesting could be used more widely. Apparently he feels that the Mayo Clinic is a good example of how the system might work.
    I don’t think he needs to outline it further- he is not a hospital administrator.

    While it might be true that a better solution would be to re-train doctors and change the insurance industry (private and public) to allow for better outcomes, how does that help the guy who is sick today?

    As to a change of ‘standard of evidence’– what makes a surgery OK?
    Not double-blind placebo controlled trials- so what? I’m asking because I don’t know.

    In the original article there is a description of an acupuncture treatment. I note that what is described is different than what is tested in the clinical trials I’ve read.
    I’m surprised nobody seems to notice that. But I think trying to design an experiment around certain treatments would be difficult.

  90. robmon 04 Jul 2011 at 1:08 am

    sonic,

    No where in that study was there any evidence to support the notion that placebos actually have any beneficial effects. The study was a survey of whether or not physicians prescribe placebos and their feeling about the ethics of doing so. The authors speculate on motives here:

    “Physicians might have multiple, possibly conflicting, beliefs and motivations for recommending active placebo treatments. They might believe that a given benign and safe treatment, such as some indicated by our respondents (for example, vitamins and over the counter analgesics), might have some finite chance of a beneficial pharmacological effect, despite remaining unproved for the symptoms or condition at hand; or, at the very least, such treatments might promote positive expectations in patients or help the patient to feel like they are being taken care of. This perceived need to administer something in the absence of other proved effective treatments for chronic symptomatic conditions (that promotes a sense of treatment options and positive expectations in response to patients’ complaints) might motivate physicians to prescribe placebo treatments.”

    There were no survey questions on whether the physicians believed that their treatments were effective. Table 2 has a breakdown of physicians willing to prescribe a sugar pill for fibromyalgia. Whats more 13% of physicians prescribe antibiotics and sedatives when there is no evidence of their effectiveness. That is highly unethical.

    Since there isn’t any more evidence that vitamins and aspirin (the two most common recommendations) are any more effective than alternative medicine it’s unethical to spend time and money (the hospitals or the patients or the insurance companies) on unproven recommendations. It won’t help the sick guy any day, well actually he will feel reassured as he either continues to suffer from his illness or is cured by proven treatments or the disease runs its course. And even if the placebo treatment did nothing a physician, nurse or the patient will give a positive testimonial convincing people there must be something to this.

  91. SteveAon 04 Jul 2011 at 7:30 am

    hippiehunteron: “doubting skeptic are you channelling skeptical atheist ?”

    Was that the one who went on about unicorns living in flowers?

    I vote Poe.

  92. Rikki-Tikki-Tavion 04 Jul 2011 at 7:49 am

    @doubting skeptic

    You have some thorough misconceptions about us.

    We are not angry about other people’s beliefs. If we act against someone’s beliefs than that is because he is causing significant harm to others with them. Homeopathic practitioners create an Atmosphere, where extremists flourish who indoctrinate their peers to forgo treatment for cancer. When I get up at 9 in the morning on a Sunday to make it to a mass homeopathic “overdose” at 10:23, then I am driven by moral outrage.
    Thus there is no hatred for you to cure.

    Saying that there is nothing supernatural and saying that life is meaningless are two fundamentally different matters. Life has all the meaning you give it. I do that by making goals and living by them. You may think it silly, but I want, in my life, to build very large rockets. I currently study for a master in mechanical engineering, and I am confident that I’m one day employed by a EADS or even SpaceX and help them build the biggest, baddest rockets ever made, so my descendants may one day visit the Stars.

    Your see life not meaningless only because it has a definite end. It may at first be a burden to abandon the safe haven of an eternal afterlife, but once you think about it, the message of humanism is a positive one: We do what feels right to us, unbound by someone else’s special interpretation of some millennia old scripture. We may not believe in the power of confession, but we use reflection to determine when we have punished ourselves enough with our guilty conscience. We do not fear the devil’s whip because of that.

    I don’t know how old you are, but I going out on a limb here and presume you are a teenager, and possibly bullied by peers (I was). If that is the case, by reading about evolution you have taken a step that is very rare for someone in your surroundings. To me that alone shows a certain flexibility in thought. And whatever computers are able to do in 10 years, there will always be a demand for creative people. So please don’t jump in front of a truck, but live through those dog years, come out of them with a clear understanding of what motivates you in life, even if it isn’t the dangling carrot of an afterlife, that the others are chasing. And seize the day.

  93. BillyJoe7on 04 Jul 2011 at 7:53 am

    Love and Peace :)

    That was a dead giveaway.

    I don’t like censorship, and I’m not suggesting it in this case, but it really pisses me off when other posters take an idiot like this seriously (as I did until that giveaway quote) and post detailed and thoughful responses to someone who does not even care.

    Watch out for that truck DS/SA. Metphorically speaking, one day it’s going to run right over the top of you. Then the joke will be on you.

  94. Happy Camperon 04 Jul 2011 at 7:57 am

    I smell a sockpuppet for the banned Skeptical Atheist!

  95. doubting skepticon 04 Jul 2011 at 8:06 am

    Thank you Rikki-Tikki-Tavi for your kind response, thank you for taking the time to write to me, yes i am bullied and ostracised by my friends because of the way i speak and behave, all of them don’t like me and they make me do their assignments for them and sometimes i even have to buy lunch for them, my only friend is my computer. Thank you so much for believing in me, i really, really appreciate it.
    I will follow your advice dear friend.

  96. Happy Camperon 04 Jul 2011 at 8:14 am

    @D.S.

    “You are a fluke
    Of the universe.
    You have no right to be here.
    And whether you can hear it or not
    The universe is laughing behind your back.”

    You may find your answer with the “Black Capsule”

  97. titmouseon 04 Jul 2011 at 8:17 am

    As to a change of ‘standard of evidence’– what makes a surgery OK?
    Not double-blind placebo controlled trials- so what? I’m asking because I don’t know.

    Some surgical procedures have been studied with blinded controls using a sham procedure and an interviewer who doesn’t know which patient got the actual procedure verses the sham.

    If the prior plausibility for some intervention is high, that makes it “okay” even without controlled trials, although we might like them.

  98. Rikki-Tikki-Tavion 04 Jul 2011 at 8:31 am

    @Happy Camper
    That’s uncalled for.

  99. Steven Novellaon 04 Jul 2011 at 9:20 am

    Doubting Skeptic is Skeptical Atheist and is now banned.

  100. tmac57on 04 Jul 2011 at 9:44 am

    I think that NeuroLogica is being used as a stage for a marionette performance,whereby the great manipulator above seeks to not only make the puppets dance,but the audience as well.

  101. Rikki-Tikki-Tavion 04 Jul 2011 at 9:56 am

    Even though he lied about not being Skeptical Atheist, I think DS actually has severe problems in his personal life (even if not bullying). I agree with the ban, but I still wish him the best.

  102. sonicon 04 Jul 2011 at 2:41 pm

    robm-
    Yes, you are right. The article did not ask the doctors why they do what they do.
    You are suggesting they do what they do because they are unethical.
    I would think a more plausible explanation would be they do what they do because they find it helpful to their patients, but let’s assume you are correct and the doctors are engaged in unethical behaviors.
    At what point is that grounds for loss of license or perhaps criminal prosecution?

    titmouse-
    Thank-you. I know some surgeries have been tested in the manner you say- but in these cases the surgeries were being preformed for years before the tests.
    Who determines prior plausibility?

  103. robmon 04 Jul 2011 at 3:14 pm

    sonic

    I think physicians who prescribe or recommend unproven treatments or treatments with unhelpful effects are not being ethical to some degree. I don’t think their goal is to be unethical, their might believe the patient is looking for something to cure them of a benign or illusionary illness and wish to comfort the patient. Take a look at table 3. They may also wish to ‘do something’ rather than just ‘do nothing’, even if it has a slim chance of help.

    I still think they shouldn’t sugarcoat things even if their recommendation is cheap and has minimal side effects, it’s still deceptive or misleading, though it doesn’t warrant loss of licence or charges. It’s possible that patients who have over the counter drugs and vitamins recommended to them may wait longer to seek treatment if they are already taking something they believe is helping them, so even that might have a potential indirect harm. The 13% of physicians who prescribe antibiotics and sedatives as placebos are engaged in what I consider very unethical behavior since the drugs they prescribe are available by prescription only for a reason. Antibiotic resistance and impairment from sedatives can do real harm and if there is little to no benefit to be expected the harm far outweighs the slim potential for good.

  104. nybgruson 04 Jul 2011 at 4:25 pm

    @sonic:

    I pretty much agree entirely with robm’s answers to your questions (thanks robm, for saving me the time of chiming in myself!). I would nitpick one point though:

    I still think they shouldn’t sugarcoat things even if their recommendation is cheap and has minimal side effects, it’s still deceptive or misleading, though it doesn’t warrant loss of licence or charges.

    Loss of license no. Charges – yes. Professional review should happen. Nothing drastic, crazy, or punitive. But here in Australia they have a system for flagging physicians that may be engaged in all sorts of actions (such as inappropriate antibiotic scripts, overservicing, etc) and can pull the physician in for a professional review. If the item is minor, a little bit of education and a sanction to step up quality of practice is all (s)he will get. If it is more serious it can keep escalating. There is indeed something similar in the states, and I think it should be used more and include the active use and endorsement of placebos.

    know some surgeries have been tested in the manner you say- but in these cases the surgeries were being preformed for years before the tests.
    Who determines prior plausibility?

    The scientific community at large. Some things are pretty darned straight-forward. Have a cancer and cut it out to cure (or at least make it better) is pretty darned plausible. But essentially, we are trained to be knowledgable in the fields necessary to determine prior plausibility. When a surgeon suggests a new procedure other similar experts can weigh in. But surgery is a (relatively speaking, of course) straightforward field for prior plausibility. It is more safety and actual outcomes that are interesting and that is accomplished by following post-surgical patients.

  105. titmouseon 04 Jul 2011 at 4:28 pm

    Which is more likely: hypothesis H is true or hypothesis H is false?

    What would it take to overturn all the evidence we have today in support of hypothesis H?

    Those are the kinds of questions that help with estimating prior plausibility.

  106. robmon 04 Jul 2011 at 4:35 pm

    nybgrus

    just for clarification I was referring to vitamins and OTC medication for mild symptoms. prescriptions are another matter because of stronger effects, more possible side effects, allergies etc.

  107. sonicon 04 Jul 2011 at 11:29 pm

    robm, nybrus-

    Here is a more recent article regarding the findings of the German Medical Assoc.
    (I’m linking to a summary- can’t get the full article. If the summery is wildly different from the actual article I’d like to know—
    http://www.bmj.com/content/342/bmj.d1535.extract

    It seems that they have found that placebo can be effective- even more so than standard treatments.

    (Here’s a news article with more–
    http://www.cbc.ca/news/health/story/2011/03/31/placebo-effect-doctors-prescribe.html

    titmouse-

    This is the best article I can find about how surgical procedures are evaluated.
    http://www.ccjm.org/content/75/Suppl_6/S37.full

  108. ccbowerson 05 Jul 2011 at 10:41 am

    “It seems that they have found that placebo can be effective- even more so than standard treatments.”

    The effects we see with placebo are not unique to placeboes. This is why we attempt to control for them in clinical trials. I’m not sure how a placebo can outperform an active treatment if the active treatment itself contains placebo effect + intervention effect. Unless the “standard treatment” makes things worse, the above statement makes no sense at all. If this is the case, we better revisit what is being considered “standard treatment.”

  109. Rikki-Tikki-Tavion 05 Jul 2011 at 10:46 am

    I think what they probably tested was, is if people who had multiple alignments and weren’t told what an active drug was for got more of an effect than people who were given a placebo with an exact description what it was supposed to cure – just an assumption on my part.

  110. ccbowerson 05 Jul 2011 at 3:24 pm

    Rikki-

    What you describe is an experiment in which 2 variables are being manipulated at the same time (unnecessarily), which gives you little useful information.

  111. Mlemaon 05 Jul 2011 at 4:59 pm

    As of 2007, the US was ranked 37th in the world for quality accessible health care.
    http://www.nytimes.com/2007/08/12/opinion/12sun1.html
    It failed in one way or another in every category of evaluation. “The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens.”
    a discussion of the problems:
    http://healthpolicyandreform.nejm.org/?p=2610

    I personally think people in the US delay seeing a doctor, even in the face of serious illness, not because they’re wasting their time on some alternative treatment, but because they have no insurance or are afraid of what it’s gong to cost. I have seen this happen.
    Maybe the growth in the use of alternative therapies is what happens in a country that has money to waste on vitamins and herbs, but not enough to go to a doctor.

  112. robmon 06 Jul 2011 at 12:00 am

    “They say placebos work best for diseases where there is a subjective component like perceptions of pain — and that they wouldn’t work for other problems like broken bones or cancer.

    Scriba said placebos shouldn’t be used for conditions where an effective therapy exists and that doctors must tell patients they’re getting something unusual.”

    Placebo effect is subjective and doesn’t provide real help, the patient only perceives they are being helped and alters their subjective answers for poorly understood/treated conditions.

    That doesn’t change placebos being dishonest.

    It does underscore the need to develop better treatments.

  113. nybgruson 06 Jul 2011 at 3:02 am

    I agree with robm. Without becoming overly logorrheic, just because the Germans decide they can toss medical ethics out the window doesn’t mean I am OK with it. It is still deception, it is still only useful for subjective problems, it still doesn’t actually help people any more than a nice chat or a kiss from mommy would, and it would only serve to erode both science and patient-doctor relationships.

    Sorry, but the Germans are wrong on this one.

  114. robmon 06 Jul 2011 at 3:17 am

    The is/ought distinction is important here, I wouldn’t consider placebos to be in an ethical gray area without very strong evidence placebos produced strong specific effects that actually treated the patients conditions. i.e. the placebo effect would have to be a real medical treatment rather than a source of bias and error in clinical trials.

  115. nybgruson 06 Jul 2011 at 4:25 am

    well, beyond that you would have to be able to implement the placebo without lying to the patient. That is why pharmaceutical trials are double blinded and placebo controlled – each patient assumes they may actually have the real drug, and thus (in theory) should all have a “placebo effect” from it. The added effect on top is what would be there without that effect.

    In other words, I can cure a bacterial infection with antibiotics regardless of whether the patient knew he was getting any drugs at all.

    I can heighten the effect of narcotics by talking them up.

    I can give saline, call it a narcotic, and still achieve some effect.

    I cannot give saline to a patient and tell them it is an antibiotic and expect it to do diddly squat.

    So in the subjective arenas where placebo would work, you would still have to lie to the patient to achieve the effect (somehow, I don’t think saying “I am going to inject you with saline which has no pharmaceutical action, but if you believe it does, your pain will go away” would work) and that is unethical

    No matter how you slice it, use of placebos is simply an untenable option for the medical profession.

    Dr. Gorksi dissected a recent article (can’t find the link at the moment) where it was stated that you could induce the placebo effect without lying to the patients. Turns out it was a poorly designed study.

  116. elmer mccurdyon 06 Jul 2011 at 11:04 am

    Here’s another analysis of that study, suggesting that it might have some value despite its flaws.

    http://disgruntledphd.blogspot.com/2010/12/placebos-now-with-added-ethics.html

  117. robmon 06 Jul 2011 at 7:31 pm

    I think Disgruntled PhD mischaracterized a couple of Gorski’s points.

    http://scienceblogs.com/insolence/2010/12/more_dubious_statements_about_placebo_ef.php

    http://www.sciencebasedmedicine.org/index.php/placebo-effects-without-deception-well-not-exactly/

    Namely his objection to the way that placebos were discussed with patients. First the researchers put out an ad asking for participants in a mind-body connection study, then told them that placebos had demonstrated efficacy in the medical literature, including the pills they were taking.

    That might not be much of a problem except the idea was to test how patients would respond if placebos didn’t come with expectations. The researchers selecting patients more likely to believe in mind-body healing and telling them that the sugar pills they were taking promoted mind-body healing undermines the purposes of the experiment. These concerns were brushed aside.

    Disgruntled PhD also said Gorski treated the study as having guilt by association with NCCAM. Quite the opposite:

    NCCAM funded the study. Why am I not surprised? Actually, come to think of it, this is one of the better studies that NCCAM has funded. Even so, it’s only just an OK study. It has a somewhat intriguing finding that could well be due to differences between the experimental groups, reporting bias, and/or recruiting bias. But ground-breaking or somehow demonstrating that the placebo effect can be activated without deceiving patients.

    Not quite, but nice try.

  118. nybgruson 06 Jul 2011 at 7:47 pm

    Thanks robm! You deserve a high five for that. I finally sat down to read that blog and was just coming over to toss in my $0.02 (AUD, since that is worth $0.024USD so you get more for your buck over on the other side of the world).

    I would also add that the blogger didn’t really add much to the discussion. Ben Goldacre has already discussed the notions that there are some inherent and odd differences to placebos including the fact that a red placebo has more of an effect than a blue one.

    It still doesn’t really change the discussion – namely that active deception is unethical and that maximal placebo response can only at best ameliorate subjective complaints, but not effect objective change. The problem with opening up non-deceptive placebo use is that we still don’t know if it would work, and even if it did who would really use it? I mean seriously – would you go to a doctor and be happy to hear him/her say, “So I’m going to give you this sugar pill. It has worked as placebo in other people and helped them feel better, so maybe it will with you too. Thanks for coming in, don’t forget to pay your bill on the way out!” Man, I would feel downright gypped! My doctor just basically said that (s)he didn’t really have anything to help me, gave me a random sugar pill (which apparently was optimized to induce the placebo response by being big and red and requiring it be taken 3 times a day), and then CHARGED me for that??

    But we haven’t even gotten that far. It was a pilot study. Pandering to a specific population that is likely more credulous to such things. With myriad confounders that haven’t been adequately addressed.

    To put it very simply, people who are being conscientious to take a pill at specified times are also likely to be more conscientious about all their other health activities. Never mind the fact that just being in a trial would likely heighten that as well. And don’t forget it was a 21 day (very short!) trial with a subjective outcome reporting.

    What I am getting at is that yeah, maybe some more research could be handy, but really I see nothing there to suspect that such non-deceptive placebo use rolled out at large would be effective at anything. It would be nice if it did, but I see nothing convincing yet.

    And of course that distracts from the main topic here which is that CAM is entirely placebo AND deceptive.

  119. robmon 06 Jul 2011 at 8:43 pm

    The ‘effect’ of the placebo effect is central to freedman’s argument for CAM, he regularly defends his article by stating he admits cam doesn’t work without the placebo effect. Whether the placebo effect is medicine or ethical (regardless of effect) is at the heart of the debate.

    If anything sidetracked the conversation it was SA/DS storming in angrily, then changing tone to a poor me/concern troll to annoy people with his melodramatic crap. Sonic got the conversation back on track. Besides after 5 days and 119 comments a little deviation is allowed.

  120. nybgruson 06 Jul 2011 at 9:10 pm

    fair point robm. And I didn’t intend to mean that none of the non-deceptive placebo use conversation was wortwhile.

  121. robmon 06 Jul 2011 at 9:22 pm

    I can’t get over how the study supposed to show the placebo effect doesn’t need false expectations created false expectations in the participants. :)

  122. elmer mccurdyon 07 Jul 2011 at 9:07 am

    I don’t believe there’s any mention of Gorski in that post.

  123. nybgruson 07 Jul 2011 at 9:09 am

    @elmer:

    ahem…. haha… of course not… how silly of us

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