Feb 18 2010

Naturopaths Can Silence Critics Too

In a pattern that is becoming all too familiar – naturopath Christopher Maloney has allegedly forced the shutdown of a blog that was critical of his medical advice. Student Michael Hawkins wrote in the Kennebec Journal:

Naturopathic medicine is pure bull.

Let’s not beat around the bush on this one. Those who practice naturopathy are quacks. They may be sincere quacks, but sincerity does not translate to evidence — or your health.

He expressed similar views on his blog, which was hosted by WordPress. Maloney allegedly responded with the British Chiropractic Association (BCA) maneuver, not by defending his claims, but by complaining about the content of Hawkins’ blog to WordPress, who responded by demanding that Hawkins censor his criticism. Hawkins apparently made changes, but not sufficient to please the WordPress censors, and so they shut him down. (Note – Maloney claims he never complained to WordPress and had nothing to do with the shutdown.)

By now you should know what happens next – fellow science and reality-based bloggers (most notably PZ Myers) got wind of the story and decided to amplify Hawkins’ criticism by many orders of magnitude.

What sparked Hawkins’ criticism of Maloney was this article, also in the Kennebec Journal, that was nothing but a thinly-veiled advertisement for Maloney’s practice, in which Maloney wrote:

It will have no effect on deadly complications in any population group (Cochrane). No study of flu vaccinations has shown any benefit for children under 2, and every year half of those killed from vaccine side effects are under 2 years old. (Cochrane and CDC data for the last 10 years). Those promoting vaccination should provide published research to inform patients.

Parents waiting for vaccinations can provide their children with black elderberry, which blocks the H1N1 virus. A single garlic capsule daily cuts in half the incidence and the severity of a flu episode for children.

Maloney pulls the typical CAM fast one here. First he disparages the efficacy of the flu vaccine, then scaremongers about side effects, without providing any actual numbers. I prefer this summary of flu vaccine efficacy by Mark Crislip. Mark acknowledges that this is a complex question without a simple yes/no answer. The flu vaccine is not a great vaccine, as vaccines go, but it does have efficacy, and clear benefit in excess of risk. Serious vaccine reactions are “very rare”, according to the same CDC sources that Maloney is apparently referring to. Life threatening adverse events occur on the order of 1/100,000 to 1/1 million injections. Meanwhile, 30,000 or so people die each year from the flu.

After Maloney cherry picks information to scaremonger about the flu vaccine, he then recommends elderberry and garlic. Ironically, he exhorts mainstream practitioners offering the flu vaccine to provide published research – then he recommends two treatments without reference to published research. Let’s take a look at the published research, shall we.

First – elderberry contains chemicals (specifically flavonoids) that have pharmacological activity. So there is some plausibility for biological activity. And in fact there are in vitro studies showing that flavonoids from elderberry extract have anti-H1N1 flu virus activity. But, as I discussed just yesterday, it is not appropriate to extrapolate from such basic science data to net clinical effects. If these flavonoids turn out to be useful, it will be because they are isolated, purified, and then studied in specific doses – in other words, just like any other drug. Perhaps this will lead to the development of the next Tamiflu. Meanwhile, I would recommend using Tamiflu – which as already been purified and studied clinically.

There is also one clinical study showing some effect, but this is a small and preliminary study. Most such preliminary studies will turn out to be wrong, when larger better studies are done. We have been through this with just about every popular herbal remedy, from echinacea to gingko biloba – early studies showing promise followed by large definitive studies that are dead negative.

So, in essence, black elderberry shows promise as an eventual source for an anti-viral treatment, but it is still preliminary and therefore unreliable. So Maloney is recommending a treatment with unreliable evidence (one small study) in favor of one with far more evidence (literally hundreds of studies and thousands of published papers).

My PubMed search on “garlic” and “flu” or “influenza” gave 7 results total. There was only one paper that looked like a clinical study – a Japanese paper from 1973 (unfortunately no abstract is available online).

Maloney’s website has this to say:

Volunteers taking garlic capsules had half as many flus, and the flus were half as long. Adv Ther. 2001 Jul-Aug;18(4):189-93

But the reference cited was for the common cold – NOT the flu. Apparently, naturopathic training did not prepare Maloney to distinguish the cold from influenza.

Further, Maloney is massively cherry picking (even from evidence not relevant to the question). A Cochrane review of garlic for the common cold concluded:

There is insufficient clinical trial evidence regarding the effects of garlic in preventing or treating the common cold. A single trial suggested that garlic may prevent occurrences of the common cold, but more studies are needed to validate this finding. Claims of effectiveness appear to rely largely on poor quality evidence.

Once again we see the reliance on cherry picked weak evidence that may not even be relevant to the clinical question, while disparaging science-based treatments. This is the standard of science within naturopathy.

Conclusion

Hawkins was correct to criticize Maloney and his claims. Maloney, rather than defend his views, decided to silence criticism, and WordPress should be ashamed for caving to such obvious censorship of important public debate.

But in our brave new world at least there are science-based outlets that will not let criticism of pseudoscience be silenced.

Thanks to PZ for bringing this to wider attention.

Addendum:

This story developed rather quickly yesterday. We now know that it is Andreas Mortiz who is threatening lawsuits against Hawkins, and now PZ Myers as well, as an intimidation tactic.

PZ has the update here: http://scienceblogs.com/pharyngula/2010/02/andreas_moritz_is_a_cancer_qua.php

Share

140 responses so far

140 Responses to “Naturopaths Can Silence Critics Too”

  1. canadiaon 18 Feb 2010 at 10:15 am

    Disgusting. Amazing that such blatant censorship can happen in a democratic, first-world country.

    Is it just me or is the UK getting more and more like 1984 all the time?

  2. Michael Meadonon 18 Feb 2010 at 11:09 am

    Nice, thanks Steve. And Streisand effect FTW…

    What can we do to shame WordPress any more? I mean, seriously, this kind of censorship is just shocking. They should face a shitstorm of criticism. And reverse their decision. And apologize publicly.

  3. johncon 18 Feb 2010 at 11:37 am

    If you’re going to be a naturopath, do it properly.

    Garlic has myriad benefits, many of which are killed off with slightest processing.

    I remember all the evidence against vitamin C being good for warding off illness, then discovering that they were using pills, not fresh oranges.

    Actually most of the truth in naturopathic medicine is basic nutrition, something naturopaths and skeptics alike tend to disregard.

    Skeptics 0 Believers 0

    (again)

  4. inconsciouson 18 Feb 2010 at 11:44 am

    I think you’re leaving something out, Dr. Novella. Though I completely agree with your argument overall the original quotation in question from Maloney about the efficacy of flu vaccine for children under 2 years of age:

    “No study of flu vaccinations has shown any benefit for children under 2, and every year half of those killed from vaccine side effects are under 2 years old. (Cochrane and CDC data for the last 10 years). Those promoting vaccination should provide published research to inform patients.”

    For some vaccines this would definitely be true, as infants don’t have a fully developed immune system. This holds true, for example, for the new flumist (which also isn’t recommended for pregnant women).

    However, there is still evidence against Maloney’s claims for certain flu vaccines (for example Fluvax):

    http://www3.interscience.wiley.com/journal/122659236/abstract?CRETRY=1&SRETRY=0

  5. ChrisHon 18 Feb 2010 at 12:01 pm

    So, johnc and inconscious, are you now going to try to kick Dr. Novella off of the internets because he said something you don’t like about naturapaths? Or did you guys just not understand the point?

  6. Joeon 18 Feb 2010 at 12:09 pm

    Actually, the 2004 test of elderberry (which you cited) was the second pilot study by the same researcher. In 1995 a small study was published in a crappy journal http://www.ncbi.nlm.nih.gov/pubmed/9395631?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2 In both cases the results were quite striking in terms of apparent efficacy; which gives me pause to think (I even sent the info to D. Kroll).

    My problem is they got really good results in 1995, then they waited 9 years to do another pilot study that came out really well, and now we are waiting 6 more years for more definitive results. For crying out loud- this is a cheap remedy for a common problem, what are they waiting for? And what are we waiting for- this is even more obvious than the original trial of AZT for AIDS; which was aborted because the difference between verum and placebo was so bloody obvious.

  7. Steven Novellaon 18 Feb 2010 at 1:06 pm

    Joe – I bet that if regulations required evidence of efficacy prior to marketing we would be seeing quality follow up studies on elderberry. A trickle of pilot studies is not impressive, and not terribly predictive of efficacy.

    The evidence for flu efficacy is complex, which is why I linked to Mark’s rather extensive blog post on the topic. It is not amenable to a brief summary.

    johnc – your scoring is curious. How did your assertion even related to my article.

    But on that score, I agree that many naturopaths incorporate common sense or basic nutrition advice into their practice. But this advice, when it is accurate and useful, is based on scientific evidence and is certainly not unique to naturopathy. What naturopaths add to basic nutrition is a host of unscientific and dubious claims and practices. In short there is nothing that defines naturopathy as a profession that is not pure pseudoscience.

  8. Draalon 18 Feb 2010 at 1:12 pm

    Here’s my take on flavonoids (aka polyphenols). There are over 9,000 characterized flavonoids. They are good at doing a lot of things but very few do anything very well biologically relevant levels. Firstly, in vitro studies of flavonoids have an inconsistent record but for the most part, you can show a positive result if the assay is carefully chosen. Secondly, flavonoids have a very low bioavailability. Less than 2% of ingested flavonoids are ever detected in the plasma and urine. Upon ingestion, any food item must run the digestive tract gauntlet. First the low pH of the stomach, then the high pH of the bile. If a molecule makes it to the intestines, it is then subject to the gut microflora. The microflora do variety of reactions including oxidations, reductions, ring cleavage, deglycosylations, and conjugations. A flavnoid must also cross over the intestinal barrier to enter the blood. If they do, then the liver has a go at it and often flavonoids are metabolized by P450 enzymes to gluconates and sulphanates which usually removes any biological activity possessed by the parent molecule. To sum it up, the literature has very inconsistent reports of the benefits of flavonoids when taken orally. Most studies are extracts and god knows what is the actual active ingredient(s) is.
    The elderberry extract article states that subject drank 15mL of extract. At that ungodly amount, one’s poop will likely turn purple. Yesh. The colored compounds are anthocyanins, a subclass of flavonoids (commonly found in fruits and flowers). They are almost always glycosylated to enhance stability. At low pH (stomach acid), the sugar group is hydrolyzed to give the aglycone. The aglycones are extremely unstable at pH > 5 (bile) and will degrade rapidly. That’s one reason such high doses of berry extracts are used in studies, to ensure that some amount of the ingested anthocyanins reaches the intestines. I read on article where rats were fed 5g/day of anthocyanins and the rat’s feces was red!

  9. Quackaliciouson 18 Feb 2010 at 1:19 pm

    Hello, all, looks like a good discussion on elderberry. Try to keep in mind that we had no vaccine and children were dying. Science is great in the lab, but I work in the field. Elderberry is harmless and resolved many clinical cases of the swine flu this year.

    A great deal of what has been said about me is a lie. Please read below or check my website: http://www.maloneymedical.com for the truth.

    Dear “Reverend” PZ Meyers,
    How fitting that, three hundred years later, the witch trials continue. If you recall, it was the herbalists that were burned then as well. Your flock has spoken to me, Reverend Meyers, with the shrieking common to all fundamentalist cults. I believe if you check you will find that fundamentalism involves a closed mind while doing science requires an open mind. It also involves a thing they call research.
    Do you do basic research into a person’s claims before posting? Did you perhaps go to medline and type the words “elderberry” and “H1N1”? Did you even bother to read my original editorial that cites Cochrane database and CDC raw data? If you had done basic research or contacted me directly you would perhaps not have posted lies in your blog.
    You can call me an idiot and a quack, but when you repeat the “fact” that I am not a doctor and not qualified, that is a written lie or libel. I am a doctor under Maine state law and meet the qualifications of that title.
    In terms of poor maligned elderberry, the medline citation is “The H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu; 0.32 microM) and Amantadine (27 microM). (Phytochemistry. 2009 Jul;70(10):1255-61) While this is a test tube study only, please keep in mind that we had no vaccine and were at the peak of the pandemic here in Maine. I never suggested elderberry as a vaccination but as a possible home treatment for sick children.
    Michael Hawkins is an undergraduate at UMA who replied to my editorial. His rambling editorial was not based on science or research, but his need to publicize himself. After failing to get an editorial published against God he decided I was, flatteringly, next on the list. All of the research and medline citations for my editorial are available under swine flu on my website, and were there for Mr. Hawkins to simply see. But, despite the reality that I practice evidence-based medicine, neither you nor Mr. Hawkins have ever bothered to read my site.
    Mr. Hawkins managed to get his own website suspended by arguing with his server about what constitutes libel and blames me. I have never directly contacted WordPress about him and I have never replied to either his hate posts or his email attacks on me personally. In doing my own research, I found that another individual is in the process of filing a lawsuit against Mr. Hawkins and requested that the individual write to Mr. Hawkins directly. It was this other individual in South Carolina, and not me, that helped Mr. Hawkins get himself kicked off. Since Mr. Hawkins has received that email today, I believe that your case against me as an enemy of free speech should be re-examined.
    It terms of his accusations against me that you have posted on your blog, I have taken the time to answer them at length and with scientific citations on my website: http://www.maloneymedical.com. I am also in the process of creating a more tolerable Youtube video for your flock.
    Thank you, Reverend Myers, for burning me without trial. It’s nice to know some things never change.
    Christopher Maloney, N.D.

  10. Steven Novellaon 18 Feb 2010 at 2:14 pm

    Christopher,

    It seems you spammed my blog with your boilerplate response.

    It seems you did not bother to read my blog post prior to posting this comment.

    If you had, you would have seen that I did look at your website and read your references, and I addressed the weakness of your evidence in the substance of my post.

    Do you care to respond to my criticisms?

    I will edit my post and note your claim that you did not complain to WordPress.

  11. nwbackpackeron 18 Feb 2010 at 2:45 pm

    “Elderberry is harmless and resolved many clinical cases of the swine flu this year.”

    I had great results with a new compound I synthesized which I call “Ultraplacebaflu X4000″. I had the flu, took the pills, and seven days later I was cured. CURED!

    In my scientific study of one, 100% of flu sufferers were cured of flu by this new medicine within one week. No deaths occurred and the side effects were only some extra weight gained because I was taking 4,000 of the pills a day. The inactive ingredient sugarlosicain probably has some kind of effect of my metabolism which caused me to gain weight. I’m working to reduce that side effect.

    I am working on a massively diluted (stronger) version of this medication and will release to the world with great fanfare, if only they can stop the witch hunt and let some real science like mine get into the mainstream.

  12. Mkey1on 18 Feb 2010 at 3:21 pm

    “Elderberry is harmless and resolved many clinical cases of the swine flu this year.”

    Uh huh.

    Citation needed, especially in light of the fact that influenza is a self-limiting disease that “tincture of time” alone cures in most cases. So, please, sir, provide the substantiation that it was elderberry and not a few days of rest that did the trick. Thanks.

    It’s statements like this one above that show Mr. Maloney is indeed full of baloney.

    LOL, Nwbackpacker. Beat me to the take-down.

  13. modoc451on 18 Feb 2010 at 3:51 pm

    “Try to keep in mind that we had no vaccine and children were dying.”

    Damn medical doctors. They never think of the children.

    “Science is great in the lab”

    So, you’re not a total idiot.

    “but I work in the field.”

    Oh, right, because medical doctors don’t ever see patients. They just sit in labs all day, doing tests and wondering how to get rid of naturopaths.

    “Elderberry is harmless and resolved many clinical cases of the swine flu this year.”

    Isn’t anecdotal evidence just the best?

  14. Draalon 18 Feb 2010 at 4:10 pm

    “Did you perhaps go to medline and type the words “elderberry” and “H1N1”?”
    Challenge accepted. Search engine: PubMed (which includes Medline plus much more)
    Results: 3 in vitro studies.
    Study 1 is discussed above. Study 2 shown no affinity an elderberry compound for the flu virus. Study 3 (ignoring the ridiculousness of journal source) was performed on 27 patients (15 experimental, 12 control). Super duper high powered study, eh?

    Elderberry flavonoids bind to and prevent H1N1 infection in vitro.
    Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS.
    Phytochemistry. 2009 Jul;70(10):1255-61. Epub 2009 Aug 12.

    Monitoring of influenza virus hemagglutinin in process samples using weak affinity ligands and surface plasmon resonance.
    Mandenius CF, Wang R, Aldén A, Bergström G, Thébault S, Lutsch C, Ohlson S.
    Anal Chim Acta. 2008 Aug 8;623(1):66-75. Epub 2008 Jun 12.

    Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama.
    Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M.
    J Altern Complement Med. 1995 Winter;1(4):361-9.

    Soooo, what was that about doing your research?

  15. Skepon 18 Feb 2010 at 4:17 pm

    ” Science is great in the lab, but I work in the field. Elderberry is harmless and resolved many clinical cases of the swine flu this year.

    In the field? Can’t you afford an office? ;->

    Anyway, these two sentences sum up why you are a quack. You reject the use of science in your practice, claiming that it doesn’t apply to you “in the field”, where, presumably, you give your “clinical experience” the upper hand. The problem with that is that humans are prone to cognitive and perceptual biases, the kind of biases that led doctors in the 1700′s to think their brand of Humeric medicine was efficacious based on **their** clinical experience, and likewise, voodoo witch doctors, iridologists, urine therapy advocates, and every other kind of sincere quack and snake oil salesman . Science is how we separate what is true from what merely seems to be true. IMO, your blithe invocation of a fallacious post hoc ergo propter hoc claim clearly demonstrates that you don’t understand science or reason as it properly pertains to the scientific application of medicine.

  16. DrNoon 18 Feb 2010 at 4:20 pm

    Hey Steve
    Is there a logical fallacy relating to appeal to hysteria or alarm?
    Or is this just a straw man?

    “# Quackaliciouson 18 Feb 2010 at 1:19 pm “ said …
    “Hello, all, looks like a good discussion on elderberry. Try to keep in mind that we had no vaccine and children were dying”

    I assume in Maine is where the “children were dying”.

    I looked at the Maine Department of HHS and this is what I found:
    Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
    December 30, 2009
    “No new deaths due to H1N1 have been reported this week. The 17 H1N1-related deaths since August have occurred in people with underlying health conditions, the vast majority with multiple serious underlying conditions.”

    Which if you know the biology of influenza virus is not surprising that this group would have problems, although I don’t have the breakdown of the individual deaths… I am working on it, I doubt they were all children. Dosen’t sound to me like there was significant pediatric H1N1 deaths there to resort to the “lets try anything” mentality.

    IF children were dying isn’t that the time we should resort to the best science and evidenced based treatments and not experiment with unproven treatments on patients or would this be an example of “off label” usage?

  17. Quackaliciouson 18 Feb 2010 at 4:30 pm

    Dear Steve Novella,

    My apologies for not responding directly to your post. At the same time, your post was simply taking PZ’s information and passing it on as the truth. Even now, you are assuming Mr. Hawkin’s version is true while assuming my response is false. Here is an excerpt from a letter I received today:

    “This is what I wrote to him.
    Michael Hawkins,
    You may blame me for having your blog pulled. WorldPress had to remove your blog because otherwise it would have faced a hefty lawsuit, given the nature of the defamation campaign you had launched against me, and having positioned your blog link second place on Google search. …”

    In other words, the individual that you are continuing to defame is not me.

    As to the effect of garlic and black elderberry, I have provided the information on my website: http://www.maloneymedical.com As you have noted, I didn’t make it up, and the data is preliminary.

    Let’s put things into context: It was the middle of a pandemic, there was no vaccine available, and the news was full of children dying. For your wise reader, yes, they weren’t dying in Maine, but the effect was that they were.

    Now, a scientist wants get conclusive answers. But patients want answers now. Tamiflu was not available, and it isn’t being given out even now. The CDC wants to keep it in reserve. Elderberry and garlic might make someone smell bad, but they have preliminary data and are food substances. In other words, they have a long history of patient use, a non-toxic side effect picture, and are readily available. Find me a drug besides aspirin that matches that clinical picture.

    I don’t claim to be an M.D. I’m an N.D., and what differentiates us from M.D.s is that we don’t believe in lifelong drug prescriptions as a treatment for illness. We also don’t believe that the body is the enemy, and we find ways of working with the body’s systems rather than relying long term on suppressants like corticosteroids.

    We will never see large scale studies on things like elderberry unless the government runs them because they cannot be patented. No drug company in their right mind will pay for a large study when their competitors can come out immediately with a cheaper option. When a drug company gets a chance, they purify the substance then use the FDA to get rid of the natural alternatives. Have a look at Lipitor and Red Yeast Rice Extract or the appearance of Prozac and the banning of tryptophan. It is far better for a drug company to create a monopoly that to help people.

    In other words, as a scientist, I agree that my data is weak. I would also reply strongly that all medical data is weak, and have updated my website to reflect that (check under Quackery and Modern Medicine).

    As a clinician, I would reply that garlic works fine (24-48 hours for resolution). The vast majority of my patients do simple things like completely change their diet and lifestyle. Miraculously, they feel better.

    But what is unique about me is that I spend the time with each patient to encourage them. Any good doctor does this, but it is becoming rarer. I am the best doctor I know because I listen and work with patients to help them feel better without limiting myself to drugs or alternatives. I try to find what will work for someone, and base my practice on not harming anyone.

    If you look, I provide a money back guarantee if a patient does not feel I have provided useful service. And yes, I have refunded money. Twice in seven years. Other times I have offered, but the patients reply that they did find my instruction about the nature of their illness helpful even when I wasn’t able to find resolution.

    Medicine is a practice, not a scientific study. Even the best drugs do not work consistently with patients, and side effects make the drugs unusable. By focusing my research on non-toxic substances that may be helpful I have helped improve the lives of many people. And no, I am not a quack, I am a man of science. The science in my area isn’t very strong, but we can’t wait for definitive studies (done by whom?) to help people who are chronically ill. I have created my own laboratory and I face the highest level of accountability. If I don’t help, I don’t get paid. How many of you have made yourselves as accountable to those around you?

    Christopher Maloney, N.D.

  18. Adam_Yon 18 Feb 2010 at 4:32 pm

    And the weirdness continues. Supposedly, someone from another state used Maloney’s name to get the blog shut down.

  19. Joeon 18 Feb 2010 at 4:39 pm

    Steven Novella on 18 Feb 2010 at 1:06 pm “Joe – I bet that if regulations required evidence of efficacy prior to marketing we would be seeing quality follow up studies on elderberry. A trickle of pilot studies is not impressive, and not terribly predictive of efficacy.”

    Of course, you are right. My post was incomplete because I was (and still am) loathe to suggest that the reason the publication is wrong is fraud, and the reason eldeberry did not catch-on is that it does not work.

    My comparison to the AZT/HIV trial was meant to suggest that (in my limited experience) if real, the elderberry result was too big to disappear in a larger trial.

  20. Steven Novellaon 18 Feb 2010 at 4:42 pm

    Christopher,

    You are making excuses. There is not a difference between practice and science – practice should be based upon science. You simply cannot really know what works without scientific evidence. It is naive hubris to think otherwise.

    Also – your original article did not advocate garlic and elderberry as a last ditch treatment when nothing else is available. It scared people off the vaccine, and then recommended garlic and elderberry.

    Further – as I pointed out above – you abuse the evidence. It is not just weak – it’s the wrong evidence, and you misrepresent it. That goes against the ethic of informed consent.

    You then perpetuate misconceptions about science-based medicine, creating a false dichotomy. I listen to my patients too. And good science-based medicine uses drugs rationally – when the evidence supports benefit in excess of risk. Patient feedback is good for individualizing treatment, but not for deciding what works.

    There are plenty of way of fund research into treatments that cannot be patented -ever hear of the NIH?

    And the FDA cannot shut down supplements – ever hear of DSHEA?

    I don’t mind informing patients with no other options about preliminary evidence for available treatments – but that is not what you did.

  21. Steven Novellaon 18 Feb 2010 at 4:43 pm

    Regarding who shut down the blog – I added the proper qualifications, and will simply see how the story plays out and report accordingly.

  22. Draalon 18 Feb 2010 at 4:45 pm

    wait, wait! I had to laugh at this:
    From http://www.maloneymedical.com

    “In children under two, the efficacy of inactivated vaccine was similar to placebo” Again, the CDC recommends the vaccination of children over six months but the scientific data available does not support this recommendation. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004879
    The information I provided above is not “cherry picking.” It is the most recent, definitive scientific medical information available.

    Oh you don’t cherry pick??! The inactivated vaccine was a control, you dummy! Of course it didn’t work, it was inactivated! But if Chris bothered post the entire paragraph from the abstract it was taken from:

    The review authors found that in children aged from two years, nasal spray vaccines made from weakened influenza viruses were better at preventing illness caused by the influenza virus (82% of illnesses were prevented) than injected vaccines made from the killed virus (59%). Neither type was particularly good at preventing ‘flu-like illness’ caused by other types of viruses (33% and 36% respectively). In children under the age of two, the efficacy of inactivated vaccine was similar to placebo. It was not possible to analyse the safety of vaccines from the studies due to the lack of standardisation in the information given but very little information was found on the safety of inactivated vaccines, the most commonly used vaccine, in young children.

    Waahhh??? The nasal spray and vaccine shot prevent 82% of illnesses?

  23. Mkey1on 18 Feb 2010 at 5:27 pm

    PZ just posted over at Pharyngula that it was Andreas Moritz, the cancer woo woo artist, who was responsible for getting Mr. Hawkins’ blog pulled. Apparently, he and “Dr.” Maloney are buds.

  24. CivilUnreston 18 Feb 2010 at 5:47 pm

    Draal, you may have proved to us that vaccines work, but what about Christopher (or god)? Have you proved it to them!?

    The children who didn’t get sick were probably taking elderberry anyway.

    (Sorry about my lame attempt at satire — it’s actually a lot harder to advocate for the naturopath position than I initially thought. We ought to give them more credit for managing to string together so much BS and still make complete sentences that aren’t run-ons…like this one)

  25. Donahueon 18 Feb 2010 at 5:50 pm

    @Mkey1 – don’t you mean Moritz and “Dr.” Makoney are buds? Very close, apparently…

  26. grendelon 18 Feb 2010 at 5:54 pm

    Christopher – do I get this right, you sent this to the blogger:

    “You may blame me for having your blog pulled. WorldPress had to remove your blog because otherwise it would have faced a hefty lawsuit, given the nature of the defamation campaign you had launched against me, and having positioned your blog link second place on Google search”

    Why would WordPress pull the blog unless they had been told that you were considering legal action – In your state is a third party (ie not the ‘defamed’ person) permitted to bring a defamation action on behalf of the ‘defamed’ person?

  27. Mkey1on 18 Feb 2010 at 6:01 pm

    @Donahue — Yup. I certainly didn’t mean to imply that PZ and “Dr.” Maloney are or that Mr. Hawkins and Maloney are! Sorry.

  28. Skepon 18 Feb 2010 at 6:02 pm

    “Now, a scientist wants get conclusive answers. But patients want answers now.

    So, rather than give your patients scientifically supportable answers you’ll just give them (“make up,” I’d say) answers because your patients want them? And you think that is ethical?

  29. Michael Hawkinson 18 Feb 2010 at 6:30 pm

    I appreciate the effort, everyone. Aside from protesting WordPress in the various methods available (blogging, moving to other sites, email – use 495@forthesakeofscience.wordpress.com somewhere in the post), more important work is out there. I have emailed state senator Libby Mitchell asking her to reconsider the status of naturopaths in Maine. I urge everyone to do the same.

  30. Michael Hawkinson 18 Feb 2010 at 7:04 pm

    As it turns out, naturopaths are not doctors in Maine. They may not call themselves “doctors” without certain qualifiers.

  31. Quackaliciouson 18 Feb 2010 at 7:18 pm

    Dear Steve Novella,

    Ok, Dr. Novella, why don’t we play a game of “prove it.” Could you tell me the last time you saw a patient with an ear infection and prescribed antibiotics without a culture? We both know this is an extremely common M.D. practice without any scientific merit. At least I’ve got preliminary studies that might show some antiviral effect for my herbs.

    In fact, let’s go a bit broader. How about showing me conclusive proof of long term effect for antidepressants (after one year) or any significant effect of hypertension medications. As we both know, because we’ve both read the the Cochrane database reports, neither is effective. So when was was the last time you kept prescribing antidepressants and how many of your patients are on multiple hypertension medications. Again, I have preliminary studies that show my supplements may have benefit.

    Let’s take it all the way. How would you explain the Dartmouth Atlas data that shows modern medicine is a crapshoot? I would be thirty times more likely to get a stent in some parts of the country than in other parts. The emperor has no clothes, Dr. Novella. I’m betting you can’t give me gold standard (Cochrane, if you please) data for most of what you do. And much of what you do clearly kills patients, while our track record is a bit better.

    The Noisy Duck

  32. Adam_Yon 18 Feb 2010 at 7:30 pm

    Ok, Dr. Novella, why don’t we play a game of “prove it.” Could you tell me the last time you saw a patient with an ear infection and prescribed antibiotics without a culture? We both know this is an extremely common M.D. practice without any scientific merit. At least I’ve got preliminary studies that might show some antiviral effect for my herbs.
    Neurologists deal with ear infections?

    I’m betting you can’t give me gold standard (Cochrane, if you please) data for most of what you do. And much of what you do clearly kills patients, while our track record is a bit better.

    I’m betting you have no clue what Steve does.

  33. Adam_Yon 18 Feb 2010 at 7:37 pm

    Grrrr…. I screwed up my post.

  34. Draalon 18 Feb 2010 at 7:39 pm

    Ok, not the best photoshopping but…
    http://img203.imageshack.us/img203/5318/duckp.jpg

    Hey Dr. N, how’s that baby diet? Losing weight yet?

  35. daijiyobuon 18 Feb 2010 at 8:18 pm

    Great post.

    -r.c.

  36. Steven Novellaon 18 Feb 2010 at 8:33 pm

    Christopher – you are just going through all the CAM logical fallacies, aren’t you.

    Now you are playing – I have bad evidence, but so does regular medicine.

    There is simply no comparison. We have already demonstrated that your ability to asses the evidence is incompetent, and you have not answered any of the direct questions. You cited irrelevant research, and you partially quoted an abstract drawing the wrong conclusion. You might as well just make it up.

    The level of evidence for elderberry and garlic is so slight that the reliability is close to zero – this is almost as good as no evidence at all.

    You cannot defend your position, so you trot out all the canards against mainstream medicine.

    Ear infections – the standard of care has been established by evidence. Of course, I advocate the standard of care, as do most physicians. That some may fall short is a problem to be fixed, but not an excuse to abandon the standard of care

    Hypertension – really? Have you actually looked at Cochrane reviews of anti-hypertension treatment. Diuretics work, beta-blockers work, ACE inhibitors work. What is your point? There is evidence looking at antihypertensive in specific medical conditions, during pregnancy, with renal hypertension – loads of high quality evidence.

    Anti-depressants? This is a more complex issue. The data shows that they work for severe depression. The controversy is over whether or not they work for mild to moderate depression. That is a legit controversy being resolved with evidence.

    And your straw man is just silly – it’s a false dichotomy. You are pretending there is either gold-standard evidence or nothing. But there are hierarchies of evidence. There is, in fact, good to excellent evidence to support everything that I do. At the very least I will use highly plausible treatments with some evidence. Or, I will get patients into experimental trials.

    Of course modern medicine has imperfect evidence and quality control. But there is no comparison between the level of plausibility and evidence for a science-based practitioner, and the kind of stuff that naturopaths do. And you have provided more evidence of that.

  37. RickKon 18 Feb 2010 at 8:48 pm

    Christopher is right about one thing. The placebos he markets rarely directly kill people. Sugar pills, water, and inactive herbs are usually pretty safe.

    And, fortunately for Christopher, when marketed by a good salesman to people who don’t know any better, they can be quite profitable.

    What is amusing and ironic, however, is the smug arrogance of Christopher – a man whose livelihood only lasts as long as he can maintain his deception.

  38. Quackaliciouson 18 Feb 2010 at 8:56 pm

    Dear Dr. Novella,
    I am sorry to continue to question you, but every other website including PZ’s cites you as the authority on alternative medicine. I’m fascinated. Have you ever taken a course on alternative medicine? How is it you know so much about what I do? As your readers have noted, I don’t even know your field. I had wrongly assumed you were a researcher, someone who has a degree in statistics and is qualified to really give authoritative answers on the necessary statistics. Are you a neurologist? When did you have time to study what I do? Or are you simply another specialist expanding his expertise to all medicine without having taken a single course in alternative medicine?
    Please don’t make this too easy. I don’t cite canards, doctor. I cite data. And, unlike you, I have been shut down by the minions that you control as high priest. So I have nothing to lose by confronting you with the awful truth that we don’t practice science, we practice as best we can with the information we have.
    Let’s start with the easiest one. First, you claim to follow the evidence based guidelines in regards to ear infections as do most of your colleagues. Do you actually prescribe for ear infections? Have you actually looked at the data? Here it is, below us. It looks to me like you and your colleagues are prescribing more antibiotics, not less. Very scientific, I suppose. Especially when it doesn’t work.
    For comparison, I have included a small study on herbal drops for the ear. Yes, it’s a small study, but my stuff actually works, while yours doesn’t.
    What do you do when you aren’t high Poobah denouncing alternative medicine?
    BMC Pediatr. 2009 Jun 24;9:41.
    Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998-2004.
    Coco AS, Horst MA, Gambler AS.
    Department of Family Medicine, Lancaster General Hospital, Research Institute, Lancaster, PA 17604-3555, USA. ascoco@lancastergeneral.org
    BACKGROUND: Overuse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown. METHODS: Analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1998 to 2004 (N = 6,878). Setting is office-based physicians, hospital outpatient departments, and emergency departments. Patients are children aged 12 years and younger prescribed antibiotics for acute otitis media. Main outcome measure is percentage of broad-spectrum antibiotics, defined as amoxicillin/clavulanate, macrolides, cephalosporins and quinolones. RESULTS: Broad-spectrum prescribing for acute otitis media increased from 34% of visits in 1998 to 45% of visits in 2004 (P < .001 for trend). The trend was primarily attributable to an increase in prescribing of amoxicillin/clavulanate (8% to 15%; P < .001 for trend) and macrolides (9% to 15%; P < .001 for trend). Prescribing remained stable for amoxicillin and cephalosporins while decreasing for narrow-spectrum agents (12% to 3%; P < .001 for trend) over the study period. Independent predictors of broad-spectrum antibiotic prescribing were ear pain, non-white race, public and other insurance (compared to private), hospital outpatient department setting, emergency department setting, and West region (compared to South and Midwest regions), each of which was associated with lower rates of broad-spectrum prescribing. Age and fever were not associated with prescribing choice. CONCLUSION: Prescribing of broad-spectrum antibiotics for acute otitis media has steadily increased from 1998 to 2004. Associations with non-clinical factors suggest potential for improvement in prescribing practice.
    PMID: 19552819
    Arch Pediatr Adolesc Med. 2001 Jul;155(7):796-9.
    Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media.
    Sarrell EM, Mandelberg A, Cohen HA.
    Pediatric and Adolescent Ambulatory Community Clinic of General Health Services, Hairis 7 Moshav Gan-Haim, 44910 Israel. sarrell@netvision.net.il
    OBJECTIVE: To determine the efficacy and tolerance of Otikon Otic Solution (Healthy-On Ltd, Petach-Tikva, Israel), a naturopathic herbal extract (containing Allium sativum, Verbascum thapsus, Calendula flores, and Hypericum perforatum in olive oil), compared with Anaesthetic (Vitamed Pharmaceutical Ltd, Benyamina, Israel) ear drops (containing ametocaine and phenazone in glycerin) in the management of ear pain associated with acute otitis media (AOM). DESIGN: Children between the ages of 6 and 18 years who experienced ear pain (otalgia) and who were diagnosed with eardrum problems associated with AOM were randomly assigned to be treated with Otikon or Anaesthetic ear drops, which were instilled into the external canal(s) of the affected ear(s). Ear pain was assessed using 2 visual analog scales: a linear scale and a color scale. Pain assessment took place throughout the course of 3 days. The mean score of pain reduction was used to measure outcome. SETTING: Primary pediatric community ambulatory centers. PARTICIPANTS: One hundred three children aged 6 to 18 years who were diagnosed with otalgia associated with AOM. RESULTS: Each of the 2 treatment groups were comparable on the basis of age, sex, laterality of AOM, and the effectiveness of ameliorating symptoms of otalgia. The 2 groups were also comparable to each other in the initial ear pain score and in the scores at each application of Otikon or Anaesthetic drops. There was a statistically significant improvement in ear pain score throughout the course of the study period (P =.007). CONCLUSIONS: Otikon, an ear drop formulation of naturopathic origin, is as effective as Anaesthetic ear drops and was proven appropriate for the management of AOM-associated ear pain.
    PMID: 11434846

  39. Enzoon 18 Feb 2010 at 9:33 pm

    “And much of what you do clearly kills patients, while our track record is a bit better.”

    I take great offense to this Mr. -licious. It’s the kind of scare tactic Dr. Novella is calling out.

    First off, actual physicians see actual patients with actual illnesses. I am going to say that the majority of your clients are little more than curious, health-conscious people that tend to mistrust medical treatment (but still visit a physician). Correct me if I’m wrong, but I sure hope people don’t come to you with serious illness….Which will go undiagnosed.

    Now let’s get into it…”Clearly kills patients” ? Any hope of your argument being taken seriously crumbles when you drop something like this. I have spent quite a large portion of my life learning how to do just the opposite. It’s hugely offensive to anyone that practices medicine or biological science to hear something like that being said.

    Dr. Novella covered some of your requests…But what would you have to say about drugs that treat very well understood illness? Myriad cancer drugs that have achieved huge extensions of survival and quality of life (and even cures in some cases), blockbuster AIDS cocktails, flu vaccine, pain meds, etc. Every doctor acknowledges that drugs have risks and in very rare circumstances have resulted in death or severe morbidity..But surely you are not trying to argue that they are unnecessarily dangerous. Especially considering the illness, if left untreated, can be fatal themselves.

    “our track record is a bit better”

    For what? You say your treatments are non-toxic and harmless. Okay. But have you considered the harm of promoting unproven or narrowly supported treatment over a clinical standard of care? People have died using treatments on the advice of naturopaths because they neglected proven treatments. Even if we ignore the big guns like cancer and AIDS that have very apparent symptoms and manifest in the short term (do you treat these illnesses?) this is still an issue. You mention flu and things like hypertension or cholesterol problems. It is simply not responsible to tell people that you can keep these problems (probably diagnosed by a physician) under control with naturopathic regimes. Yes, healthy diet and lifestyle can be a big part of it but some people should be on long term medication to prevent late-onset morbidity by these conditions.

    I’m sorry, but some minor studies about Red Yeast Rice containing active ingredients that might maybe sorta suggest they are of benefit just doesn’t hold the same weight as an FDA approved study that cost upwards of a billion dollars and was professionally evaluated by a huge number of people for safety and efficacy. It’s like saying just because you can make a firecracker that shoots 600 feet into the sky you can use the same technology to make it to the moon.

    By the way…This is especially true for things like flavonoids which an earlier comment addressed nicely. Molecules like EGCG have always shown moderate efficacy in a HUGE number of disease models but never pan out because of very important issues like bioavailability and potency. Dr. Novella is right in pointing out that weak evidence cannot be extended all the way to making an actual recommendation to a patient — but as always, it may prove to be a scaffold for future research.

    …Okay, rant over. Mwah.

  40. Draalon 18 Feb 2010 at 9:34 pm

    Isn’t this the part of the show were Steven asks the panel to “Name that logical fallacy?”

    Joke of the day:
    “I take Ginkgo biloba but I can’t remember why.”

  41. Enzoon 18 Feb 2010 at 9:55 pm

    Apparently I’m NOT done.

    There are published guidelines by (in the US) the American Pediatrics academy that recommend approaches to treating AOM. One of the options is to not treat with antibiotics. That does not mean that the use of antibiotics is ineffective to resolving infections…Which DO happen and can cause pain.

    This is what everyone is on your case for. You cited an article that looks at trends and finally suggests that prescription of antibiotics went up over time. And you compare that to an herbal study for treatment of pain (not resolution of infection)….And you say

    “Yes, it’s a small study, but my stuff actually works, while yours doesn’t.”

    Are you suggesting we have no way of treating infection or pain resulting from it? ………Because…………………That’s wrong.

    Unlike the crowd you might be used to dealing with, we are not intimidated by citations and actually read the stuff shown to us. At least cite what you say you are.

  42. Quackaliciouson 18 Feb 2010 at 9:59 pm

    Dear Dr. Novella,

    Let’s move on to the second point. Hypertension. I’m curious, are you also a cardiologist? If so, I’m sure you are aware that at this point we shouldn’t be using beta blockers anymore. The data is in, doctor, and they kill more people than they help. I have supplied the necessary Cochrane database data below. The state of the art now is that old standby, the mild diuretic.

    For my alternative medicine comparison I am going to begin with a straw man conventional doctors use. The placebo effect. As soon as we get a good study, you all cry placebo. Turns out, it’s a myth. Back in the 50′s people believed doctors in white coats, but today a sugar pill is just a sugar pill. I am including the Cochrane analysis of sugar pills. So any “placebo effect” left is actual good doctor/patient relations.

    If we get rid of the placebo effect myth, I give you my comparison study. Look, alternative medicine works as well for hypertension as the mild diuretics without the possibility of killing people!

    JAMA. 2003 May 21;289(19):2534-44.
    Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis.
    Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, Weiss NS.
    Department of Medicine, University of Washington, Seattle, USA. psaty@u.washington.edu
    Comment in:
    ACP J Club. 2004 Jan-Feb;140(1):3.
    J Fam Pract. 2003 Sep;52(9):664, 667.
    CONTEXT: Establishing relative benefit or harm from specific antihypertensive agents is limited by the complex array of studies that compare treatments. Network meta-analysis combines direct and indirect evidence to better define risk or benefit. OBJECTIVE: To summarize the available clinical trial evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major cardiovascular disease end points and all-cause mortality. DATA SOURCES AND STUDY SELECTION: We used previous meta-analyses, MEDLINE searches, and journal reviews from January 1995 through December 2002. We identified long-term randomized controlled trials that assessed major cardiovascular disease end points as an outcome. Eligible studies included both those with placebo-treated or untreated controls and those with actively treated controls. DATA EXTRACTION: Network meta-analysis was used to combine direct within-trial between-drug comparisons with indirect evidence from the other trials. The indirect comparisons, which preserve the within-trial randomized findings, were constructed from trials that had one treatment in common. DATA SYNTHESIS: Data were combined from 42 clinical trials that included 192 478 patients randomized to 7 major treatment strategies, including placebo. For all outcomes, low-dose diuretics were superior to placebo: coronary heart disease (CHD; RR, 0.79; 95% confidence interval [CI], 0.69-0.92); congestive heart failure (CHF; RR, 0.51; 95% CI, 0.42-0.62); stroke (RR, 0.71; 0.63-0.81); cardiovascular disease events (RR, 0.76; 95% CI, 0.69-0.83); cardiovascular disease mortality (RR, 0.81; 95% CI, 0.73-0.92); and total mortality (RR, 0.90; 95% CI, 0.84-0.96). None of the first-line treatment strategies-beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), alpha-blockers, and angiotensin receptor blockers-was significantly better than low-dose diuretics for any outcome. Compared with CCBs, low-dose diuretics were associated with reduced risks of cardiovascular disease events (RR, 0.94; 95% CI, 0.89-1.00) and CHF (RR, 0.74; 95% CI, 0.67-0.81). Compared with ACE inhibitors, low-dose diuretics were associated with reduced risks of CHF (RR, 0.88; 95% CI, 0.80-0.96), cardiovascular disease events (RR, 0.94; 95% CI, 0.89-1.00), and stroke (RR, 0.86; 0.77-0.97). Compared with beta-blockers, low-dose diuretics were associated with a reduced risk of cardiovascular disease events (RR, 0.89; 95% CI, 0.80-0.98). Compared with alpha-blockers, low-dose diuretics were associated with reduced risks of CHF (RR, 0.51; 95% CI, 0.43-0.60) and cardiovascular disease events (RR, 0.84; 95% CI, 0.75-0.93). Blood pressure changes were similar between comparison treatments. CONCLUSIONS: Low-dose diuretics are the most effective first-line treatment for preventing the occurrence of cardiovascular disease morbidity and mortality. Clinical practice and treatment guidelines should reflect this evidence, and future trials should use low-dose diuretics as the standard for clinically useful comparisons.
    PMID: 12759325
    Ann Pharmacother. 2009 Dec;43(12):2031-43.
    Beta-adrenergic antagonists in hypertension: a review of the evidence.
    Warmack TS, Estes MA, Heldenbrand S, Franks AM.
    Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
    OBJECTIVE: To evaluate the effects of beta-adrenergic antagonist therapy on cardiovascular and cerebrovascular outcomes in the treatment of hypertension. DATA SOURCES: Literature searches were conducted using MEDLINE (1966-August 2009), International Pharmaceutical Abstracts (1970-August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing beta-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of beta-blocker therapy for conditions other than hypertension were not included. DATA SYNTHESIS: Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of beta-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing beta-blockers with other antihypertensives found significant benefit with beta-blockers. However, the majority of meta-analyses comparing beta-blockers with other antihypertensive agents show increased risk for stroke with beta-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics. CONCLUSIONS: Overall, data supporting beta-blockers as preferred therapy in hypertension are inadequate. Although most negative cardiovascular and cerebrovascular outcomes of beta-blockers were associated with atenolol therapy, data supporting other beta-blockers in hypertension are lacking.
    PMID: 19934392
    Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003974.

    Placebo interventions for all clinical conditions.
    Hróbjartsson A, Gøtzsche PC.
    The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 3343, Copenhagen, Denmark, 2100.
    Update of:
    Cochrane Database Syst Rev. 2004;(3):CD003974.
    BACKGROUND: Placebo interventions are often claimed to substantially improve patient-reported and observer-reported outcomes in many clinical conditions, but most reports on effects of placebos are based on studies that have not randomised patients to placebo or no treatment. Two previous versions of this review from 2001 and 2004 found that placebo interventions in general did not have clinically important effects, but that there were possible beneficial effects on patient-reported outcomes, especially pain. Since then several relevant trials have been published. OBJECTIVES: Our primary aims were to assess the effect of placebo interventions in general across all clinical conditions, and to investigate the effects of placebo interventions on specific clinical conditions. Our secondary aims were to assess whether the effect of placebo treatments differed for patient-reported and observer-reported outcomes, and to explore other reasons for variations in effect. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4, 2007), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), PsycINFO (1887 to March 2008) and Biological Abstracts (1986 to March 2008). We contacted experts on placebo research, and read references in the included trials. SELECTION CRITERIA: We included randomised placebo trials with a no-treatment control group investigating any health problem. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Trials with binary data were summarised using relative risk (a value of less than 1 indicates a beneficial effect of placebo), and trials with continuous outcomes were summarised using standardised mean difference (a negative value indicates a beneficial effect of placebo). MAIN RESULTS: Outcome data were available in 202 out of 234 included trials, investigating 60 clinical conditions. We regarded the risk of bias as low in only 16 trials (8%), five of which had binary outcomes.In 44 studies with binary outcomes (6041 patients), there was moderate heterogeneity (P < 0.001; I(2) 45%) but no clear difference in effects between small and large trials (symmetrical funnel plot). The overall pooled effect of placebo was a relative risk of 0.93 (95% confidence interval (CI) 0.88 to 0.99). The pooled relative risk for patient-reported outcomes was 0.93 (95% CI 0.86 to 1.00) and for observer-reported outcomes 0.93 (95% CI 0.85 to 1.02). We found no statistically significant effect of placebo interventions in four clinical conditions that had been investigated in three trials or more: pain, nausea, smoking, and depression, but confidence intervals were wide. The effect on pain varied considerably, even among trials with low risk of bias.In 158 trials with continuous outcomes (10,525 patients), there was moderate heterogeneity (P < 0.001; I(2) 42%), and considerable variation in effects between small and large trials (asymmetrical funnel plot). It is therefore a questionable procedure to pool all the trials, and we did so mainly as a basis for exploring causes for heterogeneity. We found an overall effect of placebo treatments, standardised mean difference (SMD) -0.23 (95% CI -0.28 to -0.17). The SMD for patient-reported outcomes was -0.26 (95% CI -0.32 to -0.19), and for observer-reported outcomes, SMD -0.13 (95% CI -0.24 to -0.02). We found an effect on pain, SMD -0.28 (95% CI -0.36 to -0.19)); nausea, SMD -0.25 (-0.46 to -0.04)), asthma (-0.35 (-0.70 to -0.01)), and phobia (SMD -0.63 (95% CI -1.17 to -0.08)). The effect on pain was very variable, also among trials with low risk of bias. Four similarly-designed acupuncture trials conducted by an overlapping group of authors reported large effects (SMD -0.68 (-0.85 to -0.50)) whereas three other pain trials reported low or no effect (SMD -0.13 (-0.28 to 0.03)). The pooled effect on nausea was small, but consistent. The effects on phobia and asthma were very uncertain due to high risk of bias. There was no statistically significant effect of placebo interventions in the seven other clinical conditions investigated in three trials or more: smoking, dementia, depression, obesity, hypertension, insomnia and anxiety, but confidence intervals were wide.Meta-regression analyses showed that larger effects of placebo interventions were associated with physical placebo interventions (e.g. sham acupuncture), patient-involved outcomes (patient-reported outcomes and observer-reported outcomes involving patient cooperation), small trials, and trials with the explicit purpose of studying placebo. Larger effects of placebo were also found in trials that did not inform patients about the possible placebo intervention. AUTHORS' CONCLUSIONS: We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.
    PMID: 20091554
    Eur J Heart Fail. 2003 Jun;5(3):319-26.
    Efficacy of a homeopathic Crataegus preparation compared with usual therapy for mild (NYHA II) cardiac insufficiency: results of an observational cohort study.
    Schröder D, Weiser M, Klein P.
    Börsenstrasse 17, Frankfurt/Main, Germany.
    Comment in:
    Eur J Heart Fail. 2004 Jun;6(4):511; discussion 517-8; author reply 519.
    Eur J Heart Fail. 2004 Jun;6(4):509; discussion 517-8; author reply 519.
    Eur J Heart Fail. 2004 Jun;6(4):513; discussion 517-8; author reply 519.
    Eur J Heart Fail. 2004 Jun;6(4):515; discussion 517-8; author reply 519.
    OBJECTIVES: To compare the efficacy of the homeopathic Crataegus preparation Cralonin for non-inferiority to standard treatment for mild cardiac insufficiency. METHODS: Multicentre non-randomised cohort study in patients aged 50-75 years in New York Heart Association class II. Patients received Cralonin (n=110) or ACE inhibitor/diuretics (n=102) for 8 weeks. To adjust for confounding by baseline factors, populations were stratified according to propensity score. After adjusting, there were no statistically significant differences between treatment groups. Treatment efficacy was assessed on 15 variables. A stringent non-inferiority criterion for the upper limit of the 97.5% one-sided confidence interval of the treatment difference was set to 0.2x the standard deviation (S.D.). RESULTS: Both treatment regimens improved scores on most variables studied, with the greatest effect on double product after exercise (average score reduction 15.4% with Cralonin vs. 16.0% for the control group). Stringent non-inferiority of Cralonin was demonstrated on 7 variables. Medium-stringent (0.5xS.D.) non-inferiority was indicated by 13 variables (exceptions: systolic blood pressure (BP) during exercise and diastolic BP at rest; for these, differences between treatments were not significant). Both treatments were well tolerated. CONCLUSION: The Crataegus-based preparation Cralonin is non-inferior to usual ACE inhibitor/diuretics treatment for mild cardiac insufficiency on all parameters except BP reduction.
    PMID: 12798830

  43. Adam_Yon 18 Feb 2010 at 10:10 pm

    Yes, it’s a small study, but my stuff actually works, while yours doesn’t.

    If the study is too small it becomes useless.

  44. DLCon 18 Feb 2010 at 10:14 pm

    So.. “Elderberry is harmless”
    but you have yet to prove that it actually has a beneficial effect.

    and as for the raw garlic guy.
    Why would “processing” cause it to lose efficacy ?
    Your assertion sounds much like magical thinking to me.

  45. PapaKon 18 Feb 2010 at 10:31 pm

    It appears that Mr. Quack Maloney is now attempting to change the subject. I’m not sure why he thinks he needs to post copy and pastes of the studies he thinks add something to his commentary. Does he not understand the Dr. Novella and others can access these studies? Does he think that posting long posts will keep others from responding? In general, I am actually a bit stunned that Mr. Maloney would repeatedly walk into the trap he set for himself. I guess the nocebo effect doesn’t work online.

  46. Quackaliciouson 18 Feb 2010 at 11:04 pm

    Dear Enzo,

    I wish I were making an exaggerated claim when I say much of modern medicine harms rather than helps. Rather than use what I say, please look at the Dartmouth Atlas where they have been tracking medical practices for over twenty years. In those places where patients receive more medical intervention the mortality is higher. For comparison, please find me any large or small study that shows alternative medicine kills anyone.

    In the ear infection study, antibiotics are given as a placebo effect in the vast majority of cases. They have no clinical effect on the viral infection and are given for seven to ten days precisely because viral infections usually resolve in the period of time. The primary excuse for giving the placebo antibiotics is that they “make a patient feel better.”

    In comparision, the herbal drops really do make the patient feel better. We have a modern medical placebo that continues to be used more often even when we are facing a crisis in antibiotic resistance vs. a clinically helpful herbal mix that works better.

  47. ambulocetuson 18 Feb 2010 at 11:12 pm

    Hi Steve,

    Just a note to say how much I admire your work against woo.

    Quite aside from your actual medical work, you (and your fellow bloggers and Rogues) are providing an important and no doubt life-saving service to humanity by explaining why alt-med is the bullshit that it is.

    I hope you’ve backed up all the content on this blog in case Moritz tries to get WordPress to shut it down too.

    Mr Maloney,

    No, I don’t think Steve is a cardiologist. Are you a cardiologist? Oh, that’s right – you’re not even a doctor.

  48. Quackaliciouson 18 Feb 2010 at 11:13 pm

    Response to other comments:

    Elderberry’s clinical effects are documented on my website, which few of you seem able to find: http://www.maloneymedical.com I have included the citations below (ooh, they are too small! Fine, you get the NIH to fund a study.)

    Yes, I know the second study is talking about AIDS. I include it because it discusses a possible mechanism of action for elderberry.

    In response to the question about raw vs. cooked garlic. Cooking the garlic denatures the antibiotic compound. If you want to cook your garlic, try French shallots, which contain the same compound in a more stable form.

    J Int Med Res. 2004 Mar-Apr;32(2):132-40.

    Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.

    Zakay-Rones Z, Thom E, Wollan T, Wadstein J.

    Department of Virology, Hebrew University-Hadassah Medical School, Jerusalem, Israel.

    Elderberry has been used in folk medicine for centuries to treat influenza, colds and sinusitis, and has been reported to have antiviral activity against influenza and herpes simplex. We investigated the efficacy and safety of oral elderberry syrup for treating influenza A and B infections. Sixty patients (aged 18-54 years) suffering from influenza-like symptoms for 48 h or less were enrolled in this randomized, double-blind, placebo-controlled study during the influenza season of 1999-2000 in Norway. Patients received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study.

    Publication Types:

    * Clinical Trial

    * Multicenter Study

    * Randomized Controlled Trial

    PMID: 15080016 [PubMed - indexed for MEDLINE]

    Posit Health News. 1998 Fall;(No 17):12-4. Related Articles, Links

    A new triple combination therapy.

    Konlee M.

    AIDS: Elderberry, chondroitin, and glucosamine sulfate have been found to block HIV replication at three distinct points in the replication cycle. For quadruple therapy, a reverse transcriptase inhibitor such as olive leaf extract or Epivir (3TC) could be added. In one case, a female, taking no HIV drugs, used an elderberry extract, called Sambucol, with olive leaf extract and experienced a viral load drop from 17,000 to 4,000. Instructions are given for making both alcohol-free and alcohol-based elderberry extracts. In 1993, researchers at Jerusalem?s Hebrew University Medical School found in a placebo-controlled double-blind study that Sambucol led to a rapid recovery from influenza and inhibited replication of nine other strains of the flu virus. A theory is that elderberry renders viruses nonfunctional by staining and coating them. Another promising treatment is soil based organisms, which improved Natural Killer cell function in a person with CFIDS.
    >
    Publication Types:

    * Newspaper Article

    PMID: 11366542

  49. Joelon 18 Feb 2010 at 11:48 pm

    Oh man, it’s like the Gish Gallop on steroids!

  50. Enzoon 19 Feb 2010 at 12:32 am

    You make it sound as if the Darthmouth Atlas is about debunking health care. A quick look at the site, the publications linked from it and a summary of their purpose reveals no such thing. The study tool for the efficiency of health care systems is to address the issue that the amount of a given region’s health care resources doesn’t always correlate with the quality of care (i.e. – there are other issues, like delivery of care). I found no study that linked higher care with higher mortality. I can’t even begin to stress how compounded that question is anyway. The closest I’ll give you is that an excess of care given to an individual (unnecessary amount) can do more harm than good because it increases the chance of false diagnosis, false positives and may lead to unnecessary treatments and therefore side-effects. This is NOT the same thing and this practice is actively discouraged and always under scrutiny so that we may improve and trim excess.

    “please find me any large or small study that shows alternative medicine kills anyone.”

    I’m going for pure shock value with this one:

    http://findarticles.com/p/articles/mi_m0AYN/is_2_23/ai_n18610026/

    I’m tired and I’m leaving the lab now. I guess I’ll tell all the attending physicians to stop treatments now because they are really just killing people anyway.

  51. mgshamsteron 19 Feb 2010 at 3:06 am

    “By focusing my research on non-toxic substances that may be helpful I have helped improve the lives of many people.”

    I don’t know if this bugged anyone else, but as a toxicologist, it sure bugged me. There’s no such thing as a non-toxic substance.

    There is nothing that is not toxic. Everything is toxic. It’s the dose and the route of administration that make something toxic.

  52. SteveAon 19 Feb 2010 at 7:02 am

    ‘Quackalicious’ seems to have resorted to the ‘Gish Gallop’

    http://rationalwiki.com/wiki/index.php?title=Gish_gallop

    The next step is the ‘Fingers in ears, then go ‘La-la-la very loudly’ gambit.

  53. Quackaliciouson 19 Feb 2010 at 7:25 am

    Dear Dr. Novella readers,

    I believe the information that Dr. Novella supplied:
    we follow evidence based prescribing for ear infections,
    a range of medication including beta blockers is useful,
    and major depression is effectively treated long term with antidepressants are all false.

    Since Dr. Novella is a neurologist, not a pediatrician, a cardiologist, or a clinical psychiatrist, his ignorance in these matters is completely forgivable. But his assertion that he is up to date in all medical areas outside his field is very disturbing. Even more disturbing is the fact that I, a mere quack in general practice, have more up to date information available to me.

    Dr. Novella, I am sure you are a wonderful neurologist. But it concerns me greatly that you are so bored with your work that you have taken to moonlighting as an skeptical expert on everything. Does Yale really pay a man of your stature good money to doodle away your days running a quack watch blog? Aren’t there very important neurological diseases and clinical trials that need your help? What about the three years of clinical journals you haven’t read so that you can pontificate on areas outside your chosen field?

    Let’s be honest here. Dr. Novella, I am certain you have very pressing academic activities that need doing and I’m not sure you should bother with a little quack like me or with running a blog. I’d personally like you to be finding a cure for Alzheimers. I have some ideas under mad cow disease. Please feel free to take the ideas and get a Nobel Prize. I don’t have the clinical staff or the academic stature to get funding, but you do. Please don’t waste your life attacking people when you can do so much more for all of us.

    And, dear readers, how many of you are stealing time from your salaried positions to attack people? Do your managers and fellow workers know you spend your day tuned into skeptic sites rather than focusing on the task at hand? Do you rationalize that you are “multi-tasking” when really you are trying to distract yourselves from a gray life without any magic? There’s no reason to continue to attack me online. If you look, 98% of those using alternative medicine do so without any doctor, alternative or conventional (CDC, 2004). In other words, it’s a lost cause. Not because of me, but because people want the options. Don’t waste your time. I won’t be back often, because I have a life. Anyone needing a reply can email me (cordially if you please) at my website. But please do look at the site first. I’m not trying to be anything but what I am. And unlike all of you, I only get paid when I actually work.

  54. Draalon 19 Feb 2010 at 7:31 am

    Strong in the art of woo this one is. yes.

    In response to the two Israeli elderberry treatments, the research was tainted by conflict of interest, low powered study, ect:

    Further research in this patient group or another age group is required. S. nigra extract, Sambucol, was found to reduce the duration of symptoms in patients with laboratory-confirmed influenza virus infection. However, both randomized controlled trials,[32] and [33] which were financially supported by the manufacturer of the product, were of limited sample size and conducted in younger patients (<56 years of age) rather than older, more vulnerable, patient populations. Larger independent trials are therefore needed to confirm these results. Specific strains of influenza virus should be evaluated in separate trials.

    The American Journal of Medicine
    Volume 120, Issue 11, November 2007, Pages 923-929.e3
    32. J Int Med Res 32 (2004), pp. 132–140.
    33. J Altern Complement Med 1 (1995), pp. 361–369.

  55. Adam_Yon 19 Feb 2010 at 7:46 am

    And unlike all of you, I only get paid when I actually work.

    So you wasted an entire day doing crying like a little baby why?

  56. Draalon 19 Feb 2010 at 7:53 am

    And, dear readers, how many of you are stealing time from your salaried positions to attack people? Do your managers and fellow workers know you spend your day tuned into skeptic sites rather than focusing on the task at hand? Do you rationalize that you are “multi-tasking” when really you are trying to distract yourselves from a gray life without any magic?

    I have a pair of worn jeans you can use to finish construction of your straw man.

    There’s no reason to continue to attack me online. If you look, 98% of those using alternative medicine do so without any doctor, alternative or conventional (CDC, 2004).

    (snippet from maloney[baloney]medical.com:)

    The above is for informational purposes only. Please contact your physician. Ask them to ask me for the above research to positively affect the health of our community.

    But you just said 98% of CAM users don’t need a doctor! I’m sooo confused! Why take the word of a N.D. over the reasoning of 98% of CAM users?

    In other words, it’s a lost cause. Not because of me, but because people want the options. Don’t waste your time.

    Great advice. You don’t need a N.D. to tell you how to use CAM. perfectly logical.

    I won’t be back often, because I have a life. Anyone needing a reply can email me (cordially if you please) at my website.

    I can’t do that! My manager might catch me at work writing non-work related emails!

    But please do look at the site first. I’m not trying to be anything but what I am. And unlike all of you, I only get paid when I actually work.

    Ok, now you’ve just insulted all the union workers. I demand an apology!

  57. Steven Novellaon 19 Feb 2010 at 7:54 am

    Christopher – you have successfully evaded the criticism leveled at you and indeed have used the Gish Gallop to make a series of false accusations.

    The point of the Gish Gallop is that I do not have time to dissect all the nonsense you have spread here, so I will pick a couple of points.

    I am a full-time academic neurologist, in the clinical educator track. So I spend most of my time seeing patients and teaching.

    For the last 14 years I have also had a second career, if you will, as a skeptic, which I do all on my own time. I have studied alt med extensively, as that is the intersection of my medical and skeptical expertise.

    I never claimed to have medical expertise outside of neurology, but I can read the literature and synthesize the opinion of experts – something, apparently, you cannot do.

    You have failed to address the fact that you used a study about the common cold to back up a claim about the flu – these are not interchangeable.

    You have written off the fact that you base your treatments on evidence that are so weak they are practically non-existent. You wrongly extrapolate from basic science evidence to clinical claims, and you ignore the terrible track record of preliminary evidence.

    And then you proceed to mischaracterize the state of the medical literature and the standard of current practice, with the goal of denying the effectiveness of science-based medicine. Then you complain that my readers are savvy enough to see through you.

    For example, you said that only diuretics work and that beta blockers are dangerous. This is not true – the very study you cited showed that all forms of anti-hypertensive medication were not “significantly better than low-dose diuretics” – not better – but they work as well – they all work. Then the studies go further to look at other outcomes and find some advantages for diuretics, some for ACE inhibitors. This is all about choosing the optimal first line treatment,and also getting better at matching the best treatment to each patient.

    This is science-based medicine at its best. You completely misrepresent it as somehow casting doubt on anti-hypertensive treatment, then try to substitute your treatments backed by only weak evidence.

    That seems to be your strategy – it is a denialist strategy. Cast doubt and confusion by misreading the literature, then substitute your pseudoscience. No one here is buying it.

    The study you cite about the placebo effect matches exactly what I and others have written about it. It does not support your position at all.

  58. RickKon 19 Feb 2010 at 8:36 am

    Unintentional irony of the day:

    Christopher Maloney said “Since Dr. Novella is a neurologist, not a pediatrician, a cardiologist, or a clinical psychiatrist, his ignorance in these matters is completely forgivable.”

    Christopher, you are not a medical doctor AT ALL, so your ignorance in these matters is also forgiveable.

    However, your claim on the front page of your website that you have a “Medical” practice (“Maloney Medical”) is completely unforgiveable.

    You disparage vaccines. You cite the thoroughly-discredited Wakefield on your website and spend paragraphs on the Poling case, and say NOTHING about fatalities due to childhood illnesses. You come here and quote your cherry-picked studies, but your website certainly fails to mention any of the studies that show (1) the genetic and other factors linked to autism and (2) the complete lack of evidence of a vaccine link with autism.

    You are not dealing honestly – not on your website, not in this discussion and not with your patients. You are NOT a medical doctor. You are clearly not an honest person.

  59. eeanon 19 Feb 2010 at 9:10 am

    Garlic is a nice addition to chicken noodle soup, which let’s be honest, is a great remedy for the cold. My mom (who is a Nurse Practitioner) often “prescribes” chicken noodle soup for the cold, since lets be honest 21st century medicine hasn’t found much better. :)

    Which I guess is just adding to the point that “naturopaths” don’t really have anything to add. Eg a good practitioner of SBM should already be suggesting cough drops instead of antibiotics when its probably a virus. What we don’t need is barely studied herbs being given a pass from the FDC process…

    at least, when I think about the going-ons of medicine in the last 15 years I don’t think “gee I wish more medicine had less study and virtually no approval process” which seems to be the goal of promoting these herbal extracts.

  60. [...] Oh, and he’s an illogical crapbag who gets his ass handed to him by Dr. Steven Novella in the comment section of Novella’s NeuroLogica Blog. [...]

  61. Tom Nielsenon 19 Feb 2010 at 10:07 am

    @eean:

    Can you please cite you evidence supporting that chicken noodle soup is a great remedy for the cold… besides your mother. Saying “let’s be honest” is not an argument. It’s is neither common knowledge nor common sense.

    Even if your mother wrote all medical books in existence, her opinion is basically useless, if it there is neither evidence or plausibility to back it up.

    Yes, chicken noodle soup tastes good, and great tasting food generally makes you feel good, but this doesn’t mean that chicken noodle soup has any effect on the duration or the symptoms of the cold.

    One thing is that naturopaths don’t have anything to add, another thing is when they make unsubstantiated claims, and patients treat accordingly.

  62. Tom Nielsenon 19 Feb 2010 at 10:11 am

    @eean

    … And even if chicken noodle soup was a good remedy for the cold, is it then the chicken, the noodles, the garlic, another ingredient, or all/ or some of them working together for achieving the effect.

  63. MDPon 19 Feb 2010 at 10:11 am

    Dr. Novella, and commenters, thank you! I can’t tell you how much I enjoyed the front-row seat to an Alt-med ass kicking with my morning coffee. It’s going to be a great day. :)

  64. PapaKon 19 Feb 2010 at 10:29 am

    Tom: I didn’t take # eean’s statement about chicken soup as a “remedy” to be an actual claim. I took his post as a statement that rest (comfort) and calories (perhaps via comfort food) are about as good as it gets for treatment of a cold. Of course, I may be very wrong on that front, and may possibly be wrong about cold treatments. But, I just had to add a couple cents.

  65. Perky Skepticon 19 Feb 2010 at 10:47 am

    May I state, for the record, how insane it drives me when altmed practitioners come onto blogs like Neurologica and proceed to jump up and down with their claims and strawmen and Gish Gallops, and THEN, after being slapped down a few times, all the while whining “did you even read my article???” they make a statement similar to “As your readers have noted, I don’t even know your field.” GAH!!! Who doesn’t think of just GOOGLING someone’s name??? Is this further evidence of the sloppy thinking that pervades so-called alternative medicine, or is it just an annoying nuisance? I, personally, would love to see a retrospective study!

    *ahem.* Inconsequential rant over.

  66. canadiaon 19 Feb 2010 at 11:10 am

    Re: Chicken Soup: another factor might be that it helps raise the body temperature, acting as a fever booster?

    Re: Naturopaths: Even as a non-doctor I can see several problems with Quack’s arguments above. What I can’t wrap my head around is that people like him never have to face a SINGLE patient whose health is seriously at risk, yet they feel justified and qualified to criticize the work of doctors and scientists who save lives on a daily basis.

    “It would help if we could discuss the spiritual side of my illness as well, because I think that affects how I feel on a given day. Oh, and I want my doctor to give me bodywork or massage or maybe a foot rub when I need it. That’s not too much to ask, is it?

    Not if you come to me. ”

    I think that targets your area of expertise pretty well. You keep catering to those people. Leave the medicine to real doctors.

  67. eeanon 19 Feb 2010 at 1:43 pm

    @Tom Nielsen: my mom is a nurse practitioner at a college health clinic. So she often has patients that actually just need to rest and likely don’t need medical attention, but they’re away from home and need reassurance. I mean, the cold, do you have a better suggestion then chicken noodle soup? There’s nothing magic about chicken noodle soup.. it just feels good. That’s the point. :) No voo-doo pseudoscience explanation needed.

    Sometimes people go to their doctors and expect some magic solution to whatever ales them. Sometimes doctors do proscribe antibiotics even when its likely a harmless virus. Are these facts in dispute?

    I think plenty of SBM doctors and NPs know this. And not everything suggested by a doctor needs to have been peer-reviewed.

  68. Skepon 19 Feb 2010 at 1:47 pm

    Funny how natruoquack “Dr”. Christopher Maloney flinging out a Gish Gallop of misinterpretation of scientific studies when “Dr. Christopher Maloney says that science is irrelevant in the practice of medicine:

    ” Science is great in the lab, but I work in the field. ”

    Malony can’t have it both ways. Either science is applicable in practice or it isn’t.

    And there is some question as to whether “Dr.” Maloney can call himself “Dr.” without the ND after his name:

    2. Title. A licensee must use the title “naturopathic doctor.” Naturopathic doctors have the exclusive right to the use of the terms “naturopathic doctor,” “naturopathic,” “naturopath,” “doctor of naturopathic medicine,” “doctor of naturopathy,” “naturopathic medicine,” “naturopathic health care,” “naturopathy” and the recognized abbreviation “N.D.” Use of the title “physician” by the licensee is prohibited.

    http://withoutapologyinmaine.wordpress.com/2010/02/18/hang-on-one-cotton-picking/

    IMO using “Dr.” without ND after his name would be against my reading of that statute.

  69. eeanon 19 Feb 2010 at 2:05 pm

    Yea what PapaK said is right, its obviously not a remedy. The best thing for the cold is to deal with it.

    Though salt water does reduce inflammation of a soar throat. My mom does suggest salt water gargling as well. I have a citation this time: http://www.nlm.nih.gov/medlineplus/ency/article/003053.htm
    (I’m not sure they have a citation for it, outside of the basic facts of osmosis).

  70. Tom Nielsenon 19 Feb 2010 at 2:10 pm

    @eean

    I apologize for misunderstanding you eean. I have just heard too many times that when you have the flue, chicken noodle soup will cure it.

    Hey my mother always told me to take loads of vitamin c when I had the cold.

  71. CivilUnreston 19 Feb 2010 at 4:43 pm

    Guys, I’m quite certain that the reason chicken-noodle soup CAN CURE (100% cure it, seriously) the common cold and annhiliate 54% of flu viruses on contact has to do with the spiritual amplification of motherly energy that the water retains.

    Since all water on the planet is recycled, it’s safe to say that any bowl of chicken noodle soup is bound to contain the resonant echo of energy once imparted to it by someones mother. In other words, somewhere in every bowl of chicken noodle soup is a water molecule that interacted with someones mother. The specific (and AMAZING!) properties of chicken noodle soup can then conspire to actively AMPLIFY this healing, motherly, energy into an immune-system-boosting cocktail!

    Science has, of course, totally missed this amazing property of chicken noodle soup because it involves the transfer of insainly powerful (but totally undetectable) SPIRIT energy. Or maybe quantum fields. Dammit. Now I forget.

    Hey, watch this video of a homeopathy doctor explain how her magic works by citing Einstein and Dr. Stephen Hawking (whom she refers to as the man god gave us when he decided he needed another Einstein).
    http://www.youtube.com/watch?v=C0c5yClip4o

  72. SquirrelEliteon 19 Feb 2010 at 6:22 pm

    re: Chicken soup and the common cold

    I don’t think anyone is claiming that chicken soup is a cure for the common cold.

    As far as I know or have read, there is no reliable cure for the common cold. The benefit of the one medicine I recall reading about a few years ago was approximately that if you recognize immediately that the little bit of sniffles you have is the start of a cold and start taking it immediately, it will reduce the duration of the cold by about 1 day. That was good enough to qualify for a claim of effectiveness (as compared to “throat drops”, for instance), but hardly something to jump up and down over.

    However, chicken soup may be a useful palliative or “remedy”.

    At the very least, it helps follow the standard advice of “drink plenty of fluids”. Also, as I recall, hot liquids usually dissolve substances better than cold ones, so a hot liquid like chicken soup may have some modest benefit by dissolving and washing away the mucus that is irritating the throat.

    So, in the absence of anything notably better, it is worth trying and might have some benefit. Besides, it does have some nutritional value and it tastes good (especially with green chile added).

    As for the hot liquids raising your body temperature, however, I am pretty sure that the energy your body extracts from processing the caloric content of 12 fluid ounces of cold soda pop will raise your body temperature more than drinking 12 fluid ounces of plain hot water.

    As for Maloney, when a duck spouts canards, it is still a duck.

  73. krbon 19 Feb 2010 at 6:27 pm

    “I am the best doctor I know…”

    Wow.

    “When did you have time to study what I do?”

    A-hahahaha, haha, teehee, haha, ha, ha, ha. Heh. Hoo.

  74. Quackaliciouson 19 Feb 2010 at 9:23 pm

    Dear Dr. Novella,

    You’ve spent fourteen years studying what I do as part of “second career” and yet you don’t have time to go through a few studies that I post on your blog and that I summarize for you? The emperor has no clothes, sir.

    And no, Doctor, you are not a cardiologist, but you still “cherrypick” from one of the studies without reading the others I have handed you. You also, I presume, do not prescribe for ear infections. Admit it, you are out of your depth on your own blog. When an actual adult comes calling and calls you on playing God, you cry busy, busy.

    You are not an expert on medicine, only on neurology. And you have not taken a single course in alternative medicine but claim to be an expert. The only experts in alternative medicine are those who practice and research it. One of us is a true quack.

    And all of you dear readers, did you bother to look through what I posted? Oh, no it’s too long, we can’t be bothered with scientific studies here. And Dr. Novella can’t be wrong, even though he claims expertise in all areas of medicine. How about you, Enzo? Am I making false claims about modern medicine? Is Dr. Novella right to ignore studies supporting alternative medicine posted on his own blog?

    He’s too busy. He’s making money pretending to be an expert in something he’s never taken a course in. That he’s never studied in any way that would be recognized as scientific. Where do they get degrees in professional skepticism? Does the great Randi the magician pass them out as party favors? Can I get one? Can I make my dog an honorary expert?

    Thanks, it’s been fun. But not real fun.

  75. Michael Hawkinson 20 Feb 2010 at 12:01 am

    And you have not taken a single course in alternative medicine but claim to be an expert.

    Yes, Dr. Novella, how DARE you claim to be an expert when you haven’t taken courses like Chinese medical astrology.

  76. Michael Meadonon 20 Feb 2010 at 4:47 am

    Mr. Maloney. Seriously. Calm down and then read what Steve actually wrote. You’re misreading, tossing around red herrings, and spearing straw men.

    Find out some more about Steve before you argue with him, really. He’s on Wikipedia for crap’s sake. Steve runs the New England Skeptical Society. He blogs here, at the Rogue’s Gallery, at Science-Based Medicine, and at Skepticblog. He also hosts the Skeptics Guide to the Universe Podcast and SGU 5 by 5. He’s dedicated his life to clinical practice and science education. And all those extracurricular activities I just mention? He makes no money off them.

    “You are not an expert on medicine, only on neurology.”
    Right. Are YOU an expert on medicine? I mean, you don’t even have a proper medical degree! (A BA, a diploma [even from Harvard], and a degree in quackery does NOT qualify you.) To top it all off, you’ve demonstrated an alarming inability to reason and read the literature. I think, quite seriously, that we might have a beautiful instance of the Dunning-Kruger effect in operation

  77. Starfuryon 20 Feb 2010 at 6:09 am

    Mr Maloney,
    Politely, I must point out to you a few flaws in your post. Namely, Logical Fallacies seem to have undermined your points. I will point out the most glaring fallacies here for your convenience.

    I have noticed many ad hominems (Personal Attacks) in your posts, these undermine civil discussion and it would be much appreciated if you were to eliminate them from this dialogue.

    You employ the Straw Man fallacy in your latest post when you incorrectly assume that he is claiming No Time for any of your “few” studies that you post. That is not what he said. What he did say was that he does not have enough time to deal with all of your claims. The difference in wording is subtle, but the difference in concept is rather large.

    You seem to be quite enamored of the Tu Quoque (you too) fallacy. This fallacy is where one forgoes defending one’s own point and simply seeks to undermine the other’s point (ie: Well, my position may be flawed but yours is too!”) This tends to go hand-in-hand with the False Dichotomy, as inevitably one uses Tu Quoque to attempt to show that the other person’s position is worse than yours. The False Dichotomy comes in when you conclude that, because his position is wrong, yours is right. This is not necessarily the case, sir, as one or both positions may be incorrect.

    As you are the one making assertions that would overturn the current state of medical science (and its wealth of properly designed studies, controlled to weed out human error, personal bias, and statistical variation), it is upon your shoulders to present evidence strong enough to overturn the established theories. I might point out that he has made several criticisms of your supporting studies, ones which you have not answered. He has pointed out flaws in your studies, have you any studies where these flaws have been fixed?

    In conclusion, I find it laudable that you are willing to go to a potentially hostile site to assert your point. Unfortunately, your point thus far has been backed up by studies which would not survive the very same process Dr. Novella goes through on a daily basis, or the process that modern science has gone through to get here. Your studies are interesting, but not of sufficient weight to overturn existing studies whose better design, superior controls, greater numbers, and prior plausibility all lend them greater weight.

    If you have replicable studies of such power, please do not hesitate to share them. If Dr. Novella has not the time to devote exclusively to you, I am sure there are people here of sufficient education to look at your studies, and evaluate them. Thank you for your time, and I look foreword to your next post.

  78. Steven Novellaon 20 Feb 2010 at 7:07 am

    Christopher – thanks for showing everyone your true colors – a nice display of crankery.

    The point you miss, because you probably don’t get the Gish Gallop reference – is that it take much less time to create a misconception than to correct it. I read through your references, and gave examples as to how you misinterpret them. But a full treatment of the science behind the treatment of hypertension will take longer than I have, especially since this is not my area of expertise.

    Meanwhile, you have still not answered the questions put to you or addressed the horrific misinterpretations of the literature you committed. You just dodged them will logical fallacies.

    And to clarify my own process – expertise is not black and white, and you imply. I certainly have some degree of expertise in medicine, as an MD. Not enough to practice outside of neurology, but enough to write about it to the lay public.

    Further – you perpetuate a false dichotomy about “your specialty”. For example, do you think I am qualified to interpret the literature on acupuncture for migraines? Migraine is a neurological disorder.

    When I do write outside my specific area of specialty, I try to assess two things: 1 – what does the literature say, and 2) what do the experts say. So I always check my reading with the experts, to make sure I am getting the bottom line correct and putting things into a proper perspective. I do not rely on my own knowledge.

    This is a process that you seem to be unfamiliar with.

  79. Steven Novellaon 20 Feb 2010 at 7:14 am

    One more comment on expertise – because this is a ploy the cranks use often. I do not need to study astrology for years, understanding all of the inner workings, to know that the basic premises of astrology are flawed and to see that it is a psuedoscience, not a science.

    My skeptical expertise (what this means I have written about extensively before) is knowing the difference between science and pseudoscience.

    Further – knowing how to interpret clinical studies is a generic expertise that can apply to any clinical question. This is a skill you obviously lack, which has been amply demonstrated here. Meanwhile, I lecture at Yale on this very topic, alongside colleagues who have various specific specialties, like statistics, etc., and who can keep me honest if I stray.

  80. Quackaliciouson 20 Feb 2010 at 8:19 am

    For those who continue to post without reading my postings. Yes, I know alternative medicine has weak studies. All of the money spent an alternative medicine in a single year would fit nicely into the profit margin of a single major drug. We don’t have deep pockets, and when positive studies do come out they don’t get followed up with major clinical studies precisely because “experts” like Dr. Novella do not advocate them. But if you look at my posts, I was replying specifically to Dr. Novella’s post where he rattles off false medical information blithely. In showing that I am reading the literature and that I am more up-to-date in the literature, I am making a very specific point. My end study in each post is one supporting an alternative practice. Telling me my “data is flawed” is a ploy that can be used for any study. It ignores that I have provided, in several cases at least, the most current and comprehensive data available that Dr. Novella is not familiar with. If you are using Dr. Novella as your guide, it is important to realize that he may make statements that are not true.

    For those who wish I could be more civil, I refer you to the wonderful PZ Myers site and to the many wonderful comments I have received on this site. What about this site title, which defames me with a lie? Please. It’s like a bunch of bullies kicking a downed man and then complaining about his attitude.

    Dear Dr. Novella, we both know that you are currently taking time away from patients and residents to go quack busting. You are doing so using Yale facilities and while being paid by Yale for other duties.

    I, personally, would be furious if I knew my attending physician had a second career as a skeptic. Please engage in informed consent and tell the next ten patients something similar to the following:

    “Dear (desperate, tear stained mother),

    I know that your (fatally ill loved one) is dying, but I haven’t had time to look up clinical trials that might have saved them. You see, I have a second career as a skeptic, where I have spent all my spare time over the last fourteen years chasing quackery. I know it will be a comfort to you that I have logged hundreds of hours online attacking quacks rather than trying to cure your loved one. Now, I must go and check my blog.

    And, what about the residents?

    Don’t you owe them the following?

    “Dear (desperately tired, overworked resident),

    I know that you are constantly on call and get very little sleep. And as your attending, you rely on me for the best and most up-to-date clinical information. I know it will come as a great comfort to you that I have been spending hundreds of hours over the last fourteen years chasing quacks online rather than keeping up to speed on the latest developments in neurology. I know that when you signed on for my clinical expertise in neurology, you really wanted me to spend all my spare time as a skeptic. It will be great to know that when you go out as my student into hospitals you will be three years behind in neurology but your instructor has a large and fanatic fan base online.”

    And please be consistent about your beliefs when in the hospital. When you see tearful patients praying over their loved ones, take a moment to stop and “spank” them.

    “I’m sorry, I believe you are engaging in a quack practice in my hospital. Prayer will not help your loved one. They will die and rot. There is no afterlife, and please check with my online colleague, PZ Myers, for the facts. I really must insist that you stop this quackery immediately or I will have you removed. You see, I am both a neurologist and a skeptic. When I took my Hippocratic oath, I did not say “alleviation of suffering,” I said, “engage in quack busting.”

    If you insist on continuing your amateur skeptical bullying, I suggest taking some courses so that you can become a true professional bully.

    The AHMA has hundreds of course offerings, and a few continuing ed. credits in alternative medicine would boost your credibility from “educated layperson” http://www.holisticmedicine.org/ will give you access to the hundreds of your fellow M.D.s who not only know more about alternative medicine, but also advocate it and use it in their practices.

    Have a quackalicious day and please get back to work. Someone in the hospital is dying of your neglect while you read this posting.

  81. Draalon 20 Feb 2010 at 9:24 am

    Next time I see my GP out of the office, I’m going to shake my fist at him. How dare they show their face in public! They should make laws against doctors having social lives, hobbies, or children! CHILDREN! You know how much time a child takes away from my GP from reading the latest studies? That’s just down right criminal. Steven, if you even claim to have any children, that’s it. I’ve lost all respect for you.

  82. Riksaon 20 Feb 2010 at 9:44 am

    Wow. Just wow. Does he not read or does he not understand?

  83. Draalon 20 Feb 2010 at 10:06 am

    As for “whodda ya think ya are, you’re no naturopath!” argument…
    You think the Maine legislators who granted naturopaths the title, naturopathic doctors, have any expertise in naturopathic medicine? I don’t think so. From your logic, they have no business dictating what a naturopath can and cannot do. By law, a N.D. cannot write scripts for schedule I, II, III, IV or V drugs. I mean, anything that comes from nature must be safe, right? Those law makers don’t know anything about drugs; they shouldn’t be allowed to regulate a naturopath like that.

  84. Carlon 20 Feb 2010 at 11:12 am

    It’s fascinating watching this Maloney character thrash around here, completely failing to gain traction or score a single debating point. Steve himself hardly needs to even post, because the readers here are trained to see through Medicine Denier tactics like the Gallop and Tu Quoque.

  85. krbon 20 Feb 2010 at 11:14 am

    “I’d personally like you to be finding a cure for Alzheimers.”
    “You’ve spent fourteen years studying what I do as part of ‘second career’ and yet you don’t have time to go through a few studies that I post on your blog and that I summarize for you?…He’s too busy.”
    “Have a quackalicious day and please get back to work. Someone in the hospital is dying of your neglect while you read this posting”

    So Quackalicious wants Steven Novella to go back to work, but then he wants him to spend time on each of the studies, and then he wants him to go back to work again. In the meantime, he has ten comments for Dr. Novella’s eight, even though he claims to be off having a life.

    Also, I’m pretty sure doctors have this thing where if one of them isn’t working, another perfectly capable and qualified one is. Thanks to the rigorous schooling, they’re all somewhat interchangeable. It’s the limited resources of time and manpower that make standards so important.

  86. Joelon 20 Feb 2010 at 11:48 am

    “All of the money spent an alternative medicine in a single year would fit nicely into the profit margin of a single major drug. We don’t have deep pockets”

    Oh? Didn’t Boiron, the manufacturer of the homeopathic flu treatments Oscillococcinum have something in the neighborhood of half a billion in sales? In the U.S. alone, your industry pulls in $40 billion in sales year after year (NIH) and that’s a drop in the bucket on the global level.

    Your industry is bigger than cable television, and they have enough money to put satellites into geosynchronous orbit. Do you honestly expect people to believe you can’t afford to prove your products work?

  87. Michael Meadonon 20 Feb 2010 at 12:01 pm

    Mr. Maloney. You really have now descended from crankery and illogic to full blown idiocy and obnoxiousness.

    You are, I am afraid, not worth arguing with. You are incompetent and unaware of it.

  88. Steven Novellaon 20 Feb 2010 at 12:27 pm

    Wow – you really don’t want scientists, especially those who know how to recognize hokum when they see it – spending any of their time keeping cranks and quacks honest. I can understand why.

    What you don’t seem to understand is that understanding scientific skepticism makes one a much better scientist and physician – something which my students and patients greatly appreciate.

    You also make many absurd assumptions and false dichotomies, which my readers quickly saw through.

    You have still not answered the questions put to you. You also seem to not get the fact that we are not just accusing you of (in some cases) citing poor studies, but the studies you cite you grossly misinterpret – you get it completely wrong.

    I did not make any false medical statements – they are all supported by evidence and the consensus of expert opinion. Your attempts at demonstrating otherwise are childishly pathetic, as has been pointed out in detail – points you fail to address.

  89. Daveon 20 Feb 2010 at 12:34 pm

    This post and comments finally inspired me to register and start commenting. Two things have been especially bugging me:

    1. What a set of double standards! He implies that Steve can’t effectively comment on cardiology since that isn’t his field, but he has no qualms about commenting on that field himself. Then he claims that Steve shouldn’t keep a blog because it detracts from his practice, but apparently that isn’t a problem for Maloney. (I’ll note that I’m doing this on my own time. It’s this funny thing I call a “day off.” Besides, I only teach history.)

    2. We’re gardeners and grow elderberries. It’s not right to simply say that they are non-toxic or harmless. The stems, leaves, and roots are poisonous. Some people claim uses for teas made from the leaves – bad idea.

    The European black elderberry (Sambucus nigra aka Sambucus mexicana) is generally described as safe. But, as I understand it, the berries contain a form of cyanide in enough quantity to potentially cause illness. They’re perfectly safe when cooked, so there aren’t any issues with pies, wines, or syrups. But, raw berries and juice are suspect. I looked into it after one of my kids threw up after eating a large handful of them. That’s just one anecdote and maybe it was something else that made him sick, but I don’t let the kids eat the berries raw anymore. The CDC has a similar story at http://www.cdc.gov/mmwr/preview/mmwrhtml/00000311.htm

    Red elderberrries (Sambucus racemosa) are more toxic. Birds like them and they can be made into wine, but I think there are still some question marks around the wine. I may be overly cautious, but I won’t eat them in any form.

    I also have to note that I just had a physical. For some reason, my physician talked about diet, exercise, and didn’t once push “drugs”. Maybe his check from big pharma was late…

  90. ElasticPlaneton 20 Feb 2010 at 12:58 pm

    Maloney seems to be one of those quacks who read the list of logical fallacies and thought they were tips for making good arguments.

    (I think I’m paraphrasing that from something Dr. Novella said some time ago about someone else… Egnor maybe?)

    “Dear Dr. Novella, we both know that you are currently taking time away from patients and residents to go quack busting. You are doing so using Yale facilities and while being paid by Yale for other duties.”

    Seriously Maloney? That’s what you come up with? He can’t possibly be doing this in his free time?

    jeez. that’s just sad

  91. RickKon 20 Feb 2010 at 2:48 pm

    Christopher Maloney said: “All of the money spent an alternative medicine in a single year would fit nicely into the profit margin of a single major drug.”

    That is completely false. If we look ONLY at the U.S. supplements industry, we’re talking over $20 billion per year in revenues. Chiropractic is between $10 billion and $15 billion annually in the U.S.

    When you add up folk medicine, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, energy healing, music therapy, aroma therapy, foot reflexology, etc., you’re talking some additional very large numbers.

    There’s big money to be made off unscrupulous practitioners who call themselves doctors selling placebos to an uninformed public.

  92. Joelon 20 Feb 2010 at 4:42 pm

    Might I also add that pharmaceutical companies collectively spend $40 billion a year (2005 figure) synthesizing and testing their drugs for safety and efficacy. In science based medicine (as well as common sense), this is just a no brainer, you should make sure something works before claiming it does.

    To hear Maloney present the excuse (Paraphrased) “We can’t afford to test our treatments” as if it were actually defending his position was frankly hilarious.

    -Joel N.D. (I can legally call myself this in most states, including mine)

  93. Enzoon 20 Feb 2010 at 4:45 pm

    This is amazing.

    I can’t believe he evoked the crying mother and the babies! What is this? An angry mob?

    As far as I can see, we addressed all of your claims and challenges. You haven’t said anything in response to ours except “no doctors kill people!” Just for the sake of trying (one last time) to instill you with the core of what we are trying to say:

    It takes years and many studies to arrive at scientifically supported conclusions that clearly demonstrate specific effects. The elderberry studies in question don’t paint a full picture. Too small to account for chance/placebo and lacks further support. The test-tube study is more of a chemical synthesis paper than anything. It has one biological study that doesn’t even control for the possibility of non-specific effects (for all we know dirt extract would have the same effect). We are talking about whole viruses interacting with small molecules, and while the result may seem straight forward it not so simple. This is actually what I do and I lend no credit to this study without a great deal more shown to me. That’s what we are trying to say…While it MAY hint at a start to things, it is by no means credible for treatment as is.

    The point is that science and medicine needs skepticism to protect itself from falling victim to false conclusions and premature action.

    But it’s alright. We do not lend credibility to the “ravings of madmen and lunatics because their kind of amateur, fanatical, fantastical nonsense does not save lives — Only science can do that.”

  94. SquirrelEliteon 20 Feb 2010 at 5:21 pm

    Enzo,

    Since clostridium botulinum is common in dirt, it’s not too much of a leap to guess that properly extracting the botulism toxin might give us something that would kill viruses and germs. Surely it’s worth a study ?!?! :)

    On a more serious note, the last I heard the NCCAM had spent about $2.5 billion over the last several years on research on various complementary and alternative medicine techniques with ZERO positive results. Any change or news in that regard?

    Perhaps we would be better served if a steady and substantial portion of that money were spent on funding a comprehensive survey of known or presumed herbal treatments using the standard techniques of pharmacognosy.

    At the best, we might find a few bits of wheat amidst all the chaff. And, it couldn’t be any worse than studying stuff like the Gonzales protocol or chelation therapy. Although, at least the Gonzales study came up with good negative evidence against that protocol.

  95. Quackaliciouson 20 Feb 2010 at 10:24 pm

    Dear Dr. Novella,

    While enjoying the sunshine with my family I realized that I am in error. I want to apologize to you and your readers. This is the one blog of dozens of “sister sites” that has not used the F word as a noun, verb, adjective, or explicit direction in reference to me. I really appreciate that and I have been guilty of bringing down the generally civil level of discourse on this blog.

    I am truly curious about the level of evidence necessary to prove something in alternative medicine is effective. When I have contacted Stephen Barrett of Quackwatch, he simply replies “your studies prove nothing.” The great Randi requires that he himself perform the study and will not accept any other evidence by any party. What is the de facto level of evidence required by this blog? What if I were able to produce a Cochrane database analysis of an herb that found positive benefit in neurology? Would you, Dr. Novella, consider using it in your practice? Or is there truly absolutely no chance that you would ever consider using anything alternative regardless of the evidence?

    Again, my apologies on the personal attacks. I think they may be understandable given my level of stress, but they were inappropriate.

    My apologies,
    Christopher Maloney, N.D.

  96. storkdokon 20 Feb 2010 at 11:39 pm

    I am so loving the idea that I get to show and expose this particular quack’s statements and claims that he is a “doctor” to the Assistant of the Attorney General of Maine on Monday!

  97. RickKon 21 Feb 2010 at 12:17 am

    Maloney, don’t you realize that if an “herb” has a pharmacological effect, and you use it for medical purposes, it is a “drug”?

    So in spite of your website’s claim that you use alternatives to “drugs and surgery”, all you’re actually doing is using drugs with very few positive studies instead of drugs with many positive studies.

    What is the point?

    Similarly, when discussing vaccines and autism on your website, you conveniently ignore all the studies showing now link, and instead you concentrate on the Poling case.

    It seems that the weaker the evidence, the MORE you like something.

    But you can’t have it both ways. You can’t cherry pick some studies on elderberries or garlic and then reject all the conventional medicine that you disparage on your website.

    You seem to go through a LOT of effort to look like a doctor. You quote studies that are (or sound like) scientific studies, you call your practice “Maloney Medical”, you picture yourself with a white coat and stethoscope, and you go to great pains to compare the number of classes you took with med school classes.

    Wouldn’t it be easier to actually BECOME a medical doctor rather than spending all this time trying to LOOK like one?

  98. RickKon 21 Feb 2010 at 12:18 am

    that should read “showing no link”

    Never blog after midnight.

  99. Joelon 21 Feb 2010 at 4:04 am

    “What if I were able to produce a Cochrane database analysis of an herb that found positive benefit in neurology?”

    I’m sure you could produce plenty of herbs that have shown to be effective. Hell, I can produce plenty that have evidence based medical applications: Belladona (Atropine), Foxglove (Digitalin), Eucalyptus (menthol), Opium Poppy, Cinchona tree (Quinine), Pacific Yew (taxol), Curare tree (Tubocurarine) and Periwinkle (vinblastine) to name a few.

    There is no embargo against chemical compounds that come from nature, nobody is dismissing the indisputable fact that there are treatments and cures that derive from herbs/barks/flowers.

    Why do you suppose some herbs make their way into medicine, while others are dismissed as woo? You can’t blame it on there being no money in it since you can’t patent a plant because companies that sell aspirin do just fine as do companies that sell the natural medicines listed above.

    Think about it this way, in science based medicine the treatment for Hodgkin’s Lymphoma includes periwinkle. If there were indeed some rabid anti-natural stance coming from the EBM side, why the hell would they include Vinblastine in the treatment schedule?

    It’s been shown to work. That’s all it takes for a root to become a medication, just show it works and in no time we’ll have it on the market saving lives.

  100. Grimreaporon 21 Feb 2010 at 6:01 am

    Quack, you can’t patent a plant for obvious reasons. You can patent a specific substance mixture and chemicals although not all the time. When that fails you can patent a manufacturing process depending on how novel it is. Also you could patent key chemicals that is used in the process to manufacture it. If you don’t think herbs would make money for ‘big pharma’ look at aspirin.

    Patents are useful because it allows them to fund continuous research such as post marketing trials and further research and development. But these patents last only so long. Also some companies have taken interests in such chemicals and seen how they can alter the chemical that might be more effective and/or less side effects.

    It is funny that alternative medicine was a $10 billion industry last year and I really don’t see any good research coming from that sector. And saying no one will touch herbs for research… Botanic research is the thing you obviously have no idea of since they test herbs and plants etc, for pharmacological effects among other things.

    There are no excuse for crap research for the alternative medicines. The better the research the worse the effect size is a near perfect correlation.

  101. Quackaliciouson 21 Feb 2010 at 7:42 am

    Dear Enzo,

    Yes, this is the “quiet” scientific support for a mob that sprawls out over the blogosphere, copying PZ Myers’ site and using this site as justification and substantiation. If you check PZ Myers pages you will find that I have been arguing quite fiercely that I was falsely accused by one of your own, and that both Dr. Novella and PZ Myers are unable to retract a simple thing like a lie about who got whom kicked off the internet. That is the only reason I began to blog over the past three days. The individual who accused me, Michael Hawkins, lives in my home town and has been attacking me via his blog for months without a single reply. Even after he got a letter from another person claiming to have kicked him off, Hawkins continues to obsess about me. If you had actually read his blog, he was spending his time recently flaming a Word Press techie, Mark. He got suspended for two days and then came right back on and attacked Word Press again. What happened? He got kicked off. Then he went to PZ Myers, who lied about me getting him kicked off and sent the word out to attack me. That attack command was parroted by Dr. Novella and here we are. I have no interest in blogging, but I am not going to remain silent when a mob is using this site as justification for attacking me falsely for censureship.

    I think it is important for those advocating attacking others to realize that a very small proportion of their readers are not well balanced. In a world where angry people are looking for someone to blame, encouraging them is a bad idea. Here is Russell Brand replying to the death threats he received simply for appearing on a television show. He is a very crude and very funny man. But no one told anyone to attack him, and my attacks began when Myers listed me as a target and Dr. Novella confirmed that I was a threat to be dealt with harshly. To be fair, none of my personal emails have been quite as good as Brand’s, but it gives a sense of the sort of “reasoned discourse” I’ve received over the last few days since Myers falsely accused me (check the site, Hawkins falsely accused me to Myers, and Myers posted it as the truth.) Warning to those who don’t like vulgarity and profanity, this video (and my junk email box) are full of both.
    http://www.youtube.com/watch?v=JhSbaIq3GGY

  102. Steven Novellaon 21 Feb 2010 at 8:17 am

    Christopher – thanks for the apology. I do try to keep things civil here.

    I did report on the accusation – adding your denial as soon as you made it, and adding an addendum as to the real person who filed the complaint as soon as it came to light. So I absolutely did correct the original reporting – and in the body of my original post, not just in the comments. This is better than you will get from most journalists.

    Regarding levels of evidence – this is difficult to summarize in one comment. I have written numerous articles about it, though, here and on sciencebasedmedicine.org.

    Briefly – I apply the SAME standards to all claims. That is key. I have nothing against botanicals, I just think they should be treated like the drugs they are – not food.

    My problem is not that you have been advocating for herbal remedies, but your analysis of the evidence is deeply flawed. I think you are extremely biased in the way you evaluate evidence. And I also feel you cover it up by falsely representing mainstream medicine and the evidence for standard treatments.

    It is your process that I object to – I have no a priori bias against any form of medicine. I just hold everything to the same standard.

    I would summarize that standard as – a consilience of evidence, from basic science to clinical, showing a plausible and consistent pattern of safety and efficacy over multiple trials and researchers.

    Further – practitioners should use a hierarchy of evidence – starting with the most supported treatments, then working their way down to less and less evidence if more evidence-based treatments don’t work, are not available, or cannot be used.

    But – there also has to be a lower limit – you can only go down so low in the evidence base before you are no longer practicing scientific medicine. Below a certain threshold I think treatments should only be given with informed consent as part of ethical research.

    But there is also a point below which treatments should be abandoned, as unsafe, ineffective, or highly dubious because they are very implausible and lack evidence.

  103. Steven Novellaon 21 Feb 2010 at 8:19 am

    A side note on Randi, since I have worked with him.

    It is unfair to say he only trusts his own research. In fact, for the million dollar challenge, he does not conduct this testing – he largely leaves that to others. He merely supervises to make sure that certain standards are met.

    I have completely independently conducted screening tests for the JREF. I did submit my protocol ahead of time for approval, but I 100% designed and executed them myself.

    Randi is simply highly skeptical – but he trusts good science conducted by others, so your statement was unfair.

    And Stephen Barrett has a website full of articles examining claims and evidence in detail. You should avail yourself of this resource.

  104. Draalon 21 Feb 2010 at 12:46 pm

    To be fair, Christopher makes a valid point (regarding the reporting of information from a single source). I totally agree that Christopher has misrepresented the research regarding the alternative medicine as was pointed out by Steven, myself, and others. However, the assertion that Maloney forced the shutdown of Hawkins blog is problematic.
    “This is better than you will get from most journalists.” Well, Journalists are supposed to find as many sources to corroborate a claim. Now I know Steven is not a traditional reporter but changing media has begun to incorporate bloggers in the news cycle.

    To quote and paraphrase a book I’m reading at the moment, “Sound Reporting” by Johnathan Kern:
    It’s a “he says/she says” story where every claim on one side of an issue is offset by a counterclaim on the other, without indication of which speaker has the facts on his side. … Even if you report the same actualities from both sides, the result will almost be a Rorschach test of one’s personal views. Any reader inclined to distrust [naturopaths] will end up siding with [skeptics]; any reader who tends to be scornful of [skeptics] will find himself agreeing with [CAM proponents]. And everyone will be no closer to the truth. If you produce a seemingly “balanced” story that relies on assertions that are untrue, you do the audience a disservice- even if it appeases one faction that feels strongly about the issue.
    … Most journalists know this, and try to approach all their interviews with a large dose of skepticism; the problems crop up when reporters are unconsciously inclined to believe and accept the assertions of one side more than the other- to adopt conventional wisdom uncritically, or to see one group as the good guys and the other as the bad guys.
    It’s important for reporters to always consider the source of the claim, since groups have vested interest in inflating [information] that support their cause. In other words, it is not enough simply to attribute a claim to a person or special interest-group; you have to do your best to determine that the assertions that people make in your [blogs] are true, or at least could be true.
    … A reporter has an obligation to check these amorphous claims-and to seek information and verification from someone who does not have an axe to grind.
    … When the allegation concerns a specific individual or institution, you have to make an even more exhaustive effort to represent all important sides of a story. When a reporter fails to do that, the reputation of your [blog] can be undermined. The harsher the criticism leveled against a person or organization the more you may need to work to verify accusations and present the other side. … Even when you have no expectation of getting a response from the subject of your story, you have to give it your best shot. … So make an effort to get all sides of a story, even if you assume that effort may be fruitless.

    +++
    Personally, I find it infuriating that Maloney hasn’t bothered to correct his own website. You’ll find a sprinkling of sarcastic comments by me in this post refuting his ‘scientific claims. I definitely have issue with Maloney’s “research”. Never the less, I find it plausible that Hawkins has misrepresented the steps leading to the shut down of his blog. Have I bothered to ask either Maloney, Hawkins, PZ Meyer or WordPress to verify the claim? No, but I’m not the blogger reporting this story.

  105. Steven Novellaon 21 Feb 2010 at 1:54 pm

    Draal – you make an interesting point – here are my thoughts.

    What you write applies to investigative journalism. Blogging is different. The advantage of blogging is that it is immediate. Bloggers often will pass along stories, sometime specifically to amplify them. As long as they disclose what they are doing, readers understand what is happening.

    The disadvantage of this is that there is no time for in depth investigative journalism. But – we compensate for that by just as rapidly updating and correcting stories.

    Most of science blogging is synthesis and analysis. There is a small bit of primary reporting or investigation, usually ad hoc and opportunistic. There is some reporting of primary research. Thre are some background pieces that require significant research. There is plenty of opinion.

    But it is all fairly immediate, and mostly done by those with day jobs in their spare time. The benefit is – you get the analysis of a working expert. The downside is – there is no time for in depth primary investigation.

    We are still working out the kinks. This story is a good example.

    I think rapid and transparent updating/correction is a good compromise.

  106. Draalon 21 Feb 2010 at 4:01 pm

    “What you write applies to investigative journalism. Blogging is different.”
    Yes, you’ve spoken on the SGU about this repeatedly. Specifically I was quoting from a book on radio reporting. To continue, “One of the advantages of broadcasting has over print is that it can bring news stories to people faster than they can be published. [S]ome radio reporters specialize in “one-day-turnaround stories” -that is, stories assigned, reported, written, edited, voiced, and broadcast in less that twenty-four hours, often much less.” So investigative journalism sometimes involves four or five hours to crash a piece together. Obviously, there is no substitution for for experience.

    I have no experience in blogging so I’ll just say it’s your call on how you want to write stories; I’ve stated my concern and I’ll leave it at that.

    Honestly, it’s rare to see you correct yourself and you definitely do when it’s been pointed out. I’ve been an avid follower of your blogs and podcasts for over 6 months now to learn and hone my skepticism. I’m much appreciative to your skeptical vigilance and it’s due to your own educational work that I’d even bring out my concern. :-P

  107. Steven Novellaon 21 Feb 2010 at 8:25 pm

    I wish I had 4-5 hours to dedicate exclusively to every blog post. But alas – I have a day job and a family, in addition to the SGU. Time available for writing is variable, and I adjust my topic accordingly – writing more complex or in depth pieces when I have time, and choosing lighter pieces when I don’t. It’s a tricky balance.

    The big difference is – this is not my job, I don’t get paid for this.

  108. tmac57on 21 Feb 2010 at 10:10 pm

    Well, from my biased perspective, regardless of the weaknesses and occasional errors in the skeptical blogs, they STILL appear to be doing a far superior job of reporting than the paid (sometimes highly) journalism outlets:print,TV,Radio, and internet. NPR comes close to being the most responsible outlet that I follow, but they have their limitations too. My opinion only.

  109. Perky Skepticon 22 Feb 2010 at 11:09 am

    I’m still quite impressed that you and Orac have the fortitude/energy to bang out so many intelligent words on current science-based topics Every! Single!! Day!!! I have no idea how you do it. But, thanks for using your powers for Good and not for, say, masterminding COBRA. :)

  110. Kimball Atwoodon 22 Feb 2010 at 6:19 pm

    “please find me any large or small study that shows alternative medicine kills anyone.”

    http://www.sciencebasedmedicine.org/?p=143

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2438277/?tool=pubmed (scroll to “Other Evidence of Risks”)

    “And much of what you do clearly kills patients, while our track record is a bit better.”

    http://www.sciencebasedmedicine.org/?p=3423

    (scroll to “The Third Leading Cause of Death” Myth)

  111. Quackaliciouson 23 Feb 2010 at 8:59 pm

    Dear Dr. Novell,

    Thank you for your reply about evidence. Could you be a bit simpler (we quacks have small brains)? Are you saying that if a botanical was positively reviewed by the Cochrane database you would begin to use it in clinical practice if nothing better was available?

    And a big welcome to Kim Atwood! Am I in the presence of Dr. Barrett’s protege? It is a small blogworld, isn’t it?

    I’m not going to respond to everyone else’s postings. I don’t want to spend any more time on this unless we could actually do something constructive, and that hinges around my being able to clarify the precise level of evidence required to avoid perpetual arguments about the quality of my studies.

  112. Steven Novellaon 24 Feb 2010 at 7:48 am

    Science-based medicine is a set of methods and standards – not beliefs and treatment modalities. We would use any treatment that met appropriate criteria for being science-based.

    We discuss what this means extensively on SBM. There is no simple algorithm. It is a combination of plausibility (based upon what we know from basic science) and clinical evidence.

    Clinical evidence, in turn, comes in many types, with varying strengths and weaknesses. You have to put it all together and make a judgment. You have to interpret the overall literature, which has patterns of evidence that go beyond an analysis of any single trial.

    But it’s fair to say that if a plausible treatment was backed by several large and well-designed blinded clinical trials with a significant and clinically meaningful benefit in excess of risk, and this evidence significantly outweighs any negative evidence, and there are no better options – it is reasonable to use that treatment in clinical practice.

    Cochrane reviews are a generally good quick guide to evidence, but they are not infallible. I have read several very biased or flawed reviews. In particular Cochrane reviews give too little weight to prior probability.

    Bottom line – there is not simple answer – medical evidence is complex.

  113. Quackaliciouson 24 Feb 2010 at 9:26 am

    Dear Dr. Novella,

    I’m hearing that as a very tentative yes. So the next step would be a quick list from you of five to ten neurological conditions that do not have good drug treatments right now. I understand that, given a decent drug, you’d prefer that over any botanical. But if no drugs exist we find ourselves in the area of “experimental” medicine, which is evidently where I live.

    My job then is to spend hours and hours trying to put together a few well supported options that you get to shoot down. If I succeed, your patients benefit. If I fail, well, I tried. I would like to move something like this to a new thread? I don’t like the title of this thread, as I don’t feel it is true.

  114. Joeon 24 Feb 2010 at 3:15 pm

    “please find me any large or small study that shows alternative medicine kills anyone.”

    http://whatstheharm.net/

    @Quackalicious on 24 Feb 2010 at 9:26 am “But if no drugs exist we find ourselves in the area of “experimental” medicine, which is evidently where I live.”

    That is awfully pretentious. You do not practice any form of medicine. Moreover, if you realize you are experimenting on your customers- do you tell them and not charge for it?

  115. Quackaliciouson 24 Feb 2010 at 4:50 pm

    Studies, dear readers, are not anecdotal reports. I have thousands of those showing that we cure everything under the sun. I want a study that shows that alternative medicine is responsible for deaths. In other words, medline studies on alternative medicine. The rest is hearsay and can be made up.

    To make it simpler, something along these lines:
    Arthritis Rheum. 2009 Aug 15;61(8):1037-45.

    Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial.

    Just to save time, it was our study, it was small and it was very positive. But it’s of higher quality (submitted to a peer reviewed journal and RCT) than the random websites or newstories I’m getting in response.

  116. Joeon 25 Feb 2010 at 5:38 am

    Sorry Mr. Maloney- a small, poorly-controlled study means little. Is that the best you’ve got?

    Can you supply a more complete citation next time? You know- the kind of citation the big kids use, including authors.

  117. Quackaliciouson 25 Feb 2010 at 7:47 am

    Dear Joe, I could provide the full abstract, but before your fellow readers got upset because I think full abstracts are too much to read. I believe Dr. Novella made this point, and it is his blog.

    I recommend copying the citation, going to medline, and pasting it there. You could also go to medline and type in the citation. If it’s really an issue, I would be glad to copy the full abstact here, and even put you in contact with the authors.

    Oh, and Enzo had difficulty finding my citation from the Dartmouth Atlas on increased mortality rates and increased medical care. I put that on my website, under Quackery and the modern medicine comparison. With Dr. Novella’s forebearance, I will post the entire excerpt here because I think it is important to place all medical care in context.

    Skeptics should go to http://www.darmouthatlas.org. Here is a brief excerpt from p.4, atlas and reports, Chronic illness atlas:

    “The study of regional outcomes was repeated, restricting the analysis to patients who received their initial care at academic medical centers. The results were similar: academic medical centers in high input rate, high spending regions provided more supply-sensitive services than those in low input rate, low spending regions. For example, during the first six months following hip fracture, patients using academic medical centers in high-spending areas had 82% more physician visits, 26% more imaging exams, 90% more diagnostic tests, and 46% more minor surgery. Nevertheless, patients in high-intensity regions had higher mortality rates and worse quality scores.”

    I believe the accusations against me and quackery in general are that I provide unnecessary, expensive, and possibly life threatening care. But when we examine the results of academic medical centers, arguably our best chance of receiving evidence based care, the evidence is that patients are receiving unnecessary, expensive, and ultimately life threatening care.

    But the second argument against what I do is that what I do has no scientific validity. Rather than being able to prove this negative, those who hold this view are attached to a belief.

    The belief that nothing in alternative medicine can have scientific validity is exactly what prevents the conversion of scientific fact into clinical practice. This is not limited to alternative medicine, but stretches across medicine where we see enormous resistance to evidence-based practices. To this day we have hospital employees whose primary job is to convince medical personnel to wash their hands despite hundreds of studies. And every medical resident I’ve known maintains a filthy lab coat as a “badge of pride.” The whole idea of a nosocomial infection should be a thing of the past.

    I have made a simple offer to Dr. Novella: provide me with five to ten neurological diseases that do not have good drug treatments. If I can, I will provide high quality evidence of alternatives within my field. Dr. Novella can shoot these down and have a field day at my expense. But if I am able to make a clinical case for the use of an alternative, Dr. Novella will consider it for clinical practice. I suspect that I will not be taken up on this offer because of of the belief that nothing I have to offer could have any validity.

  118. Quackaliciouson 25 Feb 2010 at 11:48 am

    Dear Dr. Novella and readers,

    It seems that Michael Hawkins’ blog site is back up, so either your campaign was successful or WordPress has a policy of suspending bloggers who are continually attacking them. Please check out his most recent attack on WordPress on http://forthesakeofscience.freewp.us/2010/02/06/wordpress-naturopaths-and-whining/

    It also appears that Hawkins is unable to “let go” of me causing his problems. If he goes offline again, it is entirely his own fault.

  119. Joeon 25 Feb 2010 at 12:00 pm

    @ Quackalicious on 25 Feb 2010 at 7:47 am “Dear Joe, I could provide the full abstract …”

    I got the abstract, which is why I commented that it was a small, poorly-controlled study. If that represents the epitome of ND research, your business is as pitiful as we thought.

  120. Quackaliciouson 25 Feb 2010 at 1:06 pm

    Dear Dr. Novella and readers,

    Michael Hawkins’ blog was offline for all of four days, including a weekend that involved a general WordPress failure of many sites. At this point it is clear the entire skeptic storm was a lot of screaming about nothing but standard software error. I don’t expect an apology anytime soon.

    If all of you are so good at research, why is it that I’m the one bringing this up three days after Hawkins is back online?

  121. Enzoon 25 Feb 2010 at 1:15 pm

    Quackalicious,

    I must once again accuse you of interpreting the literature inaccurately. First of all, for anyone interesting in reading the report you are citing it can be found here:

    http://www.dartmouthatlas.org/atlases/2006_Chronic_Care_Atlas.pdf

    The study is called The Care of Patients with Severe Chronic Illness: An online report on the Medicare Program by the Dartmouth Atlas Project.

    So…First off, we are talking about Medicare spending in a subset of chronic illnesses. Not medical care in the broad sense.

    My first post in response to your comment about the Dartmouth Atlas states:

    “The study tool for the efficiency of health care systems is to address the issue that the amount of a given region’s health care resources doesn’t always correlate with the quality of care (i.e. – there are other issues, like delivery of care).”

    This is exactly true. Now I didn’t read the entire article (it’s 120+ pages), but I don’t need to to understand what it is trying to say. YOU need to read it more carefully. The argument is not that more care = greater mortality. It addresses inefficiency in the system such that we may improve resource use, etc. The paragraph directly following what you quoted is:

    “Health care organizations serving such regions [low care intensity regions] are not rationing care; rather, they are more efficient, achieving equal and possibly better outcomes with fewer resources”

    This study is not monitoring individual treatments received by patients, it is monitoring mortality in high vs. low spending regions. The point isn’t that health care kills people. It’s that places that spend more Medicare money don’t necessarily achieve better outcomes. This is a problem and the study tries to highlight it so that we can improve. The reason for this is inefficient systems, NOT care given. It is kind of a subtle point but VERY different from what you are saying.

  122. RobHinkleyon 25 Feb 2010 at 3:49 pm

    Michael Hawkins’ blog was offline for all of four days, including a weekend that involved a general WordPress failure of many sites. At this point it is clear the entire skeptic storm was a lot of screaming about nothing but standard software error.

    No, Michael Hawkins’ blog was not the victim of “standard software error”; WordPress suspended it because of an allegation that it violated their Terms of Service. An allegation made by a alternative medical practitioner who seems to be cancer quack Andreas Moritz, but not naturopath Maloney.

  123. Kimball Atwoodon 26 Feb 2010 at 9:24 am

    “I want a study that shows that alternative medicine is responsible for deaths.”

    Sorry, Quackalicious, the linked studies are exactly that. Well investigated and verified. Not “hearsay,” definitely not made up.

  124. TianTangon 01 Mar 2010 at 11:54 am

    Dr. Novella,

    I think it is better to address Chris Maloney, as Doctor Maloney, as he has earned that right, just as you have. I do not like your tone towards him. He is a doctor of naturopathic medicine just as you are a medical physician. I think you would better serve yourself and your readers to first get schooling in naturopathic medicine before making statements about it. I think that is what any real scientific person would want to do.

    I visit this site from time to time. I felt compelled to respond to your article regarding Dr. Maloney. First, let us be clear here, vaccines lack the gold standard for scientific study. Second, most people find it strange that the pharma lobby is able to pass laws that hold them harmless from damages related to their products, that being vaccines. One could spend four years in medical school, just on the topic of crimes committed by pharma. This is catching the eyes and ears of the elite in Europe. with an investigation into the so called swine flu scare. Does anyone know how much money was made by pharma, during this time? People are waking up and asking questions. A society that questions its leaders is a healthy society. Yes, vaccines do in fact do a lot of good, but they also have potential to do bad things. The debate is not going to go away.

    I am well versed in political and economical debate, as well as scientific debate. Dr. Maloney has the right to defend his ability to practice naturopathic medicine. One thing I am consistently shocked to see, are people like yourself and others on your side of the fence. Is the name calling, labeling of people with views different from yours. I find myself remembering back sometime not long ago, when I listened to my sister in-law as she presented her thesis. It was regarding the Nazi occupation of Europe. I was shocked to hear what was allowed and tolerated by society, in those days. Name calling and labeling passed from being accepted in society, to actually becoming the laws in society. When I read articles like yours “Homeopaths on the run” and articles with similar views, I cannot help but remember a time when the world had gone completely and utterly mad. I invite you to read the books Maus 1 & Maus 2. It will be an eye opener for anyone who does not understand just how powerful words can be. If you ever want the other side to take your arguments with merit, I highly recommend you and your collueges stop the labeling and name calling. It is unbecoming of a physician. I never thought that I would see medical physicians speak that type of language and put themselves to such a low level of professionalism. It is wrong and politically incorrect. It is also crosses the very thin line of libel and slander. A really good attorney would have a field day with such behavior. Not to mention, if the people being attacked came together to file a class action lawsuit. Sometimes it seems that legal action is the only action that people listen to or understand.

    In the future, I hope to read articles that leave out the name calling and labeling of people. That type of behavior might have been accepted during the 30′s and 40′s in Europe, or even during the 60′s here in the States. But in today’s society, it cannot and should not be tolerated.

    One final note, medicine in the United States, is a for profit enterprise. Pharma has just one reason for existence, that being to make money. To make profit margins increase and increase overall revenue. They answer to the shareholders, whose only reason for investing, is to make an increase in their investments. They have penetrated every sector of medicine, from academic institutions to hospitals to the physician’s office. The NEJM has had problems with this as has many prestigious medical academic institutions. To find truly unbiased research in today’s society, is becoming harder and harder. To make a point and give an example of our current state of affairs. Let us take Mrs. D, who recently visited the ER. She waited almost 3 hours to be seen. Her chief complaint was frontal headache. She does not have insurance. When she was seen by the ER staff, she was examined and sent home with instructions to take an over the counter NSAID. What the staff at the ER failed to uncover, is that she has hx of bleeding ulcers. So she decides to skip the NSAID and get some rest. The next day she awakes to find out that she is also having a nasal discharge. It is clear in nature and she is also feeling weak. So she decides to visit a Naturopathic physician, as she does not want to wait in the ER anymore and most medical physicians refuse to see her all because of no insurance. During her visit she is examined, diagnosed and given herbs. She takes them and feels better after a few days. The point I am making here, is that medicine is in fact failing in many ways and people have the right to make their own choices. If a person decides to see a ND, they are much better off than seeing an unlicensed person or even worse self medicating themselves.

    We could spend a life time debating the current state of affairs with our medical system. So stop the name calling and use of unprofessional tactics to discredit people with different views than yours. Otherwise you just may find yourself in a heated and massive class action lawsuit.

  125. Steven Novellaon 01 Mar 2010 at 1:12 pm

    Tian – you apparently have not read very carefully.

    1 – please point out where I engage in name calling. You need to distinguish my post and comments from the comments of readers, like yourself.

    2 – NDs are not medical doctors, I do not believe they should be lisenced, and I am entitled to my opinion.

    3 – I never denied Maloney the right to defend himself. I merely criticized his logic and use of evidence. You, on the other hand, did not address the substance of my criticism but launched into a number of logical fallacies attacking my right to criticize.

    4 – Scientific criticism is not the same thing as Nazi genocide – see Godwin’s Law.

    5 – The pharmaceutical industry is for profit, and they have at times behaved badly. I have never defended any of their bad behavior, and in fact criticize it and call for more effective regulation. Bringing up “Big Pharma” as a bogey man, however, is a non sequitur – it does not defend bad science in medicine.

    6 – Your anecdote proves nothing – it’s an anecdote. Most people who present with a headache get better on their own. I could just as easily interpret your story as the ER was absolutely right to send the patient home, as she got better on her own. There is no scientific reason to think that the herbs given her did anything.

    7 – Insurance and how we pay for medicine is a separate issue than the scientific standard of care – so again you are mixing issues and creating non sequiturs. And – last time I checked, naturopaths charge for their services as well.

    8 – The implied threat at the end about being sued is a lame intimidation tactic. You should re-read the original post.

  126. Draalon 01 Mar 2010 at 2:26 pm

    I take exception to the assertion that Pharma’s sole purpose is making money.
    That means the only motivation for all the hardworking men and women with medical degrees, doctorates, masters and bachelors in all scientific fields working for a pharmaceutical company is to make money. Nah, I say to you. People with advanced degrees do not spend 4 years in college, 6 years in graduate school, and another 2 years as post-doctorates just to fleece Americans. A career in banking is much easier way to legally take money from people.
    The pursuit of science is what drives us. The pursuit of finding cures for diseases, infections, cancer, disabilities, injuries, ect. is what drives us. The pursuit of solving challenging problems is what drives us.
    All this work is not possible without the demand for cures. All this work is not possible without scientists and doctors. And all this work is not possible without money.
    So, sir, I insist you refer to me as Doctor as I’ve earned my Ph.D. and my title is recognized without question in all 50 states of the USA. We are not the greedy Pharma shills you paint us out to be.

  127. TianTangon 01 Mar 2010 at 3:00 pm

    Dr. Novella,

    I would first like to point out your linking a reference that says Dr. Maloney is a quack. When you link something into your post, it can be taken as if you stated it yourself.

    Your article regarding homeopaths on the run, classifies them as a cult. To do such a thing, would imply that you personally know every homeopath, which mathematically would be impossible.

    I can agree that “Scientific criticism is not the same thing as Nazi genocide – see Godwin’s Law.”, but what should be understood, is that criticism that engages in labeling an entire profession into a cult, or quack or pseudoscience, is in fact unethical. Remember this; it was so called science that was to prove that all Jews were bad. So it may not be Nazi genocide, but it can lead to genocide. Just look at world history, or even the history of our country. We cannot and should not label everyone with a certain belief or opinion into something bad or abnormal.

    When you make a statement like “There is no scientific reason to think that the herbs given her did anything.” you should first do some homework in the pharmacology of such. It is a fact that most of the drugs on the market, do in fact come from herbs and natural substances. So why is it, that only when they are patented and mass produced, or even taken out of their natural environment, that you seem to think they work. If the same herb Dr. Maloney gave to a patient was from the same sources as your prescription, then why would it not work?

    The system of Insurance and how we pay for medicine is a separate picture. This I do agree on, but it is part of the puzzle, which we still have not figured out, how to deliver effective care to everyone. Naturopathic doctors do charge for services, but much less than medical physicians charge. In a for profit society, with free market allowance, everything has a price tagged on it.

    Finally, I am not threatening you, what I am doing is bringing to light, that one day, all of these so called quacks, cults and pseudoscience people as you label them as well as your supporters label them, are going to put together a lawsuit, which takes slander and libel out of scientific debate. How can one claim to be scientific, if they are engaged in such activities?

    The biggest point to take home is that if you want people on both sides of the fence to listen to you. Then leave all the labeling and name calling out. Only then can we engage in real scientific debate.

  128. Steve Pageon 01 Mar 2010 at 3:39 pm

    There is no “real scientific debate” to be had with homeopaths – homeopathy is not science. The same goes for the vast majority of alt-med. Put that in your ear candle and smoke it.

  129. Steven Novellaon 01 Mar 2010 at 3:51 pm

    Tian – I linked to the Pharyngula post as a reference for the source of the story. That is not the same thing as if I wrote the article myself. Really – that is just nonsensical – you should just acquiesce on that point.

    Homeopathy is an insular belief system, it is not scientific, and it has insulated itself from falsification. It therefore has many features of a cult. That is not name-calling – it is description.

    You seem to be characterizing legitimate criticism as name calling – and then you have the temerity to use far far worse tactics than even what you accuse me of by likening it to the Nazis, or saying that it can lead to genocide. That whooshing sound you heard was your credibility flying away.

    My point about the herbs is not that herbs cannot work (read my many other articles on the topic if you are interested) – but that the story was just an anecdote. It proves nothing.

    Finally – did you watch the video with the homeopath? Now that is name-calling and libel. You should learn to detect the difference.

  130. TianTangon 01 Mar 2010 at 4:00 pm

    Well Steve Page and Dr. Draal,

    I am intrigued as to your tone? A really good emotional burst can sometimes spark a debate, but usually they all tend to cool off.

    So tell me Dr. Draal, what cures are you speaking of? The only real evidence I see these days with pharma is for selling ED relief? Hmmmmmmmm

    I do not think you are greedy pharma shills, I do not engage in name calling as others here seem to enjoy on this forum. Your hard work, is not at question, what is at question is the executive leadership of these corporations. I will not get into some childish debate. If you do a good job and are sincere then, my hat is off to you.

    As for Steve Page, sorry to bust your bubble, but I do not smoke, nor do I use ear candles. Let it be seen here, that this poster Steve Page is exactly what I am speaking about. These types of tactics are so similar to those of the Nazi. I am not calling you a Nazi, but you need to learn some manners and read history.

    I am still wondering what cures Dr. Draal is speaking of? Do you Dr. Draal deny the wrong doing in the pharma industry?

    The same could be said of a ND who spends 4 years pre med then another 4 years of medical school, then in some cases another 1-2 years of residency

    Tone down your comments and provide some evidence to your posts.

    Learn to be nice and debate friendly, I think after all that schooling, you would of learned that by now? Hmmmmm

  131. TianTangon 01 Mar 2010 at 4:06 pm

    Also for Dr. Draal,

    Sorry to bust your bubble, but you need to read the mission statements for every pharma company that is doing business.

    Do not fool yourself into thinking that pharmas sole purpose is not to make a profit and as much money as possible. If it were not, then why would shareholders invest into the big pharma machine?

    What pharma needs is people like Dr. Draal, who do not put money first. The only problem is, that will never happen.

  132. Joeon 01 Mar 2010 at 7:35 pm

    @TianTang on 01 Mar 2010 at 11:54 am “Dr. Novella, I think it is better to address Chris Maloney, as Doctor Maloney, …”

    Speaking for myself- Mr. Maloney has not earned a doctorate from a legitimate, academic institution and, thus, does not merit the honorific.

    You should go read about NDs and homeopathy et al at http://www.quackwatch.org

    As for the profit motive of Big Pharma, that is what Big Herbal and quacks are about. They can afford to charge less because they have no overhead since what they offer is not researched for safety and efficacy.

  133. TianTangon 01 Mar 2010 at 8:47 pm

    Well Dr. Novella, you have your opinions and that is it. Your label of homeopathy is just that, your opinion. If you ever studied world history or had any real knowledge of the subject I am speaking of, then you would be able to see the link. You may not like hearing it; but I do speak the truth.

    Joe, this site and the posters on it, never seem to stop amazing me. You make a statement like that, about a University that is both nationally and regionally recognized by the Dept of Ed (both state and federal). Why don’t you do your homework before you decide to make a statement with no merit?

    I will have to link this site and its posters to my sister; she will have a field day with you guys. This would be a great educational lesson on how people still use Nazi tactics.

    I just cannot believe that medical physicians associated with the institutions they claim to be, actually lower themselves to this really low level of behavior. Abnormal behavior is present in all walks of life, I guess even in the medical professionals.

    I can see it now, Dr. A from this site, is doing rounds in the local community hospital. A patient, whose mother is a homeopath, decides they are going to incorporate both into their treatment. Dr. A then decides to start calling the patients mother a quack and cult nut. Then even goes as far to say that they are not allowed to do so. So the Admin decides that this Dr. A, does not belong in a hospital setting.

    So go ahead people, keep up your unscientific attacks. You only make the case for the opposition. I now realize that you are not allowed to do so, in a public setting. So get use to it, as this is the only place you can speak your mind. In the real world they would lock you up or slap you with a lawsuit that would instantly make you love what you seem to hate.
    It really makes someone wonder just what people will do in order to get into the pharma checkbook? Hmmmmmmmmmmmm? Very interesting question I might add

    I really think some of you need a psych consult STAT

  134. ChrisHon 01 Mar 2010 at 10:33 pm

    TianTang:

    This would be a great educational lesson on how people still use Nazi tactics.

    Godwin!.

  135. Joeon 02 Mar 2010 at 4:02 am

    @TianTang on 01 Mar 2010 at 8:47 pm “… You make a statement like that, about a University that is both nationally and regionally recognized by the Dept of Ed (both state and federal).”

    There is/was an accredited school of astrology http://64.233.169.104/search?q=cache:53OEGhaHbjIJ:query.nytimes.com/gst/fullpage.html%3Fres%3D9F02E3D71F31F93BA1575BC0A9679C8B63+astrology+accreditation&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a Accreditation need not mean much- Vern > Bullough “Free Inquiry” Winter 2001-2002 pp. 21-22. Basically, it assures that the school is financially sound and has the faculty and facilities as advertised. In the case of naturopathy, there is probably some oversight by NDs; but those are only the inmates in charge of the asylum.

  136. Steven Novellaon 02 Mar 2010 at 7:08 am

    Tian – you demonstrate nicely the hypocrisy and poor critical thinking skills of the pro-CAM side.

    You accuse me of name-calling and unscientific behavior, when I have only put forward a scientific and logical argument, largely sticking to the evidence.

    Meanwhile, you commit several egregious ad hominem attacks yourself, seemingly oblivious to the fact that you are using the very tactics you falsely accuse me of using.

    You have characterized by arguments as Nazi tactics.

    You have accused me of being a Pharma shill and in the Pharma checkbook (all without evidence).

    You have somehow deluded yourself into thinking that we are hiding here (in public) because we could not get away with our scientific criticisms in public.

    You falsely accuse me of libel, all the while committing actual libel yourself (yes – claiming I am on the take is libel).

    You seem to think that I owe the purveyors of unscientific medical practices every courtesy and deference, while deserving none myself.

    Really – it’s been quite a display. Thank you.

  137. Enzoon 02 Mar 2010 at 9:22 pm

    I can’t believe Godwin’s Law has been tripped. Amazing.

    So now in addition to being offended by Malony’s initial comments that physicians kill people and their children..I now add being offended by Tian, who broadly states that pharma and everyone that can fall under that blanket is solely profit motivated. This is the all or none kind of thinking that Dr. Novella often accuses CAM proponents to subscribe to.

    I’ll remind you again that it takes hundreds of millions of dollars and over twenty years to develop a single drug, the great majority of which fail at various stages. It is a lot of cost to absorb. Not to mention scientists that work in pharma don’t make huge sums. As someone mentioned, it would be much easier to go into business if profit was the sole motive. And by the way, most drugs are not herbs that have been patented. *IF* they started from an herb it has been highly studied, highly modified and highly purified by the time it reaches a clinical setting. They eventually come off patent and generics can be made more cheaply — an area that is under scrutiny for improvement right now.

    As was told to me, a physician might save hundreds of lives in his or her lifetime, but a scientist working on developing a drug might have contributed to literally saving millions if the drug is effective.

    And by the way, you said “I think you would better serve yourself and your readers to first get schooling in naturopathic medicine before making statements about it.”

    Does this mean you need to go get schooling in actual medicine to comment about it? Oh and while you are at it maybe a position at a pharmaceutical company so that you may comment about that? Maybe a legal degree to comment about libel law? OH! And a history degree to comment about Nazi tactics. See what I’m getting at?

  138. Quackaliciouson 10 Apr 2010 at 2:15 pm

    It’s troubling to see the terms science and logic bandied about by individuals who are clearly simply expressing subjective opinions. I have spent the last month on PZ Myers endless thread attempting to elicit a single study supporting any of the following assertions 1) naturopathic medicine kills people 2) naturopathic doctors harm people or 3) there are no studies supporting naturopathic medicine. In response, I have received nothing but profanity and references to how scientific everyone else is on the site.

    The continuing defence of a belief system without providing scientific proof or objectively evaluating what evidence is given is not science. It is a belief system characterized by the term authoritarianism. While most common among religious fundamentalists, it is also clearly evident among a great many of the American atheist crowd. PZ Myers is a spokesman for this group, and evidently Dr. Novella is a follower. Altemeyer has studied authoritarians for thirty years and has published a fascinating online book. I have placed links to this book on http://www.maloneymedical.com, bottom of the left side menu, on the Pharyngula Attack page. I also detail the multiple studies I have supplied and the astonishingly unscientific responses.

    On this site, while profanity is not used, I have failed to see any objective, scientific evaluation. Dr. Novella failed the basic humanitarian exploration of a possible treatment for ALS, his area of specialty. He requested that I provide information and when I did he has not replied (homeopaths on the run thread). I suspect strongly that his belief system has clouded his ability to explore legitimate possibilities to the detriment of his patients.

    Wishing you all a change of heart.

  139. SquirrelEliteon 11 Apr 2010 at 12:53 am

    Quackalicious,

    I find it curious that you decided to add a comment to this blog-thread where the last comment was over a month ago, but so be it.

    Personally, I respect P.Z. Myers as a scientist but don’t follow his blog much because, to mince words just a bit, I find myself dissatisfied and uninterested in the overall mixture of subject matter. That is my choice.

    However, I offer the following advice:

    1. Read the original blog post and try to keep it in mind, even if you are responding to the meandering subjects in the comment thread. I do not understand how claiming Dr Novella subscribes to the belief system known as authoritarianism invalidates his criticism of Christopher Maloney for using legal threats to shut down a blog written by a student who disagrees with him. If anything, it is Christopher Maloney who is being authoritarian.

    2. If you wish to engage in a logical discussion, be logical yourself. Referring to someone else as “authoritarian” says nothing whatsoever about the validity of their statements. It is a logical fallacy known as ad hominem or tu quoque depending on the details of how it is used.

    3. Try to keep your comments short and to the point. Avoid the 3+ screen length wallpaper postings. We have a few dedicated readers who will indeed dig through them, but most reader/commenters on these blogs lack the time to dig through them to try to figure out what you are getting at. Pick your best example and give a clear explanation of how it demonstrates or supports your point.

    4. Do your homework. Naturopathy and homeopathy are not the primary focus of this blog although Dr Novella is of course free to choose what he wishes to write about. There are plenty of articles on those subjects on Science Based Medicine. There may be better places to start, but try reading Dr Atwood’s series on CAM at Harvard. Here is a link to the first one.

    http://www.sciencebasedmedicine.org/?p=438

    By the way, since you seem to support the effectiveness of homeopathic treatments, how do you distinguish between a 10 ml bottle of distilled water and a 10 ml bottle of a 20C diluted homeopathic “medicine” diluted from the same source of distilled water?

  140. Quackaliciouson 15 Apr 2010 at 9:19 am

    Dear Squirrel Elite,
    I was giving Dr. Novella and others ample time to respond to my cited research. I would love to leave briefer messages, but other posters seem unable to follow simple links to places like http://www.maloneymedical.com to read even the abstracts before posting.
    If you take the time to look at Homeopaths on the Run, you will see that my comments are completely on point when discussing Dr. Novella. He disregarded my research entirely, even though he is ideally placed to do research on ALS. Again, I cited the data here on the blog because I didn’t want to be accused of “faking” it.
    Authoritarianism is a belief system that most clearly explains the type of “scientific” attitude that will not explore new medical hypotheses. It is not objective science. I am seeking to explain how skeptics move so far into their own belief systems they cease to be objective.
    Dr. Novella is the specific target here because, if you read the follow ups or the PZ Myers blog, he continues to lie about me in the title of this blog post. He acted as a bad journalist, and has been taken to task by several people on this very thread.
    Dr. Atwood is the protégé of Dr. Barrett. He epitomizes authoritarianism.
    I would refer you to the five thousand plus research articles on homeopathy, the meta-analyses of homeopathy, and my own website: http://www.maloneymedical.com under homeopathy.
    In other words, Squirrel Elite, all of your comments have been answered in the threads, here and on PZ Myers.

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.