Dec 15 2008

Skeptical Battlegrounds: Part III – Alternative Medicine

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Comments: 31

Being both a skeptic and a physician I have focused a great deal of my skeptical efforts towards science and medicine. While I endeavor to be a full-service skeptic, pseudoscience in medicine is definitely my specialty. It is therefore especially painful for me to admit that in this arena, more than any other, we are getting our butts kicked. We are almost at the point of being routed, with the defenders of scientific medicine being relegated to the role of insurgency. How did this happen?

What is Alternative Medicine?

I think the biggest victory scored by the promoters of complementary and alternative medicine (CAM) was the name itself. Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery. The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all – a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberate blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.

The goal of CAM proponents is nothing less than the elimination of the standard of care in medicine in exchange for an anything goes approach. Key to their strategy was the language game – getting people to talk about fraud and pseudoscience in medicine as if it were a legitimate “alternative”, that pseudoscience can “complement” science or be “integrated” with it. Scientific medicine was rebranded with derogatory labels such as “Western” and “allopathic.” Anyone defending the scientific standard of medicine was attacked as closed-minded, and accused of protectionism.

The very fact that there is a category of medicine such as CAM, whatever you call it, is a significant defeat for scientific medicine. CAM as a category includes an extremely diverse collection of claims and modalities that do not share a common theme or philosophy, including some that are mutually exclusive. The only thing they have in common is that they do not meet the scientific standards of mainstream medicine. The only purpose of the CAM category is to create a space in which substandard or unscientific modalities can exist. It exists to create a double standard.

A Perfect Storm of Anti-Science

Wallace Sampson, writing for Science-Based Medicine, gives an excellent overview of the last forty years of medicine and what went wrong. He points to several cultural trends that conspired together to allow the anti-scientific revolution to occur. These include political correctness – which has had the effect of rendering appropriate scientific criticism as impolite. The post-modernist influence in academia also played a major role, one aspect of which is the portrayal of science as just another narrative without any special relationship to the truth. In fact science, according to some post-modernists, is just a way for one group (in this case Western white males) to impose their power over minorities and the oppressed.

Add to this a general anti-establishment movement beginning in the 1960s. CAM proponents were successful in portraying scientific medicine as the Establishment – something that needed to be taken down. This evolved into the “health care freedom” movement, the ostensible purpose of which was to earn freedom for the public to access whatever health care they wanted. In reality the health care freedom movement is about earning freedom for practitioners to do whatever they want, free from any regulation meant to protect the public. I find it one of the greatest ironies of the CAM phenomenon that they have been able to pass laws that are overtly anti-consumer, in that they remove protection from fraud or incompetence, in the name of consumer freedom. Why hasn’t Ralph Nader noticed this? What if the auto industry promoted “automobile freedom” laws so that consumers could buy any vehicles they wanted, free from any government quality or safety regulation?

This brings up the political dimension of CAM. Proponents have been successful at working both sides of the aisle, appealing to anti-regulation sentiment on the right and anti-corporate/anti-establishment sentiment on the left. Unfortunately, science has no political party.

And of course all of this is happening in a generally scientifically illiterate society.  In my experience most of the public does not understand why homeopathy cannot possibly work (it’s just water), why scientists are confident that there is no mysterious life force at work in the body, why chiropractic subluxations make no sense, and why megadosing vitamins or the latest fad tropical fruit juice cannot cure everything.

And yes, of course, there are legitimate criticisms of mainstream medicine. The system is under great financial strain. Technology, while extremely effective, is very expensive and may render some medical encounters very unpleasant and frightening.  The ethical model in medicine has also shifted from a paternalistic model, where doctors just did what they thought was best, to a cooperative model that focuses on informed consent.  This is a good thing, but it means that physicians are ethically obliged to tell patients the whole and unpleasant truth. We do not have the luxury of lying to patients to make them feel better. Charlatans have no such constraints.

Tactical Defeats

The specific tactical defeats of scientific medicine include, first and foremost, the cultural non-judgmental acceptance of an “alternative” category of medicine. But in addition to this, there is the NCCAM (National Center for CAM), which was created specifically to fund CAM research. These funds, however, are generally spent doing studies designed to promote CAM, not answer the only question that really matters – does it safely work. More than a decade and hundreds of millions of dollars later, there has not been a single CAM modality that has been proven by research to the point that is has gained general acceptance, nor has any modality been rejected as disproven. Sorting what works from what does not work is the primary purpose of medical research, so in that regard the NCCAM is an unmitigated failure. But, it has lent incredible legitimacy to CAM.

Health care freedom laws have been passed in almost 20 states – eliminating the ability of states to act against practitioners simply because what they are doing is substandard (as long as they self-label what they do “alternative”). That’s right – eliminating the standard of care.

The Dietary Supplement Health and Education Act of 1994 removed “supplements” from the control of the FDA, and redefined supplements to include herbs used as drugs, and pretty much anything else that is not already a drug. It also created a separate category of health claims, so-called structure function claims, that are beyond regulation. This led to an explosion of the supplement industry.  This allows snake oil peddlers to decry the excesses of the highly regulated pharmaceutical industry, while making billions in the largely unregulated supplement industry. To further increase the irony, in many cases the two industries are one and the same.

A reasonable person might think that medical academia would be the last line of defense for scientific medicine. Surely trained medical scientists can see anti-scientific propaganda for what it is and will defend the scientific integrity of their profession. Unfortunately, this is largely not the case. Academics have been cowed by calls for “freedom” and political correctness. Promoters have learned to speak the language of academics to further subdue their skepticism – using pleasant terms like “holistic”, and “patient-centered” practice. Like most deceptions, there is always a kernel of truth to such ideas. But in the end it all amounts to a sweet-sounding justification for outright pseudoscientific quackery in medicine.

This happens, however, because the academics who should know better are largely asleep at the switch. They have mostly put CAM into the hands of proponents, because they are the ones who are interested. Most physicians and scientists are “shruggies” when it comes to CAM – they just don’t think about it and don’t want to think about it. So proponents have been able to become the gatekeepers of their own claims. CAM proponents are appointed to committees on CAM, are able to make CAM curricula for students, and decide what CAM journals should be registered with the International Library of Medicine (which means they can keep out critics). The foxes are in charge of the hen house.

What this also means is that those few of us who are trying to point out that the Emperor has no clothes (to use a tired metaphor), and defend science-based medicine are made to seem like ideological, closed-minded fanatics.  Defending science in medicine is no longer politically correct – at least not within the alternate reality of CAM.

Evidence-Based Medicine

More irony. Over the last couple of decades there has been a growing movement within mainstream medicine called evidence-based medicine (EBM). One might think that EBM would have worked to retard the advance of CAM but the opposite was true. It is an unfortunate happenstance of history that the minds behind EBM inadvertently played into the hands of CAM proponents.

The concept behind EBM is that  medical modalities should be judged primarily by the empirical evidence, not by their plausibility. The reason for this was the perception that too many practices were being widely used because they made sense – they were plausible – despite a lack of evidence that they actually worked. Therefore EBM was constructed to eliminate the advantage of plausibility. Medical claims require evidence no matter how plausible they are.

But by eliminating plausibility (or prior probability) from consideration EBM also leveled the field for highly implausible claims, even though this was never the intent. EBM is not unreasonable in a world where it is assumed that treatments and claims make basic scientific sense, but it is not equipped to deal with a world in which highly implausible claims are being promoted. This had the effect of almost eliminating basic science from consideration. Under EBM claims that are highly implausible are treated the same as claims that are highly plausible. This approach exists no where else in science.

Therefore, CAM proponents just adopted the language of EBM. It did not take long for CAM modalities to have the EBM label slapped on them, whether or not they earned it even by the flawed methods of EBM. I see “evidence-based homeopathy” or “evidence-based acupuncture” promoted all the time, even though these terms are oxymorons.  Even without consideration of prior plausibility CAM modalities do not fair well under EBM examination, so proponents simply lie. They claim their methods are EBM even when no formal EBM evaluation has validated them. They behave as if their personal assessment of the evidence is sufficient to support a claim of EBM, when in fact there are formal methods of systematic review that are required.

But the EBM infrastructure is vulnerable. They already fail to put CAM modalities in their proper scientific perspective by considering prior probability. And now they too are putting the foxes in charge of the hen house – allowing CAM proponents to perform and publish biased EBM reviews.

A Ray of Hope

I recently wrote about the National Health Statistics  on use of CAM by Americans. The stats have been misrepresented by proponents to argue that CAM is increasingly popular, followed by the argument ad populi that therefore they should be supported. A closer look at the data, however, shows that the hard-core CAM modalities are still marginal, and not significantly increasing. In the last year only 1.4% of Americans used acupuncture, 1.7% homeopathy, and 0.5% energy healing (by self report). These numbers are not significantly different than 20 years ago.

Use of these modalities remains marginal. I am not sure exactly how to interpret this. The best-case interpretation is that most of the public still regards the magical claims of homeopathy and acupuncture with skepticism. The most pessimistic interpretation is that the public accepts these modalities in greater numbers, but the infrastructure has not yet expanded to meet demand.

I also find some comfort in the fact that most of my colleagues have not drunk the Koolaid of CAM. They regard it as quackery – and yet frustratingly think it’s not their responsibility to do anything about it.  But perhaps there is a growing backlash against the nonsense. I think as CAM’s profile increases, the sham at its core is more apparent. Maybe.

Conclusion

The situation is grim. A generation of health care providers is being indoctrinated into unscientific acceptance of dubious claims and methods. The public has largely bought the framework of CAM. Even among skeptics I find that CAM is a frequent blind spot. The propaganda has simply been extremely effective.

Most disheartening is that academia has largely failed to recognize and confront this attack on science. They now understand well the threat of creationism/intelligent design. They get it. They do not understand how CAM erodes the scientific basis of medicine and the standard of care.

Those of us who are opposing the infiltration of pseudoscience into medicine have an uphill battle, and no apparent allies. We have been marginalized. We are also a couple of steps behind the CAM proponents in understanding how the language and the laws are being manipulated. We’re catching on, but we are already far behind.

The situation is not hopeless, but it is desperate. I think in the long run science always has the advantage that it actually works. But history has shown us that cultural inertia can be immense. As CAM becomes infused in the culture and in the institutions of health care it is becoming entrenched and will be difficult to remove. It will likely continue to be a drain 0n the effectiveness and efficiency of health care for decades to come.

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31 responses so far

31 Responses to “Skeptical Battlegrounds: Part III – Alternative Medicine”

  1. Clinton Huxleyon 15 Dec 2008 at 8:22 am

    Presumably, natural selection will take care of this problem eventually…..

    In the UK one of the main problems in this area is that we have self-important and yet utterly ignorant blowhards like Charles Windsor (apparently, he is a “Prince” or something. The French had the right idea about what to do with them…) promoting the foolish nonsense of CAM. Aggravating in the extreme.

  2. DevilsAdvocateon 15 Dec 2008 at 9:44 am

    Hear, hear. Standing O.

  3. Eric Thomsonon 15 Dec 2008 at 9:54 am

    Very interesting stuff.

    Do med students have to take a statistics course to get the MD? I assume so, which makes the CAM phenomenon even more strange.

    Do any mainstream top-tier medical schools include courses or modules on CAM in their curricula? And if so, is it critical or accepting?

  4. Steven Novellaon 15 Dec 2008 at 11:21 am

    Many schools do include CAM (based on the ad populi argument) and they are largely in the hands of proponents. I am currently fighting against his at my own institution. There are a few good programs around the country, but they are the exception.

  5. Clinton Huxleyon 15 Dec 2008 at 11:43 am

    I wonder if those who opt for “alternative medicine” would choose “alternative surgery” if they ever found themselves in an emergency ward….I doubt it.

    “Now, Mr Johnson, you have two options. We can stitch your finger back on and use micro-surgery to reconnet the blood vessels and nerves…..OR we could shove your hand in a pile of elephant dung during a full moon and hope your finger grows back….”

    Re the schools thing – there are universities in the UK offering degrees in homeopathy and the like (presumably the lower you score in your exam, the higher a degree you get awarded…)

  6. Skepticoon 15 Dec 2008 at 11:59 am

    What if the auto industry promoted “automobile freedom” laws so that consumers could buy any vehicles they wanted, free from any government quality or safety regulation?

    Didn’t I read something similar about the need for freedom when designing bridges? Oh yes – Alternative Engineering.

  7. daedalus2uon 15 Dec 2008 at 1:01 pm

    Actually, some types of dung can be very powerful sources of nitric oxide and could well have substantial healing properties. Ancient Egyptian women did use crocodile dung as a pessary. Precisely for what is not clear because there is a hole in the papyrus describing what it does.

    Crocodiles are uricotelic organisms, they excrete nitrogenous waste as uric acid. That turns their urine white and semi-solid. In the soil, uric acid is broken down and eventually oxidized to nitrite and nitrate in the process of nitrification. Autotrophic ammonia oxidizing bacteria that generate the NO and nitrite, and my research indicates that the NO and nitrite they produce has beneficial physiological effects.

    My own research has indicated that composted manure from another uricotelic organism (chicken) is a very powerful source of NO.

    Dung has been used by indigenous peoples in Africa and also in India to treat the umbilical cord of newborns. I presume that this is to prevent tetanus because the Clostridia are exquisitely sensitive to NO and nitrite (that is why meat is cured with nitrite).

    Dung may have special healing properties. I don’t think it would substitute for microsurgery, but a surface biofilm of the relevant bacteria might greatly speed healing by preventing infection by heterotrophic bacteria and by increasing perfusion through NO mediated vasodilation. Because any infection by heterotrophic bacteria will cause the release of ammonia (from deaminated amino acids), having endogenous bacteria that convert that ammonia into NO and nitrite at the site of heterotrophic infection might have substantial health benefits.

  8. misselaineon 15 Dec 2008 at 1:08 pm

    This rings so true. I find it odd that my fellow scientist friends give me a hard time for being so involved anti-religion and anti-psuedoscience events. It is almost like they think that I am the crazy, unbalanced person and not the other way around. In regards to CAM, I often hear comments like, “Oh, who cares if it isn’t proven, maybe it will work. Anyways. I know lots of people who swear by (insert CAM here).” I also know professors who aren’t bothered by the fact that creationism may be taught in our schools. They think that it doesn’t matter because they know that they will teach THEIR kids differently, so who cares? I just can’t believe that they are not seeing how all of this is completely eroding the public’s belief in science overall, which of course will effect them. It’s hard enough to get grants as it is now, for goodness sakes! But, when I explain to them the peril of this slippery slope, I often find that they had just never thought about it that way. So, maybe we can wake these people up before it is too late!

  9. Potter1000on 15 Dec 2008 at 1:14 pm

    You’re always good at sounding these battle cries, Dr. N, but we shouldn’t be discouraged by the indications that we’re losing the war. We should expect to be losing the war. With virtually every topic we we are concerned about, we are fighting an uphill battle against an opposition whose rules are looser than ours. It’s almost always easier to win over the public using oversimplified yet vague emotional appeals to ignorance than by using nuanced truth and logic. But science always always marches on, making the world better.

    You’re doing a tremendous amount of good with these medical issues and many others. Not only do true-believers encounter your arguments, but those on the fence do as well. And probably most important, the choir you are often preaching to learns from you, and we spread our influence in what little ways we can. We may lack your expertise, but we still have influence. And strangely, many people are much more open to be influenced by non-experts than experts. After all, experts typically are already in the pockets of those in power, as you know.

  10. DevoutCatalyston 15 Dec 2008 at 2:26 pm

    I have one word for you Steven, just one word. Are you listening?

    Chiropractic.

    Chiropractors have transmogrified themselves from back-cracking simpletons into little Swiss army knives — there are activator techniques for young sophisticate, applied kinesiology if your practice is limited to the super gullible, there’s thermography for cancer screening. Huh? Yeah, chiropractors can offer an alternative to mammography. “Your breasts are in good hands with Chiropractic”.

    What separates intelligent man from the carnival act is his use of tools. The stuff of chiropractic is child’s play, but they’re staking their claim to ideas ever further beyond their grasp. Why would anyone entrust cancer screening to a chiropractor?

    Was Wilk v. AMA the event that opened the door to much of today’s nonsense? Do you see any of the forthcoming battles against CAM winding up in court?

    What’s the overall strategy, the big picture, General?

  11. epguyon 15 Dec 2008 at 2:50 pm

    Dr. N,

    Thanks for a great post. These certainly seem like dreary times for our profession.

    I am a fellow at a prestigious academic medical center – I guess you could have categorized me as a “shruggee” when I was in medical school / residency. In an exercise as a student, I specifically remember being told that my practice would suffer if we disavowed the (hypothetical) practicing chiropractor. The message was simply that patients were going to get wrapped up in CAM on their own accords, and that it was not our place to impinge upon their “health care freedom”. I responded by adopting the laissez faire attitude you described succinctly above.

    It took me several years of practice (and skeptical schooling courtesy of SGU, The Demon-Haunted World, etc) to see the downside of passive acceptance of CAM as just another obstacle in clinical medicine. In addition to the affront to the scientific medicine and hijacking of EBM (of which I consider still myself a practitioner – by the way – ever read the article “Seven alternatives to EBM” in BMJ?), I am finiding the failure to engage the issue downright dangerous and counterproductive! Of the meds I prescribe, drugs with ridiculously complex pharmacology such as warfarin, amiodarone, and digoxin are easily included in the top ten. Add to this list other meds with incompletely understood catabolism – other anti-arrhythmics, immunosuppressants, etc. – and we have to admit that nobody can predict what will happen when you throw some St. John’s or unproven CAM med into the mix. I’ve taken a harder line in my practice, admitting to patients that I can’t vouch for the safety or efficacy of the meds patients are taking if they insist on using herbal supplements.

    As far as trying to influence medical education and other physicians – I certainly share in the frustration. As an instructor of clinical epidemiology / EBM to medical students, I’ve had the occasional opportunity to fire a salvo on CAM, at the same time encouraging the application of sound skeptical scientific method. At one point, I distributed the fMRI/PET study of “telepathy” featured some time ago on the NESS; I was pleased when my students, without much encouragement, tore the methods and conclusions limb-from-limb.

    The point of all of this is that, yes, I am now in the choir. I wasn’t always. Even though I wasn’t personally shoving Gingko in peoples mouths, the passive acceptance has contributed to the problem. It is now clear to me the basic principles of science upon which medicine is founded can not abide CAM.

  12. Annieon 15 Dec 2008 at 3:24 pm

    I did my nursing graduate work during the days of Martha Rogers holding court at NYU espousing her “theory of unitary man.” Pure bunkum, but she was building a following who then migrated into nursing academia and research in the days when nursing research programs were mostly in their infancy and where other disciplines routinely accused nursing of turf invasion. So the emphasis was on developing new territory. This occurred during the same timeframe as the rollout of DRG’s, prospective payment and managed care/HMOs where the therapeutic physician/patient relationship was being undermined and eroded.

    I think these factors coupled with the growing reliance on technology over care, and treatment over health management (un-reimbursed and highly reliant on a trusting relationship) helped to drive people away from the impersonalization and discomfort toward the familiar, immediate and comforting.

    I don’t believe that skeptics of CAM are marginalized so much as CAM has invaded and dominated the public media landscape.

    My best guess is that CAM will eventually be found wanting through the *demon* lawyers when patients have poor outcomes and lawyers see a class action opportunity. I also am inclined to think that when professionals who provide direct care take back professional autonomy and authority and demand to be reimbursed for establishing and maintaining therapeutic relationships via patient assessment, coaching, and health management, that patients will flock their way.

    Actually, they already are flocking – but there isn’t room for them to perch. For example, Maggie Mahar at the Health Beat blog recently chronicled the plight of the newly insured in MA and discovered that they now can’t afford care because their scarce dollars paid for insurance policies which have high deductibles, co-pays and restrictions, and that concomitantly, primary care physicians are swamped and have no room for new patients.

    All the pieces must be in place in order for patients to receive care: affordability, accessibility and appropriate.

    When any of those is absent or insufficient – in essence, a vacuum state, they will seek out alternatives to fill that vacuum of perceived need. That appears to be what they are doing – in droves.

    Excellent post and lots to consider in this complex situation.

  13. marineron 15 Dec 2008 at 3:31 pm

    I was disappointed to read in Parade Magazine yesterday, an article entitled “Alternative Therapies that Really Work,” by Dr. Mark Luponis. The article cherry-picked a few divergent studies to claim that acupuncture “may” work for several unrelated conditions. Alpha error and confirmation bias are probably better explanations for how these results got reported in Luponis’ article than any actual effects of acupuncture on such things as the breech position of fetuses.

    A couple of skeptics have already commented on Luponis’s article ( http://www.parade.com/health/2008/12/alternative-therapies-that-work.html ) — anybody else care to add a comment?

  14. amaon 15 Dec 2008 at 5:42 pm

    >The very fact that there is a category of medicine such
    >as CAM, whatever you call it, is a significant defeat for
    >scientific medicine.

    Not for scientific medicine, but
    a) for the whole mankind and
    b) for science

    Idiots rule. That’s the point.

    >CAM as a category includes an extremely diverse
    >collection of claims and modalities that do not share a
    >common theme or philosophy, including some that are
    >mutually exclusive.

    No, they co-exist. They cannot power a fact-based war for survival as that would have to be done with FACTS! But they do not thingk about that, because they have a common enemy: FACTS!

    CAM in itself already is a part of warfare with language. Alone to use the word “CAM” is a mistake.

    [A note about the (political) warfare in Germany: The German Democratic Republic used the abbreviation "DDR" (Deutsche dekokratische Republik). The communist underground spearheaded a (in the long run effective) war by replacing the name Deutschland with the abbreviation BRD, this way undermining the renommee of "Deutschland" as commonly used name for western Germany.]

    >The only thing they have in common is that they do not
    >meet the scientific standards of mainstream medicine.

    No.

    Scientific medicine follows the rules of science.
    Science follows the rules of logic.

    So, the esoteric stuff does not meet the rules of logic. THAT is the key.

    >The only thing they have in common is that they do not
    >meet the scientific standards of mainstream medicine.

    No.

    The use of the word “mainstream” already accepts that there is more than what “most in the herd” do.

    What “most in the herd” do, well, that is “the usual stuff”, but “WE ARE BETTER!!!” – and there you get the other part of that fraud sceme: the esotters are the self-declared ELITE, they are NOT the mainstream.

    >The only purpose of the CAM category is to create a
    >space in which substandard or unscientific modalities
    >can exist. It exists to create a double standard.

    Not only that, the are “the better ones”. They have the feeling, they have the knowledge, the have the WHOLE world of nature, they have the WHOLE body, they have the soul… THEY are the caring, the reliable, they are the REAL mankind.

    And, as I wrote, by scratching at this surface, their superiority is taken away, and they face reality: that they are bloody idiots. It is lethal for them as it their superiority is the key to their right of existence.

    WE do right, we follow the rules of logic.
    THEY cling to their superiority which is based on their NEGATION of logic. Watch their words: the esotters do aggressivly (even expressis verbis) fight against logic.

    Right of the start they are imposters. Like children playing adults. They even establish THEIR OWN “science”, just to have one, and theirs of course is better. And here we have one more key: the seamless transition of infantile behavior as adult behavior ACCEPTED BY SOCIETY.

    And, just to say it again: we must not use meta-language or meta-discussions. We must all the time use the REAL fundamental words, expressions and descriptions. A great deal of the language war is about exactly this: to force misleading meta-stuff into common use.

  15. amaon 15 Dec 2008 at 5:52 pm

    @mariner

    >I was disappointed to read in Parade Magazine
    >yesterday, an article entitled “Alternative Therapies
    >that Really Work,” by Dr. Mark Luponis.

    I know for a long time, that Marylin by far is not as bright as is claimed.

    http://www.parade.com/articles/editions/2005/edition_12-18-2005/Ask_Marilyn

  16. amaon 15 Dec 2008 at 6:07 pm

    >…there is the NCCAM (National Center for CAM),
    >which was created specifically to fund CAM research.
    >These funds, however, are generally spent doing
    >studies designed to promote CAM, not answer the only
    >question that really matters – does it safely work.

    We have an analog situation in Germany: by using “Stiftungsprofessuren” (donated professor.ship), universities are abused to install a professor (with a bit of personnell) to “research” some esoteric stuff. The University of Kassel is such a case. There anthroposophs paid some few million Euros, a Stiftungsprofessur was launched, and in some years THE STATE will take over and pay. But even if the state will decide not to pay, in these years of the Stiftungsprofessur, they wanted damage already is done: By abusing the renommee of the University of Kassel the anthroposophic bullshit gets the rank of science. And, note, you cannot wipe this out afertwards. It is part in the history of science.

    So, you see, it is so easy and so very cheap to corrupt “the system”.

    Hogwarts School of Vienna:
    SUPER_KLASSE_HERVORRAGEND/http://www.transgallaxys.com/~aktenschrank/Laborjournal_deckt_auf_Klabautermaenner_regieren_Uni_Kassel.jpg
    http://laborjournal.de/editorials/225.html

    http://www.transgallaxys.com/~kanzlerzwo/showtopic.php?threadid=4010
    http://www.transgallaxys.com/~kanzlerzwo/showtopic.php?threadid=3926

  17. amaon 15 Dec 2008 at 6:30 pm

    @DevoutCatalyston 15 Dec 2008 at 2:26 pm

    >there’s thermography for cancer screening

    I think that thermography can be very useful, IF it is used with the right analysis. But in the hand of quacks it is used as an alibi tool: they use it to claim some [whatever] and then to treat that with their fake treatments.

    In Germany we have a young company (18 years and still being a “young company” is great…) Indago (formerly BMIB) which claims to do nano particle analysis. It is a fraud from a to z. But they even got money from the Kreditanstalt für Wiederaufbau (that is the bunch of zerobrainers, who sent 300 million euros AFTER they saw that Lehman Brothers was down).

    The purpose of the nano particle analysis is to back up the naturopaths and esotter doctoriots with a “scientific” diagnosis, so that they can sell their treatments (whatever those may be).

    The Indago/BMIB guys are so audacious that they even sued one of their critics, Klaus Keck.
    (see his homepage at http://www.xy44.de )

    Neither the Kreditanstalt für Wiederaufbau nor the Sparkasse Leipzig nor any German attorney tried to shut down that fraud gang.

  18. amaon 15 Dec 2008 at 7:01 pm

    >Those of us who are opposing the infiltration of
    >pseudoscience into medicine have an uphill battle,
    >and no apparent allies. We have been marginalized.

    Yes, but why?

    The most important reason in Germany is the “Standesrecht”. Translation could be something like “laws of rank” or “laws of society”.
    In Germany engineers do not have a Standesrecht. They really are free.
    Medical doctors and lawyers have a Standesrecht. Their profession imposes on them laws of conduct on how to do their job, how to behave in public, AND HOW TO BEHAVE AMONG EACH OTHER.

    The latter part is the important one. If an engineer finds that another one messes up, he may say so. But a medical doctor can lose his “Zulassung”. A medical doctor is NOT free in his speech. A medical doctor is not free to critisize anothe rmedical doctor. And THIS is the gate wide open for ANY quackery.

    the Standesrecht must be erased totally. Engineers do not have a Standesrecht. They do not need one.

    If the engineers messed up like medical doctors, even the wheel would not have been invented.

    Did you know that in Germany the anti-vaccs base their warfare onto the Standesrecht? Yes, they declare that no-one can force them into giving vaccination, and that it were unconsitutional to make laws which force medical doctors to make vaccination.

    Please note: in Germany a medical doctor cannot be forced to do a treatment he does not like. So, a medical doctor can refuse ALL vaccination. And the esotters declare it to be unconstitutional to take off his license because of that.

    Now, if a medical doctor thinks, that vaccinaton is good, and that laws should be made like in the USA “no vaccination, no school”, then this medical doctor gets in the hell of being accused of acting against the Standesrecht.

    In Germany and Austria we have Dracula in the blood bank.

  19. amaon 15 Dec 2008 at 7:37 pm

    O, sorry, I spoiled that link:

    http://www.transgallaxys.com/~aktenschrank/SUPER_KLASSE_HERVORRAGEND/Laborjournal_deckt_auf_Klabautermaenner_regieren_Uni_Kassel.jpg

  20. sonicon 16 Dec 2008 at 2:09 am

    What people want is to be in good health. They want treatments that work and information that is truthful. They don’t really care about a war and who wins it.

    As for information that is truthful-

    http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020124&ct=1
    Why Most Published Research Findings Are False
    John P. A. Ioannidis
    “There is increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims [6–8]. However, this should not be surprising. It can be proven that most claimed research findings are false.”

    This paper gives good ideas about how to do better.
    As people interested in science we must be aware that scientists are people and that all science is to be revised. There is no theory so great that it will not be found false.
    “We have no right to assume that any physical laws exist, or if they have existed up to now, that they will continue to exist in a similar manner in the future.”
    Max Planck
    (and no, you don’t know more about science than Max did)

    As for treatments that work (with the above problem well in mind)

    http://www.mayoclinic.org/news2006-rst/3495.html
    “The results of the study convince me there is something more than the placebo effect to acupuncture,” says David Martin, M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist. “It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients.”

    http://www.sciencedaily.com/releases/2004/11/041123212055.htm
    “Acupuncture, as a complementary therapy to drug treatment for osteoarthritis of the knee, is more effective than drug treatment alone, find researchers from Spain in this week’s BMJ.”

    http://www.medscape.com/viewarticle/547251
    “Patients with chronic pain due to OA of the knee or the hip who were treated with acupuncture in addition to routine care showed significant improvements in symptoms and quality of life compared with patients who received routine care alone,” the authors state.

    The cool thing about science is that I am always learning how wrong I am about certain things.

  21. Clinton Huxleyon 16 Dec 2008 at 11:25 am

    Tighten up the protocols on those clinical trials and I would bet a modest sum of money that those “positive effects” would magically disappear.

  22. jessiedarkon 17 Dec 2008 at 9:21 am

    All right so what do I do? My daughter’s pediatrician, a respected doctor and teacher at a MAJOR university hospital offered my husband the option of treating her ADD/Anxiety/Insomnia (she was born severely dyslexic with some other signs of integrative issues) holistically????? I came to her for medicine. Now my daughter’s therapist doesn’t want to meet with my husband because she wants to use some of the ‘alternative” medicine supports in the community. How many times can I change therapist/doctor until I find one who is not so open minded her brain is falling out?

    I actually became angry when the staff at my clinic (mental health) was proud to introduce a new staff person with a speciality in “ALTERNATIVE MEDICINE”. I can’t logically fight it because they have this insane idea it is being taught at major universities so it must be real. We have a psychiatrist who regularly prescribes herbs and supplements.

    What is the answer, how do we fight when the very acts of combat are seen as “buying into big pharmacies, being closed minded?”

    I’m frightened, I truly am.
    There is a clear movement to ‘honor’ alternative medicine.

    And then, I recommend Yoga and exercise and deep breathing to address stress and for self care. I am then told that I using alternative medicine.

    So a guestion: Is there a difference in Alternative versus Complimentary medicine?

    What is the role of physical activity versus alternative medicine; I have been told and from what I thought were reasonable studies; there are documented improvements in coping wth mood disorders (non-suicidal depression, non-debilitating anxiety, poor sleep) from increased activity?

    Is that wu? Is it real?

  23. sonicon 18 Dec 2008 at 4:57 am

    jessiedark- I would hope you went to the Dr. so that your child could be helped.
    If we divide the world into “complementary” and “alternative” and “scientific”, we lose sight of the actual purpose-
    Will the therapy help the condition?
    New things about ADD are being learned everyday. Ask the Dr. why she is suggesting what she is suggesting.
    (Sitting in front of a bright light can do more for deprssion than drugs.– Who woulda guessed?)

  24. [...] useful essays on the problems with Complementary and Alternative Medicine (CAM). I especially like Steve Novella’s article: I think the biggest victory scored by the promoters of complementary and alternative medicine [...]

  25. Skepthinkon 23 Dec 2008 at 7:56 pm

    Dear Dr. Novella, Dear Skeptic fellows,

    I hope nobody has already pointed out the following (sorry if that’s the case). Did you know about THIS?

    International Society for the Study of Subtle Energies (like we say in Spain, “¡ahí es nada!”)
    http://www.issseem.org/about.cfm

    They feature a “peer-reviewed” journal. Please for laughter visit http://www.issseem.org/journal.cfm

    It’s like the Fountain of Youth for Skepticism: tons of neverending debunkable frauds! A whole university degree could come out of that.

    Dr Novella, I hope you find some time to deal with this.

    Merry Christmas!

    P.D.: I think the ISSSEEM is about to release a “peer-reviewed” article on Santa Claus sightings based on anecdotal evidence, yeti testimonials and UFO shopping patterns.)

  26. Infinite Monkeyon 30 Dec 2008 at 3:05 pm

    Mr. Huxley, I’d have to disagree with your thought of natural secation on two accounts. First, they’d have to pass before they reproduce. The problem with that is they usually have at least had children before they turn to alternative medicines. Second, that thing that states that you have to specifically refuse medical help would take precidence when they get to certain point.

    So, I submit before the peers for review my idea of alternative selection. I got it from the geniuses at Walt Disney from thier movie “Ol’ Yeller”.

  27. salzbergon 15 Jan 2009 at 10:57 am

    Excellent post, Steve! I agree that we’re getting overwhelmed by pseudoscience (CAM) proponents, but we have to try to fight back.

    Readers of this blog can help. I just posted a proposal to the Obama transition team that they eliminate funding for NCCAM. They have a site set up for new proposals, and proposals that are popular will (presumably) be taken seriously. If readers of this blog will vote for my proposal, perhaps we can slow down the CAM movement. Here’s the link:
    http://citizensbriefingbook.change.gov/ideas/viewIdea.apexp?id=087800000004y2f
    You have to login to vote, but the process only takes about 30 seconds. In less than an hour, my proposal already has at least 4 negative votes from CAM proponents, who obviously don’t like the idea. Each “yes” vote increases the proposal score by 10 points.

  28. Steven Novellaon 15 Jan 2009 at 11:25 am

    salzberg – nice job. I signed up and voted for your proposal (and added a little comment myself). I will write a post about it on SBM and link to it.

  29. Fifion 15 Jan 2009 at 11:54 am

    Well if yoga is “alternative medicine” so are skiing and snorkeling…um, anyone care to write me a prescription so my holiday, er, healing journey can be a tax write-off…

  30. salzbergon 15 Jan 2009 at 8:33 pm

    Thanks for the support, Steve! PZ Myers wrote a blog post today supporting my proposal as well:
    http://scienceblogs.com/pharyngula/2009/01/how_to_save_225_million_dollar.php
    and his huge audience of Pharygulists have been supporting it in large numbers. Orac posted as well.
    -Steven

  31. [...] Steven Novella recently wrote a great piece on how Evidence Based Medicine is losing the battle against complementary and alternative medicine. [...]

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