May 14 2007

The Standard CAM Response

In response to my chiropractic and carpal tunnel syndrome blog of Friday, Ardell wrote the following comment:

It is truly sad that so many are mislead. There are agencies with agendas that make specious claims like being “scientific” – in reality nothing could be further from the truth. The medical community is run by the pharmaceutical industry in our times. Natural products are not used – not because they don’t work but because they can’t be patented. Money rules the world and the pharmaceutical industry has the majority of it when it comes to healthcare. It isn’t even healthcare in this country – it’s disease care. The media is also paid by these agencies so if you watch it how could one expect you to think differently then you are being programmed to think. True natural healing looks at the body and asks what is the cause of disease? Natural health practitioners assist the body to heal itself. There are many disiplines and it is up to us to educate ourselves on our own health. You can educate yourself on your own body or let someone else take care of you. If you’d like more information go to my website

The above response is such a wonderfully concise and typical piece of CAM (complementary and alternative medicine) propaganda I thought it would be instructive to address it.

“It is truly sad that so many are mislead. There are agencies with agendas that make specious claims like being “scientific” – in reality nothing could be further from the truth.”

I completely agree. The National Center for Complementary and Alternative Medicine (NCCAM) is one such organization. It pretends to be scientific, but in reality most of its activity involves promoting CAM, not testing specific modalities to see if they are in fact safe and effective. There is also a growing infrastructure of “peer-reviewed” journals promoting CAM, and it is not unusual now for hospitals or even medical schools to have CAM departments.

Such institutions are the very definition of pseudoscience – they have surrounded themselves with the trappings of science, but lack the true process of science. Here’s one big clue – has any CAM research ever proven that a CAM modality does not work? Has any CAM organization ever concluded that a specific CAM modality is not effective and should be abandoned? The answer is no. Any endeavor that claims to be scientific but never has negative findings or rejects claims, is guaranteed to be pseudoscience.

“The medical community is run by the pharmaceutical industry in our times.”

There is no question that the pharmaceutical industry has influence. They have big bucks, and with money comes influence. They fund research, which means they get to dictate the direction of that research.

But to say that the pharmaceutical industry runs the medical community is a naïve and uninformed bit of conspiracy thinking and fear mongering. First, the industry is highly regulated. These regulations are increasingly designed to limit their influence on physicians and the practice of medicine. Pharmaceutical research is also highly regulated, and although there are problems with this regulation (like there is with every single kind of regulation carried out by human beings) it basically works. Drugs that are unsafe or ineffective are generally filtered out, and most of those that reach the market have adequate evidence for safety and effectiveness and turn out that way in practice. Some drugs slip through the cracks, some companies misbehave, some officials fall down, but the overall system works. We do need to maintain vigilance, and we do need to continually explore ways of tweaking the system to make it better.

Also, the “medical community” is not a monolithic entity that can be controlled by a single industry, organization, or interest group. The medical community is comprised of individual doctors, universities, medical schools, research companies, state licensing boards, federal regulatory agencies, scientific journals, allied professionals, drug and medical device producers, research funding agencies (both private and government), insurance companies (which includes the state and federal governments), and patient/disease advocacy groups. There is also a legal tort system that provides a separate layer of quality control through threat of lawsuit. These separate entities contain many individuals with differing backgrounds and training, and, more importantly, different interests and motivations. To say that the pharmaceutical industry runs this complex social construct is downright absurd.

As an academic physician I take particular offense at such suggestions. Academics, those teaching, doing research, sitting on editorial boards, and largely running professional organizations – have a disproportionate effect on determining what the standard of care is. These are people who have largely decided to forgo the much higher incomes of private practice in order to dedicate their time to research and teaching. Their academic reputations (their most valued asset) is determined by their scholarship and honesty. Shilling for a pharmaceutical company is the quickest way to squander that.

Of course, this happens, and there is also legitimate concern about individuals having a conflict of interest because they get huge sums of money from industry. But this is more the exception than the rule. Also, there are increasingly stringent rules in place at multiple levels to both prevent and openly disclose any conflicts of interest.

The bottom line is that the medical community is a complicated assortment of multiple independent organizations, and in the final analysis the most reliable scientific information tends to win out. The system is not without fraud or conflict of interest, but there are serious and effective efforts to minimize these negative influences. So it is not reasonable to dismiss all of scientific medicine as a conspiracy of big pharma.

It is also a false dichotomy – because CAM practices also have interests other than the simple health of their clients. Chiropractic is a huge and powerful lobby and generally lobbies for laws that benefit them. (Although chiropractic is really several professions operating under the same banner.) Further, chiropractors have no moral high ground from which they can say doctors are more motivated by profits than they are – if anything they have less.

“Natural products are not used – not because they don’t work but because they can’t be patented.”

Wrong. First, the concept of “natural” is pointless, and doctors and scientists don’t even make such distinctions. There is no good definition of what is “natural”, nor does having this poorly defined quality say anything about the safety or effectiveness of any particular treatment. Natural substances can be deadly poisons, and designer molecules may be completely safe and effective. The concept of “natural” is nothing more than a marketing tool, and also an intellectual misdirection from the only thing that really matters – scientific plausibility and evidence for safety and efficacy.

Also, natural products – or those derived from, say, plants and animals, are widely used. Many of our pharmaceutical products are derived from plants and animals. There is no bias against what is natural. I prescribe true supplements (vitamins and other substances normally obtained from food or that the body can make for itself) all the time – in accordance with the evidence. Again – the only thing that matters is logic and evidence.

It is true that substances that can be obtained from nature without alteration cannot be patented – you cannot patent a plant – and that this reduces their profitability. But despite this, there are many studies into herbs and other widely used unpatentable products. Such studies are carried out by university based or government funded research. The research also largely shows that the herbs in popular use largely do not work for the indications they are commonly used for.

Further, regulations in the US and most other countries are such that unpatentable products can be marketed without requiring pre-market research. This is a huge advantage in the marketplace. The proof of the pudding is in the tasting – the supplement industry has exploded to a multi-billion dollar industry. Also, there is no longer a distinction between the pharmaceutical industry and the supplement industry, and big pharma has learned there is money to be made in supplements.

So it is not plausible to cry “boo hoo” about the poor oppressed “natural” product industry, when they are doing just fine, making billions, and even tempting the pharmaceutical industry to get in on the action.

How such unpatentable products should be regulated is an interesting question that I don’t have time for today – maybe for a future post.

“It isn’t even healthcare in this country – it’s disease care.”

That’s a great soundbite, but what does this even mean? It is usually used to mean that mainstream medicine does not focus on prevention – only intervening in acute diseases. What rubbish! True preventive medicine was invented by scientific medicine, and is still a hallmark of good medicine. Doctors prescribe drugs to prevent strokes and heart attacks, manage blood pressure and cholesterol (to prevent diseases) study the effects of weight on diabetes, recommend vitamins to prevent specific diseases, like spina-bifida, have been on the forefront of the campaign to stop smoking, etc. True disease prevention and health maintenance has always been at the core of scientific medicine, and this is increasingly so as time goes on. That scientific medicine does not focus on prevention is simply a bad rap, not based on anything factual.

“The media is also paid by these agencies so if you watch it how could one expect you to think differently then you are being programmed to think.”

Another case of the pot calling the kettle black. Scientists and academics are not “programmed” by the media. But CAM proponents have been very successful in “programming” the public with slick campaigns of misdirection – like the notion that “natural” is better, or in demonizing the pharmaceutical industry.

“True natural healing looks at the body and asks what is the cause of disease?”

Wrong again. Name one CAM modality that addresses the true cause of any disease. First, most CAM modalities do not even treat “diseases” as “disease” is not part of their philosophy. They treat illness, restore balance, and promote wellness. “Disease” is a scientific reductionist concept. Ick.

Acupuncture restores the balance and flow to chi, homeopathy treats “miasmas”, therapeutic touch fluffs up your human energy field, straight chiropractic restores flow to your “innate intelligence,” coffee enemas get rid of unspecified and unmeasurable toxins, etc. None of this has any relationship to reality, let alone an understanding of the true cause of any disease. Applying the word “natural” to any of this is also just a non sequitur. It’s meaningless.

But it’s really good propaganda. It’s easy to claim that you treat the true underlying cause of disease when you just make it up. If I assume, according to my philosophy of healing, that all ailments are caused by the blockage of a mystical undetectable energy called skeptitrons (I just made that up) and my treatment restores the flow of the skeptitrons, then within my made up healing philosophy I am addressing the true underlying cause of all disease. But there is no external objective validation through scientific research – so it’s all just a bunch of nonsense.

“Natural health practitioners assist the body to heal itself.”

The body has a certain, substantial ability to heal itself. Other than generally good nutrition, good sleep habits, avoiding trauma or other negative health effects, there is not much we can do to enhance our natural healing ability. But it is really easy to claim that a magical treatment can do so. Since most ailments will improve on their own, almost any intervention is likely to seem to work.

Also, medical intervention is often required because of an acute ailment – an infection, a trauma, the appearance of a tumor, etc., that is likely to benefit from a targeted medical treatment. Chronic illnesses and those that do not get better on their own result from situations in which the body cannot heal itself. It needs help. Sometimes, the disease wins, because humans are not perfect machines.

But many CAM practitioners promote a feel-good and profitable philosophy that we can live to a ripe old age in perfect health if only our bodies were free to heal themselves. If only this were true, but there is a mountain of evidence to the contrary. When things break down, or the self-healing ability of our bodies is exceeded, we require real, scientific, reductionist medicine. Not feel-good fantasy.

“There are many disiplines and it is up to us to educate ourselves on our own health. You can educate yourself on your own body or let someone else take care of you.”

Yes, there are many disciplines, and many of them are mutually exclusive. They operate within philosophies that are not compatible with each other. But modern medicine is science based, and science is, by its very method, open and transparent – so it should be all mutually compatible.

Ardell then makes an appeal to self-empowerment. This is one of the most effective tools in the CAM proponents’ propaganda arsenal: “You can take control of your own health – don’t just submit to someone else.” This often takes the form of so-called “Healthcare Freedom” laws that seek specifically to eliminate the standard of care (at least for CAM) by saying that consumers should have access to whatever they want – even if it’s fraud. (In practice these laws give practitioners the freedom to commit fraud or practice substandard medicine – it is about their freedom, not the consumer’s.)

The problem with all this freedom is two-fold. First, it portrays all attempts at quality control as if they were authoritarian and protectionist. Second, it assumes that the best outcome will result from people making their own healthcare decisions without the benefit of professional advice. The evidence simply does not support this. In fact, even physicians should not treat themselves in the absence of advice from another physician.

I am not advocating for complete surrender to a professional, and I do recommend that everyone assume ultimate responsibility for their own healthcare. But the best outcomes result from a cooperative relationship between the patient and their healthcare provider. The professional has the training, knowledge, experience, and detachment to make helpful recommendations. The patient, however, ultimately has to agree to the treatment, and often to enact the treatment, even if it just means being compliant with a medication prescription, behavioral change, physical therapy, or whatever. Patients should ask questions and understand their doctor’s recommendations. They should seek appropriate specialists, get second opinions when necessary, and keep educated about their illness and what options are available.

But they should stop short of actually treating themselves (excepting, of course, for benign, self-limiting, everyday ailments).

Further, the idea that patients should be empowered to treat themselves is just another piece of propaganda. What CAM proponents want to do is for you to buy their product or service – to submit to their ministrations. But they want you to think you are taking control simply by rejecting the mainstream. Often, in fact, they encourage dependence – like getting weekly adjustments for the rest of your life.

Aredell is selling his own dubious chiropractic care. Do take a look at his website – you will see that Ardell thinks there is a conspiracy to hide cancer cures and has a video promoting laetrile as a cure, advises against vaccinations, and thinks that cholesterol is not a risk factor for heart disease. (How’s that for disease prevention.) But it’s OK, he has a large number of celebrity endorsements to assure you that chiropractic works.

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