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Alt Med does harm

I always hear this argument that, well, maybe those herbs and enemas don’t help that much, but they don’t hurt, and they make people feel better, so get off alternative medicine’s back. Right. Because distractions from real medicine don’t affect the legitimate work being done.

You might want to read this criticism of the National Center for Complementary and Alternative Medicine.

Paul Offit’s editorial in The Journal of the American Medical Association (JAMA. 2012;307(17):1803-1804.) goes through the history of the National Center for Complementary and Alternative Medicine(NCCAM) and nicely points out that studies funded by NCCAM have failed to prove that complementary or alternative therapies have any more benefit than placebos.

Offit points out how NCCAM spent $374,000 proving lemon and lavender scents do not promote wound healing, $750,000 to prove that prayer does not cure AIDS, or improve recovery from breast reconstruction; $390,000 to find that ancient Indian remedies do not control type 2 diabetes, $700,000 to find that magnets to not treat arthritis or even carpal tunnel syndrome; and $406,000 to show that coffee enemas do not cure pancreatic cancer.

Half a million here, half a million there begins to add up to some real money. Now maybe your big R1 universities sniff at that level of funding…but I’m at a small university where we’re accustomed to scraping by on little bitsy budgets that would barely constitute a single line item at a bigger place, and I see $400,000 uselessly sluiced into the colons of cancer patients, accomplishing nothing but increasing the discomfort of dying people, and I think…wow, that much money represents a huge difference in education.

And don’t get me started on the prayer study. I’d get down on my knees and fucking pray to any deity you want to name if it would bring in that much cash to my university. Of course, we’d use it for something a lot more useful than pretending magic incantations might heal viral diseases.

Also, it’s not just NCCAM: homeopathy sucks up a lot of money and wastes a lot of effort in Europe.

Comments

  1. dianne says

    maybe those herbs and enemas don’t help that much, but they don’t hurt,

    HA! Here’s the lecture I give residents and fellows about herbs and other “natural cures”:

    Plants make a lot of substances that are medically useful. Why? Not because the plant is being nice. It’s because the plant is trying to kill you! Plants evolved to produce toxic chemicals to prevent animals from eating them. We’ve found ways to make some of those chemicals useful. But yew trees and periwinkles don’t produce taxanes and vinca alkaloids because they want to help cure cancer, they do it to make anything fool enough to eat them sick. Never trust a “natural” product to be safe.

    I’ve said this with variations about fifty times in the last year. I’m probably starting to get a reputation as a drug company shill or something, but I’ve gotten the fellows to list alternate meds the patients are taking explicitly. And sometimes that’s made the diagnosis.

  2. Matt Penfold says

    I’ve said this with variations about fifty times in the last year. I’m probably starting to get a reputation as a drug company shill or something, but I’ve gotten the fellows to list alternate meds the patients are taking explicitly. And sometimes that’s made the diagnosis.

    You would have thought it was pretty obvious.

  3. ibbica says

    Ugh. OK, a few questions:

    1. Where is the NCCAM’s grant money coming from? Is it directly siphoning off money that could be used for other research? I’m not sure we can really complain *too* much if people are spending their own money on things “we” think are silly. But of course I reserve the right to call their actions ‘silly’ :P

    2. This is… awkward for me to ask, but: How is arguing that these things aren’t worthy of study any different from arguments against funding fundamental research that doesn’t have any readily-accessible tangible benefits? Is there *no* justification underlying the project grant requests? I mean, I can (and sometimes do) explain my own projects rather flippantly, but that doesn’t mean there aren’t scientific underpinnings and potentially useful outcomes… And for every story about “stupid things scientists bothered to research” there’s one about a “counter-intuitive result” that wouldn’t have been known if no-one had checked. That being said, when an overwhelming mountain of evidence insists on no effect (e.g. acupuncture), then yeah maybe it’s time to stop ;)

    3. How the hell do you spend THAT MUCH money on projects like those described? What is the money actually being spent on? Although if (not uncommon) 40% is university overhead, and it includes, say, a single postdoc’s salary for two years, it would approach a more understandable value.

  4. Beatrice says

    Isn’t interaction with other natural remedies or legitimate medicine also a problem with natural remedies?

    I remember that a friend ( who finished pharmacy) mentioned ginseng and wikipedia confirms that it shouldn’t be mixed with antidepressants, among other things.

  5. dianne says

    You would have thought it was pretty obvious.

    It probably would be if “natural=good and safe” weren’t such a pervasive meme in the culture that it’s gone into everyone’s unconscious.

  6. Matt Penfold says

    Isn’t interaction with other natural remedies or legitimate medicine also a problem with natural remedies?

    Yes. In some cases it make people seriously ill.

    I remember that a friend ( who finished pharmacy) mentioned ginseng and wikipedia confirms that it shouldn’t be mixed with antidepressants, among other things.

    St.John’s Wort is another than should not be taken along with anti-depressant.

  7. katansi says

    Torn on this. I think natural remedies (which also includes things like exercise, good diet, etc.) do have a place in medical care… as long as they’re backed up by science. I hate that money’s being wasted on garbage but at the same time a lot of people will try anything that hasn’t been proven not to work and I think those without critical thinking skills should be protected by predatory or stupid quacks.

  8. lucifermourning says

    in fairness, i think anything a substantial number of people are using to try and heal themselves is worthy of some study.

    not because lots of people using it increases the probability of it’s truthfulness. rather, because lots of people using it means there are a lot of people risking their health without accurate information, and providing properly researched facts about the efficacy, or lack thereof, of various treatments is important.

    because negative results are important too, even if they don’t get enough press.

    and it is a health risk to use unproven methods; if nothing else, it can divert time and money from things that are demonstrably useful.

  9. dianne says

    Isn’t interaction with other natural remedies or legitimate medicine also a problem with natural remedies?

    Yes. Warfarin is particularly flaky that way. Also chemo interactions. Green tea interferes with bortezomib, just to give a random example.

  10. Matt Penfold says

    Torn on this. I think natural remedies (which also includes things like exercise, good diet, etc.) do have a place in medical care… as long as they’re backed up by science. I hate that money’s being wasted on garbage but at the same time a lot of people will try anything that hasn’t been proven not to work and I think those without critical thinking skills should be protected by predatory or stupid quacks.

    There are a lot of drugs that contain active ingredients that were first isolated from plants. Some are still made from plants, whilst others can now be synthesised. Drug companies spend a fortune looking for novel molecules in plants, and finance explorations looking for new species.

  11. Sastra says

    I get the “what’s the harm?” response a lot. It’s particularly galling when the alt med proponent admits that the quackery-of-choice may indeed be a placebo — but so what? Isn’t the whole purpose of medicine to make the patient feel better? Does it really matter why they feel better? You can’t argue against something that “works” … not unless imposing your ideology is more important than helping people who want help, they say.

    There are a variety of good responses to this:

    1.) A placebo effect is a superficial effect. It won’t work for all, it won’t work for long, and most importantly it won’t actually get at the root cause of the problem. “Mind over matter” will only go so far. And when it doesn’t work — guess who gets blamed? The poor patient, who now has to contend with the idea that they’re sick because they have insufficient “mind power” or gumption.

    2.) Because the placebo effect is superficial, a real problem for which there is real treatment can get masked. By the time everyone figures out the quackery-of-choice isn’t actually doing anything, the real issue may be more advanced and harder — or impossible — to treat.

    3.) Where’s the integrity here? Where is the respect for the patient? What we’re now talking about is lying: a benevolent lie, a little bit of fib to fool the ignorant. Someone is making the choice to lie to someone “for their own good,” just like Mommy does to a toddler. If we want to leave the bad old days of paternal medicine behind — when doctors were gods who could not be questioned and the patient’s duty was to shut up and do as they are told — then invoking a sort of maternal medicine is going in the wrong direction. Who the hell are you to decide that someone else can’t or shouldn’t be treated like a capable adult and dealt with honestly?

    4.) Where’s the integrity here? Where is the respect for the advance of human knowledge? Where is the concern that we learn from our mistakes and progress in the real treatment of disease and alleviation of pain and suffering? When you’re dealing with placebos the only thing we find out is how good some people are with mental framing. That’s not unimportant, true. But it’s pretty damn limited.

    5.) Hell — where is the respect for the actual treatment? The quackery-of-choice, the woo du jour? If the only effect of applying it is a placebo effect, then not a bit of anything you say or think about the treatment matters. It’s all for show. You don’t have to fit the medication to the patient; you don’t have to understand the cause and course of the disease; you don’t have to know herbs; you don’t have to know all about the traditions of ancient wisdom; you don’t have to have anything “right.” There is no right because now there is no wrong. Naturopaths, reiki masters, homeopaths, etc.– NONE of them have to study anything but ACTING. When it gets right down to it, you just gave everything in alternative medicine to the Marketing Department. And we all know how much your “I’m a nature-loving rebel who won’t be manipulated” little self loves consumerism.

    I suppose there are other responses I can’t think of right now, but most of them are probably variations on the above.

    My personal experience, by the way, when trying to make the above points, is that the conversation was then steered into proposals that all of reality is an illusion created by a cosmic consciousness of which we are a part and therefore the placebo effect was far, far more magical a

  12. frankb says

    I’d get down on my knees and fucking pray to any deity you want to name if it would bring in that much cash to my university.

    So PZ, are you saying that, religiously speaking, you can be bought?

  13. Matt Penfold says

    Where’s the integrity here? Where is the respect for the patient? What we’re now talking about is lying: a benevolent lie, a little bit of fib to fool the ignorant. Someone is making the choice to lie to someone “for their own good,” just like Mommy does to a toddler. If we want to leave the bad old days of paternal medicine behind — when doctors were gods who could not be questioned and the patient’s duty was to shut up and do as they are told — then invoking a sort of maternal medicine is going in the wrong direction. Who the hell are you to decide that someone else can’t or shouldn’t be treated like a capable adult and dealt with honestly?

    I don’t know about the US, but I do know that here in the UK one of key reasons to avoid placebos that is taught to medical students is the fact it violates the trust that needs to exist between patient and doctor. They are taught that being positive about the chances of a treatment working can be beneficial, so rather than say studies have shown that in 25% of patients the treatment did not work, they should say that in 75% of cases it did work.

  14. Sastra says

    I get the “what’s the harm?” response a lot. It’s particularly galling when the alt med proponent admits that the quackery-of-choice may indeed be a placebo — but so what? Isn’t the whole purpose of medicine to make the patient feel better? Does it really matter why they feel better? You can’t argue against something that “works” … not unless imposing your ideology is more important than helping people who want help, they say.

    There are a variety of good responses to this:

    1.) A placebo effect is a superficial effect. It won’t work for all, it won’t work for long, and most importantly it won’t actually get at the root cause of the problem. “Mind over matter” will only go so far. And when it doesn’t work — guess who gets blamed? The poor patient, who now has to contend with the idea that they’re sick because they have insufficient “mind power” or gumption.

    2.) Because the placebo effect is superficial, a real problem for which there is real treatment can get masked. By the time everyone figures out the quackery-of-choice isn’t actually doing anything, the actual issue may be more advanced and harder — or impossible — to treat.

    3.) Where’s the integrity here? Where is the respect for the patient? What we’re now talking about is lying: a benevolent lie, a little bit of fib to fool the ignorant. Someone is making the choice to lie to someone “for their own good,” just like Mommy does to a toddler. If we want to leave the bad old days of paternal medicine behind — when doctors were gods who could not be questioned and the patient’s duty was to shut up and do as they are told — then invoking a sort of maternal medicine is going in the wrong direction. Who the hell are you to decide that someone else can’t or shouldn’t be treated like a capable adult and dealt with honestly?

    4.) Where’s the integrity here? Where is the respect for the advance of human knowledge? Where is the concern that we learn from our mistakes and progress in the real treatment of disease and alleviation of pain and suffering? When you’re dealing with placebos the only thing we find out is how good some people are with mental framing. That’s not unimportant, true. But it’s pretty damn limited. We are capable of growth in understanding the physical world, too. And that one matters a lot.

    5.) Hell — where is the respect for the actual treatment? The quackery-of-choice, the woo du jour? If the only effect of applying it is a placebo effect, then not a bit of anything you say or think about the treatment matters. It’s all for show. You don’t have to fit the medication to the patient; you don’t have to understand the cause and course of the disease; you don’t have to know herbs; you don’t have to know all about the traditions of ancient wisdom; you don’t have to have anything “right.” There is no right because now there is no wrong. Naturopaths, reiki masters, homeopaths, etc.– NONE of them have to study anything but ACTING. When it gets right down to it, you just gave everything in alternative medicine to the Marketing Department. And we all know how much your “I’m a nature-loving rebel who won’t be manipulated” little self loves consumerism.

    6.) If the patient learns to believe in bullshit, you’ve screwed up the way they understand disease, science, and, quite possibly, reality as a whole. This could go anywhere in their life. The more magical the thinking, the more anti-science and disunified and unrealistic the view of how we learn and understand the world and how it works, then the greater the potential for making bad choices all over the place. If this is your real point — if helping people become more “spiritual” or aware of the mysteries and wonders of God is the object — then it seems to me that imposing your ideology is more important than helping people who want help. And we are back where we started.

    I suppose there are other responses I can’t think of right now, but most of them are probably variations on the above.

    My personal experience, by the way, when trying to make the above points to a room full of alties, is that the conversation was then steered into proposals that all of reality is an illusion created by a cosmic consciousness of which we are all included and therefore the “placebo effect” of Mind over matter was far, far more magical and powerful than I could possibly understand, being an atheist materialist and non-spiritual and all.

    Iow, a cop out and retreat into an area where they thought I couldn’t challenge them any more.

    I really hate the inherent dishonesty in this sort of thinking. Lies all the way down.

  15. Simon Hayward says

    NCCAM (as I understand it) was set up to test the efficacy of “alternative” approaches. I think by “test” the politicians concerned meant “validate” and were upset when the answers that came back were pretty much always that plant extract x or incantation y was ineffective – but that’s another story. It’s a little difficult to criticize NCCAM for following guidelines imposed on it (as opposed to criticizing the guidelines themselves).

    Is this a waste of money? – well if taxpayers are spending huge amounts on (for example) homeopathy, and it can be definitively shown not to work, then that finding should result in a much larger saving to rational taxpayers than the cost of the study. The key word being “rational”, which may void my argument! But then again it’s like talking to creationists education is important (as is mockery), but you are not going to deprogram everyone.

    I do think understanding the underlying pharmacology of these bioactive compounds is important, particularly their interactions with other drugs – as noted in comments above. Drug companies are not spending serious time on researching anything that they can sell at more of a profit under the “natural remedy” banner than they could make if it was described as a prescription drug. As always some government input (oversight?) seems to be needed.

  16. Sastra says

    Whoa — double post. Sorta — my #15 has an added 6th and other corrections. Must have accidentally submitted a draft. Apologies.

    It did startle me though to see my post appear directly beneath someone quoting what I had just posted. Ooooo… spooky.

  17. Sastra says

    Ibbica #4 wrote:

    How is arguing that these things aren’t worthy of study any different from arguments against funding fundamental research that doesn’t have any readily-accessible tangible benefits? Is there *no* justification underlying the project grant requests?

    One of the major complaints made against so-called alternative medicine is that it eagerly co-opts treatments or therapies which are already included under the category of scientific medicine — and then uses them to grant more legitimacy to what is NOT scientific, and NOT medicine. Diet, exercise, herbs, and so forth are deeply entrenched into the mainstream. They were not introduced by Brave Maverick Doctors tapping in to Ancient Wisdom or thinking outside the box.

    So yes –at least some of the things studied by NCCAM should be studied. They’re chemically and biologically plausible to begin with. Maybe they work; maybe they don’t. We need to find out.

    But every single one of those kinds of studies could be studied without NCCAM. The grants have a place to go. There is no conspiracy among regular physicians and scientists and researchers to refuse to consider discovering anything from something found in nature, for example. NCCAM exists to blur the distinction between what is and is not “alternative.”

    It’s a bit like what the religious do with the term “spiritual.” They steal ideas, values, emotions, and ethics which make sense in the world and then try to pretend that atheists stole that stuff from them … it’s all supernatural. Language trick.

  18. says

    ibbica:

    How is arguing that these things aren’t worthy of study any different from arguments against funding fundamental research that doesn’t have any readily-accessible tangible benefits?

    There’s a difference between arcane research and plain bullshit. Unless something is safety critical, there has to be some degree of equipoise in a scientific experiment. In other words, there has to be at least a small sliver of doubt as to the expected outcome, otherwise there is little point in doing the experiment. While this is technically against the scientific ideal of testing everything, scientists don’t have the time or resources to perform every conceivable experiment.

    When it comes it modern quackery*, there is no degree of equipoise. The hypothesis that coffee enemas cure pancreatic cancer is a piece of arbitrary nonsense. Yes it might be true, but only in the same sense that porcupine spines might be room temperature superconductors, or that cupcakes might contain an undiscovered chemical element. Experimental investigation is an absolute waste of time.

    [*] Ancient and traditional medicines often are worth investigating, as they are sometimes the result of observation, rather than wild speculation.

  19. bodach says

    Sastra @ 17: it is only ‘spooky’ because you aren’t tuned in to all the possibilities, I mean, what was the universe trying to tell you here?
    /snark

  20. ibbica says

    @Sastra & hyperdeath:

    I should’ve done a bit more googling first (hangs head in shame)! I didn’t realize what NCCAM actually *was*, and that it was actually part of the NIH. To which I say: WTF? And also: O_O

    I wholeheartedly agree that if you set out with an assumption that ‘alternative medicine’ doesn’t fall under the umbrella of that skeeeery conventional western evidence-based ‘medicine’ thing, that it somehow follows different rules and should be held to a different standard… you’ve already lost :/

  21. says

    NCCAM relies on congress for funding as one of the institutes/centers/offices of the sprawling NIH complex. There are members of congress dead set on legitimizing alternative medicine because their states are meccas of unregulated, free-for-all quackery (Orrin Hatch, I’m looking at you). There is pressure on the NIH from multiple sources to do research on alternative medicine; Proponents who think it will legitimize this billion dollar industry and opponents who think research will finally debunk this crap (save the money–it won’t).

    In my experience, the NIH is reactive. There is a faction in congress that insists ALL research should be handled by the free market and that wants to entirely de-fund the NIH and the FDA. In response, the NIH is forever trying to accommodate the petty requests of powerful members who manage to add language to appropriations bills requiring research expenditures on their ridiculous pet projects. A good example is the recent creation of a ‘task force’ and funding to research Morgellon’s disease, universally viewed as a fictitious disorder whose extremely vocal sufferers nevertheless managed to snag govt research money by virtue of the squeakiness of their wheels to their members of congress.

    I work in the rare disease arena. There are 6,000+ rare diseases, collectively affecting 30,000,000 Americans. Many of them are absolutely devastating and the vast majority have about zero shot at NIH funding. It is extremely difficult to watch our elected officials support research funding for woo and to pacify difficult personalities while people with life-altering/life-shortening rare disorders are overlooked time and time again.

  22. jakc says

    Why is the prayer study the most expensive? Shouldn’t it be the cheapest? I mean, you don’t even have to buy coffee or anything. Were they paying Christians to pray for people with HIV?

  23. neuroturtle says

    You usually have to pay participants to be in clinical studies, on top of whatever “drugs” you’re using, paying the post-docs and/or lab techs, probably having to pay the General Clinical Research Center on campus to do blood draws since most investigators aren’t licensed for phlebotomy and the like.

    For example, I just got paid $200 over three months to eat a dose of probiotics every day, to see if improving gut leakage could improve asthma symptoms. (A legitimate question!) I had two blood draws of four vials each, four spirometry measurements, two stool samples (that was fun), ten hours of nursing time at the GCRC, and probably some I’m forgetting. That adds up fast; I don’t know what most of it costs, but the spirometry was something like $200/pop.

    To get a decent sample size, it would be very easy to run up $400,000, especially if the PI has to buy out of classes. Research is expensive. =/

    The HIV prayer study was probably so expensive because of bloodwork and sample size. Phlebotomists and pathologists gotta eat!

  24. Matt Penfold says

    Why is the prayer study the most expensive? Shouldn’t it be the cheapest? I mean, you don’t even have to buy coffee or anything. Were they paying Christians to pray for people with HIV?

    It seems the study involved “distance prayer”, so presumably a researcher had to be sent to wherever the people doing their praying were located. If that researcher had any sense it would have been some nice resort.

  25. says

    Re the discussion re the value or lack thereof in actually doing studies into this stuff:

    I’m not being sarcastic (I know it’s sometimes hard to tell), but a study that might really be useful is one which tried to assess whether people really stop wasting their money on these damned cons (and yes, that’s what they are) when you actually do and then publish and publicize the research and find no effect distinguishable from placebo.

    … because, honestly, that’s about the only value I can see to doing this–cutting off the cons’ money supplies, and protecting those taken by them. And if what we get back from such a study into the efficacy of checking out the claims (and I wouldn’t be surprised, given what I think I know of the sort of people who are into this stuff) is that it really doesn’t chill such cons, yeah, maybe it’s time to move on, try something else.

    A huge part of the problem, it seems to me, is: it’s very, very cheap to pull something out of your ass about magnets curing carpal tunnel syndrome, and quite expensive to do a proper study determining it really doesn’t. When we’ve got an army of woo peddlers out there working 24/7 dreaming up various absurd and spurious claims, we probably really can’t afford to spend six figures taking it at face value for argument’s sake and then checking it out in a proper battery of studies every time some Tom, Dick or Harriet manages to part rubes from their money by writing a book in which they claim that by standing on one foot and singing the national anthem backwards every second Tuesday of every third month you can live forever.

    Seriously, it’s the same damned problem we have with gods and superstitions in general: any sufficiently dishonest asshat can invent one (and so many dishonest asshats have), and putting that genie back in the bottle after they’ve built up a properly emotionally-committed following is extremely difficult. You could have got videotape of L. Ron dropping acid with Ginsberg, and a lot of his followers would still be his followers, probably insisting you’d just faked the footage, and rejecting their diabetes meds or what have you to their very deaths. It’s the same deal with alt-med. It’s gonna be ‘oh, of course you pharmaceutical shills found no effect–you didn’t want to enough’, and so on.

    So mebbe, with due respect to PZ and other’s very real need for research funding, that NCCAM money might rather go more efficiently into proper education programs aimed at building up people’s bullshit detectors before the wood peddlers get to them. Seems to me those are what are really broken here, anyway.

  26. says

    … erm, ‘woo peddlers’. Not wood peddlers. In case that wasn’t obvious.

    (/Tho’ lemme tell you about them danged lumber merchants…)

  27. ltft says

    I like Offit, I’m not a fan of alternative medicine, I despise the NCCAM, but I think Offit made a minor screw up. The problem with NCCAM isn’t that NCCAM funded projects that produced no positive results. The problem is that NCCAM funded projects that were never likely to produce positive results. The way Offit’s editorial was excerpted, the way he should have expected it to be excerpted, emphasizes the wrong problem.

    Offit points to the projects cited in this article (the original JAMA article is Vol 307 #17, BTW) as having no sound biological underpinings but unfortunately that is not what gets snipped here or most places. Instead we get a list of projects that produced no positive result. You can make that same sort of list from any bunch of *normal* NIH grants. Legislators, usually Republicans, do it all-too-often. A few posts have pointed out how blatantly dumb some of these projects are (and they definitely look like it to me, too). But can the average person really assess the utility of any given NIH grant from the title? I’d argue not.

    To be clear: Offit is obviously not cherry-picking failed experiments, he’s highlighting failed experimental designs that somehow, because of NCCAM’s focus, still got funded. I think that distinction will get lost by the time most people hear about Offit’s position. What they’ll hear instead is a) NCCAM is bad (good message!), and (b) NCCAM is bad because some projects fail (bad message). And then, a few weeks later when some of our legislators are pointing to a specific grant funded by the NIH that they don’t understand and that goes against their politics, the greater public will remember the doctor in JAMA who argued, from what they remember, that you can judge a grant-giving organization by the mere presence of occasional failure. (Okay, I don’t think anyone will point specifically to Offit’s piece. But I think it’s one more editorial, one more beat of the drum, that appears (as it is likely to be excerpted), to be targeting projects because they failed).

    So that I’m not just criticizing unconstructively, I would much rather Offit spent his time running through why one of those projects was not scientifically sound. That can be done in the same space he had and, at the end, he could have pointed out the same could be said for many of the projects NCCAM funds with lots of dollars. The desired take home would be the same but the likelihood of an out-of-context excerpt would be reduced.

  28. ltft says

    Hi ramaus @29,

    Offit’s editorial does, more or less, ask your question. Offit points out that one of the arguments for NCCAM is that we need it to demonstrate that a lot of complementary or alternative medicine is bunk. But for demonstrating that to have any value the greater public has to pay attention and believe it when a study says, say, acupuncture is worthless. And, generally, that doesn’t seem to be happening, or at least not happening very efficiently or effectively. As GNC chief executive Joseph Fortunato says (as quoted in Offit’s editorial), “The thing to do with [these studies] is just ride them out… We see no impact on our business.”

  29. silomowbray says

    This seems to be an ideal time to once again share the cosmological wisdom of Dr. Charlene Werner.

    If you haven’t seen this before, I promise your head will explode less than two minutes into it.

  30. gingerbaker says

    Sastra:

    “I get the “what’s the harm?” response a lot. It’s particularly galling when the alt med proponent admits that the quackery-of-choice may indeed be a placebo — but so what? Isn’t the whole purpose of medicine to make the patient feel better?…”

    I hear this a lot too.

    What I tell them is that the “placebo effect” is not the “placebo therapy”, it is the opposite. The placebo effect is a confounding phenomenon seen in a clinical research trial, and is treated as a confounder because it is not a true therapeutic response at all. It is, in fact, the very definition of what true therapy is NOT. The value of any tested therapy is precisely the true improvement in symptoms or disease that the treatment produces above and beyond the placebo effect.

    It could as well be called the “witchdoctor effect”. It is how quacks treat patients. It is the opposite of real medicine.

  31. RFW says

    Ten or fifteen years ago, the newspaper here reported on a woman who’d gone into hospital acutely ill with liver failure. On investigation, it rurned out that she was taking a witches’ brew of some thirty or so “herbal remedies” and they had interacted to destroy three-quarters of her liver function.

    Fortunately, the liver is able to regenerate after such an insult.

    The newspaper article included an interview with this dimbulb. “Oh, I take such-and-such so I won’t get disease A, and so-and-so I won’t get disease B, and…[much more of the same].” Evidently she’d learned exactly nothing from her brush with death. Regrettably, the reporter didn’t go to the window of her apartment, point at people walking along the street, and say “You see all those healthy people? They don’t take those herbal remedies, but neither do they suffer from A, B or any of the other ailments you are trying to prevent.”

    Her attitude is not rare. My boss before I retired, an educated man, was once gushing to me about his wife’s purchase of “herbs”. I replied that he had to be careful with those things because identity, purity, potency, and interactions with other drugs are all uncertain in the extreme. “But o! they’re natural!” was the reply. I gave up, shrugged, and walked away. Sure, go ahead and poison yourself and your family.

    Too bad there’s no political will to crack down, and hard, on the hucksters who sell these fake remedies. And while we’re at it, on the nutritional supplement fraud.

  32. operabuff says

    I am a Registered Nurse working in a hospital; I am REQUIRED by the administration to take a certain number of continuing education credits each year in alternative “healing”, which I find outrageous. I take the classes because if I do not, I can be removed from the work schedule until I do.
    Does anyone here know of any accredited classes I can take (preferably online) debunking alternative “healing”? I would love to take a class like that and present it as evidence of my requisite mandatory education.

  33. Amphiox says

    Why is the prayer study the most expensive?

    Possibly because it was an HIV study, and HIV studies are expensive, due to the aspects of HIV as a disease, its patient population, and its treatment(s).

  34. Sastra says

    gingerbaker #33 wrote:

    It could as well be called the “witchdoctor effect”. It is how quacks treat patients. It is the opposite of real medicine.

    A fine analogy, but I fear its appeal will be lost on many hardcore alties. In fact, it could have the opposite effect and might even be adopted as a positive term. Apparently, witchdoctors do indeed practice “real medicine” and cure many, many things.
    They just do it outside of the negative closed-minded hegemonic Western materialist imperialist science paradigm. You need to be more tolerant and holistic.

  35. says

    As long as the studies are proving or disproving, I don’t mind that they happened. It’s when they’re merely repeating the same without much reasont to expect that we’ll see a change in the data. (Or want to confirm the data. I don’t care to confirm that tomato leaves will still be inedible when no changes were observed to indicate that.)

  36. interrobang says

    As long as the studies are proving or disproving, I don’t mind that they happened.

    I disagree, for two reasons: Some of the things these studies are looking at have no possible way of working at all, regardless of what the popular delusions and madness of crowds think, and there are much better places to put money (ie. on things that actually have prior plausibility and/or clinical equipoise); and secondly, since a lot of this bullshit isn’t actually medicine so much as it’s religion by another name, you’re never actually going to convince the quacks and their most deluded followers that the remedies have been debunked, so why waste time, effort, and money.

    I gather further that NCCAM is basically Tom Harkin’s pet pork barrel, and that also seems to be a reason to get rid of it. The guy’s obviously a grifter looking for legitimacy for his affinity scams, and NIH shouldn’t give it to him.

  37. says

    #39 interrobang

    since a lot of this bullshit isn’t actually medicine

    Well now we have the scientific evidence to show. Otherwise, no evidence, no argument.
    I agree Harkin likely wanted to prove woo, but lost. He’s the slow learner here.

  38. tim rowledge, Ersatz Haderach says

    In somewhat related news that I haven’t spotted being mentioned here, Alberta (TexasNorth, y’all) has in the last few days legalised? regularised? whatever, naturopathic doctorising. Sigh.

  39. Fukuda says

    Well now we have the scientific evidence to show. Otherwise, no evidence, no argument.

    Quacks are the ones making the positive claims. It’s their job to prove that their bullshit works, not ours to disprove the effectivity of all of their… erm… “treatments”

    It’s not like showing that prayer doesn’t work to cure AIDS (no shit) will stop them from praying…

    I have seen many fine reality-based research projects being denied funding, most of them being cheaper than this, so I have no sympathy for any of this crap.

  40. DLC says

    Hey, at least homeopathic water helps treat one physical ailment: Dehydration.

    But seriously. NCCAM is Tom Harkin’s baby. He wanted it and so there it is. a complete waste of money. De-fund NCCAM and use that money for useful scientific research into treatments that might actually work.

  41. microraptor says

    While we’re on the topic, how effective is acupuncture? My mom keeps claiming that it’s the one “alternative medicine” (yes, I always put that in scare quotes) that works but I’ve yet to actually see any research offering proof.

  42. says

    operabuff, that’s terrible! Can you tell on them? Email Orac, perhaps.

    And in the meantime, can you use the alties’ co-option of real stuff to your benefit? You could study massage, tai chi, nutrition (the real dietician stuff), yoga, etc? Tai chi and yoga especially sound good to fool them with, because of the layer of woo often found over the genuinely useful core of stretching and gentle exercise.

  43. Azkyroth, Former Growing Toaster Oven says

    … erm, ‘woo peddlers’. Not wood peddlers. In case that wasn’t obvious.

    (/Tho’ lemme tell you about them danged lumber merchants…)

    Given how much quackery supposed aphrodesiacs account for, I think you had it right the first time.

  44. says

    #42 Fuckuda

    Quacks are the ones making the positive claims. It’s their job to prove that their bullshit works, not ours to disprove the effectivity of all of their… erm… “treatments”

    Here’s a hypothetical: I claim – You’re full of shit. Since I choose not to prove it, does that mean there’s nothing you can do about my claim? It has to rest right there? (Yes, I’m trying to be overly dramatic.) Actually I think we have an obligation to challenge Quacks. The best way is with scientific evidence. How else?

  45. Azkyroth, Former Growing Toaster Oven says

    Here’s a hypothetical: I claim – You’re full of shit. Since I choose not to prove it, does that mean there’s nothing you can do about my claim? It has to rest right there? (Yes, I’m trying to be overly dramatic.) Actually I think we have an obligation to challenge Quacks. The best way is with scientific evidence. How else?

    But his being full of shit is a plausible claim, given A) the prevalence of the mental and behavioral traits usually connoted by that phrase and B) the average fiber intake of industrial Westerners, who are the majority of this blog’s commenter base. Very different from claiming “coffee enemas can cure cancer.”

  46. jonathanray says

    “I’d get down on my knees and fucking pray to any deity you want to name if it would bring in that much cash to my university.”

    I could see the Templeton Foundation funding that.

  47. says

    I think this would be legitimate if it were used to determine health policy/funding AND advertising standards.
    Like, this is the official touchstone:
    If it fails their research, it mustn’t be covered by healthcare (or without extra premiums) and it mustn’t be advertised.

    St.John’s Wort is another than should not be taken along with anti-depressant.

    And the pill. The side effects are known as Jamie, Megan, Peter and Kevin

  48. ismenia says

    I’ve had experience of alternative medecines when I was younger. Let me assure you, something doing nothing does harm. It raises your hopes only to disappoint. It can be very expensive, the money people make out of this fraud is often overlooked. I was once put on a diet that was very restrictive. Thankfully, a medical student friend warned me that it was pseudoscientific. I felt let down by the therapist who had recommended it. She meant well and really believed in it but she made me do a diet that only made me miserable and it was all for nothing.

  49. kathrynhedges says

    Speaking of alt-med, a U.S. military hospital is hiring acupuncturists, according to Harriet Hall, M.D. over at Science-Based Medicine.

    http://www.sciencebasedmedicine.org/index.php/therapy-or-injury-your-tax-dollars-at-work/#more-21994

    Since she ended the post with a suggestion to contact our Congresscritters, I turned this into a petition at Change.org.

    http://www.change.org/petitions/the-u-s-senate-protect-our-troops-from-fake-medical-procedures

    The only sad thing was that when I went to my Facebook contacts to find 16 people to invite to sign it, I had a hard time finding 16 people I was fairly sure would agree it’s a bad idea to use acupuncture in military medicine. (Most of my FB contacts are from grad school… in Arcata, which is Woo Central.) I hope I don’t get a bunch of anti-science hate mail.