Orac and Paul Offit agree: get rid of the National Center for Complementary and Alternative Medicine. Harkin’s Folly has had opportunity enough to show it is a waste of time, so let’s stop tossing money into that sinkhole.
Pharyngula
Evolution, development, and random biological ejaculations from a godless liberal
That duck farm should have never existed.
But, but, Big Pharma!
In a free society, & if there are saps willing to pay for woo, then people should be allowed to peddle woo for profit. The role of Government should be to ensure that it’s clearly labelled as woo, i.e. not supported by evidence.
It’s my understanding that, unfortunately, some mainstream medical practices aren’t supported by evidence, but have just gained credibility by virtue of tradition.
Anyway, the over-the-counter crap like homeopathy could be labelled to explain that it’s got nothing more than the placebo effect. That wouldn’t stop the saps, unfortunately.
What annoyed me was that in the pet insurance that i bought, there is provision for buying a considerable amount of complementary treatment that would be covered by the policy. I object to funding woo merchants, (through other policy-holders’ stupidity), so i cancelled the policy.
@Dick the Damned #3
They are required to be labeled as woo, FDA would require them to say that it basically does nothing. And yes, you are free to sell and buy placebos, but not allowed to make false claims about products.
Unfortunately, when things like supplements are harmful, it’s up to the tax payers to show that it’s harmful and should not be sold to the public any more.
I heard all this, and more, from a former director of the FDA. This directory was quite passionate in their contempt for these peddlers of woo saying they were no more than crooks. They also said most supplement companies are in Utah because, you know, the Mormons.
It can and should join ID and the study of “psychic phenomena” that the US has undertaken at times as nonsense that has been considered far more than any evidence ever warranted.
Glen Davidson
I’m more ambivalent. The intention was certainly bad; Congress wanted it to be a rubber stamp. But that’s not how things turned out.
In reality, its now functioning more like a JREF for medical claims. And I am okay with the idea of the government funding a JREF for medical claims.
Damned Dick wrote; “It’s my understanding that, unfortunately, some mainstream medical practices aren’t supported by evidence, but have just gained credibility by virtue of tradition.”
Not challenging you, just would like to hear some examples. One very marginal one that I think may qualify is the “food pyramid” that was around for awhile.
Wait on second thought, maybe not. Unlike most woo, I don’t think it was pulled out of someone’s ass. My guess is that it was (probably) based on faulty or incomplete evidence.
Anyway, I’d like to hear what you have in mind.
nooneimparticular — The “Food Pyramid” wasn’t science. It was the creation of the Dept. of Agribusiness to convince us that it’s OK to eat cheap, high-fat foods because they are protein-dense. It’s an example of design by committee where several of the major voices on the committee have a vested interest in a particular message. Also, politicians…who are clearly a-scientific…had a lot of influence on this process and the result.
Yeah, fuck those people.
citation needed
Yeah stupid saps.
How very noble of you.
Why does my mind jump straight to this:
robro@8
A little googling and I see there is some controversy (from the usual suspects). But as the food pyramid did not originate with the USDA an updated version of the original is still supported by scientists and MDs, I think I’ll come down on the side of “nope, though flawed and potentially influenced by bidness, it was based on sound, though incomplete, science”.
I am sure there are other examples of Dick the damned’s claim, though. Just none pop into my head at the moment.
Dick — Is a free society responsible for protecting people from scams? The answer is clearly yes when it comes to investments, real estate, and shell games on the street. Why not “health” treatments?
Of course, there are examples of our free society limiting the availability of quack medicine. That’s one reason “Big Pharma” goes through so many expensive procedures before getting FDA approval to release a new medication. The purpose of the process is to prove that the treatments are not harmful and efficacious. So called alternative medicine is excused from this process through a loop hole in the legislation.
Warning labels are of questionable value. A warning in 6 point type somewhere buried the marketing blather isn’t going to impress people who’ve “heard” X works to solve their particular concern. Most people don’t read labels at all, and many who do don’t read them carefully or don’t know how to read them. Plus, there is considerable cost for policing the labeling to assure accuracy. As a professional word smith, I can assure you that it’s easy to make something “transparent” and in compliance, yet completely opaque to the average person who is casually looking at some message.
You can say “let the buyer beware,” but there is an economic cost to society when people, despite evidence and labels, opt for woo.
The worst part is how pharmacies mix junk in with over the counter
nooneinparticular — Gosh, my little bit googling quickly turned up both questions about the science behind the pyramid and the roll of agribusiness in the USDA’s version of it. But OK, the USDA didn’t originate the idea of a food pyramid…it came from Europe where I guess they don’t have a hugh agricultural industry to influence such things.
robro
Chill, bro. Remember that damned Dick said; “It’s my understanding that, unfortunately, some mainstream medical practices aren’t supported by evidence, but have just gained credibility by virtue of tradition.”
I posed (then retracted) the idea that food pyramids might one such.
Food pyramids, originally from Europe but adopted by WHO before the USDA got its hands on it, were based on science, irrespective of any influence agribusiness (BOO!) may have had. In fact, most scientists and MDs continue to support a version of it, though in an updated, based-on-current-understanding kind of way. That means, to me, it doesn’t meet Dick’s claim of gaining “credibility by virtue of tradition.”
I like Quackcast’s term: Supplementary, Complimentary, and Alternative Medicine. SCAM.
A friend of mine is into homeopathy. I tried to explain why homeopathy is bogus in as non-confrontational, calm friendly manner as possible explaining the pre-germ theory of disease history, the improbable mechanism and the volumes of water involved in dilution. I followed up with an email citing medical and government studies showing it doesn’t work.
Given her reaction, I may as well have told her she was not only an idiot but a bad mother.
Very unfortunately, unbeknownst to me, her daughter had been sick with recurring pulmonary infections. She credited the homeopathy for her child’s recovery (not the doctors, drugs or hospital).
This is only an anecdote but People’s belief in homeopathy can be very emotive. People are resistant to believing their own experience is mistaken and merely anecdotal, they tend not to credit regression to the mean etc.
When the public is deeply and fundamentally misinformed, the Government needs to help educate them, prevent harm and protect consumers from fraud.
I got into a discussion the other day with some friends who are ‘into’ alternative medicine — they not only take it themselves, but frequently advocate and promote it to others. I asked them if they could think of any alternative medicine of the last 100 years or so which is no longer used because practitioners figured out that it didn’t work. And, if so — how was this discovered?
After mentioning ‘phrenology’ and a few dangerous herbs — both of which were ‘mainstream’ enough to be open to scientific tests — they conceded that there really weren’t any examples. And they were very eager to tell me that there were LOTS and LOTS of things in ‘mainstream medicine’ which didn’t work.
So I asked them, was this a feature, or a bug? I mean, if you can’t discover mistakes and correct them – could there be any progress? Was every single remedy in “alternative medicine” effective forever just as it was, simply by virtue of being labelled “alternative?” No growth, because nothing to build on?
I don’t think they’d ever considered it from that perspective. One woman told me that every remedy worked for some people, but not others, so it didn’t matter. You have to find what’s right for you. Another one told me that an alternative remedy worked if you thought it would work. The important factor was always the patient’s belief. If you have faith, you will get better.
I asked her why then mainstream medicine didn’t always work for the people who believed it would work? She didn’t know.
I’ve noticed that my alt med friends think that “works no better than a placebo” is still an escape hatch — because the placebo is magic, too. Mind over matter and the power of intention.
Every single useful discovery made by NCCAM (and I think there have been a couple, mostly herbs) could easily have been studied by some other pre-existing organization. The only reason for NCCAM is to create a double standard for medicine which vaguely falls under the classification of “spiritual.” I think eric at #6 is too optimistic: NCCAM is not operating like the JREF. When negative results come in the call is always for more testing. Or there are claims that it “works for some people and not others” and it’s hard to test for that.
Get rid of NCCAM and repeal DSHEA.
quoderatdemonstrandum #17 wrote:
QFT. Their certainty that they could not make a mistake in interpreting their own experience can also sometimes war with their general attitude that it’s rude to tell people they are wrong. “I’m not saying I know it works; I’m just saying I know it worked for me.” Getting them to see why they can’t even say “I know it worked for me” can be like butting your head against a brick wall.
sastra
Yeah I had a similar conversation with a friend who uses a naturopath. I asked her two questions; “how do naturopaths know the therapy actually works?” and “how do you know the therapy does no harm?”.
Answer to the first was a resort to anecdote. Got a “collie staring at a fan” response to the second.
Next time record your argument and splice in about 10 hours of “ommm”s between the words. It’ll be much more effective that way.
I can only think of three things that might fall into this category:
1. Acupuncture/similar claptrap.
2. Chiropractic treatment.
3. BMI.
The last one was instituted by politicians, not medical people, and the other two are **not** supported by the AMA, so imho, are not “medical” in the first place. There may be a few “hold overs” from much earlier medical practices, purely due to older doctors not trusting new science (or being nuts of one sort or other, but not lethal enough to pull their licenses), but otherwise, the only medical practices I see a huge problem with are a) non-doctors telling doctors what treatments to “allow” a patient, and b) the pushing of “new” medications, when older ones work well, because the margin of profit is so bad for well known medicines that the major pharmaceutical companies farm out their production, if they even bother to be involved at all, to a small hand full of overburdened companies, who are willing to have a much lower profit from them, knowing that their effects are well known, they don’t have unexpected side effects, and no one is going to pull them from the market, because they discovered some problem that didn’t get detected during FDA trials. The side effect of this later issue being that, sometimes, a hospital may find it impossible to get the older medication (due to shortages, resulting from contaminated batches, or other issues), and are stuck using the more expensive product anyway (or charging you 10 times the cost of the one they did want to use, because they had to buy the shipment from some bastard who stockpiled a warehouse of it, hoping that a shortage would happen).
Neither of those things, though, are “medical products/practices”. They are greed induced failures, by parties that are not being restricted from either interfering with treatments (i.e., insurers), and big corporations, who, as with all corporations right now, seem to have been told, “Your job is to create new shit, and lots of it, not to make sure the shit we already have keeps working!”
Oh, and.. I am with the other poster than thinks this has turned into a JREF for medicine. The only reason these people want to kill it now is that its making their stupidity look like actual stupidity. If it actually supported any of the BS they believed in, they would be insisting it “needed” to stay funded. On that principle, even if the above hypothesis is only half right, we need to keep it funded, not go back to, “You can make any damn claim you want, and no one in the government is going to test it.”
@Kagehi #23
You do realize that before NCCAM, the woo pushers still couldn’t make any claims they wanted to. That’s what the FDA is for. NCCAM is nothing more than government sponsored woo research.
You can push anything past the FDA if you use the right words, like – ‘Supplement’, ‘Herbal’, ‘Some people have found this to be helpful’.
All you have to do is minimise the levels of harmful toxins and advertise, advertise, advertise and you too can join the ranks of Big Alternate Medicine.
Sorry, i can’t give citations for my claim that some mainstream medical practices aren’t supported by evidence, but have just gained credibility by virtue of tradition. I did hear or read this from a reputable source, some years ago. And i was hoping that a medical doctor reading this might possibly comment. I only mentioned this because it’s a possible problem area if warnings were legislated for all treatments not supported by evidence. (And i’m aware that drug trials might not always be as well-supported by evidence as we might wish.)
Regarding the ineffectiveness of warnings, sure, that’s a problem, but it’s up to the individual to read the label. Canada has done the right thing with cigarette packets, so the same should go for water masquerading as homeopathic ‘medicine’. Just because the homeopathic ‘medicine’ won’t kill 50% of you directly might be an argument against ostentatious warnings, but there is the possibility that using homeopathic ‘medicine’ might cause someone to delay getting proper treatment, & it wastes their money anyway, unless one considers that the placebo effect justifies it. I would think that real medicine would have a better placebo effect anyway, as well as the possibility of effecting a real cure.
I’ve been suffering from some joint pain recently, & my doctor suggested that i might like to try a herbal remedy that she said works for some people. Maybe she correctly interpreted the expression on my face, because she didn’t say any more about that.
Kagehi @#22: My doctor is totally into bizarre woo. Apparently sort of famous in sports medicine for acupuncturing a football player, wrote a self-help book (having leafed through it, YIKES). He’s not bad for what I need him for (specialist referrals), but yeah.
The last time I got seriously woo-ed at, though, was while getting a tattoo. The conversation turned to my having recently had major surgery, and the artist told me all about her naturopath, craniosacral therapist, herbs, etc. I’d have said something, but there are times even I won’t mouth off, and “at the person tattooing me” is one of those situations.
There are well-documented examples of traditional medicine that do not work. Arthroscopic knee surgery for arthritis and surgery for lower back pain come to mind right away. Bleeding is an older discredited practice which used to be common. The major difference between Big Alternative Medicine and Big Medicine is that medicine is looking at possibly considering becoming evidenced-based, mainly due to Big Insurance not wanting to pay for crap that does not work. That said, I’d much rather have medical treatment that works towards real cures based upon evidence rather than pointy needles, sugar pills, magic rocks, and water with woo.
Article on evidence against arthroscopic knee surgery for arthritis:
http://health.usnews.com/health-news/managing-your-healthcare/pain/articles/2008/09/10/6-alternatives-to-arthroscopic-knee-surgery
Article on why not to have surgery for lower back pain:
http://www.webmd.com/back-pain/tc/low-back-pain-surgery
(There is no need to post a link to bleeding, is there?)
@Jerry
Your examples are not actually good examples.
It’s my understanding that this is true. The existence of both “evidence-based medicine” and “science-based medicine” as movements within medicine are evidence that quite a few practitioners and researchers feel that improvement is needed in this direction. Medicine isn’t perfect, we all know that. Jerry’s examples seem reasonable to me.
It is *hard* to do randomised controlled trials on people. Not only is it ethically difficult, but also technically difficult: avoiding confounding variables with non-randomly selected samples, or simply achieving statistical power if the problem is rare enough. Anecdotal evidence abounds: the case study is usually a careful and thoughtful anecdote, but anecdote nevertheless. Anecdote is publishable in medical journals, and we can’t blame them because better evidence is simply not always available.
This does mean that things that seem to work via weak evidence and general plausibility can gain currency through tradition. Read the fabulous recent book about cancer “emperor of maladies”, for a great example of the evolution of medicine in recent history. The radical mastectomy is a good example, now superseded by better treatments. Or the more recent famous case of ulcer treatments, before we knew of H. pylori.
Remember also that doctors are practitioners, not researchers, and that it can take some time for the research to filter through. Especially in a political climate of underfunding and heavy workloads.
The most important effort (AFAIK) to improve this is the Cochrane group, who collate and evaluate evidence on various topics to improve practice: http://www.cochrane.org/about-us/evidence-based-health-care
And there’s a fair amount of argument about overtreatment these days – a nice collection of links here:
http://blogs.crikey.com.au/croakey/the-naked-doctor-profiling-overdiagnosis-and-overtreatment-by-dr-justin-coleman/
(None of which, of course, is supportive of the fraud and woo of “alternative medicine”.)
Thanks for sharing that. I’ve imagined having conversations with others on the topic of homeopathy and wondered how an actual one went. I’ve thought about bringing up the dilution process of bleach as an illustration of how homeopathy *doesn’t* work. Or perhaps sewage, you know, since water has a memory and all that. Of course, now that I think about it, I can imagine a follower of that woo crap might bring up their special “shake, shake, shake” method that must be performed.
When dealing with human beings, sometimes it is not easy, or even possible, to obtain evidence, at least not in an ethical fashion. It is, however, still necessary to try to treat, and something has to be used as a basis for decision making.
Because of this, EBM has classifications for the level of evidence for medical practices. Class A, for example, is what one would typically consider good evidence in science, randomized controlled trials. Class C evidence, the lowest level for practices with beneficial effects, is expert opinion (AKA tradition).
It is only a “free” choice if the people are properly educated and informed before making the choice.
Bleeding was never part of modern medicine. Bleeding is traditional Western (European) medicine, directly analogous to acupuncture/qigong/etc as traditional Chinese medicine. You can, in fact, roughly date the birth of modern medicine and its supplanting of the old traditional European medicine to the time period when bleeding became discredited and stopped being used.
This is not so much an example of something being done without evidence due to tradition as it is an example of something introduced with limited and incomplete evidence supporting it (for all the reasons listed above), with later, more complete evidence being obtained later that overturns the earlier evidence. (And there are still a subset of patients in which arthroscopic knee surgery remains the best available treatmet)
Surgery for back-dominant lower back and leg pain is not supported by any evidence except in a few rare specific conditions, such as gross dynamic instability of the vertebrae. Surgery for leg-dominant lower back and leg pain is well supported for a wide variety of indications. Leg-dominant lower back and leg pain is significantly rarer than back-dominant lower back and leg pain (and back and leg pain almost always go together) However this is not an example of something being done in the absence of evidence due to tradition. If anything, the tradition was NOT to do surgery, and the rise in back surgery is a RECENT phenomenon, (more or less UNIQUE to the USA, incidentally) and is an example of financial and systemic factors promoting a practice DESPITE the contradiction of evidence. Simply put, 1) back surgery is a massive cash cow for private hospitals, and 2) the marketization of medicine in the US has created a situation where there is a large “consumer” demand for surgery for back pain among people suffering from back pain, such that, almost invariably, if a US back surgeon tries to counsel his or her patient against surgery, over half the time that patient will not be willing to wait to get better (which is the evidence-supported course of action), and instead will doctor shop for another surgeon, and will eventually find one willing to operate. The first surgeon loses financially from this sequence of events, and thus has a powerful incentive to agree to performing the surgery in the first place.
In even simpler terms, it is due to the screwed up nature of America’s wonderful (best-in-the-world!) healthcare system, and will likely not change until that system changes.
“Big Insurance” has very little, if anything at all, to do with the rise of evidence based medicine, with has much more to do with the rise of the use of scientific methods in general. If you want to claim otherwise, you’ll need a citation.
Actually to a certain extent bleeding still has its place, though not via the old cut method. Leeches are actually used to remove blood from areas where it is pooling in things like finger reattachments. Also those suffering from haemachromatosis have to give blood regularly to keep their iron levels down. Once under control the blood can actually be used for donations I believe.
Obligatory I am not that kind of a Dr here….
NOW!
With all the benefits of WOO MEDICINE, but FEWER ANNOYING SIDE EFFECTS!*
http://www.etsy.com/listing/99763771/placebo-max-strength
*such as blathering on support of pseudoscience, tacky crystal paperweights, and holier-than-thou attitudes…
Really wish this was true, but there have been more than a few examples of insurance companies expanding coverage into woo, precisely because it often costs less than real treatment, and their customers demand it. Hard to say, given the asshole nature of the industry, which matters to them more, but I tend to suspect, “costs us less”, is the key motive, since, well… otherwise they wouldn’t try to stop people being covered for stuff they do need/want.
re #33;
The important thing is that the indications for bleeding today are completely different, with differing patient population, differing methodology, differing monitoring, differing therapeutic goals. For all intents and purposes it is a different, and new, therapeutic intervention that just happens to share one single step with the old traditional bleeding, and is in no way a continuation of the old therapy.
That said, technologically, the modern method of transfusion, with syringe, and IV, can be viewed as an evolution of the old cutting techniques. (Sharp metal blade to cut the vein + collection of blood in an external container).