Posts Tagged ‘CAM’
Faster than a speeding case report. More powerful than a double-blind, placebo-controlled study. Able to leap peer review in a single bound. Look! Up on the internet! It’s a story. It’s an anecdote. It’s a testimonial!
Every implausible and unproven quack therapy, from acupuncture to quantum healing, comes bearing testimonials of its effectiveness. These stories are typically brief, to the point, extremely powerful and, across the board, absolutely worthless. To anyone with a decent skeptical filter in place, the reliance on testimonials is an obvious sign of a complete lack of credible support for one’s claims. Yet to far too many people there is no introductory phrase more meaningful than “In my experience”. And no amount of published contradictory data or number of explanations from critically minded experts can match the effect from just one of the seemingly neverending supply of these uncontrolled, unblinded, and often tall, tales.
Sadly, even outright harm and suffering, or the complete lack of achieving the claimed benefit, are often unable to shake the faith of one who has stepped over the line that seperates credulity from a more critical approach to one’s health. It is far too easy to rationalize away these failures, placing the blame on themselves or the medical community, when the stranger whose gout was cured by taking goat urine supplements is trusted more than the family doctor. Perhaps the believer doesn’t realize that the near totality of the testimonials seen on television or on the internet are fabricated. Maybe they don’t realize that a significant number of them, as is often the case with fraudulent cancer cures, even when provided by real people are found to be the former words of the now deceased, victims of their disease process, their lack of critical thinking skills, and the bastards profiting off of them. It is more likely, however, that the undue influence of testimonials is hard-wired in the human brain, a remnant of something which at one point bestowed a survival advantage on our primitive ancestors.
There is a reason why quacks rely on testimonials. And that is because they don’t have science in their corner. Sure they will jump on poorly designed studies, usually coming out of the National Center for Complementary and Alternative Medicine and published in biased pseudojournals, and tout them as proof of their legitimacy. But they will just as quickly denigrate methodological naturalism and the methods of so-called “western science” when better studies come along revealing their pet delusion to be a charade. The testimonial circumvents this problem, rendering science irrelevant. This is a recipe for disaster, or at the very least a lighter wallet.
Proven treatments don’t need stories. In my line of work I often am faced with parents who refuse recommended practices such as vaccines and the administration of intramuscular vitamin K for newborns. When I am discussing the care of a child with parents, and presenting them with treatment options or evidence-based prophylaxis regimens, I don’t tell them about the time I used a particular treatment and how it cured the patient, or how I had this one kid who suffered a poor outcome because they didn’t get something I recommended. There are too many uncontrolled variables in most clinical situations to trust such anecdotes. I have to rely on good data, which should not consist of anecdotes regardless of how many I might collect over my career. I would be no better than the quacks I often rant about were I to attempt to manipulate parents with emotional testimonials.
Making it as a chiropractor is hard. Some do very well, but because of low demand and marketplace oversaturation many practices fail. In fact, chiropractors are more likely to default on student loans than any other health related profession. It is easy to see why so many turn to the practice building techniques taught in chiropractic school classrooms and seminars run by companies promising to bring more patients in.
Virtually everything you see on a chiropractic website or read about a chiropractor in a local publication, is part of a prepackaged practice building scheme. The wording is carefully chosed to have the biggest impact. Every flyer or handout found in a chiropractor’s waiting room is designed to indoctrinate you so that you not only come back, but you go out and spread the word. Here is a nearly ubiquitous example from a chiropractic website’s FAQ section:
“How long will you need chiropractic care?You’ll need chiropractic care as long as you live in Hanover Park and encounter physical, chemical or emotional stress that you cannot adapt to or accommodate. Ready to get started? Call our office today.”
“Ultimately, the goal of the chiropractic treatment is to restore the body to its natural state of optimal health. In order to accomplish this, I use a variety of treatment methods, including manual adjustments, massage, trigger point therapy, nutrition, exercise rehabilitation, massage, as well as counseling on lifestyle issues that impact your health. Since the body has a remarkable ability to heal itself and to maintain its own health, the primary focus is simply to remove those things which interfere with the body’s normal healing ability.”
These seemingly personal stories always revolve around two things. The chiropractor always tells the story of how he or she, or a family member, was injured and could only find relief in the caring hands of a chiropractor, thus inspiring them to join the field. And they always involve the chiropractor making a confession about how they have been taking the credit for healing all those patients when really it was the chiropractic all along. Check out the links above and you’ll see, and trust me there are thousands more that are easily accessible online.
The reason why the general format is similar, and often exactly the same word for word, is because these chiropractors are using a standard template bought from practice building firms. The chiropractor simply puts in his or her name, practice location and hours, and some personal information such as a picture and a description of his or her beautiful family. I imagine that they choose from a list of personal tragedies that led them into the chiropractors office, and the testimonials typically placed in the ad are likely invented as well.
Many of these ads disparage the medical profession, and I have come across a number which blame vaccines for SIDS and other health problems. I am constantly amazed at the audacity of placing these cookie cutter ads when the internet provides such an easy way to compare them to others and see through the charade. But I don’t think that anyone using such techniques ultimately care. It probably doesn’t take many suckers to fall for this tactic, and to sign a longterm maintenance contract, to turn a profit.
Making the rounds last week was another example of the poor quality medical and science reporting that has come to saturate the mainstream media. The article in question, on the benefits of acupuncture for animals, is fairly typical. The situation appears to be rapidly worsening as more dedicated science reporters are being replaced with generalists, although as a skeptic I must recognize that a certain degree of selection bias may be coming into play. I do tend to go out and look for this sort of fluff pseudojournalism. But as I continue to read report after credulous and poorly researched report on topics like vaccine safety, alternative medicine, and even ghost or UFO sightings my expectations continue to steadily decline. If not for blogs like Science-Based Medicine and Neurologica, I feel I would have very few places to turn. I do like to tell myself, in an attempt to feel just a little better about the current state of affairs, that the blame falls primarily on inexperienced journalists, but even seasoned reporters with significant exposure to scientific topics are dropping the ball, as was the case in E.J. Mundell’s March 3rd HealthDay News report.
According to his bio, Mundell, the Senior Assigning Editor for HealthDay News, has 10 years of experience writing (among other things*) on health related topics for a variety of outlets such as Reuters Health and The Scientist. At one point he was even the managing editor for the consumer health news division for Reuters. Yet despite this experience, he penned a sloppy piece of pseudojournalism entitled Animals Respond to Acupuncture’s Healing Touch.
In the article, it is clear that Mundell did not seek out the scientific or skeptical viewpoint on acupuncture or its use in animals. But instead of the more common error made by journalists who, because of some seemingly pathologic need to provide a sense of balance, write as if there were two legitimate sides to a scientifically one-sided issue, Mundell has written what reads more like a press release from The International Veterinary Acupuncture Society. A vet who teaches one of their certifying courses is quoted in the piece along with a pro-acupuncture private vet and a “skeptical” pet owner who is amazed by her animal companion’s miraculous turnaround. There isn’t even the typical misquoted straw man one-liner from a skeptic included so that a believer might easily shoot it down. The two vets in the piece are allowed to spread blatant misinformation unchallenged. Why would Mundell write such thoroughly false information as if it were gospel truth and pass along such worthless anecdotes and testimonials?
There is so much wrong with this story that it is difficult to know where to begin. I think I’ll start, as so many reports on alternative medicine miracles do, with the standard anecdote about how a suprising therapy changed a patients life. In the article, Mundell cleverly describes the medical problems of a patient named Nelly in a way that is meant to fool readers into thinking she is human. Status post spine surgery, weak, lethargic and with poor appetite, Nelly’s friend takes her to a specialist for a seemingly last resort attempt at recovery. After just a few sessions, Nelly the dog is restored to her vibrant former self, all thanks to acupuncture. That’s right, animal acupuncture.
“Almost immediately after the first treatment, Nelly’s energy went from zero to 100,” recalled that friend, Annie Washburn, who works as a community organizer in New York City. Nelly became more mobile, ate more and resumed regular bowel movements. “She bounced back in a way that seemed miraculous,” Washburn said.
This anecdotal experience is unreliable and unable to effectively establish that Nelly truly experienced any improvement secondary to the acupuncture. In the many months that have passed since those initial treatments, Washburn’s memory could easily have been altered over time by multiple retellings of the anecdote. Also, humans tend to exaggerate positive outcomes over time. In reality, the actual events could have been very different than what we are being told without Washburn actually lying. All memories, even those that have evolved over time or were implanted by another person, feel real to us. And the more dramatic a so-called flashbulb memory is to us, the less likely it is going to be accurate weeks, months, and years down the road. This is why we are such poor medical historians and a big part of why properly designed studies are necessary to answer questions regarding efficacy of treatments.
What is more plausible is that the dog improved slowly over time and would have recovered eventually regardless of what therapy was being provided. Many proponents of inert therapies make a fuss over animals as patients because of their supposed inability to be effected by placebo. This notion is entirely false, however, as the placebo effect does have an impact on animals as well as on the owner’s perception of their pet’s recovery. The primary error is in thinking of the placebo as a single entity, that being some kind of mind-over-matter effect stemming from the expectation of the patient. If that were the case, then I would agree that animals are not susceptible to placebo. But that is a straw man manifestation of it. Instead of simply being mind-over-matter, the placebo effect consists of a number of different components, some of which are pure artifact, which can lead to the appearance of a true improvement. Among these components are the tendency for symptoms to regress to the mean, which is probably the largest component of any placebo effect, investment justification, a novel therapy or more complicated therapy effect, or the desire to please an authority figure to name just a few. None of these have anything to do with an actual physiologic effect from the intervention and they only require the pet owner’s biased and subjective personal experience.
It is easy to imagine how a dog lover might interpret their pet’s behavior differently secondary to a placebo effect. It usually takes Rosco a whole week to get over his flare ups but with acupuncture it only takes 7 days. In addition to pet owners and the potential for biased evaluations, it is equally easy to see how an animal might act differently because of how their owner interacts with them. Rosco might actually act more energetic and appear to be feeling better simply because his owner is paying more attention to him in anticipation of a postive therapeutic result. Perhaps other changes, like an improved diet or a new and more interesting location, may lead to positive changes in behavior that do not stem from any new therapy. It is foolish to think that the placebo effect can’t be applied to animals, particularly our doting animal friends.
The article is overflowing with misinformation and contains the expected pseudohistorical mention of how acupuncture is an “ancient healing technique.” Perhaps I employ too narrow a definition of the word, but I would not consider a therapy that has in reality only been practiced for at most a few hundred years as ancient. It is a commonly accepted myth that acupuncture as we know it has existed for thousands of years. I’ve even read one source which claimed that acupuncture dated back to the dawn of man. I have to wonder where our primitive primate ancestors would have acquired not only the steel used to fashion such thin needles but also the paper upon which to bill insurance companies for their use. According to Mundell,
“Experts point out that animals have been treated with acupuncture therapy from the very beginning. In fact, Chinese records that go back thousands of years describe the use of healing needles on horses and other livestock.”
This is simply false. Needle like instruments considerably larger than what are used today were used to drain pockets of infection in animals but there is no historical record from that time period of the placing of thin needles in special areas of the body in order to remove obstructions to a mystical healing energy force. This concept, as mentioned above, is probably only a few hundred years old and did not even become popular in China until the 1960’s when it was forced on the public by their government. And it has become steadily less popular as scientific medicine has come to play a larger role in Chinese society.
Mundell further reveals his ignorance of the subject, or perhaps his purposeful covering up of the rather silly underlying mechanism claimed by acupuncture believers, in the following explanation.
“The points, referred to as loci, represent important locations for nerves and blood vessels that, when manipulated, somehow aid healing, experts say.”
Acupuncture, as it is promoted by the near totality of practitioners and patients, involves the shoving of thin needles into specific points on the body in order to relieve the obstruction of a vital, yet undetectable by any modern scientific techniques, energy force. There is no legitimate evidence, anatomic or otherwise, that these loci have any special relationship to nerves or blood vessels. They are, in fact, completely arbitrary. There isn’t even agreement over the number or location of these loci, or over which should be focused on. Some proponents claim that only the ear requires needling while others only care about the bottom of the feet.
One of the experts in the article reveals that “veterinary acupuncture has proven effective in healing or easing the symptoms of arthritis, acute injuries, hip dysplasia, respiratory disorders, immune system ailments and a host of other problems” This is also entirely false. There have been, over the years, a number of small and poorly designed studies, typically unblinded and uncontrolled, that have shown a weakly positive effect. But, as is the case with inert therapies, as larger and better designed studies are performed, particularly studies that are appropriately blinded and have a placebo control group, it becomes increasingly evident that there is no effect. This is certainly the case with acupuncture.
Animal acupuncture is only one very small step above pet psychics on the list of the most absurd jobs in the pseudosciences or the paranormal.
* E. J. Mundell was the production secretary for 1990’s Prom Night III: The Last Kiss
One of the more common approaches that attending physicians take when teaching medical students and residents is the use of clinical pearls. Rather than cold, hard facts, such as the most common form of congenital adrenal hyperplasia being 21-hydroxylase deficiency, these pearls of clinical wisdom are more akin to generally accepted rules of thumb. My personal favorite example is the admonition to avoid poking the skunk. Poking the skunk occurs when labs are ordered which aren’t necessary in the care of the patient. Checking a basic metabolic profile when all you really need is the serum sodium is risky. In fact, it seems that the less vital a particular lab value is to management decisions, the more likely it is going to come back as falsely abnormal, which often leads to further unnecessary tests. I don’t like to stick needles in babies, although you might not think that if you spent a day with me at work, so this particular clinical pearl comes up pretty often on my rounds.
I also make a point, on an almost daily basis, to incorporate pearls of critical thinking into my teaching of medical professionals in training. Naturally, these tend to focus on my particular area of interest, the myriad and often contradictory therapies falling under the umbrella term alternative medicine. As I’ve said many times before, I prefer terms like unscientific medicine, or quackery to be quite honest, over alternative medicine, integrative medicine, or complementary medicine. These are manipulative marketing terms used to lull the general public into acceptance with a false air of legitimacy, and the academic community into the application of a double standard to the evaluation of safety and efficacy of these therapies. There is only one legitimate means of determining whether a treatment works, and that is with science.
One example of a very helpful critical thinking pearl that should be applied to the claims of a large number of so-called alternative approaches to health, is that there is often an inverse relationship between the number of symptoms or conditions supposedly treated by a therapy and the number that is actually treated. This is better expressed with the adage that if something is claimed to cure everything, it almost certainly cures nothing. The number of alternative medical modalities that fall into this category are numerous and experiencing seemingly exponential growth, however the most important example because of its acceptance by the general public as a legitimate and science-based practice is that of chiropractic.
Though nobody, even chiropractors themselves, have been able to define themselves in a way that allows a consistent and practical understanding of just what it is that they do, there are some safe generalizations which can be made. For instance, they tend to be spine-centered rather than the oft advertised “holistic”, and a significant percentage of them categorize themselves as “straight”. This distinction shares a dichotomous relationship with self-described “mixers”, which as the name implies are prone to incorporating a wide variety of decidedly non-spine centered therapies into their practice such as acupuncture, applied kinesiology, or nutritional supplementation, as well as some science-based modalities like standard physical therapy. Mixers outnumber straights by a large margin, and though they do make use of other therapies, they still primarily focus on the correction of a non-existant entity known as the subluxation.
Subluxations in the chiropractic sense, as opposed to the legitimate medical diagnosis, are as polymorphous as one would expect of something invented out of whole cloth* by a former magnet healer and spiritualist over a hundred years ago. Since 1895, the term has evolved into many different forms with all stages still believed in by varying numbers of chiropractors today. The manifestation which likely is accepted by the largest number of currently practicing chiropractors involves a proposed “complex of functional and/or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health”. This definition is so slippery as to be rendered utterly meaningless, and is a prime example of the inability of chiropractors to be able to establish a standard definition of who they are and what they do. This fact actually benefits chiropractors however, as it allows for a near limitless scope of practice and the ability to bill many insurance companies for the treatment of a phantom condition.
Regardless of whether a chiropractor is a straight or a mixer, they are likely to claim that they have special insight into your particular complaint regardless of what it is. With rare exception, chiropractors assert their ability to treat not just common musculoskeletal complaints, a category of conditions falsely considered by many to be their area of particular expertise, but the entirety of known medical maladies. Many will even treat one or more of a growing number of fictitious conditions such as adrenal fatigue or Wilson’s Thyroid Syndrome. This is often done overtly with outright claims of personal success in curing conditions ranging from asthma to zoster, with some even touting their ability to treat serious life-threatening illnesses like cancer and HIV.
Straight chiropractors take a different approach, boldly claiming only to treat subluxations, which then allows for the innate healing power of the human body to heal any disease state under the sun via an unimpeded spinal conduit. A critical evaluation of the medical literature reveals a far different reality however. After a little over a century of existence, there is essentially no good evidence that chiropractic care is effective in the treatment of any medical condition, or any made up one either. The one sliver of an exception is the treatment of acute lower back pain, which does appear to resolve under the care of a chiropractor. What they may not want you to know is that it has not been shown to work any better than more standard treatments such as physical therapy and the use of ibuprofen.
*The top link on google when inserting the phrase “invented out of whole cloth” takes one to an article on the history of chiropractic
As a young mother comforts her feverish and uncomfortable infant, a handsome doctor enters the dimly lit exam room. The child’s mother and the bedside nurse look at him expectantly.
“I’ve got the results. There is an infection in your son’s spinal fluid, which was one of the things we discussed as a possible cause of his high fever and irritablity,” the physician explains to the now crying mother. “We need to start treatment right away and admit him to the hospital.”
After answering the distraught mother’s questions and discussing his treatment plan with her, the doctor leaves the room and begins to write orders in the patient’s chart. The nurse, eager to begin appropriate therapy looks over his shoulder with a confused look on his face.
“Excuse me doc, but you’ve got to be a little more clear on that order don’t you think?”
Written in barely legible doctor scribble, next to the date and time of the encounter and above his signature and hospital number, is the lone word antibiotics.
“What do you mean? This child is sick and he needs antibiotics stat!”
“Sure doc, but which one, how much and how often? Where did you go to med school again?”
“Clearly you aren’t current on the literature. Antibiotics have been around for decades and have been proven time and time again to treat infections. Millions of people take them every year. Now you are wasting precious time that could be spent caring for this sick child!”
The nurse, unhappy with the response, storms off to find assistance from his supervisor. The doctor, confident that he is providing competent medical are for his patient, expresses dismay at how closed-minded some of his colleagues are.
Naturally, the above situation is absurd, and the nurse is completely correct in questioning the physician on his order for “antibiotics”. What antibiotic, or antibiotics, are appropriate and at what dose? Through what route, oral or parenteral, should the antibiotic be administered? How often should it be given and for what duration? Five days? Two weeks? To condense the large number of antibiotics available in a hospital pharmacy into one all-encompassing term makes no sense.
Antibiotics are drugs, often consisting of completely different chemical structures and with significantly different side effect profiles. There are varying degrees of effectiveness of each individual antibiotic depending on the bacteria/virus/fungus being treated, the location of the infection, the age of the patient, and the presence of comorbid conditions such as renal or liver failure. Calling for “antibiotics” in this fashion would never happen outside of a poorly written (is there any other kind?) medical drama on Lifetime.
As new antibiotics have been developed over the years, they are studied scientifically on an individual basis. Sure there are classes of antibiotics that work via similar mechanisms, such as breaking down a bacterial cell wall, or that might be effective in killing or delaying the growth of the same types of bacteria, but nobody would make a blanket statement, let alone write an order, like the one stated and written by our fictional physician. Unfortunately, this kind of thinking is rampant in the world of so-called complementary and alternative medicine. It is employed by invidual practitioners and by large government agencies as a means of deceptively gaining a foothold for unproven therapies with little or no plausibility. Their targets are the hearts and minds of consumers as well as a growing number of academic medical institutions. In a number of instances, proponents of these therapies, buoyed by the media-fueled pseudopopularity of a variety of bogus therapies, funding from the National Center for Complementary and Alternative Medicine (NCCAM), and clever marketing, have managed to set up shop in our most hallowed halls of learning.
A common saying amongst advocates of science-based medicine, and skeptics taking on the suprisingly successful incursion of unproven therapies into academic medicine, is that there is really no such thing as alternative medicine. I agree with this completely and would add that there is no such thing as complementary or integrative medicine either, regardless of what NCCAM puts on its website. These are marketing terms meant to distract healthcare consumers and providers from the reality that these therapies have either not been subjected to proper scientific study or that they have failed that study and are held aloft only by a foundation of tenacious, anecdote fueled belief.
When proponents of alternative medicine, far too many of which being influential lawmakers, call for financial support in the form of taxpayer money, they tend to use a similar tactic. They hold up a small group of therapies that have been shown to be effective, typcially entities involving stress reduction, positive lifestyle changes like increased exercise and smoking cessation, improved nutrition, or various herbal remedies, as symbols of how wonderful alternative medicine is. This ignores two important realities. Not suprisingly, these proposed symbols of the success of alternative medicine have been co-opted from the science-based medicine which discovered them and established their benefit. More importantly, these alt med proponents are ignoring the fact that the overwhelming majority of what is considered CAM, whether legitimately or not, is absolute quackery. In other words, just because a good massage helps your migraines or decreases your fatigue it doesn’t mean that non-existant molecules of poison ivy will cure your itchy rash. The use by proponents of terminology like alternative medicine is just as preposterous as our handsome young doctor writing an order for antibiotics. Which alternative therapy? Acupuncture? Homeopathy? Quantum Reiki? And for what indication? Each individual treatment must be investigated for efficacy and safety with the tools of science, not the machinations of politicians and idealogues.
In the not too distant past, treatments supported only by sloppy anecdotal evidence or poorly designed studies that were still being offered to consumers and patients as effective had a name. Rational minded folk were unapologetic when describing a bogus cancer cure or an implausible and disproven treatment for depression as quackery. But over the past couple of decades the quack has become the alternative medicine provider and the bogus treatment has morphed into alternative medicine, CAM, or integrative medicine. This was no accident. The change in terminology has served proponents of quackery quite well by successfully leading the public to think that these therapies or just another way of achieving health. Some may be, most will not. Only science can provide the answers. In the meantime, no therapy should be allowed to circumvent science because of semantics.
During a press conference held today at their headquarters in Bethesda, Maryland, officials from the National Center for Complementary and Alternative Medicine (NCCAM) announced that preliminary data from a landmark 2008 study shows that obstructed meridians may have taken the place of heart disease as the most common cause of death in America.
“To many in the scientific community this will likely come as a complete shock and it is going to be met with skepticism,” NCCAM assistant to the travelling secretary Embeth Guzman explained. “But to other, less close-minded medical mavericks, particularly those fighting on the front lines of integarive healthcare, this is a validation of the years spent working to unclog vital human energy pathways.”
The NCCAM, which is the federal goverment’s lead agency in investigating alternative healing modalities, has issued a nationwide call for medical professionals to be on the lookout for a number of less familiar but potentially deadly conditions. Guzman further states that “It is now time for all of us in the medical field, regardless of our personal beliefs, to come together and fight this scourge of humanity. I don’t want to come off as an alarmist here, but the lives of countless millions hang in the balance.”
The updates to the list of leading causes of death in America are as follows:
1. Obstructed meridians – 219 million deaths per year
2. Chiropractic subluxations – 138 million deaths per year
3. Brain fog – 87 million deaths per year
4. Adrenal fatique – 62 million deaths per year
5. Wilson’s Thyroid Syndrome – 49 million deaths per year
6. Medical errors by allopathic physicians – 48 million deaths per year
7. Morgellons Syndrome – 18 million deaths per year
8. Engram infestation complex -9 million deaths per year
9. Chi stagnation – 3 million deaths per year
10. High-fructose corn syrup – 913,000 deaths per year
This NCCAM study, which ran from January through December of 2008, involved a randomized, double-blinded, placebo-controlled questionairre which was filled out by nearly 100 Bethesda area 5th and 6th grade students according to lead author and clinical mathologist Harken Marrow. After using a number of complex statistical analyses to arrive at the number of yearly deaths, the final results were voted on at a meeting of the top minds in complentary and alternative medicine. “The science and the math really speak for themselves on this one,” Marrow reveals. “But really it’s all about the science. Science!!!”