Everything You Need to Know About Complementary and Alternative Medicine (Part 1)

(Just belaboring the obvious again. Some things should speak for themselves but judging from my angry email defending Complementary and Alternative Medicine, this is not the case. Rather than respond publicly to private emails I thought I would address some of the major themes of my critics. -PB)

1. The Imperfections of real medicine do not validate your kooky theories.

You, oh purveyor of snake oil, may exhaust yourself pointing out the flaws in medical science. You may grimly list the horrific side effects of many of our therapies and gleefully highlight the lack of evidence for quite a few things done in the real medical world. You may even solemnly condemn our general inability to really cure much of anything but, apart from making yourself really tired and giving me a crick in my neck from nodding in agreement, all you will have demonstrated is that real medicine is an imperfect business which is not a huge revelation to anyone who has spent more than an hour in a nursing home, a hospital, or any other place where you can find incredibly sick people who, despite our best efforts, often remain incredibly sick and die after being flogged by the mightiest weapons in the medical arsenal. A darn shame but it does not follow that the solution to our limited medical knowledge is pixie dust, magical gnomes, or spiritual energy streaming from your fingertips.

On the other hand, while medicine is imperfect you’d have to be a moron or totally brainwashed into your particular CAM cult to not recognize the tremendous advances in medicine even over the last twenty years to say nothing of the huge leap from the days of snake oil at the turn of the last century. That’s the point of modern medicine. It advances. Expanding knowledge leads to to increasingly sophisticated and effective therapies. It’s Complementary and Alternative Medicine that is perfect. Everything you need to know about acupuncture for example, was elucidated a thousand years ago well before those wily Chinese had even the foggiest notion about germs or cardiac physiology. They so totally nailed it that no new research needs to be done. It’s all about qi and the meridians along which it happily flows and is so perfect as to be impervious to debate, refutation, or criticism. While we plod along with our feeble attempts to expand medical knowledge acupuncturists ply their needles in service of a perfect medical philosophy that was ossified in the Dark Ages.

2. The complexity of your kooky theory does not validate it.

For thousands of years Astrology was considered a legitimate science and the best minds of those distant ages devoted their lives to deriving horoscopes and divining the effects of the stars on our lives. They wrote books, developed complicated theories, and tried to apply the principles of Astrology in every aspect of life including medicine. And yet today if you proposed endowing a Chair of Astrology at your Alma Mater or incorporated horoscopes in your medical practice I have no doubt that even the most laissez-faire of liberal academics, grimly keeping their minds open in the face of every other stupidity under the sun, would at last have their fill and laugh in your face with all the pent-up rage of a politically correct bureaucrat forced to shuck and jive to ideas he knows to be ridiculous. Clearly astrology is ridiculous despite the vast amounts of intellectual energy that have been (and still are) devoted to it.

In the same vein, I have no doubt that Ayurvedic Medicine has been beaten to death by the learned men of India for thousands of years in the same manner that Astrology was dissected in the West. I also have no doubt that there is a massive body of Ayurvedic scholarship collecting dust in libraries from Duluth to Calcutta. But as it’s a system of medicine based on a highly imperfect understanding of physiology, more religious than scientific, and Indians who used it pretty much dropped like flies from diseases that it took Western medicine to defeat, except for historical interest all of that intellectual activity is as useless as trying to divine the future from the entrails of birds. You can learn Sanskrit to really get into the source material but you’re wasting your time. The initial premise is wrong and, like a house built on weak foundation, no matter how much you spend on the bathrooms it’s still going to collapse.

3. Complementary and Alternative Medicine is parasitic, not symbiotic.

Suppose I were to actually build a house. Along with a foundation it would require framing of the walls and floors, siding, wiring, glazing, plumbing and a dozen other skilled trades coordinating their efforts. The practitioners of Complementary and Alternative Medicine would be like your Aunt Mildred telling you how to hang the toilet paper in the finished bathrooms and then trying to claim credit as an essential part in the construction. Complementary and alternative medicine only exists because real medicine does all of the heavy lifting leaving a risk-free environment in which it may ply its patent remedies. At best it’s an afterthought, something that legitimate hospitals add to their services to attract the kook money. At worst it’s a cynical ploy to fleece a little extra from the desperate, many of whom are dying and will gladly pay for another straw to grasp. In no way is it an essential part of medical therapy except that it provides entertainment to the patients and their families while medicine and nature run their courses.

4. Placebo Medicine is not Medicine.

Millions of dollars are wasted every year on shoddily constructed studies trying to demonstrate efficacy of Complementary and Alternative Medicine. The results have been disappointing and entirely predictable. Generally, if you ignore poor study design and spin the data just so, CAM is shown to be occasionally but not reliably slightly, and we’re talking slightly, more effecitive than placebo. These results are naturally touted as a both a huge victory for kook-dom and as a justification for continuing to charge large sums of money for therapies that are so close to placebo in their effectivness that you should wonder why the opposite conclusion isn’t derived. In other words, maybe if your treatment modality is so iffy, requiring as it does to be viewed through squinted eyes in dim light at a distance of several hundred feet to show even a trace of effectivness, maybe you need to reassess your career goals. Call me a cynic but something that is slightly better than placebo could also be called next to useless. Certainly not worth spending a lot of money on unless it carries a big disclaimer saying, “For Entertainment Purposes Only.”

73 thoughts on “Everything You Need to Know About Complementary and Alternative Medicine (Part 1)

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  2. Thanks for a well written and reasoned post. I wonder what your thoughts are on treating the whole person (I know, it’s a horrible phrase, but the best I could come up with)? One of the weaknesses of Western medicine IMO is that it tends to treat the physical symptoms a person might be experiencing, but ignores the mind and spirit of the patient.

    I think that one of the reasons that disciplines such as acupunture and yoga are so popular is that in addition to the wacky health claims their practicioners make (which are demonstrably false), they include philosophies of meditation and calm that appeal to frantic, stressed Westerners.

    As someone who has practiced Yoga for several years, I can tell you that it makes me feel better. There is something about the physical and mental challenge of yoga that calms my mind, and improves my overall strength and focus. In your discussion of CAM, while a discussion of the bogus and silly scientific claims is absolutely necessary, I think it is throwing the baby out with the bathwater to dismiss any possible benefits as total placebo bunk.

    As silly as it sounds, training myself to stand on one leg and wrap myself into a pretzel has been good for me, even though I know my yoga practice can’t cure cancer and bring world peace.

  3. Hi Panda, I just discovered your blog and I love it. I am a retired Rx rep and I to am amazed at the number of people that believe in quackery. The same people that will complain about spending $5.00/day for a medicine that has been proven to work will willingly spend more than that on junk. I often thought that if I ever decide to go back to work I will work in a health food store. I will tell my customers that I sold pharmaceuticals for 27 years and they are nothing but poison. The true path to good health is ginko, glucosamine etc.

  4. I love your rants on CAM. My personal beliefs about CAM range from “intolerant” to “radical extremist”.

    What really bothers me is when proponents of CAM try to argue that it doesn’t matter what critics of CAM have to say, and so long as they “know” through their own experience that acupuncture, or homeopathy, or whatever, works, that they can be left to believe what they want to believe and that the nay-sayers can shut up. While I am not normally in the business of telling people what they can and cannot do, my problem with CAM is the its mere existence is an affront to modern medicine. It cannot be left alone in the hands of anyone to practice. Belief in CAM debases and undermines the scientific process, the diligent and rational work done by basic scientific and clinical researchers, and the concern for evidence based practice — all of which I consider tantamount to sin. CAM’s mere existence in this world is an affront to modern medicine, we cannot even tolerate its existence, and we need more people out there like you to convince these backwards-thinking people to turn around.

  5. Me again, but after reading the post ahead of mine, my blood is about to boil….

    Note the alleged complexity of the belief that attempts to justify itself. Consciousness extending beyond our bodies….quantum biological energy fields… PROVE IT!

    Another thing about CAM that bothers me: if any facet of CAM were ever proven to be scientifically supported, it would immediately be swept under the umbrella of “evidence based medicine”. Modern medicine is an inclusive philosophy: so long as you can prove it, you’re in the clear. But if you can’t, then don’t be surprised when people are skeptical.

    CAMs are exclusive philosophies. For example, acupuncture was developed thousands of years ago and nothing new can call itself acupuncture. What rubbish.

  6. “We stand at the threshold of a new era in medicine and healing. Today, instead of looking at the human body as a biological machine, we know it is a vast energetic network, where spirit, matter, and power intersect.”

    And here I am learning about genomics and DNA Microarrays.

    I knew my professors were holding out on the good stuff.

  7. A well said argument as usual, although I do have to say that having that guy spouting about the “assemblage point” with links to ridiculous websites as the first comment is, well, fucking obnoxious.


    (Everybody gets one gratuitous link to a ridiculous website. -PB)

  8. Spot on again PB. I love your well-constructed rants about how crappy CAM actually is. I wish there was a better way to get the word out.

    As a medical student, I find it amusing to walk down the street to this “herbal medicine shop” and talk to the owner about how their herbs will cure all of my problems…

  9. PB, I’m curious – have you managed to discernably change anyone’s mind regarding CAM with your series of posts? You organize your thoughts very well and lay them out in convincing fashion. At the same time, it seems your increasingly persuasive posts only bring out more and more crazies, and they seem never to truly acknowledge or address the heart of anything said against CAM of substance. Then again, it takes a certain type of personality to accept CAM to begin with.

  10. I don’t think Panda is particularly focused on changing anyone’s mind. I (and many others I suspect) like Panda because he is particularly adept at putting many of the thoughts I (we) have on a variety of topics into clear, concise written format. Not to say I (we) agree with him on every issue or even the range/scope within every issue. Who cares if he convinces anyone? No I, and I would guess not Panda.

  11. What I dont get is why all the respect for CAM from people in the medical profession. Why is everyone so afraid to challenge these snake oil salesmen. In med school so far we’ve had at least 4 lectures on CAM topics, including one by a chiropractor and one by an accupuncturist. The presentations were all pro CAM, each siting many pro CAM studies, but not a single one showing that some CAM modality was worthless. The faculty just seem to accept this stuff as a resonable addition to the curriculum.

  12. I think a great theory as to why CAM is so supported in certain intellectual circles is explored in the book “Fashionable Nonsense” by Alan Sokal and Jean Bricmont. Its a very interesting read.

  13. Panda, I am so sick of this topic 🙁
    Do you plan to go on for the whole of November? I am looking forward to reading something different again.

  14. “One of the weaknesses of Western medicine IMO is that it tends to treat the physical symptoms a person might be experiencing, but ignores the mind and spirit of the patient.”

    So I (an FP) should be a priest?

    So then, should I evangelize my patient, hand them the 10 Commandments to live by, and/or preach (spiritual, not “improve your lifestyle”) hellfire and damnation? Perhaps exorcisms for my mental patients?

    Or must the spiritual “treatment” be non-Judeochristian because CAM is often rooted in other religions?

    As to “the mind”, we make intense efforts to engage minds, to then teach, persuade, and enlighten patients. Sometimes we can make a difference, sometimes not.

  15. “I’m curious – have you managed to discernably change anyone’s mind regarding CAM with your series of posts? You organize your thoughts very well and lay them out in convincing fashion. At the same time, it seems your increasingly persuasive posts only bring out more and more crazies, and they seem never to truly acknowledge or address the heart of anything said against CAM of substance. “

    As PB said, early in his post, these are people catering to their “particular CAM cult” and (as we all should know) there’s no convincing cultists of anything. To me, PB’s style – straight-forward and aggressive – is an example, for the living, of how snipers should pick off zombies. Live and learn:

    They can’t be reasoned with.

  16. Supporters of CAM and all other kookery tend to show their support through personal stories: “I had pain, I saw a witch doctor, I feel better – so there!”

    Placebos also make people feel better, but don’t actually fix anything. CAM is absolute crap and it’s time for medical professionals to stop allowing it to pass by unopposed.

  17. Can see both sides of the coin on this issue. Neither medicine or cam can get rid of shingles. Both treat the symptoms but cam if continued is more likely to keep it from happening again. Most medicines come from plants. On the medical side, have a standarized dose of extract from the plant–sometimes this can be created by chemically though may change some of the properties. Flip side, the herb/plant has other properties that may also be helping in the treatment. If remember right, the chinese recognize over 30 types of diabetes while US only recognizes 2. This is a link to medical journal search engine: http://www.medline.de/k_finder.html
    Find out the latin name for a herb if you want to know what it does or research any condition and see what’s been published. Separating the quacks from the professionals is the biggest problem.

    (Look, shingles is caused by a varicella virus that lives in nerve roots, usually laying dormant until some immunological insult allows it the opportunity to blossom.  The only therapy, apart from symptomatic treatment, is Acyclovir (or drugs in its class) and then it only shortens the course if given in the first 24 to 48 hours.  After that the data are not clear.  We give it anyways because it is relatively (relatively, dammit!) harmless knowing full well it may have no effect…something that we are sure to tell our patients.  I don’t know where you arrive at the conclusion that homoepathy, chakra tuning, or acupuncture will keep shingles from coming back.  I drink a lot of Diet Coke.  I have never had shingles.  Ergo, Diet Coke prevents shingles.  Do you see the fallacy here?

    As for the chinese recognizing thirty kinds of diabetes, big whoop.  There are only two major types which we currently treat; either insulin resistance or failure to produce insulin (or some combination of the two) although there are many conditions that cause diabetes.  The ancient Chinese, as they had no idea what caused diabetes, may as well have had four-hundred kinds for all the good it did them.  I guarantee that insulin dependent diabetics died in China before the advent of Western medicine, and quickly.  I don’t know what you mean by “recognize.” -PB)

    As for cam being crap, have to disagree. There are many effective herbal treatments that have been in use for hundreds of years. Some people get forced into cam and others would be better off. Try getting a vitamin mineral deficiency test sometime.


  18. …and Panda Bear sticks the landing! This is a very nice and concise summary of many of the rationalizations for CAM.

    “Magdalena on November 11, 2007 7:17 am
    Panda, I am so sick of this topic
    Do you plan to go on for the whole of November? I am looking forward to reading something different again.”

    I think the CAM focus is terrific. And if you are in medicine you need to confront this issue. Many people believe that woo-woo medicine is superior to evidence based medicine in spite of the fact that many if not most kinds of “CAM” reject even the most basic and unassailable knowledge scientific medicine has discovered, including the Germ Theory of disease.

  19. slosuzy,

    Many CAM “treatments” hide behind herbal medicine and exaggerated claims for it. If tea (with theophylline) helps asthma, it does not mean that homeopathic infinite dilution of theophylline works.

    I guarantee you that any herbal treatment with proof of efficacy will be adopted by us Philistines. However, I have a healthy respect for the potential toxicity of plant derived medicines. I still use digitalis preparations in certain heart conditions, but if one is careless or ignorant dig can be lethal.

    Assertions and marketing along with anecdotal stories are not enough. Don’t assume a botanical is safe except for the plant that makes it. Most plant alkaloids are designed to make a predator sick or dead. Some just happen to be helpful in treating disease.

  20. While you make some very valid points about CAM, why is it that everyone here has such strong opinions about it? If people feel like CAM is helping them then let them be. If they fall ill even after CAM treatment, then it’s their own fault. I don’t see why everybody needs to attack CAM.

    (This is a medical blog written for people who should know better.  It is not “their own fault” if our patients are encouraged to practice witchcraft by their physicians to the detriment of their wallet and their health. -PB)

    Another point is that while many of these alternative medicine gurus say a lot of weird stuff does that mean it’s wrong? Many medicines we have now are derived from natural sources like plants. I mean who would’ve thought that we can treat diseases with fungus? If that’s the case then wouldn’t it also be possible that some of the “crazy potions” actually have value to them? Of course science detests anything from these shamans yet it’s a possibility that only the ignorant would cast off.

    We can find treatments to diseases in strange places. I’m actually working in a lab right now and we’re studying the effects of cinnamon on the large conduit arteries of male wistar rats. We’ve found that licorice administered in vitro causes vasodilation! Right now we believe licorice acts through nitric oxide synthase in the endothelium.

     (Uh, the point being that you’re studying it.  If it doesn’t pan out you will shrug your shoulders and say, “Oh well, guess we were wrong about that one,” not form the Cult of Cinnamon Therapy and defend it from all infidels.-PB)

    My point is that it would be wise to keep an open mind to these CAM treatments. I’m not saying we should use it as a part of treatments, but there may be something of value in it. Although the premises of their treatments are sort of strange it doesn’t mean there aren’t any effects.

    (I want you to explain to me, in an open-minded way, how Homeopathy, for example, can possibly work or how, as another example, chiropracty obviates the need to have your children vaccinated.  Ready…go. -PB)

  21. The alternative treatment for shingles is to take lysine or eat foods rich in lysine and avoid foods containing argenine like peanutbutter. Yes it makes a difference to me as I have reactive hypoglycemia. Have had it since was a teenager though didn’t find out what it was until mid 30’s. Health screening test at work caught glucose reading of 58 and gtt results had me bottoming out in 30’s. Unless it is caused by the thyroid or an insulinoma, you get told to just watch your diet. Since mine started within a year of having started menses, am inclined to think that it is vitamin/mineral deficiency. Multi-vitamin worked for a few years but need to get specific now with what I need to take. Most pms symptoms can by correcting vitamin/mineral deficiency. Check out calcium deficiency.

  22. R Alanko

    Agree with you whole heartedly on herbal treatments. The standards here are just not good enough–at least for me. So herbal remedies that I buy come from europe with companies that have a long history of safety and and standardizing dosage. Also don’t like the way things get marketed. Right now you can buy cinnamon supplements to help control sugar levels. This is very misleading. Cinnamon reduces insulin resistance so sugar levels will come down–it doesn’t help sugar levels to stabalize or rise. Depending on how much insulin is floating around sugar levels can drop dramatically. Also fat cells are the last ones to become insulin resistant so more likely to just put on weight.

  23. Perhaps the Indians you callously mentioned died like flies from those diseases because those were diseases they had not been exposed to prior to European contact. They had cures for conditions which the race had been exposed to historically. Which come to think of it, suggests a lot about the health, cleanliness, and lifestyle of Europeans in that wherevever they went, they brought along a whole host of diseases. Take New Zealand, USA, or Australia for example. All the indigenous people had cures for their own diseases but when exposed to measles or another such introduced disease they were severely affected because it was so sudden and they were effectively immunologically isolated prior to this. Just for the record, Ayurveda can still cure all the “traditional” diseases and conditions, albeit more slowly.

  24. rain said:

    “Which come to think of it, suggests a lot about the health, cleanliness, and lifestyle of Europeans in that wherevever they went, they brought along a whole host of diseases.”

    When those bastards from Europe discovered India, they brought their dirty diseases with them and killed all the indigents!

    Now re-roll the dice of fate, and switch “Europe” for “India.”

    Did you know that the Black Death pandemic around 1350 probably originated in China?

  25. White people denigrating the beliefs of black people, brown people, yellow people, and red people as pseudoscience.

    Ok white man, whatever you say.

  26. Your worldview, and explanation of pathology, is the only worldview.

    Because you’ve called it a “nerve” and “shingles” and conquered the world, that is the only possible scientific description of a concept.

    It is interesting to place your rants in historical context. White people labelled black practices “voodoo” as a control tool. Practice good science, be skeptical, but don’t be part of the hegemony.

    Four blind people encounter an elephant. One grabs the leg and is convinced it’s a tree trunk. One holds the tail and thinks it’s a whip. Another touches the elephant’s trunk and decides it’s a hose while the fourth man pats the side and is sure it’s a wall.

    The wise man tells them, “All of you are right.”

  27. “http://youtube.com/watch?v=4ZEi8l7p56I
    If anyone believes in this crap after watching that – they deserve what they get.”

    Oh my God, that was the most painful 8 minutes of my life.

  28. It actually took longer than I thought for someone to decide to label Panda a racist for supporting Evidence Based Medicine in favor of what amounts to scientifically unprovable indigenous/home remedies. What ridiculous nonsense.

  29. “The wise man tells them, “All of you are right.” ”

    You see, thats just not true. Despite your postmodernist foolishness, there actually is an actual scientific truth to things in the world. Cultural relativism is great, until it reaches the point that you can no longer exercise critical thought. The aztecs sacrificed people to the sun by cutting out the hearts of their victims. Maybe we should try this in hospitals? After all, their affliction might be caused by the sun god.

  30. “Oh my God, that was the most painful 8 minutes of my life.”

    Haha, yea I love how you can cross out the m in e=mc^2. Because you know, the whole point of the equation is not to actually relate mass to energy and canceling out m because you feel like it would render it meaningless.

    “Perhaps the Indians you callously mentioned died like flies from those diseases because those were diseases they had not been exposed to prior to European contact. They had cures for conditions which the race had been exposed to historically.”

    Oh really? Indians had a life expectancy of 70 and could cure diabetes? Well, bugger me silly. Though I do have a question – why the white man? The Indian subcontinent has been one of the most invaded places in the history of the world. Before the British, it was invaded by the Mughals, a bunch of Aryans, going all the way back to Alexander (and before).

  31. Another med student here… I thought I would share a little anecdote from lecture the other day. The Madagascar Periwinkle is a plant that was used in Chinese folklore for diabetes. Robert Noble and Charles Thomas Beer isolated vinca alkaloids from the plant. They discovered no effect on diabetes, but these compounds are now used in cancer therapy.

  32. oh, that video is terrible. I think just watching that is going to make me fail my physics test tomorrow.

    Question to the CAM people:

    Your son falls down the stairs and hits his head. He does not wake up. In your panic, you call several people.

    The neurosurgeon says he has a subdural hematoma, and needs emergent surgery.

    The chiropractor says he just needs some spinal manpulation.

    The Accupuncturist says the fall blocked a meridian, and he needs needles to reopen the meridian.

    The shaman says the fall released bad energy that was contained, and he needs an exorcism.

    Which specialist do you take your son to? Why?

  33. I just have to tell a little story. Had a pt. come in last night with anacute anaphylactic reaction to “chinese herbs” that she had taken for a URI about an hour prior to onset of her symptoms. Interesting how one will prefer CAM for minor ailments, but when the dung hits the dodo they rush to the local ER for all that good Western medicine. The one part of this whoe encounter that infuriated me was that when I informed the patient that her symptoms were most likely a result of ingesting said herbs, ie – the most recent thing she had ingested – she looked at me like I was an idiot!

  34. Okay, stumbled on this blog and am finding enlightening! Glad to hear that not all students buy in to the crap. I think a lot of med school teaches how to write Rx and fill out forms for “the man”

    However, on this thread I was particularly disappointed. All these references to CAM, but no mention of lifestyle. Hmmm, we could just prevent a lot of typical American fatass illnesses like hypertension, diabetes, etc. by just eating a diet of whole foods and reshaping our asses from the mold of the LazyBoy by maybe getting out of it once in awhile. I think that theory works well within modern medicine and doesn’t have to be considered CAM. I’m not suggesting that medicine is bad, or that CAM is bad. I think that McDonalds, Coke, and any food where the ingredient list requires a dictionary is bad. I think that sitting on our asses in our comfortable chairs while turning our brains to mush in front of the TV is bad. And these habits are adopted at ages as young as infancy.

    Comparing our healthcare system to other developed countries must be done with control factors. Many of the countries where good, inexpensive healthcare is available have healthy populations! Our general population is unhealthy! In fact, kids are diagnosed with ADHD, and medicated, when just a simple change in diet coupled with some real exercise would cure it.

    And, let’s not get me started on immunizations. Perhaps you could target that topic in a future rant.

  35. The medical industry (and pharm industry) rely on sickness to thrive. It doesn’t benefit the bottom line to teach people how to be truly well. For instance, if babies were simply breastfed for at least the first 6 months, millions of $$$ would be saved in healthcare costs-both immediate (ear infections, stomach upset, etc) and long term (diabetes, obesity, cancer, etc.) BUT, MD’s regularly steer their patients away from doing what is natural and good because it isn’t measuraable and doesn’t fit into the nice, neat little box.


    (I used to be, along with my wife, something of a breast-feeding Nazi.  But you know, it probably just doesn’t matter.  Maybe breast-fed babies are healthier but on the other hand they also tend to be raised by totally devoted, intelligent, educated mothers who are completely into every aspect of their baby’s health and development…which is a good thing.  I want to see studies corrected for socioeconomic status because I have only seen a handful of poor mothers who could stand to breastfeed exclusively, not for the least of which reasons being that they had to work and the kind of jobs they toil away at are not condusive to pumping.  Their children might be less healthy for a myriad of reasons which have nothing to do with breast-feeding.

    My stint at Duke cured me of the breast-feeding bug.  I regularly had experienced mothers asking me under no circumstances to allow the lactation consultants into their rooms as they didn’t feel like getting the lectures and the guilt trip.  It’s probably more important that the babies get fed a good diet than whether it comes form a breast of a bottle.  I know very well about maternal immunoglobins passed to the baby so spare me.  I’m all for breast feeding but come on now.  It falls in and out of fashion and my generation, who were not breast fed as a rule, don’t seem any stupider or sicker than anybody else.

    And doctors, by the way, especially Obstetricians and Pediatricians, promote breast-feeding in a big way.  They do not steer mothers away from it, on the contrary, it is mothers who steer themselves away for the perefectly legitimate reason that they don’t want a little ankle-snapper hanging from their breast all day.  Sorry, that’s the fact of it. -PB)

  36. ‘ The wise man tells them, “All of you are right.” ‘

    That wise man sounds retarded. After all, isn’t it an elephant?

  37. I object utterly to your suggestion that CAM does not progress. In my area a new and totally effective method of improving acupuncture by withdrawing and re-injecting blood at the correct meridian points relieved the symptoms of very many patients.

    Pity about the patients (customers / clients?) who caught Hepatitis B from the dirty needles.

  38. Another excellent post, PB.

    Ah, hippiemama,
    Breastfeeding ie mother’s milk is the normal food for our species during infancy. This is not CAM. Scientists have demonstrated that babies fed artificially constructed milk substitutes ie formula have slightly lower IQs and are more prone to a host of diseases. There is plenty of good scientific theory about how and why as well. It is true that many babies have been fed formula who are the victims of a combination of cynical marketing ploys etc and an earlier generation’s lack of understanding of immunology, a study that is only now in its heyday. The point is that through science we are constantly learning. And when we know better, we do better.

    Because of the above, every pediatrician I know at least gives lip service to breastfeeding these days. Is yours really old and fossilized that s/he doesn’t? I work with all my new mamas to promote breastfeeding. I tell them (if I think they can take the joke) that it’s because I’m lazy and don’t want to spend all day at the hospital taking care of babies with pneumonia and necrotizing enterocolitis.

    “Natural and good” I have no argument with. But what about when people get sick anyway? and they do, oh yes. I simply cannot recommend buying a bag of leaves (of dubious purity and potency)from the herbalist however natural it may be unless there is really no alternative or we are doing a (well-controlled) scientific study. Herbs however actually are medicines. A lot of the rest of CAM on the other hand boils down to :interesting historical myths, religious practices, pseudo-religious charlatanism, and exercises. I have no problem with exercises. Nor any real problem with religion (although some docs do) as long as no-one tries to pass it off as medicine.

  39. hippiemama,

    Oh dear. Doctors don’t counsel on lifestyle changes?

    We’re currently being taught techniques to “work with the patient, not talk down at them” on lifestyle changes at my med school.

    Unfortunately, I spent two years prior to school doing nutritional studies in a suburban area. As a passive observer to the docs, let me let you in on a secret: most doctors, despite not being trained in lifestyle intervention (unless they graduated in the last ten years), try their best to counsel on smoking and weight loss. Hell, my gynecologist asked if I wear a seatbelt in taxis last week.

    Patients offer an amazing amount of excuses and simple apathy to the concept that the doctor might be right. None of us can seem to start that crucial cut-the-salt, take-a-walk mentality needed. The cajoling docs were least successful, the angry doctors the best, contrary to all the well-meaning techniques offered to me these past months.

    And when I talk about patient recalcitrance, I talk from the viewpoint of someone with a BMI of 24 and almost no muscle, certainly some visceral fat building up. I’ve read the damn studies, and I can’t find time to take a walk or not scarf down fries at the cafeteria during my five-sec breaks on clerkships.

    Bottom line: we counsel. If you don’t listen despite reasonable efforts on our part, you can’t then say it was because we didn’t try hard enough. Believe it or not, people will still come down with illness if their obesity goes away. The reaper comes to us all, and I’ll still be in business.

  40. MSG wrote: “Placebos also make people feel better, but don’t actually fix anything.”

    Actually, the same can be said for most psych meds, particularly antidepressants and anxiolytics. At best (which is maddeningly infrequent), they help alleviate the symptoms of depression and anxiety, but the true “cure” to these disorders lies in learning a new way of thinking about oneself and one’s world…. After experiencing my own recovery from mental illness & addiction, I must say I’m impressed with the “power of positive thinking” (or whatever new-age phrase you wish to plug in here) and the false hope of many meds.

  41. Welcome to Panda’s blog himmiemama. If you’ll pass through the archives, you’ll find more than one post discussing many of the things you mentioned. This just happens to be Panda’s declared “CAM month” and thus most of the recent posts are on this topic. Enjoy!

  42. “I talk from the viewpoint of someone with a BMI of 24 and almost no muscle, certainly some visceral fat building up. I’ve read the damn studies, and I can’t find time to take a walk or not scarf down fries at the cafeteria during my five-sec breaks on clerkships.”

    I’m an (always trying to stop) smoker and, because of poverty, a person who has to eat lots of fast food. I’m not proud of it, but I’m not ashamed either: I’m taking what life hands me. I walk most places I go and work hard, under less-than-ideal conditions, so that’s my exercise. I’m drinking a Guinness right now.

    We know more about what kills us, now, than ever before. No need to be afraid of it because it has a name (Cancer, heart disease, your stupid cousin who owns a gun) it’s The Reaper, and he’ll have the last word, no matter what. Not accepting that is the fuel for CAM. I’ll eat better when I can afford to, of course, but, in the meantime, I’ve got to stay alive and this is what helps me – me – do it.

  43. “Your son falls down the stairs and hits his head. He does not wake up. In your panic, you call several people.

    Which specialist do you take your son to? Why?”

    I’d go straight to the ED. Kinda a dumb ass question isn’t it?

    What if you have a veteran with PTSD with associated stress related problems?

  44. Crack emcee, you’ve got the solution already. Let’s see, you smoke and eat fast food. You’re drinking guinness and claim poverty. Last I checked, malt liquor (or Lysol-LOL) was the drink of choice for those living in poverty, not a good dark ale.

  45. I do little things to keep my spirits up. We’ve all got to. I’m writing on a friends computer in a dangerous neighborhood with lots of shootings. There’s no supermarket nearby, only a liquor store, a mexican restaurant, and a Burger King.

    And, most importantly to me, I’m not complaining but “pulling myself up by my bootstraps”.


  46. crack, you are truly amazing. visited your blog and your friend seems reeaaaally generous considering how much time you must spend online. I also enjoyed seeing the list of your favorite links 😉

  47. dr. bean, “Breastfeeding ie mother’s milk is the normal food for our species during infancy. This is not CAM.”

    So, when a neonatologist prescribes breastmilk for her patient, that isn’t CAM? When the mother places drops of breastmilk in her infants infected eyes, that isn’t CAM? Or, how about when breastmilk is used to treat diaper rash or cracked nipples?

  48. I loved breast feeding and breast fed both sons only breast milk for the 1st 5 months of their lives. I was able to be on call 24/7 because I didn’t work. My mother and older female relatives didn’t understand. I didn’t flaunt it but it was a choice that I am grateful to have made. Never could pump though so hence the 24/7.

    I did continue breast feeding even after foods were reduced, which again they didn’t understand. The bonding is phenomenal…just something about it. Also great as far as no bottles. :)_

  49. hippiemama,

    Thanks. I’m one of the “working homeless” so, even though my friend isn’t home much, I can’t be online a lot. I’m just eclectic with time-management and reading material. (I noticed last night, as I was returning from work, I was carrying a recycled Wall Street Journal, a copy of AWAKE! that some lady handed me, and a paperback of Please Kill Me: The Uncensored History of Punk, which – to my utter disgust and dismay – contains the unfortunate line, “So I had an affair with Yoko Ono.”) Anyway, glad you could stop by.

  50. hippiemania: “So, when a neonatologist prescribes breastmilk for her patient, that isn’t CAM?”

    Erm… no. You couldn’t have said anything to more clearly illustrate that you don’t know what you’re talking about.

    You see, if there is EVIDENCE that a therapy or practice actually works, then it becomes part of EVIDENCE-based medicine. That’s why a neonatologist is saying breast milk is healthier for the baby and not the local herbologist / chiropractor / homeopath / other witch-doctor equivalent. (But, as PB points out, formula is much better than the alternatives if breast milk isn’t available for some reason.) That’s why any doctor will tell a patient with an unhealthy lifestyle to change it. Is there evidence an herb works? Then it (or its effective component(s) as identified by the evidence) becomes part of EVIDENCE-based medicine. The same is true for any such treatment. CAM remains CAM for the opposite reason: There is NO evidence it’s effective.

    Pepito: Actually, black people called it “voodoo” (or “vudu”, pick your spelling), with several variations such as “vodun”, “vudun”, “vodou”, etc. It’s a native African word.

    rain: India has never, ever, in all recorded history and possibly earlier, been isolated from Western contact and Western diseases. Ever. All the “voyages of discovery” did was to find a sea route to India. They knew exactly where it was. That’s how they knew where they were when they got there.

    If anything, diseases traveled from east to west, not the other way around. Learn some real history before you spout off.

  51. “hippiemania” was a genuine misreading on my part of “hippiemama”. No sarcasm was intended there, and I offer my apologies.

  52. “rain: India has never, ever, in all recorded history and possibly earlier, been isolated from Western contact and Western diseases. Ever. All the “voyages of discovery” did was to find a sea route to India. They knew exactly where it was. That’s how they knew where they were when they got there.

    If anything, diseases traveled from east to west, not the other way around. Learn some real history before you spout off.”

    Chris, who are you talking to??

  53. You’ll find a post dated 11/12 from someone calling himself “rain” who claimed that Indians (i.e. the inhabitants of India, not Native Americans) fell victim to diseases brought in by contact with Eurpoeans. Thus the apparent ineffectiveness of Ayurvedic medicine in the face of said diseases, since it had not been developed to cope with them. This was a false claim.

  54. “Chris, who are you talking to??”

    To the person named to the left of the colon in the first line of the quoted text. On November 12 in this very discussion (as you can verify by scrolling upward), he posted his hypothesis attributing the ineffectiveness of Ayurvedic medicine to the notion that it was not developed to cope with the diseases brought in by Nasty, Evil Europeans ™. This hypothesis was based on historical ignorance, which I sought to correct lest he make a fool of himself in some less well-mannered forum.

    Anything else?

  55. Hmm. PB, either these posts are not going through at all or I just posted twice after not seeing my first one appear “for moderation”. If they in fact went through, please delete whichever one is less effective.

    (Some comments go to the spam bin, especially if they contain certain key words (“Brittney Spears Nude”) or more too many links.  I get hundreds of spam messages a day and I can’t search through them all.  My apologies.-PB)

  56. Chris, so anything which seems to work suddenly becomes part of “regular” medicine, since it’s evidence based and anything that doesn’t remains CAM. What nonsense: a rose is a rose is a rose, by what ever name you choose to call it by. Please let’s be ready to give some credit to the CAM users and their docs. CAM has been in existence for centuries in the eastern countries and it HAS been evidence based, that’s why it’s still in use.

  57. Can someone out there please point out the doctor preaching that double cheeseburgers and high fructose corn syrup are the cure for what ails you? When exactly did doctors not tell people that their diet might just have something to do with their health problems, especially for something like, oh, I dunno, diabetes.

    If Bob’s Alternative Mechanic Shop takes your car, anoints it with oil, burns incense, and replaces the leaky gaskets, he doesn’t get to call his practices Alternative Mechanics and claim replacing the leaky gaskets are his exclusive purview and all the “traditional mechanics” need to kindly stuff off and leave that kind of thing to him. Nor does he get to claim that the anointing and incense are necessary to changing the gaskets because his study showed bringing a car to him improved its performance, and everyone else who skips those steps are obvious frauds.

  58. Oh, please crystal therapy is NOT CAM; it’s not anything! It’s not what I or believers in CAM are talking about. CAM is actually something that we put in our mouths, actual meds, herbs etc. Meditation may be called CAM and has been scientifically proven in many instances to work, in lowering BP but it’s not really CAM. Vitamins such as containing turmeric, yes, may be called CAM, it’s something we put in our mouths/cook with. AND it’s been seen to work in scientific studies to help cancer patients. Actual recent studies have shown that Indians suffer the least in any type of cancer in the world. THIS is CAM and it has been practiced for centuries in India.

    (Indians also die sooner than many other people in the world.  If you only live to be fifty, for example, you probably have a low risk of dying of any number of cancers, most of which strike after many years of genetic insult.  Additionally, India, while a dynamic, growing country is still a little backwards in many respects.  If you live out in some village in the Indian Hinterlands or in the slums of Calcutta and you die from some unknown cause after which you are cremated by your relatives, let’s just say that the cause of your death and the natural history of the disease that killed you is not exactly going to make it into the official statistics.  As for your scientific studies, I’ll wager you don’t know what constitutes a valid “scientific” study. I also want to point out that India produces some of the best doctors in the world, all trained in Western medicine.-PB)

    I see PB, you took off my earlier post that you had published this morning. Did it make too much sense?

    (I have an automatic spam detector that sometimes seems to act with a mind of its own.  Repost your comment if you still have a copy of it.  With a few exceptions I never delete or do not approve a comment.  The only ones I outright delete are overtly insulting or obvious spam.-PB)

    Everything in CAM doesn’t work, sure but neither do so evidence based meds as you call them with all their side effects. What about all the controversy about Avandia. Why do so many docs want to take it off the market completely? All I’m saying is let’s be more open minded about CAM and let patients use it if nothing from the “regular” medical world works for them. As a doc, don’t you think that’s fair enough?

    (If I can prove that homeopathy doesn’t work, will homeopaths take their remedies off the market?  Of course not.  CAM is faith-based and will cite science only so long as it can get away with it.  When the evidence is lacking the CAM practitioner will shrug his shoulders, say, “Oh well,” and retreat to the usual religious defense.-PB)

  59. Earlier on, you had said that my comment was emotional, not rational. PB, we all do become passionate about we believe in; am sure you’re passionate about practicing medicine, otherwise, you wouldn’t have become a doc. We need to have more freedom about how we as patients want for ourselves and if some CAM theories do work, the regular docs should respect this competitive field. It’s as important as the freedom of speech.

    I am a diabetic and am on CAM, which for me, seem to be working well. Luckily for me, I had a doc who was open minded and let me try it. The deal is that as soon as I’m not able to control it, I go on reg meds, which I don’t want to because of all the side effects connected with them. I also happen to be on allopathic meds for other problems. I’m doing well in every way, all my docs agree. This is what I mean by using all the resources we have to help ourselves. Does that make sense now?

  60. PB, do forgive me but CAM has nothing to do with religions, in India both Muslims and Hindus use Ayurvedic meds as do many Christians in the US. Faith based, maybe, being positive when we are ill helps us to heal, like the Faith we have in our docs, anywhere in the world.

    I am an Indian and proud to be one, but,yes, I totally agree with you, it’s booming but far behind in health care. We have a huge population problem and this hinders all our progress, but we will get there one day, am sure. I, myself, have come upon CAM only in later life since have become a diabetic, have read a lot about it in these last few years and yes, do know about “scientific” studies, controlled, with placebos etc. so much for your wager!! (I happen to have a MA from NYU).But no doubt, we do need many more such studies, and they are happening with more and more interest in this fascinating field. It’s never, though, going to be funded as much as “regular” meds, that for sure.

    What we need to get out are such things as crystal therapy, no doubt!!

  61. Actually, TCM has advanced tremendously since people started poking each other with sticks over 5,000 years ago.

    In many ways, your (and my) allopathic medicine is the “advance” of TCM and similar techniques.

    But what we know now doesn’t discount what people discovered before.

    The problem comes with allopaths flex their muscles. I don’t know one TCM doc who wants to replace biomedicine. But for some reason, a lot of White Coats want to destroy TCM. I don’t understand what the big to-do is about.

  62. This isn’t complicated.

    The parts of TCM that work are no longer strictly TCM. Evidence-based medicine (only “allopathy” to a homeopathy cultist) takes what works and leaves the rest. Anything that’s still TCM-only even after it’s been evaluated by scientific research for efficacy is worthless by definition.

    To be sure, there’s much TCM that probably has yet to be investigated, and no doubt over the millennia more than one treatment has been discovered that actually works. But there’s no valid methodology behind it, and no reasonable standard for diagnosis. If I have a cold it’s because I’ve been infected by a virus, not because I have “qi stagnation” or “blood cloudiness”, and treating me for either of those isn’t going to do anything for the cold — which will certainly go away on its own after a short time anyway. It certainly cannot do anything for most conditions, except in those rare instances where they happen to include an effective treatment in their pharmacopeia and the diagnosis coincidentally characterizes a condition where it would work in such a way that it’s prescribed. The other 99.9% of the time it’s useless.

  63. Ladybird: No, let’s not give them credit. Anyone who still treats using discredited methods deserves no credit whatsoever, and anyone who is willing to subject themselves to such methods is misguided at best. So a CAM discipline includes one effective treatment out of a thousand snake-oil treatments? What’s to credit?

    Had CAM wiped out smallpox (it had ample opportunity) I’d be impressed. If it could stop the flu, that’d be something. Funny how new flu strains pop up like clockwork in the heart of TCM country. If it could just be shown the damn stuff WORKS consistently…. but then, if there were evidence for it, what would we call it again?

    The very fact that studies taken as a whole are inconclusive even when you include the poorly designed non-blinded ones that always show it works ought to tell you something. That it doesn’t suggests a certain imperviousness.

  64. You are painting with very broad strokes here. Bastyr University endorses CAM (not the same as endorsing every claim made under the banner of CAM), and they also conduct double-blind studies to test it. So are they scientists, or snake-oilers?

    (Snake oil salesmen and Patent Medicine men.  I mean, seriously, you namedrop like Bastyr is Johns Hopkin.  Bastyr is the sucking gob-hole of idiot medicine.  


    Come on now.   -PB)

  65. Let’s see. I was ill, so I went to a 25 year old doctor who without a single test other than to listen to my heart determined my problem was depression. He consulted with 6 other doctors and the head of the clinic who all agreed, none having seen me or spoken with me, but based their decisions on his persuasive orations.

    I threw the prescription in the garbage alongside the very place where he had thrown my list of symptoms.

    I went to see a nurse from the same hospital. She told me that I was eating such unhealthy foods that I needed to drastically change my diet. I did this, little by little, retraining my thinking towards the concept of healthy eating. She tested my blood, she paid close and careful attention to what I told her and remarked that I pay close attention to my body. She also prescribed a compounded plant based hormone (not estrogen) to replace the one that I was found completely lacking as my body did not make it. Within a few days, I was fine. Depression was no where in the illness.

    Your “evidence based” doctor based his evidence on what someone told him to do, because the chief was fired for all the kickbacks from the antidepressants and all of the clinic’s doctors were rotated out in an exceptionally fast rotation due to the high level of patient complaints.

    Another “evidence based” doctor told my son that his painful pins and needles were psychosomatic. But my nurse again did all of the tests, well turns out he’s diabetic. She got his food sources straightened out too, and he’s been able to control his through diet and exercise.

    I’m sticking with my homeopathic nurse/practitioner. She’s the one who actually DID the tests to figure out what was the problem.

    (Your story is as full of shit as you are.  Sorry.  -PB) 

  66. How can CAM be completely disregared like this when many of today’s modern medicine come from things like plants and animals? All CAM is doing is going to the natural roots of medicine and giving it to the people. Modern medicine just takes the plants or animals, extracts them in a lab, adds a bunch of crap to the drug and sells the drug at optimum price to doctors and pro modern medicine junkies. I am not saying that modern medicine is a joke, I am just saying that modern medicine practicioners should open their minds to CAM instead of rejecting it all the time. Or you can just leave it alone altogether. I don’t care. I’m still going to use CAM and I guess I’ll use modern medicine whenever things go really f*cking bad.

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