Evidence Based Medicine? We Don’t Need No Stinking Evidence Based Medicine

The Free Netter’s Ain’t Worth It

I am an educated man. I have an extensive liberal education, a degree in Civil Engineering, a Medical Degree, and am almost done with residency training in Emergency Medicine. Just for fun, I read the kinds of books they forced you to read in your long-forgotten English literature course (not that you actually read them but instead passed the course with the help of CliffsNotes and the professor’s fear of damaging your ego). While not an expert in much, I have a good working knowledge of physics, biology, chemistry and enough of the medical sciences where I at least know enough to understand new concepts as they present themselves and when smoke is being blown up my ass.

On the other hand I am also an ordinary guy and have done my share of regular jobs from fast food to landscaping and a lot of things in between. As I may have mentioned once or twice, I was also a United States Marine Infantryman and consequently know which is the dangerous end of a gun and, while I am today just a stocky suburban dad, at one time could and did endure physical hardships that would make the typical malignant Attending Physician, cock-of-the-walk in the hospital chicken house, weep like a little girl.

I have by no means seen and done it all but I have a pretty good idea how things work. I confess, however, that about one of the major underpinnings of the great structure that supports my beliefs, I have been wrong. Completely and utterly mistaken, so much so that if I could, I would find everyone upon whom I inflicted my totally incorrect theory and humbly abase myself in abject and total apology.

You see, for my whole life I have believed, and defended vigorously, the notion that being educated does not preclude one from having common sense. The conventional wisdom is the contrary of course, and I have heard this wisdom expressed often, especially when I was a Marine. “Yeah, he’s book smart,” went the typical conversation, “But that guy can’t find his ass with two hands and a flashlight…couldn’t pour water from his boot if the instructions were on the heel.”

I’m not saying that educated people are immune from stupidity, just that education does not cause stupidity and I have been a champion, a lion, in the defense of education as a complement and even an enabler of common sense. After all, many of the cool kids at my high school who eschewed the Chess Club are currently living in single wide trailers with women who, despite weighing 400 pounds (181 kg), are still trying to cram themselves into the same revealing clothes they wore in their brief flowering of trailer park beauty, those precious couple of years as fleeting as the tundra blossoms, between their first tattoo and their first illegitimate baby.

And then I read, via Orac at Respectful Insolence, about something called the Complementary and Alternative Medicine Leadership Program, sponsored not by some third rate chiropratic mill but by the American Medical Student Association, a splinter group of the august American Medical Association, who have bribed hundreds of thousands of medical students to join their ridiculous organization by giving them a free anatomy atlas (Netter’s).

I wept.

Suddenly, what I once thought to be the stable soil underneath the foundations of my weltanschauung heaved as if nothing more substantial than wet gumbo clay. Maybe smart people are prone to be booger-eating morons after all. I mean, seriously, here’s a group of American medical students who they tell me are drawn from the very top percentiles for intelligence spending their summer sitting at the feet of homeopaths, acupuncturists, and Reiki healers, soaking up the woo like so many lumps of dry cornbread. And they are buying it. Completely and wholeheartedly. The natural skepticism which is the true birthright of an educated man seems to have skipped a generation.

Take something like Reiki, one of the latest and trendiest of the new age Complementary and Alternative Medicine therapies. The Reiki practitioner claims to produce medically significant effects on a patient by shooting sacred fire out of his appendages. That’s it. That’s all there is to it. Once you strip away the Eastern mysticism and flamboyant Asian ambience it’s just a guy shooting spiritual energy into a patient. I told my Heating and Air Conditioning Guy about Reiki and he laughed.

“Hey, maybe you can get a a Reiki healer to shoot some mystical fire out of his ass to fix your furnace,” he said, “But in the meantime I’m still going to have to charge you a hundred and twenty bucks for the new igniter.”

The Good Lord knows that I embrace the concept of Evidence Based Medicine. A lot of what we do in medicine is marginally effective (if at all) and it is sometimes only tradition and a general sense that something should work (even if it doesn’t) that keeps us doing it. Evidenced Based Medicine is a world-view, a system of thought, that allows us to test everything we possibly can and eliminate these therapies that are ineffective or even harmful. But Reiki? With respect to my colleagues investigating every aspect of medicine, I don’t need a double-blinded placebo controlled study, a meta-analysis, or any other proof except the obvious one that some smarmy guy with a mail-order degree in Eastern mysticism cannot shoot spiritual fire out of his hands. First because there is no such thing as spiritual fire and second because, well, he’s some smarmy little fraud with a mail order degree. As I mentioned in another post, res ipsa loquitor; some things just speak for themselves and while I appreciate the zeal of many in the scientific community to test even things that are obviously ridiculous on a fourth grade biology level, I don’t necessarily need a lot of evidence to suggest that magic fairies and pixie dust are not legitimate treatment modalities.

Which is kind of the point of research into things like Reiki and Homeopathy. What on Earth do you expect to find? Even those who are inclined to believe in this kind of nonsense, when pressed, will admit that for any given Complementary and Alternative Medicine therapy the research is generally incredibly shoddy and, even allowing for a generous confidence interval, a blind eye turned towards the biases of the researchers, charitable peer review, publication in journals that are only one step above the supermarket checkout line variety, a favorable wind, planetary alignment, and an early showing by the groundhog, the positive results are slim, barely detectable, and easily ascribed to a placebo effect; something that is controlled for in real medical research and, if detected taints the entire study. In the world of real medical research, you understand, discovering that your prized medication is no better than a placebo is not greeted with war whoops and fists clenched in triumph.

No high fives, in other words. Back to the old drawing board. Things work the other way in the mystical world of Complementary and Alternative Medicine. The discovery of some insignificant statistical anomaly in a poorly designed and non-reproducible study is greeted with the same enthusiasm by the true believers as the discovery of the structure of DNA and we must now run, not walk, to legitimize their particular brand of fairy dust and use it on everybody. Pulling the same trick in real medicine leads to eventual exposure, embarrassment, ridicule, and even criminal charges. While every medical therapy involves some combination of cost and effectiveness, for Complementary and Alternative Medicine the cost (because Reiki healers do not dispense spiritual energy for free) is not even remotely worth whatever miniscule and highly subjective clinical results can be delivered by what is essentially an entertainment modality and not a medical one. You could, for example probably get the same results watching old Kung Fu reruns as you could with acupuncture. Or, to put it another way, acupuncture won’t work if it’s some bored acupuncture tech named Frank doing it, even if he puts the needles in the right spots. Unless he dazzles you with his mystical dog-and-pony show it’s just some paunchy guy smelling of cheap cologne sticking needles in you.

You know, I cannot help but sympathize with the young AMSA scholars. Medical students are not generally the popular kids in high school or college. The demands of making good grades and navigating the poodle-circus of medical school admissions preclude a normal social life. For my part, I was something of a nerd in high school. I was on the Debate Team, for Mohammed’s sake. Can’t get more uncool than that so I understand full well the appeal to you, oh young AMSA scholar, of going to some retreat with a group of your geeky friends lead by a bunch of people who, as you are the future leaders of medicine, will coddle, stroke, and reaffirm how special you are. It probably gives you the same rush you got from representing Cuba in the Model United Nations. But that’s the thing, isn’t it? Complementary and Alternative Medicine at the medical student level is not about the patient but about the medical student who use it as a positive affirmation of their own values; their open-mindedness and their unshakable belief that some Native American Medicine Man chanting around a sacred fire has something legitimate to teach the medical profession. It’s a way to resist the brutal self-discipline required to put away the fantasies of childhood and deal with the World-As-It-Is rather than how you would like it to be.

It also affords you the opportunity to get close to that awkward but reasonably pretty girl who otherwise won’t give you the time of day but who sent shivers up your spine that time she accidentally brushed by you. Dude, that’s why they have Spring Break. Not that I don’t applaud your motivation, especially if you are into earnest chicks who want to save the world but just admit it and stop with the magic fairies.

Housekeeping Stuff:

1. Congratulations to Graham over at Over!My!Med!Body! for matching into Emergency Medicine. Welcome to the club and no matter what they say, all the other specialists secretly wish that they were the combination of poker player, cowboy, daredevil, scholar, and circus clown that it takes to be an Emergency Physician. I can’t imagine doing any other specialty (even though anesthesiology looked mighty good, details in a later post, when I recently did a two week rotation) and once you get through all of the intern year crap you will enjoy yourself immensely.

2. Your comments are appreciated. Please, limit your links to two (2) as my spam filter is on a hair-trigger. No matter what your comment-the cardioselectivity of various drugs, your groundbreaking economic theories-if you use the words Brittney or Spears anywhere in the comment I think it is automatically shredded.

35 thoughts on “Evidence Based Medicine? We Don’t Need No Stinking Evidence Based Medicine

  1. To be fair, AMSA is no longer part of the AMA. They broke off in the 60’s or 70’s. There is a medical student section of the AMA that is far more respectable with an emphasis on legislative work. AMSA is downright odd and will be the first group to throw the rest of the medical profession to the wolves.

    I’m glad to see you address this issue.

    (So noted.  Thanks.  -PB) 

  2. I’ve taken a course in the complementary and alternative medicine as an elective in pharmacy school just because I know I’m going to get asked about and I’d like to be able to shoot holes in the arguments people make about “traditional” medicine being worthless easier. So far I haven’t met one ‘practioner’ that was really into their “alternative therapies” that seemed to make much sense, though the person talking about meditation to relieve stress wasn’t bad. The rest were just loonies that seemed to escapet the nut house. And one was a reiki ‘specialist’ that was trying to claim scientific evidence from some group in england that “developed special cameras to see the auras”. Of course the group is dedicated to proving that reiki works and was showing pictures of water “being effected by the emotions of others” that just seemed like a load of bull to me.

    I also remember the teacher being unable to get chiropracters to come in for a guest talk because they (the chiropractors) felt that they would not be well recieved and have their message taken to heart. I’d say that was a pretty fair assessment as most of the time the class was ripping the arguments for alternative medicine apart. I loved the one comment one guest made about how “herbals/natural products/natracuticals” were harmless and that they are nothing like the medications pushed by doctors and pharmacists in the US. My answer to that is red rice yeast and lovastatin/lescol, some part of the RRY is converted by the liver to lovastatin.

  3. I remember doing a rotation with a dermatologist years ago who was sick and tired of all his patients yearning for “natural” therapies for their problems.

    He would tell them with a straight face, “sh*t is natural, but that doesn’t mean it would be good for your skin.”

    still makes me smile.

  4. On the contrary, alternative medicine has a special place in every hospital in the United States.

    It’s generally located out back, those rectangular metal containers next to the loading dock.

  5. Oh, well, I guess we’ll just have to refer to that white trash, cig smoking, bald fat baby factory in other terms. I’m sure we’ll survive.

  6. Dr. Panda, I really enjoy your blog.

    The only thing you’ve said in this blog that makes me question your common sense, nay, your very sanity, is the switch from Tanks to Infantry. Even thinking about that makes my feet hurt and my lower back scream in agony. You seem like a rational guy, so I’m just going to chalk that one up to sunspot activity.

    Semper Fi,

    Sgt. Savage Henry 0311 (1995-2000, 2002-2005)

  7. I will preface this in saying that I don’t believe in the alternative medications but I seem to remember the Australian researcher who theorized that ulcers were caused by, of all things, a bacteria. Granted, the scientific process and trials proved him right but when he first made this announcement he was regularly ridiculed. I’m not saying that the Reiki double-blind, placebo-controlled trials would actually show anything but you might occasionally have to keep an open mind to things that don’t immediately seem to make sense.

    (I do not have to have an open mind about fairies and magic pixie dust.  Sorry.  -PB) 

    Keep it up, Panda, I check your blog daily for new updates. I appreciate all the work it must be and I hope your wife understands the number of fans out here and the time you devote to it.

  8. PB I am a scientist at heart and certainly agree with much of what you have written above. I also think that many people see this issue as black and white, you either believe in EBM or you believe in CAM. The danger is real for those people who choose CAM over EBM for real diseases. But for people who actually believe in it (CAM) and only use it as an adjunct to traditional EBM, don’t you think they derive some benefit from whatever “piece of mind” it affords them. Say in relieving stress or in pain management. I have a patient who in conjunction with her traditional asthma meds has also used acupuncture. For whatever reason she feels better, more relaxed and ‘in control’ of her disease. Is this placebo effect? Probably, but if a placebo makes her feel better, who am I to argue with her. If her acupuncturist starting making grandiose claims and was telling her to stop her asthma meds, thats a different story entirely.

    (Well look, it’s a free country and I don’t generally give a rat’s ass what people do on their own time or with their own money.  But let’s say an acupuncture treatment costs 100 bucks and the lady gets them twice a month.  Suppose the government or private insurers are, at some time in the future, required to pay for this kind of thing.  In a time when we should be looking for ways to spend less money on medical care, eschewing ineffective or marginally effective therapies, how can you justify dumping large amounts of money into something that is essentially a sugar-pill? Or, to put it another way, what’s to keep every charlatan in a clown suit from claiming equal rights?-PB)

  9. mark’s tails,

    I agree with your comment. But the rubber hits the road when CAM advocates start pushing it into med school classes, and expect a financially stressed health care system to pay for it. It’s time to pump up the volume for the opposition when that happens.

    If people want to spend their own money and get some mind-body benefit, or placebo benefit, or whatever it is, then by all means. I’m sure I would feel better with a daily massage or someone calmly whispering positive thoughts into my ear. But no one else should be paying for it and doctors in training shouldn’t be taking time away from other things to study it.

  10. Don’t give too much credit to medical students. You’d think a group of the “best and brightest” would need more coaxing than a free textbook to join an organization about which they typically know nothing when they sign the papers. They see that it’s a “student” organization and they’ll get a free Netter and that’s all it takes, assuming it’s some kind of student advocacy group,when really it consists of a bunch of extremist fruit loops and social crusaders.

    On another note, happy match day to everyone.

    CC (about the only one in his class who didn’t join AMSA.)

  11. We had a lecture yesterday where an MD who is a professor at our school (family medicine) gave us a lecture about “integrative medicine.” He stood up there and talked about the benefits of Homeopathy, acupuncture, and medical hypnosis.

    He did what most CAM practitioners do: he brought up the shortcomings of “traditional western medicine,” mentioned FDA approval of drugs like Vioxx, and then tried to convince us how CAM is not only safe, but somewhat effective.

    It’s ridiculous that we have a trained medical doctor spouting off this information, but to a first year medical school class. I guarantee that half our class believed him wholly. This is how crap gets propagated.

  12. Mark’s tails,

    I can appreciate that a placebo effect derived from an otherwise useless or minimally effective therapy could be beneficial to a patient, although the safety of many alternative therapies worries me; research is needed not only to ascertain efficacy but also safety of any new treatment.

    My problem with this is that it kind of muddies the waters for patients, especially ones with little understanding of science and how EBM works. They start thinking everything is equivalent and that acupuncture is as good as albuterol is as good as Vick’s Vaporub is as good as aromatherapy for asthma. And that’s where it bugs me…it’s intellectually dishonest to present these alternative therapies as EQUALLY SAFE and EFFECTIVE therapies.

    And don’t get me started about MDs who sell diet cookies, supplements and god knows what else in their lobby of their office. I can only imagine it’s to make up for the wages lost to Medicare cuts and declining reimbursement/payments, but it’s worrisome that these people have no intellectual scruples about peddling rubbish to their vulnerable patients.

  13. Thank you, PB, it’s about time somebody brought up the AMSA. The AMSA deserves very close scrutiny. It has a far Left, anti-corporate, anti-capitalist, pro-socialist, even pro-communist agenda. AMSA brags that it, and its predecessor organizations, have supported socialized medicine in the U.S. since the 1930s. Today, AMSA strongly endorses government universal healthcare, preferably single payer. All of this and much more hair raising stuff is thoroughly documented at its Web site http://www.amsa.org where, among other things, AMSA boasts that “In the 1970s, AMSA led study tours to Cuba and China.”

    The recent tie-in with CAM is an insidious but predictable development since most CAM proponents are Leftist ideologues. Former Rep. Berkley Bedell (D-IA), for example, a leading CAM proponent and the guy who takes credit for strong arming the NIH to start up the Office of Alternative Medicine/National Center for Complementary Alternative Medicine in the 1990s, started the National Foundation for Alternatvie Medicine – NFAM. There is, or was for many years, a page at Bedell’s NFAM site titled “Cuba – A Model for Alternative Medicine.” An archived version is here: http://web.archive.org/web/20050211202803/http://nfam.org/2004yearendnewsletter_cuba.html

    The AMSA recently welcomed “naturopathic physicians” – see the AMSA’s Naturopathic Medicine Interest Group at http://www.amsa.org/naturopath/

    Naturopaths are passing themselves off – with major assistance and grants from the Federal government – as primary care docs! According to the AMSA, “Naturopathic Physicians (NDs) are primary care providers trained in conventional medical sciences, diagnosis and treatment, as well as nutrition, botanical medicine, physical medicine, homeopathy, hydrotherapy and minor surgery.” Yikes!

    Also check out the AMSA’s annual convention. Hugo Chavez or Raul Castro would have been right at home.

    There is much much more grist for the mill here. Please, eveyone with a brain and with some common sense, start Googling, and start reacting before it’s too late. Independent American medicine, free from a government choke hold and from the corrosive influence of CAM SCAM artists, is hanging by a thread.

  14. Ack, the free Netter. Many of my classmates got swept into joining AMSA just to get the book. The hard-core AMSA crowd loves nothing more than a good rain on a parade. My university is considering removing all of the drug reps so as to appear unbiased. Dude, those drug reps aren’t useful for just free lunches. Where do you think we get all of those free antibiotics that we take to the Third World for our medical mission trips?

    On an unrelated note, Panda, I need to ask you how to go about writing a personal statement for EM. While I had tons of books and examples on writing for medical school admissions, I can’t find anything for EM. What sorts of things are PD’s looking for?

  15. Half MD,

    I firmly believe that most pharma companies would provide those free meds even if you kicked them out of the medical schools.

    And I also believe we drug reps are good for more than free lunches and free antibiotics. But that is a discussion for another time.

  16. Random Med Student said that half his class believed the woo spun by a faculty lecturer. That reflects the major failing of education in the US: lack of clear performance standards, and lack of insisting on logical argument in essays, etc. But, don’t lose heart; over time, experience in the real world leads to either dumping the woo and returning to EBM , or to total failure in whatever area the student/resident chooses to pursue. So, don’t give up! It’s been a long time since I wore greens, but it was one of the best times of my life. Semper Fi.

  17. Many of you gripe about CAM yet don’t bother to find out why your patients go elsewhere. (Anyone who operated a business would be very interested in why their customers were walking away.) I guess your work load is heavy enough.

    Two days ago two people I work with came to me and asked about referral to an acupuncturist for their back pain. I gave them a card of a Japanese lady and told them I’d email everyone in our workplace to see if they had any experience with her. I was flooded with emails…all positive. Wonder why they want to go to her?

    A client just left my office with feelings of insecurity and generalized anxiety. She had been getting Reiki treatments and said she was doing better and wanted a shamanic session.

    Her husband tagged along and we discussed his weight gain, HTN, insomnia and tachcardia. He’s a 38 yr old owner of a garment factory and under a lot of stress. I discussed the effects of stress and told him the next time his BP hit 190/110 and he had a severe headache he needed to call his physician or present himself to the nearest ER. We also discussed progressive relaxation and autogenic training and finding some outlet for exercise that he would make a part of his lifestyle. I talked in his business language, ie., making an investment in himself and ultimately his business.

    So what would you guys have done? Benzos for her and hypertensive meds for him and kicked them out the door?

    (I rise in support of the benefits of a friendly conversation, a back rub now and then, and of providing an empathetic ear to listen to other’s problems.  Knock yourself out.  But is this a medical therapy?  Of course not.  If it is, then everything is.  Might as well get my wife, an avid Saber Fencer, who gains tremendous fitness and general well-being from making a vicious slashing attack to the helmet of her opponent, to market this as some kind of medical treatment and have the government pay for it.  As for Benzos, you can get a low dose of generic Alprazolam for a few bucks a month, a medication that is safe, well-tolerated, and effective.  How it makes more economic sense or is better to haul a patient suffering from some ultimately transient anxiety to his shaman four times a month for five-hundred bucks worth of conversational bullshit escapes me.

    Or, how taking the same patient who could be treated with five bucks worth of Alprazolam or four bucks worth of an ACEI to a Naturopath who will prescribe a Rube Goldberg combination of expensive home-grown herbs and Ginkgo friggin’ Biloba is better has yet to be explained. -PB)

  18. PB I’ll see your rat’s ass and raise you a mouse testicle. Seriously though, its hard enough to get insurance to pay for anything these days and Government insurance (medicare/medicaid) is even worse. I really do hope that insurers will NOT pay for this stuff until solid evidence exists, and I doubt it ever will for some forms of therapy ie homeopathy.

    (Thirty state Medicare and Medicaid plans currently pay for some kinds of chiropractic care.  Some states, Vermont for instance, force insurance companies to pay for naturopathy, pediatric chiropractic, and other snake oil.  In Europe, in the UK in particular, the NHS pays for homeopathy.  So don’t say it could never happen.  Remember, as Alexander Hamilton said, “Your people, Sir, is nothing but a great beast,” meaning that the public will get what it wants whether it makes sense or not. -PB)
    PCB and Zelda – I agree with you 100%. Luckily my patient realizes the benefit she obtains from her inhaled meds and only uses acupuncture as an adjunct or dare I say complementary to traditional medicine.

    It is a fine line and the lay public has a tough time distinguishing between how and what all these “alternatives” can and can’t do, because as many have pointed out, they just don’t understand what EBM is. Yoga, massage, acupuncture and ofcourse good old fashioned regular exercise can all have mild benefits in asthma and in patients perception of pain, maybe even an effect on blood pressure (much like owning a dog has or the recent report on married people having lower blood pressure).

    That is where a lot of the gray comes in. The distaste of these therapies, in my mind, stems from the charletons who make grandiose claims of cures or as a complete alternative to EBM, and certainly there are therapies that have absolutely no benefit and can be potentially harmful as well.

    It seems, from viewing some of the web sites from the many academic institutions offering CAM these days, that they actually are trying to incorporate CAM into traditional medicine for the appropriate reasons, ie pain control, easing the stress and anxiety of chemo for cancer patients etc.

    (No, it’s a money-maker.  CAM is not routinely offered to people who cannot pay for it.  At Duke in particular their Woo franchise caters to a self-indulgent, basically healthy but bored clientele.  It is not offered to, say, the many, many illegal immigrants they treat who, as they are fresh from the dusty plains of central Mexico, are not primed to be receptive to it even if they could pay.  On the other hand, they are unsophisticated people who believe everything the doctor tells them so you never know. -PB)
    Sadly, there will always be people who don’t understand, who are willing to take advantage of other people and the conspiracy theorists who feel that Big Pharma and the Medical community is out to get them.

    (Sure, but this is a blog for insiders.  The truth is the truth. -PB)

  19. Harumph! In my day wimmens knew their place, and that was foil!

    Yes, foil. The “ladies’ tee” of fencing. It was a restriction that didn’t even seem to make sense at the time, let alone in retrospect.

    Anyway, I’d also heard of acupuncture working for asthma, and when I tried it myself I understood why. They stick you full of needles and then leave you in a darkened, quiet room to “have a nap” for about a half hour. It’s a half hour of enforced relaxation. You really don’t want to move with all those needles in you. If your asthma happens to be stress triggered, I suppose it’s not too surprising that this might help. Unless needles stress you out, of course.

    It didn’t do a thing for me, probably because the anxiety that causes the symptoms I was trying to get treated (not asthma) is rather deeply rooted. And experiencing the treatment absolutely convinced me there was nothing to it.

  20. Uh .. Panda..
    Not to quibble, but in Mexico and in most larger illegal communities in the US already have woo practitioners called Curanderos (see http://en.wikipedia.org/wiki/Curandero). The Curanderos in the US have the traditional woo (my favorite is infidelity powder … sprinkle it on your spouse’s clothes in the morning and you don’t have to worry about the flirtatious coworkers any more). Also, the US Curanderos have many prescription meds that can be bought over the counter in Mexico, including most common antibiotics, antihypertensives and diuretics. These meds are also available in most Mexican flea markets.

    So, I would argue that the illegal Mexican worker here in the US has already tried woo, and is seeking EBM treatment. (Now, if you prescribe amoxicillin for the ailment, the patient will probably be unhappy because the Curandero has already tried this and it is woo.)

    To address the bigger issue, I believe CAM exists for a couple of reasons.
    1) The basic scientific method is not being taught in schools any more. We now have a generation of self-esteem junkies that have grown up and actually believe that American Idol is real, reality TV is real (and entertaining??!?). They think that spaceships make sounds in space and light from laser weapons travel at, well, less than the speed of light in big glowing balls. They don’t know what a Bunsen burner is because of the lawsuits against the school for the one kid that got injured, or the underfunding of the school that eliminated the science budget. These are the people that will pay big pharma for drugs for boners and baldness, not Alzheimers.

    2) The legal system that is incapable of understanding basic science. Our way of thinking is so polluted by legal cases like vaccines cause autism or silicon causes lupus or all medicines are perfectly 100% safe. The medico-legal establishment has three rules:
    -No one dies or is hurt in America
    -If someone dies or is hurt, there is a medical entity to blame
    -the one with the most money(insurance) is most at fault

    No wonder the average self-esteem junkie would believe I can shoot energy bolts out my fingers and save your life. And pay me for it, in cash.

    BTW – I wonder if the US distributorship of infidelity powder has been sold yet…


  21. Haven’t you seen Star Wars? Of course spiritual fire is real. I saw Emperor Palapatine totally fry a guy using it just a few short years ago. Then he threw him out of a window to his death. The moral of the story is not that spiritual fire doesn’t exist, but that it has an exceptionally low therapeutic index.

    (In all seriousness, this latest piece is awesome. You’ve exceeded your own high standard.)

  22. Verbose post that just did not get to the point quickly enough to make it interesting to read.

    (Yeah, but you read the motherfucker, didn’t you?  I’m putting that in the “win” column. -PB)

  23. PB writes, “How it makes more economic sense or is better to haul a patient suffering from some ultimately transient anxiety to his shaman four times a month for five-hundred bucks worth of conversational bullshit escapes me.”

    Remember many of these people have already visited your peers. If they had to come to see me four times, I’d consider myself a failure, lol! I just received this (It’s from a lady from India so excuse the writing style):

    “Hi Randy,

    This is a mail I just received from Kis***r, who attended the fire ceremony the other day. I wanted to share it with you.
    Thank you for helping her.


    Dear Priya,
    I have been suffering for so very long, it seems like it has become a part of my life.
    I do not go out much and stay home mostly.
    But my suffering is very unusual in my eyes.
    I sit ,or stand or watch things happen and am carrying on with life.BUT there is always DEAD weight in my heart.I stay lost and most of the time find it difficult to communicate with clarity.
    I feel mixed up !!!!
    2 days have passed and I don’t feel it anymore.
    I pray it never comes back.
    I have no words to thank you for thinking of me on the “fire healing day ”
    Please keep me on the mailing list. much love to you and Vicky and the kids.

    P.S. May God Bless you and keep you in his loving care!!!!”

    You have your place PB and I have mine. I don’t care what kind of therapy you want to call it!

  24. Yes, all too true, the will of the people can have strong influence on policy yet the alternative is far scarier.

    However, there has been a lot of pressure in the NHS to ban homeopathy which is a move in the right direction. Much like Democracy in general, if it begins to lean too far to the left or right the people step in to make a course correction.

    Regarding the economics of CAM, I agree it certainly is a money maker, and being the naive optimist that I am, I am hopeful that now that it is available in academic institutions appropriate studies will be done to prove or refute claims.

    However, given that the margin of profit is so low for most academic institutions, and getting even worse, is it a good thing or bad thing to take money from the naive rich (who are obviously willing to pay for this) so as to help in providing healthcare to the poor?

  25. Ah, but Chris C, it didn’t work BECAUSE you didn’t believe it would work. You have to believe in it for it to work!

  26. You’d think, wouldn’t you? When I was but a wee lad I tried believing in fairies too, but Tinkerbell never showed up with the pixie dust to let me fly.

    Much later on when I was offered some by a kindly street vendor in New York City, I declined.

  27. A society schooled in worshipping at the feet of psychotherapists of one sort or another for many decades are not going to quibble at the unscientific claims of the “medical woo” practitioners.

  28. Panda,

    I’m glad you brought this up, and I would like to say that not all of us (at least me) members of AMSA are this incredibly dumb. Thankfully, during the conference in Houston, I was able to make some sort of stand in the house of delegates against the formation of liason relationships with a couple of naturopathic organizations (AANP and NMSA). The resolutions didn’t die, but I at least was able to draw a few people into the “no” category and caused a significant amount of people to abstain.

  29. Rather fascinating that the article linked above by Michael on a chiropractic-related stroke didn’t mention chiropractic in its headline, don’t you think? The first half of the article is about vertebral artery damage due to neck “adjustment,” but the headline is about the risk of stroke from birth-control pills and beauty salons. Sheesh.

  30. To those who claim that CAM is lucrative:

    It sure the @#$% ain’t. I was a CAM practitioner for 5 years. The school cost $100,000.00+ and I owe $150,000.00 and climbing and can’t discharge the debts.

    My practice, and my family, went bankrupt and my kids sleep on the floor at my mother-in-law’s house. Don’t be fooled that CAM is some kind of cash cow. 10 years of my life have been wasted. I have no job and have to search for employment on the library computers.

    My only hope is to either join the military (I have a legitimate B.S.) or hope that I can get good enough MCAT scores. (But what will my family do for $$$?)


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