Defending the Pie

(The pie is a metaphor. I’m only mentioning this because the last time I mentioned pie, I received several irate emails, the gist of which were that pie is not to blame for the collapse of society. -PB)

Primary Snake Oil

The silliest thing about the practitioners of Complementary and alternative medicine is that they don’t know when to leave well enough alone. Currently, with the exception of the occasional over-enthusiastic chiropractor who breaks somebody’s neck or tears an important artery that he has never even heard of, Complementary and Alternative Medicine is a low-risk enterprise, the business model of which is to take a panel of essentially healthy patients with predominantly psychosomatic complaints, stroke their egos a little, mumble either some pseudo-scientific rigmarole or some whacky Eastern nonsense, and send them on their way totally cured and none the wiser. The worst that could happen is the patient still feels bad but, since lawyers have yet to work out a way to demonstrate in court that your qi was irreparably damaged by your acupuncturist, as long as the needles are reasonably sterile and there is really nothing in your homeopathic pills but sugar and a one-in-one-billion chance of one molecule of sheep spleen, you are as a CAM practitioner (if you will pardon the expression) shitting in high cotton.

It is with great interest therefore that I read about naturopaths and chiropractors, among others, trying to pass themselves off as primary care physicians. I see the usual billboards in my town from the chiropractors advertising themselves as the complete medical solution for the entire family and there is even a small subset of back-crackers billing themselves as pediatricians. Naturopaths, for their part, are even recognized as Primary Care Physicians in some states (particulary in the Northeast) and are attempting the usual inroads elsewhere. Leaving aside the obvious, that chiropractors and naturopaths are physicians in the same way that I am a Starfleet Admiral, it is puzzling that, with such a good racket going, the witchdoctors would be trying to sneak into a job for which their training is inadequate and which opens them up to all of the hassles of real medicine like deadly earnest malpractice suits (not to mention suffocating government control, and declining reimbursements).

Suppose you used a chiropractor or a homeopath as your primary care provider. In the best of circumstances, and loosely following the mid-level model for delivering primary care, the CAM practitioner would be a low-level gatekeeper, assuming they knew their limitations which is not usually the case. The typical education model for a CAM practitioner with an advanced degree in his modality, also known as lipstick on a pig, leans heavily on their own particular flavor of snake oil and throws in just enough of the traditional medical curriculum to say, “See, nobody here but us scientifically trained doctors,” but not enough where anybody should feel confident that they would even know when to refer to a real physician.

Even if you came across the rare naturopath or chiropractor who knows that he is selling hokum and is therefore keenly aware of his limitations, if he wanted to be a primary care physician he would do nothing but add another layer of expensive and completely useless medical care to an already overdoctored society. Except for the rare public service of calling 911 like any good Samaritan would if somebody showed up at his clinic with chest pain, he is contributing nothing, and the only difference between he and his more adventurous and less self-aware colleagues in that he will quickly refer to real primary care physicians for real medical problems while they might sit on the truly sick patient for a long time before getting spooked, scratching their heads and wondering why the Ginkgo friggin’ Biloba isn’t doing the trick.

Benefit to society: Zero. My neighbor can call an ambulance and most people know when to go to the doctor. Hell, the real trick is getting them not to go. There is, you see, more to primary care than referring to a real doctor or a specialist. Certainly knowing when to call a real doctor shouldn’t be all the credentials you need to label yourself as as primary care provider. You do actually have to treat something and adjusting qi to improve the subjective well-being of your bored patients isn’t it.

For their part, the chiropractors and naturopaths will point to the existing mid-level providers, many with only a couple of years of formal medical training who are also making inroads into the primary care field, and invoke the doctrine of “me too,” reasoning that since they have a fancy four-year degree they are more than qualified to work as primary care physicians. Whatever the qualification of Physician Assistants and Nurse Practitioners however, their training at least follows the rational model of medicine and is not encumbered by snake oil. A Physician Assistant may only have only two years of formal training but all of it is good which cannot be said for CAM practitioners. Chiropractic school may be four years long, for example, but as most of it involves instruction in a completely debunked treatment philosophy as well as desultory clinical years where all the student sees are mostly well patients with the aforementioned psychosomatic complaints, it is not exactly medically rigorous and in no way prepares the practitioner to understand, let alone treat, even the simplest of presentations. Not only is their first instinct is to throw useless woo at medical problems, under the theory that if you have a hammer you nail, but they don’t even know enough to know their limitations which is perhaps the most dangerous character flaw in the medical world.

Sure, anybody can see somebody with a cold or some other minor complaint and the odds are good that nothing they do, provided they don’t get too jiggy with it, will do much harm. But let’s suppose that you have never rotated on a medical service or done your share of critical care. Suppose you have never worked in an emergency department or spent a few sloppy months on the labor and delivery floor. Imagine, if you can, seeing a provider for your family’s medical care who is treating your kids but has never had a lick of formal pediatric training or so little that she has never seen the really bad pediatric diseases that look like a little bit of nothing when they first present. Does your chiropractor, for example, know the odds that a fever in a neonate is some flavor of bacteremia that needs aggressive treatment?. Let us further suppose that while your chiropractor has spent hundreds of hours learning how a little normal misallignment in the spine can cause “dis-ease,” he has never had to recognize appendicitis, pancreatitis, or the first subtle hints of colon cancer. In short, while a lot of primary care is routine stuff, little potatoes that the school nurse would have to work at to screw up, not all of it is and if all you’re barely qualified for is to pass sick patients to somebody else as some kind of completely redundant middleman, maybe you should stick to the entertainment business and leave medicine to those with training.

Seriously now, there are whole groups of trained physicians, radiologists and orthopedic surgeons for example, who have not only legitimate training in general medicine but the legal license to practice any kind of medicine in which they feel comfortable who wouldn’t dream of doing pap smears or treating some kid with an ear infection because they are a little rusty in that kind of thing. Internists do not moonlight as obstetricians even if they have delivered a few babies in medical school and for my part, although I have done six months of surgery rotations in my training as an Emergency Physician, I’m not taking out anyone’s gallbladder anytime soon. I’m not adequately trained and I could not look the patient in the eye and ask for their trust.

Remember, also, that your primary care physician has a minimum of seven years of formal medical training. Your family physician has, in fact, done a lot of inpatient pediatrics, internal medicine, and a few months in the Pediatric and Adult Intensive Care Unit. The only legitimate question is whether a residency-trained primary care physician is over-qualified for many of the patients they see. The purveyor of snake oil doesn’t even rise to the threshold of qualification.

Mid-level providers and physicians practice in the real world of medicine and when confronted as we all are from time to time by the limits of our knowledge or abilities refer to a higher level of care. The Complementary and Alternative Practitioner, in a tacit acknowledgment that his therapies are ridiculous, will always defer to real medicine when he at last realizes that he is an ineffectual bufoon but only after exhausting his repertoire of snake oil. The danger is that there is no higher level of care in complementary and alternative medicine, just a hodge podge of smooth-talking clowns to whom the customer may be sent, and unless the chiropractor or naturopath honestly assesses his abilities (which would preclude him from even wanting to be in primary care) we’ll have a subset of sick patients who need real medical attention but are not getting it. Now, while this may be good from a strictly Darwinian point of view, allowing the oldest and sickest to die before they can become to much of a burden on society, this is not exactly a ringing endorsement of Complementary and Alternative Medicine.

Currently, the only benefit at all from CAM is that it keeps otherwise healthy people with no real medical complaints from clogging a medical system that is already overloaded, in part because of patients for whom nothing really needs or can be done. And it’s fine. I have long passed the stage in my life where I view it as a personal mission in life to cure others of their stupidity. It’s a free country and if you think you have it all figured out, then knock yourself out. The only money you are wasting is yours and you obviously have more of it than you know what to do with. The problem comes when public money and “quasi-public” money from private insurance pools is used to pay for this kind of things which is, I suppose, the Holy Grail of the Complementary and Alternative Medicine practitioner. That is, to get their claws into the the trillion dollar pie, which, unlike most economic pies, is indeed finite and not big enough to feed everybody all they want. For my part, I don’t think we even need to eat the whole pie but should instead save some for later.

The trouble is that when you leave a pie out and turn off the lights, the rats will edge towards it for their share. I’d like to protect the pie from the rats, both in real medicine and most especially from the exotic rats in the world of Complementary and Alternative Medicine.

32 thoughts on “Defending the Pie

  1. PB-

    I would enjoy to hear what you think of religion, including your own and others, and how it relates to emergency medicine. If you have time that is.



    (It has no relation to it at all except that as I try to be a good Christian, when I come into contact with disgusting, foul-smelling bums or really, really sick and potentially lethal patients (to me), say those with AIDS, I try to remember the example the Lord set with the lepers of his time.  But, realistically, except as Orthodox Christianity provides the moral framework for my life and guides how I handle moral problems, there is not a lot of religion in the department because there are very few moral problems to deal with.  It’s not church, most of it is pretty straight forward, and if the occasional Jehovah’s witness doesn’t want blood products, hey, I’ll do what I can but I’m not losing sleep over it.  I don’t pray with families unless it’s my Priest and somebody who I know which has happened.  I’m not prosyletizing anybody and I respect everybody’s religion even if it is the wrong one. 

    Additionally, if I could get the non-religious to understand one thing, it’s that every religion is not the same and many of us do not view spirituality as a cafeteria where we select only those beliefs that are pleasing to us before linking hands and singing kumbayah with people who don’t even remotely believe what we do.  If you are a Christian, for example, believing in the Resurrection of Christ precludes belief in Islam…and vice versa, of course.  The muslims make a big deal about how Christ is one of their prophets, trying to lure the weak-kneed into Dhimmitude, but in Christianity, Christ is God, not just a prophet.  If you don’t believe that, you cannot be an Orthodox Christian or a Catholic to name a couple of the big Christian denominations.  Now, if you don’t believe that’s fine too and it’s all the same variation of mumbo jumbo as far as you’re concerned.  More power to you but have the goodness to appreciate the differences in religion to those with faith.  -PB)

  2. Mmmmmmm, pie.

    To me the most frustrating thing is when one of these CAM patients comes into my clinic and starts trying to educate me about how modern western medicine is all just a big sham being perpetuated by greedy doctors and pharma companies.

    They virtually never agree with anything I try to tell them. Are almost entirely opposed to any tests or treatments I propose.

    They typically come to me as though strolling into the local Burger King simply wishing to place an order.

    They are typically demanding some specific lab test or prescription for some specific medication that is totally not indicated.

    They are usually quick to inform me that the only reason they have condescended to darken my clinics door is because their “real doctor” can’t order whatever it is they want, and this is only because of the big conspiracy run by folks like me controlling the lawmakers (those same lawmakers who I can’t get to even consider doing anything meaningful with the broken court system).

    Uggghhh! I want to grab them by the shirt collar and throw them out of my clinic.

    Instead however, I know there is a bullseye on my backside with some plaintiff’s attorney drawing a bead, so I act as diplomatic as I can and waste me time carrying on with the charade that these folks actually have enough neuronal activity to benefit from anything I have to say.

    It typically degenerates into a frustrating debate, of the same sort I have with some of my 2-year old patients when it comes time for me to stick an otoscope cone in their ear.

    If they want to waste their money on these quacks, that’s fine with me. If they want to think I’m a quack and my profession is just a big scam, that’s fine with me too.

    I really wish they’d just stick to their beliefs however and stay the hell out of my damn clinic!

  3. Wow, what did chiropractors ever do to you? >). I was wondering how long the chiropractic program is, and found “The Palmer curriculum is a graduate-level program that is typically completed in a little more than three calendar years but is equivalent to a five-academic-year program.” That’s pretty good, fitting 5 years into 3. I wonder if, using the same standards, we might consider medical school 10 in 4? To be fair…what would you recommend to someone with chronic back pain that couldn’t be treated medically/surgically, but which is indeed ameliorated by chiropractic manipulation? See a physical therapist? I think most people deep down know there’s nothing more than placebo effect to acupuncture or any of the more crazy things out there…but chiropractic care is very main-stream, and not all practitioners take the “curing disease” angle but instead focus on more PT-like manipulation.

    (Let me tell you a story.  There is a chiropractor at my church who, when I first met him, seemed to be carefully sounding me out to see what my views were on his specialty.  As the priest had introduced us to the congregation as Dr. and Mrs. Bear, he knew I was a doctor but he wasn’t sure what kind or what I did.  He let on that chiropractors can cure things like asthma and GERD with manipulation but backed away from this when I told him, politelty, that I didn’t believe in his hornswoggle.  He then stressed the “Physical Therapy” angle of his profession.

    The point is that to be a chiropractor is to practice the art of stealth medicine.  I’m sure this guy makes all sorts of claims to his less knowledgable patients but around me, butter wouldn’t melt in his mouth.  “Yassah, boss.  Nobody heah’ but us good little allied health providers.”  But I’ve seen his brochure and his billboards and, despite only having a four-year degree in chiropractic, an endeavour in which he probably never saw a really sick patient or treated a kid, he bills himself as able to cure ear infections and other pediatric complaints.  Are there “good” chiropractors who confine themselves to what is essentially massage therapy?  Sure.  But from my experience they seem to be the exception and since we’re discussing overqualification, four years of massage school is definitely an overkill, even if most of it is wasted learning about subluxations and their effects, a dysfunction that doesn’t even exist (the way chiropractors view it, I mean) and a treatment modality that does nothing.

    As for chronic back pain, I recommend back strengthening exercises, instruction in correct lifting and posture, weight loss, physical activity, judicious use of NSAIDs, and occasionally just sucking it up.   For serious back pain which may be the result of HNP, tumors, or occult fractures, I recommend imaging to assess the possible source of pain and such medical or surgical therapy as an orthopedic surgeon may suggest.  I’m certainly not sending somebody with a lumbar fracture or ankylosing spondylitis to a chiropractor.  -PB)

  4. One of my interests, Dr. Panda Bear, is the intersection of CAM and collectivism/communism. It’s getting so that I can just sit back and cite the evidence. For example, on March 17, 2008 the far Left site Counterpunch published an amazing article “Taking Down Big Pharma – Beyond Progressive Malpractice.” The URL is The author wants the government to institute single payer, but to substitute CAM in place of the current medical model. Seriously. And to pay for it, taxes on people earning $1 million a year should be 90%. And of course the all-powerful government needs to force its CAM-centric “prevention” schemes on the population.

    You really have to read the article. It’s impossible to summarize it or to adequately capture the crypto-fascist mindset that lies behind it.

    I am sure that a vast vast majority of U.S. naturopaths would agree with the article. As evidence, I would cite a keynote speech delivered at the 22nd annual convention of the AANP (American Association of Naturopathic Physicians at in August 2007 in Palm Springs. The speech, which received a standing ovation from the naturopaths in attendance, was essentially a slightly more polite version of the Counterpunch article cited above.

    Naturopaths, by the way, are currently licensed to practice medicine in fourteen states and D.C. The states include some big influential ones, like California, Connecticut, Oregon, Washington, and Arizona. Lobbying efforts are underway to license naturopaths in many more states. There are about 5,000 naturopaths who qualify for licensure in the U.S., a requirement being a degree from one of four U.S. Federally accredited naturopathic “medical” schools (in Oregon, Washington, Arizona, and Connecticut). Those four schools (more are in the planning stages) turn out a total of several hundred new naturopath graduates annually.

    I will close for now with this food for thought… U.S. naturopaths now openly flaunt the fact that they treat cancer. They have started the Oncology Association of Naturopathic Physicians a.k.a. the Oncology Academy of Naturopathic Physicians (OncANP). The Web site is One of its purposes is to “certify naturopathic physicians in naturopathic oncology.” A member of the OncANP’s board of directors, a naturopath from Colorado (a state where naturopaths are currently NOT licensed), advertises on his Web site that he charges $295 for a “3 hr. visit” for “Cancer Co-Treatment.”

  5. I neglected to mention, re: naturopaths and cancer, that a leading naturopath member of the Oncology Association of Naturopathic Physicians was recently appointed by the NIH to its top CAM advisory panel at the National Center for Complementary Alternative Medicine (NCCAM). The news release is here: This indicates, then, that the Feds see these naturopaths who treat cancer not as suspect but as deserving of a leading policy making role at the NIH. Among other things, the members of this NCCAM advisory panel help to determine who and what institutions receive the scores of millions of dollars annually devoted to CAM research by the NIH.

  6. And do these CAM’s come in a three oclock in the morning to treat appendicitis? If yes, then by all means, let them at it…

  7. It’s fair enough that people are free to spend their money wherever they want. The problem is people who are not sure what to buy and are faced with a life threatening disease where they are desperate and will try anything. It sickens me that they can be fleeced by these CAM practitioner. My father has cancer, and he didn’t grow up in the US and is used to homeopathy. Try as I may, he insists on using homeopathy (he wanted to not get chemotherapy at all, but I managed to convince him after much pleading) and cites all this anecdotal evidence.

    As you could tell from my previous comments, I’m pretty leftist and progressive, but these scams people are running to exploit the desperate is so disgusting that it makes my blood boil. I shudder to think what would have happened had I not been around (or had bought into this CAM crap) and my father would have chosen to only do homeopathy instead.

  8. Wow, that was an ear full. Not that I totally disagree with everything that’s been said but, I find it funny that you smell all that crap from others breath and that you can’t smell your own. I guess 8 years of school and believing in the ressurection of the Christ blinds you to your own arrogence and conceit.
    I have been healed by both and scamed by both, I have had Dr.s and surgeons putting me on the table when all I needed was some adjutments and I have had needles and massage when I need a good anti-botic. Although it is true that chiros should keep to there field. It would be best if internists did also, which is mostly just glorified drug dealing and test givers.

    (I am not a “healer.”  I diagnose and treat medical conditions.   Religion has got nothing to do with it.  One of my readers asked me to comment about Orthodox Christianity and I did so I don’t understand your disdain.  I hazard to say that you don’t know jack about medicine. -PB)

  9. They want to play doctors? Hell, let them. One publicized lawsuit, where some quack naturopath misdiagnoses an otherwise treatable cancer leading to a death, and the entire enterprise will collapse like a house of cards.

  10. People don’t sue nice people like NDs and DCs.

    Funny story, I was at the park the other day and saw the mom of a 10-year-old kid who had said “shut your mouth” to a teacher in a class I was volunteering to help with. Same child who assaulted the aftercare worker, needs to be dragged down the hall by two adults, and is generally quite obviously severely afflicted. Oppositional defiant or some shit, will probably be in jail soon enough. So I tell mom, your kid told the teacher to shut her mouth. I was then regaled (at least 30 minutes) with the story….
    poor boy had been to many schools, even the spiritual one couldn’t keep him, and for sure he had been made irrevocably worse by a four day trial of ritalin years ago, and what had really sent him around the bend was the behavioural classroom he was in last year, where there was something like solitary confinement for misbehaving. I stayed sympathetic for a while by reminding myself that I have two healthy normal children by the grace of God and this woman has, after all, been in hell for a number of years with Johnny.

    Until she started telling me about the homeopathic remedies he had tried with varying success. She surmised that the most recent concoction must not be working.

    Yet again, I had to suppress my fury at the institution of alternative medicine.

  11. Where do you stand on podiatry? (Heh heh. Unintentional pun there.) My primary care physician sent me to a podiatrist for foot problems, and I just recently discovered that podiatrists are not M.D.s. Does this put them on the same page with chiropractors? Are podiatrists quacks, too? I’d like to know before (if) I schedule my next appointment.

    (Whoa.  Podiatrists are real medical doctors (DPM) who undergo extensive medical and surgical training for disorders of the foot and lower leg.  End of story. Period.  Nothing more needs be said.  Chiropractors are quacks and they have nothing at all in common with podiatrists. -PB)

  12. Did you see Noah Shachtman’s article at Wired, Army’s New PTSD Treatments: Yoga, Reiki, ‘Bioenergy’

    “The military is scrambling for new ways to treat the brain injuries and post-traumatic stress of troops returning home from war. And every kind of therapy — no matter how far outside the accepted medical form — is being considered. The Army just unveiled a $4 million program to investigate everything from “spiritual ministry, transcendental meditation, [and] yoga” to “bioenergies such as Qi gong, Reiki, [and] distant healing” to mend the psyches of wounded troops.”

    (Mohammed H. Prophet on a crutch. -PB)

  13. The chiro in my small town was great. He stuck to cracking peoples backs and that’s it. The guy who bought his practice was a total quack. He peddled this “natural spring water” that he insisted would cure someone of basically anything. I don’t know why people believe guys like him.

    My parents like to go to the chiro when their backs get out of whack, but that’s it. They don’t buy into anything other than fixing the backpain. I don’t know, chiropractic might be a good alternative to getting hooked on pain killers if you have lots of back pain.

    My brother-in-law is in school getting a degree in alternative medicine of some sort. When he slipped on the ice and broke his arm in two places, he staggered his way into his class and his teacher excitedly insisted that they “get some needles into him.” He told them Hell No! I want some real medicine.

  14. It’s easy to dismiss chiropractors until you’re the one in pain. I was a skeptic too.

    Then one day I was lifting a hay bale and suddenly got severe lower back pain. I had to literally crawl to the house. Despite NSAIDs and Tylenol I couldn’t sleep at night the pain was so bad. All my regular doctor would do is tell me to rest and take more pills. This went on for several weeks until ….

    it finally got better on it’s own.

    My life was changed.

    (Preach it, Brother.  Here’s my testimonial:  In an effort to get back in shape, I have started a civilian version of the Marine Corps Combat Conditioning Course.  I hurt my back doing pull-ups last week.  It really hurt.  I slept on it and it felt fine in the morning.  Now I stretch beforehand.

    Let me get an “Amen.” -PB) 

  15. PB,
    What you say. 🙂

    Seriously, your post is so well written. I think you covered every aspect of the issue beautifully.
    As for me, no one is going to fool with my spine unless they have two little letters -MD- to the right of their name. I am very wary when it comes to the treatment of my body, I’d rather see someone who has proved he/she has followed the long and conventional training required to add those two little letters to their name.

  16. Okay, so I understand your point of view. And I even agree with a lot of it. But what about someone like me, whose son was experiencing a number of problems that his doc basically told me to ignore and he’d out grow it? Um. Celiac. Not so much a growing-out-of-it condition last time I checked. It was only suggested by my midwife (and naturopath). Since we took gluten out of his diet, his skin cleared up. His digestion is better (gained a pound in a month). His poo isn’t disgusting. His *personality changed.* Neither the pediatrician nor the dermatologist even considered food as a possible source of his problems, but it was the first thing my naturopath suggested.

    (Even a blind squirrel occasionally finds a nut.  As for your pediatrician, Celiac Sprue is not a “zebra” disease and every pediatrician who I have ever known goes immedietly to diet when confronted with the typical constellation of symptoms and starts thinking about everything from lactose intolerance to IgA deficiency and everything in between including Celiac Sprue.

    I have a great deal of respect for midwives, by the way, at least the properly-trained and credentialed ones.-PB)

    Because someone chooses an alternate path to healthcare shouldn’t automatically paint them as a snake oil merchant. It is wise to remember that the history of medicine is filled with what we now revile and disdain, but at the time it was considered the pinnacle of science.



  17. “I have a great deal of respect for midwives, by the way, at least the properly-trained and credentialed ones.”-PB

    Now how are midwives any different from NPs? My ex was one for many years and then became an NP.

  18. I was wondering your thoughts on providing health care for children only. I am very ambivalent about universal health care for all. Minors have no say in what their negligent parents chose to spend on; why should they be penalized?

  19. Captain Awesome,

    It isn’t that they SHOULD be penalized, it’s just the way it works.

    To be honest, I think I’d rather provide healthcare for those under 20 for free, rather than those over 65.

    Then again, I’d prefer not to pay for anyone else’s healthcare, and let evolution take it’s course…

  20. The army’s on the forefront of battlefield acupuncture. Obviously acupuncture’s indications for pain are at the tipping point, cost-effectiveness is for you to decide.

  21. Thank you for bringing awareness to your audience about chiropractic. However, you are only brushing the surfice of the quackery involved in the chiro profession.

    The quackery starts in chiro colleges where students are led to believe they are primary care providers. Then students amass enourmous amounts of student loans when they find out what they were taught is not legitimate.

    After school chiros are encouraged to join consulting firms where the quackery is multiplied by 10. Science goes down the toilet and making money becomes the prime source of motivation.

    Don’t visit chiros but please visit our website to learn more about quackery in chiropractic.

    Thank you!

    Chirotalk: The Skeptical Chiropractic Discussion Forum

  22. I went to chiropractic school and it was unbelievably stupid and unethical. The whole profession is corrupt! Even the board examiners are scientifically illiterate.

  23. Pie. You claim that pie is not to blame:

    The pie is a metaphor. I’m only mentioning this because the last time I mentioned pie, I received several irate emails, the gist of which were that pie is not to blame for the collapse of society. -PB

    Tsk. Tsk. Pie is obviously to blame, and Richter will explain, step by step.
    Let’s take your garden variety blueberry pie.
    What is in that pie?
    1) sugar, and LOTS of it.
    2) shortening, which is saturated fat
    3) white flour, no fiber anywhere in that.
    4) cornstarch – the problem is not quite as obvious here, but Richter will explain.

    Sugar causes diabetes.
    Saturated fat causes heart disease.
    No fiber causes digestive disease.
    Think of all the medical problems being caused by that pie! Consider your other posts, which I do not have the space to quote here in their entirety, but which, and trust me on this, if you would, explain the consequences of medical problems in our medical system.
    So, I am suprised that you, PB, did not quickly blame pie yourself.

    Also, there is the opportunity cost. That poor pie eater could have been eating fresh blue berries, or whole wheat bread right out of the oven, if the VERY SAME ingredients had been put to a different use.

    (As for the cornstarch, Richter just wonders whether anyone who is allergic to corn – and of course Richter is treading on eggshells here, since allergies are more of a CAM topic than not…. however, anaphylatic shock is not usually treated by CAM but is more the type of problem to show up in an ED somewhere – anyways, Richter’s point is that if someone was allergic to corn, and ate the pie, and managed to survive the diabetes, heart disease, and digestive disease that it brought on, the anaphylactic shock still might kill them.)

  24. “Sugar causes diabetes.
    Saturated fat causes heart disease.
    No fiber causes digestive disease.”

    Ah, thanks for that. Would that I had known this oh-so-simple formula years ago. I could have skipped medical school and went straight to hanging my shingle. I’d prescribe a 100% protein, fiber, and unsaturated fat diet (zero carbs, thanks, as it’s all broken down to monosaccharides and “sugar causes diabetes”) for all my patients regardless of chief complaint and make a mint.

    ” since allergies are more of a CAM topic than not…”

    Again, thanks for that. I guess all the allergist/immunologist MD’s out there are really just CAM practitioners, right?

    Panda Bear has asked this but I have to reiterate. Are you for real?

  25. Doctor J: In the sense that you are asking, no, I am not for real. (At least I hope I understood your question.) Quick, grab a dictionary and look up “satire”. But don’t read too much into it.

  26. I think you need to understand that there is a very large difference between foofoo alternative medicine, such as adjusting one’s “qi” or “chi” and telling them their aura and practical alternative medicine that provides much relief to persons with diseases and ailments that are not accepted by the AMA (American Medical Assoc.). It is also interesting to note that, although most heat is directed and problems that come up from alternative practitioners, it is important to realize just how much error has been made by M.D. mis-diagnosing, mis-treating, over-treating, or refusing to treat etc. Not everything can be cured with drugs, pills, or with surgery and unfortunately this is how our society thinks. Doctors make it easy for you to not take responsibility for your health and leave it in their hands whether or not they can fix you.

    For many people out there in the world, the usefulness of alternative medicine cannot be understood until you go through the eye-opening experience of having an illness that M.D.s cannot treat and do not have a cure for. But- under the guidance of numerous alternative practitioners has successfully been alleviated. One of these such illnesses is advanced Lyme Disease. This is a possibly fatal disease that is very common throughout the U.S. and if this disease goes untreated past the 1st month, it is extremely unlikely that traditional allopathic medicine will cure you, they don’t understand enough about the disease.

    Getting well from something like that through the use of alternative medicine has nothing to do with placebo effect. I believe you would understand that isn’t possible if you have ever gone through treating a life threatening ailment yourself.

    I myself went the route of being treated via doctors. I had to see 30+ doctors due to my ailment and not 1 of them could properly diagnose me. Finally, I saw an M.D./N.D. who specialized in what I believed was my ailment and could supply the proper lab tests to diagnose me correctly. Obviously there is a serious flaw in the M.D. world if after 30 doctors, I still couldn’t be told what was wrong with me and each one of them told me something different.

    (Bullshit. Sorry.  -PB) 

  27. That being said…. I think you are very correct in saying that some alternative practitioners go too far. Albeit this is rare to come across, but yes, chiropractors claiming they are pediatricians is not right.

  28. And I hazard to say you don’t know jack about anything else. I guess I didn’t realize at first that I was supposed to be a MD before giving an opinion. I wasn’t calling you a healer, first off. I guess in my ignorance I used the word wrongly. Secondly, I have no disdain over religion, just people who think theirs is the only right one. Its hard to understand how a doctor who has so much knowledge about the natural word and all its ambiguity and mystery could believe in any orthodox religion. Especially one that asks you to believe a man who was God died and arose from the dead in three days. I guess its kind of like the chiropractors. They have faith in their practice even though all rational evidence points to the contrary. I wonder if there are any fundamentalist chiropractors. I don’t think so, because if there was they would pray and God would set them on their way about how fuct up their practice of snake oil is. Haha, Yeah thats it. You are right sir, sorry I have been wrong the whole time. I don’t know jack about medicine. I do know that I am an arrogant asshole and I hazard to say, you are also. I guess we will disagree. I don’t think either of us would want to agree with the other anyway. See you In heaven, Ohh, sorry that’s right. I won’t be going. luv ya

    (“Faith in the their practice” is not the same as Faith in Christ. I have faith in Christ but none in medicine which is and should be a rational activity. In other words, except that religion guides moral decisions, it has no place in medicine; neither should your medical practice be impervious to evidence and taken on faith. Simple concept. You really don’t know much about anything. -PB)

  29. Ran across your post while searching chiro care for TMJ. I am 8 months post op from c5/6 c6/7 fusion, discectomy and foramectomies. Almost completely better, I’m knocked down by this Eustuachian Tube Disorder apparently caused by TMJ. Our friend, a chiropracter, suggested I come see her to investigate my TMJ.

    Now maybe, I won’t.

    Thank you.

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