Liberating Us From Crap (And Other Totally Random Stuff)


I am no Luddite. Like most of the younger physicians today, I grew up with computers. My father had one of those suitcase-nuke Osbornes and I am old enough to remember how cool we thought the Commodore 64 was, what with its sweet cassette tape drive and way cool BASIC instruction set that let you GOTO all kinds of programming bliss. In the now-distant 1980s I was a Computer Science major and did pretty well in those classes even if I failed everything else and ended up being kicked out of the University of Vermont for bad grades. I have written a FORTRAN 77 program on punch cards and even wrote an assembler (a program that converts assembly language into the CPU’s binary instruction set) for the ancient PDP-11. I remember well the DEC VAX, the first version of windows (I preferred DOS until Windows 3.1 which finally closed the gap with Apple for a graphical user interface), and my first real computer was an IBM PS-2 with a giant 5 MB hard drive. I’ve used all the major software; WORD, Excel, and Powerpoint as well as sophisticated structural analysis programs like RISA and STRUDL, not to mention at one time being something of an expert at AutoCAD. My medical school was completely wired and all of the lectures and notes were on line. In fact, mine was the first class were the administration realized that there was no need to have a “This is a Computer, This is an Icon” orientation as everybody in the class had also been raised with computers. On top of that, we use tablets with the T-system at one of our hospitals and I have adjusted to it effortlessly as have most of my colleagues.

I therefore take umbrage to the conventional wisdom that doctors are not technologically adept. I was thinking about this the other day as I manipulated the ultrasound probe to get a better look at my patient’s aorta. It’s not that we’re not adept, it’s that we like to see a return for investment and are well beyond the reflexive, “Golly Gee Whiz” reaction when confronted with something new. We just want the motherfucker to work and by work we mean to simplify our day, not make it more complex. Take for example the typical hospital computer system which is usually an ancient relic from the 1970s, still running on some baroque IBM mainframe and to which has been grafted a modern-looking “front end” to give the illusion that we are, in fact, cooking with future gas. It can’t communicate with any other system, it’s slow, and it can only retrieve a limited amount of information, usually lab values and some dictated notes. Forgive our lack of enthusiasm but there is nothing to get excited about here.

In other words, we are in the doctor business, not the computer business. I don’t really want to learn anything about the equipment except how to get what I need out of it. I don’t trouble-shoot faulty hardware or kludgey software. If the problem can’t be solved by re-booting then I’m done. It’s time to call technical support and let them handle it as that is their business.

Or consider writing notes. Leaving aside issues of legibility and access to your notes by some nebulous doctor in the unforeseeable future, until very recently it was just much easier to open the paper chart and write a note or dictate than it was to find a computer, log in, locate the patient, check this box, click that one, and type the same note, especially on the hospital’s chimera of a system. This is all changing, of course. Windows-based and internet accessible Electronic Medical Records are much easier to use now and very fast but, as the requirement to document for billing and not for medical decision making is driving the EMR business, most of the notes you produce are automatic boilerplate and, except that we must kill what we eat, if it wasn’t for the billing requirement it would still be easier to hand write a quick note on most patients, the important information about which can usually fit on one side of an index card.

I use email and I of course have a blog. I am accessible but for the record I do not routinely carry my cell phone (I have it perpetually charging in my car for the once or twice a week when I use it) and have only a vague idea what a “ringtone” is and if it’s what I think it is, cannot believe that anybody pays money for them. I do not “text message” either and I will ignore anything on my phone written in “Cutesy.” I have a pager and believe me, that’s enough. More than enough. If someone needs to get a hold of me they can and other than that, I guess I just don’t have a lot to say.

On the other hand in our new twenty-acre Emergency Department they have us carry “in house” cell phones and I love these…but only because I can page an admitting physician, for example, and pick up the call anywhere. See? Technology making our job easier and more efficient. (Now that the charts are on the tablets I can also talk intelligently about any patient on the phone from anywhere in the department.)

My point? Nothing, really, except that I am Best Buy’s worst nightmare. I don’t own much in the way of personal electronics, I don’t really listen to that much music, and despite my cell phone having hundreds of features, all I really need is to dial a number every now and then and do not need to be in constant communication with everyone I know all the time. I know how to use all the stuff, I just don’t want to.

Except…I just bought my wife an MP3 player, thirty bucks, one GB of memory, and I’m hooked. I remember when the Sony Walkman first came out and while I eventually bought one, this thing is nothing like that. Keep in mind that most popular music is crap. Utter crap. Filler, compost really, for the one or two good songs on an album (do you kids still call them albums?). Even with the Walkman which I assure you was revolutionary for its time, you still had to buy tapes that were mostly crap to get to the one or two songs that were worth listening to. Come on now. Admit it. Very few artists and bands are consistently good. Maybe the Rolling Stones and the Talking Heads but U2? Madonna? Get real.

Now, on an intellectual level I have known for a long time that you can pick whatever tracks you want to download onto your MP3 player. I just didn’t realize the power of this until I started downloading the songs my wife wanted. She’s into the Latin sound, J-Lo, Enrique Inglesias, Santana’s “Smooth” and the like. I was skipping around her playlist, just sort of checking to make sure everything was there and I realized that every single song, while maybe not exactly my thing, is good. A winner. Worth listening to. (Say what you like about Ricky Martin, that vato can jam.)

Finally, we have been liberated from crap.

Complementary and Alternative Medicine

Maybe I haven’t been clear about the subject of Complementary and Alternative Medicine. Or maybe my articles, as has been suggested by some of my critics, are too long and the reader’s lips and brains are tired by the time they get done with them. Let me summarize:

1. CAM is mostly an expensive, carefully constructed placebo. The major academic centers that sell it to the gullible admit as much but flog it anyways using “well-being” and other nebulous concepts as an alibi (do you really think anybody at the Duke Center for Integrative Medicine with a medical degree, for example, really believes that some yahoo can shoot spiritual fire out of his appendages?). While I rise in support of having a good attitude and a positive outlook, the real medical effects of placebos are terrifically over-rated. You can feel as good as you want about your pancreatic cancer, for example, but it’s going to kill you or not pretty much on its own schedule. The microscopic advantage you may glean by believing that spiritual fire is flowing into your body is nice to have, certainly harmless if not your sole treatment, but not worth the ridiculous expense of having a shaman on the payroll.

2. In other words, even in the real world of medicine, a lot of our therapies and interventions are marginally effective at best and there has to be some consideration of cost versus effect. The effect of most CAM is not even close to being worth the cost as it is mostly entertainment and not medicine. Just because the patients want it doesn’t mean we have to give it them, except of course as part of a customer-satisfaction driven business model which is great…but not on my dime.

3. The CAM that is not pure bunk, some aspects of naturopathy, for example, that use medicinal properties of botanicals and other substances as therapies are unnecessarily complicated, unsafe, and based on a shoddy philosophical basis that makes no sense. “The Healing Power of Nature” is an insipid marketing phrase. “The Vicious Automatic Killing Default Position of Nature” is more apropos as it realistically describes what anybody who has ever watched even a few minutes of the Discovery Channel could tell you. Naturopathy and many of the other bambicentric CAM modalities are political statements, not medicine, and while they may accurately reflect the world-view of their purveyors, are less than optimal therapies in a world that is indifferent to your nature fantasies.

4. In other words, there is no “Mother Nature” or “Planet Earth” who cares about the difference between a quality-controlled dose of digoxin produced by an evil pharmaceutical company or a cup of oleander tea steeped in the hand-made clay urn of a nature-loving hippy. Now, in our Godless and tradition-rejecting society, I can understand the panic that many feel when they look into the void and see nothing. But if you’re going to reject religion, then reject it and grow some gonads. It makes no sense to eschew the irrelevant religious beliefs of your parents but then, without a pause, to eagerly latch on to some hodge-podge of Earth Worship and Eastern Mysticism except that these things don’t require the self-discipline of traditional religions and therefore give you a purpose for life on the cheap.

5. Which is to say that except as it can inform moral decisions, religion has no place in medicine. My priest offers the last rites to our parishioners but he wouldn’t think of recommending ventilator settings. It’s not his job and I wouldn’t dream of asking him. Complementary and Alternative Medicine is a shoddy, cut-rate religion preoccupied with individual ego and, as it doesn’t even offer any moral guidance (except the commandment to recycle) it has even less of a place in medicine than traditional religion. A priest from my old parish often joked that his vestments make him look like Mandrake the Magician. If Reiki healers, homeopaths, acupuncturists, and the like just dressed the part and billed themselves as chaplains I’d be a lot more accepting. I respect everyone’s right to worship or not worship how they please.

6. While it’s true that “Science Doesn’t Know Everything” and even that many things that were once considered preposterous are now generally accepted as true, if you bothered to notice the movement in science is away from mysticism. Science is moving away, not towards, the grand unifying theory that will prove acupuncture, homeopathy, and any other CAM modality devised at a time when science was in its infancy. For most of human history there really was no science as we know it today but only the venerated received wisdom of the ancients, itself based on a faulty view of the natural world. A lot of what was believed to be preposterous was only considered to be because it flew in the face of this received wisdom.

7. A person who believes in homeopathy, Reiki, and the like…I mean really believes and not just keeps his mouth shut because he’s too afraid that his ignorant peers will accuse him of being close-minded….really has no business in the medical profession and should voluntarily surrender their license. Obviously all that medical school was a waste and didn’t really take.

8. On that note, it is possible to be so open-minded that you enter a sort of Twilight Zone, a strange place where the ordinary laws of physics and reason don’t apply and you must contort your mind into impossible positions to accept many strange and often contradictory beliefs. Being open-minded to that extent is no virtue but merely a glorification of chicken-hearted indecisiveness.

67 thoughts on “Liberating Us From Crap (And Other Totally Random Stuff)

  1. “…we just want the fucker to work…” truer words have never been spoken. In a day where you’re time is planned to the 2 min interval, and people get pissed when you miss the mark spending an extra 2or3 minutes thirty times a day adds up. And that’s the problem with EMR. There is precious little though given to how the system works. The network people secure it, the EMR people make it portable and the printer people make it frustating. It’s rare any of them work in concert to make my day go faster.

  2. Dr Panda,

    Great review of your feelings on CAM, but I’m willing to bet it’s still too long for your average “holistic healer” or believer of CAM to bother to read fully.

    Eagerly awaiting the interesting comments from this and the last post.

    There aren’t many things better than watching or listening to a CAM activist spit and sputter when addressed with real facts and (GASP!) Logic.

  3. You don’t know what you’re missing out on with text messages. If you’re adept with T9 or iTap, there’s no reason to write “idk, my bff jill” as opposed to “Let’s meet at your place at 7,” and it saves you the time of waiting for the phone to ring, hoping that the other person isn’t occupied, and then talking for 1-5 minutes just because it’s polite.

  4. I have to say that when you work in a pharmacy, you usually end up playing computer/printer/misc repairman. Nothing is worse than trying to access patient profiles and have the bleeping thing die.

    I also have to say I agree with what you said on CAM. I don’t care if people want to have others pray for the health of people in the hospital, just don’t go around telling doctors how to treat a patient. It pisses me off when I’m working the pharmacy and I have people telling others waiting in line to pick up scripts that they don’t need their medications but only herbs and special therapies that will fix everything. If you want to believe all that crap, don’t push it on others get them into trouble stopping their medications and doctor’s visits so they can visit some hippy that believes he can shoot mystic fire out his rear or that by twisting your spine into a pretzel he can cure an inner ear infection (I have had a person tell me this last one. I couldn’t stop laughing when I heard this, of course he used something about re-aligning the spine and spiritual energy.)

  5. You might be amused to know that in my department we’re just now phasing out the last of our VMS systems in favor of a network of Windows workstations. It runs on the Alpha now, but I was amazed to see an old MicroVAX the other day in a lab I rarely visit.

    Which means we’re scrapping all the software I’ve written over the past 15 years, which sucks, and the 3rd party software that’s replacing it has (to put it charitably) its rough spots. But with the hardware going away, and with the 3rd party VMS software we rely on no longer supported, we have no real choice.

    My BSCS is vintage 1985, and I once had a summer job where I worked on an Osborne setting up a dBase 2 installation. Ah, the joys of routinely booting off a floppy and staring at that little tiny screen…

  6. I’ve got to admit, I didn’t expect the first part to end up being a treatise on MP3 players >). One of the things I fear most about going into medicine is how all-consuming it is. I guess this is a common fear for any student who has been sheltered from “the real world” and never had to devote a majority of each day to something other than what S/HE wants to do. I think medicine is much more consuming than a regular job though, and just as you put a life of engineering behind you, I’m dreading putting behind me the joy I get from troubleshooting a computer problem for 10 hours straight. I’ll always cherish the time in my life that I had DAYS with which to do nothing but write a single program that didn’t even do something useful. I can pour over hardware specs for days on end until I find the perfect component to meet my needs. When I have computer troubles, the very idea of calling someone else to fix it disgusts me, even if it might be more efficient. I’m sure this addiction will one day turn from technology to patients, but for now I’m finding the prospect of technology becoming a simple means to a different end terrifying.

  7. MP3 players did/have freed us from the bunch-O-crap-tunes. Listening to music one prefers vs listening to what is programmed at a zombie (automated) radio station or the ever fading radio personality in drive times is a blessing. Turn it on and it goes. No more blah blah blah. Less chatter, more platter as they used to say in the old days of radio. (back when they actually used vinyl records)

    Myself, I am a tech head. I love digital ‘things’ and prefer texting over an actual conversation. I HATE voice mail! I HATE my blackberry, only because of the thought that I am always supposed to be in contact. :/ Otherwise it’s a great gadget.

    Best of all my cell phone. I can browse the internet, check email, text message with qwerty keyboard, use a touch screen (not an iPhone) if I want use a keyboard to browse with standard arrow keys, and use navigation tools – think google maps in your phone. It can read the text messages and is pretty accurate with words. The little 2 megapixel camera rocks.

    Unlike other wireless gadgets in my life…. I can turn it off. Sometimes I must have a space of time where I am ‘unplugged’.

    I remember when digital cameras were being marketed to the masses in the late 1990’s early 2000 –the Sony camera that required a floppy disk.

    Not to mention, way before the days of broadband, a 56k dial up modem was hot stuff and 256MB’s of RAM was top of the line. 🙂

  8. I am 54, soon to be 55. I am a nurse, and only on rare, very rare occaisions do I do allopathy.Well, frankly, I can’t remember the last time… I have seen alternative practioners of several kinds – acupuncturists, naturopaths, herbalists, chiropractors and an MD who was also a homeopath, since the late 70’s, early 80’s. I’ve also seen nurse practioners since I first saw one when I was in the USAF in the 70’s. I get my preventative stuff done that way. I have read and studied enough that I can apply basic herbal and homeopathic remedies myself when the very rare occaision arises that I need anything. And I see the above VERY infrequently – except the chiropractor, largely because I am a nurse AND practice Tang Soo Do as well – roll around on the mat and grapple with 20 year olds 3 times a week. Works for me. If it’s placebo, then all hail placebo effect!!! Heh! I also practice Reiki and applied it to every infant/child I gave immunizations to in my public health years to calm them and reduce pain and reactions. All of this is FAR less expensive than seeing allopathic Docs and I am healthy as a horse. As you wrote before, I don’t need no fackin’ evidence based medicine. What I have been doing for some 30 years has me @ the top of the health curve – rather wildly healthy, infact. 😉 But, thanks for your concern! 😉

    (I am 45, eat a crappy diet high in fatty, bloody, half-cooked meat.  I exercise almost every day (weights, running) and there is no spirituality involved in my workout except for “Mohammed K. Prophet, I think I pulled something!”  I take no medications of any kind, herbal, Chinese, real or otherwise and I don’t go to the doctor except that my wife makes me and I have been given an absolutely clean bill of health every time despite being, let’s just say, “stocky.”

    Cost to me?  Almost nothing.  Think about all the money you have wasted on snake oil when the key is simply to not smoke, drink in moderation, exercise, and stay active.  If you get cancer are you going to turn away from your current beliefs? -PB)

  9. In line with your last paragraph, James Randi has a great quote – “There is a distinct difference between having an open mind and having a hole in your head from which your brain leaks out.”

    Wait! That’s it! The CAM therapies put a hole in your head!

    It reminds me of the elderly man with peripheral neuropathy who came to the ER and had to get his foot amputated…because his homeopath told him to soak his foot in the hottest water he could feel to treat a blister. Next stop, 3rd-degree burns.

  10. Or perhaps what you have been doing for 30 years has had no effect on your health and you are simply short whatever money you spent on it. The point about CAM is that they “treat” you when you have no discernible ailments or conditions that needed treating. Allopathic medicine tends to avoid treating healthy people because the point is to fix what is broken (and if its not broke don’t fix it). More likely, the physical benefits of the exercise from Tang Soo Do and other healthy living options are to thanks for your excellent health, rather than homeopathy, etc.


    (My wife’s uncles are in their 90s, still fairly healthy, and were raised on sausage, biscuits, gravy, and hard work on the farm. Anecdote is a shoddy way to prove anything.  Apparently all I have to do is find someone using natural medicine who died from diabetes or cancer and there goes the whole underpinning of th CAM proponent’s belief.  Live by the anecdote, die by the anecdote.-PB)

  11. I just found this blog and really enjoyed reading through your archives. It is a great window into ED medicine.

  12. We get CAM stuffed down our throats so freaking often that it’s unbearable.

    Here’s your death by annectode:

    One of my classmates who did a summer internship in CAM (oh the irony) was having back pain for a few months. A couple visits to a chiropractor and an X-ray revealed a “misaligned rib” that did not get better despite all of his manipulations. Accupuncture…didn’t help. Tramadol from an osteopath that closed up shop and moved to the left coast didn’t help.

    Trip to an Orthopedic Surgeon, with a properly read film revealed something that was vaguely reminiscent of an osteolytic lesion. MRI and biopsy revealed a pre-malignant tumor. Lets see accupuncture fix that…

  13. I take umbrage at your U2 comment! They’ve consistently come out with meaningful songs that are surprisingly intricate. Great music. Madonna…not so much.

  14. peepadoo,
    But you see, that is the point: we now have valid scientific evidence that Zetia doesn’t reduce the risk of cardiovascular disease. And guess what? We won’t use it anymore. That is the beauty of the scientific method: Compose a hypothesis, test it, and accept or reject your hypothesis. Whether or not the makers of Zetia witheld data suggesting that it didn’t work is no indictment of EBM or the scientific method. CAM practitioners continue to practice quackery despite no evidence that it helps, and much evidence that it harms.

  15. You have NO idea how relentless the world of CAM is until you injure some spinal nerves and have some nerve related issues that leave you in a little less “control” as you would like and experiencing the burning sensation of having fallen asleep for five hours in the Florida sun.
    But never fear the CAM people are here!!!
    Chiropractors, the Reiki people, cognitive behavioral therapy so you can tell yourself that burning feeling is just nonsense, distract yourself you fool! How about a little acupuncture? How about some acupuncture with electricity!! Biofeedback anyone? How about some ginko? Or my favorite as told to me by a doc who had the pleasure of caring for a patient after her treatment by CAM providers failed: “she was told to wear fair trade certified cotton clothes three sizes larger and some organic fair trade incontinence cloths.” The CAM gang thought her burning and incontinence wasn’t a spinal nerve injury, it was wearing tight clothes made with bad chemicals.

    Not once did someone say go to the gym every day and do some cardio, swim a little, lift some light weights…exactly what evidence based medicine recommends for treatment.
    Going to the gym isn’t full of the mysteries of the east is it? Though the gym does have some the mystery of that smell and that guy with the short shorts who does leg presses for hours…

    Seriously though CAM providers are hurting people literally. If you get trapped by them they can literally drive you to despair and delay a good recovery for months or even years. Their bs can even delay any recovery at all.
    They indulge the worst instincts in all of us. They indulge you when you feel helpless instead of empowering you. They are always the first to tell you there is no need to work for a recovery, all you need to do is lay there waving your VISA card in the air while they mumble cheerful “only you can save the environment” bs over you, sticking in the needles and giving you a brilliant massage.

  16. Mem said: “And I see the above VERY infrequently – except the chiropractor, largely because I am a nurse AND practice Tang Soo Do as well – roll around on the mat and grapple with 20 year olds 3 times a week”

    Tang Soo Do, Lol. Martial Arts has its CAM problems as well.

  17. In the right studio/school/art, Martial Arts is very good exercise and will keep you flexible (what with all the stretching and whatnot) long past the age when most Americans begin to see more muscle and tendon injuries from exertion.

    I’m a Taekwondo girl myself, and no little of Tang Soo Do, but anything that involves grappling is probably decent exercise. Just so we’re clear that I’m only referring to that component of martial arts, and nothing more. You can get good exercise doing other things too, but you should do what you enjoy.

  18. Even in the wrong school, you will probably get a decent workout. But if you want to be able to fight, you need to go to a school that actually teaches it well.

  19. To mem:

    Much as Panda has said already: the vast majority of people in their mid 50s feel and are well, so it doesn’t matter if you are doing your yearly health checkups with the standard docs or whether you eat yak testicles for breakfast every morning for the health benefits so long as you are active and have a balanced diet and good genes.

    Traditional or as you put it “allopathic” medicine treats sick people and… well, that’s pretty much the MO. So, while you are not sick, please have your jollies avoiding MDs, but don’t try and sell your snake-oil to people who need real medicine please. That’s irresponsible.

    Allopathic, by the way, is such a bullshit term. What does it mean, allo: the other guy; pathic: is sick?

  20. Always see your physician first and then if they don’t help search out someone else.

    For example, after seeing three dermatologists in three countries, including the USA, a Japanese acupuncturist cleared up a year long skin rash. Yes, the derms went all the way to clobetasol-17-propionate.

    Years ago, a Korean family-trained acupuncturist cleared up a case of bilateral tennis and golfers elbow that was giving me a fit for almost a year, and he did it in two sessions. Yes, I went to multiple ortho guys first.

    Stay away from the standardized traditional Chinese medicine curriculum crap that acupuncture schools in the USA are teaching these days.

    So allopathic guys…what do you tell patients to do when your stuff doesn’t work?


    (And that, my friend, is the crux if it.  The Big Lie of Complementary and Alternative Medicine, namely that everything can be cured…an outlook that I referred to in an earlier article as a lack of humility in the face of disease.  What do we do when our “stuff doesn’t work?”  That’s a ridiculous question.  Most of our “stuff” doesn’t work, at least not like you mean it.   I can give steroids, for example, for Lupus, and it will ameliorate the symptoms at the expense of some significant but generally tolerable side effects but we’re not “curing” or “healing.”  There is, however, no acupuncture, chiropracty, firewalking, Reiki, drumming, chanting, herbs, or faith healing that can “cure” it either (or even manage it).  It’s an autoimmune thing, you understand, and cracking the spine or sticking needles in it really has no effect unless you can explain to me how these things can effect the formation of autoantibodies.

    Now, whether the patient accepts this or not is a different story.  The fact that they turn to quacks only means that they have less of a grasp of science and medicine than you do or they are desperate or both.  The patieent’s belief in magic pixies does not validate the existence of magic pixies. -PB)

  21. The crux of what? Allopathic failed this case. Should I have just continued seeing the physicians…for how long?

    What do you do when your stuff doesn’t work? It’s a very legit question. I got no relief; that’s all I was looking for..and then I found it. What was I to do? Believe I’m not any better?

    CAM doesn’t lie; there may be people in it who do so or who are just ignorant but they are representative of people in any field.

    And how can you say this: “it really has no effect unless you can explain to me how these things can effect the formation of autoantibodies” when I just told you that it did have an effect?

    Here’s where I think a big gap is, especially speaking from my area. The research psychologist Dr. Oakley Gordon was studying how indigenous cultures heal people without medicine or drugs. He was studying patterns of verbal and nonverbal behaviors of the healers. He found there was a “deep fundamental” difference in the reality of the healers and his western reality. Basically, he found that he couldn’t understand until he experienced the healers reality. Oakley had intellectual knowledge, the healers had a non-intellectual knowledge and you can’t have it till you experience it. You can’t use any of your medical intellect to try to explain anything outside that realm. As one shaman told a doctor, “you have a lot of information but no knowledge.”

    I have run into many physicians and others who, after experiencing something that doesn’t normally happen in their world, just shake there heads because of what they just experienced.

    Want to join me in the Amazon this summer?

    (This, like CAM, is just emotional masturbation.  Seeing as the average lifespan of the indigenous people’s of the Amazon Basin as well as aboriginal people everywhere is in the thirties and they don’t even live long enough to be cut down by the things that kill those of us in the Western world, you can go into raptures over the healing power of witchdoctors but the proof is in the pudding. -PB)

  22. Here are quotes from actual chiros so people can see just how ignorant the avg chiro is… I deal with these people everyday, I am not trying to spam but it is important for everyone to see chiropractors for what they are… This is a link to the most recent posts on the Chirotalk Forum
    Thank you PB for letting me share this!

    I use the Activator Methods technique ( which I was taught as college. I KNOW it is effective from all the testimonials and more important Outcome Measures which clearly demonstrate it. LOL i guess you can say I intend to get patients better and they love it.

    And don’t tell me that chiropractic is legislated quackery because I personally believe that allopathic medicine is legislated quackery. If their supposed germ theory were true we would all be dead or be forced to live in a bubble. I find it even more disturbing that a drug only has to be effective in ONE THIRD of patients in clinical trials for the FDA to approve it. You call that scientific? Also the CDC in it’s infinite wisdom “predicts” 18 months in advance of any given flu season what strain will be prevalent that year. How can they make such a prediction with any sort of medical certainty with that kind of time frame? I agree with you that two wrongs don’t make a right. But it always seems that it is open season on chiropractors. Allopathic medicine is so quick to point out our shortcomings but hide theirs (actually they BURY theirs, literally!!)

    Dr. H
    6. Dear Doc, Sorry to hear you are not practicing chiropractic, but maybe it’s for the best. Patients getting better to refer others to you. Don’t blame chiropractic for that, just yourself. All the good docs I know started with no patients and built their practices the old fashioned way, one patient at a time. Your success has little to do with your degree, and everything to do with your knowledge, talent, character, conviction and integrity. I’m on 21 years now and I love my job. I do not give unnecessary care, but others may. I am thankful every day for the gift of giving chiropractic care to those who benefit from it. I have saved hundreds from unnecessary surgeries, and our profession has saved millions. If your patients have stuck bones causing their health problem, great! If not, refer them. Chiropractic works! Your M.D. father should not be ashamed of you being a chiropractor, only of being a quitter. Maybe it’s just not for you. Good luck. Regards, Dr. H.

  23. And here’s my acupuncture anecdote: I saw one for two sessions and got nothing but a needle in a tendon. This wasn’t someone trained in the “standardized traditional Chinese medicine curriculum crap that acupuncture schools in the USA are teaching these days.” He’s a Chinese immigrant who learned TCM in China. Such is his reputation in the local Chinese community that if another acupuncturist has been trained by him, he’s sure to mention it in his advertising.

    So I’m sorry, but your special pleading doesn’t work here.

    The herbal pills he prescribed (and sold) did nothing either. Sure, my TSH was lower the next time I had it checked. But then, it’s been up and down each time since. Last time it was down, with no Chinese herbs other than what they cook with at the restaurant down the street. At least the pills were cheap compared to the stuff in the herbal medicine section of the local health food store.

    So you see, you can throw around anecdotes all day and all it will get you is more anecdotes. It’s not good enough. But it’s all CAM has.

  24. Panda,

    I couldn’t help but get excited reading that you went to UVM. I grew up in Burlington and am currently a MS-1 and UVM COM. I read your blog regularly–it’s a breath of fresh air. Interestingly, my company commander in the Marines graduated from UVM too. He was in LAR before going to college, but I can’t imagine that you two overlapped. Great guy… nuts, but I’d follow him to hell. Take care and S/F.

  25. “This, like CAM, is just emotional masturbation. Seeing as the average lifespan of the indigenous people’s of the Amazon Basin as well as aboriginal people everywhere is in the thirties…”

    Still having trouble acknowledging that sometimes CAM works aren’t you…

    My shaman teacher’s mentor died at 99, in spite of the harsh conditions and diseases he was exposed to…

    And Chris C. you know as well as I do that even allopathic, including surgery, doesn’t always work either. All I’m saying is go allopathic first and if it doesn’t work either enjoy your condition or try something else. It’s a simple concept.

  26. So, I’ve been thinking about your pithy observations regarding CAM.
    Have you thought so far as to identify which specific illnesses would be most unaffected by specific modalities of CAM? For example, if you had a patient with HIV, would you feel more comfortable with them wasting their time, money (and pi(e)?) with a Reiki practioner, with a massage therapist, or perhaps acupuncture would help least?
    Or would you suggest that most every illness would be equally unaffected by pretty much every variety of CAM? Just curious.


    (It is all bunk and hornswoggle, absolutley useless against real disease.  The issue of what I feel comfortable with is irrelevant.  The patients can do what they want.  If they ask me (and some have), I politley but firmly tell them that CAM is a waste of money, completely ineffective, and sometimes harmful as it can keep them form getting legitimate treatments while they are in the care of a quack.

    The most laughable thing about it is that there ostensibly educated people, people who should know better, who cannot muster up the minimal intellectual courage it takes to say that sticking needles into non-existent meridians or shooting healing fire out of one’s hands is pure-D horseshit. 

    Massage is not quackery, by the way.  It’s a massage.  It makes people feel good.  I’m all for it but it is not a medical therapy and masseurs don’t pretend it is. In other words, not everything that makes us feel good is a a medical therapy.  If it were, than downing a couple greasy double cheeseburgers would be an accepted medical practice.  -PB)

  27. So, in other words, No. You have not considered my question regarding the relation between specific CAM and specific illnesses.

    The first half of your response seems to indicate that the best way you can shoot down CAM is through devices such as “horseshit”. Do you even know whether pure-D horseshit is necessary, or whether a garden variety of horseshit would be good enough?
    I suspect not.

    Although I acknowledge that a slopping bucketfull of “horseshit” is good enough if all you are able to do is smear CAM in general.

    The second half of your response simply boggles my mind. Is not medicine supposed to make you feel good?

    I mean, in the specific context where you go to a doctor because something hurts, say for the sake of argument, your broken collarbone, WOULD NOT A SPLINT MAKE THE COLLAR BONE FEEL GOOD? Or at least better than before the splint?

    To put the idea simply,
    broken collar bone + splint = feel good. Note, that in that equation, the doctor is symbolized by the “+”, as being the one who applies the splint.

    So, medicine, generally speaking, is supposed to make you feel good. At least in the specific pattern that I illustrated in the previous example, of allowing, permitting, helping, enabling, etc. etc. (where is that damn thesaurus when I need it) a wound, injury, disease, illness or pain to heal.

    So, your second paragraph just boggles my mind. There is no no no no no logic there. It was off-topic of my question, and it makes no sense at all at all.

    (I don’t know how I can be clearer that CAM is all pure-D horseshit and I don’t know why you have trouble with the concept.  Also, I don’t see how you can’t see that while some medicine makes us feel good, not everything that makes us feel good is medicine.  This is another way of saying that if everything is medicine, nothing is, and I may as well make up my own ridiculous faith-based medical therapy for all the discernment that you have between real and make-believe.

    And no, the purpose of medicine is not to “make us feel good.” It’s to diagnose and treat or prevent disease.  Insofar as being treated for a disease or not getting it in the first place makes a patient feel good…well, so much the better.  But “feeling good” is a nebulous concept.  Not everybody who “feels bad” has a medical problem. What about “feeling bad” because you feel you have no purpose in life?  Is this a medical problem? Not hardly. -PB)

  28. Out of curiousity, what is pure-D horseshit? Or, when you say “pure-D horseshit”, what are you referring to?

    I think – correct me if I’m wrong – that your horseshit, whatever it may really be, is a label to indicate that all CAM is not real.

    Therefore, not only have you not considered the relationship between specific CAM and specific illnesses, but you aren’t willing to. Because CAM = horseshit = not real. Fine. Why didn’t you just say so? Why bring horseshit into it at all? I was just asking my question.

    As for your second paragraph.
    I argue that diagnosing and treating or preventing disease does make a sick person feel good. Inasmuch as the purpose of identifying and treating or preventing a problem is to remove it, and inasmuch as removing a problem feels good – at least relative to how you felt beforehand.

    AND, obviously, “feeling good” is a nebulous concept. Obviously not every “feeling bad” is a medical problem. OBVIOUSLY. DUH. Excuse the observation, but you are OBVIOUSLY male. (Your thickheadedness gives that away.) I am limiting my comments to CAM and other medical problems.

    (“Pure-D” is ultra-refined, Grade-A, 99.999 percent pure unalloyed horseshit.  Five horses in every box.  And if, for example, you can with a straight face and no compunction tell me that something like homeopathy or Reiki can possibly work then you have purchased the economy pack, the Costco version.  Come on now. -PB)

  29. Here’s my opinion: something like homeopathy or reiki could possibly work.

    (How?  Tell me, in yuor own words, the basis of, for example, homeopathy.  -PB)

    As for doing it with a straight face and no compunction, well, you can’t see my face so you’ll have to take my word for the state of my face, and you wouldn’t know me from Adam so you’ll have to take my word for the state of my compunction.

  30. How?
    I don’t know how the fuck it works. There are many things I am not, and a homeopathy scientist is one of them.
    Also, why should I have to use my own words? As a self proclaimed proponent of evidence based medicine, you quote other people. Such as studies. Medical studies. You refer to them. So why should I have to use only my own words?
    Again, your logic boggles my mind. Boggles my mind. Your logic is horseshit. In my opinion.

    Plus, I think you asked the completely wrong question. You asked how it works. “How?” Well, how the fuck would you or I or anyone know? We could argue that until the cows come home, or in your case, until all 5 horses are safely back in their box.

    At this point, Richter is too annoyed to even bother trying to figure out whether you had a reasonable question buried in all that horseshit.
    Could you rephrase the question? Using your own words, or not, as necessary.


    (“Homeopathy Scientist” is an oxymoron.  Here’s how the homeopaths claim it works:  Suppose you have a tummy ache.  Years ago, somebody decided that sheep spleen will cure a tummy ache.  The homeopath prepares a dilute solution of sheep spleen.  So dilute that it looks like water.  He then dilutes it successively with more water, shaking it in a certain way between dilutions, until there is no chance at all that a single molecule of sheep spleen remains in the solution.  It is nothing but distilled water.  You then either drink it or, more recently, the distilled water is used to form a sugar pill.  Then, because water has “memory” of the sheep spleen and under the homeopathic maxim that “like cures like,” you are healed by the memeory of the spleen in the water.

    That’s it.  Nothing more, nothing less except for all of the smoke and mirrors to fool the credulous.  Now do you believe? -PB)

  31. Hmmmmm. Richter is processing your response.

    Well, how about this, PB.
    IF you had a tummy ache,
    IF you drank water that had a memory of sheep spleen in it,
    IF that sheep spleen water healed your tummy ache,
    would you believe?
    Richter would believe.
    At the very least, Richter would consider believing. To put this simply, if Richter drank sheep spleen water that healed Richter’s tummy ache, Richter would write down:
    2 + 2 = 4.
    Richter would let the first ‘2’ be the tummy ache, the second ‘2’ be the sheep spleen memory water, and then let the ‘4’ be a happy tummy.


    (No no no.  It is more likely that your tummy ache (or back pain or psychic distress or some other vague complaint which is the only kind that homeopaths really want to treat) went away on its own with no help from the non-existent sheep spleen at all.  Occam’s razor.  Come on now.

    Look, my blog is read mostly by physicians, residents, medical students, pre-med students, mid-level providers, The Crack Emcee (who is sort of like me but with huge fangs and none of my tolerance for ignorance), and other educated people.  I presume you to be one of them but maybe I am mistaken.  There is no mechanism by which distilled water can cure a tummy ache except that it is water and, well, sometimes water settles the stomach which is a ringing endorsement for turning on the tap and getting  a glass of water, not homeopathy.  Water otherwise has no medicinal properties other than whatever you can say about water.  Having not one single molecule of sheep spleen in the water (or the pill) does not confer medicinal properties to the water.  No way, no how.  So sorry.  There is not one iota of evidence that there is any physical basis for the claims of homeopaths.  Indeed, to believe in homeopathy is to reject totally the cumulative knowledge of the physical sciences and biology.  You “believe” in homeopathy in the same way my five-year-old believes in the Easter Bunny, that is, because he doesn’t know any better and has never bothered to think it through.

    I would go so far as to say that if you went to a decent school, by the fourth grade you knew everything you needed to know about science to recognize homeopathy as total nonsense.  In other words, while understanding cardiac ion-channels or the mechanism of complement mediated immunity might require some background that an ordinary citizen would not have, we’re talking about diluting and shaking a glass of water here.  This is not rocket science and it is only your fear of being accused by your ignorant friends of being “close-minded” that keeps you from seeing the obvious.-PB)

    Of course, Richter might let things get complicated and wonder about sheep spleen memory water. But then, new fangled modern evidence based medicine has proved that placebos work. Maybe memory sheep water is Ye Olde Placebo.

  32. PB: Homeopathy is even stupider than you describe.

    What really would have happened is that years ago someone decided that sheep spleen causes tummy-aches. From that, the homeopath says, we may conclude that extremely dilute doses of it will cure tummy-aches.

    Thus the “homeo-“, since they believe, with no evidence whatsoever to back it up, that “like cures like”. Thus also the homeopath’s coined term for real medicine, “allopathy”, by which they intend to convey “other cures like”. (Since real medicine proceeds on the rather more reasonable idea that agents antagonistic to the condition are more likely to benefit the patient.)

    Randall: Of course I know that real medicine doesn’t always work. The point is that it uses techniques that are in general well-established by good science to have, on average, more positive outcomes than doing nothing. Acupuncture does not. All acupuncture has is anecdotes, and it’s therefore perfectly valid to counter one with another — especially since you apparently don’t accept what controlled studies really say about it, and must resort to special pleading to account for null results.

    So far from showing it works, what controlled studies say about acupuncture is that while sticking needles in someone might reduce pain to a slight degree by some not-as-yet-understood mechanism, the theory behind it is nonsense. And it has never been shown to be any good for anything else.

  33. PB: By the way, I suspect that Richter is not a native English speaker and thus may not be familiar with some American idioms. He seems to have not understood what you meant by “horseshit”.

  34. “Randall: Of course I know that real medicine doesn’t always work. The point is that it uses techniques that are in general well-established by good science to have, on average, more positive outcomes than doing nothing. Acupuncture does not. All acupuncture has is anecdotes…”

    I’m all for empirical studies but I also feel the same as this guy, “I personally feel that a thousands year old practice in Chinese medicine is an adequate empirical trial”…Woodson Merrell, MD

  35. “I’m all for empirical studies but I also feel the same as this guy, “I personally feel that a thousands year old practice in Chinese medicine is an adequate empirical trial”…Woodson Merrell, MD”

    There is a reason they have allopathic doctors and hospitals even in China. Those 1000-year old remedies weren’t doing the trick.

    Damnit. There I go breaking that personal rule of non-engagement again. Must. Stop.

  36. “I’m all for empirical studies but I also feel the same as this guy, “I personally feel that a thousands year old practice in Chinese medicine is an adequate empirical trial”…Woodson Merrell, MD ”

    They also believed for a thousand years that heavier objects fall faster, and objects in motion tend to stop.

  37. Randall: Woodson Merrel, MD is more full of shit than a Christmas turkey. (As my dad likes to say.)

    Torture as a method of interrogation of prisoners is thousands of years old too. So is the belief that gods/angels/spirits are responsible for moving the planets around. Argumentum ad antiquitam doesn’t yield better results than any other fallacy.

  38. This, like CAM, is just emotional masturbation. Seeing as the average lifespan of the indigenous people’s of the Amazon Basin as well as aboriginal people everywhere is in the thirties and they don’t even live long enough to be cut down by the things that kill those of us in the Western world, you can go into raptures over the healing power of witchdoctors but the proof is in the pudding. -PB

    PB, this is a cut and paste quote of your response to a comment earlier in this thread. You are making the same point that poor, misunderstood Richter is trying to make.
    Specifically, PB says: the proof is in the pudding.
    R says: 2 + 2 = 4 – a symbolic attempt to acknowledge that if it works, it works.
    PB used a idiom, while R used a symbol to say the same thing.

    (Once again and for the last time….the key missing component to your logic is that homeopathy does not work.  Period.  Not only is it based on pure fancy but there is no physical way at all, none, zero, zip, rein, nada, that it possibly can.  We are not talking qantum physics here.  Water does not have memory of substances it has diluted.  If this were the case, then every drop of water on the planet would be a cacophony of every substance with which it came into contact and it would be impossible to separate out the desired healing effect anyways.  Can you understand that the proponents of homeopathy are at best scientificly illiterate and at worst cynical con-artists?  Are you so easy to be fooled? -PB)

  39. OK, PB, let’s take a thought experiment about pudding.
    Say you had a tummy ache.
    Richter, poor misunderstood Richter, puts 2 bowls of pudding in front of you. One had been made with water that was specially prepared to contain the memory of a sheep’s spleen. The other had a bit of Metamucil, Peptobismol, and Tylenol mixed in – three likely pharmaceuticals.
    Say you picked 1 bowl and ate the pudding. You didn’t know which bowl, because (poor, misunderstood, sneaky) Richter did not label them.
    Say your tummy ache felt better.

    Now what?
    IF you ate the bowl containing the memory of the (poor, misunderstood, dead) sheep’s spleen, would you accept that it helped your tummy ache?

    What I am asking is, IF homeopathy helped, would you accept that?
    I’m not saying that it does help. As I previously mentioned, I am not a homeopathy scientist, nor am I an expert in varieties of horseshit of any kind. (I’m not what you would call a sheep spleen expert, either.) I don’t know much at all, in fact.
    But, I’m just saying, IF it worked, would you accept it? That’s what they mean when they say the proof is in the pudding.

  40. If this were the case, then every drop of water on the planet would be a cacophony of every substance with which it came into contact and it would be impossible to separate out the desired healing effect anyways.-PB

    I do see the conundrum PB posed here. I don’t know the answer. I’m not an expert in water cacophony either.

    What I’m saying is, rather than taking it as a given that it does not work, which I believe PB expressed rather pithily:

    homeopathy does not work. Period. Not only is it based on pure fancy but there is no physical way at all, none, zero, zip, rein, nada, that it possibly can.

    I’m saying, IF it did work, would you accept that?
    And Richter hopes that PB has a better answer than to trot out some more languages (none, zero, zip, rein, nada – Italian perhaps? Spanish? Russian? Pig Latin????) with which to force (poor, misunderstood, yet strangely stubborn) Richter into believing that homeopathy could not work.

  41. Is you understanding homeopathy a prerequisite for homeopathy to work? That’s pretty arrogant, PB.


    (Whoa.  I understand how the homeopaths think homeopathy works.  But the point is that not only does it not work but it cannot possibly work. Not only are homepathic remedies nothing but water or sugar pills but the mechanism that they propose makes no sense, contradicts many well-established properties of physics and chemistry, and is on every level totally ridiculous.  Completely and totally stupid and people who are educated in medicine and even the basic sciences who believe in it are complete and total idiots.  Homeopaths are either stupid, ignorant, or shameless con-artists. So sorry.  -PB)

  42. Richter, while you may be poor and strangely stubborn you are not misunderstood. We understand your insistence that in an imaginary universe where homeopathy works (it is imaginary, of course, even you cannot claim otherwise) we would have to admit that homeopathy works. Well, I suppose an imaginary universe could be conceived of where it rains gumdrops and ice cream, but that’s not where I live. If I were presented with some well conducted, powerful, and consistent evidence that homeopathy actually worked I suppose I would “accept that”, but in my process of becoming an expert on human physiology and health, I haven’t and therefore I don’t.

    Quite the contrary, instead of being misunderstood you are misunderstanding.

    You misunderstand the placebo effect, you misunderstand power (of a study, you understand, to find a statistical difference between two groups), you misunderstand study design, you misunderstand the scientific implausibility/impossibility of a ridiculous theory such as homeopathy, and you misunderstand the fact [fact, you see, fact, not opinion] that anecdote is completely worthless when it comes to scientific study. I cannot write anything here to convince you of your ignorance but I would hope, if you are interested in the subject, you would do some reading and perhaps enroll yourself in a statistics course. Therein you will truly come to understand the random nature of our world and how statistics, the misunderstood and widely reviled method of putting some order onto seemingly random events, is the only path to knowledge of a patient population.

    While you may point to one or ten or a hundred patients who ‘got better’ on homeopathy, I can point to billions who ‘got better’ on their own, and in the same timeframe as those unfortunate enough to shell out some of their hard earned clams for water.

  43. Richter: If homeopathy worked, then we’d be naturally driven to find out why. You labor under the delusion that it’s being rejected a priori. No, it’s being rejected because it does nothing. It has been shown to do nothing — or rather, it has never been shown to do anything. Demonstrating the efficacy of a homeopathic preparation in treating a condition isn’t even part of the process homeopaths use to develop new ones. They are simply presumed to cure conditions exhibiting symptoms similar to that which the undiluted substance causes.

    If homeopathy had been shown to work, then we’d be forced to hypothesize that there is something to water memory, and that “succussion” had something to do with preserving it. But it doesn’t work. Similarly (for Randall’s benefit) if acupuncture had been shown to work, then we’d have to hypothesize there was something to the theory behind it and that qi was real. But it doesn’t.

    These and other CAM therapies can appear to work from time to time because they’re almost always used to treat self-limiting conditions: conditions that disappear or go into remission all on their own whether treated or not. Thus, favorable testimonies and anecdotes appear. But when you subject them to the ordinary processes by which other therapies are evaluated, they prove no better than placebo.

    Placebos are ethically problematic. They have a real effect that needs to be experimentally controlled for, but a doctor must lie to a patient to get them to work. I’d rather my doctor wasn’t required to lie to me.

  44. Richter, it seems you labor pointlessly under the fallacy “post hoc ergo propter hoc”, i.e. “my tummy ache got better after eating the splenic pudding therefore the homeopathy remedy must have worked”. Conclusions that homeopathy works better than say any other placebo require more than a single trial, which is why there is the consideration of power in a study, which anecdotes of success essentially lack, by definition.

  45. PB, Doctor J, Chris C. and CHenry:
    I will explain my own personal philosophy about health, using an example to illustrate: I have blue eyes. Now, the way I know that is by looking in the mirror at myself. I did not learn my eye color in a reference book, or by asking other people. I just observed my own eyes in my mirror.
    I think of health in the same way. For example, assume I skinned my knee. I would just examine my wound, clean it and bandage it, and let time pass as my body healed itself.
    Looking in a reference book or asking other people for help would complicate the matter – at least in this simple case. In the same way as I got the information about my eye color from my eyes through the mirror, I would get the information about my skinned knee and it’s healing from observing my knee.
    Fundamentally, the information about my skinned knee is located in my knee. It is not located in a book, or in another person.
    Now if it were a more complicated problem, say a dislocated knee, the solution would be more complicated. I would need a person – a doctor – who had the experience and skill, garnered from other doctors, and from books, and time and experience, to relocate my knee. But still, the doctor, his education, teachers, and reference books are resources with respect to my dislocated knee. The information about my dislocated knee is still in my knee, and the doctor will manipulate my knee until my knee clicks into place telling him that it has been relocated. Again, the ability to do this comes from his education and experience, but the use of it is centered in my knee.
    Another point of similarity between the simple and more complex case is that my body will still do the healing in either case. The doctor relocating my knee puts my knee back into a favorable position to heal, but it will still be stiff and sore for a few weeks. My body will still have work to do to heal itself, although the doctor’s help was necessary to put my body in a position to do so. In the simpler case of a skinned knee, it was only necessary to clean and cover the wound to enable my body to heal itself. In either case, my body heals itself after it receives the help it needs to be in a position to do so.

    So, to summarize:
    1) the info about my wound is found by observing my wound itself
    2) my body does the healing
    3) the doctor helps put my body in a position to heal, using his education and experience

    To get back to the topic of homeopathy, I am not defending homeopathy per se. I gave that explanation above in order to put my feelings about homoepathy into context. My context for homeopathy is that I think it could potentially be added to my third point above, as something that could help put my body in a position to heal.
    I figure that lots of CAM could potentially be added to my third point.
    (I’m not saying that from a scientific or statistical perspective, but rather from the perspective that the proof is in the pudding – if you try it and it works, then it works. One of my pet peeves is dismissing ideas out of hand, because I often find ideas interesting.)

    (What about an epidural hematoma?  Is your body going to heal that in the interval between the time you start acting funny and the time you die?  Your philosophy is ridiculous.  First you state the obvious, that the body has physiological healing mechanisms, but then you carry it to extreme lengths.   Your body will not heal everything by itself, even with help from a doctor, otherwise nobody would ever die…which they do with alarming frequency. 

    Additionally, we are not dismissing homeopathy “out of hand.”  In fact, we examined it very closely.  I told you how it is supposed to work, pointed out how it cannot possibly, and then dismissed it. 

    You cannot be for real.  Please tell me you are in high school because if you are a college student (or worse yet, a medical student), I weep for the future. -PB)

  46. Ricter,

    If you dislocate your knee you better get your butt to some kind of specialist MD. People don’t simply dislocate their knee. They do however, tear the ligmiments that hold the knee together- ACL,PCL,MCL,LCL, the cartilage on the meniscus, the quad, or the pateller ligament. These things don’t heal on their own and your chiro or CAM will do nothing for you. They would only delay and make your prognosis worse.

    It’s obvious you don’t know much about anatomy and you should not be giving people advice about their health.


    (Not to mention that a dislocated knee needs a vascular referral because the nature of the popliteal artery makes it prone to endothelial damage from stretching even if the patient’s pulses are initially intact.  Thrombi can form later.  I bet yer’ stinkin’ homeopaths and chiromancers don’t know that either. -PB)

  47. PB – OK, if you like, I’ll tell you I’m in high school. Whatever. How ever much education I may have IRL, it’s not enough for me to know what a epidural hemotoma is. (But whatever it is, I’ll put it on my list of things that sheep’s spleen memory water can’t cure.)
    It’s just my idea. I like playing with ideas. That’s all.


    (Ergo, you don’t know jack about squat.  Sorry.  I know that it is the characteristic of youth to think they know more than they do (I certainly did when I was young and had all the answers about everything) but you need to admit this and open your mind to education.  Not the undisciplined “I’m Okay, You’re Okay, Everybody is Right, Nobody is Wrong” dreck that passes for education today but the  education that comes from careful study, skepticism, and discrimination among different ideas. -PB)

  48. Also, just so you know, my lengthy comment detailing how pie is to blame for the collapse of society (in your thread Defending the Pie) was yet another example of me playing with an idea.
    I eat pie myself.
    And I do have enough eduction IRL to know that anaphylactic shock would kill you before diabetes, heart disease or digestive disease would.
    Also, in case you have never made a pie IRL, I have. In case my references to ingredients confused you, since I did not supply the recipe, shortening and white flour are ingredients in the crust, and cornstarch is used to thicken the blueberry filling, which the sugar sweetens.


    (Mohammed J. Prophet on a crutch.  I know how to make a friggin’ pie.  -PB)

  49. Surely you all can attest to the value of acupuncture in substance abuse detoxification… a quick literature search would confirm that point is beyond contention and to deny it, you would be making a mockery of the science you claim to uphold.

    (Again, pure-D bullshit.  A “literature search” only proves that something has been studied, not confirmed.  If you look at the research on acupuncture, it is generally fraught with problems that would invalidate any other study.  Because it’s CAM we pussy-foot around it for fear of offending the sensibilities of the true believers.  Generally, acupuncture research is loaded with selection bias, confirmation bias, insufficient power, lack of blinding, and the other problems.  Even bending over backwards and ignoring these kinds of things the results are unimpressive, not reproducible, and only applicable to highly subjective conditions for which confounding variables are impossible to control.

    I’m sure one of my readers will refer you to the disappointing results of a recent trial of acupuncture versus shamcupuncture. -PB)

    For pain, and detox, it’s beyond contention.

    I am not surprised that some of you won’t abandon your original positions. “The American people need to know they got a president who sees the world the way it is.” – W

  50. PB – Tut, tut.
    We’ve thoroughly examined pure-D horseshit, both what it is, and what it is not. Now you bring pure-D bullshit into the fray. Tut tut. I’d slosh my mythical sheep spleen memory water against your pure-D horse/and/or/bull shit anyday.
    Define pure-D bullshit, please. Inquiring minds want to know, plus, I need a shiny new idea to play with, since my own ideas are getting smeared all over your comments section.
    Also, since you’ve merely been attacking Richter’s (poor misunderstood uneducated) idea about health, the one that Richter politely and carefully posted in your comments section, why don’t you summarize your idea about health?
    I know as an ED doc that you treat disease, but turn it around. What is health?

  51. “Good” Health = absence of disease.

    Wow, that was ridiculously easy. You will no doubt add all sorts of modifiers, including a full belly and post-coital vertigo, but that stuff is on you to obtain.

    The “I like playing with ideas” defense is a pretty lame one, by the way. I like playing with ideas, too, but it doesn’t mean I’m going to believe in magic fairy dust just because I want it to.

    Also, that whole ‘personal philosophy about health’ thing. Just a pet peeve of mine. “Health” (in other words the diagnosis and treatment of diseases) is a rigorously studied peer-evaluated science with well established foundations and theories and, at least recently, a fairly steady march towards the accumulation of more knowledge of the complexities involved in disease. You may as well claim you have a ‘personal philosophy’ about electromagnetism, but in Richter’s version it’s impossible to generate a magnetic field with current. Anyone who knows something about the subject will laugh at you and tell you to go read a textbook.

    I understand the desire here. Your body belongs to you therefore you think you should know everything there is to know about it (rigorous study or not be damned), and the idea that you can be broken beyond repair is anathema. The only problem is that this is pie in the sky thinking. The fear that we are individually fragile and have a very real expiration date drives many to the elusive promises CAM has to offer. You have my sympathy. The world can be a scary place. But you must understand that fear is the con-artist’s tool and he wields it with considerable skill.

  52. Doctor J:
    You defined good health in terms of what it is not.
    Turn it around: what is health?

    I just looked back at my post and I had also defined health in terms of what it is not. So, after you post what health is, I’ll take a stab at defining it too.

  53. As to the acupuncture vs. shamcupuncture evidence, a good one (and I must admit I was referred to it via Orac at Respectful Insolence) can be found from the following. This study, well designed and powerful enough to find a clinically meaningful difference, found that sham acupuncture was actually superior to ‘real’ acupuncture.

    Goldman, R.H., Stason, W.B., Park, S.K., Kim, R., Schnyer, R.N., Davis, R.B., Legedza, A.T., Kaptchuk, T.J. (2008). Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use: A Randomized Controlled Clinical Trial. Clin J. Pain, 24(3), 211-218.

  54. Doctor J: I think health = the ability to live life.
    That sounds pretty vague, I know, and I’m not totally sure how to clarify it. I guess, if bad health is something that gets in your way when you do your shit, then health is being able to do your shit. (I guess for PB that would be pure-D horseshit.)
    I don’t think health is the absense of disease. If only because that seems unrealistic. But for example, if I have unhealthy eyes because I’m nearsighted, but I wear glasses, then with the glasses I’ve got enough health to see just fine. (I could probably even see well enough to tell the difference between horseshit and bullshit at a distance, which has definite advantages to having to examine it up close.) But I don’t have an absense of disease because I still have the nearsightedness, but after the doctor used their skill to help me get the proper glasses, I have enough health to live life.
    That’s just an example. I guess (poor, uneducated, pragmatic) Richter takes a simplistic approach.

  55. Also PB, while I realize that this is not a cooking blog my curiosity is killing me, so, what kind of friggin’ pies do you know how to make? Blueberry?

  56. PB: Any specific kind of pie? Come on man, out with it. Inquiring minds WANT TO KNOW. Also, what are your criteria for choosing a recipe? Do you look for a recipe that is backed up by clinical trials? Or is anecdotal evidence good enough for you? ie. “this pumpkin pie was Grandma’s specialty, she made it every Thanksgiving all growing up.”
    Also, in the case of pie, would you say that the proof would be in the pudding/filling? Or, what sort of testing would you want to subject a pie to in order to diagnose it’s condition? Just wondering.

  57. What is a Luddite?
    I have never covered that topic in school, or anywhere else really. If I wanted to learn more about Luddism(?), what class should I take? Is there possibly a pre-med class (preferably non-science) that would cover it? TIA.

  58. Richter, you’re not being pragmatic. You’re being foolish, and by now you surely know it. “I tried it and it worked” is the same kind of post hoc ergo propter hoc thinking that has kept witches in business for the past 10,000 years (and possibly longer).

    It’s like Granny’s sure-fire cure for the common cold in “The Beverly Hillbillies”. You take some and go to bed, and in a week to 10 days your cold is gone.

  59. Dr. J.: … anecdote is completely worthless when it comes to scientific study.”

    Absolutely brilliant and true. But step outside the realm of the scientific study and into real life where anecdote means something, especially to the person who no longer suffers because they did xxx, then you have another viewpoint to consider.

    Chris C.: “Similarly (for Randall’s benefit) if acupuncture had been shown to work, then we’d have to hypothesize there was something to the theory behind it and that qi was real. But it doesn’t.”

    Again, I don’t care too much about the theory behind why something works, just that it does what I want. In Chinese thought it might be qi; quantum theorists might have another viewpoint, someone else might have another. Some drugs in the PDR work, but we don’t know why.

    Placebo? Maybe, but my dearly departed dog had acupuncture for a skin rash. I asked the vet how he was going to keep him still for the treatment to work. “No problem,” he says. “I’m going to put in a few needles to calm him down.” You know as well as I do how a dog acts on his first visit to a new vet’s office and he certainly doesn’t just sit there. So, the vet slaps in a few needles and I stare in my dogs’ eyes as tries to stare back but he loses and goes to sleep. I wished I’d had my video cam with me then as it was funny as hell. The vet slaps a few more needles in him and in 20 minutes or so, he wakes up and starts exploring the office.

    Sure, it’s an anecdotal story and is absolutely useless…

  60. Randall: Anecdote doesn’t mean anything anywhere except in people’s minds when they’re not thinking clearly. That’s not a slam against people or anything like that; it’s an honest acknowledgment of the pervasiveness of some kinds of fallacious thinking. Everyone does it at one point or another.

    It’s very difficult to attribute an effect to a cause, especially when the effect is something to be expected at one point or another anyway. Was it the treatment? Was it something else? That’s why we need scientific studies. They tell us with reasonable certainty one way or another, when anecdote cannot.

  61. Still the same old anti-CAM propaganda from the same old full of it ER resident, I see.

    Each day you fall further behind the curve of modern day health care, become increasingly irrelevant and increasingly dangerous to those whom you treat.

    I offer the following from today’s news as one proof: (not that proof has ever meant anything to pseudo-demigods like yourself or the silly sycophants who comment here regularly).

    Note that this video is the first of a daily series to be aired on NBC News this week.

    “Doctors encourage ‘wellness’ alternatives”

    “May 5: The best of mainstream medicine is combining with alternative approaches to encourage “wellness,” as the best form of disease prevention. NBC’s Robert Bazell reports.”

    Reconstruct link:











    You are entitled to you own opinion PandaBear but you are not entitled to your own facts.

  62. PandaBear,

    Start your re-education here:

    Dvorak / Gilliar

    Musculoskeletal Manual Medicine
    Diagnosis and Treatment

    2008, 808 pp, 49 tables, 1313 illustrations

    ISBN: 9781588902436 / 9783131382818

    $169.95 / EUR 129.95

    Reconstruct link:










    Add to Cart

    An evidence-based reference for integrating manual medicine into everyday clinical practice


    Written by the authors of the popular Manual Medicine: Diagnostics and Manual Medicine: Therapy, this book is a comprehensive guide to integrating manual medicine into the diagnosis and clinical management of musculoskeletal disorders and pain syndromes. Brimming with instructive images and illustrations, the book provides a solid foundation in general principles of manual medicine, spinal biomechanics, neurophysiology, as well as treatments for each disorder and condition. Separate sections on the spine, limbs, and muscles present clinical applications for structural diagnosis and functional treatment.

    # Practical examples of evidence-based approaches to manual medicine

    # 1,313 illustrations and photographs of superb quality that rapidly demonstrate key concepts

    # Coverage of the essentials of the neuro-musculoskeletal examination with step-by-step descriptions of the techniques for observation, palpation, motion tests, functional examination, and provocative tests, including quick screening tests

    # Chapter on the various components of nonradicular pain syndromes, including muscle pain syndromes, with clear diagnostic criteria for distinguishing the non-radicular and soft-tissue pain syndromes from other pain syndromes

    # Succinct descriptions of common clinical neuro-orthopedic disorders and syndromes of the spine, upper limb, and lower limb in tabular format–ideal for rapid reference and review

    # Discussion of the rationale for selecting particular low-risk treatment interventions, as well as a thorough discussion of indications and contraindications for patients with potentially increased risk

    # Discussion of important considerations for documentation, informed consent, patient monitoring, and follow-up measures

    # Practical section with descriptions of exercises for patients to do on their own

    # Potential considerations for future research

    This book will serve as the definitive reference for all practitioners involved in the diagnosis and medical management of locomotor disorders and painful conditions. It will enable clinicians to enhance their diagnostic and treatment armamentarium by incorporating manual medicine techniques based on the current, evidence-based knowledge of the interrelationships between structure and function.

  63. PandaBear, it may be at 45 you are too old to learn new things but here is something new you will have to learn to remain in medicine the next 20 years so pay attention:

    “Redefining Disease, Genes and All”

    Published: May 6, 2008

    Cut from the NYTimes-dot-com Health section 5-6-08


    “Dr. Butte, an assistant professor of medicine at Stanford, is among a growing band of researchers trying to redefine how diseases are classified — by looking not at their symptoms or physiological measurements, but at their genetic underpinnings. It turns out that a similar set of genes is active in boys with Duchenne and adults who have heart attacks.”

    “The research is already starting to change nosology, as the field of disease classification is known.”


    “A consistent way to classify diseases is also essential for tracking public health and detecting epidemics. The World Health Organization takes pains to periodically revise its International Classification of Diseases, which is used, among other ways, to tally the causes of death throughout the world. The classification is also the basis of the ICD-9 codes used for medical billing in the United States.”

    “The first international classification, in the 1850s, had about 140 categories of disease…The 10th edition, in 1993, had 12,000 categories, said Dr. Chute, chairman of the committee developing the 11th version, due in 2015.”


    “…Dr. Butte said nosology based on genes would one day make today’s classifications look as quaint as ones from 100 years ago look now. One category in the 1909 listing of the causes of death, for instance, was “visitation of God.”

    “Imagine how they are going to be laughing at us,” he said. “Not 100 years from now, but even 50 or 20 years from now.”

    I’m laughing now.

  64. PandaBear, I do like the title of this section “Liberating Us From Crap (And Other Totally Random Stuff)”.

    And I just KNOW you mean ‘Liberating us from Crap like the following that Tara-Parker Hope warned the public about on her blog site published by the NY Times.

    (Whoa.  I meant “Liberating Us From Crappy Tracks on Albums and CDs.”  I thought this was clear.  You are reading too much into part one of my article.  -PB) 

    “Psychiatry Handbook Linked to Drug Industry”

    May 6, 2008, 12:54 pm

    “More than half of the task force members who will oversee the next edition of the American Psychiatric Association’s most important diagnostic handbook have ties to the drug industry, reports a consumer watchdog group.

    “The Web site for Integrity in Science, a project of the Center for Science in the Public Interest, highlights the link between the drug industry and the all-important psychiatric manual, called the Diagnostic and Statistical Manual of Mental Disorders. The handbook is the most-used guide for diagnosing mental disorders in the United States. The guide has gone through several revisions since it was first published, and the next version will be the D.S.M.-V, to be published in 2012.

    “The American Psychiatric Association’s Web site has posted the financial disclosure of most of the the 28 task force members who will oversee the revision of the D.S.M.

    “It’s not the first time the D.S.M. has been linked to the drug industry…

    Be sure to read Comment #1 by MARK KLEIN, M.D. too.

    Read more at (reconstruct link)












    Are people better off trusting their CAM provider than their medical provider today?

  65. PandaBear,

    I picked on you yesterday for being ignorant, arrogant and unable to learn modern medicine’s patient centered paradigm I thought it just to also bring this to your attention.

    The ER doctor is the hero of this piece.

    Have a good day in the ER.

    “Five Doctors, Stumped”

    “Explanation for Woman’s Fast-Growing Tremor Turns Out to Be Elementary”

    By Sandra G. Boodman
    Washington Post Staff Writer
    Tuesday, May 6, 2008


    “”The one smart person in all this was the ER doctor,”

    PS Your comment is as usual superficial and spurious.

    (Come on now.  I merely pointed out that the title of my article. “Liberating Us From Crap,” referred to the utility of the MP3 player.  I think I know what the titles of my articles mean…I do write them after all. -PB) 

Comments are closed.