#49572: — 11/18  at  09:05 AM
Why alt med in medical schools? It is because medical schools are professional schools--business schools for doctors. There's money in alt med so doctors need to know about it, the standard practices, what is currently acceptable to diagnose and prescribe.

Like any professional school, med school teaches what the employers demand. And HMOs are in the alt med business.

#49577: — 11/18  at  09:21 AM
PZ, I'm very glad you brought up this subject. I recently moved to Columbus, Ohio, home of the relatively respected Ohio State University. I was shocked to discover that the OSU College of Medicine and Public Healthy has invested a lot of money -- and a lot of prestige -- in the OSU Center for Integrative Medicine.

Because relatives are pressuring my sick father-in-law to visit this pseudoscientific abomination, I took a look at their website and it's quite obvious even to the casual visitor that only a few of these quacks are actual physicians with any sort of accredited medical degree or other professional qualifications.

Glen Aukerman, the leader at the center, is indeed an MD, but seems to have no other advanced degrees or actual experience in practicing medicine -- according to his own résumé, most of his experience has been in administrative positions.

For anyone who lives in central Ohio, here's a sampling of the other prominent practitioners at the center, and their credentials:

Emily Wright Arnold - Massage Therapist
Massages may feel just great, but I don't think there's ever been a case where a masseuse cured a disease, saved someone's life or accomplished anything remotely connected with medical practice.

Diana Garber - Certified Business Continuity Professional
Apparently she specializes in Feng Shui. Hey, for a couple of hundred dollars I will be happy to come by and arrange your throw-pillows, but I don't really think this sort of thing has anything to do with curing people.

Robin A. Hunter - Doctor of Chiropractic
Kristopher Keller - Doctor of Chiropractic
Grant Lewis - Doctor of Chiropractic
Do people still not know that chiropractic "medicine" was developed by an Iowa greengrocer? Has a chiropractor ever cured anything more serious than a temporary backache?

Diane Manos - MD
Sure, this one is an MD, but one whose specialty is Sports Medicine. She's also a Reiki Master -- another "therapy" based on touching and the manipulation of body parts (i.e. feels good, but does nothing else).

Bella Mehta - Doctor of Pharmacy
In other words a pharmacist. Useful, but hardly a medical professional capable of intelligent diagnosis, etc.

Hari Sharma - Ayurveda Specialist
For those who are puzzled, Ayurvedic medicine is supposedly the traditional medicine of India and the practice is said to be some 5,000 years old. Now, I would like someone to explain how India was, and continues to be, one of the most unhealthy places on the planet. Just curious. Some of these guys drink their own urine (they consider it "as an effective antidote against the harmful confluence of excesses of the three humours," whatever that means).

David Dehui Wang - Acupuncture and Traditional Chinese Medicine
Just substitute " India" for "China" in the description of Ayurveda above. Again, how come the Chinese are not models of health if this medicinal practice has worked so well for thousands of years?

What is extremely disappointing is that I could find no group, no newspaper article, nothing, that has criticized the creation of this center. Are there no Ohioans who are as shocked and angry as I am?

#49584: — 11/18  at  09:44 AM
Before I say this, I wish to make it clear I am absolutely f "alternative medicince".

There is only ONE positive thing I can say about "alternative medicine"*. A large proportion of a general practitioner's job is palliative care. Certain diseases/ailments (pain, stress related disorders like IBS etc) have what I can only describe as a strong "psychological component". This is the basis of the placebo effect. So if you're getting you aura cleansed or chowing down what are essentially very small sugar tablets and it makes you feel healthier (placebo), then all the better. It means more of the health service's limited cash can be spent on real medicine for real ailments that lack such a significant psychological component. I can't remember where I found them, but I seem to remember "studies have shown" (the online equivalent of "bloke down pub said"!) that "alternative medicine" could save the UK NHS money because it has very low overheads (no research, no development, no medicine!) and it takes care of this placebo/palliative care issue.

The downside of this is the anecdotal and "correlation=causation" mistakes that people make, i.e. "sugary jollop and feeling my feet made my headache go away, therefore it is real and it will help with my cancer". Sadly people will think bonkers things whatever we do, which is a great pity, but then perhaps if they didn;t think the bonkers things these placebo/palliative "cures" would work less often. Hmmm I smell a conspiracy theory in the offing!

*"Alternative medicine", there is no such thing. If it works it's medicine, if it doesn't work it's wishful thinking. Where's there an alternative? If standing on one foot under a baobab tree at midnight on the third thursday after pentacost whilst having your prostate gland massaged by an appropriately tranquilised mandrill manipulated by a team of Tibetan monks when you're sucking on a losenge made of organically grown mandrake root from the south side of a moonlit field in Acapulco and wearing a robe made out of orange peel has a demonstrable positive clinical effect above that of placebo or spontaneous remission during double blind trials, then it's fucking medicine! There ain't an alternative about it. How's THAT for a run on sentence!

#49586: — 11/18  at  09:46 AM
P.S. Perhaps more on topic: teaching "alternative medicine" at universities? Pointless. Universities are already struggling for cash as it is. Smack your Dean/Chancellor and redirect the money to useful subjects.

#49589: decrepitoldfool — 11/18  at  10:01 AM

"Some of these guys drink their own urine (they consider it "as an effective antidote against the harmful confluence of excesses of the three humours," whatever that means)."

No mystery there... if had to drink my own piss, I wouldn't exactly have any excess of humour.

#49600: Rick @ shrimp and grits — 11/18  at  10:28 AM
<blockquotwe>
Diane Manos - MD
Sure, this one is an MD, but one whose specialty is Sports Medicine. She's also a Reiki Master -- another "therapy" based on touching
</blockquote>

Does anyone other than me find it hilarious that a person by the name of "Manos" is a master at a treatment involving laying the hands on various body parts?

Is her assistant's name Torgo?

#49602: — 11/18  at  10:36 AM
Some of the attraction of traditional medicine is that some of the things involved do work - after all, many of our pharmeceuticals are derived from traditional plant/herbal remedies (aspirin/willow bark for example). The problem is that in these traditions, there is no method of distinguishing effective remedies from hokum. And, of course, some people just get better from whatever ails them and one really doesn't know if they were going to get better anyway or what.

Now, if someone could only come up with a way of testing these remedies, where neither the administer or the recipients knew if they were getting the active substance or something in place of it...

oh, right.

I read somewhere that ayurvedic medicine in the West was largely the invention of one Indian fellow in the early 20th century and is not, for the most part, even ancient mumbo-jumbo.

#49605: — 11/18  at  10:44 AM
The placebo effect is more potent than most of the tools available to mainstream medical practitioners. It's ironic that very effective treatment can come from exploiting a patient's credulity with the intentional (or not) application of useless treatments.

How does scientific medicine ethically employ the placebo effect? I don't know.

Back in my high school days I developed a disabling case of stomach cramps a day before I was to participate in a big scholastic competition. My mom called the family physician and procured some medication for me. When she handed me the bottle of "Placebin" I was both insulted and amused. Even though I didn't take a sugar pill, the humor of the situation apparently distracted my anxiety - the cramps abated almost immediately.

#49607: Jim Harrison — 11/18  at  10:47 AM
Conventional medicine focuses, not unreasonably, on conditions it can treat. Unless you are exceedingly wealthy, you will find it very difficult to find a doctor who is willing to minister to what you perceive to be illness. In the era of the seven minute appointment, nobody very impressive is around to hold your hand.

Healers are a feature of all the human societies I know of. To the extent that modern medical personnel don't fill this role, alternatives will inevitably arise. Like priests and seers, medicine men appear to be cultural universals. Their roles are doubtlessly rooted in our biology. Which is not a defense of the validity of either prophesy or homeopathy or an argument in favor of sacrificing goats or shaking gourds at broken legs. I'm simply pointing out that both religion and alternative medicine are going to persist, and the rational response to both of them is to figure out ways of limiting the damage they can cause.

#49612: Ron Sullivan — 11/18  at  10:57 AM

Facilitated by Richard Leider, ranked by Forbes as one of the world’s top life coaches, come and learn what aging means for our bodies and our minds and hear Dr. Weil’s practical yet innovative advice…

Is this mess a typical side-effect of alt-med? Some sentences beg for heavy editing; this one gives me a strong urge to find the writer and shove a red pencil up his or her nose.

Glad to see the blog back in good form, by the way, and thanks to you and your tech team.

#49614: Orac — 11/18  at  11:03 AM
Ack.

You beat me to this one. This very topic was in my queue to write about next week....

Ah, well. Maybe I'll give it a more detailed treatment. My very own medical school has an example of something similar. Qigong, anyone?

#49620: Aero — 11/18  at  11:36 AM
The witch doctors are wearing me down. I'm starting to get jealous of their cashflow and wondering if their victims are victims are supporters. Maybe good science should just take on the shamans at their own game and beat them at it and use the proceeds secretly to do real science. Science could use the cash flow. But I guess nature would soon eliminate the faithful and leave the planet to other forms of life.

#49624: Beaming Visionary — 11/18  at  11:43 AM
I've had the idiot box on more often than usual lately, and I've recently seen more than a few of my fellow visionaries boast of being "life coaches" (most recently, I admit, on that Wife Swap Lite show on F*x). Wondering if this might be tantamount to someone urging sentient adults through their 20's, 30's, 40's and beyond using a novel form of Lamaze breathing or whatever, I hit the Web site of one of these self-described mentors. This'll give you some idea of what you're in for:

http://www.deeannmodel.com/

The "game plan" evidently involves multiple breast augmentations, 95% of one's self-identity being invested in appearance, and a home page with a ripped-off porn soundtrack. Coach this!

The existence of "titles" such as "life coach" are corollaries of Idiot America's war on expertise as described by Charles Pierce in Esquire (and noted here by PZ). If real credentials aren't worth a damn, then ones made up on the spot and backed up by precisely nothing (other than, say, a nice, fake rack) take on greater value.

More on topic, I'm not sure how much money there is to be made in alternative medicine for the average naturopath. A friend of mine, a biochemistry PhD at a big California school, has a girlfriend who's completing an ND program in Arizona, and I believe he said this is one of only four states in which she can officially set up shop. Of course, "officially" may be the opertive word in that sentence. My friend is not happy with the whole arrangement.

Of course, schools dedicated to nuttery are one thing; if people are paying $40,000 a year on MD tracks to learn about the wonders of homeopathic doses of Coenzyme Q, that's both a disservice to the students and a waste of time for the faculty, to say nothing of how it doesn't serve patients down the line.

#49629: — 11/18  at  11:54 AM
I lost a very, very near and dear one to "alternative" medicine. I try not to think what might have happened if I had dragged this person to a doctor even a few weeks before the end; because then there is no end to the blame game. As for Ayurveda, it was as scientific and materialistic as it could be in those millennia past. Life expectancy in many parts of India was not way off the world average about 250 years ago, vaccination was common and there were many guilds of doctors and surgeons. Unfortunately progress isn't measured by time and in the last 100 years the scientific study of human well being has brought about epochal changes in our state of health. If Ayurvedic vaids want to be true to the spirit of Sushruta, Charaka and Atreya they should get themselves trained in contemporary medical practice or at least do no harm.

#49631: Keith Douglas — 11/18  at  12:00 PM
My mother is a nurse by training, and retired recently, in part because of increasing quackery. I read about all this crap and I wonder what to do. I do my part in public education, but I do despair of getting anywhere. Realistically, I think, skepticism and such has to begin early.

#49632: — 11/18  at  12:01 PM
Life coach is passe. The cool term is life strategist.

We see a LOT more of Weil on Maui than you do in Minnesota, for some reason.

Jim's right, unfortunately. Years ago I proposed an approach along that line. The 60% or so of physician office visitors displaying no organic symptoms would be told they are suffering from FSB (but not told it stands for Feels Bad Syndrome) and referred to an FSB specialist. This would be a tutu (kindly grandma in Hawaiian), who would hold their hand and have a nice chat over a cup of tea.

All my physician friends kind of sigh when I bring this up.

#49637: — 11/18  at  12:10 PM
You know, I know this is really just a benign form of prejudice, but I actually prefer to be seen by an Indian doctor at my HMO. They seem to be less authoratative, aloof, and "just believe what I tell you" than white American doctors. More interested in how things are going in general. And my current doctor really doesn't have a problem admitting when there's nothing much they can do for you about certain conditions (like a viral sore throat).

How does one get to be a life coach anyway? I'm great at giving other people advice about what to do different. I'd be better than most of these clowns. First piece of advice - if you've got small tits, work on getting a great ass. And a personality.

#49644: — 11/18  at  12:56 PM
The problem isn't alt medicine it's the fact that doctors are glorified technicians playing with a system that they barely understand. Going to see some smug prick who won't actually talk but instead glances at a chart for 30 seconds, makes some affirmative noises, prescribes a bunch of blood work and pills, and is gone in under 10 minutes is not encouraging. So folks are turning to treatments where the providers actually appear to pay attention and give a shit about something other than keeping their per-patient time below 15 minutes.

Start reading some Nortin Hadler and go from there. Finding a decent medical professional is a crap shoot, here's to getting lucky.

#49646: — 11/18  at  01:02 PM
Louis, you said:

"Certain diseases/ailments (pain, stress related disorders like IBS etc) have what I can only describe as a strong "psychological component". This is the basis of the placebo effect."

I wouldn't say that was the basis of the placebo effect. Hasn't the placebo effect has been demonstrated for what you call "real ailments that lack such a significant psychological component" as well?

You know, just because something has a psychological component, it doesn't make it not real or something that will go away with a bit of reassurance and hand-holding. Are you saying we shouldn't waste time and energy treating severe pain from cancer, MS, post-operative pain, etc? We might as well just treat what's wrong with the person and give them a cup of tea, right?

I get a bit fed up with this. I have a genetic disorder that means I have almost constant pain. I appreciate there is a psychological component to this - if I'm feeling down or stressed or something my ability to ignore the pain worsens, for example - but that doesn't mean that the *cause* of my pain is psychological.

I agree that some disorders have psychological components, but I don't accept the suggestion (not just from you) that that means it isn't worth treating the disorders and that all people with these disorders need is tea and a nice chat to make everything better (although I will never say no to a cup of tea and a nice chat!).

#49648: — 11/18  at  01:13 PM
I have absolutely nothing against using the Placebo effect to "treat" psychosomatic illnesses like hypochondriasis, but don't think for a second that the "alternative medicines" are harmless sugar pills.

Ayurveda has been mentioned a couple of times in the comments. For those interested in Ayurvedic "therapy", allow me to refer you to the Journal of the American Medical Association (JAMA - Dec. 15th 2004, Vol. 292 Number 23) where an article entitled "Heavy Metal Content of Ayurvedic Herbal Medicine Products" actually caused Health-Canada (the Canadian FDA) to ban the products mentioned in the article.
From the article:

Lead toxicity has been associated with use of Ayurvedic HMPs, including status epilepticus, fatal infant encephalopathy, congenital paralysis and sensorineural deafness, and developmental delay. Since 1978, at least 55 cases of heavy metal intoxication associated with Ayurvedic HMPs in adults and children have been reported in the United States and abroad.

The results?

A total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained lead, mercury, and/or arsenic...

One product actually had a lead content of 37,000 ppm, a mercury content of 22,800 ppm, and an arsenic content of 8,100 ppm. Some of the "medicines" are specifically prescribed to children. Their intake of heavy metals, based on the doses prescribed, exceed 1 to 3 ORDERS OF MAGNITUDE greater than the EPA reference dose.
Just say NO to Ayurveda. You're better off drinking latex paint.

#49652: — 11/18  at  01:30 PM
Don't rely too heavily on treatment by placebo

http://content.nejm.org/cgi/content/abstract/344/21/1594

from the conclusion:

Outside the setting of clinical trials, there is no justification for the use of placebos.

#49663: — 11/18  at  02:35 PM

You're better off drinking latex paint.

At 4% lead, you're probably better off sucking down a tube of cadmium yellow...

#49666: — 11/18  at  02:41 PM
I believe that there are legit, peer-reviewed medical studies that support limited, specific uses of chiropractic & massage. The former for temporary back problems (say, caused as the result of a car wreck); the latter for helping speed recovery from muscle injuries.

The others, I'm solidly in your court. And if it can be shown that I'm wrong about the first two, I'll change my tune.

#49669: — 11/18  at  02:46 PM
"Bella Mehta - Doctor of Pharmacy
In other words a pharmacist. Useful, but hardly a medical professional capable of intelligent diagnosis, etc."

Mostly agree w/ stuff you said, but you're wrong here. Pharmacists these days ARE medical professionals capable of intelligent diagnosis. People don't realize how similar a MODERN pharmacist's training is to a medical doctors--plus they actually understand the way drugs work, unlike many doctors. Again, not to defend this other crap in any way(Weil is discrediting my school's name), but I thought I would point this out.

#49672: — 11/18  at  02:55 PM

That's typical altie waffling: promise the world, but then lack the gonads to do anything but make mystic circles with their hands and write poetry.

Hmm, maybe we should set up a holistic ayurvedic homeopathic trepanation clinic. Because people need alternative medicine like they need...ah, screw it.