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Se Habla “woo-woo”

Posted in Denialism by Skepdude on November 21, 2008


So, America is changing. We have an African American president. The Latino population continues to grow. How can the alternative medicine community adjust to this demographic shift? What are they to do?

I’m glad you asked! It turns out that immigrants are palomas ripe for the plucking. Now, we’ve talked about the ethics of alternative medicine, and how “meaning well” is not exculpatory. If you promote quackery, it’s wrong, even if you believe your own drivel.

One of the worst types of drivel is naturopathy. This “specialty” advertises itself as “medicine-plus”, but really it’s “healing-minus”: minus the evidence, minus the training, minus intelligent thought.

It should be no surprise that recent immigrants, who may have low educational levels, especially in English, and have less access to the health care system financially, culturally, and linguistically should be ripe targets.

And targeting these vulnerable individuals is a naturopathic “doctor” in Connecticut.

This doc sounds like she really cares. But that doesn’t mitigate the fact that she is diverting people from real medical care. For example, Latinos have a much higher rate of diabetes than Anglos (6.6% of non-Hispanic whites have diabetes, 10.4% of Hispanics have diabetes). Naturopaths don’t have much to offer these folks. Let me explain.

We’ve talked before about the complications of diabetes, and how they are divided into macro- and micro-vascular. We’ve also talked about how we prevent these complications. Certain medications prevent blindness, strokes, and heart attacks in diabetics. These effects are separate from diet and exercise. As part of taking care of diabetics, I must educate them about their disease and track several different parameters, such as weight, blood pressure, kidney function, urine protein, foot exams, eye exams, cholesterol, etc. What does our naturopath have to offer? Is it all of that “plus”? Her website gives all sorts of generalities about prevention, lifestyle change, and helping the body heal itself, but there is no evidence that she knows anything about the science of disease and health.

First, like all fake doctors, this place has lots of testimonials in place of real evidence. I don’t list testimonials at my office. It’s tacky, and it doesn’t give a measure of success in keeping people healthy. All it measures is how much someone liked a doctor as a person.

And what are these folks testifying about? Probably how nice the doctor is. They certainly aren’t giving us a measure of how well she prevents and treats disease. How do I know?

Here’s what she says about herself:

She has worked with children and teenagers with various conditions such as ADHD, and food allergies. Likewise she treats women’s related issues including menopause, PMS, breast cancer and hormone related issues. Dr. Robinson is very knowledgeable in diet and exercise related issues including weight gain/loss, detox-cleansing diets, and obsessive compulsive disorders. She also does guided imagery, coupled with counseling techniques. Her philosophy is to meet the patient where they are and work with them based on their needs. She acts as a coach-motivater-cheerleader and most importantly educator. She has a vested interest in seeing her patients achieve and sustain better health. Dr. Robinson will combine whatever conventional regime currently in place with Naturopathic medicines for a safe, effective way to maximum health.

I’m a general internist. I claim an expertise in the prevention, evaluation, and management of adult diseases. That’s it. I’m not a pediatrician, a psychiatrist, gynecologist, or surgeon.

What qualifies this “doctor” to treat adults and children, and a variety of conditions such as ADHD, food allergies, breast cancer, guided imagery, and OCD? And the fact that she admits to being “very knowledgeable” about “detox-cleansing diets” is not a mark in her favor. How does a detox diet prevent stroke? Will guided imagery prevent kidney failure?

She is apparently popular in the Hispanic community where she practices. Of course, science isn’t a democratic process, and since her popularity cannot be due to her ability to implement science-based medicine, it must be based on something else.

According to a news article:

Robinson, one of many doctors in the small but growing field of naturopathic medicine, has helped build her private practice in Stamford by offering her services to the Hispanic community at affordable rates.Early in her practice, Robinson discovered Hispanic patients were drawn to the type of natural medicine she offered. Now most of her business comes from Hispanics, she said.


She went through the routines of a primary doctor – taking blood pressure, listening to Shutte’s heartbeat, taking his weight. But instead of writing a prescription for blood pressure medication, which S. once took and disliked because of side effects, Robinson recommended he supplement his diet with fish peptides, flax, pumpkin seeds and cucumber.


I’m sure the patient felt cared-for, but hypertension is a killer, and Hispanics have high rates of strokes and other complications of hypertension than non-Hispanic whites. Additionally, Hispanics are statistically more likely to have poorly-controlled blood pressure.

Look, I’m willing to accept that this naturopath may mean well, and I certainly believe that her patients like her. But she is doing a double-disservice. Not only is she practicing incorrect medicine, but she has singled out a particularly vulnerable group and preyed on them. The fact that she means well or that they like her is less important that the fact that this represents a type of altmed racism. It takes trusting, at-risk folks, abuses their trust, takes their money, and diverts them from care they desperately need.

This is shameful.



Live forever!

Posted in Altie Meds, Denialism, Medicine by Skepdude on August 18, 2008


Look, whether you like it or not, you can’t live forever. I bring this up because there is always a new book or new add purporting to have “the answer” to long life and good health, which never includes modern, evidence-based medicine. Still, perhaps some of these books contains good advice. Or not. Let me explain.

First let me disabuse some of you of the thought that doctors don’t “do” nutrition and life-style advice. In fact, we do. And as attractive as the idea seems, life-style modification will never be the answer to all of (or even most of) our medical problems. Leaving aside the fact that many people cannot make permanent and beneficial changes in their life-styles, there are many other reasons. Human health and disease is complex. Most diseases are multifactorial. For example, type II diabetes is caused by a combination of genetic factors and diet. Some patients can remain off medication using diet and exercise. Some cannot, as even with a good body mass index, good diet, and good exercise habits, their blood sugars are still out of control. Another example is hypertension. Dietary sodium reduction has been shown to reduce blood pressure, but many patients will not have significant enough improvements in blood pressure through diet and exercise alone.

Another reasons that lifestyle changes aren’t the whole answer is that sometimes drugs provide benefit that diet and exercise cannot. For example, beta blockers reduce blood pressure, but they also prevent sudden and premature death in certain groups of patients (i.e. those with significant heart failure), independent of the effect on blood pressure.

Finally, many purely genetic diseases are not amenable to lifestyle modification. No amount of diet and exercise will fix cystic fibrosis or congential adrenal hyperplasia.

Living healthy is important, but there is no miracle to maintaining health and treating disease. No one book is going to help you live forever. Lifestyle modification is not the answer to every medical question, no matter how much we all wish it were.


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Galileo, Semmelweis, and YOU!

Posted in Denialism by Skepdude on August 11, 2008


To wear the mantle of Galileo, it is not enough to be persecuted: you must also be right.
–Robert Park

I used to spend a lot of time on the websites of Joe Mercola and Gary Null, the most influential medical cranks of the internets (to call them “quacks” would imply that they are real doctors, but bad ones—I will no longer dignify them with the title of “quack”). I’ve kept away from them for a while in the interest of preserving my sanity. Unfortunately, Orac reminded me this week of the level searingly stupid and dangerous idiocy presented by these woo-meisters.

In light of this, it seems reasonable to reexamine the Galileo gambit. When a “discoverer” of some new medical “miracle” is dismissed by the medical establishment, they often invoke the ghosts of Galileo and of Ignaz Semmelweis.

Galileo and Semmelweis are a pair of historical figures that share a common story—they both made significant scientific discoveries, documented the evidence for them, and were reviled by certain authorities, but eventually honored.

Ideas are cheap. I believe that my idea to use a flow sheet to track my diabetics’ care leads to better outcomes. I have precisely NO evidence to prove this, but it doesn’t harm me or my patients, and there is at least peripheral evidence elsewhere that this is a good idea. There is also a plausible hypothesis behind this—if I have one piece of paper that contains the critical data for a diabetic, I can see right away if their blood pressure or cholesterol are above optimal levels, I can see what their weight is doing, and I can see if they have engaged in proper preventative care, such as eye and foot exams. There is also a small body of data to support the practice. It would not surprise me if someone studies this in the future and finds my method lacking, especially vs. electronic health records. When necessary, I’ll happily modify my practice in a way that benefits my patients.

Let me summarize the characteristics of a “good” clinical science thinking, in this context (no, I’m not gonna go all Popper on y’all):

    Relevance: an idea should bear directly on a real clinical problem
    Testability: it should be possible to test the idea to see if it has merit (this includes Popperian falsifiability).
    Plausibility: the idea should have some basis in reality and should not have been birthed de novo from between someone’s buttocks. It should not require a “suspension of disbelief” or “open-mindedness”.
    Abandonability: the poser of the question should be willing to abandon the idea if it is proved false. Moving the goal posts, invoking a conspiracy, or any other deus ex machina is never necessary for a good idea.
    Modifiability: an idea can be rationally modified and retested if it may still contain a kernel of truth despite failing one or another tests. Any idea that is held so tightly that reality must be modified to fit the idea should be highly suspect.

There is an enormous literature on what constitutes science, etc. This is just a little guide to reading on quackery, crankery, and other idiocy.

When you encounter possible medical crankery, a couple of questions to ask yourself are “cui bono“: who benefits? Is the answer “patients”, “medical science”, or “one dude with a P.O. box”?

The other question is, “where’s the evidence?” (remember, no conspiracy theories or you violate Pal’s Law).

Or, as Dawkins so acerbically put it:

If you are in possession of this revolutionary secret of science, why not prove it and be hailed as the new Newton? Of course, we know the answer. You can’t do it. You are a fake.