I’m a bit disappointed that when I ask you to explain your straight-forward
claim that as little as 1% of standard medicine is evidence-based, you
respond with a veritable mountain irrelevant conjecture that fails to even
address the question. Instead of showing us the hard data and meticulous
analysis that would be required to prove your point, you offer a pointless
mish-mash including platitudes and homilies about statistics being “damn
lies,” “skeptics asking God for an ID card,” and various irrelevancies such
as “Only 40% of GPs know of [the] Cochrane database, and few use it, only
20% have surgery access to bibliographic databases…” and so on ad nauseam.
So what?! Do you suppose it's possible that some GPs may have learned
something about science- and evidence-based medicine from a source other
than the Cochrane database?… such as their science-based medical training?
In order to come up with your imaginary 1-20% figure, you’ve had to resort
to an absurd definition of “evidence-based interventions” as “only those
administered by physicians who are familiar with the Cochrane database
and/or the tenets of EBM.” Is it reasonable to assume that, if a GP who has
never heard of the Cochrane database prescribes an antibiotic to treat a
susceptible bacterial infection, his/her “ignorance of the database”
somehow renders said treatment “non-evidence-based”? The issue at hand is
“how much of standard medicine is evidence-based”: not “how many GPs or MDs
have utilized the Cochrane database,” or “how many physicians have accessed
EB-checking facilities.” Your responses seem designed to obfuscate this
point.
You’ve offered us several prime examples of how alt advocates will go to
almost any lengths to mis-represent and distort the facts so that they
appear to cast scientific biomedicine in a “bad light.” They seem to feel
that maligning science and scientific biomedicine somehow bolsters the case
for acupuncture, homeopathy, and various other unproven and “evidence-free”
medical belief systems. This pathological process is somewhat akin to the
person who, when asked to prove that he’s smart, responds with a diatribe
accusing everyone else in the world of being stupid.
How many flaws, real or imaginary, will have to be “exposed” in standard
medicine in order to “validate” acupuncture, homeopathy, phrenology,
psychic surgery, chiropractic, or any other unproven therapeutic wannabes?
The only reason I can think of for one to doggedly believe in the “only 1
to 20% of standard medicine is evidence-based” fantasy is that they feel it
somehow bolsters the case for the various “0% evidence-based alternative”
therapies the alt med community is providing on a fee-for-service basis to
the public.
When you tell us that RCTs (Randomized Controlled Trials or CCTs –
Controlled Clinical Trials) have “never really been performed” because “the
theoretical requirements are unrealistic and unscientific,” what is your
point? Because no RCT is perfect, are you seriously suggesting that we
abandon this standard? In your view, we should abandon RCTs in favor of
what?
It’s not too difficult to imagine the “standards” some folks might prefer
as an alternative -- the same “ancientness,” “anecdotal,” “testimonial,”
“patient/practitioner satisfaction” standards that scientific biomedicine
has painfully and inexorably struggled to discard over the last several
centuries. Of course, there is a certain convoluted (if pathological) logic
to this position. If one is heavily invested -- financially, emotionally,
and professionally -- in the efficacy of unproven modalities, these
medieval standards are the ONLY ones that will justify the continued use of
such modalities in the 20th and 21st centuries. Therefore, in the
“tail-wag-the-dog” world of alternative medicine, these “standards” MUST be
fought for.
You tell us that prominent scientist and ethicist “Senator Edward Kennedy”
noted that IF only 10% of the data from on-going CCTs is defective the
problem is enormous." Of course, you seem to have overlooked the
all-important word “if.” You tell us: Dr. John Braithwaite, states that [in
view of] international bribery, corruption,... fraud in the testing of
drugs, [and] criminal negligence in the unsafe manufacture of drugs, the
pharmaceutical industry has a worse record of law breaking than any other
industry.” So, again, what is your point?
Does Kennedy go on to say that "controlled clinical trials are, thererore,
not worth conducting"? What does Braithwaite have to say about the
entirely unregulated manufacturers of “herbal medications,” or the
manufacturers of “homeopathic” remedies, or other “alternative” therapeutic
agents? (Answer: nothing.) Is your point that, since “bribery and
corruption” sometimes come into play in the application of scientific
biomedicine, that the tenets of science and scientific biomed are somehow
invalid? Sometimes potent antibiotics are ineffective in the face of
resistant bacterial infection. Does it follow that we should abandon
antibiotics in favor of “homeopathic water therapy” or “cow dung
poultices”? I don’t think so. It seems that the very best argument some alt
advocates can advance in support of the various unproven therapies they’re
selling the public is that “scientific biomedicine is fraught with
deficiencies.”
You are mistaken with regard to therapeutic phlebotomy and TCM. Therapeutic
phlebotomy has nothing whatever to do with the “leeches” or “ergot” you
mention. You tell us: “Yes the Chinese do still use 'pricking' as a form of
intervention, usually to lower BP, or temperature, or to reduce the effects
of shock.” The fact is that, in China, modern veterinary acupuncturists
advocate the letting of “a half-liter or more” of blood in the treatment of
some maladies.” I’d be happy to provide references if you wish. As
Kuriyama, Unschuld and other Sinologists and historians of medicine have
observed, two thousand years ago the Chinese, like the ancient Greeks
before them, often performed therapeutic phlebotomy, and in intriguingly
similar ways. The practice was eventually abandoned in human TCM, but it is
still very much a part of veterinary TCM as practiced in China.
You refer to “HealthWatch personality Dr. Neville Goodman, examiner for the
Royal College of Anaesthetists” and you immediately dismiss all his
straight-forward criticisms of homeopathy on the basis that “he doesn't
believe in it,” even though “RCTs supports it!” The hard fact is that the
highest quality RCTs and meta-analyses do NOT support homeopathy. I suspect
you know as well as I do that the highest quality (most tightly controlled,
adequately randomized, and statistically significant studies) show
precisely the opposite of what you suggest. See:
I also suspect you’re well-aware that, even when meta-analyses of extant
homeopathy trials are conducted by dyed-in-the-wool homeopathy advocates
such as Wayne Jonas, the authors are forced to concede that “we found
insufficient evidence from these studies that homeopathy is clearly
efficacious for any single clinical condition” See:
If, after 200 years of investigating homeopathy, that’s the case, why in
the world should we waste any more of our precious and limited time and/or
research funding on homeopathic “research”? How many more centuries of
investigation will we have to suffer through before we can reasonably say
“Enough is enough! We’ve examined homeopathy up and down and it obviously
doesn’t work”? And, more to the point, when will it become “medical fraud”
to persist in selling homeopathic therapies to a gullible but trusting
public?
You respond to one of my queries with the comment: “How can I refer to
5,000 years of 'acupuncture and moxibustion'? The simple answer is that I
didn't.” And my simple retort is, “I never asked the question to which
you've responded here." It seems you’ve gone out of your way to distort
both my words and your own prior comments in order to obscure the facts.”
Let’s take a quick look at what I actually said, and what you actually said
in your previous messages.
You claimed “'Inflammation of the liver'/'excessive bile production' …
retains the same symptomatology and possible differential diagnoses as it
did 5,000 years ago… the same emotions are involved … same acupoints
effective … similar modes of stimulation (needles, massage, herbs) - the
main change is how it may have developed in the patient; 5,000 years ago it
may be due to drinking excessive alcohol or a particular pathogen, nowadays
it may also be due to that, but may also be caused by our toxic
environment/food. 5,000 years ago it may have been treated with eg.
peppermint and nowadays may also be treated with that. 5,000 years ago
acupoints LIV2 or LIV3 would be effective, same today” And I responded “I’m
curious to know exactly what you believe “Chinese medicine" had to say
about “acupuncture, moxibustion” and various other things “5,000 years ago”
(3,000 BC.) I’d very much like to know the identity of the specific Chinese
medical and/or literary sources upon which you base your beliefs and claims.”
My question still stands: what sources from the Chinese historical record
allow you to make such claims? The fact is, you have no idea what TCM
really had to say about these things “5,000 years ago,” because there are
no surviving Chinese medical texts that even come close to being 5,000
years old. Therefore your claims are based on nothing more than your
imagination and your fervent “belief” that the tenets of 20th century TCM
are “thousands and thousands of years old” (and, therefore, somehow
“venerable” rather than merely obsolete).
You then proceed to regale us with the “evolutionary theory” for the
development of the "Theory of Ching Luo" or Channels and collaterals that
holds that the Chinese "started in some way using hands, then stones (BIAN
stone), then graduated to bamboo, then porcelain, and finally metals
through the ages to stimulate acupoints.”
I’t seems you haven’t “done your homework” in this regard. (Can you imagine
performing “acupuncture” with sharpened stones (bian) – ouch! -- or with
“porcelain” needles? -- snap!) If you’re interested in learning what
contemporary Sinologists and historians of medicine (as distinct from
acupuncturists and TCM advocates) actually believe regarding the probable
uses of "bian" and the development of acupuncture, I suggest you find a
copy of: The Origins of Acupuncture, Moxibustion, and Decoction, by YAMADA
Keiji, Nichibunken Monograph Series No. 1, International Research Center
for Japanese Studies, Kyoto, Japan, 1998. Various books by Sinologist and
historian of medicine Paul Unschuld cast the issue in an even more
conservative light.
You tell us “The Taoist theory I am familiar with is that 10,000 years ago
the Chinese were visited by a group of Caucasians they called 'The Son's Of
the Reflected light' who taught them physics, mathematics, astronomy,
peaceful living, and bio-electric body therapy.” My immediate response is:
“What a charming story. Why in the world would you assume it’s true?” What
textual material or objective evidence exists to support it? You’ve
provided yet another prime example of precisely the sort of “imaginary
historical TCM reference” to which I alluded earlier. (One wonders how
much anyone, including "Europeans," knew about mathematics and physics,
much less "bio-electricity," during the Mesolithic period [10,000 to 3,000
BC].)
Please keep in mind that Scientologists advance similarly evidence-free
“theories” about super-beings having populated Earth several tens to
thousands of years ago. Likewise, followers of “Chariots of the Gods”
advocate Eric von Daniken advance similar “visiting space alien theories.”
19th century “Atlantis” advocate Ignatius Donally, and his various
supporters, advanced similar beliefs, and so do any number of other
“lunatic fringe” groups. Of course, advocates of science, reason, and
historical scholarship respond as they must: with the question “where is
the hard, objective evidence?” The answer always seems to be: There is none.
Your musings regarding “enlightened beings” visiting South America and
“teaching advanced subjects which led to rapid evolutionary development”
provide yet another embarrassing illustration of the utterly credulous and
entirely “evidence-free” basis for some "pop" historical and medical
beliefs.
You tell us: “anthropologists are still trying to explain Col. James
Churchward in his books on the legendary civilisation of MU taken from
ancient tablets discovered in Hindu temples late last century [which tell]
of an advanced civilisation which was destroyed by a cataclysm probably
involving flood. His story fits the various cultures and the period of the
'flood' is within the last 12,000 years. Prior to that he states that the
MU civilisation lasted about 100,000 years. Their teachings have a great
similarity to TCM philosophy and cosmology…” Do they? Can you provide for
us transcriptions from, or a literal translations of, any of these magical
“Hindu tablets”? Of course, even if such accounts exist, we know they
can't be "first person accounts" of events taking place 12,000 years ago,
because writing, itself, is less than 6,000 years old. "Can you name a
single “anthropologist” who states they are “still trying to explain” any
of this evidence-free rubbish? Can you provide a single scrap of
documentary evidence substantiating either the existence of “MU” or the
presence of any civilization on “MU” dating to ANY epoch, much less dating
to “100,000 years ago”? I don’t think you can do any of these things.
Finally, you tell us “5,000 years may have been too conservative [a
figure]” (without having provided a single tangible, verifiable reference
to support your far-fetched beliefs regarding medical practice in Neolithic
China.) Then you ask me “Are you convinced yet, or is Skeptic [sic] an
incurable trait?” My answer is that “healthy skepticism is an inherent and
essential part of a ‘scientific world-view,’ so, yes, I suppose it's an
“incurable trait” – at least among those who chose not to be gullible
and/or those who value a scientific perspective on reality. Of course,
those who’ve emotionally, financially and professionally “committed”
themselves to the provision of various unproven and highly unlikely medical
“therapies” without waiting for “hard supportive evidence” need not fret
over the matter, since they're obviously not afflicted with this "incurable
trait.”
Rapid Response:
Re: Clarifications
I’m a bit disappointed that when I ask you to explain your straight-forward
claim that as little as 1% of standard medicine is evidence-based, you
respond with a veritable mountain irrelevant conjecture that fails to even
address the question. Instead of showing us the hard data and meticulous
analysis that would be required to prove your point, you offer a pointless
mish-mash including platitudes and homilies about statistics being “damn
lies,” “skeptics asking God for an ID card,” and various irrelevancies such
as “Only 40% of GPs know of [the] Cochrane database, and few use it, only
20% have surgery access to bibliographic databases…” and so on ad nauseam.
So what?! Do you suppose it's possible that some GPs may have learned
something about science- and evidence-based medicine from a source other
than the Cochrane database?… such as their science-based medical training?
In order to come up with your imaginary 1-20% figure, you’ve had to resort
to an absurd definition of “evidence-based interventions” as “only those
administered by physicians who are familiar with the Cochrane database
and/or the tenets of EBM.” Is it reasonable to assume that, if a GP who has
never heard of the Cochrane database prescribes an antibiotic to treat a
susceptible bacterial infection, his/her “ignorance of the database”
somehow renders said treatment “non-evidence-based”? The issue at hand is
“how much of standard medicine is evidence-based”: not “how many GPs or MDs
have utilized the Cochrane database,” or “how many physicians have accessed
EB-checking facilities.” Your responses seem designed to obfuscate this
point.
You’ve offered us several prime examples of how alt advocates will go to
almost any lengths to mis-represent and distort the facts so that they
appear to cast scientific biomedicine in a “bad light.” They seem to feel
that maligning science and scientific biomedicine somehow bolsters the case
for acupuncture, homeopathy, and various other unproven and “evidence-free”
medical belief systems. This pathological process is somewhat akin to the
person who, when asked to prove that he’s smart, responds with a diatribe
accusing everyone else in the world of being stupid.
How many flaws, real or imaginary, will have to be “exposed” in standard
medicine in order to “validate” acupuncture, homeopathy, phrenology,
psychic surgery, chiropractic, or any other unproven therapeutic wannabes?
The only reason I can think of for one to doggedly believe in the “only 1
to 20% of standard medicine is evidence-based” fantasy is that they feel it
somehow bolsters the case for the various “0% evidence-based alternative”
therapies the alt med community is providing on a fee-for-service basis to
the public.
When you tell us that RCTs (Randomized Controlled Trials or CCTs –
Controlled Clinical Trials) have “never really been performed” because “the
theoretical requirements are unrealistic and unscientific,” what is your
point? Because no RCT is perfect, are you seriously suggesting that we
abandon this standard? In your view, we should abandon RCTs in favor of
what?
It’s not too difficult to imagine the “standards” some folks might prefer
as an alternative -- the same “ancientness,” “anecdotal,” “testimonial,”
“patient/practitioner satisfaction” standards that scientific biomedicine
has painfully and inexorably struggled to discard over the last several
centuries. Of course, there is a certain convoluted (if pathological) logic
to this position. If one is heavily invested -- financially, emotionally,
and professionally -- in the efficacy of unproven modalities, these
medieval standards are the ONLY ones that will justify the continued use of
such modalities in the 20th and 21st centuries. Therefore, in the
“tail-wag-the-dog” world of alternative medicine, these “standards” MUST be
fought for.
You tell us that prominent scientist and ethicist “Senator Edward Kennedy”
noted that IF only 10% of the data from on-going CCTs is defective the
problem is enormous." Of course, you seem to have overlooked the
all-important word “if.” You tell us: Dr. John Braithwaite, states that [in
view of] international bribery, corruption,... fraud in the testing of
drugs, [and] criminal negligence in the unsafe manufacture of drugs, the
pharmaceutical industry has a worse record of law breaking than any other
industry.” So, again, what is your point?
Does Kennedy go on to say that "controlled clinical trials are, thererore,
not worth conducting"? What does Braithwaite have to say about the
entirely unregulated manufacturers of “herbal medications,” or the
manufacturers of “homeopathic” remedies, or other “alternative” therapeutic
agents? (Answer: nothing.) Is your point that, since “bribery and
corruption” sometimes come into play in the application of scientific
biomedicine, that the tenets of science and scientific biomed are somehow
invalid? Sometimes potent antibiotics are ineffective in the face of
resistant bacterial infection. Does it follow that we should abandon
antibiotics in favor of “homeopathic water therapy” or “cow dung
poultices”? I don’t think so. It seems that the very best argument some alt
advocates can advance in support of the various unproven therapies they’re
selling the public is that “scientific biomedicine is fraught with
deficiencies.”
You are mistaken with regard to therapeutic phlebotomy and TCM. Therapeutic
phlebotomy has nothing whatever to do with the “leeches” or “ergot” you
mention. You tell us: “Yes the Chinese do still use 'pricking' as a form of
intervention, usually to lower BP, or temperature, or to reduce the effects
of shock.” The fact is that, in China, modern veterinary acupuncturists
advocate the letting of “a half-liter or more” of blood in the treatment of
some maladies.” I’d be happy to provide references if you wish. As
Kuriyama, Unschuld and other Sinologists and historians of medicine have
observed, two thousand years ago the Chinese, like the ancient Greeks
before them, often performed therapeutic phlebotomy, and in intriguingly
similar ways. The practice was eventually abandoned in human TCM, but it is
still very much a part of veterinary TCM as practiced in China.
You refer to “HealthWatch personality Dr. Neville Goodman, examiner for the
Royal College of Anaesthetists” and you immediately dismiss all his
straight-forward criticisms of homeopathy on the basis that “he doesn't
believe in it,” even though “RCTs supports it!” The hard fact is that the
highest quality RCTs and meta-analyses do NOT support homeopathy. I suspect
you know as well as I do that the highest quality (most tightly controlled,
adequately randomized, and statistically significant studies) show
precisely the opposite of what you suggest. See:
I also suspect you’re well-aware that, even when meta-analyses of extant
homeopathy trials are conducted by dyed-in-the-wool homeopathy advocates
such as Wayne Jonas, the authors are forced to concede that “we found
insufficient evidence from these studies that homeopathy is clearly
efficacious for any single clinical condition” See:
If, after 200 years of investigating homeopathy, that’s the case, why in
the world should we waste any more of our precious and limited time and/or
research funding on homeopathic “research”? How many more centuries of
investigation will we have to suffer through before we can reasonably say
“Enough is enough! We’ve examined homeopathy up and down and it obviously
doesn’t work”? And, more to the point, when will it become “medical fraud”
to persist in selling homeopathic therapies to a gullible but trusting
public?
You respond to one of my queries with the comment: “How can I refer to
5,000 years of 'acupuncture and moxibustion'? The simple answer is that I
didn't.” And my simple retort is, “I never asked the question to which
you've responded here." It seems you’ve gone out of your way to distort
both my words and your own prior comments in order to obscure the facts.”
Let’s take a quick look at what I actually said, and what you actually said
in your previous messages.
You claimed “'Inflammation of the liver'/'excessive bile production' …
retains the same symptomatology and possible differential diagnoses as it
did 5,000 years ago… the same emotions are involved … same acupoints
effective … similar modes of stimulation (needles, massage, herbs) - the
main change is how it may have developed in the patient; 5,000 years ago it
may be due to drinking excessive alcohol or a particular pathogen, nowadays
it may also be due to that, but may also be caused by our toxic
environment/food. 5,000 years ago it may have been treated with eg.
peppermint and nowadays may also be treated with that. 5,000 years ago
acupoints LIV2 or LIV3 would be effective, same today” And I responded “I’m
curious to know exactly what you believe “Chinese medicine" had to say
about “acupuncture, moxibustion” and various other things “5,000 years ago”
(3,000 BC.) I’d very much like to know the identity of the specific Chinese
medical and/or literary sources upon which you base your beliefs and claims.”
My question still stands: what sources from the Chinese historical record
allow you to make such claims? The fact is, you have no idea what TCM
really had to say about these things “5,000 years ago,” because there are
no surviving Chinese medical texts that even come close to being 5,000
years old. Therefore your claims are based on nothing more than your
imagination and your fervent “belief” that the tenets of 20th century TCM
are “thousands and thousands of years old” (and, therefore, somehow
“venerable” rather than merely obsolete).
You then proceed to regale us with the “evolutionary theory” for the
development of the "Theory of Ching Luo" or Channels and collaterals that
holds that the Chinese "started in some way using hands, then stones (BIAN
stone), then graduated to bamboo, then porcelain, and finally metals
through the ages to stimulate acupoints.”
I’t seems you haven’t “done your homework” in this regard. (Can you imagine
performing “acupuncture” with sharpened stones (bian) – ouch! -- or with
“porcelain” needles? -- snap!) If you’re interested in learning what
contemporary Sinologists and historians of medicine (as distinct from
acupuncturists and TCM advocates) actually believe regarding the probable
uses of "bian" and the development of acupuncture, I suggest you find a
copy of: The Origins of Acupuncture, Moxibustion, and Decoction, by YAMADA
Keiji, Nichibunken Monograph Series No. 1, International Research Center
for Japanese Studies, Kyoto, Japan, 1998. Various books by Sinologist and
historian of medicine Paul Unschuld cast the issue in an even more
conservative light.
You tell us “The Taoist theory I am familiar with is that 10,000 years ago
the Chinese were visited by a group of Caucasians they called 'The Son's Of
the Reflected light' who taught them physics, mathematics, astronomy,
peaceful living, and bio-electric body therapy.” My immediate response is:
“What a charming story. Why in the world would you assume it’s true?” What
textual material or objective evidence exists to support it? You’ve
provided yet another prime example of precisely the sort of “imaginary
historical TCM reference” to which I alluded earlier. (One wonders how
much anyone, including "Europeans," knew about mathematics and physics,
much less "bio-electricity," during the Mesolithic period [10,000 to 3,000
BC].)
Please keep in mind that Scientologists advance similarly evidence-free
“theories” about super-beings having populated Earth several tens to
thousands of years ago. Likewise, followers of “Chariots of the Gods”
advocate Eric von Daniken advance similar “visiting space alien theories.”
19th century “Atlantis” advocate Ignatius Donally, and his various
supporters, advanced similar beliefs, and so do any number of other
“lunatic fringe” groups. Of course, advocates of science, reason, and
historical scholarship respond as they must: with the question “where is
the hard, objective evidence?” The answer always seems to be: There is none.
Your musings regarding “enlightened beings” visiting South America and
“teaching advanced subjects which led to rapid evolutionary development”
provide yet another embarrassing illustration of the utterly credulous and
entirely “evidence-free” basis for some "pop" historical and medical
beliefs.
You tell us: “anthropologists are still trying to explain Col. James
Churchward in his books on the legendary civilisation of MU taken from
ancient tablets discovered in Hindu temples late last century [which tell]
of an advanced civilisation which was destroyed by a cataclysm probably
involving flood. His story fits the various cultures and the period of the
'flood' is within the last 12,000 years. Prior to that he states that the
MU civilisation lasted about 100,000 years. Their teachings have a great
similarity to TCM philosophy and cosmology…” Do they? Can you provide for
us transcriptions from, or a literal translations of, any of these magical
“Hindu tablets”? Of course, even if such accounts exist, we know they
can't be "first person accounts" of events taking place 12,000 years ago,
because writing, itself, is less than 6,000 years old. "Can you name a
single “anthropologist” who states they are “still trying to explain” any
of this evidence-free rubbish? Can you provide a single scrap of
documentary evidence substantiating either the existence of “MU” or the
presence of any civilization on “MU” dating to ANY epoch, much less dating
to “100,000 years ago”? I don’t think you can do any of these things.
Finally, you tell us “5,000 years may have been too conservative [a
figure]” (without having provided a single tangible, verifiable reference
to support your far-fetched beliefs regarding medical practice in Neolithic
China.) Then you ask me “Are you convinced yet, or is Skeptic [sic] an
incurable trait?” My answer is that “healthy skepticism is an inherent and
essential part of a ‘scientific world-view,’ so, yes, I suppose it's an
“incurable trait” – at least among those who chose not to be gullible
and/or those who value a scientific perspective on reality. Of course,
those who’ve emotionally, financially and professionally “committed”
themselves to the provision of various unproven and highly unlikely medical
“therapies” without waiting for “hard supportive evidence” need not fret
over the matter, since they're obviously not afflicted with this "incurable
trait.”
Kindest regards to all,
Robert Imrie, DVM
NCAHF (NCRHI) Task Force on Veterinary Pseudoscience
www.seanet.com/~vettf/
www.ncahf.org/
"The Entirely On-Line Alt Med Primer"
www.seanet.com/~vettf/Primer2.htm
Competing interests: No competing interests