reader comments: alternative health practices

22 Apr 1998
Last night I heard about a new alternative treatment (or, as I call it, voodoo) that sounds like something for the Dictionary (of which I've been a follower for months).

My sister-in-law has a bone marrow disease called ITP [Immune Thrombocytopenic Purpura is an autoimmune disorder]. She is also obsessed with being thin, even though she's a rail already. Her traditional doctor prescribed cortisone, I believe, [corticosteroids are part of the first line treatment of IPP] which would have the side effect of causing weight gain. Since that is not acceptable, she is going to an acupuncturist who has her using some wacky therapy at home three times a day. She takes some herbs which, I'm told, smell somewhat like pot, rolls them into a joint, lights it, but instead of smoking it, she -- get this -- points the lighted end at certain parts of her body. With a straight face, she says that pointing this stinky joint at her big toe (right or left is irrelevant) will directly affect her spleen. She also named other extremities that "rule" internal organs. The herb is called amoxi-something.

Sorry my details are sketchy but I had to walk away from her before I started screaming at her. Any of this ring a bell with you?
Please don't use my name if you publish.

reply: My source (David Ehrensperger, an aromatheraist--see next letter ) tells me that your sister-in-law is being treated with "moxibustion." My Webster's dictionary tells me that "moxa" is an escharotic (a caustic which produces scabbing or crusting when applied to a wound or burn). In Japan, mogusa (moxa) is made from the yomigi plant. Here, leaves from mugwort (Artemisia vulgaris) or the wormwood tree (Artemisia chinensis) are usually used, according to Jack Raso.  According to Mr. Ehrensperger, moxibustionists do touch the body with moxa, and do not, as you described, point the burning mass at various body parts. (Maybe your sister's "therapist" is practicing sympathetic magic.)

Moxibustion is often used in conjunction with acupuncture, another swell treatment for serious diseases. The chance that burning herbs will harm your sister-in-law are slim, but they are not likely to help her condition, either.

I was fascinated and refreshed by The Sceptic's Dictionary. My parents-in-law use only alternative medicine to treat their two young children who have muscular dystrophy, a concept which scares and angers me. I have been excluded from the family because of my lack of belief in these treatments which do not give any proof of their ability to heal. It was great to be able to read some published information to back up what I have always believed to be true.

Their latest cure is called 'Neuro-sceletal dynamics', which consists of touching pressure points on the back in order to send messages to the brain's map of the body, which will then restore the body to the condition in which it functions best. They also see another alternative therapist who claims to be able to control all of the body's functions through pressing the navel.

What I find fascinating about these alternative therapies is that they all contain just a pinch of medical or scientific fact which, to the uneducated, is enough to convince them of their validity. Alternative medicines uses phrases like "the body system" which sound sort-of medical or scientific but which is "fuzzy."

Anyway thanks for giving me some concrete information on a topic which I have always found really infuriating.

Kristin

reply: Many believers in "alternative" health care become so devoted to their various herbs and practices that the herbs and plants become like sacraments and the practices like rituals in a religion.

19 Nov 1997
You are completely correct when you say that it's like a religion. In fact my in-law's have replaced their religion with spiritual healers, which seems to go along with their belief in the alternative medicines.

What I find most annoying about the whole situation is that I am a professional in the disability service field and also have a strong medical background, so I can pick the differences between medical science and quackery. It is incredible frustrating to me to see two young children who are going to have a shortened lifespan anyway be denied the medical help that could at least help to make their time more comfortable.

I have come to the conclusion that this is their coping mechanism, and that they are desperately clinging to any glimmer or hope that they can find. Ultimately they are avoiding the issue but for now these beliefs are the 'band-aid' which is their temporary solution.
Kristin 

22 Jan 1997
How come there aren't more articles on the ill effects of traditional medicine?? I'm willing to bet that most people don't realize that a person dies every 8 minutes directly due to Medical physicians!

reply: It would have been nice if you had provided the source of this startling statistic.

Let's do a piece on "prozac" for instance......

reply: You might be happy to know that today's [Jan 23, 1997] newspaper has a story about Prozac: a new study has found no sign that taking Prozac during pregnancy can harm a woman's unborn child. Contact Dr. Gideon Koren of the University of Toronto for more information. Or read the latest issue of the New England Journal of Medicine, if you're truly interested. I imagine, however, you are referring to stories about people who kill while on Prozac. It is true that there have have reports in the mass media about the dangers of Prozac. However, there have also been reports in the mass media about the dangers of silicon breast implants. There is another side to these reports which rarely gets reported. For instance, the scientific studies done on the health of women with breast implants versus those without them does not support the claim that breast implants are a significant causal factor in female ill health. People have killed while on Prozac. People have killed while not on Prozac. Prozac is taken by over 12,000,000 people a year. The percentage who go berserk and kill is rather small, just as it is in the population which does not take Prozac. Plus, those who are given Prozac are sometimes severely disturbed before taking it. Those who go berserk may have done so had they not taken Prozac and visited their local chiropractor or naturopath instead. Would you blame chiropractic or naturopathy for the berserk behavior just because it occurred after a visit to a chiropractor or naturopath?

...or maybe about getting the wrong leg cut off during surgery,

reply: These types of malpractice are mentioned in the article on alternative medicine.

....or possibly the removal of tonsils ( the immune system's first line of defense).

reply: Your point, I take it, is that traditional medicine has frequently advocated procedures or practices which not only did not improve health but made matters worse. You are correct.

I mean come on let's show the tragedies that are caused daily, by MD's who could care less about the patient and more about the disease!!!
Doc6262@aol.com

reply: That seems like a job for someone of your disposition. Just remember, should you ever need brain or bypass surgery, or insulin for your diabetes, your doctor may not be a chiropractor or naturopath and may not look kindly upon your slanders. She may turn you into a self-fulfilling prophecy.

Here is another missive from Doc6262:

January 31, 1997, page 1 of the USA Today quotes sources at the U.S.
Center for Disease Control and Prevention stating "Nearly all cases of
polio since 1980 were caused by the oral polio vaccine".

The oral vaccine contains a weakened polio virus intended to stimulate
immunity without causing the disease.

reply: I suppose the good doctor takes this as further proof of medical murder. Actually, it demonstrates a rather common error many people make: statistics need a reference point or standard in order to understand their significance. How many cases of polio would there have been had the polio vaccine not been used? 

reply: The naturopath did not diagnose cancer. He diagnosed something benign and treated accordingly. Had he suspected cancer, he probably would have sent her to a traditional medical doctor. I have tried to explain this elsewhere, but here goes again. No doubt there are some naturopaths who are better healers than some M.D.s. But, naturopaths should not be compared to medical doctors when the issue is naturopathy vs. medical science. Naturopathy is based upon a questionable assumption: that healing should be by a "natural" process. Medical science is based upon the same assumptions all the sciences are based upon. To prefer naturopathy to medical science is to prefer quackery to science. I never claim that quackery can't sometimes have good results. Nor do I claim that science is infallible. To expect me to be as skeptical of medical science as I am of naturopathy, homeopathy, traditional Chinese medicine, therapeutic touch, aromatherapy, etc., is unreasonable. I am not skeptical of these alternative health practices because they are fallible, but because they are based upon false or questionable assumptions and generally do not follow scientific methods to establish beliefs. It does not follow from my criticism of alternative health practices that I think traditional medicine is flawless. I do not criticize alternative health practices because their practitioners err or misdiagnose. I criticize them because I believe they are fundamentally unsound. It does not follow that I believe traditional medicine is infallible. I would criticize traditional medicine if it were fundamentally flawed, i.e., if it were based upon false or questionable assumptions. Now, there may be specific procedures which most medical doctors follow or recommend which turn out to be harmful or useless. Nevertheless, I would not reject all medicine because of errors by medical doctors. It would be foolish to reject science because of errors by scientists. It is also foolish to accept alternative medicine because it "works." Yielding results you are satisfied with is not what is meant by "works" in science. Placebos "work." Cures of misdiagnoses "work." Like you say, the only fair way to test the validity of "scientific" medicine is with double blind studies. That's how we find out what "works" in science.

While I truly appreciate the skeptic's philosophy, it would seem that it may be more of a bias against "traditional" healing practices in favor of the "modern" university approach. Yet many of our prescription drugs are discovered by investigating the "traditional" folk remedies.

reply: Yes, and many folk remedies don't really work and science is a process of testing what does and doesn't work. Traditional medicine is not opposed to folk medicine, but it does not assume that the folk remedies are necessarily correct. If by "modern university approach" you mean the approach of science, of tentatively accepting claims and testing hypotheses, then by all means that is the approach of the skeptic.

The protective sanction of 'bad' medicine by the university/medical "profession" is the major force driving the alternative medicine market. The outrageous prices of the "services" offered by M.D.'s, the pharmaceutical industry, and killing zones referred to as hospitals are the real problem. This inhuman "slaughter house" industry is regulated/driven by the profits of the insurance industry; not scientific medicine.
john pash 

reply: I'm sure you can back up these claims with evidence. I'm also sure that when you need a liver transplant you won't check into a hospital nor will you take insulin if you develop diabetes. Anyway, I recently received a letter from a man worried about his 97 year old grandfather who was shelling out $5,000 for chelation therapy. Does that sound reasonable to you? I think you should not overlook in your inventory of horrors the fact that traditional medicine cannot cure everybody's illnesses, much less even diagnose what is ailing many people. Those are reasons many seek alternatives. Science has no answers for them and they are understandably desperate and vulnerable. 

My name is Craig Nelson. I'm a chiropractor and a clinical researcher and I teach a class in critical thinking to chiropractic students. Really. You may have stumbled across my name in some of Drs. Barrett's and Jarvis's writings on alternative health care and chiropractic. My criticisms of chiropractic are often quoted by those in the skeptic community to support their points of view. This background info is intended to demonstrate that I am a dues-paying skeptic. (I'll heed your admonition about unsolicited manuscripts, but if you'd like to read some of my essays I'd be happy to send them to you.)

Your site is superb. It has been a regular stop of mine since I found it. Your entries on alternative health care and chiropractic are informative, accurate, and balanced. I regularly recommend your site to my students.

However (naturally, there's a "however"), I think it is incomplete and incomplete in a way that betrays a common misconception about the nature of science, health care, and medicine. This misconception seems to be shared by most skeptical observers of health care. One of your correspondents asks why you don't have entries on chemotherapy and radical mastectomy in your dictionary and why you only discuss alternative health care. Your reply is that, "I discuss only alternative medicine because of its general pseudoscientific or unscientific approach. Alternative medicine is generally based upon untested claims and is mainly appealing to desperate people." While you do discuss the imperfections of medicine your reply implies that medicine does not suffer from these shortcomings. This requires some examination.

One of the characteristics of most alternative health care systems is that they are predicated on some loony metaphysical or pseudoscientific principles, as you suggest. And medicine is not predicated on such principles, not an unimportant distinction. However, this distinction does not immunize medicine from the possibility of being fundamentally flawed.

Over the last decade or so there has been something of a revolution in the medical/scientific community that has concluded that medicine is deeply flawed. (I hasten to note that what I am describing originates within medicine, to its credit, and is not the product of the musings of Deepak Chopra and others.) This revolution is described, variously as "Outcomes-Based Medicine," or "Evidence-Based Medicine." The first article in the bibliography from JAMA is a good primer in the principles of this movement. That article comes to the following conclusions:

1. Medical education and the practice of medicine have been, and are currently, based primarily on tradition, common sense, uncontrolled observations, and the wisdom of elders. These are all unreliable predictors of patient outcomes.

But the item I want to address most is the one which refers to "uncontrolled observations." I have heard this criticism from other chiropractors and it has generally been based upon a profound lack of understanding about the nature of control studies and post hoc reasoning. This may not be true in your case, but I believe the misunderstanding is widespread among your colleagues and is worth commenting on.

Let me start with a non-medical example. If I have a bag of coffee beans before me and a coffee bean grinder and I want a cup of coffee, I will grind the beans. I have done this for years. I know it works. I do not have to put whole beans into the filter and pour water over them to know that I will not get the cup of coffee I desire. I do not have to do a control experiment to prove that grinding the beans is a necessary condition for making a proper cup of coffee. I don't need to make two pots of coffee, one with ground beans and one with unground beans, nor do I need to do this many times to prove I can repeat the experiment with the same results. Control experiments are only needed when there is good reason to doubt the causal relationship of two factors. It is not necessary to do a control experiment to establish reasonable belief about a causal relationship in those cases where background experience and knowledge provide sufficient evidence for the belief. The experience and knowledge can, and often are, analogical. That is, even the first time I wanted to make a cup of coffee from beans, I could have reasoned by analogy that I would have to grind the beans in order to make the coffee. I also could have been taught by another person who showed me how to make coffee by grinding the beans. Again, I would have had enough knowledge and experience to recognize that grinding the beans is necessary; there would have been no reasonable requirement to do a control experiment before making coffee on my own.

Now, let's switch to a medical example. Let's take a medical procedure understood by almost everyone: the setting of broken bones. Some chiropractors would say that this is an example where medical doctors have not done controlled experiments, so how dare they criticize "alternative" practitioners for handing out remedies and doing therapies that are untested! Medical doctors do the same thing! Non-sense. There is no significant comparison between giving someone a back manipulation to cure an ear infection and setting a broken bone. The fact that neither procedure has gone through clinical trials is a trivial fact in the argument that medical doctors use "uncontrolled observations." The knowledge and experience which leads physicians to set broken bones is vast and supportive; the knowledge and experience which should lead anyone to think that spinal manipulation would cure an ear infection is slim and counter-intuitive. Some procedures need testing; others do not. One does not need a lot of wisdom to tell the difference, but one does need to have some skill at critical thinking.

2. There is a belief that a deep understanding of basic physiologic and pathophysiologic principles will lead invariably to effective interventions even in the absence of direct evidence of patient benefit. This also turns out to be a very unreliable predictor of patient benefits.

Other principles of evidence-based medicine can be summarized as follows:

1. The clinical effectiveness, (i.e., the extent to which patients actually benefit) of most (>50%) medical procedures, both diagnostic and therapeutic, is unknown. (Some estimates of the percentage of medical procedures with known effects are as low as 15%.)

reply: This claim is false. Where do you think those statistics about your chances of recovery from, say, breast cancer through surgery and chemotherapy come from? If you mean, that no one has done a study to show that it is better to set a broken arm than to let it be, then the statistic you quote is of little importance. I've heard similar complaints from chelation therapists who compare chelation therapy for blood circulation and heart problems with bypass surgery and angioplasty. Where are the control studies of people who are given bypass surgery or angioplasty compared with a control group? To ask the question indicates a profound ignorance or conscious attempt to deceive the public. To pretend to do bypass surgery or angioplasty so that you can compare the poor dupes given the fake medical procedure with those given the real procedure would not serve medical science or knowledge. Comparing patients who have surgery with those who do not is not completely unreasonable, but it is not completely reliable, either, since individual patients will have their individual differences. Nevertheless, when a surgeon tells a family member that if a particular operation is not done, the likely outcome is "a", "b" or "c", that surgeon is not just guessing (unless he or she is a fool, and medicine has its fools, as every profession has). This does not mean that surgeons are infallible, nor does it mean that they have not, from time to time in their history, performed a number of unnecessary surgeries. Nor does it mean that even when a practice is based on sound theory, that the practice is necessary or even good. The answer to these errors is to correct them. It does not follow from the fact that surgeons have in the past advocated unnecessary surgery that all surgery should be stopped, or that we should not allow those surgeries which are based only on sound theory, experiments on animals and apparent clinical successes with many satisfied customers.

On the other hand, chemotherapies should be, and are, clinically tested, not on humans (except in desperate circumstances) but on other animals. Chelation is more like chemotherapy than surgery. Chelation seems to be based on unsound theory, but it is testable and should be tested, and has been tested, using control studies. When those studies pile up a preponderance of the evidence that the therapy is ineffective it should be dropped from the list of treatment procedures. Why do chelation therapists continue to sing the praises of a treatment which has exceedingly more evidence against it than for it?

3. Patients, and more importantly, practicing physicians, are generally unaware of principles 1&2;.

4. Medical training does not prepare practicing physicians to recognize sources of error in clinical decision making and does not prepare them to critically evaluate the scientific literature. (Physicians are not scientists. Indeed, they often tend toward the naive and credulous end of the spectrum. They tend to accept, uncritically, what is told to them or what they read.)

5. The clinical studies upon which many treatment standards are based are often of such poor quality that those standards have very little validity.

reply: Perhaps one or two physicians might read your comments and respond. You are incorrect in your expectations, however: I do take your assertions "at face value." On their face, they are preposterous and incredible.

So, in place of the chiropractic's Innate Intelligence, acupuncture's meridians, and homeopathy's magic water, medicine has been based on an unscientific principle which, although un-stated, is in force. That principle could be expressed as:

"If a procedure has been used for a long time, and if that procedure seems to make sense, and if that procedure is favored by old doctors who teach young doctors, and if that procedure does not directly violate known biological principles, then it can be assumed that that procedure benefits patients even when there is no direct evidence of such benefit."

You have characterized alternative care as untested and unscientific. Those adjectives are also accurate with regard to medicine.

reply: and you, sir, have created a straw man with your characterization of medical science and practice. Do you really think any profession could so dupe the entire world that for years it could use procedures on people "when there is no direct evidence of [patient] benefit"? I wouldn't even make such a claim about your profession or even about religion. I think, however, I have examined your claims above and have no more to say of them except to repeat that they seem to be based on a profound lack of understanding of the purpose and nature of control studies.

Back to the original question--why not subject medicine to the same type of scrutiny as alternative care? If your answer is that medicine is not afflicted with any systematic or pervasive shortcomings that threaten the health or pocketbooks of patients, and that such scrutiny is wasted, you are mistaken. Indeed, I think if one framed the question as follows--Under what circumstance and with regard to what sort of health care will a skeptical and critical perspective yield the greatest advantages in terms of preventing harm or economic loss?--the answer is under the circumstance of being a patient in the mainstream health care system.

reply: medicine suffers from the same shortcomings of all human forms of knowledge; it is fallible. It also is correctable. This cannot be said of those systems of thought which are fundamentally metaphysical in nature. In those systems of thought, the basic claims are untestable and can therefore never be proven incorrect. Hence, once they get established they tend to become dogmatically adhered to and never change. The only way to change dogma is to become a heretic and set up your own counter-dogma.

Much was made of Eiseneberg's finding in the New England Journal that $13.7 billion is spent annually on alternative health care--a lot of money to spend and waste on New Age bunk. But if that is a lot of money to waste, what of the over $1 trillion that is spent annually on conventional health care? If the above principles are even partially true it suggests that a very large percentage of that trillion is wasted. How much? Who knows, but a sum that will certainly dwarf the 13.7 billion spent on alternative care.

reply: If your claims are even partially true (whatever that means), it may suggest to you that "a very large percentage" is wasted, but to me it does not suggest any such thing. I am willing to grant that a great deal of money is wasted on medical procedures, including unnecessary diagnostic tests, duplicate and fraudulent billings by immoral physicians, and extraordinary measures taken to preserve the bodies of brain dead humans, etc. I have no idea what percentage of the total bill this amount to. Are there immoral and unethical medical doctors? Yes. What does this prove? Not that immorality is endemic to the medical profession, but that medical science is a human science, and anything humans are capable of, so are physicians. This is not a scoop.

A final thought. I think that the reason that skeptics have failed (and I think it is a failure) to properly address the issue of skepticism and health care is that they have confused the problem of scientific illiteracy and the problem of ineffective and unsafe health care. The appeal of mystical and nonsensical approaches to health, as is typical of alternative care, is certainly troubling evidence of scientific illiteracy, and it is a legitimate undertaking to oppose those practices. But while these alternative practices are more obviously and overtly unscientific, it turns out that the more subtle scientific shortcomings of medicine have a far greater impact on the public's health and well being.

reply: Obviously, you have not persuaded me of these "subtle scientific shortcomings."

In your reply to the gentleman who asked the question about chemotherapy and mastectomies, you stated that wearing a pyramid hat and chemotherapy are not in the same class. Indeed, they are not. At least in some cases of chemotherapy or other types of conventional cancer treatment, the pyramid hat is to be preferred. If I am someday afflicted with prostate cancer and I treat that cancer with a pyramid hat, I will look stupid and my cancer will be unaffected. If, on the other hand, I treat that cancer conventionally with surgery, radiation, and chemotherapy, it is highly probable that the cancer will be unaffected, and I will be impotent and incontinent. But I won't look stupid.

reply: that is a matter of opinion.

There is obviously much more to be said on this topic, and if you are interested I would very much like to hear your thoughts.
Craig F. Nelson, D.C.

BIBLIOGRAPHY (provided by Craig F. Nelson, D.C.)

Evidence-Based Medicine Working Group.  Evidence-Based Medicine: A
New
Approach to Teaching and the Practice of Medicine. 
JAMA;1992:2420-2425.
McCormick J.  Health Promotion: the ethical dimension.  The Lancet.
1994;
390-391.
Fitzgerald F.  The tyranny of health.  NEJM.  1994; 196-198.
Becker M.  The tyranny of health promotion.   1986; Public Health
Reviews.
15-23.
Relman A.  Assessment and Accountability: The Third Revolution in
Medical Care.
NEng J Med:1988;1220-1222.
Smith R.  Where is the Wisdom? The Poverty of Medical Evidence.  BMJ. 

1991:798-799.
Schoenbaum S.  Toward Fewer Procedures and Better Outcomes.  JAMA.  
1993:794-796.

I'm torn between responding in the polite and respectful tone of my original letter or in a tone more in keeping with your smug, sarcastic, and self-satisfied reply. We'll see. I may oscillate back and forth.

You make several references to my lack of understanding of "control studies." (The term is actually "controlled studies," but never mind). Sir, I am a clinical scientist, you are not. Your profound ignorance of this science is evident in every paragraph of your reply. Or am I wrong? Perhaps you do know the meaning and relevance of terms like confidence interval, p-value, correlation coefficient, cohort study, prospective clinical series, Cronbach's alpha, type I error, type II error, Bonferroni correction, and cross sectional study. If you are not familiar with these concepts you should correct that deficiency or refrain from offering your uninformed opinions on the scientific merits or shortcomings of medicine. You are not competent to do so.

Reply: Apparently, there has been a grave misunderstanding. I didn't know we were debating the merits of particular clinical studies. I thought we were discussing a philosophical issue: the nature of science and its relationship to "alternative" and "standard" medicine.

You completely misinterpreted the overall theme of my letter, which theme is blindingly clear to anyone who can for an instant transcend the inertia of their own biases. I did not at any point defend any alternative health care practice (except facetiously in the case of a pyramid hat for prostate cancer) on basis that because medicine is flawed it's OK for alternative practices to be untested and unscientific. My point was that most alternative practices are bunk and that medicine is also deeply flawed. Get it straight.

Reply: I'm glad we got that straight. Or have we? When you say "medicine is also deeply flawed" I take you to mean much more than that medicine is fallible, uses questionable procedures at times, that some doctors experiment on their patients using untested or discredited procedures, that many medical procedures are approved by some physicians but discredited or rejected by others, etc. I take you to mean that "standard" medicine shares some kind of fundamental flaw with "alternative" medicine, such as the requirement for the patient to share the practitioner's metaphysical beliefs for the cure to work; or the idea that a single type of treatment is a panacea and can cure many, completely unrelated types of disorders; or that insight and intuition are preferable to scientific testing of therapies and procedures. I didn't realize that you and I are in complete agreement about one aspect of scientific medicine: it is a fallible, human activity, and as such makes many errors. However, I see scientific medicine as essentially able to correct its errors. I don't attack and criticize "alternative" therapies because they are fallible or incorrect, but because they are essentially incapable of correcting errors. This is often due to the fact that such therapies are based upon metaphysical assumptions which cannot be tested. It is also often due to the dogmatic refusal of proponents of "alternative" therapies to give up their ideas in the face of overwhelming evidence to the contrary of what they believe.

In traditional medicine, I do not see perfection, but I see errors being admitted and attempts to correct them as part of the fundamental nature of the enterprise. I don't see the attempt to improve and weed out error, or the frequent admission of error, as being fundamental to "alternative" therapies. As just stated, such therapies tend to be pseudoscientific on one of two counts: either they are profoundly metaphysical or they dogmatically refuse to accept empirical evidence which falsifies their claims.

The untested/discredited procedures to which I refer are not the setting of broken bones, but the use of medication to treat hypertension, high cholesterol, or migraine headaches; the use of MRI to diagnose back pain and headaches; the use of fetal monitoring during labor; the use of antibiotics to treat otitis media, the use an annual physical exam to screen for disease, the use of anti-arrhythmia drugs following heart attacks, the use of various cancer screening tests, and of countless other procedures. If all this is news to you this is a function of your own ignorance and not of my misunderstanding. (Just curious. Have you ever actually read a clinical study?) And don't give me the line that all these things are approved by the FDA and must therefore by valid. It is infinitely more complex than that, but to understand the complexities you would again have to know something about clinical science.

Reply: Each of the procedures you list, and the way in which scientific medicine deals with them, will illustrate my point: there will be disagreement and controversy, error and argument, testing and more testing, etc. Decisions will be made by fallible human beings engaging in the fallible practice of scientific medicine. Some of those decisions will be bad decisions, but in time they will be discovered for what they are and treatments which were once standard will be rejected and replaced with other treatments. Medicine will grow, it will progress, it will change dramatically. Homeopathy, iridology, reflexology, aromatherapy, therapeutic touch, etc., will not change in any fundamental ways over the years. This is not a scientific issue, requiring mastery of scientific jargon to comprehend. This is a philosophical issue.

You seem to be suggesting that I should be criticizing these "untested/discredited" procedures, yet you also make it clear that you think I would need your kind of training in clinical science to be able to intelligently evaluate these procedures or any studies regarding them. So, it seems there is no way I could please you. I am not fair because I do not criticize the studies and procedures of scientific medicine but I am not competent to evaluate them, either.

I particularly enjoyed your objection that the JAMA article could not really say what I said it did because AMA members would have really been outraged. Now there's a logical gem! I won't make any further effort to explain these issues to you. If want to understand them you must actually make an effort and read these papers. You'll find them in the library--that's the big building with all the books and journals. It does not take great intellectual courage or skill to take a stand against healing crystals or psychic channelers. I'll bet you've come out firmly against the Easter Bunny as well. But if you want to engage a problem that is more interesting, important, nuanced, and requires more subtle and sophisticated reasoning skills to understand, you might consider the issues I have raised.

Reply: Actually, what I wrote was "I would guess that such a claim in one of the profession's most prestigious journals would have been met with an uproar of disapproval by the association's members." Using the straw man seems to be a favorite tactic of yours. You need to work on your ad hominem attacks, though. It is not to your advantage to make your opponent seem too pathetic. What glory can there be in winning a battle of wits with an opponent you declare to be unarmed?