Pseudoscience is common among elite athletes outside of the Olympics too…and it makes me furious.

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The many stories yesterday featuring Olympians appearing with cupping marks on their skin have brought renewed attention to pseudoscience in sports. Cupping, which involves putting a hot jar onto the skin, forming a suction that “draws out” toxins or unblocks energy meridians or something like that, might seem like a relatively benign form of pseudoscience, but it can be quite harmful.  Orac has a great post (complete with a gruesome photo) describing the harms of this particular practice:

Cupping is nothing more than an ancient medical practice based on a prescientific understanding of the body and disease, much like bloodletting and treatments based on the four humors. As the case of Lin Lin shows, it’s all risk for no benefit. It has no place in modern medicine, or at least shouldn’t.

I’m completely unsurprised to find that pseudoscience is common among the elite athletes competing in the Olympics. I’ve seen similar things rampant in the combat sports world as well.

Over the course of my martial arts career, I’ve had the opportunity to train with many extraordinary MMA fighters. What I observed in these elite professional fighters–most of them either competing in the UFC, or well on their way to it–was a razor-sharp focus on doing whatever it took to improve. This meant grueling eight hour training days, and equally grueling recovery practices to allow them to sustain that level of activity. The recovery practices included ice baths, contrast showers, yoga, expensive massages and bodywork, and a whole host of alternative medical treatments including acupuncture, energy work, and dubious supplements. And behind nearly every fighter, there’s usually at least one chiropractor lurking around in background.

[My interactions with these MMA chiropractors are so similar that they almost follow a script.  He (and it’s always a he) invariably introduces himself as “Dr. First Name”, even in casual social situations, and tries to impress his listeners by boasting about how many important clients he has.]

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This story gets at the psychological aspects of why elite athletes pursue useless–and sometimes even harmful–alternative practices. What I’ve observed among fighters is this exact mentality.   Magical thinking has long been endemic to martial arts, and there are few voices in the community who challenge these ideas, particularly when they’re promoted by influential teachers and coaches. Competitive martial artists, like MMA fighters, are so determined to do anything it takes to give themselves the extra edge that they are especially likely to listen to anyone who promises them a benefit to training, to recovery, to mental conditioning.  Another important motivation is the money that fighters can make through sponserships from alt med practitioners and supplement manufacturers. These athletes make so little money from fight contracts that they can’t afford to turn down any source of additional revenue.  This makes them vulnerable to all kinds of practices that are ‘desperately implausible’ , as the formidable enemy of pseudoscience David Colquhoun characterizes them.

If I sound angry here, it’s because I am. I see these quacks taking large fees from vulnerable fighters who can’t afford them…. but are convinced that they can’t afford not to pursue any possible advantage.  I’ve seen creepy alt med sponsors lurking around events and attaching themselves to athletes as if they were coaches. I’ve seen more than one person in the MMA world injured by pseudoscientific ‘treatments’, and more than one athletic career ruined by supplements.  This exploitation makes me furious.

I hope that as more attention is focused on pseudoscience in the Olympics, more attention will also be paid to these issues in MMA, and the work of people who are trying to push back against the BS in the community, like  Rosi Sexton, and Jeff Westfall.

57 thoughts on “Pseudoscience is common among elite athletes outside of the Olympics too…and it makes me furious.

  1. Anonymous August 9, 2016 / 10:54 am

    Real scientists examine the evidence dispassionately. The evidence before you is that a large number of people whose careers depend on being the best at what they do find a benefit from cupping, a technique popular for millenia and part of the cultural inheritance of cultures spreading all the way from eastern Europe to Korea.

    Just because no one’s bothered to study cupping … and because the mechanism of its action may elude your understanding … does not mean it’s pseudoscience.

    The real pseudoscience is engaged in by those who elevate RCT trials to the “gold standard” of medical evidence in the face of widespread and growing critiques of that model in scientific circles and journals … and who conflate the absence of evidence with evidence of absence (while excluding the kind of evidence any competent CSI investigator would find intriguing.)

    When the fundamental premises of a system of thought are held to be beyond critique … when new evidence is dismissed out-of-hand instead of sparking curiosity … you are no longer engaged in science.

    You are subscribing to a fundamentalist religion.

      • Ignaz Semmelweis August 10, 2016 / 6:10 pm

        .. and exactly why does that matter? This is where you lose respect … and it’s fascinating that that’s your first reply.

        The fact that I’m not in “the club” to which you belong has absolutely no bearing on the validity of the points I’m making.

        Going for the ad hominem … this is why more and more folks are going for alternatives. They work. And your group think blinds you. It’s a move that’s transparently bogus to everyone outside your club.

        • notnearlyanonymous August 11, 2016 / 1:03 am

          Ignatz,
          Whan ENNIFER RAFF
          (August 9, 2016 / 11:15 am)
          asked Anonymous, “Which modality(ies) do you practice?”
          You asked “exactly why does that matter?

          The answer, of course, is that Anonymous IS a practitioner of such pseudoscience treatments (what label would you like for treatments pretending to be science-based but are not?) and so not at all a “dispassionate” scientist.
          The answer is, Anonymous is one of the very charlatans (oh, there’s the other label!) engaged in taking money from people, possibly doing harm, definitely encouraging clients to forego actual treatments by simply offering techniques that the providers (should) know are simply silliness.

          But, if you have evidence these treatments are equally or more useful than science-based treatments, please do bring it out.

          Certainly a “dispassionate scientist” could easily be swayed by the better evidence even faster than a passionate one like Dr Raff.

          • Ignaz Semmelweis August 11, 2016 / 1:29 am

            Please see my reply to Zolton, below.

    • Jennifer Raff August 9, 2016 / 11:41 am

      Oh wait, never mind. I see from your website that you practice energy healing, acupuncture, and homeopathy. I wouldn’t say that you’re a ‘dispassionate’ examiner of the evidence, given that you have strong financial stakes in the field of alt med.

      What evidence would disprove the efficacy of your treatments?

    • Colin August 9, 2016 / 7:55 pm

      Just because no one’s bothered to study cupping … and because the mechanism of its action may elude your understanding … does not mean it’s pseudoscience.

      ….

      When the fundamental premises of a system of thought are held to be beyond critique … when new evidence is dismissed out-of-hand instead of sparking curiosity … you are no longer engaged in science.

      On the one hand, it’s beyond criticism even though no one’s bothered to study it and the mechanism for action is unknown. On the other, it’s wrong to hold an idea as being beyond critique. Glory to the complex human mind that can hold these two ideas simultaneously, without shame or hesitation.

      • Anonymous August 9, 2016 / 11:07 pm

        Feel free to critique cupping if you feel like addressing the technique itself … but when labels like pseudoscience start getting thrown around … know you’re in the presence of fundamentalists, not scientists.

        • Colin August 10, 2016 / 10:40 am

          but when labels like pseudoscience start getting thrown around … know you’re in the presence of fundamentalists, not scientists.

          Sounds like an article of faith.

        • Randy Wright August 10, 2016 / 8:21 pm

          Actually, with your reply it looks to me like Colin and I are in the presence of a name caller who’s unaware that “process comments” (I wonder if our “psychologist” below will weigh in on that subject) are generally avoided in ordinary conversations and social intercourse. To indulge in a “process operation” of my own, I note you’ve conveniently omitted facts in your haste to offer a generalization.

          BTW, Colin and I have had–and will doubtless continue to have–strong differences in a number of areas, but the subject of junk science isn’t one that’s likely to foment an argument. I live in Utah where in addition to the dominant religion, network marketing aka multi-level marketing aka “pyramid schemes” abound, and new ones are created almost monthly. Their are lots of chiropractors as well. Junk science and hyperbolic claims abound in their sales pitches, but as a result, I’ve acquired a finely-tuned “manure sensor,” and I’m not afraid to bring it to the discussion.

          I’ll blame my “questionable manners” on my dysfunctional upbringing here (same reason I wound up in literature and the humanities; in that case it was to preserve my sanity even though my strongest aptitude was in science, a subject I enjoy writing about despite my “essentially layman” qualifications). I had a biology teacher who taught us “Bigfoot was Gospel,” and an advanced math teacher who loved to talk about UFO’s… I see from cable TV offerings these days there’s money to be made with both.

          The same is true with the malarkey I’m seeing offered; calling it pseudoscience is just being a bit more polite.

        • notnearlyanonymous August 11, 2016 / 1:09 am

          “ANONYMOUS
          August 9, 2016 / 11:07 pm
          Feel free to critique cupping if you feel like addressing the technique itself … but when labels like pseudoscience start getting thrown around … know you’re in the presence of fundamentalists, not scientists.”

          Anonymous, what label do you think best fits techniques pretending to use science but having nothing other than anecdotal evidence, and marketing via a naturalistic or “ancient knowledge” fallacy and the clients’ fear of missing out on something that might work?

          “Fraud” fits pretty well, don’t you think?
          If you’re unsure, just look up the word.

      • Ignaz Semmelweis August 11, 2016 / 1:27 am

        Exactly.

    • ZOLTON August 11, 2016 / 12:52 am

      Please explain what sort of evidence should be more convincing about what sort of medical treatments actually work than the randomized control trial and why you think that should be the case.

      • Ignaz Semmelweis August 11, 2016 / 1:23 am

        That’s a big question, guy.

        My own take … after a lifetime of healing various forms of pain (three years of which I spent in a world-class orthopaedic clinic healing some chronic pain cases that the USC faculty doc there couldn’t touch) is that it’s important to consider all forms of evidence, as well as their flaws, looking for a preponderance of evidence.

        I think it’s entirely appropriate for practitioners of toximolecular medicine (the kind that relies on artificial compounds not found naturally in the body or in nature) to validate their work with RCT trials. It’s appropriate because invented substances can be very dangerous, as we’ve seen. Statins. Vioxx. The list goes on and on, and as we’ve seen RCT trials are no guarantee of safety (largely because the cost is so immense that they typically don’t run for very long) but it seems to me that the current system, relying on RCT evaluation of these invented unnatural compounds is the best it appears we can do.

        There’s a movement growing in reaction to the leveling and regression to the mean inherent in the RCT model called “N of one” which acknowledges that each of us is an individual and that what works for one may not work for another as a function of genetics, epigenetics and environmental influences. But that movement is in its infancy.

        My own preference is for traditional forms of legacy medicine with track records much longer than the 50-60 years of RCT trial dominance in the west. A technique (like cupping) which has been found useful enough to be passed on for dozens of generations, and which is endemic to a large part of the world population (you’ll find people cupping from eastern europe all the way through asia to china, japan and korea) … its durability, persistence and spread suggests to me that it’s worth trying. The worst that can happen is someone winds up with black and blue marks which self-resolve in about ten days. I used to do a lot of cupping, and it really kicks when dealing with chronic muscle tension. I’m sure that’s why the world-class athletes use it (another form of evidence which the RCT fundamentalists will churlishly dismiss out of hand.)

        That durability is convincing evidence for me … as is direct experience.

        I also have issues (and I’m not at all alone here) with the very concept of placebo. See the more erudite expositions on that theme I’ve cited above for details.

        But I really, really have issues with pompous apologists for a intellectual system that is less than a century old having the hubris to think they’re in a position to judge systems of medicine that were well-established when Europeans were still wearing animal skins and cooking over open fires without even trying these methods themselves.

        That’s just arrogance and blindness. And when they start slinging around the ad hominems … well … as I’ve said already, scientists don’t act that way. Not the best ones anyway, the ones that respect the tradition of open inquiry, debate and critical thinking that gave birth to their school of thought.

        Fundamentalists who march in intellectual lockstep do. They’re apologists for a system of medicine which rules out of bounds any approach that doesn’t have the potential to empty the pockets of ordinary folks to enrich pharmaceutical firms and their enablers. It’s clear that this approach, intellectually, clinically and economically, has reached a point of diminishing returns.

        Which is only natural. Reductionist medical models have performed miracles. We don’t die of ordinary infections anymore. It’s very success has now brought us to a point where the medical challenges we have left to deal with (chronic disease) are, of course, the ones reductionist models have been unable to resolve.

        But it remains the case that any effective medical technique which is free, cheap and available to anyone with a flame and a thick-lipped cup … will never attract the funding necessary to prove anything about it at all.

        And that’s, really, what this is all about. Money. RCT fundamentalists have found a way to monopolize the field. Anything that doesn’t fit cleanly through their very expensive filter … is quackery as far as they’re concerned.

        Their anger shows the insecurity inherent in their position. Anger flows from fear.

        (just to be clear … pharmaceuticals have their place, especially for acute, life-threatening conditions. But they’re not better than the alternatives … particularly if the goal is to enhance performance or quality of life with respect to chronic conditions. There … pharmaceuticals fall short. Just go visit any assisted living center and talk to the people there, the ones who’ve been managed pharmaceutically long enough for the full poisoning effects of long-term pharmaceutical dependence to become manifest.)

        If … that is … you can wake them up long enough to get a response.

        • Randy Wright August 14, 2016 / 1:35 pm

          “Toximolecular medicine,” eh?

          We’re being offered a new buzzword, folks; I can’t find it in my Webster’s (or any online medical references, and Google balked as well). That one works well with “thought stopping talking points,” another favorite tactic that’s heavy on the hype and drama but largely devoid of facts.

          They borrowed the tactic from the global warming deniers, trying to use the euphemism “climate change” instead.

          Praise you-know-who and pass the paranoia.

  2. Ryan August 9, 2016 / 11:32 am

    This article gives me a strange feeling of embarrassment for the author. Undoubtedly the author of this article is a decade behind the current neuroscience as it relates to treatment, ‘placebo’, and best practices for musculoskeletal care. I would forgive the author if she would genuinely spend some time catching up with the science, but I suspect that may not happen. If interested however, she should spend some time with the work of Lorimer Moseley, Adriaan Louw, and perhaps even dive in to some articles on Frontiers Neuroscience journal. It’s outdated thinking like hers that should not continue to be perpetuated.

    • Colin August 9, 2016 / 8:01 pm

      I did a dive into the Frontiers family of journals, on your condescending advice. You do mean the family of pay-to-publish journals, yes? Whose publishers had to retract a paper all about the harmful effects of chemtrails? Whose publishers fired dozens of editors who “held up the review process in response to what they perceived as ‘company staff…interfering with editorial decisions and violating core principles of medical publishing’, which they claimed was done to maximize company profits, possibly at the expense of patient health”?

      Perhaps the best information about neuroscience comes from such a journal. Anything is possible.

      • Jennifer Raff August 9, 2016 / 8:04 pm

        Actually, my mother happens to be a neuroscientist so I do know a bit about the field’s journals. Frontiers (which indiscriminately solicits articles from me and just about every academic I know) isn’t high on the list of respected publishers, to put it mildly.

        • Ignaz Semmelweis August 11, 2016 / 1:37 am

          Still waiting for your response to the RCT critiques I cited earlier today drawing from front-line journals.

          I’m thinking I could be waiting a long time … because it appears you actually have no cogent response to the points those peer-reviewed pieces raise. You’re really fond of dissing the messenger, it’s so much less work to just be smug than dealing with articulate critiques.

          Which means I’ll be waiting even longer for you to address the broader issues of cultural imperialism raised by your position.

          Stay angry. It suits you.

          But do try to get in touch with the fear beneath your anger. It’ll make life easier for you. And once you’ve gotten in touch with that fear and processed it … you just might find your mind opening up a wee bit.

          I’m not going to hold my breath.

    • Jennifer Raff August 9, 2016 / 8:18 pm

      Ryan,
      Thanks, but don’t trouble yourself on my account. I’m not embarrassed by my article, and there’s no reason for you to be.

      • ryan August 10, 2016 / 4:18 pm

        Perhaps you two should have a scientific discussion on pain science. To catch you up, pain is an output of the brain. That is scientific fact. It is not created by peripheral damage or structural degeneration. It’s MUCH more complicated than that and the best we can say is that pain is a threat signal. Another FACT is that cupping is equally effective as orthopedic surgery for a torn meniscus (placebo effect). Not because cupping is some great treatment. For one person it may calm the threat signal, but for the next it may do nothing. The bottom line is that if the patient THINKS it worked it worked, bottom line. If you are still stuck in the era when we believed placebo was merely a subjective improvement of a patients symptoms you are wrong. The brain is in charge. The brain controls pain. Placebo effects are now KNOWN to produce actual physiological change including dopamine release in parkinsons patients equal to deep brain stimulators. Clinicians that are still stuck thinking that the answer lies in treating structure are quickly falling behind evidence based clinicians that realize structure means VERY little. The problem with American healthcare is we have evidence snobs that truly believe they are smarter than every one else when in reality they are still a decade behind. Please can we just do a better job.

        • gewisn August 11, 2016 / 1:18 am

          Wouldn’t it be nice to have medical treatments applied to your body be Better than placebo?
          How should we evaluate which ones provide that additional effect? By collecting anecdotes?

  3. Raucous Indignation August 9, 2016 / 12:26 pm

    Oh, look! Mealy mouthed, mushy thinkers railing against the Evil of modern science-based medicine and the RCT. I’m shocked to see them here, truly I am. With their grasp of “other ways of knowing,” it should be obvious to them that they would be challenged and maybe even mocked.

    • Anonymous August 9, 2016 / 12:40 pm

      By limiting the evidence you’re willing to consider to a thin slice of the available evidence … the slice that, btw, takes huge budgets to produce … you blind yourself.

      I love it when fundamentalist RCT-glorifying science-types address critiques of their myopia with ad hominems. Tells every thinking person exactly what they need to know.

      Your rage shows that, on some level, you do understand the the train is moving on … leaving you at the station. Good luck w/that ..

      Phelps and his colleagues are showing the rest of us the way. How’s your swimming?

    • Ryan August 9, 2016 / 12:58 pm

      The irony here is that it is exactly the modern science that you speak of that has disproven the entire basis of this article. You are sadly still a few years behind on pain neuroscience. I am an evidence based, science fanatic, and that is exactly why the ignorance of what you are saying is hilarious, ironic, and frustrating all at the same time. You are still stuck in a world of where sensory c fibers act as pain receptors, detecting injury and reporting pain to the brain. Wake up, read some of the science that you are referencing…..please. If you do not know where to find the science that you speak of let me know and I’ll point you in the right direction. Clearly you haven’t been there in a while. My guess is you use silly articles like this, written by unqualified authors as your source of scientific knowledge.

      In case you still don’t get it just understand this:

      It is YOUR opinion that is disproven by current neuroscience. You sound stupid.

  4. Mike Warren August 9, 2016 / 3:23 pm

    Reblogged this on Nucella's Blog and commented:

    Woo and pseudoscience are widely practiced in the sporting world.

  5. Dr.Tom August 9, 2016 / 4:55 pm

    The Cartesian debate rears its ugly head again. Res Cogitan versus Res Extensa. Mater and Mind are both prevalent in this day and age, despite what western models of medical science may prescribe. The pharmacological answers prescribed by Western Science has not had any lasting effects, besides to mask phantom pains the body, and trick the recipient that somehow their pain does not exist. I have seen this in the psychiatric as well as the physiological health sectors. Eastern Models of Medicine, which are based upon well researched premises from the East, are only recently being studied within Western models of science. I am not a proponent of either, and believe both serve a purpose in the greater good of helping people heal from afflictions. This is especially true as placebo effect is concerned.

    Before we can jump to any conclusions, especially as it is related to science versus pseudo science, I must question, from what lens are you examining the research material provided. If not from an eastern perspective, where cupping, massage, acupuncture, and other modalities are commonly understood and researched phenomenon, an error of systemic bias occurs, where one system of thought is used to disprove another system of thought without taking into account its etiological foundations.

    • Colin August 9, 2016 / 8:13 pm

      From the article: “He (and it’s always a he) invariably introduces himself as “Dr. First Name” …”

      Why is that, Dr. Tom?

      The pharmacological answers prescribed by Western Science has not had any lasting effects…

      Ask a survivor of sepsis, or cancer, or diabetes. Or someone who just napped their way through major surgery. Or anyone who enjoyed a childhood free of polio and smallpox. Or a woman who, thanks to pharmaceuticals, is able to make reproductive choices that the vast majority of human beings were never able to make.

      The “Eastern Science” and “Western Science” model is incredibly reductionist, extremely wrong, and more than a little paternalistic. Science is science. A patient’s perspective doesn’t transform cupping or acupuncture or any other kind of magic into anything more than a placebo (at best).

      • Colin August 9, 2016 / 8:19 pm

        Oh, and pharmaceuticals for the immune system, too! Often the explanation for the supposed magical effects of “Eastern” medicine are that it stimulates the immune system… but for some reason, acupuncture doesn’t save the lives of HIV patients. Pharmaceuticals do, thank god! They also help suppress immune responses to assist organ transplantation–another feat beyond the feats of acupuncture and homeopathy and cupping and candling.

        I wonder, by the way, whether you truly believe it’s advisable to understand methodologies from alternative perspectives, or whether you draw an arbitrary line. For example, do you believe in Scientology’s touch-assist healing techniques? Why not, if you don’t understand their perspective on the science, which they claim is well-validated?

        • Dr.Tom August 9, 2016 / 9:50 pm

          Being both a marketing platform as well as a platform for academic, scientific, and philosophical thought, my moniker is only used as a marketing component to identify myself as a psychologist. Not that Dr. Ruth ever used that title as well to identify herself.

          In regards to sepsis, cancer, and / or diabetes, medicine is only an answer after the fact, as preventative care of the immunological system and methods to promote stress reduction by suppressing central nervous reactions and increasing autonomic nervous reactions help promote a physiological effect that affects both the conscious reactions to stress as well as its all to real physical consequences: eg. hypertension, high blood pressure, heart disease, etc.

          While the methods of Eastern medicine are well grounded into their etiology, it is not well studied or understood by Western counterparts. I do not insinuate a division between west and east, but instead draw attention to the difficulties present in understanding one system of thought from the lens of the other. This has been the root of reductionistic and empirical thought processes, where ideas from one system of thought are seen through the lens of bias from another system of thought. This, in and of itself represents an error of objectivity, because it too is dependent upon the subjective experience of one system of thought without necessarily looking at the literature or understanding the etiology of the other.

          So as it relates to Western Medicine, it has had wonderful effects for patients who have immunological diseases, diseases where life and death are a real consequence, and has successfully, time and time again, shown the capacity to suppress the effects or kill the disease without necessarily killing the host organism. However, a pill, as has been shown time and time again, does not provide long term cures for a number of diseases without causing multiple “side-effects,” some even more dangerous than the symptom they target to rid the patient of over a long term basis.

          So, even within the tenets of Western Medicine, we are beginning to learn about the nature of preventative medicine, versus treatment models that will only target symptoms after the fact. Such large scale medical establishment, including Kaiser Permanente, Sutter Health, and others have preventative departments that educate people on the effects of stress, the effects of diet, and the effects good exercise habits have on our overall physical and mental health. While they may not prescribe to Eastern tenets of medicine, they are definitely not discounted from the ideal of stress reduction. One need only look at the therapeutic effects massage, biofeedback, neurofeedback, progressive visualization, meditation, and other neurophysiological methods have on the overall health of their recipients. Although considered alternative health options, all have been studied extensively in peer reviewed academic journals with Z scores that form the basis of neurofeedback being based on 68,000 NASA candidates Neural topography screens. If that does not equate to science, I do not know what does. Nor should the other methods of alternative health be disproven, only because we have yet to take on the hard questions needed to expand upon the knowledge base rather than reduce it to one system of thought.

          So, while the conversation includes such alternative treatments as cupping, these systems of thought cannot be removed from the overall conversation of the neurological and physiological benefits of alternative medicine.

          Great debate, I look forward to your next article.

          Tom

          • Colin August 9, 2016 / 10:10 pm

            Whoops, I misfiled my reply. It’s below. Sorry for muddling the thread.

  6. Dale Johnston August 9, 2016 / 10:01 pm

    Love it..the arguments. Pseudoscience is a word which describes the lack ofscintific evidence
    I have just answered my husband’s query about those ‘horrible’ marks were on Michael Phelps beautiful body,
    I call that fabulous advertising.

  7. Colin August 9, 2016 / 10:07 pm

    First, “The pharmacological answers prescribed by Western Science has not had any lasting effects.” Now, “medicine is only an answer after the fact.” Are you arguing from some deeper principle, or attempting to find a momentarily convenient rationale for setting aside the greater empirical success of science-based medicine? Let’s set aside your earlier comment as clearly unwarranted; scientific medicine saves lives, as any transplant patient or diabetic could tell you.

    First, “Eastern Models of Medicine, which are based upon well researched premises from the East, are only recently being studied within Western models of science.” Now, “I do not insinuate a division between west and east, but instead draw attention to the difficulties present in understanding one system of thought from the lens of the other.” I’m not sure we’re using the same dictionary; you spent some time discussing the difference between the “East” and the “West.”

    What cultural insights would convert homeopathy or acupuncture into an empirical success? Why would the same technique not validate Scientology’s healing technologies, or protestant healing prayers, or a first-level Cure Minor Wounds spell?

    However, a pill, as has been shown time and time again, does not provide long term cures for a number of diseases without causing multiple “side-effects,” some even more dangerous than the symptom they target to rid the patient of over a long term basis.

    Are you addressing medicine as she is spoke, or a strawman? My doctor is very much in the “western” camp; her last advice to me had nothing to do with pills. She told me to eat less and exercise more. (Nor is this a recent development; my father got the same advice as a young man.) One could similarly criticize western carpenters for using hammers to cut wood, if one overlooked the fact that they don’t.

    Nor should the other methods of alternative health be disproven, only because we have yet to take on the hard questions needed to expand upon the knowledge base rather than reduce it to one system of thought.

    Should? Is your critique descriptive or prescriptive? If the evidence doesn’t support it, the evidence doesn’t support it. As you’ve written it here, your argument (again) applies just as well to Scientology as “the East.” Should their healing technologies be disproven merely because non-scientologists find they don’t work? Or, rather, should we look at the evidence and say, “The data don’t support this theory.”?

    Great debate, I look forward to your next article.

    Thanks. Mine are the legal ones, though.

    • Dr.Tom August 9, 2016 / 11:13 pm

      Not sure about the legal reference of your argument, since I also help head a law firm.

      From a purely academic perspective, not perusing into the religious aspects of your argument, the only perspective I propose in response to this article is to not commit acts of confirmatory bias. It’s too easy to get caught up in assuming one perspective over the another when viewing one set of experiences from another. This stands at the root of prejudice, no matter how much scientific fluff you surround the argument with.

      This is not objective science. In fact, if the author of the article is angered, her viewpoint is already skewed by the subjective experience of emotion. It is during this time when the premise leaves the purely objective measures of science, and becomes within itself pseudo-scientific. An objective observer simply cannot remain objective when the subjective experience of emotion enters the picture.

      That is the only premise I wished to make in my response. Res cogitation v. Res extentia is the basis for modern day objective thought, proposes that one in deed can somehow remove thought from the matter which houses it. Modern physics, neural science, and psychology are all qualitatively and quantifiable disproving this premise.

      As for medicine, there is still a great deal of academic debate, scientific and philosophical, that needs to occur to heal the many divides seen at every level within this country, medicine or not.

      • Dr.Tom August 9, 2016 / 11:16 pm

        That which divides will always divide, while that which heals, understood or not, will always heal.

        • Colin August 10, 2016 / 10:44 am

          It is what it is.

      • Colin August 10, 2016 / 10:44 am

        I say that I write the legal pieces only to point out that I didn’t write this one–it wasn’t clear to me whether you thought I was the author.

        As for medicine, there is still a great deal of academic debate, scientific and philosophical, that needs to occur to heal the many divides seen at every level within this country, medicine or not.

        As inscrutable as this comment is, I can say that I’m all for debate. I prefer it to be based on actual information, rather than vague gestures towards the wisdom of the East. I don’t think that emotions or the lack thereof will convert “It promotes blood flow!” into a logical or true statement.

  8. Anonymous August 10, 2016 / 12:19 pm

    Jennifer … if you’re interested in an intelligent discourse rather than pontificating or mounting transparently ad hominem arguments (you can do better than that, I know you can) … I’d be really interested in your response to these critiques of the RCT trial model, and then a comment re: the effect elevation of RCT design to “gold standard” status has vis-a-vis the medical traditions of other cultures.

    Here’s the RCT critiques:

    1) That the concept of placebo is problematic on a number of grounds, including:

    a) It is incapable of evaluating complex non-pharmaceutical interventions as it assumes the division of clinical effects into characteristic and incidental effects, a distinction which breaks down when evaluation non-pharmaceutical treatments. ("Characteristic and incidental (placebo) effects in complex interventions such as acupuncture." Paterson, C, Dieppe, P. 2005. BMJ 2005. 330:1202–5.)
    
    b) they lack external validity. ("Evaluating treatments in health care: the instability of a one-legged stool." Kaplan BJ, Giesbrecht G, Shannon S, McLeod K. BMC Med Res Methodol. 2011 May 11;11:65.)
    
    c) they have the potential for increasing health risk in the general population (Ibid),("Questioning the methodologic superiority of 'placebo' over 'active' controlled trials." Golomb BA., Am J Bioeth. 2009 Dec;9(12):34-6.) (Howick J. Am J Bioeth. 2009 Sep;9(9):34-48)
    
    d) they make a relatively weak contribution to clinical practice (Ibid),("Conflating scientific with clinical considerations." van der Graaf R, van Delden JJ, Am J Bioeth. 2009 Sep;9(9):58-9)
    
    e) they are extraordinarily expensive (Ibid) (a consideration particularly relevant to your position that a cultural inheritance such as cupping is fraudulent. Please explain who you would see as having the motivation to fund such a study.)
    
    f) no regulations govern placebo composition, which can influence trial outcomes and merits reporting ("What's in placebos: who knows? Analysis of randomized, controlled trials." Golomb BA, Erickson LC, Koperski S, Sack D, Enkin M, Howick J. Ann Intern Med. 2010 Oct 19;153(8):532-5.)
    
    g) given the expense of placebo controlled trials, the dominant position of pharmaceutical funding, and the inherent conflicts of interest these factors create ... the end effect is to skew the evidence base by suppressing negative studies of pharmaceuticals ... creating the false impression that pharmaceuticals (which can be placebo'd quite nicely, in contrast to legacy techniques like cupping, physical therapy, surgery, mental health therapy) are superior to these other techniques, not because the legacy interventions are inherently inferior but simply because they don't fit easily into the reductionist model of biology and healing RCT trials accept as axiomatic. (Seife, C. "Research Misconduct Identified by the US Food and Drug Administration: Out of Sight, Out of Mind, Out of the Peer-Reviewed Literature." JAMA Intern Med. 2015 Apr;175(4):567-77.)
    
    h) in view of these critiques, I'd be very interested in what you'd propose as a placebo control for cupping (one that neither the subject or the investigator would be unable to distinguish from the real thing.)
    
    i) to back out and take a more global perspective for a moment, the position that by elevating RCT trials to a "gold standard" medical researchers make a fundamental teleologic error. (Angell, IO, Demetis, DS. "Science's First MIstake" 2010. New York: Bloomsbury Academic. (http://www.sciencesfirstmistake.com/)
    
    j) and last, my comment, which is that by embracing the RCT trial with all its flaws as some kind of final arbiter of truth, the effect is to effectively disenfranchise many clinically-effective, non-pharmaceutically based treatments, including legacy medicines from other cultures ... not because they don't work, but because they simply can't be adequately placebo'd or no one will pay to study them. Further ... the assumption of intellectual superiority actually barely masks what is in reality an extension (on an intellectual level) of 500 years of western colonialism. It is entirely predictable that most legacy medical traditions, traditions which (like cupping) have been found useful enough to be passed on by dozens of generations of humans, not all of whom presumably were so intellectually inferior to you that they could be successfully hoodwinked by generations of healers ... will never be validated by RCT trials ... enabling generations of self-appointed quackbusters to pontificate on endlessly to an audience that (as Phelps shows) is turning its back and voting with its feet (or, in this case, dollars ...)
    

    Thanks. You’re smart. You know the difference between rhetoric and debate. Go for it.

    I’ll be fascinated by your response.

  9. David Colquhoun August 10, 2016 / 5:10 pm

    It’s really quite hard for a real scientist to cope with the flood of indignation that is elicited when anyone writes a sensible article which makes a real attempt to explain the nonsense of alternative medicine.

    The critics are usually anonymous and seem to have learned a few sciencey-sounding words from google, or perhaps from Dr Oz. Frequently, of course, they are making money by deceiving the public (and possibly themselves). It’s little to do with science and everything to do with making money (without doing the hard work of understanding what they are doing).

    Almost all of what the quackery advocates here have written would not pass muster in a first year university exam. They seem to feel free to string together real science words in a random order.

    If you want to know my qualifications to talk about science, they are very easy to find. So are Jennifer Raff’s. Her critics hide behind pseudonyms. That’s simply cowardice.

    • Anonymous August 10, 2016 / 6:04 pm

      Ad hominems speak for themselves. You are practicing religion, not science. Speak to the substance of the issues raised, not to the person raising them … if you wish to retain a shred of intellectual respectability.

      RCT fundamentalists always respond this way when confronted with evidence of the multiple biases embedded in the model. It’s pathetic.

        • Ignaz Semmelweis August 10, 2016 / 8:14 pm

          I’ve supplied copious references today, some of them in front line journals, documenting a growing consensus that RCT trials, and the evidence base they’ve produced over the last fifty years, is biased towards interventions that generate the large profits necessary to fund RCT-level research and biased against just about everything else.

          And instead of responding to any of that … people still want to know who I am.

          You can call me Ignaz Semmelweis.

          If you are ever in the mood to respond to the substance of my comments, I’d be interested to hear what you have to say.

          But if the level of discussion here remains on an ad hominem level … not only does that speak for itself … but it gets really, really tedious.

          The most progressive parts of the medical research community are moving beyond RCT models, recognizing that the interventions they support have had / do have serious issues. If you’re interested in highly credentialed people who make the kind of arguments I make I’d refer you to:

          Jeffrey Bland, MD (Founder and Director, Functional Medicine Institute)
          Martha Herbert, MD (Harvard faculty, Mass Gen, MIT)
          Peter Gotzsche, MD (Cochrane Collective co-founder, research director at Nordic Cochrane Centre)

          There’s more of these folks … but I’m getting tired of carrying the water for folks who seem to be obsessed with making the kind of group-think errors that only those with advanced degrees can make.

          And in any event, your day is passing. People are voting with their feet and wallets, and it pisses you off. Ghandi put it best. “First they ignore you. Then they belittle you. Then they get angry at you. And then you’ve won.”

          So you can keep your anger and your ad hominems. Those and $5 will buy you a good cup of coffee …

          • David Colquhoun August 11, 2016 / 6:52 am

            It’s interesting that you cite Peter Gotzsche, He’s a good critic of health fraud wherever it occurs. It was his group that showed convincingly that acupuncture had, at most, trivial effects ( Madsen Gøtzsche & Hróbjartsson, 2009). He also showed that placebo effects are quite weak, and that most of the reason that ineffective treatments appear to work is the statistical phenomenon known as regression to the mean -see http://www.dcscience.net/2015/12/11/placebo-effects-are-weak-regression-to-the-mean-is-the-main-reason-ineffective-treatments-appear-to-work/

            It’s understandable that enthusiasts for magic medicine wish to undermine the best methods that exist for getting reliable, unbiased evidence. Good evidence tends to reduce their profits.

            You may not have noticed the the US National Institutes of Health has a branch devoted to alternative medicine (it was set up because of a classical bit of pork-barrel politics). It has spent billions of dollars of US taxpayers’ money, and failed to produce a single useful treatment. But i has strengthened the evidence that most alternative medicine does NOT work, and for that we should be grateful.

            • Ignaz Semmelweis August 11, 2016 / 10:28 am

              Here’s a link to the JAMA report in 1998 on the World Health Organization’s consensus statement on acupuncture:

              http://www.ncbi.nlm.nih.gov/pubmed/9809733?dopt=Abstract

              I have a link to the actual report itself but it’s easy to find by googling and it’s too long to paste here.

              The issue you’re pretending to have some knowledge about was settled 18 years ago. The report above is just part of the reason why the practice has become so widespread in the west.

              The rest of the reason … is that it does, indeed work.

              If you dig into the literature you’ll find numerous discussions about the limitations of RCT trials in evaluating acupuncture (principally the difficulty of identifying a true placebo. Both placebo acupuncture and “correct” acupuncture produce improvements over a wide range of conditions. The problem with the studies is that the difference between placebo and “correct” treatment has, in many (but definitely not all) studies doesn’t achieve statistical significance.

              Which says to folks like yourself, stuck in the ideas of the twentieth century, that it’s a fraud.

              What it says to the rest of us … and to a growing number of researchers … is that there are serious problems with the idea that placebo controlled studies can accurately evaluate the effectiveness of non-pharmaceutical forms of treatment.

              Apparently … by 2009 … Gøtzsche still hadn’t gotten the word. I included him in my remarks not because of his position on acupuncture … but because of his position on the state of medical research today.

              I notice no one’s bothered to respond to the multiple citations I listed above critiquing the RCT model.

              I’d submit … it’s because you can’t.

        • Ignaz Semmelweis August 10, 2016 / 8:26 pm

          To put it more simply … the reason you’re focused on who I am rather than the substance of my argument is … that you have no good answer to it.

          Which is not surprising because it seems you haven’t even taken the trouble of examining it.

          That’s why patronizing ad hominems are all you have left.

          It’s intellectual laziness.

          • neverwonderinganymore August 11, 2016 / 1:11 am

            Anonymous, what was the substance of your argument again?

            • Ignaz Semmelweis August 11, 2016 / 10:38 am

              Actually … I’ve come out here … as Ignaz Semmelweis.

              My point is that self-appointed quackbusters who accuse all medical traditions (except their own, of course) of fraud are relying on a method of evaluation that they’d like to pretend is the least free of all bias … when in fact it’s riddled with multiple biases and appropriate only for evaluating pharmaceuticals.

              I further point out the obvious hubris of a system of thought less than 100 years old taking it upon itself to diss medical techniques that wide swaths of the world’s population have found useful enough to pass on for thousands of years.

              My next point is that none of the quackbusters here are addressing the substance of my argument. All they can do is dance around the edges and take cheap pot shots …

              … and the reason is … their intellectual tradition increasingly reveals itself with each passing year to be an emperor who’s not wearing clothes. Even to many of their own colleagues.

              My last point … is that Raff’s anger about the publicity one of acupuncture’s mainstay treatments is now receiving … reveals far more about the quackbusting mentality than may be immediately obvious.

              Because that anger is the expression of fear in those unable to perceive and grow beyond the limitations of their own mindset. History is moving on, and leaving them behind, and it scares the shit out of them.

              cf: the history of repression visited upon just about any effective progressive social movement you’d like to name.

            • Ignaz Semmelweis August 11, 2016 / 10:48 am

              And one last point … which is that by clinging to the illusion that RCT trials are the best way to evaluate all medical treatments in the face of abundant critiques mounted by highly credentialed thought leaders in the field … and refusing to address those critiques …

              … the quackbusters reveal themselves not to be scientists at all … but practitioners of a fundamentalist religion, the kind where questioning basic premises doesn’t get you an intelligent response speaking to your points … it gets you ostracized.

              This is primitive in-group/out-group stuff. At its worst.

              • David Colquhoun August 11, 2016 / 11:11 am

                It seems that you are unaware of who are “highly credentialed thought leaders in the field”. I fear that what you call research is googling until you find papers that appear to support your case. Perhaps you read only the abstracts, because I can think of no other reason why you’d cite Gotzsche, who is about the last person to agree with you,

                I wouldn’t mind do much if you just said “I believe that homeopathy etc work”. But to pretend that your arguments are based on science, logic or statistics just makes you look rather silly. Why not just admit that you find anecdotes more convincing than properly designed tests. You are quite free to think that, though the rest of the world will probably notice that your attitude might be influenced by the effect that proper testing would have on your income.

                • Ignaz Semmelweis August 11, 2016 / 11:24 am

                  Still non-responsive to the substance of my arguments. Still dancing around the edges and not addressing the points raised in the multiple peer-reviewed citations in front-line medical journals that I’ve cited. Still pompous generalizations and ad hominems.

                  Speaks for itself to anyone who’s not part of your club.

                  The public is voting with its feet and its wallet. And that’s why Raff gets so hot under the collar when we get good publicity and highly visible endorsements by some of the best athletes in the world.

                  • David Colquhoun August 11, 2016 / 11:46 am

                    If I were to reply in detail it would take many pages, and you’d need to learn some math and statistics first. You’l just have to be satisfied that every scientist and statistician in the world thinks you’ve got it all wrong about evidence. The more you bluster, the worse you look..

                    • Ignaz Semmelweis August 11, 2016 / 12:03 pm

                      Question: Do you recall who Ignaz Semmelweis was?

              • JerryA September 15, 2016 / 4:37 pm

                I would like to point out that critiquing randomized clinical trials (RCT) as imperfect in no way provides evidence for cupping or homeopathy or naturopathy or acupuncture or any other ‘alternative’ medicine. However, the RCT has given modern medicine ways to determine what is relatively safe, what works, versus what does not. That is why RCT draws alt-med fire, yet they produce no evidence in favor of their own money-making methods. On the other hand, modern medicine has extended human life expectancy over the last 150 years, reduced or even eliminated diseases, and is practiced everywhere in the world (even the mystical East, where they claim their magic comes from).

  10. Ignaz Semmelweis August 11, 2016 / 11:57 am

    Did I somehow give you the impression that I was looking for respect or validation from folks with closed minds stuck in the ideas of the last century, not even aware of contemporary developments in their own field? And who style themselves as scientists when in fact they subscribe to fundamental principles that they hold to be above critique?

    If I did … I apologize.

    I’m speaking to the folks reading this who aren’t part of your club.

    Seems maybe you missed that part …

    • Jennifer Raff August 11, 2016 / 1:06 pm

      Anonymous/Ignaz, with that comment you’ve indicated that your intention is not to have a serious conversation, but rather to perform an argument. And so you’ve just forfeited any chance that I might take the time to respond to you in a serious way. I have better things to do with my time than indulge you when you’ve made it clear you’re just here to fight.

      I find it interesting that you come here accusing us of ad hominen attacks, when a review of the language you’ve used over the last few days (with both your posting names) is full of condescension and nastiness. And yet you expect us to engage you in respectful dialogue? No. Your rudeness and name-calling has crossed the line.

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