Calling Dr. Oz: defend alt-med on Skeptics' Guide

By Phil Plait | April 27, 2011 1:53 pm

The other day, noted skeptic Dr. Steve Novella appeared on the Dr. Oz TV show. Steve is a promoter of medicine based on solid science, proven techniques, and reproducible results. Dr. Oz, um, not so much. In fact, on his show Oz has promoted questionable (at best, if not outright dangerous and provably false) things like homeopathy, faith healers, and even talking-to-the-dead guru John Edward. Oz has had such anti-science leanings of late that the James Randi Educational Foundation gave him their 2011 Pigasus Media Award.

Steve did a great job on the show, the best he could, but was hamstrung by the format of the show which gave Oz the last word and allowing him to frame the entire situation. You can read Steve’s synopsis of the episode on his site, and Orac has an excellent summary as well.

As a followup to this, Steve has invited Dr. Oz to appear either on his blog or on Steve’s podcast, the excellent Skeptics’ Guide to the Universe. I think this is a fantastic idea, since that would remove Oz’s ability to frame things the way he wants, and would force him to defend his alt-med claims on their actual merits.

I liked this idea so much I tweeted about it:

That link goes to the short invitation mentioned above. I encourage my readers to retweet that tweet, write about this, and (politely!) contact Dr. Oz about it as well.

It’s easy to defend alt-med when you control the venue. But I think it would be interesting indeed to hear Dr. Oz defend it when he’s a) given enough time to fairly and completely make his point, and then 2) have educated, intelligent, well-informed skeptics questioning it.


Related posts:

Steve Novella goes to Oz
Homeopathy slammed by Australian TV news show
2011 JREF Pigasus awards
Homeopathy: there’s nothing to it

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Comments (60)

  1. Bette Noir

    Tim Minnchin said it best, in “Storm”: You know what they call alternative medicine that’s been proven to work? Medicine!”

  2. amysrevenge

    Never happen. Not in a million years.

  3. Vern Balbert

    Thanks for the link for the e-mail to Dr. Oz. I sent along my own suggestion, although while polite, it was a bit challenging. I watched the show (mainly because I wanted to see Steve’s face after listening to all those podcasts) and I thought that Steve did the best that anybody could under those circumstances. Oz kept handwaving everything Steve brought up. I would LOVE to see Oz in a fair venue, where he can respond to questions instead of just having his opinions waved off and having the subject changed constantly.

  4. I support the call for Dr. Oz to pop over to SBM or the Skeptics’ Guide. He would definitely be treated fairly. However, he has nothing to gain from it, and thus is almost certainly not going to take Steve up on the offer, sadly.

  5. Robert S-R

    To paraphrase Tim Minnchin (again): “Of all the mysteries that have ever been solved, anywhere, ever; none have turned out to be magic.”

  6. Cory Meyer
  7. Dan I.

    Best comment I ever heard on this whole alternative medicine thing was from a comedian.

    “Well what about herbal medicine? Yes, that’s true and we tested it and the stuff that worked BECAME MEDICINE and the rest is just a nice cup of tea and some popourri.”

  8. Happy Camper

    Never happen, Oz has too much to loose. $$$$$$$$

  9. I doubt Dr. Oz would go on Skeptics Guide, but it’s possible. The fact that he reached out to Dr. Novella and had him on the show (and edited him relatively fairly) makes me think it’s possible.

    Another option could be for Dr. Oz and Dr. Novella to go on another talk show that’d be neutral setting – with a fair-minded moderator. Maybe on ABC ‘Nightline’ or something?

  10. Tim

    A lot of you seem to think Dr. Oz and Dr. Novella have the same goals. One wants to garner ratings…one wants to be right. This mismatch is why there would never be a fair debate on the subject.

  11. Travis Roy
  12. DCCNam

    Agreed. There is no way folks like Oz would EVER agree to an unbiased forum or one that they do not control. The same goes for every other loud-mouthed and obnoxious talk media celebrity whether conservative, liberal or other (and boy do we have an over-abundance of them!). Fairness and truth are just not part of their goals, simply cash and ratings as they pretend to be interested in the welfare of their listeners.

    The best one could hope for is to subject them to some minor embarrassment when they refuse to reciprocate. Since the invitation is unlikely to become widely publicized, even that effect will be insignificant.

  13. Pablo

    I don’t see what’s wrong with Dr. Oz’s statements. If alt meds work for you, whether by the placebo effect or physiologically, then it’s a good treatment for you. Things like meditation, herbs, and acupuncture have helped millions of people over the years and not harmed nearly as many as side effects/death from certain pharmaceutical drugs. Obviously, if people tried an alternative treatment and it didn’t work, they’d have no choice but to pursue a more traditional medical approach. Treating the mind, for example, is just as important in treating the body as studies have confirmed that personality/mental state correlates with conditions such as heart disease and risk factors for serious diseases such as diabetes. That said, certain alternative approaches are indeed the proverbial “snake oil”, but some also yield proven results on certain patients. A one size fits all approach to medicine doesn’t usually work.

  14. Party Cactus

    In the offhand chance that comes to pass the SGU folks should grill him on genetic engineering while they’re at it. His episode with Dr. Pamela Ronald was atrociously edited, filled with false balance, and generally had a real strong lean to the unscientific. It had me yelling at the TV, hence the reason I didn’t go out of my way to watch this last one.

  15. Dave

    Dr. Oz won’t go on SGU. He’s got nothing to gain, and the man is all about gain.

  16. Alex Murdoch

    Any chance we can get an online petition going?

  17. Alan D

    I just love it when the hide behind the generic disclaimer, “This website is for informational and entertainment purposes only and is not a substitute for medical advice, diagnosis or treatment.” (From the Dr. Oz web site.)

  18. Shane

    I want to thank Steve for making the effort! Evidence is a hard thing to sell compared to “snake oil”. But the benefits make effort worth the time. People who are “cured” or “helped” by a placebo, could be helped better with real medicine or a proper diagnosis.

  19. Pablo: ” Things like meditation, herbs, and acupuncture have helped millions of people over the years and not harmed nearly as many as side effects/death from certain pharmaceutical drugs.”

    Meditation, herbs, and acupencture often have side effects, and sometime they’re even fatal. You haven’t heard of any? Oh yeah, the practitioners don’t keep track, unlike traditional medicine.

    ” Obviously, if people tried an alternative treatment and it didn’t work, they’d have no choice but to pursue a more traditional medical approach.”

    After waisting their money, and even if it’s not too late to treat them, after needless suffering.

  20. Dr Oz may well take the challenge. It will give him credibility, and he’ll simply tell his followers that he won the debate, no matter how he actually did, and they’ll continue to stand behind him.

    In the words of The Amazing One himself: If they win they win, if they tie they win, and if they lose they win.

  21. Raptor

    Pablo, you need to first off read this: http://whatstheharm.net/

    Secondly, as Weatherwax said, it wastes time and money to do these things that do not work, and when they go after things like cancer, delaying real treatments that work is a mistake.

    Next, they give this stuff to their kids… and then claim it works.. and yet the child sits there and suffers needlessly and in some cases die because the parents refuse real treatment for them.

    The problem is that if people think it works, then they will use it.. and even if its just placebo effect, that’s not a good enough reason to do it. Its not a good enough reason to scam people out of money, or put their lives in danger. Because people aren’t logical, because they will keep coming back and thinking its working and end up harmed in some way, if not dead.

    They will not go ‘oh, well, I guess people were lying about this working’ and stop taking it, because they really truly believe that it works.. and instead make this jump ‘this isn’t working, which means real treatment wouldn’t work either and probably would have left me worse off. I was better for taking the alternative because of (insert natural/safe/whatever excuse here).’

    Instead, we need to play placebo effect with real drugs.. which does work. Wouldn’t it be better to be given a drug that works, to be told it works, and to increase its effectiveness by believing it works, than taking a fake drug and only maybe getting the placebo effect out of it?

  22. Why are doctors so afraid to prescribe alternative (unproven) remedies? [/Oz]

    Perhaps because they 1) feel an obligation to actually practise medicine and 2) don’t want to get their asses sued off for malpractice?

    I watched some of the video and was rather impressed with Dr. Novella’s handling of such a lame and biased interviewer.

  23. No. 3702

    @Alex Murdoch

    Seriously? Online petitions aren’t worth the paper they’re printed on.

  24. réalta fuar

    Haven’t watched the show, but as is typical in cases like these, it sounds as though the “good guy” got slaughtered (or else why all the calls for a rematch? That’s what the loser always wants). That’s the problem with engaging with cranks on their own ground, it often does much more harm than good. I’ve seen it happen over and over with real scientists versus creationists or ufo freaks. Lots of those cranks and charlatans are GOOD at their jobs (hey, they make a living at it, sometimes a very good living) and you meet them on their on ground not only at YOUR risk, but at the risk of a rather important thing called science. So PLEASE, if you’re going to fight where your opponent has chosen the battleground, be prepared, and do NOT do it if you’re not very confident you’re going to win. The stakes are too high. Everyone likes to think they’re the next Sagan and of course will prevail in cases like this but, unfortunately, the next Sagan has proven very hard to find (no shortage of pretenders though).
    Oh, the comedian that Dan I. quoted above is none other than Dara O Briain, who I referenced here the other day. Leave it to a professional to use the greatest tool of all, RIDICULE, against folks like the alt-med shysters.

  25. John

    @ 24 re”alta fuar:

    I take your points, but BA, for one, is no pretender!

  26. Pablo

    @ Raptor/Weatherwax – Alternative medicine as you see it is clearly not the way myself or Dr. Oz see’s it based on that interview. No real, sane doctor is going to prescribe acupuncture or magic herbs to treat cancer for example (they’d likely lose their license or get sued a lot). It’s more along the lines of treating chronic, non-life threatening ailments, such as fibromyalgia, anxiety, depression, arthritis, etc. Alternative treatments have, in fact, shown great promise in these such areas. For example, exercise has been shown to treat and often cure fibromyalgia symptoms. Fish/cod liver oil, or omega 3 supplements, have been shown to alleviate inflammation and thus pain associated with arthritis, as well as help patients suffering from anxiety/depression. Cognitive behavioral therapy (similar to meditation) has also been shown to be just as effective as medications against such mental disorders. Some may argue these are not alternative treatments because science has studied them, however I see them as alternative treatments because many doctors would often prescribe a pharmaceutical drug such as anti-depressants, tranquilizers, pain killers, etc. The alternative treatments alone have helped many people, not all, but why put yourself through the risks and side effects of some serious medications when natural remedies can help before assuming the risks of traditional medications?

    Another fine example is that of treating fungal nail infections, which could be treated with dangerous medications (very hard on the liver) or a variety of natural or OTC topical treatments. Of course, no one size fits all in pretty much every medical case, however many have cured their fungal infections without the use of traditional medications. In fact, most doctors would prescribe alternative treatments first because the oral pharmaceutical medications carry such a risk and often result in recurring infection once stopped.

    The way you both seem to paint the issue is like that of a religious nut that refuses medical treatment in belief that some deity will cure them. This is often not the case with proponents of alternative medicine, such as Dr. Oz, that practice traditional medicine daily (highly acclaimed and respected cardiologist/surgeon in NYC – my hometown), but also see the benefits of first seeking alternative treatments before potentially compromising a patient with traditional medications. Furthermore, if you seek out the episode where he invites Dr. Mercola for a debate, he has many disagreements with his stance on numerous issues. In my opinion, Mercola is out there on a number of issues and clearly has a conflict of interest in the way he runs his “business”. The point here is that the definition of alternative medicine has many degrees and an overwhelming number of doctors will often prescribe the alternative treatments, such as those stated above, before seeking more serious medications. It’s the most logical step in all but the most serious cases and there’s nothing “snake oil” about that.

  27. Sam H

    It’s easy to see that alt-med is basically BS – if the placebo effect is all that’s behind it, then why not use it with drugs that are proven to work? This may be dangerous enough to warrant limits on advertising such things to unsuspecting, desperate families (who will pass this on to children with any fake success), but of course we can’t go too far with that, like with anything else (although I don’t think going far with limiting the pr0n industry is bad – and BTW, if anyone wants an example of the “declining morality” that I recently mentioned then that would be it, along with the other rampant sexualization in the market today. Disagree if you will, but I realize that I shouldn’t have used a such a catch-all term as “declining morality” :))
    But a question: while alt-med may be BS, how much credibility would “natural/home remedies” have, such as eating the right combination of foods/herbs, resting in scented baths, gentle excercise, and the like? I of course don’t propose these for any serious illnesses, but how much could these work for more moderate ones?

  28. Pablo

    To add to the discussion, I also don’t believe in chiropractic medicine – twisting, pulling, and popping bones into place isn’t very healthy for any individual, however many have said those treatments relieved a lot of pain or cured their ailments (at least temporarily), while others have had their conditions worsened. I would consider chiropractic work alternative medicine that could help some people (as it has), but I would not endorse it for the associated risks. I’d recommend professional physical therapy and/or an exercise/diet regiment before prescription pain meds/surgery for example. In my mind, this case follows pursuing alternative medicine before traditional (meds/surgery).

  29. Lawrence

    Pablo – there are relatively minor ailments that can be “handled” through less-invasive processes (plenty of times, my doctor has recommended diet & exercise changes to address appropriate issues) .

    When someone delays treatment for Cancer, let’s say, to try meditation, herbs, acupuncture, fad diets, etc that delay worsens the overall outlook for that patient’s future.

    Delay kills – it really does.

  30. TerryEmb

    @Pablo: And the Cardiologist who was using alternative methods to assist heart disease patients? If no sane doctor is going to use Alt Med to treat cancer, is she insane for using it to treat heart disease? Why is it okay, as a doctor, to tell someone that acupuncture and reiki will solve their problems, but it is unethical (and illegal in some places) for a doctor to give someone a sugar pill outside of an approved clinical trial?

    If clinical trials prove that an alternative method WORKS than its no longer an alternative method, it’s a clinically proven method. The problem is that people are being treated by things that have never been proven to work or have been proven not to work. The problem is that there are standards required of clinical trials for the trials to be acceptable to the medical (and scientific) establishment. Some scientists build their entire careers just on trying to prove what kinds of empirical testing works and what kind has systematic or random biases. It’s HARD to put together a clinical trial that actually conducts empirical testing precisely because it is supposed to ferret out truth.

    Have the tests you cited above been conducted to accepted standards? Have they been statistically normalized to look for skew in the results (a sign of systematic bias)? Have these methods been tested against a placebo? Are they properly controlled to prevent other factors from altering the test results? Have the tests been done by people without a stake in the results?

    It seems like you are looking for something that causes results with little or no drawbacks, but there are always drawbacks. The human body is a system. You can not introduce a new balance to that system without altering other parts of that system in unexpected ways. That is a sad fact in all major systems (economics, environment, biology, and computers). A change in one place, often breaks something else. Unfortunately, if you want results, you have to look toward those things that are actually proven to work and the best problem solving method ever devised, and the only one that has continued to bring truths for the betterment of humanity, is scientific empirical study.

  31. cedric

    Perhaps this is just part of natural selection. Culling the herd of the terminally gullible?

  32. Pablo

    Still missing the point. The point is that these so-called alternative treatments (diet, exercise, therapy) are already part of the standard medical practice. Doctors who simply prescribe drugs for certain conditions without first addressing known natural remedies is foolish and irresponsible. For example, diet and exercise to treat non-hypothyroidism caused obesity vs. medications alone or prescribing medications in conjunction with diet/exercise/therapy before seeking gastric surgery. I’ve never known a doctor to simply prescribe surgery and diet pills before first seeking a lifestyle change.

    It’s like the problem with doctors over-prescribing antibiotics, an approved medical practice for treating bacterial infection, which are contributing to the growth of super bugs. Many of the infections for which antibiotics are prescribed can often be cured with time and natural remedies. People simply want to get better faster to go on with everyday life and doctors don’t want a reputation of not helping people immediately or the remote possibility of having their condition worsen resulting in another doctor visit and antibiotics that could have been prescribed earlier (likely frustrating the patient). A healthy individual can fight off most common infections without antibiotics and if they can’t after x amount of time, antibiotics should be prescribed – not the way they’re handed out like candy in many cases today. Sure, holding back on prescribing will prolong the recovery process, but is it worth the long term risk to prescribe antibiotics so much and so readily? Modern medical science seems to think so, even though this issue has been acknowledged numerous times and remains controversial. Once again, first seeking an alternative treatment (tea, water, rest, salt water gargling, etc.) may be more beneficial in these cases for the long term benefit of everyone. Also, once again, nobody is saying to prescribe acupuncture or herbs to cure a serious illness like cancer or diabetes. Alternative does not automatically mean “in lieu of” what we know works.

  33. MartinM

    It’s more along the lines of treating chronic, non-life threatening ailments, such as fibromyalgia, anxiety, depression, arthritis, etc.

    In other words, conditions which tend to naturally vary in severity over time, creating plenty of opportunity for post hoc reasoning.

    Some may argue these are not alternative treatments because science has studied them

    And they would be correct. You’re arbitrarily redefining parts of mainstream medicine as alternative to lend false legitimacy to quackeries such as acupuncture which have no evidence to support their use.

  34. Keith Bowden

    Doctors who simply prescribe drugs for certain conditions without first addressing known natural remedies is foolish and irresponsible. … I’ve never known a doctor to simply prescribe surgery and diet pills before first seeking a lifestyle change.

    So, you’ve never known an instance of it but you’re complaining about it anyway? 😉

    Regarding the efficacy of the placebo effect, while it’s been established that it can be better than no medicine, it’s not better than actual, established treatment.

  35. Allyson

    Pablo, depression is pretty life-threatening if not treated by actual medicine and therapy. There aren’t a whole lot of not-depressed people who commit suicide. If one is chronically depressed, one should not look to St John’s Wort. One should see a doctor, preferably a psychiatrist who can diagnose and treat mental illness.

  36. Pablo

    “In other words, conditions which tend to naturally vary in severity over time, creating plenty of opportunity for post hoc reasoning.”

    Because non-serious ailments such as these always require prescription meds…..? Many people with degrees of those conditions have benefited from exercise, changes in diet, CBT, and meditation/yoga either alone or in conjunction with medications. A good doctor would also prescribe those measures along with medications if necessary – as most doctors do. Are these not alternative because they’re not pills or are they because science has shown these to be effective for those respective conditions? I believe the problem is the confusion between what’s defined as alternative and what’s classified as modern medicine.

    “And they would be correct. You’re arbitrarily redefining parts of mainstream medicine as alternative to lend false legitimacy to quackeries such as acupuncture which have no evidence to support their use.”

    http://health.usnews.com/health-news/family-health/cancer/articles/2011/04/25/acupuncture-may-help-ease-hot-flashes-tied-to-prostate-cancer-treatment

    http://articles.timesofindia.indiatimes.com/2011-04-22/health/29462670_1_hot-flashes-prostate-cancer-hormone-therapy

    http://www.ncbi.nlm.nih.gov/pubmed?term=%22acupuncture%22%5BMajr%5D%20OR%20%22acupuncture%20therapy%22%5BMajr%5D%20AND%20%22therapeutic%20use%22%5BSubheading%3Anoexp%5D%20AND%20%28%22humans%22%5BMeSH%20Terms%5D%20AND%20%28Meta-Analysis%5Bptyp%5D%20OR%20Review%5Bptyp%5D%29%20OR%20systematic%5Bsb%5D%20AND%20English%5Blang%5D%20AND%20%222005/10/13%22%5BPDAT%5D%20%3A%20%222010/10/13%22%5BPDAT%5D%29&cmd=DetailsSearch

    http://www.ncbi.nlm.nih.gov/pubmed?term=%22acupuncture%22%5BMajr%5D%20OR%20%22acupuncture%20therapy%22%5BMajr%5D%20AND%20%22therapeutic%20use%22%5BSubheading%3Anoexp%5D%20AND%20%28%22humans%22%5BMeSH%20Terms%5D%20AND%20Randomized%20Controlled%20Trial%5Bptyp%5D%20AND%20English%5Blang%5D%20AND%20cam%5Bsb%5D%20AND%20%222005/10/13%22%5BPDAT%5D%20%3A%20%222010/10/13%22%5BPDAT%5D%29&cmd=DetailsSearch

    @Allyson: I never said non-prescription treatments work alone, but many depressed people do indeed benefit for natural remedies as depression can have a number of biological causes such as low vitamin B or lack of exercise. For all but the most serious conditions, as mentioned earlier, either exercise/therapy/lifestyle changes and medication – either alone or in conjunction can benefit the patient. Of course, no doctor would simply recommend exercising more often and CBT to someone who is seriously depressed on the verge of suicide, but it would make sense for someone that’s experiencing malaise on a daily basis over a relatively short period of time as a result of a bad life experience or the winter blues (seasonal affective disorder) that doesn’t significantly affect his/her daily activities.

    Everyone here seems to pick the most severe circumstances and focus on why alternative treatments wouldn’t work – and I’d agree, for the most serious cases something tried and true is necessary. However, for mild cases, alternative treatments (diet, exercise, therapy) do indeed prove beneficial.

  37. Joseph G

    @20 Weatherwax: Meditation, herbs, and acupencture often have side effects, and sometime they’re even fatal. You haven’t heard of any? Oh yeah, the practitioners don’t keep track, unlike traditional medicine.

    Meditation? Fatal? I’d like to see studies on THAT! :)

    You make a good point otherwise, but I don’t think meditation should be put into the same category as “alt med”. My own doctor (a GP of good reputation who doesn’t promote woo) gives out meditation tapes to his patients to help with such issues as anxiety and high blood pressure. I’m fairly sure meditation has a lot more scientific evidence behind it then, say, acupuncture.

    Of course, part of the problem is the tendency of “alt med” practitioners to lump all these treatments into one category. It makes it difficult to talk about them, as these treatments run the gamut, from effective for a given goal (meditation) to having real physical effects but being potentially dangerous (herbs) to having no effect whatsoever (homeopathy).

  38. Joseph G

    @ 28 Pablo: Cognitive behavioral therapy (similar to meditation) has also been shown to be just as effective as medications against such mental disorders. Some may argue these are not alternative treatments because science has studied them, however I see them as alternative treatments because many doctors would often prescribe a pharmaceutical drug such as anti-depressants, tranquilizers, pain killers, etc.

    Not to pile on here, but I’m fairly certain that it’s well accepted in the medical community that psychotherapy with medication works better then either of them by themselves anxiety and depression. The only people who exclusively deal with medication are psychiatrists, and they don’t dismiss things like cognitive-behavioral therapy – on the contrary, they recognize it as important for long-term recovery – but they’re specialists in psychopharmacology, so that’s all that they deal

    Allyson: depression is pretty life-threatening if not treated by actual medicine and therapy. There aren’t a whole lot of not-depressed people who commit suicide. If one is chronically depressed, one should not look to St John’s Wort. One should see a doctor, preferably a psychiatrist who can diagnose and treat mental illness.in.

    Too true. Of course, in some cases St John’s Wort is all the person can afford. Don’t even get me started on that, though.

    Full disclosure: I’m someone who’s struggled with depression over the course of about 15 years, and I also work on a suicide crisis hot-line, so this is obviously a subject that I have more then a passing interest in…

  39. Joseph G

    Ack. It wouldn’t let me edit the post. Stick a few “and”s and “for”s in there…

  40. TerryEmb

    @Pablo: There is a difference between modern medical science and modern medical practice. Modern medical science has questioned the repeated use of antibiotics by doctors. Modern medical practice continues to use it. Modern medical science says chiropractic, acupuncture, and naturopathy are all complete bunk, but modern medical practice (as evidenced by Dr. Oz) is filled with quacks who advocate it.

    Rest, careful exercise, diet control is not alternative medicine. It’s medicine. When science has said, “This works. It might help,” it moves from being alternative medicine to medicine. If science can’t say that, a doctor (who is paid to advise patients on how to recover from illness or injury) is committing fraud if he recommends something that he does not know works.

  41. fred edison

    #30 Pablo
    There are recorded cases of serious injury and death from seemingly innocent chiropractic neck treatments. You’re wise to be wary of it.

    The problem with alternative medicine is that it’s _rumored_ to work, not that it’s been throughly studied and found to consistently work in the majority of those treated. Alternative medicine is primarily here’s your witch doctor potion and with lots of luck it might work as intended, if it works at all and if that’s the thing that actually healed or cured you. It’s probable a consistent mind trick placebo effect occurs with alternative medicine. We could be seeing an example of the power of the positive mind (stress level, emotional state, immune function) over the falsely perceived power of an inferior alternative for tested and proven medicine.

    http://en.wikipedia.org/wiki/Alternative_medicine
    “Richard Dawkins, an evolutionary biologist, defines alternative medicine as a “set of practices which cannot be tested, refuse to be tested, or consistently fail tests.” He also states that “there is no alternative medicine. There is only medicine that works and medicine that doesn’t work.” He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.”

  42. Calli Arcale

    Pablo:

    Still missing the point. The point is that these so-called alternative treatments (diet, exercise, therapy) are already part of the standard medical practice.

    Yes, so why are *you* characterizing them as alt med nad using them to support an argument that sometimes it’s okay to use alt med, and that doctors generally don’t recommend them first? It is a common argument by defenders of alt med that “exercise works, therefore alt med deserves consideration”, but I just don’t follow the logic.

    Going back to one of your older posts:

    Another fine example is that of treating fungal nail infections, which could be treated with dangerous medications (very hard on the liver) or a variety of natural or OTC topical treatments.

    Citations, please? You seem to be setting up a false dichotomy — either the patient can choose dangerous medications that are very hard on the liver, or a natural topical treatment which, by implication, you are characterizing as alt med and *safe*.

    Fungal nail infections can be very hard to kick. For most cases, topical treatments will not be enough — the nail is very good at doing its job of protecting the nailbed, which will make it difficult to get the topical agents to the pathogens. There are a variety of these: Lamisil, Diflucan, Nizoral, etc. The one chosen may depend on the organism. If the organism isn’t known, there may be some guessing involved before finding the most effective antifungal. Lamisil is the frontline choice, and is associated with side effects to the liver (among other things); the risk will be proportionate to the dose and duration of treatment, so it’s a good idea to address the infection *early*. The longer you wait, the stronger it will get, and the longer it will take to cure it. There are some studies showing that combining oral agents with topical antifungals improves treatment — however, these studies did not look at “natural” agents, but rather various pharmaceuticals. Debridement can help, and there has been some research into a urea paste that is encouraging.

    There are some natural antifungals on the market, with one of the most effective being Australian tea tree (Melaleuca) oil. This is the substance I’ve used to treat fungal infections in my pet fish. (Unsuccessfully; they still succumbed, in part because it has some nasty side effects of its own.) It’s plausible that topical Melaleuca would help as the pharmaceutical topicals do, but again. But it’s not exactly safer than the prescription drugs. If you manage to keep it outside of your skin, it’s probably okay, but you wouldn’t want to get it in your food. Besides tasting nasty, it’s poisonous if drunk, and some people experience contact allergies from handling it. Natural substances can certainly work (a great many pharmaceuticals started out that way, and many are still made from plants or animals), but there’s really no reason to think they’ll be safer.

  43. ND

    If it doesn’t have a side-effect, it does’t work 😉

  44. Pablo

    Calli, the problem is that many people consider diet and exercise alternative treatments regardless of conditions, while in certain conditions it’s considered medicine. Once again, goes back to the definition of alternative as I mentioned earlier. What exactly is defined as alternative and when is alternative considered a viable option and when is it not? It does not mean diet and exercise will cure EVERY condition, nor does it mean that it’s not a viable option for treating SOME conditions.

    As for the fungal nail infections, I look to myself as a source and my own research on the topic. My doctors, primary care and podiatrist, both recommended natural remedies over the medication due to serious side effects. In my case, tea tree oil and daily soakings in a white vinegar mixture did the trick – need to create an acidic environment. I had tried topical OTC anti-fungals before, but the condition came back, so I tried something else. However, fungal infections are very hard to get rid of regardless of natural or prescription treatments, but most doctors would recommend a natural approach to nail fungus before seeking prescriptions. Once again, an example of seeking alternative medicine or is this a modern medical approach? On the contrary, if this had been a serious internal fungal infection, prescription oral medications would be the only effective approach.

    To sum up the critics here: basically, if it works for people, it’s medicine (including diet, exercise, natural remedies, etc.), and if it works for people, but hasn’t been tested and verified by formal studies it’s quackery. I’m sure there hasn’t been studies on tea tree oil and vinegar for treating nail fungus, but it worked and was prescribed by real doctors – albeit after I had tried an OTC treatment. Simply because it hasn’t been formally studied, doesn’t automatically mean it doesn’t work.

    I’d also like to acknowledge that natural doesn’t always mean safer, as you mentioned, but that’s not relevant here as we’re talking about alternative treatments vs. modern medicine, not about their safety. I never claimed that ALL modern medicine is dangerous, but oral fungal medications are particularly high risk when considering the condition. And antibiotics, while not particularly dangerous, create resistant bugs with liberal use. I wouldn’t acknowledge anyone to take herbal supplements, for example, without consulting a professional as drug interactions and side effects could be serious – as any doctor would advise.

  45. Pablo

    I’d also like to add that my OTC treatment was composed of undecylenic acid, which is actually a natural FDA approved medication derived from castor oil. Would this be considered alternative to those here since it’s considered a natural remedy or modern medicine since it’s OTC? Furthermore, multivitamins and omega 3 supplements are not approved by the FDA and studies haven’t proved they prevent or cure disease, yet they’re recommended by a majority of physicians in promoting general health. I’m curious to see where the critics are coming from on the definition of natural or alternative treatments vs. medicine. Where do these stand in your opinions?

  46. Colin

    to clarify Pablo… if it works it is not quackery. but how do you know it works without testing it? testing takes science.

  47. Colin

    And don’t move the goalposts as far as natural versus alternative. Alternative medicine is all anyone here is criticizing. Alternative meaning unproven.

  48. Pablo

    Since the nail fungus example seems to be the center piece here of alternative vs. not, here’s an example of alternative treatments which are anecdotal, but have proven successful in numerous cases. These are formally untested, yet effective with proven results. Therefore, alternative and untested does not automatically mean ineffective – nor does it mean doctors won’t prescribe it (living proof here). I’m also not moving any goal posts, the topic is composed of very much gray area that people seems to acknowledge as quackery simply because it’s formally untested even though many have benefited from such treatments. That’s just a fact. I’m not making a generalized all or nothing argument and I’ve made that clear repeatedly. The critics seem to have an all or nothing mentality in viewing this issue (i.e. it only works if it’s formally tested, but if it works and it’s formally untested, it’s deemed ineffective – therefore ineffective defines untested alternative medicine – which is not always the case; it displays the level of bias here). Not all alternative treatments work, not all are effective, but that doesn’t mean some alternative treatments will not be effective for certain conditions (i.e. nail fungus).

    http://www.livestrong.com/article/29128-alternative-treatments-toenail-fungus/

    http://www.livestrong.com/article/287375-white-vinegar-for-toenail-fungus/

  49. Calli Arcale

    Calli, the problem is that many people consider diet and exercise alternative treatments regardless of conditions, while in certain conditions it’s considered medicine.

    It *is* mainstream medicine to consider diet and exercise. You’re right that it’s a problem that alt med is attempting to falsely claim that it’s actually an alt med thing that mainstream medicine neglects. Alt med muddies the waters severely in this way, and often deliberately, because they then can use the proven benefits of exercise to make it look like alt med is reasonable, when this is actually not logical.

    As for the fungal nail infections, I look to myself as a source and my own research on the topic.

    Toenail fungal infections often recur, regardless of the treatment; don’t assume that this means melaleuca works better. It doesn’t mean that; it means that melaleuca was the last thing tried. And your infection might still come back; that’s always a possibility. There are many organisms that can cause toenail infections; they’re sensitive to different things.

    To sum up the critics here: basically, if it works for people, it’s medicine (including diet, exercise, natural remedies, etc.), and if it works for people, but hasn’t been tested and verified by formal studies it’s quackery.

    You misunderstand. It’s not quakery if it works but hasn’t been tested. It’s quackery if we don’t actually know it works (or know it doesn’t) and people push it anyway as if it’s proven. Without studies, we don’t actually know it works, for the most part. The placebo effect isn’t actually about mind over matter; it’s about perception, and that includes both subjective things like pain and also things like regression to the mean and confirmation bias and the many other ways a treatment can appear to be working when it is not actually doing anything at all.

    Quackery isn’t the promotion of things that work but aren’t proven. Quackery is the presentation of things that aren’t proven as if they are.

    I’m sure there hasn’t been studies on tea tree oil and vinegar for treating nail fungus, but it worked and was prescribed by real doctors – albeit after I had tried an OTC treatment. Simply because it hasn’t been formally studied, doesn’t automatically mean it doesn’t work.

    I realize absence of evidence isn’t evidence of absence. That’s not the point. The point is that absence of evidence means you don’t know it works.

    As to tea tree oil, there actually have been studies of it for treating nail fungus; it is a bona fide antifungal and antiseptic, so I have no doubt that it worked on your toenails. I’m not saying you should use Lotrimin next time; the difference probably has less to do with “natural versus artificial” and more to do with the specific organism.

    I’d also like to acknowledge that natural doesn’t always mean safer, as you mentioned, but that’s not relevant here as we’re talking about alternative treatments vs. modern medicine, not about their safety.

    How can you dismiss safety and then go on and say “but oral fungal medications are particularly high risk when considering the condition”? Obviously part of your argument is safety based.

    And it should be. One cannot separate out the safety discussion when deciding whether there is merit to a particular treatment. It’s all about risk versus benefit. If there is a high risk and a low benefit, you probably shouldn’t do it. Whether or not it’s proven factors into that, mostly because it’s what gives you confidence in the risk and benefit claims. Otherwise, you’re just guessing.

    My beef with people like Dr Oz minimizing the possible risks and unproven nature of alt med is that they make it harder for the general public to make an informed risk/benefit analysis. And people who actively sell things that are unproven while promoting them as proven are even worse — they’re the actual quacks.

    Incidentally, you bring up antibiotics as being “not particularly dangerous” and creating superbugs. Natural products can do this too; before the Internet went flaky on me and I had to stop researching (stupid DNS server — I can only hope this message submits okay) I found that studies showed that low concentrations of melaleuca were able to produce resistant populations of microorganisms. What’s more, antibiotics actually have significant side effects as well. There were the infamous terfenadine (Seldane) interactions, which killed a few people and resulted in the manufacturer voluntarily withdrawing Seldane from market (and making the safer relative fexofenadine, aka Allegra). Ciprofloxacin can cause damage to the ligaments, particularly of athletes, and this can be crippling if things go particularly wrong. Many antibiotics can cause photosensitivity. Diarrhea and yeast infections are common side effects, and not to be sniffed at, really. They can also be hard on the kidneys and liver.

    I think for the most part, Pablo, we’re in violent agreement. I think our only real disagreement is how casually one should treat unproven therapies being actively promoted. Is it a real problem, or should we shrug and let it go?

  50. Calli Arcale

    Pablo, one more, then I gotta go:

    I’d also like to add that my OTC treatment was composed of undecylenic acid, which is actually a natural FDA approved medication derived from castor oil. Would this be considered alternative to those here since it’s considered a natural remedy or modern medicine since it’s OTC?

    It’s FDA approved. Duh. It’s proven medicine.

    Furthermore, multivitamins and omega 3 supplements are not approved by the FDA and studies haven’t proved they prevent or cure disease, yet they’re recommended by a majority of physicians in promoting general healt

    The FDA does approve the supplements; they’re just only approved as food. (The “F” in FDA stands for “food” — they regulate more than just medicine). Without proving they can prevent or cure disease, manufacturers are forbidden from claiming they do. That doesn’t prevent doctors from recommending people supplement their diets in a science-based way, and that’s not quackery, nor alt med. Claiming that taking megadoses of Vitamin C will prevent allergies is alt med, however.

  51. Pablo

    I’m glad we could clear that up. I’d say we’re in agreement and I wasn’t downplaying the medical treatments of nail fungus, just explaining the facts. I noted that nail fungus is difficult to clear, naturally or not, but the point was that the natural approach worked just as well in clearing the infection – at least temporarily at this point.

    I’ve been probing how people define alternative because I’m still not clear on what people consider alternative. To me, if it worked for someone it’s worth a shot (pending risk vs benefit of course), formally tested or not – like the natural fungus cures. I also would never assume that any doctor would recommend an alternative treatment if he/she didn’t have some evidence that it works, whether by word of mouth from other patients or doctors, or as part of a study. That’s all I’m trying to clear up here because just about all the critics here defend themselves against alt meds using the excuse that it hasn’t been tested when clearly formal testing is not always required to prove that certain natural treatments are effective.

    It would absolutely be irresponsible to seek untested alt meds to treat serious diseases, but that doesn’t mean they’re all bunk or can’t be effective elsewhere. It’s really common sense – I don’t know any doctor that would prescribe such measures if there wasn’t a notion of supporting evidence. Any doctor that prescribes something without a notion of proof isn’t a doctor at all and I think many of those here have been conditioned to see “alternative medicine” and automatically generalize it with “snake oil” and “quack” without actually researching known (yet formally untested) effective alternative treatments – the bias is exposed in the responses to my inquiries basically trying to label me an illogical nut.

  52. MartinM

    To me, if it worked for someone it’s worth a shot (pending risk vs benefit of course), formally tested or not

    Formal testing is how one determines whether or not it actually worked for someone.

  53. Pablo

    By formal testing, I’m referring to statistical analysis under a medical professional vs. people trying it and having it work for them (i.e. the natural treatments for nail fungus previously mentioned which haven’t been subject to formal testing).

  54. JJ

    I know someone else has already said this but it irks me to no end to see relaxation, diet and exercise called “alternative medicine.”

    It also irks me to see the false belief propagated that doctors and health authorities don’t promoting these as a generally good idea.

    Grr.

    Anyway, carry on.

  55. Michieux

    Oz has an audience because fantasy sells. If this were not the case, Dr. Novella would have his own prime-time TV show. Even if Oz were to appear on the excellent Skeptics’ Guide to the Universe podcast, the audience would mainly be fellow skeptics. That’s not to say it shouldn’t be attempted, but we’re kidding ourselves if we think non-skeptics can be persuaded by reasoned argument and evidence.

    Personally, I think Oz ought to be struck from the register of medical practitioners. That might give his audience pause, I would think.

  56. flip

    Pablo

    To sum up the critics here: basically, if it works for people, it’s medicine (including diet, exercise, natural remedies, etc.), and if it works for people, but hasn’t been tested and verified by formal studies it’s quackery.

    Er, no. If it works for people and has been tested and verified, it’s medicine. If it works for people, but hasn’t been tested and verified, then it’s unverified and not to be trusted. If I hand over a car to you and say it works, you’d want to test it before buying no? You wouldn’t just take my word for it!

    Simply because it hasn’t been formally studied, doesn’t automatically mean it doesn’t work.

    No. It just means we’re not going to take other people’s word for it that it does. Here’s what you’re missing: we would like evidence. We don’t care which way the results go, we just want proof that it does anything at all (good or bad). Anecdotes don’t equal data. In short, that’s pretty much the main issue of your misunderstanding. There’s a reason why we study things: because memory can be unreliable, because of the post hoc fallacy, because of the placebo effect, because other people can influence our impressions of things, etc etc. And your thing of “if it worked for someone else, then give it a go” is the main reason why people try things and get hurt because of it (whatstheharm.net).

    No one is dismissing the possibility that something might work, what we’re saying is that until it is studied, people shouldn’t just dive in and try it and hope they get better. Leave the trial and error to the scientists, that’s what they’re there for and can actually catch problems with efficacy/safety before anything gets to the patient.

  57. Thanks for the YouTube links, guys! The whole segment with Novella was much shorter than I had hoped (seriously, Oz has got to go on SGU…). But the fact that he got this exposure on such a science-illiterate platform surely counts as a win, especially considering he held his own in a situation that was intended to make him fail.
    I wrote about Dr. Oz last week for anyone interested in his “business” practices: http://skeptikai.com/2011/04/26/oz-and-eastern-wizardry/

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