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The Skeptic's Dictionary Newsletter
Volume 11 No. 11
"No one is infallible, and no one can claim a monopoly on truth or virtue. It would be contradictory for skepticism to seek to translate itself into a new faith."--Paul Kurtz, The Transcendental Temptation
for more skeptical quotes see Citatum: skepticism
In memoriam: Paul Kurtz.
Reader comments: Consegrity.
Hallucinations and Science-Based Medicine
When Jesus on the little crucifix hanging next to the television set waved at me with his left hand, I became a believer. I had been told that sometimes patients hallucinate after surgery and now I knew it was true. The combination of anesthesia and pain-killing drugs produced a number of weird visual, tactile, and olfactory hallucinations. There was so much talking going on in the hall and in the room next door that I couldn't be sure that the sounds I was hearing were hallucinations. I think they were because, while the volume was low, the sounds I heard resembled the play by play of the Giants-Cardinals game I had watched the day before.
I underwent a triple bypass on Friday, October 19th. I was home the following Tuesday, resting and following orders about short walks, no lifting of anything weighing more than ten pounds, breathing exercises, etc. I spent a total of five nights in the hospital. The first night was after the cardiac catheterization procedure found that the stent implanted fourteen years ago was completely blocked and there were two other areas that needed to be bypassed. Today, just nine days after having open-heart surgery, I took three nine-minute walks, did a set of leg, shoulder, and arm exercises, and did six or seven sets of breathing exercises. In between, I ate three nice meals, read a couple of articles in Skeptical Inquirer, watched a televised European golf match and the final game of the World Series.
I have no memory of the operation. (Maybe I was abducted by aliens for five hours.). I do know that had I been offered a choice of acupuncture and homeopathic potions instead of some of the best anesthesia and pain-killing drugs known to modern science, I would have politely declined. And I would have jumped off the table and run as fast as I could for the exit had my surgeon said to me on the gurney: "Let's pray together that God in Heaven will guide my hands properly and give you a successful outcome."
Even though I was in a Catholic hospital (Mercy in Sacramento, which has an excellent reputation for its cardiac care), no doctor or nurse bothered me about prayer. One chaplain came in because I had expressed interest in a medical directive. I was asked if I had a religious preference when I was admitted and said "I'm an atheist" and the man doing the data entry smiled and said "There's a check for that." There's a crucifix in every room and every afternoon some sort of prayer, not necessarily Christian, was read over an intercom heard in the hallway. Other than that, though, religion was not an issue. The health and recovery of the patients via the best that science-based medicine has to offer seemed to be the only thing on the mind of each of the medical workers at Mercy.
What I remember most are the pain and the hallucinations. The operation took five hours and I did not regain consciousness until sometime Saturday, the day after surgery. The first night, when I closed my eyes, I saw weird formations, most of which I've forgotten. One that stays with me is a sea of chocolate figures entwined in a kind of lava flow in a kind of Bosch-like kinetic sculpture. I wasn't asleep. This was no dream. Often, when I shut my eyes a different kind of flowing pattern would appear, never in vivid colors. Some patterns would be static. In those, the objects covered the wall in front of my bed and resembled a sort of quilt made of stone. These were not pleasant and I did not want to close my eyes. The strangest visual hallucination, though, came on the second or third night in the PCU (Progressive Care Unit) when the television set hanging from a bracket on the wall in front of my bed was covered with red checkers or poker chips that turned into raspberries. This one I saw with my eyes open. Then Jesus waved at me.
One of the weirder hallucinations was tactile. After surgery I had atrial fibrillation, a common form of irregular heart beat following cardiac surgery. When it started, I felt like some pulsating creature in my chest was moving my whole body back and forth. My wife said I wasn't moving. I was hooked up to a portable pacemaker and medicated. I felt the arrhythmia for days after the operation even though the medication had kicked in almost immediately and the artificial pacemaker never activated.
The olfactory hallucination occurred my first night home. I was lying in bed watching a movie on television when a character lit up a cigarette and I could smell the smoke. This happened twice.
It is now nine days after the surgery and the hallucinations stopped a couple of days ago. I don't miss them.
Anyway, I'm back at work (more or less, mostly less for now) and feel lucky to be alive. I had been having chest pains and shortness of breath under physical stress for a few weeks and knew, with my family history of heart disease and my personal history of heart disease, that I needed to see my doctor soon. Then, I read a short piece on Facebook by one of my cousins who urged anyone with the kinds of symptoms she had to get to the doctor immediately. She had waited too long and ended up with a collapsed artery. I made an appointment with my primary care physician who saw me almost immediately. After getting the details of my symptoms and knowing my personal and family histories of heart disease, he called a Kaiser cardiologist and made an appointment for me on the spot.
There was a non-medical problem, though. Several months ago, I had agreed to do a critical thinking presentation for the Strategic Studies Group at the Naval War College in Newport, Rhode Island, on October 31st. I notified the captain in charge of the speaker's program that I was scheduled for an angiogram on the 18th. Hopefully, everything would be ok or at worst I'd need another stent and I would make the trip as planned. Everything wasn't ok and the talk was cancelled. It turned out that because of the unforeseen arrival of hurricane Sandy, I would not have made the trip to Rhode Island anyway. Watching the news reports of the devastation to the most densely populated area of our country made my problems seem small in comparison. (If you want to donate money to help with the disaster relief in the Northeast, consider Americares.)
Andrew Weil's Integrative Marketing
Whatever else you might say about Dr. Andrew Weil and his "Weil being" programs and businesses, the man is a genius at marketing the integration of science and nonsense. (At www.weilbeing.com, the SHOP button is the first on the left. If you know about Weil's main business--selling supplements--it may surprise you to find that on this site the main pitch is for shoes.) He promotes himself as a health expert, but much of his advice is unhealthy in two respects: he recommends many products that aren't needed for the good health of most people and he recommends many products and practices that aren't backed by strong scientific support. For example, several large, well designed studies have shown that supplements are a waste of money for most people because they are not needed. Weil prescribes supplements for everybody, whether they need them or not. For example, he recommend that a healthy 27-year-old woman whom he'd never met take a daily multivitamin, a daily antioxidant, a calcium/magnesium pill, evening primrose oil, milk thistle, omega 3, and 1000mg vitamin C, at a total monthly cost of $99.90 from his store. Of course, people with specific deficiencies should take specific supplements and certain cohorts probably should take certain supplements, e.g., folic acid supplements for women of child-bearing age.
In addition to his supplement and shoe businesses, Weil also has a line of mushroom facial creams and other skin care lotions of dubious value. His products are sold by Weil Lifestyle, LLC. All after-tax profits are donated to the Weil Foundation, a non-profit organization dedicated to supporting integrative medicine through training, education, and research. One of the main institutions the Weil Foundation supports with grant money is the Arizona Center for Integrative Medicine at the University of Arizona, of which Weil just happens to be the main director. One good deed deserves another. Dr. Weil is currently director of the Program in Integrative Medicine, and a Clinical Professor of Internal Medicine at the College of Medicine of the University of Arizona. No one can say he is not a very clever fellow.
Weil's main appeal to the general public seems to be in his and PBS's promotion of him as a "health expert" who offers "common sense health advice" that is "holistic" yet scientific. An example of his commonsense approach is displayed in his comment on supplements:
When it comes to obtaining the micronutrients your body needs, your best possible source is food, especially fruits and vegetables. But circumstances may prevent you from eating optimally every day. The main reason I take nutritional supplements is for insurance against gaps in my diet. I take supplements faithfully and encourage my patients to do so as well.
He lays the groundwork for his seemingly clear thinking by agreeing with what every health professional in the world accepts: food is the best source of nutrition. He adds a little scientific-sounding jargon--we're ingesting micronutrients, not just nutrients. Then he hits you with the "what's the harm?" appeal, which sounds good. Supplements, except when bought from industries like Weil, are relatively cheap. We don't always eat like we should, so as a precaution take a supplement. It might do you some good. He seems to imply contextually if not logically that it won't do you any harm to do so. The fact is, if you eat poorly once in a while, your body can handle it without supplements. And if you eat poorly most of time, hoping that supplements will keep you healthy, you are deluding yourself. In any case, there is some science that common sense might not be aware of. You'd think a health advisor would know this science.
- There's evidence that people who take a daily vitamin and mineral supplement do not live longer than those who don't.
- Vitamin supplements do no good in protecting against cancer or other diseases. They may even cause harm, including death
- Researchers have found no evidence that multivitamin use helps older women ward off heart disease and cancer, the top two killers of women.
- The evidence is conflicting on whether older women should take calcium and vitamin D supplements.
- Research suggests antioxidant supplements may increase the risk of disease.
- Research has found that calcium and vitamin D supplements offer older women no protection against breast cancer.
- Vitamin, mineral, and herbal supplements can have adverse effects when combined with prescription medications. Among the many pages of advice given me after my open heart surgery were three pages listing common dietary supplements and possible drug interactions, as well as possible adverse effects of such things as taking a ginger supplement if you have gallstone problems. I was advised not to take any supplements or over-the-counter drugs while I was recovering from the surgery and taking new medications to control by heart's rhythm, my blood pressure, and my cholesterol.
In addition to supplements, shoes, and facial creams, Weil is now in the food preparation and restaurant business. He has a video of him making a salad on his website and he's recently opened his sixth True Food Kitchen restaurant. His latest book is called True Food: Seasonal, Sustainable, Simple, Pure. His latest gimmick is in "seasonal therapeutics," the idea that the body needs different foods and supplements during each of the four seasons. We're waiting for the scientific evidence to back this up, but given the history of human dieting, you'd think we'd have noticed by now if there were seasonal needs. (There are bad seasonal diets, though.)
The one thing Weil doesn't do with respect to promoting health and well-being is practice medicine. Yet, he was invited to be the keynote speaker at the 2012 American Academy of Family Physicians (AAFP) annual scientific assembly held in Philadelphia from October 16th to the 20th. "That’s like having an astrologer give the keynote speech at an astronomy meeting," said Dr. Harriet Hall. Maybe so, but "he was ranked the #1 choice for keynote speaker by recent [AAFP] Assembly attendees."* The Assembly presented Weil in glowing terms:
The 2012 Assembly will commence with a captivating, inspirational keynote address from Dr. Andrew Weil speaking on “Why Our Health Matters.” Dr. Weil is one of the world’s foremost authorities on health and wellness.
"Why Our Health Matters." What does that even mean besides the obvious? What criteria do you have to satisfy to be considered an authority on health and wellness? If this means only that he has a lot of followers, then it isn't saying much of value. What is 'wellness' and what has Weil done to understand what wellness is or to propagate and implement that understanding? If all it means is that many people buy his books, his supplements, his shoes, and his mushroom facials, then it isn't saying much of importance. To say someone is an expert on health and wellness seems to say little more than that he's popular, pushes herbal, vitamin, and mineral supplements as essential to good health, favors "natural" cures, and favors organic food over conventional produce. Say hello to Joseph Mercola, Matthias Rath, and Joel D. Wallach.
What is the AAFP and why would they invite Weil to be their keynote speaker? AAFP is one of the largest
national medical organizations, representing 105,900 family physicians, family medicine residents, and medical students nationwide.
Dr. Hall didn't think Weil should have been invited to speak before such a group because Weil has advocated several unhealthy ideas, ideas that should clash with the views of most members of the AAFP. Since he doesn't practice medicine, his declarations are in terms of what kind of medicine he personally would use, not what he would recommend to patients. He personally would not use science-based medicine to treat viral or metabolic diseases (like hepatitis and diabetes). He wouldn't use conventional medicine for cancer, except for a few varieties (which he doesn't name), or for chronic ailments like arthritis, asthma, hypertension (high blood pressure), or multiple sclerosis.* But he would use conventional medicine if he was in a car accident or contracted bacterial pneumonia. So, even though Weil has a reputation for integrating science-based medicine with nonsense, he rejects much of science-based medicine a priori. That leaves only one kind of treatment remaining: the nonsense like the diet and supplements I suppose he'd treat himself with should he develop diabetes or hypertension, for example.
Since Weil is not a practicing physician, and since he rejects most of science-based medicine, the only advice he can give to support his reputation as one of the foremost authorities on health and wellness must be in the form of his reputation as a supporter of herbs, supplements, meditation, prayer, or similar non-pharmaceutical, non-surgical practices. People who sell health and wellness are not the same people who treat diseases and cure illnesses, do the surgery that saves lives, or prescribe the drugs that allow people to live longer, healthier lives. But he is popular and people like him.
Karen Stollznow, who attended a Weil seminar in Denver recently, had this impression:
At his seminar, Weil stumbled out on stage. He was hobbled over, flabby, and he looked as though he was in pain. He coughed throughout the performance. He was hardly a picture of health for a talk about health, although the talk was an afterthought. Weil waxed freeform about nutrition, healthy aging and breathing. When he stuck to medicine, he made some sense, offering some sensible advice about preventative healthcare, nutrition, and exercise....
Clearly unprepared for the evening, Weil ended with a Q&A in which he showed his true colors. He spoke about how acupuncture should be part of everyone’s health regime, as well as supplements and organic foods. In conclusion, he spoke about the evils of fruit drinks and coffee. Ironically, half of the True Food Kitchen menu offers coffee and fancy fruit juice drinks, with a surprisingly large range of wine, beer and fruity cocktails for a health food restaurant.
Weil’s seminar was just an infomercial for his new restaurant. Actually, the menu looks quite appetizing, if you want to pay $14 for a salad, and $4 for a latte.
In my Skeptic's Dictionary entry on integrative medicine, I write:
Integrative medicine is a synonym for "alternative" medicine that integrates sense with nonsense. It integrates the scientific with the untested, the discredited, and the questionable....
The appeal of Weil's integrative medicine is that he mixes sound scientific knowledge and advice with illogical hearsay. For example, on his Men's Health Internet page, he provides scientific information regarding men with prostate problems. He offers common sense advice such as don't ingest caffeine and alcohol if you are having trouble with frequent urination, since these substances will increase the need to urinate. But he also advises men to eat more soy because: "Asian men have a lower risk of BPH and some researchers believe it is related to their intake of soy foods." As Sally Fallon and Mary G. Enig note, however: "the same logic requires us to blame high rates of cancers of the esophagus, stomach, thyroid, pancreas and liver in Asian countries on consumption of soy" (Soy Alert! 2001). Weil also states that saw palmetto "may help" BPH because: "There is clinical evidence that saw palmetto can help shrink the size of the prostate, and it may help promote healthy prostate function." Now we know there is clinical evidence that saw palmetto doesn't help shrink the size of the prostrate.
Weil's emphasis is not on the scientific and there can't be much integration when the bulk of the advice he gives isn't backed by the scientific evidence. When you integrate the questionable with the non-existent, guess what you get?
Those of you who are getting ready to respond by reviewing all the glorious things that "natural" and integrative medicine represents versus all the hideous dangers and snake pits of conventional medicine with its drugs and surgeries that save lives, before you reply please read Steven Novella's recent post on Neurologica: Integrative Medicine Propaganda.
University of Albany to test Emotional Freedom Technique (EFT)
Heather Larkin, Assistant Professor in the School of Social Welfare at the University of Albany, will be the principal researcher testing EFT under a grant from the Global Gateway Foundation and the Association of Comprehensive Energy Psychology. The latter offers certification in EFT, which has been touted as a psychotherapeutic technique for treating such things as post-traumatic stress disorder (PTSD). According to Gary Craig, the inventor of EFT, the technique
has been astonishingly successful in thousands of clinical cases. It applies to just about every emotional and physical issue you can name and often works where nothing else will.
Wow. That's modest. Gary doesn't consider himself an inventor, though. He says he discovered EFT when he found out that he could cure people by using acupuncture without the needles by tapping on energy meridian points with his fingertips. You probably didn't know that acupuncture can cure just about any emotional or physical issue you can name. I sure didn't. (Just to be clear, Gary is not using classical acupressure, which applies pressure at so-called energy points. He just taps on the points.) Gary may have tapped into something, but I doubt if it has anything to do with energy points along imaginary meridians. He seems to have tapped into the same thing Anton Mesmer and thousands of other energy healers have tapped into. We generally refer to it as the placebo effect, but that expression can be misleading.
The placebo effect has become a catchall term for a positive change in health not attributable to medication or treatment. The change can be due to many things, such as regression to the mean, spontaneous improvement, fluctuation of symptoms, reduction of stress, misdiagnosis in the first place, subject expectancy, classical conditioning, desire to please the therapist, or the illness has just run its course. One of the more important responses placed under the rubric of the placebo effect is the reduction of stress. This is often discussed separately as the relaxation response. A caring therapist who exudes confidence and caring in a comfortable and professional-looking clinical setting can be very therapeutic by relaxing the patient. The resulting reduction of stress is physically therapeutic by reducing stress hormones and perhaps stimulating the production of hormones that enhance one's mood. The tapping, the waving of wands, the movement of a light source, or whatever gimmick the therapist might use is actually superfluous.
Anyway, I suppose Heather Larkin will figure out whether it's relaxation or tapping acupoints that matters. How did she and the University of Albany get involved in testing EFT? She said that she and her UAlbany colleagues are on the lookout for opportunities to study new therapies.
"This is an example of an emerging practice that is developing locally, and a lot of people are interested in it and that there is a need for more research on," she said.
Emerging practice? This kind of stuff has been around for a long, long time. Developing locally? Yes. Mary Sise who founded the Center for Integrative Psychotherapy in Latham, New York, and admits her methods for treating patients with post-traumatic stress disorder look a little wacky, is going to subject her technique to scientific testing. "People who are new to it don't believe it," Sise said. Actually, some of us who aren't new to it don't believe it, either. Sise said 95 percent of her patients respond to the treatment. I assume she meant that they respond positively, i.e., improve.
Craig has repackaged the technique of his mentor, Dr. Roger Callahan, the inventor of Thought Field Therapy (TFT). The idea behind TFT is that negative emotions cause energy blockage and if the energy is unblocked then the fears will disappear. Tapping acupressure points is thought to be the means of unblocking the energy. Allegedly, it takes only five to six minutes to elicit a cure. Dr. Callahan claims an 85% success rate. He even does cures over the phone using "Voice Technology" on infants and animals. He claims that by analyzing the voice he can determine what points on the body the patient should tap for treatment. You can take Callahan's course in Voice Technology for a mere $100,000. Craig did, added a few tricks of his own, developed some sort of emotional calibration scale, and now offers his own training on DVD for a mere $150.
I said above that Heather Larkin will figure out whether it's relaxation or tapping acupoints that matters. Maybe not. In an op-ed, Brandon A. Gaudiano and James D. Herbert argue that EFT "lacks even basic empirical support and exhibits many of the trappings of a pseudoscience" (Skeptical Inquirer, July/August 2000). Gaudiano and Herbert also note that "Craig speculates that a placebo algorithm may be impossible because tapping anywhere on the body will affect the body’s energy meridians. This position conveniently renders Craig’s theory unfalsifiable and therefore outside the realm of science."
Researchers are looking for volunteers for a study of Emotional Freedom Technique, an acupressure therapy for treating post-traumatic stress disorder. Volunteers must be over 55, have suffered a heart attack and developed symptoms of PTSD: increased anxiety, difficulty sleeping, physical reactions to reminders of the event, irritability, feeling alienated and increased use of drugs or alcohol. Interested individuals should call 442-3824 or email EFT@albany.edu.
You'll get a gift certificate for participating and members of the control group will get free EFT after the six-week study is over.
Sexual Harassment in the Skeptical Community
While I was recuperating from my triple bypass, I received an email from someone who describes himself as "a male, a feminist, a skeptic, and a reader." He sent me a link to an article in Slate by Rebecca Watson, the founder of Skepchick.org, about her concern with threats of physical and sexual violence against several female atheists and skeptics. The threats, she says, are coming from within the male skeptical community. The emailer wrote to me: "Someone of your caliber and authority directly addressing this hate-filled behavior would be a good start. Apply your "what's the harm" approach to this anti-female behavior."
First, if you haven't read Rebecca's article, do so now. (Note that she singles out TAM as not being as "compassionate" as other skeptical organizations regarding complaints of sexual harassment. She also states that Harriet Hall (aka The SkepDoc), wore a T-shirt at TAM that stated "I am not a Skepchick." (Another source tells me that the shirt read "I’m a skeptic, not a skepchick, not a woman skeptic, just a skeptic." new That source was correct. Click here to see a photo of the shirt. Apparently, Watson and other skepchicks found Hall's shirt offensive. I hope they didn't consider it "harassment." [/new]) Something's going on that I am not privy to. Also, D. J. Grothe addressed the issue in a way that offended one of Roth's defenders. I repeat. Something's going on that I am not privy to.)
Second, I would hope that nobody who reads my stuff is in this crowd of bullies who try to intimidate with four-letter words and threats of sexual violence. I suspect such men do so because they don't have the ability to make a coherent argument for whatever they object to in the writings or actions of women like Watson, Ophelia Benson (who has written about this issue several times), Greta Christina, Jen McCreight, and Amy Davis Roth. I have no reason to believe that these creepy men with their cowardly taunts, who probably talk this way to their mothers and sisters, are among my "fans." On the other hand, creeps and bullies are trolling everywhere on the Internet, so a few must have found their way out of the scummy haunts they inhabit to visit my site occasionally. It doesn't matter, except that my writing anything about hateful behavior by male skeptics against some of our finest thinkers and writers isn't likely to have much effect.
Third, some of the offensive behavior seems to be due to a view of what is humorous that I can in no way relate to, but have seen in the under-30 crowd from time to time. When a friend of mine told her son that he might consider having his girlfriend remove some comments on Facebook about putting his balls up for sale, she was told in no uncertain terms to mind her own business. Anyway, check this page out; it's one that many people find funny. I don't.
Fourth, I have no way of knowing what percentage of this kind of offensive behavior constitutes a real threat and how much is ugly but not likely to result in anybody getting hurt. I can say that because I've been getting vulgar, insulting, threatening emails for about two decades that I'm a bit jaded now. (I can't tell you how many people think they have made the pun of the century by making some comment about the "dick" in SkepDic.) I don't get upset by such emails anymore because I don't read them. At the first hint of insult or threat, I dump the file into the trash icon.
Fifth, I must admit that I was taken aback at the last TAM I attended a couple of years ago, when I read the sexual harassment statement given to all attendees. Is this really happening, I wondered. Yes. How prevalent is it? Prevalent enough to warrant concern. What to do about it? I don't know. But trying to expose those who complain of sexual harassment as exaggerating the problem or to turn the tables and imply that the complainers are the problem, is probably not a wise policy for any organization to make. Anyway, I hope nobody who needs to read this, reads this. There is a subtext here that at this point in my life I don't have the energy to explore. Sorry about that.