Alternative medicine: worth a try?
A Daily Dish reader who asked to remain anonymous recently wrote in about their experiences using psilocybin, also known as “magic mushrooms,” for medicinal purposes. Andrew Sullivan received so many emails about mainstream marijuana use that he and his writing team compiled them into a book — and something similar has been happening lately on the topic of psilocybin. At the Dish, it’s a sociopolitical conversation mostly about the legal status of drugs, but that’s not really what I want to talk about today.
This reader wrote:
I take small (no more than a pinch or two) quantities of psilocybin every day. Not to get high, not to unwind, but to try to heal my body. For 5+ years I’ve had an autoimmune problem that’s demyelinating my peripheral nerves – it’s called neuropathy. I do take a monthly treatment of gamma globulin to try to stabilize it, but the prognosis is for a long slow decline. Since “western medicine” doesn’t really have a clue and basically has the equivalent of sledgehammers to treat this thing, I’ve tried a host of non-Western modalities, including acupuncture and Chinese herbs, homeopathy, bio-energy balancing and strict diet. Not entirely no dice, but my condition is still declining. I suppose my fail-safe maneuver is to visit Lourdes or John of God in Brazil.
Anyway, fortunately I’ve also got contacts in the spiritual community of “medicine”, who have given me the idea of using what folks in Mexico call “the little healers”. I have a scientist friend who used it in small quantities daily to recover from bad asthma. It is reputed to help with the immune system (as well as anxiety and depression).
I am as yet too scared to undertake a full trip, which evidently can be like 6 months or a year’s worth of therapy in a few hours, but someday I will work up to it. I am befriending it right now, and I feel the mushrooms are helping my condition. You could call it merely a result of magic thinking, but what harm can it possibly cause? It’s natural, and I am determined to use whatever I can to heal.
Did you catch it? “Since ‘western medicine’ doesn’t really have a clue … I’ve tried a host of non-Western modalities.” “My fail-safe maneuver.” “The spiritual community of ‘medicine.’” “It is reputed to help.” Medicine wasn’t working out for this person, so they figured they might as well try alternative medicine as a backup. This is an attitude I’ve grown accustomed to hearing, but the frequency with which it’s repeated doesn’t make it any easier to comprehend or any more pleasant.
I think it was Tim Minchin who said it best: “Do you know what they call alternative medicine that’s been proved to work? Medicine.” These “non-Western modalities,” so appealing to our (misguided) sense of reverence toward any and all ancient wisdom, are all things that haven’t been proved to work, or have been proved not to work. Let’s take a look, shall we?
- Acupuncture: Sticking little needles all over the body at particular points, believed to heal a wide variety of ailments by manipulating “qi” or “energy flow” in some vague, magical way. It turns out that merely pretending to give someone acupuncture has equal, if not greater, healing power. Hmm.
- Chinese herbs: This is pretty nonspecific. Suffice it to say that there are plenty of herbs that do have curative effects, and many of the ones we know about have been used in actual medicines, but the simple fact that something is an herb doesn’t make it healthy by definition. The fetishization of eastern/Chinese wisdom doesn’t make an herb curative, either.
- Homeopathy: I, too, used to think that “homeopathy” was a synonym for “natural remedy.” But it turns out that it’s based such blatant magical thinking, it’s shocking that any generally sane person could buy into this scam. Homeopaths believe that the more dilute something is, the more powerful it is, so they dilute their “medicines” far beyond the point where a single molecule of the “active ingredient” would even be present in the solution. And about that active ingredient — they believe that “like cures like,” so to treat a symptom you should take something which would cause that symptom. Luckily (I guess), they dilute it into nonexistence first.
- Bio-energy balancing: What does this even mean? What is “bio-energy,” and how might an “imbalance” of it relate to peripheral neuropathy? This is just a nonsense phrase, an attempt to sound scientific and convince gullible people to open their wallets.
- Lourdes: I can only hope these last two were offered tongue-in-cheek. The shrine at Lourdes is about as credible a source of miracles as a burnt grilled cheese sandwich.
- John of God: This guy is a con artist. Perhaps he’s fooled himself too, but when you get right down to it he performs carnival tricks and scams people out of their money. Not a very good “fail-safe maneuver,” if your definition of “fail” is anything like mine.
Interestingly, the anonymous email-writer acknowledged the effectiveness of these alternative treatments: “Not entirely no dice, but my condition is still declining.” I’d chalk “not entirely no dice” up to the placebo effect, given the list that was offered and what we know about those “modalities” from scientific investigations.
I understand that people with long-lasting, painful medical conditions want some way to make themselves better. However, wanting something doesn’t make it so. The popular notion that “alternative medicine” is worth a try when you’re in dire straits can definitely be harmful. It distracts people from, and sometimes interferes with, proven science-based medical treatments. It wastes people’s time and money. In the rare cases where “alternative medicine” is not just a modern-day version of dancing around a bonfire or sacrificing a goat, where it has some actual direct physical effect, it can be very dangerous — because it isn’t regulated, hasn’t been adequately tested, and is not well-understood.
What about psilocybin? I admit I don’t have the scientific background to have an educated opinion. Perhaps it could be used for some valid treatments; our current legal framework might be constraining adequate research into these possibilities. What I can say with more certainty is that the attitude so perfectly encapsulated here — in which treatments which are “non-Western,” “spiritual,” or endorsed by “folks” in developing countries are given privileged status over evidence-based medicine — is what motivated this writer to try it. And that attitude is dangerous.
Older isn’t always better
The Washington Post has this really silly article about an on-again, off-again diet trend called the “Paleolithic diet.” It consists of eating “lots of lean meats, nuts, fresh fruits and vegetables; no grains, salt, sugar, legumes or dairy products.” Unsurprisingly, like most hip and fashionable diets, this is just an approximation of the tried-and-true but boring calorie-counting approach. They give the green light to fruits and veggies and lean meats, but cut out starches and added sugar — that sounds like a regular diet to me.
Of course, the “Paleolithic diet” has added appeal because it’s old. If traditional is good and ancient is better, why not go all the way to prehistoric?
[Fitness coach John] Main says at least half of his gym’s 80 or so members follow the diet pretty consistently, thanks to his convincing pitch that “this is how our human bodies have evolved to consume and process our nutrition” before the “onset of modern agriculture.” (“Modern agriculture” can sound like a disease in Paleo-speak.)
… [Colorado State professor Loren] Cordain writes that our Paleolithic ancestors were “lean, fit and free from heart disease and other ailments that plague Western countries.” Now, he adds: “Look at us. We’re a mess. We eat too much, we eat the wrong foods, and we’re fat.”
Any critical notions are constrained to one paragraph which begins, “Of course, there are skeptics.” Because you know how those skeptics are! Always being disagreeable, with their actual claims about human evolution and the human body’s ability to process various foods! As the reporter returns to Jennifer Jeremias, the star of the article, we read: “What’s important is that she’s never felt healthier.”
I’m not saying this is necessarily a bad diet. Like I said before, it sounds pretty much like normal calorie-counting with an added gimmick. However, it’s dangerous to endorse the idea that if humans did it a long time ago, it must be healthier than and generally superior to anything we do today. There are plenty of other so-called traditional or ancient health/medical practices that definitely result in harm, and even if this one is harmless, it teaches and normalizes an ideology that opens the door to danger.
What blows me away about the whole ancient=healthy idea is the fact that most of the people attracted to it have a great standard of living in the present, and they have no idea how bad things were long ago. Sure, people in the Paleolithic may have had a diet with the “proper balance of omega-3 and omega-6 fats,” but they didn’t have, for example, meat thermometers to make sure they never got sick from undercooking it. Pretty sure they also didn’t have refrigerators or freezers. We also have penicillin, vaccines, a deeper understanding of anatomy and genetics — heck, we have the germ theory of disease! I could go on and on. Modern life isn’t looking so unhealthy now, is it?
And let’s not get our facts muddled up, please. I agree that it’s unlikely that many people in the Paleolithic era died of type 2 diabetes or heart disease, but I’m pretty sure that has less to do with the precise details of their diet and more to do with the fact that the average life expectancy was 33.
The bottom line: there’s nothing wrong with a diet that’s high in valuable nutrients and low in calories, but there’s no reason to involve any pseudoscientific hype.
Michael Specter on the Charlie Rose Show
I’m watching Michael Specter, a science writer for the New Yorker, on the Charlie Rose Show right now. I’d never heard of this guy before but I adore him already. (I’m also admittedly not usually a fan of Charlie Rose, I suppose because I’ve fallen victim to the flashiness of modern media — I struggle to stay awake for his one-on-one interviews in front of a black screen for a full hour. The interviews are usually brilliant, though, and this is no exception.) The show’s bio of Specter says he’s just written a book called Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens our Lives. The interview and the book are about some of the same things he covers for the New Yorker: the current anti-vaccination chaos and its effects, misconceptions about organic food and genetically engineered crops, obsession with vitamins and supplements that don’t do any good … among other things. A few highlights that I managed to type before the moment passed by:
- Insightful line from Specter: “Science isn’t a company, it isn’t a country, it’s a method of doing something.” People often oppose scientific consensus and dispute the results of study after study because they claim that political and business interests shaped the results. To be sure, some funding-source bias may slip through occasionally, and a couple so-called “researchers” pop up from time to time who are outright sleazy. But to portray the entire institution of science as something so malleable, so easily lobbied and influenced, is to misunderstand deeply the concepts at the root of science.
- Explaining that eating locally grown, organic food is a nice goal but not a workable solution to the problems of starvation in the developing world, Specter emphasizes, “We’re not going to be serving everyone Swiss chard from the backyard. We’re just not.” The normally somber Charlie Rose starts giggling and says, “That’s true.”
You can watch the interview here once it goes online, probably later on Wednesday.
Disability benefits
I guess disagreeing with others’ conclusions about ethics is a hot topic around here lately. Separate from our ongoing series about “The Ethicist,” today I’d like to direct you to this post at blog.bioethics.net. Summer Johnson asks: will the Down syndrome children disappear?
If current trends continue, it would appear that the answer is yes. Dr. Johnson quotes an article which says there “would have been a 34% increase in the number of babies born with DS between 1989 and 2005, in the absence of prenatal testing. Instead, there were 15% fewer babies born [with DS]….” She also claims that “some 92% of women who know their fetus has Down syndrome choose abortion.” Then, Johnson goes on to reflect about whether or not this is a good thing. (Emphasis in this and subsequent blockquotes is mine.)
But what will our society lose if all the Down syndrome children disappear? There will certainly be a thread of our humanity that would be lost. Moreover, I doubt that there will ever be a time when Down syndrome is ever completely gone from our population. 100% of women will never terminate their Down syndrome pregnancies–nor should they. Their [sic] is a richness and fullness that raising a handicapped child brings to parents’ lives and for some parents that is what they wish to have.
I find this line of argumentation very troubling, and I said as much twice in the comments. There were also comments from two parents of children with Down syndrome, which I found disturbing in the same way. Commenter “jaws” wrote:
…I chose to keep my baby because every reason we came up with for not having her was selfish. Ten years later it was the right decision not just for my family but for the world. Her teachers say we learn more from her than she does from us. One said she was her most memorable student (after 20 years of teaching) and for good reasons. Our children’s minister said that the other children learn more from her than she does from them. I have watched her melt some of the most sinister people in the world who view terminating babies with Down syndrome differently because they know my daughter. … The world is a better place because there are people with Down syndrome here. Not just because we are the parents but just because. That’s not even to mention the scientific break through that individuals with Down syndrome are helping to conquer. Just one mom’s thoughts.
Later, commenter “Mari” posted:
I too have a child with Down Syndrome and we chose to have him with prenatal knowledge. It was a very hard decision but one I do not regret. I now feel that he was brought into this world not just to change me and my family but to touch and perhaps change many. Its not just teachers and therapists that he affects but I see friends of my daughter, his sister, in junior high. I see him melt their so cool facade and show such patience and care and joy just interacting with him. Yes, if these people are marginalized it will negatively affect our society.
So they’re saying that people with Down syndrome give us “richness and fullness.” We can “learn more from” them than we could possibly offer to them, because they teach us “patience and care and joy” and “melt [our] so cool facade.” The mechanism for that is left unspecified, but boy, are they ever sure it is true. People with Down syndrome also allow us to use them for scientific experiments, apparently. And yet! And yet our reasons for having children with Down syndrome are not selfish, but choosing not to have a child with Down syndrome would be selfish in the extreme.
Am I the only person cringing at the contradiction here? These arguments for having a baby you know will have Down syndrome are all based on how we can benefit from that baby, with no consideration at all for the child’s life. That is selfishness if I ever heard it.
Down syndrome is a serious condition. Yes, the outcome for any one person will be somewhere within a broad range of severity. But the most common health implications include “cognitive impairment, congenital heart disease, hearing deficits… and Alzheimer’s disease. Other serious, but less common illnesses include leukemia, immune deficiencies, and epilepsy.” Even a so-called mild case of a list like that is pretty serious. Do you know why children with Down syndrome teach us “patience and care and joy”? It’s a bit like watching a child with terminal cancer laughing at a cartoon. We see how our problems pale in comparison to theirs, and marvel at how they are still able to be happy. Their suffering and disadvantage shows us how to appreciate our relatively good circumstances. Let me repeat: their suffering and disadvantage.
If you are going to make the argument for not aborting a fetus you know will be born with Down syndrome, you ought to base your argument on the fact that the child’s life will still be valuable, will still have positive utility, will still mean a whole spectrum of worthwhile life experiences. We all suffer to varying degrees and in varying ways, and the existence of suffering does not mean that a life should end before it begins (or, as it is just beginning, depending on your point of view). You can make that argument. But these are standard anti-abortion arguments in general. They have nothing to do with Down syndrome in particular.
And this is not the line of argumentation that Dr. Johnson, “jaws,” and “Mari” are pursuing. They say that the presence of people with Down syndrome is important for our “humanity.” They claim it is useful and good for society to have them around, presumably because the rest of us learn about interacting with people different from ourselves. However, we will still encounter lots of people who are different from ourselves, and we can learn from them in the event that someday there are no children born with Down syndrome. The argument that we need to keep having children born with Down syndrome in order to perpetuate this would equally well apply to children born with fetal alcohol syndrome or prenatal lead poisoning. It’s an argument that would justify not fixing cleft palate, and not administering (or even inventing) the polio vaccine.
It’s unethical to use someone else’s suffering as an instrument for your own marginal self-improvement. If it were possible to live in a world where no one suffered from Down syndrome, I’d say that world would be an improvement over our current one.
Questionable Ethics #1
I’m generally a fan of advice columns. They’re sort of my replacement for gossip. I don’t want to scrape around for the dirty secrets of my friends and acquaintances, but it is reassuring to read about other people’s complicated lives and sordid problems, and realize that whatever difficult times I think I’m facing actually aren’t so bad. It’s also interesting to compare my reactions to the advice of the columnists and see how my instincts measure up to the supposed Zeitgeist.
It’s only supposed, though; most advice columnists at least appear to operate under the assumption that they offer just another opinion—perhaps a very worldly opinion, having read hundreds if not thousands of letters about people in similar situations—but an opinion nonetheless. Not Randy Cohen! A columnist for the New York Times Magazine, he purports to explain what is ethical. Period. That’s why he’s called The Ethicist. (Sounds like the most boring possible superhero.)
It’s possible that Cohen doesn’t personally believe that he has the definitive answers on all questions of morality. A Times Magazine focus group may have decided that the column could appeal to its readers’ desire for some pseudo-intellectual snobbery by reminding them of the good ol’ days of Philosophy 101. Or it might be a complete accident. I still enjoy the column anyway. However, I do think it’s worth pointing out that morality is not as clear-cut as it usually sounds in Cohen’s answers. My coblogger A and I are going to start a series which we’re calling Questionable Ethics. Each week, we’re going to examine the complexities of the situations described in “The Ethicist,” with the hopes of elucidating some of the nuances that Cohen ignores.
(We’re not the first people to attempt to supplement this column with an alternative point of view. I used to read and enjoy Gawker’s “The Unethicist,” but that doesn’t appear to be running anymore. And anyway, our approach will be a bit… different.)
I want to say first of all that there’s a lot of dispute about the meaning of “ethics” versus the meaning of “morality.” Are they synonyms, or are they completely different concepts? We’re not going to mess with that one. There is certainly a usage in which they are synonymous. We’ll mean the same thing when we talk about a “moral system” or an “ethical system,” a set of rules by which one determines right from wrong. Being “moral” or being “ethical” will mean taking actions that are considered good. The real point here is that there isn’t one single road map to ethical/moral behavior; there are numerous systems (many written down by philosophers, and theoretically infinite unwritten possibilities) that prescribe the path to follow.
This week, Cohen looks at three questions. The last two are fairly straightforward, so I’ll focus on this first letter. Read more
Health care and crazy people
I am far from the only one who is kind of baffled by the recent spurt of crazy nutjobs showing up at town hall meetings and likening the Democratic health care plan to some sort of secret Nazi plot. Lots of people have tried to explain it, and I think a lot of the explanations have a bit of truth to them. There is a segment of society (largely white, rural, religious, etc.—typical Republican base) that is losing the power that they recently had, and they’ve bought into a mythology where they’ve always had that power and deserve to retain it. (It’s the “real America” stuff, along with older things like praise for “the heartland.”) To some extent, any remotely liberal policy Obama chose to start out his administration pushing for would have led to claims that he was “stealing our country” and things of that sort.
I think, though, that health care reform—particularly the way it’s being done now—is an issue particularly favorable to conspiracy theorists and nutjobs. That’s because it’s incredibly complicated. In some ways, if Obama was actually proposing nationalized or single-payer healthcare, it’d be better in this respect. Those are huge changes to the system, but at least they’re straightforward and easy to understand. Instead, what we’re getting is a messy patchwork system of fixes for the status quo. People are confused. Telling a crowd of people that you’re going to set up a “health care exchange” doesn’t really clear up the confusion. Saying that instead of a public option you’ll have a “health care cooperative” doesn’t help either. These phrases are stand-ins for complicated, messy policy proposals. Even if someone was willing to take the time to explain it, they’d be incapable, because there are several different plans floating around and no final proposal. Each plan differs on huge issues of policy. The same piece of policy might be good in one plan and bad in another, depending on what other policy decisions are made elsewhere in the bill.
I understand the general outlines of the proposals, but I definitely don’t understand all the details. Even I am not willing to put in the time necessary to understand things well enough to make a truly intelligent judgment on the matter. I support the reforms for two simple reasons. First, I know very well that the current system is awful. Second, I trust those proposing the reforms much more than I trust the opponents. Those reasons aren’t going to be enough to win over enough of the population to push borderline senators into voting yes. Democrats need to agree on some plan that at least 55 of them in the Senate are ready to vote for. Then, they need to consolidate all the proposals, come up with more clear ways to explain what they’re proposing, and really go out campaigning for it. If the public doesn’t know what’s going on, some are going to tune out, some are going to revert to partisan predispositions, and some are going to go batshit insane. That is not a good way to make policy.
Inside an abortion clinic
You have to read this breathtaking piece from Esquire. It’s eight pages long, but please, bookmark it and read it when you have the time. It’s about Dr. Warren Hern, who is apparently the last American doctor specializing in late abortions. The reporter spent some time shadowing him, not long after the murder of Dr. George Tiller, another late abortion provider as well as Dr. Hern’s friend. It’s very vivid, and lends a perspective I think we should all have when we’re talking about abortion law. Take this excerpt, for example:
The patients can be upsetting too. They’re under terrible stress, of course, but sometimes they come in very angry. One had conjoined twins and would have died giving birth, but she exploded when he told her she couldn’t smoke in the office. And some treat him with contempt and disgust [Z's note: italics here indicates quotation of Dr. Hern], usually the ones who have been directly involved in antiabortion activities. They hate all abortion except for their special case. One even said they should all be killed. Only fourteen, she came with her mother. What brings you here? he asked. I have to have an abortion. Why? I’m not old enough to have a baby. But you told the counselor we should all be killed? Yes, you should all be killed. Why? Because you do abortions. Me too? Yes, you should be killed too. Do you want me killed before or after I do your abortion? Before.
He told her to leave. Her mother was very upset. But he isn’t an abortion-dispensing machine. He’s a physician. He’s a person.
Or this:
The abortionist comes in, remembers that the U. S. marshals don’t like him to use this room because the window is too exposed, and walks right back out. You follow, asking about the patients who were supposed to see Dr. Tiller.
The patient I just finished was very unhappy to see me. I think they are very antiabortion. She had a fetal abnormality, and she and her husband are just devastated. Stuff like that.
What kind of fetal abnormalities are we talking about?
One was Down syndrome, another was a lethal brain abnormality along with a lethal heart abnormality. Another one had a catastrophic — we’re not talking about cleft lip, we are talking about cleft face. There was no face.
The takeaway message, I think, is that this is an immensely complicated issue with no easy, pleasant solutions. No normal person enjoys the prospect of an abortion on its own, but many different people still find Dr. Hern’s services invaluable. If you consider yourself pro-choice, you should read this to get a feel of the reality of the situation. An abortion isn’t a magic spell that makes a fetus disappear; it can be devastating and tragic for everyone involved. If you consider yourself pro-life, you should read this to understand the difficult places that women, that couples, find themselves in when they go to see abortion doctors and how they are helped by these doctors. You should understand how the hateful anti-abortion rhetoric fuels the fire of violence, and forces doctors and their families and employees to live in constant fear.
I’m sorry to leave you with mostly these big blockquotes, but I just can’t add much to this article. It speaks for itself. Go read it, whoever you are.
You’re doing it wrong
A startling sight on my way in to lab this morning. I drove past a guy in athletic gear who was swerving around on his bike, and I thought that was just because he was biking through a busy intersection. As I turned the corner around him, I realized he was teetering a bit because he was only steering with one hand, in order to hold his cigarette with the other. Sigh.
GAO on DSHEA
Sorry about the acronyms; just wanted to keep things brief and to-the-point. The Government Accountability Office (GAO) released a report [PDF] recommending increased oversight of dietary supplements. The Dietary Supplement Health and Education Act (DSHEA) has allowed many pseudoscientific products to hide their fraud behind a disclaimer. I’ve discussed this issue here before.
Orac pointed out, I think correctly, that the GAO’s recommendations, while well-intentioned, are “mere Band-Aids on a sucking chest wound.” Nevertheless, it’s nice to see that the government is paying attention to problems like this one, and I’ll take a Band-Aid for starters.
Time to talk
Orac’s post on the National Center for Complimentary and Alternative Medicine (NCCAM, part of the National Institutes of Health) reminded me of this card [PDF] made by them that I’ve been carrying around in my coat pocket for a while now. It says “Ask” and “Tell” in friendly orange speech bubbles, and it encourages me to speak to my health care provider about CAM treatments. I found it in my doctor’s office, and I wasn’t sure what to make of it.
On the one hand, this card tells me that NCCAM is “[my] source for reliable information about complimentary and alternative medicine.” Reliable is good. I checked out the website for the Time to Talk campaign, which these cards are a part of, and the point of it seems to be that patients should tell their doctors (and doctors should ask their patients) about any CAM treatments they may be pursuing on their own, so that doctors can advise patients about potential health concerns. The patient tip sheet says: “If you are considering a new CAM therapy, ask your health care providers about its safety, effectiveness, and possible interactions with medications (both prescription and nonprescription).”
On the other hand, CAM is still CAM. The best way I’ve ever heard to describe the crux of the issue: “You know what they call ‘alternative medicine’ that’s been proved to work? Medicine.” If NIH’s NCCAM is doing anything other than telling people to get as far away from CAM as possible, they’re doing a deplorable job of promoting public health. From the postcard and the Time to Talk site, it seems like they could be encouraging patients to find out about how pretend acupuncture has the same effects as real acupuncture, or about how homeopathy makes no sense whatsoever. However, as Orac’s breakdown of NCCAM grants makes clear, these are not their priorities. The vast majority of their grant funding is going either to things that shouldn’t be categorized as “alternative” (such as studies of the effects of particular diets on health) or — and this is the real issue — studies of therapies based on truly ridiculous ideas that shouldn’t be getting any credibility from a national research institute. For example: NCCAM funded a study to examine homeopathic succussion (vigorous shaking, claimed to make homeopathic treatments more effective; never mind that shaking doesn’t change the fact they are pure water) and to compare succussion to regular stirring, in order to “improve standardization of homeopathic remedy manufacturing and prescribing.” It’s terrifying to think that real money was spent on this so-called study, and others like it. Orac made the very apt comparison: “it’s like studying whether eye of newt or pixie dust is more efficacious in curing cancer.”
If NCCAM was there to provide an authoritative bank of data showing which supposedly alternative therapies were actually real medicine and which were “alternative” because they were pure garbage, that would be fine with me. I would be very excited about that, to be honest. Unfortunately, no matter how scientific the stated intentions of the center’s directors, they seem dead-set on promoting CAM rather than critically examining it.
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