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.
Learning opportunities
I found myself in two frighteningly similar, yet significantly different situations while on winter break. One occurred at the home of a family member I was visiting. I found several books and pamphlets on homeopathy and other associated woo, and naturally became concerned about how deeply the woo had spread. The other happened at a party I was at with friends. I heard one person (a new friend who I don’t know all that well) tell another (a friend of mine for many years) that he had been having some mental and physical problems recently but that thankfully he’d found a “good homeopath.” I was sitting next to the conversation and could have easily jumped in, but I wasn’t being talked to directly.
My proper course of action in the first situation was obvious. Knowing this family member well, I couldn’t believe that they would honestly buy into homeopathy if they knew exactly what it meant. I sat them down and flipped through the books, explaining about dilution and succussion, using ipecac as a cure for nausea, and so on. It took less than two minutes to convince them to get rid of the books, though we talked a little longer about the details because of their curiosity. It turned out that the books were bought used and on sale very cheap, and seemed worth picking up because they looked like medical encyclopedias. We decided to throw the books away rather than donate them or bring them to a used book store, so that no one else would be fooled by them. Later, they asked me to look through a pile of books about medicine and to pull out the ones based on pseudoscience. It would have been nice to have taught them how to identify woo, rather than just how to run potential woo by me for evaluation, but overall I consider it a success.
I had quite the moral dilemma in the second situation, though. I didn’t know the person that well, wasn’t clearly a part of the conversation, and wasn’t sure whether it was actually a teachable moment. I heard him explain that he got worse before he got better — a classic hallmark of issues like a cold or a headache that appear, worsen, and heal on their own over time, and good evidence that homeopathic treatment is unrelated to the healing process. I squirmed in my seat and tried to make eye contact with a known-skeptic friend on the other side of the room. The real dilemma happened when he explained how the mind and body are so interconnected, and how so many ailments are psychosomatic. He used this as evidence for the necessity of “holistic” medicine, but I thought, good point! Maybe if you have a fake medical problem, it’s not so bad to treat it with fake medicine. This may even work for some real but not-too-serious problems — the placebo effect actually does help some people get better faster than they would have without it.
I decided not to say anything. I just complained about it later to that skeptic friend across the room, who never noticed my desperate stares. I think it was the right call because it would have made a scene and made people unhappy and upset (in a way I was safe from while visiting family). People don’t tend to learn from what you tell them, if telling them makes them very upset. Still, I know there is plenty of harm possible from this kind of stuff, and I feel bad about not even trying to intervene.
So, did I do the right thing? When do you step in to teach people about science and pseudoscience, and when should you just let it go?