Tod Kelly is trying to get me killed

That is the only possible explanation for this question:

I don’t know if you saw JB’s comment over on the main page, about wishing someone would do a post on what things *shouldn’t* be covered in whatever reformed HC we end up with. (e.g.: chiro, vitamins, massage, etc.)

I would love to see you do a post on that, and throw it up on the FP.

Regular readers of Blinded Trials (may God bless and keep you) know that every so often my co-blogger and I stray into controversial territory.  Maybe we dare to argue that circumcision is sometimes morally permissible.  Maybe we have the temerity to suggest that vaccines are good for children.  And so on and so forth.  During the conversations that follow sometimes the comments get a wee bit heated when some group of passionate Internet denizens feels that their viewpoint has not been accorded proper respect.  (It should be noted, however, that we have never been such fools as to question the greatness of Rush, doubtless because we take the time to was our vaginas.)

It seems that my old buddy Tod would like me to find the Web’s version of a gigantic hornet’s nest and go “poke-a, poke-a, poke-a.”  And on the main page, no less.  While I am going to have to politely demur on the latter suggestion, I will at least attend to the first bit.  It is, after all, Friday the 13th.

However, I’m going to try to be sensible about my response.  Again, regular readers know I take a dim view of woo.  The easy answer would thus seem to be “no woo.”  No homeopaths.  No “applied kinesiology.”  No reiki.  Etc.  Everyone should be free to see whatever shaman or witch doctor hangs out a shingle for whatever real or imagined ailment they wish.  Something something free country, and all that.  But nobody else should have to pay for it.

With that said, however, I’ll step back from the precipice and say I would be perfectly happy to chip in for anyone else’s naturopathy or chiropractic care on one condition.  Any treatment or diagnostic testing costs to be covered by health insurance must withstand scrutiny under the scientific method.  That’s it.  Easy-peasy.

Now, I may be incredibly skeptical that the magic water homeopaths hawk or mystical tugging that applied kinesiologists perform will withstand said scrutiny.  But a double-blinded, placebo-controlled trial should be easy enough to design for the former, and… well, OK.  I have no idea how applied kinesiology could possibly be scientifically validated, but that’s not my problem, is it?  If practitioners can publish a study in a legitimate, peer-reviewed journal demonstrating that their methods have the same kind of reliability as RAST tests (for example) then I’m happy to see their services paid for.  I realize studies of that kind aren’t perfect, but science is easily the best method of collectively deciding what undergirds our shared reality.  If the medications I prescribe and the tests I order have to prove their scientific bona fides, then so should everyone else’s.  And if they confer legitimate benefit, who am I to deny payment just because their approach differs from mine?

I don’t know what entity should adjudicate with regard to what counts as a a legitimate study, or when a sufficient mass of evidence has accumulated to provide grounds for payment.  Recommendations from government-sponsored panels are often fraught, even within the “traditional” medical community.  I can’t imagine the immensely rancorous battles that will spring up around how to constitute and empower a body to confer or withhold scientific validation from “complementary or alternative” treatments.  But either those who favor payment for services such as these agree to some kind of reasonable guidelines for establishing same, or they forgo payment from public or private insurers.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Recommendations from government-sponsored panels are often fraught, even within the “traditional” medical community

    I am somewhat uncomfortable with the terms traditional to refer to evidence-based medicine (EBM). When people talk about traditional medicine, I think of traditional chinese medicine or Ayurvedic medicines and other kinds of herbal remedies. When I visited India, they used the term Allopathic to refer to EBM. In Singapore they call it western medicine, though some refer to it as allopathic without using the word perjoratively.

    Maybe we should just stick to EBM, because that is precisely what it is and precisely what homeopathy is not.

  2. I want to see a post concerning your thoughts on the circumcision of Rush.
    Will circumcision and/or foreskin reconstruction make Neil Peart a better drummer?
    Can circumcision and/or foreskin reconstruction make Geddy Lee a better vocalist?

    And how do cufflinks fit into all of this?

  3. I have no idea how applied kinesiology could possibly be scientifically validated, but that’s not my problem, is it?

    Wouldn’t they just have to see which vial makes your arm go weak? I’m sure that a darkened vial would work just as well as a clear vial.

    On a more serious note, to what extent should “patient happiness” be taken into account? I mean, if I go to a doctor and I can’t lose weight and I’m feeling fat and miserable and I go to an iridologist and I can’t lose weight and I’m feeling like my power animals are making me strong, even if they are fluffier than they used to be, I shouldn’t cave into society’s expectations of beauty even if I am taking 45 fiber pills a day! Even if I’m not losing weight, my bathroom breaks are now something to look forward to rather than something to dread. (And my left eye is soo much better than it was!)

    To what extent is “patients who are thrilled with the care they receive” a goal worth achieving? (And, I suppose, how much does the question change if I change “goal” to “political goal”?)

    • To what extent is “patients who are thrilled with the care they receive” a goal worth achieving?

      It’s a perfectly lovely goal to shoot for. I want my patients to be as thrilled as possible with the care they receive. But a familiar theme hereabouts is that there is often a conflict between the goals of customer service (“happy patients!”) and medical care (“healthy, appropriately-treated patients!”). The former are dandy, so long as they do not compromise the latter.

      Since almost all woo has no hope of achieving the latter by its own means, practitioners are free to focus exclusively on the former. So it makes sense that their customers are so, so happy.

      • And I went to bed feeling bad about this. It’s not that I need *YOU* to answer these questions. I know that you’re a medical doctor who is interested in making sure that your patients get the best treatment they can possibly get and, sometimes, that means giving them treatments that they themselves disagree with. (Science is kinda wacky insofar as it doesn’t particularly care about personal inclinations in its quest to be testable, repeatable, and so on.)

        I wasn’t trying to put you on the hot seat with those questions. (If I was trying to put anybody on the hot seat, it was the policy wonks… let’s face it, the placebo effect, ridden as hard as it can possibly be ridden by people who are masters at administering it, gives one hell of a lot of bang for the buck. The question of to what extent we should subsidize placebo administration is one that I think is much tougher for them to tackle.) As such, I’m sorry.

      • No hope? when we have a 30% placebo effect, in some situations?

        • I’ve discussed the question of the placebo effect and its legitimate use in medicine, Kimmi, and agree that it does have some potential to help patients. But if all a certain practice can provide is the placebo effect, especially when it is represented as a real therapeutic intervention, it falls far short of my definition of “appropriately treated.”

          • Besides, there are cheaper ways to get the placebo effect.

          • Along those lines, am I correct in understanding that the placebo effect really only works for subjective symptoms? That is, we don’t see placebo-induced tumor shrinkage or anything like that, do we?

          • Placebos can lower stress, which directly lowers blood pressure and heart rate and can also lead to more normal sleep patterns. Those must have measurable effects on other symptoms. Probably not tumors, but, say, stomach acid levels.

          • That’s because it has a Chinese name. Chinese is more soothing than Latin. Unless you pronounce it correctly. I should market an herbal placebo and call it An Wèi Jì.

  4. While I totally agree with the intent and the principle behind what you’re saying, isn’t it true that a great deal of accepted western medicine has never actually been scientifically validated? I’m thinking in particular of many surgical procedures, but also some very old and familiar drugs as well.

    It seems like a hard problem to me. How do you ethically put someone under anesthesia, cut them open, and then do nothing, thus exposing them to all the ordinary risks of surgery up to and including death, in order to get the control sample side of the study?

    • Rod, I can’t really speak to how surgical procedures are scientifically validated. I was terrible at surgery, and couldn’t be done with that rotation fast enough. But I’m confident a good surgeon could mount a science-based defense of her specialty. It probably isn’t placebo-controlled, that’s for sure.

      And even the most time-honored medications I can think of are subjected to study from time to time.

    • you look at medicated stents versus unmedicated stents.
      And you already know the risks of “cutting someone open” or “a person stays in hospital for x days”… or you should, from actual patients.

  5. If anything, my impression is that even western/allopathic/traditional/whatever-you-want-to-call-it medicine could use more scientific testing in areas like off-label drug use.

  6. I think your last paragraph is onto something. The scientific method doesn’t have a clear standard of when we can all say, “Yes, I know this works.”

    Although I think we may be safe in concluding that if there isn’t even one study in a peer-reviewed journal showing statistical significance, we can assume it’s a no-go.

  7. Hmmm. It appears you have survived my clever Post of Death trap, Dr. Saunders. You win this round.

    [pets white cat]

  8. “…but science is easily the best method of collectively deciding what undergirds our shared reality.”

    Uh oh… Now you’ve stepped in it with the anti-science crowd!

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