Friday, March 25, 2005

A response to the "Herbinator"

My, my, Orac has been in a combative mood this week, hasn't he? (Being on call for six days straight--with three more to go, two weekends in a row--does that to him sometimes, particularly since it also often leaves a lot of "hurry up and wait" time to blog.) First there were the rants about the Schiavo case, then another broadside against a chelationist. What's next? Well, I think it's time for a little more light-hearted fare. Two days ago, an herbal "healer" named J. Mark Taylor somehow found my little blog and left a sarcastic comment. No biggie; I'm used to far worse from alties. I found it more amusing than anything else. However, I thought it might be interesting blog fodder to reply to Mr. Taylor publicly. Don't worry, Orac-philes, I'll be polite. (Aren't I always?)

But don't confuse "polite" with going easy on him. Here goes:


Dear "Herbinator":

I see you've found my humble blog. Your sarcastic little comment about how you've supposedly discovered a "blog dedicated to the celebration of conformity" amused me, but unfortunately that is an incorrect characterization. In fact, Respectful Insolence is a blog dedicated mainly to science, evidence-based medicine, and skepticism (none of which alties like yourself appear to understand or embrace)--plus whatever else the inimitable Orac feels like blogging about at any given time. In actuality, I leave the conformity to alties, too many of whom will defend even quacks like Hulda Clark rather than admit that they might have a problem with quacks among their ranks. They're much better at lockstep conformity and adherence rigid dogma than I. Oh, and before you go accusing me of the same sort of "circle the wagon no matter what" behavior with regard to conventional medicine, I suggest you read this, in which I go after conventional doctors for selling unnecessarily and potentially harmful "screening" MRIs for breast cancer. I am an advocate of evidence-based medicine, and I try to apply the same standards consistently to so-called "alternative" treatments and conventional medical treatments.

Your sarcasm notwithstanding, however, I'm still glad that someone like you discovered my blog. In fact, I even hope you'll stick around. You might actually learn something. You'll also likely find that I'm far more receptive to honest criticism than most alties are. Perhaps, if I have time later, I'll go back to your blog and politely politely on some of the stuff I encountered the first time I visited. Then, we'll find out what your tolerance for honest debate really is.

In fact, let's find out a little right now. How about a little taste of Orac's own special brand of respectful insolence? I'm afraid you're just plain wrong when you assert on your blog that little or no progress has been made against cancer in 50 years. One example: Childhood cancers that were death sentences in 1955 are now, thanks to chemotherapy, anywhere from 75-90% curable. Another example: leukemias and lymphomas that were also death sentences 50 years ago are now treatable, and, depending upon the specific disease, anywhere from 30-80% curable. It is true that we haven't made much progress for certain tumors over the last 30 years or so, but admitting that is a very different thing than saying (as you did) that we've made "little progress or no progress against" cancer in 50 years. Let me put it this way: If you were diagnosed with cancer, would you rather be treated with the methods we have now or the methods that were the standard of care in 1955? I realize it's likely that you would simply say you'd prefer "natural" methods. If so, I wish you good luck and hope you never get cancer, even more so than I hope the same thing for anyone--because if you do get a treatable cancer and opt for the "natural" treatments that you advocate on your blog over conventional therapy, you'll be screwed. And I don't wish death from cancer on anyone. Putting that aside, however, I know what my answer to the question would be (not to mention, I daresay, the answer of anyone capable of critical thinking).

But how about another little taste? In another post, you say, "Cancer treatment is probably no more effective today than it was in the 1930's." Oh really? Can you back up that assertion with, oh, say, some actual facts? Do you have some survival statistics? Have you considered not just mortality, but morbidity as well? For example, if you were a woman with an early stage breast cancer, would you want a radical mastectomy (the standard of care for even small breast cancers in the 1930's) or a lumpectomy with sentinel lymph node biopsy (the standard of care for most early stage cancers today) as your surgical therapy? And, if you were unfortunate enough to have a tumor large enough to require a mastectomy, why bother with breast reconstruction (nonexistent in the 1930's) when you can have a deformed chest? Would you want to increase your odds of long-term survival with chemotherapy or take the lower chance that surgery alone would do the trick? How about hormonal therapy? The standard means of hormonal therapy before Tamoxifen and the newer aromatase inhibitors was to do an oophorectomy to stop the body's natural production of estrogen. Now we have drugs that will do the same thing. The same is true for prostate cancer. Castration used to be the first treatment of choice for metastatic prostate cancer, even as recently as my early residency days in the late 1980's. Now, we have drugs that accomplish the same thing. The list goes on and on.

After that, how can you not want just one last taste? Correct me if I'm interpreting incorrectly, but here, you seem to be implying strongly, if not saying outright, that a "nature-cure approach is at least as effective as Standard medical treatments." You wouldn't happen to have, oh, say, some actual scientific or clinical trial evidence showing that this is so. Any disease will do, but, since I'm primarily a cancer surgeon, I'd be most interested in evidence showing such a result for a cancer, any cancer, for which there is presently effective "conventional treatment." Failing that, how about any disease for which there is presently an effective conventional treatment? Or even diseases for which present treatments leave much to be desired? No testimonials, please, because they do not show any generalizable effect, and are impossible to evaluate to see if the presentation of the case is accurate, nor do they tell us actual success rates. I'm talking hard data from well-designed, controlled clinical trials that show your therapies are as "effective as Standard medical treatments." And, if you don't think your therapies should be subjected to such testing, I would then have to ask: Why not? Why should your therapies be exempt from the same testing that mine are subject to? How do you know that your treatments work? Again, as I explained extensively before, anecdotes don't constitute adequate evidence. I will give you this, however. You said, "In the end, you either believe or you don't." The problem is, nature doesn't work on "belief." You can "believe" anything you want, but that doesn't make it so.

That ought to do it for now. I hope you don't think I was too hard on you. However, if you show up and leave sarcastic comments on my blog, don't expect me to take it lying down (although I do always reserve the right to ignore them). I've dealt with alties for a long time now on Usenet in misc.health.alternative; I highly doubt you can show me anything new, but feel free to give it your best shot, should you be so inclined. I'm always interested in honest discussions with advocates of alternative medicine who might be able to show me that I am wrong. I just haven't found one yet. Be advised, as well, that no one but Orac drives the agenda of this blog and certainly not you; so I will not allow myself to become drawn into prolonged exchanges. Orac, and Orac alone, decides when he will and will not respond. I'm sure you run your own blog the same way, which I may find out if I start leaving some comments.

Finally, don't forget Orac's favorite saying: "A statement of fact cannot be insolent!"

Sincerely,

Orac

P.S. Have a nice Easter weekend.

14 example(s) of insolence returned:


At 3/25/2005 9:41 AM, Anonymous OutEast said...

Resounding cheers, Orac! An excellent message, and I'm glad you decided to reply to this sniping - and without recourse to abusiveness of any kind (ever the curse of the Blogosphere).

 

At 3/25/2005 11:27 AM, Anonymous Wiz said...

The quacks selling their potions are bad enough, but I get frustrated at the customers/devotees as well. They never seem to understand the basic fact of evidence-based medicine which is that: if any of these alternative practices reliably showed any benefits, doctors would be delighted to use them. Why is this so difficult to comprehend?

 

At 3/25/2005 1:30 PM, Blogger Internal Medicine Doctor said...

ouch orac, it's good you didn't go hard on him. Wouldn't want to be on your shitlist.

then again, how can you attack me? I wirte nothing substantive anyways ;-}

 

At 3/25/2005 2:50 PM, Blogger DrTony said...

Have you seen this movie, Since You've Been Gone? It shows an amusing interaction between the main character, a pediatrician, and another MD, who practices and espouses the efficacy of homeopathy.

Keep it up!

 

At 3/25/2005 2:54 PM, Anonymous Harmonic Mean said...

As a statistician, I couldn't agree with you more, Orac. I believe in data-based medicine.

This may be of interest to you. The other day, there was a show on the Discovery Health Channel on "When Anesthesia Fails". There are supposedly about 40,000 cases of "anesthesia awareness" cases per year in this country. That is a large number of cases, but there are hundreds of thousands of procedures that successfully use anesthesia. No one wants to be a "victim", but I think medicine is generally approached using a utilitarian philosophy, so for every failure the countless number of successes make the risks worth taking.

That takes me to another point of those ambulance-chasing malpractice attorneys (they give me the heebie jeebies). Call me naive, but I don't believe that any respectable doctor is out to NOT do his/her best in treating patients. There are, of course, blatant cases of negligence and incompetence, but that's why it's called a freaking "practice". Medicine isn't an exact science, but what science is exact anyway? It's all based upon reasonable and tested assumptions. Patients should understand that the best and tested current technology and medicine are used to help them, and their probabilty of success is quite good, but it's not guaranteed to be perfect. Otherwise, they have the option of going to a Herbinator. I'd rather be treated by a Doogie Howser any day.

 

At 3/25/2005 4:20 PM, Anonymous Anonymous said...

Evidenced-based?tm Anyone, clinical or otherwise, foolish enough to believe the notion that evidenced-based medicine or science is the answer would be an arsehole. That would be you! Wouldn't it Orac? (fucking brilliant moniker).

 

At 3/25/2005 4:32 PM, Blogger Orac said...

Heh heh. I wonder if the "Herbinator" has made an appearance.

Regardless of whether it's the Herbinator or not, notice how our obnoxious little anonymous friend is either incapable or unwilling to discuss things substantively or politely. I may play hardball, but I try not to resort to insults unless insulted first.

That being said, our obnoxious little anonymous friend behaves quite like many of the alties I used to spar with on misc.health.alternative.

Of course, I would be a fool to delete his post. His "reasoning" should be allowed to speak for itself!

 

At 3/26/2005 3:07 AM, Blogger AnthroPax said...

Kudos to you Orac!

 

At 3/26/2005 4:28 AM, Blogger Socialist Swine said...

It never ceases to amaze me how completely moronic some people are. I'm becoming more and more convinced that Aristotle was wrong when he asserted that rationality was the essential property of humans.

P.S. You should post an anthology of quacks like Lorraine Day and quackery like the proposal that apricot pits can cure cancer. It would be really funny.

 

At 3/26/2005 5:00 PM, Blogger Dreaming again said...

Not only cancers, but organ failures & autoimmune diseases.

Years ago, Generalized Myasthenia Gravis was a vertual death sentence. Thanks to steroids, Mestinion (pyrodystigmine) and immunosuppressive chemotherapy type drugs used in organ transplants like Imuran, Cytoxan, Cyclosporin & Cellcept, Myasthenics now live a normal life expectancy without respiratory failure from respiratory muscles becoming too weak to function.

Lupus can now be treated and now has a mortality rate that has lowered in comparison with Myasthenia Gravis.

MS, Rhuematoid Arthrits, Chrohns disease and many other Autoimmune Diseases which were once completely untreatable, now have treatments that give people longer, more productive lives with some people never having to go onto disability inspite of the illness.

Go back to the days before modern medicine to the days when Alties want us to?

No thank you, I'd be in a grave! There was no treatment for myasthenia then, it was a death sentence!

 

At 4/12/2005 2:09 PM, Blogger Joan said...

I'm sure you've heard this before, and not that I didn't enjoy your very well-put dressing down of the Herbinator, but sometimes it's nice to have that concise bon mot ready at the finger tips: The plural of "anecdote" is not "data."

Excellent job as usual, Orac.

 

At 4/14/2005 8:08 PM, Anonymous Dr Bob said...

Orac,

Spot-on. And don't forget testes cancer, which has gone from death-sentence to superb success in 20 years.

I love how the herbevores always accuse the medical profession of "profiting by keeping you sick", then turn around and sell you their snake-oil at prohibitive prices based on unprovable claims.

But don't expect these folks to respond to logic, reason or fact: they are postmodernists, where you get to create your own reality if you only click your heels, close your eyes, and believe really hard.

 

At 4/15/2005 9:54 AM, Blogger Orac said...

Excellent example! I should have included it.

 

At 4/16/2005 1:16 PM, Blogger Dr. Bob said...

To be sure -- if Lance Armstrong had used Chinese herbs and cleansing enemas for his stage III testicular cancer, he'd be pushing up daisies rather than pushing over French cyclists. Now there's an anecdote you can hang your hat on!

 

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