This is an insightful essay illustrating the ultimately faith-based nature of much CAM. Statements about safety and efficacy and the indications of a treatment are determined by tradition, appeal to authority, or instinct and then justified by anecdote without any objective supporting evidence. What I find as informative as the essay are the voluminous comments, including from the legendary CAVM guru Dr. Pitcairn, illustrating how passionate people become when you suggest that their intuition and personal experience, their faith, may not be a sufficient justification for medical recommendations that don’t have any other evidentiary basis. Enjoy!
A Book from the SkeptVet
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Thank you for your scientific discussion on the petconnection.com blog.
I have always loved science even though I am not a scientist. That is the reason for my praise for your great comments at that blog.
I don’t quite know what to make of Narda Robinson. She writes quite good articles like this, and is quite hard on many CAM modalities, yet she teaches “neuroanatomical acupuncture” courses “based on science” at CSU. She seems to understand science and the need for an evidential base for medicine, but then seems to have a weak spot for some types of “energy” medicine like acupuncture and reiki. I have been tempted to post about this, but I am still not quite sure where she is coming from.
Here is her page at CSU’s website-with quite a few unsupported claims for accupuncture-like using a needle in the nasal planum during CPR, and Acupuncture assisted anesthesia;
http://csuvets.colostate.edu/pain/articles.htm
As I said, she has some very good, even skeptical articles out there, but then she has some very bad ones as well. My comment on your previous post on journal articles was actually about one of Narda’s articles in Veterinary Practice News.
Interesting! Well, I take a pretty relaxed, “big tent” approach about controversial issues. Finding complete agreement with anyone is pretty much impossible, so I’m all for finding common ground where we can and disagreeing vigorously but respectful where we must. I suspect from the link you provided that Narda and I would have plenty of disagreements, but I’m happy to be supportive of her where I think she’s right, and being treated rather unfairly.
Part of what always sets off alarms for me about ideas that seem questionable at first glance is how criticism of them is received. Legitimate scientists may aggressively defend their positions, and as human beings we’re likely to fall prey to confirmation bias and all the other pitfalls that make giving up a deeply held belief difficult. But in the end, if you really accept the rationale and method for science, you have to be able to accept that you’re likely to be wrong about a lot of things and you should at least try to respond to substantive criticism as something good, something that will strengthen your position if your are in the right and rescue you from error if you’re in the wrong.
If someone reacts to respectful but substantive critiism by being offended, by claiming they “know what they know” or that their “years of experience” deserves more respect, if they act as if you’d just insulted their religion, then what they’re defending is probably weak. Indignation is the first sign that there may be no substance behind a claim.
Yes, I agree, and one of the things that has stopped me from being too critical of Narda is her scientific criticism of most forms of CAM, and the indignation she generates as Richard Pitcairn’s comments illustrate. I find it amusing at least. However, she and CSU (my alma mater) are giving acupuncture a lot of academic support that is unjustified in my opinion. I have never met her, but I hear she is very nice. Some of her former students practice near me, and they do not seem to have gotten the message about chinese herbs.
She claims to have a lot of scientific evidence to back up her practice and teaching of acupuncture, but I have never been able to find it and I am not willing to spend over $4,000 to get it in her course.
Here is a link to the course information-check out the current PDF brochure linked from that page;
http://scienceofacupuncture.com/
I looked up that course ($4000! phew! – the price is not quoted on the website though, is it?) – have a glance at the FAQ’s, especially 3 & 6, dealing with the “scientific updating” of acupuncture and relations with Chinese medicine. Is there any evidence that Chinese animals enjoyed better health overall when treated with TCM/acupuncture (not that I think they were)?
Rita
The price is listed at the end of the brochure you can download (PDF) on that last website. Many chinese animals are treated terribly by western standards, so I kind of doubt that veterinary acupuncture is a big thing there, and is probably more of a recent invention in the west.
Certainly the rhetoric is exactly what one would hope for if scientific evidence that acupuncture truly had some benfit existed and we wanted to incorporate it into mainstream medicine without bringing along the baggage of TCM generally. Of course, it’s also the same language one would use if one wanted to establish a beachhead in academia and mainstream medicine for TCM beginning with the most popular and familiar of the therapies.
I too would be interested in taking the course just to really get into the details of the evidence and see if there’s anything to it. I can’t say as I’ve seen any convincing research that supports the claims Narda makes in the pamphlet either, and I don’t have $4,400 to satisfy my curiosity either!
I’ve actually considered training in and offering acupuncture myself just so I can say to clients, “I don’t think there’s any evidence this is helpful, but if you want it and you agree to follow all the usual science-based treatments, I’m happy to do it” just to keep them out of the hands of our local acupuncturist who also practices the wildest kinds of woo. I can see the apppeal of doing things like that just to keep a few patients out of the worst excesses of CAVM. But it also has the feeling of a slippery slope, and since I think so much CAVM appeals to those who are suspicious of science generally anyway, I’m not sure it would really work
Bartimaeus, thank you for saying what I’ve been thinking for several years.
Robinson hasn’t been able to separate fact from fiction and her articles are all over the place with both. She seems to only support those CAVM methods that she’s personally involved in, or that she personally believes in as having practiced herself. She’s willing to argue homeopathy is bunk, yet reiki and acupuncture MUST be worthwhile. She is incapable of rational debate and rather than be challenged, she attacks, ad hominem, ad nauseum, runs and ducks for cover. I’ve noticed a trend with her if someone asks for evidence, “I don’t have time to deal with you, I have papers to write, check this website for all my articles and my credentials!”
http://www.petconnection.com/blog/2009/04/09/what-works-an-open-but-skeptical-mind/
There are other examples on the Veterinary Practice News site.
How anyone would be following Robinson’s “expertise” on a pet blog, no less, is beyond me. That blog in question is a dog park with vicious attackers, in my opinion. Maybe this is Robinson’s way of gathering support when the EBM community otherwise looks to be ignoring her.
In my opinion, Narda is a master of the recent “integrative” medicine trend exemplified by MD’s such as Andrew Weil. She does not “integrate as many modalities as he does, but uses the same techniques of claiming reasonable things like massage and physical therapy as “integrative” or alternative, and then throwing in acupuncture and therapeutic touch or reiki as well. I think the science she claims as a basis for acupuncture is the basic science of neuroanatomy (guess what, some acupuncture points are close to nerves!) and physiology (sticking needles in living beings causes endorphins to be released, etc). I have not seen any clinical research to show that those documented reactions to needling have any clinical significance other than placebo. Indeed it seems that the actual points do not matter-random needle placement or tricking the patient into thinking that they are being needled works as well as “real” acupuncture. Because acupuncture seems to be a “gateway CAM” for so many of my colleagues, I have a hard time supporting her when she makes a homeopath or herbal healer mad.
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