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Sanjay Gupta Unfit? PDF Print E-mail
Swift
Written by Jeff Wagg   

guptaJim Todd, asks us to consider that Sanjay Gupta, medical rock star of the media, may not be the best choice for Surgeon General:

CNN reports that Sanjay Gupta, who has actively promoted facilitated communication as a valid and useful communication method, is being considered for United States Surgeon General.

This is indeed a concern. Randi and others have railed for years against the nonsense that is facilitated communication, or FC, which involves a practitioner grabbing the hand of a non-communicative patient, and "facilitating" their pointing out words to make sentences.

Jim continues:

As far as developmental disabilities are concerned, Gupta seems not to understand the depth of his ignorance. Real people suffer real harm because of his advocacy of autism pseudoscience and his promotion of ersatz experts over real scientists.

Hank Schlinger, Ph.d copied us on the following missive:

Dear Obama Transition Team,

I am writing to express my strong opposition to Dr. Sanjay Gupta for U.S. Surgeon general.

Dr. Gupta has actively promoted facilitated communication (FC) as a valid communication method for people with autism. FC has been thoroughly discredited scientifically, a fact which Dr. Gupta refuses to accept, opting instead for anecdotes and personal observation as evidence of its validity.

The job of Surgeon General of the United States is too important to be offered to someone who has consistently promoted a pseudoscientific technique that has harmed so many children and their families.

Thank you.

Hank goes to suggest:

Another way to express your concern about the possible nomination of Sanjay Gupta to Surgeon General is to go to Paul Krugman's blog in (the January 6) N. Y. TImes and post a comment about Gupta's endorsement of facilitated communication, which has caused harm to countless children and their families.

There are 228 posts as of this writing, and many of them are very interesting.

 

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CNN - Cable Nut Network?
written by Willy K, January 08, 2009
Is CNN being taken over by the woo-sters?

Read this from Cnn.com today. "The best alternative medicine for children"
http://www.cnn.com/2009/HEALTH/01/08/ep.alternative.medicine.kids/index.html

"The most important thing, the experts agree, is to find a doctor who is open to and knowlegeable about alternative medicine."

What freaking experts I wonder... the experts woo-sters? smilies/cry.gif
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written by Willy K, January 08, 2009
written by elitecoder, January 08, 2009
Why not let the homeopaths fill the void? Let's say buying into the 'woo' literally helps you heal faster.


Why not witch doctors? Why not let paranoid schizophrenics kill the demons making you sick?
Would you give your money to anybody who claims they can help you? No matter what "techinque" they use?

Not for me, thank you. I've met quite a few incompetent medical professionals and lots of barely competent ones as well. But to abandon the "real world" because of a few too many bad doctors would be idiotic IMHO.

How about this? Have certified medical training facilities teach proven techniques for easing patient anxiety?

We all are subject to the mechanisms of the "real" world. We don't have a choice. Only in an imaginary world can the "Road Runner" step off a cliff and run back to safety. smilies/tongue.gif
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written by ashomsky, January 08, 2009
elitecoder,

Fostering a general acceptance of magic and mysticism, especially by those who are trusted to inform the public, is a bad policy. It is true that many psychosomatic illnesses are treatable by placebos, but if people believe in magic, then how are they to know that non-psychosomatic illnesses need other kinds of treatment? I think there are a lot of disadvantages to public belief in magic and it can be especially harmful at the top levels of government.

Plus, how can is possibly be ethical to promote treatments that are known to be ineffective and let bogus practitioners take money from misled consumers?
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written by TuftedPuffin, January 08, 2009
In any case, FC isn't about the placebo effect...or if it is, it's a placebo for the parents, not the patient. You can't exactly placebo messages out of a person, after all.
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written by BillyJoe, January 08, 2009
elitecoder,

The placebo effect is part of the real world. I'm just saying that if tricking yourself can help you get better you might as well take advantage of it.

That statement is simply incorrect.
Placebos don't make you better, they make you feel better.
I hope you can see the difference.

Also, you may think it's okay to be fooled.
Me? I like my dose of reality thanks.

BJ
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written by Cygon, January 08, 2009
> It's been shown that blue placebos work better than red ones for
> treating anxiety. Water injections work better than pills. A doctor
> paying attention to you works better than all of those. Real doctors
> are expensive and have limited time. Why not let the homeopaths fill
> the void?

Because it's harmful. If you browse the swift archives, for example, you will find a case in which a "facilitated communicator" wrongly accused the parents of child abuse and, if I remember right, got them some prison time.

> Also, ask any doctor: For the most part, the body heals itself. The
> reason you need a doctor is because the body can't activate it's
> healing mechanism by will power alone. If it could you could
> override vital protective mechanisms when it's not safe to do so.

I don't agree. Our bodies have healed all on their own through the ages and animals don't have any woo-woo to "activate" their healing mechanisms.

If you're saying that being confident in your own recovery helps (which may or may not be true), I'd prefer to be told that fact and techniques to increase confidence, instead of paying for fake therapies.

And as a poster before me said, if those fake therapies would be officially condoned by real professionals, the public wouldn't know that in case of a serious illness, these fake therapies aren't enough. A honestly, the crowd offering this kind of woo-woo therapies beliefs in it themselves is just all too ready to treat patients who clearly need real help from a real professional.

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written by bosshog, January 09, 2009
It seems that Randi's expectation of a more rational, science-friendly administration is going a-glimmering.

Got hope? (-another placebo, by the way...)
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written by Rogue Medic, January 09, 2009
Maybe CNN will replace Dr. Gupta with Jenny McCarthy. She can investigate whether placebo implants work as well as real implants.

Money spent on fraud is bad. Does it matter if the fraud is financial or medical?
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written by cwniles, January 09, 2009
I think that american idol sanjay guy would be a better S.G.

As far as elitecoder and his comments, I actually see the point he/she is trying to make as far as the following comment....
"There is already a huge shortage of doctors and I think siphoning off some of the neurotics to woo-dealers could be beneficial."

While I don't know if I agree with the fact that it might be beneficial I can see your point. Doctors do waste a lot of time on people who are not really sick and could benefit from a placebo based therapy....the "neurotics" as elitecoder so eloquently put it.
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written by LuigiNovi, January 09, 2009
Interestingly, just last night I read this article, "The 6 Most Idiotic Positions of Dr. Sanjay Gupta", at: http://www.thedailygreen.com/l...ral-460109

One of the items listed was reported by Chris Mooney, the author of The Republican War on Science.
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written by BillyJoe, January 09, 2009
cwniles,

Doctors do waste a lot of time on people who are not really sick and could benefit from a placebo based therapy....the "neurotics" as elitecoder so eloquently put it.

Unfortunately this is not the solution.

Consider the consequences that lead from a general acceptance of the use of placebos like homeopathy:

- people need to believe in placebos in order to feel better.
- people will start to believe in all sorts of things that are irrational.
- rationality in general will suffer
- people will start using placebos for serious illness
- the practitioners of these placebo treatments will proliferate.
- medicare will subsidise these placebo treatments
- science based medicine will have to compete with feel good medicine for funds
- science itself will suffer through the spread of irrationality.

There are probably a lot more reasons.
But there is never any reason to use a placebo except in clincal trials of potentially useful treatments.
This is one area where I strongly disagree with the otherwise very sensible Ben Goldacre.
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Who are the neurotics
written by BillyJoe, January 09, 2009
siphoning off some of the neurotics to woo-dealers could be beneficia

the "neurotics" as elitecoder so eloquently put it.


I think you may be referring to hypochondriacs.
If so, you are mistaken that they can be "siphoned off" to alternative practitioners.
Hypochondriacs are convinced they have real ilnesses and need continual reassurance that they do not. At most they will attend alternative practitioners in addition to having all their investigations done with their genuine medical practitioner.
Think of it this way. Who decides that the patient is neurotic? Not the alternative practitioner surely, therfore the involvement of genuine medical practitioners remains.
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written by cwniles, January 09, 2009
BillyJoe, yeah, thats sort of why I qualified my statement with

"While I don't know if I agree with the fact that it might be beneficial I can see your point"

I did not mean to insinuate I was agreeing with elitecoder, just that I understood the point he/she was was trying to make in regards to medical doctors spending far too much time and energy on patients who are not really in need of medical attention.
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written by BillyJoe, January 09, 2009
Fair enough.
I will redirect my posts to elitecoder.

Except to say that neurotic and hypochondriacal patients actually do need medical help. Firstly to ensure that their next new symptom does no have an underlying physical cause* and secondly to mange their psychological illness.

*Even neurotic and hypochondriacal patients develop a physical disease eventually. In fact I'd imagine that it would take considerably more medical expertise to diagnose phyical disease in a known neurotic or hypochondriacal patient than in a previosuly well patient who presents with a recent onset of contipation for instance.

BJ
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written by elitecoder, January 09, 2009
Cygon:
"I don't agree. Our bodies have healed all on their own through the ages and animals don't have any woo-woo to "activate" their healing mechanisms."

If you don't take my word for it see this interview with Nicholas Humphrey and Richard Dawkins

http://www.richarddawkins.net/article,3484,Richard-Dawkins-interviews-Nicholas-Humphrey,RichardDawkinsnet
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written by elitecoder, January 09, 2009
Also, you guys seem to be replying as if I said that alternative practitioners should replace doctors rather than just being used as a really effective delivery mechanism for placebos.
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written by BillyJoe, January 09, 2009
ekitecoder,

Except briefly by Willy, no one is replying as if you said that alternative practitioners should replace doctors.
We are specifically criticising your suggestion that alternative pratitioners and their placebos are useful adjuncts to genuine medical practitioners and treatments.

BJ
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written by BillyJoe, January 09, 2009
If you don't take my word for it see this interview with Nicholas Humphrey and Richard Dawkins

http://www.richarddawkins.net/article,3484,Richard-Dawkins-interviews-Nicholas-Humphrey,RichardDawkinsnet

The cameraman is totally incompetent but nevermind.

But, it's not a matter of taking Humphrey's word for it. He is merely offering an opinion and we are free to disagree with that opinion.

Nicholas Humphrey essentially agrees that alternative medicine can make you feel better. This "feeling better" is the placebo effect. Humphrey believes that we should accept alternative medicine on that basis.

Because of the collateral damage it causes, I would disagree with that opinion.

BJ
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written by moby, January 10, 2009
If you have concerns with Dr. Gupta's appointment, you should also express them at the change.gov weg site: http://change.gov/page/s/healthcare

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written by Fontwell, January 10, 2009

BillyJoe...

The placebo effect is part of the real world. I'm just saying that if tricking yourself can help you get better you might as well take advantage of it.

That statement is simply incorrect.
Placebos don't make you better, they make you feel better.
I hope you can see the difference.

Also, you may think it's okay to be fooled.


I used to think this was as far as placebos went too, but according to Ben Goldacre (who I hope you agree is a trusted source) it is even more interesting than that. Some objectively quantifiable illness actually improve with placebo treatments, and some placebos are better than others - objectively. The example he gives is some kind of digestive tract ulcers, which can be counted using one of those camera on a tube things that you swallow. It seems hard to believe I know, but I reason that if stress can make you ill, then maybe thinking you are being treated can relieve that stress.
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written by Trish, January 10, 2009
A couple of problems with placebos - 1. they don't work at allfor a large percentage of the population. 2. Even for epople who do respond to placebos, the effect wears off after a while.

I'd be interested if you can refer me to references on objective physical improvements caused by placebos.
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written by BillyJoe, January 10, 2009
...according to Ben Goldacre (who I hope you agree is a trusted source)

Yes, but no one is completely trustworthy or, in other words, everyone can make a mistake sometimes - just look at Jeff Wagg and James Randi in these commentaries!
But, at this point, I'm not sure I can trust you to be quoting him correctly smilies/cheesy.gif, so yeah, like Trish, I would be interested to have a link to see for myself what he actually said, and whether the studies he based his opinion on justify the conclusion he made.

Some objectively quantifiable illness actually improve with placebo treatments,

This could just be just "reduction to the mean".

and some placebos are better than others

Yes, for psychological reasons, coloured pills work better as a placebo than white pills, and a kindly attentive doctor dispensing them works better as a placebo than a disinterested doctor dispensing them.

It seems hard to believe I know, but I reason that if stress can make you ill, then maybe thinking you are being treated can relieve that stress.

If it's relief of stress, then the idea would be to have a medical practitioner advising you about lifestyle changes, or a psychologist teaching you psychological techniques to relieve stress. These techniques are more likely to be long lasting.
I once read a first hand account from a medical practitioner who used homeopathy with very good results. When he discovered what nonsense it was, he continued treating his patients with all the care and attention he always has but stopped precribing the homeopathic treatments. He continued to have the very good results he always has.


The bottom line is that it is never justifiable to knowingly wse a treatment that you know does not work.
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written by Fontwell, January 10, 2009
I didn't quote Ben Goldacre at all. I wrote what I have understood from him after following his Bad Science blog for several years and also from his newish (UK only) book, Bad Science, as well as his various BBC Radio 4 appearances. Yes I'm a Dr Ben Goldacre groupie.

The last place I remember him talking about this was in the book... yes p66/67 and onwards too. One of the criticisms of the book has been its lack of a reference appendix but if I paraphrase the books main text it might provide sufficient info for you to track down the paper:

A meta-analysis by Danial Moerman, an anthropologist specialising in the placebo effect. He took trial data from placebo-controlled trials of gastric ulcer medication (objectively viewable by gastroscopy camera) and compared the ulcer healing rates in the placebo arms of the various trials. Cunning, as it says in the book.

I know that isn't a proper medical reference but if you want it, probably the best thing to do is drop Ben an email and ask him which papers to read. He's a top bloke and this is one of his favorite topics, so I'm fairly sure he will deliver.

Alternatively you could go to the Bad Science blog and see if the search facility there can find it for you.

http://www.badscience.net

The blogs are usually quite reference heavy compared to the book, as a high proportion of his readers appear to be other medical doctors.

I totally agree with the closing remarks about attentive doctor vs homeopathy - it just shows how fickle patients can be.
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written by BillyJoe, January 10, 2009
Fontwell,

Thanks, I've already traced down the relevant references on his website. They are in the form of two 30 minute radio programs on the placebo effect that can be downloaded.
There are also 16 other articles on the placebo effect on his site, and numerous links.

Having listened carefully to these radio interviews, especially Ben Goldacre's commentary interspersed between the opinions of various doctors and researchers he interviews, I have to conclude that he is with me on this one smilies/smiley.gif
...or vice versa smilies/cheesy.gif

The thing about the placebo affect, is that it is primarily a psychological effect and that any physiological effects are secondary. For example, patients had better recoveries after surgery if they saw trees outside their windows rather than a brick wall. The initial psychological effect is a feeling of happiness (seeing trees) rather than sadness (seeing a brick wall), the secondary effects were physiological: better appetite, ingestion of more food, better bowel function, earlier mobilisation, and better healing in those who felt happy and the opposite in those who felt sad.
It's not actually as mysterious as it sounds, and Ben Goldacre succeeds by and large in avoiding that.

And, in the end, Ben Goldacre's message is that the placebo effect should be harnessed by doctors to enhance the effect of evidence-based medical treatments, rather than used as a justification for (doctors and) alternative practitioners to use implausible treatments that have no evidence base.

regards,
BJ
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written by BillyJoe, January 10, 2009
Fontwell: Yes I'm a Dr Ben Goldacre groupie.

Well, he's pretty good, yes.
But a groupie?
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written by Fontwell, January 11, 2009
BillyJoe: Me a groupie - its the eyebrows and curly hair that do it!

Amazingly, I think we probably are all in agreement now (is this allowed?) - I'm pretty sure that the placebo effect is mainly psychological - well obviously its inputs are completely psychological by definition but any feelings of improvement are probably due to an attitude change too. But it did really shock me when I heard about the ulcer trial thing, which suggested that, for this condition at least, there was a genuine physical improvement. That was something I had assumed was not even possible. How many other illnesses can be objectively helped like this is another matter but that it can happen at all is, to me, really quite remarkable. Needless to say, when my foot gets run over by a steam roller, I don't think any amount of big red pills are going to replace ER treatment.
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written by Fontwell, January 11, 2009
Forgot to add... Yes, the best thing we can do is identify the 'active ingredients' of placebos, like with your attentive doctor or trees rather than brick walls etc. These then can be use openly as non mysterious best practice to maximise the effect of the regular medical treatment. If blue placebo pills help to calm people down more than red placebo pills, then the non placebo pill may as well be blue too. I've no idea if manufacturers actually do this.

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written by BillyJoe, January 11, 2009
But it did really shock me when I heard about the ulcer trial thing, which suggested that, for this condition at least, there was a genuine physical improvement.

I'm not sure if I have nailed down the reference here. You mentioned Daniel Moerman and googling that plus placebo gave me this this link:

http://www.annals.org/cgi/content/full/136/6/471

Is that it (the paragraph before the section headed "Conclusions")?
If so, I can immediately see a few problems:

- the study was not set up to assess the effect of placebo. It it was set up to look at cultural differences in ulcer healing rates.

- The study did no include a "no treatment" group and, unfortunately, a "no treatment" group is the control group for a trial to assess the effect of placebo. Otherwise the effect seen could just the spontaneous healing rate of ulcers.

- In the author's own words: "The quality of these studies was generally good for the era in which they were conducted (mostly between 1976 and 1986), although probably not fully adequate by contemporary standards."
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written by Fontwell, January 11, 2009
BillyJoe: I'm just a layman in these matters, I think I have only read 2 or 3 original research papers ever, so unfortunately I can't give you much more information than I already have.

From the Bad Science book, my understanding of the Moerman work is that it is an 'after the event' meta analysis and so as you say, there is no control group etc. But the nature of the meta analysis was to compare healing rates in the placebo arms of unrelated trials which were all testing different drugs for the same condition. The point being that since the placebo arms all had no drugs in them, we might reasonably expect that recovery rates would be broadly similar.

The original trials were not set up to do this, so the method is not perfect but as Ben points out, getting funding to compare different style placebos using ill people who need treatment just ain't gonna happen. But using this meta analysis method seems like a valid approach in the circumstances. So because the placebo arms were all designed differently to match the various real drugs, what Moerman had was placebo recovery rates based on 2 dummy pills, 4 dummy pills, dummy injections or whatever. And the general outcome seems to be that the more 'culturally significant' the placebo was, the better the recovery rate, as measured by the objective physical symptoms. By 'culturally significant' I take it to mean how much more important and likely to succeed the treatment appeared to be to the patient, given their culture. For me, it probably goes, some pills; pretty pills; more pills; injections; zappy machine; surgery. Dancing in a feather headdress round a fire doesn't do it for me at all.

You prompted me to listen to the two Radio 4 placebo programs again and I was surprised at how many other objective examples were mentioned that I had forgotten about - the Pakinson's/dopamine one was particularly interesting. So, I don't feel I'm resting my case on one dubious example. I just spotted another from the book: Blackwell [1972] colour and number of pills for alertness in 57 students who suffered an hour long boring lecture. "Afterwards, when they measured alertness, as well as any subjective effects..." (my emphasis) pink pills made them more alert, blue more sleepy, more pills had more effect. Again the cultural significance is that pink is more awake than blue.

The usual extent of my reading is to evaluate trusted sources in a field, such as Randi, Richard Dawkins etc and then read their stuff aimed at the general reader. I don't read hard science books or papers. Thus I do rely on what theses guys say, which I am mostly prepared to do since they are bound to be better informed than I am. For medical matters my confidence in Ben is pretty high. He may make mistakes as you say, like Jeff and Randi do, but like them too he is the kind of chap who will acknowlage mistakes and not try to deliberately deceive (IMHO).

Interestingly, this whole discussion we've had rests on the classic conundrum for me: Given the time and brain power limitations we all have (well me anyway), we inevitably rely on trust at some point. So it is vital that we have some ability to recognise what makes a trusted source. If you want to develop that issue I think it is forum time, we are already way off topic from the OP!

Quick final point - it is very refreshing for me that here, as distinct from my normal life, when we had a vague difference of opinion, we tried to resolve it by talking about the quality of sources and trials.
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written by BillyJoe, January 11, 2009
Fontwell,

Okay, let's both just maintain an interest in this topic of placebos and not try to hash it out here. I just think we need to avoid getting all mystical about placebos and there is a tendency to do this by some commentators which leads straight into the arms of homeopaths and the like. I wish I could afford the time to start a forum topic on it but unfortunately I don't.

regards,
BillyJoe
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written by Fontwell, January 11, 2009
Totally with you on all points BillyJoe, especially that mystical is not a helpful word here. There is only mystery in as much as the topic is not fully understood but it cannot be innately mysterious.
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written by bolsius, January 12, 2009
In the dec issue of Time magazine 'Man of the year' There is a picture of Obama showing clearly on his arm
an ionized Q ray bracelet. I wonder what else he believes in.
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written by BillyJoe, January 14, 2009
It looks like a watch to me:

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