Reply turned post, what about the woo? style

This is a reply to a wonderful post over at Navelgazing Midwife called “The Science of Woo.” Please read the whole article. She discusses Dr. Amy’s inglorious departure from Science Based Medicine, and the science (or lack thereof) behind so called “woo” practices.

She writes:

I’m a half-woo practitioner. Of course, being a homebirth midwife, believing in chiropractic, acupuncture, massage therapy –for those that believe in them. I don’t think any of the CAMs work for everyone; I think that’s pretty much an understanding we woo’s all share. I have a very hard time with homeopathy, Tibetan bowls, therapies that diagnose through muscle testing or therapies that hook you up to machines and tell you how to relieve your headaches with five more sessions and two referrals. I know, I know… if I just took the time to learn about them, I would believe they worked, too. If I just knew more, I would surely change my mind. I know a LOT about CAMs; I used to own an holistic healthcare center where CAMs came and went, each new therapy sure to cure everything from a broken marriage to cancer. I watched desperate people turning to CAM when traditional medicine didn’t work. I was saddened by how many got sicker and went back to allopathy to try it once again.

I LOVE this post!

I actually sent links from my blog to SBM to apply to replace Dr. Amy. Then, I wondered if I was betraying my midwifery roots. Then, I got angry at myself. The midwifery model IS evidence based. A lot of interventions in a typical hospital birth are not. But, I am still fairly certain that an association with midwifery (even though I am a research fellow at a medical school) may be enough of a woo taint for SBM to want to avoid me. Which I think is a non-evidence based shame.

As for the woo…..sigh. I am all for people doing non harmful things. I see homeopathy as non harmful but pretty much a pile of woo hooey. There are some over the counter products labeled as homeopathic, such as topical calendula, topical arnica, and chamomile teething solutions that I think are effective AND do not follow the ridiculous homeopathic premise of like curing like, infinitesimally small doses of active ingredients, etc. These preparations are not always and do not have to be labeled as “homeopathic” nor made using true homeopathic techniques, which I find very few people understand. (Hint: homeopathy is not the same thing as anything remotely natural.)

The problem I have with the Secret and the other woo philosophies that have to do with positive thinking is that they do, ultimately, blame people for their misfortune. I prefer to believe that bad things can and do happen to good people, and it’s not because they thought too much about what could go wrong.

I think a great midwifery based explanation of this is in “Spiritual Midwifery” by Ina May Gaskin. When the first woman in their group was in labor, some of their members of their band of hippies told Ina May and her husband NOT to look up how to handle certain complications in a medical reference book they had, because that would be encouraging such things to happen. She didn’t, and they were caught off guard by a complication (luckily, I think mom and baby turned out OK). Ina May has angrily regretted that attitude since, and all of the midwives at The Farm are very well trained now in complications, including neonatal resuscitation. Ignorance is bliss until something goes wrong.

Ironically, I found medicine, and ultimately midwifery and obstetrics, through a job at a health food store, and then a job in the science department of a nutritional supplement company. I saw people using crystal pendulums to decide whether to buy something at the store. I saw employees telling sick people what they really needed was a complete raw foods diet. I heard licensed practitioners recommending and using iridology. *shudder*

I saw the figurehead of our supplement company showing off his fake degrees, and making unsubstantiated claims about the effectiveness of his products. I was shocked when I went from being an outside representative of the company, being fed (and then turning around and feeding to others!) these false claims of studies on effectiveness and Jordan’s extensive education, to being on the inside as a science researcher, as they were desperately scrambling to answer the FDA and FTC charges against them. What was even worse was the unreleased information that there was possibly unacceptable levels of lead in the supplements. (This is the first time I have talked about this in public. Hope my non-disclosure agreement with them doesn’t come back and bite me in the butt right now.) They worked hard to remedy that situation immediately, but I was upset that customers weren’t warned about their possible exposure, and I wasn’t the only one in the company to raise those concerns. But, there’s a worse risk of lead poisoning from the ubiquitous children’s toys from China than there is from an unscrupulous supplement company. Both are theoretically very bad, but both can persist in the regulatory climate in the United States right now. I think safety testing should be mandatory for EVERYTHING that crosses our (and our children’s!) lips, and I don’t think that possible heavy metal contamination is a unique condemnation of dietary supplements.

I still think there are many easily documented effective uses of food, herbs, vitamins, and other nutrients. Chamomile tea works for most people, and is a hell of a lot safer and cheaper than a benzodiazepene. Vitamin D is a hugely important nutrient. Don’t get me started on omega 3′s and how wonderful they are. I am currently attending an osteopathic medical school, and think some of the osteopathic treatments are very effective. Some, like cranial sacral therapy, are woo. Sorry, DO team. It’s controversial even within the DO community.

The supplement company I worked for had a lot of problems. A lot. (By the way, SBM, I can talk up and down about DSHEA, if you need someone to.) But, so does the food industry the FDA also regulates. No one says “Oh, but our food is UNREGULATED” because the FDA has about the same control over our food supply as it does the supplement industry. And, our pharmaceutical industry is also all farked up, and has a much higher death toll associated with it than all of the woo therapies combined. Nutritional supplement companies may not have to do research on their own products, but pharmaceutical companies don’t have to release (and DO actively suppress) negative outcomes or adverse events in their research, and don’t have to compare their new drugs to existing treatments.

So, I don’t know if SBM is going to tap me to replace the notorious Dr. Amy. I have a feeling the powers that be over there will take one look at my description as a “hippiefreak idealist” (or, just look at my new tie-dye and tinfoil header) and decide there is no way I can critique evidence. But, all I can say to them is: do your research.

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22 Comments

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22 responses to “Reply turned post, what about the woo? style

  1. My reply is in the format “I was 100% with you, until you dissed _____.” I wonder how many others you’ll get like this? :)

    I’m very skeptical of every CAM in your woo list…except craniosacral. My 4th baby had colic. It almost killed me. I tried all kinds of things…babywearing, gripe water, baths, no baths, quitting dairy. At my wits end, my midwife recommended craniosacral and I went along highly skeptical, totally convinced it was just woo, but desparate enough to try anything. I will never forget paying the bill after the first treatment, and realizing that my devil of a daughter was sitting quietly awake in her carseat while I wrote the check. It was stunning. Previously, she was either crying or asleep. Each time, she’d be calm after the treatment, and over the next 2-3 days would deteriorate, and we’d take her back again. Went on for about 8 weeks.

    Was I imagining all that? Can placebo effect in the parent of the patient produce an effect? Was it simply the result of the 20 minutes spent other than with her at-her-wits-end mother?

    And I wonder….should I not recommend this to my childbirth class clients with colicky babies, whom they are just about ready to hurl out the window? Because even if it is some third-party placebo effect, for me it was a sanity saver and maybe even a life saver.

    Liz.

    • MomTFH

      I am so happy craniosacral therapy was so effective for your daughter. It is probably not as “woo” with infants, since its premise is partially based on the movement of cranial bones, which are not fused in an infant.

      I shouldn’t have been so absolute about the entire practice. I am more critical about the way the entire concept was taught in my osteopathic medical school, for use on adults. We spent hours trying to feel each others’ CRIs (Cranial Rhythmic Impulses), which are supposed to be a sort of slow pulse created by the “inherent motility” of the cranial bones, the cerebrospinal fluid, the spinal cord and the sacrum.

      I can even swallow that part of the theory. It’s the part that this CRI can be felt in any bone in the body – the humerus, the sternum, the big toe – that I had an issue with. Our table trainers would come by and check our perception of the CRI by placing a hand on the humerus or the sternum. Even if they were feeling a rhythmic movement there, why wouldn’t it be due to the much more apparent fluctuations in respirations or even the cardiovascular system?

      It’s a sore subject among osteopathic students and practitioners. Many of our students mocked the labs spent learning about the CRI, and many say they could not feel it (but would never admit that to our professors or fellows), and faked their way through the practical exam. I honestly must say I could feel something, if I tried really hard, when I had my hands in the “cranial vault” position. But, whether it was the inherent motility of the CSF and the CNS, or just power of suggestion, or respirations, I can’t tell you for sure. When my table trainer came and checked my lab partner’s sternum, she said I was on target.

  2. I hope SBM does take you on–you come from a great place to talk about birth issues, since you have a lot of exposure to both “worlds” of midwifery and obstetrics, of in-hospital and out-of-hospital births.

    I agree with you about the woo stuff for the most part.

    • MomTFH

      Thanks Rixa. I think I would be well suited for it, not just because I am researching obstetrics and writing about it anyway, but also because I am experienced in debate, and that site is notorious for active debate.

      Also, as you said, I don’t buy into the philosophy that only the most interventionist care is science based, or that out of hospital birth is inherently unsafe. Especially when the evidence doesn’t support either concept.

  3. quixotess

    This post rocks my world. Especially the oh, snap! at the end. Totally rooting for you to go up in the world.

  4. downside-up

    I’m a regular lurker, having come across you on a board elsewhere on the web, but I just wanted to delurk to say thanks for this post; as a midwifery student who is both pretty un-woo, and extremely cynical about the limitations and contradictions of current bio-medical practice, it’s just so refreshing to read your writing, and this piece in particular.

    I’m finding it so frustrating to be stuck in a netherworld in which I can neither entirely trust the pharmacological treatments and technological interventions so prevalent in western medicine, or approaches such as homeopathy that rely on placebo effects and confirmation biases for their success.

    I find myself picking and choosing approaches – a bit of acupuncture here, nutritional treatments there, a “wait and see” approach on some occasions and a “knock it out with drugs” approach on others. There’s nothing wrong with that, given evidence-based practice is my intention, but at times I feel like there’s potential for me to end up on the wrong side of everyone, since it seems so many practitioners of western medicine or CAM demand complete subservience to their own model of care/treatment.

    • MomTFH

      Thanks. It is frustrating. The more you read, learn, and talk to people, you will hopefully be able to find out more about effective (and ineffective) treatments of all types.

      It is a shame when someone doesn’t want critical examination of any paradigm of health care. It’s just as bad to tell a diabetic to eat all raw foods and not take medicine as it is to tell them to just take their pill and eat what they want.

      I hope you won’t be on the wrong side of everyone. I am always happy when I find reasonable, thoughtful, open minded people out there. And we’re out there:)

  5. Thanks for the thoughtful post. I struggle with the woo factor too, and it’s nice to hear other people who like evidence-based medicine discuss their experiences with woo-ness without the automatic dismissal of the very concept you get from some people.

    The concepts behind homeopathy makes my eyeballs explode, for example, yet I have found many “alternative” treatments incredibly useful (including, I have to admit, craniosacral therapy, the woo-ness of which makes my eyeballs smolder too, but which I found amazingly useful for some specific nursing latch problems, colic-from-hell, and the terrible headaches I had after my car accident 2 years ago).

    For many years I resisted the whole idea of things like chiropractic and acupuncture. Then out of desperation (because traditional treatments weren’t helping, but cursing myself as I went for even trying woo), I tried them and was totally shocked at how much it helped. I’ve even done some things with the specific intent of *proving* they were quackery, only to find them helpful. (Gah!) OTOH, I’ve tried some things only to find them totally worthless.

    I can’t explain why some of this stuff helps; I can only try it and then document my own response, positive or negative. Given my pretty strong biases against woo and my inconsistent experiences with woo-ness, I don’t think placebo effect is an adequate explanation for conveniently dismissing my positive experiences, though I’m sure some people would try anyhow.

    My own (and others’) experiences still only amount to “anecdata” though; I’ll never stop pushing for well-designed studies of this stuff.

    And positive personal experience with a certain type of therapy doesn’t mean I check my brain and my dubious attitude at the door. Accepting that there might be something to the acupuncture thing doesn’t mean that I buy the concept of “qi” for its success, or that I buy into homeopathy just because I find acupuncture helpful.

    We can keep an open mind to the possibilities while still keeping a critically-appraising mindset.

    Downside-up is right; both allopathic and CAM approaches want complete subservience to their points of view, so it can be really uncomfortable to try and straddle the two worlds. And yet, how much more powerful tools do we offer to ourselves and others if we are willing to keep a questing, open, yet critical mind and look to take the best from both worlds.

    • MomTFH

      “Downside-up is right; both allopathic and CAM approaches want complete subservience to their points of view, so it can be really uncomfortable to try and straddle the two worlds. And yet, how much more powerful tools do we offer to ourselves and others if we are willing to keep a questing, open, yet critical mind and look to take the best from both worlds.” -> awesome!

      I am catching a little grief for the craniosacral criticism. I do think some of the techniques themselves can be quite effective. It’s the explanation and background theory I have issues with. Please, everyone, continue to enjoy cranial treatments without expecting a sideways glance from me!

      Like you said, you don’t have to buy into the theory behind a whole type of CAM (or allopathic medicine, for that matter) to try or support an individual treatment.

      And, there’s more to this than the simple placebo argument. One of the reasons why it is difficult to test certain treatments, such as cranial techniques, is that similar, gentle laying on of hands in the area should have some sort of a beneficial effect.

      Having a doula at a delivery in and of itself is an intervention, regardless of what techniques that doula uses. (Don’t get me wrong, I think doulas are incredibly well supported by evidence. They just aren’t examined with an RCT with a traditional placebo or sham treatment. They are compared to conventional care, which is arguably a better standard for many treatments.) Sure, if she stands in the corner and does nothing, it could be a placebo, or if she is a big jerk, it may have a detrimental effect on the labor and delivery. But, barring those rare extremes, it’s not the technique, necessarily, that is the root of the positive effect. Sometimes just doing SOMETHING, especially if it’s patient centered, is really beneficial, and not simply a placebo.

  6. I think you’d be great at SBM (which I read regularly). I hope they pick you up. It was very frustrating to be pregnant and looking for good, balanced sources of information. What I mostly found were people on the extremes, which wasn’t very helpful.

    I am a scientist. My PhD training is in biochemistry/biophysics. I’m pretty suspicious of all things “woo”, but I have stuck up for yoga on a couple of science boards. I have a repetitive strain injury, and I am absolutely convinced that yoga keeps it under control. Yoga once per week does a far better job of that than targeted stretches three to five times a day. My theory is that the whole-body nature of the yoga stretches is the key. I’d be thrilled if someone would do a study and try to figure it out, but I won’t hold my breath for that. The yoga true believers don’t really want to do a study that could prove that “chakras” are a bunch of hooey, and the hard core science types are too convinced that it is all woo to think about it critically.

    I also think that the arrogant, out of hand dismissal that alternative medicine ideas get from some quarters isn’t very helpful. It won’t change anyone’s mind, and in fact makes people less likely to listen. I think this in particular with the furor around childhood vaccinations. I vaccinate my kids. I very much believe that almost everyone should (the “almost” being in there to cover people with allergies to certain vaccine components and other bona fide medical conditions)…. but calling people stupid for thinking otherwise is not going to get them to listen to my arguments and rethink their position.

    • MomTFH

      Hear, hear!

      I don’t know if you’ve seen my Mommy Wars Bingo card, but I take on both intolerant sides to the vaccination debate.

      I strongly defend the right of conscientious refusal of many interventions, including vaccines. And, it isn’t helpful to make outrageous claims like these parents should have their children taken away my protective services, or that they are idiots who would let their kids play in traffic, or that there are huge public health risks for everyone in the United States from small pockets of non-vaccinated children (from the pro vaccine side) or that these parents are sheeple who shoot their kids up with poisons without questioning them and risk autism and severe disorders from routine vaccinations (from the anti-vaccine side).

  7. I think SBM *should* take you because you have one foot in both worlds and if they want their site to influence people who may in fact be misusing woo, you’re a great candidate.

    I couldn’t agree more with your post. I have felt very uncomfortable at times in my midwifery practice with the expectation among clients that I should always begin with a CAM therapy. Just today someone I know and respect asked me what the passionflower dose was for a pregnant woman with a systolic BP of 170! (I was like, 10 drops and make sure to dilute it in some nifedipine! :) (just so readers know – that is a joke and I’m not actually dispensing any medical advice!)

    I use the same woos you do – arnica in particular. I became an arnica lover after I took a serious fall while walking home from a restaurant on my last night in Guatemala after a summer I spent there. I took arnica when I got home and woke up the next morning feeling completely fine. I expected to be sore in every bone and muscle. Years later, while telling the story to someone, I remembered that I’d had two or three margaritas that night, in celebration of the end of a great summer (during which I didn’t drink at all since I was on 24/7 call at a birth center). I realized that it may well have been the tequila not the arnica that kept my muscles loose. But for some reason it’s still my go-to treatment for minor bumps and bruises.

    Another “woo” I would add to the list of good woos is probiotics for mothers or newborns exposed to antibiotics. I’ve been trying to get my sister, whose baby was (totally unnecessarily) in the NICU for a day on antibiotics to consider probiotics for her baby who now has blood in his stool and a probable milk allergy. I think she’s been reluctant because it feels like a “woo” thing to her (and she’s actually rather into woo, but rightly wants to be careful about actively giving anything to her son.) I sent her a relevant article from a recent issue of Pediatrics, and she decided to go for it. Sometimes I feel like the dichotomous attitude that “woo” is necessarily either all good or all bad prevents us from making rational choices about them.

    Go Hilary go! You are just the OB voice that site needs!

    • MomTFH

      Ha, well, no one from the site has bothered getting back in touch with me. I am going to focus on the sites I am already writing for that I don’t have time for: this one and Mothers in Medicine.

      Arrrgh on the probiotics thing. I used to research them, and anything there is almost a dozen Cochrane reviews on doesn’t count as woo anymore. I was so annoyed that the pharm professor at our school didn’t mention Saccharomyces boulardi (Florastor) to treat Clostridium difficile. The hygiene hypothesis is pretty mainstream. But, I guess there’s too much acceptance of probiotics by people who also accept the “woo”, so it has “woo” taint on it.

  8. It is interesting how one person’s woo is another person’s wonder drug. I look at it pragmatically: does it work? I mean, really work? Or do people just say it does? What is the proof? As you said, so much of midwifery is dismissed as woo, yet it has a solid base in evidence…whereas most common obstetrical interventions have absolutely no grounds in actual science. There’s your snake oil right there.

    And OH YES on the Vit D and omega-3s! As a lifelong sufferer of chronic depression, it is really amazing how similar the effects of a daily Vit D pill, some sunshine, and omega-3 supplementation of my diet (whether naturally occuring in food or by including fresh ground flaxseed in recipes) are to Zoloft. Yet the former is so much cheaper, and the benefits go beyond making your blues go away. Do what works, I say. If that’s homeopathy, then it’s not woo for you.

    • MomTFH

      Yes, yes, yes, on omega 3′s and depression. I wonder if there’s any association between the fat-free craze (to mention another unscientific thing everyone took as not woo) and the increase in depression diagnoses and anti-depressant prescriptions.

  9. Pingback: Conversations after the survey « Mom’s Tinfoil Hat

  10. I think some of these “woo” therapies have some merit, and many are completely bogus. The tough this for science oriented people is that most of these therapies are not subjected to randomized studies, and wonder why? Sometimes CAM practitioners say that these therapies are based on ideas that cannot be studied in that way, but to me and many folks that is just an unwillingness to put their therapy to the test.

    I don’t have an opinion about craniosacral therapy, other than to say that I don’t believe there is randomized data to support it. If there are tons of people who believe in it, why not put together a randomized trial?

    ie. take 200 colicky babies and do craniosacral therapy for 100 vs non directed rubbing/touching as a comparison, and see who has more colic symptoms. It would be important to deliver the therapy away from the mother, and to not tell the mother which therapy the child got. Then mom fills out a survey about the babies behavior over the next few weeks. Compile the data and publish it. Then repeat it a couple of times.

    So why hasn’t it been done? I think it is because a lot of CAM folks would rather go off the fundamental nature of their ideas rather than using hard science to investigate their techniques. I hate to be a bit cynical about it, but I think subjecting a lot of these techniques to study could only help the therapies. Without the studies, there is a population of folks that will ask for (and pay for) these interventions. If studies are done and are negative, that business could go away.

    So many CAM therapies just don’t have a basic concept that fits with our understanding of human physiology. Acupuncture, which is perhaps the most accepted CAM therapy, is a great example. I have no idea how that works, and have some doubt if is anything more than a placebo effect. If you ask a CAM provider about it, they can only explain it by invoking a completely different thought process about how the body works, that isn’t really compatible with modern understanding of physiology.

    That being said, placebo effect is real. Even if acupuncture only works because the patient believes it will work, that doesn’t mean it didn’t have a beneficial effect. Placebo can be very powerful, and just because something is placebo doesn’t mean it doesn’t help.

    That is all.

  11. >> I hate to be a bit cynical about it, but I think subjecting a lot of these techniques to study could only help the therapies.

    I meant “could only __hurt__ the therapies”

    • MomTFH

      I think it could hurt or help the therapies, depending. So, I’ll leave both versions up. if you don’t mind.

      I know there is some research going on in the osteopathic community, including some on craniosacral therapy. Some look to examine physiology and standardization of technique (at my university, for example).

      Some studies are outcome based, and have a sham therapy as the control (like the touching the baby example). There are also studies comparing treatments like therapeutic touch, in preterm infants, for example, that compare the treated infants to standard care.

      Both control techniques have ethical and methodological issues. But, both can provide some insight into the effectiveness of treatment.

      And, I completely agree there is something to be said for the placebo effect. Especially when it is coupled with treatment and attention by a caring practitioner who hopefully has your best interest in mind, even if they have unorthodox ideas what the path to that best interest I just hate that it is assigned to treatments that have a “woo” tinge to them almost exclusively, when there is some indication that other, more medically mainstream treatments are also no more effective than placebo in most people (such as, arguably, most SSRIs).

        • MomTFH

          Oh, absolutely. I can argue with myself about it. Here goes:

          I know many, many people who have found antidepressants effective, even life saving. (That applies for many woo therapies, too.)

          But, recent reputable sources have seriously called into question SSRIs efficacy in most patients.

          I am not saying they’re evil, or non evidence based, necessarily. But, they have documented side effects and risks that are, again arguably, more significant than many woo therapies. And, their efficacy is not necessarily much better than placebo, at least according to these two recent reputable publications.

          Yet, we are giving them to pregnant women. What’s the alternative? Doing nothing and feeling like we are letting someone suffer, or recommending a stigmatized woo therapy, (even an arguably effective one, like talk therapy, and/or exercise, and/or omega 3 fatty acids)?

          It’s an agonizing subject. My cousin Susan did suffer from depression, did opt to take an SSRI during her pregnancy, and still relapsed into more severe depression and alcoholism post partum. I don’t know if she would have been better off not taking the risk with the SSRI, or if she would have been even worse without it.

          All I can say is more studies, with all of the results published, please.

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