
It’s a part of my paleo fantasy, it’s a part of my paleo dream - tokenadult
http://www.sciencebasedmedicine.org/index.php/its-a-part-of-my-paleo-fantasy-its-a-part-of-my-paleo-dream/
======
Udo
I'm getting kind of an asshole reputation for always arguing with friends who
are deeply into C/AM. But I'm also starting to realize it's exactly like
arguing with a religious person - there is absolutely nothing you can say to
make them realize their faith is based on fallacies. There is absolutely no
correlation between the general intelligence of a person and the
ridiculousness of their belief claims. You could be talking astrophysics one
minute and the next you're into a strange shamanistic wonderland where science
doesn't exist. I really do think it's a faith-like mental virus.

On the whole, it doesn't worry me too much - everyone is entitled to their
little domains of craziness and I know I have my own.

But what does worry me is the observation that C/AM believers in my
environment are almost always women. It feels like a big gaping hole in
everything we achieved with women's rights and education. Within my extremely
limited horizon of living in a western industrial society, this is in fact the
single most worrying trend. It's like a large part of our women went to a
parallel universe "girls school", whereas the men in the mean time learned
about science and reasoning.

I'm at a total loss as to where this gender disparity comes from, but there
has to be a vector _somewhere_. If anyone has any ideas, I'm looking forward
to hearing them. If there is anything to be done about this, I'd like to
volunteer my time for it.

~~~
JPKab
I've found that, at least amongst 20 and 30 something age groups, women tend
to be more religious too. Now that is my crappy anecdotal observation. It
would be interesting to see some real data on that.

I'm convinced that the whole C/AM thing taps into an instinctive love of
purity. We are wired to care about cleanliness and purity in our food sources.
Perhaps women are wired even more this way (the fact that they have superior
senses of smell to men might also explain it). The Nazi movement took
advantage of many people's innate belief that purity of anything (in their
case genetics) is a good thing no matter what.

There was an article posted not too long ago about fireplaces, and how bad for
you they really are. There are two kinds of people: those who will readily
evaluate facts which contradict their pre-conceived beleifs, and those who
will immediately dismiss them.

~~~
Udo
I really refuse to accept that women are just "wired for faith", it sounds too
similar to the Victorian notion that somehow women are naturally wired for
irrationality. There has to be a social reason why this spreads among women,
there is a gap somewhere in science education that leaves women more
vulnerable to this.

And I _actually_ watched it spread. The transmission seems to be helped by
exploiting trusted relationships among network nodes, so to speak. But that
still doesn't explain why someone is susceptible to the attack in the first
place.

I'm also skeptical about the purity idea, because it's an arbitrary (and
wrong) definition of purity to begin with and there is really no reason why
women should be hard-wired to fall for these things. This is traditionally the
moment where completely made-up cavemen analogies are introduced, but those
are exactly as unscientific as C/AM itself.

~~~
bitwize
Women are more prone to fall for BS because we enculturate them to believe
that emotions and warm fuzzy feelings are a more reliable guide than science
and logic. Third-wave feminism is partly to blame; the notion that science and
logic are "patriarchal" and that not oppressing women entails a warm and fuzzy
"feminine" replacement for disciplined thought is the third wave's doing.

Thinking logically, critically, and skeptically is an ungendered activity.
Women are as capable of and welcome to it as men are; we should be
_encouraging_ the females of our kind to apply reason and evidence to their
judgements! Sadly, we're the culture that produced Oprah and turned her into a
media mogul powerful enough to make the foundations of the earth tremble.

~~~
Udo
This is purely an image problem for science education, then. Because there is
absolutely _nothing_ warm and fuzzy about the "natural state" or whatever
romanticized notion we're entertaining about nature. Applied science, and more
importantly, the ability to apply science, enables people to build, cure,
protect, predict, ensure, improve, discover, and many other things that are
intrinsically more warm and fuzzy than, say, naturally dying of a curable
disease.

~~~
illuminate
Yes, Oprah and Dr Oz etc. are all failures of science education, they have far
too much control over public understanding of health.

------
stiff
Calling the "naturalistic fallacy" a fallacy is a bit of an overstretch IMO,
sure natural=better is not a rule true 100% of the time, but nevertheless
until sufficient evidence has not been accumulated that some of the
adjustments we make to our lifestyle are not harmful to us health-wise
avoiding them is not an unreasonable heuristic to follow. One example is how
it became clear in the last years in nutritional science that in general the
more processed the food is the more harmful it is for us.

There is also the reverse problem, illustrated by the condescending attitude
toward herbalism in this article, of people who idealize modernity, and for
example believe only medicine in the form of pills can be effective, even
though plants may contain exactly the same chemical compounds. I am not saying
there is no fraud in herbalism, sure there is plenty of it, but herbs in
general clearly can have strong both positive and negative effect on
physiology, which is really quite obvious if you consider the variety of herbs
existing and that they all contain lots of different chemical compounds.

In general I think it is ridiculous to ignore the thousands of years of
experimentation and exploration of our ancestors just because it wasn't
"science-based".

~~~
saalweachter
The problem with herbalism is that it's the first place science-based medicine
went looking for drugs. For basically any herb and effect someone ascribes to
it, there have already been twenty rigorous studies, and either no statistical
effect was found or the responsible chemicals were extracted, purified,
concentrated, and synthesized and are now marketed under two brand names and
three generics.

Going to herbs directly isn't going where no science has been before. At best
you're getting a known drug which is poorly dosed and mixed with a shotgun of
other chemicals which may be harmful. At worst you've just got a cocktail of
potentially harmful (remember, even most of the "good" effects come from
poisons the plants produce to keep things from eating them) chemicals with no
actual benefit.

~~~
stiff
Yours is a very common response I get to this - I wonder why, since there is
absolutely no evidence for it. You vastly underestimate the number of plants
in existence and vastly overestimate the fraction we have been able to study
rigorously. You also hugely simplify the chemistry of it all, the main
advantage of plants over modern medicine in its typical form is that they
contain complex compounds of chemical substances which show a synergy in a
certain direction e.g. they interact with the body in a different way when
they are administered together than if they would be ingested separately.
Analyzing such compounds and the interactions between them is still often
beyond the current state of science and is also not as well funded as
traditional drug research, simply because traditional drugs are easier to
sell.

Please don't have the impression that I am somehow advocating herbs over
traditional medicine, I don't, and there are surely problems with using herbs,
but those are different problems that the one most often mentioned. The
material you use has to be rather fresh because the concentration of active
substances degenerates with time very quickly, the concentration also varies a
lot from one area of growth to another so it might be difficult to come up
with dosages, they can have serious side effects just like traditional
medicine, they are inconvenient to store and use etc.

You can find scientific references for most of what I said and anyway it would
come to no surprise to a second-year biology undergraduate. Just reading the
wikipedia page about herbalism would clarify a lot of misunderstanding on the
topic:

<http://en.wikipedia.org/wiki/Herbalism>

~~~
saalweachter
Following the reference through from the "clinical trials" section, the
Wikipedia article is a little misleading. It makes it sound like only 356/1000
random plants have been studied, but in the paper [1] the breakdown is
actually:

15.7% had been tested in clinical trials; 50.9% had been tested in vitro or in
vivo; 20.8% had been subject to a phytochemical study; 12.1% had no studies
found in the literature search; 0.5% were "dangerous".

That's not saying only 1/3 of plants had been studied. That is saying that 87%
of plants have been studied.

[1]
[http://onlinelibrary.wiley.com/store/10.1111/j.1365-2710.200...](http://onlinelibrary.wiley.com/store/10.1111/j.1365-2710.2009.01096.x/asset/j.1365-2710.2009.01096.x.pdf?v=1&t=hefpl605&s=faea8e390010801b9f75500688ff8692ba0852e3)

~~~
stiff
I was thinking we are talking about all plants in existence, this is a study
of 1000 most commonly used herbs, still, I learned something new, so thanks.
Still it doesn't prove your more bold claim that somehow all the potential
benefits of using them are already available in a very safe to use pill.

~~~
saalweachter
My overconfidence is mostly coming from the long tail.

Even if there are millions of distinct plant chemistries out there, a small
number (say, 100) will account for 90% of the herbal remedies prescribed and
taken. These will have been studied by scientific methods exhaustively. The
next most common chunk will have received some cursory attention, and then you
enter into the vast fields of the unknown.

But the fields aren't unknown to just science: they're unknown to cultural
practitioners as well. I'm willing to believe that, even without double-blind
clinical trials, people were able to find effective treatments with enough
trial and error. But "enough trial and error" means "not the long tail". So
once you start talking the 1000th most common plant used for medicinal
properties, the amount of experience pre-scientific practitioners have
accumulated is negligible, and handful of anecdotes at best. Not even enough
to ascribe correlation, let alone causation.

So on the head of plants of potential value, I'm betting that they've all been
studied exhaustively. On the tail, there are countless plants which could have
countless benefits, but essentially no evidence to do anything but pick one at
random and hope it cures what ails you. The middle, of enough evidence to
suspect or know a plant does something, but not how, is going to be fairly
small.

~~~
stiff
I agree with your reasoning, but you assume that the outcome of the research
on a given plant will very quickly lead to a total understanding of its
ingredients and effects and that it will always be feasible to develop a
technological process to deliver the same complex of ingredients in the form
of a pill, neither of which has to be the case.

~~~
Nursie
For something to be interesting the outcome of research on a given plant
should at the very least be that there is an effect to study, or it's not
worthwhile. Nobody says "we don't understand how it works, therefore it
doesn't work and we should throw it away".

------
knowtheory
Thanks for finding this tokenadult.

I've been trying to convince my wife (who has a degree in dietetics and a
minor in anthropology/archeology) to write about this subject for a while, but
food and diet are such visceral topics for people that she finds discussions
of the topics incredibly frustrating.

Food, language, gender norms, these are all fields of study where there is
substantial research and a lot of resolute but unfounded claims by people with
axes to grind, or products to sell.

All of which is to say, there's not a lot of skepticism, even amongst
populations who claim to be generally analytical and skeptical.

~~~
teach
My wife is the same way. She has a PhD in nutrition and is also a registered
dietitian, but she just can't muster the energy to argue online with people
that have read two articles on Pub Med.

------
babblefrog
A couple of points:

1\. Most or all of the mummies studied were from neolithic societies, not
paleolithic. The only one that might be considered paleolithic is the Unangan,
but even these are from decades after they were conquered by the Russians. So
they may very well have had white flour and processed sugar in their diet. I
couldn't find information about their diet during this period.

2\. The time needed for natural selection to work. I'm not convinced by this
one. The examples that were given would have had higher selection pressure on
the young during their child-bearing years. I would guess that the selection
pressure from diseases of old-age would be much less, and would take many more
generations to be felt.

Still some good points to be made about the naturalistic fallacy.

~~~
skittles
Seems like even scientists don't have a good understanding of diet. I just
watched a show that mentioned Henry VIII's diet. They mentioned how it made
him fat because of all the meat he ate. I thought "that doesn't sound right"
and looked it up. He didn't eat vegetables (considered peasant food at the
time) and ate a lot of meat. What probably made him fat though was all the
bread, desserts, ale, and wine mixed with sugar. If he stuck to meat and added
some vegetables, he would have been fine.

------
ef4
My objection to this article is that it's posing a false dichotomy. Choosing
our diet based purely on good solid science _is not an option_ , because our
scientific knowledge is still too limited. Any honest scientists will admit
there's still a lot of complexity we don't fully understand. Which is
precisely why there's so much exciting research going on right now (example:
<https://twitter.com/whsource>)

Wherever we have solid evidence it absolutely needs to win out. But that's not
the issue here. What we have here is a lot of fuzzy, plausible ideas that are
extremely difficult to prove via experiment.

If you want to say categorically that "the paleo diet" (or almost any other)
is good or bad, then you need to do a gigantic, long-term, prospective,
randomized study of actual human beings. Which is not practical.

So we're left doing the best we can. We rely on heuristics to fill in the
gaps. Eating the same things that your ancestors ate is not a bad start.
(Granted, that's not necessarily "paleo").

------
mkr-hn
Paleo falls into the same trap as most ideologies. Some percent of True
Believers become jerks about it ("but it's so obvious! Just look at [weakly
correlated thing]!"), and end up making the whole group look bad.

It's unfortunate, because most ideologies don't seem to be made to alienate.
We get along fine as long as we don't bring up our pet beliefs.

------
venomsnake
It is not about the paleo. First - while atherosclerosis may be a normal part
of aging, does it say anything about ancient heart attacks and strokes? I
don't care of the plaques in my arteries I care about not being dead from a
heart attack.

Also the influx of refined carbohydrates in our diet is a big change. So maybe
we have not evolved yet to cope with them in the current amounts and purity.

I think most fad diets have the following problems:

1\. Little and improper science - so even if they work they can't explain why
or how.

2\. One size fits all - I invented the paleo diet without ever heard of it -
once I decided to quit sugar and starches cold turkey - I have always loved
raw nuts and vegetables, grilled meat and cheese. But this is not for everyone
- alot of people will not find it tasty. So they eat something they hate - the
result is they have problems adhering to eat and abandon it.

3\. Government has failed to do its job on the nutrition front. Every
recommendation is fought by the losing industry lobbyists, there is little
exploitative science done etc. While every person should have the choice they
also have to have access to transparent, true and scientifically proved
nutritional information - otherwise we will always have the next wonder diet
on which sizable portion of the population will be on. A lot of people will
hurt themselves taking it to the extremes and so on ...

------
vitno
and this is why I wish the paleo-fanatics would stop harping on the
"evolutionary based" part.

I eat pretty much paleo. I avoid grains, I limit dairy consumption, I avoid a
lot of sugar in my food. However, a lot of the "science" behind paleo is
bullshit. The name & culture is the worst thing that could have happened to
the diet.

Food is important to your health. I eat a lot of vegetables, high quality
meat, and avoid high amounts of carbs & sugar now. How could I not feel
better? It doesn't have anything to do with evolutionary adaptability.

edit: knowtheory below is referring to something I edited out regarding an
attempt to double blind myself to ensure this wasn't all in my head.

~~~
knowtheory
See, that's just fine! It's awesome that you've found a diet that makes you
feel better.

But here's the thing. You can't double blind yourself. That's the whole issue
with blind trials. Double blind trials require that you do not and can not
determine whether you are in the treatment group or not. Additionally, unless
you're having an unrelated person prepare the food, w/o any knowledge of which
foods are in the "paleo" group vs the control group, you're not operating
double blind.

If it's just you and another person, it would be challenging to set up a
double blind experiment (although i'd be interested to hear what you tried).

~~~
vitno
I removed that. I figured that I would get some flak. :P

I did have my roommate prepare the food. Another one of my roommates
swapped/labeled the food and then went to class, no interaction. It was mostly
because he didn't believe that I could feel it and that it was mostly in my
head. (which I totally understand, I was pretty worried about that as well)

We switched out white flour for some almond flour. We also did another one
where he sweetened something using honey and another using corn syrup. (I
could totally taste the difference there though)

Certainly not rigorous, but enough to make me pretty sure it isn't entirely a
placebo effect. I'm planning on getting a Celiac Sprue test at some point.

~~~
LaGrange
If you have adverse reactions to wheat products after provocation (even tiny
amounts should trigger the effects), then it's indeed likely that you do have
coeliac disease. About 1% of population have it, so it's not that surprising.
Just remember that a test would require a proper, long provocation, otherwise
you'll just get a negative from the biopsy because there's no intestinal
damage anymore.

On the other hand, if a diet helps, and provocations after, say, a month (but
without your knowledge) make things go downhill fast, you can be sure enough.
Welcome to the wonderful life where you get to check yoghurt for trace amounts
of wheat products, and pizza is a holy grail (one of my closest friends is
coeliac, for people in Amsterdam area, Woodstone in Haarlem makes good gluten-
free pizza).

~~~
acangiano
I'll add to this that it is often (not always) possible to detect the presence
of Coeliac Disease through a blood test. That should be the first step before
going the colonoscopy route.

------
tcskeptic
I'm not a Paleo dieter, but I am familiar with the gist of their claims. I do
not understand how this study is a response to those claims. The 137 mummies
studied are from "Individuals from ancient Egypt, ancient Peru, the Ancestral
Puebloans of southwest America, and the Unangan of the Aleutian Islands were
imaged." Of those we have 3 agricultural civilizations (Egytp, Peru, Pueblo)
and one hunter gatherer (Aleutian). So 3/4 of the studied civilizations don't
argue agains the basic Paleo claim at all. I can't see from looking the the
links what the results from the Aleutian cohort were.

~~~
darkarmani
No-true-paleo fallacy.

~~~
ef4
The no-true-scotsman fallacy implies a shifting or pedantically narrow
definition. That's not applicable here.

Paleo fans are very clear that they're trying to emulate pre-agricultural
diets. That's the _sine qua non_ of the Paleo fad. So it's totally legitimate
that they would object to evidence about agricultural societies.

------
api
I have a friend who's into homeopathy and such, and I normally keep my mouth
shut. But I have done some thinking about why. This friend is very smart, very
intellectual, very curious, and not overly credulous. She's really a bit of a
nerd.

From my few conversations on the matter, the thing that's jumped out at me is
this:

She's drawn to alternative medicine because it's open source. Like many nerds,
she hates closed proprietary systems and loathes bureaucracy.

If alt-med worked, it would be vastly superior to conventional "industrial"
medicine. The latter is bureaucratic, run by closed guilds, closed source, and
radiates this standoffish "you are an idiot, do not ask questions" mentality.

By contrast alt-med is open. Anyone can learn about it. Anyone can become a
practitioner. Anyone can experiment. It's tolerant of differences of opinion
to a much greater extent than conventional medicine. It comes off as
welcoming, inviting, and engaging.

Of course, I understand some of the reasons medicine is the way it is. Unlike
hacking code on a computer, screwing up medicine can really hurt people. (Code
on a computer generally can't, unless you're talking about certain kinds of
specialized areas.) But it does seem to me that this is part of the appeal of
alt-med.

The other appeal, I think, is escape from the bureaucratic hell that is
conventional medicine. Alt-med is actually more free-enterprise. There is more
patient choice. It's less expensive. My wife and I just had a baby, and
dealing with the insurance company has been a living hell.

Edit: one more observation.

We've tried a little bit of alt-med type stuff to varying degrees of success.
I think I can also say this, and I think it goes a long way to explaining alt-
med's popularity.

The bedside manner you get with "alternative" practitioners is _vastly_
better. I mean huge orders of magnitude better.

We have a pretty good doctor and a pretty good hospital, and even then we
occasionally feel like meat. And ours is really above average in terms of
doctor-patient relations and comfort. I've heard some real slaughterhouse
horror stories, particularly around women giving birth in ordinary hospitals.
I have a relative who has such a story. She really felt like a piece of beef,
and the doctor was a real jerk.

The physical design of the spaces is better too. Go into an alt-med clinic and
it feels warm, welcoming, calming. Go into a hospital or a conventional
doctors' office and it looks like a car repair shop. Again -- to draw an
analogy to the computer industry -- Apple has proven just how much aesthetics
matter. Apple's products are generally not technically superior, but they are
often vastly superior aesthetically and in terms of usability.

~~~
robbiep
There was an interesting study done - and written up on SBM - that suggests
that the theraputic effect of Alt-med, at least with acupuncture, is entirely
due to patient-practitioner interaction.

As someone on the cusp of becoming a Doctor, I understand this. I even
understand why traditional medicine fails at it (and it is many of the reasons
you mention). And I understand why Alt-med succeeds here.

I think it's great that alt-med can deliver a measurable placebo through the
clinical effect.

HOWEVER

this does not excuse the intellectual dishonesty of alternative medicine
practitioners.

Please anyone who replies to this suggesting that 'We don't know enough about
alt med, bla bla bla, big pharma won't study it because it can't be milked for
the elixir of life, money/human blood, etc' - Stop now. There's 3 types of
treatments. _Medicine proper, Stuff that has been tested and found wanting,
and stuff that hasn't been tested_. The second category is almost exclusively
the whole of alternative medicine.

please excuse my divergence as I return to the train of thought:

We should continue to deny alternative medicine practitioners legitimacy. As I
argue in the SMH article (3rd contribution in the article) referenced at the
bottom of this post, it causes an economic misallocation of resources away
from real, practical science towards, for want of a better word, magic.

What we should also do, I now believe, is actively encourage these people to
become 'Lifestyle practitioners'. They don't practice a form of medicine, or
at least drop the pretence that what they are doing has any scientific
backbone, and instead do what they are doing now - that is, interacting with
patients, talking with them about their lives, encouraging positive lifestyle
interventions (cutting out smoking, drinking, increasing exercise, etc) in an
environment that it seems they are more responsive to these interventions.

You can't have both. It is false and misleading for Alt-med practitioners to
continue to pretend and/or believe that what they are doing has a real
scientific basis in the same way as taking a drug that has been through a RCT
does.

But you allude to the root of the problem when you talk about the shabby
operation of many hospitals etc.

The difference is, they are built for really sick (or in your example,
pregnant) people. Lots of them. Because there are lots of them. And alt-med
practitioners will kill them by the bucketload if we were to get rid of
hospitals and doctors tomorrow. and then society would go through the process
of re-inventing something similar

Maybe one day hey?

* - [http://www.sciencebasedmedicine.org/index.php/legislative-al...](http://www.sciencebasedmedicine.org/index.php/legislative-alchemy-iii-acupuncture/)

* - [http://www.smh.com.au/opinion/the-question/should--universit...](http://www.smh.com.au/opinion/the-question/should--universities--teach--alternative--medicine-20120203-1qxb3.html)

~~~
up_and_up
What percentage of Conventional medicine practices are evidence based?, ie
what percentage of what you as a conventional MD practice has been subjected
to RCT?

I have a friend who is a Internal Medicine MD who claimed it was less than
50%. If thats the case then every conventional MD continues "to pretend and/or
believe that what they are doing has a real scientific basis".

Please give me a % of what you do in a clinical setting that has been
subjected to RCT otherwise you are setting a standard for CAM that even you
cannot meet.

Can you explain, why, with all our advanced conventional medicine etc the USA
still ranks 35 in the world for infant mortality, below even Cuba, Slovakia
and Brunei?
[http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor...](http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate)

EDIT: Okay, I did my own research into my question above. I am sure this is
just scratching the surface here.

See here:
[http://journals.cambridge.org/action/displayAbstract?fromPag...](http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=101041)

~~~
robbiep
Well let's start with your last question first.

I'm not an American and I won't practice there. I'm Australian and we score an
improved 19th on that league table. However I recently had the opportunity to
study/work in a hospital in the states and these are some of my observations.

\- The US healthcare system is fucked.

\- there is a major disparity of care by region and neighbourhood (from my
experience)

\- poor people are discriminated against by the healthcare system

\- these inequalities of care and resources are perpetuated down the line by a
social system which doesn't support the most needy n society

In comparison, Cuba has one of the highest rates of doctors per capita and a
healthcare system that performs astoundingly well, especially when compared on
a dollar basis. You don't need high tech to perform life saving basic medical
treatment, such as that which infant mortality measures.

I feel that the US healthcare system over-emphasises technology to deliver
solutions, when what is actually needed are people on the ground in places
where they are needed. Unfortunately for those people, they are unable to pay
so no-one is going to go to them.

Now to the meat and potatoes of your claim. Firstly let me say that it strikes
me as a bit aggressive. I said * in the same way as taking a drug that has
been through a RCT does.*

If I am to respond to your whole query, then really I am throwing open the
whole of medicine. And it's a big area. Everything from the correct techniques
for birthing to height projection charts for children, through immunisations
and treatment for common illnesses, to whole specialties of cardiology, renal
medicine, .... Many many more.

But let me give you some anecdotes to show you how much of medicine HAS been
studied. Maybe You will cry 'liar, deceiver!'. Or maybe I will be able to
convey to you a bit of the never-ending torrent of information every doctor is
swimming in (and I will admit, there are some that simply stop looking at it
all).

Firstly. We have to do assignments called PEARLS. basically, w come across a
clinical question and go and try and find evidence for it. As (at the time) a
3rd year med student, I still didn't really have much idea what was going on
in the hospital, let alone how to formulate a clinical question and find an
answer.

My question involved an elderly patient who had been transferred to the
service I was on. He was on an ace inhibitor and an Angiotensin-receptor
blocker. That is, 2 types of drugs which supposedly do the same thing.

This was a bit weird to me but it turned out there is some plausible science
behind it - combination treatment might lead to being able to use lower doses,
which can mean less side effects, as well as more effective RAAS blockade
which might lead to better control of blood pressure.

Well it turned out that for this question I thought was stupid and pointless
there had been a recently completed RCT, The ONTARGET Study, which proved that
dual blockade is worse than single drug use.

My housemate is currently doing his, and his clinical question is whether an
infected abdominal surgical wound should be closed or left open. Also seems
like a Bizzare question but turns out there are several papers on this, and
they say that the wound must be left open.

No RCT this time, but it is notoriously hard to do RCTs in surgical patients
for reasons I'm sure you can understand.

A thir anecdote: when we start med, they tell us that 50% of what we learn
will be obsolete at the end of 4 years of study, the problem is we don't know
which 50%. Such is the rate of scientific advancement.

When I first heard this I just thought it was an embellishment, a story
designed to boast of the speed of discovery. Turns out its true. Some
significant changes have occurred since I've started studying that have
overturned long-held practices.

An example would be the use of lidocaine and adrenaline/epinephrine in local
anaesthetic for closing a wound in the extremity.

It was thought that the adrenaline would cause vasoconstriction which would
lead to infarction and possible loss of a finger or toe if used. Recently a
RCT was performed which showed it to be totally safe. That Overturned a
practice that had been going for many many years.

The truth is, I can't give you a figure for the amount of evidence that has an
RCT done for it. This is not shirking from the responsibility, but it is
simply admitting that the scope of the practice of medicine is so unimaginably
vast that even after spending 4 years deep in the thick of it, I know I will
only ever be able to be proficient in a tiny area of the whole.

I can assure you, however, that people are working hard to ensure that
everything will be studied. I would estimate that 99%+ of our practice has
been published in some form, ranging from the worst - simple case reports,
through to the most expensive and rarest- RCTs. We even study how reliable the
examination signs are - by this I mean the percussion of fingers on your chest
to detect various conditions (dullness indicating pneumonia has a likelihood
ratio of 3, hyper resonance indicating COPD has a positive LR of 5.1) and
every other thing that we do.

Some of these studies are bad; some are outdated; and sometimes we do things
for years because they became habitual and weren't re-examined for a long
time. And sometimes these things cause harm to patients.

But you can bet that it is the aim of medicine, and of science, to test and
re-test all of the things we do, continually, with the aim of improving our
practice and providing better and safer care.

The same can't be said of alternative medicine

------
up_and_up
The problem with "Evidence Based Medicine" vs CAM are two-fold, according to
my friend who is an MD in internal medicine at the local VA.

1\. 'Evidenced based' medicine is not really 'Evidenced based' because (again
this is according to an MD) 50% of what they practice has not been subjected
to scientific study.

2\. Also there is not the time nor funding to test every aspect and modality
of CAM. So some CAM practice might really be working for patients but there is
not time nor funding to discover why.

This seems like yet another rant by some Physician whose 'religion' is
actually evidence-based medicine.

~~~
potatolicious
You're really going to base your entire argument around the purported
statements of your doctor friend whose identity, statements, and views cannot
be verified?

You'ved made multiple comments in this thread that amount to exactly "nuh-uh!
my doctor friend said!"

In the spirit of yesterday's fallacy thread, this is both a (bad) appeal to
authority and using anecdote as data.

~~~
up_and_up
Here is some 'evidence':
[http://journals.cambridge.org/action/displayAbstract?fromPag...](http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=101041)

"The number of reviews indicating that the modern biomedical interventions
show either no effect or insufficient evidence is surprisingly high.
Intterrater disagreements suggest a surprising degree of subjective
interpretation involved in systematic reviews. Where patterns of disagreement
emerged between authors and readers, authors tended to be more optimistic in
their conclusions than the readers."

------
rohern
>But how does one determine what the prevalence of cardiovascular disease was
in the ancient past? Time and the decomposition it brings are brutal on the
flimsy meat of which we are made, and it is uncommon to have access to
anything other than bones, much less bodies intact enough to be examined for
signs of atherosclerotic disease. Even so, however, there have been
indications that the idea that ancient humans didn’t suffer from
atherosclerosis is a comforting myth, the most recent of which is a study
published a week ago online in The Lancet by Prof. Randall C. Thompson of
Saint Luke’s Mid America Heart Institute and an international team of
investigators entitled Atherosclerosis across 4000 years of human history: the
Horus study of four ancient populations. Basically, it was a study of 137
different mummies from four different geographic locations spanning 4,000
years.

The whole time I was reading this I could only think, "science is great!"
Thanks for posting this.

------
wmat
I recently lost 30lbs by adopting a low-carb/real-food/paleo way of eating. As
a result, I feel much better, sleep better, and have increased energy. My
moods seem to be stabilizing and I feel more confident than ever. The decrease
in weight has enabled me to exercise more comfortably, which in turn has
resulted in an increased frequency of exercise, as it's now enjoyable. I can
appreciate that the science behind the Paleo movement is not perfect, but the
benefits I've realized from it far outweigh any questionable science employed
to sell a few books by Loren Cordain along the way. It all basically boils
down to application of the 80/20 rule to diet anyway.

------
JPKab
I agree with a lot of what this article says regarding the "naturalistic
fallacy",etc.

However, this quote is an example of shallow thinking that drives me nuts: "Of
course, it’s hard not to note that cancer and heart disease are primarily
diseases of aging, and life expectancy was so much lower back in the day that
a much smaller percentage of the population lived to advanced ages"

Life expectancy FROM BIRTH has risen dramatically, but if you rule out those
who died before they reached 5 years old, and rule out violent deaths and/or
viral/bacterial plagues, you begin to realize that life expectancy is not much
higher today.

~~~
kyllo
I came here to post the same thing. This is its own fallacy.

It was used to market estrogen supplementation, among other spurious remedies,
to post-menopausal women. "Women didn't used to live very long after menopause
--the life expectancy was only about 50. You need to take estrogen pills to
keep you healthy into old age."

This of course was people using statistics to lie. The average life expectancy
was lower primarily due to high infant mortality. Life expectancy is NOT the
average age at death.

But then they found out that the estrogen pills were causing breast cancer, so
that put a stop to that.

~~~
darkarmani
> This of course was people using statistics to lie. The average life
> expectancy was lower primarily due to high infant mortality. Life expectancy
> is NOT the average age at death.

Just because lower infant mortality raises the life expectancy, doesn't mean
that the average age at death hasn't gone up. I agree with your life
expectancy claim do, but it doesn't mean the opposite is true either.

~~~
kyllo
That's a true statement--infant mortality has declined and average age at
death has also increased, but the increases in average life expectancy are
much more greatly attributable to the former than to the latter.

The fallacy is "{disease} is a disease of old age, and people didn't used to
live past {average caveman life expectancy}. Therefore humans almost never
experienced {disease} until modern times." This is very far from the truth,
and is usually delivered as part of a sales pitch. I was surprised to see it
repeated in the OP almost verbatim. The article debunks several other
fallacies but, disappointingly, perpetuates this one.

------
randomsearch
I heartily recommend people check out "The Heretics" by Will Storr.

The book points out, amongst other insights, the tendency of scientists to
react irrationally to alternative medicine and other such phenomena. Whilst
the scientific community is usually right on such things, we (I'm a scientist)
do have a tendency to be very dismissive and even contemptuous of people who
believe in alternative therapies (or religion, or a whole host of subjects
that contradict scientific thinking).

Seems scientists can be as dogmatic as their opponents. Thought-provoking
stuff.

~~~
mattgreenrocks
No one is immune to dogma. All our beliefs eventually trace back to some
foundation, including the belief that logic is the only fount of truth. The
question is whether we can be comfortable with that, or we have to project our
own insecurities about it onto others. Can we tolerate the unbelief of other
people, and treat them well?

Or do we need everyone to be exactly like us? A lot of the screeds on the
Internet reek of this tribalism. It's utterly tiring to read.

------
rdtsc
I skimmed the article but it seems to me it misses a key component of why
people choose "alternatives". Both "naturalistic" and "old school" (as in 18th
century and earlier probably) today seem to me to be a reaction against years
of uncontrolled abuse, dangerous drugs, uncontrolled trials in the past,
poisoning and dumping chemicals in the environment (ddt and such) without any
regard for consequences. It is kind of this cavalier attitude towards human
bodies and environment during an accelerated progress in the last century that
made some (unfortunately) think twice and reject everything that modern
medicine stands for.

Another aspect of this "integrative" medical approach is basic psychology.
Patients want to be understood and paid attention to. They want doctors to
also ask them what they had for breakfast and how their son is doing. They'd
want doctors to come to their house, put the hand on their head and say
"you'll get better don't worry". All that is in contrast to a cold and robotic
5 minute chart check visits that are billed at $594.00/hour.

------
mikeleung
I've been on the paleo diet for about a year.

Besides the fantastic results I've had with it, the main reason why I'm
confident in it is the fact that what is known to be true in nutritional
science changes all the time. Meanwhile, I'm very confident we know what our
paleo ancestors ate for hundreds of thousands of years prior to the
introduction of agriculture. Even if it is eventually proven that grains do
not cause a problem with our diet, we should be confident that avoiding them
should not be detrimental to our health given the fact that we didnt eat them
for a huge span of human existence

------
darkarmani
Does anyone know the claims regarding saturated fat and coconut oil? I have
some friends who in the last 2 months have become zealots and they encourage
"high quality" fats (coconut oil) and denounce canola oil.

~~~
robbiep
It is well known in cardiovascular surgery circles that islander diets (which
have high levels of coconut oil) have vey high levels of atherosclerosis. I
have heard this comment many times in 4 years of medical school, and seen many
islander patients (Australia has a deal with the French Government to perform
tertiary care of New Caledonians) however have yet to come across a source for
it

~~~
darkarmani
I think the Paleo argument is that it is the interaction of certain saturated
fats and insulin response from high glycemic index foods that oxidize LDL
cholesterol (?). I don't know any of the science here, so i could be
paraphrasing wrong, but I'd love understand if this is as fringe as it sounds.

~~~
robbiep
Ah I see your point. I have some time tomorrow (bt 12-18 hrs from now) so will
see what I can find specifically regarding this if you'd care to check back
here,

In the meantime here's some science of atherosclerosis -

high glycemic index foods - scrap that - glucose and fructose in general is
are reactive molecules - they are often drawn as a 6-carbon circle in organic
chem but are actually moving in and out of a ionically bonded circle and a
linear structure which is very reactive.

It is relatively well understood that the 6 carbon carbohydrates are reactive
enough to be capable of causing endothelial damage which can set off the
inflammatory cascade that leads to atherosclerosis and high LDL levels will
further exacerbate the problem.

Come to think of it, maybe this answers your question?

~~~
darkarmani
Thanks for the answer. I'm not sure. Doesn't something like what you are
saying only happen if you are diabetic?

------
edem
I think that you miss the point here: If paleo diet is not the silver bullet
than what diet should I have? I'm not a paleo advocate by the way. I tried it
out but I'm not having a paleo diet at the moment. I'm still trying to find
some alternate diet which is proven to be healthy. It seems that this may be
one of the most difficult endeavor I've ever undertaken. Any suggestions?

~~~
analog
Has anyone claimed that the Paleo diet is _unhealthy_? From what I've seen the
only complaints against it are that the claimed reason for it's effectiveness
are not well supported.

I don't have any studies but it certainly seems healthier than the high-carb,
low-fat diet which was promoted by the medical establishment for so long.

~~~
freyr
For what it's worth, U.S. World & News Report annualy assembles a panel of
diet and health experts (<http://health.usnews.com/best-diet/experts>) to
judge a variety diets. In 2011 and 2012, the paleo diet ranked as the worst.
The criteria were health, weight-loss, and ease of following. In terms of
nutrition, safety, rating for diabetes, and rating for heart health, it scored
a 2/5, 2.3/5, 2.1/5, and 2/5 respectively.

~~~
analog
That's pretty unscientific, purely based on the opinions of a collection of
individuals.

It also completely ignores the very personal nature of a diet. What's easy to
follow for one person will be very difficult for another.

And if you're rating a diet for heart health I'd like to actually see the
rates of heart related illnesses for those following the diets.

~~~
freyr
I agree.

Although, many of the individuals are nutritionists at reputable scientific
institutes, so hopefully their opinions are informed by scientific studies.
There's no guarantee of that, of course, but at least their credentials are
stated up front (unlike the many nutrition experts you'll find in any given
message board).

------
Tichy
Ancient Egypt certainly was a culture with agriculture so citing mummy studies
to debunk paleo diets does not make much sense. Also ommitting the studies
about actual living hunter gatherer tribes does not lend the argument much
credibility.

I think paleo diet books should be scrutinized, but not be confused with
actual science.

------
rsheridan6
I don't see what atherosclerosis in mummies from post-neolithic cultures has
to do with the paleo diet.

------
fmurdockian
The paleo movement has long since moved away from "eat what paleoliths ate" to
focus on "nothing in biology makes sense except in light of evolution".[1]
Multiple thought leaders (e.g. Chriss Kresser[2] and Robb Wolf) have
acknowledged genetic changes such as lactase persistence and changes in iron
metabolism that have arisen in the last 10,000 years. Succesful inclusion of
dietary grains however, requires fundamental changes in our digestive tract.
From Paul Jaminet's "The Perfect Health Diet" pg 196:

"Grasses evolved in concert with grazing mammals: both originated at the same
and they became common together. [...] To reproduce successfully despite being
regularly eaten, grasses evolved [...] toxic compounds specifically designed
to sabotage digestion in mammals. [...] Grazing mammals have evolved defenses
for these toxins-for instance, digestive organs such as rumens that allow the
brunt of the toxins to be taken by bacteria." [3]

So things like gluten, opioids, agglutinin, and adiponectin trigger autoimmune
reactions, neuropathy, accelerate degenerative diseases, and prevent
absorption of micronutrients.

I find it ironic OP admits the studies of mummified remains were agricultural
societies and then asserts "certainly atherosclerosis was common even among
hunter-gatherers." Analysis of modern hunter gatherers and the most reliable
accounts of hunter gatherer populations (researchers that actually lived among
those they studied) attest to remarkably low occurrences of diseases of
civilization while eating diets devoid of grains and high in saturated fat.
[4] Rather than a "fascination with the noble savage", paleo eating is about
optimizing food quality (i.e. low toxins) and approximating the macronutrient
ratios of hunter-gatherer populations. Certainly a segment of the population
may thrive on a grain based diet of 70-80% carbohydrate, but that isn't the
case for many.

As far as 'science based medicine' is concerned regarding paleo, there is one
meaningful study I'm aware of. [5] However, I highly encourage a look at Robb
Wolf's recent post,[1] a fantastic summary of the strengths EMB has
(antiviral, trauma) compared to the weaknesses (degenerative diseases) and
nutrition. He writes that most of what happens in medical practice is based
off observation anyway, not double blind placebo controlled RCTs. I'm not
against "evidence based" but it's not the only thing out there. Manipulating
statistics [6] [7] and noncontextual studies are easily misleading. After
experimenting (including a brief bout of vegetarianism) I've been eating paleo
for about two years and am the leanest and most energetic I've ever been. The
best way to solve the nutrition challenge is to change variables until you are
happy with your health.

[1] [http://robbwolf.com/2013/03/15/evidence-based-medicine-
fraud...](http://robbwolf.com/2013/03/15/evidence-based-medicine-fraud-double-
standards-ignorance/) My favorite line from this post is "based of this wacky
stuff called the best data we had at the time"

[2] [http://chriskresser.com/rhr-what-science-really-says-
about-t...](http://chriskresser.com/rhr-what-science-really-says-about-the-
paleo-diet-with-mat-lalonde)

[3] <http://perfecthealthdiet.com/notes/#Ch19>

[4] <http://perfecthealthdiet.com/notes/#Ch2>

[5] <http://www.staffanlindeberg.com/DiabetesStudy.html>

[6][http://www.zoeharcombe.com/2013/03/meat-consumption-and-
mort...](http://www.zoeharcombe.com/2013/03/meat-consumption-and-mortality/)

[7] "The Great Cholesterol Con" by Malcolm Kendrick and "Good Calories Bad
Calories" by Gary Taubes are thorough analyses of the problems in the field of
nutrition.

------
seivan
Dietdoctor.com <= Great source (and the guy is actually a real doctor).

~~~
teach
Doctor as in MD? They don't necessarily know much about nutrition, either...

------
bane
My paternal-grandfather, who lived to 102, when asked about diet responded,
"eat variety, eat in moderation, have lots of colors on your plate"

Anecdotally, the folks I know who practice some kind of extreme diet, seem to
spend an inordinate amount of time _thinking_ about their diet. All that
planning, charts, dietary interactions, classes, support groups, supplements,
and books books books...it never sticks, they end up sick and it all seems to
be just a giant waste of time and energy and potential.

Now I'm going to say something that's going to be offensive to many folks out
there, but it's coming from a similarly personal place and it's about how
people use their control of food as a proxy to control their lives.

This mechanism seems to show up in a wide variety of ways, extremely picky
eaters, binge eating, anorexia, etc. Some rise the level of psychological or
health disorder, some are just patterns and habits. One pattern that seems to
show up over and over (and over) again is highly specialized diets for no
specific health disorder.

My mother jogs from diet to diet every few years, she dives deep into the diet
she's currently landed on: Atkins, Paleo, Gluten-free, Vegetarian, etc. buys
and reads dozens of books, finds food sources, and restocks the entire house.
Growing up I was fed under probably no less than 6 or 7 diets of this sort. My
mother is a treasure trove of semi-scientific nutritional information and
alternative medicinal practices.

My mother had a very out of control young childhood. She uses food and her
diet as a mechanism to try and bring control to her life because _that's
something she can control_.

I've found a similar pattern in my friends who also practice a similar
relationship to food. Divorced parents, absent fathers, attention draining
mentally-ill siblings, alcoholic parents, long lists of childhood illnesses,
etc. all seem to be the backstories of the people I know who have intense
desires to control their foods.

Anecdotally, it seems to be that these diets speak to a deep place in people.
These diets, and the endless books and "information" available in these
dietary communities seems to make them feel like if they can just learn the
information in the diet, they can achieve some kind of control over that
aspect of their life. It's like a complex OCD tick that's only satiated in
this way.

There's some endless justification for it, ethics, or evolution, or morals, or
health or whatever. But it usually seems to just boil down to people who want
and need to bring what they feel is order to a life that's careening out of
control.

It usually ends, like it does with all of my friends and family who go down
this route, with some mysterious health problem that they try and solve by
first doubling down on their diet, then is miraculously solved by just eating
like a normal person for a few months.

And inevitably they'll start to overthink their diet, and find some other
direction to go and the cycle will repeat. Because their feeling of wellbeing
can't overwhelm their feeling of establishing control.

I've heard almost this exact story [1], word for word, dozens of times over
the years.

[1] - [http://kristensraw.com/blog/2013/03/17/my-vegan-diet-
caused-...](http://kristensraw.com/blog/2013/03/17/my-vegan-diet-caused-
health-problems-would-primal-paleo-or-real-food-be-better/)

Eating healthy is not that hard, and it doesn't really require that much
thought or time. You don't really have to read lots of books on the subject,
or adhere to an ideology, write blogs, or read food manifestos.

Just "eat variety, eat in moderation, have lots of colors on your plate".

------
stuaxo
"undergird" .. !?

~~~
smackay
yup, it's good. From Merriam-Webster:

"to form the basis or foundation of : strengthen, support <facts and
statistics subtly undergird his commentary"

