There is reliable evidence, e.g. clinical studies, that indicate mRNA Covid vaccines saved millions of lives. Comments posted here that suggest otherwise are misplaced
Since when was the placebo effect useless? Only if you're an evidence based medicine fanatic... Plenty of placebo effects have bigger effect sizes than standard meds, so if the placebo effect is useless so is a helluva lot of "evidence based" medicine.
Medicine is failing people. With chronic diseases on the rise and approximately 80% of Americans metabolically unhealthy, we desperately need to rethink our approach.
This article exemplifies what's wrong with medicine today. While it's true that theories alone aren't enough, the real problem is that no one is rigorously testing promising theories, yet critics are quick to dismiss them. This article judges without acknowledging individual success stories (N=1 cases) that demonstrate real benefit.
Yes, large-scale studies are essential for public health guidelines. But we're now in the era of personalized medicine, where individual responses matter. Medicine must evolve beyond one-size-fits-all approaches and embrace the nuance that personalized care requires.
I am a huge proponent of N of 1 trials-which to me need to be on and off and on again-try a supplement, see how you feel, stop the supplement, see if the symptoms recur. Then start the supplement again....or whatever the theory you are testing. To often, "personalized" trials are merely anecdotes-"My doctor suggested I try this, and it worked!". That could be demonstrated benefit...or placebo or regression to the mean. Only by a more formal assessment using an N of 1 approach, will we know that we are doing evidence based medicine. Clearly if there are rigorous trials supporting an intervention, we don't need a formal N of 1 assessment
I've actually transitioned from practicing as a conventional internist to incorporating Functional Medicine principles into my work. Unlike some fringe practitioners, I use evidence-based testing, including metrics such as hs-CRP and insulin levels, which conventional physicians often overlook because they haven't been trained in how to interpret or act on them. My focus is on optimizing the fundamental pillars of health: diet, exercise, sleep, and stress management.
I don't simply prescribe supplements and experiment to see what happens. When I do recommend supplements, it's to address documented deficiencies while we work to understand the root cause, whether that's malabsorption, inadequate intake, or excessive utilization. Medical school teaches us extensively about disease, which is essential, but there's remarkably little education about health itself.
Healthcare should encompass more than treating disease. For example, when a 20-year-old woman wants to discontinue oral contraceptives without the fear of her own menstrual cycle, which is treated like a disease, I can help her achieve that transition safely. This is possible because I've opened my mind to different approaches and recognize that constantly demanding RCTs isn't appropriate for lifestyle medicine, where individualized interventions often can't be captured by traditional trial designs
Sounds like a wonderful approach you are taking with your patients! I have 50 episodes of my podcast: Live Long and Well With Dr. Bobby-the first 6 are on the 6 Pillars (exercise, sleep, nutrition, mind-body harmony, exposure to heat/cold, social connections). Might be helpful for your patients (of perhaps of interest to you).
This article is to dogmatic: In fact it is the very thing that is criticizing. There is something I wrote a long time ago that I firmly believe is true, although not 100% anymore that I believe what is in this article 100%. "The best clinical insights exceeds so-called knowledge by at least 1 step … Physician's guess at every step and the best physicians have the best guessing rate."
“When you contract an illness that the medical system can’t diagnose or cure, it feels like falling through [the solid floor of medical knowledge that every modern person takes for granted] into the basement underneath. But if you find a group of outside-the-consensus doctors who tell you not to worry, they know what they’re doing and there’s a good explanation for what’s happening to you, then even that basement can seem reassuring … It’s a hidden consensus underneath the official one, maybe not as solid, but strong enough to raise a ladder back to health.
If those treatments don’t help you, though, or if they only help you slowly and you start trying things yourself, and those things are associated with cranks and charlatans but also seem to work, well, then, guess what: You’ve fallen through the floor again … and you’re down in whatever is underneath the basement, down in the rag-and-bone shop, the deep underground, where the lights are flickering and you’re groping with your hands, feeling weird shapes in the half darkness, looking for the ladders but not sure whether they take you back up to normalcy or somewhere else entirely.”
Ross Douthat wrote that in The Deep Places regarding his experience of chronic lyme disease. Whether you believe in the disease or not, he was experiencing something and was dismissed by traditional clinicians. In his desperation, what was he supposed to do? It's not just that traditional medicine hasn't resolved many problems people face; it's that traditional clinicians so often don't earn peoples' trust (or actively burn their trust).
Using this logic, can you explain why Dr Prasad has denied RP1 which has exhibited strong results for typically hopeless metastatic melanoma patients? Thank you
Great insight. During COVID we learned that Big Pharma cannot be trusted. That knowledge has been augmented with the recent disclosure about the STATIN scam. But Little Pharma (the makers of supplements) are even worse. There is little oversight and they are free to make any claim to meet their marketing narrative. You and I could collect some leaves, grind them up and add some toxic chemicals, then market the product as boosting the immune system. Famous doctor Miller endorses the product which has cured hundreds of patients. Just watch the testimonials. We could become $ millionaires.
Given that the medical profession destroyed its reputation and credibility during Covid-19 and the government agencies tasked with protecting the public health have all been compromised by Big Pharmaceutical where they will approve Heroin as a treatment for pain and then claim it’s not addictive and then do nothing as hundreds of thousands get addicted to Oxytocin and in the end do nothing to punish the Sackler family who are we to trust???
Thank you for this down to earth, common sense report. I think it's also important to consider some of the yet unproven (via double blind placebo controlled trials) but potentially beneficial impacts of some of these science based products. As a Urologist I remember when the idea of removing kidneys laparoscopically or prostates with a robot sounded incredulous. No way that will work! It's oncologically not appropriate! Now these are the standard care after the pioneers went forth responsibly even before there were years of clinical trials proving their safety and benefit. They listened to patient demand and considered the real benefits of these yet unproven surgeries with great success.
Excellent article. Every sentence concise and on point. The myth of "preventive medicine" is one of the main drivers for these scams. A common complaint is "Doctors don't tell us how to stay healthy; they just want to take care of sick people". Well, that's our job. We are trained in the diagnosis and treatment of disease. Doctors don't really know how to prevent disease and there are no secret formulae being kept in the safe. To get a perspective on public misunderstanding and gullibility, take a look at lists of best-selling nonfiction books. Then go back over the lists for the last 10,20 or 30 years. Half to two thirds of the best sellers will be promising secrets to longer or healthier life. The words may change some from year to year, but the theme remains the same. The pharmaceutical industry is certainly corrupt but the promoters of vitamins, supplements, diets, and other magical means to a longer and healthier life are not far behind.
I agree, preventive medicine is a myth, but “preventive living” is as axiomatic as the day is long. One cannot rely on centralized medicine to keep them vibrant and healthy. That is lazy living. Everything about modernity works against a healthy life. The only way to avoid a life plagued by chronic disease is to return to savagery in every way possible. See every sunrise, barefoot and as naked as possible no matter the weather, and eat lots of animal fat and protein. And for God’s sake, shut off all your indoor lighting and video screens at sunset. Do you really think that after hundreds of thousands of years of evolution getting up with the sun and going to bed at sunset that we could adapt to a modern light environment in the 150 years since the invention of the electric grid? If you do, then you have no understanding of the evolution of our species.
Whenever someone goes on and on about “biologic plausibility”, but is silent on evidence of clinical outcome benefit, I know it’s only fit for the circular file (at least for the time being).
Missing from your analysis is risk/benefit. To lump red light therapy with invasive procedures and surgery makes for poor decision making. The risks are entirely different and so, proportionally, should be the amount of evidence required to try it. If the risks are near zero then a even minimal evidence of efficacy should be sufficient to try it.
So many doctors freak out at a patient risking a few hundred bucks on a detox cleanse but think nothing of them risking permanent disability with an ill-advised spinal surgery costing hundreds of thousands of dollars.
I agree. The issue is the apparent veracity of the claims. If they were honest that it is theory + anecdote and not based upon rigorous evidence, that would be fine to me.
Thing is, most things aren't useless. Placebo effect isn't useless. And some things make a better placebo than others. I'll happily take a "useless" substance if I get a placebo benefit. Medicine has a hate on the placebo benefit. Given so many of our treatments are less effective than the placebo effect (antidepressants I'm looking at you, also CBT to be evenhanded) it looks like sour grapes.
Yes, of course the placebo effect is real. That’s why we do prospective randomized PLACEBO-CONTROLLED clinical trials…the point is not to deny placebo effect, but to require any purported therapy to prove an effect above and beyond that which can be expected of a placebo.
And by invoking this, you should also be aware of the NOCEBO effect also. See REDUCE-IT trial for a fairly contemporary example.
When I say “safe and useless”, the placebo effect is already priced in. It should be understood as “safe and useless in excess of placebo effect”. If makers of snake-oil want to advertise their wares as “as good as a placebo”, I’d at least admire their honesty.
Placebo is very important to understand and even "known" placebos can have an effect. If that is the mechanism, great, just be up front about it and enable the patient to N of 1 test potential benefit.
There is reliable evidence, e.g. clinical studies, that indicate mRNA Covid vaccines saved millions of lives. Comments posted here that suggest otherwise are misplaced
Since when was the placebo effect useless? Only if you're an evidence based medicine fanatic... Plenty of placebo effects have bigger effect sizes than standard meds, so if the placebo effect is useless so is a helluva lot of "evidence based" medicine.
If you like ideas that merge science, consciousness, and reality itself—subscribe to mine!
https://drewponder.substack.com/
Great piece. Well-argued and spot on.
Medicine is failing people. With chronic diseases on the rise and approximately 80% of Americans metabolically unhealthy, we desperately need to rethink our approach.
This article exemplifies what's wrong with medicine today. While it's true that theories alone aren't enough, the real problem is that no one is rigorously testing promising theories, yet critics are quick to dismiss them. This article judges without acknowledging individual success stories (N=1 cases) that demonstrate real benefit.
Yes, large-scale studies are essential for public health guidelines. But we're now in the era of personalized medicine, where individual responses matter. Medicine must evolve beyond one-size-fits-all approaches and embrace the nuance that personalized care requires.
I am a huge proponent of N of 1 trials-which to me need to be on and off and on again-try a supplement, see how you feel, stop the supplement, see if the symptoms recur. Then start the supplement again....or whatever the theory you are testing. To often, "personalized" trials are merely anecdotes-"My doctor suggested I try this, and it worked!". That could be demonstrated benefit...or placebo or regression to the mean. Only by a more formal assessment using an N of 1 approach, will we know that we are doing evidence based medicine. Clearly if there are rigorous trials supporting an intervention, we don't need a formal N of 1 assessment
I've actually transitioned from practicing as a conventional internist to incorporating Functional Medicine principles into my work. Unlike some fringe practitioners, I use evidence-based testing, including metrics such as hs-CRP and insulin levels, which conventional physicians often overlook because they haven't been trained in how to interpret or act on them. My focus is on optimizing the fundamental pillars of health: diet, exercise, sleep, and stress management.
I don't simply prescribe supplements and experiment to see what happens. When I do recommend supplements, it's to address documented deficiencies while we work to understand the root cause, whether that's malabsorption, inadequate intake, or excessive utilization. Medical school teaches us extensively about disease, which is essential, but there's remarkably little education about health itself.
Healthcare should encompass more than treating disease. For example, when a 20-year-old woman wants to discontinue oral contraceptives without the fear of her own menstrual cycle, which is treated like a disease, I can help her achieve that transition safely. This is possible because I've opened my mind to different approaches and recognize that constantly demanding RCTs isn't appropriate for lifestyle medicine, where individualized interventions often can't be captured by traditional trial designs
Sounds like a wonderful approach you are taking with your patients! I have 50 episodes of my podcast: Live Long and Well With Dr. Bobby-the first 6 are on the 6 Pillars (exercise, sleep, nutrition, mind-body harmony, exposure to heat/cold, social connections). Might be helpful for your patients (of perhaps of interest to you).
For sure will listen
This article is to dogmatic: In fact it is the very thing that is criticizing. There is something I wrote a long time ago that I firmly believe is true, although not 100% anymore that I believe what is in this article 100%. "The best clinical insights exceeds so-called knowledge by at least 1 step … Physician's guess at every step and the best physicians have the best guessing rate."
Models require calibration.
“When you contract an illness that the medical system can’t diagnose or cure, it feels like falling through [the solid floor of medical knowledge that every modern person takes for granted] into the basement underneath. But if you find a group of outside-the-consensus doctors who tell you not to worry, they know what they’re doing and there’s a good explanation for what’s happening to you, then even that basement can seem reassuring … It’s a hidden consensus underneath the official one, maybe not as solid, but strong enough to raise a ladder back to health.
If those treatments don’t help you, though, or if they only help you slowly and you start trying things yourself, and those things are associated with cranks and charlatans but also seem to work, well, then, guess what: You’ve fallen through the floor again … and you’re down in whatever is underneath the basement, down in the rag-and-bone shop, the deep underground, where the lights are flickering and you’re groping with your hands, feeling weird shapes in the half darkness, looking for the ladders but not sure whether they take you back up to normalcy or somewhere else entirely.”
Ross Douthat wrote that in The Deep Places regarding his experience of chronic lyme disease. Whether you believe in the disease or not, he was experiencing something and was dismissed by traditional clinicians. In his desperation, what was he supposed to do? It's not just that traditional medicine hasn't resolved many problems people face; it's that traditional clinicians so often don't earn peoples' trust (or actively burn their trust).
Sensible indeed. Trust the bodies capacity to heal and recover and trust doctors who can say I don’t know.
Using this logic, can you explain why Dr Prasad has denied RP1 which has exhibited strong results for typically hopeless metastatic melanoma patients? Thank you
Great insight. During COVID we learned that Big Pharma cannot be trusted. That knowledge has been augmented with the recent disclosure about the STATIN scam. But Little Pharma (the makers of supplements) are even worse. There is little oversight and they are free to make any claim to meet their marketing narrative. You and I could collect some leaves, grind them up and add some toxic chemicals, then market the product as boosting the immune system. Famous doctor Miller endorses the product which has cured hundreds of patients. Just watch the testimonials. We could become $ millionaires.
yes indeed. a new business opportunity, sadly....
Given that the medical profession destroyed its reputation and credibility during Covid-19 and the government agencies tasked with protecting the public health have all been compromised by Big Pharmaceutical where they will approve Heroin as a treatment for pain and then claim it’s not addictive and then do nothing as hundreds of thousands get addicted to Oxytocin and in the end do nothing to punish the Sackler family who are we to trust???
Thank you for this down to earth, common sense report. I think it's also important to consider some of the yet unproven (via double blind placebo controlled trials) but potentially beneficial impacts of some of these science based products. As a Urologist I remember when the idea of removing kidneys laparoscopically or prostates with a robot sounded incredulous. No way that will work! It's oncologically not appropriate! Now these are the standard care after the pioneers went forth responsibly even before there were years of clinical trials proving their safety and benefit. They listened to patient demand and considered the real benefits of these yet unproven surgeries with great success.
Excellent article. Every sentence concise and on point. The myth of "preventive medicine" is one of the main drivers for these scams. A common complaint is "Doctors don't tell us how to stay healthy; they just want to take care of sick people". Well, that's our job. We are trained in the diagnosis and treatment of disease. Doctors don't really know how to prevent disease and there are no secret formulae being kept in the safe. To get a perspective on public misunderstanding and gullibility, take a look at lists of best-selling nonfiction books. Then go back over the lists for the last 10,20 or 30 years. Half to two thirds of the best sellers will be promising secrets to longer or healthier life. The words may change some from year to year, but the theme remains the same. The pharmaceutical industry is certainly corrupt but the promoters of vitamins, supplements, diets, and other magical means to a longer and healthier life are not far behind.
I agree, preventive medicine is a myth, but “preventive living” is as axiomatic as the day is long. One cannot rely on centralized medicine to keep them vibrant and healthy. That is lazy living. Everything about modernity works against a healthy life. The only way to avoid a life plagued by chronic disease is to return to savagery in every way possible. See every sunrise, barefoot and as naked as possible no matter the weather, and eat lots of animal fat and protein. And for God’s sake, shut off all your indoor lighting and video screens at sunset. Do you really think that after hundreds of thousands of years of evolution getting up with the sun and going to bed at sunset that we could adapt to a modern light environment in the 150 years since the invention of the electric grid? If you do, then you have no understanding of the evolution of our species.
Whenever someone goes on and on about “biologic plausibility”, but is silent on evidence of clinical outcome benefit, I know it’s only fit for the circular file (at least for the time being).
Good point. It is fair to say that biologic plausibility is necessary but not sufficient to justify a theory or a treatment.
Missing from your analysis is risk/benefit. To lump red light therapy with invasive procedures and surgery makes for poor decision making. The risks are entirely different and so, proportionally, should be the amount of evidence required to try it. If the risks are near zero then a even minimal evidence of efficacy should be sufficient to try it.
So many doctors freak out at a patient risking a few hundred bucks on a detox cleanse but think nothing of them risking permanent disability with an ill-advised spinal surgery costing hundreds of thousands of dollars.
“Safe but useless” is fine. To each their own. But the proponents should be honest about it, and market it as such.
I agree. The issue is the apparent veracity of the claims. If they were honest that it is theory + anecdote and not based upon rigorous evidence, that would be fine to me.
Thing is, most things aren't useless. Placebo effect isn't useless. And some things make a better placebo than others. I'll happily take a "useless" substance if I get a placebo benefit. Medicine has a hate on the placebo benefit. Given so many of our treatments are less effective than the placebo effect (antidepressants I'm looking at you, also CBT to be evenhanded) it looks like sour grapes.
Yes, of course the placebo effect is real. That’s why we do prospective randomized PLACEBO-CONTROLLED clinical trials…the point is not to deny placebo effect, but to require any purported therapy to prove an effect above and beyond that which can be expected of a placebo.
And by invoking this, you should also be aware of the NOCEBO effect also. See REDUCE-IT trial for a fairly contemporary example.
When I say “safe and useless”, the placebo effect is already priced in. It should be understood as “safe and useless in excess of placebo effect”. If makers of snake-oil want to advertise their wares as “as good as a placebo”, I’d at least admire their honesty.
Placebo is very important to understand and even "known" placebos can have an effect. If that is the mechanism, great, just be up front about it and enable the patient to N of 1 test potential benefit.