Complementary and alternative medicine Medicine Quackery

Say it ain’t so, Dr. Pho! Credulity towards alternative medicine on KevinMD

Say it ain’t so, Dr. Pho!

Back when I first started blogging over six years ago, one of the first medical blogs I came across was KevinMD, the weblog of one Dr. Kevin Pho. Back then, of course, Dr. Pho’s blog wasn’t anywhere near the medblogging juggernaut that it is now, a part of Medpage Today. Indeed, Kevin was one of my early influences, although, as you can see, I never managed to get the whole brevity in writing thing down. Or the whole commercial savvy thing, either. Or the team blogging thing, either. Respectful Insolence was and remains a one man operation (or one Plexiglass box of multicolored blinking lights operation).

In any case, I always thought that Dr. Pho was one of us, at least when it comes to opposing the pseudoscience in medicine that goes under the name of “complementary and alternative medicine” (i.e., CAM) or “integrative medicine” (i.e., “integrating” quackery with science-based medicine). Yet lately the inimitable Dr. Pho seems not to be guarding the chicken coop. There have been some posts by guest bloggers that not only show a disturbing credulity towards pseudoscience in medicine but pretty fuzzy “reasoning.” For example, in this post by Roberta Bivins, we find this pearl:

For example, in contemporary biomedicine, it is conventional to separate the mind and the body when designing a medical experiment: hence the rise of the double-blinded random controlled trial as medicine’s ‘gold-standard’ of proof. Yet physicians and researchers simultaneously acknowledge the impact of the mind on bodily processes. They call it the ‘placebo effect’. As understandings of the mind-body relationship become more sophisticated, it is possible that the blinded RCT will fall from favor, as a limited test of therapeutic activity which obscures an important variable.

Uh, no. The rationale for using placebo controls is not because we “separate the mind and the body.” What utter twaddle! Indeed, this is the same sort of nonsense that Mike Adams regularly parrots. The rationale for using placebo controls is because there is a large body of evidence supporting the existence of placebo effects and nonspecific effects that need to be controlled for. It is not necessary to posit that there is a separation between the “mind” and the body to accept and control for placebo effects in randomized clinical trials. Far from it! After all, recent advances in brain imaging and functional MRI have allowed neuroscientists to visualize the regions of the brain that are involved in placebo effects with no need to invoke mind-body dualism at all to account for them. Let’s just put it this way. Double-blind, randomized clinical trials are not likely to be going anywhere any time soon.

I also note that Bivins is known for being very sympathetic to unscientific medical modalities. Indeed, a recent NEJM review of Bivins’ book concluded that Bivins characterizes “Western” physicians past and present as “mostly predatory and misguided” and “questions why researchers continue to assess treatments from other cultures in a Western framework.” Silly me! I always thought that there was no “Eastern” or “Western” medicine; there’s just science.

For shame, Dr. Pho, for letting such a person blog for you!

Unfortunately, last week, I saw the worst example in a long time of a post utterly lacking in skepticism towards CAM in the form of a post by guest blogger Dr. Peter J. Weiss entitled Why alternative care seems to work. Of course, this could be the topic of a very good post. In fact, I’ve written about this very topic many times before. Confirmation bias, confusing correlation with causation, regression to the mean, all these things lead to a mistaken impression that CAM modalities such as homeopathy “work.” If Dr. Weiss could have concisely explained these factors and how they can contribute to the illusion that CAM “works,” then he would have done Dr. Pho’s readers a service. He didn’t. What he did instead is to invoke some of the hoariest pro-CAM canards out there. In essence, his article is based on the all-too-often used premise of CAMsters that just because we don’t understand the mechanism by which various CAM modalities “work” does not mean that they aren’t valid. It’s kind of sad, because Dr. Weiss starts out reasonably:

Suppose I believe that light is a liquid, and it travels in pipes in the wall. And I believe that when you turn on the light switch, the light travels up the pipes in the wall, over the ceiling, and comes out of the light bulb and radiates/evaporates light into the air. Is that true? Is that a good explanation of light? Probably not! But that doesn’t mean that the light switch doesn’t work for me. If I turn on a light switch it’s going to work no matter what I believe about how the light comes out of the fixture in the ceiling.

And it’s true. Scientific medicine works whether you believe in it or not. the prototypical example of this is the observation that antibiotics will treat infections quite effectively even in comatose patients. They’ll also work in patients who believe that their infection is a result of evil humors or miasmas. That’s because antibiotics have a defined mechanism of action. We understand it. We know how antibiotics work. We know which bugs they kill. We know what proteins or molecules in the bugs they target. In brief, science, it works, bitches! Unfortunately, Dr. Weiss draws precisely the wrong conclusions:

The same is true, I think, of acupuncture, which is another common modality — increasingly common in the western world — that was really developed in ancient China in a prescientific era. The Chinese developed these theories of energy flow (or Ch’i) in the body, along channels related to meridians; and all of that define the practice of acupuncture.

There’s no scientific basis for any that. None of it can be measured as far as we know, in our scientific world today. That’s a totally separate question than, “Will the practice of acupuncture help my pain get better?” or help me feel better, or help me with my problem. And many, many people are accepting that acupuncture works for them. It doesn’t mean necessarily that it works in the way that it has been traditionally explained for thousands of years.

Except that acupuncture, as it is practiced today, is not really thousands of years old or steeped in antiquity. More importantly, Dr. Weiss puts the cart before the horse. Yes, there are a number of science-based medical interventions for which we don’t know the mechanism of action. However, in general, before seeking out a mechanism of activity for an effect of an intervention we first make sure that there actually is an effect due to that intervention. For acupuncture, as I’ve described time and time again, the better the clinical trial, the more rigorously controlled it is, the smaller the apparent effect is, until that effect disappears in the largest, best-controlled acupuncture trials. After all, it doesn’t matter where you put the needles or even if you put them in at all. In fact, you can even twirl toothpicks against the skin, and acupuncture “works.” In other words, acupuncture is placebo medicine.

Dr. Weiss takes this gambit to an annoying extreme when he mentions the drug Lunesta and how at the end of Lunesta commercials there is one of these disclaimers: “The mechanism of action of Lunesta is unknown” or “How Lunesta actually works is unknown.” He then likens this to acupuncture:

Or, “We just don’t know how this stuff works basically.” So, this is a widely prescribed drug, market leading drug, many many doctors are writing for it, the drug company is making it, the FDA has approved it, and no one knows how it really works! We just know it helps people sleeps. That’s okay.

Transfer that theory into alternative care. We don’t know how all those practices work either but they seem to work to help people. So free up your mind a little bit. Don’t get hung up by explanations that don’t make sense to you. If you think the practices are safe and they might help you, open your mind a little bit give them a try. Leave the explanation behind and do what works for you.

I suppose I should be grateful for small favors in that Dr. Weiss spared me the the usual example preferred by CAMsters, namely aspirin. The usual story goes that doctors knew that aspirin worked to relieve pain and decrease fever but didn’t know the mechanism, which wasn’t worked out until long after aspirin use had become widespread. The Lunesta spin is a different one than the ones I’ve heard. In any case, here’s the difference. Even when we don’t know the exact mechanism, in general we know that there is a plausible scientific mechanism for drugs like Lunesta. They are, after all, chemicals and presumably they bind to some receptor or other protein or intracellular molecule and thereby exert their effects. Also, we aren’t entirely in the dark about the mechanism of Lunesta, even if ewe don’t know the exact mechanism, and we do know that they work.

In marked contrast, for the vast majority of CAM modalities, including acupuncture, the mechanism proposed is, as Dr. Weiss points out, completely unfounded in any science. Homeopathy, for instance, violates numerous well-established principles of physics and chemistry, and, for it to work, science would have to be not just wrong but spectacularly wrong about much of what we understand about physics and chemistry. In other words, for drugs like Lunesta there are scientifically plausible mechanisms by which they work. For something like homeopathy or acupuncture, not so much, and likening highly implausible CAM modalities to science-based medical interventions in terms of a lack of a known mechanism is fundamentally deceptive. His argument is, in essence, “We don’t know exactly how Lunesta works. We have no idea how acupuncture ‘works.’ They’re alike! So let’s use both of them!”

Moreover, Dr. Weiss seems completely oblivious to something as obvious as placebo effects. In essence, he is advocating placebo medicine. Who cares whether acupuncture or other CAM really works or not, as long as it appears to work? He is also advocating “opening your mind” to the point where your brains fall out.

I have to say, I never would have expected to find a post like this on KevinMD. I had always thought that Dr. Pho was a proponent of science-based medicine (or at least evidence-based medicine), and it’s exceedingly disappointing to see this sort of nonsense on his blog. Normally, I view KevinMD as a reliable source of medical information and a good place to go for medical commentary. I have to wonder if, in his expansion to a multi-blogger medical social media juggernaut, Dr. Pho isn’t minding the store the way he should. The result are posts like those by Weiss and Bivins.

ADDENDUM: Kevin has responded in a comment.

I posted a response, but thought of a little more after I hit “submit,” so I expand slightly here:

Post pieces you don’t necessarily agree with myself to promote discussion and debate? Give me a break! I didn’t want to believe it, but one of my readers commented that it looks like you’ve become all about the page views, traffic, and advertising. Your comment makes me think he might well have been correct.

You appear to have lost your way from way back when six years ago. Whether or not CAM modalities are scientific or whether patients should be encouraged to be “open minded” (i.e., to try them even though they are pseudoscience) goes beyond being something that you just “disagree with.” It goes to the heart of practicing science- and evidence-based medicine, which you apparently have forgotten or abandoned in your search for ad revenue.

As a result, sadly, I can no longer recommend your blog to my readers as a source of reliable medical information and will be removing it from my blogroll the next time I revamp it (soon).

Perhaps some additional opinions from my readers would persuade Dr. Pho that he has strayed into dubious territory.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

30 replies on “Say it ain’t so, Dr. Pho! Credulity towards alternative medicine on KevinMD”

The big difference, for my money, is that Lunesta has presumably shown itself useful in many phases of trials. Acupuncture, not so much. To use his analogy, acupuncturists are babbling about light-pipes in the walls, when they’re standing in an old barn without any electrical wiring at all.

Great post Orac!
Did you also contact dr. Pho directly, and if so, what was his reaction?
I had not heard of this site yet. Bummer I get to know it just when it sinks into woo…

Great post Orac!
Did you also contact dr. Pho directly, and if so, what was his reaction?
I had not heard of this site yet. Bummer I get to know it just when it sinks into woo…

So much wrong…

“We didn’t/don’t know how aspirin/Lunesta works, but we use it anyway. We also don’t know how most of CAM works, but let’s just use that also.”

Never mind that we know for sure THAT aspirin and Lunesta work. Cart. Horste. Facepalm.

As woo support goes, the question or “should we use woo to alleviate pain” isn’t all that bad, at least he admits there is no scientific explanation for the effect (unlike the water memory people). If a clever applied placebo gives (usually temporary) relief, and isn’t sold as anything else, I don’t see it as automatically negative (so I understand that Orac has ethical concerns, and selling a placebo to the patient will usually need some form of deception).

Lunesta works demonstrably better than your imagination.

Acupuncture does not work demonstrably better than your imagination.

This whole business about whether a mechanism is known or not is an enormous strawman- science based medicine has never demanded a complete understanding of a therapy’s mechanism to deem that therapy effective.

Actually a rational analysis ought to lean in exactly the opposite direction. We ought to be generally reluctant to use therapies if we really have no idea how they work because we have much less ability to predict possible adverse effects and/or we could be masking an underlying problem that could have serious long term consequences.

I’m not saying we should never resort to therapies with unknown mode of action but we certainly shouldn’t be happy about it. I would much rather know WTF is going on.

” the whole commercial savvy thing”

Which may explain *why* altmed has been integrated into a previously decent blog. The awful truth is that woo sells. Like hotcakes. People *like* this crap. There is another way.

Perhaps SBM’ers should take a lesson from CNBC ( located just a few miles from yours truly): financial news is basically numbers- thousands of them flying by at lightning speed on screens and chirons- while opinion is encountered, much of the real news is evidence-based *prices*. Often I am given very bad news indeed by a pleasant Aussie or a witty female presenter attired in great( but still business-like) silk blouses ( I could use a few of those).

Of course, I’m being facetious, but not entirely: first of all, aren’t humour and snark the essence of RI? And brilliant repartee? And reality? So, we’re already on the road without resorting to you-know-what. Readers will eventually appreciate how actually *nice* we all are.

I’m not surprised. I followed a link from your blog to Kevin MD what seems like years ago, hoping to add another good scientifc/skeptical blog to my reading list. What I found was a blog that was all about page views rather than the science. Kevin even admitted to ginning up controversy to get page views, and, presumably, ad revenue.

Then I suppose Kevin ought to be grateful to me for linking to him and sending a few hundred page views in his direction…

hehe. we don’t know exactly how gravity works either. is the force meditated by gravitons? is it due to the curvature of space? just how do you combine gravity and quantum mechanics.

since science can’t explain gravity, it must not work, eh?

wrong. we can use our phenomenological understanding of gravitational interactions to send out space probes, design buildings that don’t collapse, and deduce that jumping off a bridge isn’t necessarily an act without consequences.

“We don’t know exactly how X works and so CAM is just as good as science.” In other words: the CAM of the gaps argument.

Back in the day we had a little self-congratulatory joke about conferences: you could spot the Yale presenter because he was the one with the black-and-white slides.

We took pride in being visually rough and unimpressive. Leaving off the polish was our way of saying, “We are science, bitches. We know what counts.”

Ah, good times long gone.

“Perhaps some additional opinions from my readers would persuade Dr. Pho that he has strayed into dubious territory.”

I tried that in his comments section when I first visited his site around 2007 (based on your suggesting his blog). His excuse then–I forget the topic of the thread–was essentially the same as it is now, that he’s generating interest in his blog so whatever he does is justified.

I tried to comment about an hour ago on Dr. Kevin’s blog. It is still awaiting “moderation”…I suppose because I took swipes at Drs. Kevin and Weiss. Dr. Kevin also has a new “policy” about posters; he claims to be soooo busy that he will “moderate (out)” any and all posters with comments that exceed 3 inches or “about the length of 3 good paragraphs”.

@ cervantes: My awaiting “moderation” posting at Dr. Kevin’s site referred to many licensed medications which have “unknown mechanisms of action”, such as Dilantin. Dilantin and most of the other first line anti-convulsants have “unknown mechanisms of actions”.

I think I’d have to agree with the box o colored lights there.
I’ve perused Dr Kevin’s blog before, and thought it was okay, but those two posts you reference bother me.
I realize that people *wish* sCAM worked, but it never does better than placebos, and sometimes worse.

@Cervantes #7: For decades medical science didn’t know exactly how aspirin worked either, but it was a remedy used in antiquity.

Apparently my posting passed Dr. Kevin’s rigorous standards and “moderation”; it is posted (#22).

Just maybe, we could turn Dr. Kevin around… if other posters here cruise his site and let us know when a particular article appears.

@Cervantes #7: For decades medical science didn’t know exactly how aspirin worked either, but it was a remedy used in antiquity.

Posted by: DLC Author Profile Page | March 2, 2011 9:53 AM

Not quite “antiquity.” Aspirin was first prepared in the mid 1800s, and used as an analgesic ca. 1897. The primary analgesic in willow bark is salicin. Aspirin is named from Acetylated SPIRsaure ‘IN’ where spirsaure was the German name for what we call salicylic acid and ‘in’ was a popular ending for medicinals. The name ‘spirsaure’ indicates that the compound was derived from Spiraea (meadowsweet), not willow.

Once I read a story about a tribal “healer” in training, one of the sorts with all the ritual and chanting and talismans and things that are obviously nonsense. As the student learned the trade, he saw that. He knew it was a trick and a sham, and that even if you believed in the magic and whatnot, some of it was obviously misdirection and slight of hand.

The thing is, it still worked sometimes. In fact it was cheaper and more reliable than anything else they had. His dilemma was, does he follow his objection and refuse to trick people into wellness, or does he stick with what he’s learned and what apparently works because people value it?

Now, we don’t have the luxury of such limited resources. Sure, homeopathy and woo costs a lot less than scientific medicine but that’s nothing but a waste; there’s no sense in buying a cheap procedure if it doesn’t actually work. But what if it does work? Worth a shot, right? Not as a cure, but as a treatment.

It is important to call out woo when we see it. It’s also important that we pay more attention to whether or not something does work (on a case-by-case basis), rather than whether or not it should work. If a bit of woo can ease someone’s pain, is it right to take that from them for the sake of accuracy?

You may have a point – if there’s any evidence that homeopathy and other woo does, in fact, work better than placebo. Do you have such evidence? If so, what treatment for what condition and how much better? Are there repeatable results that can be examined? How good is that evidence?
If it doesn’t demonstrably work better than placebo, why should we encourage its use?

I applaud your post Orac. I believe that Western doctors have lost sight of what medicine (whether it’s science-based or evidence-based) is all about. In my opinion, the focus is to provide treatment and care to patients who seek it with the goal of restoring chemical balance. Everything is about restoration regardless of how it’s done. Sure we would like to achieve this through safe practice but Eastern medicine has never proved to be harmful. As a matter of fact, it is entirely more natural and holistic than Western medicine when comparing means of treatment such as herbal therapy and antibiotics. Think about it, medical doctors have to attend to thousands of patients making it difficult to provide personalized care. For example, my friend recently paid a visit to a general practitioner because she had developed an issue with her lymph nodes. The “doctor” wasn’t able to target the problem so she prescribed my friend Amoxicillin. Really? How do doctors rationalize this? Let’s just write a bunch of random prescriptions and see what happens!

Anyways, this is why I am venturing to find a compromise between the two perspectives of medicine. Tell me what you guys think.

For this kind of thing “acupuncture, TT, reiki” etc… I don’t care if there is no proof that it works as long as it’s not actually harming the patient. IF it makes them feel better, even if it’s a placebo effect, then where’s the harm? Yes, if they’ve paid money to receive something that makes them feel better, then it’s money well spent (for them). I don’t ascribe to those things. Maybe I just don’t separate the mind and body because my principle disease treatments are craniotomies for removal of my melanoma CNS mets?
I guess I’d rather see patients feeling ‘better’ than being told it is of no benefit whatsoever- and running the risk that they would then lose their belief in those ‘things’ (I hesitate to use the term treatments) and no longer enjoy the benefits of the placebo effect. Maybe I’m getting soft in my old age… or maybe I’m just getting soft upstairs.
As long as it’s not being touted as a cure, or harming a patient, I can’t see the harm in a patient perceiving their “well being” has improved.

For someone who wants to foster debate, the comment period is very short at Dr. Pho’s site. It is already closed on this matter after just a couple days.

@ Joe:

Yes, it does seem like a short comment window, doesn’t it?

I tried submitting a comment, it was rejected and the comments are now closed. Out of curiosity, I clicked on “Previous” and “Next.” Lo and behold, the comments are open for the blog posts before and after “Why alternative care seems to work”. I guess KevinMD isn’t so wild about actually “discussion and debate” when that discussion and debate touches on his possible lack of scientific and editorial standards.

I think his “I appreciate your comments” posts ring as hollow and disingenuous in light of the fact he turned of comments specifically for the “Why alternative care seems to work” post.

Like I said in your last post , I’m with you!

Like I said in your last post On teaching the controversy in medicine, I’m completely agree with you, some people prefer a lot of visits and money than the true, that’s sad but aparently the World works around the money and many scientist fall in its arms, like Dr. Pho.

Unfortunatly some people gave names to the pseudoscience that affect others. For example, my medical speciality in Mexico is “Medicina Integrada”, if I translate it, may be “Integrated Medicine” and it doesn’t have anything of lntegrative Medicine, Homephaty, Acumpuncture, etc.

The name was a unfortunate desition its founders, they never imagined the impact that the pseudoscience have in our daily practice, and now the practioners have to explain that we are scientists not chamans or something like that!

My two cents on this issue is this: Woo is catchy, and his new, non-skeptical posts are probably an attempt to capture some of that traffic. But why is woo so catchy? Well, here’s my theory: medicine, like many other fields, has not had a “major discovery” in many years. What I mean by that is a major, positive discovery that everyone can remember. For example, penicillin- everyone knows (minus serious altmed denialists) the amazing impact penicillin had on the world. Vaccines, same thing. The last big medical discovery i can recall was the possibility of transforming adult cells into pluripotent stem cells. Granted, this was pretty recent, but I doubt that too many people outside of the scientific community even heard of it or realized the potential. Medical technology is making advances, many of them relevant and with possible applications, but we’ve moved on now from “1 drug can change literally the entire future of medicine” to “wow, the asdfkjla;sdf gene has a semi-direct link to an increased risk of breast cancer!” I exaggerate of course, but I hope the point is made.

So, medical technology has advanced enormously over the years, and its advance is now subspecializing, so it seems to some that medicine is not advancing super fast anymore. However, in many ways medicine still seems to many people to be almost god-like in its power, and so whenever current methods cannot cure an illness, it’s almost as though it’s taken as proof that the entire method doesn’t work. Case in point: autism. Modern medicine really has trouble explaining and trying to treat and cure autism, so people think “hey, if it can’t cure autism, why can we trust it to cure X?” And that’s where the alties swoop in, using the placebo effect as an initial hook and then people’s own trust to defend it. The fact that doctors have less time than ever to see patients and really talk to them doesn’t hurt the alties either.

“But why is woo so catchy?”

“For every complex problem there is an answer that is clear, simple, and wrong.” H L Mencken

Alt medicine is attractive largely because it is easy to understand, accessible, friendly, filled with hopeful, positive anecdotes. Real medicine can be confusing, impersonal, and disappointing, lacking the false hope of alt med.

Let me get this right…

If I put some pipes in my wall, I can make light come out of my ceiling as long as I believe it will, even if I don’t understand how the pipes work.

Is that a fair summary?

I was going to leave a comment over at KMD but it seems comments are closed for that article. So here it is..

“So free up your mind a little bit. Don’t get hung up by explanations that don’t make sense to you. If you think the practices are safe and they might help you, open your mind a little bit give them a try. Leave the explanation behind and do what works for you.”

Try telling that to Penelope Dingle who used homeopathy as a “safe alternative” for the treatment of her bowel cancer.

She opened her mind and didn’t get hung up by explanations that homeopathy is a load of twaddle and she apparently believed explanations that it would work for her – and that it works best if real medicine is avoided – and she “gave it a try”. In short, she followed Dr Weiss’ advice to the letter.

Of course, it didn’t work and she found out far too late that explanations can matter and that those who promote pseudoscience for a living aren’t necessarily the best people to trust with your health.

I guess the problem for me is that I distinguish between a ‘perceived sense of wellbeing’, and ‘treatment of a disease’. I believe any person who has so little regard to their life as to trust alt-med to treat and cure them, is fundamentally irresponsible… to themselves and their loved ones.
I find it almost understandable to take a chance if there is no known effective conventional treatment available, but much preferred to ‘tweak’ conventional medicine and use that to my advantage.
E.g. Being told by an Onc that a neuro would only operate to remove a mel brain met once (after all, you’re palliative!)- they wouldn’t keep opening me up. Same Onc 2 years later, and numerous craniotomies, told me I need to accept my diagnosis (like I haven’t done that for 2 bloody years!)and prognosis (still here, so what’s to accept?). I sure as hell wouldn’t trust HIM with my health, so told him he was no longer required as part of my health care team 🙂
People spend more time and effort researching which mobile phone to buy, than which health care professional to “hire”, and that scares the hell out of me. BUT, to a degree, medical dominance brought about that mentality, so it needs to be adressed by the medical profession.
News flash- simply yelling “Alt-med doesn’t work” isn’t effective. After years of being expected to be treated as pseudo-gods and have patients blindly follow and acquiese, patients are understandably hesitant to be their own advocates, and are less trusting of doctors.
I hope I don’t sound anti-medico’s, because I can assure you I have the utmost respect to those doctors who deserve it, but I have seen an equal amount of doctors who I wouldn’t give the time of day, let alone entrust my care to.
[no citations required for personal opinion, I hope!]

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