Tag Archives: critical thinking

CFS and “the god of the gaps”

Chronic fatigue syndrome is a “god of the gaps” disease. Although the phrase has its origins in, obviously, religion, it works perfectly well for illnesses and conditions about which medical science knows only so much. And filling in those gaps we have quacks, scammers, controversial physicians, and other pseudoscientists trying to make a buck off what we don’t know. Some may genuinely believe that they have the answer; others are just banking on the sick and the exhausted to pony up in hopes of feeling better.

I’ve been asked a few times recently how patients are supposed to figure out who is trying to help them, and who is trying to scam them. And then, like a gift, I got a comment on my post about CFS awareness. I read it carefully, and then decided it was more suited as a way to answer that question than as an advertisement on that particular post. Here is the comment in its entirety. The only thing I have changed is that I removed the hyperlink to the site at the end, as I do not wish that site to get any referral traffic from mine. (The commenter’s personal link was the same URL.)

Great post. I have found that a lot of doctors don’t really believe in CFS and they seem to think I was making it up, but the book “Beat Sugar Addiction Now!” is written by a doctor and he knows so much about it. I feel like I learned a lot about my own body just by reading the section on CFS, and it made me annoyed that no one had told me this before. I started reading the book because I thought it was a diet book and would maybe help me lose weight, and if I wasn’t carrying around so much weight maybe I would feel better overall and be less achy. But it’s actually a whole part on CFS is in it and I learned a lot about my hypothalamus that I never knew before. The information is good and smart science but not too hard to understand. You need to find help if you have what I have-so much pain it hurts to pull my shirt over my head or bend down to tie my shoes. I had to start wearing ugly crocs just because they were easier to put on and more comfortable, and that is not who I wanted to be-a fat person in unstylish shoes who has trouble getting in and out of the car. I feel like if I can find a doctor who will help me and I can do what it says in this book, I will get a lot better. It is written very convincingly and you can tell he knows what he’s talking about. Plus he has a list to help you find doctors that treat CFS and I am ready to get treated and stop feeling like my nerves are exposed every time I move. Here’s the website for Dr. Jacob Teitelbaum: http://endfatigue.com/

By the time you get to the end of this, you’ve passed by a bevy of red flags. Let’s check them out.

  • The first two words are the only reference to my post at all.
  • The very next sentence introduces the subject of this advertisement, a book by “a doctor” — that’s intended to impress.
  • The person’s situation is not indicative of CFS. Many scammers either intentionally or out of ignorance conflate chronic fatigue, a symptom of many things, with chronic fatigue syndrome/myalgic encephalopathy, a condition that has specific criteria for a patient to be diagnosed with it. The commenter discusses being overweight and having a lot of intense physical pain — neither of which are signs or symptoms of CFS.
  • The commenter attempts to gain sympathy by weaving in a sob story, but in a 12-sentence comment, only three sentences did not refer to this amazing book.

At this point, I have enough information that I don’t need to waste my limited time and energy checking out the website, nor will I allow this comment to sit on my post about CFS awareness. “But Joey,” you may cry, plaintively if you like, “perhaps this person is not a shill, but merely someone whose life was truly changed by this doctor and his book.” Very well, if we’re going to be skeptics, let’s go check out the source. (Of course the very name of the website is a clue. As I mentioned previously, fatigue and CFS are not the same thing. The former is a symptom of just about everything, and the latter is an illness.)

Are you back? Me too. Let’s dig in.

The first thing I saw was Teitelbaum purporting to diagnose someone from Fox News in two minutes and thirty seconds. The clip itself is called “Diagnosing chronic fatigue,” (not CFS), and he doesn’t even do that. The entire front page is about branding, and that is a major red flag. Research physicians whose work has been vetted by medical science do not need to pimp themselves out with iPhone apps, mailing lists, and cute names like “Dr. T.” Right off the bat it’s clear this is a site with the intention to sell.

Next, I checked out who this fellow is. He appears to be a legitimate M.D., but his affiliations, publications, and speaking engagements do not exactly trumpet the career of a man who is regularly published by respected sources. It’s noted that he’s appeared on Oprah’s and Dr. Oz’s shows, two continuing advertisements for all manner of pseudoscience and bad medicine. In addition, this sentence caught my eye:

Dr. Teitelbaum knows CFS/Fibromyalgia as an insider — he contracted Chronic Fatigue Syndrome when he was in medical school and had to drop out for a year to recover.

One whole year to recover, huh? (Are my fellow patients laughing yet?) And has a miracle cure? If the lumping together of a cure for fatigue, CFS, and fibromyalgia didn’t set off your radar, that certainly should.

Next I checked out the site’s information page about CFS and fibromyalgia. Here, fibro is referred to as a “sister illness” of CFS. Now while this is a common theory — one my own doctor subscribes to as well — a connection has not been definitively identified by medical science, nor is patient management identical between the two. In addition, many of the “other common symptoms” of CFS listed here (such as increased thirst, weight gain, and recurring infections) are not part of either the Fukuda criteria or the Canadian Clinical Case Definition.* The man cannot even define CFS correctly. But here’s the biggest, reddest flag you could possibly want if after all this you’re still not sure if this is worth looking into.

What Causes These Illnesses?
Hypothalamic dysfunction.

That’s it, folks. We can all go home. He has the single answer that hundreds of researchers have not been able to come up with for years, and not only that — it fits all patients with CFS or fibromyalgia. It’s also conveniently vague enough to fit into any actual, valid research that might turn up. And what is a patient’s next course of action? Reading about and eventually buying products and services from “Dr. T.”

There are plenty more howlers on the site, but hopefully I’ve made my case. This guy and his presumed shill are perfect examples of the gods of the gaps who are preying on sick people by claiming to have not only an answer, but the answer. And like all good scam artists, his rap has a grain of truth to it. It is certainly suggested for people with CFS to eat less sugar. Not only that, while you may blow me off as someone primed for suspicion, I’m in fact a believer when it comes to sugar “addiction.” I saw a nutritionist in college who forced me to cut all sugars whatsoever out of my diet, and the improvements to my health and weight, plus how it felt when I fell off the wagon, left me pretty convinced that breaking that addiction is a good thing to do, if you can manage it. (I don’t know if it qualifies as a true medical addiction; I’m using the term casually here.)

And this is why this kind of person is so insidious. He does give good advice, but it’s surrounded by so much bad science and speculation and overreaching claims that he’s rendered totally untrustworthy. My hope is that any CFS patient who has any amount of knowledge about her illness (which is every patient I’ve met!) can see past the peppy nickname and shreds of decent advice, underneath to Teitelbaum’s colossal failure as a source of legitimate information or treatment for CFS or anything else. Except perhaps sugar addiction. If that’s your only problem, then knock yourself out.

I recognize that this is a long discussion of what will appear to some of my readers as a very straightforward and obvious scam to avoid. But if people didn’t buy into it, this guy wouldn’t still be around. My hope is that by examining both the comment and, briefly, the site itself, I might inspire other chronically ill people to look equally carefully at the links and sites and doctors that are recommended to them.

* “Marked weight change” is one of the many symptoms that may be used in the Canadian definition, but not specifically “weight gain.”

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Weekend sendoff: Fairly superstitious

I huff and puff a lot about the necessity of critical thinking, but it’s not because I have mastered the art of skepticism and am offering my pearls of wisdom from on high. Far from it. Unlike Jenny McCarthy, I have not yet earned my degree from Google University. I’m more like a second-grader who’s just gaining enough confidence to raise her hand in class sometimes. I’m learning every day, which is a great process but as someone once said, the more you learn, the more you realize you don’t know.

I was raised by wolves two skeptics, so the irrational beliefs and behaviors I’ve acquired over the years have not, on the whole, been too difficult to discard. With one exception: I never really absorbed the religious aspect of Judaism, but some of  the cultural superstitions did take hold. I was like a kid who resents having to go to temple, because I realized even then that I was going to grow up believing in something I didn’t want to. And that’s exactly what happened. Now, I figure if I’m going to give people grief for irrational behavior, it’s only fair that I examine my own.

(Also as a kid, I thought that Stevie Wonder was singing “fairly” instead of “very superstitious,” which made the song a little confusing.)

I’m going to talk about this for a little bit on Skeptically Speaking tonight, to which you can listen live here at 5pm Pacific time, or get from the website usually by Sunday or Monday. The main part of the episode will be about the Independent Investigations Group here in Los Angeles, which is a great group that I am just starting to get involved with. In their words:

The Independent Investigations Group investigates fringe science, paranormal and extraordinary claims from a rational, scientific viewpoint, and disseminates factual information about such inquiries to the public.

How fun is that!

And on that note, I send you off with a mystical cat who is never going to win a $50,000 prize, or any other. Cute though. Sorry I can’t remember where I saw it first, but due credit to whomever.

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My pet CAM

Recently, a new study showed the inefficacy of gingko biloba as a treatment for mental decline related to aging. Since my mother uses this, I was interested in this news, and posted a link on Twitter to Science-Based Medicine’s article on the subject. I received a very surprising response from another chronically ill person who self-describes as a skeptic, and who I considered to be a critical thinker. This response included an explosion of offense at this story, ad hominem attacks on both the site and Dr. Novella, and when I tried to remove myself from the onslaught, emotional leaps to conclusions that I was mocking or disrespecting this person because I declined to continue the “conversation.”

I’ve written before — and I will certainly write again — about the particular vulnerability of chronically ill people when it comes to considering complementary and alternative medicine (CAM). It’s why quacks target us, and why they are so often successful. As you know, I’m a strong advocate for people with long-term illnesses hanging on to their critical thinking skills, as hard as that is through the daily fatigue, pain, and sickness.

Many of us, however, do have blind spots in our critical thinking. We rely on certain treatments that may not be proven to the complete satisfaction of the medical community — and we don’t care, because they work for us. As I’ve said in the past, with the exception of homeopathy to which I will not give a pass, as long as the treatment causes no harm and the patient is informed and not going broke, then I’m not sure it’s my place to argue with what may work for someone. For one thing, I have a pet CAM of my own, and I am more than willing to admit my strict rules about this stuff break down a bit when it comes to this treatment. It’s another story for another day, but my point is that everything I say in this post applies to me as well. By no means am I trying to imply I’m above all this; I struggle with it constantly.

If you are going to invest financially and emotionally in a treatment that doesn’t have the support of the medical community, you also have to be self-aware. You must realize that there is an irrational component to your attachment, and you have to compartmentalize it. There are certain medical blogs where I simply won’t read stories about my own pet CAM, because I know I’m likely to get annoyed. Why? They are science-based and the science isn’t all there yet, and there is also a certain bias against this treatment in some circles. I realize that if I’m trying to research this subject thoroughly, I should also look elsewhere for other points of view.

But what I don’t do is then fault the people running these blogs because they don’t agree with me. I can’t help but find it the height of arrogance to label doctors with years of clinical and/or research experience, who are dedicated to the scientific investigation of medical claims, “stupid” because they focus on the science. I may disagree, but that doesn’t make their work invalid. My experience as a chronically ill, critically thinking layperson includes an enormous amount of personal data as well as anecdotes from many people (including my own GP) about the efficacy of my treatment. That does not change the fact that in science, anecdotes do not equal data. Just because you are firmly convinced, and even if you came to your decision through an analytical pathway, your personal experience does not change the way traditional medical science works.

If you think a legitimate study on your pet CAM is utter crap, fine. But don’t be shocked when evidence-based sites don’t support your assertions. Science-based medicine is that, and it has a right and responsibility to reject treatments that have not yet been vetted. Avoid places that you know aren’t going to support it, if you are too emotionally invested to read valid criticism, rather than trashing the science-based sites for being, you know, science-based. Or even better, bring your knowledge to those sites and join the discussion, if you are able. Looking back at that SBM article, I’m interested to note that the person I mentioned did not do so, but rather took anger and frustration out on me, the messenger. I can assure you this is not productive, except to provide me with blog fodder.

(Image from Science!)

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