Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, January 02, 2008

What CAM and Vanity Publishing Have in Common

What do "Complementary and Alternative Medicine" (CAM) and "Vanity Publishing" have in common? Quite a lot, as it turns out.

Some quick definitions to bring the non-writing and the non-medical public up to speed on each other:

The central tenet of legitimate publishing is "money flows to the author." Individuals and companies that make their money charging authors for anything from "reading fees" to "editing services" to actually producing books are not legitimate publishers. They are scammers preying on ignorant and/or gullible authors who, holding a book in their hands with their name on it, don't really understand what publishing is all about.

Medicine as defined in this day and age is the application of science to the diagnosis and treatment of disease. Of course there is an "art" to medicine, mainly because the science is incomplete. CAM refers to individuals who prey on ignorant, gullible and/or desperate patients who do not understand medicine, offering magical thinking cloaked in the trappings of scientific medicine (calling themselves "doctors," for example.)

One fascinating similarity is that outside their respective fields, neither is considered much of a big deal:

In general, non-physicians don't see the harm in allowing stupid people to spend money on things like homeopathy, Reiki, supplements and chiropractors, and don't understand why physicians are so up in arms over the issue. Deaths from curable conditions treated with fake medicine are chalked up to the tragedy of stupidity. They may not even believe or understand what's wrong with CAM in the first place. It makes you feel better; isn't that what medicine's all about?

Non-authors and people not involved in publishing couldn't care less about vanity publishing. What difference does it make if an author is published by Random House or Publish America? It's a free country; if people want to spend their money self-publishing their books to call themselves "published authors," so what? Good people are victims of fraud. Tough; it happens. If someone who actually writes something with legitimate potential has his career destroyed before it begins because of a Lulu ISBN, who cares? A book is a book, isn't it?

Muddying the water is the fact that under specific and limited circumstances, some versions of both CAM and vanity publishing have their uses. Certain kinds of yoga and relaxation exercises have been shown to improve well-being in patients undergoing cancer chemotherapy, for example. Some people with highly personal or technical books who need a small number of them for sentimental or professional purposes ("back of the room" books after a lecture, or a family biography) can have them produced beautifully by a company like Lulu. Problems arise when, ignoring limitations, these scenarios are used by the unscrupulous to validate other, less appropriate contexts of their false promises.

Another important similarity is that many "consumers" of both CAM and vanity publishing don't consider themselves victimized at all. They are a large part of the problem, and explain why both forms of fakery continue to flourish. Many patients with vague symptoms, ill-served by busy doctors, find "relief" in the arms of the homeopaths, the chiropractors and other quacks, and then spread the word like religious zealots. Likewise, discouraged by both the rigor as well as the seeming randomness of the legitimate publishing industry (including literary agents) plenty of people have turned to what is essentially self-publishing, where they are the ones primarily responsible for selling their books through signings and "author events." They see nothing wrong with having to purchase their own books at 50% off the cover price and then re-selling them themselves. They consider themselves legitimate, published authors and no one can convince them otherwise.

Flying equally under the radar of both groups are the forces trying to warn and protect the other, hoping to transform the ignorant and gullible into the knowledgeable and savvy:
Still, it's difficult for each group to get all worked up about the travails of the other. So why should they? Here's why: People shouldn't be allowed to defraud others out of their hard-earned cash with false promises -- whether of legitimate publishing or rational health care.


At Wed Jan 02, 09:52:00 AM, Anonymous Anonymous said...

It irritates me no end that health insurance will cover chiropractics yet I have ot pay out of pocket for my glasses. I am very nearsighted and cannot do much of anything without my glasses, but somehow they are considered not necessary. Or maybe the eye care industry just doesn't have a powerful enough lobby.

At Sat Jan 05, 06:44:00 PM, Anonymous Anonymous said...

I am published through Xlibris,A PAINED LIFE, a chronic pain journey, (,) a POD (print on demand). Since you referred to Random House vs Publish America you should be aware, if not already, that Random House owns 49%of Xlibris because they believe this is the way of publishing in the future. In fact, well know successful authors, such as Piers Anthony, are eschewing their traditional houses for POD.
Unless you are a known name most authors have to market their own books, regardless of publisher.
(And by the way, I do not have to buy my books, they are sold thru the publishers site as well as all online bookstores and can be ordered thru your local bookstore. They are distributed by the same companies: Ingram and Laverge, that traditional houses use.) (The same being true about my friend's book put out by McMillan. Small specific interest so the stores did not carry it.)
I am also completing a certification course in hypnotherapy whhc I find to be an excellent addendum to tradiional medical care.
Not all CAMs are fakery or quackery.
When I was a patient at Jefferosn Hospital in 1979, the anaesthesiologist attempted acupuncture and my neurologist asked that I see the psychologist specializing in hypnosis.
I am not sure what your beef is that you would blanket all CAM with the same negativity but you are wrong in your assessments. (That does not mean that there are no fakes in medicine, CAM or traditional.)
Thank you

At Sun Jan 06, 06:37:00 PM, Blogger #1 Dinosaur said...

XLibris and Acupuncture; you make my point eloquently. 'Nuff said.

At Mon Jan 07, 10:27:00 AM, Anonymous Anonymous said...

Random House and an anaesthesiologist. You missed mine.

At Mon Jan 07, 06:50:00 PM, Blogger #1 Dinosaur said...

Random House's purchase of XLibris does not change XLibris' status as a vanity publisher, all of their "new publishing paradigm" BS aside. They bought it because it's lucrative; they like easy money as much as anyone else.

Acupuncture is nothing but a fancy placebo, whether practiced by a board certified anesthesiologist or a Chinese llama.

It's still my point you're making.

At Mon Jan 07, 09:02:00 PM, Blogger Lynn Price said...

As a publisher, I share your disdain with POD/Vanity publication
As a novelist of integrative medicine...well...ouch. 'Course, you knew I was going to say that, didn't you?

At Mon Jan 07, 09:32:00 PM, Anonymous Anonymous said...

Wss there an error with my posting about the efficcy of acupuncture: Harvard medicl school grand rounds.?
I would hate to think you deleted a post that gave information contrary to your hard held beliefs.
To Lynn price - Piers Anthony, Stephen King, to name 2 agree that traditional houses, with their management of content, elaborate turnaround time, sometimes 18 months and longer, and less royalty, are no longer the only way to go.
I am not embarrassed to have Xlibris as my publisher. The NY Times magazine wrter's unsolicited, lovely review validates the quality of my book. (If outside validation is needed) I do not need the name, although I would have liked it, of a traditional house.
Were you not a publsher would you have gotten a publisher?
Not necessarily.
Thank you.

At Mon Jan 07, 09:33:00 PM, Anonymous Anonymous said...

And to clarify, POD is NOT vanity publishing.

At Mon Jan 07, 10:44:00 PM, Anonymous Anonymous said...

Lynn should use a disclaimer stating that she has published with Publsh America. This POD has a bad reputation, based on all I have read and heard about it.
Please don't paint all POD's with one brush.
(Please forgive the addendum but once I used Lynn's link, as above, I felt this needed to be added.)
Thank you.

At Tue Jan 08, 11:48:00 AM, Blogger Lynn Price said...

I don't think Dino intended her post to become a publishing debate that is centered around me, Carol. She merely used vanity presses as an example to illuminate her feelings regarding integrative medicine. If you'd like to continue a publishing debate, feel free to comment on our Behler blog or my personal blog . I'd be happy to educate you on the realities of publishing, including Piers, etc.

Sorry, Dino. I expected a can of worms to be opened - just not this particular can.

At Tue Jan 08, 05:06:00 PM, Anonymous Anonymous said...

I tried to write on both issues ss bundled by Dinosaur.
I just felt that a disclaimer was necessary if you are slamming POD.
As an alternative health practitioner, I had hoped you would write more about the benefits and acknowledged efficacy of many of the CAM's.
Dino disdains both POD and CAM. Another voice acknowledging that it is not fakery would have been welcomed, I would think.
Thank you.

At Tue Jan 08, 06:20:00 PM, Blogger Lynn Price said...

Dino and I have discussed integrative medicine at great length in the past. We're both aware of each other's opinions so repeating myself is a waste of time since most doctor's blogs don't offer a forum for a real exchange of opinions. Dino's comes as close as it can get without walking away bloodied and bruised. It's more fruitful to say my piece over on my own blog.

As for my opinions regarding PODs, I'm afraid it's a tomato/tomahto thing. What you call slamming, I call education - and our Behler blog is very informative regarding the world of publishing. Your "disclaimer" in the interest of "full disclosure" is amateurish because my past publishing association has never been a secret. Those experiences and my experience as a successful commercial press are what give me a very good perspective on the industry.

Another voice acknowledging that it is not fakery would have been welcomed, I would think.
It's hard for me to impeach Dino outright because I feel that she and other doubting docs have valid concerns for valid reasons. It's true that people have become sick or died due to alternatives. Where I think patients go horribly wrong is not going to their docs, and this is the crux of my argument. Alternatives and science-based medicine can and does work well together. I've seen too many medical practices that bears this out. Both the patient and doc are enriched by these exchanges and experiences.

My own writing centers on how doctors' beliefs can impact their practices. I found during my research that patients are often afraid to admit to their docs that they use Reiki or acupuncture, etc. out of fear that they'll be laughed out of the zip code. This can have serious repercussions for the patient because it drives them out of the exam room where they can be monitored.

I see many docs' blogs whose opinions are written in absolutes - "all alternatives are evil," "only stupid people allow themselves to be sucked into the CAM game." It's talk like this that prevents an open dialog where a sharing of ideas can take place. On the other hand, maybe that's the point. And if it is, then whatever I have to say is akin to nailing Jello to the wall - an interesting notion, but why bother?

At Tue Jan 08, 07:58:00 PM, Blogger #1 Dinosaur said...

No, Lynn; I'm an equal opportunity worm can opener.

You understand that vanity publishing is fake, but don't recognize that CAM is precisely analogous to it in the medical sphere.

Carol is your inverse, twisting facts to allow herself to believe that vanity publishing (not POD per se) is "legitimate." That she also happens to believe in some CAM modalities just shows that no analogy is perfect. This one is pretty close, though.

I have no problem saying "I don't know why you got better," but I do have a problem attributing it to magical thinking like Reiki or homeopathy. Bottom line is that I would rejoice with the patient for feeling better, even without knowing (or attributing) exactly what happened. The difference between me and your other docs is that I won't take the next step from "I don't know" to "It must be..." I'm ok not knowing. In a way, I find it interesting that you (and so many other patients) are not satisfied with your improved health, but feel compelled to explain it; even to the extent of invoking magical thinking.

I agree that communication is critical. Allowing patients to disclose the use of alternative modalities is vital, if only to address adverse interactions. The main reason, though, is to be there when the "alternatives" stop working (given that they're not really doing anything in the first place.) Perhaps then the patients would be more open to addressing the real problem, whatever it is, that they prefer to address with "alternatives" because real medicine have stigmas and side effects. (Guess which usually bothers people more?) That's because they're actually doing something.

At Wed Jan 09, 12:14:00 AM, Blogger Lynn Price said...

In a way, I find it interesting that you (and so many other patients) are not satisfied with your improved health, but feel compelled to explain it; even to the extent of invoking magical thinking.
Are you saying that we should just be happy for our health and shut up? If so, I have to ask why should we? If someone who’s been saddled with meds for many years suddenly no longer requires them, I would think a doc would find that interesting and want to isolate the reasons behind the change. Docs, by nature, strike me as one of the most curious human beings on earth. But if I’m reading you right, you’re saying that the reasons have no merit if they can’t be scientifically justified – magical thinking, as you say. I find the lack of curiosity amazing. More to the point, I find it interesting that you (and so many others) are so comfortable with claiming we’re idiots for our beliefs. I don’t believe I’m an idiot, nor am I an impressionable sheep.

At Wed Jan 09, 06:31:00 AM, Blogger #1 Dinosaur said...

...the reasons have no SCIENTIFIC (my addition) merit if they can’t be scientifically justified.

That's exactly what I'm saying. I'm a doctor; I'm looking for scientific explanations. The inability to find one is a limitation of the science, not an excuse to indulge in magical thinking.

Are you saying that we should just be happy for our health and shut up?

Of course not. I'd love to be able to explain it. But if, after an exhaustive scientific investigation, I couldn't, I still wouldn't resort to believing it was Reiki, any more than I'd believe the little green men from Mars finally recalled their spaceship that was beaming those tortured thoughts into the head of a schizophrenic with a spontaneous remission; even if the patient were absolutely certain that's what had occurred and became angry with me for not having an "open mind" about things I couldn't explain. I wouldn't think him "an idiot" nor "an impressionable sheep"; I would hold to my impression that he was indulging in magical thinking. BUT: if he's better, I'm still happy for him.

I'm just as curious as any doctor, with a more open mind than most; just not so open that my brain falls out. (Credit Orac)

At Wed Jan 09, 10:24:00 AM, Anonymous Anonymous said...

"Carol is your inverse, twisting facts to allow herself to believe that vanity publishing (not POD per se) is "legitimate."
I never said I think vanity is legit. I think vanity is essentially a scam. I feel sorry for those with hundreds, sometimes thousands of books they were required to buy, left in their garages and homes.
As to no expanation about sometimes feeling better, I have to tell you, and please do not stop before you finish the sentence. that I received a Miracle that even my doctors; a neurologist and ophthalmologist, among others, call a Miracle. (my neurosurgeon calls it "amazing" (in chart note).
It is more than feeling better. I went from being told 'rational suicide' was acceptable in my case (by a neuroophthalmlogist, psychiatric head of a pain clinic, 2 pain psychologists, and neuroophthalmologist) because of intractable trigeminal neuralgia.
I won't take up the room here but hope that you will read about my experience.
I would be very interested in your opinion.
Thank you.

At Wed Jan 30, 05:26:00 PM, Anonymous Anonymous said...

I hope you're well as there has been no response or other activity from you here..


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