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2009′s Top 5 Threats To Science In Medicine

As 2009 comes to an end, it seems that everyone is creating year-in-review lists. I thought I’d jump on the list band wagon and offer my purely subjective top 5 threats to rational thought in healthcare and medicine.

Of course, it strikes me as rather ironic that we’re having this discussion – who knew that medicine could be divorced from science in the first place? I thought the two went hand-in-hand, like a nice antigen and its receptor… and yet, here we are, on the verge of tremendous technological breakthroughs (thanks to advances in our understanding of molecular genetics, immunology, and biochemistry, etc.), faced with a growing number of people who prefer to resort to placebo-based remedies (such as heavy-metal laced herbs or vigorously shaken water) and Christian Science Prayer.

And so, without further ado, here’s my list of the top 5 threats to science in medicine for 2009 and beyond:

#1: Congress

Money is the most powerful gasoline that can be poured on the fire of pseudoscience. And thanks to Senator Tom Harkin, and a few merry enablers, there is now legislation in the Senate healthcare reform bill that would allocate tax dollars to disproven and unproven medical therapies. Healthcare providers recognized by CMS will include alternative medicine practitioners – many of whom can meet licensing requirements with online degrees from schools that do not teach actual science. They will be eligible to become primary care providers, use “doctor” in their self-designation, and do untold harm to patients nationwide through misdiagnosis and mistreatment.

Please refer to this post for detailed amendment language, and for goodness sake – call your congressman or woman and ask them to move to strike this language from the reconciled house and senate bills before it becomes law. Seriously. Go call them NOW.

#2:  Mainstream Media

For some reason, snake oil has captured the imagination of the mainstream media. Thanks to people like Oprah and the major news networks, there is a steady parade of pseudoscientific poppy cock being spoon fed to the public. And because of the lack of critical thinking taught in schools, Americans (on average) have a 6th grade understanding of medicine. They have a hard time distinguishing science from pseudoscience, and with the constant barrage of miracle cures, “scientific” breakthroughs, and conspiracy theories about anything that actually works (e.g. vaccines). They have become skeptical of science while often totally accepting of snake oil.

Before we become completely despairing of any sliver of health enlightenment reaching the public through mainstream media – let’s recall that 2009 brought us a handful of journalists willing to stand up for truth and critical thinking.Newsweek’s Weston Kosova, the Associated Press’ Marilynn MarchioneWired’s Amy WallaceChicago Tribune’s Trine Tsouderos, and The Washington Post’s Clive Thompson deserve praise and encouragement for standing up for science.

#3: Academic Medical Centers

Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care. Because of the economic realities of decreasing healthcare reimbursements – these once proud defenders of science are now accepting money to “study” implausible and often disproven medical treatments because they’re trendy. Scientists at these centers are forced to look the other way while patients (who trust the center’s reputation that took tens of decades to build) are exposed to placebo medicine under the guise of “holistic” healthcare.

I believe that patients are crying out for compassionate care – for more time with their providers, more dignity in their choices, and more participation in their care. In my opinion, these needs can and should be met by science-based professionals who offer patients the truth about the strengths and limitations of their options – there is no need to fill this emotional need with false cures and placebo treatments, and spin it as if the patient is getting better “integrated” care. Quackademic medicine is neither compassionate nor scientifically honest. It’s just a complex new way of providing placebo care to patients who need some common human kindness.

#4: NCCAM

Even though we’ve invested $2.5 billion tax payer dollars and 10+ years of time on studying complementary and alternative medicines – we have discovered NO single breakthrough in medical treatment as a result. Not only does this Institute appear to be a real waste of scarce resources, but In fact, the TACT trial (in particular) offers a stark example of the unethical practices that can arise when vigorous scientific standards are not met. Thanks to Dr. Atwood’s diligent review, we have a clear understanding of the shenanigans at play:

The NIH approved a research study (called the TACT Trial – Trial to Assess Chelation Therapy – a supposed treatment for arteriosclerosis) in which the treatment had no evidence for potential benefit, and clear evidence of potential harm – and even the risk of death. Amazingly, the researchers neglected to mention this risk in their informed consent document. The NIH awarded $30 million of our tax dollars to ~100 researchers to enroll 2000 patients in this risky study (ongoing from 2003-present). Even more astounding is the fact that several of the researchers have been disciplined for substandard practices by state medical boards; several have been involved in insurance fraud; at least 3 are convicted felons.

Many have called for defunding the NCCAM, and that certainly seems like a reasonable request under the circumstances of such a low ROI and ethical breaches.

#5: New Media

Just as mainstream media is beginning to fade in its influence and popularity, online and “new” media are making exponential leaps in influence.  The Huffington Post and Age Of Autism are two strongholds of health misinformation that come to mind. Of course, “user generated content” and unvetted health advice and claims are easily made by anyone anytime. And thanks to the magic of Google, a health claim need only be popular to be promoted. Truth, accuracy, and scientific rigor aren’t always rewarded in this brave new world of digital influence. Being right has been uncoupled from being influential. The “wisdom of crowds” now decides what people see first when they attempt to educate themselves about health matters.

And so, dear readers of Science-Based Medicine, we face formidable foes in our quest for honesty and integrity in medicine. I predict that the next decade will favor the organized, not the accurate. And so with that in mind, let us strive towards building our network of critical thinkers (in the government, media, research and clinical centers, and online), organizing our efforts to promote science and rational thought. We’ll each need to channel our inner “community organizer” to counter the pseudoscience movement. And we can win this, because in the end…

Science works.

Science works.The Top 5 Threats To Science In Medicine
As we wind down 2009, the Internet is filled with lists – the best and worst of 2009, top 10 holiday recipes (or weight loss tips), and predictions for the future. So I thought I’d jump on the list band wagon and offer my purely subjective top 5 threats to rational thought in healthcare and medicine.
Of course, it strikes me as rather ironic that we’re having this discussion – who knew that medicine could be divorced from science in the first place? I thought the two went hand-in-hand, like a nice antigen and its receptor… and yet, here we are, on the verge of tremendous technological breakthroughs (thanks to advances in our understanding of molecular genetics, immunology, and biochemistry, etc.), faced with a growing number of those who would like to do away with these advances and resort to placebo-based remedies (such as heavy-metal laced herbs or vigorously shaken water) and Christian Science Prayer.
People are weird.
And so, without further ado, here’s my list of the top 5 threats to science in medicine for 2009 and beyond:
#1: Congress
Money is the most powerful gasoline that can be poured on the proponents of pseudoscience’s fire. And thanks to Senator Tom Harkin, and a few merry enablers, there is now legislation in the Senate healthcare reform bill that would allocate tax dollars to disproven and unproven medical therapies. Healthcare providers recognized by CMS will include alternative medicine practitioners – many of whom can meet licensing requirements with online degrees from schools that do not teach actual science. They will be eligible to become primary care providers, use “doctor” in their self-designation, and do untold harm to patients nationwide through misdiagnosis and mistreatment.
Please refer to this post for detailed amendment language, and for goodness sake – call your congressman or woman and ask them to move to strike this language from the reconciled house and senate bills before it becomes law. Seriously. Go call them NOW.
#2:  Mainstream Media
For some reason, snake oil has captured the imagination of the mainstream media. Thanks to people like Oprah and the major news networks, there is a steady parade of pseudoscientific poppy cock being spoon fed to the public. And because of the lack of critical thinking taught in schools, Americans (on average) have a 6th grade understanding of medicine. They have a hard time distinguishing science from pseudoscience, and with the constant barrage of miracle cures, “scientific” breakthroughs, and conspiracy theories about anything that actually works (e.g. vaccines). They have become skeptical of science while totally accepting of snake oil.
Before we become completely despairing of any fraction of health enlightenment reaching the public through mainstream media – let’s recall that 2009 brought us a handful of journalists willing to stand up for truth and critical thinking. Newsweek’s , the Associated Press’, Wired’s, Chicago Tribune’s and The Washington Post’s deserve praise and encouragement for standing up for science.
#3: Academic Medical Centers
Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care. Because of the economic realities of decreasing healthcare reimbursements – these once

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34 thoughts on “2009′s Top 5 Threats To Science In Medicine

  1. windriven says:

    I would like to add an honorary mention: our nation’s secondary schools and universities for failing to provide a thorough grounding in the scientific method and critical thinking skills.

  2. daijiyobu says:

    I would suggest that there are also certain individuals — other than mentioned above — who could collectively be called

    “the celebrity pseudoknowledgeable”.

    In some sense, they are like society’s rampaging ID [e.g., Forbidden Planet] when it comes to modern medical knowledge.

    IDiots.

    -r.c.

  3. David Gorski says:

    Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care.

    Of course, I can’t take credit for coining the term “quackademic” medicine. I wish I could, but I can’t. As far as I can tell, Dr. R. W. Donnell coined the term:

    http://doctorrw.blogspot.com/2008/01/exposing-quackery-in-medical-education.html

    At least his blog was the first place I ever saw it, nearly two years ago.

  4. halincoh says:

    As a primary care doc I have seen four broad approaches by those of us in the trenches and beyond:

    1. those who hinder the fight, by passively accepting our patients’ pseudoscience time after time

    2. those who are an active participant in woo itself

    3. those, like yourself, who fight every belief that may adversely effect medical care

    4. those who choose their battles and selectively educate their patients and their community when pseudoscience interferes with care as it applies to that patient or group

    I am a number 4 type. Unfortunately, the more the deck becomes stacked against us, the more we will need #3 types in the tradtional or new media and the more difficult ( i.e., TIME CONSUMING ) it will become to practice at the number 3 or number 4 level. If we ever become a mass heard of passive number 1s, we’re sunk.

  5. halincoh says:

    herd … not heard … or perhaps more appropriately it should be changed to UNheard

  6. bolese22 says:

    I think this blog post illustrates perfectly why I feel the need to go back to teaching secondary students biology. I have moved on to a position of higher pay / more prestige / more power…however, as a high school principal I have little actual input into student learning (especially at such a small school). I enjoyed teaching for over 10 years, and I have become increasingly frustrated with my job, but a I am starting to realize that it is due to a need to return to my calling….teaching REAL SCIENCE. I sure hope I can contribute, in the near future, to educating our public in the areas of critical thinking, scientific method, and a bit of scepticism. We, as a nation, are steadily progressing down a road that leads to so many negative outcomes it is nightmarish….unless WE take it upon ourselves to become a more educated society. Most people just accept ignorance (in themselves), and this is one scary thought.

  7. nitpicking says:

    @bolese22, as a matter of fact I just applied for a science teaching job after 20 years in industry. I’m completely in sympathy.

    Dr. Jones: keep in mind that this very group blog is also new media. Like most things, it has good and bad sides.

  8. Rogue Medic says:

    I would agree with the comments that it is in the earlier grades that the problems of bad science education are established. After that point it is a much more difficult task to correct this creeping indoctrination in magical thinking.

    I think that this is the number one threat to science in medicine. all of the others only contribute to this.

    Magical thinking is a form of corruption. As with other types of corruption, it usually does not start with a cannonball into the deep end, but a gradual acclimatization to more and more corruption. At some point, critical judgment is only a fond memory.

    There must have been a time, in the beginning, when we could have said – no. But somehow we missed it. – Tom Stoppard.

    The comments about the Wisdom of Crowds misrepresent what James Suroweicki wrote. I put off reading this book for several years, not thinking that it would have any substance. He states that there are conditions that lead to a crowd making a wise decision and the absence of those conditions will not lead to a wise decision.

    There is a nice summary of these criteria in the Wikipedia article The Wisdom of Crowds.

    Another threat to science in medicine is the reliance on narrative fallacy. We extrapolate far to much from limited information. Any group of facts can be assembled into many different explanations, but we feel the need to use one of these, at the exclusion of the rest. This is myth making.

    We are uncomfortable with the uncertainty that is an essential part of life. We think that by providing an explanation, we have a better understanding of what we are describing. In stead we create a fiction. this fiction becomes difficult to overturn, but when it is, it is used as an argument for the science has been wrong arguments.

    Well intentioned explanations may come from doctors, scientists, journalists, educators, et cetera. Those least capable of correctly drawing conclusions may be the ones with the most access to media to mislead the public with these glorified hunches about the meaning of research.

    We need to be very critical of conclusions drawn from research that are not warranted. We need to be very critical of conclusions drawn from research that do not point out that there are many other possible explanations that fit the same facts. As #3 makes clear, this is not limited to education of the general public.

  9. Rogue Medic says:

    Some corrections –

    – extrapolate far too much (not to</i. much).

    to the exclusion (not at the exclusion).

    – but when it is, it is used as an example of the science has been wrong arguments (not but when it is, it is used as an argument for the science has been wrong arguments).

    And the several cases of lack of appropriate capitalization.

  10. Mojo says:

    Well, we don’t have Congress on this side of the water, and certain elements of our legislature might even be showing some promise (although we’ll have to wait and see what the report actually says), but we have an heir to the throne to contend with, I suppose.

    I would add to your list, though, the English libel laws. Can’t have science-based medicine if the evidence isn’t available to be assessed.

  11. Lawrence C. says:

    The fact that Congress is at the top of the list for this topic would make Mark Twain very happy. He provides a good scientific explanation as to why CAM supporters in Congress (and similar bodies) do what they do:

    “All Congresses and Parliaments have a kindly feeling for idiots, and a compassion for them, on account of personal experience and heredity.” – Mark Twain’s Autobiography

  12. I would add the Christian majority’s feeling that “intelligent design” is somehow a theory comparable to evolution, and should be given equal time in schools. This is absolutely unnaceptable in a public school and must be expunged.

    Evolution is a fact, with mountains of evidence to demonstrate that, from fossil record to phylogeny of species to genetic drift in DNA records to real time experiments in single celled organisms. It is proven as well as anything can be proven.

    Intelligent design is an idea borne on the concept that its all just too complicated to be true. In other words, because tons of people who have not spent years studying evolutionary biology cannot understands the intricacies of evolution, evolution is therefore bogus and untrue, and instead it is the product of supernatural intervention.

    Evolution is science. Intelligent design is creationism, and is therefore religion.

    Intelligent design can be taught in schools, but only as part of comparative religion courses. It has no place in science class.

  13. wbtittle says:

    We should also add the other attackers of rational medicine — The Epidemiologists.

    The number of quack studies is not limited to NCCAM, it is living strong and well in the regular medicine world. Fear based medicine seems to be the mode of the decade.

  14. RachelW says:

    I would add, to the lack of health/medicine literacy mentioned in #2, information literacy in general. As a librarian, I’m inclined to promote improvement in this area, but I really think there are tons of missed opportunities to teach kids to evaluate sources, to consider bias, to seek out quality information on their own. I think we could really offset a lot of the media/celebrity/woo issues to some extent if members of my profession were made better use of by teachers, schools, etc.

  15. I agree with you when write “Money is the most powerful gasoline that can be poured on the fire of pseudoscience”. However, I suggest to add also Acadèmic Medicine to pseudoscience. In a few words, why so-called scientist continue to ignore Quantum Biophysical Semeiotics Constitutions (predisposition…) “and” related INHERITED Real Risk? For example, why individuals negative for Prostate Cancer Inherited Real Risk, even positive for Oncological Terrain, must undergo PSA and all other cancer biomarker?
    Overlooking Quantum Biophysical Semeiotics accounts for the reason of today’s Middle Ages of Medicine (Ask Google.com)..

  16. margokatt says:

    FYI, science is fueled by money. Sometimes the amount of money taints the results. I am a molecular biologist and skeptical of psuedoscience BUT I have experienced some things that have changed my mind, opened it. I think that instead of western vs. eastern battles people need to be held accountable for themselves. If you want to try alternative based services great. If they help you feel better, great again! The placebo effect can be extremely powerful. Cancer patients often survice because of positive thinking during treatment. Pyschology has a huge part in our health. Combination therapies and preventative care is critical.

  17. pjcamp says:

    #6 Crazy Doctors.

    I met a neurologist at a dinner recently, former teacher at both Temple and Emory, who seemed to believe that double blind trials are the only form of experiment and, indeed, the only path to knowledge. Of course, this necessarily implies that, say, Astronomy contains no knowledge.

    I called this path learning, much like Lorenz observed in water shrews, and it made him cry.

    More seriously, medicine tends to be really insular. Ideas go round and round the same horn, with the same people talking to one another about only the things they are interested in.

    In the mildest cases, this leads to people unable to argue their case because they’ve only ever talked to the previously convinced. In more serious cases, as with the neurologist, it leads to a blinkered imagination, unable to conceive of anything beyond the groove.

    Groopman’s book How Doctors Think points to this tendency as a major issue in malpractice as well as skepticism of medical knowledge. It’s worth reading.

    Written by a physicist who’s never done a double blind trial in his life, and likely never will.

  18. pmoran says:

    “–, who seemed to believe that double blind trials are the only form of experiment and, indeed, the only path to knowledge.”

    ” — seemed to believe”?

    I am sure he merely had in mind how to establish the validity of certain types of medical claim.

    Double-blind trials are never performed without there first being some OTHER reason (path to knowledge?), for thinking that a treatment might work better than placebo.

  19. libby says:

    hello:

    I was wondering where I could find the following information.

    Out of all the deaths from H1N1 in the US, how many were unvaccinated and how many vaccinated.

    This should be very easy to find because there is a record of all those vaccinated, but oddly, this information doesn’t seem available.

    Any ideas.

    Thanks.

  20. Chris says:

    I’m sorry you did not like the answer I gave you before on the Measles post. But it is obvious this is a loaded question. Especially since many of the people died before the vaccine was available on a regular base. Plus at last count only one out of five in the USA had been vaccinated, and there have been over ten thousand deaths.

    For more information you should try http://www.flutrackers.com/forum/ .

    Why do you care? You seem to post your questions on postings here that are not really associated with the H1N1 flu. First it was on the Measles posting, and now this one… Do you see anything on H1N1 above? Um, nope!

    Have you tried actually reading the posts that come up when you search for “h1n1″ on this blog? If you had, you would have found Joe Albietz contribution from Dec. 11, 2009 more relevant to your question than this blog posting.

  21. Chris says:

    Why are you asking in odd blog postings? Have you tried on ones actually related to H1N1? Like the one Joe Albietz did specifically on the safety of vaccine on Dec. 11, 2009.

    Especially since you did not like my answer on the Measles posting. Really all of the people who died before the vaccine was available were not vaccinated! How is that a hard concept to grasp?

    Why do you care?

  22. Zoe237 says:

    I have my own list.

    1. Money. Advertising, conflicts of interest, funding of studies.

    2. The religious right (stem cell research, abortion misinformation, end of life issues).

    3. Public/science education.

    4. Money again. The lack of universal health care and the profit motive in medicine.

    5. Tradition. The refusal or slowness/ resistance to change of doctors based on previous/anecdotal experience rather than research.

    6. Lack of focus on preventative care, lack of primary family doctors. This seems to be changing though. Can’t say I like the HMO alternative much more though.

    7. Health insurance companies, med mal.

    And no, I don’t like CAM, but I don’t see it as the primary threat.

    As for NCCAM, I kind of see it as a necessary evil. It shouldn’t be necessary, but since so many people use these therapies, it is. Maybe less people will fall for the hype when they see it doesn’t work. (Wishful thinking?)

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