The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.
The practice of medicine is an art, based on science.
-Sir William Osler, AEQUANIMITAS
The truth is that many of us have some kind of “extraordinary gift.” For a few of us, that gift is the ability to throw a ball at 90 miles per hour and hit a catcher’s glove. For others, that gift is a form of extraordinary perception. Medical intuitives “see” things that others don’t. Wendy Marks has been described as a “human CT scan.” What no one has been able to diagnose by conventional methods is often seen when Wendy scans a body.
-Boston Women’s Journal April/May 2002
The concept of an art to the practice of medicine comes up frequently and in a variety of contexts. Early on in our medical education, we are exposed to the phrase and what it supposedly means, which I will discuss in more detail shortly. But the art of medicine is always painted (pun intended) in a positive light. I will admit that I have a strong opinion, perhaps biased by my involvement with the science-based medicine movement and an equally early exposure during my medical training to champions of evidence-based practice and the use of critical thinking in the approach to patient care.
Not Dr. Oz’s usual television audience
Dr. Mehmet Oz is one of the most well-known, and possibly the most influential medical doctor in America. The Dr. Oz Show is broadcast in 118 countries and reaches over 3 million viewers in the USA alone. When Oz profiles a product or supplement on his show, sales explode – it’s called “The Dr. Oz Effect”. Regrettably, Oz routinely and consistently gives questionable health advice, particularly when it comes to weight loss products, where Oz regularly uses hyperbolic terms like “miracle” for the products he profiles:
- (On green coffee extract) — “You may think magic is make-believe, but this little bean has scientists saying they found the magic weight-loss for every body type.”
- (On raspberry ketone) — “I’ve got the number one miracle in a bottle to burn your fat”
- (On Garcinia cambogia) — “It may be the simple solution you’ve been looking for to bust your body fat for good.”
Dr. Oz has profiled so many dubious health strategies that “The Dr. Oz Effect” more accurately refers to the wasted time, effort and finances of any consumer that actually follows his health advice and purchases the steady stream of “miracles” that Oz endorses on his television show. Not surprisingly, Science-Based Medicine is probably Oz’s most persistent and tenacious critic. It’s not just that he’s high profile – it’s that Dr. Oz is a bona fide physician who ought to know better, but chooses to ignore science in favour of hyperbole. It’s the antithesis of what a health professional should be doing. And this is the root of the Oz problem: Oz can give good advice, but he regularly combines it with questionable statements and pseudoscience in a way that the casual viewer can’t distinguish between the science and the fiction. So when Oz calls something a miracle – people listen. Even when miracles show up several times per year. (more…)
The BBC recently reported that a Guinean singer, Alama Kante, sang through her surgery in order to protect her voice. The reporting is unfortunately typical in that it emphasizes the seemingly amazing aspects of the story without really trying to put them into proper context. Specifically, the story emphasizes that hypnosis was used during the surgery, since Kante could not be placed under general anesthesia and still be able to sing, reporting:
“The pain of such an operation is intolerable if you are fully awake. Only hypnosis enables you to stand it,” he was reported as saying by to French publication Le Figaro.
“She went into a trance listening to the words of the hypnotist. She went a long way away, to Africa. And she began to sing – it was amazing,” he said.
Reports of major surgery being performed using self-hypnosis or hypnosis instead of anesthesia crop up regularly, because of the obvious sensationalism of such stories. I reported a similar case from 2008, for example. At least in this case the news report gave the critical piece of information, often missing entirely from such reports:
The Guinean singer, who is based in France, was given just a local anaesthetic and hypnotised to help with the pain during the operation in Paris.
A correspondent asked me to look into the science behind the health claims for turmeric. He had encountered medical professionals “trying to pass turmeric as some sort of magical herb to cure us from the ‘post-industrial chemical apocalypse.’” It is recommended by the usual promoters of CAM: Oz, Weil, Mercola, and the Health Ranger (who conveniently sells his own superior product, Turmeric Gold liquid extract for $17 an ounce).
Turmeric (Cucurma longa) is a plant in the ginger family that is native to southeast India. It is also known as curcumin. The rhizomes are ground into an orange-yellow powder that is used as a spice in Indian cuisine. It has traditionally been used in folk medicine for various indications; and it has now become popular in alternative medicine circles, where it is claimed to be effective in treating a broad spectrum of diseases including cancer, Alzheimer’s, arthritis, and diabetes. One website claims science has proven it to be as effective as 14 drugs, including statins like Lipitor, corticosteroids, antidepressants like Prozac, anti-inflammatories like aspirin and ibuprofen, the chemotherapy drug oxaliplatin, and the diabetes drug metformin. I wish those claims were true, because turmeric is far less expensive and probably much safer than prescription drugs. It clearly has some interesting properties, but the claims go far beyond the actual evidence. (more…)
NOTE ADDENDUM – Ed.
I’ll admit it: I’m a bit of a beer snob. I make no bones about it, I like my beer, but I also like it to be good beer, and, let’s face it, beer brewed by large industrial breweries seldom fits the bill. To me, most of the beer out being sold in the U.S., particularly beer made by Anheuser-Busch and MillerCoors can easily be likened to cold piss from horses with kidney disease (you need protein to get beer foam, you know), only without the taste. I have to be mighty desperate and thirsty before I will partake of such swill. I will admit that there is one exception, namely Blue Moon, which is manufactured by a division of MillerCoors, but that’s the only exception I can think of. Ever since I discovered Bell’s Oberon, a nice local (well, statewide, anyway) wheat ale, I can do without Blue Moon. Sadly, Oberon is only brewed during the spring and summer months; so when I want a similar bit of brew during the winter months sometimes I’m tempted by Blue Moon. Otherwise, I’m generally happy with one of the many craft and microbrews made by local brewers such as Short’s Brewing Company (whose brewpub I had the pleasure of visiting about a month ago) and Bells Brewery.
Despite my general hostility to Anheuser-Busch and MillerCoors products as examples of everything that is wrong with American beer, I have to say that I almost feel sorry for the people running those corporations right now. Unfortunately, they’ve fallen victim to the latest quack making a name for herself on the Internet by peddling pseudoscience. As is my wont, I’ll go into my usual excruciating detail shortly. But first, to whom am I referring?
I knew that Jann was thinking of writing about reiki and fraud, but did not know the details of her most excellent discussion from yesterday until I had finished my penultimate draft for today. Think of them as a match set, two perspectives on the same elephant.
Fraud: a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities.
There are numerous activities that one human will offer another in exchange for money that are completely divorced from reality.
Astrology. Total bunkum.
There is no force, known or unknown, that could possibly affect us here on Earth the way astrologers claim. Known forces weaken too fast, letting one source utterly dominate (the Moon for gravity, the Sun for electromagnetism). An unknown force would allow asteroids and extrasolar planets to totally overwhelm the nearby planets…
Study after study has shown that claims and predictions made by astrologers have no merit. They are indistinguishable from chance, which means astrologers cannot claim to have some ability to predict your life’s path.
Although 48% of Americans think astrology is a science, as best I can tell astrology is not part of the curriculum at any astronomy division or program. Astronomers know it is bunkum and avoid it . (more…)
The Center for Integrative Medicine at the Cleveland Clinic sells reiki treatments (also here) to patients with cancer, fertility issues, Parkinson’s Disease and digestive problems, as well as other diseases and conditions. The Center’s website ad describes reiki as
a form of hands-on, natural healing that uses universal life force energy . . . [a] vital life force energy that flows through all living things. This gentle energy is limitless in abundance and is believed to be a spiritual form of energy. The Reiki practitioner is the conduit between you and the source of the universal life force energy. . . You may experience the energy as sensations such as heat, tingling, or pulsing where the practitioner places her hands on your body, or you may feel these sensations move through your body to other locations. This is the energy flowing into you.
This “universal life force energy” is described as having certain positive effects on one’s own energy, such as “energetically balancing” one physically, replenishing one’s supply of energy, improving distribution of that energy in the body, and dissolving “energy blockages.” It also increases one’s “vibrational frequencies,” although how these frequencies relate to one’s energy, or to anything else for that matter, is not made clear. (more…)
Prolotherapy is a treatment technique used for chronic myofascial pain, back pain, osteoarthritis, or sports injury. It involves repeated injections of dextrose solution or other irritating substances into the joint, tendon, or painful tissue in order to provoke a regenerative tissue response. Similar techniques have been used for about a century, but the first formal publication describing prolotherapy dates back to 1956, by Dr. George Hackett. He wrote:
Within the attachment of weakened ligaments and tendons to bone, the sensory nerves become overstimulated by abnormal tension to become not only the origin of specific local pain, but also definite areas of referred pain throughout the body to as far as the head, fingers and toes from specific relaxed ligaments and tendons.
Prolotherapy. A treatment to permanently strengthen the “weld” of disabled ligaments and tendons to bone by stimulating the production of new bone and fibrous tissue cells has been developed.
Initially the concept, referred to a sclerotherapy, was that the injections formed scar tissue to stabilize the joint, tendon, or ligament. The newer concept, called prolotherapy, is that the injections provoke the proliferation of tissue, allowing for limited regeneration. (more…)
What AMD does to vision
Four years ago I wrote about the premature marketing of a diet supplement for macular degeneration before the results of a trial to test it were available. Now that we know the results of that trial, a follow-up post is in order.
Age-related macular degeneration (AMD) is a leading cause of blindness. The incidence increases with age; it affects 10% of people by age 66-74 and 30% of people by age 75-85. There are known risk factors including genetics and smoking, but there is no effective prevention. There are multiple diet supplement products on the market that are advertised as “supporting eye health.” Some are based on evidence from randomized, controlled studies; but the advertising hype goes beyond the evidence and tends to mislead consumers. There is evidence that supplementation may slow the progression of moderate to severe AMD, but there is no evidence that supplements are effective in milder disease or for preventing AMD from developing in the first place. (more…)
You might have noticed that I didn’t produce a post last week, something that’s unusual for me, given how prolific I have been in the blogosphere. One reason was personal. The other reason was that last weekend I was attending the annual meeting of the American Society of Clinical Oncology (ASCO) meeting in Chicago. I also must confess that, while I was there, I caused a bit of a stir on the meeting hashtag (#ASCO14) in the name of science-based medicine (SBM) on Twitter under my handle @gorskon. (What? You aren’t following me on Twitter? Get thee hence to my Twitter feed and add me. I’ll wait. Did you do it yet? Good. Now we can move on.) Of course, I know what you’re thinking: Cuddly, lovable me? Causing trouble? Making sure that I’ll almost certainly never be invited to be an official social media doc or to participate in panels on social media at ASCO, despite my extensive experience blogging, using Twitter, and just in general being a pain in the rear online to those who promote quackery and quackademic medicine? Perish the thought!
Of course, it was for just that reason that I was making a bit of a stir on Twitter. ASCO is one of the biggest (if not the biggest) and most organized oncology meetings out there, and there were several people considered “social media rock stars” in the world of oncology such as Mike Thompson, Deanna Attai, Matthew Katz, and Robert Miller live Tweeting the meeting, along with those viewed, correctly or incorrectly, as lesser lights, such as myself. In any case, on Sunday I noticed that a lot of people, including the official ASCO Twitter feed @ASCO, were Tweeting and re-Tweeting a link to this official story from ASCO, “Integrative Oncology Can Add Benefit to Traditional Cancer Treatments.” It was a description of a session that had been held on Saturday morning, Integrative Oncology: The Evidence Base, which, unfortunately, I had missed due to circumstances entirely beyond my control. Fortunately, however, ASCO is benevolent (not to mention that it also justifies the high cost of meeting registration) by providing immediate access to recordings of every major session, not to mention the slide sets used. If I couldn’t be there in person, at least I could cruise on over to the ASCO website and use my access to the 2014 virtual meeting to see what sort of quackademic medicine was being featured at ASCO. (more…)