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Integrative Medicine – Sectarians’ Trojan Horse

Integrative Medicine – Sectarians’ Trojan Horse leapfrogs science (Or, I can misuse language with the best of them…)

I stumbled across an article from Archives of Internal Medicine, 2002 (Integrative Medicine: Bringing medicine back to its roots. Arch Intern Med. 2002 Feb 25;162(4):395-7). It is one of the first authored by Andrew Weil on “Integrative Medicine “ – another is BMJ in 2001. This one he co-authored with Ralph Snyderman. Dr. Snyderman was dean of the Duke University med school, and is now upstairs as a chancellor of health affairs. He is one of the highest ranking academicians to express fondness for sectarian systems (they prefer “Integrative Medicine.”) Fondness in his case is an understatement. He appears to have fallen up to his frown into the sectarian vat and emerged transformed as the poster-prof for the Bravewell Collaboration, funding organization for the 36 departments and programs in US medical schools. Andrew Weil, of course is one of the prime movers of the “CAM” phenomenon, and may have invented the neo-term, “Integrative” – with the clever occult purpose of diverting attention away from plausibility and toward acceptance according to our suggested motto, “teach it and use it regardless of efficacy.“ He directs this activity from his spread near Tucson, where he also heads the U. of Arizona “integrative” program.

I experienced several problems on reading the article – mainly a cloud of dysphoria and a sense that of disagreement with it, but through a fog of obscure language, I could not identify why. One has to look closely at the language. The abstract alone yields enough for this entry. It displays language distortion by re-definition, as Kim Atwood recently explored, language obscurantism – use of generalizations and words with obscure or multiple meanings, and invented language. It also mis-states, misrepresents, assumes; these are established propaganda techniques and used to construct false labels on sectarianism’s Trojan Horse. After starting this I found a similar article by Edzard Ernst in Mayo Clinic Proceedings in 1993. Nothing new under the sun…

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Posted in: General, Medical Academia, Politics and Regulation, Science and Medicine

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Women in Medicine

Why aren’t there more women in science and medicine? Just because we lack certain anatomical dangly bits, does that mean we’re less capable? Apparently Harvard’s president Lawrence H. Summers thought so. In a classic case of foot-in-mouth disease, he suggested that innate differences between men and women might be one reason fewer women succeed in science and math careers. His comments (in 2005) predictably set off a media feeding frenzy. I won’t even attempt to get into that nature/nurture controversy. Whatever the statistical generalities, the fact is that individual women can and do succeed in those careers. What really matters is whether qualified women today have a fair opportunity to choose their profession and rise in it.

Something very interesting is happening in medicine. It’s happening slowly, quietly, and steadily, with no help from affirmative action programs.

At the beginning of the 20th century about 5 percent of the doctors in the United States were women. In 1970, it was still only 7 percent. By 1998, 23 percent of all doctors were women, and today, women make up more than 50 percent of the medical student population. In 1968 only 1.2% of practicing dentists were women. By 2003, 17% of dentists were women, and 35% of dentists in new active private practice were female. (more…)

Posted in: Book & movie reviews, General

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The Weekly Waluation of the Weasel Words of Woo #4

That’s What I’m Talkin’ ’bout!

The new single-paragraph paradigm for the W^5/2 seems to have worked: there were 13 Waluations for the paragraph submitted in W^5/2 #3, every one of ‘em good. Several themes emerged; I’ll discuss them in no particular order.

  • When did you stop beating your wife? The passage charges that the “biomedical model,” by which is apparently meant modern medicine, does not consider anything other than “disturbances in biochemical processes.” “Holistic medicine,” on the other hand, recognizes the Complex Interplay Between Multiple Factors. DVMKurmes, pmoran, and wertys each exposed the ahistoricity of this claim.
  • Back to the Future. Speaking of ahistoricity (is that a word?), two readers, wertys and Falx, noticed a paradox: the proposed “paradigm shift” of “medicine today” always involves the resurrection of discredited, pre-scientific notions of yesterday.
  • Dr. Feelgood. Several readers, including DVMKurmes, Michelle B, rjstan, wertys, Stu (m’man!), Calli Arcale, and overshoot, alluded to the preference of at least some Woo-Seekers for feeling good (“a healing model”) over being good (“the curative model”). I admit that my shorthand description of the point is oversimplified, but there is truth in it nonetheless. The “feelgood” phenomenon is not to be confused with the similarly named
  • Feelings…Very Special Feelings. Alotta people just want, well, their feelings to be validated. Not that there’s anything wrong with that, but if it’s at the expense of competent medical care, as rjstan, Stu, and Falx noted, they could be Takin’ Trouble by the Tail. Or at least Losin’ a Lotta Lettuce.
  • It Takes a Worried (wo)Man to Sing a Worried Song. Both rjstan and DBonez called attention to the current societal obsession with “health,” frequently called “wellness,” which is an indispensable part of the “CAM”-scam. As rjstan and pmoran pointed out, many of the obsessed have nothing wrong but a surplus of funds. Why don’t those people just getta life?
  • By Hook and By Crook. Tools honed on Madison Avenue are in the kits of sCAMsters, say DVMKurmes, Michelle B, Stu, and ShawnMilo. That they are.
  • Mastering the Art of Zen Cooking. A lotta “reduction” makes my eyes glaze, so I was pleased that at least one reader, overshoot, cited the passage for its tired misportrayal of the “scientific reductionist view.” One o’these weeks we’ll discuss that at some length.
  • The Well-Hewn Tune of Thomas Kuhn is misrepresented by those we impugn, as asserted by wertys and implied by Joe. Another topic to discuss at more length some time.
  • The Autobiography of Malcolm X…prophecies that…his…brother…Michael X…will…one day…rail…against…so-called…integrated…medicine.

This Week’s Entry:

A shaman is a type of spiritual healer distinguished by the practice of journeying to nonordinary reality to make contact with the world of spirits, to ask their direction in bringing healing back to people and the community. The journey is a controlled trance state that practitioners induce by using repetitive sound (drums, rattles) or movement (dancing) and occasionally by consuming plant substances (e.g., peyote or certain mushrooms). Characteristically experiential and cooperative, shamanic healing is found worldwide. It is fundamental to much traditional European, African, Asian, and Native American Indian folk practice and is rapidly gaining popularity among nonnative urban Americans, in which setting it is sometimes called neo-shamanism.

Happy Waluating!

The Misleading Language and Weekly Waluation of the Weasel Words of Woo series:

  1. Lies, Damned Lies, and ‘Integrative Medicine’
  2. Integrative Medicine: “Patient-Centered Care” is the new Medical Paternalism

Posted in: General, Humor, Science and Medicine

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Borderlines in research

This is a slight departure from the usual fare of pseudoscience, but a matter that should concern us because of the vulnerability this matter confers on medicine – the borderline practices of major medical centers. The article can be viewed here.

Several days ago the San Francisco Chronicle printed a second article about the plight of a 37 year old woman (EP) with an inflammatory breast cancer who was denied insurance coverage for an expensive treatment, high-dose chemotherapy with autologous bone marrow (or stem cell) transplant or infusion (HDCT/BMT or SDI.) The institution is the MD Anderson Cancer Center in Houston. The problem is that although the treatment is effective, it is no moreso than moderate dose HDCT without the marrow or stem cell infusion, and also is more expensive and has significant morbidity.

Inflammatory breast cancer is a highly aggressive form that is usually regarded as “advanced” when diagnosed, that is, spread beyond the breast and regional lymph nodes. One cannot tell from the article whether EP’s cancer spread is documented or implied. But because of the poor prognosis and presumed incurability in either case, options are limited. In the 1980s -90s, HDCT/BMT was thought to be a promising method on the basis of studies that showed a prolonged disease-free and overall survival compared to results of prior studies using more conservative treatment. The problem then was that the studies were uncontrolled.

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Posted in: Cancer, Clinical Trials, General, Medical Ethics

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Charlie Woo TV

Some of us received the announcement a week ago of the Bravewell Collaborative’s planned conference on “Integrative Medicine” co-sponsored with the National Academies’ Institute of Medicine, to take place in February, 2009.  (Note: I like to cap slogans and commercial trademarks and such and enclose them in quotation marks. Especially when the terms have no consensus meaning or are intended to obscure and confuse. ) 

Several of us may blog on the announcement. I want to emphasize a few points that struck me as revealing.  

The announcement also listed Friday’s Charlie Rose Pub TV interview program with Harvey Fineberg, MD, President of the “IOM,” Christy Mack, wife of the CEO of Morgan Stanley and the ideologue behind Bravewell and the project, and Ralph Snyderman, ubiquitous former dean of Duke University Medical School now vagabond “CAM” promoter and fund raiser. 

First off was a significant disclosure. Charlie Rose had been married at one time to Christy Mack’s sister, and Christy and he were still dear friends. As if disclosure is enough to help a viewer distinguish between facts and views obscured by a haze of politeness, appreciation, and gooey mutual stroking.

So much for  investigative, penetrating, and revealing journalism.

Snyderman, whose school was recipient also of large Templeton Foundation grants to ivestigate significance of spirituality and religion in “healing” revealed that he at one time was one of those straight arrow physicians who treated disease (instead of a person.) Until he experienced some of “the techniques” – unspecified – himself. In typical testimonial phrasing, he found it wondrous that something as intangible as hope could help heal. (Some of us also find that wondrous – even dubiousl.)  And then the tried and trite criticisms of docs being too involved in details (like what works and how to use it) and losing sight of the “whole person.”  ”Health is a value and one can have impact…” Eyes roll at such platitudinous and vacuous language.

If that were not enough, Fineberg demonstrated his deep knowledge of “Integrative Medicine” by telling the difference between “healing” and “curing,” and his democratic outlook by wanting to test any methods that works – regardless of the origin. David G’s blog the other day and Kim Atwood’s previous words discussed that issue, which still befuddles the NCCAM, which seems to test anything whether it contains molecules or not, and whether the idea generated in a crucible of observation and experimentation, or descended in a 2 AM drug-induced revelation.  He then used artemisinin (for resistant malaria) to illustrate the potential mining of miraculous natural drugs from traditional Chinese Medicine. I assume he assumed that TCM practitioners had  had been using it for malaria for centuries…despite the fact that there was no description of infectious diseases in TCM. Finding artemisinin for malaria was a product of extraction and purification from plants, known as modern pharmacology.

Christy Mack tried to introduce new concepts, explaining that one of her new aims is to empower the patient to heal oneself…That is not only decades old, but a word-linkage that, as with all esoteric ideation , means a lot to her and her co-believers, but little to the uninitiated.  Another concept was for each person to make a personal health plan for one’s life.  Can’t I do that now if I want? Seems I already did, then chance and nature intervened…

When Snyderman let slip the term, “CAM”, Mack jumped in saying, “Integrative Medicine” is not “CAM”.  Here was a clue to the joining of these otherwise poorly fitting edges of “IM” and the “IOM.”   We just won’t talk about those inconvenient absurdities that “IOM” might shrink from. My take is that Mack and ”CAM” advocacates want the blessings of as many System organizations as possible to fill their “CAM” CV as prelude to legitimization, licensing, and insurance reimbursement.  “CAM” practitioners are using the Bravewell as internediary to using “IOM.” Morgan Stanley money being an efficient lubricant. Simple.

So “IOM,” in exchange for more $?millions as it did for the NCCAM committee, sells itself and its merit badge for ”CAM”‘s  CV sash.  Fair exchange in this capitalist system, yes?  Seems that the only factor nissing in this exchange that keeps it from illegality is a sexual act. The Quiet Revolution moves on. 

Personal note: In 1993 when I awoke from 3 weeks of post-op unconsciousness in the ICU, the first things I recalled were on the overhead TV: the NCAA basketball finals, the Waco cult building complex on fire, and Charlie Rose interviewing another talking head with that ominous blacked-out background. The Quiet Revolution moves on as the Nightmare recurs. �

Posted in: Faith Healing & Spirituality, General, Health Fraud, Medical Academia, Science and Medicine, Science and the Media

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My Woo: A Confession

It’s a case of mind over matter. I have no mind but it doesn’t seem to matter.
— George Burns

I should be working on my taxes. Instead, I’ll dwell on the other, more pleasant, inevitability.

Its been a bad couple of months for death. Everyone dies, and people often die of infection, but the flu season has been busy and with the MRSA lurking in the community, I have seen too many young die who should have otherwise survived their influenza.

I spend most of my professional day working in an acute care hospital, and most people in the hospital die of something. They die when their heart or lungs or liver or brain or some combination sustain more damage than can be compensated for. People live within fairly narrow operational parameters and when those parameters are exceeded for any length of time, they die. It is never a surprise when people die due to organ failure past the point of return or support. That is the cause of death in most of the patients I see.

Sometimes, and not very often, people die of nothing in particular. They just die. You get an autopsy, and there does not appear to be any single event that caused the death, nor does the sum of the underlying diseases seem to have lead to death. Usually it is the advanced elderly who just die. There reaches a point where the organism shuts down. I once had a patient die as I walked into the room on rounds. He looked at me and then died. He had many medical problems, but none that should have killed him, and his blood work on the day of death was normal and his autopsy had no clue as to why he died. Creepy. I like to have a definitive cause of death, but I do not always get one.

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Thoughts on Neuroplasticity

I recently read a fascinating book, The Brain That Changes Itself by Norman Doidge. He describes case histories and research indicating that the brain is far more malleable than we once thought. We used to think each function was localized to a small area of the brain and if you lost that area of brain tissue the function was gone forever. We once thought you couldn’t teach an old dog new tricks. Now we know better. 

Learning a new skill actually changes the structure and function of the brain, even into old age. If you exercise one finger, the area of the brain devoted to that finger enlarges. The old concept of dedicated brain areas for specific functions no longer holds. Areas of the cortex that normally process vision can learn to process totally different inputs such as hearing. This is what happens with blind people: their hearing skills are enhanced when new neural connections for hearing invade the disused visual cortex. They may not actually have better hearing acuity, but they have learned to pay more attention to auditory input and to use it to build up a representation of the world around them.

One of the more intriguing experiments he describes was in monkeys. When sensory input nerves to one arm were severed, the monkey stopped using the arm, even though the motor nerves were intact. When the good arm was put in a sling, the monkey started using the impaired arm again.  When both arms were deprived of sensory input, the monkey used both arms.  (more…)

Posted in: Book & movie reviews, General, Neuroscience/Mental Health

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The Iraqi Civilian War Dead Scandal

This is a story about a story and a story or two within that story. The first story is one of faulty epidemiology – data collection in a war zone. The first inside one is how medical news and journals affect not only national news, but are being used as political weaponry, to affect elections , and to change history.

Within that story is yet another – how editors contribute to fabrication, accepting or refusing to recognize fraud and misinformation. Yet another is that one cannot change some opinions, even after showing that the original information on which they were based was false. Sound familiar? We’ve been illustrating the point in classes for years.

The Iraq death studies. In 2004, weeks before the US presidential election, the journal, The Lancet published a study from a group at Johns Hopkins University, of Iraqi civilian deaths since the 2003 invasion (Lancet I). The results were unseemly high; a UN group estimated the deaths to be about one tenth of the Lancet’s report. The allied forces were still receiving approval for deposing Saddam Hussein, and the world press did not publicize them.

Then, 2-3 weeks before the 2006 US national congressional elections, with the Iraqi war wearing on and US and the world public tiring of stalemate and casualties, Lancet published a follow-up study (Lancet II) by the same group, concluding that in the years 2003-2006, Iraqi civilian war related deaths exceeded 600,000. It was shocking, made headline newspaper and television news. The study had such a significant impact partly because of where it appeared. The Lancet, despite its spotty record for off-beat articles, is revered by the public and the press. If the article’s publicity did not create a wave of political disapproval, it at least helped whip up the waves of discontent, washing in a major change in the Congress. Criticism of the study at the time seemed drowned out by its publicity. But a recent repeat study of civilian Iraqi deaths brings new light on the Lancet II study.

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Posted in: General, Politics and Regulation

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Itching and the Imaginary Passenger Brake

The press and government agencies ally to shine a disproportionate amount of publicity on false and improbable medical ideas. (Danger: Congressmen and reporters at work.)

The latest was a press release from either the Centers for Disease Control (and prevention? – I’ll get to the “prevention” part later,) or from Kaiser-Permanente Medical Group. Three Bay Area newspapers carried simultaneous articles. The articles announced a new, $338,000 CDC/Permanente study of something they call “Morgellon’s disease.” I say they call it that because what they are describing is not what was originally described as “Morgellon’s,” but what is most likely a form of somatiform illness – delusional parasitosis, or neurodermatitis.

What is Morgellon’s and why is CDC funding Kaiser/Permanente with $338,000 to study it? I was never taught about anything called Morgellon’s, and althoughI had practiced medicine for forty years, I still had not known of it until several years ago when a group of affected San Francisco patients and R L Stricker MD, were reported as having a number of cases of it.

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Posted in: General, Neuroscience/Mental Health, Science and Medicine

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Who am I? Why am I here?

“Who am I? Why am I here?”

Who could forget that memorable quote from Admiral James Stockdale, candidate for Vice President running with Ross Perot in 1992, during the first Vice Presidential debate? In a way, as the seemingly junior member of the crew of bloggers assembled here at Science-Based Medicine, I feel as though I should be asking that question, although I hope that, in the weeks to come, I won’t end up giving the same impression in comparison to the rest of the august crew here as Admiral Stockdale unfortunately did during his debate with, of all people, Dan Quayle. No, I don’t want to be leading readers to wonder just what on earth Steve Novella was thinking when he invited me to blog here as a weekly regular. It doesn’t matter that I’m an NIH-funded surgical researcher who’s also been funded by the Department of Defense and the American Society of Clinical Oncology. All that says is that I’m pretty good at science and cancer research (or, if you’re more cynical, that I’m really good at persuading study sections that I do worthwhile research). Without a track record comparable to that of my co-bloggers writing about the issues that this blog will highlight, you might ask: Why should I be taken seriously?
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